Strabismus最新文献

Introduction: Topical anesthesia strabismus surgery is practised in selected surgical situations in the management of adult strabismus. Careful patient selection and patient co-operation throughout the surgery forms the crux of successfully completing the procedure.

Objective: To discuss and identify the scope of topical anesthesia in strabismus surgery based on the current level of evidence.

Methods: A literature search of articles pertaining to the use of topical strabismus surgery was carried out and summarized. The pre-operative considerations and patient counseling, timing of administration of topical anaesthetic, nuances in the surgical technique, benefits and limitations were evaluated.

Results: The patients with relatively smaller angle of deviation, single eye surgery and patients who have not had previous strabismus surgery were preferred candidates for topical strabismus surgery. It offers the additional advantage of performing an adjustable suture technique with a one stage adjustment.

Discussion: A pre-operative office room force duction test (FDT) is important both for assessing patient co-operation and from the patient perspective with regards to the level of comfort or discomfort they may experience. The results with regards to the successful completion of the procedure and its benefits and limitations support the use of topical anesthesia in strabismus surgery in a select few.

Conclusion: This review concludes that topical anesthesia strabismus surgery can be the procedure of choice in select surgical situations in the management of adult strabismus.

Introduction: The ORTHOPHTALMO study aims to evaluate the diagnostic parameters of the screening protocol for amblyopia and risk factors for amblyopia in 3-year-olds recommended in 2019 by the French Association for Pediatric Ophthalmology and Strabismus (AFSOP). This protocol uses visual acuity, photoscreening refraction, and cover test examination performed by an orthoptist. Patient referral to an ophthalmologist is only according to recommended referral criteria. Methods: A prospective, single-center study was performed between September 2020 and June 2021 on a consecutive series of 3-year-olds consulting the Ophthalmology Centre of Clinique Rive Gauche, Toulouse, France, for vision screening. Patients were first examined by an orthoptist following the screening protocol recommended by AFSOP. All patients were then systematically examined by an ophthalmologist for cycloplegic refraction measurement (reference examination). The ophthalmologist was blinded to the referral conclusion and refraction measurements of the orthoptist. Results: A total of 300 patients (149 girls and 151 boys) were included. Examination by an orthoptist was unreliable/incomplete in 7% of cases. An abnormality was detected by the orthoptist in ≥1 of the screening tests among 42% of patients; these patients were thus considered as requiring referral to an ophthalmologist. Reference ophthalmological examination found 41% of patients required treatment. The diagnostic parameters of this screening protocol were 90% for sensitivity and 89% for specificity. Discussion: We validate the effectiveness and feasibility of the AFSOP screening protocol for detection of amblyopia and risk factors for amblyopia in 3-year-olds as well as the recommended criteria for referral to an ophthalmologist.ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT04395560.Number: NCT04395560.

Aim: To draw and analyze a science map and research trends in the field of strabismus with the method of co-word analysis. Method: In this Scientometric study, all scientific outputs in the field of strabismus indexing in the Scopus database between 2005 and 2023 have been analyzed based on various Scientometric indicators. Data analysis was conducted using Excel and VOSviewer softwares. Results: The most significant growth in scientific output occurred in 2021, while the lowest was observed in 2023. The field of strabismus classified in four subject clusters, including Strabismus and Neurology, Alignment Disorders, Visual Acuity/Refraction and Strabismus, and Binocular Vision and Strabismus. Research pertaining to Genetics and Best-Corrected Visual Acuity (BCVA) have notably emerged between 2014 and 2018, reflecting a trend toward increased research focus in these areas. Conclusion: The growth of graph scientific output in strabismus shows periodic fluctuations across various years, with its pick in 2021 and the lowest point in 2023 due to spread of COVID-19. Strabismus and neurology cluster had the highest frequently especially in the USA. Genetic and BCVA as emerging topics were frequently studied in recent years due to extensive progress of genetic science.

Introduction: There remains a lack of compelling objective evidence on whether stereopsis is necessary for an ophthalmic surgical career. It is also unclear if high-grade stereoacuity correlates with better surgical performance. The present study attempts to address this question by comparing the simulated surgical performance of subjects with different levels of stereoacuity using a virtual reality (VR) intraocular surgical simulator (EYESi, VRmagic, Mannheim, Germany). Methods: Subjects were tested based on their stereoacuity level and stratified in three age-matched groups: normal stereopsis, subnormal stereopsis, and patients with no measurable stereoacuity in the clinical setting. Eleven subjects in each group to make a total of 33 subjects with no prior surgical experience were recruited from the IWK Health Centre, Halifax, Canada (REB trial registration: 1023183). Subjects performed three attempts on a standardized microsurgical module on the EYESi VR simulator. Results: There was no significant main effect of the stereo-group that the participants belonged to on their total scores, or on the time needed to complete the task, or on the odometer value, or on the amount of injury to surrounding tissues. Discussion: This study showed that for a basic simulated microsurgical task on the EYESI intraocular surgical simulator, the performance of individuals with reduced and absent stereoacuity was statistically indistinguishable from those with normal stereoacuity. Therefore, caution is still recommended when advocating for mandatory high level of stereoacuity as a requirement for admission to training programs in ophthalmology. There is still definite need for solid evidence that stereopsis is necessary to achieve satisfactory skills in ophthalmic microsurgery.

Introduction: Social media is a widely-used avenue for the public to find health information. In particular, Instagram is a popular social media platform among adults who may have children within the amblyogenic age range, and it may be used to find amblyopia-related information. The purpose of this study is to assess the quality of the amblyopia information on Instagram. Methods: The top 200 publicly available Instagram posts about amblyopia from October to December 2022 were reviewed and scored using the Currency, Reliability, Authority, and Purpose (CRAP) test. Results: A quarter of posts were from healthcare providers (ophthalmologists, optometrists, opticians), and only 3% of posts were specifically from pediatric ophthalmologists. Most posts, however, were from businesses (51%), which were of lower quality than posts by providers. Discussion: Instagram represents a tremendous opportunity to educate the public. Better utilizing this resource may allow medical professionals to broadly spread accurate, unbiased data.

Purpose: To compare the effect of combinational office-based and home-based orthoptic training regimens with part-time patching in participants with intermittent exotropia. Methods: In a randomized clinical trial study, patients with a diagnosis of IXT were involved and randomly assigned to three groups. Patients in the control group were followed with part-time patch therapy. For the Intervention 1 group, in-office and home-based orthoptic training was prescribed along with playing with a video game software (PIVOT). For Intervention 2 group the same management protocol was incorporated except using the video game software. Evaluation of the control scale and degree of deviation, accommodation, convergence, and stereopsis was performed at baseline and at 1.5 months, 3 months, and 6 months follow-ups. Results: A total of 53 patients (21 males and 32 females) with a mean age of 10.15 ± 3.80 years (range 5-18 years) completed the treatment and follow-up visits. The angle of deviation at distance decreased significantly in all groups (p < .05). No significant reduction of near angle of deviations was found in the control group (p = .38). In the intervention groups, positive fusional vergence (PFV), stereopsis, near point of convergence (NPC), and control scale of deviation at distance improved significantly compared to the control group (all, p < .05). At six months follow-up, patients in the Int 1. group showed significantly increased amplitude of accommodation and positive relative accommodation (PRA) compared to the patients in the Int 2. and control groups (all, p < .05). Conclusion: Compared to part-time patch therapy, orthoptic training is more effective in the management of children with IXT. Using video games as a home-based therapy can improve accommodative abilities in these patients.

Purpose: To determine the agreement between phoropter Risley prism and prism bar fusional vergence amplitudes in a normative group of school-aged children, aged 8 to 17 years. Method: This prospective cross-sectional study utilized multistage sampling to recruit participants with normal binocular vision. Horizontal fusional vergence amplitudes were measured at distance and near using the phoropter with Risley prisms and the prism bar. Result: The study included 422 normal participants (48.1% male, 51.9% female) with a mean age of 12.39 ± 1.94 years. There were significant differences in the base-in break, base-in recovery, base-out blur, base-out break, and base-out recovery at distance and near between phoropter Risley prism and prism bar fusional vergences (p < 0.05); amplitudes for phoropter Risley prism were higher than that for prism bar. Their mean differences were clinically meaningful except for base-in recovery at distance; however, there was no level of agreement on Bland Altman analysis. Conclusion: Fusional vergence amplitudes measured with the phoropter Risley prism and prism bar should not be considered interchangeable in African schoolchildren.

Introduction: Although there are guidance tables in the literature on surgical dosage for primary medial rectus resection-lateral rectus recession surgery, there is a lack of consensus on the surgical gains in medial rectus re-advancement (MRR) for the management of consecutive exotropia. We compared the surgical outcomes of primary medial rectus resection-lateral recession (RR) surgery, to MRR in patients with consecutive exotropia. Methods: Retrospective, electronic note review of consecutive patients undergoing primary RR surgery for basic exotropia (RR group), convergence insufficiency-type exotropia, and divergence excess, and consecutive patients undergoing MRR with or without lateral rectus recession (MRR group) for consecutive exotropia in a teaching university hospital. Results: There were 84 patients in the RR group and 27 patients in the MRR group. The median age in the RR group was 25.50 years (range 4-79) and 45 years (18-87) in the MRR group (p = .002). Median follow-up was 7 months (3-43) in the RR group and 1 month (1-12) in the MRR group. Post-operatively, there was a median exotropia reduction of 27.00 prism diopters (PD) (range +5, -65; p < .0001) for near, and 27.00 PD (+10, -51; p < .0001) for distance in the RR group. In the MRR group, the median exotropia reduction was 34.50 PD (2, -67; p < .0001) for near and 33.00 PD (1, -67; p < .0001) for distance. There was a greater reduction in the exotropia in the MRR group compared to the RR group for distance (p = .047), but this did not meet statistical significance for near (p = 0.10). The median dose-effect relationship (PD/millimeter) was higher in the MRR group both for near deviation (2.90 vs 2.15, p = .0073) and for distance deviation (2.91 vs 2.15, =0.0041). Conclusion: Based on our study cohort, medial rectus re-advancement appears to have a greater dose-effect in reducing the distance angle of deviation for both near and distance compared to primary recess-resect surgery. Further prospective longitudinal studies would shed further light on the dose-effect relationship over time.

Purpose: To conduct a quality assessment of educational content on social media for patients with strabismus.

 Methods: TikTok and Instagram were searched for several hashtags. Educational videos meeting inclusion criteria under #strabismus and #lazyeye were analyzed using the Global Quality Scale (GQS), mDISCERN, and PEMAT-A/V tools. Statistical analysis was conducted to assess associations between video quality, metrics, and authorship.

 Results: Among the top 50 videos for #strabismus and #lazyeye on both platforms (n = 200), educational videos aimed at patients (n = 54) scored an average mDISCERN of 2.8/5, GQS of 3.3/5, PEMAT-A/V understandability of 78.5%, and actionability of 42.3%. Pearson's correlation analysis showed views and likes to be negatively correlated with mDISCERN and GQS scores (p < .05), but positively correlated with PEMAT-A/V actionability (p < .05). Content created by healthcare professionals, including optometrists and ophthalmologists, scored higher mDISCERN, GQS and PEMAT-A/V understandability scores than patient-created content (p < .05).

 Conclusion: This study highlights the significant role of social media in disseminating health information on strabismus. Educational content for strabismus has marked heterogeneity, and lower-quality videos yield more views and likes, which could lead to patients following misleading or incomplete medical advice. The positive correlation between actionability and lower-quality videos is particularly concerning, as these videos, while actionable, may encourage patients to take steps based on poorly explained information. To enhance social media as an educational tool, there is a clear need for more high-quality content created by qualified healthcare professionals, to ensure that patients receive accurate, safe guidance.