British and Irish Orthoptic Journal最新文献

{"title":"How Successful is Combined Superior and Inferior Oblique Muscle Surgery in Young Children with Superior Oblique Underaction Presenting in Infancy with a Severe Head Tilt?","authors":"Revelle A Littlewood,&nbsp;John P Burke","doi":"10.22599/bioj.171","DOIUrl":"https://doi.org/10.22599/bioj.171","url":null,"abstract":"<p><strong>Background/objective: </strong>To evaluate the success of combining ipsilateral inferior and superior oblique muscle surgery in young children with congenital unilateral superior oblique under action who present in infancy with a large socially noticeable head-tilt.</p><p><strong>Methods: </strong>A consecutive retrospective case series of young children was analysed. The success of surgery in eliminating the head-tilt was evaluated by pre- and post-operative ocular motility assessment focusing on the vertical misalignment in primary position and downgaze, the magnitude of the head-tilt in degrees and the status of the superior oblique tendon.</p><p><strong>Results: </strong>Five children had a mean age at first surgery of 41 (range 25-63) months, a mean primary position vertical deviation of 26 (25-30) prism dioptres, a head-tilt of 30 (20-35) degrees and a mean post-operative follow up of 24 (8-43) months. While there was a uniform surgical plan, nonetheless each operation required individualisation based on a spectrum of per-operative superior oblique tendon findings. The head tilt was eliminated in 40% and reduced in the remainder, to a mean of 7 (0-18) degrees and with a mean post-operative primary position vertical misalignment of 3 (range 0-10) and of 10 (range 0-40) prism dioptres in downgaze.</p><p><strong>Conclusion: </strong>Combined, ipsilateral oblique muscle surgery reduced the severe head tilt and primary position alignment to a psychosocially and functionally acceptable level. For the majority, the outcome was stable or associated with further decremental improvement. A persistent downgaze vertical tropia occurred in children with macroscopically abnormal superior oblique tendons but these cases were not identifiable clinically pre-operatively.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"17 1","pages":"33-40"},"PeriodicalIF":0.0,"publicationDate":"2021-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39198578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eye Care for Children in Special Schools: An Audit of Provision.","authors":"Louise C Allen,&nbsp;Annette Dillon,&nbsp;Pamela Bowen","doi":"10.22599/bioj.166","DOIUrl":"https://doi.org/10.22599/bioj.166","url":null,"abstract":"<p><strong>Introduction: </strong>Children and young people with Special Educational Needs (SEN) are 28 times more likely to have eye problems than their typically developing peers. An ideal approach to the eye care for children attending special schools in England has been developed. Work in this area continues to evolve; therefore, an audit about existing services across the United Kingdom (UK) was undertaken.</p><p><strong>Method: </strong>A survey to ascertain key aspects of services for children with SEN that exist in the UK was developed and disseminated via Survey Monkey and at British and Irish Orthoptic Society (BIOS) events to all leads of the orthoptic profession.</p><p><strong>Results: </strong>Ninety-four service areas replied to the survey. Of these, 65 areas provide a special school service, 30 also provide a specialist service for SEN's in hospital/community clinics; five provide only a specialist service in hospital/community clinics, and 24 reported no specialist service provision, outside that provided to everyone. In the school environment, 29 (44%) areas include vision and orthoptic assessment, whereas 31 (48%) include vision, orthoptic, and refraction assessment. All but two services were reported as orthoptic-led, 26 (40%) special school services involved optometric input within school, and no services had optical dispensing within school.</p><p><strong>Discussion: </strong>The results of this survey suggest that access to all aspects of eye care is not always available in school where a service exists. Families have to travel to the hospital or community optometrist for further assessment, which is not suitable in a number of cases, though it may be desirable, in some.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"17 1","pages":"27-32"},"PeriodicalIF":0.0,"publicationDate":"2021-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39198577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parental Home Vision Testing of Children During Covid-19 Pandemic.","authors":"Sally Painter,&nbsp;Laura Ramm,&nbsp;Laura Wadlow,&nbsp;Maria O'Connor,&nbsp;Bavnesh Sond","doi":"10.22599/bioj.157","DOIUrl":"https://doi.org/10.22599/bioj.157","url":null,"abstract":"<p><strong>Background: </strong>The Covid-19 pandemic necessitated social distancing restrictions, which placed limitations on access to ophthalmic care to only those who had an imminent risk of sight loss. All other face-to-face consultations were converted to telephone consultations or were postponed. We investigated whether parents were able to test their child's vision using available home vision testing applications, with an aim to aid decision making during a telephone consultation.</p><p><strong>Methods: </strong>Families with follow-up consultations at Birmingham Children's Hospital were asked to test their child's vision at home. Instructions for the use of Peek acuity, or iSight Pro, were emailed to a parent. Parents chose to use a particular app based on available devices at home. Parents were asked to test uniocular visual acuity twice. Home versus hospital acuity was correlated. Home acuity test-retest reliability was acquired. Parental feedback was obtained through questionnaires.</p><p><strong>Results: </strong>One hundred and three families were contacted, 15 families completed home vision testing. Ten families used Peek acuity, five families used iSight Pro. Uniocular visual acuity test-retest reliability was 0.03 LogMAR. Home-hospital acuity testing had a bias of 0.14 LogMAR, hospital acuity yielding a lower LogMAR score. Most families who completed testing found it easy to do; however, some struggled, and 81 families did not undertake home vision testing.</p><p><strong>Conclusions: </strong>Uptake of home vision testing was limited by parental engagement, most likely influenced by the current pandemic. Most families who undertook home vision testing were able to generate results that could be used for clinical decision making. Extending the impact of parental vision testing will require education by clinicians and further study to increase sample sizes and to improve confidence.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"17 1","pages":"13-19"},"PeriodicalIF":0.0,"publicationDate":"2021-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39198575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Much Superior Rectus Underaction is Considered Normal?","authors":"Bethany Shaw,&nbsp;Charlotte Codina,&nbsp;Sonia Toor","doi":"10.22599/bioj.159","DOIUrl":"https://doi.org/10.22599/bioj.159","url":null,"abstract":"<p><strong>Purpose: </strong>It is considered normal to have a small amount of superior rectus weakness in laevo and dextro elevation; however, there is no documented definition for these normal parameters within a healthy young adult population using ocular movement testing and the synoptophore. The aim of this study was to collect normative data on the degree of superior rectus underaction in healthy young adults.</p><p><strong>Method: </strong>Twenty-nine healthy adults (3 males and 26 females, mean age 20.30 ± 1.70 years) were recruited. Superior recti underactions and inferior oblique overactions were recorded during routine ocular movement testing and mean and median values calculated. Subjective horizontal, vertical and torsional measurements were taken in degrees on the synoptophore in primary position, laevo elevation and dextro elevation.</p><p><strong>Results: </strong>Most participants (79.31%) had some degree of observable superior rectus underaction in either eye or in both eyes on ocular movement testing (mean superior rectus underaction of -0.69 units in laevo elevation and -0.71 units in dextro elevation, range = -1.5 to -0.5 units; median -1 units, interquartile range (IQR) = -1 to -1 units). Most participants (62.07%) had some degree of superior rectus underaction in either eye or in both eyes on the synoptophore (mean left and right superior recti underactions of -0.48 degrees, range = -3 to -1 degrees; median 0 degrees, IQR = -1 to -1 degrees).</p><p><strong>Conclusion: </strong>The majority of young healthy adults in this study showed some degree of superior rectus underaction. On ocular movement testing, -0.70 units of underaction, and on the synoptophore, -0.48 degrees of underaction are the mean levels of weakness to be expected. Superior rectus underactions greater than -1 units for ocular movement testing and -1 degrees on the synoptophore in healthy young adults should be carefully evaluated, together with other important clinical signs.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"17 1","pages":"20-26"},"PeriodicalIF":0.0,"publicationDate":"2021-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39198576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Binocular Vision Parameters Pre- and Post-EPILASIK Laser Vision Correction Surgery for Myopia in a Pilot Study - Can Vision Therapy Augment Refractive Results?","authors":"Radhika Natarajan,&nbsp;Sushmitha Arcot Dandapani,&nbsp;Jameel Rizwana Hussaindeen","doi":"10.22599/bioj.158","DOIUrl":"https://doi.org/10.22599/bioj.158","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the changes in the binocular vision parameters after bilateral Epilasik laser vision correction surgery (LVCS).</p><p><strong>Setting: </strong>Medical Research Foundation, Tamil Nadu, India.</p><p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Methods: </strong>Subjects with a best corrected visual acuity of ≤ 0.0 Log MAR scale and refractive error: < 6.00DS of myopia, < 0.75D of astigmatism, and < 1D of anisometropia were included in the study. All subjects underwent a comprehensive eye examination, LVCS workup which included corneal topography, tomography, aberrometry, and dry eye assessment prior to binocular vision assessment. Complete Binocular vision assessment which included stereopsis, fusion for distance and near, near point of convergence, phoria measurement, vergence amplitudes and facility, accommodative amplitudes, response, and facility was performed with the best corrected vision prior to LVCS, one month and six months after the surgery.</p><p><strong>Results: </strong>Twenty-five subjects of age 23.8 ± 2.9 years were included. Age ranged from 20 to 32 years. Ten were female and 15 were male. The median spherical power was -2.00DS with an inter quartile range (IQR) of -1.50DS to -3.00DS for both eyes. The median cylindrical power was plano with IQR -0.50DC to -1.00DC for both eyes. There was a statistically significant decrease in monocular and binocular accommodative amplitudes (accounting for age-related changes) as well as positive fusional vergence recovery for near between baseline and one month after surgery (p < 0.05).</p><p><strong>Conclusion: </strong>Though subjects were asymptomatic post LVCS, still there is an indication that myopic LVCS could precipitate or aggravate an existing non-strabismic binocular vision anomaly. Comprehensive binocular vision assessment and appropriate management is recommended before and after LVCS.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"17 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2021-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39198573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Aniseikonia in Anisometropia and Amblyopia.","authors":"Jayshree South,&nbsp;Tina Gao,&nbsp;Andrew Collins,&nbsp;Arier Lee,&nbsp;Jason Turuwhenua,&nbsp;Joanna Black","doi":"10.22599/bioj.154","DOIUrl":"https://doi.org/10.22599/bioj.154","url":null,"abstract":"<p><strong>Purpose: </strong>Clinically, aniseikonia (a perceived difference in shape and image size between the eyes) is often neglected in anisometropic amblyopia due to assumed measurement difficulties. Therefore, we currently lack evidence on whether correction of aniseikonia is beneficial. This study aimed to determine whether subjective aniseikonia is measurable in anisometropia with or without amblyopia.</p><p><strong>Methods: </strong>Participants (15-52 years) with Anisometropic Amblyopia (n = 7), Anisometropia without amblyopia (n = 6) and Isometropic Controls (n = 6) were recruited. Subjective aniseikonia was measured using three clinical techniques: Robertson Technique (RT) (penlight and Maddox rod), Aniseikonia Inspector Version 3 (AI3), and the New Aniseikonia Test booklet (NAT), and a psychophysical adaptive method, the Contrast-balanced Aniseikonia Test (CAT), where dichoptic contrast adjustments compensate for any suppression.</p><p><strong>Results: </strong>Eighteen participants completed all tests, one Anisometropic Amblyopia participant could only complete the CAT and NAT due to fusion loss. The Anisometropic Amblyopia group exhibited the most aniseikonia (range -1.50-+10.50%) followed by Anisometropic Controls (range -3.30-+4.50%) and Isometropic Controls (range -1.50-+3.28%). There was a significant trend of more subjective aniseikonia with increasing amounts of anisometropia across all four tests (AI3 r = 0.630, p = 0.005; NAT r = 0.542, p = 0.017; RT r = 0.499, p = 0.035; CAT r = 0.440, p = 0.059. Bland Altman analysis demonstrated clinically significant levels of variability between the tests.</p><p><strong>Conclusions: </strong>Subjective aniseikonia can be reliably measured in patients with anisometropia and suppression. Subjective aniseikonia measurement is recommended as four of the most commonly used clinical tests did not support the 1% per dioptre rule of thumb.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"16 1","pages":"44-54"},"PeriodicalIF":0.0,"publicationDate":"2020-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39198572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthoptic Services in the UK and Ireland During the COVID-19 Pandemic.","authors":"Fiona Rowe,&nbsp;Lauren Hepworth,&nbsp;Claire Howard,&nbsp;Steven Lane","doi":"10.22599/bioj.153","DOIUrl":"https://doi.org/10.22599/bioj.153","url":null,"abstract":"<p><strong>Aim: </strong>COVID-19 has widely impacted hospital services. The purpose of this study was to determine the impact of COVID-19 on Orthoptists and their clinical practice in the UK, Ireland, and Channel Islands.</p><p><strong>Methods: </strong>We conducted a prospective survey-based cross-sectional study using an online survey aiming for coverage of orthoptic departments across the UK, Ireland, and Channel Islands. We circulated the online survey through the British and Irish Orthoptic Society that reaches over 95% of UK and Irish orthoptic services, and through social media and orthoptic research networks.</p><p><strong>Results: </strong>The survey response rate was 79%. The survey was completed by orthoptic departments, on average 10 days post lockdown. Many orthoptic services were cancelled/paused with remaining services largely reserved for emergency cases and urgent care. A substantial rise in tele-consultations was reported by 94%, which largely consisted of telephone and video calls and which was regarded generally as working well. Barriers to tele-consultations were mainly IT related but with concerns also raised regarding ethical and confidentiality issues. Shortage of personal protective equipment (PPE) was reported by one third of departments along with issues relating to conflicting information about the use of PPE.</p><p><strong>Conclusions: </strong>We have reported information on the changing face of orthoptic clinical practice during the COVID-19 pandemic. The survey has highlighted emerging tele-consultation practice and the importance of centralised profession-specific guidelines.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"16 1","pages":"29-37"},"PeriodicalIF":0.0,"publicationDate":"2020-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38441065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acquired Synergistic Divergence: Contrary to Current Literature.","authors":"Martha Waters","doi":"10.22599/bioj.145","DOIUrl":"https://doi.org/10.22599/bioj.145","url":null,"abstract":"<p><p>Current literature reports synergistic divergence as a rare, congenital ocular motility pattern associated with adduction palsy. Its mechanism has been likened to Duane's syndrome, and some suggest it be referred to as Duane's Type 4 (Gupta et al. 2010; Schliesser et al. 2016; Wilcox et al. 1981; Khan et al. 2016). There are no published reports of synergistic divergence as an acquired condition, making this case report seemingly the first of its kind. This case report describes an 18-year-old female who presented to clinic in 2013 with symptoms of diplopia and left eye turning outwards. Orthoptic assessment and MRI confirmed a third nerve palsy secondary to cavernous sinus schwannoma. Further monitoring showed progression of the cranial nerve palsy but a stable schwannoma and no aberrant regeneration noted in five years of follow up. The patient was treated with multiple botulinum toxin injections and had squint correction surgery in 2017. Seven months later, synergistic divergence was first noted and remained stable in all following assessments. While the aetiology of acquired synergistic divergence in this case is unclear, we can be confident it is unlikely to be of congenital origin as it was not noted until adulthood and after five years of investigations. This report will discuss possible aetiologies of acquired synergistic divergence and, contrary to current literature, suggest clinicians should consider the possibility that synergistic divergence can be acquired, though is likely to be even rarer than its congenital form.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"16 1","pages":"25-28"},"PeriodicalIF":0.0,"publicationDate":"2020-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38441064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the EyeChart App for iPhones Give Comparable Measurements to Traditional Visual Acuity Charts?","authors":"Katie Ansell,&nbsp;Gail Maconachie,&nbsp;Anne Bjerre","doi":"10.22599/bioj.146","DOIUrl":"https://doi.org/10.22599/bioj.146","url":null,"abstract":"<p><strong>Aim: </strong>To investigate if the EyeChart app gives accurate visual acuity (VA) measurements that are comparable to those achieved using traditional VA charts.</p><p><strong>Method: </strong>Twenty-four participants (aged 18-27 years, mean 20.13 ± 1.78 years) with VA of 6/60 Snellen or better regardless of any strabismus, amblyopia, or ocular pathology volunteered for this prospective study. The best-corrected monocular VA of each participant's right eye was measured on the Snellen chart at 6 m, the ETDRS chart at 3 m, and the EyeChart app presented on an iPhone SE at 1.2 m (4ft).</p><p><strong>Results: </strong>The mean VA scores obtained were: -0.13 ± 0.08 logMAR on the Snellen chart, -0.11 ± 0.08 logMAR on the ETDRS chart, and -0.09 ± 0.07 logMAR on the EyeChart app. After Bonferroni Correction adjustments were applied, a significant difference was found between the EyeChart app and the Snellen chart (t = -3.756, p = 0.003), however the difference between the EyeChart app and the ETDRS chart did not reach statistical significance (t = -2.391, p = 0.076). The EyeChart app had a strong correlation with both the Snellen (r = 0.79, p < 0.01) and ETDRS charts (r = 0.88, p < 0.01). The Coefficients of Agreement revealed a variation of less than one logMAR line between the EyeChart app and the traditional VA charts (Snellen: 0.09 logMAR; ETDRS: 0.08 logMAR).</p><p><strong>Conclusion: </strong>This study found that the EyeChart app gives accurate VA scores that are comparable to those achieved using the gold-standard ETDRS chart in a healthy young adult population. However, the accuracy and repeatability of the EyeChart app when testing a patient population must be investigated before it can be integrated into clinical practice.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"16 1","pages":"19-24"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38440624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strabismus Surgery for Esotropia, Down Syndrome and Developmental Delay; Is an Altered Surgical Dose Required? A Literature Review.","authors":"Alia Harrison,&nbsp;Louise Allen,&nbsp;Anna O'Connor","doi":"10.22599/bioj.140","DOIUrl":"https://doi.org/10.22599/bioj.140","url":null,"abstract":"<p><strong>Background and purpose: </strong>There is a high rate of strabismus, in particular esotropia, in children with Down syndrome or developmental delay, which frequently requires surgical correction. A paper in 1994 advocated that the surgical dose be adjusted due to an altered response in these children. The aim of this literature review is to evaluate the available evidence to establish whether an altered surgical approach is required in either population.</p><p><strong>Methods: </strong>A literature review was conducted using PubMed and Web of Knowledge. Only English language papers were eligible for inclusion. The papers were collated in chronological order for analysis, and their references searched for further relevant papers. Forward citation searches were also undertaken.</p><p><strong>Results: </strong>A 2 × 2 comparison is made between publications on Down syndrome (in isolation) and developmental delay populations (including Down syndrome) with adjusted versus non-adjusted surgery. Published surgical success rates on esotropia from unaltered surgical doses range from 62.0%-85.7% (four papers) in the Down syndrome cohort, with none of the adjusted surgeries having a successful outcome. Surgical success rates from adjusted surgical doses in developmental delay cohort range from 37.5%-86.0% (seven papers), with one unadjusted surgical success rate of 76.0%. The results across the studies are summarised in a table and discussed.</p><p><strong>Conclusions: </strong>An exaggerated surgical effect in individuals with developmental delay has been reported, and this population may benefit from a reduced surgical dose. Published research does not support giving a reduced surgical dose in individuals with Down syndrome, but more research needs to be done to make a definitive conclusion.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"16 1","pages":"4-12"},"PeriodicalIF":0.0,"publicationDate":"2020-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38440622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}