Thank you to Dr. Tam Petrosyan for writing these summaries
This case report in Optometry & Visual Performance (Vol. 14, Issue 1) by Shah et al. describes the ocular management of an 18-year-old male with X-linked Alport syndrome confirmed by COL4A5 mutation. The patient presented with progressive bilateral vision loss, childhood-onset hearing loss, and hypertension; anterior segment evaluation revealed bilateral anterior lenticonus, confirmed on slit-lamp biomicroscopy and anterior segment OCT, with associated dot-and-fleck retinopathy.
Detailed retinoscopy demonstrated two distinct reflexes arising from the central lenticonus and peripheral lens, enabling precise neutralization of the high central myopic component and yielding a significant improvement in best-corrected visual acuity. Corneal topography ruled out ectatic disorders, and soft silicone hydrogel contact lenses successfully addressed the resultant anisometropia, achieving final acuities of 6/7.5 OD and 6/6 OS. The report underscores the value of meticulous retinoscopic assessment and optometric refractive strategies in the visual rehabilitation of patients with anterior lenticonus secondary to Alport syndrome.
This case report in Optometry & Visual Performance (Vol. 14, Issue 1) by Friman et al. presents the neuro-optometric rehabilitation of a 22-year-old woman with right homonymous hemianopsia following severe traumatic brain injury from a motor vehicle accident. Despite normal distance visual acuity, she experienced significant visual scanning deficits, reading difficulties, oculomotor dysfunction, accommodative insufficiency, and binocular vision problems. Treatment involved 48 weekly in-office vision therapy sessions combined with therapeutic lenses (+0.85 D add and 3Δ base-up yoked prism OU) and the progressive use of strobe glasses to enhance compensatory scanning into the blind field. The report details meaningful functional gains in reading endurance, eye-hand coordination, mobility, and reduced visual fatigue, while highlighting the role of strobe glasses as an adjunct in neuro-vision rehabilitation for homonymous hemianopsia.
The case report in Optometry & Visual Performance (Vol. 14, Issue 1) by Sharma et al. describes the optometric management of a 65-year-old male with genetically confirmed spinocerebellar ataxia type 3 (SCA3) who presented with distance diplopia and limited extraocular movements. Despite normal best-corrected visual acuity of 6/6 OU, clinical findings included 5Δ esotropia at distance, intermittent exotropia at near, reduced fusional amplitudes, and poor stereoacuity. Management consisted of 3Δ base-out prism incorporated into progressive addition lenses combined with home-based vergence exercises using a Brock string. Over two years, the patient achieved complete resolution of diplopia, improved ocular alignment, and sustained visual comfort, highlighting the value of precise prism correction and targeted binocular vision therapy in enhancing quality of life for patients with SCA-related oculomotor dysfunction.
The clinical guide by Bennett McAllister, OD, introduces “Einsteinian Low Vision Rehabilitation” as Part 1 of a 4-part series. It presents a paradigm shift in low vision care that emphasizes LogMAR thinking to make assessment and management more rational and efficient. The guide outlines three core models—the Black Box, the Chain-of-Vision (six-link sequence from light to brain processing), and Cause-Effect-Impact—to better link measurable visual deficits in acuity, fields, and contrast sensitivity to real-world functional limitations and quality-of-life outcomes. Presented through narrative dialogues with optometry students, the article explores educational principles such as self-regulated learning and evidence-based practice while aiming to restore enthusiasm for the field by moving beyond traditional mechanical approaches.
The narrative review in Optometry & Visual Performance (Vol. 14, Issue 1) by Kaiti et al. explores the relationship between developmental delay and oculo-visual deficits in children. It discusses how visual impairments—such as refractive errors, strabismus, amblyopia, oculomotor dysfunction, accommodative insufficiency, and convergence issues—are highly prevalent (68–86%) in children with developmental delays, including those with cerebral palsy, autism spectrum disorder, and ADHD. The article reviews common prenatal, perinatal, and postnatal risk factors, clinical presentation patterns, and the importance of comprehensive eye examinations. It also highlights the value of early multidisciplinary intervention, including adapted vision therapy targeting binocular vision, accommodation, and oculomotor skills, to support broader developmental progress in language, motor function, and social interaction.
Geoff Shayler’s case report describes the successful “fast-track” vision therapy of a 17-year-old female student with symptomatic convergence insufficiency. The patient presented with significant asthenopia, headaches, blurred near vision, reading difficulties, and a high COVD symptom score, along with poor near point of convergence, large near exophoria, reduced accommodative facility, and constricted functional visual fields. Previous treatments including base-in prism and pencil push-ups had provided little benefit.She completed an intensive two-week program consisting of 20 one-hour daily sessions that combined optometric vision therapy targeting the “Five Fs” (Fields, Fixations, Focus, Fusion, Flexibility) with optometric phototherapy (syntonics). Post-treatment assessment showed marked improvements in convergence, ocular alignment, accommodative flexibility, visual fields, reading speed, and visual processing measures, with complete resolution of symptoms that were maintained at six-month follow-up. The report illustrates the potential for rapid functional gains using a condensed, intensive vision therapy protocol in adolescents with convergence insufficiency.
