Contrast sensitivity in amblyopia: The fellow eye of untreated and successfully treated amblyopes

Purpose: We sought to investigate contrast sensitivity on the fellow eyes of amblyopic and successfully treated amblyopic subjects. Methods. Contrast sensitivity was tested monocularly on both eyes of 48 amblyopic patients (mean age, 11.51 years) and of 22 successfully treated amblyopic subjects (visual acuity 20/20 in each eye; mean age, 11.22 years). Inclusion criteria were visual acuity in the amblyopic eye 20/40 or better (mild amblyopia) and 20/20 or better in the fellow eye, steady fixation, no signs of congenital, latent or manifest/latent nystagmus on clinical examination. Twenty normal subjects (20 eyes) were used as age-matched controls. Results: Contrast sensitivity functions from the fellow eye of the 48 amblyopic patients, even those who had never been treated with occlusion therapy before, were significantly decreased (P < 0.001) compared with control subjects. Both the previously amblyopic and the fellow eye of the 22 “cured” amblyopic subjects demonstrated significantly lower values (P < 0.001) compared with control patients. Conclusions. We suggest that the nonamblyopic, “normal” eye of amblyopic patients behaves abnormally when evaluated for contrast sensitivity functions. Neither the previously amblyopic nor the fellow eyes of successfully treated subjects were comparable with controls. Occlusion therapy may not be implicated for depressed contrast sensitivity of the fellow eye in amblyopia. The assessment of contrast sensitivity can provide important information on the visual function and the influence of occlusion therapy in amblyopia

Subconjunctival orbital fat prolapse and thyroid associated orbitopathy: a clinical association

Klio I Chatzistefanou,1 Christianna Samara,2 Ioannis Asproudis,3 Dimitrios Brouzas,1 Marilita M Moschos,1 Elisabeth Tsianta,1 George Piaditis4 1First Department of Ophthalmology, National and Kapodistrian University of Athens Medical School, Athens, Greece; 2Department of Radiology and Endocrinology, 3Department of Ophthalmology, University of Ioannina, Ioannina, Greece; 4Athens General Hospital “G. Gennimatas”, Athens, Greece Background: Thyroid associated orbitopathy (TAO) comprises a spectrum of well-recognized clinical signs including exophthalmos, eyelid retraction, soft tissue swelling, ocular misalignment, keratopathy as well as a number of less common manifestations. Subconjunctival fat prolapse is a rare clinical condition occurring typically spontaneously in elderly patients with a mean age of 65–72 years. We describe subconjunctival prolapse of orbital fat as an uncommon clinical association of TAO. Materials and methods: Observational study of six patients presenting with a subconjunctival protrusion under the lateral canthus in a series of 198 consecutive cases with TAO examined at a tertiary care referral center. Results: A superotemporally located yellowish, very soft, freely mobile subconjunctival protrusion developed unilaterally in two and bilaterally in four patients with TAO (incidence 3.03%). It was one of the presenting manifestations of TAO in four of ten eyes studied and incited the diagnostic work-up for TAO in two of six patients in this series. Magnetic resonance imaging of the orbit indicated fat density in continuity with intraorbital fat in the area of protrusion. A male to female preponderance of 4:2 and an advanced mean age at onset of TAO is noteworthy for these six patients compared to the pool of 192 patients (64.8 versus 51.8 years, respectively, P=0.003) not bearing this sign. Conclusion: Subconjunctival orbital fat prolapse, a clinically impressive age-related ocular lesion, may occasionally predominate amid other clinical manifestations of TAO. It is a nonspecific sign developing most commonly among patients with a relatively advanced age at presentation. Awareness of this association may alert to the diagnosis of thyroid orbitopathy and reassure the patient and physician as to the benign character of the lesion. Keywords: subconjunctival orbital fat prolapse, elderly, age-related, Graves ophthalmopathy, thyroid associated orbitopathy, autoimmune thyroidopath