An orthoptist-led, time-of-school-entry vision screening service is ideal for successful childhood vision screening and is, thus, a valuable source of information regarding the prevalence of common visual problems among children.
ERG abnormalities together with antiretinal antibodies suggest a paraneoplastic origin like melanomaassociated retinopathy (MAR). In our patient with no antiretinal antibodies and a normal ERG, MAR syndrome is unlikely. 6 The vitelliform lesions of our patient may resemble other disorders with vitelliform lesions like acute exudative polymorphous vitelliform maculopathy 7 (AEPVM) or adult vitelliform macular dystrophy 8 (AVMD). Both diseases show normal ERG and no antiretinal antibodies. However in contrast to our case, AVMD patients show a solitary subretinal lesion in the fovea. AEPVM consists of bilateral vitelliform lesions and visual loss, which resolve within several months, accompanied by subnormal ERG and EOG. Neither one has associations with ocular or systemic malignities.Fundus configuration as well as the course of the mentioned diseases are quite different from that of our patient.Although our patient had a normal ERG and no antiretinal antibodies, the association of vitelliform lesions with metastatic choroidal melanoma suggests a paraneoplastic origin.The pathogenesis of paraneoplastic retinopathy is poorly understood. Further studies are required for a better understanding of the aetiology.
Sir, Pain response and follow-up of patients undergoing panretinal laser photocoagulation (PRP) with reduced exposure times I read with interest the paper by Al-Hussainy et al. 1 In their paper, the authors concluded that reducing the exposure time and increasing the laser power while performing PRP can reduce pain significantly without compromising the long-term results of the treatment.It has been our experience that using scatter retinal laser application with shorter duration setting, as described by the author, yields uneven and much smaller sized scars than the traditionally used longer duration laser setting (the scars have less than intended treatment spot size and with larger untreated retina in between). This can be explained by both insufficient time available for heat conduction into surrounding tissue to cause thermal damage and the Gaussian distribution of the energy across laser beam. 2 Additionally, it can be calculated from data provided by the authors that with reduced exposure setting, the mean laser energy necessary to achieve visible retinal reaction was much less (0.02 ms  489 mW ¼ 9.78 mJ vs 0.1 ms  178 mW ¼ 17.8 mJ) and, hence, expectedly lesser associated tissue damage and subsequent scaring.Although the immediate visible retinal burns were apparently similar, the authors failed to mention the difference in the scar appearances between the groups in their study. In our experience, spaced smaller retinal scars produced by shorter duration laser setting are usually indicative of inadequate treatment and necessitates further laser application to control the proliferative process.As the end point of their study has not been clarified, it is difficult to gain any knowledge regarding the time scale as well as the number of the sessions that were required to achieve regression of neovasculrization in their series and conclude effectiveness of their setting, compared with any published data.Finally, their treatment setting using Volks lens, 300-mm spot size and high power requirement (mean 0.47 W, no SD was mentioned) is likely to breach laser safety to the anterior segment, where the laser energy fluence is much higher than the retinal plane due to smaller laser beam size at the corneal plane
Aims This paper describes a novel test of colour vision using a standard personal computer, which is simple and reliable to perform. Methods Twenty healthy individuals with normal colour vision and 10 healthy individuals with a red/green colour defect were tested binocularly at 13 selected points in the CIE (Commission International d'Eclairage, 1931) chromaticity triangle, representing the gamut of a computer monitor, where the x, y coordinates of the primary colour phosphors were known. Results The mean results from individuals with normal colour vision were compared to those with defective colour vision. Of the 13 points tested, five demonstrated consistently high sensitivity in detecting colour defects. Conclusion The test may provide a convenient method for classifying colour vision abnormalities.
Purpose: To report two cases of spoke-like intraocular lens (IOL) opacification that resembles pseudoexfoliation of the crystalline lens. Methods: Case series presentation. Results: Patient 1 developed a circle of spoke-like opacification on the anterior IOL surface7 years after phacoemulsification. Patient 2 had paracentral anterior surface IOL opacification 18 months after cataract extraction and clinical pseudoexfoliation in the fellow eye. Conclusion: Spoke-like anterior IOL opacification should raise the suspicion of pseudoexfoliation syndrome.
Sir, Surgical management of WEBINO syndrome following pineal gland lesion removal WEBINO (walled-eyes bilateral internuclear ophthalmolplegia) is a rare clinical syndrome of exotropia with bilateral INO associated with the loss of fusional vergence. It is usually caused by demyelination or ischaemic damage to the medial longitudinal fasciculus and medial rectus subnucleus of the oculomotor nerve, 1 hence spontaneous improvement is common. We report our experience in a persistent case following pineal tumour removal. Case reportA 13-year-old boy was admitted for persistent headache and double vision for 6 weeks. His ocular findings were BCVA 6/5 each eye; bilateral papilloedema; minimal esophoria for near, esotropia for distance, and good stereopsis (see Table 1a). MRI scan showed a cystic tumour arising from the pineal gland, obliterating the aqueduct of Sylvius (Figure 1). He underwent excision of the lesion (histopathology showed papillary tumour) and received supplemental radiotherapy. He was referred back to us for persistent diplopia. He still had BCVA of 6/5 in each eye, but now showed marked alternating exotropia of 470 D dioptres. There was limitation of adduction and variable jerk nystagmus of the abducting eye on horizontal saccades (bilateral INO). Downgaze was completely absent and upbeat nystagmus was seen in upgaze. Other orthoptic findings are detailed in Table 1b. The left pupil was semi dilated and nonreactive to light or accommodation. Hess chart showed no adduction of either eye past the midline (Figures 2a and c). His condition failed to resolve over 2 years. As he was unsuitable for adjustable suture, and to optimise the cosmetic and functional outcome a two-staged squint surgery was decided. Initially he underwent bilateral 12 mm lateral rectus muscle recession, followed by bilateral medial rectus muscle resection of 6 mm. Good ocular alignment was achieved post operatively and his diplopia was relieved (Figure 2b). Table 1c shows orthoptic findings 6 months following the surgery. Comment This is the second case reported in the literature of WEBINO onset following surgical intervention. 2 Our case is unique in having combined features of WEBINO, impaired vertical gaze, loss of accommodation, convergence, and some pupillary involvement. This condition should be differentiated from pontine exotropia in which the vertical gaze remains intact. 3 It should also be differentiated from bilateral nuclear third nerve palsy, where variable degree of medial recti paresis, and bilateral ptosis are usually present, and the angle of divergence rarely exceeds 50 D dioptres. 4 Surgical intervention is an option to achieve binocularity in WEBINO syndrome if spontaneous recovery is unlikely. Demonstrable fusion response was reported by Roper-Hall et al 5 in seven out of eight patients, post operatively. In contrast to our case they achieved their results through two stages of unilateral recess-resect procedures. As the angle of squint in WEBINO is very large four-muscle operation is necessary and adjustabl...
Intraoperative retinoscopy with a high plus soft contact lens after phacoemulsification is useful but not accurate in estimating corneal power or axial length of the eye. It should be used cautiously in IOL power calculation as a substitute for standard keratometry or biometry machines when either of these is not available or in error.
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