准分子激光原位角膜磨镶术的护理体会

准分子激光原位角膜磨镶术（LASIK）是目前安全性、准确性、稳定性以及疗效的预测性都较好的一种屈光不正矫治术．是目前治疗近视及近视散光首选的屈光手术之一。其原理是用显微板层成形系统掀开一个角膜瓣．在瓣下角膜基质层上用准分子激光根据近视、远视和散光度数进行精确切削。我院于2008年2月从德国引进世界上先进的第八代爱丽丝智能高速扫描准分子激光治疗系统。自4月份开展该术以来。共有212例（408只眼）患者要求手术,通过术前资料评估及术前检查．筛查确定出198例进行LASIK术。通过术前的心理护理、术中密切配合以及术后的详细指导及定期复查随访．疗效满意．现将护理体会总结如下。     

近视眼LASIK术后眼高阶像差变化

探讨近视眼LASIK术后眼波阵面像差高阶像差各项的变化。方法:采用NIDEK OPD-Scan ARK-1000型波前像差扫描系统对LASIK治疗近视的62只眼在术前术后眼的波前像差进行了评估。在术前、术后10天、术后一个月分别测量眼的波阵面像差。比较6mm瞳孔下高阶像差各项的变化。结果:在全部接受检查的病例中,总的高阶像差(RMSh)均有所增加。从Zernik各项绝对值来看,球差C12变化最大。术后10天比术前增加6．7742倍(P=0．0001)。其次是彗差C7 C8(X轴、Y轴上的彗差),分别增加了4．883倍(P=0．0001)、3．7523倍(P=0．0001)。结论:LASIK术后眼的总的高阶像差均方根值(RMSh)明显增加,尤其是球差和彗差;但在恢复过程中高阶像差有下降的趋势。用像差仪来指导和评估LASIK等屈光手术可以更全面、更准确。     

皮质类固醇激素冲击疗法治疗LASIK术后屈光回退的观察

目的:观察皮质类固醇激素冲击疗法对准分子激光原位角膜磨镶术(excimer laser in situ keratomileusis, LASIK)治疗近视术后发生屈光回退的治疗效果, 探讨此方法在临床应用的可能性.方法:对LASIK术后发生屈光回退的近视眼患者24例(48眼)采用皮质类固醇激素冲击疗法:每天9次0.1 %氟美童滴眼液点眼, 3周后改为每天4次逐周递减再治疗4周.治疗后进行了6个月的临床观察, 评价患者的视力和屈光度改变.结果:LASIK术后出现屈光回退的病例经激素治疗后视力得到改善, 屈光状态得到改变, 治疗后3周与7周的效果差异不显著.药物治疗中有激素性高眼压和其他激素副作用产生, 经降眼压治疗后未对视功能产生明显影响.结论:皮质类固醇激素冲击疗法治疗LASIK术后屈光回退并发症安全有效, 是再次LASIK手术治疗屈光回退的补充.     

城市与山区小学生屈光筛查及配镜差异分析

目的:比较城市及山区小学生屈光不正发生率及配镜差异,探讨小学生所在地域与其的关系,并为制定干预措施提供依据。方法:于2016年7月~8月随机选取部分绍兴市小学及广西省巴马县山区小学生进行天津索维sw-800手持自动验光仪进行屈光筛查,并分析两地小学生屈光不正及配镜差异。结果:648名城市小学生中,屈光不正发生率为38.6%;394名山区学龄儿童中,屈光不正发生率为21.3%。两地区小学生屈光不正发生率差异有统计学意义(P0.05)。城市小学生屈光不正发生率呈两个极端,低年级组和高年级组屈光不正发生率较高,山区小学生屈光不正发生率呈增长趋势;两地屈光不正的小学生配镜率存在差异(P0.05)。结论:小学生屈光异常发生率较高,不同地区有所差距,应加强学生及家长眼保健意识和屈光异常儿童的个案管理,小学生进行屈光筛查对早期发现屈光不正具有重要意义。     

LASIK术后高阶像差对视觉质量影响的研究进展

随着屈光手术的发展,过去人们所追求的单纯裸眼视力的提高逐渐被追求视觉质量的提高所代替。LASIK术后患者低阶像差减小,高阶像差进一步增加,虽然裸眼视力提高,但是对比敏感度下降,尤其是暗环境下和有眩光时视觉质量不能达到理想效果,因为高阶像差是影响视网膜成像的重要因素,对比敏感度是评价视网膜成像质量好坏的重要指标之一,所以探讨不同成分高阶像差以及它们之间适当组合对视觉质量的影响和LASIK术后各频段对比敏感度的变化,研究各项高阶像差与对比敏感度之间的关系可以为临床外科屈光医生提供一定的理论指导,进而解决LASIK术后的眩光、星形放射、暗视力差等问题。本文通过概括LASIK术后高阶像差和对比敏感度的变化,对它们之间关系的研究现状和进展作一综述。     

慢性鼻窦炎鼻内镜术后问卷评估分析

目的：探讨问卷随访对慢性鼻．鼻窦炎、鼻息肉患者鼻内镜术后疗效的评价意义。方法：采用Lurid-Machay的病人症状评分系统及鼻腔鼻窦结局测量20条（sino．nasaloutcometest-20,SNOT．20）中文版,对127例慢性鼻-鼻窦炎、鼻息肉术前、术后3个月、术后6个月患者进行相关问卷测试,并与100名进行健康入职体检者的相关问卷结果进行比较。结果：鼻内镜术后患者的主观症状在术后3个月较术前均明显改善,并在术后6个月时全面改善,差异均有统计学意义（P〈0．05）,但部分症状与健康受访者相比仍有差异。结论：问卷随访作为术后鼻部生理功能恢复的评估手段,有助于对术后疗效进行客观的综合评价。     

高度近视准分子激光原位角膜磨镶术后屈光回退的相关分析

目的:探讨高度近视准发子激光原位角膜镶术(laser insitu keratomileusis,LASIK)手术后屈光回退与术前各项检查结果间的相关性。方法:将135例(241只眼)近视患者按屈光度数分为A组126只眼(-6.00 D~-9.00 D)和B组115只眼(≥-9.00 D)。记录术前的屈光度数、眼压和角膜厚度,依据预期校正屈光度数计算理论残余角膜厚度,行LASIK手术后记录术后视力、屈光度数,进行统计学分析。术后平均随访时间19.14个月。结果:A组中正常术眼108只眼(85.7%),回退术眼18只眼(14.3%);B组中正常术眼74只眼(64.3%),回退术眼41只眼(35.7%);两组比较差异有非常显著意义(P<0.01)。术后平均视力A组为1.17±0.20,B组为0.99±0.28,两组比较差异有非常显著意义(P<0.01)。两组术后的平均屈光度数比较,差异有非常显著意义(P<0.01)。平均理论残余角膜厚度A组为(452.53±28.47)μm,B组为(439.61±30.11)μm,两者比较,差异有非常显著意义(P<0.01)。屈光回退度数与术前近视屈光度数显著正相关(r=0.35,P<0.001),与理论残余角膜厚度显著负相关(r=0.13,P=0.04),与术前眼压及术前角膜厚度无相关性(r=-0.48,P=0.46;r=-0.39,P=0.55)。结论:LASIK手术术前屈光度数越大,术前计算的理论残余角膜厚度越小,术后越易出现回退。对于-6.0 D~-9.00 D的高度近视患者,LASIK手术的预测性和术后稳定性相对较好;对于≥-9.00 D的超高度近视患者,应结合手术技术和术前计算的理论残余角膜厚度慎重选择进行手术。     

屈光不正对儿童视觉皮层神经元活动影响的功能磁共振研究

目的：利用血氧水平依赖性功能性磁共振成像（BOLD-fMRI）技术及非金属MRI专用眼镜,分析探索屈光不正对儿童大脑皮层视觉功能区神经元活动的影响。方法：以1．5T磁共振成像系统采集8例屈光不正眼儿童屈光矫正前后枕叶视皮层兴趣区BOLD—fMRI数据,及8例正常眼凸透镜离焦前后枕叶视皮层兴趣区BOLD—fMRI数据,进行对比分析,比较屈光不正眼及其矫正后、正常眼及其离焦后皮层视觉功能区神经元活动的不同,分析其改变特点及原因。结果：屈光不正眼儿童矫正屈光后皮层视觉功能区神经元活动范围明显增加（P〈0．05）;正常眼离焦后皮层视觉功能区神经元活动范围明显减小（P〈0．05）。结论：屈光不正会明显降低儿童皮层视觉功能区的神经元活动。屈光不正患儿应尽早配镜矫正,以免影响视觉皮层功能发育。     

透明角膜切口白内障术后角膜曲率的临床观察*

目的:观察年龄相关性白内障行透明角膜切口超声乳化吸除及人工晶体植入术后角膜曲率的变化及相对稳定的时间。方法:收集2016年6月-8月在哈尔滨医科大学附属第一医院伍连德纪念医院进行的3.0 mm透明角膜切口白内障超声乳化吸除及人工晶体植入术的患者200例216眼,其中男88例、女128例,平均年龄71.2岁,进行相应的术前检查,并检查术前、术后第一天、一周、一个月、和三个月时的角膜曲率、视力、眼压并行相应的统计学分析。结果:术后不同时间点视力0.5的恢复情况:第一天为147眼(68.05%)、一周为175眼(81.02%)、一个月为193眼(89.35%)、三个月为197眼(91.20%);术前角膜曲率为43.94±1.35、术后第一天、术后一周的角膜曲率分别为44.98±1.06、44.45±1.18,与术前相比有显著性差异(p0.05),术后一个月、三个月的角膜曲率分别为44.13±1.27、44.02±1.24,与术前相比无显著性差异(p0.05);术源性散光于术后一天达到最大,随后逐渐减小,术后一个月、三个月与术后一天比较有显著性差异(p0.05),术后三个月与一个月比较无显著性差异(p0.05),术源性散光术后逐渐下降,并于一个月时趋于稳定。结论:3.0 mm透明角膜切口白内障超声乳化吸除及人工晶体植入术患者在术后一个月的角膜曲率基本稳定,恢复至术前状态,屈光状态趋于稳定,术源性角膜散光较小,术后视力恢复至较好状态。     

准分子激光双面式切削原位角膜磨镶术的研究进展

准分子激光双面式切削原位角膜磨镶术(Both-sided LASIK,BSL)是准分子激光原位角膜磨镶术(laser in situ keratomileusis, LASIK)的改良,BSL将部分激光切削分布在角膜瓣基质面,因而减少了对角膜基质床的切削,最大限度的保留了角膜基质床的剩余厚度,为降低术后角膜膨出提供可能,对屈光度相对偏高和/或角膜相对偏薄的患者,尽量增加手术的安全性,并为LASIK术后屈光回退的增强手术提供了一种新的方法。本文对近年BSL的研究进展作一综述。     

Interocular Difference of Peripheral Refraction in Anisomyopic Eyes of Schoolchildren

Purpose

Refraction in the peripheral visual field is believed to play an important role in the development of myopia. The purpose of this study was to investigate the differences in peripheral refraction among anisomyopia, isomyopia, and isoemmetropia for schoolchildren.

Methods

Thirty-eight anisomyopic children were recruited and divided into two groups: (1) both eyes were myopic (anisomyopic group, AM group) and (2) one eye was myopic and the contralateral eye was emmetropic (emmetropic anisomyopic group, EAM group). As controls, 45 isomyopic and isoemmetropic children were also recruited with age and central spherical equivalent (SE) matched to those of the AM and EAM groups. The controls were divided into three groups: (1) intermediate myopia group (SE matched to the more myopic eye of AM group), (2) low myopia group (SE matched to the less myopic eye of AM group and the more myopic eye of EAM group), and (3) emmetropia group (SE matched to the less myopic eye of EAM group). Peripheral refraction at 7 points across the central ±30° on the horizontal visual field with a 10° interval was measured with an autorefractor. Axial length (AL), corneal curvature (CC), and anterior chamber depth (ACD) were also determined by using the Zeiss IOL-Master.

Results

The relative peripheral spherical equivalent [RPR(M)] and relative peripheral spherical value [RPR(S)] of the more myopic eye was shifted more hyperopically than the contralateral eye in both the AM and the EAM groups (both p<0.0001). The RPR(M, S) of the less myopic eyes in the AM and EAM groups showed a relatively flat trend across the visual field and were not significantly different from the emmetropia group. The RPR(M, S) of less myopic eyes in the AM group were shifted less hyperopically than in the isomyopic low myopia group and the more myopic eye of the EAM group [RPR(M), p = 0.007; RPR(S), p = 0.001], although the central SEs of the three groups were not significantly different from each other. However, RPR(M, S) of the more myopic eyes were not different from the corresponding isomyopic groups. There was also no significant difference in the relative peripheral astigmatism [RPR(J0, J45)] between the more and the less myopic eyes in either the AM or the EAM group.

Conclusion

Refraction of anisomyopia differs between the two eyes not only at the central visual field but also at the off-axis periphery. The relative peripheral refraction of the more myopic eye of anisomyopia was shifted hyperopically, as occurs in isomyopia with similar central subjective SE values. Less myopic eyes were much less hyperopically shifted in relative peripheral refraction than the corresponding isomyopic eyes, but are comparable to emmetropic eyes. This emmetropia-like relative peripheral refraction in less myopic eyes might be a factor responsible for slowing down the progression of myopia.     

全飞秒激光与飞秒激光辅助Lasik治疗高度近视患者的效果及对角膜曲率、视觉质量的影响分析

摘要 目的：探究全飞秒激光与飞秒激光辅助Lasik治疗高度近视患者的效果,并分析治疗对患者角膜曲率、视觉质量的影响。方法：选择2020年7月至2022年7月在我院接受治疗的120例（240眼）高度近视患者为研究对象,按照随机数字表法结合患者意愿的方式将其区分为研究组（n=60,接受飞秒激光辅助Lasik治疗）与对照组（n=60,接受全飞秒激光治疗）,对比两组患者术前术后调制传递函数截止频率（MTF）值及客观散射指数（OSI）、角膜曲率变化、屈光度差异、视力情况差异,统计两组患者各类并发症发生率并进行比较。结果：（1）两组患者术前MTF值及OSI组间差异无统计学意义（P>0.05）,术后研究组患者的MTF值和OSI值均明显低于对照组,差异具有统计学意义（P<0.05）;（2）术前、术后90 d两组患者的最佳矫正视力组间差异无统计学意义（P>0.05）,但组内前后比较两组患者的最佳矫正视力均较术前有明显提高（P<0.05）;（3）术前两组患者的角膜前表面曲率以及后表面曲率组间差异均无统计学意义（P>0.05）,术后90 d时开展组间比较,研究组患者角膜前表面曲率中K1、K2以及Km值均明显低于对照组（P<0.05）,但后表面曲率中K1、K2以及Km值组间差异无统计学意义（P>0.05）;进一步分析显示,两组患者术前术后前表面曲率K1、K2以及Km值有明显变化（P<0.05）,后表面曲率K1、K2以及Km值前后差异无统计学意义（P>0.05）;（4）统计研究组患者共出现弥漫性层间反应2例,感染1例,角膜内生1例,并发症总发生率3.33%（4/120）,明显高于对照组的0.00%（0/120）（P<0.05）。结论：全飞秒激光和飞秒激光辅助Lasik术对高度近视均具有较好的治疗效果,相比于全飞秒激光术,飞秒激光辅助Lasik术在改善患者视觉质量方面明显占优,但其并发症发生率同样更高,全飞秒激光术术后视觉质量,但安全性更高,建议临床上结合患者实际情况灵活选择术式,以改善高度近视患者预后。     

Scanning laser polarimetry of retinal nerve fibre layer thickness after laser assisted in situ keratomileusis (LASIK): stability of the values after the third post-LASIK month

BACKGROUND: Monitoring the retinal nerve fibre layer thickness (RNFLT) is essential in the diagnosis and treatment of glaucoma. In a previous study we found that a decrease of the polarimetric RNFLT observed in the early period after laser-assisted in situ keratomileusis (LASIK) disappears or tends to disappear by the third post-LASIK month. PURPOSE: To study the stability of the "recovered" polarimetric retardation values between the third and twelfth month after LASIK. METHODS: Scanning laser polarimetry (SLP) with the classic GDx Nerve Fiber Analyzer was performed on 13 consecutive healthy subjects with no eye disease who underwent LASIK for ametropia correction. Measurements were performed preoperatively, then at 3 and 12 months postoperatively. RESULTS: Inferior, temporal and nasal average thickness as well as ellipse average thickness and average thickness showed no difference among the three time points (ANOVA, p > 0.05). Superior average thickness was significantly smaller both at three months (Sheffe test, p =0.008) and 12 months (p =0.006) than before LASIK. However, no difference was seen between the values measured at three months and at 12 months after LASIK (p =0.997). A statistically significant interaction between treatment type (myopic or hyperopic correction) and the change of retardation was found for the superior average thickness (two-way ANOVA, p =0.016). In this quadrant the RNFLT values of the myopic eyes decreased between the baseline and the month 3 measurements but became stable after that; the retardation of the hyperopic eyes remained unchanged throughout. CONCLUSION: RNFLT measured with the classic GDx device after LASIK shows transient changes probably due to the LASIK-induced alteration of the polarization and the healing process. The polarimetric RNFLT values, however, become stable by the third post-LASIK month, and show no further change until the end of the first year after LASIK. Baseline SLP measurements for long-term glaucoma follow-up can be obtained from the third post-LASIK month onwards.     

Posterior Corneal Elevation after Small Incision Lenticule Extraction for Moderate and High Myopia

Purpose

To investigate the changes of posterior corneal elevation after small incision lenticule extraction (SMILE) for moderate and high myopia.

Methods

In this prospective study, fifty consecutive eyes of thirty patients (10 male, 20 female) who underwent SMILE for myopia and myopic astigmatism were included. Eyes were divided in two groups based on the preoperative spherical equivalent refraction: high myopia group (32 eyes, range -6.25D to -10.00D) and moderate myopia group (18 eyes, range -3.00D to -6.00D). Posterior corneal surfaces were measured by a Scheimpflug camera (Pentacam, Oculus Germany) preoperatively and 1 month, 3 months, 6 months and 12 months postoperatively. Posterior central elevation (PCE) and posterior mean elevation (PME) at 17 predetermined points in the central-4mm area above the best-fit sphere were analyzed.

Results

No significant difference in the amount of posterior corneal elevation changes in the high myopia group was noted over time (P = 0.23 and P = 0.94 for PCE and PME, respectively). Similarly, the changes in the moderate myopia group before and after SMILE were not significant either (P = 0.34 and P = 0.40 for PCE and PME). A statistically significant correlation was found between the residual bed thickness and the shift of the PCE in the high myopia group at 12 months postoperatively (r = 0.53, P = 0.01).

Conclusions

The results of this study suggest that the posterior corneal surface remain stable within one year after SMILE for both moderate and high myopia. The changes of PCE correlate to the residual bed thickness for high myopia. Long-term changes of posterior corneal surface need further investigation.     

Lenstar LS900测量下人工晶状体公式用于高度近视白内障患者的准确性研究

目的:使用Lenstar LS900测量仪对高度近视合并白内障患者进行术前测量,比较SRK/T、Haigis、Barrett Universal II公式的精确性。方法:选择2018年5月至2018年8月于我院行白内障超声乳化吸除及人工晶状体植入术的高度近视合并白内障患者40例(54只眼),根据眼轴的长度分为三组。使用Lenstar LS900对患者进行眼部生物测量,并计算由SRK/T、Haigis、Barrett Universal II公式预测的术后屈光度。将术后一个月得到的实际屈光度与各公式预测的屈光度进行比较分析,观察上述公式在不同眼轴长度组中的准确性。结果:组内各公式的比较:A组:Haigis公式与Barrett Universal II公式间的差异有统计学意义(P0.05),其他公式间比较差异无统计学意义(P0.05);B组:SRK/T公式与Haigis公式比较差异无统计学意义(P0.05),其他公式间比较差异有统计学意义(P0.05);C组:三个公式之间的差异均具有统计学意义(P0.05)。各公式组间比较:SRK/T公式和Haigis公式比较差异具有统计学意义(P0.05),Barrett Universal II公式组间比较差异无统计学意义(P0.05)。结论:Barrett Universal II公式用于高度近视白内障患者在各个眼轴长度的测量中表现出良好的准确性,且准确性不随眼轴的增长而下降。随着眼轴的增长,SRK/T公式的准确性逐渐下降,当AL30 mm时,Haigis公式的准确性优于SRK/T公式。     

框架眼镜联合角膜塑形镜矫正青少年高度近视的临床疗效及对角膜内皮细胞和泪膜的影响

目的:探讨框架眼镜联合角膜塑形镜矫正青少年高度近视的临床疗效及对角膜内皮细胞和泪膜的影响。方法:选取2018年1月2019年3月期间我院收治的青少年高度近视患者98例(181眼),根据信封抽签法分为对照组49例92眼(框架眼镜配戴治疗)和观察组49例89眼(对照组基础上联合角膜塑形镜治疗)。对比两组裸眼视力、屈光度、眼轴长度、角膜内皮细胞密度和数量、泪膜情况以及并发症发生情况。结果:观察组治疗后1个月、3个月、6个月、1年屈光度呈下降趋势(P<0.05),眼轴长度未见明显变化(P>0.05),治疗后6个月、1年裸眼视力较治疗前,治疗后1个月、3个月增加且治疗后1年裸眼视力高于治疗后6个月(P<0.05);观察组治疗后1个月、3个月、6个月、1年屈光度低于对照组(P<0.05),治疗后6个月、1年裸眼视力高于对照组,眼轴长度短于对照组(P<0.05)。两组治疗前、治疗后1年角膜内皮细胞密度(ECD)、六角形细胞(HEX)百分比和细胞面积变异系数(CV)组间及组内对比无差异(P>0.05)。观察组治疗后1年泪膜破裂时间(TBUT)、非接触性泪膜破裂时间(NTBUT)较治疗前下降,且低于对照组(P<0.05)。两组治疗前、治疗后1年基础泪液分泌量(Schirmer)组间及组内对比无差异(P>0.05)。两组并发症总发生率对比无差异(P>0.05)。结论:青少年高度近视的患者在佩戴框架眼镜基础上应用角膜塑形镜,可有效矫正近视屈光度,提高患者裸眼视力,对角膜内皮细胞无明显影响,且不增加并发症发生率,但对人体泪膜稳定性有一定的影响,临床治疗中应加强泪膜情况的戴镜前检查和戴镜后随访。     

高浓度玻璃酸钠滴眼液与聚乙二醇滴眼液防治飞秒激光辅助LASIK术后干眼的临床疗效对比

目的:比较高浓度玻璃酸钠滴眼液与聚乙二醇滴眼液防治飞秒激光辅助LASIK术后干眼的临床效果。方法:选取2016年1月至2017年1月在我院视光学中心收治的飞秒激光辅助LASIK术后干眼患者80例并将其随机分为A、B两组,分别给予玻璃酸钠滴眼液(3 g/L)、聚乙二醇滴眼液,在用药后1周、2周、1个月进行干眼体征检查,比较患者用药前后泪液分泌试验(SIT)、泪膜破裂时间(BUT)、角膜荧光素染色(FL)的变化。结果:术后1周,所有患者BUT均较术前显著降低,FL均较术前显著升高,差异均有统计学意义(P0.05),但SIT与术前比较差异无统计学意义(P0.05)。两组患者用药后SIT数值随时间变化差异没有统计学意义(P0.05);A组和B组分别在用药后1周、2周、1个月时进行比较,SIT变化差异没有统计学意义(P0.05);而A组BUT时间、FL评分改善时间明显早于B组,差异有统计学意义(P0.05)。结论:滴用高浓度玻璃酸钠滴眼液(3 g/L)对飞秒激光辅助LASIK术后干眼患者的效果明显优于滴用聚乙二醇。     

Subjective and objective risk of breast cancer in Ashkenazi Jewish individuals at risk for BRCA1/2 mutations

The aims of the study were to (1) examine the differences between subjective and objective estimates of the risk of breast cancer in those being tested for BRCA1/2 mutations, (2) explore new ways to conceptualize risk, and (3) examine the change in subjective risk of developing breast cancer throughout the process of genetic counseling and testing. Participants were 86 Ashkenazi Jewish women with a family or personal history indicating risk for BRCA1/2 mutations. Surveys to assess subjective risk of breast cancer (percentage risk, projected age of onset, and survival time) were administered before counseling, after counseling, and after receipt of test results. Subjective percentage risk of breast cancer was compared to estimated objective risk to determine accuracy. Those with no personal history of cancer receiving positive results became more accurate from post-counseling to post-result. Those receiving positive results increased their estimate of their percentage risk, and those receiving uninformative negative results decreased their estimate of their percentage risk from post-counseling to post-result. Those without a personal history of cancer decreased in perceived risk from post-counseling to post-result. No change in projected age of onset of breast cancer or survival time with breast cancer was seen from pre- to post-counseling or from post-counseling to post-result, and no change in accuracy or in percentage risk of breast cancer was seen from pre- to post-counseling. Individuals use information from genetic counseling to form estimates of percentage risk following receipt of test results; however, projected age of onset and survival time with breast cancer, areas not targeted by genetic counseling that may be more closely linked to health behavior, do not change.