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Pavitra Jayaramachandran, Frank A. Proudlock, Nita Odedra, Irene Gottlob, Rebecca J. McLean; Optical Treatment Of Nystagmus - A Randomised, Controlled, Cross-over Study. Invest. Ophthalmol. Vis. Sci. 2012;53(14):513.
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Several studies investigated the use of contact lenses in infantile nystagmus (IN), but findings are controversial and the mechanisms of action are unclear. Rigid gas-permeable lenses (RGPL) and soft contact lenses (SCL) have not been previously compared. Our aim is to compare visual function and change in eye movements in IN using RGPL and SCL compared to glasses in a randomised controlled cross-over study.
24 patients with IN were recruited. Each patient attended 5 visits at 2-week intervals (weeks 1-2: glasses wearing; weeks 3-6: contact lens wearing - two weeks of RGPL and SCL each with the order randomized; weeks 7-8: glasses wearing). At each visit eye movement (500 Hz, Eyelink II), logMAR best-corrected visual acuity (BCVA) at near (0.4m) and distance (4m), gaze-dependent visual acuity (GDVA) and the Radner reading test (measure of reading acuity and reading speed) were recorded. The primary outcome was nystagmus intensity derived from the eye movement recordings (EMR). Extended nystagmus acuity function (NAFX) was also used to estimate foveation from the EMR. Friedman test and linear mixed models were used to analyse EMR measurements and visual function, respectively. Missing data was substituted using the last observation carried forward method, enabling an intention-to-treat analysis to be undertaken.
Neither RGPL nor SCL significantly changed nystagmus intensity (or any other EMR outcome) compared to glasses wearing (p>0.05). In contrast, BCVA and reading acuity were significantly worse with SCL wearing compared to RGPL and glasses wearing (BCVA, p<0.0001, reading acuity p=0.0009). There were no significant differences between treatment groups for GDVA (p>0.05).
In contrast to previous studies, we found SCL resulted in significantly worse visual and reading acuities compared to RGPL and glasses wearing. We also found no change in eye movement for the three treatments which implies that the deterioration in vision caused by SCL wearing is a refractive problem, possibly misalignment of the lens on the eye.
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