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PubMed1983

Reduction of asthenopia in patients with convergence insufficiency after fusional vergence training.

Seven patients with convergence insufficiency and related asthenopia underwent automated fusional convergence training. A matched-subjects control group crossover design was used to reduce placebo effects. All patients showed significant increases in vergence ranges with concurrent marked reduction of symptoms after training. All patients showed a flattening of and an increase in the base-out portion of their fixation disparity curve. Our results demonstrated the effectiveness of fusional vergence training in reducing asthenopia in these patients. Subsequent accommodation and vergence training using traditional orthoptic procedures yielded further reduction of asthenopia, as well as an increase in the base-out fusional range.

Adolescent↗
PubMed1984

Classification criterion for success in the treatment of convergence insufficiency.

Using data collected from a retrospective study of the records of 110 patients diagnosed as having convergence insufficiency, a model has been developed which allows the classification of a patient into one of two categories of success (total or partial/none) on the basis of an initial examination. The subjects were treated with orthoptics and classified into either the total success group (no objective or subjective visual difficulties) or the partial/no success group. Stepwise discriminant analysis was used in the data reduction phase in which 6 of 14 possible variables were selected which best explained the variation in the degree of success. These six variables were: (1) the AC/A ratio; (2) the negative vergence blur value at 40 cm; (3) the recovery value of the positive vergences at 6 m; (4) the break value of the positive vergence at 6 m; (5) the amplitude of accommodation; and (6) the frequency of the deviation. Subjects were more likely to be successful when 1, 2 and 3 were high, 4 and 5 were low, and the deviation was latent. Discriminant analysis using these six variables allowed 25 of 33 (76%) of the patients to be correctly classified in terms of their success. The application of the model for classifying patients with convergence insufficiency is presented and briefly discussed.

Accommodation, Ocular↗
PubMed1984

Convergence insufficiency.

A retrospective study of 110 subjects with convergence insufficiency has been completed. Their mean age was 19.9 years. There were 72 females and 38 males in the group. The clinical profiles of these subjects were examined before and after a standard orthoptic treatment regimen. Over the course of treatment, the near angle of deviation, the AC/A ratio, a portion of the negative vergence values, all the positive vergence values, the nearpoint of convergence, and the amplitude of accommodation were found to have changed in a statistically significant manner. The importance of these findings is discussed.

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

Vergence adaptation in esotropia.

Vergence adaptation and anomalous fusional movements have been used by strabismics to overcome prism. There has been controversy in the literature regarding the nature of the vergence responses by esotropes to prism, i.e., fusional, avoidance of fusion, and/or anomalous fusion. This paper reviews the various types of movements made by esotropes to prism and attempts to explain the mechanism. In addition, the relation of these vergence movements to prismatic, orthoptic, and surgical correction is discussed.

Adaptation, Ocular↗
PubMed1993

Sensitive period in stereopsis: random dot stereopsis after long-standing strabismus.

Bifoveal fixation is a requirement for random dot stereopsis. It is believed that random dot stereopsis is not possible after treatment of long-standing strabismus because binocular cortical cells are permanently damaged when strabismus is present during the sensitive period. Although the sensitive period for amblyopia has been clearly documented, the sensitive period for stereopsis is uncertain. We present a case we have followed from age 22 months to 10 years. This patient had intermittent esotropia until approximately age 3 years 4 months; he then had constant esotropia from about age 3 years 4 months to age 9 years 7 months. After orthoptic treatment at age 9 years, the patient returned to intermittent esotropia. He subsequently developed bifoveal fixation as measured by 30 sec arc of contour stereopsis and 250 to 500 sec arc of random dot stereopsis. This patient demonstrates that bifoveal fixation can be obtained after long-standing strabismus. We suggest that the sensitive period for stereopsis development, for this patient, was from birth to age 3 years.

Aging↗
PubMed1986

Effect of Fresnel prism dispersion on contrast sensitivity function.

Fresnel prisms are often used in orthoptics for binocular anomalies and in low vision for visual field defects. These prisms are made of optical polyvinyl chloride (PVC) and this material increases chromatic dispersion and produces a loss of contrast. In this study, the effect of chromatic dispersion on contrast sensitivity is determined. Contrast thresholds over a wide range of spatial frequencies are obtained on a number of subjects with the use of Fresnel prisms ranging from 5 to 30 prism dioptres. As predicted there is a decrease in visual acuity and cut-off spatial frequency threshold as prism power increases. Similarly, a decrease in contrast sensitivity at high and medium spatial frequencies is recorded.

Form Perception↗
PubMed1983

Morphological and physiological changes of the eye in patients with congenital heart disease undergoing extracorporeal circulation.

We studied 76 patients with congenital heart disease, whose ages ranged from 2 to 39 years. The following investigations were carried out pre-operatively and post-operatively in all patients: visual acuity, cycloplegic refraction, orthoptic examination, examination of the fundus. Where collaboration was sufficient the following were also studied: kinetic and static perimetry, adaptation perimetry, colour vision, electroretinography. There were no differences before and after operation of visual acuity, adaptation perimetry, refraction, electroretinography or of the fundus. Post-operative changes were only found in 4 of the 65 patients in whom perimetry was performed. By comparison, an identical study of patients with acquired heart disease showed the percentage of functional ocular changes to be higher in this group.

Adolescent↗
PubMed1985

The value of sight-screening, a comparative study of the Rodenstock sight-screener and a clinical eye examination of 109 adult employees in a hospital.

A rodenstock sight-screener has been used in examinations of more than 20 000 employees in trade and industry by an organisation sponsored by Danish optical companies. In a following report it was stated, that a great deal of these people, because of reduced sight-function, would benefit from further examination by optician or ophthalmologist with prescription of glasses. On that background we undertook an examination of 109 adults working in our hospital. First they were tested with the Rodenstock sight-screener and afterwards they underwent orthoptic and clinical ophthalmological examinations in a blind design. The sight-screening included examination of vision for near and far, stereopsis, phoria, dark adaption and visual fields. We found some difference between our results and those published earlier. Furthermore we found bad clinical accordance. In conclusion, many people will be worried by this kind of sight-screening procedure and only few will benefit from it.

Adolescent↗
PubMed1993

Oculomotor functions in a Swedish population of dyslexic and normally reading children.

Eighty-six nine-year-old dyslexic children were matched to control children with regard to age, sex, class in school, and intelligence. Orthoptic and eye movement analysis were performed on all children. It was concluded that the dyslexic pupils did not differ significantly from control children in terms of strabismus, accommodation, stereo acuity, vergence function or ocular dominance. Eye movement recordings did not show any qualitative differences between the groups in vergence dynamics during synoptophore investigations.

Accommodation, Ocular↗
PubMed1982

Results of treatment of anisohypermetropic amblyopia without strabismus.

One hundred and two patients with anisohypermetropic amblyopia without strabismus were studied. Microstrabismus was excluded by detailed orthoptic examinations including visuscopy and Cüppers' bifoveal correspondence test. Treatment consisted in wearing correcting glasses and part-time or full-time patching of the nonamblyopic eye. In patients with dense amblyopia patching of the amblyopic eye was done and Cüppers' after-image method of pleoptic therapy was instituted as the initial procedure. When visual acuity improved sufficiently by this therapy, patching was used on the nonamblyopic eye. Sixty-five (63.7%) patients showed 2 lines or more improvement on the Snellen chart. Though young children (6 to 12 years) improved their visual acuity more often than those aged 13 to 20 years, a considerable number of patients (50.0%) in the older age group improved their visual acuity after therapy. The improvement in visual acuity was accompanied by improved stereoacuity in 49.0% of the patients. It is therefore suggested that every effort should be made to treat these patients even after the age of 12 years.

Adolescent↗
PubMed2001

Anomalies of binocular function in patients with longstanding asymmetric keratoconus.

AIMS: To study binocular function in patients with longstanding asymmetric keratoconus. METHODS: In 20 adult patients with longstanding asymmetric keratoconus managed with a scleral contact lens a full clinical and orthoptic assessment was performed with and without the scleral contact lens in the poorer eye. RESULTS: All 20 patients had a corrected acuity of at least 6/9 in their better eye. With the scleral lens in situ the acuity of the poorer eye ranged from 6/6 to 6/60 and without the lens from 6/18 to hand movements. Patients were aged from 18 to 68 years and had worn a scleral contact lens for between 3 and 106 months. Without the contact lens in their poorer eye all patients had a small exotropia and all showed suppression, with the exception of one patient who had a right hypertropia with diplopia. With the scleral lens in situ 12 patients had an exophoria or esophoria, six a microexotropia, and two a manifest exotropia with suppression. CONCLUSIONS: Binocular function breaks down in some adult patients with longstanding asymmetric keratoconus. This is probably caused by longstanding unilateral visual deprivation. There are similarities to the breakdown of binocular function seen in some patients with a longstanding dense unilateral adult onset cataract who can develop intractable diplopia following cataract surgery.

Adolescent↗
PubMed1972

Eye strain from convergence insufficiency.

Eye strain and headache are common ocular symptoms, and the main cause in persons aged 15 to 40 is convergence insufficiency. It is more common in females than in males. Many patients are supplied with glasses for eye strain without the causative convergence insufficiency being treated. The treatment in most cases is orthoptic exercises.

Accommodation, Ocular↗
PubMed2006

Predictors and a remedy for noncompliance with amblyopia therapy in children measured with the occlusion dose monitor.

PURPOSE: Noncompliance is one of the limiting factors in the success of occlusion therapy for amblyopia. Electronic monitoring was used to investigate predictors of noncompliance, and, in a prospective randomized clinical trial, determined the effectiveness of an educational program. METHODS: Compliance was measured electronically during 1 week every 3 months in 310 newly diagnosed amblyopic children. The family's demographic parameters and the child's clinical parameters were assessed for their influence on the level of compliance. In addition to standard orthoptic care, children were randomized to receive an educational cartoon story, reward stickers, and an information sheet for the parents (intervention group), or a picture to color (reference group). These and the electronic device were distributed during home visits by researchers. The primary outcome measure was the percentage of compliance (actual/prescribed occlusion time) in the two groups. The secondary outcome measure was the influence of demographic and clinical factors on compliance. RESULTS: Compliance was associated with parental fluency in the national language, country of origin, level of education, and initial visual acuity of the child. During the first 1-week measurement period children in the intervention group had better compliance than the reference group had (78% +/- 32% vs. 57% +/- 40%; P < 0.0001), and fewer children were not occluded at all (3 vs. 23 in the reference group; P < 0.0001). This difference remained throughout the study period. CONCLUSIONS: Poor parental fluency in the national language, a low level of education, and poor acuity at the start of treatment were predictors of low compliance. An educational program primarily aimed at the child improved compliance and reduced the number of children who did not comply with occlusion at all.

Amblyopia↗
PubMed1992

Orthoptists reduce false-positive hospital referrals.

This paper describes changes in the pattern of new referrals of children from birth to 2 years-of-age to the Hospital Eye Service in Oxford, following the implementation of a community-based orthoptic secondary vision-screening programme. The findings show that the number of false positive referrals was reduced by a half following the introduction of the service; false-positive referrals were also discharged sooner. This paper reports the findings of this survey and the results demonstrate the cost-effectiveness of the programme compared to outpatient attendance.

Community Health Services↗
PubMed2000

[Acquired oculomotor paralysis: a new therapeutic approach. Apropos of 10 cases].

PURPOSE: The aim of this work is to report our rehabilitation scheme and outcome in patients with acquired oculomotor palsy. PATIENTS AND METHODS: We cared for 10 patients with oculomotor palsy between January 1996 and March 1998 at the Casablanca University Hospital. Our orthoptic rehabilitation scheme was based on reinforcing the patient's sensorial potential using a prism dioper and motor capacities by soliciting vergency and version movements. RESULTS: The 10 patients (7 males, 3 females, mean age 39.5 years) had unilateral IV palsy (n =3), bilateral IV palsy (n= 1), unilateral VI palsy (n= 2), bilateral VI palsy (n= 1), partial unilateral III palsy (n= 1) and dissociated bilateral III palsy (n= 2). Mean delay to initiation of rehabilitation was 49 days and mean duration for treatment was 3 months. We achieved total recovery in 50% of the cases and partial recovery in 40%. Intermittent diplopia persisted in 10 per thousand of the cases. These results differ slightly from those in the literature where total regression is reported in about 50% of the patients after therapeutic abstention. CONCLUSION: This small series is insufficient to validate our method. The results obtained do however show that rehabilitation is safe and should be applied more widely in patients with oculomotor palsy.

Adolescent↗
PubMed1999

[The therapeutic aspects in intermittent divergent strabismus].

PURPOSE: Is to evaluate the possibilities of treatment in intermittent divergent squint at children and young adults. MATERIALS AND METHOD: We studied an group of 66 patients treated in the University Clinic of Ophthalmology from Cluj-Napoca. RESULTS: The most frequent type of intermiTtent divergent squint (IDS) is the type of excess of divergency (25.76%). In 46.9% the onset was between 2-6 years. In 69.7% visual acuities were equal and stereopsis was present in 74.24%. Hyperopia +/- astigmatism was present in 69.7%. The treatment of intermittent exodeviation was conservative in 51.5% and surgical for first intention in 39.3%. CONCLUSIONS: 1. The most frequent type of intermittent exodeviation is by excess of divergency. 2. The treatment of exodeviation is an optical, orthoptic and surgical treatment. 3. The surgical technique depends on the type of intermittent exodeviation.

Adolescent↗
PubMed1975

[Unilateral aphakia in childhood (author's transl)].

The monocular and binocular vision will always be disturbed after unilateral cataract extraction in childhood. The treatment therefore not only means operation, but also correction of the optic error, pleoptics and orthoptics. In 40 cases of unilateral aphakia (12 congenital, 28 traumatical) the prognosis depends on the age of the individual and maintenance of treatment. The older the child and the sooner therapy is started the better are the functional results.

Accommodation, Ocular↗