Visual training for the treatment of retinal photoreceptor inner and outer segment connection (IS/OS) fracture: A case report.

Abstract

The inner segments and outer segments (IS/OS) of the retinal photoreceptors are the areas that receive light signals and are the most initial sites for generating visual impulses, and the integrity of the IS/OS has a direct impact on visual sensitivity. We performed OCT on a 6-year-old child with vision loss and found that the cause of his vision loss was a retinal IS/OS fracture, and the child underwent some treatments to improve microcirculation and nourish the retina at a higher-level hospital, but his vision never improved. Our examination of this child revealed that this child not only had decreased visual acuity, but also hypermetropia, but his near stereopsis was normal. The symptoms were similar to those of amblyopia, so we tried to use visual training as a treatment. First, 6 sessions of fine visual stimulation were given, followed by 3 sessions of accommodation training, and we followed the 4 stages of accommodation training: perception of accommodation, amplitude of accommodation, sensitivity of accommodation, and autonomic accommodation. After 9 consecutive visual training sessions, the child's visual acuity was stabilized at 0.6, and then we added eye movement training, and after the child's visual acuity was improved to 0.7, we suppressed the visual acuity of the left eye to 0.6, so as to make the visual acuity of both eyes similar, which would promote the establishment of binocular stereo vision, and then we carried out 9 more visual training sessions, and the patient's visual acuity was stabilized at 0.8 gradually. OCT review showed that the child's retinal IS/OS fracture was basically closed. In conclusion, our study found that visual training can restore visual acuity in children with monocular IS/OS fracture and also promote repair of IS/OS fracture, which increases our understanding and knowledge of the treatment of retinal IS/OS fracture, and this case may provide some lessons for the treatment of retinal IS/OS fracture in children. We hope to have more samples of retinal IS/OS fracture in the future to evaluate the efficacy of visual training for retinal IS/OS fracture.