FP769 : Spectacle Mounted Synoptophore: an Innovative Approach for Household Orthoptics

AIOS – Prem Prakash Disha Award

Dr. Sanjoy Chowdhury, C6721, Dr.Nilanjan Chowdhury, Dr. Hitesh

Dr Sanjoy Chowdhury, MS.DO.DNB.

Joint Director (Medical & Health Services, SAIL/BGH.

4C/3020 BOKARO STEEL CITY, JHARKHAND_827004

drsanjoybokaro@rediffmail.com

Dr Hitesh Patel

Bokaro General Hospital. Jharkhand

Abstract:

Amblyopia is a common problem in children. Early diagnosis, occlusion and orthoptic exercise are mainstay for management. Orthoptic exercises on synoptophore require institutional approach which is not available to most people.

Purpose:

To study feasibility and outcome of customized trial frame mounted miniature synoptophore made from low cost locally available materials.

Methods :

Miniature synoptophore was designed from locally available “bio-scope”toys mounted on trial frame, fitted with LED light for alternate flashing.10 amblyopic patients were given this for use at home for 4 weeks and 10 amblyopic exercising on synoptophore installed at hospital were used as controls.

Results:

Acceptability was more with miniature spectacle mounted synoptophore and results were comparable with hospital controls.

Conclusion: Innovative home exercise for amblyopia is possible with trial frame mounted miniature synoptophore

Introduction:

Synoptophore is an electrical instrument which compensates for the angle of squint and allows the stimuli to be presented to both eyes simultaneously. It is used to diagnose ocular muscular imbalance and treating them by orthoptic method. Synoptophore is also useful for treating amblyopia by alternate flashing.

Occlusion therapy and patching of the good eye has been described for more than 200 years and remains the accepted treatment.1 Compliance is often a major problem because of the child’s dislike of occlusion owing to visual, skin irritation, psychological and social reasons prospectively. Orthoptic and pleoptic treatment of amblyopia2 have been maintained in Europe since 1950 using the principle that providing the amblyopic eye with the appropriate kind of visual stimulation or making specific functional demands on it, during the period of occlusion therapy, might accelerate the improvement in its vision. 3 Orthoptic treatment being institution based availability and compliance remains a problem. Any device for home orthoptics may be helpful. Trial frame and toy Bioscope/binoculars can be used to design such instrument. Innovation consists of seeing what everybody has seen and thinking what nobody has thought.

Spectacle mount synoptophore (SMS) made from locally available materials can be customized and provided to each patient for orthoptic treatment along with occlusion to improve vision in Amblyopes.

Aim:

To study feasibility and outcome of customized trial frame mounted miniature synoptophore made from low cost locally available materials.

Methods:

SMS is designed and assembled from locally available cheap components (Illustrations 1-6):

  1. Trial frame: adjustable to angle of deviation in squint cases.
  2. Small binocular whose inner wall is covered with nonglossy sticking paper.
  3. LED bulb and switches
  4. Synoptophore slides cut according to the size and shape of binocular tube

Brief Description:

A trial frame fitted with two eyepieces made from small plastic conical toys/binoculars with convex lenses (available in village fare to see different pictures viz.bioscope).Eye pieces can be moved according to the angle of deviation. Pictures are made from synoptophore slides. This is an eye wear or spectacle to improve vergence. Alternate stimulation can be done in amblyopia (lazy eyes).They can be further reinforced with LED lights fitted with the eye pieces. Desired optical correction can also be used to correct refractive errors.

Salient Features of the innovation:

Lazy eyes are common in children which if detected and treated early can give good visual outcome. Besides occlusion, different orthoptic exercises on synoptophore require institutional approach. This is time consuming hampering studies and not accessible /available everywhere. Simple spectacle designed with very low cost materials will help the amblyopic patients exercise at home. Convergence deficiency or excess is very common among prolonged computer users. This simple device can improve vergence faculty with daily 10 minutes exercise.

Results:

Miniature synoptophore was designed from locally available “bio-scope” toys or binocular mounted on trial frame, fitted with LED light for alternate flashing.10 amblyopic patients were given this for use at home for 4 weeks and 10 amblyopic exercising on synoptophore installed at hospital were used as controls.

Discussion:

Amblyopia is the most common cause of monocular visual impairment in children 3. Most cases are associated with strabismus in infancy or early childhood. Less frequent are anisometropia, combination of strabismus and anisometropia, or visual deprivation. About 25 per cent of patients have visual acuity in the amblyopic eye worse than 6/36 and about 75 per cent have acuity of 6/36 or better. (need reference) Occlusion therapy and patching of the good eye has been described for more than 200 years and remains the accepted treatment. It is generally held that the response to treatment seems best when instituted at an early age and is poor after the age of 8 years. Compliance is often a major problem because of the child’s dislike of occlusion owing to visual, skin irritation, psychological and social reasons. Other alternative treatments to occlusion therapy have been reported such as pharmacological penalization by installation of a long acting topical cycloplegic agent: atropine sulfate, and using drug treatment: Levodopa and Carbidopa, in amblyopia.3 Orthoptic and pleoptic treatment of amblyopia have been maintained in Europe since 1950 using the principle that providing the amblyopic eye with the appropriate kind of visual stimulation or making specific functional demands on it, during the period of occlusion therapy, might accelerate the improvement in its vision. Recently home based video games4, dichoptic movie viewing5.6 etc. are also being studied. In this study compliance and visual outcome was better as this SMS could be customized according to patients’ preference.

However this is being a prototype need further refinement before commercial use.

Conclusion: (very large conclusion. Some of it should be in introduction and discussion)

Innovative home exercise for amblyopia is possible with trial frame mounted miniature synoptophore. This study suggests that amblyopia can be improved with the help of orthoptic stimulation by using spectacle mount synoptophore. It can improve the level of vision, at the first phase, to a certain degree for the children to accept the patching and resume their usual daily life. Thus, the compliance of the treatment can be well achieved.

Science and technology are the fundamental for economic development of a country. India is developing nation with world leading technological advancements in many fields; computer technology is one of them. Mammoth population of more than 125 crore is cited as a reason behind all problems. But affordable Medicare and technology can help to solve this. As Einstein once said “Innovation is not the product of logical thought, although the result is tied to logical structure”. For this, interaction between science and Industry is required. Innovative research to find products which can be made locally can reduce the cost. Patenting our innovative idea, design or discovery is the first step. Primary source of support for patented technology is the employer of the inventor, usually the assignee.

References:

  1. Parkes LC. An investigation of the impact of occlusion therapy on children with amblyopia, its effect on their families, and compliance with treatment. Br Orthopt J 2001; 58: 30-7.
  2. Sen DK, Singh B, Shroff NM. Diagnosis and measurement of cyclodeviation. Br J Ophthalmol 1977; 61: 690-2.
  3. Vijay Tailor, Manuela Bossi , John A. Greenwood , Annegret Dahlmann-Noor. Childhood amblyopia: current management and new trends. British Medical Bulletin, 2016, 119:75–86.
  4. Li SL, Reynaud A, Hess RF, et al. Dichoptic movie viewing treats childhood amblyopia. J AAPOS 2015;19:401–5.
  5. Bossi M, Anderson E, Tailor V, et al. An exploratory study of a novel home-based binocular therapy for childhood amblyopia. ARVO 2014;55:5981.
  6. Foss AJ, Gregson RM, MacKeith D, et al. Evaluation and development of a novel binocular treatment (I-BiT) system using video clips and interactive games to improve vision in children with amblyopia (‘lazy eye’): study protocol for a randomised controlled trial. Trials 2013;14:145

Illustration 1 : Binocular tube used as main body which was mounted on trial frame
Illustration 2: Customised slides and LED bulbs, switches

Illustration 3 : Different slides ,reflecting occluder

Illustration 4 : Whole device with different components

Illustration 5: Underside of the SMS with switches connecting LED lights to illuminate slides which can perform alternate flashing

Illustration 6 : SMS ready for use with slits for inserting slides

Illustraion 7: SMS in use.

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