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PubMed1985

General binocular dysfunctions in an urban optometry clinic.

The prevalence of general binocular dysfunction with asthenopia was determined for non-presbyopes at an urban optometry clinic serving municipal workers and their dependents. Of the sample of 119 patients, 42.9% had jobs with heavy desk work demands (primarily secretarial and clerical) and 39.5% were students. The prevalence of symptomatic general binocular dysfunction was 21.0%. Accommodative dysfunctions were the most commonly encountered condition at 16.8%. Symptomatic near esophoria was found in 5.9% of patients and convergence insufficiency in 4.2%. Both vergence dysfunctions overlapped with accommodative dysfunctions.

Adolescent↗
PubMed1984

Divergence excess: characteristics and results of treatment with orthoptics.

This paper retrospectively examines the results of the treatment of 18 subjects (11 males, seven females) with divergence excess, using orthoptics. The mean age of the subjects was 15.8 years, which was significantly younger than the population from which this group was referred. Diplopia (89%) and asthenopia (56%) were the most frequently reported symptoms. Seventy-two per cent of the subjects had intermittent deviations of the eyes. Over the mean necessary course of treatment of 5.2 weeks, the distance angle of deviation (slightly) and the positive vergences at distance and near were found to have changed significantly. The near angle of deviation, the negative vergences, the near point of convergence, the amplitude of accommodation, and the threshold of stereopsis were found to have remained stable over the treatment period. Further results of the study are presented and the implications of these results with regard to the treatment of divergence excess are briefly discussed.

Adolescent↗
PubMed1982

[Headache and the eye].

The contribution of ophthalmology in the diagnostic evaluation of a patient with headache is outlined. When asthenopia or an organic eye disease is cause of the headache, the ophthalmologist cannot only diagnose the etiology but can also cure the patient by adequate therapy. When the headache is sign of CNS-disease, the ophthalmologist can provide the neurologist with valuable information regarding nature and localization of the process.

Asthenopia↗
PubMed1995

A new protocol for the optometric management of patients with reading difficulties.

Research by Evans et al. (Ophthal. Physiol. Opt. 15, 481-487, 1995) has demonstrated a correlation between visual processing and ocular motor factors in people with specific reading difficulties (dyslexia). In addition, research by Wilkins et al. (Ophthal. Physiol. Opt. 14, 365-370, 1994) has shown that some people with dyslexia will benefit from a reduction of perceptual symptoms of discomfort and distortion if they use individually prescribed coloured filters. Three examples of the dyslexic patients who attend at the Institute of Optometry clearly demonstrate the importance of full investigation of ocular function, including the assessment of the effect of colour on visual perception. All three patients presented with similar symptoms of asthenopia when reading. Symptoms were alleviated for the first patient by use of orthoptic treatment of an exotropia with intermittent suppression. With the second patient, ocular motor functions were found to be within acceptable limits and relief of symptoms was obtained by the prescribing of lenses of a specific chromaticity. For the third patient, both orthoptic intervention and the use of specifically tinted lenses were necessary to relieve the visual difficulties that were being experienced. By taking advantage of recent research and developments in optometric instrumentation, it is possible for some of those with dyslexia to receive considerable benefit from optometric intervention.

Adolescent↗
PubMed1995

Is there a need for binocular vision evaluation in low vision?

The purpose of this study was to determine the need for a binocular vision evaluation in the management of low vision patients. Thirty subjects were selected with visual acuities of at least 6/60 in each eye. Twenty-three had age-related macular degeneration as the primary ocular pathology and seven had various other ocular conditions. The binocular vision evaluation comprised: detailed history and symptoms with an emphasis on the occurrence of near vision problems; modified binocular vision assessment which included cover test at near, ocular movements, convergence, Bagolini glasses, horizontal vergence reserves and prismatic measurement of any observed anomaly. History and symptoms revealed horizontal and vertical diplopia, jumbling of print, asthenopia, intermittent blurring and print being too small. Binocular vision assessment revealed exophoria at near, manifest horizontal deviations, convergence insufficiency, and vertical muscle imbalance. These anomalies occurred either singly or in combination. The results indicate that there is a need for binocular vision evaluation in low vision in order to reveal near vision disorders that may be partly attributable to binocular vision anomaly and not solely due to ocular pathology. This information should facilitate the implementation of the appropriate course of optometric management for these patients.

Aged↗
PubMed1984

Neurotoxic effects of organic solvents in exposed workers: an occupational, neuropsychological, and neurological investigation.

Ninety-eight workers, 65 exposed to organic solvents and 33 unexposed, were examined in order to assess possible neurotoxic signs and symptoms related to solvent exposure. The study group, who were selected according to the type of exposure in a given work process, had been exposed to various types of solvents. The groups were comparable in regard to age, the history of brain traumas and other neurological diseases, and alcohol consumption. The exposed workers had more symptoms of intellectual impairment, poorer performances in psychological tests, and more often signs of cerebral asthenopia. Symptoms and signs of peripheral neuropathy were not significantly increased. Solvent exposure and neurotoxic signs and symptoms were mildly correlated in the study group. Such dose-effect correlations have previously been proved only in a few epidemiological studies. This warrants reevaluation of the risk of developing toxic encephalopathy during prolonged occupational exposure to solvents.

Adult↗
PubMed1982

Statistical demonstration of minor colour vision abnormalities.

Analysis of the results from 94 male and 94 female young normal trichromats on the 100 hue test and the Nagel and Pickford-Nicolson anomaloscopes that colour deviant and/or colour weak subjects can be distinguished from the wholly normal bulk by considering the normality of certain test result distributions as well as by considering the combinations between test results considered abnormal. The stated minor abnormalities of colour vision are frequent and their types are those described by Pickford and by Lakowski (never' colour asthenopia). They are recognised by means of the anomaloscopes and not by means of the 100 hue test.

Adolescent↗
PubMed1983

Accommodative dysfunction.

A retrospective review of the records of 114 subjects with accommodative dysfunction has been completed. Most subjects (N = 96) were found to have accommodative insufficiency. Lesser numbers of subjects were categorized in the class of infacility of accommodation (N = 14), spasm of accommodation (N = 3) and fatigue of accommodation (N = 1). A majority of the subjects presented with complaints of blur, headaches and/or asthenopia while attempting nearwork. Most subjects presented with reduced abilities in one or more of the following areas: accommodative amplitude and facility, fusional vergences, near point of convergence and stereo acuities. The clinical characteristics of the group as a whole and the major subgroups have been examined both before and after treatment of the condition with orthoptic exercises and/or plus lenses at the nearpoint. The result of the treatment indicates that although most subjects (96%) experienced some relief with treatment only about half (53%) had their problems totally solved. The importance of these findings is briefly discussed.

Accommodation, Ocular↗
PubMed2006

Horizontal and vertical micropsia following macula-off rhegmatogenous retinal-detachment surgical repair.

BACKGROUND: Dysmetropsia or distorted image size perception (smaller: micropsia; larger: macropsia) is known to occur after successful surgical re-attachment for macula-off rhegmatogenous retinal detachment. However, the vertical and horizontal components of size distortion have not been previously quantified separately. The purpose of this article is to describe horizontal and vertical dysmetropsia occurring in patients following pars plana vitrectomy and gas treatment (octafluoropropane, C(3)F(8) or sulfur hexafluoride, SF(6)) for macula-off rhegmatogenous retinal detachment. MATERIAL AND METHODS: Four patients (mean+/-SD, 59+/-8 years; three women and one man) who had had pars plana vitrectomy and gas treatment for macula-off rhegmatogenous retinal detachment 6-7 months earlier underwent ocular examination, best corrected visual acuity test, threshold horizontal and vertical dysmetropsia measurement using a computerised version of the New Aniseikonia Test, slit-lamp examination and optical coherence tomography of the macula. RESULTS: All patients had binocular visual complaints including difficulty judging distances or reading, rivalry or asthenopia. The logMAR visual acuity (mean+/-SD) in the operated eye was 0.52+/-0.199 and 0.02+/-0.171 in the unaffected eye. All patients perceived the image as smaller (micropsia) with the affected eye, with differences ranging from -9 to 0%. Four patients showed 3% or more size difference between horizontal and vertical meridians. CONCLUSIONS: Dysmetropsia does occur in symptomatic patients following successful surgical repair of macula-off rhegmatogenous retinal detachment by pars plana vitrectomy and gas treatment. The effect on image size is heterogenous across the retinal area affected.

Aged↗
PubMed1988

Postural modifications of VDU operators wearing bifocal spectacles.

This paper describes the postural changes experienced by presbyopic operators of VDU workstations while wearing a pair of bifocal spectacles. All operators reported in this paper had suffered neck and back aches, in addition to generalised problems of asthenopia, while using the VDU workstation. The ages of the operators ranged between 47 and 58 years. The operators' head movements, in looking from the keyboard to the screen, were two to three times greater when bifocal spectacles were worn compared with specially prescribed single-vision occupational spectacles. There were also greater movements in the flexion of the wrist and elbow while using bifocal spectacles and looking from the keyboard to the screen. There was no relationship between the amount of head movement and the position of the bifocal reading segment with respect to the operators' pupil. It was concluded that the symptoms reported by these presbyopic operators were due to static loading of the muscles in the neck and back, induced by the use of bifocal spectacles.

Journal Article↗
PubMed1990

The effects of long-term VDT usage on the nature and incidence of asthenopic symptoms.

An opportunity arose in 1985 to become involved in a transition of working practice from hard copy to VDT. Over a two-year period, 161 VDT users and 65 control subjects in the same office environment were regularly and routinely examined for symptoms of asthenopia. The analysis of data shows that there are no significant differences in type, number and frequency of the work-related symptoms between VDT users and non-VDT users. It appears that reporting of symptoms within the group may be random, although certain symptoms do appear more frequently than others. Additionally, it appears that there is a significant difference between male and female users in the frequency of symptom reporting.

Journal Article↗
PubMed2006

The Amblyopia and Strabismus Questionnaire: English translation, validation, and subscales.

PURPOSE: To establish the English-language version of the Amblyopia and Strabismus Questionnaire (ASQE). DESIGN: Prospective cohort study. METHODS: A structured translation process was followed to generate the ASQE, a 26-item instrument (originally in Dutch) containing five subscales for fear of losing the better eye, distance estimation, visual disorientation, double vision, and social contact and appearance. The ASQE was administered to 150 adults in a private practice setting. All had strabismus with or without amblyopia and visual acuity of 20/50 or better in at least one eye. Subjects also completed a brief disability questionnaire, and they were further characterized by levels of unilateral vision loss, diplopia, and asthenopia. RESULTS: ASQE scores were highly correlated with the disability questionnaire outcomes (r = -.76, P < .0001). Internal consistency reliability (Cronbach alpha) of the subscales ranged from 0.80 to 0.92. Strong correlations were found between clinical characteristics and the ASQE (total score and subscale scores). CONCLUSIONS: The ASQE showed good psychometric properties that are in line with those of the original instrument. This, combined with strong correlations between ASQE scores and clinical characterization of the participants, establishes the ASQE as a useful tool for use in populations with strabismus and/or amblyopia.

Adolescent↗
PubMed1984

Ergonomics and lighting.

The two main principles of ergonomics can be said to 'fit the job to the man', or 'fit the man to the job'. To a high extent this is really valid for lighting ergonomics. If an employee complains that he (or she) cannot see properly what he is doing in his work it could be adjusted either by improving the job itself or by improving the visual capacity of the person in question (eg, prescribing correct work glasses). If improving measures are not taken local eye discomfort may develop with symptoms as fatigue, ache, pain, burning, pulling, tearing, etc. These symptoms make up a syndrome called asthenopia, otherwise succinctly known as eye strain. The causes of the syndrome can be myriad - but all fall in under the headings 'bad' lighting, 'bad' eyes and 'bad' work.

Journal Article↗
PubMed2005

[Comparison of two surgical techniques for the treatment of superior oblique palsy].

AIM: To compare two surgical techniques for the treatment of superior oblique palsy. PATIENTS AND METHODS: Retrospective study involving 32 patients operated on at the Rouen Teaching Hospital for superior oblique palsy. Group 1 patients were treated by surgical reinforcement of the superior oblique muscle and group 2 patients were treated by surgical loosening (or weakening) of the antagonist muscles. One-year follow-up explored head tilt, diplopia, vertical deviation and cyclotorsion. RESULTS: Functional results (presence of diplopia or stiff neck) were positive in both groups but better in group 1. Only 12.5% of patients required a second operation. Cyclotorsion amounted to less than 2% in group 1 and was still greater than 8% in group 2; on the other hand, vertical deviation had improved more in group 2, where it decreased to 2.1 diopters versus 3.1 in group 1. DISCUSSION: and conclusion: Only reinforcing the superior oblique adequately corrects cyclotorsion, which is the main cause of asthenopia and diplopia, despite an often insufficient height correction that is otherwise clinically well tolerated. We suggest reinforcing the superior oblique as a first intent rather than weakening hyperactive muscles, and in case of excessive postoperative height, we would carry out additional treatment of one of the hyperactive muscles later.

Adolescent↗
PubMed1999

A review of the management of 323 consecutive patients seen in a specific learning difficulties clinic.

Visual correlates of specific learning difficulties (SpLD) include: binocular instability, low amplitude of accommodation, and Meares-Irlen Syndrome. Meares-Irlen Syndrome describes asthenopia and perceptual distortions which are alleviated by using individually prescribed coloured filters. Data from 323 consecutive patients seen over a 15 month period in an optometric clinic specialising in SpLD are reviewed. Visual symptoms and headaches were common. 48% of patients were given a conventional optometric intervention (spectacles, orthoptic exercises) and 50% were issued with coloured filters, usually for a trial period. 40% of those who were given orthoptic exercises were later issued with coloured overlays. 32% of those who were issued with coloured overlays were ultimately prescribed Precision Tinted lenses. Approximately half the sample were telephoned more than a year after the last clinical appointment. More than 70% of those who were prescribed Precision Tints were still wearing them daily, and results for this intervention compared favourably with data for non-tinted spectacles. The data suggest that many people with SpLD need optometric care and that the optometrist needs to be skilled in orthoptic techniques and cognisant of recent research on coloured filters.

Accommodation, Ocular↗
PubMed2002

Randomised controlled trial of the effect of coloured overlays on the rate of reading of people with specific learning difficulties.

A randomised controlled trial has demonstrated that, for selected children with reading difficulties, individually prescribed coloured filters reduce symptoms of asthenopia. In the present study, we investigate the effect of individually prescribed coloured overlays on the rate of reading. Subjects were 33 children and adults who: had consulted a specific learning difficulties clinic; had received treatment to normalise any conventional optometric and orthoptic anomalies; and subsequently reported symptomatic relief from coloured filters. These subjects carried out the Wilkins Rate of Reading Test (which assesses visual rather than linguistic factors) under two conditions: with their chosen coloured overlay and with a control filter. Steps were taken to ensure that a strong placebo effect was associated with the control overlay and, when asked which they preferred, subjects were not significantly more likely to prefer their coloured overlay than the control filter (p=0.11). Nonetheless, the rate of reading was significantly faster with the coloured overlay than with the control (p=0.0019). Further analyses support the conclusion that individually prescribed coloured filters can improve reading performance for reasons that cannot be solely attributed to conventional optometric factors or to placebo effects.

Adult↗
PubMed2004

[Decompensated strabismus surso-adductorius].

Strabismus surso-adductorius is a frequent unilateral or bilateral eye movement disorder. Its clinical features include eye elevation with concomitant vertical deviation in adduction, an abnormal head posture from which the patient is unaware (head turned and tilted towards the healthy side), a moderate subjective excyclotorsion, and a positive Bielschowsky head tilt test. Despite its anglo-saxon denomination as "congenital fourth nerve palsy", it is not a paretic disorder. Strabismus surso-adductorius differs from fourth nerve palsy both by etiology and by symptoms. A proper diagnosis is important as neuroradiological examination is mandatory in cases of acquired non-traumatic fourth nerve palsy, whereas decompensated strabismus surso-adductorius can be operated on without any further investigations. Early on, the oculomotor disorder is often well compensated and it does manifest at the adult age. Asthenopia and intermittent vertical diplopia appear as the fusional mechanisms fade out. The best surgical technique for strabismus surso-adductorius is an inferior oblique weakening procedure. In severe cases a combined shortening of the superior oblique tendon may be necessary.

Adult↗
PubMed1994

[Sensory and current political weaknesses of prismatic correction with the Polatest].

BACKGROUND: The adherence of the Polatest try to enforce prismatic correction in cases of heterophoria, asthenopia, dyslexia and other kinds of disorders. They claim that some sensorial anomalies exist which can be diagnosed only by the Polatest and for which special terminology is used. The Polatest-Doctrine in microtropias, subnormal binocular vision and obligate fixation disparity leads to excessive amount of prisms and unnecessary eye muscle surgery. METHOD AND CONCLUSION: The reason for this is the erroneous interpretation of the Stereo-test with the two triangles, where it is not possible to distinguish between binocular vision or monocular suppression of the binocular visible dot. As some opticians prescribe prisms on their own, sometimes for patients who are treated by ophthalmologists, this method leads to arguments between ophthalmologists and those opticians.

Child↗