Field Of Gaze Research Articles

The construction of female gaze through the analyses of cinematic instruments in Yeşim Ustaoğlu’s film Clair Obscur (2016)

The female gaze continues to be a frequently explored and discussed concept, and most writers agree that it hasn’t been clearly defined in academic literature yet. This study aims to contribute to the definition of the female gaze by investigating the possibility of existence and construction of female gaze in cinema. For this purpose, the article focuses on examining the female gaze in Clair Obscur (Tereddüt, 2016), directed by Yeşim Ustaoğlu within the past decade. The methodology used for the research is textual film analysis. According to the findings, the film prioritizes the female characters' looks, perspectives, feelings, and thoughts, namely their subjectivities and gazes, through different cinematography, editing and mise-en-scène instruments. The film differentiates from mainstream cinema codes through its thematic narrative. Considering all these features along with other studies in this field, the existence and construction of female gaze in the cinema of women directors can be mentioned.

Human gaze prediction for 3D light field display based on multi-attention fusion network

Existing methods for simulating human visual attention primarily focus on 2D displays and limited research has been conducted on predicting visual attention in three-dimensional (3D) light field content. 3D light field displays provide a heightened sense of stereoscopic realism to viewers. To ensure that the content of the 3D light field display appears more consistent with human visual characteristics, we proposed a novel method for predicting human eye fixation in 3D light field display images. Firstly, we collected real eye movement data and utilized it to create an eye movement dataset based on 3D light field display images. This solves the problem of missing datasets in the field of human gaze based on three-dimensional light field images. Then, we proposed a convolutional neural network model with multiple inputs and outputs, integrating attention modules. This model was trained and used to predict eye fixation within the constructed eye movement dataset. A correlation exists between predicted human gaze of multiple distinct views of same light field image. Finally, we predicted the human gaze area of light field multi-view images based on our model. Experimental results demonstrate that our model accurately predicts human gaze regions across different views of a 3D light field image. The human gaze predicted by the model on each view is basically consistent and relatively accurate. By leveraging proposed method, we can effectively anticipate where viewers will focus their attention on the 3D light field display, which is beneficial for targeted improvement of 3D light field display content.

A Case of Orbital Infarction Syndrome in a Patient with Hemophagocytic Lymphohistiocytosis

Purpose: To report a case of orbital infarction syndrome in a patient with hemophagocytic lymphohistiocytosis (HLH).Case summary: A 70-year-old woman with diabetes mellitus and hypertension was referred to the Department of Ophthalmology for sudden-onset left upper eyelid ptosis after being diagnosed with HLH. After 3 days, the best corrected visual acuity in the right eye was 0.8, while there was no light perception in the left eye. In the left eye, the ocular motility examination showed limitations in all fields of gaze. On fundus examination, optic disc pallor, retinal hemorrhage, and narrowed retinal arteries were observed in the left eye. Fluorescein angiography showed no blood flow in the retinal arteries and veins in the left eye. On neck computed tomography angiography, the left distal internal carotid artery was narrowed. Orbit computed tomography showed exophthalmos and extraocular muscle hypertrophy in the left eye. Orbit magnetic resonance imaging confirmed optic nerve edema, enhancement of the optic nerve sheath, and high signal intensity of the intraocular fat in the left eye. Slit-lamp examination revealed ischemia of the anterior segment and ischemic necrosis of the eyelid in the left eye. The patient was diagnosed with orbital infarction syndrome.Conclusions: Several factors may lead to ischemia of the orbital tissues in patients with HLH, including coagulopathy, an increased incidence of blood clots, and inflammation in the orbit. It is necessary to consider the possibility of orbital infarction syndrome when HLH patients present with visual loss, ocular movement limitations, and anterior segment ischemia.

Парез горизонтального взора – какую тактику ведения выбрать

Purpose. To analyze the success of using prisms in conjugate horizontal gaze paresis compared to other treatment methods. Material and methods. The study involved 30 patients with conjugate horizontal gaze paresis. The average age of patients at the time of treatment was 57.8±6.68 years. The average period of clinical follow-up for strabismus symptoms in patients after the appropriate treatment was 12.6±3.8 months. The patients were divided into two groups: the first group (main group) of 15 patients who underwent prismatic correction in combination with etiopathogenetic treatment and 15 patients (control group) who underwent etiopathogenetic treatment without prismatic correction. Results. The treatment results were evaluated according to three criteria: absence of abnormal head posture (AHP) and diplopia, as well as elimination of esotropia. Based on our data, the AHP angle did not reveal statistically significant difference at the stage before treatment (p=0.999), however, during treatment in the first group (using prismatic correction), it was 4.4 times less than in the second group (p<0.001). Similar data were obtained in relation to esotropia. Results of the statistical analysis showed that during treatment, frequency of binocular single vision exposed a statistically significant increase (p<0.05) in both the first and second groups. Conclusion. Thus, for 15 patients with conjugate horizontal gaze paresis, prismatic correction made it possible to create conditions for shifting the image perceived by a patient to a straight field of gaze, as well as to eliminate the occurrence of induced heterotropia and diplopia in the attempt to look straight and, accordingly, the formation of AHP. The proposed method provided an opportunity to reduce complaints and improve the patients' quality of life. Key words: conjugate horizontal gaze paresis, diplopia, abnormal head posture, Fresnel prisms

E015 A case of ocular myasthenia gravis seen by rheumatology as suspected mononeuritis multiplex in an adult male shortly after Pfizer-BioNTech SARS-CoV-2 vaccination

Abstract Background/Aims Myasthenia gravis (MG) is an antibody-mediated autoimmune disease targeting proteins at the postsynaptic membrane of the neuromuscular junction. MG is thought to occur in genetically susceptible individuals following an environmental trigger. SARS-CoV-2 infection has been associated with new-onset autoimmune disease, new-onset MG, and exacerbations of pre-existing MG, with molecular mimicry between SARS-CoV-2 epitopes and autoantigen-induced autoreactivity thought to be part of the underlying mechanism. We report a case of new-onset ocular MG following first dose Pfizer-BioNTech BNT162b2 SARS-COV2 vaccination which was referred to rheumatology as suspected mononeuritis multiplex. Methods A 53-year-old man of East Asian ethnicity presented to the emergency department (ED) with sudden onset diplopia and left lateral gaze restriction 7 days after receiving his first dose of the Pfizer-BioNTech BNT162b2 SARS-COV2 vaccination. He had longstanding myopia and dry eyes but no other medical history, no regular medications or significant family history. He was a current smoker, with a 50-pack year history. He did not drink alcohol or use any recreational drugs. He was found to have an isolated left VI cranial nerve (CN) palsy with an otherwise normal ocular and physical examination. Blood tests were unremarkable apart from raised cholesterol, and he was discharged with a suspected self-limiting microvascular CN lesion. Three weeks later he presented to ED with worsening diplopia, increasingly restricted eye movements, headache, nausea, vomiting and blurred vision. Ophthalmology assessment noted new right sided CN III and VI palsy, persistent left CN VI palsy, and vertical diplopia in all fields of gaze. Neurological and physical examination were normal. Bloods including an autoimmune screen were unremarkable. SARS-CoV-2 Spike antibodies were positive consistent with SARS-CoV-2 vaccination but not infection. Intracranial and thoracic imaging were unremarkable. He was referred to and seen by both rheumatology and neurology as a case of suspected mononeuritis multiplex. Results A diagnosis of ocular MG was confirmed with positive serum acetylcholine receptor antibodies, and he was started on prednisolone, and pyridostigmine to good effect. Daily forced vital capacity (FVC) showed no respiratory muscle involvement, and nerve conduction studies and electromyography were normal, excluding secondary generalisation. Conclusion A review of the literature found 14 reported cases of new-onset MG all within 4 weeks following SARS-CoV-2 vaccine. Whilst these cases provide interesting insights into the pathogenesis of autoimmune conditions such as MG, they are not epidemiological studies to inform vaccine safety. Ultimately, current evidence suggests that the risks of SARS-COV-2 infection outweigh the risk of vaccine-related adverse events, therefore we suggest clinicians should be aware of potential new-onset autoimmune conditions, but support the safety of SARS-COV2 vaccination. Further, research into possible immunological mechanisms behind this phenomenon, including identifying potential epitopes inducing molecular mimicry, could help establish the likelihood of a causative link. Disclosure A. Storrie: None. R.M. Hum: None. J. Lilleker: None. P. Ho: None.

A Non-Laboratory Gait Dataset of Full Body Kinematics and Egocentric Vision

In this manuscript, we describe a unique dataset of human locomotion captured in a variety of out-of-the-laboratory environments captured using Inertial Measurement Unit (IMU) based wearable motion capture. The data contain full-body kinematics for walking, with and without stops, stair ambulation, obstacle course navigation, dynamic movements intended to test agility, and negotiating common obstacles in public spaces such as chairs. The dataset contains 24.2 total hours of movement data from a college student population with an approximately equal split of males to females. In addition, for one of the activities, we captured the egocentric field of view and gaze of the subjects using an eye tracker. Finally, we provide some examples of applications using the dataset and discuss how it might open possibilities for new studies in human gait analysis.

Surgical repair of large orbital floor and medial wall fractures with destruction of the inferomedial strut: Initial experience with a combined endoscopy navigation technique

The application of navigation and endoscope is an area of intense interest in the surgical repair of orbital fractures. This study explored the advantages of a combined endoscopy navigation technique (ENT) for repairing large orbital floor and medial wall fractures (OFMWFs) with destruction of the inferomedial strut (IMS). Fifty-two consecutive patients with large OFMWFs with the destruction of the IMS underwent ENT-assisted surgical repair from January 2013 to February 2016. Patient demographics, causes of injury, clinical features, imaging data, and follow-up information (diplopia, ocular dysmotility, enophthalmos, infraorbital hypoesthesia, and other conditions) were collected and analyzed. Orbital volumes and implant positions were also evaluated. The median follow-up duration was 21 (range, 16-29) months. At the end of the follow-up visits, orbital reconstruction was demonstrated by orbital computed tomography. Of the 30 patients with diplopia within the 30-degree visual field of gaze, 27 (90%) reached diplopia remission. Of 40 patients, 34 (85%) achieved complete elimination of ocular dysmotility. Of 47 patients with enophthalmos of >2mm, 43 (91%) acquired good symmetry with a mean improvement of 3.00±1.00mm. Of 33 patients, 27 (82%) recovered from infraorbital hypoesthesia. The postoperative orbital volumes of the two sides showed no significant differences (p=0.087, paired t-test). Early surgical repair showed better outcomes of diplopia, ocular motility, and enophthalmos than late repair (p=0.001, p=0.007, and p=0.000, generalized estimated equations). No patient developed surgery-related complications of visual acuity compromise, strabismus, ectropion, entropion, or lacrimal canaliculus injuries. ENT-assisted surgery appears to be safe, precise, and effective for the repair of large OFMWFs with destruction of the IMS.

The Eye in Extended Reality: A Survey on Gaze Interaction and Eye Tracking in Head-worn Extended Reality

With innovations in the field of gaze and eye tracking, a new concentration of research in the area of gaze-tracked systems and user interfaces has formed in the field of Extended Reality (XR). Eye trackers are being used to explore novel forms of spatial human–computer interaction, to understand human attention and behavior, and to test expectations and human responses. In this article, we review gaze interaction and eye tracking research related to XR that has been published since 1985, which includes a total of 215 publications. We outline efforts to apply eye gaze for direct interaction with virtual content and design of attentive interfaces that adapt the presented content based on eye gaze behavior and discuss how eye gaze has been utilized to improve collaboration in XR. We outline trends and novel directions and discuss representative high-impact papers in detail.

Ganglion cell-inner plexiform layer measurements derived from widefield compared to montaged 9-field optical coherence tomography

ABSTRACT Clinical relevance With equivalent inner retinal thickness measurements compared to a more conventional composite optical coherence tomography (OCT) protocol, Widefield optical coherence tomography (WF-OCT) is a clinically viable, time-saving option facilitating detection of ocular pathologies within the central 55° of the retina. Purpose To compare ganglion cell-inner plexiform layer (GCIPL) thicknesses obtained using a single WF-OCT scan and standard composite OCT scans acquired in 9 fields of gaze (9F-OCT). Methods Thirteen healthy participants underwent WF-OCT and 9F-OCT using the Spectralis OCT. The GCIPL was automatically segmented with a manual review for 9F-OCT and was manually segmented for WF-OCT. After registration, differences in GCIPL thicknesses were compared using 95% confidence intervals computed from one-sample t-tests and Bland-Altman analyses. Location-specific differences in B-scan tilt were analysed using Spearman correlations and linear regression models. To determine whether B-scan tilt influences GCIPL measurements, regression models of tilt versus differences between perpendicular and axial GCIPL thickness were applied. Results While scattered locations demonstrated significant GCIPL thickness differences between WF-OCT and 9F-OCT, most differences did not exceed the axial pixel resolution of the instrument of 3.87 µm. Bland-Altman analyses indicated no notable bias using WF-OCT. Moderate correlations indicating significant location-specific differences in B-scan tilt were observed for temporal, central and inferior B-scans (r = −0.62 to 0.72), with linear regression models predicting a maximum difference in the tilt of 4.65°. The quadratic regression model indicated that at tilts greater than 27.3°, perpendicular GCIPL measurements become increasingly thin relative to axial measurements. Conclusions GCIPL thicknesses and B-scan tilts from WF-OCT are comparable to 9F-OCT, indicating that WF-OCT can be applied clinically to obtain valid inner retinal OCT measurements over 55° of the central retina with relative ease. However, for peripheral locations, B-scan tilt may need to be considered when measuring GCIPL thicknesses.

Strabismus and oculomotor disorders induced by injection anesthesia for cataract surgery

To analyze diagnostic and treatment outcomes in patients with strabismus and oculomotor disorders induced by injection anesthesia for cataract surgery. The study included 11 patients (7 women and 4 men) aged 61 to 85 years (the mean age of 66±7.1 years) who complained of diplopia in the early post-op period after cataract phacoemulsification and elastic IOL implantation under retrobulbar anesthesia. Prior to further surgical treatment, all of the patients underwent functional multispiral computer tomography of the orbits. Prismatic spectacle correction was also used independently or in addition to surgical treatment. Eight out of eleven patients underwent one- or two-step surgical treatment (3 and 5 cases, respectively). In 2 patients, hypotropia did not exceed 10 prism diopters, and thus, diplopia could be compensated with prismatic spectacle correction alone. In 5 cases, binocular vision was achieved throughout the whole field of gaze. In 3 cases, surgical treatment enabled elimination of heterotropia in the primary gaze and compensation of diplopia within a radius of 40º from the center of gaze and within the entire horizontal range of eye-movement in the downward gaze. The limitation of ocular mobility decreased from 2.36 to 0.55 points leading to an associated decrease in the area of binocular diplopia - from 98% to 29%. In one case, spectacle occlusion was used. The inferior rectus restriction is the morphological substrate of anatomical and functional changes induced by retrobulbar anesthesia. As treatment options for restrictive vertical strabismus and binocular diplopia, both surgical (extraocular muscle surgery) and optical (prismatic correction, occlusion) methods should be considered.

Improvement in Both Primary and Eccentric Ocular Alignment After Thyroid Eye Disease-Strabismus Surgery With Tenon's Recession.

To evaluate the improvement in primary and eccentric gaze ocular alignment in thyroid eye disease (TED) patients undergoing horizontal strabismus surgery with Tenon's recession. This is an Institutional Review Board-approved retrospective analysis of TED patients undergoing horizontal strabismus surgery for esotropia. The study included all patients from 2007 to 2016 operated on by a single surgeon at Columbia University Medical Center. Surgical success was defined as the ability to fuse at both near and distance either without prismatic correction or with less than 10 prism diopters (PD) of correction. Measurements of ocular alignment were also made in eccentric fields of gaze. This study was Health Insurance Portability and Accountability Act compliant with protection of individually identifiable information. Thirty-eight patients with TED and restrictive horizontal strabismus underwent unilateral or bilateral medial rectus recession to relieve diplopia. All patients underwent Tenon's recession with dissection of Tenon's from the overlying conjunctiva permitting it to retract into the orbit. Overall the success rate was 87% with a reoperation rate of 7.9%. The improvement in horizontal deviation in both primary and eccentric gaze was statistically significant (p < 0.001). The change in vertical deviation in the 5 cardinal positions of gaze was not statistically significant. The postoperative change in vertical deviation was not proportional to the preoperative horizontal deviation or the amount of horizontal recession. Due to the preoperative incomitance of ocular deviations in TED patients, persistent postoperative eccentric misalignment is expected. The addition of Tenon's recession to TED-horizontal strabismus surgery led to statistically significant improvement in ocular alignment in both primary and eccentric gaze. This is the first study of TED-strabismus surgery to analyze the postoperative results in positions outside of primary and reading gaze. The authors postulate that the release of scar tissue by the addition of Tenon's recession contributes to these improvements.

Correction of a Posttraumatic Orbital Deformity Using Three-Dimensional Modeling, Virtual Surgical Planning with Computer-Assisted Design, and Three-Dimensional Printing of Custom Implants.

We describe a case of complex, posttraumatic skull and orbital deformities that were evaluated and treated with advanced computer technology, including virtual surgical planning, three-dimensional (3D) modeling, and printed patient custom implants (PCI) fabricated by 3D printing. A 50-year-old man presented to our craniofacial referral center 1 year after failed reduction of complex left orbital, zygomatic, and frontal bone fractures due to a motorcycle collision. The patient's chief complaint was debilitating diplopia in all fields of gaze. On examination, he had left enophthalmos, left canthal displacement, lower eyelid ectropion, vertical orbital dystopia, and a laterally and inferiorly displaced, comminuted zygoma with orbital rim and frontal bone defects. The normal orbit was mirrored to precisely guide repositioning of the globe, orbital reconstruction, and cranioplasty. Preinjury appearance with normal globe position was restored with complete resolution of diplopia. Modern 3D technology allows the surgeon to better analyze complex orbital deformities and precisely plan surgical correction with the option of printing a PCI. These techniques were successfully applied to resolve a case of debilitating diplopia and aesthetic deficits after facial trauma. Further application of advanced 3D computer technology can potentially improve the results of severe orbital and craniofacial trauma reconstruction.

Resolution of hypertropia with correction of consecutive horizontal deviation

BackgroundTo study the resolution of hypertropia in patients who undergo horizontal deviation surgery for consecutive esotropia or consecutive exotropia. MethodsWe retrospectively reviewed the records of 23 patients with consecutive esotropia or exotropia who had concomitant vertical tropia. All patients had had surgery for horizontal deviation that required further surgery to correct consecutive horizontal strabismus and had a minimum of six months of postoperative follow-up. All patients were noted to have vertical deviation greater than 5 prism diopters (PD) in primary position on preoperative examination. Patients underwent corrective surgery for horizontal strabismus without surgical manipulation of the vertical extraocular muscles. The exclusion criteria were coexisting oblique muscle dysfunction, manifest or latent dissociated vertical deviation, and extraocular muscle palsy. ResultsThe mean preoperative vertical deviations were 7.6 ± 2.3 PD for distance and 7.3 ± 2.3 PD for near. All patients had resolution of vertical deviation in all fields of gaze despite surgical correction only being made to horizontal extraocular muscles. No patients had measureable vertical tropia during six months of follow-up. ConclusionWe propose that measureable hypertropia unrelated to oblique muscle dysfunction, dissociated vertical deviation, or paretic/mechanical muscle that coincides with consecutive horizontal deviation can be resolved with horizontal muscle surgery alone. Therefore, it may not be necessary to perform vertical surgery to correct coincident vertical deviation in patients with consecutive horizontal deviation. More research is needed in the form of prospective clinical trials to determine whether vertical surgery has any utility for these patients.

Congenital cranial dysinnervation disorders.

The European Neuromuscular Centre (ENMC) derived the term Congenital Cranial Dysinnervation Disorders in 2002 at an international workshop for a group of congenital neuromuscular diseases. CCDDs are congenital, non-progressive ophthalmoplegia with restriction of globe movement in one or more fields of gaze. This group of sporadic and familial strabismus syndromes was initially referred to as the 'congenital fibrosis syndromes' because it was assumed that the primary pathologic process starts in the muscles of eye motility. Over the last few decades, evidence has accumulated to support that the primary pathologic process of these disorders is neuropathic rather than myopathic. This is believed that for normal development of extra ocular muscles and for preservation of muscle fiber anatomy, normal intra-uterine development of the innervation to these muscles is essential. Congenital dysinnervation to these EOMs can lead to abnormal muscle structure depending upon the stage and the extent of such innervational defects. Over last few years new genes responsible for CCDD have been identified, permitting a better understanding of associated phenotypes, which can further lead to better classification of these disorders. Introduction of high-resolution MRI has led to detailed study of cranial nerves courses and muscles supplied by them. Thus, due to better understanding of pathophysiology and genetics of CCDDs, various treatment modalities can be developed to ensure good ocular alignment and better quality of life for patients suffering from the same.

Evaluation and Management of Acute Acquired Comitant Esotropia in Children

ABSTRACTAcute acquired comitant esotropia (AACE) is characterized by a sudden-onset eye misalignment with an equal angle of deviation in all fields of gaze. This form of esotropia is distinct from common forms of childhood esotropia, such as infantile esotropia and accommodative esotropia, in the rapid tempo and typically later timing of onset; further, AACE is distinct from restrictive or paretic strabismus, which usually results in an incomitant angle of deviation that varies with the direction of gaze. The underlying etiologies for AACE are broad but, in some cases, it may be associated with significant neurologic disease. Therefore, the purpose of this article is to examine and summarize the current literature on AACE to provide a framework for the evaluation and management of this form of acquired strabismus.

Accessory Extraocular Muscle as a Cause of Restrictive Strabismus

ABSTRACTRestrictive strabismus resulting from the presence of an accessory extraocular muscle has rarely been reported in the literature. Most articles written on this topic are isolated case reports. The purpose of this paper is to describe a series of 7 similar patients presenting with atypical restrictive strabismus associated with enophthalmos in the affected eye, which was found to be caused by an accessory extraocular muscle attached to the posterior globe near the optic nerve. The medical records of 7 patients who shared these clinical characteristics were retrospectively analyzed. Orbital imaging was obtained in the 7 cases, which were compared. Three of the patients were females and four were males. The left eye was affected in all 4 males and the right eye was affected in the 3 females. The 7 patients presented with the following clinical characteristics: enophthalmos, restriction to eye movements in most fields of gaze, and presence of an anomalous orbital structure that was interpreted on magnetic resonance imaging (MRI) to be an accessory extraocular muscle inserting onto the posterior surface of the globe in the affected eye. The fellow eye was normal in all cases. Five of the 7 patients underwent surgical correction with partial improvement in only one patient. The presence of an accessory extraocular muscle should be included in the differential diagnosis of patients with atypical restrictive strabismus. Orbital computed tomography or MRI are essential for correct diagnosis in these cases.

Signet ring adenocarcinoma of the colon presenting as an orbital metastasis

A 67-year-old woman was referred after MRI imaging revealed an infiltrative, diffusely enhancing left intraconal lesion. Ophthalmic examination revealed a left proptosis, resistance to globe retropulsion, and restriction of extraocular motility in all fields of gaze. The result of a biopsy via an orbitotomy was consistent with signet ring adenocarcinoma. PET scanning was significant for lytic vertebral and rib lesions and activity within the cecum. Colonoscopy confirmed the diagnosis of stage 4 colonic adenocarcinoma. Although colon carcinoma presenting as an extraconal orbital metastasis has been reported, this is the first reported case of signet ring adenocarcinoma of the colon presenting as an intraconal orbital metastasis without eyelid involvement. Orbital metastatic disease from known primary malignancies is uncommon and in particular from carcinomas arising from the gastrointestinal tract. When metastatic orbital disease is found, studies have reported that as high as 42 % of these patients have an undiagnosed primary malignancy. This allows orbital surgery to play a role detecting as yet undiagnosed carcinomas.

Orthoptic Sequelae Following Conservative Management of Pure Blowout Orbital Fractures: Anecdotal or Clinically Relevant?

The aim of this study was to prospectively assess the prevalence of orthoptic anomalies following conservative management of pure blowout orbital fractures and to evaluate their clinical relevance. Clinical and radiologic data of patients with unilateral conservatively managed pure blowout orbital fractures with a minimum follow-up of 6 months were reviewed. Eligible patients were contacted and invited to undergo an extended ophthalmologic examination as follows: distance and near visual acuities, Hertel exophthalmometry, corneal light reflex (Hirschberg test), ductions and versions in the 6 cardinal fields of gaze, eye deviation with prisms and alternate cover test in all of the 9-gaze directions with Maddox rod, degrees of incyclo/excyclotorsion with right and left eye fixation, horizontal and vertical deviation with Hess-Weiss coordimetry, degree of horizontal/vertical and incyclo/excyclotorsion deviation with Harms wall deviometry, and vertical deviation with Bielschowsky head-tilt test. Of the 69 patients contacted, 49 declined to participate given that they were asymptomatic. Twenty patients agreed to undergo the examination. One patient complained of minimal double vision limited to the extreme downgaze. Four patients had asymptomatic ocular motility disturbances limited to the extreme gaze. Seven patients had asymptomatic horizontal heterophoria. These disturbances did not interfere with daily or professional activities in any of the patients. The current study demonstrated that conservative management of pure orbital blowout fractures can result in orthoptic anomalies. These sequelae were restricted to a very limited portion of the binocular field of the vision and were not found to be clinically relevant.

Choroidal Thickness and Peripheral Myopic Defocus during Orthokeratology.

To investigate whether significant thickening occurs in the human choroid in response to chronic peripheral myopic defocus during overnight orthokeratology. Subjects were nine children 11 to 15 years old (mean [±SD] age, 13.61 [±1.25] years). Measurements were taken at baseline and after 1, 3, 6, and 9 months of successful orthokeratology. Choroidal thickness in central, superior, temporal, and nasal gazes were measured using the Zeiss Cirrus HD-OCT. The Lenstar LS 900 biometer provided a secondary measure of subfoveal choroidal thickness. Peripheral ocular length was measured in the same four fields of gaze with the Zeiss IOLMaster. Corneal and optical changes from orthokeratology were monitored throughout the study by corneal topography (Humphrey ATLAS), aberrometry (Complete Ophthalmic Analysis System), and central and peripheral autorefraction (Grand Seiko) after tropicamide 1% cycloplegia. All subjects had acceptable acuity and physiologic response to overnight wear. After 1 month, central refractive error (mean ± SD) became significantly less myopic (-2.25 ± 0.95 diopters [D] vs. -0.24 ± 1.03 D), keratometric values flattened by 1.6 D, the shape factor (Q) became more oblate (-0.28 ± 0.05 vs. +0.34 ± 0.41), and spherical aberration became more positive (+0.14 ± 0.08 μm vs. +0.46 ± 0.15 μm; all p = 0.008). Peripheral refractive error remained -1.0 to -3.5 D myopic in all fields of gaze throughout the study. There were no consistent, significant changes in choroidal thickness or ocular length at any retinal location during the study (all p > 0.051). Lenstar measurement of choroidal thickness was unsuccessful because of the absence of choroidal peaks associated with thicker choroids (rs = -0.66, p < 0.0001). The choroid did not show long-term thickening during orthokeratology despite the presence of substantial amounts of peripheral myopic defocus. Apparent inhibition of ocular growth was not attributed to an optical artifact of choroidal thickening, although smaller amounts of thickening or greater biological activity independent of thickening cannot be ruled out.

Double vision is a major manifestation in moderate to severe graves' orbitopathy, but it correlates negatively with inflammatory signs and proptosis.

Double vision (diplopia) is a major determinant of work disability in patients with Graves' orbitopathy (GO), but is not part of the classification NOSPECS classification of GO. The objectives of the study were to quantitate diplopia in patients with moderate to severe GO and to study associations with other disease and patient variables. This was a single-center prospective study of consecutive patients at the time of referral. The study was conducted at the University Hospital Thyroid-Eye Clinic. Patients included 216 patients diagnosed with moderate to severe and active GO. Binocular diplopia in field of gaze and monocular fields of motility were prospectively recorded on diagrams and measured by planimetry. Fields of diplopia were correlated to other disease and patient variables. Six patients had only one functional eye and were excluded. Among the remaining 210 patients, diplopia was present in 75.2%. In patients with diplopia, this ranged from 5% to 100% (observed in 11.4% of patients) of binocular field of gaze. The field of diplopia correlated positively with eye motility restriction and with asymmetrical affection of orbits but negatively with signs of inflammation and proptosis that often are the main outcome measures in clinical studies of GO therapy. Diplopia is very common in moderate to severe GO and a major cause for active therapy. In moderate to severe GO, the field of diplopia correlates negatively with some other indicators of disease activity, which may be explained by the physiological properties of binocular fusion.