Ocular Rehabilitation Research Articles

Surgical results of orbital decompression: Comparing the removal of the inferomedial and superolateral orbital walls

ObjectiveOrbital decompression aims to control ocular proptosis, the most commonly associated sign in Graves’ disease, and enable ocular rehabilitation. While various surgical approaches have been studied separately, no studies have compared them. This study compared the functional results of two surgical approaches for the treatment of ocular proptosis secondary to Graves’ disease, namely orbital decompression achieved by inferomedial versus superolateral wall removal. MethodsThis study included 39 patients who underwent orbital decompression due to Graves’ disease. Twenty-four decompressions were performed by removing the inferomedial orbital walls using an endoscopic endonasal approach. Fifteen decompressions were completed by removing the superolateral orbital walls using a frontolateral approach. T-tests were used to compare means, whereas Fisher’s exact test and the chi-square test were used to compare proportions. ResultsPatients who underwent inferomedial orbital decompression presented a higher risk of new-onset strabismus/diplopia (16.7%) than those who underwent decompression via the frontolateral approach (0%). Although no cases of preoperative strabismus worsened after superolateral decompression, all cases of preoperative strabismus worsened after inferomedial decompression. ConclusionsBoth approaches achieve a reasonable decompression limit. Superolateral orbital decompression tended to offer better outcomes for diplopia and strabismus than inferomedial decompression. Due to the high risk of worsening strabismus and diplopia in patients presenting with these symptoms preoperatively, they should be treated with the transcranial approach whenever possible.

Immersive virtual reality in anxiety psychotherapy and ocular rehabilitation. A transdisciplinary approach

Immersive virtual reality (iVR) can be used not only as a guideline intervention in certain anxiety disorders but also as a brain stimulating interface, triggering neuroplasticity mechanisms and facilitating the rehabilitation of sensorimotor disorders. iVR’s potential was recently harnessed in treating or diagnosing amblyopia or in remote measuring of patient-related outcomes. We present the case of Mr. L.A., a 69-year-old man, a former academic, political and civic movement figure, currently performing successful writing. His right eye had posterior chamber pseudophakia and was treated for glaucoma, and his left eye had an evolving cataract. The right eye’s optical coherence tomography (OCT) revealed the impact of glaucoma and also the loss of nerve fibers and cells impairing signal conduction, while the combined results explained the high level of impairment of binocular vision. The impaired vision caused a very high level of concurring anxiety derived from the inability to perform daily tasks, directing him toward psychotherapy. The personalized iVR approach was preceded by cybersickness evaluation using VRQTest (Vectorush Studio). For relaxation, we used an artificial intelligence massage chair with body scanning mimicking Jacobson progressive relaxation and a specific pranayama yoga already familiar to the patient. Every session used a different iVR software for further distractibility and immersivity. The best-tolerated visual rehabilitation software was Vision Therapy, developed by Cerverum INC. The hardware used consisted of an Oculus Rift virtual reality headset and a Dell Alienware 17 R4 laptop. The patient was able to conduct daily tasks after the nineth session. The tolerance was associated with a massive improvement in eyesight of the left eye, from a visual acuity of 0.2 to 0.6 measured after the 20th psychotherapeutic session. To our knowledge, this is the first reported case of using this type of consecutive dual approach to anxiety and ocular rehabilitation.

Empirical Impression - An Efficient Alternative for Ocular Rehabilitation: A Case Report

Ocular prostheses have been used since a very long time ago. Success of ocular prosthesis depends upon its adaptation with anopthalmic socket which is best determined by ocular impressions. Various impression techniques and materials have been described in the literature. This case report highlights the use of empirical impression technique for fabrication of ocular prosthesis of a 65-year old male who had undergone enucleation surgery of left eye. The empirical impression technique involves: first a close visual examination of patient’s socket, then a wax shell is designed and modified empirically to a shape that fits the socket; second, an impression is made of the socket, using this wax shell as an impression tray. Reduced treatment time and increased simplicity are the primary advantages of this method. This technique of impression making is not feasible in cases with highly irregular sockets.

Home Low Vision Ocular Rehabilitation Telehealth Expansion Due to COVID-19 Pandemic.

Background: In March 2020, the pandemic added a major barrier resulting in the cancelation of all low vision ocular rehabilitation services. To prevent delay of beginning low vision ocular rehabilitation services, all low vision care was switched to telerehabilitation to home. Methods: Case managers began to cancel all in-person services and offer Veterans Affairs (VA) video connect services to their home. Patients with video access scheduled a home VA video connect telerehabilitation evaluation and therapy assessment. Patients who did not have video access waited to schedule a future in-person low vision appointment (postpandemic). Results: Of the in-person canceled appointments, 54% who scheduled the new home telerehabilitation evaluation were delayed on average 25 calendar days. Patients who waited for in-person low vision care were delayed on average 98, 138, or 153 calendar days. Of the 56 new patients referred for low vision optometry services during this 4-month period (COVID-19), 91% scheduled home low vision ocular telerehabilitation evaluations without delay; 5% waited until in-person clinics were open; and 4% waited until rural VA's and community-based outpatient centers were open. Discussion: Veterans with low vision who live in rural communities have limited access to services unless they are able to travel several miles to a specialty low vision clinic. Low vision ocular rehabilitation telehealth services have been successfully provided at the VA Western New York Healthcare System (Buffalo, NY) low vision clinic. Conclusions: Home low vision ocular rehabilitation telehealth increases access as early as possible once diagnosed with ocular pathology resulting in low vision.

Rehabilitation of an adolescent patient’s anophthalmic cavity with customized ocular prosthesis: a clinical report

The absence of an eyeball results in physical, psychosocial and functional alterations on an individual. Therefore, rehabilitation procedures are essential to repair the patient’s self-esteem, self-confidence and physiological features. The aim of this study is to describe a case of ocular prosthetic rehabilitation in a pediatric patient. A female teenager, 17 years old, was referred to the maxillofacial prosthetic clinic to replace her former prosthesis fabricated two years ago. The new ocular prosthesis was confectioned with termopolymerizable acrylic resin and hand painted with acrylic paint on a colorless acrylic ocular bottom. The prosthesis was installed and the instructions were explained. In teenage patients the prothesis must be elaborated as soon as possible with periodic replacements in accordance with the growth period. The awareness of legal guardians and patients is essential to the success of the treatment in pediatric patients. In the present case, the patient was satisfied with the aesthetic and functional outcome.

Fabrication of ocular prosthesis step by step procedure : Case report

An ocular defect may follow removal of a part or an entire orbit that results in visual impairment as well as esthecially and psychologically handicapped. Loosing eye is trauma not just to the patient but also for the family members. Restoring an ocular defect bring backs esthetics but also the confidence that has been lost. Rehabilitation is also very important as this also preserves the contour of remaining structure. Different materials can be used for ocular defects rehabilitation like silicone or acrylic. This is a case report of a patient with a ‘pthisicial eye’ and mainly focussed on the fabrication of an ocular prosthesis. Keywords: Enucleation, Ocular, Prosthesis, Scleral Shell.

Ocular Sequelae of Stevens-Johnson Syndrome: A Comprehensive Approach.

The chronic sequelae of Stevens-Johnson syndrome cause severe ocular morbidity. Among the various manifestations, including dry eye, cicatrization causing forniceal shortening, adnexal disorders, lid margin keratinization, and limbal stem cell deficiency, keratinization of the lid margin leads to progressive ocular surface damage through constant blink-induced microtrauma. This damage induces corneal punctate keratopathy and neovascularization and can produce epithelial defects leading to corneal infection or perforation. Management strategies for chronic ocular sequelae are broadly categorized into ocular surface stabilization procedures, tectonic procedures, and visual rehabilitation procedures. Interventions in the acute stage of the disease include amniotic membrane grafting. Timely intervention helps to prevent deterioration of the ocular surface in these eyes.

A Simplified Approach for Ocular Rehabilitation - A Case Report

Loss of an eye or any body part has an intimidating and crippling effect on the psychosocial well-being of the patient. Although the artificial prosthesis cannot restore the function, it can highly improve the patient’s esthetics and help them regain their psychological confidence. Literature has advocated various rehabilitation modalities including empirical use of stock shells, modifying stock eyes, custom-made ocular prostheses, ocular implants, etc. A custom-made ocular prosthesis, among all the techniques, shows improved adaptation to tissue bed, distributes uniform pressure, provides a more esthetic and precise result, and is relatively cost-effective. This case report explores a relatively comprehensive method of custom ocular prosthesis fabrication for an ocular defect with a satisfactory outcome.

A CUSTOM-MADE OCULAR PROSTHESIS FOR A PATIENT AFFECTED BY HERPES ZOSTER: A CASE REPORT

The ocular prosthesis functions to repair a loss or deformity of the ocular globe. Prosthetic rehabilitations destined for anophthalmic cavities that suffered cicatricial retraction represent a challenge during fabrication since they often need to be reduced due to atrophy of the cavity and simultaneously need to have a good aesthetic appearance regarding contour and artificial iris. This report describes an unusual ocular prosthetic rehabilitation of a 77-year-old patient with an atrophic anophthalmic cavity due to herpes zoster–induced loss. The steps in the creation of the ocular prosthesis involved cavity impression, artificial iris painting, wax adaptation, and laboratory processing and installation. The treatment focus included: comfort and adaptation during use, satisfactory retention, good aesthetic appearance, and achievement of total eye closure while wearing the ocular prosthesis. There was reestablishment of facial harmony and, consequently, maintenance of the functional and anatomic integrity of the cavity after a follow-up period of 6 months. Support: FAPEMIG.

VESTIBULAR OCULAR THERAPY TO OPTIMIZE THE BRAIN OF A YOUNG MAN WITH ASPERGER’S

Event Abstract Back to Event VESTIBULAR OCULAR THERAPY TO OPTIMIZE THE BRAIN OF A YOUNG MAN WITH ASPERGER’S Benjamin R. Behrendt1, 2* 1 NeuroWorks Healthcare LLC, United States 2 Carrick Institute, United States BACKGROUND: A 29-year-old male presented with Asperger’s, increased anxiety, difficulty with coordination, tremors and uncontrolled movements, following directions, comprehension, finishing tasks, mental fatigue and fogginess, sound and touch sensitivity. When in a visually busy environment he experiences blurring while “zoning out”. METHODS: An extensive neurological examination and treatment protocol was performed. Significant findings included: camptocormic posture; an accentuated 10-14 Hz tremor that was evident with hand writing and with rest; tachycardia and acceleration of HR from supine to standing. Also occurring was a loss in the ability to pursuit at frequencies approaching .2 and .4 Hz; absent optokinetic (OPK) reflexive eye movements, along with significant decrease in cognitive following OPK eye movements horizontally and vertically while staring into space and significant ptosis; decrease in gain during head impulse bilaterally going from lateral to medial, however not when going medial to lateral. Using the Unified Parkinson’s Disease Rating Scale (UPDRS) he had a grade 1 with facial expression, Luria hand sequencing and foot tap, and a grade 0 finger tap, and there was a positive glabellar sign. Noted was bilateral, dysmetric cerebellar findings with finger-to-nose; alternating hand movements; and heel/shin slide seated and supine; and past pointing. Positive extinction at the shoulder/cheek, loss of graphesthesia with recognizing letters and numbers in the hands and feet was discovered. Patellar reflexes (MSR) were 3+. He had increased instability with Romberg’s, tandem and perturbed stance; an increase in toe off/springing of gait; decreased right arm swing; increased hesitations with stiffening of gait during dual tasking. Therapy targeted the right posterior canal and left anterior canal input centrally utilizing a procedure which combined times-zero viewing into posterior canal plane, pursuing leftward into times-one viewing into the left anterior canal plane; and left anterior canal repositioning to integrate central vestibular with cervical ocular structures. A prescribed set of exercises for home included somatosensory mapping; gait training with large accentuated arm movements; cross crawl multiplanar joint movements; right unilateral multiplanar joint patterning; and orthogonal ocular movements. A return visit consisted of anterior canal reintegration, VOR head movements with head thrust to the right, cerebellar patterning, orthogonal eye movements, as well as, home therapies. RESULTS: Following the initial treatment he had reduced tremor; WNL Glabellar reflex; reduced muscle tone globally; reduced tremor in the hands; reduced light sensitivity; improved OPKs horizontally and vertically; and maintained loss of graphesthesia. Home program improved hand-writing, and reduced tremor. After second treatment he regained graphesthesia and somatosensory localization; no longer felt internal sense of jitters; and was less anxious and more relaxed. CONCLUSION: Connected functional neurological exam and treatment utilizing the vestibular system and somatosensory integration can significantly change the timing of cerebellum and brain output. Further investigation is warranted for the integration of vestibular ocular therapy for brain synchronization. Keywords: Aspergers, cognitive ehnancement, Vestibular Rehabilitation, Neurorehabilitation, Vestibular ocular rehabilitation, Cognition Conference: International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019. Presentation Type: Poster Presentation Topic: Clinical Neuroscience Citation: Behrendt BR (2019). VESTIBULAR OCULAR THERAPY TO OPTIMIZE THE BRAIN OF A YOUNG MAN WITH ASPERGER’S. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience. doi: 10.3389/conf.fneur.2019.62.00053 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Apr 2019; Published Online: 27 Sep 2019. * Correspondence: Dr. Benjamin R Behrendt, NeuroWorks Healthcare LLC, Marietta, United States, drben@neuroworkshealthcare.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Benjamin R Behrendt Google Benjamin R Behrendt Google Scholar Benjamin R Behrendt PubMed Benjamin R Behrendt Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. 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Ocular Prosthesis Rehabilitation after Treatment of Choroid Melanoma

Ocular Prosthesis Rehabilitation after Treatment of Choroid Melanoma

Virtual Interactive Environment for Low-Cost Treatment of Mechanical Strabismus and Amblyopia

This study presents a technique that uses an interactive virtual environment for the rehabilitation treatment of patients with mechanical strabismus and/or amblyopia who have lost eye movement. The relevant part of this treatment is the act of forcing the two eyes to cooperate with each other by increasing the level of adaptation of the brain and allowing the weak eye to see again. Accordingly, the game enables both eyes to work together, providing the patient with better visual comfort and life quality. In addition, the virtual environment is attractive and has the ability to overcome specific challenges with real-time feedback, coinciding with ideal approaches for use in ocular rehabilitation. The entire game was developed with free software and the 3D environment, which is made from low-cost virtual reality glasses, as well as Google Cardboard which uses a smartphone for the display of the game. The method presented was tested in 41 male and female patients, aged 8 to 39 years, and resulted in the success of 40 patients. The method proved to be feasible and accessible as a tool for the treatment of amblyopia and strabismus. The project was registered in the Brazil platform and approved by the ethics committee of the State University of Piaui—UESPI, with the CAAE identification code: 37802114.8.0000.5209.

A novel technique of custom ocular prosthesis fabrication

The literature provides several techniques for fabricating ocular prostheses, ranging from stock to custom-made prostheses. A cosmetically acceptable ocular prosthesis is that which reproduces the colour, form and orientation of the iris and allows the patient to return to a ifestyle to which they were previously accustomed. A sequence of steps for construction of custom-made ocular prostheses is outlined in this case report with emphasis on accurate positioning of iris using a transparent graph template. Ocular rehabilitation restores the compromised aesthetics, maintains the normal physiology of the ocular area, and increases the social life and self-esteem of the patient.

Different Intraorbital Implant Situations and Ocular Prosthetic Rehabilitation.

Enucleation is the removal of the entire globe of the eye and a portion of the optic nerve, while evisceration involves the removal of the contents of the globe leaving the sclera, extraocular muscles, and optic nerve. Following enucleation or evisceration, intraorbital implants are routinely placed to enhance the prosthetic outcome in addition to restoring the lost orbital volume. Current practice employs intraorbital implants made of nonporous silicone, hydroxyapatite, or porous polyethylene. Intraorbital implant selection and placement, being a highly demanding procedure in terms of knowledge, skill, and expertise, may be associated with a multiplicity of technical and surgical errors. Complications are usually minimal with these implants, but they do occur. The literature reveals many articles related to intraorbital implants, their benefits, and complications; however, the literature regarding the effect of various intraorbital implant situations on the subsequent prosthetic rehabilitation is markedly scarce. Moreover, the need for interdisciplinary surgical and prosthetic interventions required for successful rehabilitation in cases of compromised implant situations has been underemphasized. Hence, this review aimed to evaluate the effect of different intraorbital implant situations on ocular rehabilitation and the required interdisciplinary surgical and prosthetic treatment approach for rehabilitation of enucleated/eviscerated sockets with compromised implant situations, to provide a critical appraisal, and to present a simplified management strategy.

A novel simplified functional impression making for prosthetic ocular rehabilitation

Successful prosthetic rehabilitation of an ocular defect can be achieved by recording the remaining orbital anatomic structure using a functional impression technique. This clinical report discusses the ocular impression making procedure in a subject with a history of failed ocular implant in eviscerated eye. The problem encountered while making a static ocular impression is a nonfunctional recording of associated musculature, making ocular prosthesis unstable. This case report presents an accurate impression making of the anophthalmic socket using a functional impression technique.

Ocular prosthetic obturator: an innovative medical device

The following article describes the methods, materials and techniques used in the long-term management of an anophthalmic patient. Following aggressive surgery to remove a squamous cell carcinoma, the patient had...

Prosthetic guidelines for ocular rehabilitation in patients with phthisis bulbi: A treatment-based classification system

Prosthetic rehabilitation of phthisis bulbi defects is the only treatment option for cosmetic rehabilitation of patients with such defects. Currently, there is no treatment-based classification for prosthetic rehabilitation of patients with phthisis bulbi. Phthisical ocular defects and/or prosthetic rehabilitation were evaluated in an attempt to establish prosthetic guidelines that could be organized into a classification system. Fifty patients who received rehabilitation for phthisis bulbi were reviewed. Phthisis bulbi defects were divided into 4 classes. All the patients had rehabilitation, depending upon the class to which they were assigned. The aim of this treatment-oriented classification system was to organize and define the complex nature of the restorative decision-making process for patients with phthisis bulbi.

Interdisciplinary approach: A boon for ocular rehabilitation.

Interdisciplinary approach: A boon for ocular rehabilitation.

Post Traumatic Ocular Rehabilitation with Eye Prosthesis Case Report

Ocular defects that may be caused due to any maxillofacial traumatic injuries may alter not only facial appearance, but also result in psychological trauma to a sufferer. Although the basic steps of custom ocular prosthesis may be same that may be used by different maxillofacial prosthodontics, or text, but ultimate goal of aesthetics result after fabrication depends largely upon case selection, skill of technique and material used. This article describe a technique by which the state of the art custom ocular prosthesis has been fabricated in a case of traumatic injuries to eye by making accurate functional impression with fine details of the eye socket and following all the step of fabrication meticulously. Key Word- Rehabilitation, Eye Defect., Ophthalmic Injury, Functional impression

A multidisciplinary approach for ocular rehabilitation following surgical treatment of retinoblastoma: One year follow-up

Retinoblastoma is a highly malignant neoplasm. Most of the cases are usually advanced at the time of detection, requiring enucleation to salvage the child's life. Just treating the patient for cancer is not enough; the cosmetic rehabilitation of these patients is equally important and it should always be an integral part of their treatment, to help them re-integrate in the aesthetic conscious society. Rehabilitating such patients require a multidisciplinary approach involving the combined and timely efforts of an ophthalmologist, paediatric oncologist and a skilled maxillofacial prosthodontist. This paper presents a case of 3½-year-old girl who had enucleation of her right eye due to retinoblastoma along with chemotherapy and radiotherapy at the age of 3 years. The patient was recalled regularly for follow-up at 3 month intervals for ophthalmic examinations and she was rehabilitated cosmetically with customised ocular prosthesis during the various stages of her developmental growth.