Clinical Measurement of the Angle of Ocular Movements in the Nine Cardinal Positions of Gaze

Published:January 10, 2014DOI:https://doi.org/10.1016/j.ophtha.2013.11.019

      Purpose

      To measure the maximum angle of ocular versions using photographs of the 9 cardinal positions and a modified limbus test.

      Design

      An evaluation of diagnostic technology; a prospective observational study.

      Participants

      We enrolled 104 healthy subjects, 20 to 40 years of age.

      Methods

      Photographs were obtained in the 9 cardinal positions of gaze and the images were processed using Photoshop. The images were analyzed using the Image J program to measure the angle of version. The maximum angle of the 9 cardinal positions was quantified using a modified limbus test.

      Main Outcome Measures

      We measured the maximum angle of ocular versions in the 9 cardinal positions of gaze. We also compared the results for males and females.

      Results

      The mean angles of maximum version were adduction 47.4°, abduction 46.4°, elevation 31.8°, depression 47.8°, elevation in adduction 39.7°, elevation in abduction 40.7°, depression in adduction 52.7°, and depression in abduction 49.2°. The mean angle of maximum elevation was significantly smaller than that of depression ( P < 0.001). There were no correlations between the angle of maximum version and age, spherical equivalents, or axial length. The angle of maximum version for males was significantly greater than that for females, except for inferior gaze.

      Conclusions

      A modified limbus test using photographs of the 9 cardinal positions is an objective and reproducible tool for quantifying ocular movement. Considering its simplicity, ease of use, and low cost, it has clear applications in clinical practice.
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      References

        • von Noorden G.K.
        • Campos E.C.
        Binocular Vision and Ocular Motility: Theory and Management of Strabismus.
        6th ed. Mosby, St. Louis2002: 68
        • Ansons A.M.
        • Davies H.
        Diagnosis and Management of Ocular Motility Disorders.
        3rd ed. Blackwell Science, London2001: 104-105
        • Kestenbaum A.
        Clinical Methods of Neuro-ophthalmologic Examination.
        2nd ed. Grune & Stratton, New York1961: 237-242
        • Urist M.J.
        A lateral version light-reflex test.
        Am J Ophthalmol. 1967; 63: 808-815
        • Bland J.M.
        • Altman D.G.
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; 327: 307-310
        • Clark R.A.
        • Isenberg S.J.
        The range of ocular movements decreases with aging.
        J AAPOS. 2001; 5: 26-30
        • Mourits M.P.
        • Prummel M.F.
        • Wiersinga W.M.
        • Koornneef L.
        Measuring eye movements in Graves ophthalmopathy.
        Ophthalmology. 1994; 101: 1341-1346
      1. Gerling J, Lieb B, Kommerell G. Duction ranges in normal probands and patients with Graves' ophthalmopathy, determined using the Goldmann perimeter. Int Ophthalmol 1997-1998;21:213-21.

        • Chamberlain W.
        Restriction in upward gaze with advancing age.
        Am J Ophthalmol. 1971; 71: 341-346
        • Haggerty H.
        • Richardson S.
        • Mitchell K.W.
        • Dickinson A.J.
        A modified method for measuring uniocular fields of fixation: reliability in healthy subjects and in patients with Graves orbitopathy.
        Arch Ophthalmol. 2005; 123: 356-362
        • Dolman P.J.
        • Cahill K.
        • Czyz C.N.
        • et al.
        Reliability of estimating ductions in thyroid eye disease: an International Thyroid Eye Disease Society multicenter study.
        Ophthalmology. 2012; 119: 382-389
        • Bielschowsky A.
        Lectures on Motor Anomalies.
        Dartmouth College Publications, Hanover, NH1943: 11-20
        • Houben M.M.
        • Goumans J.
        • van der Steen J.
        Recording three-dimensional eye movement: scleral search coils versus video oculography.
        Invest Ophthalmol Vis Sci. 2006; 47: 179-187
        • Oguro H.
        • Okada K.
        • Suyama N.
        • et al.
        Decline of vertical gaze and convergence with aging.
        Gerontology. 2004; 50: 177-181
        • Nakagawa T.
        Topographic anatomical studies on the orbit and its contents [in Japanese].
        Nihon Ganka Gakkai Zasshi. 1965; 69: 2155-2179
        • Miller J.M.
        Functional anatomy of normal human rectus muscles.
        Vision Res. 1989; 29: 223-240
        • Maughan R.J.
        • Watson J.S.
        • Weir J.
        Strength and cross-sectional area of human skeletal muscle.
        J Physiol. 1983; 338: 37-49
        • Kawamoto K.
        Quantitative evaluation of vertical smooth pursuit eye movement in healthy young subjects.
        J Yonago Med Ass. 1998; 49: 1-6
        • Kushner B.J.
        • Fisher M.R.
        • Lucchese N.J.
        • Morton G.V.
        Factors influencing response to strabismus surgery.
        Arch Ophthalmol. 1993; 111: 75-79
        • Masters M.P.
        Relative size of the eye and orbit: an evolutionary and craniofacial constraint model for examining the etiology and disparate incidence of juvenile-onset myopia in humans.
        Med Hypotheses. 2012; 78: 649-656
        • Chau A.
        • Fung K.
        • Pak K.
        • Yap M.
        Is eye size related to orbit size in human subjects?.
        Ophthalmic Physiol Opt. 2004; 24: 35-40