Clinical characteristics of CHARGE syndrome.
CHARGE syndrome, first described by Pagon, was named for its six major clinical features. They are: coloboma of the eye, heart defects, atresia of the choanae, retarded growth and development including CNS anomalies, genital hypoplasia and/or urinary tract anomalies, and ear anomalies and/or hearing loss. We experienced three cases of CHARGE syndrome who displayed ocular coloboma, heart defects, retarded growth and development, and external ear anomalies, and we also review the previously reported literature concerning CHARGE syndrome. (+info)
Ophthalmological follow up of preterm infants: a population based, prospective study of visual acuity and strabismus.
BACKGROUND/AIMS: Prematurely born infants are known to have an increased rate of ophthalmological morbidity. The aim of the present study was to investigate visual acuity and ocular alignment in a population of preterm infants in a geographical area, in infants with and without retinopathy of prematurity (ROP). METHODS: A prospective population based study of ophthalmological status of preterm infants with a birth weight of 1500 g or less was performed during 3.5 years, with examinations at 6, 18, 30, and 42 months of corrected age. Visual acuity was tested using linear optotypes. Multiple regression analyses were used to analyse independent risk factors for poor vision and strabismus. RESULTS: Poor vision (< 0.3) was detected in 2.5% (6/237) of the children. Of these, only two (0.8%) had a severe visual impairment (< 0.1). Strabismus occurred in 13.5% (31/229). Children with cryotreated ROP and neurological complications ran the highest risk of poor vision and strabismus, according to multiple regression analysis. Among children without a history of ROP or neurological complications, 34% had a visual acuity < 0.7 and 5.9% had strabismus, compared with 61% and 22%, respectively, among the children with ROP or neurological complications. CONCLUSIONS: The overall incidence of subnormal vision and strabismus in children born prematurely was higher than in a full term population of the same age. On the basis of this study, follow up of all preterm infants screened for ROP is recommended and general guidelines are suggested. (+info)
Metabolic mapping of suppression scotomas in striate cortex of macaques with experimental strabismus.
Misalignment of the ocular axes induces double vision and rivalry. To prevent these unpleasant sensations, most subjects fixate preferentially with one eye and suppress entirely the deviating eye or else suppress portions of the visual field of either eye. To explore the mechanism of visual suppression, a divergent strabismus (exotropia) was induced in six normal, adult Macaca fascicularis by disinserting the medial rectus muscles. After 4-8 weeks, each animal was chaired to measure its exotropia and to determine its ocular fixation preference. Five of the monkeys developed a clearly dominant eye. It was injected with [(3)H]proline. Alternate sections from flat-mounts of striate cortex were then processed either for autoradiography to label the ocular dominance columns or for cytochrome oxidase (CO) to assess local metabolic activity. Two CO patterns were seen, often in the same cortex. The first consisted of thin dark columns alternating with wide pale columns. This pattern arose from reduced CO activity in the suppressed eye's monocular core zones and both eyes' binocular border strips. The second pattern consisted of thin pale bands from reduced metabolic activity in both eyes' border strips. The thin dark-wide pale CO pattern was more widespread in the three animals with a strong fixation preference. The dark CO columns usually fit in register with the ocular dominance columns of the fixating eye, suggesting that perception was suppressed in the deviating eye. In most animals, however, the correlation switched in peripheral cortex contralateral to the deviating eye, implying local suppression of the fixating eye's temporal retina (beyond 10 degrees), as reported in humans with divergent strabismus. In the two animals with a weak fixation preference, pale border strips were found within the central visual field representation in both hemispheres. This CO pattern was consistent with alternating visual suppression. These experiments provide the first anatomical evidence for changes in cortical metabolism that can be correlated with suppression scotomas in subjects with strabismus. (+info)
Waardenburg syndrome with anisocoria and exotropia.
A case of Waardenburg syndrome with unusual features such as anisocoria, exotropia is reported. (+info)
Conditions of perceptual selection and suppression during interocular rivalry in strabismic and normal cats.
Presenting the two eyes with incongruent stimuli leads to the phenomenon of interocular rivalry. At any given time, one of the stimuli is perceptually suppressed in order to avoid double vision. In squinting subjects, rivalry occurs permanently also for congruent stimuli because of developmental rearrangement of cortical circuitry. In this study, we have investigated the dynamics and stimulus dependence of rivalry in six esotropic, four exotropic and three non-strabismic cats. As an indicator for perception, we used optokinetic nystagmus that was induced by moving gratings. The esotropic cats were tested for their visual acuity by means of a jumping stand procedure. The results show that one eye can dominate perception even if both eyes have equal visual acuity and are presented with stimuli of equal contrast. Strong eye dominance asymmetry was found in all but one of the tested cats. Notably, all three of the normal cats showed a clear asymmetry in perceptual selection. Measurements with varying contrast and velocity of the stimuli revealed that the influence of these parameters on perceptual selection was independent of the presence of strabismus. In all cats, the time during which a given eye dominated perception increased with the contrast and decreases with the velocity of the stimulus presented to this eye. (+info)
Rapid anatomical plasticity of horizontal connections in the developing visual cortex.
Experience can dramatically alter the responses of cortical neurons. During a critical period in the development of visual cortex, these changes are extremely rapid, taking place in 2 d or less. Anatomical substrates of these changes have long been sought, primarily in alterations in the principal visual input from the thalamus, but the significant changes that have been found take 1 week. Recent results indicate that the initial physiological changes in the cortical circuit take place outside of the primary input layer. We now find that rapid plasticity of binocular responses in the upper layers of cortex is mirrored by similarly rapid anatomical changes in the horizontal connections between ocular dominance columns in the upper layers, which reorganize within 2 d. (+info)
Anomalies of binocular function in patients with longstanding asymmetric keratoconus.
AIMS: To study binocular function in patients with longstanding asymmetric keratoconus. METHODS: In 20 adult patients with longstanding asymmetric keratoconus managed with a scleral contact lens a full clinical and orthoptic assessment was performed with and without the scleral contact lens in the poorer eye. RESULTS: All 20 patients had a corrected acuity of at least 6/9 in their better eye. With the scleral lens in situ the acuity of the poorer eye ranged from 6/6 to 6/60 and without the lens from 6/18 to hand movements. Patients were aged from 18 to 68 years and had worn a scleral contact lens for between 3 and 106 months. Without the contact lens in their poorer eye all patients had a small exotropia and all showed suppression, with the exception of one patient who had a right hypertropia with diplopia. With the scleral lens in situ 12 patients had an exophoria or esophoria, six a microexotropia, and two a manifest exotropia with suppression. CONCLUSIONS: Binocular function breaks down in some adult patients with longstanding asymmetric keratoconus. This is probably caused by longstanding unilateral visual deprivation. There are similarities to the breakdown of binocular function seen in some patients with a longstanding dense unilateral adult onset cataract who can develop intractable diplopia following cataract surgery. (+info)
Saccadic binocular coordination in alternating exotropia.
We studied the coordination of binocular eye movements in human subjects with alternating exotropia (divergent strabismus). Binocular saccades were recorded in six subjects during binocular and monocular viewing. Subjects were instructed to make saccades between two continuously lit targets (LED's) presented in an isovergence array (with the straight-ahead target 130 cm from the eyes) in a dimly lit room. For saccades up to 20 degrees amplitude, there were no large differences in the dynamics of the saccades between control and exotropic subjects. However, for larger amplitudes subjects frequently alternated the eye of fixation during saccades. That is, subjects fixated the left target with the left eye and the right target with the right eye. The alternation in eye fixation at the end of the saccade was taken into account in the programming of the saccades. The amplitudes of the alternating saccades were approximately equal to the target amplitude minus the strabismus angle. We conclude that for those saccades where alternation occurs, there is not only a change in the eye of fixation, but also a change in the target representation provided by either eye. Thus, in this group of strabismic patients, saccades may be programmed in a retina-centered coordinate system, if we assume that for making a saccade to a new target in the contralateral visual field its representation on the temporal retinal field of the currently fixating eye is suppressed and the retinotopic target information is derived from the non-fixating eye. In executing the saccade, the non-fixating eye automatically becomes the fixating eye. (+info)