Better Vision Without Glasses

Easy Clear Vision Ebook

Dr. Benjamin Miller says that the steps given in the Easy Clear Vision guide make it is possible to get perfect 20/20 vision without wearing unattractive & highly breakable glasses or uncomfortable & even painful contact lenses and without undergoing any risky & expensive eye surgery. Further he explains that you dont have to invest anything in vision enhancing products once you follow the steps in his guide. Here are some highlighted techniques you will find inside this program: 1. How myopic develops and its treatment using eye exercises. 2. 21 Days program in which you will discover steps to get huge improvement. 3. Different eye exercises and techniques for Ocular Muscles that will improve eye muscles. Dr. Benjamin created this program in effective and natural way. You dont need any surgery or medicines to improve your eyesight. We all know that eye muscles can be trained. Doctors also agreed that eye exercises can improve the eyesight. Muscles can increase their functionality if they subjected to exercise and eye muscles are not different.

Easy Clear Vision Summary


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Cataracts and Glaucoma

The two most common causes of blindness are cataracts and glaucoma. A cataract is a clouding of the lens. It occurs as the lens thickens with age, and it is a common complication of diabetes mellitus. It causes the vision to appear milky or as if one were looking from behind a waterfall.48 Cataracts may also stem from heavy smoking and exposure to the UV radiation of the sun. They can be treated by replacing the natural lens with a plastic one. The implanted lens improves vision almost immediately, but glasses still may be needed for near vision. Glaucoma is a state of elevated pressure within the eye that occurs when the scleral venous sinus is obstructed and aqueous humor is not reabsorbed as fast as it is secreted. Pressure in the anterior and posterior chambers drives the lens back and puts pressure on the vitreous body. The vitreous body presses the retina against the choroid and compresses the blood vessels that nourish the retina. Without a good blood supply, retinal cells die...

Cornea iris and trabecular meshwork [glaucoma

Peters anomaly is shown in this figure. Corneal clouding is marked because corneal endothelium is abnormal, and glaucoma is common because the trabecular meshwork may be altered. This photograph demonstrates severe corneal clouding which would justify a penetrating corneal transplant in at least one eye of a bilaterally affected infant even though the prognosis for a successful corneal transplant in infants is poor.


Blinding diseases can destroy useful vision unless rapidly diagnosed and treated. The initial routine examination of all infants should be carried out by the primary care physician, and should include direct ophthalmoscopy, and an orderly structural examination to include the eyebrows, lids, and lashes and lacrimal system, conjunctiva, sclera, cornea, iris (note pupils), anterior chamber, lens, vitreous, and fundus (especially optic nerve and macula). Look for symmetry of ocular structures and clarity of optical media (clear cornea, lens, vitreous). The red reflex should be bright and symmetrical. In all preterm infants

Oil Drop Cataract

Galactosemia Oil Droplet Cataract

The cataract shown on the left is a classical oil drop cataract present at birth in an infant with galactosemia which is an autosomal recessive (galactoki-nase deficiency 9p13) disorder. On the right, the same eye is shown several years later with the cataract almost completely gone after years of good dietary control. Hallermann-Streiff syndrome is an autosomal dominant syndrome which is associated with hypotrichosis, mandibular hypoplasia, beaked nose, and endocephaly. The figure on the left demonstrates an early cataract in a child with the Hallermann-Streiff syndrome. The figure on the right is of die same eye a few weeks later showing progression to a dense cataract requiring surgery. Figure 2.81. Dense bilateral cataracts represent an ocular emergency since immediate referral can result in normal vision (20 20) and stereoacuity. This perfect result cannot be obtained if surgery with optical correction has not been completed by the age of 6 weeks following birth....

Infant Glaucoma

Eyes With Glaucoma

Aniridia with cerebellar malformation is an autosomal recessive disorder which seems to be associated with little variability in expression. On the left is a rather complete aniridia with corneal clouding due to glaucoma. On the right is another virtually complete aniridia with minimal iris remnants. Figure 2.58. Aniridia with cerebellar malformation is an autosomal recessive disorder which seems to be associated with little variability in expression. On the left is a rather complete aniridia with corneal clouding due to glaucoma. On the right is another virtually complete aniridia with minimal iris remnants. Figure 2.61. Rieger's syndrome is an autosomal dominant (4q23-q27) disorder with abnormal irides, associated with an abnormal umbilicus and malformed teeth. Abnormal iris stroma is present, and glaucoma is common. Families may exhibit variable expressivity. On the left is an eye with polycoria, dyscoria, and correctopia present at birth. On the right is the same eye...

How This Book Is Organized

Chapter 7 shows you how certain core beliefs darken and distort your view of yourself, your world, and your future as surely as eyeglasses with the wrong prescription muddle normal sight. We include tools for regrinding your life-lenses so you see things more clearly. Finally, in Chapter 8, you have the opportunity to practice mindfulness and acceptance more techniques for handling troubling thoughts.

Confusion in diagnosis

Deteriorating vision is not uncommon as a presentation, due either to change of refraction causing myopia (mainly in Type 1 diabetes) or to the early development of retinopathy (mainly in Type 2 diabetes). Foot ulceration or sepsis in older patients brings them to accident and emergency departments and is nearly always due to diabetes. Occasionally painful neuropathy is the presenting symptom, causing extreme pain in the feet, thighs, or trunk.

Ultraviolet treatment phototherapy

A variable degree of erythema and itching may occur after treatment. Longer term side effects include a slight risk of epitheliomas developing, premature ageing of the skin, and cataract formation (which can be prevented by wearing ultraviolet A filtering goggles during and after treatment). The total cumulative dosage is carefully monitored and kept as low as possible to reduce the risk of side effects.

Anaesthetic problems

Blood pressure is extremely sensitive to changes in extracellular fluid volume, and hypotension may occur on induction of anaesthesia. In a prospective study of 17 diabetic patients having eye surgery, 35 required vasopressors, compared with 5 of nondiabetic controls.They were required more often in those with the poorest autonomic function (Burgos et al 1989).Tracheal intubation produces less of a pressor response than is seen in normal patients and, in fact, the first few minutes after tracheal intubation is the period of highest risk for hypotension and bradycardia.

Materials And Methods

Patients were divided into male and female. In each group the visual acuity (VA) before and after the treatment was calculated by the Snellen chart on a scale of 10 10. An activity index was calculated for anterior uveitis (AU), posterior uveitis (PU), and retinal vasculitis (RV) upon the inflammatory state of each eye. Each of the inflammatory parameters was graded from zero (none) to 4 (highest degree of inflammation). These indices were determined as follows. For AU cells, flares, keratic precipitates, and hypopyon. For PU cells, snow ball and snow banking. For RV periarteritis, periphlebitis, edema of disk, edema of macula, edema of retina, papillitis, and active peripheral lesions. Both groups were similar regarding the mean duration of the eye disease (33 months for men versus 32.9 months for women) and the mean treatment time (18.5 months for men versus 20.6 months for women). In men, 212 eyes had a normal visual acuity (VA) before the treatment and remained normal during the...

Amino Acid Analysis Complementary Approaches and Further Development

At the Kiruna meeting, the main role of substituting me was kindly handled by my friend and ADH collaborator, Bert Vallee from Harvard. I phoned him just a few days before, when I was lying without vision. He flew over immediately, visited me at the hospital, went to Kiruna, and ran it all excellently. Thanks Overall, Bert and Kuggie are great friends and were collaborators for many years, giving wisdom and life experience My lack of vision was a difficult problem and was critical, but after six surgeries my ophthalmologist surgeons finally managed to fix my eyes, and after about a year of little or no vision, I saw again. A fantastic feeling Since then, I have had no eye problems and see better than ever before, but much inside my eyes has ever since been only plastics. It is not only protein chemistry, but also clinical research and ophthalmologic surgery that has made great progress during the 1980s and 1990s During these decades, I also made much of my formal, scientific career,...

Mechanisms of Tear Drainage

Collagen Arrangement Fibril

The cavernous body of the efferent tear ducts actually plays an important role in the physiology of tear outflow regulation and can be influenced pharmacologically (Fig. 1.10) 2 . Interestingly, administration of a decongestant drug or insertion of a foreign body at the ocular surface both prolong the tear transit time significantly, but by different mechanisms. Application of a decongestant drug simultaneously with insertion of a foreign body shortens the tear transit time significantly compared to the effect of the de-congestant drug alone, but there is no significant difference compared with application of a foreign body alone. The tear transit time is independent of the side (right or left) and gender, and whether the eyeglasses

Preoperative abnormalities

Skin haemangiomas can occur at other sites. Glaucoma and buphthalmos may occur. Massive involvement of the paranasal sinuses and facial distortion has been reported (Ku et al 1999). the other.There may be unilateral glaucoma, increased scalp vascularity, and unilateral hypertrophy of the carotid artery.

Drugs and the Nervous System

Parasympathomimetics enhance parasympathetic effects. Pilo-carpine, for example, relieves glaucoma (excessive pressure within the eyeball) by dilating a vessel that drains fluid from the eye. Parasympatholytics inhibit ACh release or block its receptors. Atropine, for example, blocks muscarinic receptors and is sometimes used to dilate the pupils for eye examinations and to dry the mucous membranes of the respiratory tract before inhalation anesthesia. It is an extract of the deadly nightshade plant, Atropa belladonna. Women of the Middle Ages used nightshade to dilate their pupils, which was regarded as a beauty enhancement.13

What are the symptoms of MS Which symptoms are most common

Glaucoma Although visual problems are less common at onset of illness, they become relatively common over the lifetime of patients with untreated MS. A physician should always evaluate visual symptoms, especially double vision or blurring of vision accompanied by pain in one or both eyes. MS-caused blindness is uncommon. Glaucoma is a more common cause of blindness.

The blind diabetic patient

Blind registration is available for those patients with visual acuity of less than 3 60 in their better eye or gross field defects, affording some financial help and social service support. Patients with a visual acuity of less than 6 60 in their better eye are eligible for registration as partially sighted. They must be registered by an ophthalmologist using the BD8 form. Printing in braille is valuable but many diabetic patients have impaired fine sensation in their fingertips, making it difficult for them to read it. Insulin pens , in which palpable clicks correspond to units of insulin are valuable for blind patients.

Approach Routes to the Orbit

Orbit's pyramidal shape affords five possible anatomical approach routes, namely the anterior, superior, inferior, lateral and medial faces 22, 23 . The neurosurgeon does not need to be familiar with either the anterior approaches (which tend to be restricted to ophthalmologic applications, essentially to access small, anterior neoplasms) nor, as a rule, the medial and inferior approaches (which are the domain of the Ear, Nose and Throat specialist working in collaboration with the ophthalmologist). On the other hand, the neurosurgeon is often called upon to collaborate on techniques based on an approach via either the lateral or the superior routes 9, 19 .

Patient Assessment Case History

Nation of the punctum may show it to be extremely small. If the lower canaliculus is stenosed, a DCR is of little value as 90 of tears drain via this route. Probing the lacrimal pathway with a smooth double-ended Bowman's probe often has a soft stop as the probe passes through the common canaliculus (Fig. 7.2). In some cases, probing and dilatation may be successful in re-establishing the patency of the system or with a stenosed punctum the ophthalmologist may do a three-snip procedure to enlarge the opening.

The definitive prosthesis

Putting the definitive prosthesis on and off may be difficult if hands are neuropathic and eyesight is poor, and visual inspection of the stump may be difficult. Velcro straps are useful in the patient with neuropathy and poor hand function to aid donning and doffing of the prosthesis. If skin is atrophic and circulation is reduced, stasis dermatitis may be a problem, and the skin is easily injured.

Global Strategies For Assessing Movement Disorders

The comprehensive battery strategy has already been reviewed several times in detail and will be described only briefly here (Crawley 2000 Crawley and Paylor 1997 Rogers et al. 1997 van der Staay and Steckler 2001). The comprehensive evaluation begins with a brief but broad-based observation of simple behaviors. The observations are typically not quantified, although statistical methods can be applied to uncover certain broad patterns of behaviors (Rogers et al. 1999). Instead, the purpose of this initial step is to identify defects that might influence the selection of subsequent tests. For example, simple screens for visual impairment might steer the investigator away from tests that require good eyesight. Several standardized lists of what to look for have been developed. The Irwin and SHIRPA batteries contain hundreds of items, while others have suggested shorter and more focused lists (Crawley 2000). Following the initial observational screen, a battery of secondary tests is...

Medication for More Than Just School or Work

Recognition of the pervasiveness of impairments from ADD syndrome has led many clinicians to prescribe stimulant medications to cover not only school or workdays, but every day of the week. In practice, the use of stimulant medications by persons with ADHD varies as does the use of eyeglasses. Just as some individuals wear their eyeglasses all day, every day, because the help they provide is needed for virtually everything they do, so do many with ADD syndrome maintain their stimulant medication coverage throughout virtually every day. Others, like those who need their eyeglasses only for reading or for watching TV, will plan with their physician to use their medication only when they need it for specific types of activities like schoolwork or employment.

Retinal Imaging Background

Still digital images and live digital image sequences of the human retina are captured using a digital video camera attached to a fundus camera 42, 85 . Still photography is generally performed with a flash and live imaging is done with continuous illumination. In the former case, imaging noise is lower than in the latter case where less light is available. The confocal imaging case is not considered here 116 . Readers who do not have access to a source of retinal images, such as an ophthalmology clinic, can access large collections of retinal images on CD-ROM 123 . Several aspects of retinal images make automated processing challenging. First, the images are highly variable. Large variability is observed between images from different patients, even if healthy, with the situation worsening when pathologies exist. For the same patient, variability is observed under differing imaging conditions and during the course of treatment. Unlike industrial vision problems where the conditions...

Ethnicity of Patients

Munder (1976) obtained her data by searching through psychological and medical records from a number of hospitals, selecting all brain-damaged males tested with a complete WAIS. Neurological diagnosis was arrived at independently of psychological test results for all patients based on some or all of the following criteria EEG, brain scan surgery, autopsy. Patients with vision problems or incapacitating physical anomalies were not used in the study. Multiple analysis of covari-ance was used to control for age, years of education, and time interval between brain damage and date of testing.

Complications In Patients Undergoing Kidney Transplantation

Inadequate vascular access Steal, thrombosis infection Interdialytic hypotension Progressive eye disease Progressive vascular disease Minimal rehabilitation genitourinary, lung, skin, wound Cancer skin, lymphoma, solid organ Drug induced gout, cataracts Allograft rejection acute chronic Recurrent diabetic nephropathy Progressive eye, vascular disease

Managed Care Organizations

HMOs are expected to play a major role in the delivery of preventive services (e.g., screening for disease) for several reasons (CDC 1995a). HMOs are rapidly becoming a major source of health care for most Americans, have historically included preventive services (e.g., screening), are responsible for defined or enrolled populations, and have enthusiastically embraced the recommendations of the USPSTF to define preventive services benefits (Woolf et al. 1996). Moreover, the preventive services measures developed by the National Committee for Quality Assurance (NCQA) to track health plan performance, the Health Plan Employer Data and Information Set (HEDIS), partly were based on the USPSTF recommendations. Specific measures include indicators of plan-specific effectiveness of care with respect to screening for breast cancer, cervical cancer, colorectal cancer, diabetic eye disease, hypertension, and chlamydia (NCQA 1996).

Diagnosis and Clinical Assessment

An ocular examination should be performed. Injuries in this area may be associated with ophthalmic emergency and problems such as ruptured globe or traumatic optic neuropathy especially when the principle fracture or displacement involves bones of the apex of the orbit 27-30 . There is no accurate incidence of ocular injuries associated with nasolacrimal injuries, because many studies vary in the level of ophthalmic evaluation however, a study by Holt et al. 31 found 59 of nasal fractures showed concomitant eye injuries and 76 of midfacial fractures were associated with eye injuries. For the severity of ocular injuries, 79 were temporary or minor, and 18 were serious, defined as sustained visual loss or adnexal sequelae requiring subsequent reconstructive measures 3 resulted in blindness. Therefore, an initial ocular evaluation in mid-facial fractures is necessary 32-34 . Useful guidelines are as follows 1. Develop a brief historical profile of pre-injury vision, current subjective...

Clinical examination of the eyes and screening

Visual acuity and retinal examination should be performed annually on all diabetic patients after 12 years of age, or more often if advancing changes are observed. Vision-threatening retinopathy rarely occurs in Type 1 diabetes in the first five years after diagnosis or before puberty. However, more than one-quarter of Type 2 diabetic patients have been found to have retinopathy at diagnosis, and screening should start immediately. Visual acuity should be checked annually, or more often if significant retinopathy is present or if it has changed Retinal examination. Routine fundal examination should be performed on all diabetic patients, using fundoscopy or retinal photography or preferably both. The pupils should be dilated and the fundus examined in a darkened room. Tropicamide 1 (Mydriacil) eye drops are recommended as they have a short duration of action of just two to three hours. There is no reason to avoid pupillary dilatation in patients being treated for chronic open-angle...

Results And Discussion

We evaluated the visual prognosis of the patients who had been attending follow-up sessions for at least 5 years at our clinic. The visual prognosis of patients who first visited our clinic between 1985 and 1994 and that of patients who first visited our clinic between 1975 and 1979 were compared. Behget's disease is a chronic disease. Therefore, a 5-year follow-up is the minimum necessary for evaluating visual prognosis. In 1984 cyclosporine was introduced to Japan for the treatment of patients with Behget's disease. Therefore, therapy differed between the 2 groups. In the recent study, 30 of patients was given cyclosporine. The visual prognosis in recent cases looks better than that in previous cases after 5 years of observation. In any case, the visual acuity of 27 of patients' eyes fell to 0.1 or less after 5 years in the recent study. The visual acuity of female patients was much better than that of male patients. Only 16 of patients' eyes showed a visual acuity at 0.1 or less...

Introduction And Case History

He developed right cystoid macular oedema which responded to pulsed intravenous methylprednisolone and his visual acuity varied considerably over 3 years at best 6 9 and at worst 6 60. However, there was concern about the iatrogenic effects of such large doses of steroids in a teenager so other immunosuppressants were tried in an attempt to bring his panuveitis under control on a dose of prednisolone below 20 mg. There was little success with tacrolimus, azathioprine, mycophenolate mofetil, thalidomide, cyclophosphamide, and alpha interferon. He developed many problems including weight gain, renal impairment, hypertension, osteoporosis and avascular necrosis of his hip and knee joints requiring hip decompression surgery and bilateral knee replacements. He has also required bilateral cataract surgery.

Hypertension Emergency Treatment

Monitoring of visual acuity and pupils is crucial during this time as lowering the blood pressure may lead to infarction of the optic nerve heads. Any deterioration must be treated by urgently raising the blood pressure using intravenous saline or colloid. Some children may be anuric - renal function (serum creatinine, urea, and electrolytes) should be analysed promptly.

Safety concerns regarding cardiovascular gene therapy

It is theoretically possible that VEGF may exacerbate proliferative and or hemorrhagic retinopathy in patients with diabetes in view of the high VEGF levels demonstrated in the ocular fluid of patients with active proliferative retinopathy leading to loss of vision (110). To date, this adverse effect of therapeutic angiogenesis has not been observed. The local delivery of naked plasmid DNA encoding for VEGF-1 or VEGF-2 to more than 100 patients (one third with diabetes and or remote ret-inopathy) treated at our institution with up to 4-yr follow-up did not affect the visual acuity or fundoscopic findings as evidenced by serial funduscopic examinations pre- and post-gene transfer by an independent group of retinal specialists.

Subacute myeloopticoneuropathy virus

(SMON) A herpesvirus isolated from the feces and CSF of patients with subacute myelo-optico-neuropathy. Seen mainly in Japan, the disease is characterized by sensory disturbance, especially of the lower part of the legs, abdominal symptoms, decreased muscle strength and bilateral impairment of visual acuity. There are no changes in the blood or CSF. There is degeneration of posterior and lateral tracts of the spinal cord. The virus was isolated in BAT-6 cells and causes a thinning of the cell sheet. On injection into newborn C57Bl 6 mice it is reported to cause paralysis of the hind legs. It is claimed that the virus can be derived on passage of avian infectious laryngotra-cheitis virus on the CAM or in newborn C57BL 6 mice. It is antigenically related to this virus but is said to differ from it in being non-pathogenic for fowls, less unstable at low pH and pathogenic for C57BL 6 mice. The role of the virus in subacute myelo-optico-neuropathy has suckling mouse cataract virus An...

Sensory Dysfunction Possible Contribution To Cognitive Effects

Lead also produces deficits in visual function. Altmann et al. 111 reported changes in visual evoked potentials in a cohort of over 3800 4-year-old children with average blood lead concentrations of 42 g dl, but no differences in visual acuity or spatial contrast sensitivity functions. In a study in infant monkeys with very high lead levels (300 to 500 g dl), one infant appeared to develop temporary blindness 112 . Monkeys exposed to lead during the first year of life with blood lead concentrations during exposure of 85 g dl, but not those with 60 g dl, had impaired scotopic (very low luminance) spatial contrast sensitivity at 3 years of age 113 . Both spatial and temporal (motion) contrast sensitivity were examined in monkeys with lifetime exposure to lead, with steady-state blood lead concentrations of 25 to 35 g dl 114 . Lead-exposed monkeys exhibited deficits in temporal vision at low and middle frequencies under low-luminance conditions, with no other impairments. Lead-induced...

The Survival Of Grecoislamic Medicine

Even where twentieth century laws regulating medical practice drove traditional practitioners underground, diligent explorers could still find them. For example, in French-ruled Algeria, traditional healers and their patients were reluctant to talk to outsiders because it was illegal for people without the proper French qualifications to perform surgery. Nevertheless, yunani doctors performed eye surgery, tooth extractions, cupping, cautery, bloodletting, and assisted in difficult births. Although anesthetic drugs were available, most traditional practitioners did not use them before surgery. Some healers claimed that their methods were so gentle that the patient did not suffer, but strong assistants were invariably needed to restrain the patient. Many people treated themselves with yunani drugs and cauterization in order to avoid the costs of seeing a doctor and because of their faith in such remedies.

Diabetes Preventive Care

The surveillance state consists of six concurrent substates nephropathy, eye exam, foot care, antiplatelets - aspirin, BP management, and immunization. These states are described in detail in the upcoming sections. exit SurveillanceFollowUp() sets up a timer for a future surveillance visit. This action is executed upon exiting the Surveillance state. There are also two guards that, if true, will trigger two different transition events NewIllness() T EVT (IntercurrentIllness) triggers a transition event to the intercurrent illnesses state if there is a new illness that needs to be treated. Note that the transition to the Intercurrent Illnesses state is guarded by EVT(IntercurrentIllness) , which has to be true so the transition can take place. Similarly, NewIllness() F EVT(Management) triggers a transition event back to the management state, since there are no new illnesses detected. The transition from Surveillance back to management is guarded by EVT(Management) .

Illustrative Case Report

In a car accident a few months before his 15th birthday. The accident resulted in partial paralysis of his left side and in a significant loss of vision. Vision in his right eye is limited to gross form discrimination peripherally and to light dark awareness in his central vision. Central vision in his left eye is normal but peripheral vision is severely limited. Difficulties with both short-term and long-term memory were noted after the accident.

Ageing and the Angels

This is in part built into our sensory system, since a substantial part of the retina is particularly sensitive to movement in our peripheral vision, which is just what is needed to detect danger approaching. It would not be surprising if the teachers in the society warned of unknown enemies, evil spirits and so on, which everyone must be made aware of. Such dangerous imaginary beings may well have been the first non-material creations in those early human societies.

Distinguishing the past from the present

Life-lenses develop from emotionally significant events in childhood, and they make sense when viewed in conjunction with those events. Your world has no doubt changed a great deal over the years, but you probably still look through many of the same old lenses. And those lenses don't give you a clear vision of present-day reality.

Excelling as a Learner

If learners are to perform at their best and become the best physicians they are capable of being, it is important that we help them develop a clear vision of excellence in learning. Whether they be medical students, residents, fellows, or even practicing physicians participating in continuing medical education programs, we need to help them to see their target clearly if they are to hit it. In the case of medical students and residents, it is vital that no one regard their tenure in the training program as a period of indentured servitude, something that must be merely endured. Instead, learners gain more when they see their program as a learning opportunity designed to help them excel as learners.

Excellence and Failure

In order to achieve something, it is vitally important clearly to understand what one is trying to do. Learners who aim merely to avoid mistakes have sold themselves short. In such circumstances, learning becomes a byproduct of some other pursuit, and is likely to be less efficient and less effective. The best learners are the ones who seek out challenges and continue to question and grow throughout their careers. Just as learners need to understand what they are about in order to do their best, so educational programs need a clear vision of what they are trying to accomplish. By looking beyond the most immediate and easily measured parameters of performance and adopting a larger perspective that encompasses nonmedical factors of excellence, medical education programs can prepare their learners to excel at even higher levels.

The origins of lifelenses

On the road to understanding and changing your life-lenses, it helps to reflect on what caused you to acquire the lenses you look through in the first place. When you understand these origins, you can release the notion that you're crazy, weird, or messed up. Self-forgiveness releases energy that you can use for grinding new lenses for better vision.

Other Safety Findings

An additional toxicology finding, the development of cataracts in dogs following 3 mo treatment with TNP-470, was monitored closely by the incorporation of serial ophthalmologic examinations into the study design. In two cases, a 69-yr-old prostate cancer patient and a 70-yr-old female patient with metastatic colon cancer, the development of cataracts was recorded. The former patient was treated with 47.2 mg m2 of TNP-470 for 126 d prior to cataract detection, and the latter received TNP-470 at 235 mg m2 for 85 d before mild cataract changes were noted. In both cases, earlier ophthalmologic examinations during treatment did not show these changes.

Mild Moderate Acute Crohns Colitis

Corticosteroids are effective inductive therapies for patients with moderate-severe Crohn's colitis or for patients with mild-moderate disease that has not responded to amino-salicylates and or antibiotics. Controlled release budesonide formulations are also efficacious for mild-moderate CD involving the right colon, but are not effective for more distal colonic disease. Doses of 40 to 60 mg daily of prednisone (or up to 1 mg kg d) are initiated until a clinical response has been established. Subsequent tapering is individualized according to the rate of response. Generally, the dosage is gradually reduced by 5 mg week until the drug can be ceased or symptoms flare. In the NCCDS, 78 of patients responded to steroids given in this way. The response to budesonide is somewhat less and neither systemic nor nonsystemic steroids are efficacious at preventing relapse. Indeed, after a course of corticosteroids, approximately 75 of patients will either have a flare of disease activity or...

Benefits Versus Toxicity And Risks Of Therapy

Tamoxifen is a selective estrogen receptor modular (SERM) and so may be antiestrogenic or estrogenic, depending on its interaction with the individual tissue receptor. Its toxicity profile reflects this duality. The most common acute tamoxifen side effects are menopausal symptoms. In the NSABP trial B-14, hot flashes were seen in about two-thirds of patients, about a third had weight gain, fluid retention, and vaginal discharge, and a quarter experienced nausea, and weight loss.35 Irregular menses were seen in a fourth of pre-menopausal women.35 The only significant acute toxicities were rare thromboembolic events deep vein thrombosis in 0.8 percent and pulmonary embolus in 0.4 percent. Mood swings and depression are unusual. Very-high-dose tamoxifen may cause retinal changes, but these are rarely seen with conventional doses. There are reports of cataracts in patients on the drug.66 In a large review of ocular toxicity from the NSABP, there were no cases of vision-threatening eye...

How Many Genes

Least until the second or third decade of life. But then abnormalities set is, including whitening of the hair, progressive skin changes, poor wound-healing, cataracts, diabetes, increased risk of cancer and heart disease. The average lifespan is 46 years. It has been known for a long time, that Werner's syndrome is due to a single recessive inherited defect, that is, the defective gene must be inherited from both parents. Many scientists working on this gene believed that if its function could be identified, a great deal would be learned about the process of ageing. Some even believed it might be a gerontogene which would be the key to understanding ageing. The gene has now been isolated and shown to be like one determining the structure of a protein important for unwinding the double helix of DNA, known as a helicase. How can a single defective gene like this have multiple and diverse effects on the individual One simple explanation is to think of the defective gene product as a...

Body Architecture

The eye is another vital body component which cannot be expected to last indefinitely. The lens is made up of specialised proteins known as crystallins. These are laid down early in life, and are never replaced. As we all know, their particular property is transparency, but the constituent proteins are subject to a variety of abnormal chemical changes that simply accumulate with time. One change which is essentially continuous is the loss of elasticity of the lens, this leads to a gradual decline in the ability to change the focus of the lens. (This is known as loss of accommodation). Eventually transparency itself can be lost leading to the formation of cataracts. The probability of this happening varies between individuals, and can be accelerated by environmental influences (for example, by the wood smoke generated during cooking in third world countries). Lenses are subject to age-related changes simply because there is no mechanism to replace their protein molecules. The retina...

Material And Methods

The retrospective clinical trial was performed to review the outcome of cataract extraction in 36 eyes of 25 patients (21 men, 4 women mean age 36.3 6.5 years with a range of 27-47 years) with complicated cataract due to ocular BD and compared with results of cataract surgery in 47 eyes of 41 patients (34 men, 7 women) with age-related cataract. All BD patients fulfilled the International Study Group criteria for BD. The surgical methods were intracapsular cataract extraction (ICCE), extracapsular cataract extraction (ECCE), ECCE+intraocular lens (ECCE+IOL), and lensvitrectomy. Chi-square tests and Student's t-test were used for statistical analysis.

Other Disorders That May Affect The Basal Ganglion Disorders And May Have Abnormal Eye Movements

Wilson's disease, hepatolenticular degeneration, is an autosomal recessive, inherited disorder of copper metabolism. The defect is in a copper-transporting ATPase with the gene at q14.3 on chromosome 13. CT typically shows hypodense areas, and positron emission tomography (PET) scanning indicates a decreased rate of glucose metabolism in the globus pallidum and putamen. The classic clinical picture is a movement disorder with psychiatric symptoms and associated liver disease. The Kayser-Fleisher ring is typical in the posterior cornea in Descemet's membrane, and some patients may have a sunflower cataract. Ocular motor disorders in Wilson's disease include a distractibility of gaze, with inability to voluntarily fix upon an object unless other, competing, visual stimuli are removed (e.g., fixation of a solitary light in an otherwise dark room) (113). Slow vertical saccades have also been reported in one patient with Wilson's disease (114), but are often normal. A lid-

Patients And Methods

The records of 1238 patients with recurrent aphthous stomatitis followed-up at the Multidisciplinary Behcet's Disease Unit at Ankara University Faculty of Medicine during the years 1988-2002 were retrospectively analysed. The patients with systemic diseases known to be associated with oral aphthous lesions such as systemic lupus erythematosus and inflammatory bowel diseases were excluded. At the first visit every patient was evaluated with complete dermatologic examination and ophthalmologic examination. Laboratory tests including complete blood count, serum The data extracted from the record of each patient included the demographic features (age, sex), the age at onset of oral aphthous lesions, localisation and morphology of aphthous lesions (minor, major, herpetiform), the result of the three-step pathergy test, ophthalmologic examination, and the time of onset of any other manifestation of Behcet's disease. The diagnosis of Behget's disease in patients with additional symptoms was...

Microbiology And Toxins

Botulinum toxins are the most potent toxins known. The estimated lethal doses for purified crystalline botulinum toxin type A for a 70-kg man are 0.09 to 0.15 ig when introduced intravenously, 0.80 to 0.90 ig when introduced inhalationally, and 70 ig when introduced orally (12). Botulinal toxin type A has therapeutic value in the treatment of several neurologic and ophthalmologic disorders through chemical denervation (13). It is used as a therapeutic agent through local instillations in strabismus, blepharospasm, and other facial nerve disorders.

Cell Preparation and Identification

Five- to 10-wk-old pigmented rabbits (Reimens, St. Agatha, Ontario, Canada) are anesthetized with 8 mg 100 g of sodium pentobarbital, and eyes are enucleated in accordance with the Association for Research in Vision and Ophthalmology (ARVO) statement for the Use of Animals in Ophthalmic and Vision Research.

Historical Perspective

The history of tumourous proptosis is often confused with the history of medicine and ophthalmology, but the first efforts at coherent classification are much more recent 8 . Antonio Scarpa in 1816, 67 offered the first clinical description of optic nerve (ON) tumours. Jean Cruveilhier (1835) 14 thought that meningioma should be considered as clinical entities that are entirely separate from tumours of the central nervous system. Von Graefe in 1854 79 considered ON tumours to be entirely separate and attributed to them the first semiological criteria of diagnosis. It was not before Hudson discovered it in 1912 32 that a clear distinction was made between optic nerve glioma and meningioma of the optic nerve sheath. Harvey Cushing 15 made the first distinction between primitive meningioma of the optic nerve sheath and intracranial meningioma that spreads to the orbit. The idea of approaching the orbit via the endocranial approach was successfully described and practised by Durante 1887...

Local signs of infection not noted by patient

A 53-year-old lady with type 1 diabetes of 25 years' duration, proliferative retinopathy with reduced vision, peripheral neuropathy and hallux rigidus developed a neuropathic ulcer under callus on the plantar surface of her right hallux. She was warned of the usual danger signs of deterioration (redness, warmth, swelling, pain, purulent discharge) but did not return to clinic until her routine appointment. Callus had grown over the ulcer preventing drainage and the toe had become cellulitic (Fig. 5.1a,b). Callus was debrided and pus drained (Fig. 5.1c). A deep wound swab was taken and oral amoxicillin 500 mg tds and flucloxacillin 500 mg qds were prescribed. She was reviewed the next day. The toe had not improved and she was admitted for bed rest and intravenous antibiotics according to our protocol, namely amoxicillin, 500 mg tds, flucloxacillin 500 mg qds, metronidazole 400 mg tds and ceftazidime 1 g tds. The swab taken at her outpatient clinic visit grew Staphylococcus aureus and...


Syringing Lacrimal Ducts

A glass bypass tube between the conjunctival sac and the nasal cavity was used for the first time in 1925 by J. Heermann, a German otorhinolaryngologist. The tube was inserted through the lower canaliculus 4, 9 . In the ophthalmology literature this procedure is connected with the name of Lester Jones, who described the surgery in 1962. While Heermann used an endonasal approach for the procedure, Jones used an external approach and this technique has prevailed for many years. The procedure is known as Jones' conjunctivodacryocystorhinostomy or dacryocysto-rhinostomy + bypass tube, conjunctive dacryocystorhinostomy, or dacryocystorhinostomy + Jones tube 11-14 .

Median Section Of The

Label Median Section The Eye

Behind the lens is the posterior cavity. This cavity is filled with a jellylike material called vitreous humor. Light travels through this medium to the back of the eye where it strikes the retina. The retina is the region of the eye where light waves are converted to nerve impulses. The fovea is a small area of the retina where there is a high concentration of cones (cells that determine color and visual acuity.) Behind the retina is the choroid, a darkened layer that absorbs light, making vision sharp during the daytime. Behind this layer is the sclera, the white of the eye, where muscles attach. At the posterior of the eye you can see the optic disk. This is where the optic nerve takes visual impulses from the eye to the brain. Color the median section of the eye after you have filled in the appropriate labels.

Relative Proficiency Index

The relative proficiency index (RPI), formerly called the RMI (relative mastery index) on the WJ-R, is a valuable score in better understanding a subject's quality of performance relative to peers in the normative sample. The score reads like the index used with Snellen charts to describe visual acuity. A 90 is always written in the denominator. An RPI score of 90 90 means that the subject demonstrated 90 proficiency on tasks where the average person in the comparison group (same age or grade) would also obtain 90 . The Developmental Zone (called the Instructional Zone on the WJ III ACH), is a special application of the RPI provided to help understand the subject's range of functioning on tasks from easy (independent level) to difficult (frustration level). The Developmental and Instructional Zone profiles are printed when using the Compuscore and Profiles Program.

Celery Stalk Appearance

Celery Stalk Lesions And Rubella

Children with congenital rubella may have a normal physical and neurodevelopmental outcome, although it is uncommon. Maternal rubella in the first 4 weeks of pregnancy carries a risk of congenital rubella of 50 (heart anomalies, eye defects, hearing problems, etc.) between the 12th and 16th weeks of pregnancy the risk decreases to 2 to 6 and between the 18th to 20th weeks of pregnancy the risk is practically nil. Over 80 of babies with congenital rubella shed virus during the first month of life, and 5 to 10 (those severely affected), for one year. Figure 2.137. Cicatricial skin lesions of the neck and upper back in an otherwise normal infant following maternal varicella at 5 months gestation. These skin lesions are the most common finding after maternal varicella which presents in the 1st and early 2nd trimester. Maternal infection with varicella early in pregnancy is a cause of fetal malformations including reduction deformities of the limbs (hypoplastic limbs and or...

Retinal Hemorrhage In Newborns

Retinal Hemorrhage Neonate

Retinal hemorrhages occur frequently in the neonate, especially following vaginal delivery. In some studies, the incidence of small retinal hemorrhages is as high as 25 irrespective of whether the delivery was spontaneous or required the application of forceps. These retinal hemorrhages resolve spontaneously without any consequences. In contrast, hemorrhages into the vitreous gel may prevent light from getting through to the retina for several days or even weeks and will cause a severe, irreversible deprivation amblyopia. Figure 2.6. Retinal hemorrhages occur frequently in the neonate, especially following vaginal delivery. In some studies, the incidence of small retinal hemorrhages is as high as 25 irrespective of whether the delivery was spontaneous or required the application of forceps. These retinal hemorrhages resolve spontaneously without any consequences. In contrast, hemorrhages into the vitreous gel may prevent light from getting through to the retina for several...

Newborn Marfan Syndrome

Marfan Syndrome Newborn

A term newborn with Marfan syndrome who had a birth weight of 3720 g and a length of 54 cm. Note the tall stature with long slim limbs and hypotonia. In Marfan syndrome, limbs are disproportionately long and trunk length is usually normal resulting in a low upper lower segment ratio. Ophthalmologic and cardiovascular pathologies, such as dislocation of the lens and aneurys-mal dilatation of the aorta, are usually noted after the neonatal period. Figure 3.98. A term newborn with Marfan syndrome who had a birth weight of 3720 g and a length of 54 cm. Note the tall stature with long slim limbs and hypotonia. In Marfan syndrome, limbs are disproportionately long and trunk length is usually normal resulting in a low upper lower segment ratio. Ophthalmologic and cardiovascular pathologies, such as dislocation of the lens and aneurys-mal dilatation of the aorta, are usually noted after the neonatal period.

Epibulbar Lipodermoids

Ankyloblepharon Filiforme Adnatum

Capillary hemangiomas of the lids most frequently arise nasally from either the superior or the inferior palpebral fissure. They are poorly defined soft swellings of the eyelid with purple (red-blue) discoloration of the skin. They require treatment when rapid growth threatens the visual axis which can lead to irreversible deprivation amblyopia. Figure 2.30. Capillary hemangiomas of the lids most frequently arise nasally from either the superior or the inferior palpebral fissure. They are poorly defined soft swellings of the eyelid with purple (red-blue) discoloration of the skin. They require treatment when rapid growth threatens the visual axis which can lead to irreversible deprivation amblyopia. Figure 2.35. This typical dermoid of die Goldenhar's syndrome occurs as a solid mass of the conjunctiva at the inferotemporal border of the cornea. Flattening of the cornea occurs in die meridian of the dermoid, causing an associated astigmatism and occasionally a secondary...

Infant Hemifacial Microsomia

Newborn Microsomia

When delivery has involved excessive rotation or gross lateral rotation of the neck, a lump may appear in the stemomastoid muscle (stemomastoid tumor). This usually becomes apparent in the second week of life and commonly is situated in the lower half of the muscle. It may enlarge before resolving spontaneously, and may result in torticollis as a result of contraction of the sternomastoid muscle causing flexion of the head toward the side of the lesion. This condition must be differentiated from superior oblique palsy (IVth cranial nerve palsy) by an ophthalmologist.

Cassia angustifolia vahl or Cassia acutifolia Delile Fam Fabaceae

Cassia Angustifolia

Clears Liver Heat and improves eyesight, moistens the Intestines to relieve constipation. For conjunctival congestion with swelling and pain, and for photophobia due to Liver Heat or Wind Heat in the Liver. This herb can be used alone or in combination with other herbs that clear Heat and improve eyesight. For Liver Heat, it is used with Spica Prunellae (Xia Ku Cao) and Fruc-tus Gardeniae Jasminoidis (Zhi Zi). For Wind Heat in the Liver, it is used with Folium Mori (Sang Ye) and Flos Chrysanthemi Morifolii ( Ju Hua).

Disease Activity Index

A disease activity index (DAI) has to be calculated for each section of each eye, at each visit. The calculation is based upon the inflammatory state of the eye. The severity of the inflammatory indices is graded from 0 to 4. These indices are determined as follows Anterior uveitis (AU) cells, flare, keratic precipitate and hypopyon in the anterior chamber. Posterior uveitis (PU) cells, snow ball and snow banking in the posterior chamber. Retinal vasculitis (RV) periarteritis, periphlebitis, edema of disk and macula and retina, papillitis, and active peripheral lesions in retina. The visual acuity (VA) as an overall index of the eye function was determined by the Snellen chart. VA is influenced by the inflammatory state of the eye, and complications such as synechia, cataracts, vitreous organization, and retinal scars.

Exotic ungulate encephalopathy See prion diseases

Eye disease caused by viruses eye disease caused by viruses Viruses from at least 10 families can cause ocular disease in humans. In most cases infection spreads from the upper respiratory tract or skin. (5) Togaviridae. Rubella virus infection during pregnancy is an important cause of congenital eye disease.

Intracranial Calcification

Intracranial Calcification Torch

In oculo-dento-osseous dysplasia (oculo-den-to-digital dysplasia, OMIM 164200), a narrow nose with hypoplastic alae and thin nostrils, microcornea with iris anomalies, postaxial syndactyly and or camptodactyly, hypoplasia aplasia of the 5th fingers and toes, and enamel hypoplasia are leading features (Meyer-Schwickerath et al. 1957). Additional features include short palpebral fissures, epicanthal folds, skull hyperostosis, hypotrichosis, strabismus, glaucoma, orbital hypotelorism, and a variety of neurological symptoms, such as progressive paraparesis, cerebral white matter abnormalities, ataxia, tremor, bladder dysfunction, epilepsy, migraine, and learning disabilities (Beighton et al. 1979 Fara and Gorlin 1981 Gutmann et al. 1991 Loddenkemper et al. 2002). Calcification occurs in the basal ganglia (Barnard et al. 1981). The syndrome is inherited in an autosomal dominant pattern and is caused by mutation in the connexin-43 gene mapped to 6q21-q23.2 (Gladwin et al. 1997...

Cleidocranial Dysplasia

Warfarin Stippled Bone Epiphyses

Radiograph of die upper and lower extremities showing the stippling of the epiphyses of an infant with chondrodystrophia calcificans congenita. This may occur as a rhizomelic form with a flat facies, low nasal bridge and cataracts, short humeri and femora, coronal clefts in the vertebrae, and punctate epiphyseal mineralization. It also occurs in an autosomal dominant form (Conradi-Hunermann syndrome) in which there is asymmetric limb shortness and early punctate epiphyseal mineralization. In infants with stippling of the epiphyses, consideration should also be given to the diagnoses of Zellweger syndrome and the fetal warfarin syndrome.

Project I Genetic Defects in Families and Twins

On December 16,1942, two weeks before Mengele turned up at the Berlin-Dahlem Institute, Himmler had given the general order that all Gypsies, with the exception of a very few racially pure families, ought to be transferred to Auschwitz. A detailed order was given on January 29,1943. Before, most German Gypsies had been held in various camps. The Gypsies had been an object of study for students and post-docs of von Verschuer and Fischer. In particular Dr Georg Wagner, a graduate student working in the Dahlern Institute under Fischer, had written his dissertation on them (24). He had published a paper on eye anomalies of some Gypsies in 1944 (25). Dr Karin Magnussen, a biologist and collaborator of Fischer, had specialised in eye defects. She was particularly interested in heterochromatic eyes. Wagner had briefly mentioned the prevalence of this trait among German Gypsies (24), so it made sense to continue the work after all Gypsies had been concentrated in Auschwitz. Magnussen mentions...

Conjunctival Lipodermoid

Neonatal Lid Retraction

The same patient showing a residual right upper lid ectropion after five days of bilateral pressure patches. If this occurs as a unilateral condition, it is essential to tape both eyes closed to prevent deprivation amblyopia. Figure 2.42. The same patient showing a residual right upper lid ectropion after five days of bilateral pressure patches. If this occurs as a unilateral condition, it is essential to tape both eyes closed to prevent deprivation amblyopia.

The Quest For Immortality

But so far, all attempts at physical rejuvenation have failed. Many such attempts date back to the turn of the early 1900s and involved the use of concoctions, potions, and even radioactive cocktails, often with disastrous results. One such concoction, popular in the 1920s, was Tho-Radia, a skin cream containing thorium and radium, two radioisotopes discovered by the great French physicist Marie Curie. The radioactive material was supposed to have an antiaging effect on the skin, but their use was abandoned when Curie and other scientists working with radioisotopes began having serious medical problems. Madame Curie developed cataracts, kidney failure, and a fatal leukemia, all from overexposure to radioactive materials.

Rhizomelic Chondrodysplasia Punctata

Rhizomelic Chondrodysplasia Punctata

This is the same patient shown in Figure 2.81 following bilateral removal of cataracts and immediate fitting with aphakic contact lenses. The infant developed perfect vision and binocular fusion. Figure 2.83. Cataracts are present in Lowe syndrome (oculocerebrorenal syndrome) which is an X-linked recessive disorder (Xq25). In this syndrome, glaucoma is also frequently present. Figure 2.84. In the rhizomelic chondrodysplasia punctata syndrome, an autosomal recessive disorder, cataracts are frequently present.

Interaction with Industry

As mentioned above I had a lot of experience from scientific collaboration with colleagues employed at the drug company Pharmacia. The introduction of hyaluronan in eye surgery around 1980 created a dramatic boost for Pharmacia, which was both positive and negative. On the positive side was the increase in research and development, on the negative side was the growth from a small company with informal ties to the university to a large company that became a game on the stock market.

Sternocleidomastoid Muscle

Sternocleidomastoid Muscle Fibrosis

Congenital torticollis is usually not apparent at birth but within the first week a swelling is noted over the sternoclei-domastoid muscle (stenomastoid tumor). This is thought to occur as a result of spasm, hemorrhage or fibrosis. It results in shortening of the sternocleidomastoid muscle and tilting of the head. It is important to recognize since it may cause astigmatism. Figure 4.52. Congenital torticollis is usually not apparent at birth but within the first week a swelling is noted over the sternoclei-domastoid muscle (stenomastoid tumor). This is thought to occur as a result of spasm, hemorrhage or fibrosis. It results in shortening of the sternocleidomastoid muscle and tilting of the head. It is important to recognize since it may cause astigmatism.

Salt And Pepper Chorioretinitis

Salt Papper Chorioretinitis

Rubella cataract is the most common ocular finding in infants with congenital rubella and occurs in up to 75 of these infants. Classically, the cataract is nuclear, and the virus can be isolated from the lens for years following birth. Figure 2.17. Rubella retinitis appears as a salt and pepper retinitis classically and reflects damage to the retinal pigment epithelium. It can be present without any decrease in visual acuity.

Back in Stockholm 19541958

When Does Torticollis Improve

In the meantime during my graduate work Ulla had started a career in ophthalmology. We had got our first child, Birgitta, in April 1957 and we expected our second child late in the fall of 1958. We had come to a turning point in life. What were we going to do next Bandi had offered us to come back to the Retina Foundation and we decided to accept, well aware that, in reality, we might emigrate to the USA. I had no department in Sweden to return to. Einar Hammarsten had retired and his successor, Sune Bergstrom, came from Lund and filled all the positions in the Chemistry Department with his disciples. My temporary appointment ended in 1958. We decided to move in January 1959 when our second child was born. It was a boy, Claes.

Monica L Vetter and Edward M Levine

Eye Cell Populations

Degenerative diseases of the retina result in the loss of specific populations of retinal neurons. For example, retinitis pigmentosa is characterized by progressive loss of rod photoreceptors, macular degeneration is a common disease of the elderly in which rod and cone photoreceptors degenerate, and glaucoma is marked by a loss of retinal ganglion cells. Thus, there is considerable interest in identifying retinal stem cells with the capacity to repopulate the retina in response to disease or injury. Although this has not yet been achieved in the mammalian eye, recent results hold promise for future success in this area. This work has obviously generated real excitement over the promise for regenerating retinal neurons lost to disease or injury however, a number of questions remain. For example, can the retinal stemlike cells from the pig-mented ciliary epithelium give rise to all classes of retinal neurons Will these cells (or progenitors derived from these cells) survive and...

Can I go blind with MS

Although visual loss accompanying attacks of MS, diagnosed as optic neuritis or retrobulbar neuritis, may occasionally be severe, blindness is unusual. There may be a small blind spot left after an attack, and occasionally, this may be large enough to interfere with vision. Glaucoma, which is another type of eye disease, unrelated to MS, is more common as a cause of blindness in MS patients. My vision problems range from a bit of blurriness to a complete lack of sight. I inherited extreme myopia I wear contact lenses and glasses even in the shower. Before MS, changes in my vision required new prescriptions and picking out the least offensiveframes. MS vision symptoms and Myopia nearsightedness inability to see distant objects without corrective lenses.

Picture Of Port Wine Stain Of Newborn

Capillary Bleeding Images

The capillary hemangioma involving the right side of the face in this infant demonstrates the fact that hemangiomas may expand sufficiently to interfere with function or may evidence bleeding or superficial infection. In this infant there would be marked interference with development of normal vision and, if untreated, this would lead to astigmatism and other problems. In such instances, treatment with steroids or laser surgery may be indicated. Figure 1.119. Another example of SturgeWeber syndrome in which the distribution involves both the 1st and 2nd branch of the trigeminal nerve. Note the glaucoma of the right eye. In Sturge-Weber syndrome, lesions stop at the midline. When extensive facial involvement is present, there may be an associated glaucoma (buphthalmos). As this is one of the neurocutaneous syndromes, a CT scan of the head should be done to exclude intracranial involvement. Radiographs of the skull may reveal unilateral curvilinear, double-contoured lines...

Extensive Wet Gangrene Of The Foot

Wet Gangrene Pictures

A 51-year-old male patient with type 1 diabetes diagnosed at the age of 25 years was admitted to the Vascular Surgery Department because of extremely painful wet gangrene on his right foot. The patient had proliferative diabetic retinopathy which had been treated with laser, significant loss of his visual acuity (3 10 in both eyes), hypertension and diabetic nephropathy. He had lived in a nursing home. His diabetes control was good (HBAic 7 ). The patient had complained of pain in his right foot when he was at rest, 4 weeks prior to

Congenital and Hereditary Disorders

Most of these losses do not involve syndromes with other organ systems, but a few do. Notable is Waardenburg's syndrome, an autosomal dominant disorder associated with widely displaced inner canthi of the eyes and a white forelock of hair. Another is Usher's syndrome, a recessive disorder with an eye problem, retinitis pigmentosa, as well. The severity of hearing impairment in these two is variable. In most familial disorders, the loss is bilateral. Genetic testing can now even localize and typify the gene involved.

Medication Offers Relief Not a Cure

At present, there is no cure for ADD syndrome, but there are medication treatments that have been demonstrated safe and effective in alleviating symptoms of ADD syndrome in 80 to 90 percent of children, adolescents, and adults who have the disorder. Just as eyeglasses do not repair the patient's eyes and cure impaired vision, so medications that alleviate ADD syndrome do not cure problems of brain chemistry that cause these impairments the improvements last only as long as the medication is active in the body. Yet, when carefully and appropriately utilized, these medications can facilitate substantial improvement in the daily functioning of most persons impaired by ADD syndrome, although not with equal effectiveness for all. For some patients, medication for ADD brings improvements that are dramatic and pervasive for others, effects are significant, but not huge for others, results are more modest and for 10 to 20 percent of those affected with ADD syndrome, current medication...

Dry Eye and Punctum Plugs Impact of Tear Drainage

Temporary Punctual Occlusion

Summary of dry eye disease symptoms of discomfort and or visual disturbance (Table 2.3). Much is known about the pathogenesis of the keratoconjunctivitis sicca that occurs in dry eye disease (Table 2.3). The pathological features of this condition include increased epithelial stratification and proliferative index and abnormal differentiation with maintenance of a basal phenotype (Table 2.3) 9 . Furthermore, the expression of secretory and membrane-bound mucins by the superficial ocular surface epithelial cells is reduced (Table 2.3) 3, 6, 26 . An exact mechanism for the development of these pathological changes has not yet been elucidated. The severity of keratoconjunctivitis sicca worsens as aqueous tear secretion decreases and as the ability to reflex tear in response to sensory stimulation is lost. The disease results in a vicious cycle. gland ocular surface efferent tear duct integrated unit, new paradigms may emerge regarding which patients with dry-eye disease may...

Light and Dark Adaptation

Light adaptation occurs when you go from the dark into bright light. If you wake up in the night and turn on a lamp, at first you see a harsh glare you may experience discomfort from the overstimulated retinas. Your pupils quickly constrict to reduce the intensity of stimulation, but color vision and visual acuity (the ability to see fine detail) remain below normal for 5 to 10 minutes the time needed for pigment bleaching to adjust retinal sensitivity to this light intensity. The rods bleach quickly in bright light, and cones take over. Even in typical indoor light, rod vision is nonfunctional.

Neuropathic Ulcer With Osteomyelitis

Therapeutic Nursing Shoes

A 57-year-old obese male patient with type 2 diabetes diagnosed at the age of 40 years was referred to the outpatient diabetic foot clinic because of a chronic ulcer under his right foot. He was being treated with insulin and metformin with acceptable diabetes control (HBAic 7.8 ). He had a history of background retinopathy and cataract in both eyes. He reported a severe deep tissue infection 5 years earlier after a burn sustained under his right foot. At that time he was hospitalized for about 1 month and treated with intravenous antibiotics and surgical debridement.

Surgery Anatomy And Dissection

Perhaps the most striking aspect of ancient Indian medicine was the range of surgical interventions and the level of success claimed by the disciples of Susruta and Caraka. Vedic myths speak of remarkable operations on men and gods, such as a cure for impotence achieved by transplanting the testes of a ram to the afflicted god Indra. Ayurvedic texts describe more prosaic but still formidable operations such as cesarean section, lithotomy (removal of bladder stones), couching the cataract, tonsillectomy, amputations, and plastic surgery. Thus, the Ayurvedic surgical tradition offers an interesting challenge to Western assumptions that systematic human dissection, animal vivisection, and the rejection of humoral pathology are essential for progress in surgery. In ancient India, surgeons mastered many major operations without these supposed prerequisites. The Susruta Samhita describes many difficult operations, such as couching the cataract, lithotomy, opening the chest to drain pus, and...

Mice and

Fibroblast Cells From Mammal

Striking variables often relate directly to time. For example, the gestation period for an elephant in 640 days, whereas for a mouse it is 20 days. Also, the time to reach reproductive maturity varies enormously, as does the rate and number of offspring produced in a beneficial environment. As we all know, temporal differences extend to maximum longevities. For a mouse, this is about 3 years for man it is close to a century. It is often said that one year in a dog is life is roughly equivalent to seven in a man or woman's life, but that does not apply to development to the adult, which in relative terms, is far more rapid in the dog. Also, from the keeping of pets, it is well known that the signs of ageing in a dog or cat, are not obviously dissimilar to those in a human. Old animals move more slowly, lose muscular strength, skin changes may affect coat colour or density, cataracts can develop and hearing may diminish. The internal changes are comparable too, and a good example is the...

Sequestration of MBNL Proteins

The observations that muscleblind proteins colocalize with the expanded CUG and CCUG repeats strongly suggests that loss of MBNL function due to sequestration on CUG-repeat RNA plays a major role in DM pathogenesis (Dansithong et al. 2005 Fardaei et al. 2002 Jiang et al. 2004 Mankodi et al. 2001 Miller et al. 2000). Results from Mbnl knockout mice strongly support this hypothesis (Kanadia et al. 2003a). Targeted deletion of exon 3 in mice (MBNL1ae ae) to eliminate the MBNL1 isoforms that bind expanded CUG CCUG RNA repeats resulted in myotonia, cataracts, and RNA splicing defects that are striking characteristics of DM.

Executive Functions and the Brains Signaling System

Improvement produced by stimulants generally can be seen within thirty to sixty minutes after an effective dose is administered. When the medication has worn off, ADD symptoms generally reappear at their former level. Stimulants thus do not cure ADD symptoms they only alleviate them while each dose of medication is active. In this sense, taking stimulants is not like taking doses of an antibiotic to wipe out an infection it is more like wearing eyeglasses that correct one's vision while the glasses are being worn, but do nothing to fix one's impaired eyes. This effect has been demonstrated repeatedly in over two hundred medication treatment studies that were double-blind that is, neither the doctors nor the patients knew during the study who was being given real stimulant medication and who was being treated with placebos.

First Description And Other Observations

The first description of the disease is neither by Adamantiades nor by Behget. Hippokrates of Kos (460-377 B.C.) described an illness whose manifestations resembled very well the cardinal signs of Adamantiades-Behget's disease. Already in the 5th century before Christ in his 3rd Epidemion book, case 7 (Fig. 4) he stated But there were also other fevers, as it will be described. Many had their mouths affected with aphthous ulcerations. There were also many defluxions about the genital parts, and ulcerations, boils (phymata), externally and internally about the groins. Watery ophthalmies of a chronic character, with pains fungous excrescences of the eyelids, externally and internally, called fici, which destroyed the sight of many persons. There were fungous growths, in many other instances, on ulcers, especially on those seated on the genital organs. (Many carbuncles grew in the summer as well as other lesions, which were septic, large ecthymata and many large herpetic lesions) 20. It...

Ciclesonide Asthma Copd [69

Ciclesonide, a new inhaled corticosteroid (ICS), is indicated for the prophylactic treatment of persistent asthma. ICS treatment is a widely accepted standard of care for maintenance therapy of chronic asthma, and the currently available agents include fluticasone propionate, budesonide, triamcinolone acetonide, flunisolide, and beclomethasone dipropionate. These agents exert their potent anti-inflammatory effects via modulation of the glucocorticoid receptor (GR). Although ICS drugs are generally safe and well tolerated compared with oral corticosteroids, many have measurable systemic exposures, and concerns over potential side effects resulting from it severely limit the dose at which they can be administered for long-term therapy. Systemic adverse effects associated with corticosteroids include HPA axis suppression, osteoporosis, abnormal glucose metabolism, cataracts, and glaucoma, some of which could potentially occur with the long-term use of high dose ICS. The key...

Antigen Presenting Cells and Molecular Mechanisms Underlying Induction of Immune Deviation

Schepens Eye Research Institute and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, U.S.A. 29. Masli S, Turpie B, Streilein JW. Thrombospondin (TSP) is the primary molecular mediator of ACAID-inducing properties of TGF -treated antigen presenting cells. (Abstract). The Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, 2002. 36. Masli S, Turpie B, Streilein JW. By altering TNFR2 TNFR1, TGFb prevents ACAID-inducing antigen presenting cells from secreting IL-12. (Abstract) The Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, 2003. 42. Ghafoori AP, Turpie B, Streilein JW, Masli S. Increased expression of an inhibitor of NFkB, IKBa, in APCs endows them with ACAID-inducing property. (Abstract). The Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, 2005.

Intraocular Neovascular Syndromes

Diabetes mellitus, occlusion of central retinal vein, or prematurity can all be associated with retinal ischemia and intraocular neovascularization, which may result in vitreous hemorrhages, retinal detachment, neovascular glaucoma, and blindness (165,166). Expression of VEGF mRNA spatially and temporally correlates with neovascularization in several animal models of retinal ischemia (32,167,168). Elevations of VEGF levels in the aqueous and vitreous of human eyes with proliferative retinopathy secondary to diabetes and other conditions have been previously described (169,170). Similar to the animal models, these studies demonstrated a temporal correlation between VEGF elevations and active prolifera-tive retinopathy (169). Subsequently, animal studies using various VEGF inhibitors, including soluble VEGF receptor chimeric proteins (171), monoclonal antibodies (172), antisense oligonucleotides (173), and small molecule VEGFR-2 kinase inhibitors (174), have directly demonstrated the...

Loss of Function of Surrounding Genes

Expanded CTG repeats were shown to alter chromatin structure and have regional effects on gene expression (Otten and Tapscott 1995 Wang et al. 1994). The CTG expansion in the DMPK 3'UTR are located immediately upstream of the SIX5 promoter region and were shown to lower SIX5 expression (Gennarelli et al. 1999 Inukai et al. 2000 Klesert et al. 1997 Thornton et al. 1997). Six5 is a transcription factor required for eye development in Drosophila, and the mouse homologue is implicated in distal limb muscle development (Harris et al. 2000). Six5 knockout mice develop ocular cataracts and infertility resembling some features of DM1 (Klesert et al. 2000 Sarkar et al. 2000). Cardiac conduction abnormalities were also noted in Six5 knockout mice (Wakimoto et al. 2002). However, the most common symptoms of DM1 such as muscle weakness, wasting, and myotonia were not reproduced in Six5 knockout mice (Klesert et al. 2000 Sarkar et al. 2000). The identification of a second locus causing DM2 reduced...

How are MS attacks treated Why are there different drugs to treat attacks of MS

A serious infection of the brain caused by the JC papilloma virus. Cataracts trast, oral steroids had no effect except to double the risk of relapse of optic neuritis as compared with IV Medrol. There often is a rapid response to either drug in patients with acute, severe relapses, but there are no good studies of either IV compared with any dose of oral steroids to evaluate this in MS. The side effects of steroids include an increased risk of infection, including viral, bacterial, yeast, fungal, and parasitic types. This includes progressive multifocal leukoen-cephalopathy (PML), which has been recently reported in two study patients treated with Avonex and Tysabri. Other complications include psychiatric problems, cataracts, osteoporosis, and ischemic necrosis of hips and other joints (as well as others).

Bilateral CN VI palsy

Galetta SL (1997) III, IV, VI nerve palsies. In Newman NJ (ed) Neuro-ophthalmology. American Academy of Neurology, Boston, pp 145-33-145-50 Lee AG, Brazis PW (2000) Neuro-ophthalmology. In Evans RW, Baskin DS, Yatsu FM (eds) Prognosis of neurological disorders. Oxford University Press, New York Oxford, pp 97-108 Robertson RM, Hines JD, Rucker CW (1970) Acquired sixth nerve paresis in children. Arch Ophthalmol 83 574-579

The Neuropsychiatry Of The Basal Ganglia

The basal ganglia are involved in two major brain systems associated with the regulation of emotions, mood, and behavior (a) the limbic structures with widely distributed brainstem, striatal, and paralimbic sites, with rich reciprocal connections to the basal ganglia, in particular between the amygdalae and caudate (17) and (b) five frontosubcortical circuits, linking frontal lobe regions to subcortical structures, including the basal ganglia, and back to frontal lobe areas (18). These circuits receive input from brainstem nuclei, including dopaminergic input from substantia nigra and pars compacta. In addition to motor and eye movement control, the frontosubcortical circuits subserve

Mitochondrial myopathies

Myopathie Ptosis

Cerebral lesions resembling small vessel strokes, and patients may also have pre-existing migraine headaches and or seizures. Other associated symptoms include myopathy, ataxia, cardiomyopathy, diabetes mellitus, renal tubular disorders, retinitis pigmentosa, lactic acidosis, and hyperalaninemia. The disease usually starts in the fourth or fifth decade. ii) Myoclonic epilepsy and ragged-red fibers (MERRF) symptoms start in early childhood to adulthood. Clinical findings include myoclonic and or generalized or focal seizures, cerebellar ataxia, myopathy, corticospinal tract deficits, dementia, optic atrophy, deafness, peripheral neuropathy, cardiomyopathy, multiple symmetric lipomatosis, and renal tubular acidosis. iii) Mitochondrial myopathy and cardiomyopathy This disorder is associated with a hypertrophic cardiomyopathy, congestive heart failure, bilateral cataracts, insulin-dependent diabetes mellitus, my-opathy of very great severity, and Wolf-Parkinson-White syndrome.

Surgery In The Middle Ages

One problem exacerbated during the Middle Ages was the separation between surgery and medicine. Although the leech of the early medieval period was both physician and surgeon, his surgery was generally limited to simple emergency measures, such as phlebotomy (therapeutic bloodletting), cupping (applying evacuated glass cups to intact or scarified skin in order to draw blood towards the surface), cauterization, and simple emergency measures for coping with the usual run of burns, bruises, wounds, ulcers, sprains, dislocations, toothaches, and broken bones. A few more daring practitioners had the special skills needed for couching cataracts, tooth extraction, and lithotomy (the surgical removal of stones in the urinary bladder).

Why should I take drugs that have side effects

What are the side effects of the drugs that are used for treatment of MS attacks Are cataracts a result of steroid use Is osteoporosis a complication of MS Side effects of steroids are common whether they are administered by mouth or IV. There are several categories of side effects alteration of mood, formation of cataracts, increased risk of infection, impaired wound healing, loss of calcium from bone, ischemic necrosis of bone, and muscle damage, to mention only the more commonly recognized problems. Cataracts Cataracts are a well-known complication of steroid use. The risk of cataracts is related to the total dose of steroid used but varies greatly from person to person. The type of cataract is unique to the use of steroids and is easily recognized by ophthalmologists. As with other cataracts, extraction with lens replacement is the only real treatment. There seems to be little or no risk associated with ACTH use in MS. Ophthalmologists

List of Contributors

Department of Ophthalmology Oculoplastic and Orbital Surgery New York Eye and Ear Infirmary St. Luke's - Roosevelt Hospital Center New York, NY 10003, USA Department of Ophthalmology Oculoplastic and Orbital Surgery New York Eye and Ear Infirmary St. Luke's - Roosevelt Hospital Center New York, NY 10003, USA Department of Ophthalmology Oculoplastic and Orbital Surgery New York Eye and Ear Infirmary St. Luke's - Roosevelt Hospital Center New York, NY 10003, USA E-mail rdellaro Department of Ophthalmology Department of Ophthalmology St.-Josefs-Hospital Hagen University of Hagen Dreieckstra e 17 58097 Hagen, Germany E-mail info Department of Ophthalmology Oculoplastic and Orbital Surgery New York Eye and Ear Infirmary St. Luke's - Roosevelt Hospital Center New York, NY 10003, USA Department of Ophthalmology New York Eye and Ear Infirmary St. Luke's - Roosevelt Hospital Center New York, NY 10003, USA Department of Ophthalmology Hospital Darmstadt Heidelberger...

Defending Education

Ultimately, medical education can only thrive when the larger healthcare system reflects high-quality learning as a priority. We can indoctrinate students about the importance of patience and circumspection, but if they see us cutting corners and throwing caution to the wind, they will learn what we do, not what we say. We need to instill in our students and residents a clear vision of what excellence in medicine looks like, so they go into practice with their internal compasses pointing in the right direction.