Nystagmus in Infancy and Childhood. Current Concepts in Mechanisms, Diagnoses, and Management

About this book

• Narrative observations elucidate the underlying neurophysiological mechanisms
• Clinical pearls aid the clinician in differential diagnoses, patient assessment, and therapeutic choices for individual patients
• Logical, user-friendly structure allows for a full cover-to-cover read or a pick-and-choose reference resource for those interested in a particular topic

Nystagmus in Infancy and Childhood is a highly-illustrative and thoughtfully written text that provides clinicians and scientists with detailed yet concise information regarding our current understanding, evaluation, and treatments of nystagmus in infancy and childhood. Throughout the text are clinical pearls and narrative observations intended to help the reader appreciate the enormous strides forward in the past 50 years of nystagmus research.

Timely and comprehensive, this book is an "everything you need to know" resource, and will provide the reader with:

- detailed methodologies of investigation, including analysis software, models of the ocular motor system, and current hypotheses regarding ocular motor oscillations
- complementary appendices that can be used for special purposes, i.e., as clinical examination sheets, patient information sheets, and algorithm for computer analysis of nystagmus waveforms
- new therapeutic approaches, using relevant eye-movement data and mechanisms
- a roadmap toward a more rational, data-driven approach to the medical management of infantile nystagmus

As the only resource effectively comprising the past 50 years of nystagmus research and therapeutic implications,Nystagmus in Infancy and Childhood will be a comprehensive and invaluable guide to for both clinicians and scientists who care for infants and children with nystagmus.

Readership: Eye care professionals in ophthalmology and optometry, neurologists, eye movement scientists, pediatricians, and graduate and undergraduate students in the neurological sciences.

Table of contents

Chapter 1. Relevant Anatomy and Physiology
1.1 INFRANUCLEAR OCULAR MOTOR ANATOMY
1.1.1 Extraocular Muscles
1.1.2 Extraocular Muscle Pulleys
1.1.3 Orbital Tissues
1.2 SUPRANUCLEAR OCULAR MOTOR ANATOMY
1.2.1 Frontal Eye Fields
1.2.2 Superior Colliculus
1.2.3 Brainstem Nuclei
1.2.4 Vestibular Nuclei
1.2.5 Cerebellum
1.3 AFFERENT SYSTEM
1.3.1 Retina/Optic Nerve
1.3.2 Optic Nerve
1.3.3 Lateral Geniculate
1.3.4 Geniculostriate
1.3.5 Association Cortex
1.3.6 Ocular Motor Proprioception
1.4 EFFERENT SYSTEM
1.4.1 Smooth Pursuit System
1.4.2 Saccadic System
1.4.3 Vergence System
1.4.4 Vestibuloocular System

Chapter 2. Infantile Nystagmus Syndrome
2.1 CHARACTERISTICS OF INS
2.1.1 History and Background
3.1.1.1 Ancient Descriptions and Theories
3.1.1.2 Connection to Fixation Attempt
3.1.1.3 Modern Physiological Investigation
2.1.2 Waveforms, Models, and Mechanisms
3.1.2.1 Waveform Types
3.1.2.2 Braking and Foveating Saccades
3.1.2.3 The Foveation Period
3.1.2.4 Foveation Accuracy
3.1.2.5 Target Acquisition Time
3.1.2.6 Smooth Pursuit
2.1.3 The Static Neutral Zone/Region
3.1.3.1 Latent Component
2.1.4 The Dynamic Neutral Zone/Region
3.1.4.1 Asymmetric, (a)Periodic Alternation
3.1.4.2 Optokinetic, Pursuit and Vestibuloocular Responses
2.1.5 The Null Angle/Zone/Region
2.1.6 The Convergence Null
2.1.7 The Saccadic Response
2.1.8 Static and Dynamic Head Posturing
2.1.9 Foveation and Visual Acuity (High Spatial Frequency Vision)
2.1.9.1. The eXpanded Nystagmus Acuity Function (NAFX)
2.1.9.1.1 NAFX vs. Gaze Angle
2.1.9.1.2 LFD and TID
2.1.10 Oscillopsia Suppression
2.1.10.1 Foveation Dynamics
2.1.10.2 Temporal Sampling
2.1.10.3 Efference Copy
2.1.11 Afferent Stimulation
2.1.11.1 Cutaneous Trigeminal Stimulation
2.1.11.2 Deep Muscle Stimulation
2.1.11.3 Contact Lenses
2.1.11.4 Biofeedback
2.1.12 Canine Nystagmus (Achiasmatic Belgian Sheepdog)
2.1.12.1 See-Saw
2.1.12.2 Pendular
2.1.12.3 Tenotomy & Reattachment Procedure
2.1.13 Canine Model of INS with RPE65 Retinal Degeneration (Briard)
2.2 ETIOLOGY OF INS
2.2.1 Familial (Gene Defect)
2.2.2 Developmental Disturbance Of Ocular Motor System with Associated Sensory System Deficit.
2.2.2.1 Albinism
2.2.2.2 Achiasma
2.2.2.3 Infantile Strabismus
2.2.2.4 Non-vectorial Visual Sensory Deficits
2.2.3 The Direct Cause(s) of INS with or without Sensory/Genetic Deficits
2.2.3.1 Loss of Smooth-Pursuit Damping
2.2.3.2 Tonic Vestibular-Optokinetic Imbalance
2.3 VISUAL FUNCTION DEFICITS AND MEASUREMENTS OF INS
2.3.1 Static Deficits
2.3.1.1 The eXpanded Nystagmus Acuity Function and Longest Foveation Domain Measures
2.3.2 Dynamic Deficits
2.3.2.1 Target Acquisition Time (Stationary Targets)
2.3.2.2 Target Acquisition Time (Moving Targets)
2.3.3 Clinical
2.3.3.1 Visual Acuity at Different Gaze Angles
2.4 TREATMENTS OF INS
2.4.1 Goals
2.4.2 Non-Surgical
2.4.2.1 Prisms
2.4.2.2 Contact Lenses
2.4.2.3 Drugs
2.4.2.4 Biofeedback
2.4.2.5 Gene-Transfer Therapy
2.4.3 Surgical
2.4.3.1 Four-Muscle Resection & Recession Procedure (Operation 1) (aka Kestenbaum, Anderson-Kestenbaum, or Anderson+Goto)
2.4.3.2 Two-Muscle Recession Procedure (Operation 1A) (aka Anderson)
2.4.3.3 Bilateral Medial Rectus Recession Procedure (Operation 8)
2.4.3.4 Tenotomy & Reattachment Procedure (Operation 6)

Chapter 3. Fusion Maldevelopment Nystagmus Syndrome
3.1 CHARACTERISTICS OF FMNS
3.1.1 Waveforms, Models, and Mechanisms
3.1.1.1 Types (FMNS plus Nucleus of the Optic Tract)
3.1.1.2 The Fixating Eye
3.1.1.3 Target Foveation and Dual-Mode Fast Phases
3.1.1.4 Foveation Accuracy
3.1.2 Variation with Gaze Angle
3.1.3 Head Position
3.1.4 Foveation, NAFX, and Acuity
3.1.5 Efference Copy, Foveation, and Oscillopsia Suppression
3.2 TREATMENTS OF FMNS
3.2.1. Fixation Preference
3.2.2. Alexander's Law
3.2.3. Eye Muscle Surgery

Chapter 4. Other Types of Nystagmus of Infancy
4.1 NYSTAGMUS BLOCKAGE SYNDROME
4.1.1 Characteristics of NBS
4.1.1.1 Multiple Types of Nystagmus
4.1.1.2 Waveforms and Mechanisms
4.1.1.2.1 Target Foveation
4.1.1.2.2 Foveation Accuracy
4.1.1.3 Purposive Esotropia
4.1.1.4 Head Position
4.1.1.5 Blockage Syndrome Types I and II
4.1.1.6 Foveation, NAFX, and Acuity
4.1.1.7 Efference Copy, Foveation, and Oscillopsia Suppression
4.1.2 Treatments of NBS
4.1.2.1. Fixation Preference
4.1.2.2. Alexander's Law
4.1.2.3. Surgical
4.1.2.3.1. Fixating Eye
4.2 SPASMUS NUTANS SYNDROME
4.2.1 Characteristics of SNS
4.2.1.1 Waveforms and Mechanisms
4.2.1.2 Variable Interocular Phase
4.2.1.3 Head Nodding
4.2.2 Treatment of SNS

Chapter 5. Differential Diagnosis of Nystagmus In Infancy and Childhood
5.1 NYSTAGMUS WITHOUT ASSOCIATED NEUROLOGICAL DISEASE-<"BENIGN>"
5.1.1. Infantile Nystagmus Syndrome
5.1.1.1 Association with Strabismus
5.1.1.2 Clinical Signs and Symptoms
5.1.1.3 Differential Diagnosis
5.1.1.4 Reverse-Cover and Gaze-Angle Cover Tests
5.1.2 Fusion Maldevelopment Nystagmus Syndrome
5.1.2.1 Association with Strabismus
5.1.2.2 Clinical Signs and Symptoms
5.1.2.3 Differential Diagnosis
5.1.2.4 Alternate-Cover and Gaze-Angle Cover Tests
5.1.3 Nystagmus Blockage Syndrome
5.1.3.1 Association with Strabismus
5.1.3.2 Clinical Signs and Symptoms
5.1.3.3 Differential Diagnosis
5.1.4 Spasmus Nutans Syndrome
5.1.4.1 Association with Strabismus
5.1.4.2 Clinical Signs and Symptoms
5.1.4.3 Differential Diagnosis
5.1.5 Nystagmus and Strabismus
5.2 NYSTAGMUS WITH ASSOCIATED NEUROLOGICAL DISEASE-<"SYMPTOMATIC>"
5.2.1 Vestibular Nystagmus
5.2.1.1 Peripheral Vestibular Imbalance
5.2.1.2 Central Vestibular Imbalance
5.2.1.3 Central Vestibular Instability (Periodic Alternating)
5.2.2 Gaze-holding Deficiency Nystagmus
5.2.2.1 Eccentric Gaze, Gaze-evoked, Rebound
5.2.2.2 Gaze Instability (<"Run-away>")
5.2.3 <"Vision-Loss>" Nystagmus
5.2.3.1 Pre-chiasmal, Optic Chiasm, Post-chiasmal Vision Loss
5.2.4 Other Pendular Nystagmus Associated with Diseases of Central Myelin
5.2.4.1 Oculopalatal Tremor or <"Myoclonus>"
5.2.4.2 Pendular Vergence Nystagmus Associated with Whipple's Disease
5.2.5 Convergence/Convergence Evoked Nystagmus
5.2.6 Upbeat Nystagmus
5.2.7 Downbeat Nystagmus
5.2.8 Torsional Nystagmus
5.2.9 <"See-Saw>" Nystagmus
5.2.10 Lid Nystagmus
5.3 SACCADIC INTRUSIONS/OSCILLATIONS
5.3.1 Square Wave Jerks And Oscillations
5.3.2 Square-Wave Pulses
5.3.3 Staircase Saccadic Intrusions
5.3.4 Macrosaccadic Oscillations
5.3.5 Saccadic Pulses (Single And Double)
5.3.6 Convergence Retraction <"Nystagmus>"
5.3.7 Dissociated Ocular Oscillations
5.3.8 Dysmetric Saccades
5.3.9 Ocular Flutter
5.3.10 Flutter Dysmetria
5.3.11 Opsoclonus
5.3.11.1 Opsoclonus-Myoclonus
5.3.12 Superior Oblique Myokymia
5.3.13 Ocular bobbing
5.3.13.1 Typical
5.3.13.2 Monocular
5.3.13.3 Atypical
5.3.14 Psychogenic (Voluntary) Flutter

Chapter 6. Afferent Visual System - Clinical Examination Procedures
6.1 SUBJECTIVE TESTING
6.1.1 Teller Acuity Card Procedure
6.1.2 Visual Acuity Testing (High Spatial Frequency Vision)
6.1.3 Stereo Testing
6.1.4 Color-Vision Testing
6.1.5 Contrast-Sensitivity Testing
6.1.6 Gaze- and Time-Dependent Acuity Testing
6.1.7 Visual Field Testing
6.2 OBJECTIVE TESTING
6.2.1 Visual Evoked Potentials
6.2.2 Electroretinography
6.2.3 Optical Coherence Tomography
6.2.4 Fundus Photography

Chapter 7. Treatment
7.1 MEDICAL
7.1.1 Optical
7.1.1.1 Version Prisms
7.1.1.2 Vergence Prisms
7.1.1.3 Contact Lenses
7.1.1.4 Correction of Ammetropia/Anisometropia
7.1.1.5 Intraocular Lenses
7.1.1.6 Refractive Surgery
7.1.2 Pharmacological
7.1.2.1 Sedatives/Hypnotics
7.1.2.2 Neuroleptics
7.1.2.3 Psychoactive Medications
7.1.2.4 Antiseizure Medications
7.1.2.5 Botulinum
7.1.2.6 Anticholinesterases
7.2 EYE-MUSCLE SURGERY
7.2.1 General Principles
7.2.2 Classification
7.2.3 Preoperative Evaluation
7.2.3.1 Visual Acuity
7.2.3.2 Ocular Motor and Standard Clinical Evaluations
7.2.3.3 Strabismus
7.2.3.4 Eye-Movement Recordings
7.2.3.5 Head-Posture Measurements (<"Null Zones>")
7.2.3.6 Laboratory and Special Tests
7.2.4 Results
7.2.4.1 Visual Acuity
7.2.4.2 Strabismus
7.2.4.3 Eye-Movement Recordings
7.2.4.4 Head-Posture Measurements
7.2.5 Complications
7.3 OTHER
7.3.1 Biofeedback
7.3.2 Acupuncture
7.3.3 Cutaneous Stimulation
7.3.4 Gene Transfer Therapy
7.3.5 Mind-Body Stress Reduction-Mindful Medication Techniques
7.3.6 Occupational and Vision Therapy
7.3.7 Educational Assistance
7.4 ASSESSING THERAPEUTIC OUTCOMES (POST-THERAPY)
7.4.1 Direct Outcome Measures (NAFX, LFD, and Lt)
7.4.1.1 Post-Tenotomy & Reattachment
7.4.1.2 Post-Convergence/Bimedial Rectus Recession
7.4.1.3 Post-Four-Muscle Recession & Resection or Two-Muscle Recession + Tenotomy & Reattachment
7.4.1.4 Soft Contact Lenses
7.4.1.5 Systemic Acetazolamide and Topical Brinzolamide
7.4.2 Indirect/Clinical Outcome Measures
7.4.2.1 Visual Acuity at Different Gaze Angles
7.5 ESTIMATING THERAPEUTIC OUTCOMES (POST-THERAPY)
7.5.1 Direct Outcome Measures (NAFX, LFD, and Lt)
7.5.1.1 Tenotomy & Reattachment (INS without Afferent Visual Deficits)
7.5.1.2 Tenotomy & Reattachment (INS with Afferent Visual Deficits)
7.5.1.3 Prisms/Bimedial Rectus Recession
7.5.1.4 Soft Contact Lenses
7.5.2 Indirect/Clinical Outcome Measures
7.5.2.1 Visual Acuity at Different Gaze Angles

Chapter 8. Summary and Conclusions
Epilogue

Appendices
Appendix A. Eye-Movement Recording Systems and Criteria
A.1 RECORDING METHODS
A.1.1 Contact Electrooculography
A.1.2 Infrared Reflection
A.1.3 Scleral Search Coil
A.1.4 High-Speed Video Oculography
A.2 RESEARCH CRITERIA
A.2.1 NAFX
A.2.1.1 Methodology
A.2.1.2 Estimating Visual Function Improvements
A.3 CLINICAL CRITERIA
A.3.1 Waveform Types
A.3.2 Null and Neutral Zones
A.3.3 PAN and APAN
A.3.4 Symmetry, Conjugacy, Vergence, and Monocular Evaluation
A.4 CALIBRATION TECHNIQUES
A.4.1 Adults and Children
A.4.1.1 Infantile Nystagmus
A.4.1.2 Fusion Maldevelopment Nystagmus
A.4.2 Infants

Appendix B. Clinical Examination
B.1 GENERAL CLINICAL EXAMINATION FORM
B.2 NYSTAGMUS EXAMINATION FORM
B.3 STRABISMUS EXAMINATION FORM
B.4 CLINICAL PEARLS
B.5 OPHTHALMOLOGICAL MYTHS AND FACTS

Appendix C. Illustrative Cases and Treatment
C.1 INFANTILE NYSTAGMUS SYNDROME
C.1.1 Gaze-Angle Null Only
C.1.1.1 Version Prisms
C.1.1.2 Soft Contact Lenses
C.1.1.3 Four-Muscle Resection, Recession, and Tenotomy & Reattachment
C.1.1.3.1. Fine Tuning with Prisms
C.1.1.3.2. Soft Contact Lenses
C.1.2 Convergence Null Only
C.1.2.1 Vergence Prisms with Negative Spheres
C.1.2.2 Soft Contact Lenses
C.1.2.3 Bimedial Recession
C.1.3 Both Gaze-Angle and Convergence Nulls
C.1.3.1 Convergence > Gaze-Angle
C.1.3.1.1 Composite Prisms and Negative Spheres
C.1.3.1.2 Base-out Prisms and Negative Spheres
C.1.3.1.3 Soft Contact Lenses
C.1.3.1.4 Bimedial Recession
C.1.3.2 Gaze-Angle > Convergence
C.1.3.2.1 Version Prisms
C.1.3.2.2 Soft Contact Lenses
C.1.3.2.3 Four-Muscle Resection, Recession and Tenotomy & Reattachment
C.1.4 No Nulls
C.1.4.1 Soft Contact Lenses
C.1.4.2 Four-Muscle Tenotomy & Reattachment
C.1.4.2.1 Tenotomy & Reattachment with Augmented Tendon Suture
C.1.4.2.2 Augmented Tendon Suture Procedure sans Tenotomy & Reattachment
C.1.4.3 Faden
C.2 INFANTILE NYSTAGMUS PLUS STRABISMUS
C.2.1 Gaze-Angle Null Only
C.2.1.1 Four-Muscle Resection, Recession and Tenotomy & Reattachment
C.2.2 Vertical and Torsional Nulls
C.2.3 No Nulls
C.2.3.1 Four-Muscle Tenotomy & Reattachment and Strabismus
C.3 FUSION MALDEVELOPMENT NYSTAGMUS SYNDROME
C.3.1 Uniocular Fixation
C.3.2 Alternating Fixation
C.3.3 Alexander's Law Threshold
C.4 NYSTAGMUS BLOCKAGE SYNDROME
C.4.1 Bimedial Recession (plus Tenotomy & Reattachment)
C.4.2 Recession and Resection plus Tenotomy & Reattachment
C.4.3 Four-Muscle Tenotomy & Reattachment

Appendix D. Diagnosis and Treatment Flow Charts
D.1 WAVEFORM-BASED DIAGNOSES
D.2 THERAPEUTICALLY EXPLOITABLE WAVEFORM CHARACTERISTICS
D.3 CLINICALLY BASED DIAGNOSES AND LIMITATIONS
D.4 THERAPEUTICALLY EXPLOITABLE CLINICAL CHARACTERISTICS
D.5 ANALYSIS GRAPHS

Appendix E. Included Compact Disk and On-Line Access Videos
E.1 <"EYEBALLS 3D>" EYE-MOTION AND WAVEFORM VIDEOS
MV1 INS (PPfs) 1 cycle 1/20-speed illustrating foveation period
MV2 INS (Jef) 4 cycles 1/3-speed with phase plane
MV3 INS (PPfs) 3 cycles ½-speed illustrating well-developed foveation
MV4 INS (PPfs) 3 cycles 1/5-speed with phase plane
MV5 INS (PPfs) ½-speed 3-dimensional motion with subclinical SSN
MV6 INS 1/5-speed Subclinical SSN motion amplified
MV7 INS PPfs ½-speed from OMS model and patient
MV8 INS (Pfs) step responses OMS model
MV9 INS (PPfs) ½-speed pulse responses OMS model
MV10 INS (PPfs) ½-speed OMS model ramp and step-ramp responses
MV11 FMNS gaze-angle effect OMS model
MV12 FMNS ½-speed alternate cover test OMS model
MV13 FMNS adducting eye fixation OMS model
MV14 INS damping with rapid convergence
MV15 INS ½-speed pre-T&R
MV16 INS ½-speed post-T&R
MV17 INS ½-speed RPE65-deficient canine pre-gene therapy MV18 INS ½-speed RPE65-deficient canine pre-gene therapy scan path
MV19 INS ½-speed RPE65-deficient canine post-gene therapy MV20 INS ½-speed RPE65-deficient canine post-gene therapy scan path
MV21 Oscillopsia simulation
MV22 Uniocular APN pre- and post-therapy
MV23 INS (alternating J) OMS model
E.1.1 PowerPoint Files
E.1.1 E1_INS Dynamic VA
E.1.2 E1_INS Latency Poster
E.1.3 E1_ INS Latency
E.1.4 E1_ INS Model Poster
E.2 CANINE VIDEOS (PLUS OTHERS)
CV1 Normal Brittany
CV2 Achiasmatic Belgian Sheepdog: pre-T&R
CV3 Achiasmatic Belgian Sheepdog: post-T&R
CV4 RPE65-deficient canine: pre-gene therapy behavior
CV5 RPE65-deficient canine: post-gene therapy behavior
CV6 RPE65-deficient canine: pre-gene therapy eye movements
CV7 RPE65-deficient canine: post-gene therapy eye movements
CV8 Cat with INS
CV9 Goat with SSN
E.3 PATIENT VIDEOS
PV1 Saccadic Initiation Failure
PV2 Brainstem Tumor: Tonic Gaze Deviation
PV3 Acquired Downbeat Nystagmus
PV4 Acquired Gaze-Evoked (Gaze-Holding Failure) Nystagmus
PV5 Acquired Unidirectional Gaze-Evoked (Gaze-Holding Failure) Nystagmus
PV6 Ocular Motor Neuromyotonia of Cranial Nerve III
PV7 Ocular Motor Neuromyotonia of Cranial Nerve VI
PV8 Infant with Opsoclonus (Ocular Flutter - <"Saccadomania>")
PV9 Acquired Saccadic Oscillations-1
PV10 Acquired Saccadic Oscillations-2
PV11Acquired Saccadic Oscillations-3
PV12 Acquired Nystagmus + Saccadic Oscillations
PV13 Acquired Upbeat Nystagmus with Wiernecke's Encephalopathy
PV14 Acquired Vertical Pendular Nystagmus
PV15 Fusion Maldevelopment Nystagmus-1
PV16 Fusion Maldevelopment Nystagmus-2
PV17 Down Syndrome and Infantile Nystagmus
PV18 Achiasma + See-Saw Nystagmus + Infantile Nystagmus
PV19 Octogenarian with Infantile Nystagmus
PV20 Infantile Nystagmus: Aperiodically Changing Intensity (Not Direction)
PV21 Infantile Nystagmus: Aperiodically Changing Direction (Not Intensity)
PV22 Infantile Nystagmus: Unequal-1
PV23 Infantile Nystagmus: Unequal-2
PV24 Infantile Nystagmus: Unequal-3
PV25 Infantile Nystagmus: Jerk with Extended Foveation
PV26 Infantile + NOT Nystagmus: Dual Jerk
PV27 Infantile Nystagmus: Pre- and Post-Operative
PV28 Optic Nerve Dysplasia and Infantile Nystagmus: Multiplanar
PV29 Infantile Nystagmus: Jerk with Extended Foveation
PV30 Infantile Nystagmus: Unequal with a <"latent component>"
PV31 Albinism and Infantile Nystagmus
PV32 Optic Nerve Dysplasia and Infantile Nystagmus: Multiplanar
PV33 Albinism, Up-gaze Null, and Infantile Nystagmus: Equal
PV34 Retinal Dystrophy and Infantile Nystagmus: Multiplanar
PV35 Albinism and Infantile Nystagmus: Pre- and Post-Operative Horizontal Null
PV36 Albinism and Infantile Nystagmus: Multiplanar
PV37 Infantile Nystagmus: Periodic Alternating
PV38 Infantile Nystagmus: Asymmetric Aperiodic Alternating
PV39 Albinism and Infantile Nystagmus: Pre- and Post-Operative Vertical Null
PV40 Albinism, Up-gaze Null, and Infantile Nystagmus
PV41 Albinism and Infantile Nystagmus
PV42 <"Vertical>" Infantile Nystagmus-1
PV43 Retinal Dystrophy and <"Vertical>" Infantile Nystagmus-2
PV44 Spasmus Nutans Nystagmus-1
PV45 Spasmus Nutans Nystagmus-2
PV46 Voluntary Ocular Flutter

Appendix F. Included Compact Disk and On-Line Access
F.1 OMLAB REPORTS
F.1.1 #011105 Recording and Calibrating the Eye Movements of Nystagmus Subjects
F.1.2 #111005 Using the NAFX for Eye-Movement Fixation Data Analysis and Display
F.1.3 #111905 Nystagmus Therapies: Types, Sites, and Measures
F.1.4 #090506 Original Ocular Motor Analysis of the First Human with Achiasma: Documentation of Work Done in 1994
F.1.5 #123007 The Benefits of Extraocular Muscle Surgery in INS
F.1.6 #030509 How Someone <"Sees>" the World and How to Clinically Assess Therapeutic Improvements in Visual Function
F.2 PATIENT HANDOUTS
F.2.1 INS Information
F.2.2 INS Treatments
F.2.3 Tenotomy and Reattachment
F.2.4 INS and Acuity
F.2.5 INS Miscellaneous
F.3 PHYSICIAN/RESEARCH SCIENTIST WORKSHEETS
F.3.1 Recession and Resection Surgical Calculation
F.3.2 Estimating Improvement in Peak NAFX
F.3.3 Estimating Improvement in LFD
F.3.4 NAFX vs. Visual Acuity (Motor and Sensory Components)
F.4 CLINICAL EXAMINATION FORMS
F.4.1 General Clinical Examination Form
F.4.2 Nystagmus Examination Form
F.4.3 Strabismus Examination Form
F.5 ANALYSIS SOFTWARE
F.5.1 OMtools
F.5.2 OMS Model GUI User Guide