The effect of font size on reading performance in strabismic amblyopia: an eye movement investigation.

PURPOSE: We investigated the effect of font size on reading speed and ocular motor performance in strabismic amblyopes during text reading under monocular and binocular viewing conditions. METHODS: Eye movements were recorded at 250 Hz using a head-mounted infrared video eye tracker in 15 strabismic amblyopes and 18 age-matched controls while silently reading paragraphs of text at font sizes equivalent to 1.0 to 0.2 logMAR acuity. Reading under monocular viewing with amblyopic eye/nondominant eye and nonamblyopic/dominant eye was compared to binocular viewing. Mean reading speed; number, amplitude, and direction of saccades; and fixation duration were calculated for each font size and viewing condition. RESULTS: Reading speed was significantly slower in amblyopes compared to controls for all font sizes during monocular reading with the amblyopic eye (P = 0.004), but only for smaller font sizes for reading with the nonamblyopic eye (P = 0.045) and binocularly (P = 0.038). The most significant ocular motor change was that strabismic amblyopes made more saccades per line than controls irrespective of font size and viewing conditions (P < 0.05 for all). There was no significant difference in saccadic amplitudes and fixation duration was only significantly longer in strabismic amblyopes when reading smaller fonts with the amblyopic eye viewing. CONCLUSIONS: Ocular motor deficits exist in strabismic amblyopes during reading even when reading speeds are normal and when visual acuity is not a limiting factor; that is, when reading larger font sizes with nonamblyopic eye viewing and binocular viewing. This suggests that these abnormalities are not related to crowding.

A comparative study of visual function of young myopic adults wearing contact lenses vs. spectacles.

PURPOSE: To evaluate the impact of contact lenses wear vs. spectacles wear on visual function of young adults with mild to moderate myopia. METHODS: 57 students (27 male and 30 female) with a mean age of 23 years old participated in the study. Their mean best corrected visual acuity was 10/10 binocularly, all suffered from mild to moderate myopia (-3.75 sph/SD 1.25 sph) and they were both contact lenses and spectacles wearers. The VF-14 questionnaire was administered to assess the contact lenses wear vs. spectacles wear impact score on general daily living among the young individuals. It was used translated in Greek after following the 'translation-back translation' procedure. RESULTS: The mean VF-14 score among spectacles and contact lenses wearers was 100 and 86.78 (SD 4.08) respectively. Although there was a significant difference between the two groups (p<0.05), both scores were related to a satisfactory functional vision for daily living. The contact lenses wearers were facing difficulty especially while driving at night, seeing steps, as well as doing fine handwork (i.e. sewing, knitting or carpentry). CONCLUSIONS: The use of both spectacles and contact lenses provides satisfactory visual functioning for daily activities in young individuals suffering from mild to moderate myopia. However, there is a spectacles' wear superiority in personal satisfaction when compared to contact lenses.

First postoperative day review after uneventful phacoemulsification cataract surgery: is it necessary?

BACKGROUND: Our purpose was to examine the value of the first postoperative day review after uneventful phacoemulsification cataract surgery. METHODS: 291 patients who underwent uneventful phacoemulsification were randomized into two groups (ClinicalTrials.gov Identifier: NCT01247155): i) Next day review (NDR group, n = 146) and ii) No next day review (NNDR group, n = 145). The rate of complications, percentage of patients seeking non-scheduled medical consultation up to postoperative day 14, presence of any inflammation-related sign and best corrected visual acuity (BCVA) on postoperative day 28 were analyzed. RESULTS: In the NDR group, 5.5% of patients developed a postoperative complication, whereas the respective rate was 6.2% in the NNDR group. The difference was not statistically significant (p = 0.791). The most frequent complications were: elevated intraocular pressure, allergy to postoperative treatment, corneal abrasion, punctuate epitheliopathy, iris prolapse and postoperative hyphema, whose rates did not differ between the two groups. The rate of patients seeking non-scheduled medical consultation up to postoperative day 14, presence of any inflammation-related sign, as well as BCVA on day 28 did not exhibit any significant differences between the study groups. CONCLUSIONS: First postoperative day review could be omitted in cases of uneventful cataract surgery.

The value of fundoscopy in general practice.

BACKGROUND: Many of the common systemic diseases present characteristic changes in the fundus of the eye, but fundoscopy is often performed by an ophthalmologist. Our purpose was to assess the value of fundoscopy for the general practitioners (GPs) regarding the diagnosis and management of the cases which they face in daily practice. METHODS: 689 patients were referred by GPs to the outpatient ophthalmology department for fundoscopy during the year 2010. The causes of this referral, the results of ophthalmoscopy and its significance in the final diagnosis were recorded and analyzed. RESULTS: In 22 patients (3.1%), fundoscopy revealed optic disc edema. In 7 patients with head trauma (9.7%), fundoscopy revealed intravitreous haemorrhage and Berlin edema. From the patients with photopsias or floaters, 5 (10.2%) had retinal detachment. Finally, in cases with diabetes mellitus or hypertension, ophthalmoscopy was very important to detect the existence and grade the degree of diabetic or hypertensive retinopathy, if they appeared, and as a result to evaluate the prognosis of the disease. CONCLUSIONS: Fundoscopy is fundamental for the GP, as it may help to confirm or exclude the diagnosis of many common diseases. Nevertheless, there are clinical entities where ophthalmoscopy should be performed by an ophthalmologist, in order to be more specific and accurate, and GP should be able to recognise these cases.

Bilateral herpes simplex keratitis presenting as peripheral ulcerative keratitis.

PURPOSE: To report a case of bilateral Herpes simplex keratitis (HSK) masquerading as peripheral ulcerative keratitis (PUK). METHODS: A case of a 47-year-old female complaining of painful red eyes with a history of arthritis and anterior uveitis attacks with positive antinuclear antibodies (ANA). Biomicroscopy revealed PUK, stromal infiltrations and bilateral central corneal epithelial erosions. Slit-lamp examination disclosed +3 anterior chamber cells in both eyes. RESULTS: Blood testing was positive for ANA. Herpes simplex virus (HSV) antigen was identified in both eyes using polymerase chain reaction (PCR). The management included topical prednisolone and acyclovir, as well as systemic valacyclovir. Improvement of epithelial corneal defects, PUK, and visual acuity was achieved gradually during the follow-up period. CONCLUSIONS: Bilateral herpetic keratitis presenting as PUK is an extremely rare manifestation of herpetic disease. PUK can pose a diagnostic dilemma in cases with immune system dysregulation. Excluding infectious agents is mandatory for appropriate treatment.

Childhood orbitotemporal neurofibromatosis masked by congenital glaucoma and buphthalmos.

In newborns with unilateral buphthalmos and presumed congenital glaucoma, the differential diagnosis should include the rare condition of orbitotemporal neurofibromatosis. The authors present the diagnostic challenge of an unusual case of neurofibromatosis type 1 with unilateral congenital glaucoma, buphthalmos, and sphenoid-orbital dysplasia. The accompanying type of osseous orbital dysplasia has rarely been described in the literature, complicating the diagnostic and management process.

Episcleritis Related to Drug-Induced Lupus Erythematosus following Infliximab Therapy: A Case Report.

Drug-induced lupus erythematosus is defined as a lupus-like syndrome temporally related to continuous drug exposure which resolves after discontinuation of the offending drug. Herein, we describe a patient with distinct clinical manifestations of anti-TNF-associated DILE related to infliximab therapy. The patient exhibited clinical and laboratory findings of lupus-like illnesses as well as ocular disorders, such as episcleritis. The main message is that the symptoms of DILE should not be overlooked, although sometimes other systematic conditions may underlie them. As a result, it is very important for the clinicians to evaluate the symptoms of DILE and manage appropriately these cases.

Amblyopia: a mini review of the literature.

Amblyopia is a form of cerebral visual impairment in the absence of an organic cause. It is considered to derive from the degradation of the retinal image associated with abnormal visual experience during the developmental period of the visual system in infancy and early childhood. Amblyopia is a significant cause of unilateral visual deficit in childhood and is still considered as one of the most common causes of persistent unilateral visual impairment in adulthood. The following review aims at presenting the contemporary literature regarding the prevalence, the aetiology, the neural correlates, the period of critical development, the treatment, the prognosis and the disability associated with this visual deficit.

Graves' Ophthalmopathy Misdiagnosed as Relapsing Conjunctivitis.

A 59-year-old female patient presented at the outpatients' Department of Ophthalmology with epiphora, eyelid swelling, and a foreign body feeling in the right eye. The symptoms were present for 4 months, and the patient was treated as suffering from relapsing conjunctivitis. The slit lamp examination revealed keratitis due to exposure, related with the deficient closure of the eyelids. There was a 2 mm difference in the readings with the Hertel exophthalmometry examination between the eyes. Her medical history was clear, and she was referred for computed tomography of the orbits and brain and biochemical examinations (FT(3), FT(4), and TSH) to investigate the presence of an intraorbital mass. FT(3) was significantly increased and TSH was accordingly low, indicating the diagnosis of Graves' disease, which presented without other signs and symptoms apart from ophthalmopathy. Computed tomography scan excluded the diagnosis of an intraorbital mass. Therefore, it is important not to underestimate the ocular manifestations of systemic diseases.

Reading strategies in mild to moderate strabismic amblyopia: an eye movement investigation.

PURPOSE. To investigate oculomotor strategies in strabismic amblyopia and evaluate abnormalities during monocular and binocular reading. METHODS. Eye movements were recorded with a head-mounted infrared video eye-tracker (250 Hz, <0.01 degrees resolution) in 20 strabismic amblyopes (mean age, 44.9 +/- 10.7 years) and 20 normal control subjects (mean age, 42.8 +/- 10.9 years) while they silently read paragraphs of text. Monocular reading comparisons were made between the amblyopic eye and the nondominant eye of control subjects and the nonamblyopic eye and the dominant eye of the control subjects. Binocular reading between the amblyopic and control subjects was also compared. RESULTS. Mean reading speed, number of progressive and regressive saccades per line, saccadic amplitude (of progressive saccades), and fixation duration were estimated. Inter- and intrasubject statistical comparisons were made. Reading speed was significantly slower in amblyopes than in control subjects during monocular reading with amblyopic (13.094 characters/s vs. 22.188 characters/s; P < 0.0001) and nonamblyopic eyes (16.241 characters/s vs. 22.349 characters/s, P < 0.0001), and binocularly (15.698 characters/s vs. 23.425 characters/s, P < 0.0001). In amblyopes, reading was significantly slower with the amblyopic eye than with the nonamblyopic eye in binocular viewing (P < 0.05). These differences were associated with significantly more regressive saccades and longer fixation durations, but not with changes in saccadic amplitudes. CONCLUSIONS. In strabismic amblyopia, reading is impaired, not only during monocular viewing with the amblyopic eye, but also with the nonamblyopic eye and binocularly, even though normal visual acuity pertains to the latter two conditions. The impaired reading performance is associated with differences in both the saccadic and fixational patterns, most likely as adaptation strategies to abnormal sensory experiences such as crowding and suppression.

Unilateral optic disc edema in a paediatric patient: diagnostic dilemmas and management.

Introduction. We report a case of unilateral optic disc edema in a paediatric patient and discuss the concerns involved in diagnosis and management of similar cases. Materials and Methods. Female aged 10 years was referred to our clinic due to progressive visual loss of the LE over a few days. Her visual acuities (VA) were RE 10/10, LE 3/10, and she had a relative afferent pupillary defect and decreased colour vision in her LE and normal and painless eye movements. Fundoscopy showed a remarkably swollen disc of the LE, and visual field (VF) examination revealed enlargement of the blind spot and presence of horizontal inferior papillomacular scotoma. Neurological examination, CT of brain and orbits and blood tests were normal. Visual evoked potentials revealed an obstacle in the myelin substance before the optic chiasma of the LE. Results. The patient was treated with intravenous methylprednoslone for 3 days and with oral methylprednizole for 15 days in progressively diminished daily doses. This led to gradual improvement of VA, colour vision, and visual field and resolution of optic disc oedema. Discussion. Concerns that have to be taken into account regarding diagnosis and management of similar cases are related to lumbar puncture indications, treatment with corticosteroids, and appropriate followup.