ArticleJournal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus2014
Sensitivity of the three-step test in diagnosis of superior oblique palsy.
Article in Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 52 citations in OpenAlex.
- Surgical interventions for vertical strabismus in superior oblique palsy.The Cochrane database of systematic reviews · 2017Pooled it
- Functional Anatomy of Ocular Counter-Rolling in Superior Oblique Palsy.Investigative ophthalmology & visual science · 2025Article
- Comparison of head tilt test between sagging eye syndrome and acquired unilateral trochlear nerve palsy.Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2024Article
- Masquerading Superior Oblique Palsy.American journal of ophthalmology · 2022Article
- Isolated inferior oblique pareses.International ophthalmology · 2022Article
- Can Binocular Alignment Distinguish Hypertropia in Sagging Eye Syndrome From Superior Oblique Palsy?Investigative ophthalmology & visual science · 2022Article
- Article
- Sagging eye syndrome.Japanese journal of ophthalmology · 2021Review
- Isolated trochlear palsy as the only presentation of midbrain infarction: a case report.The Journal of international medical research · 2021Article
- Two cases of acquired bilateral trochlea nerve palsy treated by simultaneous inferior rectus muscle nasal transposition and inferior oblique muscle myectomy.American journal of ophthalmology case reports · 2021Article
- Functional Anatomy of Muscle Mechanisms: Compensating Vertical Heterophoria.American journal of ophthalmology · 2021Article
- Bilateral Fundus Excyclotorsion in Unilateral Superior Oblique Palsy Confirmed by MR Imaging.Journal of clinical medicine · 2020Article
- Prevalence of Sagging Eye Syndrome in Adults with Binocular Diplopia.American journal of ophthalmology · 2020Article
- Causes, background, and characteristics of binocular diplopia in the elderly.Japanese journal of ophthalmology · 2018Article
- Differentiating Acute and Subacute Vertical Strabismus Using Different Head Positions During the Upright-Supine Test.JAMA ophthalmology · 2018Observational
- Diagnostic Utility of the Three-Step Test According to the Presence of the Trochlear Nerve in Superior Oblique Palsy.Journal of clinical neurology (Seoul, Korea) · 2018Article
- Paradoxical head tilt in unilateral traumatic superior oblique palsy.Journal of current ophthalmology · 2017Article
- Rectus Pulley Displacements without Abnormal Oblique Contractility Explain Strabismus in Superior Oblique Palsy.Ophthalmology · 2016Article
- Size of the Oblique Extraocular Muscles and Superior Oblique Muscle Contractility in Brown Syndrome.Investigative ophthalmology & visual science · 2015Observational
- Superior oblique extraocular muscle shape in superior oblique palsy.American journal of ophthalmology · 2015Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 2 institutions in 1 country.
Funding
Abstract
purposeAlthough the Parks-Bielschowsky three-step test is the cornerstone of cyclovertical strabismus diagnosis, it has not been validated against an external benchmark. We evaluated the test's sensitivity in clinical diagnosis of superior oblique palsy in patients with unequivocal magnetic resonance imaging (MRI) evidence of superior oblique atrophy.
methodsA total of 73 strabismic patients were selected from a prospective MRI study because they exhibited superior oblique atrophy indicative of superior oblique denervation and thus confirmatory of superior oblique palsy. Of these, 50 patients who had no confounding factors were included for detailed study. Ocular motility data were evaluated to determine sensitivity of single and combined clinical findings in diagnosis of superior oblique palsy.
resultsMaximum mean ipsilesional superior oblique cross section was reduced to 9.6 ± 0.6 mm(2) (mean ± standard error) in superior oblique palsy, representing 52% of the 18.5 ± 0.6 mm(2) contralesional superior oblique maximum cross section and 52% of the 18.4 ± 0.4 mm(2) control maximum superior oblique cross section (P < 0.001). Of the 50 patients, 35 (70%) with superior oblique atrophy fulfilled the entire three-step test. In 14 (28%) patients two steps were fulfilled; in 1 patient (2%), only one step. Affected superior oblique cross section was similar in orbits that fulfilled the three-step test (9.8 ± 0.9 mm(2)) and those that did not (9.1 ± 0.7 mm(2); P = 0.58).
conclusionsThe complete three-step test fails to detect 30% of cases of superior oblique atrophy. Often only two of three steps are positive in superior oblique palsy.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.