Survey of Ophthalmology - Articles in Press

The Lagerlunda Collision and the Introduction of Color Vision Testing - Corrected Proof

J.D. Mollon, L.R. Cavonius — 2012-02-02

Abstract: In histories of vision testing, the origins of occupational screening for color blindness are often traced to a fatal railroad accident that occurred in Sweden on the night of 14–15 November 1875. The scene of the accident was the estate of Baron Lagerfelt in Östergötland, but the critical events were played out at Linköping (the normal passing place for the northbound and southbound expresses) and at Bankeberg (a small station to which the passing place was reassigned at a few minutes' notice). First to arrive at Bankeberg, the northbound express slowed almost to a halt, but then inexplicably accelerated forwards towards the Lagerlunda estate, despite a sequence of signals from the stationmaster, Uno Björkelund, and a lineman, Oskar Johansson. Soon after the accident, the ophthalmologist Frithiof Holmgren suggested that the engineer of the northbound express, Andersson, or his oiler, Larsson, had been color blind. Neither survived to be tested. Using the records of the subsequent trial and other archival materials, we have re-examined the role of color blindness in the Lagerlunda incident and conclude that the accident cannot be attributed to color blindness alone. Yet the accident undoubtedly had a central role in the introduction of color vision testing by European and North American railroads. To persuade the railroad management to introduce universal screening of employees for color blindness, Holmgren used a dramatic coup de theatre and some unashamed subterfuge.

Trachomatous Trichiasis and its Management in Endemic Countries - Corrected Proof

Saul N. Rajak, J. Richard O Collin, Matthew J. Burton — 2012-01-30

Abstract: Trichiasis is the sight-threatening consequence of conjunctival scarring in trachoma, the most common infectious cause of blindness worldwide. Trachomatous trichiasis is the result of multiple infections from childhood with Chlamydia trachomatis, which causes recurrent chronic inflammation in the tarsal conjunctiva. This produces conjunctival scarring, entropion, trichiasis, and ultimately blinding corneal opacification. The disease causes painful, usually irreversible sight loss. Over eight million people have trachomatous trichiasis, mostly those living in poor rural communities in 57 endemic countries. The global cost is estimated at US$ 5.3 billion. The WHO recommends surgery as part of the SAFE strategy for controlling the disease.We examine the principles of clinical management, treatment options, and the challenging issues of providing the quantity and quality of surgery that is needed in resource-poor settings.

Causes of Blindness and Visual Impairment in Latin America - Corrected Proof

2011-12-05

Abstract: We review what is known in each country of the Latin American region with regards to blindness and visual impairment and make some comparisons to Hispanic populations in the United States. Prevalence of blindness varied from 1.1% in Argentina to 4.1% in Guatemala in people 50 years of age and older, with the major cause being cataract. Diabetic retinopathy and glaucoma are starting to make serious inroads, although epidemiological data are limited, and age-related macular degeneration is now a concern in some populations. Infectious diseases such as trachoma and onchocerciasis are quickly diminishing. Although progress has been made, retinopathy of prematurity remains the major cause of childhood blindness. If VISION 2020 is to succeed, many more epidemiological studies will be needed to set priorities, although some can be of the Rapid Assessment of Avoidable Blindness design. Developing the infrastructure for screening and treatment of ophthalmic disease in Latin America continues to be a challenge.

Once upon a Cataract Surgeon - Corrected Proof

Roma P. Patel, John Volpi, Andrew G. Lee, Jason J.S. Barton — 2011-10-24

Abstract: A 60-year-old man presented with diplopia and neurocognitive deficits, which progressed rapidly over several months. Magnetic resonance imaging of the head revealed bilateral signal abnormalities and diffusion-weighted imaging restriction in bilateral basal ganglia, thalami, mesial temporal regions, and periaqueductal gray matter. Cerebrospinal fluid analysis was positive for 14-3-3 and tau proteins. The patient developed progressive neurocognitive decline followed by sleep disturbance and myoclonic jerking consistent with probable Creutzfeldt-Jakob disease.

Blind Runner - Corrected Proof

2011-10-24

Abstract: Bilateral ocular ischemic syndrome and ischemic optic neuropathy have rarely been reported as initial manifestations of Takayasu arteritis (TA). Appearance of ocular symptoms in TA is related to the extent and severity of involvement of the aorta and its major branches. We report a case of bilateral ocular ischemic syndrome with unilateral ischemic optic neuropathy secondary to TA in a 42-year-old Pakistani man who had severe ocular and cerebral ischemia.

Conjunctival Lymphangiectasia: A Report of 11 Cases and Review of Literature - Corrected Proof

James Welch, Sathish Srinivasan, Douglas Lyall, Fiona Roberts — 2011-10-24

Abstract: Conjunctival lymphangiectasia is an uncommon clinical condition in which there is dilatation of lymphatic channels in the bulbar conjunctiva. Conjunctival lymphangiectasia is a rarely appreciated ocular surface disorder that typically occurs as a secondary phenomenon in response to local lymphatic scarring or distal obstruction. Conjunctival lymphangiectasia can either be unilateral or bilateral with focal or diffuse bulbar chemosis. We present 11 cases of biopsy-proven conjunctival lymphangiectasia. Of the 11 cases, 3 presented with bilateral diffuse bulbar chemosis, 1 had diffuse unilateral chemosis, and the remaining 7 presented with focal (<90°) bulbar chemosis. Three of these cases had co-existing pterygium, and one case presented with focal bulbar chemosis and a conjunctival keratin horn. All underwent surgical excision of the involved conjunctiva, either with no graft (n = 6), combined with amniotic membrane transplant (n = 3), or combined with conjunctival autograft (n = 2).

Curtains - Corrected Proof

Paul H. Phillips, Edgardo Angtuaco, Rudy L. VanHemert, Rod Foroozan — 2011-08-22

Abstract: A 55-year-old immunocompetent man presented with headache, nausea, progressive bilateral upper lid ptosis, and diplopia. Examination showed bilateral asymmetric upper lid ptosis with limited adduction and elevation of both eyes. Cranial magnetic resonance imaging revealed enhancing intra-axial and extra-axial midbrain lesions. Blood and cerebrospinal fluid were positive for cryptococcal antigen and cerebrospinal fluid fungal cultures grew Cryptococcus neoformans. Treatment with liposomal amphotericin B and flucytosine resulted in complete resolution of his neurological deficits and lesions on neuroimaging. Patients with cryptococcal meningitis may rarely present with bilateral cranial nerve III dysfunction.

Bilateral Optic Disk Swelling Plus - Corrected Proof

Sing Your Li, Molly E. Gilbert, Pamela S. Chavis — 2011-05-30

Abstract: A 64-year-old woman presented with bilateral optic neuropathy leading to a diagnosis of Sjögren syndrome. She improved with high-dose corticosteroids and oral azathioprine and was subsequently found to have asymptomatic bilateral iridocyclitis. Although central nervous system manifestations of Sjögren syndrome are documented in the literature, they are not widely recognized in clinical practice. Associated optic neuritis often mimics demyelinating disease such as multiple sclerosis. Treatment of CNS disease related to Sjögren syndrome is highly controversial. Uveitis is an uncommon finding associated with Sjögren syndrome.