Podcasts about Diplopia

Neuro-ophthalmic deficits significantly impair quality of life by limiting participation in employment, educational, and recreational activities. Low-vision occupational therapy can improve cognition and mental health by helping patients adjust to visual disturbances. In this episode, Katie Grouse, MD, FAAN, speaks with Sachin Kedar, MD, FAAN, author of the article “Symptomatic Treatment of Neuro-ophthalmic Visual Disturbances” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Kedar is the Cyrus H Stoner professor of ophthalmology and a professor of neurology at Emory University School of Medicine in Atlanta, Georgia. Additional Resources Read the article: Symptomatic Treatment of Neuro-ophthalmic Visual Disturbances Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Guest: @AIIMS1992 Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Sachin Kedar about his article on symptomatic treatment of neuro-ophthalmic visual disturbances, which appears in the April 2025 Continuum issue on neuro-ophthalmology. Welcome to the podcast, and please introduce yourself to our audience. Dr Kedar: Thank you, Katie. This is Sachin Kedar. I'm a neuro-ophthalmologist at Emory University, and I've been doing this for more than fifteen years now. I trained in both neurology and ophthalmology, with a fellowship in neuro-ophthalmology in between. It's a pleasure to be here. Dr Grouse: Well, we are so happy to have you, and I'm just so excited to be discussing this article with you, which I found to be a real treasure trove of useful clinical information on a topic that many find isn't covered enough in their neurologic training. I strongly recommend all of our listeners who work with patients with visual disturbances to check this out. I wanted to start by asking you what you hope will be the main takeaway from this article for our listeners? Dr Kedar: The most important takeaway from this article is, just keep vision on your radar when you are evaluating your patients with neurological disorders. Have a list of a few symptoms, do a basic screening vision, and ask patients about how their vision is impacting the quality of life. Things like activities of daily living, hobbies, whether they can cook, dress, ambulate, drive, read, interact with others. It is very important for us to do so because vision can be impacted by a lot of neurological diseases. Dr Grouse: What in the article do you think would come as the biggest surprise to our listeners? Dr Kedar: The fact that impairment of vision can magnify and amplify neurological deficits in a lot of what we think of as core neurological disorders should come as a surprise to most of the audience. Dr Grouse: On that note, I think it's probably helpful if you could remind us about the types of visual disturbances we should be thinking about and screening for in our patients? Dr Kedar: Patients who have neurological diseases can have a whole host of visual deficits. The simplest ones are deficits of central vision. They can have problems with their visual field. They can have abnormalities of color vision or even contrast sensitivity. A lot of our patients also complain of light sensitivity, eyes feeling tired when they're doing their usual stuff. Some of our patients can have double vision, they can have shaky vision, which leads to their sense of imbalance and maybe a fall risk to them. Dr Grouse: It's really helpful to think about all the different aspects in which vision can be affected, not just sort of the classic loss of vision. Now, your article also serves as a really important reminder, which you alluded to earlier, about how impactful visual disturbances can be on daily activities. Could you elaborate a little further on this, and particularly the various domains that can be affected when there are visual disturbances present? Dr Kedar: So, when I look at how visual disturbances affect quality of life, I look at two broad categories. One is activities of basic daily living. These would be things like, are you able to cook? Are you able to ambulate not just in your home, but in your neighborhood? Are you able to drive to your doctor's appointment or to visit with your family? Are you able to dress yourself appropriately? Are you able to visualize the clothing and choose them appropriately? And then the second category is recreational activities. Are you able to read? Are you able to watch television? Are you able to visit the theatre? Are you able to travel? Are you able to participate in group activities, be it with your family or be it with your social group? It is very important for us to ask our patients if they have problems doing any of this because it really can adversely impact the quality of life. Dr Grouse: I think, certainly with all the things we try to get through talking with our patients, this may not be something that we do spend a lot of time on. So, I think it's it is a good reminder that when we can, being able to ask about these are going to be really important and help us hit on a lot of other things we may not even realize or know to ask about. Now, I was really struck when I was reading your article by the meta-analysis that you had quoted that had showed 47% higher risk of developing dementia among the visually impaired compared to those without visual impairments. Should we be doing more in-depth visual testing on all of our patients with cognitive symptoms? Dr Kedar: This is actually the most interesting part of this article, and kind of hones in on the importance of vision in neurological disorders. Now I want to clarify that patients with visual disorders, it's not a causative influence on dementia, but if you have a patient with an underlying cognitive disorder, any kind of visual disturbance will significantly make it worse. And this has been shown in several studies, both in the neurologic and in the ophthalmological literature. So, I quoted one of the big meta-analysis over there, but studies have clearly shown that if you have these patients and treat them for their visual deficits, their cognitive indices can actually significantly improve. To answer your question, I would say a neurologist should include basic vision screening as part of every single evaluation. Now, I know it's a hard thing in, you know, these days when we are literally running on the hamster wheel, but I can assure you that it won't take you more than 2 to 3 minutes of your time to do this basic screening; in fact, you can have one of your assistants included as part of the vital signs assessment. What are these basic screening tools? Measure the visual acuity for both near and distance. Check and see if their visual field's off with the confrontation. Look at their eye movements. Are they able to move their eyes in all directions? Are the eyes stable when they're trying to fixate on a particular point? I think if you can do these basic things, you will have achieved quite a bit. Dr Grouse: That's really helpful, and thanks for going through some of the standard, or really, you know, solid basic foundation of visual testing we should be thinking about doing. I wanted to move on to some more details about the visual disturbances. You made an excellent point that there are many types of primary ophthalmologic conditions that can cause visual disturbances that we should keep in mind. So maybe not things that we think about a lot on a day-to-day basis, but, you know, are still there and very common. What are some of the most common ones, and when should we be referring them to see an ophthalmologist? Dr Kedar: So, it depends on the age group of your patient population. Now, the majority of us are adult neurologists, and so the kinds of ophthalmic conditions that we see in this population is going to be different from the pediatric age group. So in the adult population, we might see patients with uncorrected refractive error, presbyopia, patients who have cataracts creep on them, they may have glaucoma, they may have macular degeneration, and these tend to have a slightly higher incidence in the older age group. Now for those of us who are taking care of the younger population, uncorrected refractive errors, strabismus and amblyopia tend to be fairly common causes of visual deprivation in this age group. What I would encourage all of our neurologists is, make sure that your patients get a basic eye examination at least once a year. Just like you want them to go to their primary care and get an annual maintenance visit, everybody should go to the ophthalmologist or the optometrist and get a basic examination. And, if you're resourceful enough, have your patients bring a copy of that assessment. Whether it is normal or there's some abnormality, it is going to help you in the management. Dr Grouse: Absolutely. I think that's a great piece of advice, to think of it almost, like, them seeing their primary care doctor, which of course we offer encourage our patients to do, thinking of this as another very important piece of standard primary care. If a patient comes to you reporting difficulty reading due to possible visual disturbances, I'm curious, can you walk us through how you would approach this evaluation? Dr Kedar: It is not a very common presenting complaint of our patients, even in the neuro-ophthalmology clinic. It's a very rare patient that I see who comes and says, I cannot read or, I have difficulty reading. Most of the patients will come saying, oh, I cannot see. And then you have to dig in to find out, what does that actually mean? What can you not see? Is it a problem in your driving? Is it a problem in your reading? Or is it a problem that occurs at all times? Now you asked me, how do you approach this evaluation? One of the things that all of us, whether we are neurologists, ophthalmologists, or neuro-ophthalmologists, forget to do is to actually have the patient read a paragraph, a sentence, when they are in clinic. And that will give you a lot of ideas about what might actually be going wrong with the patient. Now, as far as how do I approach this evaluation, I will do a basic screening examination to make sure that their visual acuity is good for both distance and near. A lot of us tend to do either distance or near and we will miss the other parameter. You want to do a basic confrontation visual field to make sure that they do not have any subtle deficits that's impacting their ability to read. Examine the eye movements, do a fundoscopic examination. Now, once you've done this basic screening, as a neurologist, you already have some idea of whether your patient has a lesion along the visual pathways. If you suspect that this is a problem with, say, the visual pathways, ask your ophthalmology colleague to do a formal visual field assessment, and that'll pick up subtle deficits of central visual field. And lastly, don't forget higher visual function testing or cortical visual function testing. So basically, you're looking for neglect, phenomenon, or simultanagnosia, all of which tends to have an impact on reading. So, in the manuscript I have a schema of how you can approach a patient with reading difficulties, and in that ischemia you will see categories of where things can go wrong during the process of reading. And if you can approach your patient systematically through one of those domains, there's a fairly good chance that you'll be able to pick up a problem. Dr Grouse: Going a little further on to when you do identify problems with loss of central or peripheral vision, what are some strategies for symptomatic management of these types of visual disturbances? Dr Kedar: As a neurologist, if you pick up a problem with the vision, you have to send this patient to an eye care provider. The vast majority of people who have visual disturbances, it's from an eye disease. You know, as I alluded to earlier, it can be something as simple as uncorrected refractive error, and that can be fixed easily. A lot of patients in our older age group will have dry eye syndrome, which means they are unable to adequately lubricate the surface of the eye, and as a result, it degrades the quality of their vision. So, they tend to get intermittent episodes of blurred vision, or they tend to get glare. They tend to get various forms of optical aberration. Patients can have cataracts, patients can have glaucoma or macular degeneration. And in all of those instances, the goal is to treat the underlying disease, optimize the vision, and then see what the residual deficit is. By and large, if a patient has a problem with the central vision, then magnification will help them for activities that they perform at near; say, reading. Now for patients with peripheral vision problem, it's a different entity altogether. Again, once you've identified what the underlying cause is, your first goal is to treat it. So, for example, if your patient has glaucoma, which is affecting peripheral vision, you're going to treat glaucoma to make sure that the visual field does not progress. Now a lot of what happens after that is rehabilitation, and that is always geared towards the specific activities that are affected. Is it reading? Is it ambulating? Is it watching television? Is it driving? And then you can advise as a neurologist, you can advise your occupational therapist or low vision specialist and say, hey, my patient is not able to do this particular activity. Can we help them? Dr Grouse: Moving on from that, I wanted to also hit on your approach when patients have disorders of ocular motility. What are some things you can do for symptomatic management of that? Dr Kedar: So, patients with ocular motility can have two separate symptoms. Two, you know, two disabling symptoms, as they would call it. One is double vision and the other is oscillopsia, or the feeling or the visualization of the environment moving in response to your eyes not being able to stay still. Typically, you would see this in nystagmus. Now, let's start with diplopia. Diplopia is a fairly common presenting complaint for neurologists, ophthalmologists, and the neuro-ophthalmologist. The first aspect in the management of diplopia is to differentiate between monocular diplopia and binocular diplopia. Now, monocular diplopia is when the double vision persists even after covering one eye. And that is never a neurological issue. It's almost always an ophthalmic problem, which means the patient will then have to be assessed by an eye care provider to identify what's causing it. And again, refractive error, cataracts, opacities, they can do it. Now, if the patient is able to see single vision by covering one eye at a time, that's binocular diplopia. Now, in patients with binocular diplopia in the very early stages of the disease, the standard treatment regimen is just monocular occlusion. Cover one eye, the diplopia goes away, and then give it time to improve on its own. So, this is what we would typically do in a patient with, say, acute sixth nerve palsy or fourth nerve palsy or third nerve palsy, maybe expect spontaneous improvement in a few months. Now if the double vision does not improve and persists long term, then the neuro-ophthalmologist or the ophthalmologist will monitor the amount of deviation to see if it fluctuates or if it stays the same. So, what are the treatment options that we have in a patient who absolutely refuses any intervention or is not a candidate for any intervention? Monocular occlusion still remains the viable option. Now, patients who have stable ocular deviation can benefit from using prisms in their glasses, or they can be sent to a surgeon to have a strabismus surgery that can realign their eyes. So, again, a broad answer, but there are options available that we can use. Dr Grouse: Thank you for that overview. I think that's just really helpful to keep in mind as we're working with these patients and thinking about what their options are. And then finally, I wanted to touch on patients with higher-order vision processing and attention difficulties. What are some strategies for them? Dr Kedar: These are frankly the most difficult patients that I get to manage in my clinic, simply because there is no effective therapies for managing them. In fact, I think neurologists are far better at this than ophthalmologists or even neuro-ophthalmologists. In patients with attentional disorders, everything boils down to the underlying cause, whether you can treat it or whether it is a slowly progressive, you know, condition, such as from neurodegenerative diseases. And that tailors our goals towards therapy. The primary goal is for safety. A lot of these patients who have visual disturbances from vision processing or attention, they are at accident and fall risk. They have problems with social interactions. And, importantly, there is a gap of understanding of what's going on, not just from their side but also from the family's side. So, I tend to approach these patients from a safety perspective and social interaction perspective. Now, I have a table listed in the manuscript which will go into details of what the specific things are. But in a nutshell, if your patient has neglect in a specific part of the visual field, they have accident risk on that side. Simple things like walking through a doorway, they can hurt their shoulders or their knees when they bang into the wall on that side because they are unable to judge what's on the other side. Another example would be a patient who has simultanagnosia or a downgaze policy, such as from progressive super nuclear policy. They are unable to look down fast enough, or they are simply unable to look down and appreciate things that are on the floor, and so they can trip and fall. Walking downstairs is also not a huge risk because they are unable to judge distances as they walk down. A lot of what we see in these patients are things that we have to advise occupational therapists and help them improve these safety parameters at home. Another thing that we often forget is patients can inadvertently cause a social incident when they tend to ignore people on their affected side. So, if there is a family gathering, they tend to consistently ignore a group of people who are sitting on the affected side as opposed to the other side. And I've had more than a few patients who've come and said that, I may have offended some of my friends and family. In those instances, it's always helpful when they are in clinic to demonstrate to the family how this can be awkward and how this can be mitigated. So, having everybody sit on one side is a useful strategy. Advise your family and friends before a gathering that, hey, this may happen. And it is not because it is deliberate, but it's because of the medical condition. And that goes a lot, you know, further in helping our patients come out of social isolation because they are also afraid of offending people, you know. And they can also participate socially, and it can overall improve their quality of life. Dr Grouse: That's a really helpful tip, and something I'll keep in mind with my patients with neglect and visual field cuts. Thank you so much for coming to talk with us today. Your article has been so helpful, and I urge everybody listening today to take a look. Dr Kedar: Thank you, Katie. It was wonderful talking to you. Dr Grouse: I've been interviewing Dr Sachin Kedar about his article on symptomatic treatment of neuro-ophthalmic visual disturbances, which appears in the most recent issue of Continuum on neuro-ophthalmology. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Double vision is a symptom often experienced by patients with neurologic disease. An organized systematic approach to evaluating patients with diplopia needs a foundational understanding of the neuroanatomy and examination of eye movements and ocular alignment. In this episode, Teshamae Monteith, MD, FAAN, speaks with Devin Mackay, MD, FAAN, author of the article “Approach to Diplopia” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Mackay is an associate professor of neurology, ophthalmology, and clinical neurosurgery at Indiana University School of Medicine in Indianapolis, Indiana. Additional Resources Read the article: Approach to Diplopia Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: This is Dr Teshamae Monteith. Today I'm interviewing Dr Devin Mackay about his article on approach to diplopia, which appears in the April 2025 Continuum issue on neuro-ophthalmology. Welcome to the podcast. How are you? Dr Mackay: Thank you. It's great to be here. Dr Monteith: Congratulations on your article. Dr Mackay: Thank you. I appreciate that. Dr Monteith: Why don't you start off with introducing yourself to our audience? Dr Mackay: So, yeah, my name is Devin Mackay. I'm a neuro-ophthalmologist at Indiana University. I did my residency at what was used to be known as the Partners Healthcare Program in Boston, and I did a fellowship in neuro-ophthalmology in Atlanta. And I've been in practice now for about ten years. Dr Monteith: Oh, wow. Okay. Tell us a little bit about your goals when you were writing the chapter. Dr Mackay: So, my goal with the approach to double vision was really to demystify double vision. I think double vision is something that as trainees, and even as faculty members and practicing neurologists, we really get intimidated by, I think. And it really helps to have a way to approach it that demystifies it and allows us to localize, just like we do with so many other problems in neurology. Dr Monteith: I love that, demystification. So why don't you tell us what got you interested in neuro-ophthalmology? Dr Mackay: Yeah, so neuro-ophthalmology I stumbled on during a rotation during residency. We rotated in different subspecialties of neurology and I did neuro-ophthalmology, and I was just amazed by the exam and how intricate it was, the value of neuroanatomy and localization, the ability to take a complicated problem and kind of approach it as a diagnostic specialist and really unravel the layers of it to make it better. To, you know, figure out what the problem is and make it better. Dr Monteith: Okay, so you had a calling, clearly. Dr Mackay: I sure did. Dr Monteith: You talked about latest developments in neuro-ophthalmology as it relates to diplopia. Why don't you share that with our listeners? Dr Mackay: Yeah. So, you know, double vision is something that's really been around since the beginning of time, essentially. So that part hasn't really changed a lot, but there are some changes that have happened in how we approach double vision. Probably one of the bigger ones has been, we used to teach that with a, you know, patient over the age of fifty with vascular risk factors who had a cranial nerve palsy of cranial nerves 3, 4, or 6, we used to automatically assume that was a microvascular palsy and we just wouldn't do any more testing and we'd just, you know, wait to see how they did. And it turns out we're missing some patients who have significant pathologies, sometimes, with that approach. And so, we've really shifted our teaching with that to emphasize that it's a lot easier to get an MRI, for example, than it ever has been. And it can be important to make sure we're not missing important pathology in patients, even if they have vascular risk factors over the age of fifty and they just have a cranial nerve 3, 4, or 6 palsy. So that's been one change. Dr Monteith: Interesting. And why don't you tell us a little bit about the essential points that you want to get across in the article? Dr Mackay: Yeah. So, I think one is to have a systematic approach to double vision. And a lot of that really revolves around localization. And it even begins with the history that we take from the patients. There's lots of interesting things we can ask about double vision from the patient. For example, the most important thing you can ever ask someone with double vision is, does it go away when you cover either eye? And that really helps us figure out the first question for us as neurologists, which is, is it neurologic or non-neurologic? If it's still there when covering one eye, then it is not neurologic and that's usually a problem for an ophthalmologist to sort out. So that's really number one. And then if it is binocular double vision, then we get into details about, is it horizontal or vertical misalignment? Is it- what makes it better and worse? Is there an associated ptosis or other symptoms? And based on all of that, we can really localize the abnormality with the double vision and get into details about further testing if needed, and so forth. I also love that that approach really reduces our need to rely on things like neuroimaging sometimes when we may not need it, or on other tests. So, I think it really helps us be more efficient and really take better care of patients. Dr Monteith: So definitely that cover/uncover test, top thing there. Your approach- and you mentioned, are you really getting that history, and are there any other kind of key factors when you're approaching diplopia before getting into some of the details? Dr Mackay: Yeah, that's a good question. I think also having some basics of how to examine the patient, because double vision is such a challenging thing. A lot of us aren't as familiar with the exam toolkit, so to speak, of what you would do with a patient with double vision. And so, I go over in the article a bit about a Maddox rod, which is a handy little tool that I always keep in my pocket of my lab coat. It allows you to assign a red line to one eye and a light to the other eye, and you can see if the eyes line up or not. And you don't need any other special equipment, you just need the light in that Maddox rod. That really helps us understand a lot about the pattern of misalignment, which is really important for evaluating double vision. So, for example, if someone has a right 6th nerve palsy, I'll expect a horizontal misalignment of the eyes that worsens when the patient looks to the right and improves when they look to the left. And especially if it's a partial palsy, it's not always easy to see that just by looking at their eye movements. And having a way to really measure the eye alignment and figure out, is it worse or better in certain directions, is really essential to localization, I think, in a lot of cases. Dr Monteith: You caught me. I skipped over that Maddox rod part, even though you spent a lot of time talking about Maddox rods. Kind of skipped over it. So, you're saying that I need one. Dr Mackay: Everyone needs one. I've converted some of our residents here to carry one with them. And yeah, I realize it's a daunting tool at first, but when you have a patient with double vision and their eye movements look normal, I feel like a lot of neurologists are- kind of, their hands seem like they're tied and they're like, oh, I don't know, I don't know what to do at this point. And if you can get some more details with a simple object like that, it can really change things. Dr Monteith: So, we've got to talk to the AAN store and make sure that they have enough of these, because now there's going to be lots of… Dr Mackay: We're going to sell out on Amazon today now because of this podcast. Dr Monteith: Cyber Monday. So, let's talk about the H pattern. And I didn't know it had the- well, yeah, I guess the official name is “H pattern.” In medical school, I mean, that's what I learned. But as a resident and, you know, certainly as an attendee, I see people doing all sorts of things. You're pro-H pattern, but are there other patterns that you also respect? Dr Mackay: It depends on what you're looking for, I think. The reason I like the H pattern is because you get to look at upgaze and downgaze in two different directions. So, you get to look at upgaze and downgaze when looking to the left, and up- and downgaze when looking to the right. And the reason that matters is because vertical movements of the eyes are actually controlled by different eye muscles depending on whether the eye is adducted toward the nose or abducted away from the nose. And so that's why I love the H pattern, is because it allows you to see that. If you just have them look up and down with just a cross pattern, for example, then you really lose that specificity of looking at both the adduction and abduction aspects. So, it's not wrong to do it another way with, like, the cross, for example, but I just think there are some cases where we'll be missing some information, and sometimes that can actually make a difference. Dr Monteith: Well, there you have it. Let's talk a little bit about eliciting diplopia during the neurologic exam. What other things should we be looking out for? Dr Mackay: So, in terms of eliciting diplopia, it really starts with the exam and again, figuring out, are we covering one eye? And figuring out, is this patient still having double vision? It's tricky because sometimes the patients won't even know the answer to that question or they've never done it, they've never covered one eye. And so, if that's the case, I really make them do it in the office with me and it's like, okay, well, are we having double vision right now? Well, great, okay, we are, then we're going to figure this out right now. And we cover one eye and say, is it still double? And that way we can really figure out, are we monocular or binocular? That's always step one. And then if we've established that it's binocular diplopia, then that's when we get into the other details that I mentioned before. And then as far as other things to look for, we're always in tune to other things that are going on in terms of symptoms, like ptosis, or if there's bulbar weakness, or some sensory change or motor problem that seems to be associated with it. Obviously, those will give us clues in the localization as well. Dr Monteith: And what about ocular malalignment? Dr Mackay: Yeah. So ocular malalignment, really, the cardinal symptom of that is going to be double vision. And so, if a patient has a misalignment of the eyes and they don't have double vision, then usually that means either we're wrong and they don't have double vision, or they do have double vision and they, you know, haven't said it correctly. Or it could be that the vision is poor in one eye. Sometimes that can happen. Or, some patients were actually born with an eye misalignment and their brain has learned in a way to kind of tune out or not allow the proper development of vision in one eye. And so that's also known as amblyopia, also known as the lazy eye, some people call it. But that finding can also make someone not experience double vision. But otherwise, if someone's had normal vision kind of throughout their life, they'll usually be pretty aware of when they first notice double vision. It'll be an obvious event for them in in most cases. Dr Monteith: And then the Cogan lid twitch? Dr Mackay: Oh yes, the Cogan lid twitch. So, the Cogan lid twitch is a feature of myasthenia gravis. The way you elicit it is, you have the patient look down. I'm not sure there's a standardization for how long; you want to have it long enough that you're resting the levator muscle, which is the muscle that pulls the upper lid open. And so, you rest that by having them look down for… I usually do about ten or fifteen seconds. And then I have them look up to looking straight forward. And you want to pay careful attention to their lid position as their eye settles in that straight-forward position. What will happen with a Cogan's lid twitch is, the lid will overshoot, and then it'll come back down and settle into its, kind of, proper position. And what we think is happening there is, it's almost like a little mini “rest test” in a way, where you're resting that muscle just long enough to allow some of the neurotransmission to recover. You get a normal contraction of the muscle, but it fades very quickly and comes back down. And that's experienced as a twitch. Dr Monteith: So, the patient can feel it. And it's something you can see? Dr Mackay: Yeah, the patient may not feel it as much. It's usually it's going to be something that the clinician can see if they're looking for it. And I would say that's one of the physical exam findings that can be a hallmark of myasthenia gravis, but certainly not the only one. Some others that we often look for are fatigable ptosis with sustained upgaze. You have the patient look up for a prolonged time and you'll see the lid droop down. So that can be one. Ice pack test is very popular nowadays, and it has pretty good sensitivity and specificity for myasthenia. So, you keep an ice pack over the closed eyes for two minutes and you compare the lid position before and after the ice pack test. And in the vast majority of myasthenia patients, if they have ptosis, the ptosis will have resolved, or at least significantly improved, in those patients. And yet one more sign is, if you find the patient's eye with ptosis and you lift open the eye manually, you'll often see that the other eyelid and the other eye will lower down. So, I'm not sure there's a name for that, but that can be a helpful sign as well. Dr Monteith: Since you're going through some of these, kind of, key features of different neurologic disease, why don't you tell us about a few others? Dr Mackay: Yeah, so another I mentioned in the in the article is measurement of levator function, which is really a test of eyelid strength. And so, that can be helpful if we have- someone has ptosis, or we're not sure if they have ptosis and we're trying to evaluate that to see if it's linked to the double vision, because that really changes the differential if ptosis is part of the clinical situation. So, the way that's measured is you have a patient look down as far as they can. And you get out a little ruler---I usually use a millimeter ruler---and I set the zero of the ruler at the upper lid margin when they're looking down. So, I hold the ruler there, and then I ask the patient to look up as far as they can without moving their head. Where the lid position stops of the upper lid is the new point on the ruler. And so, you measure that and see how much that is. And so, a normal patient may have a value somewhere between, I don't know, twelve or thirteen millimeters up to seventeen or eighteen millimeters, probably, in most cases. Especially if there is an asymmetric lid position, if you find that the levator function is symmetric, then it tells you that the muscle is working fine and that the ptosis is not from the muscle. So then the ptosis may be from dehiscence of the lid margin from the muscle. And so, that's a really common cause of ptosis, and that's often age-related or trauma-related. And we can dismiss that as being part of the symptom constellation of double vision. So, it can be really helpful to clarify, is this a muscle problem, which you'd expect with myasthenia or a third nerve palsy, or is this a mechanical problem with the lid, which is non-neurologic and really should be dismissed? So that can be a really helpful exam tool. Dr Monteith: So, you're just now getting into a little localization. So why don't we kind of start from the most proximal pistol with localization. Give us a little bit of tips. I know they just got to read your article, but give us a few tips. Dr Mackay: So, in terms of most proximal causes, there are supranuclear causes of ocular misalignment. For example, a skew deviation would qualify as that. Anything that's happening from some deficient input before you get to the cranial nerve nuclei, that we would consider supranuclear. So, we also see that with things like progressive supranuclear policy and certain other conditions. And then there can be lesions of the cranial nerve nuclei themselves. So, cranial nerves 3, 4, and 6 all have nuclei, and if they're lesioned they will cause double vision in specific patterns. And then there's also another subgroup, which is known as intranuclear problems with eye alignment. And so, the most common of that is going to be intranuclear ophthalmoplegia. And so that's very common in patients with demyelinating disorders, or it can also happen with strokes and tumors and other causes. And then there's infranuclear problems, which are from the cranial nerve nuclei out, and so those would be the cranial nerves themselves. So that's where your microvascular palsies, any tumor pressing on the nerve in those locations can cause palsies like that, any inflammatory disorder along that course. Then as we get more distal, we get into the orbit, we have the neuromuscular junction---so, the connection between the nerve and the muscle. And of course, that's our myasthenia gravis. And there are rare causes, things like botulinum and tick borne illnesses and certain other things that are more rare. And then, of course, we get to the muscle itself, and there can be different muscular dystrophies, different things like myositis or inflammatory disorders of the orbit or even physical trauma. So, if a patient, you know, had a trauma in trapping an extraocular muscle, that can be a localization. So really, anywhere along that pathway you can have double vision. So, I love to approach it from that perspective to help narrow down the diagnostic possibilities. Dr Monteith: Okay, just like everything? Dr Mackay: Just like all of the rest of the neurology. See, it's not that scary. Dr Monteith: You know, and so, yeah. And then you do a lot more than, you know, a few cranial nerves, right? Dr Mackay: Right. That's right. There's a lot more to double vision than that. I think as neurologists, we get lost if it's not a cranial nerve palsy, we're like, oh, I don't know what this is. And if it's not myasthenia, not a cranial nerve palsy. But it's worth also considering that there are ophthalmologic causes of someone having double vision that we often don't consider. So maybe someone who was born with strabismus, or maybe they have a little bit of a tendency toward an eye misalignment that their brain compensates, for and then it decompensates someday and that now they have a little bit of double vision intermittently, so that those can be causes to consider as well. Dr Monteith: Yeah, well, we'll just have to, you know, request those records from forty years ago. No problem. Dr Mackay: That's right. Dr Monteith: Why don't you also give us a little bit of tip when we're on the wards and we want to teach either a medical student or a resident, or if it's a resident listening, may want to teach a junior resident and seem like a star when approaching a patient with diplopia. Give us some teaching pearls. Dr Mackay: Yeah. So, I would love people teaching more about this at the bedside. I'd say probably the first thing to do would be to equip yourself by recognizing what some of the pertinent questions are to ask someone with double vision. Those things would include, is the double vision worse when looking in a certain direction? Does the double vision go away or not when you cover one eye? What happens when you tilt your head one direction or the other? Is it intermittent or constant? What makes it better? What makes it worse? Those kinds of things can really help us narrow down the possibilities. And then the other thing would be to equip yourself with some tools for examining. And it doesn't have to be physical tools. These can actually be things like, you mentioned the cross-cover test or cover/uncover test. That's described in the article. And I think knowing how to do that properly, knowing how to examine the eye movements properly and how to check for subtle things like a subtle intranuclear ophthalmoplegia, which is also mentioned in the article, being familiar with those things can be a really useful exercise in allowing you to teach others later on. Dr Monteith: Cool. Why don't you tell us about some of the things you're most excited about in the field? Dr Mackay: One of the things about our subspecialty for so long is we really haven't had big data with, you know, big trials and all these things that all the stroke people have. And that's starting to change slowly. There's been, for example, the idiopathic intracranial hypertension treatment trial that was published back in, I think it was 2014. You know, of course we had the optic neuritis treatment trial, back a few decades ago now. Some of the exciting ones coming up, there's going to be a randomized controlled trial looking at different treatments for idiopathic intracranial hypertension that are surgically based. So, for example, comparing venous sinus stenting with optic nerve sheath fenestration. And so, figuring out, is there a best practice for surgical intervention for patients with IIH? So, we're starting to have more trials like that now than I think we've had in the past. And so, it's exciting to get to have an evidence base for some of the things that we recommend and do. Dr Monteith: And what about some of the treatment for diplopia? Like prisms, and where are we with some of that? Dr Mackay: Yeah, great. So, it's a pretty simple concept, but still kind of difficult in practice. I kind of say there are four different ways to treat double vision: you can ignore it, you can patch or cover one eye, you can treat with prisms, and you can treat with eye muscle surgery. And so, those are the main ways other than, of course, treating the underlying disorder if there's a disorder causing double vision. So those are the main ways to treat. In terms of knowing if someone's going to be a candidate for prism therapy, we also have to remember that prisms are really going to be most helpful for when someone's looking straight forward. So, we need to make sure that their double vision is happening when they look straight forward. So, for example, if they're only having double vision looking to the left or to the right, that patient may not benefit from prisms as much as someone who is having double vision when they look straight forward. So that's one thing I look for. And then strabismus surgery is something to be considered if someone is not tolerating prisms and they're not helping and their eye alignment is stable. So, if you think about it, if someone's eye alignment is changing a lot, you're probably not going to want to do surgery for that patient because it's going to keep changing after surgery. And so, if someone's eye alignment is stable for six months or more and they're not getting the benefit they'd like from prisms, then maybe referral to a strabismus surgeon might be something to consider. Dr Monteith: Great. And then, I guess another question is just popping up in my head selfishly. What are your thoughts about patients that get referrals for exercises? Say they have, like, a convergence efficiency or something causing diplopia, maybe after a concussion. Maybe there's not a lot of evidence, but what is your take on exercising? Dr Mackay: Yeah, excellent question. So, there actually is evidence for exercises for convergence insufficiency. So, we know that those do work. Now where exercises are probably not as helpful, or at least not- there isn't an evidence base for them, is really with just about every other kind of eye misalignment in adults. We hear a lot about eye movement therapies for concussion and barely any other acquired misalignment of the eyes as well. And really, the evidence really hasn't shown us that that's helpful; again, with the exception being convergence insufficiency. So, we know that an office-based vision therapy type program for convergence insufficiency does work, but of course it's kind of inconvenient. It can cost money that may or may not be covered by insurance. And so, there are difficulties even with doing that. And so, I often recommend that patients with convergence insufficiency at least try something called pencil push-ups, where they take a pencil at arm's length and they bring it in and exercise that convergence ability. You know, that's a cheap, easy way to try to treat that initially. So yeah, there can be some limited utility for eye muscle exercises in certain conditions. Dr Monteith: My one example. I was- it was fuzzy, but in a different way. So, what do you do for fun? I mean, it sounds like you like to see a lot of eyeballs? Dr Mackay: I do. I like to see a lot of eyeballs. Dr Monteith: When you're not doing these things, what do you do for fun? Dr Mackay: So, people ask me what my hobbies are, and I laugh because my hobby is actually raising children. Dr Monteith: Oh, okay! Dr Mackay: So, my wife and I have eight kids- Dr Monteith: Oh, wow! Dr Mackay: Ages three to thirteen. So, kind of doesn't allow me to have other things right now. I'm sure I'll have more hobbies later on, but no, I really love my kids. And I- they give me plenty to do. There's no shortage of- in fact, they were really, they were really excited about this podcast today. They're so excited that Dad gets to be on a podcast, and so I'm going to have to show this to them later. They're going to be thrilled about it. Dr Monteith: Excellent. Well, thank you so much for being on the podcast. Dr Mackay: Thank you. It's been my pleasure. Dr Monteith: Again, today I've been interviewing Dr Devin Mackay about his article on approach to diplopia, which appears in the most recent issue of Continuum on neuro-ophthalmology. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

https://www.youtube.com/watch?v=6uT3TxGTJ0U

More than 2 million people in the UK are living with sight loss, and this is expected to rise to 2. 7 million people by 2030. In this episode, we look at a selection of eye-related symptoms, including thyroid eye disease symptoms, vision loss, double and blurred vision, and eye pain, and considerations for primary care clinicians who may encounter patients with these symptoms.After listening to this podcast, healthcare professionals should be better able to:Recall the red flag symptoms for eye pain, vision loss, diplopia, and blurred visionThink about when to refer patients presenting with eye-related symptomsLearn about the presentation and epidemiology of thyroid eye diseaseYou can access the website version of this podcast on MIMS Learning to make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.Useful linksResources from MIMS LearningEye pain - red flag symptoms Diplopia - red flag symptomsBlurred vision - red flag symptomsLoss of vision - red flag symptomsThyroid eye diseaseMIMS LearningRegister for a free healthcare professional accountExternal resourcesHouse of Commons Library. A blueprint for eye health in Englandand the devolved nations. December 2022. Department of Health & Social Care. Vision. December 2024.Action on Smoking and Health. Smoking and eye disease. February 2019.Cleveland Clinic. Diplopia (double vision). June 2024. Cleveland Clinic. Blurred vision. April 2022. Hosted on Acast. See acast.com/privacy for more information.

In this episode of the Award-winning PRS Journal Club Podcast, 2024 Resident Ambassadors to the PRS Editorial Board – Rami Kantar, Yoshi Toyoda, and Amanda Sergesketter- and special guest, Scott Bartlett, MD, discuss the following articles from the November 2024 issue: “Predictors of Postoperative Diplopia following Orbital Fracture Repair in Adults” by Hassan, Yoon, Er, et al. Read the article for FREE: https://bit.ly/DiplopiaOFractures Special guest, Dr. Scott Bartlett, is the former chair of Plastic Surgery at the Children's Hospital of Philadelphia and is the director of the craniofacial program at CHOP where he also holds The Mary Downs Endowed Chair in Pediatric Craniofacial Treatment and Research, in addition to being a Professor of Plastic Surgery at The Perelman School of Medicine at The University of Pennsylvania. He obtained his medical degree at Washington University in St. Louis followed by plastic surgery training at The Massachusetts General Hospital, Harvard Medical School, and pediatric and craniomaxillofacial surgery fellowship at The Children's Hospital of Philadelphia. Dr. Bartlett is an international authority in craniofacial surgery and won the AAPS Clinician of the Year award in 2023. READ the articles discussed in this podcast as well as free related content: https://bit.ly/JCNov24Collection

A review of double vision, with Drs. William Signorile and Kevin Yan.Note: This podcast is intended solely as an educational tool for learners, especially neurology residents. The contents should not be interpreted as medical advice.

This podcast follows the case of a 58 year old man who presented to the haematology department at Flinders Medical Centre with intravascular coagulation and leukocytosis. He was diagnosed with acute myeloid leukaemia and treated on standard cytarabine and daunorubicin combination therapy. Nine days after initiation, the patient developed painless diplopia and ptosis, and the story is picked up with a referral to the neurology department. GuestsAssociate Professor Stephen Bacchi (Lyell McEwin Hospital; University of Adelaide)Dr James Triplett FRACP (Flinders Medical Centre, consultant neurologist) ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan and Brandon Stretton.Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity.Key Reference and Learning Points (Spoiler Alert)********Painless progressive mononeuritis multiplex secondary to AML associated neuroleukemiosis [J Neuroimmunol. 2023]  (1) Chemotherapy can have neurological complications, including chemotherapy induced peripheral neuropathy (e.g., oxaliplatin).(2) A third (oculomotor) cranial nerve palsy has multiple possible causes, which can be divided into painful vs painless causes, and compressive (classically with pupillary involvement) vs non-compressive (can spare pupil, as with microvascular insult) causes.(3) Conduction block is shown by a significant reduction in compound muscle action potential, between proximal and distal stimulation, the criteria for which varies by nerve.(4) Ascertaining whether conduction block occurs at compressible vs non-compressible sites can be a useful distinguishing feature for the various possible causes e.g. including compression, demyelination, and ischaemia, and (5) Mononeuritis multiplex, while classically associated with a vasculitic neuropathy, has a number of causes, including leukaemia. This is the very rare condition known as neuroleukemiosis.

This week on Knock Knock Eye, I discuss my tough work day due to some curveballs that came into the office, including a patient with Diplopia. It's a tricky thing to figure out as it could be an eye problem or a brain problem. — We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can't get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! – http://www.patreon.com/glaucomflecken Today's episode is brought to you by the Nuance Dragon Ambient Experience (DAX). It's like having a virtual Jonathan in your pocket. If you would like to learn more about DAX Copilot check out http://nuance.com/discoverDAX and ask your provider for the DAX Copilot experience. Produced by Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices

Welcome to the Instant Trivia podcast episode 1126, where we ask the best trivia on the Internet. Round 1. Category: Going For Ward. With Ward in quotation marks 1: Former name for what we today call a flight attendant. a stewardess. 2: All the clothes belonging to you, or a tall piece of furniture to put them all in. a wardrobe. 3: Michael S. Evans holds this top administrative position at Folsom Prison. warden. 4: It precedes "Christian Soldiers" in a 19th century hymn. "Onward". 5: "Cavalcade" and "Conversation Piece" are 2 of his most popular plays. Noël Coward. Round 2. Category: Old Testament Heroes 1: When presented with this son's bloodstained coat, Jacob assumed that "an evil beast hath devoured him". Joseph. 2: This man said, "This is now bone of my bones, and flesh of my flesh; she shall be called woman". Adam. 3: This prophet "prayed unto the Lord his god out of the fish's belly". Jonah. 4: When he came to present the Israelites with the tablets of the law, they were dancing around a golden calf. Moses. 5: Because of the many psalms he wrote, this king was called "The Sweet Psalmist of Israel". David. Round 3. Category: Sounds Serious 1: Alcohol and spicy foods can cause pyrosis, better known as this painful sensation. heartburn. 2: Cutis anserina is nothing to worry about; it's just this "fowl" reaction to cold or fear. goose bumps. 3: If you have pollinosis, you have this seasonal allergy and not necessarily to the crop in its name. hay fever. 4: Diplopia is what doctors call this, also the title of a Foreigner hit. double vision. 5: Runners know medial tibial stress syndrome better by this 2-word name; ice may help. shin splints. Round 4. Category: Legendary Creatures 1: It's a multiheaded sea serpent in Psalms and the title of a masterwork of political philosophy by Thomas Hobbes. Leviathan. 2: In heraldry a dragon is often depicted sticking this barbed feature out of its mouth; how rude. its tongue. 3: The hideous basilisk can be killed by showing it this, something a vampire can't see. its reflection in the mirror. 4: In ancient China they came in different colors, and yellow ones were superior. dragons. 5: After going to a lot of trouble building a nest of fragrant boughs and spices, the Phoenix does this to it. burns it. Round 5. Category: Broadway Musicals By Setting 1: In and around the royal palace in Bangkok in the 1860s. The King and I. 2: The land of Oz, before and after Dorothy dropped in. Wicked. 3: A junkyard on the night of the Jellicle Ball. Cats. 4: The small village of Anatevka in Russia. Fiddler on the Roof. 5: Mushnik's skid row florists. Little Shop of Horrors. Thanks for listening! Come back tomorrow for more exciting trivia!Special thanks to https://blog.feedspot.com/trivia_podcasts/ AI Voices used

In this week's conversation between Dr. James Emery White and co-host Alexis Drye, they discuss the world of Christians and politics. What should Christians consider before entering into political conversations? Is it possible to come out of these conversations as brothers and sisters in Christ? Should politics even matter to a Christian? With the primaries nearly upon us, this is a very important conversation to be having. Episode Links Dr. White delivered a five-week series at Mecklenburg Community Church related to this topic that you'll definitely want to check out. It is titled “Where Angels Fear to Tread: Meck Talks Politics” and we received so much positive feedback about this series. He also talked about the fact that it's important for pastors to speak out on important cultural topics like gay marriage, gender and creation care. You can find a collection of series that Dr. White has delivered on cultural topics HERE. There are two books that Dr. White mentioned in today's conversation to help you delve further into this subject:The Message of the Sermon on the Mount: Christian Counter-Culture by John R.W. Stott and Mass Communication and Everyday Life by Dennis Davis and Stanley Baran. In the latter, the authors cited an article from Daniel Boorstin titled “The Road to Diplopia.” In the discussion they referenced a 2016 Christianity Today article titled “Bible Influences Only 1 in 10 Evangelicals on Immigration Reform,” revealing how little Christians let the Bible guide and shape their political views. Had Dr. Martin Luther King, Jr. taken this same approach to his Christian faith, he may have never been able to pen the words in his Why We Can't Wait (Letter from a Birmingham Jail). For those of you who are new to Church & Culture, we'd love to invite you to subscribe (for free of course) to the twice-weekly Church & Culture blog and check out the Daily Headline News - a collection of headlines from around the globe each weekday.

As a young child, Kyle Campbell was diagnosed with an inoperable brain stem tumor, which caused symptoms from difficulty speaking and swallowing to nausea and general ill health. While radiation therapy in his teens alleviated some of Kyle's symptoms, effects of the tumor (and side effects of his treatments) persist to this day. Now a husband, father of three, and author, Kyle is living a full, meaningful life. Through his difficulties, Kyle has developed a deep trust in God and has learned to live on purpose with faith, focus, and flexibility.Get your copy of Kyle's book: Beyond Belief: How Living with a Brain Stem Tumor Brought Faith and Purpose to LifeKyle Campbell is a Christian, a preacher, a poet, a philosopher, a professor, and an advocate… but some of his favorite identities are husband and father. He has a BA in Philosophy from Cal Poly State University, San Luis Obispo, and an MA in Rehabilitation Counseling from California State University, Fresno. Kyle currently holds a position serving students in higher education. KEY QUESTIONS:Have you ever asked, “Why me?!”?How do you define your identity?How can you find purpose and hope when suffering seems endless?KEY SCRIPTURES:“I have seen the burden God has laid on the human race. He has made everything beautiful in its time. He has also set eternity in the human heart; yet no one can fathom what God has done from beginning to end.” -Ecclesiastes 3:10–11“As he went along, he saw a man blind from birth. His disciples asked him, ‘Rabbi, who sinned, this man or his parents, that he was born blind?' ‘Neither this man nor his parents sinned,' said Jesus, ‘but this happened so that the works of God might be displayed in him. As long as it is day, we must do the works of him who sent me. Night is coming when no one can work. While I am in the world, I am the light of the world.'” John 9:1–5 Connect with Kyle on his website and LinkedIn. Watch his new video. ----Find more encouragement on Joni Eareckson Tada's Sharing Hope podcast  and daily devotional.Follow Joni and Friends on TikTok, Instagram, Facebook, and YouTube.Your support  makes this podcast possible!Joni and Friends envisions a world where every person with a disability finds hope, dignity, and their place in the body of Christ. Founded by  Joni Eareckson Tada, we provide Christ-centered care through  Joni's House, Wheels for the World, and Retreats and Getaways, and offer disability ministry training.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 Our 9th episode features an evolving case discussion about a patient with eye movement difficulties. Dr. Ali Hamedani navigates us through the orbit, brainstem, and midbrain as we discern the structural and physiological problems that can impede extra-ocular movements. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health-identifying information. This episode was vetted and approved by Grant Liu. REFERENCES Brent GA. Clinical practice. Graves' disease. N Engl J Med 2008;358(24):2594-605. PMID 18550875Chiba A, Kusunoki S, Obata H, Machinami R, Kanazawa I. Serum anti-GQ1b IgG antibody is associated with ophthalmoplegia in Miller Fisher syndrome and Guillain-Barré syndrome: clinical and immunohistochemical studies. Neurology 1993;43(10):1911-7. PMID 8413947Cornblath WT. Diplopia due to ocular motor cranial neuropathies. Continuum (Minneap Minn). 2014 Aug;20(4 Neuro-ophthalmology):966-80. PMID 25099103Dallow RL, Pratt SG. Approach to orbital disorders and frequency of disease occurrence. In: Albert DM, Jakobiec FA, editors. The Principles and Practices of Ophthalmology: Clinical Practice. v3. WB Saunders Co.: Philadelphia, 1994.Liu GT, Volpe NJ, Galetta SL. Neuro-Ophthalmology: Diagnosis and Management. 2nd ed. Elsevier, 2010.Sanders DB, Guptill JT. Myasthenia gravis and Lambert-Eaton myasthenic syndrome. Continuum (Minneap Minn) 2014;20(5 Peripheral Nervous System Disorders):1413-25. PMID 25299290 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date. 

I read from dipl- to diplopia.     Diplococcus https://en.wikipedia.org/wiki/Diplococcus     Diplodocus is named thusly because of the "double beams" on the underside of tail bones which are basically 2 parallel boney protrusions.  https://en.wikipedia.org/wiki/Diplodocus     "Humans are diploid organisms, normally carrying two complete sets of chromosomes in their somatic cells..." https://en.wikipedia.org/wiki/Ploidy Diplophase https://en.wiktionary.org/wiki/diplophase     Diplopia can either be voluntary or involuntary, but if it's the latter you might want to get that checked out.  https://en.wikipedia.org/wiki/Diplopia     The word of the episode is "diplomacy". https://en.wikipedia.org/wiki/Diplomacy     Theme music from Jonah Kraut https://jonahkraut.bandcamp.com/     Merchandising! https://www.teepublic.com/user/spejampar     "The Dictionary - Letter A" on YouTube   "The Dictionary - Letter B" on YouTube   "The Dictionary - Letter C" on YouTube   "The Dictionary - Letter D" on YouTube     Featured in a Top 10 Dictionary Podcasts list! https://blog.feedspot.com/dictionary_podcasts/     Backwards Talking on YouTube: https://www.youtube.com/playlist?list=PLmIujMwEDbgZUexyR90jaTEEVmAYcCzuq     dictionarypod@gmail.com https://www.facebook.com/thedictionarypod/ https://twitter.com/dictionarypod https://www.instagram.com/dictionarypod/ https://www.patreon.com/spejampar https://www.tiktok.com/@spejampar 917-727-5757

We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, John presents a case of diplopia to Valeria and Madellena. Neurology DDx Schema   John Acquaviva @DrJAStrange John Acquaviva is a fourth-year medical student attending Lake Erie College of Osteopathic Medicine in Erie, Pennsylvania. He has a passion for both clinical… Read More »Episode 263: Neurology VMR – Diplopia

Marc Marquez mengalami kecelakaan saat pemanasan MotoGP di Sirkuit Mandalika pada Minggu (20/3/2022).

Greg's Garage Pod with Co-Host Jason Pridmore P/B Bike911.com - A motorcycle racing Pod about MotoGP, MotoAmerica, and World Superbike, Pro Motocross, American Flat Track, Supercross, and more. If you'd like to support the channel here is our Patreon link: https://www.patreon.com/gregsgaragetv In this episode, Co-Hosts Greg White and Jason Pridmore talk:  ARAI News -  MotoAmerica gets two new Superbikes? Yates is back in Superbike!?! Gerloff to the top? Well, it was really close as the American continues to show pre-season speed! Marc Marquez was diagnosed with Diplopia once again. This can't be good.  MotoGP - Rain, Rain, Rain... and a surprise winner! Find out what the boys saw in all classes.  MotoGP Fantasy - Round 2 is in the books, but who is leading early in the season. Plus, we pick a winner for a MotoAmerica LIVE+ App 2022 season pass! Win and ARAI Corsair-X by playing MotoGP Fantasy with us! And it is free. When you register to play join our league. https://fantasy.motogp.com/leagues/join  Use this code in the search! 3X2LNEY5 Supercross - Indy is another Tomac runaway, but the boys behind are banging bars and paying a price for it!  Supercross Fantasy - Supercross Fantasy is junk for Greg. JP... well, you'll have to find out.  The podcast has two leagues! One for the broad audience and one for the Patreon supporters. ARAI will provide a prize for the winner of each fantasy league.  Join us!! Supercross Fantasy: https://pulpmxfantasy.com/leagues/gregsgaragepodcast RM Fantasy Link: https://www.rmfantasysx.com/ Bye, Bye  Social Media Links: Jason's Instagram - @pridmore43 Greg's Instagram - @gregwhitetv Jason's Twitter - @jp43 Greg's Twitter - @gregwhite Greg's Youtube - GregsGarageTV

Il giorno successivo al GP di Indonesia Marquez è di nuovo ai box, nuovamente con problemi alla vista. Salterà i prossimi Gran Premi? Rischia il ritiro? Cosa farà la Honda sul mercato? Sono queste alcune delle domande a cui Carlo Pernat cerca di dare risposta assieme al terzetto di GPOne composta da Paolo Scalera, Matteo Aglio e Marco Caregnato

Ieri Marquez ha partecipato, praticamente a sorpresa, alla conferenza stampa di presentazione della Honda, regalandoci la notizia di un miglioramento delle sue condizioni, che attende però la conferma della pista prima di confermare la presenza ai test in Malesia. Ne parlano Carlo, Paolo e Marco, senza dimenticarsi di ricordare la grande prestazione di Petrucci alla Dakar

Diplopia, di Kala Satu Terlihat Dua Oleh. Aya Ummu Najwa Voice Over Talent: Dewi F NarasiPost.Com-“What's up, Bro? Kok buang napas kasar sekali? Muka kusut, mirip baju yang belum disetrika.” Tanyaku pada adik laki-lakiku yang terlihat uring-uringan. “Aku tuh lagi bad mood nih kak.” Jawabnya. “Wiiih.. Boleh tahu kenapa kamu bad mood?” Tanyaku penasaran. “Itu..pembalap jagoanku kena sakit mata, jadi tidak bisa balapan lagi…” Balasnya lagi. “Ya Allah, Bro. Kakak kira kenapa, kirain kamu kelewat salat subuh atau telat kajian, tak tahunya hanya karena pembalap jagoannya kena sakit mata.” Selorohku. “Ih kasihan tahu, sakit matanya itu parah, dia batal balapan, padahal aku sudah menjagokan dia! Namanya penyakitnya apa ya? Di.. Di.. Diplopia! Iya Diplopia!” Jawabnya tak terima. “Mmm, kamu tahu tidak apa itu diplopia?” Tanyaku padanya. “Nah itu, aku tak tahu.” Jawab adikku. “Oke, yuk kita cari tahu” Aku pun mulai berselancar di kanal pencarian berita, ahaa..ternyata memang benar berita terkait Marc Marquez, salah satu pembalap MotoGP dari Tim Repsol Honda memenuhi laman pencarian beberapa hari ini. Diberitakan ia harus absen pada seri penutup balapan musim ini pada 12-14 November 2021 lalu, di Valencia, Spanyol. Karena juara dunia enam kali itu mengonfirmasi bahwa ia mempunyai masalah mata diplopia, sama seperti yang pernah ia alami pada tahun 2011 silam. Naskah Selengkapnya: https://narasipost.com/2021/11/30/diplopia-di-kala-satu-terlihat-dua/ Terimakasih buat kalian yang sudah mendengarkan podcast ini, Follow us on: instagram: http://instagram.com/narasipost Facebook: https://www.facebook.com/narasi.post.9 Fanpage: Https://www.facebook.com/pg/narasipostmedia/posts/ Twitter: Http://twitter.com/narasipost

We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Gabriela presents a case of impairment of speech to Gabriel and Valeria. Neurology DDx Schema Want to test your learning? Take our Episode Quiz Gabriela Pucci Gabriela has graduated from Medical School at Unicamp and recently finished her neurology residency at Unesp, both… Read More »Episode 199: Neurology VMR – Diplopia

In this month's episode of ACEP Nowcast, Dr. Jeremy Faust reviews some tips and tricks for evaluating...

Stephanie L. Woo, OD, FAAO, FSLS, shares her secret to training staff for specialty lenses (0:55). Molly Ann R. Clymer, OD, FAAO, recounts the case of a patient with vertical diplopia and light near dissociation secondary to a pineal gland tumor (9:38). Get a step-by-step guide on how to use Facebook to market your practice from Jason E. Compton, OD, FAAO (23:37). To end the episode, find out a little more about Richard Mangan, OD, FAAO, including how he got into hand-crafting tobacco pipes (32:44).

我只是學花輪耍帥甩了一下頭髮，為什麼脖子痛痛，頭暈暈呢？ 頭暈的成因有很多，為什麼頸椎扭到也會頭暈呢？ 原來頸椎的感覺受器、前庭系統、眼球之間都存在這反射，也因此相互影響。 快點開來聽吧！ Timecode: 00:00 Stan分享了Whiplash病人在診所的小趣事 08:30 只要頸椎的關節或肌肉有異常，病人可能會有頭暈的症狀喔! 12:26 脖子的感覺受器和前庭系統、眼球控制系統都有反射存在，也因此頸椎的病人可能出現頭暈或平衡不穩的問題。 15:39 "頭暈"的感覺有很多種，病人如何描述"頭暈"是可以協助治療師做鑑別診斷的喔。 21:04 創傷性頸椎疼痛的病人在視覺和眼球控制會有哪些症狀呢?如何用這些症狀做鑑別診斷呢? (切記!如果病人說有複視(Diplopia)的話，那就不是只有頸椎的問題了喔!) 22:35 在治療鞭傷症候群的病人時，怎麼判斷病人是否也有"腦震盪"呢? 25:33 要如何評估病人脖子的本體感覺呢?目前研究最推薦的是測量"JPS"(Joint Position Sense)，臨床上非常實用的方法。 29:30 其它測量頸椎本體感覺的方法，可能臨床不實用。目前研究並不推薦使用Rod&Frame test來做鑑別診斷的測試喔。 歡迎到各平台追蹤或來信來訊跟我們提出疑問～ Facebook: https://www.facebook.com/2PROPT/ Instagram: https://www.instagram.com/2pro_pt/ Email: 2propt@gmail.com 也可以在此收聽： Apple podcast: https://tinyurl.com/y97q7tms Spotify: https://tinyurl.com/ydavzqxu Google podcast: https://tinyurl.com/yd86pbcl YouTube channel: https://tinyurl.com/y82ewo5b Music by Elizabeth's Groove by Amarià @amariamusique Creative Commons — Attribution 3.0 Unported — CC BY 3.0 Free Download / Stream: bit.ly/elizabeths-groove Music promoted by Audio Library youtu.be/-MO-mrBlo5s

No episódio de hoje trouxemos essa pergunta como título para você acompanhar nossa investigação com esse caso, esperamos que gostem! Um grande abraço da equipe Passando Visita

Diplopia, maternidade e opacidade no cinema. Neste episódio convidamos o Matheus Maltempi (Necronomiconversa e Suco Excêntrico Filmes) para conversar sobre Kotoko, um filme onde uma mãe solo tenta cuidar do seu bebê enquanto sofre de terríveis alucinações. LINKS RELACIONADOS Matheus Maltempi https://www.instagram.com/matheusmaltemm/ Necronomiconversa https://necronomiconversa.com/ Suco Excêntrico Filmes https://www.instagram.com/sucoexcentricofilmes/ IFFR 2012 Interview: SHINYA TSUKAMOTO talks KOTOKO https://screenanarchy.com/2012/02/iffr-2012-interview-shinya-tsukamoto-talks-kotoko.html Grupo no WhatsApp https://chat.whatsapp.com/LXqH4nbxBjj5TJsdixevt5 Conheça a iniciativa Podcasters Unidos https://www.instagram.com/podcastersunidos/ Conheça o Bom Som Web Radio http://bomsom.website.radio.br/ Ouça em Spotify | Deezer | Apple Podcasts | Amazon Music | Castbox | Anchor | Google Podcasts | Pocket Casts | Breaker | RadioPublic | Youtube

ANDRÉ PEPES RECEBE O OFTALMOLOGISTA DR. WALBERTO SANTANA, PARA FALAR SOBRE DIPLOPIA. SAIBA TUDO SOBRE ESTE TEMA. --- Send in a voice message: https://anchor.fm/saudeemfoco/message

Aimed at hospital Trainees advising how to assess a patient with Diplopia

A new MP3 sermon from Woolwich Evangelical Church is now available on SermonAudio with the following details: Title: Dispensational Diplopia Speaker: Charles Soper Broadcaster: Woolwich Evangelical Church Event: Bible Study Date: 11/5/2020 Bible: Revelation 20:8-10; Ezekiel 38-39 Length: 33 min.

A new MP3 sermon from Woolwich Evangelical Church is now available on SermonAudio with the following details: Title: Dispensational Diplopia Speaker: Charles Soper Broadcaster: Woolwich Evangelical Church Event: Bible Study Date: 11/5/2020 Bible: Revelation 20:8-10; Ezekiel 38-39 Length: 33 min.

Gog and Magog is a problem for all three schools of eschatology, but it is a particular Achilles' heel for pre- and post-millennialism. It causes classical dispensational diplopia. It is an ill fitting jigsaw piece. Reexamining it provides important clues to the Lord's mind and the timetable for events leading up to the End of Days.

MS ‘Symptoms Short' Episodes. This one briefly covers MS visual problems … what causes these symptoms and how to handle them. Whether it's patchy vision, loss of vision, pain behind the eyes or something that affects you only when you've got overheated after a workout. This episode is not a replacement for seeking professional medical help where necessary. Copyright Bron Webster 2020 website: www.multiplesuccess.co.uk Facebook Page: Multiple Success - https://www.facebook.com/MultipleSuccessDefyTheParadigm

Dr. Adam Quick, a neurologist at Ohio State University, discusses his NeuroByte on the clinical approach to diplopia. Show references:  https://learning.aan.com/diweb/catalog/item?id=4976531

Case discussion with Drs. Rahiwa Gebre, Chris Traner and Jeff Dewey.

Everything To Guppy is a bite-sized, four-times weekly comedy/gaming podcast in which Gary Butterfield (Watch Out For Fireballs) and William Hughes (The A.V. Club) attempt to analyze every single item, boss, character, and concept in the rogue-lite video game The Binding Of Isaac. They manage to pull it off only slightly less than 50 percent of the time.

A case of diplopia, featuring Dr. Chris Traner, Dr. Lindsay McAlpine and Dr. Jeff Dewey

i promised my mom i wouldn’t go to any events.DOWNLOAD RECORDINGsubscribe to the podcast here:  http://feeds.feedburner.com/5432fun(intro by omar)Brunch Club “Not Dead Yet” from Brunch Club EPKarima Walker “Lullaby” from Hands in Our NamesNa B “Festival Tongue” from Plato’s Drain VesselBaby Ghosts “Rise” from A Surprise PartyK^ren “DMV” from NoT BaLDDiplopia “Adeline” from A Season AtonesCabo Boing “The Cog” from Blob On A GridTight Little Ship “Raisin + Rose” from Tight Little ShipDiet Cig “Link In Bio” from Swear I’m Good At ThisZ!K “Psych Emerge” from Shoplifting From American Apparel EPFree Music “The Dancing Wu-Li Masters (A Book By Gary Zukav)” from Themes (Music for “The Future is 0”) …Honey Cutt “home sweet home” from Pick MeBasketball Shorts “Kevin McCallister” from Hot and ReadySnails “Starting with mine” from Starting with MineNanami Ozone “DAMAGE” from MAKE IT ALL RIGHT EPPretty pretty “Forget You” from DEMO IIDingbat Superminx “Dingwave” from Tasteful as Life/Discreet as DeathSnow Caps “Hard to Read” from Intimationsthanks for coming “friends forever” from ball out foreverJulia Lucille “Plot of Ground” from Chthonic

MINUTAGEM [00:23] Apresentação Convidado Dr. José Marcos [02:12] Salves! [03:06] Início caso clínico [03:40] Anamnese [20:02] Exame físico [34:51] Exames complementares [45:41] Diagnóstico e desfecho [46:54] Resposta do desafio do episódio anterior [48:32] Desafio da semana Um caso clínico de neurologia com um convidado especial! O Pedro apresenta um caso de diplopia para o dr. José Marcos e os outros integrantes do TdC. Aproveita para montar um esquema diagnóstico dessa queixa e evitar as armadilhas mais comuns! REFERÊNCIAS: Glisson, Christopher C. "Approach to Diplopia." CONTINUUM: Lifelong Learning in Neurology 25.5 (2019): 1362-1375.Pomeranz, Howard D., and Simmons Lessell. "Palinopsia and polyopia in the absence of drugs or cerebral disease." Neurology 54.4 (2000): 855-859.Jones, Matthew R., Rebecca Waggoner, and William F. Hoyt. "Cerebral polyopia with extrastriate quadrantanopia: report of a case with magnetic resonance documentation of V2/V3 cortical infarction." Journal of Neuro Ophthalmology 19.1 (1999): 1-6.

Thanks for coming back to Witchblade the tv series this week, Mistress Zeneca cover two episodes of this amazing show. ep2: Air date June 19, 2001 Sara and Jake investigate when skeletal remains are found carefully posed in a downtown park. Using missing person reports, they determine that the remains are those of Gina Maris, […]

Core Questions:    What is diplopia and how is it classified? What four questions help clinicians delineate the potential cause of a patient’s diplopia? What are the cardinal directions of gaze and how are they tested? Outline the physical exam for the patient with monocular and binocular diplopia. Outline the DDx for monocular diplopia? Outline the DDx for binocular diplopia? [Table 18.1] Detail the different oculomotor palsies. [Figure 18.3] Detail the various lacunar stroke syndromes. [Box 18.1] Define internuclear ophthalmoplegia. What ancillary tests are required for the patient presenting with diplopia? [Figure 18.4]   Wisecracks:    What are the most common oculomotor palsies and what causes them? What is orbital apex syndrome? What is the “rule of the pupil” and how reliable is it? Detail the physical exam maneuvers used to identify patients with myasthenia gravis.

Core Questions:    What is diplopia and how is it classified? What four questions help clinicians delineate the potential cause of a patient’s diplopia? What are the cardinal directions of gaze and how are they tested? Outline the physical exam for the patient with monocular and binocular diplopia. Outline the DDx for monocular diplopia? Outline the DDx for binocular diplopia? [Table 18.1] Detail the different oculomotor palsies. [Figure 18.3] Detail the various lacunar stroke syndromes. [Box 18.1] Define internuclear ophthalmoplegia. What ancillary tests are required for the patient presenting with diplopia? [Figure 18.4]   Wisecracks:    What are the most common oculomotor palsies and what causes them? What is orbital apex syndrome? What is the “rule of the pupil” and how reliable is it? Detail the physical exam maneuvers used to identify patients with myasthenia gravis.

Dr. Christopher Glisson discusses diplopia in the third part of a three-part series. To learn more, read the article "Approach to Diplopia" by Dr. Glisson in the October 2019 Neuro-ophthalmology issue of Continuum. 

Dr. Christopher Glisson discusses diplopia in the second part of a three-part series. To learn more, read the article "Approach to Diplopia" by Dr. Glisson in the October 2019 Neuro-ophthalmology issue of Continuum. 

Dr. Christopher Glisson discusses diplopia in the first part of a three-part series. To learn more, read the article "Approach to Diplopia" by Dr. Glisson in the October 2019 Neuro-ophthalmology issue of Continuum. 

Each month, EMedHome.com presents EMCast, the 90-minute podcast hosted by Dr. Amal Mattu, the premier educator in Emergency Medicine. Subscribe to EMedHome.com for an array of clinical content that will impact every shift. This month's EMCast covers:(1) ACEP Non-ST Elevation Acute Coronary Syndrome (ACS) Policy (2) Approach to Diplopia(3) 2018 Critical Care Literature Updates

Dr. Janice Kwan presents a clinical unknown to Dan and Rabih

In this episode I discuss what the prognostic factors are for persistent diplopia after orbital blowout fractures. I also discuss an article that did a benchtop study on the neurotoxicity of articaine versus lidocaine and found that there was no difference in toxicity which would suggest that Articaine may be acceptable for inferior alveolar or mandibular nerve blocks

Pelvic exams and STIs, Non-operative vs operative management of hip fractures, Tamsulosin for kidney stones, NG tube decompression for SBO, Procedural sedation with one vs two physicians, CXR in everyone with chest pain ? , Fluids and Pediatric DKA, NIPPV + NC, PRISMS trial - alteplase vs aspirin, ESBL UTI, Bicarb in the ICU, Backboards and imaging, SVT and troponin leak, Pediatric pneumonia, Lactate after HD, Tetracaine for corneal abrasions, fixed dose vs weight based PCC, ED Urgent Care transfers, Diplopia in the ED   Quick Summary   July 2018 Articles

Podcast summary of articles from the June 2018 edition of Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include Head and Neck CT in trauma, lactate as a marker of short term mortality, an emerging pathogen in cat and dog bites, acute cholecystitis management, 4 factor PCC in brain bleeds, and board review on diplopia.  Guest speaker is Dr. Colin Crowe.

This throwback Thursday, we revisit a high-yield discussion on diplopia, featuring Dr. Ali Hamedani. Ali navigates us through the orbit, brainstem, and midbrain as we discern the structural and physiological problems that can impede extra-ocular movements. Produced by James E. Siegler. Music by Little Glass Men and Montplaisir. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES 1. Liu GT, Volpe NJ and Galetta SL. Neuro-Ophthalmology: Diagnosis and Management. 2nd ed: Elsevier; 2010. 2. Cornblath WT. Diplopia due to ocular motor cranial neuropathies. Continuum (Minneap Minn). 2014;20:966-80. 3. Chiba A, Kusunoki S, Obata H, Machinami R and Kanazawa I. Serum anti-GQ1b IgG antibody is associated with ophthalmoplegia in Miller Fisher syndrome and Guillain-Barre syndrome: clinical and immunohistochemical studies. Neurology. 1993;43:1911-7. 4. L. DR and G. PS. Approach to orbital disorders and frequency of disease occurence: W. B. Saunders; 1994. 5. Sanders DB and Guptill JT. Myasthenia gravis and Lambert-Eaton myasthenic syndrome. Continuum (Minneap Minn). 2014;20:1413-25. 6. Brent GA. Clinical practice. Graves' disease. The New England journal of medicine. 2008;358:2594-605.

Author: Aaron Lessen, M.D. Educational Pearls: We can differentiate verto into benign problems such as vestibular problem (peripheral problem), or something more worrisome that originates in the brain (central problem). Dizziness + other symptoms makes us think about origination in the CNS.  Symptoms include Dizziness, Diplopia, Dysarthria, Dysphagia, Dysmetria. References:  http://www.medicalnewstoday.com/knowledge/160900/vertigo-causes-symptoms-treatments http://www.mayoclinic.org/diseases-conditions/dizziness/basics/causes/con-20023004  

A discussion of cranial nerve palsies.

Our 9th episode features an evolving case discussion about a patient with eye movement difficulties. Dr. Ali Hamedani navigates us through the orbit, brainstem, and midbrain as we discern the structural and physiological problems that can impede extra-ocular movements. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. This episode was vetted and approved by Grant Liu. REFERENCES 1. Liu GT, Volpe NJ and Galetta SL. Neuro-Ophthalmology: Diagnosis and Management. 2nd ed: Elsevier; 2010. 2. Cornblath WT. Diplopia due to ocular motor cranial neuropathies. Continuum (Minneap Minn). 2014;20:966-80. 3. Chiba A, Kusunoki S, Obata H, Machinami R and Kanazawa I. Serum anti-GQ1b IgG antibody is associated with ophthalmoplegia in Miller Fisher syndrome and Guillain-Barre syndrome: clinical and immunohistochemical studies. Neurology. 1993;43:1911-7. 4. L. DR and G. PS. Approach to orbital disorders and frequency of disease occurence: W. B. Saunders; 1994. 5. Sanders DB and Guptill JT. Myasthenia gravis and Lambert-Eaton myasthenic syndrome. Continuum (Minneap Minn). 2014;20:1413-25. 6. Brent GA. Clinical practice. Graves' disease. The New England journal of medicine. 2008;358:2594-605.

This episode covers Chapter 21 of Rosen's Emergency Medicine. Episode overview: List the differential diagnosis (critical emergent, urgent) for Diplopia Including at least 7 causes of binocular diplopia Describe the mechanisms of normal extraocular movements Describe the specific cranial nerve palsies causing diplopia Wisecracks: What are the 5 most important questions to ask yourself about diplopia? Describe your approach to diplopia in the sick patient

This episode covers Chapter 21 of Rosen's Emergency Medicine. Episode overview: List the differential diagnosis (critical emergent, urgent) for Diplopia Including at least 7 causes of binocular diplopia Describe the mechanisms of normal extraocular movements Describe the specific cranial nerve palsies causing diplopia Wisecracks: What are the 5 most important questions to ask yourself about diplopia? Describe your approach to diplopia in the sick patient

Michael Bartiss

Michael Bartiss

Hello Enter VR listeners! Welcome to another episode of the EnterVR podcast. I got the chance to hang out with Manish Gupta and James Blaha from Apollo VR and chatted about manipulating the human brain, genetically engineering life without consciousness and crossing the uncanny valley. Here is a snippet of some of the things we talked about. 25 Catching up with Apollo VR and Diplopia. Rolling enrollment is still available. Get in touch with Manish and James to be part in the study. 40 What is the number people required in order to decisively say that Diplopia works? 2:00 Understanding how the brain responds to visual and audio input. 6:00 What happens after the studies? What is the best case scenario for the project? 8:00 The response from VCs and the general public. 9:00 How the name ApolloVR came along. 10:30 Will Apollo VR reach out to different aspect 11:00 What will ApolloVR look like 5 years from now? 12:55 Demoing the Rift at coffee shops. 14:20 What's harder? Building the tech or the business? 15:40 Discussing the VR booth next to Oculus at CES 2015 17:30 How will VR make peoples lives easier? Live coding environments in VR. 20:00 Increasing workplace productivity with VR. 21:00 Impressions on GearVR. 25:00 Is there a possibility that there will be VR hardware shortages. 26:00 Streaming netflix in VR. 27:00 How to make the rift appeal able to people with nice hair. The reverse mohawk will become a thing. James Blaha predicts people will have vr hairstyles 3 years from now. 29:40 How to add pre-cognizance to your Linkedin profile. 30:00 How long before VR gets passed the pair of glasses form factor. 31:00 Is VR truly the final medium? 32:00 Strapping a hard drive and a camera to the back of your head to record your memories. 33:00 The youtube of the metaverse will be a place where people will pay you to "see" what its like to be you. 38:00 The true power of information on a macro sense. Will the information age lead us into an "idiocracy" or a more advanced sentient form of life? 40:00 Sharing my obsession with AI, with Manish and James 42:00 What is the purpose of AI in the grand scheme of our time on this planet. Why do we need AI? 43:30 How is the Militarization of Ai going to pan out?What are the chances of a robot war? 44:00 Why Elon Musk invested in Deepmind. 47:00 How can socities begin the process of adaptation to the AI economy. 49:00 The fundamental questions synthetic biology will explore. 51:00 Creating a none conscious genetically engineered goat to exploit for its milk? 52: The plot behind Dollhouse by Joss Wheddon. 54:00 Who will your data belong to inside metaverse? 55:00 Is 1984 a reality today? 1:00:10 Should there be an AI race like we've had a space race? 1:01:00 Could you bring someone back from a comatose state with a transcranial direct current stimulation device? 1:03:00 In the future you will be able to manipulate and program your very own consciousness. 1:04:00 Star Trek can be a really sad show. 1:06:30 Will the advent of human clones change the nature of how we reproduce? 1:09:00 The appeal of Counter Strike for Manish and James. 1:10:00 Could League of Legends be enhanced by VR? 1:13:00 Is Grand Theft Auto 5 in VR going to make me quit EnterVR? 1:14:00 Reporting massive online battles in EVE as a journalist. 1:16:00 What will the Oculus Rift version 12 look like? Are we living in a simulation? 1:18:00 What if AI solves problems in ways we wouldn't want them to solve them? 1:20:00 What's the point of being in a simulation? 1:21:00 How hard could it be to tailor make 7.4 billion universes, one for every person on earth? 1:24:00 Predicting humanity's greatest accomplishment of the next 50 years. How the human sexuality spectrum will evolve with time. 1:25:20 Creating an xprize for the first company that can completely cross the uncanny valley. 1:27:00 What's the point of photo realistic VR? 1:29:00 The most formidable obstacle facing the Oculus Rift. 1:34:00 How big is the portal to the human mind that VR will have access to? 1:36:00 Next generation haptic fleshlights. Brain implants. Why would you want one? 1:37:00 Slowing down your perception of time and speeding up your cognitive processes and what this could mean for life on earth? 1:42:00 If your an asshole, will augmenting your brain make you a bigger asshole? 1:44:00 Red pill or blue pill? 1:51:00 The economic implications of solar energy vs fossil fuels. 1:53:20 How to solve climate change. 1:56:00 Christopher Nolan working on a VR movie? Inception Spoiler ALERT. 2:01:00 "There are the people who don't know and the people who don't think about it" Why does experience exist? 2:04:00 The probability of finding intelligent life in the whole existence of humanity. 2:06:00 Sending a rover to Europa and taking a carnival cruise ship to Mars. 2:08:00 Is the metaverse going to rewire our brains? 2:10:00 Is the brain ready for the day we will be able to navigate the internet with your mind. Thanks again to James and Manish for being true scholars and jedi of virtual reality and thank you for listening. Get more info on Manish and James with the links below: https://twitter.com/jamesblaha https://twitter.com/manishiwa http://www.diplopiagame.com/ Here is a link to our first conversation: http://entervr.net/apollo-vr-using-virtual-reality-potentially-cure-amblyopia-lazy-eye-strabismus-crossed-eye-much/

Hello listeners! Welcome to another episode of Enter VR. On today's show I speak with James Blaha and Manish Gupta from Apollo VR. Manish and James are working on a virtual reality game that could potentially eradicate Amblyopia (lazy eye) and Strabismus (crossed eye) forever. Here is a preview of some of the things we talked about: 40: The story of how Diplopia came about. Discovering the Rift and seeing 3D for the first time. 1:44 How Manish and James paired up to form Apollo VR. 2:44 The current stage in development. Diplopia updates. 3:20 How does Diplopia work? What makes it possible for VR to potentially treat lazy eye? 6:00 How did they figure out their methodology would work? 7:14 The most common methods to treat lazy eye today. 8:30 What does it feel like to have a lazy eye? 9:30 What is it like to grow up with lazy eye? 11:14 The psychological impacts of having an eye condition. 14:04 The causes and roots of different eye conditions. 15:02 The percentage of the population that has vision problems and how this can pose an obstacle to the adoption of virtual reality. 20:10 How can VR companies/developers get around the issue of people who cannot see in 3D. How to make vr more accessible. 23:14 Monetizing 23:48 The biggest challenges facing the team. 25:11 The response from Optometrist and vision therapists. 27:05 Age ranges for people trying out the Diplopia software. 29:00 How to raise funding for an idea like theirs. 32:32 Would you drink your own milk? 33:15 Would you drink lab grown milk made from human DNA? 36:43 What would you do with your time if there were no electricity for 1 year? 42:00 How long it will take for humans to be able to manipulate the planet's weather. 43:34 It is easier than ever to genetically modify things at home. 46:00 Google's project to keep you living forever. 47:42 Genetically engineering a super virus in your garage. 50:00 What is the allure of VR? 51:50 What components are needed to cross the uncanny valley. 53:42 What are the most far fetched predictions for what VR will do to our culture. 58:51 Is VR a way to escape reality or will it enhance the way we perceive reality? 1:00:45 What will be the most important thing to happen to humanity in this century? Technology and its unpredictability in the future. 1:02:00 Does thinking about the future scare you or excite you? 1:02:50 Can VR be used to augment humans? 1:04:00 How will people react to the rise of cyborgs or lab grown humans? 1:07:50 Closing thoughts and how to stay touch. Thanks again to my guests for being true scholars Check out the links below to stay up to date with Manish and James. http://diplopiagame.com/ https://twitter.com/jamesblaha https://twitter.com/manishiwa

Double your pleasure, double your fun. Observe from two centers instead of one.

Sat, 1 Jan 2005 12:00:00 +0100 https://epub.ub.uni-muenchen.de/16968/1/10_1159_000084372.pdf Hamann, Gerhard F.; Dichgans, Martin; Pellkofer, Hannah L.; Brüning, Roland; Opherk, Christian ddc