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PubMed2000

Management of progressive school myopia with topical atropine eyedrops and photochromic bifocal spectacles.

PURPOSE: To report our results of medical management of myopia, and add these to the prior literature supporting this practice. METHOD: Retrospective review of the medical records of 35 patient-subjects offered this treatment with adequate followup over a five year period. Treatment consisted of prescription of photochromic gray extra lenses incorporating full myopic correction with a +3.00 bifocal addition, and atropine 1% ophthalmic drops, one in each eye, each night at bedtime. Compliance was monitored based upon mydriasis and cycloplegia. RESULTS: The mean change in refractive error per year was +0.07 diopters for the always compliant group, that is, a decrease in the amount of myopia; -0.18 diopters per year for the sometimes compliant group; and -0.17 diopters for the never compliant group, an increase in the degree of myopia. Statistical comparison of our always compliant group with each of the other two groups using the t-test, yielded a P value of P<.10 in each case, considered to be "medically/clinically significant". Comparison of the mean annual change in refractive error of our always compliant group (+0.07 D/yr) with the mean annual change in re-fractive error in the general population aged 8-15 years (-0.24 D/yr) shows an absolute difference of 0.31 D/yr. This difference is "statistically significant" (t-test) with a P <.02. CONCLUSION: Atropine and bifocals are an appropriate, effective, and safe management for progressive school myopia; and probably also for pathological myopia.

Adolescent↗
PubMed2004

Enlargement of parapapillary atrophy in follow-up of chronic open-angle glaucoma.

PURPOSE: To assess the frequency of an enlargement of parapapillary atrophy in follow-up of eyes with open-angle glaucoma. METHODS: Prospective observational longitudinal study. SETTING: Institutional. PATIENTS: The study included 978 eyes (511 Caucasian subjects) with open-angle glaucoma (n = 548; including 194 eyes with normal-pressure glaucoma), ocular hypertension (n = 289), or without optic nerve disease (n = 141). Highly myopic eyes with a myopic refractive error exceeding -8 diopters were excluded. Mean follow-up was 4.5 +/- 2.4 years (median, 3.8 years; range: 1.5 to 9.8 years). OBSERVATION PROCEDURES: Optic disk photographs taken annually. MAIN OUTCOME MEASURES: Two examiners compared optic disk slides for enlargement of parapapillary atrophy (zone beta) and for signs of progressive disk damage. RESULTS: An enlargement of parapapillary beta zone was detected in 16 eyes (1.6%) after 3.9 +/- 2.6 (0.6 to 9.1) years of follow-up. It was observed in 15 eyes (2.7%) with open-angle glaucoma, 1 eye (0.3%) with ocular hypertension, and in none of the normal eyes. After excluding eyes with a myopic refractive error exceeding -3 diopters, enlargement of beta zone was significantly more common in eyes with progressive glaucoma (5/81 or 6.2%) than in eyes with nonprogressive glaucoma (3/354 or 0.8%; P <.001). CONCLUSIONS: Parapapillary atrophy (zone beta) enlarges during follow-up of relatively few eyes with chronic open-angle glaucoma. In the refractive range above -3 diopters, enlargement of beta zone occurs significantly more frequently (P <.001) in progressive glaucoma than in nonprogressive glaucoma. In view of its low frequency, enlargement of beta zone may not be a very useful marker for glaucoma progression.

Adolescent↗
PubMed1996

Evaluation of three different approaches to perform excimer laser photorefractive keratectomy for myopia.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the results of myopic excimer laser photorefractive keratectomy (PRK) performed using three different ablation approaches. PATIENTS AND METHODS: Using the Apex excimer laser (Summit Technology, Inc., Waltham MA), we have treated 75 eyes. Twenty-five of them were treated by a single ablation zone (SA, 6.5 mm diameter) to correct myopia of -4.50 +/- 2.10 D (mean +/- SD); 25 eyes underwent PRK for the correction of myopia of -4.98 +/- 2.17 D using a multipass multizone technique (MP, 3 zones); and 25 eyes were corrected for myopia of -5.03 +/- 1.98 D using new software which enables the creation of three ablation zones in a single-pass fashion (MZ). RESULTS: Mean refractive error (+/-SD) at the first post-operative month was +1.34 +/- 1.00 D for SA, +1.78 +/- 1.49 D for MP, and +0.90 +/- 0.75 D for MZ. Eyes treated by MZ had significantly better uncorrected visual acuity than those treated by SA (P=0.04). Corneal topography revealed a central island in 14 eyes (56%) of those treated by SA and 2 eyes (8%) of those treated by MZ, but in no eyes treated by MP. Six months after treatment, mean refractive error was +0.28 +/- 0.75 D for SA, +0.36 +/- 0.92 D for MP, and - 0.07 +/- 0.77 D for MZ. CONCLUSION: MZ ablation induced less hyperopic shift at 1 month, thus leading to a faster visual recovery and better uncorrected visual acuity. MP and MZ ablations proved effective in preventing central island formation, thus inducing less visual disturbances than SA ablations. These results suggest that MZ ablation may be preferable to the other techniques in performing myopic PRK.

Adult↗
PubMed2002

Lasik enhancements: a comparison of lifting to recutting the flap.

PURPOSE: To compare the visual outcomes and incidence of complications of lifting with recutting the lamellar flap in laser in situ keratomileusis (LASIK) enhancement surgery. DESIGN: Retrospective case-control study. PARTICIPANTS: Two hundred twelve consecutive eyes undergoing a LASIK enhancement procedure at a single surgery location during a 5-year period. METHODS: Charts of participants were obtained and outcome measures obtained. MAIN OUTCOME MEASURES: Uncorrected visual acuity, best-corrected visual acuity, refractive error, complications. RESULTS: Relifting of flaps was performed in 164 of 212 eyes (77.4%), and recutting of flaps was performed in 48 of 212 eyes (22.6%). There were no significant differences in early visual outcomes between the two groups. At 1 year patients had significantly better uncorrected vision if the flap was lifted rather than recut (20/24.7 vs. 20/31.3, P < 0.008). In addition, the flap lift group had a significantly more stable refraction at 1 year than did the recut group (change in spherical equivalent: +0.05 diopters (D) vs. -0.57 D). The incidence of complications did not significantly differ between the two groups. CONCLUSIONS: LASIK enhancement surgery can be performed safely and effectively by either lifting or recutting a flap. Lifting the flap may show better long-term stability of refractive error and uncorrected acuity.

Adult↗
PubMed1997

[Congenital nystagmus with sensory disorder: reaction to the caloric and optokinetic stimulation].

The purpose of this study was to estimate the response on vestibular caloric and optokinetic stimulation in patients with congenital nystagmus and serious congenital anomalies of visual system. 58 patients, aged 11-20 (21 female, 37 male) underwent this stimulation with ENG registration. The patients had visual acuity from 0.04 to 0.4, caused by visual system diseases e.g. congenital cataract, optic atrophy, hypoplasia maculae, high refractive error, albinism ect. The correct response was observed with 15.5% of the patients on vestibular caloric stimulation. There was no statistically significant relationship between visual acuity or visual system disease and the correct response. 28% of the patients responded correctly on optokinetic stimulation. There was statistically significant relationship between visual system anomaly and correct OKN: 80% of this reaction was in the group of optic atrophy, 54% in the group of high refractive error. Statistically significant relationship was no observed between visual acuiy and correct OKN. High level of the incorrect response on the caloric and optokinetic stimulation in the persons with congenital nystagmus and congenital disorder of visual system limits using of this tests for diagnostic purpose.

Caloric Tests↗
PubMed1998

Laser refractive surgery.

BACKGROUND: Refractive errors; myopia, hypermetropia and astigmatism, have traditionally been corrected by glasses and more recently contact lenses. For nearly 100 years surgical techniques to treat such disorders have also been developed. The latest of these are based upon the use of the excimer laser to ablate the corneal stroma either directly under the corneal epithelium (surface PRK) or under a flap of superficial stroma (LASIK). OBJECTIVE: To look at the development of laser refractive surgery and to put this in the context of appropriate and inappropriate indications for usage. DISCUSSION: While the development of such techniques has revolutionised the field of refractive surgery unrealistic expectations with regard to the outcome of such procedures may have been raised in recent advertising by some ophthalmologists and laser centres. The most important influence on the refractive outcome of such procedures is the pre-operative refraction. The best outcomes are seen with treating low degrees of myopia and/or astigmatism. Outcomes for treating high degrees of myopia or astigmatism are often disappointing. The treatment of hypermetropia remains experimental.

Humans↗
PubMed1994

Basic fibroblast growth factor (bFGF) and transforming growth factor beta (TGF-beta) act as stop and go signals to modulate postnatal ocular growth in the chick.

Occlusion of the eye (form deprivation) during post-natal development leads to ocular enlargement and myopia. The chick model of form deprivation myopia (FDM) has been used to identify candidate factors that underly the control of ocular growth. The major biochemical change associated with eye enlargement is an increase in scleral cartilage proteoglycan production (Rada et al., 1991) which is reduced in recovering eyes. Thus increasing evidence suggests that in the chicken eye, two different signals are involved, one for stop (occluder off) and one for go (occluder on). Because transforming growth factor-beta (TGF-beta) and basic fibroblast growth factor (bFGF) are known to act in a push-pull manner in regulating extracellular matrix, their possible roles in FDM were tested. Chicks were occluded monocularly for 8 days, after which axial dimensions were assessed using A-scan ultrasonography, and refractive errors using streak retinoscopy. Under light halothane anesthesia, the control group received daily vehicle injections into both eyes whereas the experimental groups were treated with growth factors in the occluded eye and vehicle in the unoccluded eye. It was shown that: (1) bFGF reduced FDM in a dose-dependent manner, with a 50% effective dose (ED50) of 1.05 and 1.67 ng for subconjunctival and intravitreal delivery, respectively. Both axial eye length and refraction were similarly affected. The effects were mainly confined to a decrease in vitreous chamber depth. The anterior chamber was less deep but only after intravitreal injections, whereas lens thickness was not affected at all. At maximum effect, after subconjunctival applications the bFGF-treated occluded eyes were only 0.09 +/- 0.16 mm longer than controls, which corresponded to a refractive error of -0.67 +/- 0.82 diopters (D), whereas after intravitreal applications the difference in axial eye length was -0.07 +/- 0.19 mm, corresponding to -0.3 +/- 0.52 D. (2) This effect could be mimicked by aFGF, but with a potency approximately 160 times less than that of bFGF. The aFGF rescue effect could only be demonstrated for subconjunctival delivery; high intravitreal doses (> or = 300 ng per injection) induced retinal detachment and photoreceptor degeneration, while doses of aFGF close to the ED50 for bFGF (3 ng per injection) were completely ineffective. (3) TGF-beta 1 was not found to induce myopia in unoccluded eyes, or to increase myopia in occluded eyes. It was, however, a potent inhibitor of the bFGF rescue effect, if administered together with bFGF in the subconjunctival space.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1986

Five year follow-up of epikeratophakia in children.

Epikeratophakia alters the anterior curvature of the cornea by the addition of a machine-carved donor lenticule. Since March 1980, 88 patients under eight years of age have had epikeratophakia, with at least six months of follow-up. Eighty percent of the original surgeries were successful; some failed grafts were replaced successfully, so that in all, 89% of the patients had successful grafts. The average increase in curvature of the cornea was 14.7 diopters, and the average spectacle overcorrection was +0.56 diopters. In these growing eyes, we documented a myopic shift of 1.5 diopters per year. Visual acuity results varied with the timing of refractive surgery, density of the amblyopia, and the parents' ability to maintain the patching schedule. The largest group of children were those who had unilateral traumatic cataracts. In this group, 7 of 15 patients who had surgery under 4 years of age had final verbal acuities of 20/40 or better. Long-term follow-up has demonstrated that epikeratophakia safely and successfully corrects refractive errors in aphakic children either as a primary procedure, or as a secondary procedure after cataract extraction.

Cataract↗
PubMed1990

Postnatal control of ocular growth: dopaminergic mechanisms.

A vision-dependent feedback mechanism contributes to the regulation of postnatal eye growth and refraction; this mechanism is located at least in part in the retina. In chicks and rhesus monkeys, visual deprivation leads to ocular enlargement and a myopic refractive error, and it also reduces the retinal concentration of dopamine. In neonatal chicks, local application of the dopamine agonist apomorphine limits the excessive axial elongation that is associated with visual deprivation. Both D1 and D2 dopamine receptor mechanisms may participate. Remarkably, apomorphine is geometrically selective, not limiting the exaggerated equatorial growth that occurs during visual deprivation. Preliminary results in neonatal rhesus monkeys indicate that apomorphine eye drops also suppress exaggerated axial growth and myopic refractive error during visual deprivation; equatorial diameters were not measured. Our observations are consistent with a retinal hypothesis for emmetropization and suggest that retinal dopamine participates in a mechanism linking ocular growth control to vision. In addition, we conclude that axial and equatorial dimensions are independently regulated in the chick.

Animals↗
PubMedDate not supplied

Scraping and mitomycin C to treat haze and regression after photorefractive keratectomy for myopia.

PURPOSE: To evaluate the efficacy, safety, and predictability of therapeutic scraping and application of a diluted 0.02% mitomycin C solution to treat haze and regression after photorefractive keratectomy (PRK) for myopia. METHODS: We performed a non-comparative, non-randomized retrospective study of 35 eyes of 30 patients who had previously undergone PRK for myopia and developed haze and regression after treatment. The range of refractive error after regression was -0.75 to -5.50 D (mean -2.92 D). Haze, ranging from grade 3 to 4 (scale: 0 to 4) caused a best spectacle-corrected visual acuity loss of 1 to 6 Snellen lines. All eyes were treated 6 to 12 months after PRK by scraping the stromal surface and application of a 0.02% mitomycin C solution for 2 minutes using a soaked merocel sponge. No laser ablation was performed. Corneal transparency, refractive error, and visual outcomes were evaluated over a 12-month follow-up period. RESULTS: All eyes had significant improvement in corneal transparency. Thirty-one eyes had haze grades lower than 1, which were maintained over time. Only four eyes showed haze grades 1 to 2 and two of them needed further treatment using the same technique. At 12 months after treatment, all eyes were within +/-1.50 of original intended correction (mean 0.04 +/- 0.63 D). BSCVA improved in all eyes. No toxic effects were observed during re-epithelialization or during follow-up. CONCLUSION: Single application of diluted mitomycin C 0.02% solution following scraping of the corneal surface was effective and safe in treating haze and regression after PRK.

Antibiotics, Antineoplastic↗
PubMedDate not supplied

The learning curve in myopic photorefractive keratectomy.

BACKGROUND: The aim of this study was to assess the role of surgeons' skill on the final results of photorefractive keratectomy (PRK) in the correction of myopia. METHODS: We evaluated the results of 160 consecutive unilateral treatments performed by four surgeons in a multicenter study group, with a one year follow up. Eighty-eight patients were males (55%) and 72 females (45%). Mean age was 33.7 years (median = 33, standard deviation = 10.22, range 18-65). Attempted correction ranged between -1.50 and -15.00 D. All the eyes received topical corticosteroid therapy postoperatively. At the one year follow up, we evaluated the following: uncorrected visual acuity lines gained and refractive error (spherical equivalent) as parameters of efficacy and predictability; best spectacle corrected visual acuity loss and corneal clarity as safety parameters. We also examined the centration or decentration of the ablation zone. In order to draw up a kind of learning curve, the mean values for each parameter were calculated by arbitrarily grouping the first 10 cases of each surgeon in the first group (40 patients), the second 10 cases in the second group (40 patients) and so on. RESULTS: We found that increase in uncorrected visual acuity, final refractive error and corneal clarity appeared to improve as the surgeon became more experienced, while loss of best spectacle corrected visual acuity was not significantly influenced by increased surgical experience. CONCLUSIONS: We think experience with photorefractive keratectomy in at least 40 eyes is necessary to obtain best results.

Adolescent↗
PubMed2005

Ciliary body thickness increases with increasing axial myopia.

PURPOSE: To assess the relationship between ciliary body thickness and refractive error. DESIGN: Prospective observational case series. METHODS: We enrolled 75 eyes of 75 patients with no history of intraocular surgery or use of anti-glaucoma medication. Axial length was measured by A-scan ultrasonography. Ciliary body thickness (CBT) was measured by two masked observers on radial-section images of the temporal corneoscleral limbus, acquired with ultrasound biomicroscopy (UBM) at 2 and 3 mm posterior to the scleral spur (CBT2 and CBT3, respectively). RESULTS: Refractive error was inversely correlated with CBT2 and CBT3 (r = -.64 and r = -.52, P < .0001, respectively). Axial length was correlated with CBT (r = .66 and r = .57, P < .0001, for CBT2 and CBT3, respectively). CONCLUSION: CBT increases with increasing myopia and axial length.

Body Weights and Measures↗
PubMed2006

Prevalence and causes of blindness and visual impairment in Muyuka: a rural health district in South West Province, Cameroon.

AIM: To estimate the prevalence and causes of blindness and visual impairment in the population aged 40 years and over in Muyuka, a rural district in the South West Province of Cameroon. METHODS: A multistage cluster random sampling methodology was used to select 20 clusters of 100 people each. In each cluster households were randomly selected and all eligible people had their visual acuity (VA) measured by an ophthalmic nurse. Those with VA <6/18 were examined by an ophthalmologist. RESULTS: 1787 people were examined (response rate 89.3%). The prevalence of binocular blindness was 1.6% (95% CI: 0.8% to 2.4%), 2.2% (1.% to 3.1%) for binocular severe visual impairment, and 6.4% (5.0% to 7.8%) for binocular visual impairment. Cataract was the main cause of blindness (62.1%), severe visual impairment (65.0%), and visual impairment (40.0%). Refractive error was an important cause of severe visual impairment (15.0%) and visual impairment (22.5%). The cataract surgical coverage for people was 55% at the <3/60 level and 33% at the <6/60 level. 64.3% of eyes operated for cataract had poor visual outcome (presenting VA<6/60). CONCLUSIONS: Strategies should be developed to make cataract services affordable and accessible to the population in the rural areas. There is an urgent need to improve the outcome of cataract surgery. Refractive error services should be provided at the community level.

Adult↗
PubMed2003

Nearwork-induced transient myopia in preadolescent Hong Kong Chinese.

PURPOSE: To compare the magnitude and time course of nearwork-induced transient myopia (NITM) in preadolescent Hong Kong Chinese myopes and emmetropes. METHOD: Forty-five Hong Kong Chinese children, 35 myopes and 10 emmetropes aged 6 to 12 years (median, 7.5), monocularly viewed a letter target through a Badal lens for 5 minutes at either 5.00- or 2.50-D accommodative demand, followed by 3 minutes of viewing the equivalent target at optical infinity. Accommodative responses were measured continuously with a modified, infrared, objective open-field autorefractor. Accommodative responses were also measured for a countercondition: viewing of a letter target for 5 minutes at optical infinity, followed by 3 minutes of viewing the target at a 5.00-D accommodative demand. The results were compared with tonic accommodation and both subject and family history of refractive error. RESULTS: Retinal-blur-driven NITM was significantly greater in Hong Kong Chinese children with myopic vision than in the emmetropes after both near tasks, but showed no significant dose effect. The NITM was still evident 3 minutes after viewing the 5.00-D near task for 5 minutes. The magnitude of NITM correlated with the accommodative drift after viewing a distant target for more than 4 minutes, but was unrelated to the subjects' or family history of refractive error. CONCLUSIONS: In a preadolescent ethnic population with known predisposition to myopia, there is a significant posttask blur-driven accommodative NITM, which is sustained for longer than has previously been found in white adults.

Accommodation, Ocular↗
PubMed2006

[Heidelberg Retina Tomograph II topographic parameters, diagnostic capabilities of moorfields regression analysis, and their affecting factors].

PURPOSE: To investigate optic disc topographic parameters at every stage in glaucoma patients and to compare results with data from normal Japanese subjects. We used a Heidelberg Retina Tomograph II (HRT II), to evaluate the sector diagnostic capabilities of Moorfields regression analysis in early glaucoma patients, and to determine whether there is a correlation between the background factors and either the topographic parameters or the diagnostic capabilities. SUBJECTS AND METHODS: We measured topographic parameters using HRT II, and examined static visual fields in 303 normal and 130 glaucoma eyes without high refractive error. RESULTS: Mean disc area was 2.181 +/- 0.384 mm2 in the normal Japanese subjects. At the time visual field loss first appeared, disc damage was already advanced. Moorfields regression analysis of sensitivity and specificity was 81.3% and 90.1%, respectively, for early glaucoma. The best diagnostic precision was found in the temporal/inferior sector. Correlations were noted for normal subject topographic parameters and the disc area, age, sex, and conus, but not for Moorfields regression analysis and the disc area, refractive error, age, and sex, even though diagnostic capabilities declined with the presence of conus. CONCLUSIONS: HRT II is more useful in glaucoma diagnosis than in follow-up. Focus should be on the temporal/inferior sector as well as on the overall Moorfields regression analysis. Also, close attention should be paid to the presence of conus.

Aged↗
PubMed2003

Corneal thickness and intraocular pressure in the Barbados eye studies.

OBJECTIVES: To describe the distribution of central corneal thickness (CCT) and evaluate its relationship to intraocular pressure (IOP) in the predominantly black population of the Barbados Eye Studies (BES). METHODS: Participants received a standardized examination, including pachymetry, applanation tonometry, and a comprehensive ophthalmologic evaluation. Analyses were based on data from all eyes, and generalized estimating equation methods were applied to account for the correlation between eyes. RESULTS: Among the 1142 consecutive participants with pachymetry measurements, the mean age was 64.3 years, and 58% were women. Black participants tended to have thinner corneas (mean thickness, 529.8 microm) than mixed (black and white) (537.8 microm) and white participants (545.2 microm), respectively. Among black participants, increasing values of CCT were significantly related to younger age (P<.001), diabetes history (P =.03), and refractive error (P =.03); a marginally significant relationship (with thinner corneas) was found with a clinical diagnosis of glaucoma (P =.07). Intraocular pressure was not associated with CCT in this population. CONCLUSIONS: Although other studies have reported a positive correlation between CCT and IOP, such a relationship was not substantiated in the black BES population. Black participants tended to have thinner corneas than white participants, whereas younger individuals, as well as those with a history of diabetes and more positive refractive errors, had thicker corneas.

Age Distribution↗
PubMed2005

Frequency and predictors of retinal detachment after pediatric cataract surgery without primary intraocular lens implantation.

PURPOSE: To determine the frequency and to identify predictors of retinal detachment after pediatric cataract surgery without primary intraocular lens implantation. METHODS: Retrospective review at an eye hospital identified 1017 eyes among 579 patients who underwent limbal-approach surgery without primary IOL implantation at age < or =16 years for cataract unassociated with other ocular abnormalities aside from microcornea. Patients had a minimum of 2 years postoperative follow-up. The outcome measure was the presence or absence of postcataract surgery retinal detachment, and analyses were performed on patients' eyes with adjustment for intrasubject correlation. RESULTS: Mean postcataract surgery follow-up was 6.8 +/- 3.6 years (range, 2.0 to 18.3 years). Retinal detachment developed in 33 (3.2%) of the 1017 patients' eyes and was diagnosed at a mean of 6.8 +/- 4.4 years postcataract surgery (range, 0.4 to 14.8 years). Multivariable Cox proportional hazards regression analysis with adjustment for intrasubject correlation identified an aphakic refractive error more myopic than the age-adjusted aphakic norm [hazard ratio (HR), 5.9; 95% confidence interval (CI), 1.9 to 18.0; P = 0.002] and postcataract surgery wound dehiscence (HR, 15.4; 95% CI, 2.2 to 108.5; P = 0.006) as predictors of retinal detachment; a primary posterior capsulotomy/anterior vitrectomy procedure was not predictive of retinal detachment. CONCLUSIONS: Retinal detachment is infrequent following pediatric cataract surgery without primary IOL implantation, at least with short-term follow-up. A postoperative aphakic refractive error more myopic (less hyperopic) than the age-adjusted aphakic norm is predictive of this complication.

Adolescent↗
PubMed2005

X-linked infantile periodic alternating nystagmus.

OBJECTIVE: To describe the clinical and electrophysiological characterization of four family members from three generations who have X-linked infantile periodic alternating nystagmus (XIPAN). METHODS: Complete clinical ophthalmological evaluation, pedigree analysis, electroretinograms (ERG), eye movement recordings (EMR), color vision, and fundus photography were performed on all subjects. RESULTS: Three males in two generations and one female were examined. Clinical examinations showed a jerk/pendular nystagmus with a latent component, strabismus, and a significant refractive error in the three affected males, while the female had only myopic astigmatism. ERG, color contrast, and fundus examinations were normal in all four family members. All four family members showed EMR abnormalities with infantile jerk/dual jerk and pendular nystagmus waveforms. The female had nystagmus present on EMR only and all patients showed (a)periodicity to their nystagmus. CONCLUSIONS: In this family with no other congenital visual sensory system disease, affected males had obvious periodic alternating nystagmus, strabismus, and refractive errors, while the female had clinically "silent" periodic nystagmus that is probably a marker for the carrier state.

Adult↗