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Jonathan M. Holmes - One of the best experts on this subject based on the ideXlab platform.
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Innovative techniques for the treatment of adult Strabismus
Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2019Co-Authors: Stacy L. Pineles, Melinda Y. Chang, Jonathan M. Holmes, Ramesh Kekunnaya, Seyhan B. Özkan, Federico G. VelezAbstract:Adult Strabismus is often characterized by surgical complexity. In recent years, several innovative techniques for the management of complex Strabismus have been developed. Strabismus surgeons should understand the indications for various Strabismus surgical techniques in the management of these difficult cases. This workshop describes several new surgical techniques to manage complex Strabismus, including small-angle incomitant and very large-angle Strabismus, torsional diplopia, and restrictive, paralytic, and secondary Strabismus. Because Strabismus surgery is an ever-evolving field, it is important to continue to refine our surgical armamentarium. Strabismus surgeons may wish to add these techniques to their surgical repertoire for select cases.
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Strabismus and binocular diplopia due to advanced glaucomatous visual field loss
Journal of Aapos, 2017Co-Authors: Cheryl L Khanna, Jonathan M. HolmesAbstract:Purpose To describe a small series of patients with glaucoma whose Strabismus and binocular diplopia were due to advanced visual field loss and inability to maintain sensory and motor fusion. Methods This study is an observational case series of 3 patients with binocular diplopia, associated with variable Strabismus, which was due to advanced visual field loss. Results Specific characteristics of the Strabismus associated with advanced glaucomatous visual field loss were a subjective floating second image and marked variability of the prism and alternate cover measurements. Measured hypertropia changed in magnitude over a few seconds or a few minutes (even in 1 patient to a hypotropia), which distinguishes this specific type of Strabismus from other types of comitant or incomitant Strabismus associated with glaucoma. Although visual acuity was 20/400 or better in both eyes in all patients, there was advanced visual field loss in at least one eye. All patients responded poorly to prism, but their symptoms improved with a Bangerter filter applied to the spectacle lens or a MIN occlusion lens to further blur the worse-seeing eye. Conclusions Variable Strabismus associated with advanced glaucomatous visual field loss appears to be a distinct clinical entity that should be distinguished from other types of Strabismus associated with glaucoma. Management of this specific type of Strabismus is limited by inadequate visual field to fuse, analogous to hemifield slide, and therefore prism and/or Strabismus surgery is unlikely to be successful. Primary treatment options include optical blur with Bangerter filters or a MIN occlusion lens although some patients prefer to ignore the second image.
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incidence types and lifetime risk of adult onset Strabismus
Ophthalmology, 2014Co-Authors: Jennifer M Martinezthompson, Jonathan M. Holmes, Nancy N Diehl, Brian G MohneyAbstract:Objective To describe the incidence and types of adult-onset Strabismus in a geographically defined population. Design Retrospectively reviewed population-based cohort. Participants All adult (≥19 years of age) residents of Olmsted County, Minnesota, diagnosed with new-onset adult Strabismus from January 1, 1985, through December 31, 2004. Methods The medical records of all potential cases identified by the resources of the Rochester Epidemiology Project were reviewed. Main Outcome Measures Incidence rates for adult-onset Strabismus and its types. Results Seven hundred fifty-three cases of new-onset adult Strabismus were identified during the 20-year period, yielding an annual age- and gender-adjusted incidence rate of 54.1 cases (95% confidence interval, 50.2–58.0) per 100 000 individuals 19 years of age and older. The 4 most common types of new-onset Strabismus were paralytic (44.2% of cases), convergence insufficiency (15.7%), small-angle hypertropia (13.3%), and divergence insufficiency (10.6%). The incidence of adult-onset Strabismus overall and its 4 most common forms significantly increased with age ( P 0.001 for all), with a peak incidence in the eighth decade of life. The lifetime risk of being diagnosed with adult-onset Strabismus was 4.0% in women and 3.9% in men. Conclusions Paralytic Strabismus was the most common subtype of new-onset adult Strabismus in this population-based cohort. All of the most common forms of adult-onset Strabismus increased with age, especially after the sixth decade of life. Further characterization of Strabismus types found in this study is warranted to better define this disorder.
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Perinatal Risk Factors for Strabismus
International Journal of Epidemiology, 2010Co-Authors: Tobias Emil Torp-pedersen, Heather Allison Boyd, Gry Poulsen, Birgitte Haargaard, J Wohlfahrt, M Melbye, Jonathan M. HolmesAbstract:Background: Little is known about the etiologic factors underlying Strabismus. We undertook a large cohort study to investigate perinatal risk factors for Strabismus, overall and by subtype. Methods: Orthoptists reviewed ophthalmologic records for Danish National Birth Cohort children examined for Strabismus in hospital ophthalmology departments or by ophthalmologists in private practice. Information on perinatal characteristics was obtained from national registers. We used log-linear binomial regression and polytomous logistic regression to estimate risk ratios for Strabismus overall and by Strabismus subtype, respectively. Results: Among 96 842 DNBC children born in Denmark between 1996 and 2003, we identified 8783 children who had been evaluated for Strabismus. Ophthalmologic records were available for 5655 of these children, of whom 1321 were diagnosed with Strabismus. In multivariable analysis, low birth weight, prematurity, large head circumference and presence of congenital abnormalities were all associated with increased risk of Strabismus. Presence of congenital abnormalities was more strongly associated with exotropia than with esotropia. Of 183 exotropia cases, 40 (22%) had a congenital abnormality. While not associated with esotropia, delivery by Cesarean section was associated with exotropia (RR=1.65; 95% CI 1.16-2.34). After adjustment for birth weight, Apgar score at five minutes, multiple gestation and parental ages were not associated with Strabismus overall. Conclusions: Congenital abnormalities, low birth weight, prematurity, and large head circumference were independent risk factors for Strabismus. Differences in risk factors for esotropia and exotropia suggest that Strabismus subtypes may have different underlying etiologies. The proportion of exotropic children with congenital abnormalities suggests that a large angle constant exotropia in an infant should alert physicians to the possibility of a congenital malformation.
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Perinatal risk factors for Strabismus
International journal of epidemiology, 2010Co-Authors: Tobias Emil Torp-pedersen, Jonathan M. Holmes, Heather Allison Boyd, Gry Poulsen, Birgitte Haargaard, J Wohlfahrt, M MelbyeAbstract:BACKGROUND Little is known about the aetiological factors underlying Strabismus. We undertook a large cohort study to investigate perinatal risk factors for Strabismus, overall and by subtype. METHODS Orthoptists reviewed ophthalmological records for Danish National Birth Cohort (DNBC) children examined for Strabismus in hospital ophthalmology departments or by ophthalmologists in private practice. Information on perinatal characteristics was obtained from national registers. We used log-linear binomial regression and polytomous logistic regression to estimate risk ratios for Strabismus overall and by Strabismus subtype, respectively. RESULTS Among 96,842 DNBC children born in Denmark between 1996 and 2003, we identified 8783 children who had been evaluated for Strabismus. Ophthalmological records were available for 5655 of these children, of whom 1321 were diagnosed with Strabismus. In multivariable analysis, low birth weight, prematurity, large head circumference and presence of congenital abnormalities were all associated with increased risk of Strabismus. Presence of congenital abnormalities was more strongly associated with exotropia than with esotropia. Of 183 exotropia cases, 40 (22%) had congenital abnormality. Although not associated with esotropia, delivery by Caesarean section was associated with exotropia (relative risk = 1.65; 95% confidence interval 1.16-2.34). After adjustment for birth weight, Apgar score at 5 min, multiple gestation and parental ages were not associated with Strabismus overall. CONCLUSIONS Congenital abnormalities, low birth weight, prematurity and large head circumference were independent risk factors for Strabismus. Differences in risk factors for esotropia and exotropia suggest that Strabismus subtypes may have different underlying aetiologies. The proportion of exotropic children with congenital abnormalities suggests that a large angle constant exotropia in an infant should alert physicians to the possibility of a congenital abnormality.
M Melbye - One of the best experts on this subject based on the ideXlab platform.
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Perinatal Risk Factors for Strabismus
International Journal of Epidemiology, 2010Co-Authors: Tobias Emil Torp-pedersen, Heather Allison Boyd, Gry Poulsen, Birgitte Haargaard, J Wohlfahrt, M Melbye, Jonathan M. HolmesAbstract:Background: Little is known about the etiologic factors underlying Strabismus. We undertook a large cohort study to investigate perinatal risk factors for Strabismus, overall and by subtype. Methods: Orthoptists reviewed ophthalmologic records for Danish National Birth Cohort children examined for Strabismus in hospital ophthalmology departments or by ophthalmologists in private practice. Information on perinatal characteristics was obtained from national registers. We used log-linear binomial regression and polytomous logistic regression to estimate risk ratios for Strabismus overall and by Strabismus subtype, respectively. Results: Among 96 842 DNBC children born in Denmark between 1996 and 2003, we identified 8783 children who had been evaluated for Strabismus. Ophthalmologic records were available for 5655 of these children, of whom 1321 were diagnosed with Strabismus. In multivariable analysis, low birth weight, prematurity, large head circumference and presence of congenital abnormalities were all associated with increased risk of Strabismus. Presence of congenital abnormalities was more strongly associated with exotropia than with esotropia. Of 183 exotropia cases, 40 (22%) had a congenital abnormality. While not associated with esotropia, delivery by Cesarean section was associated with exotropia (RR=1.65; 95% CI 1.16-2.34). After adjustment for birth weight, Apgar score at five minutes, multiple gestation and parental ages were not associated with Strabismus overall. Conclusions: Congenital abnormalities, low birth weight, prematurity, and large head circumference were independent risk factors for Strabismus. Differences in risk factors for esotropia and exotropia suggest that Strabismus subtypes may have different underlying etiologies. The proportion of exotropic children with congenital abnormalities suggests that a large angle constant exotropia in an infant should alert physicians to the possibility of a congenital malformation.
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Perinatal risk factors for Strabismus
International journal of epidemiology, 2010Co-Authors: Tobias Emil Torp-pedersen, Jonathan M. Holmes, Heather Allison Boyd, Gry Poulsen, Birgitte Haargaard, J Wohlfahrt, M MelbyeAbstract:BACKGROUND Little is known about the aetiological factors underlying Strabismus. We undertook a large cohort study to investigate perinatal risk factors for Strabismus, overall and by subtype. METHODS Orthoptists reviewed ophthalmological records for Danish National Birth Cohort (DNBC) children examined for Strabismus in hospital ophthalmology departments or by ophthalmologists in private practice. Information on perinatal characteristics was obtained from national registers. We used log-linear binomial regression and polytomous logistic regression to estimate risk ratios for Strabismus overall and by Strabismus subtype, respectively. RESULTS Among 96,842 DNBC children born in Denmark between 1996 and 2003, we identified 8783 children who had been evaluated for Strabismus. Ophthalmological records were available for 5655 of these children, of whom 1321 were diagnosed with Strabismus. In multivariable analysis, low birth weight, prematurity, large head circumference and presence of congenital abnormalities were all associated with increased risk of Strabismus. Presence of congenital abnormalities was more strongly associated with exotropia than with esotropia. Of 183 exotropia cases, 40 (22%) had congenital abnormality. Although not associated with esotropia, delivery by Caesarean section was associated with exotropia (relative risk = 1.65; 95% confidence interval 1.16-2.34). After adjustment for birth weight, Apgar score at 5 min, multiple gestation and parental ages were not associated with Strabismus overall. CONCLUSIONS Congenital abnormalities, low birth weight, prematurity and large head circumference were independent risk factors for Strabismus. Differences in risk factors for esotropia and exotropia suggest that Strabismus subtypes may have different underlying aetiologies. The proportion of exotropic children with congenital abnormalities suggests that a large angle constant exotropia in an infant should alert physicians to the possibility of a congenital abnormality.
Tobias Emil Torp-pedersen - One of the best experts on this subject based on the ideXlab platform.
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Perinatal Risk Factors for Strabismus
International Journal of Epidemiology, 2010Co-Authors: Tobias Emil Torp-pedersen, Heather Allison Boyd, Gry Poulsen, Birgitte Haargaard, J Wohlfahrt, M Melbye, Jonathan M. HolmesAbstract:Background: Little is known about the etiologic factors underlying Strabismus. We undertook a large cohort study to investigate perinatal risk factors for Strabismus, overall and by subtype. Methods: Orthoptists reviewed ophthalmologic records for Danish National Birth Cohort children examined for Strabismus in hospital ophthalmology departments or by ophthalmologists in private practice. Information on perinatal characteristics was obtained from national registers. We used log-linear binomial regression and polytomous logistic regression to estimate risk ratios for Strabismus overall and by Strabismus subtype, respectively. Results: Among 96 842 DNBC children born in Denmark between 1996 and 2003, we identified 8783 children who had been evaluated for Strabismus. Ophthalmologic records were available for 5655 of these children, of whom 1321 were diagnosed with Strabismus. In multivariable analysis, low birth weight, prematurity, large head circumference and presence of congenital abnormalities were all associated with increased risk of Strabismus. Presence of congenital abnormalities was more strongly associated with exotropia than with esotropia. Of 183 exotropia cases, 40 (22%) had a congenital abnormality. While not associated with esotropia, delivery by Cesarean section was associated with exotropia (RR=1.65; 95% CI 1.16-2.34). After adjustment for birth weight, Apgar score at five minutes, multiple gestation and parental ages were not associated with Strabismus overall. Conclusions: Congenital abnormalities, low birth weight, prematurity, and large head circumference were independent risk factors for Strabismus. Differences in risk factors for esotropia and exotropia suggest that Strabismus subtypes may have different underlying etiologies. The proportion of exotropic children with congenital abnormalities suggests that a large angle constant exotropia in an infant should alert physicians to the possibility of a congenital malformation.
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Perinatal risk factors for Strabismus
International journal of epidemiology, 2010Co-Authors: Tobias Emil Torp-pedersen, Jonathan M. Holmes, Heather Allison Boyd, Gry Poulsen, Birgitte Haargaard, J Wohlfahrt, M MelbyeAbstract:BACKGROUND Little is known about the aetiological factors underlying Strabismus. We undertook a large cohort study to investigate perinatal risk factors for Strabismus, overall and by subtype. METHODS Orthoptists reviewed ophthalmological records for Danish National Birth Cohort (DNBC) children examined for Strabismus in hospital ophthalmology departments or by ophthalmologists in private practice. Information on perinatal characteristics was obtained from national registers. We used log-linear binomial regression and polytomous logistic regression to estimate risk ratios for Strabismus overall and by Strabismus subtype, respectively. RESULTS Among 96,842 DNBC children born in Denmark between 1996 and 2003, we identified 8783 children who had been evaluated for Strabismus. Ophthalmological records were available for 5655 of these children, of whom 1321 were diagnosed with Strabismus. In multivariable analysis, low birth weight, prematurity, large head circumference and presence of congenital abnormalities were all associated with increased risk of Strabismus. Presence of congenital abnormalities was more strongly associated with exotropia than with esotropia. Of 183 exotropia cases, 40 (22%) had congenital abnormality. Although not associated with esotropia, delivery by Caesarean section was associated with exotropia (relative risk = 1.65; 95% confidence interval 1.16-2.34). After adjustment for birth weight, Apgar score at 5 min, multiple gestation and parental ages were not associated with Strabismus overall. CONCLUSIONS Congenital abnormalities, low birth weight, prematurity and large head circumference were independent risk factors for Strabismus. Differences in risk factors for esotropia and exotropia suggest that Strabismus subtypes may have different underlying aetiologies. The proportion of exotropic children with congenital abnormalities suggests that a large angle constant exotropia in an infant should alert physicians to the possibility of a congenital abnormality.
Fatema F. Ghasia - One of the best experts on this subject based on the ideXlab platform.
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Abnormal fixational eye movements in Strabismus
The British journal of ophthalmology, 2017Co-Authors: Fatema F. Ghasia, Jorge Otero-millan, Aasef G. ShaikhAbstract:Introduction Fixational saccades are miniature eye movements that constantly change the gaze during attempted visual fixation. Visually guided saccades and fixational saccades represent an oculomotor continuum and are produced by common neural machinery. Patients with Strabismus have disconjugate binocular horizontal saccades. We examined the stability and variability of eye position during fixation in patients with Strabismus and correlated the severity of fixational instability with Strabismus angle and binocular vision. Methods Eye movements were measured in 13 patients with Strabismus and 16 controls during fixation and visually guided saccades under monocular viewing conditions. Fixational saccades and intersaccadic drifts were analysed in the viewing and non-viewing eye of patients with Strabismus and controls. Results We found an increase in fixational instability in patients with Strabismus compared with controls. We also found an increase in the disconjugacy of fixational saccades and intrasaccadic ocular drift in patients with Strabismus compared with controls. The disconjugacy was worse in patients with large-angle Strabismus and absent stereopsis. There was an increase in eye position variance during drifts in patients with Strabismus. Our findings suggest that both fixational saccades and intersaccadic drifts are abnormal and likely contribute to the fixational instability in patients with Strabismus. Discussion Fixational instability could be a useful tool for mass screenings of children to diagnose Strabismus in the absence of amblyopia and latent nystagmus. The increased disconjugacy of fixational eye movements and visually guided saccades in patients with Strabismus reflects the disruption of the fine-tuning of the motor and visual systems responsible for achieving binocular fusion in these patients.
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cross coupled eye movement supports neural origin of pattern Strabismus
Investigative Ophthalmology & Visual Science, 2015Co-Authors: Fatema F. Ghasia, Aasef G. Shaikh, Jonatha P Jacobs, Mark F WalkeAbstract:Pattern Strabismus describes horizontal Strabismus that is vertically incomitant. Historically, pattern Strabismus is attributed to the oblique muscle dysfunction.1 Little is known about the etiology of isolated primary oblique overaction. Clinical observations have suggested that a torsional offset due to loss of fusion might alter the direction of the recti muscle action, hence causing the pattern Strabismus.2,3 For example, excyclotorsion of the globe will result in medial rectus becoming a partial elevator leading to overelevation during adduction, and inferior rectus becoming a partial adductor and superior rectus a partial abductor causing a V-pattern. Correlation between the fundus torsion and static eye fixation in patients with pattern Strabismus further supported the viewpoint emphasizing altered recti pull.4 Subsequent studies suggested that oblique overaction is a clinical description rather than an actual mechanism of the pattern Strabismus.5 Static malposition or dynamic instability of the extraocular muscle pulleys in patients with craniofacial dysmorphism causes pattern Strabismus.6 Neurophysiology experiments in nonhuman primates reared with alternate monocular occlusion suggested a neural basis for pattern Strabismus.7–9 These animals had cross-axis eye movements; for example, intended horizontal saccades were associated with cross-axis vertical eye movement and vice versa. Neural recordings from ocular motor neurons have shown that horizontal cross-coupled movement corresponds to increased firing rate of horizontal motor neurons, whereas vertical cross-coupled movement corresponds to increased firing rate of vertical motor neurons. The presence of the neural correlate of cross-coupled movements in animal models suggested that abnormal central innervations might cause the pattern Strabismus.7–9 These principles describing the pathophysiology of pattern Strabismus are based on subjective clinical impression, orbital imaging, and neurophysiology in animal models. There is a paucity of investigations of objective eye movement assessments in human patients with pattern Strabismus. We aimed to quantify eye movements and fundus torsion in patients with infantile and late onset pattern Strabismus without craniofacial abnormalities. We hypothesized that overaction of the oblique muscles, as previously predicted in pattern Strabismus, should be reflected in the static misalignment as well as dynamic disconjugacy of saccades. For example, inferior oblique overaction should cause an upward deviation of the adducting eye during a horizontal saccade, and the oblique upward saccade would have greater amplitude in the adducting than the abducting eye. It is unknown whether patients with pattern Strabismus have cross-coupling of the eye movement, as described in the nonhuman primate model. If, indeed, animal models are analogous to the patients with pattern Strabismus, we should also see cross-coupled eye movements in these patients. We quantitatively assessed the presence of cross-coupling of saccades in patients with pattern Strabismus. There are several possible explanations for cross-coupled responses. Mechanical factors, such as an abnormal fundus torsion or inappropriate innervations, and consequent cross-talk between horizontal and vertical saccade generators, can result in cross-coupling. The torsion hypothesis predicts a correlation between the severity of cross-coupled saccades and the static fundus torsion. According to the torsion hypothesis, patients with greater static torsion will have larger cross-coupling of saccades. The absence of such a correlation would suggest that abnormal static torsion is not the exclusive cause of pattern Strabismus.
J Wohlfahrt - One of the best experts on this subject based on the ideXlab platform.
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Perinatal Risk Factors for Strabismus
International Journal of Epidemiology, 2010Co-Authors: Tobias Emil Torp-pedersen, Heather Allison Boyd, Gry Poulsen, Birgitte Haargaard, J Wohlfahrt, M Melbye, Jonathan M. HolmesAbstract:Background: Little is known about the etiologic factors underlying Strabismus. We undertook a large cohort study to investigate perinatal risk factors for Strabismus, overall and by subtype. Methods: Orthoptists reviewed ophthalmologic records for Danish National Birth Cohort children examined for Strabismus in hospital ophthalmology departments or by ophthalmologists in private practice. Information on perinatal characteristics was obtained from national registers. We used log-linear binomial regression and polytomous logistic regression to estimate risk ratios for Strabismus overall and by Strabismus subtype, respectively. Results: Among 96 842 DNBC children born in Denmark between 1996 and 2003, we identified 8783 children who had been evaluated for Strabismus. Ophthalmologic records were available for 5655 of these children, of whom 1321 were diagnosed with Strabismus. In multivariable analysis, low birth weight, prematurity, large head circumference and presence of congenital abnormalities were all associated with increased risk of Strabismus. Presence of congenital abnormalities was more strongly associated with exotropia than with esotropia. Of 183 exotropia cases, 40 (22%) had a congenital abnormality. While not associated with esotropia, delivery by Cesarean section was associated with exotropia (RR=1.65; 95% CI 1.16-2.34). After adjustment for birth weight, Apgar score at five minutes, multiple gestation and parental ages were not associated with Strabismus overall. Conclusions: Congenital abnormalities, low birth weight, prematurity, and large head circumference were independent risk factors for Strabismus. Differences in risk factors for esotropia and exotropia suggest that Strabismus subtypes may have different underlying etiologies. The proportion of exotropic children with congenital abnormalities suggests that a large angle constant exotropia in an infant should alert physicians to the possibility of a congenital malformation.
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Perinatal risk factors for Strabismus
International journal of epidemiology, 2010Co-Authors: Tobias Emil Torp-pedersen, Jonathan M. Holmes, Heather Allison Boyd, Gry Poulsen, Birgitte Haargaard, J Wohlfahrt, M MelbyeAbstract:BACKGROUND Little is known about the aetiological factors underlying Strabismus. We undertook a large cohort study to investigate perinatal risk factors for Strabismus, overall and by subtype. METHODS Orthoptists reviewed ophthalmological records for Danish National Birth Cohort (DNBC) children examined for Strabismus in hospital ophthalmology departments or by ophthalmologists in private practice. Information on perinatal characteristics was obtained from national registers. We used log-linear binomial regression and polytomous logistic regression to estimate risk ratios for Strabismus overall and by Strabismus subtype, respectively. RESULTS Among 96,842 DNBC children born in Denmark between 1996 and 2003, we identified 8783 children who had been evaluated for Strabismus. Ophthalmological records were available for 5655 of these children, of whom 1321 were diagnosed with Strabismus. In multivariable analysis, low birth weight, prematurity, large head circumference and presence of congenital abnormalities were all associated with increased risk of Strabismus. Presence of congenital abnormalities was more strongly associated with exotropia than with esotropia. Of 183 exotropia cases, 40 (22%) had congenital abnormality. Although not associated with esotropia, delivery by Caesarean section was associated with exotropia (relative risk = 1.65; 95% confidence interval 1.16-2.34). After adjustment for birth weight, Apgar score at 5 min, multiple gestation and parental ages were not associated with Strabismus overall. CONCLUSIONS Congenital abnormalities, low birth weight, prematurity and large head circumference were independent risk factors for Strabismus. Differences in risk factors for esotropia and exotropia suggest that Strabismus subtypes may have different underlying aetiologies. The proportion of exotropic children with congenital abnormalities suggests that a large angle constant exotropia in an infant should alert physicians to the possibility of a congenital abnormality.
