Advances in Ophthalmology and Optometry 2022 Volume 7 1 Advances Volume 7 1 Myron Yanoff MD Editor Full Chapter

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(Advances, Volume 7-1) Myron Yanoff
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ADVANCES IN
Ophthalmology
and Optometry
Editor-in-Chief
Myron Yanoff, MD
Chair Emeritus, Department of Ophthalmology, Drexel University,
Adjunct Professor, Department of Ophthalmology, University of
Pennsylvania, Philadelphia, Pennsylvania
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ADVANCES IN
Ophthalmology and Optometry
Editor-in-Chief
MYRON YANOFF, MD, Chair Emeritus, Department of Ophthalmology, Drexel Uni-
versity, Adjunct Professor, Department of Ophthalmology, University of Penn-
sylvania, Philadelphia, Pennsylvania
Section Editors
BHAVNA CHAWLA, MD – Ophthalmic Pathology & Ocular Oncology
RP Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New
Delhi, India
DAVID A. CRANDALL, MD – Cataract & Refractive Surgery

Glaucoma Fellowship Director, Henry Ford Health System, Detroit, Michigan
University of Utah, Salt Lake City, Wayne State University, Salt Lake City, Utah
GABRIELA MABEL ESPINOZA, MD – Oculoplastics

Clinical Professor, Department of Ophthalmology Ophthalmic Plastic and
Reconstructive Surgery Assistant Dean of Educational Programming, Graduate
Medical Education Saint Louis University School of Medicine
PAUL B. FREEMAN, OD, FAAO, FCOVD – Optometry

Diplomate, Low Vision, Pittsburgh, Pennsylvania, Clinical Professor, Rosenberg
School of Optometry, University of the Incarnate, Word, San Antonio, Texas
RUSTUM KARANJIA, MD, PhD, FRCSC, DABO – Neuro-ophthalmology

Department of Ophthalmology, David Geffen School of Medicine at UCLA,
Los Angeles, California; Doheny Eye Institute, Los Angeles, California, Doheny
Eye Institute, Los Angeles, California, Department of Ophthalmology, University
of Ottawa, Ottawa, Ontario, Canada, Ottawa Hospital Research Institute, The
Ottawa Hospital, Ottawa, Ontario, Canada
RONNI M. LIEBERMAN, MD – Vitreoretinal Disease

Assistant Professor of Ophthalmology, Icahn School of Medicine at Mt. Sinai,
Queens Hospital Center, Jamaica, New York
ANN-MARIE LOBO, MD – Uveitis

Co-Director, Uveitis Service, Associate Professor, Department of
Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary,
University of Illinois at Chicago, Chicago, Ilinois
vii
SECTION EDITORS continued
STEPHEN E. ORLIN, MD – Cornea and External Diseases

Associate Professor, Scheie Eye Institute, University of Pennsylvania, Perelman
School of Medicine, Philadelphia, Pennsylvania
JOSEPH M. ORTIZ, MD, FRCOphth – Glaucoma

Consultant in Ophthalmology, Sacred Heart Hospital, Allentown,
Pennsylvania; Consultant in Ophthalmology, Abington Memorial Hospital,
Abington, Pennsylvania; Formerly Assistant Professor of Ophthalmology,
Hahnemann University Hospital, Drexel University School of Medicine,
Philadelphia, Pennsylvania
LEONARD J. PRESS, OD, FAAO, FCOVD – Optometry

Press Consulting, P.C, Lakewood, New Jersey; Adjunct Professor, Southern
College of Optometry, Memphis, Tennessee
APARNA RAMASUBRAMANIAN, MD – Pediatric Ophthalmology

Director of Retinoblasma and Ocular Oncology, Phoenix Children’s Hospital,
Phoenix, Arizona
viii
ADVANCES IN
Ophthalmology And Optometry
CONTRIBUTORS
REDDIN AHMAD, BMBS, iBSC, Foundation Year 2 Doctor, Bradford Teaching

Hospitals NHS Foundation Trust, Bradford, West Yorkshire, United Kingdom
MARIB AKANDA, MD, Resident Physician, Department of Ophthalmology, Northwell
Health Eye Institute, Great Neck, New York, USA
TOMAS ANDERSEN, MD, MPH, Scheie Eye Institute, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, Pennsylvania, USA
SHAHZAN ANJUM, MSc, Ocular Pathology Services, Dr. Rajendra Prasad Centre for
Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi,
India
RAMESH AYYALA, MD, Department of Ophthalmology, University of South Florida

College of Medicine, Tampa, Florida, USA
NOORAN BADEEB, MBBS, Department of Ophthalmology, School of Medicine,

University of Jeddah, Jeddah, Saudi Arabia
ALIREZA BARADARAN-RAFII, MD, Department of Ophthalmology, University of

South Florida College of Medicine, Tampa, Florida, USA
SUZANNAH BELL, MBChB, DTMH, MSc, Queen Alexandra Hospital, Portsmouth,

United Kingdom
RUPAK BHUYAN, MD, Department of Ophthalmology, Icahn School of Medicine at

Mount Sinai Hospital, New York, New York, USA
KASTURI BHATTACHARJEE, MS, FRCSEd, Head, Department of Ophthalmic Plastic

and Reconstructive Surgery and Oculofacial Aesthetics, Sri Sankaradeva
Nethralaya, Guwahati, Assam, India
ELENA Z. BIFFI, OD, MS, FAAO, Associate Professor of Optometry, New England
College of Optometry, Boston, Massachusetts, USA
MARIE I. BODACK, OD, FAAO, Diplomate, Binocular Vision, Perception and

Pediatrics Optometry; Professor, Department of Pediatric Primary Care, Southern
College of Optometry, Memphis, Tennessee, USA
JEFFREY BROWN, MD, Department of Ophthalmology, Icahn School of Medicine at

Mount Sinai Hospital, New York, New York, USA
ix
CONTRIBUTORS continued
MEHAR CHAND SHARMA, MD, Department of Pathology, All India Institute of

Medical Sciences, New Delhi, Delhi, India
EMILY CHANG, MD, Resident, Department of Ophthalmology, Kellogg Eye Center,

University of Michigan, Ann Arbor, Michigan, USA
BHAVNA CHAWLA, MD, Professor of Ophthalmology, Ocular Oncology Service, RP

Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New
Delhi, India
BENSON S. CHEN, MBChB, MSc, FRACP, Department of Clinical Neurosciences,

University of Cambridge, Cambridge, United Kingdom; Cambridge Eye Unit,
Addenbrooke’s Hospital, CUH-NHS, Cambridge, United Kingdom; Gonville and
Caius College, University of Cambridge, Cambridge, United Kingdom
RAO V. CHUNDURY, MD, Truhlsen Eye Institute, University of Nebraska Medical

Center, Omaha, Nebraska, USA
CAROLINE W. CHUNG, MD, Resident Physician, Scheie Eye Institute, Philadelphia,

Pennsylvania, USA
Y. GRACE CHUNG, BS, Emory University School of Medicine, Atlanta, Georgia, USA
DEVIN COHEN, MD, Scheie Eye Institute, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pennsylvania, USA
STUART COUPLAND, PhD, Department of Ophthalmology, Faculty of Medicine,

University of Ottawa, Ottawa Hospital Research Institute, The Ottawa Hospital,
Ottawa, Ontario, Canada
KEVIN J. EVERETT, MD, Director of Refractive Surgery, Henry Ford Hospital

Department of Ophthalmology, Detroit, Michigan, USA; Henry Ford OptimEyes
Super Vision Center - Sterling Heights, Sterling Heights, Michigan, USA
SHAILESH GAIKWAD, MD, FNAMS, CCST, Professor, Department of Neuroimaging

and Interventional Neuroradiology, All India Institute of Medical Sciences, New
Delhi, India
SAMUEL GELNICK, MD, Northwell Health Eye Institute, Great Neck, New York, USA
ROBIN GINSBURG, MD, Director of the Vitreoretinal Service, Assistant Professor,

Department of Ophthalmology, Icahn School of Medicine at Mount Sinai
Hospital, Department of Ophthalmology, New York Eye and Ear Infirmary at
Mount Sinai, New York, New York, USA
CHLOE GOTTLIEB, MD, Department of Ophthalmology, Faculty of Medicine,

Ottawa, Ontario, Canada
x
ANGELA GUPTA, MD, PhD, Resident Physician, Scheie Eye Institute, Philadelphia,
Pennsylvania, USA
MARIAM S. HAMID, MD, Chief Ophthalmology Resident, Henry Ford Hospital

Department of Ophthalmology, Detroit, Michigan, USA
GEORGE JIAO, MD, Resident Physician, Department of Ophthalmology, Northwell

Health Eye Institute, Great Neck, New York, USA
MAN LI JIN, MD, Chief Ophthalmology Resident, Henry Ford Hospital Department of
Ophthalmology, Detroit, Michigan, USA
PRIYA KALYAM, MD, Oculo Facial Plastic and Reconstructive Surgeon, Legacy Eyelids
& Cosmetic Surgery, Plano, Texas, USA
PUSHPINDER KANDA, MD, PhD, Department of Ophthalmology, Faculty of Medicine,

University of Ottawa, Ottawa, Ontario, Canada
JOSEPH EDWARD KANE Jr, OD, FAAO, Attending Optometrist, Veterans Affairs
Boston Healthcare System
LYNCA KANTUNGANE, COMT, Department of Ophthalmology, Faculty of Medicine,

University of Ottawa, Ottawa, Ontario, Canada
RUSTUM KARANJIA, MD, PhD, Department of Ophthalmology, Faculty of Medicine,

Ottawa, Ontario, Canada; Doheny Eye Institute, Doheny Eye Centers UCLA,
Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los
Angeles, California, USA
JAMIE A. KEEN, MD, Department of Ophthalmology and Visual Sciences, University

of Iowa, Iowa City, Iowa, USA
SERENA LI, BA, Department of Clinical Neurosciences, University of Cambridge,

Cambridge, United Kingdom; Gonville and Caius College, University of
Cambridge, Cambridge, United Kingdom
RONNI M. LIEBERMAN, MD, Assistant Professor, Department of Ophthalmology,

Mount Sinai Medical Center, Ichan School of Medicine, Mount Sinai Health
Systems, New York, New York, USA
JACOB LIECHTY, MD, Department of Ophthalmology, University of South Florida

College of Medicine, Tampa, Florida, USA
TIANYU LIU, MD, Ophthalmology Resident, Scheie Eye Institute, University of

STEPHANIE M. LLOP, MD, Bascom Palmer Eye Institute, University of Miami Miller
School of Medicine, Miami, Florida, USA
xi
SAMANTHA L. MAREK, MD, Ophthalmology Resident, Scheie Eye Institute,

University of Pennsylvania, Philadelphia, Pennsylvania, USA
KERRI MCINNIS-SMITH, BA, Mayo Clinic Alix School of Medicine, Scottsdale,

Arizona, USA
ADITI MEHTA, MD, Fellow, Department of Ophthalmic Plastic and Reconstructive

Surgery and Oculofacial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati,
Assam, India
HOLLY K. MILLER, DO, Phoenix Children’s Hospital, Phoenix, Arizona, USA; Mayo
Clinic, Scottsdale, Arizona, USA
MARIYA MOOSAJEE, MBBS, BSc, PhD, FRCOphth, Professor, Moorfields Eye

Hospital NHS Foundation Trust, University College London Institute of
Ophthalmology, The Francis Crick Institute, London, United Kingdom
JENNIFER B. NADELMANN, MD, Resident Physician, Scheie Eye Institute,

Philadelphia, Pennsylvania, USA
MEHDI NAJAFI, MD, PhD, Vitreoretinal Surgeon, Boston Vision, Beth Israel
Deaconess Medical Center, Boston, Massachusetts, USA
BRIAN J. NGUYEN, MD, Ophthalmology Resident, Scheie Eye Institute, University of

JACQUELYN O’BANION, MD, MSc, Emory Eye Center, Atlanta, Georgia, USA;
Department of Ophthalmology, Emory University School of Medicine
STEPHEN E. ORLIN, MD, Associate Professor of Ophthalmology, Chief of Cornea

Service, Scheie Eye Institute, Perelman School of Medicine, University of
CHRISTIE M. PERSON, OD, FAAO, Grady Health System, Eye Clinic, Atlanta,
Georgia, USA
SUSAN A. PRIMO, OD, MPH, FAAO, Emory Eye Center, Atlanta, Georgia, USA;
Department of Ophthalmology, Emory University School of Medicine
VIVIAN L. QIN, MD, Scheie Eye Institute, Perelman School of Medicine, University of
APARNA RAMASUBRAMANIAN, MD, Phoenix Children’s Hospital, Phoenix,

Arizona, USA
ERICK RIVERA-GRANA, MD, Assistant Professor of Clinical Ophthalmology,

Department of Ophthalmology, University of Puerto Rico School of Medicine,
San Juan, Puerto Rico, USA
xii
CHRISTINE RYU, MD, Truhlsen Eye Institute, University of Nebraska Medical Center,
Omaha, Nebraska, USA
SEEMA SEN, MD, Ocular Pathology Services, Dr. Rajendra Prasad Centre for
Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi,
India
RAHUL A. SHARMA, MD, MPH, FRCSC, Department of Ophthalmology and Vision

Sciences, University of Toronto, Toronto, Ontario, Canada; Prism Eye Institute,
Oakville, Ontario, Canada
ERIN M. SHRIVER, MD, Department of Ophthalmology and Visual Sciences,

University of Iowa, Iowa City, Iowa, USA
NAVNEET SIDHU, MD, Senior Resident, Ophthalmology, RP Centre for Ophthalmic

Sciences, All India Institute of Medical Sciences, New Delhi, India
MINH TRINH, MD, Northwell Health Eye Institute, Great Neck, New York, USA
SRAVANTHI VEGUNTA, MD, Pediatric Ophthalmology and Adult Strabismus Fellow,

Department of Ophthalmology, Indiana University School of Medicine,
Indianapolis, Indiana, USA; Assistant Professor, Department of Ophthalmology
and Visual Sciences, University of Utah School of Medicine, Salt Lake City, Utah,
USA
VATSALYA VENKATRAMAN, MD, Fellow, Department of Ophthalmic Plastic and

Reconstructive Surgery and Oculofacial Aesthetics, Sri Sankaradeva Nethralaya,
Guwahati, Assam, India
LAURA WINDSOR, OD, FAAO, Low Vision Centers of Indiana, Division of the Eye
Associates Group, LLC, Indianapolis, Indiana, USA
RICHARD WINDSOR, OD, FAAO, DPNAP, Low Vision Centers of Indiana, Division
of the Eye Associates Group, LLC, Indianapolis, Indiana, USA
BENJAMIN YOUNG, OD, FAAO, Assistant Professor of Optometry, New England

College of Optometry, Boston, Massachusetts, USA
CAROLINE Y. YU, MD, Department of Ophthalmology and Visual Sciences, University

of Iowa, Iowa City, Iowa, USA
AMY ZHANG, MD, Assistant Clinical Professor, Department of Ophthalmology,

Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
xiii
ADVANCES IN
Ophthalmology And Optometry
CONTENTS VOLUME 7 2022
Associate Editors vii
Contributors ix
Preface xxxv
Myron Yanoff
Looking Backward and Forward
Optometry
Bioptic Driving in the United States

Laura Windsor and Richard Windsor
The concept of bioptic driving began in the United States
after the development of a practical bioptic system by
William Feinbloom, OD, PhD. A bioptic telescope is a
telescope mounted in or at the top of the spectacle lenses,
allowing the wearer to view underneath it, through the
carrier lenses, and to intermittently tip their head down to
quickly view through the telescope. The bioptic telescope
is used for spotting signs, traffic lights, and other objects
in the distance when driving. Mild to moderately visually
impaired patients have been using bioptics for more than
50 years to drive. Most states have regulations on bioptic
driving, but the rules vary greatly. Proper candidate
selection, fitting of the bioptic, and training are crucial for
the driver’s success and safety on the road. Patients
should be considered on a case-by-case basis to determine
their eligibility to drive. More naturalistic research, that is,
in the real world, is needed to further validate the safety
of bioptic driving, the training needed, and to look at
state vision regulations for driving.
Introduction 1
History of bioptics and driving in the United States 2
A legal pathway for bioptic driving 3
Controversies and research in bioptic driving 4
Wearing the bioptic only to obtain licensure 4
xv
CONTENTS continued
Ring scotoma of the telescope 5

Bioptic driving safety 5
Bioptics in the United States 6
Visual acuities 7
Visual fields 8
Bioptic training 8
Nighttime driving 8
Bioptic telescope requirements 8
Ocular conditions and ability to drive 8
Other factors in patient selection for bioptic driving 14
Visual processing skills and cognitive abilities 14
Motor skills and functioning 15
Age and maturity 15
Medical and medication history 15
Emotional/mental status 15
Family support 15
Designing the bioptic system 16
Power and position of the telescope 16
Field of view through the telescope 17
Adaptability of the bioptic for light and glare issues 17
Training the bioptic driver 18
Training to use the bioptic 19
Training with the certified driver rehabilitation specialist 19
After bioptic licensure 20
Vehicle modifications for bioptic drivers 21
Vehicle selection 21
Global positioning systems 21
Speedometer 21
Windshield and dash glare 21
The Indiana program for visually impaired drivers 22
Part 1: waivered drivers 22
Part 2: bioptic drivers 22
The faces of bioptic driving 23
Dr. Dennis Kelleher: first legally licensed bioptic driver in the
United States 26
Future research in bioptic driving 26
Summary 27
Clinics care points 27
Disclosure 27
The Use of B-Scan Ultrasound in Primary Eye Care
Elena Z. Biffi, Benjamin Young, Joseph Edward Kane Jr., and
Mehdi Najafi
B-scan ultrasound has been a part of an eye care provider’s
armamentarium of ophthalmic imaging techniques dating
back to at least the 1950s. Even with the advent of newer
imaging devices, B-scan ultrasonography serves an important
adjunct role in assessment of various ophthalmic conditions.
Relatively benign ocular conditions as well as potentially life-
xvi
CONTENTS continued
threatening pathologies may be identified and assessed using

this procedure. A thorough understanding of the principles
and practical applications of B-scan ultrasonography is
essential to maximize use of this technique in patient management.
Introduction 31
Indications and contraindications 32
Principles of B-scan ultrasound examination 33
B-scan description 33
Probe positions and image interpretation 34
Clinical examination principles 36
B-scan applications in clinical care 36
Vitreous diseases 36
Retinal diseases 39
Choroidal diseases 42
Optic nerve diseases 44
Advances in ultrasonography 46
Summary 47
Disclosure 47
Nonsurgical Treatment of Strabismus

Marie I. Bodack
Nonsurgical treatment options for esotropia and exotropia
may be indicated for some patients to improve outcomes
presurgery or postsurgery or in lieu of surgery. The
ideal outcome is for a patient to have binocularity and
excellent alignment. Current nonsurgical treatment
options for patients with esotropia and exotropia include
lenses, prisms, occlusion, and vision therapy.
Introduction 51
Significance/present relevance 52
Esotropia 52
Observation 52
Lens correction 53
Occlusion 55
Prism correction 56
Vision therapy/orthoptics 57
Exotropia 59
Observation 59
Lenses 60
Overminus lenses 60
Occlusion 61
Prism 63
Summary 64
Disclosure 66
xvii
CONTENTS continued
Pediatric
Update on Pediatric Optic Neuritis

Sravanthi Vegunta
Pediatric optic neuritis (ON) is a condition with a broad
differential including demyelinating syndromes,
astrocytopathies, and infectious processes. Many
retrospective studies have been published on the
similarities and differences between pediatric ON
secondary to clinically isolated syndrome, multiple
sclerosis, myelin oligodendrocyte glycoprotein, and
neuro-myelitis optica spectrum disorder. The
presentations, visual outcomes, and laboratory testing,
and imaging findings have significant overlap but
important differences. This article details how to
distinguish between various causes of autoimmune ON
to provide the appropriate acute and chronic therapies to
patients. Gaps in our current knowledge and suggestions
for future studies are discussed.
Introduction 71
Significance 72
Overview of pediatric optic neuritis 72
Multiple sclerosis-associated optic neuritis 76
Myelin oligodendrocyte glycoprotein-associated disease optic neuritis 76
Neuromyelitis optica spectrum disorder optic neuritis 80
Other causes of optic neuritis 83
Relevance and future avenues to consider 84
Summary 84
Acknowledgments 85
Genetics of Congenital Cataract

Reddin Ahmad, Suzannah Bell, and Mariya Moosajee
Up to 40,000 children are born with cataracts annually
worldwide. In the UK, children presenting with bilateral
cataract most commonly have a genetic basis. Mutations
in genes involved in lens-specific proteins or regulation
of eye development can cause isolated cataract, those
associated with more complex ocular defects and/or
syndromic features. Early surgery and frequent follow-
up are vital to avoid amblyopia and optimize visual
potential. Routine genetic testing is important to allow
accurate diagnosis and personalized management of
patients including tailored genetic counseling.
Multidisciplinary care is vital, including clinical genetic
xviii
CONTENTS continued
and ophthalmic teams, pediatricians, school, and local

pediatric visual support services.
Introduction 89
Cause and classification 90
Significance 91
Nonsyndromic congenital cataract 91
Crystallins 91
Cytoskeletal structural proteins 95
Membrane proteins 95
Transcription factors 98
Syndromic congenital cataract 110
Down syndrome (Trisomy 21) 110
Patau syndrome (Trisomy 13) 110
Lowe syndrome 110
Norrie disease 110
Nance-Horan syndrome 111
Myotonic dystrophy 1 111
Neurofibromatosis type 2 111
Zellweger spectrum disorder 111
Rothmund-Thompson syndrome 112
Cockayne syndrome 112
Cerebrotendinous xanthomatosis 112
Galactosemia 112
Acquired causes 112
Congenital infections 112
Trauma 113
Other common causes of cataract in children 113
Uveitic cataract and steroid-related cataract 113
Radiation cataract 113
Relevance 113
Management of childhood cataract 113
Genetic testing 114
Multidisciplinary care 114
Summary 114
Disclosure 115
Pediatric Graft-Versus-Host Disease

Kerri McInnis-Smith, Holly K. Miller, and
Aparna Ramasubramanian
Even with the support of evidence-based medicine
available, the proper diagnosis and treatment of graft-
versus-host disease (GVHD) and its ophthalmologic
manifestations, especially in the pediatric population, is
quite nuanced. The wide array of disease presentations,
the existence of confounding factors such as underlying
disease and concurrent treatment, and the challenge of
xix
CONTENTS continued
children accurately conveying their symptoms can further

contribute to the difficulty in effectively managing young
patients with chronic GVHD. Clinicians must consider
the expert recommendations for management while
choosing diagnostic approaches and therapeutic regimens
according to the individual patient.
Background 119
Hematopoietic stem cell transplant 120
Pathophysiology of systemic GVHD 121
Incidence of Chronic GVHD 121
Diagnosis and Classification of Systemic GVHD 122
Grading of Systemic Disease Severity 124
Risk Factors for Systemic GVHD 125
Prognosis 125
Ocular GVHD 125
Mainstays and recent developments in therapy 130
Summary 135
Disclosure 135
Ophthalmic Pathology & Ocular Oncology
Fluorescence In Situ Hybridization in Ocular Oncology

Seema Sen, Shahzan Anjum, and Mehar Chand Sharma
Fluorescence in situ hybridization is a useful tool to visualize
and map the genetic material in an individual’s cells,
including specific genes or portions of genes. This
technique has diagnostic and prognostic implications for a
variety of ocular malignant tumors because genetic
mutations detected by FISH provide useful information for
better management including targeted therapy.
Chromosomal abnormalities including t(14;18)
translocation in lymphoma, monosomy of chromosome 3
in uveal melanoma, and t(6;9) translocation in adenoid
cystic carcinoma of lacrimal gland are some of the common
genetic hallmarks of these malignancies.
Introduction 139
Significance of fluorescence in situ hybridization 140
General Principle of Fluorescence In Situ Hybridization 141
Detailed Fluorescence In Situ Hybridization Protocol for Tissue
Sections 141
Ocular Lymphomas 142
Uveal Melanomas 143
Adenoid Cystic Carcinoma 144
Present relevance and future of fluorescence in situ hybridization 145
xx
CONTENTS continued
Disclosure 148
Intra-arterial Chemotherapy for Retinoblastoma: An Update

Bhavna Chawla, Navneet Sidhu, and Shailesh Gaikwad
Retinoblastoma is the most common primary intraocular
tumor in children. It also is one of the most successfully
treated tumors using various treatment strategies.
Conventional globe salvage treatments include the use of
focal therapies in combination with systemic
chemotherapy. Intra-arterial chemotherapy (IAC) is a
comparatively newer treatment modality used primarily
for globe salvage in refractory retinoblastoma. It
involves the direct administration of chemotherapy
drugs into the ophthalmic artery to achieve a high local
intraocular concentration. IAC has been found to
successfully treat retinoblastoma, and a few newer
modifications are being tried. Our article discusses the
significance of IAC, technique employed, drugs used,
and newer advances in its administration.
Introduction 151
History 152
Intra-arterial chemotherapy terminology 153
Procedure 153
Intra-arterial chemotherapy drugs 154
Significance of intra-arterial chemotherapy 155
Complications of intra-arterial chemotherapy 156
Local 156
Systemic 156
What’s new in intra-arterial chemotherapy? 157
Treatment Approaches 157
Drugs 157
Patient profile 157
Summary 157
Disclosure 159
Advances in Pediatric Periocular Vascular Neoplasms

Kasturi Bhattacharjee, Aditi Mehta, and Vatsalya Venkatraman
Pediatric periocular vascular neoplasms originate from
transformed endothelial cells showing increased
proliferation. Commonest of these is infantile
hemangioma, which presents in the first year of life. The
lesion exhibits initial rapid growth followed by
spontaneous regression. Locally infiltrative and
malignant tumors, although rare, may exhibit metastatic
xxi
CONTENTS continued
potential. Neoplasms need to be differentiated from

congenital vascular malformations, which are
noninvoluting, exhibit growth commensurately with age,
and do not demonstrate endothelial proliferation. Timely
treatment of periocular lesions obscuring the visual axis
helps prevent amblyopia. Systemic involvement or
presence of large lesions (>5 cm) warrants assessment of
cardiac function as the high-flow lesions may produce
high-output cardiac failure. Mass effect of extensive
perioral/nasal/subglottic lesions may compromise the
airway. A multidisciplinary approach is important for
optimizing treatment outcomes. Propranolol has gained
FDA approval in 2017 as the first-line therapy for
infantile hemangioma. In contrast, malformations are
difficult to treat, and therapy mostly is symptomatic.
Introduction 161
Significance 162
Vascular tumors 162
Vascular malformations 165
Secondary orbital involvement 169
Present relevance and future avenues to consider 170
Summary 173
Disclosure 174
Cataract & Refractive Surgery
Femtosecond Laser-Assisted Cataract Surgery

Emily Chang and Amy Zhang
Since femtosecond laser-assisted cataract surgery (FLACS)
first became commercially available approximately a
decade ago, it has continued to provoke much interest as
well as controversy. As femtosecond laser technology
continues to evolve, FLACS has shown to be a safe
alternative to the conventional phacoemulsification
surgery. However, the successful adoption of a new
technology requires both cost efficiency and significant
improvement over conventional techniques. This article
summarizes the utilization of femtosecond laser
technology in certain steps of cataract surgery and
reviews its safety and efficacy in each step.
Introduction 177
Femtosecond laser technology 178
Clear corneal incision 178
Anterior capsulectomy 179
xxii
CONTENTS continued
Nuclear fragmentation 181

Astigmatism management 183
Summary 183
Disclosure 184
Advanced Technology Intraocular Lenses

Mariam S. Hamid, Man Li Jin, and Kevin J. Everett
Recently developed advanced technology intraocular
lenses (IOLs) aim to provide patients with the ability to
see in-focus images at multiple distances to mimic the
natural accommodative function of the eye. Multifocal
IOLs use diffractive, refractive, or hybrid technologies to
allow images from multiple focal points to be
simultaneously focused on the retina. This inadvertently
causes photic side effects including glare or haloes and
reduced contrast sensitivity, and therefore, careful
patient selection and consent are indicated. Extended
depth-of-focus IOLs use a single, elongated focal point to
reduce photic side effects, though often at the expense of
near vision compared with multifocal IOLs. This article
will review recent developments in advanced technology
IOLs such as multifocal, accommodative, and extended
depth-of-focus IOLs and discuss their visual outcomes
and side effects.
Introduction 187
Significance 188
Accommodative Lenses 188
Multifocal Lenses 189
Optical Side Effects in Multifocal Intraocular Lenses 191
Extended-Vision Intraocular Lens 192
Monofocal Intraocular Lenses with Increased Depth of Focus 193
Light Adjustable Intraocular Lenses 193
Phakic Intraocular Lenses 194
Discussion, future considerations, and summary 194
Vitreoretinal Disease
Diagnostic and Treatment Considerations for Macular Holes
Rupak Bhuyan, Jeffrey Brown, and Robin Ginsburg
Video content accompanies this article at http://www.

advancesinophthalmology.com
xxiii
CONTENTS continued
Macular holes are foveal neurosensory disruptions that

can impair vision and cause symptoms such as
metamorphopsia and scotomas. Stages 1A and 1B
should be observed. Stage 2 can be treated with multiple
modalities including topical dehydration agents,
pneumatic vitreolysis, and surgery. Surgery remains the
most used treatment, because it can prevent additional
vision loss from progression to stages 3 and 4. Surgery is
also the recommended treatment of stages 3 and 4.
Inverted internal limiting membrane flaps, human
amniotic membrane plugs, mesenchymal stem cell
injections, and autologous retinal transplants are newer
adjunctive treatments that offer encouraging results.
Introduction 201
Significance 203
Nonsurgical treatment 203
Surgery 204
Present relevance and future avenues 211
Topical agents 211
Ocriplasmin 212
Pneumatic vitreolysis 212
Internal limiting membrane staining 213
Glial plug after internal limiting membrane manipulation 213
Intraoperative optical coherence tomography 213
Autologous mesenchymal stem cell transplantation 213
Autologous retinal transplantation 214
Summary 214
Clinical care points 216
Disclosure 216
Supplementary data 216
Peripheral Retinal Degenerations and Treatment Options

George Jiao, Marib Akanda, and Ronni M. Lieberman
There are numerous pathologies that can be found in the
peripheral retina, including degenerative disease.
Involvement of the vitreoretinal interface and certain
intraretinal degenerations can lead to retinal tears or
detachments. The standard of care for diagnosing and
monitoring these peripheral retinal degenerations is
dilated fundus examination, but current technologies
may aid us when the diagnosis is unclear. Prophylactic
treatments may be warranted in many cases of
predisposing lesions. Definite treatments for retinal tears
are important in preventing retinal detachments.
Introduction 219
xxiv
CONTENTS continued
Benign lesions 220

Peripheral retinal drusen 220
Paving-stone (cobblestone) degeneration 220
Retinal pigment epithelium hyperplasia 220
Retinal pigment epithelium hypertrophy 221
Peripheral cystoid degeneration 222
Snowflake degeneration 222
Pars plana cysts 222
Pearl degeneration 222
White-with-pressure and white-without-pressure 222
Lesions predisposing to retinal detachment 223
Lattice degeneration 223
Senile retinoschisis 224
Vitreoretinal tufts 226
Meridional folds 226
Enclosed ora bays 226
Peripheral retinal excavations 226
Chorioretinal atrophy 227
Dark-without-pressure 227
Snail track degeneration 227
Retinal Tears and Holes 228
Dialysis 228
Horseshoe tear 228
Operculated round tear 229
Atrophic round hole 230
Treatment options for lattice peripheral degeneration 231
Summary 232
Disclosure 233
Update on Retinal and Ocular Imaging

Samuel Gelnick, Minh Trinh, and Ronni M. Lieberman
Retinal imaging has experienced rapid growth over the
past decades. An increase in resolution, field of view,
and accessibility has led to an increase in the use of
retinal imaging in clinical practice across all specialties of
ophthalmology. Understanding the advantages and
disadvantages of these retinal imaging modalities is
crucial to obtaining the appropriate studies to diagnose
and monitor retinal pathologies. In this article, we
review common imaging modalities, including their
evolution and clinical applications.
Background and introduction 237
Optical coherence tomography 238
Fundus photography 242
Artificial intelligence–deep learning 246
Adaptive optics 247
xxv
CONTENTS continued
Teleophthalmology 248
Types of teleophthalmology 249
Diabetic screening 249
Retinopathy of prematurity 249
Future directions 249
Disclosure 250
Glaucoma
30-Gauge Needle in Glaucoma/Anterior Segment Management

Ramesh Ayyala, Alireza Baradaran-Rafii, and Jacob Liechty
Video content accompanies this article at http://www.

advancesinophthalmology.com
Many clinical presentations and complications of

glaucoma, whether acute or chronic, including bleb
fibrosis, encapsulation, and so forth along with anterior
segment surgeries can be managed at the slit lamp with
the help of a 30 gauge (G) needle. This article presents
the indications and techniques involved in the use of
30G needle at the slit lamp in the management of a
myriad of ophthalmologic presentations and complications.
Introduction 253
Preparation of the patient 254
Follow-up after slit lamp procedures 254
Indications and procedure description 254
Bleb needling revision for scarred, fibrosed blebs 254
Bleb needling revision for encapsulating/encapsulated blebs
following Ahmed glaucoma valve implantation 256
Paracentesis to decrease intraocular pressure 257
Anterior chamber reformation 257
Suturing at the slit lamp 258
Suture removal 258
Injections 258
Ahmed glaucoma valve removal 259
Unplugging sclerotomy 259
Corneal procedures 259
DSEAK-related issues and 30G needle 259
Vitreous strand release 260
Astigmatic keratotomy 260
Summary 261
Disclosure 261
Supplementary data 261
xxvi
CONTENTS continued
Neuro-ophthalmology
Screening for Plaquenil

Pushpinder Kanda, Stuart Coupland, Chloe Gottlieb,
Lynca Kantungane, and Rustum Karanjia
Hydroxychloroquine use needs to be carefully monitored
for retinal toxicity that can lead to significant visual
impairment. This review summarizes the current
screening guidelines and imaging modalities
recommended by the American Academy of
Ophthalmology and highlights future research trends for
improving test sensitivity. It also discusses the utility of
using mfERG for detecting early retinopathy and
research supporting its use as a primary screening tool.
Introduction 263
Plaquenil screening modalities 266
Automated visual fields 267
Spectral-domain optical coherence tomography 270
Fundus autofluorescence 270
Multifocal electroretinogram 271
Current trends and future research 273
Summary 275
Disclosure 276
Update on Optic Neuritis in Adults: Multiple Sclerosis,

Neuromyelitis Optica Spectrum Disorder, and Myelin
Oligodendrocyte Glycoprotein Antibody–Associated Disease
Serena Li, Rahul A. Sharma, and Benson S. Chen
This review provides an update on the diagnosis and
management of inflammatory optic neuritis in adults,
focusing on presentations associated with multiple
sclerosis, neuromyelitis optica spectrum disorder, and
myelin oligodendrocyte glycoprotein antibody–associated
disease. Clinical clues that enable early recognition of
these distinct disorders are discussed, including patient
demographics, clinical features, and radiologic findings.
The use of corticosteroids, plasmapheresis, and other
acute management treatment strategies for optic neuritis
are appraised, followed by an overview of long-term
management, specifically strategies for
immunosuppression including when to initiate and with
which therapies. Finally, prognosis and future avenues
are considered.
Introduction 280
xxvii
CONTENTS continued
Diagnosis 280
Demographics 280
Clinical features 282
Radiologic features 283
Acute management 284
Long-term management 286
Clinically isolated syndrome and multiple sclerosis 287
Neuromyelitis optica spectrum disorder 288
Myelin oligodendrocyte glycoprotein antibody associated diseases 289
Prognosis 289
Future avenues 290
Summary 291
Disclosure 292
Efficacy and Safety of Tocilizumab in the Treatment of

Ocular Manifestations in Giant Cell Arteritis
Nooran Badeeb and Rustum Karanjia
Vision loss in GCA is an ophthalmic emergency that
requires prompt medical intervention. The goal of the
treatment is to preserve the remaining vision and
prevent further systemic complications. Corticosteroids
are the first-line treatment for GCA but are prone to
cause iatrogenic side effects. In this review, we discuss
the role of other immunosuppressant medications,
especially Tocilizumab in controlling cases of GCA with
ocular involvement and review the literature on the
indication, guidelines of administration, and safety of Tocilizumab.
Introduction 295
Methodology 296
Selection criteria 297
Results 297
Significance 297
Visual outcomes reported with Tocilizumab 299
Duration of treatment with Tocilizumab 305
Administration of Tocilizumab 306
Safety and side effects of Tocilizumab 306
Summary 307
Acknowledgments 308
Disclosure 308
Coronavirus Disease 2019–Related Health Disparities in

Ophthalmology with a Retrospective Analysis at a Large
Academic Public Hospital
Y. Grace Chung, Christie M. Person, Jacquelyn O’Banion, and
Susan A. Primo
xxviii
CONTENTS continued
The coronavirus disease 2019 pandemic has

disproportionately affected racial and ethnic minorities in
the United States. Although recent meta-analyses have
identified the prevalence of ocular manifestations in
severe acute respiratory syndrome coronavirus 2
infection, no studies with these potential findings have
been implemented in examining ophthalmic disparities in
racial and ethnic minorities. It is additionally clear that
patient access to eye care from coronavirus disease 2019
has been disproportionate in underserved communities.
Large public hospitals and urban academic medical
centers provide a unique opportunity to further study
ocular disease presentation and health disparities from
coronavirus disease 2019 in these populations.
Introduction 312
Significance 313
COVID-19 disproportionate impact 313
COVID-19 related health care disparities in ophthalmology 313
COVID-19 related ophthalmic manifestations 314
Relevance and future avenues 318
Conclusion 319
Summary 320
Disclosure 320
Cornea and External Diseases

Stepwise Approach to the Diagnosis and Management of
Dry Eye and Ocular Surface Disease
Jennifer B. Nadelmann, Angela Gupta, Caroline W. Chung, and
Stephen E. Orlin
Dry eye disease (DED) is a multifactorial disorder caused
by abnormalities of the tear film that causes damage to the
ocular surface. Screening tools are helpful in making the
diagnosis and in determining disease severity. It is
important to take a careful history and to evaluate
meibomian gland physiology, tear film quality,
meibomian gland status, and tear production. Clinicians
should take a stepwise approach in treating DED.
Treatments vary for evaporative dry eye, aqueous
deficiency, and/or inflammatory DED. For patients with
symptoms that have not improved following
conservative measures, prescription medications, blood
products, procedures or devices can be considered.
Introduction 325
xxix
CONTENTS continued
Significance 326
Approach to diagnosis 326
Clinical examination 330
Approach to treatment 331
Recent and upcoming innovations 336
Diagnostic imaging 336
Pipeline treatments 337
Summary 338
Disclosure 339
Update on the Classification and Management of

Corneal Dystrophies
Vivian L. Qin, Devin Cohen, Tomas Andersen, and
Stephen E. Orlin
The most recent IC3D classification (2015) categorizes the
corneal dystrophies based on genetic, clinical, and
histologic characteristics. Here we review the
classification of the corneal dystrophies as epithelial and
subepithelial, epithelial-stromal TGFB1, stromal, and
endothelial. We discuss the variety of available medical
and surgical treatment modalities based on
symptomatology and anatomic area of the cornea
affected. We explore the recent advancements in the
area of corneal regeneration without the use of donor
grafts, including injection of cultured endothelial cells
and gene therapy.
Introduction 345
Significance/in-depth analysis 347
Epithelial and Subepithelial Dystrophies 347
Epithelial-Stromal TGFB1 dystrophies 349
Stromal Dystrophies 353
Endothelial Dystrophies 356
Relevance and future avenues 358
Summary 361
Disclosure 363
Surgical Management of the Aphakic Eye

Tianyu Liu, Brian J. Nguyen, Samantha L. Marek, and
Stephen E. Orlin
Current approaches to the surgical correction of aphakia
include anterior chamber intraocular lenses (IOLs), iris-
fixated IOLs, sulcus IOLs, and scleral-fixated IOLs with
xxx
CONTENTS continued
or without sutures. Anterior chamber and iris-fixated IOLs

are technically easier to place but are associated with risks
including corneal decompensation, uveitis, and glaucoma.
Sulcus placement of IOLs can achieve physiologic
positioning of the lens but requires adequate capsular
support. Overall, current approaches to correction of
aphakia have comparable efficacy and safety outcomes,
and the advantages and disadvantages of each technique
should be considered in light of patient and surgeon
factors in surgical planning.
Introduction 367
Significance and in-depth analysis of the topic 368
Epikeratophakia 368
Anterior chamber intraocular lenses 368
Iris-fixated intraocular lenses 369
Sulcus placement of intraocular lenses 370
Sutured scleral-fixated intraocular lenses 372
Sutureless scleral-fixated intraocular lenses 374
Current relevance and future avenues 376
Minimizing suture erosion with scleral pockets and Z-sutures 376
Modifications of the Yamane sutureless fixation technique 378
Correction of pediatric aphakia 378
Summary 379
Disclosure 380
Oculoplastics
Teprotumumab: A Major Advance in the Treatment of

Thyroid Eye Disease Management
Caroline Y. Yu, Jamie A. Keen, and Erin M. Shriver
Thyroid eye disease (TED) is an uncommon orbital
inflammatory disease that can lead to disfigurement and
permanent vision loss. Traditional therapies such as
glucocorticoids and orbital radiation primarily were used
to treat inflammation during the active phase of the
disease. Teprotumumab, the first Food and Drug
Administration-approved medication for TED, targets
the insulin-like growth factor-1 receptor and has been
shown to decrease proptosis, diplopia, and clinical
activity score. In this review, the pathophysiology and
treatment landscape of TED are summarized, and the
mechanism, clinical data, and associated adverse events
of teprotumumab are described in detail.
Introduction 383
xxxi
CONTENTS continued
Pathophysiology of thyroid eye disease: the role of insulin-like

growth factor 1 receptor 385
Treatment landscape for thyroid eye disease—anti-inflammatory therapies 385
Teprotumumab: mechanism of action 387
Safety profile of teprotumumab 387
Clinical effect of teprotumumab 388
Clinical applications of teprotumumab: future avenues 390
Disclosure 396
Diagnosis and Management of Irritated Eyelids

Christine Ryu and Rao V. Chundury
Eyelid irritation is one of the most common complaints
encountered by eye care providers. The cause can be
divided into 5 broad categories of blepharitis,
immunologic, inflammatory, infectious, and neoplastic.
Some of the most common causes include staphylococcal
blepharitis, seborrheic dermatitis, posterior blepharitis,
allergic contact dermatitis, atopic dermatitis, and rosacea.
Steroids have been the first-line treatment of
immunologic and inflammatory conditions, but newer
steroid-sparing agents such as pimecrolimus and
tacrolimus also are proving effective. Patients with
atypical presentations or symptoms refractory to
treatment should be evaluated for possible malignancies.
Introduction 401
Significance 402
Blepharitis 402
Immunologic 403
Inflammatory 413
Infectious 414
Neoplastic 414
Present relevance and future avenues 419
Blepharitis 419
Immunologic 421
Inflammatory 421
Infectious 424
Neoplastic 424
Summary 425
Disclosure 428
Uveitis
Uveitic Glaucoma
Erick Rivera-Grana and Stephanie M. Llop
xxxii
CONTENTS continued
Uveitic glaucoma is a complex disease whose pathogenesis

and treatment differ greatly from other glaucoma
syndromes. Intraocular pressure elevation can be due to
open-angle, closed-angle, or mixed mechanisms and
steroid-induced processes. Up to 20% of patients with
uveitis develop glaucoma. It is important to adequately
recognize the differences in the treatment of this disease
to accurately manage both glaucoma and ocular
inflammation. We provide a review of the most common
inflammatory etiologies that cause glaucoma and
different treatment modalities used to manage it, both
medical and surgical.
Introduction 433
Significance 434
Pathogenesis 434
Signs and symptoms 435
Uveitis etiologies associated with uveitic glaucoma 436
Present relevance and future directions to consider or investigate 440
Standard treatment approaches 440
Treatments apart from well-known intraocular pressure
medications and filtering surgery 442
Summary 445
Disclosure 446
Solo Private Practice Journey

Priya Kalyam
On completing medical training, physicians have little to
no experience with choosing their future job. Much of
their experience has been tied up with choosing a career
and then competing for the best training experience.
This article provides the author’s insight into the path of
entering solo practice.
Introduction I
A step forward I
Opening the
practice II
Day-to-day
life III
Things I wish I focused on during residency IV
Summary IV
Disclosure IV
xxxiii
Advances in Ophthalmology and Optometry 7 (2022) xxxv
ADVANCES IN OPHTHALMOLOGY AND OPTOMETRY
PREFACE
Myron Yanoff, MD
Editor
LOOKING BACKWARD AND FORWARD
I
n Volume 7 of Advances in Ophthalmology and Optometry, we again have asked
experts in each of the pertinent fields to sift through the current literature to
give us insights on the latest developments, such as bioptic driving in the
United States; the use of B-scan ultrasound in primary eye care; nonsurgical
treatment of strabismus; an update on pediatric optic neuritis; genetics of
congenital cataract; intra-arterial chemotherapy for retinoblastoma: an update;
screening for plaquenil; femtosecond laser-assisted cataract surgery; COVID-
19-related health disparities in ophthalmology with a retrospective analysis at
a large academic public hospital; a stepwise approach to the diagnosis and man-
agement of dry eye and ocular surface disease; teprotumumab: a major
advance in the treatment of thyroid eye disease management; and much more.
We continue to explore the new ideas, new treatments, and new ways of do-
ing things to give us a fresh frame of reference to sort through the crush of data
and to make sense in a real way of how to proceed.
Myron Yanoff, MD
Department of Ophthalmology
University of Pennsylvania
Department of Ophthalmology
Drexel University
219 North Broad Street, 3rd Floor
Philadelphia, PA 19107, USA
E-mail address: myanoff4@gmail.com
https://doi.org/10.1016/j.yaoo.2022.05.002
2452-1760/22/ª 2022 Published by Elsevier Inc.
Another random document with
no related content on Scribd:
Yet of all the pictures of either the stately or the modest homes of
Scotland, which now hang in the gallery of memory, none exceeds in
beauty and charm those of the home at Invergowrie, where we were
several times guests. Here was a typical Scottish family of character
and culture. Father and mother were in the prime of life, health, and
manifold activities. Around them had grown up a family of sons and
daughters, from the youngest, a blooming maiden of eighteen,
educated in Germany and at Brussels, to the eldest son, who,
besides being active in business, was an officer in the local volunteer
artillery corps. At night he loved to put on his Highland suit for
comfort and enjoyment, as we chatted with his friends on British and
American politics. One of these talks, in the billiard-room, was soon
after President Cleveland had issued his strenuous proclamation
concerning Venezuela, when British feelings were hurt and when a
combination of tact, some knowledge of history, and of the political
and personal motives of American Presidents was necessary to the
guest and peacemaker.
The Invergowrie family honored the American in Scotland more
than once by inviting, to the dinners given in his honor, the
professional gentlemen of the neighborhood and from Dundee.
While in Scotland one must beware of what toes he is likely to
tread upon, should he nurse opinions differing from those welcomed
by people holding any of the various shades of Presbyterianism,
whom he will probably meet anywhere and everywhere. It was in
Scotland, above every other country, that we learned what it meant
to “mind your p’s,” yet our hope is that we succeeded measurably.
The garden parties, in which the young people had their fun and
amusement, the five o’clock teas, at which the ladies of the
neighborhood dropped in for chat and friendly calls, were as
delightful to enjoy as they are now pleasant to recall. Yet, as in the
United States the county fair excels all other inventions and facilities
for seeing the real, average American, so I valued most, for intimate
knowledge of the Scottish populace of all grades and ages, the local
exhibitions, “bazaars,” and gatherings.
To be present, as we often were, to see the modern version of
“The Cotter’s Saturday Night,”—though in this version we mean a
luxurious home, with all the appointments of comfort, culture, and of
service,—crowned all delights. This social situation in Scotland is
necessarily different from that in America, where, in the cities at
least, native-born maidens so rarely take domestic service in
families. With our composite people, also, there is usually such a
disagreement as to the theories of the universe, as taught by priest,
parson, and rabbi, that worship of the same God by all, at one time,
in the same way, and in one household, seems impossible. The
head of the house or the mistress holds usually to one form of
dogma or ritual, while the servants have been reared in an
atmosphere so very different that family worship, with the “help”
joining in or present, is, to say the least, not customary in “the land of
the free.” Occasionally British visitors, who imagine that the very
mixed people called Americans are descended chiefly from insular
instead of continental stock, like the late James Anthony Froude
when in New York city, for instance, make disagreeable discoveries.
At times, in our democracy the kitchen rules the parlor.
At Invergowrie, as in a score or more of homes on the island in
which I have been so often a guest, the two or three maids and
perhaps a man-servant came in with their Bibles and read, with the
children of the household, the Word which is above every other word
—the Father’s message to his children. Where there was but one
servant, the same rule usually held. At Invergowrie, besides a
chapter of Scripture and a prayer by the father, the high priest of the
family, the older son read one of the Psalms in Rous’s metrical
version.
The breakfast in Scotland, as in the British Isles generally, is one
that suits admirably the free-born Briton. It is certainly a festival of
freedom for the servants, who are usually apt to be upstairs or
attending to other domestic duties, though in a large family, the
members of which sit down at the same time, there is usually one
maid present to wait upon the table. At several places where I was
entertained, even in well-to-do families, the grown sons and
daughters or members of the household came and went at their
convenience, helping themselves at will from dishes on a sideboard.
After the table has been laid by one of the maids, who may or may
not remain present, it may be that the elder daughter serves. At
Invergowrie there was a large, normal family, consisting of parents
and children, with sufficient uniformity of dispositions and habits to
make both the breakfast and the dinner time a delightful gathering,
with merriment and leisure. The news of the day, the happenings of
the neighborhood, the things alike and different as between Scotland
and America, the annals of the village fair, or the social chat, or
those pleasant nothings that lubricate life, made the moments pass
all too rapidly.
That father benign and mother of imposing presence have been
long laid to sleep; but in London, and Edinburgh, and Dundee, in the
world at large, live yet these sons and daughters of “Bonnie
Scotland” who have made the Americans’ memories of their lovely
home in their home land a storehouse of delight.
Besides the private grounds of the home, with their trees and
shrubbery, there were walks that afforded plenty of room for rambles.
Still farther afield, yet not far away from either the house or the
railway station, were ruins of Dargie Church. These touched the
imagination and called history to resurrection. It appeared strange to
come across the footprints of our old friend St. Winifred, or Boniface,
whom we met with in our studies of the Pilgrim Fathers, and in the
Netherlands, whose varied and strenuous life, as ecclesiastical
politician as well as saint and soldier of the Papacy, quite as much
as preacher of the gospel, was one of such amazing activity. At
Scrooby in England, at Dokkum in Friesland, in France and in
Germany, where I visited the places made historic by his activities,
he left enduring marks of his influence and power.
At Invergowrie I meditated among the ruins of the old kirk, in
which, or near by, it is said, St. Boniface, the apostle to Germany
and a legate from the Church of Rome, in the eighth century
preached and planned to neutralize the work of the Irish monks in
favor of British uniformity, and by means of conformity with Rome.
Here also are still to be seen some singular examples of ancient
sculptured stone monuments.
In 1107, Alexander I, son of Margaret of England, had a
residence at Invergowrie, which, however, he did not long possess,
for assassination was so much of a pastime with many and a settled
custom with a few in those days, that, after having escaped the dirk
only by a narrow margin, he left Invergowrie, built a church at Scone,
and then turned over the property he left behind him for its support.
I recall that it was at the last of our visits and entertainment at
Invergowrie, which was in 1900, after the ladies had left the dinner
table and the gentlemen adjourned to the billiard-room for a smoke,
the conversation turned on the next European war, and the possible
relations of Great Britain and the United States in the alignment of
friends, foes, allies, and neutrals. One prominent Dundeean
confessed himself not so much exasperated, as hurt, by President
Cleveland’s sharp method of reasserting the Monroe Doctrine, in
regard to the boundary of Venezuela. From our town of Ithaca, the
two scholars, the ex-president of Cornell University and Professor
George Burr, had been summoned to consult archives, rectify
boundaries, and help keep the peace. After the American in Scotland
had emptied his cruse of oil upon the waters, by explaining some of
the ins and outs of American politics, the conversation drifted to
regions across the North Sea—the growth of the Kaiser’s navy, the
salient features of German politics, and the reports, then very direct
from the Fatherland, that the “Kultur” of the twentieth century
required that “England [Great Britain] needed to be taught a lesson.”
The hope was warmly expressed that, in the coming clash,—then
looked for to come before many years,—the sympathy, and even aid,
if necessary, of “the States” would be forthcoming. With American
friendliness and the possession of the coaling-stations of the world, it
was believed that the United Kingdom could withstand the coming
shock and recover triumphantly.
More than once, at these social conferences with Scotsmen, as
well as in the press, I noted the indignation, even anger, expressed,
that in all national affairs it was “England” and “the English” that took
and received the credit for what belonged to the four nations making
up the United Kingdom. The claim was for a more liberal use of
“Britain” and “British” in place of “England” and “English.” Both
Scotch and Irish, to say nothing of the Welsh, resent the assumption
that “England” is the British Empire. In a word, the great need of the
language used in the British archipelago is a common name for the
federated four countries and for all the subjects of the Crown. Here is
an instance of the priceless value of right words. The absence of an
acceptable comprehensive term is a real impediment to patriotism
and an obstacle to perfect union. The fault is in language, not in the
human spirit. The situation reinforces the argument that “words are
things.”
We Americans can throw no stones. Canadians, Mexicans, the
southern republics below Panama, all challenge our right to the
monopoly of “America” and “Americans.” Language lags behind
events.
When at last, in 1914, the great war did come, and the storm
broke, no part of the Empire responded more quickly, generously,
fully than Scotland, nor did any courage or sacrifice exceed that of
the Scots; yet, not only was the credit usually given to “England,” but
even the prayer of hate, made in Germany, chose “England” as its
butt. Yet while Scottish valor and sacrifice and Irish courage and
free-will offerings of life on the field and waves are unstinted, who
can blame the poet, nay, who does not say “amen,” to his lines, in
the Glasgow “Herald,” written in the closing days of 1915?
“The ‘English’ navy in its might

Is out upon the main;
The ‘English’ army—some in kilts—
Is at the front again;
The dogs of war are loosened
And gathering to the fray,
But the British ships and British troops—
I wonder where are they?
“When blood has flowed like water,
And ’midst the heaps of slain
Lie stalwart Scot and brawny Celt
Who victory help to gain,
The glory will be ‘England’s,’
Like every other thing;
’Tis ‘England’ this and ‘England’ that—
Flag, navy, army, king.
“Still let Scots do their duty

In Britain’s day of war;
A greater cause than ‘England’s’
Nerves Scottish hearts by far.
For Britain and the empire
We Scotsmen draw the sword,
And not like hired mercenaries,
As if ‘England’ were our lord.”
During this trial of the soul of a nation, in the wager of battle, to

decide whether truth is worth living and dying for and whether
solemn compacts are as torn paper—we catch a glimpse of a great
part of the nation at prayer.
It is in St. Giles’s Church, Edinburgh, that the General Assembly
of the Church of Scotland holds its annual sessions and the function
is made decidedly spectacular, as is supposed to become a State
Church. For two hundred and twenty-five years, the meeting has
been held without interruption. In the brilliant procession, the Lord
High Chancellor, as representative of the king, takes part, and
usually a regiment of the garrison troops adds color and a show of
worldly might to the spectacle. Few elements appropriate to the day
are omitted, for this is the august assembly of the “Church
established by law.” In the spring of 1914, the full strength of the
Cameron Highlanders was paraded.
FOR THE WHOLE WORLD
(The Edinburgh Conference of Missions)
But in 1915, after the gates of hell had been fully opened on the
Continent, swallowing up, it is said, from one regiment, by death and
wounds, no fewer than nine hundred of the Cameron Highlanders,
leaving but one hundred unwounded survivors, the meeting was
more than usual like a gathering of the ministers of the Prince of
Peace. The king’s representative on this occasion, the Earl of
Aberdeen, was dressed in a soldier’s service uniform of khaki and
the military escort as guard of honor was a corps of cadets. The
interior phenomena were equally impressive. Men cared little for
debate and turned constantly to prayer and intercession. The high-
water mark of interest in the proceedings was on Foreign Mission
Day. Then a strong note of optimism appeared regarding that work,
in comparison with the depression felt as to other interests of the
Church. It was in Edinburgh that the world-wide conference upon
missions was held in 1913, whose influence is still felt throughout the
whole earth.
Perhaps some thoughts turned to the words of the Almighty to
Job, “And the Lord turned the captivity of Job, when he prayed for
his friends.”
Be this as it may, can we not all abide in hope that the ultimate
history of “Bonnie Scotland” will follow that of Job—“Also the Lord
gave Job twice as much as he had before.”
CHAPTER XXV
AMERICA’S DEBT TO SCOTLAND
It is a tradition, rather than a fact, that we Americans—not of

Canada—of the United States of America are an English people.
The burden of popular and uncritical historiography is responsible for
this notion. Because of the overpowering influence of law and
language, and because our most direct relations, in war and in
peace, have been with Great Britain, it is assumed that we are both
an English people and an English nation.
The result has been confusion at home, prolonged
misunderstanding in Europe, and injustice to those who have
contributed generously their blood and energies to the making and
the saving of the nation.
Without the initial and formative elements, now absorbed into our
national composite, from the Dutch, Huguenot, German, Scottish,
Welsh, Irish, and Iroquois, the existence and history of the United
States are, to the unprejudiced mind, inconceivable. In this chapter
we propose to glance at the debt we owe to Scotland.
In point of time, in the unshackling of the human spirit, and in the
attainment of mental and spiritual freedom, we have shown how
Scotland led Europe; first in revolt against kings and prelates, and
then in the initiative of the constructive principles of democracy. The
spirit of Scottish history, of which Robert Burns’s poem, “A man’s a
man for a’ that,” is the epitome, and the general education of the
common people do in themselves alone show how different were
and are the Scottish from the English people.
This early Scottish influence, conveyed through both theory and
example, was especially potent with the founders of New England,
the Puritans in Old England, and the Pilgrims who, in the Dutch
Republic, received tremendous reinforcement.
In philosophy—which is greater than armies or navies—to no
other land or people were the beginners of the American nation more
indebted than to the Scotch. This may be said, not only in the
departments of political and ecclesiastical science, but equally so in
the domain of pure thought. The Scottish philosophy of realism and
common sense dominated largely our infant colleges. It swayed the
thinking and shaped the conduct of our public men in bar and pulpit.
It was translated into action by the leaders of the Revolution.
So long as the Scots were able to hold their own against the
tyrannical Stuart kings of England, and even while they were pouring
by the tens of thousands into Ulster, making a new nation in northern
Ireland,—the old land of the Scots,—there were but few emigrants,
from Scotland direct, to the Atlantic Coast colonies. Even these were
sporadic and mostly by way of Holland; but when the oppressive
economic measures of Parliament ruined the Scotch-Irish industries,
there began an emigration of people of Scottish birth or descent
which numerically excelled any previous colonial accession to
America.
Whereas, the emigration from England to New England, mostly
between 1630 and 1650, had added but twenty thousand souls to
the northeastern seacoast region, the Scotch-Irish migration, lasting
fifty years, added fifty thousand hardy, intelligent, thrifty people who
settled in the interior and on the frontiers. They not only served as a
barrier against the savages, but they developed the soil of the
valleys and built their towns on the highlands and the watersheds.
After the accession of the Hanoverian dynasty and the breaking-
up of the old economic and social conditions in Scotland, there
poured into America a flood of Scottish islanders, Lowlanders, and
Highlanders from Scotland direct, numbering tens of thousands.
From this multitude of the Scots and Scotch-Irish, scattering widely
and settling mostly on the frontiers and developing virgin land, came
forth, at the call of the Continental Congress, one third of the
American army of freedom in the Revolution.
Throughout our history none have excelled these lovers of
ordered freedom in safeguarding human rights and in illustrating
loyalty to moral convictions and public duty. The number of able men
of Scottish descent who have filled the highest offices of honor and
trust in the learned professions, in pulpit, bar, bench, in chairs of
science, or as governors, presidents, officers of the army and navy,
and in every line of human achievement, is not excelled, if equalled,
by those of any other stock in the American blend of nationalities.
Yet the total value of such an addition to the resources of
manhood, for the making of the future American commonwealth,
cannot be estimated in mathematics only. In education almost every
classical school and colonial college in the South was established by
these people. In character and abilities—trained and nourished by
education, morals, and religion—the Scotch-Irish were excelled by
no other people.
In our land—new birth of the ages—the names of the clans and
of individuals who bear Caledonian names do not only call up
scenes in Scotland’s history, but do forcibly emphasize our blessings
of peace after long strife. One of the earliest Scottish stories I
remember was of a Grant and a Macpherson, who met one day
upon a log spanning a chasm. As neither would give way to the
other, their dirks settled the controversy by subtracting two from the
population of the Highlands. In our soldier days, it was delightful to
see, under the same flag and battling for the same Union, two
generals—the ever-victorious James Macpherson and
“Unconditional Surrender” Grant. Was it the Inverness-born
Macpherson, or the Kentuckian MacClernand, who uttered the
prophecy concerning the then closed Mississippi Valley, that “the
men of the West would, with their swords, hew their way to the
Gulf”? In any event, what would the North have done had all the men
of Scottish descent been subtracted from the hosts under Grant?
Indeed, what would American history and the reality of to-day be if all
the Scotsmen who took part were eliminated from the story? Even in
Civil War days it was largely the descendants of Scots who made the
Union sentiment in East Tennessee and created West Virginia.
The long discipline of the Scotsmen, resulting in the gifts and
graces of Highlander, Lowlander, and Ulsterman, helped grandly on
American soil to make the great Republic possible. As we have
seen, the tens of thousands of Scots, emigrating beyond the Atlantic,
located themselves largely along the line and at the post of danger—
among the mountains they loved, on the frontier and the great
American highlands, the Appalachian chain, from Maine to Alabama.
In the infant days of our nation, when the vital struggle was between
savagery and civilization, the Scottish-American frontiersman, alert,
brave, tenacious, was the man for the era. He would never say “die”
nor give up, while life remained in him. His record, both with the
Continentals, in the War of Independence, and in the Union army
during the conflict between the States, is a shining one. In the
Confederate forces, from 1861 to 1865, the one body of men,
selected by that best judge of humanity, Professor N. S. Shaler, of
Harvard, as embodying the finer human qualities that shine brightest
in adversity, was a regiment composed almost wholly of
descendants of men of Scottish stock.
Even to hear casually some of these Scottish names, so
interesting to us in history, sets ringing the bells of memory, as when
Joseph Henry, at Albany, first sent a thrill through miles of wire to
make sound—which Morse, without electrical research or profound
knowledge, turned into writing, and thus won the world’s glory. Even
the commonplace names of neighbors, as our Scottish hosts in
Dundee, Invergowrie, or Newport-on-Tay mentioned them offhand,
set our imagination on the dance or to rambling to the ends of the
earth.
At home, too, do we not meet at school, in business, at garden
parties, or in church, girls and boys, friends and acquaintances, or
do we not hear of or see eminent men and women who bear these
their ancestral names most modestly? Immediately, a carillon of
associations, usually sweet, with “auld lang syne” sounds, fills the
secret chambers of memory. “Cochrane” may bring up a rosy face
and the laughing eyes of a pretty Vassar girl; “Macfarland” limns in
imagination a schoolmate or army comrade; “Cameron” pictures a
fellow of infinite wit; “MacIntosh” suggests eloquence in the pulpit.
Others recall the halls of Congress, or the seats of executives, or the
council board, business experiences, or clerical scenes, or pageants.
It has the sensation almost of a shower bath, or crash towel friction,
to see in court or pulpit, at clinic, or amid scenes of gentleness,
people who bear ancestral names of once slashing swordsmen, or
fellows of old famous for lifting cattle, or for defying the king’s writ, of
whom we have read often in poetry and romance. How the centuries
soften sharp outlines in the enchantment of distance!
It is invidious, if not mildly dangerous, to single out names. Yet
with one we close our sketch of “Bonnie Scotland,” choosing for
praise the dead, with no living line of descendants. Hepburn, for
example, instead of being associated in our minds with dirks and
poison, caste squabbles, or pitched battles,—after which “the turf
looked red,”—calls up the mild face of a saintly soul who illustrated
the Scripture promise of long life because of lips that refrained from
speaking guile and of hands that ever healed. Who that is at home in
Scottish history but has not infrequently run across the name of
Hepburn—which reproduces in its vocables, not only a Scottish
streamlet, but a line of mighty men? Who, also, that knows the story
of the making of modern Japan but has heard of the beloved
physician of Yokohama, known among the native-born as Kun-shi—
the sage, super-man, gentleman by eminence, who spent his life in
unselfish devotion to his fellow men, as a Christian healer, scholar,
lexicographer, and philanthropist. In the midst of fame and fortune
won by medical practice in the metropolitan city of New York, James
Curtis Hepburn turned his back on these, to uplift in body and spirit
the people of Japan, when just opened from hermitage to modern
life. In the days of sailing ships and at the seaport where the
selvages of two civilizations met, I saw him, day by day for years,
with his healing touch dispensing medicine and cheer. He lived to
make the dictionary which bridged the linguistic gulf between Orient
and Occident, to translate the Eternal Word, to raise up hundreds of
effective physicians, and, at ninety, to be honored by His Imperial
Majesty the Mikado with a decoration, and to live, in serene old age,
a benediction to his neighbors, until within five years of a century. In
him I saw America honored and the nobler Scotland incarnated.
THE END
CHRONOLOGICAL FRAMEWORK OF
SCOTLAND’S HISTORY
PREHISTORIC
Britain, “north of the Tweed.” Picts and various
tribes.
THE ROMAN PERIOD

b.c.
55. Julius Cæsar lands in southern Britain.
a.d.
50. Romans in Britain learn of the Caledonii in the
north.
81. Agricola’s frontier between the Firths of Forth
and Clyde.
82. The Ninth Legion at the Tay River.
84. Great battle between the Romans and northern
natives.
84. Caledonia circumnavigated.
120. Hadrian erects the Roman Wall.
139. Wall of Antoninus Pius.
181. Revolt of the Tribes. Commodus.
208. Uprising of the Tribes. Severus.
210. Roman road made through the Forth Forests.
364. Highland host invades the South.
368. Roman slaughter of the “Scots” (Irish invaders).
406. Revolt of the northern tribes.
410. The Romans leave Britain.
PERIOD OF ANARCHY—FIFTH TO SEVENTH
CENTURY
Migration of the “Scots” (Irish) to the peninsula.
Fergus, first “Scots” Prince.
Entrance of the Germanic, Continental tribes
into Britain.
Four kingdoms: Pictish (Pictland); Irish
(Dalriada); Brython (Strathclyde); and
“English” (Benicia).
CHRISTIAN SCOTLAND
563. St. Columba (521–592), Christian missionary at
Iona.
573. St. Kentigern at Glasgow.
651. St. Cuthbert at Melrose.
710. The Pict Christians conform to the Roman
Church rules.
717. The Columba monks expelled.
730–761. The Pict, Angus MacFergus, paramount.
802. Iona burnt by the Norsemen. Desolate for two
hundred years.
802–839. The Scandinavian sea-rovers settle on the
northern coasts.
844–860. Kenneth MacAlpine, King of the Picts.
Blending of the Picts and Scots into one people.
904. St. Andrews: religious centre. Stone of Scone.
945. Malcolm acquires northern Strathclyde.
1018. Lothian part of the Celto-Pict realm.
1005–1034. King Malcolm II.
FEUDAL SCOTLAND
1039–1056. Macbeth flourishes.
Ireland, “the Land of the Scots,” is known by its
modern name. “Scotland” refers to northern
Britain.
1057. Macbeth defeated and slain by Malcolm
Canmore.
1066. Normans invade England.
1058–1093. Malcolm Canmore and Queen Margaret.
Great social and political changes in Scotland.
The Celtic Church gives way to Western
uniformity.
Dunfermline, capital of the realm.
1124. Alexander, King of Scotland.
Planting of Norman, Flemish, and Anglican
colonies on east coast.
Anglo-Norman feudalism in Scotland.
David I, “The Maker of Scotland,” builder of
abbeys and bishoprics.
1153–1165. Malcolm the Maiden. Great Clan of Macdonalds
formed.
Ascendancy of Anglican influence. Inverness
granted a royal charter.
1165–1214. William the Lion. Dundee granted a royal
charter.
Chimneys introduced into Scotland.
1249–1286. Alexander III. Treaty with Norway.
Islands incorporated in the Scottish realm.
1292. John Baliol crowned on the Stone of Scone.
FIVE HUNDRED YEARS OF HOSTILITY TO

ENGLAND
AND FRIENDSHIP WITH FRANCE
1297–1305. Edward of England. Intervention in Scotland.
1298. William Wallace.
1274–1329. Robert the Bruce.
1334–1346. Battle of Bannockburn.
Scotland independent.
Scottish Parliament at Cambuskenneth.
1333–1361. Struggle with Edward III of England.
King David in Captivity. Ransom. Scheme of
Union.
Struggles between Scottish kings and nobles
looking to centralization of royal power.
Partisan warfare. The House of Douglas.
1364. Proposal of Union with England rejected by the
Scottish Parliament.
THE SCOTTISH KINGS

1371–1390. Robert II. The Stuart line of kings founded.
Policy of Scotland shaped by Earls Douglas,
Mar, March, and Moray.
English invasions of Scotland.
1390–1406. Robert III. Beginning of nearly two centuries of
royal minority, regencies, and nobles’ power.
Decline of kingly authority. Great power of the
nobles.
1395. The Lollards in Scotland: forerunners of the
Reformation.
1406–1437. James I. His reign a struggle against anarchy.
Attempts to Anglicize Scotland.
Parliament of Highlanders at Inverness. Several
chiefs seized and executed.
1437–1460. James II marries Mary of Gelderland: kills
Douglas at Stirling. Earls still powerful.
THE RENAISSANCE
1460–1488. James III marries Anne of Denmark.
The thistle, the national badge of Scotland.
Witchcraft. King imprisoned by the nobles and
assassinated.
1465–1536. Hector Boece writes the “History of Scotland.”
1488–1513. James IV. Modern History of Scotland begins.
1494. Grey Friars’ Church in Edinburgh built.
Ayala, Spanish envoy and writer on Scotland.
Music and poetry cultivated.
1495. University of Aberdeen founded.
1496. Parliament decrees compulsory education.
University of St. Andrews. Hepburn founds St.
Leonard’s College.
1503. Marriage of James IV with Margaret of England,
at Holyrood.
First Peace with England since 1332. An era of
prosperity.
1505. Royal College of Surgeons founded at
Edinburgh.
1507. Printing introduced into Scotland.
1513. Battle of Flodden Field.
THE REFORMATION
Rise of the burgesses and middle classes.
1513–1542. James V: minority. Angus rules. James escapes
to France.
1537. James marries Mary of Guise, and on her
decease, Mary of Lorraine.
1540. Lordship of the Isles annexed to the Crown.
1542. Invasion of Scotland by Henry VIII.
King and clergy on the Roman, nobles on the
Reformed, side.
1542–1587. Mary Stuart, Queen of Scots.
Close relations with France.
1505–1572. John Knox.
Destruction of monasteries and abbeys.
1557. Last Protestant martyr burned.
1565. Queen Mary marries Lord Darnley.
1566. Murder of Rizzio in Holyrood.
1567. Murder of Lord Darnley.
Marriage of Mary with Bothwell.
1567–1625. George Buchanan, scholar, reformer, author of
De Jure Regni apud Scotos.
James VI educated by George Buchanan.
PRESBYTERIAN SCOTLAND
1560. Foundation of the National Church.
First General Assembly of Scotland.
1578. Andrew Melville the Reformer. Second Book of
Discipline.
Divine Right of Presbytery taught. Nobles
debarred from spoiling the Church.
1587. Execution of Mary Queen of Scots.
1592. James gives Presbyterianism his sanction.
1603. Union of the crowns of England and Scotland.
James VI of Scotland becomes James I of
England.
1605. The Border region pacified and civilized.
1606. The Union Jack flag, uniting crosses of St.
George and St. Andrew.
STRUGGLE FOR FREEDOM OF

CONSCIENCE
1584–1688. Scotland’s fight against prelacy.
1610. King James changes his mind. Attempts
assimilation of Church of Scotland with the
Anglican Establishment.
1618. The Perth Synod accepts episcopacy.
1600–1649. Charles I asserts the royal prerogative.
1625. Attempts to fasten the liturgy and bishops upon
Scotland.
1637. Jenny Geddes. Uproar in St. Giles’s Cathedral.
Signing of the National Covenant.
1638. Episcopacy cast out.
1645. Covenanters compel Charles I to sign the
Covenant.
1649. Charles Stuart, King of England, executed.

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Advances in Ophthalmology and

Optometry, 2022 (Volume 7-1)

PHILADELPHIA LONDON TORONTO MONTREAL SYDNEY TOKYO

DAVID A. CRANDALL, MD – Cataract & Refractive Surgery

GABRIELA MABEL ESPINOZA, MD – Oculoplastics

PAUL B. FREEMAN, OD, FAAO, FCOVD – Optometry

RUSTUM KARANJIA, MD, PhD, FRCSC, DABO – Neuro-ophthalmology

RONNI M. LIEBERMAN, MD – Vitreoretinal Disease

ANN-MARIE LOBO, MD – Uveitis

STEPHEN E. ORLIN, MD – Cornea and External Diseases

JOSEPH M. ORTIZ, MD, FRCOphth – Glaucoma

LEONARD J. PRESS, OD, FAAO, FCOVD – Optometry

APARNA RAMASUBRAMANIAN, MD – Pediatric Ophthalmology

REDDIN AHMAD, BMBS, iBSC, Foundation Year 2 Doctor, Bradford Teaching

RAMESH AYYALA, MD, Department of Ophthalmology, University of South Florida

NOORAN BADEEB, MBBS, Department of Ophthalmology, School of Medicine,

ALIREZA BARADARAN-RAFII, MD, Department of Ophthalmology, University of

SUZANNAH BELL, MBChB, DTMH, MSc, Queen Alexandra Hospital, Portsmouth,

RUPAK BHUYAN, MD, Department of Ophthalmology, Icahn School of Medicine at

KASTURI BHATTACHARJEE, MS, FRCSEd, Head, Department of Ophthalmic Plastic

MARIE I. BODACK, OD, FAAO, Diplomate, Binocular Vision, Perception and

JEFFREY BROWN, MD, Department of Ophthalmology, Icahn School of Medicine at

MEHAR CHAND SHARMA, MD, Department of Pathology, All India Institute of

EMILY CHANG, MD, Resident, Department of Ophthalmology, Kellogg Eye Center,

BHAVNA CHAWLA, MD, Professor of Ophthalmology, Ocular Oncology Service, RP

BENSON S. CHEN, MBChB, MSc, FRACP, Department of Clinical Neurosciences,

RAO V. CHUNDURY, MD, Truhlsen Eye Institute, University of Nebraska Medical

CAROLINE W. CHUNG, MD, Resident Physician, Scheie Eye Institute, Philadelphia,

STUART COUPLAND, PhD, Department of Ophthalmology, Faculty of Medicine,

KEVIN J. EVERETT, MD, Director of Refractive Surgery, Henry Ford Hospital

SHAILESH GAIKWAD, MD, FNAMS, CCST, Professor, Department of Neuroimaging

ROBIN GINSBURG, MD, Director of the Vitreoretinal Service, Assistant Professor,

CHLOE GOTTLIEB, MD, Department of Ophthalmology, Faculty of Medicine,

MARIAM S. HAMID, MD, Chief Ophthalmology Resident, Henry Ford Hospital

GEORGE JIAO, MD, Resident Physician, Department of Ophthalmology, Northwell

PUSHPINDER KANDA, MD, PhD, Department of Ophthalmology, Faculty of Medicine,

LYNCA KANTUNGANE, COMT, Department of Ophthalmology, Faculty of Medicine,

RUSTUM KARANJIA, MD, PhD, Department of Ophthalmology, Faculty of Medicine,

JAMIE A. KEEN, MD, Department of Ophthalmology and Visual Sciences, University

SERENA LI, BA, Department of Clinical Neurosciences, University of Cambridge,

RONNI M. LIEBERMAN, MD, Assistant Professor, Department of Ophthalmology,

JACOB LIECHTY, MD, Department of Ophthalmology, University of South Florida

TIANYU LIU, MD, Ophthalmology Resident, Scheie Eye Institute, University of

SAMANTHA L. MAREK, MD, Ophthalmology Resident, Scheie Eye Institute,

KERRI MCINNIS-SMITH, BA, Mayo Clinic Alix School of Medicine, Scottsdale,

ADITI MEHTA, MD, Fellow, Department of Ophthalmic Plastic and Reconstructive

MARIYA MOOSAJEE, MBBS, BSc, PhD, FRCOphth, Professor, Moorfields Eye

JENNIFER B. NADELMANN, MD, Resident Physician, Scheie Eye Institute,

BRIAN J. NGUYEN, MD, Ophthalmology Resident, Scheie Eye Institute, University of

STEPHEN E. ORLIN, MD, Associate Professor of Ophthalmology, Chief of Cornea

APARNA RAMASUBRAMANIAN, MD, Phoenix Children’s Hospital, Phoenix,

ERICK RIVERA-GRANA, MD, Assistant Professor of Clinical Ophthalmology,

RAHUL A. SHARMA, MD, MPH, FRCSC, Department of Ophthalmology and Vision

ERIN M. SHRIVER, MD, Department of Ophthalmology and Visual Sciences,

NAVNEET SIDHU, MD, Senior Resident, Ophthalmology, RP Centre for Ophthalmic

SRAVANTHI VEGUNTA, MD, Pediatric Ophthalmology and Adult Strabismus Fellow,

VATSALYA VENKATRAMAN, MD, Fellow, Department of Ophthalmic Plastic and

BENJAMIN YOUNG, OD, FAAO, Assistant Professor of Optometry, New England

CAROLINE Y. YU, MD, Department of Ophthalmology and Visual Sciences, University

AMY ZHANG, MD, Assistant Clinical Professor, Department of Ophthalmology,

CONTENTS VOLUME 7  2022

Associate Editors vii

Bioptic Driving in the United States

CONTENTS VOLUME 7 2022