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Y. H. Luo, A. Liasis, B. Walters, Y. A. Abou-Rayyah; Benefits of Electrodiagnostic Testing (EDT) in the Assessment of Amblyopia in Children With Congenital Ptosis and Its Correlation With Orthoptic Findings. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4706.
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To determine the benefit of EDT in the management of congenital ptosis in children
A retrospective comparative case series of 33 patients with congenital ptosis who attended a tertiary paediatric oculoplastics centre. Patients with other ocular / neurological conditions which compromised vision were excluded. As part of their investigations patients underwent both electrodiagnostic (EDT) and orthopitc testing. The results were compared to look for similarities and discrepancies on patient co-operation with each assessment modality, the outcomes of the assessments, and the management decisions based on the assessments.
In 41 out of 70 episodes (59%), both EDT and orthoptic were in agreement to the presence or absence of amblyopia and as a result management decision was based on both assessments. In a number of cases only either EDT or orthoptic testing could be achieved and as a result management was based on the successful modality (3 separate episodes each for EDT and orthopitic testing). Of interest the EDT and orthoptic findings were in disagreement in 23 patient episodes.In these cases management was based on orthoptic findings in 18 episodes while on EDT findings in the remaining 5 episodes.
EDT was found to be beneficial in attaining monocular visual assessment in all the children patients. It did not alter clinical management in children able to carry out subjective recognition acuity tasks or in those older than 15 months of age, as subjective recognition acuity testing is considered the gold standard for monocular visual assessment on which management is based.In situations when EDT and orthoptic findings contradict each other, other clinical factors (e.g. extent of ptosis, compliance of occlusion therapy) should be taken into consideration in the decision making. In older patients who are able to perform subjective recognition visual acuity, orthoptic assessments alone may be adequate in monitoring their visual function. We recommend to perform both EDT and orthoptic assessments in patients under 15 months of age, to maximise the detection of amblyopia and allow early institution of appropriate treatment.
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