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Logo of brjopthalBritish Journal of OphthalmologyVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
Br J Ophthalmol. 2007 April; 91(4): 562.
PMCID: PMC1994752

From the Library

“Four weeks after the first mosaic was cut, the job of laying out the fountain's pattern began. A new moualem arrived at Dar Khalifa. He was fine‐boned and fragile, like a figure crafted from Meissen porcelain. Hamza led him into the house and through to the courtyard where the zelij cutters were sitting. The master craftsman unfurled a sheet of sackcloth on the green tiled floor and set to work. The central medallion was sketched out first. Then the 16 outer rosettes were drawn and, after that, the background. The moualem used tweezers to position the smallest hand‐cut mosaics for the central medallion. So adept was his skill that he laid out all 5000 mosaics upside down, without any need to see the actual pattern on the reverse. His hands moved at the speed of light, plucking individual mosaics from the assorted piles and dropping them into place. I asked how he could do the job without seeing the colors. ‘Only a blind man knows the weakness of the eyes', he said.” (Shah T. The Caliph's House: A Year in Casablanca. New York, Bantam Dell 2006:305)

Intrauterine infection has been linked to preterm delivery and neurologic injury. Of significant importance to ophthalmologists is the link between hypoxic encephalopathy and damage to the visual cortex associated with intrauterine infection. Investigators from the University of Melbourne have now demonstrated that pre‐natal exposure to repeated doses of endotoxin in fetal sheep resulted in alterations of the retina and optic nerve with specific effects on dopaminergic neurons and myelination. The possibility that intrauterine infection may predispose to damage of the retina and myelin sheath of the optic nerve in at risk infants is a logical conclusion from this study. (IOVS 2007;48:472–8)

The use of stem cells for repair of central nervous system damage continues to be a hope of neuroscientists. However, despite the fact that several clinical trials to test stem cell therapies for repairing bone, treating coronary artery problems and preventing transplant complications, only one clinical trial is underway addressing problems of the central nervous system. This is a particular interest to ophthalmologists since this trial involves injecting stem cells into six children with Batten disease. The first child was treated last December and has reportedly shown subtle improvements and speech and reduction in seizure activity. No report has been made as to the visual status of the patient despite the prominent retinal degeneration that is associated with this neurodegenerative disease. (Sci Amer 2007;296:14)

Recent reports have emphasised that the treatment of anisometropia may not require as vigorous occlusion and/ or penalisation therapy as strabismic amblyopia. In a study from Taiwan, 60 children with anisometropia were treated with spectacle correction alone until visual acuity of the amblyopic eye stabilised. In this study spectacle correction alone in previously untreated anisometropic amblyopia achieved approximately four lines of improvement. The authors recommend that spectacle correction alone be used for the first few months of treatment with anisometropic amblyopes. After 4 months if no further improvement in visual acuity is noted, occlusion therapy or atropine penalisation may be considered. (Amer J Ophthalmol 2007;143:54–60)

Although the aetiology of age related macular degeneration is still incompletely understood cigarette smoking seems to be the only epidemiologic risk factor generally accepted as being associated with increased risk of this disorder. An allelic variant in the compliment factor H gene (CFH) seems to be the strongest genetic risk factor. Several independent articles have shown that polymorphism T1277C in CFH is associated with increased risk of early and late stages of age related macular degeneration. In a study from Harvard Medical School investigators studied 103 unrelated patients with neovascular age related macular degeneration who had at least one sibling with a normal macula. In this study smoking 10 pack years or more or having the CFH CC genotype increases one's risk of neovascular age related macular degeneration 144 fold compared with smoking less than ten pack years and having the CT or TT genotype. (Arch Ophthalmol 2007;125:49–54)

A short, fossilised femur from a 38,000 year old Neanderthal has recently been studied and a genome sequencing performed. Two research groups obtained partial DNA sequencing and compared them to human DNA. The two genomes are at least 99.5% identical (in comparison, chimpanzees share 99% of the human genome). Depending on the particular genetic analysis it appears humans and Neanderthals split from a common ancestor approximately 500 000–700 000 years ago and the two stopped interbreeding about 370 000 years ago. (Nature 2006 Nov 16 online)

The pathophysiology of myopia continues to be intensively investigated. Experiments in chickens have implicated the transcription factor ZENK (also known as Egr‐1, NGFI‐A, zif268, tis8, cef5, and Krox24) in the feedback mechanism for control of axial eye growth. Investigators from Tubingen, Germany have studied a Egr‐1 knock‐out mouse and have shown that relative myopia occurs in this knock‐out model as compared to the wild type with near‐identical genetic background. It is not yet known which genes are controlled by Egr‐1 at different developmental stages and how these genes regulate eye growth. (IOVS 2007;48:11–17)

The treatment of optic pathway gliomas continues to be controversial despite the fact that many studies have shown relative stability or even spontaneous involution of many of these tumours. Some patients appear to have more aggressive forms of tumour that may merit treatment. Ophthalmologists from the University of Illinois have described a series of seven cases of patients with optic nerve gliomas and associated neurofibromatosis. Six of these patients were treated with intravenous chemotherapy and one patient was treated successfully with an on en‐block optic nerve excision. Although this study prompts us to consider possible therapeutic interventions for optic nerve glioma it does not outline for us specific indications for these therapies. (Eye 2006;20:1149–64)

“Associationism was a crucial problem for James because his idea of consciousness being a stream depended on his being able to discredit the standard idea of the association of ideas, which had held the field since the publication of David Hartley's “Observations on Man, His Frame, His Duty and His Expectations” in 1749. Newton had suggested that vibrations of corpuscles of light might cause vibrations in the retina of the eye and produce the sensation of sight. Hartley followed up on this, arguing that physical vibration in the brain, spinal cord and nerves are the basis of all sensations, all ideas, and all motions of men and animals, and that all learning is the consequence of repetitive juxtapositions of corpuscular vibrations and mental associations in space and time, producing habits according to the pleasure‐pain principle.” (Richardson RD. William James. In the Maelstrom of American Modernism. New York, Houghton Mifflin 2006:205)


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