{"title":"Examining Children with Nystagmus: Pearls for Success","authors":"K. Fray","doi":"10.1080/0065955X.2017.12023627","DOIUrl":"https://doi.org/10.1080/0065955X.2017.12023627","url":null,"abstract":"ABSTRACT Examining a child with nystagmus can be intimidating even for an experienced clinician. The purpose of this paper is to provide examination pearls for the clinical assessment of the pediatric patient with nystagmus. By employing these techniques, the clinician should be able to document the necessary information for determining the underlying cause of the nystagmus and to direct the patient's plan of care.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"67 1","pages":"22 - 26"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0065955X.2017.12023627","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48526967","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":"The Necessity of Amblyopia.","authors":"Steven M Archer","doi":"10.3368/aoj.66.1.53","DOIUrl":"10.3368/aoj.66.1.53","url":null,"abstract":"<p><p>A general property of nervous system development is that correlated activity is used to organize topographic projections. This correlated activity is typically produced by electrical coupling of adjacent neurons; however, electrical coupling is not possible for retinal ganglion cells in separate eyes that need to be precisely mapped to the same place in the brain. This forces the visual system to rely on environmental stimuli to produce the correlated activity that drives the development of binocularity, with amblyopia as necessary consequence when visual experience is abnormal. The characteristic visual deficits in both the amblyopic and the sound eyes can be understood in the context of these normal developmental processes. The auditory system provides another example-where precise connections between paired sense organs must rely on environmental stimuli for normal development-in which the analogous condition of amblyaudia occurs.</p>","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"66 1","pages":"53-62"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69588593","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":"Historical Perspective: Nonsurgical Treatment of Intermittent Exotropia","authors":"Patricia F. Jenkins","doi":"10.3368/aoj.66.1.30","DOIUrl":"https://doi.org/10.3368/aoj.66.1.30","url":null,"abstract":"Intermittent exotropia is rich in our orthoptic history, with different modes of therapy as well as surgical methods to improve the eye drifting. We explore the very earliest nonsurgical treatments documented from the Aeginaeta mask from 600 A.D. to a plethora of devices and techniques throughout the 1800s and 1900s, including stereograms, the cheiroscope, the Tibbs Binocular Trainer, and finally to computerized orthoptic programs in the twenty-first century. We note several other founding and instrumental scientists and researchers in the field's early beginning as well as the American heritage of orthoptics. From Javal, Hering, and Mary and Edmund Maddox to Elizabeth Stark, Burian, Scobee, von Noorden, Dorothy Thompson, and Sally Moore, we delve into many influential ideas, theories, and inventions. The scientific basis for many treatments and the monumental advancements made in the field of ocular motility will be discussed.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"66 1","pages":"30 - 37"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.66.1.30","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69588239","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}
You Iwata, Tomoya Handa, H. Ishikawa, N. Shoji, K. Shimizu
{"title":"Efficacy of an Amblyopia Treatment Program with Both Eyes Open: A Functional Near-Infrared Spectroscopy Study","authors":"You Iwata, Tomoya Handa, H. Ishikawa, N. Shoji, K. Shimizu","doi":"10.3368/aoj.66.1.87","DOIUrl":"https://doi.org/10.3368/aoj.66.1.87","url":null,"abstract":"Introduction and Purpose To investigate the efficacy of an amblyopia treatment program with both eyes open. Methods Ten subjects (mean age 20.5 ±1.5 years) were enrolled. All subjects had unremarkable ophthalmic examinations, but several subjects had minor refractive errors. Vision function was evaluated using the 3-D visual function trainer-ORTe. Brain measurements were made using functional near-infrared spectroscopy (fNIRS) to examine the oxygenated hemoglobin (HbO2) concentration change upon visual stimulus presentation. The three conditions were as follows: both eyes open and both eyes stimulated, both eyes open and only one eye stimulated, and one eye open and one eye stimulated. Results Changes in HbO2 between the rest and stimulation phases were not statistically different between the unilateral and bilateral stimulation conditions with both eyes open. However, HbO2 change was significantly higher in subjects with both eyes open than in subjects with one eye closed (P < 0.001, all comparisons). Conclusion Greater activation of the visual cortex is achieved when subjects are treated with both eyes open as compared to subjects with one eye occluded. From a perspective of functional brain activation, amblyopia treatment administered without occluding the healthy eye may provide the greatest therapeutic benefit.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"66 1","pages":"87 - 91"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.66.1.87","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69588485","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":"Current Nonsurgical Management of Intermittent Exotropia","authors":"J. Holmes","doi":"10.3368/aoj.66.1.42","DOIUrl":"https://doi.org/10.3368/aoj.66.1.42","url":null,"abstract":"Three common nonsurgical management strategies for childhood intermittent exotropia are observation alone, part-time patching, and over-minus spectacles. Each of these approaches has support from recent large observational studies and recent randomized clinical trials. The deterioration rate with observation alone is particularly low, over both a 6-month and 2-year period, suggesting that observation alone is a very reasonable option. Future studies on the natural history of childhood intermittent exotropia are forthcoming and a larger randomized clinical trial of over-minus spectacles versus non-over-minus spectacles is planned.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"66 1","pages":"42 - 46"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.66.1.42","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69587949","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":"Ophthalmology, 3rd Edition","authors":"Andrew L. Reynolds","doi":"10.3368/AOJ.66.1.137","DOIUrl":"https://doi.org/10.3368/AOJ.66.1.137","url":null,"abstract":"able quick reference. Differential lists are often then reinforced by the illustrations. It is certainly difficult for the novice to attain a comprehensive picture of neuroophthalmology. So much material must be absorbed and integrated. But a picture is worth a thousand words. The authors are much better teachers by eliminating tens of thousands of words and replacing them with illustrations. All the important topics are addressed. Subtle details may be left out, but the es.sential is here. I could imagine a resident, deciphering an OKAP question, and bringing page and illustration from this book to mind and acing the answer. This is a book not only for students, but also teachers. I plan on frequently pulling this book out in clinic and using the simple approach of this book and its illustrations to put specific patients in perspective. The authors use three reviewer quotes in their preface to this second edition. I was certainly skeptical of this dramatic, perhaps over the top, self-endorsement by the selection bias. But I am now a believer. The authors can now count me as one of those gushing reviewers. This is an exceptional and superlative educational tool for all.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"66 1","pages":"137 - 138"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/AOJ.66.1.137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69588158","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":"Accommodative ET-High AC/A Ratio Esotropia: The Case for Glasses","authors":"E. Raab","doi":"10.3368/aoj.66.1.1","DOIUrl":"https://doi.org/10.3368/aoj.66.1.1","url":null,"abstract":"Background and Purpose There is a continuing debate as to whether the patient optically correctable at distance to within 8 prism diopters of perfect alignment requires treatment for persisting overconvergence at near, and if treatment is indicated, what it should be. Patients and Methods For the patient whose misalignment at distance is reduced to 8 or fewer prism diopters, my preference is for the full cycloplegic correction plus a bifocal in the first prescription, to discourage virtually all accommodation initially, with pull back later. Results Review of several reports indicates a continued lack of consensus on whether this causes disuse weakening of accommodation and premature presbyopia. Recent studies found that prolonged convergence tone at near can result in anatomic and physiologic alterations in the medial rectus muscles that threaten a satisfactory distance alignment as well, despite relief of the accommodative demand. Hypoaccommodative esotropia resembles the high AC/A variety. Conclusion Spontaneously improving over-convergence at near is not likely to occur in the hypoaccommodating patient either with observation alone or with surgery. I reserve surgery for the over-convergence at near for the unusual case of an extremely high distance-near disparity, and for the teenager or adult not showing likelihood that the condition will resolve.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"66 1","pages":"1 - 4"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.66.1.1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69587049","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}
Jocelyn Zurevinsky, K. Sawchuk, H. Lim, C. Lee, Shehla Rubab
{"title":"A Clinical Randomized Trial Comparing the Cycloplegic Effect of Cyclopentolate Drops Applied to Closed Eyelids Versus Open Eyelids","authors":"Jocelyn Zurevinsky, K. Sawchuk, H. Lim, C. Lee, Shehla Rubab","doi":"10.3368/aoj.66.1.114","DOIUrl":"https://doi.org/10.3368/aoj.66.1.114","url":null,"abstract":"Background and Purpose Adequate cycloplegia and dilation are required for refraction and fundus exam in children. Standard practice is to instill cycloplegic drops in the inferior cul-de-sac, and this is often traumatic for children. Our study assesses the use of cyclopentolate on closed lids as a method of instillation for ensuring complete cycloplegia. Patients and Method Ninety children presenting for annual refraction were enrolled. Three were excluded as they did not finish the testing. One drop of Alcaine® and one drop of cyclopentolate HCL 1% were used in each eye. Cyclopentolate drops were placed on the inner canthus near the lid margin on the closed eye and directly onto the conjunctiva of the fellow eye. Results Overall, 145/174 eyes (83%) were fully cyclopleged with one drop. The methods of instillation were equally successful (seventy-two indirect vs. seventy-three direct). Age, eye color, spherical refractive error, astigmatic refractive error, and presence of amblyopia on the study visit played no role in the success of either method. Dark irises where the pupil margin was clinically indistinguishable had the largest number of failures (n = 17/44) in comparison to light irises (12/130), but had an equal amount of failures for both direct and indirect methods. Conclusion Placing one drop of cyclopentolate HCL 1% on a closed eyelid had a success rate for complete cycloplegia that was equivalent to placing one drop directly on the cornea.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"66 1","pages":"114 - 121"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.66.1.114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69587273","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}
R. Hoshikawa, Misae Ito, Takashi Yano, K. Tsutsui, Tomoki Sato, K. Shimizu
{"title":"Association Between Ocular Dominance and Anisometropic Hyperopia","authors":"R. Hoshikawa, Misae Ito, Takashi Yano, K. Tsutsui, Tomoki Sato, K. Shimizu","doi":"10.3368/aoj.66.1.107","DOIUrl":"https://doi.org/10.3368/aoj.66.1.107","url":null,"abstract":"Introduction and Purpose Anisometropia, a relative difference in the refractive state of the two eyes, is common in hyperopic patients. We investigated the association between ocular dominance (sighting dominance) and refractive asymmetry in patients with hyperopia. Methods This retrospective study included 223 hyperopic patients with a mean age of 10.1 ± 3.6 years (range 3 to 21 years). Refractive error was measured with cycloplegic refraction, and axial length was measured with IOLMaster® (Carl Zeiss Meditec, Dublin, CA). Ocular dominance was assessed with the hole-in-the-card test. The amount of hyperopic anisometropia was subdivided into four groups: less than 0.50 D, 0.50–0.99 D, 1.00–1.99 D, and 2.00 D or greater. Results Ocular dominance of the right and left eye was seen in 66% and 34% of the patients, respectively. The nondominant eye had higher hyperopia, astigmatism, and shorter axial length than the dominant eye (P < 0.001). In the group with spherical equivalent anisometropia of ≥0.50 D in particular, the nondominant eye was significantly more hyperopic and had shorter axial length than the dominant eye (both P < 0.001). Conclusions The current study revealed that the nondominant eye had a greater hyperopic refractive error and shorter axial length than the dominant eye, in patients who had a high degree of anisometropia in particular.","PeriodicalId":76599,"journal":{"name":"The American orthoptic journal","volume":"66 1","pages":"107 - 113"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3368/aoj.66.1.107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69587116","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}
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