Thank you so much for explaining this test so well. I am a pre-reg optometrist from the UK and this video helped me pick up a suspected progressive RE IV nerve palsy. I have referred her to neuro-ophthalmology for further investigation.
This px had no hx of trauma but she did have cataract surgery 2 years ago and her diplopia at near has been getting worse over past 9 months. Can cataract surgery cause a delayed IV nerve palsy / superior oblique weakness ?
I’m very thankful, with your lessons. This is the first one that confirms me, that even for some one as intelligent and eloquent as you, is hard to explain. The 2nd step was a little confusing when you made the example to the left gaze with an LHT and we started with the RHT. And then the 3rd step is not that clear, like what is it that we are looking for or trying to show. I know it is my way of understanding but with all the respect it’s how I saw this lesson and thank you 🙏. Also I would love to help in sending you, translations and helpful subtitles in Spanish and English. Because it has been hard for me since my first language is Spanish. And translations make it hard some times. Please don’t take my comment the wrong way, you’ve been a light in my residency 👏. Thank you.
Can check my understanding? If patient Has right hypertropia, pt either has weak RIR RSO or weak LIO LSR. when look towards left, right hypertropia got worse. This is because LIO RIR which are the normal unaffected muscle will get weaker and unable to compensate for LSR RSO lesion, thus worsening right hypertropia. Therefore we conclude the lesion is RSO and LSR
Correct me if i’m wrong, during left gaze , primary active muscles should be LSR & LIR since they are out by 23 degrees which is the best action, and the right eye should have RSO & RIO as primary muscles since they are are 55 degrees, but here you said RSR and LIO ?
I don't understand, if there is a RSO affected, shouldn't the patient be more comfortable in right gaze and right tilt? However this patient has more visual disturbances in the right tilt.
Thank you - excellent presentation. at 5:11 you state, "when choosing from a right intorter, [signaling to the RSO] and a left extorter [signaling to the LSR]..." Don't you mean left intorter? I believe the MOA of SR is as an intorter, correct?
As a Physical Therapist I'm having good results with gaze exercises with patients following a laser dot on a wall. They can do it in sitting, standing or supine. Different patterns of eye movement can be educated. It really works and cats love it, too. Laser dots are inexpensive.
Ask the patient to depress the eye, as it is attempted the eyes goes into intorsion depicted by movement of 12 clock conjunctival vessels medially I.e inwards
just to clarify, do you mean look for extorsion ? as the person above seems to think otherwise , but SO's action is intorsion so we should expect extorsion in this case?
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This is the best explanation of the 3step test on youtube.
Thank you so much for explaining this test so well. I am a pre-reg optometrist from the UK and this video helped me pick up a suspected progressive RE IV nerve palsy. I have referred her to neuro-ophthalmology for further investigation.
This px had no hx of trauma but she did have cataract surgery 2 years ago and her diplopia at near has been getting worse over past 9 months. Can cataract surgery cause a delayed IV nerve palsy / superior oblique weakness ?
What needs hours to make sense in a book/elsewhere just takes under 10 minutes by watching Dr. Lee’s video. Thank you!
Best ever. Dr. Lee is my hero
Dear Dr Lee, thanks for such a nice lecture.
I would request to add a little description in your every video.
I’m very thankful, with your lessons. This is the first one that confirms me, that even for some one as intelligent and eloquent as you, is hard to explain.
The 2nd step was a little confusing when you made the example to the left gaze with an LHT and we started with the RHT.
And then the 3rd step is not that clear, like what is it that we are looking for or trying to show.
I know it is my way of understanding but with all the respect it’s how I saw this lesson and thank you 🙏.
Also I would love to help in sending you, translations and helpful subtitles in Spanish and English. Because it has been hard for me since my first language is Spanish. And translations make it hard some times.
Please don’t take my comment the wrong way, you’ve been a light in my residency 👏. Thank you.
You are the best! Thank you from a pediatric neuro fellow!
Can check my understanding? If patient Has right hypertropia, pt either has weak RIR RSO or weak LIO LSR. when look towards left, right hypertropia got worse. This is because LIO RIR which are the normal unaffected muscle will get weaker and unable to compensate for LSR RSO lesion, thus worsening right hypertropia. Therefore we conclude the lesion is RSO and LSR
This is the best. Dr Lee you’re god sent!
Am studying for my part 2 in the UK, can't thank you enough for your videos.
Chelle samesies!
Correct me if i’m wrong, during left gaze , primary active muscles should be LSR & LIR since they are out by 23 degrees which is the best action, and the right eye should have RSO & RIO as primary muscles since they are are 55 degrees, but here you said RSR and LIO ?
I don't understand, if there is a RSO affected, shouldn't the patient be more comfortable in right gaze and right tilt? However this patient has more visual disturbances in the right tilt.
Fantastic explanation!👌 Thank you!
Such a great explanation!
Finally makes sense, great explanation,
Awesome sir, thanks.. & looking forward to you for simplifying more intricate parts of neurology..
For those who wonder - this video is not about 3-step-test established in Berne Convention
Thanks doctor 🤝
Excellent.... Sir.. Thank you 🙏
Excellent thank you .
Thank you...good explanation... easy way of presentation
Again thank you
Thanks Doctor for this explanation :D
Excellent explanation!! 👍👍👍👍
Excellent 💜
Very well explained!
Thank you - excellent presentation. at 5:11 you state, "when choosing from a right intorter, [signaling to the RSO] and a left extorter [signaling to the LSR]..." Don't you mean left intorter? I believe the MOA of SR is as an intorter, correct?
His hand is over the LIO when he says 'extorter' IMHO, which is active, so RSO is all that is left.
Yeah i think sir had to say intorter !!
As a Physical Therapist I'm having good results with gaze exercises with patients following a laser dot on a wall. They can do it in sitting, standing or supine. Different patterns of eye movement can be educated. It really works and cats love it, too. Laser dots are inexpensive.
Thanks so much from an optometry student!\
Thanks dr .lee
great explanation!
Dr Andy Lee..Could you also please clarify how to test for the 4th nerve function in the presence of 3rd nerve palsy?
Thanks
You should look for torsion in downgaze. watch the conjunctival vessels for torsion while patient looks down.
Ask the patient to depress the eye, as it is attempted the eyes goes into intorsion depicted by movement of 12 clock conjunctival vessels medially I.e inwards
just to clarify, do you mean look for extorsion ? as the person above seems to think otherwise , but SO's action is intorsion so we should expect extorsion in this case?
focused and illustrative
Aren’t the obliques abducters and recti’s adducters
Please make one video on hess chart
Dr Lee, i want to ask, whether 3 step test and bielschowsky head tilt test is the same? and will come out with the same single muscle?
Amazing again!
Isnt it SR and MR 3rd movement is aDduction? SO and IO: ABduction?
thank you !
Dr Pee you are very cute💕💕😍😍💋💋💋💋💋💋
Wow
abduction and adduction both sound same.
Thank you so much
i dont even understad :(
🆗👍🏻
Adeeduction Abeeduction
say simply Abduction aduction.
you are confusing us