Cortical Deficits are Correlated with Impaired Stereopsis in Patients with Strabismus / 神经科学通报·英文版

In this study, we explored the neural mechanism underlying impaired stereopsis and possible functional plasticity after strabismus surgery. We enrolled 18 stereo-deficient patients with intermittent exotropia before and after surgery, along with 18 healthy controls. Functional magnetic resonance imaging data were collected when participants viewed three-dimensional stimuli. Compared with controls, preoperative patients showed hypoactivation in higher-level dorsal (visual and parietal) areas and ventral visual areas. Pre- and postoperative activation did not significantly differ in patients overall; patients with improved stereopsis showed stronger postoperative activation than preoperative activation in the right V3A and left intraparietal sulcus. Worse stereopsis and fusional control were correlated with preoperative hypoactivation, suggesting that cortical deficits along the two streams might reflect impaired stereopsis in intermittent exotropia. The correlation between improved stereopsis and activation in the right V3A after surgery indicates that functional plasticity may underlie the improvement of stereopsis. Thus, additional postoperative strategies are needed to promote functional plasticity and enhance the recovery of stereopsis.

Women's experiences and perceptions on the impacts of maternal near miss and related complications in Rwanda: A qualitative study

Maternal morbidity and mortality continue to emerge across the globe especially in lower-income countries. This study aimed at exploring in-depth perceptions of near-miss experiences among Rwandan women and how these experiences can be used to develop strategies for health policy implementation. Using qualitative inductive research based on grounded theory, we analyzed 27 indepth interviews that were conducted with women with documented records of maternal near-miss events. Women were knowledgeable about pregnancy complications and the benefits of antenatal care. Near-miss events that occurred either before or during hospitalization. Women recognized their own involvement their near-miss events by delaying care seeking. They also mentioned delays due to healthcare providers delaying transfers, misdiagnosing the events, and delaying to intervene even at the time the diagnosis was made. Women acknowledged the life-saving role of outreach programs and community health workers. We that pregnancy outcomes would be improved in this population of women with education on pregnancy complications, training of community health workers, and sustained mentorship program. (Afr J Reprod Health 2022; 26[5]: 63-71).

Resultados de la cirugía mínimamente invasiva en pacientes con estrabismos horizontales / Results of the minimally invasive surgery in patient with horizontal strabismus

Objetivo: Determinar los resultados de la cirugía mínimamente invasiva en pacientes con estrabismos horizontales. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de una serie de 19 pacientes (16 ojos derechos, 17 izquierdos) atendidos en el Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el periodo comprendido entre junio de 2018 y julio de 2019, a quienes se les realizó cirugía mínimamente invasiva de estrabismo y fueron seguidos por 6 meses. Se evaluaron las variables: tipo de desviación, agudeza visual, signos posoperatorios, ángulo de desviación pre- y posquirúrgico, éxito quirúrgico, fusión, estereopsis y complicaciones. Resultados: El 73,7 por ciento de los pacientes presentaba esotropías; la media de agudeza visual pre- y posoperatoria entre los dos ojos fue muy similar; el signo posoperatorio más frecuente fue la hiperemia conjuntival ligera (75 por ciento ojos derechos y 64,5 por ciento ojos izquierdos) a las 24 horas. Se encontraron diferencias estadísticas (p < 0,001) en el ángulo de desviación horizontal en dioptrías prismáticas, pre- y poscirugía, con el 84,2 por ciento de éxito quirúrgico. El 78,6 y el 80 por ciento de los pacientes con esotropía y exotropías alcanzaron fusión, pero solo lograron estereopsis el 28,5 y el 60 por ciento de ellos respectivamente. La frecuencia de complicaciones ocurrió en el 15,8 por ciento de los pacientes. Conclusiones: Se alcanzaron buenos resultados motores, así como aceptables en los sensoriales en pacientes operados de estrabismos horizontales por cirugía mínimamente invasiva(AU)

Objective: Determine the results of minimally invasive surgery in patients with horizontal strabismus. Methods: A prospective longitudinal descriptive study was conducted of a series of 19 patients (16 right eyes, 17 left eyes) attending the Pediatric Ophthalmology Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from June 2018 to July 2019. These patients underwent minimally invasive strabismus surgery and were followed up for six months. The variables considered were deviation type, visual acuity, postoperative signs, pre- and postoperative angle of deviation, surgical success, fusion, stereopsis and complications. Results: Of the patients studied, 73.7 percent presented esotropias; mean pre- and postoperative visual acuity was very similar in the two eyes; the most common postoperative sign was slight conjunctival hyperemia (75 percent right eyes and 64.5 percent left eyes) at 24 hours. Statistical differences (p < 0.001) were found in the horizontal angle of deviation in pre- and postoperative prism diopters, with 84.2 percent surgical success. 78.6 percent and 80 percent of the patients with esotropia and exotropia achieved fusion, but only 28.5 and 60 percent of them, respectively, achieved stereopsis. Complications occurred in 15.8 percent of the patients. Conclusions: Good motor results were obtained, as well as acceptable sensory results in patients undergoing minimally invasive horizontal strabismus surgery(AU)

Avaliação das funções visuais e sua relação com a visão funcional e quedas em idosos ativos da comunidade / Evaluation of visual functions and their relationship to functional vision and falls in active elderly of the community

Resumo Objetivo: Avaliar as funções visuais dos idosos e a relação com a visão funcional e quedas. Métodos: Trata-se de um estudo de caráter transversal, realizado no município de Anápolis-GO com 46 idosos de idade ≥ a 60 anos, que cumpriram com todos os requisitos de inclusão. Estes foram avaliados quanto a visão funcional, funções visuais, funcionalidade global e autorrelato de quedas. Foi realizada análise estatística para verificar a correlação entre caidores e não caidores com as funções visuais e a visão funcional. Resultados: Houve uma correlação estatisticamente significativa entre o autorrelato de quedas e a estereopsia em idosos (p=0,05). Do mesmo modo, foi encontrado uma relação entre a visão funcional e a acuidade visual (p=0,023). O medo de novas quedas afetou a grande maioria dos idosos. Todavia, não houve correlação entre o autorrelato da visão e as quedas. Conclusão: Os resultados encontrados evidenciam que há correlação entre a estereopsia e a incidência de quedas, sugerindo que a visão de profundidade pode estar diretamente relacionada ao risco de quedas. Houve também, correlação entre a visão funcional e a acuidade visual, sugerindo que a capacidade do olho em distinguir detalhes, contornos e formas pode influenciar na qualidade das atividades que envolvem a visão.

Abstract Objective: To evaluate the visual functions of the elderly and the relationship with functional vision and falls. Methods: This is a cross-sectional study conducted in the municipality of Anápolis-GO with 46 elderly aged ≥ 60 years, who met all inclusion requirements. These were evaluated for functional vision, visual functions, overall functionality and self-reported falls. Statistical analysis was performed to verify the correlation between fallers and nonfallers with visual functions and functional vision. Results: There was a statistically significant correlation between self-reported falls and stereopsis in the elderly (p=0.05). Similarly, a relationship was found between functional vision and visual acuity (p=0.023). Fear of further falls affected the vast majority of the elderly. However, there was no correlation between self-reported vision and falls. Conclusion: The results show that there is a correlation between stereopsis and the incidence of falls, suggesting that deep vision may be directly related to the risk of falls. There was also a correlation between functional vision and visual acuity, suggesting that the ability of the eye to distinguish details, contours and shapes may influence the quality of activities involving vision.

Tratamento da aniseiconia induzida na correção óptica de anisometropia em escolares do ensino fundamental / Treatment of aniseikonia induced by optical correction of anisometropia in elementary school children

Resumo Objetivos: Comparar a aniseiconia e a estereopsia em escolares anisometropes do primeiro ano do ensino fundamental corrigidos com lentes oftálmicas de estoque com curvas-base selecionadas para minimizar a diferença de tamanho interocular das imagens retínicas e com lentes iseicônicas sugeridas pelo software Aniseikonia Inspector 3 e verificar a preferência dos escolares por uma destas formas de correção. Métodos: Dezenove escolares com anisometropia ≥ 1,5 D em meridianos correspondentes no uso de óculos com lentes oftálmicas de estoque e com lentes iseicônicas foram avaliados para aniseiconia (software Aniseikonia Inspector 3) e estereopsia (teste Stereo Fly test com símbolos LEA. A preferência por uma das formas de correção foi verificada após 40-50 dias de uso dos óculos. Resultados: As médias e os desvios-padrão das aniseiconias vertical e horizontal no uso de óculos com lentes oftálmicas de estoque e com lentes iseicônicas foram, respectivamente, -1,05% ± 2,20% e -1,37% ± 2,36% (p=0,82739) e -0,895% ± 2,23% e -1,16% ± 2,03% (p=0,77018). 31,6% dos escolares corrigidos com lentes iseicônicas e 21,1% dos escolares corrigidos com lentes oftálmicas de estoque identificaram os optotipos que sugerem estereopsia < 100 segundos de arco (p= 0,475). Em relação à preferência, 4/15 (26,7%) escolheram os óculos com lentes iseicônicas, 2/15 (13,3%) escolheram os óculos com lentes oftálmicas de estoque e para 9/15 (60%) a escolha foi indiferente. Conclusão: A aniseiconia induzida nos escolares anisometropes corrigidos com lentes iseicônicas sugeridas pelo software Aniseikonia Inspector 3 foi similar ao obtido na correção com lentes oftálmicas de estoque com curvas-base selecionadas para minimizar a diferença de tamanho interocular das imagens retínicas.

Abstract Objectives: To compare the aniseikonia and the stereopsis in school children anisometropes of the first-year of elementary school corrected with stock ophthalmic lenses with base curve selected to minimize the interocular size difference of retinal images and with size lenses suggested by the software Aniseikonia Inspector 3, and to check the preference of them for one of these forms of correction. Methods: Nineteen school children with anisometropia ≥ 1.5 D in corresponding meridians, in the use of glasses with stock ophthalmic lenses and with size lenses were evaluated for aniseikonia (software Aniseikonia Inspector 3) and stereopsis (Stereo Fly test with LEA symbols). The preference for one of the forms of correction was verified after 40-50 days of wearing glasses. Results: The mean and standard deviations of the vertical and horizontal aniseikonia in the use of glasses with stock ophthalmic lenses and with size lenses were, respectively, -1.05% ± 2.20% and-1.37% ± 2.36% (p = 0,82739) and -0.895% ± 2.23% and -1.16% ± 2.03% (p = 0,77018). 31.6% of the school children corrected with size lenses and 21.1% of the students corrected with stock ophthalmic lenses identified the optotypes that suggest stereopsis less than 100 seconds of arc (p = 0.475). Regarding the preference, 4/15 (26.7%) of the students chose the glasses with size lenses, 2/15 (13.3%) chose the glasses with stock ophthalmic lenses, and for 9/15 (60%) the choice was indifferent. Conclusion: The induced aniseikonia in school children with anisometropia corrected with size lenses suggested by the software Aniseikonia Inspector 3 was similar to that obtained in the correction with stock ophthalmic lenses with base curves selected to minimize the difference of interocular size of retinal images.

Estereopsis en pacientes con ambliopía en ausencia de estrabismo / Stereopsis in patients with ambliopia in absence of strabismus

Introducción: los pacientes con estrabismo comúnmente tiene algún grado de compromiso en la estereopsis, y existe evidencia clara que el tratamiento de la ambliopía severa mejora este compromiso; sin embargo, no hay datos que reporten grados de estereopsis en pacientes con ambliopía en ausencia de estrabismo. Objetivo: determinar y comparar el grado de estereopsis en pacientes sin ambliopía, con ambliopía leve y moderada en ausencia de estrabismo, que asistieron a consulta de oft almología pediátrica en el Hospital de San José entre Enero de 2015 y Agosto de 2017. Diseño del estudio: estudio de tipo transversal. Método: pacientes entre 5 y 15 años. Se utilizó el Random Dot Test para la evaluación de estereopsis. Se comparó el grado de estereopsis entre los distintos niveles de ambliopía por medio de una prueba de Kruskal Wallis. Resultados: se incluyeron 119 niños, 64 no tuvieron ambliopía y 55 tuvieron ambliopía, de los cuales el 67.3% fue leve (n=37) y el 32.7% fue moderada (n=18). La principal causa fue la refractiva; en el grupo de ambliopía leve 64.9% y moderada 77.8%. Los pacientes entre 5 y 10 años presentaron una mediana de estereopsis de 40 segundos de arco independientemente de si tenían o no ambliopía, a diferencia de los pacientes mayores de 10 años en quienes a medida que aumentó el grado de ambliopía, disminuyó la estereopsis. Conclusión: de observó una tendencia al empeoramiento del grado de estereopsis según el grado de ambliopía aunque no se alcanzó significancia estadística. El diagnóstico precoz y tratamiento oportuno de la ambliopía durante los primeros años son fundamentales para garantizar un desarrollo visual adecuado de la población pediátrica.

Background: patients with strabismus usually have some degree of disturbance in stereopsis, and there is clear evidence that the treatment of severe amblyopia improves it. However, there are no data reporting grades of stereopsis in patients with amblyopia in absence of strabismus. Objective: to determine and compare the degree of stereopsis in patients without amblyopia, with mild and moderate amblyopia in absence of strabismus who the attended pediatric ophthalmology clinic at Hospital de San José between January 2015 and August of 2017. Study design: cross sectional study. Method: study design: cross-sectional study. Participants: Patients between 5 and 15 years. Process: The Random Dot Test was used for stereopsis evaluation. The degree of stereopsis between the different levels of amblyopia was compared by means of a Kruskal Wallis test. Results: 119 children were included, 64 did not have amblyopia and 55 had amblyopia. 67.3% were mild (n = 37) and 32.7% were moderate (n = 18). The principal cause was refractive, mild amblyopia 64.9% and moderate 77.8%. Patients between 5 and 10 years had a median stereopsis of 40 seconds of arc regardless of whether they had amblyopia or not, unlike patients older than 10 years in whom as the degree of amblyopia increased, stereopsis decreased. Conclusion: It was observed a tendency to worsen the degree of stereopsis according to the degree of amblyopia although statistical signifi cance was not reached. Th e early diagnosis and timely treatment of amblyopia during the fi rst years are fundamental to guarantee an adequate visual development of the pediatric population.

Clinical Study of Changes in Eye Dominance after Pseudophakic Conventional Monovision

PURPOSE: The purpose of this study was to evaluate whether eye dominance changes after conventional pseudophakic monovision, and to identify factors that affect changes in eye dominance. METHODS: This retrospective study included 70 patients who underwent bilateral conventional monovision cataract surgery. Patients were divided into two groups based on whether they experienced a change in the dominant eye. We compared patients' uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), best-corrected visual acuity (BCVA), spherical equivalent, stereopsis, and time interval between cataract surgeries. RESULTS: The mean age was 71.26 ± 10.84 (range, 25–90) years, mean interval between surgery in each eye was 118.46 ± 183.50 (range, 17–1,018) days, and mean postoperative diopter difference was 1.16 ± 0.53 (range, 0.00–2.75) diopters. After bilateral cataract surgery, 22 patients (31.43%) experienced a change in eye dominance, whereas 48 patients (68.57%) experienced no change. There were no differences in the time interval between cataract surgeries, preoperative UCDVA and UCNVA, pre- and postoperative BCVA, or stereopsis in either group. Patients who experienced a change in eye dominance showed smaller differences between preoperative and postoperative spherical equivalent, compared with patients who experienced no change in eye dominance (t-test, p < 0.05). CONCLUSIONS: Twenty-two (31.43%) patients whose nondominant eyes were targeted for near vision showed altered eye dominance after conventional monovision cataract surgery. Eye dominance shows greater plasticity in patients with smaller differences between preoperative and postoperative spherical equivalent.

Characteristics of Patients Who Are Not Responsive to Alternate Patching for Overcorrected Intermittent Exotropia

PURPOSE: To compare the characteristics of patients with surgically overcorrected intermittent exotropia treated with alternate patching. METHODS: The medical records of 51 patients who underwent bilateral lateral rectus muscle recession for intermittent exotropia and required alternate patching to correct postoperative overcorrection were retrospectively reviewed. Patients with postoperative esodeviation ≥18 prism diopters (PD) were started on alternate patching on postoperative day 1, whereas those with postoperative esodeviation of 10 to 17 PD were started after 2 weeks. Postoperative esodeviation <10 PD was considered as slight intentional overcorrection after exotropia surgery. Patients not responsive to alternate patching treatment were defined as those with postoperative esodeviation ≥10 PD after 3 months of treatment. Sex, family history, age, refractive error, amblyopia, stereopsis, suppression, type of exotropia, surgical method, preoperative and postoperative angle of deviation, and start time of alternate patching were compared. RESULTS: Among 51 patients, 29 patients responded to alternate patching and 22 patients did not respond. Female sex (p = 0.04), larger preoperative exodeviation at distance (p = 0.04), late onset of postoperative maximal esodeviation (p < 0.01), larger postoperative maximal esodeviation at near (p = 0.02), and late initiation of alternate patching (p = 0.01) were associated with patients in the non-responsive group. Although postoperative angle of deviation was similar for 2 weeks, the angle of postoperative esodeviation was significantly larger in the non-responsive group than in the responsive group, beginning at 1 month postoperatively. CONCLUSIONS: Female sex, large preoperative exodeviation, late initiation of alternate patching, and large esodeviation 1-month postoperative predisposed patients to be resistant to alternate patching for postoperative overcorrection.

Stereopsis before and after Inferior Oblique Weakening Surgery

PURPOSE: To analyze stereopsis change before and after inferior oblique weakening surgery. METHODS: We retrospectively reviewed the medical records of 31 patients who had undergone inferior oblique weakening surgery. The factors analyzed included sex, age at surgery, preoperative and postoperative visual acuity (VA), time from first detection to surgery, degree of inferior oblique overaction (IOOA), primary/secondary IOOA, exotropia/hypertropia, bilaterality, and type of surgery. RESULTS: Eighteen patients with a mean age 7.3 ± 3.1 years exhibited stereopsis of 60 arc seconds or better before surgery and 17 had stereopsis better than 60 arc seconds after surgery. Postoperatively, stereopsis improved in 13 patients and deteriorated in 9. Better preoperative VA and the absence of superior oblique underaction were associated with better preoperative stereopsis. Better preoperative VA, postoperative VA, and the presence of head tilt were associated with better postoperative stereopsis. Unilateral inferior oblique weakening surgery and accompanying hypertropia were associated with improved stereopsis, while the absence of hypertropia was associated with deteriorated stereopsis. CONCLUSIONS: In this retrospective study, 58.1% of patients tended to have bifoveal fixation. When a vertical deviation is present in the primary position due to unilateral IOOA, IO weakening surgery can be expected to improve binocular function.

Decision for Proper Surgical Amount in Consecutive Esotropia Following Bilateral Lateral Rectus Recession

PURPOSE: To determine the amount of additional surgery required for patients with consecutive esotropia, who had an esodeviation angle similar to their pre-operative exodeviation angle, following bilateral lateral rectus recession surgery for intermittent exotropia. METHODS: The medical records of 29 patients who underwent surgery for intermittent exotropia from 1998 through 2013 were reviewed. These patients had consecutive esotropia with an unchanged postoperative esodeviation angle. Thirteen patients underwent esotropia surgery with the aim of full correction (Group A), while 16 patients underwent esotropia surgery with the aim of partial correction (Group B). The postoperative ocular alignment and stereopsis of both groups were compared. RESULTS: A total of 29 patients were evaluated including 13 patients in Group A and 16 patients in Group B. At the final follow-up visit, at least 24 months post procedure, Group B had a significantly greater success rate than Group A (62.5% vs. 23.1%, p = 0.039). Over-correction rates were higher in Group A than Group B (76.9% vs. 37.5%, p = 0.039). The changes during the follow-up period (6 months to their last follow-up) showed that the over-correction rate had increased from 30.8% to 76.9% in Group A (p = 0.034) and from 12.5% to 37.5% in Group B (p = 0.046). CONCLUSIONS: Consecutive esotropia surgery with the aim of partial correction showed favorable motor and sensory outcomes in patients who had a postoperative esodeviation angle similar to that of their pre-operative exodeviation. This strategy may also be helpful in preventing long-term postoperative over-correction in patients presenting with consecutive esotropia.

Long-term Surgical Outcomes of Initial Postoperative Overcorrection in Adults with Intermittent Exotropia

PURPOSE: To evaluate the relationship between initial postoperative overcorrection and long-term surgical success in exotropia patients. METHODS: The medical records of 46 patients who underwent surgery for intermittent exotropia after the age of 18 were enrolled. Enrolled patients also had at least 2 years of postoperative follow-up. Based on the initial postoperative deviation at distance measured by prism and the alternating cover test at 1 week, patients were assigned to one of the following groups: group A included patients who demonstrated any esodeviation, while group B included patients who showed orthophoria to exodeviation of 10 prism diopters. The records were analyzed to determine the preoperative deviation with stereoacuity and postoperative deviations with stereoacuity at the follow-up examinations at the following intervals: 1 week; 1, 3, and 6 months; and 1 and 2 years. A comparison between groups for demographic data and preoperative and postoperative angles of deviation was performed using analysis of variance. RESULTS: Of the 46 patients with intermittent exotropia included in this study, 18 (39%) belonged to group A, while 28 (73%) belonged to group B. The postoperative angle of deviation for distant fixation until 2 years of follow-up showed statistically significant differences in each group (p < 0.003 in all comparisons). The amount of exodrift until 2 years in group A (from −9.7 ± 6.1 to 1.6 ± 3.7) was greater than that in group B (from 2.0 ± 2.7 to 6.8 ± 5.6). The long-term surgical success rate within 2 years of surgery was significantly better in group A than in group B (p = 0.027). The number of patients with intermittent diplopia and the duration of diplopia were greater in group A (n = 8) than in group B (n = 2). CONCLUSIONS: Long-term surgical success was achieved in 89% of patients who were initially overcorrected. Overcorrection of an average of 10 prism diopters at the first postoperative week was found to be associated with a more favorable long-term surgical outcome.

A systematic review and meta-analyis on the effect of training with Nintendo® WiiTM in the improvement of basic laparoscopic skills among laparoscopic novices

@#<p style="text-align: justify;">Videogames offer the usual skills needed for laparoscopy namely, eye-hand coordination, depth perception, and bimanual operation. The impact of playing videogames on basic laparoscopic skills is still ambiguous with some studies showing correlation and with other studies demonstrating little or no effect.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the impact of training with Nintendo® WiiTM in the improvement of basic laparoscopic skill among laparoscopic novices by measuring the time to completion of eye-hand coordination task, two-hand manipulation task, grasping and cutting task or grasping and clipping tasks.</p><p style="text-align: justify;"><strong>METHODS:</strong> An electronic systematic search was done in online databases and search engines. This review included randomized prospective studies, written in English language, and published within the last 5 years. Participants included adults 19-29 years old, medical students and surgical residents, with a low video game experience, without or minimal experience in laparoscopic surgery and laparoscopic simulator. The studies compared the performance of participants in a laparoscopic simulator (SimbionixTM LapMentorTM or ProMIS) after training with Nintendo® WiiTM and measured their completion time of several tasks.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Training with Nintendo® WiiTM showed improvement in time to completion of eye-hand coordination task, two-hand manipulation task, and grasping and clipping task. The study however showed equivocal results in the grasping and cutting tasks.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Training with Nintendo® WiiTM can be used as a training tool for the improvement of basic laparoscopic skills of laparoscopic novices.</p>

A percepção da profundidade ou relevo da máscara côncava e convexa / The perception of depth or relief of hollow and convex face / La percepción de profundidad o relieve de la máscara hueca y convexa

Investigou-se a percepção monocular da profundidade ou relevo de máscaras policromadas objetivas côncava e convexa. Participaram do estudo 40 estudantes, que julgaram a profundidade ou relevo da máscara côncava e da máscara convexa. Mais da metade dos observadores, 67%, realizaram ou tenderam a realizar a inversão monocular da profundidade. Quando solicitados a avaliar em centímetros a distância da ponta do nariz da máscara à sua base, as maiores extensões foram designadas à máscara convexa, comparativamente à côncava. Porém, a inversão visual da profundidade de concavidades não foi afetada pela posição de apresentação das máscaras (vertical ou invertida) ou pela direção da fonte de iluminação incidente sobre elas (de cima ou por baixo). Os resultados confirmam que, na percepção de faces, o processo de alta ordem se sobrepõe ao processo de baixa ordem e que a ilusão da máscara côncava é um instrumento eficaz na verificação da percepção de profundidade.

It was investigated the monocular perception of depth or relief of objective concave and convex masks. The study included 40 students, who judge the depth or relief of a concave and a convex mask. More than half of observers, 67%, performed the monocular depth inversion. When asked to evaluate the distance in centimeters from the tip of the nose to the base of the mask, the major extensions were appointed to the convex mask, compared to concave. However, the visual inversion of depth of the concavities was not affected by the position of the masks (vertical or inverted) or by the direction of the light source incident on them (from top or bottom). The results confirm that in the face perception, the top-down process overlaps the bottom-up process and that the hollow-face illusion is an effective instrument in depth perception verification.

Se investigó la percepción monocular de profundidad o relieve de máscaras huecas y convexas objetivas. En el estudio participaron 40 estudiantes que juzgaron la profundidad o relieve de máscaras huecas y convexas. Más de la mitad de los observadores, el 67%, realizó la inversión monocular de la profundidad. Cuando se les pidió para evaluaren la distancia en centímetros desde la punta de la nariz hasta la base de la máscara, las más grandes extensiones fueron nombradas a la máscara convexa, en comparación con la máscara hueca. Sin embargo, la visual inversión de la profundidad de los huecos no ha sido afectada por la posición de presentación de las máscaras (vertical o invertida) o por la dirección de la fuente de luz incidente sobre ellas (desde arriba o abajo). Los resultados confirman que la percepción de las caras, los procesos de orden superior se superponen los procesos de orden inferior y la ilusión de la máscara hueca es una herramienta eficaz en la verificación de la percepción de profundidad.

Crianças diagnosticadas com Síndrome de Irlen: análise de produções escritas / Children diagnosed with Irlen Syndrome: analysis of written productions / Niños diagnosticados con síndrome de Irlen: análisis de producciones escritas

Este estudo objetiva analisar textos produzidos por um sujeito de 10 anos de idade, do sexo masculino, diagnosticado com Síndrome de Irlen (SI). Trata-se de um relato de um estudo de caso, pesquisa qualitativa, de cunho sócio-histórico. Priorizou-se a análise de aspectos discursivos e notacionais das produções escritas, relacionadas a quatro gêneros discursivos: uma carta (para um ídolo, para um familiar ou para um amigo), regras de um jogo, um conto infantil e um cartaz. Em relação aos aspectos discursivos, o participante da pesquisa conseguiu operar sobre vários aspectos que caracterizam as condições de produção dos gêneros requeridos, evidenciando pertinência em relação às temáticas propostas, à finalidade e ao contexto de circulação do texto. Quanto aos aspectos notacionais, o sujeito apresentou estratégias e hipóteses distantes do padrão ortográfico da língua, tais como: trocas, omissões e acréscimo de letras e segmentação indevida. Os resultados evidenciam que crianças com esse diagnóstico podem apresentar estratégias singulares em suas produções, inerentes ao processo de apropriação da linguagem escrita. Diante da análise realizada, sugere-se o implemento de estudos acerca da referida síndrome que ofereçam elementos para que profissionais da saúde e educação, envolvidos com sujeitos acometidos pela mesma, possam em suas práticas clínicas e escolares desenvolver um trabalho que priorize os processos e as diferentes dimensões envolvidas com a apropriação da leitura e da escrita.

The objective of this study was to analyze different texts produced by a 10-year-old male individual diagnosed with Irlen Syndrome (IS). This is a case report; a socio-historical qualitative study. The analysis focused on the discursive and notational aspects of the production of four different writing genres: a letter (to an idol, a family member, or a friend), the rules of a game, a children's story, and a poster. Regarding the discursive aspects, the participant was able to adequately operate the various aspects that characterize the production of the required genres, showing relevance concerning the proposed themes, objectives, and context flow. As for the notational aspects, the subject presented hypotheses and strategies that were distant from the orthographic pattern of the target language, such as changes, omissions, increase of letters and undue segmentation. The results show that children diagnosed with IS may have unique strategies, inherent to the appropriation process of written language. Based on the analysis, it is suggested that studies on IS are conducted, so that they may offer elements for health and education professionals involved with these individuals in their clinical and school practices to conduct their jobs prioritizing the processes and different dimensions involved with the appropriation of reading and writing skills.

Este estudio tiene por objetivo analizar producciones escritas por un sujeto de 10 años de edad, de sexo masculino, diagnosticado con el Síndrome de Irlen (SI). Se trata un estudio de caso, investigación cualitativa, de carácter socio-histórico. Se ha priorizado el análisis de los aspectos discursivos y notacionales de las producciones escritas relacionadas con cuatro géneros discursivos: Una carta (a su ídolo, a un miembro de la familia o a un amigo), reglas de un juego, un cuento infantil y un póster. En cuanto a los aspectos discursivos, el participante de la investigación consiguió operar bajo diversos aspectos que caracterizan las condiciones de producción de los géneros requeridos, evidenciando pertinencia para los temas propuestos, la finalidad y el contexto de circulación del texto. En cuanto a los aspectos notacionales, el sujeto presentó estrategias y hipótesis distantes de la ortografía estandarizada, tales como: cambios, omisiones y adición de letras y segmentación inadecuada. Los resultados indican que los niños con este diagnóstico pueden desarrollar estrategias únicas en sus producciones, inherentes al proceso de apropiación de la lengua escrita. Ante el análisis realizado, se sugiere el implemento de estudios acerca del síndrome que ofrezcan elementos con los cuales profesionales de la salud y educación, involucrados con los individuos afectados, puedan en sus prácticas clínicas y escolares desarrollar un trabajo que da prioridad a los procesos y a las diferentes dimensiones relacionadas con la apropiación de la lectura y escritura.

Comparison of Objective and Subjective Changes Induced by Multiple-Pinhole Glasses and Single-Pinhole Glasses

Multiple-pinhole (MPH) glasses are currently sold in many countries with unproven advertisements; however, their objective and subjective effects have not been investigated. Therefore, to investigate the effects of MPH glasses excluding the single-pinhole (SPH) effect, we compared the visual functional changes, reading speed, and ocular discomfort after reading caused by MPH and SPH glasses. Healthy 36 participants with a mean age of 33.1 years underwent examinations of pupil size, visual acuity (VA), depth of focus (DOF), and near point accommodation (NPA); tests for visual field (VF), contrast sensitivity (CS), stereopsis, and reading speed; and a survey of ocular discomfort after reading. Both types of pinhole glasses enlarged pupil diameter and improved VA, DOF, and NPA. However, CS, stereopsis, and VF parameters deteriorated. In comparison with SPH glasses, MPH glasses induced smaller pupil dilation (5.3 and 5.9 mm, P < 0.001) and showed better VF parameters with preserved peripheral VF. However, no significant difference was observed for VA, DOF, NPA, stereopsis, and CS. Reading speed using pinhole glasses was significantly slower than baseline; SPH glasses showed the slowest reading speed. Both types of glasses caused significant ocular discomfort after reading compared with baseline, and symptoms were worst with MPH glasses. In conclusion, both types of pinhole glasses had positive effects due to the pinhole effect; however, they had negative effects on VF, CS, stereopsis, reading speed, and ocular discomfort. In spite of the increased luminance and preserved peripheral VF with MPHs, these glasses caused more severe ocular discomfort than SPH glasses. This clinical trial was registered at www.ClinicalTrials.gov (Identifier: NCT02572544).

Relationship between Binocular Visual Function and Quality of Life in Bilateral Normal Tension Glaucoma Patients

PURPOSE: To analyze the effect of stereopsis and contrast sensitivity on the quality of life and to evaluate the relationship between integrated binocular visual field (IVF) and binocular visual function in bilateral normal tension glaucoma (NTG) patients. METHODS: Stereopsis and contrast sensitivity tests were performed and compared among 44 NTG patients and 32 normal subjects. The IVF was integrated using the best location method. The correlation between visual function and subscales of the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) was evaluated using univariate linear regression. RESULTS: Stereopsis and contrast sensitivity for the bilateral NTG patients were decreased compared to the normal controls. Stereopsis and contrast sensitivity exhibited a significant correlation with social functions related to vision and color vision among subscales of NEI VFQ-25. IVF mean deviation (MD) and better eye MD showed a significant correlation with stereopsis and contrast sensitivity, while worse eye MD showed no association. CONCLUSIONS: Deterioration of stereopsis and contrast sensitivity in NTG patients affects their quality of life related to social functions and color vision. Both IVF and better eye MDs are correlated with stereopsis and contrast sensitivity in NTG patients.

The Effect of Preoperative Occlusion Therapy on Long-term Outcome after Surgery for Early-onset Exotropia

PURPOSE: To investigate the effect of preoperative part-time occlusion therapy on long-term surgical success in early-onset exotropia. METHODS: The medical records of patients who underwent surgery for exotropia with onset before the first year of age and who were followed for ≥3 years were reviewed. Patients were divided into two groups according to the degree of compliance with part-time occlusion therapy: the good compliance group (>50% adherence rate) and the poor compliance group (≤50% adherence rate). Surgical success was defined as orthophoria to exodeviation less than 10 prism diopters both at distance and near. The level of postoperative stereopsis was compared between the two study groups among total enrolled patients and among those with constant exotropia. RESULTS: Of the 51 patients, 26 were assigned to the good compliance group and the remaining 25 patients to the poor compliance group. The surgical success rate was significantly higher in the good compliance group than in the poor compliance group (80.8% vs. 52.0%, p = 0.040). Among 24 constant exotropia patients (12 patients for each group), the success rate was insignificantly higher in the good compliance group than in the poor compliance group (75.0% vs. 58.3%, p = 0.448). The good compliance group had a better level of stereopsis than the poor compliance group (p = 0.045 for all 44 patients, p = 0.020 for 19 patients with constant exotropia). CONCLUSIONS: Preoperative part-time occlusion therapy was useful for improving the surgical outcome of early-onset exotropia and postoperative stereopsis.

From Exoscope into the Next Generation

An exoscope, high-definition video telescope operating monitor system to perform microsurgery has recently been proposed an alternative to the operating microscope. It enables surgeons to complete the operation assistance by visualizing magnified images on a display. The strong points of exoscope are the wide field of view and deep focus. It minimized the need for repositioning and refocusing during the procedure. On the other hand, limitation of magnifying object was an emphasizing weak point. The procedures are performed under 2D motion images with a visual perception through dynamic cue and stereoscopically viewing corresponding to the motion parallax. Nevertheless, stereopsis is required to improve hand and eye coordination for high precision works. Consequently novel 3D high-definition operating scopes with various mechanical designs have been developed according to recent high-tech innovations in a digital surgical technology. It will set the stage for the next generation in digital image based neurosurgery.

A Clinical Analysis of Intermittent Exotropia Patients Requiring More than Three Reoperations

PURPOSE: To evaluate the clinical analysis of intermittent exotropia patients who required more than three reoperations and to investigate the factors leading to situations that require more than three reoperations. METHODS: We retrospectively analyzed the results of 13 patients who underwent more than three reoperations for recurrence after the second operation, as well as for 29 patients who had successful results for operation at least 1 year after the second operation. We investigated the factors associated with surgical outcomes of the second operation using multiple logistic regression analysis, which included; onset of symptom, primary, secondary, tertiary, and fourth ages of surgery, stereopsis before and after surgery, distance and near deviation before and after surgery, and constancy of exotropia. RESULTS: There were more cases in which symptoms occurred before 1 year of age (p = 0.011) and which had constant exotropia (p = 0.023), with a large deviation at first operation (p = 0.003) after more than three operations compared to patients who only had two operations. There were less cases that achieved initial overcorrection after first operation (p = 0.003) and successful postoperative stereopsis after second operation (p = 0.043) in the three operations group than in the two operations group. Among these factors, the most important factor affecting reoperation and success after second operation was related to successful recovery of stereopsis using multiple regression analysis (odds ratio [OR] = 50.00, 95% confidence interval [CI] = 4.392–569.224, p = 0.002). CONCLUSIONS: In cases of intermittent exotropia occurring before 1 year of age, constant exotropia with a large deviation at first operation, and insufficient initial overcorrection after operation, it may be necessary for patients to receive more than three operations because of recurrence. Further, recovery of postoperative stereopsis after the second operation was the most important predictor for postoperative results.

Effects of Monocular Blur on Clinical Measurements of Stereopsis and Binocular Contrast Sensitivity / Jurnal Sains Kesihatan Malaysia

Visual conditions such as anisometropia, monovision and monocular undercorrection affect the combination of visual input from both eyes. This study investigated the effects of monocular blur, in binocularly normal participants, on stereoacuity and binocular contrast sensitivity. Fifteen young adults (age range between 19 and 23 years old) with normal visual acuity and binocular vision participated in this study. Stereopsis was measured using the TNO test with a series of positive spherical lenses placed before the dominant eye. The procedure was repeated using the Titmus Stereotest on five participants as a control experiment. Monocular and binocular contrast sensitivities were also measured using the Pelli-Robson Contrast Sensitivity Chart. Blur was induced monocularly with a series of positive spherical lenses placed before the dominant eye and binocular contrast sensitivity was re-measured. Stereopsis scores decreased significantly when monocular blur was imposed. Across blur levels, absolute stereopsis scores measured with TNO test were worse than those measured with Titmus stereotest (all p < 0.05). However, the ratio of scores obtained without blur and under monocular blur appeared to be similar for both tests. Stereopsis without blur was between 6.82× to 8× better than that obtained with the highest level of imposed monocular blur. Binocular contrast sensitivity score decreased significantly with increasing level of monocular blur (p < 0.01). Binocular contrast sensitivity score without blur was 1.62× better than that obtained under binocular viewing with highest level of imposed blur. Stereopsis tests are more sensitive than measurements of binocular contrast sensitivity as an indicator of interocular acuity discrepancies which could occur in anisometropic or monovision patients. However, the choice of stereopsis test is crucial, as the TNO test appears to be more sensitive to monocular blur than the Titmus stereostest.