Amblyopia: etiology, detection, and treatment.

Amblyopia is a preventable cause of visual loss in children that may be permanent unless it is detected and treated early. It may be caused by strabismus, refractive errors, or cataracts. Primary strabismus may lead to loss of vision from amblyopia and the loss of binocularity. Secondary strabismus may be a sign of primary visual loss in one or both eyes. The most serious disorder that may present as secondary strabismus is retinoblastoma. It is imperative to detect retinoblastoma early because of its morbidity and mortality. Amblyopia is detected by assessing the visual acuity of each eye. Strabismus is detected by using the corneal light reflex test and the cover test. Focusing problems are detected by assessing the visual acuity and the red reflex. Cataracts and retinoblastoma may be detected by examining the red reflex of the eye. Treatment of amblyopia consists of correcting the amblyogenic factor with appropriate glasses and surgery. The preferred eye is patched with an adhesive patch to stimulate visual development in the amblyopic eye. The pediatrician plays a crucial role in the early detection of amblyopia, strabismus, and cataracts. The key to successful visual outcome is early recognition by the pediatrician, referral to the pediatric ophthalmologist, and prompt treatment.

Strabismus in patients over the age of 60 years.

We studied all cases of strabismus surgery performed at the Manhattan Eye, Ear and Throat Hospital between January 1, 1981 and June 30, 1986. Of the procedures, 106 (5.4%) were performed on patients over the age of 60 years. Strabismus in patients over age 60 represents a category of diseases which are different from those of childhood. Horizontal deviations were seen in 74% of the patients equally divided between esotropia and exotropia. Vertical strabismus was seen in 17%, and a combined vertical horizontal strabismus was seen in 9% of patients. In children, the overwhelming majority of ocular deviations are horizontal, with esotropias outnumbering exotropias. The strabismus was of adult onset in 71% of cases and of childhood onset in 29% of the patients. The etiology in the adult onset strabismus group included neuroparalytic, restrictive, sensory, and post-cataract surgery strabismus, as well as decompensated exophoria/intermittent exotropia; this was in contrast to children where the most common etiology of strabismus is innervational disturbances in fusional vergences. The major indications for surgery were diplopia and aesthenopia in 71% of cases. Diplopia is uncommon in childhood. Corrective surgery for the relief of diplopia may be enhanced with the use of adjustable sutures and postoperative prism therapy. Precise realignment is the goal of strabismus surgery in all age groups, however, the role of adjustable sutures and prisms is more important in the treatment of the functional complaints of older patients. Exploration and lysis of adhesions and scar tissue are major components of surgery on patients with restrictive strabismus.(ABSTRACT TRUNCATED AT 250 WORDS)

Optic nerve involvement in retinoblastoma.

This retrospective review of 814 retinoblastoma patients discloses 240 cases of tumor extension into the optic nerve. Optic nerve involvement was classified according to the degree of invasion; grade I is superficial invasion of the optic nerve head only, grade II is involvement up to and including the lamina cribrosa, grade III is involvement beyond the lamina cribrosa, and grade IV is involvement up to and including the surgical margin. The incidence of optic nerve involvement was 29.5% (240/814). The mortality rate of patients with optic nerve involvement with grade I was 10%; grade II, 29%; grade III, 42%; and grade IV, 78%. Actuarial life-table analysis shows an increased mortality rate with increasing grade of optic nerve involvement. Multivariate statistical analysis shows that the grade of optic nerve involvement and the age at diagnosis of optic nerve involvement are the factors most significantly associated with survival.