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- Flodin, Sara, 1974, et al.
(författare)
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Clinical measurements of normative subjective cyclotorsion and cyclofusion in a healthy adult population.
- 2020
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Ingår i: Acta Ophthalmologica. - : John Wiley & Sons. - 1755-375X .- 1755-3768. ; 98:2, s. 177-181
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To investigate normative subjective cyclotorsion values and cyclofusion ranges in a healthy adult population.METHODS: A cross-sectional investigation was performed in 120 healthy, non-strabismic adults, 60 men and 60 women in the age range of 18-69 years. All subjects were assessed for cyclotorsion using the synoptophore and the single Maddox rod (SMR) methods. Cyclofusion was investigated with the synoptophore in 60 of the subjects.RESULTS: All age groups showed low values of subjective torsion, mainly excyclotorsion with mean values of -1 degree for both methods. Reference ranges of cyclotorsion were between -0.7 and -1.5 degrees for the SMR method and between -0.7 and -1.4 degrees using the synoptophore method. There were no significant differences between gender (p = 0.48), but the effect of age was significant for both methods (p = 0.026) demonstrating a slight increase in excyclotorsion with age. Cyclofusion showed a total mean amplitude of 16 degrees, the fusion range was +7 degrees of incyclotorsion to -9 degrees of excyclotorsion.CONCLUSIONS: Subjective reference ranges for cyclotorsion and cyclofusion reveal that low values of torsion are to be expected upon clinical investigation in non-strabismic adult individuals. Values outside of the reference range may be indicators of possible binocular abnormalities or physiological variations. The cyclotorsional measurements and prevalence in this adult population group can be regarded as normative data in clinical settings.
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- Flodin, Sara, 1974, et al.
(författare)
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Cyclofusion ranges in a healthy adult population
- 2018
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Ingår i: Poster ARVO annual meeting, Honolulu 2018.
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Konferensbidrag (refereegranskat)abstract
- Purpose: Cyclovergence is the simultaneous occurring cyclorotation of both eyes, which is performed in opposite directions to obtain or maintain binocular single vision (BSV), and ensures cyclofusion. To date, cyclovergence adaptation has only been estimated or observed objectively and subjective cyclofusion ranges are thus unknown. This study hypothesize that subjective cyclofusion can be measured in a healthy non-strabismic adult population using a standard clinical test, in order to establish clinical reference ranges. Methods: A cross-sectional investigation was performed on a random sample group of 60 healthy, non-strabismic adults (30 women, 30 men) in the age range of 18-69 years, median age 44 years. Ethnicity was 95% white. All subjects were assessed for cyclotorsion, before cyclofusion was investigated using the Clement Clark synoptophore model 2003 and fusion slides F9/10 (Figure 1a/b).The subject was instructed to create a composite image of one house with two trees outside. Once sensory fusion was proved, motor fusion was tested by the examiner. Break of fusion was recorded for incyclovergence and excyclovergence when the patient reported break of single image, tilting of image or suppression of one of the controls. The amplitude was the total amount of torsion fused between the in and excyclotorsion values recorded at breakpoints. Data analysis showed normal distribution, and the anova was used for statistical analysis. Results: Healthy non-strabismic adults in all age groups showed low values of cyclotorsion, mainly excyclotorsion. Mean values for the whole sample was -1 degrees (SD 2.13). Cyclovergence showed a total amplitude of 16 degrees (SD 3.96). Excyclo range was larger than the incyclo range, measuring -9 degrees (SD 2.59) and +7 degrees (SD 1.97) respectively. There was no age or gender related effect on cyclofusion range (p=0.59). Conclusions: To date, this is the first study providing true subjective scientific measures on a normal population for assessing cyclofusion in adults. A reference range for clinical guidance has been established. Values outside of the reference range are not necessarily pathologic or abnormal, but indicators of possible binocular abnormalities as well as physiological variations. The results suggest that cyclotorsion >9° interferes with vergences, dissociating binocular single vision. Patients, who complain of problems with double vision or maintaining binocularity without other obvious strabismic cause, should be assessed for cyclotorsion. If increased values of cyclotorsion are found, further investigations of fusion capacity with horizontal vergence control and cyclofusion amplitudes should be prompted.
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- Flodin, Sara, 1974, et al.
(författare)
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Measuring health-related quality of life in individuals with cyclodeviation using the Adult Strabismus 20 (AS-20) questionnaire
- 2021
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Ingår i: Journal of Aapos. - : Elsevier BV. - 1091-8531 .- 1528-3933. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE To assess health-related quality of life (HRQoL) in patients diagnosed with cyclodeviation and to evaluate subjective change following surgical treatment using the Adult Strabismus-20 (AS-20) questionnaire. METHODS A prospective cohort study was performed from 2014 to 2019 on 29 adult patients with cyclodeviation and cyclodiplopia who were due to undergo corrective strabismus surgery by the same surgeon. The group was divided into two subgroups, according to the type of surgery required for fusion. All scores were analyzed for the whole sample and subgroups. Preoperative scores were compared with those of control patients. RESULTS Pre- and postoperative QoL scores were successfully collected from 26 patients (mean age, 56 years; 8 female) using the AS-20 questionnaire. Scores were significantly higher for control subjects than for patients in the cyclodeviation group (P = 0.0001). Postoperative scores for all 20 questionnaire questions were significantly improved for all patients (P = 0.002). There was a significant improvement in the functional subscale score (P = 0.001), but not in the psychosocial subscale score (P = 0.23). Results were enhanced by Rasch analysis. CONCLUSIONS Cyclodeviation patients demonstrated significantly lower scores than controls. The functional scores were significantly lower than the psychosocial scores, in contrast to other forms of strabismus. Strabismus surgery had a significant effect on quality-of-life scores in this group of adults
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- Flodin, Sara, 1974
(författare)
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On Cyclodeviation - Strategies for Investigation, Management and quality of Life
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Cyclodeviation is a form of strabismus that is not externally visible. It is measured subjectively and in degrees, as incyclotorsion or excyclotorsion. The perception of subjective tilting does not always accompany ocular torsion, and vice versa; and patients rarely complain specifically about cyclodiplopia. Therefore, it is important to have a good understanding of the processes behind cyclodeviation, how the condition affects compensatory mechanisms, binocularity, and the implications in everyday life. Aims and Methods: To (1) evaluate measurement techniques for reliability and repeatability in adult patients with a vertical deviation. Cyclotorsion was measured using three different clinical tests, the single Maddox rod (SMR), KMScreen and the synoptophore; (2) to investigate normative subjective cyclotorsion values and cyclofusion ranges in a non-strabismic adult population aged 18–69 years, using the synoptophore and SMR; (3) to evaluate surgical outcomes and the management of cyclodeviation by reviewing pre-operative assessments and post-operative surgical results retrospectively from 2012 to 2019; (4) to assess the effect of cyclodeviation on health-related quality of life (HRQoL) using the Adult Strabismus-20 (AS-20) questionnaire, in adults with cyclodeviation. Scores were collected pre- and post-operatively and pre-operative scores were compared with scores from a non-strabismic control group. Results: We found: (1) significant differences between clinical tests, especially between the synoptophore and the SMR. All tests showed high correlation and repeatability; (2) all age groups showed low values of subjective torsion, demonstrating excyclotorsion with mean values of -1 degree; (3) post-operative results of the modified Harada-Ito procedure corresponded well to the aimed-for correction of cyclodeviation, yet the dose-effect assessment showed variable effects. (4) There was a significant difference in pre-operative scores between patients and controls. Post-operative scores overall improved significantly for patients, specifically the functional subscale score, which differs from other forms of strabismus. Conclusion: Investigation for the presence of cyclodeviation requires detailed diagnostic testing, as it can greatly influence the management and outcome of patient care. Reference data of what to expect as normal values of cyclotorsion and cyclofusion in clinical situations suggests that already a small increase in cyclotorsion (>2 degrees) may disrupt the ability to fuse binocular images. Fusion evaluation and individually based pre-operative assessments are key factors in determining individual doses for successful surgical outcomes. Including HRQoL evaluation in strabismus management expands assessments. Patients complaining of double vision or difficulties in maintaining binocularity without other obvious strabismic signs should be assessed for cyclodeviation as this may be the disruptive factor to fusion. Keywords: cyclodeviation, HRQoL, orthoptics, strabismus, synoptophore
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- Flodin, Sara, 1974, et al.
(författare)
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Surgical outcome of graded Harada-Ito procedure in the treatment of torsional diplopia : a retrospective case study with long-term results
- 2022
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Ingår i: Strabismus. - : Taylor & Francis. - 0927-3972 .- 1744-5132. ; 30:1, s. 8-17
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Tidskriftsartikel (refereegranskat)abstract
- To review and evaluate the surgical outcomes of the Fells-modified Harada-Ito procedure using a dosage scale approach with long-term follow up in patients with torsional diplopia. The records of patients who underwent the modified Harada-Ito procedure by the same surgeon during 2012–2019 were retrospectively reviewed regarding pre- and post-operative data and individual dose-scale used for the surgery. The modified Harada-Ito procedure involved advancing the anterior half of the superior oblique tendon toward the inferior edge of the lateral rectus muscle by a distance determined using a five-graded scale. A total of 27 patients (mean age 57.6 years, range, 22–81 years; 10 female) were included. Evaluating surgical outcome showed a significant difference in pre- to post-operative cyclodeviation (p = <0.001). Pre-operative mean extorsion was −10.4° and mean torsional correction achieved was 7.7°. The dose-effect relationship showed a wide spread effect, yet yielded a high success rate. All but two patients were symptom free from their torsional diplopia at the last post-operative evaluation, on average 24 months after surgery. Post-operative results and the dose-effect of the modified Harada-Ito corresponded with the aimed-for correction of torsional diplopia.. Fusion evaluation and individually based pre-operative assessments proved essential in determining individual doses for successful surgical outcomes.
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