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Association between accommodative insufficiency and amblyopia
e12 043 The effects of surgical correction on stereo acuity in adult strabismus patients. Heath W. Barto, Tiffany Jean, Marilyn B. Mets Introduction: This is a retrospective study of adult strabismus patients to determine their pre- and postoperative binocular status and possible effects of surgery. Methods: A list of all consecutive adult patients who underwent surgery (one surgeon) for strabismus between June 1990 and September 2009 was compiled and their medical charts were reviewed. Patients who had stereo acuity, measured by the Titmus test, recorded both preoperatively and postoperatively, were included. A total of 179 patients underwent surgery for strabismus. Of these, 120 patients, aged 16 to 80 years, were included; 30 were excluded as their charts did not contain information on stereo acuity at appropriate dates, and 29 charts were unavailable. Prism management was incorporated pre- and/or postoperatively in some of the patients. Results: Overall, 63 of the 120 patients improved in binocular function (52.5%), 56 remained the same (46.67%), and 1 decreased (0.83%). If you exclude those patients with 40 seconds of stereo acuity preoperatively, whose stereopsis, by definition, could not improve further (N 5 17), and look only at the 103 surgical patients who could improve, then 62% improved. Conclusions: The benefits of surgical correction of strabismus in adults include improvement in binocular function as seen in 62% of the patients in the study. 044 Infantile nystagmus: Adaptations at the effector level. Kathleen T. Berg, David G. Hunter, Erick D. Bothun, Jill A. Anderson, Linda K. McLoon Purpose: To determine if there are myofiber changes in the extraocular muscles (EOM) of patients with infantile nystagmus. Methods: EOM were collected as surgical waste from 5 infantile nystagmus patients and 5 healthy controls, frozen, sectioned and stained with hematoxylin and eosin. Myofiber cross-sectional areas were determined and the mean cross-sectional area for each population was determined. A histogram of myofiber area measurements in patients and controls was created in 100 micron increments. The degree of central nucleation, a hallmark of muscle undergoing regeneration/degeneration, was determined. Student's unpaired t-tests with Welch's correction were used to test for statistical significance. Results: There was no significant difference in the mean myofiber cross-sectional area between the two groups of muscles. However, it was apparent, both qualitatively and quantitatively, that there was a greater degree of heterogeneity in myofiber size within the patient group. In addition, there was a statistically significant (p \ 0.001) increase in the percentage of myofibers with central nucleation in the EOM taken from nystagmus patients (23.2%) compared to controls (2.00%). Discussion: These data suggest that there is a decrease in innervation and evidence of cycles of myofiber regeneration/degeneration occurring in the EOM of patients with infantile nystagmus. Conclusions: These findings represent the first direct quantification of changes in innervation and myofiber morphometry of the EOM of patients with infantile nystagmus. Having a better understanding of the pathogenesis of this condition permits the exploration of more targeted treatment methods in the future. 045 Presenting ophthalmic signs and symptoms of neuroblastoma. Emily M. Bratton, Mary E. Hoehn, Natalie C. Kerr Introduction: Horner's syndrome, proptosis, ecchymosis, and opsoclonus-myoclonus-ataxia (OMA) syndrome are ophthalmic findings in neuroblastoma. We determined the incidence of these findings at presentation, noting concurrent systemic findings.
Volume 14 Number 1 / February 2010 Methods: We performed a retrospective chart review at XXX, identifying 336 patients diagnosed with neuroblastoma since 1995. Results: Of the children diagnosed with neuroblastoma, 45 children (13.4%) had ophthalmic findings at presentation. Seven children had Horner's syndrome [57% (n 5 4) had associated systemic signs]. Sixteen children had ecchymosis, most with systemic signs (n 5 15, 93.8%). Ecchymosis was usually bilateral (n 5 14, 87.5%) and sometimes associated with proptosis (n 5 5, 31.3%). Nineteen had proptosis, 89.5% of which also had systemic signs (n 5 17). Three children with proptosis had ptosis of the involved eye. Two children with proptosis had papilledema. Seven had OMA (3 with associated systemic signs, 42.9%). In addition, one child had papilledema as the only sign at presentation. The majority of ophthalmic signs occurred with other systemic signs of neuroblastoma (86.7%). Conclusions: Prior studies have not investigated the coexistence of ophthalmic and systemic signs in children presenting with neuroblastoma. Ophthalmic signs were noted at presentation in a minority of children with neuroblastoma. Of these, the vast majority (86.7%) had systemic findings. Ophthalmologists should be aware that most children who present with ophthalmic signs of neuroblastoma also have systemic findings. Therefore careful history and complete physical examination is warranted when ophthalmic signs are noted.
046 Association between accommodative insufficiency and amblyopia. Cristina M. Brubaker, Noelle S. Matta, Eric L. Singman, David I. Silbert Purpose: To evaluate the relationship between amblyopia and accommodative ability. Methods: The open-field Grand Seiko binocular autorefractor has become the gold standard for measuring static accommodation. Unlike other autorefractors, the device measures accommodation from below utilizing a one-way mirror offering both eyes an unobstructed view of the fixation target. The fixation target can be set at any distance. Fifty-two children age x to y had their accommodative amplitudes measured on the Grand Seiko autorefractor. The testing distance was 1/3 meter, and all children were tested without their correct refraction in place. Of 108 eyes, reading were obtained on 99 eyes. Forty-five eyes were amblyopic with vision of 20/30 or worse, 54 eyes were normal without amblyopia with vision of 20/25 or better; a reading was not possible in 9 eyes (5 patients) with correction in place. Results: Normal accommodation with full accommodative effort at 1/ 3 meter is 3D, which would read as 3.00 D on the binocular autorefractor. Lack of any accommodation should give a reading of 0.00 D. On the tested subjects the average accommodative amplitudes in the amblyopic eyes measured 0.792 D (range +0.75 D to 2.00 D) and the average accommodative amplitudes of the normal eyes measured 1.94D (range, 0.75 D to 2.75 D). Conclusions: We have shown that amblyopic eyes do not accommodate as well as non-amblyopic eyes even when the patient is wearing their correct cycloplegic refraction. This may provide new methods to identify amblyopia and monitor adequacy of treatment. 047 Optical coherence tomography in the evaluation of neurofibromatosis type 1 subjects with optic pathway gliomas. Lan Chang, Mays A. El-Dairi, Terri L. Young, Tamiesha Frempong, M. Tariq Bhatti, Fawn A. Leigh Introduction: Neurofibromatosis type 1 (NF1) is the most common hereditary neurocutaneous disorder and associated with optic pathway gliomas (OPGs) in 15% of affected children. OPGs can be difficult to detect on clinical inspection, often requiring neuro-imaging. Optical coherence tomography (OCT) has been shown to be a useful
Journal of AAPOS
Volume 14 Number 1 / February 2010 Methods: We performed a retrospective chart review at XXX, identifying 336 patients diagnosed with neuroblastoma since 1995. Results: Of the children diagnosed with neuroblastoma, 45 children (13.4%) had ophthalmic findings at presentation. Seven children had Horner's syndrome [57% (n 5 4) had associated systemic signs]. Sixteen children had ecchymosis, most with systemic signs (n 5 15, 93.8%). Ecchymosis was usually bilateral (n 5 14, 87.5%) and sometimes associated with proptosis (n 5 5, 31.3%). Nineteen had proptosis, 89.5% of which also had systemic signs (n 5 17). Three children with proptosis had ptosis of the involved eye. Two children with proptosis had papilledema. Seven had OMA (3 with associated systemic signs, 42.9%). In addition, one child had papilledema as the only sign at presentation. The majority of ophthalmic signs occurred with other systemic signs of neuroblastoma (86.7%). Conclusions: Prior studies have not investigated the coexistence of ophthalmic and systemic signs in children presenting with neuroblastoma. Ophthalmic signs were noted at presentation in a minority of children with neuroblastoma. Of these, the vast majority (86.7%) had systemic findings. Ophthalmologists should be aware that most children who present with ophthalmic signs of neuroblastoma also have systemic findings. Therefore careful history and complete physical examination is warranted when ophthalmic signs are noted.
046 Association between accommodative insufficiency and amblyopia. Cristina M. Brubaker, Noelle S. Matta, Eric L. Singman, David I. Silbert Purpose: To evaluate the relationship between amblyopia and accommodative ability. Methods: The open-field Grand Seiko binocular autorefractor has become the gold standard for measuring static accommodation. Unlike other autorefractors, the device measures accommodation from below utilizing a one-way mirror offering both eyes an unobstructed view of the fixation target. The fixation target can be set at any distance. Fifty-two children age x to y had their accommodative amplitudes measured on the Grand Seiko autorefractor. The testing distance was 1/3 meter, and all children were tested without their correct refraction in place. Of 108 eyes, reading were obtained on 99 eyes. Forty-five eyes were amblyopic with vision of 20/30 or worse, 54 eyes were normal without amblyopia with vision of 20/25 or better; a reading was not possible in 9 eyes (5 patients) with correction in place. Results: Normal accommodation with full accommodative effort at 1/ 3 meter is 3D, which would read as 3.00 D on the binocular autorefractor. Lack of any accommodation should give a reading of 0.00 D. On the tested subjects the average accommodative amplitudes in the amblyopic eyes measured 0.792 D (range +0.75 D to 2.00 D) and the average accommodative amplitudes of the normal eyes measured 1.94D (range, 0.75 D to 2.75 D). Conclusions: We have shown that amblyopic eyes do not accommodate as well as non-amblyopic eyes even when the patient is wearing their correct cycloplegic refraction. This may provide new methods to identify amblyopia and monitor adequacy of treatment. 047 Optical coherence tomography in the evaluation of neurofibromatosis type 1 subjects with optic pathway gliomas. Lan Chang, Mays A. El-Dairi, Terri L. Young, Tamiesha Frempong, M. Tariq Bhatti, Fawn A. Leigh Introduction: Neurofibromatosis type 1 (NF1) is the most common hereditary neurocutaneous disorder and associated with optic pathway gliomas (OPGs) in 15% of affected children. OPGs can be difficult to detect on clinical inspection, often requiring neuro-imaging. Optical coherence tomography (OCT) has been shown to be a useful
Journal of AAPOS