Showing papers on "Strabismus published in 2019"
TL;DR: The prevalence of strabismus varies widely in the world and information about the global prevalence can help health care planners design interventions and prioritize resource allocation.
Abstract: Purpose: Despite the importance of information on the prevalence of strabismus, which can be effective in planning preventive and curative services, no study has addressed its prevalence comprehensively. In this study, a systematic search was done to estimate the regional and global prevalence of strabismus in different age and sex groups and factors affecting prevalence heterogeneity. Methods: A comprehensive and systematic search was done in different international databases, including Web of Science, Scopus, PubMed, Embase, etc. to find published articles on the total prevalence of strabismus and the prevalence of exotropia and esotropia. A binomial distribution was used to calculate the prevalence and 95% confidence interval (CI). The Cochran's Q-test and I2 were applied to evaluate heterogeneity and a random-effects model was used to assess the pooled prevalence. The Begg's test was administered to investigate publication bias and finally, a meta-regression method was applied to determine the factors affecting the heterogeneity among studies. Results: Of 7980 articles, 56 articles with a total sample size of 229,396 were analyzed. Many of these articles (n = 14) were from the Regional Office for the Americas. The estimated of pooled prevalence (95% CI) of any strabismus, exotropia, and esotropia was 1.93% (1.64-2.21), 1.23% (1.00-1.46), and 0.77% (0.59-0.95), respectively. The heterogeneity in prevalence of strabismus and its subtypes according to I2 was above 95% (p value <.001 for all). Age had a direct effect on heterogeneity in the prevalence of exotropia (b: 3.491; p: 0.002). Moreover, WHO region had a significant direct effect on heterogeneity in the prevalence of strabismus (b: 0.482; p < .001) and esotropia (b: 0.168; p: 0.027), and publication year had a significant direct effect on heterogeneity in the prevalence of exotropia (b: 0.059; p: 0.045). Sample size and publication year did not have any association with strabismus nor with other variables. There was no publication bias according to the Begg's test. Conclusion: The prevalence of strabismus varies widely in the world. As for factors affecting heterogeneity in the prevalence of strabismus, the results showed that age affected heterogeneity in the prevalence of exotropia, WHO region affected heterogeneity in the prevalence of strabismus and esotropia, and publication year affected heterogeneity in the prevalence of exotropia. Information about the global prevalence of strabismus can help health care planners design interventions and prioritize resource allocation.
163 citations
TL;DR: fixation instability and vergence instability during binocular viewing suggests that discordant binocular visual experience during childhood, especially strabismus, interferes with ocular motor development and limit potential for recovery of binocular vision in these children.
60 citations
TL;DR: A genome-wide association study for self-reported strabismus revealed a single genome- wide significant locus on chromosome 17q25, indicating an important role in conferring susceptibility to strabs, and a recessive model provided a better fit to the data.
Abstract: Strabismus refers to an abnormal alignment of the eyes leading to the loss of central binocular vision. Concomitant strabismus occurs when the angle of deviation is constant in all positions of gaze and often manifests in early childhood when it is considered to be a neurodevelopmental disorder of the visual system. As such, it is inherited as a complex genetic trait, affecting 2–4% of the population. A genome-wide association study (GWAS) for self-reported strabismus (1345 cases and 65,349 controls from UK Biobank) revealed a single genome-wide significant locus on chromosome 17q25. Approximately 20 variants across the NPLOC4–TSPAN10–PDE6G gene cluster and in almost perfect linkage disequilibrium (LD) were most strongly associated (lead variant: rs75078292, OR = 1.26, p = 2.24E−08). A recessive model provided a better fit to the data than an additive model. Association with strabismus was independent of refractive error, and the degree of association with strabismus was minimally attenuated after adjustment for amblyopia. The association with strabismus was replicated in an independent cohort of clinician-diagnosed children aged 7 years old (116 cases and 5084 controls; OR = 1.85, p = 0.009). The associated variants included 2 strong candidate causal variants predicted to have functional effects: rs6420484, which substitutes tyrosine for a conserved cysteine (C177Y) in the TSPAN10 gene, and a 4-bp deletion variant, rs397693108, predicted to cause a frameshift in TSPAN10. The population-attributable risk for the locus was approximately 8.4%, indicating an important role in conferring susceptibility to strabismus.
47 citations
TL;DR: It is concluded that monocular and binocular contrast sensitivity deficits define important characteristics of amblyopia and strabismus that are not captured by visual acuity alone and can be measured efficiently using the quick CSF.
Abstract: Purpose: Amblyopia and strabismus affect 2%-5% of the population and cause a broad range of visual deficits. The response to treatment is generally assessed using visual acuity, which is an insensitive measure of visual function and may, therefore, underestimate binocular vision gains in these patients. On the other hand, the contrast sensitivity function (CSF) generally takes longer to assess than visual acuity, but it is better correlated with improvement in a range of visual tasks and, notably, with improvements in binocular vision. The present study aims to assess monocular and binocular CSFs in amblyopia and strabismus patients. Methods: Both monocular CSFs and the binocular CSF were assessed for subjects with amblyopia (n = 11), strabismus without amblyopia (n = 20), and normally sighted controls (n = 24) using a tablet-based implementation of the quick CSF, which can assess a full CSF in <3 min. Binocular summation was evaluated against a baseline model of simple probability summation. Results: The CSF of amblyopic eyes was impaired at mid-to-high spatial frequencies compared to fellow eyes, strabismic eyes without amblyopia, and control eyes. Binocular contrast summation exceeded probability summation in controls, but not in subjects with amblyopia (with or without strabismus) or strabismus without amblyopia who were able to fuse at the test distance. Binocular summation was less than probability summation in strabismic subjects who were unable to fuse. Conclusions: We conclude that monocular and binocular contrast sensitivity deficits define important characteristics of amblyopia and strabismus that are not captured by visual acuity alone and can be measured efficiently using the quick CSF.
38 citations
TL;DR: Treatment methods in thyroid eye disease (TED) related strabismus needs careful evaluation and management to achieve optimal outcome and different surgical and non-surgical options are available for intervention in TED-related strABismus.
Abstract: Purpose To review various treatment methods in thyroid eye disease (TED) related strabismus. Methods We searched in PubMed and Google Scholar and Ovid MEDLINE for keywords including thyroid eye disease-related strabismus, strabismus in thyroid-associated ophthalmopathy, Graves’ ophthalmopathy related strabismus or squint, and restrictive strabismus. Two expert strabismus specialists selected and evaluated the English articles that were related to our paper and had been published since 2000. Some articles were added based upon the references of the initial articles. Results One hundred fifteen articles were found, 98 of which were mostly related to the topic of this review. Management of TED-related strabismus was reviewed and categorized in non-surgical and surgical. Botulinum toxin A (BTA) is a useful non-surgical management of strabismus in an active TED and residual deviation after strabismus surgery. Postoperative under-correction is relatively more common in TED-related esotropia. Lateral rectus resection and BTA are the options to manage the problem. Muscle Rectus muscle resection should be performed after maximum recession of restricted muscles. It should be avoided on a restricted or enlarged muscle. Management of TED-related vertical deviation is challenging. In these cases, the surgical treatment selected depends on forced duction test (FDT) (pre and intraoperative), orbital imaging (which muscle is enlarged), and the amount of vertical deviation (in both down-gaze and primary position). Conclusions TED-related strabismus needs careful evaluation and management to achieve optimal outcome. Different surgical and non-surgical options are available for intervention in TED-related strabismus.
34 citations
TL;DR: Despite its transient kinetics, BTA can have permanent effects on ocular alignment, promoting binocularity and reduction of diplopia, and can serve as a primary treatment or a muscle sparing option in patients at risk of anterior segment ischemia or need for future surgeries.
Abstract: Purpose: To perform a systematic review of the application of botulinum toxin A (BTA) in the management of strabismus in the adult and pediatric populations. Materials and methods: A systematic literature search was performed using the Medline database. Results: In 1989, with the FDA approval of botulinum toxin (onabotulinum toxin A, or BTA) for the treatment of strabismus, patients were provided with an alternative to surgical recession. In this review, we discuss the uses of BTA in the treatment of acute onset comitant esotropia or smaller angle esotropia and as an adjunct to surgery for larger angle esotropia or sixth nerve palsy. Its uses are also explored in intermittent exotropia and vertical strabismus, including thyroid-associated orbitopathy, fourth nerve palsies, and other orbital pathology. Discussion: Despite its transient kinetics, BTA can have permanent effects on ocular alignment, promoting binocularity and reduction of diplopia, and can serve as a primary treatment or a muscle sparing option in patients at risk of anterior segment ischemia or need for future surgeries.
28 citations
TL;DR: Standardized tests were used to compare binocular reading performance in children treated for amblyopia to that of a large normative sample, as well as to the types of control groups used in previous studies, raising the possibility that both strabismus and Amblyopia can disrupt reading ability, even following successful treatment.
28 citations
TL;DR: Experimental results demonstrate that the deviation of strabismus can be well-evaluated by the proposed method, and it was over 86% in the vertical direction, with an error of 4 diopters.
Abstract: Strabismus is a common vision disease that brings about unpleasant influence on vision, as well as life quality. A timely diagnosis is crucial for the proper treatment of strabismus. In contrast to manual evaluation, well-designed automatic evaluation can significantly improve the objectivity, reliability, and efficiency of strabismus diagnosis. In this study, we have proposed an innovative intelligent evaluation system of strabismus in digital videos, based on the cover test. In particular, the video is recorded using an infrared camera, while the subject performs automated cover tests. The video is then fed into the proposed algorithm that consists of six stages: (1) eye region extraction, (2) iris boundary detection, (3) key frame detection, (4) pupil localization, (5) deviation calculation, and (6) evaluation of strabismus. A database containing cover test data of both strabismic subjects and normal subjects was established for experiments. Experimental results demonstrate that the deviation of strabismus can be well-evaluated by our proposed method. The accuracy was over 91%, in the horizontal direction, with an error of 8 diopters; and it was over 86% in the vertical direction, with an error of 4 diopters.
27 citations
TL;DR: A novel 'lights-out' surgery that does not use a microscope's light source is devised and the usefulness of this technique is examined in 2 cases of strabismus surgery, which was performed using the NGENUITYⓇ system.
Abstract: During strabismus surgery using illumination from a light source, patients complain of photophobia. The NGENUITYⓇ (Alcon) system is equipped with a high-dynamic-range (HDR) camera. A 4K display viewed by wearing circularly polarized glasses provides clear three-dimensional images of the operative field. A light source is usually required for surgeries of the anterior segment (including strabismic surgery), but the digital processing function of the NGENUITYⓇ system allows image display in relatively dark regions even without a light source. We devised a novel 'lights-out' surgery that does not use a microscope's light source, and we examined the usefulness of this technique in 2 cases of strabismic surgery. We performed strabismus surgery using the NGENUITYⓇ system in two patients between January and June 2018. The HDR function was used, and the aperture was opened to the maximum while the gain was adjusted. Surgery was conducted without using the microscope's light source. We report the 2 cases' results and evaluate the novel method. The surgeries were performed without problem even though the microscope's light source was not used. The patients' photophobia was alleviated. Lights-out surgery is a potentially useful modality for strabismus surgery.
21 citations
6 May 2019
TL;DR: Botulinum Toxin type A (BoNT-A) injection in the treatment of different types of strabismus and oculomotor palsies is a short procedure, may reduce general anesthesia exposure, causes minimal scarring compared to surgery, and can be proposed as an early treatment in unstable strabistsus.
Abstract: There is a long and extensive experience with the use of Botulinum Toxin type A (BoNT-A) injection in the treatment of different types of strabismus and oculomotor palsies. The frequency of its use varies depending on the country and institution. It is a short procedure, may reduce general anesthesia exposure, causes minimal scarring compared to surgery, and can be proposed as an early treatment in unstable strabismus. Over many years, the experience of using BoNT-A indications has been refined and new applications have been reported. The use of BoNT-A in the postoperative period, after strabismus surgery or during surgery, can also be beneficial.
20 citations
TL;DR: Morbidity associated with ophthalmic pediatric surgery is low and predominantly associated with strabismus surgery, and the benefit–risk ratio and cost-effectiveness of oculocardiac reflex prevention should be questioned.
Abstract: Purpose:To date, no protocol of anesthesia for pediatric ophthalmic surgery is unanimously recognized. The primary anesthetic risks are associated with strabismus surgery, including oculocardiac re...
TL;DR: Tetracaine eye drop only reduces the incidence and severity of oculocardiac reflex (OCR) during the incision stage of strabismus surgery.
Abstract: Introduction: Recently, to reduce the incidence of oculocardiac reflex (OCR) in strabismus surgery, retrobulbar block and anticholinergic drugs or local anesthesia are also used. The presen...
TL;DR: Ophthalmic disorders were found in 71% of children with ASD evaluated at the university-based ophthalmology clinic, and the rates of significant refractive error, strabismus, amblyopia, and optic neuropathy exceeded those of the general pediatric population.
Abstract: Purpose To report the results of our review of all children with autism spectrum disorder (ASD) who underwent complete pediatric ophthalmologic examination at our institution over a 10-year period. Methods The medical records of all children (0-17 years of age) with a diagnosis of ASD seen at University of California, Davis, over a 10-year period were reviewed retrospectively. Demographic data, birth history, genetic testing results, neuropsychiatric comorbidities, and ophthalmologic findings were extracted from the record. Multiple logistic regression was used to identify risk factors for ophthalmologic disorders. Results A total of 2,555 children with ASD were seen at the university over the study period, of whom 380 (15%) were evaluated in the ophthalmology clinic. Eye examination revealed an ophthalmic diagnosis in 71% of children, of which the most common were significant refractive error (42%), strabismus (32%), and amblyopia (19%). Optic neuropathy occurred in 14 children (4%). Cerebral palsy was a significant risk factor for refractive error (OR = 3.22; P = 0.016), strabismus (OR = 3.59; P = 0.012), amblyopia (OR = 3.49; P = 0.0097), and optic neuropathy (OR = 14.0; P = 0.0009). Conclusions Ophthalmic disorders were found in 71% of children with ASD evaluated at our university-based ophthalmology clinic. The rates of significant refractive error, strabismus, amblyopia, and optic neuropathy exceeded those of the general pediatric population. ASD and cerebral palsy may have additive risk for these disorders.
TL;DR: CFEOM is a complex strabismus disorder for which surgical management is difficult and despite an aggressive surgical approach, multiple procedures may be necessary to achieve a desirable surgical effect.
Abstract: Purpose To detail surgical strategy and strabismus outcomes in a genetically defined cohort of patients with congenital fibrosis of the extraocular muscles (CFEOM). Methods A total of 13 patients with genetically confirmed CFEOM (via genetic testing for mutations in KIF21A, PHOX2A, and TUBB3) were retrospectively identified after undergoing strabismus surgery at Boston Children's Hospital and surgical outcomes were compared. Results Age at first surgery ranged from 11 months to 63 years, with an average of 3 strabismus procedures per patient. Ten patients had CFEOM1, of whom 9 had the KIF21A R954W amino acid substitution and 1 had the M947T amino acid substitution. Of the 3 with CFEOM3, 2 had the TUBB3 E410K amino acid substitution, and 1 had a previously unreported E410V amino acid substitution. CFEOM1 patients all underwent at least 1 procedure to address chin-up posture. Chin-up posture improved from 24° ± 8° before surgery to 10.0° ± 8° postoperatively (P Conclusions CFEOM is a complex strabismus disorder for which surgical management is difficult. Despite an aggressive surgical approach, multiple procedures may be necessary to achieve a desirable surgical effect. Knowledge of the underlying genetic diagnosis may help to inform surgical management.
TL;DR: Experimental robot-assisted strabismus surgery is technically feasible using the new robotic da Vinci Xi Surgical System and what is believed to be the first use of a surgical robot in experimental eye muscle surgery.
Abstract: Purpose This study aims to investigate the feasibility of robot-assisted simulated strabismus surgery using the new da Vinci Xi Surgical System and to report what we believe is the first use of a surgical robot in experimental eye muscle surgery. Methods Robot-assisted strabismus surgeries were performed on a strabismus eye model using the robotic da Vinci Xi Surgical System. On the lateral rectus of each eye, we performed a procedure including, successively, a 4-mm plication followed by a 4-mm recession of the muscle to end with a 4-mm resection. Operative time from conjunctival opening to closing and successful completion of the different steps with or without complications or unexpected events were assessed. Results Robot-assisted strabismus procedures were successfully performed on six eyes. The feasibility of robot-assisted simulated strabismus surgery is confirmed. The da Vinci Xi system provided the appropriate dexterity and operative field visualization necessary to perform conjunctival and Tenon's capsule opening and closing, muscle identification, suturing, desinsertion, sectioning, and resuturing. The mean duration to complete the whole procedure was 27 minutes (range, 22-35). There were no complications or unexpected intraoperative events. Conclusions Experimental robot-assisted strabismus surgery is technically feasible using the new robotic da Vinci Xi Surgical System. This is, to our knowledge, the first use of a surgical robot in ocular muscle surgery. Translational relevance Further experimentation will allow the advantages of robot-assisted microsurgery to be identified while underlining the improvements and innovations necessary for clinical use.
TL;DR: The constancy and angle of strabismus was related to the severity of motor impairment while the topographical subtype of CP has no significant relationship.
Abstract: Purpose: To investigate the correlation between clinical features of strabismus and motor dysfunction classified according to the Gross Motor Function Classification System (GMFCS) in patients with spastic cerebral palsy (CP).Methods: In this retrospective, cross-sectional study in single tertiary medical center, 62 patients who are diagnosed with spastic CP who had an ophthalmic examination between 2006 and 2014 were included. Only patients with vision sufficient to fixate were included and patients with restrictive or paralytic strabismus were excluded. The types of CP were classified as diplegia, hemiplegia, or quadriplegia for distribution of motor impairment. The GMFCS was used to grade gross motor dysfunction, which was then classified as mild (grade 1, 2 and 3) or severe (grade 4 and 5) motor impairment. Strabismus was investigated in terms of direction, constancy, and deviation angle. The relationship between strabismus characteristics and the level of GMFCS and type of CP were assessed.Results: Thirty-eight and 24 patients had mild or severe motor deficit, respectively. Forty patients had strabismus, which was more frequent in patients with severe motor impairment.(P = .014) Exotropia and esotropia occurred with similar frequency. Constant and large-angle strabismus was frequently observed in patients with severe motor impairment.(P < .005, 0.027) The topographical subtype of CP was not related to clinical features of strabismus.Conclusions: The prevalence of strabismus is higher in severe motor impairment. The constancy and angle of strabismus was related to the severity of motor impairment while the topographical subtype of CP has no significant relationship.
TL;DR: This is by far the largest published study regarding the outcome of lateralis splitting in NIII palsy and finds the procedure is difficult, yet a very useful option.
Abstract: The lateralis splitting technique has been an interesting option for treating large-angle exotropia due to complete 3rd nerve paralysis since its inception in the early 1990s The purpose of this study is to report on our experience regarding the effectiveness and complications of this method Retrospective analysis of a consecutive series of 29 patients operated by one single experienced surgeon and examined according to a specific operative and perioperative protocol Patients were examined preoperatively, on the 2nd day and 3rd month after surgery Outcome measures include strabismus angle, horizontal motility, head turn, binocular function, and incidence and resolution of postoperative serous retinal detachment as seen with infrared imaging and spectral domain optical coherence tomography (SD-OCT) Surgery brought about a large and stable reduction of strabismus angle and head turn It reduced horizontal motility, but moved the range of monocular excursion much closer to center Eighty percent of patients with constant diplopia acquired some fields of single binocular vision A significant number of cases (333%) developed transitory serous retinal detachment with varying onset and extent This is by far the largest published study regarding the outcome of lateralis splitting in NIII palsy The procedure is difficult, yet a very useful option Serous detachment is a serious complication, but usually transitory Its cause and mechanisms are not fully understood and warrant further investigation
TL;DR: This is the first study to use an operating microscope with integrated intra-operative OCT to image rectus muscle insertions, and has significant implications for the management of strabismus patients.
Abstract: OCT (optical coherence tomography) is widely used in ophthalmology and pediatric ophthalmology, but limited research has been done on the use of OCT in strabismus. This study investigates the use of different OCT machines to image rectus muscle insertions pre-, intra-, and post-operatively in pediatric strabismus patients. The OCT machines used in the study were a Bioptigen (Leica Microsystems Inc., Buffalo Grove, IL, USA), Spectralis HRA+OCT with Anterior Segment Module (Heidelberg Engineering, Heidelberg, Germany), Visante (Carl Zeiss, Oberkochen, Germany), and Zeiss Rescan 700 (Carl Zeiss, Oberkochen, Germany). Measurements from the machines were compared with the caliper distance measured during the strabismus surgery before disinsertion or after reattachment. The OCT machines had moderate (Bioptigen: 0.62) to good intraclass correlation coefficients (Rescan: 0.83, Spectralis: 0.85, Visante: 0.88) with intra-operative measurements. To our knowledge, this is the first study to use an operating microscope with integrated intra-operative OCT to image rectus muscle insertions. OCT is a useful tool in strabismus surgical patients in the pre-, intra-, and post-operative settings, particularly in patients who have had previous surgery, when the muscle insertion is unknown. The ability to accurately image rectus muscle insertions has significant implications for the management of strabismus patients.
TL;DR: This review highlights discrepancies in outcome measure reporting within published literature for amblyopia, strabismus and ocular motility and it generated an item bank of the most commonly used and reported outcome measures for each of the three conditions from recent literature to start the process ofCore Outcome Sets development.
Abstract: Core Outcome Sets (COS) are defined as the minimum sets of outcomes that should be measured and reported in all randomised controlled trials to facilitate combination and comparability of research. The aim of this review is to produce an item bank of previously reported outcome measures from published studies in amblyopia, strabismus and ocular motility disorders to initiate the development of COS. A review was conducted to identify articles reporting outcome measures for amblyopia, strabismus and ocular motility disorders. Using systematic methods according to the COMET handbook we searched key electronic bibliographic databases from 1st January 2011 to 27th September 2016 using MESH terms and alternatives indicating the different subtypes of amblyopia, strabismus and ocular motility disorders in relation to treatment outcomes and all synonyms. We included Cochrane reviews, other systematic reviews, controlled trials, non-systematic reviews and retrospective studies. Data was extracted to tabulate demographics of included studies, primary and secondary outcomes, methods of measurement and their time points. A total of 142 studies were included; 42 in amblyopia, 33 in strabismus, and 68 in ocular motility disorders (one study overlap between amblyopia and strabismus). We identified ten main outcome measure domains for amblyopia, 14 for strabismus, and ten common “visual or motility” outcome measure domains for ocular motility disorders. Within the domains, we found variable nomenclature being used and diversity in methods and timings of measurements. This review highlights discrepancies in outcome measure reporting within published literature for amblyopia, strabismus and ocular motility and it generated an item bank of the most commonly used and reported outcome measures for each of the three conditions from recent literature to start the process of COS development. Consensus among all stakeholders including patients and professionals is recommended to establish a useful COS.
TL;DR: Surgical correction of strabismus could improve ocular alignment and binocular sensory functions in patients with manifest strabistismus, regardless of onset age, strABismus duration, or type.
Abstract: To determine the factors that affect ocular alignment and binocular sensory functions after strabismus surgery and compare surgical outcomes between manifest exotropia (XT) and esotropia (ET). In a retrospective study, 41 XT and 17 ET patients who had undergone strabismus surgery were recruited. Information on type and duration of strabismus, age at onset of deviation and surgery, pre- and postoperative strabismus deviation angles, and binocular sensory functions including stereoacuity and macular fusion capacity was recorded. In all patients, the ocular alignment and binocular sensory functions improved with time following surgery. Residue strabismus deviation angles (≦ 10 prism diopters) at postoperative 1 month determined the final successful ocular alignment. In patients with final excellent binocular sensory functions, XT group restored macular fusion capacity and stereoacuity at postoperative 1 month, but ET group regained macular fusion capacity at postoperative 1 month and then restored stereoacuity at postoperative 3 months. Though XT patients showed better pre- and postoperative stereoacuity than ET patients, patients with successful ocular alignment had an odd of 4.5 in XT group and 22.5 in ET group to achieve excellent and fair binocular sensory functions. Surgical correction of strabismus could improve ocular alignment and binocular sensory functions in patients with manifest strabismus, regardless of onset age, strabismus duration, or type. Postoperative 1-month status may help to predict the final motor and sensory outcomes. ET patients would benefit more final successful ocular alignment and excellent binocular sensory functions from early surgery and maintaining postoperative small deviation angle than XT patients.
TL;DR: Addressing barriers perceived by parents may improve early presentation rates of children with strabismus allowing timely management, according to a cross-sectional study conducted in Qaseem, Saudi Arabia.
Abstract: Background: For early detection and timely management of strabismus in children, parent’s cooperation is essential. It depends upon their level of awareness. The objective was to describe the determinants and the level of knowledge and attitude towards strabismus among parents of children with strabismus in Saudi Arabia.Methods: This cross-sectional study was conducted in 2018 at a hospital in Qaseem, Saudi Arabia. Consented parents of children with strabismus presenting to Qaseem University eye clinic were interviewed. Data were anonymously collected on participant demographics and the child’s strabismus. The survey interview consisted of 8 questions related to signs, symptoms, and management of strabismus. Three questions related to the attitude towards strabismus among parents/caregivers. Two separate questions queried the source of knowledge and possible barriers, respectively.Results: Each parent of 81 children was interviewed. An excellent level of knowledge of strabismus was noted for 41 participants (50.6% at 95%CI 39.7-61.5). A positive attitude towards strabismus was noted in 57 participants (70.4% at 95% CI 60.4-80.3). No history of surgery was statistically associated to an excellent level of knowledge (P<0.001). Gender (P=0.7), age (P=0.7), father’s education (P=0.3), mother’s education (P=0.5), type of strabismus (P=0.8) were not associated with the level of knowledge. High cost (43.2%) and false beliefs (53.1%) were the main barriers to medical consultations.Conclusions: Parents of children with strabismus presenting to a tertiary care eye hospital had good knowledge about the signs, symptoms and management of strabismus. Addressing barriers perceived by parents may improve early presentation rates of children with strabismus allowing timely management.
TL;DR: A good visual outcome is indicated in the majority of pediatric patients undergoing resection of posterior fossa tumors, and the association between cerebellar mutism and postoperative esotropia and hypertropia is confirmed.
TL;DR: The purpose of this review was to identify areas of consensus and disagreement among experts for the definition of success following strabismus surgery using the Delphi process, and it was considered important that stereopsis and the range of single binocular vision be included in the definitions of success for certain types of strabs.
Abstract: Summary The purpose of this review was to identify areas of consensus and disagreement among experts for the definition of success following strabismus surgery using the Delphi process. Three rounds of electronic questionnaires were sent to a panel of 28 strabismus experts. Throughout the process, members of the panel were masked to one another’s identities to minimize the possibility of influence among members. Prior to data collection, we defined consensus as an 85% agreement on the answer to each question. Questions for which there was no consensus were reworded, and the resultant new questions were used in each subsequent round of questioning. We arrived at consensus for 23 of the 36 questions (64%). Consensus was obtained for recommending unique criteria for the definition of success for certain specific strabismus conditions. In addition, it was considered important that stereopsis and the range of single binocular vision be included in the definition of success for certain types of strabismus.
TL;DR: Cells in the rostral SC of two exotropic monkeys show responses related to eye misalignment suggesting that the SC is part of a vergence circuit that plays a role in setting strabismus angle.
Abstract: Purpose The superior colliculus (SC) is an important oculomotor structure which, in addition to saccades and smooth-pursuit, has been implicated in vergence. Previously we showed that electrical stimulation of the SC changes strabismus angle in monkey models. The purpose of this study was to record from neurons in the rostral SC (rSC) of two exotropic (XT; divergent strabismus) monkeys (M1, M2) and characterize their response properties, including possible correlation with strabismus angle. Methods Binocular eye movements and neural data were acquired as the monkeys performed fixation and saccade tasks with either eye viewing. Results Forty-two cells with responses likely related to eye misalignment were recorded from the rSC of the strabismic monkeys of which 29 increased firing for smaller angles of exotropia and 13 increased firing for larger exotropia. Twenty-six of thirty-five cells showed a pause (decrease in firing rate) during large amplitude saccades. Blanking the target briefly during fixation did not reduce firing responses indicating a lack of visual sensitivity. A bursting response for nystagmus quick phases was identified in cells whose topographic location matched the direction and amplitude of quick phases. Conclusions Certain cells in the rSC show responses related to eye misalignment suggesting that the SC is part of a vergence circuit that plays a role in setting strabismus angle. An alternative interpretation is that these cells display ocular preference, also a novel finding, and could potentially act as a driver of downstream oculomotor structures that maintain the state of strabismus.
TL;DR: The results provide evidence for a multifactorial etiology underlying selected birth anomalies in California twins, and further research is needed to understand the biological mechanisms.
TL;DR: The authors report a rare occurrence of bilateral cataract in eyes with aggressive posterior retinopathy of prematurity after bilateral administration of intravitreal bevacizumab in a neonate, with no evidence of lens touch.
Abstract: The authors report a rare occurrence of bilateral cataract in eyes with aggressive posterior retinopathy of prematurity after bilateral administration of intravitreal bevacizumab in a neonate, with no evidence of lens touch. Although the exact mechanism of cataractogenesis is unclear, the possibility of local drug toxicity needs to be investigated. [J Pediatr Ophthalmol Strabismus. 2019;56:e28-e30.].
28 Mar 2019
TL;DR: Results indicate that the system using the proposed HOCORC algorithm is a viable means of detecting and classifying strabismus.
Abstract: The study is centered around creating a system that uses digital image processing via OpenCV-Python and the central corneal light reflex (CCLR) test, or Hirschberg test, as the basis for HOCORC. This is an algorithm that would determine whether patients have strabismus and what type of strabismus found, whether esotropia or exotropia. CCLR processing of HOCORC resulted in an accuracy of 97.5% and an error rate of 2.5% for the detection of strabismus of patients. HOCORC produced an accuracy of 97.5% and an error rate of 2.5% for strabismus classification. These results indicate that the system using the proposed HOCORC algorithm is a viable means of detecting and classifying strabismus.
11 Mar 2019
TL;DR: In this article, a review was conducted to identify articles reporting outcome measures for amblyopia, strabismus, and ocular motility disorders, highlighting discrepancies in outcome measure reporting within published literature.
Abstract: BackgroundCore Outcome Sets (COS) are defined as the minimum sets of outcomes that should be measured and reported in all randomised controlled trials to facilitate combination and comparability of research. The aim of this review is to produce an item bank of previously reported outcome measures from published studies in amblyopia, strabismus and ocular motility disorders to initiate the development of COS.MethodsA review was conducted to identify articles reporting outcome measures for amblyopia, strabismus and ocular motility disorders. Using systematic methods according to the COMET handbook we searched key electronic bibliographic databases from 1st January 2011 to 27th September 2016 using MESH terms and alternatives indicating the different subtypes of amblyopia, strabismus and ocular motility disorders in relation to treatment outcomes and all synonyms. We included Cochrane reviews, other systematic reviews, controlled trials, non-systematic reviews and retrospective studies. Data was extracted to tabulate demographics of included studies, primary and secondary outcomes, methods of measurement and their time points.ResultsA total of 142 studies were included; 42 in amblyopia, 33 in strabismus, and 68 in ocular motility disorders (one study overlap between amblyopia and strabismus). We identified ten main outcome measure domains for amblyopia, 14 for strabismus, and ten common “visual or motility” outcome measure domains for ocular motility disorders. Within the domains, we found variable nomenclature being used and diversity in methods and timings of measurements.ConclusionThis review highlights discrepancies in outcome measure reporting within published literature for amblyopia, strabismus and ocular motility and it generated an item bank of the most commonly used and reported outcome measures for each of the three conditions from recent literature to start the process of COS development. Consensus among all stakeholders including patients and professionals is recommended to establish a useful COS.
TL;DR: The authors' estimates of failure, after 3 years of 6-month follow-ups, are inconclusive and consistent with a small to moderate benefit or no benefit of immediate prescription of glasses compared with careful observation (with glasses only if deteriorated).
TL;DR: The results of this informatics study support the heterogeneity and complexity of strabismus and point to specific biological pathways and brain regions for future focus.