Do we really know the prevalence of accomodative and nonstrabismic binocular dysfunctions?

Purpose: To determine the scientific evidence about the prevalence of accommodative and nonstrabismic binocular anomalies. Methods: We carried out a systematic review of studies published between 1986 and 2009, analysing the MEDLINE, CINAHL, FRANCIS and PsycINFO databases. We considered admitting those papers related to prevalence in paediatric and adult populations. We identified 660 articles and 10 papers met the inclusion criteria. Results: There is a wide range of prevalence, particularly for accommodative insufficiency (2 %-61.7 %) and convergence insufficiency (2.25 %-33 %). More studies are available for children (7) compared with adults (3). Most of studies examine clinical population (5 studies) with 3 assessed at schools and 1 at University with samples that vary from 65 to 2048 patients. There is great variability regarding the number of diagnostic signs ranging from 1 to 5 clinical signs. We found a relation between the number of clinical signs used and prevalence values for convergence insufficiency although this relationship cannot be confirmed for other conditions. Conclusion: There is a lack of proper epidemiological studies about the prevalence of accommodative and nonstrabismic binocular anomalies. Studies reviewed examine consecutive or selected patients in clinical settings and schools but in any case they are randomized and representative of their populations with no data for general population. The wide discrepancies in prevalence figures are due to both sample population and the lack of uniformity in diagnostic criteria so that it makes difficult to compile results. Biases and limitations of reports determine that prevalence rates offered are only estimations from selected populations.

Análisis ergonómico-visual del éxito relativo de las pantallas 3D

Curso corto presentado el 25 de Febrero de 2012 en la X edición de los Cursos de Formación Continuada en Optometría de la Fundación Jorge Alió (Alicante): http://www.fundacionalio.com/ver_noti.php?urlPaginaVuelta=1&idNoti=162

Is there any evidence for the validity of diagnostic criteria used for accommodative and nonstrabismic binocular dysfunctions?

Purpose: To analyze the diagnostic criteria used in the scientific literature published in the past 25 years for accommodative and nonstrabismic binocular dysfunctions and to explore if the epidemiological analysis of diagnostic validity has been used to propose which clinical criteria should be used for diagnostic purposes. Methods: We carried out a systematic review of papers on accommodative and non-strabic binocular disorders published from 1986 to 2012 analysing the MEDLINE, CINAHL, PsycINFO and FRANCIS databases. We admitted original articles about diagnosis of these anomalies in any population. We identified 839 articles and 12 studies were included. The quality of included articles was assessed using the QUADAS-2 tool. Results: The review shows a wide range of clinical signs and cut-off points between authors. Only 3 studies (regarding accommodative anomalies) assessed diagnostic accuracy of clinical signs. Their results suggest using the accommodative amplitude and monocular accommodative facility for diagnosing accommodative insufficiency and a high positive relative accommodation for accommodative excess. The remaining 9 articles did not analyze diagnostic accuracy, assessing a diagnosis with the criteria the authors considered. We also found differences between studies in the way of considering patients’ symptomatology. 3 studies of 12 analyzed, performed a validation of a symptom survey used for convergence insufficiency. Conclusions: Scientific literature reveals differences between authors according to diagnostic criteria for accommodative and nonstrabismic binocular dysfunctions. Diagnostic accuracy studies show that there is only certain evidence for accommodative conditions. For binocular anomalies there is only evidence about a validated questionnaire for convergence insufficiency with no data of diagnostic accuracy.

Análisis de la eficacia de la terapia visual en el tratamiento de la exotropía intermitente mediante videooculografía 3D

Objetivo: Evaluar la eficacia del tratamiento en 3 casos de exotropia intermitente (XT(i)) mediante ejercicios de terapia visual, completando la exploración clínica con Videooculografia-30 y evidenciar la potencial aplicabilidad de esta tecnología para dicho propósito. Métodos: Exponemos los cambios ocurridos tras ejercicios de terapia visual en una mujer de 36 años con XT(i) de -25 dioptrías prismáticas (dp) de lejos y 18 dp de cerca; Un niño de 10 años de edad con 8 dp de XT(i) en posición primaria, asociados a +6 dp de hipotropia izquierda; y un hombre de 63 años con XT(i) de 6 dp en posición primaria asociada a +7 dp de hipertropia derecha. Todos los pacientes presentaron buena agudeza visual corregida en ambos ojos. La inestabilidad de la desviación ocular se evidenció mediante análisis de VOG-30, revelando la presencia de components verticales y torsionales. Se realizaron ejercicios de terapia visual, incluyendo diferentes tipos de ejercicios de vergencias, acomodación y percepción de la diplopía. Resultados: Tras la terapia visual se obtuvieron excelentes rangos de vergencias fusionales y de punto próximo de convergencia («hasta la nariz»). El examen mediante VOG-3D (Sensoro Motoric lnstruments, Teltow, Germany) confirmó la compensación de la desviación con estabilidad del alineamiento ocular. Se observó una significativa mejora después de la terapia en los components verticals y torsionales, lo cuales se hicieron más estables. Los pacientes se mostraron muy satisfechos de los resultados obtenidos. Conclusión: La VOG-3D es una técnica útil para dotamos de un método objetivo de registro de la compensación y estabilidad de la desviación ocular después de realizar ejercicios de terapia visual en casos de XT(i), ofreciéndonos un detallado análisis de la mejoría de los components verticales y torsionales.