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Binocular vision problems after refractive surgery
Published in Jan-Tjeerd de Faber, 28th European Strabismological Association Meeting, 2020
D.J.M. Godts, M.J. Tassignon, L. Gobin
The third patient is a 40-year-old woman complaining of intermittent diplopia after LASIK for hyperopia of her left eye. She reported a history of intermittent esotropia since childhood. Postoperative best-corrected visual acuity was 20/20 in the right eye with +1.50 and 20/63 in the left eye with +1.25 (−3.50 × 150°) in the left eye. With the prism cover test, performed with glasses, an esotropia of 18 PD was found at near vision and of 10 PD at distance vision. Without glasses the esodeviation increased up to 25 PD at near and to 18 PD at distance. The diagnosis of partial accommodative esotropia was made. Ocular motility showed a V pattern with over action of the left inferior oblique muscle. The objective angle of strabismus was +7° and the subjective angle was -1° measured with the Synoptophore. These results are suggestive for an abnormal retinal correspondence with peripheral fusion on the subjective angle of strabismus. Suppression of the left eye was present in free space. Accommodation measured with the RAF test was 5D in both eyes, which is low but acceptable considering patient’s age. Fundus examination showed an extreme extorsion of both maculae. Bielschowsky head-tilt-test was negative.
SKILL Cover testing
Published in Sam Evans, Patrick Watts, Ophthalmic DOPS and OSATS, 2014
The prism cover test allows for quantitative assessment and documentation of the angle of deviation.Perform a cover test (see above) to identify the side and type of deviation, then make an estimation of the size of the deviation.Occlude the deviating eye and put a prism of approximately appropriate power in front of the occluder with its apex towards the direction of the deviation.Remove the occluder and observe the movement of the eye.Fine-tune the prism strength until no movement is seen on uncovering the eye.Check alignment under the prism using the corneal light reflex, which should be in the same position on each eye when they are aligned (Krimsky test).
Delayed Diagnosis of Amblyopia in Children of Lower Socioeconomic Families: The Hong Kong Children Eye Study
Published in Ophthalmic Epidemiology, 2022
Xiu Juan Zhang, Posey Po-Yin Wong, Emily S Wong, Ka Wai Kam, Benjamin Hon Kei Yip, Yuzhou Zhang, Wei Zhang, Alvin L. Young, Li Jia Chen, Patrick Ip, Clement C. Tham, Chi Pui Pang, Jason C. Yam
Ocular alignment was assessed by an ophthalmologist using the cover/uncover test, with a fixation target at both near (30 cm) and distant (6 m) ranges. The prism cover test was performed to measure the degree of eye misalignment. Refractive status was measured before and after cycloplegia for each child using an auto-refractor (Nidek ARK-510A, Gamagori, Japan). Two cycles of 1% cyclopentolate (Cyclogyl, Alcon-Convreur, Rijksweg, Belgium) and 1% tropicamide (Santen, Osaka, Japan) were each given 10 minutes apart. A third cycle of cyclopentolate and tropicamide drops was administered 30 minutes later if pupillary light reflex was still present or the pupil size was less than 6.0 mm. Finally, an ophthalmologist examined in detail the anterior segment using a slit-lamp (Haag-Streit, Koeniz, Switzerland) and the retina through an indirect ophthalmoscope with a 20D lens (Volk, Houston, TX).
Objective excyclotorsion in age-related distance esotropia
Published in Strabismus, 2022
A retrospective chart review of consecutive patients with ARDE who underwent fundus photography between August 2010 and April 2021 was performed. The inclusion criteria for ARDE in this study were as follows: (1) intermittent or constant horizontal uncrossed diplopia at a distance and no diplopia at near; (2) deviation of esotropia with distance fixation was less than 30 prism diopter (PD) and was greater than that with near fixation; (3) age of onset (diplopia) was over 55 years; and (4) the patient showed full ocular versions and ductions with normal saccadic eye movements. The exclusion criteria were as follows: (1) a history of paretic or non-paretic strabismus, (2) the presence of incomitance in esodeviation on lateral gaze or of slow abducting saccade, (3) presence of significant vertical strabismus (>4 PD), and (4) association with high myopia (refraction exceeding 9 diopter or axial length longer than 27 mm). Clinical characteristics were collected by routine ophthalmologic examination of strabismus. These included the alternate prism cover test at distance and near gaze, major amblyoscopic examinations, and Hess screen test. Eye dominance was determined with the hole-in-the-card method.
Reverse exercises in a case of intractable diplopia
Published in Strabismus, 2021
During his follow-up visit six weeks later, he had been compliant with the exercises but had noticed no change in his symptoms. His measurements remained stable for 20 prism diopters esotropia near and distance, and a homonymous diplopic response on Bagolini glasses for near and distance. However, by chance, it was observed on convergence in free space that his visual axes appeared to align at around 10 cm. On questioning, the patient reported no diplopia at 10 cm, and measurement of convergence with the RAF rule proved this with further investigation of, sensory fusion using Bagolini glasses atypically tested at 10 cm, where the patient reported a BSV result. Due to how close 10 cm is from the eyes, no prism cover test or stereopsis measurement was taken as accommodation may affect the result.