COMPLEMENTARY THERAPY ASSESSMENT VISUAL TRAINING for REFRACTIVE ERRORS August 2013
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Taking the Mystery out of Abnormal Pupils
Taking the mystery out of abnormal pupils No financial disclosures Course Title: Taking the mystery out [email protected] of abnormal pupils Lecturer: Brad Sutton, OD, FAAO Clinical Professor IU School of Optometry . •Review of Anatomy Iris anatomy Iris sphincter Iris dilator Parasympathetic pathway Sympathetic pathway Parasympathetic Pathway Parasympathetic Pathway Light stimulates the retina then impulse Four neuron arc travels with the ganglion cells through the Retina to the pretectal nucleus in the chiasm into the optic tracts. 80% go to the midbrain (1) LGN , 20% to the pretectal nuclei.They Pretectal nucleus to the EW nucleus (2) then hemidecussate and terminate at the EW nucleus EW nucleus to the ciliary ganglion (3) Ciliary ganglion to the iris sphincter with short ciliary nerves (4) 1 Points of Interest Sympathetic Pathway Within the second order neuron there are Three neuron arc 30 near response fibers for every light Posterior hypothalamus to ciliospinal response fiber. This allows for light - near center of Budge ( C8 - T2 ). (1) dissociation. Center of Budge to the superior cervical The third order neuron runs with cranial ganglion in the neck (2) nerve III from the brain stem to the ciliary Superior cervical ganglion to the dilator ganglion. Superficially located prior to the muscle (3) cavernous sinus. Points of Interest Second order neuron runs along the surface of the lung, can be affected by a Pancoast tumor Third order neuron runs with the carotid artery then with the ophthalmic division of cranial nerve V 2 APD Testing testing……………….AKA……… … APD / reverse APD Direct and consensual response Which is the abnormal pupil ? Very simple rule. -
Do You Know Your Eye Care Jargon? an OPTOMETRIST
Do you know your eye care jargon? Optometrists, Orthoptists and Opthalmologists all work in the field of eye care and often work as a team in the same practice. These various professional “categories” can cause quite a lot of confusion though. Not only do they sound similarbut some of their roles can overlap, thus making the differentiation even harder. One great example is that all these experts can recommend glasses. In this article, I will aim to overview the role of each specialty and so make it easier to identify who does what! The levels of training and what they are permitted to do for youas a patientare an important differentiator between these specialties. It will definitely help you make the best-informed decision when looking for help regarding your specific eye care issue. AN OPTOMETRIST In South Africa, Optometrists need to complete a four-year Bachelor of Optometry degree before they are permitted to practice. Once qualified, they provide vital primary vision care. They conduct vision tests and eye examinations on patients in order to detect visual errors, such as near-sightedness, long-sightedness and astigmatism. Optometrists also do testing to determine the patient's ability to focus and coordinate their eyes, judge depth perception, and see colors accurately. Once a visual „problem‟ has been identified andanalyzed, the optometristeffectively corrects them and their related problems, by providing comfortable glasses and or contact lenses. They are also responsible for the maintenance of these “devices”. Optometrists also play an important role in the diagnosis and rehabilitation of patients suffering from Low-vision. -
Miotics in Closed-Angle Glaucoma
Brit. J. Ophthal. (I975) 59, 205 Br J Ophthalmol: first published as 10.1136/bjo.59.4.205 on 1 April 1975. Downloaded from Miotics in closed-angle glaucoma F. GANIAS AND R. MAPSTONE St. Paul's Eye Hospital, Liverpool The initial treatment of acute primary closed-angle Table i Dosage in Groups I, 2, and 3 glaucoma (CAG) is directed towards lowering intraocular pressure (IOP) to normal levels as Group Case no. Duration IOP Time rapidly as possible. To this end, aqueous inflow is (days) (mm. Hg) (hrs) reduced by a drug such as acetazolamide (Diamox), and aqueous outflow is increased via the trabecular I I 2 8 5 meshwork by opening the closed angle with miotics. 3 7 21 3 The use of miotics is of respectable lineage and hal- 5 '4 48 7 lowed by usage, but regimes vary from "intensive" 7 8 I4 5 9 I0 I8 6 (i.e. frequent) to "occasional" (i.e. infrequent) instilla- I I 2 12 6 tions. Finally, osmotic agents are used after a variable '3 5 20 6 interval of time if the IOP remains raised. Tlle pur- I5 '4 I8 6 pose of this paper is to investigate the value of '7 '4 i6 6 miotics in the initial treatment of CAG. I9 6 02 2 2 2 8 2I 5 Material and methods 4 20t 20 6 Twenty patients with acute primary closed-angle glau- 6 I i8 5 http://bjo.bmj.com/ coma were treated, alternately, in one of two ways 8 4 i8 5 detailed below: I0 6 I8 6 I2 I0 20 6 (I) Intravenous Diamox 500 mg. -
Drug Class Review Ophthalmic Cholinergic Agonists
Drug Class Review Ophthalmic Cholinergic Agonists 52:40.20 Miotics Acetylcholine (Miochol-E) Carbachol (Isopto Carbachol; Miostat) Pilocarpine (Isopto Carpine; Pilopine HS) Final Report November 2015 Review prepared by: Melissa Archer, PharmD, Clinical Pharmacist Carin Steinvoort, PharmD, Clinical Pharmacist Gary Oderda, PharmD, MPH, Professor University of Utah College of Pharmacy Copyright © 2015 by University of Utah College of Pharmacy Salt Lake City, Utah. All rights reserved. Table of Contents Executive Summary ......................................................................................................................... 3 Introduction .................................................................................................................................... 4 Table 1. Glaucoma Therapies ................................................................................................. 5 Table 2. Summary of Agents .................................................................................................. 6 Disease Overview ........................................................................................................................ 8 Table 3. Summary of Current Glaucoma Clinical Practice Guidelines ................................... 9 Pharmacology ............................................................................................................................... 10 Methods ....................................................................................................................................... -
Care of the Patient with Accommodative and Vergence Dysfunction
OPTOMETRIC CLINICAL PRACTICE GUIDELINE Care of the Patient with Accommodative and Vergence Dysfunction OPTOMETRY: THE PRIMARY EYE CARE PROFESSION Doctors of optometry are independent primary health care providers who examine, diagnose, treat, and manage diseases and disorders of the visual system, the eye, and associated structures as well as diagnose related systemic conditions. Optometrists provide more than two-thirds of the primary eye care services in the United States. They are more widely distributed geographically than other eye care providers and are readily accessible for the delivery of eye and vision care services. There are approximately 36,000 full-time-equivalent doctors of optometry currently in practice in the United States. Optometrists practice in more than 6,500 communities across the United States, serving as the sole primary eye care providers in more than 3,500 communities. The mission of the profession of optometry is to fulfill the vision and eye care needs of the public through clinical care, research, and education, all of which enhance the quality of life. OPTOMETRIC CLINICAL PRACTICE GUIDELINE CARE OF THE PATIENT WITH ACCOMMODATIVE AND VERGENCE DYSFUNCTION Reference Guide for Clinicians Prepared by the American Optometric Association Consensus Panel on Care of the Patient with Accommodative and Vergence Dysfunction: Jeffrey S. Cooper, M.S., O.D., Principal Author Carole R. Burns, O.D. Susan A. Cotter, O.D. Kent M. Daum, O.D., Ph.D. John R. Griffin, M.S., O.D. Mitchell M. Scheiman, O.D. Revised by: Jeffrey S. Cooper, M.S., O.D. December 2010 Reviewed by the AOA Clinical Guidelines Coordinating Committee: David A. -
Mydriasis Associated with Local Dysfunction of Parasympathetic Nerves in Two Dogs
NOTE Internal Medicine Mydriasis Associated with Local Dysfunction of Parasympathetic Nerves in Two Dogs Teppei KANDA1), Kazuhiro TSUJI1), Keiko HIYAMA2), Takeshi TSUKA1), Saburo MINAMI1), Yoshiaki HIKASA1), Toshinori FURUKAWA3) and Yoshiharu OKAMOTO1)* 1)Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4–101, Koyama-minami, Tottori 680–8553, 2)Takamori Animal Hospital, 3706–2, Agarimichi, Sakaiminato, Tottori 684–0033 and 3)Department of Comparative Animal Science, College of Life Science, Kurashiki University of Science and the Arts, 2640, Tsurajima-nishinoura, Kurashiki, Okayama 712–8505, Japan. (Received 13 August 2009/Accepted 16 November 2009/Published online in J-STAGE 9 December 2009) ABSTRACT. In clinical practice, photophobia resulting from persistent mydriasis may be associated with dysfunction of ocular parasympa- thetic nerves or primary iris lesions. We encountered a 5-year-old Miniature Dachshund and a 7-year-old Shih Tzu with mydriasis, abnormal pupillary light reflexes, and photophobia. Except for sustained mydriasis and photophobia, no abnormalities were detected on general physical examination or ocular examination of either dog. We performed pharmacological examinations using 0.1% and 2% pilo- carpine to evaluate and diagnose parasympathetic denervation of the affected pupillary sphincter muscles. On the basis of the results, we diagnosed a pupillary abnormality due to parasympathetic dysfunction and not to overt primary iris lesions. The test revealed that neuroanatomic localization of the lesion was postciliary ganglionic in the first dog. KEY WORDS: autonomic nervous system, canine, mydriasis, ophthalmology, tonic pupil. J. Vet. Med. Sci. 72(3): 387–389, 2010 Mydriasis and miosis are normal physiological reactions and we report herein the clinical features, diagnosis, and that allow the eye to adjust to the level of incoming light. -
Treatment of Convergence Insufficiency in Childhood: a Current Perspective
1040-5488/09/8605-0420/0 VOL. 86, NO. 5, PP. 420–428 OPTOMETRY AND VISION SCIENCE Copyright © 2009 American Academy of Optometry REVIEW Treatment of Convergence Insufficiency in Childhood: A Current Perspective Mitchell Scheiman*, Michael Rouse†, Marjean Taylor Kulp†, Susan Cotter†, Richard Hertle‡, and G. Lynn Mitchell§ ABSTRACT Purpose. To provide a current perspective on the management of convergence insufficiency (CI) in children by summarizing the findings and discussing the clinical implications from three recent randomized clinical trials in which we evaluated various treatments for children with symptomatic CI. We then present an evidence-based treatment approach for symptomatic CI based on the results of these trials. Finally, we discuss unanswered questions and suggest directions for future research in this area. Methods. We reviewed three multi-center randomized clinical trials comparing treatments for symptomatic (CI) in children 9 to 17 years old (one study 9 to 18 years old). Two trials evaluated active therapies for CI. These trials compared the effectiveness of office-based vergence/accommodative therapy, office-based placebo therapy, and home-based therapy [pencil push-ups alone (both trials), home-based computer vergence/accommodative therapy, and pencil push-ups (large-scale study)]. One trial compared the effectiveness of base-in prism reading glasses to placebo reading glasses. All studies included well-defined criteria for the diagnosis of CI, a placebo group, and masked examiners. The primary outcome measure was the Convergence Insufficiency Symptom Survey score. Secondary outcomes were near point of convergence and positive fusional vergence at near. Results. Office-based vergence/accommodative therapy was significantly more effective than home-based or placebo therapies. -
Practical Tips for Managing Myopia
MYOPIA MANAGEMENT Practical tips for managing myopia Michael Morton This article presents a summary of Online Education Coordinator: practical approaches to diagnosing Brien Holden Vision myopia, myopia management Institute, Sydney, Australia. (with particular attention to low resource settings), reviewing myopia progression, and collecting data for myopia management programmes. Ling Lee Research Officer/ Optometrist: Part 1 Diagnosing and prescribing Brien Holden Vision Institute, Sydney, for myopia Australia. While myopia might be initially detected by a patient EDGARDO CONTRERAS, COURTESY OF IAPB (e.g. reporting distance blur), or an adult observing Refraction is the first step. MEXICO behaviour changes in a child (e.g. squinting or • Monocular estimate method (MEM) retinoscopy. viewing things closer than expected), myopia is generally An objective method to determine a child’s diagnosed by an eye care professional. accommodative (near focussing) status at near. Priya Morjaria Equipment Retinoscopy should be conducted with a near target. Research Fellow: Accommodative facility. A subjective method to Department of The minimum required equipment to diagnose myopia • Clinical Research, and assess progression includes: assess accommodation function (ability of eye to London School focus at near). A high-contrast distance visual acuity (VA) chart (e.g., of Hygiene and • • Subjective phorias. A subjective method to Tropical Medicine, Snellen, logMAR, E, or LEA) determine whether the eyes prefer to converge in or International Centre • A room or space where the viewing distance for VA diverge out, at distance and near. for Eye Health, is at least 3m/10ft. The chart should be well lit and • Vergence reserves. A subjective method that London, UK. calibrated for the working distance measures the eyes’ ability to converge in and • Occluder (ideally with pinhole occluder) diverge out. -
Glaucoma Medical Treatment: Philosophy, Principles and Practice
Glaucoma medical CLIVE MIGDAL treatment: philosophy, principles and practice Abstract assessment of these parameters. Indeed There have been numerous recent advances in compounds are under evaluation that affect the the management of glaucoma, not least the function of the optic nerve (via improved blood development of new drugs to help manage supply or improved neuronal cell physiology) raised intraocular pressure. In addition, the but may or may not lower lOP. It may even be concepts of improving blood flow to the optic possible in the future to therapeutically alter the nerve head and neuroprotection are currently human genome, genetically deliver provoking considerable interest. This article neuroprotective substances or aid regeneration considers the aims and philosophy of of the optic nerve axons. glaucoma drug therapy, summarises some of The main aim of glaucoma therapy must still the basic facts and principles of modem be the preservation of visual function. At the glaucoma medications, and suggests a same time, the therapy should not have adverse practical approach to the choice of therapy. side effects and should not affect the quality of life of the patient (by causing either side effects Key words Blood flow, Intraocular pressure, or inconvenience and disruption of daily Neuroprotection, Primary open angle glaucoma, Topical medications lifestyle). The cost of the therapy, both direct and indirect, must also be taken into consideration.s Currently, typical glaucoma management Philosophy consists of lowering the lOP to a satisfactory Primary open-angle glaucoma is a complex and safe target leve1.6 To determine the success disease for which a number of risk factors have of this treatment, the patient must be followed been identified, including intraocular pressure, long-term with routine assessment of lOP, discs age, race and family history.l,2 Due to our and fields to exclude progressive damage. -
Miotic Adie's Pupils
Journal of Cll/lical Neuro-ophtllJllmology 9(1): 43-45, 1989. RilVen Press, Ltd., New York Miotic Adie's Pupils Michael L. Rosenberg, M.D. Two young adults, aged 24 and 31, had a long history of Adie's syndrome or, pupillotonia, is typically small, poorly reactive pupilS. There was no history of characterized by either unilaterally or bilaterally large pupils, and a review of old photographs confirmed enlarged pupils that are unresponsive to light (1). 10 and 5 years, respectively, of miosis. Both were found to have bilateral tonic pupils that were supersensitive to The diagnosis is made clinically by watching for a diluted pilocarpine. Although it is possible that they had tonic constriction to near stimulation followed by a an unusually early onset of bilateral Adie's syndrome tonic redilatation. with dilated pupils that was not noticed, it is suggested Two young adults are described who were noted that some patients might have primary miotic Adie's during routine examinations to have bilaterally mi pupils without ever passing through a mydriatic phase. Key Words: Adie's syndrome-Argyll Robertson pu otic pupils that were thought to be fixed to light. pils-Miosis. They were both referred for the evaluation of Ar gyll Robertson pupils. Evaluation revealed bilat eral tonic reactions to near stimulation in both pa tients, typical of Adie's tonic pupilS. The diagnosis of parasympathetic denervation was confirmed in both patients as their pupils constricted with di luted pilocarpine. The cases reinforce the principle that any pupil regardless of size should be evalu ated for the possibility of pupillotonia. -
2019 Volume 51 Evaluation of Education of Patients with AMD Of
2019 Volume 51 Evaluation of education of patients with AMD of treatment and services Gaze behaviour of novice and glaucoma specialists of optic disc examination Orthoptics Australia workforce survey 2017 2019 Volume 51 The official journal of Orthoptics Australia ISSN 2209-1262 Editors in Chief Linda Santamaria DipAppSc(Orth) MAppSc Meri Vukicevic BOrth PGDipHlthResMeth PhD Editorial Board Jill Carlton MMedSc(Orth), BMedSc(Orth) Konstandina Koklanis BOrth(Hons) PhD Nathan Clunas BAppSc(Orth)Hons PhD Linda Malesic BOrth(Hons) PhD Elaine Cornell DOBA DipAppSc MA PhD Karen McMain BA OC(C) COMT (Halifax, Nova Scotia) Catherine Devereux DipAppSc(Orth) MAppSc Vincent Ngugen BAppSc(Hons) MAppSc PhD Gill Roper-Hall DBOT CO COMT Kerry Fitzmaurice HTDS DipAppSc(Orth) PhD Sue Silveira DipAppSc(Orth) MHlthEd PhD Mara Giribaldi BAppSc(Orth) Kathryn Thompson DipAppSc(Orth) GradCertHlthScEd MAppSc(Orth) Julie Green DipAppSc(Orth) PhD Suzane Vassallo BOrth(Hons) PhD Neryla Jolly DOBA(T) MA The Australian Orthoptic Journal is peer-reviewed and the official annual scientific journal of Orthoptics Australia. The Australian Orthoptic Journal features original scientific research papers, reviews and perspectives, case studies, invited editorials, letters and book reviews. The Australian Orthoptic Journal covers key areas of orthoptic clinical practice – strabismus, amblyopia, ocular motility and binocular vision anomalies; low vision and rehabilitation; paediatric ophthalmology; neuro-ophthalmology including nystagmus; ophthalmic technology and biometry; and public health agenda. Published by Orthoptics Australia (Publication date: January 2020). Editor’s details: Meri Vukicevic, [email protected]; Discipline of Orthoptics, School of Allied Health, La Trobe University. Linda Santamaria, [email protected]; Department of Surgery, Monash University. -
Microcoria Due to First Duplication of 13Q32.1 Including the GPR180
European Journal of Medical Genetics 63 (2020) 103918 Contents lists available at ScienceDirect European Journal of Medical Genetics journal homepage: www.elsevier.com/locate/ejmg Microcoria due to first duplication of 13q32.1 including the GPR180 gene and maternal mosaicism T Elise Pozzaa,1, Hannah Verdinb,1, Hilde Deconinckc, Annelies Dheedeneb, Björn Mentenb, ∗ Elfride De Baereb, Irina Balikovaa,d,e, a Department of Ophthalmology, Children Hospital Queen Fabiola, Brussels, Belgium b Center for Medical Genetics, Ghent University and Ghent University Hospital, Ghent, Belgium University of Ghent, Ghent, Belgium c Private Clinical Practice, Brussels, Belgium d Department of Ophthalmology, Ghent University Hospital, Belgium e Department of Ophthalmology, Leuven University Hospital, Belgium ABSTRACT Congenital microcoria (MCOR) is an eye anomaly characterized by a pupil with diameter below 2 mm, and is caused by underdevelopment or absence of the dilator muscle of the pupil. Two types have been described: a recessive, syndromic (Pierson syndrome OMIM 609049) and a dominant, isolated form (MCOR syndrome OMIM 156600). Fares-Taie and colleagues described inherited microdeletions in chromosome band 13q32.1 segregating with dominant microcoria in several families. The GPR180 gene is located within the smallest commonly deleted region and encodes a G protein-coupled receptor involved in smooth muscle cells growth. We here describe a patient with isolated, non-syndromic MCOR. The patient presented with a blue iris and small pupils, non-reactive to cycloplegic agents. Her mother had a milder ocular phenotype, namely a blue iris with hypoplastic crypts and mild myopia. We present a detailed clinical examination and follow up. DNA from the index patient was analyzed for the presence of chromosomal imbalances using molecular karyotyping.