Management of Microtropia

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Routine Eye Examination

CET Continuing education Routine eye examination Part 3 – Binocular assessment In the third part of our series on the eye examination, Andrew Franklin and Bill Harvey look at the assessment and interpretation of binocular status. Module C8290, one general CET point, suitable for optometrists and DOs he assessment of binocular previous question. Leading questions function is often one of the should be avoided, especially when weaker areas of a routine, dealing with children. If they are out if observation of candidates of line ask the patient ‘Which one is out in the professional qualifica- of line with the X?’ Ttions examination is any guide. Tests are You should know before you start the done for no clearly logical reason, often test which line is seen by which eye. because they always have been, and in If you cannot remember it from last an order which defeats the object of the time, simply look at the target through testing. Binocular vision seems to be one the visor yourself (Figure 1). Even if of those areas that practitioners shy away you think you can remember, check from, and students often take an instant anyway, as it is possible for the polarisa- dislike to. Many retests and subsequent tion of the visor not to match that of the remakes of spectacles are the result of a Mallett Unit at distance or near or both, practitioner overlooking the effects of a Figure 1 A distance fixation disparity target especially if the visor is a replacement. change of prescription on the binocular If both eyes can see both bars, nobody status of the patient.
Pediatric Ophthalmology/Strabismus 2017-2019

Academy MOC Essentials® Practicing Ophthalmologists Curriculum 2017–2019 Pediatric Ophthalmology/Strabismus *** Pediatric Ophthalmology/Strabismus 2 © AAO 2017-2019 Practicing Ophthalmologists Curriculum Disclaimer and Limitation of Liability As a service to its members and American Board of Ophthalmology (ABO) diplomates, the American Academy of Ophthalmology has developed the Practicing Ophthalmologists Curriculum (POC) as a tool for members to prepare for the Maintenance of Certification (MOC) -related examinations. The Academy provides this material for educational purposes only. The POC should not be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the best results. The physician must make the ultimate judgment about the propriety of the care of a particular patient in light of all the circumstances presented by that patient. The Academy specifically disclaims any and all liability for injury or other damages of any kind, from negligence or otherwise, for any and all claims that may arise out of the use of any information contained herein. References to certain drugs, instruments, and other products in the POC are made for illustrative purposes only and are not intended to constitute an endorsement of such. Such material may include information on applications that are not considered community standard, that reflect indications not included in approved FDA labeling, or that are approved for use only in restricted research settings. The FDA has stated that it is the responsibility of the physician to determine the FDA status of each drug or device he or she wishes to use, and to use them with appropriate patient consent in compliance with applicable law.
The Effect of the Fixation Disparity on Photogrammetric Processes

The Effect of the Fixation Disparity on Photogrammetric Processes SANDOR A. VERES, Asst. Proj., Surveying and Mapping, Purdue University ABSTRACT: This paper reviews the function oj the human eyes in photogram metry, and discusses its limitations. The correction of the observation error is presented by mathematical derivations and practical examples. The paper points out the need for continued development of techniques in view of con stantly increasing requirements. INTRODUCTION study of coincidence is most important from the photogrammetric point of view. For a HOTOGRAMMETRIC instrumentation has undergone a revolutionary development study of this kind an instrument called a P horopter has been used. since the second World War. A precision photogrammetric instrument today is able to The horopter designed by Tschermak con provide measurement to within a precision of sists of thirteen steel channels mounted so as ± 3 microns. By using these precision in to converge to the midpoint of the inter struments the compensation of errors in pupillary base line of the two eyes of an volved in the measurements becomes of pri observer. The central channel lies in a median mary importance. The compensation of errors plane, perpendicular to the eyebase of the is based upon the geometrical knowledge of observer, and the others make angles of 1, 2. the source of errors. The human eye is in 4, 8, 12, and 16 degrees on each side of the volved in every photogrammetric measure central channel. A small vertical steel rod can ment; consequently the geometrical knowl slide smoothly in each channel and the rods edge of the errors due to the limi tation of the are mounted for use at visual distances of 20, human eye is very important.
Approved and Unapproved Abbreviations and Symbols For

Facility: Illinois College of Optometry and Illinois Eye Institute Policy: Approved And Unapproved Abbreviations and Symbols for Medical Records Manual: Information Management Effective: January 1999 Revised: March 2009 (M.Butz) Review Dates: March 2003 (V.Conrad) March 2008 (M.Butz) APPROVED AND UNAPPROVED ABBREVIATIONS AND SYMBOLS FOR MEDICAL RECORDS PURPOSE: To establish a database of acceptable ocular and medical abbreviations for patient medical records. To list the abbreviations that are NOT approved for use in patient medical records. POLICY: Following is the list of abbreviations that are NOT approved – never to be used – for use in patient medical records, all orders, and all medication-related documentation that is either hand-written (including free-text computer entry) or pre-printed: DO NOT USE POTENTIAL PROBLEM USE INSTEAD U (unit) Mistaken for “0” (zero), the Write “unit” number “4”, or “cc” IU (international unit) Mistaken for “IV” (intravenous) Write “international unit” or the number 10 (ten). Q.D., QD, q.d., qd (daily) Mistaken for each other Write “daily” Q.O.D., QOD, q.o.d., qod Period after the Q mistaken for Write (“every other day”) (every other day) “I” and the “O” mistaken for “I” Trailing zero (X.0 mg) ** Decimal point is missed. Write X mg Lack of leading zero (.X mg) Decimal point is missed. Write 0.X mg MS Can mean morphine sulfate or Write “morphine sulfate” or magnesium sulfate “magnesium sulfate” MSO4 and MgSO4 Confused for one another Write “morphine sulfate” or “magnesium sulfate” ** Exception: A trailing zero may be used only where required to demonstrate the level of precision of the value being reported, such as for laboratory results, imaging studies that report size of lesions, or catheter/tube sizes.
The Nature, Testing, and Variables Influencing

THE NATURE, TESTING, AND VARIABLES INFLUENCING FIXATION DISPARITY; ROLE OF THE FUSION LOCK 1 by Leland W. Carr with Dr. James J. Saladin I ... *I Tl.e N.-1• .._1 Tufi"), A.l IJ.,.;.,l/.s I.{l..•• :? F1*'/:·.., /);,,_,. ; ~ R.lc. OF 'Tlc. ~="••1•.. C. •• l( I Introduction A fixation disparity is a small angular measurement of the mis alignment of the two eyes which can occur while still permitting single, fused binocular vision. It represents a small error in the aiming of the eyes which occurs without diplopia being detected. Fixation disparity is allowed because of the slight "slippage" pro vided to the fusional system through the existence of Panum's fusional areas. So long as binocular alignment is precise enough to place the two retinal images of a single object within corre sponding Panum's areas, the final perception is likely to be single and fused. Sensory fusion thus occurs in spite of a small error in motor fusion. A slight muscle imbalance is the rule, rather than the excep tion in individuals even with normal assymptomatic binocular systems. It is rare that all twelve extraocular muscles are precisely bal anced in their agonist-antagonist relationships, and thus the inate drive to achieve single vision requires a fusional effort to over come existing imbalance. When binocularity is dissociated (as with a covertest) the fusional drive is interrupted and the eyes deviate out of alignment under the influence of the muscle imbalance. This deviation under dissociation is referred to as the heterophoria. When both eyes are permitted to view without dissociative conditions the fusional drive to achieve single binocular vision pulls the eyes toward alignment in opposition to the phoric "stress" operating to deviate the alignment.
Management of Vith Nerve Palsy-Avoiding Unnecessary Surgery

MANAGEMENT OF VITH NERVE PALSY-AVOIDING UNNECESSARY SURGERY P. RIORDAN-E VA and J. P. LEE London SUMMARY for unrecovered VIth nerve palsy must involve a trans Unresolved Vlth nerve palsy that is not adequately con position procedure3.4. The availability of botulinum toxin trolled by an abnormal head posture or prisms can be to overcome the contracture of the ipsilateral medial rectus 5 very suitably treated by surgery. It is however essential to now allows for full tendon transplantation techniques -7, differentiate partially recovered palsies, which are with the potential for greatly increased improvements in amenable to horizontal rectus surgery, from unrecovered final fields of binocular single vision, and deferment of palsies, which must be treated initially by a vertical any necessary surgery to the medial recti, which is also muscle transposition procedure. Botulinum toxin is a likely to improve the final outcome. valuable tool in making this distinction. It also facilitates This study provides definite evidence, from a large full tendon transposition in unrecovered palsies, which series of patients, of the potential functional outcome from appears to produce the best functional outcome of all the the surgical treatment of unresolved VIth nerve palsy, transposition procedures, with a reduction in the need for together with clear guidance as to the forms of surgery that further surgery. A study of the surgical management of 12 should be undertaken in specific cases. The fundamental patients with partially recovered Vlth nerve palsy and 59 role of botulinum toxin in establishing the degree of lateral patients with unrecovered palsy provides clear guidelines rectus function and hence the correct choice of initial sur on how to attain a successful functional outcome with the gery, and as an adjunct to transposition surgery for unre minimum amount of surgery.
Suppression and Retinal Correspondence in Intermittent Exotropia

Downloaded from bjo.bmj.com on May 23, 2012 - Published by group.bmj.com British Journal of Ophthalmology, 1986, 70, 673-676 Suppression and retinal correspondence in intermittent exotropia JEFFREY COOPER AND CAROL DIBBLE RECORD From the Institute of Vision Research, SUNYIState College of Optometry, 100 East 24th Street, New York, New York 10010, USA SUMMARY Suppression scotomas and retinal projection (retinal correspondence) were measured in six intermittent exotropes during deviation. Measurements used red-green anaglyph stimuli presented on a black background which could be varied from 3-4 minutes of arc to 3024'. Results showed non-suppression of all points between the fovea and the diplopia point. Harmonious anomalous retinal correspondence was usually observed. Two subjects had spontaneous changes from anomalous retinal correspondence to normal retinal correspondence without a concurrent change in ocular position. Conventional testing resulted in more variable results in regard to retinal correspondence and suppression, suggesting that non-suppression and anomalous retinal corres- pondence occur when black backgrounds are used for testing. Patients with intermittent exotropia of the diverg- image and anomalous retinal correspondence (ARC) ence excess type (DE) or basic exotropia usually do in the deviated position and normal retinal corres- not complain of diplopia when their eyes are deviat- pondence (NRC) in the aligned position on the ing.' Parks2 believes that the absence of diplopia is Hering-Bielschowsky afterimage test.' due to a dense temporal hemiretinal suppression. We therefore attempted to qualify the depth of Using a technique employing Risley prisms, suppression in deviating intermittent exotropes while Jampolsky3 demonstrated that DE patients have a monitoring ocular position.
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.
Binocular Vision

BINOCULAR VISION Rahul Bhola, MD Pediatric Ophthalmology Fellow The University of Iowa Department of Ophthalmology & Visual Sciences posted Jan. 18, 2006, updated Jan. 23, 2006 Binocular vision is one of the hallmarks of the human race that has bestowed on it the supremacy in the hierarchy of the animal kingdom. It is an asset with normal alignment of the two eyes, but becomes a liability when the alignment is lost. Binocular Single Vision may be defined as the state of simultaneous vision, which is achieved by the coordinated use of both eyes, so that separate and slightly dissimilar images arising in each eye are appreciated as a single image by the process of fusion. Thus binocular vision implies fusion, the blending of sight from the two eyes to form a single percept. Binocular Single Vision can be: 1. Normal – Binocular Single vision can be classified as normal when it is bifoveal and there is no manifest deviation. 2. Anomalous - Binocular Single vision is anomalous when the images of the fixated object are projected from the fovea of one eye and an extrafoveal area of the other eye i.e. when the visual direction of the retinal elements has changed. A small manifest strabismus is therefore always present in anomalous Binocular Single vision. Normal Binocular Single vision requires: 1. Clear Visual Axis leading to a reasonably clear vision in both eyes 2. The ability of the retino-cortical elements to function in association with each other to promote the fusion of two slightly dissimilar images i.e. Sensory fusion. 3. The precise co-ordination of the two eyes for all direction of gazes, so that corresponding retino-cortical element are placed in a position to deal with two images i.e.
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
Surgical Classification of Squints with a Vertical Deviation

Br J Ophthalmol: first published as 10.1136/bjo.39.3.129 on 1 March 1955. Downloaded from Brit. J. Ophthal. (1955) 39, 129. COMMUNICATIONS SURGICAL CLASSIFICATION OF SQUINTS WITH A VERTICAL DEVIATION* BY ALFREDO VILLASECA Hospital Salvador, Santiago, Chile VERTICAL squints, either pure or associated with horizontal squints, are of great practical importance, since binocular single vision can only be attained if there is perfect parallelism of the visual axis in both the horizontal and vertical directions. The statistics given by various authors show that vertical deviations are very frequent: White and Brown (1939) found the following distribution in 1,062 cases : un- complicated lateral deviation in 347 patients, uncomplicated vertical deviation in 358, and combined vertical and lateral deviation in 357. Dunnington and Regan (1950) found that 50 per cent. of 79 cases of concomitant convergent strabismus showed a vertical component. Scobee (1951), in 457 cases of convergent strabismus, found 195 (43 per cent.) copyright. with a vertical component. In his patients the frequency of involvement (paresis) of the vertically acting muscles was as follows: Muscle No. of Cases Superior rectus ... ... ... ... ... 60 Superior oblique ... ... ... ... ... ... ... 32 Inferior rectus ... ... ... ... ... ... ... 25 of the same eye 20 Both depressors (superior oblique and inferior rectus) http://bjo.bmj.com/ Both superior obliques ... ... ... 15 Both inferior recti ... ... ... ... ... ... 13 Superior rectus of one eye and inferior rectus of the other eye ... ... 11 Both superior recti ... ... ... ... ... ... ... 7... Both elevators (superior rectus and inferior oblique) of the same eye ... 6 Superior oblique and inferior rectus of both eyes ... ... ... 2 Inferior oblique ... ... ... ... ... ... ... ...1 Miscellaneous groupings ... .. ... ... ... ... ... 3 He makes no specific mehtion of patients with concomitant hypertropia or on September 23, 2021 by guest.
Injections, Vaccines, and Other Physician-Administered Drugs Codes

INDIANA HEALTH COVERAGE PROGRAMS PROVIDER CODE TABLES Injections, Vaccines, and Other Physician-Administered Drugs Codes Note: Due to possible changes in Indiana Health Coverage Programs (IHCP) policy or national coding updates, inclusion of a code on the code tables does not necessarily indicate current coverage. See IHCP Banner Pages and Bulletins and the IHCP Fee Schedules for updates to coding, coverage, and benefit information. For information about using these code tables, see the Injections, Vaccines, and Other Physician-Administered Drugs provider reference module. Table 1 – Procedure Codes for Botulinum Toxin Injections Table 2 – Procedure Codes for Chemodenervation for Use with Botulinum Toxin Injections Table 3 – ICD-10 Diagnosis Codes for Medical Necessity of Botulinum Toxin Injections Table 1 – Procedure Codes for Botulinum Toxin Injections Reviewed/Updated: July 1, 2020 Procedure Code Code Description J0585 Injection, onabotulinumtoxin A, 1 unit J0586 Injection, abobotulinumtoxin A, 5 units J0587 Injection, rimabotulinumtoxin B, 100 units J0588 Injection, incobotulinumtoxin A, 1 unit Published: September 17, 2020 1 Indiana Health Coverage Programs Injections, Vaccines, and Other Physician-Administered Drugs Codes Table 2 – Procedure Codes for Chemodenervation for Use with Botulinum Toxin Injections Reviewed/Updated: July 1, 2020 Procedure Code Definition 42699 Unlisted procedure, salivary glands or ducts Esophagoscopy, flexible, transoral; with directed submucosal injection(s), 43201 any substance Esophagogastroduodenoscopy,