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Voluntary flutter presenting during ophthalmoscopy: A case report

Thomas, Nikita, Dunn, Matt J. ORCID: and Woodhouse, J. Margaret ORCID: 2022. Voluntary flutter presenting during ophthalmoscopy: A case report. Case Reports in Ophthalmology 13 (1) , pp. 286-291. 10.1159/000524384

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Voluntary flutter (sometimes known as “voluntary nystagmus”) is a conjugate saccadic oscillation of the eyes that occurs in some healthy individuals. It has no relation to pathological nystagmus, which can manifest in infancy or become acquired later in life. This report presents an unusual case of voluntary flutter that presented in a 20-year-old male with autism spectrum disorder during ocular examination via direct ophthalmoscopy. Refraction and ocular motor balance were normal, and visual acuity was good in each eye (−0.10 logMAR). During direct ophthalmoscopy, a fine intermittent tremor was initiated. The patient was referred for further assessment, and eye movements were recorded at 1,000 Hz with an EyeLink 1000 eye tracker. Upon request, the patient could manifest voluntary flutter again and sustain the eye movements with effort during convergence. The voluntary flutter consisted of back-to-back saccadic oscillations in a predominantly horizontal direction, with an average frequency of 13 Hz and an amplitude of ∼8°, both reducing over time. We speculate that the discomfort induced by the proximity of the clinician during direct ophthalmoscopy examination may have triggered the eye oscillations. Although the oscillations typically manifest during convergence, atypical forms of voluntary flutter can also occur during divergence. Voluntary flutter can be a useful differential diagnosis in patients with a recently onset apparent “nystagmus,” and no other neurological signs and symptoms.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Optometry and Vision Sciences
Additional Information: This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission.
Publisher: Karger Publishers
ISSN: 1663-2699
Date of First Compliant Deposit: 26 July 2022
Date of Acceptance: 24 March 2022
Last Modified: 12 Aug 2023 15:50

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