Restoring Visual Acuity with Eye Exercises

Vision Without Glasses

In Vision Without Glasses you'll discover: 15-minutes-a-day action plan to literally Force your entire visual system to work as a cohesive unit to self-correct and promote crystal clear sight and naturally regain perfect 20/20 vision in 1 3 months! The grave mental danger posed by uthoritarian doctors and optometrists, and a simple 3-second trick to brush off their sticky negative influence in a heartbeat. (hint: you want placebo to work in Your favor, and not the other way around!) The proper way to use glasses and contacts without ruining your progress towards the natural state of vision without glasses. A deadly diagnostic mistake made by most doctors and optometrists concerning the difference between strained and stressed eyesight. and how to correct both ailments from the comfort of your own home! Fool-proof 60-second relief from headaches and eye strain without drugs, pills, or other harmful chemicals. The natural confidence enjoyed by people with perfect vision Plus the knowingness that you've mastered something most people would consider miracle.(a young patient jokingly compared it to Clark Kent versus Superman.)

Vision Without Glasses Summary


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Visual Acuity and Refractive Errors

The visual acuity of patients with XLRS at various ages is shown in Fig. 2.33. Most patients, including young ones, show moderately poor visual acuity that gradually decreases with increasing age. Hypermetropia has been shown to be a frequent accompaniment of this disorder. In fact, many patients with XLRS are first diagnosed with hyperme tropic amblyopia or with heterotropia during infancy, and only during follow-up examinations are they found to have XLRS. A plot of the axial length as a function of the refractive error is shown in Fig. 2.34 for patients with XLRS, demonstrating that the hypermetropia is axial hypermetropia, not refractive hypermetropia 6 . Fig. 2.33. Visual acuity (ordinate) as a function of age (abscissa) in patients with XLRS Fig. 2.33. Visual acuity (ordinate) as a function of age (abscissa) in patients with XLRS

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.

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...

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...

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...

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,...


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...

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,

Lowpolarization Surface Electrodes

Warning The materials used to form Ag AgCl electrodes are relatively dangerous. Do not breathe dust or mist and do not get in eyes, on skin, or on clothing. When working with these materials, safety goggles must be worn. Contact lenses are not protective devices. Appropriate eye and face protection must be worn instead of, or in conjunction with, contact lenses. Wear disposable protective clothing to prevent exposure. Protective clothing includes lab coat and apron, flame- and chemical-resistant coveralls, gloves, and boots to prevent skin contact. Follow good hygiene and housekeeping practices when working with these materials. Do not eat, drink, or smoke while working with them. Wash hands before eating, drinking, smoking, or applying cosmetics.

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.

The Two Types Of Perimetry

However, because the operator does all these functions, manual perimetry is highly dependent on the skill and judgment of that person. An inexperienced operator with little knowledge of anatomy or the types of field defects associated with different diseases will produce perimetric maps with limited and potentially misleading information. The rise of automated perimetry with its commercial appeal has made it hard to find ophthalmic technicians with the requisite skill for manual perimetry. Nevertheless, most manual perimetry has simple instrumentation and is easy to perform. With a little familiarity with perimetric maps and a basic knowledge of anatomy and disease, all residents and practitioners of neurology, optometry, and ophthalmology should be able to do their own Goldmann perimetry when needed.

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

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...

Toxicants in foods and their effects on nutrition

With the exception of vitamin D, vitamin A, and some minerals, the intake of nutrients from natural food sources will not pose any significant health problems. However, one can argue that the health problems associated with high intakes of protein, fats, or energy are really manifestations of nutrient toxicity, i.e., cardiovascular diseases, cancers, and eye diseases such as macular degeneration and other chronic diseases. The other potential means whereby nutrient intakes can present health problems is the abuse of nutrient supplementation. A nonfood source of a nutrient can produce pharmacological actions at concentrations well above normal dietary amounts.

Blepharophimosis Syndrome

TREATMENT Treatment is indicated when visual function is threatened or for improved cosmesis. When the ptosis is severe enough to cause amblyopia, repair must be undertaken at an early age. When levator muscle function is poor or absent a frontalis suspension procedure will be required. Correction of the epicanthus and telecanthus are best delayed until the child is at least two years old in order to allow for tissues around the nose to develop enough to make surgery easier. In most cases any telecanthus does not have to be repaired since correction of the epicanthus will give adequate cosmetic results. The epicanthus is repaired with a Y to V procedure or a more complicated four-flap technique that combines a Y to V with multiple Z-plasties. When telecanthus is to be corrected, medial displacement of the canthal tendons with or without resection of bone will usually be required.

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.

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).

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...

Epidemiology of diabetic retinopathy

Among diverse microvascular complications of diabetes, diabetic retinopathy is a leading cause of adulthood blindness in the United States. According to the report of Eye Diseases Prevalence Research Group, the estimated incidence of diabetic retinopathy reaches up to 3.4 in US general population (Kempen et al., 2004). The incidence of retinopathy is increasing according to the duration of diabetes. In type I diabetes patients with duration of 20 years or more, the prevalence of any diabetic retinopathy reaches 100 (Klein et al., 1984b). Diverse classification criteria was introduced in diabetic retinopathy, but the presence of retinal new vessel (definition any new vessels arising from retina or optic disc, extending to the inner surface of retina or into the vitreous cavity) is the most frequently used criterion because of its clinical significance. Panretinal photocoagulation is indicated in proliferative diabetic retinopathy (PDR) with high risk characteristics, where there is a...

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

Sensory and perceptual alterations (visual) related to decreased visual acuity SURGICAL. There is no known medical treatment that cures, prevents, or reduces cataract formation. Surgical removal of the opacified lens is the only cure for cataracts. The lens can be removed when the visual deficit is 20 40. If cataracts occur bilaterally, the more advanced cataract is removed first. Extracapsular cataract extraction, the most common procedure, removes the anterior lens capsule and cortex, leaving the posterior capsule intact. A posterior chamber intraocular lens is implanted where the patient's own lens used to be. Intracapsular cataract extraction removes the entire lens within the intact capsule. An intraocular lens is implanted in either the anterior or the posterior chamber, or the visual deficit is corrected with contact lenses or cataract glasses. COMPLICATIONS. Complications may include retinal disorders, pupillary block, adhesions, acute glaucoma, macular edema, and retinal...

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.

Application B the disease array for a genetically heterogeneous disorder LCA

Leber congenital amaurosis was named after the German ophthalmologist Theodor von Leber who in 1869 first described severe visual loss present at birth accompanied by nystagmus, sluggish pupillary reaction and pigmentary retinopathy. A detailed description of LCA-defining clinical signs has been extensively presented in many reviews albeit a severe and early-onset disease, LCA nevertheless presents with variable expression, which can be sometimes explained by molecular genetic findings (see below). Difficulties with the clinical classification of LCA cases were most prominently demonstrated in a study where 30 out of 75 patients had been initially misdiagnosed (25). All the above further emphasizes the importance of a comprehensive molecular genetic analysis in addition to a thorough clinical evaluation.

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.

Neurofibromatosis Type

Multiple meningiomas (two or more) and unilateral vestibular schwannoma or any two of the following schwannoma, glioma, neurofibroma, or cataract. 2. First-degree family relative with NF2 and unilateral vestibular schwannoma at less than 30 years of age or any two of the following meningioma, schwannoma, glioma, or juvenile lens opacity (posterior subcapsular cataract or cortical cataract). 1. Unilateral vestibular schwannoma at less than 30 years of age and at least one of the following menin-gioma, schwannoma, glioma, or juvenile lens opacity (posterior subcapsular cataract or cortical cataract). 2. Multiple meningiomas (two or more) and unilateral vestibular schwannoma at less than 30 years of age or at least one of the following schwannoma, glioma, or juvenile lens opacity (posterior subcap-sular cataract or cortical cataract). In the Manchester criteria, any two of' refers to two individual tumors or cataract, whereas in the other sets of criteria, it refers to two tumor types...

Clinical implication and current treatment modalities of diabetic inner BRB dysfunction Diabetic macular edema

After the reports of Early Treatment of Diabetic Retinopathy Study (ETDRS) focal grid laser photocoagulation was the standard treatment method in diabetic macular edema. Stabilization or some improvement of vision was acquired in patients with macular edema who received laser photocoagulation. Although it is still the most cost-effective treatment modality in diabetic macular edema, some patients suffer from the post-treatment paracentral scotomas (Striph et al., 1988) and enlarging atrophic laser scars (Schatz et al., 1991). Although rare, vision threatening complications like choroidal neovascularization and subretinal fibrosis were also reported (Cunningham & Shons, 1979). Because of the refractory macular edema and complications of laser treatment, several pharmacological treatment modalities had been introduced. Further delineation on the exact mechanism of action is still needed, but intravitreal steroid injection is a powerful treatment option in diabetic macular edema....

Inhibitors Of Carbonic Anhydrase Pharmacokinetics and Pharmacodynamics

These agents are now most frequently used for glaucoma, but they represent a milestone in the development of diuretics. Modern diuretic therapy was launched when it was noted that sulfanilamide caused a diuresis rich in sodium bicarbonate. Chemical modification of this compound resulted in current carbonic anhydrase inhibitors such as acetazolamide, and subsequently thiazide, and loop diuretics. Little is known of the pharmacokinetics or pharmacodynamics of carbonic anhydrase inhibitors. The only study examining the pharmacokinetics of acetazolamide did so in five healthy volunteers. Peak concentrations occurred in 1 to 3 hr after an oral dose and the elimination half-life averaged 13 hr 14 . This half-life means acetazolamide can be used on a once or twice daily basis with chronic therapy. The most frequent use of acetazolamide as a diuretic is to induce an alkaline diuresis to facilitate renal elimination of drugs such as salicylates or phenobarbital in overdose settings.

Phenotypic analysis of transmitochondrial chimeric mice

(b) Ophthalmological and neurological evaluation Mice are evaluated for potential phenotypic effects on the visual, auditory, motor, and cognitive systems. Ophthalmological analysis of mutant animals includes slit-lamp analysis (for cataracts), ophthalmoscopy, electroretinograms, and retinal histology (93, 94). Auditory evoked brainstem response (ABR) is recorded at 8, 16, and 32 kHz over a range of intensities, using vertex, ear, and dorsal

Case with Normal Fullfield ERGs

In 1999 Sieving and coworkers reported on a 13-year-old boy with XLRS who had a preserved b-wave 16 . He was a member of a family affected by XLRS, with an Arg213Try mutation in the XLRS1 gene. His affected 54-year-old grandfather had negative-type ERGs. A similar patient from our clinic is shown in Fig. 2.45 17 . This 26-year-old man was first examined at age 7 years because of reduced visual acuity of 0.7 in both eyes. Ophthalmo-scopically, he had foveal cysts in both eyes but no other signs of retinoschisis a golden tapetal reflex was not detected. During the 19-year follow-up, full-field ERGs were recorded six times, and the b-wave of the mixed rod-cone (single bright flash) ERGs were always normal,

Unilateral Sudden Visual Loss

Patients complain of impairment of central vision (e.g., puff of smoke, fluffy ball). The examination reveals impaired visual acuity (20 200), a central scotoma, and occasionally papilledema (when the inflammation is just behind the nerve head) Trauma (fracture of the anterior cranial fossa extending into the optic foramen) Amblyopia with papilledema (transient attacks associated with raised intracranial pressure, e.g., benign intracranial hypertension)

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.

Cascade Activation Through Intramolecular Cyclization to Form Cyclic Drugs

Pilocarpine (139) is used as a topical miotic for controlling elevated intraocular pressure associated with glaucoma. The drug presents significant delivery problems due to its low ocular bioavailability (1-3 or less) and its short duration of action. The poor bioavailability was partly attributed to its poor permeability across the corneal membrane due to its low lipophilicity. Because of the low bioavailability,

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 .

Impact Of Dietary Essential Fatty Acids On Neuronal Cell Composition And Function

Animal studies have shown that when rodents or monkeys were maintained on an n-3-deficient diet, electroretinogram abnormalities (Benolken et al., 1973 Bourre et al., 1989b Weisinger et al., 1996a), reduced visual acuity (Neuringer et al., 1984, 1986), altered stereotyped behavior (Reisbick et al., 1994), and decreased level of learning and memory occur (Bourre et al., 1989 Mills et al., 1988 Lamptey & Walker, 1976 Yamamoto et al., 1987, 1988). Dietary n-3 fatty acid deficiency affects brain functions of preterm infants as measured by cortical visual evoked potential, electroretinograms, and behavioral testing of visual acuity (Birch et al., 1992 Carlson et al., 1993a Uauy et al., 1990). Human preterm infants fed infant formulas without 22 6n-3 were also shown to have abnormal electroretinograms, as well as decreased visual acuity compared to infants fed formulas containing 22 6n-3 (Carlson et al., 1993a Uauy et al., 1990). Furthermore, infants fed vegetable oil based formulas with...

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...

Nonsteroidal antiinflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed classes of medications worldwide. Aspirin and other chemically related compounds, used systemically for many decades for their analgesic, antipyretic, and anti-inflammatory properties, have more recently been prepared in topical ophthalmic formulations. As such, they have proven useful to enhance mydriasis, reduce postoperative inflammation, and prevent and treat cystoid macular edema (CME) associated with cataract surgery. In addition, they can be used to decrease pain and photophobia after refractive surgery and to alleviate itching associated with allergic conjunctivitis.The development of NSAIDs that preferentially inhibit COX-2 provides the potential for relieving pain and inflammation without the adverse effects of COX-1 blockade, but the advantages of this approach have been questioned. Although COX-2 inhibitors may reduce gastro-intestinal toxicity, they appear to have equivalent...

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

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.

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.

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.

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.

History and Disease Description

In 1881 Warren Tay, a British ophthalmologist, observed a cherry red spot in the retina of a one-year-old child with mental and physical retardation. Later, in 1896 Bernard Sachs, an American neurologist, observed extreme swelling of neurons in autopsy tissue from affected children. He also noted that the disease seemed to run in families of Jewish origin. Both physicians were describing the same disease, but it was not until the 1930s that the material causing the cherry-red spot and neuronal swelling was identified as a ganglioside lipid and the disease could be recognized as an inborn error of metabolism. The term ganglioside was coined because of the high abundance of the brain lipid in normal ganglion cells (a type of brain cell). In the 1960s, the structure of the Tay-Sachs ganglioside was identified and given the name GM2 ganglioside (Figure 1).

Functional Deficits in n3 Deficiency

Both Birch and co-workers (1992 1993) and Uauy et al. (1991 1994) assessed retinal function by electroretinography in very low birth weight infants fed differing amounts of n-3 fatty acids. They found infants fed human breast milk had the greatest amplitudes and lowest thresholds, whereas infants fed formula, low in n-3 fatty acids, showed significant reductions in all parameters of rod function at 36 wk. Cone receptor function was not affected at any age, in contrast to the studies on the guinea pig, where cone responses were also affected (Vingrys et al., 1998, Weisinger et al., 1999). These authors reported reductions in visual acuity as measured by a preferential looking technique, resulting from corn-oil-supplemented diets, compared with breast milk. The difference was small (in the order of 0.1 log units) (Birch et al., 1993). Makrides and co-workers (1994) investigated whether the disparity in neural maturation between breast-fed and formula-fed term infants could be corrected...

Clinical manifestation

Onset in early childhood organs most involved the bone, the viscera, the connective tissue, and the brain lichenified, dry, thick skin with diminished elasticity increased pigmentation on the dorsum of the hands sclerodermalike changes hypertrichosis of the extremities pale colored hair neurologic symptoms hypertensive hydrocephalus syndrome, changes in the tonus of the musculature and the tendon reflex, and damage of the cranial nerves myxedema in patients with associated hypothyroidism dwarfism hepat-osplenomegaly cardiovascular involvement progressive deterioration of intellect after a period of apparently normal development speech disturbances ocular symptoms progressive clouding of the cornea, megalocornea, hereditary glaucoma, and congestion and atrophy of the optic disc death often occurs before age 10 years from progressive neurologic and cardiovascular deterioration

Pharmacologic Highlights

Nursing interventions center on ongoing monitoring, protecting the patient from injury, reducing stress, and initiating teaching. Patients with exophthalmos or other visual problems might be more comfortable wearing sunglasses or eye patches to protect the eyes from light. Report any changes in visual acuity to the physician, and use artificial tears to lubricate the eyes.

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.

Molecular Genetics

Two Japanese families with RC38C and R838H mutations 13 are shown in Fig. 2.97.All of the affected members have high myopia and poor visual acuity (0.1-0.6) with central or para-central scotoma and severe color vision defects. The full-field rod ERGs are relatively well preserved with nearly undetectable cone and 30-Hz flicker ERGs (Fig. 2.98). The fundus has myopic changes, including chorioretinal atrophy around the optic disk, but minimal ophthalmoscopic abnormalities in the macula. Fluorescein angiography showed mild hyper-fluorescent pigmentary changes or small, round hyperfluorescent areas in the macula (Fig. 2.99).

Other Keratin Disorders

The spectrum of keratin disorders also encompasses a number of extracutaneous diseases. Meesmann corneal dystrophy (MSD) is inherited in an autosomal-dominant fashion with incomplete penetrance. Slit lamp identification of typical fine, round cysts in the corneal epithelium aids in differentiating this disorder from other inherited corneal dystrophies. 33 Although vision is only rarely impaired to a serious degree in MSD, cyst rupture can cause corneal erosions and intermittent decrease in visual acuity during adulthood. 33 The disorder results from dominant mutations in K3 and K12 genes that are specifically expressed in the corneal epithelium. 2

Unilateral Cone Dysfunction Syndrome

At her initial visit, visual acuity was 0.03 (OD) and 1.5 (OS) with a central scotoma in the right eye. The fundus and fluorescein angiograms were normal at that time, but 3 months later bull's-eye maculopathy appeared in the right eye her left fundus remained normal (Fig. 2.105).

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).

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 considerations

Macular edema may exist in several forms, each of which require specific treatment strategies and may vary greatly in terms of visual prognosis. Macular edema is primarily characterized as focal or diffuse. Focal macular edema represents retinal thickening involving localized areas of the macula, usually from a single microaneurysm or of clusters of them. Focal edema is often in the form of a microaneurysm with a surrounding circinate ring of precipitated hard exudates (or plasma lipoproteins), which delineates edematous from non-edematous retina (Gass 1987). Plasma lipoproteins most commonly accumulate in the outer plexiform layer but may be deposited in the subretinal space causing an independent decline in vision if the fovea is involved. Diffuse macular edema corresponds to a more generalized retinal capillary incompetence with extensive fluid leakage in the macula. Additionally, although not generally considered an element of diabetic macular edema (DME), incompetence in the...

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...

Hyperimmunoglobulinemia D with Periodic Fever Syndrome

HIDS was first described in 1984 (van der Meer et al. 1984), and 15 years later two independent groups, using complementary positional and functional approaches, identified MVK as the HIDS susceptibility locus (Drenth et al. 1999 Houten et al. 1999a). The MK enzyme is involved in the biosynthesis of cholesterol and nonsterol isoprenoids (Fig. 6). Mutations in MVK are also responsible for a second inherited disease, mevalonic aciduria (MA) (Hoffmann et al. 1986 Kelley 2000). Besides inflammatory symptoms similar to those of HIDS, MA patients exhibit mental retardation, ataxia, failure to thrive, myopathy, and cataracts (Hoffmann et al. 1993). Thus HIDS may be considered a mild presentation of MA.

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).

Was the assessment of outcomes appropriate

Comparing an agent with a long duration of action to one with a short duration can also be challenging. Timolol eye drops are a standard treatment for managing glaucoma. The maximum reduction in intraocular pressure (IOP) occurs after 1-2 hours and then wears off rapidly. Hence, multiple daily applications are required. In contrast, latanoprost is a prostaglandin analog with

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...

Design Of A Randomized Doubleblinded Placebocontrolled Study Of Dha Therapy

It is our view that although the above-presented nonrandomized studies do suggest that DHA therapy can be beneficial, the results cannot be considered conclusive. We also believe that it is unlikely that additional nonrandomized studies have the capacity to resolve this question. Therefore, we have initiated a randomized prospective study that will involve 60 PBD patients. Through a fixed randomization schedule, half of the patients will be assigned to receive DHA and half will receive a placebo. The treatment assignment will be masked from the patients and their families and all evaluators who have direct patient contact. Evaluations will be performed at baseline and at 12 mo after initiation of therapy. Emphasis will be placed on the evaluation of neurological, neurop-sychological, and visual functions. The neuropsychological test batteries will utilize those designed by Dr. Elsa Shapiro for the evaluation of patients with leukodystrophies or lysosomal disorders (Shapiro & Klein,...

Association of Negative ERG with Diseases of Unknown Etiology

The hereditary eye diseases associated with the negative-type ERG (a-wave larger than b-wave) with normal a-wave amplitude are congenital stationary night blindness, X-linked congenital In 1989 we reported four male patients 1 who had bull's-eye maculopathy and an otherwise normal fundus except for a dark choroid seen on fluorescein angiography in one patient (Fig. 2.123). The bright flash, mixed rod-cone ERG in the dark was made up of a normal a-wave but the b-wave that was reduced and smaller than the a-wave (Fig. 2.124). The full-field rod ERGs were moderately reduced, and the cone and 30Hz flicker ERGs were relatively well preserved (Fig. 2.125). Other findings common to all four patients were moderately low visual acuity (normal visual acuity initially), mild to moderate color vision deficiency, normal peripheral visual fields, normal EOGs, near-emmetropia, and appearance predominantly in men.

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 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...

OCT interpretation quantitative analysis

The data base for normal retinal thickness should be different for the different OCT devices. There are a lot of studies on retinal thickness measurements in healthy eyes, and their number is even increasing with the introduction of new OCT machines. Normal values for the central point and foveal thickness according to several studies, using TD OCT and SD OCT are presented on table 1. The diversity of data for normal eyes seems to be much more confusing, than helpful. There is a general trend of measuring higher values of retinal thickness with more refined OCT technology. All measurements with SD OCT have higher values than measurements with TD OCT. The greater axial resolution of SD OCT (5-6 m) compared to TD OCT (10 m) and the higher precision of the software may explain the The relation of macular thickness to axial length and presence of high myopia has also been described. Retinal thickness in highly myopic eyes (> 6D) was higher in the fovea, but lower in the inner and outer...

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...

How the Environment Is Involved in Complex Disease

Genes are not the only things that can affect a complex trait. Often environmental factors can also be involved. The type of environmental factors can be very different for different traits. One obvious example of this is lung cancer. Smoking cigarettes greatly increases the risk of developing lung cancer. Smoking also seems to have an effect on other diseases, including some eye diseases (such as age-related macular degeneration). However, not every chronic smoker will develop lung cancer or eye disease The presence of particular alleles of susceptibility genes is also a risk factor, as discussed below.

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).

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).

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...

Peribulbar triamcinolone

Peribulbar injections have been performed using anterior combined sub-Tenon and subconjunctival, posterior sub-Tenon, and retrobulbar approaches. Theoretically, adverse effects may be presumed to be lower than those of intravitreal triamcinolone acetonide. A peribulbar corticosteroid injection is of particular interest for eyes with DME that have good visual acuity where the risks of an intravitreal injection of corticosteroid may not be justified (E. Chew et al., 2007). The DRCR Network conducted a pilot study evaluating the effects of both anterior and posterior sub-Tenon delivery of peribulbar corticosteroids, with or without focal photocoagulation, in eyes with DME and good visual acuity. In cases of DME with good visual acuity, peribulbar triamcinolone, with or without focal photocoagulation, is unlikely to be of substantial benefit (E. Chew, et al., 2007). The group further reported long-term effects of anterior and posterior peribulbar injections of triamcinolone acetonide. The...

Gender Ethnicracial And Life Span Considerations

You may note that the skin has a waxy appearance fewer than normal wrinkles for the patient's age and a decreased amount of body, pubic, and axillary hair. Assess the patient's skin for hyperpigmentation, oiliness, acne, and diaphoresis. Assessment of visual function is important because pituitary tumors may press on the optic chiasm. Assess the patient's visual fields, visual acuity, extraocular movements, and pupillary reactions. A classic finding is bitemporal hemianopsia (blindness in the temporal field of vision). Perform an assessment of the cranial nerves. The tumor may involve cranial nerves III (oculomotor, which regulates pupil reaction), IV (trochlear, which along with the abducens regulates conjugate and lateral eye movements), and VI (abducens). Examine the patient's musculoskeletal structure, determining whether foot and hand size are appropriate for body size whether facial features are altered, such as thick ears and nose and whether the skeletal...

Sensory Deficits Introduction

Vision disorders are common in children with the most prevalent problems of a refractive type (myopia or hyperopia) and others that include amblyopia, strabismus, cataracts, and glaucoma. Eye injury may occur as a result of trauma from blunt or sharp objects, or from infection resulting in conjunctivitis, keratitis, or even blindness or loss of the eye. Hearing and vision screenings vary with the age of the infant child and are performed as part of physical assessment of all children. Treatment focuses on the correction and rehabilitation of any actual or potential impairment.

Clinical Development of Aldurazyme

Stiffness, the airway problems with associated sleep apnea, respiratory insufficiency, the diverse cardiac problems, recurrent infections, and the eye disease. Other compound clinical problems that were studied, but with more difficulty, included the fatigue malaise, severe headaches, the enlarged tongue, and signs of cord compression. Besides clinical measures, the elevated level of GAG in the urine, which reflects excessive renal distal tubular storage, is commonly used as a screen for MPS disease as well.

Phase 1 Open Label Study in Ten Mps I Patients 12711 Study Objectives and Design

NYHA classification), and eye disease. In prepubertal patients, height and weight growth velocity were also studied. Safety evaluations included the standard clinical laboratory studies, adverse event monitoring, assessments for antibodies to rhIDU, and complement activation.

Study Results in the Clinical Manifestations

Evaluation of range of motion showed that there were improvements in shoulder flexion, elbow extension, and knee extension that increased with time over 104 weeks. Sleep apnea declined 61 by 26 weeks, and the three patients with the most clinically severe sleep apnea all improved. NYHA classifications improved at least one class in all patients by 52 weeks. Visual acuity improved in the three patients with the worst vision. Height and weight growth velocity increased 85 and 131 , respectively, in the six prepubertal patients.

The Oculomotor System

The oculomotor system is comprised of the intrinsic and extrinsic muscles of the eye along with motor nuclei and higher cortical centers that serve to control the position of the eye as well as the shape of the lens and the size of the pupil. The main purpose of the system is to aid in vision by keeping the visual target focused on the fovea, the area ofcentral retina that has the highest visual acuity. Diplopia (double vision), blurred vision, or loss of depth perception can occur as a result of lesions at various points within the neuronal pathways that subserve the oculomotor system. The pathways are generally well defined and well known, so that it is possible to determine the location of a lesion in the oculomotor system by careful analysis of the types of visual deficits expressed and by direct observation of eye position and reflex eye movements. Tests of oculomotor function are an important part of most physical examinations of patients.

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...

Clinical Features

Can lead to basal ganglia calcification and, less frequently, extrapyramidal signs and symptoms (44). Cataracts may form. Osteomalacia may result from chronic hypocalcemia in association with hypophosphatemia. Chronic hypocalcemia is most often attributable to deficiencies of either PTH or 1,25(OH)2D, or resistance to these hormones. Table 4 lists the causes of hypocalcemia.

Surgical Retinal Procedures

K retinal detachment occurs when the retina is pulled away from or out of its normal position. Approximately 5 of the U.S. population has retinal breaks, but most do not lead to retinal detachment, which has a prevalence of 0.3 . Estimates are that 15 of people with retinal detachments in one eye develop detachment in the other eye, and the risk of bilateral detachment increases to 30 in people who have had bilateral cataract surgery. optic nerve and at the ciliary body. The remaining retina relies on the vitreous (jelly-like mass that fills the cavity of the eyeball) to apply pressure against the lining to maintain its position. The detachment can occur spontaneously as a result of a change in the retina or vitreous this detachment is referred to as a primary detachment. Secondary detachment occurs as a result of another problem, such as trauma, diabetes, or pregnancy-induced hypertension. Complications from retinal detachment include visual impairment and blindness.

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.

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...

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,...

Clinical Application Questions

A 75-year-old man in good general health presents at your office regarding a blistering rash on the right face and nose of 48 hours' duration. Lancinating pain was noted for 2 or 3 days before the rash. He also complains of diminished visual acuity in the right eye. You diagnose herpes zoster of the ophthalmic division of the trigeminal nerve.

Intraocular preparations of calcium dobesilate

Except of usually administerd oral tablets, some topic preparations of calcium dobesilate have also been reported. Ocular preparations for a local treatment of diabetic retinopathy and related disorders like glaucoma are the matter of the patent application of Velpandian (Velpandian, 2006). The simpliest eye solution, which is the Composition I of the Example 1 of this patent, contain 1 weight-volume (w v) calcium dobesilate, 0.76 w v sodium chloride for isotonisation and 0.1 w v sodium metabisulfite as an antioxidant. The Composition II is similar but contains only 0.70 w v sodium chloride and furtherly 0.4 w v hydroxypropylmethylcellulose as an viscosity-increasing agent. The Compositions III a IV are water insoluble and water soluble eye oitments respectively. The micronized form of calcium dobesilate in concentration 1 w v is used for preparation of both. The vehicle for water insoluble oitment is the white petrolatum mixed with a mineral oil, for the water soluble one it is a...

Sex differences in the prevalence of retinopathy noted in epidemiological studies

Earlier population studies such as the Wisconsin Epidemiological Study of Diabetic Retinopathy (WESDR) were done with predominantly white cohorts (Klein et al. 2008 Klein et al. 2010). The 25 year results of this WESDR showed that being male was an independent risk factor for the progression of diabetic retinopathy, although not a risk factor for the development of proliferative diabetic retinopathy or for visual impairment due to diabetes (Klein et al. 2010). However, many other studies show no correlation between gender and either severity or progression of diabetic retinopathy (Janka et al. 1989 Klein et al. 1994 Lloyd et al. 1995). The possibility that ethnicity or race played a role in gender differences in diabetic retinopathy was evaluated. The Los Angeles Latino Eye Study showed that in Latinos with type 2 diabetes, males were more likely to develop diabetic retinopathy (Varma et al. 2007). A study in India also demonstrated increased risk of diabetic retinopathy for men who...

Beneficial Effects of High Carotenoid Nutrition

Finally some results of the so-called Bruneck study shall be mentioned and cited. The aim of that study was to assess a relationship between plasma concentrations of important carotinoids such as a-carotene, p-carotene, lutein, lycopene, zeaxanthin, p-cryptoxanthin, and the vitamins A and E, and the degree of atherosclerosis in the carotid and femoral arteries 36 . This prospective and cross sectional study involved a randomly selected population sample of 392 men and women aged 45 to 65 years. a-Carotene and p-carotene plasma levels were inversely associated with the prevalence of atherosclerosis in the carotid and femoral arteries (p 0.004) and with the five-year incidence of atherosclerotic lesions in the carotid arteries (p 0.04). These findings were obtained after adjustment for other cardiovascular risk factors such as sex, age, LDL, ferritin, systolic blood pressure, smoking, categories of alcohol consumption, social status, C-reactive protein. Atherosclerosis risk gradually...

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 .

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

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

Seborrheic Keratosis Eyelid

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

Azoor 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.

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