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Strabismus.

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Accommodation, Ocular↗

Strabismus.

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Accommodation, Ocular↗

Strabismus.

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Abducens Nerve↗

Accommodative esotropia during the first year of life.

Two infants developed accommodative esotropia during their first six months of life. One infant, whose age at onset was 4 1/2 months, had 4.50 diopters of hyperopia. The second infant, whose age at onset was 5 months, had 3.50 diopters of hyperopia. In both infants, the eyes completely aligned with hyperopic correction. Two points are stressed. First, when the amount of hyperopia exceeds +3.00, consideration should be given to an accommodative element as the cause of the esotropia, even if the child is only 4 to 6 months old. Second, even with small angles of esotropia, an accommodative element should be considered, if there is a substantial amount of hyperopia.

Accommodation, Ocular↗

Ciliary muscle dysfunction in Adie's syndrome.

Ciliary muscle function in patients with Adie's syndrome was studied retrospectively in 122 patients and prospectively in 17 patients. When a careful history was taken, two thirds of the patients had ciliary muscle-related symptoms. Most of the patients with Adie's syndrome had a moderate accomodative paresis, but there was a strong tendency for the ciliary muscle to recover with time. Many patients showed a tonicity of accommodation, especially those who had had the condition for several years. Astigmatism could be induced with accommodation in one third of patients. This may be related to segmental paralysis of the ciliary muscle. Seventy-three percent of the patients showed supersensitivity of the ciliary muscle in the involved eye, when both eyes were treated with a mixture of 0.25% pilocarpine hydrochloride and hydroxypropyl methylcellulose (Isopto Carpine). This may be a clinical aid in diagnosing Adie's syndrome. Two patients were found to have bilateral ciliary muscle dysfunction but only unilateral pupillary abnormalities. These two patients may have had a "pupil-sparing" Adie's syndrome.

Accommodation, Ocular↗

Internal ophthalmoplegia after argon laser panretinal photocoagulation.

Internal ophthalmoplegia was found in eight eyes of four patients with juvenile-onset diabetes. All eight eyes had received argon laser panretinal photocoagulation (PRP) for proliferative diabetic retinopathy. Internal ophthalmoplegia was not found in any of the 14 eyes of seven patients with juvenile diabetes who had not had photocoagulation treatment. This group included one patient in whom internal ophthalmoplegia was present after treatment. Laser injury to the short ciliary nerves, as they course anteriorly on the inner surface of the sclera, is the probable cause of internal ophthalmoplegia in these patients. To my knowledge, this complication has not been reported previously, but it appears to be a common side effect of PRP.

Accommodation, Ocular↗

Accommodative and convergence insufficiency after decompression sickness.

Twelve professional divers had visual complaints after decompression sickness. Severe accommodative and convergence insufficiency, heretofore unrecognized, was detected and studied. Two rhesus monkeys were subjected to similar hyperbaric conditions and then examined before death for study of their eyes and brains. The animals seemed to have accommodative and convergence insufficiency.

Accommodation, Ocular↗

Echothiophate iodide cataracts in monkeys. Occurrence despite loss of accommodation induced by retrodisplacement of ciliary muscle.

Five cynomolgi underwent unilateral 360 degrees ciliary muscle retrodisplacement. Beginning several months later, they received 150 to 210 micrograms of echothiophate iodine topically once daily in both eyes for five months. In all eyes anterior and posterior subcapsular lens opacities developed that were characteristic of those caused by echothiophate. There were no apparent differences in biomicroscopic appearance or time course of the cataracts between eyes with or without retrodisplaced ciliary muscles. Since eyes with retrodisplaced ciliary muscles accommodate only minimally in response to echothiophate, possible mechanical stress on the lens due to sustained, intense accommodation cannot explain echothiophate cataractogenesis.

Accommodation, Ocular↗

Clinical evaluation of the Humphrey automatic refractor.

A new automatic objective refractor was used on healthy adults. In the absence of cycloplegic drugs, spherocylindrical objective refractions performed with the instrument provided 20/20 acuity 96% as often as with standard subjective techniques. No instrument-induced accommodations effects were seen. One hundred percent of instrument spherical findings were repeatable within 0.50 diopters; all cylindrical findings were repeatable within 0.37 D. This result represents a higher level of repeatability than that reported for standard subjective refraction under clinical conditions. In the absence of cycloplegic drugs, the correlation coefficient between the instrument's findings and standard subjective spherical findings was .97 v .98 between two practitioners' subjective refractions. The average difference between cylindrical findings of the instrument and those of an experienced practitioner was 0.04 D larger than the average difference seen between two practitioners using subjective techniques.

Accommodation, Ocular↗

Persisting accommodative esotropia.

This report examines the persistence of many cases of accommodative esotropia well beyond the expected time of resolution (age 10 to 12 years) and the potential usefulness of any associated clinical features to predict timely or delayed disappearance. In a series of 202 patients, there was no discrete age of improvement and more than half persisted after age 10 years. The results were similar for both high and normal accommodative convergence/accommodation ratio cases. Initial hyperopia did not predict persistence; subsequent increases prior to age 7 years, and decreases thereafter, were different statistically but were clinically similar. Moreover, the occurrence of inferior oblique overaction and of dissociated vertical deviation, as well as a family history of strabismus, did not predict persistence or delayed improvement.

Accommodation, Ocular↗

Counteracting the effects of mydriatics. Does it benefit the patient?

The effect of 2% pilocarpine nitrate in countering mydriasis, cycloplegia, and change in visual acuity due to 0.5% tropicamide was studied in 23 healthy volunteers. There was no significant difference in the decrease in pupil size or the rate of return of accommodation between the eye that received pilocarpine and the control eye. The effect of tropicamide on visual acuity was slight. In four (17%) of 23 eyes that received pilocarpine, visual acuity was reduced to 6/36 or worse. It is suggested that the use of 2% pilocarpine in the attempted reversal of 0.5% tropicamide to improve a patient's vision is not helpful and may possibly be harmful.

Accommodation, Ocular↗

Accommodative ability in younger-onset diabetes.

The relationships among accommodative ability, younger-onset diabetes, and other factors are examined in this report. The study population consists of younger-onset diabetic persons less than 45 years of age who participated in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. In 656 of 859 such persons, near point of accommodation was measured twice for each eye using the best correction for distance visual acuity and a Prince rule. Mean amplitude of accommodation in the diabetic population decreased with age and was less than that of a nondiabetic group and of previously published reports. Other factors associated with decreased accommodation in the diabetic population in a multiple linear regression analysis include sex, with the female population being more susceptible; absence of myopia; a longer duration of diabetes; higher glycosylated hemoglobin level; higher blood glucose level; increasing severity of diabetic retinopathy; and higher systolic blood pressure.

Accommodation, Ocular↗