Background-It has been postulated that eye movement disorders in chronic progressive external ophthalmoplegia (CPEO) have a neurological as well as a myopathic component to them.
The psychological impact of strabismus does not appear to be related to the patient's angle of deviation, age, sex, presence of diplopia, visual acuity or direction of deviation. Larger studies are required using strabismus specific tools for evaluating psychological impact to further investigate these findings.
Purpose:The recent pandemic has identified the need for telemedicine assessment of ophthalmology patients. A vital component of such assessment is visual acuity (VA) measurement. The aim of this study was to determine the feasibility and reliability of computerised 'at home' VA measurements using COMPlog software.
Methods:A Bland Altman method comparison study of worse eye 'in clinic' and 'at home' orthoptist-supervised COMPlog computerised VA measurements. Subjects underwent gold standard semi-automated computerised test and retest logMAR VA measurements on their habitually corrected worse eye both 'in clinic' and 'at home.' The orthoptist ran the test from the eye clinic with the patient viewing a secondary PC monitor either in the same clinic room or at home. A screen sharing voice and video conferencing application and standard consumer IT hardware were employed to present the test optotypes in the patient's home.Results: 23 paediatric and 13 adult patients with a range of ocular diseases and worse eye visual acuities were included (range -0.14 to 1.06 logMAR). No significant bias was found between 'in clinic' and 'at home' measurements (mean -0.01 logMAR and 95% confidence interval -0.03, 0.00 logMAR). Test-retest variability of 'in clinic,' 'at home' and 'in clinic' versus 'at home' measurements were within normal reported ranges at 0.12 logMAR (6 ETDRS letters) or less.
Conclusion:Remote home VA testing performed by an eye care professional using a semi-automated VA measurement program and video conferencing application provided unbiased measurements with acceptable test-retest reliability. Home testing was both feasible and acceptably reliable in appropriately equipped patients.
Two patients (68 and 71 years, both female) with sight threatening, active Graves orbitopathy but low clinical activity score underwent MRI scans before and after intravenous corticosteroid treatment. Two MRI techniques, short-term inversion recovery and nonechoplanar diffusion-weighted imaging, were used. Apparent diffusion coefficient values reduced in patient 1 who had successful medical treatment and remained elevated in patient 2 who had an inadequate treatment response. Nonechoplanar diffusion-weighted imaging provided a quantitative measure of treatment response by calculation of the apparent diffusion coefficient. The novel use of nonechoplanar diffusion-weighted imaging for monitoring treatment response in Graves orbitopathy is illustrated but requires further validation.
Background/goal: Hypertrophic pachymeningitis is a rare chronic inflammatory disorder characterized by marked fibrous thickening of the cerebral and/or spinal dura mater. This condition has largely been reported in adults, but there are very few reports in children. Methods: We describe a 14-year-old boy with idiopathic hypertrophic pachymeningitis, who presented with deteriorating vision on a background of severe headache. We evaluated pediatric cases of hypertrophic pachymeningitis and compared treatments and their relation to outcomes. Results: There are only eleven pediatric cases of hypertrophic pachymeningitis reported in the literature. In the patients treated with steroids either at presentation or subsequent relapses, a good response was reported. In the cases with delayed initiation of steroid treatment, this was often related to an incomplete recovery. In our patient, this delay may have contributed to his poor visual outcome. Conclusions: Early initiation of steroid treatment in children with idiopathic hypertrophic pachymeningitis may improve outcomes.
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