Saber Abdi

Orthoptic findings and asthenopia in a population of Swedish schoolchildren aged 6 to 16 years.

Purpose: To determine the prevalence of refractive errors and binocular disorders in relation to asthenopia in a representative population of Swedish schoolchildren. Methods: The study population included 216 schoolchildren, 60 in grade 1 (age 6–7 years), 96 in grade 4 (10–12 years) and 60 in grade 8 (14–16 years). Asthenopia was evaluated by questionnaire. Visual acuity was tested for distance and near, uncorrected and with the best subjective refraction. Refraction in cycloplegia and an orthoptic assessment was performed. Results: Asthenopia was reported in 23.1% of schoolchildren; all but two of these schoolchildren had an abnormal eye examination. Asthenopia was related to uncorrected visual acuity ≤ 0.65 (13.9%*) and myopia (8.8%*). No significant correlation could be found to accommodative or convergence insufficiency. Conclusion: Asthenopia was significantly associated with uncorrected visual acuity ≤ 0.65 and with myopia (spherical equivalent −0.50 D or less) among Swedish schoolchildren.

Relative difference in orbital volume as an indication for surgical reconstruction in isolated orbital floor fractures.

In orbital floor fractures, the estimation of the herniated orbital content in the maxillary sinus has traditionally been the dividing line between surgical and nonsurgical management. In this study, we evaluated whether a relative change in volume would function as an indicator for surgical versus nonsurgical treatment of orbital floor fractures. This was a follow-up study in patients with untreated unilateral isolated orbital floor fractures admitted to our department from March 2003 to April 2007. Patients were contacted by regular mail and invited to have a clinical eye examination. The volume of the orbital content was calculated digitally from the patients’ computed tomography scans at the time of their injury. Eighteen subjects with no facial skeleton fracture were included for reference of orbital content volumes. Five of 23 patients showed 2 to 4 mm of enophthalmos, and only three of them had intermittent diplopia. No statistical correlation was found between the herniated volume and enophthalmos. No statistical correlation supporting the supposition that 1 mL of herniated orbital content would result in 1 mm of enophthalmos was found. The relative volume change between the fractured and nonfractured orbit in an individual does not appear to be a useful criterion for surgery. The importance of the herniated orbital tissue for the development of enophthalmos is unclear.

Accommodation Insufficiency in Children: Are Exercises Better than Reading Glasses?

Purpose: The aim of the present study was to investigate which mode of therapy, plus lens (+1.00D) reading addition (PLRA) or spherical flipper (± 1.50D), is the most effective in the treatment of accommodative insufficiency (AI). Methods: Initially, 24 subjects (mean age 10.3 years, ± 2.5 SD) with AI were included in the study. Ten subjects completed 8 weeks of PRLA treatment whereas 9, out of 14, subjects completed 8 weeks of spherical flipper treatment. Results: There was a statistically significant improvement in the accommodative amplitude with both regimes of treatment [F(1, 17) = 18.84, p = 0.0004). Spherical flipper treatment was found to have an overall larger effect on accommodative function as compared with PLRA treatment. However, accommodation did not reach normal values after only 8 weeks of treatment. Discussion: The results indicate that both methods improve the accommodative amplitude, but that overall accommodative function reaches higher levels of improvement with spherical flipper as compared with PLRA treatment. However, the accommodative function did not gain normal values in 8 weeks of treatment with either regime.

The influence of accommodative insufficiency on reading.

Background:  It is not known how accommodative insufficiency influences reading performance.

Treatment of Accommodative Insufficiency with Plus Lens Reading Addition: is +1.00 D Better than +2.00 D?

Purpose: The aim of the present study was to evaluate if +2.00 D lens reading addition has the same effectiveness as +1.00 D reading addition in the treatment of accommodative insufficiency (AI). Methods: Initially 22 subjects (mean age 11.8 years, ±3.54 SD) with AI were included in the study. The treatment was given according to a randomization list; 11 subjects were given +1.00 D reading addition and the other 11 were given +2.00 D reading addition, for 8 weeks of treatment. The Visual Analogue Scale (VAS) was used to evaluate the subjective degree of asthenopia before and after treatment. Results: The results showed a statistical significant improvement of the accommodative amplitude with +1.00 D reading addition after 8 weeks of treatment. In the +2.00 D reading addition group the improvement of accommodative amplitude was not significant. The reduction in VAS score was significant in both groups. Discussion: The results indicate that +2.00 D reading addition does not exercise the accommodative system in the same amount as +1.00 D reading addition to improve the accommodative amplitude. We therefore recommend that +2.00 D reading addition is not used for treatment of AI.

Evaluation of Accommodative Insufficiency with the Visual Analogue Scale (VAS)

Purpose: The purpose of this study was to evaluate whether asthenopic symptoms in schoolchildren diagnosed with accommodative insufficiency (AI) and graded with the Visual Analogue Scale (VAS) could be correlated with the degree of accommodative deficiency in these children, and to investigate if VAS grading of the asthenopic symptoms could be used as an instrument to indicate the level of improvement of AI. Methods: Forty-nine children (mean age 10.2 years ± 2.7) diagnosed with AI graded their degree of asthenopia on the VAS before and after a 12-week treatment period wearing individually dispensed reading glasses. Results: The improvement in accommodation after treatment was statistically significant (p < 0.001) and 83.7% of the children obtained normal accommodative amplitude in relation to age. The reduction in asthenopic symptoms as graded with the VAS was also statistically significant (p < 0.001) after treatment and 89.9% of the children obtained a normal VAS score. However, no correlation between the degree of accommodative deficiency and the VAS grading could be found, neither before nor after treatment. Discussion: Based on these results we conclude that the visual analogue scale (VAS) cannot be used as an instrument to indicate the degree of accommodative deficiency nor can it be used to indicate the level of improvement during the course of treatment. However, the VAS can be used as an instrument to verify and document whether or not asthenopic symptoms are present, and therefore also to indicate when symptoms have been relieved.

The effect of vertical gaze position on ocular tear film stability

Background:  An enlarged exposed ocular surface area is known to degrade tear film stability. Little is known of how tear film stability alters with vertical gaze and the change of palpebral fissure height

Ophthalmologic Findings in Patients with Non-Surgically Treated Blowout Fractures

We evaluated the ocular and visual status in a group of patients with a non-surgically treated blowout fracture. Clinical examination with refraction, test of binocular function, and tear film evaluation was performed in 23 patients. These values were statistically correlated with the orbital volume measurements and ocular finding from the patient records at presentation. About 50% of the study group was symptomatic due to low visual acuity from refractive errors and decompensated phorias as a consequence of the blowout fracture. Several patients displayed changes in tear film production. There was no strong correlation between the measured parameters and orbital volume measurements. Patients with a non-surgically treated blowout fracture often display ocular and visual changes after discharge. A routine visual exam is advocated in all patients after the ocular status has stabilized after a blowout fracture.

Stepwise increase of hypermetropic correction using contact lenses in intermittent partially accommodative esotropia.

The aim was to present a series of patients with intermittent partially accommodative esotropia (pAcc‐ET) in evaluating the effect of over‐plus correcting the hypermetropia relative to the non‐cycloplegic refraction using contact lenses.