A systematic review of the applicability and efficacy of eye exercises.

PURPOSE: To examine the current scientific evidence base regarding the efficacy of eye exercises as used in optometric vision therapy. METHODS: A search was performed of the following databases: Allied and Complementary Medicine Database, Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, EMBASE, and MEDLINE. Relevant articles were reviewed and analyzed for strengths and weaknesses. Pertinent sections of classic texts were studied to provide a historical basis and to serve as a source for additional early references. RESULTS: Forty-three refereed studies were obtained. Of these, 14 were clinical trials (10 controlled studies), 18 review articles, 2 historical articles, 1 case report, 6 editorials or letters, and 2 position statements from professional colleges. Many of the references listed by the larger reviews were unpublished or published in obscure or nonrefereed sources and therefore were not accessible. CONCLUSIONS: Eye exercises have been purported to improve a wide range of conditions including vergence problems, ocular motility disorders, accommodative dysfunction, amblyopia, learning disabilities, dyslexia, asthenopia, myopia, motion sickness, sports performance, stereopsis, visual field defects, visual acuity, and general well-being. Small controlled trials and a large number of cases support the treatment of convergence insufficiency. Less robust, but believable, evidence indicates visual training may be useful in developing fine stereoscopic skills and improving visual field remnants after brain damage. As yet there is no clear scientific evidence published in the mainstream literature supporting the use of eye exercises in the remainder of the areas reviewed, and their use therefore remains controversial.

Clear lens extraction for the treatment of persistent accommodative spasm after head trauma.

We report the case of a 28-year-old man with decreased visual acuity after closed head trauma sustained in a motor vehicle accident 16 weeks earlier. Several structures thought to be associated with the control of accommodation were injured. The patient had a persistent accommodative spasm causing up to 7.0 diopters of pseudomyopia. We present the patient's progress through the clinic, including manifest and cycloplegic refractions and results of a trial with atropine drops, and successful transition to bilateral pseudophakia 2 years and 9 months after the accident.

Influence of axial length of normal eyes on PERG.

The influence of the axial length (AL) of the eye on flash electroretinogram (ERG) responses has been well established in the literature, suggesting an association between ERG abnormalities with myopia (AL > 25 mm). The aim of our present study was to determine whether the AL of normal eyes can also influence the pattern electroretinogram (PERG) on normal subjects. Thirty-nine normal volunteers were subjected to PERG measurements following the standard set by the International Society for Clinical Electrophysiology of Vision (ISCEV). The AL of the eyeball was measured using a TOMEY ultrasonic A scanner. Each volunteer had a complete ophthalmic examination including visual acuity, refraction, intraocular pressure, visual field, colour vision, orthoptic assessment and retinal photographs and had a best corrected visual acuity of 6/9 or better. Only one eye from each of the 39 normal volunteers was included in the statistical analysis of the results. The normal volunteer group had a mean P50 amplitude of 3.8 +/- 1.1 SD microV. The range of AL was between 21.8 and 25.7 mm (mean = 23.8 +/- 1.0 SD mm). Overall findings obtained from this investigation indicate a significant correlation between the AL of normal eyes and the PERG P50 amplitude (Spearman rank correlation coefficient r = -0.413, p < 0.01). The correlation accounts for 17% of the variance observed in the 39 amplitude values. This confirms the current hypothesis that the PERG amplitude is inversely related to axial length and means that AL should be considered when interpreting PERG amplitudes.

Unilateral versus bilateral medial rectus recession.

BACKGROUND: Unilateral medial rectus recession is suitable for some cases of small-angle deviation in esotropia. This approach limits surgery to one eye, leaves other muscles untouched, and should be quicker than bilateral muscle surgery. This study compared the results of a range of medial rectus recessions, both unilateral and bilateral, performed by one surgeon. METHODS: Data were collected on all pediatric patients who had undergone medial rectus recession, unilateral and bilateral, performed by one surgeon between August 1, 1995, and March 31, 2002. Postoperative deviations were calculated from the short- (2 to 8 weeks) and long-term (6 to 48 months) follow-up visits. RESULTS: Medial rectus recessions were performed on 107 patients, 56 unilateral and 51 bilateral. After exclusions were made, 45 (80%) of the unilateral procedures and 41 (80%) of the bilateral cases were studied. At long-term follow-up, the mean prism diopter (PD) change in deviation per millimeter recessed (at distance) for unilateral recessions of 5 mm, 6 mm, 7 mm, and 8 mm were 2.3, 2.2, 2.3, and 2.5, respectively. For equivalent bilateral recessions the mean changes in deviation were 4.2, 4.0, 4.3, and 5.0 PD/mm. CONCLUSION: Unilateral medial rectus recession is a predictable method for surgical correction of small-angle pediatric esotropia. The change in deviation per millimeter of recession after unilateral recession is significantly less than that obtained from equivalent amounts of bilateral recession (P <.01).