scholarly journals Minor effect of inaccurate fixation on VEP-based acuity estimates

2020 ◽  
Author(s):  
Amal A. Elgohary ◽  
Sven P. Heinrich
Keyword(s):  
Visual Acuity ◽  
Young Children ◽  
Data Quality ◽  
Minor Effect ◽  
Normal Vision ◽  
Functional Impairments ◽  
Left Edge ◽  
Eccentric Fixation ◽  
Almost All ◽  
Central Fixation

Abstract Purpose VEP-based estimation of visual acuity may be used in cases of suspected malingering to objectify subjective complaints. In such an application, a lack of cooperation needs to be expected. The same may apply to young children with suspected functional impairments. In the present study, we assessed how inaccurate fixation affects the acuity estimates obtained with a VEP technique. Methods VEP-based acuity estimates were obtained by stimulating with a series of different check sizes using a ‘stepwise sweep’ protocol. Sixteen participants were tested with normal and degraded vision under five different fixation conditions (central fixation and eccentric fixation at top, bottom, right, and left edge of the stimulus area). Results The majority of individual acuity estimates with eccentric fixation differed by less than 0.1 logMAR from central fixation, and almost all estimates differed by less than 0.3 logMAR. Median estimates with eccentric fixation differed only slightly (up to 0.08 logMAR) and, except for top fixation with normal vision, non-significantly. However, data quality was lower with eccentric fixation, which increased the probability that no acuity estimate could be derived from the recording. Conclusion VEP-based acuity estimates are relatively insensitive to eccentric fixation. Unnoticed deviations from central fixation in routine applications will probably be smaller than in the present study and will have even less impact on the outcome.

scholarly journals Electronically monitored occlusion therapy in amblyopia with eccentric fixation

2021 ◽  
Author(s):  
Berna Mehmed ◽  
Maria Fronius ◽  
Tabea Pohl ◽  
Hanns Ackermann ◽  
Charlotte Schramm ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Dose Response ◽  
Electronic Monitoring ◽  
Visual Outcome ◽  
Treatment Efficiency ◽  
Eccentric Fixation ◽  
Day Range ◽  
Best Response ◽  
Lower Treatment ◽  
Central Fixation

Abstract Purpose Amblyopia with eccentric fixation, especially when not diagnosed early, is a therapeutic challenge, as visual outcome is known to be poorer than in amblyopia with central fixation. Consequently, treatment after late diagnosis is often denied. Electronic monitoring of occlusion provides us the chance to gain first focussed insight into age-dependent dose response and treatment efficiency, as well as the shift of fixation in this rare group of paediatric patients. Methods In our prospective pilot study, we examined amblyopes with eccentric fixation during 12 months of occlusion treatment. We evaluated their visual acuity, recorded patching duration using a TheraMon®-microsensor, and determined their fixation with a direct ophthalmoscope. Dose-response relationship and treatment efficiency were calculated. Results The study included 12 participants with strabismic and combined amblyopia aged 2.9–12.4 years (mean 6.5). Median prescription of occlusion was 7.7 h/day (range 6.6–9.9) and median daily received occlusion was 5.2 h/day (range 0.7–9.7). At study end, median acuity gain was 0.6 log units (range 0–1.6) and residual interocular visual acuity difference (IOVAD) 0.3 log units (range 0–1.8). There was neither significant acuity gain nor reduction in IOVAD after the 6th month of treatment. Children younger than 4 years showed best response with lowest residual IOVAD at study end. Efficiency calculation showed an acuity gain of approximately one line from 100 h of patching in the first 2 months and half a line after 6 months. There was a significant decline of treatment efficiency with age (p = 0.01). Foveolar fixation was achieved after median 3 months (range 1–6). Three patients (> 6 years) did not gain central fixation. Conclusion Eccentric fixation is a challenge to therapy success. Based on electronic monitoring, our study quantified for the first time the reduction of treatment efficiency with increasing age in amblyopes with eccentric fixation. Despite some improvement in patients up to 8 years, older patients showed significantly lower treatment efficiency. In younger patients with good adherence, despite poor initial acuity, central fixation and low residual IOVAD could be attained after median 3 months. Hence, the necessity of early diagnosis and intensive occlusion should be emphasized.

Visual acuity and accommodation in infants and young children with Down's syndrome

1996 ◽  
Vol 40 (1) ◽  
pp. 49-55 ◽  
Author(s):  
J. M. Woodhouse ◽  
V. H. Pakeman ◽  
K. J. Saunders ◽  
M. Parker ◽  
W. I. Fraser ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Young Children ◽  
Down's Syndrome ◽  
Down’S Syndrome ◽  
Infants And Young Children

Successful Combination Therapy for Amblyopia Secondary to Micro-Esotropia And Anisometropia

2021 ◽  
pp. 195-200
Keyword(s):  
Visual Acuity ◽  
Combination Therapy ◽  
Refractive Error ◽  
Combination Treatment ◽  
Current Treatment ◽  
Short Term ◽  
Eccentric Fixation ◽  
Case Summary ◽  
Vision Therapy ◽  
Spectacle Correction

Background: Micro-esotropia is a small-angle esodeviation typically less than nine prism diopters. Patients with this ocular condition often develop amblyopia due to the presence of a constant unilateral strabismus and an anisometropic refractive error in the deviated eye. Current treatment methods for strabismic and refractive amblyopia include spectacle correction, patching, and vision therapy (VT). Case Summary: A 9-year-old Asian female presented with a constant left primary micro-esotropia with unsteady eccentric fixation, contributing to mild amblyopia and frequent suppression in the left eye. She also had a hyperopic anisometropic refractive error. Combination treatment of in-office VT with short-term patching therapy (two hours per day) was administered, with the goal of improving her binocularity, fixation, and visual acuity. Conclusions: Amblyopia results from binocular dysfunction, therefore monocular patching therapy alone will not improve the underlying issue. VT is necessary to actively treat binocularity and subsequently improve visual acuity, while short-term patching can be used in combination to effectively target monocular accommodation and fixation.

scholarly journals Aspect Clinique Atypique De La Tuberculose Oculaire A Propos D'un Cas

2018 ◽  
Vol 14 (9) ◽  
pp. 122
Author(s):  
Samia Nassik ◽  
Aouatef Masmoudi ◽  
Salssabile Nafizy ◽  
Saad Mouine ◽  
Amine Kouisbahi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Young Woman ◽  
Clinical Characteristics ◽  
Ocular Inflammation ◽  
Clinical Aspect ◽  
Ocular Tuberculosis ◽  
Know How ◽  
Almost All

Introduction: The ophthalmological manifestation of tuberculosis varies significantly, and almost all the elements of the globe and orbit can be reached. Methods and Results: The aim of this work was to report a clinical aspect of ocular tuberculosis in a young woman who has a notion of tuberculous contagion and who was presented at the fundus of a macular papillary membrane with a tubercle of Bouchut or papillary tubercle. The diagnosis was retained on a bundle of clinical, biological, and radiological arguments. The evolution under treatment was favorable with an improvement of its visual acuity. Conclusion: It is necessary to know how to evoke the tuberculous etiology in view of all ocular inflammation, even atypical. This is required considering the great polymorphism of its clinical characteristics.

Meningitis—What Is It?

2019 ◽  
pp. 1-22
Author(s):  
Janet R. Gilsdorf
Keyword(s):  
Cerebrospinal Fluid ◽  
Young Children ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Pathologic Examination ◽  
Helen Keller ◽  
Clinical Signs And Symptoms ◽  
Almost All

Before the advent of antibiotics, meningitis was a dreadful infection by any standard; many of its victims were young children, and almost all died, succumbing to the disease from days to six weeks, or sometimes longer, after the onset of their illness. Incredibly, patients occasionally survived but were often left with varying degrees of neurologic damage. Before the first spinal tap, the diagnosis of meningitis was based on clinical signs and symptoms and could be confirmed only by pathologic examination of the brains of deceased patients during an autopsy. Since the advent of the spinal tap, the diagnosis of meningitis rests on examination of the cerebrospinal fluid. Treatment of meningitis depends on which bacteria cause the infection. Helen Keller may be a famous surviving victim of this disease.

scholarly journals Periodontal Microsurgery and Microsurgical Instrumentation: A Review

2016 ◽  
Vol 04 (02) ◽  
pp. 074-080
Author(s):  
Kawaldeep Kang ◽  
Deepak Grover ◽  
Viniti Goel ◽  
Sumit Kaushal ◽  
Gurpreet Kaur
Keyword(s):  
Visual Acuity ◽  
Surgical Procedures ◽  
Wound Closure ◽  
New Technologies ◽  
Surgical Techniques ◽  
Technical Skills ◽  
Normal Vision ◽  
Lighting System ◽  
Tissue Trauma

AbstractIncreasing surgical refinement of procedures to meet both biologic and esthetic demands of patients is seen in today's periodontal practice. For these new technologies, instruments, and surgical techniques are necessary. Technical skills of the clinician are challenged by the limit of range of visual acuity. Periodontal microsurgery improves the outcome of basic periodontal surgical procedures by enhancing normal vision through magnification along with favorable lighting system. It gives enhanced outcomes not possible with traditional macrosurgery in terms of passive wound closure and reduced tissue trauma. The purpose of this review is to provide brief knowledge of periodontal microsurgery: the role of magnification, microsurgical instrumentation and applications of microsurgery.

scholarly journals Visual acuity testing in young children.

1972 ◽  
Vol 56 (11) ◽  
pp. 827-832 ◽  
Author(s):  
C G Keith ◽  
Z Diamond ◽  
A Stansfield
Keyword(s):  
Visual Acuity ◽  
Young Children ◽  
Visual Acuity Testing
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