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Piñero DP, Barberán-Bernardos L, Martínez-Plaza E, Molina-Martín A, Bataille L. Professional perspective of vision therapy worldwide among optometrists and ophthalmologists. Clin Exp Optom 2024:1-8. [PMID: 39013551 DOI: 10.1080/08164622.2024.2378136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024] Open
Abstract
CLINICAL RELEVANCE Perception of optometrists and ophthalmologists of vision therapy (VT) as well as their methods for performing the sessions is of great importance for understanding the problems that professionals face and what should be improved in their clinical practice. BACKGROUND The objective of this study was to determine the perception of VT and protocols used by eye care professionals globally. METHODS A cross-sectional study was performed among eye care professionals internationally. The participants completed via online (Google Forms) a questionnaire of 40 questions on their perception and clinical practice of VT. The survey only permitted one answer per email address and was only collected if professionals gave their consent to participate. RESULTS A total of 205 professionals from 43 countries answered the questionnaire (171 optometrists and 34 ophthalmologists). Accommodation and convergence problems were the main indication reported for VT (47.8%), followed by amblyopia (26.3%). The principal negative factor associated to VT was the limited number of professionals dedicated to this field (55.6%). The most common program of VT was the combination of VT sessions at home and at office (85.5%), with a great variability in terms of duration. Few professionals made use of the new technologies when programming VT, such as eye trackers (2.7%) or virtual reality (6.4%). European professionals surveyed had a more negative perception of VT (p < 0.031). CONCLUSIONS Eye care professionals globally perceive VT as a scientifically based procedure. Overall, they believe that it has low recognition and prestige, especially ophthalmologists. A great variability in the programming of VT sessions was found, which highlights the need for standardised protocols that professionals could follow in their clinical practice.
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Affiliation(s)
- David P Piñero
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Laura Barberán-Bernardos
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Elena Martínez-Plaza
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Ainhoa Molina-Martín
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Laurent Bataille
- Visitrain S.L., Science Park of the University of Alicante, Alicante, Spain
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Abdi S, Kangari H, Rahmani S, Baghban AA, Rad ZK. Home vision therapy and prism prescription in presbyopic persons with convergence insufficiency: study protocol for a randomized controlled trial. BMC Ophthalmol 2024; 24:169. [PMID: 38622543 PMCID: PMC11020353 DOI: 10.1186/s12886-024-03411-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/25/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Convergence insufficiency is a common issue in the field of binocular vision. Various treatment options have been suggested for managing this condition, but their efficacy in individuals with presbyopia remains unclear. The objective of this study is to compare the effectiveness of home-based vision therapy and prism prescription, in presbyopic patients with convergence insufficiency. METHODS/DESIGN It is a randomized, prospective, double-blind clinical trial, with total of 150 participants randomly assigned to the three groups. The Control Group will receive a new near glasses as a conventional prescription, along with aimless and random eye movement exercises that do not have any convergence or accommodation effects. The Home Vision Therapy Group will receive new near glasses with accommodative and convergence eye exercises. The Prism Group will receive a near prismatic glasses prescribed using the Sheard's criterion. All treatments will be administered for a period of 2 months, and measurements of the modified convergence insufficiency symptoms survey (CISS), near point convergence, near phoria, and positive fusional vergence will be taken at baseline, one month later, and at the end of the treatment. DISCUSSION We aim to identify which component - either the prism prescription or the home vision therapy - is more effective in improving binocular abilities and reducing patients' symptom scores. TRIAL REGISTRATION ClinicalTrials.gov NCT05311917 with last update on 04/22/2023.
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Affiliation(s)
- Saeid Abdi
- Department of Optometry, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Haleh Kangari
- Department of Optometry, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Rahmani
- Department of Optometry, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Kamary Rad
- Department of Optometry, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Demer JL. Phenotype and Genotype in Exotropia. JAMA Ophthalmol 2024; 142:247-248. [PMID: 38358748 DOI: 10.1001/jamaophthalmol.2023.6783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Joseph L Demer
- Stein Eye Institute and Department of Ophthalmology, University of California, Los Angeles, Los Angeles
- Department of Neurology, University of California, Los Angeles, Los Angeles
- Bioengineering Department, University of California, Los Angeles, Los Angeles
- Neuroscience Interdepartmental Program, University of California, Los Angeles, Los Angeles
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Lavrich JB, Hamburger JL, Lee KE, Thuma TBT, Omega ML, Zhang QE, Gunton KB. Creating consistency in the diagnosis of convergence insufficiency: screening methods. J AAPOS 2023; 27:346.e1-346.e6. [PMID: 37931838 DOI: 10.1016/j.jaapos.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE To determine the sensitivity of various clinical tests in the diagnosis of convergence insufficiency. METHODS A total of 254 patients were recruited with complaints consistent with convergence problems but no prior history of strabismus surgery, eye exercises, prism use, recent concussion, or other ocular or neurological diseases. Each patient completed the convergence insufficiency symptom survey (CISS), and the following data were collected: ocular alignment at distance and near, convergence and divergence fusional amplitudes at distance and near, near-point of convergence (NPC) using an accommodative target and red lens, and assessment of quality of convergence movement (QoCM) and quality of fusional movements (QoFM). The sensitivity of each clinical test was calculated. RESULTS Measurement of NPC using red lens and subjective assessment of the QoCM and QoFM were the most sensitive diagnostic tools for near symptoms consistent with convergence insufficiency: 93.3%, 98.4%, and 94.5% respectively. CISS score, convergence fusional amplitude at near, and exophoria at near had lower sensitivities: 62.9%, 46.0%, and 72.0%, respectively. Although the majority of our patients had a heterophoria or heterotropia at distance (96.8%) and/or near (98.8%), most presented with only small phorias. Furthermore, of those who had a deviation at near, only 22% had the near exophoria exceeding the distance exophoria by 10Δ. CONCLUSIONS In our study cohort, NPC with red lens and subjective assessment of QoCM and QoFM proved to be the most sensitive screening tools for near symptoms consistent with convergence insufficiency.
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Affiliation(s)
- Judith B Lavrich
- Department of Pediatric Ophthalmology and Strabismus, Wills Eye Hospital, Philadelphia, Pennsylvania.
| | - Jordan L Hamburger
- Department of Pediatric Ophthalmology and Strabismus, Wills Eye Hospital, Philadelphia, Pennsylvania; Stony Brook Department of Ophthalmology, East Setauket, New York
| | - Karen E Lee
- Department of Pediatric Ophthalmology and Strabismus, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Tobin B T Thuma
- Department of Pediatric Ophthalmology and Strabismus, Wills Eye Hospital, Philadelphia, Pennsylvania; Department of Ophthalmology, Weil Cornell Medical College, New York, New York
| | - Michelle L Omega
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Qiang Ed Zhang
- Biostatistics Consulting Core, Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Kammi B Gunton
- Department of Pediatric Ophthalmology and Strabismus, Wills Eye Hospital, Philadelphia, Pennsylvania
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de Souza DN, Jarmol M, Bell CA, Marini C, Balcer LJ, Galetta SL, Grossman SN. Precision Concussion Management: Approaches to Quantifying Head Injury Severity and Recovery. Brain Sci 2023; 13:1352. [PMID: 37759953 PMCID: PMC10526525 DOI: 10.3390/brainsci13091352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Mitigating the substantial public health impact of concussion is a particularly difficult challenge. This is partly because concussion is a highly prevalent condition, and diagnosis is predominantly symptom-based. Much of contemporary concussion management relies on symptom interpretation and accurate reporting by patients. These types of reports may be influenced by a variety of factors for each individual, such as preexisting mental health conditions, headache disorders, and sleep conditions, among other factors. This can all be contributory to non-specific and potentially misleading clinical manifestations in the aftermath of a concussion. This review aimed to conduct an examination of the existing literature on emerging approaches for objectively evaluating potential concussion, as well as to highlight current gaps in understanding where further research is necessary. Objective assessments of visual and ocular motor concussion symptoms, specialized imaging techniques, and tissue-based concentrations of specific biomarkers have all shown promise for specifically characterizing diffuse brain injuries, and will be important to the future of concussion diagnosis and management. The consolidation of these approaches into a comprehensive examination progression will be the next horizon for increased precision in concussion diagnosis and treatment.
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Affiliation(s)
- Daniel N. de Souza
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
| | - Mitchell Jarmol
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
| | - Carter A. Bell
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
| | - Christina Marini
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
| | - Laura J. Balcer
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY 10017, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10017, USA
| | - Steven L. Galetta
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY 10017, USA
| | - Scott N. Grossman
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY 10017, USA
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Merino P, Gómez de Liaño P, Guirao J, Yáñez-Merino J. Convergence insufficiency with diplopia: Surgical treatment in adults. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023:S2173-5794(23)00050-6. [PMID: 37031738 DOI: 10.1016/j.oftale.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/21/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVE To study the outcomes of treatment with central mini-plication of the medial rectus (MR) muscles in adult convergence insufficiency with diplopia. METHODS The study sample comprised 9 cases (7 women). The length of MR plication was collected. Other variables reported were postsurgical deviation, overcorrections in the early postoperative period and at the end of follow-up, final horizontal deviation at near and at distance vision, diplopia, and mean follow-up from surgery. Surgical outcome was considered to be favorable when diplopia and symptoms were resolved and final exotropia at near was ≤8 pd at the end of follow-up. RESULTS A central mini-plication of the MR was performed in 9 patients (8 unilateral). Mean (± SD) age was 58.66 (21.39) years. Mean near preoperative deviation: 16.22 (± 2.9) pd and distance preoperative deviation: 6.88 (± 4) pd Overcorrection at distance vision was recorded in 5 cases; this resolved by 3 months postoperatively. There was not overcorrection at near vision except one case. None of the cases operated on had overcorrection at the end of follow-up The final horizontal deviation was ≤8 pd at near vision, except for 3 cases (mean: 6.22). Symptoms and diplopia resolved in 8 cases. The mean follow-up was 10.33 months. CONCLUSION Central mini-plication of 1 or 2 medial rectus muscles can improve the symptoms and signs of exotropia associated with convergence insufficiency when exercises and the prisms are rejected by the patients and when these approaches have not solved the problem.
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Affiliation(s)
- P Merino
- Sección de Motilidad Ocular y Diplopía, Servicio de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - P Gómez de Liaño
- Sección de Motilidad Ocular y Diplopía, Servicio de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Guirao
- Sección de Motilidad Ocular y Diplopía, Servicio de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Yáñez-Merino
- Sección de Motilidad Ocular y Diplopía, Servicio de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Erdinest N, London N. Comment on Rauchman et al. Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System. Neurol. Int. 2022, 14, 453-470. Neurol Int 2022; 14:839-840. [PMID: 36278692 PMCID: PMC9590062 DOI: 10.3390/neurolint14040068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
This letter is regarding the article, "Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System" [...].
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Affiliation(s)
- Nir Erdinest
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem 9112001, Israel
| | - Naomi London
- Private Practice, Jerusalem 9422805, Israel
- Correspondence: ; Tel.: +972-545406646; Fax: +972-25004333
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Gantz L, Stiebel-Kalish H. Convergence insufficiency: Review of clinical diagnostic signs. JOURNAL OF OPTOMETRY 2022; 15:256-270. [PMID: 34963569 PMCID: PMC9537264 DOI: 10.1016/j.optom.2021.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/05/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
Convergence insufficiency (CI) is a common binocular vision (BV) disorder characterized by difficulty in maintaining motor fusion at near, which affects approximately 7.5 percent of the population. Diagnostic criteria for the disorder are inconsistent, ranging from one to many clinical signs. Methodology for clinical tests is inconsistent in measurement technique, visual targets, required repetitions, and normative values. This manuscript demonstrates the inconsistencies amongst published studies, and highlights the importance of consistent clinical diagnostic signs, measurement techniques, visual targets, and cut-off criteria. For each clinical sign, the recommended methodology for the procedure is described. Several studies do not take age into account when diagnosing CI in their cohorts. As such, the review emphasizes changes in diagnostic signs with age. This manuscript highlights the need for consistent and clear procedures and diagnostic criteria amongst clinicians and provides the basis for future studies in terms of diagnostic testing required for CI of varying age groups.
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Affiliation(s)
- Liat Gantz
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel.
| | - Hadas Stiebel-Kalish
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Felsenstein Research Medical Center; Neuro-Ophthalmology Division, Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel
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Abbas Farishta R, Farivar R. Montreal Brain Injury Vision Screening Test for General Practitioners. Front Hum Neurosci 2022; 16:858378. [PMID: 35911590 PMCID: PMC9330036 DOI: 10.3389/fnhum.2022.858378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
Visual disturbances are amongst the most commonly reported symptoms after a traumatic brain injury (TBI) despite vision testing being uncommon at initial clinical evaluation. TBI patients consistently present a wide range of visual complaints, including photophobia, double vision, blurred vision, and loss of vision which can detrimentally affect reading abilities, postural balance, and mobility. In most cases, especially in rural areas, visual disturbances of TBI would have to be diagnosed and assessed by primary care physicians, who lack the specialized training of optometry. Given that TBI patients have a restricted set of visual concerns, an opportunity exists to develop a screening protocol for specialized evaluation by optometrists—one that a primary care physician could comfortably carry out and do so in a short time. Here, we designed a quick screening protocol that assesses the presence of core visual symptoms present post-TBI. The MOBIVIS (Montreal Brain Injury Vision Screening) protocol takes on average 5 min to perform and is composed of only “high-yield” tests that could be performed in the context of a primary care practice and questions most likely to reveal symptoms needing further vision care management. The composition of our proposed protocol and questionnaire are explained and discussed in light of existing protocols. Its potential impact and ability to shape a better collaboration and an integrative approach in the management of mild TBI (mTBI) patients is also discussed.
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Affiliation(s)
- Reza Abbas Farishta
- McGill Vision Research Unit, Department of Ophthalmology and Vision Sciences, McGill University, Montréal, QC, Canada
- *Correspondence: Reza Abbas Farishta
| | - Reza Farivar
- McGill Vision Research Unit, Department of Ophthalmology and Vision Sciences, McGill University, Montréal, QC, Canada
- Research Institute of the McGill University Health Centre, McGill University, Montréal, QC, Canada
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Hofsli M, Torp-Pedersen TE, Sepstrup Lønkvist C, Saunte JP. Botulinum Toxin A Injection for Convergence Insufficiency. J Pediatr Ophthalmol Strabismus 2022; 60:108-113. [PMID: 35611822 DOI: 10.3928/01913913-20220324-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effects of botulinum toxin A injection in one or both lateral rectus muscles in patients with convergence insufficiency previously managed with non-surgical and/or surgical options other than botulinum toxin A injection. METHODS All patients with symptomatic convergence insufficiency treated with botulinum toxin A injection to one or both lateral rectus muscles from 2013 to 2018 at the Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen University Hospital were retrospectively reviewed. All patients had near symptoms and were previously treated with a combination of convergence exercises, prisms, and/or surgery. Patients with previous botulinum toxin A injection in an extraocular muscle were excluded. Reading symptoms and deviation at near and distance were recorded at baseline and after 1 and 6 months. RESULTS Twenty-three patients with convergence insufficiency were included (8 men and 15 women). Follow-up was conducted after a median of 47 days (interquartile range [IQR]: 31.5 to 72.5 days) and 174 days (IQR: 139 to 267 days). At baseline, median near angle of deviation was 18 PD of exophoria (IQR: 13 to 21 PD). The near deviation was reduced to 10 PD of exophoria (IQR: 7 to 17 PD) at first follow-up visit and 14 PD of exophoria (IQR: 12 to 18 PD) at last follow-up visit. Thirteen of 23 patients (57%) and 3 of 13 patients (23%) reported improvement in reading symptoms at first and last follow-up visit, respectively, compared to baseline. CONCLUSIONS Botulinum toxin A injection may be useful in patients with convergence insufficiency. However, some patients may require repeated injections. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].
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Hamburger JL, Lavrich JB, Rusakevich AM, Leibowitz JA, Zhitnitsky MD, Zhang Q, Makkena AC, Liu CK, Oh GJ, Sharpe JE, Gunton KB. The visual consequences of virtual school: acute eye symptoms in healthy children. J AAPOS 2022; 26:2.e1-2.e5. [PMID: 35032654 DOI: 10.1016/j.jaapos.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate acute eye symptoms in healthy children after a typical day of virtual school during the COVID-19 pandemic. METHODS The study population included 110 healthy children 10-17 years of age who were enrolled in full-time or hybrid virtual school. Children with a history of central nervous system or ocular pathology, recent concussions, reported poor vision, convergence insufficiency, history of orthoptic therapy, strabismus, amblyopia, or learning disorders were excluded. Background information was collected, including demographics, family and personal ocular history, and virtual school specifications. Eligible children completed a modified convergence insufficiency symptom survey (CISS) and an asthenopia survey before and after a virtual school session. CISS and asthenopia survey symptoms were scored, and the differences in symptomatology before and after school were calculated. RESULTS The average sum of the CISS scores increased from 5.17 before school to 9.82 after (P < 0.001), with 61% of children recording an increase in convergence insufficiency symptoms and 17% experiencing severe convergence insufficiency symptoms after school. Average asthenopia symptom scores increased from 1.58 to 2.74 (P < 0.001), with 53% of children recording an increase in asthenopia symptoms. Significant increases were seen in 12 of 15 CISS questions and in 4 of 5 asthenopia questions. CONCLUSIONS In this study cohort, otherwise healthy children experienced acute ocular symptoms following virtual school.
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Affiliation(s)
- Jordan L Hamburger
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Judith B Lavrich
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Pediatric Ophthalmology and Strabismus Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | | | - Jillian A Leibowitz
- Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, Florida
| | - Michael D Zhitnitsky
- Touro University - California, College of Osteopathic Medicine, Vallejo, California
| | - Qiang Zhang
- Biostatistics Consulting Core, Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Ajay C Makkena
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Catherine K Liu
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Glenn J Oh
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James E Sharpe
- Biostatistics Consulting Core, Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Kammi B Gunton
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Pediatric Ophthalmology and Strabismus Service, Wills Eye Hospital, Philadelphia, Pennsylvania.
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Patel RD, LaBella CR. Contributions of PCSS, CISS, and VOMS for Identifying Vestibular/Ocular Motor Deficits in Pediatric Concussions. Sports Health 2021; 13:565-572. [PMID: 33618579 DOI: 10.1177/1941738121994116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Vestibular/ocular motor dysfunction can occur in pediatric concussions, which can impair reading, learning, and participation in athletics. This study evaluated 3 clinical tools for identifying postconcussion vestibular/ocular motor dysfunction: (1) Post-Concussion Symptom Scale (PCSS), (2) Convergence Insufficiency Symptom Survey (CISS), and (3) Vestibular/Ocular Motor Screening (VOMS). HYPOTHESIS Evaluating vestibular/ocular motor dysfunction with multiple clinical tools will capture more symptomatic patients than any 1 tool alone. STUDY DESIGN Cross-sectional data from a prospective cohort study. LEVEL OF EVIDENCE Level 4. METHODS Patients were between 8 and 17 years old and seen in a tertiary care pediatric sports medicine clinic between August 2014 and February 2018. Data were collected from initial visit and included VOMS, PCSS, and CISS. Descriptive statistics, Pearson's correlations, and logistic regressions were used to describe relationships between clinical tools. RESULTS Of the 156 patients (55.1% female; 14.35 ± 2.26 years old) included, this study identified 129 (82.7%) with vestibular/ocular motor dysfunction. Of these 129, 65 (50.4%) reported "visual problems" on PCSS, 93 (72.1%) had abnormal CISS, and 99 (76.7%) had abnormal VOMS. Together, VOMS and CISS identified 64 (49.6%) patients without reported "visual problems" on PCSS. Higher total PCSS scores predicted abnormal CISS (odds ratio [OR], = 1.11; 95% CI, 1.07-1.17) and abnormal VOMS (OR, 1.03; 95% CI, 1.01-1.06). "Visual problems" on PCSS did not predict abnormal CISS or VOMS. CONCLUSIONS Vestibular/ocular motor dysfunction were identified in nearly 83% of study subjects when PCSS, CISS, and VOMS are used together. CLINICAL RELEVANCE These results suggest adding CISS and VOMS to the clinical evaluation of concussions can help clinicians identify post-concussion vestibular/ocular motor dysfunction.
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Affiliation(s)
- Rishi D Patel
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Cynthia R LaBella
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Division of Orthopaedic Surgery and Sports Medicine, Lurie Children's Hospital, Chicago, Illinois
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Çakır B, Aksoy NÖ, Özmen S, Bursalı Ö. The effect of amblyopia on clinical outcomes of children with astigmatism. Ther Adv Ophthalmol 2021; 13:25158414211040898. [PMID: 34541452 PMCID: PMC8442477 DOI: 10.1177/25158414211040898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 08/03/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Amblyopia is more common in children with high astigmatism, but factors contributing to development of amblyopia and visual outcomes are not fully understood. OBJECTIVE To evaluate the effect of amblyopia on the clinical outcomes in children with ⩾1.75 diopter (D) astigmatism. METHODS We reviewed the medical records of children with ⩾1.75 D astigmatism with and without amblyopia (amblyopes group and non-amblyopes group). The mean age, gender, amount and type of ocular deviation, presence of convergence insufficiency (CI), stereopsis, time of initial spectacle use and follow-up time, differences in best-corrected visual acuity (VoD) and spherical equivalent (SE) between eyes were assessed and compared between the groups. Best-corrected visual acuity (BCVA), mean SE, astigmatism measurements were assessed and compared between amblyopic, fellow, and non-amblyopic eyes. RESULTS The records included 68 eyes of 34 children with amblyopia and 56 eyes of 28 children without amblyopia. The mean age, gender, amount and type of ocular deviation, presence of CI, stereopsis, time of initial spectacle use, follow-up time, and the difference in SE did not differ between groups. In amblyopes, exodeviation was more common and statistically greater in near (33 cm) than at distance (6 m) (p = 0.005). The mean BCVA and astigmatism values were statistically different between amblyopic, fellow, and non-amblyopic eyes. CONCLUSION A greater near than distance exodeviation and higher mean astigmatism value were found in amblyopic children with astigmatism.
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Scheiman M, Kulp MT, Cotter SA, Lawrenson JG, Wang L, Li T. Interventions for convergence insufficiency: a network meta-analysis. Cochrane Database Syst Rev 2020; 12:CD006768. [PMID: 33263359 PMCID: PMC8092638 DOI: 10.1002/14651858.cd006768.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Convergence insufficiency is a common binocular vision disorder in which the eyes have a strong tendency to drift outward (exophoria) with difficulty turning the eyes inward when reading or doing close work. OBJECTIVES To assess the comparative effectiveness and relative ranking of non-surgical interventions for convergence insufficiency through a systematic review and network meta-analysis (NMA). SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PubMed and three trials registers up to 20 September 2019. SELECTION CRITERIA We included randomized controlled trials (RCTs) examining any form of non-surgical intervention versus placebo, no treatment, sham treatment, or other non-surgical interventions. Participants were children and adults with symptomatic convergence insufficiency. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. We performed NMAs separately for children and adults. MAIN RESULTS We included 12 trials (six in children and six in adults) with a total of 1289 participants. Trials evaluated seven interventions: 1) office-based vergence/accommodative therapy with home reinforcement; 2) home-based pencil/target push-ups; 3) home-based computer vergence/accommodative therapy; 4) office-based vergence/accommodative therapy alone; 5) placebo vergence/accommodative therapy or other placebo intervention; 6) prism reading glasses; and 7) placebo reading glasses. Six RCTs in the pediatric population randomized 968 participants. Of these, the Convergence Insufficiency Treatment Trial (CITT) Investigator Group completed four RCTs with 737 participants. All four CITT RCTs were rated at low risk of bias. Diagnostic criteria and outcome measures were identical or similar among these trials. The four CITT RCTs contributed data to the pediatric NMA, incorporating interventions 1, 2, 3 and 5. When treatment success was defined by a composite outcome requiring both clinical measures of convergence to be normal, and also show a pre-specified magnitude of improvement, we found high-certainty evidence that office-based vergence/accommodative therapy with home reinforcement increases the chance of a successful outcome, compared with home-based computer vergence/accommodative therapy (risk ratio (RR) 1.96, 95% confidence interval (CI) 1.32 to 2.94), home-based pencil/target push-ups (RR 2.86, 95% CI 1.82 to 4.35); and placebo (RR 3.04, 95% CI 2.32 to 3.98). However, there may be no evidence of any treatment difference between home-based computer vergence/accommodative therapy and home-based pencil/target push-ups (RR 1.44, 95% CI 0.93 to 2.24; low-certainty evidence), or between either of the two home-based therapies and placebo therapy, for the outcome of treatment success. When treatment success was defined as the composite convergence and symptom success outcome, we found moderate-certainty evidence that participants who received office-based vergence/accommodative therapy with home reinforcement were 5.12 (95% CI 2.01 to 13.07) times more likely to achieve treatment success than those who received placebo therapy. We found low-certainty evidence that participants who received office-based vergence/accommodative therapy with home reinforcement might be 4.41 (95% CI 1.26 to 15.38) times more likely to achieve treatment success than those who received home-based pencil push-ups, and 4.65 (95% CI 1.23 to 17.54) times more likely than those who received home-based computer vergence/accommodative therapy. There was no evidence of any treatment difference between home-based pencil push-ups and home-based computer vergence/accommodative therapy, or between either of the two home-based therapies and placebo therapy. One RCT evaluated the effectiveness of base-in prism reading glasses in children. When base-in prism reading glasses were compared with placebo reading glasses, investigators found no evidence of a difference in the three outcome measures of near point convergence (NPC), positive fusional vergence (PFV), or symptom scores measured by the Convergence Insufficiency Symptom Survey (CISS). Six RCTs in the adult population randomized 321 participants. We rated only one RCT at low risk of bias. Because not all studies of adults included composite success data, we could not conduct NMAs for treatment success. We thus were limited to comparing the mean difference (MD) between interventions for improving NPC, PFV, and CISS scores individually using data from three RCTs (107 participants; interventions 1, 2, 4 and 5). Compared with placebo treatment, office-based vergence accommodative therapy was relatively more effective in improving PFV (MD 16.73, 95% CI 6.96 to 26.60), but there was no evidence of a difference for NPC or the CISS score. There was no evidence of difference for any other comparisons for any outcomes. One trial evaluated base-in prism glasses prescribed for near-work activities and found that the prism glasses group had fewer symptoms compared with the placebo glasses group at three months (MD -8.9, 95% CI -11.6 to -6.3). The trial found no evidence of a difference with this intervention in NPC or PFV. No adverse effects related to study treatments were reported for any of the included studies. Excellent adherence was reported for office-based vergence/accommodative therapy (96.6% or higher) in two trials. Reported adherence with home-based therapy was less consistent, with one study reporting decreasing adherence over time (weeks 7 to 12) and lower completion rates with home-based pencil/target push-ups. AUTHORS' CONCLUSIONS Current research suggests that office-based vergence/accommodative therapy with home reinforcement is more effective than home-based pencil/target push-ups or home-based computer vergence/accommodative therapy for children. In adults, evidence of the effectiveness of various non-surgical interventions is less clear.
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Affiliation(s)
| | - Marjean T Kulp
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Susan A Cotter
- Southern California College of Optometry, Fullerton, California, USA
| | - John G Lawrenson
- Centre for Applied Vision Research, School of Health Sciences, City University of London, London, UK
| | - Lin Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tianjing Li
- Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
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The Influence of COVID-19 Isolation on Physical Activity Habits and Its Relationship with Convergence Insufficiency. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207406. [PMID: 33053701 PMCID: PMC7601297 DOI: 10.3390/ijerph17207406] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022]
Abstract
The purpose of this work is to evaluate the effects of confinement due to COVID-19 isolation on visual function, considering insufficient convergence as one of the possible effects of living the whole day in a reduced space. We pass a Convergence Insufficiency Symptom Survey (CISS) among 235 people to detect their habits before and after 25 confinement days. The data collection protocol consisted on a Google forms questionnaire included two parts: the first with current data (isolation period) and a second with pre-isolation period data. Differences between the pre-isolation and isolation period were calculated using the related paired T-tests. When statistically significant differences were found, the effect size was estimated using the Cohen’s d index (d). The reduction in physical activity levels during confinement were related to the increase in total number of minutes of screen consumption from 433.49 min to 623.97 min per day (d = 0.67; 44.01%). The CISS scores were increased by more than 43% during confinement. The increase in convergence insufficiency was 100% after the studied isolation period of 25 days. The 92.19% increase in television use during 25 days of confinement is not responsible for the increase in convergence insufficiency. However, due to the increase in the use of PCs in this period, there is a notable increase in convergence insufficiency. Therefore, we can conclude that not all increases in tasks with electronic devices are responsible for the increase in convergence insufficiency.
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Arnoldi K. Traumatic Brain Injury in Children: Do the Eyes Have It? The Orthoptic Evaluation of Traumatic Brain Injury. J Binocul Vis Ocul Motil 2020; 70:122-127. [PMID: 33275080 DOI: 10.1080/2576117x.2020.1792030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 06/12/2023]
Abstract
Because the neuropathological changes caused by mild traumatic brain injury (mTBI) more often manifest as functional impairments than structural abnormalities, the clinical diagnosis of mTBI may rely too heavily on a combination of history and self-reported symptoms. The mechanism of injury in mild traumatic brain injury (mTBI) predicts that supranuclear pathways controlling eye movement systems would be vulnerable to damage, and diagnostic tests of these systems would be high-yield. In fact, tests of oculomotor function have proven to be highly sensitive in detecting neurological soft signs, but may require expensive, specialized equipment. Fortunately, Certified Orthoptists (COs) are skilled at the evaluation of accommodative dysfunction, abnormalities of saccades, smooth pursuit, and vestibular eye movements, and vergence errors using standard ophthalmic equipment. Because COs are accustomed to adapting the sensorimotor exam to infants and pre-verbal children, they are able to modify or design objective methods, the results of which may be difficult for the patient with a functional overlay to decipher and deceive. When the patient with a history of mTBI presents to the ophthalmologist with visual symptoms and a normal routine eye exam, it is important to order a sensorimotor examination by a CO to confirm the diagnosis.
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Affiliation(s)
- Kyle Arnoldi
- Ira G. Ross Eye Institute, University at Buffalo , Buffalo, New York
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Merino P, Mustafín I, Gómez De Liaño P, Cólliga C. Central Mini-plication of the Medial Rectus for Convergence Insufficiency. J Binocul Vis Ocul Motil 2020; 70:53-56. [PMID: 32167411 DOI: 10.1080/2576117x.2020.1724741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Five cases with a mean (± SD) age of 61 (12.02) years are described to study the outcomes of treatment with central mini-plication of the medial rectus (MR) muscles in adult convergence insufficiency with diplopia and near exotropia: mean preoperative deviation: 18 (± 2) pd. Surgical outcome was considered to be favorable when diplopia and symptoms were resolved and final exotropia at near was ≤8 pd at the end of follow-up. A central mini-plication of the medial rectus (MR) muscles was performed in 5 patients (4 unilateral). Overcorrection at distance vision was recorded in 3 cases; this resolved by 3 months postoperatively. There was not overcorrection at near vision in any case. None of the cases operated on had overcorrection at the end of follow-up. The final horizontal deviation was ≤8 pd at near vision, except for 1 case. Symptoms and diplopia resolved in every case but 2/5 required reoperations. The mean follow-up was 8 (2.12) months. Central mini-plication of 1 or 2 medial rectus muscles can improve the symptoms and signs of exotropia associated with convergence insufficiency when exercises and the prisms are rejected by the patients and when these approaches have not solved the problem.
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Affiliation(s)
- Pilar Merino
- Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón , Madrid, Spain
| | - Ilshat Mustafín
- Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón , Madrid, Spain
| | - Pilar Gómez De Liaño
- Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón , Madrid, Spain
| | - Carlos Cólliga
- Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón , Madrid, Spain
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Horizontal Vestibulo-Ocular Reflex Gain Measures During Convergence Using a Monocular Video Technique. Otol Neurotol 2020; 41:e118-e123. [DOI: 10.1097/mao.0000000000002414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Diplopia in Parkinson’s disease: visual illusion or oculomotor impairment? J Neurol 2019; 266:2457-2464. [DOI: 10.1007/s00415-019-09430-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/27/2019] [Accepted: 06/11/2019] [Indexed: 11/26/2022]
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Walton MMG, Pallus A, Mustari M. A Rhesus Monkey With a Naturally Occurring Impairment of Disparity Vergence. II. Abnormal Near Response Cell Activity in the Supraoculomotor Area. Invest Ophthalmol Vis Sci 2019; 60:1670-1676. [PMID: 30999322 PMCID: PMC6736280 DOI: 10.1167/iovs.18-26440] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose Convergence insufficiency is a very common disorder that can have significant adverse effects on school performance. When reading, children with this disorder often experience diplopia and headaches. We have recently obtained a rhesus monkey with a naturally occurring impairment of vergence eye movements. In the companion paper, we report behavioral testing that shows a pattern of impairments similar to what clinicians observe in human children with convergence insufficiency, including a receded near point, an exophoria that increases as target distance decreases, and difficulty maintaining an appropriate vergence angle when presented with a large field stimulus at near. For the present case report, we wondered whether these behavioral deficits would be associated with abnormal discharge patterns in brainstem neurons related to vergence eye movements. Methods Single unit activity was recorded from near and far response cells in the supraoculomotor area in the vergence-impaired monkey, while he performed a smooth vergence tracking task or fixated visual targets at different distances. Results We found an abnormally weak sensitivity to both vergence angle and vergence velocity. Nonetheless, these neurons modulated in association with contextually inappropriate slow vergence movements that occurred in the absence of saccades but not for slow divergence drifts that immediately followed converging saccades. Modulation of activity was more robust when additional depth cues were available. Conclusions These data suggest that disorders affecting vergence eye movements may be associated with impoverished sensory input to the near and far response cells and, perhaps, aberrant tuning in vergence-related neurons.
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Affiliation(s)
- Mark M G Walton
- Washington National Primate Research Center, University of Washington, Seattle, Washington, United States
| | - Adam Pallus
- Washington National Primate Research Center, University of Washington, Seattle, Washington, United States.,Department of Ophthalmology, University of Washington, Seattle, Washington, United States
| | - Michael Mustari
- Washington National Primate Research Center, University of Washington, Seattle, Washington, United States.,Department of Ophthalmology, University of Washington, Seattle, Washington, United States.,Department of Biological Structure, University of Washington, Seattle, Washington, United States
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