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PubMed1990

[Disorders of vision and act in a child with spastic cerebral palsy].

A boy with spastic cerebral palsy, who had frequent apneic attacks during the neonatal period, showed developmental disorders; (1) cerebral poor eye sight, a disorder of visual directed attention, and associative visual agnosia (2) disorders of visuospatial perception and corporeal awareness, and (3) dyspraxia d'évolution (Stambak et al.). When the visual directed attention was completed at the age of 10 years, the integration of his cerebral higher functions was facilitated, except the following neuropsychological deficits; (1) visual line agnosia (apperceptive type) and (2) constructive apractognosia. These deficits were not compensated through the maturation of the central nervous system and through the contacts and interchanges with the outer world. MRI findings showed bilateral lesions of the white matter of occipital and parieto-occipital transitional regions, and the trunk and splenium of corpus callosum. Although this case is included in mental retardation, what differs is the fact that each "higher" function developed unevenly in this case unlike the ordinary mental retardation. In this report these disorders and deficits were discussed considering his developmental process of neuropsychological functions.

Cerebral Palsy↗
PubMed1998

Assessing the predictive ability of the test-positive findings of an elementary school vision screening.

PURPOSE: The purpose of this study is to assess the predictive ability of the test-positive findings of an elementary school vision screening program, conducted by 2nd-year optometry students, in identifying children with eye or vision disorders. METHODS: A modified version of the Modified Clinical Technique (MCT) vision screening was administered to elementary children from a below-average socioeconomic neighborhood in Houston, Texas. Comprehensive eye and vision examinations were provided to the available children who failed the vision screening. The screening was administered by groups of 2nd-year optometry students with the assistance of a 4th-year optometry student, and supervised by a faculty member licensed to practice optometry. The follow-up examinations were provided by supervised 4th-year optometry students in a clinical setting based at the elementary school. Positive predictive values calculated from the screening and examination findings estimate the probability that a failure on one or more of the screening tests would identify children with eye or vision disorders. RESULTS: Sixty-nine percent of the test-positive children examined were found to be true positives by the criteria developed in a study of vision screening methods in Orinda, California from 1954 through 1956. CONCLUSIONS: The predictive ability of this study's test-positive findings for identifying eye and vision disorders was found to be less than the predictive ability of the Orinda Study findings. This reduced predictive ability of the present study resulted in a larger number of children being overreferred for examinations than had occurred in the Orinda Study. The reduction in the ability of the test-positive findings of the current study's screening program to identify accurately children with eye and vision problems is most likely due to the limited experience of the optometry students conducting the screening program. The inability of this retrospective study to evaluate the accuracy of the test-negatives is a major limitation in assessing the total effectiveness of this vision screening program. Although the present study may indicate some value in optometry students conducting elementary vision screening programs, a prospective study which could assess the predictive ability of both test-positive and test-negative findings, as well as determine the sensitivity and specificity of the screening program, is needed to assess more fully the effectiveness of school vision screening programs using professional students.

Adolescent↗
PubMed1995

Binocular vision anomalies: an emerging cause of malpractice claims.

BACKGROUND: Tumors that affect the visual system are a significant cause of liability claims involving eyecare practitioners. Individuals with brain tumors or intraocular tumors may seek examination for associated binocular vision disorders such as strabismus and reduced acuity. A disporportionate number of these individuals are children. METHODS: A review of malpractice claims was performed to identify representative clinical presentations in which binocular vision disorders were the cause for examination. RESULTS: Strabismus and amblyopia in children, if not promptly diagnosed and properly treated, can be the basis for a malpractice claim. Binocular vision disorders may also result from brain or intraocular tumors affecting children, and failure to timely detect the presence of these underlying diseases can also become the basis for a malpractice claim. CONCLUSIONS: Eyecare practitioners should examine carefully children with binocular vision disorders to rule out the possibility of an associated brain or intraocular tumor. Key findings include decreased visual acuity, acute strabismus, and indications of neurological disease such as optic atrophy, papilledema, visual field loss, and problems with gait and coordination.

Brain Neoplasms↗
PubMed2003

Major review: The underutilization of vision screening (for amblyopia, optical anomalies and strabismus) among preschool age children.

BACKGROUND: Nearly 80% of preschool age children never get an eye examination (1). Many "back to school" physical exams do not test for common vision disorders. Untreated eye and vision problems can interfere with most life experiences. The prevalence of undetected vision problems among preschool age children is estimated to be 5% to 10% (2). Failure to detect visual impairment early may have a permanent effect on long term vision outcomes, education achievement, and self esteem (3). The most common vision disorders among children are strabismus, amblyopia and optical problems impairing visual acuity and depth perception. Various professional organizations, including the American Academy of Pediatrics (AAP), advise preschool vision screening to detect and correct vision problems before school entry. The AAP also recommends that children continue to receive periodic eye and vision examinations throughout childhood. However, resources for this level of care are rarely available. As such, only 21% of preschool age children receive vision screening and even fewer children get a comprehensive eye examination (1). PURPOSE: The purpose of this review is to determine, through a critical review of the literature, the social, economic, and political barriers which contribute to the underutilization of vision screening among preschool age children. A secondary aim is to identify gaps in the literature base that may be needed to complete a public policy response to this problem. METHOD: A comprehensive review and analysis of the pertinent available literature. RESULTS: A variety of barriers exist which prevent children from receiving proper vision screening. They include social, economic and even political problems. Social contextual barriers include ignorance, inconvenience, language, and a lack of providers. Financial barriers affect low income families. Political barriers reside in the disproportionately meager funding of preventative medicine. Moreover there are additional factors which put preventative medicine for vision at a disadvantage compared to other pediatric demands like immunizations, such as the danger to both the individual and society from the medical condition being prevented. CONCLUSION: Even considering large gaps in the literature concerning this topic, it is clear that low income, minority, uninsured families are at high risk of not utilizing vision screening. Ignorance remains a major problem at all levels so improvements in the distribution of information and education are needed and should yield improvement. Additional funding is necessary to pay for these remedies. Titration and direction of available resources to those at highest risk will create the greatest return on such efforts.

Amblyopia↗
PubMed2004

[Color vision and the diagnosis of reduced visual acuity].

Unexplained visual acuity loss requires a systematic approach to gather as many findings of diagnostic value as possible. Most retinal or optic nerve diseases are accompanied by color vision disorders. The type and severity of color vision disorders may provide additional diagnostic or guiding information or may uncover aggravating or simulating factors.

Adult↗
PubMedDate not supplied

[Pathology of the eye in sarcoidosis].

Comprehensive neurologic and ophthalmologic examinations of 100 patients with morphologically verified sarcoidosis showed the most frequent involvement of optic nerves and less incident lesions of the eye proper and its appendages. Vision disorders were detected in 39.0 patients, chiasmal disorders in 12.0%. Fundus oculi abnormalities were found in 27.0% of patients. A specific feature of vision disorders in sarcoidosis was that almost half of the patients did not feel them, which may be explained by a predominantly chronic latent pattern of these disorders and by the fact that, despite manifest disorders of peripheral vision, central vision with correction remained normal for a longer time.

Adult↗
PubMed2006

The economic impact and cost of visual impairment in Australia.

AIMS: To quantify the total economic costs of vision loss in Australia. METHODS: Prevalence data of visual impairment, unpublished data on indirect costs, and national healthcare cost databases were used. RESULTS: Vision disorders cost Australia an estimated A$9.85 billion in 2004. A$4.8 billion is the loss of wellbeing (years of life lost as a result of disability and premature mortality). Vision disorders rank seventh and account for 2.7% of the national loss of wellbeing. Direct health system costs total A$1.8 billion. They have increased by A$1 billion over the last 10 years and will increase a further A$1-2 billion in the next 10 years. Cataract, the largest direct cost, takes 18% of expenditure. The health system costs place vision disorders seventh, ahead of coronary heart disease, diabetes, depression, and stroke. Indirect costs, A$3.2 billion, include carers' costs, low vision aids, lost earnings, and other welfare payments and taxes. CONCLUSIONS: Even a developed economy such as Australia's cannot afford avoidable vision loss. Priority needs to be given to prevent preventable vision loss; to treat treatable eye diseases; and to increase research into vision loss that can be neither prevented nor treated.

Adult↗
PubMed1975

Cerebral disorders of vision in systemic lupus erythematosus.

Sensory neuroophthalmic abnormalities due to cerebral lupus erythematosus, with involvement of visual pathways posterior to the optic chiasm, occurred in 12 patients with systemic lupus erhthematosus. Five underwent detailed evaluation because of an hallucination, 4 for visual loss, and 3 for both. Hallucinations were either unformed (for example, bright lights, straight lines) or highly formed (for example, faces), in which case they were invariably recognized by the patient as inappropriate. In no instance did they occur in association with delirium, confusion, or use of hallucinogenic drugs. Patients with loss of vision had scotomas, homonymous field defects, and cortical blindness. These features indicate disease in the posterior cerebral artery circulation, a localization often supported by ancillary neurologic findings, for example, vocal cord paralysis, diminished gag reflex. Thus, various visual dysfunctions may occur in systemic lupus erythematosus due to cerebral vasculitis. At times they may be the most prominent and disabling feature of the disorder.

Adrenal Cortex Hormones↗
PubMed2000

BVAT distance vs. near stereopsis screening of strabismus, strabismic amblyopia and refractive amblyopia; a prospective study of 68 patients.

PURPOSE: Although there have been studies in the past of the difference between distance and near stereopsis in intermittent exotropia, no such comparisons have been studied and/or reported for other forms of strabismus, nor for strabismic functional amblyopia, or for refractive functional amblyopia. METHODS: The study was prospective: Sixty-eight consecutive patients, ages 6-76 years, with either childhood onset strabismus and no amblyopia, childhood onset strabismus and amblyopia, or refractive amblyopia and no strabismus, had their stereopsis measured. Distance stereopsis was determined on the Mentor BVAT with Random Dot E Test (global stereopsis) and the Circle Test (contour stereopsis). Near stereopsis was determined with the Circle Test of the Randot Stereotest. The data were tabulated and analyzed statistically. RESULTS: Of the 26 strabismus/no amblyopia cases, 14 (54%) appreciated distance stereopsis. Of these, 12/14 were intermittent, and other 2 who were constant had deviations of 8 PD or less. Only 4 of the 14 appreciated global stereopsis at distance (mean = 90 sec. of arc), but all 14 appreciated contour stereopsis at distance (mean = 125 sec. of arc). Of all 26, 21 (81%) had near stereopsis (mean = 137 sec. of arc). For the 21 strabismic amblyopes, only one appreciated global stereopsis at distance (120 sec of arc), and 2 (10%) contour stereopsis at distance (mean = 210 sec. of arc). These two and 4 others (total 29%) had near stereopsis (mean = 162 sec. of arc). For the 21 refractive amblyopes, 3 appreciated global stereopsis at distance (mean = 220 sec. of arc), 11 in all, (52%) contour stereopsis at distance (mean = 121 sec. of arc) and 20 (95%) had near stereopsis (mean = 78 sec. of arc). The percentages of patients in all categories capable of appreciating distance stereopsis were "statistically significantly" (P<.05) or clinically/medically significantly different from (less than) the percentages having near stereopsis. CONCLUSIONS: distance stereopsis is more likely to be reduced or absent than near stereopsis in strabismus, strabismic amblyopia and refractive amblyopia and thus appears to be more sensitive to, and better screening for, binocular vision disorders and a stronger and better outcome standard for treatment of binocular vision disorders than near stereopsis.

Adolescent↗
PubMed1985

[Disorders of binocular vision in amblyopic patients working at computer terminals].

For the first time two cases are described with disturbances of binocular vision caused by subjective perception of positive scotomata in the amblyopic eye. The visual strain of working at a terminal leads to a slight increase in the squint angle; as a result, a paracentral scotoma may shift into the middle of the binocular visual field and impair the image quality of the fixing eye. Amblyopic subjects presenting with these symptoms are disqualified from working at VDUs. However, not every amblyopic is affected.

Adult↗