Adaptación de lente de contacto híbrida de geometría inversa en córnea con extrema irregularidad tras cirugía LASIK fallida

Actualmente, la adaptación de lentes de contacto nos ofrece una buena solución óptica para anisometropías, ya que se consigue igualar el tamaño de las imágenes retinianas, astigmatismos irregulares, consiguiendo regularizar la superficie corneal anterior, en miopías medias y elevadas, porque se logra un mayor tamaño de imagen retiniana respecto a la lente oftálmica, en casos de hipermetropías altas o afaquias, al conseguir un aumento del campo visual, y en nistagmus, ya que la lente acompaña al movimiento del ojo. A continuación, presentamos un caso de rehabilitación visual completa con la adaptación de una lente de contacto híbrida de geometría inversa en una córnea operada de cirugía LASIK miópica fallida, que tuvo como consecuencia una inducción muy significativa de irregularidad corneal

Comparing a bifocal and trifocal diffractive IOL

With the recent development of trifocal diffractive IOLs, to overcome the potential limitation of a lack in intermediate distance vision, studies have been published confirming the benefit of these lenses. However, until now, there has been no comparative study between the visual performance achieved with a bifocal versus a trifocal diffractive IOL. In this article, the authors reveal the details and results of their recent comparative study of the AT LISA diffractive bifocal and trifocal lenses

Characterization of the geometric properties of the sclero-conjunctival structure: a review

To revise the peer-reviewed literature on geometric properties of the scleral-conjunctival structure in order to define their clinical relevance and the potential relationship between their changes and myopia development or progression. A bibliographic search focused on the study of the geometry of conjunctiva and/or sclera as well as those studies evaluating the relationship between geometric changes in the scleral-conjunctival structure and myopia was carried out. Several studies have been performed with different diagnostic technologies, including optical coherence tomography, profilometry and Scheimpflug imaging, to detect geometric changes of the scleral-conjunctival tissue in different physiological conditions of the eye, after use of contact lenses and in different ocular pathologies. Likewise, these technologies have been shown to be a valuable clinical tool to optimize scleral contact lens fitting. Future studies should investigate new potential clinical applications of such technologies, including the evaluation of anterior scleral changes related to myopia, as well as to define standardized clinical standard operating procedures for obtaining accurate and reproducible clinical measurement of the scleral-conjunctival morphology.Supported by the Project UAIND18-06B of the University of Alicante within the program “Ayudas destinadas a la formación predoctoral en colaboración con empresas 2018” supported by the Vicerrectorado de Investigación y Transferencia de Conocimiento. Piñero DP has been also supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC-2016-20471

Distribution of Visual and Oculomotor Alterations in a Clinical Population of Children with and without Neurodevelopmental Disorders

A prospective, non-randomized comparative study was conducted to compare the distribution of oculomotor and visual alterations in children with neurodevelopmental disorders and healthy children without such disorders. Sixty-nine children (aged 6–13 years) were enrolled and divided into three groups: a control group (CG) of 23 healthy children; a group of 18 healthy children with oculomotor abnormalities (OAG); and a group of 28 children with a neurodevelopmental disorder (NDDG), with 15 cases of dyslexia, 7 cases of developmental coordination disorder (DCD) and 6 cases of attention deficit/hyperactivity disorder (ADHD). Significantly worse near stereopsis was found in NDDG compared with CG (p < 0.001) and OAG (p = 0.001). Likewise, a significantly lower amplitude of accommodation was found in NDDG compared with CG in both the right (p = 0.001) and left eyes (p < 0.001). No statistically significant differences between groups were found in the measurement of near and distance phoria (p ≥ 0.557), near point of convergence (p = 0.700) and fusional vergences (p ≥ 0.059). Significantly impaired oculomotor test scores were found in NDDG compared with CG (p < 0.001), with no significant differences between OAG and NDDG (p ≥ 0.063). The comparison between the three types of neurodevelopmental disorders included revealed the presence of a significantly lower amplitude of accommodation in children with DCD compared with dyslexics. Furthermore, less exophoria at near was present in children with dyslexia compared with children with ADHD (p = 0.018) and DCD (p = 0.054). In conclusion, children with dyslexia, ADHD and DCD show an altered oculomotor pattern and a more reduced amplitude of accommodation, not always compatible with the diagnostic criteria of an accommodative insufficiency. Accommodative and binocular vision problems are not always present in these children and cannot be considered an etiologic factor.The author David P. Piñero has received funding from the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC-2016-20471

Evaluation of vision therapy efficacy in intermitent exotropia treatment by 3D video-oculography

Objetivo: Evaluar la eficacia del tratamiento en 3 casos de exotropia intermitente (XT(i)) mediante ejercicios de terapia visual, completando la exploración clínica con Videooculografia-30 y evidenciar la potencial aplicabilidad de esta tecnología para dicho propósito. Métodos: Exponemos los cambios ocurridos tras ejercicios de terapia visual en una mujer de 36 años con XT(i) de -25 dioptrías prismáticas (dp) de lejos y 18 dp de cerca; Un niño de 10 años de edad con 8 dp de XT(i) en posición primaria, asociados a +6 dp de hipotropia izquierda; y un hombre de 63 años con XT(i) de 6 dp en posición primaria asociada a +7 dp de hipertropia derecha. Todos los pacientes presentaron buena agudeza visual corregida en ambos ojos. La inestabilidad de la desviación ocular se evidenció mediante análisis de VOG-30, revelando la presencia de components verticales y torsionales. Se realizaron ejercicios de terapia visual, incluyendo diferentes tipos de ejercicios de vergencias, acomodación y percepción de la diplopía. Resultados: Tras la terapia visual se obtuvieron excelentes rangos de vergencias fusionales y de punto próximo de convergencia («hasta la nariz»). El examen mediante VOG-3D (Sensoro Motoric lnstruments, Teltow, Germany) confirmó la compensación de la desviación con estabilidad del alineamiento ocular. Se observó una significativa mejora después de la terapia en los components verticals y torsionales, lo cuales se hicieron más estables. Los pacientes se mostraron muy satisfechos de los resultados obtenidos. Conclusión: La VOG-3D es una técnica útil para dotamos de un método objetivo de registro de la compensación y estabilidad de la desviación ocular después de realizar ejercicios de terapia visual en casos de XT(i), ofreciéndonos un detallado análisis de la mejoría de los components verticales y torsionales.Objective: To evaluate in three cases of intermittent exotropia (XT(i)) treated by vis ion therapy the efficacy ofthe treatment by complementing the clinical examination with a 3-D video-oculographic register and to evidence the potential applicability of this technology for such purpose. Methods: We report the binocular changes occurring after vision therapy in a woman of 36 years with an XT(i) of 25 prism diopters ( dp) at far and 18 dp at near ; A chiId of 10 years with 8 dp of XT(i) in primary position associated to 6 dp of left eye hipotropia; and a man of 63 years with an XT(i) of 6 dp in primary position associated to 7 dp of right eye hipertropia. AH patients presented good visual acuity with correction in both eyes. Instability of ocular deviation was evident by VOG analysis, revealing also the presence of vertical and torsional components. Vision therapy was prescribed and performed including different types of vergence, accommodation, and consciousness of diplopia training. Results: After therapy, excellent ranges of fusional vergence and a «to-the-nose» near point of convergence were obtained. The VOG-30 examination (Sensoro Motoric lnstruments, Teltow, Germany) confirmed the compensation of the deviation with a high level of stability of ocular alignment. Significant improvement could be observed after therapy in the vertical and torsional components that were found to become more stable. Patients were very satisfied with the outcome obtained. Conclusion: YOG-30 is a useful technique for providing an objective register of the compensation of the ocular deviation and the stability of the alignment achieved after vision therapy in cases of XT(i), providing a detailed analysis of vertical and torsional improvements

Evaluation of Binocular Vision Therapy Efficacy by 3D Video-Oculography Measurement of Binocular Alignment and Motility

Objective: To evaluate two cases of intermittent exotropia (IX(T)) treated by vision therapy the efficacy of the treatment by complementing the clinical examination with a 3-D video-oculography to register and to evidence the potential applicability of this technology for such purpose. Methods: We report the binocular alignment changes occurring after vision therapy in a woman of 36 years with an IX(T) of 25 prism diopters (Δ) at far and 18 Δ at near and a child of 10 years with 8 Δ of IX(T) in primary position associated to 6 Δ of left eye hypotropia. Both patients presented good visual acuity with correction in both eyes. Instability of ocular deviation was evident by VOG analysis, revealing also the presence of vertical and torsional components. Binocular vision therapy was prescribed and performed including different types of vergence, accommodation, and consciousness of diplopia training. Results: After therapy, excellent ranges of fusional vergence and a “to-the-nose” near point of convergence were obtained. The 3-D VOG examination (Sensoro Motoric Instruments, Teltow, Germany) confirmed the compensation of the deviation with a high level of stability of binocular alignment. Significant improvement could be observed after therapy in the vertical and torsional components that were found to become more stable. Patients were very satisfied with the outcome obtained by vision therapy. Conclusion: 3D-VOG is a useful technique for providing an objective register of the compensation of the ocular deviation and the stability of the binocular alignment achieved after vision therapy in cases of IX(T), providing a detailed analysis of vertical and torsional improvements

La disparidad de fijación: concepto y manejo clínico

La diferencia de alineación de los ejes visuales en la Disparidad de Fijación en la gran mayoría de situaciones se produce como un efecto fisiológico no produciendo sintomatología al paciente. Sin embargo, existen ciertas situaciones en las que la Disparidad de Fijación sí que produce sintomatología al paciente, produciéndose como consecuencia del estrés de los sistemas de vergencia y acomodativo con el objetivo de mantener la visión binocular. Existen además evidencias científicas de que determinados hábitos de lectura, patologías como las migrañas y pacientes disléxicos con problemas de lectura y de aprendizaje pueden observar un incremento significativo de la Disparidad de Fijación, estando asociados a Disparidades de Fijación anormales. Debido a la información que proporciona la medida de la Disparidad de Fijación resulta de especial interés la cuantificación de la misma en la práctica clínica, existiendo en la actualidad diferentes tests y dispositivos clínicos que se utilizan comúnmente para la medida de la Disparidad de Fijación, como la Curva de Vergencias Forzadas, el Disparómetro de Sheedy, la Unidad de Mallet y la Carta de Wesson entre otros

Adjustable muscle plication: a new surgical technique for strabismic patients with high risk for anterior segment ischemia

Opinio

Opciones y criterios de adaptación de lentes de contacto híbridas: revisión bibliográfica

Este trabajo de revisión analiza toda la bibliografía encontrada en MEDLINE a través de PubMed y Ovid sobre lentes de contacto híbridas. En él se presenta la evolución de este tipo de lentes hasta los últimos estudios sobre las lentes SynergEyes. Se dan unas pautas de adaptación para alguno de estos tipos de lentes y se analizan sus diferentes usos. Se estudia la adaptación de lentes en casos de queratocono y otras ectasias corneales, comparando los distintos tipos de lentes utilizados así como los resultados que ofrecen las lentes de contacto híbridas en estos casos. Se comenta la función de este tipo de lentes en casos de córnea irregular poscirugía refractiva, así como en casos de posqueratoplastia. Por último, se analizan brevemente los nuevos avances realizados por los laboratorios especializados en este tipo de lentes de contacto

Differences in the Long-term Progression Course of Two Cases of Pellucid-like Keratoconus: Are they the Same Condition with Different Phenotypic Presentation?

We report the long-term follow-up of two cases of untreated corneal ectasia presenting a crab claw-like sagittal and tangential topographic pattern at baseline, but without peripheral thinning. Currently, according to clinical examination, these two cases are diagnosed as pellucid-like keratoconus (PLK). The first case was a 58-year-old male who developed a true pellucid marginal degeneration (PMD) in one eye and with a nonprogressive PLK in the other eye. The second case presented was a 19-year-old male without clinical signs of ectasia at baseline that progressed to PLK with evident changes in topographic and pachymetric maps but maintaining the point of minimum corneal thickness (MCT) in the central area. The presence of two different conditions in the same patient (case 1) and the progression from inferosuperior asymmetry to the development of a crab claw-pattern (case 2) suggest that PMD, PLK, and keratoconus may be different phenotypic presentations of the same pathophysiological condition.The author David P Piñero has been supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC-2016-20471