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Chen Y, You W, Hu Y, Chu H, Chen X, Shi W, Gao X. EEG measurement for the effect of perceptual eye position and eye position training on comitant strabismus. Cereb Cortex 2023; 33:10194-10206. [PMID: 37522301 PMCID: PMC10502583 DOI: 10.1093/cercor/bhad275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023] Open
Abstract
One of the clinical features of comitant strabismus is that the deviation angles in the first and second eye positions are equal. However, there has been no report of consistency in the electroencephalography (EEG) signals between the 2 positions. In order to address this issue, we developed a new paradigm based on perceptual eye position. We collected steady-state visual evoked potentials (SSVEPs) signals and resting-state EEG data before and after the eye position training. We found that SSVEP signals could characterize the suppression effect and eye position effect of comitant strabismus, that is, the SSVEP response of the dominant eye was stronger than that of the strabismus eye in the first eye position but not in the second eye position. Perceptual eye position training could modulate the frequency band activities in the occipital and surrounding areas. The changes in the visual function of comitant strabismus after training could also be characterized by SSVEP. There was a correlation between intermodulation frequency, power of parietal electrodes, and perceptual eye position, indicating that EEG might be a potential indicator for evaluating strabismus visual function.
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Affiliation(s)
- Yuzhen Chen
- Shenzhen International Graduate School, Tsinghua University, Nanshan District, Shenzhen 518055, China
| | - Weicong You
- Shenzhen International Graduate School, Tsinghua University, Nanshan District, Shenzhen 518055, China
| | - Yijun Hu
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China
| | - Hang Chu
- The National Engineering Research Center for Healthcare Devices, Tianhe District, Guangzhou 510500, China
| | - Xiaogang Chen
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Nankai District, Tianjin 300192, China
| | - Wei Shi
- Department of Ophthalmology, Beijing Children’s Hospital, Capital Medical University, Xicheng District, Beijing 100045, China
| | - Xiaorong Gao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China
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Huang Y, Liu Z, Wang M, Gao L, Wu Y, Hu J, Zhang Z, Yan FF, Deng D, Huang CB, Yu M. Cortical Reorganization After Optical Alignment in Strabismic Patients Outside of Critical Period. Invest Ophthalmol Vis Sci 2023; 64:5. [PMID: 37535007 PMCID: PMC10408769 DOI: 10.1167/iovs.64.11.5] [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: 03/22/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
PURPOSE To measure visual crowding, an essential bottleneck on object recognition and reliable psychophysical index of cortex organization, in older children and adults with horizontal concomitant strabismus before and after strabismus surgery. METHODS Using real-time eye tracking to ensure gaze-contingent display, we examined the peripheral visual crowding effects in older children and adults with horizontal concomitant strabismus but without amblyopia before and after strabismus surgery. Patients were asked to discriminate the orientation of the central tumbling E target letter with flankers arranged along the radial or tangential axis in the nasal or temporal hemifield at different eccentricities (5° or 10°). The critical spacing value, which is the minimum space between the target and the flankers required for correct discrimination, was obtained for comparisons before and after strabismus surgery. RESULTS Twelve individuals with exotropia (6 males, 21.75 ± 7.29 years, mean ± SD) and 15 individuals with esotropia (6 males, 24.13 ± 5.96 years) participated in this study. We found that strabismic individuals showed significantly larger critical spacing with nasotemporal asymmetry along the radial axis that related to the strabismus pattern, with exotropes exhibiting stronger temporal field crowding and esotropes exhibiting stronger nasal field crowding before surgical alignment. After surgery, the critical spacing was reduced and rebalanced between the nasal and temporal hemifields. Furthermore, the postoperative recovery of stereopsis was associated with the extent of nasotemporal balance of critical spacing. CONCLUSIONS We find that optical realignment (i.e., strabismus surgery) can normalize the enlarged visual crowding effects, a reliable psychophysical index of cortical organization, in the peripheral visual field of older children and adults with strabismus and rebalance the nasotemporal asymmetry of crowding, promoting the recovery of postoperative stereopsis. Our results indicated a potential of experience-dependent cortical organization after axial alignment even for individuals who are out of the critical period of visual development, illuminating the capacity and limitations of optics on sensory plasticity and emphasizing the importance of ocular correction for clinical practice.
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Affiliation(s)
- Yiru Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Zitian Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Mingqin Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Le Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yanyan Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Jingyi Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Zhenyu Zhang
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences (CAS), Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Fang-Fang Yan
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences (CAS), Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Daming Deng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Chang-Bing Huang
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences (CAS), Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Minbin Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
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Lam M, Suh D. Screening, Diagnosis, and Treatment of Pediatric Ocular Diseases. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121939. [PMID: 36553382 PMCID: PMC9777216 DOI: 10.3390/children9121939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Vision is an important aspect of a child's quality of life and intellectual, social, and emotional development. Disruptions to vision during infancy and early childhood can cause lifelong vision impairment or blindness. However, early identification and treatment of eye disease can prevent loss of sight and its consequent long-term effects. Therefore, screening guidelines exist to guide physicians in detecting the most common threats to sight in the different stages of infancy and childhood. This review describes common causes of pediatric vision impairment, the recommended screening guidelines for diagnosing them, and current treatment modalities.
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Affiliation(s)
- Matthew Lam
- Creighton University School of Medicine Phoenix Regional Campus, Phoenix, AZ 85012, USA
| | - Donny Suh
- Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA 92697, USA
- Correspondence:
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Bhate M, Flaherty M, Martin FJ. Timing of surgery in essential infantile esotropia - What more do we know since the turn of the century? Indian J Ophthalmol 2022; 70:386-395. [PMID: 35086202 PMCID: PMC9023972 DOI: 10.4103/ijo.ijo_1129_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/10/2021] [Accepted: 09/04/2021] [Indexed: 11/17/2022] Open
Abstract
This review summarizes the results and interpretations of studies pertaining to the long-standing debate regarding the timing of surgery in infantile esotropia, more recently referred to as essential infantile esotropia. A systematic search of studies from the year 2000 onward pertaining to the timing of surgery in infantile esotropia as listed in PubMed, Google Scholar, and the Cochrane database was performed. Appropriate cross-references from the articles were also included. Data collected included demographics, presentation, time of surgery, complications, and outcomes. Very early surgery, that is, within 6 months of the onset of infantile esotropia, offers significant advantages in terms of the quality of stereopsis and binocular vision as well as promoting the development of cortical visual processing, thereby benefiting cortical development in human infants. However, the postoperative alignment was not found to be significantly different in the very early, early, or late surgery groups. The reduction in the incidence of manifest dissociated vertical deviation postoperatively in the very early surgery group also showed measurable benefits. The results of this recent literature review demonstrated that very early surgery, within 6 months of misalignment, showed demonstrable benefits in essential infantile esotropia.
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Affiliation(s)
- Manjushree Bhate
- Jasti V Ramanamma Children’s Eye Care Centre, L.V.Prasad Eye Institute, Hyderabad, India
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Peng T, Xu M, Zheng F, Zhang J, Chen S, Lou J, Wang C, Wang Y, Yu X. Longitudinal Rehabilitation of Binocular Function in Adolescent Intermittent Exotropia After Successful Corrective Surgery. Front Neurosci 2021; 15:685376. [PMID: 34290584 PMCID: PMC8287070 DOI: 10.3389/fnins.2021.685376] [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: 03/25/2021] [Accepted: 06/02/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To study the longitudinal rehabilitation of binocular visual function in adolescent intermittent exotropia (IXT) after successful surgery and compare the results with those of a normal population. The role of binocular function in ocular alignment stability was also evaluated postoperatively. Methods In this prospective study, 30 adolescents with IXT successfully corrected after 1 month were followed for 12 months, and 30 children with normal vision were enrolled as controls. Stereopsis, the fusional vergence amplitude, sensory fusion, and accommodative flexibility were measured to assess binocular function at baseline and 6 and 12 months postoperatively. The controls were tested once when they were enrolled in the study. Results The deviation was −32.00 ± 8.60 prism diopters (PD) at distance fixation and −36.0 ± 9.10 PD at near fixation preoperatively with an average correction of 28.53 ± 3.79 PD and 30.67 ± 1.34 PD at 1 month postoperatively. Distance stereoacuity and near stereoacuity improved from 1 to 12 months postoperatively (p = 0.025 and p = 0.041, respectively). Compared with the controls, the fusional convergence reserve at distance (p = 0.025) and near (p = 0.033) fixations and fusion reserve ratio at distance (p = 0.000) and near (p = 0.000) fixations remained subnormal, whereas sensory fusion (p = 0.237), distance stereopsis (p = 0.120), and the fusional divergence amplitude at a distance (p = 0.168) were normal. However, no significant correlations were found between binocular functions at 1 month postoperatively and the postoperative drift. Conclusion Binocular function significantly improved from before to after successful corrective surgery and continued to improve from 1 to 12 months postoperatively in adolescents with IXT. No significant correlations were found between binocular functions at 1 month postoperatively and ocular alignment stability.
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Affiliation(s)
- Tingting Peng
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Meiping Xu
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Fuhao Zheng
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Junxiao Zhang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Shuang Chen
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Jiangtao Lou
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Chunxiao Wang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Yuwen Wang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Xinping Yu
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Leite FHF, Almeida JDSD, Cruz LBD, Teixeira JAM, Junior GB, Silva AC, Paiva ACD. Surgical planning of horizontal strabismus using multiple output regression tree. Comput Biol Med 2021; 134:104493. [PMID: 34119920 DOI: 10.1016/j.compbiomed.2021.104493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022]
Abstract
Strabismus is an eye disease that affects about 0.12%-9.86% of the population, which can cause irreversible sensory damage to vision and psychological problems. The most severe cases require surgical intervention, despite other less invasive techniques being available for a more conservative approach. As for surgeries, the treatment goal is to align the eyes to recover binocular vision, which demands knowledge, training, and experience. One of the leading causes of failure is human error during the measurement of deviation. Thus, this work proposes a new method based on the Decision Tree Regressor algorithms to assist in the surgical planning for horizontal strabismus to predict recoil and resection measures in the lateral and medial rectus muscles. In the presented method, two application approaches were taken, being in the form of multiple single target models, one procedure at a time, and the form of one multiple target model or all surgical procedures together. The method's efficiency is indicated by the average difference between the value indicated by the method and the physician's value. In our most accurate model, an average error of 0.66 mm was obtained for all surgical procedures, both for resection and recoil in the indication of the horizontal strabismus surgical planning. The results present the feasibility of using Decision Tree Regressor algorithms to perform the planning of strabismus surgeries, making it possible to predict correction values for surgical procedures based on medical data analysis and exceeding state-of-art.
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Affiliation(s)
- Fernando Henrique Fernandes Leite
- Federal University of Maranhão - UFMA, Applied Computing Group - NCA/UFMA, Av. dos Portugueses , Vila Bacanga, 65080-805, São Luís, MA, Brazil
| | - João Dallyson Sousa de Almeida
- Federal University of Maranhão - UFMA, Applied Computing Group - NCA/UFMA, Av. dos Portugueses , Vila Bacanga, 65080-805, São Luís, MA, Brazil.
| | - Luana Batista da Cruz
- Federal University of Maranhão - UFMA, Applied Computing Group - NCA/UFMA, Av. dos Portugueses , Vila Bacanga, 65080-805, São Luís, MA, Brazil
| | - Jorge Antonio Meireles Teixeira
- Federal University of Maranhão - UFMA, Applied Computing Group - NCA/UFMA, Av. dos Portugueses , Vila Bacanga, 65080-805, São Luís, MA, Brazil
| | - Geraldo Braz Junior
- Federal University of Maranhão - UFMA, Applied Computing Group - NCA/UFMA, Av. dos Portugueses , Vila Bacanga, 65080-805, São Luís, MA, Brazil
| | - Aristófanes Correa Silva
- Federal University of Maranhão - UFMA, Applied Computing Group - NCA/UFMA, Av. dos Portugueses , Vila Bacanga, 65080-805, São Luís, MA, Brazil
| | - Anselmo Cardoso de Paiva
- Federal University of Maranhão - UFMA, Applied Computing Group - NCA/UFMA, Av. dos Portugueses , Vila Bacanga, 65080-805, São Luís, MA, Brazil
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Garone G, Ferro V, Barbato M, Vanacore N, Papini L, Pro S, Boni A, Scialanga B, Nacca R, Evangelisti M, Di Nardo G, Parisi P, Raucci U. Acute strabismus in neurological emergencies of childhood: A retrospective, single-centre study. Eur J Paediatr Neurol 2021; 32:80-85. [PMID: 33857732 DOI: 10.1016/j.ejpn.2021.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/18/2021] [Accepted: 03/28/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Acute strabismus (AS) is the most common ocular motility disorder in children. In the emergency setting evaluation, the primary concern is to exclude a potentially dangerous underlying condition, requiring immediate intervention. Our first aim was to describe the epidemiology, clinical features, and underlying causes of AS in a cohort of children presenting to the emergency department (ED). Our second aim was to identify clinical features associated with a significant risk of underlying neurological emergencies (NEs). DESIGN AND SETTING Clinical records of all patients under 18 years presenting for AS to the ED of the Bambino Gesù Children's Hospital over a 10-year period were retrospectively reviewed. A logistic regression model was applied to detect predictive variables associated with a higher risk of NEs. RESULTS 208 patients (M:F = 1.19) were identified (0.35 cases per 1000 admission). Commonly associated symptoms included diplopia (18.3%), headache (23.1%), nausea or vomit (8.6%). Other ocular or neurological abnormalities were associated in 47.6% of patients. NEs accounted for 24.03% of all cases, mostly represented by brain tumours (8.65%). Ptosis, optic disk blurring, vomit, gait abnormalities and consciousness disorders were found to confer a significantly greater risk of an underlying NE. CONCLUSIONS Potentially severe neurological conditions may affect almost one in four children presenting to the ED for AS. Brain malignancies are the most common dangerous cause. Presence of ptosis, papilledema, vomit, gait disorders, consciousness impairment, pupillary defects and multiple cranial nerves involvement should be considered as red flags.
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Affiliation(s)
- Giacomo Garone
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Valentina Ferro
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marta Barbato
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Nicola Vanacore
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Laura Papini
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Pro
- Neurophysiology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Boni
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Barbara Scialanga
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Raffaella Nacca
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Melania Evangelisti
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Giovanni Di Nardo
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Zheng C, Xie X, Wang Z, Li W, Chen J, Qiao T, Qian Z, Liu H, Liang J, Chen X. Development and validation of deep learning algorithms for automated eye laterality detection with anterior segment photography. Sci Rep 2021; 11:586. [PMID: 33436781 PMCID: PMC7803760 DOI: 10.1038/s41598-020-79809-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 12/09/2020] [Indexed: 02/05/2023] Open
Abstract
This paper aimed to develop and validate a deep learning (DL) model for automated detection of the laterality of the eye on anterior segment photographs. Anterior segment photographs for training a DL model were collected with the Scheimpflug anterior segment analyzer. We applied transfer learning and fine-tuning of pre-trained deep convolutional neural networks (InceptionV3, VGG16, MobileNetV2) to develop DL models for determining the eye laterality. Testing datasets, from Scheimpflug and slit-lamp digital camera photography, were employed to test the DL model, and the results were compared with a classification performed by human experts. The performance of the DL model was evaluated by accuracy, sensitivity, specificity, operating characteristic curves, and corresponding area under the curve values. A total of 14,468 photographs were collected for the development of DL models. After training for 100 epochs, the DL models of the InceptionV3 mode achieved the area under the receiver operating characteristic curve of 0.998 (with 95% CI 0.924-0.958) for detecting eye laterality. In the external testing dataset (76 primary gaze photographs taken by a digital camera), the DL model achieves an accuracy of 96.1% (95% CI 91.7%-100%), which is better than an accuracy of 72.3% (95% CI 62.2%-82.4%), 82.8% (95% CI 78.7%-86.9%) and 86.8% (95% CI 82.5%-91.1%) achieved by human graders. Our study demonstrated that this high-performing DL model can be used for automated labeling for the laterality of eyes. Our DL model is useful for managing a large volume of the anterior segment images with a slit-lamp camera in the clinical setting.
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Affiliation(s)
- Ce Zheng
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaolin Xie
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou University Medical College, Shantou, Guangdong, China
| | - Zhilei Wang
- Department of Ophthalmology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Li
- Department of Ophthalmology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jili Chen
- Department of Ophthalmology, Shibei Hospital, Shanghai, China
| | - Tong Qiao
- Department of Ophthalmology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhuyun Qian
- Department of Ophthalmology, Shanghai Aier Eye Hospital, No. 1286, Hongqiao Road, Changning District, Shanghai, 200050, China
| | - Hui Liu
- Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China
| | - Jianheng Liang
- Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China
| | - Xu Chen
- Department of Ophthalmology, Shanghai Aier Eye Hospital, No. 1286, Hongqiao Road, Changning District, Shanghai, 200050, China.
- Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China.
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Jones‐Jordan L, Wang X, Scherer RW, Mutti DO. Spectacle correction versus no spectacles for prevention of strabismus in hyperopic children. Cochrane Database Syst Rev 2020; 4:CD007738. [PMID: 32240551 PMCID: PMC7117860 DOI: 10.1002/14651858.cd007738.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Hyperopia in infancy requires accommodative effort to bring images into focus. Prolonged accommodative effort has been associated with an increased risk of strabismus. Strabismus may result in asthenopia and intermittent diplopia, and makes near work tasks difficult to complete. Spectacles to correct hyperopic refractive error is believed to prevent the development of strabismus. OBJECTIVES To assess the effectiveness of prescription spectacles compared with no intervention for the prevention of strabismus in infants and children with hyperopia. SEARCH METHODS We searched CENTRAL (2018, Issue 12; which contains the Cochrane Eyes and Vision Trials Register); Ovid MEDLINE; Embase.com; three other databases; and two trial registries. We used no date or language restrictions in the electronic search for trials. We last searched the electronic databases on 4 December 2018. SELECTION CRITERIA We included randomized controlled trials and quasi-randomized trials investigating spectacle intervention or no treatment for children with hyperopia. We required hyperopia to be at least greater than +2.00 diopters (D). DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. The primary outcome was the proportion of children with manifest strabismus, as defined by study investigators. Other outcomes included the amblyopia, stereoacuity, and the effect of spectacle use of strabismus and visual acuity. We also collected information on change in refractive error as a measurement of the interference of emmetropization. MAIN RESULTS We identified four randomized controlled trials (985 children enrolled who were aged six months to less than 36 months) in this review. Three trials were in the UK with follow-up periods ranging from one to 3.5 years and one in the US with three years' follow-up. Investigators reported both incidence and final status regarding strabismus. Evidence of the incidence of strabismus, measured in 804 children over three to four years in four trials was uncertain although suggestive of a benefit with spectacle use (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.41 to 1.02). We have very low confidence in these results due to high risk of bias, inconsistency, and imprecision. When assessed as the proportion of children with strabismus at the end of three years' follow-up, we found a similar level of evidence for an effect of spectacles on strabismus as reported in one study (RR 1.00, 95% CI 0.31 to 3.25; 106 children). We have very low confidence in these results because of low sample size and risk of bias. One trial reported on the risk for developing amblyopia and inadequate stereoacuity after three years in 106 children. There was unclear evidence for a decreased risk of developing amblyopia (RR 0.78, 95% CI 0.31 to 1.93), and limited evidence for a benefit of spectacles for prevention of inadequate stereoacuity (RR 0.38, 95% CI 0.16 to 0.88). We have very low confidence in these findings due to imprecision and risk of bias. The risk of not developing emmetropization is unclear. One trial reported on the proportion of children not achieving emmetropization at three years' follow-up (RR 0.75, 95% CI 0.18 to 3.19). One trial suggested spectacles impede emmetropization, and one trial reported no difference. These two trials could not be combined because the methods for assessing emmetropization were different. With the high risk of bias and inconsistency, the certainty of evidence for a risk for impeding or benefiting emmetropization is very low. Based on a meta-analysis of four trials (770 children), the risk of having visual acuity worse than 20/30 measured up to three years of age or at the end of three years of follow-up was uncertain for children with spectacle correction compared with those without correction (RR 0.87, 95% CI 0.64 to 1.18; very low confidence due to risk of bias and imprecision). AUTHORS' CONCLUSIONS The effect of spectacle correction for prevention of strabismus is still unclear. In addition, the use of spectacle on the risk of visual acuity worse than 20/30, amblyopia, and inadequate emmetropization is also unclear. There may be a benefit on prevention of inadequate stereoacuity. However, these effects may have been chance findings or due to bias.
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Affiliation(s)
- Lisa Jones‐Jordan
- The Ohio State UniversityCollege of Optometry338 West 10th Avenue649 Fry HallColumbusOhioUSA43210
| | - Xue Wang
- Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology615 N. Wolfe StreetBaltimoreMarylandUSA21205
| | - Roberta W Scherer
- Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology615 N. Wolfe StreetBaltimoreMarylandUSA21205
| | - Donald O Mutti
- The Ohio State UniversityCollege of Optometry338 West 10th Avenue649 Fry HallColumbusOhioUSA43210
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Usmani B, Iftikhar M, Latif A, Shah SM. Epidemiology of primary ophthalmic procedures performed in the United States. Can J Ophthalmol 2019; 54:727-734. [DOI: 10.1016/j.jcjo.2019.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/21/2018] [Accepted: 03/17/2019] [Indexed: 12/21/2022]
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Different surgical outcomes in infantile exotropia according to onset time. J AAPOS 2019; 23:317.e1-317.e6. [PMID: 31654771 DOI: 10.1016/j.jaapos.2019.08.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/15/2019] [Accepted: 08/04/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine whether age of onset influences surgical outcomes in infantile exotropia. METHODS The medical records of patients at our tertiary care facility who underwent bilateral lateral rectus recession for infantile exotropia during the period 2004-2013 were reviewed retrospectively. Patients were grouped by onset age: 6 months or earlier (E6 group) or later than 6 months (L6 group). Motor outcomes, near stereoacuity, and distance fusional status in both groups were evaluated. RESULTS A total of 134 patients were included: 35 in the E6 group and 99 in the L6 group. At a mean follow-up of 4.6 years, recurrence occurred in 12 (34%) of the E6 group and 38 (38%) of the L6 group (P = 0.496). Overcorrection occurred in 3 (9%) of the E6 group and in 4 (4%) of the L6 group (P = 0.341). In the analysis of 109 patients eligible for sensory examinations, the E6 group demonstrated a higher proportion of patients with reduced stereoacuity of 80 arcsec or worse (54% vs 25% [P = 0.007]) and suppression (46% vs 12% [P < 0.001]) compared with those in the L6 group. In logistic regression analyses, onset of ≤6 months was significantly associated with reduced stereoacuity (OR = 6.42) and suppression (OR = 37.67) but not with recurrence or overcorrection. CONCLUSIONS In our study cohort, age of onset ≤6 months was associated with worse sensory prognosis for children with infantile exotropia but not with a difference in motor outcomes.
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12
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Du XM. Efficacy of horizontal muscle augmentation combined inferior oblique muscle shortening for pediatric strabismus: Study Protocol. Medicine (Baltimore) 2019; 98:e17941. [PMID: 31725649 PMCID: PMC6867723 DOI: 10.1097/md.0000000000017941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study will explore the efficacy and safety of horizontal muscle augmentation (HMA) combined inferior oblique muscle shortening (IOMS) for the treatment of pediatric strabismus (PS). METHODS Literature search for studies will be carried out in the following databases: Cochrane Library, MEDILINE, EMBASE, CINAHL, Web of Science, PsycINFO, CBM, and CNKI. We will search all these databases without language and publication status restrictions. Two independent authors will perform selection of studies, data collection and management, risk of bias evaluation. A third author will be consulted with the help of discrepancies. RESULTS This study will provide a synthesis of existed evidence for HMA combined IOMS for the treatment of PS. CONCLUSION The results of this study will provide evidence to evaluate the efficacy and safety of HMA combined IOMS for the treatment of PS, which can help to guide clinical decision-making. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019149716.
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13
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Heckmann JG, Vachalova I, Lang CJG, Pitz S. Neuro-Ophthalmology at the Bedside: A Clinical Guide. J Neurosci Rural Pract 2019; 9:561-573. [PMID: 30271051 PMCID: PMC6126320 DOI: 10.4103/jnrp.jnrp_145_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Neuro-ophthalmological signs and symptoms are common in the emergency department but are a frequent source of diagnostic uncertainties. However, neuro-ophthalmological signs often allow a precise neuro-topographical localization of the clinical problem. A practical concept is presented how to perform a neuro-ophthalmological examination at the bedside and to interpret key findings under the aspect of emergency medicine with limited resources.
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Affiliation(s)
- Josef G Heckmann
- Department of Neurology, Municipal Hospital, Landshut, Bavaria, Germany
| | - Ivana Vachalova
- Department of Neurology, Municipal Hospital, Landshut, Bavaria, Germany
| | - Christoph J G Lang
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Susanne Pitz
- Orbital Center, Bürgerhospital, Frankfurt, Germany
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Eghbali A, Hassan S, Seehra G, FitzGibbon E, Sidransky E. Ophthalmological findings in Gaucher disease. Mol Genet Metab 2019; 127:23-27. [PMID: 31047801 DOI: 10.1016/j.ymgme.2019.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 01/06/2023]
Abstract
Gaucher disease is an autosomal recessive lysosomal storage disorder caused by mutations in the gene GBA1, which encodes the lysosomal protein glucocerebrosidase. Patients with Gaucher disease generally have a variety of clinical manifestations ranging from visceral to neurological involvement and some develop ocular involvement. The most commonly affected organs include the spleen, liver, and bone. Moreover, patients often have hepatosplenomegaly, thrombocytopenia, anemia, and bone involvement related to deficient glucocerebrosidase and the subsequent accumulation of glucosylceramide and glucosylsphingosine in cells. A subset of patients develops neurological manifestations, including seizures, myoclonic epilepsy, and progressive neurodegeneration. Eye involvement tends to be less common and presents with diverse clinical findings. These rare and variable ocular manifestations, involving the vitreous, retina, cornea, uvea, conjunctiva and eye movements, can pose a diagnostic challenge for clinicians, especially those not familiar with the disorder. In this review, we explore the different ophthalmologic findings reported in patients with Gaucher disease, aiming to facilitate diagnosis and expedite treatment for patients presenting with ocular manifestations of this rare disorder.
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Affiliation(s)
- Areian Eghbali
- Section on Molecular Neurogenetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shahzeb Hassan
- Section on Molecular Neurogenetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gurpreet Seehra
- Section on Molecular Neurogenetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Edmond FitzGibbon
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ellen Sidransky
- Section on Molecular Neurogenetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
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15
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16
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Shaaban S, MacKinnon S, Andrews C, Staffieri SE, Maconachie GDE, Chan WM, Whitman MC, Morton SU, Yazar S, MacGregor S, Elder JE, Traboulsi EI, Gottlob I, Hewitt AW, Hunter DG, Mackey DA, Engle EC. Genome-Wide Association Study Identifies a Susceptibility Locus for Comitant Esotropia and Suggests a Parent-of-Origin Effect. Invest Ophthalmol Vis Sci 2018; 59:4054-4064. [PMID: 30098192 PMCID: PMC6088800 DOI: 10.1167/iovs.18-24082] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/19/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To identify genetic variants conferring susceptibility to esotropia. Esotropia is the most common form of comitant strabismus, has its highest incidence in European ancestry populations, and is believed to be inherited as a complex trait. Methods White European American discovery cohorts with nonaccommodative (826 cases and 2991 controls) or accommodative (224 cases and 749 controls) esotropia were investigated. White European Australian and United Kingdom cohorts with nonaccommodative (689 cases and 1448 controls) or accommodative (66 cases and 264 controls) esotropia were tested for replication. We performed a genome-wide case-control association study using a mixed linear additive model. Meta-analyses of discovery and replication cohorts were then conducted. Results A significant association with nonaccommodative esotropia was discovered (odds ratio [OR] = 1.41, P = 2.84 × 10-09) and replicated (OR = 1.23, P = 0.01) at rs2244352 [T] located within intron 1 of the WRB (tryptophan rich basic protein) gene on chromosome 21 (meta-analysis OR = 1.33, P = 9.58 × 10-11). This single nucleotide polymorphism (SNP) is differentially methylated, and there is a statistically significant skew toward paternal inheritance in the discovery cohort. Meta-analysis of the accommodative discovery and replication cohorts identified an association with rs912759 [T] (OR = 0.59, P = 1.89 × 10-08), an intergenic SNP on chromosome 1p31.1. Conclusions This is the first genome-wide association study (GWAS) to identify significant associations in esotropia and suggests a parent-of-origin effect. Additional cohorts will permit replication and extension of these findings. Future studies of rs2244352 and WRB should provide insight into pathophysiological mechanisms underlying comitant strabismus.
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Affiliation(s)
- Sherin Shaaban
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, United States
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, Massachusetts, United States
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, United States
- Dubai Harvard Foundation for Medical Research, Boston, Massachusetts, United States
| | - Sarah MacKinnon
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Caroline Andrews
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, United States
- Howard Hughes Medical Institute, Chevy Chase, Maryland, United States
| | - Sandra E. Staffieri
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Ophthalmology, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Gail D. E. Maconachie
- Department of Neuroscience, The University of Leicester Ulverscroft Eye Unit, University of Leicester, Leicester, United Kingdom
| | - Wai-Man Chan
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, United States
- Howard Hughes Medical Institute, Chevy Chase, Maryland, United States
| | - Mary C. Whitman
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, Massachusetts, United States
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Sarah U. Morton
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Seyhan Yazar
- Medical Research Council (MRC) Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine, The University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
- Centre for Ophthalmology and Visual Science, University of Western Australia, Lions Eye Institute, Perth, Western Australia, Australia
| | - Stuart MacGregor
- Stastical Genetics Laboratory, Queensland Institute of Medical Research (QIMR) Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - James E. Elder
- Department of Ophthalmology, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Elias I. Traboulsi
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Irene Gottlob
- Department of Neuroscience, The University of Leicester Ulverscroft Eye Unit, University of Leicester, Leicester, United Kingdom
| | - Alex W. Hewitt
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Lions Eye Institute, Perth, Western Australia, Australia
- Department of Ophthalmology, School of Medicine, Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Strabismus Genetics Research Consortium
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, United States
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, Massachusetts, United States
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, United States
- Dubai Harvard Foundation for Medical Research, Boston, Massachusetts, United States
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
- Howard Hughes Medical Institute, Chevy Chase, Maryland, United States
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Ophthalmology, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia
- Department of Neuroscience, The University of Leicester Ulverscroft Eye Unit, University of Leicester, Leicester, United Kingdom
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, United States
- Medical Research Council (MRC) Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine, The University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
- Centre for Ophthalmology and Visual Science, University of Western Australia, Lions Eye Institute, Perth, Western Australia, Australia
- Stastical Genetics Laboratory, Queensland Institute of Medical Research (QIMR) Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
- Department of Ophthalmology, School of Medicine, Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, Massachusetts, United States
| | - David G. Hunter
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - David A. Mackey
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Lions Eye Institute, Perth, Western Australia, Australia
- Department of Ophthalmology, School of Medicine, Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Elizabeth C. Engle
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, United States
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, Massachusetts, United States
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, United States
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
- Howard Hughes Medical Institute, Chevy Chase, Maryland, United States
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, Massachusetts, United States
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Pediatric Eye Evaluations Preferred Practice Pattern®: I. Vision Screening in the Primary Care and Community Setting; II. Comprehensive Ophthalmic Examination. Ophthalmology 2017; 125:P184-P227. [PMID: 29108745 DOI: 10.1016/j.ophtha.2017.09.032] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/22/2022] Open
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Silverstein E, Donahue SP. Field Evaluation of Automated Vision Screening Instruments: Impact of Referral Criteria Choice on Screening Outcome. J Pediatr Ophthalmol Strabismus 2015; 52:364-70. [PMID: 26393478 DOI: 10.3928/01913913-20150915-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 05/11/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Automated vision screeners can identify children with amblyopia risk factors. Two screening instruments having different referral criteria were evaluated in a community setting: SPOT (Pediavision, Lake Mary, FL) (sensitive manufacturer's referral criteria) and plusoptiX S08 (Plusoptix GmbH, Nuremberg, Germany) (specific modified Arthur referral criteria). METHODS All children were screened by SPOT, and referred children were then screened using plusoptiX. Referred children received a gold standard examination to determine whether amblyopia risk factors were present. RESULTS A total of 2,801 treatment-naïve children were screened using SPOT. Of these, 307 (11.0%) were referred by SPOT and subsequently screened by plusoptiX; 100 received a gold standard examination. Amblyopia risk factors were present in 43% (43 of 100) referred by SPOT compared to 72.7% (32 of 44) for plusoptiX. Eleven of 56 referred by SPOT had amblyopia risk factors that would have been missed by plusoptiX, including three with mild amblyopia. CONCLUSIONS PlusoptiX with modified Arthur referral criteria can be a highly specific screening device detecting amblyopia risk factors without missing children with moderate/severe amblyopia.
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19
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Bui Quoc E, Milleret C. Origins of strabismus and loss of binocular vision. Front Integr Neurosci 2014; 8:71. [PMID: 25309358 PMCID: PMC4174748 DOI: 10.3389/fnint.2014.00071] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/27/2014] [Indexed: 11/13/2022] Open
Abstract
Strabismus is a frequent ocular disorder that develops early in life in humans. As a general rule, it is characterized by a misalignment of the visual axes which most often appears during the critical period of visual development. However other characteristics of strabismus may vary greatly among subjects, for example, being convergent or divergent, horizontal or vertical, with variable angles of deviation. Binocular vision may also vary greatly. Our main goal here is to develop the idea that such “polymorphy” reflects a wide variety in the possible origins of strabismus. We propose that strabismus must be considered as possibly resulting from abnormal genetic and/or acquired factors, anatomical and/or functional abnormalities, in the sensory and/or the motor systems, both peripherally and/or in the brain itself. We shall particularly develop the possible “central” origins of strabismus. Indeed, we are convinced that it is time now to open this “black box” in order to move forward. All of this will be developed on the basis of both presently available data in literature (including most recent data) and our own experience. Both data in biology and medicine will be referred to. Our conclusions will hopefully help ophthalmologists to better understand strabismus and to develop new therapeutic strategies in the future. Presently, physicians eliminate or limit the negative effects of such pathology both on the development of the visual system and visual perception through the use of optical correction and, in some cases, extraocular muscle surgery. To better circumscribe the problem of the origins of strabismus, including at a cerebral level, may improve its management, in particular with respect to binocular vision, through innovating tools by treating the pathology at the source.
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Affiliation(s)
- Emmanuel Bui Quoc
- Ophthalmology Department, Hopital Robert Debre/Assistance Publique Hopitaux de Paris Paris, France
| | - Chantal Milleret
- Collège de France, Center for Interdisciplinary Research in Biology (CIRB), Spatial Navigation and Memory Team Paris, France
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Jones-Jordan L, Wang X, Scherer RW, Mutti DO. Spectacle correction versus no spectacles for prevention of strabismus in hyperopic children. Cochrane Database Syst Rev 2014; 8:CD007738. [PMID: 25133974 PMCID: PMC4259577 DOI: 10.1002/14651858.cd007738.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hyperopia (far-sightedness) in infancy requires accommodative effort to bring images into focus. Prolonged accommodative effort has been associated with an increased risk of strabismus (eye misalignment). Strabismus makes it difficult for the eyes to work together and may result in symptoms of asthenopia (eye strain) and intermittent diplopia (double vision), and makes near work tasks difficult to complete. Untreated strabismus may result in the development of amblyopia (lazy eye). The prescription of spectacles to correct hyperopic refractive error is believed to prevent the development of strabismus. OBJECTIVES To assess the effectiveness of prescription spectacles compared with no intervention for the prevention of strabismus in infants and children with hyperopia. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to April 2014), EMBASE (January 1980 to April 2014), PubMed (1966 to April 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 3 April 2014. We also searched the Science Citation Index database in September 2013. SELECTION CRITERIA We included randomized controlled trials and quasi-randomized trials investigating the assignment to spectacle intervention or no treatment for children with hyperopia. The definition of hyperopia remains subjective, but we required it to be at least greater than +2.00 diopters (D) of hyperopia. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data using the standard methodologic procedures expected by The Cochrane Collaboration. One review author entered data into Review Manager and a second review author verified the data entered. The two review authors resolved discrepancies at all stages of the review process. MAIN RESULTS We identified three randomized controlled trials (855 children enrolled) in this review. These trials were all conducted in the UK with follow-up periods ranging from one to 3.5 years. We judged the included studies to be at high risk of bias, due to use of quasi-random methods for assigning children to treatment, no masking of outcomes assessors, and high proportions of drop-outs. None of the three trials accounted for missing data and analyses were limited to the available-case data (674 (79%) of 855 children enrolled for the primary outcome). These factors impair our ability to assess the effectiveness of treatment.Analyses incorporating the three trials we identified in this review (674 children) suggested the effect of spectacle correction initiated prior to the age of one year in hyperopic children between three and four years of age is uncertain with respect to preventing strabismus (risk ratio (RR) 0.71; 95% confidence interval (CI) 0.44 to 1.15; very low quality evidence). Based on a meta-analysis of three trials (664 children), the risk of having visual acuity worse than 20/30 at three years of age was also uncertain for children with spectacles compared with those without spectacle correction irrespective of compliance (RR 0.87; 95% CI 0.60 to 1.26; very low quality evidence).Emmetropization was reported in two trials: one trial suggested that spectacles impede emmetropization, and the second trial reported no difference in the rate of refractive error change. AUTHORS' CONCLUSIONS Although children who were allocated to the spectacle group were less likely to develop strabismus and less likely to have visual acuity worse than 20/30 children allocated to no spectacles, these effects may have been chance findings, or due to bias. Due to the high risk of bias and poor reporting of included trials, the true effect of spectacle correction for hyperopia on strabismus is still uncertain.
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Affiliation(s)
- Lisa Jones-Jordan
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Xue Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Roberta W Scherer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Donald O Mutti
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
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Abstract
Infantile esotropia affects binocular alignment and development of binocular vision. Delayed correction may lead to loss of stereopsis. Waiting for the angle of deviation to stabilise prior to surgery does not impact overall postoperative outcomes greatly. Early surgical intervention produces better outcomes in terms of sensory and motor development, binocular vision and stereoacuity. The period of misalignment has the greatest effect on postoperative outcome therefore early surgery is recommended.
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Affiliation(s)
- Humera Sarwar
- Peninsula College of Medicine & Dentistry, RD&E Hospital Wonford, Exeter
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Abstract
Misalignment of the eyes can lead to double vision and visual confusion. However, these sensations are rare when strabismus is acquired early in life, because the extra image is suppressed. To explore the mechanism of perceptual suppression in strabismus, the visual fields were mapped binocularly in 14 human subjects with exotropia. Subjects wore red/blue filter glasses to permit dichoptic stimulation while fixating a central target on a tangent screen. A purple stimulus was flashed at a peripheral location; its reported color ("red" or "blue") revealed which eye's image was perceived at that locus. The maps showed a vertical border between the center of gaze for each eye, splitting the visual field into two separate regions. In each region, perception was mediated by only one eye, with suppression of the other eye. Unexpectedly, stimuli falling on the fovea of the deviated eye were seen in all subjects. However, they were perceived in a location shifted by the angle of ocular deviation. This plasticity in the coding of visual direction allows accurate localization of objects everywhere in the visual scene, despite the presence of strabismus.
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Anomalous head posturing in essential infantile esotropia: a hypothesis. Eur J Ophthalmol 2012; 22:297-300. [DOI: 10.5301/ejo.5000122] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2012] [Indexed: 11/20/2022]
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Wright JG, Menaker RJ. Waiting for children's surgery in Canada: the Canadian Paediatric Surgical Wait Times project. CMAJ 2011; 183:E559-64. [PMID: 21543299 DOI: 10.1503/cmaj.101530] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In addition to possibly prolonged suffering and anxiety, extended waits for children's surgery beyond critical developmental periods has potential for lifelong impact. The goal of this study was to determine the duration of waits for surgery for children and youth at Canadian paediatric academic health sciences centres using clinically-derived access targets (i.e., the maximum acceptable waiting periods for completion of specific types of surgery) as used in this Canadian Paediatric Surgical Wait Times project. METHODS We prospectively applied standardized wait-time targets for surgery, created by nominal-group consensus expert panels, to pediatric patients at children's health sciences centres across Canada with decision-to-treat dates of Sept. 1, 2007 or later. From Jan. 1 to Dec. 30, 2009, patients' actual wait times were compared with their target wait times to determine the percentage of patients receiving surgery after the target waiting period. RESULTS Overall, 27% of pediatric patients from across Canada (17,411 of 64,012) received their surgery after their standardized target waiting period. Dentistry, ophthalmology, plastic surgery and cancer surgery showed the highest percentages of surgeries completed past target. INTERPRETATION Many children wait too long for surgery in Canada. Specific attention is required, in particular, in dentistry, ophthalmology, plastic surgery and cancer care, to address children's wait times for surgery. Improved access may be realized with use of national wait-time targets.
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Affiliation(s)
- James G Wright
- Department of Surgery, The Hospital for Sick Children, Toronto, Ontario.
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Pedespan JM, Cabasson S. Strabisme. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)71072-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE Large-angle strabismus is a gray zone for surgeons with various advocates for one, two-, three-, or even four-muscle surgeries. Very frequently, reoperations are required in these cases in order to achieve a successful outcome. In this article, the authors evaluate the outcome of concomitant large-angle strabismus after a single surgical procedure. METHODS A retrospective analysis of all operated cases of concomitant large-angle strabismus (50 prism diopters or more) during a 1.5-year period was performed from patient's case files. A successful outcome of surgery was defined as deviation within 10 prism diopters of orthophoria/tropia for both distance and near. RESULTS Fifty patients met the inclusion criteria. The overall success rate was 60%, with the esotropia group having a higher success rate (68.75%) than the exotropia group (44.45%). Ten patients underwent recess-resect procedure, 20 had bimedial rectus recession, and 3 had bilateral lateral rectus recession, while 17 patients had surgery on 3 horizontal rectus muscles. Thirty-three patients had two-muscle surgery with a success rate of 57.58%, while 17 patients had three-muscle surgery with a success rate of 64.71%, the difference being statistically insignificant. There was no statistically significant difference between the various age groups analyzed for overall success rate, suggesting that age group is not a factor for positive outcome in large-angle strabismus surgery. A total of 12 patients were amblyopic at the time of strabismus surgery and they had a success rate of 33.33%, which was much poorer than the success rate (68.42%) of the remaining 38 patients who did not have amblyopia at the time of surgery. CONCLUSIONS A good surgical outcome can be obtained in large-angle strabismus with a single surgical procedure, though a randomized controlled study needs to be done to establish whether three-muscle surgeries give better results than two-muscle surgeries.
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Affiliation(s)
- Satish Thomas
- Department of Ophthalmology, Christian Medical College & Hospital, Ludhiana, India.
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Affiliation(s)
- Sean P Donahue
- Department of Pediatrics, Vanderbilt University Medical Center/Vanderbilt Eye Institute, 2311 Pierce Ave, Nashville, TN 37232-8808, USA.
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Anesthetic management for pediatric strabismus surgery: Continuing professional development. Can J Anaesth 2010; 57:602-17. [PMID: 20393822 DOI: 10.1007/s12630-010-9300-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 03/05/2010] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Strabismus surgery is one of the most common pediatric ophthalmic procedures. The purpose of this continuing professional development module is to update physicians on the anesthetic considerations of pediatric patients undergoing strabismus surgery. PRINCIPAL FINDINGS The preoperative assessment is important, as patients undergoing strabismus surgery may have an associated neuromuscular disorder, congenital syndrome, or cardiac disease. Malignant hyperthermia is no longer considered as being an issue associated with strabismus. The laryngeal mask airway is used frequently and has been shown as being associated with a low incidence of complications in strabismus surgery. The anesthesia technique can be adapted to decrease the incidence of the oculocardiac reflex and the oculorespiratory reflex, and the use of anticholinergic prophylaxis remains debatable. Since patients are at high risk for postoperative nausea and vomiting (PONV), combination anti-emetic therapy is recommended using dexamethasone and ondansetron. Metoclopramide was not found to provide additional benefit when combined with other anti-emetics. Droperidol is effective, but there remains a black box warning for dysrhythmias. Effective analgesics in this patient population include acetaminophen, nonsteroidal anti-inflammatory drugs, peribulbar blocks, and subtenon blocks. Topical tetracaine drops have demonstrated mixed results, and topical nonsteroidal anti-inflammatory drops were found not to be effective. The use of opioids should be minimized due to the increased incidence of PONV. CONCLUSIONS To provide optimal care for the pediatric patient undergoing strabismus surgery, it is important to understand the unique anesthetic considerations for strabismus surgery and to appreciate how each decision regarding the anesthetic technique can alter these considerations.
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Liu GT, Volpe NJ, Galetta SL. Eye movement disorders. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Feng C, Von Bartheld CS. Schwann cells as a source of insulin-like growth factor-1 for extraocular muscles. Muscle Nerve 2009; 41:478-86. [DOI: 10.1002/mus.21519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
PURPOSE In an investigation of the psychosocial impact of amblyopia on children, the perceived self-esteem of children who had been treated for amblyopia was compared with that of age-matched controls. The influence of amblyopia condition or treatment factors that may impact self-perception scores was also explored. METHODS Children with a history of treatment for amblyopia (n = 47; age 9.2 +/- 1.3 years) and age-matched controls (n = 52; age 9.4 +/- 0.5 years) completed a standardized age-appropriate questionnaire based evaluation of perceived self-esteem (Harter Self Perception Profile for Children). Their vision characteristics and treatment regimen were also recorded. Bivariate correlation analysis was used to investigate the amblyopic characteristics and treatment factors that may have influenced self-perception scores in the amblyopic group. RESULTS Children treated for amblyopia had significantly lower social acceptance scores than age-matched control children. In other areas related to self-esteem, including scholastic competence, physical appearance, athletic competence, behavioral conduct and global self worth, amblyopic children gave scores similar to those of control children. Within the amblyopic group, a lower social acceptance score was significantly correlated with a history of treatment with patching but not with a history of strabismus or wearing of glasses. CONCLUSIONS Self-perception of social acceptance was lower in children treated for amblyopia compared with age-matched controls. A reduction in these scores was associated with a history of patching treatment but not with a history of strabismus or spectacle wear.
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Silverstein E, Lorenz S, Emmons K, Donahue SP. Limits on improving the positive predictive value of the Welch Allyn SureSight for preschool vision screening. J AAPOS 2009; 13:45-50. [PMID: 18976944 DOI: 10.1016/j.jaapos.2008.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 08/02/2008] [Accepted: 08/05/2008] [Indexed: 02/06/2023]
Abstract
PURPOSE To describe our experience using the Welch Allyn SureSight (Welch Allyn, Inc., Skaneateles Falls, NY) when vision screening a large population of preschool children. Additionally, we explore the usefulness of altering referral criteria to create high specificity for remote field screening in instances in which over-referral is costly. METHODS Preschool children were screened for amblyogenic factors with the SureSight. Referred children received a gold standard examination with American Association for Pediatric Ophthalmology and Strabismus Vision Screening Committee-established failure criteria. Referral criteria were made increasingly more stringent to lower the rate of referral, and the effect on positive predictive value (PPV) was determined. RESULTS A total of 15,749 children were screened, with reliable screening obtained in >99%. Rowatt-modified Vision in Preschoolers Study referral criteria produced a referral rate of 7.3% and a PPV of 48.2%. The PPV was >70% for children with unreliable screenings and with estimated refractive errors exceeding the instrument's range. Altering referral criteria improved PPV until referral rate reached 4% (PPV approximately 64%); further refinement past this level did not increase PPV and, hence, inappropriately limited sensitivity. CONCLUSIONS A good test instrument should have high PPV and a referral rate approaching the population disease. Although altering referral criteria to decrease referral rate also decreases sensitivity, it should improve PPV. The presence of an asymptotic limit to PPV means additional improvement in PPV cannot be obtained with this technology. Thus, SureSight's usefulness for high-specificity screening is limited; however, the current referral criteria are sufficient for large screening programs and provide an acceptable referral rate and PPV.
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Affiliation(s)
- Evan Silverstein
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Mohney BG, McKenzie JA, Capo JA, Nusz KJ, Mrazek D, Diehl NN. Mental illness in young adults who had strabismus as children. Pediatrics 2008; 122:1033-8. [PMID: 18977984 PMCID: PMC2762944 DOI: 10.1542/peds.2007-3484] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We investigated the prevalence and types of psychiatric disorders diagnosed by early adulthood among patients who had common forms of strabismus as children. METHODS The medical records of children (<19 years) who were diagnosed as having esotropia (N = 266) or exotropia (N = 141) while residents of Olmsted County, Minnesota, between January 1, 1985, and December 31, 1994, were reviewed retrospectively for psychiatric disease diagnoses. Each case subject was compared with a randomly selected, individually birth- and gender-matched, control subject from the same population. RESULTS A mental health disorder was diagnosed for 168 (41.3%) of the 407 patients with a history of childhood strabismus, who were monitored to a mean age of 17.4 years, compared with 125 control subjects (30.7%). Children with exotropia were 3.1 times more likely to develop a psychiatric disorder than were control subjects when monitored to a mean age of 20.3 years. Children with esotropia were no more likely to develop mental illness than were control subjects when monitored for similar periods. Patients with intermittent exotropia also were significantly more likely to have greater numbers of mental health disorders, mental health emergency department visits, and mental health hospitalizations and to have suicidal or homicidal ideation. CONCLUSIONS Children diagnosed as having strabismus in this population, especially those with exotropia, were at increased risk for developing mental illness by early adulthood. Patients with intermittent exotropia seemed to be particularly prone to developing significant psychiatric diseases by the third decade of life.
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Affiliation(s)
- Brian G Mohney
- Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
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Schutte S, Polling JR, van der Helm FCT, Simonsz HJ. Human error in strabismus surgery: quantification with a sensitivity analysis. Graefes Arch Clin Exp Ophthalmol 2008; 247:399-409. [DOI: 10.1007/s00417-008-0961-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 09/22/2008] [Accepted: 09/24/2008] [Indexed: 10/21/2022] Open
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Long-term follow-up of visual functions in prematurely born children--a prospective population-based study up to 10 years of age. J AAPOS 2008; 12:157-62. [PMID: 18083590 DOI: 10.1016/j.jaapos.2007.08.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 08/09/2007] [Accepted: 08/19/2007] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Prematurely born children have an increased risk of ophthalmologic problems. There is still no consensus on how they should be followed. The purpose of this study was to evaluate predictive factors for problems in premature children at ten years of age and to discuss follow-up recommendations. MATERIALS AND METHODS One hundred ninety-nine children with a birth weight of 1500 g or less were screened for retinopathy of prematurity (ROP) in the neonatal period and thereafter ophthalmologically examined at 6 months, 1.5, 2.5, 3.5, and 10 years of age. "Visual dysfunction" at ten years of age was defined as visual acuity > or =0.1 logMAR and/or strabismus and/or subnormal contrast sensitivity. Multiple regression analyses were used to evaluate risk factors at an early age, which could predict problems at ten years of age. RESULTS Twenty-five percent of the cohort had visual dysfunction at ten years of age. Neurological complications, cryotreated ROP, anisometropia, and astigmatism were risk factors. The sensitivity was 75.5%, and the specificity 80.7% for the detection of visual dysfunction at ten years of age when all children with neurological complications, cryotreated ROP, strabismus, anisometropia > or =1 diopters (D) at 2.5 years, and astigmatism > or =2 D at 2.5 years were included in further follow-up. CONCLUSIONS Repeated ophthalmologic follow-up of prematurely born children should be performed in those with treated ROP and/or neurological conditions. For a third group without such problems, at least one follow-up is recommended. Such an examination also provides a good opportunity to identify neurological problems that warrant further ophthalmologic follow-up.
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Economides JR, Adams DL, Jocson CM, Horton JC. Ocular motor behavior in macaques with surgical exotropia. J Neurophysiol 2007; 98:3411-22. [PMID: 17928552 DOI: 10.1152/jn.00839.2007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To provide an animal model of human exotropia, a free tenotomy of the medial recti was performed in two infant macaques. When the animals were old enough to record eye movements with video eye trackers, we measured their ductions, ocular alignment, comitance, smooth pursuit, fixation preference, and gaze stability. Partial recovery of adduction occurred in each monkey from spontaneous re-attachment of the medial rectus muscle to the eye. However, each animal was left with a relatively comitant, large angle exotropia. The magnitude of the exotropia was not affected by covering one eye. There was no dissociated vertical deviation or any significant "A" or "V" pattern to the horizontal misalignment. Smooth pursuit was more accurate when tracking nasally compared with temporally in both animals. Compensatory catch-up saccades in the tracking eye were always accompanied by conjugate movements in the deviated eye. Despite tenotomy of the medial recti, the velocity of adducting saccades was normal. Both monkeys alternated fixation, preferring to use the left eye for targets on the left side and the right eye for targets on the right. Each animal was capable of switching fixation while making accurate saccades. One of the monkeys developed a vertical pendular nystagmus, which was most prominent in the deviated eye. Macaques with ocular misalignment from medial rectus tenotomy exhibit features that are present in humans with alternating exotropia. These animals will be valuable for probing the cortical mechanisms that underlie visual suppression in strabismus.
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Affiliation(s)
- John R Economides
- Beckman Vision Center, University of California, San Francisco, CA 94143-0730, USA
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