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Background Virtual reality is being increasingly applied in vision therapy. However, the differences in effectiveness, optimal treatment cycle, and prognosis between virtual reality-based vision therapy and traditional therapies remain unknown. The purpose of this study was to compare the effectiveness of virtual reality-based vision therapy and office-based vergence/accommodative therapy in young adults with convergence insufficiency or accommodative dysfunction. Methods The patients were randomly assigned to either the virtual reality-based vision therapy group or the office-based vergence/accommodative therapy group. The vision therapy lasted 12 weeks (1 h/week) in both groups. Binocular visual functions (vergence and accommodation) were measured and a subjective questionnaire-based assessment was performed at baseline and after 6 and 12 weeks of therapy. Results In total, 33 patients with convergence insufficiency and 30 with accommodative dysfunction completed the study. After 12 weeks of treatment for convergence insufficiency, the Convergence Insufficiency Symptom Survey score (F 2,31  = 13.704, P < 0.001), near point of convergence (F 2,31  = 21.774, P  < 0.001), positive fusional vergence (F 2,31  = 71.766, P  < 0.001), and near horizontal phoria (F 2,31  = 16.482, P  < 0.001) improved significantly in both groups. Moreover, the monocular accommodative amplitude (F 2,25  = 22.154, P  < 0.001) and monocular accommodative facility (F 2,25  = 86.164, P  < 0.001) improved significantly in both groups after 12 weeks of treatment. A statistically significant difference was observed in monocular accommodative facility (F 1,25  = 8.140, P  = 0.009) between the two groups, but not in other vergence and accommodative functions (0.098 <  P  < 0.687). Conclusion Virtual reality-based vision therapy significantly improved binocular vision functions and symptoms in patients with convergence insufficiency and accommodative dysfunction, thereby suggesting its effectiveness as a new optional or additional treatment for young adults with these conditions. Trial registration This study was registered at the Chinese Clinical Trials Registry on 16/04/2019 (identifier: ChiCTR1900022556 ).

Purpose: To compare base-in prism reading glasses with placebo reading glasses for the treatment of symptomatic convergence insufficiency (CI) in children aged 9 to <18 years. Methods: In a randomised clinical trial, 72 children aged 9 to <18 years with symptomatic CI were assigned to either base-in prism glasses or placebo reading glasses. Symptom level, measured with a quantitative symptom questionnaire (CI Symptom Survey-V15), was the primary outcome measure. Near point of convergence and positive fusional vergence at near were secondary outcomes. Results: The mean (SD) CI Symptom Survey score decreased (that is, less symptomatic) in both groups (base-in prism glasses from 31.6 (10.4) to 16.5 (9.2); placebo glasses from 28.4 (8.8) to 17.5 (12.3)). The change in the CI Symptom Survey scores (p = 0.33), near point of convergence (p = 0.91), and positive fusional vergence (p = 0.59) were not significantly different between the two groups after 6 weeks of wearing glasses. Conclusions: Base-in prism reading glasses were found to be no more effective in alleviating symptoms, improving the near point of convergence, or improving positive fusional vergence at near than placebo reading glasses for the treatment of children aged 9 to <18 years with symptomatic CI.

Purpose To compare the range of ocular rotations measured by Octopus versus Goldmann perimetry. Methods Forty subjects (20 controls and 20 patients with impaired ocular movements) were prospectively recruited, age range 21–83 years. Range of uniocular rotations was measured in six vectors corresponding to extraocular muscle actions: 0°, 67°, 141°, 180°, 216°, 293°. Fields of binocular single vision were assessed at 30° intervals. Vector measurements were utilised to calculate an area score for the field of uniocular rotations or binocular field of single vision. Two test speeds were used for Octopus testing: 3°/ and 10°/second. Results Test duration was two thirds quicker for Octopus 10°/second than for 3°/second stimulus speed, and slightly quicker for Goldmann. Mean area for control subjects for uniocular field was 7910.45 degrees 2 for Goldmann, 7032.14 for Octopus 3°/second and 7840.66 for Octopus 10°/second. Mean area for patient subjects of right uniocular field was 8567.21 degrees 2 for Goldmann, 5906.72 for Octopus 3°/second and 8806.44 for Octopus 10°/second. Mean area for left uniocular field was 8137.49 degrees 2 for Goldmann, 8127.9 for Octopus 3°/second and 8950.54 for Octopus 10°/second. Range of measured rotation was significantly larger for Octopus 10°/second speed. Conclusions Our results suggest that the Octopus perimeter is an acceptable alternative method of assessment for uniocular ductions and binocular field of single vision. Speed of stimulus significantly alters test duration for Octopus perimetry. Comparisons of results from both perimeters show that quantitative measurements differ, although qualitatively the results are similar. Differences per mean vectors were less than 5° (within clinically accepted variances) for both controls and patients when comparing Goldmann to Octopus 10°/second speed. However, differences were almost 10° for the patient group when comparing Goldmann to Octopus 3°/second speed. Thus, speed of stimulus must be considered if wishing to use these perimeters interchangeably.

Disconjugate eye movements have been associated with traumatic brain injury since ancient times. Ocular motility dysfunction may be present in up to 90% of patients with concussion or blast injury. We developed an algorithm for eye tracking in which the Cartesian coordinates of the right and left pupils are tracked over 200 sec and compared to each other as a subject watches a short film clip moving inside an aperture on a computer screen. We prospectively eye tracked 64 normal healthy noninjured control subjects and compared findings to 75 trauma subjects with either a positive head computed tomography (CT) scan (n=13), negative head CT (n=39), or nonhead injury (n=23) to determine whether eye tracking would reveal the disconjugate gaze associated with both structural brain injury and concussion. Tracking metrics were then correlated to the clinical concussion measure Sport Concussion Assessment Tool 3 (SCAT3) in trauma patients. Five out of five measures of horizontal disconjugacy were increased in positive and negative head CT patients relative to noninjured control subjects. Only one of five vertical disconjugacy measures was significantly increased in brain-injured patients relative to controls. Linear regression analysis of all 75 trauma patients demonstrated that three metrics for horizontal disconjugacy negatively correlated with SCAT3 symptom severity score and positively correlated with total Standardized Assessment of Concussion score. Abnormal eye-tracking metrics improved over time toward baseline in brain-injured subjects observed in follow-up. Eye tracking may help quantify the severity of ocular motility disruption associated with concussion and structural brain injury.

Disease-specific oculomotor assessments play a crucial role in the early diagnosis of hereditary cerebellar ataxias. Whereas several studies have reported on quantitative oculomotor and vestibular measurements in Friedreich’s Ataxia (FRDA), the value of specific oculomotor paradigms remains unclear. We aimed to address this knowledge gap through a systematic literature review and providing disease-specific recommendations for a tailored set of eye-movement recordings in FRDA. MEDLINE and Embase were searched for studies reporting on quantitative oculomotor and/or vestibular measurements in FRDA-patients. Data on oculomotor and vestibular parameters were extracted and correlations with a range of clinical parameters were sought. Included studies ( n  = 17) reported on 185 patients. Abnormalities observed included the presence of saccadic intrusions (143/161) such as square-wave jerks (SWJ, 90/109) and ocular flutter (21/43), impaired eccentric gaze-holding (40/104), abnormal pursuit (81/93) and angular vestibulo-ocular reflex (aVOR) deficits (39/48). For visually-guided saccades (VGS), we frequently observed increases in saccade latency (27/38) and dysmetric saccades (71/93), whereas saccade velocity was more often preserved (37/43). Augmented anti-saccade (AS) latency, downbeat nystagmus and frequent macro-SWJ correlated with disease duration. Increased AS-latency and VGS-latency, frequent macro-SWJ, reduced aVOR-gain and augmented aVOR peak-latency correlated with disease severity. A broad range of oculomotor and vestibular deficits are documented in the literature. Impairments in pursuit, saccades and aVOR-responses are most commonly reported, and as such, should be prioritized as disease markers. Quantitative oculomotor testing in FRDA may facilitate early diagnosis and prove valuable in monitoring disease progression and treatment response.

Oculomotor deficits are common in hereditary ataxia, but disproportionally neglected in clinical ataxia scales and as outcome measures for interventional trials. Quantitative assessment of oculomotor function has become increasingly available and thus applicable in multicenter trials and offers the opportunity to capture severity and progression of oculomotor impairment in a sensitive and reliable manner. In this consensus paper of the Ataxia Global Initiative Working Group On Digital Oculomotor Biomarkers, based on a systematic literature review, we propose harmonized methodology and measurement parameters for the quantitative assessment of oculomotor function in natural-history studies and clinical trials in hereditary ataxia. MEDLINE was searched for articles reporting on oculomotor/vestibular properties in ataxia patients and a study-tailored quality-assessment was performed. One-hundred-and-seventeen articles reporting on subjects with genetically confirmed ( n =1134) or suspected hereditary ataxia ( n =198), and degenerative ataxias with sporadic presentation ( n =480) were included and subject to data extraction. Based on robust discrimination from controls, correlation with disease-severity, sensitivity to change, and feasibility in international multicenter settings as prerequisite for clinical trials, we prioritize a core-set of five eye-movement types: (i) pursuit eye movements, (ii) saccadic eye movements, (iii) fixation, (iv) eccentric gaze holding, and (v) rotational vestibulo-ocular reflex. We provide detailed guidelines for their acquisition, and recommendations on the quantitative parameters to extract. Limitations include low study quality, heterogeneity in patient populations, and lack of longitudinal studies. Standardization of quantitative oculomotor assessments will facilitate their implementation, interpretation, and validation in clinical trials, and ultimately advance our understanding of the evolution of oculomotor network dysfunction in hereditary ataxias.

Abstract PurposeTo describe clinical manifestations and short-term prognosis of ocular motility disorders following coronavirus disease-2019 (COVID-19) vaccination.MethodsOcular motility disorders were diagnosed by clinical assessment, high-resolution magnetic resonance imaging, and laboratory testing. Clinical manifestations, short-term prognosis, and rate of complete recovery were analyzed.ResultsSixty-three patients (37 males, 26 females) with a mean age of 61.6 ± 13.3 years (range, 22–81 years) were included in this study. Among 61 applicable patients with sufficient information regarding medical histories, 38 (62.3%) had one or more significant underlying past medical histories including vasculopathic risk factors. The interval between initial symptoms and vaccination was 8.6 ± 8.2 (range, 0–28) days. Forty-two (66.7%), 14 (22.2%), and 7 (11.1%) patients developed symptoms after the first, second, and third vaccinations, respectively. One case of internuclear ophthalmoplegia, 52 cases of cranial nerve palsy, two cases of myasthenia gravis, six cases of orbital diseases (such as myositis, thyroid eye disease, and IgG-related orbital myopathy), and two cases of comitant vertical strabismus with acute onset diplopia were found. Among 42 patients with follow-up data (duration: 62.1 ± 40.3 days), complete improvement, partial improvement, no improvement, and exacerbation were shown in 20, 15, 3, and 4 patients, respectively.ConclusionThis study provided various clinical features of ocular motility disorders following COVID-19 vaccination. The majority of cases had a mild clinical course while some cases showed a progressive nature. Close follow-up and further studies are needed to elucidate the underlying mechanisms and long-term prognosis.

Purpose To clarify the clinical features of patients with Double seronegative (DS) ocular myasthenia gravis (OMG). Methods Sixty-one patients diagnosed with DS OMG at the Department of Ophthalmology, Hyogo Medical University Hospital over a 5-year period from 2017 were included. Patients were classified into three groups based on the initial examination findings: group P (ptosis alone), group M (ocular motility disorder alone), and group PM (combination of both). We retrospectively reviewed the patients and clarified their clinical features. Results There were 32 males and 29 females, with a mean age of 49.8 ± 20.9:1–82 years. Twenty-one patients (34.4%) were in group P, 23 (37.7%) in group M, and 17 (27.8%) in group PM. The proportion of males (73.9%) was significantly higher in group M compared with the other two groups. The diagnosis was proven by detection of neuromuscular junction (NMJ) disorder in 73.8%, oral pyridostigmine trial test in 13.1%, and eight patients (13.1%) in group M were diagnosed after surgical treatment. The clinical symptoms were resolved by oral pyridostigmine treatment in 54.1% of cases. Conclusion About 30% of patients with DS OMG had no obvious NMJ disorder, and an oral pyridostigmine trial test was necessary to diagnose these patients. Although DS OMG is often considered as the mildest form of MG, its prognosis is not optimistic and it requires aggressive therapeutic intervention. Trial registration Trial registration number: 202104–750, “2016/4/18,” retrospectively registered.

Non-motor symptoms in Parkinson’s disease are an important cause of morbidity and may even precede the onset of the motor features of the disease. Visual abnormalities are among the most frequent non-motor symptoms observed during the early stages of the disease. Some of the visual symptoms of Parkinson’s disease can likely be explained by the presence of dopaminergic neurons within the retina, where the progressive loss of dopamine and the accumulation of α-synuclein within the retinal layers leads to visual dysfunction, while some are caused by abnormalities in cortical visual processing. Many of these visual symptoms can be overlooked or go unrecognized. We review the visual symptoms in Parkinson’s disease, including visual-processing and ocular motility abnormalities, stereopsis deficits, and visual hallucinations, focusing on the early stages of the disease. We focus on the reciprocal influence between the visual symptoms and the progression of the disease, analyzing the influence of dopaminergic therapy on the visual abnormalities. Finally, we discuss the possible role of some of these visual symptoms as possible markers or early diagnostic signs of the disease.