Prevalence and 15-year incidence of retinopathy and associated characteristics in middle-aged and elderly diabetic men.

We examined 178 men for the presence of diabetic retinopathy during 1978-80. They had been part of a group of 205 men from the Jerusalem area, diagnosed as being diabetic or having an abnormal glucose tolerance test in the Israel Ischaemic Heart Disease Project, a 5-year epidemiological investigation of Israeli male government employees. Seventy-four (42%) had diabetic retinopathy as determined by direct and indirect ophthalmoscopy, 3-mirror contact lens examination, and fundus photography. Those with and without retinopathy were compared for clinical, biochemical, behavioural, and biographical variables measured subsequently in 1963, 1965, and 1968. We found no significant differences between the 2 groups with respect to antecedent Quetelet index, blood pressure, peripheral vascular disease, blood lipids, haematocrits, smoking habits, area of birth, and education. Statistically significant differences between men with and without retinopathy were found for severity of carbohydrate metabolic intolerance at identification, duration of the metabolic abnormality, age, casual glucose values, and serum uric acid levels. Low serum uric acid appears to precede the incidence of diabetic retinopathy and to decline further as the disease progresses.

Effects of experimental hyperlipoproteinaemia on the retina and optic nerve in rhesus monkeys.

Hyperlipoproteinaemia resulting from thyroid suppression and long-term ingestion of a high cholesterol diet caused prolonged lipaemia retinalis in 6 rhesus monkeys. No atherosclerotic deposits or other ophthalmoscopically visible changes of the retinal vasculature were detectable. In 2 animals histopathological examination revealed segmental atrophy and gliosis of the optic nerves bearing a resemblance to chronic ischaemic optic neuropathy. One monkey developed ophthalmoscopically visible temporal pallor of the optic discs. Emboli of fat laden cells in blood vessels of the brain in one of these 2 monkeys, and in a penicillated splenic artery in the other animal, were associated with signs of systemic embolic occlusion, suggesting a similar course in the development of optic nerve damage.

An examination of the possibilities of preventive therapy in arteriolar retinopathies.

The identification of certain chronic vascular retinopathies has been marked by a search for their classification. Such proper classification has therapeutic implications. The similarities of these retinopathies are based on a shared pathogenic process, initiated by diminished arteriolar perfusion pressure, as the result of varied causes but leading to somewhat nonspecific capillary and reactive stages. On the basis of such a pathogenesis, various possible prophylactic and therapeutic measures and their organizational requirements are significant. These measures are directed to the correction of a blood perfusion pressure defect and to leaking capillaries and new vessels. Prophylactic and therapeutic exercises will be required for various chronic arteriolar capillaropathies, although the experience with one disease may be applicable to the others. Senile macular disciform degeneration provides the factors necessary for a therapeutic trial.

Retinal vein occlusion.

A brief description is given of the main clinical, histological and epidemiological circumstances of retinal vein occlusion. In an assessment of the pathogeneis of the condition, primacy is given to the role of arteriolar flow insufficiency and stress is laid on the long-standing capillaropathy which precedes the heamorrhagic phase of the disease. Basic therapeutic considerations are mentioned but stress is laid on the diagnosis of the pre-occlusive stage and on measures of a preventive nature that may be taken. Retinal vein occlusion and haemorrhagic cerebral infarct are compared with regard to their pathogenesis and the advantages are discussed of a common ophthalmoscopic study of retinal vein occlusion with neurologists interested in cerebral vascular disease leading to an interchange of therapeutic experience in both conditions. Finally, there are detailed the studies in retinal vein occlusion being conducted by the Jerusalem Institute for the Prevention of Blindness. These are studies of incidence, natural history and of pathogenesis as observed in the experimental disease produced in rhesus monkey.

A program for preventive ophthalmology in Israel: possible implications for prevention units in other specialized branches of clinical medicine.

A program is proposed for a prevention unit in ophthalmology in a medical school situated in a technologically developed country where degenerative diseases play a major role in the etiology of eye disease. The relationship of such a unit to the corresponding curative departments, to the departments of social medicine and medical ecology, to the Ministry of Health and to the corresponding professional body are described. The role such a unit may have as a forerunner of the formation of similar units in other specialities of medicine is emphasized.