Ординатура / Офтальмология / Английские материалы / Fundamentals of Clinical Ophthalmology Strabismus_Billson_2003

Fundamentals of Clinical Ophthalmology

Strabismus

Contents

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Preface to the

Fundamentals of Clinical Ophthalmology series

This book is part of a series of ophthalmic monographs, written for ophthalmologists in training and general ophthalmologists wishing to update their knowledge in specialised areas. The emphasis of each is to combine clinical experience with the current knowledge of the underlying disease processes.

Each monograph provides an up to date, very clinical and practical approach to the subject so that the reader can readily use the information in everyday clinical practice. There are excellent illustrations throughout each text in order to make it easier to relate the subject matter to the patient.

The inspiration for the series came from the growth in communication and training opportunities for ophthalmologists all over the world and a desire to provide clinical books that we can all use. This aim is well reflected in the international panels of contributors who have so generously contributed their time and expertise.

Susan Lightman

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Preface

This book has been written for the general ophthalmologist, the trainee ophthalmologist, and the eye health professional. It will also be of interest to the paediatrician and family physician.

An increased understanding of the organisation and development of the visual cortex in primates and increased awareness of the interplay between sensory and motor development has resulted in a major shift in the way that clinicians think about infant vision and the eye and child development. The vulnerability of the visual system during development is critical to the understanding of strabismus and amblyopia in childhood and to the presentation of adult strabismus that has its origins in childhood.

There is now an emphasis on development of visual function in early infancy and away from postinfantile development. This has led to concern for development of visual pathways in the cerebral cortex in the central nervous system. Thirty to forty years ago, it was not uncommon for the family doctor to reassure families that a child would grow out of a squint. Now the understanding is that no child is too young to be assessed, managed and treated with the added assurance of safer modern anaesthesia and surgical techniques for infants and children when strabismus surgery is indicated. This goes hand in hand with the understanding that unless treatment is introduced early in the critical periods of development, a good visual outcome will be frustrated. There is now a responsibility for those entrusted with the care of children in the community to become their advocates and to ensure early recognition of abnormality in development, appropriate intervention, and completion of care in their first decade of life.

By contrast, adult onset of strabismus is more often associated with significant underlying pathology in patients with potential for normal binocular vision. Surgical options are similar to those in children except that adults can more often cooperate in surgery and procedures under local anaesthesia. With the implementation of sophisticated treatment, success is often dependent on the presence of a stable substrate of binocular vision and completion within a shorter timeframe.

The opportunity to author this text is welcome because of its challenge to present succinctly the underlying neurophysiologic substrate of binocular vision and strabismus. This perspective provides insights into the vulnerability of the visual system that is the basis for breakdown or failure to develop normal binocular vision. As clinicians, we need to remind ourselves constantly that strabismus is the recognition of a clinical sign, not a diagnosis. Rarely, the disturbed eye movement can be due to a progressive pathological process, for example, neoplasm or inflammation. The primary diagnosis could therefore be a cerebral tumour, threatening not only sight, but also life. The diagnosis of the eye movement disorder would be a secondary diagnosis. The fact that the underlying cause is so frequently static, or a developmental disorder, should not alter the principal of being alert to the possibility of a progressive pathology as the underlying cause. Integration of visual science with observations in clinical practice, and considering the causes and consequences of strabismus through the decades of life should assist us in this.

Francis A Billson

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