後天性眼球運動障害の視能訓練

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  • Orthoptic Training for Acquired Ocular Movement Disorder.

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1. Changes in Needs for Orthoptics<br>Although orthoptics has been performed mainly on children with amblyopia or strabismus, the incidence of sensory motor anomaly due to severe amblyopia or strabismus has decreased thanks to early detection and advances in prevention and treatment. Since 1993, when the orthoptists law clarified the procedures of orthoptic examinations, the range of these examinations has widened. At present, as we approach the 21st century, the social need for orthoptics has extended to various other fields: health examinations for infant and adult diseases; rehabilitation for ocular movement disorders and for low vision; and training of higher visual functions for children with learning disability, multiple disorders, etc. In this article, the topic “Orthoptics of Acquired Ocular Movement Disorders, ” which is increasingly necessary in todays ageing society, will be discussed.<br>2. Increasing Type of Acquired Ocular Movement Disorders.<br>A total of 296 cases have undergone orthoptics for acquired ocular movement disorders over the past 23 years. The most frequent cause was trauma (head/eye), followed by inflammation and cerebrovascular disorder. The incidence of such causative disease differed between patients aged 39 years or less and those aged 40 years or over. The most frequent cause was trauma (head/eye) in the former age group, but inflammation and cerebrovascular disorder were predominant in the latter.<br>3. Textbook Cases Do Not Exist.<br>Causes of acquired ocular movement disorders may include blowout fractures, muscular or oculomotor nerve disease, or internuclear disorders. Indications and effects of orthoptic training differ according to the location and severity of cause. Thus, in order to analyze each patient's needs prior to orthoptic training, we must ask, “What is the cause?” “What symptoms does the patient have?” and “What kind of inconvenience does the patient suffer?”<br>4. What Is Effective Orthoptic Training?<br>The orthoptic training program was based on the severity of reciprocal innervation disorder and the state of fusion anomaly. In cases where vertical deviation is greater than horizontal deviation, good result are obtained when training is started with ocular movements, advanced to convergence, and then fusion lock training.<br>5. Evaluation of “Cure” by Orthoptic Training<br>The results of these 296 cases showed cure grade I in 45% and cure grade II in about 44%. Each patient's final goal can be described in terms of the degree of satisfaction with his or her “ability” to assume activities of daily life and to return to work. Therefore, it is necessary to include in such evaluation, some examples of daily activities, in order to ascertain the acutual degree of “cure.” The degree of improvement in fusion ability was not always correlated to that of inconvenience (satisfaction) within the activities of daily life.<br>6. Social Significance of Orthoptic Training<br>Orthoptic training is a highly-specialized rehabilitation method, and about 88% of trainees can return to work or assume activities of daily life without problems. Since acquired ocular movement disorder is a disorder of the muscle proprioceptive system, visual and muscular perceptions of the ocular eye position can be integrated and reconstructed through rehabilitation of fusion ability. By presenting the actual effects response of orthoptics to social needs, we can promote futher development of this method.

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