closer than 6 metres away, the rays of light from this near object will be diverging by the time they reach the eye. In order to focus these diverging beams of light, the refracting power of the lens must increase. In other words the lens must accommodate.
The lens loses its elasticity with age, and thus becomes less spherical when tension in the zonule relaxes. This results in an increased longsightedness (presbyopia) requiring reading glasses for correction. (See AGEING.)... accommodation
Nutritional Profile Energy value (calories per serving): Low Protein: Moderate Fat: None Saturated fat: None Cholesterol: None Carbohydrates: High Fiber: None Sodium: Low Major vitamin contribution: B vitamins Major mineral contribution: Phosphorus
About the Nutrients in This Food Beer and ale are fermented beverages created by yeasts that convert the sugars in malted barley and grain to ethyl alcohol (a.k.a. “alcohol,” “drink- ing alcohol”).* The USDA /Health and Human Services Dietary Guidelines for Americans defines one drink as 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits. One 12-ounce glass of beer has 140 calo- ries, 86 of them (61 percent) from alcohol. But the beverage—sometimes nicknamed “liquid bread”—is more than empty calories. Like wine, beer retains small amounts of some nutrients present in the food from which it was made. * Because yeasts cannot digest t he starches in grains, t he grains to be used in mak ing beer and ale are allowed to germinate ( “malt” ). When it is t ime to make t he beer or ale, t he malted grain is soaked in water, forming a mash in which t he starches are split into simple sugars t hat can be digested (fermented) by t he yeasts. If undisturbed, t he fermentat ion will cont inue unt il all t he sugars have been digested, but it can be halted at any t ime simply by raising or lowering t he temperature of t he liquid. Beer sold in bott les or cans is pasteurized to k ill t he yeasts and stop t he fermentat ion. Draft beer is not pasteurized and must be refrigerated unt il tapped so t hat it will not cont inue to ferment in t he container. The longer t he shipping t ime, t he more likely it is t hat draft beer will be exposed to temperature variat ions t hat may affect its qualit y—which is why draft beer almost always tastes best when consumed near t he place where it was brewed. The Nutrients in Beer (12-ounce glass)
| Nutrients | Beer | %R DA |
| Calcium | 17 mg | 1.7 |
| Magnesium | 28.51 mg | 7–9* |
| Phosphorus | 41.1 mg | 6 |
| Potassium | 85.7 mg | (na) |
| Zinc | 0.06 mg | 0.5– 0.8* |
| Thiamin | 0.02 mg | 1.6 –1.8* |
| R iboflavin | 0.09 mg | 7– 8* |
| Niacin | 1.55 mg | 10 |
| Vitamin B6 | 0.17 mg | 13 |
| Folate | 20.57 mcg | 5 |
Diets That May Restrict or Exclude This Food Bland diet Gluten-free diet Low-purine (antigout) diet
Buying This Food Look for: A popular brand that sells steadily and will be fresh when you buy it. Avoid: Dusty or warm bottles and cans.
Storing This Food Store beer in a cool place. Beer tastes best when consumed within two months of the day it is made. Since you cannot be certain how long it took to ship the beer to the store or how long it has been sitting on the grocery shelves, buy only as much beer as you plan to use within a week or two. Protect bottled beer and open bottles or cans of beer from direct sunlight, which can change sulfur compounds in beer into isopentyl mercaptan, the smelly chemical that gives stale beer its characteristic unpleasant odor.
When You Are Ready to Serve This Food Serve beer only in absolutely clean glasses or mugs. Even the slightest bit of grease on the side of the glass will kill the foam immediately. Wash beer glasses with detergent, not soap, and let them drain dry rather than drying them with a towel that might carry grease from your hands to the glass. If you like a long-lasting head on your beer, serve the brew in tall, tapering glasses to let the foam spread out and stabilize. For full flavor, serve beer and ales cool but not ice-cold. Very low temperatures immo- bilize the molecules that give beer and ale their flavor and aroma.
What Happens When You Cook This Food When beer is heated (in a stew or as a basting liquid), the alcohol evaporates but the flavor- ing agents remain intact. Alcohol, an acid, reacts with metal ions from an aluminum or iron pot to form dark compounds that discolor the pot or the dish you are cooking in. To prevent this, prepare dishes made with beer in glass or enameled pots.
Medical Uses and/or Benefits Reduced risk of heart attack. Data from the American Cancer Society’s Cancer Prevention Study 1, a 12-year survey of more than 1 million Americans in 25 states, shows that men who take one drink a day have a 21 percent lower risk of heart attack and a 22 percent lower risk of stroke than men who do not drink at all. Women who have up to one drink a day also reduce their risk of heart attack. Numerous later studies have confirmed these findings. Lower risk of stroke. In January 1999, the results of a 677-person study published by researchers at New York Presbyterian Hospital-Columbia University showed that moder- ate alcohol consumption reduces the risk of stroke due to a blood clot in the brain among older people (average age: 70). How the alcohol prevents stroke is still unknown, but it is clear that moderate use of alcohol is a key. Heavy drinkers (those who consume more than seven drinks a day) have a higher risk of stroke. People who once drank heavily, but cut their consumption to moderate levels, can also reduce their risk of stroke. Numerous later studies have confirmed these findings. Lower cholesterol levels. Beverage alcohol decreases the body’s production and storage of low-density lipoproteins (LDLs), the protein and fat particles that carr y cholesterol into your arteries. As a result, people who drink moderately tend to have lower cholesterol levels and higher levels of high density lipoproteins (HDLs), the fat and protein particles that carr y cholesterol out of the body. The USDA /Health and Human Services Dietar y Guidelines for Americans defines moderation as two drinks a day for a man, one drink a day for a woman. Stimulating the appetite. Alcoholic beverages stimulate the production of saliva and the gastric acids that cause the stomach contractions we call hunger pangs. Moderate amounts of alcoholic beverages, which may help stimulate appetite, are often prescribed for geriatric patients, convalescents, and people who do not have ulcers or other chronic gastric problems that might be exacerbated by the alcohol. Dilation of blood vessels. Alcohol dilates the capillaries (the tiny blood vessels just under the skin), and moderate amounts of alcoholic beverages produce a pleasant flush that temporar- ily warms the drinker. But drinking is not an effective way to warm up in cold weather since the warm blood that flows up to the capillaries will cool down on the surface of your skin and make you even colder when it circulates back into the center of your body. Then an alco- hol flush will make you perspire, so that you lose more heat. Excessive amounts of beverage alcohol may depress the mechanism that regulates body temperature.
Adverse Effects Associated with This Food Increased risk of breast cancer. In 2008, scientists at the National Cancer Institute released data from a seven-year survey of more than 100,000 postmenopausal women showing that even moderate drinking (one to two drinks a day) may increase by 32 percent a woman’s risk of developing estrogen-receptor positive (ER+) and progesterone-receptor positive (PR+) breast cancer, tumors whose growth is stimulated by hormones. No such link was found between consuming alcohol and the risk of developing ER-/PR- tumors (not fueled by hor- mones). The finding applies to all types of alcohol: beer, wine, and spirits. Increased risk of oral cancer (cancer of the mouth and throat). Numerous studies confirm the American Cancer Society’s warning that men and women who consume more than two drinks a day are at higher risk of oral cancer than are nondrinkers or people who drink less. Note: The Dietary Guidelines for Americans describes one drink as 12 ounces of beer, five ounces of wine, or 1.5 ounces of distilled spirits. Increased risk of cancer of the colon and rectum. In the mid-1990s, studies at the University of Oklahoma suggested that men who drink more than five beers a day are at increased risk of rectal cancer. Later studies suggested that men and women who are heavy beer or spirits drinkers (but not those who are heavy wine drinkers) have a higher risk of colorectal cancers. Further studies are required to confirm these findings. Fetal alcohol syndrome. Fetal alcohol syndrome is a specific pattern of birth defects—low birth weight, heart defects, facial malformations, and mental retardation—first recognized in a study of babies born to alcoholic women who consumed more than six drinks a day while pregnant. Subsequent research has found a consistent pattern of milder defects in babies born to women who consume three to four drinks a day or five drinks on any one occasion while pregnant. To date, there is no evidence of a consistent pattern of birth defects in babies born to women who consume less than one drink a day while pregnant, but two studies at Columbia University have suggested that as few as two drinks a week while preg- nant may raise a woman’s risk of miscarriage. (“One drink” means 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits.) Alcoholism. Alcoholism is an addiction disease, the inability to control one’s alcohol consumption. It is a potentially life-threatening condition, with a higher risk of death by accident, suicide, malnutrition, or acute alcohol poisoning, a toxic reaction that kills by para- lyzing body organs, including the heart. Malnutrition. While moderate alcohol consumption stimulates appetite, alcohol abuse depresses it. In addition, an alcoholic may drink instead of eating. When an alcoholic does eat, excess alcohol in his/her body prevents absorption of nutrients and reduces the ability to synthesize new tissue. Hangover. Alcohol is absorbed from the stomach and small intestine and carried by the bloodstream to the liver, where it is oxidized to acetaldehyde by alcohol dehydrogenase (ADH), the enzyme our bodies use to metabolize the alcohol we produce when we digest carbohydrates. The acetaldehyde is converted to acetyl coenzyme A and either eliminated from the body or used in the synthesis of cholesterol, fatty acids, and body tissues. Although individuals vary widely in their capacity to metabolize alcohol, on average, normal healthy adults can metabolize the alcohol in one quart of beer in approximately five to six hours. If they drink more than that, they will have more alcohol than the body’s natural supply of ADH can handle. The unmetabolized alcohol will pile up in the bloodstream, interfering with the liver’s metabolic functions. Since alcohol decreases the reabsorption of water from the kidneys and may inhibit the secretion of an antidiuretic hormone, they will begin to urinate copiously, losing magnesium, calcium, and zinc but retaining more irritating uric acid. The level of lactic acid in the body will increase, making them feel tired and out of sorts; their acid-base balance will be out of kilter; the blood vessels in their heads will swell and throb; and their stomachs, with linings irritated by the alcohol, will ache. The ultimate result is a “hangover” whose symptoms will disappear only when enough time has passed to allow their bodies to marshal the ADH needed to metabolize the extra alcohol in their blood. Changes in body temperature. Alcohol dilates capillaries, tiny blood vessels just under the skin, producing a “flush” that temporarily warms the drinker. But drinking is not an effective way to stay warm in cold weather. Warm blood flowing up from the body core to the surface capillaries is quickly chilled, making you even colder when it circulates back into your organs. In addition, an alcohol flush triggers perspiration, further cooling your skin. Finally, very large amounts of alcohol may actually depress the mechanism that regulates body temperature. Impotence. Excessive drinking decreases libido (sexual desire) and interferes with the ability to achieve or sustain an erection. “Beer belly.” Data from a 1995, 12,000 person study at the University of North Carolina in Chapel Hill show that people who consume at least six beers a week have more rounded abdomens than people who do not drink beer. The question left to be answered is which came first: the tummy or the drinking.
Food/Drug Interactions Acetaminophen (Tylenol, etc.). The FDA recommends that people who regularly have three or more drinks a day consult a doctor before using acetaminophen. The alcohol/acetamino- phen combination may cause liver failure. Disulfiram (Antabuse). Taken with alcohol, disulfiram causes flushing, nausea, low blood pressure, faintness, respiratory problems, and confusion. The severity of the reaction gener- ally depends on how much alcohol you drink, how much disulfiram is in your body, and how long ago you took it. Disulfiram is used to help recovering alcoholics avoid alcohol. (If taken with alcohol, metronidazole [Flagyl], procarbazine [Matulane], quinacrine [Atabrine], chlorpropamide (Diabinase), and some species of mushrooms may produce a mild disulfi- ramlike reaction.) Anticoagulants. Alcohol slows the body’s metabolism of anticoagulants (blood thinners) such as warfarin (Coumadin), intensif ying the effect of the drugs and increasing the risk of side effects such as spontaneous nosebleeds. Antidepressants. Alcohol may increase the sedative effects of antidepressants. Drinking alcohol while you are taking a monoamine oxidase (M AO) inhibitor is especially hazard- ous. M AO inhibitors inactivate naturally occurring enzymes in your body that metabolize tyramine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. If you eat a food containing tyramine while you are taking an M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis. Ordinarily, fermentation of beer and ale does not produce tyramine, but some patients have reported tyramine reactions after drinking some imported beers. Beer and ale are usually prohibited to those using M AO inhibitors. Aspirin, ibuprofen, ketoprofen, naproxen, and nonsteroidal anti-inflammatory drugs. Like alcohol, these analgesics irritate the lining of the stomach and may cause gastric bleeding. Combining the two intensifies the effect. Insulin and oral hypoglycemics. Alcohol lowers blood sugar and interferes with the metabo- lism of oral antidiabetics; the combination may cause severe hypoglycemia. Sedatives and other central nervous system depressants (tranquilizers, sleeping pills, antidepres- sants, sinus and cold remedies, analgesics, and medication for motion sickness). Alcohol inten- sifies sedation and, depending on the dose, may cause drowsiness, respiratory depression, coma, or death.... beer
Disposable lenses are soft lenses designed to be thrown away after a short period of continuous use; their popularity rests on the fact that they need not be cleaned. The instructions on use should be followed carefully because the risk of complications, such as corneal infection, are higher than with other types of contact lenses.
Contraindications to the use of contact lenses include a history of ATOPY, ‘dry eyes’, previous GLAUCOMA surgery and a person’s inability to cope with the management of lenses. The best way to determine whether contact lenses are suitable, however, may be to try them out. Good hygiene is essential for wearers so as to minimise the risk of infection, which may lead to a corneal abscess – a serious complication. Corneal abrasions are fairly common and, if a contact-lens wearer develops a red eye, the lens should be removed and the eye tested with ?uorescein dye to identify any abrasions. Appropriate treatment should be given and the lens not worn again until the abrasion or infection has cleared up.... contact lenses
Astigmatism (See ASTIGMATISM.)
Blepharitis A chronic in?ammation of the lid margins. SEBORRHOEA and staphylococcal infection are likely contributors. The eyes are typically intermittently red, sore and gritty over months or years. Treatment is di?cult and may fail. Measures to reduce debris on the lid margins, intermittent courses of topical antibiotics, steroids or systemic antibiotics may help the sufferer.
Blepharospasm Involuntary closure of the eye. This may accompany irritation but may also occur without an apparent cause. It may be severe enough to interfere with vision. Treatment involves removing the source of irritation, if present. Severe and persistent cases may respond to injection of Botulinum toxin into the orbicularis muscle.
Cataract A term used to describe any opacity in the lens of the eye, from the smallest spot to total opaqueness. The prevalence of cataracts is age-related: 65 per cent of individuals in their sixth decade have some degree of lens opacity, while all those over 80 are affected. Cataracts are the most important cause of blindness worldwide. Symptoms will depend on whether one or both eyes are affected, as well as the position and density of the cataract(s). If only one eye is developing a cataract, it may be some time before the person notices it, though reading may be affected. Some people with cataracts become shortsighted, which in older people may paradoxically ‘improve’ their ability to read. Bright light may worsen vision in those with cataracts.
The extent of visual impairment depends on the nature of the cataracts, and the ?rst symptoms noticed by patients include di?culty in recognising faces and in reading, while problems watching television or driving, especially at night, are pointers to the condition. Cataracts are common but are not the only cause of deteriorating vision. Patients with cataracts should be able to point to the position of a light and their pupillary reactions should be normal. If a bright light is shone on the eye, the lens may appear brown or, in advanced cataracts, white (see diagram).
While increasing age is the commonest cause of cataract in the UK, patients with DIABETES MELLITUS, UVEITIS and a history of injury to the eye can also develop the disorder. Prolonged STEROID treatment can result in cataracts. Children may develop cataracts, and in them the condition is much more serious as vision may be irreversibly impaired because development of the brain’s ability to interpret visual signals is hindered. This may happen even if the cataracts are removed, so early referral for treatment is essential. One of the physical signs which doctors look for when they suspect cataract in adults as well as in children is the ‘red re?ex’. This is observable when an ophthalmoscopic examination of the eye is made (see OPHTHALMOSCOPE). Identi?cation of this red re?ex (a re?ection of light from the red surface of the retina –see EYE) is a key diagnostic sign in children, especially young ones.
There is no e?ective medical treatment for established cataracts. Surgery is necessary and the decision when to operate depends mainly on how the cataract(s) affect(s) the patient’s vision. Nowadays, surgery can be done at any time with limited risk. Most patients with a vision of 6/18 – 6/10 is the minimum standard for driving – or worse in both eyes should
E
bene?t from surgery, though elderly people may tolerate visual acuity of 6/18 or worse, so surgery must be tailored to the individual’s needs. Younger people with a cataract will have more demanding visual requirements and so may opt for an ‘earlier’ operation. Most cataract surgery in Britain is now done under local anaesthetic and uses the ‘phaco-emulsi?cation’ method. A small hole is made in the anterior capsule of the lens after which the hard lens nucleus is liqui?ed ultrasonically. A replacement lens is inserted into the empty lens bag (see diagram). Patients usually return to their normal activities within a few days of the operation. A recent development under test in the USA for children requiring cataract operations is an intra-ocular ?exible implant whose magnifying power can be altered as a child develops, thus precluding the need for a series of corrective operations as happens now.
Chalazion A ?rm lump in the eyelid relating to a blocked meibomian gland, felt deep within the lid. Treatment is not always necessary; a proportion spontaneously resolve. There can be associated infection when the lid becomes red and painful requiring antibiotic treatment. If troublesome, the chalazion can be incised under local anaesthetic.
Conjunctivitis In?ammation of the conjunctiva (see EYE) which may affect one or both eyes. Typically the eye is red, itchy, sticky and gritty but is not usually painful. Redness is not always present. Conjunctivitis can occasionally be painful, particularly if there is an associated keratitis (see below) – for example, adenovirus infection, herpetic infection.
The cause can be infective (bacteria, viruses or CHLAMYDIA), chemical (e.g. acids, alkalis) or allergic (e.g. in hay fever). Conjunctivitis may also be caused by contact lenses, and preservatives or even the drugs in eye drops may cause conjunctival in?ammation. Conjunctivitis may addtionally occur in association with other illnesses – for example, upper-respiratory-tract infection, Stevens-Johnson syndrome (see ERYTHEMA – erythema multiforme) or REITER’S SYNDROME. The treatment depends on the cause. In many patients acute conjunctivitis is self-limiting.
Dacryocystitis In?ammation of the lacrimal sac. This may present acutely as a red, painful swelling between the nose and the lower lid. An abscess may form which points through the skin and which may need to be drained by incision. Systemic antibiotics may be necessary. Chronic dacryocystitis may occur with recurrent discharge from the openings of the tear ducts and recurrent swelling of the lacrimal sac. Obstruction of the tear duct is accompanied by watering of the eye. If the symptoms are troublesome, the patient’s tear passageways need to be surgically reconstructed.
Ectropion The lid margin is everted – usually the lower lid. Ectropion is most commonly associated with ageing, when the tissues of the lid become lax. It can also be caused by shortening of the skin of the lids such as happens with scarring or mechanical factors – for example, a tumour pulling the skin of the lower lid downwards. Ectropion tends to cause watering and an unsightly appearance. The treatment is surgical.
Entropion The lid margin is inverted – usually the lower lid. Entropion is most commonly associated with ageing, when the tissues of the lid become lax. It can also be caused by shortening of the inner surfaces of the lids due to scarring – for example, TRACHOMA or chemical burns. The inwardly directed lashes cause irritation and can abrade the cornea. The treatment is surgical.
Episcleritis In?ammation of the EPISCLERA. There is usually no apparent cause. The in?ammation may be di?use or localised and may affect one or both eyes. It sometimes recurs. The affected area is usually red and moderately painful. Episcleritis is generally not thought to be as painful as scleritis and does not lead to the same complications. Treatment is generally directed at improving the patient’s symptoms. The in?ammation may respond to NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) or topical CORTICOSTEROIDS.
Errors of refraction (Ametropia.) These will occur when the focusing power of the lens and cornea does not match the length of the eye, so that rays of light parallel to the visual axis are not focused at the fovea centralis (see EYE). There are three types of refractive error: HYPERMETROPIA or long-sightedness. The refractive power of the eye is too weak, or the eye is too short so that rays of light are brought to a focus at a point behind the retina. Longsighted people can see well in the distance but generally require glasses with convex lenses for reading. Uncorrected long sight can lead to headaches and intermittent blurring of vision following prolonged close work (i.e. eye strain). As a result of ageing, the eye becomes gradually long-sighted, resulting in many people needing reading glasses in later life: this normal process is known as presbyopia. A particular form of long-sightedness occurs after cataract extraction (see above). MYOPIA(Short sight or near sight.) Rays of light are brought to a focus in front of the retina because the refractive power of the eye is too great or the eye is too short. Short-sighted people can see close to but need spectacles with concave lenses in order to see in the distance. ASTIGMATISMThe refractive power of the eye is not the same in each meridian. Some rays of light may be focused in front of the retina while others are focused on or behind the retina. Astigmatism can accompany hypermetropia or myopia. It may be corrected by cylindrical lenses: these consist of a slice from the side of a cylinder (i.e. curved in one meridian and ?at in the meridian at right-angles to it).
Keratitis In?ammation of the cornea in response to a variety of insults – viral, bacterial, chemical, radiation, or mechanical trauma. Keratitis may be super?cial or involve the deeper layers, the latter being generally more serious. The eye is usually red, painful and photophobic. Treatment is directed at the cause.
Nystagmus Involuntary rhythmic oscillation of one or both eyes. There are several causes including nervous disorders, vestibular disorders, eye disorders and certain drugs including alcohol.
Ophthalmia In?ammation of the eye, especially the conjunctiva (see conjunctivitis, above). Ophthalmia neonatorum is a type of conjunctivitis that occurs in newborn babies. They catch the disease when passing through an infected birth canal during their mother’s labour (see PREGNANCY AND LABOUR). CHLAMYDIA and GONORRHOEA are the two most common infections. Treatment is e?ective with antibiotics: untreated, the infection may cause permanent eye damage.
Pinguecula A benign degenerative change in the connective tissue at the nasal or temporal limbus (see EYE). This is visible as a small, ?attened, yellow-white lump adjacent to the cornea.
Pterygium Overgrowth of the conjunctival tissues at the limbus on to the cornea (see EYE). This usually occurs on the nasal side and is associated with exposure to sunlight. The pterygium is surgically removed for cosmetic reasons or if it is thought to be advancing towards the visual axis.
Ptosis Drooping of the upper lid. May occur because of a defect in the muscles which raise the lid (levator complex), sometimes the result of ageing or trauma. Other causes include HORNER’S SYNDROME, third cranial nerve PALSY, MYASTHENIA GRAVIS, and DYSTROPHIA MYOTONICA. The cause needs to be determined and treated if possible. The treatment for a severely drooping lid is surgical, but other measures can be used to prop up the lid with varying success.
Retina, disorders of The retina can be damaged by disease that affects the retina alone, or by diseases affecting the whole body.
Retinopathy is a term used to denote an abnormality of the retina without specifying a cause. Some retinal disorders are discussed below. DIABETIC RETINOPATHY Retinal disease occurring in patients with DIABETES MELLITUS. It is the commonest cause of blind registration in Great Britain of people between the ages of 20 and 65. Diabetic retinopathy can be divided into several types. The two main causes of blindness are those that follow: ?rst, development of new blood vessels from the retina, with resultant complications and, second, those following ‘water logging’ (oedema) of the macula. Treatment is by maintaining rigid control of blood-sugar levels combined with laser treatment for certain forms of the disease – in particular to get rid of new blood vessels. HYPERTENSIVE RETINOPATHY Retinal disease secondary to the development of high blood pressure. Treatment involves control of the blood pressure (see HYPERTENSION). SICKLE CELL RETINOPATHY People with sickle cell disease (see under ANAEYIA) can develop a number of retinal problems including new blood vessels from the retina. RETINOPATHY OF PREMATURITY (ROP) Previously called retrolental ?broplasia (RLF), this is a disorder affecting low-birth-weight premature babies exposed to oxygen. Essentially, new blood vessels develop which cause extensive traction on the retina with resultant retinal detachment and poor vision. RETINAL ARTERY OCCLUSION; RETINAL VEIN OCCLUSION These result in damage to those areas of retina supplied by the affected blood vessel: the blood vessels become blocked. If the peripheral retina is damaged the patient may be completely symptom-free, although areas of blindness may be detected on examination of ?eld of vision. If the macula is involved, visual loss may be sudden, profound and permanent. There is no e?ective treatment once visual loss has occurred. SENILE MACULAR DEGENERATION (‘Senile’ indicates age of onset and has no bearing on mental state.) This is the leading cause of blindness in the elderly in the western world. The average age of onset is 65 years. Patients initially notice a disturbance of their vision which gradually progresses over months or years. They lose the ability to recognise ?ne detail; for example, they cannot read ?ne print, sew, or recognise people’s faces. They always retain the ability to recognise large objects such as doors and chairs, and are therefore able to get around and about reasonably well. There is no e?ective treatment in the majority of cases. RETINITIS PIGMENTOSAA group of rare, inherited diseases characterised by the development of night blindness and tunnel vision. Symptoms start in childhood and are progressive. Many patients retain good visual acuity, although their peripheral vision is limited. One of the characteristic ?ndings on examination is collections of pigment in the retina which have a characteristic shape and are therefore known as ‘bone spicules’. There is no e?ective treatment. RETINAL DETACHMENTusually occurs due to the development of a hole in the retina. Holes can occur as a result of degeneration of the retina, traction on the retina by the vitreous, or injury. Fluid from the vitreous passes through the hole causing a split within the retina; the inner part of the retina becomes detached from the outer part, the latter remaining in contact with the choroid. Detached retina loses its ability to detect light, with consequent impairment of vision. Retinal detachments are more common in the short-sighted, in the elderly or following cataract extraction. Symptoms include spots before the eyes (?oaters), ?ashing lights and a shadow over the eye with progressive loss of vision. Treatment by laser is very e?ective if caught early, at the stage when a hole has developed in the retina but before the retina has become detached. The edges of the hole can be ‘spot welded’ to the underlying choroid. Once a detachment has occurred, laser therapy cannot be used; the retina has to be repositioned. This is usually done by indenting the wall of the eye from the outside to meet the retina, then making the retina stick to the wall of the eye by inducing in?ammation in the wall (by freezing it). The outcome of surgery depends largely on the extent of the detachment and its duration. Complicated forms of detachment can occur due to diabetic eye disease, injury or tumour. Each requires a specialised form of treatment.
Scleritis In?ammation of the sclera (see EYE). This can be localised or di?use, can affect the anterior or the posterior sclera, and can affect one or both eyes. The affected eye is usually red and painful. Scleritis can lead to thinning and even perforation of the sclera, sometimes with little sign of in?ammation. Posterior scleritis in particular may cause impaired vision and require emergency treatment. There is often no apparent cause, but there are some associated conditions – for example, RHEUMATOID ARTHRITIS, GOUT, and an autoimmune disease affecting the nasal passages and lungs called Wegener’s granulomatosis. Treatment depends on severity but may involve NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS), topical CORTICOSTEROIDS or systemic immunosuppressive drugs.
Stye Infection of a lash follicle. This presents as a painful small red lump at the lid margin. It often resolves spontaneously but may require antibiotic treatment if it persists or recurs.
Sub-conjunctival haemorrhage Haemorrhage between the conjunctiva and the underlying episclera. It is painless. There is usually no apparent cause and it resolves spontaneously.
Trichiasis Inward misdirection of the lashes. Trichiasis occurs due to in?ammation of or trauma to the lid margin. Treatment involves removal of the patient’s lashes. Regrowth may be prevented by electrolysis, by CRYOTHERAPY to the lid margin, or by surgery.
For the subject of arti?cial eyes, see under PROSTHESIS; also GLAUCOMA, SQUINT and UVEITIS.... eye, disorders of
Aphakia may be congenital, may result from surgery (for example, cataract surgery), or may be due to a penetrating injury.
Aphakia causes severe loss of focusing in the affected eye and requires correction by implanting a lens or with contact lenses or glasses.... aphakia
Hypermetropia is caused by the eye being too short from front to back, which results in images not being clearly focused on the retina. The error is present from birth, but symptoms generally do not appear until later life because the focusing power of accommodation, which compensates for hypermetropia, declines with age.
Glasses or contact lenses with convex lenses reinforce focusing power.... hypermetropia
Treatment. To activate capillary function and assist toxic elimination: Bladderwrack, Gotu Kola, Kola, Parsley tea. A diuretic may assist by eliminating excess fluid.
Gotu Kola tea: Quarter to half a teaspoon leaves to each cup boiling water; infuse 5-10 minutes. 1 cup morning and evening.
Formula. Tea. Equal parts: Alfalfa, Clivers, Fennel, Senna leaves. 1 heaped teaspoon to each cup boiling water: infuse 5-10 minutes. Half-1 cup morning and evening.
Seline. Tablets. Ingredients: Each tablet contains Lecithin 100mg; Pulverised Dandelion 100mg; Pulverised Horsetail 100mg; Pulverised extract Fucus 5:1 30mg; Vitamin C 40mg; Vitamin B6 1mg. 1 tablet thrice daily.
Aescin. Compound isolated from Horse-chestnuts to decrease capillary permeability and swelling. Topical. Decoction of Horse-chestnuts as a lotion. Or: infusion of Bladderwrack.
Aromatherapy and Herb essences. Combination for external use. Ingredients: Almond oil 47ml; Fennel oil 1ml; Juniper oil 1ml; Cypress essence 0.5ml; Lemon essence 0.5ml. Apply to affected areas morning and evening; small area 5 drops, large area 10 drops (Gerard). Gentle massage with a string glove, loofah or massage glove.
Diet. Reduce calorie intake. Raw fresh fruits and vegetable salads to account for 50 per cent of the diet. No sweet or dried fruits. Conservatively-cooked vegetables. Seafood. Iodine-rich foods. Wholegrain cereals. Protein: beans, chicken, poached eggs, fish, little lean meat: no pork, bacon or ham. Low-fat yoghurt. Cold-pressed unsaturated oils for salad dressings with lemon juice. Dandelion coffee to stimulate liver. Avoid sugar, alcohol, bananas and white flour products. Spring water.
Supportives. Stop smoking. Adopt an alternative to the contraceptive pill. To avoid fluid retention, 2-3 glasses of water daily. ... cellulite
It is spread by polluted water as in the case of the composer, Tchaikovsky, who died imprudently drinking unboiled water during a cholera epidemic, despite warnings of his friends. It is transmitted also by milk, shellfish and by the faeces of infected people.
Symptoms. Profuse rice-water diarrhoea, vomiting and shock from severe loss of body fluids. Muscle cramps, cyanosis, stupor.
Alternatives. Powders. Formula: Tormentil root 2; Ginger 8; Poplar bark 2; Ipecacuanha half; Gum Myrrh quarter; Cloves; Cayenne quarter; Slippery Elm 5. (Reformed School of Medicine, W. Beach MD, USA) No dosage recorded. Suggested hourly dose: Liquid Extract: 1 teaspoon. Tinctures: 2 teaspoons. Powders: 500mg.
Tinctures. Formula No 1. Turkey Rhubarb 3; Hops 2; Peppermint 1. Dose: 1-2 teaspoons in water hourly, as tolerated.
Tinctures. Formula No 2. Turkey Rhubarb 2; Camphor (spirits) 1; Capsicum quarter; Peppermint quarter. Dose: 1-2 teaspoons hourly, as tolerated.
Orange berries. (Maeso lanceolata) Tea drunk by natives before visiting cholera epidemic areas. (Dr Isno Kufo, University of California, Berkeley)
Barberry. Berberine alkaloid. (Indian Journal of Medical Research, 50. 732, 1962)
Camphor. In the Cholera epidemic of 1831, a Russian Consol-General reported 70 cases in two places, all were cured. Elsewhere, of 1270 cases only 108 died. Practitioner use: Spirits of Camphor (10 per cent Camphor in 90 per cent brandy, gin or Vodka). 0.3 to 2ml (5 to 30 drops). Effective in the early stages. Also, rub into soles of feet and use as an inhalant.
Calamint. Old European remedy.
Enema. Bring 2 pints (1 litre) water to boiling point. Allow to cool. Add 20 drops Goldenseal and 20 drops Tincture Myrrh; for soothing and healing injection.
Diet. During an outbreak of cholera: avoid unboiled or unbottled water, uncooked seafood, vegetables and fruit unless fruit can be peeled.
Strict sanitary hygiene. Wash hands frequently.
Recovery period. Replacement of body fluids: glasses of boiled water to which 2-3 teaspoons cider vinegar has been added. Make up potassium loss with 3-4 bananas daily. Calcium, Magnesium and Potassium. Multivitamins.
Alternative rehydration therapy: spring or bottled water with sugar and salt; salt to replace water in the blood, sugar to promote absorption. Glass of water to contain 1 teaspoon salt and 2 teaspoons sugar.
To be treated by a general medical practitioner or hospital specialist.
CHOLERETIC. An agent which reduces cholesterol levels by excreting cholesterol. It also causes bile to flow freely. Differs from a cholagogue in that the latter increases the flow of bile (Artichoke). ... cholera
Myopia, which tends to be inherited, usually appears around puberty and increases until the early 20s. If it starts in early childhood it may become very severe. The condition is detected during a vision test. Treatment is with concave glasses (or contact lenses) or by photorefractive keratectomy.... myopia
Dr Joanna Brandt knew that grapes may sometimes check malignancy. Facing up squarely to the reality of cancer, she resolved not to take any medicines to check its course or alleviate the pain . . . neither would she submit to the surgeon’s knife.
For nine years she had been desperately seeking something to destroy the growth effectively, to eliminate virulent cancer toxins and rebuild new tissue.
At the conclusion of a seven-day fast she developed a craving for grapes. From the first mouthful she felt their purifying influence and a lift physically and mentally. She was miraculously cured.
As in other cases, improvement was attended by the senses becoming abnormally acute, dim eyes became bright, faded hair took on a new gloss, a lifeless voice became vibrant, the complexion cleared; teeth, loose and suppurating in their sockets became fixed and healthy.
In “The Grape Cure”, she records: “While the system is drained of its poisons, external wounds are kept open with frequent applications of Grape poultices and compresses . . . No scabs or crusts are formed as long as the lesions are kept moist . . . From glistening bones outwards, the process of reconstruction goes on. Healthy, rosy granulations of new flesh appear and cavities are filled in.”
The body is prepared for the regime by fasting for 2-3 days, drinking plenty of pure cold water and by taking a two-pint enema of lukewarm water daily.
After the fast, she advises – “Drink one or two glasses of cold water on rising. Half hour later, have a meal of grapes, discard seeds, chew skins thoroughly, swallowing a few for medicine and fibre. Have a grape meal every two hours from 8am to 8pm (7 meals daily). Continue two weeks – even for one month. Begin with 1, 2 or 3 ounces per meal, increasing gradually to half pound. The maximum should not exceed 4 pounds. Patients taking large quantities should allow 3 hours for digestion and not take all skins.”
After years of suffering, Dr Brandt discovered a cure which worked in her particular case and which she was able to repeat in a number of others. ... grapes
Causes: exposure to chemicals, X-rays or radioactive material. Genetic factors are believed to predispose. The condition may be acute or chronic and may follow chemotherapy.
Remissions are known to have been induced by a preparation from the Periwinkle plant (Vinca rosea) now re-classified as Catharanthus roseus.
“Smokers suffer a significantly increased risk of developing acute myelocytic leukaemia.” (“Cancer”: 1987 vol 60, pp141-144)
Acute Leukaemia. Rapid onset with fatality within weeks or months. Fever. Proliferation of white cells in the bone marrow which are released and blood-borne to the liver, spleen and lymphatics. There may be bleeding from kidneys, mouth, bowel and beneath the skin. (Shepherd’s Purse, Yarrow) The acute form is known also as acute lymphoblastic or acute myeloblastic leukaemia. May be mis-diagnosed as tuberculosis.
Chronic Leukaemia. Gradual onset. Breathlessness from enlargement of the spleen. Swelling of glands under arms, in neck and groin. Loss of weight, appetite, strength, facial colour and body heat. Anaemia, spontaneous bleeding and a variety of skin conditions. Diarrhoea. Low grade fever.
No cure is known, but encouraging results in orthodox medicine promise the disease may be controlled, after the manner of diabetes by insulin. Successful results in such control are reported by Dr Hartwell, National Cancer Institute, Maryland, USA, with an alkaloid related to Autumn Primrose (Colchicum officinale). Vinchristine, a preparation from Periwinkle is now well-established in routine treatment. Red Clover, also, is cytotoxic to many mammalian cells. Vitamin C (present in many herbs and fruits) inhibits growth of non-lymphoblastic leukaemia cells. Good responses have been observed by Dr Ferenczi, Hungary, by the use of raw beet root juice.
Also treated with success by Dr Hartland (above) has been lymphocytic leukaemia in children which he treated with a preparation from Periwinkle.
Choice of agents depends largely upon the clinical experience of the practitioner and ease of administration. Addition of a nerve restorative (Oats, Kola, Black Cohosh or Helonias) may improve sense of well-being. To support the heart and circulatory system with cardiotonics (Hawthorn, Motherwort, Lily of the Valley) suggests sound therapy.
Herbal treatment may favourably influence haemoglobin levels and possibly arrest proliferation of leukaemic cells and reduce size of the spleen. It would be directed towards the (a) lymphatic system (Poke root), (b) spleen (Tamarinds), (c) bone marrow (Yellow Dock), and (d) liver (Blue Flag root).
An older generation of herbalists prescribed Blue Flag root, Yellow Dock, Poke root, Thuja and Echinacea, adding other agents according to indications of the particular case.
Tea. Formula. Equal parts: Red Clover, Gotu Kola, Plantain. 1-2 teaspoons to each cup boiling water; infuse 10-15 minutes. 1 cup thrice daily.
New Jersey tea (ceanothus). 1 teaspoon to each cup boiling water. Half-1 cup thrice daily.
Periwinkle tea (Vinca rosea). 2 teaspoons to each cup boiling water; infuse 15 minutes. 1 cup thrice daily.
Decoction. Formula. Equal parts: Echinacea, Yellow Dock, Blue Flag root. 1 teaspoon to each cup water gently simmered 20 minutes. 1 cup before meals thrice daily.
Formula. Red Clover 2; Yellow Dock 1; Dandelion root 1; Thuja quarter; Poke root quarter; Ginger quarter. Dose: Liquid Extract: 1 teaspoon. Tinctures: 1-2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.
Vinchristine. Dosage as prescribed. In combination with other medicines.
Wheatgrass. Juice of fresh Wheatgrass grown as sprouts and passed through a juicer. Rich in minerals. One or more glasses daily.
Beetroot juice. Rich in minerals. Contains traces of rare rabidium and caesium, believed to contribute to anti-malignancy effect. (Studies by Dr A. Ferenczi, Nobel Prize-winner, published 1961)
Diet: Dandelion coffee.
Supplements. B-complex, B12, Folic acid, Vitamin C 2g morning and evening, Calcium ascorbate 2g morning and evening. Copper, Iron, Selenium, Zinc.
Childhood Leukaemia. Research has linked the disease with fluorescent lighting. “Fluorescent tubes emit blue light (400mm wavelength). Light penetrates the skin and produces free radicals. Free radicals damage a child’s DNA. Damaged DNA causes leukaemia to develop. The type and intensity of lighting in maternity wards should be changed. This could be prevented by fitting cheap plastic filters to fluorescent lights in maternity wards.” (Peter Cox, in “Here’s Health”, on the work of Dr Shmuel Ben-Sasson, The Hubert Humphrey Centre of Experimental Medicine and Cancer Research, Jerusalem)
Treatment by hospital specialist. ... leukaemia
“Half of all migraine patients suffer from anxiety, and one in five experiences depression,” according to a study carried out at Manchester University. (Dr Jennifer Devlen)
Causes: many and varied. Alcohol, excess coffee and caffeine stimulants, gluten food allergies, dairy products, chocolate, citrus fruits. Related to carbohydrate metabolism. May be associated with menstruation or emotional disturbance, nervous or physical fatigue; liver, stomach or kidney disturbance, or The Pill.
Symptoms: temporary blindness, or sight may be only half the visual field. Flashing lights, throbbing headache, loud noises worsen, nausea, vomiting, depression.
Treatment. In the initial (constrictive) stage any of the following simple teas may resolve: German Chamomile, Betony, Skullcap, Wild Thyme, Valerian.
Where the condition has progressed to vasodilation (engorgement of cerebral blood vessels) give any of the following alternatives. Whilst the requirements of each individual case is observed, inclusion of a remedy for stomach and liver may enhance efficacy. Sometimes a timely diuretic to reduce volume of the blood aborts an attack.
Associated with menstrual disorders: Agnus Castus, Evening Primrose oil.
Tea: Formula. (1) Equal parts: Betony, Valerian, Dandelion root. (2) Alfalfa 1; Valerian half; Hops quarter. One heaped teaspoon to each cup boiling water; infuse 15 minutes. Half-1 cup 2-3 times daily. Formula. Skullcap 2; Mistletoe 1; Hops half. Dose: Liquid Extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon) 2-3 times daily.
Valerian. German traditional.
Feverfew. 2-3 fresh leaves on bread. Tincture (or essence) 5-10 drops.
Practitioner: Tincture Gelsemium, BPC (1963) 5 drops.
Diet: Fruit juice fast. Oily fish. Hay diet. Salt-free.
Vitamins. A. B-complex, B6, B12, C (up to 1000mg). E, Niacin.
Minerals. Manganese, Calcium, Magnesium, Zinc.
Rose-tinted glasses. Ophthalmology Department, Birmingham University.
Information. British Migraine Association, 178A High Road, West Byfleet, Surrey KT14 7ED. Send SAE. ... migraine
Amblyopia will develop if there is a marked discrepancy between the images received by the brain from each eye while vision is developing during early childhood. The most common cause is squint. Failure to form normal retinal images may also result from congenital cataract, and severe, or unequal, focusing errors, such as when one eye is normal and there is an uncorrected large degree of astigmatism in the other. Toxic and nutritional amblyopia may result from damage to the retina and/or the optic nerve.
To prevent amblyopia due to squint, patching (covering up the good eye to force the deviating eye to function properly) is the usual treatment. Surgery to place the deviating eye in the correct position may be necessary. Glasses may be needed to correct severe focusing errors. Cataracts may be removed surgically. After the age of 8, amblyopia cannot usually be remedied.... amblyopia
animals, diseases from See zoonosis. anisometropia Unequal focusing power in the 2 eyes, usually due to a difference in size and/or shape of the eyes, that causes visual discomfort. For example, one eye may be normal and the other affected by myopia (shortsightedness), hypermetropia (longsightedness), or astigmatism (uneven curvature of the cornea). Glasses or contact lenses correct the problem in most cases. ankle joint The hinge joint between the foot and the leg. The talus (uppermost bone in the foot) fits between the 2 bony protuberances formed by the lower ends of the tibia (the shinbone) and the fibula (the outer bone of the lower leg). Strong ligaments on either side of the ankle joint give it support. The ankle allows for up-anddown movement of the foot.
An ankle sprain is one of the most
common injuries.
It is usually caused by twisting the foot over on to its outside edge, causing overstretching and bruising of the ligaments.
Violent twisting of the ankle can cause a combined fracture and dislocation known as Pott’s fracture.... animal experimentation
Because the cornea is unevenly curved, it refracts (bends) the light rays that strike it to differing degrees.
The lens is then unable to bring all the rays into focus on the light-sensitive retina.
A minor degree of astigmatism is normal and does not require correction.
More severe astigmatism causes blurring of lines at a particular angle and requires correction, which be achieved by special “cylindrical” glasses that can be framed at a precise angle, contact lenses that can give an even spherical surface for focusing, or laser surgery.... astigmatism
Vision may also be impaired or blurred as a result of damage, disease, or abnormalities of parts of the eye or its connections to the brain.
The most common causes of blurred vision as a result of disease are cataract and retinopathy.... blurred vision
An eye examination usually begins with inspection of the external appearance of the eyes, lids, and surrounding skin. A check of eye movements is usually performed and the examiner looks for squint. A check of the visual acuity in each eye using a Snellen chart follows. Refraction testing (using lenses of different strengths) may be performed to determine what glasses or contact lenses, if any, may be needed. A test of the visual fields may be performed, especially in suspected cases of glaucoma or neurological conditions. Colour vision may be checked because loss of colour perception is an indication of certain disorders of the retina or optic nerve. To check for abrasions or ulcers, the conjunctiva and cornea may be stained with fluorescein. Applanation tonometry is an essential test for glaucoma.
The ophthalmoscope is an instrument used to examine the inside of the eye, particularly the retina. The slit-lamp microscope, with its illumination and lens magnification, allows examination of the conjunctiva, cornea, front chamber of the eye, iris, and lens. For a full view of the lens and the structures behind it, the pupil must be widely dilated with eye-drops.... eye, examination of
In adults, squint may be a symptom of stroke, diabetes mellitus, multiple sclerosis, hyperthyroidism, or a tumour. A squint in adults causes double vision.
Treatment in children up to 6–7 years may include covering the normal eye with a patch to force the child to use the weak eye. Deviation of the squinting eye may be controlled by glasses and/or surgery. Sudden onset of a squint in adults may have a serious underlying cause and must be investigated promptly.... squint
The eye may lose its transparency through corneal opacities, cataract, or vitreous haemorrhage. Defects near the centre of the retina cause loss of the corresponding parts of the visual field (see macular degeneration). Floaters, which are usually insignificant, may indicate a retinal tear or haemorrhage, or they may herald a retinal detachment. Optic neuritis can cause a blind spot in the centre of the visual field.
Damage to the brain (for example, from a stroke) may cause visual impairment such as hemianopia, agnosia, visual perseveration (in which a scene continues to be perceived after the direction of gaze has shifted), and visual hallucinations.... vision, disorders of
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