The aim of this study was to describe the orthoptic and ophthalmological findings in schoolchildren with asthenopia, to correlate them with asthenopic symptoms and to evaluate the effect of treatment. One hundred and twenty schoolchildren, aged 6-16 years, were included in the study. They were all referred by school nurses, for asthenopic symptoms. An orthoptic and ophthalmological assessment was performed. The main diagnoses were accommodative insufficiency, convergence insufficiency, refractive errors, and latent strabismus. Reading glasses could help 98% of the schoolchildren with reduced accommodation, and 94% of the children with refractive errors and heterophorias were helped with appropriate spherical, cylindrical and prism correction. Convergence exercise reduced the symptoms in all patients with convergence insufficiency. Ninety-three percent of all 120 schoolchildren were symptom free 3-6 month after treatment had started. By an orthoptic and ophthalmological examination abnormalities in schoolchildren with asthenopia related to visual problems can be identified. Most of the children were relieved from their symptoms by giving adequate glasses, convergence exercises and surgery.

Asthenopia was significantly associated with uncorrected visual acuity < or = 0.65 and with myopia (spherical equivalent -0.50 D or less) among Swedish schoolchildren.

In an experimental study four levels of oculomotor load were induced binocularly. Trapezius muscle activity was measured with bipolar surface electromyography and normalized to a submaximal contraction. Twenty-eight subjects with a mean age of 29 (range 19-42, std 8) viewed a high-contrast fixation target for four 5-min periods through: (i) -3.5 dioptre (D) lenses; (ii) 0 D lenses; (iii) individually adjusted prism D lenses (1-2 D base out); and (iv) +3.5 D lenses. The target was placed close to the individual's age-appropriate near point of accommodation in conditions (i-iii) and at 3m in condition (iv). Each subject's ability to compensate for the added blur was extracted via infrared photorefraction measurements. A bitwise linear regression model was fitted on group level with eye-lens refraction on the x-axis and normalized trapezius muscle EMG (%RVE) on the y-axis. The model had a constant level of trapezius muscle activity--where subjects had not compensated for the incurred defocus by a change in eye-lens accommodation--and a slope, where the subjects had compensated. The slope coefficient was significantly positive in the -D (i) and the +D blur conditions (iv). During no blur (ii) and prism blur (iii) there were no signs of relationships. Nor was there any sign of relationship between the convergence response and trapezius muscle EMG in any of the experimental conditions. The results appear directly attributable to an engagement of the eye-lens accommodative system and most likely reflect sensorimotor processing along its reflex arc for the purpose of achieving stabilization of gaze.

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.

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 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.

Background:It is not known how accommodative insufficiency influences reading performance. Methods: Reading eye movements were recorded before and after treatment for accommodative insufficiency in 12 school children (eight to 16 years). During the eight-week treatment period all subjects wore a +1.00 D addition when reading. Results: Large variations in reading patterns were found. Despite successful accommodative treatment (p < 0.001), no correlation was found to suggest improved reading velocity.

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.