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Ocular Suppression Development at Age 12 Years 12岁儿童眼抑制发育
Pub Date : 2022-04-01 DOI: 10.31707/vdr2022.8.1.p35
BACKGROUND: The patient experienced idiopathic increased intracranial pressure (pseudotumor cerebri syndrome) leading to an acquired, constant left exotropia at age 12 years. She had diplopia for about 2 months which resolved due to apparent suppression of the left eye. The patient has maintained the suppression without developing amblyopia through her current age of 17 years despite a stable large left exotropia, optic atrophy, and visual field defect.SIGNIFICANCE: The case is unusual because suppression has been assumed to develop only prior to age 10 years.BACKGROUND AND PURPOSE: Ocular suppression is an active neuroplastic process and is presumably limited to a sensitive period in childhood. It occurs when there is a difference in image clarity between the two eyes. The two most common causes are clinically significant anisometropia and strabismus. The strabismus may be monocular and constant, alternating and constant, or intermittent. The presence of suppression in anisometropia or constant monocular strabismus often leads to monocular amblyopia.The literature contains extensive animal, laboratory, and clinical evidence on the sensitive period of amblyopia, its causes, and its remediation. It is well established that amblyopia develops prior to about age 7 years, can recur up to about age 10 years, but does not develop, recur, or regress after age 12 years. Generally, response to amblyopia treatment is most robust during the sensitive period, but it is well documented that successful treatment is possible through the teen years and even adulthood.Few reports exist on suppression without amblyopia and most are based on clinical experience. von Noorden and Campos state: “As with other sensorial adaptations, such as amblyopia and anomalous retinal correspondence (ARC), the ability to suppress is limited to the immature visual system, that is, it develops only in children. Although no comparative studies exist, it is our clinical impression that the sensitive period during which suppression may develop ends after the age of 8 or 9 years”. The present paper reports an interesting case of an apparent onset of suppression at age 12 years in a patient with acquired, constant, unilateral strabismus secondary to idiopathic increased intracranial pressure.
背景:该患者在12岁时经历了特发性颅内压增高(假性脑瘤综合征),导致获得性、持续性左外斜视。她患有复视约2个月,由于左眼明显抑制而消退。尽管患者有稳定的左外斜视、视神经萎缩和视野缺损,但患者在目前的17岁期间一直保持抑制作用,未发生弱视。意义:该病例是不寻常的,因为抑制被认为只在10岁之前发展。背景与目的:眼抑制是一种活跃的神经可塑性过程,可能仅限于儿童时期的敏感期。当两只眼睛之间的图像清晰度存在差异时,就会发生这种情况。两种最常见的原因是临床上显著的屈光参差和斜视。斜视可以是单眼持续性斜视、交替性斜视或间歇性斜视。在屈光参差或持续性单眼斜视中存在抑制常导致单眼弱视。文献包含广泛的动物,实验室和临床证据的敏感期弱视,其原因,及其补救措施。众所周知,弱视在7岁以前就开始发展,10岁以前可以复发,但12岁以后不会发展、复发或退化。一般来说,对弱视治疗的反应在敏感期是最强劲的,但有充分的证据表明,成功的治疗可能贯穿青少年甚至成年期。目前关于抑制无弱视的报道很少,大多数是基于临床经验。von Noorden和Campos指出:“与其他感官适应一样,如弱视和视网膜异常对应(ARC),抑制能力仅限于未成熟的视觉系统,也就是说,它只在儿童中发展。虽然没有比较研究存在,但我们的临床印象是,抑制可能发展的敏感期在8岁或9岁后结束。本文报告了一个有趣的病例,在12岁时,患者获得性,持续性,单侧斜视继发于特发性颅内压升高。
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引用次数: 0
Clinical Management of Monofixation Syndrome due to Microtropia 斜视致单注视综合征的临床处理
Pub Date : 2022-04-01 DOI: 10.31707/vdr2022.8.1.p24
BACKGROUND: Monofixation syndrome is a binocular vision disorder characterized by peripheral fusion with a central suppression of one eye due to smallangle strabismus (microtropia) or anisometropic amblyopia. Reduced stereopsis and acuity are noted in the non-fixating eye. Although often left untreated due to good cosmetic appearance, central suppression and reduced stereopsis can affect visual performance, comfort, and depth perception.CASE REPORT: EJ, a 17-year-old Caucasian female was previously treated for amblyopia of the left eye (OS) with glasses and patching since age 8 with no improvement to vision. EJ experienced the following symptoms: blurred vision at near when reading, blurred vision at far distances, eye pain and fatigue, difficulty copying from the board, difficulty seeing at night while driving, and poor depth perception. Entering uncorrected visual acuity was 20/20-2 OD and 20/50-2 OS with Snellen Letter Chart. Near uncorrected acuity was 20/20 OD and 20/200 OS with a reduced Snellen chart at 40 cm. Microtropia of 2 to 12 prism diopters of esotropia, eccentric fixation on visuoscopy, and central suppression on various tests were measured. EJ was diagnosed with monofixation syndrome, monocular esotropia of the left eye, strabismic amblyopia of the left eye, suppression of binocular vision (OS), and fusion with defective stereopsis. The patient completed 19 sessions of in-office vision therapy with the practice of home reinforcement activities between therapy sessions. Visual performance was reassessedafter 10 and 19 sessions of vision training with improvements noted in acuity, accommodation, oculomotor accuracy and speed, eye alignment, fusional vergence skills, and stereopsis.CONCLUSION: Optometric vision therapy can decrease suppression, improve central fusional ability, visual acuity, accommodative accuracy, and stereopsis in a patient with monofixation syndrome.
背景:单注视综合征是一种双眼视力障碍,其特征是小角度斜视(微斜视)或屈光参差性弱视引起的外周融合和单眼中央抑制。在不注视的眼睛中,立体感和敏锐度下降。尽管由于美观,中枢抑制和立体感降低经常不治疗,但会影响视觉表现、舒适度和深度感知。病例报告:EJ,一名17岁的白人女性,自8岁起接受左眼弱视(OS)的眼镜和贴片治疗,视力没有改善。EJ出现以下症状:阅读时近距离视力模糊,远距离视力模糊,眼睛疼痛和疲劳,难以从黑板上抄字,夜间驾驶时视力困难,深度感知差。入组未矫正视力为20/20-2 OD, 20/50-2 OS (Snellen字母表)。近未矫正的视力为20/20 OD和20/200 OS, 40cm处Snellen图减少。测量了内斜视2 ~ 12棱镜屈光度、视镜偏心固定和各项试验的中枢抑制。EJ被诊断为单注视综合征,左眼单眼内斜视,左眼斜视弱视,双眼视力抑制(OS),融合立体视觉缺陷。患者完成了19次的办公室视力治疗,并在治疗期间进行了家庭强化活动。在进行了10和19次视觉训练后,对视觉表现进行了重新评估,在敏度、适应性、眼球运动的准确性和速度、眼睛对准、融合收敛技能和立体视觉方面都有了改善。结论:验光视力治疗可减轻单注视综合征患者的抑制,提高中枢融合能力、视力、调节精度和立体视觉。
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引用次数: 0
Integration of Myopia Management into a Behavioral Vision Practice: How and Why? 近视管理融入行为视觉实践:如何以及为什么?
Pub Date : 2022-04-01 DOI: 10.31707/vdr2022.8.1.p13
It is predicted that half of the world’s population (nearly 5 billion) will be myopic by 2050. There is a large unmet need for myopia prevention in this population. This perspective piece discusses integration of myopia management into a practice that embraces a behavior/developmental vision care philosophy. We outline the 7 foundational steps that have allowed us to develop a successful myopia management practice.
据预测,到2050年,世界人口的一半(近50亿)将是近视。在这一人群中,有很大的未满足的近视预防需求。这篇透视文章讨论了将近视管理整合到包含行为/发育视力保健哲学的实践中。我们概述了7个基本步骤,这些步骤使我们能够开发成功的近视管理实践。
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引用次数: 0
Even Professional Baseball Players Need a Hitting Coach: Why Every VTOD Should Consider a Consultant 即使是职业棒球运动员也需要一个击球教练:为什么每个VTOD都应该考虑一个顾问
Pub Date : 1900-01-01 DOI: 10.31707/vdr2023.9.2.78
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引用次数: 0
A Novel Test for Visual Cognition in School Children 一种新的学龄儿童视觉认知测验
Pub Date : 1900-01-01 DOI: 10.31707/vdr2022.8.4.p248
Early detection of visual deficits in children can lessen the impact of learning difficulties in the classroom. The aim of this study is to investigate a novel dot pattern task as a potential tool for school visual cognition screening programs.
早期发现儿童的视力缺陷可以减轻课堂上学习困难的影响。本研究的目的是探讨一种新的点图案任务作为学校视觉认知筛选项目的潜在工具。
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引用次数: 0
Some Thoughts About My Experience with a Private Practice Residency for the Last 12 Years 关于我过去12年私人实习经历的一些思考
Pub Date : 1900-01-01 DOI: 10.31707/vdr2022.5.3.p177
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引用次数: 0
Case Study: Treatment of Adult-onset Constant Esotropia with Lenses, Optometric Vision Therapy and Prisms 案例研究:成人持续性内斜视的镜片、视光疗法和棱镜治疗
Pub Date : 1900-01-01 DOI: 10.31707/vdr2022.8.3.p181
There are few documented cases, and no cases with a video journal recording a successful outcome from non-surgical treatment of adult- onset constant esotropia. Resolving diplopia caused by sudden onset esotropia is typically achieved through the application of prisms, or surgery. Surgery can resolve the diplopia and significantly reduce the strabismic angle, sometimes entirely. The application of prisms can resolve the diplopia but not alter the strabismic angle . Optometric vision therapy as a treatment, with or without the use of compensatory prisms, is rarely offered.
有文献记载的病例很少,也没有视频日志记录非手术治疗成人持续性内斜视的成功结果。解决由突发性内斜视引起的复视通常是通过应用棱镜或手术来实现的。手术可以消除复视并显著降低斜视角度,有时甚至完全降低。棱镜的应用可以解决复视,但不改变斜视角度。视光治疗作为一种治疗,有或没有使用补偿棱镜,很少提供。
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引用次数: 0
Myopia: A Behavioral Approach for Prescribing and Vision Therapy 近视:处方和视力治疗的行为方法
Pub Date : 1900-01-01 DOI: 10.31707/vdr2022.8.3.p123
Myopia has reached serious epidemic proportions in many developed countries throughout the world, and is a public health issue with which the optometric profession is deeply concerned. Different clinical approaches are available to the optometrist for treatment of myopia. For the majority of patients, prescribing minus lenses to achieve 20/20 visual acuity at distance does little to prevent a patient from becoming more myopic or to improve vision function in the broadest sense, though it provides immediate improvement in distance visual acuity. A behavioral optometric clinical approach is presented in this paper to give the doctor a clear-cut strategy offering more alternatives to the patient with myopia. Employing this approach has the potential to prevent patients from developing myopia to levels higher than -2.00 diopters, reversing minus lens powers in patients that come to the optometrist already wearing a minus lens prescription, and reducing dependency on using minus lens prescriptions.Vision therapy is addressed as a procedure to improve a patient’s vision function in addition to visual acuity. Book retinoscopy is employed as a valuable technique to arrive at a training eyeglass prescription. At the completion of treatment, a patient typically improves in distance visual acuity, reduces minus lens powers, develops increased confidence in vision capabilities (with and without minus lens wear), develops an awareness and appreciation for additional aspects of vision such as space, forms, colors, patterns, periphery, and feels empowered that they have learned how to improve distance vision through self-initiated control.
近视在世界上许多发达国家已达到严重的流行程度,是验光界高度关注的公共卫生问题。验光师可以使用不同的临床方法来治疗近视。对于大多数患者来说,通过配负晶镜来达到20/20的远距离视力,虽然可以立即改善远距离视力,但对防止患者变得更加近视或改善最广泛意义上的视力功能几乎没有作用。本文提出了一种行为验光的临床方法,为医生提供了明确的策略,为近视患者提供了更多的选择。采用这种方法有可能防止患者发展为高度超过-2.00屈光度的近视,扭转已经戴着负度数的镜片去看验光师的患者的负度数,并减少对使用负度数的依赖。视力治疗是一种除了提高视力外,还能改善患者视觉功能的治疗方法。书本视网膜镜检查是一种有价值的技术,以达到训练眼镜处方。在治疗结束后,患者通常会改善远视力,降低负晶状体的度数,增强对视力的信心(佩戴或不佩戴负晶状体),培养对视觉的其他方面(如空间、形状、颜色、图案、周边)的意识和欣赏,并感到自己已经学会了如何通过自我控制来改善远视力。
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引用次数: 0
Comparison of the BEST to the Randot® Circles BEST与Randot®圆圈的比较
Pub Date : 1900-01-01 DOI: 10.31707/vdr2023.9.1.p15
Stereopsis is important for children’s visual develop- ment, especially binocularity. Reduced stereopsis is associated with strabismus, amblyopia, and significant anisometropia. Stereopsis can be used to detect, evaluate and monitor treatment for these conditions. The purpose of this study was to compare the Bernell Evaluation of Stereopsis Test (BEST) and Randot® Stereotests via circles to determine the most efficient way to screen stereoacuity.
立体视觉对儿童的视觉发育非常重要,尤其是双目视觉。立体感降低与斜视、弱视和明显的屈光参差有关。立体视觉可用于检测、评估和监测这些疾病的治疗。本研究的目的是比较伯内尔立体视觉测试(BEST)和随机立体视觉测试,以确定最有效的方法来筛选立体视敏度。
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引用次数: 0
Enhancing Vision Therapy Through a Psychological Lens: Applications to Build a Better Method 通过心理透镜增强视力治疗:建立更好方法的应用
Pub Date : 1900-01-01 DOI: 10.31707/vdr2022.8.3.p165
Optometric vision therapy has been a treatment modality in place to correct and treat visual dysfunction for over 90 years. Despite the abun- dant support from patients who have bene- fited from treatment, there is disagreement in the medical community about its efficacy. To dispel this notion and provide the best patient- centered care, this paper regards research from developmental psychology and learning and behavior psychology to suggest avenues that will support comprehensive therapist training and improve patient outcomes. Methods to increase patient motivation, interact with patients more effectively, build autonomy in middle childhood patients, and improve retention of visual skills are suggested to enhance therapy training programs. By improving treatment success rates and providing lasting results, this modality will find increased support through the patients and families it is serving. Ongoing research to support the efficacy of vision therapy is welcome. Investigations into special needs populations, brain injury populations, personality types, cultural, and gender differences can give insight into therapist-patient interactions and could prove beneficial in training therapists as well.
90多年来,验光视力疗法一直是矫正和治疗视力障碍的一种治疗方式。尽管从治疗中获益的患者对其表示了广泛的支持,但医学界对其疗效存在分歧。为了消除这种观念并提供最佳的以患者为中心的护理,本文结合发展心理学、学习和行为心理学的研究,提出了支持综合治疗师培训和改善患者预后的途径。建议加强治疗训练计划,以增加患者的动机,更有效地与患者互动,建立中期儿童患者的自主性,并提高视觉技能的保留。通过提高治疗成功率和提供持久的效果,这种模式将通过它所服务的患者和家庭获得更多的支持。正在进行的支持视力治疗效果的研究是受欢迎的。对特殊需求人群、脑损伤人群、性格类型、文化和性别差异的调查可以深入了解治疗师与患者的互动,也可以证明对培训治疗师有益。
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引用次数: 0
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Vision Development & Rehabilitation
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