2/8/2010 Remote treatment of intermittent central suppression improves quality of life measures Eric S. Hussey, OD, FCOVD 25 W. Nora, Suite 101 Spokane, WA 99205 spacegoggle@comcast.net 1
2/8/2010 Canada Canada ~8 mi. ~8 mi. Borish Near Card Enlarged Modified Diamond Target Curlew Curlew N Polaroid Overlays Brewster Brewster H D O N N Seattle Seattle K R V S C H D O H D O C O Z N H D R Spokane Spokane Idaho Idaho V R N H D C K S O K R V S C S O C Z N H R V D K K R V S C D R K C V O Z H S N S Z H V D N R K C O C O Z N H D R C O Z N H D R R C O S V Z N D H K D S V N K H O C Z R V R N H D C K S O V R N H D C K S O S O C Z N H R V D K S O C Z N H R V D K D R K C V O Z H S N D R K C V O Z H S N o o D R K C V O Z H S N D R K C V O Z H S N S Z H V D N R K C O S Z H V D N R K C O R C O S V Z N D H K x R C O S V Z N D H K D S V N K H O C Z R D S V N K H O C Z R o o Pacific Pacific Pacific Pacific Ocean Ocean Ocean Ocean Z S VZNDH Tri- Tri -Cities Cities M R H O C Z S D Mt. St. Helens Mt. St. Helens Seen by left eye Seen by right eye Oregon Oregon OEP # Description Pratt/Haynes Norms ICS Diagnosis 4 Distance Retinoscopy Point Calculated from ICS p.e. =2/3 Target is standard non-polarized near card Monocular negative relative acommodation 21m +3.25/+2.75 blur/recovery Cylinder Pratt Near Cylinder 14A Unfused Crossed Cylinder +1.25 .37 15A Lateral Phoria through 14A 7 exo 3.5 14B Fused Crossed Cylinder +1.00 .37 15B Lateral Phoria through 14B 6 exo 3.3 Target is polarized (modified) Borish Near Card 18d Vertical fixation disparity/associated phoria ortho ICS Near fd Lateral fixation disparity/asociated phoria Binocular positive relative acommodation Binocular positive relative acommodation 20 -3.50/-2.62 / 1.00 blur/recovery -14B Unfused Crossed Cylinder +0.50 .37 15B Lateral Phoria through - 6 exo 3.3 17A/B Base-in to Break / Recovery 20/12 2.8/2.9 16A/B Base-out to Break / Recovery 19/9 4.7/4 ICS 4 Video ICS diagnosis with diamond No losses Binocular negative relative acommodation 21 +2.37/+1.87 .50/.37 blur/recovery Move to Distance with AO Vectographic Chart 7A Best VA Distance Correction - “Binocular ICS 4 Use all distance targets ICS No losses Clockdial is great for kids Stereopsis Distance Vectographic Chart Rings 88% (4th Row) ICS Vertical fixation disparity/associated phoria 4 12 (&3) fd ortho Lateral fixation disparity/asociated phoria Near retinoscopy through 7A MEM +0.62 .18 Myron - QOL Scores 45 40 5.0 35 4.5 30 4.0 25 Post- 3.5 Therapy 20 3.0 15 2.5 10 2.0 5 1.5 1.0 Diagnosis Dx + 4 mo. Dx + 8 mo. Dx + 18 mo. 0.5 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 Pre-Therapy Length of ICS Suppression Periods, Seconds 2
2/8/2010 110 100 10 90 9 80 8 Post- Therapy 70 7 P Post- 60 6 Therapy 50 5 40 4 30 3 20 2 10 1 10 20 30 40 50 60 70 80 90 100 110 1 2 3 4 5 6 7 8 9 10 11 Pre-Therapy Pre-Therapy Length of “Binocular” Periods During ICS Cycle, Seconds COVD QOL Score - Full Checklist x Blurred vision at near/reading 60 x Double vision x Headaches with near work 50 x Words run together reading x x Burning, itching, watering eyes Post- 40 Fall asleep reading Therapy x x See worse end of day See worse end of day x Skip/repeat lines when reading 30 x Dizziness/nausea with reading x x Head tilt/close an eye reading 20 Avoid near work/reading x Miss/omit small words reading x Reading comprehension down 10 x x Hold reading too close 10 20 30 40 50 60 Short attention span reading x Pre-Therapy Difficulty finishing assignments COVD QOL Score - 16 Reading Questions 1 Blur at near 16 read comprehension down over time 2 Double Vision 17 poor sports performance x 3 Headaches with near work 18 holds reading too close Blurred vision at near/reading x Double vision 4 Words run together reading 19 trouble keeping attention on reading x Headaches with near work 5 Eyes burn/sting/water 20 difficulty completing assignments on time x Words run together reading 6 falls asleep reading 21 says "I can't" x x Burning, itching, watering eyes 7 Vision worse end of day 22 avoids sports Fall asleep reading x x See worse end of day See worse end of day 8 skip/repeat lines reading 8 skip/repeat lines reading 23 poor hand-eye/handwriting - difficulty with hand tools 23 poor hand-eye/handwriting - difficulty with hand tools x Skip/repeat lines when reading 9 dizziness/nausea with near work 24 can't estimate distances x Dizziness/nausea with reading 10 tilts head/closes eye reading 25 clumsy/knocks things over on desk/table x Head tilt/close an eye reading 11 difficulty copying from board 26 difficulty with time management x Avoid near work/reading x 12 avoids near work/reading 27 difficulty with money concepts/make change Miss/omit small words reading x Reading comprehension down 13 omits words reading 28 loses papers & belongings x x Hold reading too close 14 writes uphill/downhill 29 car sickness, motion sickness Short attention span reading 15 misaligns digits/columns 30 poor memory x Difficulty finishing assignments 3
2/8/2010 p<0.001 7 Vision worse end of day 8 skip/repeat lines reading 20 difficulty completing assignments on time p<0.001 7 Vision worse end of day 8 skip/repeat lines reading 20 difficulty completing assignments on time 3 Headaches with near work 4 Words run together reading 5 Eyes burn/sting/water 6 falls asleep reading p<0.01 16 read comprehension down over time 10 tilts head/closes eye reading 13 omits words reading 14 writes uphill/downhill 1 Blur at near 17 poor sports performance 16 read comprehension down over time 18 holds reading too close 19 trouble keeping attention on reading 2 Double Vision 18 holds reading too close 3 Headaches with near work 19 trouble keeping attention on reading 4 Words run together reading 21 says "I can't" 5 Eyes burn/sting/water 5 Eyes burn/sting/water 22 avoids sports 22 avoids sports 6 falls asleep reading 23 poor hand-eye/handwriting - difficulty with hand tools 1 Blur at near 23 poor hand-eye/handwriting - difficulty with hand tools 9 dizziness/nausea with near work 24 can't estimate distances 2 Double Vision 24 can't estimate distances 10 tilts head/closes eye reading 25 clumsy/knocks things over on desk/table 9 dizziness/nausea with near work 25 clumsy/knocks things over on desk/table 11 difficulty copying from board 26 difficulty with time management 11 difficulty copying from board 26 difficulty with time management 12 avoids near work/reading 27 difficulty with money concepts/make change 12 avoids near work/reading 27 difficulty with money concepts/make change 13 omits words reading 28 loses papers & belongings 15 misaligns digits/columns 28 loses papers & belongings 14 writes uphill/downhill 29 car sickness, motion sickness 17 poor sports performance 29 car sickness, motion sickness 15 misaligns digits/columns 30 poor memory 21 says "I can't" 22 avoids sports 30 poor memory p<0.001 7 Vision worse end of day 8 skip/repeat lines reading 20 difficulty completing assignments on time 4 Words run together reading 5 Eyes burn/sting/water 6 falls asleep reading p<0.01 3 Headaches with near work TABE Reading Test Grade Level 10 tilts head/closes eye reading 13 omits words reading 14 writes uphill/downhill p << 0.001 16 read comprehension down over time 18 holds reading too close 19 trouble keeping attention on reading JobCorps average age, 19.7 yrs 10 p<0.05 1 Blur at near 2 Double Vision 15 misaligns digits/columns 12 avoids near work/reading 9 8 21 says "I can't" 24 can't estimate distances 7 7 6 All the rest improved, but 5th grade level 5 p>0.05 ~ 11 yrs. old 4 9 dizziness/nausea with near work 25 clumsy/knocks things over on desk/table 3 26 difficulty with time management 11 difficulty copying from board 2 27 difficulty with money concepts/make change 1 17 poor sports performance 28 loses papers & belongings 22 avoids sports 29 car sickness, motion sickness Diagnosis Re-Examination 23 poor hand-eye/handwriting - difficulty with hand tools 30 poor memory 12 11 10 9 8 Post- Therapy 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 9 10 11 Pre-Therapy TABE Reading Scores 4
2/8/2010 Increase in “Binocular” Periods, Seconds 10 9 8 7 6 5 4 3 2 1 -1 1 2 3 4 5 6 7 8 9 10 Decrease in Suppression Periods, Seconds Control is all in the “off” portion - active inhibition Fig 1 On Off Cortical Inhibition Increase in “Binocular” Periods, Seconds 10 On 9 Off 8 7 6 On 5 Off 4 3 2 1 -1 1 2 3 4 5 6 7 8 9 10 Decrease in Suppression Periods, Seconds Control is all in the “off” portion - active inhibition Fig 1 On Off Increase in Cortical Inhibition “Binocular” Periods, Seconds 10 On 9 Off 8 7 6 Control is in some internal timing, so on/off is a cycle of pre-determined length Fig 2 5 4 On 3 Off Internal Gating 2 1 On Off -1 1 2 3 4 5 6 7 8 9 10 Decrease in Suppression Periods, Seconds decrease in “off” = increase in “on” 5
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