The American orthoptic journal最新文献

{"title":"In Honor of the 75th Anniversary of the American Association of Certified Orthoptists","authors":"K. Arnoldi","doi":"10.3368/aoj.65.1.14","DOIUrl":"https://doi.org/10.3368/aoj.65.1.14","url":null,"abstract":"","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"65 1","pages":"14 - 19"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69584640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wernicke Encephalopathy","authors":"Patricia F. Jenkins","doi":"10.3368/aoj.65.1.104","DOIUrl":"https://doi.org/10.3368/aoj.65.1.104","url":null,"abstract":"Introduction and Purpose This paper reviews the complaints and associated symptoms/consequences of lacking essential nutrients and vitamins in our central and peripheral nervous systems. This has become important as there has been a rise in malnutrition following the increasing incidence of bariatric surgery for obesity. Methods A case report example involving review of the clinical presentation and treatment. Results A 30-year-old Caucasian woman who had gastric sleeve surgery did not take the recommended capsules as they were too large to swallow. She noted diplopia and oscillopsia 2 months later, which led her to have full orthoptic and neuro-ophthalmic evaluations. After being treated with chewable vitamins with thiamine, she noted a tremendous improvement in her symptoms. Conclusion Wernicke encephalopathy is a disease that was seen more in the 1940s and 1950s, following war times and mostly in underdeveloped countries. However, with the increasing utilization of bariatric surgery for obesity, neurological offices are seeing more patients with neurological impairments. We recommend inquiring about any obesity surgery in one's history and including Wernicke encephalopathy in possible differential diagnoses in those patients who have a recent onset of strabismus or nystagmus, altered mental status, and/or gait ataxia.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"65 1","pages":"104 - 108"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.65.1.104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69584035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmasking Bilateral Inferior Rectus Restriction in Thyroid Eye Disease: Using Degree of Cyclotropia","authors":"K. Arnoldi, J. Reynolds","doi":"10.3368/aoj.65.1.81","DOIUrl":"https://doi.org/10.3368/aoj.65.1.81","url":null,"abstract":"Purpose Thyroid eye disease (TED) frequently causes strabismus and diplopia. Though the condition involves multiple extraocular muscles in both eyes, the inferior rectus (IR) muscle is particularly susceptible. TED may be so asymmetric as to mask the involvement of the contralateral IR. The purpose of this study was to determine if the degree of preoperative cyclotropia measured with an objective test could be used to predict the extent of bilateral IR disease and assist in surgical planning. Methods Adults with TED involving the IR and demonstrating cyclotropia were enrolled. Preoperative and postoperative sensorimotor exam included quantification of cyclotropia using double Maddox rod test (DMR). Forced ductions were done intraoperatively. Degree of cyclotropia was compared to results of duction tests and surgical outcome. Results Twelve participating patients demonstrated excyclotropia on DMR test preoperatively (mean 16 ± 9°). Unilateral IR recession was planned based on the results of preoperative ocular rotations and forced duction testing in eight cases. The remaining four underwent bilateral IR recession. Four of the unilateral recession cases presented with reversal of the hypotropia, obvious limitation of elevation in the unoperated eye, and persistent symptomatic excyclotropia at the first postoperative visit. The mean excyclotropia of the bilateral cases was 21 ± 5°, compared to 5.5 ± 3° in the unilateral group (P < 0.005). Conclusions Prism diopters of hypotropia, limitation of elevation, and forced duction testing evaluate muscle function relative to its yoke and may underestimate contralateral IR involvement in the case of asymmetrical disease. Duction testing and forced ductions are qualitative and subjective. Results suggest that degree of excyclotropia correlates well with severity of IR restriction, and that amounts exceeding 15° infer bilateral IR involvement.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"8 1","pages":"81 - 86"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.65.1.81","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69585165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Macular Diplopia","authors":"S. Shippman, K. R. Cohen, L. Heiser","doi":"10.3368/aoj.65.1.26","DOIUrl":"https://doi.org/10.3368/aoj.65.1.26","url":null,"abstract":"Maculopathies affect point-to-point foveal correspondence causing diplopia. The effect that the maculopathies have on the interaction of central sensory fusion and peripheral fusion are different than the usual understanding of treatment for diplopia. This paper reviews the pathophysiology of macular diplopia, describes the binocular pathology causing the diplopia, discusses the clinical evaluation, and reviews the present treatments including some newer treatment techniques.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"65 1","pages":"26 - 30"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.65.1.26","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69584734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residual Strabismus in Children Following Improvement of Cranial Nerve Palsies Affecting Ocular Ductions","authors":"M. L. Bratton, M. Hoehn, B. Morris, T. Merchant, A. Gajjar, R. Patel, N. Kerr","doi":"10.3368/aoj.65.1.87","DOIUrl":"https://doi.org/10.3368/aoj.65.1.87","url":null,"abstract":"Background Children with brain neoplasms often develop cranial nerve palsies (CNP) affecting ocular ductions. Duction deficits may improve or resolve with treatment of their intracranial disease. However, these children may be left with residual strabismus. Methods We identified 104 children with third, fourth, and/or sixth cranial nerve palsies who were treated for central nervous system (CNS) neoplasms. A retrospective chart review was conducted to determine the presence or absence of residual strabismus following resolution of duction deficits. Results Of the 104 children with CNP secondary to an intracranial neoplasm, forty-five had improvement or resolution of their duction deficit with treatment of their CNS lesion. Of these forty-five children, one had a third cranial nerve palsy, six had fouth cranial nerve palsies (one was bilateral), thirty-seven had sixth cranial nerve palsies (thirteen were bilateral), and one had two different cranial nerve palsies in the same eye (fourth and sixth). Of the eighteen children with improved (but not resolved) duction deficits, only three (17%) experienced resolution of their strabismus. Of the twenty-seven children with resolved duction deficits, nine (33%) experienced resolution of their strabismus. For the children with residual strabismus, the average angle of strabismus before duction deficits improved or resolved was 33.2Δ; while for those children without residual strabismus, it was 20Δ. Conclusions Our findings indicated that the majority of children with improved or resolved duction deficits from CNP after treatment for CNS neoplasms are left with residual strabismus. Therefore, we suggest children with CNP secondary to CNS neoplasms need ophthalmic care after duction deficits resolve, as they are likely to have residual strabismus.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"65 1","pages":"87 - 93"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.65.1.87","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69585260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Divergence Insufficiency Esotropia: Surgical Treatment","authors":"S. Pineles","doi":"10.3368/aoj.65.1.35","DOIUrl":"https://doi.org/10.3368/aoj.65.1.35","url":null,"abstract":"Divergence insufficiency esotropia, or acquired comitant esotropia that is at least 10Δ larger at distance than at near, is most often seen in older adults, and may also be known as “age-related distance esotropia.” Surgical treatment is often indicated for patients who do not tolerate prism therapy, or for those with large angles of esotropia. Surgical treatments have evolved with our understanding of the disease-state. Currently, accepted treatments include lateral rectus resection and medial rectus recession. These surgeries can be performed unilaterally or bilaterally. New surgical techniques such as lateral rectus equatorial myopexy are under investigation and may hold promise as future therapies.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"65 1","pages":"35 - 39"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.65.1.35","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69585097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Series: Exercise-Induced Esotropia","authors":"Joseph Shin, Birgit Wahl, N. Miller, Eric L. Singman","doi":"10.3368/aoj.65.1.115","DOIUrl":"https://doi.org/10.3368/aoj.65.1.115","url":null,"abstract":"The authors present three patients with idiopathic exercise-induced esotropia. The history, physical findings, and testing that led to the diagnosis are discussed. To the authors' knowledge, this is the largest series of patients with this rare condition, with this series representing half of reported patients in the literature. It is hoped that a discussion of common features of the condition will guide further exploration of the etiology.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"65 1","pages":"115 - 120"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.65.1.115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69584091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Torsional Diplopia","authors":"Aaron M. Miller","doi":"10.3368/aoj.65.1.21","DOIUrl":"https://doi.org/10.3368/aoj.65.1.21","url":null,"abstract":"Background and Purpose Torsional diplopia can result in failure of fusion in an individual without a measureable strabismus. When presented with a patient with complaints of binocular diplopia, physicians and orthoptists should consider cyclovertical muscle dysfunction when the source of the complaint is not readily apparent. Methods A thorough review of the literature combined with the author's own personal experience in treating adult patients with strabismus was used to evaluate the different potential causes of torsional diplopia. Predisposing factors, diagnostic techniques, and strabismus diagnoses are considered. Results The most common cause of torsional diplopia is a superior oblique palsy. Other more common causes include thyroid-related orbitopathy and skew deviations. Conclusions Torsional diplopia is a common cause of undiagnosed strabismus in the adult patient population. Proper consideration of the most common causes should be made.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"65 1","pages":"21 - 25"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.65.1.21","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69584694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sensorimotor Characteristics of Neuro-Ophthalmology and Oculo-Plastics Patients","authors":"Alex Christoff","doi":"10.3368/aoj.65.1.47","DOIUrl":"https://doi.org/10.3368/aoj.65.1.47","url":null,"abstract":"Background and Purpose Certified orthoptists are routinely required, as a standard component of outpatient care, to examine and identify the cause of double vision described by neuro-ophthalmology and oculo-plastics patients. Peer-reviewed articles in the strabismus literature describing the significance of this role of the orthoptists, especially in more complex cases of strabismus, do exist, but are outdated. The importance of creating a differential diagnosis in the understanding of the disease process is a well-recognized component of medical education and modern medicine. Patients and Method This work was a retrospective chart review and descriptive study of the most common clinical characteristics of adult neuro-ophthalmology and oculo-plastics patients seen over a 9-year period by an orthoptist in a large, urban academic institution in the United States. History and clinical data obtained included demographic information; whether the subjects were neuro-ophthalmology or oculo-plastic patients or both; chief complaint; past medical history and associated medical risk factors; past ocular history of strabismus or amblyopia; whether reported diplopia was monocular or binocular; visual acuities; sensorimotor examination and fusion status information; presence or absence of ptosis; pupil size and reactivity; basic accommodative function; orthoptist and physician diagnoses; and suggested treatment of diplopia. Results Five hundred seventy-five subjects were identified based on inclusion criteria. Racial demographics matched that of the state of Maryland, with the majority of the patients being Caucasian. The minority were of Hispanic origin. Ninety-one percent of the study cohort was referred by the department of neuro-ophthalmology at the institution. Hypertension was a statistically significant medical risk factor for acquired strabismus and diplopia in this adult cohort. Etiology for the strabismus and associated diplopia suggested by the orthoptist was in close agreement with the final diagnosis made by the referring physician. Pupil-sparing oculomotor palsy (third cranial nerve, CN3) occurred as frequently as pupil-involving CN3, with tumor occurring more frequently as an etiology than aneurysm in both groups. Trochlear nerve palsy (CN4) was more often associated with hydrocephalus than abducens nerve palsy (CN6), and trauma remained a common association with acquired CN4 palsy. In patients with thyroid eye disease (TED), eso- and exo-deviations occurred with similar frequency. As has been reported in the literature, concomitant myasthenia gravis (MG) remained rare in these patients, although occurring with similar frequency in patients with both types of horizontal deviation. In patients with ptosis, asymmetry was not statistically more predictive of MG than symmetry. Prism was used most frequently, followed by surgery, to address diplopia symptoms. Lastly, there was a statistically significant association of acquired strabismus and diplop","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"65 1","pages":"47 - 57"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.65.1.47","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69584963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation and Prism Management of Divergence Insufficiency Esotropia","authors":"Terra Haller","doi":"10.3368/aoj.65.1.40","DOIUrl":"https://doi.org/10.3368/aoj.65.1.40","url":null,"abstract":"An esodeviation that is greater at distance than near in an adult patient requires a full sensorimotor exam to rule out any cofounding neurological conditions. Many etiologies are described in the literature to cause an esodeviation that is greater at distance than near in adult patients and some exist in conjunction with a neurological condition. However, many adult patients present to the adult strabismus clinic with no other findings on exam and have a purely benign divergence insufficiency esotropia. A review of the literature on divergence insufficiency reveals a few attempts of classifying these entities, but none have been completely accepted. Recently benign non-neurological divergence insufficiency esotropia has been described as a resulting condition due to a mechanical etiology. Currently, the literature only describes a couple of different etiologies. Regardless of the etiology, these patients are quite symptomatic and present to the adult strabismus clinic with various complaints and require a thorough examination. The primary focus of the exam is to first rule out the need for further neurological work-up, but secondly, to also determine the best treatment option for the patient. To determine the best treatment plan, a thorough evaluation, including a sensorimotor exam with proper testing, can help. Many of these patients do very well with base-out prism management; however, some have decompensated to a larger angle and prefer surgical intervention. However, the focus of this paper will be on nonsurgical prism management of patients with divergence insufficiency that is not associated with any neurological disorder.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"65 1","pages":"40 - 43"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.65.1.40","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69585221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}