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Biomedical subjects

D L Bremer

Publications and source records attributed to D L Bremer.

At least 37 records · Page 2Linked to original sources
PubMed1987

The contrast sensitivity function and childhood amblyopia.

We measured contrast sensitivity function and visual acuity in both eyes of strabismic and anisometropic amblyopic patients. There was a linear relationship between contrast sensitivity function and visual acuity in the amblyopic eye. As visual acuity decreased, the contrast sensitivity function decreased along the contrast sensitivity axis, and peak sensitivity shifted to lower spatial frequencies. After patching therapy, when visual acuity reached 20/20 in each eye, suggesting that the amblyopia was cured, there continued to be statistically significant difference in the contrast sensitivity functions between the eyes. The contrast sensitivity function from the previously amblyopic eye was depressed compared to the nonamblyopic eye. A comparison between patients with strabismic and anisometropic amblyopia showed that, when matched for visual acuity, the contrast sensitivity functions were similar for both the nonamblyopic and amblyopic eyes. However, a large difference was found between the amblyopic and nonamblyopic eyes of each group.

Amblyopia↗
PubMed1986

Primary-position hypotropia after anterior transposition of the inferior oblique.

Three patients with fourth cranial nerve palsy underwent a recession of the ipsilateral inferior oblique muscle. In all three cases, the inferior oblique muscle was anteriorly displaced to the temporal border of the inferior rectus muscle. In the immediate postoperative period, all three patients developed a hypotropia and diplopia in the primary position with limitation of upgaze. The hypotropia remained stable and required retrodisplacement of the inferior oblique muscle in order to eliminate the diplopia. We emphasize the power of the anterior transposition of the inferior oblique muscle and caution its use as a unilateral procedure in patients with central fusion.

Adult↗
PubMed1985

Treatment of corneal opacification in mucolipidosis IV with conjunctival transplantation.

Mucolipidosis IV is a rare, inherited metabolic storage disease producing progressive psychomotor retardation and congenital corneal clouding. Histopathologic studies have shown that the corneal epithelium is strikingly involved with intracytoplasmic vacuolated storage material with relative noninvolvement of the corneal stroma and endothelium. Additionally, it has been noted that epithelial removal results in corneal clarity. We treated a 28-month-old patient with mucolipidosis IV with conjunctival transplantation with donor conjunctiva from an unaffected sibling. Improved corneal clarity resulted and has persisted with a follow-up of one year.

Adult↗
PubMed1984

Surgical treatment of the upshoot and downshoot in Duanes' retraction syndrome.

The upshoot and downshoot that occurs when the eye is rotated into the adducted position in Duanes' retraction syndrome is believed to be related to a taut or leash effect from the lateral rectus muscle. When the eye is adducted, the lateral rectus muscle is believed to "slip" over the globe, producing this abnormal movement. Five patients with Duanes' retraction syndrome demonstrated this finding and underwent a splitting of the lateral rectus into a Y configuration. All five patients demonstrated a marked decrease in the up- or downshoot after surgery.

Child↗
PubMed1984

Surgical treatment of the upshoot and downshoot in Duanes retraction syndrome.

The upshoot and downshoot that occurs when the eye is rotated into the adducted position in Duanes retraction syndrome is believed to be related to a taut or leash effect from the lateral rectus muscle. When the eye is adducted, the lateral rectus muscle is believed to "slip" over the globe producing this abnormal movement. Five patients with Duanes retraction syndrome demonstrated this finding and underwent a splitting of the lateral rectus into a Y configuration. All five patients demonstrated a marked improvement in their up or downshoot after surgery.

Child↗
PubMed1983

Pilomatricoma in a pediatric hospital.

Of 150 cases of pilomatricoma in Columbus (Ohio) Children's Hospital, nearly 45% were discovered before the age of 5 years and 80% were present by 10 years of age. Lesions involved the periorbital region in 17% of the cases; the upper lid and brow were involved most frequently. These lesions were frequently misdiagnosed: only two of the periorbital cases were correctly diagnosed prior to excisional biopsy.

Adolescent↗
PubMed1981

Cycloplegic refraction in esotropic children. Cyclopentolate versus atropine.

Retinoscopy was performed on a population of predominantly white esotropic children younger than 5.5 years with cyclopentolate 1% and atropine 1.0%. Atropine 1.0% revealed +0.34 diopters more hyperopia than cyclopentolate 1.0%, when the mean differences between the two drugs were examined. Mean difference analysis would probably indicate that atropine retinoscopy was unnecessary. However, 22% of the children had +1.0 diopters or more of hyperopia uncovered by atropine. This significant subpopulation suggests that in young patients with esotropia, an atropine refraction is essential to uncover the maximum amount of hyperopia. Almost all of this subgroup with +1.00 or greater hyperopia had an initial cyclopentolate retinoscopy of +2.00 diopters or more. Therefore, retinoscopy using atropine cycloplegia becomes even more important in this population. There was a trend for the greater differences to be in children older than age 2 years. However, these values were not statistically significant.

Accommodation, Ocular↗
PubMedDate not supplied

Clinical assessment of visual function in the young child: a prospective study of binocular vision.

Binocular vision was evaluated in 12 children with infantile esotropia before and after corrective surgery. Stereopsis was measured by the eye movement/global stereopsis method. Also in a subgroup of four infants, binocular and monocular pattern VERs were recorded to evaluate binocular summation. Results revealed 50% of the infantile esotropia children who had corrective surgery before one year of life developed gross stereopsis two weeks following surgery. In addition, of four infants who showed no evidence of stereopsis, 50% showed some degree of binocular summation following surgery. The importance of prospective studies of binocular vision in infantile esotropia is discussed within the context of new tests that can be used to objectively assess binocularity in the preverbal child.

Esotropia↗
PubMedDate not supplied

Contrast sensitivity functions in normal children with the Vistech method.

The Vistech Contrast Sensitivity Function tester (VCTS 6500-1) for distance was evaluated to determine the minimum age of children who could complete the test and to determine changes in the CSF as a function of age. A total of 72 normal children between the ages of 24 and 84 months were tested twice with each eye. The results revealed that no child below 36 months of age could complete the test and by 48 months of age 50% could complete the test. By 60 months all children could complete the test. It was also found that age increased the CSF increased equally at all spatial frequencies. A comparison between the eyes of the CSFs revealed a highly statistically significant correlation of 0.78, which showed that the eyes were very similar. Test-retest correlations (0.78) also were highly statistically significant, which demonstrated that the test was very reliable. The results are discussed within the context of screening young children for visual disorders and the evaluation of patching therapy for amblyopia.

Child Development↗
PubMedDate not supplied

Screening of school-aged hearing impaired children.

Three hundred sixty hearing-impaired students were screened for visual problems, including Usher's syndrome, with a complete ophthalmologic exam and electroretinography (ERG). Over 25% were found to have a significant refractive error, and approximately 32% had one or more pathologic findings. Overall, 43% either had a significant refractive error or pathologic finding. The incidence of Usher's syndrome was estimated to be between 1.1% and 1.9% in the hearing impaired student population. The results emphasize the need for a complete ophthalmologic examination, and possible ERG testing, in the hearing impaired student population.

Adolescent↗
PubMedDate not supplied

Anterior tendon displacement of the inferior oblique for DVD.

The effect of grading the anteriorization of the posterior portion of the inferior oblique muscle tendon fibers, relative to the insertion of the inferior rectus, was assessed for patients with dissociated vertical deviation (DVD). The placement of these fibers was varied dependent on the degree of preoperative DVD. The results from the graded group were compared to a group of patients with DVD that always received the same amount of anteriorization regardless of the degree of preoperative DVD. The results showed that, in general, anteriorization of the inferior obligue muscle tendon fibers to the level of insertion of the inferior rectus was an effective treatment for DVD. In addition, grading the anteriorization of the posterior portion of the inferior oblique muscle tendon fibers significantly decreased residual postoperative deviation.

Adolescent↗
PubMedDate not supplied

Amblyopia: the normal eye is not normal.

When acuity was used to evaluate amblyopia in children, the amblyopic eye had decreased acuity and the nonamblyopic eye had normal acuity. However when Contrast Sensitivity Functions (CSFs) were used to evaluate amblyopia, losses in the CSF were discovered in both the amblyopic and the nonamblyopic eyes. During the course of occlusion therapy, the amblyopic eye improved in acuity and CSF and the nonamblyopic eye improved in CSF. The results suggest that the nonamblyopic eye is not normal and that the CSF provides additional information to acuity about amblyopia in children.

Amblyopia↗
PubMedDate not supplied

Levodopa and childhood amblyopia.

A pilot study was undertaken to address the tolerance and efficacy of levodopa/carbidopa treatment for amblyopia in older amblyopic children who failed to respond to conventional occlusion therapy. Five amblyopic children, between the ages of 7 and 12 years, and two normal adults were given between 100 mg/25 mg and 400 mg/100 mg of levodopa/carbidopa, respectively, depending on body weight. A symptoms questionnaire was completed, with temperature, respiration, heart rate, and blood pressure taken periodically to assess tolerance. Blood samples were taken, via a heparin well, to assess the pharmacokinetics of levodopa, dopamine, noradrenaline, and DOPAC. Snellen visual acuity, contrast sensitivity, stereo acuity, and pattern VERs were measured periodically to assess efficacy. The results revealed a high prevalence of side effects including emesis and nausea (four of seven subjects). Pharmacokinetics revealed that maximum serum levels of levodopa occurred 30 minutes to 1 hour after drug ingestion and decreased by 50% after 2 to 4 hours. One hour after drug ingestion, Snellen visual acuity temporarily improved from an average of 20/159 to 20/83 in the amblyopic eyes. Contrast sensitivity and pattern VERs (10-minute checks) temporarily improved in both dominant and amblyopic eyes, whereas visual function remained stable in normal eyes. The improvements in visual function started to decrease 5 hours after drug ingestion. The results are discussed in the context of developing a therapeutic trial of levodopa/carbidopa for childhood amblyopia.

Adult↗
PubMedDate not supplied

Longitudinal study of levodopa/carbidopa for childhood amblyopia.

To determine the tolerability and efficacy of levodopa/carbidopa combined with occlusion therapy for childhood amblyopia, a double-masked placebo-controlled randomized longitudinal study was performed on 10 amblyopic children between 6 and 14 years of age. Subjects received, on average, 20/5 mg levodopa/carbidopa or 20 mg of placebo three times per day combined with part-time occlusion over a 3-week period. Visual function was assessed by Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity charts and by contrast sensitivity. Tolerability was assessed by questionnaire, SMAC (standard laboratory tests; consists of a chem 20 and complete blood count [CBC]) analysis, and physical examination. Compliance with occlusion and capsule consumption were assessed by questionnaire and by capsule count, respectively. At the end of the dosing regimen, the levodopa/carbidopa group significantly improved in visual acuity by 2.7 lines and in mean contrast sensitivity by 72% in the amblyopic eye. The placebo group improved in visual acuity by 1.6 lines in the amblyopic eye. Tolerability and occlusion compliance were similar between groups; however, capsule ingestion compliance was significantly lower in the levodopa/carbidopa group. One month after the termination of treatment, the levodopa/carbidopa group maintained a significant 1.2-line improvement in visual acuity and 74% improvement in contrast sensitivity in the amblyopic eye. The placebo group did not maintain an improvement in visual acuity between the eyes. It is concluded that levodopa/carbidopa, at an average of 0.48/0.12 mg/kg, is well tolerated and, when combined with part-time occlusion, is efficacious in improving visual function in amblyopic children.

Adolescent↗
PubMedDate not supplied

SKILL card results in amblyopic children.

Two experiments were undertaken to assess high contrast-high luminance (HCHL) and low contrast-low luminance (LCLL) visual acuity as measured with the Smith-Kettlewell Institute Low Luminance (SKILL) card, in childhood amblyopia. In experiment 1, HCHL and LCLL visual acuity was measured in 11 amblyopic children and in 12 normal children of similar age. The results revealed that HCHL visual acuity was similar in the normal eyes and in the amblyopes' dominant eyes, and was abnormal in 91% of the amblyopic eyes. LCLL visual acuity was significantly worse in normal eyes compared to the amblyopes' dominant eyes, and was abnormal in only 64% of the amblyopic eyes. In experiment 2, HCHL and LCLL visual acuity was measured in seven previously tested amblyopic children, after a 5-month interval, and in six additional amblyopic children. In the amblyopic children who were tested twice, significant test-retest reliability for HCHL and LCLL visual acuity was found and visual acuity varied by 3.6%. The results of experiment 2 corroborated the results of experiment 1 from the amblyopic children. It is concluded that visual acuity in the amblyopic eye tends to normalize under low contrast-low luminance conditions. In addition, the mechanism(s) underlying amblyopia appear also to influence the dominant eye, resulting in superior visual acuity under low contrast-low luminance conditions.

Adolescent↗