2001 Abstracts
British Orthoptic Journal 2001
Editorial: The statistical review.
John Webster
Spasm of the near reflex: a literature review.
Ann McIntyre
Abstract: Spasm of the near reflex typically presents with variable esotropia, pseudomyopia and pupil miosis. This condition is most commonly considered to be a functional visual disorder with a predilection for young females. An impression of abnormal ocular motility may result when the spasm is triggered by movement of the eyes, particularly mimicking a sixth nerve palsy. Less often spasm may occur in association with organic disease and with a few possible exceptions it is difficult to concede a causal link. Selective spasm of individual components of the near reflex may also occur and this is cited most frequently with neurological disease or trauma. There is little evidence to suggest the need for extensive neurological assessment in patients with near reflex spasm provided that a careful clinical examination has been performed. Observation of miosis and pseudomyopia are key to establishing the correct diagnosis. Management therapies include reassurance, atropinisation with prescription of an adequate reading correction, and botulinum toxin in selected cases. The extent to which the disturbance is troublesome is distinctly variable.
Key words: Near reflex spasm, Accommodative spasm, Convergence spasm, Pseudomyopia, Pupil miosis
A review of reading difficulties in relation to saccadic and visual anomalies in very low birth weight children.
David Newsham and Paul C. Knox
Abstract: This is a review of the reading difficulties experienced by very low birth weight (VLBW) children, which may often occur in the presence of a normal IQ. Efficient reading is dependent on adequate functioning in visual areas such as accommodation, saccadic eye movements, convergence and binocular control. The review initially explores the nature of cognitive and behavioural difficulties experienced by VLBW children, then primarily assesses the evidence that some VLBW children may suffer from a specific reading disorder. The extent of specific deficits in VLBW children is then reviewed in relation to the cerebral lesions that have been reported. Special emphasis is given to the lesions that could compromise eye movement pathways. The nature and incidence of binocular and visual anomalies in VLBW children are compared with those in the general population. Finally the effect that saccadic and visual and binocular anomalies could have on reading are discussed, and some comparisons made with dyslexia.
Key words: Very low birth weight (VLBW), Preterm, Reading, Saccade, Binocular vision, IQ, Cerebral lesion
Educational attainment associated with ophthalmic morbidity in a low birth weight population.
Anna R. O�Connor, Terence J. Stephenson, Ann Johnson, Michael J.Tobin, Sonia Ratib and Alistair R.Fielder
Abstract: This is a prospective study of the ophthalmic outcome of low birth weight children at age 10-12 years. In addition to the ophthalmic assessment, questionnaires were administered to the children�s parents and teachers to assess cognitive ability and educational outcome. The aim was to determine whether there was an association between educational outcome and ophthalmic morbidity. Compared with a control group of children born at term this low birth weight cohort had a significant increase in the occurrence of ophthalmic deficits including reduced acuity, strabismus and myopia. When those with an adverse ophthalmic outcome were compared with those who had no ophthalmic deficits, the former had reduced cognitive ability as assessed by both parents and teachers. This association is independent of birth weight, gestational age and severity of illness in the neonatal period. However, it is not possible to determine whether this association between cognitive ability and ophthalmic outcome is a causal link.
Key words: Low birth weight, Ophthalmic morbidity, Education, Cognitive ability
When is surgery indicated for distance exotropia?
Sarah R. Richardson
Abstract: A retrospective study of 187 patients with distance exotropia was undertaken to compare the outcomes of surgical and non-surgical management. Patients were divided into early, late and non-surgical groups. Analysis was performed to establish comparability between the groups and to determine any trend in management choices. One hundred and fifteen patients (61%) were managed non-surgically and 72 (39%) were managed surgically; 41 (57%) underwent early surgery and 31 (43%) late surgery. The groups were comparable in terms of binocularity but the near angle of deviation was significantly smaller in the non-surgical group than in either of the surgical groups. Consultant preference also appeared to be a significant factor in the choice of management. Better outcomes were found in the late surgery group: 18 patients (58%) achieved binocular single vision at near and distance post-operatively compared with 15 patients (36%) in the early surgery group.
Key words: Intermittent distance exotropia, Surgery, Early, Late, Binocular
An investigation of the impact of occlusion therapy on children with amblyopia, its effect on their families, and compliance with treatment.
Lois C. Parkes
Abstract: Children having occlusion therapy for amblyopia react in different ways to treatment and show different changes in behaviour as a result. This study examined these changes and found that differences in the way children behaved appeared to vary according to the density of amblyopia. Children with dense and moderate amblyopia often disliked the treatment, and the changes in their behaviour reflected that. Children with mild amblyopia tended to be more tolerant of the treatment, and demonstrated fewer changes in behaviour, whereas those with dense or moderate amblyopia objected more to the occlusion patch being put on each day (Chi square, p = 0.05). Children with dense and moderate amblyopia appeared to be less compliant with the treatment than children with mild amblyopia. Compliance did not appear to be linked to the age or sex of the child, or to the type of occlusion patch worn.
Key Words: Occlusion therapy, Amblyopia, Behaviour patterns, Compliance
Is stereopsis linked to hand-eye co-ordination.
Steve Joy, Helen Davis and David Buckley.
Abstract: Spatial awareness and hand eye co-ordination were assessed in three groups of subjects: those who had no history of binocular single vision (�monocular long term�E; those who had binocular single vision (�binocular�E; and those in whom binocular single vision was present but one eye was occluded (�monocular short term'). Two tasks were used, both with spatial awareness requirements. Results showed that �binocular' individuals were significantly quicker at completing the tasks compared with the other groups. Further, the �monocular short term and �monocular long term groups were comparable in their results. It was concluded that the �binocular' individual has an advantage in situations requiring spatial certainty when compared with the �monocular�Eindividual.
Key words: Stereopsis, Spatial awareness, Hand-eye coordination
Convergence insufficiency with associated superior oblique weakness.
Fiona J. Rowe, Jeanette Swift and Carmel P. Noonan
Abstract: The purpose of this study is to present a group of patients with convergence insufficiency and associated superior oblique weakness unresponsive to conventional treatment including pen convergence, dotcard and stereograms. Additionally temporary Fresnel prisms and botulinum toxin were unsuccessful in alleviating the convergence weakness. Full resolution of the convergence insufficiency occurred following surgery aimed at the hyperdeviation which was considered to pose a barrier to the achievement of normal convergence.
Key words: Convergence insufficiency, Superior oblique, Hyperdeviation, Orthoptic exercises, Surgery
Refraction after contact lens removal, and a comparison of binocularity in contact lens and spectacles.
Sonia K. Goyal and Jon P. Whittle
Abstract: The effect of recent removal of contact lenses on refractive error was investigated and visual function in contact lens and spectacle corrections was compared. Ten myopic contact lens wearers, aged 18-23 years, were studied. After removing contact lenses, each participant was observed over a 1 hour period to detect short-term fluctuations in refractive error. To assess visual function, visual acuity, muscle balance, prism fusion range, stereo-acuity, near point of convergence, accommodative convergence / accommodation ratio (AC/A) and amplitudes of accommodation were compared in contact lenses and spectacles. Statistically significant fluctuations in refractive error occurred during the hour after removing contact lenses. However, these were judged to be unimportant clinically. AC/A ratios were slightly lower when subjects were wearing contact lenses than spectacles. This study suggests that an accurate objective refraction can be achieved immediately after removing contact lenses, and that a myopic subject may derive benefit from contact lenses if a high AC/A ratio is present.
Key words: Contact lenses, Refractive error, AC/A ratio
Alternate day hypotropia following retinal detachment surgery.
Pamela King and Helen Wortley
Abstract: A case is presented in which an alternate-day hypotropia developed following retinal detachment surgery in a 24-year-old woman. Management is described.
Key words: Alternate-day squint, Cyclic squint, Vertical strabismus
A case of third cranial nerve palsy following recurrent meningitis.
Rececca M.Groom
Abstract: A case of pneumococcal meningitis which resulted in a third nerve palsy is described. Investigations following a recurrence of the meningitis revealed a congenital malformation of the ear, which allowed contact with the cerebrospinal fluid. This was surgically corrected.
Key words: Third nerve palsy, Meningitis, Congenital malformation
A case of Gradenigo�s syndrome in a young child.
Sally C. Turner
Abstract: The case history of a boy aged 4 years and 8 months with Gradenigo�s syndrome is presented. Although the abducens nerve palsy recovered within 3 months, a convergent strabismus remained. The orthoptic treatment and muscle surgery necessary to restore binocular single vision are described.
Key words: Gradenigo�s syndrome, Abducens nerve palsy, Diplopia, Fresnel prisms
Sixth nerve and contralateral fourth nerve palsies associated with diabetes and hypertension.
Veronica S. Henshall and Allyson E. Ryder
Abstract: Two cases are presented of patients attending the Orthoptic Department with sudden-onset horizontal and vertical diplopia. Ocular motility testing revealed a sixth nerve with a contralateral fourth nerve palsy, which recovered within 6 months of the initial presentation. Both patients suffered from non-insulin-dependent diabetes and hypertension.
Key words: Diabetes, Hypertension, Sixth nerve palsy, Fourth nerve palsy
Spontaneous Pulfrich�s phenomenon occurring with Meares-Irlen syndrome.
Joyce Clark
Abstract: A case is reported in which a patient�s bizarre symptoms were treated symptomatically by ordering glasses for outdoors which incorporated a selected grey filter in front of one eye. Rose-tinted glasses were prescribed for reading. These glasses produced a dramatic improvement in her daily visual environment.
Key words: Pulfrich�s phenomenon, Meares-Irlen syndrome, Pendulum, Coloured overlays, Neutral density filter
Ataxia telangiectasia.
Tracy Wood
Abstract: Ataxia telangiectasia is a rare condition that, because of the initial clinical findings of conjunctival telangiectasia and ataxia, may be seen by orthoptists working in the community (screening) or in multi-disciplinary teams and child development centres.
Key words: Ataxia telangiectasia, Autosomal recessive, Multisystemic, Progressive neurological degeneration, Immunodeficiences, Endocrinopathies
Strabismus associated with orbital rhabdosarcoma.
Bernadette McCarry
Abstract: A case study of orbital rhabdomyosarcoma is presented. The tumour treatment is described as well as the management of associated radiotherapy-induced side-effects, particularly cataract. An associated strabismus and diplopia, which persisted over several years, is covered in detail. Comfortable binocular single vision was eventually restored following phacoemulsification, intraocular lens implant and botulinum toxin strabismus therapy.
Key words: Orbital rhabdomyosarcoma, Diplopia, Strabismus, Orbital radiotherapy side-effects, Botulinum toxin.
Ocular palatal myoclonus following cerebellar and brain stem infarct, ocular motility and recovery.
Lesley D. Stuart and Cathryn L. Edrich
Abstract: Ocular palatal myoclonus (OPM) usually follows a brain stem and/or cerebellar lesion affecting the dentato-rubro-olivary pathway. Occasionally, cortical lesions may result in OPM. The major causative factor is an infarct, affecting 70% of such patients. Patients usually present with horizontal gaze palsies, abnormal vertical eye movements, and nystagmus associated with palatal myoclonus. We report a patient who presented suddenly with left-sided cerebellar signs, a left sixth and seventh nerve palsy, left internuclear ophthalmoplegia and skew deviation who subsequently went on to develop oscillopsia affecting the right eye in association with OPM.
Key words: Ocular palatal myoclonus, Sixth nerve palsy, Internuclear ophthalmoplegia, Skew deviation, Nystagmus, Oscillopsia