The Aging Eye: Preventing and treating eye disease

StrongSight Vision Program

This is a 105-pages guide created by Dr. Benjamin for all those people that want to improve their eyesight without any surgery or medicine. It is a collection of natural holistic techniques that helped over 16,000 people worldwide and continue receiving success stories from all over the world. In this guide you will discover treatment for both short eye sightedness and long eye sightedness. This program can assist you to get better a 20/20 vision safely and securely, swiftly and without medical procedures. Whats more, it presents organic cures and beneficial data to decreased or get rid of your require for units to accurate your vision, for instance contacts and glasses. Easy Clear Vision is not a magic bullet and it requires a solid level of time commitment. You will need to follow this program for at least few weeks to see any noticeable results.

Easy Clear Vision Overview


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Ophthalmologic Manifestations

Seventy-five percent of patients with AIDS develop ocular complications. Although a wide range of ophthalmic diseases occur, recognition of a few is most critical. 22 The most common ophthalmic finding in patients with AIDS is retinal microvasculopathy, which is characterized by retinal cotton-wool spots identical in appearance to those of diabetes or hypertension. Retinal microaneurysms are also seen, primarily in the periphery. These lesions are believed to be incidental and do not cause visual disturbances. The diagnostic dilemma is to distinguish these findings from early CMV infection, and ophthalmologic consultation is recommended. CMV retinitis is the most frequent and serious ocular opportunistic infection and the leading cause of blindness in AIDS patients. The prevalence is estimated to be up to 40 percent. Visual loss and blindness occur in all cases without early detection and prompt treatment. 23 The presentation of CMV retinitis is variable. It may be asymptomatic early...

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....

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...

Ophthalmologic Infections

Ophthalmologic infections in the IVDU are usually the result of hematogenous seeding from a primary source of infection, such as endocarditis, or of opportunistic infections associated with coincident HIV disease. Bacterial endophthlamitis often presents acutely, with rapid progression of pain, redness, lid swelling, and decrease in visual acuity.46 Inflammation is usually present in the anterior and posterior chambers. White-centered, flame-shaped hemorrhages (Roth spots), cotton wool exudates, and macular holes may be present. S. aureus is the most commonly isolated organism, followed by Streptococcus sp. A rare but rapidly destructive infection has been reported with Bacillus cereus. Treatment involves subconjunctival and systemic antibiotic therapy surgical intervention may be needed. Fungal endophthalmitis, usually due to Candida, is more common than bacterial endophthalmitis. The clinical picture is often indolent, progressing over days to weeks. Symptoms include blurred vision,...

Lens Displacement and Traumatic Cataract

A cataract is present when the lens becomes opaque, and in extreme cases the lens may appear totally white. In acute traumatic cataract the opacity of the lens may be very slight and may be difficult to see. In some children I have seen marked swelling of the lens almost entirely as the result of increased clear fluid beneath the posterior lens capsule (posterior lenticonus). Such changes should be fully documented, but their traumatic significance is disputed by some. Cataract formation is a well-recognized and common consequence of blunt ocular trauma, and in blunt trauma it results from contusion or concussion to the lens.37'38 Traumatic cataracts often develop immediately after injury and are evident when the patient presents to the hospital,37 although some traumatic cataracts develop over weeks or months. Some cataracts have a rosette petal-shaped form of opacity and appear within a few hours of the injury.38 After concussion of the lens, the capsule of the lens may be severed...

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...

Ophthalmic Surgery Cataract Surgery

Cataracts may be congenital, traumatic, steroid- or radiation-induced, or degenerative. In degenerative cataracts there will also be other medical conditions of the ageing population. While diabetics have no more cataracts than the general population, they tend to present earlier and so there seems to be a preponderance of diabetic patients presenting for cataract surgery. Steroid induced cataracts present in patients taking long term steroids for other conditions, particularly eczema or asthma which should be taken into account. Cataract surgery demands a still eye with low intra-ocular pressure. This can usually be achieved by smooth anaesthesia with muscle relaxation and IPPV to achieve mild hypocapnia, whether via a tracheal tube or laryngeal mask, though the latter is preferable because of the lack of intubation pressor response or laryngeal spasm and coughing on extubation. There is a fashion for local anaesthesia for cataract surgery despite this having a higher failure rate,...

Cataracts and Photoreceptors

Several micronutrients, especially those that can have antioxidant functions in living tissues, have recently been investigated in relation to possible protection against degenerative eye diseases, such as cataract. Studies in animal models have suggested, albeit indirectly, that riboflavin status may be important here, and several recent epidemiologi-cal studies, including an intervention study in one region of China, have supported the suggestion that

Macular Degeneration and Cataracts

The eye is at particular risk of oxidative damage due to high oxygen concentrations, large amounts of oxidizable fatty acids in the retina, and exposure to ultraviolet rays. In Western countries, age-related macular degeneration (AMD) is the leading cause of blindness among older people. Cataracts are also widespread among the elderly and occur when the lens is unable to function properly due to the formation of opacities within the lens. These develop when proteins in the eye are damaged by photooxidation these damaged proteins build up, clump, and precipitate. It has been proposed that antioxidants may prevent cellular damage in the eye by reacting with free radicals produced during the process of light absorption. The results of intervention trials in this area have also been mixed. The Age-Related Eye Disease Study in the United States investigating the effects of combined antioxidant vitamins C (500 mg), E (400 IU), and -carotene (15 mg) with and without 80 mg zinc daily for 6...

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...

Relationship Between Visual Object Agnosia And Word And Face Recognition

One of the interesting recent developments in our investigations of object agnosia concerns different forms of category specificity, but here the category refers to different forms of visual stimulus recognition, such as face and word recognition. The critical issue is whether agnosia can be restricted to object recognition or whether it is reflects a broader form of visual impairment. In an extensive review of the literature, Farah suggested that the latter is more correct and that because visual recognition procedures for objects, words, and faces are not neurally separated, not all pure forms of visual deficit are possible. This argument was based on the fact that some but not all patterns of dissociation have been observed between these three classes of stimuli. In particular, Farah argues that there have been no convincing reports of patients with visual object agnosia without alexia or prosopagnosia or with prosopagnosia and alexia without visual object agnosia. The failure to...

Adlers Theory Of Personality

The Austrian psychoanalyst Alfred Adler (1870-1937) received his medical degree in 1895 from the University of Vienna with a specialty in ophthalmology but then changed to psychiatry after practicing in general medicine. Adler was one of the charter members of the Vienna Psychoanalytic Society, serving as its president in 1910, but resigned from the society in 1911 because of theoretical differences with Sigmund Freud. Adler went on to establish his own school, called the Society for Free Psychoanalytic Research (later called the Society of Individual Psychology) which attracted followers throughout the world and inspired, also, the establishment of an experimental school in Vienna that employed his theories of education. Adler's theoretical approach to personality generally emphasized the concepts of goal striving, unity, and active participation of the individual and stressed the cognitive rather than the unconscious processes of personality. Adler's theory of personality is an...

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

Diabetes And Endocrine Disorders

Diabetes mellitus is one of the most common metabolic diseases encountered. The prevalence of diabetes mellitus in both adults and children has been steadily rising in the past 20-30 years. Improved glycemic control has a beneficial effect on microvascular and neuropathic complications in type 2 diabetes, but has no effect on the incidence of macrovascular disease. However, light control of blood pressure (with an ACE inhibitor or a beta-blocker) in patients with type 2 diabetes and hypertension reduces the risk of diabetes-related death, including that secondary to macrovascular complications, as well as the risk of other diabetes-related complications and eye disease.10 Good control of diabetes also decreases the potential for postoperative infection. Diabetic patients need careful treatment with adjusted doses or infusions of short-acting insulin based on frequent blood sugar determinations.

What does Oxidant Stress Cause

Oxidant stress, through its effects on key biological sites and structures, is implicated in chronic noncommunicable diseases such as coronary heart disease, cancer, cataract, dementia, and stroke (Figure 4). Oxidant stress is also thought to be a key player in the aging process itself. A cause-and-effect relationship between oxidant stress and aging and disease has not been confirmed, however, and it is very unlikely that oxidant stress is the sole cause of aging and chronic degenerative disease. Nonetheless, there is evidence that oxidant stress contributes substantially to age-related physiological decline and pathological changes. Consequently, if it is accepted that oxidant stress is associated with aging and degenerative disease, then opposing oxidant stress by increasing antiox-idant defense offers a potentially effective means of delaying the deleterious effects of aging, decreasing the risk of chronic disease, and achieving functional longevity. For this reason, there has...

Costeffectiveness analysis

Presented as a cost-effectiveness ratio (CE ratio), with costs in the numerator and health outcomes in the denominator. The ratio is a measure of value the smaller the ratio, the fewer the resources required for a given unit of health outcome. Costs are determined in the same manner as for cost analysis, as discussed above. The health outcomes are generally measured by some biological unit, such as intraocular pressure for glaucoma interventions, or by life-years saved for cancer chemotherapy.

Preoperative Examination

Medical history, such as past history (previous abdominal surgery, trauma, accident) the presence or absence of previous anesthesia and its related complications previous drug allergies the presence or absence of contraindications to anticholinergic agents, such as ischemic heart disease, glaucoma, prostatic hypertrophy review of oral medications use of anticoagulants or nonsteroidal antiinflammatory drugs (NSAIDs) blood coagulation tests thoracic and abdominal radiography and electrocardiography.

Additional Ethical Issues

Unfortunately, many of the issues that affect younger individuals with regard to access to healthcare and research do not disappear when people get older. While this is not a great concern in countries with a national health service or national health insurance, it remains a major issue in the United States. Many people, including a surprising number of older people, assume that Medicare, the federal health insurance program for older people, covers most healthcare needs. While Medicare pays a substantial portion of hospital and physician fees for acute care, it does not cover the cost of medications, many preventive services, and important items for older people such as eyeglasses and hearing aids most important, Medicare pays for very few long-term care services. Older people who are poor, female, or minority,

The last great crisis

The farther back we try to go in time, the more we feel the effects of our geological myopia. Indicators become more and more fragmentary, and harder to decipher. So let us start with the least far-off of these mysteries, the one where there has not yet been enough time to eliminate all trace of the culprit - the KT crisis. What can paleontologists tell us about this last great crisis that struck our planet

Figure SC12 Complications

Patients with diabetes may present for incidental surgery or for surgery related to their diabetes, particularly abscesses, wound debridement, amputation of toes, feet or limbs, and cataract surgery, although diabetic patients do not have a higher incidence of cataracts, simply an earlier presentation of the condition. Whether the surgery is incidental or not, and whether the diabetes is insulin or non insulin dependent, there is an interaction between the surgical insult and the diabetes that needs to be properly managed to maintain stability and avoid further complications of both the diabetes and the surgery. Inadequately managed diabetes can result in hyper- or hypoglycaemia, ketoacidosis, wound infection and delayed healing. Occasionally the surgical condition can result in instability and toxic confusion, which will, of course, make the diabetes more unstable and worsen the surgical condition. Patients should not be presented for anaesthesia unless their diabetes is under...

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).

Visual Factors Perception of the Image

Figure Ground Perception Examples

This allows for the greatest visual acuity when the image is focused on the fovea centralis. However, this is a relatively small area owing to the fact that the cones, which are responsible for visual acuity, are concentrated at the fovea, especially at its center, and this accounts for the rapid decline in acuity just a few degrees from the fovea centralis. Of necessity, then, peripheral vision is used as the initial step in reading a radiograph. Use of peripheral vision allows for a considerably larger, although not as acute, field of vision in which to select possible abnormal areas from numerous areas of suboptimal quality images projected on the retina. There is a direct relationship between visual field size and the time required to locate a target.1 After an object of possible interest is located, the eye then moves to a position that focuses the fovea centralis on this point. In this position, detailed information can be obtained. In addition to...

Natural Infections

Although infection may be asymptomatic, symptomatic disease typically follows a predictable course. Clinical signs at the onset of disease in horses and sheep are nonspecific excited or depressed behavior, hyper-thermia, anorexia, jaundice, constipation, and colic. Classical disease becomes apparent within 1 or 2 weeks. Animals maintain an upright, wide-based stance with their heads extended. Repetitive behaviors are common and may include vacuous chewing, circular ambulation, and running into obstacles. Horses become paretic in the terminal phases of disease. A distinctive decubitus posture associated with paddling movements of the legs has been described. Frequently, in late disease, the virus migrates centrifugally along the optic nerve to cause retinopathy and visual impairment. Acute mortality may be as high as 80-100 in horses and 50 in sheep. Sheep that survive may have permanent neurologic deficits. Recurrence of acute disease has been described in sheep. Natural symptomatic...

Suggested Reading

Localisation in the Cerebral Cortex. SmithGordon, London. Mesulam, M.-M. (1994). Higher visual functions of the cerebral cortex and their disruption in clinical practice. In Principles and Practice of Ophthalmology (D. M. Albert and F. A. Jakobiec, Eds.), pp. 2640-2653. Saunders, Philadelphia. Mesulam, M.-M. (1998). From sensation to cognition. Brain 121, 1013-1052.

Measuring consciousness

Other techniques to present stimuli nonconsciously do exist, such as parafoveal presentation (presenting items in peripheral vision) or dichotic listening (ignoring a message played to one ear while listening to the message played to the other ear). However these rely on directing the focus of a subject's attention away from the stimulus whose processing is being indirectly tested. It is therefore always difficult to entirely rule out momentary switches of attention to the supposedly unattended stimuli. In contrast, a well masked stimulus is hidden from a subject however hard they try to perceive it.

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

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.

Arthropoda Models For Human Disease

The authors present several cases of genes present in Drosophila that are representative of human disease-causing genes, including polyglutamine repeat neurodegenerative disorders. In this instance, the size of the poly-glutamine repeats can be related to the onset time and severity of the resultant neurological disorders in both flies and man. Indeed, the authors cite a broad spectrum of shared mechanisms including CNS, cardiac, cancer, immune dysfunction, and metabolic disorders that relate Drosophila genes to their human counterparts in virtually every known biochemical capacity ranging from transcription factors to signaling components to cytoskeletal elements to metabolic enzymes. Specific examples (that are beyond the scope of this discussion) include (i) primary congenital glaucoma, (ii) Angelman syndrome, and (iii) Alzheimer disease.

Control of Blood Glucose Level

Irrefutable evidence exists that better control of blood glucose concentration reduces the risk of developing long-term complications from diabetes. This is especially true of microvascular complications such as retinopathy (eye disease), nephropathy (kidney disease), and nerve damage in both type 1 and type 2 diabetes. Control of blood glucose also reduces the risk of macrovascular disease (heart disease, stroke, and peripheral vascular disease), although the contribution of blood glucose to these complications is less strong.

Complications Of Immunosuppressive Agents

Glucocorticoids act primarily by inhibiting T-cell and macrophage function. In addition to immune suppression, long-term use of glucocorticoids suppresses endogenous adrenal function, which may produce Cushing syndrome and cause hypertension, glucose intolerance, osteoporosis, avascular necrosis of the hip, cataracts, pancreatitis, peptic ulcer disease, delayed wound healing, behavioral disorders, and malignancies.

Selection of Dietary Assessment Measure

A third important objective of dietary survey data is to gain a better understanding of the correlates of nutrient intake, but with respect to individual characteristics that may be associated with lower versus higher intake and the extent to which intake is associated with indicators of health. For many nutrients, the day-to-day variation in intake is considerable, and multiple days would be required to achieve stable estimates of intake at the individual level. Without this, the misclassification of individuals in the distribution leads to a weakening in the ability to see associations that may truly be there. An extreme example is vitamin A, which tends to be concentrated in a few foods. If one frequently has liver and carrots, but happened not to on the day of the recall, that individual would be classified as having low vitamin A intake when their usual intake is quite large. Conversely, one who almost never eats these foods, but happened to have liver on the day of the recall...

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

Ophthalmic Factors in Interpretation of Vitreous Biochemistry

As stated earlier, only normal vitreous should be sampled for biochemical analysis, as disease affecting the vitreous may well markedly alter its biochemical and cellular composition and lead to misleading results. This important interpreta-tional factor has hardly been considered in the extensive literature reporting biochemical and toxicologic findings in the vitreous.16 An ophthalmic history taken from the family, clinical notes, or information recorded by the family doctor or optician probably would alert the chemical pathologist to the presence of eye disease. The likelihood of intrinsic ophthalmic disease is small but should be considered in the interpretation of biochemical and toxicologic findings from the vitreous humor. Awareness of this potential problem is the key to avoiding pitfalls, and attention to the color and viscosity of vitreous samples and to the assay of samples from both eyes likely will ensure that errors do not occur. If only one vitreous humor sample is...

Complicating Effects of Radiation

The embryo has developed into a fetus at about the seventh to eighth week, and neurologic development occurs during the next 7 weeks. Significant x-ray exposure at this time (between weeks 8 and 15) may result in mental retardation, small head size, and decreased IQ. Other possible but less likely effects due to significant exposure during this period include growth retardation as an adult and sterility. Even less likely but still possible are cataracts, neuropathology, and growth retardation at term. Most of the deterministic effects mentioned above are either not observed or observed much less frequently when the fetus receives significant radiation dose beyond 15 weeks postconception. Mental retardation has been observed as a result of significant exposure during the eighth to twenty-fifth weeks but not beyond. Other effects that have been observed because of exposure after week 15 include sterility and growth retardation as an adult. Less likely effects that have been demonstrated...

External Examination

Cherry-red discoloration is variably observed in the clinical setting, which reflects the observer's visual acuity and experience, and the fact that lower COHb concentrations are usually encountered (461,471,481,500). Cyanosis is more likely (461, 532). Congestion of deeper vessels by COHb causes the skin to appear cyanotic (539). An individual in a cold environment who succumbs to CO vasoconstricts superficial skin vessels, resulting in sequestration of CO-saturated blood in deeper tissues (540). At the scene, failure to examine the entire body and poor lighting means missing the diagnosis (490). The characteristic red lividity of CO poisoning is usually associated with a COHb level greater than 30 however, some cases with a COHb level up to 80 do not show this finding (17,533,540). One study showed that about 98 of unintentional CO-related deaths had typical lividity (533). Three victims without red livor had COHb levels of 18, 28, and 31 , respectively. Coroners recognized only 61...

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...

Clinical Features

As with any ocular complaint, the physician should perform a thorough examination of the structure and function of both eyes, including, when age appropriate, examination of visual acuity, visual fields by confrontation, extraocular muscle function, periorbital area, eyelids (with eversion), conjunctivae, cornea with fluorescein staining, pupillary reflex, anterior chamber, and fundus. Erythema and increased secretions characterize conjunctivitis. Chemosis may be seen. Intense erythema and purulent discharge are more common with an infectious rather than an allergic cause. The cornea does not stain with fluorescein in children with conjunctivitis unless an associated keratitis has developed, as with herpes simplex or adenoviruses. Most importantly, visual acuity is normal.

Differential Diagnosis

The differential diagnosis of the red (or pink) eye includes conjunctivitis, orbital periorbital infection, foreign body, corneal abrasion, uveitis, and glaucoma. Periorbital and orbital infections cause obvious swelling and tenderness around the eye and or loss of ocular mobility. Foreign bodies should be visible on direct examination, often only following eversion of the upper eyelid. Thus the differential diagnosis usually revolves around four conditions conjunctivitis, corneal abrasion, uveitis, and glaucoma (Table HZ-2). Both uveitis and glaucoma are uncommon. The erythema in these conditions is concentrated around the limbus, and the discharge consists primarily of tears. Additionally, the vision is decreased in glaucoma, and the cornea may be cloudy. A corneal abrasion is easily identified by the uptake of fluorescein. Conjunctivitis is generally self-limited, with the notable exceptions of herpes simplex and N. gonorrhoeae. The potential complications are corneal ulceration...

Achromatic Versus Chromatic Contrast

Achromatic contrast detects spatial differences, which depend on the distribution of light energy in the retinal image. For daylight vision, it is mediated by the two longer wavelength-sensitive cones. It is well developed in the fovea, mediating our highest spatial resolution, and represented in relatively large areas of visual cortex. The foveal area of striate cortex is about 36 times larger than that of striate cortex serving peripheral vision. In the fovea, the responses of neighboring cones are compared for achromatic contrast (Fig. 6). Extrafoveally, spatial resolution is reduced because ganglion cells collect synergistic signals from more than one cone. Achromatic contrasts establish local lightness and darkness, which input orientation-selective neurons in striate cortex and undoubtedly contribute to form perception. Lightness or darkness is determined entirely by simultaneous contrast. Absolute values of light energy are discarded by antagonistic interactions between neurons...

Cerebral Achromatopsia

There are rare exceptions-to the tolerance of color discrimination despite large losses in acuity. An occasional subject loses color vision but maintains normal visual acuity after acquired damage of visual cortex. The cases that have been studied most completely with the entire gamut of color testing methods confirm major but not complete loss of color discrimination. They appear to be able to use wavelength

Xanthophylls Lutein and Zeaxanthin

Free radical damage is also linked to the development of cataracts. Cataracts remain the leading cause of visual disability in the US and about one-half of the 30-50 million cases of blindness throughout the world. Although cataracts are treatable, blindness occurs because individuals have either chosen not to correct the disease or do not have access to the appropriate medical treatment. Several epidemiological studies have shown inverse associations between the risk of cataracts and carotenoid intake. However, these studies also present inconsistencies with regard to the different carotenoids and their association with cataract risk. Lutein and zea-xanthin are found in the lens and are thought to protect cells in the eye against oxidative damage, and consequently prevent formation of cataracts. However, to date, there is no evidence that any carotenoid supplement can protect against cataract development. Eating plenty of fruits and vegetables, good sources of many antioxidants...

Mechanisms Of Cement Reaction

The primary requirement of back surgery is the prone position. Adequate eye care is important and there is no substitute for endotracheal intubation (possibly with an armoured tube) and IPPV using individual drugs of choice. The patient's arms must be carefully and symmetrically moved when turning into the prone position to avoid shoulder dislocation and pressure points should be padded. A suitable support should be employed to avoid abdominal compression, which will both embarrass ventilation and cause venous congestion in the epidural plexus. The Montreal mattress and Toronto frame are frequently used (Figure SI.2).

Nutritional Value of Fish and Shellfish Introductory Remarks

When included in the diet of pregnant and breastfeeding women, DHA is thought to be beneficial to infant brain (learning ability) and eye (visual acuity) development. Scientists have found that women who ate fatty fish while pregnant gave birth to children with better visual development. Babies of mothers who had significant levels of DHA in their diet while breastfeeding experienced faster-than-normal eyesight development. Preliminary research also suggests that a diet rich in omega-3 fatty acids - and in DHA in particular - may help to decrease the chance of preterm birth, thus allowing the baby more time for growth and development.

Macroscopic Examination and Recording of Pathologic Findings

The following is a brief account of the external and internal examination of the eye. Because of limitations of space this section is by no means comprehensive, and you should refer to detailed ophthalmic pathology textbooks for more detail. I recommend Lee's Ophthalmic Histopathology for both his illustrations and practical approach to diagnosis, which is particularly suitable for histopathologists with little background in ophthalmology.24

The Role of the Ophthalmic Pathologist

In reality, a large body of medical evidence is well established1032-35 and is reviewed by Levin.32 Papers such as those produced by the Ophthalmology Child Abuse Working Party3334 are attempts to find consensus views on these important issues, to guide clinical practice. This is not in any way to say that there are not difficult and poorly understood aspects of the precise mechanisms by which infants are physically abused. My aim in this chapter is to highlight the pathologic features that must be looked for and properly documented in the eyes. Once you and the ophthalmic pathologist have secured this primary evidence, other experts and lawyers will have the opportunity to see the pathologic material on which to base their discussions and opinions. If allowed by the court, juries also will be able to see the material.

Abusive Blunt Trauma to the Eyes

In my experience, I have found it extremely important to look for indications of direct blunt trauma to the eyes in dead children, even though such direct blunt traumatic injuries are extremely unlikely to have caused the death of the infant. The ophthalmology and or pathology of accidental blunt injuries to the eyes is well known, but such injuries can also be caused by nonaccidental (deliberate) trauma to the eyes. If the ophthalmic pathologist finds severe injuries attributable to blunt trauma in one eye, the injuries could be explained by accidental blunt trauma to that eye. However, if such severe injuries are found in both eyes, then simultaneous (or consecutive) severe injuries to both eyes are extremely unlikely to be accidental (as the eyes point in different directions, and they are protected by being sunk in the orbits) and are extremely likely to be deliberate. In a dead child, these findings are extremely important medicolegally, either with or without another...

Meningomyelocele Myelomeningocele

Children with meningomyelocele have multiple, complex medical problems due to impairment of nerves at or below the site of the lesion. There is variable impairment of sensory and motor nerves controlling voluntary and autonomic functioning. Associated medical concerns include neurogenic bowel and bladder function, contractures, scoliosis, club feet, hydrocephalus, Chiari II malformation, tethering of the spinal cord, spinal cord syrinx, vesicoureteral reflux, decubitus ulcers, constipation, encopresis, recurrent urinary tract infections, growth failure, latex allergy, gastroesophageal reflux, apnea stridor syndrome, seizures, partial agenesis of the corpus callosum, strabismus, visual acuity impairment, precocious puberty, and osteoporosis. Individuals also may have cognitive impairments. Mild forms of cognitive impairment may affect visual motor functioning. More severe cognitive impairment has been associated with sparing of verbal skills and a cocktail party syndrome, in which the...

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...

Disorders of Galactose Metabolism Clinical Manifestations

Classically, the term 'galactosemia' was associated with an inherited disorder of galactose utilization characterized by malnutrition, liver disease, cataracts, and mental retardation, resulting from the specific deficiency of galactose-1-phosphate uridyl-transferase. However, other enzymatic defects with variations of clinical presentation can also lead to galactosemia (Table 1). Thus it is preferably better to refer to these abnormalities of metabolism by the specific enzymatic deficiencies which are described below. Cataracts symptoms Cataracts Cataracts have been observed within a few days of birth. These may be found only on slit-lamp examination and can be missed with an ophthalmoscope, since they consist of punctate lesions in the fetal lens nucleus. Several hypotheses have been postulated to account for their formation and are mentioned above. It seems conclusive that the initiator of the process in rats is galactitol and not galactose 1-phosphate. Galactose 1-phosphate...

Legal and Ethical Background to Ophthalmic Autopsy Practice Legal Considerations

In an autopsy performed by the coroner or equivalent authority, when the eyes are required for diagnostic purposes (e.g., in suspected cases of nonaccidental injury in infants) or to determine the possible contribution of suspected eye disease to the cause of death (e.g., retinitis pigmentosa or diabetic retinopathy in a road traffic accident). Again, the coroner and pathologist should have a policy on the eventual treatment of the eye tissues that reflects the Royal College of Pathologists guidelines for the retention of tissues and organs at post-mortem examination.48 3. From patients who have donated their eyes for corneal transplantation. These eyes usually are removed by ophthalmologists after arrangement through eye banks, and pathologists are rarely involved. Specific authorization must be confirmed before the eyes are removed.

Associative Agnosia

One of the important claims of associative agnosia is that perception is intact and it is meaning that is inaccessible. Much effort has been directed at evaluating this claim and the general finding is that even patients with associative agnosia have some form of visual impairment. For example, LH, a well-known and thoroughly documented agnosic patient studied by Levine and Calvanio, was moderately impaired on several tests of perception. He was considerably slower than normal subjects in making rapid comparisons between shapes or in searching for a prespecified target figure. His performance was also poor on tasks that required him to identify letters that were fragmented or degraded by visual noise, relative to control subjects. Based on the findings from LH and other associative

Ethical Considerations

Whenever the removal of tissues is likely to alter the facial appearance of the deceased, specific signed consent from relatives or consent from the coroner or equivalent authority must be obtained for any procedure, and ethically the reasons for the procedure must be sufficiently important to warrant the possibility of further distress to relatives. Arrangements may be necessary to ensure that the body is only viewed by the relatives before the procedure. Removal of tissues to this extent must be viewed as most exceptional, and discussions with the coroner or local ethical committee may be advisable before relatives are consulted or informed. Under such circumstances it probably is advisable for a senior ophthalmologist (possibly accompanied by a senior pathologist) to explain the circumstances to the relatives to ensure truly informed consent. It must always be assumed that a close relative will view the body after the autopsy procedure has been performed, unless specific...

Managing Incompetence

Because functional or decision-making capacities occur on a continuum and because a person's capacities can be expected to fluctuate over time, in most cases a clinician need not be resigned to accept a patient as permanently incapacitated. The clinician frequently has opportunities to enhance the person's functional or decision-making capacity. Hearing aids, eyeglasses, psychotropic medication, counseling and psychotherapy, and specific behavioral training in the area of incapacity are examples of remedial efforts that can be made to improve a person's capacity. When such efforts fail, disposition of those who are incapacitated is a complex matter and varies with the context in question. In a case where life-saving treatment may be needed, the clinician may have to obtain an adjudication of legal incompetence in order to treat an incompetent refusing patient.

Rubella Congenital Syndrome

The congenital syndrome of rubella is an illness of infancy resulting from rubella virus infection in utero. Infants present with signs and symptoms from the following categories (1) cataracts congenital glaucoma, congenital heart disease, hearing loss, and pigmentary retinopathy or (2) purpura, splenomegaly, jaundice, microcephaly, mental retardation, meningoencephalitis, and radiolucent bone disease. Laboratory detection is undertaken by any of the following methods (1) isolation of rubella virus, (2) demonstration of rubella-specific IgM, or (3) infant rubella antibody levels persistently high for longer than expected from passive maternal antibody transfer. Infant antibodies should decrease by a twofold dilution each month of life.

Joseph Tan Mengistu Kifle Victor Mbarika Chitu Okoli

E-medicine can be defined as the diffusion of medicine and health care services through the use of information and communications technologies. In mainstream medical, public health, and health services research literature, terms such as telemedicine (which literally means medicine at a distance) and telehealth are often used interchangeably to refer to e-medicine services, with the understanding that telehealth encompasses not only telemedicine services but also important e-health administrative and support services (see Chapter Seven). The application of telemedicine to deliver e-health care and e-health education is not new (Bashshur, 1997). Throughout this book, however, the term e-medicine is often used not only in a broad sense because it corresponds elegantly to the notion of e-health diffusion but also in a more restricted sense because it refers to a specific aspect of e-health diffusion the diffusion of various specialties and subspecial-ties within the telemedicine domain....

Genetics of Prader Willi Syndrome

Fulfillment of diagnostic criteria and genetic testing confirm in individuals suspected with PWS. In 1993, age-stratified diagnostic criteria were published by Holm et al. PWS is very likely in children < 3years of age with 5 points (3 from major criteria) or in those > 3 years of age with 8 points (4 from major criteria). Major diagnostic criteria for PWS (1 point for each) include infantile central hypotonia, feeding difficulties in infancy, accelerated weight gain in early childhood, hypgonadism, developmental delay and typical facial features (narrow bifrontal diameter, almond palpebral fissures, narrow nasal bridge, down-turned mouth). Current minor diagnostic criteria for PWS (1 2 point each) include decreased fetal movement, sleep apnea, short stature, hypopigmenta-tion, small hands feet, narrow hands with straight ulnar border, esotropia myopia, thick saliva, skin picking and speech problems. Other commonly reported features of individuals with PWS include high pain...

Organisms S aureus S epidermidis Conjunctivitis Adult and Children Notes

If conjunctivitis is secondary to an imbedded organic material (mascara brush, tree branch), or in contact lens wearers, consider antipseudomonal coverage. 4. Slit lamp exam important to rule out herpes as organism. If herpes or gonococcus suspected, immediate ophthalmologic consultation is indicated.

Inpatient Therapy Regimen A

Antituberculosis medications have inherent toxicities and side effects INH (hepatitis, peripheral neuropathy), rifampin (hepatotoxicity, flu-like syndrome, discoloration of body fluids staining of contact lenses), PZA (arthralgias, hyperuricemia, hepatitis), ethambutol (optic neuritis), and streptomycin (ototoxicity). Close monitoring is essential.

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

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

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...

Confidence And Appearance Stereotypes

Self-perception theory asserts that we know our own attributes in the same way that we know about the attributes of others. If that is the case, then stereotypes about appearance that affect our judgments of others should affect our judgments of ourselves as well. Certainly stereotypes are powerful determinants of our judgments of others. For example, more attractive people are routinely judged to be smarter and more humorous and to have performed better at a variety of tasks (Dion, Berscheid, & Walster, 1972). Tall people are more likely to be seen as leaders conversely, people who have achieved leadership positions are judged to be taller than they actually are (Jackson & Ervin, 1992 Montepare, 1995 Wilson, 1968). Unfortunately for experimental design purposes, most stereotypical aspects of appearance, such as attractiveness or height, are not easily manipulated. Fortunately, one is. This is the stereotype that people who wear glasses are more intelligent....

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,...

Elimination By Aspects Theory

EMMERT'S LAW. size-distance invariance hypothesis. This generalized principle is named in honor of the Swiss ophthalmologist Emil Emmert (1844-1911) and refers to the tendency of a projected image (usually an afterimage) to increase in size in proportion to the distance to which it is projected onto a background surface. Emmert's law is also called the afterimage law cf., U. Ebbecke (1929) who proposed a theory of positive and negative afterimages. Another afterimage phenomenon is the McCollough effect color-contingent aftereffect - named after the American psychologist Celeste Faye McCol-lough (1926- ) - which is a persistent afterimage produced by saturating the eye with red and green patterns of different angularity in a typical demonstration, a pattern of bright red

The Foveation System

Smooth Pursuit System And The Brain

As in most primates, the human retina has a tremendously specialized central zone, the fovea, where visual acuity is 1000 times better than vision just 10 eccentric. Hence, to look at'' something is effectively to foveate it. However, the fovea subtends only 1 of visual angle (equivalent to the full moon's subtend). Therefore, the second principal function of eye movements is to foveate important parts of the visual scene.

TABLE 2311 Drugs that Can Cause Hypocalcemia

Idiopathic Hypoparathyroidism Idiopathic hypoparathyroidism is probably an autoimmune disorder in which pernicious anemia, exostoses, moniliasis, Hashimoto disease, sterility, and Addison disease may be seen. This syndrome may also be associated with cataracts, mental retardation, intracranial calcifications, and papilledema due to increased intracranial pressure.

Defining Disability Conceptual Issues

Thus, not every impairment is disabling. An abnormal shape of the eyeball that prevents light from focusing properly on the lens is an impairment, but if the afflicted person can see perfectly well with glasses or contact lenses and carry out the same activities that other people can, that impairment is not disabling. One also can ask whether a disability is a handicap. Franklin Delano Roosevelt had a disability (he could not walk) that no doubt prevented him from fulfilling some social roles, but it did not prevent him from fulfilling the role of president of the United States, and so in that respect it was not a handicap.

Emergency Department Treatment

Once the primary survey is completed, a careful head-to-toe examination should be performed to identify occult injuries. The cutaneous examination may disclose burns and may help determine the path of the current and locate potential organ injuries. Care for a superficial lightning burn includes cleansing, debridement, application of a topical antimicrobial agent, and administration of tetanus prophylaxis, if indicated. Fasciotomy is rarely indicated, since circulatory disorders are frequently consequences of vasospasm and resolve spontaneously. A careful neurologic examination should be performed to detect motor and sensory deficits. Ophthalmologic (including slit-lamp examination) and otologic examinations should be done to rule out visual and hearing disturbances, as well as tympanic membrane rupture. Abdominal distention due to ileus should be treated with gastric decompression. An acute abdomen may be due to blunt injury and intraperitoneal injury.

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...

Treatment of Infectious Patients

Derivatives of 8-oxyquinoline (intestopan, mexaform, mexase, 5-NOK) are used to treat intestinal infections. These preparations do not inhibit normal intestinal flora, decrease putrefactive and fermentative processes in the intestine. Prolonged use of 8-oxyquinolines can cause peripheral neuritis and impair vision.

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.

Parametersetting Theory

PARANORMAL PHENOMENA THEORY. extra-sensory perception parapsychology psi phenomena. The paranormal class of effects refers to supernatural events results (beyond the normal) that are inexplicable by the usual laws of science and or reason. The related terms extra-sensory perception (ESP) (including clairvoyance, precognition, and telepathy) and psychokinesis (PK) are generic terms for various hypothetical paranormal phenomena that involve experiences having no direct sensory contact, or refer to perception without the use of sense organs (cf., concordant twin theory - the proposition that identical twins will be able to communicate via ESP to a higher degree than concordant twins, and that - even if separated either at birth or soon after - such twins in the future will have similar preferences and lifestyles as well as identical physical ailments). The American parapsychologist Joseph B. Rhine (1895-1980) claimed to have coined the term extra-sensory perception in 1934, but the...

Table 152 Ocular medications commonly used by EPs

Glaucoma Agents -blockers (i.e., timolol) Mydriatics As do cycloplegics, these agents cause pupil dilation. However, mydriatics do not necessarily produce cycloplegia. The main use is to allow for adequate fundoscopic examination. Use in angle closure glaucoma and ruptured globe is contraindicated. Glaucoma agents See discussion below. Corticosteroids Steroids may worsen certain conditions and should be prescribed only in conjunction with a consulting ophthalmologist (with the possible exception of iritis).

Walter WK King1 John KS Woo2 and Dennis SC Lam3

'Centre Director, Plastic & Reconstructive Surgery Centre, Hong Kong Sanatorium & Hospital, Hong Kong Honorary Clinical Professor, Department of Surgery, The Chinese University of Hong Kong 2Consultant in Otorhionolaryngology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong Honorary Clinical Associate Professor, The Chinese University of Hong Kong 3Professor and Chairman, Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong

Agerelated Differences in Prospective Memory Proper Theoretical Expectations

In related theoretical accounts, Pichora-Fuller, Schneider, and Daneman (1995) and Schneider and Pichora-Fuller (2000) have argued that age-related declines in performance on a variety of cognitive tasks may be the result of impoverished stimulus representations due to age-related declines in sensory functions (Anstey, Stankov, & Lord, 1993 Baltes & Lindenber-ger, 1997 Lindenberger & Baltes, 1994 Salthouse, Hancock, Meinz, & Hambrick, 1996). By this view, declines in sensory functions (e.g., visual acuity, auditory acuity) lead to impoverished or inaccurate representations of stimuli, and in turn, the impoverished representations demand more top-down processing, deplete limited processing resources, and in turn lead to degradation in other resource-demanding cognitive processing. Cast in Craik's (1983) framework, age declines in sensory functioning result in less environmental support for older adults and demand more self-initiated processing. Given the age declines in...

Acanthamoebic keratitis

Improper contact lens wear and care are the most important risk factors. The condition is easily confused with herpes keratitis and if not properly diagnosed and treated, blindness is a common outcome. Patients usually present with severe eye pain and photophobia. The classical finding is a ring infiltrate in the cornea and the symptoms are usually much greater than the signs. Since Acanthamoeba is a neurotrophic organism, the presence of enlarged and prominent corneal nerves is an important clue to this condition. Treatment is difficult and requires prolonged use of relatively toxic medications like neosporin, dibromopropamidine, propamidine, polyhexamethylene biguanide and chlorhexidine.

Dietary Guidelines for Health Function and Disease Prevention

The additional susceptibility of older persons to chronic degenerative diseases makes adherence to these healthful dietary patterns, throughout the periods in the life span preceding the older years, more relevant. Recent epidemiological research has shown that compliance or behavior concordant with healthy eating guidelines are associated with lower later life incidences of certain cancers, cataracts, diabetes, hypertension, stroke, and cardiovascular diseases, as well as overall survival. There is intense interest in whether and how diet and nutrition influence the maintenance of cognitive function with aging.

The Complexity of the Health Care Market

The MBCO that consumes hospital services is in competition with the hospital with which it contracts, inasmuch as the MBCO is in the business of diverting inpatient (hospital) care to outpatient care because it is more cost-effective. Nurse practitioners, as less expensive providers, replace primary care physicians (PCPs) where feasible and, in turn, many PCPs do the work of specialists. Each of these is a market, and each is competing for a market share in an environment of scarcity. Competing markets are throughout health care orthopedic surgery versus podiatry, ophthalmology versus optometry, nurse practitioners versus physician assistants, and psychiatry versus psychology (and now psychology versus social work and other master's level practitioners). Some of these markets at times seem to resemble open warfare toward each other. But the economic trend is unmistakable The health care sector is pushing knowledge downward, using wherever appropriate less expensive providers to do the...

Painful Visual Reduction Loss

ACUTE ANGLE-CLOSURE GLAUCOMA Acute angle-closure glaucoma presents with cloudy vision, eye ache and or headache, increased intraocular pressure, and frequently nausea and vomiting. Abdominal symptoms can sometimes be misleading and delay the diagnosis. Acute angle closure typically occurs in a patient with no previous history of glaucoma. These patients generally have narrow anterior chamber angles and suddenly develop pupillary block when the pupil becomes middilated and the iris leaflet touches the lens. This prevents circulation of the aqueous humor from the posterior chamber (where it is produced by the ciliary body) through the pupil and into the anterior chamber (where it is filtered out of the eye through the trabecular meshwork located in the angle). The continuous production of aqueous in the posterior chamber is trapped and the increasing hydrostatic pressure bows the iris forward, further compromising the angle and inhibiting outflow ( Fig. 2.3.0-15.). Intraocular pressure...

Nasopharyngeal cancer

The first sign of NPC is often an enlarged metastatic cervical node in the posterior triangle. Common local signs and symptoms include nasal (blood-stained discharge, obstruction), aural (serous otitis media, tinnitis, conductive hearing loss) and neurological symptoms (diplopia due to abducen nerve paralysis). Diagnosis is by flexible fibreoptic nasopharyn-goscopy and biopsy. Elevated blood levels of antibodies to Epstein-Barr virus capsid antigen (IgA-VCA) and early antigen (IgA-EA) are often seen. CT and MRI are useful in staging the disease and in detection of recurrence. Radiation is the firstline treatment for NPC of all stages because of the radiosensi-tivity of undifferentiated carcinoma. For recurrent disease after radiotherapy, surgical resection of the nasopharynx by the transoropalatal approach, mandibular swing or maxilla swing approach are recently established surgical salvage procedures that are preferred over re-irradiation which is associated with complications...

Motion And Pursuit Eye Movements

The human visual field has a very high acuity central region, the fovea, and visual acuity declines rapidly for more peripheral regions. To position objects near the center of the fovea, humans and monkeys have developed sophisticated brain circuitry that produces two different types of eye movements saccades and smooth pursuit. Saccadic eye movements are rapid, step-like changes in eye position, that are used to quickly look around a scene or to read. Saccades have latencies of about 200 msec, very short durations (< 50 msec), and can have very high velocities (300 sec). These extremely fast eye movements cause the world to move relative to the eye with high velocities during saccades, but we do not perceive the world to move. The high saccadic velocities and short durations generally produce world motion on the retina too fast for the visual system to detect.

Step 4 Determine Whether No or Low Cost Alternatives Are Available

Funding sources are often determined by the age of the individual consumer (school system), level of income, relationship to certain state agencies (aging, rehabilitation, deaf and hard of hearing, visual impairment, etc.). Private or public insurance are considerations but primarily for purchase of medically related equipment, which often excludes assistive technologies such as computers, software, memory devices, etc.

Symptomatic Treatments Of Dystonias

Side effects of anticholinergic drugs are central and peripheral. Central effects include confusion, memory impairment, hallucinations, restlessness, insomnia, nightmares, and sedation. Peripheral side effects (such as dry mouth, blurred vision, exacerbation of acute angle glaucoma, urinary retention, and constipation) may be controlled by peripheral cholinergic drugs, such as pyridostigmine or pilocarpine. Side effects

Motor Vehicle Crashes

Motor vehicle-related injuries rank as the leading mechanism of injury that brings elderly patients to a trauma center in the United States. Motor vehicle crashes are the most common mechanism for fatal incidents in elderly persons through 80 years of age.1 Emergency physicians should anticipate an increase in motor vehicle trauma involving the elderly due to the growth in this subset of the population and the increase in elderly drivers and occupants. Recent data by Li and colleagues 5 have shown that the crash fatality rate among the elderly is considerably higher than for younger age groups. As noted earlier, similar effects of acute and chronic medical conditions can influence the incidence of motor vehicle crashes. The patient may have decreased cerebral and motor skills and may have memory and judgment losses that can compound the difficulty in operating a motor vehicle. The patient also may have decreased auditory or visual acuity that makes it more difficult to recognize...

Pedestrian Automobile Accidents

When elderly patients are struck by automobiles, devastating injuries may result. The 65 and older age group accounts for 22 percent of pedestrian-automobile fatalities in the United States.1 Elderly pedestrians struck by a motor vehicle are much more likely to die compared with younger pedestrians.7 Postural changes due to musculoskeletal decline may lead to kyphosis, which results in difficulty in lifting the head to see and obey traffic signals. Traffic signals, which operate at a crossing rate of 4 ft s, may not account for the elderly's slower walking speeds.1 Thus elderly individuals may not have enough time to safely cross an intersection. Reduced peripheral vision and decreased hearing may limit access to information needed to make rational decisions about crossing the street. Again, cognitive, memory, and judgment skills may be diminished and could play a role in pedestrians being struck by automobiles.

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.

Orbital Fissure Syndromes

A more serious variant is the orbital apex syndrome, which involves the optic nerve. Patients with the orbital apex syndrome have all the aspects of the superior orbital fissure syndrome, plus blindness or decrease in visual acuity. The swinging-flashlight test and visual acuity testing are crucial to the diagnosis. Patients with these syndromes need emergent ophthalmic intervention to save their vision. Although few emergency practioners have experience, cantholysis can be considered an ED procedure. It involves anesthetizing then crushing the lateral canthal fold to achieve hemostasis. The lateral canthal ligament is cut and the lids spring apart relieving intraocular pressure.

Encephalopathies Encephalomyelopathy of Birmans

This is a disease of Birman kittens, with onset at about 2-5 months of age (Jones et al., 1992). Affected animals show hindlimb paresis and ataxia, which progresses to hindlimb paralysis. Bilateral nuclear cataracts may be present. Affected kittens are usually related and the condition is inherited.

Laminar Differentiation

Neocortex varies in another way that also adds flexibility to its function. The laminar organization of neocortex has already been mentioned, as have the slight variations in the appearance and thickness of layers from cortical area to cortical area that reflect functional specialization. The same area can also vary across species in differentiation, so that the primary visual cortex in highly visual mammals, such as monkeys and humans, is more distinctively laminated than in poorly visual rats. Apparently, something is to be gained by tightly grouping cells in layers and sublayers of the same functional types and developing cells of different shapes to allow specialized functions, but there must also be some cost or loss for such differentiation or rats would have a highly differentiated visual cortex. Perhaps neurons in the primary visual cortex of rats, with poor vision and few visual areas, need to retain broad, general functions and thereby do not specialize. However, one of the...

Brown Shrinkage Effect

Sulzer (1858-1918) also called the Brucke effect, named after the German physiologist Ernst W. Brucke (1819-1892) and the Brewster effect, named after the Scottish physicist David Brewster (1781-1868) - refers to the phenomenon that a flash of light appears to be brighter than a steady light of the same intensity . See also RICCO'S PIPER'S LAWS. REFERENCES

Medicine in Ethiopia

As we noted earlier in this chapter, e-medicine involves delivering health care using telecommunication equipment as simple as telephones and fax machines or as complex as Internet-connected personal computers with full-motion interactive multimedia (Huston and Huston, 2000). There is a critical need to better understand the factors affecting the diffusion of e-medicine in developing countries. Services such as teleradiology, teledermatology, telepathology, telecardiology, and tele-ophthalmology can be extended to underserved communities and individuals in both urban and rural areas. In addition, e-medicine can help attract and retain health professionals in rural areas by providing ongoing training and collaboration with other health professionals. Although e-medicine, like all information and communication technologies (ICTs), was developed and tested in developed countries, it has successfully addressed some medical problems in developing countries. However, many of these...

Pure Meaning Concept Of

Vitamin A or to a congenital retinal defect. In addition to the Purkinje effect, Purkinje's name is honored in the terms Purkinje figures - the network of interwoven blood vessels of the retina that may be perceived under conditions of low ambient illumination and when a small bright light is positioned just under the eye as the person stares at a blank screen or wall Purkinje-Sanson images - named after Purkinje and the French surgeon Louis Joseph Sanson (1790-1841), refers to the perception by one person (by looking at a second person's eye) of three separate images of an object that the second person looks at, where one image is from the surface of the cornea, one is from the back of the lens, and one is from the front of the lens and the Purkinje afterimage -is the second positive afterimage that follows stimulation by a bright light that is a hue complement to the original stimulus the first in the sequence of three visual afterimages following a brief exposure to a bright light...

Periorbital and Orbital Exam

Nasal Palpation

The eye exam deserves particular attention, especially when there is periorbital injury. The exam should be performed early during the ED encounter, because, if not timely, progressive lid edema may prevent further examination. If lids are already swollen, lid retractors help visualize the globe. The bird's-eye and worm's-eye views help detect exophthalmos or enophthalmos. The pupil exam includes reactivity, and whether the pupils line up in the horizontal plane. A teardrop-shaped pupil indicates a ruptured or otherwise penetrated globe in patients without preexisting iridectomy. Examine for hyphema, although this usually requires a patient to be sitting. The presence of a hyphema correlates with significant visual loss. The Snellen chart, either standard or hand held, if feasible to administer, should be used to document visual acuity. If the patient cannot see the chart, record finger counting or, barring that, the presence or absence of light perception. Early recognition of...

Herpes Zoster Shingles

HZO is due to involvement of the ophthalmic branch of CN V and is a vision-threatening condition. The Hutchinson sign (lesions on the tip of the nose) may be seen before ocular involvement is recognized, but its absence does not rule out HZO. 20 Ocular involvement can be seen in the presence of only a slight rash on the forehead. HZO induces a keratitis and may be followed by involvement of deeper structures. There is usually facial pain, regional adenopathy, and occasionally a red eye preceding the appearance of the rash. A dendriform corneal ulcer can often be identified with fluorescein staining. The presence of a skin rash helps differentiate HZO from ocular HSV. HZO or suspected HZO mandates an ophthalmologic consultation due to the threat to vision.

Tranquilizer Rescinnamine

Histidine-derived alkaloids include pilocarpine and saxi-toxin. Pilocarpine stimulates parasympathetic nerve endings and is used to treat glaucoma. The main commercial source of pilocarpine is Pilocarpus microphyllus Stapf., known as Marnham jaborandi. Saxitoxin is an extremely toxic neuromuscular blocking agent found in the so-called coastal red tides of North America. Liver damage, carcinogenesis, venoocclusive disease (mammals) glaucoma (rat, mouse) LD ' (mouse) 20 mg kg Sanguinarine mustard oil and cereal grains (contaminated from Argemone mexicana) Expectorant for chronic eczema and skin cancers

Chronic Vesiculoulcerative Disease

CICATRICIAL PEMPHIGOID Cicatricial pemphigoid is a chronic vesiculobullous mucocutaneous disorder with an autoimmune etiology. Autoantibodies against the basement membrane result in subepithelial cleft formation. Cicatricial pemphigoid affects people in the seventh decade of life, with no race predilection. The ratio of males to females 1 2.27. Oral lesions are seen in approximately 85 percent of patients, but any mucosal or cutaneous site can be affected. Oral lesions may begin as a desquamative gingivitis or vesiculobullous lesions. Oral lesions eventually become denuded, leaving a painful, erythematous, irregularly bordered erosion or ulcer. Lesions may persist for weeks. Significantly, ocular involvement occurs in 65 percent of cicatricial pemphigoid patients and, if untreated, may lead to blindness. Referral to an ophthalmologist is essential. Diagnosis is by biopsy and immunofluorescent staining of perilesional mucosa. Histologically, the lesions show inflammatory infiltrates...

Betweenmodality Plasticity

Whereas anecdotal evidence of better audition after early blindness or better vision after early deafness exists, the available data are quite mixed. The longheld belief that multisensory integration is a necessary step in optimal development led investigators to focus initially on the disabilities caused by early blindness or deafness. For example, a number of studies, mostly from the 1970s and the early 1980s, document deficient spatial abilities in the blind and deficient visual perception in the deaf. The realization of the adaptability of the brain led investigators to carefully review this issue. It is now evident that when the etiology and characteristics of the population tested are carefully controlled and the task is appropriately chosen not to rely on encoding strategies that are not available to the deprived subjects, convincing evidence of compensatory plasticity can be established.

Visuospatial Functions

After the integrity of basic visual acuity is established, the spatial distribution of visual attention is evaluated. The presence of visual neglect is assessed through the use of tasks that require scanning across all quadrants of visual space. Assessment of left-right orientation involves directing patients to point to specific body parts, either on themselves or the examiner. Topographical orientation can be tested by instructing the patient to indicate well-known locales on a blank map. Graphic reproduction of designs and assembly of patterns using sticks, blocks, or other media are used to assess visual organization and constructional abilities. Facial recognition represents a special component perceptual process and can be measured using Benton's Facial Recognition Test. The Judgement of Line Orientation Test assesses perceptual accuracy in judging the angular displacement of lines. Warrington's Visual Object Space Perception Battery is an example of a collection of measures,...

Unconventional Surgery

A second class of unconventional surgical instrument is the micro- and nanoscale systems (microsystems are a thousand times smaller and nanosystems are a million times smaller than are current instruments). Like energy-directed systems and because of their small size, micro- and nanoscaled systems must be computer controlled. Some simple microsystems are being used for ophthalmology, otolaryngology, plastic, and neurological surgery, the most commonly employed is LASIK surgery. The experimentation now is on creating entire machines on a microscopic level for microscale there are the microelectromechanical systems (MEMS), which are etched from silicon wafers, and for nanoscale there are assemblies of molecules into specific configurations to produce tiny machines that can enter the blood stream and cells. At the time of this writing, demonstration nanoengines have been created but not designed specifically for any medical application in essence, proof of concept. How far these systems...