Relaxed Vision

Title

Relaxed Vision

Author(s)

Fitzinger Sebastian

Abstract

Study Design
This experimental clinical study is organized as pretest-postest control group design and thus belongs to the group of pragmatic randomized controlled studies.
The ad hoc – sample (not randomized sampling) which was carried out at the Hauptschule Timelkam (compulsory secondary school) comprised 280 test persons.
All received a questionnaire, 72 were returned, 40 met the inclusion criteria, but only 26 could be included in the statistical analysis.
Outline/Problem Definition
It has to be pointed out that the treatment approaches recommended in the AKH Consilium compendium focus exclusively on the eye itself, thus the eye itself is seen as the only origin of the problem. This does not correspond with Hettrich’s opinion (2002). He writes that the asthenoptic complaints are quite diverse and thus do not permit a clear conclusion about what is the direct cause of the problem.
The topic “vision” is a field that is still only little explored in osteopathy.
Research Question & Objective
Can osteopathic treatment improve asthenoptic complaints like impaired far-to-near accommodation, blurred vision, rapid fatigue, double vision, “dancing” letters, burning or watery eyes, headaches/migraine, dizziness, nausea, malpositioning of the head, squinting, winking, deteriorating vision, dyslexia or ADHD?
Hypothesis
Osteopathic treatments can influence asthenoptic complaints in a positive way?
Relevance for the Patients
“Relaxed vision” is one of the most important preconditions for children to cope with the ever increasing pressure at school.

Osteopathy could be one possibility to achieve this “relaxed vision” in a gentle and easy way.
Relevance for Osteopathy
The term asthenopia summarizes a number of symptoms like impaired near accommodation, blurred vision, rapid fatiguing, double vision, “dancing” letters, burning and watery eyes, headaches/migraine, dizziness, nausea, bad position of the head, squinting, blinking, deteriorating eyesight, dyslexia (reading/writing difficulties) and ADHD. (Saber, 2005; Hettrich, 2002; AKH-Consilium 2006)
So far only ophthalmologists and opticians/orthoptists have been concerned with the treatment of asthenopia.
But this field of ophthalmology could also open up for osteopathy.
Methodology
Primary outcome measure

The questionnaire to identify asthenoptic complaints served as primary outcome measure. Since the diagnosis asthenopia represents only a description of symptoms this approach seemed only logical to me.

Secondary outcome measure

The ophthalmologic examination and the resulting data were determined as secondary outcome measure.

Inclusion criteria

This study includes only those test persons who returned a positive questionnaire (Hettrich (2002)) on the subjective problems of asthenopia.
The questionnaire is regarded as positive if ‘5’ is marked once or several times, ‘4’ is chosen three times or more often, or ‘3’ is given six or more times as an answer.

Exclusion criteria

Patients with pathological eye conditions were excluded, but none of the test persons suffered from a pathology.

Implementation of the study

Two homogenous groups which meet the inclusion criteria are formed.
The control group (12 test persons) is examined by an ophthalmologist at the beginning of the study period, if necessary glasses are adapted, and after 7 weeks the children come to a second ophthalmologic examination.
The study group (14 test persons) is also examined by an ophthalmologist at the beginning of the study period and glasses are adapted if necessary. Within the study period of 7 weeks the children in the study group receive three osteopathic treatments. After that they are once more examined by the ophthalmologist.
The osteopathic treatment is delivered during regular class time. Treatments took place in a special room of the secondary school Timelkam.
The ophthalmologic examinations took place in a doctor’s practice.

Measuring instruments

Basically, the measuring tools used in this study can be divided into two categories:
1. Questionnaire (evaluation of the subjective perception)
2. Ophthalmologic measuring instruments and tools for diagnosis (valid data)
a. Visus examination (measurement of visual acuity without refraction)
b. Sciascopy (measurement of visual acuity with refraction)
c. Measurement of accommodation
d. Lang stereo-test (test of strabismus)
e. Funduscopy (examination of the back part of the eye’s interior to exclude pathologies)

Criteria of the questionnaire

The questionnaire comprises 25 questions which can be answered on a 1-to-5 scale, with ‘1’ meaning ‘not true’ and ‘5’ meaning ‘absolutely true’.
14 questions have to be answered by the parents, the remaining 11 questions by the children.
The questionnaire was developed by Schroth (2003) and is used by orthoptists in Germany to evaluate asthenoptic complaints.
To obtain more significant results the questions were divided in the categories ‘reading’, ‘writing’, ‘concentration’, ‘observable physical overstraining symptoms’, ‘gross motor skills’ and ‘fine motor skills’.
Results
Due to the high drop-out rate of participants the results of this study are statistically not significant. Nevertheless, some carefully formulated tendencies can be identified.
The results show that in most examined categories, which are evaluated by the questionnaire, an improvement of the subjective complaints could be observed.
Both the parents and the children of the study group identify much greater and more positive changes than the parents of the control group.
This observed tendency could speak in favour of the osteopathic treatment method.

A comparison of the measurements of the children’s myopia, emmopia and hyperopia in the course of ophthalmologic examinations before and after the osteopathic intervention showed no statistically significant differences between the study group and the control group. As regards accommodation the tendency of a slight improvement might be identifiable, which again could speak in favour of osteopathic treatment.
Critical Reflection/Perspectives/Conclusions
Summarizing it can be said that the parents and children of the study group rated all categories after the intervention better than the parents and children after the study period of seven weeks without treatment.

This could provide some evidence that asthenoptic complaints can be influenced positively by osteopathic treatment.
Due to the high drop-out rate among the participants, however, the results are statistically not significant to support the hypothesis of this thesis.
Additional Information

presented at

Wiener Schule für Osteopathie

Date Accepted

2006

Date Submitted

1.12.2007 00:00:00

Type

osteo_thesis

Language

English

Submitted by:

62

Pub-Identifier

13956

Inst-Identifier

781

Keywords

Asthenoptic complaints

Recommended

0

Medium

FitzingerSebastian.pdf

Item