Ocular hypersensitivity to thimerosal in rabbits.

Rabbits were immunized to thimerosal conjugates and challenged with specific antigen-sensitized contact lenses. The symptoms of acute ocular hypersensitivity observed included corneal edema, corneal infiltration and erosion, infiltration of the anterior chamber, iritis, conjunctival edema and hyperemia, and a significant increase in mucous production. Occasional evidence of corneal neovascularization and giant conjunctival papillae were seen. All these parameters were assessed on a five-point scale (0 to +4) and tabulated as an ocular index. The index of ocular hypersensitivity correlated with the titers of the serum antibodies to thimerosal. The major class of serum antibodies consisted of immunoglobulin (Ig) G, with IgA compromising approximately 5% of serum antibodies. During the ocular challenge, the total and IgG tear antibody titers increased as a result of increased vascular permeability. The tear IgA titers increased to a lesser extent than IgG. The influx of serum proteins directly into the tear film was confirmed by a protein-dye tracer technique. Histologic analysis showed that the ocular inflammatory response was accompanied by both polymorphonuclear and mononuclear cell infiltrates into the cornea and conjunctiva. In conclusion, thimerosal-immunized rabbits show an exquisite sensitivity to the minute quantities of thimerosal conjugates adsorbed to contact lenses. Both serum and tear antibodies correlate with the severity of the ocular inflammatory response. This model would appear to simulate an antibody-mediated immune complex or Arthus type of ocular hypersensitivity commonly seen to foreign antigens including preservatives.

Adsorption and removal of protein bound to hydrogel contact lenses.

Tear film proteins are known to adsorb to new hydrogel contact lenses. Using a radioiodine tracing technique, proteins were shown to adsorb to contact lens surfaces. The quantity of protein adsorbed to the contact lenses within 2 to 4 h was 1 to 3 micrograms/lens. The degree of protein adsorption varied from lens-to-lens depending in part on the water content of the lens. High water content ionic lenses bound the most protein, whereas lower water content and nonionic lenses bound less protein. Enzyme cleaning of the protein-coated contact lenses removed about 75% of the adsorbed protein. When the enzyme-cleaned lenses were reincubated with protein, similar quantities were quickly readsorbed within a similar period of time. The rate of readsorption appeared to vary with the type of enzyme used to clean the lenses. Hydrogel lenses adsorb protein from the tear film rapidly and irreversibly. Cleaning the lenses has only a partial and temporary effect on the bound protein. The lens-bound proteins could become partly denatured during their binding to the lenses. These observations suggest a possible role for such proteins in ocular sensitivity to contact lenses.

Thimerosal: an ophthalmic preservative which acts as a hapten to elicit specific antibodies and cell mediated immunity.

A rabbit model for the study of hypersensitivity to thimerosal was established in order to develop better techniques for screening patient sera and tears for specific antibodies to lens care re-agents. Thimerosal (sodium ethylmercury thiosalicylatelate) was successfully coupled to several protein carriers using a water soluble carbodiimide which linked the carboxyl group of thimerosal to free amino groups of the carrier proteins. Thimerosal was also shown to spontaneously react with proteins as detected by the irreversible binding of mercury to the protein carrier. Immunization of rabbits with the chemically coupled thimerosal resulted in the production of antibodies which specifically reacted with thimerosal. The rabbits also manifested delayed and immediate forms of hypersensitivity to the thimerosal conjugates. The ELISA assay for specific serum antibodies was found to be a sensitive, reliable and specific screening tool However, there was no immunological cross reactivity between the chemically coupled thimerosal and the spontaneously coupled thimerosal. Therefore, the epitopes produced by these two reaction mechanisms were probably immunochemically different even though both contained detectable thimerosal derived mercury.

Pinealoma.

A patient was admitted to the Emergency Department of the Montreal General Hospital and referred to the Ophthalmology Clinic. He reported disorientation, dizziness, frontal headaches, and near vision problems. He had reduced near vision, binocular vision anomalies, Collier's sign, and abnormal pupil sizes, shapes, and responses. A diagnosis of pinealoma with a poor prognosis due to metastases was made.

Monocular photophobia.

Uniocular eye closure in bright daylight has been considered as evidence of a binocular vision anomaly. Two groups of patients with various binocular vision anomalies were studied and compared. The control group did not manifest uniocular or binocular photophobia while the experimental group admitted frequent eye closure. The variables studied included anisometropia, refractive error, suppression, amblyopia, heterophoria and strabismus. No relations were observed between academic achievement and anomalies of binocular vision utilizing three analytical methods. Monocular photophobia was not associated with anomalous binocular vision.

The effects of PUVA on the eye.

Psoriasis is a common skin disease which may be treated with 8-methoxy psoralen and long-wave ultraviolet light (PUVA). Eye protection is provided during and after treatment to prevent the development of photokeratitis and cataracts. Fifteen patients, treated with medication and ultraviolet A (UVA) had an initial complete eye examination and a repeat examination after each treatment. No patients developed cataracts but almost one-half of the patients had a mild form of photokeratoconjunctivitis. The ocular manifestations included photophobia, conjunctivitis, keratitis, and dry eyes. Tear break-up time was reduced significantly immediately after treatment for two patients but returned to normal 8 hr later. Dermatologists who employ PUVA treatments should be concerned about photokeratoconjunctivitis and the dry-eye ocular manifestations included photophobia, conjunctivitis, keratitis, and dry eyes. Tear break-up time was reduced significantly immediately after treatment for two patients but returned to normal 8 hr later. Dermatologists who employ PUVA treatments should be concerned about photokeratoconjunctivitis and the dry-eye ocular manifestations included photophobia, conjunctivitis, keratitis, and dry eyes. Tear break-up time was reduced significantly immediately after treatment for two patients but returned to normal 8 hr later. Dermatologists who employ PUVA treatments should be concerned about photokeratoconjunctivitis and the dry-eye syndrome.

How environment affects visual development: a selected review.

This selected review covers 60 papers on animal and human studies in which the development of vision, particularly the neural pathways, has been investigated in terms of environmental stimuli or their absence. Most of these studies are summarized in a single table. Emphasis is given to the early treatment of vision deficits.

Medicare in Quebec.

A provincial health insurance system was introduced through Canada more than five years ago. The program and fee schedules for optometric and some ophthalmologic services are presented. Statistics are provided by the government concerning the utilization of optometric and some medical eye services according to the distribution of age and sex in the Quebec population. Relative costs of these services as well as the incomes of health care professionals are compared. It is hoped that this information will aid in the planning and development of the U.S. Medicare program.

Visual accommodation variations during trans-atlantic cockpit duties.

Twenty airline pilots measured their near point of accommodation employing a modified Princes' Rule. Measurements were performed periodically travelling east- and west-bound. Five clerical control subjects performed the same measurements over 2 consecutive days. The ranges of variability of the nearpoint of accommodation were compared between the two groups, directions and days. No statistically significant differences in the variability of accommodation were found in the comparisons.

The design and prescription of multifocal lenses for civil pilots.

The aging (presbyopic) pilot has difficulty with near vision which can be a serious problem in the cockpit because of the complexity and uniqueness of his visual tasks. Numerous individual studies have been reported, but the aviation industry and vision care professionals do not have available to them a set of guidelines to permit the optimum fitting of spectacles for civil aviation pilots. In this study the cockpit vision environment was studied in ten contemporary aircraft. Twenty-five pilots of seven of these aircraft types participated in a spectacle design study. Experimental spectacles were designed for each pilot and evaluated for performance. Problems of pilot acceptance of reading aids, custom designing to the geometry of a given aircraft, balancing of the visual gains from complex designs versus difficulties in use and manufacture have been analyzed. Results of this study should be of value for human factors engineering, vision testing and accurate prescription for the presbyopic pilot.