It was good to hear about a breakthrough in the treatment of nystagmus earlier this week.
Nystagmus has been a commonly met problem in eye care over the years, and approaches in management have tended toward prevention and minimisation. Nystagmus has many causes and those related to environmental hazards have largely been addressed. Even before the demise of the mining industry in the UK, miners’ nystagmus, caused by a lack of light stimulus over many years, had been tackled by better working conditions.
Nystagmus caused by toxins are also less common. Once a hazard of mercury poisoning, the restriction of use of quicksilver in industries such as millinery has also seen a decline in such variations of the condition. Sadly, this is not the case globally, and illegal discharge of mercury into local river sources has caused widespread neurological damage, including nystagmus, in some developing countries in recent decades.
Nystagmus is often seen in low vision clinics, as the involuntary movement is also associated with congenital conditions such as oculocutaneous albinism and prevents full macular development. Often the best management approach is to find the gaze position at which oscillation is least marked (the null point) and then adapt the patients viewing habits appropriately.
Some have claimed success with prism in shifting viewing angle, others with contact lenses in stabilising image input, though my experience of results in both these areas was less than impressive.
The use of magnetic implants into the orbit, one to the bony orbit and another to the muscles, has been developed in University College London and Oxford and appear to significantly reduce oscillation. The trial patient had acquired nystagmus, subsequent to Hodgkin’s lymphoma, so the visual prognosis looks good. At last a good news story.