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Peli E, Jung JH. Review: Binocular double vision in the presence of visual field loss. J Vis 2024; 24:13. [PMID: 38899959 PMCID: PMC11193068 DOI: 10.1167/jov.24.6.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 03/13/2024] [Indexed: 06/21/2024] Open
Abstract
Binocular double vision in strabismus is marked by diplopia (seeing the same object in two different directions) and visual confusion (seeing two different objects in the same direction). In strabismus with full visual field, the diplopia coexists with visual confusion across most of the binocular field. With visual field loss, or with use of partial prism segments for field expansion, the two phenomena may be separable. This separability is the focus of this review and offers new insights into binocular function. We show that confusion is necessary but is not sufficient for field expansion. Diplopia plays no role in field expansion but is necessary for clinical testing of strabismus, making such testing difficult in field loss conditions with confusion without diplopia. The roles of the three-dimensional structure of the real world and the dynamic of eye movements within that structure are considered as well. Suppression of one eye's partial view under binocular vision that develops in early-onset (childhood) strabismus is assumed to be a sensory adaption to diplopia. This assumption can be tested using the separation of diplopia and confusion.
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Affiliation(s)
- Eli Peli
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jae-Hyun Jung
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Phillips MJ, Nguyen AM, Borchert MS, Nallasamy S. An unexpected turn: a case of torsional anomalous retinal correspondence after myectomy of previously anteriorized inferior oblique muscles in a child. J AAPOS 2024; 28:103820. [PMID: 38242227 DOI: 10.1016/j.jaapos.2023.11.020] [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: 08/08/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 01/21/2024]
Abstract
We report a case of torsional diplopia caused by presumed torsional anomalous retinal correspondence after myectomy of previously asymmetrically anteriorized inferior oblique muscles for inferior oblique overaction. Given this patient's experience, it may be prudent to operate with caution on previously anteriorized inferior oblique muscles, especially when anteriorization is performed at a very young age.
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Affiliation(s)
- Mark J Phillips
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Angeline M Nguyen
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California; The Vision Center, Children's Hospital Los Angeles, Los Angeles, California
| | - Mark S Borchert
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California; The Vision Center, Children's Hospital Los Angeles, Los Angeles, California
| | - Sudha Nallasamy
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California; The Vision Center, Children's Hospital Los Angeles, Los Angeles, California.
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Bronstad PM, Peli E, Liu R, Doherty A, Fulton AB. High prevalence of strabismic visual field expansion in pediatric homonymous hemianopia. PLoS One 2018; 13:e0209213. [PMID: 30566507 PMCID: PMC6300329 DOI: 10.1371/journal.pone.0209213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/30/2018] [Indexed: 11/18/2022] Open
Abstract
If homonymous hemianopia develops in childhood it is frequently accompanied by strabismus. In some of these cases the strabismus increases the size of the binocular visual field. We determined how prevalent visual-field-expanding strabismus is in children who have homonymous hemianopia. Medical records were examined from 103 hemianopic patients with exotropia (XT) or esotropia (ET). For each participant, we determined whether their strabismus was in a direction that resulted in visual field expansion (i.e. left exotropia with left homonymous hemianopia). Ages at which hemianopia and strabismus were first noted were compared to determine which developed first. The prevalence of XT (24%) and ET (9%) with homonymous hemianopia were both much higher than in the general population (1.5% and 5%, respectively). More strabismic eyes pointed to the blind than seeing side (62 vs 41, 60% vs. 40%, p = 0.02). Exotropic eyes were five times more likely to point to the blind side than esotropic eyes (85% vs 15%). Strabismus, especially exotropia, is much more common in pediatric homonymous hemianopia than in the general population. The strabismus is significantly more often in a visual field-expanding direction. These results support an adaptive role for the strabismus. Patients with HH and exotropia or esotropia should be aware that their visual field could be reduced by strabismus surgery.
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Affiliation(s)
- P. Matthew Bronstad
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States of America
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Eli Peli
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States of America
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rui Liu
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States of America
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Amy Doherty
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States of America
| | - Anne B. Fulton
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
- Boston Children’s Hospital, Boston, Massachusetts, United States of America
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Satgunam P, Datta S, Chillakala K, Bobbili KR, Joshi D. Pediatric Perimeter-A Novel Device to Measure Visual Fields in Infants and Patients with Special Needs. Transl Vis Sci Technol 2017; 6:3. [PMID: 28685105 PMCID: PMC5497602 DOI: 10.1167/tvst.6.4.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/08/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE There are no commercially available devices to measure visual fields in infants. We developed a device, "Pediatric Perimeter," that quantifies visual field extent (VFE) for infants. We describe the construction, validation, and use of this device. METHODS A hemispherical dome with light emitting diodes (LEDs) was constructed. The LEDs were controlled using a computer program to measure reaction time (RT) to gross visual fields (GVF) and the VFE. Participants were tested in supine position in a dark room. Eye or head movement towards the stimuli was monitored with an infrared (IR) camera. Validation was done on 10 adults (mean age: 24.4 ± 5 years) with tunnel vision simulator. RESULTS Perimetry was performed on 19 infants (age: 2.3-12 months), five infants with normal milestones. GVF and VFE were estimated in 17 and 7 infants, respectively. Median RT of infants with developmental delay was 663 ms and 380 ms for healthy infants. Also, 14 children (age: 14 months-6 years) with developmental delay and five patients with cognitive impairment were tested. CONCLUSION Visual field isopter and RT can be examined with the Pediatric Perimeter device on infants and patients with special needs. Further testing on infants will need to assess the repeatability. A large-scale study will be needed to compare typically developing infants and infants with delayed milestones with this device. TRANSLATIONAL RELEVANCE Quantifiable parameters obtained with this device can be used as outcome measures in clinical examination of infants and patients with special needs. This device can be used in pediatric, neurology, and ophthalmology clinics.
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Affiliation(s)
- PremNandhini Satgunam
- Brien Holden Institute of Optometry and Vision Science, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India.,Srujana - Center for Innovation, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Sourav Datta
- Brien Holden Institute of Optometry and Vision Science, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Koteswararao Chillakala
- Srujana - Center for Innovation, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Karthik R Bobbili
- Srujana - Center for Innovation, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India.,Current affiliation: School of Science and Engineering, University of Houston-Clear Lake, Houston, TX, USA
| | - Dhruv Joshi
- Srujana - Center for Innovation, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India.,Current affiliation: Department of Management Science and Engineering, Stanford University, Palo Alto, CA, USA
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Haun AM, Peli E. Binocular rivalry with peripheral prisms used for hemianopia rehabilitation. Ophthalmic Physiol Opt 2014; 34:573-9. [PMID: 25160892 DOI: 10.1111/opo.12143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/15/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew M. Haun
- Schepens Eye Research Institute & Massachusetts Eye and Ear; Harvard Medical School; Boston USA
| | - Eli Peli
- Schepens Eye Research Institute & Massachusetts Eye and Ear; Harvard Medical School; Boston USA
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Peli E, Satgunam P. Bitemporal hemianopia; its unique binocular complexities and a novel remedy. Ophthalmic Physiol Opt 2014; 34:233-42. [PMID: 24588535 PMCID: PMC3947624 DOI: 10.1111/opo.12118] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/27/2013] [Indexed: 11/27/2022]
Abstract
Bitemporal hemianopic visual field impairment frequently leads to binocular vision difficulties. Patients with bitemporal hemianopia with pre-existing exophoria complain of horizontal diplopia, sometimes combined with vertical deviation (with pre-existing hyperphoria). The symptoms are a result of the phoria decompensating into a tropia (hemi-slide) due to the lack of retinal correspondence between the remaining nasal fields of both eyes. We measured these effects using a dichoptic perimeter. We showed that aligning the eyes with prisms could prevent diplopia if the bitemporal hemianopia is incomplete. We also describe the successful use of a novel fusion aid - the 'stereo-typoscope' - that utilizes midline stereopsis to prevent diplopia resulting from hemi-sliding in patients with complete bitemporal hemianopia.
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Affiliation(s)
- Eli Peli
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, USA
| | - PremNandhini Satgunam
- Brien Holden Centre for Eye Research, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, India
- Bausch and Lomb School of Optometry, L V Prasad Eye Institute, India
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Abstract
PURPOSE OF REVIEW This article reviews and updates basic concepts, diagnosis and treatment of cyclotorsion. RECENT FINDINGS Cyclodeviation in congenital superior oblique palsy (SOP) seems to correlate with the extent of superior oblique muscle hypoplasia. Genetic polymorphisms such as PHOX2B polymorphism, considered to be risk factors for congenital fibrosis of the extraocular muscles, may play a role in SOP and consequently in cyclotorsion. Two components of the ocular tilt reaction, ocular torsion and tilt of subjective visual vertical, seem to share similar sites of impairment in the brainstem. Harada-Ito surgery continues to be the procedure of choice in patients with isolated cyclodeviation, evidencing better outcome if less than 10° of preoperative excyclotorsion and preoperative fusion exist. Ocular torsion is not infrequent in patients with intermittent exotropia, especially in the most exo-deviated eye, emphasizing a possible role in pathogenesis. A new device for the assessment of dynamic torsion during ocular counter roll response using after-image has been described. Similarly, a new method to measure objective ocular torsion using retinal arcade tilt as a reference has been proposed. Finally, torsional data transformation such as the sum of angles of excyclodeviation, rather than using the angle of excyclodeviation of the paretic eye, is becoming increasingly popular among studies on torsion. SUMMARY Exciting developments on ocular torsion have been described recently, and new ways to access and interpret ocular torsion have been devised as well.
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Affiliation(s)
- João Lemos
- Michigan State University, East Lansing, Michigan, USA
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Apfelbaum HL, Ross NC, Bowers AR, Peli E. Considering Apical Scotomas, Confusion, and Diplopia When Prescribing Prisms for Homonymous Hemianopia. Transl Vis Sci Technol 2013; 2:2. [PMID: 24049719 DOI: 10.1167/tvst.2.4.2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 04/02/2013] [Indexed: 11/24/2022] Open
Abstract
PURPOSE While prisms are commonly prescribed for homonymous hemianopia to extend or expand the visual field, they cause potentially troubling visual side effects, including nonveridical location of perceived images, diplopia, and visual confusion. In addition, the field behind a prism at its apex is lost to an apical scotoma equal in magnitude to the amount of prism shift. The perceptual consequences of apical scotomas and the other effects of various designs were examined to consider parameters and designs that can mitigate the impact of these effects. METHODS Various configurations of sector and peripheral prisms were analyzed, in various directions of gaze, and their visual effects were illustrated using simulated perimetry. A novel "percept" diagram was developed that yielded insights into the patient's view through the prisms. The predictions were verified perimetrically with patients. RESULTS The diagrams distinguish between potentially beneficial field expansion via visual confusion and the pericentrally disturbing and useless effect of diplopia, and their relationship to prism power and gaze direction. They also illustrate the nonexpanding substitution of field segments of some popular prism designs. CONCLUSIONS Yoked sector prisms have no effect at primary gaze or when gaze is directed toward the seeing hemifield, and they introduce pericentral field loss when gaze is shifted into them. When fitted unilaterally, sector prisms also have an effect only when the gaze is directed into the prism and may cause a pericentral scotoma and/or central diplopia. Peripheral prisms are effective at essentially all gaze angles. Since gaze is not directed into them, they avoid problematic pericentral effects. We derive useful recommendations for prism power and position parameters, including novel ways of fitting prisms asymmetrically. TRANSLATIONAL RELEVANCE Clinicians will find these novel diagrams, diagramming techniques, and analyses valuable when prescribing prismatic aids for hemianopia and when designing new prism devices for patients with various types of field loss.
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Affiliation(s)
- Henry L Apfelbaum
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
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Chung STL, Bailey IL, Dagnelie G, Jackson JA, Legge GE, Rubin GS, Wood J. New challenges in low-vision research. Optom Vis Sci 2012; 89:1244-5. [PMID: 22926111 PMCID: PMC3893186 DOI: 10.1097/opx.0b013e31826ba359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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