Double vision in adults

Understanding Occupational Therapists' Knowledge and Confidence When Assessing for Spatial Neglect: A Special Issue Review

IMPORTANCE

Spatial neglect (SN)-failure to respond to stimuli on the side of the body contralateral to a poststroke lesion-is one of the most disabling impairments for stroke survivors, and 80% of stroke survivors may have undetected SN. Occupational therapists' evaluations should include determining the impact of poststroke SN.

OBJECTIVE

To investigate occupational therapists' confidence, knowledge, current practices, barriers, and facilitators when assessing for SN in adult stroke survivors.

DESIGN

A 30-item survey was created with guidance from stroke rehabilitation occupational therapists who reviewed the survey for face and content validity.

SETTING

Online survey.

PARTICIPANTS

Occupational therapist survey responders (N = 76).

OUTCOMES AND MEASURES

Self-report assessments were used to measure occupational therapists' confidence in identifying SN, SN assessment practices, and barriers to and facilitators of SN assessment. Knowledge of SN signs and symptoms, neuroanatomy, and clinical presentation were measured with a three-question quiz.

RESULTS

Eighty-one percent of the respondents reported a high level of confidence in identifying SN, and 70% reported routinely assessing for SN, with 81% using clinical observation rather than standardized tools as the primary assessment method. Barriers to SN assessment included time and resources.

CONCLUSIONS AND RELEVANCE

Most respondents, despite reporting high levels of confidence with routine SN assessments, did not use standardized SN measures and demonstrated suboptimal knowledge of SN. These results emphasize the need to increase clinical education about SN and its assessments. Plain-Language Summary: This study gathered baseline information on an underinvestigated topic-occupational therapists' education, confidence, current practices, barriers, and facilitators when assessing for spatial neglect in adult stroke survivors. The study results also contribute to future research on occupational therapists' current confidence and knowledge when assessing for spatial neglect.

Diplopia: characteristics and etiologic distribution in a referral-based university hospital

BACKGROUND AND OBJECTIVES

The etiologic distribution and clinical features of diplopia may differ according to the specialties involved in the management. This study aimed to establish the clinical features and underlying etiologies of diplopia by recruiting patients from all departments.

METHODS

We reviewed the medical records of 4127 patients with diplopia as the chief complaint, who had been recruited from all departments at Seoul National University Bundang Hospital, Seongnam, Republic of Korea, from 2003 to 2020.

RESULTS

Diplopia was binocular in 3557 (94.2%) and monocular in 219 (5.8%) patients. The common causes of binocular diplopia included microvascular (n = 516, 14.5%), strokes (n = 412, 11.6%), neoplastic (n = 304, 8.5%), myasthenia gravis (n = 253, 7.1%), traumatic (n = 240, 6.7%), and decompensated phoria (n = 232, 6.5%), and comprised more than a half of the causes. Patients with binocular diplopia were usually managed by neurologists (2549/3557, 71.7%), followed by ophthalmologists (2247/3557, 63.2%), emergency physicians (1528/3557, 43.0%), neurosurgeons (361/3557, 10.1%), and others (271/3557, 7.6%). The etiologies of binocular diplopia differed markedly according to the patients' age and the specialties involved in the management (p < 0.001).

CONCLUSIONS

Given the differences in the etiologic distribution of diplopia according to the patients' age and the specialties involved in the management, the results of previous reports on the characteristics and etiology of diplopia, primarily performed in a single specialty department, should be interpreted with a possible selection bias.

Application of Soft Directional Prismatic Contact Lenses to Correct Diplopia

PURPOSE

To verify whether diplopia due to a small-angle strabismus within 8 prism diopters (PD) could be corrected by applying soft directional prismatic contact lenses, obtaining higher comfort and quality of vision for the patients.

METHODS

A prospective study was undertaken by enrolling consecutive patients affected by vertical and/or horizontal diplopia and small-angle strabismus within 8 PD. The patients were tested for best corrected visual acuity, refraction, cover test for near and for distance, ocular motility test, prismatic fit test, corneal topography, tear film evaluation, binocular vision test, head position evaluation, retinography, and optical coherence tomography of the posterior and anterior segment. Custom soft contact lenses, made in Benz G5X material, were designed and developed for this study. All patients were first corrected with prismatic glasses according to their degree of strabismus and ametropia. Then they were asked to wear custom-made directional prismatic contact lenses with appropriate simultaneous correction of strabismus and ametropia. The patients were then asked to answer whether the comfort and quality of vision was higher with directional prismatic contact lenses or prismatic glasses.

RESULTS

Eight patients were enrolled with different causes of diplopia caused by a strabismus of 8 PD or less. The soft directional prismatic contact lenses could resolve diplopia in 100% of patients. All patients reported greater comfort and quality of vision with directional prismatic contact lenses.

CONCLUSIONS

The study demonstrated that diplopia resulting from an angle of strabismus within 8 PD can be corrected through the use of soft directional prismatic contact lenses, obtaining greater quality of vision free of aberrations. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

Characteristics of diplopia in a pediatric population

PURPOSE

To evaluate the characteristics of diplopia in children at a single tertiary eye care center.

METHODS

The medical records of patients with diplopia onset at age 18 years or younger presenting during the period 2015-2018 were reviewed retrospectively. Demographic information, clinical characteristics, diagnoses, treatment, and outcome data were collected. The exact χ² test was used to compare groups and select post hoc analyses were performed using the Fisher exact or exact χ² tests.

RESULTS

A total of 244 patients (average age, 12.2 years at presentation) were included. The most common clinical diagnoses were nonparalytic strabismus (49.2%), trauma (9.4%), and cranial nerve palsies (9%). There was no statistically significant difference in median age of diplopia onset in those with nonparalytic strabismus, cranial nerve palsies, and vision- or life-threatening conditions. There was a statistically significant difference in timing of onset of diplopia at presentation in vision- or life-threatening conditions compared to nonparalytic strabismus (P < 0.0001) and cranial nerve palsies (P = 0.01) and for neurologic symptoms in vision- or life- threatening conditions compared to nonparalytic strabismus (P = 0.032) and cranial nerve palsies (P = 0.0051). In patients with more than one neurologic symptom, the majority (58.3%) had a vision- or life-threatening condition. Initial interventions included observation (28.7%), prisms (18.4%), updating refractive correction (14.3%), and strabismus surgery (11.1%). In patients with follow-up data, 5.3% had resolution of diplopia prior to their clinic visit, and 46.6% had resolution after initial intervention.

CONCLUSIONS

In our study cohort, most children who presented with diplopia had nonemergent conditions. In those with life-threatening conditions, diplopia tended to have an acute onset and associated neurologic signs and visual symptoms.