Binocular Vision Dysfunction Research Articles

Correlating Vertical Heterophoria Symptom Questionnaire With Injury Severity, Gender, and Age in TBI Patients

Objective: To investigate the correlation between Glasgow Coma Scale (GCS) scores with scores on the Vertical Heterophoria Symptom Questionnaire (VHS-Q) in TBI patients between 18-80 years of age with headache and/or visual symptoms. Design: Observational e Cross-sectional Study (Questionnaire). Setting: Outpatient rehabilitation clinic. Participants: Patients screened were ages 18-80, had a documented TBI confirmed by evaluation from an experienced Physiatrist, and had complaints of headaches and/or visual symptoms. Exclusion criteria: patients with a history of cerebellar infarct, acoustic neuroma, blindness, or previously diagnosed binocular vision dysfunction. Consenting participants completed a 25-question VHS-Q. Interventions: None.All patients were provided routine clinical care. Main Outcome Measure(s): VHS-Q score (range of 0-75 with 16 or greater being a positive screen for Vertical Heterophoria) and GCS score. Results: 109 subjects screened, 99 met inclusion criteria and were included in the analysis. Distribution of TBI severity by GCS was 54 mild, 29 moderate, and 16 severe. There were 19% more patients than expected in the severe TBI group with a VHS-Q score < 16 (p Z 0.025).Females were more likely to have a positive VHS-Q screen where as males were less likely to have a positive VHS-Q screen (p Z 0.023).The 36-50 age group was less likely to have a negative VHS-Q score andthe 18-35 age group was more likely to have a negative VHS-Q score (p Z 0.009). Conclusions: Severity of TBI and age does not directly correlate with VHS-Q score.Further studies are required.

Identification of Binocular Vision Dysfunction (Vertical Heterophoria) in Traumatic Brain Injury Patients and Effects of Individualized Prismatic Spectacle Lenses in the Treatment of Postconcussive Symptoms: A Retrospective Analysis

To identify a form of binocular vision dysfunction (vertical heterophoria) in a traumatic brain injury (TBI) population and to assess the effect of individualized prismatic spectacle lenses on postconcussive symptoms. Retrospective study. Private physical medicine and rehabilitation practice and private optometric practice. A subset of TBI patients who were initially evaluated by a single physiatrist and who received standard treatments and medications yet had persistent postconcussive symptoms. These patients were then assessed by a single optometrist, and those found to have vertical heterophoria were treated with individualized prismatic spectacle lenses. A total of 83 patients were referred for testing; 77 were positive for vertical heterophoria on screening, of which 43 had complete data sets and were included for analysis. All patients were treated with individualized prismatic spectacle lenses to correct for vertical heterophoria. Outcomes were measured by the difference in score before and after intervention of an objective, self-administered vertical heterophoria symptom burden instrument (Vertical Heterophoria Symptom Questionnaire [VHS-Q], presently undergoing validation) and by subjective improvement in symptoms as expressed by the patient at the end of intervention. There was a 71.8% decrease in subjective symptom burden when compared with preintervention baseline. There was a mean 16.7 point absolute reduction in the VHS-Q score on a 75-point scale, which represents a relative reduction in VHS-Q score of 48.1%. Vertical heterophoria was identified in a group of TBI patients with postconcussive symptoms and treatment of the vertical heterophoria with individualized prismatic spectacle lenses resulted in a 71.8% decrease in subjective symptom burden and a relative reduction in VHS-Q score of 48.1%. It appears that vertical heterophoria can be acquired from TBI.

Poster 21: Pituitary Macroadenoma Masquerading as a Binocular Vision Dysfunction

Poster 21: Pituitary Macroadenoma Masquerading as a Binocular Vision Dysfunction

Decision-making in second-eye cataract surgery: can presence of Pulfrich phenomenon help?

To determine whether testing for the Pulfrich phenomenon (PP) can be used as a tool to assess the need for and optimal timing of second-eye cataract surgery. A total of 61 patients with logMAR 0 visual acuity (VA) after cataract surgery in one eye and logMAR 0.2-0.7 VA in the other eye were tested for PP using a computer-generated oscillating target at Baskent University Hospital. Only patients who had no ophthalmologic or systemic problem that could cause PP were included. In all, 15 normal patients with logMAR 0 VA in both eyes served as controls. The main outcome measures were presence and magnitude (measured by neutral density filters) of PP and presence of complaints related to binocular vision. Of the 61 patients, 36 (59%) and none of the controls were PP (+) (P<0.001). A total of 27 (75%) of the PP (+) patients had logMAR 0.7-0.4 VA, and nine (25%) had logMAR 0.3-0.2 VA (P=0.01). In all, 16 patients (all PP (+)) had developed binocular vision-related complaints since cataract surgery. The mean PP magnitude in these cases was significantly greater than the mean for the 20 patients without complaints (1.2+/-0.5 vs0.6+/-0.4 log units, respectively; P<0.001). There was no significant difference between the mean VA in the complaint (+) and complaint (-) subgroups (P=0.213). PP testing may detect binocular visual dysfunction after first-eye cataract surgery; thus, it could help assess the need for second-eye cataract surgery on this basis.

Prevalence of general dysfunctions in binocular vision

A 1-year clinical trial to determine the prevalence of general dysfunctions in binocular vision in a nonpresbyopic population was conducted in 1679 subjects aged 18 to 38 years. A thorough eye examination included binocular vision testing. A high prevalence of binocular vision dysfunctions was found. Of the subjects, 56.2% presented symptoms of binocular dysfunctions, 61.4% with accommodation disorders and 38.6% vergence disorders. Accommodation insufficiency was most prevalent among those with symptoms (11.4%).

Characteristics of convergence insufficiency.

Convergence insufficiency (CI) is a well-known syndrome of binocular visual dysfunction. In a review of 58 papers, considerable variation was noted in the criteria used to define the condition. Symptoms and decreased positive fusional vergences (both at the nearpoint) were the only criteria named in more than one-half of the studies. An extended nearpoint of convergence (NPC) and increased exophoria at near were criteria in about one-third of the papers. Examination of data in the reviewed papers shows that although considerable variability was noted, the distance exodeviation, distance negative vergences, visual acuity, refraction, and stereopsis were about the same as population norms. Positive vergences, negative vergence at near, and NPC were somewhat less than population norms. Vergences relative to Sheard's criterion, the near exophoria, accommodative amplitude, and the AC/A ratio were consistently below those derived from population norms. This considerable variation may largely be a result of different criteria used for diagnosis, subpopulations within the data, and other confounding factors.

Characteristics of Exodeviations

A retrospective study of 179 patients (69 males and 110 females) with binocular visual dysfunction and an exodeviation at distance or near or at both distances has been completed. The mean age of 19.7 years was significantly younger than the population from which they were referred. The patients were classed as convergence insufficiency, equal exodeviation, or divergence excess, based on the relation of the distance and near angles of deviation. Based on these criteria, interaction was found to be present between the diagnostic class and the frequency of the deviation, the symptoms reported, and a variety of clinical parameters such as the angles of deviation at distance and near, the AC/A ratio, positive and negative vergence values, the amplitude of accommodation, and the threshold of stereopsis. A number of statistical relations were noted between the frequency of the deviation vs. the symptoms reported and a variety of the clinical parameters. The implications of these results are discussed.

Characteristics of Exodeviations

This study examined retrospectively the records of 179 patients who had binocular visual dysfunction as a result of an exodeviation (either at distance or near or both). The patients were classified as having convergence insufficiency (N = 110), equal exodeviations (N = 49), or divergence excess (N = 18). The diagnostic groups and the different frequencies of deviation reacted differently to treatment with a standard orthoptic regimen. Nearly all the patients (97%) achieved some improvement in either objective or subjective areas or both. However, fewer were able to satisfy the criteria set for total success. Factors correlated with the success of the treatment were the initial angle of deviation at distance and the initial level of stereopsis. The results and implications of this study are discussed.

Eye care practitioners in blood pressure related health care: Jack E. Terry, Veterans Administration Hospital, Huntington, WV

To identify a form of binocular vision dysfunction (vertical heterophoria) in a traumatic brain injury (TBI) population and to assess the effect of individualized prismatic spectacle lenses on postconcussive symptoms.Retrospective study.Private physical medicine and rehabilitation practice and private optometric practice.A subset of TBI patients who were initially evaluated by a single physiatrist and who received standard treatments and medications yet had persistent postconcussive symptoms. These patients were then assessed by a single optometrist, and those found to have vertical heterophoria were treated with individualized prismatic spectacle lenses. A total of 83 patients were referred for testing; 77 were positive for vertical heterophoria on screening, of which 43 had complete data sets and were included for analysis.All patients were treated with individualized prismatic spectacle lenses to correct for vertical heterophoria.Outcomes were measured by the difference in score before and after intervention of an objective, self-administered vertical heterophoria symptom burden instrument (Vertical Heterophoria Symptom Questionnaire [VHS-Q], presently undergoing validation) and by subjective improvement in symptoms as expressed by the patient at the end of intervention.There was a 71.8% decrease in subjective symptom burden when compared with preintervention baseline. There was a mean 16.7 point absolute reduction in the VHS-Q score on a 75-point scale, which represents a relative reduction in VHS-Q score of 48.1%.Vertical heterophoria was identified in a group of TBI patients with postconcussive symptoms and treatment of the vertical heterophoria with individualized prismatic spectacle lenses resulted in a 71.8% decrease in subjective symptom burden and a relative reduction in VHS-Q score of 48.1%. It appears that vertical heterophoria can be acquired from TBI.