SUMMARY Eighty-four children with at least 2 lines of amblyopia were treated with the CAM vision stimulator. 91 % of the children who had received no previous amblyopia therapy showed improvement, 73 % achieving 6/12 vision or better. Of children in whom previous occlusion therapy had failed 73 8 % improved. The treatment appears to be effective, rapid, and well tolerated. Our initial impressions have been sufficiently favourable to stimulate further clinical evaluation.Amblyopia probably affects between 4%1 and 7%2 of children in this country. Our understanding of the pathophysiology of amblyopia has blossomed over the last 20 years,3-5 yet the treatment has remained essentially unchanged since 1746..6 Occlusion continues to be the mainstay of treatment, and though it is recognised to be both psychologically and educationally disruptive, alternative methods have not as yet proved sufficiently effective to supplant it.' Recent reports of experience with a new, physiologically based, form of treatment have been encouraging.89 We report an independent, preliminary assessment of this treatment.
Materials and methodsChildren attending the Orthoptic Departments of the Birmingham and Midland Eye Hospital and the Birmingham Childrens' Hospital were included in the study if they had 2 or more lines of amblyopiaas measured by linear optotypes-and were able to co-operate with treatment. All children had a full ophthalmological examination, and no child with anterior segment or fundus pathology commensurate with the visual acuity was included.All the children were refracted under cyclopentolate cycloplegia, and full optical correction was prescribed. When the spectacles had been worn for at least 1 week, treatment was started. Each child was shown a series of high-contrast square-wave gratings of different spatial frequencies, and treat- The children had a full orthoptic examination at the beginning and end of treatment, and the visual acuity was measured before and after each session. Four weeks after treatment had been discontinued the children had a further orthoptic examination.Between sessions the children received no additional treatment.
Stereoacuity has been reported to decrease significantly in the seventh decade of life. Could this decrease be due to a reduction of retinal illuminance in the ageing eye? In this study, we used a more rigorous psychophysical procedure than that used previously, on 35 subjects, aged 21-67 years, to determine if the reported effect of age on stereoacuity could be replicated. We also compared the stereoacuity of 15 healthy young adults under normal and reduced retinal illuminance. A forced-choice algorithm was used to improve the accuracy of measurements. Results suggest that the reduced retinal illuminance resulting from normal ageing is not the cause of the decreased stereoacuity found with ageing.
Complications of peribulbar anaesthesia include retrobulbar haemorrhage, globe perforation and brainstem anaesthesia. Therefore, this study took measurements relating the proximity of medial canthus to the optic nerve and also the safe angle between orbit and globe using 200 multiplanar reconstructed computed tomography (CT) images of the orbit. The principal results show that in 1.5% of the sample, the optic nerve is within 20 mm of the medial canthus, with a minimum distance of 15 mm. One% have a safe angle of 10 degrees or less between bone and globe. None of the demographic data, nor axial length were predictive of these results. We have shown that there are a minority of patients with unusual orbital anatomy. This places them at a theoretical higher risk of complications. These cases are not currently predicted by measured data.
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