Vision - nystagmus complicates fitting?

Author

nystagmus complicates fitting?

magnulus

2004-10-07, 4:08 am

Dose nystagmus complicate fitting lenses and getting a perscription for
somebody with myopia? Every time I go to get glasses I come home with
glasses that are no better than what I had previously. I do this about
every other year or so (in many cases I re-use the frames to save money). I
finally just gave up going. My vision is such that I cannot read menus at
fast food restaurants, I don't know the actual diopter or Snellen number. I
actually think it is getting worse.

I use reading glasses when I read or do computer work (bifocals don't work
well for me because of my nystagmus, I find them hard to use), and my vision
has goten no better, it's probably even a little worse. Despite the
nystagmus, I do a fair share of reading, though it probably tires me out
alot.

I also have strabismus (without amblyopia or double vision) and I tend to
read with my left eye only and see things at a distance with both eyes or
just my right eye- lately I have been having more trouble seeing with both
eyes together. I've periodically tried patching since I was a kid, but I
keep getting headaches when doing this. Also, my left eye is much more
myopic and uncorrected than my right eye.

Dr Judy

2004-10-07, 4:08 am

"magnulus" <magnulus@bellsouth.net> wrote in message
news:yB%8d.121068$as2.60054@bignews3.bellsouth.net...
> Dose nystagmus complicate fitting lenses and getting a perscription for
> somebody with myopia? Every time I go to get glasses I come home with
> glasses that are no better than what I had previously. I do this about
> every other year or so (in many cases I re-use the frames to save money).
> I
> finally just gave up going. My vision is such that I cannot read menus at
> fast food restaurants, I don't know the actual diopter or Snellen number.
> I
> actually think it is getting worse.

Nystagmus doesn't complicate the prescription but is does limit your best
corrected acuity, ie it limits how well you will see even with the best
possible glasses.

Nystagmus means your eyes constantly move and thus they never stay in any
one spot long enough for you to see clearly. Nystagmus may be due to a
problem with the central retina of your eyes -- the central retina does not
function properly which both causes poor best corrected vision and the
nystagmus. Do you know if you have another problem?

If regular glasses are not working, you might benefit from a low vision
assessment. Ask your eye doctor or family doctor for a referral to a low
vision clinic.

For more information about nystagmus and to talk to other people with the
condition see:
http://www.nystagmus.org/

For information about low vision and a listing of low vision assessment
centres see:
http://www.afb.org/Results.asp

Dr Judy

>
> I use reading glasses when I read or do computer work (bifocals don't
> work
> well for me because of my nystagmus, I find them hard to use), and my
> vision
> has goten no better, it's probably even a little worse. Despite the
> nystagmus, I do a fair share of reading, though it probably tires me out
> alot.
>
> I also have strabismus (without amblyopia or double vision) and I tend to
> read with my left eye only and see things at a distance with both eyes or
> just my right eye- lately I have been having more trouble seeing with both
> eyes together. I've periodically tried patching since I was a kid, but I
> keep getting headaches when doing this. Also, my left eye is much more
> myopic and uncorrected than my right eye.
>
>

magnulus

2004-10-07, 11:09 am

"Dr Judy" <mpace99nospam@rogers.com> wrote in message
news:ouGdnUKuMcXrKPncRVn-qw@rogers.com...
> Nystagmus means your eyes constantly move and thus they never stay in any
> one spot long enough for you to see clearly. Nystagmus may be due to a
> problem with the central retina of your eyes -- the central retina does
not
> function properly which both causes poor best corrected vision and the
> nystagmus. Do you know if you have another problem?

I have hypoplasia of the optic nerves. My retinas are normal, more or
less. I'm familiar with nystagmus, though I have never met anybody else
with the condition, I understand it is fairly rare.

It seemed when I was a kid, a teen, I had better distance vision.

>
> If regular glasses are not working, you might benefit from a low vision
> assessment. Ask your eye doctor or family doctor for a referral to a low
> vision clinic.

I keep hearing about "low vision clinics", but I've never seen one. I
have found eye doctors in general don't have much positive to say about my
condition, that no additional treatment is necessary. I generally avoid
going to a regular doctor, I'm otherwise young and reasonably healthy... and
I just don't like them, and besides they cost money.

> For information about low vision and a listing of low vision assessment
> centres see:
> http://www.afb.org/Results.asp
>

I'll look into this.

Dr Judy

2004-10-07, 11:09 am

"magnulus" <magnulus@bellsouth.net> wrote in message
news:Uvb9d.121720$as2.107566@bignews3.bellsouth.net...
>
> "Dr Judy" <mpace99nospam@rogers.com> wrote in message
> news:ouGdnUKuMcXrKPncRVn-qw@rogers.com...
> not
>
> I have hypoplasia of the optic nerves. My retinas are normal, more or
> less. I'm familiar with nystagmus, though I have never met anybody else
> with the condition, I understand it is fairly rare.
>
> It seemed when I was a kid, a teen, I had better distance vision.
>
>
> I keep hearing about "low vision clinics", but I've never seen one. I
> have found eye doctors in general don't have much positive to say about my
> condition, that no additional treatment is necessary.

There is no treatment for nystagmus. However, a low vision clinic may be
able to provide you with magnifiers, telescopes, tinted lenses and so on to
assist you in doing your activities.

Dr Judy

I generally avoid
> going to a regular doctor, I'm otherwise young and reasonably healthy...
> and
> I just don't like them, and besides they cost money.
>
>
> I'll look into this.
>
>

Scott Seidman

2004-10-07, 11:09 am

"Dr Judy" <mpace99nospam@rogers.com> wrote in news:GOSdnZOH8Orj0PjcRVn-
og@rogers.com:

> There is no treatment for nystagmus.

That's not strictly accurate, and there's a fairly substantial literature
on the treatment of nystagmus. There are no treatments for certain
patients with congenital nystagmus, and the worse the underlying visual
problem is (i.e., BCVA if the eye were standing still), the harder it
will be to treat the nystagmus.

Often though, if you examine the actual waveform of the CN, there will be
a "foveation period" where velocity of the eye movement goes to near
zero. "Treatments" involve trying to make this foveation period longer.
Many patients with CN have some sort of "null" position, where the motion
of the CN is smallest, and the foveation period is longer.

The patients often figure this out all on there own, and it will manifest
itself as a head turn while viewing. That is, they use a head turn to
place the eyes in a position where the nystagmus is damped and they see
their best. Often, there is a CN null position at near viewing, so some
CN patients will get their noses right up against their books.

So, treatment often takes the form of using optical or surgical
techniques to move the eye to its null position while allowing the
patient to keep their head pointed straight and viewing at distance--
like base out prisms with a correction factor for the increased
accomodation to take advantage of a null at near.

Also, for some reasons contact lenses often damp CN-- possibly because of
increased afferent activity from the orbital area. It also seems like
removing the muscle insertions and tacking the EOMs back down might
help--kind of like blank strab surgery.

For acquired nystagmus, which is even more disturbing to a patient than
CN, there are some pharmacological approaches, and there's even the
dramatic introduction of botulinum toxin to the EOM's

Bottom line-- sometimes you can slow the eyes down, and if the actual
visual substrate is good enough to take advantage of this, the patient
can see better. There are a few experts scattered about the country who
help many nystagmus patients. If a patient with CN tends to get his nose
right into his books, or exhibits a head turn, that's a pretty sure sign
that the patient is treatable. If seen a number of cases where this made
the difference between passing or failing the DMV vision requirements.

Scott

magnulus

2004-10-07, 10:08 pm

"Scott Seidman" <namdiesttocs@mindspring.com> wrote in message
news:Xns957B7A7559E56scottseidmanmindspri@130.133.1.4...
> There are no treatments for certain
> patients with congenital nystagmus, and the worse the underlying visual
> problem is (i.e., BCVA if the eye were standing still), the harder it
> will be to treat the nystagmus.

I have horizontal nystagmus. It's a very rapid movement of my eyes, in a
very small amount, back and forth rythmicly, and I can't see it when I look
in the mirror (but I can feel it if I put my finger on my eyelid). I'm told
this is quite normal in a person with nystagmus.

>
> Often though, if you examine the actual waveform of the CN, there will be
> a "foveation period" where velocity of the eye movement goes to near
> zero. "Treatments" involve trying to make this foveation period longer.
> Many patients with CN have some sort of "null" position, where the motion
> of the CN is smallest, and the foveation period is longer.

Yes, I have a null position, and it's annoying. I have worked on trying
to see with both eyes straight ahead, and I can, a little, but I have
trouble reading this way- alot of trouble. Null position is annoying
becaues I worry I will have neck problems later in life and this will affect
my visual ability and comfort- I already have a long neck and some mornings
I can wake up with a stiff neck. Perhaps I need a better mattress.

> Often, there is a CN null position at near viewing, so some
> CN patients will get their noses right up against their books.

I do this alot, but I'm not sure if its myopia or nystagmus as the cause.

> So, treatment often takes the form of using optical or surgical
> techniques to move the eye to its null position while allowing the
> patient to keep their head pointed straight and viewing at distance--
> like base out prisms with a correction factor for the increased
> accomodation to take advantage of a null at near.

I have zero interest in surgery, although prismatic glasses sound
interesting and I suggested it to eye doctors, but every "eye doctor' I
have been to seems disinterested. Most of them seem to know only a little
about nystagmus, they see a case only a few times per year. I believe most
doctors told me that prismatic glasses will weigh alot and that they must be
made of glass (? not sure if I remember right). I don't want to have heavy
glasses, but I might do it if it would improve my vision.

> Also, for some reasons contact lenses often damp CN-- possibly because of
> increased afferent activity from the orbital area.

I used to wear contacts, and cleaning them was a big chore and they
weren't cheap.

>If a patient with CN tends to get his nose
> right into his books, or exhibits a head turn, that's a pretty sure sign
> that the patient is treatable.

Yes, that's exactly what I do.

I also have strabismus, but I have no idea how that interacts with my
nystagmus.

One thing that pisse me off is that I refuse to drive, and my dad is
convinced that all I need is a little willpower and I'd be driving, and he
always brings up the "super-crip" crap about how there are people much worse
off than drive around- he has a friend with only one eye who drives, blah
blah blah. I tell him I don't feel comfortable driving and that I have had
too many near-misses, and to forget about me driving. He says I'm lazy, I
disagree.

Scott Seidman

2004-10-08, 7:08 am

"magnulus" <magnulus@bellsouth.net> wrote in news:Eim9d.123400$as2.36255
@bignews3.bellsouth.net:

> I have horizontal nystagmus.

What city do you live in?

Scott

magnulus

2004-10-08, 11:08 am

"Scott Seidman" <namdiesttocs@mindspring.com> wrote in message
news:Xns957C51E9B8F36scottseidmanmindspri@130.133.1.4...
> What city do you live in?

Near Orlando

Scott Seidman

2004-10-08, 11:08 am

"magnulus" <magnulus@bellsouth.net> wrote in news:l%v9d.124930$as2.44014
@bignews3.bellsouth.net:

>
> "Scott Seidman" <namdiesttocs@mindspring.com> wrote in message
> news:Xns957C51E9B8F36scottseidmanmindspri@130.133.1.4...
>
> Near Orlando
>
>
>

The closest name I can point you to in terms of a specialist would be Ron
Tusa, at Emory in Atlanta, but I'm sure you'd be able to find someone at
Bascom Palmer who treats Congenital Nystagmus.

magnulus

2004-10-08, 10:08 pm

"Scott Seidman" <namdiesttocs@mindspring.com> wrote in message
news:Xns957C6BE8EDBC2scottseidmanmindspri@130.133.1.4...
>
> The closest name I can point you to in terms of a specialist would be Ron
> Tusa, at Emory in Atlanta, but I'm sure you'd be able to find someone at
> Bascom Palmer who treats Congenital Nystagmus.

Where is Bascom Palmer?

Why is the medical profession so ignorant of this that I cannot get a good
perscription, or a straight answer, from an optometrist? I know its an
orphan disease, but I figure an optometrist would at least know SOMETHING
about it beyond "oh yeah, there is generally no cure... you see about as
good as you ever will". I was going to this guy who claimed he was a low
vision specialist, and that's what he gave me. I would just like a straight
answer for once- and don't try and talk down to me, I have read up on this
stuff, you can talk technical with me.

THe more I study this, the more I think doctors are just inept by nature,
they don't want to know anything out of their immediate field of expertise.

Did you hear that actor John Ritter died from a ruptured aorta because the
doctors thought he was having a heart attack for hours? Aortic ruptures
kill more Americans than AIDS and many kinds of cancer, yet doctors mostly
ignore it because they are brought up to think there's not much they can do
for it- it's uninteresting.

Mike Tyner

2004-10-09, 2:08 am

"magnulus" <magnulus@bellsouth.net> wrote

> orphan disease, but I figure an optometrist would at least know SOMETHING
> about it beyond "oh yeah, there is generally no cure... you see about as
> good as you ever will". I was going to this guy who claimed he was a low
> vision specialist, and that's what he gave me. I would just like a
> straight
> answer for once- and don't try and talk down to me, I have read up on this
> stuff, you can talk technical with me.

So in your reading, have you not found any reference to treatments? I found
several with one Google search.

There are "treatments" for nystagmus but none of them work very well, and
most of them only work for some people, if at all. I believe you said you
also had optic atrophy? Isn't it possible that the low vision specialist was
shooting straight when he said nothing cures it?

Some of these treatments might reduce your nystagmus but that isn't saying
they will improve your acuity. Is cosmetic improvement all you want?

Prism glasses can help if you have a "null point." If you experience less
motion in one position of gaze, you probably already seek it out with a head
turn or tilt. If you don't have a null point, then prism glasses are pretty
worthless.

Another treatment that hasn't been mentioned in this thread (or I missed it)
is rigid contact lenses. For some with CN, the little bit of lens sensation
from this type of contact lens seems to reduce the motion of nystagmus.

Neurontin, anticonvulsants, and a glass of beer all have been suggested as
medical treatments. They may work somewhat for acquired nystagmus, but
usually little or no effect on the congenital varieties.

Finally, there are reports in the older literature of success with
biofeedback, using spectacle-mounted infrared sensors that convert your eye
motion into an audible signal. Supposedly this may help you learn to control
the motion.

-MT

magnulus

2004-10-09, 7:09 am

"Mike Tyner" <mtyner@mindspring.com> wrote in message
news:mzK9d.12941$gs1.1160@newsread2.news.atl.earthlink.net...
> There are "treatments" for nystagmus but none of them work very well, and
> most of them only work for some people, if at all. I believe you said you
> also had optic atrophy? Isn't it possible that the low vision specialist
was
> shooting straight when he said nothing cures it?

No "atrophy" about it... I was born with hypoplastic optic nerves. Last
time I went for new glasses, I asked the optometrist when he looked at the
back of my retina, I asked him about the optic nerves and he said "they look
a little small".

I was born also with a ventricular septal defect of the heart, which was
repaired. I have no idea what kind of "syndrome" that would fall under, but
my guess is there are other people out there with similar stories. My IQ
was above average as a child and I don't have webbed toes or fingers (though
I do have small epicanthic folds, and nobody in my immediate family has
this).

>
> Some of these treatments might reduce your nystagmus but that isn't saying
> they will improve your acuity. Is cosmetic improvement all you want?

No, I want better acuity. I don't like having to turn my head when I read
or get so close to many things.

>
> Prism glasses can help if you have a "null point." If you experience less
> motion in one position of gaze, you probably already seek it out with a
head
> turn or tilt. If you don't have a null point, then prism glasses are
pretty
> worthless.

I have a null point, one for each eye depending on which eye I am using (I
also have strabismus).

> Neurontin, anticonvulsants, and a glass of beer all have been suggested as
> medical treatments. They may work somewhat for acquired nystagmus, but
> usually little or no effect on the congenital varieties.

I used to take depakene (valproate) several years ago in my early 20's
(I'm 28 now)... I was taking it for headaches and psychiatric problems. It
seemed to do something to my eyes- my dad remarked about my eyes moving
around less. Maybe he was just trying to say something nice, who knows.
Nowdays I don't take it because I don't have health insurance and getting a
needle in the arm every couple of months sucked just to get some pills and
be told "your liver is fine" (well, of course it's fine, I never drink booze
and I'd not taking a high enough dosage to do anything). Oh, and depakene
made me gain alot of weight and if I ever had acid reflux that crap would do
nasty stuff to the throat.

I am surprised there has been so little research into drugs to treat
nystagmus. Surely some chemical out there would improve a condition like
this.

Ann

2004-10-09, 7:09 am

On Thu, 7 Oct 2004 21:46:19 -0400, "magnulus" <magnulus@bellsouth.net>
wrote:

> One thing that pisse me off is that I refuse to drive, and my dad is
>convinced that all I need is a little willpower and I'd be driving, and he
>always brings up the "super-crip" crap about how there are people much worse
>off than drive around- he has a friend with only one eye who drives, blah
>blah blah. I tell him I don't feel comfortable driving and that I have had
>too many near-misses, and to forget about me driving. He says I'm lazy, I
>disagree.

Oh yes, I get this too. I am a one-eyed person who refuses to drive
because it simply isn't safe. Hell, I can't even walk down the street
without bumping into people, getting taken unawares on one side all
the time so driving has to be dangerous. I used to ride a motorbike
but it gave it up as I wanted to stay alive.

I usually counteract being told that so and so only has one eye too
and drives, with something like "I think the law should state that
nobody with such a diminished area of vision should drive, it's too
dangerous, and if anyone knows that I do." That usually shuts them
up.

Ann

MSEagan

2004-10-10, 7:09 pm

Does "latent" nystagmus cause the same problems as nystagmus? When I went in
for a consulation on getting a 5th surgery for strabismis, the doctor
commented that I had latent nystagmus.

"Mike Tyner" <mtyner@mindspring.com> wrote in message
news:mzK9d.12941$gs1.1160@newsread2.news.atl.earthlink.net...
>
> "magnulus" <magnulus@bellsouth.net> wrote
>
>
> So in your reading, have you not found any reference to treatments? I
> found several with one Google search.
>
> There are "treatments" for nystagmus but none of them work very well, and
> most of them only work for some people, if at all. I believe you said you
> also had optic atrophy? Isn't it possible that the low vision specialist
> was shooting straight when he said nothing cures it?
>
> Some of these treatments might reduce your nystagmus but that isn't saying
> they will improve your acuity. Is cosmetic improvement all you want?
>
> Prism glasses can help if you have a "null point." If you experience less
> motion in one position of gaze, you probably already seek it out with a
> head turn or tilt. If you don't have a null point, then prism glasses are
> pretty worthless.
>
> Another treatment that hasn't been mentioned in this thread (or I missed
> it) is rigid contact lenses. For some with CN, the little bit of lens
> sensation from this type of contact lens seems to reduce the motion of
> nystagmus.
>
> Neurontin, anticonvulsants, and a glass of beer all have been suggested as
> medical treatments. They may work somewhat for acquired nystagmus, but
> usually little or no effect on the congenital varieties.
>
> Finally, there are reports in the older literature of success with
> biofeedback, using spectacle-mounted infrared sensors that convert your
> eye motion into an audible signal. Supposedly this may help you learn to
> control the motion.
>
> -MT
>
>

Mike Tyner

2004-10-10, 7:09 pm

"MSEagan" <swimgiraffe@yahoo.com> wrote
> Does "latent" nystagmus cause the same problems as nystagmus? When I went
> in for a consulation on getting a 5th surgery for strabismis, the doctor
> commented that I had latent nystagmus.

This is one for the nystagmus experts, which I'm not. But in this newsgroup,
qualifications aren't apparently required to offer opinions, so...

By clinical definition, LN is nystagmus that only appears when one eye is
covered, so I'd expect the answer to be "no." LN isn't likely to cause the
same problems as congenital nystagmus, which tends to be constant and
significantly decreases vision.

Presuming that you're over 12 years old and your surgery is for cosmetic
benefit rather than to give you binocular vision, I'd also guess that LN
isn't likely to change or cause new problems after surgery.

-MT

magnulus

2004-10-11, 2:08 am

"MSEagan" <swimgiraffe@yahoo.com> wrote in message
news:0yhad.234743$3l3.26074@attbi_s03...
> Does "latent" nystagmus cause the same problems as nystagmus? When I went
in
> for a consulation on getting a 5th surgery for strabismis, the doctor
> commented that I had latent nystagmus.
>

This means you have nystagmus when you are only seeing through one eye,
but not both eyes together If this is possible, not all people with
strabismus can have stereoscopic vision). The eye with nystagmus is the one
turned "off", I believe.

Scott Seidman

2004-10-11, 11:09 am

"Mike Tyner" <mtyner@mindspring.com> wrote in
news:mzK9d.12941$gs1.1160@newsread2.news.atl.earthlink.net:

> There are "treatments" for nystagmus but none of them work very well,
> and most of them only work for some people, if at all. I believe you
> said you also had optic atrophy? Isn't it possible that the low vision
> specialist was shooting straight when he said nothing cures it?
>

While none of the treaments are 100%, and those with real problems on the
visual substrate (i.e., those who wouldn't see well if the eyes were
standing dead still) obviously wouldn't benefit from any of them, some
patients can benefit quite dramatically. Those patients will tell you
that its worth trying to identify them.

In this case, if the optic atrophy is dramatic, perhaps the low vision
specialist is right. Keep in mind, though, that the nystagmus effects
the eye exam, as well as the patient's vision. It's hard to image a
wiggling macula.

If it were me, I'd try to see a strabismologist with experience treating
nystagmus, or a neuro-ophth who was trained primarily as a neurologist--
not a low-vision specialist, necessarily.

> Some of these treatments might reduce your nystagmus but that isn't
> saying they will improve your acuity. Is cosmetic improvement all you
> want?
>
This patient is complaining of neck problems because of a dramatic head
turn. Resolving the head turn doesn't seem entirely cosmetic. In fact,
if the prism approach did nothing more than to resolve a dramatic head
turn, wouldn't that be a little like doing strab surgery on an adult--
not necessarily benefitting vision, but making the patient less self
concious?

> Prism glasses can help if you have a "null point." If you experience
> less motion in one position of gaze, you probably already seek it out
> with a head turn or tilt. If you don't have a null point, then prism
> glasses are pretty worthless.

This patient already has a head turn, which is fairly compelling evidence
that there is a null that can be taken advantage of. Often, in patients
with a head turn, the null associated with near vision is markedly better
than the null associated with eccentric gaze-- thus a base-out approach
(compensated, of course, for accomodation at near) is often more
successful than the patients can achieve on their own with a head turn,
or with parallel prisms. There are some little tricks that the provider
and optician needs to know, like making sure the prisms are edge-treated
to keep out annoying light, and never forgetting to adjust any correction
for accomodation.

While precise eye movement recordings will categorically display where
the nystagmus is quietest, it really doesn't cost very much to rig up the
patient in a trial set with about 15 diopters base out split between two
eyes, with a 1 diopter lens for accomodation, and then point the patient
at an eye chart and ask them to read OU.

Scott

Dan Abel

2004-10-11, 7:10 pm

In article <dpffm09nr9893tcn0c12ckce9612b8m3n4@4ax.com>, Ann
<me@privacy.net> wrote:

> Oh yes, I get this too. I am a one-eyed person who refuses to drive
> because it simply isn't safe. Hell, I can't even walk down the street
> without bumping into people, getting taken unawares on one side all
> the time so driving has to be dangerous. I used to ride a motorbike
> but it gave it up as I wanted to stay alive.
>
> I usually counteract being told that so and so only has one eye too
> and drives, with something like "I think the law should state that
> nobody with such a diminished area of vision should drive, it's too
> dangerous, and if anyone knows that I do." That usually shuts them
> up.

While I respect your decision, and don't think that anyone should drive
who doesn't feel safe driving, I don't agree that two eyes are necessary,
and neither does the State of California, fortunately for my wife and I.
My wife has had severe amblyopia her whole life, and has best vision in
her right eye of 20/800 corrected. Her left eye is fine. She is
comfortable driving. I have lost much of my vision in my right eye. I am
comfortable driving also.

--
Dan Abel
Sonoma State University
AIS
dabel@sonic.net

Dr Judy

2004-10-11, 10:08 pm

"magnulus" <magnulus@bellsouth.net> wrote in message
news:O6P9d.126315$as2.28093@bignews3.bellsouth.net...
>
> "Mike Tyner" <mtyner@mindspring.com> wrote in message
> news:mzK9d.12941$gs1.1160@newsread2.news.atl.earthlink.net...
> was
>
> No "atrophy" about it... I was born with hypoplastic optic nerves. Last
> time I went for new glasses, I asked the optometrist when he looked at the
> back of my retina, I asked him about the optic nerves and he said "they
> look
> a little small".
>
> I was born also with a ventricular septal defect of the heart, which was
> repaired. I have no idea what kind of "syndrome" that would fall under,
> but
> my guess is there are other people out there with similar stories. My IQ
> was above average as a child and I don't have webbed toes or fingers
> (though
> I do have small epicanthic folds, and nobody in my immediate family has
> this).
>
>
> No, I want better acuity. I don't like having to turn my head when I
> read
> or get so close to many things.

Since you don't want to turn your head or hold things close but want what
both those strategies will deliver (better acuity), your low vision
specialists are right in saying nothing can be done for you.

The first requirement for sucess with low vision treatment is that the
patient accept that he/she has a problem that conventional vision correction
cannot help and be willing to try unconventional things like turning a head
or holding things close. If what you want is normal vision with normal
correction, it cannot be done.

BTW, what is your best corrected acuity? You mentioned driving and
obtaining a driver's license requires pretty good vision; if your vision is
not that bad and you want better, your doctors again will be telling you it
can't be done.

Dr Judy

>
> head
> pretty
>
> I have a null point, one for each eye depending on which eye I am using
> (I
> also have strabismus).
>
>
> I used to take depakene (valproate) several years ago in my early 20's
> (I'm 28 now)... I was taking it for headaches and psychiatric problems.
> It
> seemed to do something to my eyes- my dad remarked about my eyes moving
> around less. Maybe he was just trying to say something nice, who knows.
> Nowdays I don't take it because I don't have health insurance and getting
> a
> needle in the arm every couple of months sucked just to get some pills and
> be told "your liver is fine" (well, of course it's fine, I never drink
> booze
> and I'd not taking a high enough dosage to do anything). Oh, and depakene
> made me gain alot of weight and if I ever had acid reflux that crap would
> do
> nasty stuff to the throat.
>
> I am surprised there has been so little research into drugs to treat
> nystagmus. Surely some chemical out there would improve a condition like
> this.
>
>

Scott Seidman

2004-10-12, 2:08 am

"magnulus" <magnulus@bellsouth.net> wrote in news:Eim9d.123400$as2.36255
@bignews3.bellsouth.net:

> I have horizontal nystagmus.

What city do you live in?

Scott

Mike Tyner

2004-10-12, 2:08 am

magnulus

2004-10-12, 7:07 am

"Dr Judy" <mpace99nospam@rogers.com> wrote in message
news:DeCdnS2E9rMWuPbcRVn-pw@rogers.com...
> Since you don't want to turn your head or hold things close but want what
> both those strategies will deliver (better acuity), your low vision
> specialists are right in saying nothing can be done for you.

So prisms in glasses will do nothing for me? I was under the impresion
they would.

> The first requirement for sucess with low vision treatment is that the
> patient accept that he/she has a problem that conventional vision
correction
> cannot help and be willing to try unconventional things like turning a
head
> or holding things close.

I'm getting tired of turning my head, it is frustrating to know you are
using a system your brain cobbled together, rather than really seeing like
everybody else. I cannot even read with my right eye. I see words, but
they just don't go into my brain- it's like I cannot focus on words- at
least I cannot read with my right eye closeup (give me a large sign a few
feet away, and sure, I could read it). Does that sound wierd? I use my
left eye for reading. I can watch TV with my right eye. Sometimes I can
see with both eyes, like for driving a car, playing a game, occasionally
watching TV. But if there's any text in the game at all, I often find
myself going into a "reading mode" and getting up close to the screen. (
BTW, one cool thing about PC games now days is 3D sound. You can put on a
pair of headphones and you can hear things comming from all around you-
gunshots, monsters, etc.. I must have a very developed sense of hearing
because I find that when a game has this, it is often a very important "cue"
as to where things are, so much so that turning this off makes many games
unplayable). As I said, I have been playing videogames ever since I was a
kid, in fact this is something that the opthamologists I went to when I was
a small child suggested.

I have practiced driving in real life but sometimes I feel like there are
"blind spots" in my vision. Sometimes my eyes feel tired and if cars are
moving around me, I start panicking (I once swerved when a jogger "popped
out of nowhere", and I nearly hit another car to my left- after that, I just
haven't had the courage to try driving again). I feel like things are
moving too quickly for me to follow them (I wish sometimes there were a
"pause" key). Florida does not allow bioptics, nor would I want to wear
them anyways, as I believe they would be a visual distraction.

> If what you want is normal vision with normal
> correction, it cannot be done.

But can my vision be improved any, that is what I really want to know.
Can I live and learn to read without turning my head? I don't like living
like this.

> BTW, what is your best corrected acuity? You mentioned driving and
> obtaining a driver's license requires pretty good vision; if your vision
is
> not that bad and you want better, your doctors again will be telling you
it
> can't be done.

I got a learner's permit in Oklahoma where vision requirements are pretty
lax (I think it is 20/100... here in Florida it is 20/70, 20/40 in both
eyes, I believe- it is so darn confusing to figure out). During highschool,
I was in a special PE program and did not take drivers ed. In college (I
went to a community college), I paid for some drivers education classes, and
my driving instructor said he believed I shouldn't be driving, so I just
quit driving- soon after I moved home back to Florida with my parents (I was
living with my extended kin in Oklahoma). I don't know if that sank in and
became a self-fullfilling prophecy, maybe he was just telling the truth.

I really don't know what my vision acuity is- I don't remember what my
perscription is (it is not too bad though, I believe it is less than my
parents, who have something like 7 diopters?). All I know is I cannot read
menus at fast food restaurants standing behind a counter, and I cannot read
many street signs when riding in a car. Using a printed out Snellen eye
chart- my vision I believe is around 20/70 or so in my worst eye- and that's
with closing the other eye and turning my head- I cannot read much beyond
the first couple of lines without doing this. But I may be doing the test
wrong.

Last time I went to the eye doctor and did the whole "is this better... or
this one" approach, the perscription I ended up with, was just as lousy as
before. It didn't improve my vision at all. So my vision has been
consistently bad for over 6 years or so.

I went to a guy that claimed to be a "low vision specialist", he was an
old cracker guy who had worked as optometrist in Korea in the war. He
didn't do much for me really, and wouldn't tell me if my vision was good
enough to drive or not. So I just started going to the optometrist at
these mall glasses stores. Last time I went, I made it clear to the
optometrist that I had nystagmus, that for optimal vision, I had to turn my
head to see well to even read the eye chart. He discovered I have a
v-syndrome, which I never knew I had, as well. But guess what... the
perscription he gave me was hardly different than what the other optometrist
gave me.

I use seperate reading glasses for near-work and the computer, too.
Sometimes they seem too blurry, especially for my left eye. Maybe I dont'
really need reading glasses. I sit about arm's length from the screen.

Scott Seidman

2004-10-12, 11:08 am

"Dr Judy" <mpace99nospam@rogers.com> wrote in
news:DeCdnS2E9rMWuPbcRVn-pw@rogers.com:

> Since you don't want to turn your head or hold things close but want
> what both those strategies will deliver (better acuity), your low
> vision specialists are right in saying nothing can be done for you.
>

I don't understand why you think using parallel prisms to move the eyes to
an eccentric position when the eye is straight ahead ("simulating" a head
turn) or base outs to produce vergence for far gaze won't work.

The ocular motor lab I was mentored in had a closely affiliated CN lab.
Off the top of my head, I'd estimate that at least 30% of the CN patients
that came in had an immediate improvement in visual acuity by one of these
methods of at least two lines--- and the head turn goes away because its no
longer necessary. If these methods work, and the patient doesn't like the
prisms, strab surgery is usually successful.

There is a literature on such techniques, and many papers on them are cited
in Leigh and Zee, The Neurology of Eye Movements.

Scott

Mike Tyner

2004-10-12, 7:11 pm

Dr Judy

2004-10-12, 10:08 pm

"magnulus" <magnulus@bellsouth.net> wrote in message
news:bLNad.76628$yp.16464@bignews1.bellsouth.net...
>
> "Dr Judy" <mpace99nospam@rogers.com> wrote in message
> news:DeCdnS2E9rMWuPbcRVn-pw@rogers.com...
>
> So prisms in glasses will do nothing for me? I was under the impresion
> they would.

If turning your head helps, prism might help too (you would need to see try
it to know). However, in an earlier post I thought you said you didn't want
prisms either. Prisms would not deliver better vision than turning your
head does.

> correction
> head
>
> I'm getting tired of turning my head, it is frustrating to know you are
> using a system your brain cobbled together, rather than really seeing like
> everybody else. I cannot even read with my right eye. I see words, but
> they just don't go into my brain- it's like I cannot focus on words- at
> least I cannot read with my right eye closeup (give me a large sign a few
> feet away, and sure, I could read it). Does that sound wierd?

You mentioned strabismus, is your right eye also amblyopic (lazy)? If so,
you will not be able to see detail with it.

snip
>
> But can my vision be improved any, that is what I really want to know.
> Can I live and learn to read without turning my head? I don't like living
> like this.

Prism would be the only alternative to head turn. Contact your local
Association for the Blind and get a referral to a good low vision clinic.

>
> is
> it
>
>
> Last time I went to the eye doctor and did the whole "is this better...
> or
> this one" approach, the perscription I ended up with, was just as lousy as
> before. It didn't improve my vision at all. So my vision has been
> consistently bad for over 6 years or so.

Since your vision is limited by the nystagmus, not glasses prescription.
Your "best corrected" vision is reduced and glasses will not improve it.
Prism glasses might make it as good as it is when you turn your head.

Dr Judy

Ann

2004-10-13, 11:10 am

On Tue, 12 Oct 2004 22:19:17 -0400, "Dr Judy"
<mpace99nospam@rogers.com> wrote:

>
>"magnulus" <magnulus@bellsouth.net> wrote in message
>news:bLNad.76628$yp.16464@bignews1.bellsouth.net...
>
>If turning your head helps, prism might help too (you would need to see try
>it to know). However, in an earlier post I thought you said you didn't want
>prisms either. Prisms would not deliver better vision than turning your
>head does.
>
>
>You mentioned strabismus, is your right eye also amblyopic (lazy)? If so,
>you will not be able to see detail with it.
>
>snip
>
>Prism would be the only alternative to head turn. Contact your local
>Association for the Blind and get a referral to a good low vision clinic.

NOoooooo... as a complete bystander here who has watched this whole
discussion, I've been persuaded that this guy needs to go to a
specialist and not a low vision clinic. I hope he does and I hope he
tells us how he got on.

Ann

>
>Since your vision is limited by the nystagmus, not glasses prescription.
>Your "best corrected" vision is reduced and glasses will not improve it.
>Prism glasses might make it as good as it is when you turn your head.
>
>Dr Judy
>

magnulus

2004-10-13, 11:10 am

"Dr Judy" <mpace99nospam@rogers.com> wrote in message
news:auqdnWzJje82DfHcRVn-qg@rogers.com...
> If turning your head helps, prism might help too (you would need to see
try
> it to know). However, in an earlier post I thought you said you didn't
want
> prisms either. Prisms would not deliver better vision than turning your
> head does.

Would I be able to move my eyes to track words when reading, or would
prisms prohibit this?

Currently, when I read, I have to move my head a little to follow words,
to varying degrees. It's not just I have a null point but I have to move my
head, my eyes really cannot follow the words too much. Perhaps I should be
using a larger font for the computer.

> You mentioned strabismus, is your right eye also amblyopic (lazy)? If so,
> you will not be able to see detail with it.

No, no no... Neither of my eyes has amblyopia the last time I went to a
doctor. I can see out of both of them, but I see a little differently with
each eye- I have an easier time reading with my left eye, and my right eye
has a little better distance vision. I can look through both eyes and I
have some depth perception (for instance, I can see viewmaster toys), but
often it takes some concentration on my part. Often, I just look out of one
eye or the other. I never have doubled vision. Does this make sense?

I am afraid if I ever lost vision in one eye or the other, I would be
unable to do alot of things that I now take for granted, like reading (well,
as for granted as somebody with low vision/nystagmus can take that).

> Since your vision is limited by the nystagmus, not glasses prescription.
> Your "best corrected" vision is reduced and glasses will not improve it.
> Prism glasses might make it as good as it is when you turn your head.

Well jee, you don't think turning my head is frustrating? What planet are
you from? Don't eye muscles work alot more efficiently than neck muscles?

OK, I have lived with it for 28 years or so... so I'm not sure I'd know it
any other way.

For some reason, when I talked to the optician/optometrist about prismatic
glasses, they tried to disuade me from it... but I forgot about the reason
why. Are they heavy glasses, perhaps they are thick and made from glass?+

magnulus

2004-10-13, 11:10 am

How successful is the surgery on the eyes, and does it benefit somebody
with a known etiology for their nystagmus, namely, optic nerve hypoplasia?

Eye surgery gives me the heebee jeebees, just the thought of it. The eye
is fairly fragile to begin with (and you only have two of them), and then
they have to do all this stuff to it just to get to it. If I found out it
had a poor success rate, or required multiple "retouches"... you could count
me out. Add onto that, the fact I don't even have health insurance, and it
becomes problematic. I just wouldn't want that frustration.

Scott Seidman

2004-10-13, 11:10 am

"magnulus" <magnulus@bellsouth.net> wrote in
news:5E7bd.164074$as2.38338@bignews3.bellsouth.net:

> How successful is the surgery on the eyes, and does it benefit
> somebody
> with a known etiology for their nystagmus, namely, optic nerve
> hypoplasia?
>
> Eye surgery gives me the heebee jeebees, just the thought of it. The
> eye
> is fairly fragile to begin with (and you only have two of them), and
> then they have to do all this stuff to it just to get to it. If I
> found out it had a poor success rate, or required multiple
> "retouches"... you could count me out. Add onto that, the fact I
> don't even have health insurance, and it becomes problematic. I just
> wouldn't want that frustration.
>
>
>

The worse your vision is when your eyes are standing perfectly still, the
worse the chances of any successful treatment. Some of the surgical
approaches are simply to build the optical approaches right into the eye--
so if prisms won't work, these surgeries won't work. There's a newer
procedure that simply reinserts all the eye muscles, without trying to move
the eye. The outcomes there would be less likely to be correlated with the
optical approaches, but I'm not real up on how successful it is.

Scott

Scott Seidman

2004-10-13, 11:10 am

"Dr Judy" <mpace99nospam@rogers.com> wrote in
news:auqdnWzJje82DfHcRVn-qg@rogers.com:

> If turning your head helps, prism might help too (you would need to
> see try it to know). However, in an earlier post I thought you said
> you didn't want prisms either. Prisms would not deliver better vision
> than turning your head does.
>

This is fairly accurate, but if vergence suppresses the nystagmus better
than eccentric gaze, base-outs might very well improve vision better than
the head turn.

Scott

Ann

2004-10-13, 11:10 am

On Wed, 13 Oct 2004 06:35:14 -0400, "magnulus"
<magnulus@bellsouth.net> wrote:

>
>"Dr Judy" <mpace99nospam@rogers.com> wrote in message
>news:auqdnWzJje82DfHcRVn-qg@rogers.com...
>try
>want
>
> Would I be able to move my eyes to track words when reading, or would
>prisms prohibit this?
>
> Currently, when I read, I have to move my head a little to follow words,
>to varying degrees. It's not just I have a null point but I have to move my
>head, my eyes really cannot follow the words too much. Perhaps I should be
>using a larger font for the computer.
>
>
> No, no no... Neither of my eyes has amblyopia the last time I went to a
>doctor. I can see out of both of them, but I see a little differently with
>each eye- I have an easier time reading with my left eye, and my right eye
>has a little better distance vision. I can look through both eyes and I
>have some depth perception (for instance, I can see viewmaster toys), but
>often it takes some concentration on my part. Often, I just look out of one
>eye or the other. I never have doubled vision. Does this make sense?
>
> I am afraid if I ever lost vision in one eye or the other, I would be
>unable to do alot of things that I now take for granted, like reading (well,
>as for granted as somebody with low vision/nystagmus can take that).
>
>
> Well jee, you don't think turning my head is frustrating? What planet are
>you from? Don't eye muscles work alot more efficiently than neck muscles?
>
> OK, I have lived with it for 28 years or so... so I'm not sure I'd know it
>any other way.
>
> For some reason, when I talked to the optician/optometrist about prismatic
>glasses, they tried to disuade me from it... but I forgot about the reason
>why. Are they heavy glasses, perhaps they are thick and made from glass?+

My sister has prisms in her glasses for some other reason and her
glasses look normal, I'm pretty sure they aren't glass either.

Ann

magnulus

2004-10-13, 11:10 am

Dr Judy

2004-10-14, 7:13 pm

"Ann" <me@privacy.net> wrote in message
news:vtnpm0libf81gs37s4bop2u3rbo1hvoqr1@4ax.com...
> On Tue, 12 Oct 2004 22:19:17 -0400, "Dr Judy"
> <mpace99nospam@rogers.com> wrote:

snip
>
> NOoooooo... as a complete bystander here who has watched this whole
> discussion, I've been persuaded that this guy needs to go to a
> specialist and not a low vision clinic. I hope he does and I hope he
> tells us how he got on.

A low vision clinic specializes in people with sub normal vision and the
doctors there will have experience with nystagmus and prism treatment.

Dr Judy

>
> Ann
>
>

Dr Judy

2004-10-14, 7:13 pm

"magnulus" <magnulus@bellsouth.net> wrote in message
news:nw7bd.163995$as2.154191@bignews3.bellsouth.net...
>
> "Dr Judy" <mpace99nospam@rogers.com> wrote in message
> news:auqdnWzJje82DfHcRVn-qg@rogers.com...
> try
> want
>
> Would I be able to move my eyes to track words when reading, or would
> prisms prohibit this?
>
> Currently, when I read, I have to move my head a little to follow words,
> to varying degrees. It's not just I have a null point but I have to move
> my
> head, my eyes really cannot follow the words too much. Perhaps I should
> be
> using a larger font for the computer.
>
>
> No, no no... Neither of my eyes has amblyopia the last time I went to a
> doctor. I can see out of both of them, but I see a little differently
> with
> each eye- I have an easier time reading with my left eye, and my right eye
> has a little better distance vision. I can look through both eyes and I
> have some depth perception (for instance, I can see viewmaster toys), but
> often it takes some concentration on my part. Often, I just look out of
> one
> eye or the other. I never have doubled vision. Does this make sense?
>
> I am afraid if I ever lost vision in one eye or the other, I would be
> unable to do alot of things that I now take for granted, like reading
> (well,
> as for granted as somebody with low vision/nystagmus can take that).
>
>
> Well jee, you don't think turning my head is frustrating? What planet are
> you from? Don't eye muscles work alot more efficiently than neck muscles?

Not sure what you mean here. Your problem is not with eye or neck muscles,
it is with the neurology to the eye muscles. Both turning your head and
prisms will allow the eyes to assume their nystagmus null point. The best
vision you can hope for is the vision at the null point, whether achieved by
neck turn or prism.

>
> OK, I have lived with it for 28 years or so... so I'm not sure I'd know
> it
> any other way.
>
> For some reason, when I talked to the optician/optometrist about
> prismatic
> glasses, they tried to disuade me from it... but I forgot about the reason
> why. Are they heavy glasses, perhaps they are thick and made from glass?+

Prism can be done in glass or plastic, plastic is lighter. Prism will make
lenses thicker, how much thicker depends upon how much prism will be needed.
For large amounts of prism "Fresnel" prisms can be used, they are thin,
plastic prisms that stick onto your regular lenses.

Dr Judy

Dr Judy

2004-10-14, 7:13 pm

"magnulus" <magnulus@bellsouth.net> wrote in message
news:5E7bd.164074$as2.38338@bignews3.bellsouth.net...
> How successful is the surgery on the eyes, and does it benefit somebody
> with a known etiology for their nystagmus, namely, optic nerve hypoplasia?

There isn't surgery for nystagmus. There is surgery for strabismus and
success depends on a number of individual factors that require an eye exam
by a surgeon to discuss.

Dr Judy

> Eye surgery gives me the heebee jeebees, just the thought of it. The eye
> is fairly fragile to begin with (and you only have two of them), and then
> they have to do all this stuff to it just to get to it. If I found out it
> had a poor success rate, or required multiple "retouches"... you could
> count
> me out. Add onto that, the fact I don't even have health insurance, and
> it
> becomes problematic. I just wouldn't want that frustration.
>
>

Scott Seidman

2004-10-14, 7:13 pm

"Dr Judy" <mpace99nospam@rogers.com> wrote in
news:1JGdndPrxKZRUvPcRVn-hw@rogers.com:

> There isn't surgery for nystagmus. There is surgery for strabismus
> and success depends on a number of individual factors that require an
> eye exam by a surgeon to discuss.
>
>

There are surgical procedures that have been successfully employed on
nystagmus patients without strabismus. These surgeries, like many
surgeries on the eye muscles, use the same techniques as surgeries
typically used for strabismus, and are probably best carried out by strab
surgeons, as they have the most experience with such cases. However, the
procedures are "for" whatever disorder they are being used to treat.
Regardless of the semantic argument, there are a variety of surgical
approaches, some normally associated with strabismus, used to treat CN on
patients who do not have strabismus.

I've taken the liberty of attaching the abstracts of two papers, the
first from the heavily peer reviewed "Ophthalmology" describing one such
surgical procedure, and the second from Annals NYAS, which largely
publishes meeting proceedings (and as such is not necessarily rigorously
peer reviewed), and it reviews optical and surgical approaches.

Scott

****************
Authors
Hertle RW. Dell'Osso LF. FitzGibbon EJ. Thompson D. Yang D. Mellow SD.
Institution
Pediatric Ophthalmology Associates and The Laboratory of Visual and
Ocular Motor Physiology, Columbus Children's Hospital, The Ohio State
University, Columbus, Ohio 43205, USA.
Title
Horizontal rectus tenotomy in patients with congenital nystagmus: results
in 10 adults.
Source
Ophthalmology. 110(11):2097-105, 2003 Nov.
Abstract
OBJECTIVE: We wished to determine the effectiveness of horizontal rectus
tenotomy in changing the nystagmus of patients with congenital nystagmus
and, secondarily, how their visual function changed. DESIGN: This was a
prospective, noncomparative, interventional case series. PARTICIPANTS:
Ten adult patients with varied associated sensory defects and
oculographic subtypes of congenital nystagmus (including asymmetric
periodic or aperiodic alternating nystagmus) and no nystagmus treatment
options. METHODS: By using standard surgical techniques, simple tenotomy
of all four horizontal recti with reattachment at the original insertion
was accomplished. Search-coil eye movement recordings and clinical
examinations were performed before and 1, 6, 24, and 52 weeks after
surgery. MAIN OUTCOME MEASURES: The primary outcome measure was the
expanded nystagmus acuity function, obtained in "masked" fashion directly
from ocular motility recordings. Secondary outcomes included breadth of
null zones, preoperative and postoperative masked measures of visual
acuity (Early Treatment Diabetic Retinopathy Study [ETDRS] chart), and
the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25).
RESULTS: At 1 year after tenotomy and under binocular conditions, 9 of 10
patients had persistent, significant postoperative increases in the
expanded nystagmus acuity function of their fixing (preferred) eye; 1
remained high, and 1 was not tested under the same conditions. Average
foveation times increased in all 9 fixing (preferred) eyes. Binocular
visual acuity measured with the ETDRS chart increased in 5 patients and
was unaffected in five, whereas the NEI-VFQ-25 showed an improvement in
vision-specific mental health in 9 patients. There were no adverse
events. Tenotomy also radically changed the periodicity of one patient's
asymmetric periodic or aperiodic alternating nystagmus. CONCLUSIONS: In 9
of 10 adult patients with clinical and oculographic variations in their
congenital nystagmus, tenotomy resulted in significant improvements in a
nystagmus measure and subjective visual functions.

***************
Unique Identifier
11960819
Authors
Dell'Osso LF.
Institution
Ocular Motor Neurophysiology Laboratory, Veterans Affairs Medical Center,
Cleveland, OH 44106, USA.
Title
Development of new treatments for congenital nystagmus. [Review] [64
refs]
Source
Annals of the New York Academy of Sciences. 956:361-79, 2002 Apr.
Abstract
The use of ocular motor data as the basis for the development of both
nonsurgical and surgical therapies for congenital nystagmus (CN) has been
underway since the mid-1960s. This paper presents three nonsurgical
therapies (composite prisms, soft contact lenses, and afferent
stimulation) and a new surgical therapy (four-muscle tenotomy)
hypothesized from analysis of ocular motor data. The expanded nystagmus
acuity function test was developed to both predict and measure the
effectiveness of CN therapies and for intersubject comparisons. Base-out
prisms may be used to damp CN during distance fixation in patients whose
CN damps during near fixation and who are binocular (i.e., they have no
strabismus). Soft contact lenses may be used in those whose CN damps with
afferent stimulation of the ophthalmic division of the trigeminal nerve.
Cutaneous afferent stimulation (rubbing, vibration, or electricity) of
the forehead or neck damps CN in some individuals. Finally, as first
demonstrated in an achiasmic Belgian sheepdog and later in humans,
tenotomy of the four horizontal rectus muscles and reattachment at their
original sites may also damp CN. Taken together, these findings suggest
the existence of one or more proprioceptive feedback loops acting to
change the small-signal gain of the extraocular plant. Four-muscle
tenotomy provides a needed therapeutic option for the many individuals
with CN for whom other surgical therapies are contraindicated. Tenotomy
may also prove useful in see-saw nystagmus (it abolished it in the
aforementioned canine) or other types of nystagmus; further studies of
the latter are required. [References: 64]

Dave

2004-10-14, 10:09 pm

I have congenital nystagmus and have worn 5 diopler base out
prisms in each eye. They do reduce my nystagmus, but have do
not have much improvement in my vision. But I do feel that
my overall functional vision is better. However a few times when
I wake up, I started having double vision. After a few seconds, it goes
away. Could this be caused by the wearing of the prism glasses? Also are
there any good articles in any medical journals on the effects of base out
prisms on nystagmus?

Mike vision between 20/30 - 20/40

Scott Seidman <namdiesttocs@mindspring.com> wrote in message news:<Xns9582B2A074DDCscottseidmanmindspri@130.133.1.4>...
> "Dr Judy" <mpace99nospam@rogers.com> wrote in
> news:1JGdndPrxKZRUvPcRVn-hw@rogers.com:
>
>
> There are surgical procedures that have been successfully employed on
> nystagmus patients without strabismus. These surgeries, like many
> surgeries on the eye muscles, use the same techniques as surgeries
> typically used for strabismus, and are probably best carried out by strab
> surgeons, as they have the most experience with such cases. However, the
> procedures are "for" whatever disorder they are being used to treat.
> Regardless of the semantic argument, there are a variety of surgical
> approaches, some normally associated with strabismus, used to treat CN on
> patients who do not have strabismus.
>
> I've taken the liberty of attaching the abstracts of two papers, the
> first from the heavily peer reviewed "Ophthalmology" describing one such
> surgical procedure, and the second from Annals NYAS, which largely
> publishes meeting proceedings (and as such is not necessarily rigorously
> peer reviewed), and it reviews optical and surgical approaches.
>
> Scott
>
>
> ****************
> Authors
> Hertle RW. Dell'Osso LF. FitzGibbon EJ. Thompson D. Yang D. Mellow SD.
> Institution
> Pediatric Ophthalmology Associates and The Laboratory of Visual and
> Ocular Motor Physiology, Columbus Children's Hospital, The Ohio State
> University, Columbus, Ohio 43205, USA.
> Title
> Horizontal rectus tenotomy in patients with congenital nystagmus: results
> in 10 adults.
> Source
> Ophthalmology. 110(11):2097-105, 2003 Nov.
> Abstract
> OBJECTIVE: We wished to determine the effectiveness of horizontal rectus
> tenotomy in changing the nystagmus of patients with congenital nystagmus
> and, secondarily, how their visual function changed. DESIGN: This was a
> prospective, noncomparative, interventional case series. PARTICIPANTS:
> Ten adult patients with varied associated sensory defects and
> oculographic subtypes of congenital nystagmus (including asymmetric
> periodic or aperiodic alternating nystagmus) and no nystagmus treatment
> options. METHODS: By using standard surgical techniques, simple tenotomy
> of all four horizontal recti with reattachment at the original insertion
> was accomplished. Search-coil eye movement recordings and clinical
> examinations were performed before and 1, 6, 24, and 52 weeks after
> surgery. MAIN OUTCOME MEASURES: The primary outcome measure was the
> expanded nystagmus acuity function, obtained in "masked" fashion directly
> from ocular motility recordings. Secondary outcomes included breadth of
> null zones, preoperative and postoperative masked measures of visual
> acuity (Early Treatment Diabetic Retinopathy Study [ETDRS] chart), and
> the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25).
> RESULTS: At 1 year after tenotomy and under binocular conditions, 9 of 10
> patients had persistent, significant postoperative increases in the
> expanded nystagmus acuity function of their fixing (preferred) eye; 1
> remained high, and 1 was not tested under the same conditions. Average
> foveation times increased in all 9 fixing (preferred) eyes. Binocular
> visual acuity measured with the ETDRS chart increased in 5 patients and
> was unaffected in five, whereas the NEI-VFQ-25 showed an improvement in
> vision-specific mental health in 9 patients. There were no adverse
> events. Tenotomy also radically changed the periodicity of one patient's
> asymmetric periodic or aperiodic alternating nystagmus. CONCLUSIONS: In 9
> of 10 adult patients with clinical and oculographic variations in their
> congenital nystagmus, tenotomy resulted in significant improvements in a
> nystagmus measure and subjective visual functions.
>
> ***************
> Unique Identifier
> 11960819
> Authors
> Dell'Osso LF.
> Institution
> Ocular Motor Neurophysiology Laboratory, Veterans Affairs Medical Center,
> Cleveland, OH 44106, USA.
> Title
> Development of new treatments for congenital nystagmus. [Review] [64
> refs]
> Source
> Annals of the New York Academy of Sciences. 956:361-79, 2002 Apr.
> Abstract
> The use of ocular motor data as the basis for the development of both
> nonsurgical and surgical therapies for congenital nystagmus (CN) has been
> underway since the mid-1960s. This paper presents three nonsurgical
> therapies (composite prisms, soft contact lenses, and afferent
> stimulation) and a new surgical therapy (four-muscle tenotomy)
> hypothesized from analysis of ocular motor data. The expanded nystagmus
> acuity function test was developed to both predict and measure the
> effectiveness of CN therapies and for intersubject comparisons. Base-out
> prisms may be used to damp CN during distance fixation in patients whose
> CN damps during near fixation and who are binocular (i.e., they have no
> strabismus). Soft contact lenses may be used in those whose CN damps with
> afferent stimulation of the ophthalmic division of the trigeminal nerve.
> Cutaneous afferent stimulation (rubbing, vibration, or electricity) of
> the forehead or neck damps CN in some individuals. Finally, as first
> demonstrated in an achiasmic Belgian sheepdog and later in humans,
> tenotomy of the four horizontal rectus muscles and reattachment at their
> original sites may also damp CN. Taken together, these findings suggest
> the existence of one or more proprioceptive feedback loops acting to
> change the small-signal gain of the extraocular plant. Four-muscle
> tenotomy provides a needed therapeutic option for the many individuals
> with CN for whom other surgical therapies are contraindicated. Tenotomy
> may also prove useful in see-saw nystagmus (it abolished it in the
> aforementioned canine) or other types of nystagmus; further studies of
> the latter are required. [References: 64]

Scott Seidman

2004-10-16, 10:08 pm

magnulus

2004-10-17, 2:09 am

Scott Seidman

2004-10-17, 2:09 am

magnulus

2004-10-18, 10:08 pm

magnulus

2004-10-18, 10:08 pm

Ann

2004-10-18, 10:08 pm

Ann

2004-10-19, 7:20 pm

On Thu, 14 Oct 2004 15:06:42 -0400, "Dr Judy"
<mpace99nospam@rogers.com> wrote:

>"Ann" <me@privacy.net> wrote in message
>news:vtnpm0libf81gs37s4bop2u3rbo1hvoqr1@4ax.com...
>
>snip
>
>A low vision clinic specializes in people with sub normal vision and the
>doctors there will have experience with nystagmus and prism treatment.

That isn't the opinion of everyone on list though is it? I have been
persuaded that many don't know very much about nystagmus.

Ann

Dr Judy

2004-10-20, 7:08 am

Dr Judy

2004-10-20, 7:08 am

Rishi Giovanni Gatti

2004-10-20, 7:08 am

> >A low vision clinic specializes in people with sub normal vision and the
>
> That isn't the opinion of everyone on list though is it? I have been
> persuaded that many don't know very much about nystagmus.
>
> Ann

Nobody on this list of professionals knows very much about vision,
either.

This is sad, but look around you: all they can do is just put a new
pair of glasses, and then use drugs to relieve problems, without
getting to the true causes of anything.

When you will wake up?

Mike Tyner

2004-10-20, 11:12 am

"Rishi Giovanni Gatti" <g.gatti@agora.it> wrote

> Nobody on this list of professionals knows very much about vision,
> either.

"It is not so much that I have confidence in scientists being right, but
that I have so much in nonscientists being wrong....It is those who support
ideas for emotional reasons only who can't change."

"If a scientific heresy is ignored or denounced by the general public, there
is a chance it may be right. If a scientific heresy is emotionally supported
by the general public, it is almost certainly wrong."

-Isaac Asimov, 1977

Evaristo

2004-10-21, 7:12 pm

On Wed, 20 Oct 2004 12:36:24 GMT, "Mike Tyner" <mtyner@mindspring.com>
wrote:

>"It is not so much that I have confidence in scientists being right, but
>that I have so much in nonscientists being wrong....It is those who support
>ideas for emotional reasons only who can't change."

....ideas for ECONOMICAL reasons only who can't change...

>"If a scientific heresy is ignored or denounced by the general public, there
>is a chance it may be right. If a scientific heresy is emotionally supported
>by the general public, it is almost certainly wrong."

"having a chance" and "almost certailnly"

hmm...

Evaristo

2004-10-21, 7:12 pm

On Thu, 21 Oct 2004 22:44:10 GMT, "Mike Tyner" <mtyner@mindspring.com>
wrote:

>
>"Evaristo" <evaristo.recalcati@email.it> wrote
>
>
>Since you have no intelligible comment, I'll assume you like Asimov and pass
>along a couple more of his quotes:

He left a possibility open. This shows his intelligence.
The same intelligence that led Dr.Bates to investigate
and study the famous 1 case out of 10 that was not
in accordance with the theories that tried to explain
what was happening.

If only 1 case out of 10 is not in accordance with
a theory this means that the theory IS wrong because
that case is a fact. Even if the other 9 cases are in
accordance with the theory, you CANNOT dismiss
the 1 that is not.

>"No matter how many times a theory meets its tests successfully, there can
>be no certainty that it will not be overthrown by the next observation.

Ditto.

>This, then, is a cornerstone of modern natural philosophy. It makes no claim
>of attaining ultimate truth. In fact, the phrase 'ultimate truth' becomes
>meaningless, because there is no way in which enough observations can be
>made to make truth certain and, therefore, 'ultimate.' " (from Asimov's New
>Guide to Science, 1984)

Read the first two pages (page vii) of Bates' unpolluted Perfect
Sight Without Glasses. He said the same things in 1920.

But since he is Bates then he is wrong.
Duh.

>"No one can really feel at home in the modern world and judge the nature of
>its problems - and the possible solutions to those problems - unless one has
>some intelligent notion of what science is up to." (from Asimov's New Guide
>to Science, 1984)

Read the book, Mike.

You could still retain your profession and money, but this
time CURING people from their ailments.

Rishi Giovanni Gatti

2004-10-23, 2:08 am

Ann

2004-10-24, 2:09 am