Bo Bengtsson

Disc haemorrhage and glaucoma.

The present material comprises 51 patients with at least one disc haemorrhage in at least one eye. A total of 127 hh were observed. The probability of finding a disc h increases with the number of examinations. The hypothesis that hh occur in all cases of glaucomatous destruction of the papillary tissue cannot be rejected, though not proven. H. seems to be connected with progression of field defects, though its effects are not immediately recognized. H. is detectable very early in the glaucomatous process; the denotation ‘forerunner’ is most likely justified. Hh. are highly specific for a glaucomatous process, but it has not been possible to connect h. with some clearly delimited group of glaucoma.

Optic disc haemorrhages preceding manifest glaucoma

Abstract. The Dalby population has been subjected to repeated glaucoma surveys in a deliberate effort to describe the early stages of glaucoma. A total of 28 haemorrhagic episodes were observed at 3819 examinations of persons not having manifest glaucoma. The prevalence of optic disc haemorrhages was dependent on age and residence. The mean IOP in eyes with optic disc haemorrhages was 17.0 mmHg. Only four out of 24 haemorrhages in eyes without pseudoexfoliations were associated with intraocular pressures over 20.5 mmHg. Of twelve cases followed more than six years two died and five developed manifest glaucoma. The period of latency between the detection of a haemorrhage and the development of a glaucomatous visual field defect was 2, 3, 5, 6, and 7 years, respectively.

MANIFEST GLAUCOMA IN THE AGED I: OCCURRENCE NINE YEARS AFTER A POPULATION SURVEY

The present study was based on already existing clinical data concerning 599 persons born before 1907, examined during a general ophthalmic survey 1969‐72 and still remaining in the same district in July 1980. At the survey 1969‐72, 19 out of 1057 persons had manifest glaucoma, 14 were already treated for ocular hypertension, 54 had an IOP > 20.5 mmHg and 970 were considered normal. Immediately after the survey, 17 patients were treated for manifest glaucoma and 19 for ocular hypertension. During the following 9 years treated persons were lost to a greater extent (64%) than untreated persons (43%). In July 1980 only 6 persons treated for manifest glaucoma since the survey remained, and 3 of them were socially blind. One out of 7 treated and 2 out of 28 untreated persons with ocular hypertension at the survey had developed visual field defects 9 years later. Manifest glaucomas, often advanced cases, were also detected in 9 persons considered normal at the survey. 5 out of 12 persons with manifest glaucoma detected after the survey had an IOP < 20.5 mmHg at detection. The visual capacity of persons still remaining in the district 1980 was largely independent of all efforts to prevent blindness from glaucoma in the present population.

Assessment of casual blood pressure variations.

All residents in a suburban community in southern Sweden, 8 years of age and older, were invited to an ophthalmological examination. The examination included a blood pressure determination. Of the 1917 persons invited 85·5% took part in the study. 3·5% of these were excluded because they were taking antihypertensive drugs. The investigations were conducted during 14 consecutive months and at different times of the day. The systolic and diastolic blood pressure distribution curves exhibited a positive skewing. The blood pressures rose to a plateau with essentially unchanged pressures in the age groups 28-32 years up to 38-42 years. In these ages, the systolic blood pressure was significantly higher among the males than among the females. The relation was reversed in the age groups above 48 years. The diastolic blood pressure showed no significant sex differences in the various age groups. A multiple linear regression analysis was used to determine whether there were diurnal and seasonal effects on the blood pressure independent of the age and sex. The systolic blood pressure during the winter months was 4·1 and 5·0 mmHg higher in the male and female subjects respectively, while the diastolic blood pressure during the winter months was 1·7 and 1·9 mmHg higher in the male and female subjects respectively. The time of day had no effect on the systolic blood pressure while the diastolic blood pressure increased by 0·24 and 0·27 mmHg/hr from 8 a.m. to 9 p.m. in the male and female subjects respectively. It is concluded that the small genuine effects of the time of measurement of casual blood pressure lack practical importance in screening of hypertension.

Flicker comparison of fundus photographs. A technical note.

A method for comparison of two fundus transparencies by means of alternating flickering light is described. Spurious differences between the pictures are reduced by making the exposures in a fixed position of the pulse cycle. Small haemorrhages are readily detected. Pulse variations of the vessels and changes in size of cup and disc can be measured.

Sex-linked hereditary juvenile retinoschisis: presentation of two affected families.

Retinoschisis can be defined as a splitting between any of the layers of the retina which are derived from the inner part of the optic cup; it thus differs from a retinal detachment, in which the sensory retina is separated from the pigment epithelium, restoring the primary optic vesicle. The retinoschisis is usually divided into a senile form and juvenile forms. The former, probably with dominant heredity, is not rare. The juvenile forms, however, have been described only in a few families from Europe, the USA, and Australia. These rare conditions are distinguished through their different clinical symptoms and their different heredity (Ricci 1961). The sex-linked juvenile retinoschisis was probably first described by Thomson (1932). Mann and Macrae (1938) coined the term “congenital vascular veils in the vitreous” and Sorsby et al. (1951) reported the sex-linked recessive transinission pattern. Ricci (1961) compiled and evaluated the reports of this and related conditions adding cases of his own. In the literature up to the present time about 100 cases of sex-linked juvenile retinoschisis have been described but the disease is still subject to a lively discussion. The pathogenesis is still unknown. The disease presents a rather wide range of clinical manifestations and the differential diagnosis may therefore often be difficult. Operative treatment is advocated by some authors and considered dangerous by others. No cases of juvenile sex-linked retinoschisis have been reported from Scandinavia but Forsius et al. (1962, 1963) have described two affected families in Finland. In this paper two families affected with the sex-linked type of juvenile re-

SEX‐LINKED HEREDITARY JUVENILE RETINOSCHISIS

R. Tarnquist (Urebro): In many cases the defect of the visual field in retinoschisis is considered to correspond exactly to the degree of the eyeground changes. However, not infrequently “islands” of maintained perception are found in the defect, which may be explained by the rather common perpendicular connexions between the two layers of the retinoschisis. Generally, the condition is stationary, but occasionally it may progress, and this can be observed most easily by the changes in the visual field. Only in such cases, the condition should be treated with photocoagulation, since this therapy is not without risks. Hence, an extensive rupture of the retina along the edge of the retinoschisis may occur, resulting in detachment of the retina.

Survival of elderly ophthalmic out-patients.

Elderly ophthalmic out‐patients that had visited an eye‐clinic were searched in a population register 7 years later. Observed numbers of survivors were compared with those expected according to appropriate life tables. Most observed numbers of survivors came close to the expected ones. Patients, aged more than 80 years when visiting the eye‐clinic, had, however, a consistently increased survival rate. Glaucoma patients, less than 80 years old, had a slightly (not significantly) lower survival rate than expected.

Chronic glaucoma and symptomatic vitreous detachment

Abstract Already existing data derived from two population surveys and the clinical records of a few ‘ordinary’ glaucoma patients in one and the same district were explored. Previous reports of a high prevalence of disc haemorrhage in chronic glaucoma were confirmed. The hypothesis that evident prepapillary vitreous opacities are more frequent in persons with glaucoma than in other persons was supported. Symptomatic vitreous detachment was the original reason for encounter in 5 out of 12 ‘selfselected’ patients with chronic glaucoma. If a disc haemorrhage is found in a patient with a symptomatic vitreous detachment, early chronic glaucoma should be seriously considered even if there are no other glaucomatous signs.

Characteristics of manifest glaucoma at early stages.

Intraocular pressures and optic disc hemorrhages were studied in all cases of manifest glaucoma detected in a defined population over a decade. High intraocular pressure was found to be an unreliable signat the detection of a glaucomatous visual field defect and an unusual finding 5–10 yearsbefore. The prevalence of optic disc hemorrhages at the detection of a glaucomatous visual field defect was 33%. All but 9 of 44 persons with manifest glaucoma were found to have had at least one optic disc hemorrhage at one time or another.