Best-corrected visual acuity results facilitate molecular diagnosis of infantile nystagmus patients harboring FRMD7 mutations.

The visual function of patients with infantile nystagmus (IN) can be significantly decreased owing to constant eye movement. While, reaching a definitive diagnosis becomes a challenge due to genetic heterozygous of this disease. To address it, we investigated whether best-corrected visual acuity (BCVA) results can facilitate the molecular diagnosis of IN patients harboring FRMD7 mutations. 200 patients with IN from 55 families and 133 sporadic cases were enrolled. Mutations were comprehensively screened by direct sequencing using gene-specific primers for FRMD7. We also retrieved related literature to verify the results based on our data. We found that the BCVA of patients with IN harboring FRMD7 mutations was between 0.5 and 0.7, which was confirmed by data retrieved from the literature. Our results showed that BCVA results facilitate the molecular diagnosis of patients with IN harboring FRMD7 mutations. In addition, we identified 31 FRMD7 mutations from the patients, including six novel mutations, namely, frameshift mutation c.1492_1493insT (p.Y498LfsTer14), splice-site mutation c.353C > G, three missense mutations [c.208C > G (p.P70A), c.234G > A (p.M78I), and c.1109G > A (p.H370R)], and nonsense mutation c.1195G > T (p.E399Ter). This study demonstrates that BCVA results may facilitate the molecular diagnosis of IN patients harboring FRMD7 mutations.

Improvement in health-related quality of life with Botulinum toxin A injection in acquired superior oblique palsy.

Purpose: This study aimed to investigate the outcomes of Botulinum toxin A (BTA) injection into the inferior oblique (IO) muscle for the management of unilateral acute acquired superior oblique palsy (SOP) and to evaluate changes in health-related quality of life post-injection using the Adult Strabismus-20 (AS-20) questionnaire. Methods: A prospective cohort study was performed in patients with unilateral acute acquired SOP who received BTA injections. Four units of BTA were injected into the ipsilateral IO muscle. Ocular examinations were performed pre-and post-injection, including alignment, ocular movement, and cyclotorsion deviation. The patients' AS-20 questionnaire scores were analyzed. Results: A total of 21 patients with acute acquired SOP were included. The initial median vertical deviation was 5 PD (range 1-16), which was improved to 0 PD (range 0-10) at both 1 and 6 months post-injection (p < 0.001 and p < 0.001, respectively). The median torsional deviation was 7° (range 2-18) at baseline and resolved to 0 degrees (range -3-5) at the 1-month and 0° (range -2-7) at the 6-month follow-up (p < 0.001 and p < 0.001, respectively). There were significant increases in the overall score (OAS), psychosocial subscale score (PSS), and functional subscale score (FSS) from baseline values at both the 1-month (p < 0.001, p < 0.001, and p = 0.001, respectively) and 6-month follow-up (all p < 0.001). Conclusion: Injecting BTA into the ipsilateral IO muscle successfully resolved vertical and torsional deviations and significantly improved quality-of-life scores. Our findings show that BTA treatment, as an early treatment for acute acquired SOP, can help patients by significantly improving their quality of life.

The Effects of Orthoptic Therapy on the Surgical Outcome in Children with Intermittent Exotropia: Randomised Controlled Clinical Trial.

BACKGROUND: To assess the clinical effectiveness of orthoptic therapy in the postoperative stabilisation and rehabilitation of binocular function in children with intermittent exotropia (IXT) after surgery. METHODS: This was a prospective, parallel, randomised controlled trial. A total of 136 IXT patients (aged from 7 to 17 years) who had been successfully corrected at 1 month after surgery were enrolled in this study, and 117 patients (58 controls) completed the 12-month follow-up visit. The primary outcome was established as the proportion of patients with suboptimal surgical outcomes, which were defined as: (1) exodeviation ≥10 prism diopters (PD) at distance or near using the simultaneous prism and cover test (SPCT), or (2) constant esotropia ≥6 PD at distance or near using SPCT, or (3) loss of 2 or more octaves of stereopsis from baseline. The secondary outcomes were the exodeviation at distance and near using the prism and alternate cover test (PACT), stereopsis, fusional exotropia control and convergence amplitude. RESULTS: The cumulative probability of suboptimal surgical outcome by 12 months was 20.5% (14/68) in the orthoptic therapy group and 42.6% (29/68) in the control group. There was a significant difference between these two groups (χ2 = 7.402, p = 0.007). Improvements in stereopsis, fusional exotropia control and fusional convergence amplitude were found in the orthoptic therapy group. A smaller exodrift was found in the orthoptic therapy group at near fixation (t = 2.26, p = 0.025). CONCLUSIONS: Early postoperative orthoptic therapy can effectively improve the surgical outcome as well as stereopsis and fusional amplitude.

Translating and evaluating the Chinese version of Pediatric Eye Questionnaire (PedEyeQ-CN) for children.

OBJECTIVES: To investigate the reliability and validity of Chinese version of the Pediatric Eye Questionnaire (PedEyeQ-CN) by testing ophthalmic patients in China. METHODS: The PedEyeQ (standard English version) was translated by local researchers. Children were asked to complete the Child section, and their parents the Proxy and Parent sections. 160 children (32 normal controls, 77 with refractive error, 48 with strabismus/amblyopia, 3 with other eye conditions) aged 5-11 years old, and one parent of each child were recruited. Cronbach's α and intraclass correlation coefficient were calculated to examine the reliability and test-retest reliability; the score differences between controls and patients were compared to examine the validity. RESULTS: The internal consistency (Cronbach's α ≥ 0.76) and test-retest reliability (r > 0.80) of PedEyeQ-CN were robust. Children with eye conditions had lower scores compared with children with normal vision (refractive error: 10 out of 13 domains, P ≤ 0.021; strabismus/amblyopia: all domains, P ≤ 0.015). Children with strabismus/amblyopia had lower scores compared with children with refractive error (two domains, P = 0.048, P = 0.001). Visual acuity was significantly correlated with functional vision (P = 0.005), but not significantly correlated with the eye-related quality of life (ER-QOL). CONCLUSIONS: The PedEyeQ-CN is a valuable tool for assessing the functional vision and ER-QOL of Chinese children and help us increase our understanding about the impact of eye conditions on children and their families.

Reading speed in school-age children with intermittent exotropia.

Reading speed in intermittent exotropia (IXT) children has been minimally examined. This study assessed reading speed in school-age children with IXT and determined clinical characteristics of IXT that impacted their reading ability. We compared the reading speed of 63 school-age (10-14 years) children with IXT to 44 age-matched normal counterparts. In addition, the correlation between reading speed and clinical characteristics of IXT were evaluated. The reading speed in children with IXT was 231 ± 51 CPM, while reading speed in normal counterparts was 257 ± 33 CPM. Age, gender were found to be factors associated with reading speed in children with IXT. After adjusting for the age and gender, we found a significant correlation between the LogTNO and reading speed in IXT group based on a generalized linear model (p = 0.014). These data show that reading speed was slower in school-age children with IXT assessed with the International Reading Speed Texts. When age and gender were adjusted, poor stereo function at near was found to be related with a slower reading speed.

Effects of orthoptic therapy in children with intermittent exotropia after surgery: study protocol for a randomized controlled trial.

BACKGROUND: Intermittent exotropia (IXT) is the most common type of exotropia in China. Surgery is usually required to align the eye deviation to maintain or obtain better binocular visual function. However, there is a high rate of exodrift or recurrence in surgically treated patients. Orthoptic therapy is sometimes recommended for IXT patients after surgery. However, there is a lack of high-quality randomized controlled trials to prove that orthoptic therapy could be an effective supplement to surgical treatment for IXT patients. The main purpose of this study is to test the clinical effectiveness of orthoptic therapy in long-term stabilization of postoperative IXT patient. This report describes the design and methodology of the Intermittent Exotropia Postoperative Treatment Clinical Trial, which is the first large-sample, blank-controlled, randomized clinical trial. METHODS: A total of 136 IXT patients (aged 7 to 17 years) will be enrolled and assigned to the orthoptic therapy group or blank control group according to a simple randomization scheme. Patients in the orthoptic therapy group will receive at least 2 months of orthoptic therapy, such as anti-suppression, vergence, and accommodation training. Patients in the blank control group will receive only refractive correction. All enrolled patients will need regular follow-up observation until 24 months after surgery. The primary outcome will be the proportion of participants meeting suboptimal surgical outcomes in this 24-month follow-up, which is defined as (1) exodeviation of 10 prism diopters (PD) at distance or near using the simultaneous prism and cover test (SPCT) or (2) loss of 2 or more octaves of stereoacuity from baseline, at any masked follow-up visit examination. The secondary outcomes will be the exodeviation at distance and near using the simultaneous prism and alternate cover test (PACT), magnitude of fusional convergence, stereoacuity, and accommodation. Measurements will be taken at baseline and at the 6-, 12-, 18-, and 24-month follow-ups. DISCUSSION: To the best of our knowledge, this will be the first prospective, randomized controlled study of orthoptic training in IXT patients after surgery. The aim of this work is to confirm the efficacy of orthoptic therapy in reducing the proportion of recurrence among IXT patients after surgery and improving binocular vision function. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900026891 . Registered on 25 October 2019.

Two-year longitudinal change in choroidal and retinal thickness in school-aged myopic children: exploratory analysis of clinical trials for myopia progression.

BACKGROUND: With increasing axial length and myopia progression, the micro-structure of the retina and choroid gradually changes. Our study describes the longitudinal changes in retinal and choroidal thickness in school-aged children with myopia and explores the relationship between changes in choroidal thickness and myopia progression. METHODS: An exploratory analysis of a randomized trial was performed. Children (n = 168, aged 7 to 12 years) with myopia from - 0.75 dioptre (D) to - 4.00 D were enrolled in this prospective longitudinal study. Cycloplegic refraction, axial length (AL), retinal and choroidal thicknesses were measured at baseline and at 1- and 2-year follow-ups. "Rapid progression myopia" was defined as increasing in myopia > 1.00 D and "stable progression myopia" was ≤ 1.00 D during the 2-year follow-up. Factors affecting the changes in choroidal thickness were analysed using linear mixed models. RESULTS: AL significantly increased by 0.67 ± 0.24 mm with a myopic shift of - 1.50 ± 0.64 D over the 2 years. The overall retinal thickness increased from 251.12 ± 15.91 µm at baseline to 253.47 ± 15.74 µm at the 2-year follow-up (F = 23.785, P < 0.001). The subfoveal choroidal thickness decreased from 231.03 ± 54.04 µm at baseline to 206.53 ± 59.71 µm at the 2-year follow-up (F = 73.358, P < 0.001). Choroidal thinning was significantly associated with AL elongation (ß = - 43.579 µm/mm, P = 0.002) and sex (ß = - 17.258, P = 0.001). Choroidal thickness continued to decrease in subjects with rapid progression (F = 92.06, P < 0.001) but not in those with steady progression (F = 2.23, P = 0.119). CONCLUSION: Significant choroidal thinning was observed and was associated with rapid progression and sex. These findings indicate a need to understand the role of the choroid in eye growth and myopia development. SYNOPSIS/PRECIS: The macular choroidal thickness of myopic children is relevant to different degrees of myopic progression in this 2-year longitudinal study. These findings suggest that control of choroidal thickness might work to regulate human ocular growth. Trial registration Chinese Clinical Trial Register (ChiCTR): ChiCTR-INR-16007722.

Myopia progression and stabilization in school-aged children with single-vision lenses.

PURPOSE: To investigate the longitudinal changes in myopia from onset to stabilization in school-aged children with single-vison lenses (SVLs). METHODS: The medical records of patients wearing SVLs with long-term follow-up data between 2006 and 2016 were retrospectively reviewed. The patients who were 6-10 years old at the initial visit and 16 years old at the last assessment were included and analysed. The periods of progression and stabilization of myopia were evaluated by plotting fitted curves of the changes in spherical equivalent (SE). RESULTS: Seven hundred and seventy-three patients (median initial age 9 years) were accessed over an average of 7 years (IQR, 6-7 years). The initial mean SE was -1.92 ± 1.57 D and increased to -6.05 ± 2.14 D at 16 years old. The average age at myopia stabilization was 14.6 years, and girls slightly stabilized earlier than boys. 73.7% of the 6-year-olds and 85.7% of the 7-year-olds had high myopia at 16 years old, and the risk decreased each year from 7 to 10 years old. Children who had SE greater than -4 D up to 10 years had 89.0% risk of high myopia at 16 years old. Children with SE between -0.5 D and -2 D still had 34% risk of developing high myopia at 16 years old. CONCLUSION: This study provides a comprehensive picture of myopia progression from onset to stabilization in school-aged children with SVLs in China. All children who have myopia onset below 10 years of age were at risk for high myopia, and children who have myopia onset below 8 years of age require more attention.

Improving Access to Refractive Services in Adults: A Health Examination Center-Based Model.

Purpose: To assess the potential of a health examination center-based screening model in improving service for uncorrected refractive error. Methods: Individuals aged ≥18 years undergoing the routine physical examinations at a tertiary hospital in the northeast China were invited. Presenting visual acuity, noncycloplegic autorefraction, noncontact tonometry, fundus photography, and slit-lamp examination were performed. Refractive error was defined as having spherical equivalent ≤ -0.75 D or ≥ +1 D and uncorrected refractive error was considered as refractive error combined with presenting visual acuity < 6/12 in the better eye. Costs for the screening were assessed. Results: A total of 5,284 participants (61 ± 14 years) were included. The overall prevalence of myopia and hyperopia was 38.7% (95% CI, 37.4-40.0%) and 23.5% (95% CI, 22.3-24.6%), respectively. The prevalence of uncorrected refractive error was 7.85% (95% CI, 7.13-8.58%). Women (p < 0.001 and p = 0.003), those with age ≥ 70 years (p < 0.001 and p = 0.003), and myopia (p < 0.001 and p < 0.001) were at higher risk of uncorrected refractive error and uncorrected refractive error-related visual impairment. Spectacle coverage rate was 70.6% (95% CI, 68.2-73.0%). The cost to identify a single case of refractive error and uncorrected refractive error was US$3.2 and US$25.2, respectively. Conclusion: The prevalence of uncorrected refractive error is high in the urban Chinese adults. Health examination center-based refractive error screening is able to provide an efficient and low-cost model to improve the refractive services in China.

A Survey of Clinical Opinions and Preferences on the Non-surgical Management of Intermittent Exotropia in China.

PURPOSE: This study reports clinical opinions and preferences on the non-surgical management of intermittent exotropia (IXT) among practitioners in China. METHODS: An online survey was developed and distributed through professional bodies. The study was conducted from July 25th to August 3rd, 2019. A total of 300 ophthalmologists and 188 optometrists responded. RESULTS: Of 488 participants, 257 (53%) considered fusion defects as the main cause of IXT, and 299 (61%) took IXT as a progressive disorder. Two hundred and seventy-one (56%) participants considered orthoptic exercises as the most effective non-surgical intervention for IXT. Likewise, 245 (50%) participants reported that orthoptic exercises were their most frequent non-surgical option, followed by observation (178, 37%). There are discrepancies between ophthalmologists and optometrists. A greater proportion of ophthalmologists (201, 67%) shared the view that IXT worsens over time (98, 52%) (p = .001). Additionally, ophthalmologists (121, 40%) tended to prefer observation compared with optometrists (57, 30%) (p = .021). CONCLUSIONS: This study shows that there is no general consensus on the non-surgical management of IXT in China. Given the lack of robust evidence, the findings from this study highlight the need for future randomized clinical trials to validate the effectiveness of non-surgical interventions, orthoptic exercises in particular, and to establish treatment guidelines accordingly.

Longitudinal Rehabilitation of Binocular Function in Adolescent Intermittent Exotropia After Successful Corrective Surgery.

PURPOSE: To study the longitudinal rehabilitation of binocular visual function in adolescent intermittent exotropia (IXT) after successful surgery and compare the results with those of a normal population. The role of binocular function in ocular alignment stability was also evaluated postoperatively. METHODS: In this prospective study, 30 adolescents with IXT successfully corrected after 1 month were followed for 12 months, and 30 children with normal vision were enrolled as controls. Stereopsis, the fusional vergence amplitude, sensory fusion, and accommodative flexibility were measured to assess binocular function at baseline and 6 and 12 months postoperatively. The controls were tested once when they were enrolled in the study. RESULTS: The deviation was -32.00 ± 8.60 prism diopters (PD) at distance fixation and -36.0 ± 9.10 PD at near fixation preoperatively with an average correction of 28.53 ± 3.79 PD and 30.67 ± 1.34 PD at 1 month postoperatively. Distance stereoacuity and near stereoacuity improved from 1 to 12 months postoperatively (p = 0.025 and p = 0.041, respectively). Compared with the controls, the fusional convergence reserve at distance (p = 0.025) and near (p = 0.033) fixations and fusion reserve ratio at distance (p = 0.000) and near (p = 0.000) fixations remained subnormal, whereas sensory fusion (p = 0.237), distance stereopsis (p = 0.120), and the fusional divergence amplitude at a distance (p = 0.168) were normal. However, no significant correlations were found between binocular functions at 1 month postoperatively and the postoperative drift. CONCLUSION: Binocular function significantly improved from before to after successful corrective surgery and continued to improve from 1 to 12 months postoperatively in adolescents with IXT. No significant correlations were found between binocular functions at 1 month postoperatively and ocular alignment stability.

Effect of the base-out recovery point as the surgical target for acute acquired comitant esotropia.

PURPOSE: To evaluate the treatment efficacy of the preoperative base-out recovery point as the surgical target angle for acute acquired comitant esotropia. METHODS: Prospective study. Twenty-two patients with acute acquired comitant esotropia (AACE) underwent strabismus surgery based on the target angle of the preoperative base-out recovery point. The postoperative deviation, positive fusional vergence, and negative fusional vergence were evaluated and compared with those of 23 normal individuals. RESULTS: The mean follow-up period was 18.68 ± 19.48 months. At the last follow-up, 19 (86.4%) of 22 subjects had orthophoria, whereas 3 (13.6%) had minimal esophoria. The postoperative angle of deviation was significantly smaller than the preoperative angle of deviation at near (P < 0.001) and distance (P < 0.001). Postoperative sensory fusion was significantly better than preoperative fusion at near (P < 0.001) and distance (P < 0.001). The postoperative stereoacuity improved significantly after the surgery at near (P < 0.001) and distance (P < 0.001). Compared with the controls, the convergence and divergence amplitudes in the AACE patients were similar at distance (P > 0.05) but were still narrower at near (P < 0.001). CONCLUSION: Good alignment and binocular balance were obtained with the surgical target angle of the base-out recovery point in AACE.

Correlation Between Increase of Axial Length and Height Growth in Chinese School-Age Children.

PURPOSE: To identify the relationship between the increase in axial length (AL) and height in school-age children and explore the influence of refractive status on such a relationship. METHODS: In this 5-year cohort study, 414 Chinese children (237 boys) aged 6-9 years (mean 7.12) underwent measurements annually. AL was measured using the Lenstar; height with the children standing, without shoes; and refraction using subjective refraction without cycloplegia. Participants were divided according to the refractive status: persistent emmetropia, persistent myopia, and newly developed myopia. The measurement time points of the persistent emmetropia and persistent myopia groups were marked as T1, T2, T3, T4, and T5. The time of myopia onset in the newly developed myopia group was marked as t 0; the preceding time points were marked as t -1, t -2, and so on, and the succeeding as t 1, t 2, and so on. The association between increase in AL and height was analyzed using simple correlation analysis. RESULTS: The mean changes in AL, height, and refraction were 1.39 mm, 23.60 cm, and -1.69 D, respectively, over 5 years in all children. The increase in AL and height were positively correlated for T1~T2, T1~T3, T1~T4, and T1~T5 (r = 0.262, P < 0.001; r = 0.108, P = 0.034; r = 0.165, P = 0.001; r = 0.174, P = 0.001, respectively). The changes in AL and height in the newly developed myopia group were significantly correlated (r = 0.289, P = 0.009) after myopia onset (t 0~t 2). CONCLUSION: The increase in AL and height were positively correlated, especially in the newly developed myopia group after myopia onset. Thus, when children grow quickly, AL elongation should be monitored.

Binocular Summation Is Intact in Intermittent Exotropia After Surgery.

Purpose: To determine binocular summation of surgically treated intermittent exotropia (IXT) patients by measuring the contrast threshold. Methods: We recruited 38 surgically treated IXT patients aged 8-24 years and 20 age-matched healthy controls. All participants had normal or corrected-to-normal visual acuity (Snellen ≥ 20/20) in both eyes. The IXT patients had undergone the surgery at least a year prior to the study. Twenty-one of them obtained good alignment and 17 experienced a recurrence of exotropia. We measured the observers' monocular and binocular contrast sensitivities (CS) at six spatial frequencies (1.5, 3, 6, 12, 18, 24 cycles/degree) as an index of visual information processing at the threshold level. Binocular summation was evaluated against a baseline model of simple probability summation based on the CS at each spatial frequency and the area under the log contrast sensitivity function (AULCSF). Results: The exo-deviation of IXTs with good alignment was -6.38 ± 3.61 prism diopters (pd) at 33 cm and -5.14 ± 4.07 pd at 5 m. For the patients with recurrence, it was -23.47 ± 5.53 pd and -21.12 ± 4.28 pd, respectively. There was no significant difference in the binocular summation ratio (BSR) between the surgically treated IXT patients, including those with good alignment and recurrence, and normal controls at each spatial frequency [F (2,55) = 0.416, P = 0.662] and AULCSF [F (2,55) = 0.469, P = 0.628]. In addition, the BSR was not associated with stereopsis (r = -0.151, P = 0.365). Conclusion: Our findings of normal contrast sensitivity binocular summation ratio in IXT after surgical treatment suggest that the ability of the visual cortex in processing binocular information is intact at the contrast threshold level.

Can Clinical Measures of Postoperative Binocular Function Predict the Long-Term Stability of Postoperative Alignment in Intermittent Exotropia?

PURPOSE: To evaluate whether clinical measures of postoperative binocular functions could predict the long-term stability of postoperative ocular alignment in children with intermittent exotropia. METHODS: A retrospective study was performed in thirty-nine children (median: 7 years) who have been surgically treated from intermittent exotropia without overcorrection (less than 10 prism diopters [pd] of exodeviation at 1 month postoperatively). Angles of deviation and binocular functions were measured preoperatively and at 1 month, 6 months, and the final follow-up visit (≥24 months) postoperatively. We examined the relationships between postoperative drift (change of ocular alignment) and binocular functions (sensory fusion, fusional convergence amplitude, and stereoacuity). RESULTS: The surgical success rate (esophoria/tropia ≤5 pd to exophoria/tropia ≤10 pd) dropped to 76.9% at 6 months after surgery and to 53.8% at individuals' last visit (mean: 37 months). The mean exodrift was 7.7 ± 9.2 pd from the postoperative month 1 to the final visit (p < 0.001) on distance fixation. Distance stereoacuity, central fusion, and fusional convergence amplitude significantly improved following surgery (p < 0.05). However, no significant correlation was found between their binocular functions measured at the beginning of each follow-up period and the postoperative drift (all p > 0.13). CONCLUSION: Our findings suggest that the clinical measures of sensory fusion, fusional convergence amplitude, and stereoacuity cannot serve as a robust predictor for the long-term stability of postoperative ocular alignment in patients who underwent successful surgery without overcorrection at 1 month postoperatively.

Effect of plum-blossom needling versus tropicamide eye drops on adolescent myopia: protocol for a randomized crossover trial.

OBJECTIVE: Myopia is the most common eye problem and affects an estimated 28.3% of the global population. Its incidence is increasing annually. Myopia treatment is limited to correcting visual acuity. Acupuncture is one of the main therapies in traditional Chinese medicine and includes plum-blossom needling, which has been widely used for both the prevention and treatment of adolescent myopia. We hypothesized that plum-blossom needling would be effective in treating myopia compared with a tropicamide eye drops control. METHODS: This is a crossover randomized controlled trial involving adolescents with myopia. Participants will be randomized 1∶1 to plum-blossom needle or tropicamide eye drops arms. Subjects in each arm will be treated for 20 d, followed by a 1-month washout period and treatment change for another 20 d. The primary outcome is uncorrected distance and cycloplegic refractive errors. The secondary outcomes comprise corneal curvature, lens thickness, axial length, ciliary body thickness, accommodation amplitude, the NRA/PRA (negative/positive relative accommodation), flexible adjustment, and near point of convergence. The outcome measures will be assessed at baseline, after the first treatment course (the first month), at the end of the washout period (the second month), after the second treatment course (the third month), and at follow-up (the sixth month). DISCUSSION: The results of the trial will help to provide evidence for the efficacy of plum-blossom needling for myopia in China.

Factors influencing the self-reported sense of deviation in adults with successful surgical outcomes for strabismus.

BACKGROUND: To determine whether a sense of deviation remains in adults with successful motor alignment who fulfil diplopia criteria after surgery and to examine the factors associated with this judgement. METHODS: This was a retrospective study. Adult patients defined as having a successful outcome based on more than 1 year of post-operative follow-up visits were included in the study. The sense of deviation was determined at the last visit. Pre- and post-operative deviation and characteristics including age, gender, education level, occupation, diagnosis, size of deviation, extraocular movement (EOM), binocular function, and health-related quality of life (HRQOL) were recorded. RESULTS: In total, 22 (24%) of the 91 adults with successful surgical outcomes reported a sense of deviation. No significant differences were noted between subjects with and without a sense of deviation regarding patient demographics, pre- and post-operative deviation, changes in deviation, sensory fusion or EOM. Subjects with a sense of deviation had an increased prevalence of and larger post-operative vertical deviation, poorer stereo function, and lower HRQOL scores than those with no sense of deviation. The presence of post-operative vertical deviation was associated with a sense of deviation. CONCLUSIONS: Approximately one-fourth (24%) of adults defined as having successful surgical outcomes who still had a sense of deviation exhibited worse stereo function, higher vertical deviation size and lower HRQOL scores. The presence of 3 to 5 prism dioptres(pd) of vertical deviation would be the main factor associated with a sense of deviation post-operatively.

Health-related quality of life correlated with the clinical severity of intermittent exotropia in children.

OBJECT: To evaluate whether the results of the health-related quality of life (HRQOL) is associated with the various clinical aspects of intermittent exotropia in children. METHODS: The HRQOL of children and their parents was evaluated prospectively using the Intermittent Exotropia Questionnaire (IXTQ). The deviation angle, stereo function, sensory fusion, and strabismus control were measured. RESULTS: Two hundred and sixty six children with intermittent exotropia (aged 5-17 years) were included in the study. Child HRQOL was significantly correlated with clinical severity; lower IXTQ scores were associated with a larger deviation (p < 0.001 both for distance and near) and poorer Newcastle control scores (p < 0.001). Proxy child HRQOL was significantly correlated with the deviation (p < 0.001), Newcastle control scores (p < 0.001) and stereo function (p < 0.05). Parent HRQOL was associated with their child's deviation (p < 0.01) and stereo function (p < 0.005). Multiple linear regression analysis suggested that the deviation angle at distance and the Newcastle control score at home were associated with the child's HRQOL. CONCLUSION: Both the child and their parents' HRQOL showed a trend toward correlating with clinical severity. Large deviation, poor control, and poor stereo function were significantly associated with lower IXTQ scores. The deviation angle at distance and exotropia control at home were associated with the child's HRQOL.

A Convenient and Robust Test to Quantify Interocular Suppression for Children With Amblyopia.

Interocular suppression was quantified by the interocular luminance difference that was needed when the two eyes were balanced in discriminating a black-white stripe formed butterfly stimulus, which was dichoptically presented through polarized glasses. Stronger interocular suppression was found in amblyopes than that in controls at both the near (33 cm, 0.95 ± 1.00 vs. 0.14 ± 0.18, p < .001) and far (5 m, 2.18 ± 0.97 vs. 0.24 ± 0.16, p < .001) viewing distances. The interocular suppression in amblyopes was significantly correlated with the interocular visual acuity difference, the visual acuity of amblyopic eye, the Worth-4-Dot test, and the stereo acuity at both the near and far distances (for all cases, p < .001). Our new test enables convenient and robust measurements of interocular suppression in children with amblyopia. The measured interocular suppression is in agreement with other clinical measures.