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Biomedical subjects

W E Scott

Publications and source records attributed to W E Scott.

122 records · Page 7Linked to original sources
PubMedDate not supplied

The deterioration of accommodative esotropia: frequency, characteristics, and predictive factors.

A number of patients with accommodative esotropia who are initially well controlled in their spectacle correction will deteriorate. To obtain an overall estimate of the prevalence of deterioration and to examine the associated clinical features for an indication of which factors may influence deterioration, 114 charts of patients with the diagnosis of accommodative esotropia, who were followed for a period of at least 10 years, were reviewed. Results of this review showed that 15 of the 114 patients (13%) deteriorated. Overall, 73 patients had a normal AC/A ratio (viz less than 5:1 by the gradient method) and 41 patients had a high AC/A ratio; deterioration occurred in statistically identical proportions in each group. There was an increasing frequency of deterioration the longer the delay between the onset of esodeviation and prescription of optical correction. In addition, deterioration was found to be most prevalent in patients for whom the age of onset was 24 months or younger. Other parameters were consistent with features typically reported in cases of accommodative esotropia.

Accommodation, Ocular↗
PubMedDate not supplied

Long-term stability of alignment in the monofixation syndrome.

From a collection of 328 patients with congenital esotropia, 80 patients were identified who had a minimum 4-year follow-up after surgical alignment within 8 prism diopters (pd) of orthophoria. These patients were subdivided into two groups: the M.S. group (38 patients) demonstrated the monofixation syndrome; the NO M.S. group (42 patients) did not have monofixation. The alignment of patients in each group was followed over time. After 17.5 years, 74% of patients in the M.S. group maintained alignment within 8 pd of orthophoria. In the NO M.S. group, only 45% were well aligned after 14 years. The mean time to loss of stability was significantly shorter for the NO M.S. group (P less than 0.005). Our findings suggest achievement of the monofixation syndrome improves but does not guarantee stability of ocular alignment.

Amblyopia↗
PubMedDate not supplied

The diagnosis of amblyopia in cross-fixation.

Customarily, it is taught that cross-fixation, in a patient with congenital esotropia, obviates the development of amblyopia. However, our clinical experience has shown significant amblyopia in 50% of cross-fixators. In our hands, the diagnosis of amblyopia is made based on the point at which alternation of fixation takes place. By this method, if there is equal visual acuity, alternation will occur at the midline with each eye. If amblyopia exists, the sound eye will continue to follow the target beyond midline, into abduction, before the poorer seeing eye picks up fixation. In order to test the reliability of this method, using Teller acuity cards as the standard, we compared estimates of objective and subjective vision in 25 consecutive patients with congenital esotropia and cross-fixation. Our findings suggest that there may be a significant prevalence of amblyopia in cross- fixating patients and that the point at which alternation of fixation occurs is a reliable means of detecting a difference in visual acuity between the two eyes.

Amblyopia↗
PubMedDate not supplied

Prism adaptation for esotropia with a distance-near disparity.

A series of 64 patients who had surgery for esotropia with a distance-near disparity of at least 10 prism diopters was reviewed. Thirty-three patients were prism adapted for their distance deviation (PA distance). Thirty-one patients were prism adapted for near deviation (PA near). Both groups were divided into responders and nonresponders. In the PA distance group, 22 (67%) patients were responders. All responders had surgery for their prism-adapted angle. Postoperatively, 19 (86%) responders had fusion. Thirteen (68%) required bifocals to maintain fusion. In the PA near group, 21 (68%) patients were responders. All responders had surgery for their prism-adapted angle. Ninety-four percent of responders had fusion postoperatively. None needed bifocals for fusion postoperatively and none were overcorrected. The results show that those patients who were prism adapted for their near angle, responded with fusion, and had surgery for their full amount of esotropia at prism response obtained better postoperative fusion, without the need for a bifocal at near and without overcorrection at distance.

Adaptation, Ocular↗
PubMedDate not supplied

Superior oblique tuck surgery in the management of superior oblique palsies.

Three hundred and twenty-four patients with superior oblique muscle palsies required surgery over a 15-year period. Forty-four patients underwent superior oblique tuck surgery. Fifteen patients had unilateral and six bilateral tucks alone. Seventeen had unilateral tucks and three bilateral tucks in conjunction with other extraocular muscle surgery. Three had unilateral tucks with a contralateral Harada-Ito procedure. The best results were obtained with isolated superior oblique tucks and tucks in conjunction with a contralateral inferior rectus muscle recession or an ipsilateral inferior oblique muscle weakening procedure. The mean vertical correction following isolated, unilateral surgery was 3.6 prism diopters (range, 0 to 11 delta) in primary gaze and 15.3 delta (range, 0 to 40 delta) in the field of maximum deviation. The mean eso correction in downgaze with bilateral superior oblique tucks was 15.2 delta (range, 10 to 21 delta). There was no statistically significant correlation between the size of the tuck and the amount of deviation corrected. Some degree of postoperative Brown syndrome was seen in all patients, but became less marked with time and in no patient was it severe enough to require reversal of the tuck. In only four patients was there a significant lessening of the effect of the procedure with time. The results show that the superior oblique tuck procedure is an effective operation. In patients with unilateral muscle palsies, 64.3% with an abnormal head posture, 37.5% with diplopia, and 100% with both an abnormal head posture and diplopia achieved an excellent result. In patients with bilateral muscle palsies, 50% with an abnormal head posture and 66% with both an abnormal head posture and diplopia achieved an excellent result.

Adolescent↗
PubMedDate not supplied

Compliance with safety glasses wear in monocular children.

Many ophthalmologists prescribe polycarbonate "safety glasses" to protect the remaining eye of monocular patients. Others do not routinely do so when the remaining eye is emmetropic since they feel compliance is poor. To evaluate compliance with safety glasses wear in these children, we reviewed the charts of all children (< 21 years old) treated with enucleation and followed at the University of Iowa by the Pediatric Ophthalmology Service between 1962 and 1991. Safety glasses were defined as polycarbonate lenses in a frame suitable for protective wear with spherical equivalent < or = -0.75 or < or = +2.00 diopters. Fifty-six patients were followed after enucleation. Forty-six of these patients met the inclusion criteria and 33 patients were available for follow up. Eighty-five percent of patients wear safety glasses > or = 50% of their waking hours; 61% wear them > or = 80% of the time; 33% wear them 100% of their waking hours. Twenty-one of the 33 patients participate in sports. One hundred percent of the female participants and 80% to 93% of the male participants wear safety glasses, goggles, or face shields during sports. Fifteen of the 33 respondents reported at least one potentially serious accident in which the safety glasses had protected the good eye. Compliance with safety glasses wear appears to be good in this population and may prevent injury to the remaining eye.

Adolescent↗
PubMedDate not supplied

Photoscreening for amblyogenic factors.

BACKGROUND: The Medical Technology Inc (MTI) Photoscreener is a new eccentric photoscreener that is being marketed as a device for the detection of amblyogenic factors in preverbal children. The purpose of this study was to evaluate the accuracy of the MTI Photoscreener in the target population of young, healthy children. METHODS: One thousand and three healthy children between the age of 6 months and 59 months were photoscreened with the MTI Photoscreener. Nine hundred and forty nine children were included in the study and their results were compared with a complete ophthalmologic examination with cycloplegia. RESULTS: The sensitivity of the MTI Photoscreener was determined to be 81.8% with a specificity of 90.6%. The overall agreement rate was 88.8%. The positive and negative predictive values were 68.9% and 95.2%, respectively. All cases of strabismus and media opacities were detected. CONCLUSION: The MTI Photoscreener is an accurate and reliable device designed to detect amblyogenic factors in young children. The camera offers promise as a useful mass-screening tool.

Amblyopia↗
PubMedDate not supplied

20th annual Frank Costenbader Lecture--adult strabismus.

BACKGROUND: A retrospective analysis of adults with strabismus was done to examine the potential risks and the possible benefits of surgical treatment and to describe the types of adult strabismus. METHODS: Eight hundred ninety-two patients were analyzed. Age at time of surgery ranged from 9 years to 89 years. The average follow up was 34 months. Major types of strabismus were grouped by their original diagnoses. The group of patients with horizontal strabismus, which usually had an onset before 9, was termed the before visual maturity (BVM) group. The group of patients with paretic or restrictive strabismus usually had the onset of strabismus after age 9 and was termed the after visual maturity (AVM) group. RESULTS: Patients with adult strabismus can gain restoration of alignment, as well as binocular function. At the last postoperative visit, 74% of the BVM group were aligned within 15 prism diopters. Not only was restoration of alignment accomplished, many of them gained some degree of sensory fusion as measured by the Worth 4-Dot (W4D) or Titmus stereoacuity. Twenty-nine percent of patients with congenital esotropia had some sensory fusion. The other subtypes in the BVM group had even higher percentages of patients with postoperative stereoacuity. In the AVM group, 92% had fusion at the last postoperative visit. CONCLUSIONS: The outcomes of adult strabismics in our study show that certain benefits can be gained from correction of ocular alignment. Restoration of alignment, elimination of diplopia and sensory fusion are functional benefits that can be obtained through strabismus surgery in the adult patient. It is clear that adult strabismus is more than just a cosmetic problem and treatment is worthwhile.

Adolescent↗
PubMedDate not supplied

Postoperative results in inferior oblique palsy.

PURPOSE: Although rare, the entity of isolated inferior oblique palsy has been discussed in past literature. The purpose of this study is to expand on the number of cases as well as the surgical options. Postoperative clinical findings, especially head-tilt measurements also are discussed. METHODS: The charts of patients were retrospectively reviewed following surgical correction of unilateral inferior oblique palsy. Data analyzed included type of surgical correction, pre- and postoperative measurements in all fields of gaze, torsion, and sensory status. RESULTS: Twenty-eight patients were studied. Patients were separated into groups based on the type of procedure performed. Indications for each type of procedure will be discussed. Twenty-three patients had a single surgical procedure. Of these, 16 had excellent surgical results. Five patients required reoperation with four achieving an excellent surgical result. Head-tilt testing at the last postoperative visit was positive for iatrogenic superior oblique palsy (4) and residual inferior oblique palsy (3). CONCLUSIONS: In the largest series of unilateral inferior oblique palsy to date, the results appear to be good if the indications for the proper surgical procedure are followed. The number of cases of iatrogenic superior oblique palsy appear to be consistent with that discussed in previous literature, but not higher than the incidence of residual inferior oblique palsy. Postoperative head-tilt measurements were consistent with the deviation found in other fields of gaze.

Adolescent↗
PubMedDate not supplied

Surgical correction of dissociated vertical deviations.

The surgical treatment and results of 17 patients with DVD is presented. Supermaximum recessions of the superior rectus muscle were performed on the deviating eye. No lid changes or any limitation of elevation were noted following the surgery. The manifest deviation was converted to less than ten prism diopters in all except one case. Four over-corrections of two to six prism diopters of hypotropia resulted. There was no change in eye preference to the operated eye. Saccadic velocities showed no change in the acceleration or velocity of the operated superior rectus. Discussion of this technique compared to other modalities is made.

Adolescent↗
PubMedDate not supplied

Compliance with safety glasses wear in monocular children.

1. To evaluate compliance with safety glasses wear in these children, we reviewed the charts of all children (< 21 years old) treated with enucleation and followed at the University of Iowa by the Pediatric Ophthalmology Service between 1962 and 1991. 2. Fifteen of the 33 respondents reported at least one potentially serious accident in which the safety glasses had protected the good eye. 3. Compliance with safety glasses wear appears to be good in this population and may prevent injury to the remaining eye. We recommend prescribing polycarbonate safety glasses for all monocular and functionally monocular children regardless of refractive error or gender.

Adolescent↗