Is the convergence insufficiency symptoms survey specific for convergence insufficiency?

Volume 17 Number 1 / February 2013 057 Adjustable augmented rectus muscle transposition surgery with or without ciliary vessel-sparing for abduction deficiencies. Karen Hendler, Stacy L. Pineles, Federico G. Velez, Joseph L. Demer Introduction: Vertical rectus transposition (VRT) is useful in Duane syndrome and abducens palsy. However, many clinicians avoid transpositions due to the risk of induced vertical deviations and overcorrections. Posterior fixation sutures enhance the effect of VRT, but preclude the use of adjustable sutures. An adjustable augmented VRT with or without ciliary vessel-sparing is described. Methods: We retrospectively reviewed the records of all patients undergoing adjustable suture partial or full tendon VRT augmented by resection of the transposed muscles. Ciliary vessels were preserved by either splitting the transposed muscle or by dragging the transposed muscle without disrupting the muscle insertion. Results: Six patients with abducens palsy and one with eso-Duane syndrome were included. Mean follow-up was 2.2  2.2 months. Resection of 3–5 mm was performed in all patients. Preoperativelyerative central gaze esotropia of 32.6  12.6D (range, 18-50) decreased to 8.7  7.4D (range, 0-18) at the final visit (P 5 0.002). Two patients required postoperative adjustment with recession of one of the transposed muscles due to an induced vertical deviation with overcorrection. At the final visit, one patient had a vertical deviation\4D, and none had overcorrection or anterior segment ischemia. Discussion: Unlike posterior fixation sutures, adjustable sutures can be utilized when augmenting transposition procedures by resection of the transposed muscles. This can help to overcome induced vertical deviations or overcorrections. In addition ciliary vessels can be spared in these procedures. Conclusions: Augmentation of VRT by resection of the transposed muscles can be performed with adjustable sutures and vessel-sparing technique. This allows for postoperative control of overcorrections and induced vertical deviation as well as less risk of anterior ischemia. 058 A new continuous outcome measure for assessing strabismus. Jonathan M. Holmes, David A. Leske, Sarah R. Hatt, Laura Liebermann Introduction: Previous outcome measures for strabismus surgery have categorized patients dichotomously as either success or failure depending on motor alignment alone or a combination of motor alignment and diplopia. We created a potentially more discriminatory outcome measure that is continuous (0 to 100, best to worst strabismus) and studied its distribution, test-retest reliability, and responsiveness. Methods: To calculate the diplopia-angle score (0-100), a diplopia score (0-100) was first derived from a previously validated diplopia questionnaire, evaluating diplopia as: always, often, sometimes, rarely or never in 7 gaze positions. The diplopia score was then modified by the distance and near strabismus angles; angles of 10D or less were set to have no effect on the score, whereas angles of 30D or more rendered the overall score maximal, with a sliding scale between. We evaluated distribution of the diplopia-angle scores (n5158), test–retest reliability (n 5 58), and preoperative to 6-week postoperative change in scores (n5158). Results: Diplopia-angle scores ranged from 0 (least severe strabismus) to 100 (most severe), using the entire distribution. The diplopia-angle score had good test–retest reliability (ICC 5 0.88; 95% CI, 0.80-0.92) and excellent responsiveness after surgery (improvement from 70  31 preoperatively to 23  30 postoperatively, P \ 0.0001). Discussion: The new diplopia-angle score is implementable across the whole range, of adult strabismus, has good test–retest reliability, and has excellent responsiveness to treatment.

Journal of AAPOS

e17 Conclusions: The new diplopia-angle score is likely to be useful as an outcome measure for future studies of strabismus. 059 Is the convergence insufficiency symptoms survey specific for convergence insufficiency? Lindsay Horan, Benjamin H. Ticho, Megan Allen Introduction: The Convergence Insufficiency Symptom Survey (CISS) is a 15-item questionnaire used as both a diagnostic tool and measure of symptomatology in the Convergence Insufficiency Treatment Study (CITS) and ongoing Convergence Insufficiency Treatment Trial (CITT) to quantify the severity of symptoms associated with convergence insufficiency (CI). Methods: 32 patients ages 8 to 18 were enrolled in a prospective, masked clinical trial. CISS scores of patients with and without CI (as defined by CITS) who presented for a routine eye examination were rcompared. Patients completed the CISS and then underwent a complete eye examination, including visual acuity, assessment of distance and near ocular alignment, near point of convergence, convergence and divergence amplitudes, and monocular near point of accommodation. Results: Preliminary results of the mean score on the CISS for the convergence insufficiency group (n59) was 19.2 (SD 5 12.9) vs. 16.5 (SD 5 11.7) for the non-CI group (n 5 23). There was no statistical difference between the two groups (P 5 0.7). Discussion: Our results suggest that a high CISS score may be found in patients without clinical CI. A related question (relevant to CISS use as a measure of treatment effect in clincal studies) is the test– retest variability over time. Conclusions: There may be no reliable difference in the CISS score in pediatric patients with and without convergence insufficiency. 060 Incidence of retinopathy of prematurity in infants greater than 31 weeks gestational age undergoing screening examinations for retinopathy of prematurity. Jennifer L. Hsu, Rebecca S. Braverman, Robert E. Enzenauer Introduction: There is some discrepancy regarding what gestational age should be used as the criterion for retinopathy of prematurity (ROP) screening examinations. The purpose of this study is to determine whether screening infants born at 30 weeks or less gestational age results in failure to diagnose type 1 ROP compared to screening infants at 32 weeks or less gestational age. Methods: An Institutional Review Board (IRB) approved retrospective chart review of premature infants born at 31 weeks gestational age or later who underwent ROP screening examinations between June 2008 and December 2011 was performed. Results: 101 infants met the inclusion the criteria. Four infants developed type 2 ROP and none developed type 1 ROP. Of the infants with type 2 ROP, two had a birthweight of less than 1500g, one had a birthweight of 1545 g, and one infant had a complicated clinical course. Discussion: 4% of infants in our study developed type 2 ROP and none required treatment. The infants that developed ROP had a lower birthweight and additional comorbidities. Conclusions: Our findings suggest that it may be feasible to reduce the recommended gestational age criterion for retinopathy of prematurity screening examinations from 32 weeks to 30 weeks or less gestational age. These findings are consistent with published recommendations. Eliminating unnecessary examinations would be cost effective. 061 POC vision screening analysis. Suzanne C. Johnston, Louis Vernacchio, Emily K. Trudell, Katherine Majzoub, Rashmi Dayalu, Bruce Moore