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The American Journal of Ophthalmology was the first specialty periodical to be published in the Western hemisphere; the first issue appeared in New York City July 1862. Its editor and publisher was Julius Homberger, M.D., aged 22 years, who had emmigrated from Germany in January 1861. Six issues were published the first year and The Journal ceased publication after two issues in 1864. Possibly, the American Ophthalmological Society, the first national medical specialty society, was founded in 1864 in a reaction to Homberger, his journal, and his strong belief that specialists, but not other practitioners, should be permitted to advertise their skills. In 1866, Homberger submitted his resignation to the American Medical Association, which he had served a secretary of the Section on Surgery, 1864-1865. His resignation was refused and he was expelled from membership in 1868. He moved to New Orleans to practice ophthalmology in 1867, and died in 1872. The second series of The Journal began in St. Louis in 1884 with Adolf Alt, A graduate of Heidelberg University, who trained in ophthalmology in New York City, with Hermann Knapp, founder, editor, and publisher of the Archives of Ophthalmology. In 1918, the current third series of the American Journal of Ophthalmology, consolidated five ophthalmic publications, with Edward Jackson of Denver as editor.

Many organizations and individuals prompted the authorization of the National Eye Institute by the United States Congress. The United States Marine Hospital and Public Health Service established a Laboratory of Hygiene in 1887, which became the research center of the National Institute of Health in 1930. The Albert D. and Mary Lasker Medical Foundation was mainly responsible for the 1945 conversion of the American Society for the Control of Cancer to the American Cancer Society, dedicated to medical research. Mildred Weisenfeld, a patient with retinitis pigmentosa, founded The Fight for Sight! in 1946 to provide funds for eye research. The Laskers invited Miss Weisenfeld to testify in support of a National Institute of Neurology, and her appeal was so persuasive that it emerged as the National Institute of Neurological Diseases and Blindness. Congressman John Fogarty and Senator Lister Hill directed the attention of the Congress and the public to the need for the Federal support of medical research. In 1960 Jules Stein, the legendary founder of the Music Corporation of America (MCA), established a new philanthropy, Research to Prevent Blindness, which provided skilled leadership in detailing the need for research in blinding disease and obtaining Congressional and Presidential approval of a new institute. The Committee for Research in Ophthalmology and Blindness was instrumental in bringing the groups interested in the welfare of the blind into harmony with groups concerned with medical research in blinding disease. The Association of University Professors of Ophthalmology was the first medical society to support the need for a National Eye Institute. The National Eye Institute was formally approved 8 August 1968 and celebrated its 25th anniversary in 1993.

Forty-four patients with periorbital cellulitis or abscess were admitted to the hospital for treatment in a five-year period. Twenty-five patients were less than 5 years old; nine were more than 20 years old. Skin infection or trauma, upper respiratory tract infection, and sinusitis were the most common predisposing causes. Staphylococcus aureus was cultured in 13 patients and Haemophilus influenzae in nine patients. Ampicillin and methicillin were the chief antibiotics used. Ten patients required surgical drainage.

We studied the electroretinogram in normal patients, patients with opacities of the anterior segment, and patients with vitreous hemorrage, using a high-intensity light stimulus delivered either through the sclera or through the pupil. We found the response obtained with transscleral stimulation a consistent indicator of gross retinal function. Since the stimulus entered the eye through the sclera, it provided a method for studying the retinal responses independent of opaque or translucent media.

A 23-year-old man had slow psychomotor development at 6 months of age and developed intermittent corneal clouding at about 18 months. He developed a truncal ataxia and hypotonia of the limbs combined with spasticity and active deep reflexes that did not progress. His skeleton and facies were normal. Between 1 and 13 years of age, he developed severe optic atrophy, absence of retinal blood vessels, and an extinguished electroretinogram. Biochemical analysis of cultured fibroblasts indicated no lysosomal hydrolase deficiency; cellular metachromasia was absent and there was no mucopolysaccharidoses. Ultrastructural studies indicated single-membrane-limited vacuoles containing lamellated membranes and a polymorphous substance in tissue-cultured cells and conjunctiva.

A unique form of dichromatic color vision is described in a family with incomplete achromatopsia. In 1966, incomplete achromatopsia was diagnosed in 4 of 14 children of a consanguineous marriage. The 4 affected had best visual acuities of 6/60 or 6/180, pendular nystagmus, and aversion to bright lights. The ERG showed minimal photopic responses. No abnormality of rod function was present. There was a severe color vision defect. In 1976, one of the patients returned for further color testing. Color tests included measurement of the luminous efficiency function using heterochromatic flicker photometry and colorimetric evaluation. The luminous efficiency function resembled that of the protanope. From the colorimetric measurements, we conclude that the patient has a unique form of dichromatic color vision mediated by two visual photopigments: the normal MWS cone photopigment and a photopigment with the spectral characteristics of rhodopsin.

Four patients in three different families had a form of autosomal recessive incomplete achromatopsia not previously described. The visual acuity was 6/18 to 6/60 (20/60 to 20/200) with minimal ophthalmoscopic abnormality and normal fluorescein angiogram. The photopic electroretinographic responses were present in all four patients; the fusion rate of 60 Hz was only slightly subnormal. The high-intensity scotopic response was subnormal. The patients failed color screening plates and accumulated over 400 errors with scotopic axis on the Farnsworth-Munsell 100-hue test. The Rayleigh match was abnormal, displaced toward the red primary, but with normal luminance. The photopic luminous efficiency function was similar to that of the deuteranope. Color matching revealed a trichromatic form of color vision mediated by long wavelength and short wavelength cones, and a rhodopsin receptor.

General anesthesia permits surgery involving large operative fields without limit to time. It is essential in children and uncooperative adults and provides an immobile, quiet patient who does not recall the operative procedure. Local and regional anesthesia re indicated when the surgical field is limited in size and extent. Neuroleptanesthesia in ophthalmology usually involves the administration of droperidol followed by fentanyl followed in intubation, sometimes using a muscle relaxant, and maintenance of anesthesia with nitrous oxide. The terrifying dreams produced by ketamine may be minimized by preoperative administration of diazepam and a quiet recovery period. Attempts to eliminate the oculocardiac reflex are unpredictable and unreliable and, with careful monitoring of anesthesia, elimination does not seem essential. Malignant hyperthermia is an autosomal dominant disorder occurring mainly with the administration of halogenated fluoroethane and depolarizing muscle relaxants. It is often signaled by sudden and prolonged muscle spasm following the injection of the muscle relaxant. Treatment must be directed toward hyperventilation using oxygen, correction of the metabolic respiratory acidosis, and reduction of fever.

Edward Jackson died October 29, 1942, at 86 years of age. He served as president of the major national ophthalmologic organizations and was professor and chairman of the Department of Ophthalmology at the University of Colorado. He established the first graduate course for ophthalmologists, suggested the formation of the instruction courses of the American Academy of Ophthalmology, and was the principal founder of the American Board of Ophthalmology. He founded and edited the Yearbook of Ophthalmology and Ophthalmic Literature. In 1918, he became editor of the third series of the American Journal of Ophthalmology, which consolidated five ophthalmic periodicals. In 1885, he popularized retinoscopy in the United States and was mainly responsible for making it a practical refraction tool. Two years later, he described the cross cylinder to determine the presence or absence of astigmatism. In 1907, he described the use of the cross cylinder to refine the axis of a correcting cylinder in astigmatism. He lectured and wrote widely and published over 700 scientific articles, book chapters, and books.

External ophthalmoplegia, retinal pigmentary degeneration, and heart block constitute the Kearns-Sayre syndrome. Skeletal muscle weakness, deafness, ataxia and endocrine disturbances also may occur. We examined 15 members in two generations of a family with autosomal dominant Kearns-Sayre syndrome. Seven had external ophthalmoplegia, six had electrocardiographic abnormalities, six had limb weakness nad six patients were normal. A deltoid muscle biopsy specimen from one patient contained typical "ragged-red fibers," abnormal lipid accumulation, and mitochondria increased in size and number, containing inclusions. The study demonstrated: (1) the marked variability in genetic expression; (2) the need to examine family members to discover asymptomatic patients and to establish an otherwise unrecognized hereditary pattern; and (3) the absence of specific and consistent biochemical abnormalities.