The eyes are the body’s most important sensory organ. Made up of millions of moving parts, they provide us with our sense of sight. For most of us, we rely upon them on a daily basis. Like most of our organs, however, they can succumb to various diseases. With nystagmus, the eyes involuntarily move in a repetitive pattern. While most cases are congenital, it can also be acquired later in life, sometimes as a result of other disorders.
Over the past 60 years, ASCRS Hall of Fame inductee Robert M. Sinskey, MD, faced challenges in garnering widespread acceptance of his nystagmus treatment procedure. Today, following the successful treatment of horizontal nystagmus in a 7-year-old patient (by pediatric ophthalmologist Robert W. Lingua, MD), the University of California Irvine Gavin Herbert Eye Institute receives hundreds of requests for the procedure. Nystagmus is a condition punctuated by rapid, uncontrollable eye movements that can cause functional blindness in children and adults. It was in 1960 that Dr. Sinskey first explored nystagmus treatments with monkeys. Previous treatments for the condition involved drugs or the rearrangement of eye muscles, which kept shaking muscles intact. The former ASCRS presidents horizontal nystagmus treatment procedure involves the removal of the medial and lateral rectus muscles, as far back as possible, using an enucleation snare. Dr. Sinskey first successfully performed the procedure on 2 children in 1962. His work with nystagmus treatments was put on hold when his primary focus shifted to cataract surgery. In addition to creating the modified J-loop IOL, Dr. Sinskey invented several surgical instruments. He also popularized the use of phacoemulsification, low-power IOLs, and IOLs in pediatric cataract patients. It was not until a chance introduction with a patient suffering from nystagmus that Dr. Sinskeys focus returned to the procedure. At the time, the patient compensated for his shaky vision by nodding his head, the aesthetics of which made it difficult to secure a job. Fortunately, Dr. Sinskeys procedure was a success, and the patients clear vision helped him to develop a career in psychiatry. After another achievement in treating nystagmus, Dr. Sinskey reached out to the wider ophthalmic community. As with the introduction of phaco, Dr. Sinskeys colleagues did not quickly seek to adopt his out-of-the box nystagmus treatment procedure. Many were fearful of the complete removal of the medial and lateral rectus muscles. Even those who attempted the surgery remained fearful, cutting only parts of the muscles and marking the procedure as a failure when patients visions did not stabilize. In 2000, while conducting work with the ASCRS Foundation in Ethiopia, Dr. Sinskey sought another opportunity to treat nystagmus patients. His successful treatment of 4 patientsages 6, 9, 15 and 41was published in Binocular Vision & Strabismus Quarterly in 2002. The ASCRS Foundation named the Ethiopian eyecare clinic in Dr. Sinskeys honor in 2005 for his work in Addis Ababa. Following discussions in 2013 with Roger F. Steinert, MD, Gavin Herbert Eye Institute director, Dr. Sinskey partnered with the eye institute to treat pediatric nystagmus patients with this new procedure. Drs. Sinskey and Lingua hope to educate other doctors on how to properly perform the procedure. The National Institutes of Health reports that approximately 1 in 5,000 children are born with or develop nystagmus. According to the Gavin Herbert Eye Institute, to ensure that more young patients are helped by the surgery, Sinskey made 2 generous contributions to the Gavin Herbert Eye Institute. The first was a videonystagmography instrument, which measures results of the surgery. The second was a donation to establish a state-of-the-art environment for pediatric nystagmus care and other services. In recognition, the eye institutes pediatric area will be named the Loraine and Robert Sinskey Pediatric Vision Center.
Netherlands Institute for Neuroscience researchers have overturned the long held view that congenital nystagmus, a condition where eyes make repetitive involuntary movements, is a brain disorder by showing that its cause is actually retinal. Deficits in just a few proteins involved in one of the retina's earliest light-signal processing steps result in the eye sending an erroneous movement signal to the brain rhythmically. Each time the brain receives a movement "pulse" it initiates an eye movement to compensate for the motion signaled. In this way, mutations in just a handful of proteins at the very first steps of vision lead to the oscillating side to side eye movements that characterize many forms of congenital nystagmus. The study appears in PLOS Biology on 12 September