Biomedical subjects

R P Rutstein

Publications and source records attributed to R P Rutstein.

At least 19 recordsLinked to original sources

PubMed2001

Acquired unilateral visual loss attributed to an accommodative spasm.

BACKGROUND: Accommodative spasm (AS) has been reported to be a rare cause of an acquired unilateral visual loss. We describe a unique case of acquired visual loss due to an apparent unilateral AS triggered by occlusion of the contralateral eye. Clinical examination and photorefraction techniques were performed during the acute phase of the disorder and in the follow-up evaluations. CASE REPORT: An otherwise healthy 27-year-old woman presented with a 2-month decrease of vision in her left eye. Unaided visual acuity in the right eye was 20/20 and in the left eye was finger counting. Orthophoria existed at distance and near. The decrease in vision in the left eye was attributed to an apparent unilateral AS of 5 D, which occurred only when the right eye was occluded. Under the occluder, the right eye also manifested an AS. With the left eye occluded or with binocular viewing, the right eye and left eye accommodated normally. With a 5 D convex lens before the right eye, the visual acuity in the left eye was 20/20. Refractive error with cycloplegia revealed low hyperopia in each eye. CONCLUSION: AS can be the cause of acquired unilateral visual loss. To our knowledge, this is the first documented report of an apparent unilateral AS triggered by occlusion of the contralateral eye.

Accommodation, Ocular↗

PubMed2000

Distance stereopsis as a screening device.

PURPOSE: To determine the efficacy of distance stereotesting as a screening device. METHODS: Distance stereoacuity using the global Random Dot and contour Circle test of the Mentor BVAT II-SG computerized testing system was measured for 216 patients, ages 6 to 18 years, before the clinical examination. Patients were classified into pass/fail groups in the areas of refractive error change (REC), ocular deviation (DEV), visual acuity (VA), and all three together (EXAM). Legitimate cutoff scores were obtained when patients were classified as 'pass' as follows: REC if the change was 0.50 D or less in sphere or cylinder relative to the habitual correction or to emmetropia if no habitual correction; DEV if there was no heterophoria or strabismus at distance (criteria of heterophoria of < 6 prism diopters and heterophorias of any magnitude were also tested); VA if the acuity at distance was better than or equal to 20/25 in the poorer eye and better than or equal to 20/20 in the better eye; EXAM if they were pass in REC, DEV, and VA. Optimal pass/fail cutoff values for the stereopsis measurements were determined by finding the maximum chi2 value from contingency tables constructed using pass/fail levels for the screening test at each of the observed levels. RESULTS: The pass rates for REC, DEV, VA, and EXAM were 45%, 72%, 42%, and 24%, respectively. Patients passed the BVAT at the analytically determined optimal cutoff values of less than or equal to 120 sec arc for global and less than or equal to 30 sec arc for contour stereopsis. The sensitivity and specificity for global stereopsis were 0.90 and 0.40 for REC, 0.89 and 0.30 for DEV, 0.93 and 0.51 for VA, and 0.87 and 0.63 for EXAM. For contour stereopsis, the corresponding values were 0.85 and 0.42, 0.89 and 0.34, 0.91 and 0.53, and 0.84 and 0.62. CONCLUSION: Distance stereotesting is highly sensitive to small refractive error changes, heterophorias and strabismus, visual acuities < 20/25, or any of the three. Global stereopsis is only slightly better than contour stereopsis at classifying patients. Distance stereotesting has potential as an effective screening test.

Adolescent↗

PubMed2000

Spasm of the near reflex mimicking deteriorating accommodative esotropia.

PURPOSE: To describe a patient with accommodative esotropia who developed spasm of the near reflex. CASE REPORT: A 6-year-old girl with a history of successfully treated refractive, accommodative esotropia suddenly developed spasm of the near reflex after the death of a relative. The condition resolved after 2 months. CONCLUSION: Spasm of the near reflex should be considered in children with accommodative esotropia who seem to deteriorate and become esotropic once again while wearing their hyperopic glasses.

Accommodation, Ocular↗

PubMed2000

BVAT distance vs. near stereopsis screening of strabismus, strabismic amblyopia and refractive amblyopia; a prospective study of 68 patients.

PURPOSE: Although there have been studies in the past of the difference between distance and near stereopsis in intermittent exotropia, no such comparisons have been studied and/or reported for other forms of strabismus, nor for strabismic functional amblyopia, or for refractive functional amblyopia. METHODS: The study was prospective: Sixty-eight consecutive patients, ages 6-76 years, with either childhood onset strabismus and no amblyopia, childhood onset strabismus and amblyopia, or refractive amblyopia and no strabismus, had their stereopsis measured. Distance stereopsis was determined on the Mentor BVAT with Random Dot E Test (global stereopsis) and the Circle Test (contour stereopsis). Near stereopsis was determined with the Circle Test of the Randot Stereotest. The data were tabulated and analyzed statistically. RESULTS: Of the 26 strabismus/no amblyopia cases, 14 (54%) appreciated distance stereopsis. Of these, 12/14 were intermittent, and other 2 who were constant had deviations of 8 PD or less. Only 4 of the 14 appreciated global stereopsis at distance (mean = 90 sec. of arc), but all 14 appreciated contour stereopsis at distance (mean = 125 sec. of arc). Of all 26, 21 (81%) had near stereopsis (mean = 137 sec. of arc). For the 21 strabismic amblyopes, only one appreciated global stereopsis at distance (120 sec of arc), and 2 (10%) contour stereopsis at distance (mean = 210 sec. of arc). These two and 4 others (total 29%) had near stereopsis (mean = 162 sec. of arc). For the 21 refractive amblyopes, 3 appreciated global stereopsis at distance (mean = 220 sec. of arc), 11 in all, (52%) contour stereopsis at distance (mean = 121 sec. of arc) and 20 (95%) had near stereopsis (mean = 78 sec. of arc). The percentages of patients in all categories capable of appreciating distance stereopsis were "statistically significantly" (P<.05) or clinically/medically significantly different from (less than) the percentages having near stereopsis. CONCLUSIONS: distance stereopsis is more likely to be reduced or absent than near stereopsis in strabismus, strabismic amblyopia and refractive amblyopia and thus appears to be more sensitive to, and better screening for, binocular vision disorders and a stronger and better outcome standard for treatment of binocular vision disorders than near stereopsis.

Adolescent↗

PubMed1999

Relationship between anisometropia, amblyopia, and binocularity.

PURPOSE: To determine if higher degrees of anisometropia cause deeper amblyopia and poorer binocularity than lower degrees of anisometropia in children and adults. METHODS: The clinical records for 60 patients with untreated anisometropic amblyopia without strabismus, ranging in age from 3 to 39 years, were reviewed. The refractive error, the initial best corrected visual acuities in the amblyopic and nonamblyopic eyes, and the level of binocularity were recorded from each chart. The degree of anisometropia was determined by: (1) calculating the difference between spherical equivalents for each eye; (2) calculating the difference in the vertical meridians for each eye; (3) calculating the difference in the horizontal meridians for each eye; and (4) calculating the root mean square difference which also takes into account differences in astigmatic axis. The depth of amblyopia was determined by converting the visual acuity score to its logarithmic value, logarithm of the minimum angle of resolution (logMAR), and calculating the difference between the amblyopic and nonamblyopic eye. The level of binocularity was determined from stereopsis testing. RESULTS: For all patients, there was a significant relationship between the four measures of anisometropia, the depth of amblyopia, and the level of binocularity (median correlations 0.61 and 0.61, respectively). For the myopes (N = 10), there was no significant relationship between the 4 measures of anisometropia, the depth of amblyopia, and the level of binocularity (median correlations 0.34 and 0.61, respectively). For the hyperopes (N = 50), the relationship was significant for all 4 measures of anisometropia (median correlations 0.72 and 0.62, respectively). CONCLUSION: As the degree of anisometropia increases, the depth of amblyopia becomes greater and the level of binocularity becomes poorer, at least for hyperopic patients.

Adolescent↗

PubMed1998

Clinical course of accommodative esotropia.

PURPOSE: To report the clinical course of patients having accommodative esotropia and to determine whether the strabismus resolves during the adolescent years. METHODS: Patients diagnosed with accommodative esotropia from 1983 to 1991 were recalled to the clinic for re-examination. For all patients, the clinical records indicated that the esotropia had begun in early childhood and was controllable at some time during the follow-up period with plus power single vision glasses and/or bifocals. Re-examination included assessment of patient history, visual acuity, ocular alignment, versions, sensory fusion, and refractive error. The ocular alignment status with and without any current plus single vision and/or bifocal correction, and the refractive error at recall, were compared to the same findings taken at the patient's initial clinic visit. These findings were compared to determine whether the accommodative esotropia had resolved, improved, remained the same, or increased in amount. RESULTS: Thirty-nine patients participated in the study. At the time of recall their average age and follow-up period were 16.8 and 9.5 years, respectively. Before treatment, the mean eso deviation was 14.5 delta at distance and 21.6 delta at near. At recall, 15 patients used single vision glasses, 9 used glasses with bifocals, 11 used contact lenses, and 4 patients used no optical correction. Five patients (12.8%) had best corrected acuity in one eye of 20/30 or poorer. Twenty patients (57.1%) were not strabismic with their current refractive correction, whereas 15 patients (42.8%) continued to be esotropic (intermittent or constant) at distance and/or near. When assessing ocular alignment without the current plus power correction, 26 patients (82%) were esotropic and 4 patients (15.6%) were heterophoric. The mean deviation without the optical correction was 18.6 delta at distance and 19 delta at near. Of the 4 patients presenting without an optical correction, 3 were esotropic at distance and/or near and 1 patient was heterophoric. Six patients (15.3%) also had inferior oblique overaction, 2 which occurred with superior oblique palsy. Thirty-three patients (86.8%) fused the Worth dot test at distance and/or near, and 35 patients (89.7%) had stereopsis (mean, 84 sec arc). The mean spherical equivalent refractive error changed for the group from 2.77 D hyperopia at the initial evaluation to 1.95 D hyperopia at recall (mean refractive shift = -0.08 D/year). CONCLUSIONS: Accommodative esotropia persists for most patients into adolescence and early adulthood. These patients need to be carefully monitored during this period because most do not outgrow their hyperopia and some can again become esotropic.

Accommodation, Ocular↗

PubMed1996

Horror fusionis: a report of five patients.

BACKGROUND: Horror fusionis is an uncommon anomaly and is rarely reported in the literature. METHODS: Five adults with long-standing diplopia associated with horror fusionis were examined. RESULTS: All patients had strabismus since early childhood and had been treated at that time either with surgery, occlusion, and/or orthoptics/vision therapy. Prisms could not eliminate the diplopia. Graded occlusion was attempted with one patient but was not tolerated. Another patient with an asymmetrical dissociated vertical deviation could ignore the second image by fixating with the eye with the smaller deviation. Two patients reported the diplopia becoming less noticeable over the years. CONCLUSIONS: Because of its poor prognosis, the diplopia associated with horror fusionis must be differentiated from other types of diplopia occurring in adults with childhood onset strabismus.

Adult↗

PubMed1995

The relationship between duration of superior oblique palsy and vertical fusional vergence, cyclodeviation, and diplopia.

BACKGROUND: The purpose of this study was to explore the relationship between the duration of superior oblique palsy (SOP) and relevant clinical findings. METHODS: We studied 39 patients with SOP and 14 patients with normal binocular vision (NBV). Vertical fusional vergences and cyclodeviations were measured through the habitual prescription. Each patient was asked if he or she currently experienced diplopia. To establish duration of SOP, those patients were asked and grouped according to whether they were diagnosed within the past 5 years, within the past 6 to 15 years, or more than 15 years ago. RESULTS: The SOP patients were significantly different from the NBV patients on every measure except the infra recovery value. Among the SOP patients, the infra break value and the total break amplitude (infra plus supra) were the measures that were significantly different for the three SOP groups, increasing with the duration of the deviation. Since the infra break value was measured relative to any corrective prism in place, the total break amplitude proved to be the best distinguishing feature of duration of the SOP. There was no monotonic relation between the duration and the magnitude of the cyclodeviation. Likewise, there was no significant difference among the SOP groups in the frequency of reported diplopia even though there was a monotonic decrease in the percentage of diplopic patients with increasing duration of SOP. CONCLUSIONS: While an increased vergence amplitude and the presence of both diplopia and excyclodeviation distinguish patients with SOP from those with NBV, the total break amplitude is the only significant distinguishing feature of the duration of SOP.

Adolescent↗

PubMed1995

Binocular vision anomalies: an emerging cause of malpractice claims.

BACKGROUND: Tumors that affect the visual system are a significant cause of liability claims involving eyecare practitioners. Individuals with brain tumors or intraocular tumors may seek examination for associated binocular vision disorders such as strabismus and reduced acuity. A disporportionate number of these individuals are children. METHODS: A review of malpractice claims was performed to identify representative clinical presentations in which binocular vision disorders were the cause for examination. RESULTS: Strabismus and amblyopia in children, if not promptly diagnosed and properly treated, can be the basis for a malpractice claim. Binocular vision disorders may also result from brain or intraocular tumors affecting children, and failure to timely detect the presence of these underlying diseases can also become the basis for a malpractice claim. CONCLUSIONS: Eyecare practitioners should examine carefully children with binocular vision disorders to rule out the possibility of an associated brain or intraocular tumor. Key findings include decreased visual acuity, acute strabismus, and indications of neurological disease such as optic atrophy, papilledema, visual field loss, and problems with gait and coordination.

Brain Neoplasms↗

PubMed1994

Distance stereopsis in orthophores, heterophores, and intermittent strabismics.

The purpose of this study was to investigate the value of clinical testing of distance stereopsis. Distance stereopsis was assessed with the Mentor Binocular Vision Testing System (B-VAT) system for 45 patients with ocular deviations of 6 delta or more at distance (heterophoria and intermittent strabismus) and for 36 patients with orthophoria. On the average, distance stereopsis was better for patients with the smaller ocular deviations than for those with the larger ocular deviations. The mean distance stereoacuities, both contour and global, for the orthophores were 53 and 81 sec arc, for the heterophores 93 and 100 sec arc, and for the intermittent strabismics 95 and 169 sec arc. Although the average size of the deviation at distance and near for the heterophoric and strabismic patients was nearly the same, distance stereopsis tended to be poorer than near stereopsis. There was a significant difference between the proportion of orthophores and the proportion of intermittent strabismics exhibiting distance stereopsis with both contour and global stereo targets (p < 0.05).

Adolescent↗

PubMed1993

Comparing the amplitude of accommodation determined objectively and subjectively.

The purpose of this study was to determine if differences exist between subjective and objective methods of measuring the amplitude of accommodation. In a double-masked study on 57 patients, ages 6 to 35 years, 2 examiners measured the amplitude, 1 using the subjective push-up method and the other using a modified form of dynamic retinoscopy. Significant differences among the findings occurred (p < 0.001), the amplitude of accommodation being on the average 2.7 D higher with dynamic retinoscopy. The amplitudes as determined subjectively for each eye were highly correlated (gamma = 0.92), as were the objective findings (gamma = 0.85). Four other examiners also used this method of dynamic retinoscopy to determine the amplitude of accommodation on 43 patients, ages 11 to 39 years. For three examiners, the average amplitude of accommodation measured objectively was statistically similar to that measured subjectively. For the other examiner, the objective findings were on the average 1.19 D higher than the subjective findings. This study suggests that this modified form of dynamic retinoscopy can give consistent results, although different for some examiners than the traditional push-up method when determining the amplitude of accommodation.

Accommodation, Ocular↗

PubMed1992

Vertical vergence adaptation for normal and hyperphoric patients.

This paper discusses the use of vertical fixation disparity (VFD) measurements to determine a patient's ability to adapt to vertical prism. Vertical vergence adaptation for orthophoric patients, hyperphoric patients, and patients with vertical deviations associated with superior oblique paresis is reported. The effect of orthoptic training on the ability to adapt to vertical prism is also reported.

Adaptation, Ocular↗

PubMed1992

Efficacy and stability of amblyopia therapy.

To determine the efficacy and stability of therapy, we reviewed the charts of 64 amblyopes with strabismus and/or anisometropia who had been treated by direct occlusion. For patients aged 7 years or less (N = 39), 90% (35/39) showed some acuity gain, with 69% (27/39) achieving at least a doubling of acuity (0.3 log units). Fifty-four percent obtained 20/40 (6/12) or better after an average treatment period of 3.8 months. Some reduction in visual acuity (VA) subsequently occurred for 75% (24/32) of those patients followed. For patients aged 8 years or more (N = 26), 77% (20/26) showed some acuity gain with 31% (8/26) improving at least 0.3 log units. Twenty-seven percent (7/26) obtained 20/40 (6/12) or better after an average treatment period of 4.2 months, although no patients older than 10 years (N = 13) achieved 20/40 (6/12). Loss of some of the acuity gain subsequently occurred for 67% (12/18) of those followed. These findings indicate that VA can be improved by patching therapy in most patients older than 7 years, but the acuity improvement is somewhat less than in younger patients. At least 67% of all amblyopes followed for 1 year lost some of the acuity gain after cessation of therapy, regardless of the age when treated. As a reduction of the acuity gain is likely to occur within the first year after cessation of therapy, it is recommended that amblyopic patients of all ages be followed at regular intervals.

Adolescent↗

PubMed1992

Duane's retraction syndrome.

The clinical findings for 29 patients with Duane's retraction syndrome (DRS) are reported. Similar to other studies, a preponderance of females, left eye involvement, and type I DRS occurred. The incidence of both anisometropia and amblyopia was somewhat higher than for the normal population. Unexpectedly, complaints of diplopia existed for seven patients.

Adolescent↗

PubMed1991

Changes in retinal correspondence after changes in ocular alignment.

We studied the changes in retinal correspondence for 32 constant strabismic patients whose ocular alignment was altered either surgically or spontaneously over a period of time. Patients having normal retinal correspondence (N = 10) generally maintained normal correspondence after the change in ocular alignment. Patients with anomalous retinal correspondence (N = 20) behaved differently. Thirteen of these patients maintained anomalous correspondence and seven patients developed normal correspondence after the change in ocular alignment. For the patients who developed normal correspondence, the direction of the strabismus also changed. We conclude that normalization of retinal correspondence is more likely to occur in strabismic deviations that are overcorrected.

Adolescent↗

PubMed1990

Effect of cyclodeviations on the axis of astigmatism (for patients with superior oblique paresis).

Cyclodeviations may interfere with fusional ability and may also affect the refractive status. If a cyclodeviation is present, the axis of astigmatism determined under monocular viewing conditions will be different from that determined under binocular viewing conditions. The change in the axis should correlate with the amount and direction of the cyclodeviation. We measured the refractive status under monocular and binocular viewing conditions of patients with cyclodeviation of 3 degrees or more and astigmatism of 1.00 D or more. All patients had superior oblique paresis. We then compared the change in the axis of astigmatism to the cyclodeviation measured with the double Maddox rod test. The average change in the axis of astigmatism was 5.0 degrees and the average cyclodeviation was 5.2 degrees. We recommend that all patients with 3 degrees or more of cyclodeviation, 1.00 D or more of astigmatism, and capable of fusion should have their refractive status determined under binocular viewing conditions.

Adult↗

PubMed1990

Measuring visual acuity in children using preferential looking and sine wave cards.

Preferential looking using square waves is commonly used to measure visual acuity of infants. Since sine-wave gratings have the advantage of presenting only a single spatial frequency, we completed a study to develop and validate a set of acuity cards using sine waves. The subjects were 83 children (mean age = 41.5 months, range = 3 to 69 months). The sine-wave cards were compared with Teller cards. Identical visual acuity was determined in 83% of the cases. Wilcoxon non-parametric analysis provided no evidence to reject the null hypothesis of equal visual acuities between the two methods. We conclude that sine-wave cards may be used to measure the preferential looking acuity of children.

Child↗

PubMed1989

Evaluation of a new criterion of binocularity.

The purpose of this study was to assess a new criterion for binocular comfort analogous to the classical Sheard's criterion. Instead of equating the fusional demand with the monocular phoria as is done when Sheard's criterion is applied, the new criterion uses a calculated binocular fusional demand. The binocular demand was derived using a clinical measurement of the convergence accommodation per convergence (CA/C) ratio. Sheard's criterion was also evaluated. Other commonly used indicators of binocularity (heterophoria, vergences, accommodative amplitude, facility and response, fixation disparity, and the associated phoria) were measured. One hundred subjects (52 males, 48 females; mean age 26 years) were classified as either symptomatic or asymptomatic by an interviewing clinician. The examining clinician was intentionally masked as to the classification of the subjects. We hypothesized that the new criterion would best discriminate between the two groups of patients inasmuch as it is based on currently accepted dual-interaction models of accommodation and vergence. Our analysis confirmed that the CA/C ratio corresponded closely to those published previously (mean = 0.06 D/delta). Significant differences (p less than 0.05) were determined between the symptomatic and asymptomatic groups for gender, near phoria through a +2.00 D add, accommodative amplitude, positive vergences at near, and both the classical Sheard's and the new criterion. The new criterion was the best discriminator between the groups, identifying 72% correctly, an improvement of 6% over the classical Sheard's. However, various stepwise discriminant analysis procedures consistently failed to demonstrate that the calculated binocular fusional demand or the new criterion was superior to the near phoria or the classical Sheard's value. These results suggest potential clinical utility for new procedures based on recently described models of accommodation and vergence, but further development appears necessary.

Accommodation, Ocular↗