Latest Advancements in Nystagmus Treatment

Highlights

Traditional nystagmus treatment approaches focus on improving visual acuity and reducing eye movements but may not address the underlying neurological or muscular causes of nystagmus.
Advanced diagnostic techniques, such as VR eye-tracking technology and high-resolution imaging, provide optometry professionals with a more detailed understanding of nystagmus.
Pharmaceutical interventions, surgical options, and gene therapy are emerging as potentially effective approaches to treating nystagmus.

Nystagmus is a relatively common condition affecting approximately 24 in 10,000 people, and it is the most prevalent form of visual impairment in school-aged children. Because the condition has many types and causes, nystagmus treatment can be challenging.

Conventional treatment options typically revolve around managing eye movements and improving focus, but the most recent development in nystagmus management addresses the condition’s root causes.

Traditional Nystagmus Treatment Approaches

Traditional treatment approaches for nystagmus have primarily focused on improving visual acuity and reducing the severity of eye movements. These methods often include corrective lenses, prisms, and occlusion therapy. While these approaches can relieve and improve visual function, they have limitations.

One of the main challenges with traditional treatments is that they do not address the root neurological or muscular causes of nystagmus. There are numerous forms of nystagmus, from benign nystagmus and horizontal nystagmus to congenital nystagmus and optokinetic nystagmus.

Unfortunately, traditional treatments may be unsuitable for all patients, especially those with severe or atypical forms of nystagmus. Achieving significant improvements in visual acuity and eye movement with standard procedures may be challenging.

With continued research and development of alternative treatment modalities, optometrists can implement new treatment approaches to enhance patient outcomes and quality of life.

Latest Diagnostic Techniques

Advancements in diagnostic techniques for nystagmus have made new treatments available. Optometrical tools such as eye-tracking technology, video-oculography, and high-resolution imaging have improved the evaluation process. These techniques provide optometry professionals with a more detailed and comprehensive understanding of the condition.

A 2022 study on the effectiveness of an eye-tracking smartphone app for diagnosing nystagmus found that the app had an 82.14% detection sensitivity rating. These findings indicate that an app using eye-tracking technology could be a useful tool for nystagmus diagnostics.

A 2022 systematic review of studies on virtual reality (VR) and augmented reality (AR) in ophthalmology found that these technologies have potential as diagnostic and screening tools. Various VR and AR tests were implemented for different conditions, including nystagmus. Results indicated that while VR and AR tools showed promise in terms of user experience and automation, they had limitations regarding accuracy, validation, and hardware.

Specifically, a VR tool for detecting contrast sensitivity in nystagmus showed some positive trends but had inconsistent results. VR and AR were found to be more suitable for dynamic visual acuity testing rather than static visual acuity.

Pharmaceutical Interventions

New medications specifically designed to target the underlying nystagmus causes are emerging as potential treatment options. These medications primarily aim to modulate neurotransmitters or inhibit specific neuronal pathways associated with abnormal eye movements. By doing so, they help reduce the intensity and frequency of nystagmus episodes, leading to improved visual stability.

The efficacy of these new medications varies depending on the subtype and severity of nystagmus. While some individuals experience significant improvement in their eye movements and visual symptoms, others may only experience modest benefits.

Recent developments include promising studies on:

Memantine and acetyl-DL-leucine (ADLL). A 2023 case study focused on a patient with acquired pendular nystagmus (APN) due to multiple sclerosis (MS). The patient experienced significant improvement in oscillopsia and balance after receiving a combination treatment of memantine and acetyl-DL-leucine (ADLL). The combination therapy reduced nystagmus velocity and frequency, providing a potential therapeutic alternative for acquired nystagmus in MS patients.
Botulinum toxin A. This drug has also shown promising results for nystagmus. A 2022 study evaluated the efficacy of botulinum toxin injection in patients with nystagmus associated with exotropia.
Six patients received botulinum toxin A Dysport injections in the lateral muscles of each eye. Results showed a significant reduction in nystagmus and a noticeable improvement in abnormal head position. Participants tolerated the treatment well and had limited side effects, with 83.3% of patients wishing to continue the treatment.

Surgical Options

Surgical options for nystagmus correction have advanced significantly in recent years, offering new hope for individuals with this condition. Various surgical techniques are being explored to address the anatomical or neural abnormalities contributing to nystagmus.

One of the latest surgical nystagmus treatments involves targeting specific muscles responsible for abnormal eye movements. By selectively weakening or repositioning these muscles, surgeons aim to reduce the intensity and frequency of nystagmus.

A 2022 review article discusses various surgical techniques for managing childhood nystagmus. Strategies include:

Shifting the eccentric null position
Artificial divergence surgery
Correcting associated strabismus
Four horizontal muscle recession
The Hertle-Dell’Osso procedure

The study found that the augmented Anderson procedure is ideal for correcting head turns, while bilateral rectus recessions are suitable for vertical head postures. The study also highlights the challenges in cases with associated strabismus and the limitations of certain surgical approaches. The lasting effectiveness of some procedures remains uncertain, and drastic measures like total myectomy are not widely recommended due to complications.

A 2022 report conducted by the American Academy of Ophthalmology (AAO) reviewing surgical procedures for infantile nystagmus syndrome (INS) found that while improvements in visual acuity were modest, there was no clear advantage to any specific procedure.

Some surgical interventions for nystagmus in infants evaluated included large recessions, tenotomy and reattachment (TAR), myectomy, and anterior extirpation of horizontal rectus muscles. Statistically significant improvements in binocular best-corrected visual acuity (BCVA) were observed in 75% of studies that performed statistical analyses. Complications and reoperations were lowest in TAR patients and highest in those undergoing myectomy or anterior extirpation.

Success rates for nystagmus surgery vary depending on factors such as the type and severity of the condition, patient age, and associated co-morbidities. While some individuals experience significant improvement in their eye movements and visual function, others may have more modest outcomes.

Gene Therapy

Gene therapy holds promise as a potential treatment for nystagmus. This innovative approach aims to correct the genetic mutations or abnormalities associated with the condition. By delivering healthy copies of the affected gene or modifying the existing gene, gene therapy can help restore normal function and reduce the severity of nystagmus.

Early research and preclinical studies have shown encouraging results demonstrating the feasibility and effectiveness of gene therapy in reducing nystagmus symptoms. However, further research and clinical trials are needed to determine the safety and efficacy of gene therapy in humans with nystagmus.

A 2022 study on achromatopsia (ACHM) presenting with nystagmus found that mutations in six genes result in functional and structural abnormalities in cone photoreceptors. The study’s results suggest that gene therapy to treat ACHM could address the underlying cause of nystagmus.

While currently, no approved treatment exists, preclinical studies using gene therapy have shown promise. Clinical trials for CNGA3- and CNGB3-related ACHM are underway, aiming to provide gene supplementation therapy and improve visual function in patients.

Implement Innovative Nystagmus Treatment at Your Optometrist Practice

Optometrists can support their patient’s nystagmus treatment with a completely integrated, cloud-based optometry EHR system. RevolutionEHR is a comprehensive optometry practice management platform that can help you streamline patient care and improve patient engagement for nystagmus treatment protocols.

With RevolutionEHR’s patient engagement software, RevConnect, optometrists can easily communicate with patients and track their interactions for optimal treatment outcomes. This includes appointment and recall reminders, personalized messages, and updates on optical orders. With seamless integration of text and email, your staff can deliver essential information directly to patients.

RevolutionEHR’s SmartFlow feature enables optometrists to deliver more personalized care. By partnering with vision product suppliers, practitioners can offer specialty eyewear and ensure patients receive timely prescription items, enhancing their visual experience and overall treatment outcomes.

Support Your Patients’ Ocular Health With RevolutionEHR

Schedule a demo with a RevolutionEHR Specialist today and discover how our integrated practice management software enables you to integrate cutting-edge nystagmus treatments into your practice. Experience the freedom to focus on providing superior care to your patients.