The Association Between Astigmatic Anisometropia with Visual Acuity and Stereopsis
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Pediatric Anisometropia: Case Series and Review
Pediatric Anisometropia: tacles, vision therapy, and occlusion. Case two Case Series and Review is anisometropia caused by organic vision loss from optic neuritis early in life. Case three is John D. Tassinari OD, FAAO, FCOVD an infant with hyperopic anisometropia and Diplomate Binocular Vision esotropia. The esotropia did not respond to Perception and Pediatric Optometry, spectacles and home based vision therapy. American Academy of Optometry Neonatal high bilateral hyperopia that Associate Professor Western converted to anisometropia because of early University of Health Sciences onset cosmetically invisible unilateral esotropia College of Optometry is speculated. Case four describes a boy Pomona, California diagnosed with hyperopic anisometropia at age 11 months coincident with a diagnosis of pseudoesotropia. His compliance with ARTICLE prescribed spectacles was spotty until age three years. An outstanding visual outcome ABSTRACT was achieved by age five years with spectacles Background only (no occlusion therapy). Case five concerns The etiology and natural course and history a boy who acquired hyperopic anisometropia of pediatric anisometropia are incompletely because one eye experienced increasing understood. This article reviews the literature hyperopia during his toddler years. His regarding pediatric anisometropia with much response to treatment, spectacles and part of the review integrated into a case series. time occlusion with home vision therapy, was The review and case reports are intended to outstanding. Case six is an infant diagnosed elevate clinical understanding of pediatric with 2.50 diopters of hyperopic anisometropia anisometropia including and especially at age six months. Monocular home based treatment outcomes. vison developmental activities, not glasses, were prescribed. Her anisometropia vanished Case Reports three months later. -
Cataract Surgery and Diplopia
…AFTER CATARACT SURGERY Lionel Kowal RVEEH Melbourne חננו מאתך דעה בינה והשכל DISTORTION Everything in my talk is distorted by selection bias I don‟t do cataract surgery. I don‟t see the numerous happy pts that you produce I see a small Array of pts with imperfect outcomes that may /not be due to the cataract surgery DIPLOPIA AFTER CATARACT SURGERY ‘Old’ reasons ‘New’ reasons : Normal or near- normal muscle function: usually ≥1 ‘minor’ stresses on sensory & motor fusion Inf Rectus contracture after -- Anisometropia: Monovision & -caine damage Aniseikonia Other muscles damaged by -caine Metamorphopsia 2ary to macular disease Incidental 4ths and occult Minor acquired motility changes Graves‟ Ophthalmopathy of the elderly: Sagging eye uncovered by cataract surgery muscles Old, Rare & largely forgotten Other sensory issues: Big Amblyopia: fixation switch difference in contrast between Hiemann Bielschowsky images, large field defects. „OLD‟ REASONS : -CAINE TOXICITY IS IT A PERI- OR RETRO- BULBAR? If you add an EMG monitor to your injecting needle, whether you think you are doing a Retro- or Peri- Bulbar, you are IN the inf rectus ~ ½ of the time* *Elsas, Scott „OLD‟ REASONS : -CAINE TOXICITY CAN BE ANY MUSCLE, USU IR, ESP. LIR Day 1: LIR paresis : left hyper, restricted L depression, diplopia : everyone anxious ≤1% Day 7-10: diplopia goes : everyone happy Week 2+: LIR fibrosis begins - diplopia returns : left hypo, vertical & torsional diplopia, restricted L elevation: everyone upset 0.1-0.2% Hardly ever gets better Spontaneous recovery from inferior rectus contracture (consecutive hypotropia) following local anesthetic injury. Sutherland S, Kowal L. Binocul Vis Strabismus Q. -
Vision Services Professional Payment Policy Applies to the Following Carepartners of Connecticut Products
Vision Services Professional Payment Policy Applies to the following CarePartners of Connecticut products: ☒ CareAdvantage Premier ☒ CareAdvantage Prime ☒ CareAdvantage Preferred ☒ CarePartners Access The following payment policy applies to ophthalmologists who render professional vision services in an outpatient or office setting. In addition to the specific information contained in this policy, providers must adhere to the policy information outlined in the Professional Services and Facilities Payment Policy. Note: Audit and disclaimer information is located at the end of this document. POLICY CarePartners of Connecticut covers medically necessary vision services, in accordance with the member’s benefits. GENERAL BENEFIT INFORMATION Services and subsequent payment are pursuant to the member’s benefit plan document. Member eligibility and benefit specifics should be verified prior to initiating services by logging on to the secure Provider portal or by contacting CarePartners of Connecticut Provider Services at 888.341.1508. Services, including periodic follow-up eye exams, are considered “nonpreventive/nonroutine” for members with an eye disease such as glaucoma or a condition such as diabetes. Routine Eye Examinations and Optometry Medical Services CarePartners of Connecticut has arranged for administration of the vision benefit through EyeMed Vision Care. Ophthalmologists Ophthalmologists must be contracted with EyeMed Vision Care in order to provide routine eye services or dispense eyewear to CarePartners of Connecticut members. Ophthalmologists may provide nonroutine, medical eye services to members according to their CarePartners of Connecticut agreement. REFERRAL/PRIOR AUTHORIZATION/NOTIFICATION REQUIREMENTS Certain procedures, items and/or services may require referral and/or prior authorization. While you may not be the provider responsible for obtaining prior authorization, as a condition of payment you must confirm that prior authorization has been obtained. -
Refractive Errors
Refractive Errors - Epidemiology & Risk Factors (("refractive errors/epidemiology"[MAJR:noexp]) OR ("refractive errors/ethnology"[MAJR:noexp]) OR (hyperopia/epidemiology[MAJR:noexp]) OR (hyperopia/ethnology[MAJR:noexp]) OR (myopia/epidemiology[MAJR:noexp]) OR (myopia/ethnology[MAJR:noexp]) OR (astigmatism/epidemiology[MAJR:noexp]) OR (astigmatism/ethnology[MAJR:noexp]) OR (presbyopia/epidemiology[MAJR:noexp]) OR (presbyopia/ethnology[MAJR:noexp])) ((Refractive Errors[MAJR:noexp]) OR (Hyperopia[MAJR:noexp]) OR (Myopia[MAJR:noexp]) OR (Astigmatism[MAJR:noexp]) OR (Presbyopia[MAJR:noexp])) AND (Prevalence[MeSH Terms) ((Refractive Errors[MAJR:noexp]) OR (Hyperopia[MAJR:noexp]) OR (Myopia[MAJR:noexp]) OR (Astigmatism[MAJR:noexp]) OR (Presbyopia[MAJR:noexp])) AND (Risk Factors[MeSH Terms]) (("myopia/epidemiology"[MeSH Terms]) OR (("myopia"[MeSH Terms]) AND ("risk factors"[MeSH Terms]))) AND ((reading[tiab]) OR (near work[tiab]) OR (nearwork[tiab]) OR (cylinder power[tiab]) OR (optical power[tiab]) OR (accommodation[tiab])) (refractive error*[tiab] OR hyperopia[tiab] OR myopia[tiab] OR astigmatism[tiab] OR presbyopia[tiab]) AND (epidemiolog*[tiab] OR ethnolog*[tiab] OR prevalen*[tiab] OR risk factor*[tiab]) (myopia[tiab]) AND (reading[tiab] OR nearwork[tiab] OR near work[tiab]) Diagnosis – Reproducibility of Results ("refractive errors/diagnosis"[MAJR]) AND ("reproducibility of results"[MeSH Terms]) (refractive error*[tiab] OR hyperopia[tiab] OR myopia[tiab] OR astigmatism[tiab] OR presbyopia[tiab]) AND (diagnos*[tiab] OR reproducib*[tiab]) -
Association of British Dispensing Opticians Heads You Win, Tails
Agenda Heads You Win, Tails You Lose • The correction of ametropia • Magnification, retinal image size, visual Association of British The Optical Advantages and acuity Disadvantages of Spectacle Dispensing Opticians • Field of view Lenses and Contact lenses • Accommodation and convergence 2014 Conference Andrew Keirl • Binocular vision and anisometropia Kenilworth Optometrist and Dispensing Optician • Presbyopia. 1 2 3 Spectacle lenses Contact lenses Introduction • Refractive errors that can be corrected • Refractive errors that can be corrected using • Patients often change from a spectacle to a using spectacle lenses: contact lenses: contact lens correction and vice versa – myopia – myopia • Both modes of correction are usually effective – hypermetropia in producing in-focus retinal images – hypermetropia • apparent size of the eyes and surround in both cases • There are of course some differences – astigmatism – astigmatism between modes, most of which are • not so good with irregular corneas • better for irregular corneas associated with the position of the correction. – presbyopia – presbyopia • Some binocular vision problems are • Binocular vision problems are difficult to manage using contact lenses. easily managed using spectacle lenses. 4 5 6 The correction of ametropia using Effectivity contact lenses • A distance correction will form an image • Hydrogel contact lenses at the far point of the eye – when a hydrogel contact lens is fitted to an eye, The Correction of Ametropia the lens “drapes” to fit the cornea • Due to the vertex distance this far point – this implies that the tear lens formed between the will lie at slightly different distances from contact lens and the cornea should have zero the two types of correcting lens power and the ametropia is corrected by the BVP of the contact lens – the powers of the spectacle lens and the – not always the case but usually assumed in contact lens required to correct a particular practice eye will therefore be different. -
Strabismus: a Decision Making Approach
Strabismus A Decision Making Approach Gunter K. von Noorden, M.D. Eugene M. Helveston, M.D. Strabismus: A Decision Making Approach Gunter K. von Noorden, M.D. Emeritus Professor of Ophthalmology and Pediatrics Baylor College of Medicine Houston, Texas Eugene M. Helveston, M.D. Emeritus Professor of Ophthalmology Indiana University School of Medicine Indianapolis, Indiana Published originally in English under the title: Strabismus: A Decision Making Approach. By Gunter K. von Noorden and Eugene M. Helveston Published in 1994 by Mosby-Year Book, Inc., St. Louis, MO Copyright held by Gunter K. von Noorden and Eugene M. Helveston All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the authors. Copyright © 2010 Table of Contents Foreword Preface 1.01 Equipment for Examination of the Patient with Strabismus 1.02 History 1.03 Inspection of Patient 1.04 Sequence of Motility Examination 1.05 Does This Baby See? 1.06 Visual Acuity – Methods of Examination 1.07 Visual Acuity Testing in Infants 1.08 Primary versus Secondary Deviation 1.09 Evaluation of Monocular Movements – Ductions 1.10 Evaluation of Binocular Movements – Versions 1.11 Unilaterally Reduced Vision Associated with Orthotropia 1.12 Unilateral Decrease of Visual Acuity Associated with Heterotropia 1.13 Decentered Corneal Light Reflex 1.14 Strabismus – Generic Classification 1.15 Is Latent Strabismus -
SHAW-Lens-Book.Pdf
THE LATEST ADVANCEMENT IN BINOCULAR VISION Aniseikonia WITH OPHTHALMIC Solved LENSES. EXPLORING ITS IMPACT ON PATIENT COMFORT AND VISION GET IT WORKING FOR YOU OD 03 Table of Contents “Majority of patients have a wow experience and said it’s the best lens they’ve ever worn.” Shaw Lens Inc. Clinical trials and research indicate that A Shajani, OD, BC Solving aniseikonia is the single most important thing ........................................4 spectacle-induced aniseikonia is a principal cause Why is dynamic aniseikonia so important? .....................................................5 of patient discomfort with eyeglasses. There are Symptoms ...............................................................................................6 Binocular Lens Design ..................................................................................7 no norms for tolerance to aniseikonia. This book Differentiate your practice ............................................................................9 Love at First Sight Guarantee ......................................................................11 contains real-life case summaries that demonstrate When to use the SHAW lens ......................................................................12 how solving aniseikonia can dramatically improve Case Summaries SHAW lens NO PATCH amblyopia treatment .........................................13 a patient’s experience with glasses. Amblyopia – Straight-eye amblyopia with monocular hyperopia .............................14 Amblyopia – Adult refractive -
10.01.521 Routine Vision Care
BENEFIT COVERAGE GUIDELINE – 10.01.521 Routine Vision Care Effective Date: Mar. 1, 2021 RELATED MEDICAL POLICIES / GUIDELINES: Last Revised: Feb. 2, 2021 9.03.508 Orthoptic and Vision Therapy, Visual Perceptual Training, Vision Replaces: N/A Restoration Therapy, and Neurovisual Rehabilitation Select a hyperlink below to be directed to that section. BENEFIT COVERAGE CRITERIA | CODING | RELATED INFORMATION EVIDENCE REVIEW | REFERENCES | HISTORY ∞ Clicking this icon returns you to the hyperlinks menu above. Introduction Vision services is a broad term that means care of the eyes. Vision services are usually either “routine” or “medical”. Although the exams and activities may be similar, the reason for the visit determines whether it’s a routine or medical visit. Visiting an ophthalmologist (a medical doctor) does not necessarily make the visit or exam “medical” in nature. Benefits vary depending on the reason for the examination. • Routine eye exam: Routine exams are often done to find the cause of blurry vision. They produce a diagnosis such as myopia (nearsightedness), hyperopia (farsightedness), presbyopia (inability to focus on near objects), or astigmatism (irregular curvature of the clear cover of the eye, the cornea). After a routine exam, a prescription for corrective lenses (glasses) may be given to the patient. If the plan offers a routine vision benefit, the routine services are covered at the level stated in the member’s contract. If the plan does not offer a routine vision benefit, routine services are not covered. • Medical eye exam: Medical exams are to diagnose, treat, or monitor eye conditions such as aniridia, aniseikonia, anisometropia, aphakia, bullous keratopathy, congenital cataract, corneal abrasion, corneal disorders, corneal ulcer, irregular astigmatism, keratoconus, pathological myopia, post-traumatic disorders, progressive high (degenerative) myopia, recurrent erosion of cornea, Sjogren disease, or tear film insufficiency. -
Excimer Lasertreatment of Corneal Surface Pathology: a Laboratory And
258 BritishJournalofOphthalmology, 1991,75,258-269 ORIGINAL ARTICLES Br J Ophthalmol: first published as 10.1136/bjo.75.5.258 on 1 May 1991. Downloaded from Excimer laser treatment ofcorneal surface pathology: a laboratory and clinical study David Gartry, Malcolm Kerr Muir, John Marshall Abstract to bond breakdown.'3 Ultraviolet radiation in The argon fluoride excimer laser emits this spectral domain does not propagate well in radiation in the far ultraviolet part of the air, and at any biological interface the photons electromagnetic spectrum (193 nm). Each are virtually all absorbed within a few microns of photon has high individual energy. Exposure of the surface. Thus, with each laser pulse a layer of materials or tissues with peak absorption tissue only a few molecules thick will be ablated around 193 nm results in removal of surface fromthesurface. Tissuedamageinduced by other layers (photoablation) with extremely high clinical lasers is achieved by concentrating laser precision and minimal damage to non- energy into a focused point. However, the irradiated areas. This precision is confirmed in excimerlaserbeamhasalargecross sectional area, a series ofexperiments on cadaver eyes and the and since every photon in the beam has the poten- treatment of 25 eyes with anterior corneal tial to produce tissue change the entire cross sec- disease (follow-up 6 to 30 months). Multiple tion can be utilised. The 1 cm by 2 cm rectangular zone excimer laser superficial keratectomy is profile is adjusted by cylindrical quartz lenses, considered the treatment of choice for rough, and the resultant square beam profile becomes painful corneal surfaces. Ali patients in this circularby passing the emergent beam through an group were pain-free postoperatively. -
CPG-17---Presbyopia.Pdf
OPTOMETRY: OPTOMETRIC CLINICAL THE PRIMARY EYE CARE PROFESSION PRACTICE GUIDELINE 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 32,000 full-time equivalent doctors of optometry currently in practice in the United States. Optometrists practice in more than 7,000 communities across the United States, serving as the sole primary eye care provider in more than 4,300 communities. Care of the Patient with The mission of the profession of optometry is to fulfill the vision and eye Presbyopia 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 PRESBYOPIA Reference Guide for Clinicians Prepared by the American Optometric Association Consensus Panel on Care of the Patient with Presbyopia: Gary L. Mancil, O.D., Principal Author Ian L. Bailey, O.D., M.S. Kenneth E. Brookman, O.D., Ph.D., M.P.H. J. Bart Campbell, O.D. Michael H. Cho, O.D. Alfred A. Rosenbloom, M.A., O.D., D.O.S. James E. Sheedy, O.D., Ph.D. Reviewed by the AOA Clinical Guidelines Coordinating Committee: John F. Amos, O.D., M.S., Chair Kerry L. -
Presbyopia, Anisometropia, and Unilateral Amblyopia
REFRACTIVE SURGERY COMPLEX CASE MANAGEMENT Section Editors: Karl G. Stonecipher, MD; Parag A. Majmudar, MD; and Stephen Coleman, MD Presbyopia, Anisometropia, and Unilateral Amblyopia BY MITCHELL A. JACKSON, MD; LOUIS E. PROBST, MD; AND JONATHAN H. TALAMO, MD CASE PRESENTATION A 45-year-old female nurse is interested in LASIK. She the AMO WaveScan WaveFront System (Abbott Medical does not wear glasses. She says there has always been a large Optics Inc.) for the patient’s right eye calculated a pre- difference in prescription between her eyes and that she scription at 4 mm of +2.20 -4.22 X 9 across a 5.75-mm rarely wore glasses in the past. Her UCVA is 20/200 OD, cor- pupillary diameter. This had a corresponding higher-order recting to 20/30 with +1.75 -4.25 X 180. Her UCVA is 20/40 aberration root mean square error of 0.20 µm. The OS, correcting to 20/15 with -0.75 -0.25 X 30. The patient is patient’s left eye had a calculated prescription of -0.56 right-handed, and her left eye is dominant. Central ultra- -0.21 X 31, also at 4 mm. The pupillary diameter of her left sound pachymetry measures 488 µm OD and 480 µm OS. eye was 5.25 mm, and the higher-order aberration root Figure 1 shows TMS4 (Tomey Corp.) topography of the mean square error was determined to be 0.17 µm patient’s right and left eyes, respectively. Both the (Figure 2). Klyce/Maeda and Smolek/Klyce Keratoconus Screening How would you counsel this patient regarding her suitability Systems are highlighted. -
Eye on Pacific
INSIDE -Avoid misinterpreting OCT data: p. 5 pacificu.edu -Introducing Pacific’s new Dry Eye Solutions clinic: p. 6 Pacific University College of Optometry EYE ON PACIFIC As vision subspecialties continue to grow, we can ensure that patient s Summer | 2015 continue to get the care they deserve. Prescribing Tips for Preschoolers JP LOWERY, OD, FAAO | PEDIATRIC VISION SERVICE CHIEF The vast majority of prescribing decisions in pediatric vision care revolve around refractive issues: when and how much power to prescribe. From a purely epidemiological standpoint, 15 to 25% of young children can benefit from corrective lenses. The first challenge for optometrists lies in obtaining accurate refractive measures, particularly with preschoolers. Since we need to rely on purely objective measures with this young population, I find it useful to have as much data as possible. This means both dry and wet retinoscopy and auto-refraction, as well as dynamic retinoscopy for hyperopes. In the spring issue we briefly discussed how the autorefractor is a very useful adjunct measurement for astigmatism, but the spherical component is only valid under cycloplegia. Assuming we obtain valid measurements, we are still faced with the primary challenge of what to prescribe. There are several factors that play into prescribing decisions for preschoolers. These include the age of the child, our knowledge of the emmetropization process, the magnitude of the refractive error, and the Preschool Prescribing Tips (co ntinued ) potential for the refractive error to cause amblyopia or hinder overall perceptual-motor development. First, let's look at what we have learned about emmetropization and amblyopia in the last 20 years.