1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
2
|
Schurr S, Foy C, Polonenko T, Scheiman M. Comparison of Visual Symptom Frequency and Occupational Issues Between Patients With and Without Concussion. Am J Occup Ther 2024; 78:7802180040. [PMID: 38422432 DOI: 10.5014/ajot.2024.050353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
IMPORTANCE Occupational therapy practitioners' knowledge of and advocacy for clients with visual symptoms postconcussion can have a considerable impact on recovery. OBJECTIVE To compare the frequency of vision symptoms and occupational performance deficits in a sample of participants with and without concussion. DESIGN Cross-sectional study. SETTING Sports medicine clinic. PARTICIPANTS Adolescents and adults with concussion (n = 20) and musculoskeletal injuries (n = 19). OUTCOMES AND MEASURES Measures included monocular amplitude of accommodation, near point of convergence, Binocular Vision Assessment (BVA) computerized screening for phoria, BVA computerized screening for fusional vergence, the Developmental Eye Movement Test, the Canadian Occupational Performance Measure, and the Convergence Insufficiency Symptom Survey-Concussion Version (CISS-CON). RESULTS We found significant differences between participants with and without concussion using the CISS-CON (p = .001), positive fusional vergence (p = .02), and near point of convergence (p = .02). Participants with concussion scoring above cutoffs on multiple measures reported poorer performance (p = .005) and satisfaction (p = .004) with valued occupations. CONCLUSIONS AND RELEVANCE Concussion has a detrimental effect on vision and occupation, and occupational therapy practitioners are well-positioned to assess and address issues arising from this relationship. Plain-Language Summary: Vision symptoms commonly experienced after a concussion are associated with reduced occupational performance and satisfaction and can have a considerable impact on recovery. Occupational therapy assessment for clients with concussion should include screening for vision difficulties.
Collapse
Affiliation(s)
- Stephanie Schurr
- Stephanie Schurr, OTD, OT Reg. (Ont.), is Clinical Manager, Physical Rehabilitation, St. Joseph's Care Group, Thunder Bay, Ontario, Canada;
| | - Caitlyn Foy
- Caitlyn Foy, DOT, MOTR/L, CLA, is Associate Professor, Occupational Therapy, Salus University, Elkins Park, PA
| | - Tanya Polonenko
- Tanya Polonenko, OD, FAAO, FCOVD, is Optometrist and Owner, Visual Sense Eye Care, Kitchener, Ontario, Canada
| | - Mitchell Scheiman
- Mitchell Scheiman, OD, PhD, FAAO, FCOVD, is Professor of Optometry and Dean of Biomedicine, Salus University, Elkins Park, PA
| |
Collapse
|
3
|
Grossman SN, Rucker JC. Opsoclonus and ocular flutter: evaluation and management. Curr Opin Ophthalmol 2023; 34:465-469. [PMID: 37603546 DOI: 10.1097/icu.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
PURPOSE OF REVIEW Opsoclonus and ocular flutter are saccadic intrusions characterized by spontaneous, back-to-back, fast eye movements (saccades) that oscillate about the midline of central visual fixation without intervening inter-saccadic intervals. When this type of movement occurs exclusively in the horizontal plane, it is called ocular flutter. When it occurs in multiple planes (i.e. horizontal, vertical, and torsional) it is called opsoclonus. The most common etiologic categories are parainfectious and paraneoplastic diseases. Less common are toxic-metabolic, traumatic, or idiopathic origins. The mechanism of these movements relates to dysfunction of brainstem and cerebellar machinery involved in the generation of saccades. In this review, we discuss the characteristics of opsoclonus and ocular flutter, describe approaches to clinical evaluation and management of the patient with opsoclonus and ocular flutter, and review approaches to therapeutic intervention. RECENT FINDINGS Recent publications demonstrated eye position-dependent opsoclonus present only in left gaze, which may be related to dysfunction of frontal eye fields or structures in the cerebellar vermis. SUMMARY Opsoclonus and ocular flutter originate from a broad array of neuropathologies and have value from both a neuroanatomic and etiologic perspective.
Collapse
Affiliation(s)
| | - Janet C Rucker
- Department of Neurology
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
4
|
Syeda SI, Kumar R, Jayaseelan XC, Vijayaraghavan R. A Comparative Study to Assess the Accommodation and Vergence Relationship of Myopia in Indian Adolescent. Ethiop J Health Sci 2023; 33:523-532. [PMID: 37576169 PMCID: PMC10416341 DOI: 10.4314/ejhs.v33i3.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/17/2023] [Indexed: 08/15/2023] Open
Abstract
Background Accommodation and Vergence disorder are diverse visual anomalies which can interfere with a child's school performance and impair one's ability to function efficiently. Its association with refractive error and its intervention were studied less in Indian myopia children; hence, there is a need for research in such setting. Method One hundred and fifty Indian adolescents aged 10 to 17 years were divided into three refractive error groups (high, moderate, and low myopia). Baseline vision examination and a comprehensive binocular vision assessment were performed on all eligible adolescents. Vision therapy was provided to participants whose parents gave consent on behalf of the children. Chi-square analysis was utilized to look at the association between the groups of refractive errors. To compare the mean constants of the experimental and control groups, a two-way RM ANOVA was performed. Results The most common dysfunction found in low myopia (75.3%), and moderate myopia (54%) was convergence insufficiency. High myopes (62.8%) were found to have combined convergence and accommodative insufficiency followed by accommodative dysfunction (14%) and basic exophoria (6%). In moderate myopia, a significant relationship was found between this dysfunction and refractive error. The experimental group in the overall sample showed statistically significant improvement after vision therapy (P<0.001), in comparison to the control group. Conclusion Refractive error is linked to accommodative and convergence insufficiency. Thus, vergence and accommodative impairment must be tested for all myopic children, and vision therapy should be advised along with spectacle prescription for efficient binocular vision.
Collapse
Affiliation(s)
- Sadiya Ikram Syeda
- Lecturer-Optometry, Department of Ophthalmology, Saveetha Medical College & Hospitals, Chennai, Tamil Nadu, India
| | - Radha Kumar
- Professor, Department of Paediatrics, Saveetha Medical College & Hospitals, Chennai, Tamil Nadu, India
| | - Xavier C Jayaseelan
- Professor, Department of Ophthalmology, Saveetha Medical College & Hospitals, Chennai, Tamil Nadu, India
| | - Rajagopalan Vijayaraghavan
- Director Research, Department of Research, Saveetha Medical College & Hospitals, Chennai, Tamil Nadu, India
| |
Collapse
|
5
|
Jenewein EC, Cotter S, Roberts T, Kulp M, Mitchell GL, Jones-Jordan LA, Chen AM, Hopkins K, Huang K, Amster D, Fecho G, Tyler J, Meiyeppen S, Scheiman M. Vergence/accommodative therapy for symptomatic convergence insufficiency in children: Time course of improvements in convergence function. Ophthalmic Physiol Opt 2023; 43:105-115. [PMID: 36271753 PMCID: PMC9798873 DOI: 10.1111/opo.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the time course of improvements in clinical convergence measures for children with symptomatic convergence insufficiency treated with office-based vergence/accommodative therapy. METHODS We evaluated convergence measures from 205, 9- to 14-year-old children with symptomatic convergence insufficiency randomised to office-based vergence/accommodative therapy in the Convergence Insufficiency Treatment Trial - Attention and Reading Trial (CITT-ART). Near-point of convergence (NPC) and near-positive fusional vergence (PFV) were measured at baseline and after 4, 8, 12 and 16 weeks of therapy; mean change in NPC and PFV between these time points were compared using repeated measures analysis of variance. Rates of change in NPC and PFV from: (1) baseline to 4 weeks and (2) 4-16 weeks were calculated. For each time point, the proportion of participants to first meet the normal criterion for NPC (<6 cm), PFV blur (break if no blur; >15Δ and >2 times the exodeviation) and convergence composite (NPC and PFV both normal) were calculated. RESULTS The greatest change in NPC and PFV (7.6 cm and 12.7 Δ) and the fastest rate of improvement in NPC and PFV (1.9 cm/week and 3.2 Δ/week, respectively) were both found during the first 4 weeks of therapy, with both slowing over the subsequent 12 weeks. After 12 weeks of therapy, the NPC, PFV and convergence composite were normal in 93.2%, 91.7% and 87.8% of participants, respectively, and normalised with another 4 weeks of therapy in 4.4%, 2.0% and 4.4% of participants, respectively. CONCLUSION Although the greatest improvements in NPC and PFV occurred in the first 4 weeks of therapy, most participants had weekly improvements over the subsequent 12 weeks of treatment. While most children with convergence insufficiency obtained normal convergence following 12 weeks of therapy, an additional 4 weeks of vergence/accommodative therapy may be beneficial for some participants.
Collapse
Affiliation(s)
- Erin C Jenewein
- Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania, USA
| | - Susan Cotter
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California, USA
| | - Tawna Roberts
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
| | - Marjean Kulp
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | - G Lynn Mitchell
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | | | - Angela M Chen
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California, USA
| | - Kristine Hopkins
- University of Alabama at Birmingham School of Optometry, Birmingham, Alabama, USA
| | - Kristine Huang
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California, USA
| | - Deborah Amster
- Nova Southeastern University College of Optometry, Ft. Lauderdale, Florida, USA
- SUNY College of Optometry, New York, New York, USA
| | - Gregory Fecho
- Nova Southeastern University College of Optometry, Ft. Lauderdale, Florida, USA
| | - Julie Tyler
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California, USA
- Nova Southeastern University College of Optometry, Ft. Lauderdale, Florida, USA
| | | | - Mitchell Scheiman
- Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania, USA
| |
Collapse
|
6
|
Lee SK, Lee MS. Ocular neuromyotonia: a review of diagnosis and treatment. Curr Opin Ophthalmol 2022; 33:465-470. [PMID: 35980029 DOI: 10.1097/icu.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The current review will cover the clinical presentation, causes, epidemiology, differential diagnoses, workup, and treatment of ocular neuromyotonia (ONM) in detail. RECENT FINDINGS While ONM largely remains a unilateral eye movement disease affecting adults with a history of sellar radiation, recent case reports highlight an expansion of this presentation to include bilateral, pediatric, and congenital cases. SUMMARY ONM is a rare but recognizable ocular motility disorder involving sustained contraction of the extraocular muscle, commonly resulting in intermittent diplopia. Diagnosis of ONM relies upon a thorough history and clinical exam, with particular attention to history of radiotherapy and eccentric gaze testing. Treatment with carbamazepine remains first-line therapy, although other membrane stabilizing agents and surgical interventions can be effective.
Collapse
Affiliation(s)
| | - Michael S Lee
- Departments of Ophthalmology, Neurology, and Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
7
|
Rovick LP. Evaluation and Management of Convergence Insufficiency in Adults. J Binocul Vis Ocul Motil 2022; 72:234-242. [PMID: 36279480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A search was performed of the literature published in peer-reviewed journals from disciplines related to eye care and rehabilitation between 2000 and 2022. The purpose was to discover new thinking on the topic of the evaluation and management of convergence insufficiency in adults. Ninety-one papers were reviewed and summarized. The etiology, identification, evaluation, and management of convergence insufficiency in this population, as reported in the literature, is presented in this paper. Many publications addressing rehabilitation after traumatic head injury addressed the management of convergence insufficiency. There was consensus in the importance of complete patient examination, to include a complete sensorimotor examination and careful refraction, prior to initiating any therapy. A chronic issue continues in the paucity of large, placebo-controlled studies to provide clear best practice for providers. Additionally, healthcare professionals from eye care and other professions are working with patients who have convergence insufficiency without significant interprofessional collaboration.
Collapse
Affiliation(s)
- Lisa P Rovick
- Interprofessional Education, St. Catherine University, St. Paul, Minnesota
| |
Collapse
|
8
|
Lorenzana IJ, Leske DA, Hatt SR, Dean TW, Jenewein EC, Dagi LR, Beal CJ, Pang Y, Retnasothie DV, Esposito CA, Erzurum SA, Aldrich AE, Crouch ER, Li Z, Kraker RT, Holmes JM, Cotter SA. Relationships among Clinical Factors and Patient-reported Outcome Measures in Adults with Convergence Insufficiency. Optom Vis Sci 2022; 99:692-701. [PMID: 35914096 PMCID: PMC9463113 DOI: 10.1097/opx.0000000000001929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE When exploring relationships among clinical measures and patient-reported outcome measures in adults with convergence insufficiency, worse symptoms (Convergence Insufficiency Symptom Survey [CISS] score) seemed to be correlated with worse reading function domain score (Adult Strabismus-20 quality-of-life questionnaire). After treatment, improved symptoms were associated with improved reading function quality of life. PURPOSE This study aimed to explore relationships between clinical measures and patient-reported outcome measures in adults undergoing treatment for symptomatic convergence insufficiency. METHODS In a prospective multicenter observational study, we evaluated adults with symptomatic convergence insufficiency (i.e., clinical measures of near exodeviation, receded near point of convergence, reduced near positive fusional vergence; CISS score ≥21). Fifty-seven participants treated with vision therapy/exercises (n = 35) or base-in prism (n = 22) were analyzed. Spearman correlation coefficients ( R ) were used to assess associations among the three clinical measures and patient-reported outcome measures (CISS, Diplopia Questionnaire, four Adult Strabismus-20 quality-of-life domains) before treatment (baseline) and after 10 weeks and 1 year. Associations were interpreted to be present when the lower limit of the 95% confidence interval (CI) was moderate to strong ( R ≥ 0.4). RESULTS Among multiple exploratory analyses, the only moderate to strong baseline correlation was between worse CISS and worse Adult Strabismus-20 reading function scores ( R = 0.62; 95% CI, 0.43 to 0.76). Regarding change in measures with treatment, the only moderate to strong correlations were between improved CISS and improved Adult Strabismus-20 reading function scores for prism at 10 weeks ( R = 0.78; 95% CI, 0.52 to 0.91) and 1 year ( R = 0.85; 95% CI, 0.65 to 0.94) and for vision therapy/exercises at 1 year ( R = 0.78; 95% CI, 0.57 to 0.89). CONCLUSIONS In exploratory analyses, we found positive correlations between CISS symptom scores and reading function quality-of-life scores. The absence of correlations between symptoms and individual clinical measures is consistent with clinical experience that, in convergence insufficiency, symptoms and clinical findings can be discordant.
Collapse
Affiliation(s)
| | | | | | | | | | - Linda R Dagi
- Boston Children's Hospital, Boston, Massachusetts
| | | | - Yi Pang
- Ticho Eye Associates, Chicago Ridge, Illinois
| | - Dashaini V Retnasothie
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California
| | | | | | | | - Eric R Crouch
- Virginia Pediatric Eye Center, Virginia Beach, Virginia
| | - Zhuokai Li
- Jaeb Center for Health Research, Tampa, Florida
| | | | | | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California
| |
Collapse
|
9
|
Chang MY, Morrison DG, Binenbaum G, Heidary G, Trivedi RH, Galvin JA, Pineles SL. Home- and Office-Based Vergence and Accommodative Therapies for Treatment of Convergence Insufficiency in Children and Young Adults: A Report by the American Academy of Ophthalmology. Ophthalmology 2021; 128:1756-1765. [PMID: 34172337 DOI: 10.1016/j.ophtha.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/14/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To review home- and office-based vergence and accommodative therapies for treatment of convergence insufficiency (CI) in children and young adults up to 35 years of age. METHODS Literature searches were conducted through October 2020 in the PubMed database for English-language studies. The combined searches yielded 359 abstracts, of which 37 were reviewed in full text. Twelve of these were considered appropriate for inclusion in this assessment and assigned a level of evidence rating by the panel methodologist. RESULTS Of the 12 studies included in this assessment, 8 were graded as level I evidence, 2 were graded as level II evidence, and 2 were graded as level III evidence. Two of the level I studies included older teenagers and young adults; the remainder of the studies exclusively evaluated children. Two randomized controlled trials found that office-based vergence and accommodative therapies were effective in improving motor outcomes in children with symptomatic CI. However, the studies reported conflicting results on the efficacy of office-based therapy for treating symptoms of CI. Data were inconclusive regarding the effectiveness of home-based therapies (including pencil push-ups and home computer therapy) compared with home placebo. In young adults, office-based vergence and accommodative therapies were not superior to placebo in relieving symptoms of CI. CONCLUSIONS Level I evidence suggests that office-based vergence and accommodative therapies improve motor outcomes in children with symptomatic CI, although data are inconsistent regarding symptomatic relief. Evidence is insufficient to determine whether home-based therapies are effective.
Collapse
Affiliation(s)
- Melinda Y Chang
- Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - David G Morrison
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gil Binenbaum
- Department of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rupal H Trivedi
- Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer A Galvin
- Eye Physicians and Surgeons PC, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | | |
Collapse
|
10
|
CITT-ART Investigator Group. Effect of Vergence/Accommodative Therapy on Attention in Children with Convergence Insufficiency: A Randomized Clinical Trial. Optom Vis Sci 2021; 98:222-33. [PMID: 33771952 DOI: 10.1097/OPX.0000000000001659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE The results of this study suggest that clinicians providing vergence/accommodative therapy for convergence insufficiency in children should not suggest that such treatment will lead to improvements in attention when compared with placebo treatment. PURPOSE This study aimed to compare the effects of 16 weeks of vergence/accommodative therapy and placebo therapy on changes in attention for children in the Convergence Insufficiency Treatment Trial-Attention and Reading Trial. METHODS Three hundred ten children 9 to 14 years old with convergence insufficiency were assigned to receive treatment with office-based vergence/accommodative therapy or placebo therapy. Attention tests were administered at baseline and after 16 weeks of treatment. The primary measure of attention was the Strengths and Weaknesses of Attention-Deficit/Hyperactivity Disorder Symptoms and Normal Behavior (SWAN) scale. Other measures included the Swanson, Nolan, and Pelham checklist; the Homework Problems Checklist; and the d2 Test of Attention. Within and between-group differences are reported using Cohen d effect sizes. RESULTS For the SWAN, there was no significant difference between the groups for the inattention scale parental report (d = 0.036; 95% confidence interval, -0.21 to 0.28) or for the hyperactivity impulsivity scale parental report (d = -0.003; 95% confidence interval, -0.24 to 0.24). Similar results were found for teacher reports and the secondary measures (d estimates from -0.97 to +0.10). There were, however, large within-group changes with d ≥ 1 in both treatment groups for the SWAN, the Homework Problems Checklist, and the d2 Test of Attention. CONCLUSIONS These results suggest that vergence/accommodative therapy is no better than placebo therapy in improving attention. Large improvements in inattention, completing homework, and selective and sustained attention were found in each group. However, these improvements cannot be attributed to improvements in vergence and accommodation and are likely due to nonspecific effects of an intensive therapy regimen.
Collapse
|
11
|
Scaramuzzi M, Murray J, Nucci P, Shaikh AG, Ghasia FF. Fixational eye movements abnormalities and rate of visual acuity and stereoacuity improvement with part time patching. Sci Rep 2021; 11:1217. [PMID: 33441575 PMCID: PMC7806581 DOI: 10.1038/s41598-020-79077-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/03/2020] [Indexed: 11/09/2022] Open
Abstract
Residual amblyopia is seen in 40% of amblyopic patients treated with part-time patching. Amblyopic patients with infantile onset strabismus or anisometropia can develop fusion maldevelopment nystagmus syndrome (FMNS). The purpose of this study was to understand the effects of presence of FMNS and clinical subtype of amblyopia on visual acuity and stereo-acuity improvement in children treated with part-time patching. Forty amblyopic children who had fixation eye movement recordings and at least 12 months of follow-up after initiating part-time patching were included. We classified amblyopic subjects per the fixational eye movements characteristics into those without any nystagmus, those with FMNS and patients with nystagmus without any structural anomalies that do not meet the criteria of FMNS or idiopathic infantile nystagmus. We also classified the patients per the clinical type of amblyopia. Patching was continued until amblyopia was resolved or no visual acuity improvement was noted at two consecutive visits. Children with anisometropic amblyopia and without FMNS have a faster improvement and plateaued sooner. Regression was only seen in patients with strabismic/mixed amblyopia particularly those with FMNS. Patients with FMNS had improvement in visual acuity but poor stereopsis with part-time patching and required longer duration of treatment.
Collapse
Affiliation(s)
- Matteo Scaramuzzi
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Neuroscience, Unit of Ophthalmology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- DISCCO, University of Milan, Milan, Italy
| | - Jordan Murray
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Aasef G Shaikh
- Daroff-Dell'Osso Ocular Motility Laboratory, Cleveland, OH, USA
- Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Fatema F Ghasia
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
- Case Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| |
Collapse
|
12
|
Chen AM, Roberts TL, Cotter SA, Kulp MT, Sinnott LT, Borsting EJ, Tea YC, Jones-Jordan LA, Hertle R, Mitchell GL, Arnold LE, Chase C, Scheiman MM. Effectiveness of vergence/accommodative therapy for accommodative dysfunction in children with convergence insufficiency. Ophthalmic Physiol Opt 2021; 41:21-32. [PMID: 33119180 PMCID: PMC10545079 DOI: 10.1111/opo.12747] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/04/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To determine the effectiveness of office-based vergence/accommodative therapy for improving accommodative amplitude and accommodative facility in children with symptomatic convergence insufficiency and accommodative dysfunction. METHODS We report changes in accommodative function following therapy among participants in the Convergence Insufficiency Treatment Trial - Attention and Reading Trial with decreased accommodative amplitude (115 participants in vergence/accommodative therapy; 65 in placebo therapy) or decreased accommodative facility (71 participants in vergence/accommodative therapy; 37 in placebo therapy) at baseline. The primary analysis compared mean change in amplitude and facility between the vergence/accommodative and placebo therapy groups using analyses of variance models after 4, 8, 12 and 16 weeks of treatment. The proportions of participants with normal amplitude and facility at each time point were calculated. The average rate of change in amplitude and facility from baseline to week 4, and from weeks 4 to 16, were determined in the vergence/accommodative therapy group. RESULTS From baseline to 16 weeks, the mean improvement in amplitude was 8.6 dioptres (D) and 5.2 D in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 3.5 D, 95% confidence interval (CI): 1.5 to 5.5 D; p = 0.01). The mean improvement in facility was 13.5 cycles per minute (cpm) and 7.6 cpm in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 5.8 cpm, 95% CI: 3.8 to 7.9 cpm; p < 0.0001). Significantly greater proportions of participants treated with vergence/accommodative therapy achieved a normal amplitude (69% vs. 32%, difference = 37%, 95% CI: 22 to 51%; p < 0.0001) and facility (85% vs. 49%, difference = 36%, 95% CI: 18 to 55%; p < 0.0001) than those who received placebo therapy. In the vergence/accommodative therapy group, amplitude increased at an average rate of 1.5 D per week during the first 4 weeks (p < 0.0001), then slowed to 0.2 D per week (p = 0.002) from weeks 4 to 16. Similarly, facility increased at an average rate of 1.5 cpm per week during the first 4 weeks (p < 0.0001), then slowed to 0.6 cpm per week from weeks 4 to 16 (p < 0.0001). CONCLUSION Office-based vergence/accommodative therapy is effective for improving accommodative function in children with symptomatic convergence insufficiency and coexisting accommodative dysfunction.
Collapse
Affiliation(s)
- Angela M. Chen
- Southern California College of Optometry at Marshall B. Ketchum University, CA
| | - Tawna L. Roberts
- Department of Ophthalmology, Stanford University School of Medicine, CA
| | - Susan A. Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, CA
| | | | | | - Eric J. Borsting
- Southern California College of Optometry at Marshall B. Ketchum University, CA
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Scheiman MM, Alvarez TL, Cotter SA, Kulp MT, Sinnott LT, Plaumann MD, Jhajj J. Negative Fusional Vergence Is Abnormal in Children with Symptomatic Convergence Insufficiency. Optom Vis Sci 2021; 98:32-40. [PMID: 33394929 PMCID: PMC7789288 DOI: 10.1097/opx.0000000000001626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
SIGNIFICANCE Deficits of disparity divergence found with objective eye movement recordings may not be apparent with standard clinical measures of negative fusional vergence (NFV) in children with symptomatic convergence insufficiency. PURPOSE This study aimed to determine whether NFV is normal in untreated children with symptomatic convergence insufficiency and whether NFV improves after vergence/accommodative therapy. METHODS This secondary analysis of NFV measures before and after office-based vergence/accommodative therapy reports changes in (1) objective eye movement recording responses to 4° disparity divergence step stimuli from 12 children with symptomatic convergence insufficiency compared with 10 children with normal binocular vision (NBV) and (2) clinical NFV measures in 580 children successfully treated in three Convergence Insufficiency Treatment Trial studies. RESULTS At baseline, the Convergence Insufficiency Treatment Trial cohort's mean NFV break (14.6 ± 4.8Δ) and recovery (10.6 ± 4.2Δ) values were significantly greater (P < .001) than normative values. The post-therapy mean improvements for blur, break, and recovery of 5.2, 7.2, and 1.3Δ, respectively, were statistically significant (P < .0001). Mean pre-therapy responses to 4° disparity divergence step stimuli were worse in the convergence insufficiency group compared with the NBV group for peak velocity (P < .001), time to peak velocity (P = .01), and response amplitude (P < .001). After therapy, the convergence insufficiency group showed statistically significant improvements in mean peak velocity (11.63°/s; 95% confidence interval [CI], 6.6 to 16.62°/s), time to peak velocity (-0.12 seconds; 95% CI, -0.19 to -0.05 seconds), and response amplitude (1.47°; 95% CI, 0.83 to 2.11°), with measures no longer statistically different from the NBV cohort (P > .05). CONCLUSIONS Despite clinical NFV measurements that seem greater than normal, children with symptomatic convergence insufficiency may have deficient NFV when measured with objective eye movement recordings. Both objective and clinical measures of NFV can be improved with vergence/accommodative therapy.
Collapse
Affiliation(s)
- Mitchell M Scheiman
- Pennsylvania College of Optometry at Salus University, Elkins Park, Pennsylvania
| | - Tara L Alvarez
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey
| | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California
| | - Marjean T Kulp
- The Ohio State University College of Optometry, Columbus, Ohio
| | | | | | - Jasleen Jhajj
- Nova Southeastern University, College of Optometry, Ft. Lauderdale, Florida
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Affiliation(s)
- David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain; Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain.
| |
Collapse
|
16
|
Alvarez TL, Scheiman M, Santos EM, Morales C, Yaramothu C, D’Antonio-Bertagnolli JV, Biswal BB, Gohel S, Li X. The Convergence Insufficiency Neuro-mechanism in Adult Population Study (CINAPS) Randomized Clinical Trial: Design, Methods, and Clinical Data. Ophthalmic Epidemiol 2020; 27:52-72. [PMID: 31640452 PMCID: PMC6944764 DOI: 10.1080/09286586.2019.1679192] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/17/2019] [Accepted: 10/07/2019] [Indexed: 01/28/2023]
Abstract
Purpose: To describe the design and methodology of the Convergence Insufficiency Neuro-mechanism in Adult Population Study (CINAPS), the first randomized clinical trial (RCT) studying young adults with symptomatic convergence insufficiency (CI) using a combination of traditional clinical tests, objective eye movement recordings, and functional brain activities as outcome measures.Methods: In this double-masked RCT, binocularly normal controls (BNC) (N = 50) and CI patients (N = 50) are randomized into office-based vergence/accommodative therapy (OBVAT) or office-based placebo therapy (OBPT). Outcome measures included clinical signs and symptoms, phoria adaptation, forced fixation disparity curves, binocular rivalry, vergence and saccadic objective eye movements, and task-induced functional brain activities. This study is registered on ClinicalTrials.gov NCT03593031.Results: No significant baseline differences are observed between the BNC (p > .4) or CI (p > .3) participants assigned to OBVAT or OBPT for age, near point of convergence (NPC), positive fusional vergence (PFV), phoria at distance and near, amplitude of accommodation, or the Convergence Insufficiency Symptom Survey (CISS). Significant differences are observed between the CI and BNC cohorts at baseline measurements for NPC, PFV, difference in phoria from far to near, amplitude of accommodation, and CISS (p < .001). For the CI patients, 26% had a comorbidity of accommodation insufficiency, and 16% self-reported ADHD.Conclusion: Features of the study design include the following: standardized diagnostic and office-based therapeutic intervention, placebo treatment arm, masked clinical outcome examinations, objective eye movement recordings, functional imaging, phoria adaptation, fixation disparity curves and binocular rivalry measurements.
Collapse
Affiliation(s)
- Tara L. Alvarez
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
| | - Mitchell Scheiman
- Pennsylvania College of Optometry, Salus University, Elkins Park, USA
| | - Elio M. Santos
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
| | - Cristian Morales
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
| | - Chang Yaramothu
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
| | | | - Bharat B. Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
| | - Suril Gohel
- Department of Health Informatics, Rutgers University School of Health Professions, Newark, USA
| | - Xiaobo Li
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
| |
Collapse
|
17
|
Effect of Vergence/Accommodative Therapy on Reading in Children with Convergence Insufficiency: A Randomized Clinical Trial. Optom Vis Sci 2019; 96:836-849. [PMID: 31651592 PMCID: PMC6855328 DOI: 10.1097/opx.0000000000001442] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/14/2018] [Accepted: 07/29/2019] [Indexed: 01/02/2023] Open
Abstract
SIGNIFICANCE The results of this study suggest that clinicians providing vergence/accommodative therapy for the treatment of childhood convergence insufficiency should not suggest that such treatment, on average, will lead to improvements on standardized assessments of reading performance after 16 weeks of treatment. PURPOSE The purpose of this study was to determine the effect of office-based vergence/accommodative therapy on reading performance in 9- to 14-year-old children with symptomatic convergence insufficiency. METHODS In a multicenter clinical trial, 310 children 9 to 14 years old with symptomatic convergence insufficiency were randomized in a 2:1 ratio to 16 weeks of office-based vergence/accommodative therapy or office-based placebo therapy, respectively. The primary outcome was change in reading comprehension as measured by the reading comprehension subtest of the Wechsler Individual Achievement Test, Third Edition (WIAT-III) at the 16-week outcome. Secondary reading outcomes of word identification, reading fluency, listening comprehension, comprehension of extended text, and reading comprehension were also evaluated. RESULTS The adjusted mean improvement in WIAT-III reading comprehension was 3.7 (95% confidence interval [CI], 2.6 to 4.7) standard score points in the vergence/accommodative therapy group and 3.8 (95% CI, 2.4 to 5.2) points in the placebo therapy group, with an adjusted mean group difference of -0.12 (95% CI, -1.89 to 1.66) points that was not statistically significant. No statistically significant treatment group differences were found for any of the secondary reading outcome measures. CONCLUSIONS For children aged 9 to 14 years with symptomatic convergence insufficiency, office-based vergence/accommodative therapy was no more effective than office-based placebo therapy for improving reading performance on standardized reading tests after 16 weeks of treatment.
Collapse
|
18
|
Abstract
Multiple sclerosis can give rise to signs and symptoms from the entire nervous system, including visual impairments. Visual impairments often go unreported because they are not obvious to patients, which means that doctors must ask about them specifically. Regular monitoring of vision is important, however, to provide personalised rehabilitation and assistive technologies, and thereby improve patients’ functioning and quality of life.
Collapse
|
19
|
Al Jabri S, Kirkham J, Rowe FJ. Development of a core outcome set for amblyopia, strabismus and ocular motility disorders: a review to identify outcome measures. BMC Ophthalmol 2019; 19:47. [PMID: 30736755 PMCID: PMC6368710 DOI: 10.1186/s12886-019-1055-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 01/29/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Core Outcome Sets (COS) are defined as the minimum sets of outcomes that should be measured and reported in all randomised controlled trials to facilitate combination and comparability of research. The aim of this review is to produce an item bank of previously reported outcome measures from published studies in amblyopia, strabismus and ocular motility disorders to initiate the development of COS. METHODS A review was conducted to identify articles reporting outcome measures for amblyopia, strabismus and ocular motility disorders. Using systematic methods according to the COMET handbook we searched key electronic bibliographic databases from 1st January 2011 to 27th September 2016 using MESH terms and alternatives indicating the different subtypes of amblyopia, strabismus and ocular motility disorders in relation to treatment outcomes and all synonyms. We included Cochrane reviews, other systematic reviews, controlled trials, non-systematic reviews and retrospective studies. Data was extracted to tabulate demographics of included studies, primary and secondary outcomes, methods of measurement and their time points. RESULTS A total of 142 studies were included; 42 in amblyopia, 33 in strabismus, and 68 in ocular motility disorders (one study overlap between amblyopia and strabismus). We identified ten main outcome measure domains for amblyopia, 14 for strabismus, and ten common "visual or motility" outcome measure domains for ocular motility disorders. Within the domains, we found variable nomenclature being used and diversity in methods and timings of measurements. CONCLUSION This review highlights discrepancies in outcome measure reporting within published literature for amblyopia, strabismus and ocular motility and it generated an item bank of the most commonly used and reported outcome measures for each of the three conditions from recent literature to start the process of COS development. Consensus among all stakeholders including patients and professionals is recommended to establish a useful COS.
Collapse
Affiliation(s)
- Samia Al Jabri
- Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 2nd Floor, 1-3 Brownlow Street, L69 3GL Liverpool, UK
| | - Jamie Kirkham
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Fiona J. Rowe
- Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 2nd Floor, 1-3 Brownlow Street, L69 3GL Liverpool, UK
| |
Collapse
|
20
|
Kudo Y, Sugawara E, Takahashi K, Tanaka F, Johkura K. An attempt to treat ocular flutter and opsoclonus by cerebellar magnetic stimulation. J Neurol Sci 2018; 395:119-120. [PMID: 30312902 DOI: 10.1016/j.jns.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/18/2018] [Accepted: 10/03/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Yosuke Kudo
- Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Eriko Sugawara
- Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Koji Takahashi
- Department of Clinical Laboratory, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ken Johkura
- Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan.
| |
Collapse
|
21
|
Henze T, Feneberg W, Flachenecker P, Seidel D, Albrecht H, Starck M, Meuth SG. [New aspects of symptomatic MS treatment: Part 4-sexual dysfunction and eye movement disorders]. Nervenarzt 2018; 89:193-197. [PMID: 29079866 DOI: 10.1007/s00115-017-0441-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The symptomatic treatment of multiple sclerosis (MS) is nowadays of similar importance as immunotherapy within a comprehensive treatment concept of this chronic disease. It makes a considerable contribution to the reduction of disabilities in activities of daily living as well as social and occupational life. Moreover, symptomatic treatment is of great importance for amelioration of the quality of life. Since our last survey of symptomatic MS treatment in 2004 and publication of the guidelines of the German Neurological Society and the Clinical Competence Network Multiple Sclerosis (Klinisches Kompetenznetz Multiple Sklerose, KKNMS) in 2014, several developments within the topics of mobility, bladder and sexual function, vision, fatigue, cognition and rehabilitation have taken place. These new findings together with further aspects of disease measurement methods and overall treatment strategies of the respective symptoms as well as treatment goals are introduced in several individual contributions. In this article the symptoms of sexual dysfunction and eye movement disorders are discussed.
Collapse
Affiliation(s)
- T Henze
- Praxisgemeinschaft für Neurologie, Psychiatrie, Psychotherapie, Günzstr. 1, 93059, Regensburg, Deutschland.
| | - W Feneberg
- Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gemeinnützige GmbH, Berg, Deutschland
| | - P Flachenecker
- Neurologisches Rehabilitationszentrum Quellenhof, Bad Wildbad, Deutschland
| | | | - H Albrecht
- Praxis für Neurologie, München, Deutschland
| | - M Starck
- Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gemeinnützige GmbH, Berg, Deutschland
| | - S G Meuth
- Department für Neurologie und Institut für Translationale Neurologie, Klinik für Allgemeine Neurologie, Universitätsklinikum, Münster, Deutschland
| |
Collapse
|
22
|
|
23
|
Nakamagoe K, Nohara S, Takahashi Y, Takiguchi M, Kawakami R, Koganezawa T, Tamaoka A. The Successful Application of Plasmapheresis in the Treatment of a Patient with Opsoclonus and Autoantibodies to Glutamate Receptor δ2. Intern Med 2017; 56:2773-2778. [PMID: 28924105 PMCID: PMC5675942 DOI: 10.2169/internalmedicine.6771-15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Glutamate receptor δ2 (GluRδ2) is expressed in the neuronal postsynaptic densities at the junctions between the Purkinje cells and the parallel fibers. Recent reports have described patients with opsoclonus who possess anti-GluRδ2 antibodies. We report the case of a 53-year-old man with opsoclonus whose cerebrospinal fluid was positive for anti-GluRδ2 antibodies. Electronystagmography revealed abnormal sinusoidal eye movements, which were definitively identified as opsoclonus. The frequency and amplitude of saccadic oscillations diminished after plasmapheresis (PE). The patient's opsoclonus was altered after PE, suggesting that anti-GluRδ2 antibodies may act on the saccade generator in the brainstem via the cerebellum and that they may be involved in the onset of opsoclonus.
Collapse
Affiliation(s)
- Kiyotaka Nakamagoe
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Seitaro Nohara
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Yukitoshi Takahashi
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Japan
| | - Mao Takiguchi
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Rio Kawakami
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Tadachika Koganezawa
- Department of Physiology, Division of Biomedical Science, Faculty of Medicine, University of Tsukuba, Japan
| | - Akira Tamaoka
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
| |
Collapse
|
24
|
Singh NK, Mani R, Hussaindeen JR. Changes in stimulus and response AC/A ratio with vision therapy in Convergence Insufficiency. J Optom 2017; 10:169-175. [PMID: 28126262 PMCID: PMC5484784 DOI: 10.1016/j.optom.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/25/2016] [Accepted: 10/03/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE To evaluate the changes in the stimulus and response Accommodative Convergence to Accommodation (AC/A) ratio following vision therapy (VT) in Convergence Insufficiency (CI). METHODS Stimulus and response AC/A ratio were measured on twenty five CI participants, pre and post 10 sessions of VT. Stimulus AC/A ratio was measured using the gradient method and response AC/A ratio was calculated using modified Thorington technique with accommodative responses measured using WAM-5500 open-field autorefractor. The gradient stimulus and response AC/A cross-link ratios were compared with thirty age matched controls. RESULTS Mean age of the CI and control participants were 23.3±5.2 years and 22.7±4.2 years, respectively. The mean stimulus and response AC/A ratio for CI pre therapy was 2.2±0.72 and 6.3±2.0 PD/D that changed to 4.2±0.9 and 8.28±3.31 PD/D respectively post vision therapy and these changes were statistically significant (paired t-test; p<0.001). The mean stimulus and response AC/A ratio for controls was 3.1±0.81 and 8.95±2.5 PD/D respectively. CONCLUSIONS Stimulus and response AC/A ratio increased following VT, accompanied by clinically significant changes in vergence and accommodation parameters in subjects with convergence insufficiency. This represents the plasticity of the AC/A crosslink ratios that could be achieved with vision therapy in CI.
Collapse
Affiliation(s)
- Neeraj Kumar Singh
- Srimathi Sundari Subramanian Department of Visual Psychophysics, Elite School of Optometry, Chennai, India(1)
| | - Revathy Mani
- Binocular Vision and Vision Therapy Clinic, Sankara Nethralaya, Chennai, India
| | - Jameel Rizwana Hussaindeen
- Srimathi Sundari Subramanian Department of Visual Psychophysics, Elite School of Optometry, Chennai, India(1); Binocular Vision and Vision Therapy Clinic, Sankara Nethralaya, Chennai, India.
| |
Collapse
|
25
|
Krásný J. [Brown´s Syndrome: the Various forms and Their Treatment (Including an Expander own Design)]. Cesk Slov Oftalmol 2017; 73:146-154. [PMID: 29589462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM Familiar with the treatment of various forms of Browns syndrome and its success. To document preparation of the expander own design. MATERIAL AND METHODS In the years 1996-2016 was operated 33 pacients with congenital Browns syndrome by using an extension of its tendon expander at the Eye Clinic of the University Hospital Vinohrady in Prague. Author proves photographs preparing expander own design and modified surgical technique. It was also operated on 10 patients for accompanying Y-exotropia. Eleven patients with acute form of Brown´s syndrome in the pulley of upper oblique muscle applied Betamethasoni. RESULTS The using expander own design - non-resorbable Ethibond 5-0 cauted silicone cannula - held at congenital form of Browns syndrome, without a weighty complication or its exclusion in the period. The result of the performance was determined age of patients at the time of implantation of the expander. Preschoolers postoperative condition was fully compliant, this expander standardized vertical mobility. The vertical alignment motility is reduced with advancing age, especially in adulthood. Optimal surgical procedures at Y-exotropia were antepozice with recession of the inferior oblique muscle possibly supplemented by retroposition ipsilateral external rectus. The application efficiency of Betamethasoni for acute form of Brown´s syndrome in the pulley of upper oblique muscle was successful in only two weeks after the initial symptoms vertical diplopia. CONCLUSION Expander own design which represented non-resorbable Ethibond cauted silicone cannula was very effective in dealing with congenital form of Browns syndrome. The application of glucocorticoids in the pulley of upper oblique muscle should always be a quantity result.Key words: Browns syndrome, Betamethasoni, expander, Ethibond, silicone cannula, Y - exotropia.
Collapse
|
26
|
Veselý P, Spurná G, Hanák L, Synek S. [Disorders of Simple Binocular Vision in Heterophoria and their Spectacle Correction]. Cesk Slov Oftalmol 2016; 72:223-225. [PMID: 28229606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study deals with evaluation of binocular vision in group of young subjects without eye pathology. We examined at whole 68 subjects with average age 26 years, median 24 years. The sample was divided into two main groups. Group A contains subjects with far and near ortophoria (at whole 26 subjects = 38 %). Group B contains subjects with binocular vision disorder (at whole 42 subjects). One subject had strabismus. The most frequent non-strabismus disorder of binocular vision was convergence insufficiency (13 subjects = 19 %), simple esophoria (12 subjects = 17 %) and simple exophoria (8 subjects = 12 %). We decreased average distance heterophoria value (from 1.02 to 0.36 cm/m esophoria) and near heterophoria value (from 0.60 to 0.31 cm/m exophoria) after proper sphere-cylindrical correction. Result of our study shows that adequate and actual sphere-cylindrical correction can reduce disorder of simple binocular vision.Key words: simple binocular vision, heterophoria, spectacle lenses, convergence insufficiency.
Collapse
|
27
|
Ueda T. [A case of opsoclonus due to diphenhydramine overdose in which ECG change could be used to predict convulsion]. Chudoku Kenkyu 2014; 27:216-218. [PMID: 27526516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
28
|
Affiliation(s)
- Nicholas R Plummer
- Acute Stroke Unit, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| | - Thomas Thorp
- Acute Stroke Unit, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| | - Sulaiman Sultan
- Acute Stroke Unit, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| |
Collapse
|
29
|
Abstract
BACKGROUND AND PURPOSE To conduct a retrospective study to investigate the causes of acquired superior oblique dysfunction, excluding paralysis, in a consecutive series of adult patients and to compare presenting symptoms and clinical findings. METHODS A retrospective review of all adult patients with superior oblique dysfunction between the ages of 18 and 80 who met the study profile was conducted at Saint Louis University Medical Center between January 2000 and April 2012. The presenting symptoms, clinical findings, and treatment course for each patient was recorded. The study was approved by the Institutional Review Board of our institution. RESULTS Acquired forms of nonparalytic superior oblique dysfunction were identified in forty-eight patients. These included superior oblique myokymia (twenty-three patients), superior oblique click syndrome or variable Brown syndrome (nine), canine tooth syndrome (five), spontaneous acquired Brown syndrome (four), iatrogenic or traumatic Brown syndrome (four), and ocular neuromyotonia affecting the superior oblique (three). CONCLUSIONS Several nonparalytic entities were identified that caused superior oblique dysfunction. Clinical findings may be similar despite entirely different mechanisms. Subjective symptoms may be difficult for the patient to describe or for the examiner to elicit on the day of the examination. Specific techniques can be used in eliciting, differentiating, and documenting the conditions. These included trochlear palpation, modified head tilt technique, interpretation of torsion, and Hess charts.
Collapse
|
30
|
Pitz S, Jordan B, Zierz S. [Reply]. Ophthalmologe 2013; 110:1202. [PMID: 24482815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
31
|
Abstract
BACKGROUND AND PURPOSE Orthoptic exercises are routinely prescribed to treat symptoms of convergence insufficiency (CI). The type and duration of treatment tends to vary among providers as until recently, few strong randomized control studies have addressed the efficacy of convergence insufficiency management. The aim of this paper is to address these studies and discuss their limitations. METHODS A review of the literature pertaining to convergence insufficiency was conducted. Articles relevant to the treatment of this disorder were analyzed, and those with adequate studies pertaining to CI treatment methods were included. RESULTS There are limited randomized control trials evaluating the effectiveness of vision therapy, and those that do exist have limitations: small patient populations, differing outcome measures, treatment length and intensity, and placebo effects, which are all confounding factors when assessing the validity of the current studies. CONCLUSION Despite the prevalence of convergence insufficiency, the known efficacy of vision therapy remains somewhat questionable. There is evidence to suggest that some form of therapy is effective in reducing symptoms and clinical findings of convergence insufficiency, but there is a lack of equal comparison in order to conclude which forms of treatment are best.
Collapse
|
32
|
Coetzee D, Pienaar AE. The effect of visual therapy on the ocular motor control of seven- to eight-year-old children with developmental coordination disorder (DCD). Res Dev Disabil 2013; 34:4073-4084. [PMID: 24055711 DOI: 10.1016/j.ridd.2013.08.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 08/20/2013] [Indexed: 06/02/2023]
Abstract
The aims of this study were to determine the extent of ocular, motor control problems and the effect of visual therapy on such problems, among seven- to eight-year-old children diagnosed with DCD. Thirty-two, children with a mean age of 95.66 months (SD ± 3.54) participated in the study. The MABC was used to classify children into DCD categories (<15th, percentile) while the Sensory Input Systems Screening Test and QNST-II, were used to evaluate ocular motor control. A two-group pre-test-post-test, cross-over design was followed with a retention test two years, thereafter to determine the lasting effect of the visual therapy, intervention. The 18-week visual therapy programme was executed once a week, for 40 min during school hours, after which the two groups were, crossed over. Percentages of ocular motor control problems ranging, between 6.25% and 93.75% were found in both the groups before participating, in the visual therapy programme, with the highest percentage problems found, in visual pursuit with the left eye. Visual therapy contributed to a, significant improvement of 75-100% in visual pursuit, fixation, ocular, alignment and convergence, with significant lasting effects (p<0.001). Visual therapy is recommended for children with DCD experiencing poor, ocular motor control.
Collapse
Affiliation(s)
- Dané Coetzee
- Physical Activity, Sport and Recreation, Faculty Health Sciences, North-West University, Potchefstroom, South Africa.
| | | |
Collapse
|
33
|
Abstract
Convergence insufficiency is a commonly seen disorder of the vergence system. Its clinical characteristics and symptoms have been well described by Duane and von Graefe. Laboratory studies have clarified the vergence pathway, which includes a bi-phasic response. Several recent randomized controlled trials show the effectiveness of common treatment modalities, including pencil pushups, computer orthoptics, and office-based therapy. More studies are needed to investigate the possibility that other treatments may treat convergence insufficiency in a more profound way by acting on other parts of the vergence system.
Collapse
|
34
|
Abstract
Herein, we summarize articles in the field of neuro-otology published in the Journal of Neurology over the last year. Topics included acute and chronic vertigo as well as auditory and ocular motor disorders. Characteristic lesion locations in Pusher syndrome are reported and the usefulness of bedside ocular motor tests in vertebrobasilar stroke is revisited. Probing the vestibular system and its value in predicting the outcome in vegetative state is discussed. Several articles address new diagnostic and therapeutic approaches in different disorders associated with chronic vestibular, auditory or gait deficits. In a series of case reports, we focus on different eye movement disorders in the vertical plane, which are often difficult to assess.
Collapse
Affiliation(s)
- Alexander A Tarnutzer
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
| | | |
Collapse
|
35
|
Fu T, Lu W. [Clinical manifestations and treatment of Skew deviation]. Zhonghua Yan Ke Za Zhi 2012; 48:856-860. [PMID: 23141582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Skew deviation is a vertical strabismus caused by supranuclear lesions. It is often associated with ocular torsion and head tilt, which together constitute the ocular tilt reaction. Skew deviation can result from any injury within the posterior fossa, and is often the initial manifestation of diseases that affect the brainstem, cerebellum, or peripheral vestibular system. Clinical subtypes include comitant, nonconcomitant, paroxysmal (intermittent), periodic or slowly alternating, lateral alternating and transient neonatal skew deviation. It should be differentiated from superior oblique muscle palsy, inferior oblique muscle palsy and primary oblique muscle overaction. Most skew deviations are transient and spontaneous recovery. Prisms, botulinum toxin, and vertical rectus muscle recession have all been used for vertical diplopia secondary to persistent skew deviation.
Collapse
Affiliation(s)
- Tao Fu
- Capital Medical University, Beijing, China.
| | | |
Collapse
|
36
|
Leeamornsiri S, Chirapapaisan N, Chuenkongkaew W. Clinical profiles of Thai patients with ocular myasthenia gravis in Siriraj Hospital. J Med Assoc Thai 2011; 94:1117-1121. [PMID: 21970202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Ninety-six patients with ocular myasthenia gravis (OMG) seen at Siriraj Hospital during 1994 to 2004 were retrospectively reviewed. There were 59 female (61.5%) and 37 (38.5%) male patients with mean ages of 39.5 and 33.8 years, respectively Patients presented with initial symptoms of only ptosis in 46.9%, only diplopia in 13.5% and both ptosis and diplopia in 39.6%. However, diplopia alone is uncommon in childhood OMG. Fifteen percent developed systemic symptoms within two years of diagnosis. Thyroid function test was abnormal in 27.5% of investigated patients. Most abnormalities were hyperthyroidism. Thymoma associated with OMG is a rare condition. Most purely OMG patients can control the disease by pyridostigmine, prednisolone or immunosuppressive drugs.
Collapse
Affiliation(s)
- Supinda Leeamornsiri
- Department of Ophthalmology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | | | | |
Collapse
|
37
|
Abstract
BACKGROUND Convergence insufficiency is a common eye muscle co-ordination problem in which the eyes have a strong tendency to drift outward (exophoria) when reading or doing close work. Symptoms may include eye strain, headaches, double vision, print moving on the page, frequent loss of place when reading, inability to concentrate, and short attention span. OBJECTIVES To systematically assess and synthesize evidence from randomized controlled trials (RCTs) on the effectiveness of non-surgical interventions for convergence insufficiency. SEARCH STRATEGY We searched The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov ) on 7 October 2010. We manually searched reference lists and optometric journals. SELECTION CRITERIA We included RCTs examining any form of non-surgical intervention against placebo, no treatment, sham treatment, or each other. DATA COLLECTION AND ANALYSIS Two authors independently assessed eligibility, risk of bias, and extracted data. We performed meta-analyses when appropriate. MAIN RESULTS We included six trials (three in children, three in adults) with a total of 475 participants. We graded four trials at low risk of bias.Evidence from one trial (graded at low risk of bias) suggests that base-in prism reading glasses was no more effective than placebo reading glasses in improving clinical signs or symptoms in children.Evidence from one trial (graded at high risk of bias) suggests that base-in prism glasses using a progressive addition lens design was more effective than progressive addition lens alone in decreasing symptoms in adults. At three weeks of therapy, the mean difference in Convergence Insufficiency Symptoms Survey (CISS) score was -10.24 points (95% confidence interval (CI) -15.45 to -5.03).Evidence from two trials (graded at low risk of bias) suggests that outpatient (or office-based as used in the US) vision therapy/orthoptics was more effective than home-based convergence exercises (or pencil push-ups as used in the US) in children. At 12 weeks of therapy, the mean difference in change in near point of convergence, positive fusional vergence, and CISS score from baseline was 3.99 cm (95% CI 2.11 to 5.86), 13.13 diopters (95% CI 9.91 to 16.35), and 9.86 points (95% CI 6.70 to 13.02), respectively.In a young adult population, evidence from one trial (graded at low risk of bias) suggests outpatient vision therapy/orthoptics was more effective than home-based convergence exercises in improving positive fusional vergence at near (7.7 diopters, 95% CI 0.82 to 14.58), but not the other outcomes.Evidence from one trial (graded at low risk of bias) comparing four interventions, also suggests that outpatient vision therapy/orthoptics was more effective than home-based computer vision therapy/orthoptics in children. At 12 weeks, the mean difference in change in near point of convergence, positive fusional vergence, and CISS score from baseline was 2.90 cm (95% CI 0.96 to 4.84), 7.70 diopters (95% CI 3.94 to 11.46), and 8.80 points (95% CI 5.26 to 12.34), respectively. Evidence was less consistent for other pair-wise comparisons. AUTHORS' CONCLUSIONS Current research suggests that outpatient vision therapy/orthoptics is more effective than home-based convergence exercises or home-based computer vision therapy/orthoptics for children. In adult population, evidence of the effectiveness of various non-surgical interventions is less consistent.
Collapse
Affiliation(s)
| | - Jane Gwiazda
- New England College of Optometry, Boston, Massachusetts, USA
| | - Tianjing Li
- Cochrane Eyes and Vision Group US Project, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
38
|
Abstract
We review current concepts of nystagmus and saccadic oscillations, applying a pathophysiological approach. We begin by discussing how nystagmus may arise when the mechanisms that normally hold gaze steady are impaired. We then describe the clinical and laboratory evaluation of patients with ocular oscillations. Next, we systematically review the features of nystagmus arising from peripheral and central vestibular disorders, nystagmus due to an abnormal gaze-holding mechanism (neural integrator), and nystagmus occurring when vision is compromised. We then discuss forms of nystagmus for which the pathogenesis is not well understood, including acquired pendular nystagmus and congenital forms of nystagmus. We then summarize the spectrum of saccadic disorders that disrupt steady gaze, from intrusions to flutter and opsoclonus. Finally, we review current treatment options for nystagmus and saccadic oscillations, including drugs, surgery, and optical methods. Examples of each type of nystagmus are provided in the form of figures.
Collapse
Affiliation(s)
- Matthew J Thurtell
- Departments of Neurology and Daroff-Dell'Osso Laboratory, Veterans Affairs Medical Center and University Hospitals, Case Western Reserve University, Cleveland, OH 44106, USA
| | | |
Collapse
|
39
|
Pop AM. [Brown syndrome. General considerations. Case report]. Oftalmologia 2011; 55:47-54. [PMID: 22642136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This is an overview of a few general aspects of Brown's syndrome followed by a case report of a three year old girl suffering from congenital Brown's syndrome, astigmatism and amblyopia, which was detected by an ophthalmological screening at her kindergarten. The main differential diagnosis is ipsilateral inferior oblique paresis/paralysis. Since this was a mild-degree syndrome, it didn't require surgery only optical treatement and follow-up.
Collapse
|
40
|
Abstract
This chapter covers the very large number of possible disorders that can affect the three ocular motor nerves, the neuromuscular junction, or the extraocular muscles. Conditions affecting the nerves are discussed under two major headings: those in which the site of damage can be anatomically localized (e.g., fascicular lesions and lesions occurring in the subarachnoid space, the cavernous sinus, the superior orbital fissure, or the orbit) and those in which the site of the lesion is either nonspecific or variable (e.g., vascular lesions, tumors, "ophthalmoplegic migraine," and congenital disorders). Specific comments on the diagnosis and management of disorders of each of the three nerves follow. Ocular motor synkineses (including Duane's retraction syndrome and aberrant regeneration) and disorders resulting in paroxysms of excess activity (e.g., neuromyotonia) are then covered, followed by myasthenia gravis and other disorders that affect the neuromuscular junction. A final section discusses disorders of the extraocular muscles themselves, including thyroid disease, orbital myositis, mitochondrial disease, and the muscular dystrophies.
Collapse
Affiliation(s)
- Christian J Lueck
- Department of Neurology, The Canberra Hospital, and Australian National University Medical School, Canberra, Australia.
| |
Collapse
|
41
|
Cotter S, Kulp M, Scheiman M, Hertle R, Mitchell GL, Rouse M. Response to editorial about the convergence insufficiency treatment trial. Arch Ophthalmol 2009; 127:1229-1231. [PMID: 19752443 DOI: 10.1001/archophthalmol.2009.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
42
|
Ponsonby AL, Williamson E, Smith K, Bridge D, Carmichael A, Jacobs A, Burrill J, Ollington N, Keeffe J, Dwyer T. Children with low literacy and poor stereoacuity: an evaluation of complex interventions in a community-based randomized trial. Ophthalmic Epidemiol 2009; 16:311-321. [PMID: 19874111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To assess, among children with low literacy and poor stereoacuity, the efficacy of two intervention programs on child vision and education compared to a control program. METHODS Eighty-eight children aged 8 to 13 years who had reading problems, and demonstrated poor stereoacuity as measured by the Titmus stereocircle test (> 100 seconds arc) or computerized assessment were randomized to one of two intervention programs: Lawson vision or Phono-Graphix, or a control group: Parental Literacy Support. Vision (Lang test, visual acuity, convergence insufficiency symptom survey) and education assessments (Woodcock Reading Mastery Tests-Revised) were conducted at baseline, intervention end (10 weeks), and 36 weeks. Analysis used intention to treat multi-level models. RESULTS Compared to the parental literacy support group, convergence insufficiency symptoms were reduced 36 weeks post-randomization amongst those receiving the Lawson orthoptic intervention (mean difference -5.55; 95% confidence interval (CI): -11.1 to -0.05, P < 0.05). Stereoacuity, measured by the Lang test, improved for both the Lawson and Phono-Graphix interventions compared to the parental literacy support group (-1.01; 95% CI: -1.6 to -0.4, P = 0.001, and -0.77; 95% CI: -1.4 to -0.2, P = 0.01). At the 36 week follow-up assessment, word identification had also improved for the Lawson and Phono-Graphix groups but other educational outcomes did not improve. CONCLUSION A formal randomized control trial was feasible in this setting. Intervention among children with poor stereoacuity and low literacy produced small improvements in stereopsis and convergence insufficiency symptom scores. Further randomized control trials should be conducted to clarify the role of orthoptic intervention on literacy in selected child populations.
Collapse
|
43
|
Abstract
PURPOSE To investigate whether orthoptic exercises are an effective way to influence the near point of convergence, fusion range and asthenopic symptoms. METHODS Seventy-eight patients met the inclusion criteria of visual acuity 6/9 or better, no history of orthoptic treatment, squint surgery or Meares Irlen syndrome/dyslexia. Information was collected from case records related to diagnosis, near point of convergence, fusion range, prism and cover test measurements and symptoms. Type, duration and frequency of exercises were also recorded. Non-parametric statistics were applied. RESULTS Patients ranged in age from 5 to 73 years (mean 11.9). Females outnumbered males (46:32). The diagnoses were: decompensating heterophoria (n = 50) or convergence insufficiency (n = 28: primary 27; secondary 1). Exophoria was more common (n = 65), than esophoria (n = 11) or orthophoria (n = 1). Treatments were aimed at improving near point of convergence and/or reduced fusional reserves. The mean treatment period was 8.2 months. Reduced near point of convergence normalized following treatment in 47/55 cases, and mean near point of convergence improved from 16.6 to 8.4 cm (p = 0.0001). Fusional reserves normalized in 29/50. Fusional convergence improved significantly for those with exodeviation (p > 0.0006). Asthenopic symptoms improved in 65 patients. A reduction in deviation of 5 pd or more occurred in 20 patients. CONCLUSIONS Orthoptic exercises are an effective means of reducing symptoms in patients with convergence insufficiency and decompensating exophoria, and appear to target the proximal and fusional components of convergence. Their role in esophoria is unclear and needs further study.
Collapse
Affiliation(s)
- S Aziz
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK.
| | | | | | | |
Collapse
|
44
|
Moguel-Ancheita S, Castellanos-Pérez Bolde CG, Orozco-Gómez LP. Skew deviation. Strabismological diagnosis and treatment alternatives. CIR CIR 2009; 77:267-255. [PMID: 19919787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND We undertook this study to analyze diagnostic and treatment alternatives in patients with skew deviation (SD). METHODS This is a prospective, observational and longitudinal study of patients with SD. The study took place in a third-level medical center during the period from September 2007 to May 2008. Strabismological exploration, multidisciplinary diagnosis and treatment alternatives were analyzed. RESULTS Ten patients presenting SD were studied. Diagnoses were multiple sclerosis, arteriovenous malformation, epilepsy, hydrocephalus, ischemic encephalopathy, cortical atrophy, hypoplasia of corpus callosum and thalamic hemorrhage. Psychomotor retardation was present in 80%. Other diagnoses were Cogan apraxia, Parinaud syndrome, see-saw nystagmus, Foville syndrome, and hemiplegic alterations. Related strabismuses were exotropia (5), esotropia (3), hypertropia (2), and dissociated vertical deviation (1). Lesions of II, III and VII cranial nerves were found. CONCLUSIONS Complete strabological study allows a better diagnosis of the lesion and consequently relapsing disease in order to achieve a better treatment according to each patient. Optical rehabilitation and botulinum applications are especially indicated.
Collapse
Affiliation(s)
- Silvia Moguel-Ancheita
- Servicio de Estrabismo, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, México, D.F., Mexico.
| | | | | |
Collapse
|
45
|
Kornilova LN, Naumov IA, Azarov KA, Temnikova VV, Sagalovich SV, Dotsenko VI, Sliva SS, Solov'eva AD. [A computerized method for the combined evaluation of otoneurological and non-pharmacological correction of vestibulo-sensory and oculomotor disturbances]. Vestn Otorinolaringol 2009:28-33. [PMID: 19365360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Methodology and a new <<Oculostim>> hard/software complex (HSC) have been developed jointly by the Institute of Biomedical Problems, <<Statokyn>> and <<Rhythm>> Companies to be used in vestibulometric, otoneurological, and psychophysiological tes-ting with synchronous registration and in the analysis of head movements, various types of nystagmus, and all forms of visual pursuit. The complex is intended for the expert/diagnostic evaluation, prognosis, and monitoring of the vestibular function, intersensory interactions, and eye pursuit movements as well as for teaching correction and elimination of unfavourable perceptive and vestibular-sensorimotor responses by developing a fixation reflex during exposure to visual and dynamic stimuli. The <<Oculostim>> HSC was tested during pre- and post-flight observation of astronauts, under simulated and clinical conditions, as well as in monitoring the functional status of athletes engaged in various sports. The study has demonstrated that the use of special computerized stimulation programs allowing (by irritating visual and vestibular sensory inputs) to produce perceptive and sensorimotor responses provides a promising tool for the evaluation of the state of the vestibular and related sensory systems, stability of static and dynamic spatial orientation in the presence of separate and combined visual and vestibular stimuli or without them.
Collapse
|
46
|
Convergence Insufficiency Treatment Trial Study Group. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol 2008; 126:1336-49. [PMID: 18852411 DOI: 10.1001/archopht.126.10.1336] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare home-based pencil push-ups (HBPP), home-based computer vergence/accommodative therapy and pencil push-ups (HBCVAT+), office-based vergence/accommodative therapy with home reinforcement (OBVAT), and office-based placebo therapy with home reinforcement (OBPT) as treatments for symptomatic convergence insufficiency. METHODS In a randomized clinical trial, 221 children aged 9 to 17 years with symptomatic convergence insufficiency were assigned to 1 of 4 treatments. MAIN OUTCOME MEASURES Convergence Insufficiency Symptom Survey score after 12 weeks of treatment. Secondary outcomes were near point of convergence and positive fusional vergence at near. RESULTS After 12 weeks of treatment, the OBVAT group's mean Convergence Insufficiency Symptom Survey score (15.1) was statistically significantly lower than those of 21.3, 24.7, and 21.9 in the HBCVAT+, HBPP, and OBPT groups, respectively (P < .001). The OBVAT group also demonstrated a significantly improved near point of convergence and positive fusional vergence at near compared with the other groups (P CONCLUSIONS Twelve weeks of OBVAT results in a significantly greater improvement in symptoms and clinical measures of near point of convergence and positive fusional vergence and a greater percentage of patients reaching the predetermined criteria of success compared with HBPP, HBCVAT+, and OBPT. Application to Clinical Practice Office-based vergence accommodative therapy is an effective treatment for children with symptomatic convergence insufficiency. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00338611.
Collapse
|
47
|
Abstract
Congenital cranial dysinnervation disorders (CCDDs) are responsible for 1-2% of infant strabismus cases. Insufficient innervation and misinnervation of aberrant nerve fibres lead to motility restrictions and synkinesis. We present the most common CCDDs and explain their pathogenesis and the resulting clinical features. Furthermore, we emphasize essential diagnostic steps and treatment aspects.
Collapse
Affiliation(s)
- C Pieh
- Universitätsaugenklinik Freiburg, Killianstrasse 5, 79106 Freiburg.
| | | |
Collapse
|
48
|
Kubarko AI, Kubarko NP. [Corrective saccades in patients with multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2008; 108:47-51. [PMID: 18577935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Basing on the data analysis of natural and erroneous fast eye movements, the quantitative estimation of static and dynamic features of corrective saccades in patients with multiple sclerosis has been carried out. The differences in latency, maximal velocity and other parameters of corrective movements are used in the discussion of brain strategies on the development of normal and corrective eye movements and neuronal pathways for their realization.
Collapse
|
49
|
Affiliation(s)
- Marc J Dinkin
- Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
| | | |
Collapse
|
50
|
Kerty E. [One-sided involuntary eye movement]. Tidsskr Nor Laegeforen 2007; 127:3223. [PMID: 18181298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- Emilia Kerty
- Nevrologisk avdeling Nevroklinikken Rikshospitalet. emilia.kertymedisin.uio.no
| |
Collapse
|