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Portela-Camino JA, Sanchez I, Gutierrez C, Martín-González S. Successful treatment of diplopia using prism correction combined with vision therapy/orthoptics improves health-related quality of life. PeerJ 2024; 12:e17315. [PMID: 38737743 PMCID: PMC11088820 DOI: 10.7717/peerj.17315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
Background To track improvement in diplopia symptoms with strabismus-specific health-related quality of life (HRQOL) questionnaire across a treatment consisting of prism correction followed by vision therapy/orthoptics when prism treatment alone has not succeeded. Methods Forty-eight participants with diplopia and a mean age of 62.45 were asked to complete an Adult Strabismus-20 (AS-20) questionnaire and a Diplopia Questionnaire (DQ) before and after prism correction. Inclusion criteria were diplopia reported on the DQ as "sometimes", "often" or "always" at reading or straight-ahead distance. The prism correction was classified as successful if the participant reported "never" or "rarely" on the DQ for reading and straight-ahead distance; and unsuccessful if the perceived diplopia worsened or remained the same. For all participants, mean initial AS-20 scores were compared with mean post-prism correction scores, taking into account AS-20 subscales (reading and general functions, and self-perception and interaction). Participants in the failed prism treatment subgroup subsequently underwent a programme of vision therapy wearing their prism correction, the results of which were again determined by participants' responses on the AS-20 questionnaire, completed before and after the vision therapy. Results Five of the 48 participants dropped out of the study. Prism correction was classified as successful in 22 of 43 participants (51%), and unsuccessful in 21 (49%). Those participants for whom the prism correction was classified as a success showed a statistically significant improvement (p = 0.01) in both reading and general functions. In the failed treatment subgroup, no significant change in AS-20 score was recorded for any of the domains (p = 0.1). After treatment with vision therapy/orthoptics, however, 13 of the 20 participants in the unsuccessful prism correction subgroup (one of them dropped out the study) achieved binocular vision and statistically significant improvement in reading and general functions (p = 0.01). Conclusions Although effective prism correction of diplopia is correlated with enhanced HRQOL, prism correction alone is frequently not sufficient to achieve this objective. In these cases, vision therapy/orthoptics treatment as a coadjutant to prism correction is shown to improve HRQOL.
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Affiliation(s)
| | - Irene Sanchez
- Departamento de Física Teórica Atómica y Óptica, Universidad de Valladolid, Valladolid, Spain
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
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Chen C, Xu M, Yu H, Li Y, Yu X. Improvement in health-related quality of life with Botulinum toxin A injection in acquired superior oblique palsy. Front Med (Lausanne) 2023; 10:1198380. [PMID: 37457574 PMCID: PMC10339737 DOI: 10.3389/fmed.2023.1198380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose This study aimed to investigate the outcomes of Botulinum toxin A (BTA) injection into the inferior oblique (IO) muscle for the management of unilateral acute acquired superior oblique palsy (SOP) and to evaluate changes in health-related quality of life post-injection using the Adult Strabismus-20 (AS-20) questionnaire. Methods A prospective cohort study was performed in patients with unilateral acute acquired SOP who received BTA injections. Four units of BTA were injected into the ipsilateral IO muscle. Ocular examinations were performed pre-and post-injection, including alignment, ocular movement, and cyclotorsion deviation. The patients' AS-20 questionnaire scores were analyzed. Results A total of 21 patients with acute acquired SOP were included. The initial median vertical deviation was 5 PD (range 1-16), which was improved to 0 PD (range 0-10) at both 1 and 6 months post-injection (p < 0.001 and p < 0.001, respectively). The median torsional deviation was 7° (range 2-18) at baseline and resolved to 0 degrees (range -3-5) at the 1-month and 0° (range -2-7) at the 6-month follow-up (p < 0.001 and p < 0.001, respectively). There were significant increases in the overall score (OAS), psychosocial subscale score (PSS), and functional subscale score (FSS) from baseline values at both the 1-month (p < 0.001, p < 0.001, and p = 0.001, respectively) and 6-month follow-up (all p < 0.001). Conclusion Injecting BTA into the ipsilateral IO muscle successfully resolved vertical and torsional deviations and significantly improved quality-of-life scores. Our findings show that BTA treatment, as an early treatment for acute acquired SOP, can help patients by significantly improving their quality of life.
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Affiliation(s)
- Chonglin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Meiping Xu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Huanyun Yu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yipao Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xinping Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Hatt SR, Leske DA, Wernimont SM, Bothun ED, Birch EE, Holmes JM. Diplopic versus nondiplopic strabismus: effects on functional vision and eye-related quality of life in adolescents. J AAPOS 2021; 25:297-300. [PMID: 34425237 PMCID: PMC8675351 DOI: 10.1016/j.jaapos.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/03/2021] [Accepted: 05/16/2021] [Indexed: 10/20/2022]
Abstract
Twenty adolescents (12-17 years old) with diplopic strabismus and 20 with nondiplopic strabismus (matched to diplopic subjects for direction and magnitude of ocular deviation) completed the Pediatric Eye Questionnaire (PedEyeQ). Children completed the Child PedEyeQ, and one parent for each child completed the Proxy PedEyeQ and Parent PedEyeQ. PedEyeQ Rasch domain scores were calculated and converted to a scale of 0 (worst) to 100 (best). Distributions of domain scores were compared between diplopic and nondiplopic cohorts using Wilcoxon tests. Diplopic adolescents had significantly lower Child PedEyeQ scores on Functional Vision (72 vs 90; P = 0.008), Bothered by Eyes/Vision (65 vs 90; P = 0.009), and Frustration/Worry (53 vs 75; P < 0.001) domains. There was no difference on the Child Social domain (85 vs 90; P = 0.22). Proxy and Parent PedEyeQ scores were similar between diplopic and nondiplopic cohorts (P > 0.06 for each comparison). These findings highlight the importance of addressing diplopia when managing childhood strabismus.
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Affiliation(s)
- Sarah R Hatt
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - David A Leske
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | - Erick D Bothun
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas
| | - Jonathan M Holmes
- Department of Ophthalmology and Vision Science, University of Arizona-Tucson.
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Abstract
Thyroid diseases may cause a variety of functional and structural body changes, including eye and vision abnormalities, which can have a negative impact on a patient’s well-being. However, only a few studies on the impact of other benign thyroid diseases on the visual process are available in the literature. In this study, using the Polish version of the thyroid-specific quality of life (ThyPROpl) questionnaire, we aimed to determine the self-reported influence of benign thyroid diseases (e.g., nodular goiter, toxic nodular goiter, Graves’ disease, thyroid orbitopathy, Hashimoto’s thyroiditis, and surgical hypothyroidism) on patients’ eyes and vision. This was a prospective study. In total, 374 randomly selected euthyroid patients and 255 control subjects responded to the ThyPROpl questionnaire and the results were evaluated. Nearly 69% of the respondents reported that the most frequent condition was “reduced sight.” Men most often reported wet/tearing eyes (66%). The occurrence of eyelid sacks or swollen eyelids (64%), ophthalmalgia (62%), and eye dryness (61%) was marked almost as often. In total, 29% of the patients reported diplopia, and it was found to be most prevalent among those with thyroid orbitopathy. Other complaints were similarly prevalent among all the subgroups. A positive correlation was also observed between the scores of the “eye symptoms” and other ailments. Except for swelling around the lower eyelids, patients with thyroid diseases more frequently experienced all of the ocular complaints analyzed in this study compared with controls. This study showed that eye complaints are common in patients with benign thyroid diseases and ocular disturbances have a negative impact on the overall quality of life of patients.
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Kumaran SE, Khadka J, Baker R, Pesudovs K. Patient‐reported outcome measures in amblyopia and strabismus: a systematic review. Clin Exp Optom 2021. [DOI: 10.1111/cxo.12553] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Sheela E Kumaran
- Discipline of Optometry and Vision Science, Flinders University, Adelaide, South Australia, Australia,
| | - Jyoti Khadka
- Discipline of Optometry and Vision Science, Flinders University, Adelaide, South Australia, Australia,
| | - Rod Baker
- Discipline of Optometry and Vision Science, Flinders University, Adelaide, South Australia, Australia,
| | - Konrad Pesudovs
- Discipline of Optometry and Vision Science, Flinders University, Adelaide, South Australia, Australia,
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Tamhankar MA, Luo S, Kwong B, Pistilli M. Benefits and side effects of prisms in the management of diplopia in adults: a prospective study. J AAPOS 2021; 25:85.e1-85.e6. [PMID: 33901672 DOI: 10.1016/j.jaapos.2020.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 10/21/2022]
Abstract
PURPOSE To analyze the various factors affecting patient satisfaction with prism glasses in adults with diplopia. METHODS In this prospective case series, the benefits and side effects of prisms and factors affecting prism satisfaction were assessed by means of a questionnaire. RESULTS A total of 134 patients were included. Overall, 58% of patients were highly satisfied, 22% were somewhat satisfied, and 20% were either neutral, somewhat dissatisfied, or very dissatisfied with prism glasses. Prior history of prism use, amplitude of prisms, comitancy of deviation, and type of lenses worn, had no influence on satisfaction rates. The extent of resolution of diplopia was highly correlated with prism satisfaction (P < 0.001), improvement in depth perception (P < 0.001), driving (P < 0.001), and reading (P < 0.008). Up to 22% of the participants noted "bothersome" side effects, including headaches, dizziness, eye strain and pulling (22%), alteration of depth perception (16%), visual distortion (13%), halos (8%), and weight of the prisms (6%). CONCLUSIONS In this cohort of adults with diplopia, prisms were beneficial in treating diplopia of different etiologies, incomitance, and a wide range of deviations. The side effects experienced with prism glasses themselves accounted for patient dissatisfaction in our study.
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Affiliation(s)
| | - Shiming Luo
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Brady Kwong
- Scheie Eye Institute, University of Pennsylvania, Philadelphia
| | - Maxwell Pistilli
- Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia
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Flodin S, Rydberg A, Pansell T, Grönlund MA. Measuring health-related quality of life in individuals with cyclodeviation using the Adult Strabismus 20 (AS-20) questionnaire. J AAPOS 2021; 25:20.e1-20.e6. [PMID: 33326839 DOI: 10.1016/j.jaapos.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/18/2020] [Accepted: 08/22/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess health-related quality of life (HRQoL) in patients diagnosed with cyclodeviation and to evaluate subjective change following surgical treatment using the Adult Strabismus-20 (AS-20) questionnaire. METHODS A prospective cohort study was performed from 2014 to 2019 on 29 adult patients with cyclodeviation and cyclodiplopia who were due to undergo corrective strabismus surgery by the same surgeon. The group was divided into two subgroups, according to the type of surgery required for fusion. All scores were analyzed for the whole sample and subgroups. Preoperative scores were compared with those of control patients. RESULTS Pre- and postoperative QoL scores were successfully collected from 26 patients (mean age, 56 years; 8 female) using the AS-20 questionnaire. Scores were significantly higher for control subjects than for patients in the cyclodeviation group (P = 0.0001). Postoperative scores for all 20 questionnaire questions were significantly improved for all patients (P = 0.002). There was a significant improvement in the functional subscale score (P = 0.001), but not in the psychosocial subscale score (P = 0.23). Results were enhanced by Rasch analysis. CONCLUSIONS Cyclodeviation patients demonstrated significantly lower scores than controls. The functional scores were significantly lower than the psychosocial scores, in contrast to other forms of strabismus. Strabismus surgery had a significant effect on quality-of-life scores in this group of adults.
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Affiliation(s)
- Sara Flodin
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden.
| | - Agneta Rydberg
- Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden
| | - Tony Pansell
- Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden
| | - Marita Andersson Grönlund
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden
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Clinical Practice Guidelines for Occupational Therapists in the Evaluation and Treatment of Oculomotor Impairment Following Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021; 9:93-99. [PMID: 34094719 PMCID: PMC8171233 DOI: 10.1007/s40141-021-00310-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 02/08/2023]
Abstract
Purpose of review Currently, a lack of guidelines exists regarding best practices for occupational therapists (OTs) in the treatment and evaluation of oculomotor dysfunction following traumatic brain injury (TBI). Furthermore, individuals with TBI would benefit significantly from collaboration between OTs and optometrists during inpatient rehab. Recent findings Although few articles examine interdisciplinary models of inpatient rehab care that include optometry, a recent pilot study is explored. Emerging evidence from the field of optometry supports the use of restorative approaches for oculomotor impairment in mild TBI; however, cases with moderate to severe TBI are not addressed. Summary We describe an interdisciplinary approach involving collaboration between optometry and occupational therapy, yielding a comprehensive model to effectively evaluate and treat oculomotor impairments in those with TBI and facilitate improved performance in daily activities. We also provide guidelines useful for OTs working in settings where collaboration with optometry is not feasible.
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Sanz PM, Osuna V, Gómez de Liaño Sánchez P, Torres HED. Surgical treatment for small-angle vertical strabismus. Strabismus 2020; 28:181-185. [DOI: 10.1080/09273972.2020.1832543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Pilar Merino Sanz
- Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón, Madrid
| | - Verónica Osuna
- Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón, Madrid
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NICULA C, NICULA D, BULBOACĂ AE. Non-surgical correction of diplopia after stroke- a strong impact factor on quality of life-minireview. BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
One of the most frequent disorders accompanied by diplopia is represented by stroke. Beyond different symptoms of stroke, diplopia constitutes an important clinical factor in influencing the quality of life in surviving patients. In this paper we discuss the visual impairment associated with stroke location, types of diplopia, the clinical examination, and the nonsurgical treatment of diplopia. The purpose of diplopia treatment is to restore binocular vision and eliminate the double vision. The most used nonsurgical treatment for diplopia is the optical correction by the prisms. Another therapeutic option is the botulinum toxin injections.
Key words: diplopia, stroke, visual rehabilitation, prism correction,
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Affiliation(s)
- Cristina NICULA
- Department of Ophthalmology, “Iuliu Hatieganu”University of Medicine and Pharmacy”, Cluj- Napoca, Romania, Oculens Clinic, Cluj-Napoca, Romania
| | | | - Adriana Elena BULBOACĂ
- Department of Pathophysiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj- Napoca, Romania
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Wang Z, Zhou J, Xu Y, Yin H, She X, Bian W, Wang X. Development of a conceptual model regarding quality of life in Chinese adult patients with strabismus: a mixed method. Health Qual Life Outcomes 2018; 16:171. [PMID: 30176900 PMCID: PMC6122201 DOI: 10.1186/s12955-018-0991-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/01/2018] [Indexed: 11/24/2022] Open
Abstract
Background Substantial challenges have been reported in China in terms of the large number of adult patients with strabismus and their poor quality of life. Quality of life is a cultural concept that varies according to personal feelings and perceptions, and it is influenced by physical, psychological and social factors. However, to date, there has been no mixed-method research of the quality of life of Chinese adult patients with strabismus, and no conceptual model has been reported. This study aimed to utilize mixed methods to explore the influence of strabismus on health-related quality of life in Chinese adult patients and to develop a conceptual model. Methods Thirty adult patients with strabismus from three tertiary hospitals in China participated in the interview. In-depth one-to-one interviews were semi-structured and addressed strabismus-related symptoms and the impacts on the participants’ quality of life. Transcripts were analysed to identify themes. A self-designed questionnaire was distributed to 448 patients, 437 of whom returned valid questionnaires. Descriptive statistics and x2 test were conducted. Results Five themes were revealed regarding the impact of strabismus on patient quality of life: appearance, daily activities, personal development, social interaction, and emotions. In the survey, the top three symptoms (n ≥ 70%) rated by the participants were monocular vision, eye fatigue and physical discomfort. Compared to those without diplopia, the patients who suffered diplopia more often reported experiencing the symptoms of blurred vision, monocular vision, physical discomfort, eye fatigue, cannot estimate depth well and increasing deviation size (all p < 0.05). Conclusions This study is the first to examine quality of life among Chinese strabismus patients using both qualitative and quantitative methods and proposing a conceptual model. Symptom burden and appearance were the two original reasons for the decreased quality of life, and they were also the triggers for strabismus patients to visit clinics and undergo surgery. The interventions to treat symptoms burden should be different between patients with and without diplopia.
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Merino Sanz P, Finianos Mansour SY, Gómez de Liaño Sánchez P, Márquez Santoni JL, Lourenço da Saude JD. Indications and outcome of vertical rectus partial recessions. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2018; 93:381-385. [PMID: 29853417 DOI: 10.1016/j.oftal.2018.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 04/18/2018] [Accepted: 04/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the indications and results obtained with partial vertical recti recessions in patients with diplopia and small-angle vertical strabismus (≤10 dp). MATERIAL AND METHODS A retrospective study was conducted on 9 patients that were operated on with partial temporal or nasal recession of the superior (SR) or inferior rectus (IR), during 2017. A good outcome was considered when diplopia was resolved in primary position and infraversion, at the end of follow-up. RESULTS A total of 9 cases were included, with a mean age 66.3 years (55.5% women), diagnosed with sixth nerve palsy (3), incomplete third nerve palsy (2), sagging eye (2), age related strabismus (1), and restrictive strabismus post-retinal surgery (1). Mean preoperative vertical deviation was 8.2 dp in primary position and the post-operative vertical deviation was 0.8 dp (mean difference was statistically significant, P=.007). In 4 cases, the SR was operated on (temporal pole in 3 and nasal in 1). The IR was operated on in 5 patients (temporal pole in 4 and nasal in 1). Mean recession was 3.77mm. In 55.5% of case diplopia was eliminated, and in a 33.3% a well-tolerated, intermittent diplopia persisted. A good outcome was obtained in 88.8% of the cases at the end of follow-up (mean: 7. 1 months), with no over-corrections. CONCLUSIONS Partial SR or IR recessions obtained good results in most of the cases with small angle vertical strabismus and diplopia. Although post-operative torsion or modification of the pre-operative torsion was not observed, a prior study should be made of torsion.
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Affiliation(s)
- P Merino Sanz
- Sección de Motilidad Ocular, Departamento de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - S Y Finianos Mansour
- Sección de Motilidad Ocular, Departamento de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P Gómez de Liaño Sánchez
- Sección de Motilidad Ocular, Departamento de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J L Márquez Santoni
- Sección de Motilidad Ocular, Departamento de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J D Lourenço da Saude
- Sección de Motilidad Ocular, Departamento de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Merino P, Fuentes D, Gómez de Liaño P, Ordóñez MA. Binocular diplopia in a tertiary hospital: Aetiology, diagnosis and treatment. ACTA ACUST UNITED AC 2017; 92:565-570. [PMID: 28720313 DOI: 10.1016/j.oftal.2017.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/29/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To study the causes, diagnosis and treatment in a case series of binocular diplopia. MATERIAL AND METHOD A retrospective chart review was performed on patients seen in the Diplopia Unit of a tertiary centre during a one-year period. Diplopia was classified as: acute≤1 month since onset; subacute (1-6 months); and chronic (>6 months). Resolution of diplopia was classified as: spontaneous if it disappeared without treatment, partial if the course was intermittent, and non-spontaneous if treatment was required. It was considered a good outcome when diplopia disappeared completely (with or without treatment), or when diplopia was intermittent without significantly affecting the quality of life. RESULTS A total of 60 cases were included. The mean age was 58.65 years (60% female). An acute or subacute presentation was observed in 60% of the patients. The mean onset of diplopia was 82.97 weeks. The most frequent aetiology was ischaemic (45%). The most frequent diagnosis was sixth nerve palsy (38.3%), followed by decompensated strabismus (30%). Neuroimaging showed structural lesions in 17.7% of the patients. There was a spontaneous resolution in 28.3% of the cases, and there was a good outcome with disappearance of the diplopia in 53.3% at the end of the study. CONCLUSIONS The most frequent causes of binocular diplopia were cranial nerve palsies, especially the sixth cranial nerve, followed by decompensated strabismus. Structural lesions in imaging tests were more than expected. Only one third of patients had a spontaneous resolution, and half of them did not have a good outcome despite of treatment.
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Affiliation(s)
- P Merino
- Sección de Motilidad Ocular, Departamento de Oftalmología, HGU Gregorio Marañón, Madrid, España.
| | - D Fuentes
- Sección de Motilidad Ocular, Departamento de Oftalmología, HGU Gregorio Marañón, Madrid, España
| | - P Gómez de Liaño
- Sección de Motilidad Ocular, Departamento de Oftalmología, HGU Gregorio Marañón, Madrid, España
| | - M A Ordóñez
- Sección de Motilidad Ocular, Departamento de Oftalmología, HGU Gregorio Marañón, Madrid, España
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Weiler DL. Thyroid eye disease: a review. Clin Exp Optom 2016; 100:20-25. [PMID: 27701774 DOI: 10.1111/cxo.12472] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/27/2016] [Accepted: 07/16/2016] [Indexed: 01/01/2023] Open
Abstract
Thyroid eye disease is a multifactorial autoimmune disease with a spectrum of signs and symptoms. Oftentimes, the diagnosis of thyroid eye disease is straightforward, based upon history and physical examination. The purpose of this review is to assist the eye-care practitioner in staging the severity of thyroid eye disease (mild, moderate-to-severe and sight-threatening) and correlating available treatment modalities. Eye-care practitioners play an important role in the multidisciplinary team by assessing functional vision while also managing ocular health.
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Affiliation(s)
- Danielle L Weiler
- Optometry Section, Southern Arizona Veterans Affairs Health Care System, Tucson, Arizona, USA.,Southern California College of Optometry, Fullerton, California, USA
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15
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Partial tendon recession for small-angle vertical strabismus. J AAPOS 2016; 20:392-395. [PMID: 27647113 DOI: 10.1016/j.jaapos.2016.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effectiveness of the partial tendon recession procedure in correcting small-angle vertical deviations. METHODS The medical records of patients who underwent partial tendon recession (one pole) were reviewed retrospectively. Orthophoria was the primary outcome success criterion; residual deviation, torsion, and the dose-response relationship were also evaluated. A secondary analysis was performed on subsets of patients with thyroid eye disease (TED) and those with procedures on a muscle that had previous surgery. RESULTS A total of 53 procedures in 44 patients (average age, 58 years; age range 8-88 years) were evaluated. The mean preoperative vertical deviation was 4.3Δ ± 1.8Δ (range, 2Δ-9Δ); the mean postoperative vertical deviation was 0Δ ± 2.3Δ. The mean response to surgery was 1.5Δ/mm. In the entire cohort, 62% of the procedures resulted in orthophoria, but 82% of patients had resolution of vertical diplopia with a single procedure. In TED patients, 60% of the procedures resulted in orthophoria, whereas only 29% of procedures on previously operated muscles resulted in orthophoria. CONCLUSIONS Partial tendon recession of vertical rectus muscles reliably corrects small vertical deviations. This is equally true for patients with TED, but results are less predictable with reoperated muscles.
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Leske DA, Hatt SR, Liebermann L, Holmes JM. Lookup Tables Versus Stacked Rasch Analysis in Comparing Pre- and Postintervention Adult Strabismus-20 Data. Transl Vis Sci Technol 2016; 5:11. [PMID: 26933524 PMCID: PMC4771079 DOI: 10.1167/tvst.5.1.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/10/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose We compare two methods of analysis for Rasch scoring pre- to postintervention data: Rasch lookup table versus de novo stacked Rasch analysis using the Adult Strabismus-20 (AS-20). Methods One hundred forty-seven subjects completed the AS-20 questionnaire prior to surgery and 6 weeks postoperatively. Subjects were classified 6 weeks postoperatively as “success,” “partial success,” or “failure” based on angle and diplopia status. Postoperative change in AS-20 scores was compared for all four AS-20 domains (self-perception, interactions, reading function, and general function) overall and by success status using two methods: (1) applying historical Rasch threshold measures from lookup tables and (2) performing a stacked de novo Rasch analysis. Change was assessed by analyzing effect size, improvement exceeding 95% limits of agreement (LOA), and score distributions. Results Effect sizes were similar for all AS-20 domains whether obtained from lookup tables or stacked analysis. Similar proportions exceeded 95% LOAs using lookup tables versus stacked analysis. Improvement in median score was observed for all AS-20 domains using lookup tables and stacked analysis (P < 0.0001 for all comparisons). Conclusions The Rasch-scored AS-20 is a responsive and valid instrument designed to measure strabismus-specific health-related quality of life. When analyzing pre- to postoperative change in AS-20 scores, Rasch lookup tables and de novo stacked Rasch analysis yield essentially the same results. Translational Relevance We describe a practical application of lookup tables, allowing the clinician or researcher to score the Rasch-calibrated AS-20 questionnaire without specialized software.
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Affiliation(s)
- David A Leske
- Department of Ophthalmology Mayo Clinic, Rochester, MN, USA
| | - Sarah R Hatt
- Department of Ophthalmology Mayo Clinic, Rochester, MN, USA
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