[Eye and pregnancy.]

Personal factors influencing the visual reaction time of pedestrians to detect turn indicators in the presence of Daytime Running Lamps

Daytime running lamps (DRL) on vehicles have proven to be an effective measure to prevent accidents during the daytime, particularly when pedestrians and cyclists are involved. However, there are negative interactions of DRL with other functions in automotive lighting, such as delays in pedestrians' visual reaction time (VRT) when turn indicators are activated in the presence of DRL. These negative interactions need to be reduced. This work analyses the influence of variables inherent to pedestrians, such as height, gender and visual defects, on the VRT using a classification and regression tree as an exploratory analysis and a generalized linear model to validate the results. Some pedestrian characteristics, such as gender, alone or combined with the DRL colour, and visual defects, were found to have a statistically significant influence on VRT and, hence, on traffic safety. These results and conclusions concerning the interaction between pedestrians and vehicles are presented and discussed. Practitioner Summary: Visual interactions of vehicle daytime running lamps (DRL) with other functions in automotive lighting, such as turn indicators, have an important impact on a vehicle's conspicuity for pedestrians. Depending on several factors inherent to pedestrians, the visual reaction time (VRT) can be remarkably delayed, which has implications in traffic safety.

Ocular changes during pregnancy

BACKGROUND

Most ocular changes in pregnancy are harmless. For example, 14% of pregnant women need a new eyeglass prescription. Some changes, however, are serious, such as retinal effects of hypertension, which can be a sign of pre-eclampsia. Ocular changes may give rise to uncertainty about the administration of ophthalmological drugs or the optimal method of childbirth.

METHOD

This review is based on pertinent literature retrieved by a selective search in Medline and on guidelines from Germany and abroad. Recommendations about drugs were taken from the Embryotox and Reprotox databases, the German Red List, and the United States Food and Drug Administration (FDA).

RESULTS

40% to 100% of pregnant women with high blood pressure have retinal changes whose severity is correlated with the severity of pre-eclampsia or eclampsia. Diabetic women should undergo ocular examination before and during pregnancy. Pre-existing retinal changes worsen during pregnancy in 55% of cases. Most ocular diseases can be treated with the usual drugs in pregnant women and nursing mothers, although the evidence for drug safety is derived from case series and the treatment is usually provided off label. Ocular conditions that are present before pregnancy are irrelevant to the choice of a method of childbirth.

CONCLUSION

Pregnant women and nursing mothers can undergo most types of ophthalmological examination and treatment. Recommendations about drug treatment should be checked against current information that can be found on the embryotox.de and reprotox.de websites.

[Influence of mode of delivery on pre-existing eye diseases]

Many ophthalmologists and obstetricians recommend either an assisted vaginal delivery with forceps or vacuum extraction, or a Caesarean section in cases of pre-existing eye diseases, such as myopia, retinal detachment, glaucoma or diabetic retinopathy. This is mainly based on the increase of intraocular pressure during the final stage of labor. These recommendations, however, are not evidence-based. None of the published trials have reported any retinal changes after vaginal delivery. This report provides information on the influence of physiological changes on eye diseases during the final stage of delivery. In general eye disease is not an indication for an instrumental or operative delivery provided regular eye examinations (once each trimester) have been performed.

[Management of patients with ocular diseases during pregnancy. Diabetes, glaucoma and uveitis]

Many ocular diseases require treatment even during pregnancy. Some conditions, such as diabetic retinopathy tend to worsen during pregnancy but others, such as uveitis may benefit from the physiological changes occurring during pregnancy. But generally even a favorable development is not sufficient to obtain a steady state without treatment. Each medication applied during pregnancy should only be given after thorough consideration of the pros and cons and discussion of these with the patient. There are sufficient medications for ocular diseases that can be given when indicated following published guidelines and experiences. This review focuses on the course and therapy of glaucoma, diabetic retinopathy and uveitis during pregnancy.

[Ophthalmic agents during pregnancy and breastfeeding]

Ocular therapy is necessary even during pregnancy but the use of pharmaceutical substances bears the risk of side effects on mother and child. The article reflects current knowledge on how to treat the most important eye diseases during pregnancy and breastfeeding. The review covers the diagnostics (tonometry, mydriasis, angiography) as well as treatment of infections of the eyes, glaucoma, allergies, diabetic retinopathy, pain and inflammation.