British and Irish Orthoptic Journal最新文献

Language is important. Words we use can be much more descriptive. We propose using the prefix reconstruction when describing strabismus surgery. This word emphaises that extra ocualr muscle surgery is much more that cosmetic, it is always functional even when restoring facial aesthetics that improve patients confidence and perception fo themselves to others.

Aim: The aim of this literature review was to determine if a consensus could be reached on whether amblyopia treatment causes distress to patients and/or their guardians, and if so, establish the impact of this reported psychological distress upon paediatric patients and/or their parents/guardians.

Methods: A systematic review of the literature was conducted of all publications written in English. Search terms included both MeSH terms and alternatives related to amblyopia and psychological distress. Evidence quality was assessed using an adapted Newcastle-Ottawa Score (NOS) and evaluation of the literature was used to form a narrative synthesis of the findings.

Results: Initial searches yielded 7,838 titles in total, with 25 peer reviewed papers published between 1999 and 2021 meeting the study inclusion criteria. Factors such as the presence of strabismus, moderate and severe amblyopic density, occlusive patch treatment and patching during school age increase the likelihood of experiencing distress as a result of amblyopia treatment.

Conclusions: Both parents/guardians and patients can experience psychological distress as a result of undertaking amblyopia treatment. School-aged children and those receiving occlusion therapy in the form of patching report higher distress than infants and young-children, and those receiving atropine occlusion therapy or refractive correction only. Further study measuring the physiological markers of distress such as Cortisol and BDNF, is recommended.

Objective: To investigate if the type of unilateral amblyopia can impact the improvement of visual acuity in amblyopic eyes during a longitudinal interventional study involving standard occlusion therapy in children.

Methods: A longitudinal and interventional study of 91 children, aged 3-9 years (6.12 ± 1.879) with amblyopia was undertaken. Amblyopia was unilateral and caused by either strabismus, anisometropia, or both. Amblyopia was divided into three levels of severity mild, moderate, and severe. Children underwent amblyopia treatment with standard occlusion therapy and were followed monthly, for eight visits.

Results: A significant improvement in visual acuity was observed in all assessment visits across the three types of amblyopia, with a mean improvement of (0.30 ± 0.184) LogMAR. Specifically, anisometropic amblyopia with (0.28 ± 0.18) LogMAR, strabismic amblyopia (0.31 ± 0.18) LogMAR, and mixed amblyopia (0.31 ± 0.18) LogMAR. No significant differences were found between the improvement in visual acuity during the eight control visits and the types of amblyopia (r = 0.174, p = 0.182). However, a significant correlation was observed within all groups in the mean improvement in visual acuity and the severity level (r = 0.712, p = 0.034).

Conclusion: Amblyopia types do not appear to significantly affect the improvement in visual acuity; however, the initial severity of amblyopia may be a key factor influencing the degree of visual recovery achieved with occlusion therapy.

Care for people with idiopathic intracranial hypertension (IIH) needs improving and I think orthoptists are in a perfect position to help. The problems with IIH care are multi-fold:  People with fulminant IIH are still losing sight due to delayed diagnosis or mismanagement.People with IIH often have a poor quality of life due to disabling chronic headaches and poor mental health.There is a lack of access to evidence-based weight-loss interventions and support.Weight stigma in healthcare remains pervasive and damaging and disproportionately impacts women.Functional vision loss and headaches in IIH can complicate the interpretation of visual function which can have implications for management.There is a lack of evidence to support treatment options. Below I will describe the issues in more detail and outline the ways in which we as orthoptists can help this patient group.

Background and objectives: The absence of the orthoptic profession in Spain contrasts with its value and recognition in other countries. This study aimed to gauge Spanish ophthalmologists' interest in including and promoting orthoptists in paediatric and strabismus departments. Secondary objectives included assessing interest in requesting orthoptists, involvement in their training, and aligning their competencies with European standards.

Methodology: Participants were recruited via WhatsApp and flyers during the 30th SEEOP Congress in May 2023 and invited to review a report on orthoptists' significance followed by completing a 12-question online survey. Profile questions were asked via multiple-choice options. Opinions on integrating orthoptists to enhance care quality, training involvement, and alignment with European standards were rated using a Likert scale. Open-ended questions captured themes, and comments.

Results: Forty-two paediatric and strabismologists in Spain participated, mostly hospital-employed with advanced degrees, 90% supported integrating orthoptists into their teams, with 83% interested in having them in their workplace. Nearly 90% believed that collaboration between ophthalmologists and orthoptists would improve care quality and reduce waiting lists, and 83% supported promoting this within national medical organisations. Additionally, 90% advocated level 4 advanced European-standard training for orthoptists and 25% were neutral about participating in training orthoptists. Participants emphasised the importance of qualified orthoptists for treating eye movement abnormalities, distinguishing them from other eye healthcare professionals and advocating for collaboration rather than replacement.

Conclusions: This initial survey of paediatric ophthalmologists and strabismologists in Spain highlights support for orthoptists as allied health professionals, though garnering support for their training could be challenging. These conclusions should be considered in light of methodological, sample size, and resource limitations. The survey serves as a pilot for the future, suggesting improvements to explore the feasibility of introducing orthoptists in Spain.

Introduction: The treatment options available for Superior Oblique Myokymia (SOM) previously included surgery and systemic drugs, with the addition of beta blockers from the early 1990's. This case review aims to examine the efficacy of topical timolol (0.5%) as a treatment for SOM in the short and long term.

Methods: This is a retrospective case series review on a group of patients identified with this condition who have been assessed and treated with topical timolol 0.5% (off-label), within the same district and general hospital over a period of four years.

Results: Six patients were identified from the case review. Five out of the six patients were treated with the use of off label timolol 0.5%. One patient declined treatment due to other systemic conditions and another later discontinued treatment due to change in cardiac status. Two of the patients required increased dosage from OD to BD to achieve success initially. All the patients treated were symptom free at eight weeks and remained symptom free at six months follow-up. None of the patients in the cohort reported significant side effects.

Conclusion: This case series highlights the efficacy of the use of off label timolol 0.5% for the management of SOM with an 80% success rate for those treated with the drug.

Background: Microtropia is a small angle strabismus of less than or equal to ten prism diopters. It often co-exists with anisometropia, and patients may require amblyopia treatment. Diplopia following amblyopia treatment is considered rare, but older literature can advise caution when treating amblyopia in microtropia. This study aimed to explore orthoptists' opinions on amblyopia treatment in microtropia.

Methods: Orthoptists working in Scandinavia were invited to complete an online questionnaire regarding their views on amblyopia treatment. They were presented with three different clinical scenarios: 1) patient with anisometropia; 2) patient with anisometropia and microtropia with identity; and 3) patient with anisometropia and microtropia without identity.

Results: The questionnaire received responses from 30 orthoptists, which were analysed. The results showed a significantly higher concern for diplopia in patients with microtropia undergoing amblyopia treatment than in patients with anisometropia. They responded that to prevent diplopia, it is more important to stop amblyopia treatment before equal visual acuity (VA) is reached in microtropia compared to anisometropia. Thus, amblyopia treatment was stopped more often in microtropia, even if VA was improving and diplopia was absent. Equal VA was perceived to be more difficult to achieve in microtropia, both with and without identity, compared to anisometropia.

Conclusion: Despite more recent evidence that diplopia following amblyopia treatment is extremely rare, orthoptists working in Scandinavia reported more concerns about diplopia when treating amblyopia in microtropia than in anisometropia. Stopping amblyopia treatment in microtropia before equal VA was achieved was considered somewhat important to prevent diplopia. Orthoptists also reported that equal VA was difficult to achieve in patients with microtropia, both with and without identity. Further research would help improve the evidence and inform clinical decisions about microtropia and amblyopia treatment in microtropia.

Introduction: Children with special educational needs are more likely to have vision problems than peers in mainstream education. Reports focus on visual acuity and refraction, overlooking visuoperceptual difficulties, including cerebral visual impairment. This article reports on the feasibility and outcomes of visual function testing performed during in-school visual assessments.

Method: A retrospective chart review was undertaken of children participating in a special school vision programme. The testing strategy included acuity, fields, contrast sensitivity, eye movements, accommodation, stereopsis, visual attention, refraction and a parent-completed questionnaire. The testing method was chosen based on the child's ability to engage with testing.

Results: 78 cases were identified (mean age 9.6 years). Low vision (worse than 6/19) was identified in 31%. All six tests of visual function were completed by 44% (mean 5.1; range 2-6). The mean number of atypical responses was 1 (range 0-4). Almost half (49%) showed at least one atypical response, most commonly visual attention (35%) and 25% had atypical eye movements.

Discussion: Overall, only 20% of children in the special school setting demonstrated a normal response to each test they were able to complete. Acuity testing alone does not demonstrate the atypical visual function of a child with special needs. Using techniques which require minimal cognitive, speech or motor function, a range of visual functions can be elicited during in-school testing. This testing strategy has the advantage of demonstrating areas of visual (dys)function impacting on the child's ability to access learning which can be immediately fed back to teaching staff and carers.

Background and objective: Ensuring a high level of adherence to wearing spectacles is essential to preserve eye health and achieve optimal vision correction. Comprehending the factors influencing adherence to wearing spectacles can inform strategies to improve eye care outcomes. This study aimed to assess the prevalence and factors influencing adherence to wearing spectacles among Moroccan adults residing the Beni-Mellal Khenifra region.

Methods: A cross-sectional interview survey was conducted involving 389 adult spectacle wearers. Participants were recruited through a multilevel random sampling technique and interviewed using a structured questionnaire. This questionnaire collected data on demographics, spectacle prescription, usage patterns, and barriers to compliance. Compliance was assessed based on self-reported frequency and duration of spectacle wear according to the prescription. Possible factors influencing the wearing of spectacles were investigated using both univariate and multivariate regression models.

Results: This study revealed that 57.6% of participants adhered to the recommended use of spectacles. Factors associated with compliance were higher education level, longer duration of spectacle use, awareness about the importance of spectacle wear, absence of a family history, specific refractive error types, and increased severity of refractive errors. Participants reported various reasons for not adhering to the recommended use of spectacles, with the most common being forgetfulness, perceiving improved vision without spectacle, discomfort while wearing spectacle, difficulty adapting to spectacle, and loss of spectacle.

Conclusion: Given the high prevalence of non-compliance to spectacle wear among adults in the Beni-Mellal Khenifra region, it is evident that additional efforts are required to improve understanding and education regarding the advantages of consistent spectacle usage. Targeted educational and awareness initiatives have the potential to substantially enhance adherence rates and consequently improve visual health outcomes in the region.