Faculty Bibliography

PURPOSE/OBJECTIVE:Atropine 1% has been used to slow the progression of myopia; however, it has not gained worldwide clinical acceptance because it results in clinically significant pupillary mydriasis and accommodative paralysis. Lower concentrations of atropine (0.5 to 0.01%) have been reported to be associated with fewer symptoms, while still controlling myopia. It is the purpose of this study to find the highest concentration of atropine that does not result in significant symptoms from pupillary dilation and accommodative paralysis. METHODS:A 3 × 3 phase I clinical trial paradigm was used in 12 subjects, to determine the maximum dosage of atropine which could be prescribed without creating symptoms or clinical signs of insufficient accommodation or excessive pupillary dilation. Accommodation was measured by pushouts and pupillary dilation by photography. Prior to this study, we established the following criteria for comfort: 5D or more of residual amplitude of accommodation, less than or equal to a 3 mm pupillary difference between the eyes, and a report of minimal symptoms of near vision blur or outside photophobia. RESULTS:Our results indicate that atropine 0.02% is the highest concentration that did not result in clinical symptoms and findings associated with higher dosages. Mean pupillary dilation was 3 mm, and mean accommodative amplitude was 8 diopters with this concentration. Further, reduction of the concentration of atropine from 0.02 to 0.01% did not seem to result in a decrease in clinical signs or symptoms associated with atropine. CONCLUSIONS:Atropine 0.02% is the highest concentration that does not produce significant clinical symptoms from accommodation paresis or pupillary dilation. This would be an appropriate starting point in evaluating a low dosage of atropine to slow myopic progression.

PURPOSE/OBJECTIVE:The aim of this study was to look for the response to strabismus images in the limbic network (amygdala, hippocampus, parahippocampus) of healthy volunteers and to compare it with their reaction to viewing normal eyes. DESIGN/METHODS:Prospective, observational study. PARTICIPANTS/METHODS:Thirty-one healthy volunteers underwent functional magnetic resonance imaging (fMRI). METHODS:Functional magnetic resonance imaging data and blood oxygen level-dependent signal changes were analyzed using the BrainVoyager QX software package (Brain Innovation, Maastricht, The Netherlands). MAIN OUTCOME MEASURES/METHODS:Responses to viewing strabismus images were compared with those observed while viewing normal eye images. RESULTS:Strabismus images led to significant activation of the amygdala, hippocampus, parahippocampal, and fusiform gyri in 30 of 31 subjects compared with normal eye images, indicating a negative emotional response. CONCLUSIONS:These fMRI results confirm that strabismus influences organically not only the patient with nonparallel eyes but also observers. Treatment of strabismus therefore changes the interpersonal dynamic for patients with strabismus on a demonstrable organic basis. FINANCIAL DISCLOSURE(S)/BACKGROUND:The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Congenital Horner syndrome is a rare disorder that accounts for less than 5% of all cases of Horner syndrome. Like Horner syndrome in general, it consists primarily of ptosis, miosis, and anhidrosis. Congenital Horner syndrome may manifest some special features such as iris heterochromia since the sympathetic nervous system is an essential component for the development and maintenance of eye color. We present 3 cases of unilateral straight hair in association with congenital Horner syndrome in which the patients had straight hair ipsilateral to the Horner syndrome, whereas on the contralateral side, it was curly, and we discuss possible mechanisms for this phenomenon.

We report iridocorneal endothelial syndrome in a male who presented at the age of 16 years with a 3-year history of complaints of blurred vision, altered pupillary shape, and monocular diplopia OD. The examination was notable for unilateral effacement of the iris architecture, stretch holes, corectopia, and localized ectropion uveae. Intraocular pressures were 41 mm Hg OD and 10 mm Hg OS. Gonioscopy revealed intermittent areas of broad synechiae anterior to Schwalbe's line alternating with a clinically normal appearance. The left eye and angle were unremarkable. Specular microscopy confirmed the presence of unilateral endothelial pleomorphism and polymegathism. To our knowledge, this is the earliest reported case of iridocorneal endothelial syndrome in a young man

PURPOSE/OBJECTIVE:To compare measurements of eccentric fixation using two different targets for fixation, a traditional visuoscope target and the streak target of an ophthalmoscope. PATIENTS AND METHODS/METHODS:Monocular fixation was evaluated using visuoscopy in 47 patients ranging in age from 4 months to 22 years. Visuoscopy measurements were compared using both the traditional visuoscope target and the streak target of a Welch Allyn ophthalmoscope. The streak light was rotated both horizontally and vertically to detect both horizontal and vertical eccentric fixation. RESULTS:The streak target improved testability of eccentric fixation in children younger than 3 years compared to the traditional visuoscope target (75% versus 30%). All of the patients older than 3 years were testable using both targets, with both methods yielding the same results. All of the patients with a visual acuity of at least 20/20 also demonstrated central fixation using both techniques. CONCLUSIONS:Using the streak of a Welch Allyn ophthalmoscope as a visuoscope target allows for testing of eccentric fixation in children younger than 3 years.