Comparison dominant eye and anisometropia by Worth 4 dot test and hole-in-the-card test / 国际眼科杂志(Guoji Yanke Zazhi)

ATM: To investigate the relationship between the oculus dominans and the eye with higher diopter among myopes, and to study the difference between the Worth 4 dot test and hole-in-the-card test. METHODS: Totally 125 cases were divided into two groups as physiogenic anisometropic group and pathological anisomitropic group according to the degree of binoculus anisometropy. Worth 4 dot test and hole-in-the-card test were used to distinguish oculus dominans respectively based on medical optometry. RESULTS: In physiogenic anisometropic group, the oculus dominans and the eye with higher diopter among myopes had significant relationship by hole-in-the-card test (Z = -4. 057, P0. 05); distinguish the oculus dominans had no statistically significant difference between the Worth 4 dot test and hole-in-the-card test (n=125, P>0. 05). CONCLUSION:The oculus dominans is determined by gene or formed during juvenile period, then myopia anisometropic may affect the choice of that. The Worth 4 dot test has some reference significance for observing oculus dominans.

The Change of Sensory Binocularity according to the Surgical Results in Intermittent Exotropia

PURPOSE: This study was designed to determine which sensory test best reflects the improvement of binocular function according to the surgical outcome of intermittent exotropia METHODS: We examined the visual acuity, refractive error, angle of exodeviation, fusional status with the Worth-4-dot, Bagolini tests and stereoacuity with the Titmus test preoperatively in 61 intermittent exodeviation patients who had undergone the bilateral lateral rectus recession operation from February 2002 to 2003 July. We compared the binocularity tests between the two groups: esodeviated and orthotropic or exodeviated. RESULTS: The average improvement time of the Bagolini, Worth 4 dot and Titmus tests was 0.54 +/- 1.2, 2.03 +/- 2.90, 1.12 +/- 2.1 weeks, respectively. Although the shortest time was for the Bagolini test (p=0.001), the Titmus test was more sensitive. CONCLUSIONS: The high variability of the binocularity tests should be remembered and take into account when we interpret the test results.

The Usefulness of the Worth 4-Dot Test under Room Light On and Off in Intermittent Exotropes

PURPOSE: It is known that fusion is promoted in the presence of a peripheral fusion clue in patients with intermittent exotropia, X(T). Therefore, this study compared the results of the Worth 4-dot test (W4D) with the room lights on and off in order to determine the status of the binocular function. METHODS: The W4D test was performed with lights on and off, and the polarized 4-dot test (P4D) was administered in 52 X(T) patients. RESULTS: Among these 3 tests, the fusion rate was the lowest with distance in the W4D with the lights off at 9.6%, which was followed by the W4D with the lights on at 26.9% and the P4D at 57.7%. The fusion rate of the W4D with the lights on in the patients with a distance stereoacuity better than 120 seconds of arc (") was 50%, which was significantly higher than the 18.4% observed in the patients with a stereoacuity at 120" or worse (P=0.023). Among the 14 patients who showed fusion with the distance W4D with the lights on, 10 could not fused with the W4D with the lights off. Therefore, a weak motor fusion was observed in 71.4 % of these 14 patients. CONCLUSIONS: It is possible to verify the more natural condition of the binocular sensory function of patients with X(T) using either the P4D or the W4D with the lights on rather than with the lights off. Furthermore, the W4D test with the lights on can be performed together with and be compared with that conducted with the lights off, for a better understand of the degree of motor fusion.

Sensory Status in Patients Showing Orthophoria After Strabismus Surgery in Exotropes

PURPOSE: The purpose of this study is to evaluate sensory function and stereoacuity in patients showing orthophoria after surgery in exotropes, and to elucidate factors influencing postoperative improved sensory status METHODS: We prospectively studied 45 patients showing orthophoria or exophoria within 4 prism diopters after strabismic surgery in exotropes. Three tests (Worth-4-dot test, Bagolini striated lens test and Titmus test) were performed at pre and postoperative period. We studied the effect of different variables (age at surgery, visual acuity, angle of deviation, Bagolini striated lens test, Titmus test, anisometropia, and fusional status) with suspected clinical influence on the sensory and motor outcomes. RESULTS: In Worth-4-dot test, 34 patients (75.6%) showed improvement after surgery. Thirty-three patients (73.3%) and 35 patients (77.8%) showed improvement respectively in the Bagolini striated lens test and Titmus test. Thirty-eight patients showed improvement in 2 or more tests after surgery and 7 patients showed no change. Of patients showing preoperative abnormal response in each test, 21 patients (65.6%) in Worth-4-dot test, 14 patients (53.8%) in Bagolini striated lens test, and 22 patients (68.8%) in Titmus test showed normal response at postoperative 6 months. Of 3 tests and other factors, Bagolini striated lens test was the only factor predicting postoperative sensory recovery (x2=4.18, P<0.05). CONCLUSIONS: In patients showing orthophoria or exophoria within 4 prism diopters after strabismic surgery in exotropes, Bagolini striated lens test was the only meaningful factor predicting postoperative sensory recovery

Evaluation of Factors Influencing Stereoacuity in Exodeviation

The purpose of this study was to evaluate factors influencing stereoacuity in exodeviation. We examined the visual acuity, refractive error, angle of exodeviation, fusional status with the Worth-4-dot test, and stereoacuity with the Titmus test preoperatively in 139 exodeviated patients who had undergone operation from August 1994 to February 1997. We evaluated the association of stereoacuity to the following factors with chi-square test: sex, age at surgery, visual acuity, type and degree of refractive error, associated hypertropia, angle of exodeviation, and fusional status.The stereoacuity was normal-under 100 second of arc, when age at surgery was under 8 years, when visual acuity was 0.6 or better, when abgle of exodeviation was under 40 prowm and when fusion was intact at near only or both(p<0.05). There was no statistical significance between sex, type or degree of refractive error, associated hypertropia, and stereoacuity.Of these, age at surgery and fusional status were found to be independent factors influencing stereoacuity with discriminant analysis test. In conclusion, in aspect of perserving normal stereoacuity, age atsurgery and fusional status are important factors in the surgical criteria of exotropia.

Artifact of Worth Four Dot Test in Strabismic Patients

It is the purpose of this study to evaluate fusional status of 49 strabismic patients who showed orthophoria less than 10 prism diopters (PD) after surgery under alternate prism and cover test. We undertook the Worth 4-dot(W4D) test twice, reversing the position of the red/green glasses between the eyes for the second trial. Bagolini test was also performed in 31 of 49 cases. Nineteen of 49 case(18.4%) showed different results on the W4D test with red/green glasses after reversal at near or distance, either changing fusional status or changing laterality of suppression. Four of 31 cases (18.0%) showed different status of fusion or suppression between W4D and Bagolini tests. We think that it repeating test twice, with the red/green glass reversed between trials, and with combination of Bagolini test, provides better reliability of W4D test.

Comparison Between Worth Four-Dot and Polarized Four-Dot Test

To compare between the Worth 4-dot test(W4D) with polarized 4-dot test(P4D), we examined the interpretable response rate, response time, age of test failure, false positive rate and negative rate of reporting fusion in 133 patients older than 3 years of age. The interpretable response rate for W4D was 91% and for P4D 93.2%. The mean response times were 20.9 seconds for W4D versus 16.9 seconds for the P4D, the difference being statistically significant(p<0.05). The age of test failure for W4D was 4.8 years old and for P4D 3.8 years old. The false positive rate of reporting fusion for W4D was 4.5% and for P4D 8.8%. The false negative rate for W4D was 37.5%, while for P4D was 15.2%, the difference being statistically significant(p<0.05). In conclusion, the P4D was found to be less dissociative test by allowing more natural environment, and was easier, more rapid interpretable test. Therefore, the P4D may provide a more accurate assessment of a patients sensory status.

Effect of Levodopa on Visual Function in Amblyopia

Recently many attempts have been made to find a meaical treatment for amblyopes who failed or were stable to respond to conventional occlusion therapy. To evaluate the efficacy and tolerability of levodopa, double-masked placebocontrolled study was performed on 20 older children with strabismic and anisometropic amblyopia. 12 subjects received 2.0mg/0.5mg/kg of levodopa/benzerazide and 8 subjects received 2.0mg/kg of placebo(lactose). Snellen visual acuity, steroacuity, Worth 4 dot test were measured to assess efficacy at baseline, 1 and 5 hours after drug ingestion. Tolerance was assessed by questionnare. Log Snellen fraction in the amblyopic eyes of levodopa group improved by 0.1(one line), from an overall average of 0.49 to 0.39 at 1 hour and 5 hours after drug ingestion(p<0.01). No significant changes in visual acuity were found in the dominant eyes of levodopa group and in both eyes of placebo group. In levodopa group the improvements of stereoacuity (more than 1 step) were by 50% at 1 hour and 83% at 5 hours after drug ingestion, but in placebe group, only 13% at both 1 and 5 hours after. No changes in Worth 4 dot test were found in both levodopa group and placebo group. Side effects reported in the study were transient episodes of nausea, emesis and sleepiness, but similar between two groups. In conclusion, we found levodopa is efficacious in temporarily improving visual function in amblyopic eyes, and further investigation with a large number of patients and longer duration of follow up is needed.