In 2010-2011 research efforts continued to concentrate on identifying sites

within the brain responsible for the abnormal eye movements in patients with

infantile nystagmus syndrome. Dr. Kashou in our group recently presented the

results of this research at the 2011 annual meeting of the Association for

Research in Vision and Ophthalmology titled “Tractography of Infantile

Nystagmus Syndrome”. This study utilized diffusion tensor imaging (DTI) to

compare the number of white matter tracks for patients with infantile nystagmus

syndrome compared with controls. Our group was the first to use these imaging

techniques to assess the white matter tracks of patients with nystagmus. We

found that a loss of fibers at the level of the Pons and Cerebellum could

contribute to the involuntary ocular-motor dysfunction characterized by infantile

nystagmus syndrome. We believe that further investigation of the cerebellumbrainstem-

cerebrum connections using DTI will be crucial in identifying trouble

regions in these pathways. We plan to continue our future research in this area.

Dr. Leguire collaborated with Dr. David Rogers in the Department of

Ophthalmology at NCH to study different ways to measure visual acuity in

children. Visual acuity is the smallest letters on the eye chart that can be

correctly identified. It is very important to have reliable and accurate visual acuity

data as this information plays a key role in the management of conditions such

as amblyopia. Obviously, poor techniques in measuring visual acuity will lead to

poor quality of data and potential mismanagement of the patient. Over a two day

period at two different elementary schools, 334 children aged 8 to 11 years of

age were tested using the EVA vision screening system. The children were

divided into two groups, both of which were tested using the E-ETDRS protocol.

One group was given a card on which the 10 letters of the ETDRS chart were

printed and were instructed only to choose from those letters (Forced choice

group). The other group was tested with the standard E-ETDRS protocol

(Standard group). We found that the visual acuity was significantly better in the

Forced choice group for both eyes. We have prepared this data for presentation

at the 2012 annual meeting of AAPOS and are developing the manuscript for

publication.

Dr David Rogers and Dr. Leguire have also been working on ways to

improve surgical outcomes in strabismus surgery. We undertook a quality

improvement study designed to determine the accuracy of the calipers used

during strabismus surgery. Our data revealed that the surgical calipers have

surprising variability. Based on this information, we have modified our surgical

techniques. We now verify the measurement on the surgical caliper against a

ruler prior to using the instrument during surgery. This data is being prepared for

both presentation at the 2012 AAPOS annual meeting and for publication.