scholarly journals Fixation stability after surgical treatment of strabismus and biofeedback fixation training in amblyopic eyes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Otto Alexander Maneschg ◽  
Mirella Telles Salgueiro Barboni ◽  
Zoltán Zsolt Nagy ◽  
János Németh
Keyword(s):  
Surgical Treatment ◽  
Vision Loss ◽  
Surgical Intervention ◽  
Visual Fixation ◽  
Stable Fixation ◽  
Central Vision Loss ◽  
Fixation Stability ◽  
Potential Use ◽  
Fixation Area ◽  
Fellow Eyes

Abstract Background Visual fixation may be affected in amblyopic patients and, moreover, its stability may be associated with the effects of amblyopic treatments on visual performance in patients with strabismus. Therefore, fixation stability is a relevant biomarker that might predict the recurrence of amblyopia after a therapeutic intervention. Microperimetric biofeedback fixation training (BFT) can stabilize visual fixation in adult patients with central vision loss. It was the purpose of the present study to evaluate the effects of BFT on fixation stability in adult amblyopic patients after surgical intervention to treat strabismus. Methods Participants were 12 patients with strabismus (mean age = 29.6 ± 8.5 years; 6 females) and 12 healthy volunteers (mean age = 23.8 ± 1.5 years; 9 females). The protocol included ophthalmological and microperimetric follow-ups to measure fixation stability and macular sensitivity. BFT was applied monocularly to four amblyopic eyes either on the spontaneous preferential retinal locus or to a fixation area closer to the anatomical fovea after surgical treatment of strabismus. Results Baseline measurements showed significantly altered microperimetric average threshold in amblyopic eyes compared to fellow eyes (p = 0.024) and compared to control eyes (p < 0.001). Fixation was unstable in amblyopic eyes compared to control eyes (p < 0.001). Fixation stability did not significantly change after surgical alignment of strabismus (p = 0.805). BFT applied to operated eyes resulted in a more stable fixation with improvements of about 50% after three months of training. Conclusions Fixation stability improvements following BFT highlight its potential use in adult amblyopic eyes after the surgical alignment of the strabismus. Future investigations may also consider applying this method in combination with standard treatments to improve vision in amblyopic patients.

Plasticity of fixation in patients with central vision loss

2009 ◽  
Vol 26 (5-6) ◽  
pp. 487-494 ◽  
Author(s):  
LUMINITA TARITA-NISTOR ◽  
ESTHER G. GONZÁLEZ ◽  
SAMUEL N. MARKOWITZ ◽  
MARTIN J. STEINBACH
Keyword(s):  
Motor Control ◽  
Vision Loss ◽  
Reading Performance ◽  
Visual Performance ◽  
Biofeedback Training ◽  
Ocular Motor ◽  
Central Vision ◽  
Central Vision Loss ◽  
Fixation Stability ◽  
Ocular Motor Control

AbstractThe aim of this study was to explore the plasticity of fixation in patients with central vision loss. Most of these patients use preferred retinal loci (PRLs) in the healthy eccentric part of the retina to fixate, but fixation stability and retinal location are not always optimal for best visual performance. This study examined whether fixation stability and a new PRL location can be trained and whether these changes in ocular motor control transfer into better reading performance. Six patients with age-related macular degeneration participated in the study. Fixation stability measurements, microperimetry, and auditory biofeedback training were performed with the MP-1 microperimeter. The auditory biofeedback was used during five 1-h long training sessions to improve fixation and relocate the PRL. Fixation location and stability were recorded while viewing four different targets: a cross, a letter, a word, and a nine-cycle radial grating. Visual acuity was assessed with the Early Treatment Diabetic Retinopathy Study (ETDRS) chart and reading performance with the MNRead test. The results showed that all patients developed a new PRL in an optimal location for reading, and they were able to use it consistently while viewing different targets. Fixation stability improved 53% after training. Learning transferred to the old PRL even though fixation stability at this location was not trained. All these improvements in ocular motor control translated into better reading performance: reading speed improved 38% and reading acuity and critical print size gained two lines. We conclude that the ability of the ocular motor system to fixate is flexible in patients with central vision loss: a new PRL can be trained, fixation stability can be improved, and learning transfers to an untrained location. These gains in ocular motor control result in better visual performance. This property can be successfully used to optimize the residual vision of patients with central vision loss.

scholarly journals Biofeedback fixation training method for improving eccentric vision in patients with loss of foveal function secondary to different maculopathies

2019 ◽  
Vol 40 (2) ◽  
pp. 305-312 ◽  
Author(s):  
Marco U. Morales ◽  
Saker Saker ◽  
Craig Wilde ◽  
Martin Rubinstein ◽  
Paolo Limoli ◽  
...  
Keyword(s):  
Vision Loss ◽  
Reading Speed ◽  
Light Sensitivity ◽  
Central Vision ◽  
Functional Characteristics ◽  
Eccentric Fixation ◽  
Central Vision Loss ◽  
Fixation Stability ◽  
Group A ◽  
Group B

Abstract Purpose Fixation stability (FS) of the preferred retinal locus (PRL) may be improved by biofeedback fixation training (BFT) with microperimetry. Such training can be done on the patient’s PRL or in different retinal loci with better functional characteristics. We studied both options and compared the outcomes. Methods Sixty-seven consecutive patients with bilateral central vision loss, poor FS and visual acuity (VA) lower than 0.3 LogMAR were recruited for BFT with microperimeter. Patients were assigned into 2 groups. In group A, BFT was performed on the patient’s spontaneous PRL. In group B, PRL was located between 2 adjacent loci with the highest light sensitivity and the lowest distance from the fovea. Two sets of 12 weekly BFT sessions were performed. Primary outcomes were: FS, VA and reading speed. Results Outcomes were statistically significantly better in group B. Mean percentage of FS at therapy end improved from 32 to 35% for group A and from 40 to 55% in group B. Mean VA improved from 1 to 0.86 in group A and from 1 to 0.84 in group B. Reading speed (wpm) improved from 56 to 58 in group A and from 63 to 89 in group B. Conclusions This study describes a reliable methodology of improving eccentric fixation stability using BFT in microperimetry, when the fixation training locus is individualized as the retinal area with best functional characteristics. Further studies are needed to validate its value in a larger scale of patients, at different stages of the disease, and its persistence over time.

scholarly journals Influence of Retinal Microsecond Pulse Laser Treatment in Central Serous Chorioretinopathy: A Short-Term Optical Coherence Tomography Angiography Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2418
Author(s):  
Michelle Prasuhn ◽  
Yoko Miura ◽  
Aysegül Tura ◽  
Felix Rommel ◽  
Vinodh Kakkassery ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Central Serous Chorioretinopathy ◽  
Vision Loss ◽  
Subretinal Fluid ◽  
Spot Size ◽  
Optical Coherence ◽  
Non Invasive ◽  
Central Vision Loss ◽  
The Impact ◽  
Fellow Eyes

Background: Central serous chorioretinopathy (CSC) is a common macular condition characterized by detachment of the neuroretina and is a frequent cause of central vision loss in adults. Among the various therapeutic strategies, subthreshold microsecond pulsed laser (SML) treatment has become a useful option. Despite the suggested involvement of choroidal circulatory disturbances in CSC, the effects of this treatment on macular microperfusion have not been fully evaluated yet. Herein, we report the impact of SML on retinal and choroidal microvascular flow using non-invasive optical coherence tomography (OCT) angiography (OCTA). Methods: In this study, CSC patients with persistent subretinal fluid (SRF) with or without secondary choroidal neovascularization (CNV) were included (referred to as the pachychoroid neovasculopathy (PNV) group and the CSC group, respectively). SML was conducted using a yellow (577 nm) laser with a duty cycle of 10%, spot size of 200 µm and duration of 200 ms. Best corrected visual acuity (BCVA) as well as OCT and OCTA images were evaluated at baseline and 4 weeks after SML. OCTA parameters of interest included full retinal perfusion (FRP), choriocapillaris perfusion (CCP), Sattler’s layer perfusion (SLP), and Haller’s layer perfusion (HLP), which were evaluated longitudinally and compared to unaffected fellow eyes. Results: 27 affected eyes and 17 fellow eyes from 27 patients were included. Before treatment, central retinal thickness (CRT) and subfoveal choroidal thickness (SFCT) of affected eyes were significantly larger than in fellow eyes. Four weeks after SML, CRT decreased significantly, whereas perfusion parameters did not change. In subgroup analyses, the CSC group showed a significant decrease in SFCT, whereas the PNV group did not despite the decrease in CRT. Conclusion: Our results suggest that the SML may affect the SFCT of the CSC, but not the PNV patients at least within four weeks following treatment. This effect seems to be independent of the change in choroidal perfusion measured with OCTA.

scholarly journals Clinical Features and Surgical Management of Pituitary Adenoma During Pregnancy: Case Series and Literature Review

2022 ◽  
Author(s):  
Xinyu Jia ◽  
Xiaopeng Guo ◽  
Mingjie Luo ◽  
Yong Yao ◽  
Wei Lian ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Vision Loss ◽  
Surgical Intervention ◽  
Case Series ◽  
Healthcare Management ◽  
Visual Field Defects ◽  
Tumor Diameter ◽  
College Hospital ◽  
Medical College ◽  
Gestation Time

Abstract Purpose Although conservative treatment was recommended for pregnant patients with pituitary adenomas (PAs), surgical treatment is occasionally necessary for those with acute symptoms. However, surgical intervention among these patients is poorly studied. Methods Six patients with PAs who underwent surgical treatment during pregnancy at Peking Union Medical College Hospital between January 1990 and June 2021 and another 35 pregnant patients profiled in the literature were included. Results All the 41 enrolled patients (mean age 29.8 ± 5.3 years) had acute symptoms including visual field defects, severe headaches, or vision loss requiring emergency pituitary surgeries. Mean tumor diameter was 2.16 ± 0.9 cm, and 92.6% were macroadenomas. PA apoplexies were found in 23 patients. The average gestation time at surgery was 25.1 ± 7.1 weeks; 55.9% of these patients underwent surgery in the second trimester of pregnancy. Multidisciplinary team was involved from before surgery to after delivery. Except one patient underwent an induced abortion, and one fetus died due to a nuchal cord, thirty-nine patients delivered successfully, and 37 of fetuses were healthy till the last follow-up. One fetus died of congenital diaphragmatic hernia, and another had a low Apgar score after a cesarean section but survived. Conclusion PA surgery for pregnant patients with PAs is effective and safe during the second and third trimesters. Pregnant patients requiring emergency PA surgery need multidisciplinary evaluation and healthcare management. Cooperation of neurosurgery, endocrinology, obstetrics, anesthesiology, and neonatology is necessary for a successful surgical intervention for pregnant patients with PAs.

scholarly journals Influence of Retinal Microsecond Pulse Laser Treatment in Central Serous Chorioretinopathy: A Short-Term Optical Coherence Tomography Angiography Study

2021 ◽  
Author(s):  
Michelle Prasuhn ◽  
Yoko Miura ◽  
Aysegül Tura ◽  
Felix Rommel ◽  
Vinodh Kakkassery ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Central Serous Chorioretinopathy ◽  
Vision Loss ◽  
Subretinal Fluid ◽  
Spot Size ◽  
Optical Coherence ◽  
Non Invasive ◽  
Central Vision Loss ◽  
The Impact ◽  
Fellow Eyes

Background: Central serous chorioretinopathy (CSC) is a common macular condition characterized by detachment of the neuroretina and is a frequent cause of central vision loss in adults. Among the various therapeutic strategies, subthreshold microsecond pulsed laser (SML) treatment has become a useful option. Despite the suggested involvement of choroidal circulatory disturbances in CSC, effects of this treatment on macular microperfusion have not been fully evaluated yet. Herein, we report the impact of SML on retinal and choroidal microvascular flow using non-invasive optical coherence tomography (OCT) angiography (OCTA). Methods: In this study, CSC patients with persistent subretinal fluid (SRF) with or without secondary choroidal neovascularization (CNV) were included (referred to as pachychoroid neovasculopathy (PNV) group and CSC group, respectively). SML was conducted using a yellow (577 nm) laser with duty cycle of 10%, spot size of 200 &micro;m and duration of 200 ms. Best corrected visual acuity (BCVA) as well as OCT and OCTA images were evaluated at baseline and 4 weeks after SML. OCTA parameters of interest included full retinal perfusion (FRP), choriocapillaris perfusion (CCP), Sattler&rsquo;s layer perfusion (SLP), and Haller&rsquo;s layer perfusion (HLP), which were evaluated longitudinally and compared to unaffected fellow eyes. Results: 27 affected eyes and 17 fellow eyes from 27 patients were included. Before treatment, central retinal thickness (CRT) and subfoveal choroidal thickness (SFCT) of affected eyes were significantly larger than in fellow eyes. Four weeks after SML, CRT decreased significantly, whereas perfusion parameters did not change. In subgroup analyses, the CSC group showed a significant decrease of SFCT, whereas the PNV group did not despite the decrease of CRT. Conclusion: Our results suggest that the SML may SFCT of CSC, but not of PNV patients at least within four weeks following treatment. This effect seems to be independent of the change in choroidal perfusion measured with OCTA.

The Use of Eye Tracking to Discern the Threshold at Which Metopic Orbitofrontal Deformity Attracts Attention

2020 ◽  
Vol 57 (12) ◽  
pp. 1392-1401
Author(s):  
Mark P. Pressler ◽  
Emily L. Geisler ◽  
Rami R. Hallac ◽  
James R. Seaward ◽  
Alex A. Kane
Keyword(s):  
Surgical Treatment ◽  
Graduate Students ◽  
Eye Tracking ◽  
Dwell Time ◽  
Surgical Intervention ◽  
Three Dimensional ◽  
Average Dwell Time ◽  
Eye Tracker ◽  
Gaze Patterns ◽  
Areas Of Interest

Introduction and Objectives: Surgical treatment for trigonocephaly aims to eliminate a stigmatizing deformity, yet the severity that captures unwanted attention is unknown. Surgeons intervene at different points of severity, eliciting controversy. This study used eye tracking to investigate when deformity is perceived. Material and Methods: Three-dimensional photogrammetric images of a normal child and a child with trigonocephaly were mathematically deformed, in 10% increments, to create a spectrum of 11 images. These images were shown to participants using an eye tracker. Participants’ gaze patterns were analyzed, and participants were asked if each image looked “normal” or “abnormal.” Results: Sixty-six graduate students were recruited. Average dwell time toward pathologic areas of interest (AOIs) increased proportionally, from 0.77 ± 0.33 seconds at 0% deformity to 1.08 ± 0.75 seconds at 100% deformity ( P < .0001). A majority of participants did not agree an image looked “abnormal” until 90% deformity from any angle. Conclusion: Eye tracking can be used as a proxy for attention threshold toward orbitofrontal deformity. The amount of attention toward orbitofrontal AOIs increased proportionally with severity. Participants did not generally agree there was “abnormality” until deformity was severe. This study supports the assertion that surgical intervention may be best reserved for more severe deformity.

scholarly journals Driving Habits in Older Patients with Central Vision Loss

Ophthalmology ◽  
2014 ◽  
Vol 121 (3) ◽  
pp. 727-732 ◽  
Author(s):  
Sabyasachi Sengupta ◽  
Suzanne W. van Landingham ◽  
Sharon D. Solomon ◽  
Diana V. Do ◽  
David S. Friedman ◽  
...  
Keyword(s):  
Older Patients ◽  
Vision Loss ◽  
Central Vision ◽  
Central Vision Loss

scholarly journals MEAN 6 YEAR CLINICAL OUTCOMES, SURVIVORSHIP, AND RETURN TO SPORTS AFTER ARTHROSCOPIC CAPSULAR REPAIR WITH SUTURE ANCHORS FOR ADOLESCENT MULTIDIRECTIONAL SHOULDER INSTABILITY

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0002
Author(s):  
Brendon C. Mitchell ◽  
Matthew Y. Siow ◽  
Alyssa Carrol ◽  
Andrew T. Pennock ◽  
Eric W. Edmonds
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Shoulder Instability ◽  
Surgical Intervention ◽  
Operation Time ◽  
Demographic Variables ◽  
Return To Sports ◽  
Suture Anchors ◽  
Surgical Failure

Background: Multidirectional shoulder instability (MDI) refractory to rehabilitation can be treated with arthroscopic capsulolabral reconstruction with suture anchors. No studies have reported on outcomes or examined the risk factors that may contribute to poor outcomes in adolescent athletes. Hypothesis/Purpose: To identify risk factors for surgical failure by comparing anatomic, clinical, and demographic variables in adolescents who underwent surgical intervention for MDI. Methods: All patients undergoing arthroscopic shoulder surgery at one institution between January 2009 and April 2017 were reviewed. Patients >20 years old at presentation were excluded. Multidirectional instability was defined by positive drive-through sign on arthroscopy plus positive sulcus sign and/or multidirectional laxity on anterior and posterior drawer testing while under anesthesia. Two-year minimum follow-up was required, but those whose treatment failed earlier were included for reporting purposes. Demographics and intraoperative findings were recorded, as were Single Assessment Numeric Evaluation (SANE) scoring, Pediatric and Adolescent Shoulder Survey (PASS), and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) results. Results: Eighty adolescents (88 shoulders) were identified for having undergone surgical treatment of MDI. Of these 80 patients, 42 (50 shoulders; 31 female, 19 male) were available at a minimum of 2-year follow-up. Mean follow-up was 6.3 years (range, 2.8-10.2 years). Thirteen (26.0%) shoulders experienced surgical failure defined by recurrence of subluxation and instability, all of which underwent re-operation. Time to re-operation occurred at a mean of 1.9 years (range, 0.8-3.2). Our cohort had an overall survivorship of 96% at 1 year after surgery and 76% at 3 years. None of the anatomic, clinical, or demographic variables tested, or the presence of generalized ligamentous laxity, were correlated with subjective outcomes or re-operation. Number of anchors used was not different between those that failed and those that did not fail. Patients reported a mean SANE score of 83.3, PASS score of 85.0, and QuickDASH score of 6.8. Return to prior level of sport (RTS) occurred in 56% of patients. Conclusion: Multidirectional shoulder instability is a complex disorder that can be challenging to treat. Adolescent MDI that is refractory to non-surgical management appears to have long-term outcomes after surgical intervention that are comparable to adolescent patients with unidirectional instability. In patients who do experience failure of capsulorraphy, we show that failure will most likely occur within 3 years of the index surgical treatment. [Table: see text][Figure: see text]

Predictors of Surgical Intervention in Patients with Inflammatory Bowel Disease

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Khaled Hamdy Abd El Megeed ◽  
Shereen Abou Bakr Saleh ◽  
Christina Alphonse Anwar ◽  
Ahmed Elkattary Mohamed Elkattary
Keyword(s):  
Inflammatory Bowel Disease ◽  
Surgical Treatment ◽  
Bowel Disease ◽  
Surgical Intervention ◽  
High Sensitivity ◽  
Medical Patients ◽  
Mayo Score ◽  
Calprotectin Level ◽  
Inflammatory Bowel ◽  
The Mean

Abstract Background Inflammatory bowel disease (IBD) is comprised of two major disorders: Ulcerative Colitis and Crohn’s disease. Ulcerative Colitis affects the colon, where as Crohn’s disease can involve any component of the gastrointestinal tract from the mouth to the perianal area. These disorders have somewhat different pathologic and clinical characteristics, but with substantial overlap; their pathogenesis remains poorly understood. Objective To determine & detect different predictors that help us to characterize patients with high probability of undergoing surgical intervention for inflammatory bowel diseases. Patients and Methods The present study was designed to detect & identify possible factors that can be used to predict surgical intervention in patients with IBD. The present study was a case control study that was conducted on 80 patients with inflammatory bowel disease (either controlled by medical treatment or needed surgical intervention as a part of disease control) who were recruited form Ain-Shams university hospitals and El Quabbary general hospital in Alexandria. In the present study, the mean age of the included patients was 36.67 ±8.5 years old and 50% of the patients were males. The mean age at the onset of the disease was 25.81 ±6.8 years old. Results In the present study, there were statistically significant differences between surgical and medical patients in terms of CDAI for CD (p &lt; 0.001) and Mayo score for UC (p &lt; 0.001). Surgical patients were more likely to have higher scores. CDAI and Mayo score were negative predictors of surgical treatment. CDAI score &gt; 287 and Mayo score &gt; 8.5 achieved high sensitivity and specificity for the detection of surgical treatment. In the present study, we found that there was statistically significant differences between surgical and medical patients in terms of Stool Calprotectin level. Surgical patients were more likely to have higher Stool Calprotectin level. Stool Calprotectin level was negative predictor of surgical treatment at a level of &gt; 341.5 microgm/gm with high sensitivity and specificity. Conclusion Surgical treatment is a common outcome in IBD. Certain clinical features and the extent of disease are risk factors for surgical intervention. Our study indicates that smoking, Chron’s disease, perianal disease, granulomas, higher severity scores, higher stool Calprotectin level, CRP, and ESR were associated with higher risks of surgical intervention. In addition, smoking, peri-anal disease, CDAI, Mayo score, Stool Calprotectin level, and CRP level were predictors of surgical treatment. The findings of our analysis have implications for practice, particularly in the promotion of preoperative individualized risk prediction. The ability to predict which patients will need surgery and target more intensive, early treatment to that group would be invaluable. Further research through large prospective cohort studies is needed to confirm our findings and conclusions.

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