244
AMERICAN JOURNAL OF OPHTHALMOLOGY
SPECTACLE AID DEVICE FOR BILATERAL APHAKIC PATIENTS
Editor: I read with interest the article, "Spectacle aid for contact lens wearers with bilateral aphakia" (Am. J. Ophthalmol. 80:547, 1975), by R. A. Brown, S. G. Kramer, and D. Erickson, describing a hinged spectacle device. Since 1967, I have used a simpler version of the same idea for bilateral aphakic patients (Figure). Its availability has en abled many patients to use contact lenses who might otherwise not have been able to do so.
Figure (Hodes). The simple modification of a conventional spectacle frame, shown with an aphakic correction on one side. No lens is provided for the opposite side.
Because most aphakic individuals have old spectacles which they are no longer able to use, I prefer to use that frame. The left side of the frame is left open without a correction so the first contact lens may be inserted on that side without encumbrance. The optician removes the bottom portion of the rim, leav ing % of the nasal rim for support against the nose and nothing below the hinge tempor ally. The spectacle correction ordered as a single vision lens for the other side is +1.50 D more than the appropriate aphakic distance correction for that eye. This mid-range pow er, together with the 30% magnification af forded by the aphakic spectacle lens, provides sufficient clarity of vision for contact lens cleaning, wetting, and rinsing while still al lowing the patient to see through a mirror (with a doubled working distance) to ac curately position the first contact lens on the cornea. The vision achieved once this first contact lens has been inserted is suffi
FEBRUARY, 1976
cient for handling and inserting the second lens without any additional optical aids. This simple device is inexpensive, easily made, and lightweight. BARTON L. HODES,
M.D.
Chicago, Illinois
BOOK REVIEWS By Joseph Lang. Hassenbergsteige, Germany, Ferdinand Enke Verlag, 1973. Paperbound, 121 pages, table, of contents, index, 39 black and white figures. $12.54
MIKROSTRABISMUS.
Ultrasmail angles of strabismus may es cape detection by ordinary methods of ex amination. Since amblyopia is a regular fea ture of microtropia, such patients often are subjected to an extensive and unnecessary neurological examination to establish the cause for reduced visual acuity in one eye. Thus, microstrabismus is practically and clinically important in ophthalmology. From a theoretical point of view the meticulous observation of sensory and motor distur bances in patients with microtropia has added to our understanding of the pathophysiology of strabismus. Unfortunately, there is a multiplicity of terms and defini tions for the entity. For this reason we wel come the publication of a monograph on microstrabismus by the originator of this term, who has contributed extensively to our knowledge on the subject. This monograph contains the story of his exploits together with a comprehensive review of the litera ture. The story makes interesting reading for every strabismologist with a command of German. The material is stimulating and at times controversial. For instance, one may argue with the concept that microstrabismus is a primary sensory disturbance, maintained by anomalous retinal correspondence, that anisometropic amblyopia is a different nosological entity, that the cover test is positive
AMERICAN JOURNAL OF OPHTHALMOLOGY
SPECTACLE AID DEVICE FOR BILATERAL APHAKIC PATIENTS
Editor: I read with interest the article, "Spectacle aid for contact lens wearers with bilateral aphakia" (Am. J. Ophthalmol. 80:547, 1975), by R. A. Brown, S. G. Kramer, and D. Erickson, describing a hinged spectacle device. Since 1967, I have used a simpler version of the same idea for bilateral aphakic patients (Figure). Its availability has en abled many patients to use contact lenses who might otherwise not have been able to do so.
Figure (Hodes). The simple modification of a conventional spectacle frame, shown with an aphakic correction on one side. No lens is provided for the opposite side.
Because most aphakic individuals have old spectacles which they are no longer able to use, I prefer to use that frame. The left side of the frame is left open without a correction so the first contact lens may be inserted on that side without encumbrance. The optician removes the bottom portion of the rim, leav ing % of the nasal rim for support against the nose and nothing below the hinge tempor ally. The spectacle correction ordered as a single vision lens for the other side is +1.50 D more than the appropriate aphakic distance correction for that eye. This mid-range pow er, together with the 30% magnification af forded by the aphakic spectacle lens, provides sufficient clarity of vision for contact lens cleaning, wetting, and rinsing while still al lowing the patient to see through a mirror (with a doubled working distance) to ac curately position the first contact lens on the cornea. The vision achieved once this first contact lens has been inserted is suffi
FEBRUARY, 1976
cient for handling and inserting the second lens without any additional optical aids. This simple device is inexpensive, easily made, and lightweight. BARTON L. HODES,
M.D.
Chicago, Illinois
BOOK REVIEWS By Joseph Lang. Hassenbergsteige, Germany, Ferdinand Enke Verlag, 1973. Paperbound, 121 pages, table, of contents, index, 39 black and white figures. $12.54
MIKROSTRABISMUS.
Ultrasmail angles of strabismus may es cape detection by ordinary methods of ex amination. Since amblyopia is a regular fea ture of microtropia, such patients often are subjected to an extensive and unnecessary neurological examination to establish the cause for reduced visual acuity in one eye. Thus, microstrabismus is practically and clinically important in ophthalmology. From a theoretical point of view the meticulous observation of sensory and motor distur bances in patients with microtropia has added to our understanding of the pathophysiology of strabismus. Unfortunately, there is a multiplicity of terms and defini tions for the entity. For this reason we wel come the publication of a monograph on microstrabismus by the originator of this term, who has contributed extensively to our knowledge on the subject. This monograph contains the story of his exploits together with a comprehensive review of the litera ture. The story makes interesting reading for every strabismologist with a command of German. The material is stimulating and at times controversial. For instance, one may argue with the concept that microstrabismus is a primary sensory disturbance, maintained by anomalous retinal correspondence, that anisometropic amblyopia is a different nosological entity, that the cover test is positive
