Clinical problems in strabismus: the Smith-Kettlewell Eye Research Institute symposium.

The Smith Kettlewell Eye Research Institute (SKERI), celebrating its 50th anniversary in 2014, hosted a symposium to identify the most pressing clinical problems in strabismus and binocular vision. Forty-five experts from around the world shared their perspectives at the San Francisco meeting, held November 6-9, 2012. Prior to the meeting, the organizers (TR, APW, RH, JB, AJ) asked attendees to identify the most pressing clinical problems in strabismus and to discuss them in a workshop-based format.

The influence of body position on Bielschowsky's test.

Purpose: To investigate the veracity of Jampolsky's statement that Bielschowsky's head tilt test is inverted if performed with the patient in the upside-down position and to interpret its neuromuscular mechanism.

Methods: We present a series of 10 patients selected from a referred sample who were diagnosed with superior oblique paresis. Hypertropia was measured in the primary position, with the head erect and tilted toward both shoulders with the patient in the erect, supine, and upside-down positions.

Sideslip of the medial rectus muscle during vertical eye rotation.

Purpose: The kinematics of eye rotation is not entirely elucidated despite two centuries of fascination with the deceptively simple yet geometrically complex nature of the movement. Recently, the traditional view that oculorotatory muscles except the superior oblique muscle exert straight pull on the globe has been challenged by the claim that the muscles also go through a connective tissue pulley-like structure that holds them steady during eye rotation. Although earlier studies failed to observe sideslippage at the posterior part of muscles, a finding supportive of the pulley hypothesis, the conclusions should not be taken as conclusive given short-comings in the techniques used in the studies.

The SKILL Card. An acuity test of reduced luminance and contrast. Smith-Kettlewell Institute Low Luminance.

Purpose: To design and evaluate a new vision test that combines low contrast and reduced illumination to stress the visual system and be sensitive to subtle alterations in function.

Methods: A simple new clinical test, the Smith-Kettlewell Institute Low Luminance (SKILL) Card, is designed to measure spatial vision under conditions of reduced contrast and luminance using normal office lighting. The SKILL Card consists of two near acuity charts mounted back to back.