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The following is the preliminary report of a surgical procedure for primary chronic glaucoma of the shallow chamber type: According to recent microgonioscopic and surgical investigations 1 primary glaucoma may, with few exceptions, be divided into two main anatomic types according to the mechanical cause of the increased intra-ocular pressure. One type is characterized by normal or deep chamber and open iridic angle. In this the increased pressure is caused by blockage of the sclerocorneal trabeculum, and a rational operation, "goniotomy," has been suggested for its relief. 2 The second type is characterized by a shallow chamber and is produced by obstruction of the filtration angle by the root of the iris. An operative procedure for its relief is presented herewith. This procedure may be employed as an early or prophylactic operation or it may be employed, with safety and without complicating sequelae, for the relief of those cases in

In 1906 I presented a paper before the Section on Ophthalmology on "The Treatment of Simple Chronic Glaucoma by Miotics", 1 in which attention was called to the very satisfactory results which attend the use of these drugs in this variety of glaucoma, and their more intelligent and persistent administration was urged. It was pointed out that "while the results of operation are known to be less favorable in simple chronic glaucoma than those obtained in other forms of this disease, yet it is almost commonly conceded that even in this type iridectomy gives a better chance for retaining vision than any other form of treatment." It was questioned, however, whether there is positive evidence that miotics are of less value than iridectomy in the treatment of chronic glaucoma, as no statistical study had ever been made of a series of cases of this variety of glaucoma which had been treated

From the viewpoint of most general practitioners, the diagnosis of ocular disease requires equipment and training that are out of proportion to their productivity. Consequently, the responsibility for both diagnosis and treatment of ocular diseases has been left to the eye specialist by common consent. Such an arrangement might be satisfactory if the more serious progressive ocular problems were promptly recognized and referred for care as soon as they became manifest. Such is not the case however, for one of us (L. C.) has found that an appreciable percentage of the blind and near-blind patients examined in the outpatient clinic of the University of Oregon Medical School had previously passed unrecognized through practitioners' offices, clinics, and hospitals while their disease was in an active phase. 1 This was particularly true of chronic glaucoma, in which adequate therapy depends on early recognition. At least 20,000 persons (15% of the blind population)

I have already treated of this subject before the Section on two previous occasions, at the Boston session in 1906 and the Chicago session in 1908, and this third paper is largely supplementary to these earlier communications. At the 1908 meeting, sixty-five cases of simple chronic glaucoma were analyzed which had been treated by miotics, of which all but seven had been observed over a period of two years, and twelve for more than ten years, and the results attained by the constant and prolonged use of these drugs were compared with a similar series of cases treated by iridectomy. Among the percentages deduced from this analytic study it was found that central vision was maintained in the miotic series, each case of which was observed over an average period of five years and eight months, in 80 per cent, of the cases, in comparison with 25 per cent. in

The time has come when the accent on blindness prevention must be placed where it rightly belongs; on the two greatest causes of blindness in the United States, chronic glaucoma and amblyopia ex anopsia. Since the problem is primarily one of detection, both of these conditions are preventable to a large degree. Considerable information has accumulated recently indicating that chronic glaucoma is commoner than is generally realized. Mass screening, by Brav and Kirber, 1 of 10,000 persons employed in Philadelphia industries revealed a 1.53% incidence of undiscovered glaucoma in the age group 40-65 years alone. These authors estimate the incidence of undiscovered glaucoma in the general population at 2%. The more recent Cleveland Glaucoma Survey 2 indicates exactly the same figure in a free screening of about 14,000 persons. Zeller and Christensen, 3 working in Portland, Ore., found the same incidence in a somewhat smaller series. These authors point out

The operation of cyclodialysis suggested by Heine in 1905, consists in making an artificial communication between the anterior chamber and the suprachorioidal space, allowing a new channel for the escape of the aqueous humor and thus reducing intraocular tension. The operation is performed under local anesthesia by making an incision in the sclera 6 to 8 mm. posterior to the sclerocorneal junction after reflecting a conjunctival flap and with a bent spatula, separating the ciliary body from the overlying sclera and breaking through the pectinate ligament. A quadrant of the iris periphery is then detached. I have performed this operation in eighteen cases specially selected to test its merits. These cases have now been observed for a sufficiently long time to permit an opinion on the value of this operation. The cases can be arranged in the following groups: A. CHRONIC GLAUCOMA