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Treating Progressive Myopia
Published in John William Yee, The Neurological Treatment for Nearsightedness and Related Vision Problems, 2019
Asthenopia, or eye strain, was thought to be prevalent among those with hyperopia (or farsightedness). The symptoms are fatigue, headaches, and blurred vision when performing work in the near range for an extending period. The crystalline lens’ inability to take on the proper bulged shape when attempting to bring a near image into focus contributes to the discomfort. Asthenopia is not usually associated with nearsightedness even though the myopia tends to make an effort to bring something far away into focus. The contention is that if the myopic eye cannot make out a blur image, it would eventually give up. The hyperopic eye, on the other hand, would continue trying to bring it into focus.
Rehabilitation and management of visual dysfunction following traumatic brain injury
Published in Mark J. Ashley, David A. Hovda, Traumatic Brain Injury, 2017
In the case of inadequate ability to sustain fixation, the first step is to rule out refractive, binocular, accommodative, or other ocular–motor dysfunctions that may lead to asthenopia (i.e., eyestrain and/or headache) or discomfort. Such dysfunctions may make extended viewing aversive. They are also remediable, and a primary attention or fixation mechanism dysfunction might not be.
Ocular Findings in Children with Headache
Published in Ophthalmic Epidemiology, 2023
Lisa Y. Lin, Wei Pan, Gui-Shuang Ying, Gil Binenbaum
The most common finding in our cohort was a refractive issue, identified in 18.2% of children with headache in a tertiary pediatric ophthalmology clinic. Prior studies have reported associations between refractive errors and headaches.15–18 Asthenopia, which may be characterized by chronic headache and eye fatigue, can be caused by uncorrected refractive errors or impairment of convergence.19 In our study, among children who had a full cycloplegic refraction, 6.9% had a significant change in spherical equivalent refractive error, 12.9% had an astigmatic change ≥1D, and 8.0% had an anisometropic change ≥1 D. Two children had either their astigmatic axes or amounts switched between the eyes. Thus, even in children with a recent refraction, if there is a new onset of headache, it is important to consider refractive issues as a potential cause. Further, children may be more likely than adults to describe symptoms of asthenopia as a headache, as they may not have the words to report eye strain, and as with other diseases in children, it is important to think more broadly as to what a child means when they report head pain. Convergence insufficiency can cause difficulty with prolonged reading and near work, which can contribute to headaches particularly in school-aged children. We found that children complaining of headache with reading or at the end of the day were more likely to have strabismus on exam (p = .02), 4.4% of children were diagnosed with new or worsening strabismus when they presented with headache, and 25.3% of those with new strabismus had convergence insufficiency.
Reading Difficulty Due to Oculomotor Dysfunction following Mild Traumatic Brain Injury: A Case Report
Published in Journal of Binocular Vision and Ocular Motility, 2023
Pritam Dutta, Ayisha Atiya, Smita Vittal, Jameel Rizwana Hussaindeen
His best-corrected visual acuity was 20/20 for distance and near with a refractive correction of Plano in the right eye and +0.00DS/-0.75DC × 160 in the left after cycloplegic refraction. Pupils of both eyes were round, regular in shape, and normally reacting to light and near with no relative afferent pupillary defect. No ocular motility restrictions were present. Slit-lamp biomicroscopy revealed normal ocular adnexa, lids, lashes, cornea, and conjunctiva in both eyes. Intra-ocular pressure was 14 mm Hg in both eyes. Four mirrored gonioscopy was performed that showed normal and open anterior chamber angles with no pigmentation. Humphrey visual field testing (30–2) revealed a normal visual field in both eyes. Dilated fundus examination showed a normal-appearing macula with a healthy neuro-retinal rim and normal cup-disc ratio. He was then referred to the neuro-optometry clinic for management of the persisting asthenopia and other visual symptoms.
Central Mini-plication of the Medial Rectus for Convergence Insufficiency
Published in Journal of Binocular Vision and Ocular Motility, 2020
Pilar Merino, Ilshat Mustafín, Pilar Gómez De Liaño, Carlos Cólliga
Convergence insufficiency is a frequent binocular disorder characterized by exophoria or exotropia at near vision, with less or no deviation at distance vision, and a decrease in fusional convergence amplitude. It is associated with symptoms such as asthenopia, headache, double vision, and inability to read.1,2 The incidence of convergence insufficiency in adulthood peaks in the eighth decade of life and is generally not associated with neurological disorders.3 Several surgical and nonsurgical methods are available for treatment. Surgery may be necessary in cases where convergence exercises fail to improve symptoms, in cases where patients reject the exercises, and in cases associated with a deviation >10 pd in near vision with orthophoria or exotropia in distance vision.3–6 Central plication of the rectus muscle was described by Leenheer and Wright for the treatment of small-angle strabismus. Outcomes were good for divergence insufficiency and in horizontal and vertical small-angle strabismus.7,8