1
|
Hashemi H, Mohayeji A, Farzaneh A, Yekta A, Ostadimoghaddam H, Asharlous A, Khabazkhoob M. Anterior segment indices in mentally retarded children. Sci Rep 2023; 13:14498. [PMID: 37666932 PMCID: PMC10477204 DOI: 10.1038/s41598-023-41827-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023] Open
Abstract
To compare the anterior segment indices between mentally retarded and normal children. The current study was conducted as a cohort. In this study, 73 mentally retarded and 76 normal children were selected from normal school and special schools for mentally retarded children using random cluster sampling method. Mental retardation in children was confirmed by a psychologist. Optometry examinations including visual acuity and refraction were performed for all participants, and ultimately, corneal imaging measurements were taken by Pentacam. The mean age of mentally retarded and normal children was of 13.30 ± 1.83 and 13.05 ± 1.82 years, respectively (P = 0.180). A multiple generalized estimating equations model demonstrated that there is a significant association between central corneal thickness (CCT) (coef = 1.011, P < 0.001), corneal diameter (CD) (coef = 0.444, P = 0.046), anterior chamber depth (ACD) (coef = 0.23), P < 0.001) and index of vertical asymmetry (IVA) (coef = 0.12, P < 0.001) and mental retardation. Cerebral palsy children had higher keratoconus index (KI), central keratoconus index (CKI), index of height asymmetry(IHA), and index of height decentration (IHD) compared to those without cerebral palsy (P < 0.05). Children with moderate mental retardation had higher index of surface variance (ISV), IVA, IHA, and IHD than those with mild mental retardation (P < 0.05). The mean and standard deviation of CCT, CD, ACD and IVA index in mentally retarded children were 535.3 ± 46.68 micron, 11.87 ± 0.42 mm, 3.29 ± 0.24 mm and 0.25 ± 0.18 mm, respectively. These indices in the normal group were 525.53 ± 47.52 micron, 11.84 ± 0.38 mm, 3.15 ± 0.28 mm and 0.17 ± 0.05 mm, respectively. The findings of this study showed that some anterior segment indices were different in mentally retarded compared to normal children. Moreover, some keratoconus indicators were worse in cerebral palsy children and children with higher grade mental retardation. So, it is important to consider keratoconus screening in these children.
Collapse
Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Amin Mohayeji
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Abdollah Farzaneh
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Abbasali Yekta
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Ostadimoghaddam
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Asharlous
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
| | - Mehdi Khabazkhoob
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
The Ophthalmic Manifestations of Down Syndrome. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020341. [PMID: 36832470 PMCID: PMC9955748 DOI: 10.3390/children10020341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/18/2023] [Accepted: 01/29/2023] [Indexed: 02/12/2023]
Abstract
Down Syndrome is one of the most common chromosomal conditions in the world, affecting an estimated 1:400-1:500 births. It is a multisystem genetic disorder but has a wide range of ophthalmic findings. These include strabismus, amblyopia, accommodation defects, refractive error, eyelid abnormalities, nasolacrimal duct obstruction, nystagmus, keratoconus, cataracts, retinal abnormalities, optic nerve abnormalities, and glaucoma. These ophthalmic conditions are more prevalent in children with Down Syndrome than the general pediatric population, and without exception, early identification with thoughtful screening in this patient population can drastically improve prognosis and/or quality of life.
Collapse
|
3
|
Toprak I, Cavas F, Velázquez JS, del Barrio JLA, Alio JL. A three-dimensional morpho-volumetric similarity study of Down syndrome keratopathy vs. keratoconus. EYE AND VISION (LONDON, ENGLAND) 2023; 10:4. [PMID: 36593521 PMCID: PMC9809058 DOI: 10.1186/s40662-022-00315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/26/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND To compare and contrast morpho-volumetric features between Down syndrome (DS) cornea and non-DS keratoconic cornea by three-dimensional (3D) modelling. METHODS Forty-three subjects (43 eyes) with DS and 99 patients matching their age and sex (99 eyes) with keratoconus (KC) were included in this single-center cross-sectional study. Main outcome measures were high-order aberrations (HOA), central corneal thickness (CCT), spherical equivalent refraction, and morpho-volumetric parameters established using a 3D corneal model, such as deviation of anterior and posterior corneal apices (Dapexant/Dapexpost) and minimum thickness points (Dmctant/Dmctpost) from corneal vertex, areas of the anterior and posterior surfaces (Aant/Apost), sagittal area passing through the anterior and posterior corneal apices (Aapexant/Aapexpost) and minimum thickness point (Amctpost) and corneal volume of the complete cornea (Vtotal). RESULTS Age, gender, spherical equivalent refraction, CCT and Vtotal were similar between the net on-DS KC and DS groups (P > 0.05), while non-DS KC group had higher HOA than the DS group (P < 0.05). Dapexant, Aant, Apost and Aapexant showed higher values in the DS group than in the non-DS KC group, whereas Dapexpost showed a reduction in the DS group when compared with the non-DS KC group (P < 0.05). CONCLUSIONS This study demonstrated that anterior and posterior corneal apex dynamics were specifically different in DS subjects, as the anterior apex tends to displace more prominently when compared to that from the non-DS KC group, while the posterior apex appears to be more stable than that in non-DS KC, which also support the theory that DS patients suffer from a specific keratopathy, distinctively different to KC but strongly related to it, and probably showing a diversity of corneal phenotypes in all cases of DS.
Collapse
Affiliation(s)
- Ibrahim Toprak
- grid.411742.50000 0001 1498 3798Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Francisco Cavas
- grid.218430.c0000 0001 2153 2602Bioengineering and Applied Computational Simulation Research Group, Technical University of Cartagena, Cartagena, Spain ,grid.218430.c0000 0001 2153 2602Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, Cartagena, Spain
| | - José S. Velázquez
- grid.218430.c0000 0001 2153 2602Bioengineering and Applied Computational Simulation Research Group, Technical University of Cartagena, Cartagena, Spain ,grid.218430.c0000 0001 2153 2602Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, Cartagena, Spain
| | - Jorge L. Alio del Barrio
- grid.419256.dDepartment of Research and Development, VISSUM, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain ,grid.419256.dCornea, Cataract and Refractive Surgery Department, VISSUM, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain
| | - Jorge L. Alio
- grid.419256.dDepartment of Research and Development, VISSUM, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain ,grid.419256.dCornea, Cataract and Refractive Surgery Department, VISSUM, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain
| |
Collapse
|
4
|
Akoto T, Li JJ, Estes AJ, Karamichos D, Liu Y. The Underlying Relationship between Keratoconus and Down Syndrome. Int J Mol Sci 2022; 23:ijms231810796. [PMID: 36142709 PMCID: PMC9503764 DOI: 10.3390/ijms231810796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Keratoconus (KC) is one of the most significant corneal disorders worldwide, characterized by the progressive thinning and cone-shaped protrusion of the cornea, which can lead to severe visual impairment. The prevalence of KC varies greatly by ethnic groups and geographic regions and has been observed to be higher in recent years. Although studies reveal a possible link between KC and genetics, hormonal disturbances, environmental factors, and specific comorbidities such as Down Syndrome (DS), the exact cause of KC remains unknown. The incidence of KC ranges from 0% to 71% in DS patients, implying that as the worldwide population of DS patients grows, the number of KC patients may continue to rise significantly. As a result, this review aims to shed more light on the underlying relationship between KC and DS by examining the genetics relating to the cornea, central corneal thickness (CCT), and mechanical forces on the cornea, such as vigorous eye rubbing. Furthermore, this review discusses KC diagnostic and treatment strategies that may help detect KC in DS patients, as well as the available DS mouse models that could be used in modeling KC in DS patients. In summary, this review will provide improved clinical knowledge of KC in DS patients and promote additional KC-related research in these patients to enhance their eyesight and provide suitable treatment targets.
Collapse
Affiliation(s)
- Theresa Akoto
- Department of Cellular Biology & Anatomy, Augusta University, Augusta, GA 30912, USA
| | - Jiemin J. Li
- Department of Cellular Biology & Anatomy, Augusta University, Augusta, GA 30912, USA
| | - Amy J. Estes
- Department of Ophthalmology, Augusta University, Augusta, GA 30912, USA
- James & Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Yutao Liu
- Department of Cellular Biology & Anatomy, Augusta University, Augusta, GA 30912, USA
- James & Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Correspondence: ; Tel.: +1-706-721-2015
| |
Collapse
|
5
|
Management of Keratoconus in Down Syndrome and Other Intellectual Disability. Cornea 2022; 41:456-461. [PMID: 35244626 DOI: 10.1097/ico.0000000000002793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/03/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to assess an intellectual disability (ID) cohort with keratoconus (KC) regarding ophthalmic (visual acuity and corneal tomography) and systemic characteristics and to describe an appropriate clinical algorithm for investigation and management of KC in this setting. METHODS This was the retrospective cohort study of patients with ID (Down syndrome, autism, and other) in the cornea department of a tertiary referral ophthalmic hospital in Dublin, Ireland. Retrospective chart review was conducted on people with ID undergoing examination under anesthesia or crosslinking under general anesthetic. Key outcome data included corneal examination findings, corneal tomography, visual acuity, and examination findings (eg, type of ID, general anesthetic, and cardiac status). RESULTS Mean age of the 24 patients was 31.9 years (66.7% male). ID type was Down syndrome (66.7%), autism (25%), and other (8.3%). KC was diagnosed in 98% of eyes, with 45.8% having untreatable advanced disease (57.1% of these bilateral), 39.6% amenable to corneal collagen crosslinking (35.7% of these bilateral), and 6.3% having corneal transplantation. Congenital heart defects were present in 37.5% of the Down syndrome group. There were no serious ocular or systemic adverse events. CONCLUSIONS KC is strikingly prevalent in the ID population. Ireland has the highest rate of Down syndrome in Europe (26.3:10,000 live births). This group is rarely suitable for corneal transplantation, and corneal collagen crosslinking is an effective intervention to prevent progression to advanced KC in this already socially restricted group. We propose an algorithm for investigation/treatment and also recommend uniform pediatric KC screening/treatment in ID populations.
Collapse
|
6
|
Neustein RF, Lenhart PD. Detecting Keratoconus: Feasibility and Findings in Three Pediatric Risk Groups. J Pediatr Ophthalmol Strabismus 2022; 59:94-101. [PMID: 34928766 DOI: 10.3928/01913913-20210802-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the utility of three corneal screening devices in three groups of children. METHODS This was a prospective study of patients with Trisomy 21 (group 1), patients with a first-degree relative with keratoconus (group 2), and control patients (group 3). Informed consent was obtained before testing with the Pentacam (Oculus Optikgeräte GmbH), Orbscan (Orbscan, Inc), and Ocular Response Analyzer (ORA) (Ametek Reichart Technologies). The ability to complete tests, the quality of results, and the corneal parameters obtained for each eye were recorded. A one-way analysis of variance test was used to compare the results between the three groups. RESULTS Fifty-four patients aged from 7 to 17 years (mean: 11.74 years) were enrolled between July 2014 and July 2016. The number of patients and the percentage of tests completed for groups 1, 2, and 3 were 12 (55%), 21 (87%), and 21 (88%), respectively. The Pentacam values by group were central corneal thickness of 524, 543, and 542 µm (P = .36); thinnest point of 498, 536, and 534 µm (P = .03); corneal front mean keratometry of 44.9, 43.2, and 43.2 (P = .01); and quality score of 1.42, 0.22, and 0.04 (P < .0001), respectively. Orbscan values by group were central corneal thickness of 493, 551, and 550 µm (P = .01) and thinnest point of 451, 536, and 538 µm (P < .0001), respectively. ORA values by group were corneal hysteresis of 10.6, 12.1, and 11.6 (P = .124); corneal resistance factor of 9.9, 11.8, and 11.6 (P = .03); and waveform score of 5.6, 7.6, and 7.3 (P < .0001), respectively. CONCLUSIONS Patients in group 1 completed fewer tests reliably and had thinner corneas and lower corneal resistance factors than patients in groups 2 and 3. Corneal tests used to evaluate adults for keratoconus may not be reliable for the evaluation of certain high-risk pediatric patients. [J Pediatr Ophthalmol Strabismus. 2022;59(2):94-101.].
Collapse
|
7
|
Haseeb A, Huynh E, ElSheikh RH, ElHawary AS, Scelfo C, Ledoux DM, Maidana DE, Elhusseiny AM. Down syndrome: a review of ocular manifestations. Ther Adv Ophthalmol 2022; 14:25158414221101718. [PMID: 35795721 PMCID: PMC9252013 DOI: 10.1177/25158414221101718] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/27/2022] [Indexed: 02/01/2023] Open
Abstract
Down syndrome is the most common genetically mediated intellectual disability. Although many physiologic and pathologic features of Down syndrome are discussed at length in the literature, the ocular manifestations of Down syndrome have seldom been discussed in a comprehensive fashion. Given that Down syndrome has ocular manifestations from the front to the back of the eye, it is important for physicians to become familiar with these manifestations, especially given the prevalence of Down syndrome. This review aims to discuss the varied ophthalmologic manifestations of Down syndrome – including strabismus, amblyopia, nystagmus, accommodation deficits, nasolacrimal duct obstruction, keratoconus, optic nerve pathology, neoplastic disease, and retinal pathology – to facilitate better care and visual outcomes in this important patient population.
Collapse
Affiliation(s)
- Abid Haseeb
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Elisah Huynh
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Reem H ElSheikh
- Department of Ophthalmology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | | | - Christina Scelfo
- Department of Ophthalmology, Boston Children's Hospital, Hawthorne, NY, USA
| | - Danielle M Ledoux
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel E Maidana
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
8
|
Thiagarajan K, Srinivasan K, Gayam K, Rengaraj V. Comparison of central corneal thickness using non-contact tono-pachymeter (Tonopachy) with ultrasound pachymetry in normal children and in children with refractive error. Indian J Ophthalmol 2021; 69:2053-2059. [PMID: 34304177 PMCID: PMC8482885 DOI: 10.4103/ijo.ijo_364_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To compare the central corneal thickness (CCT) measured by non-contact tono-pachymeter [Tonopachy (TP)] with the gold standard ultrasound pachymetry (UP) in normal children and in children with refractive error. Methods This cross-sectional study involved 95 normal children (190 eyes) and 123 children with refractive error (246 eyes), a total of 218 children (436 eyes) aged 7-15 years. After refraction and complete ophthalmic evaluation, axial length was measured with IOLMaster 700, CCT was measured with TP followed by UP. The correlation between the CCT measurements obtained with the two methods was analysed by Intraclass correlation coefficient (ICC) and the limits of agreement were assessed with Bland-Altman analysis plot. Results Mean CCT measured with TP was 537.46 ± 36.41 μm and by UP was 537.17 ± 39.80 μm in normal children (P = 0.79) and in refractive error group, the mean CCT was 533.50 ± 34.91 μm by TP and 531.60 ± 36.30 μm by UP (P = 0.04). The 95% limits of agreement between TP and UP ranged from -19.2 to + 21.6 μm (mean = 1.20) for total children, -20.8 to + 21.4 μm (mean = 0.29) for normal group and -18.0 to + 21.8 μm (mean = 1.90) for refractive error group. ICC for CCT measurement between TP and UP was 0.980 for total children and refractive error group and 0.981 for normal group. Conclusion The CCT measurement obtained by TP showed an excellent agreement with UP. Hence non-contact TP can be used to assess CCT in children above seven years of age.
Collapse
Affiliation(s)
| | - Kavitha Srinivasan
- Department of Glaucoma and Paediatric Services, Aravind Eye Hospital, Pondicherry, India
| | - Keerthi Gayam
- Department of Glaucoma and Paediatric Services, Aravind Eye Hospital, Pondicherry, India
| | - Venkatesh Rengaraj
- Department of Glaucoma and Paediatric Services, Aravind Eye Hospital, Pondicherry, India
| |
Collapse
|
9
|
Clinical, Demographic, and Tomographic Aspects Related to Iris Mammillations Among Patients With Keratoconus: A Cross-Sectional Study. Cornea 2021; 39:1247-1251. [PMID: 32398425 DOI: 10.1097/ico.0000000000002366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Iris mammillations (IM) were previously described in patients with keratoconus, but the clinical implications of this finding have never been studied. Our aim was to investigate demographic, tomographic, and clinical characteristics potentially associated with the presence of IM among patients with keratoconus. METHODS This was a cross-sectional study performed among patients with keratoconus in a public-affiliated university hospital. All patients under follow-up were considered eligible to participate in the study. Participants were evaluated by 2 trained ophthalmologists and submitted to corneal tomography (Pentacam). Selected demographic, clinical, and tomographic characteristics were assessed and compared among participants with IM (IM group) and without IM (No-IM group) using the Wilcoxon test or 2-tailed Fisher exact test, as appropriate. RESULTS The study population consisted of 106 subjects and 19 (17.9%) presented with IM. The median age and interquartile range were 18 years old (14-24) in the IM group and 20 years old (17-24) in the No-IM group (P = 0.135). The female proportion was 47.3% in the IM group and 52.8% in the No-IM group (P = 0.801). Median (interquartile ranges) pachymetric values of the right eyes were 498 (466-525) for the IM group and 459 (421-482) for the No-IM group (P = 0.005). For the left eyes, the values were 490 (456-523) in the IM group and 450 (418-485) in the No-IM group (P = 0.024). CONCLUSIONS Subjects with keratoconus presenting with IM have thicker corneas than those without IM. Follow-up studies should be performed to evaluate the clinical implications of this finding.
Collapse
|
10
|
Kristianslund O, Drolsum L. Prevalence of keratoconus in persons with Down syndrome: a review. BMJ Open Ophthalmol 2021; 6:e000754. [PMID: 33981858 PMCID: PMC8061858 DOI: 10.1136/bmjophth-2021-000754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/04/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Keratoconus is a vision-threatening condition, and there is a need for knowledge about the occurrence in subgroups of the population. The progression of the disease can be effectively stopped, and vision may be restored, if keratoconus is diagnosed at an early stage. The purpose of this review was to evaluate the literature of the prevalence of keratoconus in persons with Down syndrome. Methods We conducted a literature review of keratoconus prevalence in persons with Down syndrome. A thorough search was performed in Pubmed (Medline), and the quality of evidence was evaluated. Results The literature review identified 20 relevant studies, which reported keratoconus in 0%–71% of persons with Down syndrome. These studies varied greatly in design, patient selection, sample sizes and mean age, and the quality of evidence concerning estimates for the prevalence of keratoconus was generally evaluated as low. Most studies that included adults reported high prevalences of keratoconus–in many studies more than 10-fold the prevalence in the general population. No large screening studies in persons with Down syndrome were identified. Conclusions The present review showed that the prevalence of keratoconus in persons with Down syndrome is higher than in the general population. However, estimates from previous studies vary widely. Screening for keratoconus in this group should be considered.
Collapse
Affiliation(s)
- Olav Kristianslund
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv Drolsum
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
11
|
Toprak I, Cavas F, Vega A, Velázquez JS, Alio del Barrio JL, Alio JL. Evidence of a Down Syndrome Keratopathy: A Three-Dimensional (3-D) Morphogeometric and Volumetric Analysis. J Pers Med 2021; 11:jpm11020082. [PMID: 33573177 PMCID: PMC7911434 DOI: 10.3390/jpm11020082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to investigate whether a different and abnormal corneal profile is present in Down syndrome (DS) by personalized three-dimensional (3D) modelling. This single-centre cross-sectional study included 43 patients with DS (43 eyes) and 58 age-sex-matched control subjects (58 eyes) with normal karyotype and topography. Refraction, central corneal thickness (CCT), aberrations (high-order, coma and spherical), asphericity and morphogeometric/volumetric parameters based on a 3D corneal model that was generated from raw topographical data were evaluated. Deviation of anterior/posterior apex (Dapexant/Dapexpost) and thinnest point (Dmctant/Dmctpost) from corneal vertex, anterior/posterior surface area (Aant/Apost), sagittal area passing through the anterior/posterior apex (Aapexant/Aapexpost) and thinnest point (Amctpost), total corneal volume (Vtotal) and volumetric progression for each 0.05 mm step of the radius value centred to the thinnest point (VOLMCT) and anterior/posterior apex (VOLAAP/VOLPAP) comprised the morphogeometric/volumetric parameters. In the DS group, 58.1% of the eyes presented abnormal topography. High-order and coma aberrations, asphericity, Dapexant, Aant, Apost and Aapexant were significantly higher, whereas CCT, Aapexpost, Amctpost, Vtotal, VOLAAP, VOLPAP and VOLMCT were lower in the DS group than in the control group (p < 0.05). Dapexpost did not differ between the groups (p > 0.05). This study demonstrates that corneas of the subjects with DS are different and more aberrated than those of normal age- and sex-matched non-DS controls. Anterior corneal apex appears to be displaced in DS even with normal topography, while posterior apex seems stable although topography is abnormal. These findings may help to modify our approach in the diagnosis of keratopathy in subjects with DS.
Collapse
Affiliation(s)
- Ibrahim Toprak
- Department of Research and Development, VISSUM, 03016 Alicante, Spain; (I.T.); (A.V.); (J.L.A.d.B.)
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli 20160, Turkey
| | - Francisco Cavas
- Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, 30202 Cartagena, Spain;
- Correspondence: ; Tel.: +34-968-338-856
| | - Alfredo Vega
- Department of Research and Development, VISSUM, 03016 Alicante, Spain; (I.T.); (A.V.); (J.L.A.d.B.)
- Cornea, Cataract and Refractive Surgery Department, VISSUM, 03016 Alicante, Spain;
- Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, 03016 Alicante, Spain
| | - José S. Velázquez
- Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, 30202 Cartagena, Spain;
| | - Jorge L. Alio del Barrio
- Department of Research and Development, VISSUM, 03016 Alicante, Spain; (I.T.); (A.V.); (J.L.A.d.B.)
- Cornea, Cataract and Refractive Surgery Department, VISSUM, 03016 Alicante, Spain;
- Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, 03016 Alicante, Spain
| | - Jorge L. Alio
- Cornea, Cataract and Refractive Surgery Department, VISSUM, 03016 Alicante, Spain;
- Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, 03016 Alicante, Spain
| |
Collapse
|
12
|
Asgari S, Mehravaran S, Aghamirsalim M, Hashemi H. Tomography-based definition of keratoconus for Down syndrome patients. EYE AND VISION 2020; 7:49. [PMID: 33029546 PMCID: PMC7534157 DOI: 10.1186/s40662-020-00215-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/14/2020] [Indexed: 01/04/2023]
Abstract
Background To assess the diagnostic ability of Pentacam HR (Oculus Optikgeräte, GmbH, Wetzlar, Germany) tomographic indices in discriminating keratoconus (KC) and KC suspect (KCS) in 10- to 30-year-old patients with Down syndrome (DS). Methods In this study, DS patients were enrolled through special needs schools, the National Down Syndrome Society, and relevant non-profit organizations. Diagnoses were made independently by two experienced specialists. Forty Pentacam indices related to corneal thickness, volume, density, keratometry, power, shape, aberration, and elevation were extracted. For each index, the accuracy for KC and KCS diagnosis was evaluated using discriminant analysis and the area under receiver operating characteristic curve (AUROC). From each enrolled case, data from only one eye was entered in the analyses. Results Analyses were performed on data from 25 KC, 46 KCS, and 154 non-ectatic DS eyes. The best discriminants for KC were anterior higher order aberrations (HOA) (cutoff > 0.643, AUROC = 0.879), posterior vertical coma (cutoff > 0.0702 μm, AUROC = 0.875), anterior vertical coma (cutoff > 0.4124 μm, AUROC = 0.868), and total HOA (cutoff > 0.608, AUROC = 0.867). The difference between AUROCs were not statistically significant (all P > 0.05). For KCS, the best discriminants were minimum corneal thickness (cutoff ≤ 480.0 μm, AUROC = 0.775), corneal volume (cutoff ≤ 55.3 μm, AUROC = 0.727) and Belin Ambrosio display-total deviation (BAD-D) (cutoff > 2.23, AUROC = 0.718) with no significant difference between AUROCs (all P > 0.05). Conclusions In this sample of DS patients, best KC discriminators were HOA and coma which showed good diagnostic ability. For KCS, best predictors were minimum corneal thickness, corneal volume, and BAD-D with relatively good diagnostic ability. Defining a new set of KC diagnostic criteria for DS patients is suggested.
Collapse
Affiliation(s)
- Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran
| | - Shiva Mehravaran
- ASCEND Center for Biomedical Research, Morgan State University, Baltimore, MD USA
| | | | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran
| |
Collapse
|
13
|
Application of Topographical Keratoconus Detection Metrics to Eyes of Individuals with Down Syndrome. Optom Vis Sci 2020; 96:664-669. [PMID: 31479021 DOI: 10.1097/opx.0000000000001417] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE The challenges associated with clinical assessment of individuals with Down syndrome contribute to a wide range of estimates on the prevalence of keratoconus in the Down syndrome population. This work focuses on two topographical indices previously identified with keratoconus detection, applying them to a topographical data set meeting strict sampling criteria. PURPOSE The purpose of this study was to quantify the level of keratoconus-like topographical morphology in a large sample of eyes from individuals with Down syndrome, as identified by two keratoconus detection metrics: inferior-superior dioptric asymmetry (I-S) and KISA%. Severity of the asymmetry was also cast within the context of established Collaborative Longitudinal Evaluation of Keratoconus study disease severity classification criteria. METHODS Corneal topography data on both eyes of 140 subjects with Down syndrome and 138 control subjects were collected. Both I-S and KISA% were calculated from the topography data of eyes with sufficient sampling. Steep and flat keratometry data are reported for subjects with measurements on both eyes in the context of values recorded by the Collaborative Longitudinal Evaluation of Keratoconus study in frank keratoconus to examine within-eye and between-eye asymmetry and severity. RESULTS Keratoconus detection thresholds were exceeded in 20.8% of the eyes of subjects with Down syndrome and 2.2% of the eyes of controls using I-S and 11.8% of the eyes of subjects with Down syndrome and 0.0% of the eyes of controls using KISA%. Examination of the level of intraeye difference between flat and steep keratometry data for individuals with Down syndrome detected as having corneal morphology consistent with moderate keratoconus yields an average of 1.81 D of toricity, whereas the Collaborative Longitudinal Evaluation of Keratoconus study reported 3.28 D of toricity. CONCLUSIONS Morphology consistent with keratoconus as codified in the detection metrics I-S and KISA% is present in a large percentage of the eyes of individuals with Down syndrome. Differences were observed in the distribution of severity of corneal morphology in individuals with Down syndrome and the keratoconus population at large.
Collapse
|
14
|
Hashemi H, Miraftab M, Amanzadeh K, Seyedian MA, Vinciguerra R, Ambrósio R, Roberts C, Makateb A, Vinciguerra P, Asgari S. Keratoconus detection by novel indices in patients with Down syndrome: a cohort population-based study. Jpn J Ophthalmol 2020; 64:285-291. [PMID: 32108918 DOI: 10.1007/s10384-020-00725-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 01/08/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To use novel indices to determine the prevalence of KC and its progression in patients aged 10-30 years with Down syndrome. STUDY DESIGN Cohort population-based study. METHODS Two hundred twenty-six of 250 invited Down syndrome patients were enrolled. The diagnostic criteria were confirmed by two independent expert examiners using slit-lamp examinations and topographic indices measured by Pentacam HR (Oculus Optikgeräte): maximum keratometry centered on the steepest point (zonal Kmax-3 mm), Ambrósio's relational thickness (ART), inferior-superior asymmetry (IS-value), Belin/Ambrósio deviation value (BAD-D), the Tomographic and Biomechanical Index (TBI), and a posterior elevation map. In the KC cases, Corvis ST (Oculus Optikgeräte) was done. All the KC cases completed the second phase in 2017. RESULTS KC was identified in 28 patients (12.39%; 95% confidence interval: 8.2-17.9%): 20 bilateral and eight unilateral cases. Of these, 24 were in the ≤ 20-years age group, and four, in the > 20-years age group. The frequency of KC was not significantly correlated with age (P = 0.804) or gender (P = 0.322). In the KC cases, the mean zonal Kmax-3 mm, ART-max, IS-value, BAD-D, CBI, and TBI were 50.40 ± 5.88 D, 321.63 ± 111.94 μm, 1.99 ± 2.51, 3.73 ± 3.12, 0.54 ± 0.61, and 0.86 ± 0.20, respectively, and the minimum corneal thickness was 492.17 ± 42.67 μm. Of the 28 patients, 39.6% showed progression, and all were in the ≤ 20-years age group. CONCLUSION The prevalence of KC in Down syndrome patients is significantly higher than that reported in non-Down syndrome individuals of the same age groups. The progression rate is approximately similar to that of the non-Down syndrome population. Screening programs should be applied to prohibit serious visual impairment in these populations.
Collapse
Affiliation(s)
- Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd, Vali'asr Ave, Tehran, Iran
| | - Mohammad Miraftab
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Kazem Amanzadeh
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd, Vali'asr Ave, Tehran, Iran
| | - Mohammad Amin Seyedian
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd, Vali'asr Ave, Tehran, Iran
| | - Riccardo Vinciguerra
- St Paul's Eye Unit, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
| | - Renato Ambrósio
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, RJ, Brazil
- Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Cynthia Roberts
- Department of Ophthalmology and Visual Science, Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Ali Makateb
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd, Vali'asr Ave, Tehran, Iran
| | - Paolo Vinciguerra
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele Milan, Italy
- Humanitas Clinical and Research, Rozzano, Italy
| | - Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd, Vali'asr Ave, Tehran, Iran.
| |
Collapse
|
15
|
Hashemi H, Saatchi M, Khabazkhoob M, Emamian MH, Yekta A, Fotouhi A. Distribution of corneal thickness and its determinants in 6-12-year-old children in an Iranian general population. J Curr Ophthalmol 2017; 31:150-156. [PMID: 31317092 PMCID: PMC6611839 DOI: 10.1016/j.joco.2017.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/25/2017] [Accepted: 12/05/2017] [Indexed: 10/29/2022] Open
Abstract
Purpose To determine the central corneal thickness (CCT), apex, and paracentral thicknesses and their determinants in children aged 6-12 years. Methods The present study was part of the phase 1 of Shahroud School Children Eye Cohort Study in 2015. Cluster sampling was done in urban areas while all children were invited to participate in the study in rural areas. The Pentacam HR was used for measurements. CCT was measured within the central 3 mm zone of the cornea, and corneal thickness 3 mm further from the center was considered paracentral thickness. Results Of 6624 students who were selected, 5620 (84.8%) participated in the study. Among 4956 students, studied in this report, 52.2% were boys, and the mean age of the study participants was 9.75 ± 1.71 years (6-12). The mean CCT and apical thickness was 556.29 ± 34.04 and 557.43 ± 34.03 μm, respectively. The mean paracentral thickness was 657.62 ± 39.11 μm in the superior, 632.65 ± 37.63 μm in the inferior, 648.64 ± 38.75 μm in the nasal, and 617.36 ± 37.19 μm in the temporal region. A multiple regression model showed that CCT decreased by 4.70 μm with every 1 diopter increase in the mean keratometry and increased by 20.06 μm with every 1 mm increase in the anterior chamber depth (ACD) (Both P-Value < 0.001). Age, sex, ethnicity and residence place were also found to be associated with CCT. Conclusions This study is the first to describe the distribution of corneal thickness in Iranian children with a large sample size. This study showed that corneal thickness was significantly correlated with younger age, female gender, urban residence, and a number of biometric variables.
Collapse
Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mohammad Saatchi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Mohammad Hassan Emamian
- Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
- Corresponding author.
| | - Abbasali Yekta
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
16
|
Ma Y, Zhu X, He X, Lu L, Zhu J, Zou H. Corneal Thickness Profile and Associations in Chinese Children Aged 7 to 15 Years Old. PLoS One 2016; 11:e0146847. [PMID: 26751798 PMCID: PMC4709113 DOI: 10.1371/journal.pone.0146847] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/22/2015] [Indexed: 12/29/2022] Open
Abstract
Corneal thickness (CT) maps of the central (2-mm diameter), para-central (2 to 5-mm diameter), peripheral (5 to 6-mm diameter), and minimum (5-mm diameter) cornea were measured in normal Chinese school children aged 7 to 15 years old using Fourier-domain optical coherence tomography. Multiple regression analyses were performed to explore the effect of associated factors [age, gender, refraction, axial length and corneal curvature radius (CCR)] on CT and the relationship between central corneal thickness (CCT) and intraocular pressure (IOP). A total of 1228 eyes from 614 children were analyzed. The average CCT was 532.96 ± 28.33 μm for right eyes and 532.70 ±28.45 μm for left eyes. With a 10 μm increase in CCT, the IOP was elevated by 0.37 mm Hg, as measured by noncontact tonometry. The CT increased gradually from the center to the periphery. The superior and superior nasal regions had the thickest CTs, while the thinnest points were primarily located in the inferior temporal cornea. The CCT was associated with CCR (p = 0.008) but not with gender (p = 0.075), age (p = 0.286), axial length (p = 0.405), or refraction (p = 0.985). In the para-central region and the peripheral cornea, increased CT was associated with younger age, male gender, and a flatter cornea.
Collapse
Affiliation(s)
- Yingyan Ma
- Shanghai Eye Hospital, Shanghai Eye Disease Prevention & Treatment Center, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Zhu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangui He
- Shanghai Eye Hospital, Shanghai Eye Disease Prevention & Treatment Center, Shanghai, China
- Department of Maternal and Child Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Lina Lu
- Shanghai Eye Hospital, Shanghai Eye Disease Prevention & Treatment Center, Shanghai, China
| | - Jianfeng Zhu
- Shanghai Eye Hospital, Shanghai Eye Disease Prevention & Treatment Center, Shanghai, China
| | - Haidong Zou
- Shanghai Eye Hospital, Shanghai Eye Disease Prevention & Treatment Center, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail:
| |
Collapse
|
17
|
Abstract
PURPOSE Subjects with Down syndrome have structural differences in the cornea and lens, as compared with the general population. This study investigates objectively measured refractive and corneal astigmatism, as well as calculated internal astigmatism in subjects with and without Down syndrome. METHODS Refractive (Grand Seiko autorefraction) and anterior corneal astigmatism (difference between steep and flat keratometry obtained with Zeiss Atlas corneal topography) were measured in 128 subjects with Down syndrome (mean [±SD] age, 24.8 [±8.7] years) and 137 control subjects without Down syndrome (mean [±SD] age, 24.9 [±9.9] years), with one eye randomly selected for analysis per subject. Refractive astigmatism and corneal astigmatism were converted to vector notation (J0, J45) to calculate internal astigmatism (Refractive - Corneal) and then converted back to minus cylinder form. RESULTS Mean [±SD] refractive astigmatism was significantly greater in subjects with Down syndrome than in control subjects (-1.94 [±1.30] DC vs. -0.66 [±0.60] DC, t = -10.16, p < 0.001), as were mean corneal astigmatism (1.70 [±1.04] DC vs. 1.02 [±0.63] DC, t = 6.38, p < 0.001) and mean internal astigmatism (-1.07 [±0.68] DC vs. -0.77 [±0.41] DC, t = -4.21, p < 0.001). A positive linear correlation between corneal and refractive astigmatism was observed for both study populations for both the J0 and J45 vectors (p < 0.001 for all comparisons; R(2) range, 0.31 to 0.74). The distributions of astigmatism orientation differed significantly between the two study populations for comparisons of corneal and calculated internal astigmatism (χ(2), p < 0.007), but not refractive astigmatism (p = 0.46). CONCLUSIONS This study demonstrates that corneal astigmatism is predictive of overall refractive astigmatism in subjects with Down syndrome, as it is in the general population. The greater magnitudes of astigmatism and wider variation of astigmatism orientation in subjects with Down syndrome for refractive, corneal, and calculated internal astigmatism are likely attributable to previously reported differences in the structure of the cornea and internal optical components of the eye from that of the general population.
Collapse
|
18
|
Abstract
Keratoconus is a bilateral, non-inflammatory corneal ectasia characterized by progressive conical thinning and protrusion of the cornea. Its etiology has long been believed to be multifactorial, with environmental, behavioral, and genetic factors all contributing to the disease process. This review focuses specifically on examining the evidence that supports a genetic basis for keratoconus.
Collapse
|