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Syntosi A, Felizzi F, Bouchet C. A Social Media Listening Study to Understand the Unmet Needs and Quality of Life in Adult and Pediatric Amblyopia Patients. Ophthalmol Ther 2022; 11:2183-2196. [PMID: 36175822 PMCID: PMC9587203 DOI: 10.1007/s40123-022-00571-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Amblyopia is an important cause of monocular vision impairment worldwide, and it negatively impacts patients' quality of life (QoL). Understanding patients' perspectives may help to optimize treatment outcomes and improve treatment adherence. METHODS This was a non-interventional, retrospective analysis of social media data available in the public domain posted by patients and caregivers on selected social media channels (Twitter®, forums, blogs, and news) from 12 countries between July 2018 and June 2020. RESULTS Approximately 2662 conversations relevant to the research objective were analyzed. The patient journey for adults and children was constructed based on the conversations. Eyeglasses, eye patches, contact lenses, and vision exercises were the common treatment options for amblyopia. Patients also reported vision improvement with emerging technologies such as digital therapeutics. Amblyopia and its treatment had a negative impact on QoL, and increased caregiver burden. Insurance coverage, long appointment waiting times, and recurring expenses of treatment options were reported as barriers to treatment. Non-compliance, switching between treatment options or technology, or discontinuation of treatment options was found to emanate from various issues including no improvement of the condition, discomfort with the treatment option, bullying, dissatisfaction with healthcare professional (HCP) recommendation, cost of treatment/issues with insurance coverage, side effects, and/or other unspecified reasons. The need for regular eye examinations, better diagnostic tests, awareness of the disease, awareness amongst HCPs about treatment options, and the need for better health insurance coverage policies emerged as unmet needs. CONCLUSION This social media listening study generated insights on patients with amblyopia and their caregivers regarding the patient journey, treatment options, reasons for non-compliance, reasons for switching HCPs, barriers to treatment, and unmet needs. Further qualitative research is required to validate the findings.
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Affiliation(s)
- Annie Syntosi
- Department of Ophthalmology, Novartis Pharma AG, Fabrikstrasse 2, 4056, Basel, Switzerland.
| | - Federico Felizzi
- Department of Ophthalmology, Novartis Pharma AG, Fabrikstrasse 2, 4056, Basel, Switzerland
| | - Christine Bouchet
- Department of Ophthalmology, Novartis Pharma AG, Fabrikstrasse 2, 4056, Basel, Switzerland
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Elam AR, Tseng VL, Rodriguez TM, Mike EV, Warren AK, Coleman AL. Disparities in Vision Health and Eye Care. Ophthalmology 2022; 129:e89-e113. [PMID: 36058735 PMCID: PMC10109525 DOI: 10.1016/j.ophtha.2022.07.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 10/14/2022] Open
Abstract
Significant disparities in vision health and eye care exist. To achieve health equity, we must understand the root causes and drivers of health disparities and inequities, including social determinants of health and systemic racism.
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Affiliation(s)
- Angela R Elam
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
| | - Victoria L Tseng
- UCLA Stein and Doheny Eye Institutes, David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Elise V Mike
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexis K Warren
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Anne L Coleman
- UCLA Stein and Doheny Eye Institutes, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
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Pineles SL, Repka MX, Velez FG, Yu F, Perez C, Sim D, Coleman AL. Prevalence of pediatric eye disease in the optumlabs data warehouse. Ophthalmic Epidemiol 2022; 29:537-544. [PMID: 34459319 PMCID: PMC8882702 DOI: 10.1080/09286586.2021.1971261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 08/06/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To define the prevalence of medical eye disease diagnoses among children enrolled in commercial insurance plans in the United States and to evaluate differences among groups based on the US census region, race/ethnicity, and familial net worth. METHODS : Retrospective study of de-identified claims data from the OptumLab® Data Warehouse (OLDW) between 2007 and 2018. All children (<19 years) in the OLDW with coverage were studied and those with a claim for a significant eye disease (strabismus, amblyopia, nystagmus or structural eye disorders) with minimum 6-months follow-up were studied. Baseline characteristics were extracted for the calculation of eye disease prevalence, including age, sex, race/ethnicity, region of residence, and family net worth. The prevalence of each type of eye disease was calculated among all children and by baseline characteristics. RESULTS : 10,759,066 children met the study criteria. The presence of any significant eye diagnosis was 6.7%. Disease was diagnosed more often in whites (6.9%) than blacks (5.6%) and Hispanics (5.9%). The most common eye disease diagnosed was strabismus (3.2%) followed by amblyopia (1.5%). In the North-East region, there was a 10.6% prevalence of any significant eye disease diagnosis, whereas in the Mid-West, it was 7.4% followed by the South and West (5.9% and 5.3%, respectively) (p < .001). There was an increase in eye disease diagnoses with increasing income (5.5% in<$25,000 and 9.4% in >$500,000 household net worth groups, p > .001). CONCLUSION : Diagnosis of significant eye diseases is relatively common in American children. The most common medical eye disease diagnosis is strabismus. Prevalence of eye disease diagnosis from claims data varies between geographical regions and different income groups. This may reflect differences in healthcare utilization rather than true disease prevalence.
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Affiliation(s)
- Stacy L Pineles
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, United States
- OptumLabs Visiting Fellow, Eden Prairie, MN, United States
| | - Michael X Repka
- Department of Ophthalmology, Wilmer Eye Institute, the Johns Hopkins University School of Medicine, United States
| | - Federico G Velez
- Department of Ophthalmology, Doheny Eye Institute, University of California, Los Angeles, United States
- Department of Ophthalmology, Duke University School of Medicine, United States
| | - Fei Yu
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, United States
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health
| | - Claudia Perez
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Danielle Sim
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Anne L Coleman
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, United States
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, United States
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Zhu B, Liao M, Liu L. Measuring the impact of suppression on visual acuity in children with amblyopia using a dichoptic visual acuity chart. Front Neurosci 2022; 16:860620. [PMID: 35911993 PMCID: PMC9334724 DOI: 10.3389/fnins.2022.860620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo develop a novel dichoptic visual acuity chart that measures the impact of interocular suppression on the visual acuity of each eye when two eyes are open.MethodsFifty-four subjects (19 anisometropic amblyopia, 20 treated amblyopia, and 15 normal children) participated in this study. The visual acuity that was tested under dichoptic-optotypes condition (i.e., presented optotypes to the untested eye) was compared with that under monocular condition (i.e., cover the untested eye with opaque patch). Visual acuity differences between these two conditions were compared among the three groups. The correlations between visual acuity differences and the depth of interocular suppression were then computed. Some participants performed the visual acuity test under dichoptic-luminance condition (i.e., presented mean luminance to the untested eye), and the test-retest reliability was established.ResultsA reduced visual acuity of the non-dominant eye was found in the dichoptic-optotypes condition for the amblyopia group (P < 0.001) and the treated group (P = 0.001); the difference in the treated group was less than that in the amblyopia group (P < 0.001) but more than that in the normal group (P = 0.026). A significant correlation was found between the visual acuity differences and the depth of suppression, which was tested with a binocular phase combination task (P = 0.005). No change was found in the dichoptic-luminance condition.ConclusionThe amblyopic eye and the previous amblyopic eye seem to suffer from a reduced visual acuity when two eyes are open due to suppression. This was successfully captured by our novel and reliable dichoptic-optotypes visual acuity chart.
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Affiliation(s)
- Bixia Zhu
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
| | - Meng Liao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Longqian Liu
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Longqian Liu,
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Oliveira I, Ferreira A, Vieira R, Malheiro L, Caiado F, Maia S, Miranda V, Parreira R, Menéres P. The Impact of Early Photoscreening on Medium-term Visual Acuity: A Population-Based Study. J Pediatr Ophthalmol Strabismus 2022; 60:178-183. [PMID: 35611825 DOI: 10.3928/01913913-20220428-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the outcomes of an early ophthalmological intervention in children included in the pilot project of the "Rastreio de Saúde Visual Infantil" (RSVI) visual screening program in Portugal. METHODS This was a retrospective analysis of the medical records of all children included in the RSVI from April 1, 2016 to December 31, 2016, and who were referred to an ophthalmology appointment. Data of refractive errors, anisometropia, amblyopia, instituted treatments, and visual acuity at the end of the ophthalmological intervention were collected. RESULTS Two hundred sixty-seven (18.2%) 2-year-old children from the Centro Hospitalar Universitário do Porto reference area had a positive screening result and were subsequently referred to an ophthalmology appointment. Glasses were prescribed to 31.1% of the patients who attended. Presumed amblyopia was diagnosed in 2.5% and occlusion was prescribed. At the end of a median follow-up of 3 years, of those who wore glasses without occlusion, 94.3% had a visual acuity of 20/25 or better in both eyes with an asymmetry of two lines or less between eyes. Of the 4 children who wore glasses with occlusion, 3 of them had a visual acuity of 20/25 or better in both eyes with an asymmetry of two lines or less between eyes. CONCLUSIONS This study demonstrates the effectiveness of an early intervention in the prevention and treatment of amblyopia, because after a median follow-up of 3 years after treatment none of the referred children met criteria for amblyopia and 94.3% of the referred children who had an intervention had a normal visual acuity. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].
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Hu B, Liu Z, Zhao J, Zeng L, Hao G, Shui D, Mao K. The Global Prevalence of Amblyopia in Children: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:819998. [PMID: 35601430 PMCID: PMC9114436 DOI: 10.3389/fped.2022.819998] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/15/2022] [Indexed: 01/15/2023] Open
Abstract
Epidemiological data about the prevalence of amblyopia around the world vary widely among regions and periods. This meta-analysis aimed to determine the global prevalence of amblyopia in children. PubMed, Embase, and the Cochrane Library were searched for prevalence studies published up to 5 November 2021. The outcome was the prevalence of amblyopia, analyzed as pooled estimates with 95% confidence intervals (CI). A total of 97 studies were included, including 4,645,274 children and 7,706 patients with amblyopia. The overall worldwide pooled prevalence of amblyopia was 1.36% (95%CI: 1.27-1.46%). The prevalence of amblyopia was higher in males (1.40%, 95%CI: 1.10-1.70%) than in females (1.24%, 95%CI: 0.94-1.54%) (OR = 0.885, 95%CI: 0.795-0.985, P = 0.025). The results of the meta-regression analysis showed that there were no significant associations between the prevalence of amblyopia and geographical area, publication year, age, sample size, and whether it was carried out in a developed or developing country (all P > 0.05). Begg's test (P = 0.065) and Egger's test (P < 0.001) showed that there was a significant publication bias in the prevalence of amblyopia. In conclusion, amblyopia is a significant vision problem worldwide, and public health strategies of early screening, treatment, and management are important.
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Handa T, Thakkar H, Ramakrishnan M, Shah K, Prajapati V, Sayed S, Joshi A, Ishigaki Y. Comparison of the effectiveness of amblyopia treatment with eye-patch and binocular Occlu-tab for the same treatment duration. Indian J Ophthalmol 2022; 70:1722-1726. [PMID: 35502060 PMCID: PMC9332975 DOI: 10.4103/ijo.ijo_1733_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/10/2021] [Accepted: 12/17/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose This study aimed to compare the conventional eye patch with Occlu-tab-a binocular open-type amblyopia training device-and evaluate their effectiveness in amblyopia treatment. Methods In this prospective, multi-center study, 40 patients between ages 3 to 12 years, diagnosed with anisometropic amblyopia (refraction difference of both eyes ≥ 2 D, best-corrected visual acuity [BCVA] of the amblyopic eye ≤ 0.1 [logMAR]) were treated with Occlu-tab or conventional eye patch for 1 h per day thrice a week. We compared the visual acuity of both groups before and after 6, 7, and 8 weeks of amblyopia treatment. One-way repeated-measures analysis of variance and Tukey's test were used to compare the visual acuity of both groups pre- and post-treatment. Results Both groups had significantly improved visual acuity at 6, 7, and 8 weeks compared to that before treatment (all P < 0.001). The improvement in BCVA of the Occlu-tab group (0.33 ± 0.25) was significantly greater than that of the eye patch group (0.16 ± 0.17) after 8 weeks of treatment (P = 0.02). Conclusion Amblyopia treatment using binocular open game training with Occlu-tab led to greater improvement in visual acuity than that with a conventional eye patch for the same treatment duration.
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Affiliation(s)
- Tomoya Handa
- Department of Rehabilitation, Orthoptics and Visual Science Course, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Hansa Thakkar
- M & J Regional Institute of Ophthalmology, Civil Hospital, Ahmedabad, India
| | - Minu Ramakrishnan
- Department of Ophthalmology, K. J. Somaiya Medical College Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Kalpit Shah
- M & J Regional Institute of Ophthalmology, Civil Hospital, Ahmedabad, India
| | - Vaishali Prajapati
- Department of Ophthalmology, GMERS Medical College and Hospital, Ahmedabad, Gujarat, India
| | - Sania Sayed
- Department of Ophthalmology, K. J. Somaiya Medical College Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Aishwarya Joshi
- Department of Ophthalmology, K. J. Somaiya Medical College Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Yo Ishigaki
- Graduate School of Informatics and Engineering, University of Electro-Communications, Tokyo, Japan
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Stoll N, Di Foggia E, Speeg-Schatz C, Meunier H, Rimele A, Ancé P, Moreau PH, Sauer A. Development and validation of a new method for visual acuity assesment on tablet in pediatric population: eMOVA test. BMC Ophthalmol 2022; 22:180. [PMID: 35439959 PMCID: PMC9020062 DOI: 10.1186/s12886-022-02360-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Amblyopia is a major public health concern. Its screening and management require reliable methods of visual acuity assessment. New technologies offer nowadays many tests available on different app stores for smartphone or tablet but most of them often lack of scientific validation for a medical use. The aim of our study was to attempt validating a tablet-based near visual acuity test adapted to the pediatric population: the eMOVA test (electronic Measurement Of Visual Acuity) by comparing visual acuity measured with more conventional test. METHODS A cohort of 100 children aged 3 to 8 attending the ophthalmic-pediatric for eye examination between September 2016 and June 2017 were included in the study. Near visual acuity was assessed on participants using both the eMOVA test and a Standard test (Rossano-Weiss test). Duration of each test, its comprehension, its acceptability and the attention of the child during the test was also investigated. RESULTS The eMOVA test overestimated near visual acuity by 0.06 logMAR. This difference, statistically significant, was not clinically relevant. The duration of the eMOVA test was longer than the reference test, but less discomfort and preferred by children and their parents compared to standard tests. CONCLUSION The eMOVA test appears as a reliable test to assess near visual acuity in children. By its portability and efficiency, this application proved to be a relevant tool to be used for children eye examination in daily routine at the hospital.
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Affiliation(s)
- Noémie Stoll
- Three borders ophthalmologic center, 76 rue de Battenheim, 68170, Rixheim, France.
| | - Elsa Di Foggia
- Colmar Civil Hospitals, 39 avenue de la Liberté, 68000, Colmar, France
| | - Claude Speeg-Schatz
- University professor, University hospitals of Strasbourg, 1 quai Louis Pasteur, 67000, Strasbourg, France
| | - Hélène Meunier
- Cognitive and Adaptative Neuroscience Laboratory, Strasbourg University, 67000, Strasbourg, Alsace, France
| | - Adam Rimele
- SILABE Platform, Strasbourg University, Fort Foch, 67207, Niederhausbergen, France
| | - Pascal Ancé
- SILABE Platform, Strasbourg University, Fort Foch, 67207, Niederhausbergen, France
| | - Pierre-Henri Moreau
- SILABE Platform, Strasbourg University, Fort Foch, 67207, Niederhausbergen, France
| | - Arnaud Sauer
- University professor, University hospitals of Strasbourg, 1 quai Louis Pasteur, 67000, Strasbourg, France
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Abstract
Occlusion therapy has a long history as the gold standard treatment for amblyopia. Over the past two decades, large multicenter randomized controlled trials and objective dose-monitoring studies have characterized the effects of refractive correction, patching, and atropine penalization, providing insights into the impact of factors such as age and treatment dose. More recent approaches, whose development has been accelerated by advances in technology, are designed to provide different stimulation to the amblyopic eye and the fellow eye. This review explores a variety of such dichoptic approaches, categorized according to whether they primarily feature requisite use of the amblyopic eye in the face of fellow-eye masking, integration of visual information from both eyes, or reduction of stimulus salience in the fellow eye. It is still unclear whether dichoptic treatments are superior to traditional, low-cost treatment methods or whether their therapeutic mechanisms are fundamentally different from those of established treatments. Expected final online publication date for the Annual Review of Vision Science, Volume 8 is September 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Kimberly Meier
- Department of Psychology, University of Washington, Seattle, Washington, USA;
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Raza SA, Amitava AK, Gupta Y, Afzal K, Kauser F, Saxena J, Masood A, Bose A, Singh R. Canon CP-TX1 camera - As a screening tool for amblyogenic risk factors. Indian J Ophthalmol 2022; 70:1313-1316. [PMID: 35326044 PMCID: PMC9240504 DOI: 10.4103/ijo.ijo_2161_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To evaluate the Canon CP-TX1 camera as a screening tool for ARFs in a pediatric population and estimate the prevalence of ARFs. Methods: In a pediatric outpatient space, largely in the immunization clinic, after obtaining parental consent, we encouraged children to be photographed from a distance of 5 feet in a dim room by using a CP-TX1 camera with the red-eye reduction feature off. Based on the captured red reflex, children were labeled as normal (symmetrical red reflexes in the two eyes, with no visible crescents); all others were considered as abnormal or positive for ARFs. All photographed children were assessed by an optometrist/refractionist for VA by age-appropriate methods. Data were entered into a 2 × 2 contingency table on statpages.org, and diagnostic indices were calculated with 95%CI. Results: With a sample of 262 children, we obtained a sensitivity of 0.82, a specificity of 0.98, a positive predictive value of 0.92, a negative predictive value of 0.94, a positive likelihood ratio of 41.06, a negative likelihood ratio of 0.17, and a prevalence of 0.24 for ARFs Conclusion: CP-TX1 performed well as a screening tool to identify ARFs in children. Placing such a camera in an immunization clinic offers a chance to identify children with ARFs at a time when amblyopia is eminently reversible.
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Affiliation(s)
- Syed Aisha Raza
- Senior Resident, JNMC, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Abadan Khan Amitava
- Professor Institute of Ophthalmology, JNMC, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Yogesh Gupta
- Professor Institute of Ophthalmology, JNMC, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Kamran Afzal
- Professor Department of Pediatrics, JNMC, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Farnaz Kauser
- Former Resident, Institute of Ophthalmology, JNMC, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Juhi Saxena
- Former Resident, Institute of Ophthalmology, JNMC, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Anam Masood
- Resident, Institute of Ophthalmology, JNMC, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Aparna Bose
- Resident, Institute of Ophthalmology, JNMC, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Ramprakash Singh
- Resident, Institute of Ophthalmology, JNMC, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Ma MML, Kang Y, Scheiman M, Chen Q, Ye X, Chen X. Reliability of step vergence method for assessing fusional vergence in intermittent exotropia. Ophthalmic Physiol Opt 2022; 42:913-920. [PMID: 35243666 DOI: 10.1111/opo.12972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the reliability of the step vergence method in measuring fusional vergence in subjects with intermittent exotropia. METHODS Thirty-two Chinese participants aged 7-20 years with intermittent exotropia (excluding the convergence insufficiency type) were enrolled in this prospective study. At the eligibility screening, visual acuity, cover test and the Office Control Score were performed. For eligible participants at study visit 1, negative and positive fusional vergence at distance and near, eye dominance and the fusion maintenance test were performed. All eligible participants returned for study visit 2 on the same day (2-4 h later), and the testing was repeated. The primary outcome measures were the intra-class correlation coefficient, coefficient of repeatability and smallest detectable change in the break and recovery points of negative and positive fusional vergence between the two study visits. RESULTS The intra-class correlation coefficient for different vergence parameters ranged from 0.64 to 0.87. The coefficient of repeatability and the smallest detectable change for the distance positive fusional vergence break point were ±20.5 and 13.1 ∆, respectively. There was no significant difference in any vergence parameter between the first and second visits. The coefficient of repeatability and the smallest detectable change in all distance vergence parameters were high when compared to the mean value. The association between distance vergence parameters and the Office Control Score was significant only when including subjects who failed to fuse at the beginning of the test. CONCLUSION The data demonstrate that measurement of fusional vergence with a prism bar has low repeatability in subjects with intermittent exotropia. In these individuals, convergence ability at distance is compromised, whereas other vergence parameters are not adversely affected. While the step vergence method is a valuable test in daily practice, caution is warranted when using it in clinical research.
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Affiliation(s)
- Martin Ming-Leung Ma
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ying Kang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mitchell Scheiman
- Pennsylvania College of Optometry at Salus University, Elkins Park, Pennsylvania, USA
| | - Qiwen Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xuelian Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiang Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Guo Y, Fu J, Hong J, Liu Z, He X. Functional changes in the visual cortex in preoperative and postoperative patients with intermittent exotropia: study protocol for a non-randomised case-control clinical trial. BMJ Open 2022; 12:e055848. [PMID: 35210343 PMCID: PMC8883252 DOI: 10.1136/bmjopen-2021-055848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Intermittent exotropia (IXT) is the most common type of divergent squint. IXT is primarily a cortical neurologic dysfunction disorder, occurring as a result of the insufficient maintenance of sensory and motor fusion. Recent reports have demonstrated the relationship between IXT and visual cortical impairment. We planned to assess blood oxygen level-dependent (BOLD)-functional magnetic resonance imaging (fMRI) in patients with IXT during the preoperative and postoperative follow-ups to evaluate the functional changes in the visual cortex. METHODS AND ANALYSIS A total of 90 Chinese subjects will be recruited, and their ages will be between 18 and 40 years old. The subjects will include the surgical treatment (ST) group (45 subjects with IXT who will undergo surgery) and the HC group (45 age-matched, sex-matched and education-matched healthy volunteers). The assessments will include the following aspects: fMRI and general ophthalmic examinations, optometry measurements and strabismus-related tests, such as the ocular deviation, binocular vision test and Newcastle Control Score (NCS). Each subject will complete the resting-state BOLD-fMRI, and the sequences will include echo planar imaging (EPI) pulse and 3-dimensional brain volume (3D-BRAVO) to acquire high-resolution images. The follow-up schedule will be 6 and 12 months after the surgery. The primary outcome will be determined by cortex changes in BOLD-fMRI in the ST group before and after surgery. We will also compare the HC group with the preoperative subjects in the ST group. The secondary outcomes will be changes in strabismus-related examinations, such as binocular visual function and NCS. ETHICS AND DISSEMINATION Ethical approval was obtained from the Medical Ethics Committee of Beijing Tongren Hospital. We plan to publish the results of this study in a peer-reviewed journal article. TRIAL REGISTRATION NUMBER ChiCTR2100048852.
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Affiliation(s)
- Yanan Guo
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Fu
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jie Hong
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Liu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xueying He
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Functional connectivity density alterations in children with strabismus and amblyopia based on resting-state functional magnetic resonance imaging (fMRI). BMC Ophthalmol 2022; 22:49. [PMID: 35109804 PMCID: PMC8808980 DOI: 10.1186/s12886-021-02228-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/07/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose To explore functional connectivity density (FCD) values of brain areas in children with strabismus and amblyopia (SA) based on blood oxygen level-dependent (BOLD) signals. Methods This study recruited 26 children (14 male, 12 females) with SA and 26 healthy children (14 male, 12 female) as healthy controls (HCs). Both groups matched in age, gender, educational level and socioeconomic background. While resting, all participants underwent fMRI scanning and global FCD (gFCD) and local FCD (lFCD) values were calculated. Receiver operating characteristic (ROC) curves were created to investigate whether there was a significant difference between children with SA and healthy controls. Results When compared with healthy controls, children with SA had significantly lower gFCD values in the right cerebellum, left putamen, and right superior frontal gyrus; however, the same metrics showed opposite changes in the right angular gyrus, left middle cingulate gyrus, left angular gyrus, right superior parietal gyrus, and right middle frontal gyrus. In children with SA, lFCD values were found to be remarkably decreased in regions of the middle right temporal pole, right cerebellum, left putamen, left hippocampus, right hippocampus, left thalamus, left cerebellum; values were increased in the right superior parietal gyrus as compared with healthy controls. Conclusion We noted abnormal neural connectivity in some brain areas of children with SA; detailing such connectivity aberrations is useful in exploring the pathophysiology of SA and providing useful information for future clinical management.
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Asare AO, Maurer D, Wong AMF, Ungar WJ, Saunders N. Socioeconomic Status and Vision Care Services in Ontario, Canada: A Population-Based Cohort Study. J Pediatr 2022; 241:212-220.e2. [PMID: 34687692 DOI: 10.1016/j.jpeds.2021.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/08/2021] [Accepted: 10/15/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To test the association of material deprivation and the utilization of vision care services for young children. STUDY DESIGN We conducted a population-based, repeated measures cohort study using linked health and administrative datasets. All children born in Ontario in 2010 eligible for provincial health insurance were followed from birth until their seventh birthday. The main exposure was neighborhood-level material deprivation quintile, a proxy for socioeconomic status. The primary outcome was receipt of a comprehensive eye examination (not to include a vision screening) by age 7 years from an eye care professional, or family physician. RESULTS Of 128 091 children included, female children represented 48.7% of the cohort, 74.4% lived in major urban areas, and 16.2% lived in families receiving income assistance. Only 65% (n = 82 833) had at least 1 comprehensive eye examination, with the lowest uptake (56.9%; n = 31 911) in the most deprived and the highest uptake (70.5%; n =19 860) in the least deprived quintiles. After adjusting for clinical and demographic variables, children living in the least materially deprived quintile had a higher odds of receiving a comprehensive eye examination (aOR 1.43; 95% CI 1.36, 1.51) compared with children in the most materially deprived areas. CONCLUSIONS Uptake of comprehensive eye examinations is poor, especially for children living in the most materially deprived neighborhoods. Strategies to improve uptake and reduce inequities are warranted.
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Affiliation(s)
- Afua Oteng Asare
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; The Hospital for Sick Children, Toronto, Canada
| | - Daphne Maurer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Psychology, Neuroscience, and Behavior, McMaster University, Hamilton, Canada
| | - Agnes M F Wong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; The Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada; ICES, Toronto, Canada
| | - Natasha Saunders
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; The Hospital for Sick Children, Toronto, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada; ICES, Toronto, Canada; Department of Pediatrics, University of Toronto, Toronto, Canada.
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Arnold RW, Donahue SP, Silbert DI, Longmuir SQ, Bradford GE, Peterseim MMW, Hutchinson AK, O'Neil JW, de Alba Campomanes AG, Pineles SL. AAPOS uniform guidelines for instrument-based pediatric vision screen validation 2021. J AAPOS 2022; 26:1.e1-1.e6. [PMID: 35066152 DOI: 10.1016/j.jaapos.2021.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND As instrument-based pediatric vision screening technology has evolved, the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) has developed uniform guidelines (2003, updated 2013) to inform the development of devices that can detect specified target levels of amblyopia risk factors (ARFs) and visually significant refractive error. Clinical experience with the established guidelines has revealed an apparent high level of over-referral for non-amblyopic, symmetric astigmatism, prompting the current revision. METHODS The revised guidelines reflect the expert consensus of the AAPOS Vision Screening and Research Committees. RESULTS For studies of automated screening devices, AAPOS in 2021 recommends that the gold-standard confirmatory comprehensive examination failure levels include anisometropia >1.25 D and hyperopia >4.0 D. Astigmatism >3.0 D in any meridian and myopia < -3 D should be detected in children <48 months, whereas astigmatism >1.75 D and myopia < -2 D should be detected after 48 months. Any media opacity >1 mm and manifest strabismus of >8Δ should also be identified. Along with performance in detecting ARFs and refractive error, validation studies should also report screening instrument performance with regard to presence or absence of amblyopia. Instrument receiver operating characteristic curves and Bland-Altman analysis are suggested to improve comparability of validation studies. CONCLUSIONS Examination failure criteria have been simplified and the threshold for symmetric astigmatism raised compared to the 2013 guidelines, whereas the threshold for amblyogenic anisometropia has been decreased. After age 4 years, lower magnitudes of symmetric astigmatism and myopia are also targeted despite a low risk of amblyopia, because they can influence school performance and may warrant consideration of myopia prevention therapy.
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Affiliation(s)
| | - Sean P Donahue
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | | | | | | | | | - Stacy L Pineles
- Stein Eye Institute, University of California Los Angeles, Los Angeles
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Lai WC, Nguyen NS, Husain A, Rajpal SD, Michael MB. Thyroid Eye Disease With Divergence Insufficiency Causing Recurrent Falls in an Elderly Patient. Cureus 2022; 14:e21695. [PMID: 35237487 PMCID: PMC8882349 DOI: 10.7759/cureus.21695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 11/07/2022] Open
Abstract
Recurrent falls are a common cause of morbidity in the elderly population, as more than one-third of individuals aged 65 years or older experience falls each year. Falls remain a multifactorial phenomenon that can potentially result in devastating debilitation and hence require proper medical attention and management. In an elderly patient presenting with recurrent falls, the workup for differential diagnoses remains wide with various causes such as postural hypotension, syncope, seizures, arrhythmia, medication-induced, and cognitive impairment. In this report, we discuss an interesting case of recurrent falls in an elderly woman with hyperthyroidism who was repeatedly found to have unremarkable lab results and negative imaging studies. She was later diagnosed with divergence insufficiency with intermittent esotropia secondary to thyroid ophthalmopathy, which was the cause of her underlying horizontal diplopia contributing to her falls. This can cause blurry vision at further distances, which is observed especially in individuals older than 50 years. Treatment typically involves prism therapy, surgery in refractory patients, and, currently, novel therapy using teprotumumab infusion. The patient was referred to see a strabismus specialist for prism prescription and possible surgical intervention. In elderly patients with a history of recurrent falls, a comprehensive visual exam should be strongly considered, especially for individuals with repeated negative workups, to prevent further testing or procedures.
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Harada S, Nakashima Y, Uematsu M, Morimoto S, Mohamed YH, Kitaoka T, Moriuchi H. Effectiveness of a photoscreener in identifying undiagnosed unilateral amblyopia at vision screening of 3-year-old children in Japan. Jpn J Ophthalmol 2022; 66:193-198. [PMID: 35044563 DOI: 10.1007/s10384-021-00896-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE In Japan a basic preparatory ophthalmic examination is routinely performed for 3-year-old children. This study aimed to determine the value of incorporating a photoscreener into the examination and evaluate parents' satisfaction with the photoscreener examination. STUDY DESIGN Prospective study. METHODS Children aged 42-47 months in Nagasaki City, Japan, underwent a visual acuity test by a parent at home and by automated vision screening using a photoscreener at their local municipal health center between October 2018 and March 2019. Subjects were children referred to Nagasaki University Hospital for examination after failing either test. Children previously diagnosed with strabismus and/or amblyopia were excluded. A questionnaire survey evaluated the level of satisfaction with the photoscreener-based screening by parents who attended these examinations at the local municipal health center. RESULTS Of children who completed the two tests, 52 (failed visual acuity test, 3; failed photoscreener examination, 49) were referred for examination. Of the 49 photoscreener failures, 12 were diagnosed with amblyopia: unilateral amblyopia with anisometropic hyperopia in 10 (83.3%), and bilateral amblyopia with astigmatism and hyperopia in 2 (16.7%). The photoscreener detected all 12 cases of amblyopia, whereas the home-based visual acuity test detected only two cases. More than 80% of 1035 parents were satisfied with the photoscreener examination. CONCLUSION Unilateral amblyopia with anisometropic hyperopia was easily overlooked with the home-based test but was detectable by photoscreener examination. The photoscreener proved to be an effective screening tool for amblyopia in children and was considered a satisfactory examination by a high proportion of parents.
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Affiliation(s)
- Shiori Harada
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Yumiko Nakashima
- Department of Pediatrics, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Masafumi Uematsu
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan.
| | - Shinpei Morimoto
- Clinical Research Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Yasser Helmy Mohamed
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Takashi Kitaoka
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Hiroyuki Moriuchi
- Department of Pediatrics, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
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Kulp MT, Ciner E, Ying GS, Candy TR, Moore BD, Orel-Bixler D. Vision Screening, Vision Disorders, and Impacts of Hyperopia in Young Children: Outcomes of the Vision in Preschoolers (VIP) and Vision in Preschoolers - Hyperopia in Preschoolers (VIP-HIP) Studies. Asia Pac J Ophthalmol (Phila) 2022; 11:52-58. [PMID: 35044337 PMCID: PMC8813881 DOI: 10.1097/apo.0000000000000483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT This review summarizes clinically relevant outcomes from the Vision in Preschoolers (VIP) and VIP-Hyperopia in Preschoolers (VIP-HIP) studies. In VIP, refraction tests (retinoscopy, Retinomax, SureSight) and Lea Symbols Visual Acuity performed best in identifying children with vision disorders. For lay screeners, Lea Symbols single, crowded visual acuity (VA) testing (VIP, 5-foot) was significantly better than linear, crowded testing (10-foot). Children unable to perform the tests (<2%) were more likely to have vision disorders than children who passed and should be referred for vision evaluation. Among racial/ethnic groups, the prevalence of amblyopia and strabismus was similar while that of hyperopia, astigmatism, and anisometropia varied. The presence of strabismus and significant refractive errors were risk factors for unilateral amblyopia, while bilateral astigmatism and bilateral hyperopia were risk factors for bilateral amblyopia. A greater risk of astigmatism was associated with Hispanic, African American, and Asian race, and myopic and hyperopic refractive error. The presence and severity of hyperopia were associated with higher rates of amblyopia, strabismus, and other associated refractive error. In the VIP-HIP study, compared to emmetropes, meaningful deficits in early literacy were observed in uncorrected hyperopic 4- and 5-year-olds [≥+4.0 diopter (D) or ≥+3.0 D to ≤+6.0 D associated with reduced near visual function (near VA 20/40 or worse; stereoacuity worse than 240")]. Hyperopia with reduced near visual function also was associated with attention deficits. Compared to emmetropic children, VA (distance, near), accommodative accuracy, and stereoacuity were significantly reduced in moderate hyperopes, with the greatest risk in those with higher hyperopia. Increasing hyperopia was associated with decreasing visual function.
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Affiliation(s)
| | - Elise Ciner
- Pennsylvania College of Optometry at Salus University, Elkins Park, PA, US
| | | | - T Rowan Candy
- Indiana University School of Optometry, Bloomington, IN, US
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Hong EH, Shin YU, Bae GH, Choi YJ, Ahn SJ, Kim I, Cho H. Ophthalmic complications in retinopathy of prematurity in the first decade of life in Korea using the national health insurance database. Sci Rep 2022; 12:911. [PMID: 35042903 PMCID: PMC8766475 DOI: 10.1038/s41598-021-04616-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/23/2021] [Indexed: 11/21/2022] Open
Abstract
The aim of this study is to investigate the epidemiology of ophthalmic complications of retinopathy of prematurity (ROP) after preterm birth using population-based database in South Korea. Using the National Health Insurance database, ophthalmic complications among premature infants born in 2007-2008 during their 10-year follow-up period were identified. Annual cumulative incidence rate and period prevalence of complications at each age were analyzed among those with ROP and those who underwent treatment for ROP (tROP). The hazard ratios (HRs) according to the presence of ROP and treatment for ROP were also analyzed. We identified 18,256 premature infants, 6995 of whom had ROP. The prevalence at 10th year for overall ophthalmic complications was 11.1% and 35.9% among ROP and tROP, respectively. Strabismus, amblyopia, and glaucoma were the three most common complications. The presence of ROP was associated with higher risk of complications (HR 1.53, 95%CI 1.44-1.61) among premature infants, and the presence of treatment for ROP was associated with higher risk of complications (HR 4.31, 95%CI 3.74-4.98) among ROP cases. This study reports the nationwide epidemiologic data on ophthalmic complications of ROP during the first decade of life, which will help advance our understandings and establish national strategies in managing ROP.
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Affiliation(s)
- Eun Hee Hong
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
| | - Yong Un Shin
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
| | - Gi Hwan Bae
- Department of Occupational and Environment Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Young Jin Choi
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Seong Joon Ahn
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
| | - Inah Kim
- Department of Occupational and Environment Medicine, Hanyang University College of Medicine, Seoul, Korea.
| | - Heeyoon Cho
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea.
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Strabismus outcomes after surgery: the nationwide SOS France study. Graefes Arch Clin Exp Ophthalmol 2022; 260:2037-2043. [PMID: 34982221 DOI: 10.1007/s00417-021-05541-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To describe the types of strabismus operated on, the surgical procedures performed, and the 2-year reoperation rate in France. METHODS Entire population 5-year cross-sectional analysis of a national medico-administrative database in France between January 2013 and December 2017 included all patients who underwent a first strabismus surgery, with a 2-year follow-up. Patient identification was based on the diagnostic codes of the 10th International Classification of Diseases and surgical procedures on the codes of the Common Classification of Medical Acts. A subgroup analysis comparing non-paralytic and paralytic strabismus was performed. RESULTS Among the 56,654 patients included (women: 50.8%), 26,892 (47.5%) patients were under 10 years old. Overall, 52,711 (93%) were diagnosed with non-paralytic strabismus and 3,943 (7%) with paralytic strabismus. Among the non-paralytics, the most frequent diagnosis was esotropia (21,282, 37.6%), followed by exotropia (14,392, 25.4%) and vertical strabismus (2,017, 3.6%). Among the paralytics, fourth cranial nerve palsy (1,499, 2.6%) was more frequent than sixth cranial nerve palsy (691, 1.2%) and third cranial nerve palsy (431, 0.8%). The 2-year reoperation rate was 7.7% (4,362 patients), the lowest for non-paralytic (7.4%) and the highest for paralytic (11.4%). CONCLUSION This first French population-based study about strabismus will contribute to the evaluation of practices at a national level and permit comparisons between countries. Although the 2-year reoperation rate was found to be 1 out of 13 patients, it should be interpreted with caution. Long-term follow-up is still warranted due to considerable variability of the type and severity of strabismus as well as surgical practices.
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Gong W, Chen H, Yang F, Lin S, Li C, Wang G. Inter-eye Differences in Ocular Biometric Parameters of Concomitant Exotropia. Front Med (Lausanne) 2022; 8:724122. [PMID: 35059408 PMCID: PMC8763704 DOI: 10.3389/fmed.2021.724122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate the ocular biometric parameters in patients with constant and intermittent exotropia by the measurement of swept-source optical coherence tomography (SS-OCT) optical biometer OA-2000 and comparing it with the normal control subjects. Design: Cross-sectional case-control study. Participants: Fifty-five constant and 24 intermittent patients with exotropia with central fixation and 77 orthotropic normal control participants aged 4-18 years old. Methods: Non-contact and high-resolution optical biometric OA-2000 measurements were conducted under uniform ambient light conditions. The statistical analysis included intraclass correlation coefficient (ICC), Bland-Altman plot, and independent t-tests. Main Outcome Measures: Spherical equivalent (SE), ocular biological parameters such as pupil diameter (PD), anterior chamber depth (ACD), lens thickness (LT), and axial lengths (AL). The absolute values of inter-eye differences for SE, PD, ACD, LT, and AL were recorded as AnisoSE, AnisoPD, AnisoACD, AnisoLT, and AnisoAL, respectively. Results: AnisoSE (0.878 vs. 0.577, P = 0.019), AnisoAL (0.395 vs. 0.208, P = 0.001), AnisoACD (0.060 vs. 0.032, P < 0.001), AnisoLT (0.060 vs. 0.031, P = 0.002), and AnisoPD (0.557 vs. 0.340, P = 0.002) were significantly larger in concomitant patients with exotropia. The SE, AL, ACD, LT, and PD showed excellent binocular correlation with ICC values that ranged from 0.943 to 0.987 in control participants and from 0.767 to 0.955 in concomitant exotropia patients. Bland-Altman plots showed the wider range of agreement in patients with concomitant exotropia than the control participants (SE: 5.0288 vs. 3.3258; AL: 2.2146 vs. 1.3172; ACD:0.3243 vs. 0.1682; PD: 2.4691 vs. 1.9241; and LT:0.3723 vs 0.1858). Conclusion: Patients with concomitant exotropia showed larger inter-eye differences in SE, ACD, LT, PD, and AL. Advice should be given to suspicious children to avoid or delay the development of concomitant exotropia.
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Affiliation(s)
- Weifen Gong
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
| | | | | | | | | | - Geng Wang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
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Agrawal S, Chahal V, Singh V, Singh J, Kaur G, Srivastava R. Profile of orthoptic clinic patients at a tertiary care Government Medical University in North India: A 6-year review. JOURNAL OF CLINICAL OPHTHALMOLOGY AND RESEARCH 2022. [DOI: 10.4103/jcor.jcor_123_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hunter SC, He J, Han M, Suh DW. The UCI EyeMobile Preschool Vision Screening Program: Refractive Error and Amblyopia Results from the 2019-2020 School Year. Clin Ophthalmol 2022; 16:4249-4255. [PMID: 36573233 PMCID: PMC9789699 DOI: 10.2147/opth.s382899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/18/2022] [Indexed: 12/30/2022] Open
Abstract
Purpose To introduce the University of California Irvine (UCI) EyeMobile for Children preschool vision screening program and describe the ophthalmic examination results of children who failed screening with the PlusoptiX S12C photoscreener during one school year. Patients and Methods Children aged 30-72 months were screened with the PlusoptiX using ROC mode 3 during the 2019-2020 school year. Children who failed screening were referred for comprehensive eye examination on the EyeMobile mobile clinic. Presence of amblyopia risk factors (ARFs), amblyopia, and refractive error was determined via retrospective review of records. Amblyopia was defined as unilateral if there was ≥ 2-line interocular difference in the best-corrected visual acuity (BCVA) and as bilateral if BCVA was < 20/50 for children < 4 years old and < 20/40 for children ≥ 4 years old. ARFs were defined using 2021 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) instrument-based screening guidelines. Results 5226 children were screened during the study period. Of the 546 children who failed screening, 350 (64%) obtained consent and were examined. Mean age of examined children was 4.45 years. Amblyopia was found in 8% of examined children, with unilateral amblyopia seen in 79% of amblyopic subjects. Glasses were prescribed to 246 (70.3%) children. Of the 240 children who received cycloplegic examinations, 43% had hyperopia and 30% had myopia. The positive predictive value (PPV) of the PlusoptiX screening for ARFs in children who received cycloplegic examinations was 70.4%. Conclusion A significant proportion of Orange County preschoolers with refractive errors and amblyopia have unmet refractive correction needs. The PlusoptiX S12C photoscreener is an adequate screening device for the UCI EyeMobile for Children program, although modification of device referral criteria may lead to increased PPV. Further research is necessary to understand and overcome the barriers to childhood vision care in our community.
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Affiliation(s)
- Stephen C Hunter
- University of California Riverside School of Medicine, Riverside, CA, USA
| | - Jody He
- Department of Ophthalmology, Jamaica Hospital, New York City, NY, USA
| | - Michael Han
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
| | - Donny W Suh
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
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Wang Y, Chen X, Jiang T, Gu Y, Zhang X, Yuan W, Zhao A, Li R, Wang Z, Hu Z, Liu H. Expanding the phenotypic spectrum of mutations in LRP2: a novel candidate gene of non-syndromic familial comitant strabismus. J Transl Med 2021; 19:495. [PMID: 34872573 PMCID: PMC8647414 DOI: 10.1186/s12967-021-03155-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022] Open
Abstract
Background Comitant strabismus (CS) is a heterogeneous disorder that is a major contributing factor to unilateral childhood-onset visual impairment. Studies have confirmed that genetic factors play an important role in the development of CS. The aim of this study was to identify the genetic cause of non-syndromic familial CS. Methods Fourteen unrelated CS families were recruited for the study. Twelve affected and 2 unaffected individuals from a large four-generation family (CS08) were selected to perform whole genome-wide linkage analysis. Parallel whole-exome sequencing (WES) was conducted in the same family (9 patients and 1 unaffected member) and 31 additional CS cases from 13 other unrelated families. Sanger sequencing was used to determine whether any of the remaining variants co-segregated with the disease phenotype in the corresponding family. Results Based on linkage analysis, CS in family CS08 mapped to a novel region of 34.17 centimorgan (cM) on chromosome 2q22.3-2q32.1 between markers D2S151 and D2S364, with a maximum log odds (LOD) score of 3.54 (theta = 0) at D2S142. Parallel WES identified a heterozygous variant, LRP2 c.335 A > G (p.Q112R), located in such a linkage interval that completely co-segregated with the disease in the family. Furthermore, another novel heterozygous variant (c.7274A > G, p.D2425G) in LRP2 that co-segregated was detected in 2 additional affected individuals from another unrelated family by WES. Both variants are predicted to be damaging by PolyPhen-2, SIFT and MutationTaster, and were absent in 100 ethnically matched normal controls. Conclusion LRP2 is a novel candidate genetic cause of non-syndromic familial CS. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-021-03155-z.
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Affiliation(s)
- Yue Wang
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China.,Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, 101 Longmian Rd, NanjingNanjing, 211166, China
| | - Xuejuan Chen
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China.,Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, 101 Longmian Rd, NanjingNanjing, 211166, China
| | - Tao Jiang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, 101 Longmian Rd, NanjingNanjing, 211166, China
| | - Yayun Gu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, 101 Longmian Rd, NanjingNanjing, 211166, China
| | - Xiaohan Zhang
- Department of Ophthalmology, Wuxi Children's Hospital, Wuxi, China
| | - Wenwen Yuan
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Andi Zhao
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Rui Li
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Zijin Wang
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Zhibin Hu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China. .,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, 101 Longmian Rd, NanjingNanjing, 211166, China.
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China.
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Birch EE, Kelly KR, Wang J. Recent Advances in Screening and Treatment for Amblyopia. Ophthalmol Ther 2021; 10:815-830. [PMID: 34499336 PMCID: PMC8589941 DOI: 10.1007/s40123-021-00394-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022] Open
Abstract
Amblyopia is the most common cause of monocular visual impairment in children, with a prevalence of 2-3%. Not only is visual acuity reduced in one eye but binocular vision is affected, fellow eye deficits may be present, eye-hand coordination and reading can be affected, and self-perception may be diminished. New technologies for preschool vision screening hold promise for accessible, early, and accurate detection of amblyopia. Together with recent advances in our theoretical understanding of amblyopia and technological advances in amblyopia treatment, we anticipate improved visual outcomes for children affected by this very common eye condition. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.
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Affiliation(s)
- Eileen E Birch
- Retina Foundation of the Southwest, 9600 N. Central Expressway, Suite 200, Dallas, TX, 75231, USA.
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Krista R Kelly
- Retina Foundation of the Southwest, 9600 N. Central Expressway, Suite 200, Dallas, TX, 75231, USA
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jingyun Wang
- SUNY College of Optometry, State University of New York, New York, NY, USA
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76
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Effect of refractive error type in the amblyopic eyes on factors for treatment success in anisometropic amblyopia. Sci Rep 2021; 11:21927. [PMID: 34753997 PMCID: PMC8578641 DOI: 10.1038/s41598-021-01377-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/01/2021] [Indexed: 11/08/2022] Open
Abstract
To investigate the factors for treatment success in anisometropic amblyopia according to the spherical equivalent (SE) type of amblyopic eyes. Medical records of 397 children with anisometropic amblyopia aged 3 to 12 years who presented in a secondary referral eye hospital during 2010 ~ 2016 were retrospectively reviewed. Anisometropia was defined as ≥ 1 diopter (D) difference in SE, or ≥ 1.5 D difference of cylindrical error between the eyes. According to the SE of amblyopic eyes, patients were categorized into hyperopia (SE ≥ 1D), emmetropia (− 1 < SE < + 1) and myopia (SE ≤ − 1D) groups. Treatment success was defined as achieving interocular logMAR visual acuity difference < 0.2. Multivariate logistic regression was used to analyze the factors for treatment success. Significant factors for the amblyopia treatment success in hyperopia group (n = 270) were younger age [adjusted odds ratio (aOR) (95% confidence interval, CI) = 0.529 (0.353, 0.792)], better BCVA in amblyopic eyes at presentation [aOR (95% CI) 0.004 (0, 0.096)], longer follow-up period [aOR (95%CI) = 1.098 (1.036, 1.162)], and no previous amblyopia treatment history [aOR (95% CI) 0.059 (0.010, 0.364)]. In myopia group (n = 68), younger age [aOR (95% CI) 0.440 (0.208, 0.928)] and better BCVA in amblyopic eyes [aOR (95% CI) 0.034 (0.003, 0.469)] were associated with higher odds of treatment success. There was no significant factor for treatment success in emmetropia group (n = 59) in this population. The refractive error type of amblyopic eyes at presentation affects the factors for treatment success in anisometropic amblyopia.
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77
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Wang Y, Zhao A, Zhang X, Huang D, Zhu H, Sun Q, Yu J, Chen J, Zhao X, Li R, Han S, Dong W, Ma F, Chen X, Liu H. Prevalence of strabismus among preschool children in eastern China and comparison at a 5-year interval: a population-based cross-sectional study. BMJ Open 2021; 11:e055112. [PMID: 34667017 PMCID: PMC8527110 DOI: 10.1136/bmjopen-2021-055112] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To update data on strabismus and evaluate the changes in prevalence and patterns among preschoolers in eastern China over a period of 5 years. DESIGN Nanjing Eye Study, a longitudinal population-based study. SETTING Recruitment and testing in kindergartens in Yuhuatai District, Nanjing. PARTICIPANTS 2300 eligible children. MAIN OUTCOME MEASURES Comprehensive ocular examinations were conducted in 1986 children aged 48-<60 months in Nanjing Eye Study (NES, 2016-2017), including visual acuity, ocular alignment, refractive error and ocular structures evaluation. The prevalence rate and pattern of strabismus were calculated and compared with those from the Nanjing Pediatric Vision Project (NPVP, 2011-2012) in children of the same age, of the same area and using the same diagnostic criteria. RESULTS The overall prevalence rate of strabismus in NES was 5.56% (95% CI 4.54% to 6.57%), which was not significantly different from that in NPVP (4.99%, 95% CI 4.13% to 5.84%, p=0.40). The prevalence of subtypes of strabismus underwent significant changes, with significant increase in intermittent exotropia (IXT) in NES (2.78% vs 4.69%, p=0.001) and significant decrease in constant exotropia (1.17% vs 0.15%, p<0.001). Significant change in pattern was observed in IXT, where the proportion of the convergence insufficiency type (2.90% vs 27.17%) increased and exceeded the divergence excess type (20.29% vs 11.96%) to be the second common type (p<0.001). CONCLUSION The prevalence of strabismus appeared stable in children aged 48-<60 months in eastern China at a 5-year interval. The prevalence of IXT increased significantly, and the convergence insufficiency type became more prevalent in patients with IXT. Timely detection and intervention of IXT are important among preschoolers.
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Affiliation(s)
- Yue Wang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Andi Zhao
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaohan Zhang
- Ophthalmology, Wuxi Children's Hospital, Wuxi, China
| | - Dan Huang
- Department of Child Healthcare, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hui Zhu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qigang Sun
- Ophthalmology, Maternal and Child Healthcare Hospital of Yuhuatai District Nanjing China, Nanjing, Jiangsu, China
| | - JiaJia Yu
- Ophthalmology, Wuxi No 2 People's Hospital, Wuxi, Jiangsu, China
| | - Ji Chen
- Ophthalmology, Maternal and Child Healthcare Hospital of Yuhuatai District Nanjing China, Nanjing, Jiangsu, China
| | - Xiaoyan Zhao
- Ophthalmology, The Affiliated Changzhou No 2 People's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Rui Li
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shu Han
- Ophthalmology, Soochow University Affiliated Children's Hospital, Suzhou, Jiangsu, China
| | - Weiyi Dong
- Fourth School of Clinical Medicine of Nanjing Medical University, Nanjing, China
| | - Fanfei Ma
- Fourth School of Clinical Medicine of Nanjing Medical University, Nanjing, China
| | - XueJuan Chen
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical University, Nanjing, Jiangsu, China
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Cui J, Fu J, Li L, Chen W, Meng Z, Su H, Yao Y, Dai W. Prevalence and pattern of refractive error and visual impairment among schoolchildren: the Lhasa childhood eye study. BMC Ophthalmol 2021; 21:363. [PMID: 34641830 PMCID: PMC8513166 DOI: 10.1186/s12886-021-02134-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background Early and effective ocular screening may help to eliminate treatable eye disorders. The Lhasa Childhood Eye Study (LCES) revealed the particular prevalence of refractive error and visual impairment in grade one schoolchildren (starting age of 6 years old) in Lhasa. Methods This is a cross-sectional part of school-based cohort study. One thousand nine hundred forty-three children were enrolled (median age, 6.78 years, range, 5.89 to 10.32). Each child underwent general and ocular examinations, including logarithm of the minimum angle of resolution (logMAR) visual acuity, cycloplegic autorefraction, and slit-lamp biomicroscopy evaluation. Multivariate and correlation analyses were performed to evaluate the association between refractive error with gender and ethnics. Results The prevalence of visual impairment (logMAR visual acuity ≥0.3 in the better-seeing eye) of uncorrected, presenting and best-corrected visual acuity (BCVA) was 12.2, 11.7 and 2.7%, respectively. Refractive error presented in 177 (78.0%) out of 227 children with bilateral visual impairment. Myopia (spherical equivalent refractor [SER] ≤ − 0.50 diopter [D] in either eye) was present in 4.7% children when measured after cycloplegic autorefraction. Hyperopia (SER ≥ + 2.00 D) affected 12.1% children. Hyperopia was significantly associated with female gender (P<0.001). Astigmatism (cylinder value ≤ − 0.75 D) was present in 44.8% children. In multivariate regression and correlation analysis, SER had no significant difference between ethnic groups. Conclusion The Lhasa Childhood Eye Study is the first school-based cohort study to reveal the prevalence and pattern of refractive error and visual impairment in Lhasa. Effective strategies such as corrective spectacles should be considered to alleviate treatable visual impairment.
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Affiliation(s)
- Jiantao Cui
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Jing Fu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China.
| | - Lei Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Weiwei Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China.,Beijing Institute of Ophthalmology, Beijing, China
| | - Zhaojun Meng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Han Su
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Yao Yao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Wei Dai
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
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Zhang XJ, Wong PPY, Wong ES, Kam KW, Yip BHK, Zhang Y, Zhang W, Young AL, Chen LJ, Ip P, Tham CC, Pang CP, Yam JC. Delayed Diagnosis of Amblyopia in Children of Lower Socioeconomic Families: The Hong Kong Children Eye Study. Ophthalmic Epidemiol 2021; 29:621-628. [PMID: 34620042 DOI: 10.1080/09286586.2021.1986551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS To determine the prevalence of amblyopia and the factors associated with delayed diagnosis among school-aged children in Hong Kong. METHODS Completed comprehensive ophthalmoscopic examinations were conducted among 4.273 children aged 6-8 years in the population-based Hong Kong Children Eye Study. New and previous diagnoses of amblyopia were identified. Socioeconomic status was surveyed through questionnaires. RESULTS According to criteria from the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS), amblyopia was present in 43 out of 4,273 children (1.01%; 95% CI, 0.71-1.31). Among them, 33 (0.77%) were newly detected cases that were more likely from families living in Public Rental Housing or subdivided flats (OR, 4.22; P = .012), with lower paternal (OR 6.68, P = .008) and maternal education levels (OR, 4.38; P = .039). Multivariate analysis revealed associations of amblyopia with hyperopia (≥+2.00D; OR, 6.23; 95% CI, 2.86-13.56, P < .001), astigmatism (≥+2.00D; OR, 24.88; 95% CI, 10.69-57.91, P < .001) and anisometropia (≥2.00D; OR, 14.49; 95% CI, 5.93-37.63, P < .001). CONCLUSION These children with delayed diagnoses of amblyopia were more likely to come from lower socioeconomic backgrounds. Public education aimed at increasing awareness and utilization of child vision screening among such families is needed.
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Affiliation(s)
- Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Tianjin Eye Hospital, Tianjin, China
| | - Posey Po-Yin Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Emily S Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Benjamin Hon Kei Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Wei Zhang
- Tianjin Eye Hospital, Tianjin, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Lks Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Tianjin Eye Hospital, Tianjin, China.,Hong Kong Eye Hospital, Kowloon, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Kowloon, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
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80
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Candy TR, Cormack LK. Recent understanding of binocular vision in the natural environment with clinical implications. Prog Retin Eye Res 2021; 88:101014. [PMID: 34624515 PMCID: PMC8983798 DOI: 10.1016/j.preteyeres.2021.101014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/26/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
Technological advances in recent decades have allowed us to measure both the information available to the visual system in the natural environment and the rich array of behaviors that the visual system supports. This review highlights the tasks undertaken by the binocular visual system in particular and how, for much of human activity, these tasks differ from those considered when an observer fixates a static target on the midline. The everyday motor and perceptual challenges involved in generating a stable, useful binocular percept of the environment are discussed, together with how these challenges are but minimally addressed by much of current clinical interpretation of binocular function. The implications for new technology, such as virtual reality, are also highlighted in terms of clinical and basic research application.
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Affiliation(s)
- T Rowan Candy
- School of Optometry, Programs in Vision Science, Neuroscience and Cognitive Science, Indiana University, 800 East Atwater Avenue, Bloomington, IN, 47405, USA.
| | - Lawrence K Cormack
- Department of Psychology, Institute for Neuroscience, and Center for Perceptual Systems, The University of Texas at Austin, Austin, TX, 78712, USA.
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81
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Sun Y, Fu J, Li L, Chen W, Meng Z, Su H, Yao Y, Dai W. Stereoacuity and its determinants in 7-year-old children: the Lhasa Childhood Eye Study. Graefes Arch Clin Exp Ophthalmol 2021; 260:599-608. [PMID: 34499245 DOI: 10.1007/s00417-021-05390-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/01/2021] [Accepted: 08/13/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To explore the distribution of stereoacuity and to examine its determinants in school-age children in Tibetan plateau, Southwest China. METHODS This is the cross-sectional part of a school-based cohort study of 7-year-old children in Lhasa, Tibet Autonomous Region, Southwest China. Children in first year of primary school were invited to undergo a comprehensive examination, including height, weight, visual acuity, cycloplegic autorefraction (1% cyclopentolate), anterior segment, cover and uncover test, and stereoacuity (Titmus Stereo Test). RESULTS A total of 1833 eligible subjects were included, with a mean age of 6.82 ± 0.46 years. Mean stereoacuity was 1.78 ± 0.21 in log units (median: 60 arcsec). Children with stereoacuity equal to 40 arcsec and stereoacuity worse than 100 arcsec accounted for 29.24% and 8.18% of the cohort, respectively. Tibetan ethnicity (OR = 1.98; 95%CI, 1.30-3.03), astigmatism (OR = 1.65; 95%CI, 1.26-2.17), strabismus (OR = 2.92; 95%CI, 1.38-6.18), and amblyopia (OR = 3.77; 95%CI, 1.14-12.49) were risk factors for normal stereoacuity (= 40 arcsec). Shorter height, younger age, strabismus, and worse BCVA (P < 0.05 for all) were both related to lower stereoacuity in Spearman correlation analysis and associated with lower stereoacuity in multivariate regression analysis. CONCLUSION Stereoacuity maturation does not appear fully completed in 7-year-old children, while few children present stereoacuity worse than 100 arcsec (8.18%). Lower stereoacuity was associated with younger age, shorter height, strabismus, and lower best-corrected visual acuity.
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Affiliation(s)
- Yunyun Sun
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China
| | - Jing Fu
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China. .,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China.
| | - Lei Li
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China
| | - Weiwei Chen
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China
| | - Zhaojun Meng
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China
| | - Han Su
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China
| | - Yao Yao
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China
| | - Wei Dai
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China
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Patel A, Abou-Al-Shaar H, Chiang MC, Algattas HN, McDowell MM, Stone JG, Mitchell EB, Emery SP, Greene S. Neuroophthalmological manifestations of congenital aqueductal stenosis. J Neurosurg Pediatr 2021; 28:320-325. [PMID: 34171841 DOI: 10.3171/2021.2.peds20824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Congenital aqueductal stenosis (CAS) is a common etiology of hydrocephalus that occurs in a subset of infants and may be linked to an increased incidence of ophthalmological abnormalities and delayed developmental milestones. Although hydrocephalus is common and widely studied, sparse literature exists on patients with isolated (no identifiable genetic link) CAS along with analysis of ophthalmological manifestations. In this study, the authors sought to describe the ophthalmological abnormalities and delayed developmental milestones of patients with isolated CAS. METHODS Data of patients with CAS were prospectively entered and monitored in a surgical database maintained by the Department of Neurological Surgery at Children's Hospital of Pittsburgh from January 2005 to October 2016. Patients with a family history of congenital hydrocephalus, positive testing for genetic forms of aqueductal stenosis, other congenital abnormalities suggesting an underlying genetic syndrome, and stenosis/obstruction due to secondary causes were excluded from this study. Prenatal and perinatal history, CSF diversion history, and a variety of outcomes, including ophthalmological deficits and developmental milestones, were collected and analyzed. RESULTS A total of 41 patients with isolated CAS were identified, with a mean follow-up duration of 6 years. Among that cohort, 26 patients (63.4%) developed neuroophthalmological complications, which were further stratified. Fourteen patients (34.1%) developed strabismus and 11 (26.8%) developed astigmatism, and 1 patient (2.4%) with papilledema was recorded. Among patients with ophthalmological abnormalities, 76.9% had delayed developmental milestones (p = 0.045). CONCLUSIONS Patients with CAS were found to have increased risk of ophthalmological abnormalities requiring correction, along with an increased risk of delayed developmental milestones. Importantly, there was a significant correlation between the development of ophthalmological abnormalities and delayed developmental milestones that was independent of CSF diversion history. Larger patient cohort studies are required to explore whether earlier development of hydrocephalus, as is the case in CAS, causes elevated rates of neurological and ophthalmological complications, and if earlier CSF diversion correlates with improved outcomes.
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Affiliation(s)
- Aneek Patel
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | | | | | | | | | | | | | - Stephen P Emery
- 4Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Sii S, Chean CS, Kuht HJ, Thomas MG, Rufai SR. Home-based screening tools for amblyopia: a systematic review protocol. BMJ Open 2021; 11:e051830. [PMID: 34452969 PMCID: PMC8404433 DOI: 10.1136/bmjopen-2021-051830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Amblyopia is an important public health concern associated with functional vision loss and detrimental impact on the physical and mental well-being of children. The gold standard for diagnosis of amblyogenic conditions currently involves screening by orthoptists and/or ophthalmologists. The bloom of technology enables the use of home-based screening tools to detect these conditions at an early stage by the layperson in community, which could reduce the burden of screening in the community, especially during restrictions associated with the COVID-19 pandemic. Here, we propose a systematic review aiming to evaluate the accuracy and reliability of home-based screening tools compared with the existing gold standard. METHODS AND ANALYSIS We aim to search for studies involving home-based screening tools for amblyopia among children aged under 18 years. Oxford Centre for Evidence-Based Medicine Level 4 evidence and above will be included, without language or time restrictions. The following platforms will be searched from inception to 31 August 2021: PubMed, Medline, The Cochrane Library, Embase, Web of Science Core Collection and Clinicaltrials.gov. Two independent reviewers will identify studies for inclusion based on a screening questionnaire. The search and screening will start on 14 August 2021 until 1 October 2021. We aim to complete our data analysis by 30 November 2021. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool for diagnostic accuracy studies only. Our primary outcome measure is the diagnostic accuracy of home-based screening tools, while secondary outcome measures include validity, feasibility, reproducibility and cost-effectiveness, where available. ETHICS AND DISSEMINATION Ethical approval is not necessary as no primary data will be collected. The findings will be disseminated through presentations at scientific meetings and peer-reviewed journal publication. PROSPERO REGISTRATION NUMBER CRD42021233511.
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Affiliation(s)
- Samantha Sii
- Department of Ophthalmology, Kettering General Hospital NHS Trust, Kettering, UK
| | - Chung Shen Chean
- Department of Ophthalmology, Northampton General Hospital, Northampton, UK
| | - Helen J Kuht
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Mervyn G Thomas
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Sohaib R Rufai
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK
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Bohonowych JE, Vrana-Diaz CJ, Miller JL, McCandless SE, Strong TV. Incidence of strabismus, strabismus surgeries, and other vision conditions in Prader-Willi syndrome: data from the Global Prader-Willi Syndrome Registry. BMC Ophthalmol 2021; 21:296. [PMID: 34380467 PMCID: PMC8359621 DOI: 10.1186/s12886-021-02057-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/09/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is a relative lack of information on the incidence and treatment of vision problems in Prader-Willi syndrome (PWS). Using data from the Global PWS Registry, we performed a cross-sectional study of vision problems in PWS. METHODS Data, reported by caregivers who completed the Vision Survey in the Global PWS Registry between May of 2015 and March of 2020, were analyzed using descriptive statistics. RESULTS There were 908 participants in this survey, with a mean age of 14.5 years (range 0-62 years). The prevalence of strabismus in this population was 40 %, with no statistically significant difference in prevalence by genetic subtype. Ninety-one percent of participants with strabismus were diagnosed before 5 years of age. Of those with strabismus, 42 % went on to have strabismus surgery, with 86 % of those having their first strabismus surgery before 5 years of age and 10.1 % having more than one strabismus surgery. Additional vision issues reported included myopia (41 %), hyperopia (25 %), astigmatism (25 %), and amblyopia (16 %). CONCLUSIONS The prevalence of strabismus, amblyopia, and hyperopia are considerably higher in the PWS population represented in the Global PWS Registry as compared to the general population. People with PWS should be screened early and regularly for vision problems.
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Prevalence of strabismus and its risk factors among school aged children: The Hong Kong Children Eye Study. Sci Rep 2021; 11:13820. [PMID: 34226578 PMCID: PMC8257606 DOI: 10.1038/s41598-021-93131-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/04/2021] [Indexed: 11/08/2022] Open
Abstract
The study aims to determine the prevalence of strabismus and its risk factors among school children in Hong Kong. This is a cross-sectional study involving 6–8 year old children from different districts in Hong Kong. 4273 children received comprehensive ophthalmological examination, cycloplegic auto-refraction, best corrected visual acuity (BCVA), anterior segment examination, cover/uncover test, ocular motility, and fundus examination. Demographic information, pre- and post- natal background, parental smoking status, and family history of strabismus were obtained through questionnaires. Strabismus was found among 133 children (3.11%, 95% CI 2.59–3.63%), including 117 (2.74%) exotropia and 12 (0.28%) esotropia cases (exotropia-esotropia ratio: 9.75:1). There was no significant difference in prevalence across age (6–8 years) and gender. Multivariate analysis revealed associations of strabismus with myopia (≤ − 1.00D; OR 1.61; 95% CI 1.03–2.52; P = 0.037) hyperopia (≥ + 2.00D; OR 2.49; 95% CI 1.42–4.39; P = 0.002), astigmatism (≥ + 2.00D; OR 2.32; 95% CI 1.36–3.94; P = 0.002), and anisometropia (≥ 2.00D; OR 3.21; 95% CI 1.36–7.55; P = 0.008). Other risk factors for strabismus included maternal smoking during pregnancy (OR 4.21; 95% CI 1.80–9.81; P = 0.001), family history of strabismus (OR 6.36; 95% CI 2.78–14.50, P < 0.0001) and advanced maternal age at childbirth (> 35 years; OR 1.65; CI 1.09–2.49, P = 0.018). The prevalence of strabismus among children aged 6—8 years in Hong Kong is 3.11%. Refractive errors, family history of strabismus and maternal smoking history during pregnancy are risk factors. Early correction of refractive errors and avoidance of maternal smoking during pregnancy are potentially helpful in preventing strabismus.
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Jain M, Anjani P, Krishnamurthy G, Sachdeva V, Kekunnaya R. One-year Profile of Eye Diseases in Infants (PEDI) in secondary (rural) eye care centers in South India. Indian J Ophthalmol 2021; 69:906-909. [PMID: 33727457 PMCID: PMC8012936 DOI: 10.4103/ijo.ijo_1084_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: The aim of this study was to report the proportion and patterns of eye diseases observed among infants seen at two rural eye care centers in South India. Methods: A retrospective review of case records of infants seen between January 1, 2017 and December 31, 2017 at two rural secondary eye care centers attached to L V Prasad Eye Institute, Hyderabad. Data were collected regarding their demographic profile, the pattern of eye problems observed, management at the facility itself, and need for referrals. Results: During this period, a total of 3092 children were seen. Among them, 141 were infants (4.56%, 71 boys: 70 girls, median age: 8 months). Twenty-five percent of infants were less than 6 months of age. The most common eye problem was congenital nasolacrimal duct obstruction (n = 76, 53.90%), followed by conjunctivitis (n = 33, 23.40%), retinopathy of prematurity (n = 4, 2.84%) and strabismus (n = 3, 2.13%). One case each of congenital cataract and suspected retinoblastoma were identified. Majority of the cases (58.8%) belonged to the oculoplastic and orbital surgery sub-specialty. Sixteen percent of the infants (n = 23) had sight-threatening eye problems. Twenty percent (n = 28) were referred to tertiary care hospital for further management. Conclusion: Profile of eye disease in infants in secondary or rural eye care centers ranged from simple to complex, including sight-threatening diseases. While our study concluded that nearly 4/5th of these eye problems were simple and could be managed by a well-trained comprehensive ophthalmologist, 20% of these cases required a referral to a tertiary care center.
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Affiliation(s)
- Mayank Jain
- L V Prasad Eye Institute, KAR Campus, Banjara Hills, Hyderabad, Telangana, India
| | - Pratap Anjani
- L V Prasad Eye Institute, KAR Campus, Banjara Hills, Hyderabad, Telangana, India
| | | | - Virender Sachdeva
- L V Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India
| | - Ramesh Kekunnaya
- L V Prasad Eye Institute, KAR Campus, Banjara Hills, Hyderabad, Telangana, India
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Tegegne MM, Assem AS, Merie YA. Prevalence and Associated Factors of Amblyopia Among School Age Children at Bahir Dar City, Northwest Ethiopia: A Community-Based Cross-Sectional Study. CLINICAL OPTOMETRY 2021; 13:143-153. [PMID: 34040476 PMCID: PMC8140911 DOI: 10.2147/opto.s293446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/21/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Worldwide, amblyopia prevalence among children is in the range of 0.13% to 12.9%. However, there are no known community-based data regarding amblyopia prevalence and its associated factors among school age children in Ethiopia. The aim of this study was to determine the prevalence of amblyopia and to identify factors associated with amblyopia among school age children in Bahir Dar city, northwest Ethiopia. METHODS AND MATERIALS A cross-sectional study among a school age community of Bahir Dar city was conducted from April 1 to May 29, 2018. Data were collected using a pretested structured questionnaire and checklist through interview and physical examination. Bivariable logistic regression was done, and variables with p value <0.2 were entered to multivariable logistic regression using SPSS 20. Variables with p value of <0.05 in the multivariable binary logistic regression were considered as significant predictors. RESULTS In total 601 (94.8%) subjects participated. Amblyopia was prevalent in 6.5% of school age children in Bahir Dar city. The odds of being amblyopic among participants who had anisometropia >2D were about 9.3 times (AOR=9.35, CI: 2.86-30.60) more as compared to those who had no anisometropia. The odds of being amblyopic among participants having a refractive error >+5D hypermetropia were about 22 times (AOR=21.77, CI: 7.15-66.34) more as compared to participants who had no hypermetropia. CONCLUSION The prevalence of amblyopia among school age children at Bahir Dar city is higher than the World Health Organization cut point. Having anisometropia greater than 1 diopter, anisometropia >2 diopter, having anisometropia less than 1 diopter, having a history of strabismus, having a hyperopia of > +5 diopter, > +2 diopter, having a positive history of visual deprivation and having a positive history of strabismus in the family were the significant factors positively associated with amblyopia.
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Affiliation(s)
- Mebratu Mulusew Tegegne
- Department of Optometry, School of Medicine, College of Medicine & Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Abel Sinshaw Assem
- Department of Optometry, School of Medicine, College of Medicine & Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
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Kaur S, Bhatia I, Beke N, Jugran D, Raj S, Sukhija J. Efficacy of part-time occlusion in amblyopia in Indian children. Indian J Ophthalmol 2021; 69:112-115. [PMID: 33323591 PMCID: PMC7926133 DOI: 10.4103/ijo.ijo_1439_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: To study the effectiveness of part-time occlusion (PTO) in different types of amblyopia in Indian population. Methods: Prospective case series of consecutive cases of amblyopia from a tertiary care center were subjected to PTO of the better eye and monitored periodically for 6 months. Those who failed to improve by 6 months were shifted to full-time occlusion of the better eye and followed for a further 3 months. Results: 175 eyes of 175 patients with amblyopia underwent PTO for 6 months. The mean age of the patients was 10.47 ± 4.69 years (range: 3–26 years). Major subgroups included 94 eyes with strabismic amblyopia and 70 with anisometropic amblyopia. Overall, 168 (96%) children benefited from PTO (improvement being defined as a gain of at least one line of Snellen's visual acuity). The improvement rates for strabismic amblyopes (97.9%) was significantly more than anisometropia (94.3%); P = 0.027. Of the seven patients not responding to PTO, six did not benefit even after full-time patching. Conclusion: PTO is a viable and effective modality of management of amblyopia in Indian patients. Strabismic amblyopia was the commonest and responded best to the occlusion therapy in our cohort.
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Affiliation(s)
- Savleen Kaur
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Indresh Bhatia
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nihkil Beke
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Jugran
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Srishti Raj
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaspreet Sukhija
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Tegegne MM, Fekadu SA, Assem AS. Prevalence of Strabismus and Its Associated Factors Among School-Age Children Living in Bahir Dar City: A Community-Based Cross-Sectional Study. CLINICAL OPTOMETRY 2021; 13:103-112. [PMID: 33854396 PMCID: PMC8041646 DOI: 10.2147/opto.s300124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/18/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Strabismus is a manifest deviation of the eye that exceeds the control of the fusional mechanism so that the eyes are misaligned under binocular conditions. Its prevalence reaches from 0.7% to 5% globally and 1.5% to 17.9% in Ethiopia. OBJECTIVE This study aimed to assess the prevalence of strabismus and its associated factors among school-age children living in Bahir Dar city. METHODS A community-based cross-sectional study was conducted from April 15 to May 25, 2019, in Bahir Dar city and a total of 632 participants were recruited using a multistage sampling technique. The data were collected with a face-to-face interview, Snellen acuity, prisms, pen torch, portable slit lamp, and ophthalmoscope. The collected data were entered into Epi Info version 7 and transposed to statistical package for social science version 20 for formal statistical analysis. Frequency (percentage), mean (standard deviation), tables and graphs were used to present the summary statistics. All variables with a p-value of less than 0.2 in bi-variable logistic regression were entered into multiple logistic regression and variables with a p-value of less than 0.05 were taken as significantly associated with strabismus. The strength of association between variables was shown with an odds ratio and a 95% confidence interval. RESULTS A total of 611 children participated with a response rate of 96.7% and a mean age of 12.3 (±3.25). The prevalence of strabismus was 31 (5.0%), 95% CI: (3.45, 6.97). Family history of strabismus (AOR= 3.9 (95% CI: 1.71, 11.22)), hyperopia ≥ +3.00 diopters sphere (AOR=5.3 (95% CI: 2.01, 10.77)), and not with exclusive breastfeeding (AOR= 2.9 (95% CI: 1.14, 4.71)) were the only risk factors found for strabismus. CONCLUSION The prevalence of strabismus was 5% among children living in Bahr Dar city. A family history of strabismus, not with exclusive breastfeeding, and hyperopia ≥ +3.00 diopters sphere were associated with strabismus.
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Affiliation(s)
- Mebratu Mulusew Tegegne
- Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sofonias Addis Fekadu
- Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abel Sinshaw Assem
- Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Pineles SL, Repka MX, Yu F, Velez FG, Perez C, Sim D, Coleman AL. The use of atropine for treatment of amblyopia using the OptumLabs Data Warehouse. J AAPOS 2021; 25:107-109.e1. [PMID: 33348039 PMCID: PMC9037612 DOI: 10.1016/j.jaapos.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/12/2020] [Accepted: 11/11/2020] [Indexed: 11/15/2022]
Abstract
Atropine and patching are standard treatments for amblyopia, but the prevalence of atropine therapy in the United States is unknown. This study used the OptumLabs Data Warehouse to evaluate pharmacy claims for topical atropine to evaluate the frequency of its treatment for amblyopia and to compare demographic factors in cohorts of amblyopic children who were and were not prescribed atropine. Overall, 55.2% of amblyopic children were prescribed atropine more than once. The children who were prescribed atropine had a higher likelihood of living in geographic regions in the South or Midwest.
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Affiliation(s)
- Stacy L Pineles
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, California; OptumLabs Visiting Fellow, Cambridge, Massachusetts.
| | - Michael X Repka
- Department of Ophthalmology, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fei Yu
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, California; Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, California
| | - Federico G Velez
- Department of Ophthalmology, Doheny Eye Institute, University of California, Los Angeles, California; Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Claudia Perez
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Danielle Sim
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Anne L Coleman
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, California; Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, California
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Mao K, Yang Y, Guo C, Zhu Y, Chen C, Chen J, Liu L, Chen L, Mo Z, Lin B, Zhang X, Li S, Lin X, Lin H. An artificial intelligence platform for the diagnosis and surgical planning of strabismus using corneal light-reflection photos. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:374. [PMID: 33842595 PMCID: PMC8033395 DOI: 10.21037/atm-20-5442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Strabismus affects approximately 0.8–6.8% of the world’s population and can lead to abnormal visual function. However, Strabismus screening and measurement are laborious and require professional training. This study aimed to develop an artificial intelligence (AI) platform based on corneal light-reflection photos for the diagnosis of strabismus and to provide preoperative advice. Methods An AI platform consisting of three deep learning (DL) systems for strabismus diagnosis, angle evaluation, and operation plannings based on corneal light-reflection photos was trained and retrospectively validated using a retrospective development data set obtained between Jan 1, 2014, and Dec 31, 2018. Corneal light-reflection photos were collected to train the DL systems for strabismus screening and deviation evaluations in the horizontal strabismus while concatenated images (each composed of two photos representing different gaze states) were procured to train the DL system for operative advice regarding exotropia. The AI platform was further prospectively validated using a prospective development data set captured between Sep 1, 2019, and Jun 10, 2020. Results In total, 5,797 and 571 photos were included in the retrospective and prospectively development data sets, respectively. In the retrospective test sets, the screening system detected strabismus with a sensitivity of 99.1% [95% confidence interval (95% CI), 98.1–99.7%], a specificity of 98.3% (95% CI, 94.6–99.5%), and an AUC of 0.998 (95% CI, 0.993–1.000, P<0.001). Compared to the angle measured by the perimeter arc, the deviation evaluation system achieved a level of accuracy of ±6.6º (95% LoA) with a small bias of 1.0º. Compared to the real design, the operation advice system provided advice regarding the target angle within ±5.5º (95% LoA). Regarding strabismus in the prospective test set, the AUC was 0.980. The platform achieved a level of accuracy of ±7.0º (95% LoA) in the deviation evaluation and ±6.1º (95% LoA) in the target angle suggestion. Conclusions The AI platform based on corneal light-reflection photos can provide reliable references for strabismus diagnosis, angle evaluation, and surgical plannings.
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Affiliation(s)
- Keli Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chong Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yi Zhu
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chuan Chen
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jingchang Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Li Liu
- The Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, China
| | - Lifei Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zijun Mo
- Zhongshan Medical School, Sun Yat-sen University, Guangzhou, China
| | - Bingsen Lin
- Zhongshan Medical School, Sun Yat-sen University, Guangzhou, China
| | - Xinliang Zhang
- Zhongshan Medical School, Sun Yat-sen University, Guangzhou, China
| | - Sijin Li
- Zhongshan Medical School, Sun Yat-sen University, Guangzhou, China
| | - Xiaoming Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Hashemi H, Nabovati P, Pakzad R, Yekta A, Aghamirsalim M, Sardari S, Rafati S, Ostadimoghaddam H, Khabazkhoob M. Prevalence of amblyopia and its determinants in a rural population: a population-based cross-sectional study. Strabismus 2021; 29:10-18. [PMID: 33455499 DOI: 10.1080/09273972.2020.1871375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To determine the prevalence of amblyopia and its determinants in underserved rural villages of Iran. This population-based cross-sectional study was conducted in 3850 subjects selected from two underserved districts in the north (Kojur District, Nowshahr County, Mazandaran Province) and southwest (Shahyun District, Dezful County, Khuzestan Province) of Iran using multi-stage cluster sampling. The subjects underwent complete ophthalmic examinations including the measurement of uncorrected (UCVA) and best-corrected (BCVA) visual acuity, objective and subjective refraction, unilateral and alternate cover tests and ocular health examination. Amblyopia was defined as a reduction of BCVA to 20/30 or less in one eye or a 2-line interocular optotype acuity difference in the absence of any pathological factors. Of 3850 selected subjects, 3314 participated in the study (response rate = 86.08%). The mean age of the participants was 36.90 ± 20.21 years (range: 3-93 years). The prevalence and 95% confidence interval of total, bilateral, and unilateral amblyopia were 2.73% (2.17 to 3.38), 0.50% (0.28 to 0.83), and 2.23% (1.73 to 2.83), respectively. The most common type of amblyopia was anisometropic followed by strabismic and mixed. The lowest and highest prevalence was seen in the age group 6-20 years (1.36%; 0.65 to 2.49) and above 70 years (5.97%; 3.02 to 10.44), respectively. According to the results of multiple logistic regression analysis, compared to illiterate subjects, the odds ratio of amblyopia was 0.321 (P = .033) in subjects with High school education, 0.181 (P = .030) in subjects with secondary School education, and 0.486 (P = .041) in subjects with primary school education. The odds ratio of amblyopia for north villages residence vs southwest villages residence was 2.105 (P = .012). The odds ratio of amblyopia was 2.765 for age group>70 years vs. 6-20 years (P = .033). The prevalence of amblyopia was higher in north region, in participants with lower education level and older individuals. The high prevalence of amblyopia in older people may be due to the lack of screening programs in previous generations and consequently the lack of timely diagnosis and treatment.
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Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran
| | - Payam Nabovati
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam
| | - Abbasali Yekta
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad
| | | | - Sara Sardari
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran
| | | | - Hadi Ostadimoghaddam
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran
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Hatt SR, Leske DA, Castañeda YS, Wernimont SM, Liebermann L, Cheng-Patel CS, Birch EE, Holmes JM. Association of Strabismus With Functional Vision and Eye-Related Quality of Life in Children. JAMA Ophthalmol 2021; 138:528-535. [PMID: 32215586 DOI: 10.1001/jamaophthalmol.2020.0539] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Strabismus is common, affecting 2% to 4% of children, but how children and their families are affected in everyday life is poorly understood. Objective To evaluate the association of strabismus with functional vision and eye-related quality of life in children and their families using the Pediatric Eye Questionnaire (PedEyeQ). Design, Setting, and Participants This cross-sectional study was conducted between December 2017 and October 2019 and included 91 children with strabismus and 166 visually normal controls across 3 age groups (0-4, 5-11, and 12-17 years) who were enrolled at Mayo Clinic, Rochester, Minnesota, and Retina Foundation of the Southwest, Dallas, Texas. Exposures Children completed the child PedEyeQ (5 to 11- and 12 to 17-year versions: functional vision, bothered by eyes/vision, social, and frustration/worry domains); parents completed the proxy (0 to 4-, 5 to 11-, and 12 to 17-year versions: functional vision, bothered by eyes/vision, social, frustration/worry, and eye care domains) and the parent PedEyeQ (impact on parent and family, worry about child's eye condition, worry about child's self-perception and interactions, and worry about child's functional vision domains). Rasch-calibrated PedEyeQ scores were calculated for each domain and converted to 0 (worst) to 100. Main Outcomes and Measures PedEyeQ domain scores. Results Of 91 participants with strabismus, 41 (45.1%) were girls, 74 (81.3%) were white, 4 (4.4%) were Asian, 5 (5.5%) were more than 1 race, 5 (5.5%) were African American, and 2 (2.2%) were American Indian/Alaska Native. Child PedEyeQ domain scores were lower with strabismus vs visually normal controls among children ages 5 to 11 years and the greatest mean (SD) difference was in functional vision (12 [14] points; 95% CI, 6-18; P = .001), and among children ages 12 to 17 years, the greatest mean (SD) difference was in frustration/worry (27 [13] points; 95% CI, 18-36; P < .001). Proxy PedEyeQ domain scores were also lower with strabismus. The greatest difference among children ages 0 to 4 years was in functional vision (13 [9] points; 95% CI, 9-16; P < .001), among children ages 5 to 11 years was in functional vision (26 [10] points; 95% CI, 22-30; P < .001); and among children ages 12 to 17 years was in functional vision (21 [12] points; 95% CI, 12-30; P < .001), social (21 [13] points; 95% CI, 12-30; P < .001), and frustration/worry (21 [13] points; 95% CI, 12-30; P < .001). Parent PedEyeQ domain scores were lower with strabismus; the greatest difference was in worry about child's eye condition (38 [14] points; 95% CI, 34-42; P < .001). Conclusions and Relevance Strabismus is associated with reduced functional vision and eye-related quality of life in children. Parents of children with strabismus also experience a reduced quality of life. These findings advance our understanding of how strabismus affects children and their families and should be considered when defining patient management goals.
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Affiliation(s)
- Sarah R Hatt
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - David A Leske
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | - Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas.,Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas
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94
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Akbari MR, Mehrpour M, Mirmohammadsadeghi A. The influence of alternate part-time patching on control of intermittent exotropia: a randomized clinical trial. Graefes Arch Clin Exp Ophthalmol 2021; 259:1625-1633. [PMID: 33415357 DOI: 10.1007/s00417-020-05065-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/13/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate the effect of alternate part-time patching on deviation control in patients with intermittent exotropia in comparison to observation. METHODS In a randomized clinical trial, untreated 3-8-year-old children with intermittent exotropia were randomly divided into patching group who treated with alternate part-time patching and observation group. Deviation control was assessed with 3-point and 6-point scales. Stereoacuity and suppression were evaluated with Titmus and Worth-4-dot tests respectively. All exams were repeated 3 and 6 months after beginning of treatment. RESULTS Seventy-six patients (35 in patching and 41 in observation group) with a mean age of 4.99 ± 1.33 years completed the 6-month course of study. Based on 3-point scale, deviation control was significantly better in patching group after 3 and 6 months at near and after 3 months at far (p = 0.011, 0.011, and 0.03, respectively) but non-significant after 6 months at far (p = 0.16). According to 6-point scale, deviation control was also significantly better in patching group after 3 months (p = 0.03 at far, 0.003 at near) and 6 months (p = 0.03 at far, 0.003 at near). Three and 6 months stereoacuity was not significantly different between groups (p = 0.86 for both). However, there was greater stereoacuity changes among patching group in comparison with observation group from baseline to 3 and 6 months (p = 0.006 for both). CONCLUSION Patching seems effective in improving deviation control of 3-8-year-old children with intermittent exotropia in comparison with observation based on two common office control scales. TRIAL REGISTRATION NUMBER AND DATE NCT03700632 (10/9/2018).
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Affiliation(s)
- Mohammad Reza Akbari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehrpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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95
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Çakır B, Aksoy NÖ, Özmen S, Bursalı Ö. The effect of amblyopia on clinical outcomes of children with astigmatism. Ther Adv Ophthalmol 2021; 13:25158414211040898. [PMID: 34541452 PMCID: PMC8442477 DOI: 10.1177/25158414211040898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 08/03/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Amblyopia is more common in children with high astigmatism, but factors contributing to development of amblyopia and visual outcomes are not fully understood. OBJECTIVE To evaluate the effect of amblyopia on the clinical outcomes in children with ⩾1.75 diopter (D) astigmatism. METHODS We reviewed the medical records of children with ⩾1.75 D astigmatism with and without amblyopia (amblyopes group and non-amblyopes group). The mean age, gender, amount and type of ocular deviation, presence of convergence insufficiency (CI), stereopsis, time of initial spectacle use and follow-up time, differences in best-corrected visual acuity (VoD) and spherical equivalent (SE) between eyes were assessed and compared between the groups. Best-corrected visual acuity (BCVA), mean SE, astigmatism measurements were assessed and compared between amblyopic, fellow, and non-amblyopic eyes. RESULTS The records included 68 eyes of 34 children with amblyopia and 56 eyes of 28 children without amblyopia. The mean age, gender, amount and type of ocular deviation, presence of CI, stereopsis, time of initial spectacle use, follow-up time, and the difference in SE did not differ between groups. In amblyopes, exodeviation was more common and statistically greater in near (33 cm) than at distance (6 m) (p = 0.005). The mean BCVA and astigmatism values were statistically different between amblyopic, fellow, and non-amblyopic eyes. CONCLUSION A greater near than distance exodeviation and higher mean astigmatism value were found in amblyopic children with astigmatism.
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96
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Su H, Fu J, Chen W, Meng Z, Li L, Dai W, Yao Y. Prevalence of Heterophoria in Tibetan Grade-One Students: The Lhasa Childhood Eye Study. J Ophthalmol 2020; 2020:9570908. [PMID: 33489351 PMCID: PMC7803105 DOI: 10.1155/2020/9570908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 11/14/2020] [Accepted: 12/11/2020] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The study aims to explore the prevalence of heterophoria and associate factors in Tibetan grade-one students. METHODS The Lhasa Childhood Eye Study (LCES) is a school-based cohort study. 1942 grade-one students from 7 elementary schools were randomly sampled by stratified cluster sampling. Ocular examinations were performed in participants, including ocular motility, distance and near visual acuity, cycloplegic autorefraction, and stereoacuity. The near (33 cm) and distance (6 m) fixation cover test was used to differentiate orthophoria, heterophoria, and heterotropia, and the magnitude of the phoria was measured by the Maddox rod and prisma. RESULTS Of 1856 grade-one students completing all the ocular examinations, 1852 participants finished the ocular alignment test. The mean age was 6.82 ± 0.46 years (range 6∼10 years); 981 (52.97%) were males, and 871 (47.03%) were females. The prevalence of phoria was 22.89% (n = 424). At distance fixation, the prevalence of heterophoria, exophoria, and esophoria was 4.64%, 4.21%, and 0.43% separately, while at near fixation, the prevalence was 22.73%, 22.35%, and 0.38%. No vertical phoria was detected. The mean magnitude of heterophoria at near and distance fixation was -7.63 ± 5.15 PD (exo: -7.83 ± 4.91 PD, eso: +5.67 ± 3.61 PD) and -4.84 ± 5.94 PD (exo: -6.26 ± 4.20 PD, eso: +8.13 ± 3.04 PD). The prevalence of esophoria was associated with hyperopia (OR = 6.38, 95% CI: 1.15-35.28, P = 0.03; OR = 5.42, 95% CI: 1.04-28.24, P = 0.04) and amblyopia (OR = 16.02, 95% CI: 1.81∼141.96, P = 0.01; OR = 11.37, 95% CI: 1.34∼96.52, P = 0.03) at near and distance fixation. The prevalence of exophoria was associated with myopia at near fixation (OR = 2.43, 95% CI: 1.47-4.00, P<0.01). In the near heterophoria group, the proportion of children with abnormal stereoacuity was 23.26% (n = 97), significantly higher (χ 2 = 5.70, P = 0.017) than that in orthophoria (17.99%, n = 244). CONCLUSIONS In Lhasa, grade-one pupils have a lower prevalence of heterophoria. Near exophoria was associated with myopia, while esophoria was related to hyperopia and amblyopia both near and distance. Heterophoria may be one of the affected factors for reducing stereoacuity.
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Affiliation(s)
- Han Su
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Jing Fu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Weiwei Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
- Beijing Institute of Ophthalmology, Beijing, China
| | - Zhaojun Meng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Lei Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Wei Dai
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Yao Yao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
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97
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Qanat AS, Alsuheili A, Alzahrani AM, Faydhi AA, Albadri A, Alhibshi N. Assessment of Different Types of Strabismus Among Pediatric Patients in a Tertiary Hospital in Jeddah. Cureus 2020; 12:e11978. [PMID: 33425550 PMCID: PMC7790318 DOI: 10.7759/cureus.11978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/21/2022] Open
Abstract
Background Strabismus, also known as squint, is an ocular disorder in which the eyes do not align properly with each other when looking at an object. The estimated global prevalence of strabismus among children is between 1.3% and 5.7%. This study aimed to assess the various types of strabismus among pediatric patients in Jeddah, in the western region of Saudi Arabia. Methods The medical records of 281 patients with strabismus aged ≤18 years, who presented to the pediatric ophthalmology clinic in King Abdulaziz University Hospital between 2010 and 2019, were retrospectively reviewed. Data were analyzed using the Statistical Package for Social Sciences (SPSS; IBM Corp., Armonk, NY, USA). A p-value of 0.05 or less was considered statistically significant. Results Out of the 281 patients, 141 were (50.2%) female. The average age of the patients was 9.50 ± 4.24 years. The most common type of strabismus was esotropia (177 [63%] patients), followed by exotropia (96 [34.2%] patients), hypertropia (10 [3.6%] patients), and dissociated vertical deviation (four [1.4%] patients). Two-hundred thirty-one (82.8%) patients had bilateral strabismus. A total of 178 patients (63.3%) had no associated conditions with strabismus, whereas 103 (36.7%) had an associated condition. A significant relationship was observed between esotropia and prematurity (p = 0.024). Conclusion Esotropia was the most common type of strabismus among the patients, followed by exotropia. The results of this study showed that males were equally affected as females. We also found a significant relationship between esotropia and prematurity. Implementation of a compulsory nationwide pediatric ophthalmic screening program for children aged one, three, and five years is recommended to enable timely diagnosis of strabismus and any other refractive errors.
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Affiliation(s)
- Ahmed S Qanat
- Research, King Abdulaziz University Hospital, Jeddah, SAU
| | | | | | | | | | - Nizar Alhibshi
- Ophthalmology, King Abdulaziz University Hospital, Jeddah, SAU
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98
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Meng Z, Fu J, Chen W, Li L, Su H, Dai W, Yao Y. Prevalence of Amblyopia and Associated Risk Factors in Tibetan Grade One Children. Ophthalmic Res 2020; 64:280-289. [PMID: 33279900 DOI: 10.1159/000511264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/31/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Amblyopia is an important public health problem and standard screening is quite necessary for early diagnosis and treatment especially for the remote areas. As the place of the largest Tibetan population, the Tibetan Plateau has special geographical characteristics such as high altitude, time zone, and ethnic composition, where very little information is available about the prevalence of amblyopia and other ocular diseases. The article aims to determine the prevalence of amblyopia and associated factors in grade 1 Tibetan children, living in Lhasa, Tibet Autonomous Region. METHODS A cross-sectional study was conducted. All the participants were scheduled for comprehensive eye examinations including visual acuity testing, ocular deviation and movement evaluation, cycloplegic refraction and examinations of the external eye, anterior segment, media, and fundus. Amblyopia was assessed in the children according to the standard definition. RESULTS A total of 1,856 students participated in the examinations (97.58% response rate). 1,852 students completed all the related examinations, and 34 of them were diagnosed as amblyopia with the prevalence of 1.84% (95% confidence interval [CI]: 1.22-2.45%). Unilateral amblyopia was diagnosed in 23 students (1.24%, 95% CI: 0.74-1.75%), including 16 anisometropic, 4 strabismic, 1 visual deprivational, and 2 mixed. Other 11 students were diagnosed as bilateral amblyopia (0.59%, 95% CI: 0.24-0.94%), including 9 ametropic, 1 deprivational, and 1 with nystagmus. The mean cylinder refraction and absolute value of the spherical equivalent refraction of amblyopic eyes was respectively -2.15 ± 1.52 D and 2.70 ± 2.33 D. Amblyopia was significantly associated with hyperopia (≥+2.00 D, odds ratio [OR] 8.22, 95% CI 3.42-19.72), astigmatism (≤-2.00 D, OR 6.76, 95% CI 2.56-17.85), and anisometropia (≥+0.50 to <+1.00 D, OR 3.95, 95% CI 1.44-10.79; ≥+1.00 D, OR 21.90, 95% CI 8.24-58.18). CONCLUSIONS The prevalence of amblyopia in grade 1 students of Lhasa is relatively higher than that of many other ethnic populations in China previously reported. Refractive errors including anisometropia, hyperopia, and astigmatism are the major risk factors of amblyopia.
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Affiliation(s)
- Zhaojun Meng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Jing Fu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China,
| | - Weiwei Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China.,Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Lei Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Han Su
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Wei Dai
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Yao Yao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
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He H, Fu J, Meng Z, Chen W, Li L, Zhao X. Prevalence and associated risk factors for childhood strabismus in Lhasa, Tibet, China: a cross-sectional, school-based study. BMC Ophthalmol 2020; 20:463. [PMID: 33238929 PMCID: PMC7687812 DOI: 10.1186/s12886-020-01732-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background To estimate the prevalence of strabismus and associated risk factors among grade one school children in Lhasa, Tibet, China. Methods The Lhasa Childhood Eye Study (LCES) was a cross-sectional, school-based childhood study conducted in Grade one students from primary schools in Lhasa, Tibet, China. Comprehensive ophthalmic examinations and basic systemic examinations were evaluated. A questionnaire survey containing information about children, as well as parents’ information, was sent to the corresponding parents of eligible children. The prevalence of strabismus and its 95% confidence interval was estimated. Univariate and multivariate logistic regression analyses were conducted to determine the associated risk factors. Results A total of 1942 eligible grade one students were enrolled, of which 1856 participants completed all examinations. The average age was 6.83 ± 0.46 years, 53% of participants were boys and 1762 were the Tibetan Minority. Over all, the prevalence of strabismus was 68/1856 (3.7%) (95%CI: 2.81,4.52), with no difference between the ages, genders, ethnicities and body mass index, while tilting one’s head when writing may be a risk factor for strabismus (P = 0.004). Strabismus students had mean best corrected visual acuity of 0.16 ± 0.28(LogMAR), over 50% patients with esotropia were hyperopic, and participants who had stereopsis impairments showed a significant difference between esotropia and exotropia (P = 0.026). Conclusions The prevalence of strabismus in LCES was 3.7%, which is higher than previous reports from Chinese childhood epidemiology studies. Strabismus is a common contributing factor to amblyopia. Tilting one’s head when writing may be a risk factor. Esotropia is more likely to affect stereopsis and be associated with the refractive state of hyperopia. Trial registration The study has finished the clinical registration on Chinese Clinical Trial Registry. (http://www.chictr.org.cn, ChiCTR1900026693). Supplementary Information The online version contains supplementary material available at 10.1186/s12886-020-01732-2.
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Affiliation(s)
- Hailong He
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China.,Beijing Institute of Ophthalmology, Beijing, China
| | - Jing Fu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China.
| | - Zhaojun Meng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Weiwei Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China.,Beijing Institute of Ophthalmology, Beijing, China
| | - Lei Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Xinyu Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
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100
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Ma MML, Kang Y, Scheiman M, Chen Q, Ye X, Chen X. Maintenance of normal fusion in intermittent exotropia. Ophthalmic Physiol Opt 2020; 41:33-41. [PMID: 33179304 DOI: 10.1111/opo.12758] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the reliability of the Bagolini filter bar and striated lenses for measuring the fusion maintenance score, which is the ability of participants with intermittent exotropia to maintain normal sensorimotor fusion. METHODS Thirty-two Chinese participants aged 7-20 years with intermittent exotropia (excluding the convergence insufficiency type) were enrolled in this prospective study. At the eligibility screening, visual acuity, cover test and assessment of the office control score were performed. At study visit 1, eligible participants underwent negative and positive fusional vergence tests at far and near, eye dominance test and the fusion maintenance test. All eligible participants returned for study visit 2 on the same day (2-4 h later) and the testing was repeated. The primary outcome measure was the intra-class correlation coefficient of the fusion maintenance score between the two study visits. RESULTS The intra-class correlation coefficient of the fusion maintenance score was 0.84, indicating good reliability. There was no significant difference (mean difference = 0.05, p = 0.95) between the fusion maintenance scores for the first (5.62) and second study visits (5.57). The coefficient of repeatability and the smallest detectable change for the fusion maintenance scores were 7.6 and 6.3, respectively. The fusion maintenance score was significantly associated with the distance (Spearman correlation -0.57, p < 0.001) and near (Spearman correlation -0.4, p = 0.02) office control scores. CONCLUSION These data demonstrate that the fusion maintenance score is a reliable tool to evaluate sensorimotor fusion in intermittent exotropia. These results suggest that the fusion maintenance score may be a useful outcome measure in future clinical trials to evaluate the effectiveness of treatments for intermittent exotropia.
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Affiliation(s)
- Martin Ming-Leung Ma
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ying Kang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mitchell Scheiman
- Pennsylvania College of Optometry at Salus University, Elkins Park, PA, USA
| | - Qiwen Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xuelian Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiang Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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