DOCSLIB.ORG

Development of a Core Outcome Set for Amblyopia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Development of a Core Outcome Set for Amblyopia Jabri et al. BMC Ophthalmology (2019) 19:47 https://doi.org/10.1186/s12886-019-1055-8 RESEARCHARTICLE Open Access Development of a core outcome set for amblyopia, strabismus and ocular motility disorders: a review to identify outcome measures Samia Al Jabri1, Jamie Kirkham2 and Fiona J. Rowe1* Abstract Background: Core Outcome Sets (COS) are defined as the minimum sets of outcomes that should be measured and reported in all randomised controlled trials to facilitate combination and comparability of research. The aim of this review is to produce an item bank of previously reported outcome measures from published studies in amblyopia, strabismus and ocular motility disorders to initiate the development of COS. Methods: A review was conducted to identify articles reporting outcome measures for amblyopia, strabismus and ocular motility disorders. Using systematic methods according to the COMET handbook we searched key electronic bibliographic databases from 1st January 2011 to 27th September 2016 using MESH terms and alternatives indicating the different subtypes of amblyopia, strabismus and ocular motility disorders in relation to treatment outcomes and all synonyms. We included Cochrane reviews, other systematic reviews, controlled trials, non- systematic reviews and retrospective studies. Data was extracted to tabulate demographics of included studies, primary and secondary outcomes, methods of measurement and their time points. Results: A total of 142 studies were included; 42 in amblyopia, 33 in strabismus, and 68 in ocular motility disorders (one study overlap between amblyopia and strabismus). We identified ten main outcome measure domains for amblyopia, 14 for strabismus, and ten common “visual or motility” outcome measure domains for ocular motility disorders. Within the domains, we found variable nomenclature being used and diversity in methods and timings of measurements. Conclusion: This review highlights discrepancies in outcome measure reporting within published literature for amblyopia, strabismus and ocular motility and it generated an item bank of the most commonly used and reported outcome measures for each of the three conditions from recent literature to start the process of COS development. Consensus among all stakeholders including patients and professionals is recommended to establish a useful COS. Keywords: Amblyopia, Strabismus, Ocular motility disorders, Outcome measures, Core outcome set * Correspondence: [email protected] 1Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 2nd Floor, 1-3 Brownlow Street, L69 3GL Liverpool, UK Full list of author information is available at the end of the article © The Author(s). 2019, corrected publication March/2019. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Jabri et al. BMC Ophthalmology (2019) 19:47 Page 2 of 22 Background Development of a COS involves a number of stages Amblyopia, strabismus and ocular motility disorders that commence with a systematic review of the literature occur in about 10% of the general population (amblyopia to identify existing knowledge about outcome measures 2–5%, strabismus 4%) [1]. They often present as child- [7]. This is then followed by qualitative studies, Delphi hood conditions and can constitute long-term problems surveys to consult widely on outcome measures and fi- for children and young adults. Strabismus and ocular nally, consensus meetings to discuss and agree on the motility disorders can also develop as acquired condi- COS [7]. This paper reports the first stage – the litera- tions due to neurological, endocrine and traumatic ture review to identify the reported range of outcome causes. There are several approaches to the management measures in the published literature for amblyopia, stra- of these conditions including occlusion, penalisation, bismus and ocular motility disorders. spectacles, prisms, drugs, surgery, botulinum toxin, exer- cises, watchful waiting, or a combination of two or more Objectives of the above [2]. The effects from these treatments such The primary aim of this review is to generate an item as improvements in symptoms or side effects are bank of relevant outcome measures previously reported assessed by outcome measures and are usually used to by researchers and clinicians in studies of treatment of formally evaluate management options in clinical stud- conditions under evaluation. The review aims also to de- ies. However varied outcome measures and several end- termine the variation in measuring methods used and – points are often used [3 5]. This lack of standardisation timings of assessments. makes it difficult to compare the conclusions of these The secondary objectives of this review are to investi- studies and, as a result, renders it challenging to discuss gate sources of variability of outcome measure defini- realistically the likely outcomes of treatment with pa- tions including different age groups, study designs, types tients in the clinic [6]. of amblyopia (e.g. refractive, strabismic, stimulus One strategy suggested to overcome the issues result- deprivation), types of strabismus (e.g. exotropia, esotro- ing from variable outcome measures is the development pia), and types of ocular motility disorder (e.g. accom- of Core Outcome Sets (COS). This is defined as the modation and convergence disorders, mechanical minimum set of outcomes that should be measured and restrictions, myogenic, neurogenic, nystagmus, patterns reported in all randomised controlled trials [7]. The deviation and gaze palsy). COS will make it easier for the results of trials to be compared, contrasted and combined, lead to research that is more likely to have measured relevant outcomes Methods due to involvement of relevant stakeholders, and en- A protocol for the development of this COS project was – hance the value of evidence synthesis by ensuring that written by a steering committee a team of stakeholders all trials contribute usable information [7]. Therefore, it including COS developers, ophthalmologists, orthoptists is postulated that the use of COS would increase the po- and journal editors. The review protocol was registered tential in carrying out future meta-analysis for target in the COMET initiative website (http://www.comet-ini- conditions. tiative.org/studies/details/900?result=true) and published The numerous and diverse outcome measures that as open access (http://pcwww.liv.ac.uk/~rowef/index_- may be used for amblyopia, strabismus and ocular motil- files/Page356.htm). The review, using systematic rigor- ity disorders include, amongst others, visual acuity, angle ous methods, was conducted in accordance with the of deviation, range of ocular movements, fixation stabil- guidelines from the COMET handbook [7]. A PRISMA ity and binocular vision measurements. There are a checklist [10] has been completed for the systematic re- number of Cochrane systematic reviews that consider a view and can be found in Additional file 1 : Table S1. range of treatment trials for amblyopia, strabismus and ocular motility disorders. Their recommendations call Eligibility criteria for clarification of dose/response effect and further in- Age vestigation of treatment regimens [2–4]. An attempt to Subjects of all ages with target conditions were included. utilise a COS is evident for the National Strabismus Data Target conditions: Set project [8]. A recent review recommended four out- comes for reporting results of surgery for intermittent 1. Amblyopia (unilateral, bilateral) of any type or exotropia [5] but was limited by the extent of literature severity (refractive, meridional, ametropic, review and lack of external consensus. A short narrative strabismic or stimulus deprivation). review of outcome measurements for size of deviation 2. Strabismus (latent, manifest, constant, intermittent, showed considerable variability across the tests available micro) of any type and severity (eso, exo, hyper, and the recommendations for their use [9]. hypo, cyclo deviation) Jabri et al. BMC Ophthalmology (2019) 19:47 Page 3 of 22 3. Ocular motility disorders (OMDs) of any type and September 2016. This period was selected given the con- severity (nystagmus, horizontal/vertical gaze palsy, siderable increase in studies, trials and reviews in recent cranial nerve palsy, convergence/divergence years and to extract treatment outcome measures that disorder, patterns of horizontal incomitance, are relevant to recent research and clinical practice. As mechanical restrictions, myogenic disorders like per COMET handbook guidance [7] we recognised that thyroid eye disease and myasthenia with ocular overly large reviews would be resource intensive and involvement). might not yield important additional outcomes. We did not search for unpublished studies or in clin- We included all three target conditions in recognition ical trials registries and we did not hand-search any add- of the considerable overlap between them, for example itional resources. We performed citation
Load more

Recommended publications
  • Hereditary Nystagmus in Early Childhood
    J Med Genet: first published as 10.1136/jmg.7.3.253 on 1 September 1970. Downloaded from Journal of Medical Genetics (1970). 7, 253. Hereditary Nystagmus in Early Childhood BRIAN HARCOURT* Nystagmus is defined as a rhythmic involuntary clinical characteristics of various types of hereditary movement of the eyes, and as an acquired pheno- nystagmus and the techniques which are available menon arising in later childhood or in adult life is to differentiate between 'idiopathic' nystagmus and usually a symptom of serious neurological or laby- nystagmus as a symptom of an occult disorder of the rinthine disease; in such cases the movements of the visual apparatus in early childhood, some descrip- eyes commonly produce subjective symptoms of tion of the modes of inheritance and of the long- objects moving in the visual panorama (oscillopsia). term visual prognosis are given in the various Nystagmus may also be 'congenital', or, more categories of infantile nystagmus which can be so accurately, may first be observed within a few weeks defined. of birth when the infant begins to attempt to fix and to follow visually stimulating targets by means of Character of Nystagmus conjugate movements of the eyes. In such cases, Though it is not usually possible to arrive at the nystagmus may persist throughout life, but even an exact diagnosis of the cause of nystagmus by ob- at a later stage there is always a complete absence of servation of the eye movements alone, a great deal of the symptom of oscillopsia. Nystagmus which useful information can be obtained by such a study.
    [Show full text]
  • Treacher Collins Prize Essay the Significance of Nystagmus
    Eye (1989) 3, 816--832 Treacher Collins Prize Essay The Significance of Nystagmus NICHOLAS EVANS Norwich Introduction combined. The range of forms it takes, and Ophthalmology found the term v!to"[<xy!too, the circumstances in which it occurs, must be like many others, in classical Greece, where it compared and contrasted in order to under­ described the head-nodding of the wined and stand the relationships between nystagmus of somnolent. It first acquired a neuro-ophthal­ different aetiologies. An approach which is mological sense in 1822, when it was used by synthetic as well as analytic identifies those Goodl to describe 'habitual squinting'. Since features which are common to different types then its meaning has been refined, and much and those that are distinctive, and helps has been learned about the circumstances in describe the relationship between eye move­ which the eye oscillates, the components of ment and vision in nystagmus. nystagmus, and its neurophysiological, Nystagmus is not properly a disorder of eye neuroanatomic and neuropathological corre­ movement, but one of steady fixation, in lates. It occurs physiologically and pathologi­ which the relationship between eye and field cally, alone or in conjunction with visual or is unstable. The essential significance of all central nervous system pathology. It takes a types of nystagmus is the disturbance in this variety of different forms, the eyes moving relationship between the sensory and motor about one or more axis, and may be conjugate ends of the visual-oculomotor axis. Optimal or dysjugate. It can be modified to a variable visual performance requires stability of the degree by external (visual, gravitational and image on the retina, and vision is inevitably rotational) and internal (level of awareness affected by nystagmus.
    [Show full text]
  • Macular Dystrophies Mimicking Age-Related Macular Degeneration
    Progress in Retinal and Eye Research 39 (2014) 23e57 Contents lists available at ScienceDirect Progress in Retinal and Eye Research journal homepage: www.elsevier.com/locate/prer Macular dystrophies mimicking age-related macular degeneration Nicole T.M. Saksens a,1,2,7, Monika Fleckenstein b,1,3,7, Steffen Schmitz-Valckenberg b,4,7, Frank G. Holz b,3,7, Anneke I. den Hollander a,5,7, Jan E.E. Keunen a,5,7, Camiel J.F. Boon a,c,d,5,6,7, Carel B. Hoyng a,*,7 a Department of Ophthalmology, Radboud University Medical Centre, Philips van Leydenlaan 15, 6525 EX Nijmegen, The Netherlands b Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany c Oxford Eye Hospital and Nuffield Laboratory of Ophthalmology, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford OX3 9DU, United Kingdom d Department of Ophthalmology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands article info abstract Article history: Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the elderly Available online 28 November 2013 population in the Western world. AMD is a clinically heterogeneous disease presenting with drusen, pigmentary changes, geographic atrophy and/or choroidal neovascularization. Due to its heterogeneous Keywords: presentation, it can be challenging to distinguish AMD from several macular diseases that can mimic the Age-related macular degeneration features of AMD. This clinical overlap may potentially lead to misdiagnosis. In this review, we discuss the AMD characteristics of AMD and the macular dystrophies that can mimic AMD. The appropriate use of clinical Macular dystrophy and genetic analysis can aid the clinician to establish the correct diagnosis, and to provide the patient Differential diagnosis Retina with the appropriate prognostic information.
    [Show full text]
  • 39Th Annual Meeting
    North American Neuro-Ophthalmology Society 39th Annual Meeting February 9–14, 2013 Snowbird Ski Resort • Snowbird, Utah POSTER PRESENTATIONS Tuesday, February 12, 2013 • 6:00 p.m. – 9:30 p.m. Authors will be standing by their posters during the following hours: Odd-Numbered Posters: 6:45 p.m. – 7:30 p.m. Even-Numbered Posters: 7:30 p.m. – 8:15 p.m. The Tour of Posters has been replaced with Distinguished Posters. The top-rated posters this year are marked with a “*” in the Syllabus and will have a ribbon on their poster board. Poster # Title Presenting Author 1* Redefining Wolfram Syndrome in the Molecular Era Patrick Yu-Wai-Man Management and Outcomes of Idiopathic Intracranial Hypertension with Moderate-Severe 2* Rudrani Banik Visual Field Loss: Pilot Data for the Surgical Idiopathic Intracranial Hypertension Treatment Trial Correlation Between Clinical Parameters And Diffusion-Weighted Magnetic Resonance 3* David M. Salvay Imaging In Idiopathic Intracranial Hypertension 4* Contrast Sensitivity Visual Acuity Defects in the Earliest Stages of Parkinsonism Juliana Matthews 5* Visual Function and Freedom from Disease Activity in a Phase 3 Trial for Relapsing Multiple Sclerosis Laura J. Balcer Dimensions of the Optic Nerve Head Neural Canal Using Enhanced Depth Imaging Optical 6* Kevin Rosenberg Coherence Tomography in Non-Arteritic Ischemic Optic Neuropathy Compared to Normal Subjects Eye Movement Perimetry: Evaluation of Saccadic Latency, Saccadic Amplitude, and Visual 7* Matthew J. Thurtell Threshold to Peripheral Visual Stimuli in Young Compared With Older Adults 9* Advanced MRI of Optic Nerve Drusen: Preliminary Findings Seth A. Smith 10* Clinical Features of OPA1-Related Optic Neuropathy: A Retrospective Case Series Philip M.
    [Show full text]
  • The Pharmacological Treatment of Nystagmus: a Review
    Review The pharmacological treatment of nystagmus: a review Rebecca Jane McLean & Irene Gottlob† Ophthalmology Group, University of Leicester, UK 1. Introduction 2. Acquired nystagmus Nystagmus is an involuntary, to-and-fro movement of the eyes that can result in a reduction in visual acuity and oscillopsia. Mechanisms that cause 3. Infantile nystagmus nystagmus are better understood in some forms, such as acquired periodic 4. Other treatments used in alternating nystagmus, than in others, for example acquired pendular nystagmus nystagmus, for which there is limited knowledge. Effective pharmacological 5. Conclusion treatment exists to reduce nystagmus, particularly in acquired nystagmus 6. Expert opinion and, more recently, infantile nystagmus. However, as there are very few randomized controlled trials in the area, most pharmacological treatment options in nystagmus remain empirical. Keywords: 3,4-diaminopyridine, acquired nystagmus, acquired pendular nystagmus, baclofen, downbeat nystagmus, gabapentin, infantile nystagmus, memantine, multiple sclerosis, periodic alternating nystagmus, upbeat nystagmus Expert Opin. Pharmacother. (2009) 10(11):1805-1816 1. Introduction The involuntary, to-and-fro oscillation of the eyes in pathological nystagmus can occur in the horizontal, vertical and/or torsional plane and be further classified into a jerk or pendular waveform [1]. Nystagmus leads to reduced visual acuity due to the excessive motion of images on the retina, and also the movement of images away from the fovea [2]. As the desired target falls further from the centre of the fovea, receptor density decreases and therefore the ability to perceive detail is reduced [3]. Visual acuity also declines the faster the target moves across the fovea [4]. Three main mechanisms stabilize the line of sight (to static targets) so that the image we see is fixed and clear.
    [Show full text]
  • Visual Perception in Migraine: a Narrative Review
    vision Review Visual Perception in Migraine: A Narrative Review Nouchine Hadjikhani 1,2,* and Maurice Vincent 3 1 Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA 2 Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, 41119 Gothenburg, Sweden 3 Eli Lilly and Company, Indianapolis, IN 46285, USA; [email protected] * Correspondence: [email protected]; Tel.: +1-617-724-5625 Abstract: Migraine, the most frequent neurological ailment, affects visual processing during and between attacks. Most visual disturbances associated with migraine can be explained by increased neural hyperexcitability, as suggested by clinical, physiological and neuroimaging evidence. Here, we review how simple (e.g., patterns, color) visual functions can be affected in patients with migraine, describe the different complex manifestations of the so-called Alice in Wonderland Syndrome, and discuss how visual stimuli can trigger migraine attacks. We also reinforce the importance of a thorough, proactive examination of visual function in people with migraine. Keywords: migraine aura; vision; Alice in Wonderland Syndrome 1. Introduction Vision consumes a substantial portion of brain processing in humans. Migraine, the most frequent neurological ailment, affects vision more than any other cerebral function, both during and between attacks. Visual experiences in patients with migraine vary vastly in nature, extent and intensity, suggesting that migraine affects the central nervous system (CNS) anatomically and functionally in many different ways, thereby disrupting Citation: Hadjikhani, N.; Vincent, M. several components of visual processing. Migraine visual symptoms are simple (positive or Visual Perception in Migraine: A Narrative Review. Vision 2021, 5, 20. negative), or complex, which involve larger and more elaborate vision disturbances, such https://doi.org/10.3390/vision5020020 as the perception of fortification spectra and other illusions [1].
    [Show full text]
  • Simulation of Oscillopsia in Virtual Reality
    This is a repository copy of Simulation of oscillopsia in virtual reality. White Rose Research Online URL for this paper: http://eprints.whiterose.ac.uk/132350/ Version: Published Version Article: Randall, D., Griffiths, H. orcid.org/0000-0003-4286-5371, Arblaster, G. orcid.org/0000-0002-3656-3740 et al. (2 more authors) (2018) Simulation of oscillopsia in virtual reality. British and Irish Orthoptic Journal, 14 (1). pp. 45-49. ISSN 1743-9868 10.22599/bioj.112 Reuse This article is distributed under the terms of the Creative Commons Attribution (CC BY) licence. This licence allows you to distribute, remix, tweak, and build upon the work, even commercially, as long as you credit the authors for the original work. More information and the full terms of the licence here: https://creativecommons.org/licenses/ Takedown If you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing [email protected] including the URL of the record and the reason for the withdrawal request. [email protected] https://eprints.whiterose.ac.uk/ Randall, D, et al. 2018. Simulation of Oscillopsia in Virtual Reality. British and Irish Orthoptic Journal, 14(1), pp.4549, DOI: https://doi.org/10.22599/bioj.112 ORIGINAL ARTICLE Simulation of Oscillopsia in Virtual Reality David Randall, Helen Griffiths, Gemma Arblaster, Anne Bjerre and John Fenner Purpose: Nystagmus is characterised by involuntary eye movement. A proportion of those with nystagmus experience the world constantly in motion as their eyes move: a symptom known as oscillopsia. Individuals with oscillopsia can be incapacitated and often feel neglected due to limited treatment options.
    [Show full text]
  • Towards an International Classification of Vestibular Disorders
    Journal of Vestibular Research 19 (2009) 1–13 1 DOI 10.3233/VES-2009-0343 IOS Press Classification of vestibular symptoms: Towards an international classification of vestibular disorders First consensus document of the Committee for the Classification of Vestibular Disorders of the B ar´ any´ Society Alexandre Bisdorffa,∗, Michael Von Brevernb, Thomas Lempertc and David E. Newman-Tokerd aDepartment of Neurology, Centre Hospitalier Emile Mayrisch, L-4005 Esch-sur-Alzette, Luxembourg bVestibular Research Group Berlin, Department of Neurology, Park-Klinik Weissensee, Berlin, Germany cVestibular Research Group Berlin, Department of Neurology, Schlosspark-Klinik, Berlin, Germany dDepartment of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA On behalf of the Committee for the Classification of Vestibular Disorders of the Bar´ any´ Society: Pierre Bertholon, Alexandre Bisdorff, Adolfo Bronstein, Herman Kingma, Thomas Lempert, Jose Antonio Lopez Escamez, Måns Magnusson, Lloyd B. Minor, David E. Newman-Toker, Nicolas´ Perez,´ Philippe Perrin, Mamoru Suzuki, Michael von Brevern, John Waterston and Toshiaki Yagi Received 4 February 2009 Accepted 1 September 2009 1. Introduction such as psychiatry and headache, where often there is no histopathologic, radiographic, physiologic, or other The Committee for Classification of Vestibular Dis- independent diagnostic standard available. However, orders of the Bar´ any´ Society was inaugurated at the diagnostic standards and classification are also crucial meeting of the Bar´ any´ Society in Uppsala 2006. Its in areas of medicine such as epilepsy and rheumatolo- charge is to promote development of an implementable gy, where, although confirmatory tests do exist, there classification of vestibular disorders. is substantial overlap in clinical features or biomarkers Symptom and disease definitions are a fundamen- across syndromes.
    [Show full text]
  • Assessment and Management of Infantile Nystagmus Syndrome
    perim Ex en l & ta a l ic O p in l h t C h f Journal of Clinical & Experimental a o l m l a o n l r o Atilla, J Clin Exp Ophthalmol 2016, 7:2 g u y o J Ophthalmology 10.4172/2155-9570.1000550 ISSN: 2155-9570 DOI: Review Article Open Access Assessment and Management of Infantile Nystagmus Syndrome Huban Atilla* Department of Ophthalmology, Faculty of Medicine, Ankara University, Turkey *Corresponding author: Huban Atilla, Department of Ophthalmology, Faculty of Medicine, Ankara University, Turkey, Tel: +90 312 4462345; E-mail: [email protected] Received date: March 08, 2016; Accepted date: April 26, 2016; Published date: April 29, 2016 Copyright: © 2016 Atilla H. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract This article is a review of infantile nystagmus syndrome, presenting with an overview of the physiological nystagmus and the etiology, symptoms, clinical evaluation and treatment options. Keywords: Nystagmus syndrome; Physiologic nystagmus phases; active following of the stimulus results in poor correspondence between eye position and stimulus position. At higher velocity targets Introduction (greater than 100 deg/sec) optokinetic nystagmus can no longer be evoked. Unlike simple foveal smooth pursuit, OKN appears to have Nystagmus is a rhythmic, involuntary oscillation of one or both both foveal and peripheral retinal components [3]. Slow phase of the eyes. There are various classifications of nystagmus according to the nystagmus is for following the target and the fast phase is for re- age of onset, etiology, waveform and other characteristics.
    [Show full text]
  • Genetic Syndromes with CMI, Including Many of Skeletal Abnormality, Such
    Correspondence 402 genetic syndromes with CMI, including many of skeletal Correspondence: S George, abnormality, such as achondroplasia.1,2 Tel: þ 44 2890 240 503; CMI is thought to be a skeletal mesodermal disorder Fax: þ 44 2890 330 744. resulting from faulty division embryonic somites E-mail: [email protected] forming the skull base and cranoicervical junction.2 Governing this process is the gene Pax-1, whose Eye (2006) 20, 400–402. doi:10.1038/sj.eye.6701887; malfunction causes vertebral fusion and a small posterior published online 22 April 2005 cranial fossa.2 Altered cerebrospinal fluid flow in this constricted environment produces the varied symptoms, the commonest being suboccipital headache. Ophthalmic Sir, symptoms occur in the majority of patients and include A brief history of punctoplasty: the 3-snip revisited retro orbital pain, floaters, photopsia, photophobia, diplopia, and visual field loss. Hearing loss and We read with interest the article by Caesar et al1 on ‘A vestibular impairment causing vertigo, oscillopsia, and brief history of punctoplasty: the 3-snip revisited’. In the nystagmus, as well as symptoms of spinal cord article, the authors reviewed the development of various dysfunction, are prevalent.4 surgical methods for treating punctal stenosis and Extensive literature search has failed to identify reported their results of 3-snip punctoplasty. We feel that another reported case of familial CMI in the United some issues that may affect the outcomes warrant further Kingdom. Learning points illustrated herein include the discussion. diagnostic challenges posed by CMI, and the importance All the patients were assessed for subjective of assessing family history to increase surveillance of improvement of epiphora at 1 week after operation.
    [Show full text]
  • Ocular Side Effects of Systemic Drugs.Cdr
    ERA’S JOURNAL OF MEDICAL RESEARCH VOL.6 NO.1 Review Article OCULAR SIDE EFFECTS OF SYSTEMIC DRUGS Pragati Garg, Swati Yadav Department of Ophthalmology Era's Lucknow Medical College & Hospital, Sarfarazganj Lucknow, U.P., India-226003 Received on : 06-03-2019 Accepted on : 28-06-2019 ABSTRACT Systemic drugs are frequently administered in persons of all age group Address for correspondence ranging from children to the elderly for various disorders. There has been Dr. Pragati Garg increased reporting of ocular side effects of various systemic drugs in the Department of Ophthalmology past two decades. Some offenders well known are α -2-adrenergic agonists, Era’s Lucknow Medical College & quinine derivatives, β- adrenergic antagonists and antituberculosis drugs. Hospital, Lucknow-226003 Newer systemic drugs causing ocular side effects are being reported in Email: [email protected] available literature. Knowledge regarding these is expected to aid Contact no: +91-9415396506 clinicians in identifying these side effects and the offending drug, thereby, prescribing the appropriate treatment for the condition the patient maybe suffering from without any ocular disturbances. KEYWORDS: Ocular side effects, Systemic drugs. Introduction This article will briefly cover how systemic drugs can Many common systemic medications can affect ocular affect the various ocular structures. tissues and visual function to varying degrees. When a Factors Affecting The Production Of Ocular Side systemic medication is taken to treat another part of the Effects By A Drug body, the eyes frequently are affected. Systemic A) Drug related factors medications can have adverse effects on the eyes that range from dry eye syndrome, keratitis and cataract to (1) The nature of the drug: Absorption of drug in blinding complications of toxic retinopathy and optic body and its pharmacological effects on the body's neuropathy (1).
    [Show full text]
  • Management of Symptomatic Latent Nystagmus
    MANAGEMENT OF SYMPTOMATIC LATENT NYSTAGMUS CHRISTOPHER LIUI, MICHAEL GRESTy2 and JOHN LEEI London SUMMARY hood squint2,3,6,7 and dissociated vertical deviation Most patients with latent nystagmus are asymptomatic (DVD).8 It is a benign condition and is not associated with and do not require treatment. We discuss the manage­ neurological diseases.2 Under most circumstances, the ment by botulinum toxin injection and surgery of five demonstration of latent nystagmus is of trivial importance cases of latent nystagmus in which the patients suffered and the majority of patients are asymptomatic. The main loss of visual acuity on certain manoeuvres as a con­ reported problem with latent nystagmus is in the assess­ 9 sequence of an exacerbation of the nystagmus amplitude. ment of monocular visual acuity, especially in children The importance of eye movement recordings for accurate with strabismus.lO,ll A further variety of latent nystagmus diagnosis is stressed and the investigative role of bot­ may be encountered in which the direction of nystagmus ulinum toxin injection is discussed. Extraocular muscle beat is independent of the laterality of covering. In our surgery is helpful in some cases of symptomatic latent experience patients with this variety are rare and on analy· nystagmus. sis have turned out to be cases of congenital nystagmuses. They are not accompanied by strabismus. The term 'latent nystagmus' is commonly used in clinical We report five patients with latent nystagmus all of practice to refer to a nystagmus which appears or mark­ whom had problems directly related to their nystagmus. edly enhances when one or other eye is covered.
    [Show full text]