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PubMed1992

Tangent Streak RGP bifocal contact lenses in the treatment of accommodative esotropia with high AC/A ratio.

Patients with the diagnosis of high accommodative convergence/accommodation (AC/A) ratio, accommodative esotropia traditionally have been fit with bifocal spectacles. For cosmetic reasons, however, many patients prefer non-spectacle correction. Orthoptics, miotics, contact lenses, and surgery have been used as alternatives. We describe the treatment of three patients with the Tangent Streak bifocal rigid gas permeable (RGP) contact lens in which functional control of the patient's deviation was attained. Tangent Streak RGP bifocal contact lenses offer an acceptable alternative to bifocal spectacles, surgery, miotics, or orthoptics in the treatment of accommodative esotropia with high AC/A ratio.

Accommodation, Ocular↗
PubMed2006

[Results of 10 years observation of organ of sight in prematurity].

PURPOSE: (1) To compare the incidence of refractive errors and the orthoptic condition in ten-year-old children, born prematurely and treated with cryotherapy versus children, whom did not apply such a procedure. (2) To estimate condition of the extraocular muscles. MATERIAL AND METHODS: A group of 60 prematurely born children was divided into 2 subgroups: I--30 children treated with cryotherapy, II--30 no treatment was applied. All the children had anterior segment, fundus and visual acuity examined. Refraction following cycloplegia was evaluated. Visual acuity and orthoptic status was assessed. RESULTS: In the group of prematurely born children who had retinopathy in the infantile age and were treated with cryotherapy, refractive errors were frequently observed. In over half of those children squint or impaired eye movement were found. In the group of children who required no cryotherapy the percentage of those with refractive errors was similar. CONCLUSIONS: In prematurely born children with retinopathy refractive errors and squint occur quite often. Prematurely born children should be subject to ophthalmologic follow-up throughout their childhood.

Child↗
PubMed1990

[Delayed development of binocular function in the long postoperative period of infantile esotropia].

Long-term observation of binocular function was carried out in 30 postoperative cases of infantile esotropia. The period of observation was 5 to 12 years and the targets used for evaluation were deviating angle and stereo acuity. In the successful group, 20 cases out of 30 (67%) achieved a stereo acuity of 60 seconds or better. Among the remainder, partial improvement was seen in 20% and no improvement in 13%. Preexisting amblyopia and ARC improved in the successful group, and the final deviating angle was a mean of 2.3 prism diopter. There were 2 types of cure processes in the successful group. The first group achieved a good binocular function in a relatively early postoperative stage (7 cases), while the second group had delayed development of binocular function over a period of several years (13 cases). The former cases had sufficient orthoptic treatment during admission and the latter showed a gradual improvement of stereo acuity accompanied by good eye position. It has been generally accepted that the rate of binocular function recovery is very poor among cases of infantile esotropia, but our study revealed that skillful orthoptics administered by a selected member of our team over an extended period enabled the achievement of good binocular function in infantile esotropia.

Child↗
PubMed1989

[Measurement of visual acuity in infants in 6 minutes: Teller's Acuity Cards].

Most of the development of infant visual function occurs during the first year of life. Early pathological symptoms affecting visual or oculomotor processes, particularly ocular misalignment or amblyopia, should be detected and treated at the earliest age. Orthoptic and ophthalmological tests have been available for a long time but there remained a need for a convenient test for measuring visual acuity. Preferential looking techniques fulfill this demand and have been proven reliable and convenient to estimate visual acuity in preverbal infants. A new commercial presentation of the test, called Teller Acuity Cards, is described. Testing an infant was rapid, 5 to 6 minutes for a normal child, and easy because the child enjoys the convivality of the situation. Space requirement is reduced. Measures were taken from a population of 50 normal children aged 4 to 12 months. All children responded in the three situations, binocular and monocular (there was no blind eye in the group). Grating acuity values were higher than those obtained by projection preferential looking techniques. Binocular acuity was 6.5 cycles/deg (approximately 2.5/10) at 4 months of age, 9.8 cycles/deg (approximately 3.3/10) at 9 months and up to 13 cycles/deg (approximately 5/10) around 12 months. Acuities were found to be half an octave lower in monocular condition as compared to binocular. Orthoptic and ophthalmological check-up of infants is important, especially in case of children at risk of visual disorder. In most instances acuity can be preserved by therapeutic action provided it is initiated during the first year of life, when sensitivity to appropriate stimulation is at its peak.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed2002

Macular translocation with 360 degrees retinotomy for exudative age-related macular degeneration.

BACKGROUND: Macular rotation surgery comprises surgical extraction of choroidal neovascular membranes in age-related macular degeneration (AMD) and translocation of the foveal neural retina over adjacent retinal pigment epithelium. OBJECTIVE: To determine whether macular translocation with 360 degrees retinotomy can stabilize and/or improve visual acuity in patients with subfoveal choroidal neovascularization (CNV) secondary to AMD. DESIGN: This study consisted of a standardized surgical procedure on a series of 90 consecutive patients and follow-up examinations at fixed intervals for 12 months. PARTICIPANTS: All patients in this study had experienced recent visual loss resulting from subfoveal CNV caused by AMD. Twenty-six patients had major macular subretinal hemorrhage, 39 patients had occult subfoveal CNV, and 25 patients had classic subfoveal CNV. METHODS: Macular translocation surgery was performed between 1997 and 1999. The patients were examined preoperatively and at 3, 6, and 12 months postoperatively, including visual acuity, microperimetry, angiography, and orthoptic assessment. RESULTS: Visual acuity increased by 15 or more letters in 24 patients, remained stable in 37 patients, and deteriorated by 15 or more letters in 29 patients at 12 months postoperatively. A secondary procedure was necessary in 17 patients because of severe complications; proliferative vitreoretinopathy was observed in 17 eyes, macular pucker in 5 eyes, and macular hole in 1 patient. CONCLUSION: Macular translocation is a technically demanding surgical procedure. Although the procedure has a high rate of surgical and postoperative complications, the functional and anatomical results appear to be promising for selected patients with subfoveal CNV secondary to AMD.

Aged↗
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↗
PubMed1984

Treatment of heterophorias.

It is well known that the treatment of heterophorias is first of all medical (optical and orthoptic). In some cases surgery is required. The surgical indications are stressed by the authors.

Adolescent↗
PubMedDate not supplied

Diplopia after retinal detachment surgery.

In the Amsterdam Academic Medical Centre with an annual rate of 200 retinal detachment procedures, about the same incidence (4.5%) of diplopia after detachment surgery was found as by Fison and Chignell (1987). In 13 out of 18 patients with diplopia (sent for orthoptic evaluation between 01.01.1986 and 31.12.1987) double vision could be eliminated by various ways: orthophorization with or without temporary prismatic therapy was seen in 3 patients; a compensatory head posture eliminated diplopia in two cases, and prisms were effective in 4 cases (one of them had additional squint surgery). In 4 patients strabismus surgery alone restored binocular single vision. Binocular single vision was not restored in 5 cases.

Adolescent↗
PubMed1984

Accommodative stimulus/response function in human amblyopia.

Three parameters are essential to describe static accommodative behavior in a comprehensive, quantitative manner: the slope of the stimulus/response curve, the depth of focus, and the tonic response. These parameters were obtained in amblyopes, former amblyopes, strabismus without amblyopia, and normals. Results showed that the accommodative response in the amblyopic eye was characterized by a reduction in the slope of the stimulus/response curve and increased depth of focus. Similar abnormalities but of lesser magnitude were found in the non-dominant eye of some former amblyopes and some strabismus without amblyopia. Orthoptic therapy always increased the slope of the stimulus/response curve in the amblyopic eye. We believe that the reduced accommodative responses found in amblyopic eyes reflect a primary sensory loss over the central retinal region that occurs as a result of prolonged, early, abnormal visual experience associated with the presence of strabismus and/or anisometropia.

Accommodation, Ocular↗
PubMed1993

Preferential looking techniques yield important information in strabismic amblyopia follow-up.

Two groups of monocular strabismic patients were followed-up by means of both PL and orthoptic examinations. The first group underwent a full-day occlusion except 1 to 4 hours; the second was occluded less than 4 hours per day. The first treatment regimen proved to be faster in getting pseudo-isoacuity and alternating fixation, but was followed by relative occlusion amblyopia and/or shifting of the dominant eye in three patients. PL techniques proved to be particularly useful in strictly monitoring these patients.

Amblyopia↗
PubMed1995

Convergence insufficiency and failure of accommodation following midfacial trauma.

A prospective evaluation of patients who had sustained midfacial trauma was carried out in order to determine the prevalence of impaired convergence and accommodation and to establish the risk factors for such defects. Of 52 patients in this study, 11 suffered accommodation and/or convergence disturbances. They included 6 males (17% of the male population) and 5 females (29% of the female population). Nine of these 11 patients sustained their injuries due to alleged assaults (24.3% of all assaulted patients) and 2 following simple falls (25% of all fall victims). Five patients complained of double vision for near (5/11 = 45.5%) and another 4 had blurred vision and/or difficulty with reading (4/11 = 36.4%). The remaining two were asymptomatic. Six patients were randomly selected to receive orthoptic exercises/treatment while the other five were monitored for signs of spontaneous recovery. Within six months of injury/surgery, 83% of the treated patients (n = 5) and 80% of the non-treated patients (n = 4) recovered to within the normal values of accommodation and convergence. No significant statistical relationship was found between the incidence of accommodation and/or convergence failure, and the cause or the type of fracture sustained. It may, however, be related to the severity of both the impact and the associated closed head trauma.

Accidental Falls↗
PubMed1979

A new look at pleoptics.

Sixty-four patients who did not respond adequately to passive conventional occlusion were treated with active pleoptic therapy, and followed with orthoptic therapy when fusion potential was demonstrated. Patients ranged in age from 4 to 17 years, and ranged in visual acuity from 20/30 to 20/100. Seventeen patients had some fusion prior to starting pleoptics. All 64 patients achieved an immediate post-therapy acuity of 20/30 or better; 25 were fusing and demonstrated some stereopsis. Twenty-seven patients were followed for a period of one to ten years, including the 25 patients who were fusing at completion of therapy. Twenty-four (88%) maintained visual acuity of 20/30 or better. All fused either normally or with ARC. Three patients, whose visual acuity dropped to 20/50, had no fusion. Only one patient who had fusion at the completion of therapy was unable to maintain it. We conclude, therefore, that pleoptics retains values in the treatment of amblyopic patients with steady and unsteady central fixation, in those situations where conventional occlusion in unsuccessful.

Adolescent↗
PubMed1994

Extraocular muscle problems in thyroid eye disease.

In this paper methods of visualisation of the extraocular muscle changes in thyroid eye disease are discussed. The histopathology of extraocular muscle biopsies has been studied by both light and electron microscopy to show the type of cellular infiltration and the amorphous material in the extracellular matrix. A series of questions to which answers have not yet been found concerning thyroid eye disease are posed which may help to direct new research projects. Finally, in the last part of the paper, the surgical results in a series of 41 patients having ocular muscle surgery for diplopia and/or compensatory head postures due to thyroid eye disease are described. The conclusions drawn from these results are that one should maintain the patient euthyroid, establish by orthoptic measurements that the ocular movements have been stable for at least 6 months, treat by recessing tight muscles using adjustable sutures, and aim to undercorrect the vertical deviation at the time of adjustment.

Diplopia↗
PubMed2000

[Strabismus, hemianopsia and the sundial of Mawas and Franceschetti].

UNLABELLED: THE ARTIFACT: The artifact is a light rectangular slate of black cardboard showing two white lines at 40 degrees angle. It provokes physiological diplopia in lateral vision. BACKGROUND: In normal subjects, the right oblique line stimulates the right nasal hemiretina, perceived as an oblique line, and the left temporal hemiretina, perceived as a vertical line, both lines being on the right hand side. Likewise, the left oblique line is seen as two lines on the left hand side. The 4 lines form and M and a W combined. The strabismus subject sees 3 lines for he neutralizes one; the alternating squint sees only 2; the heterophoric sees 4 lines, two of which blurred, and the hemianopic sees only part of the dial. RESULTS: The subject must select the image he sees from an array of possibilities shown on the back of the dial. From 5 years of age on, normal subjects select the [symbol: see text] or the "butterfly"; hemianopic subjects correctly describe the loss of either the left or right field. CONCLUSIONS: The sundial facilitates both the screening and the treatment of binocular vision disorders. Bangerter's hemifilter will be used in association with exercises for physiological diplopia at home under monthly orthoptic control. All this made it possible to obtain useful peripheral fusion in early onset strabismus.

Diplopia↗
PubMed1980

Optometric therapy of divergence excess strabismus.

A review and analysis of the vision-training procedures were carried out over a period of 2 years at State University of New York (SUNY), University Optometric Center by 20 staff optometrists on 28 patients exhibiting divergence excess strabismus using models proposed by Flax and Greene. Training included motility, accommodative rock, fusion, antisuppression, and stereoscopic skills by a variety of techniques and devices. Patients who exhibited smaller pretraining angles of deviation, increased maturity, and greater motivation responded most successfully to treatment. The results achieved in this study compare favorably with those obtained by traditional orthoptic procedures.

Adaptation, Ocular↗
PubMed1982

The course and effect of visual training on the vergence system.

The effect of a variety of vergence training procedures on the visual system of 35 asymptomatic young adults with normal binocularity was evaluated. The visual training took place on the weekdays of three consecutive weeks. Vergence ranges were measured before the study began and at the end of the 3-week period. Subpopulations were evaluated at one week and at 6 months to document further the course of the effects. Positive fusional vergence training significantly increased the vergence ranges after 1 week of training; a greater effect was measured after 3 weeks. The vergence capability was found to have decreased 6 months later, but the effects of the training were still apparent. Negative fusional vergence training was less effective; however, significant increases were demonstrable after 3 weeks of training. The phorias the accommodative amplitude were not affected by the orthoptics. We conclude that relatively short periods of training can provide long-lasting increases in the vergence ability of a group of binocular normals. The implications of such findings relative to possible neural control mechanisms and clinical visual training situations are discussed.

Accommodation, Ocular↗
PubMed1983

Accommodative insufficiency.

A retrospective review of the records of 96 patients with accommodative insufficiency has been completed. In addition to the major sign of reduced accommodative amplitude for their ages, I often found a reduction in the facility of accommodation, a smaller lag of accommodation, a tendency toward convergence insufficiency, slightly reduced fusional vergence and stereopsis, and a reduced nearpoint of convergence. Suppression was not generally found. The results of orthoptic exercises and/or a plus lens addition at near were examined. Most patients (90%) obtained some relief with treatment. About 53% had their objective and subjective problems totally solved during an average treatment period of 3.7 weeks. I determined the characteristics of the patients before and after treatment. The current state of the treatment of accommodative insufficiency is discussed.

Accommodation, Ocular↗
PubMed1983

Optical characteristics of Transpaseal as a partial occluder.

The acuity degradation produced by Transpaseal, a typical adhesive scattering material applied to spectacle lenses to produce partial occlusion during orthoptic treatment, is studied by measuring the angular characteristics of the scattering and its effect upon the visual contrast sensitivity function. Whereas in general the material acts as a low-pass spatial frequency filter, it is shown that the scattering function is not symmetrical and hence that the visual degradation produced varies with the orientation of the detail observed.

Adhesives↗