Radium in Angiomatosis

AMERICAN JOURNAL OF OPHTHALMOLOGY Published Monthly by the Ophthalmic Publishing Company EDITORIAL STAFF L T . - C O L . DERRICK V A I L , M.C., U.S.A.,

in-Chief

Editor-

(on active duty)

LAWRENCE T . POST, Acting

Editor-in-Chief

R A L P H H . MILLER

803 Carew Tower, Cincinnati

C. S. O ' B R I E N

The State University of Iowa, College of Medicine, Iowa City

640 South Kingshighway, Saint Louis EDWARD JACKSON, Consulting

Republic Building, Denver

W I L L I A M H . CRISP, Consulting

Editor

ALGERNON Β. REESE

73 East Seventy-first Street, New York

Editor

M.

530 Metropolitan Building, Denver

W I L L I A M L. BENEDICT

The Mayo Clinic, Rochester, Minnesota GRADY E . CLAY

F. E. WOODRUFF

824 Metropolitan Building, Saint Louis

A L A N C. WOODS

Wilmer more

Medical Arts Building, Atlanta

FREDERICK

C. C O R D E S

384 Post Street, San Francisco

URIBE TRONCOSO

500 West End Avenue, N e w York

Ophthalmological

E M M A S. B U S S , Manuscript

Institute,

Balti­

Editor

5428 Delmar Boulevard, Saint Louis

Directors: LAWRENCE T . POST, P r e s i d e n t ; W I L L I A M L. BENEDICT, Vice-President; DONALD J . LYLE, Secretary and T r e a s u r e r ; EDWARD JACKSON, W I L L I A M H . CRISP, HARRY S. GRADLE.

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surface application is best. In these cases the seeds were sutured to the sciera—in In his Presidential Address, before the one case three seeds, which were removed Ophthalmological Society of the United on the tenth day; in the other case they Kingdom in 1935, R. Foster Moore re­ were removed after four days. Reaction ported his experience with radium, em­ was shown by changes in the conjunctiva ployed in .two cases of retinal angio- and lids. The large vessels supplying the matosis, and also in cases of glioma of the angioma became irregular in caliber and retina. The retinal angiomas were in presently disappeared together with the women 24 and 36 years of age. In both smaller branches connected with them. cases the retinal lesions were illustrated In each case the vascular tumor was re­ by excellent pictures. The treatment was moved and replaced by atrophie patches. by radon seeds, enclosed in aluminum A more recent case of angiomatosis of foil, and planted in or close to the lesions. the retina has been reported in the Pro­ Moore concluded that angiomata can be ceedings of the Royal Society of Medi­ cured by this means. For prominent cine, November 14, 1941, by Professor growths, interstitial insertion of the seeds A. J. Ballantyne, of Glasgow. This case is advisable, whereas for flat growths is also well illustrated. The method of RADIUM I N ANGIOMATOSIS

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using the radium was different : At first four radon seeds were placed on the sciera. But a month later there was no change in the fundus picture. Radiograms showed the seeds had not remained fixed in their original position. Later the patient was submitted to X-ray applications made in three directions : from above the eye­ brow, from near the outer canthus, and in the malar region; in each case directed toward the posterior pole of the eye. Dur­ ing the next year the patient suffered from recurrent neuralgia in and around the eye, relieved by alcohol injection of the trigeminus nerve. There was X-ray loss of lashes, deep pigmentation of the skin, closure of the lacrimal puncta, and general rigidity of the lids. At the end of two years there was sudden loss of vision, due to intraocular hemorrhage. The eye was excised. But that operation was im­ peded, "by the very rigid state of the eyelids, the conjunctiva, and the orbital tissues." The shrinking of the skin and orbital tissues now gives a shrunken appearance to the artificial eye. The ex­ cised eye showed hemorrhages in the retina and a collection of serum, resem­ bling a cyst. The implantation of radon seeds is an operation requiring exact and close atten­ tion. It is certain they can exert an im­ portant local influence. To refer the pa­ tient to an expert for treatment by X rays is easier. But it does not give the desired result. A remedy may be useful and of the highest value. But it is not the name or general character of the remedy, but the way that it is used that gives it value. Ballantyne's case, with the description and illustrations of the tissue changes found in the enucleated eye teaches that radiation treatment exercises a very wide influence on the tissues of the body, especially on the blood vessels and cell life of the tissues. It is a resource rela­ tively new in therapeutics and can only be

wisely and safely used when controlled by an understanding of its dangers and close watching of the tissues accessible to inspection in the fundus of the human eye. Edward Jackson. OPTOMETRY LEGISLATION Freed from the fantastic trimmings which have been conferred upon it in certain optometry laws, optometry is merely optical measurement of the human eye, without the use of drugs. At its best, the optometry movement is a sincere attempt to develop the professional status of those opticians who undertake the measurement of human refraction. At its worst, the movement is an ambitious cam­ paign to assume the prerogatives of those physicians whose practice is limited to the care of the human eye and its appendages. Many optometrists are simply opticians under a new name. Some of them have very flimsy notions concerning the measurement and correction of refractive errors. Some have been accepted into the optometric fold because they were op­ ticians when optometry laws were first created; just as there are still a very few aged physicians who fall extremely short of modern standards of medical educa­ tion, but have been permitted to practice by reason of their having entered the medical fold when standards of medical education hardly existed. A further group of optometrists have a fair knowledge of practical refraction, although such knowledge was acquired in commercial stores and workshops rather than in educational institutions. Most of these men and women still display greater expertness in the commercial and me­ chanical qualities associated with their work than in refractive diagnosis and treatment. A last, important group of modern