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Yagasaki A, Yagasaki T, Yokoyama Y. Medial rectus insertion site in cases of acute acquired comitant esotropia associated with excessive digital device usage. Jpn J Ophthalmol 2024:10.1007/s10384-024-01113-y. [PMID: 39215882 DOI: 10.1007/s10384-024-01113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 07/25/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE To compare the distance of the medial rectus muscle insertion to the limbus (DMIL) between patients with acute acquired comitant esotropia (AACE) associated with excessive digital device usage (EDDU) and exotropic patients. STUDY DESIGN Retrospective study. METHODS The medical records of 72 eyes of 44 patients with EDDU were retrospectively analyzed. The DMIL was measured from the anterior part at the midpoint of the medial rectus muscle insertion into the anterior limbus using a caliper after dissecting the medial rectus muscle with two control sutures at 12 o'clock and 6 o'clock. The DMIL in the non-fixation eye was compared between 44 patients with AACE and 23 patients with exotropia. RESULTS The mean daily EDDU was 6.5 ± 3.1 h. The mean cycloplegic refractive errors (spherical equivalent: SE) were - 3.18 ± 2.52 diopters (D) OD and - 3.03 ± 2.42 D OS. The mean DMIL in the 72 eyes of 44 patients with AACE associated with EDDU was 4.30 ± 0.66 mm. The difference in DMIL of non-fixation eyes between 44 AACE patients and 23 exotropic patients was significant (4.28 ± 0.65 mm vs. 5.28 ± 0.50 mm, p < 0.0001). However, the SE in 44 non-dominant eyes of AACE was - 3.08 ± 2.56 D, significantly stronger than - 1.22 ± 1.93 D in the 23 exotropic eyes (p = 0.008). CONCLUSION DMIL in patients with AACE associated with EDDU was significantly shorter. This anatomical anomaly may be an etiology of AACE associated with EDDU.
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Affiliation(s)
- Ayaka Yagasaki
- Yagasaki Eye Clinic, 62-6, Gonaka, Kaimei, Ichinomiya, 494-0001, Aichi, Japan
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Aichi, Japan
| | - Teiji Yagasaki
- Yagasaki Eye Clinic, 62-6, Gonaka, Kaimei, Ichinomiya, 494-0001, Aichi, Japan.
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Aichi, Japan.
| | - Yoshimi Yokoyama
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Aichi, Japan
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Ota J, Ando R, Motegi H, Sugino H, Mitsuhashi T, Ishida S. Acute acquired comitant esotropia associated with Lhermitte-Duclos disease: a case report. J Med Case Rep 2024; 18:365. [PMID: 39127687 DOI: 10.1186/s13256-024-04683-0] [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: 01/30/2024] [Accepted: 07/04/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Acute acquired comitant esotropia caused by prolonged near work, such as the use of digital devices, has been frequently reported in recent years. However, intracranial examination is necessary even for patients with nonparalytic comitant esotropia. Lhermitte-Duclos disease is a rare tumor that grows in layers in the cerebellum. Among those with this disease, cases of esotropia have been reported due to abduction limitation of the eye, but there have been no reports of comitant esotropia. Here, we report the case of a young woman with acute acquired comitant esotropia who was found to have Lhermitte-Duclos disease. CASE PRESENTATION A 16-year-old Japanese female patient, whose ethnicity was Asian, was referred to our hospital for acute acquired comitant esotropia. Fundus examination revealed papilledema in both eyes, and magnetic resonance imaging of the head revealed a cerebellar tumor in the right cerebellum with obstructive hydrocephalus. She underwent partial tumor resection, and a histopathological diagnosis of Lhermitte-Duclos disease was obtained. However, comitant esotropia status remained unchanged, and she underwent strabismus surgery. Finally, diplopia disappeared completely. CONCLUSION Neurological and intracranial imaging examinations are essential when acute acquired comitant esotropia is observed. Acute acquired comitant esotropia by Lhermitte-Duclos disease did not improve with partial tumor resection and required strabismus surgery, but good surgical results were obtained.
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Affiliation(s)
- Junya Ota
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Ophthalmology, Sunagawa City Medical Center, Sunagawa, Japan
| | - Ryo Ando
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Hiroaki Motegi
- Department of Neurosurgery, Hokkaido University School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hirokazu Sugino
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomoko Mitsuhashi
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Cassano F, Procoli U, Ferrari LM, Buonamassa R, Zaccaro F, Boscia F, Alessio G. Acute acquired concomitant esotropia: May COVID-19 lockdowns have changed its presentation? Eur J Ophthalmol 2024; 34:1009-1013. [PMID: 37956466 DOI: 10.1177/11206721231213415] [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] [Indexed: 11/15/2023]
Abstract
PURPOSE To evaluate the effects of COVID-19 lockdown in Italy on the features of Acute Acquired Concomitant Esotropia (AACE). SUBJECTS Patients of the Polyclinic Hospital of Bari diagnosed with AACE between January 2018 and December 2021, subdivided in pre-lockdown group - diagnosed before March 2020 - and post-lockdown group. METHODS Medical records were reviewed, and statistical analysis performed. Deviation size was assessed in the 9 cardinal positions of gaze with refractive correction. Wilcoxon test for unpaired samples was used to compare data of age, near maximum deviation and best corrected visual acuity (BCVA) for each eye; Student's t test was used to compare far maximum deviation, difference far/near maximum deviation and spherical equivalent data. Fisher exact test was used to compare subtype cases (Bielschowsky vs Non-Bielschowsky) in the two groups. A p-value lower than 0.05 was considered statistically significant.The primary outcome measure was the difference in AACE subtypes between the two groups. RESULTS Nineteen patients were included, of which 12 males (63.2%); 7 belong to the pre-lockdown group and 12 to the post-lockdown group. The difference in types between the two groups proved to be statistically significant (p = 0.01977).The differences in the mean of age, right BCVA, right spherical equivalent and mean spherical equivalent between the two groups proved to be statistically significant (p < 0.05). CONCLUSIONS After the COVID-19 pandemic, the profile of the typical patient with AACE has probably changed, and now it is more probably myopic and elderly than before. Thus, we observed an increase in the Bielschowsky subtype.
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Côté E, Reginald YA, Wan MJ. Risk of serious intracranial pathology in children presenting with acute acquired comitant esotropia. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00001-2. [PMID: 38281727 DOI: 10.1016/j.jcjo.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/05/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Acute acquired comitant esotropia (AACE) is defined as a sudden-onset constant nonaccommodative esodeviation. The purpose of this study was to determine the risk of serious intracranial pathology in children presenting with AACE. DESIGN Retrospective observational cohort study. SETTING Tertiary care pediatric hospital. METHODS The study included consecutive children who met the diagnostic criteria for AACE and had neuroimaging at a tertiary care pediatric hospital between 2000 and 2020. Patients were identified by searching the radiology database for all children who underwent neuroimaging for esotropia. The primary outcome measure was the proportion of patients with serious intracranial pathology. Secondary outcomes included risk factors for finding likely causative intracranial pathology and the proportion of patients with incidental findings. RESULTS A total of 107 patients met the inclusion criteria. Most of the patients (75.7%) had normal neuroimaging. The next most common result was an incidental finding unrelated to the esotropia (18.7%). Five patients (4.7%) had findings with uncertain contribution to esotropia, including 3 cases of type I Chiari malformation. A serious intracranial pathology was found in 1 patient (0.9%) who had a cerebellar medulloblastoma. CONCLUSION In this large series of pediatric patients with AACE who underwent neuroimaging, there was a small but nontrivial risk of serious intracranial pathology. In these patients, it is advisable either to obtain neuroimaging or to monitor closely for the development of concerning signs or symptoms.
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Affiliation(s)
- Elie Côté
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, ON
| | - Y Arun Reginald
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, ON
| | - Michael J Wan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, ON..
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Hayashi R, Hayashi S, Nishimura T, Machida S. Conformation of Horizontal Extraocular Muscle Insertions in Acute Acquired Concomitant Esotropia Induced by Excessive Digital Device Usage. Clin Ophthalmol 2024; 18:41-47. [PMID: 38205266 PMCID: PMC10778159 DOI: 10.2147/opth.s440322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/02/2023] [Indexed: 01/12/2024] Open
Abstract
Purpose Acute acquired concomitant esotropia induced by excessive digital device usage, especially smartphones (SAACE), has been increasing over the past few years. Convergence spasm induced by excessive near work has been suggested as a mechanism. Anatomical differences could also potentially contribute to SAACE onset. The present study investigated the conformation of horizontal recti between SAACE patients and normal subjects. Patients and Methods In 15 SAACE patients (SAACE group), the distances between the limbus and insertion of the horizontal recti (LI distance) and the widths of horizontal recti on the insertion (insertion width) were measured. The control group consisted of 30 patients who underwent retinal detachment surgery. Differences in LI distances and insertion widths were compared between SAACE and control groups. Results While there were no differences between the two groups for LI distances and insertion widths of lateral recti, there were significantly shorter LI distances for the medial recti in the SAACE group (P<0.05). Moreover, the SAACE group tended to exhibit larger insertion widths of the medial recti. Medial/lateral ratio of LI distances were significantly lower and insertion widths were significantly higher in the SAACE compared to the control group (P<0.05). Conclusion Based on the observations of more anterior insertion and larger muscle widths, this suggests there are stronger forces of medial recti in SAACE. In addition to excessive accommodation followed by increases in medial recti tonus, the results also suggest that an anatomical imbalance between lateral and medial recti contributes to esotropia onset following excessive near work.
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Affiliation(s)
- Rijo Hayashi
- Department of Ophthalmology, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Saitama, Japan
| | - Shimmin Hayashi
- Department of Ophthalmology, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Saitama, Japan
- Lively Eye Clinic, Soka, Saitama, Japan
| | - Tomoharu Nishimura
- Department of Ophthalmology, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Saitama, Japan
| | - Shigeki Machida
- Department of Ophthalmology, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Saitama, Japan
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Sharma R, Tibrewal S, Majumdar A, Rath S, Ganesh S. Acquired comitant esotropias - comparison of surgical outcomes of accommodative vs non-accommodative types. Strabismus 2023; 31:293-305. [PMID: 38086747 DOI: 10.1080/09273972.2023.2281979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Purpose: To compare the motor and sensory outcomes of strabismus surgery and the factors affecting surgical success in acquired acute non-accomodative esotropia (ANAET) and partially accommodative refractive esotropia (pARET). Methods: A retrospective chart review of patients with ANAET and pARET who underwent unilateral or bilateral horizontal rectus muscle surgery between January 2020 and December 2021 was conducted. Patients with postoperative follow-up of at least six weeks were included. Patients with pattern deviation, lateral incomitance, and near-distance disparity were excluded. Motor success was defined as a postoperative deviation within eight prism diopters of orthophoria. Sensory success was defined as presence of binocular single vision (BSV) for both distance and near (Worth four dot test). The effect of factors like age at onset, age at surgery, amblyopia before surgery, duration of squint before treatment, presence or absence and magnitude of vertical deviation, preoperative angle of deviation, and spherical equivalent on the motor and sensory success in each group were analyzed and compared. Results: 38 patients with ANAET and 33 patients with pARET were included. The mean age of onset of esotropia was 8.55 ± 4.65 years and 4.39 ± 2.27 years (p < .001) and the mean age at surgery was 10.62 ± 4.99 years and 7.89 ± 2.84 years (p = .006) in the ANAET and the pARET group respectively. The mean duration of the final follow-up was 38.51 weeks in the ANAET and 48.68 weeks in the pARET group (p = .089). Patients were successfully aligned for both distance and near in 81.5% of patients in the ANAET and 78.9% of patients in the pARET group at the final follow-up (p. 0.775). A BSV for both distance and near at the final follow-up was seen in 81.2% vs 66.6% of patients in the ANAET and the pARET group respectively (p = .25). A good near stereoacuity (<120 arcsecs) was seen in 60.6% and 41.9% of the ANAET and the pARET groups respectively (p = .175). The percentage of patients in the ANAET group who had orthophoria, any esodeviation, and any exodeviation for distance at the final follow-up was 63.1%, 34.2% and, 2.6%. The percentage of patients in the pARET group in similar categories was 36.3%, 42.4% and, 21.2%. None of the demographic and preoperative factors were found to affect the surgical outcomes in the two groups. Conclusions: The motor and sensory outcomes were similar in the two groups. A higher proportion of ANAET patients remained orthophoric during the follow-up. The patients in the pARET group showed a tendency toward exodrift.
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Affiliation(s)
- Richa Sharma
- Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Dr Shroff's Charity Eye Hospital, New Delhi
| | - Shailja Tibrewal
- Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Dr Shroff's Charity Eye Hospital, New Delhi
| | - Atanu Majumdar
- Department of Biostatistics, Dr Shroff's Charity Eye Hospital, New Delhi
| | - Soveeta Rath
- Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Dr Shroff's Charity Eye Hospital, New Delhi
| | - Suma Ganesh
- Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Dr Shroff's Charity Eye Hospital, New Delhi
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Shah C, Goyal A, Sen P, Peeush P, Sen A, More A, Jain E. Mobile battery blast injuries: An emerging ocular health hazard in children. Indian J Ophthalmol 2023; 71:3620-3625. [PMID: 37991293 PMCID: PMC10788765 DOI: 10.4103/ijo.ijo_1169_23] [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: 05/05/2023] [Accepted: 07/19/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE To assess clinical features, visual outcomes, and setting of mobile battery blast-induced eye injuries in children. METHODS Retrospective case sheets of children with mobile battery blast injuries were reviewed at a tertiary eye care center from January 2015 to March 2022. We noted the mode of injury, battery status, and clinical presentation and analyzed the treatment outcomes. RESULTS The study included 14 eyes of 11 patients. Three patients (27%) had bilateral ocular injuries. The most common reasons for the blast were wiring a bulb to the battery or charging the battery with a universal mobile charger, seen in four cases each. Three eyes had closed-globe injuries (CGIs), whereas 11 had open-globe injuries (OGIs). Of the 11 eyes with OGI, four also had a retained intraocular foreign body (IOFB). Only four (36%) eyes having OGI could achieve vision better than 6/60. All three eyes with CGIs developed secondary glaucoma, and two underwent trabeculectomy. However, the visual prognosis was better (>6/36) in eyes with CGI. Overall, mean visual acuity at the final follow-up was improved to 1.41 ± 1.14 logMAR from 2.32 ± 0.76 logMAR at presentation. This was also found to be statistically significant with a P value of 0.02. CONCLUSION Battery blast-induced ocular injuries, although rare, often lead to poor outcomes. Apart from charging, playing with discarded or damaged batteries was a common reason for battery blasts in our series.
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Affiliation(s)
- Chintan Shah
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya and Post Graduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Anand Goyal
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya and Post Graduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Pradhnya Sen
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya and Post Graduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Parimal Peeush
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya and Post Graduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Alok Sen
- Department of Retina and Uvea, Sadguru Netra Chikitsalaya and Post Graduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Amruta More
- Department of Retina and Uvea, Sadguru Netra Chikitsalaya and Post Graduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Elesh Jain
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya and Post Graduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
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Iimori H, Nishina S, Hieda O, Goseki T, Nishikawa N, Suzuki S, Hikoya A, Komori M, Suzuki H, Yoshida T, Hayashi S, Mori T, Kimura A, Morimoto T, Shimizu Y, Negishi T, Shimizu T, Yokoyama Y, Sugiyama Y, Azuma N, Sato M. Clinical presentations of acquired comitant esotropia in 5-35 years old Japanese and digital device usage: a multicenter registry data analysis study. Jpn J Ophthalmol 2023; 67:629-636. [PMID: 37695434 DOI: 10.1007/s10384-023-01023-5] [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: 01/12/2023] [Accepted: 07/26/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE To describe clinical presentations of acquired comitant esotropia and digital device use in children, adolescents, and young adults without neurological problems. STUDY DESIGN Multicenter prospective observational study. METHODS Patients with acquired comitant esotropia, without intracranial diseases aged 5-35 years at the time of visit, who were seen at pre-registered facilities within 1 year of onset were enrolled. The duration from the onset of symptoms and the time of digital device usage approximately 1 month before onset and their lifestyles were surveyed. Visual acuity, cycloplegic refraction, and strabismus angles were measured. Data were analyzed in three age groups (Child: 5-12 years, Adolescent: 13-18 years, and Young adult: 19-35 years). RESULTS Between November 2019 and December 2021, 218 patients were enrolled from 55 facilities, and 194 patients (including 62 children, 69 adolescents, and 63 young adults) were analyzed. The child group spent the least amount of time using digital devices (children: 159; adolescents: 210; young adults: 267 min/work day, p < 0.05; (mean time in the same order below) 229, 338, 314 min/holiday, p < 0.05) and had the largest strabismus angle (mean strabismus angle at near: 30, 22, 18 PD, p < 0.01; at far: 28, 26, 21 PD, p<0.05). CONCLUSION The clinical features of acquired comitant esotropia and hand-held digital device usage differed between children aged ≤ 12 years and older patients. This report gives the current clinical characteristics of young patients with acquired esotropia and digital device usage.
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Affiliation(s)
- Hirohito Iimori
- Department of Ophthalmology, Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Higashi-ku, Hamamatsu, Japan
- Department of Ophthalmology, Ehime University, Toon, Japan
| | - Sachiko Nishina
- Division of Ophthalmology, National Center for Child Health and Development, Tokyo, Japan
| | - Osamu Hieda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiaki Goseki
- Department of Ophthalmology, Kitasato University, Sagamihara, Japan
- Department of Ophthalmology, Kanagawa Dental University Yokohama Clinic, Yokohama, Japan
- Department of Ophthalmology, International University of Health and Welfare, Atami Hospital, Atami, Japan
| | - Noriko Nishikawa
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Sadao Suzuki
- Department of Public Health, Nagoya City University, Nagoya, Japan
| | - Akiko Hikoya
- Department of Ophthalmology, Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Higashi-ku, Hamamatsu, Japan
| | - Miwa Komori
- Department of Ophthalmology, Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Higashi-ku, Hamamatsu, Japan
| | - Hiroko Suzuki
- Department of Ophthalmology, Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Higashi-ku, Hamamatsu, Japan
| | - Tomoyo Yoshida
- Division of Ophthalmology, National Center for Child Health and Development, Tokyo, Japan
| | - Shion Hayashi
- Division of Ophthalmology, National Center for Child Health and Development, Tokyo, Japan
- Department of Ophthalmology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takafumi Mori
- Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
| | - Akiko Kimura
- Department of Ophthalmology, Hyogo Medical University, Nishinomiya, Japan
| | - Takeshi Morimoto
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yukiko Shimizu
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Takashi Negishi
- Department of Ophthalmology, Juntendo University Fuculty of Medicine, Tokyo, Japan
| | - Tamami Shimizu
- Department of Ophthalmology, Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Higashi-ku, Hamamatsu, Japan
- Department of Ophthalmology, Saga University, Saga, Japan
| | - Yoshimi Yokoyama
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Yoshiko Sugiyama
- Department of Ophthalmology, Kanazawa University, Kanazawa, Japan
| | - Noriyuki Azuma
- Division of Ophthalmology, National Center for Child Health and Development, Tokyo, Japan
- Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Miho Sato
- Department of Ophthalmology, Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Higashi-ku, Hamamatsu, Japan.
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Kaur K, Muralikrishnan J, Hussaindeen JR, Deori N, Gurnani B. Impact of Covid-19 on Pediatric Ophthalmology Care: Lessons Learned. Pediatric Health Med Ther 2023; 14:309-321. [PMID: 37849985 PMCID: PMC10578174 DOI: 10.2147/phmt.s395349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Abstract
The COVID-19 pandemic came with many new challenges that forced personal and professional lifestyle modifications. Medical facilities were in scarcity against this new unknown enemy and were challenged with the overloaded patient flow, scarcity of healthcare staff, and evolving treatment modalities with a better understanding of the virus each day. Ophthalmology as a "branch of medicine" suffered challenges initially because of a lack of guidelines for patient management, close working distance during routine examinations, and halt of major surgeries, including cataracts. Pediatric ophthalmology had major implications, as reduced outpatient visits would mean deeper amblyopia, and changed lifestyles, including online classes and home refinement, predisposing children to myopia, digital eye strain, and worsening of strabismus. COVID-19 also unveiled underlying accommodation and convergence anomalies that predisposed pediatric and adolescent patients to an increased prevalence of headache and acute onset esotropia. Teleophthalmology and other innovative solutions, including the use of prism glasses, safe slit-lamp shields, alternative ways of school screening with the use of photoscreeners, performing retinoscopy only when needed, and using autorefractors were among the few guidelines or modifications adopted which helped in the efficient and safe management of pediatric patients. Many pediatric ophthalmologists also suffered in terms of financial constraints due to loss of salary or even closure of private practices. School screening and retinopathy of prematurity screening suffered a great setback and costed a lot of vision years, data of which remains under-reported. Important implications and learnings from the pandemic to mitigate future similar situations include using teleophthalmology and virtual platforms for the triage of patients, managing non-emergency conditions without physical consultations, and utilizing home-based vision assessment techniques customized for different age groups. Though this pandemic had a lot of negative implications, the innovations, modifications, and other important learnings helped pediatric ophthalmologists in navigating safely.
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Affiliation(s)
- Kirandeep Kaur
- Children Eye Care Center, Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Chitrakoot, Madhya Pradesh, India
| | - Janani Muralikrishnan
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Chennai, India
| | | | - Nilutparna Deori
- Department of Pediatric Ophthalmology and Strabismus, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Bharat Gurnani
- Department of Cornea and Refractive Services, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Chitrakoot, Madhya Pradesh, India
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Perilli L, Fetta M, Capponi M, Guido CA, Grosso S, Iannetti P, Spalice A. Peripheral nervous system involvement in SARS-CoV-2 infection: a review of the current pediatric literature. Front Neurol 2023; 14:1134507. [PMID: 37305745 PMCID: PMC10249431 DOI: 10.3389/fneur.2023.1134507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/19/2023] [Indexed: 06/13/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the pathogen responsible for the pandemic health emergency declared by the World Health Organization in March 2020. During the first part of the pandemic, adults showed mild to severe respiratory symptoms. Children seemed initially exempt, both from acute and subsequent complications. Hyposmia or anosmia were promptly identified as the main symptoms of acute infection, so neurotropism of SARS-CoV-2 was immediately suspected. (1, 2). As the emergency progressed, post infectious neurological complications were described also in pediatric population (3). Cases of cranial neuropathy in connection with acute SARS-CoV-2 infection have been reported in pediatric patients, as an isolate post infectious complication or in the context of the multisystem inflammatory syndrome in children (MIS-C) (4-6). Neuroinflammation is thought to be caused by several mechanisms, among which immune/autoimmune reactions (7), but so far, no specific autoantibody has been identified. SARS-CoV-2 can enter the central nervous system (CNS) directly and/or infect it retrogradely, through the peripheral nervous system (PNS), after replicating peripherally; several factors regulate invasion and subsequent neuroinflammation. Indeed, direct/secondary entry and replication can activate CNS-resident immune cells that, together with peripheral leukocytes, induce an immune response and promote neuroinflammation. In addition, as we will discuss in the following review, many cases of peripheral neuropathy (cranial and non-cranial) have been reported during or after SARS-CoV-2 infection. However, some authors have pointed out that the increase of cranial roots and ganglia in neurological imaging is not always observed in children with cranial neuropathy. (8). Even if a variety of case reports were published, opinions about an increased incidence of such neurologic diseases, linked to SARS-CoV-2 infection, are still controversial (9-11). Facial nerve palsy, ocular movements abnormalities and vestibular alterations are among the most reported issues in pediatric population (3-5). Moreover, an increased screen exposure imposed by social distancing led to acute oculomotion's disturbance in children, not primarily caused by neuritis (12, 13). The aim of this review is to suggest food for thought on the role of SARS-CoV-2 in neurological conditions, affecting the peripheral nervous system to optimize the management and care of pediatric patients.
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Affiliation(s)
- Lorenzo Perilli
- Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Marina Fetta
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
| | - Martina Capponi
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
| | - Cristiana Alessia Guido
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
| | - Salvatore Grosso
- Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Paola Iannetti
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
| | - Alberto Spalice
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
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11
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Mylona I, Glynatsis MN, Floros GD, Kandarakis S. Spotlight on Digital Eye Strain. CLINICAL OPTOMETRY 2023; 15:29-36. [PMID: 36875935 PMCID: PMC9983433 DOI: 10.2147/opto.s389114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Digital Eye Strain (DES) is a clinical syndrome manifested with visual disturbances and/or ophthalmic dysfunction related to the usage of screen-enabled digital equipment. This term is gradually replacing the older term computer vision syndrome (CVS) that focused on the same symptoms found on personal computer users. DES is encountered more frequently during the past years due to the explosive increase in the usage of digital devices and subsequent increase in time in front of any screens. It presents with a series of atypical symptoms and signs stemming from asthenopia, dry eye syndrome, preexisting untreated vision issues and poor screen ergonomics. This review summarizes research data to date to determine whether the concept of DES has been conclusively defined and demarcated as a separate entity and if sufficient guidance is offered on professionals and the lay public. The maturity of the field, grouping of symptoms, examination techniques, treatment and prevention modalities are summarily presented.
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Affiliation(s)
- Ioanna Mylona
- Department of Ophthalmology, General Hospital of Katerini, Katerini, Greece
| | - Mikes N Glynatsis
- Department of Ophthalmology, ‘Hippokration’, General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Georgios D Floros
- 2nd Department of Psychiatry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stylianos Kandarakis
- 1st Department of Ophthalmology, General Hospital “G. Gennimatas”, National and Kapodistrian University of Athens, Athens, Greece
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12
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Pavel IA, Bogdanici CM, Donica VC, Anton N, Savu B, Chiriac CP, Pavel CD, Salavastru SC. Computer Vision Syndrome: An Ophthalmic Pathology of the Modern Era. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020412. [PMID: 36837613 PMCID: PMC9961559 DOI: 10.3390/medicina59020412] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/08/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
Digital device usage has increased significantly in last decade among all age groups, both for educational and recreational purposes. Computer vision syndrome (CVS), also known as digital eye strain (DES), represents a range of ocular, musculoskeletal, and behavioral conditions caused by prolonged use of devices with digital screens. This paper reviews the principal environmental, ocular, and musculoskeletal causes for this condition. Due to the high prevalence of DES and frequent usage of digital devices, it is important that eye care practitioners be able to provide advice and management options based on quality research evidence.
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Affiliation(s)
- Irina Andreea Pavel
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No.16, 700115 Iasi, Romania
| | - Camelia Margareta Bogdanici
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No.16, 700115 Iasi, Romania
- Correspondence: (C.M.B.); (V.C.D.)
| | - Vlad Constantin Donica
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No.16, 700115 Iasi, Romania
- Correspondence: (C.M.B.); (V.C.D.)
| | - Nicoleta Anton
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No.16, 700115 Iasi, Romania
| | - Bogdan Savu
- Department of Pediatrics, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No.16, 700115 Iasi, Romania
| | | | - Cristian Dan Pavel
- Department of Histology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No.16, 700115 Iasi, Romania
| | - Silvia Cristina Salavastru
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No.16, 700115 Iasi, Romania
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13
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Suwannaraj S, Rojanasaksothron C, Methapisittikul Y, Wongwai P, Yospaiboon Y. Botulinum Toxin Injection versus Extraocular Muscle Surgery for Acute Acquired Comitant Esotropia. Clin Ophthalmol 2023; 17:413-420. [PMID: 36748049 PMCID: PMC9899017 DOI: 10.2147/opth.s401019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Purpose To compare the success rate of extraocular muscle surgery and botulinum toxin injection for treatment in patients with acute acquired comitant esotropia (AACE). Patients and Methods This is a retrospective cohort study in which we treated 34 patients of AACE with botulinum toxin compared with 80 patients who had been treated with surgery. The data included angle of deviation in prism diopter (PD) at baseline and one, three, and six months after treatment. The main outcome was the success rate in each treatment group. Results In the surgery group, mean esodeviation angles at baseline and one, three, and six months after treatment were 50.8 ± 18.3 PD, 4.9 ± 8.3 PD, 4.6 ± 9.5 PD, and 5.5 ± 10.3 PD, whereas those in the botulinum toxin group were 51.2 ± 14.3 PD, 13.9 ± 17.4 PD, 22.0 ± 19.3, and 31.3 ± 23.8 PD, respectively. There was a statistically significant difference in the deviation angles between the two groups (p < 0.001). The success rate in the surgery group at one, three, and six months was 81%, 84%, and 79%, whereas that in the botulinum toxin group was 50%, 27%, and 27%. Conclusion Botulinum toxin injection was not as effective as conventional extraocular muscle surgery in AACE patients. However, the treatment is safe, fast-acting, and improves both cosmetic appearance and quality of life. This may be considered as a chance for patients not preferring surgery.
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Affiliation(s)
- Sirinya Suwannaraj
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chawisa Rojanasaksothron
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Yanasiri Methapisittikul
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Phanthipha Wongwai
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Yosanan Yospaiboon
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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14
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Carter D, Pujara P, Bolton K, Nicholson R. Simultaneous Development of Acute Acquired Concomitant Esotropia in Two Siblings during the COVID-19 Pandemic: A Case Report. Br Ir Orthopt J 2023; 19:1-6. [PMID: 36818462 PMCID: PMC9912853 DOI: 10.22599/bioj.283] [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] [Received: 08/22/2022] [Accepted: 12/23/2022] [Indexed: 02/08/2023] Open
Abstract
Aim To report a case of two siblings who near-simultaneously developed a large angle concomitant esotropia during the COVID-19 pandemic, and to describe their treatment and outcomes. Method A 5-year-old boy and his 11-year-old sister were presented to the hospital eye service in early 2021, having both developed acute-onset large angle esotropia within three months of each other. Neither had any significant past medical, ophthalmic, or family history. The siblings lived in the same household, and both experienced lifestyle changes as a result of the UK lockdown in response to COVID-19. Results Each sibling was treated with right medial rectus recession (5.5 mm) and right lateral rectus resection (7 mm), and at a three-month follow-up, both were minimally esophoric with restored binocularity. Conclusion The unusual and abrupt changes in lifestyle imposed by the COVID-19 pandemic highlight the likelihood of an environmental aetiology for some forms of esotropia and raise the possibility that extended screen time may be a contributory factor.
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Affiliation(s)
| | | | - Kate Bolton
- Portsmouth Hospitals University NHS Trust, GB
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15
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Yagasaki T, Yokoyama Y, Yagasaki A, Eboshita R, Tagami K, Haga Y, Touya A. Surgical Outcomes with and without Prism Adaptation of Cases with Acute Acquired Comitant Esotropia Related to Prolonged Digital Device Use. Clin Ophthalmol 2023; 17:807-816. [PMID: 36937166 PMCID: PMC10017831 DOI: 10.2147/opth.s403300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023] Open
Abstract
Purpose To analyze surgical results of 32 cases with acute acquired comitant esotropia (AACE) related to prolonged use of digital devices (DDs). Patients and Methods Medical records of cases with AACE related to prolonged use of DDs that had undergone surgery were retrospectively revised. Complete medical history and full ophthalmological examinations before and surgery were obtained for all cases. All cases also underwent neurological examinations using brain and orbital imaging. Motor success was considered as alignment within 10 prism diopters (Δ) at both near and distance. Sensory success was defined as stereopsis ≤60 arcsec. Nineteen cases (Group S) underwent surgery alone and 13 cases were treated with surgery and prism adaptation (Group S+P). Motor and sensory outcomes were compared between groups. Results Mean age at first visit was 22.0 ± 9.0 years and mean daily use of DDs use was 6.3 ± 3.4 hours. Mean angle of preoperative alignment for distance and near were 26.5 ± 13.0Δ and 24.6 ± 16.4Δ, respectively. Surgery was performed at a mean of 23.3 ±3.5 years old and mean angle of alignment at final examination for distance and near were 5.8 ± 7.7Δ and 3.5 ± 5.7Δ, respectively. Final motor and sensory success rate were 84% and 53%, respectively. No significant differences in motor or sensory outcomes were evident between groups at initial or last visit. Conclusion Favorable motor and sensory outcomes were achieved with surgical intervention with and without prism adaptation for AACT related to prolonged use of DDs.
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Affiliation(s)
- Teiji Yagasaki
- Yagasaki Eye Clinic, Ichinomiya, Aichi, Japan
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Aichi, Japan
- Correspondence: Teiji Yagasaki, Yagasaki Eye Clinic, 62-6 Gonaka, Kaimei, Ichinomiya, Aichi, 494-0001, Japan, Tel +81-586-61-8787, Fax +81-586-61-9210, Email
| | - Yoshimi Yokoyama
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Aichi, Japan
| | - Ayaka Yagasaki
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Aichi, Japan
- Department of Ophthalmology, Gifu Prefectural General Medical Center, Gifu, Gifu, Japan
| | | | | | - Yayoi Haga
- Yagasaki Eye Clinic, Ichinomiya, Aichi, Japan
| | - Arisu Touya
- Yagasaki Eye Clinic, Ichinomiya, Aichi, Japan
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16
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Roda M, di Geronimo N, Valsecchi N, Gardini L, Fresina M, Vagge A, Fontana L, Schiavi C. Epidemiology, clinical features, and surgical outcomes of acute acquired concomitant esotropia associated with myopia. PLoS One 2023; 18:e0280968. [PMID: 37200284 DOI: 10.1371/journal.pone.0280968] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/20/2023] [Indexed: 05/20/2023] Open
Abstract
PURPOSE To analyze epidemiology, clinical features, and surgical outcomes of type III acute acquired concomitant esotropia (Bielschowsky esotropia (BE)). METHODS The medical charts of patients diagnosed with acquired concomitant esotropia between 2013 and 2021 were reviewed. Assessed data were age, gender, age at diplopia onset, age at the diagnosis, refraction, visual acuity, neuroimaging, diplopia onset, angle of deviation, stereopsis, surgical procedure, amount of surgery, and relapse of diplopia after surgery. Moreover, we investigated the correlation between the use of electronic devices and the onset of diplopia. RESULTS One hundred seventeen patients (mean age 35.07 ± 15.81 years) were included in the study. The mean delay to the diagnosis was 3.29 ± 3.62 years. Myopia range was 0 to 17 diopters spherical equivalent. 66,3% spent more than 4 hours a day using laptops, tablets, or smartphones at the onset of diplopia, and 90,6% presented a subacute onset. None showed neurologic signs or symptoms. Patients who underwent surgery were ninety-three, with a rate of surgical success of 93.6%, and a relapse rate of 17.2%. A negative correlation resulted between pre-operative deviation and age at diagnosis (ρ = -0.261; p<0.05), whereas factors associated with surgical failure were older age at diplopia onset (p = 0.042) and longer delay between onset and diagnosis (p = 0.002). CONCLUSION We registered an outstanding increase in prevalence of BE, which could be related to the exponential increase in the use of electronic devices for professional, educational, and recreational purposes. A prompt diagnosis and an augmented dose of surgery allows good motor and sensory results.
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Affiliation(s)
- Matilde Roda
- Ophthalmology Unit, DIMEC, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Natalie di Geronimo
- Ophthalmology Unit, DIMEC, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Nicola Valsecchi
- Ophthalmology Unit, DIMEC, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Gardini
- Ophthalmology Unit, DIMEC, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Michela Fresina
- Ophthalmology Unit, DIMEC, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Aldo Vagge
- DINOGMI, Polyclinic Hospital San Martino IRCCS, University Eye Clinic, Genoa, Italy
| | - Luigi Fontana
- Ophthalmology Unit, DIMEC, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Costantino Schiavi
- Ophthalmology Unit, DIMEC, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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17
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Merino P, Freire M, Yáñez-Merino J, Gómez de Liaño P. Surgical outcomes of acquired acute comitant esotropia. Causes and classification. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:558-564. [PMID: 35871999 DOI: 10.1016/j.oftale.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/22/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To study the results of surgical treatment of acquired concomitant esotropia and its posible causes. METHODS Retrospective study of the patients with acute acquired esotropia that were operated on since 2017. Distance and near horizontal deviation, spherical equivalent and the excessive use of the tablets and smartphones were analyzed. A good sensorial outcome was considered when stereopsis was recovered and good motor outcome if horizontal deviation was ≤10 prism diopters at the end of the follow-up. RESULTS A total of 15 cases were included (60% women), mean age: 29.07 years (86.66% ≥16 years). Mean time since the beginning of the symptoms to the surgery was 23.3 months. Mean horizontal preoperative deviation was 19.73 ± 7.2 pd at near and 22.93 ± 7.3 dp at distance decreasing to 3.33 ± 3.8 pd at near and 3.86 ± 3.9 pd at distance (P < .001). The 66.6% had diplopía. The 46.66% had decompensated esophoria or microesotropia, 86,66 % myopia and the 33.33% referred excesive use of the tablets and smartphones. The medial rectus recession were done in 10 cases. A good motor outcome was obtained in the 93.33% of the cases and sensorial outcome in the 53.3% without diplopía. CONCLUSION Surgery was an excellent treatment to resolve the deviation and diplopia. The esophorias and microesotropias represented near the half of the cases and the excesive use of the tablets and smartphones were the third part of the sample. Most of the patients had myopia.
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Affiliation(s)
- P Merino
- Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón, Madrid, Spain.
| | - M Freire
- Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón, Madrid, Spain
| | - J Yáñez-Merino
- Departamento de Oftalmología, Hospital Miguel Servet, Zaragoza, Spain
| | - P Gómez de Liaño
- Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón, Madrid, Spain
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18
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The effects of topical cycloplegics in acute acquired comitant esotropia induced by excessive digital device usage. BMC Ophthalmol 2022; 22:366. [PMID: 36088414 PMCID: PMC9463501 DOI: 10.1186/s12886-022-02590-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Acute acquired comitant esotropia induced by excessive digital device usage, especially smartphones (SAACE), has been increasing over the past few years. One suggested mechanism is convergence spasm induced by excessive near work, with refraining from digital device use considered to be an effective method for decreasing the degree of esodeviation. However, if symptoms persist and are untreated over time, recovery becomes more difficult. The present study evaluated the effects of topical cycloplegics on persistent SAACE untreated for over 1 year.
Methods
Patients with sustained SAACE that was untreated for over 1 year were evaluated. Digital device usage was discouraged and a topical cycloplegic, 0.4% tropicamide, was prescribed at bedtime. After obtaining informed consent, the 14 out of 23 enrolled patients who agreed to eye drop administration were defined as the study group, with the others serving as the controls. After a 3-month follow-up, patients who elected to undergo surgery were analyzed as the surgery group. Changes in esotropia angles, stereoacuity and diplopia complaints were evaluated after a 3-month follow-up.
Results
Esotropia angles decreased and stereoacuity improved after a 3-month treatment in the study group (P < 0.01). Diplopia disappeared in 13 patients (92.9%, totally disappeared or disappeared when using glasses with built-in prisms). Among 11 patients with untreated esotropia ranging from 1–3 years, decreases in esotropia angles were correlated to untreated esotropia duration (near: R = -0.6; distance: R = 0.7; both P < 0.05). Esotropia angles in the control group exhibited a tendency to increase while stereoacuity tended to deteriorate after the 3-month follow-up. As diplopia did not disappear in any patients, 7 elected to undergo surgery and were enrolled as the surgery group. While esotropia angles decreased in the study group, they were lower than the surgery group (P < 0.01), but higher than the control group (P < 0.01). Stereoacuity was worse in the control versus the study and surgery groups (both P < 0.05).
Conclusion
Results suggest short-acting topical cycloplegics are effective in SAACE patients with long untreated periods. Decreases in esotropia angles were negatively correlated to untreated esotropia duration, which suggests the necessity of early treatment.
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Cortés-Albornoz MC, Ramírez-Guerrero S, Rojas-Carabali W, de-la-Torre A, Talero-Gutiérrez C. Effects of remote learning during the COVID-19 lockdown on children's visual health: a systematic review. BMJ Open 2022; 12:e062388. [PMID: 35922104 PMCID: PMC9352565 DOI: 10.1136/bmjopen-2022-062388] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Increased exposure to digital devices as part of online classes increases susceptibility to visual impairments, particularly among school students taught using e-learning strategies. This study aimed to identify the impact of remote learning during the COVID-19 lockdown on children's visual health. DESIGN Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Scopus, PubMed and ScienceDirect databases from the year 2020 onwards. ELIGIBILITY CRITERIA We included cross-sectional, case-control, cohort studies, case series and case reports, published in English, Spanish or French, that approached the effects of remote learning during the COVID-19 lockdown on visual health in neurotypical children. DATA EXTRACTION AND SYNTHESIS We included a total of 21 articles with previous quality assessments using the Joanna Briggs checklist. Risk of bias assessment was applied using the National Institutes of Health quality assessment tool for before-and-after studies with no control group; the tool developed by Hoy et al to assess cross-sectional studies; the Murad et al tool to evaluate the methodological quality of case reports and case series; and the Newcastle-Ottawa Scale for cohort studies. RESULTS All but one study reported a deleterious impact of the COVID-19 lockdown on visual health in children. Overall, the most frequently identified ocular effects were refractive errors, accommodation disturbances and visual symptoms such as dry eye and asthenopia. CONCLUSIONS Increased dependence on digital devices for online classes has either induced or exacerbated visual disturbances, such as rapid progression of myopia, dry eye and visual fatigue symptoms, and vergence and accommodation disturbances, in children who engaged in remote learning during the COVID-19 lockdown. PROSPERO REGISTRATION NUMBER CRD42022307107.
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Affiliation(s)
- María Camila Cortés-Albornoz
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogota D.C, Colombia
| | - Sofía Ramírez-Guerrero
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogota D.C, Colombia
| | - William Rojas-Carabali
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogota D.C, Colombia
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogota D.C, Colombia
| | - Claudia Talero-Gutiérrez
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogota D.C, Colombia
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20
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Kaur K, Gurnani B, Nayak S, Deori N, Kaur S, Jethani J, Singh D, Agarkar S, Hussaindeen JR, Sukhija J, Mishra D. Digital Eye Strain- A Comprehensive Review. Ophthalmol Ther 2022; 11:1655-1680. [PMID: 35809192 PMCID: PMC9434525 DOI: 10.1007/s40123-022-00540-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/14/2022] [Indexed: 11/02/2022] Open
Abstract
Digital eye strain (DES) is an entity encompassing visual and ocular symptoms arising due to the prolonged use of digital electronic devices. It is characterized by dry eyes, itching, foreign body sensation, watering, blurring of vision, and headache. Non-ocular symptoms associated with eye strain include stiff neck, general fatigue, headache, and backache. A variable prevalence ranging from 5 to 65% has been reported in the pre-COVID-19 era. With lockdown restrictions during the pandemic, outdoor activities were restricted for all age groups, and digital learning became the norm for almost 2 years. While the DES prevalence amongst children alone rose to 50-60%, the symptoms expanded to include recent onset esotropia and vergence abnormalities as part of the DES spectrum. New-onset myopia and increased progression of existing myopia became one of the most significant ocular health complications. Management options for DES include following correct ergonomics like reducing average daily screen time, frequent blinking, improving lighting, minimizing glare, taking regular breaks from the screen, changing focus to distance object intermittently, and following the 20-20-20 rule to reduce eye strain. Innovations in this field include high-resolution screens, inbuilt antireflective coating, matte-finished glass, edge-to-edge displays, and image smoothening graphic effects. Further explorations should focus on recommendations for digital screen optimization, novel spectacle lens technologies, and inbuilt filters to optimize visual comfort. A paradigm shift is required in our understanding of looking at DES from an etiological perspective, so that customized solutions can be explored accordingly. The aim of this review article is to understand the pathophysiology of varied manifestations, predisposing risk factors, varied management options, along with changing patterns of DES prevalence post COVID-19.
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Affiliation(s)
- Kirandeep Kaur
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, 605007, India.
| | - Bharat Gurnani
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, 605007, India
| | - Swatishree Nayak
- Department of Ophthalmology, AIIMS, Raipur, Chhattisgarh, 492001, India
| | | | - Savleen Kaur
- Advanced Eye Center, Post Graduate Institute of Ophthalmology, Chandigarh, 160012, India
| | - Jitendra Jethani
- Baroda Children Eye Care and Squint Clinic, Vadodara, Gujarat, 390007, India
| | | | - Sumita Agarkar
- Department of Pediatric Ophthalmology and Adult Strabismus, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, 600006, India
| | | | - Jaspreet Sukhija
- Advanced Eye Center, Post Graduate Institute of Ophthalmology, Chandigarh, 160012, India
| | - Deepak Mishra
- Department of Ophthalmology, Regional Institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
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AlHarkan DH, Alazmi AL, Al-Mutairi RH. Prevalence and Risk Factors of Parents Perceived Digital Eye Strain Syndrome among Saudi Students 1 Year after Online Studies: A Web-Based Survey. Middle East Afr J Ophthalmol 2022; 29:132-140. [PMID: 37408721 PMCID: PMC10319080 DOI: 10.4103/meajo.meajo_71_22] [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] [Received: 03/16/2022] [Revised: 01/09/2023] [Accepted: 03/06/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE The purpose is to present the prevalence and risk factors of parents' perceptions of digital eye strain (DES) syndrome 1 year after virtual learning among Saudi students. METHODS This web-based survey was conducted in December 2021 in Qassim, Saudi Arabia. Sixteen symptoms of DES were inquired. Parents responded to the frequency and severity of DES symptoms in their wards. The DES score assessed by the parents/guardian was associated with different determinants. RESULTS The survey included 704 students. The prevalence of DES was 59.4% (95% confidence interval 55.0; 63.8). Severe (scoring 18+) and moderate (score 12-18) grades of DES were found in 24% and 14% of students, respectively. Headache (20.9%), deterioration of vision (14.5%), difficulty focusing (12.5%), watering/tearing of eyes (10.1%), and blurred vision (10.8%) were noted as main DES symptoms. Girls, intermediate school students, students with spectacles, those with more than 4 h daily screen time or who position devices 25 cm or less from their eyes, and those attending virtual class for more than 4 h a day were found to have significantly severe DES grades. Females (P = 0.16), having outdoor activities of 1+ h (P = 0.02), 2+ h of daily screen time (P = 0.24), and attending virtual class for 4+ h (P = 0.001) were significant predictors of moderate and severe DES. Poor eye health and lower scholastic status were associated with severe DES. CONCLUSION DES in students after 1 year of virtual studying was high. Risk factors need to be addressed to avoid DES and its impact on students.
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Affiliation(s)
| | - Amal L. Alazmi
- King Saud Hospital, Unaizah, Qassim Health Cluster, Qassim, Saudi Arabia
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22
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Aldukhayel A, Baqar SM, Almeathem FK, Alsultan FS, AlHarbi GA. Digital Eye Strain Caused by Online Education Among Children in Qassim Region, Saudi Arabia: A Cross-Sectional Study. Cureus 2022; 14:e23813. [PMID: 35530919 PMCID: PMC9067335 DOI: 10.7759/cureus.23813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Online learning is the educational format adopted by schools and universities during the coronavirus disease 2019 (COVID-19) pandemic. It comprises Internet-based learning, computer-based learning, virtual classrooms, and digital collaborations. This study aims to assess digital eye strain (DES) among children attending online classes in the Qassim region, Saudi Arabia. Materials and methods This is a cross-sectional study conducted among children aged 3 to 18 years old in the Qassim region, Saudi Arabia. We sent out a self-administered questionnaire to parents of the targeted children by using social media, such as WhatsApp (Meta Platforms, Inc., Menlo Park, California, United States), Telegram (Telegram FZ LLC, Dubai), and Twitter (Twitter, Inc., San Francisco, California, United States). The questionnaire included questions on socio-demographic profile, smart devices being used, frequency of devices used per day before and during the lockdown, and DES. Results A total of 547 children were involved (50.3% males vs. 49.7% females). During online classes, the most commonly used device was tablets (51.2%). A significant increase was noticed in the use of devices during the COVID-19-related lockdown among children (p<0.001). The prevalence of DES-positive symptoms was 69.8%. The presence of DES symptoms was associated with age group (p=0.003), school level (p=0.040), device preferred for online classes (p=0.001), number of hours spent attending online classes (p=0.010), and number of hours spent using an electronic device during the lockdown (p<0.001). Conclusion Our study underlines a higher prevalence rate of DES among children during this time of the COVID-19 pandemic. Children who used a digital device for more than five hours during the lockdown had a greater risk of having DES than the rest.
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