Binocular vision & strabology quarterly, Simms-Romano's最新文献

Introduction: Affordable, portable A-scan ultrasound technology is important to the pediatric or mission cataract surgeon. Some units (i.e.; Biopen) are no longer marketed and report poorly on atypically shaped eyes.

Methods: A clear plastic tube-housing was shaped to accept a USB-portable B-scan for supine immersion ultrasonography.

Results: With IRB approval and consent, 34 eye surgery subjects, aged 0.3 to 70 years, had both conventional contact A-scan compared with modified B-scan immersion measurements. The correlation between them was: A-Scan = 0.995 (B-Scan) +0.197. r2 = 0.995.

Discussion: The immersion B-Scan closely matched conventional A-Scan over a range of axial lengths from 18 to 26 mm.

Conclusions: Affordable combined B-Scan and A-Scan technology can be useful for the pediatric and mission cataract surgeon.

Purpose: To evaluate the surgical and functional results of slanted medial rectus resection for treatment intermittent exotropia of the convergence insufficiency type.

Methods: Fifteen patients with near vision asthenopia and intermittent exotropia of the convergence insufficiency type were included in this prospective study. The upper edge of the MR was resected more than the lower edge. Slanted bilateral or unilateral medial rectus resection was performed. The mean length of follow-up was 14.9 months.

Results: Slanted medial rectus resection(s) caused a significant postoperative reduction in the mean distance exodeviation from 11.40 to 4.53 PD, as well as a change in the mean near exodeviation from 23.93 to 10.73 PD. Although mean near-distance difference reduced from 12.53 to 6.2 PD. In final examination, 11 patients showed surgical success rate and recurrent exotropia occurred in 4 cases. On the other hand, 13 cases had experienced significant relief from their symptoms.

Conclusion: Slanted medial rectus resection is useful in decreasing the symptoms of intermittent exotropia of the convergence insufficiency type. However, it can result in undercorrection in larger deviations.

Purpose: To compare the results of a medial rectus (MR) Y-split recession with those of a MR retroequatorial myopexy for the treatment of partially accommodative esotropia with convergence excess.

Methods: In this retrospective study, patients who underwent bilateral MR Y-split recession or bilateral MR retroequatorial myopexy for partially accommodative esotropia with convergence excess (accommodative convergence: accommodation ratios greater than 5 prism diopters:diopters) between March 2006 and January 2011 were included.

Results: Sixty-one patients underwent bilateral MR Y-split recession, and 60 patients underwent retroequatorial myopexy of the bilateral MR muscles. Satisfactory binocular alignment was achieved in 77 percent of the patients who underwent MR Y-split recession by the final examination and 78 percent of patients who underwent a MR retroequatorial myopexy. There was no statistically significant difference in near or distance deviation or the near-distance disparity at the postoperative 1 month or final examination. The proportions of patients who had a successful alignment at the final examination did not differ between the two groups. No patients had any complications.

Conclusion: We determined that both the MR Y-split recession and MR retroequatorial myopexy achieved satisfactory results for the treatment of partially accommodative esotropia with convergence excess though both techniques had some disadvantages.

Introduction: The effect of the unequal visual inputs in uniocular cataracts is addressed through the hypothesis that a marked inequality of the visual inputs will have an interference effect that will degrade the binocular vision relative to that of the better eye. We tested this hypothesis of reverse interference effect by both clinical and functional Magnetic Resonance Imaging assessments in an acute unilateral cataract patient. The patient was 63 year old woman who rapidly developed a dense sub-capsular cataract following steroid radio-chemotherapy treatment for breast cancer.

Methods: Clinical: Ophthalmologic evaluation and distance visual acuity (both uniocular and binocular), contrast sensitivity, binocular function, ocular motility and cover test to evaluate the presence of strabismus, and a slit lamp assessment of cataract density were performed. Neuroimaging: Functional MRI was run in a 1.5T Philips Intera Master with a SENSE neurovascular coil of 8 channels. The experimental design included three conditions: a) Binocular: both eyes viewing; b) OS-mono: left eye viewing, right eye occluded by a black cover; c) OD-mono: right eye viewing, left eye occluded by a black cover.

Results: Clinical: The logMAR visual acuity was 0.9 OD, hand movement at one meter OS, and 0.7 for binocular viewing, that is, the binocular acuity was worse than the better eye acuity alone. As hypothesized, adding a diffuser lens and a penlight glare on the cataract eye increased the interference signal from that eye, and thus further reduced the binocular acuity to 0.4. Binocular contrast sensitivity also was worse than the OD alone. Neuroimaging: The fMRI results were consistent with the clinical findings. The number of activated voxels in the visual cortex under binocular viewing was reduced by about 40 percent relative to that for the fellow eye alone.

Conclusion: Clinical and fMRI data were well-correlated and consistent with the prediction for the marked binocular asymmetry. The results imply that the mechanisms operating under a severe binocular vision asymmetry caused by unilateral diffusion (blur without contour perception, or light perception only) exhibit an interference effect under binocular viewing that is not seen in the case of weaker asymmetry such as in functional amblyopia, or from the extreme case of total elimination of visual input from one eye, such as in occlusion or monocular blindness.

Background: New photoscreening models promise to detect amblyopia risk factors early in hopes of reducing permanent pediatric monocular and binocular vision impairment. The 3 commercially available interpreted photoscreeners had not yet been compared.

Methods: This is a prospective, observational screening study following AAPOS guidelines on pediatric patients with and without developmental delays. 270 patients in a pediatric eye practice aged 4.7 +/- 4 years with 7% special needs. From December 2011 through March 2012, the Plusoptix, the iScreen, and the Pediavision SPOT were applied before confirmatory exam in a clinical pediatric eye practice.

Results: The inconclusive rate ranged from 1-4% (iScreen) to 12% (Plusoptix). Sensitivity ranged from 72% (iScreen) to 84% (Plusoptix) and specificity ranged from 68% (SPOT) to 94% (Plusoptix). The iScreen can provide results in 99% of high risk patients.

Conclusions: In this cohort with high pre-screening prevalence, the 2011 photoscreeners had favorable validation that is expected to improve with further clinical study. Pediatricians have practical technology with a recognized procedure code to assist in amblyopia reduction.

Objective: To evaluate two cases of intermittent exotropia treated by vision therapy the efficacy of the treatment by complementing the clinical examination with a 3D videooculography to register and to evidence the potential applicability of this technology for such purpose.

Methods: We report the binocular alignment changes occurring after vision therapy in a woman of 36 years with an intermittent exotropia of 25 prism diopters at far and 18 PD at near and a child of 10 years with 8 PD of intermittent exotropia in primary position associated to 6 PD of left eye hypotropia. Both patients presented good visual acuity with correction in both eyes. Instability of ocular deviation was evident by VOG analysis, revealing also the presence of vertical and torsional components. Binocular vision therapy was prescribed and performed including different types of vergence, accommodation, and consciousness of diplopia training.

Results: After therapy, excellent ranges of fusional vergence and a to-the-nose near point of convergence were obtained.The 3D VOG examination confirmed the compensation of the deviation with a high level of stability of binocular alignment. Significant improvement could be observed after therapy in the vertical and torsional components that were found to become more stable. Patients were very satisfied with the outcome obtained by vision therapy.

Conclusion: 3D-VOG is a useful technique for providing an objective register of the compensation of the ocular deviation and the stability of the binocular alignment achieved after vision therapy in cases of intermittent exotropia, providing a detailed analysis of vertical and torsional improvements.

Importance: The gold standard of vision screening is considered acuity testing, this article will compare the gold standard against new technology to provide more choices for pediatric vision screening programs.

Objective: To determine the reliability of recognition visual acuity screening performed by a lay screener compared to the plusoptiX A09 photoscreener for the detection of amblyopia risk factors.

Design: One lay screener received basic training in how to test monocular visual acuity using the 10 foot Patti Pics single crowded chart and the plusoptiX A09 photoscreener. All children underwent a complete pediatric ophthalmology examination and cycloplegic refraction after screening and this examination was the standard against which the screening method was compared. Each patient received a pass or refer grade after either screening. For the Patti Pics screening, children were referred if they failed to reach threshold visual acuity of twenty forty in either eye; the plusoptiX determines if the child is a pass or refer based on pre-set referral criteria.

Setting: Pediatric ophthalmology clinic.

Participants: Screening was performed on children ages 3 to 10 years.

Results: Seventy-one children were screened. Flip chart-screening was found to have a sensitivity of 83%, specificity of 44%, false positive rate of 56% and false negative rate of 17%. Those same metrics for the plusoptiX A09 were 94%, 89%, 11% and 6%, respectively.

Conclusion: The plusoptiX photoscreener was more sensitive and specific in making appropriate referrals for further care than flip chart-screening in this cohort of children age 3-10. The plusoptiX A09 photoscreener operated by a lay screener is a reliable method to screen for amblyopia risk factors. These finding have important implications for community based vision screening, and screening in the medical home.

Purpose: Distance stereo acuity has been shown to be useful in monitoring conditions such as control of intermittent strabismus. The Frisby Davis distance (FD2) stereotest has been shown to be reliable and is felt to be the gold standard in England. The device however is not widely available in the United States or Canada and is not automated. This study compares the Innova distance stereoacuity test with the Frisby Davis distance (FD2) stereotest.

Methods: Twenty-seven patients with normal acuity and a normal ophthalmology exam were evaluated. Prior to dilation all patients had an Innova distance stereoacuity test and FD2 test. Both the Innova distance stereoacuity test and the FD2 test were performed at ten feet. The results of the tests were compared using Bland-Altman plot analysis.

Results: The INNOVA system tended to underestimate distance stereoacuity by approximately 30 arc seconds compared to the FD2 test. If the INNOVA results were corrected by this amount, then there was a good correlation between the INNOVA results and the FD2.

Conclusion: The Innova distance stereoacuity test underestimates stereopsis by approximately 30 arc seconds but does so with sufficient consistency that it may serve as an acceptable method of measuring distance stereoacuity. This study is the first that has correlated the Innova stereoacuity test with the FD2.