19th Annual Meeting Abstracts - 2006


Sir Harold Ridley’s Almost-Forgotten Protégée
David J Apple

Introduction or Purpose: The purpose of this paper is to document several important accomplishments in the field of anterior segment surgery that Mr. Peter Choyce achieved in the post World War II period up until his death in 2001. His work is extremely underrated, in large part because his personality led to many authorities not wanting to hear him out regarding his work, especially his very dogged adherence to anterior chamber lens technology. 
Historical approach or resources: The material presented is almost entirely original, based first upon my numerous visits to the U. K. over the period between 1985 and 2000, working primarily on a biography of Harold Ridley, which is now in press, but also observing the work of Choyce very closely during this entire period. After his death his wife provided me complete access to his records, papers and memorabilia at his home in South-End-On-Sea and I will show some of them in this presentation.
Body of Paper: The story of Sir Harold Ridley’s invention and first implantation of the intraocular lens at Saint Thomas’s Hospital in London on 29 November, 1949 is well-known. Choyce’s first contact with Ridley was in 1950 at Moorfield’s Eye hospital where, as a young ophthalmologist-in-training, he had the good fortune to witness Ridley’s second implant. A review of Choyce’s record confirms a significant number of original innovations in the field of anterior segment surgery—including many procedures taken for granted today, but not properly associated with his name. These include early work on both kerato- and intraocular lens refractive procedures, keratoprostheses, pioneering pediatric implant procedures and others. He was one of the first to systematically do measurements of various anterior segment structures in order to more scientifically determine appropriate sizes for both cornea techniques and IOL techniques. This includes measurements of corneal sizes and other measurements in both children and adults. He was the second person to implant an IOL in a child.
Summary or Conclusions: Unfortunately, Choyce’s tenacious adherence to anterior chamber lens technology, while in general clinically sound, caused many to question his influence and hence he remained poorly understood, even until after his death in 2001. It is ironic and he would no doubt happily smile from his grave if he knew that today there is a significant resurrection of anterior chamber lens types, especially for use as phakic IOLs.


Harry S. Truman: The influence of hyperopia and spectacles on the making of a President
Darron A Bacal

Introduction or purpose: Nature (genetics, physical attributes and ailments) and nurture (family and societal conditions) combine to shape all of us. The interaction between these at a young age can have a profound impact on the formation of one’s personality, motivations, aptitudes and interests. Harry S. Truman had visual difficulties at a young age due to high hyperopia. Could significant childhood hyperopia and one’s response to it be indicative of certain personality traits? Could the reaction of people in a late 19th century rural community to a young boy with spectacles produce certain attributes in this child, shaping and influencing his future? Did these events (nature & nurture) help to formulate the man who would eventually go on to become the President of our country?
Historical approach or resources: A quick review of the history of hyperopia (detection, treatments) and the factors that influence whether it produces a secondary esotropia will be presented. A recently published paper looking at the association of certain personality traits with a child’s response to uncorrected high hyperopia (accommodative esotropia versus orthophoria and blur) will serve as a background for the discussion of Harry S. Truman. Truman, authored by David McCullough, will serve as the main resource on Truman’s life, and world events that occurred at that time. Other sources will be used to provide additional background information on Mr. Truman’s vision problems, including material from the Harry S. Truman museum and library.
Body of paper: The effect of high hyperopia on ocular alignment is determined by a person’s accommodative efforts and fusional reserve. A recent study reported that orthophoric high hyperopes are less fearful and displayed more laughter and smiling than those high hyperopes who developed strabismus. Might certain personality traits be more or less common in conjunction with the person’s adaptive mechanisms? At age 5, it was noted that Harry S. Truman had very poor vision. He was diagnosed with ‘flat eyeballs’, and prescribed hyperopic spectacles. Some of Harry S. Truman’s childhood personality traits, combined with his maintenance of orthophoria in the presence of high hyperopia, agree with the findings of the aforementioned recently published article. In addition, although spectacles improved Harry’s vision, they made him a ‘spectacle’ in his hometown. His visual condition and the wearing of spectacles had a major influence on his childhood interests and activities as well as on the course and timing of his military career. These events during his formative years helped to shape the personality of this future President.
Summary or conclusions: Harry S. Truman displayed certain personality traits that have been reported to be more common in a child who maintains orthophoria in the setting of high hyperopia. In addition, because Harry was bespectacled as a child, his interaction with peers was altered, as were the activities he participated in. The events of his childhood and young adulthood had long-range effects on his life and career path.


Standardization of Visual Acuity Testing in Antiquity (Before Donders, Jaeger and Snellen)
George M Bohigian

Purpose: This presentation explores the history and methods of testing eyesight in antiquity. In addition, it briefly discusses the optics of retinal resolution and addresses the question if humankind is becoming more myopic.
Resources: The research is based on books from the Bernard Becker Rare Book Library, the Library of Congress, and Optics and Astronomy Journals.
Body of Paper: Testing for good eyesight was as important in ancient times as it is today. Hunters' and warriors' very survival depended on keen eyesight.
In many cultures, the predominant testing method was the recognition and identification of the constellations and celestial bodies of the night sky. For example, the second star from the end of the handle of the Big Dipper is really a "double star". With careful inspection, there are two stars: one is "Alcor, " a dimmer star, and the second is "Mizar". The separation between these two stars is a mere 0.2 degrees or 12 minutes of arc apart. Native Americans as well as Arabs commonly used this test to determine excellent eyesight. There was an old saying in Arabia, "He could see Alcor, but he could not see the full moon." This describes someone who perceives trivial detail, but loses sight of something obvious. Other tests included identifying the phases of Venus, Pleiades Constellation (perceiving all the seven sisters of this constellation), and counting seeds on the ground.
Conclusion: This presentation will provide an enhanced appreciation of the history of standards of visual acuity in antiquity.


Ophthalmology and the History of Penicillin: A tale of Three Cities
John D Bullock

Purpose: To review briefly the history of the development of penicillin and to highlight the importance of ophthalmology in proving its therapeutic value and thus encouraging its extraction and purification.
Resources: (1) Literature search: primary and secondary sources; (2) Site visits
Body of Paper: In early September, 1928, at the St. Mary’s Hospital in London, Alexander Fleming first noted the lytic effect that a fungal mold, later identified as Penicillium notatum, had on nearby colonies of Staphylococcus aureus. On April 29, 1929 Frederick Ridley, a future ophthalmologist working under Fleming, extracted a substance from the fungal broth which was lethal to S. aureus at a dilution of 30,000:1. In 1930, a decade before Howard Florey and Ernst Chain extracted the sodium salt of penicillin and proved its non-toxicity and efficacy in experimental staphylococcal/streptococcal peritonitis, crude penicillin was first successfully used therapeutically. Dr. C.G. Paine, a pathologist [and later, obstetrician/gynecologist], and Mr. A.B. Nutt, an assistant ophthalmic surgeon at the Sheffield Royal Infirmary, cured 4 of 5 serious ocular infections. [This data was never published.] Alexander Fleming’s first reported successful clinical use of penicillin was in 1932, also an ocular infection [in a physician]. In September, 1940, the first patient treated therapeutically, at the Radcliffe Infirmary, Oxford, with Florey and Chain’s extracted penicillin, had a severe bilateral ocular-orbital-facial staphylococcal infection with septicemia. Brief biographies of Fleming, Ridley, Paine, Nutt, Florey, and Chain will be presented. The details of the ocular infections and methods of penicillin therapy will be given.
Conclusion: A variety of ocular infections were the first to be treated successfully with penicillin, underscoring the therapeutic benefit of this new agent. Thus, ophthalmology was instrumental in the inauguration of this new era of scientific therapeutic medicine.


Phillips Thygeson: His Search for the Cause and Cure of Trachoma
G Richard O'Connor

Purpose: The purpose of this paper is to show how reliance on fragile scientific authority may delay or subvert the emergence of important medical knowledge. Phillips Thygeson and his co-workers ultimately showed that the cause of trachoma was a filtrable microbe, intermediate in size between the true viruses and common bacteria. The medical community had previously been misled by Noguchi and Nicolle, famous Nobel Prize winners of the early 1930s.
Historical approach: This paper is based on the publications of Drs. Phillips Thygeson, William Finnoff and Francis I. Proctor. The subject matter is also derived from the personal written memoirs of Phillips Thygeson.
Body of paper: In the early 1930s, the cause of trachoma, a devastating, blinding disease, was unknown. It was, however, suspected of being an infection. Isamu Noguchi had proposed that it was caused by Bacterium granulosis, a potential pathogen isolated from virtually every case of trachoma. Thygeson and Finnoff confirmed these isolations but were unable to reproduce the disease in apes or human volunteers.
Conclusions: Thygeson and his group showed that an infectious agent, identical to the "elementary body" seen in stained smears of the conjunctival epithelium, could always be recovered from collodion filters of the Elsford type (median porosity of 0.75 micron). This filtered agent could regularly cause trachoma in apes and human volunteers. That disease, in turn, could be cured by the use of sulfonamides.


The Debt of the AOS to the Heidelberg Ophthalmological Society: Historical Speculation
Robert C Drews

Introduction or purpose: This paper reflects on the state of ophthalmology in the 1850’s and 60’s, on the founding of the AOS and on the European training of its founders. The establishment of the Heidelberg Ophthalmological Society and its meetings, beginning in 1857, would seem to be a pivotal inspiration for the organization of the American Ophthalmological Society in 1864.
Historical approach or resources: Histories of the two societies and biographies of the key colleagues in each were consulted. Contemporary publications were also useful.
Body of paper: The interlacing of these histories forms a fertile ground for speculation. The paper will expound on this. Summary or conclusions: This exciting, seminal era in the history of ophthalmology saw the origin of the two oldest, and still two of the most important societies in medicine and our specialty. The chronological concurrence is no accident.


The New Discovery of a Rare Ancient Egyptian Lens
Jay M Enoch

Purpose: To describe the new finding, and significance, of an ancient Egyptian mummy-case eye-lens.
Methods: On October 9, 2004, the author visited the Museum of Fine Arts (MFA), Boston, and noticed the remaining eye from an Egyptian mummy case seemed to follow him about! This artifact is designated as MFA #1872-4731. The purposeful illusory-motion, known as motion parallax, was incorporated into the design of the oldest-known lenses. The author visited MFA a second time in June, 2005, to record more completely the find.
Findings and analysis: This mummy case was designated by MFA as originating during the Egyptian Third Intermediate Period, 1070-653 BC. The find extends forward-in-time known use of this lens design by ca 800-850 years ("period A"). Thus, this first-known lens design (which later disappeared) was in use from ca 2560 BC to 860 BC, or approximately 1700 years. For this technology to survive so long, one infers additional lenses of this general design were created, and a cadre of trained artisans persisted. All other early first-known-design lenses were made from rock crystal. During period A, two major changes occurred relative to lens optics; meaningful advances were made in glass-technology, and simpler lens designs utilizing convex lenses were introduced. The illusion was not incorporated into the simpler lens group. The Museum stated the newly described lens is made of glass.
Conclusion: The new lens raises interesting questions about the persistence and implications of lens technology.


Lincoln’s Craniofacial Microsomia
Ronald S Fishman

Purpose: To re-examine the nature of Abraham Lincoln's squint.
Methods: Two life masks of Lincoln, one made in 1860, the other in 1865, 2 months before his assassination, were made available for study at the Chicago Historical Society. This paper will present the results of three-dimensional laser scanning of the two life masks, which allows computer modeling of the face with relatively accurate measurements.
Body of paper: Abraham Lincoln was observed to have an intermittent left hypertropia as early as his early 20’s in New Salem, Illinois. Reporters during the Lincoln-Douglas debates noted his “wildly rolling left eye”. Of all the photographs of Lincoln, only one definitely and one possibly, show the LHT. Several photographs suggest a head tilt. Most of his photographs are taken of his right side in half or full profile, relatively few from his left, and even fewer in primary gaze. Because Lincoln was kicked in the head and was unconscious for several hours when he was 10 years old, trauma has most often been supposed as the etiology of the intermittent squint. However, since his son Robert (the only Lincoln child to reach adulthood) also showed a prominent vertical strabismus (as well as a cousin, Joseph Hanks) familial or genetic etiology is also thought to be a possibility. The modeling from his life masks clearly demonstrates Lincoln’s prominent facial asymmetry, a feature not commented on previously. The left orbit in particular is smaller on the left side, which shows a mild form of craniofacial microsomia. This suggests relative retrodisplacement of the trochlea on that side, producing a mechanical disadvantage in action of the superior oblique muscle.
Conclusions: Lincoln's squint would may been a developmental defect rather than genetic or traumatic.


Forefathers of Contemporary Refractive Surgery
Natalie Afshari, Francesann Ford

Introduction or purpose: The notion of a surgical solution to correct the visual handicap of ametropia stems from hundreds of years of thought and experimentation on subjects like physiologic optics and objective methods for measuring ocular parameters from great minds like Leonardo da Vinci. The expansion of these fields over the years was essential for the birth of refractive surgery as a separate discipline. Advances like the measurement of the anterior surface of the cornea by Scheiner in 1619 and the development of keratometry by von Helmholtz in 1867 quantified the parameters of the cornea thus enabling theories for alteration of corneal shape to be proposed. In 1869, Snellen published a thesis on how astigmatism might be corrected through incisions across the steep median of the cornea. Although there was an abundance of exciting new thought generated by young, innovative scientists and ophthalmologists of the day, the overriding consensus amongst early 19th century professional ophthalmic society was an attitude of contempt for their ideas. Early attempts at surgical correction of refractive errors were described as “rash by ignorance” in the first substantial scientific publications on accommodative and refractive errors written by Donders in 1864. Nevertheless, rigorous intellectual curiosity persisted leading to the first systematic study of keratotomy by Leendert van Lans in 1898. His thesis ignited the search for effective surgical means for correction of refractive errors. Certain milestones in the development of the discipline now known as refractive surgery can be attributed to several great individuals. The knowledge gained from past ideas provided these great scientists and surgeons the scholarly fodder needed to transform those early hypotheses into what is today easily recognizable as an established and progressive specialty. This historical review will chronicle those individuals and procedures since the 1940s that were instrumental in creating a new era in ophthalmic surgery.
Historical approach or resources: Much of the information for this article is extracted from historical articles that will be listed in the reference section. Academic textbooks and chapters from historic works dealing with refractive surgery are also used. Several articles are available in which great detail has been written about two of the ophthalmologists to be discussed in the paper, namely Sato and Barraquer. Great attempts have been made to obtain and translate these works from the original language in order to place new insights into this article.
Body of paper: The paper will be organized by decade beginning with the 1940s and ending with the 1990s. The prominent procedures of the decade and the surgeon instrumental in the development and promotion of the technique will be discussed. Extensive consideration will be restricted to four surgeons (Sato, Barraquer, Fyodorov and Trokel) and their techniques with limited overview of other procedures that were being performed at the time.
Summary or conclusions: At the present time much debate still persists among ophthalmologists about the benevolence and necessity of refractive surgery. The aim of this article will be to initiate discussion about the work that has been done and to credit the scientific prowess of the forefathers of this field.


A Confederate Surgeon’s Treatment of Amblyopia in Adults
Richard W Hertle

Introduction: Although there is consensus that amblyopia can be treated effectively in young children many eye care professionals believe that treatment beyond a certain age is ineffective. Some eye care professionals believe that a treatment response is unlikely after the age of 6 or 7 years, while others consider age 9 or 10 years to be the upper age limit for successful treatment. The American Academy of Ophthalmology Preferred Practice Pattern for amblyopia recommends treatment up to age 10 years. The opinion that amblyopia treatment is ineffective in older children may have arisen because the age of 6 to 7 years is thought to be the end of the “critical period” for visual development in humans. A 2005 multicenter clinical trial found that throughout the age range of 7 to 17 years, optical correction alone improved visual acuity by 10 or more letters (which equates to 2 or more lines) in about one fourth to one half of patients. This paper will present case reports from the mid to late 19th century by Confederate Surgeon Julian J Chisolm MD whereby the sight was restored in adults with lifelong visual deprivation amblyopia.
Historical approach or resources: Reprints obtained from Articles obtained from the 19th century Journal of the American Medical Association and Dr. Julian J Chisolm’s direct records are used as resources.
Body of paper: The paper will be present the cases of adult amblyopia treatment by Dr. Chisolm from the 19th century.
Summary or conclusions: The aim of this paper is to show that treatment of amblyopia in adulthood has a history well before the 20th century.


Concerning Helmholtz’s View of Static Ocular Counterrolling
Robert S Jampel

Purpose: To describe some of the ideas of Helmholtz (1821-1894) concerning extraocular muscle function with emphasis on how the eyes function during head tilt.
Resource: The primary source is chapter 27 the “Movements of the Eyes”, in volume lll, of Helmholtz’s “Treatise on Physiological Optics”. This chapter contains a supplement written in 1911 by von Kries (economist and physiologist, 1853-1928). Body of Paper: Donders (1818-1890) published his Law of ocular kinematics in 1846. Helmholtz (1821-1894) enthusiastically embraced Donders’ Law and agreed that it was also true when the head was tilted. Donders was obviously pleased that Helmholtz used his research as the foundation for his monumental work in the “Handbuch der Physiologischen Optik” the “Movements of the Eyes”, Section §27, Volume 3. Donders’ showed in his great book “Accommodation and Refraction of the Eye” (1864) his admiration for Helmholtz: “I freely admit that I am not competent to follow the investigations of Gauss and of Bessel in this department (mathematics), and even the study of the physiological dioptrics of Helmholtz required an effort on my part.” Helmholtz’s believed that there was no counterrolling of the eyes (OCR) and that anatomical data could serve as a basis for the mathematical analysis of eye movement.
Kries in his supplement in 1911 wrote “Subsequent researchers have shown that, contrary to what [Helmholtz] believed rolling motions (OCR) do occur when the head is tilted.” In fact, Helmholtz and Donders did not deny the existence of rolling eye movements during head tilt. What they denied was static OCR. Many investigators over a period of two hundred years affirmed or denied OCR, the great majority of contemporary researchers agree in its existence.
Conclusions: The question of how the eyes respond to head movement and position is still not answered. No new insights into extraocular function have resulted from current research.


Tatsuji Inouye -- Topographer of the Visual Cortex
Danny H-Kauffmann Jokl

Purpose: To give historic recognition to Tatsuji Inouye, MD, as the originator of our modern concepts of the topography of the visual cortex and to highlight his further contributions to Ophthalmology.
Historical approach or Resources: Hirschberg J. Geschichte der Augenheilkunde XIV 1915-18 pp386-387, 390; InouyeT. Die Sehstoerungen der kortlichen Sehsphaere,1909; Mishima S. History of Ophthalmology in Japan, 2004.
Body of paper: The Meiji era (1868-1912) was a period in which Japan welcomed all Western influences. Germany became the primary source for dissemination of modern medical knowledge, a role that the Dutch had played for 250 years during the prior Edo era. Within a short 40-year span, Japan’s physicians were to make significant contributions in all medical fields.
Among them, Tatsuji Inouye must be recognized. In the Russo-Japan War (1904-05), he examined bullet wounds of the occiput and in his subsequent publication deduced the functional role of the visual cortex. His achievement was overshadowed by similar studies carried out in WWI by Gordon Holmes, whose name alone, to this day, is identified in medical texts with the map of the visual cortex.
Conclusions: Tatsuji Inouye deserves credit, along with Holmes, for our modern concepts of the topography of the visual cortex and for furthering ophthalmic care in Japan.


Snyder Lecture: Historical Aspects of Yellow the Color Associated with Cowardice
Gordon K Klintworth

The gift of being able to discriminate objects of different color provides one of the joys of life for all who are fortunate to possess vision. Much thought has been devoted since time immemorial to how individuals see objects of various colors and a vast body of information about color vision has accumulated over the years. Not only can specific colors be recognized based on the wavelength of the light, but not all living creatures that are exposed to light of the same wave length perceive the same color. Moreover specific colors have acquired specific meanings unrelated to the visual image. As someone who has never been able to appreciate the wide spectrum of colors that women, such as my wife can see and actually name, I have always considered myself handicapped when it comes to color perception. As my crystalline lens ages I have gradually experienced a greater and greater difficulty in distinguishing the yellow and white flags on the greens of golf courses that indicate the location of the holes to which one hopes to target the ball. Hence recently I have become particularly interested in the color yellow. In this lecture I will discuss some historical aspects of this most visible color of all colors that is traditionally associated with cowardice. Yellow has also fascinated others. The most famous is perhaps Vincent van Gogh, the renowned Dutch painter and his preference of yellow spawned many speculations to account for why he liked this particular color.


James IV of Scotland: “Cataract King”
Linda Lawrence

Introduction or purpose: James IV of Scotland (1473-1513) performed at least one cataract couching surgery as king of Scotland in 1501. Of historical interest is his involvement in the formation of the Royal College Surgeons Edinburgh in 1505-1506, one of the oldest medical organizations in the world.
Historical approach or resources: I have been working with Dawn McInnis, rare book librarian at the Clendening Library at University of Kansas Medical Center.

1. “Accounts of the Lord High Treasurer of Scotland” Vol II p. 102 (this is the original reference from 1501)

2. History of Scottish Medicine, Comrie, John, Wellcome Historical Medical Museum, London, 1932, vol. 1 pp 148-157

3. J Med Biogr, 1993 Aug;1(3) 175-85, James IV of Scotland: Monarchy and Medicine”, Short, Al, Lennard TW, Dept of Surgery, The Medical School, the University, Newcastle upon Tyne, UK

4. Seal of Cause granted to the Barber Surgeons by the town council of Edinburgh, July 1, 1505

Body of paper: James IV of Scotland, of the Stuart Dynasty, was fascinated by medical science and practiced surgery and dentistry as king. Of special interest is his performance of a couching procedure April 10, 1501 which is documented in the Accounts of the Lord High Treasurer of Scotland, original court documents from the time.
He was instrumental in the establishment of the Royal College of Surgeons of Edinburgh in 1505. This was granted to the Barber Surgeons incorporating them as a Craft Guild. The history of this organization will be presented in brief as a part of history of the surgical profession that is little remembered.
Summary or conclusions: The interest of James IV of Scotland in Medicine and surgery was influential in establishing the oldest medical organization in the world. There is documentation of at least one cataract couching procedure performed by him as King of Scotland.



Historical Treatment of Eye Disease in the Pennsylvania Dutch Region
Charles E Letocha

Introduction or purpose: Since the Cogan Meeting is being held in Pennsylvania Dutch Country, I thought it might be interesting to explore local historical treatments of eye diseases.
Historical approach or resources: This will be mostly secondary sources but include primary references such as Hohman's "Long Lost Friend", newspaper and almanac advertisements and the deBenneville and Wagner manuscripts at the College of Physicians of Philadelphia.
Body of paper: Introduction to Pennsylvania Dutch history, "standard" treatments of the 18th and 19th centuries, folk medicine treatment of eye diseases and pow-wow treatment of eye diseases.
Summary or conclusions: Treatment of eye diseases in the Pennsylvania Dutch region included the same methods as their "English" neighbors but also unique folk medicine and pow-wowing techniques.


The Four-Diopter Prism Test
Donelson R Manley

Introduction or purpose: The purpose is to review the development of this test by the American ophthalmologist, Alexander Irvine, MD.
Historical approach or resources: This author reviewed Irvine’s original article that appeared in the AJO in 1944. Also reviewed were those references cited by Irvine that were written by Verhoeff and Krimsky. Additional information was gathered by written and oral communication with two of Dr. Irvine’s sons.
Body of paper: Unilateral decreased vision in one eye that is otherwise normal has been a diagnostic dilemma for centuries. At the beginning of WW II the visual acuity of every inductee was evaluated as part of the routine physical examination. Those individuals with decreased vision were referred for an ophthalmological evaluation. Alexander Irvine was assigned as an ophthalmologist to the Armed Forces center in Clearwater, Florida. He found that the incidence of unilateral poor vision in recruits was out of proportion to that seen in civilian practice. Since malingering and hysteria were so prevalent under circumstances of wartime anxiety, and in the absence of demonstrable pathologic change, Irvine struggled to ascertain why the acuity was decreased in such a large number of patients. Irvine devised a single test to detect binocular fixation that proved to be useful in the evaluation of ocular dominance, amblyopia, minimal strabismus and malingering.
Summary or conclusions: The four-diopter prism test is standard today and all ophthalmologists should understand and use it.


Delius and the Impact of Blindness in Composition
Michael F Marmor

Purpose: To describe how blindness and paralysis affected the composer, Frederick Delius, and to muse on parallels with deafness and with blind artists.
Methods: Books, films and articles about Delius were reviewed, as well as more general literature about blindness and deafness in the arts. A Ken Russell film gave life to this history. And of course, it was necessary to listen to the music.
Presentation: The English composer, Frederick Delius (1862 - 1934), became blind and paralyzed from syphilis for the last decade of his life, but his hearing and intellect were unimpaired. Handel (1685 - 1759) became blind late in life, and dictated music, but he could play his instruments (piano and organ). The same is true for his contemporary John Stanley (1712 - 1786) who had been blind since age 2 after a childhood accident. The deaf Beethoven and Smetana could write out their musical ideas, but Delius could no longer play the piano. He was able to resume composition only because a young musician, Eric Fenby, volunteered to help him -- and evolved a mechanism for exchanging (albeit laboriously) musical ideas.
Deafness in music is not equivalent to blindness in painting because skilled musicians can "hear" notes written on paper, while artists have no alternative means of representing their work. Blindness in musical composition becomes a serious impediment when the composer lacks the physical means to translate the musical ideas.


Pixels and painters
G Ravin

Purpose: To analyze the visual and artistic effects of artistic images that have been created through pixelated elements.
Historical approach or resource: Scientific and art historical analysis of the work of an American artist, Chuck Close (b. 1940). His work involves breaking the image into small geometric forms.
Body of paper: For millennia artists have created images out of thousands of small pieces. Mosaics are an early example. Late in the 19th century, Seurat came up with an astonishingly fresh method of painting called Pointillism. His magnificent painting of a small island in the Seine near Paris, La Grande Jatte, is an icon of art history. A contemporary American artist, Chuck Close, makes portraits with small geometric forms (squares, rectangles and circles) that combine to make a large astonishing image but can still be seen as being composed of many small fragments. He began by using photographs, working in a style called Photo-Realism, and has expanded his technique in several directions.
Summary or conclusions: Pixelating images makes fascinating art and science.
Conclusions: Delius continued to compose only with the skilled help of a musical amanuensis who could voice his ideas on the piano. Creative artists can envision new works, but it is difficult to realize them when ongoing feedback is compromised by disease.


Rosalba Carriera and Her Vision Problems
Tracy Ravin

Introduction or purpose: To examine the vision problems of Rosalba Carriera, a famous Italian artist of the late 18th Century.
Historical approach or resources: Literature search as well as primary documents will be used.
Body of paper: Rosalba Carriera (1675-1757) has been considered Europe’s most celebrated female painter of the first half of the eighteenth century. A native of Venice, she first earned recognition as a miniaturist. When her eyesight began to fail (most likely due to presbyopia), she turned her attention more exclusively to pastel. She popularized the use of pastel. She became a much sought after portraitist and teacher in this medium. The Empress of Germany was one of her pupils. Her career was ended by her loss of vision due to cataracts. She underwent cataract surgery in 1749 which provided some initial hope of visual recovery. By 1751, however, she was blind. She had suffered from depression previously and losing her sight caused her despair.
Summary or conclusions: Rosalba Carriera, an 18th Century Italian artist suffered vision problems including presbyopia and cataract which affected her career.



Proof and Consequences: The History of Clinical Trials in Ophthalmology
Pamela C Sieving

Introduction or purpose: To present the history of clinical trials in ophthalmology and vision.
Historical approach or resources: Historical overview of development of the theoretical bases for evidence-based medicine, and ophthalmology in particular. The study uses both primary and secondary literature; some resources for the understanding the current status of this subject are Web-based.
Body of paper: Evidence-based medicine, as the term is understood today, regards randomized controlled trials, systematic reviews and meta-analyses as the highest level of evidence to guide medical practice. Ophthalmic studies were among the earliest modern clinical trials, and ophthalmologists have been leaders in promoting the creation of evidence-based knowledge, and early adapters of its use.
Summary or conclusions: Ophthalmic researchers have been among the pioneers and leaders in understanding the importance of subjecting etiologic, diagnostic and therapeutic knowledge to rigorous testing in randomized controlled trials. In addition, the National Eye Institute has provided leadership in establishing the model of multi-center studies.


Ocular Immunology 1905-1914: The Bandwagon Effect
Arthur M Silverstein

Abstract: By 1900, after 20 years of remarkable success, immunology was the darling of all the medical sciences. Then in 1902/03 two major immunopathological phenomena were described: the necrotizing Arthus Reaction and anaphylaxis. In short order many young ophthalmologists (and some older ones) sought to apply these new concepts to the eye, and many ocular diseases were attributed to immunopathological processes. These included keratitis, cataract, uveitis, and sympathetic ophthalmia. In this presentation the 1905 immunological stage will be set, and the busy decade of ophthalmic speculations and experiments will be described. This vogue will be compared to others, such as changing fashions in the etiological diagnosis of uveitis, the concept of focal infection, and -----(fill in the blank).
Materials: The early French and German literature.
Significance: This should provide a nice model for the effects of a scientific vogue in a medical field.


Antoine Maître-Jan (1650-1725)
William Tasman

Purpose: To present evidence of the first description of a detached retina.
Historical Approach: Review of biographical material on Maitre-Jan and of the 1722 2nd edition of his Maladies de L'Oeil.
Presentation: The retina had been previously recognized as an organ of sight by among others Leonardo Da Vinci, but it was Jean Méry in 1704 who was the first to visualize the retina in a living eye while observing pupillary dilation in a drowning cat. However, Antoine Maître-Jan was the first to recognize a detached retina. This important observation was made on a post mortem cow’s eye, and to the best of our knowledge his is the first such description of this malady. The question, of course, comes up as to whether the detachment may have been artifactitious and there is no way to properly answer that question. But what makes Maître-Jan’s observation most likely credible is the fact that he had made earlier observations about the eye. He was a talented clinician and investigator and used chemical fixation. Previously he had noted while observing a couching procedure that a cataract was a cloudy lens and not a membrane. This led him to use his fixation techniques to demonstrate the onion-like lens structure as well as the “fibrous fluid” nature of the vitreous. He then confirmed in post mortem eyes that cataracts were indeed opaque lenses. Maître-Jan also was aware of historical observations and in his 1722 book on Maladies De L’Oeil he referred to a case of Vesalius who described what may have been a persistent hyperplastic primary vitreous and another of hypoplastic optic nerve.
Summary: Maître-Jan, by presenting evidence of a detached retina as well as descriptions of the lens and vitreous in his writings in the early 1700’s, for the first time documented intraocular changes which would become important knowledge for clinicians who would come later.


Irene E. Loewenfeld, PhD, Physiologist of the Pupil
H. Stanley Thompson, Randy H Kardon

Introduction: This is a simple biographical sketch of a life devoted to the physiology of the pupil and to its clinical applications. It was requested by the Journal of Neuro-ophthalmology as a matching piece to the biosketch on Otto Lowenstein published there in March ’05. It is expected to be published in March ‘06.
Resources: For several years I have borrowed and copied photos of Loewenfeld’s family, and read of the accomplishments of her father and grandfather. I have interviewed her with regard to her childhood and her career and her academic accomplishments - and recorded her comments.
Body of paper: The paper consists of an account of her family, her up-bringing, her education and her work, followed by a brief review of some of her academic accomplishments.
Summary: This paper is in honor of an industrious investigator who added to our knowledge of ocular physiology, who greatly respected the history of her subject, and was in fact a Member of our Society (and I believe still is), and who, 43 years ago, was one of my teachers.