Lennart Berggren

Iridology: A critical reveiw

Abstract. Iridology has existed for more than 100 years and has now aroused new interest in the age of alternative medicine. The conception that disorders in different organs of the body are projected in the iris by the appearance of a variety of signs and spots has repeatedly been rejected by medical science, apparently with little success. Supporters of iridology pretend that their critics have a professional unwillingness to accept unorthodox ideas and that future research will demonstrate the true value of iridology. An evaluation of the concepts of iridology and of controlled scientific reports has, however, established the following points: The basis of iridology and the different iris signs are explained by physiological variations of the normal human iris; controlled clinical trials and experiments conclusively show that iridology has no ability to detect disorders in other parts of the body; there are sufficient proofs that iridology is purely conjectural. Iridology is of no medical value and might even be a potential danger to people seeking medical care. It should be exposed as a medical fraud.

Individual responsiveness to topical pilocarpine and the effects of variations in application technique

Abstract. The effects of nasolacrimal obstruction (NLO) and of eyelid closure (EC) were studied in a group of 6 healthy female subject (25–29 years). The aim was to determine the best application technique for patients. NLO or EC for 1 min was assumed to be a maximum time for patient compliance. A standard eye drop bottle was used with a drop volume of about 40 μl. One drop of a 1% pilocarpine solution was instilled into the lower conjunctival sac of one eye in a randomized manner: a) NLO b) EC c) NLO and EC d) neither NLO nor EC. The effects on the pupil size, static refraction for distance and accommodative power were followed for 2 h. The results showed no significant difference between the 4 techniques. Pronounced interindividual differences but only small intraindividual differences were found in this group of healthy young females. Two subjects always responded strongly, and 2 other subjects always did so weakly. The application of the same amount of pilocarpine ointment (3%) increased and prolonged the effects on pupil size, refraction and accommodation at all points of time without reaching statistical significance compared with eye drops. Pilocarpine ointment caused considerable subjective discomfort. The experiments with pilocarpine suggest that, from a practical point of view, different techniques of application of ocular drugs seem to be a little importance with regard to local effect. The possibility of pronounced individual differences in pharmacological response should be borne in mind. Pilocarpine induced a significant increase in accommodative power.

Visual impairment of open angle glaucomas at first presentation and after a five to ten year follow-up.

Of all patients attended to in a clinic during 1986, 441 had open angle glaucoma diagnosed during 1974-1986 on the basis of either a verified visual field defect, a glaucomatous disc, or a repeated intraocular pressure value of at least 35 mm Hg. At first presentation of recent cases 1984-1986 (N = 128) 65 per cent were more than 70 years old. Capsular glaucomas were twice as common as simple glaucomas (low tension cases included). 62 per cent of capsular but only 26 per cent of simple glaucomas had an initial pressure of 35 mm Hg or more (p < 0.001). One third of both capsular and simple glaucomas had an advanced visual field defect with breakthrough to the periphery in the worse eye already at first presentation. This was more common if the initial pressure was 35 mm Hg or more (p < 0.05). Almost half remained unilateral cases, and the rate of severely impaired visual function in the better eye did not exceed 15 per cent. While generally 30-50 per cent of glaucomatous field defects had progressed in five years, the progression in early detected cases was only three per cent (p < 0.05). Visual field defects with breakthrough to the periphery already at first presentation progressed more often than circumscribed scotomas (p < 0.02).

Further studies on the effect of autonomous drugs on in vitro secretory activity of the rabbit eye ciliary processes. A. Inhibition of the pilocarpine effect by isopilocarpine, arecoline, and atropine. B. Influence of isoproterenol and norepinephrine.

The blocking effect of pilocarpine on the secretory pumping in vitro of the rabbit eye ciliary processes has been established repeatedly (5,6). In the present experiments the pilocarpine concentration in the bathing medium was 10-5 M final concentration, which was regarded as giving a reliable blocking effect. Another parasympatomimetic alkaloid, arecoline, had no significant effect up to a concentration of 10-5M in previous experiments (5) . The parasympatolythic agent, atropine inhibited secretory activity in vitro only in a concentration of 10-5 M but not at 10-7 M (5 ) . The experimental set-up does not allow different drugs to be added successively to the medium in the same experiment. The period for studying drug effects is restricted to between 5-60 minutes. A time of up to 5 min is needed to check that the surviving ciliary processes are in normal condition, and after one hour the ciliary processes have pumped themselves dry and might be regarded as less viable. Thus, in order to study drug interaction each drug must be tested separately as well as simultaneously. The demonstrated inhibitory effect of epinephrine on the normal shrinkage

INTRAOCULAR PRESSURE AND EXCRETION OF MUCOPOLYSACCHARIDES IN OSTEOGENESIS IMPERFECTA

Osteogenesis imperfecta is, as a rule, a genetic disease with autosomal dominance. It is characterized by fragility of the bones, blue sclerae and impaired hearing. Different types of the condition can be distinguished. These different types should be regarded as different degrees of severity of the same disease, rather than as distinct disease entities. Although the degree of severity within any one family generally shows only sinall variations. it can vary greatly from family to family. Sporadic cases are probbaly mutations. Familial and sporadic cases show no significant differences with respect to clinical symptoms and signs. No factor connected with the occurrence of mutations is known. Plasma calcium, phosphorus and alkaline phosphatases are normal. Osteogenesis imperfecta is a disorder of the mesodermal tissues with a deficiency in collagen maturation. The basic chemical defect is unknown. Slightly increased urinary excretion of acid mucopolysaccharides has been reported6, 10. O c d a u mctnifcstntio72c. The blue sclerae are not due to a coloration of the sclera itself, but to an increased translucency, allowing the underlying uveal pigment to become visible. Clear sclerae instead of blue sclerae has been suggested as a more exact term. The anatomical cause of the transparency has been the subject of dispute. Thin fibrous coats may be found, but the condition is essentially a persistence of the fetal condition. There is a reduction of collagen and a persistence of the precollagenous reticulin, as well as an increase in the mucopolysaccharide ground substance, indicating an immature fibrous tissue*. An arcus corneae may be associated with blue sclerae. Among other

ONE‐SIDED HYPOPLASIA OF THE OPTIC NERVE

A seven year old girl was admitted to hospital for a strabismus operation. She had been treated for a right convergent squint since one and a half years of age. The parents, who disapproved of recommended occlusion therapy, that always failed, had consulted several ophthalmologists during the years in between. Impaired vision in the right eye was constantly found but in no case was any abnormality of the fundus noted. Ocular examination. Visual acuity was less than 6/60 in the right eye and 6/6 in the left eye. Both eyes were of normal size and appearance. There was no asymmetry of the face (Fig. 1). Retinoscopy revealed no appreciable refractive error in either eye. The media were clear. The fundus examination revealed a small optic disc surrounded by a peripapillar atrophy in the right eye. The diameter of the right optic disc was about half of that of the left optic disc (See Fig. 2). The visual field in the right eye was seriously impaired but normal in the left eye (See Fig. 4). X-ray examination of the orbits showed that the right optic foramen was smaller than the left one (Fig. 3). This was further established by tomography. The pupils were of normal size but the right pupil reacted less prompty to light. Normal conditions were established in the following examinations: electroencephalography, X-ray of the skull (except the orbits), pediatric general and neurological status (except the pupils), earnoseand throat status and dental examination.

FURTHER OBSERVATIONS ON THE APPEARANCE OF FLUORESCEIN IN THE RABBIT EYE AFTER INTRAVENOUS INJECTION

Following intravenous injection of fluorescein a green cloud appears in the pupil after a certain time. This appearance time has been used in determinations of the flow of aqueous humour. In order to give a true index of aqueous flow the fluorescein cloud should originate in the posterior chamber. In a previous paper (Berggren 1956) it was demonstrated that thermal convection currents as well as the position of the bulb might be sources of error in such investigations of aqueous flow. The importance of being able to differentiate between flow from the posterior chamber and diffusion from the vessels of the anterior iris is further discussed by LinnCr and Friedenwald 1957. In the present paper the events taking place in the posterior and anterior chambers after an intravenous fluorescein injection have been simultaneously followed by examinations of sagittal sections of frozen eyes under ultraviolet illumination.

TONUS OF THE CILIARY MUSCLE DURING SLEEP

The miotic pupil during sleep is a well-known phenomenon but the mechanism has so far been incompletely analysed. Information on the tonus of the parasympathetic ciliary muscle is on the whole lacking. The state of the ciliary muscle during sleep is of physiologic interest particularly with reference to effects on the outflow resistance. Some methodological factors have to be considered in an investigation of this problem: A study of the tonus of the ciliary muscle restricts the material to primates. Induced sleep with general anesthetics is not acceptable since it may very possibly have central and local eye effects different from those in physiological sleep. In the present investigation the experimental material was selected from human subjects with a high arousal threshold (i. e. children) and who were examined during a defined period of sleep by retinoscopy. Physiology of sleep: Sleep is not a uniform condition. In humans two principal types of physiological sleep are distinguished. At the onset of sleep slow ccrtical waves with big amplitude and sleep spindles appear on the EEG. The muscle tonus diminishes, the blood pressure, the pulse rate, the respiratory frequency and the temperature decrease. Sweat and gastric secretion increase, salivation decreases and peripheral vessels dilate. I n the pioneer work on sleep by Hess 9110 some of these physiological data were taken as evidence of a generally increased parasympathetic activity during sleep. This “synchronized” sleep is interrupted after 1-2 hours for a period of 10-15 minutes of “desynchronized” sleep. This period is characterized by the appearance of fast waves with small amplitude on the EEG. Fluctuations in blood pressure, pulse rate, and respira-

SECRETORY ACTIVITY IN VITRO OF THE RABBIT EYE CILIARY PROCESSES INCUBATED WITH CORTICOSTEROIDS, NEUROHYPOPHYSEAL HORMONES, AND ASCORBIC ACID

Corticosteroids have pronounced effects on the exchange of sodium and potassium but a full analysis of their effects on transport mechanisms and directions of transport is still lacking. The mineral corticoids stimulate the sodium-hydrogen (or potassium) exchange in the distal tubules and they decrease the sodium content and increase the potassium content in for instance sweat and saliva. In the eye corticosteroids have well-established pressure increasing effects on intraocular pressure. Here also their basic action is unsolved although the pressure increasing effects are mostly attributed to effects on outflow facility. Possible effects on secretion, however, have never been ruled out. LinnCr (2223) has presented evidence that prednisolone caused an elevation of the intraocular pressure with no change in the facility of outflow or in the episcleral venous pressure. The effect was explained to be caused by an increase in the rate of aqueous flow. It can be noted that Jackson & Waitzman (20) reported a dual intraocular pressure response and the secondary hypertensive response was accompanied by changes in flow. They could also demonstrate a sustained hypotension by aldosterone probably caused by decreased aqueous flow. However, aldosterone has a stimulatory effect on sodium transport in in vi tro experiments on toad bladder (12) and Cole (10) showed that the aldosterone antagonist, spirolactone, reduced sodium and water influx across the ciliary epithelium in the rabbit eye.

THE INTRAOCULAR PRESSURE IN RABBITS AFTER LITHIUM ADMINISTRATION WITH COMMENTS ON PRESSURE EFFECTS OF INJECTIONS INTO THE VITREOUS

Transport mechanisms in epithelial cells are specific with regard to the movement of certain ions. Thus lithium has been shown to be unable to replace sodium in some epithelial systems. In the frog skin lithium can only partially replace sodium (Zerahn 1955, Hansen and Zerahn 1964). The outside membrane is as permeable to lithium as it is to sodium but extrusion out of the cell is partially inhibited. Thus lithium accumulates in the epithelium and blocks the pump mechanism which leads to a decrease of sodium efflux. If the transport mechanisms in other epithelial membranes are similar to the mechanism in the frog skin the inhibition of active transport of sodium by blocking the pump mechanism with lithium might be of importance in controlling the secretion of various fluids. In a study of the function of the ciliary processes in vitro (Berggren, 1965), it was found that the secretory activity was blocked, if sodium was replaced by lithium in the bath solution and in the tissue fluid of the ciliary processes. Even a partial substitution of sodium with lithium led to inhibition. In order to investigate whether the inhibition of secretion in vitro can be reproduced in vivo, the present paper deals with measurements of intraocular pressure in the living animal after lithium administration by different routes.