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Home > Archive > Vision > November 2004 > A-pattern and V-pattern strabismus
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A-pattern and V-pattern strabismus
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| Hi all,
I can see a single perfectly perpendicular line as two tilted lines,
joined at the top, resembling the letter "A". I was wondering is this
an "A" pattern syndrom, or a "V"-pattern syndrom? I actually got
doagnosed with an "A" pattern, but thinking logically I think that it
is a "V" pattern. In the "V" pattern, eyeballs follow the lines of the
letter "V", and therefore, what the patient really sees should be a
mirror image, i.e. the letter "A". Is my thinking correct?
I believe the letter syndroms are associated with cyclotropia. By the
way, is there a commonly accepted criterion about the extent of
cyclotropia that is operable? For instance, is a 15 degree angle
excyclotropia operable? A 5-degree incyclotropia?
Thanx,
Peter
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| Mike Tyner 2004-11-06, 4:07 am |
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"Peter" <fresnelp@yahoo.com> wrote
> I can see a single perfectly perpendicular line as two tilted lines,
> joined at the top, resembling the letter "A". I was wondering is this
> an "A" pattern syndrom, or a "V"-pattern syndrom? I actually got
> doagnosed with an "A" pattern, but thinking logically I think that it
> is a "V" pattern. In the "V" pattern, eyeballs follow the lines of the
> letter "V", and therefore, what the patient really sees should be a
> mirror image, i.e. the letter "A". Is my thinking correct?
"A and V patterns" apply to horizontal phoria or tropia, not cyclorotation,
which is relatively rare.
I have a V-pattern tropia, meaning when I look way up, my eyes tend to
diverge and I see double. There is a rotational component (vertical lines go
diagonal) but that isn't what makes it V-pattern. "V" simply means that the
horizontal deviation is greater in up gaze, where in A-pattern the deviation
is greater in down-gaze.
I'll let someone else reply on the operability of cyclotropia.
-MT
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| Dr/Mr. Tyner,
Thanx for the reply.
If I see a vertical line as 2 lines, the top of the left one (seen by
left eye) tilted toward the nose, and the top of the right line (seen
by right eye) tilted toward the nose, thus forming an "A"-pattern,
does that mean I have 2 excyclotropias? I was diagnosed with having an
excyclotropia and incyclotropia, but it seems to me I have 2
excylcotropias.
Best,
P.
"Mike Tyner" <mtyner@mindspring.com> wrote in message news:<eU0jd.1614$_J2.1525@newsread2.news.atl.earthlink.net>...
> "Peter" <fresnelp@yahoo.com> wrote
>
>
> "A and V patterns" apply to horizontal phoria or tropia, not cyclorotation,
> which is relatively rare.
>
> I have a V-pattern tropia, meaning when I look way up, my eyes tend to
> diverge and I see double. There is a rotational component (vertical lines go
> diagonal) but that isn't what makes it V-pattern. "V" simply means that the
> horizontal deviation is greater in up gaze, where in A-pattern the deviation
> is greater in down-gaze.
>
> I'll let someone else reply on the operability of cyclotropia.
>
> -MT
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| Mike Tyner 2004-11-07, 11:09 am |
| "Peter" <fresnelp@yahoo.com> wrote
> If I see a vertical line as 2 lines, the top of the left one (seen by
> left eye) tilted toward the nose, and the top of the right line (seen
> by right eye) tilted toward the nose, thus forming an "A"-pattern,
> does that mean I have 2 excyclotropias? I was diagnosed with having an
> excyclotropia and incyclotropia, but it seems to me I have 2
> excylcotropias.
It seems to me that incyclo in one eye and excyclo in the other eye would
result in vertical lines perceived as a tilted "H". Of course they'd have to
be perfectly equal in degree to make a parallel H, and that's unlikely, but
the point is that both eyes would perceive tilt in the same subjective
direction. So I'm inclined to agree with you as to the direction.
You could get an A-pattern with a minor incyclo in one eye and a major
excyclo in the other eye, but it would be a highly tilted "A" and instead
you're reporting that both eyes perceive a vertical tilt inward.
You still haven't said how this condition came about, but having a
symmetrical condition in each eye more likely suggests congenital causes.
-MT
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| David Robins, MD 2004-11-09, 2:08 am |
| Since both lines tilt inwards at the top, that means the eyes are rotated
outwards at the top, that is, excyclotorsion of each each. HOWEVER, most
people, even if they have it each eye, generally on notice it in the
nondominant eye. The torsion in the dominant eye is generally "zeroed out"
by you system; it perceives it as the "normal".
In any case, torsions less than about 10 degrees total tend not to be a
problem - your system often can fuse such an angle. Larger angles can be
operated. The surgery is a Harada-Ito procedure, to rotate the eye inwards
(incyclotort it) by advancing the anterior portion of the superior oblique
tendon.
On 11/7/04 12:12 AM, in article
e80bbf48.0411070012.1b70a33d@posting.google.com, "Peter"
<fresnelp@yahoo.com> wrote:
[vbcol=seagreen]
> Dr/Mr. Tyner,
>
> Thanx for the reply.
>
> If I see a vertical line as 2 lines, the top of the left one (seen by
> left eye) tilted toward the nose, and the top of the right line (seen
> by right eye) tilted toward the nose, thus forming an "A"-pattern,
> does that mean I have 2 excyclotropias? I was diagnosed with having an
> excyclotropia and incyclotropia, but it seems to me I have 2
> excylcotropias.
>
> Best,
> P.
>
>
> "Mike Tyner" <mtyner@mindspring.com> wrote in message
> news:<eU0jd.1614$_J2.1525@newsread2.news.atl.earthlink.net>...
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| Dr/Mr. Tyner,
Thanx for the reply.
If I see a vertical line as 2 lines, the top of the left one (seen by
left eye) tilted toward the nose, and the top of the right line (seen
by right eye) tilted toward the nose, thus forming an "A"-pattern,
does that mean I have 2 excyclotropias? I was diagnosed with having an
excyclotropia and incyclotropia, but it seems to me I have 2
excylcotropias.
Best,
P.
"Mike Tyner" <mtyner@mindspring.com> wrote in message news:<eU0jd.1614$_J2.1525@newsread2.news.atl.earthlink.net>...
> "Peter" <fresnelp@yahoo.com> wrote
>
>
> "A and V patterns" apply to horizontal phoria or tropia, not cyclorotation,
> which is relatively rare.
>
> I have a V-pattern tropia, meaning when I look way up, my eyes tend to
> diverge and I see double. There is a rotational component (vertical lines go
> diagonal) but that isn't what makes it V-pattern. "V" simply means that the
> horizontal deviation is greater in up gaze, where in A-pattern the deviation
> is greater in down-gaze.
>
> I'll let someone else reply on the operability of cyclotropia.
>
> -MT
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| Mike Tyner 2004-11-10, 2:13 am |
| "Peter" <fresnelp@yahoo.com> wrote
> If I see a vertical line as 2 lines, the top of the left one (seen by
> left eye) tilted toward the nose, and the top of the right line (seen
> by right eye) tilted toward the nose, thus forming an "A"-pattern,
> does that mean I have 2 excyclotropias? I was diagnosed with having an
> excyclotropia and incyclotropia, but it seems to me I have 2
> excylcotropias.
It seems to me that incyclo in one eye and excyclo in the other eye would
result in vertical lines perceived as a tilted "H". Of course they'd have to
be perfectly equal in degree to make a parallel H, and that's unlikely, but
the point is that both eyes would perceive tilt in the same subjective
direction. So I'm inclined to agree with you as to the direction.
You could get an A-pattern with a minor incyclo in one eye and a major
excyclo in the other eye, but it would be a highly tilted "A" and instead
you're reporting that both eyes perceive a vertical tilt inward.
You still haven't said how this condition came about, but having a
symmetrical condition in each eye more likely suggests congenital causes.
-MT
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