Melvin L. Rubin

Methylprednisolone pulse therapy in severe dysthyroid optic neuropathy

Five patients with severe dysthyroid optic neuropathy were treated with intravenous methylprednisolone (1 g daily for 3 consecutive days). Before administration, visual acuity of the more severely affected eyes of each patient was counting fingers at 5 feet, 8/200, 20/400, 20/200, and 20/80. Immediately after completion of pulse therapy, visual acuity improved to 20/25 in four patients and 20/30 in one. Remissions were maintained with oral prednisone and external beam irradiation of the orbit. Pulse methylprednisolone therapy appears to be beneficial in the initial management of severe dysthyroid optic neuropathy.

Spectacles: Past, present, and future☆

The history of spectacles is reviewed with particular attention to recent developments in lens materials. The author advocates the use of polycarbonate, a high resin plastic, because of its strength, high refractive index, light weight, and resistance to fogging.

Myopia--a treatable "disease"?

The authors cite various information and misinformation regarding proposed treatments (atropinization, contact lenses, orthokeratology, wearing glasses, not wearing glasses) for the progression of myopia. They conclude that there is insufficient evidence to support the more vigorous approaches to treatment of myopia, and provide some useful explantations for patients and their parents who question the ophthalmologists decision to treat conservatively.

The case of the dramatic impression.

A patient has presented with mysterious vision loss following administration of eye drops for lid edema. The patient (and his attorney) blame the eye drops and the prescribing ophthalmologist. The consulting ophthalmologist describes the examination techniques and rationale that led to correct diagnosis and cure.

Refraction problems after refractive surgery

While refractive surgery such as radial keratotomy, epikeratophakia, and corneal relaxing incisions offer many potential benefits to patients, they can also generate optical problems such as overcorrection or undercorrection of the prior refractive error and variable vision. The authors offer suggestions for avoiding problems through proper patient selection; candid preoperative communication with the patient about possible difficulties and limitations; understanding of the physiological changes that may occur; and optical techniques for alleviating postoperative vision problems.

Posterior Vitreous Cyst

We observed two patients who had unilateral posterior vitreous cysts; one patient had been observed for 17 years. Both patients were young females who reported transient, infrequent obscurations of vision that were not disabling. One involved eye was emmetropic, and the other was highly myopic. No other ocular abnormalities were present. In the patient observed for 17 years, the physical characteristics of the posterior vitreous cyst remained unchanged. With this stable clinical course, posterior vitreous cyst that does not visually disable the patient may be managed by periodic observation.

The Ophthalmic Knowledge Assessment Program (OKAP): A personal view

This essay relates the historic process that led to the development of the Ophthalmic Knowledge Assessment Program (OKAP) as an established component of ophthalmic training in the U.S.A. Begun in the early 1960s as an evaluative examination for residents at the University of Florida, the first national OKAP examination took place in May 1968, with over 85% of all eye training programs participating. It was later incorporated into the Continuing Education program of the American Academy of Ophthalmology and Otolaryngology, where it prospered. Beginning January 1980 the OKAP was combined with American Board of Ophthalmology exam, thus establishing a single, unified national exam.

Electroretinograms in early fungal endophthalmitis

To facilitate the early diagnosis of exogenous fungal endophthalmitis, we developed a rabbit model for Aspergillus fumigatus endophthalmitis. Six eyes of six New Zealand white rabbits were inoculated with forty spores of A. fumigatus. A control group of their six contralateral eyes received a similar but sterile inoculum. The rabbit eyes were evaluated with respect to clinical appearance and the electroretinogram. Clinically evident endophthalmitis developed in all six infected eyes at an average of five days after injection (range 3–7 days). Data samples each 48 hours showed transient b-wave amplitude elevations in three infected eyes. These were greater than two standard deviations above the mean pre-injection values (p < 0.05). These amplitude increases preceded the onset of ophthalmoscopically recognizable infection and were observed at 2 to 5 days after injection (mean = 4 days). B-wave amplitudes in the infected eyes fell below two standard deviations of pre-injection values (p < 0.05) at an average of 5 days (range 3–7 days) after injection, a time corresponding to the onset of clinically obvious infection. At an average of 7 days after injection, all the infected eyes exhibited unmeasurable electroretinogram waveforms and severe infection. Histopathologic study of infected eyes showed extensive fungal infiltration of retina and vitreous tissues. The electroretinogram may be helpful in the early diagnosis of fungal endophthalmitis.

A case for myopia

This case presentation reviews the refractive options facing a myopic patient who chose to remain myopic after cataract extraction. The factors leading to this choice are explained.

Extended-wear lenses. An update

Abstract Extended-wear lenses present problems to be overcome by both the lens fitter and the patient. Guidelines are given for selecting patients and lenses, fitting the lenses, educating the patient, and handling complications. It is emphasized that patients who are happy with their day-wear lenses should not be urged to change to extended-wear lenses, and that if extended-wear lenses are worn, conscientious followup is crucial.