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1.
Neurology ; 94(7): e705-e717, 2020 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-31964693

RESUMO

OBJECTIVE: A cross-sectional study was performed to evaluate whether quantitative oculomotor measures correlate with disease severity in late-onset GM2 gangliosidosis (LOGG) and assess cognition and sleep as potential early nonmotor features. METHODS: Ten patients with LOGG underwent quantitative oculomotor recordings, including measurements of the angular vestibulo-ocular reflex (VOR), with results compared to age- and sex-matched controls. Disease severity was assessed by ataxia rating scales. Cognitive/neuropsychiatric features were assessed by the cerebellar cognitive affective syndrome (CCAS) scale, Cerebellar Neuropsychiatric Rating Scale, and sleep quality evaluated using subjective sleep scales. RESULTS: Oculomotor abnormalities were found in all participants, including 3/10 with clinically normal eye movements. Abnormalities involved impaired saccadic accuracy (5/10), abnormal vertical (8/10) and horizontal (4/10) pursuit, reduced optokinetic nystagmus (OKN) responses (7/10), low VOR gain (10/10), and impaired VOR cancellation (2/10). Compared to controls, the LOGG group showed significant differences in saccade, VOR, OKN, and visually enhanced VOR gains. Severity of saccadic dysmetria, OKN, and VOR fixation-suppression impairments correlated with ataxia scales (p < 0.05). Nine out of ten patients with LOGG had evidence of the CCAS (5/10 definite, 2/10 probable, 2/10 possible). Excessive daytime sleepiness was present in 4/10 and 8/10 had poor subjective sleep quality. CONCLUSIONS: Cerebellar oculomotor abnormalities were present in all patients with LOGG, including those with normal clinical oculomotor examinations. Saccade accuracy (dorsal cerebellar vermis localization), fixation suppression, and OKN gain (cerebellar flocculus/paraflocculus localization) correlated with disease severity, suggesting that quantitative oculomotor measurements could be used to track disease progression. We found evidence of the CCAS, suggesting that cerebellar dysfunction may explain the cognitive disorder in LOGG. Sleep impairments were prevalent and require further study.


Assuntos
Movimentos Oculares , Gangliosidoses GM2/diagnóstico , Adulto , Encéfalo/diagnóstico por imagem , Cognição , Estudos de Coortes , Estudos Transversais , Feminino , Gangliosidoses GM2/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/fisiopatologia , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Sono , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/fisiopatologia
3.
Am J Ophthalmol ; 209: 107-116, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31472159

RESUMO

PURPOSE: To study effects of age and horizontal duction on deformation of the optic nerve head (ONH) and peripapillary retina (PPR), as reflected by displacement of vascular landmarks, to explore the influence of adduction tethering. DESIGN: Cross-sectional study. METHODS: Setting: University. STUDY POPULATION: Single eyes of 20 healthy young adults (average age 23.9 ± 3.9 [SD] years) were compared to 20 older subjects (average age 61.4 ± 9.3 years). Observational Procedure: The disc and PPR were imaged by scanning laser ophthalmoscopy in central gaze and at 35 degrees abduction and adduction. MAIN OUTCOME MEASURE: Deformations of the disc and adjacent PPR were measured by comparing positions of epipapillary and epiretinal blood vessels. RESULTS: Vessels within the ONH of younger subjects shifted temporally during adduction and nasally during abduction. Displacement of the nasal hemi-disc in adduction was greater at 38.5 ± 1.7 µm (standard error of mean) than the temporal half at 4.1 ± 2.1 µm (P < .001). PPR within 1 radius of the disc margin underwent 7.6 ± 1.6 µm average temporal displacement in adduction in young subjects. In abduction, the young temporal hemi-disc shifted 4.4 ± 0.6 µm nasally without significant displacement in the nasal half. Older subjects' ONH showed less temporal shift and less displacement in the PPR within 1 disc radius (P < .0001) in adduction; the nasal hemi-disc shifted 24.5 ± 1.3 µm compared with 4.4 ± 2.1 µm in the temporal half. There were no significant deformations of the disc during abduction by older subjects. CONCLUSION: Large horizontal duction, particularly adduction, deforms the disc and peripapillary vasculature. This deformation, which is larger in younger than older subjects, may be due to optic nerve tethering in adduction.


Assuntos
Envelhecimento/fisiologia , Transtornos da Motilidade Ocular/fisiopatologia , Disco Óptico/patologia , Doenças do Nervo Óptico/fisiopatologia , Retina/patologia , Doenças Retinianas/fisiopatologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Transtornos da Motilidade Ocular/diagnóstico , Oftalmoscopia , Doenças do Nervo Óptico/diagnóstico , Doenças Retinianas/diagnóstico , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica , Adulto Jovem
4.
BMC Ophthalmol ; 19(1): 257, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842796

RESUMO

BACKGROUND: Lithium salts have been commonly used for prophylaxis and treatment of bipolar disorder and have numerous side effects. However, there has been no report of skew deviation and downbeat nystagmus associated with lithium. Herein, we report the first case of lithium-induced skew deviation and downbeat nystagmus. CASE PRESENTATION: A 39 years-old woman presented with intermittent vertical diplopia and dizziness within 1-2 months. Ophthalmologic examination revealed downbeat nystagmus and 6 prism diopters of right hypertropia. Funduscopic examination showed mild incyclotorsion on right eye. However, ductions and versions were within normal range. Other neurological examinations were also normal. She had a history of bipolar disorder treated with daily 600-900 mg of lithium for past 6 years, and 2 months before the first visit, daily dose of lithium was increased to 1200 mg. We referred the patients to psychiatrist. Although the serum level of lithium was within the normal therapeutic range, her daily dose of lithium was reduced to 600 mg and then stopped. 6 days after cessation of lithium, down beat nystagmus and right hypertropia were completely resolved and symptoms did not recur over a year. CONCLUSION: Even within a normal therapeutic range, downbeat nystagmus and skew deviation can occur as side effect of lithium. Dehydration may contribute to the neurotoxicity of lithium.


Assuntos
Transtorno Bipolar/tratamento farmacológico , Compostos de Lítio/efeitos adversos , Nistagmo Patológico/induzido quimicamente , Transtornos da Motilidade Ocular/induzido quimicamente , Adulto , Encéfalo/diagnóstico por imagem , Diplopia/fisiopatologia , Feminino , Humanos , Compostos de Lítio/administração & dosagem , Imagem por Ressonância Magnética , Nistagmo Patológico/fisiopatologia , Transtornos da Motilidade Ocular/fisiopatologia , Visão Binocular/fisiologia
5.
J Clin Neurophysiol ; 36(6): 396-404, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31688322

RESUMO

The brainstem contains ocular motor and vestibular structures that, when damaged, produce specific eye movement disorders. In this review, we will discuss three brainstem syndromes with characteristic ocular motor and vestibular findings that can be highly localizing. First, we will discuss the lateral medullary (Wallenberg) syndrome, focusing on ocular lateropulsion, saccadic dysmetria, and the ocular tilt reaction. Second, we will review the medial longitudinal fasciculus syndrome including the ocular tilt reaction, nystagmus, and the vestibular-ocular reflex. Lastly, we will discuss hypertrophic olivary degeneration and oculopalatal tremor, which may develop weeks to months after a brainstem or cerebellar lesion. In these syndromes, the clinical ocular motor and vestibular examination is instrumental in localizing the lesion.


Assuntos
Encefalopatias , Tronco Encefálico , Transtornos da Motilidade Ocular , Doenças Vestibulares , Encefalopatias/complicações , Tronco Encefálico/patologia , Tronco Encefálico/fisiopatologia , Humanos , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/fisiopatologia , Síndrome , Doenças Vestibulares/etiologia , Doenças Vestibulares/fisiopatologia
6.
J Clin Neurophysiol ; 36(6): 405-414, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31688323

RESUMO

The cerebellum works as a network hub for optimizing eye movements through its mutual connections with the brainstem and beyond. Here, we review three key areas in the cerebellum that are related to the control of eye movements: (1) the flocculus/paraflocculus (tonsil) complex, primarily for high-frequency, transient vestibular responses, and also for smooth pursuit maintenance and steady gaze holding; (2) the nodulus/ventral uvula, primarily for low-frequency, sustained vestibular responses; and (3) the dorsal vermis/posterior fastigial nucleus, primarily for the accuracy of saccades. Although there is no absolute compartmentalization of function within the three major ocular motor areas in the cerebellum, the structural-functional approach provides a framework for assessing ocular motor performance in patients with disease that involves the cerebellum or the brainstem.


Assuntos
Cerebelo , Movimentos Oculares/fisiologia , Transtornos da Motilidade Ocular , Animais , Cerebelo/fisiologia , Cerebelo/fisiopatologia , Humanos , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/fisiopatologia
7.
Continuum (Minneap Minn) ; 25(5): 1376-1400, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31584542

RESUMO

PURPOSE OF REVIEW: This article provides an overview of nystagmus and saccadic intrusions with the goal of facilitating recognition and differentiation of abnormal eye movements to assist with accurate diagnosis of neurologic disease and evidence-based specific treatment of oscillopsia. Myriad advances have been made in the understanding of several types of nystagmus and saccadic intrusions, even in the past 5 to 10 years, especially regarding underlying pathophysiology, leading to pharmacologic advances rooted in physiologic principles. RECENT FINDINGS: Specific recent advances in the study of nystagmus and saccadic intrusions include (1) improved understanding of the underlying etiologies and mechanisms of nystagmus enhanced or unmasked by provocative maneuvers such as supine position or head shaking; (2) recognition of the differences in behavior and treatment responsivity of acquired pendular nystagmus in demyelinating disease versus oculopalatal myoclonus; (3) recognition that oculopalatal myoclonus results from a dual mechanism of abnormal inferior olivary gap junction connection formation and maladaptive cerebellar learning; and (4) well-controlled clinical trials to evaluate the efficacy of pharmacologic interventions, such as memantine for acquired pendular nystagmus and 4-aminopyridine for downbeat nystagmus. SUMMARY: Accurate recognition of nystagmus and saccadic intrusions, including familiarity with the subtleties of examination techniques that allow such eye movements to be unmasked, is critical to proper diagnosis and ultimate alleviation of the visual impairment these patients experience.


Assuntos
Fixação Ocular/fisiologia , Nistagmo Patológico/fisiopatologia , Transtornos da Motilidade Ocular/fisiopatologia , Movimentos Sacádicos/fisiologia , Adulto , Feminino , Humanos , Nistagmo Patológico/congênito , Nistagmo Patológico/etiologia , Transtornos da Motilidade Ocular/etiologia
8.
Invest Ophthalmol Vis Sci ; 60(12): 3970-3979, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31560371

RESUMO

Purpose: Pattern strabismus is characterized by a cross-axis pattern of horizontal and vertical misalignments. In A-pattern strabismus, for example, a divergent change in the horizontal misalignment occurs on downgaze. Work with nonhuman primate models has provided evidence that this disorder is associated with abnormal cross-talk between brainstem pathways that normally encode horizontal and vertical eye position and velocity. Neurons in the interstitial nucleus of Cajal (INC) are normally sensitive to vertical eye position; in the present study, we test the hypothesis that, in monkeys with pattern strabismus, some INC neurons will show an abnormal sensitivity to horizontal eye position. Methods: Monkeys were rewarded for fixating a visual target that stepped to various locations on a tangent screen. Single neurons were recorded from INC in one normal monkey, and two with A-pattern strabismus. Multiple linear regression analysis was used to estimate the preferred direction for each neuron. Results: In the normal monkey, all INC neurons had preferred directions within 20° of pure vertical (either up or down). The preferred directions were significantly more variable in the monkeys with pattern strabismus, with a minority being more sensitive to horizontal eye position than vertical eye position. In addition, the vertical eye position sensitivity was significantly less in the monkeys with strabismus. Conclusions: In pattern strabismus, neurons in INC show neurophysiological abnormalities consistent with a failure to develop normal tuning properties. Results were consistent with the hypothesis that, in pattern strabismus, INC receives an abnormally strong signal related to horizontal eye position.


Assuntos
Neurônios Motores/fisiologia , Transtornos da Motilidade Ocular/fisiopatologia , Estrabismo/fisiopatologia , Tegmento Mesencefálico/fisiopatologia , Animais , Movimentos Oculares/fisiologia , Fixação Ocular/fisiologia , Macaca mulatta , Macaca nemestrina
9.
BMJ Case Rep ; 12(9)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31519722

RESUMO

Monocular elevation deficit can result from either inferior rectus restriction, superior rectus palsy or from supranuclear causes. We report a case of monocular elevation deficit after scleral perforation repair which was managed by surgery on contra lateral eye. This improved elevation of the affected eye with no diplopia in the postoperative period.


Assuntos
Diplopia/etiologia , Transtornos da Motilidade Ocular/cirurgia , Oftalmoplegia/etiologia , Esclera/lesões , Adulto , Diagnóstico Diferencial , Diplopia/diagnóstico , Diplopia/prevenção & controle , Movimentos Oculares/fisiologia , Humanos , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Músculos Oculomotores/patologia , Músculos Oculomotores/fisiopatologia , Músculos Oculomotores/cirurgia , Oftalmoplegia/fisiopatologia , Período Pós-Operatório , Esclera/patologia , Esclera/cirurgia , Perfuração Espontânea/cirurgia , Resultado do Tratamento
10.
Korean J Ophthalmol ; 33(4): 353-358, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31389211

RESUMO

PURPOSE: To evaluate the long-term efficacy of slanted lateral rectus recession in children for reducing distance and near exodeviation and near-distance deviation difference in intermittent exotropia with convergence insufficiency. METHODS: The medical records of 53 patients with convergence insufficiency intermittent exotropia who underwent slanted bilateral lateral rectus recession performed by a single surgeon and received follow-up for more than 12 months were retrospectively analyzed. Deviation angles at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively and on the last visit were reviewed. Surgical success was defined as postoperative residual distance and near deviation angles ≤8 prism diopters and a difference between the near and distance angles ≤8 prism diopters. RESULTS: The mean duration of follow-up was 24 months (range, 12 to 61 months). On the last visit, the residual deviation angles were ≤8 prism diopters in 75.5% for distance, 62.3% for near, and 81.1% for the near-distance difference. Surgical success was achieved in 31 (58.5%) patients, and none of them manifested limitations in eye movements or diplopia at the last follow-up visit. CONCLUSIONS: Slanted lateral rectus recession is an effective surgical method for reducing distance and near exodeviation and near-distance deviation difference in intermittent exotropia with convergence insufficiency.


Assuntos
Convergência Ocular/fisiologia , Exotropia/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Visão Binocular/fisiologia , Adolescente , Criança , Pré-Escolar , Exotropia/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Transtornos da Motilidade Ocular/cirurgia , Músculos Oculomotores/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
12.
Curr Opin Ophthalmol ; 30(6): 443-448, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31449085

RESUMO

PURPOSE OF REVIEW: Impaired eye movements are frequently seen in ophthalmic and neurologic clinical practice, especially in individuals with movement disorders. Identification of the abnormal movement can aid initial diagnosis and improve understanding of the underlying disease pathophysiology. The present article reviews the ocular motor manifestations and recent research on them in common movement disorders. RECENT FINDINGS: Ocular motor manifestations and their pathophysiologic correlates are being defined. In particular, study of eye movements can help clarify the changing clinicopathologic spectrum of atypical parkinsonian disorders. The pathophysiology and natural history of blepharospasm are being elucidated. Recent research focuses on high-resolution imaging and other technological advances to improve the sensitivity of the ocular motility exam. Eye movements are being studied as biomarkers for diagnosis and progression in clinical care and trials. SUMMARY: The current review summarizes ocular motor manifestations in common movement disorders, and presents recent research investigating their cause and treatment.


Assuntos
Blefarospasmo/diagnóstico , Doença de Huntington/diagnóstico , Doença de Niemann-Pick Tipo C/diagnóstico , Transtornos da Motilidade Ocular/diagnóstico , Doença de Parkinson/diagnóstico , Ataxias Espinocerebelares/diagnóstico , Blefarospasmo/fisiopatologia , Movimentos Oculares/fisiologia , Humanos , Doença de Huntington/fisiopatologia , Doença de Niemann-Pick Tipo C/fisiopatologia , Transtornos da Motilidade Ocular/fisiopatologia , Doença de Parkinson/fisiopatologia , Ataxias Espinocerebelares/fisiopatologia
14.
Curr Opin Ophthalmol ; 30(5): 314-318, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31313749

RESUMO

PURPOSE OF REVIEW: Congenital fibrosis of the extraocular muscles (CFEOM) is caused by abnormal development of the innervation of extraocular muscles. We update the recent literature regarding the clinical, anatomic, genetic, and molecular characteristics of CFEOM. Surgical considerations are addressed. RECENT FINDINGS: CFEOM is broken down into three main subtypes, CFEOM1, CFEOM2, and CFEOM3. Several recent reports of individuals, as well as family pedigrees, highlight the phenotypic heterogeneity of CFEOM. Intracranial and intraorbital radiologic findings have enhanced our understanding of the disease pathophysiology. Molecular genetics research has increased our understanding of the development of extraocular muscles and their innervation as well as pathophysiology of CFEOM. SUMMARY: Our understanding of the pathophysiology of CFEOM has increased with the recent contributions from neuroimaging, molecular genetics, and pedigree analysis. Surgical management of patients with CFEOM continues to be challenging.


Assuntos
Fibrose , Oftalmoplegia , Blefaroptose/fisiopatologia , Blefaroptose/cirurgia , Oftalmopatias Hereditárias/fisiopatologia , Oftalmopatias Hereditárias/cirurgia , Fibrose/classificação , Fibrose/fisiopatologia , Fibrose/cirurgia , Humanos , Transtornos da Motilidade Ocular/fisiopatologia , Transtornos da Motilidade Ocular/cirurgia , Oftalmoplegia/classificação , Oftalmoplegia/fisiopatologia , Oftalmoplegia/cirurgia , Fenótipo
15.
Optom Vis Sci ; 96(8): 542-555, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31343512

RESUMO

SIGNIFICANCE: This study reports prevalence data combined independently for accommodative dysfunction, convergence insufficiency, visual field loss, and visual acuity loss in patients with traumatic brain injury in the absence of eye injury. OBJECTIVE: The objective of this study was to conduct a systematic review and meta-analysis to determine the prevalence rates of accommodative dysfunction, convergence insufficiency, visual field loss, and visual acuity loss in TBI patients without concomitant eye injury. DATA SOURCES: The data sources used in this study were PubMed, EMBASE, EBSCO, and Cochrane Library. STUDY APPRAISAL AND SYNTHESIS METHODS: Publications reporting the prevalence of diagnosed accommodative dysfunction, convergence insufficiency, visual field loss, or visual acuity loss to the level of legal blindness in TBI patients of any age were included. Univariate metaregression analyses and subgroup analyses were performed to account for statistical heterogeneity. RESULTS: Twenty-two eligible publications were identified across the four visual conditions. Random-effects models yielded combined prevalence estimates: accommodative dysfunction (42.8; 95% confidence interval [CI], 31.3 to 54.7), convergence insufficiency (36.3%; 95% CI, 28.2 to 44.9%), visual field loss (18.2%; 95% CI, 10.6 to 27.1%), and visual acuity loss (0.0%; 95% CI, 0.0 to 1.1%). Metaregression and subgroup analyses revealed that visual field loss was significantly more prevalent in moderate to severe (39.8%; 95% CI, 29.8 to 50.3%) compared with mild TBI (6.6%; 95% CI, 0 to 19.5%). CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: This study demonstrates that accommodative dysfunction, convergence insufficiency, and visual field loss are common sequelae of TBI. Prospective longitudinal research with rigorous and uniform methodology is needed to better understand short- and long-term effects of TBI on the vision system.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Transtornos da Motilidade Ocular/etiologia , Transtornos da Visão/etiologia , Acomodação Ocular/fisiologia , Lesões Encefálicas Traumáticas/fisiopatologia , Humanos , Transtornos da Motilidade Ocular/fisiopatologia , Transtornos da Visão/fisiopatologia , Acuidade Visual/fisiologia , Campos Visuais/fisiologia
16.
J Binocul Vis Ocul Motil ; 69(3): 116-125, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31161888

RESUMO

Amblyopia is a neurodevelopmental disorder of the visual system, as a result of discordant visual experience during infancy or early childhood. Because amblyopia is typically defined as monocularly reduced visual acuity accompanied by one or more known amblyogenic factors, it is often assumed that the fellow eye is normal and sufficient for tasks like reading and eye-hand coordination. Recent scientific evidence of ocular motor, visual, and visuomotor deficits that are present with fellow eye monocular viewing and with binocular viewing calls this assumption into question. This clinical update reviews the research that has revealed fellow ocular motor and visual deficits and the effect that these deficits have on an amblyopic child's visuomotor and visuocognitive skills. We need to understand how to prevent and rehabilitate the effects of amblyopia not only on the nonpreferred eye but also on the fellow eye.


Assuntos
Ambliopia/diagnóstico , Técnicas de Diagnóstico Oftalmológico , Ambliopia/fisiopatologia , Criança , Humanos , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/fisiopatologia , Transtornos da Percepção/diagnóstico , Transtornos da Percepção/fisiopatologia , Exame Físico , Desempenho Psicomotor , Visão Binocular/fisiologia , Acuidade Visual/fisiologia
17.
Neurology ; 92(20): e2299-e2308, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31004067

RESUMO

OBJECTIVE: We present an objective and quantitative approach for diagnosing internuclear ophthalmoplegia (INO) in multiple sclerosis (MS). METHODS: A validated standardized infrared oculography protocol (DEMoNS [Demonstrate Eye Movement Networks with Saccades]) was used for quantifying prosaccades in patients with MS and healthy controls (HCs). The versional dysconjugacy index (VDI) was calculated, which describes the ratio between the abducting and adducting eye. The VDI was determined for peak velocity, peak acceleration, peak velocity divided by amplitude, and area under the curve (AUC) of the saccadic trajectory. We calculated the diagnostic accuracy for the several VDI parameters by a receiver operating characteristic analysis comparing HCs and patients with MS. The National Eye Institute Visual Function Questionnaire-25 was used to investigate vision-related quality of life of MS patients with INO. RESULTS: Two hundred ten patients with MS and 58 HCs were included. The highest diagnostic accuracy was achieved by the VDI AUC of 15° horizontal prosaccades. Based on a combined VDI AUC and peak velocity divided by amplitude detection, the prevalence of an INO in MS calculated to 34%. In the INO group, 35.2% of the patients with MS reported any complaints of double vision, compared to 18.4% in the non-INO group (p = 0.010). MS patients with an INO had a lower overall vision-related quality of life (median 89.9, interquartile range 12.8) compared to patients without an INO (median 91.8, interquartile range 9.3, p = 0.011). CONCLUSIONS: This study provides an accurate quantitative and clinically relevant definition of an INO in MS. This infrared oculography-based INO standard will require prospective validation. The high prevalence of INO in MS provides an anatomically well described and accurately quantifiable model for treatment trials in MS.


Assuntos
Esclerose Múltipla/fisiopatologia , Transtornos da Motilidade Ocular/diagnóstico , Adulto , Idoso , Medições dos Movimentos Oculares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Transtornos da Motilidade Ocular/epidemiologia , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/fisiopatologia
18.
Invest Ophthalmol Vis Sci ; 60(5): 1657-1669, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30999321

RESUMO

Purpose: Human children with disorders affecting vergence eye movements have difficulty during close work, such as reading. Patients with convergence insufficiency show a receded near point and an exophoria that is greater at near than at far. Neurologic abnormalities may underlie these symptoms, but it is difficult to test this idea directly because there is no animal model for this disorder. In the present case report, we describe behavioral testing in a rhesus monkey with a naturally occurring impairment of vergence eye movements (monkey CI). Methods: Three monkeys were trained to perform a variety of oculomotor tasks that required saccades, vergence, and/or smooth tracking of a visual target moving in depth. Results: Two of the monkeys (N1 and N2) were able to perform these tasks correctly. The third, monkey CI, was able to correctly perform these tasks when the required vergence angle was ≤5° but had difficulty when the task required larger convergence. This animal showed a consistent exodeviation that worsened as the target drew closer. When a variable prism was used to test disparity vergence in monkey CI, the animal showed an unstable convergence response (maximum 6°) that increased with prism correction, up to 12 prism diopters. By comparison, monkey N1 was able to achieve stable, appropriate convergence up to 26 prism diopters. Monkey CI's performance on vergence tasks improved when a large-field random checkerboard pattern was used to provide additional depth cues. Conclusions: Monkey CI appears to have a naturally occurring disorder of vergence eye movements.


Assuntos
Comportamento Animal/fisiologia , Transtornos da Motilidade Ocular/fisiopatologia , Movimentos Sacádicos/fisiologia , Disparidade Visual/fisiologia , Visão Binocular/fisiologia , Acomodação Ocular/fisiologia , Animais , Fixação Ocular/fisiologia , Macaca mulatta
19.
Invest Ophthalmol Vis Sci ; 60(5): 1670-1676, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30999322

RESUMO

Purpose: Convergence insufficiency is a very common disorder that can have significant adverse effects on school performance. When reading, children with this disorder often experience diplopia and headaches. We have recently obtained a rhesus monkey with a naturally occurring impairment of vergence eye movements. In the companion paper, we report behavioral testing that shows a pattern of impairments similar to what clinicians observe in human children with convergence insufficiency, including a receded near point, an exophoria that increases as target distance decreases, and difficulty maintaining an appropriate vergence angle when presented with a large field stimulus at near. For the present case report, we wondered whether these behavioral deficits would be associated with abnormal discharge patterns in brainstem neurons related to vergence eye movements. Methods: Single unit activity was recorded from near and far response cells in the supraoculomotor area in the vergence-impaired monkey, while he performed a smooth vergence tracking task or fixated visual targets at different distances. Results: We found an abnormally weak sensitivity to both vergence angle and vergence velocity. Nonetheless, these neurons modulated in association with contextually inappropriate slow vergence movements that occurred in the absence of saccades but not for slow divergence drifts that immediately followed converging saccades. Modulation of activity was more robust when additional depth cues were available. Conclusions: These data suggest that disorders affecting vergence eye movements may be associated with impoverished sensory input to the near and far response cells and, perhaps, aberrant tuning in vergence-related neurons.


Assuntos
Transtornos da Motilidade Ocular/fisiopatologia , Complexo Nuclear Oculomotor/fisiopatologia , Disparidade Visual/fisiologia , Animais , Fixação Ocular/fisiologia , Macaca mulatta , Movimentos Sacádicos/fisiologia , Visão Binocular/fisiologia
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