The management of vascular and tumorous lesions of the parasellar region still remains one of the most demanding tasks in neurosurgery. It is only a short time ago that the major concepts of the anatomy of the so-called cavernous sinus were described in detail. Surgical interventions in this region are very complex, they are time-consuming and require an extensive back ground of experience in surgery of the cranial base. Pioneer anatomical studies of the parasellar region done by Taptas, and the daring direct operative approach introduced by Parkinson pro moted the development of modern neuroradiological intervention proce dures, which were initiated by Serbinenko and further refined by Debrun, Vifiuela and others. The technique of the detachable balloon catheter stimulated surgeons to proceed with the direct operative approach to lesions of the parasellar region. Today, it is hard to imagine a successful man agement of vascular pathologies of this region without a complementary use of the two techniques."

There has been considerable increase in the knowledge concern ing tear secretion, the ocular surface, and pathophysiologic con ditions leading to the dry eye. Much of this new knowledge is not widely appreciated. Although there have been proceedings of symposia published, there is no currently available book of suf ficient scope, yet reasonable length, which ties together aspects of this newly acquired knowledge. This textbook is designed to give the ophthalmic practitioner a comprehensive, yet concise, guide line concerning the diagnosis and treatment of the dry eye. We have been able to bring together leading researchers to accom plish the same. We wish to express our special thanks to the company Dr. Mann Pharma of Berlin without whose generous sponsorship we could not have completed our task. The sponsor ship, in bringing together the authors in planning, preparation, and realization of this text, is gratefully acknowledged. Washington/Ulm, March 1992 M. A. Lemp R. Marquardt Contents Introduction 1 Chapter 1 History of the Dry Eye J. Murube . . . . . 3 1 lntroduction 3 2 The Concept of the Dry Eye 5 3 The History of the Causes of the Dry Eye 6 4 The History of the Diagnosis of the Dry Eye 11 5 The History of the Treatment of the Dry Eye 15 6 The Social Response to the Dry Eye 19 References . . . . . . . . . . . . . . . . 19 Chapter 2 Functional Morphology of the Conjunctiva J. W. Rohen and E. Lutjen-Drecoll. With 20 Figures and 3 Tables . . . . . . . . . 35 1 Conjunctiva . . . . . . . .

This conference was instigated by a combination of factors: The nature of the problem, the wide spread occupational epidemiology reported on eye symptoms and eye fatigue in the workplace, and the organizers' awareness of the complexity of the scientific and clinical bases of knowledge that might be usefully applied. The introduction of new methods into system neurobiology provides new insights into how we receive and process information from the external world, and act upon it. New, non-invasive methods have opened the way to direct observation of the human brain in action. Due particularly to the interaction between the visual and oculomotor requirements involved, several clinical and scientific fields intersect when these issues are considered. To provide clear vision the accommodative and pupillary mechanisms are used. To maintain binocularity, the ver gence oculomotor system, sensitive to fatigue, must attain congruence with accommodative levels. This accommodation-vergence linkage was a focus of our symposium."

This book contains the proceedings of the International Symposium on Ophthalmie Drug Delivery, which was held in Pisa in October 1986. Topical ophthalmic therapy is a matter of interest to specialists from different fields (medical, pharmaceutical, chemical, technological, etc.), who, unfortunately, have a tendency to meet separately, thus limiting a diffusion of knowledge, ideas and experience that would greatly favour the overall pro- gress in this area of research. The Symposium, for the first time in Europe, provided the opportunity for specialists from different disciplines and from different countfies to meet, to discuss and to share their experience. This multidisciplinary approach is reflected in the wide variety of topics that appear in the book. The papers are aimed at reviewing many of the complex, interrelated, medical pharmaceutical and technological facets of topical ophthalmic therapy. lt is our hope that they may stimulate further thought in this fascinating field, and may provide possible guidelines for future research. The editors wish to express their appreciation to the sponsors of the Symposium: Fidia Research Laboratories, whose generosity permitted the meeting tobe held, and the ltalian National Research Council (CNR, Progetto Finalizzato Chimica Fine e Secondaria) who gave its scientific tutorship. Thanks are also due to the other Symposium contributors, ACRAF SpA, Rome, and Allergan Italia SpA, Rome. The assistance, support and coopera- tion given before, during and after the Symposium by Dr. Patrizia Chetoni, Dr. Maria Tilde Torracca and Dr. Elena Parolini arealso gratefully acknowledged.

The research workers at the Eye Clinic of the Medical Academy of Erfurt are proud of having been entrusted, for the second time, with the organization of the yearly ISCEV symposium. Twelve years ago the 6th Symposium was held in Erfurt. This time we turned to Reinhardsbrunn, an old castle situated in the vicinity of Erfurt on the fringes of the wonderful mountainscape of the Thuringian Forest. Reinhardsbrunn castle serves today as a holiday hotel and convention place. It seemed to us to be the right place for carrying on the discussions in a comfortable and informal way after the actual sessions were over. Comparing the scientific reports read at the 6th and 17th Symposium, both organized in Erfurt, one readily becomes aware of the impressive advances in our rapidly developing field of interest. The technical and, more specifically, the electronic advancements have been enormous, especially in the field of recording and processing the visually evoked cortical potentials.. Adually, the addition of this special field of study to our realm, led to the renaming of the Society some years ago. Moreover, it became more and more obvious that interdisciplinary cooperation between ophthalmologists, physiologists, physi cists, technologists and mathematicians is essential. This is also reflected in the composition of our membership."

Curbside Consultation in Glaucoma: 49 Clinical Questions has been updated into a Second Edition! The Second Edition contains new questions and is completely updated! Curbside Consultation in Glaucoma, Second Edition contains new questions and brief, practical, evidence-based answers to the most frequently asked questions that are posed during a "curbside consultation" between surgical colleagues. Dr. Steven J. Gedde and associate editors Dr. Dale K. Heuer, Dr. Richard A. Lewis, and Dr. Joseph Panarelli have assembled the top glaucoma consultants from the United States and abroad to offer expert advice, preferences, and opinions on tough clinical questions commonly associated with glaucoma in this updated reference. The unique Q&A format provides quick access to current information related to glaucoma in the simplicity of a conversation between two colleagues. Numerous images, diagrams, and references are included to enhance the text and illustrate surgical pearls. Some of the questions that are answered inside the Second Edition include: What imaging technology is best for diagnosing glaucoma? For detecting progression? What new methods are available to measure intraocular pressure? Are any devices available for continuous monitoring of intraocular pressure? Do anti-VEGF agents produce intraocular pressure elevation? How should I set a target intraocular pressure? How should I manage a patient who is progressing at low levels of intraocular pressure? Does cataract extraction produce significant and sustained intraocular pressure reduction? When should I perform a combined procedure versus cataract surgery alone? What are MIGS? When should I use them? Curbside Consultation in Glaucoma: 49 Clinical Questions, Second Edition provides information basic enough for residents while also incorporating expert pearls that even high-volume glaucoma specialists will appreciate. General practitioners, residents, fellows, and optometrists alike will benefit from the user-friendly, casual format and the expert advice contained within.

From the foreword: "Microsurgery of Retinal Detachment is an important contribution to the practice of vitreoretinal surgery. In this comprehensive volume, Dr. Bonnet shares her extensive experience in the management of conditions ranging from retinal tears and primary retinal detachment to giant retinal breaks and vitreoretinal surgery. The field of microsurgery has continued to evolve over the last twenty years, both for the anterior segment surgeon and, since 1970, for the vitreoretinal surgeon. Although there have been extensive descriptions of vitrectomy techniques, little has been written about microsurgical techniques for scleral buckling operations. This subject is well covered in the present edition, which consequently will be a valuable resource to the majority of retinal surgeons who do not as a rule employ microsurgery in the repair of retinal detachments."

Over the weekend of 21-23 February 1997, a small group gathered in Tallahassee, Florida, at the invitation of Ted Williams, to discuss "photo stasis and related topics." The majority of participants were former students and colleagues of Ted's, but an occasional outsider such as myself was generously included. The papers presented there are collected in this volume. The theory of photo stasis was first outlined in a landmark paper by John Penn and Ted, published in 1986 in Experimental Eye Research. They provided compelling data showing that, in the albino rat eye, levels of rhodopsin, outer-segment length, rhodopsin regeneration rate, and even, perhaps, rhodopsin packing density all depend on the levels of cyclic illumination (12 hours light, 12 hours dark) in which the animal was reared. So, for example, there is fourfold less rhodopsin in a retinal extract derived from an animal reared at 400 lux than in an extract from the retina of an animal reared at 3 lux. Animals reared at intermediate levels of light show intermediate amounts of rhodopsin that are correlated with illumination level. What these data immediately suggested is that the photoreceptor cell can adjust its photon-catching ability in response to the levels of light in which an animal is reared, and they also provided a compelling rationale for outer-segment turnover, a phenomenon discovered 20 years earlier by Richard Young but whose function has remained obscure.

to the Second Edition here have been significant changes in pediatric Chapter 56 by Maya Eibschitz-Tsimhoni, MD, is a T ophthalmology and strabismus since the first wonderful contribution to the literature, as it reviews edition. Great effort has gone into incorporat 235 important ocular disorders that have systemic ing recent advances into this second edition. Each manifestations, and it includes a detailed glossary of chapter in the book has been revised, and over half of terms. them have been completely rewritten. In addition to As with the first edition, our goal is to present a updating and revising the entire book, we have added comprehensive textbook of pediatric ophthalmology three new chapters: Chapter 7 on electrophysiology and strabismus written in a clear, reader-friendly style. and the eye, Chapter 1 7 on strabismus surgery, and Our hope is that the readerwill find the second edi Chapter 56 on congenital syndromes with ocular man tion of Pediatric Ophthalmology and Strabismus to ifestations. Chapter 17 is the definitive work on pedi be scientifically informative, clinically useful, and en atric ocular electrophysiology, bar none, and was fin joyable to read. ished just weeks before the untimely death of its author, Dr. Tony Kriss (see tribute in Chapter 17).

I have been asked to write a brief foreword to this volume honoring Hisako Ikeda, providing a review of the accomplishments in our field over the past four decades, when Hisako was an active participant. This I am delighted to do. It has been a most exciting time in vision research and Hisako has been right in the middle of much of the excitement, publishing on a wide variety of topics and providing much new data and many new insights. Hisako's research career can be divided by decades into four quite distinct areas of inquiry. In the 1950s, as a student in Japan, her research interests were psychophysical in nature, and she was concerned with visual illusions, figural aftereffects, and motion detec tion. In the 1960s, after her move to London, she began electrophysiological studies. Much of her work in the 1960s was concerned with the electroretinogram (ERG), its components, and the use of this electrical response for evaluating spectral sensitivities of the eye and retinal degenerations. This work represented the beginning of her electrodiagnostic clinical work, which continued until her retirement."

This book is designed to provide the busy ophthal inftammation, lacrimal gland tumors and inftamma mologist with a practieal guide to the management tion, lacrimal sac tumors and inftammation, and of lid and ocular adnexal disease. The book encom lid tumors and inftammations. passes more than tumors simply because other in This book provides the ophthalmologist with a ftammatory conditions may mimic tumors in their step-by-step approach to patients with lid and orbital presentation and vice versa. It is not meant to be tumors and inftammations. an encyclopedie, definitive work on a single subject, organized around individual disease entities; instead Acknowledgments it approaches the patient much as clinician does. It concentrates on the patient and considers various disease processes logieally. Work -up, differential We wish to thank all the referring doctors who diagnosis, and initial treatment are discussed. have allowed us to treat their patients with orbital When any patient presents with an orbital or an and ocular adnexal disease and without whom a ocular adnexal mass, the question that needs to be book of this type would have been impossible. We answered is whether the process is due to inftamma also would like to give special thanks to our teachers, Dr. Lorenz E. Zimmerman and Dr. Byron Smith."

Are you looking for concise, practical answers to questions that are often left unanswered by traditional references on refractive surgery? Are you seeking brief, evidence-based advice for the daily examination of patients? This book provides quick and direct answers to the thorny questions most commonly posed during a "curbside consultation" between experienced clinicians. Drs. Bonnie An Henderson and Sonia H. Yoo have designed this unique reference in which refractive specialists offer expert advice, preferences, and opinions on tough clinical questions commonly encountered by ophthalmologists, residents, and other health care professionals. The unique Q&A format provides quick access to current information related to refractive and lens-based surgery with the simplicity of a conversation between two colleagues. Images, diagrams, and references are included to enhance the text and to illustrate clinical diagnoses and treatment plans. Based on clinical scenarios that a refractive surgeon might encounter in real life, Curbside Consultation in Refractive and Lens-Based Surgery provides information basic enough for residents while also incorporating expert pearls that even high-volume ophthalmologists will appreciate. General ophthalmologists and residents alike will enjoy the user-friendly and casual format. Some of the questions that are answered: * How do I manage epithelial ingrowth after LASIK? What if it recurs? * Should I perform PRK in patients with forme fruste keratoconus? * How do I manage patients with dry eyes after LASIK surgery? * How do I determine my surgically induced astigmatism? * Is a monocular implantation of a multifocal IOL tolerated? * How do you manage an unhappy multifocal patient who is experiencing halos and glare?

As there recently has been increased interest in the applications of optical techniques in biomedical research and clinical diagnostics, it seemed to be appropriate to organize a comprehensive international conference on optics in medicine and biology. Such a broad international meeting had not been held before. An international conference on Optics in Biomedical Sciences was organized and took place in Graz, Austria, September 7th through 11th, 1981, sponsored by the International Commission for Optics (ICO) in co operation with the European Optical Committee, the Austrian Association on Biomedical Engineering, and the German Society for Applied Optics. It seemed timely to establish a forum for communication among specialists on an international level. This book, presenting the papers given at this conference, demonstrates the state of the art of this increasingly expanding field of applications of optics. Furthermore, the interested reader will find an extended list of references in the various contributions. This book helps to overcome the difficulty, inherent in all interdisciplinary research fields, of gathering widely scattered literature. The contributions to this book are focussed on the following topics: Biomedical applications of - unconventional imaging in microscopy, - image processing, - interferometry and holography, - speckle-techniques and spectroscopy, - optometry, and - Moire methods. In addition, the brilliant and humorous closing remarks of Nils Abramson from the Royal Institute of Technology, Stockholm, have been included."

In this book the authors relate and discuss the idea that perceptual processes can be considered at many levels. A phenomenon that appears at one level may not be the same as a superficially similar phenomenon that appears at a different level. For example "induced motion" can be analyzed in terms of eye movements or at the retinal level or at a much higher cognitive level: how do these analyses fit together? The concept of levels also makes us think of the flow of information between levels, which leads to a consideration of the roles of top-down and bottom-up (or feed-forward, feed-back) flow. There are sections devoted to vestibular processing, eye movement processing and processing during brightness perception. The final section covers levels of processing in spatial vision. All scientists and graduate students working in vision will be interested in this book as well as people involved in using visual processes in computer animations, display design or the sensory systems of machines.

The papers included in this volume were presented as a part of the dedication of a new clinical/teaching/research facility for the University of Houston College of Optometry, March 27-31, 1977. These papers were intended to cover the "state of the art" knowledge in all areas of visual system investigation. While we may not have quite reached our goal of covering all areas, the papers presented here cover a broad cross-section of investigations in vision. However, without doubt, the intention of "state of the art" coverage was achieved in all areas discussed. From the beginning, with the presentation of Nobel Laureate, Ragnar Granit, to the end, with consideration of Vision Health Care Delivery Systems, each speaker was thorough in treatment of his/her subject. From studies of the ~ and of contact lenses, through examination of crystalline lens function, ocular pathologies and retina! function, the eye is very thoroughly considered. Much of this volume covers material dealing with the process of vision after coding of information in the eye. Psychophysical studies of vision compare and contrast with neurophysiological studies of v1sual function; and a very thorough section on the development of visual system function should prove valuable to a wide cross section of teachers, researchers, and clinicians. All-in-all, the contents of this volume represent a vast array of knowledge about the visual system, and this should be a valuable teaching/research resource for many years.

The topics in this volume explore the etiology, cellular mechanisms, epidemiology, genetics, models and potential therapeutic measures for the blinding diseases of retinitis pigmentosa and age-related macular degeneration. Special focus is highlighted in the areas of Mechanisms of Photoreceptor Degeneration and Cell Death (extremely important because very little is known how or why photoreceptors die in these diseases, despite an abundance of genetic information), Age-Related Macular Degeneration (with several novel approaches to its analysis), Usher Syndrome (the most severe form of retinitis pigmentosa, which includes an early or congenital loss of hearing along with blindness), and Gene Therapy. In addition, the section on Basic Science Related to Retinal Degeneration is particularly strong with several laboratories reporting on new discoveries in the area of outer segment phagocytosis, a key component of photoreceptor-retinal pigment epithelial cell interactions in normal and degenerating retinas.

This book highlights the unique aspects of oncologic ophthalmology as a medical and surgical discipline practiced at a comprehensive cancer center. Multi-disciplinary management of ocular, orbital and adnexal cancers are highlighted using simple and tried-and-true algorithms. In addition, ocular problems caused as a direct result of cancer treatment are reviewed using illustrative photographs and case presentations. The content is provided by full-time ophthalmology faculty and fellows at M. D. Anderson Cancer Center. Experts in complementary disciplines such as ophthalmic pathology, dermatopathology, radiation oncology, radiology, and other surgical subspecialties have brought their unique perspective to each chapter.

The book is abundant with clinical photographs as well as interesting case presentations that will help the clinician correctly diagnose cancers of the orbit, eye, and adnexal structures, initiate appropriate management, as well as recognize and treat common ocular complications of cancer therapy.

An International Symposium on Low Vision was sponsored by the Centre for Sight Enhancement of the School of Optometry, University of Waterloo in June 1986, bringing low vision researchers and clinicians together from a number of countries. The unique feature of the conference is the multi-disciplinary approach towards low vision care. A total of 44 papers were presented in the three day period by speakers of note from the fields of optometry, ophthalmology, psychophysics, special education, nursing and vision rehabilitation. The papers deal with issues in diagnostic science, low vision assessment and rehabilitation. The proceedings volume is ideal for clinicians and vision scientists to update their understanding of low vision research and clinical practice.

During the past several decades, a significant international research effort has been directed towards understanding the composition and regulation of the preocular tear film. This effort has been motivated by the recognition that the tear film plays a critical role in maintaining corneal and conjunctival integrity, protecting against microbial challenge and preserving visual acuity. In addition, research has been stimulated by the knowledge that alteration or deficiency of the tear film, which occurs in numerous individuals throughout the world, may lead to desiccation of the ocular surface, ulceration and perforation of the cornea, an increased incidence of infectious disease, and potentionally pronounced visual disability and blindness.

Opening Remarks of the President, 2nd ISVO, Professor G.M. Breinin, M.D. The study of visual processes is surely unique as a clinical specialty, in corporating the disciplines of physics, chemistry, physiology, and psycho logy. Diagnosing and correcting disorders of the visual system in these last two decades of the 20th century has brought all of us into close prox imity with computer sciences, laser technology, the marvels of electronic microcircuitry, and the impressive developments in optical materials. Dur ing the course of this meeting we shall be hearing about how these different technologies can interact with one another, and we shall discover that such interaction may produce new diagnostic tools and new optical devices. We shall also learn that the optical qualities of the eye change during life, producing subtle and complex alterations in vision. On behalf of the members and organizing committee of the American Commit tee on Optics and Visual Physiology and our co-sponsoring organization, the Optical Society of America, I welcome you to this second symposium on visual optics. The first symposium took place in Japan in 1978 and, like the pres ent one, was a satellite meeting of the International Congress of Ophthal mology. The third symposium in this series will take place in Italy in 1986 as part of the next session of the International Congress of Ophthalmology.

During the past decade a significant international research effort has been directed towards understanding the composition and regulation of the preocular tear film. This effort has been motivated by the recognition that the tear film plays an essential role in maintaining corneal and conjunctival integrity, protecting against microbial challenge and preserving visual acuity. In addition, research has been stimulated by the knowledge that alteration or deficiency of the tear film, which occurs in countless individuals throughout the world, may lead to desiccation of the ocular surface, ulceration and perforation of the cornea, an increased incidence of infectious disease, and potentially, pronounced visual disability and blindness. 7 To promote further progress in this field of vision research, the International Conference on the Lacrimal Gland, Tear Film and Dry Eye Syndromes: Basic Science and Clinical Relevance was held in the Southampton Princess Resort in Bermuda from November 14 to 17, 1992. This meeting was designed to assess critically the current knowledge and 'state of the art' research on the structure and function of lacrimal tissue and tears in both health and disease. The goal of this conference was to provide an international exchange of information that would be of value to basic scientists involved in eye research, to physicians in the ophthalmological community, and to pharmaceutical companies with an interest in the treatment of lacrimal gland, tear film or ocular surface disorders (e. g. Sjogren's syndrome).

With over 20 years of experience, Dr. Kenneth A. Lane has designed "Developing Ocular Motor and Visual Perceptual Skills: An Activity Workbook" to help occupational therapists, optometrists, and other professionals develop the ocular motor and visual perceptual skills of learning disabled children.

To establish a framework for understanding, each chapter begins with the scientific theories used to develop the activity forms. Insightful suggestions are included on how to solidify the program's success.

The easy-to-follow activity forms are then presented, along with numerous illustrations that help develop ocular motor and visual perceptual skills. The forms are divided into as many as five levels of difficulty so both children and teenagers can benefit from each activity.

"Developing Ocular Motor and Visual Perceptual Skills" contains daily lesson plans and practical tips on how to successfully start an activities program. Other helpful features include a glossary of terms and a reference list of individuals and organizations that work with learning disabled children to develop these skills.

The first of its kind, "Developing Ocular Motor and Visual Perceptual Skills" utilizes a learning approach by linking the theories with the remediation activities to help learning disabled children improve their perceptual and fine motor skills. All professionals looking to assess and enhance a variety of fine motor and visual perception deficiencies will welcome this workbook into their practices.
Topics include:

• Complexity of reading
• Ocular motor
• Gross motor
• Visual-motor perception
• Visual memory
• Laterality
• Reversals

Recent developments in the field of retinal detachment surgery have called for a substantial revision of the previous edition of this text. The most significant advances have focused around the increased use of pars plana vitrectomy and of various intraocular gases. The illustrations have also been improved, including more colour material, and the references have been revised and supplemented where indicated. The basic format of the first edition has, nevertheless, been adhered to: namely, a concise textbook on retinal detachment surgery which will enable the reader to attain a sequential approach to the examination and treatment of patients with retinal detachment. The clear presentation will benefit those in training as well as the more experienced general ophthalmologist who normally does not specialize in vitreo-retinal surgery, but who has to cope with retinal detachment surgical problems.

Dr. Zoltan Z. Nagy performed the first femtosecond laser-assisted cataract surgery in a human eye in 2008. As one of the most authoritative sources on the topic, Femtosecond Laser-Assisted Cataract Surgery: Facts and Results presents the history of the development and use of femtosecond laser-assisted cataract surgery summarizes the results of five years of pioneering techniques by Dr. Nagy and his team, including personal reflections and thoughts, as well as a series of classic papers. Femtosecond Laser-Assisted Cataract Surgery consists of two main sections. The first section discusses and reviews the new results for the reader from the research. The second section comprises original articles on the topic of femtosecond laser cataract surgery that is essential to ophthalmologists. Additional features include: * A review of the current state-of-the-art usages of femtosecond laser-assisted cataract surgery * Examine existing technologies that compete with femtosecond laser-assisted cataract surgery and compare outcomes * Discuss key secrets to successful surgical techniques using femtosecond laser-assisted cataract surgery * How to address and manage common complications associated with femtosecond laser-assisted cataract surgery Femtosecond Laser-Assisted Cataract Surgery presents these clinical results with cataract and corneal application, and highlights basic research with the strength of the anterior capsule and will assist ophthalmologists and residents alike gain a better understanding of the femtosecond laser cataract surgery process.