Blindness of Johann Sebastian Bach

Johann Sebastian Bach (1685–1750) was one of the greatest composers of all time. Apart from performing as a brilliant organist, he composed over 1.100 works in almost every musical genre. He was known as a hardworking, deeply Christian person, who had to support his family of 20 children and many students staying at his home. At the age of 64 years, his vision started to decline. Old biographies claim that it was the result of overstressing his vision in poor illumination. By persuasion of his friends, he had his both eyes operated by a travelling British eye surgeon. A cataract couching was performed. After surgery, Bach was totally blind and unable to play an organ, compose or direct choirs and orchestras. He was confined to bed and suffering from immense pain of the eyes and the body. He died <4 months after surgery. In this paper, as the plausible diagnosis, intractable glaucoma because of pupillary block or secondary to phacoanaphylactic endophthalmitis is suggested.     

Lacrimal duct cyst (dacryops) following ocular chemical injury

A 37-year-old man presented with swelling under the lateral aspect of the right upper eyelid. He had sustained an alkali ocular chemical injury 10 years before resulting in persistent lateral canthal webbing. Diagnosis was made of lacrimal duct cyst (dacryops) and webbing of the lateral canthus and the findings were confirmed on computed tomography. He underwent lacrimal duct cyst marsupialisation and lateral canthoplasty with good cosmetic result, and there was no recurrence of symptoms at 2 months post-operatively. Lacrimal duct cyst is a rare clinical entity and has been postulated to result from localized inflammation or trauma to conjunctiva. To the best of our knowledge, this is the first report of dacryops following a chemical injury.     

Holistic processing of impossible objects: Evidence from Garner’s speeded-classification task

Holistic processing, the decoding of the global structure of a stimulus while the local parts are not explicitly represented, is a basic characteristic of object perception. The current study was aimed to test whether such a representation could be created even for objects that violate fundamental principles of spatial organization, namely impossible objects. Previous studies argued that these objects cannot be represented holistically in long-term memory because they lack coherent 3D structure. Here, we utilized Garner’s speeded classification task to test whether the perception of possible and impossible objects is mediated by similar holistic processing mechanisms. To this end, participants were asked to make speeded classifications of one object dimension while an irrelevant dimension was kept constant (baseline condition) or when this dimension varied (filtering condition). It is well accepted that ignoring the irrelevant dimension is impossible when holistic perception is mandatory, thus the extent of Garner interference in performance between the baseline and filtering conditions serves as an index of holistic processing. Critically, in Experiment 1, similar levels of Garner interference were found for possible and impossible objects implying holistic perception of both object types. Experiment 2 extended these results and demonstrated that even when depth information was explicitly processed, participants were still unable to process one dimension (width/depth) while ignoring the irrelevant dimension (depth/width, respectively). The results of Experiment 3 replicated the basic pattern found in Experiments 1 and 2 using a novel set of object exemplars. In Experiment 4, we used possible and impossible versions of the Penrose triangles in which information about impossibility is embedded in the internal elements of the objects which participant were explicitly asked to judge. As in Experiments 1–3, similar Garner interference was found for possible and impossible objects. Taken together, these findings emphasize the centrality of holistic processing style in object perception and suggest that it applies even for atypical stimuli such as impossible objects.     

Cerebellar role in smooth pursuit movement

It is generally believed that pursuit eye movements are unaffected by cerebellar cortical atrophy or cerebellectomy. The present study was performed on patients who underwent partial vermis and hemisphere ablations as a result of severe cranial injury or cerebellar tumors.Eye movements were measured by DC electro-oculography. A clear disparity of the slow phase of the optokinetic nystagmus was observed. When eye movements were contralateral to the ablated side the slow phase of optokinetic nystagmus was statistically slower than drum or visual field velocity. It is suggested that the cerebellum network is involved in the mechanisms of the smooth pursuit movement.The study was supported by a special grant from S.R. & P.N. Foundation.     

Galactitol is not a cause of senile cataract

It has been postulated that the accumulation of sugar alcohol, galactitol, from milk induces cataract in the eye lens through an osmotic mechanism. In this study the concentrations of galactitol and other sugar alcohols (sorbitol, mannitol and inositol) were measured by sensitive gas chromatography in the lenses of 15 patients operated on for senile idiopathic cataracts and in 14 clear lenses removed at autopsy. Large amounts of inositol (mean ± SD, 4.1 ± 3.1 vs 4.7 ± 3.0 mol/g lens wet weight) and small amounts of mannitol and sorbitol were detected in both study groups. Galactitol levels remained clearly below the detection limit (2 nmol/g) in all lenses. It seems unlikely that senile cataract is a result of the accumulation of galactitol in the eye lens.This study was supported by grants from the Foundation for Nutrition Research, Emil Aaltonen Foundation and Mary och Georg C. Ehrnrooths Stiftelse Offprint requests to: H. Arola     

Life,eye disease and work of Joseph Plateau

The Belgian physicist Joseph Plateau (1801–1883) suffered from uveitis which made him blind at the age of 42 years and which has been ascribed to a previous solar retinitis. Plateau described many visual phenomena, including the persistence of visual impressions. He invented instruments which foreshadowed the cinema.     

The cerebellum involvement in the generation of saccades

It was assumed that the cerebellum is not essential for eye movements, playing only a modifying and influencing role. Recently it has been shown that the directions of the saccades can be related to a stimulated cerebellar site.This study was done on patients who underwent partial vermis and hemisphere ablations as a result of severe cranial or cerebellar tumors. The results further indicate that lack of some cerebellar neural structure affects the nature of the saccade: it does not move the eyes in one saccade to acquire the new target and its amplitude duration relationship changes.It is suggested that cerebellar cortex generates a neural pulse based on teleceptive information about stimulus location with respect to an observer's head, corrects this information for initial eye position and sends out a signal to the saccadic pulse generators which move the eyes to acquire the new target.This study was supported by a special grant from S.R. & P.N. Foundation.     

Inert intraocular eyelash foreign body following phacoemulsification cataract surgery

INTRODUCTION: We describe the first reported case of tolerated eyelash inoculation following phacoemulsification surgery, with 4 years follow-up, that did not result in endophthalmitis or low grade chronic uveitis. CASE REPORT: A 79-year-old man with bilateral cataracts underwent phacoemulsification and posterior chamber intraocular lens implantation in the right eye. Three months later, he was found to have an eyelash within the right anterior chamber. The patient opted to leave his asymptomatic right eye alone. Four years later, he was referred to our hospital for review of his intraocular foreign body. He had remained asymptomatic with bilateral 6/6 vision, and without pain, photophobia or monocular diplopia. He declined surgery to remove the foreign body and opted for annual review. DISCUSSION: Intraocular implantation of cilia is a rare surgical complication following cataract surgery. The reaction of the eye to cilia has been reported to be variable and unpredictable, varying from absolute lack of reaction to endophthalmitis. Careful preoperative preparation can prevent similar incidents with potential complications. The position of the cilium is an important consideration. In contrast to other organic materials, a cilium is relatively inert and is rarely associated with infection. Acute inflammation most commonly occurs within days or after a few months, although the eye can tolerate the cilium for many years. Some ophthalmologists prefer observation, particularly when there is no inflammation present. We believe that each patient should be considered on an individual basis. The decision to remove an intraocular eyelash remains controversial and should be considered at the onset of inflammatory or infective clinical signs.     

Interesting life father's of Polish ophthalmology--Wiktor Feliks Szokalski (1811-1891)--in 200 years anniversary of his birth

Victor Szokalski is considered to be the father of Polish ophthalmology. He was born in Warsaw in 1811, where he also began his medical studies. He fought in the November's Uprising. He was awarded the Military Cross Virtuti. After its fall he went to Germany, where he continued his studies. In 1834 he defended his doctoral thesis. Then he moved to France, where worked at the Eye Clinic of Jules Sichel. He wrote many articles for medical journals and taught students. Already in Paris he acted in a number of social societies, collaborated with Prince Adam Czartoryski, was a friend of Adam Mickiewicz. Fifteen years later he returned to Warsaw, where became a consultant, then the chief at the Ophthalmic Institute. For 33 years he has served as secretary of the Warsaw Medical Society. He wrote the first Polish original textbook of ophthalmology. He died in Warsaw in 1891.     

A comparison of five methods for estimating general glaucomatous visual field depression

The separation of local and diffuse visual field loss is important for evaluating the nature and extent of glaucomatous visual field damage. Here, five automated methods for estimating diffuse loss in glaucomatous visual fields (as measured with the Octopus Gl program) are compared. Four are taken from the published literature, and one is introduced in this investigation. It is shown that the new index (here called diffuse loss) provides the best agreement with a value determined using a more empirical approach. Offprint requests to: A.T. FunkhouserThis work was supported in part by the Swiss National Science Foundation Grant 32-27563.89 and in part by the Swiss Foundation to Prevent and Combat Blindness     

Penetrating keratoplasty for pseudophakic corneal oedema.

AIMS--The study was designed to investigate the results of penetrating keratoplasty (PK) for pseudophakic corneal oedema (PCO). METHODS--Retrospective analysis of 80 consecutive patients (82 eyes) who underwent PK for PCO between the years 1980-1992 with a minimum follow up of 12 months. RESULTS--PKs for PCO have accounted for as many as 20% of all grafts performed in the hospital in recent years. The interval between cataract extraction and PK ranged from 6 to 161 months (mean 51 months). The intraocular lens was removed in 45 (55%), left in situ in 30 (37%), and exchanged in seven (8%) of cases respectively. Of the intraocular lenses involved 62% were iris supported, 31% angle supported, and 7% were posterior chamber lenses. Actuarial analysis shows graft survival to be 91% at 1 year and 86% at 2 years after surgery. The likelihood of graft survival was significantly enhanced by removal of the intraocular lens (p < 0.01). A corrected Snellen visual acuity worse than 6/60 was present in 36% of patients with a clear corneal graft. Ocular comfort was achieved in all patients with a clear corneal graft. CONCLUSION--PK for PCO resulted in a disappointing visual result in a large proportion of patients. PK was, however, successful in relieving pain and corneal ulceration when present.     

Comparison of the anti-miotic effect of 0.03% flurbiprofen with 1% indomethacin in cataract extraction

Maintaining successful mydriasis is essential during cataract extraction. The use of nonsteroidal anti-inflammatory drugs in order to inhibit trauma induced miosis has been advocated by many authors. Indomethacin 1% has proved his efficacy since many years. Flurbiprofen has been introduced more recently and has been accepted largely because of a better patient comfort. He proved his efficacy against placebo. We conducted a randomized double blind study in order to verify if there is any difference in efficacy between these two drugs. 40 cases were randomly assigned to a pretreatment, not known by the surgeons, with Indomethacin 1% (Indoptic) or Flurbiprofen 0.03% (Ocuflur). Measurements were taken at the beginning of surgery, after nucleous extraction and after irrigationaspiration of lens cortical material. Sodium hyaluronate and epinephrine were not used during this study. After nucleous extraction, the mean pupillary constriction was 1.53 mm in the Indomethacin group and 1.23 mm in the Flurbiprofen group (p greater than 0.1). After aspiration of cortical material, the mean pupillary constriction was 2.27 mm in the Indomethacin group and 2.00 in the Flurbiprofen group (p greater than 0.1). Cumulative results of patients who constricted the pupil more than 2 and 3 mm showed a better result in the Flurbiprofen group. Flurbiprofen has proved in this study his efficacy compared to an other nonsteroidal anti-inflammatory drug in inhibiting trauma induced miosis.     

Long-term results of amniotic membrane transplantation-assisted bleb revision for leaking blebs

Background To report long-term results of amniotic membrane transplantation (AMT)-assisted bleb revision for intractable late-onset bleb leak. Methods Retrospective medical record review of six consecutive patients who underwent AMT-assisted bleb revision for late-onset bleb leak at the Kobe University hospital between December 2001 and March 2004. Results The median (range) of age was 60 (20–77) years. All patients had a history of trabeculectomy with adjunctive use of 0.4 mg/ml mitomycin C. The median (range) of interval between the prior trabeculectomy and bleb leak was 15 (4–54) months. Preoperative intraocular pressure (IOP) was lower than 10 mmHg in two cases, while it was 25 mmHg or higher in three patients, who had a localized, ischemic, thin-wall leaking bleb circumscribed with extensively scarred tissue. The median (range) of follow-up after the AMT-assisted bleb revision was 49 (41–67) months. Postoperative IOP was well controlled in all patients without medication or with a maximum of three glaucoma medications. No patients presented recurrence of the bleb leak or AMT-related complications during entire follow-up. All patients showed at final visit a diffuse bleb which extended posteriorly beyond the conjunctival incision line. Conclusion AMT-assisted bleb revision successfully treated intractable late-onset bleb leak. Further comparative studies are needed to confirm the present result. Financial support: This study was supported in part by Grant-in-Aid No. 16390499 (AN, MN) and No. 17591835 (MN) from the Ministry of Education, Culture, Sports, Science and Technology of the Japanese Government and by Suda Memorial Foundation for Glaucoma Research (MN). MN is a recipient of the 12th ROHTO award for Ophthalmic Research.     

Safety of daily oral vitamin A supplementation for individuals with retinitis pigmentosa

Many patients with retinitis pigmentosa take 15,000 IU of vitamin A daily, but the safety of supplementation has not been well characterized. A review of the published literature shows that vitamin A supplementation at this level is safe in healthy adult men and nonpregnant women who eat a diet without excessive intake of food high in vitamin A. Annual monitoring of liver enzyme and triglyceride levels is recommended for patients receiving supplementation. This work was supported by the Foundation Fighting Blindness, Owings Mills, Md The author has stated that he does not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article.     

Development of visual pursuit in the first 6 years of life

Background There are few previous investigations on the development of smooth visual pursuit in children. The aim of this study was to determine normative values for the development of horizontal and vertical smooth pursuit in a large number of normal children. Methods Eye movements of 358 healthy children aged 6 weeks through 6 years were recorded using infrared photo-oculography. Visual pursuit was elicited with colored squares of 1.2° of visual angle. The stimulus moved horizontally or vertically with constant velocities of 7.5, 15, or 30°/s. Results Attention time increased with increasing age from 0.54 to 0.77 (P<0.01) and decreased with increasing stimulus velocities (P<0.01). The ratio of time of smooth pursuit to time of smooth pursuit plus saccades increased with increasing age from 0.63 to 0.78 (P<0.01) and decreased with increasing stimulus velocities (P<0.01). For stimulus velocities of 7.5°/s, no significant difference was found between horizontal and vertical gain values. For stimulus velocities of 15°/s and 30°/s, gains for horizontal movements were larger that for vertical (P<0.05). Increasing stimulus speeds were associated with decreasing gains (P<0.05). Conclusions This study provides the following normative values for photo-oculography in healthy children aged 6 weeks through 6 years of age: attention time, smooth pursuit time, and gain for three stimulus velocities presented horizontally and vertically. This normative database should help to diagnose pathologic ophthalmological or neuropediatric conditions, to perform screening interventions, and to initiate therapies. This research followed the tenets of the Declaration of Helsinki and was approved by the Ethical Committee of Kantonsspital St Gallen. This study was supported by Swiss National Science Foundation (Bern, Switzerland) Grant 3200-052503.97/1 and the OPOS Foundation (St Gallen, Switzerland).     

Unilateral acute retinal necrosis occurring 2 years after herpes simplex type 1 encephalitis

Acute retinal necrosis (ARN) syndrome is known to occur occasionally in association with or shortly after herpetic encephalitis. We describe a patient with unilateral ARN occurring 2 years after herpes simplex virus (HSV) type 1 encephalitis. A 49-year-old man presented with unilateral visual loss. He had a history of HSV-1 encephalitis 2 years previously, and had been successfully treated without a subsequent recurrence. The ophthalmologic findings were all consistent with the ARN syndrome. The same type 1 HSV was identified from ocular fluid as was identified from the patient's cerebrospinal fluid 2 years ago. There was no evidence of a recurrence of encephalitis. This case suggests that following encephalitis retinal neurons may function as a reservoir for latent HSV-1, that can be reactivated to cause ARN in situ several years later.     

J Donald M Gass MD: father of macular diseases, and one of the ten most influential ophthalmologists of the 20th century

John Donald MacIntyre Gass, MD was one of the most significant figures to emerge in ophthalmology in the last 100 years. There could be few ophthalmologists who cannot attribute part of their increase in understanding of retinal disease to the influence of Don Gass. His insights opened up opportunities for many new effective therapies. He has influenced ophthalmic thought worldwide, if not by his presence as a visitor, then through his scientific publications, his outstanding books and the international fellows he trained. Like many distinguished physicians, Don Gass's clinical acumen was well grounded in his understanding of ocular pathology. This experience was gained under the mentorship of Lorenz E Zimmerman, MD, who trained a number of distinguished ophthalmologists, who subsequently became professors. Professor Gass passed away on February 26, 2005 at the age of 76 years from pancreatic carcinoma. With the demise of Don Gass, the world of ophthalmology has lost an extraordinary physician of great talent, commonsense and humility. On the other hand it has gained a generation of young ophthalmologists inspired by his example.     

Diffuse unilateral subacute neuroretinitis. Apropos of a case

Between 1963 and 1973, Gass described in 13 healthy children and young adults the unilateral wipe out syndrome, acquired ocular syndrome affecting only one eye and including marked visual loss. Later, early stages of the disease were analysed and the name of "diffuse unilateral subacute neuroretinitis" (DUSN) was preferred. He suggested that the migration of a worm in the subretinal space over a period of many months or years could be the primary cause of this syndrome. We describe one case of DUSN observed during four years and we discuss the possible clinical aspect of ocular toxocariasis, the difficulty of its biological diagnosis and the mechanisms of retina and pigment epithelium changes.     

The global burden of trachomatous visual impairment: II. assessing burden

This paper builds on results of a previous paper on the prevalence of trachomatous visual impairment as the foundation for assessing the global burden of trachomatous blindness and low vision: approximately 2.9 million cases of trachomatous blindness and 3.8 million low visioned corresponding to a global prevalence of trachomatous visual impairment equal to 1.3/1,000 in 1990 was estimated. For each visually impaired person, the years of life lost due to premature mortality and the years lived in a handicapped state are added to yield a single measure of disease burden called handicap adjusted life years (HALYs). Age, gender and visual acuity group specific HALYs are multiplied by the prevalence of trachomatous visual impairment to yield an estimate of the global burden of trachoma visual impairment equal to 80 million HALYs. Analysis of the distribution of the global burden by age, gender, visual acuity and region provide direction for trachoma research and programme priorities. Sensitivity analysis reveals that the burden estimates of trachomatous visual impairment may vary from as low as 15 million to as high as 500 million HALYs. Given this degree of variability, burden comparisons with other blinding and non-blinding conditions for the purposes of identifying health sector priorities may be misleading.Paper supported by The Edna McConnell Clark Foundation.     

Stereoacuity testing in patients with retinal and optic nerve disorders

A study comparing the relative sensitivity for detecting abnormal stereoacuity in patients with retinal or optic nerve disease on clinically used stereoacuity tests is not available. It is also not apparent from the ophthalmic literature if optic nerve or retinal diseases are likely to have a greater impact on stereoacuity performance. We were also interested in determining a level of visual acuity loss that would likely result in an impairment of stereoacuity on these clinical tests. Forty-two patients with various retinal and optic nerve disorders and eighteen normal subjects were evaluated for stereoacuity using three tests: Titmus Stereoacuity Test (TST), Randot Stereoacuity Test (RST), and TNO Stereoacuity Test (TNO). The performance on these three stereoacuity tests was compared with the normal subjects. Additionally, TST scores from our patients were compared to predicted TST scores derived from a previously published nomogram. For patients with retinal and optic nerve disease, an abnormal score on one clinical test of stereoacuity was likely to predict an abnormality on the other tests. Performance on the TST relative to the predicted value derived from a nomogram was not significantly different for patients with retinal vs. optic nerve disease. With some exceptions, patients with visual acuities of 20/30 or worse in at least one eye were likely to show abnormal stereoacuity.This study was supported by a center grant from The Foundation Fighting Blindness, Baltimore, Maryland