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Voluntary Flutter Presenting During Ophthalmoscopy: A Case Report
Nikita Thomas1, Matt J Dunn1, J Margaret Woodhouse1
1School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom.
Case Reports in Ophthalmology
|June 15, 2022
Summary
Voluntary flutter, an eye oscillation in healthy individuals, was observed in a young male with autism spectrum disorder. This case highlights its potential as a differential diagnosis for new-onset nystagmus.
Area of Science:
- Ophthalmology
- Neuroscience
- Autism Spectrum Disorder Research
Background:
- Voluntary flutter is a rare, conjugate saccadic eye oscillation seen in healthy individuals.
- It is distinct from pathological nystagmus, which has various causes and onset times.
- This condition is often associated with convergence but can manifest atypically.
Observation:
- An unusual case of voluntary flutter presented in a 20-year-old male with autism spectrum disorder during an eye exam.
- The patient exhibited normal visual acuity, refraction, and ocular motor balance.
- Fine, intermittent eye tremors were observed, particularly during convergence, upon request.
Findings:
- Eye movements were recorded using an EyeLink 1000 eye tracker at 1,000 Hz.
- The voluntary flutter consisted of horizontal saccadic oscillations with an average frequency of 13 Hz and amplitude of ~8°.
- The oscillations reduced in frequency and amplitude over time and could be sustained with effort.
Implications:
- The study suggests that discomfort during close examination might trigger voluntary flutter.
- Voluntary flutter can be a crucial differential diagnosis for apparent new-onset nystagmus without other neurological signs.
- Understanding this phenomenon aids in accurate diagnosis and patient management, especially in neurodevelopmental contexts.
