What have we learned about exfoliation syndrome since its discovery by John Lindberg 100 years ago?

Exfoliation syndrome (XFS) is a systemic disease with significant ocular manifestations, including glaucoma and cataract. The disease impacts close to 70 million people globally and is now recognised as the most common identifiable cause of open-angle glaucoma. Since the discovery of XFS 100 years ago by Dr John G. Lindberg, there has been considerable advancement in understanding its pathogenesis and resulting clinical implications. The purpose of this paper is to summarise information regarding the epidemiology, pathophysiology, ocular manifestations and systemic associations of XFS with the objective of sharing clinical pearls to assist in early detection and enhanced management of patients.

Von Helmholtz's ophthalmometer: historical review and experience with one of the last surviving original devices.

Hermann von Helmholtz (1821-1894) was one of the most important scientists of the nineteenth century in optics and ophthalmology. One of his significant contributions in the field of vision sciences was the invention of the ophthalmometer in 1850, which was the precursor of the keratometers still used in clinical practice today. However, this development tends to be little recognized, and to be overshadowed by others of the achievements of this singular scientist. This review describes the historical setting behind the von Helmholtz's ophthalmometer and its mechanism. We also describe the modifications that were later made to the design. We report on our experience measuring a living human cornea with one of the last surviving devices in the world. The ophthalmometer by von Helmholtz marked the beginning of an era in the ophthalmology of the late nineteenth century, and although its original design was not broadly used in the clinical practice, and later abandoned, it opened the way for the development of practical systems very similar to the ones that we use even today.

Why did Donders, after describing pseudotorsion, deny the existence of ocular counterrolling together with Ruete, Volkmann, von Graefe and von Helmholtz, until Javal reconfirmed its existence?

After the rapid spread of strabismus surgery by total tenotomy, which had been proposed by the orthopedist Louis Stromeyer from Göttingen in 1838 and performed by the plastic surgeon Johann Friedrich Dieffenbach on October 26th and by the ophthalmologist Florent Cunier on October 29th, 1839, brilliant researchers studied the physiology of eye movements, resulting in the laws by Franciscus Cornelis Donders on pseudotorsion in tertiary positions of gaze and by Johann Benedict Listing that each eye position can be reached by rotation about an axis perpendicular to the primary and the new position of gaze. John Hunter had first described ocular counterrolling (OCR) with head tilt in 1786. The anatomist Alexander Friedrich von Hueck inferred from anatomical studies, however, that up to 28.6° OCR would be possible onhead-tilt to right or left shoulder in 1838, and estimated his own OCR seen in a mirror at approximately 25°. Donders, Christian Georg Theodor Ruete, Alfred Wilhelm Volkmann, Albrecht von Graefe and Hermann von Helmholtz subsequently denied the existence of OCR for many years and thought that only pseudotorsion existed. Louis Emile Javal had myopia and astigmatism, and he re-established the existence of OCR in 1867 when he noticed that, on head tilt to either shoulder, the axis of astigmatism of his eyes no longer coincided with the axis of astigmatism of his glasses.

[The study of ocular tuberculosis during the 19th and early 20th century].

During the 19th and early 20th century the achievements in the study of ocular tuberculosis were of great significance. The development of pathological anatomy in those years helped physicians to understand the histological image and the pathophysiology of the disease and allowed the scientists to detect the specific anatomical structures of the eye, where the disease could be present. The physicians of those years tried to describe the clinical image of the disease and to give value information, in order to facilitate the diagnosis. Despite major efforts made in the field of clinical approach to ocular tuberculosis, the treatment of the disease in those years was not very effective. Nevertheless, the physicians of the time used every new pharmacological or not pharmacological treatment to fight the disease.

François Pourfour du Petit (1664-1741): pioneer in ocular biometry.

PURPOSE: To outline the important contributions of the French physician Petit to the development of ocular biometry. CONTENT: After a brief review of Petit's life and his studies in neurology, anatomy, and cataract surgery, the methodology and results of his work in measuring many of the biometric parameters of the human eye are discussed. Among other techniques, he made use of frozen sections of eyes to explore their dimensions and employed an immersion technique to avoid the effect of corneal refraction on the appearance of the iris. His pioneering biometric results have been largely confirmed by modern studies. Those on the changes in the crystalline lens with age are particularly striking and suggest that these ocular aging effects have changed little over the last 300 years. Although largely forgotten today, his biometric work exercised a considerable influence on his more immediate successors, including Porterfield and Thomas Young. SUMMARY: François Pourfour du Petit deserves to be remembered as an important contributor to our understanding of the structure and dimensions of the human eye.

Historia de la cirugía del glaucoma (II): de la goniotomía a la primera cirugía no perforante / History of glaucoma surgery (II): From goniotomy to the first non-penetrating surgery

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Parallax-free exophthalmometry: a comprehensive review of the literature on clinical exophthalmometry and the introduction of the first parallax-free exophthalmometer.

PURPOSE: To present the first parallax-free exophthalmometer design. BACKGROUND: Exophthalmometry is an important clinical tool. We provide a historic overview of clinical exophthalmometer designs, and we review current problems encountered in exophthalmometry. METHODS: We present a new and parallax-free exophthalmometer design that we have evaluated in 49 patients visiting our orbital clinic. RESULTS: The mean age of the patients was 49.8 years and 72% were female. The Pearson interobserver variation was 0.97, and 94% of the Hertel values measured by the two observers were within the limits (1.6 mm) of agreement. CONCLUSION: This meter appears to be a reliable instrument for exophthalmometry. It is the first instrument that allows for a complete parallax-free measurement.

Orbital pseudotumor--historical origin and modern relevance.

PURPOSE: To translate the original article from German in order to understand what the author was describing when Birch-Hirschfeld first used the diagnosis of orbital pseudotumor in 1905. To study why he used that diagnosis in the context of medical care and orbital diagnosis at the beginning of the twentieth century. Then to determine whether the term still has scientific relevance today. DESIGN: Perspective. RESULTS: In 1905, orbital pseudotumor was used as a term to describe clinical situations in which modern scientific methods would have provided more accurate and specific diagnoses. The original reasons for its use were a consequence of the limitations of medical care at the juncture of the nineteenth and twentieth centuries and the nature of orbital diseases more than a century ago. CONCLUSIONS: Orbital pseudotumor should no longer be used as a diagnosis because it is not based on current scientific knowledge. It is not specific and it hinders the application of diagnoses that are more useful in patient management.

Allvar Gullstrand and the slit lamp 1911.

The Swedish ophthalmologist and self-taught mathematician Allvar Gullstrand (1862-1930) invented the slit lamp to illuminate the anterior of the eye. With its rectangular beam of very bright light, he studied the structure of the cornea and the function of the lens. His dioptric investigations showed that, as well as the extracapsular mechanism described by Helmholtz, changes in the substance of the lens, that he termed intracapsular, also contribute to accommodation. However, his invention has been appropriated by clinical ophthalmologists and is now routinely used in examination of the eye.

Optical coherence tomography: history, current status, and laboratory work.

Optical coherence tomography (OCT) imaging has become widespread in ophthalmology over the past 15 years, because of its ability to visualize ocular structures at high resolution. This article reviews the history of OCT imaging of the eye, its current status, and the laboratory work that is driving the future of the technology.

Thomas Young's contribution to visual optics: the Bakerian Lecture "on the mechanism of the eye".

Thomas Young (1773-1829) carried out major pioneering work in many different subjects. In 1800 he gave the Bakerian Lecture of the Royal Society on the topic of the "mechanism of the eye": this was published in the following year (T. Young, 1801). Young used his own design of optometer to measure refraction and accommodation, and discovered his own astigmatism. He considered the different possible origins of accommodation and confirmed that it was due to change in shape of the lens rather than to change in shape of the cornea or an increase in axial length. However, the paper also dealt with many other aspects of visual and ophthalmic optics, such as biometric parameters, peripheral refraction, longitudinal chromatic aberration, depth-of-focus and instrument myopia. These aspects of the paper have previously received little attention. We now give detailed consideration to these and other less-familiar features of Young's work and conclude that his studies remain relevant to many of the topics which currently engage visual scientists.

Evaluation of the retinal nerve fiber layer: descriptive or predictive?

For nearly a century, ophthalmologists have recognized that thinning of the retinal nerve fiber layer (rNFL) could be observed ophthalmoscopically in diseases of the optic nerve. Using high-resolution red-free fundus photography, Hoyt found slit-like rNFL defects that corresponded to visual field defects in glaucoma. Frisén extended these observations to multiple sclerosis, predicting the later discovery that axonal loss occurs in the retina without clinical bouts of optic neuritis. In measurement of the rNFL, red-free fundus photography has been superseded by more widely available, robust, and quantitative retinal imaging techniques, including Heidelberg retinal tomography, scanning laser polarimetry, and optical coherence tomography (OCT). Having emerged as the technique of choice in measuring the rNFL, OCT has shown that the degree of preoperative rNFL thinning reliably predicts whether vision will recover after surgery for pituitary adenoma. Such quantitative studies of the rNFL have the potential, therefore, of providing descriptive and predictive information that will be valuable in clinical care.