Faculty Bibliography

In cooperation with the New York State Athletic Commission, 74 boxers applying for a new or yearly renewal license were sequentially referred over a 2-year period for a complete dilated ocular examination at the Sports Vision Institute of the Manhattan Eye, Ear and Throat Hospital. At least one ocular injury was found in 66% of boxers. Vision-threatening injuries, defined as significant damage to the angle, lens, macula, or peripheral retina occurred in 58% of boxers. Nineteen percent of boxers had angle abnormalities. Nineteen percent of boxers had pathologic cataracts, over 70% of these were posterior subcapsular. Six boxers had macular lesions. A total of 24% of boxers had retinal tears. Standardized photographs were used to distinguish pathologic cataracts from congenital opacities and pathologic retinal tears from atrophic holes. Attempts were made to identify risk factors in boxing that might be predictive for ocular injury. Variables included age, weight division, left- or right-handedness, total number of losses, and total number of bouts. Significant correlations were found between the total number of bouts and the total number of losses, and the presence of retinal tears. College varsity athletes were selected as controls. Significant differences were found between boxers and controls for the total number of injuries, total vision-threatening injuries, and the number of retinal tears. A series of recommendations are proposed to aide in the early detection and prevention of serious ocular injuries

The posterior segment of the eye can be affected by blunt orbital trauma by either direct or indirect mechanisms or by equatorial expansion. Commotio retinae can occur either at the site of direct or indirect injury. Retinal detachments can be precipitated at the site of the direct injury by a necrotic tear, at the site of the indirect injury with a macular hole, or just posterior to the vitreous base if equatorial expansion plays a role. Contusion effects on the choroid can manifest as a localized hemorrhage, a hemorrhagic choroidal detachment, or a choroidal rupture. Chorioretinitis sclopetaria results from simultaneous laceration of both the retina and choroid due to the shock waves from a high-velocity missile passing adjacent to the globe in the orbit

A consecutive series of newly-diagnosed patients with central serous chorioretinopathy (CSC) was compared to two independent control groups chosen from the same patient population for the presence of a Type A behavioral pattern based on the Jenkins Activity Survey. The patients selected as matched controls had painless, reduced central vision and other chorioretinal diseases (Group I), or non-chorioretinal ocular conditions (Group II). The Type A behavior was significantly more frequent in study patients than in either Control Group I (X2 = 6.1 and P less than 0.025) or Control Group II patients (X2 = 17.7 and P less than 0.001). When both control groups were combined for comparison to the CSP patients, there was also a highly significant difference with regard to Type A behavior (X2 = 14.1 and P less than 0.001). A comparison of Control Group I with Control Group II revealed no significant difference in Type A behavior. Subfactor analysis of the Type A behavior pattern was also studied. The results of this clinical study were used in conjunction with experimental evidence linking catecholamines with CSP in developing a multifactorial etiologic hypothesis. The hypothesis suggests that the eyes as an organ system, and the macula as an ultimate target area, can be intermittently or continuously stimulated adversely by Type A behavior and its physiological consequences, most notably a sympathetic discharge. The multifactorial concept alludes to other potential risk factors such as age, race, sex, refractive state, or unknown tissue susceptabilities. The pathogenesis implies an inter-relationship between finely balanced components of a complex biopsychological system involving an individual's genetic endowment, his environment, and his behavioral pattern. The concept also offers new possible lines of investigation for the treatment of CSP, utilizing pharmacological regulators and for its prevention through early identification of CSP-prone individuals. A review of the pertinent cardiovasculature literature linking the Type A behavior with coronary artery disease and the significant papers in the ophthalmic literature on central serous pigment epitheliopathy are included in the discussion

This is a report on the results of a national survey designed to study the nature and frequency of moderate and severe complications of intravenous fluorescein angiography. In this survey, 2434 responding ophthalmologists reported on 221,781 fluorescein angiograms performed in the year 1984. Adverse reactions were classified as mild, moderate, severe, and death, depending on the duration of the effect, the necessity for medical intervention, the time required for its resolution, and the final outcome. The frequency rate for a moderate reaction was (1:63), for a severe reaction (1:1900), and for death (1:222,000). A review of previous studies on adverse reactions to the drug, a compilation of suggested methods for the amelioration and prevention of the complications, and a comparison of the responses of the general ophthalmic public to the members of The Macula Society are also reported