Arnold Robert W, Arnold Andrew W, Eby Eryn, Aleshire Jennifer
Binocul Vis Strabolog Q Simms Romano. 2012;27(2):129-34.
Asymptomatic - or minimally so, eye conditions like uveitis, iritis, and glaucoma are silent stealthily blinding diseases, especially when present in children. The iritis that accompanies Juvenile Idiopathic or Rheumatoid Arthritis (JIA or JRA) is characteristically asymptomatic. Children with these must be examined regularly and routinely(see Reference 1 and Table) on an opthalmologic biomicroscopic slit lamp for the microscopic cells (and aqueous flare) which occurr in the anterior chamber of the eye, signaling the presence of iritis, and an immediate need for anti-inflammatory agents. Such an exam is also indicated when the so afflicted develop most any symptoms of a new or recurrent eye problem. Slit lamp iritis determination remains challenging. It virtually requires a major, not portable, table mounted and expensive biomicroscope. And the examiner designated in schedules (1) is a trained ophthalmolgist,, an "Eye M.D.". Both. There are times and places throughout the world where and when a slit lamp may be available but there is no Eye MD (or qualified ophthalmic technician or assistant) available in a timely manner to timely examine for iritis when such is needed as noted. However, there are theoretical advantages if a parent could detect iritis in their J I A child if a slit lamp were available, if they had been trained to use it and recognize iritis cells and flare.
A portable model of varying iritis severity was developed. Parents of JIA patients were instructed on slit lamp use and then attempted to match unknown models of iritis severity with known training models of varying concentrations of cells and flare.
Twelve parents ranked the 5 unknowns with an average summed deviation from expected of 2.2 +/-2 grade levels (out of 12). This was a good and useful degree of training.
We were able to teach lay adults to match a model of iritis severity on a slit lamp. We would suggest that where needed, they could provide urgent and more convenient and faster diagnosis and treatment of recurrent iritis and also augment recommended scheduled Eye MD screening for iritis in JIA patients providing an effectively higher level of care, quality of life, and reduction in loss of vision for JIA victims at lower cost and greater facility for the patients, their caregivers and society as a whole.
葡萄膜炎、虹膜炎和青光眼等无症状或症状轻微的眼部疾病是隐匿性致盲疾病，尤其是在儿童中。青少年特发性关节炎或类风湿性关节炎（JIA或JRA）伴发的虹膜炎通常无症状。患有这些疾病的儿童必须定期接受眼科生物显微镜裂隙灯检查（见参考文献1和表格），以检查眼前房中出现的微小细胞（和房水闪光），这些是虹膜炎存在的信号，提示需要立即使用抗炎药物。当这些患儿出现任何新的或复发性眼部问题的症状时，也需要进行此类检查。裂隙灯检查虹膜炎仍然具有挑战性。实际上，这需要一台大型的、非便携式的、安装在桌子上的昂贵生物显微镜。而且计划中指定的检查人员是经过培训的眼科医生，即“眼科医学博士”。世界各地都存在这样的情况：在某些时间和地点，虽然有裂隙灯，但在需要时却没有眼科医学博士（或合格的眼科技术人员或助手）及时进行虹膜炎检查。然而，如果家长能够使用裂隙灯，并经过培训学会识别虹膜炎细胞和闪光，那么他们就有可能在自己患有JIA的孩子身上检测出虹膜炎，这在理论上具有优势。
开发了一种具有不同虹膜炎严重程度的便携式模型。指导JIA患者的家长使用裂隙灯，然后让他们尝试将未知的虹膜炎严重程度模型与已知的不同细胞浓度和闪光的训练模型进行匹配。
12位家长对5个未知模型进行了排序，与预期的平均总偏差为2.2±2个等级水平（满分12分）。这是一个良好且有用的训练程度。
我们能够教会非专业成年人使用裂隙灯匹配虹膜炎严重程度模型。我们建议，在需要的地方，他们可以为复发性虹膜炎提供紧急、更便捷和快速的诊断与治疗，还可以加强对JIA患者推荐的定期眼科医学博士虹膜炎筛查，以更低的成本为患者、其护理人员和整个社会提供更高水平的护理、生活质量，并减少JIA患者的视力丧失。
