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ABSTRACT: To measure binocular function and patient satisfaction with monovision induced by photorefractive keratectomy (PRK) in myopic presbyopic patients.
Refractive Department, Cleveland Clinic, Cleveland, Ohio, USA.
This study comprised 21 myopic presbyopic patients with monovision induced by PRK. Sixteen emmetropic patients who had PRK served as a control group. Monovision was induced by undercorrecting the nondominant eye by 1.25 diopters for near vision and correcting the dominant eye with emmetropia for distance vision. Monocular and binocular uncorrected Snellen visual acuities at 20 feet and 13 inches, manifest refraction, ocular dominance, stereopsis at 20 feet and 13 inches, monocular and binocular contrast sensitivities, Worth-4-Dot test at 20 feet and 1/3 of a meter, and fusional convergence amplitudes were examined in each patient.
In the monovision group at near and distance, 20 patients (95.3%) had binocular visual acuity of 20/25 or better. No patient in the monovision group used reading glasses postoperatively; 4 of 16 patients (25.0%) in the control group used such glasses. All patients maintained binocular fusion and stereo acuity ranging from 40 to 800 seconds of arc. Mean patient satisfaction was 86% (range 40% to 100%). In the control group, 12 patients (75.0%) had binocular distance visual acuity of 20/25 or better and 11 (68.8%) had binocular near visual acuity of 20/25 or better.
Monovision PRK patients had better near vision than control PRK patients, with minimal compromise in stereo acuity and overall high patient satisfaction.
Journal of Cataract [?] Refractive Surgery 03/1999; 25(2):177-82. · 2.26 Impact Factor
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ABSTRACT: There are various methods for weakening the inferior oblique muscle; here we describe the results of a graded anterior transposition.
Charts of 21 children (37 eyes) who underwent graded anterior transposition of the inferior oblique muscle were reviewed. Graded anterior transposition consisted of reinsertion of the inferior oblique muscle at various points along the temporal aspect of the inferior rectus muscle; the more severe the overaction, the more anterior the placement of the new insertion. In all cases the new inferior oblique insertion line was oriented parallel to the inferior rectus muscle axis. We analyzed the preoperative to postoperative change in inferior oblique overaction (versions) and vertical alignment in primary position.
Postoperatively, 18 of 21 patients had normal versions, 2 patients had -1 underaction of 1 eye, and 1 patient had +1 overaction of both eyes. Eleven patients (15 eyes) had a preoperative vertical deviation in primary position of 4 PD or more. Three of these patients had unilateral congenital superior oblique palsy and a preoperative hypertropia of 20 PD. They underwent unilateral graded anterior transposition with a mean postoperative vertical change of 18 PD. Three patients had asymmetric primary inferior oblique overaction with true hypertropia, 1 patient had amblyopia and primary inferior oblique overaction, and 4 patients had dissociated vertical deviation associated with inferior oblique overaction. All patients had improvement after surgery, with no significant vertical deviation in primary position.
Graded anterior transposition of the inferior oblique muscle is effective in normalizing versions and correcting vertical deviations in primary position.
Journal of American Association for Pediatric Ophthalmology and Strabismus 09/1998; 2(4):201-6. · 1.03 Impact Factor
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ABSTRACT: A 17-year-old woman presented with a history of 1-week of headache and 3 days of horizontal diplopia. Examination revealed 20/20 vision in both eyes, no papilledema, and an abduction deficit in her left eye. Lumbar puncture revealed an opening pressure of 440 mm H2O. After treatment with acetazolamide, the headache and abduction deficit resolved. Papilledema never developed. This is a unique case of pseudotumor cerebri sine papilledema with a unilateral abduction deficit. We suggest that young women with headache and unilateral abduction deficits may be unrecognized cases of pseudotumor cerebri.
Journal of Neuro-Ophthalmology 03/1998; 18(1):53-5. · 1.45 Impact Factor
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Eye 02/1998; 12 ( Pt 6):1029-30. · 1.85 Impact Factor
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ABSTRACT: To report a child with leukocoria caused by occult penetrating trauma.
Case report. The clinical findings and surgical repair of acquired leukocoria of the right eye in a 2-year-old boy are presented.
In the right eye, slit-lamp examination disclosed a retrolenticular cyclitic membrane and moderately severe (3+) cells and flare anterior chamber reaction. The eye was hypotonous, and B scan showed that the membrane was associated with a retinal detachment. Surgery was performed to repair the retinal detachment and to remove the retrolenticular membrane. Two months before initial examination, the patient had been attacked by a rooster.
Occult penetrating trauma should be considered in the differential diagnosis of pediatric leukocoria.
American Journal of Ophthalmology 08/1997; 124(1):117-9. · 4.22 Impact Factor
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K W Wright
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ABSTRACT: Posterior chamber intraocular lenses are a well-accepted treatment of aphakia in children 2 years of age and older, with many now considering them as the treatment of choice. Infants, however, are usually treated with contact lens, rather than intraocular lens implantation, as the infant eye undergoes significant axial elongation. The use of intraocular lenses in children with cataracts associated with juvenile rheumatoid arthritis remains controversial, but a recent article [9] describes good results in these patients, who historically have a poor prognosis. The management of amblyopia associated with unilateral congenital cataracts is evolving. In the 1970s and 1980s, full-time occlusion of the sound eye was advocated for infants with unilateral congenital cataracts. It was also taught that binocular fusion was impossible to obtain, and children with unilateral cataracts inevitably develop strabismus. Recent studies have shown that part-time occlusion may in fact yield better results, allowing the development of binocular vision and stereopsis and reducing the incidence of strabismus.
Current Opinion in Ophthalmology 03/1997; 8(1):50-5. · 2.65 Impact Factor
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K W Wright
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ABSTRACT: Describe characteristics and possible etiology of late overcorrection after inferior rectus recession in patients without Graves disease.
Seven adult patients with initial good alignment (< 5 prism diopters) but an overcorrection 1 month after inferior rectus recession were studied.
Two patients had congenital superior oblique paresis, one had traumatic superior oblique paresis, two had orbital fracture, one had strabismus after retinal detachment surgery, and one had hypotropia after cataract surgery. Overcorrection occurred 4 to 6 weeks after surgery, measuring 12 to 25 prism diopters. Six patients with late overcorrection after inferior rectus recession underwent repeat surgery of the inferior rectus muscle. All six patients had scarring of the Lockwood ligament but no muscle slippage.
Late overcorrection can occur unrelated to Graves ophthalmopathy or a slipped muscle. Postoperative scarring around the Lockwood ligament was identified, which could result in reduced inferior rectus muscle force. It is hypothesized that late scar contracture in the vicinity of the Lockwood ligament could pull the inferior rectus muscle anteriorly, thus slackening the anterior aspect of the muscle. This slackening of the anterior aspect of the inferior rectus muscle would weaken the depression function, thus producing a late overcorrection.
Ophthalmology 09/1996; 103(9):1503-7. · 5.45 Impact Factor
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ABSTRACT: This review reports on articles written on comitant strabismus during the past year. Congenital esotropia was a recurring theme in these publications. Included in this review are articles that provide an insight into the basis for motor epiphenomena such as optokinetic nystagmus asymmetry and latent nystagmus. The optimum window of opportunity to achieve quality binocular vision by surgical alignment in congenital esotropia is discussed. We also report on articles that address various aspects of the management of comitant strabismus including the amount of medial rectus recession for esotropia, the target angle for best results in accommodative esotropia with high accommodation convergence/accommodation ratio, and issues related to comitant exotropia.
Current Opinion in Ophthalmology 11/1995; 6(5):15-21. · 2.65 Impact Factor
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K W Wright
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ABSTRACT: In this article, three topics of current interest in strabismus are covered. These include strabismus after glaucoma implant surgery, management of accommodative esotropia, and the timing of treatment for strabismic amblyopia. Glaucoma implants have improved our results with difficult glaucoma syndromes, however, a high incidence of postoperative strabismus has been associated with this procedure. The mechanism of the strabismus has not been clearly defined in previous literature, but in this article we describe three mechanisms that cause strabismus after glaucoma implant surgery and describe methods for managing this problem. The standard management of accommodative esotropia has historically resulted in a large number of undercorrections. Patients with accommodative esotropia have good fusion potential as the strabismus is acquired and binocular visual development occurred during the critical period. Recent studies indicate that we should increase our surgical numbers when managing patients with accommodative esotropia. Various treatment strategies are covered in the section on accommodative esotropia. Finally, a discussion on the management of strabismic amblyopia is presented. The importance of treating amblyopia first, then secondarily correcting the strabismus is emphasized.
Current Opinion in Ophthalmology 11/1994; 5(5):25-9. · 2.65 Impact Factor
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K W Wright
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ABSTRACT: Monocular optokinetic nystagmus (OKN) asymmetry is associated with disruption of early binocular visual development.
Three groups of treated esotropic patients and a group of normal controls were evaluated for the presence of clinically detectable monocular OKN asymmetry. Clinical assessment of monocular OKN asymmetry was performed by observing eye movements in response to a hand-held rotating drum. Asymmetry was quantitated on a scale of 0 to +3 OKN asymmetry. Clinical OKN asymmetry was evaluated in the following groups of patients: those with congenital esotropia treated with very early surgery achieving high-grade stereo acuity (group 1); those with congenital esotropia treated with late surgery achieving no stereopsis (group 2); those with acquired esotropia achieving high-grade stereo acuity after treatment with spectacle correction (group 3); and normal controls (group 4).
Two of the three patients in group 1 showed +3 OKN asymmetry despite having high-grade stereo acuity; the third one, who was surgically aligned earliest (13 weeks), demonstrated +1 OKN asymmetry. This patient achieved orthotropia, 40 seconds stereo acuity, perfect Randot stereo acuity, and had no dissociated vertical deviation or latent nystagmus. All 10 patients in group 2 (those with late alignment-after 1 year-and no stereo acuity) showed +3 OKN asymmetry. All four patients in group 3 (those with acquired hypermetropic esotropia and high-grade stereo acuity after treatment) and all 10 patients in the normal control group showed no OKN asymmetry.
Clinically obvious monocular OKN asymmetry can occur in patients with congenital esotropia who are aligned early and develop high-grade stereo acuity. Even brief periods of strabismus during the early period of binocular motor development can result in persistent OKN asymmetry. This suggests that binocular motor processing may develop distinct from, and prior to, the development of high-grade stereo acuity. OKN asymmetry appears to be a clinical sign of an insult to early binocular motor development.
Journal of Pediatric Ophthalmology & Strabismus 33(3):153-5. · 0.63 Impact Factor
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ABSTRACT: To determine the prognostic implication of compensatory head posturing in patients with unilateral or asymmetric congenital ptosis.
A retrospective review of 80 consecutive patients with unilateral or asymmetric congenital ptosis was performed. The presence of documented compensatory head posturing, age of onset, age of presentation, visual acuity, refraction, and amblyopia were recorded, and binocularity was tested.
Five of seven (71%), patients with unilateral or asymmetric congenital ptosis and compensatory head posturing had amblyopia. All of these patients had straight eyes and four of the five amblyopic patients had anisometropia of less than 2 diopters (D).
The high incidence of amblyopia in this group can occur in the absence of significant anisometropia and strabismus. This unusually high incidence of amblyopia in this subgroup of patients with unilateral or asymmetric congenital ptosis and compensatory head posturing warrants compulsive examination and prophylactic part-time occlusion therapy of the nonptotic eye until reliable vision testing can be performed.
Journal of Pediatric Ophthalmology & Strabismus 36(2):74-7. · 0.63 Impact Factor
