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Strabismus surgical time-out: an illustrated whiteboard modification.

J AAPOS 2021 Mar 15. Epub 2021 Mar 15.

Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas; Department of Surgery, Division of Ophthalmology, Texas Children's Hospital, Houston, Texas.

Background: Errors in strabismus surgery-including wrong eye, wrong muscle, and wrong procedure-can occur when there is confusion about the surgical plan among members of the surgical team, including surgeons, anesthesia staff, nurses, and technicians. The purpose of this study was to assess whether implementation of a strabismus-specific whiteboard combined with oral statement of the surgical plan using nonophthalmological terminology could improve communication among the team before commencement of surgery.

Methods: A strabismus-specific whiteboard with labeled diagram of the eyes and extraocular muscles was designed. Read More

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Scope and costs of autorefraction and photoscreening for childhood amblyopia-a systematic narrative review in relation to the EUSCREEN project data.

Eye (Lond) 2021 Mar 30;35(3):739-752. Epub 2020 Nov 30.

Erasmus Medical Centre, Rotterdam, The Netherlands.

Background: Amblyopia screening can target reduced visual acuity (VA), its refractive risk factors, or both. VA testing is imprecise under 4 years of age, so automated risk-factor photoscreening appears an attractive option. This review considers photoscreening used in community services, focusing on costs, cost-effectiveness and scope of use, compared with EUSCREEN project Country Reports describing how photo- and automated screening is used internationally. Read More

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Strabismus surgery in Angelman syndrome: More than ocular alignment.

PLoS One 2020 13;15(11):e0242366. Epub 2020 Nov 13.

Epilepsy and Clinical Neurophysiology Unit, Scientific Institute IRCCS Eugenio Medea, Conegliano-Pieve di Soligo (TV), Italy.

Purpose: To report and evaluate strabismus surgery in children with Angelman syndrome, in order to optimize and standardize surgical approach. Other purposes are to understand the possible relation between ocular findings and motor ability, and between improvement in ocular alignment and changes in motor skills in this population.

Design: Observational cross-sectional study. Read More

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January 2021

Intranasal dexmedetomidine versus oral midazolam premedication to prevent emergence delirium in children undergoing strabismus surgery: A randomised controlled trial.

Eur J Anaesthesiol 2020 12;37(12):1143-1149

From the Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University (YY, JL, WC, YL, XZ) and Department of Gynaecology, Fujian Cancer Hospital, Affiliated Hospital of Fujian Medical University (YS).

Background: Dexmedetomidine is being used increasingly as a premedicant in the paediatric population. However, the effectiveness of pre-operative intranasal dexmedetomidine premedication, compared with oral midazolam, for emergence delirium is not well characterised.

Objective: To identify the effectiveness of pre-operative intranasal dexmedetomidine for emergence delirium in the paediatric patient population following general anaesthesia. Read More

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December 2020

Novel compact device for clinically measuring extraocular muscle (EOM) tension.

J Biomech 2020 08 15;109:109955. Epub 2020 Jul 15.

Department of Mechatronics and Electronic Engineering, Konkuk University Glocal Campus, Chungcheongbuk-do, Republic of Korea. Electronic address:

Accurate knowledge of extraocular muscle (EOM) tension is important for the diagnosis of and surgical planning for strabismus, such as choosing which eye to operate or determining the amount of muscle displacement. Previous evaluations of passive EOM tension have relied extensively on the experience and skill of ophthalmic surgeons, who generally perform such evaluations by gripping the eyeball and then pushing and pulling it. This methodology, named the forced duction test, has the significant limitation that the tension is felt subjectively via the forceps, with the results therefore not being quantifiable. Read More

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The Effect of a Photochromic Contact Lens on Visual Function Indoors: A Randomized, Controlled Trial.

Optom Vis Sci 2020 07;97(7):526-530

Johnson & Johnson Vision Care, Inc., Jacksonville, Florida.

Significance: Photochromic soft contact lenses contain light-sensitive additives that allow them to darken when exposed to ultraviolet or violet light. One question, however, is whether the lenses influence vision indoors (minimally activated). In this study, we found that the minimally activated lenses improved many aspects of visual function under bright light. Read More

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A One-Step, Streamlined Children's Vision Screening Solution Based on Smartphone Imaging for Resource-Limited Areas: Design and Preliminary Field Evaluation.

JMIR Mhealth Uhealth 2020 07 13;8(7):e18226. Epub 2020 Jul 13.

TerryDr Infomation Technology, Nanjing, China.

Background: Young children's vision screening, as part of a preventative health care service, produces great value for developing regions. Besides yielding a high return on investment from forestalling surgeries using a low-cost intervention at a young age, it improves school performance and thus boosts future labor force quality. Leveraging low-skilled health care workers with smartphones and automated diagnosis to offer such programs can be a scalable model in resource-limited areas. Read More

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Suppression Rather Than Visual Acuity Loss Limits Stereoacuity in Amblyopia.

Invest Ophthalmol Vis Sci 2020 06;61(6):50

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Purpose: To investigate the influence of interocular suppression and visual acuity loss on stereoacuity in observers with and without abnormal vision development from strabismus or amblyopia. To determine whether stereoacuity improves in amblyopic observers when suppression is neutralized.

Methods: Experiment 1: Visual acuity (VA), depth of suppression (contrast ratio [CR]), and stereoacuity (digital random-dot) were tested in adult amblyopic observers (n = 21; age 27 ± 11 years). Read More

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Detection of Amblyogenic Refractive Error Using the Spot Vision Screener in Children.

Optom Vis Sci 2020 05;97(5):324-331

White River Family Eye Care, White River Junction, Vermont.

Significance: Vision screenings are conducted to detect significant refractive errors, amblyopia, and ocular diseases. Vision screening devices are desired to have high testability, sensitivity, and specificity. Spot has demonstrated high testability, but previous reports suggest that the Spot has low sensitivity for detecting amblyogenic hyperopia and moderate sensitivity for amblyogenic astigmatism. Read More

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Reduced stereoacuity as a predictor for clinically significant convergence insufficiency.

Br J Ophthalmol 2021 01 18;105(1):37-41. Epub 2020 Mar 18.

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Background: Stereoacuity relies on accurate binocular alignment. Convergence insufficiency (CI) a binocular motor disorder, interferes with near work.

Objective: To investigate the association between convergence amplitude (CA) and stereoacuity in a large paediatric cohort. Read More

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January 2021

Stereotactic Navigation Improves Outcomes of Orbital Decompression Surgery for Thyroid Associated Orbitopathy.

Ophthalmic Plast Reconstr Surg 2020 Nov/Dec;36(6):553-556

Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan.

Purpose: To test whether intraoperative stereotactic navigation during orbital decompression surgery resulted in quantifiable surgical benefit.

Methods: This retrospective cohort study examined all consecutive patients who underwent primary orbital decompression surgery for thyroid associated orbitopathy performed by a single surgeon (A.K. Read More

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Management of stretched scar- induced secondary strabismus.

BMC Ophthalmol 2020 Feb 19;20(1):58. Epub 2020 Feb 19.

Department of ophthalmology, Benha University, Benha, Egypt.

Background: To determine characteristics and management of consecutive or recurrent strabismus secondary to stretched scar.

Methods: This is a retrospective review of all patients diagnosed with late secondary consecutive or recurrent strabismus due to stretched scar from 2012 to 2017. The diagnosis of stretched scar was made in any case of late (≥ 1 month) consecutive or recurrent strabismus associated with underaction of the previously operated muscle. Read More

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February 2020

Amblyopia: Detection and Treatment.

Am Fam Physician 2019 12;100(12):745-750

The Ohio State University Wexner Medical Center, Columbus, OH, USA.

Amblyopia is the leading cause of monocular vision loss in children. Early recognition and treatment are important to prevent vision loss. The U. Read More

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December 2019

Marcus Gunn Jaw-Winking Syndrome: a Case Report.

Med Arch 2019 Aug;73(4):282-284

Eye Clinic Svjetlost, Sarajevo, Bosnia and Herzegovina.

Introduction: Marcus Gunn syndrome is a rare phenomenon with very less number of cases reported in literature. It may be congenital or acquired.

Aim: The aim of this case report was to report the clinical characteristics of Marcus Gunn patient from our Clinic. Read More

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Diplopia after strabismus surgery for adults with nondiplopic childhood-onset strabismus.

J AAPOS 2019 12 3;23(6):313.e1-313.e5. Epub 2019 Oct 3.

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota. Electronic address:

Purpose: To describe frequency of postoperative diplopia after strabismus surgery in nondiplopic adults with childhood-onset strabismus and to report health-related quality-of-life (HRQOL) outcomes.

Methods: We prospectively enrolled 79 adults with no diplopia in any gaze who had childhood-onset strabismus and were scheduled for strabismus surgery. Diplopia was assessed preoperatively and at 6 weeks and 1 year postoperatively using a standardized diplopia questionnaire with 5 response options in 7 gaze positions. Read More

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December 2019

Conservative management of intermittent exotropia to defer or avoid surgery.

Authors:
Burton J Kushner

J AAPOS 2019 10 14;23(5):256.e1-256.e6. Epub 2019 Sep 14.

Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin. Electronic address:

Background: Surgery for intermittent exotropia performed at a very young age has poorer sensory outcomes than surgery performed later; moreover, postoperative recurrence is common, regardless of age. Alternate occlusion decreases the size of the exotropia and improves control. The purpose of this study was to report the long-term effects of part-time alternate occlusion and overminus spectacles combined with prism on delaying or avoiding surgery in intermittent exotropia. Read More

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October 2019

[Intermittent exotropia].

Authors:
F Audren

J Fr Ophtalmol 2019 Nov 10;42(9):1007-1019. Epub 2019 Jul 10.

Fondation ophtalmologique Adolphe-de-Rothschild, 25, rue Manin, 75019 Paris, France. Electronic address:

Intermittent exotropia (IXT) is the most common type of divergent strabismus. It is the consequence of passive mechanisms due to the anatomy of the globes and orbits or due to active innervational mechanisms, resulting in divergence of the visual axes, which is compensated by fusional convergence. Intermittent insufficiency in this compensation gives this form of exotropia its intermittent nature. Read More

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November 2019

Strabismus surgery in the setting of glaucoma drainage devices in the pediatric population.

J AAPOS 2019 04 15;23(2):83.e1-83.e8. Epub 2019 Mar 15.

Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina. Electronic address:

Purpose: To evaluate outcomes of strabismus surgery performed subequent to or concomitant with glaucoma drainage device (GDD) implantation for refractory childhood glaucoma.

Methods: The medical records of children who underwent strabismus surgery after or concomitantly with GDD implantation were reviewed retrospectively. Included were surgeries with motility and alignment data measured preoperatively and ≥3 months postoperatively. Read More

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Efficacy of Smartphone-based Exercises in Conjunction with Modified Glasses Prescription in the Treatment of Convergence Insufficiency and Fusion Weakness.

J Binocul Vis Ocul Motil 2019 Jan-Mar;69(1):30-33. Epub 2019 Mar 1.

c Department of Ophthalmology , SMS Medical College , Jaipur , India.

Purpose: To determine the efficacy of Smartphone-based exercises in conjunction with modified glasses prescription in the treatment of convergence insufficiency and fusion weakness.

Methods: A total of 150 patients using glasses and having asthenopia between 15 and 30 years of age were subjected to thorough eye examination including binocular vision testing and refraction. Of them 26 individuals were found to have convergence insufficiency with fusion weakness and exophoria >6 pd. Read More

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Ocular motility alterations in orbital fractures: pre-post evaluation in maxillofacial surgical treatment.

G Chir 2018 Nov-Dec;39(6):363-367

Purpose: The study aims to investigate the ability of maxillofacial surgery to reduce strabismus and improve ocular clinical symptomatology in patients with fracture of the medial or lateral floor of the orbit, or both, and to evaluate such abilities relative to the temporal distance between trauma and surgery.

Patients And Methods: 25 patients with traumatic diplopia were evaluated by CT, Goldman manual field of view, Hess-Lancaster test, eye examination and orthoptic examination, before and after surgery.

Results: We observed: a statistically significant reduction of the deviation angle, both from close and long distance (P = 0. Read More

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September 2019

[Evaluation by quality of life questionnaires in patients undergoing strabismus surgery in Graves' disease].

J Fr Ophtalmol 2018 Nov 11;41(9):814-822. Epub 2018 Sep 11.

Service d'ophtalmologie, CHU Nancy-Brabois, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.

Purpose: To evaluate the improvement in quality of life of patients operated within 6 months for strabismus in Graves' disease using a questionnaire.

Materials And Methods: A retrospective study was based on a cohort of patients undergoing strabismus surgery for Graves' disease at the Nancy university medical center between June 2015 and January 2017. A quality-of-life questionnaire composed of the functional GO QOL questionnaire plus 10 additional questions was given to patients. Read More

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November 2018

Damage to the inferior oblique muscle branch of the oculomotor nerve: a complication during orbital fat decompression.

Int Ophthalmol 2019 Mar 8;39(3):711-716. Epub 2018 Feb 8.

Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan.

Purpose: To present patients who suffered damage to the inferior oblique muscle branch of the oculomotor nerve during orbital fat decompression.

Methods: This study was a retrospective chart review of all patients who underwent orbital decompression surgery between April 2009 and June 2016 by the authors.

Results: Among 414 sides from 226 consecutive patients who underwent orbital decompression, the inferior oblique muscle branch was injured in two sides (0. Read More

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Botulinum toxin as an initial therapy for management of sixth nerve palsies caused by nasopharyngeal carcinomas.

Eye (Lond) 2018 04 26;32(4):768-774. Epub 2018 Jan 26.

Hong Kong Eye Hospital, Kowloon, Hong Kong.

PurposeThe purpose of this study is to evaluate the efficacy and safety of botulinum toxin injection as a primary treatment for strabismus in a cohort of patients with nasopharyngeal carcinoma (NPC)-related chronic sixth nerve palsy.Patients and methodsWe retrospectively reviewed all cases of NPC-related sixth nerve palsy receiving botulinum toxin injection in the Hong Kong Eye Hospital between January 2009 and January 2016. Only cases with diplopia for at least 6 months; and failed a trial of Fresnel prism therapy were recruited. Read More

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Factors Associated With Failure of Adult Strabismus-20 Questionnaire Scores to Improve Following Strabismus Surgery.

JAMA Ophthalmol 2018 01;136(1):46-52

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.

Importance: Health-related quality of life (HRQOL) typically improves following strabismus surgery. Nevertheless, for some patients, HRQOL does not improve, and reasons for this are unknown.

Objective: To identify factors associated with failure of adult strabismus-20 (AS-20) HRQOL scores to improve following strabismus surgery. Read More

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January 2018

Synergistic divergence: case series and literature review.

Br J Ophthalmol 2018 07 12;102(7):892-901. Epub 2017 Oct 12.

Faculty of Medicine, Cairo University, Cairo, Egypt.

Background: To present the data of a series of patients with synergistic divergence, to propose a different modality of surgical correction and to perform a literature review of such a rare entity.

Methods: A retrospective study was performed on all patients who presented with unilateral or bilateral synergistic divergence to the Ophthalmology Department, Cairo University, during the period from January 2007 to July 2016. The demographic data, the results of sensorimotor examination, the surgical procedures performed and the ophthalmological as well as the systemic findings of all patients were collected and tabulated. Read More

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Surgical Outcome of Intermittent Exotropia With Improvement in Control Grade Subsequent to Part-time Preoperative Occlusion Therapy.

J Pediatr Ophthalmol Strabismus 2018 Jan 9;55(1):59-64. Epub 2017 Oct 9.

Purpose: To evaluate the effect of improvement in the control grade of intermittent exotropia using part-time occlusion therapy on the final postoperative outcome.

Methods: Control of intermittent exotropia was graded as good, fair, or poor in 89 consecutive patients with intermittent exotropia during their first visit. The patients were reevaluated after part-time preoperative occlusion therapy and divided into two groups (improvement and no improvement) according to whether they showed improvement in control grade. Read More

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January 2018

Animal Model for Retinopathy of Prematurity Laser Surgery Training.

J Pediatr Ophthalmol Strabismus 2017 Aug 24;54:e47-e49. Epub 2017 Aug 24.

Peripheral retinal laser ablation for high-risk retinopathy of prematurity (ROP) improves visual outcomes. Some pediatric ophthalmology fellows receive little exposure to this procedure. The authors identified and evaluated an animal teaching model that simulates peripheral retinal laser ablation in human infants with ROP. Read More

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Reeducation of vergence dynamics improves postural control.

Neurosci Lett 2017 Aug 17;656:22-30. Epub 2017 Jul 17.

CNRS, FR3636, IRIS, University Paris Descartes, Paris, France. Electronic address:

Introduction: The purpose was to investigate the effect of vergence reeducation on postural control, in subjects with isolated vergence disorders.

Material And Methods: We studied the dynamics of vergence in 19 subjects (20-44 years old) using video-oculography (Eye See Cam). On the basis of orthoptic and symptomatology assessments, ten of the subjects were diagnosed for vergence disorders then vergence eye movements were reeducated with the REMOBI method (US8851669, 5 weekly sessions lasting for 35min). Read More

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Combination of anterior segment optical coherence tomography modalities to improve accuracy of rectus muscle insertion location.

J AAPOS 2017 Jun 17;21(3):243-246. Epub 2017 May 17.

Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida. Electronic address:

Anterior segment optical coherence tomography (AS-OCT) is useful for locating the extraocular muscle insertion prior to strabismus surgery; however, its accuracy decreases in reoperations. This masked retrospective study investigated whether a combination of AS-OCT modalities improves accuracy. The distance between the corneoscleral limbus and extraocular muscle insertion was measured with AS-OCT, first using the standard grayscale modality alone and then refined with the color modality. Read More

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