Effects of age, viewing distance and target complexity on static ocular counterroll

Goltz, Herbert C.; Mirabella, Giovanni; Leung, Joanne; Blakeman, Alan; Colpa, Linda; Abuhaleeqa, Khaled; Wong, Agnes M. F.

doi:10.1016/j.visres.2009.04.021

Cited by 11 publications

(14 citation statements)

References 46 publications

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“…To test whether OCR is abnormal in skew deviation, we first sought to clarify the effects of age and target characteristic on OCR gain in a normal population across the age span (n ¼ 60). We found that OCR gain is dependent on age, viewing distances, and target complexity, 19 as well as whether the target is head fixed or earth fixed. 20 Using an earth-fixed complex target at a distance of 1 m that has been shown to elicit higher gain in normal subjects, we recorded the eye movements of 18 patients with skew deviation and 18 normal participants by scleral search coil.…”

Section: Skew Deviationmentioning

confidence: 81%

New understanding on the contribution of the central otolithic system to eye movement and skew deviation

Wong

2014

Eye

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The otolith organs consist of the utricle and saccule. The utricle mediates the utriculoocular reflex by detecting horizontal head translation and static head tilt. Skew deviation is a vertical strabismus caused by imbalance of the utriculo-ocular reflex pathway and is commonly caused by lesions in the brainstem or cerebellum. It is associated with abnormal utriculo-ocular reflexes including asymmetric reduction of the translational vestibulo-ocular and ocular counterroll responses. Skew deviation is also associated with head position-dependent changes in ocular torsion and vertical strabismus. The reduction in ocular torsion and vertical strabismus when changing from an upright to supine position in skew deviation allows us to devise a new bedside 'upright-supine test' to differentiate skew deviation from fourth nerve palsy and other causes of vertical strabismus.

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Section: Skew Deviationmentioning

confidence: 81%

New understanding on the contribution of the central otolithic system to eye movement and skew deviation

Wong

2014

Eye

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“…43 We provided further evidence to confirm its existence by demonstrating that the magnitude of ocular counterroll responses is dependent on the age of subjects, viewing distance, target characteristics, and whether or not the target moves simultaneously with the head. 44,45 The ocular tilt reaction is a pathological synkinetic triad of skew deviation, ocular torsion, and head tilt. It has been attributed to lesions in the vestibular organ and its nerve, and central connections within the brainstem or cerebellum that asymmetrically disrupt the utriculo-ocular pathway.…”

Section: Pathophysiologymentioning

confidence: 99%

Understanding skew deviation and a new clinical test to differentiate it from trochlear nerve palsy

Wong¹

2010

Journal of American Association for Pediatric Ophthalmology and

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SUMMARYSkew deviation is a vertical strabismus caused by a supranuclear lesion in the posterior fossa. Because skew deviation may clinically mimic trochlear nerve palsy, it is sometimes difficult to differentiate the 2 conditions. In this review we compare the clinical presentations of skew deviation and trochlear nerve palsy and examine the pathophysiology that underlies skew deviation. We then describe a novel clinical test-the upright-supine test-to differentiate skew deviation from trochlear nerve palsy: a vertical deviation that decreases by ≥50% from the upright to supine position suggests skew deviation and warrants investigation for a lesion in the posterior fossa as the cause of vertical diplopia.Skew deviation is a vertical strabismus caused by supranuclear lesions. It is often associated with ocular torsion and head tilt, which together constitute the ocular tilt reaction. [1][2][3][4] Skew deviation is often the initial manifestation of diseases that affect the brainstem, cerebellum, or peripheral vestibular system. [4][5][6][7][8][9][10] Because both skew deviation and trochlear nerve palsy may result from intracranial lesions or trauma, and because some skew deviations may clinically mimic trochlear nerve palsy, differentiating these 2 conditions can be challenging. Understanding skew deviation remains difficult, partly because it requires knowledge of the underlying anatomy and pathophysiology. In this review, we first compare the clinical presentation of skew deviation versus trochlear nerve palsy. We then focus on the pathophysiologic mechanism of skew deviation and examine some current evidence that shows that skew deviation results from an imbalance of the utriculo-ocular pathway. We then present a novel upright-supine test that can be used clinically to differentiate skew deviation from trochlear nerve palsy at the bedside. Clinical PresentationSkew deviation was first induced experimentally in animals by Magendie 11 and later Hertwig, 12 who produced skew deviation in cats by sectioning the middle cerebellar peduncle. It was first observed in humans with cerebellar tumors by Stewart and Holmes in 1904. 13 Skew deviation is a vertical misalignment of the visual axes caused by a disturbance of supranuclear inputs as a result of lesions in the brainstem, cerebellum, or peripheral CIHR Author ManuscriptCIHR Author Manuscript CIHR Author Manuscript vestibular system (ie, the inner ear and its afferent projections). The vertical misalignment may be comitant or incomitant. Rarely, it alternates with eye position (eg, right hypertropia on right gaze and left hypertropia on left gaze). 14,15 Skew deviation often is associated with other neurologic signs and may be part of the ocular tilt reaction, which consists of a triad of skew deviation, ocular torsion, and head tilt. [1][2][3]10 In ocular tilt reaction, the pathologic head tilt is ipsilateral to the hypotropic eye, and the ocular torsion is such that the upper poles of both eyes rotate in the same direction as that of the head tilt (ie, the h...

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“…3,9 -11 The utricle normally mediates the static ocular counterroll (OCR) reflex which generates partially compensatory torsional eye movements during static head roll. [12][13][14] In a previous study, 5 we found that the OCR response was asymmetrically reduced in patients with skew deviation caused by cerebellar lesions. However, a definitive pattern could not be drawn because of the study's small sample size (n ϭ 3).…”

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confidence: 76%

Static ocular counterroll reflex in skew deviation

Chandrakumar¹,

Blakeman²,

Goltz³

et al. 2011

Neurology

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Objective:The static ocular counterroll (OCR) reflex generates partially compensatory torsional eye movements during head roll. It is mediated by the utricle in the inner ear. Skew deviation is a vertical strabismus thought to be caused by imbalance in the utriculo-ocular pathway. We hypothesized that if skew deviation is indeed caused by damage to this reflex pathway, patients with skew deviation would show abnormal OCR. Methods:Eighteen patients with skew deviation caused by brainstem or cerebellar lesions and 18 normal participants viewed a target at 1 m. Ocular responses to static passive head roll-tilts of approximately 20°were recorded using search coils. Static OCR gain was calculated as the change in torsional eye position divided by the change in head position during sustained head roll. Perception of the subjective visual vertical (SVV) was also measured.Results: Group mean OCR gain was reduced by 45% in patients. At an individual level, OCR gains were asymmetric between eyes and between torsional directions in 90% of patients. In addition, the hypotropic eye incyclotorting gain was lower than the hypertropic eye excyclotorting gain during head roll toward the hypotropic eye in 94% of patients. No consistent pattern of gain asymmetry was found during head roll toward the hypertropic eye. The SVV was tilted toward the hypotropic eye. Conclusion:Static OCR gain is significantly reduced in skew deviation. Interocular and directional gain asymmetries are also prevalent. The asymmetries provide further evidence that disruption of the utriculo-ocular pathway is a mechanism for skew deviation. Neurology ® 2011;77:638-644 GLOSSARY OCR ϭ ocular counterroll; OTR ϭ ocular tilt reaction; SVV ϭ subjective visual vertical.

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Effects of age, viewing distance and target complexity on static ocular counterroll

Cited by 11 publications

References 46 publications

New understanding on the contribution of the central otolithic system to eye movement and skew deviation

New understanding on the contribution of the central otolithic system to eye movement and skew deviation

Understanding skew deviation and a new clinical test to differentiate it from trochlear nerve palsy

Static ocular counterroll reflex in skew deviation

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