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At least 1,081 records · Page 60Linked to original sources
PubMed1992

Results of amblyopia therapy in eyes with unilateral structural abnormalities.

PURPOSE: The purpose of this study is to analyze the visual results of full-time occlusion therapy in pediatric patients with monocular structural abnormalities and amblyopia. METHODS: The authors reviewed the charts of visually immature patients with unilateral structural abnormalities and decreased visual acuity, who presented to the University of Iowa Hospitals and Clinics over a 20-year period, and underwent amblyopia therapy. The results were categorized according to the type of structural abnormality (i.e., partial media opacity, macula lesion, or optic nerve abnormality). Associated factors, including anisometropia, strabismus, age of presentation, and pupillary responses, were analyzed. RESULTS: Fifty-one percent of the 51 patients in the study achieved a visual acuity of at least 20/80, including 72% of the patients with media opacities, 42% with macular lesions, and 21% with optic nerve anomalies. Strabismus and anisometropia occurred frequently and were not prognostically significant. Relative afferent pupillary defects did not contraindicate good results. Amblyopia recurred in 31% of patients and was successfully treated with resumption of full-time occlusion. Occlusion amblyopia occurred in only one patient and was easily reversed. CONCLUSION: The authors recommend a trial of full-time occlusion for patients with all three types of unilateral structural abnormalities. The patients with partial media opacities have a high success rate. Despite lower success rates for the other two groups, good results are possible; no better treatment option exists.

Amblyopia↗
PubMed1993

The efficacy of optical and pharmacological penalization.

PURPOSE: Optical and pharmacological penalization of sound eyes are infrequently used alternatives to occlusion for treating amblyopia. The authors evaluated the efficacy of penalization as their primary treatment of amblyopia. METHODS: One hundred sixty-six patients underwent penalization treatment for strabismic or anisometropic amblyopia for a minimum of 3 months. Both atropine and optical penalization methods were used. RESULTS: Visual acuity improved in 67 (77%) of 87 patients treated with optical penalization. There was a significant improvement of the geometric mean visual acuity of the amblyopic eyes from 20/38 to 20/28 (P < 0.001). Visual acuity of 60 (76%) of 79 patients treated with pharmacological penalization improved. There was a significant improvement of mean visual acuity of the amblyopic eyes from 20/61 to 20/40 (P < 0.001). Neither therapy produced an instance of occlusion amblyopia. Thirteen patients discontinued therapy because of blur or discomfort. CONCLUSION: This study demonstrates that penalization methods are effective methods for the treatment of amblyopia, with a low risk of occlusion amblyopia. Patient acceptance of these methods was excellent. Penalization should be considered more often for the primary treatment of amblyopia.

Amblyopia↗
PubMed1998

The accuracy of experienced strabismologists using the Hirschberg and Krimsky tests.

OBJECTIVE: The purpose of the study was to assess the accuracy of a group of strabismologists applying the Hirschberg and Krimsky tests. DESIGN: A clinical trial. PARTICIPANTS: Sixteen very experienced strabismologists participated in this study. INTERVENTION: The participants were asked to evaluate slides of four different patients using the Hirschberg method and to evaluate two of the four patients with the Krimsky method. The slides included a patient with 25 delta left esotropia, a patient with 25 delta right exotropia, a patient with 80 delta esotropia with a positive angle kappa, and a patient with 75 delta infantile esotropia. Alternate prism and cover testing was performed immediately after the photograph was taken and considered to be the actual deviation of the patient. MAIN OUTCOME MEASURE: Measured was the accuracy in assessing the angle of strabismus. RESULTS: With the Hirschberg method, each participant underestimated at least one patient by at least 10 delta. In addition, the participants tended to underestimate both large and small angle esotropic and exotropic patients with greater errors of estimation occurring with larger angles of strabismus. With the Krimsky method, a majority of participants overestimated at least one patient by 10 delta and showed difficulty in appreciating differences of 5 delta. In addition, the authors noted inconsistent responses by each participant. CONCLUSION: The Hirschberg and Krimsky methods are substantially less accurate than the alternate prism and cover test.

Adult↗
PubMed1999

Diagnosis and management of divergence weakness in adults.

OBJECTIVE: To determine how frequently neurologic disease accompanies divergence weakness, the stability of the eye movement disorder, and the response to treatment. DESIGN: Prospective, interventional, noncomparative case series. PARTICIPANTS AND METHODS: Seventeen consecutive adult patients (28-96 years of age) with divergence weakness were prospectively evaluated from 1991 to 1997. MAIN OUTCOME MEASURES: Ocular alignment was measured at distance and near and in up, down, left, and right gaze. Fusional divergence amplitudes were measured at distance. The presence or absence of associated neurologic disease was noted. The response to treatment (prisms or strabismus surgery or both) was recorded. RESULTS: None of the patients had concurrent neurologic disease. Thirteen patients remained stable, 3 improved, and 1 progressed. Sixteen patients were treated successfully: 12 with prisms and 4 with strabismus surgery; 1 patient was not treated. CONCLUSION: Divergence weakness is usually an isolated condition that tends to remain stable and respond to treatment with either prisms or strabismus surgery.

Adult↗
PubMed2002

The gatekeeper in vision care. An analysis of the co-ordination of professional services in The Netherlands.

Data from a national survey were used to explore the position of ophthalmologists, general practitioners, orthoptists, optometrists and opticians in the domain of vision care services. Options for organising the gatekeeper function were analysed. This was done on the basis of six cases that the five key occupations considered as their overlapping areas. Nearly all respondents reported to be consulted by patients with the given complaints, indicating rather unclear boundaries between the professions. Further, the opinions indicated preference for a medical gatekeeper (ophthalmologist, GP) rather than a non-medical one (optometrist). Lack of agreement on suggested gatekeeper options suggest other options to consider, like regional networks of GPs, ophthalmologists, orthoptists and optometrists who share the responsibility for a specified client population. At present, such innovative arrangements are being introduced. GPs and optometrists could share the responsibility for gate-keeping and for referring patients to more specialised services.

Attitude of Health Personnel↗
PubMed1997

Active vision therapy for pseudophakic amblyopia.

PURPOSE: To study the benefit of active vision therapy using various pleoptic methods in pseudophakic amblyopic children and young adults. SETTING: Daljit Singh Eye Hospital, Amritsar, India. METHODS: This study comprised 160 consecutive pseudophakic amblyopic patients who had had iris-claw lens implantation for congenital or traumatic cataract. Their ages ranged from 3.5 to 25.0 years. Before active vision treatment, visual acuity was worse than 20/200 in 63 patients (39.3%), 20/200 in 77 (48.1%), 20/120 to 20/80 in 14 (8.7%), and 20/60 in 6 (3.7%). The methods included Haidinger brushes on the synoptophore, after images, CAM stimulator, drawings on the cheiroscope, Pigeon-Cantonnet stereoscope, video games with the amblyopic eye, and exercises for promoting eye-hand coordination. Mean duration of therapy was 6 months. RESULTS: After therapy, visual acuity was worse than 20/200 in 31 patients (19.4%), 20/200 in 38 (23.7%), 20/120 to 20/80 in 41 (25.6%), 20/60 to 20/40 in 36 (22.5%), and 20/20 in 14 (8.7%). In 20 patients (12.5%), all younger than 15 years, visual acuity decreased within 1 month after treatment stopped. However, vision was rapidly restored after another session of active vision therapy. CONCLUSIONS: Active vision therapy helped improve visual acuity in the majority of young pseudophakic amblyopes.

Adolescent↗
PubMed1999

Visual acuity tests using chart, line, and single optotype in healthy and amblyopic children.

PURPOSE: The purpose of this study was to evaluate the difference between full chart, single line, and single optotypes visual acuity (VA) test results in healthy and amblyopic children. METHODS: Thirty-five children with amblyopia (20 with strabismus and 15 with anisometropia) and 40 ophthalmologically normal age-matched children were examined. The mean age of the patients in the study and control groups did not differ significantly (P= .9). A commercial projector that projected tumbling-E randomly placed optotypes was used. The VA of the amblyopic eye of the patients in the study group and the right eye of the patients in the control group was examined first using a full chart of optotypes, then using a single line of optotypes, and finally with individual symbols. The procedure was repeated with the other eye. RESULTS: LogMAR VA improved when the full chart was substituted with a single line, and improved by a similar increment further with single optotypes, in both the study and control groups. VA improved significantly more in eyes with amblyopia than in control subjects. Results were not influenced by age. CONCLUSION: VA testing using a single line gives better, sometimes misleading results, than tests with a full chart because it reduces but does not eliminate the crowding effect. When using a device that can employ more than 1 mode, the exacttest mode should be specified and maintained throughout the follow-up.

Amblyopia↗
PubMed1989

The prism bar--Prentice and frontal positions.

The prism cover test has been in use for many years for measuring ocular alignment. The measurements obtained are used for both calculating the amount of correction needed in strabismus surgery, and monitoring any change in ocular alignment with recovery from muscle imbalance. Variability may arise from its use in either the frontal position or the Prentice position. Most prism bars used in the United Kingdom are calibrated for use in the Prentice position. Inaccurate results arise when a prism bar is used in a position for which it is not calibrated. The theoretical calculation for adjusting measurements obtained in the frontal position with prisms calibrated for use in the Prentice position was assessed clinically. A new modified equation is proposed incorporating practical aspects of performing the prism cover test. A table of values is included to assist in determining the necessary adjustment, so allowing for a more reliable assessment.

Adolescent↗
PubMed2001

Autosomal dominant congenital superior oblique palsy.

PURPOSE: We describe a mother and all her offspring with congenital superior oblique palsy (CSOP), and a father and all his sons with unilateral CSOP. We discuss the inheritance pattern in our pedigrees and compare it with previous reports. METHOD: All available family members were examined. The prism cover test was performed. Ocular movements were examined in all positions of gaze and where possible a Hess chart plotted. Lang and TNO stereotests were used to determine the stereo-acuity. The results of these tests combined with the Bielschowsky head tilt test (BHTT) were used to confirm the diagnosis of superior oblique palsy. The condition was classified as congenital if it presented early based on history or the observation of old photographs and in the absence of a causative factor. RESULTS: The affected members of family A consist of a father and his three sons with unilateral CSOP. His daughter had a mild weakness of her left inferior and superior rectus muscle. One of his sons was asymptomatic and only recognised on screening of the family for the study. The affected members of family B consist of a mother and her younger daughter with unilateral CSOP and her older daughter with bilateral CSOP. She had no other children. CONCLUSIONS: Our families demonstrate what is probably an autosomal dominant form of CSOP. It is possible that hereditary CSOP is more common than previously reported.

Adult↗
PubMed2005

Interventions for intermittent distance exotropia: review.

PURPOSE: Management decisions in intermittent distance exotropia vary and lack well-defined clinical guidelines. We undertook a systematic review in an attempt to clarify the effects of various surgical and nonsurgical treatments and to establish the significance of factors such as age with respect to outcome. The review was undertaken in collaboration with the Cochrane Eyes and Vision Group. METHODS: Electronic and manual searches were undertaken to identify randomised controlled trials of surgical or nonsurgical treatments for intermittent distance exotropia. We also contacted researchers active in this field for information about further published or unpublished studies. There were no language restrictions. Study abstracts identified from the searches were analysed independently by the two reviewers (SR and LG) and marked for inclusion, exclusion, or consideration. Reviewer analysis was compared and full papers for appropriate studies were requested. RESULTS: No randomised controlled trials were found that met our selection criteria. CONCLUSIONS: The current literature consists mainly of retrospective reviews. These are difficult to compare and analyse due to variations in definition, intervention criteria, and outcome measures. However, there appears to be an agreement that the nonsurgical treatment is more appropriate in small-angle deviations or as a supplement to surgery. Studies supporting both early and late surgical intervention were found, so the optimal timing of surgical intervention could not be concluded. There is a need for robust clinical trials to improve the evidence base for the management of this condition.

Child↗
PubMed2001

The effects of accommodative facility training on a group of children with impaired relative accommodation--a comparison between dioptric treatment and sham treatment.

The effects of accommodative facility training were evaluated by comparing training with plano lenses and +/-2.00 D lens flipper sets. Thirteen children with symptoms and signs of accommodative dysfunction were included in the study. Seven started with 2 weeks of plano lens training before proceeding to traditional dioptric flipper training; later, one patient from this group was lost to follow-up. The remaining six children used powered flipper training from the start. The positive (PRA) and negative relative accommodation (NRA) were examined every second week. During the initial training period both the PRA and the NRA decreased in the sham treatment group (P = 0.010 and P= 0.102, respectively), while the PRA and the NRA increased during the dioptric training in both groups (P = 0.102 and P = 0.033, respectively). The result of this study indicates that accommodative facility training has a real effect on the amplitude of relative accommodation in patients with impaired relative accommodation.

Accommodation, Ocular↗
PubMed1985

[Endocrine ophthalmopathy].

The author lists the various ocular complications of Graves' disease, ranging from the very mild, which need no treatment, to those which require medical treatment, usually with cortisone, sometimes in combination with immunosuppressors. The relatively slight oculomotor problems can sometimes be alleviated with prisms. More serious complications require surgery of the extraocular muscles, which is not discussed in this paper.

Adult↗
PubMed1984

[A new instrument for daily fusion training at home].

With a few modifications the Vew-Master stereo viewer can be used for fusion training at home. Special image disks have been developed for this purpose, each image having a different angle of view. An additional motion sequence covering all 7 pairs of images makes the fusion game attractive and varied for children.

Child↗
PubMed1980

[Microtropia - heterophoria].

In 31 cases of microtropia combined with large angle esophoria, prism treatment and surgery to eliminates the phoria component were performed. In 19 cases a stable microsotropia remained after elimination of the phoria component. In 12 cases unstable microtropia was found, i.e., the microtropia disappeared after treatment. In these cases, microtropia may be secondary to the heterophoria. The treatment of the esophoria component in cases of microtropia/esophoria with refraction or bifocal correction, prisms and surgery is as much indicated as in simple esophoria.

Humans↗
PubMed1980

[Eight years' prismatic treatment of convergent alternating squint (author's transl)].

Two groups of 178 Children, treated and untreated by prisms, were examined 1 year after strabotomy. The advantage of prism treatment is clear from the 22% normalization of binocularity (compared with 11%), 51% normalization of retinal correspondence (compared with 22%), and 93% good cosmetic result (compared with 68%). However, in spite of prism treatment, binocular vision remains defective in 71% of cases of squint. A reexamination of the same persons 3.6 years on average after the operation shows the same tendency in both groups (with and without prism treatment): impairment of binocularity, decrease on angle of squint, increase in number of persons with good cosmetic result but defective binocular vision (77% of prism patients).

Child↗