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Ophthalmology
Ophthalmology
LEAD EDITORS FIFTH EDITION
Myron Yanoff, MD Jay S. Duker, MD
Chair Emeritus, Ophthalmology Director
Professor of Ophthalmology & Pathology New England Eye Center
Departments of Ophthalmology & Pathology Professor and Chairman
College of Medicine Department of Ophthalmology
Drexel University Tufts Medical Center
Philadelphia, PA, USA Tufts University School of Medicine
Boston, MA, USA

SECTION EDITORS
James J. Augsburger, MD Michael H. Goldstein, MD, MBA Alfredo A. Sadun, MD, PhD
Professor and Chairman Co-Director, Cornea and External Diseases Flora Thornton Chair, Doheny
Department of Ophthalmology Service Professor of Ophthalmology
University of Cincinnati College of Medicine New England Eye Center Vice-Chair of Ophthalmology, UCLA
Cincinnati, OH, USA Tufts Medical Center Los Angeles, CA, USA
Boston, MA, USA
Dimitri T. Azar, MD, MBA Joel S. Schuman, MD
Senior Director, Google Verily Life Sciences Narsing A. Rao, MD Professor and Chairman of Ophthalmology
Distinguished University Professor and B.A. Professor of Ophthalmology and Pathology Director, NYU Eye Center
Field Chair of Ophthalmic Research USC Roski Eye Institute Professor of Neuroscience and Physiology
Professor of Ophthalmology, Pharmacology, and Department of Ophthalmology Neuroscience Institute
Bioengineering University of Southern California NYU School of Medicine
University of Illinois at Chicago Los Angeles, CA, USA Professor of Electrical and Computer
Chicago, IL, USA Engineering
Shira L. Robbins, MD NYU Tandon School of Engineering
Sophie J. Bakri, MD Clinical Professor of Ophthalmology
Professor of Neural Science
Professor of Ophthalmology Ratner Children’s Eye Center at the Shiley Eye
Center for Neural Science, NYU
Vitreoretinal Diseases & Surgery Institute
New York, NY, USA
Mayo Clinic University of California San Diego
Rochester, MN, USA La Jolla, CA, USA Janey L. Wiggs, MD, PhD
Paul Austin Chandler Professor of
Scott E. Brodie, MD, PhD Emanuel S. Rosen, MD, FRCS, Ophthalmology
Professor of Ophthalmology FRCOphth Harvard Medical School
NYU School of Medicine Private Practice Boston, MA, USA
New York, NY, USA Case Reports Editor for Journal of Cataract &
Jonathan J. Dutton, MD, PhD Refractive Surgery
Professor Emeritus Manchester, UK
Department of Ophthalmology
University of North Carolina
Chapel Hill, NC, USA
For additional online content visit ExpertConsult.com

Edinburgh London New York Oxford Philadelphia St Louis Sydney 2019

© 2019, Elsevier Inc. All rights reserved.

First edition 1999

Second edition 2004
Third edition 2009
Fourth edition 2014

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about
the Publisher’s permissions policies and our arrangements with organizations such as the Copyright
Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/
permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).

Chapter 4.29: “Endothelial Keratoplasty: Targeted Treatment for Corneal Endothelial Dysfunction” by
Marianne O. Price, Francis W. Price, Jr.
Marianne O. Price and Francis W. Price, Jr. retain copyright of the video accompanying this chapter.

Chapter 6.5: “Contact B-Scan Ultrasonography” by Yale L. Fisher, Dov B. Sebrow

Yale L. Fisher retains copyright of the video accompanying this chapter. The remainder of this lecture as
well as additional lectures on ophthalmology can be found at www.OphthalmicEdge.org.

Chapter 7.2: “Mechanisms of Uveitis” by Igal Gery, Chi-Chao Chan

This chapter is in the Public Domain.

Chapter 7.23: “Masquerade Syndromes: Neoplasms” by Nirali Bhatt, Chi-Chao Chan, H. Nida Sen
This chapter is in the Public Domain.

Chapter 11.8: “Torsional Strabismus” by Scott K. McClatchey, Linda R. Dagi

This chapter is in the Public Domain.

Chapter 12.16: “Aesthetic Fillers and Botulinum Toxin for Wrinkle Reduction” by Jean Carruthers,
Alastair Carruthers
Jean Carruthers retains copyright of Figures 12.16.1 & 12.16.6.

Notices

Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds or experiments described herein. Because of
rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug
dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier,
authors, editors or contributors for any injury and/or damage to persons or property as a matter of
products liability, negligence or otherwise, or from any use or operation of any methods, products,
instructions, or ideas contained in the material herein.

ISBN: 978-0-323-52819-1
E-ISBN: 978-0-323-52821-4
ISBN: 978-0-323-52820-7

Content Strategist: Russell Gabbedy

Content Development Specialist: Sharon Nash
Content Coordinator: Joshua Mearns
Project Manager: Joanna Souch
Design: Brian Salisbury
Illustration Manager: Karen Giacomucci
Illustrator: Richard Tibbitts
Marketing Manager: Claire McKenzie

Printed in China

Last digit is the print number: 9 8 7 6 5 4 3 2 1

 User Guide

User Guide
COLOR CODING
Ophthalmology is organized into 12 parts, which are color-coded as follows
for quick and easy reference:

Part 1: Genetics

Part 2: Optics and Refraction

Part 3: Refractive Surgery

Part 4: Cornea and Ocular Surface Diseases

Part 5: The Lens

Part 6: Retina and Vitreous

Part 7: Uveitis and Other Intraocular Inflammations

Part 8: Intraocular Tumors

Part 9: Neuro-Ophthalmology

Part 10: Glaucoma

Part 11: Pediatric and Adult Strabismus

Part 12: Orbit and Oculoplastics

EXPERTCONSULT WEBSITE
n Full searchable text and downloadable image gallery
n Full reference lists for each chapter
n Additional online content including text, figures, & video clips

v
 Video Contents Video available at
Video Contents
ExpertConsult.com

Part 3: Refractive Surgery Chapter 6.25 Coats’ Disease and Retinal Telangiectasia
Chapter 3.4 LASIK 6.25.1 Pars Plana Vitrectomy and Subretinal Fluid and Exudate Drainage Performed
for a Severe Exudative Retinal Detachment
3.4.1 iLASIK
Chapter 6.32 Macular Hole
Chapter 3.5 Small Incision Lenticule Extraction (SMILE)
6.32.1 Macular Hole Surgery
3.5.1 SMILE Instructional Video
Chapter 6.33 Epiretinal Membrane
Chapter 3.7 Phakic Intraocular Lenses
6.33.1 Epiretinal Membrane Removal
3.7.1 Cachet Lens
3.7.2 Artisan/Verisyse Lens Implantation for Hyperopia After Radial Keratotomy Chapter 6.34 Vitreomacular Traction
3.7.3 Toric Artiflex Phakic Intraocular Lens in a Patient With High Myopia and
6.34.1 Vitreomacular Traction Syndrome
Astigmatism After Deep Anterior Lamellar Keratoplasty
3.7.4 Toric Artiflex Lens Implantation in a Patient With a Previous Intracorneal Chapter 6.39 Rhegmatogenous Retinal Detachment
Ring for Keratoconus 6.39.1 Internal Limiting Membrane (ILM) Peeling for Primary Rhegmatogenous
3.7.5 ICL Implantation Repair to Reduce Postoperative Macular Pucker
3.7.6 ICL Exchange
Chapter 6.41 Choroidal Hemorrhage
Part 4: Cornea and Ocular Surface Diseases 6.41.1 Transconjunctival Trocar/Cannula Drainage of Suprachoroidal Fluid
Chapter 4.17 Noninfectious Keratitis
Chapter 6.43 Posterior Segment Ocular Trauma
4.17.1 Patient With Lax Eyelids Recommended for Sleep Study
6.43.1 Intraocular Foreign Body Removal
Chapter 4.29 Endothelial Keratoplasty: Targeted Treatment for Corneal 6.43.2 Intraocular Foreign Body Removal With Rare Earth Magnet
Endothelial Dysfunction
Part 9: Neuro-Ophthalmology
4.29.1 DSEK Pull-Through
4.29.2 DMEK Donor Preparation Chapter 9.19 Nystagmus, Saccadic Intrusions, and Oscillations
4.29.3 Descemet’s Membrane Endothelial Keratoplasty (DMEK) 9.19.1 Congenital Nystagmus
9.19.2 Oculocutaneous Albinism With Associated Nystagmus
Part 5: The Lens 9.19.3 Latent Nystagmus
Chapter 5.8 Anesthesia for Cataract Surgery 9.19.4 Spasmus Nutans
5.8.1 Standard Technique for Sub-Tenon’s Anesthesia 9.19.5 Right Internuclear Ophthalmoplegia
5.8.2 “Incisionless” Technique for Sub-Tenon’s Anesthesia 9.19.6 Convergence Retraction Nystagmus in Parinaud’s Syndrome

Chapter 5.9 Phacoemulsification Part 10: Glaucoma

5.9.1 Two Examples of “Sculpting” Using Low Flow and Vacuum but Higher Chapter 10.7 Optic Nerve Analysis
Power/Amplitude 10.7.1 Three-Dimensional Imaging of the Optic Nerve Head
5.9.2 Two Examples of Using Higher Flow and Vacuum for Nucleus Fragment
Removal Chapter 10.28 Minimally Invasive and Microincisional Glaucoma Surgeries
Chapter 5.11 Small Incision and Femtosecond Laser-Assisted 10.28.1 iStent G1 Implantation
Cataract Surgery 10.28.2 Key Steps in Trabectome Surgery
5.11.1 Unexpected Subluxation Chapter 10.29 Trabeculectomy
5.11.2 Microincision Phaco 10.29.1 Bleb Leak Detection Using Concentrated Fluorescein Dye
5.11.3 Microincision Refractive Lens Exchange 10.29.2 Trabeculectomy With Mitomycin C
5.11.4 700µ Phaco 10.29.3 5-Fluorouracil Subconjunctival Injection
Chapter 5.13 Combined Procedures Chapter 10.32 Complications of Glaucoma Surgery and Their Management
5.13.1 Combined Phacoemulsification Cataract Surgery and Descemet’s Stripping 10.32.1 Small Pupil Cataract Surgery With Use of Pupil Expansion Ring (I-Ring;
Automated Endothelial Keratoplasty (DSAEK) Beaver Visitec, Waltham, MA) and Trypan Blue Capsular Staining
5.13.2 Combined Phacovitrectomy 10.32.2 Repair of Bleb Leak
Chapter 5.16 Complications of Cataract Surgery
Part 11: Pediatric and Adult Strabismus
5.16.1 Artisan Implantation
Chapter 11.3 Examination of Ocular Alignment and Eye Movements
Part 6: Retina and Vitreous 11.3.1 Strabismus Exam Elements
Chapter 6.3 Retinal and Choroidal Circulation 11.3.2 Cover/Uncover Test
11.3.3 Exotropia
6.3.1 Fluorescein and Indocyanine Green (ICG) Video Angiogram 11.3.4 Esotropia
Chapter 6.5 Contact B-Scan Ultrasonography 11.3.5 Hypertropia
11.3.6 Prism Alternate Cover Test
6.5.1 Examination Techniques for Contact B-Scan Ultrasonography
11.3.7 Simultaneous Prism Cover Test
Chapter 6.11 Scleral Buckling Surgery 11.3.8 Exophoria
11.3.9 Alternate or Cross Cover Test
6.11.1 Scleral Buckle
6.11.2 Suture Total running time approximately 2 hours and 34 minutes
6.11.3 Drain
Chapter 6.12 Vitrectomy
6.12.1 Vitrectomy for Nonclearing Vitreous Hemorrhage

vi
 Preface
Preface

It’s been 20 years since the first edition of Ophthalmology was published. Ophthalmology was never intended to be encyclopedic, but with each
We are delighted that our textbook now has gone to a fifth edition. The lon- edition we strived to make it quite comprehensive, readable, and easy to
gevity of this title reflects the uniqueness and utility of its format; the hard access. Like the fourth edition, this edition is thoroughly revised, with new
work of our authors, editors, and publishers; and the pressing need in our section editors and many new authors. Chapters have been rewritten and
field for updated, clinically relevant information. We continue to recognize restricted to reflect the new way diseases are diagnosed, categorized, and
the advantage of a complete textbook of ophthalmology in a single volume treated. We have discarded out-of-date material and have added numerous
rather than multiple volumes. The basic visual science is admixed with new items. Extra references and other material have been moved online to
clinical information throughout, and we have maintained an entire sepa- keep the book itself as one volume.
rate section dedicated to genetics and the eye.

xii
 Preface to First Edition

Preface to First Edition

Over the past 30 years, enormous technologic advances have occurred in To achieve the same continuity of presentation in the figures as well
many different areas of medicine—lasers, molecular genetics, and immu- as in the text, all of the artworks have been redesigned from the authors’
nology to name a few. This progress has fueled similar advances in almost originals, maximizing their accessibility for the reader. Each section is
every aspect of ophthalmic practice. The assimilation and integration of color coded for easy cross-referencing and navigation through the book.
so much new information makes narrower and more focused ophthalmic Despite the extensive use of color in artworks and photographs through-
practices a necessity. As a direct consequence, many subspecialty textbooks out, the cost of this comprehensive book has been kept to a fraction of the
with extremely narrow focus are now available, covering every aspect of multivolume sets. We hope to make this volume more accessible to more
ophthalmic practice. Concurrently, several excellent multivolume textbooks practitioners throughout the world.
detailing all aspects of ophthalmic practice have been developed. Yet there Although comprehensive, Ophthalmology is not intended to be encyclo-
remains a need for a complete single-volume textbook of ophthalmology pedic. In particular, in dealing with surgery, we do not stress specific tech-
for trainees, nonophthalmologists, and those general ophthalmologists niques or describe rarer ones in meticulous detail. The rapidly changing
(and perhaps specialists) who need an update in specific areas in which nature of surgical aspects of ophthalmic practice is such that the reader
they do not have expertise. Ophthalmology was created to fill this void will need to refer to one or more of the plethora of excellent books that
between the multivolume and narrow subspecialty book. cover specific current techniques in depth. We concentrate instead on
This book is an entirely new, comprehensive, clinically relevant, sin- the areas that are less volatile but, nevertheless, vital surgical indications,
gle-volume textbook of ophthalmology, with a new approach to content and general principles of surgical technique, and complications. The approach
presentation that allows the reader to access key information quickly. Our to referencing is parallel to this: For every topic, all the key references are
approach, from the outset, has been to use templates to maintain a uniform listed, but with the aim of avoiding pages of redundant references where a
chapter structure throughout the book so that the material is presented in smaller number of recent classic reviews will suffice. The overall emphasis
a logical, consistent manner, without repetition. The majority of chapters of Ophthalmology is current information that is relevant to clinical practice
in the book follow one of three templates: the disease-oriented template, superimposed on the broad framework that comprises ophthalmology as
the surgical procedure template, or the diagnostic testing template. Metic- a subspecialty.
ulous planning went into the content, sectioning, and chapter organization Essential to the realization of this ambitious project is the ream of
of the book, with the aim of presenting ophthalmology as it is practiced, Section Editors, each bringing unique insight and expertise to the book.
rather than as a collection of artificially divided aspects. Thus, pediatric They have coordinated their efforts in shaping the contents list, finding
ophthalmology is not in a separate section but is integrated into relevant contributors, and editing chapters to produce a book that we hope will
sections across the book. The basic visual science and clinical information, make a great contribution to ophthalmology.
including systemic manifestations, is integrated throughout, with only two We are grateful to the editors and authors who have contributed to
exceptions. We dedicated an entire section to genetics and the eye, in rec- Ophthalmology and to the superb, dedicated team at Mosby.
ognition of the increasing importance of genetics in ophthalmology. Optics Myron Yanoff
and refraction are included in a single section as well because an under- Jay S. Duker
standing of these subjects is fundamental to all of ophthalmology. July 1998

xiii
 List of Contributors
List of Contributors

The editor(s) would like to acknowledge and offer grateful thanks for the input of all previous editions’ contributors, without whom this new edition
would not have been possible.

Erika C. Acera, OC(C) Ferhina S. Ali, MD, MPH Steve A. Arshinoff, MD, FRCSC Nicole Balducci, MD
Clinical Orthoptist Vitreoretinal Surgery Fellow Associate Professor Consultant
Department of Ophthalmology Wills Eye Hospital University of Toronto Ophthalmology Division
Anne F. and Abraham Ratner Retina Service Department of Ophthalmology and Studio Oculistico d’Azeglio
Children’s Eye Center Mid Atlantic Retina Visual Sciences Bologna, Italy
Shiley Eye Institute Philadelphia, PA, USA Toronto, ON, Canada
University of California San Diego Piero Barboni, MD
La Jolla, CA, USA Jorge L. Alió, MD, PhD Penny A. Asbell, MD, FACS, FARVO Consultant
Professor of Ophthalmology Professor of Ophthalmology Neuro-Ophthalmology
Natalie A. Afshari, MD Miguel Hernandez University, Vissum Icahn School of Medicine at Mount Scientific Institute San Raffaele
Stuart I. Brown MD Chair in Alicante, Spain Sinai Milan, Italy
Ophthalmology in Memory of New York, NY, USA Studio Oculistico d’Azeglio
Donald P. Shiley Norma Allemann, MD Bologna, Italy
Professor of Ophthalmology Adjunct Professor Kerry K. Assil, MD
Chief of Cornea and Refractive Surgery Department of Ophthalmology and Corneal, Cataract and Refractive Cullen J. Barnett, COT, CRA, OCT-C,
Vice Chair of Education Visual Sciences Surgeon CDOS
Shiley Eye Institute University of Illinois at Chicago Medical Director Clinical Supervisor of Ophthalmology
University of California San Diego Chicago, IL, USA The Assil Eye Institute Roski Eye Institute
La Jolla, CA, USA Adjunct Professor Beverly Hills, CA, USA Keck Medicine USC
Department of Ophthalmology and Los Angeles, CA, USA
Anita Agarwal, MD Visual Sciences Neal H. Atebara, MD, FACS
Adjoint Professor of Ophthalmology Escola Paulista de Medicina (EPM) Associate Professor Soumyava Basu, MS
Vanderbilt Eye Institute Universidade Federal de São Paulo Department of Surgery Head of Uveitis Services
West Coast Retina (UNIFESP) University of Hawaii LVPEI Network
Vanderbilt University Medical Center São Paulo, SP, Brazil John A. Burns School of Medicine L V Prasad Eye Institute
San Francisco, CA, USA Honolulu, HI, USA Bhubaneswar, Odisha, India
David Allen, BSc, MB, BS, FRCS,
Joshua S. Agranat, MD FRCOphth James J. Augsburger, MD Priti Batta, MD
Resident Physician Consultant Ophthalmologist (Cataract) Professor of Ophthalmology Assistant Professor of Ophthalmology
Department of Ophthalmology Cataract Treatment Centre Dr. E. Vernon & Eloise C. Smith Chair Director of Medical Student Education
Massachusetts Eye and Ear Sunderland Eye Infirmary of Ophthalmology New York Eye and Ear Infirmary of
Harvard Medical School Sunderland, Tyne & Wear, UK College of Medicine, University of Mount Sinai
Boston, MA, USA Cincinnati New York, NY, USA
Keith G. Allman, MBChB, MD, FRCA Founding Director, Ocular Oncology &
Radwan S. Ajlan, MBBCh, FRCS(C), Consultant Anaesthetist Diagnostic Ultrasonography Service, Caroline R. Baumal, MD, FRCSC
FICO, DABO West of England Eye Unit University of Cincinnati Medical Associate Professor of Ophthalmology
Assistant Professor Royal Devon and Exeter NHS Trust Center Director ROP Service
Retina and Vitreous Exeter, Devon, UK Attending Surgeon, University of Vitreoretinal Surgery
Department of Ophthalmology Cincinnati Medical Center New England Eye Center
University of Kansas School of Nishat P. Alvi, MD Consulting Surgeon, Cincinnati Tufts University
Medicine Medical Director of Ophthalmology Children’s Hospital Medical Center School of Medicine
Kansas City, KS, USA The Vision Institute of Illinois Cincinnati, OH, USA Boston, MA, USA
Elgin, IL, USA
Anam Akhlaq, MBBS G. William Aylward, FRCS, FRCOphth, Srilaxmi Bearelly, MD, MHS
Postdoctoral Fellow Leonard P.K. Ang, MBBS, MD, FRCS, MD Assistant Professor of Ophthalmology
Center for Translational Ocular MRCOphth, MMed, FAMS Consultant Ophthalmologist Ophthalmology
Immunology Associate Professor of Ophthalmology London, UK Columbia University Medical Center
Department of Ophthalmology Medical Director, Lang Eye Centre New York, NY, USA
Tufts Medical Center Singapore Dimitri T. Azar, MD, MBA
Senior Director, Google Verily Life Jesse L. Berry, MD
Boston, MA, USA David J. Apple, MD †
Associate Director, Ocular Oncology
Sciences
Thomas A. Albini, MD Formerly Professor of Ophthalmology Distinguished University Professor Service
Associate Professor of Ophthalmology and Pathology and B.A. Field Chair of Ophthalmic Associate Residency Program Director
Department of Ophthalmology Director, Laboratories for Ophthalmic Research for Ophthalmology
Bascom Palmer Eye Institute Devices Research Professor of Ophthalmology, USC Roski Eye Institute
University of Miami John A. Moran Eye Center Pharmacology, and Bioengineering Keck School of Medicine, University of
Miami, FL, USA University of Utah University of Illinois at Chicago Illinois Southern California
Salt Lake City, UT, USA College of Medicine Attending Surgeon, Children’s Hospital
Ahmed Al-Ghoul, MD, MBA, FRCSC, Chicago, IL, USA of Los Angeles
DipABO Maria Cecilia D. Aquino, MD, MMED, Los Angeles, CA, USA
Clinical Lecturer (Ophthalmology) Sophie J. Bakri, MD
Division of Ophthalmology Resident Physician II Professor of Ophthalmology Angela P. Bessette, MD
Department of Surgery Ophthalmology/Glaucoma Vitreoretinal Diseases & Surgery Assistant Professor
University of Calgary National University Hospital Mayo Clinic Department of Ophthalmology
Calgary, AB, Canada National University Health System Rochester, MN, USA Flaum Eye Institute
Singapore University of Rochester
Laura J. Balcer, MD, MSCE Rochester, NY, USA
Anthony C. Arnold, MD Professor of Neurology
Professor and Chief Vice-Chair, Neurology
Neuro-Ophthalmology Division New York University
xiv UCLA Stein Eye Institute
Los Angeles, CA, USA
School of Medicine
†
Deceased New York, NY, USA
Nirali Bhatt, MD Igor I. Bussel, MS, MHA Chi-Chao Chan, MD Abbot (Abe) Clark, PhD, FARVO
Assistant Professor Doris Duke Clinical Research Fellow Scientist Emeritus Regents Professor of Pharmacology

List of Contributors
Department of Ophthalmology Department of Ophthalmology Laboratory of Immunology and Neuroscience
University of Pennsylvania University of Pittsburgh School of National Eye Institute Executive Director, North Texas Eye
Perelman School of Medicine Medicine National Institutes of Health Research Institute
Philadelphia, PA, USA Pittsburgh, PA, USA Bethesda, MD, USA University of North Texas Health
Visiting Professor Science Center
Orry C. Birdsong, MD Louis B. Cantor, MD Zhongshan Ophthalmic Center Fort Worth, TX, USA
Clinical Fellow Jay C. and Lucile L. Kahn Professor Sun Yat-Sen University
Ophthalmology and Chair China Jonathan C.K. Clarke, MD, FRCOphth
Hoopes Vision Department of Ophthalmology Consultant Ophthalmologist
Draper, UT, USA Indiana University Melinda Y. Chang, MD NIHR Moorfields Biomedical Research
School of Medicine Assistant Professor of Ophthalmology Centre
Jyotirmay Biswas, MS, FMRF, FNAMS, Indianapolis, IN, USA USC Roski Eye Institute and Children’s Moorfields Eye Hospital
FIC, Path, FAICO Hospital Los Angeles UCL Institute of Ophthalmology
Director Hilda Capó, MD Keck School of Medicine of the London, UK
Uveitis and Ocular Pathology Professor of Clinical Ophthalmology University of Southern California
Department Bascom Palmer Eye Institute Los Angeles, CA, USA François Codère, MD
Sankara Nethralaya Division Chief Pediatric Associate Professor
Chennai, Tamil Nadu, India Ophthalmology and Adult Stanley Chang, MD Ophthalmology/Oculoplastic and
Strabismus KK Tse and KT Ying Professor of Orbital Surgery Section
Bahram Bodaghi, MD, PhD, FEBOphth Miller School of Medicine Ophthalmology Université de Montréal
Professor of Ophthalmology John T. Flynn Professor of Department of Ophthalmology Montréal, QC, Canada
DHU ViewRestore Ophthalmology Chair Columbia University
APHP, UPMC, Sorbonne University University of Miami New York, NY, USA Ian P. Conner, MD, PhD
Paris, France Miami, FL, USA Assistant Professor
Victoria S. Chang, MD Ophthalmology
Swaraj Bose, MD Antonio Capone, Jr., MD Assistant Professor of Clinical UPMC Eye Center
Associate Professor of Ophthalmology Professor Ophthalmology Pittsburgh, PA, USA
UCI and Attending Physician Department of Ophthalmology Ophthalmology, Cornea and External
Cedars Sinai Medical Center Oakland University Disease Peter Coombs, MD
Los Angeles, CA, USA William Beaumont Hospital Bascom Palmer Eye Institute Vitreoretinal Physician and Surgeon
School of Medicine University of Miami Utah Eye Centers
Charles S. Bouchard, MD, MA Salt Lake City, UT, USA
Professor and Chairman of Auburn HIlls, MI, USA Naples, FL, USA
Ophthalmology Alastair Carruthers, MA, BM, BCh, David G. Charteris, MD, FRCS(Ed), Zélia M. Corrêa, MD, PhD
Loyola University Health System FRCP(Lon), FRCPC FRCOphth Tom Clancy Endowed Professor of
Maywood, IL, USA Clinical Professor Professor Ophthalmology
Department of Dermatology and Skin Vitreoretinal Unit Head of Ocular Oncology and
Michael E. Boulton, PhD Echography
Susan and Dowd Ritter/RPB Endowed Science Moorfields Eye Hospital
University of British Columbia London, UK Retina Service, Wilmer Eye Institute
Chair of Ophthalmology Johns Hopkins University School of
University of Alabama Birmingham Vancouver, BC, Canada
Soon-Phaik Chee, MD Medicine
Birmingham, AL, USA Jean Carruthers, MD, FRCSC, Professor Baltimore, MD, USA
James D. Brandt, MD FRC(OPHTH) Cataract Service, Ocular Inflammation
Clinical Professor & Immunology Service Steven M. Couch, MD, FACS
Professor Assistant Professor
Department of Ophthalmology & Department of Ophthalmology Singapore National Eye Centre
University of British Columbia Singapore Department of Ophthalmology &
Vision Science Visual Sciences
Vice-Chair for International Programs Fellow
American Society for Ophthalmic John J. Chen, MD, PhD Washington University in St Louis
and New Techology Assistant Professor St Louis, MO, USA
Director - Glaucoma Service Plastic and Reconstructive Surgery
Vancouver, BC, Canada Department of Ophthalmology and
University of California Davis Neurology Stuart G. Coupland, PhD
Sacramento, CA, USA Keith D. Carter, MD, FACS Mayo Clinic Associate Professor
Lillian C. O’Brien and Dr. C.S. O’Brien Rochester, MN, USA Department of Ophthalmology
Scott E. Brodie, MD, PhD University of Ottawa
Professor of Ophthalmology Chair in Ophthalmology
Professor and Chair Xuejing Chen, MD, MS Ottawa, ON, Canada
NYU School of Medicine Clinical Fellow
New York, NY, USA Department of Ophthalmology & Claude L. Cowan, Jr., MD, MPH
Visual Sciences Retina
Ophthalmic Consultants of Boston Clinical Professor of Ophthalmology
Michael C. Brodsky, MD Carver College of Medicine Georgetown University Medical Center
Professor of Ophthalmology and University of Iowa New England Eye Center at Tufts
Medical Center Washington, DC, USA
Neurology Iowa City, IA, USA Staff Physician
Knights Templar Research Professor of Boston, MA, USA
Rafael C. Caruso, MD Surgical Service
Ophthalmology Paul T.K. Chew, MMed, FRCOphth Veterans Affairs Medical Center
Mayo Clinic Staff Clinician
National Eye Institute Director Glaucoma Division Washington, DC, USA
Rochester, MN, USA Ophthalmology/Glaucoma
National Institutes of Health E. Randy Craven, MD
Cassandra C. Brooks, MD Bethesda, MD, USA National University Hospital Singapore
Singapore Associate Professor, Glaucoma
Resident in Ophthalmology Johns Hopkins University
Duke Eye Center Harinderpal S. Chahal, MD
Oculofacial Plastic and Reconstructive Bing Chiu, MD Baltimore, MD, USA
Duke University School of Medicine Ophthalmology Resident
Durham, NC, USA Surgery Catherine A. Cukras, MD, PhD
Eye Medical Center New York University
New York, NY, USA Director, Medical Retina Fellowship
Matthew V. Brumm, MD Fresno, CA, USA Program
Ophthalmologist Clement C. Chow, MD National Eye Institute
Cataract and Refractive Surgery Wallace Chamon, MD
Adjunct Professor Partner Physician National Institutes of Health
Brumm Eye Center Retinal Diagnostic Center Bethesda, MD, USA
Omaha, NE, USA Department of Ophthalmology and
Visual Sciences Campbell, CA, USA
Linda R. Dagi, MD
Donald L. Budenz, MD, MPH University of Illinois at Chicago Mortimer M. Civan, MD Director of Adult Strabismus
Kittner Family Distinguished Professor Chicago, IL, USA Professor of Physiology and Professor Boston Children’s Hospital
and Chairman Adjunct Professor of Medicine Associate Professor of Ophthalmology
Department of Ophthalmology Department of Ophthalmology and Department of Physiology Director of Quality Assurance
University of North Carolina at Chapel Visual Sciences University of Pennsylvania Department of Ophthalmology
Hill Escola Paulista de Medicina (EPM) Perelman School of Medicine Children’s Hospital Ophthalmology
Chapel Hill, NC, USA Universidade Federal de São Paulo Philadelphia, PA, USA Foundation Chair
(UNIFESP) Harvard Medical School
São Paulo, SP, Brazil Boston, MA, USA
xv
 Elie Dahan, MD, MMed, (Ophth)† Gary R. Diamond, MD† Bryan Edgington, MD Ayad A. Farjo, MD
Formerly Senior Consultant Pediatric Formerly Professor of Ophthalmology Associate Professor, Cornea Division President & Director
List of Contributors
Ophthalmology and Glaucoma and Pediatrics Casey Eye Institute Brighton Vision Center
Department of Ophthalmology Drexel University School of Medicine Oregon Health Sciences University Brighton, MI, USA
Ein Tal Eye Hospital Philadelphia, PA, USA Staff Ophthalmologist
Tel Aviv, Israel Veterans Health Administration Eric Feinstein, MD
Daniel Diniz, MD Portland Health Care System Surgical Retina Fellow
Iben Bach Damgaard, MD Surgical Optics Fellow Portland, OR, USA Department of Ophthalmology
PhD Fellow Department of Ophthalmology & Rocky Mountain Lions Eye Institute
Department of Ophthalmology Visual Sciences Howard M. Eggers, MD University of Colorado
Aarhus University Hospital Federal University of São Paulo Professor of Clinical Ophthalmology School of Medicine
Aarhus, Denmark (UNIFESP) Harkness Eye Institute Denver, CO, USA
São Paulo, SP, Brazil New York, NY, USA
Karim F. Damji, MD, FRCSC, MBA Karen B. Fernandez, MD
Professor Diana V. Do, MD Dean Eliott, MD Consultant
Department of Ophthalmology & Professor of Ophthalmology Stelios Evangelos Gragoudas Associate Department of Ophthalmology
Visual Sciences Byers Eye Institute Professor of Ophthalmology The Medical City
University of Alberta Stanford University Harvard Medical School Pasig City, Metro Manila, Philippines
Edmonton, AL, Canada School of Medicine Associate Director, Retina Service
Palo Alto, CA, USA Massachusetts Eye & Ear Yale L. Fisher, MD
Dipankar Das, MD Boston, MA, USA Voluntary Clinical Professor
Senior Consultant & Ocular Pathologist Peter J. Dolman, MD, FRCSC Department of Ophthalmology
Uveitis, Ocular Pathology and Neuro- Clinical Professor George S. Ellis, Jr., MD, FAAP, FAAO, Bascom Palmer Eye Institute
ophthalmology Services Division Head of Oculoplastics and FACS Miami, FL, USA
Sri Sankaradeva Nethralaya Orbital Surgery Director Ophthalmology Voluntary Clinical Professor
Guwahati, Assam, India Fellowship Director Children’s Hospital New Orleans Department of Ophthalmology
Department of Ophthalmology & Associate Clinical Professor of Weill Cornell Medical Center
Adam DeBusk, DO, MS Visual Sciences Ophthalmology and Pediatrics New York, NY, USA
Instructor Division of Oculoplastics and Orbit Tulane University
Department of Ophthalmology University of British Columbia Associate Clinical Professor of Gerald A. Fishman, MD
Wills Eye Hospital Vancouver General Hospital Ophthalmology and Pediatrics Director
Sidney Kimmel Medical College Vancouver, BC, Canada Louisiana State Universities Schools of The Pangere Center for Inherited
Thomas Jefferson University Medicine Retinal Diseases
Philadelphia, PA, USA Sean P. Donahue, MD, PhD New Orleans, LA, USA The Chicago Lighthouse
Professor Professor Emeritus of Ophthalmology
Jose de la Cruz, MD, MSc Department of Ophthalmology & Michael Engelbert, MD, PhD Department of Ophthalmology &
Assistant Professor Visual Sciences Research Assistant Professor Visual Sciences
Ophthalmology, Cornea Refractive Vanderbilt University Department of Ophthalmology University of Illinois at Chicago
Surgery Service Nashville, TN, USA NYU/VRMNY College of Medicine
University of Illinois Eye and Ear New York, NY, USA Chicago, IL, USA
Infirmary Richard K. Dortzbach, MD
Chicago, IL, USA Professor Emeritus Miriam Englander, MD Jorge A. Fortun, MD
Department of Ophthalmology and Attending Surgeon Associate Professor of Ophthalmology
Joseph L. Demer, MD, PhD Visual Sciences Vitreo-Retinal Surgery Vitreoretinal Diseases and Surgery
Arthur L. Rosenbaum Chair in University of Wisconsin Ophthalmic Consultants of Boston Medical Director of Bascom Palmer
Pediatric Ophthalmology School of Medicine and Public Health Boston, MA, USA Eye Institute
Professor of Neurology Madison, WI, USA Palm Beach Gardens Bascom Palmer
Chief, Pediatric Ophthalmology and Bita Esmaeli, MD, FACS Eye Institute
Strabismus Division Kimberly A. Drenser, MD, PhD Professor of Ophthalmology University of Miami Miller School of
Director, Ocular Motility Laboratories Associated Retinal Consultants, PC Director, Ophthalmic Plastic & Medicine
Chair, EyeSTAR Residency/PhD and Department of Ophthalmology Reconstructive Surgery Fellowship Miami, FL, USA
Post-doctoral Fellowship Program in Oakland University Program, Department of Plastic
Ophthalmology and Visual Science William Beaumont Hospital School of Surgery Veronica Vargas Fragoso, MD
Member, Neuroscience Medicine Chair, Graduate Medical Education Refractive Surgery Fellow
Interdepartmental Program Royal Oak, MI, USA Committee Vissum Corporation
Member, Bioengineering University of Texas MD Anderson Alicante, Spain
Interdepartmental Program Jacob S. Duker, MD Cancer Center
University of California Los Angeles Resident Physician Houston, TX, USA Nicola Freeman, MBChB, FCOphth,
Los Angeles, CA, USA Department of Ophthalmology MMed
Bascom Palmer Eye Institute Joshua W. Evans, MD Senior Specialist
Shilpa J. Desai, MD University of Miami Assistant Professor of Ophthalmology Department of Pediatric
Assistant Professor Miami, FL, USA Division of Glaucoma Ophthalmology
Department of Ophthalmology University of Kentucky Red Cross Children’s Hospital
Tufts University Jay S. Duker, MD Lexington, KY, USA Cape Town, Western Province, South
School of Medicine Director Africa
Boston, MA, USA New England Eye Center Monica Evans, MD
Professor and Chairman Ophthalmology David S. Friedman, MD, MPH, PhD
Deepinder K. Dhaliwal, MD, L.Ac Department of Ophthalmology San Jose, Costa Rica Director, Dana Center for Preventive
Professor of Ophthalmology, University Tufts Medical Center Ophthalmology
of Pittsburgh School of Medicine Tufts University School of Medicine Daoud S. Fahd, MD Professor of Ophthalmology, Wilmer/
Director, Cornea and Refractive Boston, MA, USA Clinical Assistant Professor Glaucoma
Surgery Services Department of Ophthalmology Johns Hopkins University
Director and Founder, Center for Vikram D. Durairaj, MD, FACS Ophthalmic Consultants of Beirut Baltimore, MD, USA
Integrative Eye Care ASOPRS Fellowship Director and Jal el Dib, Metn, Lebanon
Co-Director, Cornea and Refractive Managing Partner Deborah I. Friedman, MD, MPH
Oculoplastic and Orbital Surgery Lisa J. Faia, MD Professor
Surgery Fellowship Partner, Associated Retinal Consultants
Associate Medical Director, Charles TOC Eye and Face Department of Neurology
Austin, TX, USA Associate Professor & Neurotherapeutics and
T. Campbell Ocular Microbiology Oakland University
Laboratory Ophthalmology
Jonathan J. Dutton, MD, PhD William Beaumont School of Medicine University of Texas
Medical Director, UPMC Laser Vision Professor Emeritus Ophthalmology - Retina
Center Southwestern Medical Center
Department of Ophthalmology Royal Oak, MI, USA Dallas, TX, USA
University of Pittsburgh Medical University of North Carolina
Center Chapel Hill, NC, USA Katherine A. Fallano, MD Neil J. Friedman, MD
Pittsburgh, PA, USA Department of Ophthalmology Adjunct Clinical Associate Professor
University of Pittsburgh School of Department of Ophthalmology
Medicine Stanford University School of Medicine
Pittsburgh, PA, USA
xvi †
Stanford, CA, USA
Deceased
Nicoletta Fynn-Thompson, MD Jeffrey L. Goldberg, MD, PhD Jason R. Guercio, MD, MBA Joshua H. Hou, MD
Partner Professor and Chairman Senior Resident in Anesthesiology Assistant Professor

List of Contributors
Cornea, Cataract and Refractive Surgery Department of Ophthalmology Department of Anesthesiology Department of Ophthalmology &
Ophthalmic Consultants of Boston Byers Eye Institute at Stanford Duke University Medical Center Visual Neurosciences
Boston, MA, USA University Durham, NC, USA University of Minnesota
Palo Alto, CA, USA Minneapolis, MN, USA
Neha Gadaria-Rathod, MD Julie Gueudry, MD
Assistant Clinical Instructor Debra A. Goldstein, MD, FRCSC Senior Consultant Odette M. Houghton, MD
Department of Ophthalmology Magerstadt Professor of Ophthalmology Senior Associate Consultant
SUNY Downstate Medical Center Ophthalmology Charles Nicolle University Hospital Ophthalmology
New York, NY, USA Director Uveitis Service Rouen, France Mayo Clinic
Northwestern University Scottsdale, AZ, USA
Debora E. Garcia-Zalisnak, MD Feinberg School of Medicine Ahmet Kaan Gündüz, MD
Cornea Fellow Chicago, IL, USA Professor of Ophthalmology Kourtney Houser, MD
Department of Ophthalmology Ankara University Assistant Professor
University of Illinois at Chicago Michael H. Goldstein, MD, MBA Faculty of Medicine Ophthalmology
Chicago, IL, USA Co-Director, Cornea and External Ankara, Turkey University of Tennessee
Diseases Service Health Science Center
Gregg S. Gayre, MD New England Eye Center Joelle A. Hallak, PhD Memphis, TN, USA
Chief of Eye Care Services Tufts Medical Center Assistant Professor, Executive Director
Department of Ophthalmology Boston, MA, USA Ophthalmic Clinical Trials & Frank W. Howes, MBChB, MMed, FCS,
Kaiser Permanente Translational Center FRCS, FRCOphth, FRANZCO
San Rafael, CA, USA John A. Gonzales, MD Department of Ophthalmology & Associate Professor
Assistant Professor Visual Sciences Bond University
Steven J. Gedde, MD Francis I. Proctor Foundation and University of Illinois at Chicago Company and Clinical Director
Professor of Ophthalmology, John Department of Ophthalmology Chicago, IL, USA Cataract Refractive & Glaucoma
G. Clarkson Chair, Vice Chair of University of California San Francisco Surgery
Education San Francisco, CA, USA Julia A. Haller, MD Eye & Laser Centre
Bascom Palmer Eye Institute Ophthalmologist-in-Chief, Wills Eye Gold Coast, QLD, Australia
University of Miami Miller David B. Granet, MD, FACS, FAAp Hospital
School of Medicine Anne F. Ratner Chair of Pediatric William Tasman, MD Endowed Chair Jason Hsu, MD
Miami, FL, USA Ophthalmology Professor and Chair of Ophthalmology Co-Director of Retina Research
Professor of Ophthalmology & Sidney Kimmel Medical College at Retina Service of Wills Eye Hospital
Igal Gery, PhD Pediatrics Thomas Jefferson University Associate Professor of Ophthalmology
Scientist Emerita Director of the Ratner Children’s Eye Philadelphia, PA, USA Thomas Jefferson University
Laboratory of Immunology Center at the Shiley Eye Institute Mid Atlantic Retina
National Eye Institute University of California San Diego Pedram Hamrah, MD, FACS Philadelphia, PA, USA
National Institutes of Health La Jolla, CA, USA Director of Clinical Research
Bethesda, MD, USA Director, Center for Translational Jeffrey J. Hurwitz, MD, FRCS(C)
Matthew J. Gray, MD Ocular Immunology Professsor, Ophthalmology
Ramon C. Ghanem, MD, PhD Assistant Professor Cornea and Associate Professor, Ophthalmology University of Toronto
Director External Disease Tufts Medical Center Oculoplastic Specialist
Cornea and Refractive Surgery Department of Ophthalmology Tufts University Mount Sinai Hospital
Department University of Florida School of Medicine Toronto, ON, Canada
Sadalla Amin Ghanem Eye Hospital Gainesville, FL, USA Boston, MA, USA
Joinville, SC, Brazil Francisco Irochima, PhD
Kyle M. Green, BA David R. Hardten, MD Professor, Biotechnology
Vinícius C. Ghanem, MD, PhD Medical Student Researcher Director of Refractive Surgery Universidade Potiguar
Ophthalmologist, Medical Director Ophthalmology Department of Ophthalmology Natal, Rio Grande do Norte, Brazil
Department of Ophthalmology University of Southern California Minnesota Eye Consultants
Sadalla Amin Ghanem Eye Hospital Roski Eye Institute Minnetonka, MN, USA Jihad Isteitiya, MD
Joinville, SC, Brazil Los Angeles, CA, USA Cornea Fellow, Ophthalmology
Alon Harris, MS, PhD, FARVO Icahn School of Medicine at Mount
Saurabh Ghosh, MBBS, DipOphth, Craig M. Greven, MD Professor of Ophthalmology Sinai
MRCOphth, FRCOphth Richard G. Weaver Professor and Letzter Endowed Chair in New York, NY, USA
Consultant Ophthalmologist Chairman Ophthalmology
Cornea, Cataract, External Eye Disease Department of Ophthalmology Director of Clinical Research Andrea M. Izak, MD
Sunderland Eye Infirmary Wake Forest University Eugene and Marilyn Glick Eye Institute Post-Doctoral Fellow
Sunderland, Tyne & Wear, UK School of Medicine Indiana University Storm Eye Institute
Winston-Salem, NC, USA School of Medicine Medical University of South Carolina
Allister Gibbons, MD Charleston, SC, USA
Assistant Professor Indianapolis, IN, USA
Margaret A. Greven, MD
Bascom Palmer Eye Institute Assistant Professor Jeffrey S. Heier, MD Deborah S. Jacobs, MD
University of Miami Ophthalmology Co-President and Medical Director Associate Professor of Ophthalmology
Miami, FL, USA Wake Forest University Director, Vitreoretinal Service Harvard Medical School
School of Medicine Ophthalmic Consultants of Boston Medical Director
James W. Gigantelli, MD, FACS BostonSight
Professor Winston-Salem, NC, USA Boston, MA, USA
Needham, MA, USA
Department Ophthalmology & Visual Josh C. Gross, MD Leon W. Herndon, Jr., MD
Sciences Clinical Research Fellow Professor, Ophthalmology Sandeep Jain, MD
University of Nebraska Medical Center Ophthalmology Duke University Eye Center Associate Professor, Ophthalmology
Omaha, NE, USA Eugene and Marilyn Glick Eye Institute Durham, NC, USA University of Illinois at Chicago
Indiana School of Medicine Chicago, IL, USA
Pushpanjali Giri, BA Allen C. Ho, MD
Research Specialist Indianapolis, IN, USA Henry D. Jampel, MD, MHS
Wills Eye Hospital Director of Retina
Department of Ophthalmology Ronald L. Gross, MD Research Odd Fellows Professor of
University of Illinois at Chicago Professor and Jane McDermott Schott Retina Service Ophthalmology
College of Medicine Chair Wills Eye Hospital Wilmer Eye Institute
Chicago, IL, USA Chairman, Department of Philadelphia, PA, USA Johns Hopkins University
Ophthalmology School of Medicine
Ivan Goldberg, AM, MB, BS, FRANZCO, Christopher T. Hood, MD Baltimore, MD, USA
FRACS West Virginia University
Morgantown, WV, USA Clinical Assistant Professor
Clinical Professor Michigan Medicine Ophthalmology Lee M. Jampol, MD
University of Sydney Sandeep Grover, MD Cornea and Refractive Surgery Clinic Louis Feinberg Professor of
Head of Discipline of Ophthalmology Associate Professor & Associate Chair W.K. Kellogg Eye Center Ophthalmology
and Glaucoma Unit of Ophthalmology Ann Arbor, MI, USA Feinberg School of Medicine
Sydney Eye Hospital University of Florida Northwestern University
Director Jacksonville, FL, USA Chicago, IL, USA
Eye Associates xvii
Sydney, NSW, Australia
 Aliza Jap, FRCS(G), FRCOphth, FRCS Kevin Kaplowitz, MD Jeremy D. Keenan, MD, MPH Victor T.C. Koh, MBBS, MMed(Oph),
(Ed) Assistant Professor Associate Professor of Ophthalmology FAMS
List of Contributors
Senior Consultant Ophthalmologist Ophthalmology, VA Loma Linda Francis I. Proctor Foundation and Associate Consultant, Ophthalmology
Division of Ophthalmology Loma Linda University Department of Ophthalmology National University Hospital
Changi General Hospital, Singapore Loma Linda, CA, USA University of California San Francisco Singapore
Singapore National Eye Centre San Francisco, CA, USA
Singapore Michael A. Kapusta, MD, FRCSC Thomas Kohnen, MD, PhD, FEBO
Associate Professor Kenneth R. Kenyon, MD Professor and Director
Chris A. Johnson, PhD, DSc Director of Retina and Vitreous Surgery Clinical Professor, Ophthalmology Department of Ophthalmology
Professor Department of Ophthalmology Tufts University University Clinic Frankfurt
Department of Ophthalmology & Jewish General Hospital School of Medicine Goethe University
Visual Sciences McGill University Harvard Medical School Frankfurt am Main
University of Iowa Hospitals and Montreal, QC, Canada Schepens Eye Research Institute Germany
Clinics Boston, MA, USA
Iowa City, IA, USA Rustum Karanjia, MD, PhD, FRCSC Andrew Koustenis, BS
Assistant Professor, Ophthalmology Sir Peng Tee Khaw, PhD, FRCS, FRCP, Medical Student
Mark W. Johnson, MD University of Ottawa FRCOphth, FRCPath, FRSB, FCOptom Clinical Ophthalmology Research
Professor, Chief of Retina Section Ottawa Hospital Research Institute (Hon), DSc, FARVO, FMedSci Internship
Department of Ophthalmology & The Ottawa Hospital Professor of Glaucoma and Ocular Department of Ophthalmology
Visual Sciences Ottawa, ON, Canada Healing Eugene and Marilyn Glick Eye Institute
University of Michigan Doheny Eye Institute Consultant Ophthalmic Surgeon Indiana University
Ann Arbor, MI, USA Doheny Eye Centers Director, National Institute for Health School of Medicine
UCLA, David Geffen School of Research, Biomedical Research Indianapolis, IN, USA
T. Mark Johnson, MD, FRCS(C) Medicine Centre for Ophthalmology
Attending Surgeon, Vitreo-Retinal Los Angeles, CA, USA Moorfields Eye Hospital Stephen S. Lane, MD
Surgery UCL Institute of Ophthalmology Medical Director
Retina Group of Washington Randy H. Kardon, MD, PhD London, UK Adjunct Clinical Professor
Rockville, MD, USA Professor and Director of Neuro- Chief Medical Officer and Head Global
ophthalmology and Pomerantz Gene Kim, MD Franchise Clinical Strategy
Mark M. Kaehr, MD Family Chair in Ophthalmology Assistant Professor and Residency Associated Eye Care
Partner Ophthalmology/Neuro-ophthalmology Program Director University of Minnesota, Alcon
Associated Vitreoretinal and Uveitis Director of the Iowa City VA Center Department of Ophthalmology & Minneapolis, MN, USA
Consultants for the Prevention and Treatment of Visual Science at McGovern Medical
Assistant Clinical Professor of Visual Loss School at UTHealth Patrick J.M. Lavin, MB, MRCPI
Ophthalmology University of Iowa and Iowa City VA Houston, TX, USA Prof. Neurology and Ophthalmology
Indiana University Medical Center Neurology, Ophthalmology and Visual
Associated Vitreoretinal and Uveitis Iowa City, IA, USA Ivana K. Kim, MD Science
Consultants Associate Professor of Ophthalmology Vanderbilt University Medical Center
Indiana University Carol L. Karp, MD Retina Service, Massachusetts Eye and Nashville, TN, USA
School Of Medicine Professor of Ophthalmology Ear
Indianapolis, IN, USA Richard K. Forster Chair in Harvard Medical School Fabio Lavinsky, MD, PhD, MBA
Ophthalmology Boston, MA, USA Research Fellow
Malik Y. Kahook, MD Bascom Palmer Eye Institute NYU Langone Eye Center
The Slater Family Endowed Chair in University of Miami Alan E. Kimura, MD, MPH NYU School of Medicine
Ophthalmology Miller School of Medicine Clinical Associate Professor New York, NY, USA
Vice Chair of Clinical & Translational Miami, FL, USA Department of Ophthalmology Director, Ophthalmic Imaging
Research University of Colorado Department
Professor of Ophthalmology & Chief of Amir H. Kashani, MD, PhD Health Sciences Center Lavinsky Eye Institute
Glaucoma Service Assistant Professor of Clinical Aurora, CO, USA Porto Alegre, Brazil
Director of Glaucoma Fellowship Ophthalmology
University of Colorado University of Southern California Michael Kinori, MD Andrew W. Lawton, MD
School of Medicine Roski Eye Institute Senior Physician Director, Neuro-Ophthalmology
Aurora, CO, USA Los Angeles, CA, USA The Goldschleger Eye Institute Division
Sheba Medical Center, Tel Hashomer Ochsner Health Services
Peter K. Kaiser, MD Michael A. Kass, MD Ramat Gan, Israel New Orleans, LA, USA
Chaney Family Endowed Chair in Bernard Becker Professor,
Ophthalmology Research Ophthalmology and Visual Science Caitriona Kirwan, FRCSI(Ophth) Bryan S. Lee, MD, JD
Professor of Ophthalmology Washington University Consultant Ophthalmic Surgeon Private Practitioner
Cleveland Clinic School of Medicine Mater Private Hospital Altos Eye Physicians
Cole Eye Institute St Louis, MO, USA Dublin, Ireland Los Altos, CA, USA
Cleveland, OH, USA Adjunct Clinical Assistant Professor of
Paula Kataguiri, MD Szilárd Kiss, MD Ophthalmology
Sachin P. Kalarn, MD Research Fellow Chief, Retina Service Director Stanford University
Resident Physician Department of Ophthalmology and Clinical Research Director Stanford, CA, USA
Department of Ophthalmology & Center for Translational Ocular Tele-Ophthalmology Director
Visual Sciences Immunology Compliance Associate Professor of Daniel Lee, MD
University of Maryland Tufts Medical Center Ophthalmology Clinical Instructor, Glaucoma Service
Baltimore, MD, USA New England Eye Center Weill Cornell Medical College Wills Eye Hospital
Boston, MA, USA New York, NY, USA Philadelphia, PA, USA
Ananda Kalevar, MD, FRCSC, DABO PhD Candidate
Associate Professor, Department of John W. Kitchens, MD Gregory D. Lee, MD
Department of Ophthalmology Retina Surgeon, Partner Assistant Professor, Ophthalmology/
Ophthalmology Universidade Federal de São Paulo
University of Sherbrooke Co-Fellowship Director Retina
(UNIFESP) Retina Associates of Kentucky New York University
Sherbrooke, QC, Canada São Paulo, SP, Brazil Lexington, KY, USA New York, NY, USA
Steven Kane, MD L. Jay Katz, MD
Cornea, Cataract, and Refractive Kendra Klein, MD Olivia L. Lee, MD
Director, Glaucoma Service Faculty Physician Assistant Professor of Ophthalmology
Surgery Specialist Wills Eye Hospital
Eye Institute of West Florida Department of Ophthalmology David Geffen School of Medicine
Philadelphia, PA, USA University of Arizona University of California Los Angeles
Largo, FL, USA
Paul L. Kaufman, MD Associated Retina Consultants Los Angeles, CA, USA
Elliott M. Kanner, MD, PhD Ernst H. Bárány Professor of Ocular Phoenix, AZ, USA Associate Medical Director
Chief, Glaucoma Service Pharmacology Doheny Image Reading Center
Hamilton Eye Institute Douglas D. Koch, MD Doheny Eye Institute
Department Chair Emeritus Professor and Allen, Mosbacher, and
University of Tennessee Department of Ophthalmology & Los Angeles, CA, USA
Health Science Center Law Chair in Ophthalmology
Visual Sciences Cullen Eye Institute
Memphis, TN, USA University of Wisconsin-Madison Baylor College of Medicine
xviii School of Medicine & Public Health Houston, TX, USA
Madison, WI, USA
Paul P. Lee, MD, JD Pedro F. Lopez, MD Jodhbir S. Mehta, BSc, MD, MBBS, Majid Moshirfar, MD, FACS
F. Bruce Fralick Professor and Chair Professor and Founding Chair FRCS(Ed), FRCOphth, FAMS Professor of Ophthalmology

List of Contributors
Director W.K. Kellogg Eye Center Department of Ophthalmology Associate Professor, Cornea and Hoopes Vision and John A. Moran Eye
Department of Ophthalmology & Herbert Wertheim College of Medicine External Disease Center
Visual Sciences Florida International University Singapore National Eye Centre Draper, UT, USA
University of Michigan Director of Vitreoretina and Macular Singapore
Heather E. Moss, MD, PhD
Ann Arbor, MI, USA Division
Luis J. Mejico, MD Assistant Professor
Center for Excellence in Eye Care
Richard M.H. Lee, MSc, FRCOphth Professor and Chair of Neurology Departments of Ophthalmology and
Miami, FL, USA
Clinical Fellow Professor of Ophthalmology Neurology & Neurological Sciences
Department of Glaucoma Mats Lundström, MD, PhD SUNY Upstate Medical University Stanford University
Moorfields Eye Hospital Adjunct Professor Emeritus Syracuse, NY, USA Palo Alto, CA, USA
London, UK Department of Clinical Sciences,
Carolina L. Mercado, MD Mark L. Moster, MD
Ophthalmology
Dawn K.A. Lim, MBBS, MRCP, Clinical Research Fellow, Director, Neuro-Ophthalmology
Faculty of Medicine
MMed(Int, Med), MMed(Ophth), FAMS Ophthalmology Fellowship
Lund University
Consultant, Ophthalmology/Glaucoma Bascom Palmer Eye Institute Professor, Neurology and
Lund, Region Skåne, Sweden
National University Hospital Miami, FL, USA Ophthalmology
Singapore Robi N. Maamari, MD Wills Eye Hospital
Ophthalmology Resident Shahzad I. Mian, MD Sidney Kimmel Medical College of
Jennifer I. Lim, MD, FARVO Department of Ophthalmology & Associate Chair, Terry J. Bergstrom Thomas Jefferson University
Marion H. Schenk Esq. Chair in Visual Sciences Professor Philadelphia, PA, USA
Ophthalmology for Research of the Washington University School of Associate Professor, Ophthalmology &
Aging Eye Visual Sciences Kelly W. Muir, MD, MHSc
Medicine in St Louis
Professor of Ophthalmology University of Michigan Associate Professor of Ophthalmology,
St Louis, MO, USA
Director of the Retina Service Ann Arbor, MI, USA Glaucoma Division
University of Illinois at Chicago Assumpta Madu, MD, MBA, PharmD Duke University
Illinois Eye and Ear Infirmary Vice Chair, Operations William F. Mieler, MD, FACS School of Medicine
Chicago, IL, USA Associate Clinical Professor of Cless Family Professor of Durham, NC, USA
Ophthalmology Ophthalmology
Ridia Lim, MBBS, MPH, FRANZCO Vice-Chairman of Education Ann G. Neff, MD
NYU School of Medicine
Ophthalmic Surgeon Illinois Eye and Ear Infirmary Dermatology Associates
NYU Langone Medical Center
Glaucoma Service University of Illinois at Chicago Sarasota, FL, USA
New York, NY, USA
Sydney Eye Hospital College of Medicine Jeffrey A. Nerad, MD
Sydney, NSW, Australia Maya H. Maloney, MD Chicago, IL, USA Oculoplastic & Reconstructive Surgery
Consultant, Medical Retina
Tony K.Y. Lin, MD, FRCSC David Miller, MD Cincinnati Eye Institute
Mayo Clinic
Assistant Professor Associate Clinical Professor of Volunteer Professor, Ophthalmology
Rochester, MN, USA
Department of Ophthalmology Ophthalmology University of Cincinnati
Schulich School of Medicine and Naresh Mandava, MD Harvard Medical School Cincinnati, OH, USA
Dentistry Professor and Chair Boston, MA, USA Neda Nikpoor, MD
Western University Department of Ophthalmology
Clinical Instructor, Ophthalmology
London, ON, Canada University of Colorado Kyle E. Miller, MD
Byers Eye Institute
School of Medicine Assistant Professor, Ophthalmology
Stanford University
John T. Lind, MD, MS Denver, CO, USA Naval Medical Center Portsmouth
Palo Alto, CA, USA
Associate Professor Portsmouth, VA, USA
Michael F. Marmor, MD
Department of Ophthalmology & Robert J. Noecker, MD, MBA
Professor Tatsuya Mimura, MD, PhD
Visual Sciences Director of Glaucoma
Department of Ophthamology Tokyo Womens Medical University
Washington University in St Louis Ophthalmic Consultants of
Byers Eye Institute Medical Center East
St Louis, MO, USA Connecticut
Stanford University Tokyo, Japan
Fairfield, CT, USA
Yao Liu, MD School of Medicine
Assistant Professor Palo Alto, CA, USA Rukhsana G. Mirza, MD Ricardo Nosé, MD
Department of Ophthalmology & Associate Professor Clinical Research Fellow
Jeevan R. Mathura, Jr., MD Department of Ophthalmology
Visual Sciences New England Eye Center
Private Practitioner and Owner Northwestern University
University of Wisconsin-Madison Tufts Medical Center
Diabetic Eye and Macular Disease Feinberg School of Medicine
Madison, WI, USA Boston, MA, USA
Specialists, LLC Chicago, IL, USA
Sidath E. Liyanage, MBBS, FRCOphth, Washington, DC, USA Annabelle A. Okada, MD, DMSc
PhD Mihai Mititelu, MD, MPH Professor of Ophthalmology
Cynthia Mattox, MD Assistant Professor
Consultant Ophthalmologist Kyorin University
Associate Professor, Ophthalmology Department of Ophthalmology &
Bristol Eye Hospital School of Medicine
Tufts University Visual Sciences
Bristol, UK Tokyo, Japan
School of Medicine University of Wisconsin-Madison
Alastair J. Lockwood, BM, BCh, Boston, MA, USA School of Medicine and Public Health Michael O’Keefe, FRCS
FRCOphth, PhD Madison, WI, USA Professor, Ophthalmology
Scott K. McClatchey, MD
Consultant, Ophthalmology Mater Private Hospital
Associate Professor, Ophthalmology Ramana S. Moorthy, MD
Queen Alexandra Hospital Dublin, Ireland
Naval Medical Center Clinical Associate Professor,
Portsmouth, Hampshire, UK San Diego, CA, USA Jeffrey L. Olson, MD
Ophthalmology
Nils A. Loewen, MD, PhD Indiana University Associate Professor
Stephen D. McLeod, MD
Associate Professor of Ophthalmology School of Medicine Department of Ophthalmology
Theresa M. and Wayne M. Caygill
Vice Chair of Electronic Health Founding Partner and CEO University of Colorado
Distinguished Professor and Chair,
Records in Ophthalmology Associated Vitreoretinal and Uveitis School of Medicine
Ophthalmology
University of Pittsburgh Consultants Denver, CO, USA
University of California San Francisco
Pittsburgh, PA, USA San Francisco, CA, USA Indianapolis, IN, USA Jane M. Olver, MB, BS, BSc, FRCS,
Reid A. Longmuir, MD Andrew A. Moshfeghi, MD, MBA FRCOphth
Brian D. McMillan, MD
Assistant Professor Director, Vitreoretinal Fellowship Consultant Ophthalmologist
Assistant Professor of Ophthalmology
Department of Ophthalmology & Associate Professor of Clinical Eye Department
WVU Eye Institute
Visual Sciences Ophthalmology Clinica London
West Virginia University
Vanderbilt University University of Southern California London, UK
School of Medicine
Nashville, TN, USA Morgantown, WV, USA Roski Eye Institute Yvonne A.V. Opalinski, BSc, MD, BFA,
Keck School of Medicine MFA
Alan A. McNab, DMedSc, FRANZCO, Los Angeles, CA, USA Clinical Associate Cardiovascular
FRCOphth
Surgery
Associate Professor and Director
Department of Cardiovascular Surgery
Orbital Plastic and Lacrimal Clinic
Royal Victorian Eye and Ear Hospital Trillium Health Partners xix
Toronto, ON, Canada
Melbourne, VIC, Australia
 Faruk H. Örge, MD Alfio P. Piva, MD P. Kumar Rao, MD Damien C. Rodger, MD, PhD
William R. and Margaret E. Althans Professor of Neurosurgery and Professor of Ophthalmology and Visual Assistant Professor of Clinical
List of Contributors
Chair and Professor Ophthalmology Science Ophthalmology
Director, Center for Pediatric University of Costa Rica Washington University Research Assistant Professor of
Ophthalmology and Adult San Jose, Costa Rica St Louis, MO, USA Biomedical Engineering
Strabismus USC Roski Eye Institute and Viterbi
Rainbow Babies, Children’s Hospital, Dominik W. Podbielski, HonBSc, MSc, Rajesh C. Rao, MD School of Engineering
UH Eye Institute MD, FRCSC Leslie H. and Abigail S. Wexner University of Southern California
Cleveland Medical Center Staff Physician, Ophthalmology Emerging Scholar Los Angeles, CA, USA
Cleveland, OH, USA Prism Eye Institute Assistant Professor, Retina Service
North Toronto Eye Care Department of Ophthalmology & Miin Roh, MD, PhD
Mark Packer, MD, FACS, CPI Toronto, ON, Canada Visual Sciences Vitreoretina Surgery Clinical Fellow
President W.K. Kellogg Eye Center Department of Ophthalmology/Retina
Mark Packer MD Consulting, Inc. Nicolas J. Pondelis, BA University of Michigan Service
Boulder, CO, USA Ophthalmic Photographer and VA Ann Arbor Health System Massachusetts Eye and Ear
Research Assistant Ann Arbor, MI, USA Boston, MA, USA
Suresh K. Pandey, MD Tufts Medical Center
Director, Ophthalmology Boston, MA, USA Sivakumar Rathinam, FAMS, PhD Shiyoung Roh, MD
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The dark eyes met his with a look of triumph he could not
understand.
“What can I do to help you to your vengeance?” he asked, but she
shook her head and made no reply.
 CHAPTER XI.
Days came and went, and Cecil Laurens was a daily visitor at
Ferndale, filled with the laudable desire to please his old friend, Mrs.
Barry, by making time pass pleasantly for her niece. At least, that
was the reason he assigned to himself when he set out every
morning for a canter with Molly over the rough mountain roads, in
the golden June weather.
If any one had told him that he was taking an unusual interest in the
madcap girl whose acquaintance he had made in such a ludicrous
manner, he would have been indignant at the imputation. He would
have told you, as his family and friends said of him, that he was not
susceptible, not a marrying man. In his thirty years of life he had
met many beautiful and charming women, had

“Knelt at many a shrine,

Yet laid the heart on none.”

So little had he cared for women that he had not, as many men have
done, created an ideal woman in his mind; but if he had done so,
she would not have resembled Molly Trueheart in the least; she
would have been full of gracious ease and dignity:

“A perfect creature, nobly planned,

To warn, to comfort, and command,
And yet a spirit still and bright,
With something of an angel’s light.”

Molly Trueheart did not come up to this ideal at all. She was a merry,
willful little maid, reminding one of April weather with her
alternations from frowns to smiles, and from laughter to tears. Cecil
Laurens never suspected her of a bit of sentiment until one day
when he came upon her unexpectedly, and found her reading Mrs.
Browning with the page open at “Lady Geraldine’s Courtship.”
“You read poetry, then? I am surprised,” he said.
Molly left her finger between the pages and looked up at him
without a trace of surprise at his sudden coming. Perhaps she had
seen or heard him.
“You are surprised—why? Did you think I could not read?” she
inquired flippantly.
“Certainly not—but poetry! I thought you had no romance about you
—only fun,” he rejoined.
“You were mistaken. I am romantic. If I had not been I should never
have come to Ferndale.”
“I fail to see the romance of your coming here, Miss Barry.”
“It is not necessary that you should see it,” with a twinkle of mirth in
her eyes.
“No,” he returned, piqued at the brusquerie of the retort. In a
minute he added: “Since you confess to being romantic, perhaps you
will read ‘Lady Geraldine’s Courtship’ aloud for me. It is just the
scene for reading poetry—this grassy seat, these nodding ferns,
overarching trees, sunshine, and all the rest of it.”
“Yes, I will read it for you. That will be better than hearing you sneer
at me,” said Molly.
She let her stony, dark eyes meet his violet ones for a moment
coolly, then dropped her gaze to the book. In a minute she began to
read with a clear, pure enunciation and a faultless accuracy that
amazed him. Throwing himself down on the velvety greensward by
her side, he listened like one fascinated to the poet’s flowing
numbers rendered with faultless accuracy by Molly’s fresh, young
voice.
Who does not know the story of “Lady Geraldine’s Courtship”?—the
story of the poor poet’s love for a lovely, noble lady who trampled
under her dainty feet the prejudices of pride and rank and wedded
the young genius, her lover? Molly’s eloquent voice gave full value to
the story, rose in passion, sank in pathos, thrilled and trembled
alternately, while her eyes sparkled or melted to tears in sympathy.
Cecil Laurens, the handsome, gifted man of the world, indolent, self-
conceited, proud, gazed and listened in unfeigned astonishment.
“The little witch has been teasing me all this while. She is not the
little ignoramus and madcap I believed her at first. She has been
well-educated, her voice is thoroughly trained. No wonder she
laughed when I wanted her to go to school again,” he said to
himself, but instead of being angry with her, he experienced pleasure
in finding out that she had culture he had not dreamed she
possessed.
The long poem came to an end at last and Molly folded her small
hands together over the page. Her listener started up to a sitting
posture.
“Thank you, for the pleasure you have given me,” he said, earnestly.
“It is indeed a grand poem.”
“I scarcely expected you to say so,” she retorted, meaningly. “I
thought you were too proud. How can you reconcile yourself to the
idea of the Lady Geraldine marrying so far beneath her in station—
you who are always taking for a text my poor father’s mésalliance?”
“This case was different—the poet’s genius leveled the barrier
between him and the earl’s daughter—raised him to her rank,” he
replied.
“My—step-mother—had genius. She was a star of the dramatic
stage. She gave up a brilliant career to marry the man she loved, yet
you condemn her as unworthy,” Molly said, excitedly, with flashing
eyes.
He frowned.
“Why will you always drag that into the conversation? You have
owned of your own accord that that woman’s daughter was sly and
disagreeable—a real tiger-cat!” he exclaimed.
“Ah, I see that poetic license is not to be carried into real life,” she
replied, falling from seriousness into levity. Then, gayly: “And are
you sure, quite sure, that you should not fall in love with golden hair
and golden eyes, and l’air noble?”
“Quite sure,” he replied, with disdain.
She laughed, and there was something hidden in the laugh that
vexed him; but she said, politely enough, the next moment:
“Now you will read to me, will you not?”
“Pardon me; I would rather talk to you. When are you going to the
White?”
But he had taken the book from her hands, and was turning the
leaves while he spoke. Molly answered, reluctantly:
“I—don’t know. Aunt Thalia said something about—about waiting
until you got ready.”
“How kind! I shall be delighted. I can go in about three days, I
should say. But you don’t look very glad at the thought of my
company.”
“I would as soon excuse you,” she replied, with her usual frankness.
He frowned, but would not answer, and in a minute began to read
aloud, as it seemed, at random:

“‘She was not as pretty as women I know,

And yet all your best made of sunshine and snow
Drop to shade, melt to naught in the long-trodden ways,
While she’s still remembered on warm and cold days,
My Kate.’

“There,” he said, looking down at her with a half smile, “those words
seem to have been written of you, you provoking child! Do you know
that when I’m away from you my thoughts always return to you, and
that the hard things you say to me hurt me worse than when first
uttered? I resolve firmly not to go near you again, but ‘a spirit in my
feet’ brings me back to Ferndale the next day. What have you done
to me, Miss Willy Whisk, as old Betsy calls you, to make me your
abject slave? I certainly,” laughing, “do not approve of you, so I can
not have lost my heart to you.”
“Heaven forbid!” Molly Trueheart exclaimed, starting to her feet in
such dismay that he said, hastily:
“Pray do not be alarmed. You could not suppose I really meant it!”
“Of course not. It would be the worst possible taste,” she returned
sarcastically, and Cecil Laurens, angered out of his usual good
breeding, cried out, sharply:
“I agree with you, Miss Barry!”
That was enough. Molly’s eyes blazed upon him in such wrath that
they almost withered him. She snatched her book rudely from his
hand, and stalked away with the pace of a tragedy queen.
Left alone thus suddenly under the big tree, Mr. Laurens watched
Molly’s white garments flutter into the big porch, then he muttered
something under his breath not very complimentary to his tormentor,
remounted his horse, which was waiting under a tree, and rode
home.
The next day he stayed away from Ferndale, and the next day he
sent his old friend a short note saying that he had been so busy he
had no time to call, and found that unexpected business would take
him into Lewisburg for several days. He hoped she would not wait
for him any longer, as it might not be possible for him to go to the
White at all.
With a very sober face Mrs. Barry read this aloud to her niece,
watching the guilty young face with covert eyes.
“Louise Barry, you have done something to Cecil,” she said, with
conviction.
But Molly protested loudly that she hadn’t said a word to Mr.
Laurens. Then she went off to one of her wildest haunts by a
secluded little mountain stream and flung herself down on the green
bank to rest and think.
She caught a glimpse of her pale face and heavy eyes in the clear
stream, and started in surprise.
“Molly Trueheart, is that you looking so pale and big-eyed? What is
the matter with you, silly? It is the best thing that ever happened.
You ought to thank your lucky stars that you got rid of him so soon,
the hateful wretch!”
And then very inconsistently she burst into a storm of angry tears.
 CHAPTER XII.
Mrs. Barry and her niece had been at the White two weeks, when
Cecil Laurens made his appearance quite unexpectedly one evening,
and explained to Mrs. Barry that as he was going away soon he had
come over to bid her good-bye.
To Molly he was very stiff and formal indeed, although he could
almost have sworn that a sudden light of joy leaped into her eyes at
his abrupt approach—a light instantly veiled beneath the fringe of
her dark lashes, and her voice was distinctly careless as she gave
him a brief greeting and went away from her aunt’s side with her
partner in the dance.
For Molly had become in the weeks of her sojourn here one of the
belles of the place, and was enjoying her prestige with all the ardor
of youth and a light heart. No one was more sought in the dance
than she, no one had more bouquets and invitations, and she would
not have owned to herself that pique lay at the bottom of her
gayety.
Her girlish pride had been cruelly wounded by Cecil Laurens’
sarcastic words, and a strange longing came over her to know if
they were really true.
“Would it indeed be such poor taste for any one to love me?” she
asked herself, soberly; and the gravity of the thought turned the
child into a woman.
She threw aside the carelessness that had distinguished her, and put
on what she called grown-up ways. As she had a good education,
and a high order of intellect, she succeeded in making the change
very striking and charming, and in less than two weeks disproved
the truth of the ungallant Cecil’s assertion.
On his part, he was astonished when, after two weeks of sulky exile,
he saw her again, the cynosure of all eyes at this famous resort of
fashion, bright, beautiful, and admired, as he had not believed it
possible for any one to admire the will-o’-the-wisp creature, as she
had always seemed to him, even while she drew him to her side by
a charm which he would not understand.
“But she is beautiful, certainly, and very brilliant here—most unlike
the forlorn creature that Hero threw over his head that night at my
feet,” he said to himself with a smile, followed by a frown—the smile
for the ludicrousness of the adventure, and the frown for the secret
that lay behind that night’s “lark,” as she called it—the escapade so
carefully hidden from her aunt.
“I had no right to keep it hidden from my old friend. I wish I had not
promised to do so,” he thought, vexed at the sight of Molly gliding
like a fairy down the long ball-room in the arms of as handsome a
partner as ever made maiden’s heart throb faster in the gay waltz.
Mrs. Barry saw his eyes following the light form, and said with a
touch of pride:
“Louise is a graceful waltzer?”
“Yes,” he answered, then a little testily: “But I do not approve of
indiscriminate waltzing for young ladies.”
“No?” said Mrs. Barry, turning her inquisitive glasses on his rather
moody face.
After a minute’s study of its grave lines, she added:
“I can not say that I think it matters except in the case of engaged
girls. Of course a betrothed lover would have a right to object, but
then you know Louise is free.”
Did he fancy it, or was there really a pointed significance in her
tone? He rejoined half-resentfully:
“Are you sure she is free, and that she did not leave a lover behind
her in Staunton?”
She started, and looked at him keenly, then she laughed:
“Cecil, you actually frightened me for a moment; but now you make
me laugh,” she said, gayly, with a laugh that would have been merry,
only that it was so cracked with age. “My dear boy, there is no lover
in Staunton in the case. The child never thought of a lover until she
saw you. But she has offended you. I believed it all the while, now I
am sure of it. You are jealous.”
“You are mistaken,” Cecil cried, furiously.
Then he shut his lips tightly. He did not like to contradict his old
friend, but it was ridiculous, this fancy she entertained. Jealous! He
would have to be in love first, and the idea of loving Louise Barry
was—absurd.
“Yes, it is absurd! A spoiled baby in spite of her twenty-five years,
with the audacious frankness of youth so freely indulged that it
degenerates into lack of manners. Mrs. Barry must be losing her
mind, indeed!” he exclaimed to himself, deciding that he would
certainly go in the morning.
But he did not do so. Something held him back, something kept him
always in the vicinity of the girl he fancied he disliked more than
ever now, for she seemed bent on keeping up their feud. She was so
cool, so reserved, so dignified, taking as she said to herself grimly “a
leaf out of his own book.” So apparently indifferent was she that
many times when he lingered near her she remained in ignorance of
his proximity, so that day when she thought herself alone for a
minute with a charming novel, Cecil was quite close to her swinging
in a luxurious hammock hung between two trees, his lazy, sleepy
glance resting on the lovely, spirited face as it bent over the book.
“Poor Madelon!” she sighed, referring to the heroine, and then there
came a sudden interruption.
A man had come straight across the greensward toward her—a
young man with a grave, sad face, handsome but rather weak, while
his attire, partaking wholly of the shabby genteel, proclaimed that he
was certainly not a favorite of fortune.
Cecil Laurens saw this man going toward Molly with a bright, eager
light in his eyes, and he was filled with indignant wonder.
“Does Miss Barry know that shabby man? Surely not,” he thought,
and leaned forward to watch with jealous eyes.
Molly was so intent on her reading that she heard and saw nothing
until a shadow fell on her book as the man stopped by her side. She
glanced up, and the face that Cecil was watching grew radiant with
surprise and pleasure.
“Johnny!” she exclaimed, and held out her little hand.
He took it, clasped it tightly a moment, and Cecil heard him murmur,
hoarsely:
“How good you are! You never fail one! But I had no right to expect
a welcome. It is the old story—no work yet, and no money to make
a home for my darling! But I heard you all were here, and I could
not keep from coming for just one sight of my cruel darling’s face,
although I feared her reproaches. Where is—”
“Hush-h-h!” Molly whispered, pinching his arm severely; “some one
may hear us from the cottage yonder. Come this way, Johnny,
toward the trees.”
They moved away, and Cecil Laurens’ face grew dark and gloomy.
“The impecunious lover has come upon the scene!” he muttered,
with angry sarcasm.
 CHAPTER XIII.
Molly Trueheart walked under the trees with that mysterious
“Johnny” for a long half hour. While Cecil Laurens in the hammock
raved and fretted against the little fraud, as he began to call her in
his thoughts.
“Suppose I go and bring her aunt upon the scene?” he thought, with
grim resentment.
Then he mentally shook himself.
“Cecil Laurens, you ought to be ashamed of yourself! Where is your
honor that you can be led away like this by petty spite? Let the girl
alone. This is no business of yours!”
A few minutes later Molly and her good-looking, shabby companion
came back to the rustic seat, still unobservant of the hammock and
its occupant. By leaning forward a little he could look into both
faces, and he noticed that Molly’s was pale and annoyed, the man’s
eager and excited.
“You must not come here again,” he heard her say. “It would not be
safe. And you must not go after her. She would be furious if you
interfered with her plans. Better keep quiet for awhile. I will help you
all I can, Johnny,” with a sob, “but you know how little I can do.”
“You are an angel,” said the man, tenderly. “If she were only you,
there would be no trouble. My dear, you’ll write to me?”
“Yes, yes, only do keep quiet and not go after her, or you’ll spoil
everything! I’ll write to you at the old address! Johnny, I’m sorry for
you from my heart, but I’m under her thumb as well as you. We
must both have patience. Good-bye, now, some one will be coming.”
“Good-bye, dear,” said the man, sadly, and Cecil saw him clasp her
little rosy fingers tightly in his broad palm. “God bless you, little one.
I shall look for a letter soon. Write me everything about her, and I’ll
try to stay away, hard as it seems!”
He sighed and turned away, going straight across the lawn to the
broad gates that led to the railroad. There was something pathetic in
his worn, shabby garments and slow, dejected pace in that scene of
wealth and gayety, and Cecil would have been touched only for that
fierce pain tugging at his heart. But he turned his eyes away from
the man back to Molly, who had dropped down on her seat and was
gazing after him with sad, wet eyes. He heard her murmur
passionately, “It is a shame!” then she dropped her face in her
hands and sobs shook her slender form.
Cecil had seen Molly in many moods, but here was a new one, and it
excited in him a strange feeling, that of pity mixed with a bitter
resentment, as if he had suffered some personal wrong at her
hands. After a minute, and still watching the sobbing girl, he began
to analyze his emotions, and as a result the color flew hotly to his
face and he muttered:
“I have actually taken an undue and sentimental interest in this girl
—pshaw, why mince matters? Through some unexplainable madness
I have lost my heart to a madcap, and am suffering all the torments
of jealousy because another man has a claim on her. Mrs. Barry was
wiser than I thought, and is no doubt laughing in her sleeve this
moment at my folly.”
The flush deepened on his face, and he remained for some moments
watching Molly in moody silence.
It was a dangerous occupation for a man who had just found out
that she was fatally fair, for Molly, as she crouched in a forlorn and
drooping position on the hard bench, was a very tempting little
specimen of femininity.
The day was warm and she wore a dress of thin white mull, through
whose transparent texture her plump arms and shoulders gleamed
rosy-white. Her hat had fallen off, and the loose dark curls half
confined by a scarlet ribbon, drooped against the graceful neck, and
contrasted with the warm pink of a round cheek nestled in a dainty
hand. On this picture of beauty in distress fell pretty flecks of
sunlight from between the green boughs overhead, bringing out
glints of brightness from the wavy curls, that in the shade always
looked so dark and rich, and Cecil remembered that there were
golden lights in her eyes, too, when she was pleased and happy.
Then he caught himself up again with a jerk.
“Happy! How can she ever be happy again with that tramp of a lover
on her mind?” angrily.
Something—he scarce knew what, but most probably that sullen
misery that was so new, so bitter, and so humiliating—drove him to
her side. Slipping noiselessly from the luxurious hammock he stole
around the tree and sat down by her side, touching the bowed head
lightly with his hand, and murmuring with uncontrollable fondness:
“Louise!”
Molly gave a great, frightened start and whirled around.
“Oh, it’s you, Cecil Laurens, is it? Well, then, what do you want?” she
demanded, wrathfully, angered because he had caught her in
distress.
For once he was not angered at her sharp retort. He comprehended
now something of what she was enduring, and made patient
allowance for her pain.
“Do not be angry, Louise. I want nothing only to tell you how sorry I
am for you, and how gladly I would help you in your trouble,” he
said so gently that she stared at him in amazement, although she
said brusquely:
“Trouble! I have no trouble!”
“Ah, Louise, you can not deceive me any longer. Look yonder! I was
in that hammock just now and saw your companion, also heard
some of his words!”
“Spy!” she exclaimed indignantly, although she grew pale and
trembled like the leaves on the tree above her head.
Again he put a stern guard on himself, and would not resent her
rudeness.
“It is despair that makes her hard!” he thought, and answered
gently:
“I did not mean to be a spy, Louise, I was in the hammock when you
came here, and presently he came and spoke to you. I could not
help hearing what was said until you walked away with him. But—do
not look so frightened—I did not follow you!”
He saw a gleam of palpable relief flash into the white face, and
comprehended that she was glad he had not heard what was spoken
in that walk under the trees.
“But I had heard enough!” he said slowly, after a pause. “Ah, Louise,
I was right when I told you that it was a lover who was drawing your
heart back to your old home.”
She looked at him pale and startled, but with mute defiance.
“A—a—lover!” she echoed, wildly. “Now I suppose you will go and
tell Aunt Thalia of your wonderful discovery!” in a tone of terrified
entreaty.
“Why will you wrong me so?” he cried, smarting under the lash of
her injustice. “You know I did not betray you before?”
“But—but—why do you meddle with me so?” she cried, with a
bewildered air. “You are always finding out things—and—and always
blaming me!”
“No, no, child, I do not always blame you, I do not want to meddle—
yet I—yet you—seem so ignorant, I ought to—to advise you. Will
you listen to me kindly, Louise?”
“Go on,” she answered, folding her hands in her lap and looking so
like a martyr that he cried out hastily:
“Do not look as if a big bear was going to eat you, Louise. I only
want to tell you that it is not right to have secrets from your good
aunt—to have a shabby lover whom you write to and meet by
stealth. No good will come of such a clandestine affair.”
“Heaven give me patience!” cried Molly indignantly. “Poor Johnny, to
think of this rich man calling you shabby! But, Mr. Laurens, that was
no meeting by stealth just now. If you heard his first words you
must know that it was not an appointment.”
“No, he came because he had heard you were here—that was the
difference,” dryly. “But the first time I met you, you know—when
Hero flung you over his head at my feet—perhaps you met him that
night, perhaps—”
“Perhaps you are a great simpleton, Cecil Laurens!” Molly cried,
indignantly. “I did not meet him that night, nor any night. Morover,
he is no lover of mine. I never had a lover in my life!”
“You have one now!” Cecil Laurens said softly, but Molly did not
comprehend.
“I have not!” she declared angrily. “Poor Johnny came here because
he thought that my step-sister was here. They have been engaged
two years, and he can not get a salary large enough to support
them, and Lou—I mean my sister Molly,” crimsoning, “is angry and
wants to break it off. And I promised to beg her to make it up with
the poor fellow, and to write to him, so there!”
“That step-sister again! It is the first time I ever was glad to hear
her name!” exclaimed Cecil, radiant. “Oh, Louise, how glad I am that
he was her lover and not yours!”
“What have you got to do with it any way?” she demanded pettishly.
“I love you!” he replied, audaciously.
 CHAPTER XIV.
The black eyes and the blue ones met for an instant, Cecil’s full of
passion, Molly’s full of incredulous amazement, but her lover did not
wait for her to utter a protest, he caught her little hands in both his
own—and said eagerly:
“Louise, darling, I owe you an apology for the unjust words I said to
you that day at Ferndale. They were not true, for I love you as I
hinted to you then, and it was pique at your rejoinder that made me
blurt out those untruthful words. Will you forgive me, and let me
love you?”
He had never spoken such words to any woman before, but carried
away by the strength of his newly discovered passion, they rushed
from his lips eloquent with the heart’s emotion. He had a right to
expect a serious reply, but to his horror, mortification, and distress,
Molly blurted out a curt:
“Nonsense!”
Her elegant lover gave a gasp as if some one had thrown cold water
over him, and a momentary anger struggled with the delicious
emotion of love. He lifted his violet eyes to her face full of
reproachful tenderness.
“Louise!” he exclaimed.
She hung her pretty head in bashful confusion.
“You did not mean it!” she muttered, deprecatingly.
“I did mean it. I do mean it. Do not coquette with me, Louise, when
I am so much in earnest. You said just now you never had a lover.
You have one now—will you reject him, or will you accept the heart
he offers? Will you be my wife, little one?”
He felt her trembling as he held her hands tightly in his, and
dropping one, he placed his hand beneath her chin and lifted her
face so that he might look into her eyes. To his surprise and joy they
drooped bashfully, and the warm color rose over her face.
“Louise, what are you going to say to me in return for my
confession? Won’t you love me a little in return? Won’t you give me
some hope?”
Was this Cecil Laurens, the cold, the proud, the dignified, pleading to
the girl he had disapproved of, the girl he had called such a baby?
She looked at him in wonder and consternation.
“Oh, what have I done?” she cried out in dismay.
“You have bewitched me, I think,” her lover replied with his rarely
beautiful smile.
“Mr. Laurens, do you really mean it? I—I believed you disliked me,
hated me,” she breathed in a low, half-tender tone, very different
from her usual mocking one.
“I mean it all, Louise. I love you passionately, and I have suffered
torments in the last three weeks from pique and jealousy that I
mistook for anger. Now, my dear, I have been very frank with you.
Will you be as candid in return?” asked Cecil Laurens in a low,
winning tone, and with a glorious smile. Certainly although he had
learned his love so suddenly, he knew how to play the lover well.
She trembled and drew back from him as he leaned toward her. All
the sweet vivid color faded from her face, and her dark eyes sought
the ground.
“I believe you now, Mr. Laurens, although at first I thought you were
jesting,” she said, and her voice was distinctly tremulous. “I—I—yes,
I will be candid with you. I am—am—sorry—you—care for me—for—
it—is—useless, hopeless!”
“Hopeless, Louise? Are you sure?” he asked. “If you have no other
lover, let me try to win you. Your heart is free?”
“No, no, for I love some one else,” she said, desperately.
He was very clever, this Cecil Laurens, and at that moment he read
the heart of the simple girl as he had read his own as by a flash of
light. Smilingly, and with a man’s masterful air, he returned:
“It is my turn now to cry out nonsense, my darling, for I do not
believe that my love is hopeless. I saw in your sweet, shy eyes just
now a tenderness that belonged not to ‘some one else,’ but to me.
Look up, Louise, and own that in these weeks while we seemed to
be playing at cross purposes we were falling headlong into love!”
She tried to deny it, but the usually pert little tongue faltered under
his quizzical and tender gaze.
“Let me alone!” she began frantically, but Cecil Laurens’ arms had
slipped around her waist and he smothered the remonstrating words
on her lips with a long, sweet, lingering, lover’s kiss—one that
seemed to draw the girl’s pure soul from her body and merge it into
his.
Faint with the sweetness of this exquisite emotion, Molly rested
passive in his clasp for a moment, then drawing back from him,
sighed bitterly.
“Oh, this is dreadful! Why did I ever come to Ferndale?” she
exclaimed to herself, while Cecil Laurens’ eyes glowed upon her full
of passionate love. Under their warmth, the girl hung her head
bashfully, all her usual effrontery conquered by the thrilling
consciousness of her love and the bitter pain she suffered in her
secret knowledge of its folly.
“Ah, if he but knew!” she thought with an inward shudder, and
looking up at him with eyes full of pain, she said:
“I did not try to make you love me, you must always remember
that!”
He laughed as he answered:
“No, you did not court my love, dear, certainly. I never saw a rose so
full of thorns as this one that I have won.”
“You have not won me!” she cried with a frightened start, but the
triumphant lover, sure of his prize, replied:
“I do not think you will deny that your heart is mine, Louise,
although I no more tried to win your love than you did mine. But this
being so, the fact remains we were mutually strongly attracted to
each other, so we must charge our union to the score of fate.”
“A strange fate!” Molly muttered, but her lover, who saw nothing but
perfection now, where a short while ago he found so much fault,
answered fondly:
“A very beneficent fate. Only think, we shall not only make ourselves
happy by our marriage, but we shall please our families, who have
been neighbors and intimates almost a century.”
“I have not said I would marry you, Mr. Laurens!” she cried out,
quickly, more and more frightened, but he only smiled at what
seemed to him maidenly bashfulness.
“Marriage naturally follows love like ours, dear,” he said, tenderly.
“And, Louise, darling, I shall make you a very good husband. You
will not find me such a bear as I have been these past weeks, when
your coldness hurt my unconscious love and stung me to anger. You
will be different, too, my pet, for our love will change our thoughts
and our lives.”
“Yes,” she murmured, faintly, for she knew far better than he the
extent of that change, but just now she did not contradict him again.
“What is the use? He will not listen,” she thought, feverishly. “I will
let him love me while he is here and when he is gone I will write him
very positively that I can not marry him.”
Her love and his happy masterful air made a coward of her, and she
was willing to put off the fatal declaration, feeling a guilty pleasure
in basking in this sunshine to which she had no right, and from
which she must soon steal away into the gloom of a life made sad
by an unhappy love.
For deep down in her heart Molly Trueheart knew already that this
mutual love between her and Cecil Laurens was a catastrophe, not a
blessing, as he believed it. She knew that she could never marry
him, but her feeble declarations to that effect had been silenced by
his objections, so she decided to filch from fate a few bitter-sweet
hours before she parted forever from this splendid yet forbidden
love.
Afterward, when the storm-rains of despair beat on her defenseless
head, and her heart ached on amid fiercest tortures, Molly looked
back on this hour, the beginning of it all, with a great wonder at her
weakness and cowardice. Why had she yielded even for an hour to
this madness? Why had she let her love make her a craven and a
coward?
She laid all the blame upon herself in wonder and sorrow and
repentance, too ignorant and unversed in the mysteries of life and
nature to comprehend that it was not so much her honesty that had
been at fault as that through her love her will-power had been
dominated by the magnetic force of her lover. For grand, handsome,
noble Cecil Laurens, although unconscious of his power, was
possessed of a strong magnetism that subtly influenced all with
whom he came in contact, and doubly attracted the susceptible girl
whom he loved. She did not realize the power of this magnetic will
any more than Cecil himself did, yet certainly it was more than half
to blame for poor Molly Trueheart’s treachery.
 CHAPTER XV.
All in a minute, as it seemed, he was putting on her first finger the
splendid solitaire diamond from his own hand.
“Will you wear this for an engagement ring, or shall I buy you a new
one?” he asked.
“I prefer this because you have worn it,” she answered, frankly, and
blushing very much, at which Cecil was delighted.
To herself she said, sadly:
“That is the truth, but there is another reason still for my preference.
I must not put him to the expense of a new ring, for this will do for
the few days that I shall be able to keep up the farce of an
engagement.”
She sat silent, twisting the costly gem uneasily about her finger,
when suddenly she saw coming toward her across the lawn Mrs.
Barry, attended by Agnes Walker, her maid.
The sight roused Molly from the dream of bliss into which she was
falling. She pulled the ring from her finger.
“Here, take it back; I—I can’t marry you. Don’t tell Aunt Thalia,
please,” she faltered, desperately.
Cecil took the ring and her hand with it, and pushed the jewel back
on the slim, rosy finger.
“My darling, what a bashful little goose you are!” he returned,
laughingly; and just then Mrs. Barry came up and found him holding
the little hand tightly in his own.
“Louise, I was so uneasy about your long absence, I took Agnes and
came to hunt you; but if I had known that Cecil was with you, I
should not have been alarmed,” she said.
Molly muttered something incoherently, and tried to wrest her hand
from its captor, but Cecil held it up triumphantly before Mrs. Barry,
who laughed in glee as she caught the glitter of the diamond.
“Engaged!” she exclaimed, gladly.
“Yes,” he replied, jubilantly. “Will you give us your blessing, Aunt
Thalia?”
“With all my heart,” replied the old woman. “Louise, do not look so
bashful and frightened, my dear, for I am very much pleased at your
choice;” and she actually kissed the little bit of white forehead that
was visible above the arm with which Molly had hidden her face.
Agnes Walker, too, looked very proud and pleased, and uttered a few
words of congratulation that would have delighted Molly if this had
not been, as she said to herself, “all a dreadful sham.”
She sat like one in a dream, listening to Mrs. Barry’s cracked voice in
its complacent chatter.
“Of course you will not go abroad so soon now, Cecil?”
“I am afraid I ought to go. Mother and father will expect me, and I
promised to go as soon as I had attended to that business. But—it
will be hard to go now. I have a bright idea. Can not you and Louise
go with me?”
Molly’s heart leaped wildly, then calmed again as Mrs. Barry shook
her head.
“I am too old to cross the sea again. I want to die in my native
land,” she said.
“Louise, then—with a maid, of course?” he said, but again the old
woman shook her head.
“I’m afraid it would not be exactly proper then,” she replied.
“Then I shall write to my folks that I shall delay my return until my
bride is ready to accompany me,” he replied, with a tender smile at
Molly, who replied, in a fright:
“No, no, I’m too young yet.”
“Nonsense!” said Mrs. Barry, sharply. “Why, Louise Barry, in my
young days a girl of five-and-twenty was considered an old maid,
and here you are talking of being too young. Don’t mind her, Cecil.
I’ll order her wedding things at once, and she shall be ready as soon
as you wish.”
“Thank you, Mrs. Barry!” exclaimed the prospective bridegroom,
radiant.
But Molly muttered, frantically:
“I know Aunt Lucy will not be willing!”
“Lucy Everett has nothing to do with it. I shall not ask her advice,
nor Cecil her consent. If you love Cecil, there is no more to do but to
marry him and settle down,” proclaimed Mrs. Barry with the air of an
autocrat, and she added, after a minute, sharply: “I don’t think I
shall even invite Lucy Everett to the wedding, for she would want to
bring that Trueheart girl, and she shall never with my consent cross
the threshold of a Barry!”
“As for the wedding things, don’t they order them always from Paris?
Then, what more will Louise need but a traveling-dress, since we will
go straight to Europe on our wedding-tour. She can get all the
dresses she wants, then,” said Cecil Laurens, eagerly.
“That is true,” said the old lady, adding slyly: “What a hurry you are
in all at once, Cecil!”
He flushed and laughed, then said, with a fond glance at Molly:
“I am in a hurry for my happiness; but then you know, Mrs. Barry, I
have been a spoiled boy always, and never had patience enough to
wait for anything I wanted!”
“You never had to wait, being one of Fortune’s favorites, always!”
she replied, indulgently.
And Molly thought, with a hushed sigh:
“He will hate me one day, because he will meet his first
disappointment through me!”
Mrs. Barry believed in taking time by the forelock, and, unknown to
the young fiancé, she sent an order that very day to New York—an
order for a recherché wedding-dress, a traveling costume in all its
details, several dresses besides, comprising walking, dinner, and ball
dresses, hats and bonnets ad. lib., and a dozen outfits of
embroidered lawn and linen underwear. These articles were to be
furnished within three weeks.
“They will be as much as she will need until she gets to Paris. I will
give her a large check to take with her for a trousseau there. I can
afford to be generous as all my money will go to her some day, and
as she is marrying so well,” said the old lady to Agnes Walker, feeling
very complacent over the happy turn events had taken. She was
very fond of the bride-elect from that time forward, and often
thought remorsefully of the time when she had locked the girl into
the garret.
Cecil Laurens was greatly altered, too, for the better, by his love. He
ceased to see a single fault in the gay, young girl whom he had at
first condemned. He lavished the whole wealth of his heart upon her,
and he could not fail to see through all her shyness that his love was
fully returned.
Molly had not known herself capable of such depths of passion as
her lover’s devotion roused in her breast. She gave herself up with
feverish delight to the happiness of the flying weeks, salving her
conscience with the thought that her deception would soon be over
—that at the very last she would break off with him even though he
would go away from her hating her memory forever.
But day by day the bonds of love grew stronger. That which she
thought but a garland of roses strengthened into a chain that held
her fast. A mad love made the brave, honest little girl a traitor.
The day that had been set for her marriage dawned, yet she had
never spoken the words that were to save Cecil Laurens from
wedding a deceiver.
“For I could not break it off without telling him the truth, and that
would ruin Louise. And how could I part with him now?” she would
sigh to herself when alone, and gradually her love and his made a
bond that she could not break through.
“I should die if I were parted from him now,” she sighed. “Of course
I know that he would find me out some day, and then I should lose
him forever. But I should have a little happiness first. It would not be
so terrible to die of grief, having had my day first.”
Then Molly would sob bitterly until she fell asleep upon her tearwet
pillow. Truly the love to which she clung so desperately was not all
unalloyed pleasure, but perhaps its element of uncertainty made it
all the more precious.
They went back to Ferndale, and Mrs. Barry, in the seventh heaven
of delight, made preparations on a grand scale for a real old-
fashioned country wedding. Invitations were sent out far and near to
the friends of the family. A dozen cooks took possession of the
kitchen and dining-room. Flowers were ordered from a New York
florist. The old lady declared that her niece’s wedding should be the
grandest that ever took place in Greenbrier County.

It was. A hundred guests danced at Molly Trueheart’s wedding with

Cecil Laurens. Ferndale did not look like the “poky old hole” she had
called it two months ago. By the aid of lights and flowers and music
it was temporarily transformed into fairy-land. The trees were
illuminated by picturesque Chinese lanterns. The old house in every
corner was as bright as day, and the light glowed resplendently on
the trailing lengths of Molly’s white satin bridal-dress as she came
down the wide stairway almost an hour later than the time
appointed, for at the very last her conscience had stung her so
cruelly that she had hidden herself in a closet, from which she was
dragged forth after vigilant search by her almost distracted aunt.
“Louise Barry, what do you mean by such a caper? You’ve given me
such a fright as I never had in my life! I’ve a mind to give you a
good shaking!” she vociferated, excitedly, and Molly whimpered,
faintly:
“Please forgive me, Aunt Thalia. I—I was so frightened, I thought I’d
rather not—”
“Rather not what?” sharply.
“Not—get—married,” sighed the delinquent, and Mrs. Barry burst out
laughing.
“What under the heavens makes girls so silly when they are going to
be married?” she cried, and just then one of the bridesmaids tapped
at the door.
“Is the bride ready yet? It’s almost an hour past the time, and Mr.
Laurens sent me to ask—” she began, but Mrs. Barry cut the
sentence short by opening wide the door.
“She’s ready. Tell the bridesmaids to come in,” she said; and then
she whispered in Molly’s ear: “Behave yourself like a little lady now,
and I’ll never tell Cecil that you were such a baby as to hide in the
closet because you were afraid to have a husband.”
“I’ll behave,” Molly answered, desperately; and so well did she keep
her promise that Mrs. Barry had no occasion to tell her husband of
that hour in which Molly’s good angel had been pleading for the
right.
 CHAPTER XVI.
Cecil was waiting at the foot of the stairs, so eager, so happy, so
grand looking in his wedding garments, that all her regrets vanished
in passionate love and admiration. She clung to his arm, sighing to
herself:
“Oh, Heaven grant that he may never, never find me out!”
Five minutes more and the ring was on her finger, the marriage
vows had passed her lips, and Cecil Laurens’ lips had called her wife.
She stood in the middle of the room, pale, but with a quiet dignity,
receiving the congratulations of the guests.
Suddenly there was a stir and bustle at the door where the servants
were congregated, looking on at the brilliant scene. A shabby young
man, ghastly pale, with eyes of fire blazing out of his weak, good-
looking face, pushed through the crowd of guests, crying out,
fiercely:
“The bride—let me see the bride!”
A wild hubbub arose as he advanced, for in the hand that hung
down at his side a score of eyes had caught the gleam of a knife.
Insane fury flashed from his eyes as he advanced upon the beautiful
bride.
Her eyes dilated with terror, her face waxed ghastly as she faced
him, but not a sound came from her pallid, parted lips.
“Ha! ha!” the intruder cried with a horrible laugh as he stopped so
close to her that his hot breath fanned her brow, while his eyes fairly
devoured her terrified face.
Then—
All in an instant, and as suddenly as he had rushed upon her, the
infuriated man fell back a pace and his hand dropped to his side,
while the glare of his eyes changed to a stupid stare.
“You!” he muttered, “you!” and the murderous knife fell from his
hand upon the floor.
Some one shrieked aloud:
“A madman! Take him away!”
The men rushed upon him and dragged him from the room. Molly
clung sobbing to her new-made husband.
“Oh, Cecil,” she whispered, “he is not mad. It is John Keith, my
sister’s lover. He has made some strange mistake, I am sure! He
must have thought it was his own sweetheart being married instead
of me! Oh, let me go and speak to him, poor tortured Johnny!”
A shout came back from the hall.
The captive had broken loose and escaped into the darkness of the
night.
“I am so glad!” sighed Molly, with infinite relief.
And Cecil Laurens looked down at her with grave eyes.
“Louise, are you sure the man is not an old lover of yours?” he asked
in a tone divided between jest and earnest.
“I have never had a lover but you!” she replied, fondly, and lifting
her dark eyes to his face that he might read the love written there.
“Darling!” he whispered, rapturously, as he led her to a seat.
Every one had run out into the hall to look after the maniac, and
they were for a moment alone.
Molly whispered, anxiously:
“Dear Cecil, don’t you pity that poor fellow? He is not rich like you,
and he can not find work enough to support a wife! She is growing
tired of waiting, and he will lose her, unless something happens in
his favor. You will help him, Cecil? You’ll find him some work?”
So earnest was the plaint that tears rushed into the dark eyes, and
Cecil, moved to sympathy, answered ardently:
“I believe you are an angel, Louise, as I once heard that unlucky
fellow call you. Certainly, I’ll try to find him some work; but I doubt
if I’ll be doing him a good turn helping him to marry selfish Molly
Trueheart. And then, you know, we leave tomorrow on our wedding-
tour, and shall not know where to find him, as he has run away.”
“I know where to write to him. I have his address; and, oh, Cecil, I
shall love you more than ever for this!” Molly cried, impetuously.
“Thanks, my little love. With that reward in view, I shall strive
earnestly to set your forlorn friend up in business before we leave
tomorrow,” Cecil Laurens replied, gayly, but tenderly and earnestly.