Prism Therapy and Surgical Intervention for Oscillopsia

Vollständiger Abstract

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Abstract Purpose of Review The purpose of this article is to present a critical appraisal of current therapeutic and surgical strategies for patients with nystagmus and associated oscillopsia. Different forms of nystagmus and associated oscillopsia as well as evidence supporting successful use of prism and surgical treatment of these patients are considered. Recent Findings Low power yoked prisms are effective and under-utilized in the treatment of infantile nystagmus syndrome (INS). Surgical treatments for INS and acquired nystagmus are still being refined and studied, with future clinical trials required for additional assessment of the efficacy of various surgical treatments for acquired nystagmus and oscillopsia. Summary Nystagmus is an involuntary, uncontrolled rhythmic movement of the eyes initiated by slow drift of the eyes and can have many diverse underlying etiologies. Nystagmus can reduce visual acuity as result of decreased centering of images on the fovea, the cone-rich center of the retina responsible for maximum visual sharpness and color vision. Steady foveal fixation is required for high-resolution tasks like reading or facial recognition. Acquired nystagmus also often causes the uncomfortable symptom of oscillopsia or shaking of the visual environment. Accurate diagnosis requires a comprehensive examination often including neurological evaluation. Important clinical considerations in the evaluation of these patients includes age of onset, direction of nystagmus, presence of abnormal head posture (AHP) or possible underlying systemic or neurological conditions. Treatment of nystagmus focuses on shifting the null point, the specific direction of gaze where nystagmus is minimized, to improve visual function in primary position and reduce AHP and bothersome oscillopsia. Prism therapy, including the use of yoked prisms, can shift the null point towards primary gaze and in doing so can also reduce abnormal head posture. Surgical management, including the Anderson-Kestenbaum procedure and extraocular muscle recession techniques, may be considered when conservative treatment is insufficient. However, further clinical research is needed to better evaluate surgical treatment outcomes, especially for patients with acquired nystagmus.