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PubMed1998

[Cardiovascular autonomic regulation following orthoptic heart transplantation].

Numerous recent observations have indicated autonomic reinnervation of transplanted human hearts. In order to assess autonomic regulation 5 patients were studied 1 to 5 years following cardiac transplantation. A series of tests were performed, including blood pressure and ECG recordings on rest, during 15/min patterned breathing, isometric handgrip exercise, and Valsalva manoeuvre. The time domain indices (SDRR, pNN50, rMSSD) and the frequency domain indices of heart rate variability were also studied. Among the five patients under study only one exhibited features compatible with both sympathetic and parasympathetic reinnervation. Traditional autonomic reflex tests and the analysis of time and frequency domain indices of HRV serve as simple tool in primary assessment of cardiac reinnervation.

Adult↗
PubMed2004

Speed-accuracy of saccades, vergence and combined eye movements in children with vertigo.

Vergence abnormalities could lead to inappropriate vestibulo-ocular reflex (VOR), causing vertigo and imbalance (Brandt 1999). Indeed, a recent study by Anoh-Tanon et al. (2000) reported the existence of a population of children with symptoms of vertigo in the absence of vestibular dysfunction but with abnormal vergence findings in orthoptic tests. The purpose of this study was to examine in such children the accuracy, duration and mean velocity of vergence and saccades; additionally, for a few subjects, the effect of orthoptic vergence training on these parameters was also investigated. LEDs were used to stimulate saccades, pure vergence along the median plane and combined saccade-vergence movements. Movements from both eyes were recorded with a photoelectric device (Bouis). The results show that children with vertigo perform saccades as normal subjects of comparable age. In contrast, vergence, particularly convergence, shows abnormalities: poor accuracy, long duration and low speed. During combined movements, the well known reciprocal interaction between the saccade and the vergence is present only for saccades combined with divergence; for saccades combined with convergence such interaction is abnormal: the saccade is slowed down by the convergence but the convergence is not accelerated by the saccade. Orthoptic training improves significantly the accuracy of all eye movements; such improvement was significant for all types of eye movements except for divergence (pure and combined). Furthermore, convergence remains abnormal and the lack of acceleration by the saccade persists. These specific convergence deficits could be of both subcortical and cortical origin. Orthoptic training improves the accuracy presumably via visual attentional mechanisms, but cannot completely override deficits related to subcortical deficiencies.

Adolescent↗
PubMed2002

The assessment and management of strabismus and amblyopia: a national audit.

AIMS: To determine what systems are in place within ophthalmic services for the assessment and management of children suspected of having amblyopia and strabismus. To find out what methods are used for the assessment of these children. METHODS: A questionnaire-based study auditing 288 orthoptic departments in the UK. RESULTS: Responses were received from 75% orthoptic departments. Most hospitals employ more than one system for the assessment of strabismus and amblyopia, which is generally dependent on route of referral. These include 'orthoptic assessment without refraction' (66%), 'combined orthoptist and ophthalmologist assessment' (66%), while 22% have an entirely orthoptist/optometric system. Ophthalmologists are involved in the initial assessment in 145 units (67%), whereas some units involve an ophthalmologist only if response to treatment is poor (15%), or if surgery is required (6%). Fourteen per cent of units reviewed all children, with discharge criteria being based on normal visual acuity (52%), accurate visual acuity (39%) and a normal orthoptic assessment (42%). Seventy-six per cent of units review some children, commonly as a result of family history (55%), parental concern (43%), poor co-operation (30%) and young age (72%). In the absence of squint or amblyopia children are discharged at the first visit, in only 8% of units. There is considerable variation in the tests used to assess visual acuity. LogMAR-based tests (eg EDTRS) are not routinely used in 75% of units. CONCLUSION: Different systems exist for the assessment and management of squint and amblyopia across the country. While much of this variation is to be expected given their possible aetiologies, some could be reduced to produce a more cohesive service. There is also considerable scope for rationalising the tests used to screen infants and children for amblyopia and strabismus.

Amblyopia↗
PubMed2002

[In paediatric ophthalmology there is no preferred timing for retinoscopy].

BACKGROUND: In paediatric ophthalmology retinoscopy may be performed immediately after an orthoptic examination or during an additional ambulatory visit. So far, no studies have been performed to investigate which of both procedures is preferred by the persons accompanying or examining the children. PATIENTS AND METHODS: 32 consecutive children under the age of 16 were randomly assigned to have retinoscopy immediately after the orthoptic examination or during an additional visit. Children coming from far away or needing a cycloplegia with atropine were excluded from this study. The accompanying persons and the examiners (orthopedist/physician) were interviewed using a validated, written questionnaire. Associations between answers were determined via a cluster analysis. RESULTS: 84 % (28/32) of all accompanying persons returned the questionnaire. The timing of retinoscopy was not associated with other variables. The question "Would you recommend our Department?" was strongly associated with how the accompanying persons judged the medical and orthoptic examination and also with the waiting times. CONCLUSIONS: There is no difference for the accompanying persons and the examiners if retinoscopy is performed immediately after an orthoptic examination or during an additional visit. As reported in the literature about patient satisfaction in an ambulatory setting, we found that the satisfaction of the accompanying persons correlated with the interaction between health professionals and the persons accompanying the children, as well as with the waiting times.

Adolescent↗
PubMed2004

Factors influencing the detection of visual developmental deficits in 3-year-old kindergarten children.

PURPOSE/BACKGROUND: In the 'Tübingen Kindergarten study', an orthoptic screening program for amblyopia in three-year-olds was evaluated. In the retrospective analysis presented here, the association between a child's history--especially participation in the regular preventive care examinations in Germany (U4 to U7)--and the time of detection of target diseases was investigated. METHODS AND SUBJECTS: The parents of three groups of children were interviewed by telephone. Group 1 consisted of 21 children already treated for amblyopia before orthoptic screening; group 2 of 26 children with target conditions newly detected by orthoptic screening; and group 3 of 32 children with newly detected moderate ametropia. The groups were tested for differences in history and utilization/results of the regular preventive care examinations. RESULTS: Participation in regular preventive care ranged from 82% to 92%. There were no significant differences between the groups. Nearly 90% of parents from groups 2 and 3 had not heard of amblyopia before orthoptic screening. Only one child had been referred after regular preventive care examinations. CONCLUSIONS: The regular preventive care examinations contributed little to the detection of amblyopia. The strong position of the pediatrician should be used for the early information of parents.

Amblyopia↗
PubMed1996

[Detection and diagnosis of small ocular misalignment with the Purkinje reflex pattern method].

BACKGROUND: Application test for an automatic classification strategy for ocular alignment data for the detection of ocular misalignment in strabismic patients. METHODS: Photographic Purkinje Reflection Pattern Evaluation was used a) with a handheld device for the detection and measurement of ocular misalignments in near fixation (group 1, n = 64 strabismic patients) and b) with a stationary device for the detection and measurement of ocular misalignments in near fixation (group 2, n = 38 patients) and in distance fixation (group 3, n = 36 patients). The orthoptic diagnoses were mostly primary and secondary microtropia with manifest angles of strabismus from naught or 0.25 degrees to 3-4 degrees, with maximum angles up to 6-9 degrees. The ocular alignment data were classified using the computer based strabismus index procedure. This strategy relies on thresholds derived from means and standard deviations in orthotropic control populations. In this way the data sets were classified automatically as "no referral" or "referral". In addition, an automatic diagnosis of the type of misalignment was given and the results were compared to the orthoptic gold standard. RESULTS: The sensitivity for the detection of a manifest ocular misalignment was a ca. 80% in group 1 and 2, and 90% in group 3, with specificities from 90% to 100%. All manifest angles of strabismus larger than 1 degree were correctly classified as "referral". There was good agreement between the diagnoses of the type of misalignment in most cases. Discrepancies were observed with very small ocular misalignments or with incomplete data sets, or they could be explained by a switch of fixation. The amount of the misalignment varied markedly as compared to the orthoptic measurement in a number of cases. CONCLUSIONS: The examination allows for a detection of small manifest ocular misalignments with a very high sensitivity. The deviated eye and the type of the misalignment in the primary position are evaluated automatically by a data base computer algorithm. The differences between the measured angles of strabismus indicate that the photographic examination conditions and the orthoptic simultaneous prism and cover test conditions are not exactly alike. Purkinje Reflection Pattern Evaluation represents a step towards an examiner-independent measurement of the angle of strabismus.

Adolescent↗
PubMed1976

Mangement of infantile esotropia.

We evaluated the management of infantile esotropia-constant, alternating esotropia before 6 months of age-in 34 children. Planned one-state surgery for satisfactory mechanical alignment was highly predicatable (79 to 84%), and was obtained at any age. Stable bifoveal motor fusion was also obtained but was more frequent with alignment before 2 years of age. The use of postsurgical spectacle orthoptics (minus lenses or prisms, or both) increased the incidence of bifoveal fusion. Surgery alone resulted in bifoveal fusion in 6% of the cases, whereas an overall incidence of 33% bifoveal fusion resulted after the use of postsurgical spectacle orthoptics by some patients. Of those receiving postsurgical spectacle orthoptics, 53% obtained bifoveal fusion. This study demonstrated a correlation between the incidence of secondary A patterns (after surgery for V esotropia) and the amount of horizontal muscle surgery done in combination with bilateral inferior oblique muscle myectomies.

Age Factors↗
PubMed2003

Restoration of binocular single vision after long-term fusion disruption.

BACKGROUND: One of the most difficult situations faced by orthoptists and pediatric ophthalmologists is attempting to restore binocular single vision to a patient who has experienced a long-term disruption of fusion. Initial poor results with standard treatment modalities, including prisms and strabismus surgery, may lead to a diagnosis of intractable diplopia. METHODS: We examined, treated, and followed up 5 patients with strabismus after an extended period of monocular vision loss. All patients were diplopic after the restoration of visual acuity in the affected eye. RESULTS: All 5 patients experienced a period of uncomfortable intermittent fusion with the initial prismatic correction. After many months of close follow-up with prism and orthoptic therapy, comfortable fusion was restored for 3 patients. Convergence amplitudes improved with the orthoptic exercises, and we were eventually able to eliminate most or all of the horizontal prism in the 3 patients who regained binocular single vision; however vertical fusion was less responsive and most often required permanent prismatic correction. CONCLUSIONS: A combination of prism therapy, orthoptic treatment, and follow-up during a period of many months to years can restore fusion in some patients who have experienced a long-term disruption of fusion.

Adolescent↗
PubMed1976

[Value of functional and electrophysiological studies in amblyopia].

In a group of patients suffering from amblyopia, the authors confront the results after orthoptic treatment with data provided by functional and electrophysiological examination. In 37 patients the clinical diagnosis of functional amblyopia had been made, but in 8 of these cases complimentary functional and electrophysiological examinations showed organic perturbations. This explains the failure, in these cases, of the orthoptic treatment. In the remaining 29 patients, clinical forms of functional amblyopia were found. In this group, the authors studied 20 cases showing no improvement with treatment: in 15 out of the 20 the VERs were pathological. In the 9 remaining cases which have showed improvement the VER'S were never abnormal. VER study can be undertaken, without general anaesthesia, as from 3 to 4 years of age. The authors conclude that all clinical forms of amblyopia should undergo VER investigation: patients showing pathological changes should be excluded from orthoptic treatment, from which they have no possibility of deriving benefit.

Amblyopia↗
PubMed1994

[Intermittent exotropia: evaluation of results on the basis of different treatments].

The aim of the study is to evaluate the results obtained in treatment of Intermittent Exotropia with the therapeutic programme applied at the Orthoptic Centre of Sassari Oculist Clinic. 250 patients were considered; 176 completed treatment. The patients were divided into four groups according to the kind of treatment adopted: orthoptic exercises, surgery (double recession of lateral rectus), exercises and surgery, no therapy. Results were evaluated by measuring the acquired state of orthophoria or residual exotropia: less than 10 prismatic diopters (excellent result); residual exotropia between 11 and 20 prismatic diopters (unsatisfactory result); residual exotropia > 20. The highest percentage of excellent results was found in those patients who underwent surgery but only among those who completed the therapy with cycles of orthoptic exercises. Conversely, the worst results were evident in patients who followed no therapeutic programme.

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↗
PubMed1995

Children's vision screening: impact on inequalities in central England.

STUDY OBJECTIVE: To investigate the relationship between age at presentation of amblyopia and social deprivation before and after the introduction of changes to a vision screening service. DESIGN: Two cohorts of children treated for amblyopia in 1983 and 1992. SETTING: THe orthoptic department of Leicester Royal Infirmary. PARTICIPANTS: The 209 patients treated for amblyopia who first attended the orthoptic department in 1983, and 203 who first attended in 1992. MEASUREMENTS: Age at presentation to the orthoptic department was the main outcome measure. Social deprivation was measured by Townsend deprivation score for the electoral ward in which the child lived, using 1981 and 1991 census data. MAIN RESULTS: After the introduction of changes in the screening programme, the mean at presentation of amblyopia associated with microtropia or no strabismus was reduced from 6.6 years to 5.0 years. In 1983 there was a significant relationship between deprivation and age at presentation (p = 0.0001), with those from more deprived areas presenting later. No similar association was found in children referred in 1992 (p = 0.17). There was no change in mean age of presentation of amblyopia associated with a large angle of strabismus (3.3 years in 1983 and 1992) and no relationship between deprivation and age at presentation 1983 or 1992 (p = 0.24 and p = 0.39 respectively). CONCLUSION: Since the introduction of changes to vision screening, the relationship between social deprivation and the age of presentation of asymptomatic amblyopia seems to have disappeared. Children are now referred earlier and those from deprived areas are not being overlooked.

Age Factors↗
PubMed2003

[Indications for refractive procedures in adult patients with strabismus and results of the subsequent therapeutic procedures].

The authors estimated the contribution of the refraction intervention and a possible evolution in the position of eyes in 102 adult individuals considering a refraction intervention. The indications for this intervention were a disorder in eye position or amblyopia in those who were interested in this operation and were examined in the years 1996 to 2002. The basic refraction examination was always supplemented by a detailed orthoptic analysis. Based on this examination the intervention was not recommended in 14 examined subjects (14%). ARK represented the contraindication of the refraction intervention in 9 patients, since subsequent changes in the size of the deviation or operation adjustment of strabismus could result in diplopia. An excessive convergence with a high AC/A in hyperopia was also considered as an unsuitable indication, since a lasting cosmetic and functional significant convergent deviation into near distances could not be excluded. Five patients declined from the refraction intervention on the basis of this explanation. The paper is mainly dealing with an analysis of the development of position of the eyes and binocular functions in 46 adult patients, who decided to undergo a refraction intervention and further orthoptic care after a complex stroboscopic and refraction examination. The adjustment of refractive error was made by the LASIK methods (Laser in Situ Keratomileusis) on 69 eyes (80%) and CLE (Cleans Lens Extraction) on 17 eyes (20%). The orthoptic analyses before and the refraction intervention revealed that in all 29 even only partially accommodating esotropia, the deviation was diminished after the refraction intervention on the average by +11.2 degrees (in the rage of +2 degrees to +30 degrees) to 5.4 degrees (in the range of parallel position to +20 degrees) in the predominantly represented hyperopia, but also in 6 myopias. The improved position of the bulbs was not directly associated with the degree of hyperopia with the original deviation. The deviation after the refraction intervention in 23 patients (79%) with esotropia was not higher than degrees. The cosmetic position of the eyes was completely satisfactory and did not therefore represent even indication for the operation. The 9 patients (35%) with esotropia and hyperopia there were an improvement of binocular functions. It could be theoretically due to the newly developed emetropia making permanent optimal sensory information possible. In all 17 exotropias there were not any significant changes in the size of deviation and the binocular functions were not reestablished, if they were not retained before. The position of eyes was solved surgically in 12 patients, while exotropia predominated in two thirds of them. The weakening or strengthening interventions on horizontal straight muscles were selected according to character of strabismus in 11 patients. Recession of the lower oblique muscle was indicated one case only for the simultaneously present torticollis with exotropia. The residual deviation was not greater than 5 degrees immediately after the operation or during the following months. Binocular functions were not reestablished in any patients. A alternate suppression or suppression of perception on one eye were proved.

Adult↗
PubMed2004

[Visual function in developmental dyslexia. Opthalmological and neuropsychological results].

BACKGROUND: We aimed to test children with developmental dyslexia for possible alterations of their spatial and visuoperceptual ability. METHODS: A total of 31 children with developmental dyslexia were included in the study. All children underwent a complete ophthalmological and orthoptic examination. Neuropsychological testing was performed using the Visual Object and Space Perception Battery (VOSP) and the subtest "Gestalt Closure" of the Kaufman Assessment Battery for children. Even though the VOSP is validated and standardized for adults, no normal values for children exist thus far. Therefore, a sex- and age-matched control group was tested. In addition, the parents of the dyslectic children completed the Child Behavior Checklist for Ages 4-18 (CBCL/4-18). RESULTS: All children presented normal ophthalmological and orthoptic findings. Performance in the VOSP subtests "progressive silhouettes test'" and "number location" was significantly reduced in dyslectic children when compared to controls ( p<0.0003 and p<0.046, respectively). There was also a tendency towards lower values in the subtest "position discrimination" ( p=0.07). In the other subtests no significant difference between dyslectic children and controls was observed. The results of the subtest "Gestalt Closure" of the K-ABC and the CBCL/4-18 were within normal ranges. CONCLUSION: The study demonstrates that developmental dyslexia is not based on ocular deficits, but indicates possible disturbances of visual-spatial cognition and visual-spatial perception in dyslectic children.

Child↗
PubMed2004

Abnormality of vergence latency in children with vertigo.

It is well known that vergence movements are important for distance appreciation, depth vision and stereopsis. Moreover, vergence movements are very probably used by the CNS during head and body motion to adjust the gain of the vestibulo-ocular reflex (VOR) according to the viewing distance. A recent clinical study of Anoh-Tanon et al. suggested that vertigo in children with normal vestibular function could be associated with abnormal vergence clinically assessed. The purpose of this study was to test this hypothesis with objective vergence eye movement recordings. We examined the latency of vergence, saccades and combined movements in twelve children with the complaint of vertigo but without vestibular abnormality. Convergence and saccades combined with convergence or with divergence had abnormally long latencies (relative to normal children of matched age). In contrast, divergence and isolated saccades showed only mild latency increase relative to normals. Lengthening of latency could be due to impaired cortical control. Orthoptic vergence training reduced all latencies; however, even the reduced latency of vergence and of combined movements was still abnormal. The improvement after orthoptic vergence training could be due to increased visual attention, although such mechanism cannot eliminate completely the initiation deficit of vergence movements. Objective eye movement recordings are thus useful for a diagnosis and treatment of children with vertigo.

Adolescent↗
PubMed2006

Evidence for frequent divergence impairment in French dyslexic children: deficit of convergence relaxation or of divergence per se?

AIM: There is a controversy as to whether dyslexic children present visuo-motor disabilities such as vergence and accommodative problems assessed with orthoptic tests. The purpose of this study is to re-examine this issue in a large population of children. METHODS: Extensive orthoptic evaluation was made in 57 dyslexic and 46 non-dyslexic ("normal") age-matched children. Convergence and divergence capacities were evaluated at two distances (30 cm and 400 cm). RESULTS: Binocular vision measured with stereo-acuity tests was normal in dyslexics. In contrast, the near point of convergence was significantly more remote in dyslexics; most importantly, divergence at both far and near distance was significantly more reduced in dyslexics (median value 4 pD and 10 pD, respectively, at far and near) than in "normals" (median value 6 pD and 12 pD, at far and near). CONCLUSION: The existence of the divergence deficit at far distance indicates the presence of deficit of divergence per se, independently from convergence and accommodation relaxation. This result is novel and corroborated by physiological studies indicating distinct control of convergence and divergence, both at the cortical and subcortical premotor level. We conclude that vergence deficits are frequently present in dyslexics, and that dyslexics should be re-educated; training should address distinctively convergence and divergence subsystems.

Accommodation, Ocular↗
PubMed2004

Binocular vision impairment after refractive surgery.

PURPOSE: To illustrate the need for an accurate preoperative orthoptic examination to prevent postoperative changes in binocular vision. SETTING: Department of Ophthalmology, University Hospital Antwerp, Edegem, Belgium. METHODS: Five patients presenting major subjective complaints after refractive surgery were analyzed. RESULTS: In 1 patient, a latent N IV palsy decompensated after laser in situ keratomileusis (LASIK) in the more myopic eye to achieve monovision. A second patient, operated on for N IV palsy 10 years earlier, presented a recurrence of the palsy after bilateral LASIK for myopia. The third patient complained of discomfort in binocular vision caused by aggravation of a preexisting intermittent esotropia that worsened after LASIK for hyperopia. The fourth patient complained of diplopia after LASIK in the highly anisometropic and exotropic eye. The fifth patient experienced a decrease in fusion and stereopsis at the time he became anisometropic after bilateral LASIK. CONCLUSIONS: Special care should be taken of patients who have a preoperative history of strabismus surgery, an overcorrection or undercorrection in 1 or both eyes, or anisometropia and of those who are unhappy with contact lenses. An orthoptic examination should be done with and without spectacle correction to detect underlying vertical phorias. Intended monovision should be examined initially using contact lenses.

Adult↗
PubMed1982

Oculomotor biofeedback therapy for exotropia.

Twelve exotropes of various types received oculomotor biofeedback therapy at State College of New York (SUNY) University Optometric Center. Feedback of a variable pitch tone which reflected changes in ocular vergence reinforced motor control of eye posture. Patients were trained to achieve and sustain alignment in a variety of viewing situations. The six intermittent exotropes in the study who did not have amblyopia or prior history of unsuccessful surgical or orthoptic therapy achieved the highest recovery rating after training. The amblyope and those who had orthoptic training learned to voluntarily correct their eye position, although they did not achieve as acute a sensitivity to loss of alignment as did the others. Therapy restored eye control at near in a young constant exotrope whose condition resulted from severe neurological dysfunction. A constant postsurgical exotrope who had no ability for sensory fusion made little progress. Advantages of oculomotor biofeedback therapy are shorter treatment time, elimination of lengthy home training exercises, and enhanced patient motivation.

Adolescent↗