Clinical reading-related oculomotor assessment in visual snow syndrome / Evaluación oculomotora clínica relacionada con la lectura en el síndrome de nieve visual

Purpose: Visual snow syndrome (VSS) is a complex neurological condition presenting with an array of sensory, motor, and perceptual dysfunctions and related visual and non-visual symptoms. Recent laboratory studies have found subtle, basic, saccadic-based abnormalities in this population. The objective of the present investigation was to determine if saccadic-related problems could be confirmed and extended using three common clinical reading-related eye movement tests having well-developed protocols and normative databases. Methods: This was a retrospective analysis of 32 patients (ages 16–56 years) diagnosed with VSS in the first author's optometric practice. There was a battery of three reading-related tests: the Visagraph Reading Eye Movement Test, the Developmental Eye Movement (DEM) Test, and the RightEye Dynamic Vision Assessment Test, all performed using their standard documented protocols and large normative databases. Results: A high frequency of oculomotor deficits was found with all three tests. The greatest percentage was revealed with the Visagraph (56%) and the least with the RightEye (23%). A total of 77% of patients failed at least one of the three tests. Conclusion: The present findings confirm and extend earlier investigations revealing a high frequency of saccadic-based oculomotor problems in the VSS population, now including reading-related tasks. This is consistent with the more general oculomotor/motor problems found in these individuals.(AU)

Distance horizontal fusional facility (DFF): A new diagnostic vergence test for the acquired brain injury (ABI) population

Purpose To report the retrospectively-based, clinical diagnostic findings for the horizontal, distance, fusional facility (DFF) test in the non-TBI (traumatic brain inury), ABI (acquired brain injury) population. Methods The DFF test (4 pd base-out/2 pd base-in) was assessed and compared retrospectively in the first author's optometric practice in three clinical populations: (1) post-mTBI, visually-symptomatic (n = 52), (2) post-ABI, non-mTBI, visually-symptomatic (n = 34), and (3) visually-normal, visually asymptomatic (n = 44). Results The DFF values in each group were significantly different from each other (p < 0.05). The mean non-TBI, ABI group value was significantly lower than found in the mTBI group, and both were significantly lower than the mean found in the normal cohort (p < 0.05). There was a significant reduction in DFF with increased age (p < 0.001). ROC values for the AUC ranged from excellent to acceptable (0.94–0.74). Conclusion The DFF test is a new and useful way to assess horizontal, distance, dynamic, fusional facility in those with presumed non-mTBI, ABI neurological conditions to assist in its diagnosis. (AU)

Distance horizontal fusional facility (DFF): A new diagnostic vergence test for the acquired brain injury (ABI) population.

PURPOSE: To report the retrospectively-based, clinical diagnostic findings for the horizontal, distance, fusional facility (DFF) test in the non-TBI (traumatic brain inury), ABI (acquired brain injury) population. METHODS: The DFF test (4 pd base-out/2 pd base-in) was assessed and compared retrospectively in the first author's optometric practice in three clinical populations: (1) post-mTBI, visually-symptomatic (n = 52), (2) post-ABI, non-mTBI, visually-symptomatic (n = 34), and (3) visually-normal, visually asymptomatic (n = 44). RESULTS: The DFF values in each group were significantly different from each other (p < 0.05). The mean non-TBI, ABI group value was significantly lower than found in the mTBI group, and both were significantly lower than the mean found in the normal cohort (p < 0.05). There was a significant reduction in DFF with increased age (p < 0.001). ROC values for the AUC ranged from excellent to acceptable (0.94-0.74). CONCLUSION: The DFF test is a new and useful way to assess horizontal, distance, dynamic, fusional facility in those with presumed non-mTBI, ABI neurological conditions to assist in its diagnosis.

Clinical reading-related oculomotor assessment in visual snow syndrome.

PURPOSE: Visual snow syndrome (VSS) is a complex neurological condition presenting with an array of sensory, motor, and perceptual dysfunctions and related visual and non-visual symptoms. Recent laboratory studies have found subtle, basic, saccadic-based abnormalities in this population. The objective of the present investigation was to determine if saccadic-related problems could be confirmed and extended using three common clinical reading-related eye movement tests having well-developed protocols and normative databases. METHODS: This was a retrospective analysis of 32 patients (ages 16-56 years) diagnosed with VSS in the first author's optometric practice. There was a battery of three reading-related tests: the Visagraph Reading Eye Movement Test, the Developmental Eye Movement (DEM) Test, and the RightEye Dynamic Vision Assessment Test, all performed using their standard documented protocols and large normative databases. RESULTS: A high frequency of oculomotor deficits was found with all three tests. The greatest percentage was revealed with the Visagraph (56%) and the least with the RightEye (23%). A total of 77% of patients failed at least one of the three tests. CONCLUSION: The present findings confirm and extend earlier investigations revealing a high frequency of saccadic-based oculomotor problems in the VSS population, now including reading-related tasks. This is consistent with the more general oculomotor/motor problems found in these individuals.

Orthoptic Vision Therapy: Establishing a Protocol for Management of Diplopia Following Orbital Fracture Repair.

INTRODUCTION: Persistent diplopia following orbital fracture is a well-recognized problem. While observation is the standard-of-care, symptoms may be protracted. Orthoptic vision therapy is a form of ocular physical therapy that achieves functional rehabilitation through targeted exercises. This study presents a protocol for post-traumatic orthoptics and describes preliminary results. MATERIALS AND METHODS: Protocols for home-therapy/office-assessment were developed using commercial software and exercises targeting motility and fusion. Office-assessment also included validated questionnaire chronicling symptomatology. Healthy-volunteers (n = 10) trailed the protocol three times (n = 30) and normative data was compiled. Comparative measurements were made in chronic (>1year; n = 8) and acute (<2 weeks; n = 4) fracture cohorts. Time-of-therapy was recorded, monetary cost-analysis performed, and side-effects assessed. RESULTS: Severe/moderate motility limitation was found in 3 of 4 acute fracture patients but not in chronic or healthy cohorts. The acute cohort had worse fusion when comparing convergence (mean break/recovery of 8.0/6.5 prism diopters (pd) versus 31.87/21.23pd; P = 0.001/0.015) and divergence (3.00/1.50pd versus 18.37/12.83pd; P = 0.000/0.001) to the healthy cohort. Those with chronic fracture had lower convergence (15.71/5.00pd; P = 0.01/0.001) and divergence (12.29/4.71pd; P = 0.04/0.002) when compared with healthy subjects, but better function than acute patients. Acute fracture patients reported greater symptomatology than chronic (mean score 18.8 versus 4.6; P = 0.003) or healthy (5.0; P = 0.02) groups, but there was no difference between chronic and healthy groups (P = 0.87). Assessment took <10 minutes. Per patient software cost was <$70. Mild eyestrain related to therapy was self-resolving in all cases. CONCLUSIONS: Orthoptic therapy may improve fusion and motility following orbital fracture. This protocol serves as basis for prospective work.

Prevalence of esophoria in concussed patients / Prevalencia de la endoforia en los pacientes con conmoción

Purpose: To assess the prevalence of esophoria at near in concussed patients in a neuro-optometric private practice setting. Methods: A retrospective analysis was performed involving a chart review in a neuro-optometric, private practice setting of consecutive patients with a medical diagnosis of concussion from January 1st 2016 to December 31st 2016. A total of 71 patients were included in the analysis. All received a comprehensive vision examination, with a near vision emphasis. The near horizontal phoria was assessed with the cover test and the von Graefe test. Results: Approximately 30% of the patients with a medically based diagnosis of concussion exhibited esophoria at near, with good agreement (95%) between the two tests. Mean esophoria was 5.2 (SD=2.8) prism diopters (pd), with a range from 2pd to 14pd of esophoria. Convergence excess was diagnosed in 23%. Discussion: Near esophoria was found in nearly one-third of this practice-based sample of concussed patients. Thus, it was more common than typically believed to be the case. Two proposed oculomotor-based mechanisms related to these symptomatic esophoric patients included phoria decompensation and excessive accommodative vergence

Objetivo: Evaluar la prevalencia de la endoforia de cerca en pacientes con conmoción, en un centro privado de neuro-optometría. Métodos: Se realizó un análisis retrospectivo, en un centro privado de neuro-optometría, con revisión de las historias de pacientes consecutivos con diagnóstico médico de conmoción desde el 1 de enero al 31 de diciembre de 2016. Se incluyó en el análisis a un total de 71 pacientes. A todos ellos se les realizó un examen ocular amplio, enfatizando la visión de cerca. La foria horizontal de cerca se valoró mediante el cover test y la prueba de von Graefe. Resultados: Aproximadamente el 30% de los pacientes con diagnóstico médico de conmoción mostraron endoforia de cerca, con buena concordancia (95%) entre las dos pruebas. La endoforia media fue de 5,2 (SD = 2,8) dioptrías prismáticas (pd),con un rango de 2 pd a 14 pd de endoforia. El exceso de convergencia se diagnóstico en el 23%. Discusión: Se encontró endoforia de cerca en cerca del 25% de la muestra de pacientes con conmoción. Por tanto, esta condición clínica resultó ser más común de lo que se creía. Dos mecanismos propuestos basados en el sistema oculomotor con relación a estos pacientes endofóricos sintomáticos incluyeron descompensación de foria y exceso de vergencia acomodativa

Prevalence of esophoria in concussed patients.

PURPOSE: To assess the prevalence of esophoria at near in concussed patients in a neuro-optometric private practice setting. METHODS: A retrospective analysis was performed involving a chart review in a neuro-optometric, private practice setting of consecutive patients with a medical diagnosis of concussion from January 1st 2016 to December 31st 2016. A total of 71 patients were included in the analysis. All received a comprehensive vision examination, with a near vision emphasis. The near horizontal phoria was assessed with the cover test and the von Graefe test. RESULTS: Approximately 30% of the patients with a medically based diagnosis of concussion exhibited esophoria at near, with good agreement (95%) between the two tests. Mean esophoria was 5.2 (SD=2.8) prism diopters (pd), with a range from 2pd to 14pd of esophoria. Convergence excess was diagnosed in 23%. DISCUSSION: Near esophoria was found in nearly one-third of this practice-based sample of concussed patients. Thus, it was more common than typically believed to be the case. Two proposed oculomotor-based mechanisms related to these symptomatic esophoric patients included phoria decompensation and excessive accommodative vergence.

Elevated coherent motion thresholds in mild traumatic brain injury.

PURPOSE: Individuals with mild traumatic brain injury (mTBI) frequently complain of increased sensitivity to visual motion. Thus, the purpose of this study was to assess the coherent motion threshold (CMT) in subjects with mTBI and reported visual motion sensitivity. METHODS: Fourteen adult subjects with mTBI and symptoms of motion sensitivity were tested. They were compared with 40 age-matched asymptomatic visually normal individuals. CMT was assessed using a 2-alternative, forced choice paradigm. A symptom rating-scale questionnaire related to motion and light sensitivity, vertigo, and self-reported reading ability was also administered to the mTBI group. RESULTS: Mean CMTs were significantly elevated in the mTBI (8.81%) versus the normal subjects (6.53%). There was a trend for a progressive increase in mean CMT in mTBI with increased symptoms related to visual motion sensitivity and vertigo. However, there was no apparent relation to either light sensitivity or self-reported reading ability in mTBI. There was no significant age effect in either group. CONCLUSIONS: The elevated CMT in mTBI suggests damage to the magnocellular pathway, such as extrastriate visual cortical area V5, visual area medial temporal, and the medial superior temporal cortex, which is involved directly in various aspects of motion processing. These findings are consistent with the subjects' symptoms of motion sensitivity and vertigo in their natural environments.

Complex regional pain syndrome type I: associated visual sensorimotor case findings.

OBJECTIVE: The objective was to present new visual sensorimotor findings in a patient with complex regional pain syndrome type I, formerly known as reflex sympathetic dystrophy. DESIGN: Clinical measurements were compared for the following visual sensorimotor tasks before and after 10 minutes of near visual stimulation: accommodation, vergence, and reading eye movements. PATIENT: The patient was a 19-year-old female university student with complex regional pain syndrome type I. RESULTS: All visual sensorimotor findings worsened dramatically after performance of the brief near visual task. In addition, the patient experienced severe dizziness, nausea, dull eye ache, and general fatigue, which persisted for 30 to 45 minutes following each test period. CONCLUSIONS: The patient manifested signs and symptoms of complex regional pain syndrome type I per the prior neurologic diagnosis, as well as the newly diagnosed accommodative infacility, accommodative insufficiency, convergence insufficiency, and deficits of saccades and pursuits, which were severely debilitating. The findings neither support nor refute the conventional notion of abnormal sympathetic mediation as a mechanism of fatigue and pain. However, the diagnoses of accommodative infacility and insufficiency suggest abnormal parasympathetic activation. Further investigation is needed to characterize the array of visual dysfunctions in a large sample of such patients, which may help elucidate the precise underlying neurologic causes of the sensorimotor deficits in these patients.

A 13-year followup of a case of Wallenberg's syndrome: first-person account and ocular motor abnormalities.

BACKGROUND: We present a 13-year followup of a case of Wallenberg's syndrome, including a first-person account and ocular motor abnormalities. METHODS: Objective infrared eye-tracking systems were used to record horizontal and vertical eye movements binocularly under a variety of conditions. RESULTS: Fixation in the dark along the midline remained as before, with vestibular jerk nystagmus continuously present. While saccades and pursuit to a visual target also remained the same as found earlier, fixation was somewhat worse, revealing not only saccadic intrusions but also a prominent right-jerk nystagmus. DISCUSSION: The results suggest lack of additional oculomotor neural plasticity after the end of the initial 10-year test period, and furthermore reveal apparent subtle age-related changes in oculomotor responsivity.