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REPORT OF A CASE History and Preoperative Course.—S. H., a man aged 29, referred by Dr. Joseph Edeiken, was first seen on March 26, 1934. He complained of blurred vision and sharp retrobulbar pain which had been present for two weeks. The pain was especially marked on lateral movement of the eyes and on sneezing or coughing. The ophthalmic examination showed that the pupils were regular and equal and responded promptly to all the tests for normal reflexes. The media were clear. The optic disks were normal in color and well outlined, and the eyegrounds appeared entirely healthy. Visual acuity was 10/200 in the right and 20/40 in the left eye. There was a bitemporal hemianopic paracentral scotoma extending above and below the horizontal line with a moderate bitemporal peripheral contraction (fig. 1). A provisional diagnosis of retrobulbar neuritis probably secondary to sinusitis, or of a pituitary lesion

Aim: To prospectively assess the visual acuity outcomes of phacoemulsification surgery in 2 tertiary referral hospitals over an 8-year period, and to compare the outcomes achieved by ophthalmology consultants and registrars in routine clinical practice to assess the appropriateness of patient allocation.Methods: This prospective/retrospective case series of phacoemulsification surgery recruited patients from 1 July 2000 to 30 Dec 2008. Patients underwent detailed ophthalmic examination before and after surgery.Phacoemulsification and insertion of intraocular lens was performed by consultants and senior and junior registrars, who were allocated by the treating consultant. Postoperative review was conducted 1 day, 1 week, 1 month, and 3 months after surgery.Results: Of the 1812 cases, 1596 (88.1%) were complication free. The mean postoperative visual acuity was 0.17 LogMAR (6/9 Snellen equivalent), with 1630 cases (90.0%) achieving 0.30 LogMAR (6/12) or better. Consultants, and senior and junior registrars all achieved similar postoperative visual acuities of 0.15 to 0.17 LogMAR (p = 0.5). There was a significantly different rate of vitreous loss between the 3 groups (p = 0.002), with consultants at 2.9% (9/309), senior registrars at 1.9% (15/804) and junior registrars at 5.3% (37/699).Conclusions: The visual acuity outcomes and complication rates confirm that quality care is being delivered to patients. The different complication rates between consultants and registrars reflect consultants allocating themselves more complicated cases and the training of junior registrars. The similar postoperative visual acuities achieved showed that allocation of patients among consultants and registrars was appropriate and good visual acuity outcomes were delivered to all patients.

THE average physician cannot boast of great familiarity with the conduct or interpretation of roentgen examinations, or of adequate comprehension of the possibilities of diagnostic aid to be obtained from X-ray studies. His contact with X-ray problems consists in the main of emergency cases in which fractures or dislocations are suspected, and occasional reference of cases to X-ray laboratories for a “picture” of the lungs, stomach, or urinary tract. He has not appreciated that, in addition to skeletal diseases and injuries, roentgen studies may be applied with advantage to nearly all visceral disorders, including many diseases of the nervous system. He does not stop to realize that examination with the X-rays is much more complicated than the simple taking of a “picture”; that it is really no more a simple laboratory procedure than an ophthalmic examination or a urinary tract examination or a gynecologic study, and that a clinical knowledge of the conditions entering into his problems is a necessary part...

ObjectiveTo report the outcome of mushroom keratoplasty for the treatment of full thickness corneal disease in pediatric patients with healthy endothelium.MethodsA retrospective analysis of pediatric patients who underwent mushroom keratoplasty. The medical records of pediatric patients suffering from full thickness corneal stromal disease with normal endothelium who underwent mushroom keratoplasty at our Institution were included. A two-piece donor graft consisting of a large anterior stromal lamella (9.0mm in diameter and ±250μm in thickness) and a small posterior lamella (5–6.5mm in diameter) including deep stroma and endothelium, prepared with the aid of a microkeratome had been transplanted in all cases. Ophthalmic examination including slit lamp examination, best corrected visual acuity, and corneal topography was performed preoperatively and at each postoperative visit on all patients. The endothelial cells were assessed by specular microscopy in these patients.ResultsSix eyes of six patients (five males and one female) were included. The mean age was 9.3years (range 5–15years). Average follow-up was 17.8months (range 9–48months).There were no early or late complications recorded. All corneas were clear at the last follow up visit.Preoperative best corrected visual acuity (BCVA) was worse than 20/70 in all six eyes. Postoperatively, four eyes achieved BCVA of 20/40 or better.Endothelial cell loss (n eyes=3 averaged 24% (range 19–31%). The mean endothelial cell loss was 24% (range 19–31%) among these patients.ConclusionsMicrokeratome assisted mushroom keratoplasty is a viable surgical option for pediatric eyes with full thickness corneal stromal disease and healthy endothelium. Mushroom keratoplasty combines the refractive advantage of a large penetrating keratoplasty with the survival advantage of a small penetrating keratoplasty. Furthermore, mushroom keratoplasty exhibits the mechanical advantage of a shaped keratoplasty.

A 20-year-old woman was noted to have progressive cataractous changes in the left eye for two years. Ophthalmic examination showed a yellow-pink mass in the iris root (between the 8- to 10- o'clock positions, facing the patient). No associated colobomatous defect was present. A sector iridectomy with partial cyclectomy was performed. Histopathologically the mass, which was composed of an admixture of glial cells and neurons, was diagnosed as glioneuroma. It was believed the tumor had been incompletely excised at the posterior margin of surgical resection. No additional therapy was instituted. When the patient was reexamined 6 1/2 years later, the residual mass remained unchanged. Four previously reported cases of glioneuromas of the iris and ciliary body are summarized.

SUMMARY Cataract surgery with intraocular lens implantation (cataract-IOL surgery) performed by ophthalmology residents under supervision of experienced surgeons in 1974-1978 was analyzed. Retrospective evaluation of 32 cases noted patient age and sex distribution, preoperative ophthalmic examination findings, technique for cataract surgery with implantation of iris support intraocular lenses, postoperative complications, and visual acuity with best correction 30 months after surgery as well as on the last examination. Postoperative follow-up, ranging from one to 84 months, recorded a visual acuity with best correction of 20/40 or better in 87.5% of cases. Excluding two cases in which decreased visual acuity resulted from macular degeneration, visual acuity with best correction was 20/40 or better in 94% of cases.

Existing methods for early detection of ocular injury from diabetes have serious limitations. We describe a new method, measuring visual flicker discrimination of the blue-sensitive mechanism of vision. This method is noninvasive, quantitative, and capable of distinguishing two types of impairment. Blueflicker discrimination was measured in 10 adults with type I (insulin-dependent) diabetes for

A case is presented of a 16-year-old anticoagulated, immunocompromised male presenting with a blind, proptotic left eye, total ophthalmoplegia, and central retinal artery occlusion. Ophthalmic examination revealed other features of the orbital apex syndrome. Mucormycosis misdiagnosed as a traumatic orbital hemorrhage led to the patient's death. In this review, differential diagnosis of the orbital apex syndrome (loss of cranial nerves II, III, IV, ophthalmic division of V, and VI) is outlined, and features, diagnosis, and treatment of mucormycosis are discussed. Although mucormycosis is most commonly seen in diabetics, it should be considered in any immunocompromised patient presenting with the constellation of features of orbital apex syndrome.

We studied the application of preferential looking (PL) procedures to evaluation of visual performance of 59 prematurely born infants and young children. Neurological abnormalities were present in 29 of the 59 patients. Ophthalmic examination revealed normal eyes in 20 of the patients; retinopathy of prematurity (20 patients) and strabismus (13 patients) were the most prevalent ophthalmological disorders; the remaining 6 patients had a variety of ophthalmic anomalies. Results indicate that PL testing of such patients is best accomplished after age 2 months. Patients with developmental delays can be tested, but they may have poor PL performance that is not accounted for by ophthalmic abnormalities. Differences in PL acuities between right and left eyes were indicative of amblyopia in some of the strabismic patients; sequential PL acuities monitored occlusion therapy in these pre-verbal youngsters. Prematurely born infants are at risk not only for retinopathy of prematurity,1 but also significant refractive errors,2,3 a higher-than-normal prevalence of strabismus,4 and ocular disorders associated with congenital infections and chromosomal anomalies. Besides the specific ocular conditions that can lead to visual loss, the symptoms of visual inattention, especially among the developmentally delayed infants, leads to ophthalmologic consultation. Successful assessment of vision in these prematurely born infants could complement the ophthalmologist's examination (just as vision testing in older patients does), and contribute to the information in which the family and other providers base plans for care of the prematurely born patient with visual problems. We tested the vision of prematurely born infants using preferential looking (PL) procedures.5-8 PL is one of several methods currently available that may be clinically useful5,6,8,10 for investigation of infants' visual capabilities.9 The prematurely born patients provided a population, acknowledged to have a high prevalence of ocular disorders, that allowed us to evaluate further the clinical utility of PL. Also, we wanted to appraise PL visual performance of the prematurely born among our high-risk-infant patient population" that often requires integration of ongoing medical care and education services.

The author offers a logical procedure and philosophy for the pediatrician to use for the examination of infants and children, giving guidelines for proper time periods for examinations and for the extent of the examination.

The authors present a case of neuro-ophthalmic systemic lupus erythematosus in which an initial diagnosis of "hysteria" was made. The authors review the ophthalmic symptoms of systemic lupus erythematosus and technical aspects of the ophthalmic examination useful in differentiating organic from functional blindness.

A brief review is made of the major factors that are likely to cause eye discomfort fromclerical work in traditional office environments. A procedure is proposed whereby cases ofcomplaint may be systematically investigated. Methods are suggested for making a fairlyquick evaluation of the task characteristics and the lighting conditions and it is suggestedthat measurements of the thermal characteristics of the environment also be carried out.In order to complete the investigation, it is necessary to obtain a person's subjectiveresponses to the environment, using a suitably prepared questionairre, and for an eyeexamination to be performed by an ophthalmic optician.IntroductionMany papers have been published on eye discomfort but most of them have been concernedwith a specific aspect of that subject, such as eyestrain, glare, or visual task conditions.However, all of these factors and others should be considered when complaints arise fromworking conditions and this paper brings together a number of assessments that can be madein specific situations so that a comprehensive analysis may be carried out. Eye discomfortis a complaint that has been recognised for years, and it has received particular emphasisin recent times with the introduction of visual display units into working environments.This new technology has tended to overshadow the fact that clerical work is still common-place and the reading of paperwork will no doubt continue for a long time to come oftenaccompanied by visual discomfort.A survey on office workers employed on traditional office tasks, conducted by Brundrett2in 1974, showed that about 40% of the 600 staff studied, complained of eyestrain. Goacherreported in 1980 to the National Lighting Conference, that symptoms of eyestrain wereexperienced by 50% of his patients attending for ophthalmic examination and for 25% of themeyestrain was their sole complaint. He concluded that evidence from various sourcesindicated that eyestrain affects about a third of the working population. Variousresearches have compared ordinary clerical tasks with work on VDU's, Grandjean &Vigiliani 1980, and they have shown that a considerable incidence of eyestrain does existamong the clerical workers although it is generally higher for the VDU task.It is proposed here that a systematic analysis to identify the cause or causes of eyediscomfort in specific situations can be made by progressing through a series of observa-tions, of both a physical and a subjective type. Such observations would be made onvarious attributes of the following

A clinical study of bumetanide, a new diuretic, was conducted in outpatients of a cardiology clinic to determine its long-term effectiveness and safety in the treatment of peripheral edema due to congestive heart failure. The drug was administered for at least 24 weeks on a selected group of 34 patients. The patients were monitored for clinical response, evidenced by changes in cardiac signs and symptoms, and by laboratory tests, as well as by slit-lamp ophthalmic examination, electrocardiogram, and chest x-ray. Based on the clinical evaluation of effects on body weight, chronic edema, functional physical capacity, and results of selected laboratory data, it was concluded that bumetanide is as effective as other diuretics and can be used as an initial diuretic for maintenance of body weight for long-term use in patients with peripheral edema due to congestive heart failure. Bumetanide mobilizes peripheral edema effectively in most patients and leads to improvement in functional physical capacity. Safety and adverse reactions during treatments are discussed.

A 7-year-old male Kerry Blue Terrier had been compensating for a visual deficit for approximately 2 months. Five days before examination, the dog had suddenly lost all vision and the pupils had become widely dilated and unresponsive to light. Ophthalmic examination revealed inflammation of the optic discs. Response to therapy was favourable but temporary. Post mortem findings consisted of granulomatous optic neuritis, meningoencephalitis and chorioretinitis, similar to reticulosis.

The prevalence of open-angle glaucoma is believed to be very high among West Indian blacks. To begin investigating the prevalence and risk factors for glaucoma and other eye diseases in Barbados, WI, a pilot study was conducted. The pilot project identified a stratified, random national sample of 300 persons over 35 years of age who were invited to participate in an ophthalmic examination and an interview. Of those contacted 89% were eligible and 95% of these agreed to participate. The overall glaucoma prevalence in the participants was 6%; it was 13% among black and mixed persons over 54 years. Age related cataract, hypertension, and diabetes were frequent findings. Although the sample size of the pilot project is small, the results suggest a high prevalence of glaucoma in Barbados, a finding that merits further study.

Ophthalmic examination of 64 307 Aborigines and 41 254 non-Aborigines in remote rural Australia during the course of the National Trachoma and Eye Health Program revealed a positive correlation between the prevalence of senile cataract and levels of climatic ultraviolet (UV) radiation. Aborigines were more likely to be affected by senile cataract than non-Aborigines. It seems that Aborigines who live in areas of higher UV irradiation are more likely to acquire cataract; more likely to acquire the condition earlier in life; and more likely to be blind or visually disabled by it, than their counterparts living in areas of low UV irradiation. Provision of adequate shelter in areas of high insolation, where most cases of cataract occur, is likely to be an effective preventive measure.

We assessed the accuracy of ten ophthalmic technologist trainees (OTs) in commonly performed tasks of the ophthalmic examination. Results were derived from 224 patient examinations; 160 patients were examined both by OTs and ophthalmology residents, and an additional 64 were examined both by OTs, residents, and a faculty ophthalmologist. In measurement tasks, there was no significant difference in the results produced by the three types of providers. In identifying abnormalities of the globe and adnexae, and in history-taking, OT performance was nearly as accurate as that of the residents, when compared to the findings of the faculty ophthalmologist. In diagnosis and disposition, OT performance fell below the physician standard, especially in difficult cases. Patient acceptance of both formally trained and on-the-job trained ophthalmic medical assistants was very high. These results suggest that assistants with training comparable to that of the participants in this study may perform a large proportion of the routine ophthalmic examination without sacrificing quality or satisfaction with care.

Fluctuating left exophthalmos in a mature male Macaca fascicularis was studied clinically utilizing the diagnostic modalities of A- and B-scan ultrasonography and computerized tomography in addition to routine ophthalmic examination and radiography. Laboratory results were suggestive of thyroid hypofunction. Clinical and histopathologic observations were consistent with a diagnosis of dysthyroid orbitopathy, a condition previously unreported in nonhuman primates and the most common cause of unilateral exophthalmos in humans.

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In January 1927 at Kansas City, Kan., a 2 year old white boy had his left eye removed because of a glioma of the retina, verified pathologically. There was no extension into the optic nerve. The boy grew up and married, and in February 1948 his wife gave birth to a girl. In August 1948, when the child was 6 months old, the parents noticed that her right eye was larger than her left. The first ophthalmic examination was at the Manhattan Eye, Ear and Throat Hospital on October 26, at which time the right eye was noted to be rather large, the cornea steamy, the iris discolored, the tension extremely high as determined by palpation, and the globe injected. Examination the same day, with the patient under ether anesthesia and with the left pupil dilated, showed almost complete detachment of the retina of the left eye, with yellowish white

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Twelve out of 19 battered babies seen with ocular damage have permanent impairment of vision affecting one or both eyes. Ocular disease, especially retinal haemorrhage, is common in the battered-baby syndrome, and infants with this condition should always have a complete ophthalmic examination.

Purpose: In this study we decided to answer the question of whether spending more time on reading and writing leads to higher prevalence of myopia.Material and methods: A total of 70 people (140 eyes) – 17 men and 53 women aged 18–29 years (mean 22.5 ±2.8) were examined. A questionnaire concerning the amount of time spent each day on reading and writing, as well as ophthalmic examination involving: visual acuity, anterior segment and fundus examination, keratometry, auto‍‑refractometry and axial length of the eyeball measurement (using IOL Master) were carried out in all participants. The refractive errors were described as spherical equivalents (SE). Hyperopia was defined to be SE higher than +0.5 Dsph, and emmetropia to be higher than –0.5 and lower than +0.5 Dsph. Myopia was defined to be with a SE lower than –0.5 Dsph. High myopia was defined as SE lower than –8, medium myopia in the range between –8 and –4, and low myopia lower than –0.5 and higher than –4 Dsph. The obtained results were typed into an Excel spreadsheet and analyzed statistically using Statistica 10 software. P values of < 0.05 were considered statistically significant.Results: It was found that people with low myopia spent statistically more time on reading and writing than participants in the emmetropic group (5.8 ±2.4 vs 4.1 ±2.4 h/day, p = 0.003). A relationship between reading and writing and medium and high myopia and hyperopia was not observed (p > 0.05).Conclusion: Near visual work leads to higher prevalence of low myopia.

PURPOSE To assess the short-term anatomic effect of intravitreal ranibizumab for polypoidal choroidal vasculopathy. METHODS All patients had undergone a full ophthalmic examination. A monthly injection of ranibizumab was performed for 3 months. Indocyanine angiography (ICG) and optical coherence tomography (OCT) were performed 1 month after the third-month ranibizumab injection. RESULTS Polyps disappeared on ICG angiography in 9 out of 13 lesions (69.2%). Retinal thickness diminished significantly on OCT (p=0.02). In our series we noticed a significant reduction of the percentage of patients presenting with subretinal fluid (p=0.02) and pigment epithelium detachment between the initial and final visits (0.016). In addition, we noticed that BCVA increased significantly (p 0.02). CONCLUSIONS Monthly intravitreal injection of ranibizumab for 3 months has a short-term beneficial anatomic effect.

In the ophthalmic examination, photographs document both normal and pathologic findings in patients. Thus, they constitute an invaluable part of the medical record. High-quality external photographs, produced quickly and inexpensively, are particularly helpful as a surgeon's reference in blepharoplasty, blepharoptosis correction, and other oculoplastic procedures. 1 Instant-camera photography is also useful in the evaluation of ocular motility and neuro-ophthalmic disorders.

To the Editor. —A stool guaiac testing solution (Hemoccult) consisting of 5% hydrogen peroxide and 95% alcohol is packaged and labeled in an almost identical manner as the ocular topical anesthetic, Ophthaine (proparacaine hydrochloride). This note is to bring this fact to the attention of the ophthalmic community. Report of a Case. —During a routine ophthalmic examination of a 35-year-old woman, 1 drop of Hemoccult was placed in both inferior conjunctival cul-de-sacs in preparation for placement of mydriatics for funduscopic examination. Immediate blepharospasm, copious tearing, and expression of more than the usual stinging occurred. The examiner had verified the contents of the anesthetic bottle earlier, had placed the container separate from other containers, and was surprised to see at this point that the printing on the just-used container was now different. Investigation disclosed that a person who was determining stool guaiac tests that day with Hemoccult had come to the

Some areas of application of the infrared image converter to diagnostic procedures in cases of corneal opacification are presented. Further extension of areas of usefulness will be paced by technical advances in infrared optics, quality of screen image, and simplification of design to facilitate the adaptation of the tube as an auxiliary for direct ophthalmic examination.

Ophthalmic examination and visual function tests often require apparatus brought close to the patient's face. Such apparatus often distracts or frightens infants and children, creating instrument artifact. In adults, misalignment with the apparatus can also interfere with successful examination or measurement. These problems can be minimized or eliminated by using an optical system to form an aerial image of the patient in free space. The examination or test is then performed on the aerial image of the patient's eyes, avoiding instrumentation near the patient's face. Several newly developed remote optical systems are described for clinical and research application.

The paper demonstrates that limited cryosurgery combined with scleral buckling in premature infants with acute proliferative retrolental fibroplasia in a procedure which can be extremely successful in the treatment of this devastating disease. Timing for surgical intervention is critical. The indications for the surgical intervention are stated. The continuous monitoring of those infants with retrolental fibroplasia is critical to the success of the operative procedure. Since critical timing for success is involved, a new schedule for ophthalmic examination of the premature infant is proposed. This new schedule differs significantly from that proposed by the American Academy of Pediatrics in 1971. At that time, there was no successful treatment for retrolental fibroplasia. In contrast, we submit that limited cryosurgery combined with scleral buckling is an efficacious form of therapy for this disease.

To the Editor.— Dr King (235:908, 1976) quite correctly pointed out the importance of performing careful examination of visual fields by confrontation, as part of the ordinary neurologic and ophthalmic examination. This is a simple diagnostic technique requiring no special equipment. It has often been poorly taught. Finger wiggling in the far periphery, which is still taught in most medical schools, is the crudest of tests and will pick up only absolute field defects. When done carefully, the confrontation technique is as sensitive a way of getting basic information about the visual fields as formal perimetry with a tangent screen or a Goldmann perimeter—and it is a lot quicker and cheaper. It is useful to think of the confrontation test as consisting of three steps. The patient, with one eye well patched, is seated comfortably, facing the examiner, and is asked to fixate on the examiner's nose. The examiner watches

To the Editor. —There have been several reports on the incidence of central nervous system (CNS) side effects associated with ocular β-blocker administration, 1-2 including the recent preliminary study by Lynch et al 3 reported in the July 1988 issue of theArchives. Recently, we completed a double-masked pilot study that was designed to quantitatively compare the incidence of CNS effects secondary to the use of two ocular β-blockers, betaxolol hydrochloride/maleate and timolol hydrochloride/maleate. Forty-four normal male and female volunteers enrolled in this five-week, randomized, comparative study. All of the subjects were between 50 and 75 years of age. The data for each of the 23 men and 21 women were included in the analysis; none of the subjects was withdrawn from the study. Analysis of the demographic variables indicated no significant differences between the treatment groups at baseline. Further analysis of the physical examination results, the ophthalmic examination results

Case 1. —Permanent quadrant and hemianopic losses following so-called "migrainous attacks." Five weeks ago, I was asked to examine the eyes of a woman, aged 46, with a visual disturbance of several days' standing. It was stated that the patient had always enjoyed the best of health until the present attack, which she ascribed to the effects of a late supper of beer and Welsh rabbit, becoming overheated from dancing, and a cold ride home in a taxicab. The morning after these indiscretions, she awoke with a dull headache and blurred vision, and thinking herself bilious, took calomel and castor oil, without, however, procuring any abatement in her symptoms, the headache, which was chiefly centered over the right eye, and the loss of sight, which seemed to be confined to the same eye, still persisting. It was at this juncture that my advice was sought and an ophthalmic examination instituted.

The first edition of Harrington's textbook, The Visual Fields , appeared in 1956 and filled a definite need in ophthalmology, neurology, and neurosurgery. It received almost immediate and well-deserved recognition. The third edition is most welcome and reflects continued demand for this book. It is a thorough and sensible compendium of useful knowledge concerning the techniques for obtaining visual fields and their diagnostic interpretation. The illustrations are exceptionally clear and cover the entire range of field abnormalities. The text is lucid and readable. The bibliography is adequate. The visual field examination is a significant part of the ophthalmic examination. It provides information obtainable in no other way and can provide essential clues to diagnosis. However, in my experience, it is generally poorly performed and poorly utilized. Part 1 of Dr. Harrington's book is a discussion of the examination of the visual field and is practical and sensible and will provide

REPORT OF CASE History. —G. R. a boy then 6 years old, was first brought to me in 1929 for removal of a facial rash and correction of the right upper eyelid. I noted that he had an angioma of the right upper lid, measuring about 6 by 10 mm., and that his face—both cheeks and the nose—was covered with a reddish brownish rash. Each small nodule apparently had a fine vascular loop. Careful ophthalmic examination, with instillation of drops, revealed that he was slightly far sighted ; otherwise, his eyes were normal. The fundi were normal, and vision was 20/20 with a +0.75 D. sphere. He was referred to a dermatologist, but the diagnosis of adenoma sebaceum was not made. The dermatologist suggested electrolysis for removal of what was apparently a congenital lesion, but permission for this was refused. I saw the patient again in 1936, when an examination of

The animals in this study include twenty-nine female burros surviving a single exposure to Ta'82 y-radiation (dose range 320 to 545 R) (1), twenty female burros surviving multiple exposures to Co60 y-radiation (total dose 375 R), and ten female controls. The multiple exposures were administered in increments of 25 R each week at a rate of 40 R/hr, and the single exposures at a rate of 25 R/hr. All the animals in these groups are approximately the same age. Table I lists animals by dose groups. The burros are maintained on pasture with approximately one and one-half acres allowed per animal. Concentrates, 1 to 4 pounds per animal, according to the condition of the pastures and quality of hay available, are fed daily throughout the year. The animals are observed each day at the time the concentrates are fed. Physical examinations are made on each animal semiannually. The semiannual examination routinely includes hematology, electrocardiograms (ECG), urinalysis, fecal examination for parasitic ova and occult blood, ophthalmic examination, and appraisal of general physical condition (2-5). Weights are recorded quarterly. Photographs of each surviving animal are made semiannually. If an animal exhibits abnormal behavior, it is isolated for observation, diagnosis