Correction: Management of nystagmus in children: a review of the literature and current practice in UK specialist services.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Management of nystagmus in children: a review of the literature and current practice in UK specialist services.

Nystagmus is an eye movement disorder characterised by abnormal, involuntary rhythmic oscillations of one or both eyes, initiated by a slow phase. It is not uncommon in the UK and regularly seen in paediatric ophthalmology and adult general/strabismus clinics. In some cases, it occurs in isolation, and in others, it occurs as part of a multisystem disorder, severe visual impairment or neurological disorder. Similarly, in some cases, visual acuity can be normal and in others can be severely degraded. Furthermore, the impact on vision goes well beyond static acuity alone, is rarely measured and may vary on a minute-to-minute, day-to-day or month-to-month basis. For these reasons, management of children with nystagmus in the UK is varied, and patients report hugely different experiences and investigations. In this review, we hope to shine a light on the current management of children with nystagmus across five specialist centres in the UK in order to present, for the first time, a consensus on investigation and clinical management.

Modelling of congenital nystagmus waveforms produced by saccadic system abnormalities.

Models of the mechanisms of normal eye movements are typically described in terms of the block diagrams which are used in control theory. An alternative approach to understanding the mechanisms of normal eye movements involves describing the eye movement behaviour in terms of smooth changes in state variables. The latter approach captures the burst cell firing against motor error (difference between target gaze angle and current gaze angle) phase plane behaviour which is found experimentally and facilitates the modelling of variations in burst cell behaviour. A novel explanation of several types of congenital nystagmus waveforms is given in terms of a saccadic termination abnormality.

Oscillopsia and tolerance to retinal image movement in congenital nystagmus.

PURPOSE: To determine the relationship between retinal image movement (RIM) and oscillopsia in subjects with idiopathic congenital nystagmus (CN). METHODS: Eye movements were recorded using an IRIS infrared system. The eye movement signal was fed back to move an otherwise stationary target on a screen and thereby modify the RIM experienced by each of the five CN subjects. The target was present with either no background (the absolute condition) or a textured background (the relative condition). Feedback gains were varied from -1.0 (i.e., 100% retinal image increase) to +1.0 (i.e., 100% retinal image decrease or complete stabilization), with 0 representing the zero feedback or stationary target condition. In the first experiment, RIM thresholds were determined for a range of feedback values. Using zero feedback, a second experiment measured the detection threshold for absolute and relative motions to a ramp-generated target movement for five CN and five control subjects. RESULTS: Under feedback control spatial constancy broke down for both increased and reduced RIM. The range of spatial constancy was greater for absolute (-0.56 to +0.44) compared with relative (-0.18 to +0.18) RIM. Motion detection thresholds for the CN group were 8 times less sensitive to the absolute and 17 times less sensitive to the relative motion of the target compared with the control group. CONCLUSIONS: These results suggest that in CN subjects perceptual stability is achieved primarily by extraretinal signals.

Dynamical systems analysis: a new method of analysing congenital nystagmus waveforms.

Congenital nystagmus is an oculomotor disorder in which fixation is disrupted by rhythmical, bilateral involuntary oscillations. Clinically these eye movements have been described with some degree of success in terms of their peak-to-peak amplitude, frequency, mean velocity and waveform shape. However, it has not proved possible to diagnose any underlying pathology from the nystagmus characteristics. Here, we propose a new approach to understanding the nystagmus using dynamical systems theory. Our approach is based on the use of delay embedding techniques, which allow one to relate a time series of scalar observations to the state space dynamics of the underlying dynamical system. Using this approach we quantify the dynamics of the nystagmus in the region of foveation and present evidence to suggest that it is low-dimensional and deterministic. Our results put new constraints on acceptable models of nystagmus and suggest a way to make a closer link between data analysis and model development. This approach raises the hope that techniques originally developed to stabilise chaotic systems, by using small perturbations, may prove useful in the control of nystagmus.