Eye Exercises for People With Cataracts

StrongSight Vision by Dr. Benjamin Miller

This Easy Clear Vision strategy, by Dr. Benjamin Miller, has helped a over 16000 people enhance their vision in only 3 months. Easy Clear Vision strategy works for equally near sightedness in addition to extended sightedness, considering that both equally circumstances are a result of the same root result in. This one is a comprehensive system that focuses on keeping your eye safe and helping it to regain its lost vision. This program can help you to recover a 20/20 vision safely, quickly and without surgery. It also offers natural remedies and useful information to lower or eliminate your need for devices to correct your vision, such as 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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Glaucoma Clinical Summary

Acute narrow or closed-angle glaucoma (ACG) results from a physical impedance of aqueous humor outflow. Symptoms range from colored halos around lights and blurred vision to severe pain (described as a headache or brow ache) with nausea and vomiting. Intraocular pressure (IOP) is markedly elevated. Perilimbal vessels are injected, the pupil is middilated and poorly reactive to light, and the cornea may be hazy and edematous. Two-thirds of glaucoma patients have open-angle glaucoma. Often they are asymptomatic. They may have a family history of glaucoma. Funduscopy may show asymmetric cupping of the optic nerves. The optic nerve may show notching, local thinning of tissue, or disk hemorrhage. Optic cups enlarge, especially vertically, with progressive damage. Tissue loss is associated with visual field abnormalities. The IOP is often but not always greater than 21 mm Hg.

In Neurology And Ophthalmology

The classical application of VEP measurements for clinical purposes is its contribution to the diagnosis of multiple sclerosis (MS). The main characteristic of this disease is the patchy demyelination of afferent and efferent nerve fibers distributed all over the nervous system, and the patients have neurological symptoms that cannot be explained by a single lesion. Myelin is an insulating sheath, found on most axons, that increases conduction velocity (cf. Kandel et al., 2000), thus, electrophysiologically, latency prolongations are expected when demyelination occurs. In many patients the visual system is affected at an early state of the disease, and one finds patients with pathological VEP results who, however, do not display any subjective visual symptoms (i.e., they have normal visual acuity and visual fields). An optic neuritis occurs frequently at a very early stage of the disease, which in general is followed by a recovery after several weeks, whereas other symptoms...

Testing Visual Acuity

Several diagnostic tests are used to detect strabismus, amblyopia, ocular disease, and refractive errors. These include visual acuity and fixation preference tests, corneal light reflex test, cover test, simultaneous red reflexes test, fundus examination, stereoscopic tests, and photorefractive techniques. The best way to screen for possible visual loss caused by amblyopia is to measure the visual acuity or fixation preference of each eye separately. The covered eye should be firmly occluded during the assessment to avoid any peeking. When there is no apparent sign of amblyopia, the only clue to poor vision may be the child's objection to having the better eye occluded. Additionally, the child may demonstrate a fixation preference of the better-seeing eye, with an inability to fixate on distance objects in the amblyopic eye. Both are common signs of amblyopia that may be caused by a refractive error, media opacities, retinal or optic nerve abnormality, or cortical processing problem.

Strabismus and Amblyopia

Strabismus and amblyopia are two of the most common visual problems affecting children. Strabismus occurs in 4 and amblyopia in 4 of the population. Half of all amblyopia patients have a concomitant strabismus. Conversely, half of all amblyopia patients will have no demonstrable strabismus. Loss of vision in a relatively normal eye is called amblyopia. The phrase lazy eye should not be used in diagnosing patients because it can be confused with amblyopia and strabismus. As mentioned earlier, these two distinct clinical entities Figure 41-12 Amblyopia. This 5-year-old patient also required patching of the better-seeing eye to improve vision in the amblyopic eye. Figure 41-12 Amblyopia. This 5-year-old patient also required patching of the better-seeing eye to improve vision in the amblyopic eye. are associated with each other in only 50 of cases. In children younger than 4 years, amblyopia is the most frequent cause of unilateral vision loss (Fig. 41-12). The condition is usually...

History and Ocular Examination

In patients with pediatric cataracts, the physician should determine the age when the cataract or decreased vision occurred. A detailed history of maternal intrauterine infections should include rubella, toxoplasmosis, herpes simplex, cytomegalovirus, and varicella. Drug and medication use during pregnancy and birth trauma should be ruled out. A complete ocular examination should be performed, including visual acuity assessment using fixation and following responses. Infants with complete bilateral congenital cataracts usually demonstrate decreased visual interest and may have delayed development. Nystagmus results from early visual deprivation and is an ominous sign of poor vision. Ocular fixation and following movements may be decreased or absent. In some cases, strabismus is a presenting sign, especially in children with monocular cataracts. Glaucoma and other ocular disorders must be ruled out. Examination of the red reflexes by retinoscopy can reveal even minute lens opacities....

Correction of Refractive Errors Contact Lenses

A major use of contact lenses is to correct myopia, apha-kia, and astigmatism. It is critical to have a well-motivated patient who will wear contacts successfully. The many types of contact lenses mainly fall into four groups (1) daily-wear hard lenses, (2) daily-wear soft lenses, (3) rigid, gas-permeable lenses, and (4) extended-wear soft lenses. Hard lenses have generally been constructed of polymethyl methacrylate. The material absorbs less fluid than soft contact lenses. Soft contacts may become 80 or more hydrated. New materials for hard and soft lenses continue to be developed. Complications of contact lenses, particularly extended-wear contacts, include infection, ocular allergies, follicular conjunctivitis, contact lens opacification, corneal edema, and corneal vas-cularization. Therefore, patients wearing contacts and complaining of red eyes require urgent evaluation.

Thyroid Eye Disease Thyroid Orbitopathy

Hyperthyroidism may induce an orbitopathy in some patients. In such cases, there is diffuse hyperplasia of the thyroid and infiltrative ophthalmopathy. Thyroid eye disease is seen in association with thyroid dysfunction, although thyroid function test results may be normal. With thyroid orbitopathy, the extraocular muscle becomes infiltrated this may occur even when the disease appears to be under good systemic control. The precise extraocular mechanism is unknown and the genetic predisposition uncertain.

Eye Problems in Childhood and Their Influence on

It may appear paradoxical that an individual with poor eyesight would decide upon a career as a visual artist, yet this has happened repeatedly and with a variety of visual impairments. When the visual condition occurs in childhood, then as with other early illnesses, it is important to have an encouraging and nurturing caregiver, one who focuses on the young person's desire for creativity rather than on the presence of a visual disorder. Albert Pinkham Ryder (American, 1847-1917) had the good fortune to have such a caretaker in his father. When Ryder developed a severe inflammation of both eyes in response to a childhood vaccination, his father, knowing that his son liked to draw, gave him art supplies. The gift changed Ryder's life. He said, When my father placed a box of colors and brushes in my hands and I stood before my easel with its square of stretched canvas, I realized that I had in my possession the wherewith to create a masterpiece that would live throughout the coming...

Macular Degeneration and Cataract

Macular degeneration is the leading cause of blindness after age 65, and nothing prevents or delays its progression. Smoking 20 or more cigarettes a day increases the risk of macular degeneration two- to threefold. As with other smoking-related disorders, macular degeneration also appears to be dose related, with the incidence increasing with the number of pack-years (Christen et al., 1996 Thornton et al., 2005). Smoking is also a cause of nuclear cataract, with smokers having two to three times the risk of never-smokers.

Patient Encounter 1 Part 1 Risk Factor Evaluation and Recommended Frequency of Eye Care

A 65-year-old African American female with a history of type 2 diabetes, mild intermittent asthma, and hypertension presents to your clinic for her yearly checkup. She states that she is concerned about losing her eyesight because her sister has started losing her vision from glaucoma. She denies any changes in her vision. What risk factors does this patient have for glaucoma

Primary Angle Closure Glaucoma

Table 61-4 Topical Drugs Used in the Treatment of Glaucoma FIGURE 61-4. Algorithm for the pharmacotherapy of open-angle glaucoma. a ourth-line agents not commonly used any longer. bMost clinicians believe laser procedures should be performed earlier (e.g., after three-drug maximum, poorly adherent patient). CAI, carbonic anhydrase inhibitor. (From Lesar TS, Fiscella RG, Edward D. Glaucoma. In DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharma-cotheraphy A Pathophysiologic Approach, 7th ed. New York McGraw-Hill, 2008 1557.)

Directed Neurological Examination Visual Acuity

Visual acuity is a measurement of the individual's capacity for visual discrimination of fine details of high contrast. Best corrected visual acuity should be tested for each eye. 1 Distance vision is assessed with a standard Snellen chart and near vision with a hand-held card. If the patient does not bring corrective lenses for the examination, a pinhole can correct most refractive errors. Acuity is most often recorded as, for example, 20 40, in which the numerator refers to the distance (in feet) from which the patient sees the letters and the denominator the distance from which a patient with normal vision sees the same letters. Visual acuity with the near card is often recorded using the standard Jaeger notation (J1, J3, etc). If a patient is unable to read the largest Snellen letters (20 200 or 20 400), the acuity should be characterized by the ability to count fingers (CF) (and at what distance), detect hand motions (HM), or have light perception (LP). An eye that is blind has...

Pathophysiology of Angle Closure Glaucoma

The development of PACG is associated with several anatomical risk factors that lead to shallow anterior chambers. PACG patients may have a thick, anteriorly displaced lens that results from myopia or old age. The axial length ofthe eye is smaller in individuals with PACG which leads to a lens that is situated more anteriorly than those without PACG.25,26

Local Anesthetics For Eye Surgery

Anesthesia of the cornea and conjunctiva can be obtained readily by topical application of local anesthetics. However, most of the local anesthetics described earlier are too irritating for ophthalmologic use. The Figure 13-19 The most frequently used local anesthetics in ophthalmology. Figure 13-19 The most frequently used local anesthetics in ophthalmology. first local anesthetic used in ophthalmology, cocaine, has the disadvantage of producing mydriasis and corneal sloughing and has fallen out of favor. The two compounds used most frequently today are proparacaine (Alcaine, Ophthaine, others) and tetracaine ( Fig. 13-19 ). In addition to being less irritating during administration, proparacaine has the added advantage of bearing little antigenic similarity to the other benzoate local anesthetics. Thus, it sometimes can be used in individuals sensitive to the amino ester local anesthetics. For use in ophthalmology, these local anesthetics are instilled a single drop at a time. If...

Primary Open Angle Glaucoma

Evaluate patients 2 to 4 weeks after the initiation or alteration of medical therapy. The clinician should elicit the status of ocular health since the last visit, systemic medical history, medication history, and presence of local and ocular adverse effects of medications. IOP measurement, visual acuity assessment, and slit-lamp biomicroscopy at every POAG follow-up visit is necessary. The frequency of visual fields and optic nerve evaluation depends on whether IOP is controlled, the length of time IOP has been controlled, and whether there is progression of the disease. Patients who are at target IOP and have no disease progression should have optic nerve head evaluation and visual field testing every 6 to 18 months. Patients with disease progression or who are not at target IOP should receive optic nerve head evaluation every 2 to 12 months eye drops. ' (See Application of Ophthalmic Solutions of Suspensions textbox.) Finally, evaluate the patient's adherence to their medical...

Hearing and Vision Screening

Eyesight evaluation is a recommended part of routine health maintenance examinations in children beginning in the newborn period. In young children (< 3 years) the evaluation, besides the actual eye examination, is somewhat subjective and based on parental history. Children with risk factors, such as prematurity, family history of retinoblastoma or glaucoma, or significant developmental delays or neurologic difficulties, should be referred to an experienced pediatric ophthalmologist. More formal testing of visual acuity should begin at age 3 years, using standardized systems such as the Allen Cards, which have easily recognized pictures (AAP Committee on Practice and Ambulatory Medicine, 2003). Normal visual acuity is in the 20 30 to 20 40 range for children 3 to 4 years old, but increases to 20 20 by early school age. Eye-specific screening should be attempted in an effort to detect amblyopia (more than one line difference on the chart) (SOR B). The suspicion of amblyopia or...

Vision Screening and Ocular Examination

Appropriate vision screening is one of the most important factors in pediatric eye care. Because focused visual stimuli are critical to normal development, early detection and correction of visual problems reduce serious vision impairment or blindness. The American Academy of Ophthalmology (AAO), American Academy of Pediatrics (AAP), and American Association of Pediatric Ophthalmology and Strabismus (AAPOS) strongly support the goal of early detection and treatment of eye problems in children. In particular, vision screening is needed to detect four major conditions strabismus, amblyopia, ocular disease, and refractive errors. Family physicians are ideal vision screeners because of their ability to detect abnormalities at an early age. Essential components of vision screening are age, testing format, testing procedures, efficacy, and referral criteria. On a practical level, vision screening must be cost-effective and time-efficient. The testing devices must be readily available and...


A detailed history of visual symptoms is essential in examining these patients. Visual field defects are often not obvious to the patient, especially homonymous hemianopic defects, but history taking may document the consequence of visual-field defects on everyday life (e.g., frequent auto accidents). Loss of vision is an important symptom that may indicate tumors near the optic nerve, chiasm, or tract, but the patient often is not aware of the loss. Early signs of progressive visual loss are not always easy to detect, but a history of poor vision under poor lighting or disturbances of color sensation is suggestive of optic nerve dysfunction. Patients with papilledema may experience sudden visual loss lasting usually not more than 30 seconds and more often only a few seconds. These attacks may be preceded by photopsias for example, a sensation of sparks or lightning usually in both eyes and both visual fields. tion suggest a lesion of oculomotor subnucleus in the midbrain, whereas...

Visual Acuity

Visual acuity is expressed as a ratio, such as 20 20. The first number is the distance at which the patient reads the chart. The second number is the distance at which a person with normal Myopia Acute narrow-angle glaucoma Opacities in lens or cornea Cataracts If a standard Snellen eye chart is available, the patient should stand 20 feet from the chart. If the patient wears glasses, he or she should wear them for the examination. The patient is asked to cover one eye with the palm and read the smallest line possible. If the best he or she can see is the 20 200 line, the patient's vision in that eye is 20 200 this means that at 20 feet, the patient can see what a person with normal vision can see at 200 feet. If a patient at 20 feet cannot see the 20 200 line, he or she is moved closer until the letters are recognized. If the patient can read these letters at 5 feet, the patient's visual acuity in that eye is 5 200. Using a Pocket Visual Acuity Card If the standard Snellen chart is...


Strabismus and Amblyopia Pediatric Cataracts Adult Ophthalmology Pediatric Ophthalmology Vision Screening and Ocular Examination Testing Visual Acuity Patients present to the family physician with a limited set of symptoms, often with subtle differences to indicate mild or serious ocular conditions. To decide when to treat patients and when to refer them to an ophthalmologist, the family physician must possess a complete appreciation of these subtle differences. Knowledge of the basic anatomy of the eye is essential in determining these diagnostic differences (Fig. 41-1).

Congenital Glaucoma

Congenital glaucoma is a potentially blinding condition with an incidence of 1 per 10,000 births. It is often confused with chronic dacryocystitis. About two thirds of these cases are bilateral. These patients, similar to those with dacryo-cystitis, present with excessive tearing. The infants usually are light sensitive (photophobic) and frequently bury their head in a pillow or blanket. These infants often have intense Figure 41-5 Congenital glaucoma in a 2-month-old infant who presented with a cloudy cornea involving the right eye. Intraocular pressure was elevated. The diagnosis was congenital glaucoma. blinking or lid spasm (blepharospasm). An enlarged cornea or corneal clouding can be detected clinically and measured with a plastic ruler (normal, < 12 mm) (Fig. 41-5). Corneal edema is the result of elevated IOP, which causes breaks in the inner corneal layers (Descemet's membrane) and intrusion of anterior chamber fluid into the corneal stroma. Increased IOP causes significant...


A cataract is a condition that affects a large percentage of the population. As a result, cataract surgery is the most common U.S. surgery performed. Currently, cataracts affect approximately 40 million people in the United States. Generally, the normal aging and cataractous changes in the lens are related to its metabolic activity. Acquired cataracts may be caused by penetrating trauma, irradiation, heat, or blunt trauma. Metabolic cataracts occur particularly in association with diabetes. Changes in the blood glucose concentration may alter the refractive power of the lens. With hyperglycemia, glucose byproducts enter the lens, causing it to swell and inducing a myopic shift. Nuclear sclerosis cataract is the most common cause of lens opacity seen by the ophthalmologist an increased central density makes lens power stronger. As a result, frequent changes in the eyeglass prescription are necessary to correct the changing lens power. This type of cataract develops slowly, and surgery...


Glaucoma is responsible for at least 10 of people with blindness in the United States. Glaucoma is four times more common in African Americans, who are also eight times more likely to develop blindness from glaucoma. Glaucoma appears to increase with age in the United States and decreases with age in Japan. Diabetic patients also have an increased risk for developing glaucoma. The most common form of glaucoma in the United States is primary open-angle glaucoma, which accounts for about two thirds of all cases. In Asia the most common form of glaucoma is angle-closure glaucoma. Open-angle glaucoma tends to be genetically based, with multifactorial inheritance or as an autosomal recessive trait, with a high prevalence of carriers. Glaucoma is bilateral and occurs predominantly after age 50, although incidence is significant during the 30s and 40s, and it may even occur during the teenage years. Glaucoma is more severe in the African American population. Current incidence of glaucoma is...

Deficiency Amblyopia

This disorder is most likely related to the depletion of one or more B vitamins, although none has been specifically implicated. Deficiency amblyopia occurs only after severe and prolonged nutritional deprivation. The strict dietary deficiencies required to produce amblyopia are known to occur mainly in mistreated prisoners of war and alcoholics. Smoking tobacco was once considered another risk factor (hence, the alias tobacco-alcohol amblyopia), but this is no longer believed to be true. Patients with this disorder experience the subacute onset (over days to weeks) of symmetrical loss of visual acuity, and colors perceived appear to be washed out. On examination, the central portion of vision is especially impaired, and occasionally patients exhibit pallor of the optic discs. Patients often have evidence of other syndromes of nutritional deficiency, including a predominantly sensory polyneuropathy. The possible causes of optic neuropathy are legion, and most are much more common than...

Pediatric Cataracts

Approximately 40 of acquired pediatric cataracts are secondary to trauma, and as many as approximately one third of pediatric cataracts are inherited. The basic approach to the patient with pediatric cataracts is to determine whether the cataract is an isolated finding, part of a systemic abnormality, or associated with ocular disease. When several members of the same family are affected by congenital cataracts, a hereditary origin may be assumed. Autosomal dominant hereditary patterns are the most frequent mode of transmission. X-linked cataracts are rare and occur primarily with the ocu-locerebrorenal syndrome. Congenital or infantile cataracts have been described in association with a large number of congenital anomalies. (See online content for additional information on pediatric cataract differential.)

Literature and Specialties

Tion works and individual monographs were devoted to such problems as children's diseases, the diseases of women, skin problems, eye complaints, and throat ailments. The following provide a few examples The earliest extant title concerned with the diseases of children is the Lu-hsin ching (Classic of the Fontanel), of unknown authorship and compiled around A.D. 907, which was presumably based on sources of the fourth century or even earlier. The oldest available text today on women's diseases and obstetrics is the Fu-jen liang fang (Good prescriptions for females) of 1237 by Ch'en Tzu-ming. A text, lost now, possibly dating back to T'ang times and indicating the Indian origins of Chinese ophthalmology, is the Lung-shu p'u-sa yen lun (Bodhisattva Nagaijuna's discourse on the eyes), and a first monograph on leprosy was published by Hsiieh Chi in 1529 under the title Li-yang chi-yao (Essentials of the li-lesions). On ailments affecting the throat, the oldest text extant is the Yen-hou...

Emergency Department Treatment and Disposition

Urgent ophthalmology consultation and systemic therapy are required. Oral nonsteroidal anti-inflammatory drugs are useful however, steroids and other immunosuppressive agents may be required, and management is best left to an ophthalmologist. Diagnosis and treatment of underlying systemic conditions is mandatory. Figure 2.21.

My daughter becomes overexcited if there is too much to look at but she loves staring at lights

One theory suggests that children identify people and objects by their overall shapes rather than by the details of their appearances. While people typically use their central vision for identifying details, it's possible that children with ASDs instead favor the peripheral part of the retina that focuses on shape and movement. This may explain why some children with ASDs are so comfortable moving about in the dark or running aimlessly without looking where they're going. It turns out that the motion-sensing part of the eye is engaged mostly when we're in near-darkness, when we can't make out details. Like Jake, many children I work with demonstrate a preference for peripheral vision you can observe it through their stimming behaviors. They will peer out of the corners

Athletes with Organ Loss or Impairment

Athletes with one functional eye must take special precautions to protect the intact eye, and must realize that depth perception is decreased, making them more prone to injury. Athletes who have undergone eye surgery or serious eye injury likewise need special protective eye gear. Sports involving a puck or ball carry an increased risk for these individuals.

Diagnostic Considerations for Esthetic Implant Therapy

Accurate and precise planning includes detecting any existing clinical difficulties prior to the treatment and viewing or foreseeing the final result before the treatment is started. This requires imagination, creativity, and farsightedness on the part of the clinician, but surely helps the dentist determine what is needed to restore the missing dentition and or its supporting structures if dental implants are to be considered.

Effectiveness of Early Detection and Intervention

Intensive glycemic control in persons with clinically detected diabetes can reduce progression of microvascular disease. The benefits of tight glycemic control on microvas-cular clinical outcomes, such as severe visual impairment or end-stage renal disease, require long-term follow-up. There is inadequate evidence that early diabetes control as a result of screening provides an incremental benefit for microvascular clinical outcomes compared with initiating treatment after clinical diagnosis (USPSTF, 2008).

Associated Neurological Findings

Patients with cerebellar disease and acquired nystagmus, particularly pendular, may complain of oscillopsia, the illusion of motion, and may suffer a reduction in visual acuity. Conversely, patients with bilateral visual loss involving the anterior visual pathways, especially if congenital or acquired in childhood, may develop nystagmus with vertical and horizontal components. Patients with severe visual loss of any type may also display a searching nystagmus in their attempt to localize objects without adequate visual feedback.

Allochthonous Parasites in the Americas Previous Syntheses

Rubella was added to the list for two reasons. First, although a relatively mild disease in adults, it can seriously affect the reproductive fitness of a population. If a woman develops German measles during the first trimester of pregnancy, the fetus may be born with major congenital defects, including cataracts, heart disease, microcephaly, and mental retardation (Top 1976). Second, although rubella was confused with measles and smallpox until the eighteenth century, the presence of measles and smallpox in America during the sixteenth and seventeenth centuries suggested that rubella could have been introduced at the same time.

Development of EP Systems in the United Kingdom

The Burton on Trent Trust has also been working with electronic medicines management systems since 1992.21 Queen's Hospital, Burton, had a Meditech HISS (hospital information support system) already in place, and implemented the pharmacy module of the Meditech system in 1992. In 1995, the Trust was selected by the then NHS Information Management Group to be one of two sites to participate in the EPR programme. The chief criterion for this was that the Trust was already operating an integrated HISS and had commitment from all the major stakeholders in the implementation process - clinicians, hospital management and suppliers. The EPR programme included electronic prescribing as one of its subprojects and, when the EPR programme was complete in December 1996, three pilot wards in the elderly care directorate were using the EP system. The system was subsequently extended to two further care of the elderly wards, the admissions unit and the ophthalmology ward. The EP system at Burton...

Neurophysiological Bases Of Evoked Electrical Brain Activity

Visually elicited activity may be recorded noninvasively, both at the level of the retina as electroretinogram (ERG) and from the visual cortex as visual evoked potential. Here the focus is concentrated on VEP activity, and the reader is referred elsewhere for a more detailed description of electroretinographical methods in basic research and in clinical settings (Armington, 1974 Heckenlively and Arden, 1991). Skrandies and Leipert (1988) give some instructive examples on how the combination of cortical and retinal electro-physiological recordings allows the topo-logical identification and diagnosis of the causes of visual field defects in neuro-ophthalmologic patients.

Sympathetic Nervous System

Activation of the sympathetic nervous system produces an immediate and sustained increase in catecholamine secretion (i.e., epinephrine and norepinephrine EPI NE). Sympathetic nerve terminals secrete EPI NE directly onto target tissues, which elicits an immediate postsynaptic response that clears and subsides within a very short time frame (i.e., within a few seconds). For instance, secretion of EPI NE from sympathetic nerve terminals directly onto cardiac muscle potently increases heart rate and strengthens the force of contractions. Meanwhile, EPI NE release within the eye dilates the pupil to boost visual acuity and responsivity. These are just two common examples of how direct sympathetic innervation can promote coordinated activity within different effector organs, and thus promote survival in a threatening context.

Ms perceptual motor and cognitive functions are intact

The results of extensive testing of sensory functions showed that H.M.'s perceptual capacities are entirely normal. He performs well within the normal range on tests of visual acuity, adaptation, and other commonly tested visual-perceptual functions. He can recognize and name common objects. He has some loss of touch and fine motor coordination revealed in sophisticated tests, but these are not noticed in his generally good performance on tasks that require coordination in his daily environment. H.M.'s intelligence was above average in standard IQ tests just before the operation. After the surgery his IQ actually rose somewhat, perhaps because of the alleviation of his seizures. H.M.'s language capacities are largely intact, although he exhibits slight deficits in the fluency of his speech, and his spelling is poor. He appreciates puns and linguistic ambiguities, and communicates well and freely. His spatial perceptual capacities that do not depend on memory are mixed. For example, he...

Neurologic Examination

Kim et al reported the neurologic findings in 16 GC patients.14 The most common disturbances were papilledema (63 ), decreased visual acuity or visual field deficit (33 ), facial palsy (25 ), trigeminal nerve dysfunction (19 ), extraocular movement disturbance (13 ), lower cranial nerve dysfunction (6 ), and hearing deficit (6 ).

Therapeutic Uses Of Botulinum Toxin

Ophthalmologist who pioneered preclinical evaluation of botulinum toxin in monkeys and its subsequent clinical use in patients with strabismus (wandering eye) and blepharospasm 49 Edward Schantz was a protein chemist who had crystallized botulinum toxin type A and provided it on request to Scott.50 Botulinum toxin type A was licensed by the US Food and Drug Administration on December 1989 for the treatment of blepharospasm and strabismus, thus culminating more than a decade of collaborative effort by Scott and Schantz.

Head and Neck Diseases

In the hot, dry climate of northwestern India, eye diseases have always been common, and thus the sections on eye diseases are among the most detailed and remarkable of the Ayurveda. These diseases are divided into two broad groups Netrarogas, or diseases of the eyeball and Drshtirogas, or disturbances of vision. Seventy-three Netrarogas are described, although some seem to be different manifestations of the same disease. Four of these, for example, seem to be forms of trachoma and two more forms of blepharitis. Various types of corneal ulcers are dis cussed, as is conjunctivitis and glaucoma. The Ayurvedic variants of a disease called Adhimantha are actually the progressive stages of glaucoma, producing a swift loss of vision if untreated. The section on diseases of vision describes cataract and various forms of another disease that resulted in disturbed vision - possibly symptomatic of glaucoma. Other disturbances of vision included day blindness and night blindness.

Distortions as Clues to Reasoning

Early on, the Gestalt psychologists attempted to demonstrate that memory for figures got distorted in the direction of good figures (see Riley, 1962). This claim was contested and countered by increasingly sophisticated empirical demonstrations. The dispute faded in a resolution visual stimuli are interpreted, sometimes as good figures memory tends toward the interpretations. So if o - o is interpreted as eyeglasses, participants later draw the connection curved, whereas if it is interpreted as barbells, they do not (Carmichael, Hogan, & Walter,

Clinical Features

In their 1954 pineal tumor study, Ringertz and colleagues defined the pineal region as being bound by the splenium of the corpus callosum and telachoroidea dorsally, the quadrigeminal plate and midbrain tectum ventrally, the posterior aspect of the third ventricle rostrally, and the cerebellar vermis caudally.58 Mass lesions that compress these adjacent structures will result in typical clinical syndromes. One of the most common presentations is headache, nausea, and vomiting caused by aque-ductal compression and resultant obstructive hydrocephalus.15 Untreated, hydrocephalus may progressively lead to lethargy, obtundation, and death. Compromise of the superior colliculus either through direct compression or tumor invasion will result in a syndrome of vertical gaze palsy that can be associated with pupillary or oculomotor nerve paresis. This eponymic syndrome was first described by the French ophthalmologist Henri Parinaud in the late 1800s and has become virtually pathognomonic for...

Perceiving the outer worldtt

Vision is an active information acquisition process - the eyes dart about frenetically under the direction of the brain. As we have arBn already discovered, clear vision is possible only when the fovea J inspects a scene. This provides a very restricted window of clarity and so to generate the perception of a 'movie in the head' the eyes must be moved around. The eyes move speedily from one place to another where they dwell for a while, enabling your brain to take a high definition snapshot. From a number of these sequential snaps the brain builds the mind's eye picture of the outside world. The whole process is an active feedback loop in which the retina supplies information to the brain, which then makes an educated guess about what is out there and on this basis instructs the eyes to move, thereby changing the visual information being supplied. Multiple brain regions are required to perform all of the computational tasks that are necessary to convert information supplied by the...

The somatic marker hypothesis Cognition meets emotion

Initial investigations by Damasio and colleagues employed skin conductance response measures (SCR Damasio, 1994 Damasio et al., 1990) in reaction to emotionally laden stimuli as a measure of the somatic marker response. This data indicated that individuals with compromise of the VMPFC featured a blunted response to the stimulus material in comparison to unimpaired controls (Damasio & Anderson, 1993 Eslinger & Damasio, 1985). These impairments existed despite preserved intelligence, language, memory, perception, executive functions, and social knowledge (Eslinger & Damasio, 1985 Saver & Damasio, 1991). Damasio (1994 Saver & Damasio, 1991) has proposed that VMPFC-lesioned patients make choices that have high immediate reward but severe delayed punishment because they have a myopia for the future. They seem to be guided only by the immediate prospects of the gain associated with the stimulus, whatever that might be, and are insensitive to the ultimate consequences of the...

Diagnostic procedures in eczema herpeticum

Patients with EH should be seen by an ophthalmologist to monitor for herpetic keratitis. A neurologist should examine the patient if meningeal involvement is suspected. Clinical features of CNS infection with HSV may be headache, confusion, and fever. Areas with decreased attenuation in the temporal lobes in the CT scan of the head, abnormalities in the EEG, and pleo-cytosis and increased protein levels in the cerebrospinal fluid will only be found if the herpes encephalitis is suspected and the tests are ordered.26

Self preservation and survival

The horse has evolved over many centuries into what we now accept as the modern horse. As a prey species the horse has developed its use of eyesight and its 'flight or fight' instinct and it is important to remember these characteristics when approaching the horse and to appreciate why sudden movements in and out of the blind spot may precipitate a strong reaction. The horse's eyesight is not developed to cope with

What are the alphablockers

Contraindicated in moderate to severe hepatic impairment, should not be used with co administration of potent CYP3A4 inhibitors. Intraoperative Floppy Iris Syndrome has been reported in patients taking uroxatral while undergoing cataract surgery. Administer with caution if impaired hepatic function. Intraoperative Floppy Iris Syndrome has been reported in patients taking doxazosin while undergoing cataract surgery. Use with caution in pts with mild or moderate hepatic impairment, not recommended with severe hepatic impairment. Intraoperative Floppy Iris Syndrome has been reported in patients taking doxazosin while undergoing cataract surgery. As with other alpha-blockers, individuals taking silodosin should discuss this with opthalmolo-gist prior to undergoing cataract surgery due to risk of Intraoperative Floppy Iris Syndrome. Use with caution in combination with moderate or strong CYP2D6 or CYP3A4 inhibitors if pt has a serious or life-threatening sulfa allergy, caution warranted...

Screening For Vhl Disease

Any patients younger than 50 years old with a CNS hem-angioblastoma or any patient at any age with multicentric CNS hemangioblastoma should have full CNS MRI with contrast, ophthalmologic examination, abdominal CT scan with contrast, and single voided urine metanephrine assay. 2. Any patient with a VHL-disease pedigree should undergo routine CNS MRI (starting as early as age 10, no later than age 20) and ophthalmologic examination and should have routine abdominal CT scans with contrast (starting at 20 years of age).

Clinical Symptoms And Signs

Suprasellar, or neurohypophy-seal, tumors compress the optic chiasm, resulting in bitemporal hemianopsia and decreased visual acuity. Tumor invasion into the neurohypophysis produces panhypopituitarism and diabetes insipidus. The survey of pituitary function reveals lowered anterior pituitary hormones (especially GH, FSH, and LH) and vasopressin and elevated prolactin titer.21 Tumors in the basal ganglia or thalamus invade the pyramidal tract and result in contralateral hemiparesis. However, with the exception of HCG-secreting tumors, the clinical signs and symptoms of the different histologic subtypes are not tumor specific. Some tumors secreting HCG manifest intratumoral hemorrhage that results in acute intracranial hypertension. In sexually immature males, they induce precocious puberty. Of 50 patients with neurohypophyseal tumors, 43 (86.0 ) presented with diabetes insipidus. Visual disturbance, including narrowing of visual field and decreased visual...

Presenting Features Symptoms And Signs

No single symptom or sign is specific for patients with intracra-nial meningiomas. Some patients are asymptomatic, and their tumors are detected incidentally. Other patients have symptoms such as headache, paresis, seizures, personality change or confusion, and visual impairment. Headache and paresis occur in 36 and 30 of patients, respectively.13

Clinical Manifestations

Upper and lower cranial nerve palsies. Permanent or intermittent diplopia is the first symptom in most patients, generally the result of compromising of the sixth cranial nerve.1,8,16 Other symptoms include those related to other cranial nerve palsies, such as decreased visual acuity, facial numbness, facial weakness, hearing loss, dysphasia, dysarthria, hoarseness, and difficulty with speech and swallowing, as well as symptoms of brainstem or cerebellar compression such as dysmetria, gait ataxia, motor weakness, and memory disturbances. Local tumor extension into the retropharyngeal space or into the nasal cavity may occur, and nasopharyngeal symptoms, such as nasal obstruction or discharge, eustachian tube obstruction, throat fullness, dysphasia, or epistaxis, may occur, occasionally being the only symptoms.1,16,20,21 Physical examination often discloses optic nerve dysfunction or extraocular palsies, particularly when the tumor involves the upper clivus.8,20,21 Cranial nerve...

Antiepileptic Drugs Topiramate

Sedation can accompany use of TPM, so dosing in a single dose at night may be of benefit to patients who have difficulty sleeping. Other rare adverse effects include calcium phosphate renal calculi, hyperchloremic acidosis, oligohydrosis in younger patients, and narrow angle glaucoma, an ophthalmologic emergency.

TABLE 629 Toxic Alcohol Ingestion Treatment

Moreover, since both parent compounds and metabolites are low molecular weight and have small volumes of distribution, hemodialysis is generally employed in methanol toxicity hemodialysis is indicated for levels > 50 mg dL, if acidemia is present, or visual acuity is impaired with ethylene glycol toxicity hemodialysis is generally employed for levels > 20 mg dL

Nonsteroidal Anti Inflammatory Drugs

Low-dose glucocorticoid treatment (equivalent to prednisone 10 mg day or less) effectively reduces inflammation through inhibition of cytokines and inflammatory mediators and prevents disease progression.19,21 The goal of glucocorticoid use is to minimize adverse drug events by keeping doses low and using the drugs as infrequently as possible. Patients may receive glucocorticoids for a brief time as bridge therapy following DMARD initiation or via intra-articular injections to relieve symptoms of active disease. Patients taking more than 10 mg day prednisone or equivalent are at an increased risk for clinically significant adverse reactions, especially bone loss leading to osteoporosis. Other glucocorticoid-related adverse reactions include Cushing's syndrome, peptic ulcer disease, hypertension, weight gain, infection, mood changes, cataracts, dyslipidemia, and hyperglycemia.

Symptoms and Incidence

A concussion usually results in the rapid onset of brief neurologic impairment that resolves spontaneously. Symptoms of concussion include loss of consciousness, amnesia, confusion, headache, vision problems, nausea, and balance problems (Box 29-3). A concussion may or may not be associated with a loss of consciousness. Over 90 of concussions are not associated with a loss of consciousness, and unconsciousness is not a marker of the severity of the injury (Lovell et al., 1999). Amnesia can include loss of memory of the events before (retrograde amnesia) or

Balance the neglected organs

Information from the balance organs splits in two in the brainstem. Part of the signal goes to the region of the brain controlling eye movements, which allows us to fix on an object and keep tracking it, even if our head is moving and we are in a moving object. This system is incredibly fast, accurate and sophisticated and allows us to keep images absolutely fixed on a minute part of the retina. If there is a problem with the balance organs or the eye movement control, we will have the flicking eye movements of nystagmus. The other part of the signal goes to the regions of the brain controlling limb and trunk position, so that we do not fall over (unless we want to). This makes sure our weight always passes through our centre of gravity, which is always over our feet.

Peroxisomal Leukodystrophies Adrenoleukodystrophy

Neonatal adrenoleukodystrophy is characterized clinically by early onset, dysmorphic features, and a very protracted course. Occasionally, the symptoms occur at a somewhat later period than expected.y One patient presented at 23 months with frequent emesis and acute mental deterioration, followed very quickly by refractive seizures. A long history of developmental, mental, and motor delay had previously been observed in this child. There tends to be a staggering course, sometimes with developmental stagnation or regression preceded or followed by improvement in stasis, visual impairment, truncal hypotonia, and limb spasticity. Subdural hematoma and its sequelae have been associated with this syndrome. '791

Us Call An Ambulance

You should have your vision tested every 2 years, especially once you are over 40. The most common test gauges the sharpness of your distance vision by assessing how well you can read letters lined up in decreasing size on a Snellen chart. Your ability to focus on near objects may also be measured by asking you to read very small print on a chart held at normal reading distance. These tests show whether you need corrective lenses, and, if so, which ones. In addition, your optician will examine your eyes to look for disorders such as diabetes and high blood pressure, which can cause changes in the back of the eye before general symptoms develop. You may also be tested for glaucoma (see Screening for glaucoma, opposite).

Antidepressants in the selective serotonin reuptake inhibitor category SSRIs

Another rare but important side effect is their propensity for causing blurred vision and or partial blindness, usually in one eye, a condition officially called nonarteric ischemic optic neuropathy (NAION). At least forty cases have been reported, and the eye changes are usually permanent. Men who have hypertension, diabetes, hy-perlipidemia, and or a small optic cup (which can be assessed via an exam by an ophthalmologist or optician) are at higher risk for this side effect.19

Local anaesthetic technique

Facial nerve paralysis Postinjection trismus Prolonged anaesthesia Visual impairment Visual impairment is a reported complication but is very rare. Its cause is unknown although vasospasm has been suggested as a possible factor. Any impairment of vision warrants immediate referral to an ophthalmic specialist.

Ophthalmia Trachoma Conjunctivitis

The term derives from the Greek ophthalmos (eye), and almost any eye disease was called ophthalmia until the twentieth century. The problem for historians of past disease is that ophthalmia meant any of a number of eye ailments and that blindness from ophthalmia had many possible causes. Historically, two of the most important ophthalmias were trachoma and conjunctivitis.

Neurofibromatosis 2

Molecular Genetics and Clinical Presentation. Neurofibromatosis type 2, also known as bilateral acoustic or central neurofibromatosis, is less common than NF1. NF2 occurs in 1 out of every 40,000 to 100,000 live births.351 Isolated in 1993, the NF2 gene is located on chromosome 22 (22q12.2 locus) and codes for a protein called merlin, or schwannomin.17-18,48 Merlin, or schwannomin, is expressed in fetal brain, kidney, lung, breast, and ovary. Its function is unclear but possibly involved with membrane stabilization of a cytoskeleton-associated protein and intercellular communication. The loss of merlin may lead to the elimination of intercellular contact inhibition, which could lead to tumor development.102 In 10 of cases, NF2 patients become symptomatic before the age of 10. Fifty percent of NF2 patients become symptomatic by age 30 and 90 by age 50.3 NF2 is characterized by schwannomas of the cranial nerve roots, particularly the vestibular portion of the eighth cranial nerve, as...

Clinical Presentation

Ocular and ophthalmologic findings are also often detected in patients with primary tumors of the thalamus. Visual field deficits resulting from compression of the optic tract or genic-ulate ganglia are quite common. Ocular signs most often found include a poorly reactive, myotic pupil ipsilateral to the lesion and divergent extraocular motions. An ipsilateral third nerve palsy can also occur. These findings result from tumor infiltration or compression of the optic radiations, the retrolenticular segment of the internal capsule, or the rostral mesencephalic tegmentum.

Improved Biomembrane Permeability Passive Diffusion

A major problem in the use of the b-adrenergic antagonist timolol (Figure 9.11) in the treatment of glaucoma is the high incidence of cardiovascular and respiratory side effects. This is due to absorption of the topically applied drug into the systemic circulation, which again can be attributed to insufficient corneal penetration of the drug. The use of more lipophilic prodrugs has been investigated to improve the corneal penetration of timolol and it was found that 0-butyryl timolol, which is 50 times more lipophilic than timolol (Figure 9.11), was absorbed into the aqueous humor

What It Can Do for You

Proper amounts of exposure to natural sunlight can contribute to one's good health by promoting a consistent circadian rhythm and exposure to vitamin D, which is required for maintaining healthy teeth and bones and for absorbing calcium. Working in adequately lighted workspaces usually reduces eyestrain

Delivery Systems For The Anterior Segment

The cornea is the primary route for anterior drug absorption, which is important for the treatment of diseases including infections, dry eye, glaucoma, and inflammations. Medications delivered in conventional eye drops are quickly removed from the eye by tear turnover and reflex blinking. The volume of a drop dispensed from a typical eye drop bottle varies significantly based on the tip design, formulation surface tension and viscosity, and the angle of instillation, but is on average approximately 40 pL. This volume is well in excess of the 20 pL holding capacity of the pre-corneal space, which is regularly filled with 7 pL tear film in an average person. Accordingly, while some of the instilled 40 pL drop is absorbed systemically through the conjunctival stroma, much of the drug spills over onto the cheeks or drains into the nasolacrimal duct, where it flows down the throat and gets swallowed, or enters the systemic circulation through the nasopharyngeal mucosa. As a result, most...

Mycobacterium tuberculosis

The American Academy of Pediatrics recommends a combination of Isoniazid (INH), rifampin, pyrazinamide, and streptomycin as the Initial therapy of tuberculous meningitis In children. y The doses are listed In Tab e 42-3 . When antimicrobial sensitivities are known, the treatment regimen may be altered. Standard therapy uses four drugs for 2 months followed by INH and rifampin alone for 6 to 9 months. Most drug regimens Include Isoniazid, rifampin, and pyrazinamide and either ethambutol or streptomycin (In children too young to be monitored for visual acuity). y When the results of drug susceptibility studies are available, and If the organism Is sensitive to INH and rifampin, ethambutol and pyrazinamide are continued

Pollution Emotional and Cognitive Responses

Research relating air pollution to human task performance shows that prolonged exposure to various air pollutants can decrease visual acuity, interfere with sensorimotor balance, impair time estimation, diminish attention span, disrupt memory and problem-solving ability, and reduce overall work capacity.13 There are a number of moderating variables, such as the perception that the pollution is controllable and individual differences in adaptability and environmental stress tolerance, but the fact remains that, for far too many people, air pollutants carry a high cost in terms of psychological well-being.

Evaluation Symptoms and Signs

Abnormal light sensitivity (photophobia) is a third danger symptom that must be elicited by the family physician. Photophobia occurs with corneal inflammation, iritis, and angle-closure glaucoma. Patients who have conjunctivitis usually do not have abnormal light sensitivity (Box 41-1). Patients who complain of a red eye often complain of discharge from the eye (Table 41-2). If they do not complain of eye discharge spontaneously, the physician must inquire about the presence, type, and quantity of discharge. Purulent (creamy white or yellow watery) discharge suggests a bacterial cause. A serous or clear discharge suggests a viral cause. Scanty, white, stringy exudate occurs most often with allergic conjunctivitis. The absence of discharge indicates an unusual cause for red eye, such as iridocyclitis, ultraviolet (UV) light keratitis (snow blindness), or acute angle-closure glaucoma. A complaint of diminished visual acuity is a serious danger sign and must be elicited in the history.

Clinical Preparation for Radiation Therapy

In selected patients where high doses of radiation therapy will include a portion of the orbits, consideration of a baseline ophthalmologic evaluation may be indicated. This can be important in patients being treated for nasopharyngeal carcinoma and malignancies of the nasal cavity and paranasal sinuses.

Bacterial Conjunctivitis

Causes of hyperacute conjunctivitis are N. gonorrhoeae and N. meningitidis. Risk factors for bacterial conjunctivitis include contact lens wear, exposure to infectious persons, compromised immune systems, nasolacrimal duct obstruction, and sinusitis. In the presence of a severe purulent discharge, culture of the conjunctiva is mandatory (see Fig. 41-3). Subcon-junctival hemorrhage may occur with bacterial conjunctivitis and is especially common with H. influenzae conjunctivitis. Treatment of conjunctivitis is with a topical antibiotic, such as erythromycin or bacitracin. Tobramycin ophthalmic ointment may be used for many gram-positive and gram-negative conjunctivitis cases. Ciprofloxacin and ofloxacin also provide effective broad coverage of most types of conjunctivitis. Gonococcal and Haemophilus conjunctivitis require systemic and topical therapy. If the conjunctivitis does not improve within 2 to 3 days or the worsening symptoms develop, the patient should be referred to an...

Corneal Herpetic Infections

Primary ocular infection in a nonimmune subject usually presents as conjunctivitis with a clear watery discharge, skin vesicles on the lids, and preauricular nodes. Associated vesicles and ulcers on the oral mucosa and skin are common. Corneal involvement also may occur with single or multiple dendrites. If dendrites are present, the patient should be referred for treatment. Particular attention should be given to inspecting the nose for possible lesions. A lesion at the tip of the nose indicates involvement of the cornea through the nasociliary branch of cranial nerve V. Treatment generally involves trifluridine 1 (Viroptic) drops five times daily for 10 to 14 days. If other regions are involved, oral acyclovir is added to trifluridine, as in eyelid or corneal involvement. These patients should be managed by an ophthalmologist.

Corneal and Scleral Lacerations

Corneal and scleral lacerations fall within the realm of the ophthalmologist and should be referred immediately after a shield is placed over the eye. Frequently, signs of corneal and scleral lacerations include unequal pupils, decreased IOP, iris prolapse, and hyphema, and a corneal laceration often also involves the lens. It is important to consider posterior injuries to the globe, including retinal detachment, retinal tear, and vitreous hemorrhage (Fig. 41-11). Patients can often be managed as outpatients with oral antibiotics. Intravitreal antibiotics may be given at ruptured-globe repair. Some patients are hospitalized for IV antibiotics, although current intravitreal penetration of many antibiotics is often comparable. Corneoscleral lacerations should be principally repaired at the presenting institution when possible with available ophthalmology services. Hospital transfers delay wound closure or risk wound extension or prolapse of intraocular contents.

Evaluation of Vision within First 4 Months of Life

Parents may report that their baby does not appear to look at them. This statement requires the physician to document a history of prematurity, fetal distress, anoxia, or birth trauma carefully. A failure to reach developmental milestones may indicate neurologic abnormalities. A history of seizure disorder, cerebral palsy, or chromosomal abnormalities helps identify potentially serious causes. In this case, visual acuity or the child's ability to fixate must be assessed. Normal newborns follow faces. By age 2 or 3 months, infants normally follow light and high-contrast objects. Assessment of vision can be achieved by using an optokinetic nystagmus drum. Oculomotor disturbances may be the underlying cause of the child's apparent visual inattention. Bilateral cranial nerve III palsy, congenital fibrosis syndrome, or partial cranial nerve III palsy may give this impression as well. Searching or roving eye movements are a form of profound nystagmus, with little foveal perception....

Four Stages of Screening

The AAO and AAPOS recommend that children be examined for eye problems in the following four stages (Table 41-4) 1. In the newborn nursery, physicians should examine all infants. Ophthalmologists should be consulted to examine patients at high risk for conditions such as retinopa-thy of prematurity (ROP), cataracts, congenital defects, and other ocular pathology. The AAO statement recommends that family physicians establish a close working relationship with a local ophthalmologist who is familiar with children's eye problems. The collaboration can help clarify questions about vision screening and the need for referral. (See online content for specific information on different stages of vision screening.) Also, special groups may need additional vision screening. The following children should also be screened, even if they are not due to be examined by their age all children Table 41-4 Recommended Vision Screening by Family Physicians Table 41-4 Recommended Vision Screening by Family...

Clinical Manifestations and Pathology

Upon examination, the liver and spleen frequently are found to be enlarged, and a range of other symptoms have been documented. Among the more common are anemia and vitamin A deficiency, with some vision impairment, a range of micro-nutrient deficiencies, plus tendencies to hypothermia, higher bilirubin, hyponatremia, hypoglycemia, and very low plasma albumin.

Learning Disabilities and the

Although reading may be easier and faster when sight is clear, visual problems generally do not cause learning disabilities, and eye defects are not responsible for reversal of letters. In the past, reading problems were blamed on the eyes, although children with a learning disability have no greater incidence of eye problems than the rest of the population. Other issues, such as dyslexia, attention-deficit hyper-activity disorder, social issues, or family problems are often found to be contributing to a child's poor attention in class or learning difficulties. It is important that a thorough medical eye examination be performed. The presence or absence of visual defects can be diagnosed and corrected. Once vision is corrected, no other examinations or therapies involving the eyes diminish a learning disability. Meta-analysis shows that children with learning disabilities do not benefit from visual training, muscle exercises, perceptual training, or hand-eye coordination exercises...

Travels to Russia Relocating in Dresden

In 1844, Schumann and Clara embarked on what would be a triumphant concert tour of Russia for Clara, but a demeaning experience for Schumann. He was mainly acknowledged as Clara Schumann's husband. At social events, he remained silent and reserved. Schumann was a poor traveler and 4 months of horrendous schedules soon affected his moods. He was incapable of working under those stressful conditions. Following the trip to Russia, Schumann experienced one of his most severe depressions. A move to Dresden seemed advisable and Schumann, no longer interested in publishing his New Journal, decided to sell it. In December 1844, the Schumann household moved to Dresden. Schumann consulted a physician to treat his violent nerve attacks, also his blurred vision and nearsightedness.

Complete Lens Opacities

Workup for complete cataracts includes systemic evaluation, ocular ultrasonography, metabolic evaluation, serum chemistry, and chromosomal analysis. Congenital cataract causes include intrauterine infection, metabolic disorders, chromosomal anomalies, and systemic syndromes. Workup for congenital cataracts includes urinalysis for reducing substances and amino acids. Serum chemistry for calcium, phosphorus, glucose, and blood urea nitrogen (BUN) levels and TORCH (toxoplasmosis, other agents, rubella, cytomeg-alovirus, herpes simplex) titers should be obtained. When warranted, genetic and pediatric consultations should be requested. Radiologic imaging, including CT or MRI, may be needed.

Ophthalmic Conditions in Older Adults

The most important causes of central and peripheral visual impairment in older adults include glaucoma, cataract, diabetic retinopathy, and macular degeneration. Most of these conditions can be controlled or, as in the case of cataracts, vision can be restored to a significant level to improve the quality of life. Glaucoma and macular degeneration progression may be slowed with proper treatment. Regular eye examinations for older adults can detect early signs of ocular abnormalities and ensure that proper treatment is initiated. Generally, adults older than 40 years should have a complete examination at least every 3 years. After age 65, the examination should be at 1- to 2-year intervals.

Carotid Cavernous Sinus Fistulas

Patients with a direct CCF may develop monocular visual loss and abnormalities of the oculomotor nerves (III, IV, VI) ipsilaterally or bilaterally. Ocular manifestations include diplopia, proptosis, ocular bruit, chemosis, ocular pulsation, dilatation of retinal veins, optic disc swelling, visual loss, and potentially glaucoma. There are often signs of intracranial hypertension. Trigeminal nerve dysfunction is the most common cranial nerve abnormality. Dural types usually occur in middle-aged or elderly women. They present similar clinical symptoms and signs but are less severe than those of the direct type. Urgent treatment is indicated in patients who have rapidly deteriorating vision, hemorrhage, and intracranial hypertension. Surgical repair of the damaged portion of the intracavernous ICA is only rarely used these days. Endovascular occlusion using detachable balloons has a success rate of 90 to 100 percent with low complication rates (2 to 5 percent).1 1 The recurrence rate is 1...

Anterior Ischemic Optic Neuropathy

The clinical characteristics of ischemic optic neuropathy include age at onset generally older than 60 years, painless vision loss, and afferent pupillary defect (Marcus Gunn pupil). These patients also usually have a visual field abnormality. Examination of the optic disc reveals edema in almost all cases. Pathology appears to be related to a diseased ciliary circulation. It is generally difficult to determine whether the disc edema will result in a mild peripheral (side) visual field defect and good visual acuity, or reduced central acuity and a significant visual field defect. Giant cell arteritis must be ruled out in these patients. A general physical examination and associated blood work are indicated. No treatment prevents the progression of ischemic optic neuropathy, including steroids and anticoagulants.

Hypertension The Pressures On

Blood pressure is measured by a sphygmomanometer. A normal reading is about 120 80 a reading of 140 90 measured at least on two office visits is officially considered high blood pressure. Hypertension rarely exhibits symptoms, so it's often called the silent killer. Left untreated, high blood pressure can lead to serious conditions such as vision problems, heart attack, stroke, or kidney failure. If early symptoms do occur, they may include headaches, sweating, muscle cramping, palpitations, rapid pulse rate, dizziness, vision problems, or shortness of breath. Having your blood pressure checked every four to six months is an easy precaution to ensure your pressure is staying on course.

Cranial Nerve II Optic Nerve

The principal function of the optic nerve is vision. Testing of the optic nerve includes assessment of visual acuity and visual fields, funduscopic examination, and pupillary light reflex. Visual acuity is assessed in each eye individually. Visual fields are evaluated by confrontation. When performing the fun-duscopic examination, look for papilledema, hemorrhages, cholesterol emboli, and atrophy. Atrophy is characterized by a small, pale disc. Pupillary function assesses CNs II and III as well as sympathetic activity. The direct and consensual responses require CNs II and III to work correctly. If CN II is damaged, an afferent pupillary defect is often present. If the optic nerve is damaged, the light reflex is sluggish.

Neurologic Manifestations

Of the focal manifestations of pituitary tumors, the visual system is often hardest hit and a consultation from a neuro-ophthalmologist is often appropriate. Visual-field deficits, with bitemporal hemianopsia being the classic hallmark, are often presenting signs. Other visual-field defects, including superior temporal quadrant defects, anterior chiasmatic syndromes, junctional scotomas, and monocular hemianopsia, can also occur depending on the precise growth trajectory of the tumor. Impairments in visual acuity, though typically later in occurrence, are still encountered. These tend to be asymmetric and can sometimes take the form of a relative afferent pituitary defect. Fundoscopic abnormalities, including various patterns of optic atrophy and papilledema, should be carefully sought

Hyperprolactinemia Prolactinomas

Dren will have visual impairment as a result of compression of the optic apparatus. The diagnosis may not be entertained, especially in young children when other conditions such as optic gliomas and craniopharyngiomas occur more commonly in this age group. A plea is therefore made for clinicians to perform a prolactin level test in all children with large pituitary lesions so that the diagnosis of a prolactinoma is not missed.

Signs and Symptoms

The most common symptoms at presentation are visual and endocrine abnormalities. In a retrospective study of patients (adults and children) treated at the University of Erlangen from 1983 to 1997, 47 had visual symptoms, 24 had symptoms referable to anterior pituitary dysfunction, and 5 had diabetes insipidus.29 Other symptoms included headache without hydro-cephalus (8 ), headache secondary to hydrocephalus (8 ), and undefined neurologic symptoms (5 ). Visual symptoms underestimated the effect upon visual function, because 75 of patients demonstrated documented abnormalities on formal ophthalmologic examination. Mental status changes are unusual in children but occur in 25 of adults. Frontal lobe involvement can lead to dementia, apathy, and abulia. Temporal lobe involvement can lead to seizures and amnesia.48

Physical Appearance

Infants with increased pulmonary blood flow and congestive heart failure are frail and poorly developed' with cyanosis that is inconspicuous or absent. When truncus arteriosus occurs with hypoplasia of a pulmonary artery' the ipsilateral hemithorax tends to be small (see Fig. 28-16A).13 DiGeorge syndrome is an important aspect of truncus arteriosus.27'56'71'83 Typical appearance includes hypertelorism' low-set ears' micrognathia' a small fishlike mouth' a short philtrum' short down-slanting palpebral fissures' deformed or absent pinnae' cleft lip' a high-arched or cleft palate' a malformed nose' and bilateral cataracts (Fig. 28-6). Extracardiac congenital abnormalities involve the limbs' kidneys' and intestines.56 Infants experience hypocalcemic seizures and severe infections due to deficient cell-mediated immunity and absence of the thymus and parathyroid glands.56 The CHARGE association includes coloboma' heart disease' choanal atresia' retardation of growth and mental development'...

Age Related Macular Degeneration

Fig. 19.3 The presence of drusen in a patient with neovascular age-related macular degeneration (Machemer, 2005). Copyright, Online Journal of Ophthalmology, used with permission. Fig. 19.3 The presence of drusen in a patient with neovascular age-related macular degeneration (Machemer, 2005). Copyright, Online Journal of Ophthalmology, used with permission.

Aneurysmal Bone Cyst

A, Axial and B, coronal computed tomography scans of a 15-year-old boy obtained after an episode of difficulty with mental concentration. The appearance of this lesion is atypical of fibrous dysplasia because it is symmetric. The sphenoid bone is thickened with a ground-glass appearance. Even though the optic canals are narrow, ophthalmologic examination showed no abnormalities. The child was followed regularly without change in his examination results to date. FIGURE 102-4 Fibrous dysplasia. A, Axial and B, coronal computed tomography scans of a 15-year-old boy obtained after an episode of difficulty with mental concentration. The appearance of this lesion is atypical of fibrous dysplasia because it is symmetric. The sphenoid bone is thickened with a ground-glass appearance. Even though the optic canals are narrow, ophthalmologic examination showed no abnormalities. The child was followed regularly without change in his examination results to date.

Macugen Clinical Trials

From a safety standpoint, no significant ocular or systemic safety issues were observed. Although Phase I studies are not designed to evaluate efficacy, at 3 months after Macugen injection, 12 of 15 eyes (80 ) demonstrated stable or improved visual acuity, including four patients (27 ) who gained the ability to read an additional three lines on the standardized eye chart, compared with their baseline pre-treatment visual acuity (Eyetech Study Group, 2002). Since it was expected that Macugen would stabilize vision - not necessarily improve it - these preliminary data were encouraging. Safety analysis revealed that none of the 21 patients experienced a serious drug-related adverse event in this study (Eyetech Study Group, 2003). Of the eight patients who received Macugen alone and who completed the 3-month study, 87.5 had stable or improved visual acuity, including 25 who gained at least three lines of vision on the standardized eye chart. In comparison, of the 10 patients receiving...

Hedgehogs Erinaceus europaeus

Hedgehogs are the wild mammal most commonly brought into a centre and seasonal changes affect the reasons and the number of admissions (Table 34.2). Hedgehogs inhabit parks and gardens, farmland, waste ground and hedgerows, where they forage for earthworms, slugs and beetles. They will also take small mammals and eggs. Their eyesight is poor and they use their sense of smell to detect prey.

Clinicopathologic Correlations

Senile macular degeneration occurs in nearly 10 of the geriatric population, affecting more women than men. It represents the most common cause of legal blindness in the United States. There is painless and progressive loss of central vision. The patient frequently complains of difficulty reading. Because only the macula is involved, peripheral vision is spared, and complete blindness does not result. See Figures 10-121 to 10-123. Several modifiable risk factors have been identified with falling. These include lower body weakness, problems with walking and balance, and taking four or more medications or any psychoactive medications. The health-care provider should try to encourage elderly patients to improve lower body strength and balance through regular physical activity. Tai chi is one exercise program that has been shown to be very effective. In one study, tai chi reduced the number of falls by 47 . All health-care providers must also review carefully all of a given patient's...

Rehabilitative Interventions

Heat sensitivity is especially prominent, although muscle fatigue and lassitude can follow heat exposure in any patient with a neurologic disease, especially with stroke, myelopathies, or myasthenia gravis. Visual impairment from an optic neuritis may require magnifying lenses or braille materials. Diplopia sometimes responds to a prism, but patients more often prefer to cover one of their eyes, unless the resulting loss of depth perception is disabling. Pendular nystagmus causing oscil-lopsia often interferes with ADLs, vision, and balance. It has been successfuly reduced with isoniazid in some cases.109 An action tremor may also respond to up to 1200 mg of isoniazid or to propanolol, acetazolamide, glutethemide, benzodiazepines, or mysoline, although functional gains are generally modest. Deep brain electrical stimulation lessens tremor in some instances. Limb ataxia can be dampened by slightly weighting the distal limb or the utensils used by the patient....

Neurocutaneous Syndromes

The neurocutaneous syndromes consist of several heterogeneous disorders grouped together because of their common involvement of the neurologic, dermatologic, and ophthalmologic systems and various other organ systems. These disorders have previously been referred to as the phakomatoses, a term coined by van der Hoeve in the early twentieth century. This term, derived from the Greek root phakos (birthmark), captured the common, visible dermatologic manifestations characteristic of these syndromes. Disorders classified as neurocutaneous syndromes include neurofibromatosis (types 1 and 2), tuberous sclerosis complex, von Hippel-Lindau disease, and SturgeWeber syndrome. Less common disorders, also categorized as neurocutaneous syndromes, include Rendu-Osler-Weber disease, Wyburn-Mason disease, nevoid basal cell carcinoma syndrome, and Cowden's disease. In addition to the common involvement of similar organ systems with these disorders, further evidence supporting their classification...

Neurofibromatosis Type

As in NF1, patients with NF2 may suffer from a variety of ophthalmologic conditions. Juvenile posterior subcapsular lenticular opacities are the most common ocular findings in NF2, present in approximately 50 of patients. These lesions have the potential to cause visual impairment, and consideration of their surgical removal may be indicated. This is of par- The care of patients with NF2 and their families should involve the coordinated efforts of the neurosurgeon, otolaryn-gologist, and geneticist. At the initial diagnosis, the patient should undergo a complete neurologic and otologic assessment, followed by imaging of the entire craniospinal neuraxis, audiometry, and BAERs. Subsequently, annual or biannual evaluations are recommended between the ages of 15 and 45 years.15 Ophthalmologic assessment should be undertaken when the patient becomes symptomatic from ocular abnormalities. For family members of a patient with NF2, either clinical, radiologic, or molecular testing may be...

Antiarrhythmic Agents

Quinidine is present in the cinchona bark, along with quinine and other alkaloids. Nervous system manifestations are usually not significant, but with overdosage or in susceptible individuals, quinidine causes a type of intoxication similar to that of quinine. The corresponding clinical syndrome, namely cinchonism, is manifested as headache, nausea, vomiting, blurring of vision, transient visual obscurations, and ringing of the ears. i The visual symptoms are short lived but can be confused with visual transient ischemic attacks or the visual accompaniments of migraine. More persistent quinidine amblyopia is the result of direct damage to the retinal ganglion cells. 62 Finally, there have been two case reports of dementia associated with chronic quinidine use, which reversed after drug discontinuation. y

Balance Disorders Frailty and Falls in the Elderly

Years half of these elderly persons fall repeatedly.157 Approximately 5 of falls cause a fracture and another 10 result in serious injury. Falls are a strong risk factor for placement in nursing homes.158 For many geriatric patients, the intrinsic and external causes of falls interact (Table 12-3) a drug causes mild delirium, arthritis makes weight bearing on the knees painful, and residual impairments from an old mild hemiparesis combine to make the person stumble over a raised crack on a sidewalk. Risks for a serious injury from falls in disabled elderly persons differ from independent persons. A Finnish study associated single status, low body mass index, impaired visual acuity, use of long-acting benzodiazepines, and impaired gait with injuries in the disabled group compared to insomnia and diminished sensation in the feet from a peripheral neuropathy in the able group.159 Weakness of the iliopsoas was another common finding in disabled subjects.

Grey squirrels Sciurus carolinensis

Squirrels are active by day and use their sense of smell and eyesight to survey their surroundings and search for food. They eat nuts, bark, leaves, shoots, acorns, buds and flowers and nest in dreys high up in the trees. Young are born early in the spring - the average litter size is three and late litters may be seen in September. They are independent by about 2 months old and are reared exclusively by the female.

Hydrogels Synthetic Hydrogels

Polymethylmethacrylate, polytetrafluoroethylene, polyurethanes, and silicones. Products made from these polymers have been used as bone and tissue replacements, as drug delivery devices, and have been variously employed in nearly all medical disciplines, including heart surgery, orthopedic surgery, ophthalmology, gynecology, and plastic surgery with remarkable success. Synthetic polymers are also utilized in topical applications and as coatings for stents and other implants. The potential of synthetic hydrogels as biomaterials was first recognized by Wichterle and Lim in the 1950s. Hydrogels based on hydroxyethyl-methacrylate (HEMA), sparingly cross-linked by diesters of diglycols (mono-, di-, tri-, and tetra-) and methacrylic acid were tested on animals mid-century and later developed for soft contact lenses. They later were tested for use as an implant material for reconstructive, plastic, ophthalmic, thoracic, orthopedic, and general surgery and for drug delivery. Covalently...