How to Cure Amblyopia In Adults, Easy Vision Therapy

Natural Clear Vision

Youll have full access to the Natural Clear Vision Manual that covers a whole bunch of wide-ranging topics such as how to enhance your eyes health and performance plus how to care and feed our priceless eyes, just to name a few! Contained inside are also absolutely priceless techniques and exercises on how to enhance your vision. Theyre so easy to follow that even my kids and folks could do it without supervision! So its not something that just benefits you, but the whole family as well! All the steps and techniques are explained step-by-step in a clear and concise manner, so you wont miss out any important details as well. If seeing is believing for you, not to worry because theres a really helpful instructional video thats included too! It contains important tips that teach you how to create healthy vision habits as well as increasing overall awareness about your vision. Just think of it as a fitness video thats meant for your eyes!

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Principles for organizing an eye health system for the care of diabetic retinopathy

Accuracy of examination results If diabetic retinopathy is suspected after screening, a decision must be made about the overall management for a given level of diabetic retinopathy. In many developing countres, there are too few persons to provide even basic eye care to the population, let alone specialized eye care for patients with diabetes and related blindness prevention. Involving non-ophthalmic health care providers in varous aspects of eye care for patients with diabetes is a viable alternative. Appropriate follow-up intervals Significant problems have been encountered in ensurng regular follow-up of patients with diabetic retinopathy High rates of follow-up have, however, been reported with the use of vans and trained photographic readers using reference standard photographs to provide immediate feedback to patients. By directly addressing patient convenience, access and feedback, this system might serve as a model for a 'marketing' approach for patient-centred detection of...

Evaluation and improvement of eye care for patients with diabetes mellitus

In assessing approaches to improving the care system, it is important to (i) determine the purpose of the proposed system, for example, to screen for a threshold referral level of retinopathy or to provide guidance in management (ii) assess the performance of the system relative to that of the gold standard, in order to identify trade-offs (ii) assess the success and actual performance of different eye care systems in various settings and (iv) understand how patients perceive the benefits of the system. From the perspective of health policy, it should be shown that a traditional or non-traditional proposal for care offers significant benefits over the existing system, sufficient to justify any additional costs. The performance of systems for eye care for patients with diabetes, even in developed countres, leaves much to be desired. Application of a systems approach to the current systems indicates that alternatives should be explored to improve performance in every area of eye care...

Conduct international research into systemic deficiencies in health and eye care that contribute to blindness from

Improvements to increase the cost-effectiveness of eye care for diabetes patients are a global necessity. Blindness due to diabetic retinopathy occurs in part because factors important to both patients and health care providers have not been recognized or incorporated into current diabetes education, screening and treatment programmes. Systems analyses are needed in varous cultures to understand better why patients with diabetic retinopathy go bind, particularly when the technical knowledge and services to prevent the condition exist. Operations research is needed for comprehensive, evidence-based characterzation of the contrbutions of significant factors and their interactions to blindness among patients with diabetic retinopathy. Within a standardized protocol, focus group methods can give detailed insight about bind and non-blind patients with retinopathy, members of their families or social support systems and diabetes and eye care providers, including information on the actual...

Alternatives in eye care for patients with diabetes mellitus

Al treatment should be consistent with uniform international standards. The I nternational Council of Ophthalmology guidelines for diabetic retinopathy care (52) (See Annex 4.) give detailed information about the expected performance of ophthalmologists who treat diabetic retinopathy. Education can improve the performance of health care providers, including non-eye care professionals, although long-term data on persistence are lacking. Use of photographic standards might be an alternative that would also enhance the performance of all systems to detect and follow-up cases of diabetic retinopathy.

Features of dysthyroid eye disease

Although Werner's early NOSPECS classification of dysthyroid eye disease Table 11.1 Assessment of common clinical features of dysthyroid eye disease (after Thyroid 1992 2 235-6). An objective deterioration in visual acuity, reduced colour perception, an acquired visual field defect, impaired visual-evoked potentials or corneal ulceration are signs of serious sight-threatening disease for which urgent intervention is essential. Visual acuity, fields and colour vision Sum one point for each of the following spontaneous retrobulbar pain pain with eye movement eyelid erythema eyelid oedema conjunctival injection conjunctival chemosis caruncular swelling steroids during therapy may prevent exacerbation of the eye disease. Although most patients with the clinical features of dysthyroid eye disease have abnormal thyroid function, some will be euthyroid and the clinical diagnosis may be supported only by raised levels of serum thyroid auto-antibodies. Orbital imaging in dysthyroid eye disease...

Surgical rehabilitation of the patient with dysthyroid eye disease

Compressive Optic Neuropathy

Other surgery for dysthyroid eye disease Upper eyelid retraction in thyroid eye disease occurs due to a combination of primary factors (adrenergic stimulation, inflammation and fibrosis) and secondary retraction due to inferior rectus fibrosis - with secondary overaction of the superior rectus levator complex. If secondary upper eyelid retraction is present, the restriction of ocular motility should be addressed first, with inferior rectus recession. Primary upper eyelid retraction is treated by one of the several techniques for graded levator tenotomy (Chapter 7), but with all methods it is particularly important to completely divide the lateral horn of the levator aponeurosis and to maintain a levator action on the medial part of the upper eyelid. Lateral tarsorrhaphy invariably stretches with time and, with appropriate surgery to address the other position of the globe and upper eyelid, there is almost no indication for this rather disfiguring procedure in the patient with...

Principles In Eye Care For Patients With Diabetes

Diabetic retinopathy remains the leading cause of new-onset blindness in populations of working age, even in the United States (21) and other industralized countres. Despite clearly defined clinical standards for evaluating and treating diabetic retinopathy cost-effectively, for a varety of reasons (see below), effective treatments such as laser surgery are underused. It has been estimated that 50 of adults with diabetes mellitus in the United States do not receive the recommended annual eye care that would allow diagnosis and treatment of diabetic retinopathy (38-41). Studies have also shown that many persons who require sight-preserving laser surgery do not receive it (42,43). It has been reported that about 26 of patients with type 1 and 36 of those with type 2 diabetes mellitus have never had their eyes examined (44). These patients tend to be older, less educated and to have had a more recent diagnosis than those receiving regular eye care. They are also likely to live in rural...

Amblyopia and Strabismus

Amblyopia is a visual loss with no apparent gross pathology. There is no cloudiness of the cornea or lens, or apparent retinal lesions. Amblyopia is not corrected by glasses. It is a microscopic defect in the wiring of the retina-to-brain connections that results from disuse of one eye at an early age (generally before age 7). An adult who does not use an eye will not develop amblyopia. A child below age 7 who does not use an eye will develop amblyopia, and the condition may become irreversible if not corrected quickly. Amblyopia occurs in only one eye. It is proposed that connections in the brain from one eye do not develop well if that eye is not used. Instead, connection sites are usurped by nerve fibers from the good eye. After maturity, correcting the cause of amblyopia will not restore function, as the connection (synaptic) sites are already filled by permanent connections from the normal eye. There are three main causes of amblyopia physical occlusion (as by cataract or...

Treatment of dysthyroid eye disease

Most patients with thyroid eye disease will have relatively few symptoms and signs, and many will require only topical lubricants during the active phase of the disease and no long-term therapy. Patients without proptosis when the disease is inactive, but with persistent lid retraction or incomplete lid closure, may need eyelid surgery to protect the cornea (Chapter 7). Likewise, squint surgery may be needed when the eye disease has been shown to be stable and inactive for some months. Management of more severe and significant thyroid eye disease should be first directed towards suppression of orbital inflammation and later the restoration of orbital function.

Prevention of amblyopia

In orbital trauma in children it is important to take steps to prevent amblyopia by measures aimed at reducing swelling rapidly (ice packs, prompt treatment of infection) and occluding the fellow eye if necessary. While it would be acceptable to delay the repair of a traumatic ptosis in an adult, this would carry the risk of amblyopia in a child and a temporary brow suspension should be carried out urgently if necessary. It is preferable to use a non-integratible material for the suspension such as a prolene suture or silicone rod so that it can be removed subsequently if the ptosis recovers.

Improvement in Visual Acuity

Improvements in visual acuity following reattachment surgery may be achievable using several different methods. The first would be a reduction in the rate of complications associated with macular dysfunction. These include both macular edema and macular pucker. Both are well-described complications of retinal reattachment surgery as well as other vitreoretinal conditions and may be amenable to pharmacological intervention. Recent reports suggest that intra-vitreal steroids, principally triamcinolone acetonide, and also dexa-methasone in a bioerodable polymer may reduce macular edema associated with several conditions, including diabetic retinopathy, uveitis, and retinal vein occlusion 11,12 . The use of steroids by other routes of administration, including oral and parenteral, may also be of benefit in preventing macular complications, such as pucker 13 . It may also be possible to improve visual acuity through the enhancement of photoreceptor regeneration in eyes with macula-off...


Another treatable eye disease is glaucoma, which is characterized by the following triad the IOP increases ( 21 mmHg) this leads to progressive excavation of the optic disc, the site where the optic nerve leaves the eye and cupping of the disc. This leads to ischemic damage to the optic nerve fibers, which may result in blindness. Two types of glaucoma are known, chronic open-angle glaucoma (COAG), which is the frequently diagnosed type, and the closed-angle type, which is rare (7-10). The incidence of COAG in the population increases rapidly with age, from a low of 0.2 in the fifth decade to about 1 in the seventh decade, 3 in the eighth decade, and 10 in the ninth decade. OAG is characterized by an insidious and slow onset, initially asymptomatic and then gradually leading to blindness if unchecked. Closed-angle glaucoma is rare and is characterized by an acute attack of severe eye pain and marked loss in vision due to a rapid increase in IOP compressing the entire retina. Recent...


A Majority of cases are idiopathic age-related ('senile cataracts'). Numerous secondary causes including Some may experience monocular diplopia and see haloes around lights. Some may notice that they can read without glasses (nuclear sclerotic cataract may lens-converging power). In infants, there may be amblyopia or nystagmus. E Loss of red reflex and hazy lens appearance. Reduced visual acuity. M Congenital cataracts must be treated urgently to avoid amblyopia. The decision for surgery depends on the effect of the cataracts on the patient's vision and life. C None, other than reduced quality of life from reduced visual acuity. P Good with treatment for age-related cataracts.

Visual Impairment

As discussed in Chapter 10, retinopathy of prematurity (ROP) is a common complication of prematurity that increases with decreasing gestational age and birth weight. As a group, pre-term children have a higher risk of impaired visual acuity than full-term children (Table 11-4). Myopia (i.e., nearsightedness) is one of the most common visual sequelae, and its incidence increases with the severity of ROP and with decreasing gestational age. Myopia occurs in 20 to 22 percent of children born with birth weights of less than 1,251 or 1,751 grams, and 4.6 percent have a high degree of myopia (i.e., 5 diopters) (O'Connor et al., 2002 Quinn et al., 1998). Other visual problems include hyperopia and astigmatism (in 12 and 29 percent of children born at less than 29 weeks of gestation, respectively) (Hard et al., 2000). The need for glasses was higher in 7-year-olds born at gestational ages of less than 32 weeks than in controls born full term (13 and 4 percent, respectively) (Cooke et al.,...

Crop Plants And Renewable Resources

A very interesting and scientifically important step into this modern field has been taken by the recent release of Golden Rice. This transgenic rice supplies provitamin A and iron and is expected to reduce major micro-nutrient deficiencies in substantial populations where rice is the major diet (49). Iron deficiency (a health problem in many women) is compensated by several transgenes leading to better iron uptake and hydrolysis of phytate. Vitamin A (required to prevent eye problems and blindness) is provided by substantial levels of 3-carotene accumulating in the rice grains due to four transgenes to allow carotinoid formation.

Neurological manifestations

The patient classically presents with paraesthesiae, muscle weakness or difficulty in walking and sometimes dementia, psychotic disturbances or visual impairment. Long-term nutritional cobalamin deficiency in infancy leads to poor brain development and impaired intellectual development. Folate deficiency may cause mental changes such as depression and slowness and has been suggested to cause organic nervous disease, but this is uncertain. Methotrexate injected into the cerebrospinal fluid may, however, cause brain or spinal cord damage. Neural tube defects in the fetus are discussed above.

Indications and Testing

The evaluation of candidates follows a similar pattern to that of the kidney patient, with emphasis in the diabetic complications that can threaten successful transplantation. Consequently, great emphasis is placed on the cardiac and peripheral vascular workup. Cardiologic workup and clearance usually entails a peripheral vascular evaluation, chest X-rays, an EKG, a dobutamine stress echocardio-gram, and frequently a coronary angiogram. Other common tests with other transplant recipients include serologic testing (i.e., CMV, HIV, HCV, etc.), HLA, blood group testing, complete blood count (CBC), and coagulation studies, to mention a few. Ophthalmologic, neurologic, and urologic workups are performed on a case-by-case basis (Table 4.2). Absolute contraindications include active infection, recent or current history of malignancy, positive crossmatch, and HIV infection. Relative contraindications include advanced age, obesity, and cardiovascular disease. Many centers consider that, in...

Physicochemical Properties

Drugs developed for ophthalmic use should have good chemical stability to allow formulation into topical ready-to-use aqueous eyedrops, which is the most practical and commonly used administration route for treatment of ophthalmic diseases. This is often challenging in the development of ophthalmic prodrugs that are intended to be rapidly converted to active drug after absorption. Therefore, only those prodrugs that show good chemical stability combined with high enough enzymatic lability can be easily developed without resorting to multivial reconstitutable products.

Reasons for Modification

This experience somewhat parallels the trend described by Lincoff,who drained 48 of cases in 1963 and only 13 by 1971 39 , or by Kreissig who drained almost all cases in 1966,6 of cases in 1972 40 and none in 1992 36 . The reasons for drainage were (1) giant tears, (2) severe preretinal retraction, (3) uncertain localization of the break, (4) defective choroid, (5) thin sclera, or (6) glaucoma 39 . Reasons 1-3 might be managed by vitrectomy techniques today including encircling with the ubiquitous 3.5-mm band, which reduces indications for drainage.

What to tell parents

An explanation for the presenting symptom(s) is required and need for further investigations. Further discussions depend on results of these investigations. Long-term hormone replacement therapy, management of intercurrent infections (see above) and importance of glucose monitoring needs to be discussed. Child minders need to be informed about the risk of adrenal insufficiency during an intercurrent illness. Babies with anomalies of the optic nerve may have reduced visual acuity or be blind. Implications of associated anomalies, particularly the brain will require discussion.

Symptomatic treatment

Drug is started at a dose of 25-35 mg kg, given by an 8- to 12-h subcutaneous infusion overnight, approximately 1 year after the start of regular transfusion. The usual dose in older children and adults is 40 mg kg. Patients should receive up to 200 mg of ascorbate on the day of infusion, approximately 30 min before it is started. Intolerance to desferrioxamine is extremely rare but, particularly at high doses, there may be ocular changes, including cataracts and retinal damage, or acoustic nerve impairment. Other complications, particularly if the drug is given to patients with low body iron levels, include reduction in linear growth, sometimes associated with evidence of cartilaginous dysplasia of the long bones and spine. Infection with Yersinia enterocolitica is a rare but well-documented complication. But these complications are rare in children who are kept under careful surveillance and the main problem posed by desferrioxamine is non-compliance much can be done by intensive...

Similarities and Differences Between WS and Aging

Werner's Syndrome is an inherited disease with clinical symptoms (forming a syndrome) that resemble premature aging (87). Early susceptibility to a number of major age-related diseases is a key feature of this disorder. Principal WS features include shortness of stature senile appearance cataracts and graying of the hair beginning at 20 to 30 years skin changes (i.e., tautness, atrophy or thickening, ulceration) designated as scleroderma joint deformities, soft-tissue calcifications and osteoporosis atrophy of muscles and connective tissue early cessation of menstruation and increased incidence of neoplasms. Most of these conditions occur in aging as well but at a later age and with more or less severity (85).

Evaluate use by health care workers of standardized reference photographs and direct ophthalmoscopy as a lowcost

As noted in section 5, this approach, involving general health care workers, probably offers an acceptable level of performance, as observed in other areas of eye care delivery (e.g. trachoma). Demonstrating that this is the case will be essential to its widespread adoption and acceptance by the societies and populations that might benefit most from such services. This information will also be necessary to provide the basis for informed decisions about trade-offs between cost and performance.

Visual Functional Results

The functional results of PR reported in the literature vary widely, so that it is difficult to compare and summarize the data. For those patients with macula-involved detachments, final best-corrected visual acuity greater than or equal to 20 50 was achieved in between 35 and 80 of cases. The wide variation in these numbers probably represents variation in the duration of macular detachment. Studies that categorized detachments of less than 2 weeks of macular involvement tended to have better outcome averages. Overall, most series reported averages for best-corrected visual acuity greater than or equal to 20 50 following macula-involving detachments to be about 65 . When examining the data for patients without preoperative detachment of the macula, 86 to 88 will have the same or improved best-corrected visual acuity 9,13 . However, between 12 and 14 of patients will lose two or more lines of best-corrected visual acuity. Surgical failures and complications were the reason for vision...

Evidence vs Professional Consensus

The second aspect of the evidence problem is that clinical research may not address outcomes that matter from a patient's perspective, e.g., changes in patient's quality of life. Adar et al. reviewed 39 studies of a surgical procedure intended to open popliteal or femoral arteries, to relieve leg pain, and to restore patients' ability to walk. These studies usually evaluated the success of surgery according to whether the artery remained open. Not one study measured pain relief or whether patients could walk after recovery from surgery.16 Studies of corneal transplantation measure visual acuity (with an eye chart), but not patients' ability to see in everyday situations.

Plasticity Driven Gene Expression in the Adult Mammalian Retina

We showed that undisturbed (UD) rats, which remained housed in standard laboratory cages, and handled-only (HO) controls displayed only a few immunolabeled cells in the inner nuclear layer (INL) and ganglion cell layer (GCL), when compared to animals exposed to an EE (Pinaud et al., 2002b) (Fig. 5.1). Animals in the latter group had a marked increase of NGFI-A labeling in these retinal layers. In addition, Arc immunoreactivity was found in an upregulated fashion in the inner and outer plexiform layers of EE animals, but not in UD and HO controls (discussed below) (Fig. 5.1). These findings suggest that enhanced complexity of the visual environment triggers a cascade of gene expression that might be correlated with circuit rewiring. We postulate that these putative wiring modifications may be associated with the optimization of information capture and processing and thus, increased functional capacity. In fact, it has been demonstrated that exposure of mice to an enriched environment...

Optic Nerve Sheath Meningiomas The Role of Stereotactic Radiotherapy

Purpose Primary orbital meningiomas are rare, the usual site of origin being the optic nerve sheath. These represent 1-2 of all meningiomas. This is a review of a single centre's experience. Materials and Methods Between 1990 and February 2004 26 patients were referred and 16 patients were treated by radiotherapy (mean age 51 years). This retrospective study evaluated 16 patients - 18 tumours (1 patient with NF2 had bilateral optic nerve tumours and 1 optic nerve was treated twice). Nine patients were treated with newly diagnosed lesions, and 7 recurrent after prior treatment including radiotherapy for 1 patient. The median duration of symptoms to onset was 2 months. Treatment consisted of stereotactic radiosurgery (median dose 20 Gy) where vision was not a consideration, and fractionated SRT (median dose 5,040 Gy in 28 fx) for vision preservation. Results Median follow up is 46.8 months. Recurrence after SRT occurred in 1 patient (a geographical miss) leading to progressive disease...

Third Category of Difficult Detachments

Actually, the indication for a vitrectomy in these eyes, combined with a preceding anterior segment surgery, does not depend only on the size of the tear or the presence of vitreoretinal proliferation, but also on the expertise of the surgeon in diagnostics in the presence of optical interferences. Biomicroscopy with the use of the new indirect wide-field contact lenses combined with simultaneous depression of the retinal periphery and application of the 4 Rules for finding the primary break 19, 20 might enable a limited prospective buckling and reduce the need for an invasive surgery.

Use of photographic systems by nonphysician nonprofessional providers

The use of non-physician health care professional examiners for detecting diabetic retinopathy has been coupled with use of photographic systems in the United Kingdom (84,85). The performance of trained photographic readers using a Polaroid camera system has matched or exceeded that of physicians and optometrcs. An accuracy of more than 90 in staging retinopathy has been reported with a modified Early Treatment Diabetic Retinopathy Study system that is similar to the International Clinical Diabetic Retinopathy system used by the Amercan Academy of Ophthalmology and the International Council of Ophthalmology Use by ancillary health care workers (and physicians) of a reference card or set of photographs in grading the severity of disease has been validated in the care of trachoma and other eye diseases, such as with the WHO trachoma grading card and prmary eye care chart. The pirnciple has also been used in numerous randomized controlled trals to achieve consistency in grading the...

Aircraft Travel And The

The atmosphere of an aircraft is drier and is under lower pressure than normal. In addition there are often blowers above seats that cause increased evaporation of tears. Travellers often cannot sleep on long haul flights and will attempt to while away time by reading, using their computers and watching triple movie screenings. When people are overtired their rate of blinking also decreases. These conditions can aggravate existing eye problems as well as giving rise to symptoms in people who do not ordinarily suffer from dry eyes.

Advantages of Primary Minimal Segmental Buckling Without Drainage

There are, except for a rare choroidal in 0.3 , no intraocular complications, such as secondary glaucoma, cataract, intraocular hemorrhage, intraocular infection, incarceration of retina or vitreous, or iatrogenic tears, because the procedure is extra-ocular. 10. The recovery of visual acuity is optimal after minimal segmental buckling without drainage. In the series of 107 detachments with a mean preoperative visual acuity of 0.3, the mean value at 1 year is 0.6 and 0.5 at 15 years. The observed slight decrease over years is an effect of aging and not of secondary complications.

Reduction in Other Non Macular Complications Limiting Either Anatomic Retinal Reattachment or Normal Physiological

Well-known complications of retinal reattachment surgery include alterations in the intraocular pressure, both glaucoma and hypotony, postoperative inflammation, cataract, motility disorders, and PVR. Pharmacological therapy, both intraoperatively as well as postoperatively, may play a role in the reduction of several of these complications, either singly or in combination. The remainder of this chapter is devoted to a discussion of the principal cause of retinal reattachment failure after primary surgery, PVR, and the methods by which pharmacological therapy might favorably influence this condition.

Help And Proxy Assessment

However, some patients may be unable to complete the questionnaire by themselves or have difficulty understanding the questions. Examples range from vision problems and forgotten glasses, to cognitive impairment. In these cases help should be provided, as assisted completion is better than either total absence of data or incorrect information through misapprehension. Similarly, if a few patients are too ill or too distressed to complete the forms, someone familiar with their feelings may act as a proxy. Proxies are typically a significant other such as a partner, spouse or close family member, but may include staff such as a nurse who knows the patient well. For some trials, such as those in psychiatry or advanced brain malignancies, it might be anticipated that the majority of patients will be unable to complete questionnaires and it may be appropriate to make extensive or even exclusive use of proxy assessment. Proxy assessment may also be needed for young children who are unable to...

Principles in assessing methods of care

Secondly, for evaluation, the performance of the system relative to that of the gold standard must be known, so that the trade-offs can be identified. I n the case of diabetic retinopathy, the practice guidelines of the I nternational Council of Ophthalmology (52) and the Amercan Academy of Ophthalmology (50) prescrbe observation by a trained, experienced observer or a full seven-field photographic interpretation according to the standards of the Wisconsin Reading Center as the gold standard. Thus, any study of the value of a system, such as remote telemedicine care in diabetic retinopathy, must establish its performance and reliability relative to either of these gold standards. Nevertheless, no system is perfect at the outset. If a new approach offers added advantages, such as better access to care, reaching more people with diabetes at a lower unit cost, then a level of technical performance that is at least as good as (or perhaps lower than) current care even i not up to the gold...

Changes inside and outside the lesion projection zone as a function of postlesion survival time

Secondly, we established that the cortical reorganization after retinal lesioning is certainly also driven by molecular changes occurring outside the LPZ, i.e. in remote non-deprived cortex (Qu et al., 2000, 2003, Massie et al., 2003a,b). Every neurotransmitter and neuromodulator that was investigated showed clearly increased levels in regions of area 17 devoted to peripheral vision as compared to control regions in normal animals (Table 9.1). The effect on extracellular fluid glutamate and GABA levels in remote area 17 turned out to increase with post-lesion survival time. The pronounced increase in glutamate could point to hyperexcitability and hyperactivity in remote visual cortex. The observation that also all the neuromodulatory systems were upregulated hints to a similar conclusion. Noradrenaline levels were specifically augmented, and as discussed by Pinaud (2000, 2004), nora-drenergic input to the visual cortex regulates light-induced zif268 expression. Therefore a...

Myotonic Dystrophy DMPK

Similar to FRM1, DMPK is an autosomal dominant dynamic mutation in chromosome 19 (19q13.2-13.3), resulting from the expansion of triplet repeat, with a prevalence of 1 in 8000 live births. This is a severe neurodegenerative disorder chalacterized by myotonia, muscle wasting in the distal extremities, cataract, hypogonadism, defective endocrine functions, and cardiac arryth-mias. As mentioned in Chapter 3, DM was one of the most frequent indications for PGD, which also provided the possibility for obtaining affected embryos for the establishment of the ES cell lines with DMPK. One of the PGD cycles for the maternally derived mutation is presented in Figure 7.7, showing the results of blastomere biopsy of six embryos, which resulted in the transfer of two mutation-free embryos (embryos 5 and 7). Two of the remaining four embryos were with aneuploidies, monosomy 16 in embryo 8 and monosomy 22 in embryo 10, and two affected embryos were donated for research and resulted in the...

Eye Movements Visual Thresholds Critical Flicker Frequency and Field and Spatial Vision

Aging Changes in Visual Field and Spatial Vision With aging, a loss in the size of visual field is observed, ranging from 3 to 3.5 in middle age to two and four times as much at 60 and 65 years, respectively. Disturbances in visuomotor performance are particularly observed when changes in useful or effective visual field are measured, in contrast to measures of visual field under standard clinical conditions (61). Visual acuity reflects the ability to detect details and contours of objects. It is defined as the minimum separable distance between objects (usually fine lines) and is one of the measures of the visual system's spatial discrimination ability. As shown in Figure 6, visual acuity declines, commencing at 50 years, particularly worsening during and after the eighth decade, when it becomes detrimental to vision (8,61). Recent Studies on Spatial Vision and Visual Acuity A recently devised measure of spatial visual ability is contrast sensitivity, where the test format and...

Advice For The Disabled Traveler The Visually Impaired Traveler

Travelers needing eyeglasses should take an extra pair during travel, as well as a copy of their current prescription. Tools for emergency eyeglass repairs, sold in pharmacies or at opticians' offices, may come in handy. Contact lens wearers should take all required equipment and solutions with them, as well as an extra pair of glasses. Iodine-purified water should not be used for lens care as it will permanently stain lenses. Daily disposable contact lenses are an attractive, relatively inexpensive, maintenance-free alternative to conventional contact lenses.

U Pharmacological Treatment

Modern pharmacological therapy for glaucoma may be pursued in three stages (102). First-line treatments are ocular hypotensive agents e.g., b-blockers (timolol) . If b-blockers are ineffective, prostaglandin and carbonic anhydrase inhibitors and a-2-adrenergic agonists (e.g., epinephrine) are used. Miotics (pilocarpine) represent second or third lines of treatment along the third line of treatments are the cholinesterase inhibitors, with fewer side effects. Therapy is often enhanced when drugs are used in combination (102). Dorzolamide (dorzolamide hydrochloride), a topical carbonic anhydrase inhibitor, is highly effective in the management of glaucoma and ocular hypertension. It reduces intraocular pressure by decreasing aqueous humor formation. Effects are additive when used with topical a-adrenergic antagonists. Side effects are bitter taste, transient local burning, and a stinging sensation. The prostaglandin analogs latanoprost and unoprostone, which act as hypotensive drugs, are...

Gene Therapy in Ocular Disorders

The study of ocular disorders at the molecular genetics level has opened an opportunity for gene therapeutics m ophthalmology. It has been observed that a number of mutations in the human rhodopsin gene are the cause of autosomal retinitis pigmentosa (83). Besides rhodopsin gene mutations, the gene encoding cGMP phosphodiesterase has been identified in autosomal recessive pigmentosa (84). Some eye disorders like color blindness, choroideremia, and Norrie's disease have genetic linkage with the X chromosome (85 87). Aniridia, color vision and cone dystrophies, Leber's hereditary optic neuropathy, Marfan's syndrome, retinoblastoma, stickler syndrome, uveal melanoma, and von Hippel-Lindau disease are a number of genetic eye disorders m which the defective genez have been identified (88) The localization and identification of disease-causing genes and their products, helps to utilize the potential of gene therapy in a particular ailment. Considering the delivery of a particular gene, the...

Dacryocystorhinostomy indications

Dacryocystorhinostomy Scar

The usual indication for DCR is complete or partial obstruction of the nasolacrimal duct such obstruction can cause skin excoriation, visual impairment, social embarrassment, chronic ocular discharge and acute or chronic dacryocystitis. Less common indications for DCR include lacrimal calculi, facial nerve palsy, gustatory lacrimation (crocodile tears), and lacrimal sac trauma. In the presence of lacrimal sac mucocoele, DCR is mandatory prior to intraocular surgery because of the risk of post operative endophthalmitis. Ezra EJ, Restori M, Mannor GE, Rose GE. Ultrasonic assessment of rhinostomy size following external dacryocystorhinostomy. Br J Ophthalmology 1998 82 786-9. Hanna IT, Powrie S, Rose GE. Open lacrimal surgery a comparison of admission outcome and complications after planned daycase or inpatient management. Br J Ophthalmol 1998 82 392-6. Hartikainen J, Grenman R, Pukka P, Seppa H. Prospective randomized comparison of external dacryocystorhinostomy and endonasal laser...

Agenda purpose and expected outcome

Issues in eye care in diabetics Eye care deficiencies contrbuting to blindness from diabetic retinopathy Improving integration of eye care within diabetes management Training of general practitioners in diabetic retinopathy detection Detection and referral within diabetes care clinics Detection within eye care clinics (prmary, secondary tertiary) Community-based screening modes Identify core diabetic retinopathy related eye health education messages for integration with diabetes patient education materials.

Everyday Prospective Memory

Sixty-nine worksheets were collected, describing 29 successes and 40 failures to perform an intended action during the intended period. The types of intentions reported fell into four categories event-based episodic (e.g., buy toothpaste while at a drugstore), time-based episodic (e.g., take car to garage before 5 p.m.), habitual (close top of bottle of contact lens solution), and multiple component. The last category consists of intentions with multiple intended actions grouped under a superordinate goal, such as going to a store to buy several items. Failing to pick up one item of several might be viewed as a failure of the retrospective component of prospective memory in some situations, but in other situations it seemed clearly a problem with the prospective component. For example, one participant reported going to a store to buy an item, then thinking of additional items while at the store and buying those items, but forgetting to buy the item originally intended. Perhaps picking...

Lower eyelid reconstruction

Hughes Flap Eye

A semicircular flap (Tenzel flap) (Figure 6.13) is useful for the reconstruction of defects up to 70 of the lower eyelid where some tarsus remains on either side of the defect, particularly where the patient's fellow eye has poor vision. Under these circumstances it is preferable to avoid a procedure which necessitates closure of the eye for a period of some weeks. A semicircular incision is made starting at the lateral canthus, curving superiorly to a level just below the brow and temporally for approximately 2cm.

Benign vascular anomalies of the orbit

Affected children should be monitored for impairment of visual development, being refracted when at an age suitable for spectacle correction of anisometropia or marked astigmatism. If the child is tending to develop an amblyopic eye, then appropriate corrective measures should be taken to maintain vision and consideration be given to treating the lesion. Cavernous haemangioma is the most common benign orbital tumour of adults and may be a developmental hamartoma that presents late in life, typically in the fourth or fifth decades, with gradually increasing painless proptosis. It is usually solitary and lies in the retrobulbar space, thereby causing axial proptosis, induced presbyopia, choroidal folds and optic disc congestion. There is often a global reduction in the extremes of eye movement. Excision of cavernous haemangiomas is curative, although the induced hyperopia and choroidal folds do not resolve in all cases. Whilst an ophthalmologist should supervise the day-to-day...

Impact of PET Radionuclide Decay Schemes

Tions in natural background radiation 1 . The effective dose limits are supplemented by limits on the equivalent dose to the tissues most likely to receive a high exposure at work - the skin, eyes and the hands and feet ( extremities ) - to avoid damage to skin and formation of cataracts in the lens of the eye. For the purposes of monitoring a person's exposure to an external source of radiation, the ambient dose equivalent at a depth of 10 mm in tissue, H*(10), also called the deep dose equivalent (DDE), may be taken as the effective dose from a uniform whole-body exposure. The directional dose equivalent at a depth of 0.07 mm in tissue, H'(0.07), also called the shallow dose equivalent (SDE), can be taken as the equivalent dose at the average depth - 70 m-of the basal cell layer in skin 2 .

Peroxygens 121 Hydrogen peroxide

Hydrogen peroxide has been used in aseptic packaging technology and also for disinfecting contact lenses as it has been shown to be effective against the opportunistic pathogen Acanth-ameoba, the causative agent of Acanthameoba keratitis. This is a potentially blinding infection which contact lens users are more susceptible to (Hughes & Kilvington, 2001). The use of hydrogen peroxide as a contact-lens disinfectant has been reviewed (Miller, 1996) and is further described in Chapter 8.1.

The Cell Biology of PVR

The introduction of long-acting gases, particularly perfluoro-propane, and the re-emergence of silicone oil (polydimethylsilox-ane) were major steps in the improvement in surgical success rates. The definitive silicone oil study confirmed that while silicone oil was superior to sulfur hexafluoride in providing visual acuity improvement and retinal reattachment in PVR, a companion study further amplified the relative equivalence of perfluoropropane to silicone oil in achieving retinal reattachment 27 . Approximately 64-73 of patients in the latter study achieved complete posterior retinal attachment and 43-45 achieved functional visual acuity of greater than 5 200 compared with success rates less than half that prior to the utilization of both of these long-acting tamponade techniques 28 . Paradoxically, with the improvement in anatomic reattachment associated with the long-acting tamponades of per-fluoropropane and silicone oil, both the medical need and the likelihood of...

The History of Retinal Detachment Surgery

Gonin Retina

In 1920, Gonin reported the first successful treatment of retinal detachment by sealing the retinal break to the underlying retinal pigment epithelium (RPE) and the choroid (Fig. 1.1) 7,8 . During and after the time of Gonin's contributions, many surgeons contributed to the advancement and success of retinal surgery. Prior to this time, however, there was little or no successful treatment for retinal detachment but a large number of treatments were proposed and are mentioned here for historical interest. Some of this work has been adapted from the great historical collection of Duke Elder's System of Ophthalmology and from Michels' Retinal Detachment 9,10 .

Intraorbital foreign bodies

Reversible visual impairment, persistent pain, diplopia, inflammation or infection, or when the object is palpable in the anterior part of the orbit. Unless the foreign body is visible under the conjunctiva, surgery should be under general anaesthesia as location of the materials can be difficult. When a foreign body is inert and posterior within the orbit (Figure 14.10), it can be left in place and the risk of surgical damage to the orbital contents avoided.

Congenital myogenic dysgenetic ptosis

The initial priority is to assess the child's visual development and to treat any co-existant strabismus, ametropia and amblyopia. When severe unilateral ptosis covers the visual axis there is a risk of occlusion amblyopia and ptosis repair is required urgently. Similarly, bilateral ptosis with a marked chin-up head posture may require early intervention. If visual development is normal then most surgeons would delay surgery to about 4 years of age when more accurate pre-operative measurements are possible, and yet is prior to school age. The choice between levator resection and brow suspension depends on the levator function.

Prodrugs of Adrenergic Antagonists

P-Adrenergic antagonists ( -blockers) are effective ocular hypotensive agents that act by decreasing the formation of aqueous humor (Sugrue, 1989). Timolol, a nonselective P-adrenergic antagonist, was introduced in 1978 for the treatment of glaucoma. Today, timolol is one of the most frequently prescribed drugs for this disease. In addition to timolol, betaxolol, carteolol, levobunolol and metipranolol are currently in clinical use. Additionally, various other P-blockers, such as atenolol, labetalol, metoprolol, nadolol, pindolol, and propranolol, have been evaluated for their topical ocular hypotensive activities.

Telomeres and Premature Aging

The reduced-longevity and premature-aging phenotypes of mTR- - mice are even more pronounced when combined with a deficiency in WRN (Chapter 3), the gene that is defective in the human premature-aging disorder, Werner syndrome (WS) (148). WRN encodes a DNA exonuclease helicase that participates in several processes important for genomic stability, including telomere maintenance (149). Humans with WS develop multiple aging phenotypes (e.g., wrinkled skin, thin gray hair, cataracts, osteoporosis, type II diabetes, cancer)

Special Considerations For Altitude Travel

Exposure of the cornea to hypoxia causes swelling and changes in corneal topography. For persons who have had radial keratotomy, the swelling ofthe hypoxic cornea is not uniform, and this results in significant visual changes. In contrast, significant refractive changes are not noted in people who have had LASIK surgery (laserassisted in situ keratomileusis) following corneal hypoxia.

Malignant orbital disease in children

Long-term side-effects of orbital radiotherapy include cataract, dry eye with secondary corneal scarring, loss of skin appendages (lashes and brow hair), atrophy of orbital fat and, if performed in infancy, retardation of orbital bone growth. There is also a risk of late radiation-induced orbital malignancy, such as fibrosarcoma and osteosarcoma, and there may be an increased propensity to certain other primary tumours in adulthood.

Benign neural and osseous lesions

Ophthal Plast Reconstr Surg 1999 15 9-16. Harris GJ, Sokol PJ, Bonavolonta G, De Conciliis C. An analysis of thirty cases of orbital lymphangiomas. Pathophysiologic considerations and management recommendations. Ophthalmology 1990 97 1583-92. Katz BJ, Nerad JA. Ophthalmic manifestations of fibrous dysplasia a disease of children and adults. Ophthalmology 1998 105 2207-15. Lacey B, Rootman J, Marotta TR. Distensible venous malformations of the orbit clinical and hemodynamic features and a new technique for management. Ophthalmology 1999 106 1197-209. McNab AA, Wright JE. Cavernous haemangiomas of the Ophthalmology 1990 97 28-32. McNab AA, Wright JE, Casswell AG. Clinical features and surgical management of dermolipomas. Aust NZ J Ophthalmol 1990 18 159-62. Miszkiel KA, Sohaib SAA, Rose GE, Cree IA, Moseley IF. Radiological and clinicopathological features of orbital xanthogranuloma. Br J Ophthalmol 2000 84 251-8. Nugent RA, Lapointe JS, Rootman J, Robertson WD, Graeb DA....

Technical issues in the use of standard photographic images

In 2004, the American Academy of Ophthalmology concluded that, in the United States, single-field photography is adequate for screening for the purpose of detecting diabetic retinopathy but not for management (73) What is 'acceptable' necessarily varies from society to society in relation to the acceptable 'error' or 'miss' rates and the associated costs of achieving specific performance levels. Most studies indicate that performance levels with photographic systems are at least as good as or better than those of examinations by physicians and health care providers other than experienced retina specialists (75). Sufficient evidence therefore exsts that different societies and countres can adopt different technical performance standards and thus use different techniques. Some will want to do everything possible to avoid misclassification and thus use dilated seven-field photography, while others will adopt the seemingly opposite approach of using a single-field photograph through an...

Prophylaxis in Fellow Eye of Primary Retinal Detachment What Not to Do and What to Do

This thinking, which was believed to justify the concept of prophylactic treatment,was greatly advanced and crystallized in the 1950s by the bringing together of two important developments in ophthalmology. The first of these was the popularization by Schepens 1 of a definitive method of retinal examination, using binocular indirect ophthalmoscopy combined with simultaneous localized scleral indentation. This method opened the possibility of examining in detail all areas of the retina in multiple, stereo-scopically viewed images. This development was a vast advance over previous methods and eventually led to the accurate characterization of various peripheral retinal lesions and to the quantitative collection of natural history data that had previously remained unknown. A further category of fellow eyes that simultaneously harbor multiple risks has always represented a special group which has been thought to have a more marked vulnerability to detachment and therefore to be...

Information Processing in the Elderly

Sensoriperceptual changes include age-related vision deficits such as altered color perception as a result of yellowing of the eye lens, difficulty seeing at various distances as a result of presbyopia, difficulty adjusting from light to dark, and decreased peripheral vision and depth perception. Sen-sorineural hearing loss affects the ability to hear high-frequency sounds and consonants and hinders communication. Also, excessive noise interferes with the ability to hear in the elderly.

Sebaceous gland carcinoma SGC

Sebaceous Gland Carcinoma

This tumour is well recognised for its ability to masquerade as chronic blepharo-conjunctivitis or recurrent chalazion (masquerade syndrome). Recurrent chalazion or atypical solid chalazions should alert the ophthalmologist to the possibility of underlying sebaceous gland carcinoma (Figure 6.6). Histopathologic features of sebaceous gland carcinoma are characteristic and may be confirmed by lipid stains (oil red O) on fresh tissue specimens. Multicentric origin is a feature of some SGCs. Clinical presentation of chronic

Mammals Have Some Capacity for Lens Regeneration

Rabbits, cats, and mice can regenerate an imperfect lens if the lens is removed from the lens capsule, leaving the capsule behind (Gwon et al., 1990 Call et al., 2004). A new lens is formed by the proliferation and differentiation of residual lens epithelium cells that remain adherent to the lens capsule. Interestingly, in human cataract surgery to replace the lens with a plastic lens, the posterior, and part of the anterior, lens capsule is left behind to hold the artificial lens. Residual lens epithelial cells adhering to the anterior part of the capsule sometimes undergo an epithelial to mesenchymal transformation and proliferate across the whole posterior lens surface, where they essentially form new cataracts, a process called posterior capsule opacification (PCO) (Wormstone et al., 2001). In these cases, the surgeon uses a laser to ablate the proliferating cells and the posterior capsule. PCO happens in other mammals as well, but is diminished considerably by 20 days...

Pathogenesis And Clinical Significance

There are two types of ocular microsporidiosis. Infections caused by E. hellem, E. cuniculi, E. intestinalis and T. hominis have been restricted to the corneal and conjunctival epithelia, and caused distressing bilateral punctate keratopathy with redness, irritation and decreased visual acuity. M. ceylonensis, M. africanum, V. corneae, B. algerae and N. ocularum have infected cells of the corneal stroma. The cases of M. ceylonensis and B. algerae led to severe ulceration and necessitated keratoplasty, while that of M. africanum required surgical removal of the eye.

Fractures of the orbital roof zygoma and midface

Fractures of the orbital roof are uncommon and usually accompany major head injury, larger fractures often being comminuted and involving the frontal sinuses, the cribriform plate or intracranial injury the ophthalmologist is, therefore, unlikely to be in charge of the primary management of these cases. Similarly, midfacial fractures are treated by maxillo-facial surgeons and the ophthalmologist's role is in the assessment of visual function, treatment of the ocular injury and in the late management of associated soft tissue injury and diplopia. orbit, through the zygomaticotemporal suture line. It is unlikely that the ophthalmologist will be required to identify such fractures, which are characterised by dental malocclusion.

Clinical Features

Toxocaral Eye Disease Toxocaral eye disease is usually referred to as ocular larva migrans (OLM) because the larva migrates to the eye and, at its most acute, infection may result in blindness (Sheilds, 1984). Reaction to its presence and to its shed antigens may cause local or widespread damage to the retina and to other intra-ocular structures. Intraocular infection usually occurs unilaterally in children, but occasionally both eyes are affected and adults develop the condition (Sheilds, 1984). Good, Holland and Taylor (unpublished observations) have found no association between convulsions and a raised Toxocara titre in a community study of over 100 000 schoolchildren but have found an association between convulsions and toxocaral eye disease in a case-control study. In a case-control investigation of human Toxocara infection of the central nervous system, Magnaval et al. (1997) failed to find an association between case status and clinical signs but did record a signification...

Aging Related Changes in the Retina

Retinas of humans and monkeys lose cones at a rate of 3 per decade (8). The turnover rate of cones was believed to be about a year, making them susceptible to accumulated effects of light damage and posttranslational modification of their photoreceptor proteins. Cone pigment density decreases with aging, presumably as a result of cone cell loss (9). The remaining cones increase in average diameter. Because size and geometry of foveal cones are important in visual acuity, these changes may contribute to the observed losses in visual acuity with age (see below). Nerve cell loss during aging in other neuronal types of retina, i.e., bipolar, amacrine, and horizontal cells, is around 30 . The loss for the ganglion cells is believed to be higher, about 50 . Mueller cells (a type of glia cell in the retina) take over the space left by the lost neurons and form cysts, which are common in the aged retina (7,8,11). The degeneration of macula in advanced age is discussed in section titled Aging...

Appropriate followup intervals

Once diabetes mellitus has been diagnosed and patients have had an initial eye assessment, of any kind, they must continue eye care. As there is no cure for diabetes mellitus, prevention of vision loss requires regular examinations. Nevertheless, there are significant problems in ensurng appropriate follow-up. The shortfall in efforts to ensure approprate follow-up is illustrated by studies showing that only 68-85 of patients referred for treatment start the treatment, and only 85 who start treatment compete it (43-45), indicating that 28-42 of patients who are referred for treatment do not receive the necessary care. The fact that over 40 of patients with diabetes who are referred for treatment do not actually compete it has not been addressed in educational and intervention programmes. Merely concentrating on ensurng that patients are examined (and that those examinations are accurate) is not sufficient. In 1989, Olsen, Kassoff & Gerber (95) reported the results of a survey of...

Specific Infections Affecting The Eyes In Travellers

Mio Mondo Una Sfera Cristallo

The management is to irrigate immediately and copiously with any fluid that is to hand, preferably normal saline but any bland fluid, including milk, will do. To irrigate, get somebody to hold open the eyelids and pour fluid directly on to the cornea. If this is not possible due to severe blepharospasm, plunge the patient's head into bucket of water, to reduce the concentration of venom, and then retry. Use as much fluid as is possible, preferably 2-3 litres. Sedate the patient if you are having difficulty. Enlist the help of an ophthalmologist as soon as possible. The eye will look oedematous and inflamed with a whitish discharge. It will take some time for this to settle and the extent of damage to the be evaluated. Management. Reassure the patient. The eye and lid may be grossly swollen and look alarming. This will resolve. Remove the sting and give antihistamines if there is a large amount of swelling. A cold compress may also help. If corneal sting has occurred, a whitish opacity...

The Eyes Optical Components Cornea

Human Power

The cornea is the anterior portion of the eye, and its curved surface together with the watery layer of tears is responsible for most of the refraction of the light rays. During aging, the cornea becomes thicker and less curved, mainly due to an increase in the horizontal diameter of the eye. These changes alter the refractive properties of the cornea, leading to against the rule astigmatism, a condition characterized by defective corneal A flattening (more horizontal than vertical) of both anterior and posterior corneal surfaces of the cornea was reported in a recent study (21). With aging, the asphericity of both corneal surfaces change significantly, causing a peripheral thinning of the cornea. As a result, the astigmatism (i.e., defective curvature of the cornea resulting in blurred and imperfect image) of the posterior corneal surface compensates for that of the anterior one. According to another recent study by Roszkowska et al. (22), both central and peripheral endothelial cell...

Neurodevelopmental Disabilities

Among the earliest concerns about the health of premature infants was the association between preterm delivery and neurodevelopmental disabilities. Neurodevelopmental disabilities are a group of chronic interrelated disorders of central nervous system function due to malformation of or injury to the developing brain. The spectrum of neurodevelopmental disabilities includes the major disabilities cerebral palsy (CP) and mental retardation. Sensory impairments include visual impairment and hearing impairment. The more subtle disorders of central nervous system function include language disorders, learning disabilities, attention deficit-hyperactivity disorder (ADHD), minor neuromotor dysfunction or developmental coordination disorders, behavioral problems, and social-emotional difficulties.

Costs of Preterm Birth

Lion in 2005, or 51,600 per infant born preterm. The share that medical care services contributed to the total cost was 16.9 billion ( 33,200 per preterm infant), or about two-thirds of the total cost, with more than 85 percent of that medical care delivered during infancy. Maternal delivery costs contributed another 1.9 billion ( 3,800 per preterm infant). Special education services associated with a higher prevalence of four disabling conditions (cerebral palsy, mental retardation, hearing loss, and visual impairment) among preterm infants added 1.1 billion ( 2,200 per preterm infant), whereas lost household and labor market productivity associated with such disabling conditions contributed 5.7 billion ( 11,200 per preterm infant).

Anterior Chamber and Vitreous Gel Humor

Geriatric Medical Humor

FIGURE 3 Changes in visual accommodation in humans with age. Note that the decline occurs throughout life, resulting in presbyopia in the early 50s. Source From Ref. 36. FIGURE 3 Changes in visual accommodation in humans with age. Note that the decline occurs throughout life, resulting in presbyopia in the early 50s. Source From Ref. 36. meshwork leads to markedly elevated IOP ( 22 mmHg) and the serious eye disease glaucoma (7,8,10) (see below).

Retinal detachment 175

A R Associated with myopia, aphakia, pseudophakia, i.e. cataract removal with lens implant, trauma (including previous ocular surgery), congenital malformations, metabolic disorders, vascular disease, vitreous disease or degeneration. E Examine closely the visual acuity, visual field, pupil reaction and fundus. Indirect ophthalmoscopy is required. to diagnose retinal detachment, but they may be necessary to detect intraocular foreign bodies and tumours. If the retina cannot be visualised because of corneal changes or cataracts, USG is necessary.

A uniform classification system should be adopted

It is recommended that the International Clinical Classification of Diabetic Retinopathy (See Annex 3.), which provides a sound scientific bass for a uniform grading system, be used as an acceptable minimum standard for assessing diabetic retinopathy in programmes for prevention of blindness. This system provides a simplified but sound scientific basis for uniform grading by general ophthalmologists who have a basic understanding of diabetic retinopathy and skills in evaluating the retina. It has been adopted by the International Council of Ophthalmology and by many member societies.

Nonophthalmic health professionals

PR I NC I PLES FOR ORGAN I Z I NG EYE HEALTH SYSTEM FOR THE CARE OF D I ABETI C RETI NOPATHY having to see yet another doctor (an ophthalmologist) presents an additional burden (59). Thus, being able to see just one doctor for comprehensive diabetes care enhances the continuity of care and thus the ability to receive higher quality care. General practitioners are usually best paced to situate the rsk for vision loss for each patent as part of the overall care strategy for diabetes, as the known rsk factors for retinopathy are among the conditions managed by the general practitioner or endocrinologist. Awh, Coupes & Javitt (66) conducted pre- and post-educational assessments of 10 university-affiliated physicians (five in family practice, three internists and two endodcrmologists), who examined 20 patients. I n the pre-test, 80 found that pupil dilatation for direct ophthalmoscopy was both unfamiliar and uncomfortable, and only one physician could name a medication used for dilatation....

U Surgery And Laser Therapy

Argon laser trabeculoplasty (ALT) has been increasingly used instead of surgery for treating open-angle glaucoma that is unresponsive to drugs. The treatment consists of tiny laser burns evenly spaced around the trabecular meshwork it can also be used as a preventive measure, while pharmacological treatment continues. The higher incidence of age-related macular degeneration (ARMD) in monozygotic, compared to dizygotic, twins suggests the importance of genetic factors (114). Alcohol consumption does not increase the risk of ARMD (115), but cigarette smoking poses a significant risk (116). Treatment of macular degeneration is not nearly as successful as that of cataract and glaucoma (108). Although a protective role for antioxidants and trace minerals against ARMD development is widely believed, the use of antioxidants for ARMD treatment remains controversial (117).

Ophthalmic System and Vision

Preterm infants are more likely than term infants to have significant abnormalities of all parts of the visual system, leading to reduced vision (Repka, 2002). The optic vesicles that will become the eyes form during the fifth and sixth weeks after conception (Back, 2005). The eyeball is well formed by the lower limit of viability (22 to 25 weeks of gestation). However, a pupillary membrane covers the anterior vascular capsule of the lens and gradually disappears between 27 and 34 weeks of gestation (Hittner et al., 1977). The retina is a vascular layer in the back of the eye that translates light into electrical messages to the brain. The retina is the one of the last organs to be vascularized in the fetus (Madan and Good, 2005). Blood vessel-forming cells originate near the optic disc (where the optic nerve enters the retina) from spindle cell precursors at 16 weeks of gestation and gradually spread across the surface of the retina, from the center to the periphery. Vessels cover...

Laboratory Diagnosis In Humans

Immunological reactions in aqueous and vitreous humour may be a more reliable indicator of toxocaral eye disease but such measurements are made only infrequently. Petithory et al. (1993) reported a comparison of sera and vitreous humour antibody studies in 10 subjects. In eight patients sera were negative for T. canis antibody, while vitreous humour antibody was found in nine subjects. Furthermore, for six (out of a total of nine) patients, antibody to T. cati was detected in the vitreous humour. Petithory et al. (1987) have suggested the following criteria for the diagnosis of ocular larva migrans (a) positive immunologic tests for nematode antigens in aqueous or vitreous humour (b) eosinophilia of aqueous or vitreous humour (c) ocular lesions. However, few ophthalmologists have aqueous or vitreous humour material available to them, and in most cases the diagnosis is based on the

Surgical Treatment of Retinal Detachment

Permanent drainage of subretinal fluid using trephining was advocated by de Wecker in 1872 and Argyll Robertson in 1876 21, 22 . The introduction of Elliot's operation for glaucoma popularized trephining between 1915 and 1920 9 . Groenholm in 1921 advocated the Holt pre-equatorial sclerectomy the removal of a large disc of sclera so that the suprachoroidal space is in communication with subtenon's space 23 . In 1924, Wiener made two trephine holes 1 mm apart and threaded a strand of horse-hair into one hole and out of the other 24 . There were numerous other surgical methods attempted for retinal detachment. Subconjunctival injections were first suggested by Grossman in 1883 and then popularized by Mellinger in 1896 who used hypertonic saline to extract the subretinal fluid by osmotic forces 25, 26 . Division of vitreous fibers to treat retinal detachment was attempted by Deutschmann in 1895 27 . Reduction of the globe capacity on the basis of von Graefe's theory that the cause of...

Rendell Mcdaniel Forbes And Einstein Experiment

The ongoing task in Rendell et al. (2007, Experiment 1) closely followed Maylor's (1993, 1996, 1998) famous faces task as participants were shown 120 pictures of famous faces one at a time and asked to name the faces. The nonfocal prospective memory condition was similar to the Maylor (1996) version as participants were asked to make a response whenever they saw a famous face wearing eyeglasses. In the focal prospective memory condition, participants were asked to make a response whenever they saw a face with the first name of John. The pacing of the ongoing task was identical for the 78 younger adults (M 19.6 years) and the 60 older adults (M 75.4 years). Twenty-six younger adults and 20 older adults were assigned to each of two prospective memory conditions (focal, nonfocal) and to a control condition in which participants performed only the ongoing task. These results are consistent with the multiprocess framework (McDaniel & Einstein, 2000). Although the cues of eyeglasses and...

Complications of Drainage

All of the reports on drainage and its complications are retrospective. It is hard to imagine a detailed report about the exact sub-macular distribution of blood in the operative note. Yet, as Cibis wryly remarked, As you all know, surgeons, as a rule, do not report their complications and mistakes unless they are related to a technique devised by another surgeon 25 . Nevertheless, reports of failures exist, relating failure to complications of drainage in a majority of cases 35 . Underreporting of less than a major hemorrhage is likely. Blagojevic, who noted intraocular hemorrhages in 16 wrote It is important to stress that the intraocular hemorrhages were never widespread, and that they did not unfavorably affect the results of the operation. Hemophthalmus and choroidal hematoma were not noticed 29 . There have been many modifications of the drainage technique 27-34 , attesting to the difficulty of producing a bloodless perforating injury in a highly perfused, inflamed and...

Diabetes Ocular Disease and Travel

Some forms of diabetic retinal disease and surgery could be relative contraindications to prolonged flights requiring pressurized cabins. Daniele and Daniele (1995) reported a 62-year-old woman who had bilateral panretinal laser treatment (argon photocoagulation) for diabetic re-tinopathy and cystoid macular degeneration. Prolonged flights, totaling 42 h, may have severely exacerbated retinal hypoxia and cystoid macular degeneration. The authors postulated an inability of the diabetic retina to respond to hypoxia nearly 1 year after laser treatments. These authors also warn that recent operations on cornea, retina or cataracts must be closely monitored. Cases of central retinal vein occlusion and other forms of chor-ioretinopathy have been linked to air travel.

Age Related Senile Macular Degeneration

An important cause of visual impairment in the elderly, often leading to legal blindness within five years after onset, is senile macular degeneration or age-related macular degeneration (ARMD or AMD) (7-10,107,108). The disease accounts for nearly half of the registered (legal) cases of blindness in the United States and England. The incidence of ARMD increases with increasing age, from about 4 in the 66 to 74 years age group, to 17 in the 75 to 84 years age group, and 22 in the 84 years age group. The macula lutea is an area of retina 6 mm in diameter that is located at the posterior end of the eye's visual axis (Fig. 2B). Through its high density of cones and involvement in day and color vision, the macula, and in particular its central zone, the fovea, provides the structural basis for high visual acuity. Hence, macular degeneration, more than any other eye disease, affects visual acuity and central vision. This disease occurs generally in both eyes and more often (50 ) in women....

The operators chair

There can be no doubt that any tooth is best visualised by direct vision (Fig. 1.2). However, the nature of operative dentistry demands that, whenever possible, the line of vision is perpendicular to the tooth surface. Clearly, those surfaces inaccessible by direct vision must be visualised indirectly through a mirror (Fig. 1.3). Nevertheless, it remains important, however difficult, to position the mirror and attempt a near perpendicular view. Magnification of the working area provides a major advantage in both the reduction of eye strain and the promotion of high standards.

Pilocarpine Prodrugs

Pilocarpine is a direct-acting cholinergic agonist that is used to control the elevated IOP associated with glaucoma. Pilocarpine shows a low ocular bioavail-ability (1-3 of instilled dose) due to poor absorption into the cornea coupled with a short duration of action. Because of these drawbacks, pilocarpine is generally instilled 3-4 times per day, which results in undesirable side effects and poor patient compliance. The ocular absorption of pilocarpine is mainly limited by its low lipophilicity (log Papp -0.15) (Bundgaard et al., 1986b). Thus lipophilic prodrugs have been studied to improve both the ocular absorption and delivery of pilocarpine.


Trichiasis is the term used for distorted eyelashes. They may arise from a normal position i.e. from lash roots that are just anterior to the tarsal plate (aberrant eyelashes) or from an abnormal position (dysplastic eyelashes). Blepharitis and chronic external eye disease are the commonest causes of aberrant eyelashes, but anything which leads to scarring of the lid margin can be responsible e.g. trauma. Dysplastic lashes are caused by chronic ongoing external eye disease conditions such as pemphigoid which may lead to eyelashes arising from the posterior lid margin.

New Experiments

This experiment was a variation of Rendell et al. (2007, Experiment 1), but rather than asking participants to write down the names of the faces, we asked them to write down the occupations of the faces. The focal target cue was a particular occupation (politician), whereas the nonfocal cue was the presence of eyeglasses on the face. As in Rendell et al., to examine possible trade-offs between the prospective and ongoing tasks, we compared participants' performance on the ongoing task in the prospective memory groups with performance on the ongoing task in control groups that performed only the ongoing task.


Cataract 11,13-15,17,18 such as sector or spoke cortical cataracts, peripheral capsular opacification, and vitreous hemorrhage, which preclude a clear view, may be less well suited to PR. The risk of new break formation is minimized using prophylactic treatment of at-risk lesions, such as lattice patches, cystic tufts, and meridional complexes,with laser prior to gas injection. Consideration should be given to prophylactic 360 laser at the vitreous base, which has been reported to lower the rate of new missed breaks and increase surgical success 14 . Delayed resorption of SRF is encountered in between 0 and 6 of cases 10,14,16 . In most instances, the original detachment was subacute or chronic, and the SRF was shifted away from the original break, trapping it in the subretinal space. Late anterior segment complications include cataract formation. Although lens injury during injection is rare, late cataract presumably due to gas-lens touch is much more common. Cataract is reported in...

C Hedgehog Proteins

Other signaling molecules that may be important in lens regeneration are the hedgehog proteins and their receptors, Patched 1 and 2. In the developing eye, Sonic hedgehog (Shh) is expressed in the ganglion cell layer of the retina. Indian hedgehog (Ihh) is expressed exclusively in PECS, and desert hedgehog (Dhh) is expressed in PECs and the neural retina. The patched receptors are also expressed in these tissues. Perturbing the Shh signal transduction pathway in various ways (mutations, inhibitors, overexpression) results in eye defects (Sasagawa et al., 2002 Perron et al., 2003 Tsonis et al., 2004). The patched receptors are found in the lens and in the dorsal and ventral iris of the intact eye in the adult newt. Neither Ihh nor Shh are found in the adult lens, nor is Shh found in the dorsal or ventral iris of the intact eye. However, Ihh is expressed in both dorsal and ventral iris. During lens regeneration, shh and ihh transcripts are found in both the dorsal and ventral iris and...


In view of the increasing prevalence of diabetes mellitus and diabetic retinopathy throughout most of the word, a consultation on prevention of blindness from diabetes mellitus was convened by the WHO unit of Prevention of Blindness and Deafness to review the current status of diabetic retinopathy care and to define approaches for screening, early detection and management in populations in different settings. (See agenda in Annex 1.) The consultation was held within the context of a contractual agreement between the programme for Prevention of Blindness and Deafness, WHO, and the National Eye Institute of the National Institutes of Health, Bethesda, Maryland, United States of America. The participants were drawn from all the WHO regions and represented experts in both general diabetes care and ophthalmology. (See Annex 2.) Durng the consultation, the participants sought to build on prior international collaboration and previous successful work of WHO, Member States, the International...

P53 Mutant Mice

(151), whereas the other expressed a naturally occurring isoform (152). p53 forms a tetramer, and both short p53 proteins appeared to integrate into tetrameric p53 and increase its activity. Not surprisingly, both mouse models were remarkably tumor free. Surprisingly, though, both were short lived and prematurely developed aging phenotypes including gray hair, thin skin, osteoporosis, cataracts, and diabetes. Cells from these mice were also more prone to apoptosis (151) and senescence


There are two major types of learning. Classical conditioning (also called Pavlovian conditioning, after Russian physiologist Ivan Pavlov) involves transfer of control of reflexes to new environmental stimuli. For example, a glaucoma test at an optometrist's office used to involve a puff of air being delivered into the patient's eyes, which elicited blinking. After this experience, putting one's head into the machine would elicit blinking the glaucoma-testing machine would elicit the reflex of blinking, before the air puff was delivered.

Patient evaluation

Patient selection and evaluation is of paramount importance in all branches of surgery cosmetic surgery is no exception. A detailed history is essential. The patients' concerns and their expectations of surgery need to be established at the outset. Relevant past ophthalmic history should be taken including previous surgery, dry eyes or contact lens intolerance and general health problems, such as bleeding disorders, hypertension or diabetes. Similarly a past history of psychiatric or psychological disorders may prove important. Drug history is important with particular reference to anti-coagulants and aspirin, in addition to topical medication, and social and family history. Relevant factors such as outstanding or past litigation should also be noted.


If, as is commonly the case, acquired data are to be presented to a human observer, there will be a choice as to the format in which such presentation will be most appropriate for the investigative task on hand. Some of the earliest scanners simply displayed on an oscilloscope the amplitude of the incoming echo signals, in either r.f. or rectified ('video') form and usually following time-gain compensation (see below) against a time base triggered by the transmit pulse. This so-called 'A-scan' is now rarely, if ever, used apart perhaps from some restricted measurement applications in ophthalmology, where the anatomy lateral to the beam is expected to be reasonably invariant and predictable.

Informed Consent

Hearing or vision problems must be expected bright light and large print, together with honest and simple language, much used for eliciting the informed consent. Research subjects, whether elderly or not, should be able to understand the informed consent process, feel free to refuse or to withdraw from the study without reprisal, and understand the uncertain outcomes of the new drug, the use of placebo and the random allocation of treatment.


Secondary glaucoma, cataract, or anterior ischemia did not occur, and because the procedure was extraocular, there were no iatrogenic breaks. Intraocular complications from cryopexy did not occur, because all applications were monitored by indirect ophthalmoscopy for a medium lesion (first appearance of white in the retina) 43 . There was a rare choroidal in highly myopic eyes.

Ophthalmic Delivery

Constant removal of foreign matter instilled in the eye by tear secretions generally reduces the effective half-life of drug and exposure of the cornea to the drug, resulting in the need for frequent administration. Analogous to the concept of using lipophilic ester prodrugs for parenteral sustained release, attempts have been made to provide prolonged release in the eye using prodrugs. Butyryl and palmitoyl ester prodrugs of tilisolol were synthesized and incorporated into hydrogel polymer inserts for the treatment of glaucoma (Kawakami et al., 2001). The in vitro release of the lipophilic ester was prolonged compared to that of the parent drug with the more lipophilic palmitoyl prodrug releasing only in the presence of serum albumin. The aqueous humor concentrations of tilisolol were prolonged with a lower Cmax from both prodrug inserts compared to the active drug insert Thus, in vivo controlled release of the prodrug from the polymer insert also resulted in higher selectivity with...

Vitreous Chamber

Sual acuity may stem either from refractive errors (which may be improved by glasses) or from non-refractive errors, e.g. corneal opacity, cataract, retinal detachment (which glasses will not correct). One can often distinguish refractive from non-refractive problems by determining the visual acuity at far


Fingernail or twig injuries usually cause corneal abrasions. Always take a history of the injury. Check and record visual acuity. Abrasions (Figure 22.21) can be diagnosed by the use of fluorescein stain and a pen torch. It is useful if the torch has a blue filter as this will show up any corneal epithelial deficit as a yellow area if fluorescein is instilled however, even without a filter, it is possible to still see epithelial deficits. Check for any pupil distortion or corneal foreign body with a pen torch it is possible to see them. If symptoms worsen or the eye becomes more painful after 3 4 days, referral to an ophthalmologist is essential. The corneal epithelium usually heals within 24 48 h. If the abrasion was caused by a dirty object, especially in the context of a rural or farming setting or in humid climates, there could be a risk of fungal infection (Figure 22.22). However, antifungals should not be used as a first-line treatment if fungal infection is suspected, refer to...


Preceding the explosion of interest in laser resurfacing in the USA, Kaufmann and coworkers (339-343) in Ulm, Germany, had been studying since 1988 (almost a full decade earlier) the erbium YAG laser, which held the potential for much more precise cutaneous ablation since its absorption by water was an order of magnitude greater than that of CO2. It had been first researched in the USA in the mid-1980s for ophthalmologic use (344,345). Walsh and coworkers (346,347) published the first American cutaneous studies showing the markedly diminished zone of residual thermal dermal damage after erbium YAG pulses. Kaufmann's initial studies were not followed by American cutaneous laser surgeons until 1997 when Teikemeier (also German) and Goldberg published the first preliminary study on 20 patients (348). Immediately, the laser pendulum began to swing away from the CO2 laser (which had been so heavily touted as safer and more efficacious


However, we have to keep in mind that the resources available for ophthalmology are diminishing as life expectancy increases and new treatments for various macular and retinal diseases become available. This expanding spectrum includes invasive and noninvasive, but expensive, treatment modalities. All this may force us to reconsider how to spend the limited resources for the increasing number of patients.