Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1

Refractive Disorders (Ametropias) Renal Artery Stenosis 1277

generally require a lens of modest power (e.g.,+1.00 D), whereas

a fully presbyopic individual generally requires a more powerful

convex lens (e.g.,+2.50 D). This convex power is “added” to any

underlying lens power used to correct a co-existing ametropia,

either in the form of bifocals or reading spectacles. Specially

designed bifocal contact lenses can also be used to correct pres-

byopia. Monovision is a method of correcting one eye for distance

and the other eye for reading, thereby sacrificing depth percep-

tion and stereopsis.

➣Surgical correction – Multifocal and accommodating intraocular

lens implants can correct presbyopia but require surgical removal

of the crystalline lens as part of cataract surgery or clear lens

extraction. Alternatively, a keratorefractive or lens-based pro-

cedure may be used to create a monovision correction. Other

approaches, such as corneal inlay procedures, remain investiga-

tional.

follow-up

n/a

complications and prognosis

n/a

RENAL ARTERY STENOSIS

STEPHEN C. TEXTOR, MD

history & physical

■Fibromuscular disease: Early onset of hypertension: Women more

likely than men

■Atherosclerosis: Risk Profile:

➣Vascular/Coronary disease history, esp. claudication/aortic

aneurysm

➣Smoking history

➣Hyperlipidemia

➣Diabetes

■Clinical Syndromes

➣May be asymptomatic, incidental finding during “screening”

➣Progressive hypertension, when stenosis exceeds 70%

➣Unexplained deterioration of renal function

➣Acute change in renal function with ACE inhibitors or other BP

meds