Historical, Diagnostic, and Chromatic Treatment in Visual Snow Syndrome: A Retrospective Analysis.

PURPOSE: This study aimed to determine the historical, diagnostic, and treatment aspects in patients with documented visual snow syndrome/visual snow in an academic, optometric setting. METHODS: A retrospective analysis was performed in patients (N = 40, aged 12 to 55 years) with documented visual snow syndrome/visual snow examined over a 4-year period. Information was collected by a detailed case history and the Visual Snow Syndrome Symptom Survey. Treatment assessment was performed using the Intuitive Colorimeter, and a wide selection of chromatic tints was assessed under the most provocative/exacerbating and other conditions. RESULTS: Visual snow was typically constant and monochromatic, with it being present on average 6.43 years. Bright and dark surfaces were the most provocative/exacerbating/revealing conditions, along with the viewing of computer screens. The most common etiology was mild traumatic brain injury. The most common primary and secondary symptoms were photosensitivity and tinnitus, respectively. There was a high frequency of occurrence of oculomotor deficits, especially accommodative and vergence insufficiency (~40 to 50%). Eighty percent of the patients were prescribed a chromatic tint with subjective visual reduction of visual snow ranging from 15 to 100% (mean, 45%). CONCLUSIONS: The present information will help in understanding this unusual medicoperceptual condition, especially with respect to simple treatment frequently using readily available chromatic tints.

Astigmatism and early academic readiness in preschool children.

PURPOSE: This study investigated the relationship between uncorrected astigmatism and early academic readiness in at-risk preschool-aged children. METHODS: A vision screening and academic records review were performed on 122 three- to five-year-old children enrolled in the Philadelphia Head Start program. Vision screening results were related to two measures of early academic readiness, the teacher-reported Work Sampling System (WSS) and the parent-reported Ages and Stages Questionnaire (ASQ). Both measures assess multiple developmental and skill domains thought to be related to academic readiness. Children with astigmatism (defined as >|-0.25| in either eye) were compared with children who had no astigmatism. Associations between astigmatism and specific subscales of the WSS and ASQ were examined using parametric and nonparametric bivariate statistics and regression analyses controlling for age and spherical refractive error. RESULTS: Presence of astigmatism was negatively associated with multiple domains of academic readiness. Children with astigmatism had significantly lower mean scores on Personal and Social Development, Language and Literacy, and Physical Development domains of the WSS, and on Personal/Social, Communication, and Fine Motor domains of the ASQ. These differences between children with astigmatism and children with no astigmatism persisted after statistically adjusting for age and magnitude of spherical refractive error. Nonparametric tests corroborated these findings for the Language and Literacy and Physical Health and Development domains of the WSS and the Communication domain of the ASQ. CONCLUSIONS: The presence of astigmatism detected in a screening setting was associated with a pattern of reduced academic readiness in multiple developmental and educational domains among at-risk preschool-aged children. This study may help to establish the role of early vision screenings, comprehensive vision examinations, and the need for refractive correction to improve academic success in preschool children.

Medications prescribed to brain injury patients: a retrospective analysis.

BACKGROUND: The purposes of this study were to retrospectively evaluate the frequency of medications used by individuals with either traumatic brain injury (TBI) or cerebrovascular accident (CVA) and to consider the possible relationship between vision symptoms and diagnoses in this sample and the established visual and ocular side effects of the prescribed medications. METHODS: Charts of patients examined in the Raymond J. Greenwald Rehabilitation Center at the SUNY State College of Optometry from the years 2000 to 2003 were reviewed. Only TBI (n=160) or CVA (n=60) patients were included. Prescribed medications from 12 possible categories were identified. Patients experiencing blurred vision, diplopia, asthenopia, poor depth perception, and/or light sensitivity were identified. Patients with accommodative dysfunction, vergence dysfunction, versional dysfunction, dry eyes, and/or ptosis were also identified. RESULTS: The 4 most common medication categories taken by TBI patients were anti-anxiety/antidepressants (42.5%), anticonvulsants (26.9%), opiate/combination analgesics (23.8%), and cardiac/antihypertensives (23.1%). For the CVA patients, the medications were cardiac/antihypertensives (66.7%), anti-anxiety/antidepressants (31.7%), vitamins/mineral supplements (26.7%), and anticonvulsants (23.3%). Frequency of vision symptoms and diagnoses in the TBI and CVA patients appeared not to be related to medication use in most cases. CONCLUSIONS: Anti-anxiety drugs, antidepressants, and anticonvulsants were the overlapping medication categories between the TBI and CVA groups. Medication intake did not affect the frequency of the reported vision symptoms and diagnoses in most cases, suggesting the symptoms and diagnoses were primarily related to either the TBI or CVA itself.

The frequency of occurrence, types, and characteristics of visual field defects in acquired brain injury: a retrospective analysis.

BACKGROUND: The purpose of this retrospective study was to determine the frequency of occurrence of visual field defects in a sample of visually symptomatic, ambulatory outpatients who have acquired brain injury (ABI), either traumatic brain injury (TBI) or cerebral vascular accident (CVA). METHODS: The medical records of 220 individuals with TBI (n=160) or CVA (n=60) were reviewed retrospectively. This was determined by a computer-based query spanning the years 2000 through 2003. The individuals' records were reviewed to determine the frequency of targeted visual field defects that were classified as scattered, restricted, homonymous, nonhomonymous, and visual neglect. The altitudinal and lateral characteristics of these defects were also determined. RESULTS: In the total ABI sample of 220, some 102 (46.36%) individuals had 1 of the targeted defects diagnosed. These defects were present in 62 (38.75%) of the TBI subgroup and in 40 (66.67%) of the CVA subgroup. The most frequent defects in the TBI group were scattered (58.06%) followed by homonymous (22.58%). In the CVA group, the most numerous were homonymous (47.5%), with scattered and nonhomonymous accounting for 20% each. CONCLUSION: The uniqueness of the current study is that it reports the frequency of occurrence of specified visual field defects in the total ABI sample and in the TBI and CVA subgroups. This enabled comparisons with other studies that generally have reported on just 1 of these groupings. The current results are in accord with most of the other studies that are reviewed. The findings of this study should alert the reader to the high frequency of occurrence of visual field defects in the ABI population, and make the reader aware of the adverse effects they can have on quality of life and rehabilitation.

Vision therapy for oculomotor dysfunctions in acquired brain injury: a retrospective analysis.

BACKGROUND: Oculomotor dysfunctions are among the most common abnormalities found in the brain-injured population. The purpose of the current study was to determine retrospectively the effectiveness of conventional optometric vision therapy for oculomotor disorders of vergence and version in a sample of ambulatory, visually symptomatic, predominantly adult outpatients who had either mild traumatic brain injury (TBI) or cerebrovascular accident (CVA). METHODS: A computer-based query for acquired brain injury patients examined between the years of 2000 and 2003 was conducted in our clinic. This yielded 160 individuals with mild TBI and 60 with CVA. Of these patients, only those for whom vision therapy was prescribed and who completed an optometric vision therapy program for remediation of their oculomotor dysfunctions were selected. This included 33 with TBI and 7 with CVA. The criterion for treatment success was denoted by marked/total improvement in at least 1 primary symptom and at least 1 primary sign. RESULTS: Ninety percent of those with TBI and 100% of those with CVA were deemed to have treatment success. These improvements remained stable at retesting 2 to 3 months later. CONCLUSION: Nearly all patients in the current clinic sample exhibited either complete or marked reduction in their oculomotor-based symptoms and improvement in related clinical signs, with maintenance of the symptom reduction and sign improvements at the 2- to 3-month follow-up. These findings show the efficacy of optometric vision therapy for a range of oculomotor abnormalities in the primarily adult, mild brain-injured population. Furthermore, it shows considerable residual neural plasticity despite the presence of documented brain injury.

Spontaneous, bilateral intraocular lens dislocation in a patient with exfoliation syndrome.

BACKGROUND: Exfoliation syndrome (XFS) is a relatively common age-related disorder characterized by the production and progressive accumulation of a fibrillar extracellular material in numerous ocular tissues and throughout the body. XFS is a known identifiable cause of open-angle glaucoma. However, because of its widespread distribution, other structures in the eye are affected. Because of weakening of the zonular apparatus and posterior capsule, and subsequent loss of support for the lens or posterior chamber intraocular lenses (IOLs), its presence must be factored into the pre- and postoperative management of persons undergoing cataract surgery. CASE REPORT: An 89-year-old white female presented with the sudden onset of decreased vision in her left eye. She had a history of uncomplicated cataract extraction and posterior chamber IOL implantation in each eye about 10 years previously. She was also known to have XFS. Examination found XFS, a dislocated posterior chamber IOL, anterior uveitis, and markedly elevated intraocular pressure. After stabilizing the eye medically, the patient presented 5 months later with the same condition in the right eye. This eye was also stabilized medically. The patient refused further treatment. CONCLUSIONS: It is imperative that the comanaging optometrist and cataract surgeon be cognizant of the presence of XFS when planning cataract surgery. However, the effects of XFS may not be seen for many years after apparently successful cataract surgery.

Occurrence of oculomotor dysfunctions in acquired brain injury: a retrospective analysis.

BACKGROUND: The purpose of this retrospective study was to determine the frequency of occurrence of oculomotor dysfunctions in a sample of ambulatory outpatients who have acquired brain injury (ABI), either traumatic brain injury (TBI) or cerebrovascular accident (CVA), with associated vision symptoms. METHODS: Medical records of 220 individuals with either TBI (n = 160) or CVA (n = 60) were reviewed retrospectively. This was determined by a computer-based query spanning the years 2000 through 2003, for the frequency of occurrence of oculomotor dysfunctions including accommodation, version, vergence, strabismus, and cranial nerve (CN) palsy. RESULTS: The majority of individuals with either TBI (90%) or CVA (86.7%) manifested an oculomotor dysfunction. Accommodative and vergence deficits were most common in the TBI subgroup, whereas strabismus and CN palsy were most common in the CVA subgroup. The frequency of occurrence of versional deficits was similar in each diagnostic subgroup. CONCLUSION: These new findings should alert the clinician to the higher frequency of occurrence of oculomotor dysfunctions in these populations and the associated therapeutic, rehabilitative, and quality-of-life implications.

Occurrence of ocular disease in traumatic brain injury in a selected sample: a retrospective analysis.

PRIMARY OBJECTIVE: To determine retrospectively the relative risk of ocular disease in a selected, visually-symptomatic sample of clinic patients having traumatic brain injury (TBI; n=160) vs. cerebrovascular accident (CVA; n=60), with all initially presenting at the clinic with symptoms and/or signs of vision dysfunction. METHODS AND PROCEDURES: To review retrospectively 220 medical records of individuals with TBI (n=160) vs. CVA (n=60), as determined by a computer-based query spanning the years 2000-2003, to ascertain the frequency of occurrence of ocular disease in the two major sub-groups of acquired brain injury. MAIN OUTCOMES AND RESULTS: Conditions with high relative risk unique to TBI included corneal abrasion, blepharitis, chalazion/hordeolum, dry eye, traumatic cataract, vitreal prolapse and optic atrophy. This is distinct from those ophthalmic conditions unique to CVA, which included sub-conjunctival haemorrhage and ptosis. CONCLUSION: These new findings should alert clinicians to the potential increased frequency of occurrence of specific ocular diseases in a selected, visually-symptomatic population with TBI and their associated rehabilitative and quality-of-life implications.

Monocular deprivation in an identical twin.

PURPOSE: The scientific literature contains minimal human studies of the effect of monocular deprivation on a single eye of twins. This report examines the effects of early visual deprivation on axial length measurements by comparing the refractive findings and axial length measurements of identical twins' 4 eyes, 1 visually deprived and 3 nondeprived. METHODS: A retrospective record review was performed on the medical records of identical 6-year-old Hispanic female twins. Both patients had received eye care at the University Optometric Center, State University of New York, for a period of at least 5 years. Subsequently, an Internal Review Board-approved prospective study was undertaken. Each twin received a comprehensive eye examination and an A-scan. RESULTS: The findings of the 3 nondeprived eyes were compared with those of the 1 deprived eye. The 3 nondeprived eyes had at least 20/20 visual acuity, low hyperopia or astigmatism, low with the rule keratometric findings, 12-mm corneal diameters, and A-scan results ranging from 21.0 to 21.55 mm. The remaining eye, which was visually deprived secondary to congenital cataract from birth to 6 months of age, had an aphakic refractive condition, decreased visual acuity, glaucoma, esotropia, and borderline microcornea. Keratometric findings were comparable with those of the other 3 eyes, whereas the A-scan finding was 25.16 mm. CONCLUSION: This case presented a unique opportunity to directly examine the effect of visual deprivation on axial elongation. Although other factors, such as glaucoma and borderline microcornea, may influence axial elongation, the findings in this patient indicate that a substantial portion, if not all, of the axial elongation can be attributed to early monocular deprivation.