Henry B. Stallard, MD: The 1924 Paris Olympics, and Chariots of Fire

Hyla Bristow Stallard was one of the greatest middle-distance runners in British athletic history. While an English medical student, he won the bronze medal in the 1500-meter run at the 1924 Paris Olympics, immortalized in the critically acclaimed 1981 epic British film, Chariots of Fire. He later became one of the most famous ophthalmologists in the world for his pioneering work in radiation therapy of malignant eye disease. He was an inspiring role model for both athletes and physicians. As a gifted individual who enjoyed two international careers, he is worthy of great admiration and emulation.     

The Enigma of Galileo's Eyesight: Some Novel Observations on Galileo Galilei's Vision and His Progression to Blindness

Galileo Galilei became blind. Before this happened he revealed that his left eye had always had less than perfect vision. A study of his written works, his handwriting, and the originals of the portraits undertaken during his lifetime indicate that this probably was the case. These portraits suggest that his left eye tended to lose fixation and that, at the age of 60, he suffered from a mucocoele of the right frontal sinus; but these conditions would not have caused blindness. Considering the systemic diseases from which he suffered over his lifetime, he could possibly have had a long standing uveitis with secondary pupillary block glaucoma, common in those with the group of conditions classified as sero-negative arthropathies. Posterior scleritis with secondary glaucoma is less likely. If either of these were the cause, then the disease was probably triggered by a well-documented, severe acute illness as a young adult, the inflammation being localized to the eye as a result of severe recurrent conjunctival infections in his youth. The intermittent nature of the visual loss, the normal appearance of the cornea and pupils in his portraits, the absence of any evidence of inflammatory joint disease, the presence of halos, and the severe nature of the pain—combined with the high level of visual acuity in between attacks and its persistence until the last few weeks of vision means that angle-closure glaucoma must also be considered. These suggestions might be confirmed or refuted by studying his remains. Application has been made for this to be done.     

Enterobacter cloacae Postsurgical Endophthalmitis: Report of a Positive Outcome

We report a positive outcome of postcataract endophthalmitis caused by Enterobacter cloacae, which has previously resulted in poor outcomes in endophthalmitis. A 67-year-old man underwent uncomplicated cataract surgery. On the morning of postoperative day (POD) #1, he had significant anterior chamber inflammation without pain, hypopyon, or vitritis but then rapidly developed hypopyon and worsening visual acuity. He underwent a tap and inject with vancomycin and ceftazidime and was prescribed topical steroids and antibiotics as well as oral levofloxacin. On POD #3, cultures of the vitreous and aqueous returned positive for E. cloacae. By POD #6, his hypopyon had resolved with improved vitritis, decreased inflammation, and visual acuity of 20/200. Two weeks after surgery, his best-corrected visual acuity was 20/60. Contrary to prior reports, we demonstrate that it is possible to achieve a good outcome in cases of E. cloacae endophthalmitis treated early with appropriate antibiotics and anti-inflammatory agents.Key words: Endophthalmitis, Gram-negative, Enterobacter cloacae, Cataract surgery     

The eyes of Johann Sebastian Bach

Johann Sebastian Bach's only physical problem seems to have been his vision. Myopia seems most likely, and it is probable that he developed cataracts at an older age. In addition to the cataracts, his worsening vision may have been due in part to some other eye problem. During the last year of his life, Bach's vision became so poor that he decided to have his eyes operated on. Two operations were performed in 1750 by the traveling English eye surgeon John Taylor. Most likely the first operation was Taylor's standard couching procedure. About 1 week after the first operation, Bach had to be operated on again because of a reappearance of the cataract. Many painful and/or vision-reducing complications could have been induced by these intraocular operations: uveitis or endophthalmitis, secondary glaucoma, hemorrhage, retinal detachment, and even sympathetic ophthalmia. Bach was "completely blind" after the operations, and he died less than 4 months after the final operation.     

Pillow case

An 80-year-old man with severe kyphosis and visually significant cataracts in both eyes came to us for care. He had been scheduled for cataract surgery elsewhere, but his surgery was cancelled in the operating room when he could not be positioned adequately beneath the operating microscope. As he sat in a chair in our examining room, he was only able to elevate his head to a position 30 degrees below the horizontal. His cataract surgery was performed safely and effectively by padding the operating table with 14 pillows. Eleven pillows were placed under his buttocks and legs and 3 pillows beneath his head and neck. The operating table was also positioned in maximum reverse Trendelenburg to obtain a good red reflex.     

Late-onset bleb-related endophthalmitis caused by Streptococcus pseudopneumoniae

We report our findings in a 63-year-old male who developed late-onset bleb-related endophthalmitis. The patient had undergone glaucoma surgery 46 years earlier, and had a thin-walled cystic bleb prior to the endophthalmitis in his right eye. He underwent immediate vitrectomy with intravitreal injections of ceftazidime and vancomycin. After surgery, he was given topical 0.5 % moxifloxacin and 1 % vancomycin, intravenous doripenem, and oral minocycline. Culture of the vitreous specimen identified Streptococcus pseudopneumoniae by 16S rRNA sequence analysis, by optochin susceptibility test, and by bile solubility test. Our findings indicate that S. pseudopneumoniae can be isolated from a late-onset bleb-related endophthalmitis and that molecular analysis and phenotypic testing can be accurate methods to identify S. pseudopneumoniae.     

An artist with extreme deuteranomaly

Background : There has been speculation about the colour vision of some artists of earlier generations based on the uncertain evidence of how they used colour, but it seems that no major artist has been shown to have a colour vision defect. A few lesser artists are known to have abnormal colour vision and its influence on their painting has been reported in the literature. However, there has been only one report of a deuter‐anomalous artist and no detailed report of one with extreme deuteranomaly. Methods : An amateur artist was diagnosed as having extreme deuteranomaly using standard clinical tests. He was interviewed about his difficulty with colour when painting and the strategies he used to counter these problems. His work was studied to determine the colour palette he used and he was set the task of copying another painting to determine the nature of any errors he might make. Results : The subject limits his palette to short‐wave blues and blue‐greens and longwave yellow, orange and red. He avoids use of yellow‐greens of which he is uncertain. He has adopted a few strategies that help him avoid mistakes in manipulating colour. Despite diese difficulties, he is able to create attractive paintings. His early work tended toward monochrome but in his later work he has been able to create warm colourful effects with a limited palette. Conclusion : Defective colour vision is a handicap in those artistic activities using colour but it is not an insurmountable barrier. Optometrists should counsel patients with a colour deficiency who are considering a career in the graphic arts about the difficulties they will encounter and the strategies they can use to help minimise those problems.     

Horner's syndrome associated with contralateral superior oblique paresis

A patient presented with Homer's syndrome together with a contralateral superior oblique paresis. Both conditions had been present for at least 12 years. While the patient had suffered what he considered to be minor head trauma on the sporting field and admitted to several altercations during his life, there was no specific event in his medical history that could account for this presentation.     

Leonardo and the eye

Conclusion Sir Ernst Gombrich said that there are passages in Leonardo's Notebooks which are beyond our understanding. Perhaps the above comments on what Leonardo wrote on ocular anatomy and visual physiology are mistaken. While I can follow Leonardo's Italian, I cannot claim to be able to decypher all he has written even though sample checks have satisfied me that the experts know best. Once or twice I baulked e.g. at Pedretti's translation of luce by cornea, but, on reflexion, I decided that, while not strictly correct, this rendering might make it easier for the non-specialist reader.Now, I must confess to a sense of loss. Leonardo's was without question one of the great minds in depth and width. But it seems to me that his insight and ingenuity did not prevent him from making mistakes he could easily have avoided. The heights of greatness are lonely: perhaps he should have shared his ideas - much as Plato gives us to understand that he did - and, unlike Plato, he could have tested criticism by experiment, in the ingenuity of which he shone. But he did not, and that is that.We must remember, however, that it is his ideas that he records, and that there are other records of what was going on at the time. He was a contemporary of the mad friar Girolamo Savonarola as he was of the Medici who had made and undone him. There had been the invasion of the French. And, even if Florence did not deal with him harshly as she had done once with Dante and, during Leonardo's life-time, with Michelangelo, he lived, a restless spirit, like most of humanity, in restless times. The occasional inconsistency in his reasoning, the odd non sequitur, are mere echoes perhaps of the breathlessness with which he was forced to do some of his work.     

The ophthalmic trials of G. H. A. Hansen

G. H. A. Hansen (1841-1912) is widely known as the discoverer of the infectious cause of leprosy. It is less well known that his career was threatened by an episode involving experimentation on the eye. As a staff physician at the leprosy hospitals of Bergen, Norway, early in his career, Hansen learned about ocular involvement in leprosy and co-authored Leprous Diseases and the Eye. In 1873 he observed bacilli in leprous nodules, but proof of an infectious origin was difficult to obtain because the agent could not be cultured and no one had demonstrated direct transmission. Hansen tried several unsuccessful experiments, and in 1879 he passed a cataract knife that had incised an active leprous nodule into a woman's conjunctiva. No nodule developed, but the woman complained of pain and said she was never asked for permission. Hansen was brought to trial where eminent physicians testified on his behalf-but Hansen himself readily admitted that no permission had been sought for fear the woman would say no. He was convicted, and relieved of his post as staff physician, but he was allowed to retain an appointment as Chief Medical Officer of Health for Leprosy, in which capacity he worked for the rest of his life.     

Father Waclaw Szuniewicz,M.D., an ophthalmologist of unusual courage and devotion

The authors present a short biography of the missionary-priest ophthalmologist Waclaw Szuniewicz (1892–1963). This remarkable man completed his ophthalmologic training between 1922 and 1927 at the Department of Ophthalmology of the Stefan Batory University in Wilno, Poland. From 1931 to 1949 he served as a missionary priest in China, and for part of this time he was the head of the Department of Ophthalmology at a hospital in the Chinese town of Shuntehfu. He organized and ran a 100 bed ophthalmology department there, also supervising 18 outpatient clinics in the surrounding area. During this period he regularly saw over 145,000 patients and performed over 5000 ophthalmic operations a year! From 1949 to 1952 Dr Szuniewicz carried out research work on the surgical treatment of corneal astigmatism. His interesting refractive procedures were done at Yale University in the USA and the techniques he developed arose from the work he had initially done in China from 1946 to 1948. Dr Suniewicz moved from the USA to Brazil in 1952 where he continued his refractive surgery research until 1954 and his missionary service until his death in 1963.     

The foundation of experimental ophthalmology by Theodor Leber

Theodor Leber grew up in Heidelberg as the son of a professor of Romance languages. Initially he planned to study natural sciences. Bunsen's advice led him to medicine. During his studies he succeeded in solving a competition problem posed by Helmholtz in the medical department. A short period of practical work in the eye hospital of Knapp was unsatisfactory. In Vienna with the physiologist Carl Ludwig, he was able in 1863/64, at the age of only 24 years, to demonstrate the blood circulation of the eye by color injections into the arteries and veins. Since that time the schematic drawings of his results can be found in every textbook of ophthalmology. On the occasion of the congress of the German Ophthalmological Society in Heidelberg in 1864, Theodor Leber reported on these findings and met with immense approval. In 1864–67 he followed an invitation as coworker of Liebreich to Paris; in 1867 he became A.v. Graefe's coworker in Berlin; in 1871 he moved to Göttingen, which became the first eye clinic with a laboratory for experimental investigations.The second epoch-making discovery accomplished by Leber was the detection of the fluid exchange in the eye. These results have also been confirmed by modern methods. Therefore, Theodor Leber can be called the father of experimental ophthalmology.     

Wiley Post,around the world with no stereopsis

In 1933, famed aviator Wiley Post (1898–1935) was the first pilot to fly around the world solo. In addition, during one of his many stratospheric flights, he discovered the jet stream. What makes his accomplishments even more remarkable is that he did this monocularly, having lost his left eye from traumatic endophthalmitis following an oil rig accident. He underwent a period of self-imposed visual training to maximize his depth perception, and then accomplished what no one had before.     

Jaeger,About Glaucoma

E. Jaeger published the first illustration of the glaucomatous cup. Throughout his clinical career he published multiple observations about findings in glaucoma. In his bookUeber Glaucom he praised and advocated A. von Graefe's iridectomy but contradicted Graefe's concept of the etiology being a localized choroiditis in favor of systemic gout.     

Little known ophthalmic interests of Emil von Behring,the first Nobel Prize Laureate in Medicine or Physiology

Although the work for which Emil von Behring (1854–1917) was awarded the first Nobel Prize Winner for Medicine or Physiology in 1901 was on serum therapy, not only was he trained and worked as an ophthalmologist but he also wrote his doctoral dissertation on a practical ophthalmological topic whilst in Berlin under Carl Schweigger (1830–1905). He later worked for 3 years as an assistant and co‐worker with the famous Polish ophthalmologist Boleslaw Wicherkiewicz (1847–1915), in Poznan where he described an interesting ophthalmic case in a scientific journal. His life and work in other fields have been well studied, but his interests and relationship to ophthalmology that played an important role in, at least part of, Behring’s life have never previously been analysed thoroughly.     

The history of color theories

The origins of color theories are closely linked to the Greeks' theories of vision. Plato explained vision as a combined action of light from within (i.e. from the eye) and light from without: this view was, in a certain sense, revived by Goethe. Aristotle, on the other hand, defined vision as the passive reception, by the eye, of an action originating in objects: thus, he was the originator of scientific optics, as propounded 2000 years later by Newton. The present author compares Newton's experimental analysis of spectral colors produced by triangular glass prisms with Goethe's more intuitive theory of the primordial phenomena (Urph?nomene) of color vision. Apparently, Goethe started from the same point as Newton: experimentation with optical prisms. But he looked, as it were, in the opposite direction: he did not examine the objective image formed by a prism but described what he himself perceived when looking through a prism. It was this subjective image which he analyzed and on which he built his own color theory. The direction of his argument was fixed right from the beginning: from the very first glance through his prism he was convinced--by intuition, not by reflection--that Newton must have been wrong. No wonder this prejudice led him astray! However, Goethe's careful and skillful analysis of the subjective perception of light and colors bore other fruits. Under the heading of "physiological colors" he describes, in his "Farbenlehre", some important phenomena of visual physiology such as simultaneous and successive color contrasts.(ABSTRACT TRUNCATED AT 250 WORDS)     

The eye disease of Jefferson Davis (1808-1889)

The only Confederate president, Jefferson Davis, led a long and eventful life. He was a Mississippi planter, a husband, a father, West Point graduate, war hero, congressman, senator, secretary of war, and finally President of the Confederate States of America. In many ways he was a study of contrast with his northern counterpart, Abraham Lincoln. Davis was personally courageous and a rich, educated, southern aristocrat who did not deeply understand the political process or have the refined personal skills necessary to work well with others. Prior to his Presidency he served with distinction in two wars, but as a result of his confederate activity and pro-slavery philosophy he is one of the least discussed famous Americans. Davis's health was a constant problem and he suffered an almost fatal attack of “malaria” in 1836. In the winter of 1857–1858 he again was seriously ill and by the end of February 1858 a chronic, relapsing, ocular inflammatory condition began. Using historical evidence from multiple sources, this paper will propose a diagnosis of the Confederate President's ocular condition and consider how this could have influenced his military and political decisions.     

Neovascular glaucoma associated with uveitis

A 65-year-old white male presented with severe corneal edema in his left aphakic eye. Though he had been wearing a contact lens in that eye, the cause of his corneal edema was found to be neovascular glaucoma. This paper discusses the case and reviews the literature on neovascular glaucoma.     

Ophthalmological complications of the asphyxiophilic "scarf game" in a 12-year-old child

PURPOSE: To report a first case of Terson-like syndrome associated with asphyxiophilic practices in an adolescent. METHODS: A 12-year-old boy was referred for decreased visual acuity in his right eye. His father had been diagnosed 3 weeks before with subarachnoidal hemorrhage. Fundus examination showed a dense preretinal hemorrhage in the right eye suggestive of Terson syndrome. RESULTS: Angio-magnetic resonance imaging eliminated aneurysm and arteriovenous malformation from the diagnosis. After questioning the boy further, he reported that he had participated in the "scarf game", a very popular (but lethal) asphyxiophilic practice in middle school, some hours before he noticed a sharp drop in the visual acuity of his right eye. After 2 months of follow-up, he recovered 20/20 vision in his right eye. CONCLUSION: Retinal hemorrhages are quite rare in children. When the cause is not clear (subarachnoidal hemorrhage, arteriovenous malformation, shaken baby syndrome), it must be determined whether the patient has participated in the asphyxiophilic "scarf game" in order to prevent its lethal consequences.     

NUT carcinoma of the sinonasal tract infiltrating the orbit in a man with birdshot chorioretinitis

A 48-year-old man with a history of birdshot chorioretinitis presented with blurry vision, retro-bulbar pain and sinusitis. Though visual acuity was unaffected, he had left optic disc oedema and mild restriction of left eye abduction. His symptoms progressed quickly, with diplopia in primary gaze, epistaxis from his left nostril, and a left relative afferent pupillary defect (RAPD). On computed tomography, there was a mass in the nasal cavity that extended through the left cribriform plate and lamina papyracea and posteriorly into the optic canal.Pathological examination of biopsy specimens revealed sheets of undifferentiated cells with extensive areas of necrosis and islands of squamous differentiation. The tumour cells expressed monokeratin, p63, CD34, and p16. Molecular testing indicated rearrangement of the NUTM1 (15q14) locus and fusion of the NUTM1 and BRD4 (19p13.12) loci, confirming the diagnosis of NUT carcinoma of the sinonasal tract.This is the first reported case of NUT carcinoma in a patient with birdshot chorioretinitis. The onset of chorioretinitis may have been the earliest sign of the effects of the BRD4-NUTM1 fusion protein, resulting in expression of HLA-A29. There is evidence that bromodomain and extra terminal (BET) family proteins play a role in inflammatory marker expression.