Human Cataract Formation. Ciba Foundation Symposium 106

61 ethical problem, thereby taking it out of the realm of abstract ethical debate and into the real world. Dr. Shea, starting well with a quote by Dr. Ingelfinger, presents a well-written and absorbing essay on conflict between pharmacist and physician. In general this is a fine book dealing with highly relevant problems. The difficult questions at best have difficult answers, if they have any at all. One would certainly have liked more essays such as those of Heins or Shea, but a reader will still find this volume worthwhile and look forward to the tenth and eleventh conferences, either in person or in uniform type. Human Cataract Formation is the result of a symposium of basic science research held at the Ciba Foundation in October of 1983. Ten years earlier, the first Ciba symposium on lens disease shifted the emphasis on research in the scientific community. Until the early 1970s, most of the work conducted on lens opacity was based upon animal models, and the applicability of this early data was questionable. The etiology of cataract formation in relatively short-lived mammals (rat, rabbit) probably was different from that of human senile cataracts. The original Ciba symposium resulted in a new interest in human lens opacity, and it led to a classification of lens disease developed by Leo Chylack. Human Cataract Formation begins with a classification of cataract change developed by the American Cooperative Research Group. The symposium then proceeds to an epidemiological study of risk factors in cataractogenesis. It is not surprising that Clayton et al. found low plasma calcium levels, high galactose levels, uremia, and diabetes to have a greater incidence in patients with cataracts. Less well-known risk factors showing statistically significant differences between patient and control populations included psychiatric illness, high blood pressure, and use of diuretics and antibiotics. In the symposium a paper was presented by A. Spector on oxidation and cataracts. Superoxide free radicals have previously been implicated in induction of cell damage. Spector's paper demonstrated cataract formation as a possible sequela to oxidation of certain membrane proteins in the lens. He also showed that an oxidizing agent, possibly hydrogen peroxide, may come from outside the area of the lens capsule. Lens opacity in the diabetic and galactosemic patient was one of the more interesting papers in Human Cataract Formation. Biochemical analysis of lenses from diabetic patients uncovered many abnormalities such as electrolyte imbalance, changes …