Intraocular Medulloepithelioma in a 15-Year-Old: A Rare Presentation

BACKGROUND: A 15-year old male presented with decrease in vision for the past 2 years. He was referred for a potential tumor due to an obstructed view of the right eye posterior segment. The patient was in good systemic health with no current medications. FINDINGS: Best-corrected visual acuities were 20/63 OD and 20/16 OS through -4.00 DS OD and -4.25 DS OS. A dull fundus reflex was noted OD. Pupils were normal with no RAPD and biomicroscopy showed no cells or flare. IOP was 11 mm Hg OD and 12 mm Hg OS. The nasal quadrant of the right eye pupil failed to dilate completely. Fundus examination OD revealed diffuse vitreous haze and a large exudative retinal detachment due to a choroidal lesion spanning from 1 to 5 o’clock, sparing the macula. ASSESSMENT: B-scan ultrasound showed a circumferential retinochoroidal mass with no calcification or excavation of underlying ocular structures. The dimensions of the tumor were 21.7mm ✕ 21.2mm ✕ 12.5mm. Ultrasound biomicroscopy showed anterior iris displacement from 3 to 5 o’clock. A large homogeneous mass containing multiple cystic spaces was noted. There was the presence of a lental apposition to the mass, retrolental cyclytic membrane. This atypical presentation led to the finding of a ciliary body tumor supplied by sentinel vessels extending to the retina causing exudative retinal detachment. The patient was referred for chest CT to rule out pleuropulmonary blastoma. MRI results showed hypointense signal in T2 weighted imaging with respect to the vitreous. Based on the findings we suspected this case to be an amelanotic melanoma or medulloepithelioma. MANAGEMENT: The patient was referred to an ocular oncologist for fine needle aspiration biopsy under general anesthesia. Histopathology reports confirmed the presence of intraocular medulloepithelioma. Since the tumor base was too large for globe salvage and too thick for radioactive plaque, enucleation was performed and a vicryl mesh wrapped orbital ball implant was inserted

Assessment of Enchroma Filter for Correcting Color Vision Deficiency

Purpose: Color vision deficiency (CVD) especially the Red-Green type (RG), affects 8% of the male and 0.5% of the female population. There is no cure for color deficiency. However, there are specially-tinted lenses marketed to enhance the color contrast for CVD individuals. Recently, EnChroma Filters claim to enhance color perception. The aim of this study was to examine EnChroma Cx-14, red, and green filters subjectively on subjects with RG CVD. Methods: Nine males and one female (aged 19 – 52 years) with RG CVD were recruited. Five were severe deutans, two moderate deutans, and two were severe protans. Subjective responses to EnChroma were tested using ColorDx software on a tablet and online Farnsworth-Munsell (FM) 100-Hue tests. Error scores of the ColorDx and FM 100 Hue tests with EnChroma CX-14, Red and Green filters were calculated and compared against Placebo (untinted glasses). Results: In only two subjects , EnChroma filters resulted in CVD improvement from severe protan to moderate protan and from severe deutan to moderate deutan using ColorDx. Neither EnChroma nor green filters improved the mean error scores of ColorDx (p = 0.39) and (p = 1.00), respectively. However, red filter significantly improved color discrimination from severe deutan to mild deutan in all deutan subjects, and in one subject, from severe protan to mild deutan (p = 0.013). Similarly, EnChroma did not significantly improve the error score of FM 100 Hue test. Also, none of the other filters showed significant improvement in the error scores of the FM 100 Hue. Conclusions: EnChroma Cx-14 filters are multi-notch filters that modify the wavelength transmission to the observer. To our knowledge this is the first study to measure the effectiveness of EnChroma Cx-14 on digital version of Ishihara (ColorDx). Our results showed that the EnChroma filters had no significant effect on the performance of any of the CVD subjects, but improved the error score in only two subjects

Congential Tritanopia: A Comparison of Two Clinical Cases

This poster discusses two patient cases of presumed blue-yellow color deficiency in order to help optometrists care for this rare class of patients. Since this condition is extremely uncommon at birth, and is not possible to see by looking in the eye, practitioners may miss the symptoms of this condition. Optical treatment options are also discussed

Dynamic accommodative response to different visual stimuli (2D vs 3D) while watching television and while playing Nintendo 3DS console

PURPOSE: The aim of the present study was to compare the accommodative response to the same visual content presented in two dimensions (2D) and stereoscopically in three dimensions (3D) while participants were either watching a television (TV) or Nintendo 3DS console. METHODS: Twenty-two university students, with a mean age of 20.3 ± 2.0 years (mean ± S.D.), were recruited to participate in the TV experiment and fifteen, with a mean age of 20.1 ± 1.5 years took part in the Nintendo 3DS console study. The accommodative response was measured using a Grand Seiko WAM 5500 autorefractor. In the TV experiment, three conditions were used initially: the film was viewed in 2D mode (TV2D without glasses), the same sequence was watched in 2D whilst shutter-glasses were worn (TV2D with glasses) and the sequence was viewed in 3D mode (TV3D). Measurements were taken for 5 min in each condition, and these sections were sub-divided into ten 30-s segments to examine changes within the film. In addition, the accommodative response to three points of different disparity of one 3D frame was assessed for 30 s. In the Nintendo experiment, two conditions were employed - 2D viewing and stereoscopic 3D viewing. RESULTS: In the TV experiment no statistically significant differences were found between the accommodative response with TV2D without glasses (-0.38 ± 0.32D, mean ± S.D.) and TV3D (-0.37 ± 0.34D). Also, no differences were found between the various segments of the film, or between the accommodative response to different points of one frame (p > 0.05). A significant difference (p = 0.015) was found, however, between the TV2D with (-0.32 ± 0.32D) and without glasses (-0.38 ± 0.32D). In the Nintendo experiment the accommodative responses obtained in modes 2D (-2.57 ± 0.30D) and 3D (-2.49 ± 0.28D) were significantly different (paired t-test p = 0.03). CONCLUSIONS: The need to use shutter-glasses may affect the accommodative response during the viewing of displays, and the accommodative response when playing Nintendo 3DS in 3D mode is lower than when it is viewed in 2D.None of the authors has an interest in the products and devices mentioned in the study. This study has been funded by projects PTDC/SAU-BEB/098392/2008 funded by the Portuguese Fundacao para a Ciencia e Tecnologia through the European Social Fund

Induced vertical disparity effects on local and global stereopsis

Purpose: Although significant amounts of vertical misalignment could have a noticeable effect on visual performance, there is no conclusive evidence about the effect of very small amount of vertical disparity on stereopsis and binocular vision. Hence, the aim of this study was to investigate the effects of induced vertical disparity on local and global stereopsis at near. Materials and Methods: Ninety participants wearing best-corrected refraction had local and global stereopsis tested with 0.5 and 1.0 prism diopter (Δ) vertical prism in front of their dominant and non-dominant eye in turn. This was compared to local and global stereopsis in the same subjects without vertical prism. Data were analyzed in SPSS.17 software using the independent samples T and the repeated measures ANOVA tests. Results: Induced vertical disparity decreases local and global stereopsis. This reduction is greater when vertical disparity is induced in front of the non-dominant eye and affects global more than local stereopsis. Repeated measures ANOVA showed differences in the mean stereopsis between the different measured states for local and global values. Local stereopsis thresholds were reduced by 10s of arc or less on average with 1.0Δ of induced vertical prism in front of either eye. However, global stereopsis thresholds were reduced by over 100s of arc by the same 1.0Δ of induced vertical prism. Conclusion: Induced vertical disparity affects global stereopsis thresholds by an order of magnitude (or a factor of 10) more than local stereopsis. Hence, using a test that measures global stereopsis such as the TNO is more sensitive to vertical misalignment than a test such as the Stereofly that measures local stereopsis. © 2014 Informa Healthcare USA, Inc. All rights reserved: reproduction in whole or part not permitted

Body mass index and binocular vision skills

AbstractIntroductionBody Mass Index (BMI) is of increasing interest to eye care practitioners. Associations have recently been proven between high BMI and several diseases affecting the eyes, including AMD, intracranial hypertension, optic disc cupping, and glaucoma. The symptoms of dizziness and vertigo have also been associated with high BMI. However, to these authors’ knowledge, there has been no study performed comparing BMI to binocular function.MethodsIn this analytical-descriptive study, 119 randomly selected young subjects had their BMI measured, along with refractive error, dissociated phoria, near point of convergence, vergence ranges and facility, and stereopsis.ResultsIn most situations, the subjects classified as normal and overweight, based on their BMI had better performance than those classified as underweight or obese. The worst binocular performance was found in underweight subjects. The one-way ANOVA showed only statistically significant differences between mean of near point of convergence and vergence facility, in different states of BMI.ConclusionUnlike most ocular diseases that are adversely affected by higher BMI values, most binocular vision skills are adversely affected by lower BMI values. The possible reasons for this are discussed