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The Earth is the Lord's: The Supremacy of Christ in Christian Learning
First a few comments about the spirit from which this vision of Bethlehem College and Seminary1 flows. There is no sense of triumphalism here. There is no sense of having the last word in education, or easy answers to the challenges of our times, or the ideal philosophy of college and seminary training.
Instead, there is a trembling sense that pride and poverty (and many other things!) make this a dangerous undertaking. A word about each of these.
The Danger of Pride
One of the most fertile fields of pride is academic higher education. I spent sixteen years of my life in it and have felt its dangers. And I read this morning in Ezekiel 16 how God took Israel from her misery and made her beautiful and renowned. Then the dreadful verse 15 said, "But you trusted in your beauty and played the whore because of your renown" (Ezekiel 16:15).
And I thought, God has blessed Bethlehem and The Bethlehem Institute and Desiring God and me personally. And the greatest danger of all right now is that we trust in our blessed condition and our renown. Pride lurks at every door. So we tremble and ask, Is this our motive—to flaunt power, to get praise, to make a name for ourselves? If so, O God, may we fail, and fail quickly without harming others.
But pride has other forms, and one is cowardice—the fear of being criticized. And criticism there will be aplenty, because this school will affirm biblical truths that are unpopular, even with many Christians, as beautiful as we think they are—I will mention ten of them later on. That is the risk we believe we are called to take. And may the Lord do whatever it takes to keep us humble and make us servants, not lords, as we move forward with Bethlehem College and Seminary.
The Danger of Poverty
Another reality that makes a college and seminary a dangerous undertaking is that, as we read our books and listen to our lectures and write our papers and have our discussions, we are aware that our urban centers are broken and generations languish unable to escape the tangles of addiction and dysfunction and poverty and crime. And beyond these shores are millions of people who live with no clean water, insufficient food, no medical care, and could only dream of such an education. This vast discrepancy gives us a sense of uneasiness in the affluent halls of learning.
But then we ask, Is the answer to the miseries of the world a generation of young people who do not know how to observe accurately, or think carefully, or know history, or understand culture, or comprehend the Bible, or plan strategically? So again we take the risk, and pray that Bethlehem College and Seminary will not be part of the problem of poverty but part of the solution because students have developed habits of mind and heart move toward need creatively, not toward comfort fearfully.
Biblical Foundations
We turn now to the biblical foundations of Bethlehem College and Seminary. In 1 Corinthians 10:25-26, the apostle Paul said, "Eat whatever is sold in the meat market without raising any question on the ground of conscience. For 'the earth is the Lord's, and the fullness thereof.'" This implies Jesus Christ owns the world and everything in it. It also implies that we who are his loyal subjects may make use of any of it freely for his glory. Education is about how we do that.
Abraham Kuyper, who founded the Free University of Amsterdam in 1880, said in one of his most famous sentences, "No single piece of our mental world is to be hermetically sealed off from the rest, and there is not a square inch in the whole domain of our human existence over which Christ, who is Sovereign over all, does not cry, 'Mine!'"1 This was the foundation of his educational dream for the Free University.
That truth is absolutely biblical and true and foundational to Bethlehem College and Seminary, but it is not the most ultimate or defining truth. Christ not only made and owns the world; he not only holds everything together by the word of his power, but he also created it and sustains it to display his beauty and his worth and greatness so that those whom he created in his image will know him and treasure him above all things, and in that treasuring of him above all that he has made, manifest his supreme value in the universe. That's the ultimately defining truth for Bethlehem College and Seminary.
The decisive text in this regard is Colossians 1:15-17:
[Christ] is the image of the invisible God, the firstborn of all creation. For by him all things were created, in heaven and on earth, visible and invisible, whether thrones or dominions or rulers or authorities—all things were created through him and for him. And he is before all things, and in him all things hold together.
So we learn that Christ made all things and holds all things together "for himself." "All things were created through him and for him." "For him" does not mean that Christ had deficiencies that he had to create the world to supply. It means that his complete self-sufficiency overflowed in the creation of the world so that the world would display the greatness of Christ.
That is the deepest foundation stone of Bethlehem College and Seminary. All things not only belong to Christ, but all things display Christ. Human beings exist to magnify his worth in the world. Our worth consists of our capacity to consciously make much of his worth. The goal of Bethlehem College and Seminary cannot be expressed with man as the end point. Christ is the endpoint. All things are from him and through him and to him (Romans 11:36). Not to us, O Lord, not to us, but to your name give glory (Psalm 115:1).
No paragraph outside the Bible is more foundational to this school than one from the notebooks of Jonathan Edwards. It not only sums up the ultimate purpose of God to glorify himself in creation, but also shows how God accomplishes that self-exaltation in such a way that it becomes love and not megalomania. Here is how Edwards says it. And with this he opens the door for Bethlehem College and Seminary to be unshakably joyful and radically God-exalting in the very same act.
God glorifies Himself toward the creatures also in two ways: 1. By appearing to . . . their understanding. 2. In communicating Himself to their hearts, and in their rejoicing and delighting in, and enjoying, the manifestations which He makes of Himself. . . . God is glorified not only by His glory's being seen, but by its being rejoiced in. When those that see it delight in it, God is more glorified than if they only see it. His glory is then received by the whole soul, both by the understanding and by the heart. . . . He that testifies his idea of God's glory [doesn't] glorify God so much as he that testifies also his approbation of it and his delight in it.2
Essential to the foundation of Bethlehem College and Seminary is the truth that God is most glorified in us when we are most satisfied in him. God's self-exaltation and our everlasting joy are not at odds. They happen together. His worth is magnified when we treasure him above all things. Our joy in him reflects his glory. The great quest of Bethlehem College and Seminary is for minds and hearts that see and savor the glory of Christ in all things, and spread that experience to the world.3
Everywhere you turn in the history of redemption, from beginning to end, God's design is the same: that his glory—supremely the glory of his grace in the person and work of Christ—be seen and savored and spread. God is manifestly exuberant about making himself and his Son supreme in the thoughts and affections of his people, and making himself known as Lord in the world.
That is the ultimate foundation of why Christ is supreme in Christian learning and in Bethlehem College and Seminary. We are simply joining God himself in his exuberant commitment to magnify his greatness and the glory of his Son.
What Do We Study?
The question arises: Where do we see his glory? That is, what is the focus of our education? What do we study? If God's aim in creating and governing the world is the display of his glory that we might see it and delight in it and reflect it, where will we focus our attention? Where will we see it? How does this happen?
The answer is that God has two books: the Word and the world. The Bible, on the one hand, and the whole organic complex of nature and history and human culture, on the other hand. The Bible is inspired and authoritative. The world is not. But this doesn't mean that all we focus on is the Bible. The Bible gives the decisive meaning of all things. But the Bible itself sends us over and over again to the world for learning.
Consider the lilies; consider the birds (Matthew 6:26, 28). "Go to the ant, O sluggard; consider her ways, and be wise" (Proverbs 6:6). "The heavens declare the glory of God, and the sky above proclaims his handiwork" (Psalms 19:1). "Lift up your eyes on high and see: who created these?" (Isaiah 40:26).
In fact, think about the way the prophets and apostles and Jesus himself used language. They used analogies and figures and metaphors and similes and illustrations and parables. They constantly assume that we have looked at the world and learned about vineyards, wine, weddings, lions, bears, horses, dogs, pigs, grasshoppers, constellations, businesses, wages, banks, fountains, springs, rivers, fig trees, olive trees, mulberry trees, thorns, wind, thunderstorms, bread, baking, armies, swords, shields, sheep, shepherds, cattle, camels, fire, green wood, dry wood, hay, stubble, jewels, gold, silver, law courts, judges, and advocates.
In other words, the Bible both commands and assumes that we will know the world, and not just the Word. We will study the general book of God called nature and history and culture. And we will study the special book of God called the Bible. And the reason is that God has revealed his glory in both—and means for us to see him in both.
The two books of God are not on the same level. The Bible has supreme authority, because God gave the Bible as the key to unlock the meaning of all things. Without the truth of the Bible, the most brilliant scholars may learn amazing things about nature. And we may read their books and learn from them. But they miss the main point without the special revelation of God—that everything exists to glorify Christ, that they are blinded by sin, that they need a Savior, that Christ came into the world to save sinners, and that the whole universe gets its ultimate meaning in relationship to him. When they miss the main thing, everything is skewed.
So the entire curriculum of Bethlehem College and Seminary is permeated by the study of the Bible. The Bible gives the key that unlocks the deepest meaning of everything else.
What Do We Do With God's Books?
So if Bethlehem College and Seminary is going to focus on these two books—the Word that God inspired and the world that God made—because this is where God has revealed his glory, then what should we do with these two books? What does this education try to impart to the students?
Our aim is not to impart degrees. The BA and MDiv degrees are almost entirely incidental to the aims of education.
Our aim is not mainly to impart facts because these will be soon forgotten, but the aims of education should last.
Our aim is not mainly to impart skills for a trade or a profession, since these change with the trades and technologies.
Our aim is to build into the student habits of mind and heart that will never leave them and will fit them for a lifetime of ongoing growth. The well-educated person is the person who has the habits of mind and heart to go on learning what he needs to learn to live in a Christ-exalting way for the rest of his life—and that would apply to whatever sphere of life he pursues.
These habits of mind apply to all objects in the world, but most importantly the Bible. We can sum them up like this:
We aim to enable and to motivate the student to observe his subject matter accurately and thoroughly, to understand clearly what he has observed, to evaluate fairly what he has understood by deciding what is true and valuable, to feel intensely according to the value of what he has evaluated, to apply wisely and helpfully in life what he understands and feels, and to express in speech and writing and deeds what he has seen, understood, felt and applied in such a way that its accuracy, clarity, truth, value, and helpfulness can be known and enjoyed by others.
So the habits of mind and heart are:
- observation
- understanding
- evaluating
- feeling
- applying
- expressing
Whether you are looking at a passage in the Bible, or at the U. S. Constitution, or a mysterious pattern of scratches on your car, the habits of mind and heart are the same.
1) Observing
We aim to enable and to motivate the student to observe his subject matter accurately and thoroughly. We must see what is really there. Our teaching is designed to force students to see for themselves. They must keep looking until they see things they did not see at first—in the Word and in the world.
We must learn to read slowly and observe rigorously and minutely and comprehensively. The observing must be accurate and thorough. Otherwise, our understanding and evaluation will be flawed. Quickly reading many books ordinarily begets bad habits of mind. We will not encourage students to read for the sake of quantity but to read with rigorous observation and reflection.
2) Understanding
We aim to enable and to motivate the student to understand clearly what he has observed thoroughly and accurately. Understanding involves the severe discipline of thinking. The mind wrestles with the traits and features of what it has observed. The aim when reading the Bible is that we discern what the author intended us to understand. This understanding comes through the language conventions on the page. We observe them and we think about them until we can say, "I understand what he meant." We want his, not ours. We aim to think the author's thoughts after him. Otherwise, education simply becomes a reflection of my own ignorance.
3) Evaluating
We aim to enable and to motivate the student to evaluate fairly, but not to shrink back from the judgments that must be made about truth and value on the basis of careful observation and accurate understanding. Here is where our worldview will make all the difference. We believe there is such a thing as truth, and that with the compass of the Scriptures and the help of the Spirit, we can know it.
4) Feeling
We aim to enable and to motivate the student to feel properly in response to what he has observed and understood and evaluated. His feeling should be in accord with the truth and worth of what he has observed and understood. If he has observed and understood a terrible reality like hell, his feeling should be fear and horror and compassion. If he has observed and understood a wonderful reality like heaven, then his feelings should be joy and hope and longing.
Since God is glorified in our emotional response to his glory and not just by seeing it and understanding it and evaluating it, we cannot be indifferent to the emotional life of the students. This means that prayer and reliance on the Holy Spirit become essential in the life of Bethlehem College and Seminary.
5) Applying
We aim to enable and to motivate the student to apply wisely and helpfully what he has observed and understood and evaluated and felt. It takes wisdom, not just factual knowledge, to know how to wisely and helpfully apply what they understand and feel.
If they observed and understood and felt the truth that they should "redeem the time" (from Ephesians 5:16), a wise application might be go to bed earlier and get up earlier so that there is time for devotions without being exhausted. Or it might be to get a job as an intern at an inner-city emergency service center. A well-educated person is growing in the wise application to life of all he learns.
6) Expressing
We aim to enable and to motivate the student to express in speech and writing and deeds what he has seen, understood, evaluated, felt, and applied. And the goal is that he do it in such a way that its accuracy, clarity, truthfulness, preciousness, and helpfulness can be known and enjoyed by others. We want the students to have a growing ability to communicate and demonstrate compellingly to others what they have seen and understood and evaluated and felt and applied.
This brings us back to our original reason for being. God created the world and inspired the Word to display his glory. A well-educated person sees the glory of God in the Word that God inspired and the world that God made and understands it and evaluates it and feels it and applies it and expresses it for others to see and enjoy.
Where We Stand
We do not assume that the process of deciding what is true and valuable starts over with every generation of students. And it didn't start with us. Therefore, we are a confessional institution. The Bethlehem Elder Affirmation of Faith defines what we believe and teach in Bethlehem College and Seminary.
We do not aim to force students into this mold. That would not be education, not an honor to Christ. We aim to come alongside them in the processes of observation, understanding, evaluation, feeling, application, and expression and show them why we land where we do. The faculty will advocate and seek to persuade. We will not coerce or deceive or hide difficult problems. In this way, we believe truth will be honored, and the integrity of careful thinking will be encouraged.
We believe that this way of doing education with a view to seeing and savoring and spreading the glory of Christ, while making his Word our supreme rule in all our thinking about his world, with these rigorous habits of mind and heart—we believe that this way of doing education leads to humble, courageous convictions in a fallen world where Christ urges us to live peaceably as far as it lies in us (Romans 12:18), but not to shrink back from telling the truth that is often controversial (Matthew 10:27-28; Acts 20:20, 27).
Therefore, I pray that Bethlehem College and Seminary will be marked by unashamed courage and openness in the stands we take. We feel the force of Martin Luther's words as they relate to the controversies of our day:
If I profess with the loudest voice and clearest exposition every portion of the truth of God except precisely that little point which the world and the devil are at that moment attacking, I am not confessing Christ, however boldly I may be professing Christ. Where the battle rages there the loyalty of the solider is proved, and to be steady on all the battlefield besides is mere flight and disgrace if he flinches at that point.4
It will be helpful in closing to position Bethlehem College and Seminary in such battles. Here are a few with the battleground in parentheses and our position following.
1) (Historical Criticism) The Bible teaches only what is true. It is coherent and non-contradictory in the progress of revelation.
The Bible is inspired and inerrant so that what it teaches is true and stands in judgment on all tradition and all science and all culture and all human opinion. It is more precious than gold and sweeter than honey. It is worthy of a lifetime of assiduous reflection, heart-felt meditation, and joyful obedience.
2) (Roman Catholicism) Justification involves the imputation of Christ's righteousness by faith alone.
Justification by grace alone through faith alone on the basis of Christ alone for the glory of God alone is at the heart of the biblical gospel. It includes the imputation, not the impartation, of the righteousness of Christ to us and on the basis of Christ's perfect obedience to all that the Father commanded him to do.
3) (Relativism and Pluralism) Jesus is the only way to God.
In order to be saved from eternal damnation all peoples—Jewish and Muslim and Hindu and Buddhist and animist and secularist—must know and believe in Jesus Christ as the Lord and Savior who died for them and rose again. World missions is a priority for all who love people, know Christ, and see the world of unreached peoples.
4) (Universalism and Annihilationism) Hell is real and terrible.
Hell, as Jesus taught more than anyone else, is real. It is a conscious, eternal experience of torment pictured in part as weeping and gnashing of teeth, outer darkness, unquenchable fire, eternal punishment, divine vengeance, and the lake of fire. People should be warned with tears and urgency.
5) (Abortion) The unfettered abortion license is abominable.
Abortion is morally monstrous. Unborn human life should be protected for the same reasons that all human life should be protected.
6) (Feminism and Egalitarianism) The complementary differences of manhood and womanhood are beautiful, practical, and important.
Concerning biblical manhood and womanhood we believe that God's merciful purpose for our great good is that humble, Christ-like, servant-hearted men bear the burden of leadership as elders and pastors in the church, and that such men function as the caring, providing, protecting, leaders of their homes; and that women come alongside these men with their manifold gifts and help them carry through the mission of the church and the home.
7) (Divorce and Homosexuality) Marriage is a life-long covenant between a man and a woman.
No kind of relationship between two men or two women is marriage. Whatever two men do or say to each other, or whatever two women do or say to each other it is not now, never has been, and never will be marriage in God's eyes. Marriage is the life-long covenant relationship between a man and a woman as husband and wife on the analogy of Christ and the church.
8) (Racism and Ethnocentrism) Delighting in and desiring racial and ethnic diversity is crucial.
Indifference to active love across ethnic lines is an assault on the purpose of the cross of Christ who ransomed people from every tribe and tongue and people and nation. Happy, unified ethnic diversity in Christ is our destiny in the age to come and should be loved, longed for, and sought after here and now.
9) (Consumerism and Materialism) Desiring riches is deadly, and wartime simplicity is good.
Desiring to be rich is suicidal, and commending that desire as part of the Christian life is therefore worse than murderous because not just this life but the next is at stake. Followers of Jesus should feel a magnetic pull on their lives toward wartime simplicity so that they may be lavish in giving and alleviate as much suffering as we can—especially eternal suffering.
10) (Arminianism and Open Theism) God is absolutely sovereign.
God is sovereign over all things including natural calamity and human sin. To quote the Bethlehem Elder Affirmation of Faith: "God, from all eternity, in order to display the full extent of His glory for the eternal and ever-increasing enjoyment of all who love Him, did, by the most wise and holy counsel of His will, freely and unchangeably ordain and foreknow whatever comes to pass. God upholds and governs all things—from galaxies to subatomic particles, from the forces of nature to the movements of nations, and from the public plans of politicians to the secret acts of solitary persons—all in accord with His eternal, all-wise purposes to glorify Himself, yet in such a way that He never sins, nor ever condemns a person unjustly; but that His ordaining and governing all things is compatible with the moral accountability of all persons created in His image."
For Our Joy, To His Glory
For those who have been around Bethlehem Baptist Church for some time, you will know that our overwhelming spirit of worship and ministry and missions is aggressively proactive and positive. We do not define ourselves mainly by what we respond to or disagree with. But neither do we shrink back out of fear that others will define us this way.
The spirit of the church and the spirit of the school is the spirit of Christian Hedonism—in Jesus Christ, crucified and risen, God is 100% for us and not against us. "Christ suffered once for sins, the righteous for the unrighteous, that he might bring us to God" (1 Peter 3:18). And in bringing us to God, He brought us to our greatest Treasure and highest joy. To know him and enjoy him and show him in every way we can from his Word and his world is our passion, because we know that God is most glorified in us when we are most satisfied in him. When we rest in him as our supreme Treasure, especially in times of suffering, and continue to love others for his sake, we display the glory of Christ.
May God prosper this vision for the joy of all peoples and the glory of his Son.
1 What do we mean by the terms college and seminary? We simply mean that as soon as feasible, we will offer an accredited Bachelor of Arts and Master of Divinity. The words college and seminary do not signify hundreds of students, or multiple academic departments, or large faculties, or athletic teams. Instead, in the seminary, think of a group of a dozen students or so (nowadays called a cohort) linked with pastoral mentors, moving together through the unified course sequence based on the Greek and Hebrew Bible.
And in the college, think similarly of a cohort of students moving together through an integrated and unified curriculum of humanities and sciences built into a historical framework from creation to the present. Think Bethlehem faculty mentors and many guest professors.
Think of both of these programs as church-based where all the students are expected to be involved in the life and ministry of the church. Our aim is that the limited scope of the programs, and the connection with the church, and the wider funding of the vision will bring down costs to the place where students will not be burdened with debt when they are finished. The present financial crisis in higher education is one of the reasons for starting Bethlehem College and Seminary, but not the main one.
2 Abraham Kuyper, Abraham Kuyper: A Centennial Reader, ed. James D. Bratt (Grand Rapids, Mich.: Eerdmans, 1998), 488.
3 Jonathan Edwards, The "Miscellanies," ed. by Thomas Schafer, The Works of Jonathan Edwards, Vol. 13 (New Haven: Yale University Press, 1994), p, 495. Miscellany #448.
4 I have laid out the biblical foundation for this more fully in several places. See for example, Let the Nations Be Glad, Second Edition (2003), pp. 21-28, and The Pleasures of God (2000), chapters 1 and 4. The ultimate biblical foundation for the truth that we glorify God by joining him joyfully in his goal to glorify himself in all things is that God does indeed make himself the supreme goal of all that he does in the world from beginning to end. We are not the main point of the universe. God is.
- He created us for his glory: "Bring My sons from afar And My daughters from the ends of the earth, . . . whom I have created for My glory, Whom I have formed, even whom I have made" (Isaiah 43:6-7).
- Christ will come again at the end of the age for his glory: "He comes to be glorified in His saints on that day, and to be marveled at among all who have believed" (2 Thessalonians 1:9-10).
- Romans 9:23 says that all his mercy, all his wrath, and all his power are aiming "to make known the riches of his glory for vessels of mercy, which he has prepared beforehand for glory."
- In 1 Corinthians 10:31, God makes himself the aim of every human endeavor from the smallest to the largest: "So, whether you eat or drink, or whatever you do, do all to the glory of God."
- In Romans 3:23, God defines the very essence of sin as failing to make him supreme: "For all have sinned and fall short of the glory of God." Sin is sin because it belittles the glory of God.
- And when God's act of redemption reaches its climactic moment in the death of Christ for sinners, the aim of God is that the glory of his grace be seen and praised above all things: "He predestined us for adoption through Jesus Christ, according to the purpose of his will, to the praise of the glory of his grace" (Ephesians 1:5-6). And he defined the gospel in 2 Corinthians 4:4 as "the light of the gospel of the glory of Christ, who is the image of God."
5 Quoted in Parker T. Williamson, Standing Firm: Reclaiming Christian Faith in Times of Controversy (Springfield, PA: PLC Publications, 1996), p. 5. Luther's Works, Weimar Edition, Letters, vol. 3, 1883, pp. 81-82.


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Nystagmus is a condition of involuntary (or voluntary, in some cases)[1] eye movement, acquired in infancy or later in life, that may result in reduced or limited vision.[2] Due to the involuntary movement of the eye, it has been called "dancing eyes".[3][lower-alpha 1]
Nystagmus | |
Horizontal optokinetic nystagmus, a normal (physiological) form of nystagmus | |
Specialty | Neurology, otorhinolaryngology |
In a normal condition, while the head rotates about an axis, distant visual images are sustained by rotating eyes in the opposite direction on the respective axis.[4] The semicircular canals in the vestibule of the ear sense angular acceleration. These send signals to the nuclei for eye movement in the brain. From here, a signal is relayed to the extraocular muscles to allow one's gaze to fixate on one object as the head moves. Nystagmus occurs when the semicircular canals are being stimulated (e.g. by means of the caloric test, or by disease) while the head is not in motion. The direction of ocular movement is related to the semicircular canal that is being stimulated.[5]
There are two key forms of nystagmus: pathological and physiological, with variations within each type. Nystagmus may be caused by congenital disorder or sleep deprivation, acquired or central nervous system disorders, toxicity, pharmaceutical drugs, alcohol, or rotational movement. Previously considered untreatable, in recent years several drugs have been identified for treatment of nystagmus. Nystagmus is also occasionally associated with vertigo.
The cause for pathological nystagmus may be congenital, idiopathic, or secondary to a pre-existing neurological disorder. It also may be induced temporarily by disorientation (such as on roller coaster rides) or by certain drugs (alcohol, lidocaine and other central nervous system depressants, inhalant drugs, stimulants, psychedelic drugs, and dissociative drugs).
Early-onset nystagmus
Early onset nystagmus occurs more frequently than acquired nystagmus. It can be insular or accompany other disorders (such as micro-ophthalmic anomalies or Down syndrome). Early-onset nystagmus itself is usually mild and non-progressive. The affected persons are not normally aware of their spontaneous eye movements, but vision can be impaired depending on the severity of the movements.
Types of early-onset nystagmus include the following, along with some of their causes:
- Infantile:
- Albinism
- Aniridia
- Bilateral congenital cataract
- Bilateral optic nerve hypoplasia
- Idiopathic
- Leber's congenital amaurosis
- Optic nerve or macular disease
- Persistent tunica vasculosa lentis
- Rod monochromatism
- Visual-motor syndrome of functional monophthalmus
- Latent nystagmus
- Noonan syndrome
- Nystagmus blockage syndrome
X-linked infantile nystagmus is associated with mutations of the gene FRMD7, which is located on the X chromosome.[6][7]
Infantile nystagmus is also associated with two X-linked eye diseases known as complete congenital stationary night blindness (CSNB) and incomplete CSNB (iCSNB or CSNB-2), which are caused by mutations of one of two genes located on the X chromosome. In CSNB, mutations are found in NYX (nyctalopin).[8][9] CSNB-2 involves mutations of CACNA1F, a voltage-gated calcium channel that, when mutated, does not conduct ions.[10]
Acquired nystagmus
Nystagmus that occurs later in childhood or in adulthood is called acquired nystagmus. The cause is often unknown, or idiopathic, and thus referred to as idiopathic nystagmus. Other common causes include diseases and disorders of the central nervous system, metabolic disorders and alcohol and drug toxicity. In the elderly, stroke is the most common cause.
General diseases and conditions
Some of the diseases that present nystagmus as a pathological sign or symptom are as follows:
- Brain tumors (medulloblastoma, astrocytoma, or other tumors in the posterior fossa.)
- Canavan disease
- Head trauma
- Lateral medullary syndrome
- Ménière's disease and other balance disorders
- Multiple sclerosis
- Optic nerve hypoplasia
- Pelizaeus–Merzbacher disease
- Superior canal dehiscence syndrome
- Tullio phenomenon
- Whipple's disease
Toxicity or intoxication, metabolic disorders and combination
Sources of toxicity that could lead to nystagmus:
- Alcohol intoxication
- Amphetamines
- Barbiturates
- Benzodiazepines
- Ketamine
- Pregabalin
- Lithium
- Phencyclidine (PCP)
- Phenytoin (Dilantin)
- Salicylates
- Selective serotonin reuptake inhibitors (SSRIs)
- Other anticonvulsants or sedatives
- Thiamine deficiency
Thiamine deficiency
Risk factors for thiamine deficiency, or beri beri, in turn include a diet of mostly white rice, as well as alcoholism, dialysis, chronic diarrhea, and taking high doses of diuretics.[12][13] Rarely it may be due to a genetic condition which results in difficulties absorbing thiamine found in food.[12] Wernicke encephalopathy and Korsakoff syndrome are forms of dry beriberi.[13]
Central nervous system (CNS) diseases and disorders
Central nervous system disorders such as with a cerebellar problem, the nystagmus can be in any direction including horizontal. Purely vertical nystagmus usually originates in the central nervous system, but it is also an adverse effect commonly seen with high phenytoin toxicity. Other causes of toxicity that may result in nystagmus include:
- Cerebellar ataxia
- Chiari Malformation
- Multiple sclerosis
- Stroke
- Thalamic hemorrhage
- Trauma
- Tumor
Other causes
- Non-physiological
- Trochlear nerve malfunction[14]
- Vestibular Pathology (Ménière's disease, SCDS (superior canal dehiscence syndrome), BPPV, Labyrinthitis)
- Exposure to strong magnetic fields (as in MRI machines)[15]
- A slightly different form of nystagmus may be produced voluntarily by some people.[16]
Nystagmus is very noticeable but rarely recognized. Nystagmus can be clinically investigated by using a number of non-invasive standard tests. The simplest one is the caloric reflex test, in which one ear canal is irrigated with warm or cold water or air. The temperature gradient provokes the stimulation of the horizontal semicircular canal and the consequent nystagmus. Nystagmus is often very commonly present with Chiari malformation.
The resulting movement of the eyes may be recorded and quantified by special devices called electronystagmograph (ENG), a form of electrooculography (an electrical method of measuring eye movements using external electrodes),[17] or even less invasive devices called videonystagmograph (VNG),[18] a form of video-oculography (VOG) (a video-based method of measuring eye movements using external small cameras built into head masks) by an audiologist. Special swinging chairs with electrical controls can be used to induce rotatory nystagmus.[19]
Over the past forty years, objective eye-movement-recording techniques have been applied to the study of nystagmus, and the results have led to a greater accuracy of measurement of and understanding of the condition.
Orthoptists may also use an optokinetic drum, or electrooculography to assess a patient's eye movements.
Nystagmus can be caused by subsequent foveation of moving objects, pathology, sustained rotation or substance use. Nystagmus is not to be confused with other superficially similar-appearing disorders of eye movements (saccadic oscillations) such as opsoclonus or ocular flutter that are composed purely of fast-phase (saccadic) eye movements, while nystagmus is characterised by the combination of a smooth pursuit, which usually acts to take the eye off the point of regard, interspersed with the saccadic movement that serves to bring the eye back on target. Without the use of objective recording techniques, it may be very difficult to distinguish between these conditions.
In medicine, the presence of nystagmus can be benign, or it can indicate an underlying visual or neurological problem.[20]
Pathologic nystagmus
Pathological nystagmus is characterized by "excessive drifts of stationary retinal images that degrades vision and may produce illusory motion of the seen world: oscillopsia (an exception is congenital nystagmus)".[21]
When nystagmus occurs without fulfilling its normal function, it is pathologic (deviating from the healthy or normal condition). Pathological nystagmus is the result of damage to one or more components of the vestibular system, including the semicircular canals, otolith organs, and the vestibulocerebellum.
Pathological nystagmus generally causes a degree of vision impairment, although the severity of such impairment varies widely. Also, many blind people have nystagmus, which is one reason that some wear dark glasses.[22]
- Central nystagmus occurs as a result of either normal or abnormal processes not related to the vestibular organ. For example, lesions of the midbrain or cerebellum can result in up- and down-beat nystagmus.
- Gaze induced nystagmus occurs or is exacerbated as a result of changing one's gaze toward or away from a particular side which has an affected central apparatus.[23]
- Peripheral nystagmus occurs as a result of either normal or diseased functional states of the vestibular system and may combine a rotational component with vertical or horizontal eye movements and may be spontaneous, positional, or evoked.
- Positional nystagmus occurs when a person's head is in a specific position.[24] An example of disease state in which this occurs is Benign paroxysmal positional vertigo (BPPV).
- Post rotational nystagmus occurs after an imbalance is created between a normal side and a diseased side by stimulation of the vestibular system by rapid shaking or rotation of the head.
- Spontaneous nystagmus is nystagmus that occurs randomly, regardless of the position of the patient's head.
Physiological nystagmus
Physiological nystagmus is a form of involuntary eye movement that is part of the vestibulo-ocular reflex (VOR), characterized by alternating smooth pursuit in one direction and saccadic movement in the other direction.
The direction of nystagmus is defined by the direction of its quick phase (e.g. a right-beating nystagmus is characterized by a rightward-moving quick phase, and a left-beating nystagmus by a leftward-moving quick phase). The oscillations may occur in the vertical,[25] horizontal or torsional planes, or in any combination. The resulting nystagmus is often named as a gross description of the movement, e.g. downbeat nystagmus, upbeat nystagmus, seesaw nystagmus, periodic alternating nystagmus.
These descriptive names can be misleading however, as many were assigned historically, solely on the basis of subjective clinical examination, which is not sufficient to determine the eyes' true trajectory.
- Optokinetic (syn. opticokinetic) nystagmus: a nystagmus induced by looking at moving visual stimuli, such as moving horizontal or vertical lines, and/or stripes. For example, if one fixates on a stripe of a rotating drum with alternating black and white, the gaze retreats to fixate on a new stripe as the drum moves. This is first a rotation with the same angular velocity, then returns in a saccade in the opposite direction. The process proceeds indefinitely. This is optokinetic nystagmus, and is a source for understanding the fixation reflex.[26]
- Postrotatory nystagmus: if one spins in a chair continuously and stops suddenly, the fast phase of nystagmus is in the opposite direction of rotation, known as the "post-rotatory nystagmus", while slow phase is in the direction of rotation.[26]
Congenital nystagmus has traditionally been viewed as non-treatable, but medications have been discovered in recent years that show promise in some patients. In 1980, researchers discovered that a drug called baclofen could effectively stop periodic alternating nystagmus. Subsequently, gabapentin, an anticonvulsant, was found to cause improvement in about half the patients who received it to relieve symptoms of nystagmus. Other drugs found to be effective against nystagmus in some patients include memantine,[27] levetiracetam, 3,4-diaminopyridine (available in the US to eligible patients with downbeat nystagmus at no cost under an expanded access program[28][29]), 4-aminopyridine, and acetazolamide.[30] Several therapeutic approaches, such as contact lenses,[31] drugs, surgery, and low vision rehabilitation have also been proposed. For example, it has been proposed that mini-telescopic eyeglasses suppress nystagmus.[32]
Surgical treatment of congenital nystagmus is aimed at improving the abnormal head posture, simulating artificial divergence or weakening the horizontal recti muscles.[33] Clinical trials of a surgery to treat nystagmus (known as tenotomy) concluded in 2001. Tenotomy is now being performed regularly at numerous centres around the world. The surgery aims to reduce the eye shaking (oscillations), which in turn tends to improve visual acuity.[34]
Acupuncture has conflicting evidence as to having beneficial effects on the symptoms of nystagmus. Benefits have been seen in treatments where acupuncture points of the neck were used, specifically points on the sternocleidomastoid muscle.[35][36] Benefits of acupuncture for treatment of nystagmus include a reduction in frequency and decreased slow phase velocities which led to an increase in foveation duration periods both during and after treatment.[36] By the standards of evidence-based medicine, the quality of these studies can be considered poor (for example, Ishikawa has a study sample size of just six, is unblinded and without proper control), and given high quality studies showing that acupuncture has no effect beyond placebo, the results of these studies have to be considered clinically irrelevant until higher quality studies are produced.
Physical or occupational therapy is also used to treat nystagmus. Treatment consist of learning compensatory strategies to take over for the impaired system.
Nystagmus is a relatively common clinical condition, affecting one in several thousand people. A survey conducted in Oxfordshire, United Kingdom found that by the age of two, one in every 670 children had manifested nystagmus.[2] Authors of another study in the United Kingdom estimated an incidence of 24 in 10,000 (c. 0.240%), noting an apparently higher rate amongst white Europeans than in individuals of Asian origin.[37]
Law enforcement
In the United States, testing for horizontal gaze nystagmus is one of a battery of field sobriety tests used by police officers to determine whether a suspect is driving under the influence of alcohol. The test involves observation of the suspect's pupil as it follows a moving object, noting
- lack of smooth pursuit,
- distinct and sustained nystagmus at maximum deviation, and
- the onset of nystagmus prior to 45 degrees.
The horizontal gaze nystagmus test has been highly criticized and major errors in the testing methodology and analysis found.[38][39] However, the validity of the horizontal gaze nystagmus test for use as a field sobriety test for persons with a blood alcohol level between 0.04–0.08 is supported by peer reviewed studies and has been found to be a more accurate indication of blood alcohol content than other standard field sobriety tests.[40]
- Note however that "dancing eyes" is also a common term for opsoclonus myoclonus syndrome.
- Zahn JR (July 1978). "Incidence and characteristics of voluntary nystagmus". J. Neurol. Neurosurg. Psychiatry. 41 (7): 617–23. doi:10.1136/jnnp.41.7.617. PMC 493105. PMID 690639.
- "General Information about Nystagmus". American Nystagmus Network. February 21, 2002. Retrieved 2011-11-09.
- Weil, Andrew (2013). "Dealing with dancing eyes". Weil Lifestyle, LLC. Retrieved 2014-04-16.
- "Nystagmus". Medline Plus. February 27, 2013. Retrieved 2012-12-12.
- Saladin, Kenneth (2012). Anatomy and Physiology: The Unity of Form and Function. New York: McGraw-Hill. pp. 597–609. ISBN 978-0-07-337825-1.
- Self, James; Lotery, Andrew (2007). "A Review of the Molecular Genetics of Congenital Idiopathic Nystagmus (CIN)". Ophthalmic Genetics. 28 (4): 187–91. doi:10.1080/13816810701651233. PMID 18161616.
- Li, N; Wang, L; Cui, L; Zhang, L; Dai, S; Li, H; Chen, X; Zhu, L; Hejtmancik, JF; Zhao, K (2008). "Five novel mutations of the FRMD7 gene in Chinese families with X-linked infantile nystagmus". Molecular Vision. 14: 733–8. PMC 2324116. PMID 18431453.
- Poopalasundaram, S; Erskine, L; Cheetham, M; Hardcastle, A (2005). "Focus on Molecules: Nyctalopin". Experimental Eye Research. 81 (6): 627–8. doi:10.1016/j.exer.2005.07.017. PMID 16157331.
- Leroy, B P; Budde, B S; Wittmer, M; De Baere, E; Berger, W; Zeitz, C (2008). "A common NYX mutation in Flemish patients with X linked CSNB". British Journal of Ophthalmology. 93 (5): 692–6. doi:10.1136/bjo.2008.143727. PMID 18617546.
- Peloquin, J.B.; Rehak, R.; Doering, C.J.; McRory, J.E. (2007). "Functional analysis of congenital stationary night blindness type-2 CACNA1F mutations F742C, G1007R, and R1049W". Neuroscience. 150 (2): 335–45. doi:10.1016/j.neuroscience.2007.09.021. PMID 17949918.
- Ganança, Fernando Freitas; Ganança, Ricardo; Ganança, Maurício M.; Korn, Gustavo P.; Dorigueto, Ricardo S. (2005). "É importante restringir a movimentação cefálica após a manobra de Epley?" [The number of procedures required to eliminate positioning nystagmus in benign paroxysmal positional vertigo]. Revista Brasileira de Otorrinolaringologia (in Portuguese). 71 (6): 769–75. doi:10.1590/S0034-72992005000600013. PMID 16878247.
- "Beriberi". Genetic and Rare Diseases Information Center (GARD) – an NCATS Program. 2015. Archived from the original on 11 November 2017. Retrieved 11 November 2017.
- "Nutrition and Growth Guidelines | Domestic Guidelines - Immigrant and Refugee Health". CDC. March 2012. Archived from the original on 11 November 2017. Retrieved 11 November 2017.
- Lindgren, Stefan (1993). Kliniska färdigheter: Informationsutbytet mellan patient och läkare (in Swedish). Lund: Studentlitteratur. ISBN 978-91-44-37271-6.
- Roberts, Dale; Vincenzo, Marcelli; Joseph, Gillen; Carey, John; Santina, Charles; Zee, David (2011). "MRI Magnetic Field Stimulates Rotational Sensors of the Brain". Current Biology. 21 (19): 1635–1640. doi:10.1016/j.cub.2011.08.029. PMC 3379966. PMID 21945276.
- Tusa, RJ (June 1999). "Nystagmus: diagnostic and therapeutic strategies". Seminars in Ophthalmology. 14 (2): 65–73. doi:10.3109/08820539909056066. PMID 10758214.
- Markley, BA (2007). "Introduction to electronystagmography for END technologists". American Journal of Electroneurodiagnostic Technology. 47 (3): 178–89. doi:10.1080/1086508X.2007.11079629. PMID 17982846.
- Mosca, F; Sicignano, S; Leone, CA (2003). "Benign positional paroxysmal vertigo: videonystagmographic study using rotatory test". Acta Otorhinolaryngologica Italica. 23 (2): 67–72. PMID 14526552.
- Eggert, T (2007). Eye movement recordings: methods. Developments in Ophthalmology. 40. pp. 15–34. doi:10.1159/000100347. ISBN 978-3-8055-8251-3. PMID 17314477.
- Serra A, Leigh RJ (December 2002). "Diagnostic value of nystagmus: spontaneous and induced ocular oscillations". Journal of Neurology, Neurosurgery, and Psychiatry. 73 (6): 615–8. doi:10.1136/jnnp.73.6.615. PMC 1757336. PMID 12438459.
- "Differences Between Physiologic and Pathologic Nystagmus". Spencer S. Eccles Health Sciences Library. Retrieved 22 November 2016.
- "nystagmus". Retrieved 2007-06-07.
- Gold, Daniel. "Gaze-evoked and rebound nystagmus in a cerebellar syndrome". Neuro-Ophthalmology Virtual Education Library (NOVEL): Daniel Gold Collection. Spencer S. Eccles Health Sciences Library. Retrieved 9 September 2019.
- Anagnostou, E (2006). "Positional nystagmus and vertigo due to a solitary brachium conjunctivum plaque". Journal of Neurology, Neurosurgery & Psychiatry. 77 (6): 790–2. doi:10.1136/jnnp.2005.084624. PMC 2077463. PMID 16705203.
- Pierrot-Deseilligny C, Milea D (June 2005). "Vertical nystagmus: clinical facts and hypotheses". Brain. 128 (Pt 6): 1237–46. doi:10.1093/brain/awh532. PMID 15872015.
- "Sensory Reception: Human Vision: Structure and function of the Human Eye" vol. 27, p. 179 Encyclopædia Britannica, 1987
- Corbett, J (2007). "Memantine/Gabapentin for the treatment of congenital nystagmus". Current Neurology and Neuroscience Reports. 7 (5): 395–6. doi:10.1007/s11910-007-0061-z. PMID 17764629.
- Muscular Dystrophy Association Press Release
- Clinical trial number NCT02189720 for "Expanded Access Study of Amifampridine Phosphate in LEMS, Congenital Myasthenic Syndrome, or Downbeat Nystagmus Patients (EAP-001)" at ClinicalTrials.gov
- Groves, Nancy (March 15, 2006). "Many options to treat nystagmus, more in development". Ophthalmology Times.
- Biousse, V; Tusa, RJ; Russell, B; Azran, MS; Das, V; Schubert, MS; Ward, M; Newman, NJ (2004). "The use of contact lenses to treat visually symptomatic congenital nystagmus". Journal of Neurology, Neurosurgery & Psychiatry. 75 (2): 314–6. doi:10.1136/jnnp.2003.010678. PMC 1738913. PMID 14742616.
- Cerman, E. "Mini-telescopic eyeglasses suppress nystagmus". World Society of Pediatric Ophthalmology and Strabismus Conference in Barcelona 2015. Retrieved 26 January 2016.
- Kumar, Anand; Shetty, S; Vijayalakshmi, P; Hertle, RW (Nov–Dec 2011). "Improvement in visual acuity following surgery for correction of head posture in infantile nystagmus syndrome". Journal of Pediatric Ophthalmology and Strabismus. 48 (6): 341–6. doi:10.3928/01913913-20110118-02. PMID 21261243.
- Wang, Z; Dell'Osso, LF; Jacobs, JB; Burnstine, RA; Tomsak, RL (December 2006). "Effects of tenotomy on patients with infantile nystagmus syndrome: foveation improvement over a broadened visual field". Journal of the American Association for Pediatric Ophthalmology and Strabismus. 10 (6): 552–60. doi:10.1016/j.jaapos.2006.08.021. PMID 17189150.
- Ishikawa, S.; et al. (1987). "Treatment of nystagmus by acupuncture". Highlights in Neuro-ophthalmology (6th ed.): 227–232.
- Blekher, T. (1998). "Effect of acupuncture on foveation characteristics in congenital nystagmus". British Journal of Ophthalmology. 82 (2): 115–120. doi:10.1136/bjo.82.2.115. PMC 1722486. PMID 9613375. Retrieved May 6, 2012.
- Sarvananthan, N.; Surendran, M.; Roberts, E. O.; Jain, S.; Thomas, S.; Shah, N.; Proudlock, F. A.; Thompson, J. R.; McLean, R. J.; Degg, C.; Woodruff, G.; Gottlob, I. (2009). "The Prevalence of Nystagmus: The Leicestershire Nystagmus Survey". Investigative Ophthalmology & Visual Science. 50 (11): 5201–6. doi:10.1167/iovs.09-3486. PMID 19458336.
- Booker JL (2004). "The Horizontal Gaze Nystagmus test: fraudulent science in the American courts". Science & Justice. 44 (3): 133–9. doi:10.1016/S1355-0306(04)71705-0. PMID 15270451.
- Booker JL (2001). "End-position nystagmus as an indicator of ethanol intoxication". Science & Justice. 41 (2): 113–6. doi:10.1016/S1355-0306(01)71862-X. PMID 11393940.
- McKnight AJ, Langston EA, McKnight AS, Lange JE (May 2002). "Sobriety tests for low blood alcohol concentrations". Accident Analysis and Prevention. 34 (3): 305–11. doi:10.1016/S0001-4575(01)00027-6. PMID 11939359.
External links
Classification | |
External resources |

subset: commoncrawl


text:
Drugi jezik na kojem je dostupan ovaj članak: Bosnian
Source: Nielsen
What if you could easily reach a dynamic audience that is influential, educated, entrepreneurial and committed to the continued growth of society? Increasingly, that driving force is women, a rumbling economic powerhouse. In the U.S. alone, women make up just over half of the population, and they're accountable for over $39 trillion dollars. That puts them in charge of 30% of the world's wealth, and the number is growing.
Nielsen's research into consumer behavior allows us to connect with women, to hear their voices and learn more about their daily media and purchasing patterns. Understanding their behavior is imperative to publishers and brands who seek to create content and craft messages that tap into women's power to move markets.
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Brands and organizations looking to reach these conscious consumers have more options than ever before. Women are prodigious consumers of video, internet and radio, and they're increasingly engaged with media and technology. According to Nielsen's Q2 2017 Total Audience Report, generally, American adults consume almost 76 hours of content per week across all screens and devices. The majority of time is still devoted to traditional live TV, but current trends project consumers are spending more and more time with digital devices, especially women. Radio also has high consumption among women, as they spend almost two hours a day listening. In the second quarter of 2017, women over the age of 18 in the U.S. were spending over 11 hours a day consuming media across devices—from their TV to their smartphone.
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Local news is key to reach mothers
The drivers behind how women invest in their time and attention have more to do with their life stage and experience. The best example is mothers in the U.S. and their news consumption on a daily basis. Marketers have long recognized moms as a powerful segment, and new products and campaigns are constantly being developed with moms in mind.
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Women play an active role within the digital and traditional media space. As the media landscape changes, they're also adapting to the new media landscape by using new forms of technologies for everyday purchasing. These habits highlight the need for marketers to know how and where to reach them.