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Biomedical subjects

B J Kushner

Publications and source records attributed to B J Kushner.

At least 19 recordsLinked to original sources
PubMed1995

Grating visual acuity with Teller cards compared with Snellen visual acuity in literate patients.

OBJECTIVE: To determine the usefulness of Teller Acuity Cards for detecting three levels of vision deficit, the cutoff for amblyopia (20/40 or poorer), vision impairment (20/70), or legal blindness (20/200). DESIGN: We compared grating visual acuity with the Teller cards with Snellen visual acuity (our gold standard) in 69 literate patients with amblyopia or other cause of vision loss in a prospective masked study. RESULTS: Teller card visual acuity and distance Snellen visual acuity correlated significantly (r = .508, P < .001); however, Teller card visual acuity explained only 26% of the variation in distance Snellen visual acuity. Teller card visual acuity had a low sensitivity for detecting vision deficit of 20/40 or poorer (58%), vision deficit of 20/70 or poorer (39%), or legal blindness (24%), but somewhat more accurately reflected near Snellen visual acuity than distance visual Snellen acuity. Teller cards had a higher positive predictive value--80% for 20/70 visual acuity and 43% for legal blindness, as determined by near Snellen visual acuity. Specificity of Teller cards was 88% for detecting visual acuity loss of 20/70 and 98% for legal blindness. Negative predictive value of Teller cards for detecting visual acuity loss of 20/70 was 50% and for legal blindness was 71%. CONCLUSIONS: Teller Acuity Cards may underestimate the presence of amblyopia of all types, legal blindness, and a specified level of vision impairment (20/70). Even in the presence of normal visual acuity measurements with Teller cards, significant visual loss as assessed by standard Snellen optotypes may be anticipated in many patients.

Adolescent↗
PubMed1995

Fixation switch diplopia.

OBJECTIVE: To present guidelines for the diagnosis and management of fixation switch diplopia. BACKGROUND: Adults with a history of strabismus since childhood may experience acquired diplopia if a change in their refractive error or use of spectacles encourages fixation with their nondominant eye. This is referred to as "fixation switch diplopia." If correctly diagnosed, this seldom-recognized cause of acquired diplopia in adults can almost always be successfully treated with the proper optical management. PATIENTS: A retrospective review was carried out for all patients with the diagnosis of fixation switch diplopia who were seen in my private practice. RESULTS: A review of patient records identified 16 patients with fixation switch diplopia. In four patients, the switch in fixation was spontaneous owing to the development of myopia in the previously preferred eye in patients with mild contralateral amblyopia. Six patients developed diplopia owing to their "monovision" (one eye optically corrected for distance and the other eye presbyopic). In six patients, fixation switch diplopia occurred because a noncycloplegic subjective refraction was performed in the presence of amblyopia, resulting in an unbalanced refractive correction. In all 16 patients, symptoms were eliminated when proper optical correction was instituted to encourage fixation with the dominant eye. CONCLUSIONS: Fixation switch diplopia is a cause of acquired diplopia in adults with a history of strabismus since childhood. It can usually be successfully treated with proper optical management.

Adult↗
PubMed1995

Infantile uniocular blindness with bilateral nystagmus. A syndrome.

BACKGROUND: A syndrome has been described in which some patients with uniocular infantile blindness have a horizontal nystagmus in their contralateral, structurally sound eye. This nystagmus has the characteristics of latent nystagmus. This study investigated the hypothesis that this syndrome is present when infantile monocular blindness occurs in patients who are genetically predisposed to congenital strabismus. In these patients, nystagmus, which would be latent, is made manifest by media opacity or suppression acting as an occluder. PATIENTS: 1 prospectively studied all patients with this syndrome whom I examined between 1982 and 1994. Evaluation included a careful investigation of whether there was a family history of congenital strabismus. Three patients underwent electro-oculography. RESULTS: The series consisted of 24 patients with the syndrome of infantile uniocular blindness with bilateral nystagmus, of whom 14 (58%) had a family history of congenital strabismus. In a consecutive series of 50 patients with monocular congenital blindness caused by opacity of the ocular media but not manifesting nystagmus of the contralateral eye, only three patients (6%) had a family history of congenital strabismus. This difference was statistically significant (P < .01). CONCLUSIONS: It appears likely that the syndrome of monocular infantile blindness with bilateral nystagmus represents a manifest nystagmus of the latent type in patients who have inherited a genetic predisposition for congenital strabismus. In these patients, the monocular blindness (opacity of the media or suppression) acts as an occluder, making manifest what would have been latent nystagmus.

Blindness↗
PubMed1995

Management of diplopia limited to down gaze.

OBJECTIVE: To evaluate the usefulness of various optical and surgical treatment modalities in the treatment of patients who were symptom free in the primary position of gaze yet had symptomatic diplopia in the reading position (down gaze at near). PATIENTS AND METHODS: A retrospective chart review was conducted to identify all patients with presbyopia I have treated who were symptom free in the primary position but had diplopia in down gaze associated with vertically incomitant strabismus. Of 51 patients identified, 32 were symptomatic in down gaze due to a hypertropia associated with a unilateral inferior rectus muscle underaction. Twenty-two of these patients had previously undergone recession of the affected inferior rectus muscle for treatment of thyroid eye disease; four patients, for correction of entrapment secondary to blow-out orbital fracture; and four patients, for treatment of superior oblique muscle palsy. Two patients had undergone prior surgery for superior oblique myokymia. Eight patients had horizontal diplopia associated with an A pattern, and eight patients had horizontal diplopia associated with a V pattern. Three patients had vertical and horizontal diplopia after partial recovery from third-nerve palsy. RESULTS: The treatment modalities were varied and individualized. Treatment consisted of optical management (20 patients), surgical management (21 patients), or a combination of both (10 patients). These treatment modalities resulted in comfortable single binocular vision for reading in 41 of the 51 patients. Successful optical treatment consisted of Fresnel prisms (four patients), slab-off prisms (two patients), single-vision readers (seven patients), switch to nonprogressive bifocal lenses (three patients), and a high bifocal segment (16 patients). Successful surgical modalities included posterior fixation of the contralateral inferior rectus muscle (10 patients), surgery for A- or V- pattern strabismus (five patients), or bilateral inferior rectus muscle recession (six patients). CONCLUSION: Diplopia in the reading position frequently can be alleviated with a systematic approach that includes both optical and surgical modalities.

Adult↗
PubMed1995

Partly accommodative esotropia. Should you overcorrect and cut the plus?

OBJECTIVES: To investigate the long-term motor stability and sensory outcome of patients with partly accommodative esotropia who were overcorrected surgically and in whom the hyperopic correction was reduced postoperatively, and to determine if those results depended on the amount of hyperopia present. DESIGN: A 15-year prospective study that analyzed 5-year outcome. Patients whose esotropia was not initially overcorrected were used as controls. PATIENTS: Of 382 patients who underwent surgery for partly accommodative esotropia, 22 were surgically overcorrected and were followed up for 5 years. RESULTS: Of the eight patients in the study group with 2.5 diopters or less of hyperopia in their fixing eye, seven had good motor alignment compared with four of 14 patients who had more than 2.5 diopters of hyperopia. Ninety-one percent (148/163) of the control patients who had greater than 2.5 diopters of hyperopia maintained good motor alignment 5 years after surgery compared with 29% of the study group patients. This difference was statistically significant. Of the eight study patients with less than 2.5 diopters of hyperopia, five developed good stereopsis compared with one of 14 patients with greater hyperopia. CONCLUSIONS: Surgical overcorrection in patients with partly accommodative esotropia with greater than 2.5 diopters of hyperopia may not be reversible by postoperative reduction in the hyperopic correction. It often is reversible, however, in patients with 2.5 diopters or less of hyperopia.

Accommodation, Ocular↗
PubMed1994

Binocular field expansion in adults after surgery for esotropia.

OBJECTIVES: To determine how frequently adults with long-standing esotropia will experience an expansion of their binocular visual field after surgical correction of their strabismus and to determine if the postoperative expansion of binocular fields in esotropic adults correlates with the type of esotropia (infantile vs acquired), duration of the deviation, visual acuity in the deviating eye, or a history of satisfactory alignment in early childhood. DESIGN: Preoperative and postoperative binocular visual fields were measured in a consecutive series of 37 adults undergoing surgery for esotropia. The fields were obtained and graded by masked observers. RESULTS: Before surgery, all patients had a constricted binocular field on the side of the deviating eye. In 35 of the 37 patients, the visual fields met predetermined criteria for accuracy and were included in data analysis. After surgery, 34 of those 35 patients experienced an expansion of their binocular field consistent with the degree to which the eye was surgically straightened. There was no correlation with binocular field expansion after surgery and the type of esotropia (infantile vs acquired), duration of the deviation, visual acuity in the deviating eye, or a history of satisfactory alignment in early childhood. CONCLUSIONS: Binocular field expansion occurs in the vast majority of esotropic patients after strabismus surgery if the surgery is successful in correcting esotropia. The developmental gains that are reported in infants undergoing surgery for infantile esotropia may be due to an expansion of their binocular field after surgery.

Adolescent↗
PubMed1993

Factors influencing response to strabismus surgery.

Based on analyses in a series of 116 patients, we found that the response to strabismus surgery (degrees of change of ocular alignment per millimeter of rectus recession) correlated significantly with the preoperative deviation for esotropic and exotropic patients. The prediction of response to strabismus surgery was not improved significantly with the inclusion of axial length, age, and/or preoperative refractive error beyond the prediction provided with use of only the preoperative deviation, even though we have previously suggested that the response to strabismus surgery should be related to axial length. We believed that larger eyes should have a smaller response for the same number of millimeters of surgery than smaller eyes. We now believe that although the response to strabismus surgery does correlate significantly and inversely with axial length, this correlation may not be clinically important given the much stronger influence of preoperative deviation.

Adolescent↗
PubMed1992

A surgical procedure to minimize lower-eyelid retraction with inferior rectus recession.

Advancement of the capsulopalpebral head at the time of inferior rectus recession has been described as a technique to minimize postoperative lower-eyelid retraction. In a prospective randomized masked clinical trial, this technique combined with inferior rectus recession was compared with inferior rectus recession alone, with respect to post-operative lower-eyelid retraction. The mean (+/- SD) postoperative lower-eyelid retraction was 0.7 +/- .82 mm for patients in whom the capsulopalpebral head was advanced, as opposed to 1.3 +/- .85 mm for the control group. This difference was statistically significant (Student's t = 2.787; P = .006).

Eyelids↗
PubMed1992

Subconjunctival cysts as a complication of strabismus surgery.

Six patients were operated on for large subconjunctival cysts that developed up to 35 years after strabismus surgery. In four of these patients the cyst was found to arise between the anterior edge of the muscle and the site to which the muscle had been sutured during previous surgery. The muscle was attached to the posterior wall of the cyst and not to the sclera. A pseudotendon was found running between the point on the sclera to which the muscle had been sutured and the undersurface of the muscle far posteriorly. In the other two patients a sudoriferous cyst was found that the referring ophthalmologist had mistakenly thought to represent an abscess when excision was attempted.

Child, Preschool↗
PubMed1992

Unexpected cyclotropia simulating disruption of fusion.

Fifteen patients with diplopia associated with prior scleral buckling, prior penetrating keratoplasty, severe corneal scarring, monocular aphakia, long-standing strabismus, or prior vertical offsets of the horizontal recti were thought to have disruption of fusion because diplopia could not be eliminated with prisms. They were each found to have a substantial symptomatic cyclotropia unassociated with an obvious dysfunction of an oblique muscle. In 13 patients, diplopia resolved after the cyclotropia was corrected surgically.

Aphakia↗
PubMed1992

'V' esotropia and excyclotropia after surgery for bilateral fourth nerve palsy.

Six patients had residual diplopia at near in the downgaze position after surgery for bilateral fourth nerve palsy. They all showed a large excyclotropia in the downgaze position that was associated with a "V"-pattern esotropia and could not fuse in the reading position because of the size of the excyclotropia. They were treated with bilateral recessions of the inferior recti, which resulted in an expansion of the single binocular field of vision in downgaze, with an elimination of diplopia in the reading position. None experienced a deterioration in their alignment in the primary position.

Adult↗
PubMed1992

Postoperative binocularity in adults with longstanding strabismus.

The authors tested preoperatively and postoperatively for binocularity with the Bagolini lenses in a series of 359 adults who underwent surgery for long-standing constant strabismus. Eighty-six percent of patients showed a binocular response with the Bagolini lens test almost immediately after surgery. Regardless of the type of deviation present preoperatively, the duration of strabismus, or the depth of amblyopia in the deviating eye (if present), the vast majority of patients developed binocularity. The development of binocularity with the Bagolini lenses after surgery appears to be related to the stability of the postoperative ocular alignment.

Adult↗