NOTES, CASES AND INSTRUMENTS
flap so formed, together with the other tissues overlaying the tarsus, is dissected free from the tarsus up its superior border. The lower skin flap is then dissected free from the tarsus down to the lower or free border of the tarsus, and the dissection continued
eye and the newly made lower tarsal border is covered with conjunctiva. Besides correcting the trichiasis the operation markedly obliterates the effect of the ptosis, causing the lid to appear well elevated. LOSS OF INDUSTRIAL VISION. WALTER N. SHARP,
Fig. 1—Layson's operation for trichiasis.
around this lower border detaching the palpebral conjunctiva upward for about 2 mm. on the under surface of the tarsus. This strip of tarsus of about 2 mm. in width, and tapering at each end, should be dissected free thruout the length of the tarsus. This portion of tarsus freed is then excised. In freeing the conjunctiva from the tarsus because of the intimate adherence, the dissection must proceed carefully to avoid buttonholing the flap. Any fibers of the orbicularis remaining on the lower flap should now be excised with scissors. If there seems to be too great a redundance of skin in the upper flap a small strip of it might be excised before placing the sutures. The operation is completed by bringing the tissues together in the desired relations by three or four silk sutures. A curved needle is used passing from without inward thru the lower skin flap, then thru the tarsus alone at its upper border, then from within outward thru the upper skin flap. All the sutures are thus introduced. When they are tied the cilia portion of the skin is placed up and away from the
What is the percentage of loss of industrial vision? This is a question the court or industrial board asks when an employee's vision is considerably reduced by reason of accident to an eye. We might ask the court what it considers as industrial blindness, or 100% loss of industrial vision; for without knowing this we cannot estimate the percentage of loss of vision. The percentage of industrial vision has evidently been estimated too high; as most attorneys believe that if 20/20 equals normal, or 100% vision, then 20/40 must represent 50% loss of vision. W e should then ask, upon that basis what would 100% loss of vision be? The percentage of loss of vision is confusing to the employee, the attorney and even the oculist, and no uniformity of percentage can be attained until we use a uniform system of testtypes and numerator; nor until industrial boards of the various states adopt a standard loss of vision to represent 100%. A number of states, including Indiana, have concluded, by law, that 20/200 vision represents 100% loss of industrial vision. This being the case, then every foot lost must represent 0.5% less 10% for the numerator (20 feet) which is normal, or 100% vision, thus: Loss of industrial vision. 20/200 — il0% vision or 90% loss 20/150 — 35% " " 65% loss 20/100 = 60% " " 40% loss 20/ BO = 70% " " 30% loss 20/ 70 = 75% " " 25% loss 20/ 60 — 80% " " 20% loss 2 0 / 50 — 85% " " 15% loss
NOTES, CASES AND INSTRUMENTS
20/ 40 = 90% " " 10% loss 20/ 30 = 95% " " 5%- loss 20/ 20 = 1 0 0 % " " no loss If one uses the metric measurements, as I do, the percentage of loss is the same. 6/60 representing 100% loss of industrial vision, we have a loss of 1 2/3 for every meter lost, less 10% for 6/6 or normal vision. After I had completed my table I found that it corresponds with the table included in an article by Dr. Vernon A. Chapman and printed in the transactions of the American Academy of Ophthalmology and Oto-L. for 191718. Should we compute our percentage of loss of vision upon the basis of 20/20 (6/6) as 100% vision, then 20/200 (6/60) would be but 54% loss; 20/100 (6/30) 24% loss; 20/40 (6/12) 6% loss; etc. These correspond with a table included in an article by Dr. Samuel G. Higgins and published in the AMERICAN JOURNAL OF O P H T H A L MOLOGY, Nov., 1919.
What may be 50% loss of vision for one employee may mean 100% loss of vision for another, who is dependent upon a greater visual acuity to continue his vocation. I will leave this, however, for legislation to decide. There is great need at this time to decide just what the percentage of loss of-vision is, and just what it means to the individual employee. The latter can only be gotten at from an individual economic standpoint; and should be decided jointly, by oculists and the courts. The former should only be decided by oculists. I trust the time will soon come when we can have a standard basis upon which to work, also a test card for universal use, based upon metric measurements.
CATARACT PROBABLY DUE TO X-RAY EXPOSURE OSCAR W I L K I N S O N , A.M., WASHINGTON, D.
Read before the Medical Society of the District of Columbia in March, 1920. The case which I wish to present is one of double cataract in a woman only
40 years of age. The history in this case is negative up to two years ago. She first came to see me in October, 1917, complaining of failing vision and a slight irritation of eyes on use. Examination revealed nothing abnormal about the eyes except a slight irritation of the conjunctiva, a low degree of astigmatism and a slight clouding of both crystalline lenses, more 20 marked in the left eye. R.V. = —2, 20 20 and L. V. = — with a low cylindric 30 correction. A general examination of the patient by her physician revealed: blood normal, urinalysis negative; examination of tonsils, teeth and sinuses negative, and no digestive disturbance. No physical abnormality was noted except a very extensive lesion of lupus erythematosus, which covered a considerable portion of each cheek and a part of her nose. It is to be noted that the patient is gray, and without further analysis one might consider the gray hairs and cataracts as marks of early senility. However, I learned on inquiring into her family history that her father became gray at 36, his sister was white-headed at 25, and this patient and her sister began to get gray as early as 17 years of age, and she was quite gray at 25. I ordered correcting lenses, and gave stimulating eye drops of zinc sulphat and requested her to return in a month, at which time there was a very slow but decided increase in the lenticular opacities. I then advised a more vigorous treatment, which consisted in the use of dionin and mercury cyanid, a drop each night, with hot and cold fomentations three times a day and the use of K. I. and small doses of Hyd. Bichlo. three times a day after meals; and this was changed to iron and arsenic tonic treatment, when no improvement was manifested. No progress being made, and in view of the fact that she had lupus, despite a negative reaction to tuberculin, she was given twenty injections of gradually in-