The Influence of the Head Posture on the Motor Alignment and Sensory Status in the Patients with the Abnormal Head Posture

PURPOSE: To analyze clinical manifestations of the abnormal head posture of ocular origin and to evaluate the effect of the abnormal head posture on the improvement of binocularity. METHODS: In this prospective study 58 patients with abnormal head posture of ocular origin were enrolled. Best corrected visual acuity, Titmus stereotest, Worth four dot test at near and far and the deviations at far were recorded in the abnormal head posture and the forced primary position. Changes of the head postures and the stereoacuity were evaluated postoperatively in the operated cases. RESULTS: The most common cause of abnormal head posture was superior oblique palsy and the most common type of that was head tilt. The deviating angles were significantly decreased in 30 patients (80%) and not changed in 8 patients (20%) of 38 patients with strabismus in abnormal head posture compared to the forced primary position. However, the results of Titmus stereotest improved only in 28% of patients in abnormal head posture. Six among 7 patients with nystagmus showed the disappearance of nystagmus in the abnormal head posture. Twenty (90%) among 22 patients who had surgical procedures showed improvement in the head posture. CONCLUSIONS: The abnormal head posture improved the motor alignment in most of the strabismus patients. However, in many patients it failed to improve the sensory status or binocularity. Most patients who had surgical procedures showed the improvement of abnormal head posture.

Sensory Testing for Binocular Suppression in Accommodative Esotropes

It is important to detect binocular suppression of pediatric strabismic patients, especially in accommodative esotropes and intermittent exotropes. However, it may take a long time and false results may be obtained in young children. In order to examine binocular suppression, we selected 103 accommodative esotropes with binocular suppression. Vectograph test, Worth 4 dot test, and 4 prism base-out test were performed at distance, and Worth 4 dot test, TNO test, and Bagolini test at near. Titmus fly test and Randot stereotest were administerd to know the relationship between stereoacuity and suppression. In detecting binocular suppression, the true rate of vectogram was 95%, which was the highest result of all tests and 4 prism base-out test was the next with 88% of the true rate. The stereoacuity was increased in proportional to the absence of suppression. The vectographic porject test was the easiest and the most accurate test to identify normal fusion or binocular suppression at distance in young strabismic children. The accuracy will be increased in the combination with 4 prism base-out test. Therefore the vectograph also can be used in the screening of small amount of deviation, monocular amblyopia and low vision in kindergarten and elementary school.