Infantile nystagmus syndrome: Broadening the high-foveation-quality field with contact lenses

Giovanni Taibbi^1,4,5, Zhong I Wang^1,3, Louis F Dell’Osso^1–3

¹The Daroff-Dell’Osso Ocular Motility Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center and CASE Medical School; ²Department of Neurology; ³Department of Biomedical Engineering, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, OH, USA; ⁴Pediatric Ophthalmology and Strabismus Unit, San Paolo Hospital, Milan, Italy; ⁵University of Milan, Milan, Italy

Abstract: We investigated the effects of contact lenses in broadening and improving the high-foveation-quality field in a subject with infantile nystagmus syndrome (INS). A high-speed, digitized video system was used for the eye-movement recording. The subject was asked to fixate a far target at different horizontal gaze angles with contact lenses inserted. Data from the subject while fixating at far without refractive correction and at near (at a convergence angle of 60 PD), were used for comparison. The eXpanded Nystagmus Acuity Function (NAFX) was used to evaluate the foveation quality at each gaze angle. Contact lenses broadened the highfoveation-quality range of gaze angles in this subject. The broadening was comparable to that achieved during 60 PD of convergence although the NAFX values were lower. Contact lenses allowed the subject to see “more” (he had a wider range of high-foveation-quality gaze angles) and “better” (he had improved foveation at each gaze angle). Instead of being contraindicated by INS, contact lenses emerge as a potentially important therapeutic option. Contact lenses employ afferent feedback via the ophthalmic division of the V cranial nerve to damp INS slow phases over a broadened range of gaze angles. This supports the proprioceptive hypothesis of INS improvement.

Keywords: contact lenses, infantile nystagmus, visual function