(1994). Diagnosis of Defective Colour Vision. Clinical and Experimental Optometry: Vol. 77, No. 2, pp. 85-85.

Diagnosis of Defective Colour Vision

The morphology and natural history of childhood cataracts.

Congenital and infantile cataracts produce deprivation amblyopia and can thus cause lifelong visual impairment. Successful management is dependent on early diagnosis and referral for surgery when indicated. Accurate optical rehabilitation and postoperative supervision are essential. The timing of surgery and its relationship to the duration of deprivation is important. Unilateral congenital cataract surgery within 6 weeks of birth produces the best outcomes. The equivalent ‘latent’ period for bilateral visual deprivation may be longer at around 10 weeks. Visual deprivation has a significant impact on the development of fixation stability. Major form deprivation, even after early surgery, leads to nystagmus. This is mostly manifest latent nystagmus (MLN). The latent period for fixation stability may be as short as 3 weeks. Preoperative congenital nystagmus (CN) can convert to more benign MLN after surgery. Infantile IOL implantation is becoming increasingly accepted. A satisfactory long-term refractive result requires that allowance be made for childhood axial growth and myopic shift. In a series of 25 infants (33 eyes) implanted before 12 months of age, the mean myopic shift at 12 months was 4.83 D. This increased to 5.3 D in infants implanted before 10 weeks. The initial desired refractive outcome following IOL implantation is thus hypermetropia, with the degree dependent on the age of the child. Glaucoma or ocular hypertension is a common complication following paediatric cataract surgery. Microphthalmia and surgery in early infancy are risk factors. Tonometry results may be influenced by the increased corneal thickness seen in aphakic and pseudophakic children. The long-term prognosis of eyes with aphakic glaucoma is not necessarily poor but intraocular pressure control may require three or more medications. Surgical intervention appears to be necessary in over a quarter of eyes. Posterior capsule opacification (PCO) is common in infants undergoing primary lens implantation. Primary capsulotomy and anterior vitrectomy reduce the risk of PCO. In the absence of anterior vitrectomy, primary posterior capsulotomy does not prevent visual axis opacification. Further developments will continue to be driven by clinical research. The prevention of capsule opacification and cellular proliferation may in future be achieved by the use of devices to specifically target epithelial cells at surgery.

/pdf/advances-in-the-management-of-congenital-and-infantile-5fufurhcpv.pdf

Advances in the management of congenital and infantile cataract.

In his 1933 Doyne Lecture A.B. Cridland cited Emmerson: 'An institution is the lengthened shadow of one man: The Oxford Congress is such an institution, founded on 15 July 1909/ with Robert Walter Doyne as the first Master; it holds a special place in the academic calendar of ophthalmologists around the world because of its academic excellence, the beautiful city in which the meeting is held, and the warmth and conviviality of the members. I was particularly pleased and proud to be asked to give the 75th Doyne Lecture in the 80th year of the lectureship because this is the first such lecture to be given by a British paediatric ophthalmologist and it is given at a time when paediatric ophthalmology in general and in the British Isles in particular is flourishing clinically and academically. I chose congenital cataract as my subject not only because it has been a lifelong interest: it is still the major preventable cause of lifelong visual handicap, and there are a number of controversial areas which have not yet been resolved.

/pdf/the-doyne-lecture-congenital-cataract-the-history-the-nature-20fvxomhlv.pdf

The Doyne Lecture. Congenital cataract: the history, the nature and the practice

Objective The aim of our study was to evaluate whether wearing sunglasses (the "sunglasses sign") can be used by neuro-ophthalmologists to predict nonorganic visual loss (NOVL) in their patients. Methods We prospectively collected information on all new patients seen by us over 13 months. We included all patients who ultimately received a diagnosis of NOVL, and all patients wearing sunglasses in our clinic. We recorded demographics, iris color, number of positive review of systems, ocular examination, precipitating event or trauma, workers' compensation claims, disability and lawsuit related to the visual loss, and the reason for wearing sunglasses. Results Among the 1,377 consecutive new patients seen in our clinic during the study, 34 patients wore sunglasses, among whom 7 (20.6%) had organic visual loss. During the study period, 59 patients were diagnosed with NOVL, among whom 27 (45.8%) wore sunglasses. The sensitivity of wearing sunglasses for NOVL was 0.46 (95% CI 0.33 to 0.59). The probability that a patient walking into our clinic had NOVL was 0.043 (95% CI 0.033 to 0.055); it increased to 0.79 (95% CI 0.62 to 0.91) in sunglasses patients. The specificity of sunglasses for the diagnosis of NOVL was 0.995 (95% CI 0.989 to 0.998). At least one of the following characteristics (highly positive review of systems, workers' compensation claim, disability, and lawsuit) was found in 26 of 27 (96.3%) of NOVL patients wearing sunglasses and in none of the sunglasses patients with organic neuro-ophthalmic disorders. All 7 sunglasses patients with organic neuro-ophthalmic disorders had reasonable ophthalmic explanations for wearing sunglasses. Conclusion The "sunglasses sign" in a patient without an obvious ophthalmic reason to wear sunglasses is highly suggestive of nonorganic visual loss.

The “sunglasses sign” predicts nonorganic visual loss in neuro-ophthalmologic practice

Background Patients with non-organic visual loss (NOVL) can take up a disproportionate amount of clinic time and clinicians often resort to expensive and prolonged investigations to ensure the correct diagnosis. This is especially the case in children. Methods The case notes of 30 children (18 girls, 12 boys) were retrospectively reviewed following presentation with a primary complaint of visual impairment and a diagnosis of non-organic visual loss. This figure represents 1% of new paediatric referrals to our unit. Associated symptoms included headache, periorbital pain, diplopia, photopsia and photophobia. Visual field defects were present in 5 patients and spasm of the near reflex in 1 child. Results Treatment consisted of reassurance and was associated with recovery of normal visual function in all cases. Three children were referred to other health care professionals. All psychophysical, electrophysiological and neuroradiological investigations were negative. Conclusion Our study shows that non-organic visual loss is relatively common in pre- pubertal children and that this condition can be safely diagnosed using standard clinical tests in the majority of cases. Prompt diagnosis prevents unnecessary investigations and prolonged 'disease' course. Coexisting social conflict was common and may be a contributory factor. Careful explanation and reassurance to both the child and parents remains the mainstay of management.

/pdf/non-organic-visual-loss-in-children-16cvy3lw9z.pdf

Non-organic visual loss in children.

Posterior lenticonus tends to be unilateral and there is no evidence that this is a familial condition. We report three cases of bilateral posterior lenticonus in boys. The mothers of all three cases had posterior lenticular changes, less severe than their sons. We suggest that bilateral posterior lenticonus may be inherited in an X-linked fashion.

/pdf/familial-posterior-lenticonus-1capc6mu9c.pdf

Familial posterior lenticonus.

This article presents a survey of the demographical, educational and visual functional characteristics of children attending a specialist paediatric low-vision assessment clinic at Manchester Royal...

Paediatric low-vision assessment and management in a specialist clinic in the UK:

Large-angle congenital exotropia due to ‘absent’ medial recti: a case of congenital cranial dysinnervation disorder

/pdf/large-angle-congenital-exotropia-due-to-absent-medial-recti-2nfalimoij.pdf

Large-angle congenital exotropia due to 'absent' medial recti: a case of congenital cranial dysinnervation disorder.

Optic disc drusen and peripapillary subretinal neovascular membranes in children.

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