"TO CROSS OR NOT TO CROSS"
The Proceedings of the Ocular Motor Tonus Symposium
Sponsored by the Smith-Kettlewell Eye Research Institute
Tiburon, California June 2-4, 2006
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Introduction
Strabismus specialists have good reasons to be proud of advances in their field over the past few decades. The introduction of Botox by Scott has provided a non-surgical option for the treatment of many strabismus patients. Its widespread use in a myriad of other areas in medicine would not have been possible without the pioneering work done by strabismus experts. The reintroduction and refinement of adjustable suture techniques by Jampolsky has provided an invaluable tool for the management of complicated strabismus re-operations, especially in adults. Recent well-controlled trials of treatment schemes for amblyopia have clarified some, although hardly all, of the vagaries surrounding the treatment of this frequent companion of strabismus.
However, many fundamental questions about the pathophysiology of the most common forms of strabismus- childhood, comitant, and horizontal deviations-continue to remain unanswered. At times, perhaps, they seem not to be even considered in scientific grant applications, publications, and meetings. The most fundamental of these is the issue of ocular motor tonus. Tonus is the most prominent, variable element in the genesis and manifestations of childhood strabismus. Nevertheless, it is incompletely understood and clearly understudied.
About 5 years ago, discussions began between Art Jampolsky and Mike Brodsky about the importance of ocular motor tonus, its relevance to infantile strabismus, methods of measuring it and possible non-surgical approaches to treatment. For this reason, the Smith-Kettlewell Eye Research Institute organized a symposium on Ocular Motor Tonus that was held on June 2-4, 2006 at Tiburon, California. Experts in several fields, including muscle and nerve physiology, neuropharmacology, neuroophthalmology, nano- and micro-technology, and pediatric ophthalmology and genetics were invited to participate. Although the discussions reached out in several directions to include numerous topics, the focus of this meeting was childhood strabismus and its pathophysiology. What causes it? Is it under genetic control? Can we model it? Can we be more creative in its treatment? How can basic scientists partner with clinicians in an effort to understand the underlying neurologic correlates of strabismus? Undoubtedly more questions were asked than answered. However, the exchanges that took place seemed valuable and energized the participants to consider future research directions to help answer at least some of the questions raised. We hope these proceedings will prompt other interested investigators and clinicians to renew their efforts in the study of ocular motor tonus and its effect on childhood strabismus.
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Henry Metz MD
Executive Director
Smith-Kettlewell Eye Research Institute