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Halegoua J, Schwartz RH. Vision photoscreening of infants and young children in a primary care pediatric office: can it identify asymptomatic treatable amblyopic risk factors? Clin Pediatr (Phila) 2015; 54:33-9. [PMID: 25009113 DOI: 10.1177/0009922814541805] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the feasibility and accuracy of vision photoscreening a large cohort of asymptomatic children age 6 months to 6 years. METHODS Photoscreening was performed at the 6 and 18 months and annually at the 2- to 5-year scheduled pediatric health assessment visits. RESULTS A total of 1976 children underwent photoscreening for amblyopic risk factors during an 18-month period; 167 of them (8.5%) screened positive. Of the 94 study children who were evaluated by a pediatric ophthalmologist, 25 required intervention at their initial visit (26.6%). Ten children were diagnosed with amblyopia, representing 0.5% of all children screened. CONCLUSION Vision photoscreening of 1976 young children identified 10 with previously undiagnosed amblyopia and an additional 15 with treatable pre-amblyopic risk factors. It is unlikely that any of these children with serious refractive errors would have been detected without the use of in-office vision photoscreening.
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Affiliation(s)
- Jason Halegoua
- Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Richard H Schwartz
- Inova Children's Hospital, Virginia Commonwealth University School of Medicine, Falls Church, VA, USA
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102
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Jin H, Chung SA. Comparison of Improvement Rates between Distance and Near Visual Acuity in Children with Unilateral Amblyopia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.9.1432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hosung Jin
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Seung Ah Chung
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
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103
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Cotter SA, Cyert LA, Miller JM, Quinn GE. Vision screening for children 36 to <72 months: recommended practices. Optom Vis Sci 2015; 92:6-16. [PMID: 25562476 PMCID: PMC4274336 DOI: 10.1097/opx.0000000000000429] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 06/10/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This article provides recommendations for screening children aged 36 to younger than 72 months for eye and visual system disorders. The recommendations were developed by the National Expert Panel to the National Center for Children's Vision and Eye Health, sponsored by Prevent Blindness, and funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration, United States Department of Health and Human Services. The recommendations describe both best and acceptable practice standards. Targeted vision disorders for screening are primarily amblyopia, strabismus, significant refractive error, and associated risk factors. The recommended screening tests are intended for use by lay screeners, nurses, and other personnel who screen children in educational, community, public health, or primary health care settings. Characteristics of children who should be examined by an optometrist or ophthalmologist rather than undergo vision screening are also described. RESULTS There are two current best practice vision screening methods for children aged 36 to younger than 72 months: (1) monocular visual acuity testing using single HOTV letters or LEA Symbols surrounded by crowding bars at a 5-ft (1.5 m) test distance, with the child responding by either matching or naming, or (2) instrument-based testing using the Retinomax autorefractor or the SureSight Vision Screener with the Vision in Preschoolers Study data software installed (version 2.24 or 2.25 set to minus cylinder form). Using the Plusoptix Photoscreener is acceptable practice, as is adding stereoacuity testing using the PASS (Preschool Assessment of Stereopsis with a Smile) stereotest as a supplemental procedure to visual acuity testing or autorefraction. CONCLUSIONS The National Expert Panel recommends that children aged 36 to younger than 72 months be screened annually (best practice) or at least once (accepted minimum standard) using one of the best practice approaches. Technological updates will be maintained at http://nationalcenter.preventblindness.org.
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Affiliation(s)
- Susan A Cotter
- *OD, MS, FAAO †PhD, OD, FAAO ‡MD, MPH §MD, MSCE Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California (SAC); Northeastern State University Oklahoma College of Optometry, Tahlequah, Oklahoma (LAC); University of Arizona College of Medicine, Tucson, Arizona (JMM); and Department of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (GEQ)
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Leone JF, Mitchell P, Kifley A, Rose KA. Normative visual acuity in infants and preschool-aged children in Sydney. Acta Ophthalmol 2014; 92:e521-9. [PMID: 24606232 DOI: 10.1111/aos.12366] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 01/09/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To provide population-based normative visual acuity (VA) by age, in children participating in the Sydney Paediatric Eye Disease Study aged 6 to <72 months. METHODS Monocular VA was measured using the Amblyopia Treatment Study (ATS HOTV) protocol (24 to <72 months). Some children were also tested using linear ETDRS or HOTV logMAR VA charts (30 to <72 months). If unable to perform recognition acuity, the Teller Acuity Cards II (TAC II) was performed (6 to <42 months). Children with significant refractive error or ocular disease were excluded. RESULTS Improvement in VA with age was shown on all three vision tests (all p < 0.0001). Mean VA using ATS HOTV (n = 836) was 0.13 logMAR (6/8) at <36 months, which improved to -0.01 (6/6) at 66 to <72 months. Mean ETDRS/HOTV (n = 399) VA was 0.26 logMAR (6/11) at <36 months, which improved to 0.1 (6/7.5) at 66 to <72 months. Mean monocular TAC II (n = 442) was 5.7 cycles/degree (0.72 logMAR) at 6 to <9 months and improved to 12.4 cycles/degree (0.38 logMAR) at age 30 to <33 months. Associations with ATS HOTV VA included prematurity (p = 0.027) and socio economic status (SES) factors such as home ownership (p = 0.039) and employment of one (p = 0.019) or both parents (p = 0.003). CONCLUSIONS VA norms in children improved with age and were different according to the VA test used. Low SES was associated with poorer VA, supporting the need for test specific VA norms to be established for different populations. The ATS HOTV appears to be the best test to use for vision screening due to its lower false positive referral rate.
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Affiliation(s)
- Jody F. Leone
- Discipline of Orthoptics; The University of Sydney; Lidcombe NSW Australia
| | - Paul Mitchell
- Department of Ophthalmology; Centre for Vision Research; Westmead Millennium Institute; Westmead Hospital; The University of Sydney; Sydney NSW Australia
| | - Annette Kifley
- Department of Ophthalmology; Centre for Vision Research; Westmead Millennium Institute; Westmead Hospital; The University of Sydney; Sydney NSW Australia
| | - Kathryn A. Rose
- Discipline of Orthoptics; The University of Sydney; Lidcombe NSW Australia
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Yeh EA, Marrie RA, Reginald YA, Buncic JR, Noguera AE, O'Mahony J, Mah JK, Banwell B, Costello F. Functional-structural correlations in the afferent visual pathway in pediatric demyelination. Neurology 2014; 83:2147-52. [PMID: 25361777 DOI: 10.1212/wnl.0000000000001046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE We evaluated the relationship of optical coherence tomography (OCT)-measured ganglion cell layer (GCL) and retinal nerve fiber layer (RNFL) thickness to other functional measures of afferent visual pathway competence including high-contrast visual acuity (HCVA) and low-contrast visual acuity (LCVA), visual field sensitivity, and color vision perception in a pediatric population with demyelinating disorders. METHODS This was a cross-sectional evaluation of 37 children, aged 8-18 years, with pediatric demyelinating disorders (n = 74 eyes), and 18 healthy controls (n = 36 eyes), who were recruited from the University of Toronto, Hospital for Sick Children and the University of Calgary, Alberta Children's Hospital, Canada. A standardized visual battery, including spectral-domain OCT, visual fields, LCVA, and HCVA, was performed in all subjects. RESULTS Mean RNFL thickness was 26 µm (25.6%) lower in patients with demyelination (76.2 μm [3.7]) compared to controls (102.4 μm [2.1]) (p < 0.0001). Mean GCL thickness was 20% lower in patients as compared to controls (p < 0.0001). Mean GCL and RNFL thickness were strongly correlated (r = 0.89; p < 0.0001), yet in contrast to RNFL thickness, no differences in GCL thickness were noted between optic neuritis (ON) eyes and non-ON eyes of patients. HCVA and LCVA and visual field mean deviation scores decreased linearly with lower RNFL thickness. CONCLUSION GCL thickness was decreased in patients regardless of history of ON. The retina may be a site of primary neuronal injury in pediatric demyelination.
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Affiliation(s)
- E Ann Yeh
- From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada.
| | - Ruth Ann Marrie
- From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada
| | - Y Arun Reginald
- From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada
| | - J Raymond Buncic
- From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada
| | - Austin E Noguera
- From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada
| | - Julia O'Mahony
- From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada
| | - Jean K Mah
- From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada
| | - Brenda Banwell
- From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada
| | - Fiona Costello
- From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada
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Repka MX, Kraker RT, Holmes JM, Summers AI, Glaser SR, Barnhardt CN, Tien DR. Atropine vs patching for treatment of moderate amblyopia: follow-up at 15 years of age of a randomized clinical trial. JAMA Ophthalmol 2014; 132:799-805. [PMID: 24789375 DOI: 10.1001/jamaophthalmol.2014.392] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Initial treatment for amblyopia of the fellow eye with patching and atropine sulfate eyedrops improves visual acuity. Long-term data on the durability of treatment benefit are needed. OBJECTIVE To report visual acuity at 15 years of age among patients who were younger than 7 years when enrolled in a treatment trial for moderate amblyopia. DESIGN, SETTING, AND PARTICIPANTS In a multicenter clinical trial, 419 children with amblyopia (visual acuity, 20/40 to 20/100) were randomly assigned to patching (minimum of 6 h/d) or atropine sulfate eyedrops, 1% (1 drop daily), for 6 months. Treatment after 6 months was at the discretion of the investigator. Two years after enrollment, an unselected subgroup of 188 children were enrolled into long-term follow-up. INTERVENTION Initial treatment with patching or atropine with subsequent treatment at investigator discretion. MAIN OUTCOMES AND MEASURES Visual acuity at 15 years of age with the electronic Early Treatment Diabetic Retinopathy Study test in amblyopic and fellow eyes. RESULTS Mean visual acuity in the amblyopic eye measured in 147 participants at 15 years of age was 0.14 logMAR (approximately 20/25); 59.9% of amblyopic eyes had visual acuity of 20/25 or better and 33.3%, 20/20 or better. Mean interocular acuity difference (IOD) at 15 years of age was 0.21 logMAR (2.1 lines); 48.3% had an IOD of 2 or more lines and 71.4%, 1 or more lines. Treatment (other than spectacles) was prescribed for 9 participants (6.1%) aged 10 to 15 years. Mean IOD was similar at examinations at 10 and 15 years of age (2.0 and 2.1 logMAR lines, respectively; P = .39). Better visual acuity at the 15-year examination was achieved in those who were younger than 5 years at the time of entry into the randomized clinical trial (mean logMAR, 0.09) compared with those aged 5 to 6 years (mean logMAR, 0.18; P < .001). When we compared subgroups based on original treatment with atropine or patching, no significant differences were observed in visual acuity of amblyopic and fellow eyes at 15 years of age (P = .44 and P = .43, respectively). CONCLUSIONS AND RELEVANCE At 15 years of age, most children treated for moderate amblyopia when younger than 7 years have good visual acuity, although mild residual amblyopia is common. The outcome is similar regardless of initial treatment with atropine or patching. The results indicate that improvement occurring with amblyopia treatment is maintained until at least 15 years of age. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00000170.
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Affiliation(s)
- Michael X Repka
- Wilmer Ophthalmological Institute, The John Hopkins University, Baltimore, Maryland
| | - Raymond T Kraker
- Pediatric Eye Disease Investigator Group Coordinating Center, Jaeb Center for Health Research, Tampa, Florida
| | | | | | | | | | - David R Tien
- Pediatric Ophthalmology and Strabismus Associates, Providence, Rhode Island
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107
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Cotter SA, Mohney BG, Chandler DL, Holmes JM, Repka MX, Melia M, Wallace DK, Beck RW, Birch EE, Kraker RT, Tamkins SM, Miller AM, Sala NA, Glaser SR. A randomized trial comparing part-time patching with observation for children 3 to 10 years of age with intermittent exotropia. Ophthalmology 2014; 121:2299-310. [PMID: 25234012 DOI: 10.1016/j.ophtha.2014.07.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/19/2014] [Accepted: 07/10/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of prescribed part-time patching for treatment of intermittent exotropia (IXT) in children. DESIGN Multicenter, randomized clinical trial. PARTICIPANTS Three hundred fifty-eight children 3 to <11 years of age with previously untreated (except for refractive correction) IXT and near stereoacuity of 400 seconds of arc or better were enrolled. Intermittent exotropia met the following criteria: (1) IXT at distance OR constant exotropia at distance and either IXT or exophoria at near; (2) exodeviation (tropia or phoria) of at least 15 prism diopters (PD) at distance or near by prism and alternate cover test (PACT); and (3) exodeviation of at least 10 PD at distance by PACT. METHODS Participants were assigned randomly either to observation (no treatment for 6 months) or to patching for 3 hours daily for 5 months, with a 1-month washout period of no patching before the 6-month primary outcome examination. MAIN OUTCOME MEASURES The primary outcome was deterioration at either the 3-month or the 6-month follow-up visit, defined as: (1) constant exotropia measuring at least 10 PD at distance and near by simultaneous prism and cover test, and/or (2) near stereoacuity decreased by at least 2 octaves from baseline, both assessed by a masked examiner and confirmed by a retest. Participants who were prescribed any nonrandomized treatment without first meeting either deterioration criteria also were counted as having deteriorated. RESULTS Of the 324 participants (91%) completing the 6-month primary outcome examination, deterioration occurred in 10 of the 165 participants (6.1%) in the observation group (3 of these 10 started treatment without meeting deterioration criteria) and in 1 of the 159 participants (0.6%) in the part-time patching group (difference, 5.4%; lower limit of 1-sided exact 95% confidence interval, 2.0%; P = 0.004, 1-sided hypothesis test). CONCLUSIONS Deterioration of previously untreated childhood IXT over a 6-month period is uncommon with or without patching treatment. Although there is a slightly lower deterioration rate with patching, both management approaches are reasonable for treating children 3 to 10 years of age with IXT.
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Affiliation(s)
| | - Susan A Cotter
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California.
| | | | | | | | - Michael X Repka
- Wilmer Ophthalmological Institute, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
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The Handy Eye Check: a mobile medical application to test visual acuity in children. J AAPOS 2014; 18:258-60. [PMID: 24924280 DOI: 10.1016/j.jaapos.2014.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 12/29/2013] [Accepted: 01/13/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare visual acuity results obtained with the Handy Eye Chart to results obtained using the Handy Eye Check, a mobile medical application that electronically presents isolated Handy Eye Chart optotypes according the Amblyopia Treatment Study (ATS) protocol. METHODS Consecutive patients 6-18 years of age presenting for eye examinations between May 30, 2012, and June 26, 2012, were invited to participate. Monocular visual acuity testing was performed on the subject's poorer-seeing eye using both the Handy Eye Check and the Handy Eye Chart under the same conditions. Visual acuity was first tested using the mobile application, then using the chart, followed by repeated application testing. Patients were excluded if they were unable to undergo the required visual acuity testing or if visual acuity in the worse-seeing eye was less than 20/200 (for validity testing, but not reliability testing). RESULTS There was a strong linear correlation (r = 0.92) and a mean difference in acuity of -0.005 logMAR, or less than one letter (95% CI, -0.03 to 0.02), between the two tests. The 95% limits of agreement were ± 2 lines. Test-retest reliability was high, with 81% of retest scores within 0.1 logMAR (5 letters) and 100% within 0.2 logMAR (10 letters), an intraclass correlation coefficient of 0.93, and a standard error of measurement of 0.08. CONCLUSIONS The Handy Eye Check mobile application compares similarly to the Handy Eye Chart as a valid and reliable test of visual acuity in children age 6-18 years.
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Kulp MT, Ying GS, Huang J, Maguire M, Quinn G, Ciner EB, Cyert LA, Orel-Bixler DA, Moore BD. Associations between hyperopia and other vision and refractive error characteristics. Optom Vis Sci 2014; 91:383-9. [PMID: 24637486 DOI: 10.1097/opx.0000000000000223] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate the association of hyperopia greater than +3.25 diopters (D) with amblyopia, strabismus, anisometropia, astigmatism, and reduced stereoacuity in preschoolers. METHODS Three- to five-year-old Head Start preschoolers (N = 4040) underwent vision examination including monocular visual acuity (VA), cover testing, and cycloplegic refraction during the Vision in Preschoolers Study. Visual acuity was tested with habitual correction and was retested with full cycloplegic correction when VA was reduced below age norms in the presence of significant refractive error. Stereoacuity testing (Stereo Smile II) was performed on 2898 children during study years 2 and 3. Hyperopia was classified into three levels of severity (based on the most positive meridian on cycloplegic refraction): group 1: greater than or equal to +5.00 D, group 2: greater than +3.25 D to less than +5.00 D with interocular difference in spherical equivalent greater than or equal to 0.50 D, and group 3: greater than +3.25 D to less than +5.00 D with interocular difference in spherical equivalent less than 0.50 D. "Without" hyperopia was defined as refractive error of +3.25 D or less in the most positive meridian in both eyes. Standard definitions were applied for amblyopia, strabismus, anisometropia, and astigmatism. RESULTS Relative to children without hyperopia, children with hyperopia greater than +3.25 D (n = 472, groups 1, 2, and 3) had a higher proportion of amblyopia (34.5 vs. 2.8%, p < 0.0001) and strabismus (17.0 vs. 2.2%, p < 0.0001). More severe levels of hyperopia were associated with higher proportions of amblyopia (51.5% in group 1 vs. 13.2% in group 3) and strabismus (32.9% in group 1 vs. 8.4% in group 3; trend p < 0.0001 for both). The presence of hyperopia greater than +3.25 D was also associated with a higher proportion of anisometropia (26.9 vs. 5.1%, p < 0.0001) and astigmatism (29.4 vs. 10.3%, p < 0.0001). Median stereoacuity of nonstrabismic, nonamblyopic children with hyperopia (n = 206) (120 arcsec) was worse than that of children without hyperopia (60 arcsec) (p < 0.0001), and more severe levels of hyperopia were associated with worse stereoacuity (480 arcsec for group 1 and 120 arcsec for groups 2 and 3, p < 0.0001). CONCLUSIONS The presence and magnitude of hyperopia among preschoolers were associated with higher proportions of amblyopia, strabismus, anisometropia, and astigmatism and with worse stereoacuity even among nonstrabismic, nonamblyopic children.
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Affiliation(s)
- Marjean Taylor Kulp
- *OD, MS, FAAO †PhD ‡MS §MD, MSCE ∥OD, FAAO **PhD, OD, FAAO ††OD, PhD, FAAO The Ohio State University College of Optometry, Columbus, Ohio (MTK); University of Pennsylvania, Philadelphia, Pennsylvania (G-sY, JH, MM); Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania (GQ); Pennsylvania College of Optometry at Salus University, Philadelphia, Pennsylvania (EBC); Northeastern State University Oklahoma College of Optometry, Tahlequah, Oklahoma (LAC); University of California, Berkeley School of Optometry, Berkeley, California (DAO-B); New England College of Optometry, Boston, Massachusetts (BDM)
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Summers CG, Connett JE, Holleschau AM, Anderson JL, De Becker I, McKay BS, Brilliant MH. Does levodopa improve vision in albinism? Results of a randomized, controlled clinical trial. Clin Exp Ophthalmol 2014; 42:713-21. [PMID: 24641678 DOI: 10.1111/ceo.12325] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 02/20/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dopamine is an intermediate product in the biosynthesis of melanin pigment, which is absent or reduced in albinism. Animal research has shown that supplying a precursor to dopamine, levodopa, may improve visual acuity in albinism by enhancing neural networks. This study examines the safety and effectiveness of levodopa on best-corrected visual acuity in human subjects with albinism. DESIGN Prospective, randomized, placebo-controlled, double-masked clinical trial conducted at the University of Minnesota. PARTICIPANTS Forty-five subjects with albinism. METHODS Subjects with albinism were randomly assigned to one of three treatment arms: levodopa 0.76 mg/kg with 25% carbidopa, levodopa 0.51 mg/kg with 25% carbidopa, or placebo and followed for 20 weeks, with best-corrected visual acuity measured at enrollment, and at weeks 5, 10, 15, and 20 after enrollment. Side-effects were recorded with a symptom survey. Blood was drawn for genotyping. MAIN OUTCOME MEASURES Side-effects and best-corrected visual acuity 20 weeks after enrolment. RESULTS All subjects had at least one mutation found in a gene known to cause albinism. Mean age was 14.5 years (range: 3.5 to 57.8 years). Follow up was 100% and compliance was good. Minor side-effects were reported; there were no serious adverse events. There was no statistically significant improvement in best-corrected visual acuity after 20 weeks with either dose of levodopa. CONCLUSIONS Levodopa, in the doses used in this trial and for the time course of administration, did not improve visual acuity in subjects with albinism.
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Affiliation(s)
- C Gail Summers
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA; Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
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Abstract
PURPOSE To determine the intertester agreement of refractive error measurements between lay and nurse screeners using the Retinomax Autorefractor and the SureSight Vision Screener. METHODS Trained lay and nurse screeners measured refractive error in 1452 preschoolers (3 to 5 years old) using the Retinomax and the SureSight in a random order for screeners and instruments. Intertester agreement between lay and nurse screeners was assessed for sphere, cylinder, and spherical equivalent (SE) using the mean difference and the 95% limits of agreement. The mean intertester difference (lay minus nurse) was compared between groups defined based on the child's age, cycloplegic refractive error, and the reading's confidence number using analysis of variance. The limits of agreement were compared between groups using the Brown-Forsythe test. Intereye correlation was accounted for in all analyses. RESULTS The mean intertester differences (95% limits of agreement) were -0.04 (-1.63, 1.54) diopter (D) sphere, 0.00 (-0.52, 0.51) D cylinder, and -0.04 (1.65, 1.56) D SE for the Retinomax and 0.05 (-1.48, 1.58) D sphere, 0.01 (-0.58, 0.60) D cylinder, and 0.06 (-1.45, 1.57) D SE for the SureSight. For either instrument, the mean intertester differences in sphere and SE did not differ by the child's age, cycloplegic refractive error, or the reading's confidence number. However, for both instruments, the limits of agreement were wider when eyes had significant refractive error or the reading's confidence number was below the manufacturer's recommended value. CONCLUSIONS Among Head Start preschool children, trained lay and nurse screeners agree well in measuring refractive error using the Retinomax or the SureSight. Both instruments had similar intertester agreement in refractive error measurements independent of the child's age. Significant refractive error and a reading with low confidence number were associated with worse intertester agreement.
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Ying GS, Maguire MG, Cyert LA, Ciner E, Quinn GE, Kulp MT, Orel-Bixler D, Moore B. Prevalence of vision disorders by racial and ethnic group among children participating in head start. Ophthalmology 2014; 121:630-6. [PMID: 24183422 PMCID: PMC4128179 DOI: 10.1016/j.ophtha.2013.09.036] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 09/16/2013] [Accepted: 09/24/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To compare the prevalence of amblyopia, strabismus, and significant refractive error among African-American, American Indian, Asian, Hispanic, and non-Hispanic white preschoolers in the Vision In Preschoolers study. DESIGN Multicenter, cross-sectional study. PARTICIPANTS Three- to 5-year old preschoolers (n=4040) in Head Start from 5 geographically disparate areas of the United States. METHODS All children who failed the mandatory Head Start screening and a sample of those who passed were enrolled. Study-certified pediatric optometrists and ophthalmologists performed comprehensive eye examinations including monocular distance visual acuity (VA), cover testing, and cycloplegic retinoscopy. Examination results were used to classify vision disorders, including amblyopia, strabismus, significant refractive errors, and unexplained reduced VA. Sampling weights were used to calculate prevalence rates, confidence intervals, and statistical tests for differences. MAIN OUTCOME MEASURES Prevalence rates in each racial/ethnic group. RESULTS Overall, 86.5% of children invited to participate were examined, including 2072 African-American, 343 American Indian (323 from Oklahoma), 145 Asian, 796 Hispanic, and 481 non-Hispanic white children. The prevalence of any vision disorder was 21.4% and was similar across groups (P=0.40), ranging from 17.9% (American Indian) to 23.3% (Hispanic). Prevalence of amblyopia was similar among all groups (P=0.07), ranging from 3.0% (Asian) to 5.4% (non-Hispanic white). Prevalence of strabismus also was similar (P=0.12), ranging from 1.0% (Asian) to 4.6% (non-Hispanic white). Prevalence of hyperopia >3.25 diopter (D) varied (P=0.007), with the lowest rate in Asians (5.5%) and highest in non-Hispanic whites (11.9%). Prevalence of anisometropia varied (P=0.009), with the lowest rate in Asians (2.7%) and highest in Hispanics (7.1%). Myopia >2.00 D was relatively uncommon (<2.0%) in all groups with the lowest rate in American Indians (0.2%) and highest rate in Asians (1.9%). Prevalence of astigmatism >1.50 D varied (P=0.01), with the lowest rate among American Indians (4.3%) and highest among Hispanics (11.1%). CONCLUSIONS Among Head Start preschool children, the prevalence of amblyopia and strabismus was similar among 5 racial/ethnic groups. Prevalence of significant refractive errors, specifically hyperopia, astigmatism, and anisometropia, varied by group, with the highest rate of hyperopia in non-Hispanic whites, and the highest rates of astigmatism and anisometropia in Hispanics.
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Affiliation(s)
- Gui-shuang Ying
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Maureen G Maguire
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lynn A Cyert
- College of Optometry, Northeastern State University, Tahlequah, Oklahoma
| | - Elise Ciner
- Pennsylvania College of Optometry at Salus University, Elkins Park, Pennsylvania
| | - Graham E Quinn
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Bruce Moore
- New England College of Optometry, Boston, Massachusetts
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Raveendran RN, Babu RJ, Hess RF, Bobier WR. Transient improvements in fixational stability in strabismic amblyopes following bifoveal fixation and reduced interocular suppression. Ophthalmic Physiol Opt 2014; 34:214-25. [PMID: 24495165 DOI: 10.1111/opo.12119] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 12/27/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To test the hypothesis that fixational stability of the amblyopic eye in strabismics will improve when viewing provides both bifoveal fixation and reduced inter-ocular suppression by reducing the contrast to the fellow eye. METHODS Seven strabismic amblyopes (Age: 29.2 ± 9 years; five esotropes and two exotropes) showing clinical characteristics of central suppression were recruited. Interocular suppression was measured by a global motion task. For each participant, a balance point was determined which defined contrast levels for each eye where binocular combination was optimal (interocular suppression minimal). When the balance point could not be determined, this participant was excluded. Bifoveal fixation was established by ocular alignment using a haploscope. Participants dichoptically viewed similar targets (a cross of 2.3° surrounded by a square of 11.3°) at 40 cm. Target contrasts presented to each eye were either high contrast (100% to both eyes) or balanced contrast (attenuated contrast in the fellow fixing eye). Fixation stability was measured over a 5 min period and quantified using bivariate contour ellipse areas in four different binocular conditions; unaligned/high contrast, unaligned/balance point, aligned/high contrast and aligned/balance point. Fixation stability was also measured in six control subjects (Age: 25.3 ± 4 years). RESULTS Bifoveal fixation in the strabismics was transient (58.15 ± 15.7 s). Accordingly, fixational stability was analysed over the first 30 s using repeated measures anova. Post hoc analysis revealed that for the amblyopic subjects, the fixational stability of the amblyopic eye was significantly improved in aligned/high contrast (p = 0.01) and aligned/balance point (p < 0.01) conditions. Fixational stability of the fellow fixing eye was not different statistically across conditions. Bivariate contour ellipse areas of the amblyopic and fellow fixing eyes were therefore averaged for each amblyope in the four conditions and compared with normals. This averaged bivariate contour ellipse area was significantly greater (reduced fixational stability, p = 0.04) in amblyopes compared to controls except in the case of aligned and balanced contrast (aligned/balance point, p = 0.19). CONCLUSION Fixation stability in the amblyopic eye appears to improve with bifoveal fixation and reduced interocular suppression. However, once initiated, bifoveal fixation is transient with the strabismic eye drifting away from foveal alignment, thereby increasing the angle of strabismus.
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Reply: To PMID 23791414. J AAPOS 2013; 17:653. [PMID: 24321430 DOI: 10.1016/j.jaapos.2013.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 11/03/2013] [Indexed: 11/21/2022]
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Risk factors for amblyopia in the vision in preschoolers study. Ophthalmology 2013; 121:622-9.e1. [PMID: 24140117 DOI: 10.1016/j.ophtha.2013.08.040] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/14/2013] [Accepted: 08/28/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate risk factors for unilateral amblyopia and for bilateral amblyopia in the Vision in Preschoolers (VIP) study. DESIGN Multicenter, cross-sectional study. PARTICIPANTS Three- to 5-year-old Head Start preschoolers from 5 clinical centers, overrepresenting children with vision disorders. METHODS All children underwent comprehensive eye examinations, including threshold visual acuity (VA), cover testing, and cycloplegic retinoscopy, performed by VIP-certified optometrists and ophthalmologists who were experienced in providing care to children. Monocular threshold VA was tested using a single-surround HOTV letter protocol without correction, and retested with full cycloplegic correction when retest criteria were met. Unilateral amblyopia was defined as an interocular difference in best-corrected VA of 2 lines or more. Bilateral amblyopia was defined as best-corrected VA in each eye worse than 20/50 for 3-year-olds and worse than 20/40 for 4- to 5-year-olds. MAIN OUTCOME MEASURES Risk of amblyopia was summarized by the odds ratios and their 95% confidence intervals estimated from logistic regression models. RESULTS In this enriched sample of Head Start children (n = 3869), 296 children (7.7%) had unilateral amblyopia, and 144 children (3.7%) had bilateral amblyopia. Presence of strabismus (P<0.0001) and greater magnitude of significant refractive errors (myopia, hyperopia, astigmatism, and anisometropia; P<0.00001 for each) were associated independently with an increased risk of unilateral amblyopia. Presence of strabismus, hyperopia of 2.0 diopters (D) or more, astigmatism of 1.0 D or more, or anisometropia of 0.5 D or more were present in 91% of children with unilateral amblyopia. Greater magnitude of astigmatism (P<0.0001) and bilateral hyperopia (P<0.0001) were associated independently with increased risk of bilateral amblyopia. Bilateral hyperopia of 3.0 D or more or astigmatism of 1.0 D or more were present in 76% of children with bilateral amblyopia. CONCLUSIONS Strabismus and significant refractive errors were risk factors for unilateral amblyopia. Bilateral astigmatism and bilateral hyperopia were risk factors for bilateral amblyopia. Despite differences in selection of the study population, these results validated the findings from the Multi-Ethnic Pediatric Eye Disease Study and Baltimore Pediatric Eye Disease Study.
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Fink C, Garcia-Filion P, Borchert M. Failure of stem cell therapy to improve visual acuity in children with optic nerve hypoplasia. J AAPOS 2013; 17:490-3. [PMID: 24160969 DOI: 10.1016/j.jaapos.2013.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 06/14/2013] [Accepted: 06/26/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the effectiveness of stem cell therapy in improving visual acuity or optic nerve function in children with optic nerve hypoplasia (ONH). METHODS Subjects with ONH aged 7-17 years who voluntarily elected to undergo stem cell therapy in China were matched with controls on age, visual acuity, and communication level. Visual acuity, optic nerve size, and sensitivity to light were assessed before stem cell therapy and twice after. Controls were evaluated on the same schedule. RESULTS Two case-control pairs were enrolled. There were no clinically significant changes in pupillary constriction or optic nerve measurements in any participant eye. Improvement in visual acuity was noted in study participants regardless of treatment status. CONCLUSIONS On the basis of this small sample, there is no evidence that stem cell therapy improves visual acuity in children with ONH.
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Affiliation(s)
- Cassandra Fink
- The Vision Center, Department of Ophthalmology, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California.
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Birch EE, Subramanian V, Patel CC, Stager D. Preoperative visual acuity and contrast sensitivity in children with small, partial, or non-central cataracts. J AAPOS 2013; 17:357-62. [PMID: 23993715 PMCID: PMC3775336 DOI: 10.1016/j.jaapos.2013.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 02/27/2013] [Accepted: 03/26/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND While there is clear evidence that dense central cataracts >3 mm diameter warrant prompt intervention to prevent deprivation amblyopia, guidelines for management of small, partial and non-central cataracts are not evidence-based. Consensus guidelines advise managing affected infants and preschool children by monitoring for possible progression in size or density and pharmacologic pupillary dilation, if indicated. Extraction is deemed necessary if the cataract progresses sufficiently to obscure the visual axis or if strabismus or nystagmus develops. We evaluated the long-term visual acuity outcome of the consensus guidelines and whether sensory testing during infancy and early childhood may be helpful in guiding treatment. METHODS A total of 40 consecutive children diagnosed with small, partial, or non-central cataracts at 1 week to 2.5 years of age were enrolled in a prospective study of forced-choice preferential looking visual acuity and contrast sensitivity development. Long-term visual acuity outcome was assessed by crowded HOTV or ETDRS at 4-11 years. RESULTS Of the 40 children managed by consensus guidelines, 24 (60%) had abnormal visual acuity at 4-11 years of age, including 9 (23%) who had moderate to severe visual impairment (20/80 or worse) in 1 or both eyes. Abnormal visual acuity and contrast sensitivity during development were predictive of abnormal long-term visual acuity outcomes. CONCLUSIONS Visual acuity and contrast sensitivity tests were sensitive to the effects of visual deprivation on the developing visual system and may be useful in early identification of children with small, partial, or non-central cataracts who could benefit from cataract extraction.
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Affiliation(s)
- Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas 75231, USA.
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Anjos T, Altmäe S, Emmett P, Tiemeier H, Closa-Monasterolo R, Luque V, Wiseman S, Pérez-García M, Lattka E, Demmelmair H, Egan B, Straub N, Szajewska H, Evans J, Horton C, Paus T, Isaacs E, van Klinken JW, Koletzko B, Campoy C. Nutrition and neurodevelopment in children: focus on NUTRIMENTHE project. Eur J Nutr 2013; 52:1825-42. [PMID: 23884402 DOI: 10.1007/s00394-013-0560-4] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 07/11/2013] [Indexed: 02/03/2023]
Abstract
There is growing evidence that early nutrition affects later cognitive performance. The idea that the diet of mothers, infants, and children could affect later mental performance has major implications for public health practice and policy development and for our understanding of human biology as well as for food product development, economic progress, and future wealth creation. To date, however, much of the evidence is from animal, retrospective studies and short-term nutritional intervention studies in humans. The positive effect of micronutrients on health, especially of pregnant women eating well to maximise their child's cognitive and behavioural outcomes, is commonly acknowledged. The current evidence of an association between gestational nutrition and brain development in healthy children is more credible for folate, n-3 fatty acids, and iron. Recent findings highlight the fact that single-nutrient supplementation is less adequate than supplementation with more complex formulae. However, the optimal content of micronutrient supplementation and whether there is a long-term impact on child's neurodevelopment needs to be investigated further. Moreover, it is also evident that future studies should take into account genetic heterogeneity when evaluating nutritional effects and also nutritional recommendations. The objective of the present review is to provide a background and update on the current knowledge linking nutrition to cognition and behaviour in children, and to show how the large collaborative European Project NUTRIMENTHE is working towards this aim.
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Affiliation(s)
- Tania Anjos
- Department of Pediatrics, School of Medicine, University of Granada, Granada, Spain
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Reliability and validity of an automated computerized visual acuity and stereoacuity test in children using an interactive video game. Am J Ophthalmol 2013; 156:195-201.e1. [PMID: 23582763 DOI: 10.1016/j.ajo.2013.02.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 02/26/2013] [Accepted: 02/26/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the test-retest reliability and validity of the new automated computerized distance visual acuity and stereoacuity test for children, which uses an interactive video game. DESIGN Retrospective, observational case series. METHODS A total of 102 children aged between 3 and 7 years underwent the Snellen visual acuity test, the Distance Randot Stereotest, and the new automated computerized distance visual acuity and stereoacuity test. The test-retest reliability and validity of the automated computerized tests were assessed and compared with the Snellen visual acuity test and the Distance Randot Stereotest with frequency distributions of the differences, Bland-Altman plots, and Deming regression. RESULTS The automated computerized distance visual acuity test had high test-retest reliability (95% limits of agreement ±0.18 logMAR, 90.0% of the differences within 0.2 logMAR) and acceptable validity as compared with the Snellen visual acuity chart (95% limits of agreement ±0.27 logMAR, 81.3% of the differences within 0.2 logMAR). The automated computerized distance stereoacuity test had high test-retest reliability (95% limits of agreement ±0.29 log arc second, 95.1% of the differences within 0.3 log arc second) and acceptable validity as compared with the Distance Randot Stereotest (95% limits of agreement ±0.35 log arc second, 93.9% of the differences within 0.3 log arc second). CONCLUSIONS The new automated computerized distance visual acuity and stereoacuity test, which uses an interactive video game, has good reliability and acceptable validity compared with the Snellen visual acuity chart and the Distance Randot Stereotest.
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Barrett BT, Bradley A, Candy TR. The relationship between anisometropia and amblyopia. Prog Retin Eye Res 2013; 36:120-58. [PMID: 23773832 DOI: 10.1016/j.preteyeres.2013.05.001] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 05/17/2013] [Accepted: 05/23/2013] [Indexed: 01/28/2023]
Abstract
This review aims to disentangle cause and effect in the relationship between anisometropia and amblyopia. Specifically, we examine the literature for evidence to support different possible developmental sequences that could ultimately lead to the presentation of both conditions. The prevalence of anisometropia is around 20% for an inter-ocular difference of 0.5D or greater in spherical equivalent refraction, falling to 2-3%, for an inter-ocular difference of 3D or above. Anisometropia prevalence is relatively high in the weeks following birth, in the teenage years coinciding with the onset of myopia and, most notably, in older adults starting after the onset of presbyopia. It has about one-third the prevalence of bilateral refractive errors of the same magnitude. Importantly, the prevalence of anisometropia is higher in highly ametropic groups, suggesting that emmetropization failures underlying ametropia and anisometropia may be similar. Amblyopia is present in 1-3% of humans and around one-half to two-thirds of amblyopes have anisometropia either alone or in combination with strabismus. The frequent co-existence of amblyopia and anisometropia at a child's first clinical examination promotes the belief that the anisometropia has caused the amblyopia, as has been demonstrated in animal models of the condition. In reviewing the human and monkey literature however it is clear that there are additional paths beyond this classic hypothesis to the co-occurrence of anisometropia and amblyopia. For example, after the emergence of amblyopia secondary to either deprivation or strabismus, anisometropia often follows. In cases of anisometropia with no apparent deprivation or strabismus, questions remain about the failure of the emmetropization mechanism that routinely eliminates infantile anisometropia. Also, the chronology of amblyopia development is poorly documented in cases of 'pure' anisometropic amblyopia. Although indirect, the therapeutic impact of refractive correction on anisometropic amblyopia provides strong support for the hypothesis that the anisometropia caused the amblyopia. Direct evidence for the aetiology of anisometropic amblyopia will require longitudinal tracking of at-risk infants, which poses numerous methodological and ethical challenges. However, if we are to prevent this condition, we must understand the factors that cause it to develop.
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Affiliation(s)
- Brendan T Barrett
- School of Optometry & Vision Science, University of Bradford, Richmond Road, Bradford BD7 1DP, United Kingdom.
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121
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A randomized trial of increasing patching for amblyopia. Ophthalmology 2013; 120:2270-7. [PMID: 23755872 DOI: 10.1016/j.ophtha.2013.04.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 04/04/2013] [Accepted: 04/08/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE After treatment with refractive correction and patching, some patients have residual amblyopia resulting from strabismus or anisometropia. We conducted a clinical trial to evaluate the effectiveness of increasing prescribed daily patching from 2 to 6 hours in children with stable residual amblyopia. DESIGN Prospective, randomized, multicenter clinical trial. PARTICIPANTS A total of 169 children aged 3 to <8 years (mean, 5.9 years) with stable residual amblyopia (20/32-20/160) after 2 hours of daily patching for at least 12 weeks. INTERVENTION Random assignment to continue 2 hours of daily patching or increase patching time to an average of 6 hours/day. MAIN OUTCOME MEASURES Best-corrected visual acuity (VA) in the amblyopic eye after 10 weeks. RESULTS Baseline VA was 0.44 logarithm of the minimum angle of resolution (logMAR) (20/50(-2)). Ten weeks after randomization, amblyopic eye VA had improved an average of 1.2 lines in the 6-hour group and 0.5 line in the 2-hour group (difference in mean VA adjusted for acuity at randomization = 0.6 line; 95% confidence interval, 0.3-1.0; P = 0.002). Improvement of 2 or more lines occurred in 40% of participants patched for 6 hours versus 18% of those who continued to patch for 2 hours (P = 0.003). CONCLUSIONS When amblyopic eye VA stops improving with 2 hours of daily patching, increasing the daily patching dosage to 6 hours results in more improvement in VA after 10 weeks compared with continuing 2 hours daily.
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McKean-Cowdin R, Cotter SA, Tarczy-Hornoch K, Wen G, Kim J, Borchert M, Varma R. Prevalence of amblyopia or strabismus in asian and non-Hispanic white preschool children: multi-ethnic pediatric eye disease study. Ophthalmology 2013; 120:2117-24. [PMID: 23697956 DOI: 10.1016/j.ophtha.2013.03.001] [Citation(s) in RCA: 219] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 02/28/2013] [Accepted: 03/01/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To determine the age- and race-specific prevalence of amblyopia in Asian and non-Hispanic white children aged 30 to 72 months and of strabismus in children aged 6 to 72 months. DESIGN Cross-sectional survey. PARTICIPANTS A population-based, multiethnic sample of children aged 6 to 72 months was identified in Los Angeles and Riverside counties in California to evaluate the prevalence of ocular conditions. METHODS A comprehensive eye examination and in-clinic interview were conducted with 80% of eligible children. The examination included evaluation of ocular alignment, refractive error, and ocular structures in children aged 6 to 72 months, as well as a determination of optotype visual acuity (VA) in children aged 30 to 72 months. MAIN OUTCOME MEASURES The proportion of 6- to 72-month-old participants with strabismus and 30- to 72-month-olds with optotype VA deficits and amblyopia risk factors consistent with study definitions of amblyopia. RESULTS Strabismus was found in 3.55% (95% confidence interval [CI], 2.68-4.60) of Asian children and 3.24% (95% CI, 2.40-4.26) of non-Hispanic white children, with a higher prevalence with each subsequent older age category from 6 to 72 months in both racial/ethnic groups (P=0.0003 and 0.02, respectively). Amblyopia was detected in 1.81% (95% CI, 1.06-2.89) of Asian and non-Hispanic white children; the prevalence of amblyopia was higher for each subsequent older age category among non-Hispanic white children (P=0.01) but showed no significant trend among Asian children (P=0.30). CONCLUSIONS The prevalence of strabismus was similar in Asian and non-Hispanic white children and was found to be higher among older children from 6 to 72 months. The prevalence of amblyopia was the same in Asian and non-Hispanic white children; prevalence seemed to be higher among older non-Hispanic white children but was relatively stable by age in Asian children. These findings may help clinicians to better understand the patterns of strabismus and amblyopia and potentially inform planning for preschool vision screening programs. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Roberta McKean-Cowdin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
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Sachdeva V, Mittal V, Kekunnaya R, Gupta A, Rao HL, Mollah J, Sontha A, Gunturu R, Rao BV. Efficacy of split hours part-time patching versus continuous hours part-time patching for treatment of anisometropic amblyopia in children: a pilot study. Br J Ophthalmol 2013; 97:874-8. [PMID: 23677988 DOI: 10.1136/bjophthalmol-2012-302978] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To compare efficacy of 'split hours part-time patching' and 'continuous hours part-time patching' for the treatment of anisometropic amblyopia. METHODS We designed a prospective, interventional, non-randomised, comparative pilot study involving children between 4 and 11 years of age with anisometropic amblyopia who were treated with either continuous wear (Group A) or split hours part-time patching (Group B) as per parents wish, after appropriate discussion with the parents. Children were followed-up for the improvement in visual acuity and the compliance at each follow-up visit. RESULTS 44 and 24 children were recruited in Group A and Group B, respectively (mean ± SD baseline BCVA of the amblyopic eye: 0.99 ± 0.32 and 0.95 ± 0.23 logMAR, respectively). BCVA (adjusted for baseline BCVA and age) at 3 months in Group A (0.59 ± 0.24) was comparable (p=0.08) with that in Group B (0.71 ± 0.24). This was same even at 6 months (0.51 ± 0.25 in Group A and 0.59 ± 0.25 in Group B, p=0.25). The improvement in BCVA at 3 months was also comparable (p=0.06) in Group A (0.39 ± 0.23) and Group B (0.26 ± 0.23). The improvement in BCVA at 6 months was also comparable (p=0.14) in Group A (0.47 ± 0.26) and Group B (0.37 ± 0.26). CONCLUSIONS Both patching regimens lead to significant and comparable improvement in BCVA in anisometropic amblyopia up to 6 months of follow-up.
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Affiliation(s)
- Virender Sachdeva
- Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Nimmagada Prasad Children's Eye Care Centre, L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
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Afsari S, Rose KA, Gole GA, Philip K, Leone JF, French A, Mitchell P. Prevalence of anisometropia and its association with refractive error and amblyopia in preschool children. Br J Ophthalmol 2013; 97:1095-9. [PMID: 23613508 DOI: 10.1136/bjophthalmol-2012-302637] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To determine the age and ethnicity-specific prevalence of anisometropia in Australian preschool-aged children and to assess in this population-based study the risk of anisometropia with increasing ametropia levels and risk of amblyopia with increasing anisometropia. METHODS A total 2090 children (aged 6-72 months) completed detailed eye examinations in the Sydney Paediatric Eye Disease Study, including cycloplegic refraction, and were included. Refraction was measured using a Canon RK-F1 autorefractor, streak retinoscopy and/or the Retinomax K-Plus 2 autorefractor. Anisometropia was defined by the spherical equivalent (SE) difference, and plus cylinder difference for any cylindrical axis between eyes. RESULTS The overall prevalence of SE and cylindrical anisometropia ≥1.0 D were 2.7% and 3.0%, for the overall sample and in children of European-Caucasian ethnicity, 3.2%, 1.9%; East-Asian 1.7%, 5.2%; South-Asian 2.5%, 3.6%; Middle-Eastern ethnicities 2.2%, 3.3%, respectively. Anisometropia prevalence was lower or similar to that in the Baltimore Pediatric Eye Disease Study, Multi-Ethnic Pediatric Eye Disease Study and the Strabismus, Amblyopia and Refractive error in Singapore study. Risk (OR) of anisometropic amblyopia with ≥1.0 D of SE and cylindrical anisometropia was 12.4 (CI 4.0 to 38.4) and 6.5 (CI 2.3 to 18.7), respectively. We found an increasing risk of anisometropia with higher myopia ≥-1.0 D, OR 61.6 (CI 21.3 to 308), hyperopia > +2.0 D, OR 13.6 (CI 2.9 to 63.6) and astigmatism ≥1.5 D, OR 30.0 (CI 14.5 to 58.1). CONCLUSIONS In this preschool-age population-based sample, anisometropia was uncommon with inter-ethnic differences in cylindrical anisometropia prevalence. We also quantified the rising risk of amblyopia with increasing SE and cylindrical anisometropia, and present the specific levels of refractive error and associated increasing risk of anisometropia.
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Affiliation(s)
- Sonia Afsari
- Department of Ophthalmology, Westmead Millennium Institute, Centre for Vision Research, University of Sydney, New South Wales, Australia
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Prevalence and causes of visual impairment in Asian and non-Hispanic white preschool children: Multi-ethnic Pediatric Eye Disease Study. Ophthalmology 2013; 120:1220-6. [PMID: 23561327 DOI: 10.1016/j.ophtha.2012.12.029] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 11/15/2012] [Accepted: 11/28/2012] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine the prevalence and causes of decreased visual acuity (VA). DESIGN Population-based cross-sectional study. PARTICIPANTS Multi-ethnic sample of children 30 to 72 months of age identified in Los Angeles. METHODS All eligible children underwent a comprehensive ophthalmic evaluation including monocular VA testing, cover testing, cycloplegic autorefraction, fundus evaluation, and VA retesting with refractive correction. Decreased VA was defined as presenting or best-measured VA worse than 20/50 in children 30 to 47 months of age and worse than 20/40 for children 48 months of age and older. The prevalence and causes of decreased VA were determined, for both presenting and best-measured VA, in the better-seeing and the worse-seeing eyes. MAIN OUTCOME MEASURES Prevalence and causes of decreased vision. RESULTS Presenting VA was assessed in 1840 children and best-measured VA was assessed in 1886 children. Presenting VA was decreased in the worse eye of 4.2% of Asian children and of 3.6% of non-Hispanic white (NHW) children. Close to one-fourth of these cases had no identifiable cause, and 81% of these resolved on retesting. Decreased presenting VA in the worse eye with an identifiable ophthalmic cause was present in 3.4% of Asian children and in 2.6% of NHW children. Decreased presenting VA attributable to simple refractive error (myopia ≥ 0.5 diopters [D]; hyperopia ≥ 3.0 D; astigmatism ≥ 2.0 D or ≥ 1.5 D for children older than 36 months) was present in the worse eye of 2.3% of Asian children and of 1.4% of NHW children and in the better eye of 0.5% of Asian children and of 0.3% of NHW children. Decreased best-measured VA attributable to a cause was present in the worse eye of 1.2% of both Asian children and NHW children and in the better eye of 0.2% of Asian and of 0.3% of NHW children. Amblyopia related to refractive error was the most common cause, and was 10 times as common as ocular disease. Severe visual impairment was rare. CONCLUSIONS Seventy percent of all decreased VA in Asian and NHW preschool children and more than 90% of decreased VA with an identifiable cause is related to refractive error--either uncorrected refractive error or amblyopia resulting from refractive error. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Clinical Translation of Recommendations from Randomized Clinical Trials on Patching Regimen for Amblyopia. Ophthalmology 2013; 120:657-62. [PMID: 23395531 DOI: 10.1016/j.ophtha.2012.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 09/04/2012] [Accepted: 09/11/2012] [Indexed: 11/21/2022] Open
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Subramanian V, Jost RM, Birch EE. A quantitative study of fixation stability in amblyopia. Invest Ophthalmol Vis Sci 2013; 54:1998-2003. [PMID: 23372053 DOI: 10.1167/iovs.12-11054] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine whether fixation instability contributes to reduced visual acuity in amblyopia, we compared fixation instability, quantified by the Nidek MP-1 microperimeter, in amblyopic and nonamblyopic children. METHODS Participants were 89 children (5-17 years old) with strabismus (n = 31), anisometropia (n = 29), or both conditions (n = 29). Fixation instability was measured using the Nidek MP-1 microperimeter, which calculated horizontal and vertical eye position at 25 Hz as the child attempted steady fixation for 30 seconds. Fixation instability was quantified as the 95% bivariate contour ellipse area (95% BCEA), the best-fit ellipse within which 95% of fixation occurred during the 30-second test. BCEA was normalized by log transformation. RESULTS Children with amblyopia had significantly larger BCEAs for amblyopic eyes (mean = 0.56 log deg(2)) than fellow eyes (mean = 0.2 log deg(2), P < 0.01) and right eyes of normal controls (mean = 0.12 log deg(2), P ≤ 0.01). Fixation instability was significantly greater along the horizontal axis of the ellipse for amblyopic (mean = 3.53°) than fellow (mean = 1.98°, P = 0.008), and control (mean = 1.62°, P < 0.001) eyes. CONCLUSIONS Fixation instability in amblyopic eyes of children with strabismus and/or anisometropia, and the associated poor stereoacuity probably is the consequence of decorrelated binocular experience early in life. Longer duration of decorrelated visual experience is associated with increased fixation instability, poorer stereoacuity, and more severe amblyopia. Treatments that minimize the duration of decorrelated visual experience may improve stereoacuity and decrease fixation instability.
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Associations of anisometropia with unilateral amblyopia, interocular acuity difference, and stereoacuity in preschoolers. Ophthalmology 2012; 120:495-503. [PMID: 23174398 DOI: 10.1016/j.ophtha.2012.08.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 08/07/2012] [Accepted: 08/07/2012] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the relationship of anisometropia with unilateral amblyopia, interocular acuity difference (IAD), and stereoacuity among Head Start preschoolers using both clinical notation and vector notation analyses. DESIGN Multicenter, cross-sectional study. PARTICIPANTS Three- to 5-year-old participants in the Vision in Preschoolers (VIP) study (n = 4040). METHODS Secondary analysis of VIP data from participants who underwent comprehensive eye examinations, including monocular visual acuity testing, stereoacuity testing, and cycloplegic refraction. Visual acuity was retested with full cycloplegic correction when retest criteria were met. Unilateral amblyopia was defined as IAD of 2 lines or more in logarithm of the minimum angle of resolution (logMAR) units. Anisometropia was defined as a 0.25-diopter (D) or more difference in spherical equivalent (SE) or in cylinder power and 2 approaches using power vector notation. The percentage with unilateral amblyopia, mean IAD, and mean stereoacuity were compared between anisometropic and isometropic children. MAIN OUTCOMES MEASURES The percentage with unilateral amblyopia, mean IAD, and mean stereoacuity. RESULTS Compared with isometropic children, anisometropic children had a higher percentage of unilateral amblyopia (8% vs. 2%), larger mean IAD (0.07 vs. 0.05 logMAR), and worse mean stereoacuity (145 vs. 117 arc sec; all P<0.0001). Larger amounts of anisometropia were associated with higher percentages of unilateral amblyopia, larger IAD, and worse stereoacuity (P<0.001 for trend). The percentage of unilateral amblyopia increased significantly with SE anisometropia of more than 0.5 D, cylindrical anisometropia of more than 0.25 D, vertical and horizontal meridian (J0) or oblique meridian (J45) of more than 0.125 D, or vector dioptric distance of more than 0.35 D (all P<0.001). Vector dioptric distance had greater ability to detect unilateral amblyopia than cylinder, SE, J0, or J45 (P<0.001). CONCLUSIONS The presence and amount of anisometropia were associated with the presence of unilateral amblyopia, larger IAD, and worse stereoacuity. The threshold level of anisometropia at which unilateral amblyopia became significant was lower than current guidelines. Vector dioptric distance is more accurate than spherical equivalent anisometropia or cylindrical anisometropia in identifying preschoolers with unilateral amblyopia.
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Rine RM, Roberts D, Corbin BA, McKean-Cowdin R, Varma R, Beaumont J, Slotkin J, Schubert MC. New portable tool to screen vestibular and visual function--National Institutes of Health Toolbox initiative. ACTA ACUST UNITED AC 2012; 49:209-20. [PMID: 22773523 DOI: 10.1682/jrrd.2010.12.0239] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As part of the National Institutes of Health Toolbox initiative, we developed a low-cost, easy-to-administer, and time-efficient test of vestibular and visual function. A computerized test of dynamic visual acuity (cDVA) was used to measure the difference in visual acuity between head still and moving in yaw. Participants included 318 individuals, aged 3 to 85 years (301 without and 17 with vestibular pathology). Adults used Early Treatment of Diabetic Retinopathy Study (ETDRS) optotypes; children used ETDRS, Lea, and HOTV optotypes. Bithermal calorics, rotational chair, and light box testing were used to validate the cDVA. Analysis revealed that the cDVA test is reliable for static (intraclass correlation coefficient [ICC] >/= 0.64) and dynamic (ICC >/= 0.43-0.75) visual acuity. Children younger than 6 years old were more likely to complete cDVA with Lea optotypes, but reliability and correlation with ETDRS was better using HOTV optotypes. The high correlation between static acuity and light box test scores (r = 0.795), significant difference of cDVA scores between those with and without pathology (p </= 0.04), and the good to excellent sensitivity (73%) and specificity (69%) establish that the cDVA is a valid and reliable measure of visual acuity when the head is still and moving, as well as a good proxy of vestibular function to yaw rotation.
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Effect of ocular alignment on emmetropization in children <10 years with amblyopia. Am J Ophthalmol 2012; 154:297-302.e1. [PMID: 22633344 DOI: 10.1016/j.ajo.2012.02.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 02/24/2012] [Accepted: 02/28/2012] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine whether change in refractive error is associated with ocular alignment in 105 children 3 to <7 years of age who previously participated in a randomized trial comparing atropine and patching for moderate amblyopia. DESIGN Prospective cohort study. METHODS One hundred five children 3 to <7 years of age previously participated in a randomized trial comparing atropine with patching for moderate amblyopia. Cycloplegic refraction was measured at baseline and 10 years of age. Ocular alignment at baseline was categorized as orthotropic, microtropic (1-8 Δ horizontal tropia), or heterotropic (>8 Δ horizontal tropia). Multivariate regression models evaluated whether change in spherical equivalent refractive error was associated with alignment category, after adjusting for age, baseline spherical equivalent refractive error, and type of amblyopia treatment. RESULTS Between enrollment and the age 10-year examination, there was a decrease in spherical equivalent refractive error from hyperopia to less hyperopia (amblyopic eye: -0.65 diopter, 95% CI -0.85, -0.46; fellow eye: -0.39 diopter, 95% CI -0.58, -0.20). A greater decrease in amblyopic eye refractive error was associated with better ocular alignment category (P = .004), with the greatest decrease occurring in orthotropic patients. There was no relationship between ocular alignment category and change in fellow-eye refractive error. CONCLUSIONS Among children treated for anisometropic, strabismic, or combined mechanism amblyopia, there is a decrease in amblyopic eye spherical equivalent refractive error to less hyperopia after controlling for baseline refractive error. This negative shift toward emmetropia is associated with ocular alignment, which supports the suggestion that better motor and sensory fusion promote emmetropization.
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131
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Leone JF, Gole GA, Mitchell P, Kifley A, Pai ASI, Rose KA. Visual acuity testability and comparability in Australian preschool children: the Sydney Paediatric Eye Disease Study. Eye (Lond) 2012; 26:925-32. [PMID: 22498798 DOI: 10.1038/eye.2012.60] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To establish standardised protocols for vision screening, testability and comparability of three different vision tests were examined in a population-based, cross-sectional sample of preschool children (Sydney Paediatric Eye Disease Study). METHODS Measurement of presenting monocular distance visual acuity (VA) using the Amblyopia Treatment Study (ATS) HOTV protocol, was attempted by all (1774) children aged≥24 months. In addition, in children aged≥60 months (576), VA was also tested using the logMAR retro-illuminated HOTV or Early Treatment Diabetic Retinopathy Study (ETDRS) linear charts (CSV 1000). Children able to have both eyes tested monocularly were considered. RESULTS Testability significantly increased with age for all VA tests. The ATS HOTV with an overall testability of 80% (females: 82%, males: 78%) was the most testable of the VA tests (P<0.0001). In children aged <3 years testability was low (≤47%) rising to≥80% in children aged≥3. In children≥60 months, testability was higher for the HOTV (94%) than the ETDRS (59%) chart. In those that did two VA tests, mean difference of the ATS HOTV compared with the HOTV(CSV) was -0.1, and compared with ETDRS was -0.12 (P<0.0001). CONCLUSIONS Children aged <3 years had poor VA testability, whereas those 3 years and above were highly testable using the ATS HOTV. The HOTV (CSV) retro-illuminated test was appropriate for children aged >5 years, and may be possible in younger children with early educational exposure. When comparing VA measures using these tests, the higher VA attained using the ATS HOTV, needs to be taken into account.
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Affiliation(s)
- J F Leone
- Discipline of Orthoptics, The University of Sydney, Lidcombe, NSW, Australia
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The prevalence of ocular structural disorders and nystagmus among preschool-aged children. J AAPOS 2012; 16:182-4. [PMID: 22525177 PMCID: PMC3343741 DOI: 10.1016/j.jaapos.2011.12.156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 11/07/2011] [Accepted: 12/14/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE To describe the prevalence of structural disorders of the eye and nystagmus in preschool-aged children. METHODS Population-based evaluation of children 6 months through 71 months of age in Baltimore, Maryland, United States. RESULTS Among 4,132 children identified from 54 census tracts, 3,990 eligible children (97%) were enrolled and 2,546 children (62%) were examined. Structural disorders were found in 41 children and nystagmus in 9 children for an overall prevalence of 1.96% (95% CI, 1.46%-2.59%). Only 11 (0.43%; 95% CI, 0.22%-0.77%) had vision loss in at least one eye, most often due to posterior segment disease. CONCLUSIONS Structural ocular abnormalities and nystagmus combined are present in nearly 2% of preschool-aged children in this population-based study. Vision loss due to these abnormalities is uncommon.
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Uncorrected refractive error among first-grade students of different racial/ethnic groups in southern California: results a year after school-mandated vision screening. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2012; 17:499-505. [PMID: 21964359 DOI: 10.1097/phh.0b013e3182113891] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT The California Department of Education requires that kindergartners receive vision screening in preparation for school. Information is not available in the literature, however, on the prevalence of and factors associated with uncorrected refractive error (ie, the lack of eyeglasses), which is the primary cause of decreased visual acuity in children, among first-grade students of different racial/ethnic groups in California. OBJECTIVE To determine the proportion of first-grade students with decreased visual acuity who need eyeglasses but do not have any and whether the lack of eyeglasses is associated with racial/ethnic and other factors. SETTING Three school districts in Southern California. PARTICIPANTS The University of California, Los Angeles Mobile Eye Clinic examined the eyes of 11 332 first-grade students over a 7-year period. Statistical analyses included adjusted logistic regression and linear trend models. FINDINGS Among 11 332 first-grade students, 6973 (61.5%) were Latino, 1511 (13.3%) were Asian/Pacific Islander, 1422 (12.5%) were African American, 310 (2.7%) were non-Hispanic white, and 1116 (9.8%) were from other or mixed races/ethnicities. The prevalence of decreased visual acuity was 8.0%; 95% of children with decreased visual acuity (858 of 906 children) lacked eyeglasses that would have helped them attain normal vision. The lack of eyeglasses was more common in boys and African American/Latino children compared with that in girls and non-Hispanic white children, respectively. The percentage of children lacking eyeglasses over the years exhibited an increasing linear trend (R = 0.86). CONCLUSIONS Most first-grade students with decreased visual acuity, especially African American and Latino children, need eyeglasses but do not have any. Interventions to correct decreased visual acuity in first-grade students are important because the first grade is a period of critical academic development.
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Kumar A, Shetty S, Vijayalakshmi P, Hertle RW. Improvement in visual acuity following surgery for correction of head posture in infantile nystagmus syndrome. J Pediatr Ophthalmol Strabismus 2011; 48:341-6. [PMID: 21261243 DOI: 10.3928/01913913-20110118-02] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 11/23/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the effect of the abnormal head posture (AHP) correcting procedures on the visual acuity improvement in patients with infantile nystagmus syndrome (INS) and the visual acuity improvement outcomes in different AHP correcting surgeries in INS. METHODS This was a prospective, non-randomized, interventional study. Twenty-eight patients underwent the Anderson-Kestenbaum procedure or the modified Anderson procedure with or without tenotomy of at least one horizontal recti for correction of AHP. Best-corrected binocular null zone acuity and degree of AHP was recorded preoperatively and compared with those done 1 month postoperatively. RESULTS The average null zone logarithm of the minimum angle of resolution acuity was 0.42 preoperatively, which improved significantly to 0.33 postoperatively (P = .002). The AHP ranged from 10° to 40° (mean: 20.89°), which improved significantly to a mean of 3.21° (P = .000). No significant difference (P = .65) was found in the visual acuity improvement among patients who underwent the Anderson-Kestenbaum procedure or the modified Anderson procedure with or without tenotomy. No significant difference in the visual acuity improvement was seen in patients who underwent tenotomy of at least one horizontal rectus muscle along with the modified Anderson procedure compared to those who underwent the modified Anderson procedure alone (P = .28). CONCLUSION The procedures used mainly for correction of AHP in INS do yield significant improvement in the visual acuity. This improvement is seen in patients undergoing surgery for both horizontal and vertical AHP.
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Affiliation(s)
- Anand Kumar
- Department of Pediatric Ophthalmology and Strabismus, Bombay City Eye Institute and Research Centre, Mumbai, India
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Holmes JM, Lazar EL, Melia BM, Astle WF, Dagi LR, Donahue SP, Frazier MG, Hertle RW, Repka MX, Quinn GE, Weise KK. Effect of age on response to amblyopia treatment in children. ARCHIVES OF OPHTHALMOLOGY (CHICAGO, ILL. : 1960) 2011; 129:1451-7. [PMID: 21746970 PMCID: PMC3217111 DOI: 10.1001/archophthalmol.2011.179] [Citation(s) in RCA: 203] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine whether age at initiation of treatment for amblyopia influences the response among children 3 to less than 13 years of age with unilateral amblyopia who have 20/40 to 20/400 amblyopic eye visual acuity. METHODS A meta-analysis of individual subject data from 4 recently completed randomized amblyopia treatment trials was performed to evaluate the relationship between age and improvement in logMAR amblyopic eye visual acuity. Analyses were adjusted for baseline amblyopic eye visual acuity, spherical equivalent refractive error in the amblyopic eye, type of amblyopia, prior amblyopia treatment, study treatment, and protocol. Age was categorized (3 to <5 years, 5 to <7 years, and 7 to <13 years) because there was a nonlinear relationship between age and improvement in amblyopic eye visual acuity. RESULTS Children from 7 to less than 13 years of age were significantly less responsive to treatment than were younger age groups (children from 3 to <5 years of age or children from 5 to <7 years of age) for moderate and severe amblyopia (P < .04 for all 4 comparisons). There was no difference in treatment response between children 3 to less than 5 years of age and children 5 to less than 7 years of age for moderate amblyopia (P = .67), but there was a suggestion of greater responsiveness in children 3 to less than 5 years of age compared with children 5 to less than 7 years of age for severe amblyopia (P = .09). CONCLUSIONS Amblyopia is more responsive to treatment among children younger than 7 years of age. Although the average treatment response is smaller in children 7 to less than 13 years of age, some children show a marked response to treatment.
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Affiliation(s)
- Jonathan M Holmes
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.
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Wallace DK, Lazar EL, Melia M, Birch EE, Holmes JM, Hopkins KB, Kraker RT, Kulp MT, Pang Y, Repka MX, Tamkins SM, Weise KK. Stereoacuity in children with anisometropic amblyopia. J AAPOS 2011; 15:455-61. [PMID: 22108357 PMCID: PMC3223370 DOI: 10.1016/j.jaapos.2011.06.007] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 06/08/2011] [Accepted: 06/14/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine factors associated with pretreatment and posttreatment stereoacuity in subjects with moderate anisometropic amblyopia. METHODS Data for subjects enrolled in seven studies conducted by the Pediatric Eye Disease Investigator Group were pooled. The sample included 633 subjects aged 3 to <18 years with anisometropic amblyopia, no heterotropia observed by cover test, and baseline amblyopic eye acuity of 20/100 or better. A subset included 248 subjects who were treated with patching or Bangerter filters and had stereoacuity testing at both the baseline and outcome examinations. Multivariate regression models identified factors associated with baseline stereoacuity and with outcome stereoacuity as measured by the Randot Preschool Stereoacuity test. RESULTS Better baseline stereoacuity was associated with better baseline amblyopic eye acuity (P < 0.001), less anisometropia (P = 0.03), and anisometropia due to astigmatism alone (P < 0.001). Better outcome stereoacuity was associated with better baseline stereoacuity (P < 0.001) and better amblyopic eye acuity at outcome (P < 0.001). Among 48 subjects whose amblyopic eye visual acuity at outcome was 20/25 or better and within one line of the fellow eye, stereoacuity was worse than that of children with normal vision of the same age. CONCLUSIONS In children with anisometropic amblyopia of 20/40 to 20/100 inclusive, better posttreatment stereoacuity is associated with better baseline stereoacuity and better posttreatment amblyopic eye acuity. Even if their visual acuity deficit resolves, many children with anisometropic amblyopia have stereoacuity worse than that of nonamblyopic children of the same age.
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Cotter SA, Foster NC, Holmes JM, Melia BM, Wallace DK, Repka MX, Tamkins SM, Kraker RT, Beck RW, Hoover DL, Crouch ER, Miller AM, Morse CL, Suh DW. Optical treatment of strabismic and combined strabismic-anisometropic amblyopia. Ophthalmology 2011; 119:150-8. [PMID: 21959371 DOI: 10.1016/j.ophtha.2011.06.043] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 06/28/2011] [Accepted: 06/29/2011] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To determine visual acuity improvement in children with strabismic and combined strabismic-anisometropic (combined-mechanism) amblyopia treated with optical correction alone and to explore factors associated with improvement. DESIGN Prospective, multicenter, cohort study. PARTICIPANTS We included 146 children 3 to <7 years old with previously untreated strabismic amblyopia (n = 52) or combined-mechanism amblyopia (n = 94). METHODS Optical treatment was provided as spectacles (prescription based on a cycloplegic refraction) that were worn for the first time at the baseline visit. Visual acuity with spectacles was measured using the Amblyopia Treatment Study HOTV visual acuity protocol at baseline and every 9 weeks thereafter until no further improvement in visual acuity. Ocular alignment was assessed at each visit. MAIN OUTCOME MEASURES Visual acuity 18 weeks after baseline. RESULTS Overall, amblyopic eye visual acuity improved a mean of 2.6 lines (95% confidence interval [CI], 2.3-3.0), with 75% of children improving ≥ 2 lines and 54% improving ≥ 3 lines. Resolution of amblyopia occurred in 32% (95% CI, 24%-41%) of the children. The treatment effect was greater for strabismic amblyopia than for combined-mechanism amblyopia (3.2 vs 2.3 lines; adjusted P = 0.003). Visual acuity improved regardless of whether eye alignment improved. CONCLUSIONS Optical treatment alone of strabismic and combined-mechanism amblyopia results in clinically meaningful improvement in amblyopic eye visual acuity for most 3- to <7-year-old children, resolving in at least one quarter without the need for additional treatment. Consideration should be given to prescribing refractive correction as the sole initial treatment for children with strabismic or combined-mechanism amblyopia before initiating other therapies. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
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Affiliation(s)
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- Southern California College of Optometry, Fullerton, California, USA.
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Astle AT, Webb BS, McGraw PV. The pattern of learned visual improvements in adult amblyopia. Invest Ophthalmol Vis Sci 2011; 52:7195-204. [PMID: 21810976 DOI: 10.1167/iovs.11-7584] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Although amblyopia is diagnosed in terms of a monocular letter acuity loss, individuals typically present with deficits on a wide range of spatial tasks. Many of these deficits can be collapsed along two basic visual dimensions (visual acuity and contrast sensitivity) that together account for most of the variability in performance of the amblyopic visual system. In this study, this space was exploited, to target the main deficits and fully characterize the pattern of learned visual improvements in adult amblyopic subjects. METHODS Twenty-six amblyopic subjects (mean age, 39 ±12 years) were trained on one of four tasks, categorized as either visual acuity (letter or grating acuity) or contrast sensitivity (letter or grating contrast) tasks. Performance was measured on all tasks before and after training, to quantify learning along each dimension and generalization to the other dimension. Performance in 35 visually normal subjects (mean, age 24 ± 5 years) was used to establish normal variation in visual performance along each dimension, against which the learned improvements in amblyopic subjects was compared. RESULTS Training on the contrast sensitivity tasks produced substantial within-task learning and generalization to measures of visual acuity. The learned improvements in performance after training on the letter acuity task were also substantial, but did not generalize to contrast sensitivity. CONCLUSIONS Mapping the pattern of learning onto the known deficit space for amblyopia enabled the identification of tasks and stimulus configurations that optimized learning, guiding further development of learning-based interventions in this clinical group.
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Affiliation(s)
- Andrew T Astle
- Visual Neuroscience Group, School of Psychology, University of Nottingham, Nottingham, United Kingdom.
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McKean-Cowdin R, Varma R, Cotter SA, Tarczy-Hornoch K, Borchert MS, Lin JH, Wen G, Azen SP, Torres M, Tielsch JM, Friedman DS, Repka MX, Katz J, Ibironke J, Giordano L. Risk factors for astigmatism in preschool children: the multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies. Ophthalmology 2011; 118:1974-81. [PMID: 21856010 DOI: 10.1016/j.ophtha.2011.06.031] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 06/23/2011] [Accepted: 06/23/2011] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To evaluate risk factors for astigmatism in a population-based sample of preschool children. DESIGN Population-based cross-sectional study. PARTICIPANTS Population-based samples of 9970 children ages 6 to 72 months from Los Angeles County, California, and Baltimore, Maryland. METHODS A cross-sectional study of children participating in the Multiethnic Pediatric Eye Disease Study and the Baltimore Eye Disease Study was completed. Data were obtained by clinical examination or by in-person interview. Odds ratios and 95% confidence intervals (CI) were calculated to evaluate potential associations between clinical, behavioral, or demographic factors and astigmatism. MAIN OUTCOME MEASURES Odds ratios (ORs) for various risk factors associated with astigmatism. RESULTS Participants with myopia (≤-1.0 diopters) were 4.6 times as likely to have astigmatism (95% CI, 3.56-5.96) than those without refractive error, whereas participants with hyperopia (≥+2.00 diopters) were 1.6 times as likely (95% CI, 1.39-1.94). Children 6 to <12 months of age were approximately 3 times as likely to have astigmatism than children 5 to 6 years of age (95% CI, 2.28-3.73). Both Hispanic (OR, 2.38) and African-American (OR, 1.47) children were as likely to have astigmatism than non-Hispanic white children. Furthermore, children whose mothers smoked during pregnancy were 1.46 times (95% CI, 1.14-1.87) as likely to have astigmatism than children whose mothers did not smoke. CONCLUSIONS In addition to infancy, Hispanic and African-American race/ethnicity and correctable/modifiable risk factors such as myopia, hyperopia, and maternal smoking during pregnancy are associated with a higher risk of having astigmatism. Although the prevalence of smoking during pregnancy is typically low, this association may suggest etiologic pathways for future investigation. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
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Affiliation(s)
- Roberta McKean-Cowdin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Risk factors for decreased visual acuity in preschool children: the multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies. Ophthalmology 2011; 118:2262-73. [PMID: 21856014 DOI: 10.1016/j.ophtha.2011.06.033] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 06/23/2011] [Accepted: 06/23/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To investigate risk factors associated with unilateral or bilateral decreased visual acuity (VA) in preschool children. DESIGN Population-based, cross-sectional prevalence study. PARTICIPANTS Population-based samples of 6504 children ages 30 to 72 months from California and Maryland. METHODS Participants were preschool African-American, Hispanic, and non-Hispanic white children from Los Angeles, California, and Baltimore, Maryland. Data were obtained by a parental interview and a detailed ocular examination. Logistic regression models were used to evaluate the independent associations between demographic, behavioral, and clinical risk factors with unilateral and bilateral decreased VA. MAIN OUTCOME MEASURES Odds ratios (ORs) for various risk factors associated with interocular difference (IOD) in VA of ≥2 lines with ≤20/32 in the worse eye, or bilateral decreased VA <20/40 or <20/50 if <48 months of age. RESULTS In multivariate logistic regression analysis, 2-line IOD with a VA of ≤20/32 was independently associated with Hispanic ethnicity (OR, 2.05), esotropia (OR, 8.98), spherical equivalent (SE) anisometropia (ORs ranging between 1.5 and 39.7 for SE anisometropia ranging between 0.50 to <1.00 diopters [D] and ≥2.00 D), and aniso-astigmatism in J0 or J45 (ORs ranging between 1.4 and ≥5.3 for J0 or J45 differences ranging between 0.25 to <0.50 D and ≥1.00 D). Bilateral decreased VA was independently associated with lack of health insurance (OR, 2.9), lower primary caregiver education (OR, 1.7), astigmatism (OR, 2.3 and 17.6 for astigmatism 1.00 to <2.00 D and ≥2.00 D), and SE hyperopia ≥4.00 D (OR, 10.8). CONCLUSIONS Anisometropia and esotropia are risk factors for IOD in VA. Astigmatism and high hyperopia are risk factors for bilateral decreased VA. Guidelines for the screening and management of decreased VA in preschool children should be considered in light of these risk associations. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
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Cotter SA, Varma R, Tarczy-Hornoch K, McKean-Cowdin R, Lin J, Wen G, Wei J, Borchert M, Azen SP, Torres M, Tielsch JM, Friedman DS, Repka MX, Katz J, Ibironke J, Giordano L. Risk factors associated with childhood strabismus: the multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies. Ophthalmology 2011; 118:2251-61. [PMID: 21856012 DOI: 10.1016/j.ophtha.2011.06.032] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 06/23/2011] [Accepted: 06/23/2011] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To investigate risk factors associated with esotropia or exotropia in infants and young children. DESIGN Population-based cross-sectional prevalence study. PARTICIPANTS Population-based samples of 9970 children 6 to 72 months of age from California and Maryland. METHODS Participants were preschool African-American, Hispanic, and non-Hispanic white children participating in the Multi-Ethnic Pediatric Eye Disease Study and the Baltimore Eye Disease Study. Data were obtained by parental interview and ocular examination. Odd ratios and 95% confidence intervals were calculated to evaluate the association of demographic, behavioral, and clinical risk factors with esotropia and exotropia. MAIN OUTCOME MEASURES Odds ratios (ORs) for various risk factors associated with esotropia or exotropia diagnosis based on cover testing. RESULTS In multivariate logistic regression analysis, esotropia was associated independently with prematurity, maternal smoking during pregnancy, older preschool age (48-72 months), anisometropia, and hyperopia. There was a severity-dependent association of hyperopia with the prevalence of esotropia, with ORs increasing from 6.4 for 2.00 diopters (D) to less than 3.00 D of hyperopia, to 122.0 for 5.00 D or more of hyperopia. Exotropia was associated with prematurity, maternal smoking during pregnancy, family history of strabismus, female sex, astigmatism (OR, 2.5 for 1.50 to <2.50 D of astigmatism, and 5.9 for ≥2.5 D of astigmatism), and anisoastigmatism in the J0 component (OR, ≥2 for J0 anisoastigmatism of ≥0.25 D). CONCLUSIONS Prematurity and maternal smoking during pregnancy are associated with a higher risk of having esotropia and exotropia. Refractive error is associated in a severity-dependent manner to the prevalence of esotropia and exotropia. Because refractive error is correctable, these risk associations should be considered when developing guidelines for the screening and management of refractive error in infants and young children. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Susan A Cotter
- Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Lam DS, Zhao J, Chen LJ, Wang Y, Zheng C, Lin Q, Rao SK, Fan DS, Zhang M, Leung PC, Ritch R. Adjunctive Effect of Acupuncture to Refractive Correction on Anisometropic Amblyopia. Ophthalmology 2011; 118:1501-11. [DOI: 10.1016/j.ophtha.2011.01.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 01/06/2011] [Accepted: 01/06/2011] [Indexed: 10/18/2022] Open
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Christoff A, Repka MX, Kaminski BM, Holmes JM. Distance versus near visual acuity in amblyopia. J AAPOS 2011; 15:342-4. [PMID: 21907115 PMCID: PMC3172569 DOI: 10.1016/j.jaapos.2011.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/09/2011] [Accepted: 05/10/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE There are conflicting reports about whether distance and near visual acuity are similar in eyes with amblyopia. The purpose of this study is to compare monocular distance visual acuity with near visual acuity in amblyopic eyes of children. METHODS Subjects 2 to 6 years of age were evaluated in a randomized trial of amblyopia therapy for moderate amblyopia (20/40 to 20/80) due to anisometropia, strabismus, or both. Prior to initiating the protocol-prescribed therapy, subjects had best-corrected visual acuity measured with standardized protocols at 3 meters and 0.4 meters using single-surrounded HOTV optotypes. RESULTS A total of 129 subjects were included. The mean amblyopic eye visual acuity was similar at distance and near (mean, 0.45 logMAR at distance versus 0.45 logMAR at near; mean difference, +0.00, 95% CI, -0.03 to 0.03). Of the 129 subjects, 86 (67%) tested within 1 line at distance and near; 19 (15%) tested more than 1 logMAR line better at distance, and 24 (19%) tested more than 1 logMAR line better at near. The mean visual acuity difference between distance and near did not differ by cause of amblyopia, age, or spherical equivalent refractive error. CONCLUSIONS We found no systematic difference between distance and near visual acuity in 2- to 6-year-old children with moderate amblyopia associated with strabismus and/or anisometropia. Individual differences between distance and near visual acuity are likely due to test-retest variability.
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Affiliation(s)
- Alex Christoff
- Zanvyl Krieger Children's Eye Care Center, The Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Wallace DK, Kraker RT, Beck RW, Cotter SA, Davis PL, Holmes JM, Repka MX, Suh DW. Randomized trial to evaluate combined patching and atropine for residual amblyopia. ARCHIVES OF OPHTHALMOLOGY (CHICAGO, ILL. : 1960) 2011; 129:960-2. [PMID: 21746992 PMCID: PMC3156057 DOI: 10.1001/archophthalmol.2011.174] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Rutstein RP, Foster NC, Cotter SA, Kraker RT, Lee DH, Melia M, Quinn GE, Tamkins SM, Wallace DK. Visual acuity through Bangerter filters in nonamblyopic eyes. J AAPOS 2011; 15:131-4. [PMID: 21419678 PMCID: PMC3098928 DOI: 10.1016/j.jaapos.2010.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 11/04/2010] [Accepted: 11/06/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the amount of visual acuity degradation induced by Bangerter filters in the better seeing eye and to evaluate its stability over time in children with moderate amblyopia. METHODS Visual acuity with and without a Bangerter filter was measured in the nonamblyopic eye of 186 children with moderate amblyopia who were then treated with either patching or the Bangerter filters. A 0.2 filter was used for amblyopia of 20/80 and a 0.3 filter for amblyopia from 20/40 to 20/63. For the 89 children randomized to Bangerter filters, visual acuity was also measured in the nonamblyopic eye with and without the filters at both 6 weeks and 12 weeks after initiating treatment. RESULTS Mean degradation in visual acuity of the nonamblyopic eye at baseline was 5.1 logMAR lines with the 0.2 filter and 4.8 logMAR lines with the 0.3 filter. The degradation with each filter did not always agree with the manufacturer's specifications. Over time, the amount of degradation with the filters decreased. CONCLUSIONS The 0.2 and 0.3 Bangerter filters degrade nonamblyopic eye visual acuity sufficiently in amblyopic children. Because the amount of degradation decreases over time, it is recommended to periodically apply a new filter when using this type of amblyopia treatment.
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Affiliation(s)
- Robert P Rutstein
- School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Hertle RW, Yang D, Adams K, Caterino R. Surgery for the treatment of vertical head posturing associated with infantile nystagmus syndrome: results in 24 patients. Clin Exp Ophthalmol 2011; 39:37-46. [PMID: 20662845 DOI: 10.1111/j.1442-9071.2010.02380.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The study of the clinical and electrophysiological effects of eye muscle surgery on patients with infantile nystagmus has broadened our knowledge of the disease and its interventions. DESIGN Prospective, comparative, interventional case series. PARTICIPANTS Twenty-four patients with a vertical head posture because of electrophysiologically diagnosed infantile nystagmus syndrome. The ages ranged from 2.5 to 38 years and follow up averaged 14.0 months. METHODS Thirteen patients with a chin-down posture had a bilateral superior rectus recession, inferior oblique myectomy and a horizontal rectus recession or tenotomy. Those 11 with a chin-up posture had a bilateral superior oblique tenectomy, inferior rectus recession and a horizontal rectus recession or tenotomy. MAIN OUTCOME MEASURES Outcome measures included: demography, eye/systemic conditions and preoperative and postoperative; binocular, best optically corrected, null zone acuity, head posture, null zone foveation time and nystagmus waveform changes. RESULTS Associated conditions were strabismus in 66%, ametropia in 96%, amblyopia in 46% and optic nerve, foveal dysplasia or albinism in 54%. Null zone acuity increased at least 0.1 logMAR in 20 patients (P < 0.05 group mean change). Patients had significant (P < 0.05) improvements in degrees of head posture, average foveation time in milliseconds and infantile nystagmus syndrome waveform improvements. CONCLUSIONS This study illustrates a successful surgical approach to treatment and provides expectations of ocular motor and visual results after vertical head posture surgery because of an eccentric gaze null in patients with infantile nystagmus syndrome.
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Affiliation(s)
- Richard W Hertle
- Children's Hospital Medical Center of Akron and SUMMA Medical Center, Akron, Ohio, USA.
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Khalaj M, Zeidi IM, Gasemi MR, Keshtkar A. The effect of amblyopia on educational activities of students aged 9 - 15. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/jbise.2011.47066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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