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88 Cards in this Set
- Front
- Back
How common is acquired pendular nystagmus?
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One of the more common types
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Is there a fast phase with acquired pendular nystagmus?
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no
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What are the three trajectories of acquired pendular nystagmus?
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horizontal, vertical, and oblique
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How many trajectories might a patient's nystagmus take?
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Can be all three
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What determines trajectory?
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Phase relationship between the different components.
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If horizontal and vertical components are in phase then the trajectory with be________.
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oblique
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If the horizontal and vertical components are 180 degrees out of phase then the trajectory will be __________.
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elliptical
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If the horizontal and vertical components are 90 degrees out of phase then the trajectory will be __________.
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circular
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Is acquired pendular nystagmus conjugate, diconjugate, or disjunctive?
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Can be any
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What is the common presentation?
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disconjugate, disjunctive, with equal frequency
OR monocular |
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What is common about the frequency in binocular acquired pendular nystagmus?
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usually the same in both eyes
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Where is the interruption with acquired pendular nystagmus?
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In the circuitry between the neural integrators in the brainstem (MVN, NPH, and INC) and the cerebellum.
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What are the 4 main categories of causes of acquired pendular nystagmus?
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1. Vision Loss
2. Demyelination 3. Oculopalatal Tremor 4. Whipple's Disease (oculomasticatory myorhythmia) |
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What are 3 other categories of causes of acquired pendular nystagmus?
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1. Spasmus nutans
2. Acute brainstem stroke 3. Spinocerebellar degeneration |
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Acquired pendular nystagmus due to vision loss most often occurs with what?
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Optic nerve disease (in one or both eyes)
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Which type of APN can be monocular?
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When it is due to vision loss.
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What might occur if there is APN in both eyes due to optic nerve disease?
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The eye with worse VAs (worse disease) has worse nystagmus.
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What is it called when the APN is worse in the eye with worse ON disease and therefore worse VAs?
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Heinmann-Bielschowsky Phenomenon
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APN due to vision loss (an ON disease) is characterized by what type of waveform?
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vertical, low frequency with subtle horizontal jerks
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Besides ON disease, what can cause APN due to vision loss?
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Leber's "Congenital" Amaurosis
Rod-Cone Dystrophy Severe Amblyopia |
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How would you describe the APN caused by amblyopia due to deprivation as a young child?
This nystagmus is also called what? |
Poor fixations (visuoscopy)
Low amplitude Irregular frequency Slow velocity Slow drifts |
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Besides amblyopic patients who else will have slow drifts?
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Patients with:
-macular holes -solar retinopathy |
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What is the most common cause of APn due to myelination?
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MS
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What else might you expect to see with MS?
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internuclear ophthalmoplegia
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How would you treat a patient with APN and INO due to MS? (drug)
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Memantine
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Besides MS what other demyelinating disease can cause APN?
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Pelizaeus-Merzbacher disease
Cockayne's syndrome Peroxisomal assembly disorders Toluene abuse |
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What is memantine
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low-to-moderate
uncompetitive NMDA receptor agonist |
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What does memantine do for APN due to MS?
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suppresses it
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What are some other drug options besides memantine for APN due to MS?
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gabapentin
clonazepam valproate scopolamine |
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What is the underlying cause of APN due to oculopalatal tremor?
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Brainstem stroke to the red nucleus
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Which drug is the Tx of choice for patients with APN due to oculopalatal tremor?
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Gabapentin
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Why is gabapentin the DOC for APN due to oculpalatal tremor?
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Not sure
Inhibitory neurotransmitter GABA is mimiced by gabapentin. |
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What is gabapentin usually used as?
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Anticonvulsant
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What type of propeties does Gabapentin have?
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GABA-ergic
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What is a significant side effect of gabapentin?
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Increased ataxia
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What 2 things are caused by Whipple's disease?
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APN and oculomasticatory myorhythmia
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How common is Whipple's disease?
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Rare
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What causes Whipple's disease?
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Infection by the bacteria Tropheryma whippelii (intestinal)
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The sole symptom of Whipple's disease is what
Signs (4)? |
The CNS involvement
1. Altered mentation 2. Polydipsia 3. Hyperphagia 4. Myoclonus |
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Describe the APN caused by Whipple's disease?
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Convergence-divergence (occasionally vertical) oscillations
Frequency: 1Hz Pathognomonic for Whipple's Persists during sleep |
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What about amplitude with APN?
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Can differ between eyes or even be monocular
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What can sometimes momentarily suppress oscillations in APN?
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a saccade
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Frequency APN with demyelinating disease?
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2-8 Hz
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What type of component might you have associated with APN due to demyelinating disease?
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an upbeat component
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Which type of nystagmus, APN or congenital PN, has a more regular waveform and what is it?
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APN
sinusoidal |
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For which type of nystagmus, APN or CPN, is dissociation between the eyes more rare?
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congenitcal pendular nystagmus
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Which direction does APN go?
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Horizontal, Vertical, or Torsional
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What direction does congenital PN go?
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Horizontal and uniplanar
(RARELY vertical or torsional) |
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For which type of pendular nystagmus, acquired or congenital, will you see an OKN reversal?
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Congenital
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Will a patient with congenital pendular nystagmus experience oscillopsia?
APN? |
No
Yes |
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What are the 3 types of Developmental Nystagmus discussed in Kundart's lecture?
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1. Infantile
2. Latent 3. Spasmus nutans |
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What is another name for Latent nystagmus?
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Fusional maldevelopment nystamus syndrome
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What are two most common features of infantile nystagmus (usually)?
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Horizontal
Conjugate |
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What 2 things should you look for here to Dx?
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A null point (dampening zone)
Reversal of OKN response |
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What can cause increased frequency of the nystagmus?
What might make it better? |
attempted fixation
dark or on convergence (sometimes also it helps to just ask the patient to try to keep their eyes still rather than asking them to fixate on something) |
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What does uniplanar mean in describing this type of nystagmus?
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It stays horizontal in all positions of gaze
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What are the only 2 other types of nystagmus that are uniplanar?
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1. Peripheral vestibular
2. PAN |
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What does SLOFUN+ stand for?
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S: symptoms (none)
L: Latency (+, beats away from occluder) O: OKN (reversal or double fast) F: Fixation (worse when trying to fix) U: Upgaze (stays horizontal, uniplanar) N: Null Point (R, L, or Conv) +: Gone with lid closure or sleep |
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What is the management plan for congenital nystagmus?
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Correct RE
BO possibly for dampening by conv. Yoked prism with bases toward head turn. Surgery for positioning null point. |
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What is the surgery for positioning the null point called?
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Kestenbaum procedure
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What should you look for as far as RE goes with patients with congenital nystagmus?
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A lot of WTR cylinder
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Can you see latent nystagmus binocularly?
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No
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When does latent nystagmus become manifest?
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With occlusion of either eye
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What happens to the direction of the nystagmus when you occlude each of the eyes?
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It changes from one eye to the other
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How can you take VAs or refract this patient?
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Use blur instead of occlusion
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What else is also present in most cases?
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Infantile esotropia
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What 3 other conditions are commonly associated with latent nystagmus?
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Down syndrome
DVD - dissociated (double) vertical deviation (see video in Wong) Lack of steropsis (binocular vision) |
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What way does a latent nystagmus beat?
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Away from the covered eye
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What other directions besides horizontal might be present with latent nystagmus?
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A torsional component
A vertical upbeating component |
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What might be off about smooth pursuits with latent nystagmus?
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Asymmetric
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With associated DVD in latent nystagmus (dissociated vertical deviation) what happens when an eye is covered?
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Eye under cover goes up
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At what age does spasmus nutans usually present?
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age 1
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How long does spasmus nutans usually last? How long CAN it last?
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1-2 years
more than 8 years |
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What type of waveform do you see with spasmus nutans?
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pendular with intermittent, small, fast horizontal movements
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In spasmus nutans the intermittent small horizontal fast movements are worse in which eye?
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The abducting eye
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Does spasmus nutans get worse or better with convergence?
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worse
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What is the Spasmus nutans triad?
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1. Nystagmus
2. Head nodding 3. Abnormal head position |
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Is spasmus nutans usually conjugate or disconjugate or disjunctive?
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disconjugate and disjunctive
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How would you describe the head movements AW spasmus nutans?
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irregular with horizontal and vertical components
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What else might you find in regards to the eyes?
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strabismus
amblyopia |
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What could you do to rule out structural lesions in the visual pathway with spasmus nutans?
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A normal ophthalmoscopic exam
normal MRI or CT |
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How does spasmus nutans resolve?
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Spontaneous remission
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What are 3 miscellaneous Tx discussed in class for nystagmus?
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1. Botox
2. Static Optics (prism) 3. Dynamic optics (CL) |
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What does Botox do?
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Paralyzes muscle for a period of a few months
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What kind of prism would you use for a patient that has nystagmus that dampens with convergence?
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BO
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To correct a head tilt where should you place the bases of yoked prisms?
Will this also straighten the eyes? |
Toward the head tilt
No |
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What is the problem with spectacle correction for patients with nystagmus?
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The optical centers of the lenses don't move with the eyes.
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Why might CL be better than specs for correcting patients with nystagmus?
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The optical centers do move with the eye.
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