Independent and reciprocal accommodation in anisometropic amblyopia

Accommodation is considered to be a symmetrical response and to be driven by the least ametropic and nonamblyopic eye in anisometropia. We report the case of a 4-year-old child with anisometropic amblyopia who accommodates asymmetrically, reliably demonstrating normal accommodation in the nonamblyopic eye and antiaccommodation of the amblyopic eye to near targets. The abnormal accommodation of the amblyopic eye remained largely unchanged during 7 subsequent testing sessions undertaken over the course of therapy. We suggest that a congenital dysinnervation syndrome may result in relaxation of accommodation in relation to near cues and might be a hitherto unconsidered additional etiological factor in anisometropic amblyopia

Ocular Refraction at Birth and Its Development During the First Year of Life in a Large Cohort of Babies in a Single Center in Northern Italy

The purpose of this study was to investigate refraction at birth and during the first year of life in a large cohort of babies born in a single center in Northern Italy. We also aimed to analyze refractive errors in relation to the gestational age at birth. An observational ophthalmological assessment was performed within 24 h of birth on 12,427 newborns. Refraction was examined using streak retinoscopy after the administration of tropicamide (1%). Values in the range of between +0.50 ≤ D ≤ +4.00 were defined as physiological refraction at birth. Newborns with refraction values outside of the physiological range were followed up during the first year of life. Comparative analyses were conducted in a subgroup of babies with known gestational ages. The following distribution of refraction at birth was recorded: 88.03% of the babies had physiological refraction, 5.03% had moderate hyperopia, 2.14% had severe hyperopia, 3.4%, had emmetropia, 0.45%, had myopia, 0.94% had astigmatism, and 0.01% had anisometropia. By the end of the first year of life, we observed reductions in hyperopia and astigmatism, and stabilization of myopia. Preterm babies had a four-fold higher risk of congenital myopia and a three-fold higher risk of congenital emmetropia as compared to term babies. Refraction profiles obtained at birth changed during the first year of life, leading to a normalization of the refraction values. Gestational age at birth affected the incidence of refractive errors and amblyopia

Ocular manifestations in Gorlin-Goltz syndrome

Background: Gorlin-Goltz syndrome, also known as nevoid basal cell carcinoma syndrome, is a rare genetic disorder that is transmitted in an autosomal dominant manner with complete penetrance and variable expressivity. It is caused in 85% of the cases with a known etiology by pathogenic variants in the PTCH1 gene, and is characterized by a wide range of developmental abnormalities and a predisposition to multiple neoplasms. The manifestations are multiple and systemic and consist of basal cell carcinomas in various regions, odontogenic keratocistic tumors and skeletal anomalies, to name the most frequent. Despite the scarce medical literature on the topic, ocular involvement in this syndrome is frequent and at the level of various ocular structures. Our study focuses on the visual apparatus and its annexes in subjects with this syndrome, in order to better understand how this syndrome affects the ocular system, and to evaluate with greater accuracy and precision the nature of these manifestations in this group of patients. Results: Our study confirms the presence of the commonly cited ocular findings in the general literature regarding the syndrome [hypertelorism (45.5%), congenital cataract (18%), nystagmus (9%), colobomas (9%)] and highlights strabismus (63% of the patients), epiretinal membranes (36%) and myelinated optic nerve fiber layers (36%) as the most frequent ophthalmological findings in this group of patients. Conclusions: The presence of characteristic and frequent ocular signs in the Gorlin- Goltz syndrome could help with the diagnostic process in subjects suspected of having the syndrome who do not yet have a diagnosis. The ophthalmologist has a role as part of a multidisciplinary team in managing these patients. The ophthalmological follow-up that these patients require, can allow, if necessary, a timely therapy that could improve the visual prognosis of such patients

Saccadic latency in amblyopia.

We measured saccadic latencies in a large sample (total n = 459) of individuals with amblyopia or risk factors for amblyopia, e.g., strabismus or anisometropia, and normal control subjects. We presented an easily visible target randomly to the left or right, 3.5° from fixation. The interocular difference in saccadic latency is highly correlated with the interocular difference in LogMAR (Snellen) acuity-as the acuity difference increases, so does the latency difference. Strabismic and strabismic-anisometropic amblyopes have, on average, a larger difference between their eyes in LogMAR acuity than anisometropic amblyopes and thus their interocular latency difference is, on average, significantly larger than anisometropic amblyopes. Despite its relation to LogMAR acuity, the longer latency in strabismic amblyopes cannot be attributed either to poor resolution or to reduced contrast sensitivity, because their interocular differences in grating acuity and in contrast sensitivity are roughly the same as for anisometropic amblyopes. The correlation between LogMAR acuity and saccadic latency arises because of the confluence of two separable effects in the strabismic amblyopic eye-poor letter recognition impairs LogMAR acuity while an intrinsic sluggishness delays reaction time. We speculate that the frequent microsaccades and the accompanying attentional shifts, made while strabismic amblyopes struggle to maintain fixation with their amblyopic eyes, result in all types of reactions being irreducibly delayed

The effect of anisometropia on stereopsis

Background and aim: For good stereopsis, the two retinal images should have similar clarity, shape, and size. Anisometropia is one of the factors which has affect on stereopsis. The purpose of this study was investigation of induced anisometropia effect on binocular function and stereopsis. Methods: In this semi experimental study, a total of 135 students from Zahedan University of Medical Sciences who had inclusion criteria were selected randomly. At the beginning of the work, the refractive errors of the subjects were determined and corrected with retinoscop and their stereopsis measured using T.N.O test. Subsequently, this hyperopic and myopic anisometropia induced by use of negative and positive spherical lenses (power 1, 2, 3 diopter) in trial frame in front of one eye and in each state stereopsis measured again. In agreement and against the rule astigmatic anisometropia induced by positive cylindrical lenses in 180 and 90 degree axes and stereopsis measured again. Data were analyzed by SPPS.14 software using within subjects factorial and repeated measurement ANOVA test. Results: This study showed that both type and amount of anisometropia had significant effect on stereopsis (P<0.001). The mean of stereopsis before intervention was (36.42±12.65). The most and least reduction of stereopsis were related to 3D hyperopic anisometropia (339.42±125.1) and 1D with the rule astigmatic anisometropia (36.57±12.6), respectively. The mean of stereopsis before and after different type and amount of induced anisometropia were significantly different (P<0.001). Conclusion: The result of this study showed that with increasing of anisometropia, stereoacuity decreases. Therefore, low degree of anisometropia, even 1D, can decrease both stereopsis and binocular function and thus, the amendment of stereopsis is necessary

Evaluation of stereopsis in children with corrected anisometropia according to type, severity, and presence of amblyopia

Objective: This study was designed to determine the level of stereopsis in anisometropic children with and without amblyopia who used corrective glasses and to investigate the effect of the type and magnitude of anisometropia on the level of stereopsis. Materials and Methods: The medical records of 256 children with a diagnosis of non-amblyopic anisometropia or anisometropic amblyopia, and healthy controls were retrospectively reviewed for this study. Anisometropia was categorized into 3 groups: spherical equivalent-only anisometropia, astigmatic-only anisometropia, or combined anisometropia. The level of stereopsis was measured using the Titmus stereo test, compared between groups, and the correlation of the stereopsis with the magnitude of anisometropia was analyzed. Results: Patients in the non-amblyopic anisometropia group had a similar stereopsis level when compared with the control group (55.2 +/- 41.03 and 47.2 +/- 19.8 seconds of arc, respectively; p=0.223). The level of stereopsis was significantly less in the anisometropic amblyopia group (279.4 +/- 120 seconds of arc) compared with the non-amblyopic anisometropia (55.2 +/- 41.03 seconds of arc) and control groups (47.2 +/- 19.8 seconds of arc) (p=0.008, p=0.006, respectively). A greater spherical equivalent difference between the eyes resulted in poorer stereopsis in the anisometropic amblyopia group, and combined anisometropia was found to be associated with poorer stereopsis levels in the nonamblyopic anisometropia (NA) group. Conclusion: The NA patients had a similar level of stereopsis compared with controls while wearing corrective glasses. This result suggests that as long as patients have good visual acuity, stereopsis is preserved, and that refractive correction with glasses does not interfere with stereopsis in childhood anisometropia

A retinoscopic survey of 333 horses and ponies in the UK

Introduction: Ophthalmic examination in the horse is generally limited to crude assessment of vision and screening for ocular lesions. The refractive state of equine eyes and the potential impact on vision and performance requires further investigation. Objective: To assess the refractive state of a large, mixed breed sample of horses and ponies in the United Kingdom (UK). Procedure: The refractive state of both eyes of 333 horses and ponies was determined by streak retinoscopy and the effect of age, height, gender, breed and management regime on the refractive state assessed. Results: The majority of eyes tested were emmetropic (83.63%), with 68.5% of horses having refractive errors of ≤ -0.50D or ≥ +0.50D. Refractive errors of greater than 1.50D (in either direction) were found in 2.7% of the eyes tested. Ametropic eyes included hyperopia (54%) and myopia (46%). Anisometropia was found in 30.3% of horses and ponies. Breed of horse/pony was the only factor that affected refractive state (in the left eye only, p<0.05) with 2 Thoroughbred crosses having a tendency towards myopia and Warmbloods / Shires towards hyperopia. Discussion / Conclusion: The retinoscopic survey found emmetropia to be the predominant refractive state of the equine eye with no evidence of an overall trend towards myopia or hyperopia. However, individual and breed related differences were found. Such factors should be considered in the selection of horses for sport and leisure, and when evaluating their performance potential. More comprehensive visual testing would be valuable in identifying underlying causes of behavioural problems

Quantifying the vertical fusion range at four distances of fixation in a normal population.

Aim: To compare the vertical fusional amplitudes in isometropic participants with normal binocular single vision at four distances of fixation: 33 cm, 1 m, 4 m, 6 m. Methods: Vertical fusion ranges (break point and recovery point) were measured with a Gulden vertical prism bar with the participant fixing a 6/12 Snellen equivalent letter, twice at each distance. Order effects were controlled with randomisation of both fixation distance and prism direction. Results: Twenty-seven participants were examined (aged 20.4 ± 1.05 years). Base up and base down measurements were similar, therefore measurements were combined to give a total vertical range. Median values for the break points were: 33 cm, 6(Δ) ; 1 m, 6(Δ); 4 m, 5.5(Δ); 6 m, 5.5(Δ); and for the recovery points were: 33 cm, 4(Δ); 1 m, 4(Δ); 4 m, 3.5(Δ); 6 m, 3.5(Δ). The difference was significant between either of the near measures (i.e. 33 cm and 1 m) and either of the far measures (i.e. 4 m and 6 m). Conclusions: The vertical fusion range appears to be slightly greater at near than distance. However, the difference is not clinically significant. Measurements for distance, in a normal population, appear to be the same whether a fixation distance of 4 m or 6 m is used

Marcus Gunn Jaw Winking Phenomenon - A case of the widening eye

Marcus Gunn jaw winking phenomenon is a congenital synkinetic movement due to synkinesis between the upper eyelid and the pterygoids and it accounts for 8% of patients with congenital ptosis. In rare instances, ptosis may be absent. We present a case of Marcus Gunn Jaw Winking phenomenon without ptosis at presentatio