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Purpose Methods Results Conclusions To evaluate the short‐term (1 week after completion of treatment) effect of office‐based vergence and anti‐suppression therapy (OBVAT) on binocular vision and accommodative function when compared to observation alone in children with small‐to‐moderate angle intermittent exotropia (IXT).In this single‐masked (examiner masked), two‐arm, single‐centre randomised clinical trial, 40 participants, 6 to <18 years of age with untreated IXT were randomly assigned to OBVAT or observation alone. Participants assigned to therapy received 16 weeks of OBVAT (60 min per visit, once per week) with home reinforcement (15 min per day, 5 days a week). Therapy included vergence, accommodation and anti‐suppression techniques. This paper reports the results of clinical measures of binocular vision and accommodation, including fusional vergence, near point of convergence, vergence facility, amplitude of accommodation, the Worth 4‐dot test and the Fusion Maintenance Score (FMS).Treatment group differences at the primary outcome visit significantly favoured the OBVAT group (n = 20) over the observation group (n = 16) in negative fusional vergence break point at both distance (p ≤ 0.001; r = 0.58) and near (adjusted mean difference: 12.3 Δ; 95% CI: 5.3–19.3 Δ; p = 0.001; partial eta squared: 0.28), positive fusional vergence break point at both distance (p = 0.009; r = 0.43) and near (adjusted mean difference: 20.6 Δ; 95% CI: 11.8–29.4 Δ; p ≤ 0.001; partial eta squared: 0.41), vergence facility (adjusted mean difference: 5.6 cpm; 95% CI: 1.9–9.4 cpm; p = 0.005; partial eta squared: 0.22) and the FMS (p = 0.007; r = 0.44).In this randomised clinical trial of participants aged 6 to <18 years with IXT, those in the OBVAT group had a significantly better fusional vergence range, vergence facility, near Worth 4‐dot test result and FMS than the observation group at the 17‐week visit. The improvement in these areas further support the effectiveness of OBVAT for improving IXT. [ABSTRACT FROM AUTHOR]

Purpose: To assess the long‐term stability of clinical measures of convergence (near point of convergence [NPC] and positive fusional vergence [PFV]) in participants enrolled in the Convergence Insufficiency Treatment Trial‐Attention and Reading Trial (CITT‐ART) who received 16 weeks of office‐based vergence/accommodative therapy. Methods: A total of 310 children, 9–14 years old, with symptomatic convergence insufficiency were enrolled in CITT‐ART. Some 270 completed both their 16‐week primary outcome visit followed by a 1‐year follow‐up visit. Of those 270, 181 (67%) were randomised to the vergence/accommodative therapy. Of the 181 in the vergence/accommodative group, 121 (67%) reported not receiving any additional treatment after the 16‐week primary outcome visit. The mean change in NPC, PFV and percentages of children classified by the predetermined success criteria of convergence (normal NPC [<6 cm] and/or improved by ≥4 cm; normal PFV [passing Sheard's criterion and base‐out break >15Δ] and/or improved by ≥10Δ) were compared at the 16‐week primary outcome visit and 1 year later. Results: Of the 121 who returned for their 1‐year follow‐up visit, there was no significant change in mean adjusted NPC (reduction of −0.2 cm; 95% CI: −1.0 to 0.5 cm) at 1 year. There was a statistically significant decrease in mean‐adjusted PFV (−4.7∆; 95% CI: −6.5 to −2.8Δ) at 1 year. There were similar percentages of participants classified as 'normal' (p = 0.30), 'normal and/or improved' (p > 0.50) and 'normal and improved' (p > 0.14) based on NPC and PFV at the 1‐year visit compared with the 16‐week primary outcome visit. Conclusion: The improvements in NPC and PFV following 16 weeks of vergence/accommodative therapy (with no reported additional treatment thereafter) in children with symptomatic convergence insufficiency persisted 1‐year post‐treatment. [ABSTRACT FROM AUTHOR]

Purpose: To report the change in the magnitude of near exodeviation in children with symptomatic convergence insufficiency successfully treated with office‐based vergence/accommodative therapy in the Convergence Insufficiency Treatment Trial–Attention and Reading Trial. Methods: A total of 131 children 9–14 years of age with symptomatic convergence insufficiency classified as successfully treated with office‐based vergence/accommodative therapy at the 16‐week outcome visit were included. Masked examiners measured the near ocular deviation by the prism and alternate cover test at baseline, primary outcome and 1‐year post‐treatment. The mean change in near deviation was calculated from baseline to primary outcome, from primary outcome to 1‐year post‐treatment and from baseline to 1‐year post‐treatment. Results: Of the 131 participants successfully treated with vergence/accommodative therapy, 120 completed the 1‐year post‐treatment visit. A significant change in near exodeviation was observed at baseline to primary outcome (2.6Δ less exo, p < 0.001, moderate effect size d = 0.61) and at baseline to 1‐year post‐treatment (2.0Δ less exo; p < 0.001, small effect size d = 0.45). The change from primary outcome to 1‐year post‐treatment (0.6Δ more exo; p = 0.06, small effect size d = 0.11) was not significant. Forty per cent (48/120) of participants had a decrease in near exodeviation >3.5∆ (expected test/retest variability) between baseline and the primary outcome examination. Of the 120 participants, one (1.0%) was esophoric at the primary outcome and was subsequently exophoric at 1‐year post‐treatment. Four participants (3.3%) who were orthophoric or exophoric at the primary outcome were esophoric (all ≤3∆) at the 1‐year post‐treatment visit. Conclusion: On average, the near exodeviation was smaller in size immediately after the discontinuation of vergence/accommodative therapy (2.6∆, moderate effect size) and 1 year post vergence/accommodative therapy (2.0∆, small effect size) in children with convergence insufficiency who were successfully treated; 40% had a clinically meaningful decrease in exophoria. The development of near esophoria was rare. [ABSTRACT FROM AUTHOR]

Visual difficulties are common after brain tumors, despite a lack of visual complaints at diagnosis. These include difficulties with eye movements, visual coordination, vergence, accommodation, and photophobia, in addition to more obvious problems such as visual field defects. This case report presents the results of a thorough neuro-visual evaluation in a boy with sequelae after a brain tumor including intermittent double vision that was not explained by routine visual examination. Subjective complaints included poor reading perseverance, intermittent blurred and double vision, headache around the eyes when performing near activities, less efficient eye movement behavior in reading tasks, and increased sensitivity to visual motion. The patient participated in a multidisciplinary visual rehabilitation program that included reading glasses with prism compensation and tinted glasses, as well as training with the aim of improving eye teaming, near vision functions, and perseverance in eye movements. The patient responded quickly to the vision therapy program, with positive changes after just four weeks. Repeated neuro-visual evaluations over eight months showed remarkable improvements that were stable over time. This encouraging case report supports the notion that neuro-visual evaluation and rehabilitation should be included in the follow-up of patients after brain tumors. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the short‐term (1 week after completion of treatment) effect of office‐based vergence and anti‐suppression therapy (OBVAT) on the Office Control Score when compared to observation alone in children with small‐to‐moderate angle intermittent exotropia (IXT). Methods: In this single‐masked (examiner masked), two‐arm, single‐centre randomised clinical trial, 40 participants, 6 to <18 years of age with untreated IXT, were randomly assigned to OBVAT or observation alone. Participants assigned to therapy received 60 min of OBVAT with home reinforcement once per week for 16 weeks. Therapy included vergence, accommodation and anti‐suppression techniques. The primary outcome measure was the comparison of the distance Office Control Score between the two groups at the primary outcome visit (i.e., 17‐week follow‐up visit). Results: At the primary outcome visit, the OBVAT group (n = 20) had a significantly better distance Office Control Score (adjusted mean difference: −0.9; 95% CI: −0.2 to −1.5; p = 0.008; partial eta squared: 0.19) than the observation group (n = 16). Participants from the OBVAT group were more likely than those from the observation group to have ≥1 point of improvement at the 17‐week visit (OBVAT group: 75%; Observation group: 25%; p = 0.006). Conclusions: In this randomised clinical trial of participants aged 6 to <18 years with IXT, we found that the OBVAT group had a significantly better distance Office Control Score than the observation group at the 17‐week visit. This study provides the first data from a randomised clinical trial demonstrating the effectiveness of OBVAT for improving the control of IXT. Eye care practitioners should consider OBVAT as a viable, non‐surgical treatment option for IXT. A full‐scale randomised clinical trial investigating the long‐term effectiveness of OBVAT in treating IXT is warranted. [ABSTRACT FROM AUTHOR]

In the last two years, orthoptists have counteracted patient drop-out through visual telerehabilitation. Efforts were made to transfer the in-person visual rehabilitation setting to the telematic environment in response to the worldwide crisis. Nowadays, statistical evidence on the effects of visual telerehabilitation is still scarce. The present research is the first, in Italy, to offer a pre-post assessment of the impact of visual telerehabilitation. Twenty-four (n = 24) children (64% male, 14% monocles) aged 4 to 15 years (mean age = 9.21 years, SD = 3.36, mean residual vision 1.3/10) were randomly assigned to three different group types for rehabilitation: a telematic rehabilitation group (n = 7), a mixed rehabilitation group (n = 8), and an in-person rehabilitation group (n = 9). Each group underwent a six-week visual rehabilitation. Ergo-perimetric evaluation before and after the rehabilitation was administered to the three groups. t-tests showed a significant improvement in ergo-perimetric outcomes in the visual telerehabilitation group (p < 0.05) and in the mixed rehabilitation group (p < 0.01), via a shortening of the response times. The findings suggest that visual telerehabilitation and mixed rehabilitation can lead to an ergo-perimetric improvement in visually impaired children within six weeks. Further research is needed, both to corroborate the findings with a larger sample size and to attain a follow-up measurement in order to clarify whether visual telerehabilitation could represent a stand-alone method. [ABSTRACT FROM AUTHOR]

Introduction: Uncorrected refractive error is the leading cause of vision impairment in India. Myopia is a common refractive error that can also be defined by a spherical equivalent (SE) =-0.5 dioptre (D). To explore the combined effect of Yogic eye exercise and Diet compared with Yogic eye exercise in the management of myopia. Method: In a comparative study, 28 students diagnosed with myopia were randomly assigned into two groups. Group A received a naturopathic diet protocol and Yoga eye exercises, and Group B received Yogic eye exercises. Improvement in myopia was assessed as the mean change in refractive error - Spherical equivalent (SE) from baseline. Result: The mean SE values were reduced post-intervention in both groups. Within-group comparison of SE pre- and post-intervention showed a significant reduction in SE measures in Yoga and diet (Group A) for the right and left eyes at 95% CI with a p-value of 0.003 and 0.01 respectively. There were no significant changes in SE values in the Yoga-only group. When compared between groups, no statistically significant changes were observed in SE. Conclusion: The group that followed the diet combined with Yoga showed better improvement in preand post-assessments for both eyes. But when compared between the two groups there were no statistically significant changes in SE. Yogic eye exercise proved beneficial in both groups, but the results are better when combined with diet. The findings need to be verified further by conducting a large-scale placebo-controlled clinical trial with a wider population base on diverse age groups. [ABSTRACT FROM AUTHOR]

A 29-year-old female presented with large-angle hypertropia, and small-angle exotropia associated with inferior oblique over action (IOOA). Orthoptic examination revealed right hypertropia of 35 PD with 12 PD of exotropia by prism cover test. There was no restriction of ocular motility, but we found right inferior oblique over action. She had a head tilt of approximately 30 degrees towards the left side. The Patient underwent "Antero-medial transposition of the inferior oblique" to correct strabismus. After surgery, she was orthotropic in the primary position with an average head-chin posture. Single approach surgery like the antero-medial transposition with an overacting inferior oblique may help to correct the large angle hypertropia associated with superior oblique (SO) palsy. [ABSTRACT FROM AUTHOR]

Care for children with acquired brain injury requires a multi-disciplinary team (MDT) to maximize rehabilitation. These children frequently present to the orthoptic clinic with complex difficulties impacting visual functions and eye movements. We report on one case which led to a reevaluation of our current assessment methods, clinical care pathways and the contents of clinic correspondence. We present a case report of a 14-year-old girl who suffered a cardiac arrest due to underlying Wolff–Parkinson–White syndrome; MRI revealed hypoxic brain injury with extensive white matter and basal ganglia volume loss. On presentation, it was evident there was a significant impact on visual function. Conventional optotype acuity testing was not possible. Her inability to maintain fixation made observational responses unreliable. Observations revealed no steady fixation, exotropia and roving eye movements. Although she was reported to be unable to speak, progress with communication was reported and she was able to give repeatable, reliable responses to indicate "yes" or "no." These cues were used and a response of 1.70 cycles per degree was obtained under binocular conditions. This communication method was also utilized to assess visual fields by confrontation. However, the clinic letter written by the ophthalmologist based on the orthoptic assessment simply provided the acuity score with no interpretation of the information or how it was obtained. This case highlighted the importance of understanding a child's communication methods so that assessment can be appropriately adapted. The referral letter was lacking in detail regarding the patient's abilities but equally the ophthalmology letter provided limited detail impacting on the MDT practitioner's ability to understand and apply the information. This case has highlighted the importance of good communication: professionals need to acknowledge and work with an individual's communication methods so that assessment can be completed. Professionals also need to improve communication of relevant findings to others involved in the patient's care. [ABSTRACT FROM AUTHOR]

This paper describes a novel model of learning, designed to enhance interprofessional education (IPE) and interprofessional collaboration (IPC). Lessons learned, plans for sustainability and future directions for policy, practice, implementation, and curriculum training are also discussed. The RIPE-N model (Reflective Interprofessional Education – Network model) was developed for an interprofessional simulation environment involving five health professions – pharmacy, nursing, orthoptics, physiotherapy, and speech pathology with the potential to increase the number of health professions involved. The RIPE-N model was adapted from the original RIPE Model (Reflective Interprofessional Education Model), utilising unfolding multidisciplinary case from admission through to discharge. Key adaptations of RIPE to include a greater focus on professional practice and the opportunity for collaboration by all disciplines. Reflection is critical to the RIPE-N model to develop the reflective practitioner, hence the inclusion of collaborative reflective ('pause and reflect') stations aimed at improving collaborative clinical decision-making skills among diverse healthcare professionals. [ABSTRACT FROM AUTHOR]

Purpose: To study the current practice patterns of pediatric ophthalmologists in the management of strabismus in Punjab. Study Design: Questionnaire based Practice pattern survey. Place and Duration of Study: Teaching hospitals of Punjab from July 2018 to July 2019. Material and Methods: This study was conducted at ophthalmology departments of various teaching hospitals of Punjab. A questionnaire was designed to find out the current practice pattern for management of strabismus. Ophthalmologists who were members of Ophthalmological Society of Pakistan (OSP), having their expertise in strabismus surgery for more than 5years and practicing pediatric ophthalmology were selected. Discussion was also held regarding questionnaire and practices being performed after filling the proforma. This data was compiled, analyzed and was converted to a summary in points. Results: We contacted 90 ophthalmologists out of whom 76 responded to our Questionnaire. Complete Orthoptic Assessment was performed by only 46% (35) of the ophthalmologists. Prism cover test was used as a diagnostic tool by 70 (92%) ophthalmologists. Rest of the ophthalmologists used Synoptophore with it. Percentage of ophthalmologists performing cycloplegic refraction was very low. Only 5 (6.57%) surgeons used adjustable sutures. Only 46% of surgeons used to explain the complications of Anesthesia. More than 90% of surgeons explained the surgical procedures being done, its complications, post-operative care and need to use glasses or need for orthoptic exercises. All the surgeons kept follow up of the patients on 1st post-operative day. Conclusion: The current practices in strabismus need to be standardized and a consensus should be developed at a national level. [ABSTRACT FROM AUTHOR]

This study investigates the underlying physiological mechanisms that may lead to improved outcomes for symptomatic convergence insufficiency (CI) patients after 12 weeks of officebased vergence/accommodation therapy (OBVAT) by evaluating the change in the main sequence of vergence and saccadic eye movements. In this prospective trial, 12 participants with symptomatic CI were recruited and treated with 12 weeks of OBVAT. Outcome measures included the objective assessment of the following: peak velocity, time to peak velocity, latency, response amplitude, and clinical changes in the near point of convergence (NPC), positive fusional vergence (PFV) and symptoms via the Convergence Insufficiency Symptom Survey (CISS). Ten of the twelve participants (83%) were categorized as "successful" and two were "improved" based on pre-determined published criteria (CISS, NPC, PFV). There were statistically significant changes in peak velocity, time to peak velocity, and response amplitude for both 4° and 6° symmetrical convergence and divergence eye movements. There was a significant change in the main sequence ratio for convergence post-OBVAT compared to baseline measurements (P=0.007) but not for divergence or saccadic responses. Phasic/step vergence movements adjust the underlying neural control of convergence and are critical within a vision therapy program for CI patients. [ABSTRACT FROM AUTHOR]

Purpose: This paper presents the results of the 2017 Orthoptics Australia Workforce Survey (OWS). The results are compared and contrasted with the outcome of the previous 2012-2013 OWS. Method: The 2017 OWS was implemented using the online tool - SurveyMonkey. All financial members of Orthoptics Australia were contacted to participate in the OWS. To achieve maximum uptake, non-OA members were also encouraged by colleagues to participate in the workforce survey, through publicity at annual conferences and via social media. Results: Three hundred and twenty-eight orthoptists responded to the 2017 OWS. The profession continues to be female dominated (88.7%), with a young workforce (49.9% between 20-39 years), and high levels of Australian nationality (94%). Most respondents (79.9%) worked in metropolitan NSW (46.7%) or Victoria (31.1%). The main components of current orthoptic employment included public sector (24.9%) and salaried positions in the private sector (52.5%), with 89.5% working in orthoptic related clinical work. Levels of satisfaction with current hours of work were high (91.3%), with 56% indicating their intention to continue to work in an orthoptic-related field for more than the next 10 years. Conclusion: The 2017 OWS provides a broad overview of the current orthoptic workforce and modes of practice in Australia. These comprehensive survey results can be applied to workforce development, and are available to government and health bodies for future eye health care planning. [ABSTRACT FROM AUTHOR]

Intermittent exotropia of the divergence excess type is a unique strabismus with characteristic sensorimotor findings, symptoms and etiology. This paper reviews the most salient findings and incorporates these findings into a theory of etiology. Based upon etiology, a treatment regimen is presented which is consistent with clinical findings. [ABSTRACT FROM AUTHOR]

A method of treating divergence excess intermittent exotropia which differs from standard orthoptics is presented. Training is not done at the objective angle; ARC is ignored; diplopia awareness is not cultivated; stereoscopic targets are introduced before flat fusion or simultaneous perception targets; little emphasis is placed on developing base-out prism vergence ranges; monocular skills and accommodative facility are developed; and plus adds are utilized. The rationale for this approach is developed. [ABSTRACT FROM AUTHOR]

Background: To evaluate the impact of treatment of symptomatic convergence insufficiency using office-based vergence/accommodative therapy on reading skills in children.Methods: Children (n = 44) ages nine to 17 years with symptomatic convergence insufficiency were administered the following four reading tests: Wechsler Individual Achievement Test II; Test of Word Reading Efficiency; Test of Silent Word Reading Fluency; and the Gray Oral Reading Test, at baseline and eight weeks after completion of a 16-week program of office-based vergence/accommodative therapy. To determine whether significant change occurred with therapy, change in performance was compared to zero. Treatment response was determined using a composite score of symptoms and signs at the conclusion of treatment and at the 24-week outcome visit. Participants were classified as early responders, late responders, or non-responders based upon whether criteria for successful treatment were met at the completion of 16 weeks of treatment, at the 24-week outcome visit, or not met at either visit, respectively.Results: After treatment for convergence insufficiency, statistically significant improvements were found for reading comprehension (mean = 4.2, p = 0.009) and the reading composite score (mean = 2.4, p = 0.016) as measured by the Wechsler Individual Achievement Test at the 24-week visit. These improvements were related to the clinical treatment outcome measures (p = 0.011) with the largest improvements occurring in those who were early responders to treatment. Reading speed (words per minute) increased significantly on the Gray Oral Reading Test (p < 0.0001). No significant improvements were observed for single word reading or reading fluency as measured by the Test of Word Reading Efficiency, the Test of Silent Word Reading Fluency or the Gray Oral Reading Test.Conclusion: Improvements in reading comprehension and reading composite were found after office-based vergence/accommodative therapy, with the greatest improvements in those who responded early to treatment. [ABSTRACT FROM AUTHOR]

Objective: To determine association of convergence insuffiency in patients with myopia of age group 15-25 years Methods: This prospective, descriptive, cross-sectional study was conducted between 15th March to 15th august 2016 at Isra University Islamabad Campus. All patients in 15-25years age group were included in the study, excluding those who had any manifest deviation (tropia) in distance or near or other refractive error. Patients were first checked for having Myopia and NPC with RAF rule. Data regarding patien's age, sex were recorded. Results: Total 100 patients' data 51, (51%) male and 49, (49%) female were collected. It was observed that at least every second patient has convergence insufficiency; total 71 patients had reduced convergence with more common among females (39%) and in male (32%) and in patients between 20-25 years (71%), especially those who were engaged in near work study having normal vision 6/6 with best correction of myopia. Out of this 71% suffered convergence insufficiency was. Conclusion: this study shows that a large number of myopic patients after correction with headache who have normal visual acuity may be suffering from convergence insufficiency. Near work is a single important contributing factor. The study highlights the importance of Orthoptic examination and convergence exercises in all cases of eye strain and headache. [ABSTRACT FROM AUTHOR]

Aims: This is a needs assessment study with the primary aim of examining the relevance of orthoptic tests to ophthalmology residents' practice, and their confidence in performing and interpreting the tests, to establish the need for further orthoptic education during residency. Method: Participants were Years 1 to 5 ophthalmology residents from a tertiary hospital training program where no formal orthoptic training is offered. An online nine-question survey was conducted over four weeks to assess residents' perceptions of the relevance of orthoptic tests to their practice, their confidence in performing and interpreting ten common orthoptic tests, and preferences for curriculum content and delivery. Responses consisted of 5-point Likert scale options and selection of tests out of ten options. Data were analysed by descriptive statistics using median and range. Results: Of 31 eligible residents, 23 (74%) responded. Relevance to practice was rated high among all respondents (median rating 4 out of 5, range 2 to 5) for all ten tests. Self-rated confidence in test performance was generally low (median rating 3, range 1 to 5). Confidence in test interpretation was higher (median rating 4, range 1 to 5). Respondents selected five tests for which they desired further training. Preference for e-learning was high, with 70% considering this modality 'very useful'. Conclusion: Ophthalmology residents consider orthoptics to be relevant to their practice. Baseline self-reported confidence in test performance is low. They express a desire for further orthoptic training and e-learning is an acceptable teaching format. [ABSTRACT FROM AUTHOR]

Purpose: This study sought to explore the practice of orthoptists internationally in care provision for poststroke visual impairment. Methods: Survey questions were developed and piloted with clinicians, academics, and users. Questions addressed types of visual problems, how these were identified, treated, and followed up, care pathways in use, links with other professions, and referral options. The survey was approved by the institutional ethical committee. The survey was accessed via a web link that was circulated through the International Orthoptic Association member professional organisations to orthoptists. Results: Completed electronic surveys were obtained from 299 individuals. About one-third (35.5%) of orthoptists saw patients within 2 weeks of stroke onset and over half (55.5%) by 1 month post stroke. Stroke survivors were routinely assessed by 87%; over three-quarters in eye clinics. Screening tools were used by 11%. Validated tests were used for assessment of visual acuity (76.5%), visual field (68.2%), eye movement (80.9%), binocular vision (77.9%), and visual function (55.8%). Visual problems suspected by family or professionals were high (86.6%). Typical overall follow-up period of vision care was less than 3 months. Designated care pathways for stroke survivors with visual problems were used by 56.9% of orthoptists. Information on visual impairment was provided by 85.9% of orthoptists. Conclusions: In international orthoptic practice, there is general agreement on assessment and management of visual impairment in stroke populations. More than half of orthoptists reported seeing stroke survivors within 1 month of the stroke onset, typically in eye clinics. There was a high use of validated tests of visual acuity, visual fields, ocular motility, and binocular vision. Similarly there was high use of established treatment options including prisms, occlusion, compensatory strategies, and oculomotor training, appropriately targeted at specific types of visual conditions/symptoms. This information can be used to inform choice of core outcome orthoptic measures in stroke practice. [ABSTRACT FROM PUBLISHER]

Aim: To present an overview of the range of systematic reviews on intervention trials pertinent to orthoptic practice, produced by the Cochrane Eyes and Vision group (CEV). Methods: We searched the 2016 Cochrane Library database (31.03.2016) to identify completed reviews and protocols of direct relevance to orthoptic practice. These reviews are currently completed and published, available onwww.thecochranelibrary.com(free to UK health employees) or via the CEV website(http://eyes.cochrane.org/). Results: We found 27 completed CEV reviews across the topics of strabismus, amblyopia, refractive errors, and low vision. Seven completed CEV protocols addressed topics of strabismus, amblyopia, refractive errors, low vision, and screening. We found 3 completed Cochrane Stroke reviews addressing visual field loss, eye movement impairment, and age-related vision loss. Conclusions: The systematic review process presents an important opportunity for any clinician to contribute to the establishment of reliable, evidence-based orthoptic practice. Each review has an abstract and plain language summary that many non-clinicians find useful, followed by a full copy of the review (background, objectives, methods, results, discussion) with a conclusion section that is divided into implications for practice and implications for research. The current reviews provide patients/parents/carers with information about various different conditions and treatment options, but also provide clinicians with a summary of the available evidence on interventions, to use as a guide for both clinical practice and future research planning. The reviews identified in this overview highlight the evidence available for effective interventions for strabismus, amblyopia, refractive errors, and low vision or stroke rehabilitation as well as the gaps in the evidence base. Thus, a demand exists for future robust, randomized, controlled trials of such interventions of importance in orthoptic practice. [ABSTRACT FROM PUBLISHER]

Purpose To assess whether the early light deprivation induced by congenital cataract may influence the cone-driven retinal function in humans. Methods Forty-one patients affected by congenital cataract ( CC) who had undergone uncomplicated cataract extraction surgery and intraocular lens implant, and 14 healthy subjects ( HS) were enrolled. All patients underwent complete ophthalmological and orthoptic evaluations and best-corrected visual acuity ( BCVA) measurement; light-adapted full-field electroretinograms ( ERG) and photopic negative responses (Ph NR) were recorded to obtain a reliable measurement of the outer/inner retinal function and of the retinal ganglion cells' function respectively. Results Mean values of light-adapted ERG a- and b-wave and Ph NR amplitude of CC eyes were significantly reduced and photopic ERG b-wave implicit time mean values were significantly delayed when compared to HS ones. When studying photopic ERG mean amplitudes at 5 ms, significant differences were found when comparing CC and control eyes. In CC eyes, statistically significant correlations were found between a- and b- wave amplitudes and Ph NR amplitudes. No significant correlations were found between ERG parameters and BCVA, as well as between the age of CC patients at surgery and the time elapsed from lens extraction. No significant differences were found when functional parameters of bilateral and unilateral congenital cataract ( uCC) eyes were compared, however uCC eyes showed significant differences when compared with contralateral healthy eyes. Conclusion We found a significant impairment of cone-driven retinal responses in patients with a history of congenital cataract. These changes might result from the long-lasting effects of early light deprivation on the cone retinal pathways. Our findings support the relevance of retinal involvement in deficits induced by early light deprivation. [ABSTRACT FROM AUTHOR]

Background: “Dragged-fovea diplopia syndrome” is a type of central binocular diplopia that is secondary to a foveal displacement, caused by epiretinal membranes (ERMs) or other macular diseases. Its management is difficult, because prisms are not effective. Case Reports: Two cases of dragged-fovea diplopia syndrome were presented. Both patients were affected with a unilateral epiretinal membrane. Therefore, the pathophysiology underlying their diplopia was the conflict between central and peripheral fusion mechanisms. Conclusions: Diplopia caused by ERM “shift” deserves a complex management. We suggest to be careful about subjective symptoms and to optimize the residual visual function to customize the orthoptic management. A strict cooperation between ophthalmologists and orthoptists could lead to a successful outcome. [ABSTRACT FROM AUTHOR]

Purpose: This implementation study evaluated orthoptists’ use of an educational cartoon (“the Patchbook”) and other measures to improve compliance with occlusion therapy for amblyopia. Methods: Participating orthoptists provided standard orthoptic care for one year, adding the Patchbook in the second year. They attended courses on compliance and intercultural communication by communication skills training. Many other compliance-enhancing measures were initiated. Orthoptists’ awareness, attitude, and activities regarding noncompliance were assessed through interviews, questionnaires, and observations. Their use of the Patchbook was measured. The study was performed in low socio-economic status (SES) areas and in other areas in the Netherlands. It was attempted to integrate education on compliance into basic and continuing orthoptic training. Results: The Patchbook was used by all 9 orthoptists who participated in low-SES areas and 17 of 23 orthoptists in other areas. Courses changed awareness and attitude about compliance, but this was not sustained. Although orthoptists estimated compliance during patching at 70%, three-quarters never suspected noncompliance during a full day of observation in any of their patients. Explanations to parents who spoke Dutch poorly were short. In the second year, explanations to children were longer. Implementation of all 7 additional compliance-enhancing measures failed. Education on compliance was not integrated into orthoptists’ training. Conclusion: Almost all orthoptists used the Patchbook and, as another study demonstrated, it proved to be very effective, especially in low-SES areas. Duration of explanation was inversely proportional to parents’ fluency in Dutch. Noncompliance was rarely suspected by orthoptists. Although 7 additional compliance-enhancing measures had been conceived and planned with the best intentions, they were not realized. These required extra, unpaid time from the orthoptists, which is especially scarce in hospitals in low-SES areas where the educational cartoon is most needed. [ABSTRACT FROM AUTHOR]

Purpose: To establish if cyclotorsion measurements obtained in a patient population using different methods of testing give equivalent results, and if the results from each test are repeatable over time. Methods: Twenty referrals, from the orthoptic waiting list at Sahlgrenska University Hospital, Mölndal, Sweden, with vertical deviation stated as the primary reason for referral, were examined. Subjective cyclotorsion measurements using three different methods were performed. The methods included two standard tests: a synoptophore, with slides A17a/18a, the single Maddox rod test (SMR), and a new test method: the KMScreen method. Measurements were repeated 3 times for fixing either eye, and on two separate test occasions, for repeatability within each of the methods. Results: During the first test measurements, 11 (55%) showed excyclotorsion measured with the synoptophore method, 18 (90%) with the SMR test, and 15 (75%) with the KMScreen method. During the second set of measurements, 11 (55%) showed excyclotorsion with the synoptophore method, 17 (85%) with the SMR test, and 10 (50%) with the KMScreen test. Median perceived torsional measurements at the first visit for the synoptophore, SMR, and KMScreen tests were -1°, -5°, and -1°, respectively. There were significant differences between the synoptophore and SMR (P=0.025), and the SMR and KMScreen (P=0.025), but not between the synoptophore and KMScreen (P=0.90) methods on measuring the affected eye. All three tests showed repeatable values. The 95% limits of agreement (LoAs) between visits, defined as mean torsional difference ±1.96 SD of difference, for the synoptophore, SMR, and KMScreen methods were -0.5°±4.5°, -0.3°±5°, and -0.7°±3.5°, respectively.Pvalues for differences between visits wereP=0.45,P=0.75, andP=0.90, respectively, using an exact permutation test. Conclusion: In this small study group, the three different methods used for testing cyclotorsion showed significantly different results. However, all methods showed significant repeatability (test-retest reliability) over time. This finding is of clinical importance when investigating cyclotorsion in patients. Clinicians need to be aware of the differences between methods when monitoring recovery or changes in patients, and in particular when planning surgical correction for cyclotorsion. [ABSTRACT FROM AUTHOR]

Although lots of studies have been reported on convergence insufficiency (CI), no specific case of CI among African patients has been reported. We report a case of symptomatic classic convergence insufficiency in a female student who previously had been misdiagnosed and managed for refractive error. This case highlights the need for comprehensive binocular vision assessment, administration of validated symptom questionnaires in cases of suspicious CI, and the use of simple and inexpensive vision therapy procedures to manage CI in optometric centres in developing countries. [ABSTRACT FROM AUTHOR]

Introduction and Purpose: To investigate the level of agreement between orthoptists and medical practitioners in the comprehensive eye examination of children seen in an orthoptist-led triage clinic. Patients and Methods: Patient records over a 6-month period were retrospectively reviewed. Those with a presenting complaint related to vision or ocular motility were triaged into the orthoptist-led clinic and included in the study. Patients who did not meet the triage protocol and those who were not assessed by a medical practitioner at a subsequent appointment were excluded from analysis. The clinical findings from the orthoptist and medical practitioner were collected and compared. Results: In total, sixty-three patients were reviewed during the 6-month period and met the inclusion criteria. After the initial comprehensive eye examination with an orthoptist, thirty-two were discharged from hospital and thirty-one were asked to return for a review appointment with a medical practitioner. Agreement between the orthoptists and medical practitioners for the diagnosis of strabismus and/or amblyopia was 84.6% (κ = 0.649, P < 0.001). There was strong agreement between orthoptists and medical practitioners for refractive error of the right eye [τ (19) = 0.352, P = 0.729] and left eye [τ (19) = 1.785, P = 0.090]. Fundus examination comparisons between the orthoptists and medical practitioners showed very high agreement (95.7%). Conclusions: Orthoptists have the skills necessary to provide comprehensive care of children referred for ocular motility and/or vision related disorders. There was close agreement between orthoptists and medical practitioners when performing comprehensive eye examinations. [ABSTRACT FROM AUTHOR]

Intermittent exotropia is rich in our orthoptic history, with different modes of therapy as well as surgical methods to improve the eye drifting. We explore the very earliest nonsurgical treatments documented from the Aeginaeta mask from 600 A.D. to a plethora of devices and techniques throughout the 1800s and 1900s, including stereograms, the cheiroscope, the Tibbs Binocular Trainer, and finally to computerized orthoptic programs in the twenty-first century. We note several other founding and instrumental scientists and researchers in the field's early beginning as well as the American heritage of orthoptics. From Javal, Hering, and Mary and Edmund Maddox to Elizabeth Stark, Burian, Scobee, von Noorden, Dorothy Thompson, and Sally Moore, we delve into many influential ideas, theories, and inventions. The scientific basis for many treatments and the monumental advancements made in the field of ocular motility will be discussed. [ABSTRACT FROM AUTHOR]

The orthoptist plays an essential role in patient education and practice management. We present three unusual episodes of patient medication misuse, including two patients who mistakenly placed alternative liquids into their eye following surgery and a further patient who continued to use their medication after the family dog had used the bottle as a chewing device. Vision and safety outcomes varied considerably between cases. An orthoptist-driven review of postoperative standing orders was undertaken to reduce the risk of future occurrences. Supplementary graphics of the medications were added to the information forms. Patients were further requested to return accompanied to postoperative information visits to aid recall and emphasise proper protocol. Anecdotally there has been a reduction in medication-related enquiries following the intervention and no additional cases of ocular injury. [ABSTRACT FROM AUTHOR]

This lecture was presented in honour and memory of Patricia Mary Lance in recognition of her contribution to orthoptics in the fields of research, education and the association, both in Australia and internationally. After seven years of publishing the transactions of the annual scientific meetings, the first titled edition of the Australian Orthoptic Journal was published in 1966 as Volume 8, which means that 2016 marked 50 years of our journal with its current name. This anniversary provided an opportune time to look back over the journal and its development over the decades, from the very first orthoptic paper in the transactions of the 1959 meeting, which was by Patricia Lance, to the latest research publications in 2015. Over this time the changes in society, culture, education and technology have all affected the development of research and this has been reflected in our journal. [ABSTRACT FROM AUTHOR]

Aim: To determine the effectiveness of the orthoptist-led diabetic retinopathy screening clinic at Northern Health by investigating the diagnostic agreement between orthoptists and ophthalmologists. Method: This study was a retrospective audit of 1,097 patients booked at the Northern Health orthoptist-led screening clinic. The demographic data and clinical assessment findings were recorded for the 101 included patients (192 eyes). The orthoptists' diabetic retinopathy diagnoses were compared with those made by the ophthalmologists using a kappa analysis. Results: Substantial agreement was observed between the orthoptists and ophthalmologists in relation to the diagnosis and detection of diabetic retinopathy (k = 0.660, p <0.001). Conclusions: Strong agreement was found between the orthoptists and ophthalmologists when detecting and diagnosing diabetic retinopathy for patients attending the Northern Health orthoptist-led clinic. This suggests that orthoptists are able to effectively detect and diagnose patients with diabetic retinopathy in a hospital outpatient setting and provide a high level of care. [ABSTRACT FROM AUTHOR]

Background: Vision Therapy/Orthoptics(VT/O) is a package of treatments that enables patients to achieve the maximum level of visual performance. The aim was to determine the effect of three months vision therapy/orthoptics on best corrected visual acuity (BCVA), fusion, stereopsis and ocular alignment in 3-7 year old children. Materials and Methods: In this randomized clinical trial study, 80 children with amblyopia and/or non- paralytic horizontal deviations were randomly divided into intervention and control groups. Intervention group was treated by vision therapy/orthoptics for three months. These modalities included patch, red filter, sector patch, over minus lens, prism and synoptophore exercises. Controls were treated by only patching for the same period. Pre and post-treatment BCVA, fusion, stereopsis and alignment were compared. Visual performance was classified as excellent (BCVA≥20/30, deviation≤10pd and stereopsis≤70sec/are), acceptable (BCVA≥20/30, deviation ≤10pd and stereopsis 70 to 3000sec/are) and unsatisfactory (BCVA<20/30, deviation>10pd and no stereopsis). Results: A total of 80 cases (56 girls and 24 boys) with the mean age of 5.6±1.4 years entered the study. Although more improvement of fusion and stereopsis was seen in the intervention group (P<0.001 for both groups), there was no significant differences in BCVA and alignment between two groups. Also the difference of visual performance was not statistically significant between two groups, whereas the improvement was significant in each group (P<0.001, for both groups). Conclusion: Vision therapy/orthoptics treatment can be effective for improving sensory status in 3 to 7 year old children with amblyopia and/or strabismus. Further studies with larger sample sizes and focusing on accommodation and fusional amplitude are warranted. [ABSTRACT FROM AUTHOR]

Background: To evaluate and compare corneal biomechanical indices and their specificity among keratoconus (KC), keratoconus suspect (KCS), and normal eyes (NL) before and after controlling potential confounders. Materials and Methods: A total of 160 eyes in three groups were included prospectively: NL, KC, and KCS groups based on clinical examination and topography. Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured by the ocular response analyzer. CH and CRF were compared between the three groups by analysis of variances test. Results: The three groups consisted of 80 NL, 48 KC, and 32 KCS eyes. The mean CH measured was 10.4 ± 1.25, 7.83 ± 1.28 and 10.17 ± 1.80 mm Hg in NL, KC and KCS eyes, respectively. The mean CRF was 10.23 ± 1.75, 6.5 ± 1.63 and 9.98 ± 2.00 mm Hg in NL, KC and KCS eyes, respectively. Mean CH and CRF were significantly different between the NL and KC (P < 0.05); however after controlling for central corneal thickness and sex; there was no significant difference between NL and KCS (P > 0.05). Conclusion: CH and CRF can be helpful in differentiating KC from NL eyes; however, they are not valuable for detecting KCS that is the main concern for refractive surgery. Future studies focusing on more accurate tests for identifying KCS, using a consistent grading scale for defining KC and KCS are still warranted. [ABSTRACT FROM AUTHOR]

Purpose: To assess the accuracy of the Plusoptix A09 photoscreener in detecting amblyopia risk factors in children and determine referral criteria when using Plusoptix A09 for a large-scale vision screening. Methods: Pediatric patients attending our eye clinic underwent a comprehensive ophthalmic examination that included photorefraction, orthoptic examination, anterior segment assessment, fundus examination and cycloplegic retinoscopy. The measurements were collected for statistical analyses. Results: One hundred and seventy-eight children (mean age ± SD: 6.2±2.4 years, range: 2.2 to 14.1 years) were included in the study. The mean spherical equivalent (SE) obtained using Plusoptix A09 (PSE) was 0.57 D lower than that obtained from cycloplegic retinoscopy (CRSE) (P = 0.00). However, there was no statistically significant difference of Jackson cross cylinder J0 and J45 between Plusoptix A09 (PJ) and cycloplegic retinoscopy (CRJ) (P = 0.14, P = 0.26). The relationship of SE obtained from Plusoptix A09 and SE obtained from cycloplegic retinoscopy was presented as the equation: CRSE = 0.358 + 0.776 PSE + 0.064 PSE2 + 0.011 PSE3. Based on the Receiver Operating Characteristic (ROC) curve, the Plusoptix A09 had an overall sensitivity of 94.9% and specificity of 67.5% for detecting refractive amblyopia risk factors. The sensitivity and specificity of the Plusoptix A09 for detection of strabismus were 40.7% and 98.3%, respectively; detection of amblyopia and/or strabismus was 84.7% and 63.2%, respectively. Conclusions: The Plusoptix A09 photoscreener underestimated hyperopia and overestimated myopia according to SE when compared with cycloplegic retinoscopy. The accuracy of the Plusoptix A09 in detecting amblyopia risk factors in children could be improved by the regression equation and optimized criteria for refractive amblyopia risk factors developed in the present study. Moreover, the Plusoptix A09 photoscreener is not suitable for a large-scale strabismus screening when it is applied solely. [ABSTRACT FROM AUTHOR]

This research tested the hypothesis that the successful treatment of convergence insufficiency (CI) with vision-training (VT) procedures, leads to an increased capacity of vergence adaptation (VAdapt) allowing a more rapid downward adjustment of the convergence accommodation cross-link. Nine subjects with CI were recruited from a clinical population, based upon reduced fusional vergence amplitudes, receded near point of convergence or symptomology. VAdapt and the resulting changes to convergence accommodation (CA) were measured at specific intervals over 15 min (pre-training). Separate clinical measures of the accommodative convergence cross link, horizontal fusion limits and near point of convergence were taken and a symptomology questionnaire completed. Subjects then participated in a VT program composed of 2.5 h at home and 1 h in-office weekly for 12–14 weeks. Clinical testing was done weekly. VAdapt and CA measures were retaken once clinical measures normalized for 2 weeks (mid-training) and then again when symptoms had cleared (post-training). VAdapt and CA responses as well as the clinical measures were taken on a control group showing normal clinical findings. Six subjects provided complete data sets. CI clinical findings reached normal levels between 4 and 7 weeks of training but symptoms, VAdapt, and CA output remained significantly different from the controls until 12–14 weeks. The hypothesis was retained. The reduced VAdapt and excessive CA found in CI were normalized through orthoptic treatment. This time course was underestimated by clinical findings but matched symptom amelioration. [ABSTRACT FROM AUTHOR]

Background: Some post-LASIK patients complain of blurry distance vision months after refractive surgery, despite good corneal healing and negligible refractive error. We postulated that perceiving blur in the absence of refractive error or significant monocular aberrations might result from poor binocular control. Binocular vision testing in a series of such patients revealed convergence problems in 83% of cases. Case Reports: We report on 8 patients (average age 37.4 yrs) who completed up to 40 sessions of vision therapy (VT), either completely via computer or in a combination of computer orthoptics and office vision therapy. Seven patients had received LASIK; one had PRK. Optometric measurements and symptoms were recorded before and after VT treatment, starting at least 3 months after refractive surgery. Near point of convergence improved in 7 cases following VT, and convergence break and/or recovery improved in 6 cases. Six cases reported symptom reduction, and pre-presbyopic cases tended to improve accommodative facility. The number of binocular functions showing improvement per case correlated with the number of VT sessions completed. Convergence changes were statistically significant when pre-/post-VT data were compared for these cases as a group. Conclusion: Patients complaining of distance blur following refractive surgery may have undiagnosed binocular vision problems. VT incorporating an internet orthoptics component improved convergence ability in the cases reported here, and most patients reported symptomatic relief. [ABSTRACT FROM AUTHOR]

BACKGROUND: Persistent postural-perceptual dizziness (PPPD) (formerly chronic subjective dizziness) may be treated using the habituation form of vestibular and balance rehabilitation therapy (VBRT), but therapeutic outcomes have not been formally investigated. OBJECTIVE: This pilot study gathered the first data on the efficacy of VBRT for individuals with well-characterized PPPD alone or PPPD plus neurotologic comorbidities (vestibular migraine or compensated vestibular deficits). METHODS: Twenty-six participants were surveyed by telephone an average of 27.5 months after receiving education about PPPD and instructions for home-based VBRT programs. Participants were queried about exercise compliance, perceived benefits of therapy, degree of visual or motion sensitivity remaining, disability level, and other interventions. RESULTS: Twenty-two of 26 participants found physical therapy consultation helpful. Fourteen found VBRT exercises beneficial, including 8 of 12 who had PPPD alone and 6 of 14 who had PPPD with co-morbidities. Of the 14 participants who found VBRT helpful, 7 obtained relief of sensitivity to head/body motion, 5 relief of sensitivity to visual stimuli, and 4 complete remission. Comparable numbers for the 12 participants who found VBRT not helpful were 1 (head/body motion), 3 (visual stimuli), and 0 (remission). CONCLUSIONS: This pilot study offers the first data supporting the habituation form of VBRT for treatment of PPPD. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of Chinese eye exercises on reducing accommodative lag in children by a randomized, double-blinded controlled trial. Methods: A total of 190 children aged 10 to 14 years with emmetropia to moderate myopia were included. They were randomly allocated to three groups: standard Chinese eye exercises group (trained for eye exercises by doctors of traditional Chinese medicine); sham point eye exercises group (instructed to massage on non-acupoints); and eyes closed group (asked to close their eyes without massage). Primary outcome was change in accommodative lag immediately after intervention. Secondary outcomes included changes in corrected near and distant visual acuity, and visual discomfort score. Results: Children in the standard Chinese eye exercises group had significantly greater alleviation of accommodative lag (-0.10D) than those in sham point eye exercises group (-0.03D) and eyes closed group (0.07D) (P = 0.04). The proportion of children with alleviation of accommodative lag was significantly higher in the standard Chinese eye exercises group (54.0%) than in the sham point eye exercises group (32.8%) and the eyes closed group (34.9%) (P = 0.03). No significant differences were found in secondary outcomes. Conclusion: Chinese eye exercises as performed daily in primary and middle schools in China have statistically but probably clinically insignificant effect in reducing accommodative lag of school-aged children in the short-term. Considering the higher amounts of near work load of Chinese children, the efficacy of eye exercises may be insufficient in preventing myopia progression in the long-term. Trial Registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

Background: Some post-LASIK patients complain of blurry distance vision months after refractive surgery, despite good corneal healing and negligible refractive error. We postulated that perceiving blur in the absence of refractive error or significant monocular aberrations might result from poor binocular control. Binocular vision testing in a series of such patients revealed convergence problems in 83% of cases. Case Reports: We report on 8 patients (average age 37.4 yrs) who completed up to 40 sessions of vision therapy (VT), either completely via computer or in a combination of computer orthoptics and office vision therapy. Seven patients had received LASIK; one had PRK. Optometric measurements and symptoms were recorded before and after VT treatment, starting at least 3 months after refractive surgery. Near point of convergence improved in 7 cases following VT, and convergence break and/or recovery improved in 6 cases. Six cases reported symptom reduction, and pre-presbyopic cases tended to improve accommodative facility. The number of binocular functions showing improvement per case correlated with the number of VT sessions completed. Convergence changes were statistically significant when pre-/post-VT data were compared for these cases as a group. Conclusion: Patients complaining of distance blur following refractive surgery may have undiagnosed binocular vision problems. VT incorporating an internet orthoptics component improved convergence ability in the cases reported here, and most patients reported symptomatic relief. [ABSTRACT FROM AUTHOR]

Background, and Purpose: Torsional diplopia can result in failure of fusion in an individual without a measureable strabismus. When presented with a patient with complaints of binocular diplopia, physicians and orthoptists should consider cyclovertical muscle dysfunction when the source of the complaint is not readily apparent. Methods: A thorough review of the literatu re combined with the author's own personal experience in treating adult patients with strabismus was used to evaluate the different potential causes of torsional diplopia. Predisposing factors, diagnostic techniques, and strabismus diagnoses are considered. Results: The most common cause of torsional diplopia is a superior oblique palsy. Other more common causes include thyroid-related orbitopathy and skew deviations. Conclusions: Torsional diplopia is a common cause of undiagnosed strabismus in the adult patient population. Proper consideration of the most common causes should be made. [ABSTRACT FROM AUTHOR]

The authors present three patients with idiopathic exercise-induced esotropia. The history, physical findings, and testing that led to the diagnosis are discussed. To the authors' knowledge, this is the largest series of patients with this rare condition, with this series representing half of reported patients in the literature. It is hoped that a discussion of common features of the condition will guide furth er exploration of the etiology. [ABSTRACT FROM AUTHOR]

Background, and Purpose: Certified orthoptists are routinely required, as a standard component of outpatient care, to examine and identity the cause of double vision described by neuro-ophthalmology and oculo-plastics patients. Peer-reviewed articles in the strabismus literature describing the significance of this role of the orthoptists, especially in more complex cases of strabismus, do exist, but are outdated. The importance of creating a differential diagnosis in the understanding of the disease process is a well-recognized component of medical education and modern medicine. Patients and Method: This work was a retrospective chart review and descriptive study of the most common clinical characteristics of adult neuro-ophthalmology and oculo-plastics patients seen over a 9-year period by an orthoptist in a large, urban academic institution in the United States. History and clinical data obtained included demographic information; whether the subjects were neuro-ophthalmology or oculo-plastic patients or both; chief complaint; past medical history and associated medical risk factors; past ocular history of strabismus or amblyopia; whether reported diplopia was monocular or binocular; visual acuities; sensorimotor examination and fusion status information; presence or absence of ptosis; pupil size and reactivity; basic accommodative function; orthoptist and physician diagnoses; and suggested treatment of diplopia. Results: Five hundred seventy-five subjects were identified based on inclusion criteria. Racial demographics matched that of the state of Maryland, with the majority of the patients being Caucasian. The minority were of Hispanic origin. Ninety-one percent of the study cohort was referred by the department of neuro-ophthalmology at the institution. Hypertension was a statistically significant medical risk factor for acquired strabismus and diplopia in this adult cohort. Etiology for the strabismus and associated diplopia suggested by the orthoptist was in close agreement with the final diagnosis made by the referring physician. Pupil-sparing oculomotor palsy (third cranial nerve, CN3) occurred as frequently as pupil-involving CN3, with tumor occurring more frequently as an etiology than aneurysm in both groups. Trochlear nerve palsy (CN4) was more often associated with hydrocephalus than abducens nerve palsy (CN6), and trauma remained a common association with acquired CN4 palsy. In patients with thyroid eye disease (TED), eso- and exo-deviations occurred with similar frequency. As has been reported in the literature, concomitant myasthenia gravis (MG) remained rare in these patients, although occurring with similar frequency in patients with both types of horizontal deviation. In patients with ptosis, asymmetry was not statistically more predictive of MG than symmetry. Prism was used most frequently, followed by surgery, to address diplopia symptoms. Lastly, there was a statistically significant association of acquired strabismus and diplopia in female subjects with breast cancer and no past ocular history of childhood strabismus or amblyopia. Conclusion: The thorough assessment of sensorimotor function, fusion, and visual acuity provided by the orthoptist is an important clinical adjunct in developing the differential required to make an accurate final diagnosis, which sometimes may not subscribe to accepted clinical norms reported in the literature. The orthoptist also plays an important role in the nonsurgical treatment of acquired diplopia due to strabismus. Fresnel Press-On™ or ground-in spectacle prism was a commonly used treatment for diplopia. [ABSTRACT FROM AUTHOR]

Background and Purpose: The profession of orthoptics has been present for over 100 years and was created as a partnership with pediatric ophthalmology in an effort to provide better strabismus care to children. Orthoptists are known to improve practice efficiency, but to date, no quantitative data has been presented in the literature to support this claim. Proper utilization of an orthoptist is critical to improving practice efficiency and revenue. Methods: Over a 6-month period, the financial impact to a pediatric ophthalmology practice by the addition of a second certified orthoptist (C.O.) was analyzed. Both indirect and direct income and expenses were considered. Results: Despite their increased salary compared to an ophthalmic assistant, the utilization of an orthoptist provides considerable return on investment. The addition of a certified orthoptist increased practice revenue by over $70,000. Conclusion: The addition of a certified orthoptist in a physician's practice significantly increases practice revenue generated. When considering models of healthcare within ophthalmology, the use of an orthoptist as a physician extender has been shown to improve practice efficiency in a cost-effective manner. [ABSTRACT FROM AUTHOR]

The article mentions the 75th anniversary of the American Association of Certified Orthoptists (AOC).

The year 2015 marks the 75th anniversary of the American Association of Certified Orthoptists (AACO), the second oldest orthoptic professional organization in the world. Since its inception, October 7,1940, approximately 90% of all certified orthoptists (C.O.) have consistently maintained membership in their professional society. Approximately 80% of AACO members attend AACO-sponsored scientific meetings at least once annually. And 17-20% of members are actively involved in AACO leadership, management, and activities. Eye care has changed dramatically over the last 75 years, and orthoptics has successfully adapted to survive due to the fortitude and resilience of its practitioners. The AACO has weathered opposition from much more powerful competitors, ever-increasing health care regulation, and an evolution in the standard management of strabismus, only to emerge transformed and even more durable. One constant remains: the qualities that inspired thirty-three individuals to create a profession and a society dedicated to the care of patients with strabismus and disorders of binocular vision, and the education of parents, orthoptists, and ophthalmologists exist in every orthoptist today. These qualities are determination, creativity, dedication, and passion. [ABSTRACT FROM AUTHOR]

Background: Dyslexia affects 5%-8% of the population of the Western world. While reading, different eye movements are required. Compared to other persons, dyslexics have more and longer fixations, shorter saccade amplitude, a higher percentage of regression, and more fixation disparity when reading. In non-reading situations, dyslexics do not have more binocular problems than others. The aim of the present study was to investigate whether computerized orthoptic vergence training could improve reading ability for dyslexic children. Methods: The study was conducted at Ängkärrskolan, Solna, an elementary school exclusively for dyslexic children. Twelve subjects, aged 13-14 years, were trained with RetCorr, a computerized vergence training program. Reading speed was assessed before and after treatment. The results were compared with an age-matched control group. Results: The dyslexic subjects conducted on average 11.75 sessions (±2.53 SD) of orthoptic training over a 5-week period. On average, the number of words read per minute before training were 87.83 (±16.80 SD) and after training 95.58 words (±18.08 SD). The difference was statistically significant ( p = 0.0066). In the control group, the change was from 85.00 (±19.68 SD) words to 89.37 words (±19.71 SD) over the same time period. This difference was not significant ( p = 0.1235). Discussion: Most scientists agree that dyslexia is mainly a phonological impairment. Nevertheless, the results show that vergence treatment might help dyslexics. Larger studies are required to provide guidance in this area. [ABSTRACT FROM AUTHOR]

ObjectiveTo develop a tool for assessing amblyopic risk and monitoring the treatment effect of propranolol in periocular haemangioma management.MethodsWe present a study of nine children with periocular haemangioma who underwent propranolol treatment at York Hospital between 2009 and 2013.A proposed measure of amblyogenic risk based on the induced anisometropia resulting from a periocular haemangioma was calculated in the form of a single quantitative value, measured in dioptres. This calculation used published work and developed it to produce a new function, termed the delta defocus equivalent (DFE-∂).Refraction measurements were retrospectively collected from patients' notes in order to measure the trend of DFE-∂ over the treatment period with propranolol.ResultsThe average DFE-∂ at commencement of propranolol was 1.54 (±0.62) D. The average at the end of treatment was 0.39 (±0.38) D.ConclusionThis work presents a possible tool for assessing amblyopic risk in cases of periocular infantile haemangioma. The DFE-∂ gives a measure in dioptres, which may represent the true amblyopic risk, and so be useful in supporting treatment decisions in paediatric ophthalmology. [ABSTRACT FROM AUTHOR]

The article offers information on orthoptic management of incomitant strabismus. It discusses studies on the diagnosis of this eye disease and on its management as well as treatment, particularly the use of prisms in treating small-angle comitant strabismus and of occlusive methods. The use of surgical methods is also mentioned.