Eye-pressing by visually impaired children

SURVEY

OF

OPHTHALMOLOGY

CURRENT CREIG

S. HOYT,

VOLUME 29 * NUMBER 5 * MARCH-APRIL

1985

OPHTHALMOLOGY EDITOR

Eye-Pressing by Visually Impaired Children, 1,~J. 1:. J; HI, R.D. Freeman, A.Q. Md :ormic~k, K.1’. Scott, \t’.l). Rohcrtson, and 1I.E:. Newman. Del .Ilni C;hi/d ~Zhzcrol.?5:755-762, I!183

Unless otherwlse tndlcated, additions by Dr Hoyt

the abstracts

appearing

here are taken from the orIgInal publications

37’1

with appropriate

modlflcatlons

and

CURRENT

OPHTHALMOLOGY

mannerisms seen in flandicapfxd children. Hr)wr\rer, thr authors point out thal \Gual self-stimulation is distinct from other mannerisms in that it is influenced mostI>. fly early onset and se\,erit!, of\sisual impairment and t!‘pr of ocular pathofo,gS)~. In other words, a child b,fio fias the early onset of severe visual impairment 0l‘ retinaf origin is apt to engage in liequent intense eye-pressing even if’his intcllcctual and neurologic development is normal or near normal. The authors offbr a clinical pearl in the ol,servation that children blind from ofltic ner1.c or cortical disease nc\‘er fx-ess their e!‘rs and those with retinal disease have the highest incidence, of fxssing. These observations may be usefill in a numhcr oI‘indi~iclua1 clinical situations. For instance, a blind child \sithout evidence ofassociatcd ahnormalities who is enga,ging in frequent and intense c!re pressing should I)( susfxcted ofha\ring a severe amount ofvisual impairment, and a retinal ctiofog), should he looked Ibr. On the other hand, ifa cflifd wit11 multif)lc handicaps and ohxGn]s se\rcrc \.isual impairment is not engaging in an)’ eye pressing, ofltic ner\x’ or cortical disease should be suspected. It‘ a blind child has a sudden unexplained increase in tflc 1kqu~wcy and intensity ofeye-pressing fix no apparent reason, the clinician should recall that tflis beha\.ior ma)’ reflect emotional stress and make appropriate inquiries. It is interesting to note that eye-fxessing increases M*!ICII a cflild is fistming intrntly. This is in contrast with other mannerisms \vhirh ,gencraffy decrease Lvitfi ,greater attention, and further ser\.es to rcmo\xx tfiis refxtiti\,c phenomenon from the large group of non\,isual nxmwrisms. There are se\.craf areas of the brain w’hcrc infixmation from tfle visual and auditor)systems overlap. Phosf~flencs, ant1 c\‘cn more comf~lcs visual experiences can he f>rodurcd by sound, indicating the close linkage of‘ these two senses which LVCusuall~~ consider to lx separate. It may be that the production of‘f~l~osl~fwncs incrcascs the child’s ability to attrnd to aural stimulation fly changin,q the electrical acti\+t!, in one of these ovcrlappin,g association areas. I)ocumentation of the sof’t tissue and bony ahnormalities that may he fxoduccd hy longterm intense c>.epressing raises the question of what can be done to alter this lxfia\*ior. The authors correctly point out that the to tfle child’s emotional needs and encouragement to keep acti\.c \vilf he f)rol)fcm is a difficult one. Attention the most fixitrul niancu[‘ers. Rol~l:K’I’ I,I:zlxc;Tcn.

s. B.\FCI:K KI~:uTl~c:I;\~

Pseudophakodonesis and Cornea1 Endothelial Contact: Direct Observations by HighSpeed Cinematography, by P.M. Jacobs, H. Ghcng, and N.C:. Price. BYJ Ophthnlnzol67:650654.

1983

A feature of iris clip intraocular lens implants following intracapsular cataract cstraction is considerable movement ofthe implant within the eye (psrudophakodonesis) that can Colfo\~ even minor eye mo\~cments. It has hcen suggested that such movement may he sufIicientf)- great for parts of‘the implanted 1~11sto touch the cornea! cndothelium intermittently and thus produce continuing endothclial cell damage. The authors report the results of’60 patients who had undergone intracapsular cataract extraction with the implantation ofa Frderol. type I lens implant pcrfhrmcd 2-24 months previously. These flaticnts bverc studied \cith hiah speed cinematography to observe tflc movement of‘ tile Frdrrov type I lens implants within the anterior chamber. The authors’ results do not suflport the thesis that INIS implant contact \vith the cornea1 cndothelium is a frequent occurrence. They conclude that pseudophakodoncsis is not suflicicnt cause 4~ a centrally situated I:ederov type I lens implant to touch the cornea! andotl~cfium unless tflt’ anterior chamber is ahnorniafl~~ sfiallocc-.

Comment This is an excellent report which shows that the direct contact between the lens implant and the cornea is not the cause of the continuing cell loss after lens insertion. No rcsponsihfe implant surgeon can he ohli\+)us 01 the importance ofcomplications and ofstudies which may help us to understand and prevent complications. Towards the end oftflis year, 2 million lens implants would ha1.c heen inserted. Although clinical impressions and puhfished figures indicate that a posterior chamber implant causes fewer complications and is the implant of‘choicc, the dehate is not over. Tflrre is still a lack of critical longterm prospecti\.c studies on the compfications of posterior chamber implants. The continuing cndothclial cell loss following intracapsular cataract