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Low vision aids for preschool children
82
Surv Ophthalmol
35 (1) July-August
1990
CURRENT
OPHTHALMOLOGY
in the absence of a luminance artifact that appears to be present in their stimulus. The published stimulus size does not divide as a whole number into the field diameter. This produces an imbalance ofblack/white areas of the display and an (undesirable) change in integrated luminance during each stimulus cycle. Nevertheless, their annulus field comparison technique holds definite promise for the reduction of variance and for the sharpening of discrimination. Appreciation of the final sensitivity of this new technology must (as Weinstein et al advise) await very carefully done prospective research. WILLIAMW. DAWSOK,PH.D. GAINESVILLE.
Oculomotor
Palsy With Cyclic Spasms, by D.I. Friedman,
Neurology 39:1263-1264, The authors describe suggest that the patient muscle function. These palsy. (Author’s address:
FLoRIDA
K.W. Wright, and A.F. Sadun.
1989
a 39-month-old boy with abnormal movements of the left pupil and lid. The authors exhibited cyclical movements of the left lid and pupil without changes in extraocular findings are thought to be the most compatible with a partial cyclical ocular motor Alfred0 Sadun, M.D., Department
of Ophthalmology,
University of Southern California,
1355
San Pablo Street, Los Angeles, CA 90033.)
Comment This child had many of the typical features of “oculomotor paresis with cyclic spasms,” so there is little doubt about the diagnosis. The duration of the full cycle was 90 seconds; and in the cases described in the literature, the mean duration was 74 seconds (range 20-210 seconds). The onset with a febrile illness has been reported before. The flickering of the ptotic lid at the beginning of the spastic phase is characteristic. In these patients the spasms occur on a background of third nerve paresis, and generally speaking, the worse the palsy the stronger the spasms. A muscle that is receiving appropriate third nerve innervation usually has little movement during the spasm. The apparent exception to this rule in this case is the pupil in the affected eye, which both reacted to light and moved dramatically (from 7 mm down to 3 mm) in the spastic phase. Large pupillary movements during the cycles are common and this may be due to the fact that aberrant regeneration often provides extra innervation; more than the small iris sphincter muscle needs or gets-under ordinary circumstances. SIANLEY TIIOMPSON, M.D. IOWA
CI’IY,
IOWA
Low Vision Aids for Preschool Children, by J.P. Ritchie, P.M. Sonksen, and E. Gould. Dev
Med Child Nemo1 31:509-519,
1989
The authors describe a study of preschool children. The purpose of this study was to investigate a variety of low vision aids for young children with severe visual disabilities using nursery age learning material, and to establish the value of the aids in this age group. The visual and developmental criteria for inclusion in this study were wide enough to encompass children with both poor and better vision, and at earlier and later stages of development than the team thought would necessarily benefit from the aids, in order to provide guidelines which would be of clinical value to professionals deciding upon the appropriateness of low visual aids in preschool children. The lowest age for inclusion was eighteen months, and the minimal level of vision was visually directed reaching for a 5 1 mm white ball on a table surface. The authors discuss the indications for the use of low vision aids in preschool children. (Author’s address: P.M. Sonksen, Developmental Pediatrics, Wolfson Centre,
Institute of Child Health, London,
England.)
Comment The authors show that severely visually impaired children 5 years old or younger may benefit from the use of a near low vision aid, specifically a 20 diopter stand magnifier. Of 30 patients who were introduced to a
CURRENT
s:i
OPHTHALMOLOGY
stand magnifier. 13 had visu;il ;tcuit), of‘ (i/60; the others had vision poorer than this. Fifieett patiettts demottsct-ated improved visu:tl fttttctiott on the tests perfitrmed. Patients who had improved performance were 2 years or older, had achieved ;t verbal perfi~rtnance level of‘at least 2 years of‘age, attention control ofat least 27 to 39 months, and tttittimum vision of‘ l/l 20 Snellen. Of‘interest is the fact that a number ofchildren showed improvement in the unaided visual fknction at the end of the six-\veek trial with the magnifier. The at-tick uttderscores the fkt that prc-school children cat1 USC anti may achieve improvrd visual reaolutiott fi-0111 low vision aids. AsIH+L~..\(:II
Convulsion
Der-mott,
Following
I>.(:. Saunders,
Intravenous
and
Fluorescein
F.N. Leach.
Angiography,
Rt.,/ Ophthn/ml
by S.P. Kelly, N.J.(i.
Mac-
7~33655-656, 1989
Fl‘otiic clonic seic.ure5 ii)llow-cd intravenous fluorcsceitt injection fi)r fi~ndus angiogt-aphy in a 47-year-old male. Despite precautions, this ;idvct-se rcactioti t~eoc~ut-red ott r-e-exposure to the intravenous fluoresceitt in this patient. ‘I‘he authors discussed the potential cotiiplicatiotis of‘the use ofititravenous fluoresceitt. (Author’s %l 1 :St)\\:H. England.) ;tdd~-css: Sitttott K~llv. FK( 3, IllanchcstclRoyal Eve Hospital. Oxford KoA~, bl;rt~c Ircstel-.
Comment to distinguish iiti ad\,erse reaclioti tl-on1 L$‘hcii evaluating a possible drit~-t-elated rvetit. it is difkult multiple c11her reactiotts, cspeciallv with IV injections of’an unusually coloiwl fluid. This paper is importattt be~airse it is the first to report 2 Lpeat seizt;rc afier ;t rechallenge With 1V fluorescein. Yatitiitz2 et al have evalu;ilt~tl dinost ;I quarter of‘a million fluorescein angiography pt~oc~dut~~~; 16 0l‘Thcse uonc 01 M,hich was tatal (l’;tttttuzzi I, et al: Ol,hth~rlm(~lo~~ 93.6 1 l-6 17, 1Wi). ~l‘he reported cotivulsiotts, National Kegistry of‘I)t.ug-ittd~r~~[l 0cd11. Sidr Efkcts (Portland. OK) has recorded a case in which corlvulsion occurred within minutes after IV fluoresceitt atitl t’iuo hours later, the patient died ofpultnonar~ edema. Additional cases itt the Kegistr!’ report p:tlirttls with convulsive historks, in whom con\~ulsions occurred afirt fluoresccitt atigiogt-aph!,, even though Ihc patients were on anticonvulsive medicatioit. (~otiviilsiot~s can occur secottdary to fluoresceitt ;tngiography fk)m a few tttinutcs to a kw hottrs after the injectiott. .l‘hr CXIIW ofthcse c~ottvulsions is ttot ICIIOMtt, ttor do WC’know if the\,at-r mot-c fi-equertt \vith the hi~Shet~c~onccntt~;ttions of‘ fluorescciit given in ;I sinallt~ uol~li~l~. WC ;igrce with 1’atitiii/.~i el al tIl;it fluot-csc,eiii ati~iogt-;tph) has ;i \‘rry sn~all risk. alid itidecd is a rclativcl) safe procedure. particularly cotrtp;tred lo other diagnostic invasive procedures it, allied medical specialties. 1.anttuzA ct al. as well as K.E. b:L’estky. nope that the concurrent LISC of‘ 10% phen)le~~~rt.ine, rather that fluoresceiti injection, ili;i\. bvell 13~ rhc more’ likrly precipitating fktor in tiian~ of thy cardiac arrests attd C, 0 1‘1, 19x3; I~l-a~11lcardiac itif~ircTiotis after fluorescein atigiogt-aphy, (Lt’osley ICE::,/ (krrl~t. T/!(,~.(r/g Slrqp.2 l_-_ kldetFl‘. Scafidi AF: :irrr ,/ O/~/t/lrt~l~~/ Sj:-147-4:i:i, 1978). 1;.-1‘. I;K \I~Zt~Fl.l)~.K, $1.1). h)KII.\Nl),
()Kb(.Oi\r
INDEX OF ADVERTISERS July-August 1990
Asia-Pacific
J 111.Oph.
. . . . . . . . ..___._................._........
(k-1 Zeiss, inc. .................................................... Ciba Vision, Grieshabet;
Inc. .............................................. Inc.
7a
I,ombart
Ia
Ophthalmic
...2a
. . . . . . . . . . . . .._._......_.._.....__..__............ Xa
Kesources
Itistrutnenl
Co.
Reviews
7 ...............................
ti)t- Kehabilitation
Site Microsurgical
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..kt (Iover
...........................
2
...6a
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (:over
4
Surv Ophthalmol
35 (1) July-August
1990
CURRENT
OPHTHALMOLOGY
in the absence of a luminance artifact that appears to be present in their stimulus. The published stimulus size does not divide as a whole number into the field diameter. This produces an imbalance ofblack/white areas of the display and an (undesirable) change in integrated luminance during each stimulus cycle. Nevertheless, their annulus field comparison technique holds definite promise for the reduction of variance and for the sharpening of discrimination. Appreciation of the final sensitivity of this new technology must (as Weinstein et al advise) await very carefully done prospective research. WILLIAMW. DAWSOK,PH.D. GAINESVILLE.
Oculomotor
Palsy With Cyclic Spasms, by D.I. Friedman,
Neurology 39:1263-1264, The authors describe suggest that the patient muscle function. These palsy. (Author’s address:
FLoRIDA
K.W. Wright, and A.F. Sadun.
1989
a 39-month-old boy with abnormal movements of the left pupil and lid. The authors exhibited cyclical movements of the left lid and pupil without changes in extraocular findings are thought to be the most compatible with a partial cyclical ocular motor Alfred0 Sadun, M.D., Department
of Ophthalmology,
University of Southern California,
1355
San Pablo Street, Los Angeles, CA 90033.)
Comment This child had many of the typical features of “oculomotor paresis with cyclic spasms,” so there is little doubt about the diagnosis. The duration of the full cycle was 90 seconds; and in the cases described in the literature, the mean duration was 74 seconds (range 20-210 seconds). The onset with a febrile illness has been reported before. The flickering of the ptotic lid at the beginning of the spastic phase is characteristic. In these patients the spasms occur on a background of third nerve paresis, and generally speaking, the worse the palsy the stronger the spasms. A muscle that is receiving appropriate third nerve innervation usually has little movement during the spasm. The apparent exception to this rule in this case is the pupil in the affected eye, which both reacted to light and moved dramatically (from 7 mm down to 3 mm) in the spastic phase. Large pupillary movements during the cycles are common and this may be due to the fact that aberrant regeneration often provides extra innervation; more than the small iris sphincter muscle needs or gets-under ordinary circumstances. SIANLEY TIIOMPSON, M.D. IOWA
CI’IY,
IOWA
Low Vision Aids for Preschool Children, by J.P. Ritchie, P.M. Sonksen, and E. Gould. Dev
Med Child Nemo1 31:509-519,
1989
The authors describe a study of preschool children. The purpose of this study was to investigate a variety of low vision aids for young children with severe visual disabilities using nursery age learning material, and to establish the value of the aids in this age group. The visual and developmental criteria for inclusion in this study were wide enough to encompass children with both poor and better vision, and at earlier and later stages of development than the team thought would necessarily benefit from the aids, in order to provide guidelines which would be of clinical value to professionals deciding upon the appropriateness of low visual aids in preschool children. The lowest age for inclusion was eighteen months, and the minimal level of vision was visually directed reaching for a 5 1 mm white ball on a table surface. The authors discuss the indications for the use of low vision aids in preschool children. (Author’s address: P.M. Sonksen, Developmental Pediatrics, Wolfson Centre,
Institute of Child Health, London,
England.)
Comment The authors show that severely visually impaired children 5 years old or younger may benefit from the use of a near low vision aid, specifically a 20 diopter stand magnifier. Of 30 patients who were introduced to a
CURRENT
s:i
OPHTHALMOLOGY
stand magnifier. 13 had visu;il ;tcuit), of‘ (i/60; the others had vision poorer than this. Fifieett patiettts demottsct-ated improved visu:tl fttttctiott on the tests perfitrmed. Patients who had improved performance were 2 years or older, had achieved ;t verbal perfi~rtnance level of‘at least 2 years of‘age, attention control ofat least 27 to 39 months, and tttittimum vision of‘ l/l 20 Snellen. Of‘interest is the fact that a number ofchildren showed improvement in the unaided visual fknction at the end of the six-\veek trial with the magnifier. The at-tick uttderscores the fkt that prc-school children cat1 USC anti may achieve improvrd visual reaolutiott fi-0111 low vision aids. AsIH+L~..\(:II
Convulsion
Der-mott,
Following
I>.(:. Saunders,
Intravenous
and
Fluorescein
F.N. Leach.
Angiography,
Rt.,/ Ophthn/ml
by S.P. Kelly, N.J.(i.
Mac-
7~33655-656, 1989
Fl‘otiic clonic seic.ure5 ii)llow-cd intravenous fluorcsceitt injection fi)r fi~ndus angiogt-aphy in a 47-year-old male. Despite precautions, this ;idvct-se rcactioti t~eoc~ut-red ott r-e-exposure to the intravenous fluoresceitt in this patient. ‘I‘he authors discussed the potential cotiiplicatiotis of‘the use ofititravenous fluoresceitt. (Author’s %l 1 :St)\\:H. England.) ;tdd~-css: Sitttott K~llv. FK( 3, IllanchcstclRoyal Eve Hospital. Oxford KoA~, bl;rt~c Ircstel-.
Comment to distinguish iiti ad\,erse reaclioti tl-on1 L$‘hcii evaluating a possible drit~-t-elated rvetit. it is difkult multiple c11her reactiotts, cspeciallv with IV injections of’an unusually coloiwl fluid. This paper is importattt be~airse it is the first to report 2 Lpeat seizt;rc afier ;t rechallenge With 1V fluorescein. Yatitiitz2 et al have evalu;ilt~tl dinost ;I quarter of‘a million fluorescein angiography pt~oc~dut~~~; 16 0l‘Thcse uonc 01 M,hich was tatal (l’;tttttuzzi I, et al: Ol,hth~rlm(~lo~~ 93.6 1 l-6 17, 1Wi). ~l‘he reported cotivulsiotts, National Kegistry of‘I)t.ug-ittd~r~~[l 0cd11. Sidr Efkcts (Portland. OK) has recorded a case in which corlvulsion occurred within minutes after IV fluoresceitt atitl t’iuo hours later, the patient died ofpultnonar~ edema. Additional cases itt the Kegistr!’ report p:tlirttls with convulsive historks, in whom con\~ulsions occurred afirt fluoresccitt atigiogt-aph!,, even though Ihc patients were on anticonvulsive medicatioit. (~otiviilsiot~s can occur secottdary to fluoresceitt ;tngiography fk)m a few tttinutcs to a kw hottrs after the injectiott. .l‘hr CXIIW ofthcse c~ottvulsions is ttot ICIIOMtt, ttor do WC’know if the\,at-r mot-c fi-equertt \vith the hi~Shet~c~onccntt~;ttions of‘ fluorescciit given in ;I sinallt~ uol~li~l~. WC ;igrce with 1’atitiii/.~i el al tIl;it fluot-csc,eiii ati~iogt-;tph) has ;i \‘rry sn~all risk. alid itidecd is a rclativcl) safe procedure. particularly cotrtp;tred lo other diagnostic invasive procedures it, allied medical specialties. 1.anttuzA ct al. as well as K.E. b:L’estky. nope that the concurrent LISC of‘ 10% phen)le~~~rt.ine, rather that fluoresceiti injection, ili;i\. bvell 13~ rhc more’ likrly precipitating fktor in tiian~ of thy cardiac arrests attd C, 0 1‘1, 19x3; I~l-a~11lcardiac itif~ircTiotis after fluorescein atigiogt-aphy, (Lt’osley ICE::,/ (krrl~t. T/!(,~.(r/g Slrqp.2 l_-_ kldetFl‘. Scafidi AF: :irrr ,/ O/~/t/lrt~l~~/ Sj:-147-4:i:i, 1978). 1;.-1‘. I;K \I~Zt~Fl.l)~.K, $1.1). h)KII.\Nl),
()Kb(.Oi\r
INDEX OF ADVERTISERS July-August 1990
Asia-Pacific
J 111.Oph.
. . . . . . . . ..___._................._........
(k-1 Zeiss, inc. .................................................... Ciba Vision, Grieshabet;
Inc. .............................................. Inc.
7a
I,ombart
Ia
Ophthalmic
...2a
. . . . . . . . . . . . .._._......_.._.....__..__............ Xa
Kesources
Itistrutnenl
Co.
Reviews
7 ...............................
ti)t- Kehabilitation
Site Microsurgical
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..kt (Iover
...........................
2
...6a
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (:over
4