Nexus of ocular motility and dry eye

Purpose: To evaluate the effectiveness of vision therapy (VT) in patients with chronic presumed refractory dry eye disease (DED) and concurrent nonstrabismic binocular vision anomalies (NSBVAs). To propose an algorithmic approach to manage patients with refractory DED. Methods: Thirty?two patients with chronic (>1 year) presumed refractory DED and NSBVA were prospectively evaluated. The baseline dry eye evaluation and comprehensive orthoptic evaluation were done. VT was administered by a trained orthoptist for 2 weeks. The binocular vision (BV) parameters and percentage subjective improvement were assessed after the VT. Results: On evaluation, 12 patients (37.5%) had both DED and NSBVA, and 20 patients (62.5%) had only NSBVA. Twenty?nine patients (90.62%) showed significant improvement in BV parameters following VT. Binocular near point of accommodation (median, range) improved from 17 (8–40) to 12 (5–26) mm (P value < 0.0001), and near point of convergence (median, range) improved from 6 (3–33) to 6 (5– 14) (P value 0.004) with VT. Thirty?one patients (96.87%) reported symptomatic improvement after VT, and 62.5% of these showed more than 50% improvement in symptoms. Conclusion: The present study confirms the beneficial role of VT in the treatment of patients with DED with concurrent NSBVA. It is essential to diagnose and treat NSBVA in patients with DED to ensure complete relief of symptoms and patient satisfaction. As there is a significant overlap between symptoms of dry eye disease and that of NSBVA, a complete orthoptic evaluation is recommended in all patients presenting with refractory dry eye disease related symptoms

Vision therapy system 4D combined with stereoscopic 3D training technology for the treatment of amblyopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the effect of vision therapy system 4D combined with stereoscopic 3D technology training for the treatment of amblyopia.METHODS: Prospective study. A total of 102 children with amblyopia who attended the clinic from January 2018 to January 2022 were selected, and they were randomly assigned into two groups by computer, with 51 cases in each group. Control group received stereoscopic 3D technology training, while observation group participated in vision therapy system 4D on the basis of control group. Then the overall effective rate, binocular visual function, spherical equivalent(SE), axial length(AL), mean corneal curvature(Km), best corrected visual acuity(BCVA)and visual evoked potential were compared between two groups.RESULTS: The overall efficacy rate was 94.1% in observation group, which was obviously higher than control group(74.5%; P&#x003C;0.05). The improvement in binocular vision parameters simultaneous perception, total fusion, and stereoacuity were all more remarkable in observation group than in control group(P&#x003C;0.05). The △SE, △AL and △Km yielded no statistical difference between two groups(P&#x003E;0.05). The latency of two spatial frequencies(1°grid and 15'grid)showed a decline in both groups, and the decline was more notable in observation group than in control group(P&#x003C;0.05). In both groups, BCVA improved, and the improvement was more significant in observation group compared with control group(P&#x003C;0.05).CONCLUSION: Application of vision therapy system 4D combined with stereoscopic 3D technology training for amblyopia can effectively ameliorate the visual acuity, promote the reconstruction of simultaneous perception, total fusion, and stereoacuity without additional risk of myopic shift, and improve visual pathway function in children.

Results of fusional vergence therapy in managing consecutive esotropia: A case series

Purpose: To analyze the efficacy of fusional vergence therapy (FVT) in management of consecutive esotropia with diplopia after intermittent exotropia (IXT) surgery. The current study is carried on how FVT affects the duration of treatment, sensory fusion, and exotropic drift. Methods: This was a retrospective study for the medical record of 11 patients with consecutive esotropia after IXT surgery of 543 patients over the period of 5 year, with mean surgery age of 9.5 (range: 4–33 y). FVT was planned after minimum 6 weeks of surgery and was considered for maximum 24 weeks. Patients underwent a combination of office-based and home-based FVT. Successful outcome of therapy was considered where diplopia resolves in free space and achieves sensory fusion, stereopsis with no manifest deviation. Results: Record of 543 patients who had horizontal muscle surgery for IXT were identified and reviewed. Records of 11 patients who showed consecutive esotropia of 10 prism diopter (PD) or more with normal retinal correspondence, with or without diplopia complaint, after 6 week of surgery and had undergone vision therapy management were reviewed. A successful outcome of binocular single vision with good sensory and motor fusion with no manifest deviation or prism requirement was achieved with in the mean duration of 4.8 month of therapy. With a mean duration of 4 weeks of therapy, the mean angle of deviation reduced by 53% for distance (17 PD to 8 PD) and 27% for near (11 PD to 8 PD) and mean stereopsis improvement by 80% with 94% patients demonstrating sensory fusion on Bagolini test and 94% of patients having no symptoms of diplopia or squint. Conclusion: With nonsurgical management involving refractive error correction, FVT, and prism, consecutive esotropia was resolved in 74% cases. Management of consecutive esotropia with FVT can result in satisfactory sensory fusion and successful motor alignment.

Improvement of asthenopia caused by abnormal visual functions via visual training in adult patients / 中华实验眼科杂志

Objective:To analyze the improving effect of visual therapy on the symptoms of asthenopia caused by abnormal visual function in adults.Methods:A serial case study was conducted.Ninety-three adult patients (186 eyes) with visual dysfunction caused by abnormal visual function who underwent training in the visual training room of the Optometry Center of Tianjin Eye Hospital from October 2018 to October 2019 were enrolled, among which there were 48 males and 45 females.The average age of patients was (30.43±6.39) years old.Binocular visual function examination included vision examination by phoropter, simultaneous vision and stereopsis by Worth 4 Dots test, distance and near heterophoria by Von-Graefe method test, fusion range by rotating prism method, the accommodation reaction by fusion cross cylindrical lens (FCC), the accommodation amplitude by minus technique, the accommodation flexibility and the vergence flexibility by flipper, and a personalized training program was formed on the basis of the above examination results.The training process was divided into initial examination, first review and second review, and each stage containing 5 times of training was followed by a review.The results of the initial examination, first review and second review were compared.The study protocol was approved by an Ethics Committee of Tianjin Eye Hospital (No.KY201906). Written informed consent was obtained from each patient prior to any examination.Results:The average near heterophoria was -8.0 (-15.3, -3.0) △ at the initial examination, and it was reduced to -5.0 (-9.0, 0.0) △ at the first review, showing significant difference (Z=-3.586, P<0.01). The mean accommodation amplitude of left and right eyes were 4.00 (3.25, 5.25)D and 4.00 (3.00, 5.00)D respectively before visual training, which were increased to 5.50 (4.25, 7.00)D and 5.00 (3.75, 7.00)D at the first review, showing significant differences (Z=-4.284, -3.995; both at P<0.01). The broken point and the recovery point of the long-distance positive fusion at the initial inspection were 7.5 (5.0, 15.8) △ and 0.0 (0.0, 4.0) △ respectively, which were increased to 11.0 (6.0, 22.0) △ and 4.0 (0.0, 7.0) △ respectively at the first review, showing significant differences (Z=-3.192, -3.748; both at P<0.01). The broken point and the recovery point of the near positive fusion at the initial inspection were 18.0 (8.0, 28.0) △ and 6.0 (0.0, 12.0) △, respectively, which were increased to 26.0 (21.5, 35.0) △ and 11.5 (6.0, 16.0) △ respectively at the first review, showing significant differences (Z=-4.695, -3.377; both at P<0.01). The monocular and binocular accommodation flexibility were increased from 2-3 cycles/minute at the initial examination to 10-12 cycles/minute at the first review, showing significant differences (all at P<0.01). Logistic regression analysis showed that age, distance heterophoria and near heterophoria were not related to the difference in accommodation improvement of the right and left eyes.At the initial examination, the average CISS score of 22 patients was (25.13±9.64) points, which was dropped to (19.18±7.22) points at the first review, showing significant difference ( t=6.79, P<0.01). The 67.60% (48/71) of the patients who did not answer the questionnaire had obvious improvement in their main complaints and physical signs, and 29.58% (21/71) of them had improvement but still needed more training, and 2.82% (2/71) had no improvement in visual fatigue symptoms. Conclusions:Systemic visual therapy can improve the visual function and alleviate symptoms majority of the adult patients with abnormal visual function, suggesting that adult visual function is still of strong plasticity.

Efficacy of vision therapy in impaired stereoscopic depth with intermittent exotropia (true divergence excess) with unilateral amblyopia: a case report

Divergence excess (DE) can be described clinically as exotropia at far greater than the near deviation by at least 10 prism dioptres (PD). We are reporting a rare case of 25-year-old female visited in the eye department for a routine eye check-up with a history of decreased vision in one eye. On examination, it was detected as a case of unilateral amblyopia with intermittent exotropia of true divergence excess with high accommodative-convergence over accommodation (AC/A) ratio. The patient was asymptomatic from exo-deviation due to the presence of binocular vision and good fusional reserve. The patient was started on active conventional vision therapy along with occlusion therapy. Post 16 weeks of constant therapy, a vision assessment with complete squint assessment along with binocular vision tests were performed. The result interprets to support the use of active conventional vision therapy as an integral part of the clinical treatment of amblyopia and intermittent exotropia. The rate of recovery of several monocular functions monitored during the vision therapy period provides the evidence of neural plasticity at multiple sites in the visual pathway in this adult amblyope. Therefore, if an ordered plan is being followed for the management of the patient of unilateral amblyopia and divergence excess, it can yield long-lasting improvement in visual acuity and binocular functions of any age.

Terapia visual: ¿En qué consiste y cuándo indicarla? / Vision therapy: what is it and when should it be indicated?

RESUMEN La terapia visual es un programa de ejercicios visuales personalizados, donde se realiza una estimulación neurofisiológica que nos permite desarrollar, mejorar e integrar las capacidades visuales. Esta serie de actividades específicas están pensadas para corregir problemas de visión. La terapia visual tiene como fin obtener una visión simple, nítida, confortable y eficaz. En la sociedad actual de la información y del conocimiento, donde hay un uso excesivo de la visión de cerca que provoca síntomas oculares como consecuencia del estrés visual, esta es una opción terapéutica a tener presente en sus diferentes variantes(AU)

ABSTRACT Vision therapy is a program of personalized visual exercises by which neurophysiological stimulation is provided to develop, improve and integrate visual capacities. It consists of a series of specific activities designed to correct vision problems. The purpose of vision therapy is to obtain single, neat, comfortable and efficient vision. In today's information and knowledge society, characterized by excessive use of near vision, leading to ocular symptoms resulting from visual stress, this is a therapy option to be taken into account in its various forms(AU)

Simplified updates on the pathophysiology and recent developments in the treatment of amblyopia: A review

Amblyopia is the most common cause of monocular visual impairment affecting 2-5% of the general population. Amblyopia is a developmental cortical disorder of the visual pathway essentially due to abnormal visual stimulus, reaching the binocular cortical cells, which may be multivariate. Ganglion cells are of two types: parvocellular (P cells) and magnocellular (M cells); they are the first step where the light energy is converted in to neural impulse. P cells are involved in fine visual acuity, fine stereopsis, and color vision and M cells are involved in gross stereopsis and movement recognition. Strabismus, refractive error, cataract, and ptosis, occurring during critical period are highly amblyogenic. The critical period extends from birth to 7--8 years. The earlier the clinically significant refractive error and strabismus are detected and treated, the greater the likelihood of preventing amblyopia. Treatment for amblyopia in children includes: optical correction of significant refractive errors, patching, pharmacological treatment, and alternative therapies which include: vision therapy, binocular therapy, and liquid crystal display eyeglasses are newer treatment modalities for amblyopia. Age of starting the treatment is not predictive of outcome, instituting treatment on detection and early detection plays a role in achieving better outcomes. This review aims to give a simplified update on amblyopia, which will be of use to a clinician, in understanding the pathophysiology of the complex condition. We also share the cortical aspects of amblyopia and give recent developments in the treatment of amblyopia.

The Effectiveness Of The Dot Card Therapy Towards Convergence Insufficiency Patients Among Young Adults

@#Convergence insufficiency is a common binocular vision disorder. It has been reported that the frequency of this anomaly has reached as high as 6% among school children and young adults and may affect their quality of life and near work performance. One of the treatment modalities is the Dot Card therapy. However, there is scarce research report on the effectiveness of the Dot Card therapy. Hence, this study was conducted to compare the effectiveness of the therapy given to convergence insufficiency patients among young adults. A total of 33 university students (age range=22.55±1.66 years) with convergence insufficiency problems participated in this study. Convergence insufficiency symptoms based on the Convergence Insufficiency Symptom Survey (CISS) and binocular vision components such as near point of convergence, fusional vergence and phoria were measured before and after the Dot Card therapy was given to each participant. All participants were reviewed after 2 weeks and 4 weeks. The results indicated that participants demonstrated statistically and clinically significant changes and improvement in symptom from CISS score (22.30 to 15.30, p<0.001), NPC (11.08 cm to 6.50 cm, p<0.001) and PFV at near (13.82Δ to 18.36Δ, p=0.035) at the end of 4-week visit. Participants’ near phoria were improved (2.12 exo to 1.79 exo, p=0.369) even though it is not statistically and clinically significant. The convergence insufficiency patients have achieved significant improvements in symptoms and near point of convergence both statistically and clinically, within one month of the Dot Card therapy treatment.

Cambios del estado oculomotor en pacientes de 18 a 25 años diagnosticados con insuficiencia de convergencia (IC) de la Universidad El Bosque, tras el tratamiento sugerido de ortóptica durante tres meses, 2013 / Oculomotor status changes in patients 18 to 25 years diagnosed with convergence insufficiency (CI) of the universidad el bosque, after orthoptics suggested treatment for three months, 2013

Estudio de casos prospectivo longitudinal, cuyo propósito es valorar los cambios de las condiciones binoculares, en pacientes diagnosticados con insuficiencia de convergencia, tras el tratamiento sugerido de ortóptica durante tres meses, con el fin de establecer el porcentaje de mejoría. Durante el desarrollo de esta investigación, se establecieron como criterios de inclusión: exoforia (X´) en visión próxima <20 Dioptrías prismáticas (Dpt), reservas fusiónales positivas (RFP) <15 Dpt, amplitud de acomodación baja (AA), punto próximo de convergencia (PPC) ≥6cm, acomodación relativa positiva (ARP) <2.50 y edades entre 18-25 años. Un total de 7 pacientes fueron incluidos; quienes firmaron el consentimiento informado. Inicialmente se valoró el estado oculomotor de cada paciente y respondieron la encuesta de síntomas pre-tratamiento; posteriormente fueron instruidos para realizar ejerciciosy/o terapia visual diarios en casa por 30 minutos. Una vez, finalizado el tratamiento, se tomaron medidas, las cuales evidenciaron cambios significativos en el PPC con luz ruptura/ recuperación (p = 0.0022) / (p = 0.0017); PPC con objeto real ruptura/ recuperación (p = 0.0040) / (p= 0.0017); reservas fusiónales positivas en visión próxima ruptura/ recobro (p = 0.0017) / (p = 0.0027). El 100% de los pacientes presentaron una ruptura ≤6cm y una recuperación de 7 ±3,6 cm en el PPC con luz; con objeto real el 71,4% presento una ruptura ≤ 6cm y una recuperación de 9 ±1,2 cm; las RFP incrementaron en el 85,7% siendo esta ≥15Δ en ruptura y una recuperación ≥15Δ en el 71,4% y en la encuesta el 48% de los pacientes reportaron mejoría de sus síntomas. Con lo anterior, se puede concluir que el tratamiento sugerido de ortoptica, presentó cambios y mejoras significativas de los signos clínicos los cuales se acompañan de una reducción de síntomas, los que permiten mejoras en la calidad de vida de los jóvenes universitarios y el restablecimiento de las condiciones binoculares.

Prospective longitudinal study of cases, the purpose is evaluate the changes in binocular conditions, in patients diagnosed with convergence insufficiency after orthoptic suggested treatment for three months, with the objective of determine the percentage of improvement. During the development of this investigation, were established as inclusion criteria: exophoria (X) in near vision <20 prism diopters (DPT), positive fusional reserves (RFP) <15 Dpt, low amplitude accommodation (AA), next point Convergence (CPP) ≥6cm, positive relative accommodation (PRA) low and ages 18-25 years. A total of 7 patients were included; They signed the informed consent. Initially the oculomotor status of each patient were evaluated and respondents survey of pretreatment symptoms; then they were instructed to perform exercises and / or vision therapy daily at home for 30 minutes.. Once treatment is completed, measures were taken, which showed significant changes in the PPC with break light / recovery (p = 0.0022) / (p = 0.0017); PPC real object breakdown / recovery (p = 0.0040) / (p = 0.0017); positive fusional reserves near sighted ness breakdown / recovery (p = 0.0017) / (p = 0.0027). 100% of patients had a breakdown and recovery ≤6cm 7 ± 3.6 cm in the PPC with light; real object with 71.4% showed a break ≤ 6cm and a recovery of 9 ± 1.2 cm; RFPs increased by 85.7% this being ≥15Δ in breaking ≥15Δ recovery and 71.4% in the survey and 48% of patients reported improvement in their symptoms. With this, one can conclude that the treatment suggested orthotopic, introduced significant changes and improvements in the clinical signs which are accompanied by a reduction in symptoms, which allow improvements in the quality of life in college students and restoring binocular conditions.

Accommodation and Convergence, Anomalies of Convergence

PURPOSE: Accommodation and convergence, the main factors of near vision complex on near vision associated with miosis are essential ocular movements for binocularity. Therefore, we attempted to find appropriate treatments for anomalies of accommodation and convergence. METHODS: The basic theories and anomalies of accommodation and convergence were reviewed. Various treatment modalities for anomalies of convergence were discussed and treatment guidelines were proposed. RESULTS: Anomalies of convergence were classified into convergence insufficiency, convergence insufficiency associated with accommodative insufficiency, convergence paralysis, convergence spasm, and convergence excess. Treatment was divided into non-surgical and surgical methods which include not only vision therapy and optical treatment using a prism after cycloplegic refraction, but also rectus muscle surgery. CONCLUSIONS: The choice of effective treatments according to various causes is necessary for anomalies of accommodation and convergence through complete eye examinations. Thus, not only simple refractive error measurement and glasses prescription for best corrected visual acuity are necessary, but also active treatment by fundamental ophthalmic and neurologic evaluation in hospitals.