This document discusses various types of exodeviations (eye turning out), including their etiology, clinical characteristics, classification, treatment options, and management. The main types covered are intermittent exotropia (the most common type), pseudoexotropia, exophoria, convergence insufficiency exotropia, and constant exotropia. Nonsurgical and surgical treatment approaches are described for different exodeviation subtypes.
This document summarizes an expert lecture on updates in intraocular lenses (IOLs). It discusses the historical evolution of IOLs from 1949 to present day, with over 298 available IOL options now catalogued online. The main characteristics of IOLs that determine their optical features are reviewed, including refractive power, asphericity, toricity and multifocality. Platform designs and their impact on biocompatibility and postoperative outcomes are also evaluated. Specific IOL types like toric, refractive multifocal, and diffractive bifocal and trifocal lenses are then analyzed in depth for their designs and performance characteristics. Head-to-head comparisons of popular trifocal IOL models are made based on visual ac
This document discusses different types of multifocal intraocular lenses (IOLs) used in cataract surgery. There are three main types: refractive, diffractive, and a combination. Refractive IOLs use concentric rings of different optical powers while diffractive IOLs use diffraction optics to create two focal points. Combination IOLs can provide the advantages of both refractive and diffractive technologies. The document also covers specific multifocal IOL models and considerations for patient selection.
Motor adaptation in paretic and nonparetic strabismuskopila kafle
This document discusses motor adaptation in paresis and non-paresis strabismus. It begins by defining strabismus and describing the different types. It then discusses the consequences of strabismus and the different ways motor adaptation occurs, including through changes in muscle tone, compensatory head posture, and blind spot mechanisms. It describes how motor adaptation occurs differently in incomitant versus comitant strabismus. The document goes on to discuss various cranial nerve palsies and how they result in specific eye positions and compensatory head postures. It also covers special restrictive disorders like Duane's retraction syndrome.
This document discusses aniseikonia, which is a condition where the two eyes perceive images as being different in size. It can be caused by differences in the dioptric images formed by the retina or differences in retinal element distribution. The document describes static aniseikonia, where peripheral images differ in size with static gaze, and dynamic aniseikonia, where the eyes must rotate different amounts to gaze. Signs include aphakia, anisometropia, astigmatism, low stereopsis, and strabismus. Symptoms include headaches, asthenopia, reading difficulty, photophobia, nausea, vertigo, and fatigue. Aniseikonia is measured using an e
This document summarizes key aspects of sensory evaluation of squint or strabismus. It begins by describing normal binocular development and vision, including the development of binocular fusion and stereopsis in infants. It then discusses abnormal binocular vision including sensory adaptations like suppression, anomalous retinal correspondence, and eccentric fixation. Finally, it outlines several tests used to evaluate the sensory system in strabismus, including visual acuity tests, Worth four-dot test, Bagolini striated glasses, 4 prism base out test, synaptophore, and after-image tests.
This document discusses toric intraocular lenses (IOLs) for correcting astigmatism during cataract surgery. It provides details on the evolution of toric IOL designs from early PMMA lenses that often rotated, to current acrylic models with improved stability. Precise keratometry measurements and accounting for surgically induced astigmatism are important for toric IOL power calculations. The document outlines the toric IOL implantation procedure and factors affecting postoperative rotation. Toric IOLs can provide high levels of spectacle independence when used appropriately in patients with regular corneal astigmatism over 1.5 D.
Intraocular lenses have evolved significantly from the early rigid lens designs implanted in the 1950s. Modern intraocular lenses are classified based on location, design, and material. Premium lens options include multifocal lenses that provide multiple focal points for both distance and near vision, toric lenses that correct astigmatism, and accommodating lenses designed to restore the eye's ability to focus on near objects. Proper patient selection is important for multifocal lenses, considering an individual's lifestyle and visual needs.
This document summarizes an expert lecture on updates in intraocular lenses (IOLs). It discusses the historical evolution of IOLs from 1949 to present day, with over 298 available IOL options now catalogued online. The main characteristics of IOLs that determine their optical features are reviewed, including refractive power, asphericity, toricity and multifocality. Platform designs and their impact on biocompatibility and postoperative outcomes are also evaluated. Specific IOL types like toric, refractive multifocal, and diffractive bifocal and trifocal lenses are then analyzed in depth for their designs and performance characteristics. Head-to-head comparisons of popular trifocal IOL models are made based on visual ac
This document discusses different types of multifocal intraocular lenses (IOLs) used in cataract surgery. There are three main types: refractive, diffractive, and a combination. Refractive IOLs use concentric rings of different optical powers while diffractive IOLs use diffraction optics to create two focal points. Combination IOLs can provide the advantages of both refractive and diffractive technologies. The document also covers specific multifocal IOL models and considerations for patient selection.
Motor adaptation in paretic and nonparetic strabismuskopila kafle
This document discusses motor adaptation in paresis and non-paresis strabismus. It begins by defining strabismus and describing the different types. It then discusses the consequences of strabismus and the different ways motor adaptation occurs, including through changes in muscle tone, compensatory head posture, and blind spot mechanisms. It describes how motor adaptation occurs differently in incomitant versus comitant strabismus. The document goes on to discuss various cranial nerve palsies and how they result in specific eye positions and compensatory head postures. It also covers special restrictive disorders like Duane's retraction syndrome.
This document discusses aniseikonia, which is a condition where the two eyes perceive images as being different in size. It can be caused by differences in the dioptric images formed by the retina or differences in retinal element distribution. The document describes static aniseikonia, where peripheral images differ in size with static gaze, and dynamic aniseikonia, where the eyes must rotate different amounts to gaze. Signs include aphakia, anisometropia, astigmatism, low stereopsis, and strabismus. Symptoms include headaches, asthenopia, reading difficulty, photophobia, nausea, vertigo, and fatigue. Aniseikonia is measured using an e
This document summarizes key aspects of sensory evaluation of squint or strabismus. It begins by describing normal binocular development and vision, including the development of binocular fusion and stereopsis in infants. It then discusses abnormal binocular vision including sensory adaptations like suppression, anomalous retinal correspondence, and eccentric fixation. Finally, it outlines several tests used to evaluate the sensory system in strabismus, including visual acuity tests, Worth four-dot test, Bagolini striated glasses, 4 prism base out test, synaptophore, and after-image tests.
This document discusses toric intraocular lenses (IOLs) for correcting astigmatism during cataract surgery. It provides details on the evolution of toric IOL designs from early PMMA lenses that often rotated, to current acrylic models with improved stability. Precise keratometry measurements and accounting for surgically induced astigmatism are important for toric IOL power calculations. The document outlines the toric IOL implantation procedure and factors affecting postoperative rotation. Toric IOLs can provide high levels of spectacle independence when used appropriately in patients with regular corneal astigmatism over 1.5 D.
Intraocular lenses have evolved significantly from the early rigid lens designs implanted in the 1950s. Modern intraocular lenses are classified based on location, design, and material. Premium lens options include multifocal lenses that provide multiple focal points for both distance and near vision, toric lenses that correct astigmatism, and accommodating lenses designed to restore the eye's ability to focus on near objects. Proper patient selection is important for multifocal lenses, considering an individual's lifestyle and visual needs.
The Implantable Collamer Lens (ICL) is a soft, flexible, posterior chamber phakic intraocular lens made of collagen-copolymer material called Collamer. Studies have shown ICL implantation is safe and effective for correcting myopia between -3 to -25 diopters and astigmatism up to -6 diopters. It provides stable refractive results with few complications over 4 years. Toric ICL models were found to be superior to LASIK in safety, efficacy, predictability and stability for high myopic astigmatism. The procedure is reversible and preserves corneal tissue, reducing risks compared to LASIK.
The document describes the procedures for performing subjective refraction to determine a patient's distance and near visual prescription. It involves first establishing the patient's best corrected and uncorrected visual acuity. The examiner then determines the patient's best vision sphere and estimates their astigmatism before refining the prescription with trial lenses to account for cylinder power and axis. Verification steps like binocular balance and range of clear vision are also mentioned. Near addition is calculated based on the patient's near point of focus and amplitude of accommodation. The document provides guidance on techniques, tools, and considerations for optimizing subjective refraction outcomes.
Ultrasonography, also known as B-scan, was first used in ophthalmology in the 1940s. It uses high frequency sound waves to generate images of the inside of the eye. B-scans can be used to evaluate conditions like tumors, retinal detachments, and vitreous opacities. The document discusses the history, physics, principles and various applications of B-scan ultrasonography for examining the eye. Key aspects covered include probe orientation, scan types, interpretation of echogenicity and advantages in providing a non-invasive evaluation of intraocular structures.
1) Infantile esotropia is a type of crossed eyes that develops within the first 6 months of life in an otherwise normal infant, with no significant refractive error or eye movement limitations.
2) The cause is unknown but theories involve a congenital deficit in the brain's "fusion center" or a primary motor misalignment disrupting binocular vision.
3) Treatment involves early surgical alignment of the eyes through muscle surgery like bilateral medial rectus recession, along with non-surgical measures to enhance binocularity and improve vision, with the goal of aligning the eyes within 10 prism diopters of orthophoria.
This presentation covers the Optics & application of Jackson Cross Cylinder | Jackson Cross Cylinder works on an optical principle that constricts & expands the sturm's conoid.
This document discusses myopia control strategies. It summarizes research showing that increased time spent outdoors is protective against myopia while near work promotes progression. Optical interventions like atropine drops, multifocal lenses, and orthokeratology have been shown to slow axial elongation by up to 50%, but have side effects. The ATOM studies found that low-dose atropine 0.01% effectively reduced myopia progression with minimal side effects and rebound. Controlling environmental factors and further developing interventions may help manage the growing public health challenge of myopia.
This document discusses different designs of progressive additional lenses (PALs). It describes hard and soft, symmetrical and asymmetrical, mono and multi designs. Conventional PALs add power on the front surface while internal PALs add power to the back surface. Digital PALs and freeform technology allow for smoother progression of power. Specialty PALs include short corridor and near variable focus lenses tailored for specific tasks. The document provides details on characteristics and advantages and disadvantages of each PAL design.
This document discusses tips for calculating intraocular lens (IOL) power in difficult situations. It begins by outlining situations that can make IOL power calculation challenging, such as previous refractive surgery, high astigmatism, previous keratoplasty, pediatric cases, eyes with silicone oil or posterior staphyloma.
It then provides details on methods to calculate IOL power in each situation, including using previous refractive data, topography readings, and specialized formulas. Optical biometry is generally preferred over ultrasound biometry in difficult cases. The document emphasizes using third and fourth generation formulas and online calculators.
Special considerations are discussed for cases like piggyback IOLs, aphakia,
Aphakia is the absence of the crystalline lens in the eye. It can be congenital or acquired through cataract surgery. Patients with aphakia experience high hyperopia and a loss of accommodation. Treatment options include spectacle correction, contact lenses, intraocular lens implantation, or refractive corneal surgery. Each option has advantages and disadvantages related to image quality, comfort, risk of complications, and cost.
1) Biometry is the process of measuring the eye to determine the ideal intraocular lens power for cataract surgery. It involves measuring the corneal power and axial length of the eye.
2) Traditional A-scan ultrasound biometry measures axial length using sound waves, but has limitations like variable corneal compression. Newer devices like the IOL Master use optical interferometry and are non-contact.
3) Proper technique and accounting for factors like intraocular lens material are important for accurate biometry and intraocular lens power calculation. Inaccuracies can result in postoperative refractive surprises.
This document discusses various imaging techniques used to evaluate glaucoma, including OCT, HRT, and GDx. OCT uses interferometry to measure retinal nerve fiber layer thickness. HRT uses confocal laser scanning to create 3D images of the optic nerve and measure disc parameters. GDx uses scanning laser polarimetry to measure retinal nerve fiber layer thickness and detect glaucomatous damage through thickness maps, deviation maps, and TSNIT plots compared to normative data. Together these quantitative imaging techniques provide objective assessment to aid in glaucoma diagnosis and detection of progression.
This document discusses ocular biometry and ultrasound. It begins with definitions of biometrics and ultrasound terminology. It then describes the different modes of ultrasound - A-scan, B-scan and M-scan. Key components of ultrasound devices like transducers, amplifiers and velocities of sound through ocular tissues are explained. Factors affecting ultrasound reflection and penetration are outlined. The document concludes with an introduction to ocular biometry procedures and a brief history.
This document discusses pediatric refraction and various techniques used for refracting children. Pediatric refraction is different from adult refraction due to active accommodation in children. Cycloplegic refraction is preferable to paralyze accommodation. Different techniques are used based on the age of the child, including near retinoscopy, dynamic retinoscopy, and book retinoscopy. Cycloplegics help obtain an accurate refraction by paralyzing accommodation.
1. Binocular balancing ensures equal accommodation relaxation in both eyes during subjective refraction. It does not aim to equalize visual acuity between eyes.
2. There are several techniques for binocular balancing, including successive alternate occlusion, vertical prism dissociation, fogging/Humphiss test, polarized filters, and the septum technique. These techniques add plus lenses until the patient reports equal blurriness between eyes.
3. The vertical prism dissociation technique uses prisms to displace one eye's image vertically while fogging is used, and plus lenses are added until equal blur is reported. The polarized technique uses polarizing filters to partially separate the images while the sept
1) Phakic IOLs are artificial lenses implanted in the eye to correct refractive errors while leaving the natural lens intact. They are classified as angle-supported, iris-fixated, or posterior chamber IOLs.
2) The first phakic IOLs date back to the 1950s but modern designs from the 1980s/90s include the Artisan iris-claw lens and posterior chamber lenses like the ICL.
3) Ideal phakic IOL candidates have a stable refraction and meet endothelial cell and anterior chamber depth requirements. Assessments include VA, biometry, and endothelial cell counts.
This document discusses various contrast sensitivity tests used in vision testing. It describes several grating and letter-based contrast sensitivity charts, including the FACT chart, Pelli-Robson chart, Vistech tests, and Cambridge Low Contrast tests. It provides details on test administration and scoring for many of these assessments. The document also discusses computer-based contrast sensitivity testing and considerations for contrast calibration of video displays used for testing.
Corneal topography provides a graphic representation of the geometrical properties of the corneal surface. It uses techniques such as Placido disk, photokeratoscopy, videokeratoscopy, and slit imaging to map over 8000 points across the corneal surface. This provides detailed information about the shape and irregularities of the cornea which can then be used to diagnose conditions that degrade vision and guide treatment.
This document discusses various types of non-accommodative esotropia, including microtropia, near esotropia, distance esotropia, acute esotropia, secondary esotropia, consecutive esotropia, divergence insufficiency, cyclic esotropia, and high myopia esotropia. For each type, the document outlines typical presentation, clinical signs, and treatment approaches. The overall document provides an overview of different non-accommodative esotropia subtypes for ophthalmologists.
The Implantable Collamer Lens (ICL) is a soft, flexible, posterior chamber phakic intraocular lens made of collagen-copolymer material called Collamer. Studies have shown ICL implantation is safe and effective for correcting myopia between -3 to -25 diopters and astigmatism up to -6 diopters. It provides stable refractive results with few complications over 4 years. Toric ICL models were found to be superior to LASIK in safety, efficacy, predictability and stability for high myopic astigmatism. The procedure is reversible and preserves corneal tissue, reducing risks compared to LASIK.
The document describes the procedures for performing subjective refraction to determine a patient's distance and near visual prescription. It involves first establishing the patient's best corrected and uncorrected visual acuity. The examiner then determines the patient's best vision sphere and estimates their astigmatism before refining the prescription with trial lenses to account for cylinder power and axis. Verification steps like binocular balance and range of clear vision are also mentioned. Near addition is calculated based on the patient's near point of focus and amplitude of accommodation. The document provides guidance on techniques, tools, and considerations for optimizing subjective refraction outcomes.
Ultrasonography, also known as B-scan, was first used in ophthalmology in the 1940s. It uses high frequency sound waves to generate images of the inside of the eye. B-scans can be used to evaluate conditions like tumors, retinal detachments, and vitreous opacities. The document discusses the history, physics, principles and various applications of B-scan ultrasonography for examining the eye. Key aspects covered include probe orientation, scan types, interpretation of echogenicity and advantages in providing a non-invasive evaluation of intraocular structures.
1) Infantile esotropia is a type of crossed eyes that develops within the first 6 months of life in an otherwise normal infant, with no significant refractive error or eye movement limitations.
2) The cause is unknown but theories involve a congenital deficit in the brain's "fusion center" or a primary motor misalignment disrupting binocular vision.
3) Treatment involves early surgical alignment of the eyes through muscle surgery like bilateral medial rectus recession, along with non-surgical measures to enhance binocularity and improve vision, with the goal of aligning the eyes within 10 prism diopters of orthophoria.
This presentation covers the Optics & application of Jackson Cross Cylinder | Jackson Cross Cylinder works on an optical principle that constricts & expands the sturm's conoid.
This document discusses myopia control strategies. It summarizes research showing that increased time spent outdoors is protective against myopia while near work promotes progression. Optical interventions like atropine drops, multifocal lenses, and orthokeratology have been shown to slow axial elongation by up to 50%, but have side effects. The ATOM studies found that low-dose atropine 0.01% effectively reduced myopia progression with minimal side effects and rebound. Controlling environmental factors and further developing interventions may help manage the growing public health challenge of myopia.
This document discusses different designs of progressive additional lenses (PALs). It describes hard and soft, symmetrical and asymmetrical, mono and multi designs. Conventional PALs add power on the front surface while internal PALs add power to the back surface. Digital PALs and freeform technology allow for smoother progression of power. Specialty PALs include short corridor and near variable focus lenses tailored for specific tasks. The document provides details on characteristics and advantages and disadvantages of each PAL design.
This document discusses tips for calculating intraocular lens (IOL) power in difficult situations. It begins by outlining situations that can make IOL power calculation challenging, such as previous refractive surgery, high astigmatism, previous keratoplasty, pediatric cases, eyes with silicone oil or posterior staphyloma.
It then provides details on methods to calculate IOL power in each situation, including using previous refractive data, topography readings, and specialized formulas. Optical biometry is generally preferred over ultrasound biometry in difficult cases. The document emphasizes using third and fourth generation formulas and online calculators.
Special considerations are discussed for cases like piggyback IOLs, aphakia,
Aphakia is the absence of the crystalline lens in the eye. It can be congenital or acquired through cataract surgery. Patients with aphakia experience high hyperopia and a loss of accommodation. Treatment options include spectacle correction, contact lenses, intraocular lens implantation, or refractive corneal surgery. Each option has advantages and disadvantages related to image quality, comfort, risk of complications, and cost.
1) Biometry is the process of measuring the eye to determine the ideal intraocular lens power for cataract surgery. It involves measuring the corneal power and axial length of the eye.
2) Traditional A-scan ultrasound biometry measures axial length using sound waves, but has limitations like variable corneal compression. Newer devices like the IOL Master use optical interferometry and are non-contact.
3) Proper technique and accounting for factors like intraocular lens material are important for accurate biometry and intraocular lens power calculation. Inaccuracies can result in postoperative refractive surprises.
This document discusses various imaging techniques used to evaluate glaucoma, including OCT, HRT, and GDx. OCT uses interferometry to measure retinal nerve fiber layer thickness. HRT uses confocal laser scanning to create 3D images of the optic nerve and measure disc parameters. GDx uses scanning laser polarimetry to measure retinal nerve fiber layer thickness and detect glaucomatous damage through thickness maps, deviation maps, and TSNIT plots compared to normative data. Together these quantitative imaging techniques provide objective assessment to aid in glaucoma diagnosis and detection of progression.
This document discusses ocular biometry and ultrasound. It begins with definitions of biometrics and ultrasound terminology. It then describes the different modes of ultrasound - A-scan, B-scan and M-scan. Key components of ultrasound devices like transducers, amplifiers and velocities of sound through ocular tissues are explained. Factors affecting ultrasound reflection and penetration are outlined. The document concludes with an introduction to ocular biometry procedures and a brief history.
This document discusses pediatric refraction and various techniques used for refracting children. Pediatric refraction is different from adult refraction due to active accommodation in children. Cycloplegic refraction is preferable to paralyze accommodation. Different techniques are used based on the age of the child, including near retinoscopy, dynamic retinoscopy, and book retinoscopy. Cycloplegics help obtain an accurate refraction by paralyzing accommodation.
1. Binocular balancing ensures equal accommodation relaxation in both eyes during subjective refraction. It does not aim to equalize visual acuity between eyes.
2. There are several techniques for binocular balancing, including successive alternate occlusion, vertical prism dissociation, fogging/Humphiss test, polarized filters, and the septum technique. These techniques add plus lenses until the patient reports equal blurriness between eyes.
3. The vertical prism dissociation technique uses prisms to displace one eye's image vertically while fogging is used, and plus lenses are added until equal blur is reported. The polarized technique uses polarizing filters to partially separate the images while the sept
1) Phakic IOLs are artificial lenses implanted in the eye to correct refractive errors while leaving the natural lens intact. They are classified as angle-supported, iris-fixated, or posterior chamber IOLs.
2) The first phakic IOLs date back to the 1950s but modern designs from the 1980s/90s include the Artisan iris-claw lens and posterior chamber lenses like the ICL.
3) Ideal phakic IOL candidates have a stable refraction and meet endothelial cell and anterior chamber depth requirements. Assessments include VA, biometry, and endothelial cell counts.
This document discusses various contrast sensitivity tests used in vision testing. It describes several grating and letter-based contrast sensitivity charts, including the FACT chart, Pelli-Robson chart, Vistech tests, and Cambridge Low Contrast tests. It provides details on test administration and scoring for many of these assessments. The document also discusses computer-based contrast sensitivity testing and considerations for contrast calibration of video displays used for testing.
Corneal topography provides a graphic representation of the geometrical properties of the corneal surface. It uses techniques such as Placido disk, photokeratoscopy, videokeratoscopy, and slit imaging to map over 8000 points across the corneal surface. This provides detailed information about the shape and irregularities of the cornea which can then be used to diagnose conditions that degrade vision and guide treatment.
This document discusses various types of non-accommodative esotropia, including microtropia, near esotropia, distance esotropia, acute esotropia, secondary esotropia, consecutive esotropia, divergence insufficiency, cyclic esotropia, and high myopia esotropia. For each type, the document outlines typical presentation, clinical signs, and treatment approaches. The overall document provides an overview of different non-accommodative esotropia subtypes for ophthalmologists.
This document discusses the management of esotropia, a type of strabismus where the eyes turn inward. It describes the different types of esotropia including concomitant, accommodative, and inconcomitant esotropia. For treatment, it emphasizes correcting refractive errors and amblyopia first before considering surgery. For concomitant esotropia in young children, the initial surgery is typically recession of both medial rectus muscles. For accommodative esotropia, treatment involves correcting refractive errors or surgery depending on the severity. Management is tailored based on the specific type and cause of esotropia.
This document discusses various cases of exotropia (XT, outward turning of the eyes) and provides surgical treatment recommendations for each case. It begins with an introduction to exotropia, including classifications and clinical presentations. It then presents 8 sample cases, each with the measured deviation and any special findings. For each case, it recommends a surgical approach, such as recessing (weakening) one or both lateral rectus muscles. It provides discussions justifying the recommended approaches and considerations for different exotropia subtypes and patient factors. The overall document serves as a guide for surgeons on standard surgical doses and techniques for various exotropia presentations.
1. Intermittent exotropia is the most common type of exodeviation, usually beginning in early childhood.
2. It involves periods where the eyes are aligned (phoric phase) and misaligned outward (tropic phase), with suppression present only during the tropic phase.
3. Deteriorating fusional control over time, as shown by an increasing frequency of the tropic phase, loss of stereopsis, or increase in deviation size, indicates progression requiring surgical intervention to prevent further loss of binocular function.
1. Intermittent exotropia is the most common type of exodeviation, usually beginning in early childhood.
2. It involves periods where the eyes are aligned (phoric phase) and misaligned outward (tropic phase), with control deteriorating over time.
3. Surgical treatment is recommended if control is worsening, as indicated by an increasing tropic phase, loss of fusion, increased deviation angle, or suppression development. Non-surgical management can be tried for small angles or young ages but is often ineffective long-term.
This document discusses congenital infantile esotropia. It defines esotropia as eyes turning inward and provides background on types. Congenital infantile esotropia is characterized by a large-angle esotropia present before 6 months of age. It may be associated with cerebral palsy or low birth weight. Treatment involves correcting refractive errors, amblyopia therapy, and bilateral medial rectus recession surgery between 6 months to 2 years of age. Post-surgical outcomes include orthophoria, small residual deviations managed with observation, or large residual deviations requiring repeat surgery.
Esotropia , classification , diagnosis and managementDrAzmat Ali
This document provides information on various types of esotropia (convergent strabismus), including:
- Accommodative esotropia caused by uncorrected hyperopia or a high AC/A ratio
- Partially accommodative esotropia with both accommodative and non-accommodative components
- Non-accommodative esotropia including convergence excess, cyclical esotropia, and acquired forms
- Esotropia associated with high myopia or nystagmus is also discussed
Treatment options including refractive correction, orthoptic exercises, prisms, botulinum toxin, and surgery are mentioned for different types of esotropia.
This document discusses esotropia, or convergent strabismus. It describes the different types of esotropia including concomitant and incomitant deviations. It further categorizes esotropia as accommodative or non-accommodative. Early-onset esotropia developing within the first 6 months is discussed in detail, including typical clinical features and management with early surgical alignment and treatment of amblyopia and refractive error. Subsequent development of inferior oblique overaction and dissociated vertical deviation are also addressed.
Lecture on Squint For 4th Year MBBS Undergraduate Students By Prof. Dr. Hussa...DrHussainAhmadKhaqan
This document defines and describes different types of strabismus (squint) including heterophoria, heterotropia, esotropia, exotropia, and their subtypes. It provides details on the definition, characteristics, and treatment for each type. The treatment section discusses approaches such as refractive correction, orthoptic treatment, prism therapy, and surgery depending on the specific type and features of the strabismus. The document is written by an ophthalmologist and professor to inform about strabismus for medical professionals.
The document discusses the nature and management of comitant convergent and divergent strabismus. It covers factors to consider in evaluation such as age, angle of strabismus, and sensory adaptations. For management of convergent strabismus, it discusses approaches for fully accommodative esotropia, partially accommodative esotropia, convergence excess, and non-refractive esotropias. For divergent strabismus, it discusses divergence excess, near exophoria, and constant exotropia. Surgical correction is usually needed for large angle or non-accommodative deviations.
This document discusses exodeviation, also known as divergent strabismus, where the visual axes diverge outward instead of converging. There are two main types - concomitant and incomitant. Exodeviation can be primary, such as infantile exotropia which begins in the first 6 months of life, or intermittent exotropia where the eyes diverge intermittently. Secondary exodeviation includes sensory exotropia caused by visual impairment, and consecutive exotropia following correction of esotropia. Treatment depends on the type and may include correcting refractive errors, vision therapy, prism therapy, or surgery. The angle of exodeviation is measured using tests
That is, an inward squint that does not vary with the direction of gaze.
##Clinical_optometry #vision_care #eyecare #Eye_Awareness #optometry #eye #squint #Esotropia #eye_health #OSC #Ashith_Tripathi
This document provides an overview of esotropia, or convergent strabismus, including its classification and types. It discusses accommodative esotropia in more detail. Accommodative esotropia can be refractive, caused by hyperopia, or non-refractive, caused by a high AC/A ratio. Treatment involves correcting refractive errors with glasses and potentially bifocals. Surgery such as medial rectus recession may be considered if the deviation is not fully corrected with optical correction alone. The document outlines different types of accommodative esotropia and their typical treatments.
This document discusses subluxation of the lens, which occurs when the lens is partially displaced from its normal position due to weakening or damage of the zonular fibers that suspend it. It defines subluxation and dislocation and describes the normal anatomy. Causes of subluxation include congenital conditions like Marfan syndrome or trauma. Evaluation involves examining lens position, refractive error, and checking for other ocular issues or systemic diseases. Management depends on degree of subluxation and includes lenses, capsular tension rings, or different surgical techniques like phacoemulsification or lensectomy. Close follow up is important due to risks of complications.
This document discusses esotropia, which is an inward turning of one or both eyes. It defines esotropia and describes the different types including accommodative esotropia, congenital esotropia, and microtropia. It outlines the causes, characteristics, diagnosis, and management of each type of esotropia. Some key points covered include the role of accommodation and refractive error in accommodative esotropia, the importance of early treatment for congenital esotropia to prevent amblyopia, and the use of occlusion therapy, refractive correction, surgery, and botulinum toxin injection in the management of esotropia.
This document discusses exodeviations (divergent strabismus), which occurs when the visual axis is deviated laterally and the fovea is rotated nasally. Exodeviations can be comitant or incomitant. Comitant exodeviations include infantile exotropia, intermittent exotropia, and sensory exotropia. Incomitant exodeviations include paralytic, restrictive, and musculofascial innervational anomalies. Treatment options depend on the type of exodeviation and include non-surgical approaches like optical treatment and orthoptic exercises or surgical approaches like lateral rectus recession and medial rectus resection.
Learn SQL from basic queries to Advance queriesmanishkhaire30
Dive into the world of data analysis with our comprehensive guide on mastering SQL! This presentation offers a practical approach to learning SQL, focusing on real-world applications and hands-on practice. Whether you're a beginner or looking to sharpen your skills, this guide provides the tools you need to extract, analyze, and interpret data effectively.
Key Highlights:
Foundations of SQL: Understand the basics of SQL, including data retrieval, filtering, and aggregation.
Advanced Queries: Learn to craft complex queries to uncover deep insights from your data.
Data Trends and Patterns: Discover how to identify and interpret trends and patterns in your datasets.
Practical Examples: Follow step-by-step examples to apply SQL techniques in real-world scenarios.
Actionable Insights: Gain the skills to derive actionable insights that drive informed decision-making.
Join us on this journey to enhance your data analysis capabilities and unlock the full potential of SQL. Perfect for data enthusiasts, analysts, and anyone eager to harness the power of data!
#DataAnalysis #SQL #LearningSQL #DataInsights #DataScience #Analytics
Global Situational Awareness of A.I. and where its headedvikram sood
You can see the future first in San Francisco.
Over the past year, the talk of the town has shifted from $10 billion compute clusters to $100 billion clusters to trillion-dollar clusters. Every six months another zero is added to the boardroom plans. Behind the scenes, there’s a fierce scramble to secure every power contract still available for the rest of the decade, every voltage transformer that can possibly be procured. American big business is gearing up to pour trillions of dollars into a long-unseen mobilization of American industrial might. By the end of the decade, American electricity production will have grown tens of percent; from the shale fields of Pennsylvania to the solar farms of Nevada, hundreds of millions of GPUs will hum.
The AGI race has begun. We are building machines that can think and reason. By 2025/26, these machines will outpace college graduates. By the end of the decade, they will be smarter than you or I; we will have superintelligence, in the true sense of the word. Along the way, national security forces not seen in half a century will be un-leashed, and before long, The Project will be on. If we’re lucky, we’ll be in an all-out race with the CCP; if we’re unlucky, an all-out war.
Everyone is now talking about AI, but few have the faintest glimmer of what is about to hit them. Nvidia analysts still think 2024 might be close to the peak. Mainstream pundits are stuck on the wilful blindness of “it’s just predicting the next word”. They see only hype and business-as-usual; at most they entertain another internet-scale technological change.
Before long, the world will wake up. But right now, there are perhaps a few hundred people, most of them in San Francisco and the AI labs, that have situational awareness. Through whatever peculiar forces of fate, I have found myself amongst them. A few years ago, these people were derided as crazy—but they trusted the trendlines, which allowed them to correctly predict the AI advances of the past few years. Whether these people are also right about the next few years remains to be seen. But these are very smart people—the smartest people I have ever met—and they are the ones building this technology. Perhaps they will be an odd footnote in history, or perhaps they will go down in history like Szilard and Oppenheimer and Teller. If they are seeing the future even close to correctly, we are in for a wild ride.
Let me tell you what we see.
The Building Blocks of QuestDB, a Time Series Databasejavier ramirez
Talk Delivered at Valencia Codes Meetup 2024-06.
Traditionally, databases have treated timestamps just as another data type. However, when performing real-time analytics, timestamps should be first class citizens and we need rich time semantics to get the most out of our data. We also need to deal with ever growing datasets while keeping performant, which is as fun as it sounds.
It is no wonder time-series databases are now more popular than ever before. Join me in this session to learn about the internal architecture and building blocks of QuestDB, an open source time-series database designed for speed. We will also review a history of some of the changes we have gone over the past two years to deal with late and unordered data, non-blocking writes, read-replicas, or faster batch ingestion.
06-04-2024 - NYC Tech Week - Discussion on Vector Databases, Unstructured Data and AI
Discussion on Vector Databases, Unstructured Data and AI
https://www.meetup.com/unstructured-data-meetup-new-york/
This meetup is for people working in unstructured data. Speakers will come present about related topics such as vector databases, LLMs, and managing data at scale. The intended audience of this group includes roles like machine learning engineers, data scientists, data engineers, software engineers, and PMs.This meetup was formerly Milvus Meetup, and is sponsored by Zilliz maintainers of Milvus.
State of Artificial intelligence Report 2023kuntobimo2016
Artificial intelligence (AI) is a multidisciplinary field of science and engineering whose goal is to create intelligent machines.
We believe that AI will be a force multiplier on technological progress in our increasingly digital, data-driven world. This is because everything around us today, ranging from culture to consumer products, is a product of intelligence.
The State of AI Report is now in its sixth year. Consider this report as a compilation of the most interesting things we’ve seen with a goal of triggering an informed conversation about the state of AI and its implication for the future.
We consider the following key dimensions in our report:
Research: Technology breakthroughs and their capabilities.
Industry: Areas of commercial application for AI and its business impact.
Politics: Regulation of AI, its economic implications and the evolving geopolitics of AI.
Safety: Identifying and mitigating catastrophic risks that highly-capable future AI systems could pose to us.
Predictions: What we believe will happen in the next 12 months and a 2022 performance review to keep us honest.
ViewShift: Hassle-free Dynamic Policy Enforcement for Every Data LakeWalaa Eldin Moustafa
Dynamic policy enforcement is becoming an increasingly important topic in today’s world where data privacy and compliance is a top priority for companies, individuals, and regulators alike. In these slides, we discuss how LinkedIn implements a powerful dynamic policy enforcement engine, called ViewShift, and integrates it within its data lake. We show the query engine architecture and how catalog implementations can automatically route table resolutions to compliance-enforcing SQL views. Such views have a set of very interesting properties: (1) They are auto-generated from declarative data annotations. (2) They respect user-level consent and preferences (3) They are context-aware, encoding a different set of transformations for different use cases (4) They are portable; while the SQL logic is only implemented in one SQL dialect, it is accessible in all engines.
#SQL #Views #Privacy #Compliance #DataLake
2. etiology
The exact etiology of most exodeviation
is unknown, proposed causes include:
Anatomical and mechanical factors
within the orbit.
Innervational abnormalities such as
excessive tonic divergence.
3. Pseudoexotropia
An appearance of exodeviation when in
fact the eyes are properly aligned.
Wide interpupillary distance.
Positive angle kappa without other
ocular abnormalities.
Positive angle kappa together with
ocular abnormalities such as temporal
dragging of the macula in ROP.
4. exophoria
Is an exodeviation controlled by fusion.
An exophoria is detected when binocular
vision is interrupted, as during an
alternate cover test.
Exophoria is usually asymptomatic.
Prolonged, detailed visual work or
reading may bring about asthenopia.
Treatment is usually not necessary
unless an axophoria progresses to an
INT XT.
5. Intermittent exotropia
With the possible exception of exophoria
at near, the most common type of
exodeviation is intermittent exotropia.
6. Clinical characteristics
The onset is an early, before age 5.
The deviation often becomes manifest during
times of visual inattention, fatigue, or stress.
Parents report that the exotropia occurs late in
the day with fatigue or during illness,
daydreaming, or drowsiness upon awakening.
Exposure to bright light often causes a reflex
closure of 1 eye.
7.
8.
9. During the early stages, the deviation is
usually larger for distance than for near.
Later, the near and distance
exodeviations tend to be more equal in
magnitude.
Intermittent exotropias can be
associated with small hypertropias, A or
V patterns, and oblique muscle
dysfunction.
10. In many patients, untreated intermittent
exotropia progresses toward constant
exotropia.
Children younger than 10 years of age may
initially have diplopia but often develop the
cortical adaptations of suppression and ARC.
However, NRC and good binocular function
remain when the eyes are straight.
Amblyopia is uncommon unless the exotropia
progresses to constant at an early age.
11. Clinical evaluation
History of the age of onset of the
strabismus.
The clinician records how often and
under what circumstances the deviation
is manifest.
A qualitative measurement of the control
of the deviation, is an important
component of the evaluation.
12. Good control: exotropia manifests only after
cover testing, and the patient resumes fusion
rapidly without blinking or refixating.
Fair control: exotropia manifests after fusion is
disrupted by cover testing, and the patient
resumes fusion only after blinking or refixating.
Poor control: exotropia manifests
spontaneously and may remain manifest for an
extended time.
13. The deviation at near fixation is often less than
the deviation at distance fixation.
The difference may be due to either a high
AC/A ratio or to tenacious proximal fusion.
Tenacious proximal fusion is a proximal
vergence aftereffect that occurs in some
patients with intermittent XT.
This aftereffect is due to a slow-to-dissipate
fusion mechanism that prevents intermittent
exotropia from manifesting at near fixation.
14. For patients with significantly more
exodeviation in the distance than at
near, 1 hour of monocular occlusion,
eliminates the effects of tenacious
proximal fusion and may help to
distinguish between a truly high AC/A
and a pseudo high AC/A.
A patient with a pseudo high AC/A ratio
would have equal distance and near
measurement after occlusion.
16. Basic type
Is present when the exodeviation is
approximately the same at distance and
near fixation.
17. Divergence excess
Consist of an exodeviation that is greater
at distance fixation than at near.
It can be divided into 2 subtypes.
1-true divergence excess.
2-simulated divergence excess.
18. True divergence excess
Refers to those deviations that remain
greater at distance than at near even
after a period of monocular occlusion.
Some of these patients prove to have a
high Ac/A ratio when tested at near with
+3 D lenses.
19. Simulated divergence excess
Refers to a deviation that is initially
greater at distance than at near but that
becomes about the same after 1 eye is
occluded for 1 hour ( to remove the
effect of tenacious proximal fusion).
20. The convergence insufficiency
Is present when the exodeviation is
greater at near than at distance.
This type excludes isolated convergence
insufficiency.
21. Sensory testing usually reveals excellent
stereopsis and NRC when the
exodeviation is latent.
And suppression with ARC when the
deviation is manifest.
However, if the deviation manifests
rarely, diplopia may persist during those
manifestations.
22. Treatment
Some ophthalmologists prefer to delay
surgery in young children.
Other ophthalmologists worry that
delaying surgery could allow for
development of permanent suppression
and loss of long-term stability following
surgical correction.
23. Nonsurgical management
Corrective lenses for any significant
refractive error.
Mild to moderate hyperopia are not
routinly corrected.
Hyperopia of more than 4.00 D and
astigmatism of more than 1.50 D is
better to be corrected.
Correction of even mild myopia may help
to control the deviation.
24. Additional minus lens power to stimulate
accomodative convergence may help to
control the deviation.
Part-time patching of the dominant eye
4-6 hours per day, can be an effective
treatment for small-to moderate-sized
deviations. persumably due to disruption
of suppression.
25. Active orthoptic treatments
Antisuppression therapy, diplopia
awareness and fusional convergence
training, can be used alone or in
combination with patching, minus lenses,
and surgery.
This type of treatment can be effective
for deviations of 20 P or less, but is not
recommended for poorly controlled
deviations.
26. Surgical treatment
Many patients with intermittent exotropia
ultimately require surgery,
The best sensory outcomes are probably
achieved with motor alignment before
age 7 or before 5 years of strabismus
duration, or while the deviation is still
intermittent.
Many surgeons use manifestation of the
deviation more than 50% of the time as
criterion for surgery.
27. Symmetric recession of both LR is the
most common surgical procedure.
R&R procedure is an acceptable
alternative and may be preferred in basic
type INT XT.
Unilateral LR recession may be
performed in small-angle exodeviations.
28. Management of surgical
overcorrection
A temporary overcorrection of up to 10-
15 P is desirable after bilateral LR
recession.
Persistent overcorrection may require
treatment with base-in prisms or
alternate patching to prevent amblyopia
or diplopia.
Corrective lenses or miotics should be
considered if hyperopia is significant.
Bifocals can be used for a high AC/A
29. Unless in a case of slipped or lost
muscle, a delay of several months is
recommended before reoperation
because spontaneous improvement is
common.
Bilateral MR muscle recession, R&R of
the fellow eye.
Botulinum toxin injection into 1 MR
muscle may be effective.
30. Management of surgical
undercorrection
Mild to moderate residual XT is only
observed alone if fusional control is
good.
Aggressive base-in prism management
with a gradual weaning of the prism
dosage.
Postoperative patching and orthoptic
treatment can be useful.
Botulinum toxin injection into LRM.
31. Indication for reoperation
If the nonsurgical management failed.
The type of surgery is related to the type
of previous surgery.
The surgical dose-response curve
appears to be similar to that for the initial
surgery.
33. Congenital exotropia
Presents before age 6 months.
Large angle constant deviation.
Most of these patients have associated
neurologic problems or craniofacial
disorders.
Early surgery can lead to gross SBV.
DVD and IO overaction may be seen in
these patients.
34.
35. Sensory exotropia
Any condition that reduces visual acuity
in 1 eye can cause sensory exotropia.
Anisometropia, corneal and lens
opacities, optic atrophy or hypoplasia,
macular lesions, and amblyopia.
Both sensory ET and XT are common in
children, but exotropia predominates in
older children and adults.
36. Loss of fusional abilities, known as
central fusional disruption, or horror
fusionis, can lead to constant and
permanent diplopia when adult-onset
sensory exotropia has been present for
several years prior to visual rehabilitation
and realignment.
In these patients, intractable diplopia
may persist, even with well aligned eye.
37. Consecutive exotropia
An exotropia that follows previous
surgery for esotropia.
Treatment of consecutive exotropia
depends on many factors, including the
size of the deviation, the type and
amount of previous surgery, the
presence of duction limitation, lateral
incomitance, and the level of visual
acuity in each eye.
38. Exotropic Duane retraction
syndrome
Duane syndrome can present with
exotropia, usually accompanied by a
face turn away from the affected eye.
Adduction is most often markedly
deficient.
Other signs include eyelid narrowing,
glob retraction, and upshoot and
downshoot.
39. Dissociated horizontal
deviation
DVD may contain vertical, horizontal, and
torsional components.
DHD is when the dissociated abduction is
predominate.
It may be confused with a constant or
intermittent exotropia.
DVD and latent nystagmus often coexist with
DHD.
Treatment consists of unilateral or bilateral LR
recess in addition to any necessary oblique or
vertical muscle surgery.
40.
41. Convergence insufficiency
Characteristics are:
Asthenopia, blurred near vision, reading
problems.
Poor near fusional convergence
amplitude
Remote near point of convergence.
42. The patient, typically an older child or
adult
May have an exophoria at near.
Rarely accomodative spasm may occur
in an effort to overcome the convergence
insufficiency.
43. Treatment
Orthoptic exercises.
Base-out prisms can be used to
stimulate fusional convergence.
Stereogram, pencil pushups and other
near point exercises are often used.
If these exercises fail, base-in prism
reading glasses may be needed.
44. Unilateral or bilateral MR resection may
be used in rare cases but may be
associated with risk of diplopia in
distance viewing.
Patients with combined convergence
and accomodative insufficiency may
benefit from plus lenses and base-in
prisms for reading.
45. Convergence paralysis
Is usually secondary to an intracranial lesion.
Is characterized by normal adduction and
accomodation with exotropia and diplopia on
attempted near fixation only.
It differs from convergence insufficiency in its
relatively acute onset and the patient,s inability
to overcome any base-out prism.
It usually results from a lesion in the corpora
quadrigemina or the nucleus of the cranial
nerve 3 and may be associated with Parinaud
syndrome.
46. Treatment
Is limited to providing base-in prism at
near to alleviate diplopia.
When accomodation is also weakened,
plus lenses also may be needed.
If SBV can not be restored at near by
any way, occlusion of one eye is
indicated during reading.
Eye muscle surgery is contraindicated.