Poster Abstracts

withdrawn 86 42 Annual Scientific Congress of RANZCO 2010 Clinical and Experimental Ophthalmology 2010; 38 (Suppl 2): 61–86 © 2010 Royal Australian and New Zealand College of Ophthalmologists 64. USING TORSION TO ASSIST THE DIAGNOSIS OF BILATERAL SUPERIOR OBLIQUE PALSY Zoran Georgievski, Kara Muecke, Konstandina Koklanis Email: z.georgievski@latrobe.edu.au La Trobe University, VIC, Australia Introduction: This study aimed to determine the best indicator for differentiating between unilateral and bilateral superior oblique palsy (SOP) when comparing torsion measurements in primary position, downgaze and the difference between the two positions. Methods: Data of 24 participants with a likely acquired onset of superior oblique palsy (SOP) were included in the study (6 bilateral, 18 unilateral). Subjective torsion was measured in primary position and 30° downgaze using the synoptophore, Torsionometer® and double Maddox rod. Torsion measurements were averaged for the three tests in each position. Using a ROC analysis, the threshold amount of torsion (in degrees) providing the highest probability for correctly diagnosing a bilateral SOP was established for primary position, downgaze and for the difference in torsion between primary position and downgaze. Results: This study found that excyclotorsion was significantly larger in bilateral SOP than in unilateral SOP in primary position, downgaze and for the increase in torsion between primary position and downgaze. Cut-off points of excyclotorsion were established as ≥8.3° in primary position, ≥14.7° in downgaze and an increase of ≥7° in excyclotorsion between primary position and downgaze, to give the highest probability of correctly diagnosing a bilateral SOP. An overlap in the range of torsion measurements in the unilateral and bilateral group was found in all positions, meaning that there was room for misclassification if torsion is used alone to differentiate between the two. Conclusion: Torsion was found to be helpful in the diagnosis of bilateral versus unilateral SOP and can be considered as another useful sign in the challenging task of correctly classifying a SOP. Cut-off points should be used in conjunction with other possible signs of bilateral involvement to increase the chance of correctly diagnosing a bilateral SOP and in identifying cases of masked bilateral SOP before surgery. 65. HOW IS ACCOMMODATIVE ESOTROPIA MANAGED AROUND THE WORLD? AN INTERNATIONAL SURVEY OF ORTHOPTISTS’ PRACTICE PATTERNS Zoran Georgievski, Katrina Lee, Konstandina Koklanis Email: z.georgievski@latrobe.edu.au La Trobe University, VIC, Australia Introduction: Health professionals are increasingly required to ensure that their practice is based on robust evidence, yet there has not been enough highlevel evidence to report guidelines for managing refractive accommodative esotropia. It is important to gain insight into the consistency and variance of current practices so that we can inform further research. Therefore, this study aimed to describe the practice patterns of orthoptists managing refractive accommodative esotropia, and to explore whether practices vary depending on the country an orthoptist works in, and how long they have been working, and whether practices are consistent with trends in the literature. Methods: Data collection was via an online survey of closed questions. Included in the study were 743 orthoptists from 24 countries, who had been working for an average of 17 years (range = 2 months – 48 years, SD = ±12.5 years). Results: The survey respondents showed variation in management practices, especially between countries. This was consistent with gaps in the literature and indicated that the long-term outcome of full versus undercorrection, the threshold of hypermetropia that can predict the discontinuation of correction, the efficacy of orthoptic exercises and/or gradual reduction of hypermetropic correction in the dispensing of glasses, and when, if ever, strabismus surgery might be appropriate for refractive accommodative esotropia, would benefit from further research. Conclusion: Responses to the survey varied significantly between countries for most aspects of management, whereas the number of years orthoptists had been working appeared to have made a more minimal impression on practice patterns.