Nystagmus (ni’-stag-mus) refers
to a condition of involuntary eye movements. The eye muscles that
control eye movement receive a pulsating stimulus to contract,
instead of a quiet steady tone. Patients with this affliction will
adopt an unusual head, or eye position to minimize their unwanted
appearance, or wear dark glasses. It can be present at birth or
acquired anytime throughout life due to neurologic or ocular disease.
When it has its onset in adulthood, the world appears in constant
motion. When it has its onset in childhood, there is often a significant
impact on education and social development. It affects approximately
1 in 5,000 people.
The clinical appearance is variable. The uncontrollable eye shaking
can be horizontal, vertical, rotational, or any in combination
of those directions. It can consist of a slow, to and fro slow
oscillation of the eyes (“pendular”), or have both
a slow drifting phase and a rapid repositioning (“jerk”)
Congenital nystagmus, that occurring at or shortly after birth,
has traditionally been thought of as untreatable. Research in treatment
has been primarily directed toward trials of medications that quiet
the nervous system, for example, those used for seizure control,
and therefore their use has many potential unwanted side effects.
Surgical approaches to change the effects of muscle contractions
on the eye have had limited success in eliminating the unwanted,
uncontrollable eye movement.
In 2002, Dr. Robert Siskey and colleagues, reported on an aggressive
surgical approach to quiet the unwanted eye movements by removing
the offending muscles. Not only was the eye shaking controlled
but the eyes could still move sufficiently to accomplish normal
tasks of daily living. After evaluating one of these patients,
10 years after that surgical approach, Dr. Robert Lingua and colleagues
at the Gavin Herbert Eye Institute, have re-opened the case for
eye muscle removal (“sub-total anterior extirpation”)
to treat nystagmus. Preliminary results can be found in a 9 minute
video on YouTube:
Dr. Lingua now regularly performs this surgery even if the patients
who were treated with other types of unsuccessful surgery in the
past, and has achieved a near surgical cure of the nystagmus, as
documented by objective, sophisticated, infra-red video eye movement
recordings (infra-red videonystagmography). Dr. Lingua was the
first surgeon to apply this technique to children with nystagmus,
operating as young as 1 year of age, with the goal of optimizing
vision development in childhood, and improving personal self image,
in the child’s school and formative years.
UC Irvine Health eye surgeon describes new treatment that restored
August 15, 2014
IN THE NEWS:Dr.
Robert Lingua and Grace Nassar talk with Dr. Bruce Hensel of NBC4 about
the procedure that restored the seven-year old's vision. Dr. Lingua, a pediatric
ophthalmologist at the UC Irvine Health Gavin Herbert Eye Institute, is perfecting
a surgery to treat nystagmus, a condition marked by uncontrollable eye movements.
Grace was three months old when her parents were told she had nystagmus. Worse,
an underlying condition would eventually make her functionally blind.
By age six, Grace was studying Braille, walking with a white cane and facing
an uncertain future. An acquaintance told her parents about Dr. Lingua and
the eye institute. Last summer, Grace underwent a revolutionary operation to
eliminate her eye movements and improve her vision.