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Radiating Lights and Radial Keratotomy
738
AMERICAN JOURNAL OF OPHTHALMOLOGY
November 5 in San Francisco. A. Edward Maumenee is President, Frank W. Newell and Bradley R. Straatsma are Vice Presidents, and Bruce Spivey is the Secretary-General. Plans for this XXIV International Congress began in 1975. The International Council ofOphthalmology awarded the meeting to the United States when it met in Tokyo in 1978. The main themes of the Congress are advances and diagnostic techniques in genetics, with the discussions to be led by Harold Henkes, The Netherlands' Franz Fankhauser, Switzerland; Jule~ Francois, Belgium; Irene Maumenee, United States; Karl Ossoinig, United States; and advances in surgical techniques, the discussions to be led by Robert Machemer, United States; Jose Barraquer, Colombia; Jacques Charleux, France; and Saiichi Mishima, Japan. Abstracts of scientific papers and films must be received by Dec. 15, 1981. Forms for submission of abstracts are available from Frederick C. Blodi, M. D., International Congress of Ophthalmology Box 3030, San Francisco, CA 94119, U.S.A. A number of satellite meetings have been arranged by Bradley R. Straatsma; these will meet before and after the Congress. The opening session will be held on Sunday, Oct. 31, 1982, with the award of the Gonin medal. There will be five simultaneous scientific sessions and 36 instruction courses held at the Moscone Convention Center and adjacent hotels and Merchandise Mart complex. The San Francisco Opera and the San Francisco Symphony will be performing at the time of the meeting. The official languages of the Congress will be English, French, Japanese, and Spanish. Further information concerning the International Congress and its joint meeting with the Academy is available from Phillip Rollins, M.D., P.O. Box 3030, San Francisco, CA 94119. FRANK W. NEWELL
NOVEMBER, 1980
CORRESPONDENCE Letters to the Editor must be typed double-spaced on 8 1/2 x ll-inch bond paper, with 11/2-inch margins on all four sides, and limited in length to two manuscript pages.
Cecil Textbook of Medicine Editor: As the editor of the "Cecil Textbook of Medicine," I must comment on your review (Am. J. Ophthalmol. 90:119, 1980). It is an interesting review and makes a good point that textbooks of medicine should continue to show a high level of ophthalmic awareness. We hope we have achieved some measure of success in that venture by inclusion of the section on Diseases of the Eye, by Maurice Landers. I was momentarily jolted by your statement that Horner's syndrome is not mentioned in connection with pulmonary lesions, or cotton-wool patches in the chapter on lupus erythematosus. The reportedly absent references do occur. Admittedly, the descriptions could be more extensive, but I was happy to note that the references were there after all. JAMES B. WYNGAARDEN, M.D.
Durham, North Carolina
Mea maxima culpa-The Editor
Radiating Lights and Radial Keratotomy Editor: Radial keratotomy has been widely publicized in the lay press'f and courses teaching the surgical techniques are readily available. The few scientific studies publishedv' indicate some subjective visual complications such as photophobia,
VOL. 90, NO.5
CORRESPONDENCE
fluctuating vision, and glare," in addition to possible induced hyperopia, residual myopia, and astigmatism. I recently examined an asymptomatic patient with a visual acuity of 6/6+ (20/20+) three weeks after he underwent radial keratotomy in one eye. On monocularly viewing a pen light in a minimally darkened room, the patient reported seeing streaks of light around the pen light with the surgically treated eye and none with the fellow eye. He counted eight lines radiating around the light source. This simple light test provides objective information (which the patient can document with a drawing) about what may be a manifestation of the lightscattering properties of the induced linear corneal scars. We have yet to evaluate the significance of the radiating streaks of light after monocular and binocular radial keratotomy in relation to ordinary activities such as driving or flying at night. STEVEN L. LEMPERT, M.D. Pittsburgh, Pennsylvania REFERENCES
739
pole region but not gonioscopy. One can use a contact lens of the Zeiss or Goldmann type, or a noncontact Hruby-type lens. The contact lenses require topically applied anesthesia; the Goldmann lens also requires an exogenous coupling medium. The Hruby lenses available on the Haag-Streit and Zeiss slit lamps offer very limited flexibility in lens position and movement relative to the patient's eye and the biomicroscopic observation system. The hand-held clamp-mounted Zeiss four-mirror gonioscopy lens allows rapid, flexible, dynamic noncontact stereobiomicroscopic visualization of the posterior fundus and, in our opinion, in most situations eliminates the need for a separate slit-lamp-mounted Hruby lens system. The central portion of the Zeiss gonioscopy lens, like the Hruby, is a highminus lens, and thus permits biomicroscopic observation of the fundus whether or not the lens touches the cornea. The great positional flexibility of the handheld Zeiss lens allows the various reflections from the lens of the slit-lamp illumi-
1. Surgeon's vision. Soviet doctor claims his operation will make nearsightedness a thing of the past. Pittsburgh Press, April 28, 1980. 2. Surgery for nearsightedness sparks a controversy. New York Times, July 29, 1980. 3. Fyodorov, S. N., and Durnev, V. V.: Operation of dosage dissection of corneal circular ligament in cases of myopia of mild degree. Ann. Ophthalmoi. 11:1885, 1979. 4. Bores, L.: American experience with myopia procedure of Fyodorov. In Schachar, R. A., Levy, N. S., and Schachar, L. (eds.): Keratorefraction. Denison, Texas, LAL Publishing, 1980, p. 175. 5. N.A.E.C.: Others urge caution on radial keratotomy. Argus, June 1980, p. 1.
Zeiss Gonioscopy Lens for Noncontact Biomicroscopic Ophthalmoscopy Editor: Many patients should undergo stereoscopic biomicroscopy of the posterior
Figure (Kaufman, Bundy, and Neider). Prismatic effect of lens/eye optics centers object of regard. Arrows indicate direction of lens movement required to bring the optic disk from periphery to center of field.
AMERICAN JOURNAL OF OPHTHALMOLOGY
November 5 in San Francisco. A. Edward Maumenee is President, Frank W. Newell and Bradley R. Straatsma are Vice Presidents, and Bruce Spivey is the Secretary-General. Plans for this XXIV International Congress began in 1975. The International Council ofOphthalmology awarded the meeting to the United States when it met in Tokyo in 1978. The main themes of the Congress are advances and diagnostic techniques in genetics, with the discussions to be led by Harold Henkes, The Netherlands' Franz Fankhauser, Switzerland; Jule~ Francois, Belgium; Irene Maumenee, United States; Karl Ossoinig, United States; and advances in surgical techniques, the discussions to be led by Robert Machemer, United States; Jose Barraquer, Colombia; Jacques Charleux, France; and Saiichi Mishima, Japan. Abstracts of scientific papers and films must be received by Dec. 15, 1981. Forms for submission of abstracts are available from Frederick C. Blodi, M. D., International Congress of Ophthalmology Box 3030, San Francisco, CA 94119, U.S.A. A number of satellite meetings have been arranged by Bradley R. Straatsma; these will meet before and after the Congress. The opening session will be held on Sunday, Oct. 31, 1982, with the award of the Gonin medal. There will be five simultaneous scientific sessions and 36 instruction courses held at the Moscone Convention Center and adjacent hotels and Merchandise Mart complex. The San Francisco Opera and the San Francisco Symphony will be performing at the time of the meeting. The official languages of the Congress will be English, French, Japanese, and Spanish. Further information concerning the International Congress and its joint meeting with the Academy is available from Phillip Rollins, M.D., P.O. Box 3030, San Francisco, CA 94119. FRANK W. NEWELL
NOVEMBER, 1980
CORRESPONDENCE Letters to the Editor must be typed double-spaced on 8 1/2 x ll-inch bond paper, with 11/2-inch margins on all four sides, and limited in length to two manuscript pages.
Cecil Textbook of Medicine Editor: As the editor of the "Cecil Textbook of Medicine," I must comment on your review (Am. J. Ophthalmol. 90:119, 1980). It is an interesting review and makes a good point that textbooks of medicine should continue to show a high level of ophthalmic awareness. We hope we have achieved some measure of success in that venture by inclusion of the section on Diseases of the Eye, by Maurice Landers. I was momentarily jolted by your statement that Horner's syndrome is not mentioned in connection with pulmonary lesions, or cotton-wool patches in the chapter on lupus erythematosus. The reportedly absent references do occur. Admittedly, the descriptions could be more extensive, but I was happy to note that the references were there after all. JAMES B. WYNGAARDEN, M.D.
Durham, North Carolina
Mea maxima culpa-The Editor
Radiating Lights and Radial Keratotomy Editor: Radial keratotomy has been widely publicized in the lay press'f and courses teaching the surgical techniques are readily available. The few scientific studies publishedv' indicate some subjective visual complications such as photophobia,
VOL. 90, NO.5
CORRESPONDENCE
fluctuating vision, and glare," in addition to possible induced hyperopia, residual myopia, and astigmatism. I recently examined an asymptomatic patient with a visual acuity of 6/6+ (20/20+) three weeks after he underwent radial keratotomy in one eye. On monocularly viewing a pen light in a minimally darkened room, the patient reported seeing streaks of light around the pen light with the surgically treated eye and none with the fellow eye. He counted eight lines radiating around the light source. This simple light test provides objective information (which the patient can document with a drawing) about what may be a manifestation of the lightscattering properties of the induced linear corneal scars. We have yet to evaluate the significance of the radiating streaks of light after monocular and binocular radial keratotomy in relation to ordinary activities such as driving or flying at night. STEVEN L. LEMPERT, M.D. Pittsburgh, Pennsylvania REFERENCES
739
pole region but not gonioscopy. One can use a contact lens of the Zeiss or Goldmann type, or a noncontact Hruby-type lens. The contact lenses require topically applied anesthesia; the Goldmann lens also requires an exogenous coupling medium. The Hruby lenses available on the Haag-Streit and Zeiss slit lamps offer very limited flexibility in lens position and movement relative to the patient's eye and the biomicroscopic observation system. The hand-held clamp-mounted Zeiss four-mirror gonioscopy lens allows rapid, flexible, dynamic noncontact stereobiomicroscopic visualization of the posterior fundus and, in our opinion, in most situations eliminates the need for a separate slit-lamp-mounted Hruby lens system. The central portion of the Zeiss gonioscopy lens, like the Hruby, is a highminus lens, and thus permits biomicroscopic observation of the fundus whether or not the lens touches the cornea. The great positional flexibility of the handheld Zeiss lens allows the various reflections from the lens of the slit-lamp illumi-
1. Surgeon's vision. Soviet doctor claims his operation will make nearsightedness a thing of the past. Pittsburgh Press, April 28, 1980. 2. Surgery for nearsightedness sparks a controversy. New York Times, July 29, 1980. 3. Fyodorov, S. N., and Durnev, V. V.: Operation of dosage dissection of corneal circular ligament in cases of myopia of mild degree. Ann. Ophthalmoi. 11:1885, 1979. 4. Bores, L.: American experience with myopia procedure of Fyodorov. In Schachar, R. A., Levy, N. S., and Schachar, L. (eds.): Keratorefraction. Denison, Texas, LAL Publishing, 1980, p. 175. 5. N.A.E.C.: Others urge caution on radial keratotomy. Argus, June 1980, p. 1.
Zeiss Gonioscopy Lens for Noncontact Biomicroscopic Ophthalmoscopy Editor: Many patients should undergo stereoscopic biomicroscopy of the posterior
Figure (Kaufman, Bundy, and Neider). Prismatic effect of lens/eye optics centers object of regard. Arrows indicate direction of lens movement required to bring the optic disk from periphery to center of field.