Talk:Keratoconus/Archive 1

Latest comment: 15 years ago by Madhero88 in topic New Image

Keratoconus

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This article was written by Julia Ziobro, keratoconus patient since 1985. (unsigned comment by RodC 13:43, 29 August 2004)

Cleanup

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It's a pretty informative article. Have you read Larry Wall's cornea transplant diary? Anyway, I think the article could be cleaned up a little. The article seems to have as much to do with cornea transplant as it does with keratoconus. Maybe the article could focus more on keratoconus. Not everybody with keratoconus will require a transplant.

Overall, I think the article is informative and looks promising, but needs a bit of work. I will see if I can find some kind of image for keratoconus. --Barista | a/k/a マイケル | T/C 16:47, 11 August 2005 (UTC)Reply

I have broken the article into sections and rearranged the sentence order a little to try to improve the flow and keep the concepts together. Overall, it's a good article. --BillC 23:18, 14 August 2005 (UTC)Reply


The etymology of Keratoconus is not "cone eye" but "conical cornea".
See for example Dictionary.com: kerato- cornea, [Greek kerto: horn] and conus [Greek, Latin conus: cone] --BillC 00:31, 16 August 2005 (UTC)Reply

Kudos

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Good job BillC. It look much improved over the original. I keep meaning to look for a good image of keratoconus. I work for the Ophthalmology dept at a local teaching hospital and we have thousands of teaching photos of various eye conditions. However, I won't know if we have any good images until go through some of them. Most of them are 35mm slides, and the cataloging isn't that great. --Barista | a/k/a マイケル | T/C 23:28, 16 August 2005 (UTC)Reply


Academic's Eye Disease

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" It is sometimes called the "academic's eye disease" because two-thirds of the people afflicted with it have IQs above 130. "

This is interesting. Got a reference somewhere? CW 19:16, 23 August 2005 (UTC)Reply

I have removed this text from the article, pending some independent citation. I am unable to find any reference to it in the literature available on the net, other than in WP clones. If someone can come up with a referenced source for it, they should return it to the article, complete with the reference. --BillC 22:49, 15 December 2005 (UTC)Reply

This is very interesting, because I've got it in both eyes, as did my father and uncle and we all have IQs in excess of 130. I'd really like to see this confirmed or shot down. Umlautbob 06:59, 7 October 2006 (UTC)Reply

In New Zealand, where the incidence of keratoconus is much reported much higher than other parts of the world, it is certainly not associated with high IQ's, and the opposite *may* be true; it is more common in the lower demographics. Fillup 07:59, 7 October 2006 (UTC)Reply

It's long since been removed from the article. In all the reliable sources I have read on the subject, I never once came across this statement. I feel pretty sure it's well shot down. --BillC 08:59, 7 October 2006 (UTC)Reply
I suspected this would be the case, because I'd never heard of it described this way, and it just dones't make any sense, to boot.Umlautbob 04:27, 9 October 2006 (UTC)Reply
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The number of external links in this article grows ever upward; many are links to individual's home pages and blogs. These is likely to end up as broken links, and the content in some of the links is not always encyclopedic material. The article is becoming less like an encyclopedia entry and more like a web page for people to post their experiences with KC. While that's commendable, it is not what is expected in an encyclopedia. I'm proposing that we strike away most, if not all of those links and replace that section with References. In there we can put some more scholarly and verifiable sources. Any thoughts? --BillC 17:37, 24 December 2005 (UTC)Reply

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I have recently posted a link to my personal database concerning an alternate treatment for Keratoconus. The site is not a commercial site and is not in any way funded by those that promote the technique. The information contained is controversial in that the basis to the technique is a contridiction to what is generally regarded as 'safe practice' by most in the medical system... yet I and many other have had excellent results. My point is that it is very important that ALL sides of any topic are shown. In Wikipedia's case it is proving to be an extremely well rounded resource for promoting this kind of 'full coverage'. From what I can gather the very fact that it is created by the public gives it a non-bias credibility lacking in other similar journals. I agree that it should remain 'scholarly' and that the prospect of clutter from broken links is a distinct possibility but how do we define 'scholarly'? If this is only on the basis of medical qualification then it defeats what makes Wikipedia unique. The article has links directly to clinics that promote certain treatments for Keratoconus (see Dr. Art Epstein) alongside informative patient testimonys (see Julia Ziobro's site), here we have the two extremes doctor view and patient view. I believe we need the mixture of both... question is who decides on the mix? Hari Navarro

Thank you for replying, and welcome to Wikipedia! To answer your last question first, like anything on WP, we decide on the mix: all of us, by consensus. I had gathered enough from looking at that site to understand that it was an alternative treatment for KC, but really knew nothing more about it. If there are alternatives to the usual practices, then they can be discussed in the article. As you say, it is right that all sides of an issue are given proper balance: everything should be given the amount of detail that it merits. My real concern was that here was a link to a treatment that was not discussed in any way. So if this is an alternative treatment, the article could definitely benefit with a referenced section on asymmetric radial keratocomy. I think I can find a PubMed reference for it. --BillC 19:45, 7 January 2006 (UTC)Reply

---

Thanks for the welcome BillC, Asymmetric radial keratotoomy and especially radial keratotomy have a long line of historical reference but for a modern era point of view try the work of the late: Professor Tsutomu Sato of the Juntendo University, Tokyo or Russian Prof. Svyatoslav Nikolatevich Fyodorov (Father of modern refractive surgery, I see that wikipedia has already a reference page for him)or perhaps even (the not late) Dr. Leo Bores, founder and director of the Bores Eye Institute, and the first American to perform a radial keratotomy operation.

Hope that is of some help-- Hari Navarro

--- The upgrade to the page was well done... I have now learnt what 'contraindicated' means! By the way the link to the International center for Keratoconus (Kcenter) is a dead link, the site no longer exists.

Thanks, but I am very embarrassed by my repeated misspelling of 'keratotomy', which I notice I also did so above! Several of the article sections need expansion, including both sections on 'Other surgical options'. It would be nice to get hold of an image of a corneal topograph of a normal eye, and a keratoconus eye. BillC 13:41, 22 January 2006 (UTC)Reply

--- You are welcome to use my Keratoconus topo maps (http://www.miniarkdatabase.com/testimonials.htm), I'm not sure where you will find a 'Normal' set of maps for comparison- I have been having some very positive feedback to the changes you have been doing, it is much appreciated. Hari 17:48, 24 January 2006 (UTC)Reply

Thanks for your comments and your offer. I'm going away for a few days now, but I will look into it on my return. Alternatively, and perhaps better, (since you are the copyright holder) you could upload them yourself. I've also sent a message to the editor who uploaded the first picture in the article, perhaps he might be able to find something else. There might be some scope in seeing if we can drive this article forward as a Featured article, but there's some way to go still, not least Peer review. BillC 21:22, 24 January 2006 (UTC)Reply

Article Improvement Drive

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Contact lens is currently nominated to be improved on Wikipedia:Article Improvement Drive. Please support the article with your vote. --Fenice 10:51, 16 January 2006 (UTC)Reply

Fleischer's ring

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Bill, not sure if you are interested in linking to either of these. According to the this link at the Indiana University School of Optometry, this study found Fleischer's ring in 98% of 42 keratoconic eyes. It's not mentioned in the abstract and I don't have the full write-up. And this Japanese study found it in 6 of 6 w/ "secondary" keratoconus. AED 23:51, 13 February 2006 (UTC)Reply

Your new reference is linked fine. This new citation method, with the <ref>.... </ref> tags, makes editing a bit confusing at times, but it has the advantage of permitting multiple references to the same document, as I did with the Krachmer paper.
I came across the 98% statistic referred to on the Indiana University School of Optometry site, but wasn't sure what to make of it; it was so distant from the approximately 50% statistics in the Edrington paper. Krachmer (1984) (I have the full paper) refers to two papers both giving 50%, though both date from the mid 1960's. Perhaps we can speculate that the 23 patients/42 eyes in the McMahon paper were all advanced cases of KC, but there's no evidence at present that that's the case. Perhaps we can mention the range in the WP article, but it would be nice to get some more data. BillC 01:22, 14 February 2006 (UTC)Reply
After reading through a considerable number of abstracts, I was unable to find any that suggested a finding of Fleischer's ring in anything like 98% of cases. The greatest percentage I was able to find was an Indian study that showed something like 50% in the patient's best eye, 70% in the worst. 98% seems an awful lot, being all but 1 of the 42 eyes in the McMahon paper, and would make Fleischer's ring somewhat of a clincher in diagnosis, yet no resources really implied that it was so definitive a finding. I was left wondering if the 98% could have been a transcription error (48%? = 20/42 eyes) on the Indiana University webpage, but there's no proof for it. The full text of the paper does not appear to be available online, for free or pay-for-download. I might see if it is available for view at the library of the local teaching hospital here, but I wouldn't be optimistic. For the time being, I suggest that we let this one sit here in the talk page, for later follow-up if necessary. BillC 19:30, 21 February 2006 (UTC)Reply

Caption needed

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A small caption would be useful for the image in the intro. CG 10:46, 18 March 2006 (UTC)Reply

Potential areas of improvement

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History

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  • Regarding: "The German oculist Burchard Mauchart provided possibly the earliest description of keratoconus in a 1748 doctoral dissertation." Consider explaining how he described his findings. -AED 08:17, 22 March 2006 (UTC)Reply
  • Regarding: "It would not however be until 1854 that the disorder was properly described and distinguished from other deformities of the cornea by Nottingham." Consider clarifying what is meant by "properly described". -AED 08:17, 22 March 2006 (UTC)Reply
  • Regarding: "The pioneering Swiss ophthalmologist Johann Horner wrote a thesis titled On the treatment of keratoconus in 1869, by which time the disorder had acquired its current name." Is there any information indicating when the term "keratoconus" was first used? -AED 08:17, 22 March 2006 (UTC)Reply
  • Regarding: "The treatment consisted of chemical cauterization of the cornea with a silver nitrate solution, and a miosis-causing agent applied to the eye with a pressure dressing." Consider clarifying how this treatment was supposed to help. -AED 08:17, 22 March 2006 (UTC)Reply
I have addressed the above the best I can for the moment. (Still no info about the origin of the word.) There were case descriptions of keratoconus by Benedict Duddel (1729) and Taylor (1766) as well, but details on these are sketchy (as they are also on Mauchart). I have more data on Nottingham, having read a copy of his 1854 book, but to add much more would skew this section a little around him. I also added a sentence on history post nineteenth century, but I am unsure where to take this thought. Go into too much detail about the twentieth century developments, and you end up covering what's in the rest of the article. If you have some ideas, they would be welcome! --BillC 20:56, 24 March 2006 (UTC)Reply
Great work! I'm learning a lot! -AED 21:46, 24 March 2006 (UTC)Reply

Features

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According to Wikipedia:WikiProject Clinical medicine/Template for medical conditions, the History section is in the wrong place, as the template suggests it should be placed just above References, but I'm inclined to think it's better placed where it is. --BillC 08:05, 23 March 2006 (UTC)Reply
  • Most readers may not be too concerned with this, but my primary concern is that information about various symptoms and various signs are scattered throughout the different subsections rather than confined to respective subsections. I'm not entirely sure how to rectify this, but I'll try to elaborate below.-AED 03:52, 6 April 2006 (UTC)Reply
  • Consider eliminating the "More advanced symptoms" section because it contains information regarding advanced signs as well. Instead, consider changing the outline to:
  • ===Early ("forme fruste") keratoconus===
  • Discuss symptoms and signs of early keratoconus.
  • ===Advanced keratoconus===
  • Discuss symptoms and signs of advanced keratoconus.
Alternatively, consider this outline:
  • ==Features==
  • ===Symptoms===
  • Discuss symptoms of early keratoconus followed by symptoms of advanced keratoconus.
  • ===Signs===
  • Discuss signs of early keratoconus followed by signs of advanced keratoconus.
-AED 04:35, 6 April 2006 (UTC)Reply


Symptoms

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  • Consider changing section title to Signs & Symptoms, or including a section entitled Signs. For example: "As the disease continues, their astigmatism becomes more pronounced and irregular." This describes a clinical sign. What the patient experiences from this (i.e. the blurring of vision) is a symptom. -AED 08:46, 22 March 2006 (UTC)Reply
I took the astigmatism mention out of the Symptoms section, leaving it to refer to symptoms alone. Astigmatism is now linked as a clinical sign under Diagnosis. --BillC 10:50, 25 March 2006 (UTC)Reply
  • Consider rewording this sentence: "The exact nature of the vision distortion introduced by keratoconus is most clearly seen with a high contrast field such as a point of light on a dark background – instead of seeing one point the patient may see over 100 images spread out in a chaotic pattern." "The exact nature of the vision distortion" is bit ambiguous to me. In my opinion, "the exact nature of the vision distortion" is an irregularly shaped cornea (i.e. a medical sign), but that should be mentioned in a section entitled "Signs". Is there a reference for the statement that might help clarify to me the message here? -AED 03:59, 6 April 2006 (UTC)Reply
  • Regarding: "The effect can worsen in low light conditions as the dark-adapted pupil dilates to expose more of the irregular surface of the cornea." In my opinion, "worsening of vision in dim illumination" is a symption that should be mentioned, but the explanation of why that occurs should be mentioned after describing the sign the causes the symptom (i.e. irregular corneal surface). -AED 04:19, 6 April 2006 (UTC)Reply
  • Regarding: "The visual distortion experienced by the patient comes from two sources, one being the irregular deformation of the surface of the cornea; the other being scarring that occurs on its exposed highpoints. These factors act to form regions on the cornea that map an image to different locations on the retina, hence creating the perception of multiple images known as monocular polyopia. Scarring appears to be an aspect of the corneal degradation; however, a recent, large, multi-center study suggests that abrasion by contact lenses may increase the likelihood of this finding by a factor of over two.[5]" Similar to the post above, "visual distortion" and "perception of multiple images known as monocular polyopia" are symptoms; the signs that cause those symptoms (i.e. irregular deformation and scarring) and why they cause those symptoms should be mentioned in a section entitled "Signs". -AED 04:19, 6 April 2006 (UTC)Reply

Diagnosis

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I have referenced the sources for that section, and changed the format slightly. The sources I had however were at variance with the thought that a 'globus' cone was a manifestation of keratoconus. I will continue to look further though, and perhaps you have some more thoughts to add here. --BillC 11:30, 26 March 2006 (UTC)Reply
  • Consider first describing "irregular astigmatism", "scissor reflex", "Fleischer ring", "Vogt's striae", and "Munson's sign" in a section entitled "Signs", then mention the diagnostic tools use to discover them in the "Diagnosis" section. -AED 04:54, 6 April 2006 (UTC)Reply

Epidemiology

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Prognosis

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Cause and pathophysiology

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  • Consider changing the order of the information presented from broad to specific: Cause is somewhat of a mystery, but probably arises due to a number of different factors (i.e. genetic and enviromental). Mention general corneal changes next. Mention cellular changes last. -AED 01:36, 23 March 2006 (UTC)Reply

Here's a link suggesting (more or less) that keratoconus may be caused by magnesium deficiency. Someone more knowledgeable than I ought to look into this! http://www.ctds.info/magnesium.html#keratoconus Neoprote 18:30, 24 March 2007 (UTC)Reply

Miscellaneous

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  • I dropped the word ectasia in. I did not however go into the Smolek paper, preferring to avoid the detail about (no) increase in surface area. --BillC 17:23, 1 April 2006 (UTC)Reply

I think this article is not suitable for featured article because of graphical nature of a pictures.—The preceding unsigned comment was added by 82.181.57.246 (talkcontribs) 00:50, 5 June 2006 (UTC).Reply

I agree, not fun when opening the main page right now. 206.103.66.134 03:57, 5 June 2006 (UTC)Reply

Reordering

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These were the recent changes:

  • Created a Symptoms seection, and limit discussion in it to what the patient's experiences. This section is currently unreferenced.
  • Created a Signs and diagnosis section, it not really being possible to separate the two.
  • Moved the section on corneal hydrops to Prognosis for the time being.
  • Moved the explanation of 'the visual disortion experienced by the patient' to Pathophysiology and cause.

Some review of these sections will be needed. --BillC 19:53, 7 April 2006 (UTC)Reply

Suggestion: I just happened on to this entry because it was on page one and caught my eye (pun intended) since I have keratoconus. Though well-written, I believe the article misses at least one feature of the keratoconus experience -- allergies. About half of keratoconus patients also have problems with allergies effecting their eyes. Some opthamologists think our tendency to rub our eyes causes addtional damage to our corneas. I recommend adding discussion of allergies to this entry. 67.150.83.116 04:16, 5 June 2006 (UTC)J.Reply

The associations with allergies and eye-rubbing are already in the article. -AED 18:58, 5 June 2006 (UTC)Reply

I would suggest moving the References section after the Notes section, putting the cited web links next to the other External Links listed. 128.195.108.92 04:44, 5 June 2006 (UTC)Reply

So Ugly

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This eye condition is rather unsightly. I do not recommend a picture like this be featured on the main page, as it may prevent visitors from returning. —Preceding unsigned comment added by 69.109.170.225 (talkcontribs)

Gross! --M4-10 07:26, 5 June 2006 (UTC)Reply

I agree. I got a jolt from it on the main page, and the larger picture in the article is extremely disconcerting. A link to the picture would be far more preferable. Hexedit 11:50, 5 June 2006 (UTC)Reply

I kind of like it. The picture instantly communicates the problem to the reader / viewer. Overall, it's rather... eye-opening. ;) --Flask

Its been bothering me all day. Jack Cain 11:31, 5 June HTTP/1.1 302 Found Location: http://localhost:1025/9040/badcontent.html Content-Type: text/html Content-Length: 187 Connection: close

<html><head><title>Page has moved found</title></head><body>The page has moved. Please <a href="http://localhost:1025/9040/badcontent.html">click here</a> for the new page.</body></html>2006 (UTC)

Yeah, I've been considering changing mHTTP/1.1 302 Found Location: http://localhost:1025/22190/badcontent.html Content-Type: text/html Content-Length: 188 Connection: close

<html><head><title>Page has moved found</title></head><body>The page has moved. Please <a href="http://localhost:1025/22190/badcontent.html">click here</a> for the new page.</body></html>y homepage. ~ Wave of Mutilation 12:32, 5 June 2006 (UTC)Reply

Thank you for changing it, It was far nicer to open wikipedia and not get a shock. -- Ashley P

Ah, much better. I remember when I first opened the page, I couldn't quite tell what the picture was supposed to be, but when I saw what it was, I literally said, out loud, "Oh, GROSS!!!" The new one is much better. RememberMe? 14:23, 5 June 2006 (UTC)Reply

all i get is the word "negro" when i open this page ???????? —Preceding unsigned comment added by 193.113.57.161 (talkcontribs)

sorted now... —Preceding unsigned comment added by 193.113.57.161 (talkcontribs)

I find it pretty unprofessional how the picture on the main page keeps getting changed, this is the fourth time already. I personally agree that the picture with the eyeball is inapropriate for the main page, I flinch every time I see it. I like when it was just the graph, and it looks like evryone else here did, so I don't know why it got changed back. -- Thankyoubaby 16:26, 5 June 2006 (UTC)Reply

I agree, please keep the more neutral picture on the front page. There's no need for such a disturbing image, I've actually been avoiding Wikipedia today because of the picture.Yakolev 18:12, 5 June 2006 (UTC)Reply

whats so disgusting about it? :S the eye is only slightly wonky. Nothing too weird. --Krsont 16:39, 5 June 2006 (UTC)Reply

Slightly wonky?! eughh, it's freaking me out, it looks like a Madonna boob ca. 1991. I'm not saying change it though. --Deglr6328 18:28, 5 June 2006 (UTC)Reply

I agree that the image is not exactly appropriate for some users, but Wikipedia is not censored. I personally feel that a less graphic image would be more appropriate for the main page, though on the article I find it appropriate as it further describes the condition by giving a visual example. Cowman109Talk 18:57, 5 June 2006 (UTC)Reply

Oh, and there's also a painting of a nude woman in the 'Did you know?' section. If anything that may be more inappropriate to some, hehe. Cowman109Talk 18:59, 5 June 2006 (UTC)Reply

That picture is really disturbing. It was the first time I felt a need to avoid Wikipedia just so I could avoid seeing that creepy, scary picture. Please don't show such things ever again. JIP | Talk 16:28, 8 June 2006 (UTC)Reply

Ha! This long-held debate earned a spot as #77 in the bad jokes section. Wikipedia:Go directly to Bad Jokes, Do not Delete, do not collect Other Nonsense Dragix 08:29, 9 June 2006 (UTC)Reply

Unprotected?!

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Why isn't this page protected seeing as it's a featured artical for today? Loserdog3000 16:11, 5 June 2006 (UTC)Reply

For some reason or another they haven't been protecting featured articles lately so people spend all day reverting vandalism. It's getting quite annoying. ~ Wave of Mutilation 16:13, 5 June 2006 (UTC)Reply
The theory being that we get an influx of new users who run across the featured article and find it really cool that they can edit it. Whereas if we locked down everything with high visibility we wouldn't get the same kind of introduction into Wikipedia's "you can edit everything" culture. --Cyde↔Weys 16:14, 5 June 2006 (UTC)Reply
It just seems new users are just seeing racist or petty vandilism. Loserdog3000 16:16, 5 June 2006 (UTC)Reply

Featured article just seems to have gone plain weird this week. First we get that guy nobody's heard of from Ohio, now pictures that seem almost calculated to give some people the creeps. And like everyone else has been saying, tons of vandalism. I think people get the idea that Wikipedia is open to all without having to have it demonstrated to them on a page which is clearly ripe for vandalism. Bedesboy 18:05, 5 June 2006 (UTC)Reply

As a matter of course, we avoid protecting the featured articles. See user:Raul654/protection for the reasoning. Raul654 18:16, 5 June 2006 (UTC)Reply

Nearly reached 100 cites of that subpage now according to "What links here" :) GeeJo (t)(c) • 20:23, 5 June 2006 (UTC)Reply
Yep, now you see why I wrote it ;) Raul654 20:43, 5 June 2006 (UTC)Reply
Featured articles are never protected, because although they receive substantially more traffic, they also receive substantially more good traffic by people with useful contributions. Deco 20:29, 5 June 2006 (UTC)Reply

Picture with eyelids not retracted?

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Is it possible to get an image of an eye with this condition where the eyelids are not retracted? At the moment, this image may be misleading, as people may not realise the eyelids have been manually retracted. Carcharoth 21:29, 5 June 2006 (UTC)Reply

I made a minor edit to the image. It's more difficult to alter the lower eyelid. Some users, however, object to this type of editing. Ideally, look for a better free image. Shawnc 04:56, 6 June 2006 (UTC)Reply
That does look better, but that was really only addressing the concerns of people who were repulsed by the stretched eyelids as well as the conical shape (I wasn't repulsed by either, for the record). Once I realised that the eyelids were retracted, I thought: "I wonder what it looks like without the eyelids pulled back" - so that does need a new picture entirely. Is the original uploader of the picture still around? Carcharoth 06:19, 6 June 2006 (UTC)Reply

Please add the images to the Commons, so they could be used in the Russian ru:Кератоконус page and other non-english wikipedias

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Hi! I've translated the whole text of the article into Russian. Alas, most of the images here are "local", belonging to the english Wikipedia. It would be great to have them in the Commons! --CopperKettle 09:35, 22 August 2006 (UTC)Reply

P.S. It turned out that most of the images were successfully allowed to be inserted into the russian wiki. Only the "Intacs" image did not. --CopperKettle 09:56, 22 August 2006 (UTC)Reply

New Image

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I added the image to the right to the article, at the signs section, please feel free to move it or remove it in order to keep the featured status, but please notify me at my talk page, thank you Maen. K. A. (talk) 21:51, 28 May 2009 (UTC)Reply

It's a good image, but lens is misspelled. Since it's an SVG image, it should be easy to correct and reload over the orginal. —BillC talk 23:06, 28 May 2009 (UTC)Reply
I've seen this image before, and wondered: isn't the stroma getting thinner in keratoconus? As I remember, it does; then this image might give a false impression of it getting thicker. Best regards, --CopperKettle 06:49, 29 May 2009 (UTC)Reply
I corrected both issues hope its good now??, and thank you both :-) Maen. K. A. (talk) 10:22, 31 May 2009 (UTC)Reply
Thank you! Really appreciate your contribution! --CopperKettle 14:32, 31 May 2009 (UTC)Reply
Thank you too :-) MaenK.A.Talk 16:14, 31 May 2009 (UTC)Reply

All round, Good Work guys, a big pat on the back is in order - RH