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Orthoptic Vision Therapy: Establishing a Protocol for Management of Diplopia Following Orbital Fracture Repair
Brandon J. De Ruiter, BS1; Robert P. Lesko, BA1; Barry Tannen, OD, FCOVD, FAAO2; Noah Tannen, OD2; Edward H. Davidson, MD3
1Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New Yor
2020-01-30
Presenter: Brandon J De Ruiter
Affidavit:
I certify that the included work is the original work of the authors. All authors have reviewed the enclosed abstract to ensure accuracy of the submission.
Director Name: Edward H. Davidson
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND
Non-entrapment associated diplopia following orbital fracture repair is a well-recognized problem. Observation is the standard-of-care, however symptoms may be protracted. Orthoptic therapy is a form of ocular physical therapy that achieves functional rehabilitation through targeted exercises. This study aims to present baseline data for using orthoptics for managing diplopia following orbital-floor fracture repair.
METHODS
Protocols for home-exercise and office-assessment were developed. Exercises and computerized programs to train and assess convergence/divergence, smooth-tracking, and saccades were included. Office-assessment also involved scoring ocular motility and assigning surveys assessing symptom burden. Healthy volunteers (n=10) trialed the office-assessment thrice (n=30) and results were compiled to establish normative data. Comparative measurements were made in those with chronic (>1year; n=8) and acute (<2 weeks; n=4) orbital fractures. Time-of-therapy was recorded and monetary cost-analysis was performed.
RESULTS
Patients with acute fracture displayed limited fusional ability when comparing convergence (mean break/recovery of 8.0/6.5 prism diopters (pd) vs 31.87/21.23pd; p=0.001/0.015) and divergence (3.00/1.50pd vs 18.37/12.83pd; p=0.000/0.001) to the normative values. Those with chronic fracture had lower convergence (15.71/5.00pd; p=0.01/0.001) and divergence (12.29/4.71pd; p=0.04/0.002) when compared with norms, but better function than those with acute injury. Those with acute fracture reported higher symptom burden than chronic (mean score 19 vs 4.6; p=0.01) or healthy (19 vs 3.4; p=0.01) cohorts. Assessment took 7min 41sec on average. Per patient software cost was <$70.
CONCLUSIONS
Orthoptic therapy is applicable following orbital fracture repair and may improve fusional capacity and ocular motility. Normative data defined here may serve as a benchmark for clinical use.
