Optometry & Vision Science:
CLINICAL COMMUNICATIONS: Clinical Pearls
This month, “Clinical Communications,” under the clinical editorship of Editorial Board member Larry Alexander, OD, FAAO, includes color image content and optional supplementary digital content, with no cost to our authors.
Each article in this section is followed by a clinical comment by our clinical editor, emphasizing the clinical take-home message. We provide these “Clinical Pearls” of the publication following the article’s title, authors, and abstract. The full text and illustrations are found online with the colored images and any video clips.
Dr. Larry Alexander provides all of the clinical comments (“Clinical Pearls”) on each article in “Clinical Communications.” This is all part of our OVS program to enrich the clinical content of OVS and make it very accessible, in color and motion, to clinicians, readers, and authors alike.
Tony Adams, OD, PhD, FAAO
Editor in Chief
Vision Rehabilitation Team Management of Acquired Monocular Vision
Purpose. Existing low-vision programs do not readily meet the needs of the monocular patient. This case report illustrates the implementation and benefits of an Acquired Monocular Vision Rehabilitation (AMVR) evaluation and training program from the patient’s perspective. The AMVR program guides and teaches specific skills to each monocular patient. Adaptive skills are demonstrated to enhance and maximize the person’s remaining monocular vision; to teach visual skills; to acquire and maintain independence, living, and functioning; and to prevent depression. The purpose of this article is to illustrate the potential for monocular vision rehabilitation and justify adding monocular rehabilitation therapy to current vision rehabilitation programs and encourage future clinical case studies to measure functional outcomes.
Case Report. This case report illustrates one example of concurrent vision rehabilitation team management including low-vision optometrists, ophthalmologists, blind rehabilitation specialists (also known as vision rehabilitation therapist), and orientation and mobility (O&M) instructors of a later stage–acquired monocular patient within a 1-year period.
Conclusions. After completion of the AMVR program (detailed components are available in Appendices, available at http://links.lww.com/OPX/A114), our patient expressed an increase in self-confidence, improved motor skills, and less depression since learning more about his condition and the adaptations that he can maintain. He stated that he feels he is a “better me.” The patient’s positive feedback encourages further data to be collected with future monocular patients evaluated at an earlier stage of their vision loss and to continue to structure supportive services by demonstrating new adaptive techniques and exercises to show that each person “is-able” and not “dis-abled.”
Adult-Onset Cyclic Esotropia: A Case Report
Antonio di Meo, Ciro Costagliola, Michele Della Corte, Antonio Romano, Consuelo Foria, and Alfonso di Costanzo
Purpose. This case report presents the diagnosis and management of an adult patient with cyclic esotropia, a rare and poorly understood form of strabismus, which is characterized by alternating periods of manifest strabismus and orthotropia. Few cases of adult-onset cyclic strabismus have been reported. The etiology, pathogenesis, and treatment for this condition are reviewed.
Case Report. A 37-year-old man with high unilateral myopia and anisometropic amblyopia in his left eye developed cyclic esotropia 2 months after a scleral buckle procedure for a retinal detachment. A 48-hr cycle that consisted of a 24-hr period of orthotropia followed by a 24-hr period of constant left esotropia was present. Magnetic resonance imaging, electromyography, electroencephalography, and ocular and orbital echography were unremarkable, as was a neurologic assessment that included fatigue and edrophonium testing. The patient was successfully managed with muscle surgery.
Conclusions. The etiology and pathogenesis of adult-onset cyclic esotropia remain unknown. Cyclic esotropia should be considered in the differential diagnosis when an individual presents with a history of intermittent strabismus that is present some days and not others.