Archives of Ophthalmology

BARKAN, OTTO;BARKAN, HANS;RANDEL, HARVEY O.;SMITH, H. GORDON

doi: 10.1001/archopht.1931.00820050011001pmid: N/A

Abstract Since strabismus was described by the earliest medical writers its nature has been the subject of much controversy. Many attempts have been made to explain the problem of squint, especially its origin and development. Many valuable contributions have been added from time to time. Worthy hypotheses have been promulgated ; numerous ideas as to its etiology have been followed by many ingenious methods for its correction. The three outstanding hypotheses that have enjoyed popularity are: (1) the muscular hypothesis, (2) the accommodation hypothesis of Donders,1 and (3) Worth's2 fusion hypothesis. These hypotheses are so well known to ophthalmologists and are so widely published that repetition is unnecessary. Each hypothesis contains truths, but none offers a plausible explanation for the origin and development of all cases of squint. Each hypothesis has many advocates among the leading members of the profession, but the very multiplicity of the explanations denotes the inadequacy References 1. Donders, F.: Anomalies of Refraction and Accommodation , London, 1864, pp. 292, 293, 294, 295, 301 and 303. 2. Worth, C.: Squint , Philadelphia, P. Blakiston's Son & Company, 1920, p. 53. 3. The term "squint" as used in this paper is synonymous with concomitant convergent squint, although in general principle the conclusions drawn also apply to divergence, heterophoria and paralysis. 4. Landolt: Arch. d'opht. 35:416, 466 and 529, 1915. 5. Parinaud, H.: Le strabisme et son traitement , Paris, O. Doin, 1899. 6. Worth, C.: Squint , ed. 6, Philadelphia, P. Blakiston's Son & Company, 1929. 7. Zentmayer, W.: The Present Status of the Etiology of Squint , J. A. M. A. 55:118 ( (July 9) ) 1910.Crossref 8. Peter, Luther C.: Extra-Ocular Muscles , Philadelphia, Lea & Febiger, 1927. 9. Stevens, G. T.: Motor Apparatus of the Eyes , Philadelphia, F. A. Davis Company, 1906. 10. Savage, G.: Ophthalmic Myology , Nashville, Tenn., 1904 11. Ocular Muscles , in Wood: American Encyclopedia , Chicago, Cleveland Press, 1917, vol. 11, pp. 8096 and 8097. 12. Duane, A., in Fuchs: Textbook of Ophthalmology , ed. 6, Philadelphia, J. B. Lippincott & Company, 1917. 13. Wilkinson, O.: Strabismus, Its Etiology and Treatment , St. Louis, C. V. Mosby Company, 1927. 14. van der Hoeve: Beiträge zur Lehre vom Schielen , Wiesbaden, 1902 15. Arch. f. Augenh. 46:172, 1902-1903. 16. Sherrington : The Integrative Action of the Nervous System , London, Constable and Company, Ltd., 1909. 17. Stimulation of the center of one movement produces inhibition of the center for the opposing movement and vice versa. 18. O'Connor, Roderic: A New Shortening Technic . Tr. Sect. Ophth., A. M. A. , 1916, p. 236. 19. O'Connor, Roderic: Tr. Am. Acad. Ophth. 31:155, 1926.

GOLDSTEIN, ISADORE;WEXLER, DAVID

doi: 10.1001/archopht.1931.00820050024002pmid: N/A

Abstract Niemann,1 in 1914, described a peculiar disease in a female infant, aged 18 months, which resembled Gaucher's disease in some respects, but which was unlike it in others. Several years later, Pick2 showed that similar cases subsequently reported were not cases of Gaucher's disease, but constituted a clinical and pathologic entity for which he proposed the term lipoid splenohepatomegaly. The specific anatomic feature was the presence of large numbers of vacuolated or "foam" cells in many organs and in most tissues of the body. As the great mass of foam cells are derived from the various kinds of histiocytes, and as the foamy appearance is due to lipoid droplets in the histiocytes, Bloom3 suggested the term lipoid histiocytosis as a more accurate description of the condition than lipoid splenohepatomegaly, the latter indicating that the process is limited to the liver and spleen, which is not the case. References 1. Niemann: Jahrb. f. Kinderh. 79:1, 1914. 2. Pick: Ergebn. d. inn. Med. u. Kinderh. 29:519, 1926. 3. Bloom: Am. J. Path. 1:595, 1925. 4. Abt, I. A., and Bloom, W.: Essential Lipoid Histiocytosis (Type Niemann-Pick) , J. A. M. A. 90:2076 ( (June 30) ) 1928.Crossref 5. Knox, Wahl and Schmeisser : Bull. Johns Hopkins Hosp. 27:1, 1916. 6. Hamburger: Jahrb. f. Kinderh. 116:41, 1927. 7. Bloom, W.: Histogenesis of Essential Lipoid Histiocytosis (Niemann-Pick's Disease) , Arch. Path. 6:827 ( (Nov.) ) 1928. 8. Pick and Bielschowsky: Klin. Wchnschr. , 1927, p. 1631. 9. Kramer: M. Clin. North America 11:905, 1928. 10. Sachs and Strauss: J. Exper. Med. 12:685, 1910.Crossref 11. Grinkler: Am. J. Path. 3:768, 1927. 12. Axenfeld: Ber. d. ophth. Gesellsch., Heidelberg 34:300, 1907. 13. Peschel: Arch. f. Ophth. 39:1, 1893. 14. Bietti: Arch. f. Ophth. 49:224, 1899. 15. Ginsberg, in Henke-Lubarsch: Handbuch der speziellen Anatomie und pathologischen Histologie , Berlin, Julius Springer, 1928, vol. 2, p. 302. 16. Stock: Klin Monatsbl. f. Augenh. 5:225, 1908. 17. Greenfield and Holmes: Brain 48:183, 1925.Crossref 18. Holden: J. Nerv. & Ment. Dis. 25:550, 1898.

FERREE, C. E.;RAND, G.;HARDY, C.

doi: 10.1001/archopht.1931.00820050039003pmid: N/A

Abstract Two important reasons might be given for studying the refractive condition of the peripheral field of the eye: (a) to study its relation to determinations of acuity in the peripheral field, and (b) to study its relation to determinations of chromatic and achromatic sensitivity in the peripheral field. In former studies we have made rather elaborate series of determinations on both of these points. There remains for this study an investigation of the refractive condition of the peripheral field. Another angle of approach has been to complete our study of the variable factors that influence the determination of the limits of the color and form fields. This is, of course, but an aspect of (b). In listing the factors that cause a variation of result for a given person, we find the following: wave length and purity of stimulus, intensity of stimulus, size of stimulus or of angle subtended at References 1. The factors that cause variability of result for a given eye produce different amounts of effect for different eyes. To this extent, then, they also contribute to the variability of result from eye to eye. 2. Ferree, C. E.; Rand, G., and Monroe, M. M.: Studies in Perimetry : I. Preliminary Work on a Diagnostic Scale for the Form Field , Am. J. Ophth. 9:95, 1926 3. Studies in Perimetry: II. Preliminary Work on a Diagnostic Scale for the Color Fields , Ferree Am. J. Ophth. 12:269, 1929 4. Studies in Perimetry: III. Errors of Refraction, Age and Sex in Relation to Size of the Form Field , Ferree Am. J. Ophth. 12:659, 1929 5. Studies in Perimetry : IV. Preliminary Work on a Diagnostic Scale with a 0.17° Stimulus , Ferree Am. J. Ophth. 13:859, 1930. 6. Laurance, L.: General and Practical Optics , London, The Orthos Press, 1903, pp. 163-166 7. ed. 3, 1920, pp. 245-247. 8. It is assumed here that the eyes are under considerable pressure from the external muscles in a prolonged eccentric fixation, the amount depending on the degree of eccentricity. It is also assumed that they are under some pressure in taking and holding far fixation in the median plane; that is, when relaxed and freed from all incentives to adjustment for clear sight, as with closed lids and in the dark, the eyes take a more converging position.

ZUBAK, MATTHEW F. C.

doi: 10.1001/archopht.1931.00820050054004pmid: N/A

Abstract As I had used electrocoagulation for three years and realized its usefulness in the removal of minute growths, such as warts, moles, milia, cysts, etc., its possibilities in the destruction of pterygia appealed to me. In the first case it required no small amount of daring, not only in the patient, to whom the situation was explained, but probably even more in myself. Nothing unfavorable resulted, however, and the success of the initial venture caused me to adopt it in all cases for the past two years. The machine used is that regularly sold for electrocoagulation, fulguration and surgical diathermy, with the means available for changing from one type of current to the other. One switch is marked "strong-weak." The switch is set at "strong" and the voltage, and spark gap settings are adjusted so that on short-circuiting the coagulation current, the milliamperemeter reading is 2,000. Then

DUANE, ALEXANDER

doi: 10.1001/archopht.1931.00820050056005pmid: N/A

Abstract BINOCULAR VISION Binocular Single Vision; Fusion.—In all but a small minority of cases binocular fixation is present whenever one looks with both eyes. The image of the object looked at, then, is formed on each fovea (fig. 1). Yet, though there are two images, one sees, not two objects, but one object (binocular single vision). For the mind by a peculiar process which we denominate fusion combines the two retinal images into a single visual impression, which differs notably from the impression derived from each eye when seeing separately. Fusion of Images Formed on Corresponding Points.—Not only does the mind fuse the two retinal images of any object looked at directly, but it also fuses the images of a number of objects seen by indirect vision. Fusion, in fact, occurs for any object, the retinal images of which fall on corresponding points, i. e., on the two points References 1. If u bears exactly the same relation to f that s does to m and t to n and if projection is made from u strictly on the basis of sensory perceptions, then the combined visual impressions set up by a body D would be reprojected, not to D, but to E a little nearer the midline. Apparently, however, no such false projection takes place, the sensory impressions here, as generally, being corrected by the muscular impressions, so that D is not seen at E, but in its true place. 2. LeConte, J.: Sight: An Expression of the Principles of Monocular and Binocular Vision , New York, D. Appleton & Company, 1881. 3. Parson, Beaufort, S.: Lefthandedness: A New Interpretation , New York, The Macmillan Company, 1924. 4. Straub, Arch. f. Ophth. , 1909, vol. 70, no. (1) . 5. Dolman, P.: Am. J. Ophth. 3:867 ( (Dec.) ) 1919. 6. Howard ( Am. J. Ophth. , (April) , 1919) 7. LeConte (footnote 2). 8. Howard, H. J.: Am J. Ophth. 2:656 ( (Sept.) ) 1919. 9. Andersen, E. E., and Weymouth, F. W.: Visual Perception and the Retinal Mosaic , Am. J. Physiol. 64:561 ( (May) ) 1923.

KIRBY, DANIEL B.

doi: 10.1001/archopht.1931.00820050076006pmid: N/A

Abstract Before it was learned that the calcium metabolism of patients with senile cataract was within normal limits, and that they did not need treatment with parathyroid extract, it was thought that possibly they might benefit from the use of the latter. There had come to my attention certain unpublished reports on the use of various parathyroid extracts with more or less success. As calcium enters into the mechanism of so many physiologic processes, Collip thought it possible that clinical research would later indicate that it was desirable under definite circumstances to keep certain patients in a state of mild hypercalcemia. Besides, there were other possibilities: 1. Although the greater percentage of patients with cataract had more than sufficient calcium in their blood serum, the amount that was diffusing into the aqueous was insufficient to keep up a proper balance. 2. There was an excess of calcium in the

COWAN, ALFRED;McANDREWS, LEO F.

doi: 10.1001/archopht.1931.00820050082007pmid: N/A

Abstract The attempt to localize retinal lesions is not new. In 1882, von Graefe1 described his method of localizing a retinal cysticercus cyst. He also invented a new type of ophthalmoscope to be used in such cases. His method embodied several principles that are in use today. Accurate localization of a retinal tear is a difficult procedure. The reason is obvious. One is working with many variable factors, e. g., the cooperation of the patient, the possible movement of the detached retina containing the tear, the length of the globe and the surgeon's judgment in estimating distance. No method, therefore, is free from error. At the present time various methods are employed. Schoenberg,2 in a recent article, described the method that Gonin employs. He locates the retinal tear with the ophthalmoscope, and ascribes it to a meridian corresponding to the hour hand of the clock. A black silk suture References 1. von Graefe, A.: Epikritische Bemerkungen über Cysticercus Operationen und Beschreibung eines Localisierungs-Ophthalmoscops , Arch. f. Ophth. 28:187, 1882. 2. Schoenberg, M.: The Gonin Operation for Detachments of the Retina , Arch. Ophth. 3:684 ( (June) ) 1930.Crossref 3. Lindner, K.: Ein neurer Weg zur Lagebestimmung von Stellen des Augenhintergrundes und seine Verwendung bei der Goninschen Behandlung der Netzhautabhebung , Arch. f. Ophth. 153:233, 1929. 4. Salzmann, M.: Ortbestimmung im Augeninneren , Arch. f. Ophth. 153:252, 1929. 5. Cowan, A.: A Suggestion for a New Perimetric Chart , Am. J. Ophth. 3:49, 1920 6. Perimetric Chart Used for Measuring Retinal Lesions , Cowan Am. J. Ophth. 4:28, 1921. 7. Whitnal, S. E. : Anatomy of the Human Orbit , London, Oxford University Press, 1921, p. 254. 8. von Imre: A Simple Method for Localizing Retinal Tears , Klin. Monatsbl. f. Augenh. 84:90, 1930.

ABRAHAM, S. V.

doi: 10.1001/archopht.1931.00820050088008pmid: N/A

Abstract Many new tests for heterophorias have been described by as many different authors. All of them, however, are much alike in that no new fundamental principles have been introduced. Since von Graefe1 described his diplopia test for excess of divergence, in 1857, many others have used minor variations of it. This type of test depends on the suspension of the fusion sense by creating an insurmountable diplopia in one meridian and by measuring the manifest phoria in the opposite meridian. The other type of test, of which the Maddox rod test is the best example, depends on a similar suspension of the fusion sense by producing so much distortion of one of the images that fusion is practically impossible. The manifest deviation can then be measured by prisms. In 1886, Stevens2 emphasized the importance of heterophorias and gave his widely used classification of the different types. He early References 1. von Graefe, A.: Insufficienz der inneren Augenmuskeln , Arch. f. Ophth. 3:308, 1857. 2. Stevens, G. F.: Nomenclature des differents états reunis sous le nom d'insuffisance musculaire , Arch. d'opht. 6:536, 1886. 3. Wells, D. W.: Stereoscope in Ophthalmology , Boston, E. F. Mahady Company, 1926, p. 31. 4. Peter, L. C.: Extra-Ocular Muscles , Philadelphia, Lea & Febiger, 1927, p. 20. 5. Gould, G.: Innervational Abnormalism the Cause of Heterophoria , Ann. Ophth. & Otol. 3:35, 1894. 6. Worth, C.: Squint , ed. 5, Philadelphia, P. Blakiston's Son & Company, 1921, p. 170. 7. Savage, G. C.: Ophthalmic Myology , Nashville, Tenn., Gospel Advocate Publishing Company, 1902, p. 254. 8. Zentmayer, W.: A Study of the Effect on Heterophoria of the Correction of Ametropia , J. A. M. A. 63:572 ( (Aug. 15) ) 1914. 9. Howe, L.: Muscles of the Eye , New York, G. P. Putnam's Sons, 1908, vol. 2, p. 100. 10. Stevens, G. T.: Motor Apparatus of the Eye , Philadelphia, F. A. Davis Company, 1906, p. 292. 11. Dolman, P.: Maddox Rod Screen Test , Tr. Am. Ophth. Soc. 17:235, 1919. 12. Marlow, F. W.: Prolonged Occlusion Test , Am. J. Ophth. 10:567, 1927. 13. Worth, C.: Squint , ed. 6, Philadelphia, P. Blakiston's Son & Company, 1921, p. 183. 14. Whenever prisms are referred to in this article, prism diopters (Δ) are indicated. Since 1895, most authors have been using prism diopters in their work, although not always specifically stating that they have done so. In fact, many have carelessly used the term "prism degree" for "prism diopters." 15. Savage, G. C.: Ophthalmic Myology , Nashville. Tenn., Gospel Advocate Publishing Company, 1902, p. 84. 16. Peter (footnote 4, p. 99). 17. Worth (footnote 6, p. 21). 18. Peter (footnote 4, p. 220). 19. Stevens, G. T.: Motor Apparatus of the Eyes , Philadelphia, F. A. Davis Company, 1906, p. 281. 20. Hansell and Bell: Equilibrium of the Ocular Muscles , Ann. Ophth. & Otol. 1:148, 1892. 21. Worth (footnote 6, p. 191). 22. Doak, quoted by Savage, G. C.: Ophthalmic Myology , Nashville, Tenn., Gospel Advocate Publishing Company, 1902, p. 269. 23. Manufactured by the American Optical Company, Rochester, N. Y. The instrument is now called the "Wellsworth" phorometer. 24. There is no material difference in the results if the room is fairly well lighted, but many patients have difficulty seeing only one streak under these conditions. Then, too, working in the dark results in readings less influenced by the examiner's opinions. In my experience it is rarely difficult for a patient to see both the streak and the spot with the room darkened. When difficulty is present, it seems to be due rather to an improper adjustment of the apparatus. 25. Occasionally, a horizontal prism may be needed to bring the streak and light together. 26. Marlow, F. W.: Prolonged Occlusion Test , Am. J. Ophth. 10:567, 1927. 27. Peter (footnote 4, p. 121). 28. Savage (footnote 15, p. 114). 29. The clinic is under the direction of Dr. E. V. L. Brown. 30. Walter, W.: Heterophoria and Heterotropia , Am. J. Ophth. 3:201, 1902. 31. Peter, L. C.: Extra-Ocular Muscles , Philadelphia, Lea & Febiger, 1927, p. 119. 32. Peter (footnote 4, p. 119). 33. Macklin, W. F.: Prevalence of Heterophoria , M. Clin. North America 4:337, 1920. 34. Field, P. C. : Phorometry of Normal Eyes , Arch. Ophth. 40:526, 1911. 35. Bielschowsky, A.: Ueber die relative Ruhelage der Augen , Ber. ü. d. Versamml. d. deutsch. ophth. Gesellsch. 39:67, 1913. 36. Bannister, J. M.: Hints in Relation to the Dynamics of the Extrinsic Muscles , Am. J. Ophth. 3:878, 1920. 37. Burnett, S. M.: Heterophoria and Its Relation to Asthenopia , Tr. Am. Ophth. Soc. 6:217, 1891. 38. Dolman, P.: Relation of the Sighting Eye to the Measurements of Heterophoria , Am. J. Ophth. 3:258, 1920. 39. Posey, W. C.: Study of Two Hundred and Eighty-Seven Cases of Hyperphoria , Ophth. Rev. 17:372, 1898. 40. Macklin, W. F.: Prevalence of Heterophoria , M. Clin. North America 4:337, 1920.

DELANEY, JAMES H.

doi: 10.1001/archopht.1931.00820050103009pmid: N/A

Abstract Cases of sympathetic ophthalmia, as every ophthalmologist knows, are not a rarity. One is immediately on the lookout for this disorder in case of injury to the eye in which there has been either a perforation of the eyeball (operative cases included) or a rupture of the tunics of the eye. This is especially true when the opening involves the ciliary region, or so-called danger zone. Does the average ophthalmologist look for this condition when there has been no perforation or rupture of the eyeball? Does he even consider this possibility when he is confronted with an ocular injury caused by a blow from a fist or even as innocent an object as a snowball? A careful search of the literature fails to show undisputed cases arising without perforation or rupture of the eyeball (cases of melanosarcoma excepted). Jackson1 stated : "The occurrence of true sympathetic ophthalmia References 1. Jackson, E.: Am. J. Ophth. 9:631, 1926. 2. Butler, T. H.: Tr. Ophth. Soc. U. Kingdom 48:346, 1928.

ELLETT, E. C.

doi: 10.1001/archopht.1931.00820050106010pmid: N/A

Abstract The surgical treatment for retinal detachment has been the subject of a number of recent papers, and several of these, which have not been so generally quoted or referred to, have presented the question from what might be called the two points of view now most discussed, so that it might be worth while to review briefly some of these contributions, especially those of Gonin1 (Lausanne, Switzerland), Sourdille2 (Nantes), Finlay3 (Havana) and Badeaux4 (Montreal), since they come from four different countries. The great interest in this subject at present is undoubtedly due to Gonin's contributions, which, to quote Sourdille, have been made "with an abundance of extraordinary means, in journals of all languages and in communications to societies of all countries." The remarkable number of cures, up to 50 or 60 per cent, reported as the result of this operation, in a disease References 1. Gonin, J.: Remarks and Comments on Two Hundred and Forty Cases of Retinal Detachment Treated for the Most Part by Operation , Ann. d'ocul. 167:361 ( (May) ) 1930 2. The Treatment of Detached Retina by Searing the Retinal Tears , Arch. Ophth. 4:622 ( (Nov.) ) 1930. 3. Sourdille, G.: A Note on the Pathogenesis and Treatment of Detachment of the Retina , Rev. cubana de oft. , (July) , 1930. 4. Finlay, C. A.: A Modification of Gonin's Surgical Method of Treatment of Detachment of the Retina , Arch. Ophth. 4:662 ( (Nov.) ) 1930.Crossref 5. Badeaux, Francois : Reflections on the Operative Treatment of Detachment of the Retina , Ann. d'ocul. 167:383 ( (May) ) 1930. 6. Sourdille, G.: Arch. d'opht. , (July) , 1923. 7. Gonin (footnote 1, first reference). 8. Gonin (footnote 1, second reference). 9. Sourdille, G.: Ann. d'ocul. , (March) , 1921.