Bagolini lenses vs the Polarized Four-Dot test.

The applicability and accuracy of two minimally dissociative sensory tests were compared in a pediatric ophthalmology clinic. The Polarized Four-Dot (P4D) test and Bagolini striated lenses (BAG) were used to evaluate 133 patients who were at least 3 years old. The outcomes measured were test failure rate and mean age at the test failures. Test sensitivity and specificity were determined using the distance vectograph as a reference. The failure rate for the BAG test, 14%, was significantly higher than that for the P4D test, 5% (P = .0005). The mean age of the test failures also was higher for the BAG test (4.7 vs 3.8 years). Both sensitivity and specificity for the detection of central suppression were greater using the P4D test. The P4D test is simple to use, widely applicable, and accurate in the detection of peripheral fusion, central fusion, or suppression, without the confounding colors of the Worth Four-Dot test. We recommended the P4D test as the test of choice for routine evaluation of binocular fusion status.

Worth vs Polarized four-dot test.

A direct comparison between the Worth four-dot (W4D) and Polarized four-dot (P4D) flashlights is reported in a randomized trial on 107 unselected patients greater than 2.5 years old. The primary outcome variable was the interpretable response rate. Secondary outcomes were response time and age of test failure. There were 29 patients who failed to complete the W4D test, but only 10 patients who could not complete the P4D test, giving interpretable response rates of 73% and 91%, respectively (p < .001). The P4D test was found to be less dissociative and easier to administer. It also had a higher detection rate for fusion. We recommend its use as a tool in the clinical evaluation of binocular sensorial states.

Long-term stability of alignment in the monofixation syndrome.

From a collection of 328 patients with congenital esotropia, 80 patients were identified who had a minimum 4-year follow-up after surgical alignment within 8 prism diopters (pd) of orthophoria. These patients were subdivided into two groups: the M.S. group (38 patients) demonstrated the monofixation syndrome; the NO M.S. group (42 patients) did not have monofixation. The alignment of patients in each group was followed over time. After 17.5 years, 74% of patients in the M.S. group maintained alignment within 8 pd of orthophoria. In the NO M.S. group, only 45% were well aligned after 14 years. The mean time to loss of stability was significantly shorter for the NO M.S. group (P less than 0.005). Our findings suggest achievement of the monofixation syndrome improves but does not guarantee stability of ocular alignment.

The polarized three-dot test.

A new binocular sensory test was designed using polarizing filters. The polarized three-dot test (P3D) subtends the same visual angle as the Worth four-dot test (W4D). Sensory testing was performed at distance and near in 100 patients using the W4D and P3D tests. Every patient reliably completing the W4D test also completed the P3D test. Twelve patients failed to complete both tests. Fifteen patients could not reliably complete the W4D test but were able to perform the P3D, thus increasing the interpretable response rate from 73% for the W4D test to 88% for the P3D (chi square, p less than .0001). In every case but one, fusion by W4D testing was also found by the P3D test. In addition, the P3D identified 19 cases of fusion not found by W4D testing. The results suggest that the P3D test is superior to the W4D test in the clinical assessment of central and peripheral fusion.

Ultrastructural effects of topical timolol on the rabbit cornea. Outcome alone and in conjunction with a gas permeable contact lens.

Corneal epithelial erosions developed in two patients wearing gas permeable contact lenses (Boston) soon after commencing topical timolol maleate therapy. This prompted the following investigation. Forty rabbit corneas were examined by scanning and transmission electron microscopy after treatment for one month with one of the following: timolol ophthalmic solution, preservative-free timolol, contact lens, contact lens and timolol, contact lens and preservative-free timolol, contact lens and saline, or no treatment. Corneas treated with either timolol or contact lens alone showed mild to moderate edema or degeneration of epithelial and endothelial cells. However, the combined use of a contact lens and timolol produced marked alterations in both the corneal epithelium and endothelium.