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PubMed1985

Contrast and accommodation in amblyopia.

Steady-state accommodation as a function of sinusoidal and square-wave grating contrast was measured in amblyopes. The amblyopic eyes exhibited reduced average response levels and required greater contrast to sustain accommodation than the fellow dominant eye or the eyes of visually-normal control subjects. Following therapy, accommodation in the amblyopic eye markedly improved. These results suggest: reduced accommodative controller gain, reduced stimulus effectiveness of target contrast, and considerable residual visual system plasticity with respect to the neurological control pathways of accommodation, in the amblyopic eye.

Accommodation, Ocular↗
PubMed2005

Visual training: current status in ophthalmology.

PURPOSE: To inform ophthalmologists of the current status of visual training. DESIGN: Personal perspective. METHOD: A perspective and analysis of current practices that include a review of the literature and personal experiences of the author. RESULTS: Visual training of some sort has been used for centuries. In the first half of the twentieth century, in cooperation with ophthalmologists, orthoptists introduced a wide variety of training techniques that were designed primarily to improve binocular function. In the second half of the twentieth century, visual training activities were taken up by optometrists and paramedical personnel to treat conditions that ranged from uncomfortable vision to poor reading or academic performance. Other visual training has been aimed at the elimination of a wide variety of systemic symptoms and for the specific improvement of sight and even for the improvement of athletic performance. At present, ophthalmologists and orthoptists use visual training to a very limited degree. Most visual training is now done by optometrists and others who say it works. Based on an assessment of claims and a study of published data, the consensus of ophthalmologists regarding visual training is that, except for near point of convergence exercises, visual training lacks documented evidence of effectiveness. CONCLUSION: Although visual training has been used for several centuries, it plays a minor and actually decreasing role in eye therapy used by the ophthalmologist. At the beginning of the twenty-first century, most visual training is carried out by non-ophthalmologists and is neither practiced nor endorsed in its broadest sense by ophthalmology.

Amblyopia↗
PubMed2004

The emotional impact of amblyopia treatment in preschool children: randomized controlled trial.

PURPOSE: To investigate the emotional status of children undergoing active treatment for amblyopia. DESIGN: Postal survey, in the context of a prospective, multicenter, randomized controlled trial. PARTICIPANTS: Parents of 177 children with a unilateral visual impairment referred from preschool vision screening. The children had been recruited to a randomized controlled trial of treatment for unilateral visual impairment and randomly assigned to receive either glasses with or without patches, glasses alone, or treatment deferred for 1 year. METHODS: A self-completion questionnaire, including a psychometric behavioral scale, was sent to the parents of all children recruited to the trial at age 4 years, to 66 whose deferred treatment began at age 5 years, and finally to 151 remaining in the trial at the end of follow-up. MAIN OUTCOME MEASURES: Mean scores per treatment group on the Revised Rutter Parent Scale for Preschool Children. Comparison of parent responses to questions assessing the child's general well-being and difficulties associated with treatment. RESULTS: Completed questionnaires were returned for 144 of 177 (81%) children at a mean age (standard deviation) of 48 months (5.0), for 45 of 66 (68%) at a mean age of 61 months (5.8), and for 78 of 151 (52%) at a mean age of 67 months (5.0). Most parents reported having difficulty with patching their child regardless of age (77% at age 4 years and 73% at age 5 years), with fewer reporting difficulties with glasses alone (42% and 53%, respectively). Children were significantly more upset by patching than by glasses only (chi-square test, P = 0.03 for age 4 years and P = 0.01 for age 5 years), as were the parents of 4-year-olds (chi-square test, P = 0.01). Most parents thought their children were happy, cooperative, and good tempered, and behavioral scores did not differ between treatment groups. CONCLUSIONS: Treatment for unilateral visual impairment is not easy to implement and is commonly associated with some degree of distress. Despite this, no impact on the child's global well-being or behavior was seen either during or after the treatment period.

Affective Symptoms↗
PubMed2005

Comparison of Harms tangent screen and search coil recordings in patients with trochlear nerve palsy.

Harms tangent screen, a subjective measurement method of three-dimensional binocular alignment, was compared with search coil recording. Twenty-three patients with unilateral trochlear nerve palsy were measured in nine gaze positions. The two methods correlated best for the horizontal gaze deviation, the vertical gaze deviation, and the vertical incomitance, but there was no correlation for the results of torsional incomitance. Using Harms tangent screen, torsional deviation underestimated the torsional incomitance measured by the search coils. Therefore, central torsional fusional mechanisms or alignment error in the Harms tangent screen are assumed.

Adolescent↗
PubMed1980

Visual acuity and binocularity in unilateral high myopia.

Thirty-eight patients with unilateral high myopia ranging from 5 to 19 diopters were followed up for a median of two years. All were treated with full-spectacle correction and most had occlusion. When initially examined one patient (3%) had visual acuity of 6/12 (20/40) or better, four patients (12%) had central fusion, and 24 patients (63%) were phoric. At the conclusion of the study 12 patients (32%) had visual acuities of 6/12 (20/40) or better, 17 patients (45%) had central fusion, and 29 patients (76%) were phoric. Age at the start of treatment was not a factor in the versely affect the response to amblyopia was inversely related to both final fusion and final visual acuity.

Adolescent↗
PubMed1985

Effect of monocular occlusion on visuomotor perception and reading in dyslexic children.

101 (68%) of 148 dyslexic children had unstable vergence eye movement control (unfixed reference) in the Dunlop synoptophore test. These children tended to make visual rather than phonemic errors when reading and writing; the opposite was true for those with stable control (fixed reference). The 148 dyslexic children were given plano spectacles to wear for 6 months when reading and writing and were randomised to receive either spectacles that had the left lens occluded or untreated ones. The trial was double blind. Conversion from unfixed to fixed reference occurred in 51% of the children who wore occluded spectacles, compared with 24% of those who wore plain spectacles. In the former group increase in reading ability improved by almost 6 months relative to change in age, whereas in those who wore plain spectacles and whose reference did not become fixed reading ability regressed by 0.4 months. The children with unfixed reference who did not benefit from occlusion were those who made not only visual but also phonemic and sequencing errors. Monocular occlusion may thus help one-sixth of dyslexic children to develop reliable vergence control and thereby to read.

Child↗
PubMed1993

The sensitive period for strabismic amblyopia in humans.

PURPOSE: In order to assess the sensitive period for strabismic amblyopia, the period of susceptibility to monocular occlusion was investigated in 407 children who ranged in age from 21 months to 12 years. METHODS: Patients were treated between 1975 and 1990 by occlusion of the best eye. The efficiency of the treatment was measured as the ratio of reduction of the amblyopia at the end of the occlusion. RESULTS: The efficiency of the occlusion is shown to depend on the age of the onset of the treatment: recovery of acuity of the amblyopic eye was maximum when the occlusion was initiated before 3 years of age, decreased as a function of age and was about null by the time the patient was 12 years of age. CONCLUSION: This is assumed to be an indication of the sensitive period for strabismic amblyopia in humans. The results are discussed on the basis of the neurophysiological mechanisms of amblyopia established in animals.

Age Factors↗
PubMed1979

Ninth Annual Richard G. Scobee Memorial Lecture. Sensory response in exotropia.

The characteristics, methods of clinical investigation, and incidence of amblyopia, suppression, and anomalous retinal correspondence in exotropia have been reviewed from the ophthalmic literature. It is hoped that reemphasizing the sensory anomalies in exotropia may lead to more sensitive clinical investigation in these areas and, ultimately, to a better understanding of the sensory system and some of its enigmatic responses.

Amblyopia↗
PubMed1992

Visual rehabilitation. The challenge, responsibility, and reward.

BACKGROUND: A multispecialty ophthalmology clinic created a not-for-profit foundation to establish a center for visual rehabilitation. METHODS: The Center's objective of equipping and enabling visually impaired people to lead more productive, independent, and satisfying lives by improving their remaining functional sight is performed through a four-phase program comprised of an intake interview, low vision examination, rehabilitation training, and counseling. RESULTS: Since its inception in 1986, the Center has cared for 947 females and 511 males. Although the majority of the patients examined are 61 to 90 years of age, all age groups have received care, including 41 patients younger than 10 years of age and 42 patients 91 years of age or older. CONCLUSION: The role of the ophthalmologist in the visual rehabilitation process is pivotal. The author acknowledges that most practices are unable to develop such a center. A number of suggestions are made, however, that may enable many practices to participate in the rehabilitation of their patients.

Adolescent↗