SUMMARY The prevalence of refractive errors was studied in an adult rural population. Of the 8102 eyes studied 18-4% were myopic, 57-1 % were emmetropic, and 24-5 % were hypermetropic. Mild myopia was commoner in males than in females, and mild hypermetropia was commoner in females than in males. There was increasing hypermetropia with increasing age, probably due to unmasked, latent hypermetropia up to the age of 70 years and to a true shift toward hypermetropia after the age of 70 years.
Since Gonin (1921, 1930) established the role of retinal breaks in the aetiology of retinal detachment, the closure or isolation of retinal breaks has become an essential part of all procedures for the treatment of this condition. The "prophylactic" treatment of retinal breaks is practised in many centres, but in recent years it has been shown that asymptomatic retinal breaks without detachment are a frequent finding in "normal" eyes (Halpern, I966; Byer, I967; Rutnin and Schepens, I967).About two-thirds of retinal detachments occur in myopic eyes (Duke-Elder and Dobree, I967). The present report deals with degenerative changes in the peripheral retina of asymptomatic myopic eyes, with special reference to retinal breaks.
Material and methodsBiomicroscopical examination of the peripheral fundus of 332 myopic eyes was performed using the Goldmann three-mirror contact lens and the Haag-Streit goo slit lamp. The first two myopic patients appearing in the eye clinic of the Rothschild Government-Municipal Hospital, Haifa, on any receiving day during a 14-month period were included in the study provided that they fulfilled the following criteria: It was felt that the cases examined represented an unselected group of myopes, asymptomatic with regard to retinal disease.Maximum dilatation of the pupil was achieved by one or more instillations of o 5 per cent. tropicamide and io per cent. phenylephrine. The cornea was anaesthetized with 0o4 per cent. novesine.The entire peripheral fundus was examined using both fundus mirrors of the contact lens, turning the slit into the horizontal position for examination of the nasal and temporal periphery. Each eye was examined only once, 5 to I0 minutes being allotted to each examination. Only one eye was examined at each session and all the patients were invited to attend for examination of the second eye at a later date; 2I patients did not attend for examination of the fellow eye and in these cases the results of the examination of only one eye were included in the results.
The following case is reported because of the rarity with which keratoconus or keratoglobus is associated with blue sclerae. Examination of the family of the propositus and a study of the literature suggest that these findings may be the ocular manifestations of a distirct, heritable disorder of connective tissue.
Case reportA 4-year-old girl was referred to the department of ophthalmology of the Rothschild Hospital, Haifa, because of a blue discoloration of the sclerae from birth, bulging of the eyes which had been first noticed at the age of 4 months, and apparent short sight. The child was the product of a normal pregnancy and a normal full-term delivery. The birth weight was 3-6 kg. There had been three episodes of bronchopneumonia in the past which responded satisfactorily to antibiotics. There wvas no history of fractures or dislocations.PHYSICAL EXAMINATION The child was reasonably well nourished and in good general condition.Her height was I03 cm. (5oth percentile) and her weight I5 kg. (25th percentile). There was marked hypotony of the limbs, hyperextensibility of the joints throughout the body (Fig. I), and a small umbilical hernia. The skull was elongated in its antero-posterior axis, giving the impression of scaphocephaly. The skin was highly freckled but of normal texture and elasticity. The hair was There was a bilateral hearing loss due to chronic otitis media and cholesteatoma. The teeth were in poor condition and dental examination established a diagnosis of dentinogenesis imperfecta. The rest of the physical examination was normal.
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