1
|
Liao J, Li Y, Zhang W. Binocular summation of visual acuity and contrast sensitivity in children with intermittent exotropia. BMC Ophthalmol 2023; 23:245. [PMID: 37264304 DOI: 10.1186/s12886-023-02961-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/05/2023] [Indexed: 06/03/2023] Open
Abstract
PURPOSE To investigate the binocular summation (BiS) of visual acuity (VA) and contrast sensitivity (CS) in children with intermittent exotropia (IXT) before and after surgery and to probe the relationship between the two BiS phenomena and corresponding influencing factors. METHODS This prospective study included 21 IXT children (11 males and 10 females; aged 6-13 years) who underwent strabismus surgery in Tianjin Eye Hospital from January to April 2022. The visual function was assessed preoperatively and 2.95 ± 0.14 months postoperatively, including monocular/ binocular visual acuity (MVA/BVA) at 100% contrast and 2.5% contrast as well as monocular/binocular contrast sensitivity (MCS/BCS), deviation, near and distant stereopsis, and fusion. RESULTS All patients had postoperative deviation ranging from 0 to -4 PD. Either preoperative or postoperative BVA at 2.5% contrast was superior to the MVA. The postoperative BiS at 2.5% contrast was significantly superior to the preoperative BiS for 2.5% contrast and postoperative BiS for 100% contrast (P < 0.05). Except for 3 c/d, the MCS and BCS at 6 c/d, 12 c/d and 18 c/d spatial frequencies were all notably improved postoperatively. The postoperative binocular summation ratio of CS (BSR) was highest while interocular difference ratio of CS (IOR) was the lowest at 6 c/d among 4 spatial frequencies. The deviation, distant and near stereopsis, and fusion performance were all remarkably improved after surgery (p = 0.001; p = 0.041; p = 0.000), all of which were not related to BVA at 2.5% contrast, BiS, BSC and BSR. The BCS at middle and high frequencies (6 c/ds, 12 c/ds, and 18 c/ds) was significantly negatively correlated with the BVA at 2.5% contrast, and BSR was irrelevant to the corresponding IOR across different spatial frequencies. CONCLUSION BVA at low contrast and BCS examinations were not equivalent to stereopsis and fusion status, which contributed to the evaluation of binocular function in the real environment and in the different aspects. BVA in 2.5% contrast is related with BCS in moderate and high spacial frequencies (especially 18c/d) but BCS in 6c/d presents more binocular summation of contrast sensitivity. MCS, BCS and the BSR persist inhibition at 3c/d after surgery. The improvement of BCS is better than that of BSR to evaluate the binouclar function in IXT. Those two methods showed different sensitivities to impairment and rehabilitation of binocular summation and inhibition.
Collapse
Affiliation(s)
- Jun Liao
- Chengdu AIDI Eye Hospital, Chengdu, China
| | - Yueping Li
- Pediatric Ophthalmology and Strabismus Department, Tianjin Eye Hospital, Affiliated Eye Hospital of Nankai University, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Key Laboratory of Ophthalmology and Vision Science, Tianjin, 300020, China.
| | - Wei Zhang
- Pediatric Ophthalmology and Strabismus Department, Tianjin Eye Hospital, Affiliated Eye Hospital of Nankai University, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Key Laboratory of Ophthalmology and Vision Science, Tianjin, 300020, China.
| |
Collapse
|
2
|
Moradi F, Mirzajani A, Akbari MR, Khorrami-Nejad M, Abolghasemi J, Masoomian B. Binocular contrast sensitivity in patients with intermittent exotropia in relation to angle of strabismus and level of compensation. Strabismus 2022; 31:1-8. [PMID: 36415944 DOI: 10.1080/09273972.2022.2141272] [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] [Indexed: 11/24/2022]
Abstract
Intermittent exotropia (IXT) causes photophobia, and photophobia has been studied by measurement of contrast sensitivity (CS). CS was reduced in children with IXT. We compared binocular CS (BCS) in patients with IXT and normal subjects in relation to the angle of strabismus and control of IXT. This case-control study was performed on 40 patients with IXT and 40 normal subjects who were examined with the CSV1000 CS device in mesopic (3 cd/m2) and photopic (85 cd/m2) conditions with and without a glare stimulus at 3, 6, 12, and 18 cycle/degree (cpd) spatial frequencies. The angle of strabismus and near stereoacuity were also measured. The patient's IXT compensation was graded based on the office control scale. The mean age for IXT and normal participants were 12.30 ± 0.60 (range, 6-18) and 11.00 ± 0.78 (range, 6-18) years, respectively (P = .34). The IXT patients had lower binocular CS than controls at all spatial frequencies (P < .001). The largest decrease in CS occurred at 6 cpd spatial frequency under mesopic condition (1.61 ± 0.07 vs 1.38 ± 0.15, P < .001) and photopic condition with glare (2.03 ± 0.06 vs 1.77 ± 0.13, P < .001). Patients with better control scores had higher levels of BCS; also, the score of BCS showed a significant decrease in patients with a deviation of 25 prism diopter or more, compared to those with less deviation. BCS correlated at 3 and 6 cpd with near stereoacuity (r = -0.652, P < .001 and r = -0.613, P < .001). Binocular CS in patients with IXT correlates with the angle of strabismus and level of compensation.
Collapse
Affiliation(s)
- Fatemeh Moradi
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran
| | - Ali Mirzajani
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran
| | - Mohammad Reza Akbari
- Translational research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran
| | - Masoud Khorrami-Nejad
- Translational research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran
| | - Jamileh Abolghasemi
- Biostatistics Department, School of Public Health, Iran University of Medical Sciences, Tehran
| | - Babak Masoomian
- Translational research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran
| |
Collapse
|
3
|
Bae YH, Choi DG. Changes in contrast sensitivity after surgery for intermittent exotropia. Sci Rep 2022; 12:6542. [PMID: 35449175 PMCID: PMC9023475 DOI: 10.1038/s41598-022-10399-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/24/2022] [Indexed: 11/09/2022] Open
Abstract
To determine whether intermittent exotropia (IXT) surgery affects contrast sensitivity (CS), this retrospective study evaluated the changes in monocular and binocular CS and the binocular summation ratio (BSR) quantified as the ratio between the values of the binocular and the better monocular CS score (BSR = binocular CS score/better monocular CS score) after surgery for IXT. The subjects were patients who had undergone IXT-correcting surgery with a postoperative follow-up of > 3 months and had pre- and postoperative records of Mars CS test scores. In total, 64 patients (128 eyes) were evaluated. Both the binocular and monocular CS scores of the operated eyes were significantly worse on postoperative 1 day than the preoperative scores, but they were recovered after 1 week. The monocular CS scores of the operated eyes were significantly worse than those of the non-operated eyes until 1 week. There was no significant difference in monocular CS scores between the one-muscle and two-muscle surgeries and in binocular CS scores between the successful alignment and overcorrection groups even on the first day after surgery. The mean BSR was significantly decreased until postoperative month 1, however, recovered to preoperative levels after month 3. In conclusion, IXT-correcting surgery may temporarily worsen the CS, but it is recovered to preoperative levels. Thus, changes in CS in the immediate postoperative period after strabismus surgery should not be of concern.
Collapse
Affiliation(s)
- Young Hwan Bae
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 665 Shiheongdae-ro, Seoul, 07442, South Korea
| | - Dong Gyu Choi
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 665 Shiheongdae-ro, Seoul, 07442, South Korea.
| |
Collapse
|
4
|
Xu M, Chen Y, Peng Y, He Z, Jiang J, Yu X, Hou F, Zhou J, Qu J. Binocular Summation Is Intact in Intermittent Exotropia After Surgery. Front Med (Lausanne) 2021; 8:791548. [PMID: 34993215 PMCID: PMC8724027 DOI: 10.3389/fmed.2021.791548] [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: 10/08/2021] [Accepted: 11/30/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: To determine binocular summation of surgically treated intermittent exotropia (IXT) patients by measuring the contrast threshold. Methods: We recruited 38 surgically treated IXT patients aged 8–24 years and 20 age-matched healthy controls. All participants had normal or corrected-to-normal visual acuity (Snellen ≥ 20/20) in both eyes. The IXT patients had undergone the surgery at least a year prior to the study. Twenty-one of them obtained good alignment and 17 experienced a recurrence of exotropia. We measured the observers' monocular and binocular contrast sensitivities (CS) at six spatial frequencies (1.5, 3, 6, 12, 18, 24 cycles/degree) as an index of visual information processing at the threshold level. Binocular summation was evaluated against a baseline model of simple probability summation based on the CS at each spatial frequency and the area under the log contrast sensitivity function (AULCSF). Results: The exo-deviation of IXTs with good alignment was −6.38 ± 3.61 prism diopters (pd) at 33 cm and −5.14 ± 4.07 pd at 5 m. For the patients with recurrence, it was −23.47 ± 5.53 pd and −21.12 ± 4.28 pd, respectively. There was no significant difference in the binocular summation ratio (BSR) between the surgically treated IXT patients, including those with good alignment and recurrence, and normal controls at each spatial frequency [F(2,55) = 0.416, P = 0.662] and AULCSF [F(2,55) = 0.469, P = 0.628]. In addition, the BSR was not associated with stereopsis (r = −0.151, P = 0.365). Conclusion: Our findings of normal contrast sensitivity binocular summation ratio in IXT after surgical treatment suggest that the ability of the visual cortex in processing binocular information is intact at the contrast threshold level.
Collapse
Affiliation(s)
- Meiping Xu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Yiya Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Yiyi Peng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Zhifen He
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Jun Jiang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Xinping Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Fang Hou
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Jiawei Zhou
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- *Correspondence: Jiawei Zhou
| | - Jia Qu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Jia Qu
| |
Collapse
|
5
|
Li Y, Ding J, Zhang W. Improvement of binocular summation in intermittent exotropia following successful postoperative alignment. Sci Rep 2021; 11:15584. [PMID: 34341420 PMCID: PMC8329255 DOI: 10.1038/s41598-021-95049-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 07/15/2021] [Indexed: 11/11/2022] Open
Abstract
To investigate the improvement of binocular summation (BiS) at high contrast (100%) and different low contrasts (10, 5 and 2.5%) in patients with intermittent exotropia (IXT) after successfully postoperative alignment. A total of 76 patients (aged 9–40 years) with IXT and poor control at distance before surgery were enrolled in this study. The postoperative deviations ranged between 4 PD esophoria to 10 PD exotropia in the primary position (at near and at distance) in all the enrolled patients. The follow-up visits were 2–3 months after the surgery. We analyzed preoperative and postoperative BiS and the proportions of patients with different BiS for the high contrast and the low contrasts. Binocular summation (BiS) was classified into three situations: binocular summation, equal and inbibition. The results of the distant random dots stereograph (RDS) were grouped into A, unable to recognize; B, moderate, 200″ ≤ RDS ≤ 400″ and C, good, RDS < 200″. Following the successful postoperative alignment, the proportion of patients with BiS were increased from 9.2 to 40.8%, 17.1 to 53.9%, 21.1 to 76.1% and 21.1 to 72.4% at 100%, 10%, 5% and 2.5% contrasts respectively. At 2.5% contrast, (1) more patients presented binocular summation in the groups B and C; (2) postoperative improvements of binocular visual acuity (BVA) in groups B (1.5 ± 1.03 lines) and C (1.57 ± 1.26 lines) were significantly different from the BVA in the group A (0.74 ± 1.00 line); and (3) in the group with central fusion, more patients presented BiS after surgery and the postoperative BVA improved by 1.43 ± 1.16 lines. Binocular summation for high contrast and different low contrasts can be improved in patients with IXT after successful surgical treatment. The improvement of BiS was associated with obtaining central fusion, recovering distant stereopsis and good alignment after the surgeries. The most significant improvement was shown at 2.5% contrast and was associated with good stereopsis and central fusion. The improvement of BiS, particularly at low contrast, has benefits for the daily activities in the real environment. BiS improvement could be used as a supplementary assessment of binocular function in patients with IXT before and after treatment.
Collapse
Affiliation(s)
- YuePing Li
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Vision Science, Affiliated Eye Hospital of NanKai University, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin, 300020, China.
| | - Juan Ding
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Vision Science, Affiliated Eye Hospital of NanKai University, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin, 300020, China
| | - Wei Zhang
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Vision Science, Affiliated Eye Hospital of NanKai University, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin, 300020, China
| |
Collapse
|
6
|
Choi WJ, Jang Y, Kim SJ, Jung JH. Investigation of transient eye closure evoked with bright light in the patients with intermittent exotropia. BMC Ophthalmol 2021; 21:291. [PMID: 34332561 PMCID: PMC8325830 DOI: 10.1186/s12886-021-02046-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to present a simple method for evaluating transient eye closure (TEC) evoked by bright light and find the agreement between TEC and photosensitivity. We also assessed the associated factors with TEC in the patients with intermittent exotropia (IXT). METHODS In this retrospective study, IXT patients were exposed to different brightness: darkness, low-intensity white light, and high-intensity white light using a near-infrared camera vision monitor system (Mon CV3, Metrovision, France). TEC was considered to be present if the subject closed his or her eyes immediately, and for more than half of the scotopic lid fissure distance in response to the high-intensity or low-intensity photopic stimulus of light, compared with lid fissure distance in the scotopic phase. We assessed the presence of photosensitivity using a questionnaire and evaluated the agreement between TEC and photosensitivity. We also investigated the sensory fusion, motor fusion, and pupil dynamic components for the existence of TEC in IXT patients. RESULTS Sixty-one patients with IXT were included. With the new method to evaluate TEC under different light intensities, 27 (44.3%) of the 61 IXT patients showed TEC, and 34 (55.7%) did not demonstrate TEC. TEC under high-intensity white light had a strong correlation with self-reporting photosensitivity (r = 0.77). The smaller angle of deviation at near was associated with the presence of TEC, with statistical significance (p = 0.04). Normal sensory status at a distance was significantly associated with TEC (p < 0.01). Multivariate analysis using multiple logistic regression analysis showed that normal sensory status was significantly associated with TEC (p = 0.02). CONCLUSIONS The test using a near-infrared camera vision monitor system was a simple and objective tool in identifying TEC evoked by bright light. The presence of TEC strongly correlated with self-reporting photosensitivity in patients with IXT. However, TEC may be an independent phenomenon with motor alignment, stereopsis, and pupil reflex pathway in patients with IXT.
Collapse
Affiliation(s)
- Won Jong Choi
- Department of Ophthalmology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, South Korea
| | - Yeonji Jang
- Department of Ophthalmology, Uijeongbu Eulji Medical Center and Eulji University, Uijeongbu, South Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, South Korea
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, South Korea.
| |
Collapse
|
7
|
Na JH, Lee SJ. Change in Contrast Sensitivity after Surgery for Consecutive Esotropia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.6.826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
8
|
Kwon JM, Lee SJ. Factors Affecting Contrast Sensitivity in Intermittent Exotropia. KOREAN JOURNAL OF OPHTHALMOLOGY 2020; 34:392-397. [PMID: 33099561 PMCID: PMC7597612 DOI: 10.3341/kjo.2020.0058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/30/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine whether contrast sensitivity (CS) can represent photophobia in intermittent exotropia (IXT) by comparing the CS test with and without glare stimulus, and to analyze the factors of IXT affecting CS. METHODS We retrospectively reviewed the medical records of 107 patients with basic-type IXT. We compared CS under mesopic and photopic conditions, with and without glare. We compared the difference in CS before and after glare (ΔCS) between mesopic and photopic conditions, and compared CS with glare between patients with and without photophobia. The correlations between the clinical features of IXT and CS were analyzed. RESULTS There was no significant reduction in CS at all spatial frequencies by glare stimulus. ΔCS was greater at high spatial frequencies under photopic conditions than under mesopic conditions. The group with subjective photophobia showed lower CS at 10.2 cpd under mesopic conditions with glare. CS showed a negative correlation with stereopsis under both mesopic and photopic conditions, and a positive correlation with fusional ability at low and intermediate spatial frequencies under mesopic conditions. ΔCS was smaller at intermediate spatial frequencies with better fusional ability, greater at high spatial frequencies with photophobia, and greater at intermediate spatial frequencies with a higher frequency of exotropia. CONCLUSIONS The CS test could not represent photophobia in IXT. However, CS tended to decrease with glare stimulus, and CS under mesopic conditions with glare was worse when accompanied by photophobia. Moreover, a poorer degree of stereopsis was associated with lower CS, and better fusional ability was associated with higher CS under mesopic conditions. Therefore, the CS test can be considered helpful in evaluating sensory function in IXT.
Collapse
Affiliation(s)
- Ji Min Kwon
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Soo Jung Lee
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|