Pyramidal Variant of Anterior Polar Cataracts
In April’s Blink (Congenital Cataract), the writer describes the case’s opacity as an anterior polar cataract. This is an incomplete description. The excellent photograph nicely demonstrates a pyramidal anterior polar cataract, which is an important variant of anterior polar cataract. Anterior polar cataracts tend to be small and do not, except in rare cases, progress.1 They are strongly associated with both strabismus and amblyopia, and necessitate regular care, even in cases where cataract extraction is not necessary.
Pyramidal anterior polar cataracts have the configuration shown in the photograph and are highly associated with progression to cortical involvement.2,3 In their study, Wheeler and colleagues found cortical opacification in 20 of 24 affected eyes. Nineteen of 24 eyes required cataract surgery. They also documented amblyopia in all six patients with unilateral pyramidal anterior polar cataracts, and in eight of nine patients with bilateral such cataracts (four with bilateral amblyopia and four with unilateral amblyopia).
Therefore, it is important clinically to recognize the pyramidal variant of anterior polar cataracts in early childhood and to follow these patients more closely to prevent irreversible visual loss. It is useful to inform families that cataract surgery will likely be required.
Linda M. Christmann, MD
Montreal
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1 Jaafar, M. S. and R. M. Robb. Ophthalmology 1984;91:249–254.
2 Wheeler, D. T. et al. Ophthalmology 1999;106:2362–2367.
3 Christensen, G. R. Ophthalmology 2001;108:430–431.
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Note: This Blink photo can be viewed full size in the March issue of the online archives.
The Importance of Academy Surveys
I strongly agree with June’s Opinion (Surveys: Which Ones Matter?) on the importance of Academy members completing surveys sent to them by CMS and the AMA. I would also like to stress the importance of Academy members responding to surveys by the Academy itself.
Those in Academy leadership positions study the results of surveys of our members very carefully. The staff and the board try to be responsive to them. It would be very unfortunate, therefore, if the results were not representative of all members of the Academy. So, if you want your voice to be heard and if you want to influence the Academy, it is vitally important that you respond to our own surveys, in addition, of course, to those by the AMA and CMS.
Humphrey J. F. Taylor
Public Trustee to the Academy’s Board of Trustees
New York
Keratoconus and Phakic Lenses
In May’s Ophthalmic Pearls (Keratoconus: Diagnosis and Management), Mr. Gupta and Dr. Carlson offer a variety of surgical options for treating the disease, including penetrating keratoplasty.
I would like to mention treatment with phakic lenses. My experience with phakic lenses and corneal ectasias has more than three years of follow-up with very good refractive predictability and visual acuity outcomes.
Carmen J. Barraquer, MD
Miami
Cosmetics and Hypotony
A new class of cosmetics may pose a problem for patients with hypotony. A number of new products such as RevitaLash (Athena Cosmetics) are being marketed as eyelash stimulating agents. These cosmetics are designed to be painted along the lash line in order to increase length, thickness and pigmentation of lashes. Since these products are prostaglandins, however, they may potentially exacerbate hypotony in patients with ciliary body dysfunction, such as those with chronic uveitis. These cosmetics are not FDA regulated and, while there are no reports as yet of ocular complications, ophthalmologists who encounter unexpected inflammation or worsening hypotony in their patients should consider asking about the use of lash enhancers.
Debra A. Goldstein, MD, and
Howard H. Tessler, MD
Chicago
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