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J Binocul Vis Ocul Motil. 2018 Oct-Dec;68(4):122-133. doi: 10.1080/2576117X.2018.1522917. Epub 2018 Oct 17.

Longitudinal Studies and Eye-Movement-Based Treatments of Infantile Nystagmus Syndrome: Estimated and Measured Therapeutic Improvements in Three Complex Cases.

Author information

1
a Daroff-Dell'Osso Ocular Motility Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center and Department of Neurology, CASE Medical School, Cleveland, Ohio.
2
b Department of Neurology , Case Western Reserve University and University Hospitals Cleveland Medical Center , Cleveland , Ohio.
3
c Department of Ophthalmology , Case Western Reserve University and University Hospitals Cleveland Medical Center , Cleveland , Ohio.
4
d Department of Biomedical Engineering , Case Western Reserve University and University Hospitals Cleveland Medical Center , Cleveland , Ohio.

Abstract

INTRODUCTION AND PURPOSE:

To demonstrate the utility of using eye-movement data to reveal the diagnostic characteristics of infantile nystagmus syndrome (INS), determine treatment, and both estimate and document therapeutic improvements in three patients with well-developed foveation periods, fairly broad, lateral gaze "nulls," head turns, strabismus, and complex, multiplanar nystagmus.

PATIENTS AND METHODS:

Infrared reflection, magnetic search coil, and high-speed digital video systems were used to record the eye movements of INS patients, pre- and post-Kestenbaum null-point correction surgery (horizontal or vertical). Data were analyzed and estimations made, using the eXpanded Nystagmus Acuity Function (NAFX) that is part of the OMtools toolbox for MATLAB.

RESULTS:

In all three subjects (S1-S3), both peak NAFX and longest foveation domain (LFD) improved from their pre-Kestenbaum values. S1: 0.700-0.745 (6.4%) and 25-34° (36%), respectively. S2: 0.445-0.633 (42.4%) and >40° to >50° (10%), respectively. S3: 0.250-0.300 (20%) and 13° to ≫18° (see text), respectively.

CONCLUSIONS:

S1: Even at the high ends of the pre-therapy NAFX and LFD spectra, INS foveation (and therefore, visual-function) improvements may be adequate to justify nystagmus surgery and provide clinical improvements beneficial to the patient. S2: INS foveation improvements in the vertical plane are equal to those originally estimated using the horizontal data in prior patients. S3: Two apparent NAFX peaks can be converted into a very broad peak by surgery based on the preferred lower peak.

KEYWORDS:

Infantile nystagmus syndrome; acuity; diagnosis; eye movements; foveation; surgery

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