History of Acta Ophthalmologica – the first 50 years

Acta Ophthalmologica appeared as the scientific journal of the Nordic ophthalmological Societies in 1923. The intention was to expose the clinical and experimental developments among the ophthalmological communities of the four Nordic countries: Denmark, Finland, Norway and Sweden. The collaboration within the field of ophthalmology had been attempted with the publication of ‘Nordisk ophthalmologisk Tidsskrift’ in the years 1889–1892. Now, once again, the wish for a tighter Nordic cooperation was explored by enthusiastic ophthalmologists in all four countries. One person stands out as the driving force, K.K.K. Lundsgaard, who in spite of his early death in 1931 was remembered by name on the front page of Acta since 1936 by the Latin phrase ‘A K.K.K. Lundsgaard edi coepta’. The present review recalls details from the early years when the journal found its place in the ophthalmology and creates the background for some reflections on purpose and goals by publishing a scientific journal.     

David Maurice's contributions to optical ophthalmic instrumentation: roots of the scanning slit clinical confocal microscope

This paper explores the seminal contributions of David Maurice to the field of ophthalmic instrumentation. His development of the specular microscope, the scanning slit optical confocal microscope, and the corneal microfluorometer resulted in advances in our understanding of corneal morphology, physiology, and pathology. The development of the scanning slit, clinical confocal microscope is not a new paradigm or a paradigm shift, but a continuous series of interlinked technical advances from the early work of Vogt to Thaer's development of a clinical confocal microscope. For each instrument both the connection to the prior work of others and the unique advances are discussed and contrasted. This paper develops the connections and parallel developments in the instrument developments of Goldmann, Maurice, Svishchev, Baer, Koester, Masters, and Thaer. The evidence in support of the thesis consists of published papers, patents, personal communication, and study of Goldmann's book collection in Bern. A second theme is that knowledge of physics is a prerequisite for optical instrument development in ophthalmology. David Maurice had a university degree in physics and Hans Goldmann learned physics from his books. The contributions of David Maurice to optical instrumentation follow the major contributions of Goldmann and facilitated and stimulated other scientists who acknowledged their important intellectual debt to David Maurice.     

Genetic association study of age‐related macular degeneration in the Spanish population

Acta Ophthalmol. 2011: 89: e12–e22

Abstract.

Purpose: To investigate new genetic risk factors and replicate reported associations with advanced age‐related macular degeneration (AMD) in a prospective case–control study developed with a Spanish cohort. Methods: Three hundred and fifty‐three unrelated patients with advanced AMD (225 with atrophic AMD, 57 with neovascular AMD, and 71 with mixed AMD) and 282 age‐matched controls were included. Functional and tagging SNPs in 55 candidate genes were genotyped using the SNPlex^TM genotyping system. Single SNP and haplotype association analysis were performed to determine possible genetic associations; interaction effects between SNPs were also investigated. Results: In agreement with previous reports, ARMS2 and CFH genes were strongly associated with AMD in the studied Spanish population. Moreover, both loci influenced risk independently giving support to different pathways implicated in AMD pathogenesis. No evidence for association of advanced AMD with other previous reported susceptibility genes, such as CST3, CX3CR1, FBLN5, HMCN1, PON1, SOD2, TLR4, VEGF and VLDLR, was detected. However, two additional genes appear to be candidate markers for the development of advanced AMD. A variant located at the 3′ UTR of the FGF2 gene (rs6820411) was highly associated with atrophic AMD, and the functional SNP rs3112831 at ABCA4 showed a marginal association with the disease. Conclusion: We performed a large gene association study in advanced AMD in a Spanish population. Our findings show that CFH and ARMS2 genes seem to be the principal risk loci contributing independently to AMD in our cohort. We report new significant associations that could also influence the development of advanced AMD. These findings should be confirmed in further studies with larger cohorts.     

Time spent in outdoor activities in relation to myopia prevention and control: a meta‐analysis and systematic review

Outdoor time is considered to reduce the risk of developing myopia. The purpose is to evaluate the evidence for association between time outdoors and (1) risk of onset of myopia (incident/prevalent myopia); (2) risk of a myopic shift in refractive error and c) risk of progression in myopes only. A systematic review followed by a meta‐analysis and a dose–response analysis of relevant evidence from literature was conducted. PubMed, EMBASE and the Cochrane Library were searched for relevant papers. Of the 51 articles with relevant data, 25 were included in the meta‐analysis and dose–response analysis. Twenty‐three of the 25 articles involved children. Risk ratio (RR) for binary variables and weighted mean difference (WMD) for continuous variables were conducted. Mantel–Haenszel random‐effects model was used to pool the data for meta‐analysis. Statistical heterogeneity was assessed using the I² test with I² ≥ 50% considered to indicate high heterogeneity. Additionally, subgroup analyses (based on participant's age, prevalence of myopia and study type) and sensitivity analyses were conducted. A significant protective effect of outdoor time was found for incident myopia (clinical trials: risk ratio (RR) = 0.536, 95% confidence interval (CI) = 0.338 to 0.850; longitudinal cohort studies: RR = 0.574, 95% CI = 0.395 to 0.834) and prevalent myopia (cross‐sectional studies: OR = 0.964, 95% CI = 0.945 to 0.982). With dose–response analysis, an inverse nonlinear relationship was found with increased time outdoors reducing the risk of incident myopia. Also, pooled results from clinical trials indicated that when outdoor time was used as an intervention, there was a reduced myopic shift of ?0.30 D (in both myopes and nonmyopes) compared with the control group (WMD = ?0.30, 95% CI = ?0.18 to ?0.41) after 3 years of follow‐up. However, when only myopes were considered, dose–response analysis did not find a relationship between time outdoors and myopic progression (R² = 0.00064). Increased time outdoors is effective in preventing the onset of myopia as well as in slowing the myopic shift in refractive error. But paradoxically, outdoor time was not effective in slowing progression in eyes that were already myopic. Further studies evaluating effect of outdoor in various doses and objective measurements of time outdoors may help improve our understanding of the role played by outdoors in onset and management of myopia.     

The Hoya ULT-2000 Universal Light I Transmission Meter: An Assessment of Its Performance

ABSTRACT The performance of the Hoya ULT-2000 Universal Light Transmission Meter was investigated in three experiments. Firstly the effect of orientation of gradient tinted lenses was investigated, secondly the linearity of the meter was established and thirdly comparison was made with the data obtained with an Hitachi 100-50 Spectrophotometer. Sources of errors are discussed and the possibility of the ULT-2000 being used for assessing performance of tints with respect to Australian Standard 1067–1971 is commented upon.     

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.     

Nordisk ophthalmologisk tidsskrift 1889–1892

In the second half of the nineteenth century several ophthalmological journals appeared (Germany, England, France, United States). In the northern countries (Denmark, Finland, Norway, Sweden) an initiative lead to ‘Nordisk ophthalmologisk Tidsskrift’ published in the scandinavian languages in the years 1889–92. The ‘driving force’ behind the journal was the first professor in Ophthalmology in Copenhagen, Dr. Edmund Hansen Grut. The purpose with this presentation is to give the background for the rise and fall of the journal which was an attempt to promote Nordic Ophthalmology. The authors turned out, however, to be mainly those involved as editors. The journal never gained broad acceptance and it simply stopped in 1892, without any closing remarks. In spite of its short life the journal should be remembered for the very first publication on the arcuate scotoma, the Bjerrum scotoma from 1889. Although shortlived the initiative was not in vain, as can be read in the preface to the very first volume of Acta ophthalmologica.     

The epidemiology of cataract: a study in Greece

Purpose: We conducted a case–control study to identify risk factors for cataract in the Mediterranean Greek population. Three hundred and fourteen cases and 314 frequency‐matched controls of both genders, aged 45–85, attending the ophthalmology department of a major teaching hospital in Athens, Greece, were included in the study. Methods: Cases were medically diagnosed and classified. Controls were healthy visitors without cataract. A detailed questionnaire, covering demographic, socioeconomic, somatometric, lifestyle and medical history variables, provided data on possible risk factors for cataract. Analyses were conducted through multiple logistic regression. Main outcome measures: Cataract overall and by type: nuclear, cortical and posterior subcapsular (PSC). Results: Statistically significant increased risk for cataract overall was found for current (OR = 1.99, 95%CI: 1.23–3.23) and ex‐smokers (OR = 1.64, 95%CI: 1.02–2.70), history of coronary heart disease (OR = 2.25, 95%CI: 1.43–3.55), family history of ophthalmologic diseases (OR = 1.51, 95%CI: 1.03–2.20) and higher sunlight exposure at the beach (OR = 2.26, 95%CI: 1.37–3.72) as well as at work (OR = 2.03, 95%CI: 1.32–3.12). Use of measures protecting against sunlight at the beach, i.e. hat (OR = 0.58, 95%CI: 0.39–0.85) and vision repair spectacles (OR = 0.44, 95%CI: 0.30–0.65), were associated with reduced risk. Results for cataract overall were also evident for the nuclear type and in most circumstances for PSC type, but were only suggestive for the cortical type of cataract. Conclusion: We identified certain possible risk factors for age‐related cataract. In a Mediterranean Greek population, we found that smoking, use of cortisone drops, cardiovascular heart disease and sunlight exposure increase the risk for cataract, while use of hat and vision repair spectacles act protectively.     

Perimetry,tonometry and epidemiology: the fate of glaucoma management

This is the lecture that I gave when I was awarded Acta Ophthalmologica’s gold medal and honorary award at the Nordic Ophthalmological Congress in Reykjavik in August 2010. I was inspired by Jared Diamond’s famous book: Guns, Germs, and Steel, The Fates of Human Societies. Diamond is professor of geography and physiology at the University of California, Los Angeles. In this book, which won the Pulitzer Prize, the author explains why the European civilization took over the world. This was all because of predetermined factors of biological nature, environmental differences that were strengthened by feedback loops, and resulted in technological innovation and superiority. In this presentation, I write about the development of glaucoma knowledge and management. I suggest that the development might have been predetermined, just waiting for more facts to be unveiled by research. The technologies tonometry and perimetry have been fundamental as has epidemiological techniques and controlled trials. The new and increased knowledge about glaucoma must now be translated to improvements of clinical glaucoma care. The glaucoma scientists of today and tomorrow will continue to reveal as yet unknown facts, maybe in a predetermined way, but nevertheless of benefit to all patients with glaucoma.     

我国4种眼科学术期刊中视力相关问题的统计与分析

目的 了解《中华眼科杂志》《中国实用眼科杂志》《中华眼底病杂志》《眼视光学杂志》4种期刊中有关视力方面问题的统计.方法 仔细阅读2008年在这4种期刊中刊出的所有论文,记录每一篇论文的特征,包括是否提及视力、是否以视力作为结果、使用的视力表类型、视力检查细节、远近视力、视力矫正方式、视力记录法、视力的描述性统计等,采用Excel 2003软件对数据进行分类、整理、归纳和求百分比.结果 2008年这4种期刊共发表论文1111篇,提及视力的有476篇,以视力为结果的有237篇.在这237篇中,51篇提到其所使用的视力表类型,其中国际标准视力表占43.1%,标准对数视力表占29.4%;155篇提到了视力矫正方式,以最佳矫正为主;213篇在论文中体现了其所使用的视力记录法,小数记录法占75.1%,5分记录法占10.1%;216篇论文对视力进行了描述性统计,对视力进行分级的占66.7%,以均数±标准差表示的占24.5%.结论 国内眼科学术期刊在书写视力检查细节方面,特别是对视力数据的描述性统计方面还存在较大问题.加强我国眼科医生的眼视光学基础知识培训迫在眉睫,同时相关期刊编辑也需重视对该方面问题的审读.     

北京市眼科研究所2013-2015年科技论文发表情况

目的 分析北京市眼科研究所2013-2015年科技论文发表情况,为科研工作的发展和管理提供参考。设计 回顾性研究。研究对象 2013年1月1日至2015年12月31日北京市眼科研究所作为第一完成单位发表的中英文科技论文。方法 对2013-2015年各年度科技论文发表的分布（SCI、中华、核心、非核心）,水平（影响因子）,研究类型（临床、基础、流行病）,研究方向,第一作者的年龄、职称、学位在各年度和期刊类型的分布情况,科研项目对论文的支持等情况进行统计描述。主要指标 论文数量、论文性质、期刊类型分布、研究类型、研究方向、第一作者年龄、职称和学位。结果 北京市眼科研究所3年间共发表科技论文292篇,其中2013、2014、2015年分别发表论文90篇、92篇和110篇。SCI收录期刊论文120篇（41.1%）、中华系列91篇（31.2%）、核心期刊68篇（23.3%）、非核心期刊13篇（4.5%）。三年间每年发表收录在SCI期刊的论文平均单篇影响因子为3.0~3.1,论文以临床研究类型为主,主要研究方向是青光眼和眼底病。＜30岁年龄组和45岁以上年龄组是作为第一作者发表文章的主要人群。具有博士学位的人员发表论文数量最多,121篇（46.9%）。具有硕士学位的人员发表的论文SCI收录比例最高,占67.6%（25篇）。研究生作为第一作者发表论文数量最多,82篇（31.8%）;其次是正高级职称人员,74篇（28.7%）。中级职称人员发表SCI收录期刊论文29篇（占总SCI论文数的28.7%）。发表论文标注的资助项目出现频次共计288次,主要来自国家自然科学基金、北京市科技新星和首都卫生发展科研专项。 结论 2013-2015年间发表论文的数量和质量整体趋势稳中有升,高影响因子论文数量有待提升。正高级职称人员是发表科技论文的主力。国家级科研项目等多渠道基金资助对科技论文的发表有积极的推动作用。     

Gerhard Henrik Armauer Hansen (1841–1912) – 100 years anniversary tribute

2012 marks the 100th year of death of Gerhard Henrik Armauer Hansen (1841–1912), who discovered Mycobacterium leprae, but also gave the first systematic scientific work on the leprosy of the eye. The article reviews his life and scientific achievements with special regard to eye and ophthalmology.     

John G. Lindberg and the discovery of exfoliation syndrome

John G. Lindberg, a young Finnish ophthalmology resident, started a research project in 1914 aiming at an academic dissertation. His plan was to elucidate Axenfeld's observations on iris changes in senile eyes. Axenfeld had described two types of degeneration of the iris: a hyaline degeneration of the iris pupillary zone causing poor pupillary dilatation with mydriatics and an atrophy of the iris pigment epithelium at the pupillary border. For his research Lindberg had to construct a slit-lamp biomicroscope by studying Gullstrand's monograph on the matter; slit-lamp biomicroscopes were not commercially available at that time. A Sach's lamp was used for transillumination of the iris. While conducting his research Lindberg paid attention to greyish flakes and fringes at the pupillary border. He also noted how this strange material formed a membrane on the anterior lens surface. Documentation was made by skillful hand drawings. The new phenomenon was found to be as common in cataract patients as in non-cataractous controls older than 55 years. The phenomenon was observed in 50% of glaucoma patients. Age was the decisive factor; the phenomenon was more prevalent with advancing age. Lindberg published his results as a thesis at the University of Helsinki in 1917. When attending a Nordic Congress of Ophthalmology in 1921, Lindberg met Norwegian ophthalmologist, Birger Malling, and gave him his thesis and explained the new findings. In 1920-21 Lindberg worked at Axenfeld's clinic in Freiburg, Germany. During this period he met in Basel, Switzerland, a Swiss ophthalmologist, Alfred Vogt. He told Vogt about his research and provided him with copies of his thesis. Both Malling and Vogt published papers on exfoliation in 1923 without referring to Lindberg's work. Lindberg did not, however, interfere with these papers. Thus Lindberg was forgotten by his contemporaries as a scientist. However, his main conclusions on exfoliation are still valid today. The life of this remarkable ophthalmologist is described in the present paper.     

Visual function deficits in children

In the past year, new work on sensory testing in preverbal infants has expanded our knowledge in three areas: 1) visual acuity testing in infants in varying levels of illumination; 2) visual evoked cortical potential-evidence for binocular function in infantile esotropia; and 3) a new time-efficient method to evaluate color vision in newborns and infants. A newly reported sequel to loss of binocularity is the development of A and V pattern strabismus. In another study, loss of fusion, as with acute concomitant esotropia, was shown to be a sign of serious intracranial disease. Regarding motor visual function deficits, new treatments of infantile esotropia syndrome and nystagmus with botulinum toxin type A are presented. Regarding social issues, visual function deficit of abused children and infants born to drug-abusing mothers are presented as a timely reminder that child abuse is still an enormous social problem, and that the visual system is far from exempt from damage.     

Michael Constantine Psellus (1020–1105 AD) and his definition of strabismus

Strabismus was a known eye misalignment since the Hippocratic era (ca 5th century BC). Hippocrates and his followers were the first to introduce the hypothesis of a hereditary condition. Many ancient Greek physicians like Galen (ca 2nd AD) provided several definitions, while Paul of Aegina (625–690 AD) was the scholar who introduced a method to treat it. Paul used a full face mask and an oil lamb to guide the eyeballs toward the desired direction. It seems that this approach endured for centuries to come. During 11th century AD in Constantinople, the Byzantine scholar and politician Michael Constantine Psellus (ca 1020–1105 AD) composed a series of philosophical, religious, political and scientific treatises. Among his work stands a medical iambic didactic poem of 1732 lines, in which he had mentioned strabismus. Although he was not an oculist, he had managed to define strabismus. His definition was noted as such, “Strabismus is caused by a spasm of the bodies which move (the eye balls) and the oblique tendency of the muscles”. Psellus was aware of the knowledge of the past and recorded what was still valid at that era, presenting a memorable definition. As his reference was completely neglected from the medical bibliography, our study aims to add him in the scientific chain of those who understood this disorder. This study aims to compose Psellus biography, present ancient Greek and Byzantine ophthalmology’s opinion concerning strabismus and note Psellus’ definition. The TLG and MedLine/PubMed databases were searched and the terms “strabismus” and “Psellus” were used as key words.     

The American Journal of Ophthalmology 1862–1864

TheAmerican Journal of Ophthalmology was the first specialty periodical to be published in the Western hemisphere; the first issue appeared in New York City July 1862. Its editor and publisher was Julius Homberger, M.D., aged 22 years, who had emmigrated from Germany in January 1861. Six issues were published the first year andThe Journal ceased publication after two issues in 1864. Possibly, the American Ophthalmological Society, the first national medical specialty society, was founded in 1864 in a reaction to Homberger, his journal, and his strong belief that specialists, but not other practitioners, should be permitted to advertise their skills. In 1866, Homberger submitted his resignation to the American Medical Association, which he had served a secretary of the Section on Surgery, 1864–1865. His resignation was refused and he was expelled from membership in 1868. He moved to New Orleans to practice ophthalmology in 1867, and died in 1872. The second series ofThe Journal began in St. Louis in 1884 with Adolf Alt, A graduate of Heidelberg University, who trained in ophthalmology in New York City, with Hermann Knapp, founder, editor, and publisher of theArchives of Ophthalmology. In 1918, the current third series of theAmerican Journal of Ophthalmology, consolidated five ophthalmic publications, with Edward Jackson of Denver as editor. Read at the annual meeting of the Cogan Ophthalmic History Society, The National Library of Medicine, Bethesda Maryland, March 15 and 16, 1996.     

The present status of the Hirschberg Library

Conclusion Although the Hirschberg Library is used only by a few scholars today, it remains a precious and useful collection of ophthalmic literature, especially as old literature on ophthalmology is scanty in Japan. Recently I read Arthur Hailey's novel Roots and I was quite surprised to learn that the records of ships of two hundred years ago are still kept in good order so that the author could trace back the history of the ships by record. Old literature is precious, but as the amount of new information increases exponentially, the method of storing the information is rapidly changing. Computers will be utilized more and more, such as is the case in publishing information on the sequence of DNA and proteins. At the same time, books and journals will continue to be just as important, for the exchange of results and of new ideas, and for reviews.At present, Dr. F.C. Blodi, Department of Ophthalmology, University of Iowa, USA, is preparing a detailed bibliography on Hirschberg.     

Vogt–Koyanagi–Harada syndrome in a Greenlandic Inuit

Purpose: To report a case of Vogt–Koyanagi–Harada syndrome (VKH) in an Inuit. Methods: We carried out a medical evaluation and human leucocyte antigen (HLA) genotyping. Results: A 36‐year‐old male Inuit developed severely decreased vision, intense headache and vertigo over a 3‐week period. Ocular examination revealed panuveitis with bilateral serous retinal detachment and optic nerve head oedema. There was no history of ocular trauma or evidence suggestive of other disease entities. The patient responded well to high‐dose systemic prednisolone. Vitiligo presented late in the course. Conclusions: This case report describes the first published case of VKH in a patient of Inuit ancestry. The patient was homozygous for HLA‐DR4, a genotype previously associated with VKH.     

A study comparing ocular pressure pulse and ocular fundus pulse in dependence of axial eye length and ocular volume

Acta Ophthalmol. 2010: 88: 766–772

Abstract.

Purpose: There is a long‐standing discussion about whether myopia is associated with decreased choroidal blood flow, as suggested by pneumotonometric measurements of pulsatile ocular blood flow (POBF). However, it has been noted previously that calculations of POBF depend on intraocular volume. Methods:  In the present study we investigated this volume dependence through the comparison of ocular pressure pulse and ocular fundus pulse. Fifty‐one healthy participants with different refractive errors participated in the study. Pulse amplitude (PA) and POBF were measured using pneumotonometry. Fundus pulsation amplitude (FPA) was measured with laser interferometry. Axial eye length (AEL) was measured with partial coherence interferometry. A mathematical model was used to calculate choroidal volume changes based on FPA. The ocular pressure pulse was converted into pulse volume (PV) according to the standard procedure used for pneumotonometry. Results: PA and POBF were found to decrease with increasing axial length (r = ?0.55, p < 0.001 and r = ?0.57, p < 0.001, respectively). A similar relationship existed for PV (r = ?0.57, p < 0.001) and FPA (r = ?0.46, p = 0.001). In addition, there was a significant association between PV and choroidal volume change during the cardiac cycle (r = 0.61, p < 0.001). Conclusion: The present study confirms experimentally that PA, FPA and POBF are dependent on ocular volume and indicates that the pulsatile component of ocular blood flow is not reduced in myopic patients. Accordingly, the relationship between AEL and POBF described previously appears to be a consequence of different ocular volumes. Our findings have important implications for studies using PA or POBF.     

Nordic research in ophthalmology

PURPOSE: To provide an overview of some of the current activities in eye research in the Nordic countries. METHODS: The presentations at the biannual Nordic Congress of Ophthalmology, held in Tampere, Finland in 2002, were reviewed and the contributions found most noteworthy are included in this article along with a limited discussion of each research field. However, space requirements prevented the inclusion of many interesting scientific contributions. RESULTS: Important contributions in various subfields of eye research and ophthalmology are reviewed. These include cornea, cataract, paediatric ophthalmology, glaucoma, diabetic eye disease, age-related macular degeneration, physiology and pharmacology and oncology. CONCLUSIONS: Eye research is very active in the Nordic countries and significant contributions are being made to ophthalmology in several fields on a world scale. We hope to continue to review Nordic contributions to eye research after each Nordic Congress of Ophthalmology and plan to make the reviews more systematic and comprehensive in the future.