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At least 631 records · Page 35Linked to original sources
PubMed2006

Assessment of visual function in chronic progressive external ophthalmoplegia.

AIMS: To assess the visual function of patients with chronic progressive external ophthalmoplegia (CPEO) using the Visual Function Index (VF-14). To identify discriminatory questions that reflect visual disability in mitochondrial ocular myopathies. To investigate the relationship between visual impairment and the ocular parameters routinely measured in clinical practice. METHODS: We studied 40 CPEO patients. Each patient underwent ophthalmological assessment, including best-corrected visual acuity, ptosis measures, and fundus examination for pigmentary retinopathy, and orthoptic assessment including cover test in the primary position, assessment of diplopia, and measurement of uniocular fields of fixation using the Goldmann perimeter. Patients were interviewed by telephone by an independent observer and their visual function was assessed using the VF-14. RESULTS: A total of 38 patients (95%) were visually impaired. The mean VF-14 was 72 (95% CI 66-79). Patients reported having the most difficulty with reading small print and driving at night. No significant correlation was found between the VF-14 and ocular motility parameters, ptosis, or pigmentary retinopathy. CONCLUSIONS: CPEO is associated with significant visual impairment. Measures of visual disability should be included in studies of natural history and treatment of mitochondrial ocular myopathies.

Activities of Daily Living↗
PubMed2006

Causes and outcomes for patients presenting with diplopia to an eye casualty department.

PURPOSE: To evaluate the causes and outcomes for patients presenting with diplopia to an eye casualty department. METHODS: Patients presenting with diplopia as a principal symptom, who were referred to the Orthoptic Department from Moorfields Eye Casualty over a 12-month period, were retrospectively investigated. RESULTS: One hundred and seventy-one patients were identified with complete records in 165 cases. There were 99 men and 66 women with an age range of 5-88 years. Monocular diplopia accounted for 19 cases (11.5%), whereas 146 patients (88.5%) had binocular diplopia. Cranial nerve palsies were the most common cause of binocular diplopia accounting for 98 (67%) of cases. Isolated sixth nerve palsy was the largest diagnostic group (n=45). Microvascular disease (hypertension or diabetes mellitus, or both) was present in 59% of patients with cranial nerve palsies, and of this group, 87% resolved spontaneously by 5 months rising to 95% by 12 months. CONCLUSION: Patients with clinically isolated single cranial nerve palsies associated with diabetes or hypertension are likely to recover spontaneously within 5 months and initially require observation only. However, patients with unexplained binocular diplopia and those who progress or fail to recover should be investigated to establish the underlying aetiology and managed as appropriate.

Adolescent↗
PubMed1998

Shared goals, shared learning: evaluation of a multiprofessional course for undergraduate students.

Twenty-eight undergraduate degree students from seven health care professions attended a two-day pilot course. Using small multiprofessional groups, final-year students from occupational therapy, orthoptics, therapy radiography, nursing, physiotherapy, medicine and dentistry explored professional roles and clinical problem-solving using a theme-based approach. A balance of didactic and interactive small-group learning enabled them to identify issues surrounding multiprofessional teamworking and collaboration in the National Health Service. Evaluation results showed that the course increased knowledge and understanding of other health care professions, developed more positive attitudes and demonstrated the importance of multiprofessional teamwork and communication. Participating students believed that both early and regular opportunities for shared learning should be essential aspects of undergraduate courses.

Adult↗
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↗
PubMed2001

[Unilateral aplasia of a lateral rectus muscle].

BACKGROUND: The congenital absence of an extraocular muscle is rare. The case of an unilateral lateral rectus muscle and a review of the literature are presented. PATIENT AND METHODS: A healthy 7-year old boy with inconspicuous family history was seen in our clinic. The boy had been noted to have a right esotropia from infancy. Clinical orthoptical examinations and magnetic resonance imaging (MRI) were performed. The esotropia was corrected by transposition of the superior and inferior rectus muscle. RESULTS: With correction of the myopic astigmatism the visual acuity of either eye was 0.8. The right eye could not abduct to pass the midline, the left eye passed the midline by 35 degrees. From the primary position the right eye was able to elevate by 20 degrees and the left eye to elevate 15 degrees. The alternate prism and cover test showed in either eye fixation an esotropia of 24 degrees without significant change in elevation or depression. Besides, there was a hypertropia (+VD) of 14 degrees which increased to 21 degrees in left gaze and decreased to 0 degree in right gaze. Indirect ophthalmoscopy showed a bilateral excyclo position of approximately 5-10 degrees. Retraction of either eye was not seen in any gaze direction. The axial length of the right/left eye was 25.2 mm/24.6 mm. Aplasia of the right lateral rectus muscle and hypoplasia of the left lateral rectus muscle could be demonstrated by magnetic resonance imaging. Intraoperatively the right lateral rectus muscle was absent. The vertical eye muscle inserted regularly. Hummelsheim's procedure was performed. Eight months postoperatively, the boy was orthotropic in primary position. The inferior oblique overaction was still present together with a "V" pattern of 8 degrees. The Bagolini test was positive. CONCLUSION: The congenital absence of one or more extraocular muscles is a rare condition, which has to be considered as a differential diagnosis to neurogenic nerve palsy.

Child↗
PubMed2001

[Functional reduction of vision symptomatic of a conversion reaction in paediatric population].

BACKGROUND: First case reports of psychogenic visual disorders date back into the 19th century. Nowadays we speak of functional visual disorders of somatoform origin, a conversion reaction in which neurotic conflicts are solved on somatic level. This is the initial kind of reduction of agitation specially in children. In contrary to malingering and aggravation conversion symptoms are unconscious actions. Besides the problems of numerous specific tests for differential diagnosis between organic and functional disturbances strategies for further management are necessary. PATIENTS AND METHODS: 26 patients at the age of 8 - 17 years with isolated reduction of vision due to conversion reaction were analyzed referring to sex, age, wether one or both eyes were affected, the duration of symptoms, the possible reasons for the conversion reaction and the further management. RESULTS: 75 % of our patients were females, the average was 12 years old, in 50 % we found a bilateral involvement. The main reasons for the conversion reaction were in 30 % interfamiliar problems, in 25 % school problems, 2 cases (4 %) occurred after mild head trauma and in 41 % no reason was found. Treatment consisted in discussions and suggestive therapy - "eyeglasses" and/or "eyedrops" parents were not primarily informed the diagnosis. One to three months later the tests were repeated. 90 % were without symptoms, 10 % needed psychotherapy. CONCLUSION: Apart from comprehensive neuroophthalmologic and orthoptic examination it is important to observe the patient for possible doctor shopping, symptom shift and the rare development of depression.

Adolescent↗
PubMedDate not supplied

[Cyclotropia and surgical treatment after macular translocation].

PURPOSE: Macular translocation is a new surgical treatment method successfully performed in recent years in cases of age-related macula degeneration. Cyclotropia and associated orthoptic problems may occur after macular translocations. The aim of our study was to present the application and results of various external eye muscle surgery techniques to eliminate cyclodeviation after macular translocation. METHODS: Between January 2001 and April 2001, 15 patients underwent macular translocation. After an average of 47 days counterrotation was applied to these patients to eliminate incyclotropia formed due to macular translocation. In 8 cases, superior and inferior oblique muscle surgery was combined with opposite vertical transpositions of the horizontal recti. In 5 cases, full tendon transposition of the superior oblique muscle to the nasal part of the globe was combined with the anterior margin advancement of the inferior oblique muscle. In 2 cases, only combined surgery of superior and inferior oblique muscles was performed. The degree of cyclodeviation was measured by both objective and subjective methods before and after counterrotation. Mean follow-up period was 53.9 days. RESULTS: The average objective cyclodeviation formed after macular translocation was 29.6 degrees. Combined surgery of superior and inferior oblique muscles led to a mean excyclorotation of 15 degrees whereas combined oblique muscle surgery performed with vertical transposition of horizontal recti provided a mean excylorotation of 20.8 degrees. The most effective method was the combination of total nasal transposition of superior oblique muscle with the anterior margin advancement of the inferior oblique muscle resulting in an improvement by 33 degrees. CONCLUSIONS: Macular translocations cause cyclodeviation. The ensuing cyclotropia can be eliminated by various surgical techniques of external eye muscles according to the degree of cyclotropia.

Aged↗
PubMedDate not supplied

[Myokymia of the obliquus superior muscle and cryptogenetic epilepsy].

BACKGROUND: Myokymia of the obliquus superior muscle is a rare episodic microtremor caused by uncontrolled activities of the trochlearis nerve fibres. Epilepsy is also caused by spontaneous discharges of neurons. In our report we present an associated epilepsy which to the best of our knowledge is described for the first time. PATIENT: An 61-year old man with twitches of the right eye for 6 weeks and a subjective feeling of eye movement was investigated at our hospital. His history was void of any ophthalmologic diseases. However, he suffered from cryptogenetic epilepsy known since childhood. The morphological and orthoptical findings of his eyes were normal. During the slit-lamp investigation a unilateral rotating microtremor of the right eye induced by looking downward was seen. The neurologic investigation, magnetic resonance imaging and assessment of the thyreoid function did not show further pathological results. The patient underwent treatment with carbamazepine. Under this therapy he did not show any symptoms of myokymia during follow-up. SUMMARY: To the best of our knowledge this is the first case of myokymia of the obliquus superior muscle associated to epilepsy. To our opinion, any case of this syndrome should be investigated for epilepsy. A causal relation is unlikely since the most probable etiologies are either spontaneous discharges of trochlear nucleus neurons or a close contact between vessel and nerve analogously to trigeminal neuralgia.

Anticonvulsants↗
PubMed2003

[Orbital blow-out fractures, a series of 12 operated cases].

BACKGROUND: The management for blow-out fractures is controversial. Some studies suggest early surgical treatment, others a conservative attitude. PATIENTS AND METHODS: We studied retrospectively the data of patients with blow-out fracture, referred to our Neuro-Ophthalmology and Strabismus Clinic from July 1993-May 2000. Out of 48 patients, 22 were operated. We evaluated all 12 patients who underwent pre- and postoperative orthoptic examinations. RESULTS: The patients' age at the time of the accident was 7.8 to 67.8 years (median 25.3). The delay between accident and operation was 2 to 91 days (median 5.5). Eleven patients were operated within 14 days, one after three months. All patients suffered preoperatively from double-vision. Postoperatively the field of fusion augmented, the middle point centralised. The follow-up time was 22 to 915 days (median 251). However, at the last examination, 0.5 to 16 months (median 4.5) after surgery, only seven out of 12 patients were symptom-free. CONCLUSION: Surgical reconstruction within the first week after trauma shows good results concerning ocular motility, sensibility, enophthalme, and field of fusion. An individual evaluation is surely necessary.

Adolescent↗
PubMed1993

[Treatment of stenosed or occluded hemodialysis shunts. Results of percutaneous angioplasty and combined radiologic-surgical therapy].

The results of all recanalisations of stenosed and occluded haemodialysis shunts over a period of three years are reported; there were 112 percutaneous angioplasties and 40 combined radiological-surgical procedures. In 13% of cases a metallic endoprosthesis (wall stent) and in 3% Simpson's atherectomy catheter was used. The functional results were retrospectively evaluated for all 152 interventions which involved 60 orthoptic Brescia-Cimino shunts and 19 PTFE prostheses. In addition, the primary and total functions of the treated shunts were calculated. Cumulative function rate (percentage at a given time of effective shunts) for Brescia-Cimino shunts at one year was 80% and after two years 68.5%; for the PTFE prosthesis the corresponding figures were 83.8 and 75.5% respectively. The average number of interventions per patient was 2.3 with a range of 1-7. Total functional rate of all shunts following the first percutaneous procedure after one year was 78.2%, for combined radiological-surgical procedures for the treatment of acute thromboses it was 68%. Comparison with the results of surgical treatment reported in the literature confirms the effectiveness of percutaneous or combined treatment of stenosed or acutely occluded haemodialysis shunts. The outstanding advantage of radiological intervention is its repeatability.

Angioplasty, Balloon↗
PubMed1998

[Normal accommodative convergence excess--long-term follow-up of conservative therapy with bifocal eyeglasses].

BACKGROUND: In patients with normaccommodative convergence excess it is possible to reduce or eliminate the excess of accommodative convergence by adding plus lenses. The resulting reduction of near deviation can lead to an improvement in the quality of binocular vision at near, and also to a better compensation of an esophoria at near. The aim of the paper was to study long term results in patients with small angle esotropia and esophoria and accommodative convergence excess treated by bifocals. METHODS: Clinical data of 91 patients were analysed retrospectively. Among them were 13 patients with esophoria, 32 patients with microesotropia and 46 with microesotropia and a phoric component. An orthoptic status was performed every three months and at every examination it was tried to reduce the added plus lenses. The mean follow up was 5.6 +/- 2.4 years (range: 1.1-13.2). RESULTS: The mean onset of strabismus was similar in all groups: i.e. 2.5 (+/- 1.7) years. The patients received their first bifocals on average 3.4 (+/- 1.9) years later. In 40 of the 91 patients the near addition could be stopped because of sufficient decrease of accommodative convergence excess during the follow-up period. The convergence excess decreased continuously in all patients with esophoria and microesotropia and the additional plus lenses could be stopped on average after 6.4 (3.5-8.4) years (esophoria) and 5.0 (2.6-8.1) years (microesotropia) respectively. In patients with microesotropia and an additional phoric deviation bifocals were only partly successful to reduce the convergence excess. The basic angle decompensated in more than half of the patients (27 out of 46) and was operated in 14 cases by unilateral resection/recession procedure. After the operation the convergence excess decreased rapidly and the bifocals could be stopped after 4.4 (3.4-7.4) years. In the remaining 19 cases it was possible to reduced the convergence excess with bifocals in 8 patients after about 8.1 (4.1-9.3) years and in some of the remaining 11 cases a Fadenoperation has been suggested. CONCLUSION: While wearing bifocals the accommodative convergence excess decreased completely in patients with esophoria and microesotropia. In the condition with markedly reduced binocular vision and a large phoric component at far and near, the convergence excess decreased only in some of the patients while wearing bifocals. Conventional strabismus surgery to reduce the basic angle has a positive influence. A Fadenoperation is only necessary in a few cases.

Accommodation, Ocular↗
PubMed1998

[Screening for amblyopia, strabismus and refractive abnormalities in 1,030 kindergarten children].

BACKGROUND: There are controversies concerning the necessity of pre-school vision screening. AIM OF THE STUDY: evaluation of the prevalence of pathologic ophthalmologic findings in kindergarten children. MATERIALS AND METHODS: 1030 families were offered a vision screening. Of these, a total of 948 children, aged 3 to 6 years, voluntarily underwent a screening for strabismus, amblyopia and refractive anomalies. The examination was performed in the kindergarten in the absence of the parents. METHODS OF EXAMINATION: A questionnaire concerning general and ophthalmologic history of the child and of the family was evaluated. Visual acuity, cover-uncover-test, Lang-stereotest, retinoscopy, ophthalmoscopy (undilated pupils) were performed and the glasses were evaluated. RESULTS: The screening was highly accepted by the parents and 92% of the families (n = 948) took part. The compliance of the children was very good. A total of 38.7% (n = 381) of the children showed one or more abnormal parameters. 21.4% (n = 229) showed a reduced visual acuity. Strabismus was found in 3.7%. Half of the children with abnormal findings already had had a vision screening, but only 25% had received ophthalmologic treatment. Of those who possessed glasses, 25% came without them, and another 25% had a reduced visual acuity even with their glasses. The main problems were many false-positive results and high costs. CONCLUSIONS: Ophthalmologic and orthoptic screening in kindergarten is technically easy and conclusive in experienced hands. Ideas to reduce costs and to avoid overreferrals are an age-related lowering of the visual acuity limit and a rescreening of suspected children in a screening-setting a second time before sending them to an ophthalmologist. Another possibility to reduce costs would be to perform examinations not by ophthalmologists but by "screening-orthoptists" who should be trained in retinoscopy and ophthalmoscopy.

Amblyopia↗
PubMed1996

[Pathogenesis of eso- and hypotropia in high myopia].

BACKGROUND: In myopia characteristic types of strabismus and defects of ocular motility can occur. One of these myopia related disturbances shows a gradually increasing eso- and hypodeviation in progressively myopic eyes, caused by a corresponding deficit of abduction and elevation. Different pathogenetic factors have been described for this long known clinically uniform entity. PATIENTS AND METHODS: In eight patients with pathologic myopia a marked eso- and hypotropia was operated on in the last 15 years. The deviation was infantile in two and acquired in six cases. We performed a routine orthoptic examination and looked for anatomic variations of the rectus muscles during surgery. RESULTS: In seven of the eight cases the anterior portion of the lateral rectus muscle was not directed straight dorsaly but obliquely into the lower temporal quadrant of the orbit. A supraposition of the horizontal recti muscles in addition to a recess-resect procedure provided satisfactory results in five of six cases. CONCLUSIONS: Scleral ectasia in high myopia can lead to a downslip of the lateral rectus muscle relative to the globe, giving this muscle a depressing effect at the cost of its physiological action. As in Duane's syndromes with up- or down-shoot, a repair of the deviation is possible by combining horizontal surgery with vertical transposition of the horizontal recti muscles. Additional operations on the vertical recti muscles can thus be avoided.

Duane Retraction Syndrome↗
PubMed1995

[Congenital familial cornea plana with ptosis, peripheral sclerocornea and conjunctival xerosis].

BACKGROUND: Cornea plana is an extremely rare, congenital hereditary malformation of the corneo-scleral shape. The curvatures of cornea and sclera are nearly equal with an indistinct limbus. In addition to the flatness, there is a peripheral sclerocornea that produces a pseudomicrocornea. The low corneal refraction and the short anterior segment often result in hyperopia. Myopia is also described. Usually the posterior segment is not involved. MATERIALS AND METHODS: A young man of 22 years, his three- and five-year-old sons, and his newborn daughter showed this hereditary abnormality of the cornea. In this uncommon anomaly we measured corneal curvature, refraction, diameter and in three of the four patients echographical length of the bulbi. RESULTS: The family showed an autosomal dominant inheritance of the cornea plana. The corneal refraction was less than 32 diopters. The scleral encroachment caused an oval cornea measuring horizontally between 5 and 6.5 mm, vertically 4 to 5 mm. Additionally a pseudoblepharoptosis and a conjunctival xerosis of the father and his sons was observed, which is not regularly found. A-scan measuring of the bulbi revealed age-related normal values. CONCLUSIONS: There is no evidence for progression of this anomaly during life. No therapeutical consequences are necessary. To preserve a satisfactory function a conscientious orthoptical maintainance should be guaranteed.

Adult↗
PubMed1995

[Disorders of eye movement in amyotrophic lateral sclerosis--report of 2 patients].

BACKGROUND: Amyotrophic lateral sclerosis (ALS), a neurodegenerative disorder of unknown origin, was thought to spare the extraocular muscles. Extraocular involvement has recently been reported to occur in the late stages of ALS following respiratory insufficiency. CASE REPORT: We report on two patients with ALS who were referred for screening of oculomotor impairment in ALS. Orthoptic examination in a 64-year-old woman with peripheral ALS revealed retraction of the upper eye lids as well as impaired abduction and upgaze in both eyes, developing prior to respiratory insufficiency. A 50-year-old man with bulbar ALS was found to have bilateral impairment of upgaze as well as a negative Bell's phenomenon. Horizontal pursuit was interrupted by compensatory saccades, vertical fixating saccades were slightly hypometric. These oculomotor changes were also seen prior to respiratory insufficiency. CONCLUSION: These findings provide further evidence of early oculomotor involvement in ALS, e.g. prior to respiratory failure and prior than previously suspected. Oculomotor impairment may occur in both the peripheral and the bulbar type of ALS.

Amyotrophic Lateral Sclerosis↗
PubMed1994

[Treatment of fusional disorders in patients with brain damage].

BACKGROUND: We trained fusional convergence systematically using 3 orthoptic devices (fusion trainer, prisms, cheiroscope) in brain damaged patients with a severe deficit of convergent fusion. PATIENTS AND METHODS: 12 patients were selected, 6 with vascular cerebral lesions and 6 with traumatic brain damage. The chronicity (time since lesion) was 15.8 months (range: 2-108). Near and far visual acuity, accommodation, convergent fusional range, stereopsis (Titmus and TNO test), maximal reading duration and subjective complaints (e.g. eye strain, headache) were evaluated. To separate improvements during treatment from spontaneous recovery of function or measurement artefacts we performed repeated measurements before treatment (baseline period) during a time span of 4-6 weeks. Follow-up measurements could be performed in 9 of 9 patients 10 months after cessation of treatment. RESULTS: No improvements were seen during the baseline period. 11 of 12 patients showed a significant recovery of fusional range during training which remained stable during the 10-month follow-up period. 10 of 11 patients showed significant improvements of local stereopsis (Titmus test) and 4 of 5 patients of global stereopsis (TNO test). All patients showed a significant increase of near visual acuity of about 10% (decimal visual acuity), improved reading ability and a reduction of subjective symptoms resulting from fusional deficiency, e.g. eye strain, headache. CONCLUSIONS: These results suggest a considerable potential for recovery of oculomotor and visual functions in brain damaged patients after training.

Accommodation, Ocular↗
PubMed1992

[Treatment of dyslexia with occlusion or prisms].

In the German speaking part of Switzerland in the last few years there have been two singular trends in orthoptic and surgical treatment of dyslexia. Professor Otto performs occlusion to achieve dominance in one eye. Of 300 cases treated he has operated on 147 for an exodeviation. Dr. Pestalozzi prescribes prismes based on the Polatest to reach perfect binocular vision. In 175 cases he operated on 43 dyslectic children for an esodeviation. Both treatments are critically analysed and refused.

Child↗
PubMed1991

[Development of impaired vision in mentally handicapped children].

The aim of the following study was 1) to show the incidence of ophthalmic disorders in severely visually and mentally handicapped children retrospectively 2) to follow up the change in visual acuity over at least 2 years prospectively 3) to look at the effect of therapeutic concepts. 270 children of the "Blindeninstituts-stiftung Würzburg" were followed up between 1960 and 1987. ad 1) Optic atrophy was the leading cause of visual impairment (24%) followed by cataract and retinopathy of prematurity (both found in 17%), malformations of the anterior segment (12%), cortical amblyopia (8%) and refractive error (6%). Strabismus was an additional finding in 38% of the children often associated with nystagmus. Convergent and divergent strabismus had the same incidence. ad 2) Visual acuity improved in 30% of cases of cortical amblyopia, in 40% of refractive errors and in 30% of optic atrophy. In cases of cataract there was a slight improvement in 20%. In 24% of aphakia a secondary glaucoma was observed. In cases of malformations of the anterior segment and ROP the visual acuity remained stable on a low level. The cases of ROP were advanced and had not received any surgical treatment. A deterioration in vision as often seen after surgical intervention was observed in 20% of ROP. In respect of the high incidence of refractive errors and orthoptic problems in multiple handicapped children they should be seen as early as possible by an ophthalmologist. Detection of a congenital cataract soon after birth as well as complications of other disorders should help to prevent blindness. The remaining visual perception is especially important for the handicapped child to communicate and move about.

Adolescent↗