Friday, March 29, 2013

The outcomes of horizontal strabismus surgery and influencing factors of the surgical success

The outcomes of horizontal strabismus surgery and influencing factors of the surgical success

.....The surgical [failure rate] of horizontal strabismus surgery was [39.8%] and [showed] no statistically significant improvement of visual acuity after surgery. ......

Comments: 39.8% of patients were judged to be not successful after surgery for strabismus. Once again I would like to suggest to my ophthalmology colleagues to team up with doctors who are Fellows in the College of Optometrists in Vision Development when you care for these patients. Let us help you make your success rate post-strabismus surgery better!! (please note that I changed the wording from the original article from success rate to failure rate and from 60.2% success rate to a 39.8% fail rate. When this is done, it really changes your perspective doesn't it?) DM

Thursday, March 28, 2013

Depression Linked to Vision Loss

Depression Linked to Vision Loss'

 ...More than 10 percent of U.S. adults who report vision loss have clinical symptoms of major depression, according to a large study....In the study of 10,500 participants, the prevalence of depression was 11.3 percent among those with vision loss compared with 4.8 percent for those with no visual problems....

Tuesday, March 26, 2013

Outcomes of strabismus surgery for esotropia in children with down syndrome compared with matched controls

Outcomes of strabismus surgery for esotropia in children with down syndrome compared with matched controls

.... Mean preoperative esotropia was 28.4 prism diopters (PD) in the DS group and 27.9 PD in the control group. ..... The 4-month postoperative mean angles of esotropia for the DS and control groups were 3.15 and 2.66 PD, respectively. The 24-month mean angles of esotropia for the DS and control groups were 7.09 and 6.60 PD, respectively...

Comments: The esotropia noted in those with Down Syndrome tend to be functional in nature (accommodative esotropia) with the esotropia improving or eliminated with a pair of multifocal lenses (bifocals). It is interesting that the residual post surgical esotropia is becoming greater over time as noted in this study. Will these patients return to about 30 PD of esotropia as is typical in accommodative esotropia in another year or two? DM

Monday, March 25, 2013

Long-term results of the surgical management of intermittent exotropia

 Long-term results of the surgical management of intermittent exotropia

....Long-term surgical results in intermittent exotropia are less encouraging when sensory status is added to the evaluation. Patients with anisometropia, lateral incomitance, and immediate postoperative undercorrection are at increased risk for poor outcomes and to require....

Comments: Better rates of success should be achievable when you use the principles of neuro-plasticity while using Optometric Vision Therapy. DM

The Long-term Follow-up of Accommodative Esotropia in a Population-Based Cohort of Children

The Long-term Follow-up of Accommodative Esotropia in a Population-Based Cohort of Children


.... 306 children with accommodative esotropia were diagnosed during the study years; 244 (80%) were fully accommodative (FAET) and 62 (20%) were partially accommodative (PAET). The Kaplan-Meier rate of discontinuing spectacles for strabismus in this population was 8% by 5 years after diagnosis, 20% by 10 years, and 37% by 20 years. Children born prematurely ... or having a greater initial hyperopic refractive error ... were significantly less likely to become spectacle-free ..... During a median follow-up of 9.8 years (range, 0 to 27.9 years), ...13.5%... with FAET ...underwent strabismus surgery. [Males]... an earlier age at onset ... and ...[a diagnosis] of FAET were associated with a higher likelihood of requiring surgery.....[most] children with accommodative esotropia in this population continued to require spectacle correction into their second decade of life. A small proportion of children with FAET required surgical intervention, ....

Comments: Accommodative esotropes should be wearing mulitfocal lenses and undergoing optometric vision therapy to improve this functional vision problem. Click on the title to read the full article. DM



Sunday, March 24, 2013

Persistently recurrent infantile esotropia

Persistently recurrent infantile esotropia

.....The number of surgeries per patient ranged from 3-9 (mean 5). All of the horizontal surgeries in eight patients were for esotropia, while three patients developed exotropia after three or more surgeries for esotropia. .....

Comments: This disorder requires up to 9 surgeries...and then the patient my go on to develop exotropia. Many of the patients evaluated had various disorders and developmental disabilities....a population that has been shown to typically have poor outcomes to strabismus surgery. DM

Postoperative outcomes of patients initially overcorrected for intermittent exotropia

Postoperative outcomes of patients initially overcorrected for intermittent exotropia

..... The mean postoperative day 1 alignment was 6(Δ) ± 3(Δ) esotropia at distance and 5(Δ) ± 3(Δ) esotropia at near. At the last visit, 31 (49%) were orthotropic to <8 b="" exotropia="">26 (41%) had recurrence of exotropia >8(Δ), and 6 (10%) had monofixational esotropia <10 b="">.....The results of overcorrection for exotropia are variable and unpredictable. We were unable to determine associations with the recurrence of exotropia or secondary esotropia.....

Comments: More than 50% of these patients either had residual exotropia or esotropia after surgery.  Always consider a second or even third opinion when surgery is recommended. Go to http://covd.org, http://oepf.org and/or http://aoa.org to find a doc to help. DM

Comparing outcome criteria performance in adult strabismus surgery

Comparing outcome criteria performance in adult strabismus surgery

....Combining criteria, the highest success rate was for motor plus diplopia criteria (67%) and the lowest success rate was when combining motor, diplopia, and Health Related Quality Of Life  criteria (50%).....

Comments: 1/3 to 1/2 of the adults who had strabismus surgery had poor outcomes. What is of primary interest is how poor the outcomes become when you add in the quality of life aspect. DM

Behavioral, Functional, & Developmental Vision Care


Behavioral, Functional, & Developmental Vision Care Explained

My friend and colleague, Dr. Paul Harris, has done a nice job in describing and explaining behavioral vision care. Read these papers to get a better understanding of this approach to eye and vision care.

Read these:

Behavioral Vision Care 1

Behavioral Vision Care 2