Management of nystagmus in children: A review of the literature and current practice in UK specialist services

Nystagmus is an eye movement disorder characterised by abnormal, involuntary rhythmic oscillations of one or both eyes, initiated by a slow phase. It is not uncommon in the UK and regularly seen in paediatric ophthalmology and adult general/strabismus clinics. In some cases, it occurs in isolation, and in others, it occurs as part of a multisystem disorder, severe visual impairment or neurological disorder. Similarly, in some cases, visual acuity can be normal and in others can be severely degraded. Furthermore, the impact on vision goes well beyond static acuity alone, is rarely measured and may vary on a minute-to-minute, day-to-day or month-to-month basis. For these reasons, management of children with nystagmus in the UK is varied, and patients report hugely different experiences and investigations. In this review, we hope to shine a light on the current management of children with nystagmus across five specialist centres in the UK in order to present, for the first time, a consensus on investigation and clinical management

A 93 year old man with an unusual kyphosis: Question

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Methane fluxes from a wetland using the flux-gradient method : the measurement of methane flux from a natural wetland pond and adjacent vegetated wetlands using a TDL-based flux-gradient technique

Methane emissions were measured from a bog andlake in the Experimental Lakes Area in Northern Ontario in 1992and 1993, prior to and following flooding. Bog fluxes were smallin 1992 (0.27 mg m⁻² d⁻¹) but increased 5-fold in 1993 afterflooding. Over the bog, there was a diel cycle of nighttimeemission and daytime uptake in 1992 in contrast to constantemission in 1993. Lake emissions decreased after flooding butwere much greater than bog emissions in both years (average = 7.3 mg m⁻² d⁻¹). Seasonally, the bog flux was correlated withground temperatures after flooding. In 1992, lake fluxes werecorrelated with air temperature on a daily basis. In contrast,seasonal lake fluxes were correlated with water and sedimenttemperatures in 1992, but only with sediment temperatures in 1993. These results are explained with respect to the effects offlooding on lake and bog dynamics.8 page(s

How is Eye Fixation Affected by Optic Neuropathy

"Instability of fixation and emergence of alternate preferred retinal loci (PRL) for fixation are well described in macular disease, but have not been well characterized in optic neuropathy. We evaluated the extent of retinal movements recorded during a standard OCT macular volume scan and explored its diagnostic utility.

Neurological basis for eye movements of the blind.

When normal subjects fix their eyes upon a stationary target, their gaze is not perfectly still, due to small movements that prevent visual fading. Visual loss is known to cause greater instability of gaze, but reported comparisons with normal subjects using reliable measurement techniques are few. We measured binocular gaze using the magnetic search coil technique during attempted fixation (monocular or binocular viewing) of 4 individuals with childhood-onset of monocular visual loss, 2 individuals with late-onset monocular visual loss due to age-related macular degeneration, 2 individuals with bilateral visual loss, and 20 healthy control subjects. We also measured saccades to visual or somatosensory cues. We tested the hypothesis that gaze instability following visual impairment is caused by loss of inputs that normally optimize the performance of the neural network (integrator), which ensures both monocular and conjugate gaze stability. During binocular viewing, patients with early-onset monocular loss of vision showed greater instability of vertical gaze in the eye with visual loss and, to a lesser extent, in the normal eye, compared with control subjects. These vertical eye drifts were much more disjunctive than upward saccades. In individuals with late monocular visual loss, gaze stability was more similar to control subjects. Bilateral visual loss caused eye drifts that were larger than following monocular visual loss or in control subjects. Accurate saccades could be made to somatosensory cues by an individual with acquired blindness, but voluntary saccades were absent in an individual with congenital blindness. We conclude that the neural gaze-stabilizing network, which contains neurons with both binocular and monocular discharge preferences, is under adaptive visual control. Whereas monocular visual loss causes disjunctive gaze instability, binocular blindness causes both disjunctive and conjugate gaze instability (drifts and nystagmus). Inputs that bypass this neural network, such as projections to motoneurons for upward saccades, remain conjugate