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Publication History View all

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    ABSTRACT: Two cases of cerebellar tonsilar herniation due to shunt complications in idiopathic intracranial hypertension are reported in which both patients presented with visual symptoms. One patient had horizontal diplopia due to an acute sixth nerve palsy along with severe constriction of visual fields while the second patient had symptoms of blurred vision. Both patients required neurosurgery, one patient requiring surgery for tonsillar descent and revision of an over-draining lumbar peritoneal shunt and the second patient only requiring revision of his over-draining lumbar peritoneal shunt. Following surgery the visual signs of reduced vision, cranial nerve palsy, and visual field loss gradually resolved. Both patients had normal ocular movements and visual fields at final follow-up.
    Strabismus 12/2012; 20(4):181-4.
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    ABSTRACT: The use of botulinum toxin as an investigative and treatment modality for strabismus is well reported in the medical literature. However it is unclear how effective its use is in comparison to other treatment options for strabismus. To evaluate the efficacy of botulinum toxin in the treatment of strabismus compared with alternative treatment options, to investigate dose effect and complication rates. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 11), MEDLINE (January 1950 to December 2011), EMBASE (January 1980 to December 2011), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to December 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 5 December 2011. We manually searched the Australian Orthoptic Journal and British and Irish Orthoptic Journal and ESA, ISA and IOA conference proceedings. We attempted to contact researchers who are active in this field for information about further published or unpublished studies. We included randomised controlled trials (RCTS) of any use of botulinum toxin treatment for strabismus. Each review author independently assessed study abstracts identified from the electronic and manual searches. Author analysis was then compared and full papers for appropriate studies were obtained. We found four RCTs that were eligible for inclusion. Two trials found that there was no difference between the use of botulinum toxin and surgery for patients requiring retreatment for acquired esotropia or infantile esotropia. There was no evidence for a prophylactic effect of botulinum toxin in a treatment trial of acute onset sixth nerve palsy. Botulinum toxin had a poorer response than surgery in a trial of patients requiring treatment for horizontal strabismus in the absence of binocular vision. Reported complications included ptosis and vertical deviation and ranged from 24% in a trial using Dysport™ to 52.17% and 55.54% in trials using Botox™. The majority of published literature on the use of botulinum toxin in the treatment of strabismus consists of retrospective studies, cohort studies or case reviews. Although these provide useful descriptive information, clarification is required as to the effective use of botulinum toxin as an independent treatment modality. Four RCTs on the therapeutic use of botulinum toxin in strabismus have shown varying responses ranging from a lack of evidence for prophylactic effect of botulinum toxin in acute sixth nerve palsy, to poor response in patients with horizontal strabismus without binocular vision, to no difference in response in patients that required retreatment for acquired esotropia or infantile esotropia. It was not possible to establish dose effect information. Complication rates for use of Botox™ or Dysport™ ranged from 24% to 55.54%.
    Cochrane database of systematic reviews (Online) 01/2012; 2:CD006499.
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    ABSTRACT: To review the literature on visual impairment in children in order to determine which manneristic behaviors are associated with visual impairment, and to establish why these behaviors occur and whether severity of visual impairment influences these behaviors. A literature search utilizing PubMed, OVID, Google Scholar, and Web of Knowledge databases was performed. The University of Liverpool ( www.liv.ac.uk/orthoptics/research ) and local library facilities were also searched. The main manneristic or stereotypic behaviors associated with visual impairment are eye-manipulatory behaviors, such as eye poking and rocking. The degree of visual impairment influences the type of behavior exhibited by visually impaired children. Totally blind children are more likely to adopt body and head movements whereas sight-impaired children tend to adopt eye-manipulatory behaviors and rocking. The mannerisms exhibited most frequently are those that provide a specific stimulation to the child. Theories to explain these behaviors include behavioral, developmental, functional, and neurobiological approaches. Although the precise etiology of these behaviors is unknown, it is recognized that each of the theories is useful in providing some explanation of why certain behaviors may occur. The age at which the frequency of these behaviors decreases is associated with the child's increasing development, thus those visually impaired children with additional disabilities, whose development is impaired, are at an increased risk of developing and maintaining these behaviors. Certain manneristic behaviors of the visually impaired child may also help indicate the cause of visual impairment. There is a wide range of manneristic behaviors exhibited by visually impaired children. Some of these behaviors appear to be particularly associated with certain causes of visual impairment or severity of visual impairment, thus they may supply the practitioner with useful information. Further research into the prevalence of these behaviors in the visually impaired child is required in order to provide effective management.
    Strabismus 09/2011; 19(3):77-84.
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    ABSTRACT: Occurrence of ocular motor cranial nerve palsies (OMCNP), following stroke, has not been reported in relation to the type of OMCNP seen and in relation to brain area affected by stroke. The aim of this study was to identify all patients referred with suspected visual impairment to establish the presence and type of OMCNP. Prospective, observation study with standardised referral and assessment forms across 20 sites. Visual assessment included visual acuity measurement, visual field assessment, ocular alignment, and movement and visual inattention assessment. Multicentre ethics approval and informed patient consent was obtained. In total, 915 patients were recruited with mean age of 69.18 years (SD 14.19). Altogether, 498 patients (54%) were diagnosed with ocular motility abnormalities. Of these, 89 patients (18%) had OMCNP. Unilateral third nerve palsy was present in 23 patients (26%), fourth nerve palsy in 14 patients (16%), and sixth nerve palsy in 52 patients (58%). Out of these, 44 patients had isolated OMCNP and 45 had OMCNP combined with other ocular motility abnormalities. Location of stroke was reported mainly in cerebellum, brain stem, thalamus, and internal and external capsules. Treatment was provided for each case including prisms, occlusion, typoscope, scanning exercises, and refraction. OMCNP account for 18% of eye movement abnormalities in this stroke sub-population. Sixth CNP was most common, followed by third and fourth CNP. Half were isolated and half combined with other eye movement abnormality. Most were treated with prisms or occlusion. The reported brain area affected by stroke was typically the cerebellum, brain stem, and diencephalic structures.
    Eye (London, England) 04/2011; 25(7):881-7.
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    ABSTRACT: Ocular causes of reading impairment following stroke include visual field loss, eye movement impairment and poor central vision. Non ocular causes may include cognitive errors or language impairment. The purpose of this study was to identify all patients referred with suspected visual impairment who had reported reading difficulty to establish the prevalence of ocular and non ocular causes. Prospective, multicentre, observation study with standardised referral and assessment forms across 21 sites. Visual assessment included visual acuity measurement, visual field assessment, ocular alignment, and movement and visual inattention assessment. Multicentre ethical approval and informed patient consent were obtained. A total of 915 patients were recruited, with a mean age of 69·18 years (standard deviation 14·19). Reading difficulties were reported by 177 patients (19·3%), with reading difficulty as the only symptom in 39 patients. Fifteen patients had normal visual assessment but with a diagnosis of expressive or receptive aphasia. Eight patients had alexia. One hundred and nine patients had visual field loss, 85 with eye movement abnormality, 27 with low vision and 39 patients with visual perceptual impairment. Eighty-seven patients had multiple ocular diagnoses with combined visual field, eye movement, low vision or inattention problems. All patients with visual impairment were given targeted treatment and/or advice including prisms, occlusion, refraction, low vision aids and scanning exercises. Patients complaining of reading difficulty were mostly found to have visual impairment relating to low vision, eye movement or visual field loss. A small number were found to have non ocular causes of reading difficulty. Treatment or advice was possible for all patients with visual impairment.
    International Journal of Stroke 03/2011; 6(5):404-11.
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    ABSTRACT: Impaired visual function occurs frequently in patients with idiopathic intracranial hypertension (IIH) and may be the most seriously affected function following raised intracranial pressure. The aim of this review was to overview the methods available for the assessment of visual function in IIH. A review of databases, including PubMed, Web of Knowledge and ocular and motility and strabismus was undertaken to identify articles relating to visual function and its assessment in IIH. Options for visual assessment include fundus evaluation, retinal imaging, visual field, visual acuity, contrast sensitivity, colour vision, electrodiagnostic and ocular motility evaluations. Many aspects of visual function assessment contribute to the monitoring of vision in patients with IIH. However, the assessment of visual field, plus fundus and retinal imaging, are particularly important in providing accurate and repeatable measurements on which to determine the progression of the condition.
    British Journal of Neurosurgery 02/2011; 25(1):45-54.
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    ABSTRACT: To evaluate accuracy of referrals from multidisciplinary stroke teams requesting visual assessments. Multicentre prospective study undertaken in 20 acute Trust hospitals. Stroke survivors referred with suspected visual difficulty were recruited. Standardised screening/referral and investigation forms were used to document data on referral signs and symptoms, plus type and extent of visual impairment. Referrals for 799 patients were reviewed: 60% men, 40% women. Mean age at onset of stroke was 69 years (SD 14: range 1-94 years). Signs recorded by referring staff were nil in 58% and positive in the remainder. Symptoms were recorded in 87%. Diagnosis of visual impairment was nil in 8% and positive in the remainder. Sensitivity of referrals (on the basis of signs detected) was calculated as 0.42 with specificity of 0.52. Kappa statistical evaluation of agreement between referral and diagnosis of visual impairment was 0.428 (SE 0.017: 95% confidence interval of -0.048, 0.019). More than half of patient referrals were made despite no signs of visual difficulty being recorded by the referring staff. Visual impairment of varying severity was diagnosed in 92% of stroke survivors referred for visual assessment. Referrals were made based predominantly on visual symptoms and because of formal orthoptic liaison in Trusts involved.
    Eye (London, England) 02/2011; 25(2):161-7.
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    ABSTRACT: BaCKGROUND AND PURPOSE: Intermittent distance exotropia is difficult to conservatively manage, with techniques varying widely between institutions. This review aims to examine current literature on conservative management for intermittent distance exotropia, investigate its impact upon current clinical practice, and identify areas for further research. A literature search was performed using PubMed, Web of Knowledge, LILACS, and the University of Liverpool Orthoptic Journals and Conference Transactions Database. All English-language papers published between 1950 and the present day were considered. Intermittent distance exotropia is a difficult condition to manage because of its variability / uncertain natural history, although control scores can facilitate management decisions. Research is required to establish recommended dosages for antisuppression occlusion and determine whether other treatments such as minus lenses are more effective. Use of orthoptic exercises has declined, but recently certain exercises have been shown to improve surgical outcomes if applied preoperatively. Prisms are mainly used postoperatively. Minus lens therapy is recommended as a first line treatment, but may not always be successful. Conservative management techniques for intermittent distance exotropia have their place as both an alternative and an adjunct to surgery. However, further research needs to be conducted to determine which techniques are appropriate for which patients.
    American Orthoptic Journal 01/2011; 61:103-16.
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    ABSTRACT: To compare the range of ocular rotations measured by Octopus versus Goldmann perimetry. Forty subjects (20 controls and 20 patients with impaired ocular movements) were prospectively recruited, age range 21-83 years. Range of uniocular rotations was measured in six vectors corresponding to extraocular muscle actions: 0°, 67°, 141°, 180°, 216°, 293°. Fields of binocular single vision were assessed at 30° intervals. Vector measurements were utilised to calculate an area score for the field of uniocular rotations or binocular field of single vision. Two test speeds were used for Octopus testing: 3°/ and 10°/second. Test duration was two thirds quicker for Octopus 10°/second than for 3°/second stimulus speed, and slightly quicker for Goldmann. Mean area for control subjects for uniocular field was 7910.45 degrees(2) for Goldmann, 7032.14 for Octopus 3°/second and 7840.66 for Octopus 10°/second. Mean area for patient subjects of right uniocular field was 8567.21 degrees(2) for Goldmann, 5906.72 for Octopus 3°/second and 8806.44 for Octopus 10°/second. Mean area for left uniocular field was 8137.49 degrees(2) for Goldmann, 8127.9 for Octopus 3°/second and 8950.54 for Octopus 10°/second. Range of measured rotation was significantly larger for Octopus 10°/second speed. Our results suggest that the Octopus perimeter is an acceptable alternative method of assessment for uniocular ductions and binocular field of single vision. Speed of stimulus significantly alters test duration for Octopus perimetry. Comparisons of results from both perimeters show that quantitative measurements differ, although qualitatively the results are similar. Differences per mean vectors were less than 5° (within clinically accepted variances) for both controls and patients when comparing Goldmann to Octopus 10°/second speed. However, differences were almost 10° for the patient group when comparing Goldmann to Octopus 3°/second speed. Thus, speed of stimulus must be considered if wishing to use these perimeters interchangeably.
    Albrecht von Graæes Archiv für Ophthalmologie 01/2011; 249(6):909-19.
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    ABSTRACT: The aims of this study were to analyze the relationship between the performance on fine motor skills tasks and peripheral and bifoveal sensory fusion, phasic and tonic motor fusion, the level of visual acuity (VA) in the poorer seeing eye, and the interocular VA difference. Subjects aged 12 to 28 years with a range of levels of binocular vision and VA performed three tasks: Purdue pegboard (number of pegs placed in 30 s), bead threading task (with two sizes of bead to increase the difficulty, time taken to thread a fixed number of beads), and a water pouring task (accuracy and time to pour a fixed quantity into five glass cylinders). Ophthalmic measures included peripheral (Worth 4 dot) and bifoveal (4 prism diopter) sensory fusion, phasic (prism bar) and tonic (Risley rotary prism) motor fusion ranges, and monocular VA. One hundred twenty-one subjects with a mean age of 18.8 years were tested; 18.2% had a manifest strabismus. Performance on fine motor skills tasks was significantly better in subjects with sensory and motor fusion compared with those without for most tasks, with significant differences between those with and without all measures of fusion on the pegboard and bead task. Both the acuity in the poorer seeing eye (highest r value of all motor tasks = 0.43) and the interocular acuity difference were statistically significantly related to performance on the motor skill tasks. Both sensory and motor fusion and good VA in both eyes are of benefit in the performance of fine motor skills tasks, with the presence of some binocular vision being beneficial compared with no fusion on certain sensorimotor tasks. This evidence supports the need to maximize fusion and VA outcomes.
    Optometry and vision science: official publication of the American Academy of Optometry 11/2010; 87(12):942-7.
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