1
|
Chang MY, Binenbaum G, Heidary G, Cavuoto KM, Morrison DG, Trivedi RH, Kim SJ, Pineles SL. Surgical Treatments to Improve Visual Acuity in Infantile Nystagmus Syndrome: A Report by the American Academy of Ophthalmology. Ophthalmology 2023; 130:331-344. [PMID: 36435636 PMCID: PMC9979093 DOI: 10.1016/j.ophtha.2022.10.006] [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: 09/14/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To review the literature on the efficacy of surgical procedures to improve visual acuity (VA) in patients with infantile nystagmus syndrome (INS). METHODS Literature searches were last conducted in January 2022 in the PubMed database for English-language studies with no date restrictions. The combined searches yielded 354 abstracts, of which 46 were reviewed in full text. Twenty-three of these were considered appropriate for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. RESULTS One included study was a randomized trial; the remaining 22 were case series. The 23 studies included children and adults with INS and a variable proportion with anomalous head position (AHP), strabismus, and sensory diagnoses. The surgical interventions evaluated included large recessions, tenotomy and reattachment (TAR), myectomy with or without pulley fixation, and anterior extirpation of the 4 horizontal rectus muscles, as well as various procedures to correct an AHP in which VA was reported as a secondary outcome. The data were mixed, with improvements in binocular best-corrected visual acuity (BCVA) ranging from no improvement to 0.3 logarithm of the minimum angle of resolution (logMAR), or 3 lines. (Most studies were in the range of 0.05-0.2 logMAR.) Statistically significant improvement in VA was noted in 12 of 16 studies (75%) that performed statistical analyses, with no clear advantage of any single procedure. Complications and reoperations were lowest in patients who underwent TAR and highest in those who underwent myectomy or anterior extirpation. CONCLUSIONS The best available evidence suggests that eye muscle surgery in patients with INS results in a modest improvement in VA. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
Collapse
Affiliation(s)
- Melinda Y Chang
- Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Gil Binenbaum
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kara M Cavuoto
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Rupal H Trivedi
- Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | |
Collapse
|
2
|
Salchow DJ. [Nystagmus in Children - a Survey]. Klin Monbl Augenheilkd 2023; 240:617-635. [PMID: 36827996 DOI: 10.1055/a-2022-1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Nystagmus describes an involuntary, periodic movement of one or both eyes. About 1/600 children and adolescents have nystagmus, most of them idiopathic infantile nystagmus (IIN), also called "congenital nystagmus", which can be caused by mutations in the FRMD7 gene. Other frequent forms of nystagmus are latent nystagmus, which is usually associated with infantile strabismus, and nystagmus associated with albinism. Sometimes difficult to distinguish in young infants is a sensory nystagmus, where a defect in the visual system reduces vision and causes nystagmus. Causes include retinal dystrophies, congenital stationary night blindness and structural ocular defects including optic nerve hypoplasia or dense bilateral congenital cataracts. Unilateral nystagmus can be the sign of an anterior visual pathway lesion. Seesaw nystagmus may be associated with suprasellar and mesodiencephalic lesions and - rarely - with retinal dystrophies.The ophthalmology plays a key role in identifying the form of nystagmus. Children with new onset nystagmus, with spasmus nutans, with vertical or unilateral nystagmus and those with seesaw nystagmus require neurologic evaluation including imaging of the brain.The treatment of nystagmus depends on the underlying cause. Even minor refractive errors should be corrected, contact lenses offer advantages over glasses.Gabapentin and memantine, possibly also carbonic anhydrase inhibitors, are effective in treating IIN, nystagmus in albinism and sensory nystagmus. Nevertheless, pharmacologic treatment of nystagmus is rarely used in children; the reasons are the limited effects on vision, the need for lifelong therapy, and potential side effects. Eye muscle surgery (Anderson procedure, Kestenbaum procedure) can correct a nystagmus-related anomalous head posture. The concept of "artifical divergence" of Cüppers may help to decrease nystagmus intensity in patients whose nystagmus dampens with convergence. The four-muscle-tenotomy, which involves disinsertion and reinsertion of the horizontal muscles at the original insertion of both eyes, has a proven but limited positive effect on visual acuity.
Collapse
|
3
|
Salchow DJ. Nystagmus bei Kindern – eine Übersicht. AUGENHEILKUNDE UP2DATE 2023. [DOI: 10.1055/a-1774-3608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
ZusammenfassungNystagmus ist definiert als unwillkürliche, periodische Bewegung, bei der eines oder beide Augen vom Fixationspunkt wegdriften (sog. Drift). Auf die Drift, die langsame Phase, folgt entweder eine schnelle, refixierende Bewegung (sog. Refixationssakkade oder schnelle Phase) oder eine langsamere Bewegung zur Wiederaufnahme der Fixation. In dieser Übersichtsarbeit sollen die wichtigsten Formen von Nystagmus bei Kindern erörtert werden, für eine Übersicht bei Erwachsenen sei auf 1 verwiesen.
Collapse
|
4
|
Jacobs DS, Carrasquillo KG, Cottrell PD, Fernández-Velázquez FJ, Gil-Cazorla R, Jalbert I, Pucker AD, Riccobono K, Robertson DM, Szczotka-Flynn L, Speedwell L, Stapleton F. CLEAR - Medical use of contact lenses. Cont Lens Anterior Eye 2021; 44:289-329. [PMID: 33775381 DOI: 10.1016/j.clae.2021.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022]
Abstract
The medical use of contact lenses is a solution for many complex ocular conditions, including high refractive error, irregular astigmatism, primary and secondary corneal ectasia, disfiguring disease, and ocular surface disease. The development of highly oxygen permeable soft and rigid materials has extended the suitability of contact lenses for such applications. There is consistent evidence that bandage soft contact lenses, particularly silicone hydrogel lenses, improve epithelial healing and reduce pain in persistent epithelial defects, after trauma or surgery, and in corneal dystrophies. Drug delivery applications of contact lens hold promise for improving topical therapy. Modern scleral lens practice has achieved great success for both visual rehabilitation and therapeutic applications, including those requiring retention of a tear reservoir or protection from an adverse environment. This report offers a practical and relevant summary of the current evidence for the medical use of contact lenses for all eye care professionals including optometrists, ophthalmologists, opticians, and orthoptists. Topics covered include indications for use in both acute and chronic conditions, lens selection, patient selection, wear and care regimens, and recommended aftercare schedules. Prevention, presentation, and management of complications of medical use are reviewed.
Collapse
Affiliation(s)
- Deborah S Jacobs
- Massachusetts Eye & Ear, Cornea and Refractive Surgery Service, Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | | | | | | | | | - Loretta Szczotka-Flynn
- Department of Ophthalmology & Visual Science, Case Western Reserve University, Cleveland, OH, USA
| | - Lynne Speedwell
- Great Ormond Street Hospital for Children NHS Trust, Moorfields Eye Hospital, London, UK
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
| |
Collapse
|
5
|
Cham KM, Abel LA, Busija L, Kowal L, Bachar Zipori A, Downie LE. Surgical interventions for infantile nystagmus syndrome. Cochrane Database Syst Rev 2021; 2:CD013390. [PMID: 33598911 PMCID: PMC8094175 DOI: 10.1002/14651858.cd013390.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Infantile nystagmus syndrome (INS) is a type of eye movement disorder that can negatively impact vision. Currently, INS cannot be cured, but its effects can potentially be treated pharmacologically, optically, or surgically. This review focuses on the surgical interventions for INS. Despite the range of surgical interventions available, and currently applied in practice for the management of INS, there is no clear consensus, and no accepted clinical guidelines regarding the relative efficacy and safety of the various treatment options. A better understanding of these surgical options, along with their associated side effects, will assist clinicians in evidence-based decision-making in relation to the management of INS. OBJECTIVES To assess the efficacy and safety of surgical interventions for INS. SEARCH METHODS We searched CENTRAL, MEDLINE Ovid, Embase Ovid, ISRCTN registry, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) to 3 July 2020, with no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) studying the efficacy and safety of surgical options for treating INS. DATA COLLECTION AND ANALYSIS Our prespecified outcome measures were the change from baseline in: binocular best-corrected distance visual acuity; head posture; amplitude, frequency, intensity, and foveation period durations of the nystagmus waveform; visual recognition times; quality of life and self-reported outcome measures; incidence of adverse effects with a probable causal link to treatment; and permanent adverse effects after surgery. Two review authors independently screened titles and abstracts and full-text articles, extracted data from eligible RCTs, and judged the risk of bias using the Cochrane tool. We reached consensus on any disagreements by discussion. We summarised the overall certainty of the evidence using the GRADE approach. MAIN RESULTS We only identified one eligible RCT (N = 10 participants), undertaken in India. This trial randomised participants to receive either a large retro-equatorial recession of the horizontal rectus muscle of 9 mm on the medial rectus and 12 mm on the lateral rectus, or a simple tenotomy and resuturing of the four horizontal rectus muscles. We did not identify any RCTs comparing a surgical intervention for INS relative to no treatment. In the single eligible RCT, both eyes of each participant received the same intervention. The participants' age and gender were not reported, nor was information on whether participants were idiopathic or had sensory disorders. The study only included participants with null in primary position and did not explicitly exclude those with congenital periodic alternating nystagmus. The study did not report funding source(s) or author declaration of interests. The evaluation period was six months. We judged this study at low risk for sequence generation and other sources of bias, but at high risk of bias for performance and detection bias. The risk of bias was unclear for selection bias, attrition bias, and reporting bias. There is very uncertain evidence about the effect of the interventions on visual acuity and change in amplitude, frequency, and intensity of the nystagmus waveform. We were unable to calculate relative effects due to lack of data. None of the participants in either intervention group reported adverse effects at six-month follow-up (very low-certainty evidence). There was no quantitative data reported for quality of life, although the study reported an improvement in quality of life after surgery in both intervention groups (very low-certainty evidence). Change in head posture, foveation period durations of the nystagmus waveform, visual recognition times, and permanent adverse effects after surgery were not reported in the included study. We judged the certainty of the evidence, for both the primary and secondary efficacy outcomes, to be very low. Due to a lack of comprehensive reporting of adverse events, there was also very low-certainty of the safety profile of the evaluated surgical interventions in this population. As such, we are very uncertain about the relative efficacy and safety of these interventions for the surgical management of INS. AUTHORS' CONCLUSIONS This systematic review identified minimal high-quality evidence relating to the efficacy and safety of surgical interventions for INS. The limited availability of evidence must be considered by clinicians when treating INS, particularly given these procedures are irreversible and often performed on children. More high-quality RCTs are needed to better understand the efficacy and safety profile of surgical interventions for INS. This will assist clinicians, people with INS, and their parents or caregivers to make evidence-based treatment decisions.
Collapse
Affiliation(s)
- Kwang M Cham
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Larry A Abel
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Ljoudmila Busija
- Biostatistics Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lionel Kowal
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Anat Bachar Zipori
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
6
|
Current and emerging treatments for albinism. Surv Ophthalmol 2020; 66:362-377. [PMID: 33129801 DOI: 10.1016/j.survophthal.2020.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 10/07/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
Abstract
Albinism is a group of rare inherited disorders arising from impairment of melanin biosynthesis. The reduction of melanin synthesis leads to hypopigmentation of the skin and eyes. A wide range of ophthalmic manifestations arise from albinism, including reduction of visual acuity, nystagmus, strabismus, iris translucency, foveal hypoplasia, fundus hypopigmentation, and abnormal decussation of retinal ganglion cell axons at the optic chiasm. Currently, albinism is incurable, and treatment aims either surgically or pharmacologically to optimize vision and protect the skin; however, novel therapies that aim to directly address the molecular errors of albinism, such as l-dihydroxyphenylalanine and nitisinone, are being developed and have entered human trials though with limited success. Experimental gene-based strategies for editing the genetic errors in albinism have also met early success in animal models. The emergence of these new therapeutic modalities represents a new era in the management of albinism. We focus on the known genetic subtypes, clinical assessment, and existing and emerging therapeutic options for the nonsyndromic forms of albinism.
Collapse
|
7
|
Weaterton R, Tan S, Adam J, Kaur H, Rennie K, Dunn M, Ewings S, Theodorou M, Osborne D, Evans M, Lee H, Self J. Beyond Visual Acuity: Development of a Simple Test of the Slow-To-See Phenomenon in Children with Infantile Nystagmus Syndrome. Curr Eye Res 2020; 46:263-270. [PMID: 32615805 DOI: 10.1080/02713683.2020.1784438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Conventional static visual acuity testing profoundly underestimates the impact of infantile nystagmus on functional vision. The slow-to-see phenomenon explains why many patients with nystagmus perform well in non-time restricted acuity tests but experience difficulty in certain situations. This is often observed by parents when their child struggles to recognise familiar faces in crowded scenes. A test measuring more than visual acuity could permit a more real-world assessment of visual impact and provide a robust outcome measure for clinical trials. METHODS Children with nystagmus and, age and acuity matched controls attending Southampton General Hospital were recruited for two tasks. In the first, eye-tracking measured the time participants spent looking at an image of their mother when alongside a stranger, this was then repeated with a sine grating and a homogenous grey box. Next, a tablet-based app was developed where participants had to find and press either their mother or a target face from up to 16 faces. Here, the response time was measured. The tablet task was refined over multiple iterations. RESULTS In the eye-tracking task, controls spent significantly longer looking at their mother and the grating (P < .05). Interestingly, children with nystagmus looked significantly longer at the grating (P < .05) but not their mother (P > .05). This confirmed a facial target was key to further development. The tablet-based task demonstrated that children with nystagmus take significantly longer to identify the target; this was most pronounced using a 3-min test with 12-face displays. CONCLUSION This study has shown a facial target is key to identifying the time-to-see deficit in infantile nystagmus and provides the basis for an outcome measure for use in clinical treatment trials.
Collapse
Affiliation(s)
- Ruaridh Weaterton
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton , Southampton, UK
| | - Shinn Tan
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton , Southampton, UK
| | - John Adam
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton , Southampton, UK
| | - Harneet Kaur
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton , Southampton, UK
| | - Katherine Rennie
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton , Southampton, UK
| | - Matt Dunn
- School of Optometry and Vision Sciences, University of Cardiff , Cardiff, UK
| | - Sean Ewings
- School of Health Sciences, University of Southampton , Southampton, UK
| | - Maria Theodorou
- Moorfields Eye Hospital , London, UK.,National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital , London, UK
| | - Dan Osborne
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton , Southampton, UK
| | - Megan Evans
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton , Southampton, UK
| | - Helena Lee
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton , Southampton, UK
| | - James Self
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton , Southampton, UK
| |
Collapse
|
8
|
Ozcelik F, Ozturk Karabulut G, Ocak OB. The efficacy of low vision aids with contact lenses in pediatric population. Int Ophthalmol 2020; 40:2677-2681. [PMID: 32488591 DOI: 10.1007/s10792-020-01449-7] [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: 07/22/2019] [Accepted: 05/23/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the efficacy of contact lens use with low vision aids (LVA) with the efficacy of spectacle use with low vision aids. METHODS Thirty-six pediatric patients with low vision were enrolled in this study between January 2015 and March 2017. The patients were examined for best-corrected visual acuity (BCVA) with spectacles, spectacles with LVA, contact lenses and contact lenses with LVA. Toleration of the patients with contact lenses and LVA were recorded at the final follow-up exam. RESULTS The mean BCVA with spectacles was detected as 1.11 ± 0.25 log MAR and the mean BCVA improved to 0.35 ± 0.13 log MAR with the use of spectacles and LVA, which was statistically significant. The mean BCVA with contact lens, which was 0.99 ± 0.22 log MAR, improved to 0.40 ± 0.21 log MAR with contact lens and LVA, which was also significant. There was a statistically significant improvement in BCVA of the patients with contact lenses only when compared to spectacles only. The mean BCVA significantly improved in patients using LVA with contact lenses when compared to LVA with spectacles. Tolerations of the patients with contact lenses and LVA were found to be well at 29 of 36 (80.55%) at final follow-up (26.11 ± 6.85 months). CONCLUSION Contact lens use in pediatric patients with low vision especially with LVA offers better visual acuity, a decrease in nystagmus amplitude, wider field of view and comfort.
Collapse
Affiliation(s)
- Ferah Ozcelik
- Istanbul Beyoglu Eye Research and Training Hospital, Galata, 34421, Istanbul, Turkey
| | | | - Osman Bulut Ocak
- Istanbul Beyoglu Eye Research and Training Hospital, Galata, 34421, Istanbul, Turkey. .,, Istanbul, Turkey.
| |
Collapse
|
9
|
Cham KM, Abel LA, Busija L, Kowal L, Bachar Zipori A, Downie LE. Surgical interventions for infantile nystagmus syndrome. Hippokratia 2019. [DOI: 10.1002/14651858.cd013390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kwang M Cham
- The University of Melbourne; Department of Optometry and Vision Sciences; Level 4, Alice Hoy Building Monash Road Melbourne Victoria Australia 3010
| | - Larry A Abel
- The University of Melbourne; Department of Optometry and Vision Sciences; Level 4, Alice Hoy Building Monash Road Melbourne Victoria Australia 3010
| | - Ljoudmila Busija
- Monash University; Biostatistics Unit, Department of Epidemiology and Preventive Medicine; Melbourne Victoria Australia 3000
| | - Lionel Kowal
- The University of Melbourne; Department of Surgery (Ophthalmology); Level 4, Alice Hoy Building Melbourne Victoria Australia 3010
| | - Anat Bachar Zipori
- Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University; Department of Ophthalmology; 6 Weizmann Street Tel Aviv Israel 6423906
| | - Laura E Downie
- The University of Melbourne; Department of Optometry and Vision Sciences; Level 4, Alice Hoy Building Monash Road Melbourne Victoria Australia 3010
| |
Collapse
|
10
|
Theodorou M, Quartilho A, Xing W, Bunce C, Rubin G, Adams G, Dahlmann-Noor A. Soft Contact Lenses to Optimize Vision in Adults with Idiopathic Infantile Nystagmus: A Pilot Parallel Randomized Controlled Trial. Strabismus 2018; 26:11-21. [PMID: 29333910 DOI: 10.1080/09273972.2017.1418394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The optimal management of infantile nystagmus syndrome (INS) is still unclear. Contact lenses (CL) may be superior to glasses in improving visual function in INS but it is not known whether their beneficial effects are due to optical correction alone, or to an additional proprioceptive effect, and whether soft CLs would be as effective as rigid CLs. There is little data on feasibility and and the present study aimed to provide this information. METHODS We completed a pilot Randomized Control Trial (RCT) at a single tertiary referral centre in London, UK. We enrolled 38 adults with idiopathic INS and randomised them to either plano CL (with corrective spectacles if required) or to corrective CL. CL wear was required for a minimum of 2 weeks. Primary outcome measures were feasibility and safety of CL wear in INS; secondary outcome measures were visual acuity and nystagmus waveform parameters. RESULTS 27 completed the study (27/38,71%). 4 partcipants withdrew due to difficulty with CL insertion/removal and 7 were lost to follow up. CL tolerability was high (24/27,89%) - 2 found the CLs irritant, and 1 had an exacerbation of allergic eye disease. At two weeks, mean improvement in binocular visual acuity from baseline with plano CLs was 0.07 logMAR (95% confidence interval (CI: 0.03-0.11) and 0.06 logMAR with fully corrective CLs (95% CI:0.02-0.1). Mean improvement in the eXpanded Nystagmus Acuity Function (NAFX, a nystagmus acuity function based on eye movement recording) with plano CLs was -0.04(95% CI: -0.08-0.005) and -0.05 with fully corrective CLs(95% CI: -0.09-0.003). CONCLUSIONS CLs are well tolerated, with a low risk profile. Whilst our study was not powered to detect significant changes in BCVA and waveform parameters between treatment arms, we observed a trend towards an improvement in visual function at two weeks from baseline with CLs.
Collapse
Affiliation(s)
- Maria Theodorou
- a Paediatric Ophthalmology and Strabismus , Moorfields Eye Hospital , London , UK.,b National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital , London , UK
| | - Ana Quartilho
- b National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital , London , UK.,c UCL Institute of Ophthalmology , University College London , London , UK
| | - Wen Xing
- b National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital , London , UK
| | - Catey Bunce
- b National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital , London , UK.,d Kings College, University of London , London , UK.,e Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London , UK
| | - Gary Rubin
- b National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital , London , UK.,c UCL Institute of Ophthalmology , University College London , London , UK
| | - Gillian Adams
- a Paediatric Ophthalmology and Strabismus , Moorfields Eye Hospital , London , UK
| | - Annegret Dahlmann-Noor
- a Paediatric Ophthalmology and Strabismus , Moorfields Eye Hospital , London , UK.,b National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital , London , UK
| |
Collapse
|
11
|
Hertle RW. Nystagmus in Infancy and Childhood: Characteristics and Evidence for Treatment. ACTA ACUST UNITED AC 2017; 60:48-58. [DOI: 10.3368/aoj.60.1.48] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Richard W. Hertle
- Medical Center of Akron, Children's Hospital, and The Laboratory of Visual and Ocular Motor Physiology, Akron, Ohio
| |
Collapse
|
12
|
Zahidi AA, Woodhouse JM, Erichsen JT, Dunn MJ. Infantile nystagmus: an optometrist's perspective. CLINICAL OPTOMETRY 2017; 9:123-131. [PMID: 30214368 PMCID: PMC6118861 DOI: 10.2147/opto.s126214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Infantile nystagmus (IN), previously known as congenital nystagmus, is an involuntary to-and-fro movement of the eyes that persists throughout life. IN is one of three types of early-onset nystagmus that begin in infancy, alongside fusion maldevelopment nystagmus syndrome and spasmus nutans syndrome. Optometrists may also encounter patients with acquired nystagmus. The features of IN overlap largely with those of fusion maldevelopment nystagmus syndrome, spasmus nutans syndrome, and acquired nystagmus, yet the management for each subtype is different. Therefore, the optometrist's role is to accurately discern IN from other forms of nystagmus and to manage accordingly. As IN is a lifelong condition, its presence not only affects the visual function of the individual but also their quality of life, both socially and psychologically. In this report, we focus on the approaches that involve optometrists in the investigation and management of patients with IN. Management includes the prescription of optical treatments, low-vision rehabilitation, and other interventions such as encouraging the use of the null zone and referral to support groups. Other treatments available via ophthalmologists are also briefly discussed in the article.
Collapse
Affiliation(s)
- Asma Aa Zahidi
- Research Unit for Nystagmus, School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK,
| | - J Margaret Woodhouse
- Research Unit for Nystagmus, School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK,
| | - Jonathan T Erichsen
- Research Unit for Nystagmus, School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK,
| | - Matt J Dunn
- Research Unit for Nystagmus, School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK,
| |
Collapse
|
13
|
Vincent SJ. The use of contact lenses in low vision rehabilitation: optical and therapeutic applications. Clin Exp Optom 2017; 100:513-521. [PMID: 28664572 DOI: 10.1111/cxo.12562] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/25/2017] [Accepted: 03/24/2017] [Indexed: 12/28/2022] Open
Abstract
Ocular pathology that manifests at an early age has the potential to alter the vision-dependent emmetropisation mechanism, which co-ordinates ocular growth throughout childhood. The disruption of this feedback mechanism in children with congenital or early-onset visual impairment often results in the development of significant ametropia, including high levels of spherical refractive error, astigmatism and anisometropia. This review examines the use of contact lenses as a refractive correction, low vision aid and therapeutic intervention in the rehabilitation of patients with bilateral, irreversible visual loss due to congenital ocular disease. The advantages and disadvantages of the use of contact lenses for increased magnification (telescopes and microscopes) or field expansion (reverse telescopes) are discussed, along with the benefits and practical considerations for the correction of pathological high myopia. The historical and present use of therapeutic tinted contact lenses to reduce photosensitivity and nystagmus in achromatopsia, albinism and aniridia are also presented, including clinical considerations for the contact lens practitioner. In addition to the known optical benefits in comparison to spectacles for high levels of ametropia (an improved field of view for myopes and fewer inherent oblique aberrations), contact lenses may be of significant psycho-social benefit for patients with low vision, due to enhanced cosmesis and reduced conspicuity and potential related effects of improved self-esteem and peer acceptance. The contact lens correction of patients with congenital vision impairment can be challenging for both practitioner and patient but should be considered as a potential optical or therapeutic solution in modern low vision rehabilitation.
Collapse
Affiliation(s)
- Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| |
Collapse
|
14
|
Blechschmidt T, Krumsiek M, Todorova MG. The Effect of Acupuncture on Visual Function in Patients with Congenital and Acquired Nystagmus. MEDICINES 2017; 4:medicines4020033. [PMID: 28930248 PMCID: PMC5590069 DOI: 10.3390/medicines4020033] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/15/2017] [Accepted: 05/18/2017] [Indexed: 11/18/2022]
Abstract
Background: The aim of this study is to examine the short-term effect of visual function following acupuncture treatment in patients with congenital idiopathic nystagmus and acquired nystagmus (CIN and AN). Methods: An observational pilot study on six patients with confirmed diagnosis of nystagmus (three CIN and three AN patients (2♀, 4♂; mean age 42.67; SD ± 20.57 y)), was performed. Acupuncture treatment was done following a standardized protocol applying needle-acupuncture on the body and the ears. The treatment was scheduled with 10 sessions of 30 min duration over five weeks. To assess the effect of the treatment, we performed before, between, and after acupuncture objective measurement of the BCVA (EDTRS charts), contrast vision (CSV-1000, Vector Vision), nystagmography (Compact Integrated Pupillograph), complemented by evaluation questionnaires. A placebo non-acupuncture control group (Nr: 11, 22 eyes; 8♀, 3♂; mean age: 33.34 y (SD ± 7.33 y)) was taken for comparison. Results: The results showed that, following acupuncture treatment, CIN and AN patients showed improvement (SD± mean) in their binocular BCVA (baseline: 0.45 ± 0.36; between: 0.53 ± 0.34 and post-treatment: 0.51 ± 0.28), and in their monocular contrast sensitivity (baseline: 11.29 ± 12.35; between: 11.43 ± 11.45 and post-treatment: 14.0 ± 12.22). The post-/baseline-difference showed a significant improvement in contrast vision and in BCVA for CIN and AN patients, but not for controls (p = 0.029 and p = 0.007, respectively). The effect of the eye showed also, within CIN and AN, significant values for the examined parameters in the post-/baseline difference (p = 0.004 and p ≤ 0.001). Evaluated only binocularly, the respective between-/baseline and post-/baseline difference in the CIN and AN group showed significant values (p < 0.045). Two AN patients reported reduction of oscillations. Among general subjective symptoms, our patients reported reduction of tiredness and headache attacks, improvement of vision, and shorter sleep onset time. Conclusion: The applied acupuncture protocol showed improvement in the visual function of nystagmus patients and thus, in their quality of life. Further studies are mandatory to differentiate which group of nystagmus patients would benefit more from acupuncture.
Collapse
Affiliation(s)
- Tilo Blechschmidt
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031 Basel, Switzerland.
| | - Maike Krumsiek
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031 Basel, Switzerland.
| | - Margarita G Todorova
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031 Basel, Switzerland.
| |
Collapse
|
15
|
Abokyi S, Manuh G, Otchere H, Ilechie A. Knowledge, usage and barriers associated with contact lens wear in Ghana. Cont Lens Anterior Eye 2017; 40:329-334. [PMID: 28533022 DOI: 10.1016/j.clae.2017.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/05/2017] [Accepted: 05/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite findings that contact lens wear for vision correction provides better quality of life than spectacles, contact lens use in developing countries is low. This study evaluated knowledge, usage and barriers associated with contact lens wear among spectacle wearers in Cape Coast, Ghana. METHOD A cross-sectional survey using a structured questionnaire was conducted on an adult population of spectacle wearers to assess their knowledge of contact lens wear for vision correction. The participants were proportionately sampled from three eye clinics in the Cape Coast Metropolis, Ghana. Questionnaires were either self-administered or completed with the help of a research assistant. RESULTS Of the 422 participants, only 147 (34.8%) knew of contact lens wear for vision correction. The proportion of spectacle wearers reporting history of contact lens wear was 14 (3.3%). Barriers to contact lens wear reported were satisfaction with vision through spectacles 102 (25.0%), lack of adequate information 111 (27.2%), fear of side effects 94 (23.0%) and cost 78 (19.1%). The younger adults and those with higher number of changes of spectacles were more likely to know of contact lenses. CONCLUSION Knowledge and usage of contact lenses among spectacle wearers was low. Contact lens education and demonstration of visual performance through fitting of trial contact lenses on potential candidates may help overcome barriers to contact lens wear.
Collapse
Affiliation(s)
- Samuel Abokyi
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China; Department of Optometry, University of Cape Coast, Cape Coast, Ghana.
| | - George Manuh
- Department of Optometry, University of Cape Coast, Cape Coast, Ghana
| | - Heinz Otchere
- Sight for Africa Eye Clinic (Non-Governmental Organization), Accra, Ghana
| | - Alex Ilechie
- Department of Optometry, University of Cape Coast, Cape Coast, Ghana
| |
Collapse
|
16
|
Bagheri A, Abbasi H, Tavakoli M, Sheibanizadeh A, Kheiri B, Yazdani S. Effect of Rigid Gas Permeable Contact Lenses on Nystagmus and Visual Function in Hyperopic Patients with Infantile Nystagmus Syndrome. Strabismus 2017; 25:17-22. [DOI: 10.1080/09273972.2016.1276939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Abbas Bagheri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Abbasi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Tavakoli
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Bahareh Kheiri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Yazdani
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
17
|
Richards MD, Wong A. Infantile nystagmus syndrome: clinical characteristics, current theories of pathogenesis, diagnosis, and management. Can J Ophthalmol 2016; 50:400-8. [PMID: 26651297 DOI: 10.1016/j.jcjo.2015.07.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/12/2015] [Accepted: 07/22/2015] [Indexed: 11/25/2022]
Abstract
Infantile nystagmus syndrome (INS) is an important clinical diagnosis because it is a common presenting sign of many ocular, neurologic, and systemic diseases. Although INS has been studied for more than a century, its diagnosis and treatment remains a challenge to clinicians because of its varied manifestations and multiple associations, and its pathogenesis continues to rouse considerable scientific debate. Fueled by these challenges, recent basic research and clinical investigations have provided new insights into INS. New genetic discoveries and technological advances in ocular imaging have refined our understanding of INS subtypes and offer new diagnostic possibilities. Unexpected surgical outcomes have led to new understanding of its pathogenesis based on novel hypothesized pathways of ocular motor control. Comparative studies on nonhuman visual systems have also informed models of the neural substrate of INS in humans. This review brings together the classic profile of this disorder with recent research to provide an update on the clinical features of INS, an overview of the current theories on how and why INS develops, and a practical approach to the diagnosis and management of INS.
Collapse
Affiliation(s)
- Michael D Richards
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children; Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ont..
| | - Agnes Wong
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children; Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ont
| |
Collapse
|
18
|
Bagheri A, Abbasi H, Tavakoli M, Baradaran-Rafii A, Shaibanizadeh A, Kheiri B, Yazdani S. Effect of Photorefractive Keratectomy on Nystagmus and Visual Functions in Myopic Patients With Infantile Nystagmus Syndrome. Am J Ophthalmol 2016; 162:167-172.e2. [PMID: 26546564 DOI: 10.1016/j.ajo.2015.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/26/2015] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the effect of photorefractive keratectomy (PRK) on involuntary eye movements, visual acuity, and contrast sensitivity in myopic patients with infantile nystagmus syndrome. DESIGN Prospective interventional case series. METHODS This study was conducted on patients with infantile nystagmus syndrome and myopia equal to or more than -1 diopter (D), who were referred to our clinic over a 2-year period. Patients older than 18 years of age with a stable refraction for at least 1 year who were good candidates for PRK were included. Complete ophthalmologic examinations including assessment of best-corrected visual acuity (BCVA), contrast sensitivity, and videonystagmography were performed for all patients before and 3 months after surgery. RESULTS Twenty-four eyes of 12 patients with mean age of 23 ± 2 years were enrolled in this study. Spherical equivalent refractive error was -2.82 ± 1.65 D and -0.26 ± 0.25 D before and after PRK, respectively (P < .001). Monocular BCVA improved from 0.36 ± 0.21 logMAR to 0.27 ± 0.25 logMAR and binocular BCVA improved from 0.33 ± 0.2 logMAR to 0.17 ± 0.16 logMAR (P < .001). Contrast sensitivity significantly improved at low (P < .001), intermediate (P < .001), and high frequencies (P = .01). The frequency, amplitude, and intensity of nystagmus were significantly decreased after PRK (P < .001). There was no correlation between the degree of myopia correction and improvement in sensory and motor indices of nystagmus (P > .1, Spearman correlation coefficient). CONCLUSION PRK in patients with infantile nystagmus syndrome and myopia improved monocular and binocular BCVA and contrast sensitivity. Furthermore, motor indices of nystagmus (frequency, amplitude, and intensity) were significantly improved after surgery in these patients.
Collapse
Affiliation(s)
- Abbas Bagheri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Abbasi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Tavakoli
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | | | - Bahareh Kheiri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Yazdani
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
19
|
Penix K, Swanson MW, DeCarlo DK. Nystagmus in pediatric patients: interventions and patient-focused perspectives. Clin Ophthalmol 2015; 9:1527-36. [PMID: 26345377 PMCID: PMC4551307 DOI: 10.2147/opth.s62786] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Nystagmus refers to involuntary, typically conjugate, often rhythmic oscillations of the eyes. The most common cause of nystagmus in children is infantile nystagmus syndrome (INS). INS presents within the first few months of life and is sometimes accompanied by an ocular condition associated with sensory impairment. Because this condition affects a person throughout life, it is important to understand the options available to manage it. This review focuses on the underlying nystagmus etiology, psychosocial and functional effects of nystagmus, as well as current principles of management, including optical, pharmacological, surgical, and rehabilitative options. Currently, the neural mechanisms underlying INS are not fully understood. Treatment options are designed to increase foveation duration or correct anomalous head postures; however, evidence is limited to mainly pre- and post-study designs with few objective comparisons of treatment strategies. Management of INS should be individualized. The decision on which treatment is best suited for a particular patient lies with the patient and his/her physician.
Collapse
Affiliation(s)
- Kimberly Penix
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark W Swanson
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dawn K DeCarlo
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
20
|
Ghosh D, Rothner AD. Congenital Idiopathic Nystagmus: An Observational Diagnosis. Pediatr Neurol 2015; 53:177. [PMID: 25887921 DOI: 10.1016/j.pediatrneurol.2015.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/22/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Debabrata Ghosh
- Division of Pediatric Neurology, Nationwide Children's Hospital, Ohio State University Medical Center, Columbus, Ohio.
| | | |
Collapse
|
21
|
Lee SHK, Jun W, London R. Optical Management Using Monovision and Yoked Prism for Acquired Strabismus and Nystagmus Secondary to a Neurodegenerative Disease. Neuroophthalmology 2015; 39:147-151. [PMID: 27928348 DOI: 10.3109/01658107.2015.1035450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 11/13/2022] Open
Abstract
Acquired involuntary eye movement disorders, including noncomitant strabismus, nystagmus, and saccadic dyskinesia, are common ocular manifestations of many neurodegenerative diseases. These patients may experience visual symptoms, such as blurred vision, diplopia, and oscillopsia, which can significantly impact their use of vision. The goal of the management for these patients is to reduce the visual symptoms using any combination of available management strategies. This case report discusses the effective optical management using the combination of spectacle monovision correction and yoked prism to improve visual symptoms in a patient with olivopontocerebellar atrophy.
Collapse
Affiliation(s)
| | - Weon Jun
- VA Portland Health Care System Portland, Oregon USA
| | - Richard London
- Pacific University College of Optometry Forest Grove, Oregon USA and
| |
Collapse
|
22
|
Jayaramachandran P, Proudlock FA, Odedra N, Gottlob I, McLean RJ. A Randomized Controlled Trial Comparing Soft Contact Lens and Rigid Gas-Permeable Lens Wearing in Infantile Nystagmus. Ophthalmology 2014; 121:1827-36. [DOI: 10.1016/j.ophtha.2014.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 11/30/2022] Open
|
23
|
Pothier DD, Hughes C, Dillon W, Ranalli PJ, Rutka JA. The use of real-time image stabilization and augmented reality eyewear in the treatment of oscillopsia. Otolaryngol Head Neck Surg 2012; 146:966-71. [PMID: 22261498 DOI: 10.1177/0194599811434708] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES/HYPOTHESIS The symptom of oscillopsia in patients with bilateral vestibular loss (BVL) can be reduced as dynamic visual acuity (DVA), the reduction in visual acuity during head movement, is improved by using real-time image stabilization, delivered by augmented reality eyewear. SETTING Tertiary multidisciplinary neurotology clinic. STUDY DESIGN Prospective experimental study. METHODS Immersive virtual reality glasses used in combination with a compact digital video camera were used. A software algorithm was developed that used a center-weighted Lucas-Kanade optical flow method to stabilize video in real time. Six patients with BVL were tested for changes in DVA using the eyewear. The ability to read a Snellen chart during a 2-Hz oscillating head rotation DVA test was measured. RESULTS For combined scores of vertical and horizontal head rotations, the mean number of lines readable at rest was 7.86, which dropped to 2.77 with head movement (a combination of vertical and horizontal perturbations). This increased to a mean of 6.14 lines with the image stabilization software being activated. This difference was statistically significant (P < .001). CONCLUSION This is the first successful attempt to improve dynamic visual acuity in patients with bilateral vestibular loss. Recent hardware upgrades are promising in improving these results even further.
Collapse
Affiliation(s)
- David D Pothier
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, University Health Network, Toronto, Ontario, Canada.
| | | | | | | | | |
Collapse
|
24
|
|
25
|
Labiris G, Katsanos A, Fanariotis M, Tsirouki T, Pefkianaki M, Chatzoulis D, Tsironi E. Psychometric properties of the Greek version of the NEI-VFQ 25. BMC Ophthalmol 2008; 8:4. [PMID: 18325083 PMCID: PMC2287166 DOI: 10.1186/1471-2415-8-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Accepted: 03/06/2008] [Indexed: 11/15/2022] Open
Abstract
Background To evaluate the reliability and construct validity of a Greek version of the NEI-VFQ-25 in patients with chronic ophthalmic diseases. Methods We developed the Greek version of the instrument using forward and backward translation. One hundred-eighty-six patients responded to the questionnaire. To examine reliability, Cronbach's alpha for each subscale was used as an index of internal consistency. Test-retest reliability was evaluated with intraclass correlation coefficients. Regarding construct validity, both convergent and discriminant validities were calculated by means of multi-trait analysis. Rasch analysis was used to estimate the visual ability required by each item for a particular response, and each patient's visual ability. Correspondingly, instrument validity was evaluated by estimating the distribution of residuals for item and subject measures. Results Four patient groups were studied, each including participants with a single cause of visual impairment. Group 1 consisted of 84 glaucoma subjects. Group 2 included 30 subjects with age-related macular degeneration (ARMD); group 3 included 25 subjects with dry-eye syndrome, whereas group 4 included 18 cataract patients. Twenty-nine healthy individuals comprised the control group. NEI-VFQ scores (mean ± SD) for the glaucoma, ARMD, dry-eye, cataract and control groups were: 76.9 ± 20.2, 70.9 ± 20.2, 81.6 ± 16.5, 73.5 ± 24.0 and 93.7 ± 8.9 respectively. Item analysis revealed no significant data skewing. Cronbach's alpha ranged from 0.678 to 0.926, with most subscales having high internal consistency. Intraclass correlation coefficient ranged from 0.717 to 0.910 for all subscales. All items passed the convergent and discriminant validity tests. Strong correlations were detected between visual acuity and "general vision", "distant activities" and "near activities" subscales. Significant correlations were also detected between visual field deficits and the "peripheral vision" and "general vision" subscales. Rasch analysis revealed potential weaknesses of the instrument that are associated with the assumptions of the model itself. Specifically, low precision of the "agreement" items was detected in the estimation of visual ability. Twenty-three percent of the subjects had fit statistics that fell outside the tolerance box. Conclusion Although traditional validation methods indicated that the Greek version of the NEI-VFQ-25 is a valid and reliable instrument for VS-QoL assessment, Rasch analysis detected significant misfits to the model, especially of the "agreement" items. This means that results of the corresponding subscales should be interpreted with extreme caution.
Collapse
|
26
|
Affiliation(s)
- Marc J Dinkin
- Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
| | | |
Collapse
|
27
|
|
28
|
Corbett J. Memantine/gabapentin for the treatment of congenital nystagmus. Curr Neurol Neurosci Rep 2007; 7:395-6. [PMID: 17764629 DOI: 10.1007/s11910-007-0061-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
29
|
Football players' contrast sensitivity comparison when wearing amber sport-tinted or clear contact lenses. ACTA ACUST UNITED AC 2007; 78:232-5. [PMID: 17478341 DOI: 10.1016/j.optm.2006.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Revised: 08/28/2006] [Accepted: 11/05/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Many experiments are conducted each year in the sporting world to try and improve the existing technology and equipment in an effort to positively influence athletic outcomes. These studies, at times, are concerned about vision and how athletes can improve their visual inputs to respond most advantageously. Sports vision aids are becoming a more integral part of an athlete's equipment. Recently, sport-tinted contact lenses have become available to athletes of various sports. The purpose of this study was to compare football players' contrast sensitivity when wearing specially designed sport-tinted contact lenses to that when wearing clear contact lenses or no contact lenses in the case of an emmetropic athlete. METHODS Participants were fitted with either clear contact lenses or sport-tinted contact lenses. Spherical equivalent refractions were used because sport-tinted contact lenses are not currently available for astigmatic prescriptions. Contrast sensitivity was measured monocularly on a sine-wave grating chart of 4 spatial frequencies, each with decreasing contrast. Testing then was repeated with the other contact lens. Comparison was made to determine if statistically or clinically significant data would support the claim of increased contrast enhancement for the athletes while wearing the sport-tinted contact lenses. RESULTS Thirty-five subjects participated (35 left eyes), ranging in age from 18 to 32 years. All subjects were professional or collegiate football players. Testing done at 3, 6, 12, and 18 cycles per degree (cpd) of spatial frequency found statistically significant improvement with the sport-tinted contact lenses where P < 0.05. With an examination of the emmetropic-only subgroup, these same results were confirmed at 3 and 6 cpd. Although most of the results were statistically significant, it is questionable whether there is any clinically significant improvement in contrast enhancement while wearing these lenses. CONCLUSION Sport-tinted contact lenses appear to have a statistically significant effect on contrast sensitivity when worn by a relatively low astigmatic or spherically refracted patient. These results also hold true for enhancing sensitivity in the emmetropic athlete. This information is dampened, however, when considering clinical significance. Overall, there does not appear to be overwhelming evidence that the sport-tinted lenses provide any clinically significant difference when considering contrast enhancement. There are always exceptions to any study; therefore, each case would have to be evaluated by the individual practitioner and the athlete.
Collapse
|
30
|
Evans BJW. Interventions for infantile nystagmus syndrome: towards a randomized controlled trial? Semin Ophthalmol 2006; 21:111-6. [PMID: 16702079 DOI: 10.1080/08820530600614272] [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] [Indexed: 10/24/2022]
Abstract
A PubMed search for papers in the last 10 years on interventions for Infantile Nystagmus Syndrome (INS) reveals 18 papers on surgical or pharmacological interventions and 6 papers describing other interventions. There is only one randomized controlled trial (RCT), with all the other studies being uncontrolled trials/case series. To investigate the importance of RCTs, the data from the one RCT is re-analyzed as if it had been a case series. If only the group receiving the experimental treatment are considered, then the visual acuity was significantly better after than before treatment (paired t-test, p = 0.04). However, the control group who received a placebo treatment improved to a similar degree (p = 0.90). The literature on the placebo effect shows that it can influence objective variables and the outcome of surgical interventions. It is suggested that previous studies on interventions for nystagmus have laid an important foundation for future work in this field, which should involve RCTs.
Collapse
Affiliation(s)
- Bruce J W Evans
- Institute of Optometry and Department of Optometry and Visual Science, City University, London, SE1 6DS UK.
| |
Collapse
|
31
|
Abstract
This review examines current approaches to the diagnosis and management of congenital forms of nystagmus. Emphasis is placed on diagnostic features that are amenable to clinical identification but those issues that can be addressed only with more detailed investigations, such as eye movement recording, are indicated. Non-surgical management, including prism spectacles, contact lenses and vision therapy, is discussed, as are surgical approaches. Because many aspects of congenital forms of nystagmus, particularly as experienced by patients with the condition in their normal lives, are poorly addressed in both the clinical and research literature, these limitations are also highlighted.
Collapse
Affiliation(s)
- Larry A Abel
- Department of Optometry and Vision Sciences, The University of Melbourne, Vic, Australia.
| |
Collapse
|
32
|
Astle WF, Papp A, Huang PT, Ingram A. Refractive laser surgery in children with coexisting medical and ocular pathology. J Cataract Refract Surg 2006; 32:103-8. [PMID: 16516787 DOI: 10.1016/j.jcrs.2005.11.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Accepted: 02/17/2005] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the visual, refractive, and functional outcomes of photorefractive keratectomy (PRK) and of laser-assisted subepithelial keratectomy in a group of children with significant refractive error and underlying medical conditions or ocular pathology who were noncompliant with traditional management. SETTING Nonhospital surgical facility and a hospital clinic. METHODS This case series comprised 5 individual cases of anisometropic amblyopia and/or high myopia. Underlying medical and ocular conditions were as follows: upper eyelid hemangioma with oblique myopic astigmatism, Pelizaeus-Merzbacher leukodystrophy with nystagmus, Klippel-Trenaunay-Weber syndrome with glaucoma, incontinentia pigmenti with unilateral optic nerve atrophy, and Goldenhar syndrome with unilateral optic nerve hypoplasia. Photorefractive keratectomy or LASEK was performed in 6 eyes of 5 patients. Age range at the time of surgery was 1.0 to 7.0 years. All procedures were performed under general anesthesia. RESULTS Best corrected visual acuity improved by 2 lines in 2 patients and 1 line in 2 patients by 6 months after surgery. Stereopsis and/or fusional status improved in 3 patients. Amblyopia treatment compliance improved in 1 patient. Alignment improved without strabismus surgery in 2 cases. A functional vision survey demonstrated a positive effect on the ability of all 5 children to function in their environment. CONCLUSION During the period of visual cortical plasticity, refractive surgery, by eliminating the refractive component of amblyopia and by promoting fusional ability, provides considerable improvement in children, even those with underlying medical conditions associated with ocular pathology.
Collapse
Affiliation(s)
- William F Astle
- Alberta Children's Hospital, University of Calgary, Division of Ophthalmology, Canada
| | | | | | | |
Collapse
|
33
|
Abstract
Acquired and congenital nystagmus often causes decreased visual acuity as a direct result of the inability to maintain stable foveal vision. In addition, acquired nystagmus causes a disabling subjective sensation of movement of the visual world called oscillopsia. The eye movements themselves do not require treatment if the patient is asymptomatic. However, therapy is necessary if visual disability is present. Treatments based in pharmacologic mechanisms are preferred. There are few controlled treatment trials and therapeutic efficacy generally is sought in a trial and error approach, depending on the type of nystagmus present. Treatment with 3,4-diaminopyridine and 4-aminopyridine recently have been shown to be effective for downbeat nystagmus. Gabapentin, baclofen, and clonazepam also are useful in some patients with downbeat nystagmus. Baclofen is the therapy of choice for periodic alternating nystagmus. Gabapentin often is effective for acquired pendular nystagmus. Clonazepam and valproate also may be effective for acquired pendular nystagmus. Memantine now is available in the United States and is promising in the treatment of pendular nystagmus. Optical devices that negate the negative effects of nystagmus continue to undergo development research. These and other medical, surgical, and optical devices are potentially useful alone or in combination with other therapies.
Collapse
Affiliation(s)
- Janet C Rucker
- Department of Neurology, Case Western Reserve School of Medicine, Hanna House 5th Floor, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| |
Collapse
|