Resolution of cyclic esotropia with 5-year follow-up after brief Fresnel prism treatment.

Cyclic esotropia is a rare form of strabismus that is characterized by a recurring esotropic deviation, usually with a 48-hour cycle. On esotropic days, the patient has a constant deviation with suppression, followed by a day with straight eyes and good binocular function. We report a case of cyclic esotropia in which the cycling resolved with 2 months of Fresnel prism for the amount of the distance deviation on her "straight" days. Five years later, with low plus hyperopic correction, she remains with a stable esophoria and normal stereopsis.

Aniseikonia: A 21st Century Look.

Purpose: Aniseikonia, an appreciation of image size differences between the eyes, can produce symptoms in patients, ranging from headaches to loss of fusion. The purpose of this research was to take a 21st century look at aniseikonia. Methods: Kellogg Eye Center patient records were evaluated for measurable aniseikonia in patients tested with the Aniseikonia Helper, a tablet-based application. Anaglyph slides for the synoptophore were developed to test the limits of induced aniseikonia on stereopsis and fusion. A survey was developed to determine how frequently members of the American Association of Certified Orthoptists (AACO) examine and treat patients with aniseikonia.Results: The prevalence of measurable aniseikonia in this cohort was 7.8%. Moderate amounts of induced aniseikonia, 4% induced image size disparity, disrupt fusion and can cause a loss of stereopsis. Eighty percent of responding AACO members see patients with aniseikonia and among those, 25% see them on a monthly basis. Treatment options, other than wearing contact lenses, are limited to occlusion or fogging techniques. Conclusions: Aniseikonia remains a frequent complaint among patients. The ophthalmologic community needs to use the best methods for measuring aniseikonia and to develop better methods for treating aniseikonia.

Fresnel prism use among orthoptists.

PURPOSE: To better understand current uses of Fresnel prisms. METHODS: A seventeen-question survey was completed by members of the American Association of Certified Orthoptists (AACO). RESULTS: Surveys were emailed to 211 orthoptists with a 36% response rate (n = 76). Prisms are used preoperatively to determine the surgical angle for 72% of respondents, 94% use prisms for postoperative misalignment. Prisms are used for incomitant deviations by up to 96% of respondents. The greatest patient objection to Fresnel use is reduced vision and distortion, not diplopia out of primary position. Of orthoptists surveyed, 99% use Fresnel prisms for near-distance disparity, 36% splitting prisms for upper and lower segments, and 40% encourage separate spectacles for near and distance. When deciding to grind prism, 66% wait more than one month. Ninety-nine percent of orthoptists use Fresnel prisms with adults, 67% use them with children. When correcting vertical and horizontal deviations, 70% of orthoptists rotate a prism over one lens. CONCLUSION: Fresnel prisms have a wide use among North American certified orthoptists, including use with pediatric patients. Incomitance is not a contraindication to Fresnel use. Orthoptists prefer rotating one prism to bilateral Fresnel prisms.

Management of binocular diplopia due to maculopathy with combined bangerter filter and fresnel prism.

PURPOSE: To describe treatment of binocular diplopia due to maculopathy with a combination of Bangerter foil and Fresnel prism. Methods and Case Report: A protocol for prescribing a combination of Bangerter foil and Fresnel prism is described. A series of three patients in whom a Bangerter foil or prism alone were ineffective for binocular diplopia due to maculopathy, along with a detailed case report of one of these patients, illustrates how a combination of both were used to treat the diplopia. CONCLUSIONS: Fogging is presumed to relieve binocular diplopia due to maculopathy by inducing a functional central scotoma in the affected eye. In some patients, prism correction is needed in addition to a Bangerter foil to eliminate diplopia, possibly by impoving superimposition of the scotoma in the affected eye and the fovea of the sound eye.

Current concepts in the management of concomitant exodeviations.

Intermittent exotropia is the most common form of divergent strabismus. Treatment is indicated with increasing tropia phase to preserve or restore binocular function and restore/reconstruct normal ocular alignment. While medical treatment is sometimes helpful for temporary relief, surgical therapy is the preferred definitive treatment modality by most pediatric ophthalmologists and strabismologists. Congenital exotropia is rare and is associated with a high incidence of amblyopia. The treatment of choice in this condition is also surgical. Sensory exotropia is most often acquired after monocular visual loss. The preferred treatment is surgical recession/resection on the impaired eye. Convergence insufficiency is usually not diagnosed until the teenage years or later, and it is best approached nonsurgically with convergence exercises. In this article, we review the current literature and practice on the diagnosis and management of exotropia with emphasis on intermittent exotropia.