Another joint statement regarding learning disabilities,dyslexia, and vision—A rebuttal

Several medical organizations have published yet another joint statement trivializing vision therapy and vision disorders in the learning-disabled population. A review of the references in the joint statement as well as other references find that the joint statement is misleading because of inappropriate citations and selected references, as was the case with previous joint statements. The most current joint statement ignores the results of evidence-based research and makes recommendations regarding the treatment of convergence insufficiency that have no scientific validity. Ophthalmology should not allow professional rivalry to cloud its judgment regarding optometry's involvement in the diagnosis and treatment of learning-related vision problems.     

Another visual illusion involving orientation

The orientation of a grating may be misperceived when that grating appears superimposed within one-dimensional visual noise of a different orientation. An adjustment procedure was employed to measure the size of this tilt illusion and its dependence on noise orientation. The illusion is maximum when the noise and test differ by 20 to 40 deg, depending on the spatial frequency of the test grating. Noise composed of spatial frequencies several octaves removed from the test spatial frequency can still cause illusory tilt, although the degree of tilt under these conditions depends on test spatial frequency. This orientation illusion, like the tilt aftereffect, simultaneous tilt illusion and angle expansion illusion, may reflect inhibitory interactions between orientation selective neurons in human vision.     

SANDO: another presentation of mitochondrial disease

PURPOSE: To describe a unique mitochondrial syndrome that may present with the combination of ocular manifestations, sensory symptoms, and speech dysfunction. DESIGN: Case report. METHODS: Case report and review of the literature. RESULTS: A 43-year-old man presented with a Sensory Ataxic Neuropathy, Dysarthria, and Ophthalmoparesis (SANDO). Nerve conduction studies showed a sensory ganglionopathy. Skeletal muscle biopsy revealed ragged red fibers, and polymerase chain reaction analysis of the tissue demonstrated multiple mitochondrial DNA deletions. CONCLUSION: Mitochondrial disease should be considered in cases of external ophthalmoplegia, especially if a sensory ganglionopathy and dysarthria are present.     

Primary intraocular lymphoma: another great masquerader

PURPOSE: To describe diverse and atypical presentations of the most common masquerader in neoplastic masquerade syndromes. METHODS: Retrospective interventional case series. The authors identified three patients who presented with atypical and diagnostically challenging masquerading manifestations. These patients were eventually found to have primary intraocular lymphoma (PIOL). Their case histories, presenting signs and symptoms, diagnostic tests, and treatments are described. RESULTS: Patient 1 masqueraded as viral retinitis and branch retinal vein occlusion but was resistant to 5 weeks of oral and intravenous acyclovir. Patient 2 presented with choroidal infiltrates and vision loss. This patient had had breast carcinoma for the last 25 years and secondary metastasis was suspected. Patient 3 had chronic uveo-retinitis and a chronic Propionibacterium acnes infection was suspected. All three patients were diagnosed with PIOL. CONCLUSIONS: PIOL is an aggressive masquerader and not only presents clinical diagnostic difficulties but also requires expert tissue handling and analysis, so that early diagnosis can be made and therapy can be instituted.