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Jan Roelof Polling
Published: 3 July 2017
Strabismus, Volume 25, pp 94-94; https://doi.org/10.1080/09273972.2017.1352402

, J. Ygge, M. Olsson
Published: 3 July 2017
Strabismus, Volume 25, pp 156-159; https://doi.org/10.1080/09273972.2017.1350727

Abstract:
Purpose: To assess the ocular motor functions in children with spastic hemiplegia by using the Ocular Motor Score (OMS). Material: This study included 34 children, median age 11 years. The children were divided into 3 groups according to the underlying brain lesion; group 1 malformations, group 2 white matter damage of immaturity (WMDI), and group 3 cortical/subcortical lesions. Methods: The OMS protocol consists of 15 different subtests evaluating ocular motor functions. The OMS is divided into 2 parts, a static and a dynamic. The results from each subtest are scored 0, 0.3, 0.5, or 1, according to the level of disturbance, where 0 corresponds to normal function and 1 represents the maximum disability in the certain subtest. A total OMS (tOMS) between 0 and 15 can be obtained. Results: The median tOMS in the whole spastic hemiplegia group was 2.5 (range 1.3–5.8). The highest median tOMS 5.2 was seen in group 1, in the children with malformations. Strabismus was found in 45% (15/34) of the children, with an equal percentage in all 3 groups. Conclusions: The children with spastic hemiplegia had a median tOMS of 2.7 and the highest median tOMS was seen in children with malformations. The OMS protocol is easy to use clinically and gives a quick overview of the patient´s ocular motor functions.
, M. C. Verkaik-Rijneveld, , E. De Jongh
Published: 3 July 2017
Strabismus, Volume 25, pp 160-165; https://doi.org/10.1080/09273972.2017.1350726

Abstract:
Purpose: The 15∆ base in prism test (15∆BIPT) introduced by Gobin is often used in The Netherlands to detect fixation preference, especially in young and preverbal children in whom a reliable measurement of the visual acuity (VA) is difficult. It is assumed that the fixation preference detected by the 15∆BIPT can be used to predict the presence of amblyopia. The aim of this retrospective case note review was to investigate the accuracy of the 15∆BIPT in detection of amblyopia in anisometropic patients. Methods: Four hundred and twelve files of anisometropic patients visiting the orthoptic department of The Rotterdam Eye Hospital were analyzed. Amblyopia was defined as an intraocular difference in VA of 2 or more Snellen lines. The sensitivity, specificity, and positive and negative predictive values of the 15∆BIPT were calculated and the receiver operating characteristic (ROC) curve was plotted. Results: One hundred and fifty-two patients ranging from 3.3–13.1 years of age (median 5.4 years) met the inclusion criteria. One hundred and two patients were diagnosed with amblyopia. Best-corrected median VA of the best eye was 1.0 (range 0.5–1.2) and the worst eye 0.70 (range 0.05–1.2). Sensitivity of the 15∆BIPT (based on detecting amblyopia) was 34.3%. Specificity was 88.0%. The positive predictive value was 85.4% versus a negative predictive value of 39.6%. The area under the ROC curve (AUC) was 0.65 (95% CI 0.56–0.74). Conclusion: The low sensitivity, large number of false negatives and the AUC show that the 15∆BIPT can be considered a poor test for detecting amblyopia in anisometropic patients.
, Jibin John, Satinder Aneja,
Published: 10 August 2017
Strabismus, Volume 25, pp 200-213; https://doi.org/10.1080/09273972.2017.1350865

Abstract:
Purpose: Familial clustering of common forms of primary strabismus like esotropia (ET) and exotropia (XT) is observed in a proportion of the strabismus cohort. The genetic components of this remain unidentified. Linkage studies have demonstrated susceptibility locus for primary strabismus at the STBMS1 locus on 7p22.1 as well as other loci on 4q28.3 and 7q31.2. Recently next generation sequencing (NGS) technology has emerged as a powerful tool in discovery genomics and a large number of novel disease-causing variants are being reported. In this study, we recruited informative families for subsequent genetic analysis for disease-causing variant identification. Methods: All consecutive families with two or more affected members with primary concomitant horizontal strabismus were prospectively recruited at the ophthalmic outpatients department (OPD) of Lady Hardinge Medical College, New Delhi, from August 2014 to February 2017. Detailed phenotypic evaluation and pedigree documentation was performed. Results: Of the 39 recruited families of north Indian origin, 18 families each had affected family members demonstrating either ET or XT. 100% concordance of the phenotype in the affected family members was observed in these families. While vertical transmission was observed in 17/18 families with XT, 7 with ET had affected members across one generation, 2 demonstrated consanguineous pedigree, and 2 comprised identical twin families. In 3 families, a combination of ET and XT was noted. This comprised one family with the ET and XT patients being from 2 separate arms of the family related by marriage, one family where one sibling had XT and the other had ET, and another family where the maternal aunt of the affected proband with ET had XT. Conclusions: Subjects with familial primary concomitant strabismus recruited in this study may provide a valuable resource to unravel the genetic determinants of this condition, which is a common disorder of early childhood with high ophthalmic morbidity.
, Mari Gutter, Jan Roelof Polling
Published: 3 July 2017
Strabismus, Volume 25, pp 134-139; https://doi.org/10.1080/09273972.2017.1349815

Abstract:
Purpose: Cranial nerve palsies often require neurological imaging by MRI. Guidelines on whether or not to utilize MRI have been absent or lack clarity. In daily practice, both neurologists and ophthalmologists treat patients with cranial nerve palsy and determine whether neuro-imaging is required. There appear to be differences in policy with respect to neuro-imaging. The question, which will be answered in this study, is the following: to what extent do differences in policy exist between ophthalmologists and neurologists regarding imaging by MRI of patients with acquired ocular cranial nerve palsy? Method: PubMed database was searched for literature on acquired cranial nerve palsy and MRI scanning performed by ophthalmologists and neurologists. Case series published between 2000 and 2015 were included. The first author screened the literature on eligibility, profession of the authors, and conducted data abstraction. Result: Ten case series were found eligible for analysis. A total of 889 cranial nerve palsies were described, 770 by ophthalmologists and 119 by neurologists. The age range of patients in all case series was 2 to 96 years of age. The oculomotor nerve was investigated in 162 patients, the trochlear nerve in 131 patients, and the abducens nerve in 486 patients. All neurologists (n=3) and 2 out of 7 investigated ophthalmologists recommended performing MRI scanning in every patient who presented with an ocular cranial nerve palsy, while 5 ophthalmologists (5/7) opted to triage patients for risk factors associated with cranial nerve palsies prior to ordering MRI imaging. When different groups of patients were viewed separately, it became apparent that almost all specialists agreed that every patient with a third nerve palsy and patients under 50 years of age should undergo MRI scanning. In patients with fourth nerve palsy, MRI scanning was not indicated. Conclusion: The neurologists in this study were more likely to perform MRI scanning in every patient presenting with ocular cranial nerve palsy. Ophthalmologists were more likely to determine risk factors associated with cranial nerve palsy, which they took into account when deciding whether or not to perform neurological imaging in patients aged more than 50 years or presenting with abducens nerve palsy.
L. De Meij, M. A. J. Telleman, M. R. C. Luijten, J. R. Polling,
Published: 3 July 2017
Strabismus, Volume 25, pp 128-133; https://doi.org/10.1080/09273972.2017.1349813

Abstract:
Purpose: Fixation disparity (FD) is a small misalignment of the eyes within the normal alignment when viewing under binocular condition. Ogle’s apparatus measures FD. Standards of procedures vary, which may lead to different outcomes. Methods: Students with normal ocular alignment, stereopsis ≤60 seconds of arc and visual acuity <0.1 logMAR, were included in this prospective comparative study. Four procedures (P1-P4) of measuring FD with Ogle’s apparatus were performed with divergent placement of the line (P1 and P3), or the line moving from subjective zero (P1 and P2: prisms of ascending strength; P3 and P4: prisms alternating base in base out; combined and P4). Differences in the FD curve were determined by looking at point zero, motor fusion amplitude, and the degree of FD. Results: Twenty-six participants were examined by these 4 procedures. Point zero showed a significant difference between P1-P2 (P=0.006) and P3-P4 (P=0.001). P1 and P3 indicated the highest point zero: median of -1 and -1.5 minutes of arc exodisparity. Motor fusion amplitude showed a significant difference between P1-P2 (P=0.037), P1-P3 (P=0.004), and P2-P4 (P=0.002). P1 revealed the highest motor fusion amplitude (median of 34Δ) and P4 the lowest amplitude (median of 28Δ). No significant differences were found in esodisparity. In exodisparity there was a significant difference comparing P1-P2 (P=0.000), P3-P4 (P=0.000), and P1-P3 (P=0.021). P1 gave the highest exodisparity (median 22 minutes of arc) and P4 the lowest (median 10 minutes of arc). Conclusion: Clinically relevant differences were found in exodisparity, mainly caused by difference in line shifting. Exodisparity was significantly lower, moving the line from subjective zero. The most accurate procedure is using prisms of ascending strength combined with divergent placement of the line (P1). These findings standardize a reliable procedure of measuring the FD curve for clinical use. Patients will not be misdiagnosed with reduced FD.
, , Achia Nemet
Published: 3 July 2017
Strabismus, Volume 25, pp 140-144; https://doi.org/10.1080/09273972.2017.1349816

Abstract:
Aim: To evaluate the results of bilateral lateral rectus to superior rectus myopexy for the treatment of acquired adult distance esotropia. Methods: The charts of all adult patients who were operated for esotropia by the first author at the Department of Ophthalmology, Assaf Harofeh Medical Center, Tel Aviv University, Zrifin, Israel, between the years 2010-2015 were analyzed. Patients with the following inclusion criteria were included: acquired esotropia (not present during childhood); deviation greater for distance than near by at least 4 prism diopters (PD); slight abduction deficit in one or both eyes and/or displacement of the lateral rectus downwards as evident by CT/MRI with or without superior rectus nasal shift and no neurologic abnormalities such as cranial nerve palsies or other. Results: Eighteen patients were identified (age 31–80 years, mean 49.6 years, 77.7% females). Pre-operative esodeviation averaged 24.3 PD (range 14–35 PD) for distance and 15.7 PD (range 8-25 PD) for near. Thirteen patients (72%) had diplopia. All patients were myopic (average -5.54 diopters, range -2.00 to -13.00). All patients underwent bilateral superior rectus–lateral rectus myopexy. Seven patients needed additional single medial rectus recession of between 2–6 mm, and two had additional inferior rectus recession. After a follow-up period of 3–52 months (average 16 months), 16/18 patients (88%) had a deviation less than 5 PD. No overcorrections were noted. Conclusion: Lateral to superior rectus myopexy is a safe and effective treatment for patients with distance esotropia in which displacement of these muscles is identified. Additional single medial rectus and/or inferior rectus recession may be needed in some patients.
Published: 3 July 2017
Strabismus, Volume 25, pp 145-155; https://doi.org/10.1080/09273972.2017.1349814

Abstract:
Purpose: The stability of binocular vision depends upon good fusional amplitudes, but the clinical assessment of fusional amplitudes varies around the world. The purpose of this study was to determine whether or not there is variation in the assessment of fusional amplitudes in normal subjects. The author looked at the testing distance, the order of testing, the role of examiner encouragement, and the subject’s level of alertness. Methods: In a prospective study using a modified crossover design, the author assessed fusional amplitudes in 99 subjects with normal eye exams. The measurements were done in two separate sessions on different days with each subject being randomized as to the order of fusional vergence testing. All subjects were assessed without and with encouragement in the first session. In the second session, all were assessed at different testing distances. Results: The author previously presented data on 50 subjects. In this expanded cohort, statistical significance was reached confirming the previous findings that convergence is significantly affected by encouragement, divergence is significantly reduced if assessed after convergence, and near amplitudes are significantly higher than distance amplitudes. Finally, there is a negative correlation between age and convergence break point. Conclusions: The results of this study demonstrate that divergence is significantly reduced if assessed after convergence in the subject with normal binocular function. Next, convergence is significantly affected by the use of encouragement. Measurements at near produced significantly higher results for all of the convergence and divergence tests. Finally, there is a significant negative correlation between age and convergence break point. We need to develop a standard of testing fusional amplitudes so there is consistency in the clinical assessment.
Published: 3 July 2017
Strabismus, Volume 25, pp 112-119; https://doi.org/10.1080/09273972.2017.1349812

Abstract:
This study sought to explore the practice of orthoptists internationally in care provision for poststroke visual impairment.Survey questions were developed and piloted with clinicians, academics, and users. Questions addressed types of visual problems, how these were identified, treated, and followed up, care pathways in use, links with other professions, and referral options. The survey was approved by the institutional ethical committee. The survey was accessed via a web link that was circulated through the International Orthoptic Association member professional organisations to orthoptists.Completed electronic surveys were obtained from 299 individuals. About one-third (35.5%) of orthoptists saw patients within 2 weeks of stroke onset and over half (55.5%) by 1 month post stroke. Stroke survivors were routinely assessed by 87%; over three-quarters in eye clinics. Screening tools were used by 11%. Validated tests were used for assessment of visual acuity (76.5%), visual field (68.2%), eye movement (80.9%), binocular vision (77.9%), and visual function (55.8%). Visual problems suspected by family or professionals were high (86.6%). Typical overall follow-up period of vision care was less than 3 months. Designated care pathways for stroke survivors with visual problems were used by 56.9% of orthoptists. Information on visual impairment was provided by 85.9% of orthoptists.In international orthoptic practice, there is general agreement on assessment and management of visual impairment in stroke populations. More than half of orthoptists reported seeing stroke survivors within 1 month of the stroke onset, typically in eye clinics. There was a high use of validated tests of visual acuity, visual fields, ocular motility, and binocular vision. Similarly there was high use of established treatment options including prisms, occlusion, compensatory strategies, and oculomotor training, appropriately targeted at specific types of visual conditions/symptoms. This information can be used to inform choice of core outcome orthoptic measures in stroke practice.
, A. M. Horwood,
Published: 3 July 2017
Strabismus, Volume 25, pp 95-100; https://doi.org/10.1080/09273972.2017.1349811

Abstract:
Previous research indicates that a significant proportion of children underaccommodate at 1/3 m. Accommodation may vary with task demand, so children may accommodate appropriately if required, for example, when reading small print. This study explores the range of accommodative responses elicited in typical children, under naturalistic conditions, to a range of targets.
Isolde Den Tonkelaar, Harold H. Henkes, Gijsbert K. Van Leersum
Published: 3 April 2017
Strabismus, Volume 25, pp 1-6; https://doi.org/10.1080/09273972.2017.1319166

Eric Singman, , Jing Tian, Abby Brubaker, David Silbert
Published: 29 May 2013
Strabismus, Volume 21, pp 85-87; https://doi.org/10.3109/09273972.2013.786735

Abstract:
Purpose: We compare the plusoptiX S04 and A09 photoscreeners on a single cohort of children. Methods: One hundred and thirteen children were evaluated on both the plusoptiX S04 and A09 photoscreener. A lay screener performed all of the testing prior to a pediatric ophthalmology examination. The order was alternated so that the S04 was performed first on one patient then second on the next to minimize fatigue bias. Results: Utilizing our modified criteria previously published, the plusoptiX S04 was found to have a sensitivity of 85%, specificity of 94%, false positive rate of 15%, and false negative rate of 6% in detecting American Association for Pediatric Ophthalmology and Strabismus–defined amblyopia factors. The plusoptiX A09 was found to have a sensitivity of 92%, specificity of 88%, false positive rate of 11%, and false negative rate of 8%. Conclusion: The plusoptiX S04 and A09 photoscreeners perform similarly when used by a lay screener to evaluate the same population of children.
Danielle N. Jackson,
Published: 5 March 2012
Strabismus, Volume 20, pp 17-23; https://doi.org/10.3109/09273972.2011.650813

Abstract:
Motion sickness is reported to be a common symptom in patients with vertical heterophoria. The goal of this study was to assess the relationship between vertical phoria and susceptibility to motion sickness in a nonclinical sample of 43 subjects. Vertical phoria was measured with a Maddox rod after 30 s of occlusion. To evaluate susceptibility to motion sickness, subjects read text while sitting inside a rotating optokinetic drum for 10 min. Subjects rated their level of motion sickness at 1 min intervals during drum rotation and the magnitude of 13 motion sickness symptoms after drum rotation ended. The magnitude of vertical phoria ranged from 0 to 2.13 prism diopters (pd) with a mean of 0.46 pd and correlated significantly with both the maximum rating of motion sickness during drum rotation and the summed symptom score following rotation. A vertical phoria of 0.75 pd discriminated best between subjects with low vs high summed motion sickness symptom scores (p< 0.0001). Introducing a prism to artificially increase the phoria of 12 subjects with vertical phorias 0.75 pd reduced motion sickness symptoms in 2 of the 4 subjects tested. The results confirm an association between vertical phoria and motion sickness, but suggest the relationship may not be causal.
Published: 26 August 2011
Strabismus, Volume 19, pp 99-109; https://doi.org/10.3109/09273972.2011.600420

Abstract:
Amblyopia is a common visual disorder that results in a spatial acuity deficit in the affected eye. Orthodox treatment is to occlude the unaffected eye for lengthy periods, largely determined by the severity of the visual deficit at diagnosis. Although this treatment is not without its problems (poor compliance, potential to reduce binocular function, etc) it is effective in many children with moderate to severe amblyopia. Diagnosis and initiation of treatment early in life are thought to be critical to the success of this form of therapy. Occlusion is rarely undertaken in older children (more than 10 years old) as the visual benefits are considered to be marginal. Therefore, in subjects where occlusion is not effective or those missed by mass screening programs, there is no alternative therapy available later in life. More recently, burgeoning evidence has begun to reveal previously unrecognized levels of residual neural plasticity in the adult brain and scientists have developed new genetic, pharmacological, and behavioral interventions to activate these latent mechanisms in order to harness their potential for visual recovery. Prominent amongst these is the concept of perceptual learning—the fact that repeatedly practicing a challenging visual task leads to substantial and enduring improvements in visual performance over time. In the normal visual system the improvements are highly specific to the attributes of the trained stimulus. However, in the amblyopic visual system, learned improvements have been shown to generalize to novel tasks. In this paper we ask whether amblyopic deficits can be reduced in adulthood and explore the pattern of transfer of learned improvements. We also show that developing training protocols that target the deficit in stereo acuity allows the recovery of normal stereo function even in adulthood. This information will help guide further development of learning-based interventions in this clinical group.
Fatma Yulek, , Sherwin J. Isenberg, Joseph L. Demer,
Published: 3 April 2017
Strabismus, Volume 25, pp 81-86; https://doi.org/10.1080/09273972.2017.1318929

Abstract:
Background: Binocular summation (BiS), or improvement in binocular vision exceeding the better eye alone, is affected by strabismus. Being easily measured, BiS may be a useful indicator for subjective outcomes like stereopsis in strabismus. This study aims to investigate the relationship between BiS and measures of control of intermittent exotropia (IXT). Methods: Patients with IXT were recruited before undergoing strabismus surgery and underwent tests of binocular and monocular high- and low-contrast visual acuity, stereopsis at distance and near, and Newcastle Control Score (NCS), a score developed by incorporating home control and clinic control criteria into a control rating scale. BiS was calculated using high-contrast Early Treatment of Diabetic Retinopathy Study (ETDRS) and Sloan low-contrast acuity charts (LCA) at 2.5% and 1.25% contrast as the difference between the binocular score and that of the better eye. The relationship between BiS and measures of IXT control (NCS and distance near stereoacuity disparity) was evaluated using a correlation analysis by Spearman correlation coefficients and the Kruskal-Wallis test. Results: Thirty-four patients were included (mean [± standard deviation (SD)] age 19±16 years) having a mean (±SD) of 26±16Δ IXT at distance and 20±16Δ at near. Mean (±SD) BiS for ETDRS and Sloan LCA at 2.5% and 1.25% was 0.8±3.6, 1.9±6.0, and -2.3±7.2, respectively. The Spearman correlation coefficient of BiS and NCS was -0.53 (95% CI -0.85 to -0.25) for 2.5% LCA and -0.43 (95% CI -0.77 to -0.13) for 1.25% LCA. BiS at 2.5% LCA (P=0.006) and at 1.25% LCA (P=0.029) significantly differed between the groups based on NCS score groupings (1-3, 4-6, and 7-9), with patients who had better control scores having higher levels of BiS. BiS did not differ significantly between patients grouped according to the difference between stereoacuity measured at near versus distance. Conclusion: Significantly lower low-contrast BiS in patients with higher NCS may suggest that decreased BiS is associated with less control in IXT. This finding suggests that BiS may reflect control in IXT across a population of patients with IXT.
Lucy Barker, Kelly MacKenzie, Gill Gw Adams,
Published: 3 April 2017
Strabismus, Volume 30, pp 1-6; https://doi.org/10.1080/09273972.2017.1318151

Abstract:
Vertical deviations in thyroid eye disease (TED) can present a surgical challenge due to the difficulty and unpredictability of surgery and the high risk of postoperative drift towards overcorrection. This study reports the postoperative outcomes of patients who underwent adjustable vertical strabismus surgery with Vicryl sutures for thyroid eye disease.
, Mehmet N. Agaoglu, Vallabh E. Das
Published: 3 April 2017
Strabismus, Volume 25, pp 47-55; https://doi.org/10.1080/09273972.2017.1317821

Abstract:
Purpose: Under monocular viewing conditions, humans and monkeys with infantile strabismus exhibit asymmetric naso-temporal (N-T) responses to motion stimuli. The goal of this study was to compare and contrast these N-T asymmetries during 3 visually mediated eye tracking tasks—optokinetic nystagmus (OKN), smooth pursuit (SP) response, and ocular following responses (OFR). Methods: Two adult strabismic monkeys were tested under monocular viewing conditions during OKN, SP, or OFR stimulation. OKN stimulus was unidirectional motion of a 30°x30° random dot pattern at 20°, 40°, or 80°/s for 1 minute. OFR stimulus was brief (200 ms) unidirectional motion of a 38°x28°whitenoise at 20°, 40°, or 80°/s. SP stimulus consisted of foveal step-ramp target motion at 10°, 20°, or 40°/s. Results: Mean nasalward steady state gain (0.87±0.16) was larger than temporalward gain (0.67±0.19) during monocular OKN (P<0.001). In monocular OFR, the asymmetry is manifested as a difference in OFR velocity gain (nasalward: 0.33±0.19, temporalward: 0.22±0.12; P=0.007). During monocular SP, mean nasal gain (0.97±0.2) was larger than temporal gain (0.66±0.14; P<0.001) and the mean nasalward acceleration during pursuit initiation (156±61°/s2) was larger than temporalward acceleration (118±77°/s2; P=0.04). Comparison of N-T asymmetry ratio across the 3 conditions using ANOVA showed no significant difference. Conclusions: N-T asymmetries are identified in all 3 visual tracking paradigms in both monkeys with either eye viewing. Our data are consistent with the current hypothesis for the mechanism for N-T asymmetry that invokes an imbalance in cortical drive to brainstem circuits.
Published: 3 April 2017
Strabismus, Volume 25, pp 60-66; https://doi.org/10.1080/09273972.2017.1317820

Abstract:
The prevalence of tropia and phoria was high in our study. Moreover, the prevalence of exotropia and exophoria was higher than esotropia and esophoria. The prevalence of phoria was significantly higher in older age groups and in the participants living in the southern villages.
, Joseph L. Demer, Sherwin J. Isenberg, ,
Published: 3 April 2017
Strabismus, Volume 25, pp 73-80; https://doi.org/10.1080/09273972.2017.1318153

Abstract:
Purpose: Binocular summation (BiS) occurs when binocular visual function surpasses that of the better eye alone. We sought to evaluate whether strabismic amblyopia reduces BiS more than strabismus alone, and determine whether BiS improves in strabismic amblyopes after strabismus surgery. Methods: We prospectively recruited 15 patients with strabismic amblyopia who then underwent strabismus surgery. Thirty age-matched normal subjects and 30 non-amblyopic strabismic patients served as controls. Subjects underwent binocular and monocular visual acuity testing on high-contrast Early Treatment Diabetic Retinopathy Study (ETDRS) as well as 2.5% and 1.25% Sloan low contrast acuity (LCA) charts. BiS was calculated as the difference between better eye and binocular scores. Results: Strabismic amblyopes and strabismic controls did not significantly differ in preoperative BiS, but both had subnormal BiS preoperatively on LCA charts. Among 11 strabismic amblyopes with preoperative and postoperative BiS measurements, average postoperative BiS was not significantly different from preoperative. Improved LCA BiS postoperatively occurred in some patients and was associated with measurable preoperative stereoacuity (P=0.02), older age at strabismus onset (P=0.02), and larger preoperative angle of strabismus (P=0.0043).Conclusions: In this preliminary study, strabismic amblyopes experienced subnormal BiS, but amblyopia generally did not further impair BiS beyond that due to strabismus alone. Some strabismic amblyopes experienced improved low-contrast BiS after strabismus surgery. This suggests that further investigation in larger groups of patients should be undertaken to analyze a previously unrecognized functional benefit of strabismus surgery in strabismic amblyopes.
, , Nurşen Arıtürk, Ozlem Terzi
Published: 3 April 2017
Strabismus, Volume 41, pp 1-4; https://doi.org/10.1080/09273972.2017.1318152

Abstract:
The aim of our study was to examine the effect of hypermetropia and anisometropic, exotropic, and esotropic amblyopia on choroidal thickness.
Published: 20 April 2017
Strabismus, Volume 25, pp 120-127; https://doi.org/10.1080/09273972.2017.1305425

Abstract:
The theme of the 2016 Burian Lecture is how our understanding of strabismus has been changed by the research carried out in our laboratory in Reading over the years. Accommodation and convergence are fundamental to orthoptics, but actual responses have often been very different compared to what we had expected. This paper outlines how our laboratory's understanding of common issues such as normal development of accommodation and convergence, their linkage, intermittent strabismus, anisometropia, orthoptic exercises, and risk factors for strabismus have changed. A new model of thinking about convergence and accommodation may help us to better understand and predict responses in our patients.
, Sue Elliott, Iris Gordon, Anupa Shah
Published: 17 April 2017
Strabismus, Volume 25, pp 101-111; https://doi.org/10.1080/09273972.2017.1305424

Abstract:
To present an overview of the range of systematic reviews on intervention trials pertinent to orthoptic practice, produced by the Cochrane Eyes and Vision group (CEV).
Isolde Den Tonkelaar, Harold H. Henkes, Gijsbert K. Van Leersum
Published: 2 January 2017
Strabismus, Volume 25, pp 43-46; https://doi.org/10.1080/09273972.2017.1285159

Abbas Bagheri, Hamed Abbasi, , Abdolreza Sheibanizadeh, Bahareh Kheiri,
Published: 2 January 2017
Strabismus, Volume 25, pp 17-22; https://doi.org/10.1080/09273972.2016.1276939

Abstract:
Purpose: To determine the effect of rigid gas permeable contact lenses (RGPCL) on involuntary eye movements and visual function in hyperopic patients with infantile nystagmus syndrome. Methods: This prospective interventional case series was conducted on 16 patients with infantile nystagmus and hyperopia equal or more than +0.5 D and astigmatism more than -1 D over a 2-year period. A complete ophthalmological examination including determination of best corrected visual acuity (BCVA), contrast sensitivity, and videonystagmography was performed for all patients before and after at least 3 months of RGPCL use, and the outcomes were compared. Results: Thirty-two eyes of 16 patients with mean age of 18.6±4.9 years were enrolled. Mean spherical equivalent refractive error was +1.5±2.35 (range +1 to +6.25) diopters (D); corresponding values were +2.45±2.44 D (range +0.5 to +7.5) for spherical error and +1.90±0.83 D (range +1 to +4) for astigmatism. Monocular BCVA improved from 0.56±0.23 to 0.51±0.23 Log MAR (P=0.007), and binocular BCVA improved from 0.54±0.25 to 0.48±0.24 Log MAR (P=0.01) after fitting RGPCL. Following the use of RGPCL, contrast sensitivity was significantly improved at low (P=0.02) and intermediate (P< 0.001) frequencies but not at high frequencies (P=0.6). The frequency, amplitude, and intensity of nystagmus were decreased significantly after RGPCL use (P<0.001). Conclusion: RGPCL improved monocular and binocular BCVA and contrast sensitivity in hyperopic patients with infantile nystagmus syndrome. Motor indices of nystagmus (frequency, amplitude, and intensity) were also significantly improved after RGPCL use.
Su Ann Tay, Sonal Farzavandi,
Published: 2 January 2017
Strabismus, Volume 25, pp 23-32; https://doi.org/10.1080/09273972.2016.1276940

Abstract:
Efforts to reduce the progression of myopia in childhood are on the rise, due to an increasing incidence of myopia worldwide and its associated sight-threatening complications. Interventions are aimed at reducing myopia in childhood and include environmental considerations, spectacles, contact lenses, and pharmacological agents. We reviewed recent literature with interventions aimed at reducing myopia progression in children and found that a number of interventions were significant in reducing the progression of myopia. Of these interventions, atropine showed the largest dose-related effect on myopia progression control. Although higher doses are associated with side effects of pupil dilatation, loss of accommodation, near vision blur, and rebound phenomenon, low-dose atropine has also been shown to provide effective myopia control with minimal side effects and rebound. To a lesser degree, bifocal soft contact lenses have also been shown to be effective in reducing the progression of myopia, though compliance is an issue. Similarly, orthokeratology lenses have also been shown to be effective in reducing axial length elongation and myopia progression, though long-term data on its rebound effects are unavailable.
, Ángel García-García, Francisco J. Hurtado-Ceña, José M. Rodríguez-Sánchez
Published: 2 January 2017
Strabismus, Volume 25, pp 1-4; https://doi.org/10.1080/09273972.2016.1276936

Abstract:
Background and purpose: To study the clinical characteristics, treatment options, and outcome of patients with trochleitis in our population. Methods: Retrospective review of 59 patients diagnosed with trochleitis in the Ramon y Cajal Hospital Emergency Service between 2003 and 2010. Demographic data and trochleitis features were described. The relationship between outcome and treatment options was analyzed by SPSS. Results: The estimated prevalence rate of trochleitis in our area was 12 per 100,000. The average age of patients was 43±18 years. The majority of cases were women (86%). One case was bilateral. Patients’ chief complaints were continuous pain (66%), pain only with ocular movements (25%), or pain only with palpation (8%). Ocular movement limitations were presented in 14%. Diplopia was observed in 12%, and 19% complained of headache. Oral non-steroidal anti-inflammatory drugs (NSAIDs) were the first option for treatment in 85% of cases, associated with oral steroids in 8% of patients. Oral steroids were the first and only option for treatment in 3%. Symptoms completely resolved in 80%, with the worst responses seen in cases with motility disturbances. Peritrochlear triamcinolone acetonide was injected in 14% of cases, achieving a good response in 62%. Conclusions: The prevalence of trochleitis in our area is low, and this pathology is more frequent in females. Oral NSAIDs are efficient to resolve isolated pain, but the response is partial if diplopia or motility limitations are associated. Some non-responders achieved good results with peritrochlear triamcinolone. Successful management provides a good prognosis for most patients.
Sarah R. Hatt, David A. Leske, Suzanne M. Wernimont, Eileen E. Birch,
Published: 2 January 2017
Strabismus, Volume 25, pp 33-38; https://doi.org/10.1080/09273972.2016.1276941

Abstract:
Background: A rating scale is a critical component of patient-reported outcome instrument design, but the optimal rating scale format for pediatric use has not been investigated. We compared rating scale performance when administering potential questionnaire items to children with eye disorders and their parents. Methods: Three commonly used rating scales were evaluated: frequency (never, sometimes, often, always), severity (not at all, a little, some, a lot), and difficulty (not difficult, a little difficult, difficult, very difficult). Ten patient-derived items were formatted for each rating scale, and rating scale testing order was randomized. Both child and parent were asked to comment on any problems with, or a preference for, a particular scale. Any confusion about options or inability to answer was recorded. Results: Twenty-one children, aged 5-17 years, with strabismus, amblyopia, or refractive error were recruited, each with one of their parents. Of the first 10 children, 4 (40%) had problems using the difficulty scale, compared with 1 (10%) using frequency, and none using severity. The difficulty scale was modified, replacing the word “difficult” with “hard.” Eleven additional children (plus parents) then completed all 3 questionnaires. No children had problems using any scale. Four (36%) parents had problems using the difficulty (“hard”) scale and 1 (9%) with frequency. Regarding preference, 6 (55%) of 11 children and 5 (50%) of 10 parents preferred using the frequency scale. Conclusions: Children and parents found the frequency scale and question format to be the most easily understood. Children and parents also expressed preference for the frequency scale, compared with the difficulty and severity scales. We recommend frequency rating scales for patient-reported outcome measures in pediatric populations.
Yukari Seki, , Rika Takahashi, Ikumi Umebara, Fumi Tanabe, , Yoshikazu Shimomura
Published: 2 January 2017
Strabismus, Volume 25, pp 12-16; https://doi.org/10.1080/09273972.2016.1276938

Abstract:
Stereoacuity in X(T) was different according to test distance when measured controlling subtended angle of stereogram at both distances. Far stereoacuity was significantly worse than near stereoacuity when measured using test targets with both crossed and uncrossed disparities. Additionally, stereoacuity measured with crossed disparity was better than that with uncrossed disparity at both distances.
Muralidhar Rajamani, Vidhya Nagasubramanian, , Palany Raghupathy, Ramamurthy Dandapani
Published: 2 January 2017
Strabismus, Volume 25, pp 39-42; https://doi.org/10.1080/09273972.2016.1277768

Abstract:
Surgically induced necrotizing scleritis (SINS) is a rare but serious disorder that can develop many years after strabismus surgery. It is generally treated with high-dose steroids or immunosuppression. We describe a patient with Varadi Papp syndrome and congenital fibrosis of the extraocular muscles, who developed surgically induced necrotizing scleritis a month after strabismus surgery and was successfully managed by oral vitamin C and topical N-acetylcysteine 10%. While SINS is conventionally treated with steroids/immunosuppression, a conservative approach may be tried in milder cases. The role of topical N-acetylcysteine in managing this complication needs to be explored.
, , , , Somayeh Ghasemi-Moghaddam, Javad Heravian, Asgar Doostdar,
Published: 2 January 2017
Strabismus, Volume 25, pp 5-11; https://doi.org/10.1080/09273972.2016.1276937

Abstract:
Purpose: To study binocular and accommodative characteristics and their associations with age and gender in an Iranian young adult population. Methods: In this cross-sectional study, multistage cluster sampling was done from the students of Mashhad University of Medical Sciences. All participants had visual acuity, refraction, and cover tests followed by measurements of the near point of convergence (NPC), amplitude of accommodation (AA), monocular and binocular accommodative facility (MAF and BAF) using ±2.00 diopter (D) flipper lenses, and negative and positive relative accommodation (NRA and PRA). Near and distance fusional vergence reserves were measured using prism bar, and near associated phoria was assessed using the Mallett unit. Results: The mean age of the participants was 22.5±4.4 years (range: 18-35 years). The binocular and accommodative characteristics and their means in the studied sample included: mean distance dissociated phoria: 1.15 exophoria±2.04 prism diopters (PD), near dissociated phoria: 5.02 exophoria±4.74 PD, near associated phoria: 0.55 base-in±1.02, gradient accommodative convergence/accommodation (AC/A) ratio: 4.66±1.59, NPC: 5.27±3.60 cm, MAF: 11.33±5.58 cpm, BAF: 8.84±4.47 cpm, NRA: 2.08±0.33 D, PRA:-2.92±0.76 D, and AA: 11.14±2.6 D. In the multiple regression model including age and gender, near exophoria was significantly higher in men and levels of near base-out-break and near base-out-recovery were higher in females. Distance exophoria, distance base-in-break, distance base-in-recovery, and NPC increased with age and near base-out-break, PRA, BAF, MAF, and AA significantly decreased with age. Conclusion: Studied indices in this study significantly differ from available guidelines and these differences must be considered when making diagnostic or therapeutic decisions. Certain indices can be affected by age and gender.
Agneta Rydberg, Birgit Ericson, Gunnar Lennerstrand, , Eva Lindstedt
Published: 1 January 1999
Strabismus, Volume 7, pp 1-24; https://doi.org/10.1076/stra.7.1.1.656

Abstract:
The aim of the study was to assess different visual acuity tests in the age group 1½-6 years in 105 children with assumed normal vision, visual impairment due to ocular disease or strabismus. Acuity tasks for young children can be divided into three subtypes according to the kind of stimulus used. For "detection acuity", the stimulus should be detected or distinguished from the background, as assessed with the Stycar Rolling Balls. For "resolution acuity", the stimulus pattern should be resolved, as assessed with the Preferential Looking procedure (Teller Acuity Cards). For "recognition acuity", the stimulus must be recognized by the subject as assessed with the BUST-D symbol test, Sheridan Gardiner (S-G) single letters, LH single symbols and line tests, and also the HVOT test. Different acuity values were obtained with regard to detection, resolution and recognition acuities. Assessment with the Stycar Rolling Balls only gave a rough estimate of the visual function. There was an overestimation of the acuity values in all groups of children when using the Preferential Looking technique. Good agreement was found between the LH line and HVOT tests. The BUST-D test, S-G single letters, and LH single symbols gave slightly better acuity values than linear recognition tests. A "crowding ratio" was calculated by dividing the single optotype acuity by the linear acuity, and also by dividing the grating acuity by the optotype linear and single acuity. The crowding ratio varied in the individual children and in the different groups, being highest for strabismic amblyopia. The general conclusion is that reliable visual acuity measurements were not obtained until the visual acuity could be assessed with a recognition test using linear letters or symbols.
Published: 1 October 2016
Strabismus, Volume 24, pp 153-160; https://doi.org/10.1080/09273972.2016.1242639

Abstract:
Purpose: To determine the prevalence, types and early-life risk factors associated with strabismus in a multi-ethnic birth cohort of children aged 4-5 years in the first year of school. Methods: Data were collected prospectively over a 3-year period (2012-2015) from children participating in the vision screening program provided by orthoptists and carried out in schools located in the city of Bradford, UK. Prevalence of strabismus was determined for 17,018 children aged 4 to 5 years. Data linkage was undertaken for 4563 children participating in the Born in Bradford birth cohort study and the vision screening program. 4067 children had complete data and were included in the multivariable regression analyses to determine associated factors. Results: 401/17018 (2.4%) children were found to have either a constant or an intermittent strabismus; 179/401 (45%) had an esotropic deviation, 214 (53%) an exotropic deviation, and 8 (2%) had a vertical deviation. No significant difference in the overall prevalence of strabismus was found between the white British, Pakistani, or children of other ethnic origin (P=0.41). Multivariable analysis showed that children of white British ethnicity have twice the odds of having esotropia (OR 2.4, 95% CI: 1.1, 5.3). The odds of having esotropia were highest in children with a hyperopic mean spherical equivalent (OR 2.0, 95% CI: 1.7, 2.6). There was some evidence of an interaction between ethnicity and mean spherical equivalent in children with esotropia (P=0.058). Conclusions: Prevalence of strabismus is consistent with other population-based studies in this cohort of children aged 4-5 years. Prevalence of esotropia (constant or intermittent) is greater in the white British population, odds of esotropia increased with increasing hyperopic refractive error in both white British and Pakistani children. Exotropia (constant or intermittent) was not found to be associated with refractive error, ethnicity, or other early life factors.
Published: 1 October 2016
Strabismus, Volume 24, pp 161-168; https://doi.org/10.1080/09273972.2016.1242638

Abstract:
Purpose: To generate a statistical model for personalizing a patient’s occlusion therapy regimen. Methods: Statistical modelling was undertaken on a combined data set of the Monitored Occlusion Treatment of Amblyopia Study (MOTAS) and the Randomized Occlusion Treatment of Amblyopia Study (ROTAS). This exercise permits the calculation of future patients’ total effective dose (TED)—that predicted to achieve their best attainable visual acuity. Daily patching regimens (hours/day) can be calculated from the TED. Results: Occlusion data for 149 study participants with amblyopia (anisometropic in 50, strabismic in 43, and mixed in 56) were analyzed. Median time to best observed visual acuity was 63 days (25% and 75% quartiles; 28 and 91 days). Median visual acuity in the amblyopic eye at start of occlusion was 0.40 logMAR (quartiles 0.22 and 0.68 logMAR) and at end of occlusion was 0.12 (quartiles 0.025 and 0.32 logMAR). Median lower and upper estimates of TED were 120 hours (quartiles 34 and 242 hours), and 176 hours (quartiles 84 and 316 hours). The data suggest a piecewise linear relationship (P = 0.008) between patching dose-rate (hours/day) and TED with a single breakpoint estimated at 2.16 (standard error 0.51) hours/day, suggesting doses below 2.16 hours/day are less effective. Conclusion: We introduce the concept of TED of occlusion. Predictors for TED are visual acuity deficit, amblyopia type, and age at start of occlusion therapy. Dose-rates prescribed within the model range from 2.5 to 12 hours/day and can be revised dynamically throughout treatment in response to recorded patient compliance: a personalized dosing strategy.
Subhash Dadeya,
Published: 1 October 2016
Strabismus, Volume 24, pp 146-152; https://doi.org/10.1080/09273972.2016.1242637

Abstract:
To investigate the role of television video games in childhood amblyopia treatment. This prospective, randomized, interventional study included 40 patients between 4-7 years of age, with unilateral amblyopia (visual acuity in amblyopic eye between 1-0.6 LogMAR equivalents) attending the squint clinic at a tertiary eye hospital. All patients were prescribed optimal spectacle correction and occlusion therapy, i.e. full time patching according to patient's age, was initiated after six weeks.; full-time patching according to patient's age was initiated after 6 weeks. Subjects were randomly divided into two groups of 20 each. Patients in the first group, Group A (control), were prescribed patching alone. Patients in the second group, Group B (study), were made to play action video games, with the help of a commercial television set, along with patching. They attended 12 half-hour sessions each, at weekly intervals. Follow-up assessments included best corrected visual acuity (BCVA) (both distance and near) and stereoacuity measurements at 3, 6, 9, and 12 weeks. The mean age of patients was 6.03 ± 1.14 years. The distance BCVA in the amblyopic eye showed a significant improvement at final follow-up (12 weeks) in both groups: from 0.84 ± 0.19 to 0.55 ± 0.21 LogMAReq in Group A and 0.89 ± 0.16 to 0.46 ± 0.22 LogMAReq in Group B. However, improvement in BCVA was significantly better in group B at all visits (P=0.002, 12 weeks). The study group also had a significantly better outcome in terms near visual acuity improvement (P = 0.006, 12 weeks). There was also greater stereoacuity improvement in group B, with 7 patients improving to 100 secs of arc or better. Video games supplemental to occlusion may be considered favorable for visual development in amblyopic children, and the study encourages further research on this subject.
Marianne E. F. Piano, ,
Published: 1 October 2016
Strabismus, Volume 24, pp 169-172; https://doi.org/10.1080/09273972.2016.1242636

Abstract:
Purpose: Extensive literature exists on normative stereoacuity values for younger children, but there is less information about normative stereoacuity in older children/adults. Individual stereotests cannot be used interchangeably—knowing the upper limit of normality for each test is important. This report details normative stereoacuity values for 5 near/distance stereotests drawn from a large sample of participants aged 16-40 years, across 3 studies. Methods: Participants (n=206, mean age 22.18±5.31 years) were administered the following stereotests: TNO, Preschool Randot, Frisby, Distance Randot, and Frisby-Davis 2. Medians and upper limits were calculated for each test. Results: Upper limits for each stereotest were as follows: TNO (n=127, upper limit=120” arc), Preschool Randot (PSR, n=206, upper limit=70” arc), Frisby (n=206, upper limit=40” arc), Distance Randot (n=127, upper limit=160” arc), and Frisby-Davis 2 (n=109, upper limit=25” arc). Conclusions: Normative values for each stereotest are identified and discussed with respect to other studies. Potential sources of variation between tests, within testing distances, are also discussed.
, , Feyza Çalış, Cem Alay
Published: 2 July 2016
Strabismus, Volume 24, pp 97-100; https://doi.org/10.1080/09273972.2016.1210173

Abstract:
Purpose: Surgery for strabismus associated with neurological impairment is assumed to have unsatisfactory results in comparison with other strabismus cases. The aim of this study is to compare the surgical success rates of infantile esotropia (IE) and strabismus associated with neurological impairment. Methods: The records of 103 patients that received operations for IE and strabismus associated with neurological impairment between January 1994 and May 2014 were reviewed retrospectively. The angles of deviation and surgical success rates were evaluated at preoperative, 1-month postoperative, and 24-month postoperative visits. Results: Forty-five patients received operations for strabismus associated with neurological impairment (25 patients with esotropia and 20 patients with exotropia) and 58 patients for IE. Mean preoperative angles of deviation in cases with neurological impairment were 42 prism diopters (PD) for esotropia, 44.7 PD for exotropia, and 44.4 PD for IE. One patient from each group had consecutive deviation at first visit, and at last visit, 3 patients with neurological impairment and 5 patients with IE had consecutive deviations. Surgical success rates at the end of the second year were 52% for esotropia and 50% for exotropia in patients with neurological impairment and 56.8% for IE cases. Conclusion: This study was unable to find the differences between surgical success rates in IE and strabismus associated with neurological impairment.
Published: 2 July 2016
Strabismus, Volume 24, pp 136-137; https://doi.org/10.1080/09273972.2016.1215334

Abstract:
The eminent Greek physician Paul of Aegina, native of the Saronic island Aegina and pupil of the Alexandrian School, understood both exotropia and endotropia, his designation for esotropia and proposed therapeutic measures for their treatment during baby or toddler age. He had introduced an innovative method for the newborns to have a straight vision, “the congenital strabismus of the newborns must be treated with the placement of a facial mask (with 2 open holes in the middle axes of the eyes), so that the babies could only see in a straight line”, combined with a small oil lamp to assure a direct eye alignment. Although not even a diagram of the masks was saved until nowadays, Paul was the first to suggest the early correction of the eyes deviation, and considered to be the father of orthoptics.
, J. P. Burke
Published: 2 July 2016
Strabismus, Volume 24, pp 93-96; https://doi.org/10.1080/09273972.2016.1212080

Abstract:
Aim: To describe the surgical management and long-term outcome of a case of symptomatic residual acquired primary position excyclotropia, without changing the primary position vertical deviation. Methods: This case report describes ipsilateral half tendon width transpositions of the left superior rectus temporally and inferior rectus nasally, combined with right inferior rectus posterior fixation suture at 11 mm. Results: Three days postoperatively, the transposition procedure produced a 10° cyclotorsional change in primary position, resulting in 5° of incyclotorsion (double Maddox rod). Six weeks postoperatively, the incyclotorsion regressed to 1° (synoptophore) and a central field of binocular single vision (BSV) (90° horizontally and 60° vertically) was demonstrated without an abnormal head posture. Fifteen months postoperatively, 1° primary position incyclotorsion (Torsionometer) and the central field of BSV remained stable. The primary position vertical deviation was changed by 1 prism diopter and no V pattern was induced. Conclusion: In our case, ipsilateral half tendon width horizontal transpositions of the vertical recti achieved satisfactory correction of excyclotorsion and restored BSV without significantly changing the primary position vertical deviation. The result was stable 15 months postoperatively.
, D. Plager, P. Merino, M. M. Galan, M. Swaminathan, S. Ramasuramanian, J. T. H. N. De Faber
Published: 1 October 2016
Strabismus, Volume 24, pp 178-183; https://doi.org/10.1080/09273972.2016.1242641

Abstract:
Restrictive strabismus resulting from the presence of an accessory extraocular muscle has rarely been reported in the literature. Most articles written on this topic are isolated case reports. The purpose of this paper is to describe a series of 7 similar patients presenting with atypical restrictive strabismus associated with enophthalmos in the affected eye, which was found to be caused by an accessory extraocular muscle attached to the posterior globe near the optic nerve. The medical records of 7 patients who shared these clinical characteristics were retrospectively analyzed. Orbital imaging was obtained in the 7 cases, which were compared. Three of the patients were females and four were males. The left eye was affected in all 4 males and the right eye was affected in the 3 females. The 7 patients presented with the following clinical characteristics: enophthalmos, restriction to eye movements in most fields of gaze, and presence of an anomalous orbital structure that was interpreted on magnetic resonance imaging (MRI) to be an accessory extraocular muscle inserting onto the posterior surface of the globe in the affected eye. The fellow eye was normal in all cases. Five of the 7 patients underwent surgical correction with partial improvement in only one patient. The presence of an accessory extraocular muscle should be included in the differential diagnosis of patients with atypical restrictive strabismus. Orbital computed tomography or MRI are essential for correct diagnosis in these cases.
, P. K. Pandey, Sanjeev Kumar Mittal, , Chirag Bahuguna, Prashant Kumar
Published: 1 October 2016
Strabismus, Volume 24, pp 173-177; https://doi.org/10.1080/09273972.2016.1243136

Abstract:
Purpose: To evaluate the role of superior oblique transposition on primary position alignment, A pattern, and intorsion in third nerve palsy. Methods: Ten patients with isolated, unilateral third nerve palsy were included in this prospective study. The patients were treated by conventional surgery on horizontal recti together with superior oblique transposition by Scott’s procedure in the paretic eye. Results: Pre-operative primary horizontal deviation was 60-80 PD (mean 70.00±7.45 PD). Pre-operative primary hypotropia was 15-22 PD (mean 18.80±2.48 PD). Mean A-pattern was 17.80±2.65 PD. All patients included in the study had some degree of objective torsion as measured by Guyton’s method. One patient had grade I objective intorsion, 2 had grade II, 6 had grade III, and 1 had grade IV objective intorsion. Primary position horizontal alignment (up to ±8 PD) was achieved in 9 patients. Primary position vertical alignment (up to ±8 PD) was achieved in all 10 patients. Only 2 of 10 patients had A-pattern of 10 PD, in the remaining 8 patients it was eliminated (P<0.05). Postoperatively, 5 patients had no objective intorsion and 5 had grade I intorsion, and none of the patients had hypertropia or paradoxical eye movements. Conclusion: Superior oblique transposition by Scott’s procedure along with conventional surgery on horizontal recti in third nerve palsy results in better horizontal and vertical alignment, and improves A-pattern and intorsion, thus leading to better binocular interaction.
, David A. Leske, Laura Liebermann,
Published: 1 October 2016
Strabismus, Volume 24, pp 139-145; https://doi.org/10.1080/09273972.2016.1242640

Abstract:
Purpose: In childhood intermittent XT, the frequency and type of symptoms have not been rigorously studied. We aimed to identify specific symptoms in children with intermittent XT, their frequency, and effects on health-related quality of life (HRQOL). Methods: 35 children (5-13 years) with intermittent XT without previous surgery were enrolled in a prospective cohort study. Specific symptoms were identified from a previous study involving child and parent interviews and formulated as a 22-item symptom questionnaire. A frequency Likert-type rating scale was used and a response of “sometimes” or more was considered consistent with having the symptom. All 35 children, along with one parent for each child, also completed the patient-derived intermittent XT HRQOL questionnaire (IXTQ) with Child, Proxy, and Parent components. The frequency of symptoms was calculated, and the relationship between individual symptom question scores and Child, Proxy, and Parent HRQOL scores, was evaluated in multivariate linear regression analyses. Results: The mean number of specific symptoms was 7 (range 2 to 19). The most frequently reported were: rubbing the eye (29 [83%] of 35), problems with eyes in the sun, and the eyes feeling tired (each 22, 63%). Lower (worse) Child IXTQ HRQOL scores were associated with symptoms of difficulty focusing eyes (P=0.0007), double vision (P=0.007), eyes hurting (P=0.006), and problems with eyes in the sun (P=0.06). There were weak associations between Proxy IXTQ and Parent IXTQ scores and child symptoms. Overall, 7 symptom questions were associated with reduced HRQOL in multivariate models. Conclusion: Children with intermittent XT frequently experience symptoms, some of which impact the child’s HRQOL. Formal assessment of symptoms may aid understanding of the effects of intermittent XT on an individual child, and could use just the 7 symptom questions associated with reduced HRQOL.
, H. Tugrul Atasoy, Hayriye Sayarlioglu, Murat Köksal, Suat Hayri Uğurbaş, Atilla Alpay, Hayriye Sayarlıoglu
Published: 1 January 2005
Strabismus, Volume 13, pp 85-88; https://doi.org/10.1080/09273970590935101

Abstract:
The authors report a patient who was diagnosed with idiopathic orbital myositis based on the findings of diplopia, worse on right gaze, globe retraction on adduction and injection at the lateral muscle tendon insertion of the left eye. Although orbital myositis as a cause of acquired retraction of the eye is rare, they wish to emphasize the importance of globe retraction with injection over the recti as an important clue for the diagnosis of orbital myositis.
John D. Porter, Robert S. Baker
Published: 1 January 1993
Strabismus, Volume 1, pp 173-180; https://doi.org/10.3109/09273979309052368

Abstract:
Extraoclar muscle development has been studied in two species of monkeys (Macaca nemestrina and Macaca fascicularis). In these studies, the authors have demonstrated a distinctive developmental difference between the two macaques. Specifically, tubular aggregates (ordered aggregations of sarcoplasmic reticulum) occur transiently in the orbital singly innervated muscle fiber type in nemestrina extraocular muscles only. Tubular aggregates are typically seen in skeletal muscle fast-twitch fibers during neuromuscular disease or experimental denervation. The alterations in developing extraocular muscle either may be indicative of a primary muscle disorder or may be secondary to neurologic maldevelopment. The authors suggest that the presence of tubular aggregates in the extraocular muscles of nemestrina monkeys may be indicative of aberrant innervation levels during early postnatal development.
, , , Batool Haghighi, Havva Shafiee, , Payam Nabovati, Amir Asharlous,
Published: 2 July 2016
Strabismus, Volume 24, pp 113-119; https://doi.org/10.1080/09273972.2016.1205103

Abstract:
Purpose: To determine the prevalence of strabismus and amblyopia, and the distribution of the near point of convergence (NPC), in a population of children aged 4 to 6 years. Methods: In this cross-sectional study, preschoolers in Mashhad were sampled using a random multistage cluster sampling approach. Examinations were done after obtaining parental consent. All participants had measurements of uncorrected visual acuity, corrected visual acuity, and non-cycloplegic refraction, and they had near and far cover tests to determine tropia and phoria. Results: Of the 3765 selected children, 3701 participated in the study. The prevalence of tropia was 1.21% (95% confidence interval [CI]: 0.86–1.57). Near and near/far tropia was observed in 0.83% (95% CI: 0.53–1.12) and 0.39% (95% CI: 0.18–0.59), respectively. Tropia was significantly more prevalent in boys (P=0.005). The most common type of tropia was esotropia, 0.22% (95% CI: 0.07–0.37). Among participants, 63.92% (95% CI: 62.36–65.48) had phoria; prevalence of far, near, and near/far phoria was 0.22% (95% CI: 0.07–0.37), 60.47% (95% CI: 58.88–62.07), and 3.22% (95% CI: 2.65–3.8), respectively. Mean NPC was 5.1 cm (95% CI: 5.05–5.14). NPC increased by 0.08 cm per month of age (P=0.033) and was 0.10 cm higher in boys compared to girls (P=0.027). Based on NPC, 61.58% (95% CI: 59.99–63.17) were symptomatic. The prevalence of amblyopia was 0.41% (95% CI: 0.20–0.61). The type of amblyopia was anisometropic, strabismic, and isoametropic in 75%, 11.1%, and 8.5%, respectively. Conclusion: The prevalence of amblyopia in this study population was not high; however, the prevalence of tropia was average compared to previous studies in Iran. Describing NPC in a 4- to 6-year-old Iranian population for the first time, we found that NPC increased with age in this sample.
, W. L. Asjes-Tydeman, G. Holtslag, E. Vukovic, M. M. Sinoo, S. E. Loudon, J. Passchier, H. J. De Koning, H. J. Simonsz
Published: 2 July 2016
Strabismus, Volume 24, pp 120-135; https://doi.org/10.1080/09273972.2016.1205101

Abstract:
Purpose: This implementation study evaluated orthoptists’ use of an educational cartoon (“the Patchbook”) and other measures to improve compliance with occlusion therapy for amblyopia. Methods: Participating orthoptists provided standard orthoptic care for one year, adding the Patchbook in the second year. They attended courses on compliance and intercultural communication by communication skills training. Many other compliance-enhancing measures were initiated. Orthoptists’ awareness, attitude, and activities regarding noncompliance were assessed through interviews, questionnaires, and observations. Their use of the Patchbook was measured. The study was performed in low socio-economic status (SES) areas and in other areas in the Netherlands. It was attempted to integrate education on compliance into basic and continuing orthoptic training. Results: The Patchbook was used by all 9 orthoptists who participated in low-SES areas and 17 of 23 orthoptists in other areas. Courses changed awareness and attitude about compliance, but this was not sustained. Although orthoptists estimated compliance during patching at 70%, three-quarters never suspected noncompliance during a full day of observation in any of their patients. Explanations to parents who spoke Dutch poorly were short. In the second year, explanations to children were longer. Implementation of all 7 additional compliance-enhancing measures failed. Education on compliance was not integrated into orthoptists’ training. Conclusion: Almost all orthoptists used the Patchbook and, as another study demonstrated, it proved to be very effective, especially in low-SES areas. Duration of explanation was inversely proportional to parents’ fluency in Dutch. Noncompliance was rarely suspected by orthoptists. Although 7 additional compliance-enhancing measures had been conceived and planned with the best intentions, they were not realized. These required extra, unpaid time from the orthoptists, which is especially scarce in hospitals in low-SES areas where the educational cartoon is most needed.
Mohammad Reza Akbari, Masoomeh Mohebbi, , , Alireza Mahmoudi
Published: 2 July 2016
Strabismus, Volume 24, pp 101-105; https://doi.org/10.1080/09273972.2016.1205104

Abstract:
To present clinical findings of a 28-year-old woman with multifocal surgically induced necrotizing scleritis following uncomplicated strabismus surgery. A 28-year-old woman underwent uncomplicated strabismus surgery of her right eye for sensory exotropia under general anesthesia (6 mm right medial rectus muscle resection and 8 mm right lateral rectus muscle recession). Retrospective, observational case report and literature review. One month after strabismus surgery, the patient presented with surgically induced necrotizing scleritis in the nasal aspect of sclera. Bacterial culture of the bed of the scleral melt showed no growth and all laboratory evaluation was normal. The scleritis completely resolved after initiation of systemic corticosteroids and oral azathioprine. Three weeks later (after tapering dose of systemic medication), the patient returned with large area of necrotizing scleritis in the same eye, but this time in the temporal aspect of sclera. To our knowledge, this is the first documented case of multifocal surgically induced necrotizing scleritis occurring after strabismus surgery. This study also highlights the fact that scleritis may recur even in an area distant from the site of surgery, despite initial control. It seems that maybe with a longer course of treatment it is less likely to recur, and tapering medications should be carefully managed.
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