Do spectacles alter all squints: Dr. Madhu Karna Strabismologist
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This document discusses how corrective spectacle lenses can introduce artifacts when measuring strabismus. It provides a simplified model and formula to calculate the true strabismus deviation based on the measured deviation through spectacles. Specifically, it states that plus lenses decrease the measured deviation while minus lenses increase it, with the effect becoming significant for refractive errors over +5 diopters. The document emphasizes that in clinical practice the measured deviation is found first and the true deviation must then be calculated using this correction formula.
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2) Examination found a central corneal edema, brown pupil, iris cyst, and elevated intraocular pressure of 60mm Hg. B-scan was unremarkable. A diagnosis of anteriorly subluxated lens with malignant glaucoma or iris pigment epithelial/ciliary body tumor was considered.
3) The intraocular pressure was reduced with medications but remained elevated. The iris cyst was then aspirated using a minimally invasive approach with chemical ablation using absolute alcohol, resulting in cyst retraction and improved vision.
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1) Measured strabismus deviations taken over glasses can differ from the true deviation depending on the glasses' refractive power, with plus lenses decreasing and minus lenses increasing the measured deviation.
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2. The duochrome test which takes advantage of chromatic aberration, using a split red-green filter to refine the endpoint by comparing clarity on red and green backgrounds.
3. Additional methods like pinhole and fogging are described to control accommodation and improve accuracy.
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This document discusses guidelines for prescribing glasses for different ages and refractive errors. It provides recommendations for fully correcting or undercorrecting various degrees of myopia, hyperopia and astigmatism in children and adults. It also discusses the differences in prescribing for children under 5 years versus adults. Examples are given of specific prescriptions. The document also explains what progressive addition lenses are and their advantages over traditional bifocals.
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This document discusses various techniques for subjective refraction including determining the best vision sphere and using the duochrome test. It provides details on:
1. Using plus and minus lenses to find the maximum plus or minimum minus that can be tolerated without blurring vision, known as the best vision sphere.
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Visual acuity in infants
This document discusses methods of measuring visual acuity in infants. It describes that visual acuity improves rapidly in the first years of life and matures around 5-6 years old. Several tests are mentioned, including optokinetic nystagmus testing, preferential looking tests, visually evoked responses, Cardiff acuity card tests, and observation of fixation behavior. Normal visual development milestones from birth to age 5 are provided. The document gives details on different visual acuity tests used with infants, such as the optokinetic nystagmus test, preferential looking test, and Lea paddle test.
By pd examination of a squint
Please look at the light and tell me what you see
Patient: I see two lights that are side by side
Assistant: Now I am going to move the lights closer together. Tell me if you still see two lights or if they merge into one.
Patient: As you move the lights closer, they are now merging into one light.
Assistant: Thank you. That demonstrates you do not have diplopia in primary position. Now I am going to move the light up, down, left, and right. Please tell me if you see one light or two lights as I move it to different positions.
This tests for diplopia in different gazes which helps localize the site of the problem causing diplopia
Accommodative esotropia
This document discusses different types of esotropia (inward eye turning), including accommodative esotropia caused by uncorrected refractive errors, convergence excess esotropia caused by a high AC/A ratio, and early onset esotropia appearing before age 6 months. Accommodative esotropia is treated initially with corrective lenses, while convergence excess may require bifocals or surgery. Early onset esotropia often requires surgery by age 1-2 years to align the eyes, with risks of undercorrection, amblyopia, or development of dissociated vertical deviation. The document provides details on diagnostic criteria and management approaches for various forms of esotropia.
Methods of visual acuity testing in preverbal children
The document discusses various methods for testing visual acuity in preverbal children, including historical and observational techniques, fixation targets, binocular fixation preference testing, and the CSM method. Visual acuity develops rapidly in the first year of life and continues to mature, reaching adult levels around 5-6 years of age. A variety of tests are used depending on the child's age and verbal ability, including forced choice preferential looking tests and visual evoked potentials for younger infants, and recognition tests using toys, balls, or pictures for older children. Accurate assessment of visual acuity in preverbal children relies on their visual behaviors and responses.
Slit lamp
Slit lamps are used to carefully examine the cornea, conjunctiva, and lids of the anterior eye segment. The microscope and light source are coupled so that the same part of the eye being examined is illuminated. This coupling facilitates examination. Main components include the slit lamp microscopes, illumination systems, and mechanical coupling. Attachments allow for fundus examination, gonioscopy, tonometry, laser photocoagulation, and measuring visual acuity in patients with hazy media. Magnification typically ranges from 6x to 40x.
Amblyopia
Amblyopia is a reduction in best corrected visual acuity that cannot be attributed to structural eye abnormalities and results from strabismus, anisometropia, high bilateral refractive error, or visual deprivation. It is primarily a defect in central vision and prevalence is 2-4% in North America. Treatment involves refractive correction, patching or penalizing the better eye to force use of the weaker eye. Prognosis is best when treatment begins early in childhood during the critical period of visual development.
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Methods of visual acuity testing in preverbal children
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refractive technique
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Extracapsular cataract surgery involves removing the clouded lens and surrounding capsule from the eye. The most common method is phacoemulsification, which uses ultrasound to break up the lens for removal through a small incision. After removal of the cataract, an intraocular lens implant is typically placed. Surgery is usually quick and has a high success rate in improving vision, but risks include infection, swelling, bleeding or complications that may require further treatment.
Refraction Method by Siddhartha Khandewal ( Click below for Online Lecture)
This document provides guidance on performing subjective refraction to determine a patient's prescription. It discusses verifying and refining the spherical and cylindrical corrections, as well as balancing the prescription between the two eyes. A variety of tests are described to evaluate different aspects of the refractive error, including JCC, duochrome, and fogging tests. The importance of measuring working distance and performing a binocular balance test is also emphasized. Proper documentation of the distance and near vision findings and prescription is advised.
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The document discusses various surgical and non-surgical treatment modalities for presbyopia including corneal procedures, scleral procedures, intraocular implants, and laser treatments. It provides details on specific procedures and technologies such as conductive keratoplasty, PRK and LASIK ablation patterns, intracorneal inlays, scleral expansion bands, and accommodating, multifocal, and refractive diffractive intraocular lenses. The advantages and disadvantages of different approaches are summarized.
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This document provides guidelines for prescribing glasses in children. It discusses that the pediatric eye is different from the adult eye in terms of axial length, corneal curvature, and lens power. The goals of prescribing glasses in children are to provide a focused retinal image and achieve optimal balance between accommodation and convergence. It is more difficult to prescribe glasses for children due to lack of subjective response and poor attention. American guidelines provide recommendations on refractive errors that warrant correction at different ages. Factors like emmetropization, amblyopia risk, and presence of strabismus are considered. Frame selection depends on the child's condition and age, aiming for correct fit, comfort, safety, and not hindering nasal development.
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This document discusses techniques for cataract surgery and considerations for improving patient outcomes and satisfaction. It recommends performing cataract surgery earlier based on symptoms to improve vision and quality of life. Achieving accurate refractive outcomes is emphasized through repeatable capsulorhexis, minimizing induced astigmatism, and using toric and multifocal IOLs. Sources of refractive surprise are examined. Markings and alignment of toric IOLs are covered. Stable lens position is important for predictable results. Multifocal IOLs are presented as an option for reducing glasses dependence.
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This document provides guidance on properly measuring and prescribing glasses prescriptions. It emphasizes the importance of accurately measuring the pupilary distance (IPD) to avoid issues like decentration, tilt and induced astigmatism. It also discusses evaluating and correcting for accommodation, prescribing readers and bifocals, managing anisometropia and presbyopia, and using glasses to treat strabismus and amblyopia. Key points are measuring IPD before trials, testing reading function, and advising patients on minimizing decentration through small frames.
Non surgical management of strabismus .ppt
Non-surgical treatments such as prescription lenses and occlusion therapy can effectively manage certain types of strabismus. Prescribing lenses aims to provide a clear retinal image while balancing accommodation and convergence. For children, the full refractive error is typically prescribed from infancy to preschool age. Occasionally, hyperopic corrections may be reduced in older children or esotropic patients. Occlusion therapy and minus lenses are common non-surgical approaches for intermittent exotropia. Prisms can also effectively treat strabismus, diplopia, and symptomatic heterophoria in some cases.
Control of ACCOMMODATION
Definition Of The Accommodation
Mechanism Of Accommodation
Triggers Accommodation
Terms Of Accommodation
Accommodative Dysfunction
Spasm Of Accommodation
Accommodative Esotropia
Controlling Accommodation In Vision Test
Tips To Control Accommodation In Lifestyle
References
Clinical Procedures In Optometry By J.D. Bartlett, J.B. Eskridge, J.F. Amos
Theory And Practice Of Squint And Orthoptics By A.K.Khurana
Adler’s Physiology Of The Eye By L.A. Levin, S.F. Nilsson
Borish’s Clinical Refraction By W.J. Benjamin
Duke-elder’s Practice Of Refraction By David Abrams
Optics & Refraction By A.K.Khurana
Textbook Of Ophthalmology By E Ahmed
Clinical Optics By A R. Elkington, Werner L, Trindade F, Pereira F, Werner L
Physiology Of Accommodation And Presbyopia, ARQ. Bras. OFTALMOL, December 2000.
Optometry And Ophthalmology Websites
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This document discusses advances in intraocular lens (IOL) technology for cataract surgery and presbyopia correction. It covers the following key points in 3 sentences:
New IOL properties like asphericity, toricity, and presbyopia corrections have improved vision quality and expanded treatment options. Surgical advances like mini-incisions and faster recovery have increased safety and allowed targeting of emmetropia. Continued improvements to IOL optics through aspheric designs, toric lenses, and multifocal/extended depth of field IOLs aim to provide spectacle independence while minimizing visual side effects.
Objective Refraction and Subjective Refraction
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Challenging Refraction
This document discusses various aspects of refractive error assessment and management. It begins by defining refractive error and describing its causes and treatment options. It then discusses the distribution of refractive errors in the normal population. Several sections provide details on objective refraction techniques like retinoscopy, including prerequisites, procedures, troubleshooting difficulties, and the importance of retinoscopy. Guidelines are provided for prescribing for various refractive error types and patient characteristics.
Cataracts
- A cataract is a clouding of the lens in the eye that can cause vision loss. It is often related to aging but may be caused by other factors like smoking.
- Symptoms include decreased vision, glare from lights, and frequent changes to prescriptions. Cataract surgery is usually done to replace the cloudy lens with an artificial lens implant.
- There are different types of intraocular lenses that provide varying levels of vision correction and independence from glasses after surgery. Conventional lenses correct one distance while newer lenses aim to provide multifocal vision.
NAVP Treatment of Amblyopia
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Do spectacles alter all squints: Dr. Madhu Karna Strabismologist
- 1. Do Spectacles alter all squints? Dr. Madhu Karna Strabismologist
- 3. Infantile esotropia after surgery
- 4. Hyperopia & Congenital esotropia Frequency Degree Management Habitual Mild Earlier surgery Occasional Significant(>3.5D) Early surgery contraindicated Postoperative Eventual increase Secondary Et that improves with optical Rx
- 5. This squint may trap you by seeming simple but HYPEROPIA WITH EXOTROPIA
- 6. Before you operate this patient Just remove the glasses
- 8. What is it? High hyperopia with Accomodative Esotropia with Consecutive ExotropiaExotropia
- 9. High hyperopia with Accomodative Esotropia with Consecutive Exotropia Reduce hyperopic power by half If exotropia still manifest or there is a drop in visual acuity then operate on the consecutive Exotropia after measuring over maximum cyclopegic refraction.
- 10. What do you do when you see this kind of a patient? EXOTROPIA HIGH MYOPIA
- 11. ESOTROPIA HIGH HYPEROPIA Or one like this
- 12. Do you measure with prism over glasses and operate on the measured angle? A hyperopic patient of +10.00 ref error measured to have 50 pd of esotropia over glasses. He was operated for 50 pd to achieve ortho but was undercorrected with residual eso of 15-20pd
- 13. We really don’t learn anything from our experience we only learn from reflecting on our experience.
- 14. ARTIFACTS INTRODUCED BY SPECTACLE LENSES IN THE MEASUREMENT OF STRABISMIC DEVIATIONS KIRK D. SCATTERGOOD , M H BROWN,D L GUYTON AJO 96:439-448,1983 The peripheral prismatic effect of corrective spectacles introduce an artifact when measuring strabismus
- 15. The peripheral prismatic effect of corrective spectacles introduce an artifact when measuring strabismus cθt ∆t h 11.5 13.5 25 D ∆m [ ∆t ][ ∆t ] x 100 =x 100 = 100100 %% [ ∆m ] 1- 0.025 D[ ∆m ] 1- 0.025 DSimplified model
- 16. In clinical practice it is the measured deviation that is found first and true deviation must then be calculated
- 17. In clinical practice it is the measured deviation that is found first and true deviation must then be calculated
- 18. Calculating the true deviation If glasses are plus Measured deviation = True deviation – 2.5 D% [D-lens power] If glasses are minus Measured deviation = True deviation + 2.5 D% In clinical practice it is the measured deviation that is found first and true deviation must then be calculated . Using the simplified model the authors obtain an expression for true deviation [∆t] as a percentage of measured deviation [∆m] [ ∆t ] x 100 = 100 % [ ∆m ] 1- 0.025 D
- 19. Plus lenses decrease and minus lenes increase the measured deviation. Spectacle lens power True deviation as %of measured deviation To find true deviation Change measured deviation by Example -20 67 Decrease by 33% 4/6 -10 80 Decrease by 20% 4/5 PLANO 100 No change 4/4 +10 133 Increase by 33% 4/3 +20 200 Increase by100% 4/2
- 20. High Plus lenses in both exo & eso – M D <T D [undercor] High Minus lenses in both exo & eso – M D >T D [overcor] This becomes Sx significant with refractive errors of + 5 d This formula deals with strabismus measurements with distance fixation
- 21. If you have built castles in the air, your work need not be lost, that is where they should be, now put the foundations under them.
- 22. If you have not measured with C L, with this formula you can still achieve orthophoria Myope of 10D with measured deviation- exo of 40 pd was operated for the true deviation 32pd (20% less) which gave good alignment -10D MYOPE WITH EXOTROPIA POSTOPERATIVE MEASURED DEVIATION 40PD PREOP
- 23. Take home message Plus lenses decrease & Minus lenses increase the measured deviation
- 24. Fortune favors the prepared mind
- 25. THANK YOU