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Joo J, Kim SY, Kim D, Lee JE, Lee SM, Suh SY, Kim SJ, Kim SC. Enhancing automated strabismus classification with limited data: Data augmentation using StyleGAN2-ADA. PLoS One 2024; 19:e0303355. [PMID: 38787813 PMCID: PMC11125505 DOI: 10.1371/journal.pone.0303355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
In this study, we propose a generative data augmentation technique to overcome the challenges of severely limited data when designing a deep learning-based automated strabismus diagnosis system. We implement a generative model based on the StyleGAN2-ADA model for system design and assess strabismus classification performance using two classifiers. We evaluate the capability of our proposed method against traditional data augmentation techniques and confirm a substantial enhancement in performance. Furthermore, we conduct experiments to explore the relationship between the diagnosis agreement among ophthalmologists and the generation performance of the generative model. Beyond FID, we validate the generative samples on the classifier to establish their practicality. Through these experiments, we demonstrate that the generative model-based data augmentation improves overall quantitative performance in scenarios of extreme data scarcity and effectively mitigates overfitting issues during deep learning model training.
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Affiliation(s)
- Jaehan Joo
- Department of Electronics Engineering, Pusan National University, Busan, Republic of Korea
| | - Sang Yoon Kim
- Department of Ophthalmology, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Donghwan Kim
- Department of Electronics Engineering, Pusan National University, Busan, Republic of Korea
| | - Ji-Eun Lee
- Department of Ophthalmology, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Seung Min Lee
- Department of Ophthalmology, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Su Youn Suh
- Department of Ophthalmology, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Su-Jin Kim
- Department of Ophthalmology, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Suk Chan Kim
- Department of Electronics Engineering, Pusan National University, Busan, Republic of Korea
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Wang H, Zheng W. Effect of the prism and Maddox rod test as the surgical target for type III acute acquired comitant esotropia. Front Med (Lausanne) 2024; 11:1389201. [PMID: 38686368 PMCID: PMC11056567 DOI: 10.3389/fmed.2024.1389201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction This study aims to explore more accurate and efficient examination methods to provide precise target surgical measurements for patients with type III acute acquired comitant esotropia (AACE). Methods The study conducted a retrospective analysis of 108 patients diagnosed with AACE who received surgical treatment at the Department of Ophthalmology, the First Affiliated Hospital of Fujian Medical University, from January 2018 to September 2023. All patients underwent examinations of the deviation angle, including the Hirschberg test, prism and Maddox rod test (PMT), and prism and alternate cover test (PACT). For the PACT, the minimum value (PACTmin) and maximum value (PACTmax) were obtained based on differences in examination methods, as well as the deviation angle range (PACT range), which represents the difference between PACTmax and PACTmin. Postoperatively, these patients were followed up for at least 6 months to assess changes in eye position and whether diplopia symptoms recurred. Results In both near and distant examinations, the results of PACTmax were significantly greater than those of PACTmin (p < 0.001), while the deviation angles obtained from PACTmax and PMT showed no significant statistical difference [p = 0.689 (33 cm), p = 0.436 (5 m)]. There was a strong linear correlation between PACTmin and PMT at both near (R = 0.8887) and distant (R = 0.8950) distances, but each PACTmin corresponded to multiple PMT values. There was no significant difference between the results of PACT range at near and distant distances (p = 0.531). The deviation angles obtained by PMT and PACTmin significantly decreased postoperatively compared to preoperative values, and diplopia disappeared in all patients, with alternative cover test showing no movement or presenting as an esophoria state. Conclusion The PMT can provide precise target surgical measurements for type III AACE, making it a fast, effective, and cost-efficient examination method. It is worthy of being promoted and applied in clinical practice.
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Affiliation(s)
- Huihang Wang
- Department of Ophthalmology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Ophthalmology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Weidong Zheng
- Department of Ophthalmology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Ophthalmology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Tamura K, Kimoto K, Kubota T. Magnetic resonance imaging findings of high myopic strabismus with sagging eye-like symptoms, heavy eye syndrome, and non-highly myopic eyes with sagging eye syndrome. Strabismus 2024; 32:48-53. [PMID: 38357815 DOI: 10.1080/09273972.2024.2314036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Progressive esotropia accompanied by restricted abduction and supraduction due to high myopia is known as esotropia fixus with high myopia or heavy eye syndrome (HES). Some conditions, such as sagging eye syndrome (SES), show esotropia for distance or cyclovertical strabismus with no abduction limitations despite highly myopic eyes. We evaluated the magnetic resonance imaging (MRI) findings and clinical features of HES, high myopia with SES-like symptoms (highly myopic SES), and SES. METHODS We reviewed all patients diagnosed with HES, highly myopic SES, and SES who underwent MRI of the orbits and brain over 6 years. To quantitatively assess the orbital anatomy, we compared the conditions of the superior rectus muscle (SR), lateral rectus muscle (LR), and inferior rectus muscle (IR) using orbital MRI among the three groups. RESULTS Among the 14 patients (27 eyes) with high myopia, 5 (9 eyes) had HES, and 9 (18 eyes) had highly myopic SES. Eleven patients (22 eyes) with SES were also compared with these 14 patients. The mean axial length was 29.6 ± 1.0 mm in participants with HES, 29.0 ± 1.5 mm in those with HES-SES, and 23.7 ± 0.9 mm in those with SES. The average distance esotropia was 48.0 ± 19.9Δprism, 4.6 ± 1.5Δprism, and 6.1 ± 4.6Δprism for participants with HES, highly myopic SES and SES, respectively. The average distance hypertropia was 5.3 ± 5.9Δprism in participants with highly myopic SES and 4.8 ± 2.7Δprism in those with SES. The mean vertical angle of the LR was 32.6 ± 10.8°, 18.1 ± 5.4°, and 14.6 ± 6.8°; the mean tilting angle of the LR was 31.6 ± 9.2°, 15.9 ± 6.0°, and 13.8 ± 5.9°; and the mean displacement angle between the LR and SR was 152.3 ± 16.7°, 125.0 ± 7.1°, and 112.5 ± 7.5° for participants with HES, highly myopic SES and SES, respectively. The LR-SR displacement angle in HES-SES was significantly larger than in SES (p < .001) but the vertical and tilting angles were not. Also, the IR shift showed no significant difference with HES-SES and HES (5.8 ± 1.4 mm and 5.3 ± 1.2 mm) but not with SES (4.0 ± 0.8 mm) (p < .0001). DISCUSSION SES-like symptoms can develop in highly myopic eyes; however, MRI showed that the state of the LR muscle in highly myopic SES deviated almost similarly to that in SES; however, the eyeball was more dislocated than in SES. This may be useful in deciding the appropriate operative procedure.
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Affiliation(s)
- Koichiro Tamura
- Department of Ophthalmology, Oita University of Faculty of Medicine, Japan
| | - Kenichi Kimoto
- Department of Ophthalmology, Oita University of Faculty of Medicine, Japan
| | - Toshiaki Kubota
- Department of Ophthalmology, Oita University of Faculty of Medicine, Japan
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Grudzińska E, Durajczyk M, Grudziński M, Marchewka Ł, Modrzejewska M. Usefulness Assessment of Automated Strabismus Angle Measurements Using Innovative Strabiscan Device. J Clin Med 2024; 13:1067. [PMID: 38398381 PMCID: PMC10889385 DOI: 10.3390/jcm13041067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The variability of the obtained results of manual tests assessing the angle of strabismus depends on the experience, skills, and training of the examiner. The authors hope that this new measuring device will provide a more sensitive and repeatable method for detecting small strabismus angles compared to the gold standard-PCT. The purpose of this article is to present an innovative strabismus angle demonstration device, called Strabiscan, to provide automated measurements of eye deviation and to compare the obtained results of these measurements to the traditional manual method. METHODS For patients with manifest strabismic disease (n = 30) and a group of healthy subjects (n = 30), a detailed history was taken and routine ophthalmologic examinations were performed, including best-corrected distance visual acuity, assessment of refractive error using an autorefractometer after cycloplegia, biomicroscopic evaluation of the anterior segment of the eye and evaluation of the eye fundus by indirect ophthalmoscopy. Subsequently, each patient and healthy subject was subjected to a prismatic cover-uncover test using a manual method, after which the presence of strabismus was detected and its angle assessed using a Strabiscan demonstration device. RESULTS In the control group using the Strabiscan demonstration device, small-angle latent strabismus ≤ 3DP was diagnosed in 83% of patients, while >3DP was found in 13%. In contrast, using the prismatic cover-uncover test, latent strabismus ≤ 3DP was diagnosed in only 13% of patients, and latent strabismus with an angle > 3DP was found in 13% of patients. No statistically significant differences were noted in the measurements of strabismus angles made by the different methods. CONCLUSIONS The Strabiscan demonstration device allows quick and accurate assessment of the strabismus angle. Compared to the prismatic cover-uncover test, it has a higher sensitivity for detecting low-angle latent strabismus. Measurements with the Strabiscan do not require the presence of additional assistants for the test.
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Affiliation(s)
- Ewa Grudzińska
- Second Chair and Department of Ophthalmology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (E.G.); (M.D.)
| | - Magdalena Durajczyk
- Second Chair and Department of Ophthalmology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (E.G.); (M.D.)
| | - Marek Grudziński
- Faculty of Mechanical Engineering and Mechatronics, West Pomeranian University of Technology in Szczecin, 70-310 Szczecin, Poland; (M.G.); (Ł.M.)
| | - Łukasz Marchewka
- Faculty of Mechanical Engineering and Mechatronics, West Pomeranian University of Technology in Szczecin, 70-310 Szczecin, Poland; (M.G.); (Ł.M.)
| | - Monika Modrzejewska
- Second Chair and Department of Ophthalmology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (E.G.); (M.D.)
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Zhou Z, Zhang X, Tang X, Grzybowski A, Ye J, Lou L. Global research of artificial intelligence in strabismus: a bibliometric analysis. Front Med (Lausanne) 2023; 10:1244007. [PMID: 37799591 PMCID: PMC10548140 DOI: 10.3389/fmed.2023.1244007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/05/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose To analyze the global publications on artificial intelligence (AI) in strabismus using a bibliometric approach. Methods The Web of Science Core Collection (WoSCC) database was used to retrieve all of the publications on AI in strabismus from 2002 to 2023. We analyzed the publication and citation trend and identified highly-cited articles, prolific countries, institutions, authors and journals, relevant research domains and keywords. VOSviewer (software) and Bibliometrix (package) were used for data analysis and visualization. Results By analyzing a total of 146 relevant publications, this study found an overall increasing trend in the number of annual publications and citations in the last decade. USA was the most productive country with the closest international cooperation. The top 3 research domains were Ophthalmology, Engineering Biomedical and Optics. Journal of AAPOS was the most productive journal in this field. The keywords analysis showed that "deep learning" and "machine learning" may be the hotspots in the future. Conclusion In recent years, research on the application of AI in strabismus has made remarkable progress. The future trends will be toward optimized technology and algorithms. Our findings help researchers better understand the development of this field and provide valuable clues for future research directions.
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Affiliation(s)
- Ziying Zhou
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, China
| | - Xuan Zhang
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, China
| | - Xiajing Tang
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, China
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Juan Ye
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, China
| | - Lixia Lou
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, China
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Varrone E, Lenhart P, Peragallo J, Hutchinson A, Weil N. Surgical outcomes in sensory exotropia. J AAPOS 2023; 27:147.e1-147.e5. [PMID: 37182651 DOI: 10.1016/j.jaapos.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/15/2023] [Accepted: 04/16/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE To determine success rates over time for strabismus surgery for sensory exotropia and to determine factors associated with successful outcomes. METHODS We retrospectively reviewed medical records of patients with sensory exotropia (best-corrected visual acuity ≤20/200 in the affected eye) who underwent strabismus surgery between May 2009 and December 2019. Patients with paralytic/restrictive exotropia and patients who did not follow up postoperatively were excluded. Surgical success was defined as exotropia of ≤10Δ or esotropia of ≤6Δ. Cox-proportional hazard models were used to evaluate covariate relationships with surgical outcome (α = 0.05). RESULTS A total of 94 patients (64% female) were included. Mean patient age was 27.2 years (range, 3-69). Mean follow-up was 2.35 ± 2.77 years. The mean preoperative near deviation was 39Δ ± 14.8Δ of manifest or intermittent exotropia. Successful alignment was achieved in 51 of 83 patients (61%) at 1 month, 19 of 32 (59%) at 1 year, and 8 of 16 (50%) at 5 years. We found a significant correlation (P value = 0.0476) between success and smaller surgical doses in patients that underwent one- and two-muscle surgeries. CONCLUSIONS In our study cohort of 94 patients, 50% of patients still had satisfactory ocular alignment at 5 years.
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Affiliation(s)
- Emilia Varrone
- Department of Ophthalmology, Virginia Commonwealth University, Richmond, Virginia
| | - Phoebe Lenhart
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Jason Peragallo
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Amy Hutchinson
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Natalie Weil
- Department of Ophthalmology, Children's Hospital of New Orleans, New Orleans, Louisiana; Department of Ophthalmology, Louisiana State University Health Sciences Center, New Orleans; Department of Ophthalmology, Tulane University School of Medicine, New Orleans, Louisiana.
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Automated Mathematical Algorithm for Quantitative Measurement of Strabismus Based on Photographs of Nine Cardinal Gaze Positions. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9840494. [PMID: 35372579 PMCID: PMC8970860 DOI: 10.1155/2022/9840494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
This study presents an automated algorithm that measures ocular deviation quantitatively using photographs of the nine cardinal points of gaze by means of deep learning (DL) and image processing techniques. Photographs were collected from patients with strabismus. The images were used as inputs for the DL segmentation models that segmented the sclerae and limbi. Subsequently, the images were registered for the mathematical algorithm. Two-dimensional sclera and limbus were modeled, and the corneal light reflex points of the primary gaze images were determined. Limbus recognition was performed to measure the pixel-wise distance between the corneal reflex point and limbus center. The segmentation models exhibited high performance, with 96.88% dice similarity coefficient (DSC) for the sclera segmentation and 95.71% DSC for the limbus segmentation. The mathematical algorithm was tested on two cranial nerve palsy patients to evaluate its ability to measure and compare ocular deviation in different directions. These results were consistent with the symptoms of such disorders. This algorithm successfully measured the distance of ocular deviation in patients with strabismus. With complementation in the dimension calculations, we expect that this algorithm can be used further in clinical settings to diagnose and measure strabismus at a low cost.
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Tengtrisorn S, Tungsattayathitthan A, Na Phatthalung S, Singha P, Rattanalert N, Bhurachokviwat S, Chouyjan S. The reliability of the angle of deviation measurement from the Photo-Hirschberg tests and Krimsky tests. PLoS One 2021; 16:e0258744. [PMID: 34851974 PMCID: PMC8635364 DOI: 10.1371/journal.pone.0258744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/01/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To compare the angle of deviation measured from Photo-Hirschberg testing and Krimsky testing, with that from an alternate prism cover test (APCT) in strabismus patients. METHODS A cross-sectional study was conducted in Songklanagarind Hospital, Thailand. Thirty-three strabismus patients were photographed for analysis by Photo-Hirschberg testing using computer software. The corneal light reflex displacement, converted into prism diopter (PD), was compared to the angle of deviation measured with APCT. Twenty-eight strabismus patients were tested with the Krimsky test. Data were analyzed using Pearson correlation and paired t-tests. The study excluded 4 intermittent exotropia cases, 1 intermittent esotropia case and 2 which cases missing data for krimsky test. RESULTS The mean±SD of the deviation angle, measured by APCT with a fixation target at 30 cm and 6 m; were 48.09±16.34PD and 47.82±15.73 PD, respectively. At 1 m, the difference in the angle of deviation measured from APCT and the Photo-Hirschberg test within 10 PD were 58.8% and 63.6%, for ET and XT, respectively. The difference in the angle of deviation measured from APCT and Krimsky tests within 10 PD in ET and XT were 86.7% and 80.0%, respectively. At 4 m, the difference in angle of deviation measured from APCT and Photo-Hirschberg tests within 10 PD in ET and XT were 58.8% and 54.5%, respectively; whereas, the difference in the angle of deviation measured from APCT and Krimsky tests within 10 PD in ET and XT were 80.0% and 70.0%, respectively. CONCLUSION The reliability of Krimsky test was better than Photo-Hirschberg test for measuring an angle of deviation.
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Affiliation(s)
- S. Tengtrisorn
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- * E-mail:
| | - A. Tungsattayathitthan
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - S. Na Phatthalung
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - P. Singha
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - N. Rattanalert
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - S. Bhurachokviwat
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - S. Chouyjan
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Mao K, Yang Y, Guo C, Zhu Y, Chen C, Chen J, Liu L, Chen L, Mo Z, Lin B, Zhang X, Li S, Lin X, Lin H. An artificial intelligence platform for the diagnosis and surgical planning of strabismus using corneal light-reflection photos. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:374. [PMID: 33842595 PMCID: PMC8033395 DOI: 10.21037/atm-20-5442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Strabismus affects approximately 0.8–6.8% of the world’s population and can lead to abnormal visual function. However, Strabismus screening and measurement are laborious and require professional training. This study aimed to develop an artificial intelligence (AI) platform based on corneal light-reflection photos for the diagnosis of strabismus and to provide preoperative advice. Methods An AI platform consisting of three deep learning (DL) systems for strabismus diagnosis, angle evaluation, and operation plannings based on corneal light-reflection photos was trained and retrospectively validated using a retrospective development data set obtained between Jan 1, 2014, and Dec 31, 2018. Corneal light-reflection photos were collected to train the DL systems for strabismus screening and deviation evaluations in the horizontal strabismus while concatenated images (each composed of two photos representing different gaze states) were procured to train the DL system for operative advice regarding exotropia. The AI platform was further prospectively validated using a prospective development data set captured between Sep 1, 2019, and Jun 10, 2020. Results In total, 5,797 and 571 photos were included in the retrospective and prospectively development data sets, respectively. In the retrospective test sets, the screening system detected strabismus with a sensitivity of 99.1% [95% confidence interval (95% CI), 98.1–99.7%], a specificity of 98.3% (95% CI, 94.6–99.5%), and an AUC of 0.998 (95% CI, 0.993–1.000, P<0.001). Compared to the angle measured by the perimeter arc, the deviation evaluation system achieved a level of accuracy of ±6.6º (95% LoA) with a small bias of 1.0º. Compared to the real design, the operation advice system provided advice regarding the target angle within ±5.5º (95% LoA). Regarding strabismus in the prospective test set, the AUC was 0.980. The platform achieved a level of accuracy of ±7.0º (95% LoA) in the deviation evaluation and ±6.1º (95% LoA) in the target angle suggestion. Conclusions The AI platform based on corneal light-reflection photos can provide reliable references for strabismus diagnosis, angle evaluation, and surgical plannings.
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Affiliation(s)
- Keli Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chong Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yi Zhu
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chuan Chen
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jingchang Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Li Liu
- The Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, China
| | - Lifei Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zijun Mo
- Zhongshan Medical School, Sun Yat-sen University, Guangzhou, China
| | - Bingsen Lin
- Zhongshan Medical School, Sun Yat-sen University, Guangzhou, China
| | - Xinliang Zhang
- Zhongshan Medical School, Sun Yat-sen University, Guangzhou, China
| | - Sijin Li
- Zhongshan Medical School, Sun Yat-sen University, Guangzhou, China
| | - Xiaoming Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Zheng C, Yao Q, Lu J, Xie X, Lin S, Wang Z, Wang S, Fan Z, Qiao T. Detection of Referable Horizontal Strabismus in Children's Primary Gaze Photographs Using Deep Learning. Transl Vis Sci Technol 2021; 10:33. [PMID: 33532144 PMCID: PMC7846951 DOI: 10.1167/tvst.10.1.33] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/09/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE This study implements and demonstrates a deep learning (DL) approach for screening referable horizontal strabismus based on primary gaze photographs using clinical assessments as a reference. The purpose of this study was to develop and evaluate deep learning algorithms that screen referable horizontal strabismus in children's primary gaze photographs. METHODS DL algorithms were developed and trained using primary gaze photographs from two tertiary hospitals of children with primary horizontal strabismus who underwent surgery as well as orthotropic children who underwent routine refractive tests. A total of 7026 images (3829 non-strabismus from 3021 orthoptics [healthy] subjects and 3197 strabismus images from 2772 subjects) were used to develop the DL algorithms. The DL model was evaluated by 5-fold cross-validation and tested on an independent validation data set of 277 images. The diagnostic performance of the DL algorithm was assessed by calculating the accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). RESULTS Using 5-fold cross-validation during training, the average AUCs of the DL models were approximately 0.99. In the external validation data set, the DL algorithm achieved an AUC of 0.99 with a sensitivity of 94.0% and a specificity of 99.3%. The DL algorithm's performance (with an accuracy of 0.95) in diagnosing referable horizontal strabismus was better than that of the resident ophthalmologists (with accuracy ranging from 0.81 to 0.85). CONCLUSIONS We developed and evaluated a DL model to automatically identify referable horizontal strabismus using primary gaze photographs. The diagnostic performance of the DL model is comparable to or better than that of ophthalmologists. TRANSLATIONAL RELEVANCE DL methods that automate the detection of referable horizontal strabismus can facilitate clinical assessment and screening for children at risk of strabismus.
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Affiliation(s)
- Ce Zheng
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Ophthalmology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Qian Yao
- Department of Ophthalmology, Zhaoqing Gaoyao People's Hospital, Zhaoqing, Guangdong, China
| | - Jiewei Lu
- Department of Electronic Engineering, Shantou University, Shantou, Guangdong, China
| | - Xiaolin Xie
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou University Medical College, Shantou, Guangdong, China
| | - Shibin Lin
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou University Medical College, Shantou, Guangdong, China
| | - Zilei Wang
- Department of Ophthalmology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Siyin Wang
- Department of Ophthalmology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zhun Fan
- Department of Electronic Engineering, Shantou University, Shantou, Guangdong, China
| | - Tong Qiao
- Department of Ophthalmology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
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11
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Yagasaki T, Yokoyama Y, Tsukui M. Relationship between stereopsis outcome and timing of surgical alignment in infantile esotropia. J AAPOS 2020; 24:78.e1-78.e5. [PMID: 32224285 DOI: 10.1016/j.jaapos.2019.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 12/12/2019] [Accepted: 12/28/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To clarify the relationship between stereopsis outcome and timing of surgical alignment in infantile esotropia. METHODS The medical records of otherwise healthy patients with infantile esotropia who underwent surgery by 8 years of age were divided into the following groups according to age at time of surgery: very early surgery (≤8 months), early surgery (>8 to ≤24 months) and late surgery (>24 months). Binocular response and stereopsis were compared between groups. RESULTS A total of 76 patients were included: 22 in the very early group, 30 in the early group, and 24 in the late group. Binocular response at near was found in 96% of the very early group and in 80% of the early group, significantly higher than the 50% of the late group (P < 0.001 and P < 0.05 [Dunn test], resp.). Stereopsis was present in 77% of the very early group, significantly higher than the 20% of the early group and 13% of the late group (P < 0.001 [Dunn test]). A significant correlation was also found between age (months) at surgery and stereopsis (seconds) outcome (logarithmic fit: y = 2539.4ln(x) + 147.2; R2 = 0.2691; P < 0.001). CONCLUSIONS In this study cohort, earlier surgery was associated with better binocularity in patients with infantile esotropia. Our results suggest that very early surgery, at ≤8 months, can improve the chance for postoperative stereopsis, with the caveat that some infants might have had spontaneous esotropia resolution.
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Affiliation(s)
- Teiji Yagasaki
- Yagasaki Eye Clinic, Ichinomiya, Japan; Department of Ophthalmology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan.
| | - Yoshimi Yokoyama
- Department of Ophthalmology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Makiko Tsukui
- Department of Ophthalmology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
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12
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Hultman O, Beth Høeg T, Munch IC, Ellervik C, la Cour M, Andersson Grönlund M, Buch Hesgaard H. The Danish Rural Eye Study: prevalence of strabismus among 3785 Danish adults - a population-based cross-sectional study. Acta Ophthalmol 2019; 97:784-792. [PMID: 31025814 DOI: 10.1111/aos.14112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 03/19/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To determine the prevalence of strabismus among Danish adults and to find the frequency of history of strabismus and strabismus surgery. Furthermore, to evaluate the prevalence of strabismus-associated amblyopia among participants with strabismus and to relate the results to the current national vision screening programme. METHODS In total, 3785 adults in the Danish Rural Eye Study underwent an interview regarding eye health, visual acuity measurement, Hirschberg test and retinal photography. Participants were categorized into groups based on their birth date in relation to the introduction of the national vision screening programme. RESULTS In total, the prevalence of strabismus was 1.1% (41/3785; 95% CI: 0.8-1.5); no differences were found in relation to gender or screening status. The prevalence of exotropia (XT) was 0.3% (12/3785; 95% CI: 0.2-0.6) and of esotropia (ET) 0.8% (29/3785; 95% CI: 0.5-1.1), resulting in an XT:ET ratio of 1:2.7. A history of strabismus was present in 4.6% (174/3785; 95% CI: 4.0-5.3), and a history of strabismus surgery was present in 0.8% (32/3785; 95% CI: 0.6-1.2) of the participants. Among participants with manifest strabismus, 24% had strabismus-associated amblyopia. CONCLUSION In this first European population-based study of strabismus prevalence in adults, the prevalence was similar to three out of five previous studies using cover test. The use of Hirschberg test may have led to an underestimation of the true prevalence. The prevalence was neither related to screening status nor gender. Our results are the first to display a predominance of ET among Caucasian Scandinavian adults.
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Affiliation(s)
- Oscar Hultman
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
| | - Tracy Beth Høeg
- Department of Physical Medicine & Rehabilitation School of Medicine University of California‐Davis Sacramento California USA
| | - Inger Christine Munch
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Christina Ellervik
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
- Department of Production, Research, and Innovation Region Zealand Sorø Denmark
- Department of Laboratory Medicine Boston Children's Hospital Harvard Medical School Boston Massachusetts USA
| | - Morten la Cour
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
| | - Marita Andersson Grönlund
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- Department of Ophthalmology Sahlgrenska University Hospital Mölndal Sweden
| | - Helena Buch Hesgaard
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- Department of Ophthalmology Sahlgrenska University Hospital Mölndal Sweden
- Copenhagen Eye & Strabismus Clinic Capio‐CFR Hospitals Copenhagen Denmark
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13
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Dericioğlu V, Çerman E. Quantitative measurement of horizontal strabismus with digital photography. J AAPOS 2019; 23:18.e1-18.e6. [PMID: 30682411 DOI: 10.1016/j.jaapos.2018.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 08/10/2018] [Accepted: 08/21/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To develop a method to calculate the gaze angle in photographs and to determine its validity and reliability in real strabismus patients. METHODS Photographs of eyes from 15 orthophoric subjects (n = 1,022) with known gaze angle and imaging distance were investigated with the help of a smartphone application developed by the authors. The application provided measurements of the distance from the geometrical center of the cornea to the light reflex (RD) and corneal diameter (CD). The RD/CD ratio of each gaze angle was recorded. To estimate the eyes' gaze angle, an equation to determine the best-fit line for the gaze angle data according to each RD/CD ratio was created. In a second clinical analysis, this equation was applied to photographs of real strabismus patients (n = 72), and the results were compared with measurements taken by a double-masked strabismus specialist. Separately, an equation was created to calculate the imaging distance using the given interpupillary distance. RESULTS There was a high correlation between the real and estimated gaze angles (r = 0.990, P < 0.001). The mean error of the estimated gaze angle was found to be 0.03Δ ± 4.60Δ. There was a high correlation between the real and estimated imaging distance (r = 0.997, P < 0.001) and a high correlation between the measurements of the application and the specialist (r = 0.966, P < 0.001). The average error was -0.68 Δ ± 6.1Δ, and the reliability was high (Cronbach's α = 0.983). CONCLUSIONS The application measured horizontal strabismus in photographs with high reliability.
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Affiliation(s)
| | - Eren Çerman
- Marmara University School of Medicine, Istanbul, Turkey.
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Ban JH, Moon SH. The Analysis of Ocular Deviations between Dominant and Non-dominant Eye Using Video-oculography in Intermittent Exotropia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.7.685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ji Hoon Ban
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Hyuk Moon
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Jethani J, Dave P. The subjectivity of objective evaluation of torsion on fundus photographs by practicing strabismologists. Indian J Ophthalmol 2018; 66:1301-1303. [PMID: 30127145 PMCID: PMC6113826 DOI: 10.4103/ijo.ijo_182_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To assess the variability of assessing the ocular torsion on fundus photographs among strabismus surgeons. Methods: This was a prospective, noninterventional, clinical trial involving 16 trained and experienced squint surgeons participated in the study. Two videos were prepared of a total of 10 fundus pictures with or without lines for disc foveal angle. The first video had a 4 s viewing time for each fundus image. The second video had the disc foveal lines drawn and a similar 4 s viewing time for each image. The participants were asked to grade the torsion. The primary outcome measure was to assess the agreement between the raters for ocular torsion measurement. Difference in the response of observers from the standard response was the secondary outcome measure. Results: A 4 s viewing time was given to mimic the exposure time in the clinic while assessing torsion in a patient. Large variability was found among the responses. The kappa test was done for comparing the agreement between various observers which ranged from slight to fair (<0.40). There was no difference in torsion grading in 30.6% and 26.3% responses in the first and second video from the standard response, respectively. When a limit of ±1 grade was taken as acceptable for the responses, 66.2% for the first and 68.7% for the second video respectively were similar to standard response. Conclusion: There is wide variability in assessing ocular torsion by fundus photography. The level of accuracy does increase with marking the line on photographs but still remains unreliable.
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Affiliation(s)
- Jitendra Jethani
- Department of Paediatric Ophthalmology and Squint, Dr. Thakorbhai V Patel Eye Institute, Vadodara, Gujarat, India
| | - Paaraj Dave
- Department of Pediatric Ophthalmology and Strabismus, Dr. Thakorbhai V Patel Eye Institute, Vadodara, Gujarat, India
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Park N, Park B, Oh M, Moon S, Kim M. A quantitative analysis method for comitant exotropia using video-oculography with alternate cover. BMC Ophthalmol 2018; 18:80. [PMID: 29566654 PMCID: PMC5863817 DOI: 10.1186/s12886-018-0747-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 03/16/2018] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of this study was to evaluate the efficacy of a quantitative analysis method for comitant exotropia using video-oculography (VOG) with alternate cover. Methods Thirty-four subjects with comitant exotropia were included. Two independent ophthalmologists measured the angle of ocular deviation using the alternate prism cover test (APCT). The video files and data of changes in ocular deviation during the alternate cover test were obtained using VOG. To verify the accuracy of VOG, the value obtained using VOG and the angle of a rotating model eye were compared, and a new linear equation was subsequently derived using these data. The calculated values obtained using VOG were compared with those obtained using the APCT. Results Rotation of the model eye and the values obtained using VOG demonstrated excellent positive correlation (R = 1.000; p < 0.001). A simple linear regression model was obtained: rotation of the model eye = 0.978 × value obtained using VOG for a model eye – 0.549. The 95% limit of agreement for inter-observer variability was ±4.63 prism diopters (PD) for APCT and that for test-retest variability was ±3.56 PD for the VOG test. The results of APCT and calculated VOG test demonstrated a strong positive correlation. Bland-Altman plots revealed no overall tendency for the calculated values obtained from VOG to differ from those obtained using APCT. Conclusions VOG with alternate cover is a non-invasive and accurate tool for quantitatively measuring and recording ocular deviation. In particular, it is independent of the proficiency of the examiner and, can therefore, be useful in the absence of skilled personnel. Trial registration ClinicalTrial.gov, NCT03119311, Date of registration: 04/17/2017, Date of enrolment of the first participant to the trial: 04/25/2017.
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Affiliation(s)
- Nohae Park
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea
| | - Byunggun Park
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea
| | - Minkyung Oh
- Department of Pharmacology, Busan Paik Hospital, Inje University College of medicine, Busan, Republic of Korea
| | - Sunghyuk Moon
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea.
| | - Myungmi Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Republic of Korea
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Hull S, Tailor V, Balduzzi S, Rahi J, Schmucker C, Virgili G, Dahlmann‐Noor A. Tests for detecting strabismus in children aged 1 to 6 years in the community. Cochrane Database Syst Rev 2017; 11:CD011221. [PMID: 29105728 PMCID: PMC6486041 DOI: 10.1002/14651858.cd011221.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Strabismus (misalignment of the eyes) is a risk factor for impaired visual development both of visual acuity and of stereopsis. Detection of strabismus in the community by non-expert examiners may be performed using a number of different index tests that include direct measures of misalignment (corneal or fundus reflex tests), or indirect measures such as stereopsis and visual acuity. The reference test to detect strabismus by trained professionals is the cover‒uncover test. OBJECTIVES To assess and compare the accuracy of tests, alone or in combination, for detection of strabismus in children aged 1 to 6 years, in a community setting by non-expert screeners or primary care professionals to inform healthcare commissioners setting up childhood screening programmes.Secondary objectives were to investigate sources of heterogeneity of diagnostic accuracy. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 12) (which contains the Cochrane Eyes and Vision Trials Register) in the Cochrane Library, the Health Technology Assessment Database (HTAD) in the Cochrane Library (2016, Issue 4), MEDLINE Ovid (1946 to 5 January 2017), Embase Ovid (1947 to 5 January 2017), CINAHL (January 1937 to 5 January 2017), Web of Science Conference Proceedings Citation Index-Science (CPCI-S) (January 1990 to 5 January 2017), BIOSIS Previews (January 1969 to 5 January 2017), MEDION (to 18 August 2014), the Aggressive Research Intelligence Facility database (ARIF) (to 5 January 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 5 January 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 5 January 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 5 January 2017. We did not use any date or language restrictions in the electronic searches for trials. In addition, orthoptic journals and conference proceedings without electronic listings were searched. SELECTION CRITERIA All prospective or retrospective population-based test accuracy studies of consecutive participants were included. Studies compared a single or combination of index tests with the reference test. Only those studies with sufficient data for analysis were included specifically to calculate sensitivity and specificity and determine diagnostic accuracy.Participants were aged 1 to 6 years. Studies reporting participants outside this range were included if subgroup data were available.Permitted settings included population-based vision screening programmes or opportunistic screening programmes, such as those performed in schools. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. In brief, two review authors independently assessed titles and abstracts for eligibility and extracted the data, with a third senior author resolving any disagreement. We analysed data primarily for specificity and sensitivity. MAIN RESULTS One study from a total of 1236 papers, abstracts and trials was eligible for inclusion with a total number of participants of 335 of which 271 completed both the screening test and the gold standard test. The screening test using an automated photoscreener had a sensitivity of 0.46 (95% confidence interval (CI) 0.19 to 0.75) and specificity of 0.97 (CI 0.94 to 0.99). The overall number affected by strabismus was low at 13 (4.8%). AUTHORS' CONCLUSIONS There is very limited data in the literature to ascertain the accuracy of tests for detecting strabismus in the community as performed by non-expert screeners. A large prospective study to compare methods would be required to determine which tests have the greatest accuracy.
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Affiliation(s)
- Sarah Hull
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
| | - Vijay Tailor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
| | - Sara Balduzzi
- University of Modena and Reggio EmiliaCochrane Italy, Department of Diagnostic, Clinical and Public Health MedicineVia del Pozzo 71ModenaItaly41124
| | - Jugnoo Rahi
- UCL Institute of Child Health and UCL Institute of OphthalmologyDepartment of EpidemiologyLondonUK
| | - Christine Schmucker
- Medical Center – Univ. of Freiburg, Faculty of Medicine, Univ. of FreiburgCochrane GermanyBreisacher Straße 153FreiburgGermany79110
| | - Gianni Virgili
- University of FlorenceDepartment of Translational Surgery and Medicine, Eye ClinicLargo Brambilla, 3FlorenceItaly50134
| | - Annegret Dahlmann‐Noor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
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18
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Wallace DK, Christiansen SP, Sprunger DT, Melia M, Lee KA, Morse CL, Repka MX. Esotropia and Exotropia Preferred Practice Pattern®. Ophthalmology 2017; 125:P143-P183. [PMID: 29108746 DOI: 10.1016/j.ophtha.2017.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- David K Wallace
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephen P Christiansen
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
| | - Derek T Sprunger
- Indiana University Health Physicians, Midwest Eye Institute, Indianapolis, Indiana
| | | | - Katherine A Lee
- Pediatric Ophthalmology, St. Luke's Health System, Boise, Idaho
| | | | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
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Sethi H, Naik M, Joshi M. Modified Krimsky test for irregular scarred corneas. Int Ophthalmol 2016; 37:1243-1245. [PMID: 27826935 DOI: 10.1007/s10792-016-0392-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
The measurement of the amount and nature of deviation is the essence of diagnostic workup of a patient with strabismus and also has important therapeutic implications while planning the amount of surgery or prescribing therapeutic prisms. Although Krimsky test is a useful method, it cannot be used to measure deviation in patients with scarred and irregular cornea with an anechoic posterior segment making it difficult to see the corneal reflex. We hereby take the opportunity to present a modification of the original Krimsky test which is extremely helpful in determining the deviation in patients with irregular opaque corneas.
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Affiliation(s)
- Harindersingh Sethi
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Ring Road, Ansari Nagar, New Delhi, 110029, India
| | - Mayuresh Naik
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Ring Road, Ansari Nagar, New Delhi, 110029, India. .,Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Room No. 430 of Eye OPD, 4th Floor of OPD Building, Ring Road, Ansari Nagar, New Delhi, 110029, India.
| | - Mukesh Joshi
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Ring Road, Ansari Nagar, New Delhi, 110029, India
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20
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Bušić M, Bjeloš M, Petrovečki M, Kuzmanović Elabjer B, Bosnar D, Ramić S, Miletić D, Andrijašević L, Kondža Krstonijević E, Jakovljević V, Bišćan Tvrdi A, Predović J, Kokot A, Bišćan F, Kovačević Ljubić M, Motušić Aras R. Zagreb Amblyopia Preschool Screening Study: near and distance visual acuity testing increase the diagnostic accuracy of screening for amblyopia. Croat Med J 2016; 57:29-41. [PMID: 26935612 PMCID: PMC4800325 DOI: 10.3325/cmj.2016.57.29] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To present and evaluate a new screening protocol for amblyopia in preschool children. METHODS Zagreb Amblyopia Preschool Screening (ZAPS) study protocol performed screening for amblyopia by near and distance visual acuity (VA) testing of 15 648 children aged 48-54 months attending kindergartens in the City of Zagreb County between September 2011 and June 2014 using Lea Symbols in lines test. If VA in either eye was >0.1 logMAR, the child was re-tested, if failed at re-test, the child was referred to comprehensive eye examination at the Eye Clinic. RESULTS 78.04% of children passed the screening test. Estimated prevalence of amblyopia was 8.08%. Testability, sensitivity, and specificity of the ZAPS study protocol were 99.19%, 100.00%, and 96.68% respectively. CONCLUSION The ZAPS study used the most discriminative VA test with optotypes in line as they do not underestimate amblyopia. The estimated prevalence of amblyopia was considerably higher than reported elsewhere. To the best of our knowledge, the ZAPS study protocol reached the highest sensitivity and specificity when evaluating diagnostic accuracy of VA tests for screening. The pass level defined at ≤0.1 logMAR for 4-year-old children, using Lea Symbols in lines missed no amblyopia cases, advocating that both near and distance VA testing should be performed when screening for amblyopia.
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Affiliation(s)
| | - Mirjana Bjeloš
- Mirjana Bjeloš, University Eye Clinic, University Hospital "Sveti Duh", Sveti Duh 64, Zagreb, Croatia,
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Abstract
IMPORTANCE In strabismus, the fixating eye conveys the direction of gaze while the fellow eye points at a peripheral location in space. The stability of the eyes may be reduced by the absence of a common target. OBJECTIVE To quantify the stability of eye position in strabismus and to measure variability in the ocular deviation. DESIGN, SETTING, AND PARTICIPANTS From 2010 to 2014, a prospective comparative case study of 25 patients with alternating exotropia with normal visual acuity in each eye and 25 control individuals was conducted in a laboratory at a tertiary eye center. A video eye tracker was used to measure the position of each eye while participants alternated fixation on the center of a cross under dichoptic conditions or scanned pictures of natural scenes. MAIN OUTCOMES AND MEASURES Spatial and temporal variability in the position of the fixating eye and the nonfixating eye in patients with strabismus and control individuals, quantified by the log area of ellipses containing 95% of eye positions or mean SDs of eye position. RESULTS In the 25 patients with strabismus, the mean (SD) age was 28 (14) years (range, 8-55 years) and the mean (SD) ocular deviation was 14.2° (5.9°) (range, 4.4°-22.4°). In the patients with strabismus, the mean position variability (1.80 log units; 95% CI, 1.66-1.93) for the deviating eye was greater than for the fixating eye (1.26 log units; 95% CI, 1.17-1.35) (P < .001). The fixating eye of patients with strabismus was more variable in position than the fixating eye of individuals without strabismus (0.98 log units; 95% CI, 0.88-1.08) (P < .005). CONCLUSIONS AND RELEVANCE In patients with strabismus, even without amblyopia, the deviated eye is more variable in position than the fixating eye. Both eyes are less stable in position than the eyes of control individuals, which indicates that strabismus impairs the ability to fixate targets steadily. Saccades contribute to variability of the deviation angle because they are less conjugate in patients with strabismus.
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Affiliation(s)
- John R Economides
- Department of Ophthalmology, University of California, San Francisco
| | - Daniel L Adams
- Department of Ophthalmology, University of California, San Francisco2Center for Mind/Brain Sciences, The University of Trento, Trento, Italy
| | - Jonathan C Horton
- Department of Ophthalmology, University of California, San Francisco
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Sousa de Almeida JD, Silva AC, Teixeira JAM, Paiva AC, Gattass M. Computer-Aided Methodology for Syndromic Strabismus Diagnosis. J Digit Imaging 2016; 28:462-73. [PMID: 25561067 DOI: 10.1007/s10278-014-9758-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Strabismus is a pathology that affects approximately 4 % of the population, causing aesthetic problems reversible at any age and irreversible sensory alterations that modify the vision mechanism. The Hirschberg test is one type of examination for detecting this pathology. Computer-aided detection/diagnosis is being used with relative success to aid health professionals. Nevertheless, the routine use of high-tech devices for aiding ophthalmological diagnosis and therapy is not a reality within the subspecialty of strabismus. Thus, this work presents a methodology to aid in diagnosis of syndromic strabismus through digital imaging. Two hundred images belonging to 40 patients previously diagnosed by an specialist were tested. The method was demonstrated to be 88 % accurate in esotropias identification (ET), 100 % for exotropias (XT), 80.33 % for hypertropias (HT), and 83.33 % for hypotropias (HoT). The overall average error was 5.6Δ and 3.83Δ for horizontal and vertical deviations, respectively, against the measures presented by the specialist.
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Affiliation(s)
- João Dallyson Sousa de Almeida
- Applied Computing Group-NCA, Federal University of Maranhão - UFMA, Av. dos Portugueses, SN, Campus do Bacanga, 65085-580, São Luís, MA, Brazil,
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23
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Abstract
Potential errors and complications during examination and treatment of strabismic patients can be reduced by recognition of certain optical issues. This articles reviews basic as well as guiding principles of prism optics and optics of the eye to equip the reader with the necessary know-how to avoid pitfalls that are commonly encountered when using prisms to measure ocular deviations (e.g., during cover testing), and when observing the corneal light reflex to estimate ocular deviations (e.g., during Hirschberg or Krimsky testing in patients who do not allow for cover testing using prisms).
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Affiliation(s)
- Kristina Irsch
- Laboratory of Ophthalmic Instrument Development, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA ; Clinical Investigation Center - CIC 1423 INSERM, Quinze-Vingts National Eye Hospital, Paris, France
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SR and LR Union Suture for the Treatment of Myopic Strabismus Fixus: Is Scleral Fixation Necessary? BIOMED RESEARCH INTERNATIONAL 2015; 2015:470473. [PMID: 25954751 PMCID: PMC4410502 DOI: 10.1155/2015/470473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/12/2015] [Accepted: 03/19/2015] [Indexed: 11/20/2022]
Abstract
Purpose. To evaluate and compare the effectiveness of scleral fixation SR and LR union suture and nonscleral fixation union suture for the treatment of myopic strabismus fixus. Methods. Retrospective review of 32 eyes of 22 patients with myopic strabismus fixus who had undergone union suture of superior rectus (SR) and lateral rectus (LR) with or without scleral fixation, and follow-up longer than 6 months at Hong Kong Eye Hospital from 2006 to 2013. Surgical techniques and outcomes in terms of ocular alignment are analyzed. Results. There is significant overall improvement both in postoperative angle of esodeviation (P < 0.01) and postoperative range of movement (P = 0.042). Comparing between the sclera fixation group (11 eyes) versus nonscleral fixation group (21 eyes), the postoperative horizontal deviation, the postoperative vertical deviation, successful outcome, and the change in horizontal deviation were not significantly different (P > 0.05). Conclusions. Union suture of SR and LR is an effective procedure in correcting myopic strabismus fixus. Fixation of the union suture to the sclera does not improve surgical outcome.
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Al Oum M, Donati S, Cerri L, Agosti M, Azzolini C. Ocular alignment and refraction in preterm children at 1 and 6 years old. Clin Ophthalmol 2014; 8:1263-8. [PMID: 25061274 PMCID: PMC4086852 DOI: 10.2147/opth.s59208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate cycloplegic refraction and ocular alignment in a population of preterm children at 1 and 6 years old. Patients and methods We included 261 preterm infants with a birth weight ≤1,500 g and a gestational age ≤32 weeks; there were 217 preterm infants (group 1), 28 preterm infants with mild retinopathy of prematurity (ROP) (group 2), and 16 preterm infants affected by severe ROP (group 3). Each patient underwent retinoscopy, ocular alignment assessment, and fundus examination at 1 and 6 years old. Results The prevalence of refractive errors and ocular alignment abnormalities at 1 year old in groups 2 and 3 compared to group 1 were, respectively (P<0.05): myopia 18% and 40.6% versus 6.9%; hyperopia 28.6% and 22% versus 39.2%; astigmatism 53.4% and 37.4% versus 53.9%; and strabismus 12.5% and 38% versus 5.3%. At 6 years old, they were, respectively (P<0.05): myopia 10.8% and 28.4% versus 7.4%; hyperopia 48.3% and 40.5% versus 62%; astigmatism 40.9% and 31.1% versus 30.6%; and strabismus 25% and 56.25% versus 11.5%. Conclusion At 6 years old, we observed increased rates of both hyperopia and strabismus in all groups compared to 1-year-old children. In preterm children with mild and severe ROP, we recorded increased rates of myopia and strabismus versus preterm children without ROP, and the risk of developing these disorders increased significantly with ROP severity. Astigmatism at 1 year old is not predictive of further development during growth. Patients born prematurely should be informed of the possible risks of ocular alterations due to refractive and ocular component changes.
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Affiliation(s)
- Muna Al Oum
- Department of Surgical and Morphological Sciences, Section of Ophthalmology, School of Medicine, University of Insubria, Varese, Italy
| | - Simone Donati
- Department of Surgical and Morphological Sciences, Section of Ophthalmology, School of Medicine, University of Insubria, Varese, Italy
| | - Luigi Cerri
- Department of Surgical and Morphological Sciences, Section of Ophthalmology, School of Medicine, University of Insubria, Varese, Italy
| | - Massimo Agosti
- Neonatology Unit, Ospedale Filippo Del Ponte, Varese, Italy
| | - Claudio Azzolini
- Department of Surgical and Morphological Sciences, Section of Ophthalmology, School of Medicine, University of Insubria, Varese, Italy
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Joo KS, Koo H, Moon NJ. Measurement of strabismic angle using the distance Krimsky test. KOREAN JOURNAL OF OPHTHALMOLOGY 2013; 27:276-81. [PMID: 23908574 PMCID: PMC3730070 DOI: 10.3341/kjo.2013.27.4.276] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 11/29/2012] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the correlation of the distance Krimsky test and the alternate prism cover test (APCT) for the distance deviation in patients with horizontal strabismus. METHODS Forty patients with horizontal strabismus (20 esotropia and 20 exotropia) were included in this study. Patients with a variable angle of deviation, vertical angle over 5 prism diopters, impaired binocular vision, or poor cooperation were excluded. We instructed the patient to look a target 6 meters away, and applied a prism over the patient's dominant eye while flashing a light source 33 centimeters from the middle of both eyebrows. When the corneal light reflexes were located on the center of each cornea, we measured the angle of deviation. We defined this method as 'distance Krimsky test,' and the angle measured by this method was compared with the conventional Krimsky test and APCT at distance. We analyzed the accuracy and intra- and inter-observer reliability. RESULTS The angle of strabismus measured by the distance Krimsky test showed a significant agreement and correlation with the deviation angle measured by the APCT. We elicited the correlation gradient between the angle measured by the distance Krimsky test and the APCT. In addition, the distance Krimsky test showed significant intra- and inter-observer reliabilities. CONCLUSIONS The distance Krimsky test is expected to be more useful than the Krimsky test in measuring the distance angle of deviation for patients with strabismus in whom it is difficult to measure the angle of deviation using the APCT. The distance Krimsky test can be an accurate and useful test through the improvement of proficiency of examiners and the establishment of individualized normative data.
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Affiliation(s)
- Kwang Sic Joo
- Department of Ophthalmology, Chung-Ang University Hospital, Seoul, Korea
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Influence of timing of initial surgery for infantile esotropia on the severity of dissociated vertical deviation. Jpn J Ophthalmol 2011; 55:383-388. [DOI: 10.1007/s10384-011-0043-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 02/22/2011] [Indexed: 11/27/2022]
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Abstract
PURPOSE The purpose of this study was to determine whether an equal amount of exotropia (XT) or esotropia (ET) produces a more noticeable eye turn, which gives the better impression of eye contact, and how a positive angle kappa (K) affects this judgment. METHODS Images from a white male model were manipulated to simulate 0, 5, 10, and 15° of ET and XT for both 0 and +5° K. A series of image pairs was then created that juxtaposed XT and ET of equal angles for both 0 and +5° K. Forty-five optometry students then judged which image in each pair appeared to have the greater tropia and which gave the greater impression of eye contact. RESULTS When angle kappa was 0, there was no significant difference in whether XT or ET appeared to be more noticeable. However, when angle kappa was +5°, an XT of 5° or greater became more apparent than an equal ET (p < 0.001). However, when the criterion was eye contact, ET gave the greater impression that eye contact was being made when the deviation was 10° or more, and this was true for both 0 and +5° K (p < 0.001). CONCLUSIONS When a strabismus is to be evaluated or corrected purely for cosmetic reasons, the results may differ depending on the value of angle kappa and whether the criterion for good cosmesis is ocular deviation or eye contact.
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Abstract
A novel automated method to measure eye misalignment in infants is presented. The method uses estimates of the Hirschberg ratio (HR) and angle Kappa (the angle between the visual and optical axis) for each infant to calculate the angle of eye misalignment. The HR and angle Kappa are estimated automatically from measurements of the direction of the optical axis and the coordinates of the center of the entrance pupil and corneal reflexes in each eye when infants look at a set of images that are presented sequentially on a computer monitor. The HR is determined by the slope of the line that describes the direction of the optical axis as a function of the distance between the center of the entrance pupil and the corneal reflexes. The peak of the distribution of possible angles Kappa during the image presentation determines the value of angle Kappa. Experiments with five infants showed that the 95% limits of agreement between repeated measurements of angle Kappa are ± 0.61 (°). The maximum error in the estimation of eye alignment in orthotropic infants was 0.9 (°) with 95% limits of agreement between repeated measurements of 0.75 (°).
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Affiliation(s)
- Dmitri Model
- Department of Electrical and Computer Engineering,University of Toronto, Toronto, ON M5S 3G4, Canada.
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National Retinoblastoma Strategy Canadian Guidelines for Care: Stratégie thérapeutique du rétinoblastome guide clinique canadien. Can J Ophthalmol 2010; 44 Suppl 2:S1-88. [PMID: 20237571 DOI: 10.3129/i09-194] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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The neuro-ophthalmic examination. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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White JJE, Gole GA. Combining the Bruckner reflex and Krimsky test for measuring the angle of strabismus. Clin Exp Ophthalmol 2009; 37:633-4. [PMID: 19702721 DOI: 10.1111/j.1442-9071.2009.02064.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aring E, Grönlund MA, Andersson S, Hård AL, Ygge J, Hellström A. Strabismus and Binocular Functions in a Sample of Swedish Children Aged 4–15 Years. Strabismus 2009; 13:55-61. [PMID: 16020358 DOI: 10.1080/09273970590922664] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate strabismus, head posture, nystagmus, stereoacuity, ocular motility, near point of convergence (NPC) and accommodative convergence to accommodation ratio (AC/A) in a sample of Swedish children. METHODS A prospective cross-sectional study was carried out on 143 children, 4-15 years of age. RESULTS Heterotropia was found in five children (3.5%), four with esotropia and one with exotropia. One child with esotropia had a slight overaction of both inferior oblique muscles. Heterophoria was found in 37 children (26%) at near and/or distance fixation and it was four times more common at near than at distance. In 29 children, heterophoria was found at one distance only and orthophoria at the other. Orthophoria at both near and distance fixation was noted in 101 children (70.5%). The near point of convergence was < or =6 cm in 97% of the children and 97% had stereoacuity of 60" or better. In the whole group, the median AC/A ratio calculated with the heterophoria method was 5.6/1 prism diopters/diopters (PD/D) and with the gradient method, 1.3/1 PD/D. No anomalous head postures or nystagmus were observed and all children had normal versions. CONCLUSION In this study, 143 well-defined children were investigated with a battery of accurately described tests, commonly used in clinical practice. These results are in agreement with those of other studies examining one or few variables in larger populations and the authors therefore conclude that their results may be used for comparisons with different patient groups.
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Affiliation(s)
- Eva Aring
- Institute of Clinical Neuroscience, Section of Ophthalmology, Department of Paediatrics, The Sahlgrenska Academy at Göteborg University, Ostra, SE-416 85 Göteborg, Sweden.
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Rauscher FM, Gedde SJ, Schiffman JC, Feuer WJ, Barton K, Lee RK. Motility disturbances in the tube versus trabeculectomy study during the first year of follow-up. Am J Ophthalmol 2009; 147:458-66. [PMID: 19038375 DOI: 10.1016/j.ajo.2008.09.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 09/09/2008] [Accepted: 09/11/2008] [Indexed: 02/06/2023]
Abstract
PURPOSE To describe the preoperative and postoperative motility disturbances encountered in the Tube Versus Trabeculectomy (TVT) Study during the first year of follow-up. DESIGN Multicenter randomized clinical trial. METHODS settings: Seventeen clinical centers. population: Patients 18 to 85 years old who had previous trabeculectomy and/or cataract surgery and uncontrolled glaucoma with intraocular pressure > or =18 mm Hg and < or =40 mm Hg on maximum tolerated medical therapy. interventions: 350-mm(2) Baerveldt glaucoma implant or trabeculectomy with mitomycin C (MMC). main outcome measures: Preoperative and postoperative evaluation of ocular motility and diplopia. RESULTS Motility disturbances were detected in 55 patients (28%) at baseline. New-onset persistent diplopia was reported in 5 patients (5%) in the tube group and no patients in the trabeculectomy group at 1 year (P = .06). A new postoperative motility disturbance developed or worsened in 7 patients (9.9%) in the tube group and no patients in the trabeculectomy group during the first year of follow-up (P = .005). Postoperative motility disturbances were also associated with increasing age (P < .001) and right eye surgery (P = .044). CONCLUSIONS Preoperative motility disturbances were common among patients in the TVT Study. New postoperative motility disturbances were more frequent following tube shunt surgery than trabeculectomy with MMC after 1 year of follow-up.
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Millán T, de Carvalho KM, Minguini N. Results of monocular surgery under peribulbar anesthesia for large-angle horizontal strabismus. Clinics (Sao Paulo) 2009; 64:303-8. [PMID: 19488586 PMCID: PMC2694455 DOI: 10.1590/s1807-59322009000400006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Accepted: 12/26/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the results of monocular surgery under peribulbar anesthesia for large-angle horizontal strabismus. INTRODUCTION Monocular surgery may preserve some muscles if a repeat operation is required, may help to avoid the exposure of the dominant eye to the inherent risks of a surgical procedure and may reduce surgical time. METHODS We evaluated ninety-two consecutive patients who underwent monocular surgery under peribulbar anesthesia for large-angle horizontal strabismus (angle of 40 prism diopters or greater). Patients were divided into group 1- esotropia and group 2 -exotropia. The postoperative follow-up was at 6 months, when the residual deviation was evaluated. In cases of residual deviations of over 15 PD (prism diopter), a second procedure was indicated. RESULTS In all patients with preoperative deviations up to 60 PD, residual deviations were under 15 PD. Some patients with preoperative deviations of 65 PD (two in group 1 and four in group 2) and all patients with deviations over 65 PD had residual deviations over 15 PD. The 13 patients who underwent a second procedure experienced successful outcomes. Our ROC curve analysis showed that the cutoff point for obtaining a successful surgical result was 62.5 PD. No patient presented with a major limitation in respect of ocular movement. CONCLUSIONS Monocular surgery under peribulbar anesthesia can be an alternative for horizontal large-angle strabismus given deviations of up to 60 PD. Monocular surgery did not result in successful outcomes for deviations of over 65 PD.
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Affiliation(s)
- Tatiana Millán
- Ophthalmology Department, UNICAMP, Campinas, SP, Brazil.
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Hong JP, Rhiu SLN, Chang YH, Chang JH, Lee JB. Intraoperative Adjustment in Horizontal Strabismus Surgery Using Corneal Reflex. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.1.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jin Pyo Hong
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Lie Nah Rhiu
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Chang
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Jee Ho Chang
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Bucheon, Korea
| | - Jong Bok Lee
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Birch EE, Felius J, Stager DR, Weakley DR, Bosworth RG. Pre-operative stability of infantile esotropia and post-operative outcome. Am J Ophthalmol 2004; 138:1003-9. [PMID: 15629292 DOI: 10.1016/j.ajo.2004.07.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2004] [Indexed: 11/16/2022]
Abstract
PURPOSE To define the prevalence and time course of significant changes in angle of deviation during the first months after the diagnosis of infantile esotropia and to determine whether long-term alignment and sensory outcomes differ when surgical alignment is performed on infants with stable vs unstable angles of deviation. DESIGN Prospective cohort study. METHODS setting: Institutional and clinical practice. patient population: Newly diagnosed patients with infantile esotropia (N = 208). observation procedure: Preoperative measurements of the angle of deviation on the initial visit and at approximate six-week intervals until surgery was performed. main outcome measures: Ocular alignment at six weeks, one year, and four years postoperative and stereoacuity at age five to nine years. RESULTS Overall, 57% of infants had an esodeviation on the second visit that was within 10 prism diopters (p.d.) of the deviation measured on the initial visit (stable group), 33% had an increase of 10 p.d. or more (unstable group), and 11% had a decrease of 10 p.d. or more. Among the 127 patients with additional preoperative visits, many switched between the stable and unstable categories during follow-up. Long-term, stable and unstable preoperative alignment groups had similar postoperative motor alignment, re-operation rates, rates of prescription of hyperopic, or bifocal spectacle correction and stereoacuity. CONCLUSIONS It may not be necessary to wait for a "stable" angle of esodeviation before surgery since both alignment and sensory outcomes were similar for stable and unstable groups.
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Affiliation(s)
- Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas 75231, USA.
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Abstract
BACKGROUND Albinism is an inherited disorder of deficient melanin production. There is a high prevalence of strabismus in patients with albinism. We investigated the prevalence of a positive angle kappa in patients with albinism and report its effect on assessment of binocular alignment. METHODS We retrospectively reviewed the charts of 207 consecutive patients with the diagnosis of albinism seen at the University of Minnesota between 1984 and 2002. Angle kappa and alignment using prism and alternate-cover test (PACT) and Krimsky measurements were recorded. RESULTS In 99.6% of our patients with albinism, angle kappa was noted to be positive. The mean difference between PACT and Krimsky measurements was 17.11 prism diopters in the more exotropic (or less esotropic) direction per Krimsky test. Because of the high prevalence of a positive angle kappa, esodeviations often appeared less and exodeviations appeared greater than when measured using PACT. CONCLUSIONS Positive angle kappa can be considered another clinical feature of albinism. Consideration should be given to the effect of positive angle kappa on alignment as observed by Krimsky measurement when planning extraocular muscle surgery, particularly when preoperative sensory testing suggests binocular potential.
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Affiliation(s)
- Kimberly S Merrill
- Department of Ophthalmology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
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Forrest MP, Finnigan S, Finnigan S, Gole GA. Three horizontal muscle squint surgery for large angle infantile esotropia. Clin Exp Ophthalmol 2004; 31:509-16. [PMID: 14641159 DOI: 10.1046/j.1442-9071.2003.00713.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND To report the long-term outcome of a series of 49 patients who underwent three horizontal muscle squint surgery for large angle infantile esotropia. METHODS; The patient records were retrospectively reviewed of 49 (24 girls [49%], 25 boys) consecutive patients with infantile esotropia of angle > or =60 Delta, who had undergone three horizontal muscle surgery performed by one surgeon (author GG). Surgery consisted of bilateral medial rectus recession combined with graded unilateral lateral rectus resection. Surgeries were carried out over a 6-year period with a mean follow-up period of 32.9 months (3.7-71.8 months). RESULTS Using Kaplan-Meier life-table analysis, cumulative surgical success (orthotropia +/-10 Delta) was 93.9% at 1 week, 91.8% at 2 and 6 months, 87.7% at 12 and 18 months, 79.9% at 2 years, 77.1% at 3, 4 and 5 years, and 70.6% at 6 years. The mean preoperative deviation was 68.7 Delta. The mean age at surgery was 12.9 months. The failure rate was independent of preoperative deviation. Prevalence of residual esotropia (>10 Delta) varied from 2.0% at 1 week to 17.0% at 6 years. Similarly the prevalence of consecutive exotropia (>10 Delta) varied from 4.0% at 1 week to 12.4% at 6 years. CONCLUSION; Operating in a graded fashion on three horizontal muscles in children with large angle infantile esotropia has a high success rate, even over long-term follow up. Based on the study's results, amounts of surgery for a given angle of strabismus are proposed.
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Affiliation(s)
- Michael P Forrest
- Great Ormond Street Hospital for Children, Great Ormond Street, London, UK
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Deacon MA, Gibson F. Strabismus measurements using the alternating and simultaneous prism cover tests: a comparative study. J Pediatr Ophthalmol Strabismus 2001; 38:267-72. [PMID: 11587174 DOI: 10.3928/0191-3913-20010901-06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the most accurate method of strabismus measurement in patients with constant manifest esotropia. METHODS Patients underwent routine cover test assessment with the cover-uncover test and the alternating cover test with any increase in the angle of deviation being noted between the two methods. The simultaneous and alternating prism cover test was then performed to see if a qualitative increase in angle deviation was represented by a quantitative measurement. Patients also were assessed for the presence of binocular vision in free space using Bagolini striated lenses and motor fusion responses to base out prisms. RESULTS There was a significant difference between the alternating and simultaneous prism cover test measurements for all patients (mean difference for near fixation: 4.72 prism diopters [delta]; 95% confidence interval [CI], 1.68-7.75 delta; df=51; P<.001). For patients who showed a qualitative change in angle based on observational judgement using the cover tests, the mean difference in angle measured by simultaneous and alternating prism cover test for near fixation was 7.42 delta (95% CI, 5.75-10.30 delta; df=25; P<.001). CONCLUSION To obtain an accurate interpretation of the size of manifest esotropia, the angle of deviation needs to be measured by the simultaneous and alternating prism cover test when an observable difference is noted on the cover test. The presence of a latent component to a manifest deviation should prompt the investigation of binocular reflexes even if the manifest angle is too large to be commensurate with binocular vision.
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Affiliation(s)
- M A Deacon
- Orthoptic Department, The General Infirmary at Leeds, United Kingdom
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Abstract
PURPOSE To determine whether normal maximum versions change as a function of age. METHODS One hundred twenty-four healthy subjects without any history of strabismus, ocular or periocular surgery, or major illness were examined to confirm visual acuity better than 20/60 in each eye and the absence of strabismus. Maximum sustained elevation, depression, dextroversion, and levoversion were quantified by using a standardized lateral version light-reflex (LVR) test. RESULTS Subjects ranged in age from 23 to 84 years. All LVR measurements were converted into degrees of eye rotation assuming standard globe size. For each maximal gaze position, the regression line (whether determined directly or scaled against historical normal values) was formed by plotting the LVR measurements versus age had a negative slope significantly different than zero (P =.0001 for all). Depression had a significantly smaller decrease in LVR measurement with age (-0.5% per year) than elevation (-1% per year, P = .0001), adduction (-0.8% per year, P = .0001), or abduction (-0.7% per year, P = .0017). Elevation had the largest decrease in LVR measurement with age compared with depression and abduction (P = .003). CONCLUSION As measured by LVR, the maximum versions into extremes of gaze decrease by an average of 0.5% to 1.0% per year of life between the third and ninth decade. The version least affected and most affected by age is depression and elevation, respectively. Age should be considered when assessing versions for evidence of rectus muscle overaction and underaction.
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Affiliation(s)
- R A Clark
- Department of Ophthalmology, Jules Stein Eye Institute, Harbor-UCLA Medical Center, UCLA School of Medicine, Los Angeles 90509, USA
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Cheung JC, Dick PT, Kraft SP, Yamada J, Macarthur C. Strabismus examination by telemedicine. Ophthalmology 2000; 107:1999-2005. [PMID: 11054321 DOI: 10.1016/s0161-6420(00)00377-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the reliability of strabismus assessment using telemedicine (TM) technology. DESIGN Two prospective interobserver agreement studies. One study compared the agreement between a standard and a TM examination, whereas the other assessed agreement between two independent standard examinations. PARTICIPANTS Strabismus patients over 4 years of age examined at a remote community clinic and patients assessed in a strabismologist's urban practice. METHODS Forty-two patients were examined in person by a pediatric ophthalmologist at the remote community and independently by a pediatric ophthalmology fellow by means of TM (TM-standard study). The TM examination was performed with the help of a qualified ophthalmic assistant at the remote telecommunication center using a Power Cam 100 camera, a Picture Tel Concorde 4500 teleconferencing system, and a 224 kilobyte bandwidth. For comparison, independent in person examinations were performed on 43 patients by both examiners (standard-standard study). Agreement was measured using unweighted kappa (k) for categorical data, the intraclass correlation coefficient (ICC) for continuous data, and percent agreement. The odds of disagreement with TM (comparing the TM-standard versus standard-standard studies) was assessed with logistic regression analysis. MAIN OUTCOME MEASURES Three parameters were assessed: (1) category of strabismus, determined by observation without cover test; (2) angle of deviation at 0.33 and 6.0 m; and (3) ocular muscle action. RESULTS Agreement on the category of strabismus was good (k > 0.61) other than for vertical deviations. However, there was good to excellent agreement between TM and standard examinations on the vertical (ICC = 0.78) and horizontal (ICC = 0.79) angles of deviation with 6-m fixation with the cover test. Muscle ratings agreed within one point for the lateral, superior, and inferior rectus muscle actions in more than 90% of the eyes examined. Although good agreement was observed in the TM-standard study, it was inferior to the agreement in the standard-standard study. Examination by TM increased the odds of disagreement compared with examination in person by twofold to threefold. CONCLUSIONS Strabismus examination can be performed with a good level of reliability with the use of medium bandwidth video teleconferencing equipment. However, reduced reliability has been noted in the detection of small vertical deviations by inspection and in evaluating oblique muscle actions.
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Affiliation(s)
- J C Cheung
- Department of Ophthalmology, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
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Abstract
Misalignment of the ocular axes induces double vision and rivalry. To prevent these unpleasant sensations, most subjects fixate preferentially with one eye and suppress entirely the deviating eye or else suppress portions of the visual field of either eye. To explore the mechanism of visual suppression, a divergent strabismus (exotropia) was induced in six normal, adult Macaca fascicularis by disinserting the medial rectus muscles. After 4-8 weeks, each animal was chaired to measure its exotropia and to determine its ocular fixation preference. Five of the monkeys developed a clearly dominant eye. It was injected with [(3)H]proline. Alternate sections from flat-mounts of striate cortex were then processed either for autoradiography to label the ocular dominance columns or for cytochrome oxidase (CO) to assess local metabolic activity. Two CO patterns were seen, often in the same cortex. The first consisted of thin dark columns alternating with wide pale columns. This pattern arose from reduced CO activity in the suppressed eye's monocular core zones and both eyes' binocular border strips. The second pattern consisted of thin pale bands from reduced metabolic activity in both eyes' border strips. The thin dark-wide pale CO pattern was more widespread in the three animals with a strong fixation preference. The dark CO columns usually fit in register with the ocular dominance columns of the fixating eye, suggesting that perception was suppressed in the deviating eye. In most animals, however, the correlation switched in peripheral cortex contralateral to the deviating eye, implying local suppression of the fixating eye's temporal retina (beyond 10 degrees), as reported in humans with divergent strabismus. In the two animals with a weak fixation preference, pale border strips were found within the central visual field representation in both hemispheres. This CO pattern was consistent with alternating visual suppression. These experiments provide the first anatomical evidence for changes in cortical metabolism that can be correlated with suppression scotomas in subjects with strabismus.
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