Visual improvement of an amblyopic eye in an adult patient after visual loss in the non-amblyopic eye

BACKGROUND: The sensitive period for a successful amblyopia treatment is limited to the age of 11 to 13 years. HISTORY AND SIGNS: We present a 60-year-old patient with complete visual loss on his dominant eye after retinal arterial occlusion. The fellow eye had a known severe amblyopia with a corrected visual acuity of 0.1. THERAPY AND OUTCOME: After retinoscopy the patient received a full correction for his amblyopic eye and the vision increased to 0.25. After three months follow-up visual acuity was 0.5 for single optotypes. CONCLUSIONS: Even in adulthood a attempt at full correction of an amblyopic eye after loss of vision in the dominant eye should be performed for optimising the quality of life.     

Visual improvement during psychophysical training in an adult amblyopic eye following visual loss in the contralateral eye

Background Recent publications have demonstrated neural plasticity in adult amblyopes subjected to psychophysical training based on perceptual learning. The purpose of this case report is to present rarely available prospective data of visual acuity development in a strabismic amblyope undergoing psychophysical training and pleoptic treatment after loss of function of the non-amblyopic eye.Methods The design is a prospective, observational and interventional case report. Visual acuity was tested monthly, with constant optical correction. The 60-year-old female patient participated in a psychophysical training implemented in our laboratory, and in pleoptic treatment.Results Slow functional improvement of the amblyopic eye was observed during a period of 10 months, both in the tests used for training and in visual acuity: single optotypes increased by 4 chart lines, crowded optotypes by 2–3 lines.Conclusions To our knowledge, this is the first report of the new approach of perceptual learning in an adult amblyope after loss of vision in the contralateral eye. Our results represent further evidence that the visual system of adult amblyopes preserves a certain degree of neural plasticity, whether spontaneous or enhanced by training. Furthermore, that plasticity in adults is limited, and early diagnosis and treatment of amblyopia must remain the primary goal.     

Visual improvement in amblyopia after visual loss in the dominant eye

Partial recovery from amblyopia can occur in animals if the the influence from the dominant eye is removed. This report describes a human, adult amblyope who lost central vision in the dominant eye, and regained useful vision in the amblyopic eye.     

Training the adult amblyopic eye with "perceptual learning" after vision loss in the non-amblyopic eye

We recently reported acuity development in the amblyopic eye of a 60-year-old patient after loss of vision in her non-amblyopic eye. Here, we focus on the training that we implemented, based on new insights from psychophysical procedures aiming at functional visual improvement of adults ("perceptual learning"). We alternately used the following procedures: grating acuity (Teller-Cards); contrast sensitivity (Vistech-Charts); two spatial localization tests (vertical alignment, pointing); and labyrinth patterns for a eye-hand coordination exercise. One month without intervention was followed by six months of training and two blocks of pleoptic treatment. Clinical parameters were assessed monthly. Besides acuity gain, we observed enhanced grating resolution and contrast sensitivity, decreased alignment distortions, pointing shifts, mainly after pleoptics, and more efficient labyrinth tracing. A questionnaire reflected the patient's perception of the changes. These data confirm the plasticity of the adult amblyopic system, be it spontaneous due to the loss of the non-amblyopic eye or caused by the intervention or both. Further experience is necessary to isolate the role of the intervention. Our results also underline the limitation of adult plasticity, emphasizing the importance of early diagnosis and treatment of amblyopia.     

Visual loss in one eye after spinal surgery

PURPOSE: To report a patient who developed an unusual combination of central retinal artery occlusion with ophthalmoplegia following spinal surgery in the prone position. METHODS: A 60-year-old man underwent a cervical spinal surgery in the prone position. Soon after recovery he could not open his right eye and had ocular pain due to the general anesthesia. Upon examination, we determined that he had a central retinal artery occlusion with total ophthalmoplegia. RESULTS: Despite medical treatment, optic atrophy was still present at the following examination. Ptosis and the afferent pupillary defect disappeared and ocular motility was recovered, but visual loss persisted until the last follow-up. CONCLUSIONS: A prolonged prone position during spinal surgery can cause external compression of the eye, causing serious and irreversible injury to the orbital structures. Therefore, if the patient shows postoperative signs of orbital swelling after spinal surgery the condition should be immediately evaluated and treated.     

Recovery after loss of an eye

Recovery after loss of one eye requires an adjustment to monocular vision and resolution of a significant, serious emotional trauma. The impact on everyday life is not well documented. We surveyed 125 monocular patients by questionnaire regarding their recovery. Eighty-five of 125 respondents reported that loss of one eye had not changed their life in any permanent way. Only seven reported persistent visual problems, whereas 12 described problems in employment and 21 had anxiety or poor self-image. Among 49 adults who had suddenly lost a sighted eye, 50% reported that their adjustment period for driving, work, recreation, home activities, or walking was less than 1 month. Ninety-three percent thought that their adjustment was completed by 1 year. In conclusion, most patients were able to resume everyday activities after a short period of adjustment. Problems with employment and self-image were frequent, but visual problems were unusual.     

近视眼LASIK矫正前后优势眼的分析

目的:研究近视眼LASIK矫正前后优势眼的分布以及术后优势眼的变化情况。方法:325例接受LASIK手术近视患者,按照双眼屈光参差的程度分为非屈光参差组与屈光参差组。采用卡洞法判别双眼术前和术后1,3mo和6mo的优势眼眼别。结果:对于所有个体,优势眼眼别与双眼中近视性屈光程度较高眼眼别显著相关(P<0.01)。LASIK手术前后优势眼眼别没有改变。结论:优势眼眼别与双眼中近视性屈光程度较高眼眼别显著相关,LASIK手术前后优势眼眼别没有改变。     

Visual improvement in high myopic amblyopic adult eyes following phakic anterior chamber intraocular lens implantation

PURPOSE: To evaluate the efficacy and safety of angle-supported phakic anterior chamber intraocular lenses in amblyopic adult eyes with very high myopia. METHODS: We evaluated 12 eyes in nine patients with very high myopic amblyopia who received angle-supported phakic intraocular lenses (Phakic 6H) and followed them for more than six months. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and complications were evaluated. A satisfaction score was rated by patients using a 5-point (1-5) numeric scale. RESULTS: The mean age of patients was 37.3 +/- 9.4 years, ranging from 29 to 59 years old. The preoperative mean refraction (spherical equivalent, SE) was -20.10 +/- 5.41 diopters (D). The postoperative mean refraction (SE) was -1.75 +/- 0.76 D at six months. The postoperative BCVA improved an average 3.92 +/- 1.24 lines over preoperative values, and mean endothelial cell loss was 8.9% at six months. Development of cataracts, glaucoma, and pupil abnormalities were not demonstrated in any case during the study. The patients were all very satisfied, as the average satisfaction score was 4.3. CONCLUSIONS: This study indicates that angle-supported phakic anterior chamber intraocular lens implantation may be an effective surgical alternative for the correction of amblyopic adult eyes with very high myopia. However, long-term evaluation is necessary to assess possible complications and long-term safety.     

Visual recovery after retinal detachment

Visual recovery after successful surgery for the macula-off rhegmatogenous retinal detachment continues to be an important topic for ophthalmologists. Recent studies have shown that despite the intuitive notion regarding outcomes in macula-off detachment, there is no improvement in final visual acuity despite more expedient repair within the first week. Macula-off detachments can therefore be treated with less urgency and can wait for the next scheduled available operating room time. Surgeons involved in retinal detachment surgery should be aware that visual function based on acuity testing may continue to improve in the long term, most notably in those with the following patient characteristics: younger age, no or mild myopia (less than -5.00 D), and shorter duration of macular detachment (30 days or less).     

Deficient motion perception in the fellow eye of amblyopic children

The extent of motion processing deficits and M/dorsal pathway involvement in amblyopia is unclear. Fellow eye performance was assessed in amblyopic children for motion-defined (MD) form, global motion, and maximum displacement (Dmax) tasks. Group performance on MD form was significantly worse in amblyopic children than in control children. Global motion deficits were significantly related to residual binocular function. Abnormally elevated Dmax thresholds were most prevalent in children with anisometropia. Our findings from these three uncorrelated tasks implicate involvement of binocular motion-sensitive mechanisms in the neural deficits of amblyopic children with strabismic, anisometropic, and aniso-strabismic etiologies.     

主视眼对LASIK术后视觉质量影响的研究

目的 探讨主视眼对准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)术后视觉质量的影响.方法 对66例(132只眼)近视患者行常规LASIK手术,术后随访3月.观察术前术后裸眼视力、最佳矫正视力、屈光度、像差、对比敏感度、眩光敏感度及主观视觉生活质量调查问卷评分并进行统计学分析.结果 ①主视眼发生改变的患者术后1月时有4例(6.06%)、术后3月时有3例(4.55%).②主视眼与非主视眼比较,裸眼视力、最佳矫正视力及眩光敏感度:术前、术后两者差异均无统计学意义(P>0.05);屈光度:术前主视眼低与非主视眼,差异有统计学意义(P<0.05),术后两者差异无统计学意义(P>0.05);高阶像差:术前两者差异无统计学意义(P>0.05),术后1周时彗差主视眼高于非主视眼,差异有统计学意义(P<0.05);对比敏感度:术前两者差异无统计学意义(P>0.05),术后1周时3.0c/d、12.0c/d频率对比敏感度主视眼高于非主视眼,差异有统计学意义(P<0.05,P<0.01).③术后主视眼未改变组主观视觉生活质量调查问卷各项结果均优于主视眼改变组,但这种优势只有在术后3月的视功能评价上有统计学意义(P<0.05).结论 ①LASIK术后极少数患者主视眼可发生改变.②除术后早期外,主视眼对LAISK术后的视觉质量无明显影响.③在LASIK手术时保持术前术后主视眼一致,能改善患者对视觉生活质量的主观评价.