Refractive error changes and associated asthenopia observed after COVID-19 infection: Case reports from two continents

COVID-19 infection has been linked to various ocular complications and complaints, but not to refractive errors. In this case report, we present ethnically diverse patients who reported asthenopic symptoms shortly after recovering from COVID-19 infection. The hyperopic shift in the refractive error, post-COVID could indicate the ciliary body muscle’s inability to sustain accommodation, resulting in asthenopia. Hence, refractive errors should also be considered as a post-COVID complication, even if the magnitude is small, especially when patients have a headache and other asthenopic symptoms. Performing dynamic retinoscopy and cycloplegic refraction will also aid in the better management of these patients

Characteristics of binocular vision and oculomotor function among sports-concussed athletes

Purpose: To compare the binocular vision and oculomotor function between sports?concussed athletes and aged?matched controls. Methods: Thirty mild concussed athletes were recruited and compared with aged?matched controls. All the participants underwent a comprehensive ocular assessment followed by an oculomotor assessment which included tests for accommodation, vergence, eye movements, and reading parameters. Results: Three categories of oculomotor?based deficits were found: convergence insufficiency (40%), accommodative insufficiency (25%), and oculomotor?based reading dysfunctions (20%). A statistically significant reduction in the mean ± SD of the following parameters was noted in concussed athletes v/s controls:? binocular accommodative amplitude: 7.13 ± 1.59 v/s 15.35 ± 2.95 (P < 0.001), convergence amplitude: 14.23 ± 5.00 v/s 5.65 ± 0.90 (P < 0.001), positive fusional vergence for distance: 21.17 ± 8.97 v/s 31.32 ± 6.23 (P < 0.001), vergence facility: 6.47 ± 1.47 v/s 11.84 ± 1.00 (P < 0.001), accommodative facility: 7.10 ± 4.57 v/s 11.67 ± 1.83 (P < 0.001), reading speed: 66.97 ± 17.82 v/s 144.13 ± 24.45 (P = 0.03) and Developmental Eye Movement ratio: 1.40 ± 0.19 v/s 1.17 ± 0.06 (P < 0.001). Conclusion: Concussions caused by sports have a considerable impact on binocular vision and oculomotor parameters. These findings have substantial therapeutic implications in terms of establishing a periodic screening program for athletes so that essential therapy can be provided for a better outcome.

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

Factores del estrabismo incomitante para mejorar el pronóstico de los casos / Factors of incomitant strabismus to improve the prognosis of cases / Fatores no estrabismo incomitante para melhorar o prognóstico dos casos

El estrabismo es una alteración de la visión binocular, es decir, la pérdida de paralelismo de los ejes visuales. Las personas que padecen estrabismo presentan disminución de la profundidad visual y percepción de dimensionalidad. Se estima que este padecimiento ocular, afecta alrededor del 2 al 4 % de la población infantil. La clasificación de los estrabismos y su misma definición han sido parte de un debate mundial durante años. La edad de aparición, el ángulo de desviación, el ojo desviado, y la magnitud del ángulo en distancia de enfoque tambien; sin embargo, siempre debe confirmarse con exámenes más exhaustivos luego de un primer diagnóstico realizado por un profesional de la salud visual. Objetivo. Identificar las características de los estrabismos incomitantes, formas de diagnóstico, clasificación y factores para poder manejarlos específicamente y mejorar el pronóstico del caso. Metodología. Se realizó una síntesis de la información disponible de literatura sobre el estrabismo incomitante a través de un análisis bibliográfico donde se empleó descriptores de búsqueda para lo cual se revisaron las bases de datos: Google académico y Proquest Prisma. Se realizó el análisis de referencias desde el año 2010 al 2020 y como resultado se obtuvieron 34 referencias que describen una clasificación de estrabismos, tipo de diagnóstico y tratamiento. Conclusión. Se considera fundamental aumentar la conciencia pública sobre el tema del diagnóstico temprano de afectaciones oculares para generar medidas de prevención que busquen atenuar la ocurrencia de esta alteración. Delimitar el tipo de estrabismo incomitante podría evitar consecuencias irreparables para el paciente.

Strabismus is an alteration of binocular vision, that is, the loss of parallelism of the visual axes. People suffering from strabismus have decreased visual depth and dimensionality perception. It is estimated that this ocular condition affects about 2 to 4% of the child population. The classification of strabismus and its very definition have been part of a worldwide debate for years. The age of onset, the angle of deviation, the deviating eye, and the magnitude of the angle in focusing distance as well; however, it should always be confirmed with more exhaustive examinations after a first diagnosis by an eye care professional. Objective. To identify the characteristics of incomitant strabismus, ways of diagnosis, classification and factors to be able to manage them specifically and improve the prognosis of the case. Methodology. A synthesis of the information available in the literature on incomitant strabismus was made through a bibliographic analysis using search descriptors for which the following databases were reviewed: Google Scholar and Proquest Prisma. The analysis of references from 2010 to 2020 was carried out and as a result 34 references were obtained describing a classification of strabismus, type of diagnosis and treatment. Conclusion. It is considered essential to increase public awareness on the issue of early diagnosis of ocular disorders in order to generate preventive measures that seek to mitigate the occurrence of this disorder. Delimiting the type of incomitant strabismus could avoid irreparable consequences for the patient.

O estrabismo é um distúrbio da visão binocular, ou seja, a perda do paralelismo dos eixos visuais. As pessoas que sofrem de estrabismo têm uma percepção de profundidade e dimensionalidade visual reduzida. Estima-se que essa condição ocular afete cerca de 2 a 4% da população infantil. A classificação do estrabismo e sua própria definição têm sido parte de um debate mundial há anos. A idade de início, o ângulo de desvio, o olho desviado e a magnitude do ângulo na distância de focalização também; no entanto, devem sempre ser confirmados por exames adicionais após um primeiro diagnóstico feito por um oftalmologista. Objetivo. Identificar as características do estrabismo incomitante, as formas de diagnóstico, a classificação e os fatores para poder tratá-los especificamente e melhorar o prognóstico do caso. Metodologia. Foi feita uma síntese das informações disponíveis na literatura sobre estrabismo incomitante por meio de uma análise bibliográfica usando descritores de pesquisa para os quais foram revisados os seguintes bancos de dados: Google Scholar e Proquest Prisma. A análise das referências de 2010 a 2020 foi realizada e, como resultado, foram obtidas 34 referências que descrevem a classificação do estrabismo, o tipo de diagnóstico e o tratamento. Conclusões. Considera-se essencial aumentar a conscientização pública sobre a questão do diagnóstico precoce de distúrbios oculares para gerar medidas preventivas que busquem mitigar a ocorrência desse distúrbio. Delimitar o tipo de estrabismo incomitante poderia evitar consequências irreparáveis para o paciente.

The effect of virtual reality technology in children after surgery for concomitant strabismus

Purpose: This study aimed to investigate the effect of virtual reality (VR) technology in children after surgery for concomitant strabismus. Methods: A total of 200 children with concomitant exotropia or concomitant esotropia were randomly divided into a training group and a control group according to the single even number random method (100 cases in each group). Patients in the training group received VR intervention training within 1 week after surgery. Patients in the control group did not receive any training. Results: Six months after the surgery, the orthophoria (the far or near strabismus degree was ?8?) rate was significantly higher in the training group than in the control group (P = 0.001), while the eye position regression rate (compared to the strabismus degree within 1 week after the surgery, the amount of regression >10?) was significantly lower in the training group than in the control group (P = 0.001). Six months after the surgery, the number of children with simultaneous vision and remote stereovision was significantly higher in the training group than in the control group (P = 0.017 and 0.002, respectively). The differences in the number of patients with peripheral stereopsis, macular stereopsis, and stereopsis in macular fovea centralis at 1, 3, and 6 months after the surgery between the training and the control groups were not statistically significant (P = 0.916, 0.274, and 0.302, respectively). Conclusion: The intervention of VR technology after strabismus correction effectively improved children’s visual function and maintained their eye position

Observation on the curative effect of horizontal rectus transposition combining recess-resect treatment on monocular elevation deficiency with horizontal strabismus

Purpose: To explore the clinical effect of horizontal rectus transposition combining recess and resect treatment on monocular elevation deficiency (MED) with horizontal strabismus. Methods: Ten patients (10 eyes) scheduled to undergo horizontal rectus transposition combining recess?resect surgery to treat MED with horizontal strabismus in the ME Department of Ophthalmology of the First Affiliated Hospital of Guangxi Medical University between July 2016 and February 2022 were included in the study. The degree of vertical and horizontal prism strabismus, the grading of upper movement of the paralyzed eye, and the improvement of binocular vision were evaluated before and after the surgery. Results: Horizontal rectus transposition combined with recess and resect treatment was used to treat 10 patients with MED combined with horizontal strabismus. A good curative effect was seen in eight patients. The differences in the degree of vertical strabismus, the degree of horizontal strabismus, and the movement function of the paretic eyes before and after surgery were significantly different (all P < 0.05). The binocular haplopia function in six patients was reconstructed in the primary position after surgery. Conclusion: Horizontal rectus transposition combining recess?resect is easy to perform, and the number of recti involved in the surgery is small. This approach can effectively correct the eye position, improve eye movement, and reconstruct binocular vision in patients with MED by combining horizontal strabismus

Clinical observation of postoperative visual perceptual training in children with intermittent exotropia on the recovery of visual function at all levels / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the role of visual perception training on the recovery of visual function at all levels and the improvement of perceptual eye position in children with intermittent exotropia(IXT).METHODS: Prospective clinical study. A total of 74 patients with IXT who received corrective surgery for strabismus in the Ophthalmology Department of the First People's Hospital of Lanzhou City from January to June 2022 were collected and followed up for 3mo. The patients were randomly divided into 2 groups at 1d after surgery: 35 patients in the training group received binocular visual perception training, and 39 patients in the control group did not receive visual training. The changes of visual function and perceived eye position at all levels were observed at 1d and 3mo after operation.RESULTS: There were 24 patients(69%)with simultaneous perception in the training group at 1d after surgery and 34 patients(97%)with recovered visual function at 3mo after surgery, which was significantly higher than 1d after surgery(P=0.002). Furthermore, there were 22 cases(56%)of fusion function in the control group at 3mo after surgery, 13 cases(33%)of far stereopsis, 20 cases(51%)of dynamic stereopsis and 17 cases(44%)of static fine stereopsis. In the training group, there were 31 cases(89%)of fusion function, 25 cases(71%)of far stereopsis, 30 cases(86%)of dynamic stereopsis and 27 cases(77%)of static fine stereopsis, which were significantly higher than those in the control group(all P&#x003C;0.05). The degree of perceived eye displacement in the training group decreased more significantly than that in the control group(all P&#x003C;0.05).CONCLUSION: Postoperative visual perceptual training in children with IXT can promote recovery of visual function at all levels, improve perceptual eye position and enhance the control of eye position at the perceptual level of the brain.

Research progress of visual perception training on postoperative reconstruction of binocular vision in patients with intermittent exotropia / 国际眼科杂志(Guoji Yanke Zazhi)

Intermittent exotropia(IXT)is a common ophthalmic disease with high incidence, variable deviation, and varying degrees of impaired binocular visual function. The defect of binocular visual function is related to the changes of visual cortex. IXT involves the functional changes of many brain regions, including the cortical areas related to binocular fusion. After correcting the eye position, the abnormal changes of cerebral cortex still exist in some patients with IXT, and the recovery of binocular vision is still difficult. In order to solve these problems, visual perception training is gradually applied to the postoperative reconstruction of binocular visual function in patients with IXT. Visual perception training repairs the visual cortex from the brain level, improving the ability of the visual cortex to process information by constantly stimulating the visual center, thus repairing the visual central function, so that patients can obtain good binocular visual function, stabilize the eye position and reduce recurrence. This article reviews the mechanism of binocular visual impairment and the role of visual perception training in the treatment of IXT. It is hoped to provide more evidence for visual perception training to reconstruct postoperative binocular visual function and reduce the recurrence rate in patients with IXT.

Smartphone Use on Accommodation and Vergence Parameters: A Systematic Review

@#Introduction: The frequency and the trend of smartphone use increase rapidly, and 85% of Malaysians owns a smartphone and spend an average of 187 minutes per day to use the smartphone. Aims: To evaluate the potential effects of smartphone use on Accommodation and Vergence of the users. Methods: A total of 18 articles were selected in this review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, and the research question was formulated based on the population, intervention, control, and outcomes (PICO) method. This review was registered with PROSPERO (reference number: CRD42022293325). Data Sources: Databases namely PubMed, Web of Science, and Science-Direct were used in the article search using appropriate keywords, phrases, and Medical Subject Heading (MeSH) terms. The inclusion criteria of this review were journal articles published from January 2010 until December 2021 with full articles or abstract in English available. Results: Accommodative function has been reported to changed significantly with 20 minutes of smartphone use, with reduced amplitude, facility, relative and increased lag. In addition, vergence function has been reported to be altered significantly with receded near point of convergence. Conclusion: Smartphone use has an effect on the accommodation and vergence parameters among adults. Assessments of accommodation and vergence parameters need to be conducted in patients with the symptoms of Computer Vision Syndrome to prevent vision problems. Future reviews are required in younger cohorts with various smartphone features.

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.

Clinical profile and management of sixth nerve palsy in pediatric patients (0–15 years) in Southern India – A hospital-based study

Purpose: This study was done to evaluate the clinical profile in pediatric patients (0–16 years) presenting with acute onset esotropia due to sixth nerve palsy and its management options in a tertiary care set up of Southern India. Methods: A total of 12 patients presenting to our OPD with acute onset esotropia due to sixth nerve palsies were included in this retrospective study. All patients were observed for 6 months and managed with prism and/or patching while waiting for spontaneous resolution and later managed surgically. Neuroimaging was done in all cases. Results: The mean deviation of esotropia at presentation was 30.17 ± 5.7 Prism Diopter (range 12–50 Prism Diopter 95% CI, SD 10.11). Mean age of the patients during presentation was 8.6 ± 2.4 years (range: 1–15 years, SD 4.27). Among the common causes of sixth nerve palsy in our study population were trauma and idiopathic intracranial hypertension followed by tumor and miscellaneous causes. Only three patients underwent surgical correction of residual deviation after a waiting period of 6 months for self?resolution. Spontaneous resolution was observed in 41.6% patients, and surgical correction (unilateral resection–recession) was done in 25% of the patients with good surgical outcome. Conclusion: At 1?year follow up, the motor outcome was satisfactory except for one patient who had diffuse pontine glioma and had worsening neurological symptoms on follow?up

First-dose response of part-time versus full-time occlusion therapy for the treatment of amblyopia in children / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the efficacy of the first follow-up visit after daily partial or full-day occlusion of the dominant eye in patients with unilateral amblyopia and assess the maximum efficacy produced by different amounts of occlusion.METHODS: A retrospective clinical study was conducted on 135 cases of unilateral amblyopia cured in our hospital's outpatient clinic from January 2020 to December 2021. They were divided into 2h/d occlusion group, 6h/d occlusion group and all-day occlusion group according to the duration of occlusion, with fine sight training of amblyopic eyes. The effect of the first dose(baseline visual acuity-first review visual acuity), cured visual acuity, stereo vision at the first review and cure time of amblyopic eyes were recorded. The factors affecting the first dose effect in patients with unilateral amblyopia were also analyzed.RESULTS: All patients had a baseline visual acuity of 0.4(0.22, 0.52), a first follow-up visual acuity of 0.22(0.15, 0.3), a first-dose effect of 0.1(0.08, 0.18), and a visual acuity of 0(-0.08, 0.05)when amblyopia cured. The first-dose effects were 0.08(0.07, 0.12)for patients in the 2h/d occlusion group, 0.18(0.08, 0.3)for the 6h/d occlusion group, and 0.10(0.08, 0.18)for the all-day occlusion group. The most significant first-dose effect was the 6h/d occlusion group(P&#x003C;0.05); Analysis of different influencing factors showed that the highest values of the first-dose effect of 6h/d occlusion were in the 3-6 years group, 7-12 years group, female group, strabismic amblyopia group and mild to moderate group(P&#x003C;0.05); Furthermore, the first dose effect of the 6h/d occlusion was positively correlated with cure time of amblyopic eyes(rs=0.334, P=0.038). At the first follow-up, 21 cases(53.8%)had improved Titmus stereo visual acuity in the 6h/d occlusion group, which was higher than that in the 2h/d and all-day occlusion groups [16 cases(41.0%), 13 cases(22.8%), P&#x003C;0.017].CONCLUSIONS: For monocular amblyopia, the first-dose effect of 6h/d occlusion treatment was the most significant, and the recovery of stereopsis was the best.

Effect of wearing multifocal rigid corneal contact lens on binocular visual function in patients with myopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effect of rigid contact lenses with multifocal design on binocular visual function in myopic patients. <p>METHODS: A self-control study before and after. Fifteen myopic students of North Sichuan Medical College were recruited as test persons between July and August 2020. The subjects first wore framed glasses for binocular visual function examination, then wore single vision and multifocal rigid contact lenses(1wk apart), and binocular visual function examination was performed after wearing each lens for 2wk. One-way analysis of variance was used to compare the binocular visual function of multifocal rigid contact lens, single vision rigid contact lens and frame glasses.<p>RESULTS: There were no significant differences among the three lenses in stereopsis, far horizontal phoria, far positive fusional vergence, far negative fusional vergence, near negative fusional vergence, convergence and dispersion flexibility, convergence near point, adjustment magnitude, adjustment flexibility and negative relative adjustment(<i>P</i>>0.05). Compared with frame glasses, multifocal rigid contact lenses had significant difference in near horizontal phoria, near positive fusional vergence, accommodation lag, positive relative accommodation increased and AC/A decreased(<i>P=</i>0.023,0.048,0.001,0.013,0.046); Compared with single vision rigid contact lenses, multifocal rigid contact lenses had significant difference in near horizontal phoria, accommodation lag, positive relative accommodation increased and AC/A decreased(<i>P</i>=0.014,<0.001,0.001,0.009).<p>CONCLUSION:Wearing multifocal rigid contact lenses can lead to near horizontal phoria, accommodation lag, positive relative accommodation increase and AC/A decrease, which may have some influence on proximal use of eyes. These expected changes should be considered in clinical application in order to evaluate and manage patients correctly.

Curative effect of slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To observe curative effect and safety of slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia.<p>METHODS:This study included 29 patients who underwent slanted bilateral lateral rectus recession for convergence insufficiency-type intermittent exotropia in our hospital between October 2017 and November 2019 with a follow-up of 6mo, the deviation, the surgical success rate, the binocular vision function and the complications were observed.<p>RESULTS:In our study, the mean near deviations, the mean distance deviations and the near-distance deviation differences reduced from -41.72±3.35PD, -23.28±9.75PD and 16.90±2.47PD before surgery to -5.97±4.85PD, -2.66±4.78PD, 3.28±1.10PD 6mo after surgery, the surgical success rate was 76%. The Grades I and Ⅱ binocular vision function improved 6mo after surgery(<i>P</i><0.05), the distance stereopsis and the near stereopsis were not statistically significant(<i>P</i>>0.05). None of the patients developed A-V pattern, limitation of eye movement, restrictive strabismus, vertical strabismus, and rotated diplopia, some patients had transient horizontal diplopia, which disappeared within 2-3wk after surgery.<p>CONCLUSION:Slanted bilateral lateral rectus recession may successfully reduce the near exodeviations, the distance exodeviations and the near-distance deviations difference without obvious complications, proved to be a safe and effective procedure for the treatment of convergence insufficiency-type intermittent exotropia.

Research progress on the abnormal brain structure and function of patients with strabismus / 国际眼科杂志(Guoji Yanke Zazhi)

@#Strabismus is a common type of eye movement disorders, which is characterized by ocular misalignment and binocular visual dysfunction. Alignment relies on the normal structure and function of the visual and oculomotor systems. Any abnormalities of these regions may lead to strabismus. With the application of neurophysiological techniques and radioautography in the early years, the impairment of primary visual cortex was found, including decreased number of binocular neurons and metabolic changes of ocular dominant column. In recent years, the progress of functional magnetic resonance imaging has promoted to find more functional changes in human strabismic brains, especially in extrastriate cortex. In addition to the structural impairment of cerebral cortex and intercortical connections, functional remodeling of cerebral cortex was also observed in patients with strabismus. Besides, studies based on voxel-based morphometry and diffusion tensor imaging provided more precise anatomical evidence for human brain abnormalities. To provide reference for further studies, we review the current literature on functional and morphological deficits within brain regions in strabismus.

Strabismic amblyopia: compliance with occlusion treatment in a tertiary hospital in Midwestern Brazil / Ambliopia estrabísmica: adesão ao tratamento oclusivo em hospital terciário no Centro-Oeste Brasileiro

Abstract Purpose: Study aimed to determine compliance of patients with strabismic amblyopia undergoing occlusion treatment, followed from January 1 st, 2011 to January 1 st, 2017 at an Ophthalmology Reference Center, and identify risk factors for poor compliance. Methods: Retrospective, consecutive cohort study. Compliance reported at each visit was related to visual acuity, family history, changes in occlusion schedules and in patients' care team during treatment. The patients were divided into two groups according to the compliance: poor compliance group and compliance group (subdivided in full compliance subgroup and partial compliance subgroup). Results: Age at treatment beginning vary from 3.7 to 13.7 years, esotropia was the most frequent deviation and the occlusion was realized from 5 to 7 hours a day. Of 220 patients, compliance was achieved by 193 (87.7%), 114 (51.8%) in full compliance subgroup and 79 (35.9%) in partial compliance subgroup, and 27 do not achieved compliance (12.3%). Poor compliance was significantly related to a history of epilepsy, higher rate of suspension of treatment due to inefficacy, higher evasion rate, lower recurrence, and lower rate of maintenance of prophylactic occlusion after treatment. Good compliance was related to family history of strabismus, higher recurrence rate, and higher maintenance of prophylactic occlusion after treatment. No relations were found between poor compliance and changes in occlusion schedules or in patients' care team during treatment. Conclusion: Compliance with occlusion treatment of strabismic ambliopia was similar to other studies that included refractive and strabismic amblyopia and not related to changes in occlusion schedules or in patients' care team during treatment. Family history of strabismus was a protective factor.

Resumo Objetivo: Determinar a adesão de pacientes com ambliopia estrabísmica submetidos a tratamento oclusivo, acompanhados em Centro de Referência em Oftalmologia do Centro-Oeste do Brasil, e identificar fatores de risco para baixa adesão. Métodos: Estudo de coorte retrospectivo e consecutivo. A adesão relatada em cada visita foi relacionada à acuidade visual, história familiar, mudanças no tempo de oclusão e na equipe de atendimento ao paciente durante o tratamento. Os pacientes foram divididos em dois grupos de acordo com a adesão: grupo de não-adesão e grupo adesão (subdividido em subgrupo adesão total e subgrupo adesão parcial). Resultados: A idade ao início do tratamento variou de 3,7 a 13,7 anos, o desvio mais frequente foi a esotropia, o tempo médio de oclusão foi de 5 a 7 horas por dia. Dos 220 pacientes, 193 (87,7%) obtiveram adesão, 114 (51,8%) no subgrupo de adesão total e 79 (35,9%) no subgrupo de adesão parcial, e 27 não aderiram (12,3%). A não-adesão foi relacionada à história de epilepsia, maior taxa de suspensão do tratamento devido à ineficácia, maior taxa de evasão, menor recorrência e menor taxa de manutenção da oclusão profilática pós tratamento. A boa adesão foi relacionada à história familiar de estrabismo, maior taxa de recorrência e maior manutenção da oclusão profilática pós tratamento. Não houve relação entre não-adesão e mudanças nos horários de oclusão ou na equipe de atendimento durante o tratamento. Conclusão: A adesão ao tratamento oclusivo da ambliopia estrabísmica foi semelhante aos estudos que incluíram ambliopia refracional e estrabísmica e não se correlacionou a mudanças no tempo de oclusão ou na equipe de atendimento. A história familiar de estrabismo foi um fator de proteção.

Clinical observation of binocular vision function after intermittent exotropia surgery at different ages / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the recovery of binocular vision in patients with intermittent exotropia of different age.<p>METHODS: Totally 172 patients with intermittent exotropia who underwent strabismus correction in our department from January 2016 to January 2018 were selected, including 95 males and 77 females, aged from 3 to 32 years, with an average age of 11.4±1.5 years. All patients with intermittent exotropia were basic type. According to the age of operation, the patients were divided into two groups: the group of less than 9 years old(90 cases)and the group of more than 9 years old(82 cases).The preoperative, 1d, 7d, 1mo and 3mo after operation were observed. The function of binocular vision was examined by synoptophore and myopia was examined by Titmus.<p>RESULTS: A comparison of simultaneous vision: at the same time, the visual function, fusion function, fusion range, far stereo, near stereo recovery effect of patients ≤9 years group was better than that of patients >9 years group. The difference was statistically significant(<i>P</i><0.05). <p>CONCLUSION:Suggested surgical treatment of intermittent exotropia before 9 years old. Early operation is conducive to better improvement of binocular vision after surgery.

Research progress on the risk factors and treatment of consecutive esotropia after exotropia surgeries / 上海交通大学学报（医学版）

Consecutive strabismus refers to the secondary manifest strabismus right after or a period after strabismus surgeries, including consecutive esotropia and consecutive exotropia. It is reported that the incidence of consecutive esotropia is 6%-20%. Consecutive esotropia may lead to increased risks of amblyopia and visual deficiency in children and diplopia in adults. As the multiformity and complexity of continuous esotropia, there exist many challenges for clinicians to know the risk factors well and select appropriate treatment. The article reviews the latest research progress on the risk factors and treatment strategies of consecutive esotropia, aiming to help better evaluate the risks of continuous esotropia after exotropia surgeries, adjust the operation plans, and provide references to select the appropriate treatment plan.

Non - strabismic binocular vision anomalies among students of a Malaysian private university uses visual display unit / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM: To determine the status of non - strabismic binocular vision anomalies ( NSBVA) among students of a Malaysian private university uses visual display units ( VDU) .?METHODS: A cross- sectional study was conducted among university students who use VDU 3h or more from January 2019 to May 2019. A convenient sampling method was utilized. All subjects had gone through primary eye-examinations to satisfy the inclusion criteria. Those who satisfy the inclusion criteria, further gone through the NSBVA assessment. The descriptive analysis was done to rule out the percentage of NSBVA and Chi-square test of independence was carried out to observe the association of NSBVA with age, gender and hours of VDU usage.?RESULTS: A total of 140 students including 88 females ( 62. 9％) and 52 males ( 37. 1％) participated in this study. The mean age of the participants was 22. 54 ± 1. 48 years and the mean VDU usage hours were 5. 76 ± 2. 49h. The percentage of NSBVA is 40％ among the students those who use VDU. The occurrence of accommodative and vergence anomalies among the VDU users is 17. 86％ and 22. 14％ respectively. There was a moderate association between gender and NSBVA (P=0. 010). However, there was no significant association observed for age ( P =0. 334) and hours of VDU usage ( P=0. 835) with NSBVA.?CONCLUSION:NSBVA is 40％ among the students of a Malaysian private university uses VDU. Accommodation insufficiency ( 15％) and convergence insufficiency ( 10％) is more common among all NSBVA for VDU users.

A controlled clinical study on the effect of PVEP-CD comprehensive therapy for children amblyopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the therapeutic effect of the PVEP-CD comprehensive therapy \〖a multimedia visual training system uses the individualized PVEP(pattern visual evoked potential)sensitive spatial frequency parameters\〗 in children with amblyopia by comparing the differences in visual acuity and stereo acuity enhancement between the PVEP-CD comprehensive therapy and traditional therapy. <p>METHODS: A total of 38 children(54 eyes)with amblyopia who were treated in our hospital from April 2018 to January 2019 were randomly divided into two groups. Traditional therapy group(19 cases, 27 eyes; therapeutic methods contain refractive correction, patching/optical or drug suppress and precision eyesight training); PVEP-CD comprehensive therapy group(19 cases, 27 eyes; therapeutic methods contain refractive correction, patching/optical or drug suppress and a multimedia visual training using the individualized P-VEP sensitive spatial frequency parameters). To study the clinic therapeutic effect, the best distance corrected visual acuity(BCVA)and near stereo acuity were measured at the enrollment visit and the final visit after 6mo treatment.<p>RESULTS: After 6mo treatment, both groups had an apparent BCVA improvement(both therapy effective rate≥85%). PVEP-CD comprehensive therapy group were significantly better than traditional therapy group in BCVA lines improvement \〖3(2, 3)lines\〗, near stereo acuity therapy effective rate(89%)and near stereo acuity level improvement \〖2(1, 4)levels\〗(all<i> P</i><0.05). In amblyopic children older than 6y, PVEP-CD comprehensive therapy group showed a significantly greater BCVA lines improvement(<i>P</i>=0.018). In mild amblyopia cases, PVEP-CD comprehensive therapy group showed a significantly better clinical efficacy in near stereo acuity(<i>P</i>=0.048)and greater improvement in near stereo acuity level(<i>P</i>=0.029). In moderate amblyopia cases,the BCVA lines improvement(<i>P</i>=0.003)was significantly greater in PVEP-CD comprehensive therapy group. <p>CONCLUSION:Both PVEP-CD comprehensive and traditional therapy can improve the BCVA in children with amblyopia and have a good clinical efficacy. Furthermore, the PVEP-CD comprehensive therapy could improve the BCVA and near stereo acuity level more obviously and help amblyopic children get a better binocular vision.