Strabismus Research Articles

Surgical Strategies for Divergence Excess: A Comparison of True Divergence Excess and Pseudo-Divergence Excess Cases

Introduction : True divergence excess (True DE) intermitent exotropia (IXT) is characterized by a greater deviation at distance than near ?10 prism diopters, while pseudo-divergence excess (Pseudo-DE) has greater deviation at distance than near but the difference becomes minimal after patching. Bilateral Lateral Recess (BLR) and Monocular Recess Resect (MRR) are commonly chosen for surgical planning.
 Case Illustration : Case 1, a 4-year-old female presented with squint since 1 year old. Hirschberg test showed XT 15° in near (N) and 30° in distance (D). Prism alternate cover test (PACT) result was 30 ?D (N) and 60 ?D (D). Case 2, a 4-year-old female presented with squint since 6 months old. Hirschberg test showed XT 30° (N) and 45° (D) and dominant right eye. PACT result was 70 ?D (N) and 80 ?D (D). Poor fusion was found in both cases. Both patients underwent monocular patching for 30 minutes. We diagnosed patient 1 with True DE and BLR was done, while patient 2 with IXT dominant right eye Pseudo-DE and MRR was done on the left eye.
 Discussion : First case was a patient with True DE who underwent 8-mm BLR, while second case was Pseudo-DE with dominant right eye who underwent monocular recess 11 mm and resection 8 mm on the left eye. Orthophoria was found after surgical correction in both cases.
 Conclusion : Surgery management in True DE and Pseudo-DE are challenging, especially in determining the amount of surgery dosage and it depends on surgeon's experience. Both cases achieved successful outcomes with surgical correction resulted in orthophoria.

Zez zbieżny do dali. Diagnostyka różnicowa i metody postępowania

Primary divergence insufficiency is a generally benign condition affecting the elderly. Many patients have spontaneous resolution of the double vision within few months, so it is advisable to postpone strabismus surgery and follow the patient. It is also important to perform a differential diagnosis in order to rule out other causes of distance esotropia. For this purpose, a thorough history and careful ophthalmologic/strabologic examination should be performed. Clinical neurological evaluation is an effective tool to distinguish between patients with primary and secondary forms of divergence insufficiency. When making the diagnosis, special attention should be paid to the presence of nystagmus and the role of neuroimaging studies.

Unusual outcome of strabismus surgery in a case of Apert syndrome: A case report

Abstract Apert syndrome (AS) is a form of acrocephalosyndactyly, which is characterized by craniosynostosis, midfacial hypoplasia, and symmetrical syndactyly of the hands and feet. A 3-year-old female with craniosynostosis, high-arched palate, syndactyly, strabismus, and diagnosed as a case of Apert syndrome was brought to the outpatient department. Strabismus evaluation revealed 35 prism diopters of left convergent squint. Magnetic resonance imaging of the brain and orbit revealed hypoplastic extraocular muscles. A plan to carry out a bilateral medial rectus recession was made. However, intraoperatively, normal-sized muscles were found and the plan was modified to carry out only a left eye medial rectus recession of 5.5 mm. The patient was orthophoric postoperatively, indicating the unusual postoperative outcome in such a case. This report aimed to underline the challenges of managing a case of strabismus and the variable postoperative outcomes encountered in a case of Apert syndrome.

Study of etiological profile of patients with paralytic strabismus in a tertiary care hospital in India: a cross-sectional study

Abstract Introduction: Paralytic strabismus, a type of strabismus caused by paralysis of one or more extraocular muscles, can lead to a variety of ocular and psychosocial sequelae. Etiology varies in different types of paralytic strabismus. Numerous studies have shown that ocular motor cranial nerve palsies have a variety of causes including vascular disease, head trauma, intracranial tumour or aneurysm and inflammatory disorders.Materials and Methods: A cross-sectional study was conducted at a tertiary eye hospital to evaluate Paralytic squint by Neuroimaging in patients presenting to the Squint department of Sarojini Devi Eye Hospital Hyderabad from June 2021 to May 2022. Paralytic strabismus cases with limitation of ocular motility were enrolled and a detailed examination was performed to know the etiology. Results: 190 patients (1.35%) were diagnosed with paralytic strabismus. Ischemia constituted to be the major cause of paralytic strabismus i.e. (42.1%) followed by trauma (20%). The 3rd cranial nerve was the most commonly involved (34.73%), followed by the 6th cranial nerve (32.63%). Multiple cranial nerves were involved in 20% of cases. The 3rd CN was involved, primarily due to ischemia in both males and females while the 6th CN was affected with trauma, neoplasm, and ischemia being prominent causes. Conclusion: The study showed that ischemia, trauma and idiopathy are some of the major etiologies of paralytic strabismus with male predominance. The cranial nerve involvement also varied with the etiology of paralytic strabismus.

Characterization of cornea donors at a tissue center in the city of Medellin, Colombia

The cornea transplant is considered the most frequently performed type of transplant in the world, with a demand that has been increasing in recent years. An observational descriptive study was conducted, focusing on the ocular tissue extracted from cadaveric donors from January 2019 to December 2021 at the Red Cross Eye Bank in Medellin, Colombia. This is the first epidemiological characterization of corneal donor tissues within the eye banks of our city, where high rates of violence-related deaths explain that tissue donors are mostly young individuals. This, in turn, results in excellent counts of endothelial cells and tissue viability in their microscopic studies. Additionally, there are lower rates of discarded tissues compared to similar studies.

Результаты хирургического лечения нейротрофической кератопатии методом прямой невротизации роговицы

Relevance. Trigeminal nerve defeat can lead to the development of neurotrophic keratopathy. The only pathogenetically justified method of treating this pathology is corneal neurotization. Purpose. To develop rehabilitation tactic for the patients with neurotrophic keratopathy based on the analysis of the results of operations performed according to the author's technique of direct corneal neurotization. Material and methods. 10 direct corneal neurotizations: with initial manifestations – in 2 cases and in the advanced stage of neurotrophic keratopathy – in 8 cases. Results and discussion. Postoperative period proceeded without complications. Corneal sensitivity was restored in 60%. In all cases, corneal transparency improved, the density of the eyesore and the depth of the invasion of opacities decreased, subbasal nerve fibers began to be visualized, positive dynamic in the state of tear production were observed. Perforation defects of the cornea was closed. In initial stage of the disease corneal opacity has almost completely regressed. Conclusion. Direct corneal neurotization provides restoration of its sensitivity, prevention of neurotrophic keratopathy, which provides medical and social rehabilitation. Key words: facial nerve, paralytic lagophthalmos, abductive nerve, convergent paralytic strabismus, trigeminal nerve, corneal innervation, corneal opacity, corneal sensitivity, esthesiometry, supraorbital nerve, supratrochlear nerve

Latent Convergent Strabismus Clinical Features and Management in Sudanese Patients

Purpose: To describe the clinical features and management of latent convergent strabismus among Sudanese patients. Study Design: Descriptive observational study. Place and Duration of Study: Makkah Eye Complex, Khartoum, Sudan, from December 2018 to August 2020. Methods: The study included 137 patients, diagnosed with latent convergent strabismus (esophoria). Demographic data and ocular examination findings including visual acuity, refractive error, and degree of esophoria was collected. Esophoria was assessed by prism cover test (PCT) at near and distance. Results: Esophoria was more common among females (n = 107, 78.1%) and in age group 15 to 25 years. Headache was the most common complaint (n = 64, 46.7%). Most of the patients (n = 114, 83.2%) had 1 to 5 ∆ of esophoria with a mean of 4.17 ± 2.99∆. Majority of the patients (n = 132, 96.3%) had normal near point of convergence (NPC) 6.98 ± 3.10 cm. Positive fusional vergence (PFV) was high at 24.06 ± 9.01∆, whereas negative fusional vergence (NFV) was low at 5.0 ± 0.21∆D, P = 0.001. Majority of the patients (76.6%) responded well to the refractive correction, 11.7% patients to vision therapy and remaining 11.7% to both refractive correction and vision therapy. Correlation coefficients revealed that there was a positive correlation between, refraction, NPC, and PFV (P ˃ 0.05). Conclusion: Sophoria was more common among females and young adults. Most of the esophoric patients had uncorrected hyperopia, good PFV and relatively poor NFV amplitude. Early detection and management of young esophoric patients is essential to improve vision and binocular functions.

Binocular Function in Adults Before and after Strabismus Surgery

Purpose: To evaluate the state of binocular vision, the amount and direction of the ocular deviation before and after strabismus surgery in adult patients and to monitor the occurrence of postoperative complications. Methods: The retrospective study of 58 adult patients with selected types of strabismus who were surgically treated in the Eye Department of the Tomas Bata Regional Hospital in Zlín. We evaluated the amount and the degree of the primary ocular deviation and the binocular alignment before and after surgery, as well as the state of binocular vision after surgery and the occurrence of postoperative complications. Results: The average deviation in convergent strabismus before surgery was +23.46 degrees, after surgery +6.6 degrees, in divergent strabismus it was -21.5 degrees, after surgery -1.48 degrees, for vertical strabismus before surgery +12.5 degrees and +3.75 degrees after surgery and in paralytic strabismus +20 degrees before surgery and +3 degrees postoperatively. Preoperatively there was effectively no binocular vision in up to 63.9% of patients, superposition occurred in 31%, fusion in 5.1%. No patient had stereopsis before surgery. After surgery, superposition was present in 39.7%, fusion in 31% and stereopsis in 6.9% of patients. Only 22.4% of patients experienced no binocular vision after surgery. Of the selected 21 patients out of 58 with an observation period of at least 3 years, we observed an improvement or development of binocular vision functions after surgery in 12 patients and no improvement of binocular vision functions in 9 patients. In the first group, 58.3% had a stable deviation throughout the follow-up period. While in the second group the deviation was stable in only 33.3%. We can assume that the improvement in binocular vision function after strabismus surgery, leads to a greater longer-term stability of postoperative deviations. Conclusion: Strabismus surgery in adult patients is an effective and safe method, which is not only a cosmetic procedure used to adjust the position of the eyes, but also enables us to induce or improve the state of binocular vision functions.

Decrease of over-elevation in adduction after surgery of medial rectus muscles in partially refractive accommodative esotropia.

The course of over-elevation in adduction after strabismus surgery has been evaluated in a small number of research in the literature, we believe our study is the first to report the results in a specific group of esotropia (ET) patients. To report the course of postoperative over-elevation in adduction in patients who underwent surgery for horizontal deviation on the medial recti in partially accommodative ET. The medical charts of patients who had partially accommodative ET with over-elevation in adduction were reviewed retrospectively. A scale from -4 to +4 was used to grade the oblique muscle function. Among these, 17 patients who were operated solely on the horizontal rectus muscles were identified. The primary outcome measure was the degree of improvement in over-elevation in adduction after medial rectus surgery. Nine (52.9%) of the 17 patients (mean age: 5.18 ± 2.24 months) were males and 8 (47.1%) were females. The mean follow-up period was 17.06 ± 15.32 months. Overall, 15 patients (88.2%) achieved surgical success. The mean inferior oblique overaction was found 1.44 ± 0.56 preoperatively and the final postoperative mean inferior oblique overaction was 0.53 ± 0.51 (P = 0.001). Postoperative over-elevation in adduction after 3 months was significantly decreased compared to the preoperative value (P = 0.003, P = 0.001, P = 0.001 at 3rd and 6th months and final visits respectively). Over-elevation in adduction accompanying partially refractive accommodative ET seems to regress after medial rectus weakening surgery. This finding should be considered in the presurgical evaluation of these patients.

Surgical outcomes of bilateral lateral rectus recession versus unilateral recession and resection for the divergence excess type of intermittent exotropia.

To compare bilateral lateral rectus recession (BLR) with unilateral recession and resection (RR) for divergence excess intermittent exotropia (IXT). Retrospective analysis of 66 patients with divergence excess IXT who underwent either BLR or RR from January 2013 to December 2020 was conducted. Data on demographics, pre- and postoperative deviations, fusion, stereopsis, control, and accommodative convergence/accommodation ratio were collected. Success was defined as esodeviation ≤5 PD (prism diopter) to exodeviation ≤10 PD with a follow-up time of at least 8.0 ± 2.0 weeks. BLR (42 cases) and RR (24 cases) groups had the same success rate (83.3%, P = 0.688) and similar reduced postoperative deviations both in distance and at near (P > 0.05). Near-distance disparity decreased significantly in both groups (P = 0.000) with no intergroup difference (P = 0.193). BLR and RR were equally effective for divergence excess IXT with comparable outcomes of both distance and near deviations.

Genomic Signatures Associated with Transitions to Viviparity in Cyprinodontiformes.

The transition from oviparity to viviparity has occurred independently over 150 times across vertebrates, presenting one of the most compelling cases of phenotypic convergence. However, whether the repeated, independent evolution of viviparity is driven by redeployment of similar genetic mechanisms and whether these leave a common signature in genomic divergence remains largely unknown. Although recent investigations into the evolution of viviparity have demonstrated striking similarity among the genes and molecular pathways involved across disparate vertebrate groups, quantitative tests for genome-wide convergent have provided ambivalent answers. Here, we investigate the potential role of molecular convergence during independent transitions to viviparity across an order of ray-finned freshwater fish (Cyprinodontiformes). We assembled de novo genomes and utilized publicly available genomes of viviparous and oviparous species to test for molecular convergence across both coding and noncoding regions. We found no evidence for an excess of molecular convergence in amino acid substitutions and in rates of sequence divergence, implying independent genetic changes are associated with these transitions. However, both statistical power and biological confounds could constrain our ability to detect significant correlated evolution. We therefore identified candidate genes with potential signatures of molecular convergence in viviparous Cyprinodontiformes lineages. Motif enrichment and gene ontology analyses suggest transcriptional changes associated with early morphogenesis, brain development, and immunity occurred alongside the evolution of viviparity. Overall, however, our findings indicate that independent transitions to viviparity in these fish are not strongly associated with an excess of molecular convergence, but a few genes show convincing evidence of convergent evolution.

A Case of Paralytic Strabismus after a Snake Bite on the Toe

Purpose: To report a patient who developed paralytic strabismus despite receiving antivenom injection after a snake bite on his toe and recovered following treatment with anticholinesterase.Case Summary: A 25-year-old man with no previous ophthalmological or neurological illnesses presented to our emergency room after viper bite on the left toe. Because there were no other symptoms without localized pain, he was discharged after antivenom. The next day, he returned to the emergency room with sudden onset binocular diplopia. The alternate prism cover test showed 12 prism diopters of exotropia and 5 prism diopters of hypotropia at distance fixation in his left eye. The ocular movement test and Hess screen test revealed hypodeviation and limitation of the upper and medial gazes of the left eye. Under the impression of left oculomotor nerve palsy due to venom toxin, he underwent brain imaging to rule out the presence of another lesion and it was normal. Therefore, the patient was prescribed antibiotics, hydration and anticholinesterase, daily for 3 days. Three days after treatment, his diplopia disappeared and eye position was orthotropic in all directions; this was maintained at the 6 months follow-up.Conclusions: A delayed onset of neurotoxin-induced paralytic strabismus may occur due to viper bite even after antivenom administration. Early anticholinesterase treatment needs to be considered unless contraindicated.

Eight-Year Outcomes of Bilateral Lateral Rectus Recessions versus Unilateral Recession-Resection in Childhood Basic-Type Intermittent Exotropia

To report 8-year outcomes from a randomized controlled trial (RCT) comparing bilateral lateral rectus muscle recession (BLRc) with unilateral recession-resection (R&R) for childhood intermittent exotropia (IXT). Eight-year follow-up of RCT cohort. Of 197 randomized participants, 123 agreed to continue follow-up after the 3-year outcome visit (baseline age, 3-< 11 years; basic-type IXT, 15-40 prism diopters [Δ] by prism and alternate cover test [PACT]; baseline stereoacuity, ≤ 400 arcsec; no prior surgery). After the RCT primary outcome at 3 years, annual follow-up from 4 through 8 years with treatment at investigator discretion. Suboptimal surgical outcome by 8 years after randomization, defined as any of the following at any visit: exotropia of 10 Δ or more by simultaneous prism cover test (SPCT) at distance or near, constant esotropia (ET) of 6 Δ or more by SPCT at distance or near, loss of near stereoacuity by 0.6 log arcsec or more from baseline, or reoperation. Secondary outcomes included (1) reoperation by 8 years and (2) complete or near-complete resolution at 8 years, defined as exodeviation of less than 10 Δ by SPCT and PACT at distance and near and 10 Δ or more reduction from baseline by PACT at distance and near, ET of less than 6 Δ at distance and near, no decrease in stereoacuity by 0.6 log arcsec or more from baseline, and no reoperation or nonsurgical treatment for IXT. The Kaplan-Meier cumulative probability of suboptimal surgical outcome through 8 years was 68% (55 events among 101 at risk) for BLRc and 53% (42 events among 96 at risk) for R&R (difference, 15%; 95% confidence interval [CI], -2% to 32%; P= 0.08). Complete or near-complete resolution at 8 years occurred in 15% (7/46) for BLRc and 37% (16/43) for R&R (difference, -22%; 95% CI, -44% to -0.1%; P= 0.049). The cumulative probability of reoperation was 30% for BLRc and 11% for R&R (difference, 19%; 95% CI, 2%-36%; P= 0.049). Despite no significant difference for the primary outcome, the 95% CI did not exclude a moderate benefit of R&R, which together with secondary outcomes suggests that unilateral R&R followed by usual care may yield better long-term outcomes than BLRc followed by usual care for basic-type childhood IXT using these surgical doses. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

E32 Intra cranial hypertension in juvenile neurolupus

Abstract Introduction Neurolupus is one of the two key prognostic parameters of lupus. Its manifestation can be central or peripheral, revealing the disease or occurring during the course of evolution. It’s important to not consider all neurological manifestations during SLE as related to lupus, ruling out Central nervous system (CNS) infection and anti-phospholipid syndrome (APS) is primordial. Objectives To share 3 rare observations of neurolupus with intracranial hypertension syndrome and discuss their therapeutic modalities. To highlight the lack of evidence in the treatment of such cases. Method A retrospective analysis of data from medical records. Results We report three observations of Intracranial hypertension syndrome involving three girls, ranging from 9 to 14 years. Clinical symptomatology was dominated by headache, vomiting and visual disturbances. Examination found papillary oedema stage 3 in all the three patients, convergent strabismus in two patients and elevated intracranial pressure measurement in all the three girls ranged from 95 mm to 57 mm of H2O. Brain MRI performed in all three-patients was normal. Data from laboratory tests showed, thrombocytopenia in one patient, pancytopenia in one patient, positive antinuclear antibodies in all patients, positive anti-DNA antibody in one patient, C3, C4 consumption in two patients, positive proteinuria in two patients and positive anti phospholipid antibodies in one patient. All patients had active SLE at the time of admission with a Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) at least at 17. Symptomatic treatment with carbonic anhydrase inhibitor was initiated, followed by methylprednisolone pulse therapy then oral corticosteroids and hydroxychloroquine in all the three patients. Immunosuppressive therapy with Rituximab 1 g at two-week intervals was administrated in two patients, the third one did not receive any suppressive treatment in addition to corticosteroids due to the favorable outcome. The course was favorable in all patients with regression of clinical symptoms of intracranial hypertension and papillary oedema immediately after cerebro spinal fluid (CSF) subtraction. Discussion and Conclusion Neurolupus presents with heterogeneous symptoms that make its diagnosis difficult. Intracranial hypertension syndrome is a rare manifestation resulting from a disorder of CSF resorption, its pathogenesis is poorly understood with an inflammatory hypothesis based on immune deposits. There are no therapeutic recommendations to date. This isolated syndrome without other neurological signs of severity responds very well to symptomatic treatment with carbonic anhydrase inhibitors and to CSF withdrawal, as was the case in our patients. The use of immunosuppressive therapy (rituximab in our patients) was indicated due to the severity of the clinical picture with severe renal involvement. In addition, other immunosuppressive drugs can be an alternative option therapy. Ethics The study was performed according to the principles of the Declaration of Helsinki.

A case of neurodegenerative Langerhans cell histiocytosis exhibiting high osteopontin in cerebrospinal fluid without specific radiological abnormalities.

Neurodegenerative Langerhans cell histiocytosis (ND-LCH) manifests several years after onset of LCH, with progressive neurological symptoms and characteristic brain imaging features. Although ND-LCH has a dismal neurological prognosis, distinct treatment strategies are not available owing to the unknown pathophysiology. We describe the case of a 6-year-old boy who developed left convergent strabismus four years after onset of multisystem LCH (MS-LCH). Although radiological imaging showed no abnormalities, the osteopontin level in the cerebrospinal fluid (CSF-OPN) was highly elevated without other abnormal CSF findings, leading to a diagnosis of ND-LCH. The patient received monthly intravenous immunoglobulin therapy for four years, without symptoms worsening. To investigate the relevance of OPN levels in LCH, we retrospectively analyzed serum and CSF OPN levels in eight LCH patients. Serum OPN levels were markedly elevated in the two MS-LCH patients with macrophage activation (400 and 445ng/mL) compared to the other six patients (mean: 59ng/mL). CSF-OPN levels were elevated in the ND-LCH patient (620ng/mL) compared to the two patients with pituitary involvement (160 and 182ng/mL), suggesting that the pathophysiology of ND-LCH reflects its inflammatory status. Analysis of CSF-OPN levels would be a useful tool to detect and treat ND-LCH.

Nonsurgical Consecutive Exotropia Following Childhood Esotropia: A Multicentered Study

PurposeNon-surgical consecutive exotropia (NCX) occurs when an esotropia (ET) spontaneously converts to exotropia (XT) without surgical intervention. Although considered to occur in early onset accommodative esotropia with high hyperopia, consensus on causation is lacking. We report the clinical characteristics of NCX and assess response to conservative management. DesignRetrospective, multi-centered observational case series. MethodsPatients aged 6 months and older with initial diagnosis of esotropia who converted to exotropia without surgical intervention. Sensory strabismus was excluded. Age, visual acuity, cycloplegic refraction, glasses prescriptions, deviation and binocular vision were collected. ResultsForty-nine children were included with a mean age of 3.5±1.6 and 8.4±3.6 years at time of ET and NCX, respectively. Mean refractive error was +4.40±2.13D and +4.05±2.74D at time of ET and NCX, respectively. Accommodative esotropia occurred in 60% of cases, and only 35.7% were high hyperopes. All but one patient presented with their XT at distance. In response to the XT, a mean decrease in hyperopic prescription of 1.55±0.48D was given (N=17); only 1 case reverted to esotropia. Eventually, 43% had exotropia surgery, with similar rates between those who had refractive management and those who did not. ConclusionsNCX occurs in both accommodative and non-accommodative esotropia; high hyperopia is present in only a third of cases. On average, drift to exotropia occurs within 5 years. Refractive management has a modest result. No predictive risk factors were identified. Our findings challenge hyperopia-linked theories of causation. Non-refractive explanations, such as the role of the vergence system, deserve further study.

OPERATIVE TREATMENT OF CONVERGENT STRABISM - A CASE REPORT

The objective of this case report is to show the results of surgical treatment of convergent strabismus on the example of a 7-year-old patient. The treatment was conducted at The Clinic for Eye Diseases in Tuzla, Bosnia &amp; Herzegovina. Convergent strabismusis a sensorimotor anomaly characterized by deviation of the eyes from the parallel position, manifestly, inwards/towards the nose, often in addition with visual impairment. After applying a range of conservative treatments, surgical treatment was performed on the patient. Retropositio MRM 6 mm and Resectio MRL 7 mm were performed through surgery. Post-operative check showed that, alongside aesthetic, functional healing was achieved through operation. Key words: convergent strabismus, orthopleoptic treatment, strabismus surgery.

Comparison of sensory fusion recovery in different types programming of liquid crystal glasses

Objective: to compare the effectiveness of new method of sensory fusion recovery in patients with personalized adjustment of the frequency of alternation of liquid crystal glasses (LCG) compared with the empirical selection of the frequency of alternation. Material and methods. The study included 39 patients with concomitant convergent strabismus with orthotropy and no sensory fusion after surgical treatment of strabismus, who were prescribed LCG. The glasses were programmed empirically at 2 Hz in 21 patients (empiric group), in 18 patients — using the developed formula for calculating the frequency of alternation of LCG (calculated group). The compared groups did not differ in gender, age, visual acuity, and other characteristics. Results. Recovery of sensory fusion occurred more often with LCG in calculated group (16 patients, 88.9%) than in empiric group (9 patients, 42.9%), the difference is highly reliable (p=0.001). Conclusions. Anew method for personalized selection of the frequency of alternating LCG using video oculography is more efficient than empirical programming for sensory fusion restoration in children after surgery for concomitant convergent strabismus.

Comparison of sensory fusion recovery in different types programming of liquid crystal glasses

Objective: to compare the effectiveness of new method of sensory fusion recovery in patients with personalized adjustment of the frequency of alternation of liquid crystal glasses (LCG) compared with the empirical selection of the frequency of alternation. Material and methods. The study included 39 patients with concomitant convergent strabismus with orthotropy and no sensory fusion after surgical treatment of strabismus, who were prescribed LCG. The glasses were programmed empirically at 2 Hz in 21 patients (empiric group), in 18 patients — using the developed formula for calculating the frequency of alternation of LCG (calculated group). The compared groups did not differ in gender, age, visual acuity, and other characteristics. Results. Recovery of sensory fusion occurred more often with LCG in calculated group (16 patients, 88.9%) than in empiric group (9 patients, 42.9%), the difference is highly reliable (p=0.001). Conclusions. Anew method for personalized selection of the frequency of alternating LCG using video oculography is more efficient than empirical programming for sensory fusion restoration in children after surgery for concomitant convergent strabismus.

Race, Ethnicity, Insurance, and Population Density Associations with Pediatric Strabismus and Strabismic Amblyopia in the IRIS® Registry

To evaluate the associations of sociodemographic factors with pediatric strabismus diagnosis and outcomes. Retrospective cohort study. American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) patients with strabismus diagnosed before the age of 10 years. Multivariable regression models evaluated the associations of race and ethnicity, insurance, population density, and ophthalmologist ratio with age at strabismus diagnosis, diagnosis of amblyopia, residual amblyopia, and strabismus surgery. Survival analysis evaluated the same predictors of interest with the outcome of time to strabismus surgery. Age at strabismus diagnosis, rate of amblyopia and residual amblyopia, and rate of and time to strabismus surgery. The median age at diagnosis was 5 years (interquartile range, 3-7) for 106 723 children with esotropia (ET) and 54 454 children with exotropia (XT). Amblyopia diagnosis was more likely with Medicaid insurance than commercial insurance (odds ratio [OR], 1.05 for ET; 1.25 for XT; P < 0.01), as was residual amblyopia (OR, 1.70 for ET; 1.53 for XT; P < 0.01). For XT, Black children were more likely to develop residual amblyopia than White children (OR, 1.34; P < 0.01). Children with Medicaid were more likely to undergo surgery and did so sooner after diagnosis (hazard ratio [HR], 1.23 for ET; 1.21 for XT; P < 0.01) than those with commercial insurance. Compared with White children, Black, Hispanic, and Asian children were less likely to undergo ET surgery and received surgery later (all HRs < 0.87; P < 0.01), and Hispanic and Asian children were less likely to undergo XT surgery and received surgery later (all HRs < 0.85; P < 0.01). Increasing population density and clinician ratio were associated with lower HR for ET surgery (P < 0.01). Children with strabismus covered by Medicaid insurance had increased odds of amblyopia and underwent strabismus surgery sooner after diagnosis compared with children covered by commercial insurance. After adjusting for insurance status, Black, Hispanic, and Asian children were less likely to receive strabismus surgery with a longer delay between diagnosis and surgery compared with White children. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.