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Context: The utility of baseline vestibular and ocular motor screening (VOMS) in high school and collegiate athletes is demonstrated throughout the literature; however, baseline VOMS data at the youth level are limited. In addition, with the recent adoption of the change scoring method, there is a need to document baseline VOMS total and change scores in a pediatric population. Objective: To document baseline VOMS total and change scores and to document the internal consistency of the VOMS in pediatric soccer athletes. We hypothesized that the VOMS would demonstrate strong internal consistency in pediatric soccer athletes. Design: Cross-sectional study. Methods: Pediatric soccer athletes (N = 110; range = 5–12 y) completed the VOMS at baseline. Descriptive statistics summarized demographic information, VOMS total scores, and VOMS change scores. Cronbach α assessed internal consistency for VOMS total scores and change scores. Results: Twenty-one (19.1%) participants had at least one total score above clinical cutoffs (≥2 on any VOMS component and ≥5 cm on average near point convergence). Forty (36.4%) participants had at least one change score above clinical cutoffs (≥1 on any VOMS component and ≥3 cm on average near point convergence). The internal consistency was strong for total scores with all VOMS components included (Cronbach α =.80) and change scores (Cronbach α =.89). Conclusions: Although results suggest VOMS items measure distinct components of the vestibular and ocular motor systems, caution should be taken when interpreting VOMS total and change scores in pediatric athletes, as overreporting symptoms is common, thereby impacting the false-positive rate. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a multifactorial neurodegenerative disorder with high prevalence among the elderly, primarily manifested by progressive decline in motor function. The aging global demographic and increased life expectancy have led to a rapid surge in PD cases, imposing a significant societal burden. PD along with other neurodegenerative diseases has garnered increasing attention from the scientific community. In PD, motor symptoms are recognized when approximately 60% of dopaminergic neurons have been damaged. The irreversible feature of PD and benefits of early intervention underscore the importance of disease onset prediction and prompt diagnosis. The advent of digital health technology in recent years has elevated the role of digital biomarkers in precisely and sensitively detecting early PD clinical symptoms, evaluating treatment effectiveness, and guiding clinical medication, focusing especially on motor function, responsiveness and sleep quality assessments. This review examines prevalent digital biomarkers for PD and highlights the latest advancements. [ABSTRACT FROM AUTHOR]

The aim of this systematic review was to investigate the relationship between fractures of the floor of the orbit (blow outs) and their repercussions on eye movement, based on the available scientific literature. In order to obtain more reliable results, we opted for a methodology that could answer the guiding question of this research. To this end, a systematic review of the literature was carried out, using a rigorous methodological approach. The risk of bias was assessed using version 2 of the Cochrane tool for the risk of bias in randomized trials (RoB 2). This systematic review was carried out according to a systematic review protocol previously registered on the PROSPERO platform. The searches were carried out in the PubMed (National Library of Medicine), Scopus, ScienceDirect, SciELO, Web of Science, Cochrane Library and Embase databases, initially resulting in 553 studies. After removing duplicates, 515 articles remained, 7 were considered eligible, of which 3 were selected for detailed analysis. However, the results of the included studies did not provide conclusive evidence of a direct relationship between orbital floor fractures and eye movement. [ABSTRACT FROM AUTHOR]

Purpose: To clarify the clinical features of patients with Double seronegative (DS) ocular myasthenia gravis (OMG). Methods: Sixty-one patients diagnosed with DS OMG at the Department of Ophthalmology, Hyogo Medical University Hospital over a 5-year period from 2017 were included. Patients were classified into three groups based on the initial examination findings: group P (ptosis alone), group M (ocular motility disorder alone), and group PM (combination of both). We retrospectively reviewed the patients and clarified their clinical features. Results: There were 32 males and 29 females, with a mean age of 49.8 ± 20.9:1–82 years. Twenty-one patients (34.4%) were in group P, 23 (37.7%) in group M, and 17 (27.8%) in group PM. The proportion of males (73.9%) was significantly higher in group M compared with the other two groups. The diagnosis was proven by detection of neuromuscular junction (NMJ) disorder in 73.8%, oral pyridostigmine trial test in 13.1%, and eight patients (13.1%) in group M were diagnosed after surgical treatment. The clinical symptoms were resolved by oral pyridostigmine treatment in 54.1% of cases. Conclusion: About 30% of patients with DS OMG had no obvious NMJ disorder, and an oral pyridostigmine trial test was necessary to diagnose these patients. Although DS OMG is often considered as the mildest form of MG, its prognosis is not optimistic and it requires aggressive therapeutic intervention. Trial registration: Trial registration number: 202104–750, "2016/4/18," retrospectively registered. [ABSTRACT FROM AUTHOR]

\nSYNOPSISBackground: Inferior oblique muscle overaction (IOOA) is a prevalent ocular muscle motility disorder. This study aimed to investigate the outcomes and impact of IO muscle myectomy with and without tucking the proximal end of the muscle into Tenon’s capsule in two surgical groups as a treatment for IOOA. Methods: Randomized cohort study that involves two surgical groups. A total of 33 patients (55 eyes). Patients were randomly divided into two groups: first group underwent myectomy without tucking the proximal end of the muscle, whereas the second group underwent myectomy with tucking of the proximal end of the muscle. Each patient had four visits. During each visit, each patient had a comprehensive ophthalmic examination. Surgical success was defined as IOOA grade range of 0 to + 1 and correction of hypertropia in primary gaze. Results: The median age was 6 years. Sixteen (48.5%) patients underwent IO muscle myectomy with tucking, while 17 (51.5%) had an IO myectomy without tucking. Both the tucking and without tucking groups showed reductions in the angles of deviations, but there was no significant difference between the groups at baseline or postoperatively at 6 months. The success rate was 92.85% for the tucking group and 92.59% for the without tucking group. Conclusion: The study suggests that both surgical techniques are effective in correcting IOOA and associated HT, without any clear benefits of the addition of tucking. Ultimately, the two surgical techniques are equally effective, and the choice of surgical technique remains a personal preference of the surgeon.The study found that incorporating myectomy with tucking the proximal end of the muscle into Tenon’s capsule does not improve the overall effectiveness of surgery. Yet, the decision to include tucking remains a personal choice for the surgeon. [ABSTRACT FROM AUTHOR]

Post-secondary data literacy education is critical to students' academic and career success. However, the literature has not adequately addressed the conceptualization and assessment of data literacy for post-secondary students. In this study, we introduced a novel digital performance-based assessment for teaching and evaluating post-secondary students' data literacy skills. The purpose of this study is to validate the assessment and identify problematic items for later modifications using the argument-based approach to validation. We analyzed students' item responses and eye movements using psychometric and eye-tracking analyses to collect two types of validity evidence: internal structure and response processes. Descriptive and psychometric results showed that the nine example items measuring basic data analysis were of acceptable psychometric quality. The eye-tracking analysis of two representative items indicated that most students first attended to and processed expected item areas when the items were available. In addition, the critical item regions for task success were associated with students' highest cognitive effort. These results rejected our alternative score interpretation that the developed assessment questions evaluate students' abilities that are weakly connected to the skill of basic data analysis. Possible explanations of the findings and theoretical and pedagogical implications of our study were discussed. [ABSTRACT FROM AUTHOR]

Summary Breathing and sleep state are tightly linked. The traditional approach to evaluation of breathing in rapid eye movement sleep has been to focus on apneas and hypopneas, and associated hypoxia or hypercapnia. However, rapid eye movement sleep breathing offers novel insights into sleep physiology and pathology, secondary to complex interactions of rapid eye movement state and cardiorespiratory biology. In this review, morphological analysis of clinical polysomnogram data to assess respiratory patterns and associations across a range of health and disease is presented. There are several relatively unique insights that may be evident by assessment of breathing during rapid eye movement sleep. These include the original discovery of rapid eye movement sleep and scoring of neonatal sleep, control of breathing in rapid eye movement sleep, rapid eye movement sleep homeostasis, sleep apnea endotyping and pharmacotherapy, rapid eye movement sleep stability, non‐electroencephalogram sleep staging, influences on cataplexy, mimics of rapid eye movement behaviour disorder, a reflection of autonomic health, and insights into cardiac arrhythmogenesis. In summary, there is rich clinically actionable information beyond sleep apnea encoded in the respiratory patterns of rapid eye movement sleep. [ABSTRACT FROM AUTHOR]

To estimate the prevalence of convergence insufficiency (CI) in adult patients with post-concussion syndrome and determine the impact of CI on symptom load. Cross-sectional study of 103 patients with neurological symptoms 2–6 months after a concussion. Symptoms were assessed with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and CI was diagnosed using near point of convergence, vergence facility, and the Convergence Insufficiency Symptom Survey. The RPQ score for patients with and without CI was compared, and sensitivity, specificity, and area under the receiver operating characteristic curve for the two visually related RPQ questions as indicators of CI were calculated. The proportion of patients diagnosed with symptomatic CI was 20.4% (95% confidence interval: 13.1–29.5%). The RPQ score was significantly higher for patients with symptomatic CI both before (p =.01) and after removal of the two visually related questions in the RPQ-questionnaire (p =.03). The two visually related RPQ questions were unable to detect CI. In patients with post-concussion syndrome, the load of nonvisual symptoms is higher in the presence of CI. A prospective interventional study on CI is required to study the relationship between CI and other post-concussion symptoms. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Neuroblastoma is a malignant tumor primarily affecting infants. Originating from embryonic cells of the sympathetic nervous system, NB commonly arises in the adrenal glands, followed by the abdomen, mediastinum, head, and neck. Clinical presentation varies depending on the tumor's location. General symptoms, if present, include fatigue, weight loss, and fever. The paraneoplastic syndrome refers to symptoms and disorders associated with malignant tumors but not directly caused by the tumor itself or its metastases. Opsoclonus-myoclonus syndrome and diarrhea are the most common paraneoplastic syndromes linked to neuroblastoma. REVIEW METHODS: The article was conducted using PubMed and Google Scholar data concerning paraneoplastic syndromes associated with neuroblastoma. THE STATE OF KNOWLEDGE: Opsoclonus-myoclonus syndrome is a neurological paraneoplastic syndrome that presents itself with characteristic eye movement disorder, short, involuntary, irregular twitches or spasms occurring in a muscle, sleep disturbance, and changes in behavior. Diarrhea resulting in hypokalemia may be also present as a paraneoplastic syndrome associated with neuroblastoma. Cushing's syndrome is a rare condition in childhood, but it also may be linked to neuroblastoma. CONCLUSIONS: Neuroblastoma is one of the most common childhood cancers, Paraneoplastic syndromes associated with neuroblastoma are rare conditions. Diagnosing chronic diarrhea, OMS, and Cushing's syndrome should always lead to the exclusion of neuroblastoma. Heightened awareness among pediatricians regarding PNS could result in faster diagnosis, timely treatment commencement, and ultimately enhance patient prognosis. [ABSTRACT FROM AUTHOR]

Currently, there is no established system for quantifying patterns of ocular ductions. This poses challenges in tracking the onset and evolution of ocular motility disorders, as current clinical methodologies rely on subjective observations of individual movements. We propose a protocol that integrates image processing, a statistical framework of summary indices, and criteria for evaluating both cross-sectional and longitudinal differences in ductions to address this methodological gap. We demonstrate that our protocol reliably transforms objective estimates of ocular rotations into normative patterns of total movement area and movement symmetry. This is a critical step towards clinical application in which our protocol could first diagnose and then track the progression and resolution of ocular motility disorders over time. [ABSTRACT FROM AUTHOR]

This article provides a summary of key publications on progressive supranuclear palsy (PSP), a Parkinsonian disorder. The article highlights the landmark 1964 publication by John C. Steele that unveiled PSP as a distinct clinical syndrome and pathology. It also discusses other important publications that have contributed to the understanding of PSP, including studies on eye movement abnormalities, distinctive facial appearances, dystonia, cognitive deficits, and the molecular biology of PSP. The article emphasizes the need for sensitive diagnostic capabilities and disease-modifying therapies for PSP. The author acknowledges the increasing research efforts and resources dedicated to understanding and treating PSP. [Extracted from the article]

Simple Summary: "Surgery-first" is the main paradigm of treatment for intracranial meningiomas, with the aim of maximal safe tumor resection while preserving the neurological function. This purpose is not always achievable for meningiomas involving the spheno-orbital region, due to their close anatomical relationship with highly functional neurovascular structures, which limits the extent of resection. Therefore, surgery aims to achieve an onco-functional balance, mainly addressed to symptoms and signs of resolution. For this purpose, several surgical approaches, each with related pros and cons, can be considered. Surgery stands as the primary treatment for spheno-orbital meningiomas, following a symptoms-oriented approach. We discussed the decision-making process behind surgical strategies through a review of medical records from 80 patients who underwent surgical resection at the University of Naples Federico II. Different surgical approaches were employed based on the tumor's location relative to the optic nerve's long axis, categorized into lateral (type I), medial (type II), and diffuse (type III). We examined clinical, neuroradiological, surgical, pathological, and outcome factors. Proptosis emerged as the most frequent symptom (97%), followed by visual impairment (59%) and ocular motility issues (35%). Type I represented 20%, type II 43%, and type III 17%. Growth primarily affected the optic canal (74%), superior orbital fissure (65%), anterior clinoid (60%), and orbital apex (59%). The resection outcomes varied, with Simpson grades I and II achieved in all type I cases, 67.5% of type II, and 18% of type III. Recurrence rates were highest in type II (41.8%) and type III (59%). Improvement was notable in proptosis (68%) and visual function (51%, predominantly type I). Surgery for spheno-orbital meningiomas should be tailored to each patient, considering individual characteristics and tumor features to improve quality of life by addressing primary symptoms like proptosis and visual deficits. [ABSTRACT FROM AUTHOR]

This article discusses the use of video-oculography (VOG) as a diagnostic tool for myasthenia gravis (MG), a neuromuscular disorder characterized by muscle weakness and fatigue. The case study presented describes a young male patient with intermittent double vision, which improved with rest and closure of either eye. Despite negative results from standard diagnostic tests, an in-depth VOG assessment revealed significant oculomotor fatigability during repetitive saccadic movements at higher frequencies. The patient was diagnosed with probable MG and started on medication, resulting in symptom improvement. The study suggests that VOG testing at higher saccade frequencies could enhance diagnostic accuracy for MG. [Extracted from the article]

Biological sex and history of motion sickness are known modifiers associated with a false-positive baseline Vestibular/Ocular Motor Screening (VOMS). However, other factors may be associated with a false-positive VOMS in collegiate athletes. To identify contributing factors to false-positive VOMS assessments using population-specific criteria. We also critically appraised previously reported interpretation criteria. Descriptive laboratory study. Single-site collegiate athletic training clinic. National Collegiate Athletic Association Division I athletes (n = 462 [41% female]) aged 18.8 ± 1.4 years. Participants completed the Athlete Sleep Behavior Questionnaire, the 7-Item Generalized Anxiety Index, the Immediate Postconcussion Assessment and Cognitive Testing battery, the Patient Health Questionnaire-9, the Revised Head Injury Scale, the Sensory Organization Test, and the VOMS as part of a multidimensional baseline concussion assessment. Participants were classified into 2 groups based on whether they had a total symptom score of greater than or equal to 8 after VOMS administration, excluding the baseline checklist. We used χ2 and independent t tests to compare group demographics. A binary logistic regression with adjusted odds ratios (ORs) was used to evaluate the influence of sex, corrected vision, attention-deficit/hyperactivity disorder, Immediate Postconcussion Assessment and Cognitive Testing composite scores, concussion history, history of treatment for headache and/or migraine, Generalized Anxiety Index scores, Patient Health Questionnaire-9 scores, Athlete Sleep Behavior Questionnaire scores, and Sensory Organization Test equilibrium scores and somatosensory, visual, and vestibular sensory ratios on false-positive rates. Approximately 9.1% (42 of 462 [30 females]) met criteria for a false-positive VOMS. A significantly greater proportion of females had false positives (χ21 = 18.37, P <.001). Female sex (OR = 2.79; 95% CI = 1.17, 6.65; P =.02) and history of treatment for headache (OR = 4.99; 95% CI = 1.21, 20.59; P =.026) were the only significant predictors of false-positive VOMS. Depending on cutoff interpretation, false-positive rates using our data ranged from 9.1% to 22.5%. Our results support the most recent interpretation guidelines for the VOMS in collegiate athletes due to a low false-positive rate and ease of interpretation. Biological sex and history of headaches should be considered when administering the VOMS in the absence of a baseline. [ABSTRACT FROM AUTHOR]

Sleep is essential for human physical and mental health. Sleep disorders are a significant threat to human health, and a large number of people in the world suffer from sleep disorders. Effective detection of sleep disorders is essential for the treatment of sleep disorders. Questionnaires and scale assessments are traditional methods of sleep disorder detection, which are subjective, time-consuming and prone to misdiagnosis. To detect sleep disorders quickly and accurately, a Multimodal Attention-Fusion Convolutional Neural Network is proposed in this paper. The network uses electroencephalography, electrooculography, electrocardiography, and electromyography signals to automatically identify healthy and five sleep disorders, namely insomnia, narcolepsy, periodic leg movement, rapid eye movement behaviour disorder and nocturnal frontal lobe epilepsy. First, multiple convolutional neural network branches are used to extract time-invariant features of multimodal signals. Then, a multi-scale attention module based on dilated convolutional networks and a squeeze and excite block is proposed for further extracting features with different scales and fusing feature information. Finally, a prediction module consisting of fully connected layers is used to detect sleep disorders. The accuracy, F1 score, and Kappa coefficient obtained on the Cyclic Alternating Pattern sleep dataset are 99.56%, 99.49% and 0.9942, respectively. Compared to the existing state-of-the-art studies, the method proposed in this paper has higher performance in sleep disorder detection. [ABSTRACT FROM AUTHOR]

This work aims to explore whether students' learning outcomes in the virtual museum (VM) 's Life and Science course are influenced by the type of knowledge and the different levels of interaction within the museum. The study was conducted using an eye-movement experimental method, based on cognitive load theory, knowledge visualisation and connectionist theory, to construct a virtual museum interaction hierarchy index to identify high and low levels of interaction in the experimental material. A randomised two-factor experiment was organised to obtain eye-movement related indicators and to analyse statistical data in conjunction with retention test scores and transfer test scores, taking into account the influence of the perceived difficulty of the learning material and the level of mental effort of the students on the experiment. This study will provide effective suggestions for museum learning design and resource development, ultimately offer insights in exploring the most suitable learning rules and learning material selection for VM learners. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this study was to evaluate the amount of sensitivity and specificity of the slit-light (SL) method in the diagnosis of ocular cyclotorsion. MATERIALS AND METHODS: One hundred and twenty eyes of 60 individuals (10-60 years old), with mean visual acuity of 0.08 ± 0.14 LogMAR, were divided into two groups (normal and torsion groups). Individuals without ocular motility disorder were selected as normal and patients with extraocular motility disorders and oblique muscle dysfunctions as the torsion group. The sensitivity and specificity of SL in the diagnosis of ocular torsion were measured by masked investigators and compared to fundus photography (FP). Inter- and intraobserver variability of these techniques was also determined. RESULTS: The amounts of sensitivity and specificity of SL, measured by the first examiner, were 60% and 92% for intorsion and 50% and 96% for extorsion assessment, respectively. These amounts were 53% and 95% for intorsion, and 54% and 97% for extorsion by the second examiner. The contingency coefficient between the two examiners was 68.6% for SL. This amount was 61% between FP and SL for the first examiner and 63% for the second. The contingency coefficient for the repeatability of SL was 72.2% for the first examiner and 75.7% for the second. This amount was 71.2% between the two examiners. CONCLUSION: SL can be considered a useful method for the diagnosis of cyclotorsion. [ABSTRACT FROM AUTHOR]

Background: Disconjugate eye movements are essential for depth perception in frontal-eyed species, but their underlying neural substrates are largely unknown. Lesions in the midbrain can cause disconjugate eye movements. While vertically disconjugate eye movements have been linked to defective visuo-vestibular integration, the pathophysiology and neuroanatomy of horizontally disconjugate eye movements remains elusive. Methods: A patient with a solitary focal midbrain lesion was examined using detailed clinical ocular motor assessments, binocular videooculography and diffusion-weighted MRI, which was co-registered to a high-resolution cytoarchitectonic MR-atlas. Results: The patient exhibited both vertically and horizontally disconjugate eye alignment and nystagmus. Binocular videooculography showed a strong correlation of vertical and horizontal oscillations during fixation but not in darkness. Oscillation intensities and waveforms were modulated by fixation, illumination, and gaze position, suggesting shared visual- and vestibular-related mechanisms. The lesion was mapped to a functionally ill-defined area of the dorsal midbrain, adjacent to the posterior commissure and sparing nuclei with known roles in vertical gaze control. Conclusion: A circumscribed region in the dorsal midbrain appears to be a key node for disconjugate eye movements in both vertical and horizontal planes. Lesioning this area produces a unique ocular motor syndrome mirroring hallmarks of developmental strabismus and nystagmus. Further circuit-level studies could offer pivotal insights into shared pathomechanisms of acquired and developmental disorders affecting eye alignment. [ABSTRACT FROM AUTHOR]

Summary: Non‐rapid eye movement parasomnia disorders, also called disorders of arousal, are characterized by abnormal nocturnal behaviours, such as confusional arousals or sleep walking. Their pathophysiology is not yet fully understood, and objective diagnostic criteria are lacking. It is known, however, that behavioural episodes occur mostly in the beginning of the night, after an increase in slow‐wave activity during slow‐wave sleep. A better understanding of the prospect of such episodes may lead to new insights in the underlying mechanisms and eventually facilitate objective diagnosis. We investigated temporal dynamics of transitions from slow‐wave sleep of 52 patients and 79 controls. Within the patient group, behavioural and non‐behavioural N3 awakenings were distinguished. Patients showed a higher probability to wake up after an N3 bout ended than controls, and this probability increased with N3 bout duration. Bouts longer than 15 min resulted in an awakening in 73% and 34% of the time in patients and controls, respectively. Behavioural episodes reduced over sleep cycles due to a reduction in N3 sleep and a reducing ratio between behavioural and non‐behavioural awakenings. In the first two cycles, N3 bouts prior to non‐behavioural awakenings were significantly shorter than N3 bouts advancing behavioural awakenings in patients, and N3 awakenings in controls. Our findings provide insights in the timing and prospect of both behavioural and non‐behavioural awakenings from N3, which may result in prediction and potentially prevention of behavioural episodes. This work, moreover, leads to a more complete characterization of a prototypical hypnogram of parasomnias, which could facilitate diagnosis. [ABSTRACT FROM AUTHOR]

Anti‐human epidermal growth factor receptor 2 (HER2) agents have exhibited pronounced tumor‐inhibitory activity, yet the accompanying ocular toxicity has frequently been underestimated. We aim to conduct a comprehensive comparative analysis of ocular toxicity risk related to various anti‐HER2 agents. We executed a retrospective pharmacovigilance investigation based on the FDA Adverse Event Reporting System (FAERS) database, covering the period from Q2 2018 to Q1 2023. The disproportionality analysis was performed to assess ocular toxicity risk. Multivariate logistic regression was implemented to mitigate potential biases. Moreover, the time to onset of ocular toxicity was also evaluated. A total of 3467 ocular adverse event (AE) reports concerning anti‐HER2 agents were collected. At the preferred term (PT) level, there were 69 positive signals, among which excessive eye blinking, abnormal sensation in the eye, and asthenopia presented a significant risk. In comparison to tyrosine kinase inhibitors (TKIs), antibody drugs were associated with a broader range of ocular disorders at Standardized MedDRA Queries (SMQ)levels, including conjunctival disorders, corneal disorders, ocular infections, ocular motility disorders, optic nerve disorders, and retinal disorders. In terms of onset time, pertuzumab displayed an earlier onset at 21.5 days, while trastuzumab deruxtecan had the latest at 91.5 days. In summary, our study reveals varying degrees of ocular toxicity related to anti‐HER2 agents, with a significantly higher risk observed in antibody drugs. Additionally, novel ocular toxicity signals, not documented in product labels, have been detected. In the future, further research will be necessary to validate our findings. [ABSTRACT FROM AUTHOR]

The article provides an overview of traumatic ptosis, a condition characterized by drooping of the eyelid due to trauma. It criticizes the term "traumatic ptosis" for being too broad and not specifying the underlying cause. The article suggests subclassifying traumatic ptosis based on the specific anatomical or pathophysiological cause, such as direct injury to the eyelid retractors, neurogenic causes, or mechanical causes. It emphasizes the importance of a thorough history, examination, and appropriate imaging for accurate diagnosis and management. The prognosis and surgical outcomes for traumatic ptosis vary depending on the underlying cause, and the decision to observe or perform surgery should be individualized based on the patient's symptoms and goals. [Extracted from the article]

The most frequent neurodegenerative proteinopathies include diseases with deposition of misfolded tau or α-synuclein in the brain. Pathological protein aggregates in the PNS are well-recognized in α-synucleinopathies and have recently attracted attention as a diagnostic biomarker. However, there is a paucity of observations in tauopathies. To characterize the involvement of the PNS in tauopathies, we investigated tau pathology in cranial and spinal nerves (PNS-tau) in 54 tauopathy cases [progressive supranuclear palsy (PSP), n = 15; Alzheimer's disease (AD), n = 18; chronic traumatic encephalopathy (CTE), n = 5; and corticobasal degeneration (CBD), n = 6; Pick's disease, n = 9; limbic-predominant neuronal inclusion body 4-repeat tauopathy (LNT), n = 1] using immunohistochemistry, Gallyas silver staining, biochemistry, and seeding assays. Most PSP cases revealed phosphorylated and 4-repeat tau immunoreactive tau deposits in the PNS as follows: (number of tau-positive cases/available cases) cranial nerves III: 7/8 (88%); IX/X: 10/11 (91%); and XII: 6/6 (100%); anterior spinal roots: 10/10 (100%). The tau-positive inclusions in PSP often showed structures with fibrillary (neurofibrillary tangle-like) morphology in the axon that were also recognized with Gallyas silver staining. CBD cases rarely showed fine granular non-argyrophilic tau deposits. In contrast, tau pathology in the PNS was not evident in AD, CTE and Pick's disease cases. The single LNT case also showed tau pathology in the PNS. In PSP, the severity of PNS-tau involvement correlated with that of the corresponding nuclei, although, occasionally, p-tau deposits were present in the cranial nerves but not in the related brainstem nuclei. Not surprisingly, most of the PSP cases presented with eye movement disorder and bulbar symptoms, and some cases also showed lower-motor neuron signs. Using tau biosensor cells, for the first time we demonstrated seeding capacity of tau in the PNS. In conclusion, prominent PNS-tau distinguishes PSP from other tauopathies. The morphological differences of PNS-tau between PSP and CBD suggest that the tau pathology in PNS could reflect that in the central nervous system. The high frequency and early presence of tau lesions in PSP suggest that PNS-tau may have clinical and biomarker relevance. [ABSTRACT FROM AUTHOR]

Purpose: Lifestyle in the modern era has drastically changed across the globe, and the healthcare profession was no exception. The increased time spent in the virtual space for various purposes, including online classes and webinars, is hypothesized to increase the risk of vision-related disorders such as asthenopia, dry eyes, and visual fatigue. The purpose of this study was to evaluate fusional vergence and ocular accommodation among optometry professionals in a tertiary eye care center during the immediate post-coronavirus disease 2019 (post-COVID-19) lockdown period. Methods: Optometrists posted in the general out-patient department, specialty clinics, and the ocular diagnostics department were included in the study. A total of 65 optometrists were included in the study. All optometrists underwent a comprehensive binocular vision assessment. Convergence Insufficiency Symptom Survey questionnaires were administered to all optometrists at the beginning of the assessment. Results: Out of 65 optometrists, 48 (73.8%) were women. The mean (standard deviation) age of the participants was 24 (3) years. Eleven (16.9%) optometrists had normal binocular vision parameters, and the rest 54 (83.1%) had non-strabismic binocular vision anomalies. Reduced accommodative facility and convergence insufficiency were seen among 43 (66.2%) optometrists, whereas 30 (46.2%) had reduced accommodative facility alone. Twelve (18.5%) participants were symptomatic as per the convergence insufficiency symptom survey. Conclusion: This study highlights the fact that a large proportion of optometrists have undetected non-strabismic binocular vision anomalies in a tertiary eye care center. It is important for eye care professionals to undergo regular binocular vision assessments in association with ophthalmic examinations and relevant management. This will ensure that these dysfunctions do not impede work productivity and overall quality of life. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to analyze risk factors for ocular surface irritation symptoms in patients with non-corneal-damage inactive mild and moderate-to-severe Graves' orbitopathy (GO). Methods: This retrospective study enrolled 307 patients with non-corneal-damage inactive GO admitted to Sun Yat-sen Memorial Hospital from April 2017 to September 2023. The activity and severity of GO were evaluated using the Clinical Activity Score (CAS) and the European Group on Graves' Orbitopathy (EUGOGO) classification, respectively. Multivariate logistic regression analysis was performed to analyze risk factors for ocular surface irritation symptoms. Results: Among patients with inactive GO, for mild cases, CAS (P < 0.001), upper eyelid lag (P = 0.049), and extraocular muscle involvement (P = 0.019) in the symptomatic group were greater than those in the asymptomatic group, and multivariate logistic regression analysis demonstrated that upper eyelid lag (P = 0.048), CAS 1 (P < 0.001), CAS 2 (P = 0.005), and extraocular muscle involvement (P = 0.029) were risk factors for ocular surface irritation symptoms; for moderate-to-severe cases, CAS (P = 0.004), extraocular muscle involvement (P < 0.001), marginal reflex distance 1 (MRD1) (P = 0.030), and thyroid-stimulating hormone (TSH) (P = 0.034) in the symptomatic group were greater than those in the asymptomatic group, while multivariate logistic regression analysis indicated that extraocular muscle involvement (P = 0.018) and MRD1 (P = 0.012) were risk factors for ocular surface irritation symptoms. Conclusion: In non-corneal-damage inactive mild and moderate-to-severe GO, eyelid malposition and periocular muscle inflammation are risk factors for ocular surface irritation symptoms. Plain Language Summary: Graves' orbitopathy is the most common outward sign of Graves' disease. Patients with inactive Graves' orbitopathy often complain of ocular surface irritation symptoms. This study retrospectively collected clinical data from 307 patients with inactive Graves' orbitopathy and no concurrent corneal damage. The aim was to analyze risk factors for ocular surface irritation symptoms. Upper lid lag, eye movement disorder, and the Clinical Activity Score were found to be risk factors for mild cases. Eye movement disorder and the distance between the upper eyelid margin and corneal reflection point were risk factors for moderate-to-severe cases. To reduce symptoms, it may be helpful to treat inflammation around the eyes and address any eyelid abnormalities. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate eye and head movements, which are objective parameters in ADHD. Method: While the children were watching the course video task, which included the relevant (teacher and smart board) and irrelevant (any regions outside the relevant area) areas of interest, their eye movements were evaluated through eye tracking, and video recordings were made simultaneous. Head position estimation was made using through video recordings. The proportion of total fixation duration on areas of interest (PFDAOI) and saccade count, amplitude, velocity for eye movements, number of total head movements and angular change of head movement in x - y - z axes for head movements were compared. Results: Children with ADHD had lower PFDAOI on the relevant area, and had more saccade and head movements The angular change of head movement in the x-axis was higher in the ADHD group. Conclusion: In the assessment of ADHD, the eye and head movements may be particulary useful. [ABSTRACT FROM AUTHOR]

This document discusses the rise of diplopia, or double vision, as a side effect of neurotoxin injections used for cosmetic purposes. It emphasizes the importance of expertise in cosmetic medicine and the need for thorough examination and medical history assessment to identify any underlying vulnerabilities. The document provides information on the importance of documentation and assessment in cosmetic treatments involving neurotoxin injections, as well as the significance of proper injection technique and potential risks. It also provides instructions for conducting a comprehensive eye examination to diagnose and treat diplopia following neurotoxin injections, and highlights the importance of understanding ocular anatomy and open communication with patients. [Extracted from the article]

Early detection of dyslexia and learning disorders is vital for avoiding a learning disability, as well as supporting dyslexic students by tailoring academic programs to their needs. Several studies have investigated using supervised algorithms to screen dyslexia vs. control subjects; however, the data size and the conditions of data acquisition were their most significant limitation. In the current study, we leverage a large dataset, containing 4243 time series of eye movement records from children across Europe. These datasets were derived from various tests such as saccade, vergence, and reading tasks. Furthermore, our methods were evaluated with realistic test data, including real-life biases such as noise, eye tracking misalignment, and similar pathologies among non-scholar difficulty classes. In addition, we present a novel convolutional neural network architecture, adapted to our time series classification problem, that is intended to generalize on a small annotated dataset and to handle a high-resolution signal (1024 point). Our architecture achieved a precision of 80.20% and a recall of 75.1%, when trained on the vergence dataset, and a precision of 77.2% and a recall of 77.5% when trained on the saccade dataset. Finally, we performed a comparison using our ML approach, a second architecture developed for a similar problem, and two other methods that we investigated that use deep learning algorithms to predict dyslexia. [ABSTRACT FROM AUTHOR]

This study is to describe the special clinical and genotypic features of a Chinese family with variant types of Duane retraction syndrome and to present our experience on managing these cases. Four individuals from one family were reviewed by ophthalmologic examinations, in which two affected and two unaffected individuals were revealed. MRI scans were performed on the two patients. Relevant gene mutations were screened by the next-generation sequencing technology and confirmed by Sanger sequencing technology. The six-year-old proband presented with special clinical features of severe horizontal gaze dysfunction, exotropia and mild scoliosis. His mother showed significantly limited binocular abductions, with retraction of eyeballs in adduction. From MRI scans, abducens nerves were not observed in both patients and the oculomotor nerve was slightly thin in the proband. The proband and his mother shared the same CHN1 gene mutation site (c. 62A>G; p.Y21C). Strabismus surgery was performed on the proband to correct the primary gaze exotropia. (NM_001822: exon3 or NM_001025201: exon4: c. 62A>G; p.Y21C) A novel CHN1 gene mutation was revealed from a Chinese family with Duane retraction syndrome. Remarkably, the proband and his mother presented different clinical features of ocular motility disorder. Strabismus correction surgery and amblyopia training helped to improve the appearance and visual function of the proband. [ABSTRACT FROM AUTHOR]

Importance: Occupational therapy practitioners' knowledge of and advocacy for clients with visual symptoms postconcussion can have a considerable impact on recovery. Objective: To compare the frequency of vision symptoms and occupational performance deficits in a sample of participants with and without concussion. Design: Cross-sectional study. Setting: Sports medicine clinic. Participants: Adolescents and adults with concussion (n = 20) and musculoskeletal injuries (n = 19). Outcomes and Measures: Measures included monocular amplitude of accommodation, near point of convergence, Binocular Vision Assessment (BVA) computerized screening for phoria, BVA computerized screening for fusional vergence, the Developmental Eye Movement Test, the Canadian Occupational Performance Measure, and the Convergence Insufficiency Symptom Survey–Concussion Version (CISS–CON). Results: We found significant differences between participants with and without concussion using the CISS–CON (p =.001), positive fusional vergence (p =.02), and near point of convergence (p =.02). Participants with concussion scoring above cutoffs on multiple measures reported poorer performance (p =.005) and satisfaction (p =.004) with valued occupations. Conclusions and Relevance: Concussion has a detrimental effect on vision and occupation, and occupational therapy practitioners are well-positioned to assess and address issues arising from this relationship. Plain-Language Summary: Vision symptoms commonly experienced after a concussion are associated with reduced occupational performance and satisfaction and can have a considerable impact on recovery. Occupational therapy assessment for clients with concussion should include screening for vision difficulties. This study compares the frequency of vision symptoms and occupational performance deficits in a sample of participants with and without concussion. [ABSTRACT FROM AUTHOR]

The current data on various aspects of Brown syndrome are limited and sporadic. This review provides a coherent and comprehensive review of basic features, etiology, classification, differential diagnosis, and different management strategies of patients with Brown syndrome. In this topical review, PubMed, Scopus, and Google Scholar search engines were searched for papers, published between 1950 and January 2023 based on the keywords of this article. The related articles were collected, summarized, categorized, assessed, concluded, and presented. Brown syndrome is identified by restricted passive and active elevation of the eye in adduction. The condition is divided into congenital and acquired causes. The clinical features result from a restricted motion of the superior oblique tendon sheath through the trochlea while trying to look up in adduction. The newest explanation of the underlying pathophysiology has been explained as the presence of a fibrotic strand in the superior oblique muscle tendon with variable insertion sites which creates various elevation deficits seen in Brown syndrome. The most common clinical features include the presence of an abnormal head posture, V-pattern strabismus, and hypotropia in the primary position. Management of Brown syndrome includes watchful observation, surgical, and non-surgical procedures. Some cases might resolve spontaneously without any intervention; however, some acquired cases might require systemic and/or intra-trochlear steroid administration to treat the underlying causes. Surgical procedures such as superior oblique tenectomy and using a silicon tendon expander are indicated in the presence of hypotropia and significant abnormal head posture in the primary position. [ABSTRACT FROM AUTHOR]

Introduction: Eye movement disorder in patients with Parkinson's disease (PD) is less likely to appear when observing complex images compared with simple images. However, in case of auditory stimuli, meaningful stimuli can promote PD movement. Thus, we measured visual search movements with an eye tracker to investigate whether visual search changes in PD depending on the meaningfulness of visual stimuli; additionally, we measured event‐related potentials (ERPs) to neurophysiologically examine visual information processing in PD. Methods: Data from 11 patients with cognitively unimpaired PD and 10 neurologically healthy individuals (controls) were used in this study. We simultaneously measured eye tracking and ERPs during the observation of three types of images: operation, noun, and meaningless figures. We compared intergroup differences in visual search parameters, such as saccade count, fixation time, and saccade amplitude, as well as in ERPs vertex‐to‐vertex amplitudes and latency among P1, N1, P2, and N2 at the posterior regions. These ERPs reflect different stages of visual information processing and provide insights into the underlying neural mechanisms of visual search in PD. Results: All visual search parameters were consistently smaller in the PD group than in the control group, regardless of visual stimulus. The saccade count in the PD group was significantly lower than in the control group for operation and meaningless figures but not for noun figures. Further, P1 and N1 amplitudes—bottom–up processing—were smaller in PD group when viewing operation figures and N2 amplitudes—top–down processing—were larger in PD group when viewing operation and meaningless figures. Conclusions: PD's visual search movements may change depending on the meaningfulness of visual stimuli. Further, the abnormal visual search movements in PD may be due to insufficient bottom–up processing and excessive top–down processing. Plain Language Summary: Parkinson's disease (PD) is a neurodegenerative disorder that can cause eye movement disorders. People with PD may have difficulty searching for and processing visual information. In this study, we investigated how meaningfulness affects visual search movements and visual information processing in people with PD. We measured eye movements and brain activity in response to different types of visual stimuli, including meaningful and meaningless images, and compared them to a group of healthy control participants. Our results showed that PD patients had fewer eye movements and different brain activity patterns compared to healthy controls, regardless of the meaningfulness of the visual stimuli. However, we also found that the meaningfulness of visual stimuli had an effect on visual search movements in PD patients. This suggests that meaningfulness can impact the way people with PD process visual information. Understanding these differences could help in the development of new therapies to improve visual processing in people with PD. [ABSTRACT FROM AUTHOR]

Purpose: Newborn and infant vision screening is an essential component of the health promotion visit, where the provider screens for ocular risk factors and abnormalities that may cause future impairment or vision loss. Providers may underestimate the importance of screening or find neonatal vision assessments difficult due to poor patient cooperation or time‐consuming exams, but the reversibility of vision impairment in infants makes early detection paramount to proper treatment. This article provides a clinical review of evidence‐based, practical guidance to providers who care for infants from birth through 6 months of age in the primary care setting. Conclusions: The comprehensive eye exam in infants should include a thorough history and physical examination of eye structures, visual acuity, evaluation of extraocular movements and alignment, and assessment of the red reflex. Recommended exam maneuvers differ with age as visual acuity improves and development advances through infancy. Practice Implications: Early detection of ocular pathology is critical to avoid permanent vision loss, serious morbidity, and even mortality. The seemingly complex vision screening exam can be completed with little to no cooperation from the patient when a competent pediatric healthcare provider prioritizes opportunistic exam maneuvers. The opportunistic exam allows providers to maximize efficiency while maintaining thorough technique during vision exams and screenings. [ABSTRACT FROM AUTHOR]

The inconsistency in terminology for Cortical Visual Impairment or Cerebral Visual Impairment presents challenges: (1) different levels of changes in visual pathway and other cerebral areas do not allow discrimination; (2) different visual and oculomotor aspects are not adequately considered. We open a debate to consider a more appropriate diagnosis. [ABSTRACT FROM AUTHOR]

Although chronic lymphocytic leukemia (CLL) is the most common leukemia in the Western world, neurologic complications arising from direct leukemic involvement of the nervous system are reported in only 1% of patients with CLL. Ocular involvement in CLL, direct or indirect, is less known and exceptionally rare. This case involves a 63-year-old female with CLL undergoing chemotherapy for a year, who recently presented with unusual eye movements in the horizontal plane (ocular flutter), resting and intentional tremors in the right upper and lower limbs, and intermittent jaw movements. With no established protocol for CLL with central nervous system involvement, collecting case data becomes crucial for determining optimal treatment and diagnostic approaches early on. [ABSTRACT FROM AUTHOR]

This article discusses a unique case of spastic paraplegia 7 (SPG7), a hereditary condition characterized by progressive lower extremity weakness and spasticity. The patient in this case presented with ataxia, periodic alternating nystagmus (PAN), and progressive lower extremity spasticity. The diagnosis was confirmed through the identification of compound heterozygous mutations in the SPG7 gene. This case highlights the clinical variability and genetic complexity of SPG7 and emphasizes the importance of multidisciplinary care in diagnosis and treatment. [Extracted from the article]

Background: Overelevation in adduction is common in patients with primary esotropia. This study evaluates the variation in ocular motility pattern in patients with primary inferior oblique (IO) muscle overaction after esotropia surgery. Methods: The medical records of consecutive patients who underwent surgery for infantile, partially accommodative, and basic esotropia over eleven years and had at least one year of follow-up were reviewed. Patients with primary inferior oblique muscle overaction (IOOA) presented at baseline or during follow-up were selected and divided according to the first surgery performed concurrently with horizontal rectus surgery: without IO recession (NO-recess), with unilateral IO recession (UNIL-recess), and with bilateral IO recession (BIL-recess). The success (version normalisation or at least 2 points upgrade in severity scale [0–4] in the operated eye), recurrence rates, and the evolution of the non-operated IO muscles were evaluated. Results: One hundred and ten patients were included – 53 NO-recess, 26 UNIL-recess, and 31 BIL-recess. Medial rectus muscle posterior fixation sutures surgery (PFS) was performed in 88.2% of patients for esotropia. A recession with graded anterior transposition was the weakening IO procedure. In the NO-recess group, 28 (52.8%) patients normalised their mild IOOA after PFS surgery alone. In the UNI-recess group, the success rate was 88.5%, with 16 (61.5%) patients showing worsened IO muscle of the fellow eye, which prompted additional surgery in 10 patients. In the BIL-recess group, all 31 patients improved the adduction pattern of the operated eye for an 80.6% success rate (6 improved marginally). Conclusion: Graded anterior transposition of the inferior oblique muscle effectively normalises versions. However, it's frequent for a contralateral overaction to become manifest after unilateral IO surgery. [ABSTRACT FROM AUTHOR]

To describe a new phenotype and the diagnostic workup of a vitamin-B6-dependent epilepsy due to pyridoxal 5′-phosphate-binding protein (PLPBP) deficiency in an infant with early-onset epilepsy at the age of 5 years 6 months. Following immediate and impressive clinical response to treatment with pyridoxine, metabolic screening for vitamin-B6-dependent epilepsies and targeted next-generation sequencing (NGS)-based gene panel analysis were performed. Potentially pathogenic variants were confirmed by Sanger sequencing in the patient, and variants were analyzed in both parents to confirm biallelic inheritance. The clinical phenotype and course of disease were compared to the 44 cases reported in the literature, harboring variants in pyridoxal phosphate homeostasis protein (PLPHP) and with cases of vitamin-B6-dependent epilepsy due to other known causative genes. Levels of alpha-aminoadipic semialdehyde in urine and amino acids were normal. Two inherited pathogenic variations in PLPHP were found in compound heterozygosity, including one novel deletion. We here describe a previously unreported individual harboring biallelic pathogenic PLPHP variants presenting with paroxysmal eye–head movements followed by epileptic spasms and an almost normal interictal electroencephalogram, thus expanding the clinical spectrum of PLPBP deficiency. This warrants consideration of vitamin-B6-dependent epilepsies in patients with early-onset epilepsy, including epileptic spasms, and eye movement disorders also beyond the neonatal period even when metabolic screening for vitamin-B6-dependent epilepsies is negative. PLPHP should be included systematically in NGS epilepsy gene panels. [ABSTRACT FROM AUTHOR]

Background: Skull base chondrosarcoma is rare, arising from the clivus or petroclival junction, and usually presents as ocular motility disorders. Endonasal transsphenoidal surgery may be performed in some cases of midline clivus chondrosarcoma. Chondrosarcoma is located within the cavernous sinus and presents a softer/gelatinous mass and can be removed with suctions and curettage. We have been using a simple intradural keyhole transcavernous approach, avoiding a complex extradural transcavernous dissection. Methods: The intracavernous chondrosarcoma was removed via a 5 mm keyhole opening over the Parkinson's triangle using a standard frontotemporal intradural approach. Conclusion: Minimally invasive keyhole surgical resection can be performed to eradicate skull base chondrosarcomas, avoiding complex extradural cranial base approaches. [ABSTRACT FROM AUTHOR]

Prompt neuro-ophthalmology consultation prevents diagnostic errors and improves patient outcomes. The scarcity of neuro-ophthalmologists means that the increasing outpatient demand cannot be met, prompting many emergency department (ED) referrals by non–neuro-ophthalmologists. We describe our quaternary care institution's ED and inpatient neuro-ophthalmology consultation patterns and patient outcomes. Prospective observational study. Consecutive neuro-ophthalmology ED and inpatient consultation requests over 1 year. We collected patient demographics, distance traveled, insurance status, referring provider details, consultation question, final diagnosis, complexity of consultation, time of consultation, and need for outpatient follow-up. Consultation patterns and diagnoses, complexity, and follow-up. Of 494 consecutive adult ED and inpatient neuro-ophthalmology consultations requested over 1 year, 241 of 494 consultations (49%) occurred at night or during weekends. Of ED consultations (322 of 494 [65%]), 127 of 322 consultations (39%) occurred during weekdays, 126 of 322 consultations (39%) occurred on weeknights, and 69 of 322 consultations (22%) occurred on weekends or holidays. Of 322 ED consultations, 225 of 322 consultations (70%) were patients who initially sought treatment in the ED with a neuro-ophthalmic chief symptom. Of the 196 patients sent to the ED by a health care professional, 148 patients (148/196 [76%]) were referred by eye care specialists (74 optometrists and 74 ophthalmologists). The most common ED referral questions were for papilledema (75 of 322 [23%]) and vision loss (72 of 322 [22%]). A total of 219 of 322 patients (68%) received a final active neuro-ophthalmic diagnosis, 222 of 322 patients (69%) were cases of high or very high complexity, and 143 of 322 patients (44%) required admission. Inpatient consultations (n = 172) were requested most frequently by hospitalists, including neurologists (71 of 172 [41%]) and oncologists (20 of 172 [12%]) for vision loss (43 of 172 [25%]) and eye movement disorders (36 of 172 [21%]) and by neurosurgeons (58 of 172 [33%]) for examination for mass or a preoperative evaluation (19 of 172 [11%]). An active neuro-ophthalmic diagnosis was confirmed in 67% of patients (116 of 172). Outpatient neuro-ophthalmology follow-up was required for 291 of 494 patients (59%). Neuro-ophthalmology consultations are critical to the diagnosis and management in the hospital setting. In the face of a critical shortage of neuro-ophthalmologists, this study highlights the need for technological and diagnostic aids for greater outpatient access. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

Orbital floor fractures can cause functional disorders such as limitation of ocular motility. The dysfunction of the extrinsic muscles was studied with the Hess-Lancaster test; although we expected a large percentage of inferior rectus muscle dysfunction, the results showed 52% superior rectus muscle dysfunction. In light of these results, we began testing five patients with functional deficits evidenced by the Hess-Lancaster test with magnetic resonance imaging to assess the change in thickness of the affected muscle compared to the contralateral healthy muscle during standardized eye movements. This investigation showed an increase in the size of the inferior rectus muscle on the affected side during the fraction of time when the patient was asked to look up, probably due to post-traumatic fibrosis. According to our hypothesis, muscle thickness would condition the correct release of the inferior rectus muscle to such an extent that it would also influence the contraction of the superior rectus muscle, which would then be deficient. Based on our experience, a multidisciplinary approach and longer follow-up with thorough investigations should be considered for patients with orbital floor fractures. Furthermore, our results suggest the need for early surgical treatment, in contrast to current guidelines that aim to delay restorative surgery. [ABSTRACT FROM AUTHOR]

Introduction: Strabismus, specifically esotropia, presents a significant challenge in ophthalmic surgery, while several treatment options exist. This study aims to evaluate the results of posterior fixation sutures (PFS) on the medial rectus as a primary approach for some types of esotropia. Methods: The medical records of consecutive patients who underwent surgery for esotropia over 11 years and had at least 1 year of follow-up were reviewed retrospectively. Patients were classified into one of three types of deviation: infantile (IE), partially accommodative (PAE) and basic (BE) esotropias. An alignment within 16 prism diopters (PD) of orthotropia was a successful outcome. Results: A total of 404 patients were included: 67 IE, 180 PAE and 157 BE. Before surgery, a deviation greater than 30 PD was present in 88.1% and 80.1%, and a deviation greater than 50 PD was present in 66.5% and 52.9% of patients (near and distance, respectively). In the BE group, PFS was the baseline surgery in a smaller number of cases (75%) compared to the other two groups (versus 86.6% [IE] and 88.3% [PAE], p = 0.002). The need for an additional procedure was significantly higher in the infantile esotropia group (44.8% vs. 18.9% and 24.8%, p < 0.001). Final surgical success was achieved in 95.3% of all patients. Orthotropia was achieved in 19.4% (IE), 29.6% (PAE) and 25.5% (BE) of cases. Conclusion: PFS of the medial rectus without recession proved successful as a first-line procedure for esotropia in the subtypes of patients evaluated in this study. [ABSTRACT FROM AUTHOR]

Strabismus, also known as a squint, is an ocular misalignment. In the UK the prevalence of strabismus in children is 2.1%. There are multiple causes of strabismus in children; some of which can be sinister and are potentially eye or life threatening. Therefore it is essential that strabismus is identified and managed appropriately and in a timely manner. Amblyopia is frequently associated with strabismus, and can be a cause or a complication of strabismus, it needs to be recognized and treated early to prevent a permanent reduction in visual acuity. This article explains how to correctly assess strabismus in children. A detailed history should be taken, and an ocular examination should be performed using the correct techniques and ocular motility tests. The important red flag features of strabismus in children are also outlined in this article. [ABSTRACT FROM AUTHOR]

Nystagmus is a type of eye movement which can be physiological (normal), or associated with myriad eye disorders and neurological conditions. As such, it is commonly encountered in paediatric practice and context is key. Accordingly, children who present with apparently isolated nystagmus can cause significant clinical concern due to the bewildering number of underlying aetiologies in an otherwise broadly well child. This is compounded by the complexity of eye movement disorder definitions, descriptions, features and classification systems. Clinical workup and subsequent management of these children can be extremely variable and depend on how, and to whom the child has presented, availability of investigations and cultural familiarity with single specific causes. In this article we take the non-specialist clinician through a methodical approach to managing children with apparently isolated nystagmus in an Q and A format. We provide some key clinical practice points and discuss subsequent management. [ABSTRACT FROM AUTHOR]

Diagnosing reading disorders involves complex procedures to evaluate complex cognitive processes. For an accurate diagnosis, a series of tests and evaluations by human experts are required. In this study, we propose a quantitative tool to diagnose reading disorders based on natural reading behaviors using minimal human input. The eye movements of the third- and fourth-grade students were recorded while they read a text at their own pace. Seven machine learning models were used to evaluate the gaze patterns of the words in the presented text and classify the students as normal or having a reading disorder. The accuracy of the machine learning-based diagnosis was measured using the diagnosis by human experts as the ground truth. The highest accuracy of 0.8 was achieved by the support vector machine and random forest classifiers. This result demonstrated that machine learning based automated diagnosis could substitute for the traditional diagnosis of reading disorders and enable large-scale screening for students at an early age. [ABSTRACT FROM AUTHOR]

Background: To date, no study has specifically examined children with acute-onset pupillary motility disorders (APMD). Especially in the Emergency Department (ED), it is crucial to distinguish benign and transient conditions from life-threatening or urgent conditions (UCs). The aim of the study is to describe the clinical characteristics of children with APMD and their association with an increased risk of UCs. Methods: We conducted a pediatric retrospective study of APMD referred to ED over a 10-year period. We described the characteristics in the overall sample and in two subgroups divided according to urgency of the underlying condition. Furthermore, we applied a logistic regression model to identify the variables predictive of LT condition. Results: We analyzed 101 patients. In 59.4%, the APMD was isolated. In patients with extra-ocular involvement, the most frequently associated features were altered consciousness, headache, and vomiting. Exposure to toxic agents was reported in 48.5%. Urgent conditions occurred significantly more frequently in older children, presenting bilateral APMD and/or other ocular or extra-ocular manifestations. Conclusions: Our study shows that UCs most commonly occur in patients presenting with bilateral APMD and other associated features. In unilateral/isolated APMD ophthalmological examination, exclusion of toxic exposure and observation until resolution of symptoms should be recommended. [ABSTRACT FROM AUTHOR]

Benign Tonic Downgaze of Infancy, also known as the Pseudo-Sunset Phenomenon, is a rare ocular motility disorder that typically occurs in the first few months of life. It is characterized by a downward deviation of the eyes, which is usually temporary and resolves within weeks or months. The cause of this condition is unknown, but it is believed to be related to a delay in the maturation of the gaze reflex systems. A case study of a 5-month-old girl with this disorder is presented, detailing her symptoms, examinations, and the course of the condition. It is important to conduct a comprehensive ophthalmic evaluation and neurological assessment to rule out other underlying neurological disorders that may mimic benign tonic downgaze. [Extracted from the article]

Adverse childhood experiences predict recidivism. In incarcerated individuals, post‐traumatic stress disorder (PTSD) rates are higher. A study with 122 inmates with PTSD and substance use disorder explored eye movement desensitization and reprocessing (EMDR)'s effectiveness. EMDR worked across gender and race, reducing PCL‐C scores posttreatment and at 2 and 4 weeks. IER‐R scores lowered from weeks 1 to 9. EMDR boosted affect, reasoning, and attitudes posttreatment. [ABSTRACT FROM AUTHOR]

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