R P Rutstein

University of Alabama at Birmingham, Birmingham, AL, United States

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Publications (50)42.76 Total impact

  • Robert P Rutstein
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    ABSTRACT: PURPOSE.: To report the clinical findings for patients with binocular vision difficulties attributed to retinally induced aniseikonia. METHODS.: Clinical records of patients referred to the author and diagnosed with retinally induced aniseikonia from 2006 to 2012 were retrospectively reviewed. RESULTS.: Twelve patients with retinally induced aniseikonia attributed to epiretinal membrane, retinal detachment surgical repair, or age-related macular degeneration are reported. Eleven patients were male. The age range was 44 to 76 years. Diplopia occurred in 10 patients, and prism lenses were prescribed for seven patients by their referring practitioner. The amount of aniseikonia measured using either the computerized Aniseikonia Inspector (visual field angle, ∼ 14.5 degrees) or the New Aniseikonia Test (visual field angle, ∼ 5.7 degrees) ranged from 1.7 to 11.3% and from 1.5 to 13.3% in the vertical and horizontal meridians, respectively. At other visual field angles, the amount of aniseikonia might have been different. Five patients perceived macropsia and seven patients perceived micropsia in the affected eye. Seven patients had measurable stereopsis. Use of Bangerter filters was the most frequent treatment modality. Detailed case reports on three patients are included. CONCLUSIONS.: Retinally induced aniseikonia is an increasingly important cause of binocular vision symptoms in the aging population. Long-term studies on its incidence, clinical course, and effect of treatment are needed.
    Optometry and vision science: official publication of the American Academy of Optometry 10/2012; · 1.53 Impact Factor
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    ABSTRACT: The aim of this study was to report the clinical course for 3 young patients diagnosed with idiopathic amblyopia. The clinical course for 3 young patients with unilateral visual loss initially attributed to idiopathic amblyopia is presented. Extensive evaluations over the years, including optical coherence tomography, were performed in addition to routine clinical testing. In 1 patient, transient anisometropic refractive error during infancy was likely causative for the unilateral visual loss. For the second patient, a subclinical microtropia with varying eccentric fixation was subsequently diagnosed, and for the third patient, a subtle retinal disorder was subsequently diagnosed. The diagnosis of idiopathic amblyopia is one of exclusion and should only be made after extensive testing to rule out subclinical binocular vision or pathological anomalies.
    Optometry (St. Louis, Mo.) 05/2011; 82(5):290-7.
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    ABSTRACT: To describe the amount of visual acuity degradation induced by Bangerter filters in the better seeing eye and to evaluate its stability over time in children with moderate amblyopia. Visual acuity with and without a Bangerter filter was measured in the nonamblyopic eye of 186 children with moderate amblyopia who were then treated with either patching or the Bangerter filters. A 0.2 filter was used for amblyopia of 20/80 and a 0.3 filter for amblyopia from 20/40 to 20/63. For the 89 children randomized to Bangerter filters, visual acuity was also measured in the nonamblyopic eye with and without the filters at both 6 weeks and 12 weeks after initiating treatment. Mean degradation in visual acuity of the nonamblyopic eye at baseline was 5.1 logMAR lines with the 0.2 filter and 4.8 logMAR lines with the 0.3 filter. The degradation with each filter did not always agree with the manufacturer's specifications. Over time, the amount of degradation with the filters decreased. The 0.2 and 0.3 Bangerter filters degrade nonamblyopic eye visual acuity sufficiently in amblyopic children. Because the amount of degradation decreases over time, it is recommended to periodically apply a new filter when using this type of amblyopia treatment.
    Journal of AAPOS: the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus 03/2011; 15(2):131-4. · 1.07 Impact Factor
  • Robert P Rutstein
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    ABSTRACT: PURPOSE: The aim of this study was to describe the use of Bangerter filters in adults having intractable diplopia. METHODS/CASE REPORTS: A series of adults having intractable diplopia caused by either cyclotorsion, retinal disease, monocular diplopia, or rapid alternating fixation who were treated with Bangerter filters is reported. Detailed case reports on 4 of the 10 patients are included. CONCLUSION: Bangerter filters can be used to mitigate diplopia that cannot be eliminated with either prism, modification of the spectacle prescription, vision therapy, or extraocular muscle surgery. The weakest density filter that eliminates the diplopia should be prescribed. Prospective studies reporting the long-term efficacy and quality of life with the filters are needed.
    Optometry (St. Louis, Mo.) 08/2010; 81(8):387-93.
  • Robert P Rutstein
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    ABSTRACT: Accommodative spasm is a rare condition occurring in children, adolescents, and young adults. A familial tendency for this binocular vision disorder has not been reported. I describe accommodative spasm occurring in a brother and sister. Both children presented on the same day with complaints of headaches and blurred vision. Treatment included cycloplegia drops and bifocals. Siblings of patients having accommodative spasm should receive a detailed eye exam with emphasis on recognition of accommodative spasm.
    Indian Journal of Ophthalmology 01/2010; 58(4):326-7. · 1.02 Impact Factor
  • Robert P Rutstein
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    ABSTRACT: The aim of this study was to present an update on accommodative esotropia. The diagnosis, clinical features, etiology, treatment, prognosis, and clinical course for the 3 types of accommodative esotropia are presented. Accommodative esotropia is the most common pediatric strabismus and must be differentiated from other pediatric esotropias. Although its average age of onset is 2.5 years, it can begin during the first year of life and is seen rarely in older children and teenagers. Refractive accommodative esotropia and nonrefractive accommodative esotropia have a better prognosis for achieving normal binocular vision and high-grade stereopsis with appropriate and timely treatment than partly accommodative esotropia. Children with successfully treated accommodative esotropia need to be followed up with to prevent possible deterioration and development of a superimposed nonaccommodative esotropia, which in some cases may require extraocular muscle surgery. Emmetropization and spontaneous resolution of the esotropia occur rarely and may take many years. Approximately 50% of all pediatric esotropias are either entirely or partly accommodative. Proper care is long term and includes monitoring the refractive error and binocular vision status over the years.
    Optometry - Journal of the American Optometric Association 08/2008; 79(8):422-31. · 0.62 Impact Factor
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    Roderick J Fullard, Robert P Rutstein, David A Corliss
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    ABSTRACT: To evaluate the accuracy and repeatability of size lens induced aniseikonia measurement with the Aniseikonia Inspector Version 1 and a newer customized version of the Aniseikonia Inspector, Version 2. Aniseikonia was measured on 27 subjects with both versions of the Aniseikonia Inspector in normal room illumination. Measurements of induced aniseikonia were made using size lenses in a randomized order. Twenty-five subjects were further tested in the dark using target sizes of equal visual angle for both tests. Repeatability of the intrinsic aniseikonia measurement was assessed on five subjects using randomized testing order for instrument and light and dark measurements. In normal illumination, the mean slopes for plots of induced aniseikonia vs. size lens magnification for Version 1 were 0.883 and 0.838 for the vertical and horizontal meridians, respectively. For Version 2, the corresponding slopes were 1.162 and 1.043. In the dark and using targets of the same size for both tests, the slopes for Version 1 were 1.038 in the vertical meridian and 0.866 in the horizontal meridian whereas for Version 2, the slopes were 1.195 in the vertical meridian and 1.127 in the horizontal meridian. The amount of underestimation or overestimation within any given testing condition showed considerable intersubject variation. Version 1 was more repeatable than 2, particularly in the vertical meridian. On average, the most accurate and repeatable measurement of aniseikonia was found with Version 1 in the vertical meridian in the dark. Measurement of aniseikonia in the horizontal meridian appears to be less reliable. Version 2 overestimates size lens-induced aniseikonia under all testing conditions. Intersubject variation in slopes of induced aniseikonia vs. size lens magnification should be further addressed.
    Optometry and Vision Science 01/2008; 84(12):1093-100. · 1.90 Impact Factor
  • Robert P Rutstein, Mark W Swanson
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    ABSTRACT: To describe a child with hyperopia and anisometropia who manifests strabismus and amblyopia in the much less hyperopic eye. A 6-year-old child presented with a history of strabismus and refractive error since infancy, which has been treated with glasses and patching. The present examination revealed 3 D of hyperopic anisometropia, intermittent exotropia, and amblyopia. The strabismus and amblyopia occur in the less hyperopic eye. Ocular health assessment including optical coherence tomography was normal. After patching therapy, the vision improved in the amblyopic eye. Amblyopia and strabismus need not always occur in the more ametropic eye when accompanied by anisometropia.
    Optometry and Vision Science 10/2007; 84(9):848-51. · 1.90 Impact Factor
  • Robert P. Rutstein, Roderick J. Fullard, David A. Corliss
    Optometry and Vision Science - OPTOMETRY VISION SCI. 01/2007; 84(6).
  • Robert P Rutstein, David A Corliss, Roderick J Fullard
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    ABSTRACT: The purpose of this study was to compare the new, computerized Aniseikonia Inspector with the Space Eikonometer for the measurement of aniseikonia. Eighteen subjects, ages 21 to 61 years, with normal binocular vision and normal visual acuity had aniseikonia measured with both the Aniseikonia Inspector Version I and the Space Eikonometer. Aniseikonia was measured first with the subjects' habitual refractive correction and then with afocal size lenses of 1%, 2%, and 3.5% added in random order before the right and left eyes. Measurements were taken initially with the Aniseikonia Inspector and on a subsequent day with the Space Eikonometer. For the Space Eikonometer, the slopes of the lines for the relationship between the measured aniseikonia and the induced magnification differences in the vertical and horizontal meridians are not significantly different from 1.0. For the Aniseikonia Inspector, the slopes of the lines in the vertical and the horizontal meridians are less than and significantly different from 1.0. On average, the Aniseikonia Inspector underestimates the magnitude of induced aniseikonia, predicting only 68% and 61% of the overall size lens magnification in the vertical and horizontal meridians, respectively. The corresponding values of the Space Eikonometer in the vertical and horizontal meridians are 99% and 93%. Variability is greater with the Space Eikonometer than the Aniseikonia Inspector. The Space Eikonometer appears to be measuring the induced aniseikonia appropriately, whereas the Aniseikonia Inspector underestimates the amount of aniseikonia. However, the Space Eikonometer shows greater measurement variability. Modification of the Aniseikonia Inspector or the testing conditions should be pursued in future studies.
    Optometry and Vision Science 12/2006; 83(11):836-42. · 1.90 Impact Factor
  • Robert P Rutstein
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    ABSTRACT: The aim of this report is to review the contemporary research in amblyopia treatment and how it will affect clinical practice patterns. Topics addressed include prescribing the optimal refractive correction, the most effective treatment, duration and intensity of treatment, regression after treatment, the upper age for treatment, and the chance of the amblyope losing his or her sound eye. The optimal refractive correction is best determined with cycloplegic retinoscopy; pharmacologic penalization can be as effective as patching in children with moderate amblyopia; less-intense treatment regimens have been found to be as effective as more-intense treatment regimens; regression can occur in as many as 25% of all treated patients; some older amblyopes can be treated successfully; and the amblyope has a higher chance of becoming blind than the nonamblyope.
    Optometry - Journal of the American Optometric Association 11/2005; 76(10):570-8. · 0.62 Impact Factor
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    ABSTRACT: To determine the measurement characteristics of a new computerized test, the Aniseikonia Inspector Version 1, on a sample of clinic patients. Aniseikonia was measured in the vertical, horizontal, and oblique meridians on 320 patients (mean 55 years old, range 17-89 years) prior to their optometric exam using the psychometric methods programmed into the Aniseikonia Inspector Version 1. Statistical analyses were performed to determine the distribution of aniseikonia in the sample of patients and the relationships between the amount of aniseikonia and patients' habitual refractive correction, visual acuity, stereopsis and binocular alignment status. The characteristics of the individual measurements were also examined. The means and standard deviations of the measured aniseikonia in the vertical, horizontal, and oblique meridians were -0.5% (2.5%), -0.1% (3.3%) and 0.3% (2.8%) respectively. The means in the vertical and oblique meridians were significantly different from 0.0 (p=0.0001, p=0.0314) while that in the horizontal was not (p=0.61). The distributions of aniseikonia showed that 65.6%, 57.5% and 64.3% had within +/-1.0% aniseikonia in the vertical, horizontal and oblique meridians, respectively. Correspondingly, 16.9%, 25.6% and 25.8% had aniseikonia of +/-3.0% or greater. The discrepancy between these percentages and those expected in a normal distribution indicate that the distributions were significantly more peaked than a normal distribution. This departure from normal is due to a few extreme values in the tails. The magnitude of aniseikonia had no statistically significant relationship with the patients' habitual refractive correction, visual acuity or stereopsis. The effect of phoria on the amount of aniseikonia was significant, more so for measurements in the horizontal meridian. The individual measurements, which are the average of two trials using the method of adjustment, showed no significant bias, no relationship between the means and differences in the two readings, but large differences between the two readings. Measurements in the vertical direction seem to be more stable than those in the other two meridians. As measured with the Aniseikonia Inspector 1.0, the majority of the patients sampled in this study exhibited 1.0% or less aniseikonia and were therefore not likely to have symptoms related to aniseikonia. At least 17% of patients had 3.0% or greater aniseikonia measured in the vertical meridian. The Aniseikonia Inspector warrants further evaluation in a clinical setting because of the large limits of agreement between the two settings that are average to determine the magnitude of the aniseikonia. These limits differ considerably from those established by the designers and, therefore, raise questions regarding the actual resolution of the instrument as compared to the nominal resolution.
    Binocular vision & strabismus quarterly 02/2005; 20(4):205-15; discussion 216.
  • Robert P Rutstein, David A Corliss
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    ABSTRACT: To report long-term changes in visual acuity and refractive error for strabismic, anisometropic, and isoametropic amblyopes. Records of patients with strabismic amblyopia, anisometropic amblyopia, and isoametropic amblyopia who were treated from 1983 to 1993 were reviewed. Excluded were patients having ocular or neurological diseases, developmental delay, and follow-up <4 years after treatment cessation. Data included best-correctable visual acuity and spherical equivalent refractive error of the amblyopic and the nonamblyopic eye at pretreatment, posttreatment, and long-term follow-up. Records for 61 patients met the inclusion criteria. For strabismic amblyopia (n = 22), mean visual acuity in amblyopic and nonamblyopic eyes improved 0.36 and 0.05 logarithm of the minimum angle of resolution (logMAR) units after a mean treatment time of 1 year. At long-term follow-up (mean = 9.3 years after treatment), visual acuity in the amblyopic eye regressed 0.09 logMAR and visual acuity in the nonamblyopic eye improved 0.10 logMAR units. For anisometropic amblyopia (n = 26), mean visual acuity in amblyopic and nonamblyopic eyes improved 0.30 and 0.02 logMAR units, respectively, after a mean treatment period of 1.1 year. At the long-term follow-up visit (mean = 7.1 years after treatment), visual acuity in the amblyopic eye regressed 0.09 logMAR unit and in the nonamblyopic eye improved 0.03 logMAR unit. Repeated-measures analysis of variance showed no significant effect of type of amblyopia on visual acuity of the amblyopic eye and a significant effect of visit due to treatment but not regression. The changes in visual acuity in the nonamblyopic eye from the pretreatment to the follow-up visit were significant and interacted with type, the changes being larger in strabismic amblyopia. For strabismic amblyopia, the mean refractive error in amblyopic and nonamblyopic eyes changed from +2.15 D and +1.85 D, respectively, initially to +0.45 D and +0.58 D, respectively, at the follow-up visit. For anisometropic amblyopia, the mean refractive error in amblyopic and nonamblyopic eyes changed from +1.04 D and +0.12 D, respectively, initially to +0.23 D and -0.94 D, respectively, at the follow-up visit. The effect of visit on amblyopic and nonamblyopic refractive errors was significant. For isoametropic amblyopia (n = 13), visual acuity in both right and left eyes initially was 0.39 logMAR unit and improved to 0.14 logMAR unit in each eye after a mean follow-up of 8.9 years. Refractive error in the right and the left eyes changed from -1.22 D and -1.14 D, respectively, to -2.68 D and -2.56 D, respectively, at follow-up. These differences were all significant. After treatment and with long-term follow up, visual acuity regresses but not significantly in the amblyopic eye in strabismic amblyopia and anisometropic amblyopia. At the same time, visual acuity in the nonamblyopic eye improves slightly. Visual acuity also improves significantly over time in isoametropic amblyopia. The refractive error of both amblyopic and nonamblyopic eyes tends to show a myopic shift regardless of the type of amblyopia.
    Optometry and Vision Science 07/2004; 81(7):510-5. · 1.90 Impact Factor
  • Robert P Rutstein, Martin S Cogen
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    ABSTRACT: Paradoxical diplopia occurs when binocular visual cerebral cortex projection of diplopic images (the "subjective angle") is not commensurate and identical with angle or direction of strabismus (the "objective angle"). Its presence infers anomalous retinal correspondence and is manifest as heteronymous or crossed diplopia in esotropia and homonymous or uncrossed diplopia in exotropia. When treated, the prognosis for achieving fusion is poor, while the risk for intractable diplopia is reputedly high. We report a patient with paradoxical diplopia that resolved (and some binocular fusion developed) following botulinum toxin injections and prism therapy. Case report. A 25 year old man was evaluated for an exotropia. At age 4 years, he had acquired an esotropia due to a traumatic lateral rectus palsy. The esotropia resolved over 3 years. At age 14 years, he developed a consecutive exotropia. The exotropia was eventually treated surgically. There remained a residual exotropia following surgery, and he experienced paradoxical diplopia and projected it homonymously on all sensory tests as if he was esotropic. Treatment with botulinum toxin injections to both lateral rectus muscles along with a small prismatic correction in spectacles eliminated the exotropia and paradoxical diplopia, permitting some binocular fusion. Botulinum toxin injection and prism therapy can be effective in eradicating paradoxical diplopia.
    Binocular vision & strabismus quarterly 02/2004; 19(1):35-8.
  • Robert P Rutstein, David A Corliss
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    ABSTRACT: To report the clinical course for patients with intermittent exotropia. The clinical records of patients diagnosed with intermittent exotropia from 1983 to 1991 who had at least 4 years of follow-up were reviewed. All patients with neurological or medical abnormalities, developmental delays, ocular disease, or having strabismus surgery during the follow-up period were excluded. Of the 468 records reviewed, 73 met the inclusion criteria. Forty-four patients were female, and 29 were male. Fifty-two patients had basic intermittent exotropia, 11 patients had divergence excess intermittent exotropia, and 10 patients had convergence insufficiency intermittent exotropia. The mean age at initial visit was 20 years (range, 1 to 63 years). The mean follow-up was 10 years (range, 4 to 23 years). Four patients had amblyopia of 20/30 or worse, nine patients had a vertical deviation in the primary position, and 10 patients had undergone extraocular muscle surgery before coming to our clinic. Sixty patients received some form of treatment during follow-up. The mean stereoacuity at the initial and final visits were 59 and 70 s arc, respectively. The initial mean spherical equivalent refraction was -0.48 D and increased to -1.15 D at the end of the study. The mean exodeviation changed from 17.2 Delta at distance and 17.6 Delta at near at the initial visit to 13.7 Delta at distance and 13.5 Delta at near at the final visit. At the initial visit, 63 patients were exotropic and 10 patients were either heterophoric or orthophoric at distance, whereas, 60 patients were exotropic and 13 patients were either heterophoric or orthophoric at near. At the final visit, 37 patients were exotropic and 36 patients were either heterophoric or orthophoric at distance whereas 33 patients were exotropic and 39 were either heterophoric or orthophoric at near. One patient was esotropic at near at the last visit. Changes in the size and quality of the exodeviation, although statistically significant (p < 0.001), were not associated with any specific treatment regimen or with longer periods of follow-up. Measurements exhibited a regression toward the mean. Intermittent exotropia improved for many patients quantitatively and qualitatively over time. That the improvement was unrelated to any treatment and length of follow-up suggests that the changes at least quantitatively are not associated with any physiologic process and may be due, in part, to regression toward the mean.
    Optometry and Vision Science 09/2003; 80(9):644-9. · 1.90 Impact Factor
  • R P Rutstein, W Marsh-Tootle
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    ABSTRACT: Accommodative spasm (AS) has been reported to be a rare cause of an acquired unilateral visual loss. We describe a unique case of acquired visual loss due to an apparent unilateral AS triggered by occlusion of the contralateral eye. Clinical examination and photorefraction techniques were performed during the acute phase of the disorder and in the follow-up evaluations. An otherwise healthy 27-year-old woman presented with a 2-month decrease of vision in her left eye. Unaided visual acuity in the right eye was 20/20 and in the left eye was finger counting. Orthophoria existed at distance and near. The decrease in vision in the left eye was attributed to an apparent unilateral AS of 5 D, which occurred only when the right eye was occluded. Under the occluder, the right eye also manifested an AS. With the left eye occluded or with binocular viewing, the right eye and left eye accommodated normally. With a 5 D convex lens before the right eye, the visual acuity in the left eye was 20/20. Refractive error with cycloplegia revealed low hyperopia in each eye. AS can be the cause of acquired unilateral visual loss. To our knowledge, this is the first documented report of an apparent unilateral AS triggered by occlusion of the contralateral eye.
    Optometry and Vision Science 08/2001; 78(7):492-5. · 1.90 Impact Factor
  • R P Rutstein
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    ABSTRACT: To describe a patient with accommodative esotropia who developed spasm of the near reflex. A 6-year-old girl with a history of successfully treated refractive, accommodative esotropia suddenly developed spasm of the near reflex after the death of a relative. The condition resolved after 2 months. Spasm of the near reflex should be considered in children with accommodative esotropia who seem to deteriorate and become esotropic once again while wearing their hyperopic glasses.
    Optometry and Vision Science 08/2000; 77(7):344-6. · 1.90 Impact Factor
  • R P Rutstein, D A Corliss
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    ABSTRACT: To determine the efficacy of distance stereotesting as a screening device. Distance stereoacuity using the global Random Dot and contour Circle test of the Mentor BVAT II-SG computerized testing system was measured for 216 patients, ages 6 to 18 years, before the clinical examination. Patients were classified into pass/fail groups in the areas of refractive error change (REC), ocular deviation (DEV), visual acuity (VA), and all three together (EXAM). Legitimate cutoff scores were obtained when patients were classified as 'pass' as follows: REC if the change was 0.50 D or less in sphere or cylinder relative to the habitual correction or to emmetropia if no habitual correction; DEV if there was no heterophoria or strabismus at distance (criteria of heterophoria of < 6 prism diopters and heterophorias of any magnitude were also tested); VA if the acuity at distance was better than or equal to 20/25 in the poorer eye and better than or equal to 20/20 in the better eye; EXAM if they were pass in REC, DEV, and VA. Optimal pass/fail cutoff values for the stereopsis measurements were determined by finding the maximum chi2 value from contingency tables constructed using pass/fail levels for the screening test at each of the observed levels. The pass rates for REC, DEV, VA, and EXAM were 45%, 72%, 42%, and 24%, respectively. Patients passed the BVAT at the analytically determined optimal cutoff values of less than or equal to 120 sec arc for global and less than or equal to 30 sec arc for contour stereopsis. The sensitivity and specificity for global stereopsis were 0.90 and 0.40 for REC, 0.89 and 0.30 for DEV, 0.93 and 0.51 for VA, and 0.87 and 0.63 for EXAM. For contour stereopsis, the corresponding values were 0.85 and 0.42, 0.89 and 0.34, 0.91 and 0.53, and 0.84 and 0.62. Distance stereotesting is highly sensitive to small refractive error changes, heterophorias and strabismus, visual acuities < 20/25, or any of the three. Global stereopsis is only slightly better than contour stereopsis at classifying patients. Distance stereotesting has potential as an effective screening test.
    Optometry and Vision Science 03/2000; 77(3):135-9. · 1.90 Impact Factor
  • R P Rutstein, D A Corliss
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    ABSTRACT: Although there have been studies in the past of the difference between distance and near stereopsis in intermittent exotropia, no such comparisons have been studied and/or reported for other forms of strabismus, nor for strabismic functional amblyopia, or for refractive functional amblyopia. The study was prospective: Sixty-eight consecutive patients, ages 6-76 years, with either childhood onset strabismus and no amblyopia, childhood onset strabismus and amblyopia, or refractive amblyopia and no strabismus, had their stereopsis measured. Distance stereopsis was determined on the Mentor BVAT with Random Dot E Test (global stereopsis) and the Circle Test (contour stereopsis). Near stereopsis was determined with the Circle Test of the Randot Stereotest. The data were tabulated and analyzed statistically. Of the 26 strabismus/no amblyopia cases, 14 (54%) appreciated distance stereopsis. Of these, 12/14 were intermittent, and other 2 who were constant had deviations of 8 PD or less. Only 4 of the 14 appreciated global stereopsis at distance (mean = 90 sec. of arc), but all 14 appreciated contour stereopsis at distance (mean = 125 sec. of arc). Of all 26, 21 (81%) had near stereopsis (mean = 137 sec. of arc). For the 21 strabismic amblyopes, only one appreciated global stereopsis at distance (120 sec of arc), and 2 (10%) contour stereopsis at distance (mean = 210 sec. of arc). These two and 4 others (total 29%) had near stereopsis (mean = 162 sec. of arc). For the 21 refractive amblyopes, 3 appreciated global stereopsis at distance (mean = 220 sec. of arc), 11 in all, (52%) contour stereopsis at distance (mean = 121 sec. of arc) and 20 (95%) had near stereopsis (mean = 78 sec. of arc). The percentages of patients in all categories capable of appreciating distance stereopsis were "statistically significantly" (P<.05) or clinically/medically significantly different from (less than) the percentages having near stereopsis. distance stereopsis is more likely to be reduced or absent than near stereopsis in strabismus, strabismic amblyopia and refractive amblyopia and thus appears to be more sensitive to, and better screening for, binocular vision disorders and a stronger and better outcome standard for treatment of binocular vision disorders than near stereopsis.
    Binocular vision & strabismus quarterly 02/2000; 15(3):229-36.
  • R P Rutstein, D Corliss
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    ABSTRACT: To determine if higher degrees of anisometropia cause deeper amblyopia and poorer binocularity than lower degrees of anisometropia in children and adults. The clinical records for 60 patients with untreated anisometropic amblyopia without strabismus, ranging in age from 3 to 39 years, were reviewed. The refractive error, the initial best corrected visual acuities in the amblyopic and nonamblyopic eyes, and the level of binocularity were recorded from each chart. The degree of anisometropia was determined by: (1) calculating the difference between spherical equivalents for each eye; (2) calculating the difference in the vertical meridians for each eye; (3) calculating the difference in the horizontal meridians for each eye; and (4) calculating the root mean square difference which also takes into account differences in astigmatic axis. The depth of amblyopia was determined by converting the visual acuity score to its logarithmic value, logarithm of the minimum angle of resolution (logMAR), and calculating the difference between the amblyopic and nonamblyopic eye. The level of binocularity was determined from stereopsis testing. For all patients, there was a significant relationship between the four measures of anisometropia, the depth of amblyopia, and the level of binocularity (median correlations 0.61 and 0.61, respectively). For the myopes (N = 10), there was no significant relationship between the 4 measures of anisometropia, the depth of amblyopia, and the level of binocularity (median correlations 0.34 and 0.61, respectively). For the hyperopes (N = 50), the relationship was significant for all 4 measures of anisometropia (median correlations 0.72 and 0.62, respectively). As the degree of anisometropia increases, the depth of amblyopia becomes greater and the level of binocularity becomes poorer, at least for hyperopic patients.
    Optometry and Vision Science 05/1999; 76(4):229-33. · 1.90 Impact Factor