Ophthalmologic Knowledge Base

Quantum Vision System

The Quantum Vision System is an overall package to heal and thereby improve vision all together. The step by step guide and the instructional videos contain lots of information regarding the dos and don'ts to protect eyes from further damage. The program is not based on the treatment but also saves us from damaging vision with the use of lenses or glasses. The 3 in one package contains methods to nourish, cleanse, and effectively improve the vision with simple exercise. The eye chart provided is to be used to track the vision improving progress. According to the treatment program, Quantum Vision System can be used to treat various eye problems like Myopia or Near sightedness, Hyperopia or Farsightedness, Prebyopia, Dyslexia, Macular Degeneration, Lazy Eye or Amblyopia, Astigmatism, Cataract, Glaucoma, Tension Headache and Eye strain. The program can treat visual problems within 2 to 3 months.

Quantum Vision System Summary


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Immunopathogenesis of Thyroid Eye Disease

A causative role of stimulating TSH-R antibodies (TSI) in the development of GO is very attractive as it allows a unifying hypothesis for the various clinical manifestations of GD Graves' hyperthyroidism (GH), GO and thyroid dermopathy. Arguments against such a hypothesis cannot, however, be dismissed. TSI, in contrast to T cells, cross the placenta and may cause fetal and neonatal hyperthyroidism. GO, however, has never been observed in neonatal thyrotoxicosis TSI are almost always present in GH, but clinically apparent GO develops only in a subset of the patients. Lastly, serum TSI are only slightly related to the severity of GO, although more so to the activity of the eye disease 18 . Whereas TSI might contribute to further progression of GO, it remains doubtful if TSI act as the primary mediator in the immunopathogene-sis of GO.

Classification Of Glaucoma

Glaucoma is not a single disorder, but rather multiple disorders (Table 1). There are multiple classification schemes. Glaucoma can be classified into congenital glaucoma, primary glaucoma, and secondary glaucoma. Congenital glaucoma is caused by an abnormality in the aqueous humor outflow tract in the anterior chamber. There may be other associated developmental ocular abnormalities. Primary glaucoma is divided into two categories, primary open angle glaucoma, and primary closed angle glaucoma. Primary open angle glaucoma is the most common form of glaucoma 9 . It is caused by chronic obstruction of outflow of aqueous humor from the anterior chamber through the trabecular network. The angle between the iris and the cornea is open and there is free passage of aqueous humor from the posterior chamber to the anterior chamber. The reported causes of obstruction at the level of the trabecular network are multiple and include accumulation of debris in the trabecular network, loss of the...

Visual Acuity and Refractive Errors

Erg Complete Incomplete Csnb

Distribution of the corrected visual acuity of patients with both types of CSNB is shown in Fig. 2.56. The visual acuities ranged from 0.1 to 1.0 (mean 0.4-0.5). The visual acuities of the patients with complete CSNB do not differ significantly from those with incomplete CSNB 10 . Fig. 2.56. Distribution of visual acuity of complete and incomplete CSNB. (From Miyake 10 ) Fig. 2.56. Distribution of visual acuity of complete and incomplete CSNB. (From Miyake 10 )

Dietary n3 Deficiency in the Mouse 721 Mouse Visual Acuity and n3 Deficiency

As seen in rats, there is no evidence of a strong correlation between visual acuity and learning in the mouse. The second generation of mice (F1) fed a diet poor in LNA was compared to a group fed laboratory chow. In adult mice, there was a significant difference in the retinal concentration of DHA, but the difference in b-wave electroretinograms ceased to be significant at the seventh week (Carrie, et al., 1999). The ability to learn was examined using the passive-avoidance test and the LNA-deficient group continued to The data on behavior for the mouse is less consistent than the data on visual acuity, even if most studies point to beneficial effects of a diet enriched in DHA and its precursor LNA. Wainright (Wainright, et al., 1994) fed mice one of three diets through pregnancy, lactation, and weaning. They were the same basic diet but with (1) saturated fat, (2) adequate LA but deficient in LNA, and (3) sufficient LNA and LA (n-6 n-3 ratio of 3.7). Six weeks after weaning, two...

Treatment of Thyroid Eye Disease in Childhood

One important issue is the use of steroids in patients with TED who received radioiodine treatment (RAI) for hyperthyroidism. Two randomized, prospective, controlled clinical trials by Tallstedt et al. 33 and Bartalena et al. 39 clearly demonstrated in adults that radioiodine administration may be associated with a progression of ophthalmopathy in a small proportion of patients ( 15 ). GC can prevent, at relatively low doses and for short periods of time, exacerbation of eye disease and can effectively cure pre-existing ocular manifestations.

Diuretics and Glaucoma

Glaucoma is a series of eye diseases characterized by increased intraocular pressure, optic nerve degeneration, and visual field defects 3, 4, 8 . It is one of the leading causes of blindness in the United States. The incidence of the disease increases with advancing age and ranges from 1 to 5 of adults over the age of 40. The disease is insidious in its origin and most patients are asymptomatic until late in the course of the illness. By the time the diagnosis of glaucoma is made, permanent visual loss often has already occurred. The primary basis of glaucoma is an increase in intraocular pressure (greater than 20-24 Torr) leading to progressive deterioration of the optic nerve 3, 4,8 . The mechanism of the increased intraocular pressure is an obstruction to aqueous humor outflow from the posterior chamber, from the anterior chamber through the trabecular meshwork on the way to the canal of Schlemm into the venous drainage system, or via drainage through uveal vessels and the sclera....

Medical Therapy Of Glaucoma

Medical treatment for glaucoma involves multiple medications (Table 2) 3, 5, 10 . The principal goal of medical treatment is lowering of intraocular pressure. Local administration of cholinergic agents, beta-adrenergic blockers, and alpha- TABLE 1 Classification of Glaucoma 1. Congenital glaucoma 2. Primary glaucoma a. Open angle glaucoma b. Closed angle glaucoma 3. Secondary glaucoma TABLE 2 Medical Therapy of Glaucoma adrenergic agonists have been used to treat glaucoma. Cholinergic agents, with the prototype drug pilocarpine, lower intraocular pressure by stimulation of the ciliary muscle and by constriction of the pupil, with the resultant reduction of trabecular resistance to aqueous humor outflow. Beta-adrenergic antagonists, with the prototype drug timolol, lower intraocular pressure by blockade of the ciliary process production of aqueous humor. Alpha-adrenergic agonists, with the prototype drug epinephrine lower intraocular pressure by stimulation of receptors in the...


An infusion of IVY leaves was still in use in Fifeshire during the 20th century as an eye lotion (Rorie) -interesting, for Gerard recommended the same usage four hundred years ago - the leaves laid in steepe in water for a day and a nights space helpe sore and smarting waterish eies, if they be washed and bathed with the water wherein they have been infused . Even more interesting is the fact that in homeopathy, a tincture of the young leaves is used to treat cataracts to this day (Schauenberg & Paris). Lady Gregory recorded a belief from the west of Ireland that a cure can be made for bad eyes from the ivy that grows on a white-thorn bush . A note in Cockayne, acknowledging Pliny, mentioned the use of an amulet of chamacela, which could be either SPURGE LAUREL (Daphne aureola) or LADY LAUREL Daphne mezereum), to cure pearl (albryo), which is probably cataract, in the eyes, if the plant is gathered before sunrise, and the purpose outspoken . AGRIMONY tea is another eye lotion for the...

Diabetic Eye Disease

Diabetic eye disease includes three conditions diabetic retinopathy, cataracts, and glaucoma. Recently, it has been shown that injecting the anticancer drug bevacizumab (Avastin) into the eye can stop the growth of the new blood vessels due to diabetic eye disease. Bevacizumab works by blocking the action of VEGF. Cataracts A cataract is a clouding of the lens of the eye so that the person cannot see clearly. The symptoms of cataracts are Cataracts occur as part of the natural aging process, but they occur earlier and more often in people with diabetes. It is thought that the high glucose level causes changes in the proteins inside the cells of the lens, altering the optical properties of the lens. The treatment for cataracts is surgery the cloudy lens is removed and replaced with an artificial lens. Glaucoma The inside of the eye is filled with fluid. New fluid is constantly being made, and the fluid that is being replaced leaves the eye by entering a drainage meshwork toward the...


Glaucoma is a progressive optic neuropathy characterized by structural damage to the optic nerve leading to blindness through loss of retinal ganglion cells. Risk factors in glaucoma include elevated intraocular pressure (IOP), age, race, family history, myopia, and diabetes. The growing body of evidence indicates there is a heightened risk of developing glaucoma among individuals with Alzheimer's disease 165-168 . The pathogenesis of the optic nerve neuropathy in glaucoma is a matter of debate. It is widely accepted that elevated IOP and a variety of factors may all contribute to primary insult of the optic nerve 169-171 . Cellular mechanisms involving vascular insufficiency 172, 173 , vasospasm 174, 175 , glutamate exitotoxicity 176 , neurotoxic cytokine release 177, 178 , abnormal metabolism, and autoimmune reaction have all been suggested 170 . There are numerous major factors contributing to the cumulative optic nerve insult and malnutrition in glaucoma (Fig. 4.4). Ultimately,...

Ocular Manifestations

The most common finding in AGS patients is posterior embryotoxon, which is the more minor form of eye anterior chamber abnormality. Posterior embryotoxon has no consequence on visual acuity and is present in 10-15 of normal individuals. All the spectrum of eye anterior chamber abnormalities may be observed including glaucoma. Retinal changes such as pigmentary retinitis were formerly ascribed to vitamin deficiency, but progressive blindness may occur even with normal vitamin level. 6

Vitamins and Minerals as Antioxidants

Every cell in our body needs oxygen to use the nutrients that food provides. However, when oxygen is used by cells, by-products called free radicals are formed. If allowed to accumulate, these free radicals can damage tissues, cells, and deoxyribonucleic acid (DNA, the genetic material of cells). The process of oxidative damage can be observed as the browning that occurs when sliced apples or potatoes are exposed to the air or the rancid flavor that butter and cooking oils develop when stored for long periods. Environmental pollutants such as cigarette smoke and ultraviolet light from the sun also contribute to the formation of free radicals in our bodies. Although not proved, studies suggest that excess free-radical production can increase the risk of cancer, heart disease, cataracts, and the other types of cell deterioration that are associated with aging.

Discharge And Home Healthcare Guidelines

Cataract DRG Categ ry 039 Cataracts are the leading cause of preventable blindness among adults in the United States. The incidence of cataracts in the United States is 1.2 to 6.0 cases per 10,000 people. A cataract is defined as opacity of the normally transparent lens that distorts the image projected on the retina. The lens opacity reduces visual acuity. As the eye ages, the lens loses water and increases in size and density, causing compression of lens fibers. A cataract then forms as oxygen uptake is reduced, water content decreases, calcium content increases, and soluble protein becomes insoluble. Over time, compression of lens fibers causes a painless, progressive loss of transparency that is often bilateral. The rate of cataract formation in each eye is seldom identical. Without surgery, a cataract can lead to blindness.

Primary Nursing Diagnosis

Activity therapy Communication enhancement Visual deficit Environmental management Fall prevention Reality orientation Surveillance Safety Eye care Medication management Glaucoma is often treated medically. Surgery is required when medications are ineffective in reducing IOP. Argon laser trabeculoplasty is preferred because it has an 80 success rate in reducing IOP. Surgical filtering treatment produces a permanent fistula from the anterior chamber and the subconjunctival space. Filtering procedures include trabeculectomy, cyclodialysis, peripheral iridectomy, sclerectomy, and ocular implantation devices such as the Molento implant.

Medicinal Loganiaceae

Strychnine was elucidated in 1947 owing to the major contribution of H. Leuchs and Sir Robert Robinson. Since then, strychnine has been characterized fro several Strychnos species Strychnos ignatii Berg., Strychnos wallichiana Steud. Ex DC, and Strych-nos lucida R. Br. The strong convulsive strychnine is accompanied by series of related alkaloids, such as brucine, colubrine, vomacine, and novacine. Strychnine and related alkaloids could be present in other species, but the complete chemical composition of many Strychnos species is as yet unknown (66). In the Pacific Rim, about 20 species of Loganiaceae, including Strychnos ignatii Berg., Strychnos gauthierana Pierre ex Dop, Strychnos lucida R. Br., Strychnos minor Dennst., and Strychnos axillaris Colebr., are medicinal and often used to invigorate, counteract putrefaction, treat eye diseases, and expel worms from intestines.

Vascular Endothelial Growth Factor VEGF

VEGF is a potent vascular permeability factor, and VEGF upregulation has been linked to neovascular eye diseases including diabetic retinopathy23. VEGF-induced neovascular changes have previously been demonstrated on animal models based on increasing VEGF levels through implants26, recombinant adenovirus-mediated VEGF expression27, 28, or transgenic technologies29, 30.

Icosahedral Reconstruction

Initially, each micrograph captured from a CCD camera or digitized from photographic film is evaluated for its image quality based on the power spectrum derived from the average of multiple Fourier transforms of computationally isolated particle images. This power spectrum contains information about the structure of the particles, the imaging conditions used, and the image quality. The ring pattern in the power spectrum (Figure 3(a)) reflects the imaging condition known as the contrast transfer function (CTF). It can vary in appearance according to factors such as defocus, astigmatism, specimen drift, and signal decay as a function of resolution, all of which are attributable to various instrumental factors. The signal-to-noise ratio (SNR) in each micrograph can be computed from the circularly averaged power spectrum. The SNR plot (Figure 3(b)) indicates the potential signal strength

Clinical Manifestations

The first group includes three disorders that in the past had been considered to be separate clinical entities the Zellweger syndrome (ZS) (Bowen, et al., 1964 Wilson, et al., 1986 Zellweger, 1987) neonatal adrenoleukodystrophy (NALD) (Ulrich, et al., 1978 Kelley, et al., 1986) and infantile Refsum disease (IRD) (Scotto, et al., 1982). ZS, NALD, and IRD are now considered to represent a clinical continuum, with ZS the most severe, NALD intermediate, and IRD the mildest compared to the other forms, even though in absolute terms it still causes marked disability. Classical ZS is a very severe disorder, often leading to death during the first year and psychomotor development is severely compromised and sometimes absent. It is associated with a striking and characteristic defect in neuronal migration (Evrard, et al., 1978). NALD and IRD share many of the features of the features of ZS, but are somewhat milder. Patients live longer a few have survived to the fourth...

Clinical manifestation

Skin findings striae hyper extensible skin elastosis perforans serpiginosa high, arched palate poor wound healing Skeletal findings joint hypermobility pec-tus excavatum scoliosis long arms and legs Ocular findings ectopic lens early cataracts Cardiopulmonary findings aortic root dilatation and dissection aortic valve prolapse spontaneous pneumothorax Neurologic findings dura ectasia

Anti Vascular Endothelial Growth Factor VEGF agents

American Collaborative Retina study group (Arevalo 2007). This retrospective interventional multicenter study evaluated the retinal thickness and ETDRS acuity data of 80 consecutive patients receiving intravitreal Avastin injections for center-involving diabetic macular edema in eyes not previously treated with focal laser. Eyes received at least one Avastin injection (either 1.25mg or 2.50mg) with smaller percentages of patients requiring a second or third injection over a six-month period (on average every 11 to 13 weeks). The group reported a favorable decline in OCT retinal thickness and visual acuities that were stable if not improved from baseline (Arevalo 2007). The 24-month extension of this study supported the six-month findings. Patients who received on average 5.8 injections of single or double dose Avastin demonstrated a partial resolution of macular edema and maintained, if not improved, upon baseline visual acuity (Arevalo 2009). To date, there has been no formal...

OCT findings in DME 31 Retinal thickness

The particular value of OCT is the possibility for objective, reliable and repeatable retinal thickness measurements. Since the introduction of OCT several authors have studied the possibility of OCT for early diagnosis of macular edema, and have suggested criteria to detect the so called subclinical diabetic macular edema (Hee et al., 1995, 1998 Massin et al., 2002). There are studies reporting significant differences in retinal thickness between controls and eyes with diabetic retinopathy (without clinically detectable DME) in the fovea (Sanchez-Tochino et al., 2002 Schaudig et al., 2000), superior and nasal quadrants (Schaudig et al., 2000). Difference was also found between healthy eyes and diabetics without diabetic retinopathy in the fovea (Sanchez-Tochino et al., 2002), the paramacular ring (Schaudig et al., 2000) and the superior zone (Sugimoto et al., 2005). When comparing eyes of diabetics with and without retinopathy (and no clinical evidence of...

Mild Macular Grid MMG laser photocoagulation

The DRCR Network trial was designed to compare 2 laser techniques for previously untreated DME. One technique was the most commonly used approach in current clinical practice, the modified ETDRS technique, and the other approach was the MMG technique. At 12 months after treatment, the MMG technique was less effective at reducing OCT-measured retinal thickening than the current modified ETDRS laser photocoagulation approach. The visual acuity outcomes with both approaches were not substantially different. (Fong, et al., 2007).

Central Retinal Artery Occlusion

The ERGs elicited by a single bright flash (mixed rod and cone ERG), the visual fields, and visual acuities of five patients with CRAO are shown in Fig. 3.14. Despite the extremely constricted visual fields and poor visual acuity, the ERGs in the affected eyes are well preserved. Although the b a ratio in the affected eyes is lower than that of fellow eye, none of the ERGs from the affected eyes has a negative configuration. These results suggest that the function of the retinal layer related to the ERG can recover to some degree following recovery of the retinal Fig. 3.14. Mixed rod-cone (bright flash) ERGs, visual fields, and visual acuity (right) obtained from the affected eye and normal fellow eye of five patients with central retinal artery occlusion (CRAO). Despite the severe decrease of the subjective visual functions, the ERGs are relatively well preserved Fig. 3.14. Mixed rod-cone (bright flash) ERGs, visual fields, and visual acuity (right) obtained from the affected eye and...

Results of clinical studies

Formation and improved visual acuity (Salama Benarroch et al., 1977). A double-blind crossover clinical trial performed on 18 diabetics, the results of which were published in the same year, investigated the effect of calcium dobesilate on capillary resistance and background retinopathy in comparison with placebo. Each treatment lasted 8 months. The study gave no evidence of a significant beneficial effect of calcium dobesilate on the capillary resistance in diabetics or on the course of the diabetic retinopathy (Larsen et al., 1977). The additional two independent, double-blind, controlled studies were performed to evaluate the efficacy of calcium dobesilate for the treatment of nonproliferative diabetic retinopathy. In the first suty, forty-two patients underwent a six-month crossover evaluation while receiving calcium dobesilate (750 mg per day) and placebo in random order. In the second ome, thirty-six patients received calcium dobesilate (1,000 mg per day) or placebo for one...

Plexiform Neurofibroma

Vagina Diseases

INTRODUCTION Plexiform neurofibromas are the most common benign peripheral nerve tumor occurring in the eyelid and are considered pathognomonic for type 1 neurofibromatosis (NF-1). The lesion arises from and grows along any peripheral nerve. Plexiform neurofibromas typically present in children during the first decade of life. Mechanical ptosis can be profound, and in younger children may cause deprivation amblyopia. Associated systemic and ocular findings in patients with neurofibromas are related to underlying neurofibromatosis. Systemic findings may include hamartomas of the CNS, and cranial and peripheral nerves. Patients are at increased risk of developing pheochromocytoma, breast carcinoma, medulllary thyroid carcinoma, and gastrointestinal tumors. Ocular findings may include iris nodules (Lisch nodules), glaucoma, retinal astrocytic hamartoma, optic nerve glioma or meningioma, pulsating exophthalmos due to defects of the sphenoid wing, and orbital schwannoma. Rarely an eyelid...

Retinal and Choroidal Detachment

Choroidal detachment is separation of the choroid from the sclera, which results from accumulation of clear fluid or blood within and under the choroid (Fig. 3.15). The ERG may be normal or only slightly abnormal when only a choroidal detachment is present. It may be associated with rhegmatogenous retinal detachment, either preoperatively or postoper-atively, and is sometimes seen in the uveal effusion syndrome. Choroidal detachments may also follow trauma or glaucoma surgery, often associated with hypotonic maculopathy.

Inverted Follicular Keratosis

Follicular Keratosis

Lever WF. Inverted follicular keratosis is an irritated seborrheic keratosis. Am J Dermatopathol 1983 5 474. Mehregan AH. Inverted follicular keratosis is a distinct follicular tumor. Am J Dermatopathol 1983 5 467-470. Sassani JW, Yanoff M. Inverted follicular keratosis. Am J Ophthalmol 1979 87 810-813. Schweitzer JG, Yanoff M. Inverted follicular keratosis. Ophthalmology 1987 94 1465-1468.

Peripheral Schisis Without Foveoschisis

Retina Schisis

As mentioned above, foveoschisis or nonspecific macular degeneration is always present in patients with XLRS. We have studied one patient who had a peripheral schisis with normal maculas. This 15-year-old boy had visual acuity of 1.0 in both eyes also visual field defects in both eyes. His maternal brother was reported to have poor visual acuity but was not available for examination. A peripheral schisis with inner retinal breaks in the inferior retina was present in both fundi, but ophthalmoscopy

Mewds Azoor Acute Idiopathic Blind Spot Enlargement Syndrome

Multiple evanescent white dot syndrome (MEWDS) 4 , acute zonal outer retinopathy (AZOOR) 5 , and acute idiopathic blind spot enlargement syndrome 6 have several similar ophthalmological and demographic findings unilateral, blurred vision, multiple paracentral scotomas usually including a temporal scotoma, photopsia, and blind spot enlargement and it affects young women. These symptoms usually develop soon after a flu-like illness. Among these disorders, only MEWDS has ophthalmoscopic abnormalities, which include clusters of tiny white or light-orange dots in the foveola and multiple small, often poorly defined gray-white patches at the level of the RPE and outer retina (Fig. 3.20). The visual function and fundus abnormalities may The clinical course of acute idiopathic blind spot enlargement is exemplified by the case of a 35-year-old woman. This patient, in previous good health, noted a small purple flickering spot in the upper right field of her right eye. Her visual acuity was 1.0...

Focal Macular ERGs

Pictures Retinal Disorders

The distribution of the best-corrected visual acuity for each type of CME is shown in Fig. 4.6. The difference in visual acuity between types 1 and 3 is statistically significant. Fluorescein angiograms and focal macular ERGs in eyes with CME and after the resolution of CME are illustrated for three representative cases in Figs. 4.7 to 4.9. Case 1 (Fig. 4.7) was a 51-year-old man who had had cataract surgery on his right eye with implantation of a posterior chamber lens. His preoperative visual acuity of 0.1 improved to 0.9 postoperatively but then gradually decreased to 0.6 five months later. Fluorescein angiography disclosed CME in the right eye. The OPs of the focal macular ERGs were selectively reduced (type 1) compared with that of the normal fellow eye. Six months later the CME resolved spontaneously, and fluorescein angiography disclosed a Fig. 4.6. Distribution of best-corrected visual acuity in patients with types 1, 2, and 3 aphakic or pseudophakic CME.The difference between...

Evaluation of Eyelid Malpositions

Basal Cell Carcinoma Eyelid

A history of previous eye surgery is important. Eyelid malpositions are not uncommon sequelae of retinal detachment surgery, strabismus surgery or cataract extraction. Ptosis is reported to occur following cataract surgery in 7-8 of cases. Other surgery, especially intracranial or thoracic procedures, may result in central third nerve palsy or Horner's syndrome respectively. For all patients with eyelid malpositions a complete ophthalmic examination is mandatory. Visual acuity with a current refraction is recorded, and especially in children presenting with upper eyelid ptosis, the presence of amblyopia must be ruled-out. In any patient unexplained decrease in vision requires comprehensive investigation. Pupil size and reactivity should be measured, and any asymmetry noted. Corneal examination must evaluate the presence of keratopathy secondary to corneal exposure as a result of the malpositioned eyelid. Appropriate documentation of all eyelid malpositions with photographs and formal...

Hereditary Retinal and Allied Diseases

Chorioretinal Atrophy

The visual acuity of this patient was 1.2, and the visual fields were normal only in the central 15 in both eyes. The rod and cone components of the full-field ERGs were unrecordable, but the focal macular ERGs elicited by 5 , 10 , and 15 stimuli were within normal limits. The amplitudes of the multifocal ERGs were within normal limits in the macular area, but the topographic map of the multifocal ERGs showed an extremely reduced periphery, indicating marked reduction of the peripheral responses 5 . Among the RP patients with normal visual acuity, some have better preservation of the macular oscillatory potentials (OPs) than the a-waves and b-waves of the focal macular ERGs. Such examples are shown in Fig. 2.6. The reason macular OPs are selectively preserved is still unknown, although Banin et al. 6 reported an increase in the amplitude OPs of the full-field ERGs in transgenic pigs with a rhodopsin mutation. Some enhancement of inner retinal function may occur at certain stages of...

Idiopathic Epimacular Membranes

Epimacular membranes (Fig. 4.13) can be caused by trauma, inflammation, retinal vascular disease, and retinal detachment surgery. We have studied the focal macular ERGs of patients with unilateral idiopathic epimacular membrane (IEM) to determine how the altered retinal function correlates with visual acuity and OCT images 1, 2 . We found that the changes in the focal macular ERG while the macula was altered and after recovery of the macula closely resemble those seen in the presence of aphakic (pseudophakic) CME (see Section 4.2). Fig. 4.14.A 56-year-old woman noted decreased vision in her right eye with visual acuity of 1.0 the visual acuity in her left eye was 2.0. She had an IEM in the right eye, and the a-waves and b-waves of her focal macular ERGs for the right eye were not significantly different from those in the normal fellow eye at the initial visit. However, OPs of the right eye were smaller (Fig. 4.14A). Six months later, the best-corrected visual acuity in her right eye...

Cicatricial Pemphigoid

Mondino BJ, Brown SI, Lempert S, Jenkins MS. The acute manifestations of ocular cicatricial pemphigoid Diagnosis and treatment. Ophthalmology 1979 85 543-555. Mondino BJ, Brown SI. Ocular cicatricial pemphigoid. Ophthalmology 1981 88 95-100. Shore JW, Foster CS, Westfall CT, Rubin PA. Results of buccal mucosal grafting for patients with medically controlled ocular cicatricial pemphigoid. Ophthalmology 1992 383-385.

Effects Of La And Gla Treatment On Diabetic Nerve

A number of investigators have examined the effect of supplementing the diet of the diabetic animals with essential fatty acids, a treatment that might ameliorate the loss of AA. One approach has been to feed large amounts of LA and this has yielded variable results. In several studies, feeding a diet rich in corn oil or sunflower oil, which have a high content of LA but no GLA, failed to improve reduced nerve conduction velocity and nerve blood flow. In contrast, in one investigation corn oil administration was effective in preventing decreased nerve conduction velocity (Kuruvilla et al. 1998). In this study, the administration of LA elevated the proportion of ACMS in the nerve from normal animals, but it did not correct the fall in ACMS in diabetic nerve. Inclusion of LA in the diet was found to largely prevent diabetic cataract formation in rats, despite the persistence of high sorbitol levels in the lens (Hutton et al. 1976). Beneficial effects on diabetic...

Concerns About Accuracy of Analysis

Drug-test target, often resulting in a mottled, nonuniform array of visual test lines. Several manufacturers indicate on the package insert that any presence of color change, no matter how faint it may appear, should be interpreted as a negative result. There is considerable subjectivity to the test-result interpretation, leading to potential false-negative and false-positive errors. Timing of the test is critical, and the interpreter must read the test result during the time indicated on the package insert, usually between 3 and 8 min. Improperly timed readings could potentially result in false-negative or false-positive results. Visual acuity, color vision, and lighting conditions may also play a role in the interpreter's accuracy in reading visually interpreted endpoints. Subjective interpretation, or translation of the analytical result from the test strip to the test result report, is of major concern in point-of-collection testing.

Central or Peripheral Cone Dystrophy

Progressive Cone Dystrophy

For mild temporal pallor of the optic disk in some of the patients (Fig. 2.100). The corrected visual acuity in the three patients ranged from 1.2 to 0.2, and the color vision was abnormal in two of the three. The full-field cone ERGs were significantly reduced, but the rod responses were normal, as in patients with typical cone dystrophy (Fig. 2.101). However, the focal macular cone ERG were well preserved (Fig. 2.102), and the results of multifocal ERGs support the findings made by full-field and focal macular ERGs (Fig. 2.103). One of the patients (case 3) was examined 4 years after the initial examination using focal macular ERG because he had reported progressively increased blurring of his paracentral vision in the left eye. The responses clearly had become smaller during the 4 years (Fig. 2.101), suggesting that his retinopathy was progressive, even though his visual acuity was unchanged. Psychophysical rod-cone perime-try demonstrated that only the peripheral cone system was...

Nettleship Falls XLinked Ocular Albinism

Ocular Albinism Oct

Nettleship-Falls ocular albinism is an X-linked recessively inherited retinal disease characterized by reduced visual acuity, translucent irides, congenital nystagmus, photophobia, hypopig-mentation of the fundi, and foveal dysplasia (Fig. 2.49) 1, 2 . Full-field ERGs and EOGs are normal (Fig. 2.50), and focal macular ERGs are moderately reduced because of the foveal dysplasia (Fig. 2.51). In a variant of X-linked ocular albinism in Black and Japanese men, the transillumination defect of the iris and the characteristic fundus hypopigmentation may not be present as shown in Fig. 2.49. Visual acuity may be better than that in typical X-linked ocular albinism. In such cases, the diagnosis may require skin biopsy. However, it should be noted that asymptomatic female carriers of these mutations always show streaky and mottled RPE ophthal-moscopically, which is of diagnostic value (Fig. 2.53) 2 . The full-field ERGs and the focal macular ERG and OCT are normal in the female carriers. Fig....

Age Related Macular Degeneration

Submacular Hemorrhage Oct

Fundus photograph (A), OCT image (B), fluorescein angiogram (C, D each left), and indocyanine green angiogram (C, D each right) of early-phase (C) and late-phase (D) in age-related macular degeneration (AMD) obtained from a 62-year-old man. Present are submacular hemorrhages, a choroidal neovascular membrane, and sensory detachment of the macula.The visual acuity was 0.2 Fig. 4.29. Fundus photograph (A), OCT image (B), fluorescein angiogram (C, D each left), and indocyanine green angiogram (C, D each right) of early-phase (C) and late-phase (D) in age-related macular degeneration (AMD) obtained from a 62-year-old man. Present are submacular hemorrhages, a choroidal neovascular membrane, and sensory detachment of the macula.The visual acuity was 0.2

Juvenile Xanthogranuloma

Xanthoma Molluscum

INTRODUCTION Juvenile xanthogranuloma (JXG) is a rare systemic childhood disease of non-Langerhans cell histiocytes. It is characterized by cutaneous and, on occasion, intraocular lesions. It may be a gran-ulomatous reaction of histiocytes to an unidentified stimulus. There is special predilection for skin and eye involvement. It affects children below the age of five years with 85 of the cases being under one year of age. Most patients are younger than two years of age at presentation. There is no sexual or racial predilection. Other sites of ocular involvement include the orbit, conjunctiva, cornea, episclera, iris, and ciliary body. Iris lesions are associated with spontaneous hyphema, unilateral glaucoma, uveitis, and heterochromia iridis. Although lesions are common on the face CLINICAL PRESENTATION The eyelid is the most frequent site of ocular involvement. Lesions on the lid often appear quite suddenly. They typically present as a rapidly growing solitary papular or nodular...

Driving and Hypoglycemia

Some of the medicines used to treat diabetes (insulin, sulfonylureas, repaglinide, and nateglinide) can cause hypoglycemia, which can affect reflexes and judgment. In addition, long-term diabetes complications, especially vision problems and neuropathy, may interfere with driving ability. Be extra vigilant if you have complications, especially vision problems and diabetic neuropathy.

Full Field Electroretinograms

The development and advancement of clinical electroretinography (ERG) were the consequence of a better understanding of the cellular origins of the major components of the ERG initially demonstrated by Granit in 1934 1 the progressive improvement of the recording devices, as shown by introduction of the contact lens electrode by several investigators such as Riggs 2 , Karpe 3 , and Burian and Allen 4 and the development of computers for improving the signal-to-noise ratio by averaging techniques. Many Japanese investigators have contributed significantly to full-field clinical ERG. Among the representative studies are the method for distinguishing cone from rod responses pioneered by Motokawa and Mita 5 , the study of human oscillatory potentials (OPs) by Yonemura et al. 6 , and the study of photopic ERG by Nagata 7 . In 1968 when I became an ophthalmologist, I thought that the major works on clinical ERG had already been done. However, looking back on the past 37 years, it is now...

Care and Maintenance of Optical Filters

Colored glass filters are relatively robust but should be kept free of fingerprints while in use or storage. Clean with lens tissue as you would eyeglasses and handle around edges. Final cleaning with alcohol on a Q-tip cotton swab followed by wiping with lens tissue will remove most fluorescent materials that might be present. Colored glass filters should be very stable unless used directly in high-intensity light. These filters should be inspected visually for unevenness in color about every 6 months.

Ocular Disease Caused by DNA Viruses

Adenovirus is probably the most common DNA virus to cause eye disease. Three common ocular syndromes have been identified. Simple follicular conjunctivitis occurs with infection by many adenovirus types and may be subclinical. Pharyngoconjunc-tival fever typically follows infection with adenovirus types 3, 4, and 7. As the name implies, patients have pharyngitis, conjunctivitis and fever, and may be misdiagnosed as having influenza. Epidemic keratoconjunctivitis, most often caused by adenovirus types 8, 19 and 37, is a highly contagious syndrome with significant morbidity. The conjunctivitis can be severe (Fig. 3) associated inflammatory conjunctival membranes can permanently scar the eyelids to the globe. Corneal involvement begins as a punctate epithelial keratitis and may proceed to a large central epithelial ulcer. Stromal keratitis presents about 2 weeks after the conjunctivitis as multifocal subepithelial corneal infiltrates, and causes both foreign body sensation and reduced...

Doxium For Varicose Veins

Calcium dobesilate in diabetic retinopathy. A retrospective controlled study. Ophthalmologica, Vol. 190, No. 2, (February 1985), pp. (102-111), ISSN 0030-3755 Aiello, L.M (2003). Perspectives on diabetic retinopathy. American journal of ophthalmology, Barber, A. J., Antonetti, D.A. & Gardner, T. W. (2000). Altered expression of retinal occludin and glial fibrillary acidic protein in experimental diabetes. Investigative Ophthalmology and Visual Science, Vol. 41, No. 11, (October 2000), pp. (3561-3568), ISSN 1552-5783 Ribeiro, M. L., Seres, A. I., Carneiro, A. M., Stur, M., Zourdani, A., Caillon, P. & Cunha-Vaz, J. G. (2006). Effect of calcium dobesilate on progression of early diabetic retinopathy a randomised double-blind study. Graefe's archive for clinical and experimental ophthalmology, Vol. 244, No. 12, (December 2006), pp. (1591-1600), ISSN 0721-832X Assessment of calcium dobesilate in diabetic retinopathy. A double-blind clinical investigation....

Herpes and Varicella Zoster

Impetigo Eyelid

CLINICAL PRESENTATION Following an incubation period of approximately two weeks and a prodrome of fever and malaise, the cutaneous lesions begin as a mild maculo-papular eruption. The papules evolve into clear vesicles that show an umbilicated center. Characteristic vesicles overlie a larger patch of erythema and develop in several successive crops. The vesicles become cloudy, rupture, and form crusts. Healing occurs over the ensuing few weeks with little or no scarring unless they become infected. In contrast to varicella, the lesions in herpes zoster are limited to a single dermatome however, hematologic dissemination of the virus can result in a few distant skin lesions as well. Pain in the region supplied by the involved nerve is not common but can precede the skin changes by several days. Preauricular adenopathy is often seen. The nasociliary branch of the ophthalmic nerve supplies sensation to the eye, with terminal branches going to the tip of the nose. Lesions on the tip of...

Occult Macular Dystrophy

Occult macular dystrophy is an unusual, inherited macular dystrophy characterized by progressively decreased visual acuity due to macular dysfunction, but the fundus and fluorescein angiograms are essentially normal. In 1989 we reported three patients in one family with hereditary macular dystrophy without a visible fundus abnormality 1 . Since then we have diagnosed 43 patients (26 men and 17 women) with this disease from 14 families and termed the disorder occult macular dystrophy ( occult meaning hidden from sight ). suggest autosomal dominant heredity. The fundus photographs and fluorescein angio-grams from three affected members of Family C 1 are shown in Fig. 2.130 the fundus and angiograms were normal. Full-field ERGs were normal in all these patients, but the focal macular ERGs were absent, indicating that the pathological basis for the depressed visual acuity lies in the macula. Recently, this localized dysfunction in the macula was confirmed by multifocal ERGs, which showed...

Arteriovenous Hemangioma Malformation

TREATMENT Treatment is not indicated during infancy or childhood unless visual symptoms or amblyopia threatens. When treatment is required surgical resection with prior occlusion of feeder vessels is best, but is usually very difficult and can be mutilating. Identification and ligation of feeder vessels will give only temporary relief since rapid recruitment of flow from nearby arteries will reestablish blood supply in most cases. Embolization can be considered, but it carries a risk of undesirable intracranial or retinal vessel obstruction when employed in periorbital lesions. Sclerotherapy can be useful if the feeder vessels are first ligated. While laser therapy is useful for slow flow venous malformations they are less useful for the AVM.

Tumor Necrosis Factor alpha TNFa

In young patients with newly diagnosed diabetes increased activity of TNF-a has been demonstrated (Mysliwiec et al, 2006). High levels of TNF-a have been detected also in type 1 diabetic children and adolescents with non-proliferative retinopathy (Mysliwiec et al, 2006, Zorena et al. 2007). TNF-a may become a relevant indicator of development and risk of diabetic retinopathy. Similar observations were made in adult patients with PDR (Gustavsson et al., 2008 Koleva-Georgieva et al., 2011). Levels of TNF-a in vitreous of Type 2 diabetic patients with PDR were higher than those found in control group. Furthermore a correlation between TNF-a and HbA1c is observed, suggesting that there is a close relation between glycaemic control and inflammatory factors in T2DM patients (Adamiec-Mroczek et al., 2008 Lee JH, 2008). TNFRI and TNFRII receptors' levels in vitreous of patients with PDR and proliferative vitreoretinopathy were much higher than in patients with perforation in...

Are Complete and Incomplete Cases of CSNB Really Nonprogressive

Complete Incomplete Csnb

Long-term follow-up of the corrected visual acuity in patients with complete and incomplete CSNB 24 is shown in Fig. 2.76. For both types of CSNB, most patients do not show significant changes or even slight improvement in their visual acuity during the long follow-up period. This strongly indicates that both types of CSNB are nonprogressive, at least when assessed by visual acuity. Fig. 2.76. Changes in visual acuity in patients with complete and incomplete CSNB during long-term follow-up periods. (From Miyake et al. 24 ) Fig. 2.76. Changes in visual acuity in patients with complete and incomplete CSNB during long-term follow-up periods. (From Miyake et al. 24 )

Aphakic or Pseudophakic Cystoid Macular Edema

Cystoid Macular Edema Oct

Cystoid macular edema (CME), a common complication of cataract surgery, manifests as leakage of plasma from the perifoveal capillaries, formation of macular cystoid spaces, and marked visual impairment 1, 2 . The disease may or may not resolve spontaneously, and vit-rectomy leads to successful resolution of the edema in some patients with CME. Fluorescein angiograms and OCT images of a patient with typical CME before and after vitrectomy are shown in Fig. 4.4. The fluorescein angiogram (Fig. 4.4A) shows extensive fluorescein leakage from the macular capillaries, and OCT reveals multiple cystic spaces in the macula before surgery. After vitrectomy, fluorescein leakage

Phakomatous Choristoma

CLINICAL PRESENTATION Phakomatous choristoma appears in newborns or in young children usually within the first few months of life and not associated with other developmental abnormalities. It presents as a circumscribed firm to rubbery subcutaneous mass in the medial lower eyelid near the inner canthus and can occasionally occur in or extend to the anterior orbit. They may range up to several centimeters in size. When large there may be concern about amblyopia or astigmatism. HISTOPATHOLOGY Within dense collagenous tissue are nests and irregular islands of polygonal epithelial cells having lightly eosinophilic cytoplasm and round to oval nuclei without nucleoli. The nests and islands of epithelial cells are surrounded by basement membrane material that stains positively with periodic acid-Schiff reagent (PAS stain), and thick strands of PAS-positive material often accumulate between cells (shown below on the right). Swollen epithelial cells may resemble bladder cells occurring in...

How Does Subretinal Hemorrhage Damage the Retina

Subretinal macular hemorrhages can be successfully removed by vitrectomy using tissue plasminogen activator 2 , leading to an improvement in the postoperative visual acuity of patients whose vision was good before the hemorrhage 3 (Fig. 4.31). Changes in the focal macular ERGs elicited by a 10 spot in five patients who had a sub-macular hemorrhage removed by vitrectomy using tissue plasminogen activator are shown in Fig. 4.32. The submacular hemorrhage was caused by rupture of a macroaneurysm in three of the eyes, AMD in one of the eyes, and an unknown reason in the fifth eye. The duration of the subretinal hemorrhage ranged from 3 to 14 days. All of the patients had extremely poor visual acuity (from hand motion to 0.05) before surgery, and the visual acuity improved to 0.1-0.7 after surgery. Three points can be made based on these results. First, focal macular ERGs were unde-tectable in all of these patients before surgery regardless of the duration of the submacular hemorrhage....

Discovery of Highly Potent AChE by In Situ Click Chemistry

Carbonic anhydrases are Zinc-enzymes that catalyze the interconversion of HCO3- and CO2. They are involved in key biological processes related to respiration and the transport of CO2 HCO3, bone resorption, calcification and tumori-genicity 60 . Systemically and topically administered carbonic anhydrase inhibitors have long been used to control the elevated intraocular pressure associated with glaucoma 61, 62 . Most inhibitors are aromatic or heteroaromatic systems that carry a sulfonamide functional group 63-65 , which coordinates the Zn2+ ion in the active site. Based on this information, Kolb et al. designed 4-ethynylbenze-nesulfonamide as an anchor molecule for the target-guided formation of carbonic anhydrase inhibitors (Fig. 15.5) 53 . The benzenesulfonamide anchor molecule was incubated with each of 24 azide reagents in the presence of bovine carbonic anhydrase II for 40 h. Analysis of all 24 reaction mixtures by liquid chromatography with mass spectrometry selected ion mode...

Diabetic Vitreous Hemorrhage

The preoperative full-field ERGs elicited by a single bright flash can be used to classify patients with diabetic retinopathy into three groups (Fig. 3.6) Group A includes those with a b a ratio 1.0, and the OPs are clearly recordable. Group B includes those with a b a ratio 1.0, but the OPs are absent. Group C comprises those with a b a ratio 1.0, with no recordable OPs. The distribution of the postoperative visual acuity for each group is shown in Fig. 3.7. The postoperative visual acuity for group C was significantly worse than that for group A or group B. The low b a ratios may indicate a more severe ischemic retina, which in turn may account for the relatively good correlation with visual acuity. However, among the patients in group C, there were some whose postoperative visual acuity was good, indicating that a b a ratio 1.0 is not necessarily a contraindication for surgery. Another interesting observation is that most patients who have distinct OPs preoperatively have good...

Diffuse Unilateral Subacute Neuroretinitis

Acute Macular Neuroretinitis

Diffuse unilateral subacute neuroretinitis (DUSN) 8 is caused by an unidentified species of nematodes that may wander in the subreti-nal space for 4 years or longer and cause progressive ocular damage. DUSN is characterized by early visual loss, vitritis, papillitis, retinal vasculitis, and recurrent crops of evanescent, grayish white outer retinal lesions that may develop in one eye of an otherwise healthy individual. At a late stage, there is severely reduced vision, optic atrophy, retinal vessel narrowing, and diffuse RPE degeneration. The appearance of the fundus can resemble that in several other diseases at different stages, such as optic neuritis, sarcoidosis, MEWDS, unilateral optic atrophy, unilateral retinitis pigmentosa, among others. Ancylostoma caninum, a hookworm of dogs, is a common cause of DUSN. There are at least two endemic areas for the nematode in the United States. It is also found in the Caribbean islands and Latin America, and individual cases have been...

Gender Ethnicracial And Life Span Considerations

When assessing vital signs, you may note hypertension, a common complication in diabetic patients. Palpate the peripheral pulses to determine their strength, regularity, and symmetry. During the neurological examination, use an ophthalmoscope to evaluate the patient for retinopathy or cataracts. Assess the patient for any signs and symptoms of hypoglycemia or hyperglycemia (Table 2).

The Msr System and Age Related Diseases

It is now established that in age-related diseases such as Alzheimer's disease, Parkinson's disease, Huntington's disease and cataractogenesis, oxidized proteins accumulate 85-87 . Furthermore, methionine oxidation has been observed in neurodegenerative diseases despite high expression of the MsrA protein in the cerebellum and neurons of rat brain 67 . Indeed, Gabbita et al. 88 revealed a decrease in MsrA activity in all brain regions studied in an Alzheimer patient compared with control subjects. This decrease in MsrA activity was accompanied by an increase in brain protein carbonyl levels. In Parkinson's disease, it was shown that a-synuclein oxidation plays a critical role in the disease. a-synuclein contains four methionines that are all solvent-exposed. It was shown that oxidation of these methion-ine residues inhibited its fibrillation and could thus be an important factor in Parkinson's disease if Msr activity is impaired during this pathology 89 . However, it was shown that...

Application A the gene array for ABCA4associated retinal dystrophies

Several laboratories independently described ABCA4 (ABCR) in 1997 as the causal gene for Stargardt disease (STGD1, MIM 248200) (6-8). STGD1 is usually a juvenile-onset macular dystrophy associated with rapid central visual impairment, progressive bilateral atrophy of the foveal retinal

Primary Disorders of LDL Metabolism

The synthesis ofbile acids is defective in this disorder, which results in increased cholesterol levels and consequent accumulation of cholesterol in peripheral tissues. Progressive neurologic dysfunction resulting in dementia, spasticity, and ataxia typically ensue by the fifth decade, as well as premature coronary artery disease, cataracts, and tendinous xanthomas (2).

Use of the Product Hazard Varies According to the Route of Administration Eye Nose Respiratory Tract

Amebocytes and interferon in the circulating blood, mucous and hair to trap and filter organisms in the nose, etc. Consequently, the route of administration can and will affect the ability of organisms to infect the user. The eye provides a significant barrier unless the cornea is scratched. Such scratching can occur with contact lenses, fingernails, dirt, inadvertent injuries, etc. The eye has very little vascularization, which means that any type of defense depending on circulation will be hindered. The respiratory tract and intestinal tract provide routes where the skin barrier is bypassed. The low pH in the intestinal tract protects against many organisms. However, the respiratory tract provides only limited natural host defenses. Consequently, inhaled products such as nasal sprays can put the user at increased risk. An adverse reaction that is very unlikely to occur is called idiosyncratic. However, what would the individual affected call such a reaction

Syndrome with an Unusual Form of ERG

Supernormal Erg

This unusual combination is illustrated in three of our patients 4 . A 15-year-old girl (case 1), an 11-year-old girl (case 2), and a 32-year-old woman (case 3) had low visual acuity of 0.1-0.4 with moderate to high myopia from birth. The family history was negative in the three patients. Night blindness was detected by dark-adaptation curves with elevation of the final rod thresholds by 1.5-2.3 log units. The visual fields were almost normal except for slight constriction with small and dim targets. The color vision was markedly abnormal, with a scotopic pattern similar to that of rod monochromats. The fundus and fluorescein angiograms are essentially normal (Fig. 2.120), except for bull's-eye maculopathy in case 1 and slight optic atrophy in case 3. We have followed two of these patients for more than 10 years, and the clinical condition has not changed (i.e., it is stationary).

Pax6 Developmental Genetics Of Eyes And Olfactory Systems

Mutations of pax-6 have disastrous effects. We have already noted the effect in Drosophila. In the mouse they cause a condition known as small eye (Sey). In the heterozygous condition sey mice eyes have significantly smaller lenses and optic cups. Homozygous sey is lethal. Early mice embryos (9.5 days) show no lens placode and the neural layers of the retina are highly abnormal. The olfactory placode, similarly, fails to develop, and the embryo shows no sign of nasal pits or an olfactory bulb. Clearly pax-6 plays a crucial role in the early development of eye and nose. Humans heterozygous for PAX-6 suffer from a condition known as aniridia. In this condition there is a complete or partial failure of the iris to develop along with other defects including cataract, corneal opacity, glaucoma, etc. The incidence lies between 1 64000 and 1 96 000. In addition mutations of PAX-6 can also lead to defects in the anterior chamber of the eye, including opacity of the central cornea, known as...

Clinical Description

Individuals with NF1 are at increased risk for malignant neoplasms. 8 The most common is optic glioma, affecting approximately 15 . 9 Most of these tumors are asymptomatic, but progressive growths can impair vision or cause neuroendocrine disturbance. Gliomas can occur elsewhere in the brain, especially the brainstem. Malignant peripheral nerve sheath tumors are sarcoma-like lesions that arise from neurofibromas (usually plexiform neurofibromas), with a lifetime risk around 10 . Other malignancies that are associated with NF1 include juvenile myelomonocytic leukemia and rhabdomyosarcoma.

Oculodermal Melanocytosis

Conjunctiva, sclera, and uveal tract. Other ipsilateral involved tissues may be orbital fat and muscles, bone, periorbita, dura, and brain. The nevus tends to be unilateral, but bilateral involvement may occur. Pigmentation is irregular and may occur in small isolated disconnected patches. It may be so pale as to be overlooked on casual observation. Glaucoma can be an associated finding. Intraocular nevi, choroidal malignant melanoma, and orbital melanoma may occur.

Effects on Particular Organs or Organ Systems

The eye is vulnerable to irritants such as smog, solvents, detergents, and corrosive substances. Other pollutants act systemically and can damage the optic nerve. For example, methanol and carbon disulfide damage the central vision in this way, and pentavalent arsenic and carbon monoxide affect peripheral vision.

Marcus Gunn Jaw Winking Syndrome

In most patients the synkinesis is used to reduce the true degree of ptosis which often is greater than appears clinically. With contraction of the masticatory muscles, most commonly the external pterygoid muscle, the ptotic eyelid shows coordinated elevation or even retraction. The characteristic appearance is a winking of the eyelid during eating or chewing. The degree of ptosis and the amount of kinetic lid elevation are related proportionately. Aberrant and sometimes bizarre synkinetic movements between the eyelid and other muscles, such as the masseter or temporalis, may be seen. Levator muscle function may be normal or somewhat decreased. Unlike congenital myogenic ptosis, the eyelid crease is usually normal in position. Various types of strabismus may be seen in 25 to 35 of cases, and amblyopia in 35 to 60 . An association between the Marcus Gunn Jaw Winking syndrome and Duane's Retraction syndrome, another neural miswiring disorder, has been reported. TREATMENT Therapy is...

Examination of the newborn infant

A systematic search for congenital abnormalities can be rapidly performed by examining along the midline and then passing to the limbs. Starting with the head, the facial features should be noted and thought given to dysmor-phic syndromes. The palate needs to be examined visually to exclude a clef palate or bifid uvula which signifies a sub-mucus cleft. The eyes must be examined by ophthal-moscopy to exclude cataracts in a normal eye the red reflex is immediately obvious. Eye movements may not be fully coordinated in the first week of life and momentary strabismus is common.

Pathophysiology and Macular ERGs

Eyes with an idiopathic full-thickness macular hole usually have reduced visual acuity and an absolute central scotoma caused by the macular hole. Relative scotomas are usually detected in areas surrounding the hole that can be identified by OCT (Fig. 4.18). The loss of retinal function is attributed to the defect in the The changes in the focal macular ERGs before and after macular hole surgery 3 are shown in Fig. 4.22. A 65-year-old man had noted decreased vision in his left eye for 6 months. Examination disclosed a stage 3 full-thickness macular hole, and his visual acuity was 0.08 (OD) and 1.0 (OS). Focal macular ERGs were recorded with 2 , 3 , and 4 stimu The patient underwent surgery, and the macular hole was closed. Six months later his visual acuity improved to 0.4, and focal macular ERGs were successfully recorded even with the smallest 2 spot. These results confirmed that the area of retinal deficit, the macular hole, was closed by the surgery, and function had returned (B)....

Focal grid laser photocoagulation

Focal Grid Laser

Although focal laser photocoagulation reduces the risk of moderate visual loss by approximately 50 , approximately 12 of treated eyes still lose vision, many because of persistent DME (ETDRS group, 1985). Kim et al. assessed macular optical coherence tomography (OCT) findings of DME patients to determine whether specific OCT patterns are predictive of visual outcome after focal laser photocoagulation (Kim et al., 2009). DME was classified into four different OCT patterns, which are diffuse retinal thickening, cystoids macular edema, serous retinal detachment, and vitreomacular interface abnormalities (Figure 1). In this study, eyes with diffuse retinal thickening achieved a greater visual acuity increase than eyes with other patterns.

Familial Optic Atrophy with Negative ERG

In 1992, in collaboration with Richard Weleber of Portland, Oregon, we found that the affected members of two families with presumably autosomal dominant optic atrophy also had negative-type ERGs (Fig. 2.126) 3 . They had poor central vision, and the decrease occurred during the second to third decade of life. Ophthalmological examinations showed that the affected members had visual acuities of 1.0-0.4, defective color vision, mild to moderate myopia, and pericentral or centrocecal sco-tomas. Optic atrophy was found in four of the five patients (Fig. 2.127). The age of the affected members ranged from 21 to 56 years (mean 42 years). The moderately low visual acuity of these patients may be caused by optic atrophy or some macular problem. The essentially normal focal macular ERGs suggest that the low visual acuity is caused by optic nerve dysfunction. Because negative ERGs are not seen with other familial optic atrophies, we concluded that this disease, with an association of optic...

Fundus flavimaculatus

Renal Oncocytoma Fundus Images

Patients in group 4 are relatively rare. A 36-year-old woman was found to have multiple flecks in both fundi, and fluorescein angiography revealed multiple flecks of hyperfluores-cence associated with a dark choroid, indicating group 4 Stargardt's disease (Fig. 2.141). She had no subjective complaint, and her visual acuity was 0.9 in both eyes. The full-field ERG, the focal macular ERG, and the multifocal ERGs were normal (Fig. 2.142). The multifocal ERGs recorded from the sites of the flecks were also normal, indicating that the flecks do not affect retinal function. Fig. 2.141. Fundus photograph (top) and fluorescein angiogram (bottom) from a 36-year-old woman with group 4 Stargardt's disease. Multiple flecks in the posterior pole and dark choroid of fluorescein angiography are observed. The macula appears normal, and the visual acuity was 0.9 in both eyes Fig. 2.141. Fundus photograph (top) and fluorescein angiogram (bottom) from a 36-year-old woman with group 4 Stargardt's...

Pigmented Epithelial Derived Factor PEDF

PEDF is a natural extracellular component of the retina and has been found in the vitreous and aqueous humors. Decreased levels of PEDF were reported in the ocular fluids of patients with angiogenic eye diseases41. PEDF has potent antiangiogenic activity in retinal EC growth and migration and suppressed ischemia-induced retinal neovascularization42. PEDF has been shown to be a major antiangiogenic growth factor in the mammalian eye. Joachim41 et al analyzed the in vivo regulation of PEDF in patients with and without hypoxic eye disease. Their data strongly support the concept that retinal angiogenesis is induced by loss of the major angiogenesis inhibitor in the eye, PEDF, in combination with an increased expression of angiogenic growth factors such as VEGF. These findings suggest that substitution of angiogenesis inhibitors may be an effective approach in the treatment of PDR41.

Epidermal Necrolysis Disease Spectrum

Powers WJ, Ghoraishi M, Merayo-Lloves J, Neves RA, Foster CS. Analysis of the acute ophthalmic manifestations of the erythema multiforme Stevens-Johnson Syndrome toxic epidermal necrolysis disease spectrum. Ophthalmology 1995 102 1669-1676. Watts MT, Nelson ME. External Eye Disease A Color Atlas. Edinburgh Churchill Livingstone, 1992. Whitmore PV. In Duane TD ed Clinical Ophthalmology. Vol. 5. Philadelphia Harper & Row, 1983, Chap. 27.

Triamcinolobe Acetonide For Crohns Disease Conclution

In particular, anti-VEGF therapies, in conjunction with laser or as standalone treatments, have shown promise in not only maintaining but also improving visual acuity. Intravitreal triamcinolone also has a role in treating patients with DME refractory to laser and anti-VEGF therapy, and it remains to be seen whether extended-release corticosteroid devices might play a role in the management of DME. Diabetic patients with macular edema who have a taut posterior hyaloid membrane may benefit from pars plana vitrectomy and removal of the posterior hyaloids

Subject Population and Endpoints

In drugs developed for non-life-threatening diseases, a Phase II clinical trial is usually the first one to recruit patients with the disease under study. Patients for Phase II trials are recruited so that these patients may be most likely to benefit from the drug candidate and least likely to be exposed to potential toxicities. Endpoints used in Phase II studies include efficacy and safety endpoints. The efficacy endpoints may be clinical endpoints such as blood pressure, time to disease relapse, number of painful joints, visual acuity or surrogate markers such as white blood cell count, bone mineral density, among others.

Collaboration with the food industry retail and manufacturing

The question of whether allergic customers should be given an extra warning - such as a coloured flash or symbol - has generated much debate. The views of individual customers differ on this, some people wanting a prominent warning about the presence of nuts, others preferring a statement guaranteeing that a product is nut-free. The official view of the Anaphylaxis Campaign - not necessarily shared by every member - is that the prime concern is to get all allergenic ingredients printed in the ingredient list. Although this is sometimes hard on those with poor eyesight, we feel that people should be able to rely on one simple, uniform system of getting information. Coloured flashes or symbols that differ from company to company may only serve to confuse, particularly when these are placed well away from the ingredient list. What may be helpful is an additional statement, CONTAINS NUTS, for example, placed immediately under the ingredient list.

Host Seeking by Parasitoids

Parasitoids are holometabolous insects that are free living as adults their larvae are parasites within the bodies of other insects, which they invariably kill as they develop. Most parasitoids are small-to-large wasplike insects in the hymenopteran superfamilies Ichneumonoidea, Chacidoidea, Serphoidea, and Cynipoidea, or are flies in the dipteran family Tachinidae. Adult females, which are well suited for this task, almost always carry out host seeking in parasitoids. Most have wings and are active fliers, making it possible for them to explore large areas, relative to their body size. Most also have well-developed legs that facilitate the exploration of complicated surfaces. Typically, they possess tactile and chemosensory receptors on the antennae, feet, mouthparts, or ovipositor, and they have good visual acuity. Their ability to find specific host species may be important because many larval parasitoids exist inside other insects that often are capable of mounting immune...

Phase3 Study of Aldurazyme 12721 Study Objectives and Design

The phase-3 study was designed as a randomized, double-blind, placebo-controlled study in 45 MPS I patients treated with weekly infusions of Aldurazyme over a 26-week period 13 . The patient population was restricted to patients over 5 years of age and was predominantly Hurler-Scheie in phenotype. The primary endpoints were the change between baseline and week-26 in the forced vital capacity (FVC), and the 6-min walk test. FVC is a measure of lung capacity, which is severely restricted in MPS I patients such that respiratory insufficiency is a common contributor to death. The 6-min walk test is commonly used in congestive heart failure studies as a measure of endurance. In MPS I, the 6-min walk distance can be severely restricted due to a combination of factors that includes poor respiratory function, cardiac disease, and joint stiffness and pain. In addition to these endpoints, secondary endpoints in the study were liver size, sleep apnea, shoulder flexion, and the Health Assessment...

Proteolytic Systems and Types of Extracellular Substrates

Accumulation of extracellular modified proteins is involved in several pathologies such as arteriosclerosis, cataract formation and aging 14,32 . The accumulation of oxidized proteins can result from several kinds of malfunctions of cellular metabolism including an age-related over-expression of protein, decrease of proteolytic activities or increase of oxidative stress 31 .

Transforming Growth Factor beta TGFP

Scarring in the cornea and conjunctiva, fibrosis in the corneal endothelium, post-cataract surgery fibrosis of the lens capsule, excess scarring of tissue around the extraocular muscles in the strabismus surgery and proliferative vitreoretinopathy (Saika et al., 2009 Sumioka et al., 2011 Hills et al., 2011). Those properties of TGF- are confirmed in animal models (Yingchuan et al., 2010 Kowluru et al., 2010) as well as in patients with diabetic retinopathy (George et al., 2009 Abu El-Asrar et al., 2010). It is believed that TGF- plays a role in pathogenesis of diabetic retinopathy via hyperglycaemia and inflammation. Kowluru et al., 2010 have reported that both the duration of the initial exposure to high glucose, and normal glucose that follows high glucose, are critical in determining the outcome of the alterations in the inflammatory mediators such as IL-1 beta, NF-kB, VEGF, TNF-a including with TGF- in retinal.

Subthreshold Micropulse Diode Laser Photocoagulation SMDLP

A study comparing the efficacy and side effects of conventional green laser photocoagulation and SMDLP treatment for diabetic CSME was conducted with prospective, randomized, double-masked manner. There were no statistically significant differences in best-corrected visual acuity (BCVA), contrast sensitivity and retinal thickness between the two laser modalities at 0, 4 and 12 months. It is found that laser scarring was much more apparent with conventional green laser than with the SMDLP (Figueira et al., 2009).

OCT interpretation qualitative analysis morphology and reflectivity

Retinal pathological features can be associated with changes in optical properties of the tissue and thus be detected on the OCT scan as changes in reflectivity. While performing this reflectivity analysis one should always remember that the reflectivity displayed on the scan is a result from the tissue reflectivity, the amount of light absorbed by overlying structures, and the amount of light that reaches the sensor after it has been further attenuated by interposing tissues. Thus care is required in interpreting OCT images when media opacities, poor alignment of the OCT instrument while imaging, high astigmatism or poorly centered intraocular implants are present, as these may reduce signal intensity.

Clinical Presentation

Kayser-Fleischer rings are characteristic although not mandatory findings in Wilson disease, representing deposits of copper in the Descemet's membrane of the peripheral cornea. They appear as a band of golden-brownish pigment when visible by direct inspection. However, in most cases, slit-lamp examination by a skilled examiner is required. Other ophthalmological changes such as sunflower cataracts representing copper deposition in the lens might be revealed. These clinical observations are of diagnostic value, but do not obstruct vision. Nonetheless, Kayser-Fleischer rings are not entirely specific for Wilson disease and are also observed in patients with chronic cholestatic diseases. 9 KayserFleischer rings typically develop later in the course of the disease, are rare in childhood, and are mostly although not necessarily detectable in patients with neurological manifestations, but in only about 55 of patients presenting initially with liver disease. 10

Dietary Modulation of Retinal Fatty Acid Composition and Function

Although retina and rod outer segment tenaciously retain 22 6n-3 during essential fatty acid deficiency (Connor et al., 1990, 1991 Wiegand et al., 1991), severe unbalanced n-6 n-3 diets or depleted n-3 fatty acid levels in membrane can cause abnormal change in biochemical and physiological membrane function. The level of 22 6n-3 in n-3 fatty acid-deficient chick brain and retina is restored by a diet containing 22 6n-3 (Anderson & Conner, 1994) and also after n-3 deficiency in the rhesus monkey (Neuringer et al., 1986 Neuringer & Connor, 1986). Functionally, n-3 fatty acid-deficient monkeys show delayed recovery of the dark adapted electroretinogram and impaired visual acuity at an early age (Neuringer et al., 1986), suggesting that n-6 fatty acids are not interchangeable with n-3 fatty acid in maintaining normal retinal function. After repletion with fatty acids from fish oil, the 22 6n-3 level increased rapidly after feeding, but no improvement in the electroretinogram occurred...

Symmetrical Neuropathies

It is important to appreciate that many subjects with distal symmetrical neuropathy may not have any of the above symptoms, and their first presentation may be with a foot ulcer (7). This underpins the need for carefully examining and screening the feet of all people with diabetes, in order to identify those at risk of developing foot ulceration (7). The insensate foot is at risk of developing mechanical and thermal injuries, and patients must therefore be warned about these and given appropriate advice regarding foot care (7,23). A curious feature of the neuropathic foot is that both numbness and pain may occur, the so called painful, painless leg (23). It is indeed a paradox that the patient with a large foot ulcer may also have severe neuropathic pain. In those with advanced neuropathy, there may be sensory ataxia. The unfortunate sufferer is affected by unsteadiness on walking, and even falls particularly if there is associated visual impairment because of retinopathy.

Patients And Methods

Clinical examination and serological tests were performed monthly during the first year of follow-up, and every 3 months thereafter. The monitoring of the Wassermann reaction (WaR) and the Venereal Disease Research Laboratory (VDRL) test was started 1 month after therapy the monitoring of the T. pallidum immobilization (TPI) test as well as the fluorescent treponemal antibody-absorption (FTA-ABS) test was initiated 12 months after treatment. All patients have been examined by an internist, an ophthalmologist, a neurologist, and an otorhinolaryngologist.

Disability Categories

There are several categories of conditions or disorders defined in the IDEA that are deemed appropriate for special education services. These categories are autism, deaf-blind, deaf, hearing impairment, mental retardation, multiple disabilities, orthopedic impairment, other health impairment, serious emotional disturbance, specific learning disability, speech or language impairment, traumatic brain injury, and visual impairment including blindness. The states have established specific criteria for inclusion in special education. These criteria can vary widely between states. The entire IDEA document is available online at

Following Sequential Fields

Check which targets were used, so that one knows that the isopters being compared are the same targets. This also means checking that factors that alter retinal illumination or focus have not changed either, since they will alter the effective isopter too. If the patient was tested with a different lens, make sure that this was because the patient's refraction had changed and not because of an error. Could the patient's pupil size have changed drastically This usually means being tested with drops on one occasion but not on another do not forget the possibility of a patient discontinuing miotic medication for glaucoma, as well as the more obvious case of mydriatic drops applied in the clinic. Do the clinic notes suggest that the patient may have had progression of a cataract in the interim (Fig. 14) Fortunately, almost all of these factors will alter sensitivity globally rather than focally. For example, a cataract makes a target fainter and blurred, which can make an I3e target...

Shortwavelength Automated Perimetry

Short-wavelength automated perimetry (SWAP) tests the detection of a large blue stimulus against a yellow background. The targets are retinal ganglion cells with blue-yellow color opponency, which account for 1 of the total population. These blue-yellow ganglion cells form a specific class that project to the intralaminar-koniocellular layers of the lateral geniculate nucleus (15). They have large dendritic fields and axons, nearly as large as those of the magnocellular cells, and may thus number among the large fibers preferentially lost in pathologic studies of glaucomatous damage to the optic nerve. A number of studies have shown that SWAP detects glaucomatous defects earlier than conventional perimetry (14). How ever, it may be more variable between tests, and its thresholds may be adversely affected by posterior subcapsular cataracts. High-pass resolution perimetry appears to be as good as conventional automated perimetry at detecting glaucomatous defects, but not any better...

Batrachus porosissimus See Toadfishes

Except for studies of symmetry, studies devoted to the perception of 'beauty' in fishes do not appear to have been conducted to date. However, its perception is likely, as many species combine a high visual acuity with complexly structured colour patterns on their bodies. (See also Asymmetry Handicap principle Reproduction Sexual selection Social Darwinism).

Clinical Description Dm1

Ninety percent of DM1 patients present at adulthood with delayed muscle maturation, distal muscle weakness, wasting, myotonia, cataracts, cardiac abnormalities, smooth muscle dysfunction, insulin resistance, daytime sleepiness, testicular atrophy (low reproductive fitness), ''difficult'' personality, neuropsychiatric disturbances, and frontal balding. 1 Ten percent of the patients present at infancy with hypotonia (floppy infant), oromotor dysfunction, tent-shaped mouth, feeding and respiratory insufficiency (diaphragmatic hypoplasia), arthrogryposis, and mental retardation in those who survive until adulthood (congenital DM). 1 All manifestations show a progressive course. Usually, creatine kinase is elevated. Muscle biopsy shows type 1 predominance, centrally located nuclei, severe fiber atrophy with nuclear clumps, hypertrophic and angulated fibers, and occasionally, necrotic fibers, fibrosis, or fat deposits. Cardiac involvement comprises conduction defects (mostly HV...

Therapeutic Hyaluronidases

Hyaluronidase exerts it therapeutic effect by making tissue more permeable to injected fluids, leading to increased speed of drug absorption. Preparations of bovine testicular hyal-uronidase have been applied therapeutically in the fields of orthopedics, ophthalmology, and internal medicine for many years with efficacy and safety. A common field of application is its addition to local anesthetic agents, especially ophthalmic anesthesia, to improve the rapidity of onset, dispersion, depth, and duration of the local anesthesia 153,154 .

Gap Junctions And Neuropathology

7.10.2 Cataract As with deafness there are many genetic causes of cataract. One cause, however, is a mutation in the connexin 50 (Cx50) gene on chromosome 1. A transition at nucleotide 262 leads to C being replaced by T (C262T) and this, in turn, causes proline88 to be replaced by serine (P88S). A second cause of cataract is an A to G transition at position 188 (A188G) in the connexin 46 (Cx46) gene on chromosome 13. This leads to the substitution of serine for asparagine at position 63 in the Cx46 protein (N63S). Yet another cause is a frameshift mutation at nucleotide 1137 in the Cx46 gene. This causes a mistranslation of 56 C-terminal amino acids in the Cx46 protein. All of these mishaps cause defective gap junctions between lens fibres and thus to patchy, dust-like, lens opacities known as pulverulant cataract.

Genetic Considerations

Examine the patient's fingers for signs of thickening. Inspect the patient's torso, noting a barrel chest or kyphosis. Note any signs of bowed legs. Assess the patient's skin for signs of oiliness or excessive sweating (diaphoresis). Assess the patient's hand strength. Test the patient's vision for bitemporal hemianopia and loss of visual acuity. Note a deep, hollow-sounding voice.

Biology Of The Organisms

The human pathogen C. trachomatis has been further subdivided into 15 serovars (A-K and L1-L3), based on the monoclonal antibodies that identify epitopes located in the major outer membrane protein (MOMP). Chlamydia trachomatis can also be classified into two biovars, based on the diseases it causes. Serovars A, B, Ba, and C have been associated with the eye disease trachoma, and serovars D, E, F, G, H, I, J, and K with genitourinary tract infections. Both diseases have worldwide distribution. Together, they are termed the trachoma biovar. The L1, L2, and L3 serovars are associated with the more invasive sexually transmitted disease (STD) lymphogranuloma venereum (LGV), which is prevalent in sub-Saharan Africa, South America, and Southeast Asia (the LGV biovar).

Blue Cone Monochromacy

Atrophic changes may develop in the macula. The visual acuity is approximately 0.2-0.3, which is slightly better than that of the complete form of rod monochromacy. Unlike rod monochromats, the blue cone function is selectively preserved. The results of the Farnsworth dichotomous Panel D-15 test shows several crossing lines perpendicular to the tritan axis (Fig. 2.112).

Clinical Picture and Pathogenesis

And increase in serum creatinine, and then polyuria), and thrombocytopenia, but the extent of hemorrhages (hematuria, petechiae, internal hemorrhages), requirement for dialysis treatment, hypotension, and case-fatality rates are much higher in HFRS caused by Amur, Dobrava, or Hantaan viruses than in NE caused by Puumala or Saaremaa viruses. About a third of NE patients experience temporary visual disturbances (myopia), which is a very characteristic if not pathognomonic sign of the disease. Notably, the clinical consequences of all of the hantaviral pathogens in humans vary from none to fatal. Severe NE is associated with a certain haplotype, HLA-B8, DR3, DQ2 alleles, severe HPS with HLA-B35, and mild NE with HLA-B27. Yet, although Puumala virus infection is generally associated with mild HFRS, NE may have significant long-term consequences. A 5-year followup study demonstrated that 20 of NE patients had a somewhat increased systolic blood pressure and proteinuria. This is important,...

Early signs and symptoms

Physical findings in thyrotoxicosis may include hyperactivity, tachycardia or atrial fibrillation, systolic hypertension, warm, moist, smooth skin, stare and eyelid retraction, tremor, hyperreflexia, and muscle weakness (28). Goiter is not invariably present one study found that 37 of thyrotoxic patients over age 60 did not have thyroid enlargement (29). In Graves' disease, ophthalmologic findings may include exopthalmos, extraocular muscle dysfunction, periorbital edema, conjunctival chemosis and injection, and exposure keratitis (30). Pretibial myxedema is rarely seen in patients with Graves' disease and only when eye disease is also present.

The Role of Sex Hormones in Diabetic Retinopathy 331

During the past few decades great progress has been made in our understanding of pathophysiology, management and treatment of diabetic retinopathy. However, diabetic retinopathy still remains the leading cause of blindness among working adults worldwide. The goal of the book is to provide an update on latest developments in the understanding of pathophysiology of the disease, diagnosis and recent treatments strategies for physicians, ophthalmologists, researchers and medical students. Department of Ophthalmology, College of Medicine, King Saud University, Riyadh,

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