Lorne Bellan, MD, FRCSC, Acting Department Head, Department of Ophthalmology, Misericordia Health Centre, Winnipeg, MB.

In addition to the clinical presentation and diagnosis of cataracts, a summary of the development of cataract surgery is presented. Indications for cataract surgery are now based on subjective visual impairment rather than measured visual acuity. Cataract surgery can now be done safely through 3mm self-sealing incisions with excellent results and rapid recovery.
Key words: cataract, lens, phacoemulsification, visual acuity, red reflex.

Catherine M. Birt, MD, FRCSC, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, ON.

Primary open angle glaucoma (POAG) is a disease of the optic nerve head, frequently but not always associated with elevated intraocular pressure. This article discusses the presentation and risk factors associated with POAG, how the diagnosis is made by the ophthalmologist, and the current medical management of the disease.
Key words: primary open angle glaucoma, risk factors, anti-glaucoma medications.

Robert J. Campbell MD, MSc and William G. Hodge MD, PhD, FRCSC, University of Ottawa Eye Institute, Ottawa, ON.

The differential diagnosis of the red eye involves structures ranging from the periorbita, lids and conjunctiva, to the surface sclera and episclera, to the cornea and uvea and to acute angle closure glaucoma. The history and physical examination can usually differentiate these entities from one another. The most important part of the examination is the visual acuity, which can usually distinguish the serious red eye from more benign causes.
Key words: orbital cellulites, conjunctivitis, blepharitis, keratitis, acute glaucoma, red eye.

Doron Milstein, PhD, Hofstra University, Long Island, NY, USA.
Barbara E. Weinstein, PhD, Graduate School and University Center, CUNY, New York, NY, USA.

Hearing loss diminishes quality of life. The elderly rely on auditory input to maintain social contact and awareness of their environment, such that hearing loss in this age group can lead to isolation and withdrawal from the community. Most elderly individuals do not take advantage of available audiological services nor do they use hearing aids (HAs), the treatment of choice for their hearing loss. Modern HAs utilise digital technology and computer software to improve speech intelligibility. Current research reveals that HAs are effective in minimising the negative consequences of hearing loss in the daily functioning of the elderly. The availability of sophisticated technology allows for more efficient HA fitting, and allows the audiologist to spend more time counseling.
Key words: presbycusis, hearing aid technologies, rehabilitation, assistive listening devices.

Sohel Somani, MD, Senior Resident, Department of Ophthalmology, University of Toronto, Toronto, ON.

Age-related macular degeneration (ARMD) is a progressive disease affecting the central vision of patients older than 55 years. Typically, ARMD patients are classified into dry and wet forms based on clinical characteristics. This has important implications with respect to their clinical presentation, prognosis and management options. Important risk factors in the progression of disease include age, smoking and drusen characteristics. The promising results of a new study on vitamin supplementation provide direction for treatment and prevention, as well as the understanding of the role of antioxidants in ARMD pathogenesis. High-dose vitamins (beta- carotene, vitamins C and E and zinc) should be considered in certain patients with ARMD.
Key words: macular degeneration, vitamins, low vision, supplementation, Amsler grid.

A newly developed wireless application that allows health care providers to transmit patient data and digital photos to consulting physicians at major medical centres and clinics may change the way home-care services are provided.

Pixalere ("pix" for pixel and "alere" meaning "to tend to") is a web-based wireless application designed to manage home-care patients on-site, reducing or eliminating the need for costly and time-consuming trips to their GP or the emergency department. Physicians and home-care nurses in British Columbia are being outfitted with pocket PCs equipped with Pixalere to securely transmit patient reports and compressed digital photographs to consulting nurses or doctors at a central facility.

Remote management of patients with the Pixalere device would be particularly beneficial for nursing home residents for whom it can be difficult or expensive to travel to a clinic to be seen for a few minutes and for relatively routine ailments, such as minor wounds, bedsores and burns, that could be treated locally by nurses on-site. Instead, using a handheld device or laptop computer, a home-care nurse in rural Northern B.C., for instance, will be able to transmit patient data and colour photos for immediate review by consulting specialists in Vancouver efficiently, easily and inexpensively.

Physicians in Hamilton and North Bay, ON. collaborated to perform two successful laparoscopic fundoplication surgeries using remotely controlled robotic arms, making them the world's first hospital-to-hospital telerobotic-assisted surgeries. Though still in early stages of development, the success of these telesurgeries shows promise for a procedure that could bring specialized surgical techniques to rural areas in which specialists are not available.

Using voice commands and his hands to operate the robotic arm 300km away, Dr. Mehran Anvari from St. Joseph's Healthcare Hamilton performed the microsurgery while Dr. Craig McKinley in North Bay assisted on-site. Dr. Anvari was impressed at the ease with which he was able to direct the remotely operated surgical instruments, and was pleased with the duration of the operations. With network backup systems in place, the one in 10,000 chance of a network failure becomes even less of a risk. Both patients are reported to be recovering well.

Despite the Canadian physicians' optimism, telesurgery has not yet been accepted as a commercially viable means of surgery in the U.S., where doctors are considerably more skeptical of its benefits. They claim it is still safer, more practical and less expensive to fly the surgeon into the rural area to perform the surgery. Obviously still in a nascent stage, telesurgery may have potential as a tool that can bring surgical expertise into underserved, remote rural communities in Canada.

Innovative applications of the mobile phone are quickly emerging in clinical practice as a time- and money-saving tool for physicians and patients alike. Physicians from Graz's University Medical School in Austria have successfully monitored from afar the blood pressures and heart rates of 25 people with hypertension using mobile phones. In the comfort of their own homes, patients entered key values, including blood pressure, pulse and body weight, on a regular basis into their mobiles using a specially developed software program. Immediately, physicians were informed of a patient's vitals, while the software alerted them to intervene if a patient's values became too high or too low. Patients, in turn, were able to receive almost instant remote advice from their physicians.

Meanwhile, researchers in the U.K. are preparing a pilot study of remote monitoring of asthmatics via mobile phone. A newly developed device hooks a peak flow meter up to a mobile phone that gathers, records and submits accurate asthma data in real-time to physicians. Furthermore, an electronic diary enables patients to describe, and then transmit, their symptoms on a daily basis. At any time, GPs or nurses have access to their patients' data stored on the server, allowing them to monitor their patients' conditions with up-to-date, accurate and reliable data. Initially, 100 asthmatics will receive the mobile device for the duration of the trial. Researchers hope the innovation will provide a more efficient, proactive management of asthma and perhaps help understand the relationships between symptoms and a patient's environment, by analysing whether symptoms are exacerbated at home or at work.

Durhane Wong-Rieger, PhD, President, Anemia Institute for Research & Education.

Anemia affects tens of thousands of Canadians, including many older people. While some types of anemia are relatively easy to diagnose and treat, complications such as chronic disease or complex medication regimes can often interfere with diagnosis and management of this condition.

The Anemia Institute for Research & Education (AIRE) is the first and only nonprofit organization in the world committed entirely to generating and sharing knowledge about anemia. AIRE supports patients in understanding anemia, its causes, effects and the available treatment options. The Institute partners with numerous patient and professional groups to facilitate patient education on anemia and blood safety and supply. Furthermore, through a yearly research grant competition, AIRE sponsors numerous anemia research studies. All in all, the Anemia Institute is working hard to ensure that anemia is treated seriously.

For Physicians: Anemia Guidelines for Primary Care
In a 2001 survey of family physicians across Canada, 90% of doctors indicated their interest in clinical practice guidelines on anemia for family practice. The Anemia Institute responded, initiating the development of Anemia Guidelines for Primary Care with MUMS Guidelines Clearinghouse (Medication Use Management Services), to be published in May 2003. The Anemia Guidelines is the fifth book in the Orange Book guideline series published by MUMS. This easy to use, peer-reviewed and fully-referenced book provides diagnostic and treatment guidelines for the full range of anemia conditions (see Table 1 for a selection of topics covered).

A limited number of complimentary copies of the Anemia Guidelines is available from AIRE. To order, please visit www.anemiainstitute.org and go to the Healthcare Professionals section.

For Your Patient: Anemia Educational Tools
The Anemia Institute's series of patient leaflets covers the most common types of anemia. Patient Educational Leaflets include:

• What is Anemia?
• What is Hemoglobin?
• Anemia & Nutrition
• Anemia & Iron Deficiency
• Anemia & Cancer
• Anemia & Kidney Disease
• Anemia & Surgery
• Anemia & Hepatitis C
• Anemia & HIV/AIDS
• Anemia & Children and Teens.

Anemia Awareness Week is the Institute's yearly campaign to raise awareness of anemia among the general public. This takes place each year during the last week of March. In March 2003, the public were invited to visit numerous hemoglobin screening clinics and anemia display booths in pharmacies and hospitals across Canada. Similar events are planned for Anemia Awareness Week next year, March 22&endash;26, 2004.

Research & Development Fund
The Anemia Institute Research & Development Fund supports research initiatives through a yearly, peer-reviewed grant competition. Projects currently funded include:

• the role of anemia and red blood cell substitutes in traumatic brain injury;
• new strategies to treat post-transplant anemia;
• anemia among the inner city homeless.

More information on the AIRE research grant process, including funding priorities and application procedures, can be found on the Internet at www.anemia-institute.org.

Wilbert S. Aronow, MD, Divisions of Cardiology and Geriatrics, New York Medical College, Valhalla, NY.

Patients with unstable angina pectoris/non-ST-segment elevation myocardial infarction should be treated with nitrates, beta-blockers, Aspirin plus clopidogrel and angiotensin-converting enzyme inhibitors, as well as with diet plus statins if the serum low-density lipoprotein cholesterol is = 100mg/dL. Intravenous unfractionated heparin or preferably low-molecular-weight heparin should be given to high-risk or intermediate-risk patients. A platelet glycoprotein IIb/IIIa inhibitor should be administered if percutaneous coronary intervention is planned. Eptifibatide or tirofiban should be given to patients with continuous myocardial ischemia, an elevated troponin T or I level, or other high-risk features, and in whom an invasive strategy is not planned. High-risk patients should have early invasive management.
Key words: acute coronary syndromes, unstable angina pectoris, non-ST-segment elevation myocardial infarction, percutaneous coronary intervention.