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PubMed1984

Modelling the results of the orthoptic treatment of divergence excess.

Using data compiled from an earlier study of the results of the orthoptic treatment of divergence excess [Daum, K. M. Ophthal. Physiol. Opt. 4, 15-24 (1984)], a model has been presented regarding the results of the treatment. Provided the calibration sample is representative, the model may be used after an initial examination to predict the class of success a given subject will eventually be placed in as a result of orthoptic treatment. After treatment with a standard orthoptic regimen, the subjects were classified as being either totally successful (no objective or subjective visual difficulties) or partially/not successful. Stepwise discriminate analysis of 15 independent variables for the dependent variable success was used in order to choose the model with the highest coefficient of determination (r2) and the best statistical significance. The three variables chosen for the model were the angle of deviation at near and the blur and break values of the negative vergences at near. Using these variables, discriminant analysis was performed on the calibration sample of nine subjects. Each was classified correctly. The use and limitations of the model are briefly discussed.

Adolescent↗

PubMed1978

Orthoptic treatment of strabismus.

The purpose of this paper will be to carefully examine the effectiveness of orthoptics as a viable treatment modality for strabismus. It will be necessary to first examine the scope of this problem and the significance of functional cure. A short discussion of perceptual and psychological effects will be included. A review of pertinent literature and an analysis of the data will be presented. Any commonalities or generalizations which can be identified will then be discussed and analyzed. Finally, the training of the optometrist in orthoptics and associated subjects will be examined to demonstrate the qualification of the optometrist to administer orthoptics in the treatment of visual anomalies.

Adolescent↗

PubMed2006

Asthenopia in schoolchildren, orthoptic and ophthalmological findings and treatment.

The aim of this study was to describe the orthoptic and ophthalmological findings in schoolchildren with asthenopia, to correlate them with asthenopic symptoms and to evaluate the effect of treatment. One hundred and twenty schoolchildren, aged 6-16 years, were included in the study. They were all referred by school nurses, for asthenopic symptoms. An orthoptic and ophthalmological assessment was performed. The main diagnoses were accommodative insufficiency, convergence insufficiency, refractive errors, and latent strabismus. Reading glasses could help 98% of the schoolchildren with reduced accommodation, and 94% of the children with refractive errors and heterophorias were helped with appropriate spherical, cylindrical and prism correction. Convergence exercise reduced the symptoms in all patients with convergence insufficiency. Ninety-three percent of all 120 schoolchildren were symptom free 3-6 month after treatment had started. By an orthoptic and ophthalmological examination abnormalities in schoolchildren with asthenopia related to visual problems can be identified. Most of the children were relieved from their symptoms by giving adequate glasses, convergence exercises and surgery.

Accommodation, Ocular↗

PubMed1986

Static vergence and accommodation: population norms and orthoptics effects.

The steady-state characteristics of the accommodation and vergence systems can be described by a model with six major oculomotor parameters. These include the system biases (tonic vergence and accommodation) and forward-loop gains (vergence and accommodative gains), as well as the interactive system gains (AC/A and CA/C ratios). We investigated these parameters in two populations: (1) 22 visually-normal asymptomatic individuals, and (2) 21 visually-abnormal symptomatic individuals before and after conventional orthoptic therapy. Two parameters related to system gain differentiated between the symptomatic and asymptomatic individuals: the slope of the fixation disparity curve with accommodation open-looped and the slope of the accommodative response/stimulus curve. Following orthoptic therapy, 4 static model parameters and 1 dynamic clinical parameter showed changes toward the normal mean; this included tonic accommodation, slope of the fixation disparity curve with accommodation closed-loop (2.5D), slope of the accommodative response/stimulus curve, the CA/C ratio, and the +/- 2D monocular accommodative flipper rate.

Accommodation, Ocular↗

PubMed2002

Coloured overlays in schools: orthoptic and optometric findings.

In two studies, the first in a school in Peterborough and the second in a school in Norwich, more than 233 children aged 8-12 years received either an orthoptic examination, or an optometric examination, together with an examination using coloured overlays and a test of reading fluency. In both studies more than one-third of the children reported visual symptoms. More than one-third of the children chose to use an overlay, and they read more quickly with it than without. The colour of the overlay chosen was weakly related to the binocular amplitude of accommodation: overlays reflecting greater energy at long wavelengths were chosen more frequently by children with a higher amplitude of accommodation. Although the visual symptoms were strongly related to the use of an overlay, in neither study was the benefit from an overlay strongly related to the orthoptic or optometric findings. Nevertheless, children who used an overlay had slightly, but significantly, reduced mean binocular amplitude of accommodation and fusional reserves. On average, children with 'sensory' or 'motor' instability of the nonius strips of the Mallett unit read more slowly than others, as did those with poor stereopsis. However, 60% of those demonstrating sustained overlay use gave a normal response on the Mallett aligning prism test, compared with 80% of those who did not use an overlay for a sustained period. Another indicator of decompensated heterophoria, Sheard's criterion, did not differentiate subjects who used overlays from those who did not. Although binocular and accommodative anomalies do not appear to be the underlying mechanism for the benefit from coloured filters in most cases, there may be some individuals who respond to coloured filters and in whom these ocular motor factors require treatment. Children with visually precipitated symptoms and/or reading difficulties need both a careful evaluation of their accommodative and binocular status, and an investigation of the effect of coloured filters.

Accommodation, Ocular↗

PubMed1998

[Orthoptic problems after macular rotation with and without muscle surgery].

BACKGROUND: In spite of new therapeutic approaches the treatment of age related macular degeneration remains unsatisfying. Macular rotation is so far only a rarely employed surgical procedure, where the macula is translocated to an area with intact retinal pigment epithelium. The aim of this study was to elucidate the orthoptic problems of macular rotation and describe possible treatment modalities. PATIENTS AND METHOD: Between February and July of 1997 a macular rotation was performed in 8 patients with exsudative macular degeneration, followed by silicone oil removal and implantation of an intraocular lens. In 3 out of 8 patients the oblique muscles were transposed at the beginning of the surgery to produce an excylotropia. In all patients visual acuity for distance and near was determined pre- and postoperatively along with a complete orthoptic status including measuring of cyclotropia. Mean postoperative follow-up was 5.5 months. RESULTS: Due to the unilateral ectopia of the macula all patients presented with a postoperative strabismus with vertical deviation of 2 degrees to 10 degrees. The change of the visual axis resulted in a displacement of the pupillary reflex. The patients described a cyclotropia of 12 degrees to 45 degrees corresponding to the ophthalmoscopically estimated angle of retinal rotation. Patients after surgery of the oblique muscles showed less cyclotropia with an angle of 12 degrees to 20 degrees. They were less disturbed by diplopia and tilted visual impression than those without muscle surgery. All patients exhibited an abnormal head position with chin up and tilt to the side of the operated eye. CONCLUSION: Macular rotation always causes diplopia because of the unilateral ectopia with cyclotropia and vertical deviation. These problems can be considerably reduced by combining macular rotation surgery with oblique muscles surgery. It may well be that in the future these problems can be completely resolved by additional surgery on the rectus muscles.

Aged↗

PubMed1981

[Orthoptic exercises - a historical survey (author's transl)].

A survey is presented of orthoptic exercises practiced over the last 120 years. An attempt is made to deduce attitudes to the exercises from contemporary sensory theories. The currently prevalent nihilistic attitude toward orthoptic training is discussed.

History, 19th Century↗

PubMed1979

Objective assessment of accommodation orthoptics. I. Dynamic insufficiency.

Three young adult females with symptoms related to focusing difficulties at near were treated by standard orthoptic procedures, including jump focus, plus-and-minus lens flippers, and pencil pushups. Home training was done 20 minutes each day for 4 1/2--7 weeks. Objective measures of dynamic accommodation were made each week in our Neuro-optometry Clinic. Initially, these objective measures showed prolongations of time constants and latencies of accommodation. During treatment, the patients showed significant reductions in time constants and latencies that correlated well with elimination of subjective symptoms. Also, in all three patients, flipper rates increased and symptoms were either markedly diminished or no longer present at termination of therapy. These results clearly demonstrate that orthoptic treatment in our three adult patients resulted in objective improvement of accommodation function.

Accommodation, Ocular↗

PubMed1982

Effect of orthoptics upon the ability of patients to adapt to prism-induced heterophoria.

In a previous study we showed that subjects with abnormal binocular vision either lacked or had a deficient ability to adapt their oculomotor systems to a prism-induced heterophoria. In this study we report on the results of an experiment designed to establish whether the adaptation ability improves in patients who are successfully treated, by means of orthoptics, for convergence insufficiency. In all seven patients examined, we found an improved ability to adapt. Whereas at the beginning of the experiment only two patients fell within the 95% confidence limits of the norm, at the end five patients fell within these limits. These results demonstrate that the success of orthoptics in relieving symptoms is associated with an improved ability to adapt to prism-induced heterophoria.

Adaptation, Ocular↗

PubMed1983

Vision function recovery during orthoptic therapy in an exotropic amblyope with high unilateral myopia.

Orthoptic therapy was instituted in a 6 1/2-year-old patient having deep amblyopia, constant exotropia, and high unilateral myopia. The combination of these factors pointed toward a poor prognosis for attainment of normal monocular and binocular vision function. Rates of recovery of several vision functions were monitored during orthoptic therapy. Results showed marked improvement in most areas, thus providing evidence of neural plasticity at multiple sites in the visual pathways.

Amblyopia↗

PubMed1984

Predicting results in the orthoptic treatment of accommodative dysfunction.

A retrospective analysis of the records of 114 orthoptic patients diagnosed as having accommodative dysfunction (accommodative insufficiency, fatigue of accommodation, infacility of accommodation, or spasm of accommodation) has allowed the construction of models of the results of orthoptic treatment. Discriminant analysis completed on various samples of the group provides linearized discriminant functions for the success of the treatment (either total or partial/none) and for the change in accommodative amplitude. These data indicate that linearized discriminant functions using the age and AC/A ratio of the patient are effective in postpredicting the success category of 60% of a calibration sample of 99 patients. Similar functions using the patient's age, initial accommodative amplitude, and blur value of the near positive vergences allow the postprediction of the category of change in accommodative amplitude with treatment (3 D or more vs. 2 D or less). Seventy-eight percent of a sample of 68 patients were correctly classified. The application of these models in predicting the results of treatment of similarly afflicted subjects is discussed.

Accommodation, Ocular↗

PubMed1979

Mobile orthoptic service for primary screening of visual disorder in young children.

A mobile orthoptic service was begun in 1976. General practitioners, clinic doctors, and health visitors referred 4544 preschool children to the service in 18 months. Of the children referred, no defect was detected in 3138 (69%), 927 (20%) were recalled for a second assessment within 12 months, and 479 (11%) were referred for treatment. Out of 261 who received treatment in Oxford, 24 (9%) received aftercare. Benefits of the service included a 25% decrease during 1976-7 in inappropriate referrals of preschool children to the specialist hospital. The chance of inappropriate referral was reduced by a factor of 30 if a child was referred to the mobile service instead of to the eye hospital. A prevention programme such as the mobile orthoptic service can improve the rate of detection of visual disorder in young children, while providing the support needed by primary-care doctors and nurses for visual screening of preschool children easily and cheaply.

Adolescent↗

PubMedDate not supplied

Role of orthoptic treatment in the management of intermittent exotropia.

30 patients of intermittent ACDS were studied prospectively for a period of 8 weeks to 1 year to evaluate the role of orthoptics in the management of these cases. In patients with convergence insufficiency and a maximum deviation of 25 PD or less the orthoptic treatment was found to be effective in offering symptomatic relief and improving binocular functional status. A reduction in the maximum angle of deviation by 4 PD to 8 PD was observed in 4 patients. Even though the basic angle of deviation remained unchanged in most of the patients, significant functional and symptomatic improvement was obtained in 64% to 85.7% of these cases. The long term stability of these results remains to be studied. In patients with a deviation of more than 25 PD there was no significant improvement in symptoms or reduction in maximum angle of deviation. In 6(37.5%) of these patients some improvement in the fusional range could be demonstrated on the synoptophore without any symptomatic relief.

Adolescent↗

PubMed1986

Different rates and amounts of vision function recovery during orthoptic therapy in an older strabismic amblyope.

Orthoptic therapy was instituted in an 11-year-old patient having deep amblyopia, constant small-angle esotropia with anomalous retinal correspondence, and a past history of minimal success with such therapy. This combination of factors pointed toward a poor prognosis for substantial recovery of vision function. Rate of recovery of several monocular and binocular vision functions was monitored during the course of 18 months of intensive orthoptic therapy. Results showed marked improvement in several monocular vision functions, suggesting presence of considerable residual neural plasticity of multiple sites in the visual pathways of this older amblyope.

Accommodation, Ocular↗

PubMed1986

Vision function recovery during orthoptic therapy in an adult esotropic amblyope.

Orthoptic therapy was instituted in a 29-year-old patient having moderate amblyopia, constant small-angle esotropia, and large and steady eccentric fixation. This combination of factors, especially the age, pointed toward a poor prognosis for attainment of markedly improved vision function. Rate of recovery of several monocular vision functions was monitored during one year of orthoptic therapy. Results showed substantial improvement in most areas, thus providing evidence of neural plasticity at multiple sites in the visual pathways in this adult amblyope.

Accommodation, Ocular↗

PubMed1985

Orthoptic effects on accommodation and related visual functions in an adult alternating esotrope.

Orthoptic therapy was instituted in an adult, alternating esotrope with asthenopia who exhibited inaccurate static accommodative responses with adequate, clinically determined, accommodative facility. During and following therapy the patient showed considerable improvement in accommodative accuracy and related visual functions, such as contrast sensitivity, in the absence of any change in strabismic deviation. This case provides the first laboratory documentation of orthoptic effects on accommodation in an adult strabismic.

Accommodation, Ocular↗

PubMed1982

Orthoptic treatment in teenage patients.

A survey of 100 patients who received orthoptic treatment in the Bradford University Clinic is examined to see the level of success with the different binocular anomalies, indicating what factors were common in successful cases, and the type of treatment given. A successful outcome or worthwhile improvement was achieved in enough cases to conclude that orthoptics in teenage patients is often appropriate, even in strabismus, if the cases are selected carefully. There was no indication that the actual age made any difference once the patients was between 11 and 19 years, but the starting acuity was significant.

Adolescent↗

PubMed1981

[Home orthoptic practice by means of stereoprojection].

As we know polarisationhaploscopy is a method of dividing right and left side vision. Modern visusprojectors have this installed for the examination of binocular vision. A method of stereoprojection on a large silver screen is demonstrated, until now this was not done on account of technical difficulties. With this new method principally the same examinations are possible as with the phase-difference-haploscope. The projected picture is a fusionimpuls of brilliant picture quality. Fusion and stereobjects with differently near foreground motives that were photographed in differing distances and with different stereobasis as well as numerous projection variations give a wide spectrum for practicing. The slides should be taken in the known surroundings of the children so that they show more interest in practice than when using the prism bar. The optimal circumstances for stereoprojection and orthoptic practices relying on literature are shown. The position of the geometric pictures and circumstances of orthomorphe and heteromorphe pictures are demonstrated by graphics. A convergent systemposition always leads to a heteromorphe projection with a shortening of the stereoscopic range. The perception frequently differs from the objective geometric construction. The normal stereoprojection and orthoptic practices are not disturbed by the objective and described pictureblurring. Examples demonstrate how to set up the system for a defined squintangle as well as how to find the reached fusionspan. Using a third projector enables a continuous change from uncrossed dispertion to crossed without change of slides.

Humans↗