Christine L. Allison

Effect of Amblyopia Treatment on Macular Thickness in Eyes With Myopic Anisometropic Amblyopia.

PURPOSE To determine whether abnormal macular thickness in myopic anisometropic amblyopia differed after amblyopia treatment. Furthermore, to investigate whether effect of treatment on macular thickness was associated with subject age or improvement in stereoacuity. METHODS Seventeen children (mean age: 9.0 [±3.0] years, ranging from 5.7-13.9 years) with myopic anisometropic amblyopia (visual acuity [VA] in amblyopic eyes: 20/80-20/400) were recruited and treated with 16-week refractive correction, followed by an additional 16-week refractive correction and patching. Macular thickness, best-corrected VA, and stereoacuity were measured both before and after amblyopia treatment. Factorial repeated-measures analysis of variance was performed to determine whether macular thickness in amblyopic eyes changed after amblyopia treatment. RESULTS Mean baseline VA in the amblyopic eye was 1.0 ± 0.3 logMAR and improved to 0.7 ± 0.3 after amblyopia treatment (P < 0.0001). The interaction between eye and amblyopia treatment was statistically significant for average foveal thickness (P = 0.040). There was no treatment effect on fellow eyes (P = 0.245); however, the average foveal thickness in the amblyopic eye was significantly reduced after amblyopia treatment (P = 0.049). No statistically significant interactions were found for the other macular thickness parameters (P > 0.05). CONCLUSIONS Abnormal central macula associated with myopic anisometropic amblyopia tended to be thinner following amblyopia treatment with no significant changes in peripheral macular thickness.

Proportion of Refractive Errors in a Polish Immigrant Population in Chicago

Purpose. This retrospective record review was conducted to investigate the proportion of patients with refractive error in a Polish immigrant population residing in an urban environment. Illinois has more than 1 million people of Polish descent as citizens, and Chicago is considered to have the second largest population of Polish descent in the world, outside of Warsaw, Poland. Methods. Six hundred seventy-five records (271 men/404 women) of Polish immigrants were reviewed from a practice with >92% Polish immigrants in the patient base. The patients ranged in age from 3 to 94 years. Refractive status for each eye, and the existence of any strabismus or amblyopia, was recorded. Results. The proportion of myopia [spherical equivalent at least −0.75 diopter (D)] was found to be 35.1%, whereas the proportion of hyperopia (spherical equivalent ≥+0.75 D) was found to be 38.4%. Fifteen percent of the patients exhibited astigmatism ≥1.00 D. Amblyopia was present in 9% of the patients, whereas the prevalence of strabismus was found to be 3%, with 76% of the strabismics exhibiting esotropia. In the 0- to 18-year age range and the 19- to 45-year age range, the most common refractive error was low myopia (43.9 and 36.9%), whereas in the patients >45 years of age, it was low hyperopia (31.2%). Conclusions. Refractive error data are presented for a population base that has not been previously reported, although Polish Americans comprise 3% of the US population. Myopia is more common in young Polish patients than in the general US population. The strong hyperopic shift in older patients may either be normal aging or the product of increased near work in the young. The high rates of amblyopia call for more aggressive education and treatment.

Diagnosing and managing functional visual complications after brain injury

BACKGROUND Brain injury caused by an arteriovenous malformation (AVM) hemorrhage is an uncommon occurrence in a teenager. An AVM is a congenital anomaly of unknown etiology, often described as a tangle of arteries and veins that may vary in length and width leading to a loss of capillary bed. The vessels can break down with time and cause hemorrhage or aneurysm. Hemorrhage occurs in a significant number of patients with AVM. Intracranial hemorrhage causes brain injury, which can lead to systemic and ocular complications, neurologic deficits, and death. CASE REPORT A 15-year-old girl presented to our clinic with a chief complaint of horizontal diplopia while reading, lasting from seconds to 5 minutes. Nine months before the examination she had a ruptured cerebral AVM, then surgery to control the bleeding. She spent 6 weeks in a coma after surgery and woke up a hemiplegic. There were no visual problems before the bleeding. Our evaluation showed accommodative insufficiency, oculomotor dysfunction, dry eye syndrome, and a right beating latent nystagmus in both eyes. Perceptual testing showed a severe visual sequential memory deficit. The patient was given a reading prescription to aid with accommodation and was to use artificial tears and lacrilube ointment. At the follow-up examination, she reported increased efficiency and fewer episodes of diplopia while reading with bifocals and fewer dry eye symptoms since using the artificial tears. CONCLUSIONS After a brain injury, a young adult can present with perceptual and visual efficiency problems as well as nystagmus. It is important to test all areas that may be affected by this type of event and to investigate all complaints thoroughly with continued follow-up care. A latent nystagmus was discovered during thorough near point testing. The visual perceptual testing helped to confirm the visual sequential memory deficit, which may otherwise have been overlooked. It is believed that the diplopic complaint and poor oculomotor skills were directly related to the newly acquired nystagmus.