The Use of the Saccadometer to Identify Saccadic Characteristics in Myasthenia Gravis: A Pilot Study.

Background: Myasthenia gravis (MG) often presents with ocular signs that mimic other forms of ocular defects, such as isolated cranial nerve palsy. Normal velocity or even hyperfast saccadic eye movements in the presence of deficits of smooth pursuit have been well described in the literature in myasthenic patients. The reason for these paradoxical clinical findings has been reported to be due to increased postsynaptic folding of the fast-twitch fibers responsible for the execution of a saccade which is absent in those fibers responsible for slower, smooth eye movement.

Accuracy of kinetic perimetry assessment with the Humphrey 850; an exploratory comparative study.

Aim: To compare kinetic perimetry on the Humphrey 850 and Octopus 900 perimeters for assessment of visual fields, uniocular rotations and fields of binocular single vision.

Methods: Prospective cross section study comparing Humphrey 850 kinetic perimetry to kinetic perimetry using the Octopus 900. Results were compared for both perimeters for the measurement of visual field boundaries, uniocular rotations and fields of binocular single vision in subjects with normal visual function, with comparisons of mean vector extremity values and duration of testing.

Visual Function Questionnaire as an outcome measure for homonymous hemianopia: subscales and supplementary questions, analysis from the VISION trial.

Background: We conduct supplementary analyses of the NEI VFQ-25 data to evaluate where changes occurred within subscales of the NEI VFQ-25 leading to change in the composite scores between the three treatment arms, and evaluate the NEI VFQ-25 with and without the Neuro 10 supplement.

Methods: A prospective, multicentre, parallel, single-blind, three-arm RCT of fourteen UK acute stroke units was conducted. Stroke survivors with homonymous hemianopia were recruited.

Neuromyelitis optica spectrum disorders.

Neuromyelitis optica spectrum disorder (NMOSD) is an uncommon antibody-mediated disease of the central nervous system. Long segments of spinal cord inflammation (myelitis), severe optic neuritis, and/or bouts of intractable vomiting and hiccoughs (area postrema syndrome) are classic presentations of the disease and may alert the clinician to the diagnosis. Untreated, approximately 50% of NMOSD patients will be wheelchair users and blind, and a third will have died within 5 years of their first attack.

Interventions for eye movement disorders due to acquired brain injury.

Background: Acquired brain injury can cause eye movement disorders which may include: strabismus, gaze deficits and nystagmus, causing visual symptoms of double, blurred or 'juddery' vision and reading difficulties. A wide range of interventions exist that have potential to alleviate or ameliorate these symptoms. There is a need to evaluate the effectiveness of these interventions and the timing of their implementation.

Botulinum toxin for the treatment of strabismus.

Background: The use of botulinum toxin as an investigative and treatment modality for strabismus is well reported in the medical literature. However, it is unclear how effective it is in comparison to other treatment options for strabismus.

Objectives: The primary objective was to examine the efficacy of botulinum toxin therapy in the treatment of strabismus compared with alternative conservative or surgical treatment options.

A Randomised Controlled Trial of Treatment for Post-Stroke Homonymous Hemianopia: Screening and Recruitment.

The authors report the screening process and recruitment figures for the VISION (Visual Impairment in Stroke; Intervention Or Not) trial. This is a prospective, randomised, single-blinded, three-arm controlled trial in 14 UK acute hospital stroke units. Stroke teams identified stroke survivors suspected as having homonymous hemianopia.

Bilateral optic disc edema as a presentation of an obstructing spinal plasmacytoma.

Purpose: To report a rare case of bilateral optic disc edema as presentation of an obstructing spinal plasmacytoma.

Methods: Case report.

Results: A 41-year-old healthy man presented with distortion of his peripheral vision for 9 months.

Delivery of high quality stroke and vision care: experiences of UK services.

Purpose: We sought to identify exemplars of high quality care provision from established stroke vision services.

Methods: We identified areas of high quality services across the UK, judged as having integrated stroke/vision care provision for stroke survivors. Healthcare professionals were selected to participate in 1:1 interviews or focus groups.

Detection of Visual Field Loss in Pituitary Disease: Peripheral Kinetic Versus Central Static.

Visual field assessment is an important clinical evaluation for eye disease and neurological injury. We evaluated Octopus semi-automated kinetic peripheral perimetry (SKP) and Humphrey static automated central perimetry for detection of neurological visual field loss in patients with pituitary disease. We carried out a prospective cross-sectional diagnostic accuracy study comparing Humphrey central 30-2 SITA threshold programme with a screening protocol for SKP on Octopus perimetry.

Care provision for poststroke visual impairment.

Background: We sought to explore the care provision for poststroke visual impairment and variations in this in the United Kingdom.

Methods: Survey questions were developed and piloted with clinicians, academics, and users. Questions addressed types of visual problems; how these were identified, treated, and followed up; care pathways in use; links with other professions; and referral options.

Comparison of octopus semi-automated kinetic perimetry and humphrey peripheral static perimetry in neuro-ophthalmic cases.

Aim. To compare semikinetic perimetry (SKP) on Octopus 900 perimetry to a peripheral static programme with Humphrey automated perimetry. Methods.

Botulinum toxin for the treatment of strabismus.

Background: The use of botulinum toxin as an investigative and treatment modality for strabismus is well reported in the medical literature. However it is unclear how effective its use is in comparison to other treatment options for strabismus.

Objectives: To evaluate the efficacy of botulinum toxin in the treatment of strabismus compared with alternative treatment options, to investigate dose effect and complication rates.

Losing sight under pressure.

A non-communicative patient with vascular dementia who was admitted to hospital with non-specific symptoms. Ophthalmic emergencies are rare, however they should be considered as part of a systemic work-up in unexplained non-specific presentations, particularly in patients who are not able to communicate as in the case we present here.

Relatively spared central multifocal electroretinogram responses in acute quinine toxicity.

A 71-year-old man was investigated with electrodiagnostic testing 4 months after a deliberate quinine overdose. Initially he was admitted to intensive care unit with visual acuity (VA) of perception of light in both eyes. VA recovered to 6/6 right eye and 6/12 left eye, though severely constricted fields were noted.

The psychosocial effects of strabismus: effect of patient demographics on the AS-20 score.

Purpose: The introduction of the AS-20 strabismus-specific quality-of-life questionnaire allows clinicians to quantify the effects of strabismus on adults for the first time. We correlated strabismic patients' demographic and clinical findings to their AS-20 scores.

Methods: A consecutive cohort of patients from an ongoing prospective study of adults with manifest strabismus was recruited.

The psychosocial effects of adult strabismus: a review.

Correction of adult strabismus is not a cosmetic procedure but one that restores normality to an individual's appearance that has been altered by a disease process. Two fundamental principles underpinning facial attractiveness are symmetry and averageness-manifest strabismus affects both of these giving an unconscious signal of poor genetic history. The presence of manifest strabismus adversely affects many aspects of patients' lives including finding a partner, job prospects and interaction with peers, and may manifest more seriously as psychiatric disorders.

Ketamine and botulinum: a safe combinationfor the management of childhood strabismus.

Aims: To determine the prevalence of ketamine side effects in children receiving botulinum toxin injections for strabismus under ketamine anesthesia and to establish the prevalence, severity, and duration of ptosis in these children.

Methods: Children who had undergone ketamine anesthesia for botulinum toxin injections (1999 to 2006) to correct strabismus were identified in a retrospective review. A questionnaire to establish occurrence of nightmares, sleepless nights, hallucinations (ketamine side effects), or ptosis (botulinum toxin side effect), was sent to parents or guardians.

Dose effect of botulinum toxin a in heterotropia and heterophoria.

Purpose: To evaluate the short-term dose effect of botulinum toxin in manifest and intermittent horizontal strabismus types.

Methods: Dysport of 2 international units was injected into a single muscle in cases of constant esotropia and exotropia plus decompensating esophoria and exophoria. Electromyography (EMG) signal was recorded during each procedure.

Complications of botulinum toxin a and their adverse effects.

Aim: To evaluate the prevalence of complications after low doses (< 3 units) of botulinum toxin (BT) injection to horizontal extraocular muscles for diagnostic and therapeutic purposes.

Methods: A case record review was undertaken of patients treated with BT (Dysport) since 2000. Data were extracted for gender, age, diagnosis, number of BT injections, dose, recorded complications, and time to recovery.

Botulinum toxin for the treatment of strabismus.

Background: The use of botulinum toxin as an investigative and treatment modality for strabismus is well reported in the medical literature. However it is unclear how effective its use is in comparison to other treatment options for strabismus.

Objectives: To evaluate the efficacy of botulinum toxin in the treatment of strabismus compared with alternative treatment options, to investigate dose effect and complication rates.

Bilateral combined resection and recession of the medial rectus muscle for convergence excess esotropia.

Five patients with true convergence excess esotropia were surgically managed with combined resection and recession of the medial rectus muscles. This technique was chosen to address the near/distance angle disparity. The use of this surgical technique produced full asymptomatic binocular control at near and distance fixation in four patients.

Modified Lundie loops improve apraxia of eyelid opening.

Background: Current treatments are unsatisfactory for improving apraxia of eyelid opening, defined as a delay or inability to open closed eyelids voluntarily in the presence of intact motor pathways.

Methods: Improvement in functional health was assessed using the Blepharospasm Disability Scale (BDS) in five consecutive patients with apraxia of eyelid opening treated with wire loops affixed behind ordinary spectacles (Lundie loops) and modified to provide pressure on the brow as a stimulus to keep the eyelids elevated.

Results: All five patients showed improvement in BDS scores.

Surgical treatment for progressive esotropia in the setting of high-axial myopia.

Acquired esotropia in association with high myopia may be secondary to displacement of the lateral rectus muscle pulley system or to the mechanical restriction due to the contact between the posterior elongated globe and the orbital apex limiting rotation. We present the clinical findings and surgical management of a patient with this condition.