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Jo E, Kim SM, Kim JM, Han SY. Changes in ocular biometrics following cycloplegic refraction in strabismic and amblyopic children. Medicine (Baltimore) 2024; 103:e38143. [PMID: 38758890 PMCID: PMC11098244 DOI: 10.1097/md.0000000000038143] [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] [Received: 03/08/2024] [Accepted: 04/15/2024] [Indexed: 05/19/2024] Open
Abstract
This study was aimed to analyze ocular biometric changes following cycloplegia in pediatric patients with strabismus and amblyopia. Cycloplegia is routinely used to measure refractive error accurately by paralyzing accommodation. However, effects on axial length (AL), anterior chamber depth (ACD), keratometry (Km), and white-to-white distance (WTW) are not well studied in this population. This retrospective study examined 797 patients (1566 eyes) undergoing cycloplegic refraction at a Samsung Kangbuk hospital pediatric ophthalmology clinic from 2010 to 2023. Ocular biometry was measured before and after instilling 1% cyclopentolate and 0.5% phenylephrine/0.5% tropicamide. Patients were categorized by strabismus diagnosis, age, refractive error and amblyopia status. Differences in AL, ACD, Km, WTW, and refractive error pre- and post-cycloplegia were analyzed using paired t tests. ACD (3.44 ± 0.33 vs 3.58 ± 0.29 mm, P < .05) and WTW (12.09 ± 0.42 vs 12.30 ± 0.60 mm, P < .05) increased significantly after cycloplegia in all groups except other strabismus subgroup (Cs) in both parameters and youngest subgroup (G1) in ACD. Refractive error demonstrated a hyperopic shift from -0.48 ± 3.00 D to -0.06 ± 3.32 D (P < .05) in overall and a myopic shift from -6.97 ± 4.27 to -8.10 ± 2.26 in high myopia (HM). Also, AL and Km did not change significantly. In conclusion, cycloplegia impacts ocular biometrics in children with strabismus and amblyopia, significantly increasing ACD and WTW. Refractive error shifts hyperopically in esotropia subgroup (ET) and myopically in high myopia subgroup (HM), eldest subgroup (G3) relating more to anterior segment changes than AL/Km. Understanding cycloplegic effects on biometry is important for optimizing refractive correction in these patients.
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Affiliation(s)
- Eunhui Jo
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Mo Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Mo Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Young Han
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Li D, Chan VF, Virgili G, Mavi S, Pundir S, Singh MK, She X, Piyasena P, Clarke M, Whitestone N, Patnaik JL, Xiao B, Cherwek DH, Negash H, O'Connor S, Prakalapakorn SG, Huang H, Wang H, Boswell M, Congdon N. Impact of Vision Impairment and Ocular Morbidity and Their Treatment on Quality of Life in Children: A Systematic Review. Ophthalmology 2024; 131:188-207. [PMID: 37696451 DOI: 10.1016/j.ophtha.2023.09.005] [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: 07/07/2023] [Revised: 08/16/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023] Open
Abstract
TOPIC This review summarizes existing evidence of the impact of vision impairment and ocular morbidity and their treatment on children's quality of life (QoL). CLINICAL RELEVANCE Myopia and strabismus are associated with reduced QoL among children. Surgical treatment of strabismus significantly improves affected children's QoL. METHODS We conducted a systematic review and meta-analysis by screening articles in any language in 9 databases published from inception through August 22, 2022, addressing the impact of vision impairment, ocular morbidity, and their treatment on QoL in children. We reported pooled standardized mean differences (SMDs) using random-effects meta-analysis models. Quality appraisal was performed using Joanna Briggs Institute and National Institutes of Health tools. This study was registered with the International Prospective Register of Systematic Reviews (identifier, CRD42021233323). RESULTS Our search identified 29 118 articles, 44 studies (0.15%) of which were included for analysis that included 32 318 participants from 14 countries between 2005 and 2022. Seventeen observational and 4 interventional studies concerned vision impairment, whereas 10 observational and 13 interventional studies described strabismus and other ocular morbidities. Twenty-one studies were included in the meta-analysis. The QoL scores did not differ between children with and without vision impairment (SMD, -1.04; 95% confidence interval [CI], -2.11 to 0.03; P = 0.06; 9 studies). Myopic children demonstrated significantly lower QoL scores than those with normal vision (SMD, -0.60; 95% CI, -1.09 to -0.11; P = 0.02; 7 studies). Children with strabismus showed a significantly lower QoL score compared with those without (SMD, -1.19; 95% CI, -1.66 to -0.73; P < 0.001; 7 studies). Strabismus surgery significantly improved QoL in children (SMD, 1.36; 95% CI, 0.48-2.23; P < 0.001; 7 studies). No randomized controlled trials (RCTs) concerning refractive error and QoL were identified. Among all included studies, 35 (79.5%) were scored as low to moderate quality; the remaining met all quality appraisal tools criteria. DISCUSSION Reduced QoL was identified in children with myopia and strabismus. Surgical correction of strabismus improves the QoL of affected children, which supports insurance coverage of strabismus surgery. Further studies, especially RCTs, investigating the impact of correction of myopia on QoL are needed. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Dongfeng Li
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China; Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China; Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Ving Fai Chan
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Gianni Virgili
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Department Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Sonia Mavi
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Sheetal Pundir
- Department of Ophthalmology, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Xinshu She
- School of Medicine, Stanford University, Stanford, California
| | - Prabhath Piyasena
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | | | - Jennifer L Patnaik
- Orbis International, New York, New York; Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Baixiang Xiao
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Affiliated Eye Hospital of Nanchang University, Nanchang City, China
| | | | | | - Sara O'Connor
- Advanced Center for Eyecare Global, Bakersfield, California
| | - S Grace Prakalapakorn
- Departments of Ophthalmology and Pediatrics, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Huilan Huang
- Shandong First Medical University (Shandong Academy of Medical Science), Jinan, China
| | - Huan Wang
- Centre on China's Economy and Institutions, Stanford University, Stanford, California
| | - Matthew Boswell
- Centre on China's Economy and Institutions, Stanford University, Stanford, California
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Orbis International, New York, New York; Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou City, China.
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Zhu H, Guo W, Wu Q, Hu H, Xu X, Wu F, Du J, Liu H, Hu Z. Structural and Functional Changes of Brain in Children With Intermittent Exotropia: A Study Combining Multiple MRI Modalities. J Neuroophthalmol 2023; 43:557-562. [PMID: 37167002 DOI: 10.1097/wno.0000000000001865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND To investigate structural and functional changes of brain in children with intermittent exotropia (IXT) and their relationship with clinical features. METHODS Twenty-one IXT patients (mean age 9.38 ± 2.62 years) and 21 age-, gender-, education-, and handedness-matched healthy controls (HCs, mean age 9.52 ± 3.28 years) underwent high-resolution T1 imaging, diffusion tensor imaging (DTI), and resting-state functional MRI (rs-fMRI). The gray and white matter volume analyzed by voxel-based morphometry (VBM) based on T1 imaging, the fractional anisotropy (FA) and mean diffusivity (MD) indices based on DTI, and the amplitude of low frequency fluctuation (ALFF) value based on rs-fMRI were compared between these 2 groups. The correlations between MRI-derived parameters in significant brain regions and various clinical characteristics of IXT were analyzed. RESULTS Compared with HCs, IXT children showed significantly decreased FA in right precentral gyrus (PRG) and right postcentral gyrus (POG), and significantly decreased ALFF in bilateral calcarine sulcus, bilateral cuneus, left lingual gyrus, and left superior occipital gyrus. The FA value in right PRG and right POG was negatively correlated with disease duration (r = -0.520, P = 0.016), angle of exodeviation at near (r = -0.549, P = 0.010), and angle of exodeviation at distance (r = -0.547, P = 0.010). CONCLUSIONS IXT children exhibited abnormalities of white matter microstructure and reduced spontaneous neural activities in brain regions involving in oculomotor performance and binocular fusion. Further studies are needed to determine whether these findings are related to the neuropathologic mechanism or downstream changes of IXT.
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Affiliation(s)
- Hui Zhu
- Ophthalmology (HZ, WG, HL), The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Radiology (QW, HH, XX, FW), The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; State Key Laboratory of Reproductive Medicine (JD, ZH), Nanjing Medical University, Nanjing, China; and Epidemiology (JD, ZH), School of Public Health, Nanjing Medical University, Nanjing, China
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Oruz O, Pelit A, Akar S, Ateş EG, Oto S. Refractive change in pediatric patients with intermittent exotropia. J AAPOS 2023; 27:284.e1-284.e4. [PMID: 37730159 DOI: 10.1016/j.jaapos.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/04/2023] [Accepted: 07/31/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE To determine the relationship between intermittent exotropia (IXT) and refractive change and the effects of the methods applied in IXT follow-up on refractive change. METHOD The medical records of 228 patients with IXT (group 1) and 110 patients without strabismus (group 2) who were followed between 2008 and 2022 were analyzed retrospectively. Group 1 was divided into three subgroups: overminus correction (group 1A), patients who underwent surgery (group 1B), and patients who were observed (group 1C). RESULTS Annual myopic progression was -0.21 ± 0.32 D (range, -1.26 to +1.92) in group 1 and -0.07 ± 0.30 D (range, -1.13 to +1.00) in group 2 (P < 0.001). Annual myopic progression was -0.26 ± 0.29 D (range, -1.26 D to +0.12 D) in group 1A, -0.25 ± 0.35 D (range, -1.15 D to +0.25 D) in group 1B, and -0.19 ± 0.33 D (range, -1.12 D to +1.92 D) in group 1C. There was no difference in annual myopic progression between the subgroups (P = 0.670). The annual change in myopic refraction between each of the group 1 subgroups and group 2 was statistically significantly different (P < 0.001, P = 0.023, P < 0.001, resp.). CONCLUSIONS Myopia progression was significantly greater in children with IXT than in the normal population. Myopia progression did not vary with exotropia treatment.
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Affiliation(s)
- Oğuzhan Oruz
- Department of Ophthalmology, Başkent University School of Medicine, Adana, Turkey.
| | - Aysel Pelit
- Department of Ophthalmology, Başkent University School of Medicine, Adana, Turkey
| | - Serpil Akar
- Department of Ophthalmology, Başkent University School of Medicine, İstanbul, Turkey
| | - Eylem Gül Ateş
- Department of Biostatistics, Baskent University Faculty of Medicine, Ankara, Turkey; Middle East Technical University, Institutional Big Data Management Coordination Office
| | - Sibel Oto
- Department of Ophthalmology, Başkent University School of Medicine, Ankara, Turkey
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Chen H, Jiang X, Liu W, Zhou J, Chen J, Sun Q, Liang L, Lou J, Yu X, Qu J. Quantitative interocular suppression in children with intermittent exotropia. Front Neurosci 2023; 17:1204061. [PMID: 37600014 PMCID: PMC10434520 DOI: 10.3389/fnins.2023.1204061] [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: 04/11/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose We have demonstrated that the depth of unbalanced interocular suppression can be quantified by balancing the interocular luminance differences required when both eyes are viewing simultaneously. In this study, we aimed to investigate the applicability of this method in children with intermittent exotropia (IXT), offering a quantitative assessment of interocular suppression in individuals with binocular imbalance. Additionally, we evaluated its association with the clinical characteristics of IXT. Methods Interocular suppression in IXT was quantitatively measured using a polarizer and neutral-density (ND) filters. The density of the ND filter was adjusted incrementally from 0.3ND to 3ND, with a step size of 0.3ND (a total of 10 levels). Our prospective study involved 46 patients with IXT (mean age: 10.12 ± 4.89 years; mean ± SD) and 24 normal observers (mean age: 7.88 ± 1.83 years). Results The suppression test exhibited good test-retest reliability, supported by statistical analysis. We observed more pronounced interocular suppression in individuals with IXT compared to controls. Notably, the magnitude of suppression during distant and near viewing significantly differed in IXT (1.55 ± 0.93 vs. 0.57 ± 0.64; Z = 4.764, p < 0.001). Furthermore, we identified a positive correlation between interocular suppression and data obtained from the Worth-4-Dot test. Additionally, interocular suppression showed a significant association with distance control scores. Conclusion Our novel test offers a convenient and reliable means to quantify interocular suppression in patients with IXT. The quantitative assessment of interocular suppression provides a sensitive tool to evaluate the clinical characteristics of IXT.
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Affiliation(s)
- Hui Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiaohui Jiang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Weijie Liu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jiawei Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jie Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qianqian Sun
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lin Liang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jiangtao Lou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xinping Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jia Qu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Ma MML, Scheiman M. Divergence excess and basic exotropia types of intermittent exotropia: a major review. Part 1: prevalence, classification, risk factors, natural history and clinical characteristics. Strabismus 2023; 31:97-128. [PMID: 37489263 DOI: 10.1080/09273972.2023.2227681] [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: 07/26/2023]
Abstract
INTRODUCTION Intermittent exotropia (IXT) is a common form of strabismus. It is an outward deviation of one eye typically when viewing at distance. Symptoms include, but are not limited to double vision, eyes feeling tired, excessive blinking, and reduced quality of life. Its clinical characteristics are distinctive from other types of strabismus. This paper provides a comprehensive review of prevalence, classification, risk factors, natural history and clinical characteristics of the divergence excess and basic exotropia types of IXT. METHODS Search strategies involving combination of keywords including intermittent exotropia, exotropia, divergences excess, basic exotropia, prevalence, incidence, classification, terminology, risk factor, natural history, observation, angle of deviation, control, control score, symptom, quality of life, suppression, anomalous retinal correspondence, AC/A, accommodative convergence/accommodation, accommodative convergence, convergence, accommodation, vergence, incomitance and vertical were used in Medline. All English articles from 1900/01/01 to 2020/09/01 were reviewed. The reference list of the identified article was also checked for additional relevant article. Studies focused on animal model or strabismus associated with neurologic disorder or injury were excluded. RESULTS The estimated prevalence of IXT in children ranges from 0.1% to 3.7%. Hypoxia at birth and being female are potential risk factors of IXT. Using validated measures of control, multicenter prospective studies showed that the rate of conversion from IXT to constant exotropia is low. The angle of deviation is the most reported outcome measure in studies of IXT. It is often used to represent the severity of the condition and has been suggested as one of the four core outcomes for studies of the surgical management of IXT. Control of exodeviation is one of the four suggested core outcomes for study of surgery of IXT and is considered the main parameter of disease severity. Several validated tools for quality of life score are available to evaluate the subjective severity of IXT. DISCUSSION We reviewed the prevalence, classification, risk factors, natural history and clinical characteristics of the divergence excess and basic exotropia types of IXT. Further research into these areas, especially its clinical characteristics (e.g. suppression, dual retinal correspondence), will increase our understanding of this condition and potentially lead to better management of this common form of strabismus.
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Affiliation(s)
- Martin Ming-Leung Ma
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou
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Liu P, Fu J, Zhang R, Chu H. Initial postoperative plasticity as a predictor of mid-term stereoacuity outcome after surgery for intermittent exotropia. BMC Ophthalmol 2023; 23:213. [PMID: 37189107 DOI: 10.1186/s12886-023-02958-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/04/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Intermittent exotropia (IXT) would cause different degrees of damage to stereopsis. We aimed to introduce a visual perception plasticity score (VPPS) that reflects initial postoperative plasticity and evaluate its effectiveness in predicting the mid-term surgical outcome in IXT patients. METHODS A total of 149 patients with intermittent exotropia who underwent surgery in November 2018 and October 2019 were recruited. All subjects underwent detailed ocular examinations before and after surgery. VPPS were calculated based on visual perception examination system at one week postoperatively. Demographic, angle of deviation and stereopsis were collected and analyzed with regard to the VPPSs preoperatively and at one week, one month, three months, six months postoperatively. Predictive performances of VPPS were assessed using receiver operating characteristic (ROC) curves, the area under the curve (AUC) and cut-offs were obtained. RESULTS Of the 149 patients, the average deviation was 43Δ at distance and 46Δ at near. The average rate of normal stereopsis before surgery was 22.81% at distance and 29.53% at near. Higher VPPS was associated with preoperative better near stereoacuity (r = 0.362, p = 0.000), less angle of deviation at distance (r=-0.164, p = 0.046), and better near (r = 0.400, p = 0.000) and distant stereoacuity (r = 0.321, p = 0.000) during the early postoperative period (1 week). The areas under the curves suggested that VPPS could be an effective predictor of sensory outcome(AUC>0.6). Cut-off values of 50 and 80 were calculated for VPPS using ROC curve analysis. CONCLUSION Higher VPPSs were associated with a greater possibility of stereopsis improvement in patients with IXT. VPPS is a potentially promising indicator to predict the mid-term surgical outcome of intermittent exotropia.
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Affiliation(s)
- Peipei Liu
- Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, Beijing, China
| | - Jing Fu
- Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, Beijing, China.
| | - Ronghan Zhang
- Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, Beijing, China
| | - Hang Chu
- Office of Academic Research, National Engineering Research Center for Healthcare Devices, Guangzhou, China
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Xu M, Peng Y, Zheng F, Yu H, Zhou J, Zheng J, Wang Y, Hou F, Yu X. The Effects of Orthoptic Therapy on the Surgical Outcome in Children with Intermittent Exotropia: Randomised Controlled Clinical Trial. J Clin Med 2023; 12:jcm12041283. [PMID: 36835820 PMCID: PMC9964836 DOI: 10.3390/jcm12041283] [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: 11/23/2022] [Revised: 01/04/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To assess the clinical effectiveness of orthoptic therapy in the postoperative stabilisation and rehabilitation of binocular function in children with intermittent exotropia (IXT) after surgery. METHODS This was a prospective, parallel, randomised controlled trial. A total of 136 IXT patients (aged from 7 to 17 years) who had been successfully corrected at 1 month after surgery were enrolled in this study, and 117 patients (58 controls) completed the 12-month follow-up visit. The primary outcome was established as the proportion of patients with suboptimal surgical outcomes, which were defined as: (1) exodeviation ≥10 prism diopters (PD) at distance or near using the simultaneous prism and cover test (SPCT), or (2) constant esotropia ≥6 PD at distance or near using SPCT, or (3) loss of 2 or more octaves of stereopsis from baseline. The secondary outcomes were the exodeviation at distance and near using the prism and alternate cover test (PACT), stereopsis, fusional exotropia control and convergence amplitude. RESULTS The cumulative probability of suboptimal surgical outcome by 12 months was 20.5% (14/68) in the orthoptic therapy group and 42.6% (29/68) in the control group. There was a significant difference between these two groups (χ2 = 7.402, p = 0.007). Improvements in stereopsis, fusional exotropia control and fusional convergence amplitude were found in the orthoptic therapy group. A smaller exodrift was found in the orthoptic therapy group at near fixation (t = 2.26, p = 0.025). CONCLUSIONS Early postoperative orthoptic therapy can effectively improve the surgical outcome as well as stereopsis and fusional amplitude.
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Affiliation(s)
- Meiping Xu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China
| | - Yiyi Peng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
| | - Fuhao Zheng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China
| | - Huanyun Yu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China
| | - Jiawei Zhou
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China
| | - Jingwei Zheng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China
| | - Yuwen Wang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China
| | - Fang Hou
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China
| | - Xinping Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
- Correspondence: ; Tel.: +86-13695854678
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Wang X, Lu L, Liao M, Wei H, Chen X, Huang X, Liu L, Gong Q. Abnormal cortical morphology in children and adolescents with intermittent exotropia. Front Neurosci 2022; 16:923213. [PMID: 36267233 PMCID: PMC9577327 DOI: 10.3389/fnins.2022.923213] [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] [Received: 04/19/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate cortical differences, age-related cortical differences, and structural covariance differences between children with intermittent exotropia (IXT) and healthy controls (HCs) using high-resolution magnetic resonance imaging (MRI). Methods Sixteen IXT patients and 16 HCs underwent MRI using a 3-T MR scanner. FreeSurfer software was used to obtain measures of cortical volume, thickness, and surface area. Group differences in cortical thickness, volume and surface area were examined using a general linear model with intracranial volume (ICV), age and sex as covariates. Then, the age-related cortical differences between the two groups and structural covariance in abnormal morphometric changes were examined. Results Compared to HCs, IXT patients demonstrated significantly decreased surface area in the left primary visual cortex (PVC), and increased surface area in the left inferior temporal cortex (ITC). We also found increased cortical thickness in the left orbitofrontal cortex (OFC), right middle temporal cortex (MT), and right inferior frontal cortex (IFC). No significant differences were found in cortical volume between the two groups. There were several negative correlations between neuroanatomic measurements and age in the HC group that were not observed in the IXT group. In addition, we identified altered patterns of structural correlations across brain regions in patients with IXT. Conclusion To our knowledge, this study is the first to characterize the cortical morphometry of the children and adolescents with IXT. Based on our results, children and adolescents with IXT exhibited significant alterations in the PVC and association cortices, different cortical morphometric development patterns, and disrupted structural covariance across brain regions.
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Affiliation(s)
- Xi Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Optometry and Vision Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Lu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Meng Liao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Optometry and Vision Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Wei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Optometry and Vision Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaohang Chen
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Optometry and Vision Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xiaoqi Huang,
| | - Longqian Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Optometry and Vision Sciences, West China Hospital, Sichuan University, Chengdu, China
- Longqian Liu,
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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10
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Tan SW, Cai GQ, Li QY, Guo Y, Pan YC, Zhang LJ, Ge QM, Shu HY, Zeng XJ, Shao Y. Altered Brain Activity in Strabismic Amblyopic Children as Determined by Regional Homogeneity: A Resting-State Functional Magnetic Resonance Imaging Study. Front Neurosci 2022; 16:879253. [PMID: 35720698 PMCID: PMC9201242 DOI: 10.3389/fnins.2022.879253] [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: 02/19/2022] [Accepted: 05/13/2022] [Indexed: 11/22/2022] Open
Abstract
Objective Earlier research has determined that amblyopia or strabismus may cause remarkable brain anatomical and functional variations. Nonetheless, thus far, the spontaneous changes in brain activity in children with strabismus amblyopia (SA) remain unclear. The purpose of this study was to determine the association between abnormal brain activity in children with SA and its behavioral manifestations. Patients and Methods ?A total of 24 children with SA (10 male and 14 female children) as well as 24 healthy controls (HCs), including 10 male and 14 female children were closely matched in sex and age, and examined using resting-state functional magnetic resonance imaging (fMRI). The regional homogeneity (ReHo) technique was applied to evaluate spontaneous cerebral activity variations in children with SA and HCs. Moreover, associations between altered ReHo values in distinct cerebral areas and the degree of strabismus were assessed using Pearson correlation analysis. Results Remarkably increased ReHo values were observed in the right lingual, right superior frontal medial, bilateral superior parietal, and right inferior parietal gyri of children with SA compared with HCs. In contrast, mean ReHo values in children with SA were lower in the right cerebellum, left superior frontal gyrus, and left putamen nucleus. Furthermore, esotropia showed a positive correlation with ReHo values of the left putamen. Conclusion The anomalous spontaneous activity changes in several brain areas that are caused by SA may indicate neuropathologic mechanisms of visual deficits and oculomotor disorders in children with SA.
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Affiliation(s)
- Si-Wen Tan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,The First Clinical Medical College, Nanchang University, Nanchang, China
| | - Guo-Qian Cai
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiu-Yu Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu Guo
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi-Cong Pan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li-Juan Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qian-Min Ge
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hui-Ye Shu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xian-Jun Zeng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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11
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Le Z, Antonov E, Mao Q, Petrov V, Wang Y, Wang W, Shevkolenko M, Dong W. Anti-Fatigue Glasses Based on Microprisms for Preventing Eyestrain. SENSORS 2022; 22:s22051933. [PMID: 35271080 PMCID: PMC8914742 DOI: 10.3390/s22051933] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 02/04/2023]
Abstract
Although microprisms have become an important medical means of strabismus treatment, related research concerning the design, fabrication, and testing of microprismatic glasses for preventing eyestrain has rarely been reported. In this study, the structure of microprismatic glasses for preventing eyestrain related to using electronic monitors, including computers and mobile phones, is introduced. A designing theory of anti-fatigue glasses with microprisms is developed. The fabrication technique and the process are described, and the performances of the fabricated microprisms are characterized. Finally, a compact testing system for the measurement of prismatic diopter is designed and constructed. This measuring system can be used not only for Fresnel microprisms, but also for other types of prisms. The measured results agree with our calculations. Although this study is focused on optimizing the objective prismatic diopter for anti-fatigue microprismatic glasses, 2.0–3.0 prismatic diopters (Δ) for each eye in the anti-fatigue glasses are suggested according to our experience on strabismus treatments. The clinical research for patients using the developed anti-fatigue glasses will be fully implemented in our further research to confirm the optimal subjective prismatic value.
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Affiliation(s)
- Zichun Le
- College of Science, Zhejiang University of Technology, Hangzhou 310023, China; (Z.L.); (Q.M.); (Y.W.); (W.W.)
| | - Evhen Antonov
- Institute for Information Recording, National Academy of Sciences of Ukraine, 03113 Kiev, Ukraine; (E.A.); (V.P.)
| | - Qiang Mao
- College of Science, Zhejiang University of Technology, Hangzhou 310023, China; (Z.L.); (Q.M.); (Y.W.); (W.W.)
| | - Viacheslav Petrov
- Institute for Information Recording, National Academy of Sciences of Ukraine, 03113 Kiev, Ukraine; (E.A.); (V.P.)
| | - Yuhui Wang
- College of Science, Zhejiang University of Technology, Hangzhou 310023, China; (Z.L.); (Q.M.); (Y.W.); (W.W.)
| | - Wei Wang
- College of Science, Zhejiang University of Technology, Hangzhou 310023, China; (Z.L.); (Q.M.); (Y.W.); (W.W.)
| | - Marina Shevkolenko
- Kiev City Clinical Ophthalmological Hospital “Eye Microsurgery Centre”, 03680 Kiev, Ukraine;
| | - Wen Dong
- College of Environment, Zhejiang University of Technology, Hangzhou 310014, China
- Correspondence: ; Tel.: +86-13306524039
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12
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Guo Y, Fu J, Hong J, Liu Z, He X. Functional changes in the visual cortex in preoperative and postoperative patients with intermittent exotropia: study protocol for a non-randomised case-control clinical trial. BMJ Open 2022; 12:e055848. [PMID: 35210343 PMCID: PMC8883252 DOI: 10.1136/bmjopen-2021-055848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Intermittent exotropia (IXT) is the most common type of divergent squint. IXT is primarily a cortical neurologic dysfunction disorder, occurring as a result of the insufficient maintenance of sensory and motor fusion. Recent reports have demonstrated the relationship between IXT and visual cortical impairment. We planned to assess blood oxygen level-dependent (BOLD)-functional magnetic resonance imaging (fMRI) in patients with IXT during the preoperative and postoperative follow-ups to evaluate the functional changes in the visual cortex. METHODS AND ANALYSIS A total of 90 Chinese subjects will be recruited, and their ages will be between 18 and 40 years old. The subjects will include the surgical treatment (ST) group (45 subjects with IXT who will undergo surgery) and the HC group (45 age-matched, sex-matched and education-matched healthy volunteers). The assessments will include the following aspects: fMRI and general ophthalmic examinations, optometry measurements and strabismus-related tests, such as the ocular deviation, binocular vision test and Newcastle Control Score (NCS). Each subject will complete the resting-state BOLD-fMRI, and the sequences will include echo planar imaging (EPI) pulse and 3-dimensional brain volume (3D-BRAVO) to acquire high-resolution images. The follow-up schedule will be 6 and 12 months after the surgery. The primary outcome will be determined by cortex changes in BOLD-fMRI in the ST group before and after surgery. We will also compare the HC group with the preoperative subjects in the ST group. The secondary outcomes will be changes in strabismus-related examinations, such as binocular visual function and NCS. ETHICS AND DISSEMINATION Ethical approval was obtained from the Medical Ethics Committee of Beijing Tongren Hospital. We plan to publish the results of this study in a peer-reviewed journal article. TRIAL REGISTRATION NUMBER ChiCTR2100048852.
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Affiliation(s)
- Yanan Guo
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Fu
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jie Hong
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Liu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xueying He
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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13
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Acheampong HO, Kumah DB, Addo EK, Asare AK, Agyei-Manu E, Mohammed AS, Baah-Konadu B, Osei Duah Junior I, Mintah P, Darrah S, Akuffo KO. Practice patterns in the management of amblyopia among optometrists in Ghana. Strabismus 2022; 30:18-28. [PMID: 35023425 DOI: 10.1080/09273972.2021.2022715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite internationally recognized guidelines, amblyopia management varies among eye care professionals worldwide. Hence, we sought to investigate the practice patterns of amblyopia management and the factors associated with the decision to treat amblyopia among optometrists in Ghana. A cross-sectional survey was conducted among registered optometrists in Ghana from January 2020 to October 2020. Data collection was done through the administration of online questionnaires via e-mail (google form). The structured questionnaires included demographic information, mode, and scope of practice, diagnostic criteria, examination procedures, treatment modalities, and prognosis. A p value of less than 0.05 was deemed statistically significant. The mean (±SD) age of all the 168 respondents was 32.6 (±6.1) years (range: 24-50 years). The majority of the optometrists (64.9%) treated amblyopia in their practice; with the most prevalent being refractive amblyopia (68.2%), followed by strabismic amblyopia (27.1%), then form-deprivation amblyopia (4.7%). Most (76.1%) amblyopic patients presented with symptomatic squinting. The most common ocular and medical history was anisometropia (90.0%), and the most common diagnostic procedures were patient history, visual acuity, and refraction. Optical correction (88.3%) was mainly prescribed for amblyopia treatment, followed by patching (58.5%). Nearly half of the respondent (45.0%) reported good prognosis after amblyopia treatment. After statistical adjustment, female optometrists were significantly associated with decreased odds of treating amblyopia (AOR = 0.36, p = .004). Refractive amblyopia is the main type of amblyopia managed by optometrists in Ghana. Hence, optical correction is the primary treatment regime. Current amblyopia management practice among optometrists adhere to recommended guidelines and our findings demonstrate uniformity in the standard of care.
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Affiliation(s)
- Hubert Osei Acheampong
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi.,Department of Anatomy and Cell Biology, School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - David Ben Kumah
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi
| | - Emmanuel Kofi Addo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi.,Department of Ophthalmology and Visual Sciences, Moran Eye Centre, University of Utah, Salt Lake City, Utah.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Akosua Kesewah Asare
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi.,Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver
| | - Eldad Agyei-Manu
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi.,Usher Institute for Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh
| | - Abubakar Sadik Mohammed
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi
| | - Benjamin Baah-Konadu
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi
| | - Isaiah Osei Duah Junior
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi
| | - Prince Mintah
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi
| | - Samson Darrah
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi
| | - Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi
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14
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Hu B, Liu Z, Zhao J, Zeng L, Hao G, Shui D, Mao K. The Global Prevalence of Amblyopia in Children: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:819998. [PMID: 35601430 PMCID: PMC9114436 DOI: 10.3389/fped.2022.819998] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/15/2022] [Indexed: 01/15/2023] Open
Abstract
Epidemiological data about the prevalence of amblyopia around the world vary widely among regions and periods. This meta-analysis aimed to determine the global prevalence of amblyopia in children. PubMed, Embase, and the Cochrane Library were searched for prevalence studies published up to 5 November 2021. The outcome was the prevalence of amblyopia, analyzed as pooled estimates with 95% confidence intervals (CI). A total of 97 studies were included, including 4,645,274 children and 7,706 patients with amblyopia. The overall worldwide pooled prevalence of amblyopia was 1.36% (95%CI: 1.27-1.46%). The prevalence of amblyopia was higher in males (1.40%, 95%CI: 1.10-1.70%) than in females (1.24%, 95%CI: 0.94-1.54%) (OR = 0.885, 95%CI: 0.795-0.985, P = 0.025). The results of the meta-regression analysis showed that there were no significant associations between the prevalence of amblyopia and geographical area, publication year, age, sample size, and whether it was carried out in a developed or developing country (all P > 0.05). Begg's test (P = 0.065) and Egger's test (P < 0.001) showed that there was a significant publication bias in the prevalence of amblyopia. In conclusion, amblyopia is a significant vision problem worldwide, and public health strategies of early screening, treatment, and management are important.
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Affiliation(s)
- Budan Hu
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, China
| | - Zongshun Liu
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, China
| | - Jiao Zhao
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, China
| | - Li Zeng
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, China
| | - Gengsheng Hao
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, China
| | - Dan Shui
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, China
| | - Ke Mao
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, China
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15
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Xu M, Chen Y, Peng Y, He Z, Jiang J, Yu X, Hou F, Zhou J, Qu J. Binocular Summation Is Intact in Intermittent Exotropia After Surgery. Front Med (Lausanne) 2021; 8:791548. [PMID: 34993215 PMCID: PMC8724027 DOI: 10.3389/fmed.2021.791548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/30/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: To determine binocular summation of surgically treated intermittent exotropia (IXT) patients by measuring the contrast threshold. Methods: We recruited 38 surgically treated IXT patients aged 8–24 years and 20 age-matched healthy controls. All participants had normal or corrected-to-normal visual acuity (Snellen ≥ 20/20) in both eyes. The IXT patients had undergone the surgery at least a year prior to the study. Twenty-one of them obtained good alignment and 17 experienced a recurrence of exotropia. We measured the observers' monocular and binocular contrast sensitivities (CS) at six spatial frequencies (1.5, 3, 6, 12, 18, 24 cycles/degree) as an index of visual information processing at the threshold level. Binocular summation was evaluated against a baseline model of simple probability summation based on the CS at each spatial frequency and the area under the log contrast sensitivity function (AULCSF). Results: The exo-deviation of IXTs with good alignment was −6.38 ± 3.61 prism diopters (pd) at 33 cm and −5.14 ± 4.07 pd at 5 m. For the patients with recurrence, it was −23.47 ± 5.53 pd and −21.12 ± 4.28 pd, respectively. There was no significant difference in the binocular summation ratio (BSR) between the surgically treated IXT patients, including those with good alignment and recurrence, and normal controls at each spatial frequency [F(2,55) = 0.416, P = 0.662] and AULCSF [F(2,55) = 0.469, P = 0.628]. In addition, the BSR was not associated with stereopsis (r = −0.151, P = 0.365). Conclusion: Our findings of normal contrast sensitivity binocular summation ratio in IXT after surgical treatment suggest that the ability of the visual cortex in processing binocular information is intact at the contrast threshold level.
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Affiliation(s)
- Meiping Xu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Yiya Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Yiyi Peng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Zhifen He
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Jun Jiang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Xinping Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Fang Hou
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Jiawei Zhou
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- *Correspondence: Jiawei Zhou
| | - Jia Qu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Jia Qu
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16
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Association between refractive errors and horizontal strabismus: the Korea National Health and Nutrition Examination Survey. J AAPOS 2021; 25:340.e1-340.e7. [PMID: 34752909 DOI: 10.1016/j.jaapos.2021.07.012] [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: 11/27/2018] [Revised: 05/25/2021] [Accepted: 07/05/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate the association between refractive error and horizontal strabismus based on a Korean population-based survey. METHODS The study included 22,887 participants >5 years of age who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011. Refractive error was classified into myopia, hyperopia, astigmatism, and anisometropia. The association between refractive error and exodeviation or esodeviation was assessed using multivariate logistic regression analysis. RESULTS After adjusting for potential confounders, the analyses revealed an increased odds ratio (OR) for exodeviation with an increasing trend according to the severity of myopia (mild myopia, OR = 1.36 [95% CI, 1.11-1.66]; moderate myopia, OR = 1.75 [95% CI, 1.36-2.26]; severe myopia, OR = 2.01 [95% CI, 1.50-2.69]; Ptrend < 0.001). Hyperopia was not associated with exodeviation (P = 0.273). There were also significant associations for exodeviation with astigmatism (OR = 1.36 [95% CI, 1.16-1.59; P < 0.001]) and anisometropia (OR = 1.78 [95% CI, 1.38-2.30; P < 0.001]) In comparison, esodeviation was significantly associated with hyperopia (OR, 10.24 [95% CI, 4.43-23.70; P < 0.001]) and anisometropia (OR, 5.16 [95% CI, 2.27-11.76; P < 0.001]), while no significant association was found with myopic degree (P = 0.170) or astigmatism (P = 0.816). CONCLUSIONS Refractive error was closely associated with exodeviation and esodeviation. These risk associations should be considered when managing refractive errors.
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17
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He X, Hong J, Wang Q, Guo Y, Li T, Qu X, Liu J, Li W, Zhang L, Fu J, Liu Z. Altered Spontaneous Brain Activity Patterns and Functional Connectivity in Adults With Intermittent Exotropia: A Resting-State fMRI Study. Front Neurosci 2021; 15:746882. [PMID: 34776850 PMCID: PMC8586526 DOI: 10.3389/fnins.2021.746882] [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: 07/25/2021] [Accepted: 09/29/2021] [Indexed: 01/06/2023] Open
Abstract
The purpose of this study is to investigate brain functional changes in patients with intermittent exotropia (IXT) by analyzing the amplitude of low-frequency fluctuation (ALFF) of brain activity and functional connectivity (FC) using resting-state functional magnetic resonance imaging (rs-fMRI). There were 26 IXT patients and 22 age-, sex-, education-, and handedness-matched healthy controls (HCs) enrolled who underwent rs-fMRI. The ALFF, fractional ALFF (fALFF) values in the slow 4 and slow 5 bands, and FC values were calculated and compared. The correlations between ALFF/fALFF values in discrepant brain regions and clinical features were evaluated. Compared with HCs, ALFF/fALFF values were significantly increased in the right angular gyrus (ANG), supramarginal gyrus (SMG), inferior parietal lobule (IPL), precentral gyrus (PreCG), and the bilateral inferior frontal gyri (IFG), and decreased in the right precuneus gyrus (PCUN), left middle occipital gyrus (MOG), and postcentral gyrus (PoCG) in IXT patients. The Newcastle Control Test score was negatively correlated with ALFF values in the right IFG (r = −0.738, p < 0.001). The duration of IXT was negatively correlated with ALFF values in the right ANG (r = −0.457, p = 0.049). Widespread increases in FC were observed between brain regions, mainly including the right cuneus (CUN), left superior parietal lobule (SPL), right rolandic operculum (ROL), left middle temporal gyrus (MTG), left IFG, left median cingulate gyrus (DCG), left PoCG, right PreCG, and left paracentral gyrus (PCL) in patients with IXT. No decreased FC was observed. Patients with IXT exhibited aberrant intrinsic brain activities and FC in vision- and eye movement-related brain regions, which extend current understanding of the neuropathological mechanisms underlying visual and oculomotor impairments in IXT patients.
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Affiliation(s)
- Xueying He
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jie Hong
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qian Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yanan Guo
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ting Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaoxia Qu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Liu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lirong Zhang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Fu
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Liu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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18
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Wang X, Zhu Q, Liu L. Efficacy of bilateral lateral rectus recession versus unilateral recession and resection for basic-type intermittent exotropia: a meta-analysis. Acta Ophthalmol 2021; 99:e984-e990. [PMID: 33576184 DOI: 10.1111/aos.14726] [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: 08/17/2020] [Revised: 10/25/2020] [Accepted: 11/23/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the efficacy of bilateral lateral rectus recession (BLR) versus unilateral recession and resection (RR) for the treatment of patients with basic-type intermittent exotropia (IXT). METHODS We systematically searched the EMBASE, PubMed, Web of Science and Cochrane Library databases for relevant studies published before April 2020 with no language restrictions. Related studies meeting the eligibility criteria were included. The primary outcomes were success rate and mean postoperative deviation. Odds ratios (ORs) and weighted mean differences (MDs) with 95% confidence intervals (CIs) were calculated. RESULTS From 1243 screened articles, a total of 10 studies involving 967 patients were included in the analysis. No differences were observed in success rates between the BLR and RR groups at 1-day to 1-week postoperatively (OR: 0.9, 95% CI: 0.53 to 1.53, p = 0.69), or at 6-month postoperatively (OR: 1.11, 95% CI: 0.59 to 2.11, p = 0.74), or at the last follow-up visit (OR: 0.76, 95% CI: 0.44 to 1.34, p = 0.34). The unsatisfactory effects (the overcorrection and undercorrection rates) between the two groups were comparable. In addition, there were no significant differences between the two groups in postoperative deviation at 1-day to 1-week postoperatively (MD: 0.03, 95% CI: -1.32 to 1.27, p = 0.97), or at 6-month postoperatively (MD: 1.42, 95% CI: -0.43 to 3.27, p = 0.13) or at the last follow-up visit (MD: 0.29, 95% CI: -1.39 to 1.97, p = 0.74). CONCLUSION This meta-analysis provides evidence that both the BLR and RR procedures have similar efficacy for the treatment of basic-type IXT.
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Affiliation(s)
- Xi Wang
- Department of Ophthalmology West China Hospital Sichuan University Chengdu China
| | - Qiurong Zhu
- Department of Optometry and Visual Science West China Hospital Sichuan University Chengdu China
| | - Longqian Liu
- Department of Ophthalmology West China Hospital Sichuan University Chengdu China
- Department of Optometry and Visual Science West China Hospital Sichuan University Chengdu China
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Amblyopia risk factors among pediatric patients in a hospital-based setting using photoscreening. PLoS One 2021; 16:e0254831. [PMID: 34324539 PMCID: PMC8320995 DOI: 10.1371/journal.pone.0254831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/04/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of our study was to determine the prevalence of amblyopia risk factors in children visiting the American University of Beirut Medical Center (AUBMC) using automated vision screening. METHODS This was a hospital-based screening of 1102 children aged between 2 and 6 years. Vision screening was performed using PlusoptiX S12 over 2 years (2018-2020). The need for referral to a pediatric ophthalmologist was based on the amblyopia risk factors set forth by the American Association for Pediatric Ophthalmology and Strabismus. Referred patients underwent a comprehensive eye examination. RESULTS A total of 1102 children were screened, 63 were referred for amblyopia risk factors (5.7%); 37/63 (59%) underwent comprehensive eye examination and 73% were prescribed glasses. Of the non-referred group of children, 6.35% had astigmatism, 6.25% were hyperopic and 3.27% were myopic. The refractive errors observed among the examined patients were distributed as follows: 41% astigmatism, 51% hyperopia, and 8% myopia; amblyopia was not detected. Refractive amblyopia risk factors were associated with the presence of systemic disorders. Bland-Altman plots showed most of the differences to be within limits of agreement. CONCLUSION Using an automated vision screener in a hospital-based cohort of children aged 2 to 6 years, the rate of refractive amblyopia risk factors was 5.7%. Hyperopia was the most commonly encountered refractive error and children with systemic disorders were at higher risk.
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Mao D, Lin J, Chen L, Luo J, Yan J. Health-related quality of life and anxiety associated with childhood intermittent exotropia before and after surgical correction. BMC Ophthalmol 2021; 21:270. [PMID: 34193079 PMCID: PMC8247233 DOI: 10.1186/s12886-021-02027-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intermittent exotropia (IXT) is the most common form of exotropia in children. In addition to cosmetic effects and loss of stereoscopic function, IXT may negatively impact the psychological well-being of children and their parents. The purpose of this study was to assess the patient-reported outcomes of Chinese children with IXT before and after strabismus surgery. METHODS The records of children with IXT who underwent strabismus surgery at the Zhongshan Ophthalmic Center of Sun Yat-sen University, China over the period from January 1, 2016 to December 31, 2018 were prospectively recruited. All children underwent ophthalmic and orthoptic examinations, including the prism and alternate cover test, fusion function by synoptophore, stereoacuity and Newcastle control score. Two patient-reported outcome measures were used: the intermittent Exotropia Questionnaire (IXTQ) to measure disease-specific health-related quality of life (HRQOL) and the Hospital Anxiety and Depression Scale (HADS) to measure anxiety and depression. Patient-reported outcome measurements were made before and after surgery with responses from children and their parents. RESULTS A total of 389 children were eligible for inclusion (47.8% male, 52.2% female, mean + SD age = 8.17 ± 2.81). Preoperative IXTQ scores in both children (48.21 ± 26.2) and their parents (44.6 ± 25.68) were significantly correlated with near stereoacuity (P = 0.029 and P = 0.015, respectively). The angle of deviation at near vision showed a negative linear relationship with visual function (P = 0.026) and psychological (P = 0.019) scores as well as opinions regarding surgery (P = 0.024). HADS scores (anxiety scale score: 11 ± 2.92, depression scale score: 10.44 ± 2.9) were also related to near stereoacuity (P < 0.05). After surgery, both children's (74.83 ± 16.59) and parents' (68.57 ± 17.06) IXTQ scores significantly improved (p<0.01). Children's IXTQ scores were related to the angle of deviation at distance, and their psychological and visual function scores showed a negative relationship with the angle of deviation at near vision (P < 0.05). CONCLUSION Children and parents' HRQOL and HADS were associated with near stereoacuity. Parents usually attend more readily to the angle of deviation at near in their IXT children. HRQOL improved significantly after surgery and can be used as one of the indices for preoperative evaluation but is not recommended as a criterion for surgical intervention.
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Affiliation(s)
- Danyi Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Jing Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Lina Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Jiying Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Jianhua Yan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.
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Egocentric Distance Perception Disorder in Amblyopia. Psychol Belg 2021; 61:173-185. [PMID: 34221439 PMCID: PMC8231473 DOI: 10.5334/pb.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Egocentric distance perception is a psychological process in which observers use various depth cues to estimate the distance between a target and themselves. The impairment of basic visual function and treatment of amblyopia have been well documented. However, the disorder of egocentric distance perception of amblyopes is poorly understood. In this review, we describe the cognitive mechanism of egocentric distance perception, and then, we focus on empirical evidence for disorders in egocentric distance perception for amblyopes in the whole visual space. In the personal space (within 2 m), it is difficult for amblyopes to show normal hand-eye coordination; in the action space (within 2 m~30 m), amblyopes cannot accurately judge the distance of a target suspended in the air. Few studies have focused on the performance of amblyopes in the vista space (more than 30 m). Finally, five critical topics for future research are discussed: 1) it is necessary to systematically explore the mechanism of egocentric distance perception in all three spaces; 2) the laws of egocentric distance perception in moving objects for amblyopes should be explored; and 3) the comparison of three subtypes of amblyopia is still insufficient; 4) study the perception of distance under another theoretical framework; 5) explore the mechanisms of amblyopia by Virtual Reality.
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He X, Hong J, Liu Z, Wang Q, Li T, Qu X, Fei N, Li W, Fu J. Decreased Functional Connectivity of the Primary Visual Cortex and the Correlation With Clinical Features in Patients With Intermittent Exotropia. Front Neurol 2021; 12:638402. [PMID: 33841308 PMCID: PMC8032987 DOI: 10.3389/fneur.2021.638402] [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: 12/09/2020] [Accepted: 03/02/2021] [Indexed: 12/14/2022] Open
Abstract
The purpose of this study is to investigate characteristic alterations of functional connectivity (FC) patterns in the primary visual area (V1) in patients with intermittent exotropia (IXT) using resting-state functional magnetic resonance imaging (rs-fMRI) and how they relate to clinical features. Twenty-six IXT patients and 21 age-, sex-, handedness-, and education-matched healthy controls (HCs) underwent rs-fMRI. We performed FC analyses between bilateral V1 and other brain areas and compared FC strength between two groups. A Pearson correlation analysis was used to evaluate the correlation between the FC differences and clinical features. Compared with HCs, patients with IXT showed significantly lower FC of the right V1 with the right calcarine sulcus and right superior occipital gyrus, and the left V1 with right cuneus and right postcentral gyrus. The Newcastle Control Test score was positively correlated with mean FC values between the left inferior parietal lobule and bilateral V1, and between the left supramarginal gyrus and left V1. The duration of IXT was positively correlated with mean FC values between the right inferior occipital gyrus and right V1. Reduced FC between the V1 and various brain regions involved in vision and eye movement processes may be associated with the underlying neural mechanisms of impaired visual function in patients with IXT.
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Affiliation(s)
- Xueying He
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jie Hong
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Liu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qian Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ting Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaoxia Qu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Nanxi Fei
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Fu
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Qanat AS, Alsuheili A, Alzahrani AM, Faydhi AA, Albadri A, Alhibshi N. Assessment of Different Types of Strabismus Among Pediatric Patients in a Tertiary Hospital in Jeddah. Cureus 2020; 12:e11978. [PMID: 33425550 PMCID: PMC7790318 DOI: 10.7759/cureus.11978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/21/2022] Open
Abstract
Background Strabismus, also known as squint, is an ocular disorder in which the eyes do not align properly with each other when looking at an object. The estimated global prevalence of strabismus among children is between 1.3% and 5.7%. This study aimed to assess the various types of strabismus among pediatric patients in Jeddah, in the western region of Saudi Arabia. Methods The medical records of 281 patients with strabismus aged ≤18 years, who presented to the pediatric ophthalmology clinic in King Abdulaziz University Hospital between 2010 and 2019, were retrospectively reviewed. Data were analyzed using the Statistical Package for Social Sciences (SPSS; IBM Corp., Armonk, NY, USA). A p-value of 0.05 or less was considered statistically significant. Results Out of the 281 patients, 141 were (50.2%) female. The average age of the patients was 9.50 ± 4.24 years. The most common type of strabismus was esotropia (177 [63%] patients), followed by exotropia (96 [34.2%] patients), hypertropia (10 [3.6%] patients), and dissociated vertical deviation (four [1.4%] patients). Two-hundred thirty-one (82.8%) patients had bilateral strabismus. A total of 178 patients (63.3%) had no associated conditions with strabismus, whereas 103 (36.7%) had an associated condition. A significant relationship was observed between esotropia and prematurity (p = 0.024). Conclusion Esotropia was the most common type of strabismus among the patients, followed by exotropia. The results of this study showed that males were equally affected as females. We also found a significant relationship between esotropia and prematurity. Implementation of a compulsory nationwide pediatric ophthalmic screening program for children aged one, three, and five years is recommended to enable timely diagnosis of strabismus and any other refractive errors.
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Affiliation(s)
- Ahmed S Qanat
- Research, King Abdulaziz University Hospital, Jeddah, SAU
| | | | | | | | | | - Nizar Alhibshi
- Ophthalmology, King Abdulaziz University Hospital, Jeddah, SAU
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He H, Fu J, Meng Z, Chen W, Li L, Zhao X. Prevalence and associated risk factors for childhood strabismus in Lhasa, Tibet, China: a cross-sectional, school-based study. BMC Ophthalmol 2020; 20:463. [PMID: 33238929 PMCID: PMC7687812 DOI: 10.1186/s12886-020-01732-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background To estimate the prevalence of strabismus and associated risk factors among grade one school children in Lhasa, Tibet, China. Methods The Lhasa Childhood Eye Study (LCES) was a cross-sectional, school-based childhood study conducted in Grade one students from primary schools in Lhasa, Tibet, China. Comprehensive ophthalmic examinations and basic systemic examinations were evaluated. A questionnaire survey containing information about children, as well as parents’ information, was sent to the corresponding parents of eligible children. The prevalence of strabismus and its 95% confidence interval was estimated. Univariate and multivariate logistic regression analyses were conducted to determine the associated risk factors. Results A total of 1942 eligible grade one students were enrolled, of which 1856 participants completed all examinations. The average age was 6.83 ± 0.46 years, 53% of participants were boys and 1762 were the Tibetan Minority. Over all, the prevalence of strabismus was 68/1856 (3.7%) (95%CI: 2.81,4.52), with no difference between the ages, genders, ethnicities and body mass index, while tilting one’s head when writing may be a risk factor for strabismus (P = 0.004). Strabismus students had mean best corrected visual acuity of 0.16 ± 0.28(LogMAR), over 50% patients with esotropia were hyperopic, and participants who had stereopsis impairments showed a significant difference between esotropia and exotropia (P = 0.026). Conclusions The prevalence of strabismus in LCES was 3.7%, which is higher than previous reports from Chinese childhood epidemiology studies. Strabismus is a common contributing factor to amblyopia. Tilting one’s head when writing may be a risk factor. Esotropia is more likely to affect stereopsis and be associated with the refractive state of hyperopia. Trial registration The study has finished the clinical registration on Chinese Clinical Trial Registry. (http://www.chictr.org.cn, ChiCTR1900026693). Supplementary Information The online version contains supplementary material available at 10.1186/s12886-020-01732-2.
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Affiliation(s)
- Hailong He
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China.,Beijing Institute of Ophthalmology, Beijing, China
| | - Jing Fu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China.
| | - Zhaojun Meng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Weiwei Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China.,Beijing Institute of Ophthalmology, Beijing, China
| | - Lei Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Xinyu Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
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Prevalence of Strabismus and Its Impact on Vision-Related Quality of Life. Ophthalmology 2020; 127:1113-1122. [DOI: 10.1016/j.ophtha.2020.02.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/23/2019] [Accepted: 02/20/2020] [Indexed: 12/20/2022] Open
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Can Clinical Measures of Postoperative Binocular Function Predict the Long-Term Stability of Postoperative Alignment in Intermittent Exotropia? J Ophthalmol 2020; 2020:7392165. [PMID: 32774909 PMCID: PMC7391110 DOI: 10.1155/2020/7392165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/24/2020] [Accepted: 06/13/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose To evaluate whether clinical measures of postoperative binocular functions could predict the long-term stability of postoperative ocular alignment in children with intermittent exotropia. Methods A retrospective study was performed in thirty-nine children (median: 7 years) who have been surgically treated from intermittent exotropia without overcorrection (less than 10 prism diopters [pd] of exodeviation at 1 month postoperatively). Angles of deviation and binocular functions were measured preoperatively and at 1 month, 6 months, and the final follow-up visit (≥24 months) postoperatively. We examined the relationships between postoperative drift (change of ocular alignment) and binocular functions (sensory fusion, fusional convergence amplitude, and stereoacuity). Results The surgical success rate (esophoria/tropia ≤5 pd to exophoria/tropia ≤10 pd) dropped to 76.9% at 6 months after surgery and to 53.8% at individuals' last visit (mean: 37 months). The mean exodrift was 7.7 ± 9.2 pd from the postoperative month 1 to the final visit (p < 0.001) on distance fixation. Distance stereoacuity, central fusion, and fusional convergence amplitude significantly improved following surgery (p < 0.05). However, no significant correlation was found between their binocular functions measured at the beginning of each follow-up period and the postoperative drift (all p > 0.13). Conclusion Our findings suggest that the clinical measures of sensory fusion, fusional convergence amplitude, and stereoacuity cannot serve as a robust predictor for the long-term stability of postoperative ocular alignment in patients who underwent successful surgery without overcorrection at 1 month postoperatively.
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Visual outcomes after refractive laser corneal surgery and phakic IOL in amblyopic eyes. Int Ophthalmol 2020; 40:2827-2834. [PMID: 32601965 DOI: 10.1007/s10792-020-01466-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the outcomes of laser corneal surgery and phakic IOL surgery in adult amblyopic eyes. METHODS Retrospective assessment was done in 688 amblyopic eyes 640 patients who underwent LASIK or phakic IOLs. Ophthalmological evaluation included measurement of uncorrected (UDVA) and corrected (CDVA) distance visual acuities. Analysis of modulation transfer function (MTF) was also done post-operatively as a measure of contrast sensitivity. Patients completed follow-up examinations at 1 day, 3 day, 3 months and 12 months after surgery. RESULTS The mean patient age was 24.30 ± 3.04 years with 59% females. The CDVA of amblyopic eyes improved significantly from the mean preoperative level of 0.48 ± 0.18 to 0.59 ± 0.18 at 12 months. There was improvement in the contrast sensitivity at all spatial frequencies. Refractive errors were corrected in both LASIK and phakic IOL group, but there was no clinically significant difference in visual outcomes between each group. CONCLUSION Laser vision correction and phakic IOL surgery for amblyopic eyes are promising alternative methods for improving visual outcomes in adult refractive amblyopia patients who have failed with conventional approaches.
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Lingham G, Mackey DA, Sanfilippo PG, Mountain J, Hewitt AW, Newnham JP, Yazar S. Influence of prenatal environment and birth parameters on amblyopia, strabismus, and anisometropia. J AAPOS 2020; 24:74.e1-74.e7. [PMID: 32151573 DOI: 10.1016/j.jaapos.2019.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/09/2019] [Accepted: 12/31/2019] [Indexed: 10/24/2022]
Abstract
PURPOSE To report the prevalence of amblyopia, strabismus, and anisometropia in a young adult population at a single center in Australia and to investigate the underlying prenatal and early-life risk factors. METHODS Participants in the Raine Study have been followed from mid-gestation (n = 2,868 newborns) to young adulthood. At age 20 years, 1,344 participants had a comprehensive eye examination, including visual acuity and a detailed orthoptic assessment. Risk factors were determined from medical records and questionnaires completed by the mothers at 18 weeks' gestation. The main outcome measures were the proportions of participants with amblyopia, esotropia, exotropia, or anisometropia (defined as >1 D difference). RESULTS Of the 1,125 white participants, 12 (1.1%) had amblyopia, 39 (3.5%) had strabismus, and 33 (2.9%) had anisometropia. In multivariable logistic regression, amblyopia was associated with a maternal history of pregnancy-induced hypertension (OR = 3.80; 95% CI, 1.19-12.13); esotropia, with lower gestational age (OR = 0.97; 95% CI, 0.95-0.97) and a heavier placenta (OR = 1.02; 95% CI, 1.00-1.04); exotropia, with a maternal history of previously treated hypertension (OR = 4.00; 95% CI, 1.06-15.03) and maternal use of recreational drugs during early pregnancy (OR = 3.61; 95% CI, 1.06-15.03); and anisometropia, with older maternal age (OR = 1.07; 95% CI, 1.01-1.14) and an abnormal umbilical cord (OR = 2.39; 95% CI, 1.04-5.47). CONCLUSIONS The prevalence of amblyopia, strabismus, and anisometropia in this cohort was similar to that in other studies. Preterm birth and maternal health may have adverse effects on eye development.
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Affiliation(s)
- Gareth Lingham
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth
| | - David A Mackey
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth.
| | - Paul G Sanfilippo
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth; Centre for Eye Research Australia, University of Melbourne, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Jenny Mountain
- School of Population Health, University of Western Australia, Perth
| | - Alex W Hewitt
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth; Centre for Eye Research Australia, University of Melbourne, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; School of Medicine, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - John P Newnham
- School of Women and Infants Health, University of Western Australia, King Edward Memorial Hospital, Perth
| | - Seyhan Yazar
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth
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Ryu WY, Lambert SR. Incidence of Strabismus and Amblyopia Among Children Initially Diagnosed With Pseudostrabismus Using the Optum Data Set. Am J Ophthalmol 2020; 211:98-104. [PMID: 31730842 DOI: 10.1016/j.ajo.2019.10.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/15/2019] [Accepted: 10/24/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the frequency of strabismus among children initially diagnosed with pseudostrabismus using big data. DESIGN Population-based retrospective cohort study. METHODS Setting: Population-based retrospective cohort study using claims data. StudyPopulation: 17,885 children diagnosed with pseudostrabismus at age ≤3 years who were later diagnosed with strabismus using the Optum deidentified Clinformatics Data Mart Database (2003-2016). We excluded patients diagnosed with strabismus before the diagnosis of pseudostrabismus or diagnosed simultaneously with strabismus and pseudostrabismus. OBSERVATIONS We assessed age, refractive error, and presence of amblyopia. Patients with pseudostrabismus were compared to a group of patients from the Optum data set diagnosed with esotropia, exotropia, and unspecified heterotropia who had not been previously diagnosed with pseudostrabismus. MainOutcomeMeasures: Incidence of strabismus, among patients initially diagnosed with pseudostrabismus vs those without an initial diagnosis of pseudostrabismus. RESULTS Strabismus was diagnosed in 9.6% (n = 1,725) of children initially diagnosed with pseudostrabismus at a median age of 1.65 years (IQR: 1.17-2.46) compared to 1.7% (136,047 of 7,787,743) of children in the control group (P < .001). Strabismus was diagnosed more than a year later in the pseudostrabismus group (3.32 years; IQR: 2.28-4.74) compared with the control group (2.28 years, IQR: 1.43-3.16) (P < .001). Esotropia was the most common type of strabismus in both groups (pseudostrabismus, 69.7%; control, 62.1%). A total of 377 children (21.9%) in the pseudostrabismus group underwent strabismus surgery compared with 12.1% of children in the control group (P < .001). CONCLUSIONS Young children diagnosed with pseudostrabismus are at increased risk of developing strabismus and undergoing strabismus surgery.
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Affiliation(s)
- Won Yeol Ryu
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA; Department of Ophthalmology, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA.
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Pan XX, Huang CA, Lin JL, Zhang ZJ, Shi YF, Chen BD, Zhang HW, Dai ZY, Yu XP, Wang XY. Prevalence of the thoracic scoliosis in children and adolescents candidates for strabismus surgery: results from a 1935-patient cross-sectional study in China. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:786-793. [PMID: 32112152 DOI: 10.1007/s00586-020-06341-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/16/2020] [Accepted: 02/12/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE No study so far has paid attention to strabismus-related spinal imbalance. This study aimed to determine the epidemiology of thoracic scoliosis in children and adolescents with strabismus and investigate the association of two diseases. METHODS AND DESIGN A cross-sectional study. Study group consists of 1935 consecutive candidates for strabismus surgery (4-18 years); Control group consists of the age- and sex-matched patients with respiratory diseases. All subjects underwent a screening program based on chest plain radiographs using the Cobb method. Their demographic information, clinical variables and results of Cobb angle were recorded and analyzed. RESULTS A significantly higher prevalence of thoracic scoliosis (289/1935, 14.94% versus 58/1935, 3.00%) was found in study group compared with control group. Among strabismic patients, the coronal thoracic scoliosis curve mainly distributed in right and in main thoracic (198/289) and in the curves 10°-19° (224/289); Age range 7-9 years (103/1935), female (179/1935) and concomitant exotropia patients (159/851) were more likely to have thoracic scoliosis. According to the logistic regression, thoracic scoliosis had no significant association with age, BMI, duration of illness and onset age (p > 0.05). However, gender, BCVA, type of strabismus and degree of strabismus showed a significant relationship with the prevalence of thoracic scoliosis (p < 0.05). CONCLUSIONS With a pooled prevalence of 14.94%, strabismus patients showed a great higher risk of developing thoracic scoliosis. Screening for scoliosis in strabismus patients can be helpful to discover a high prevalence of potential coronal scoliosis. More attention should be paid to ophthalmological problems in patients with scoliosis. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Xiang-Xiang Pan
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Zhejiang Spine Research Center, Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chong-An Huang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Zhejiang Spine Research Center, Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jia-Liang Lin
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Zhejiang Spine Research Center, Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zeng-Jie Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Zhejiang Spine Research Center, Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yi-Feng Shi
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Zhejiang Spine Research Center, Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Bo-Da Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Zhejiang Spine Research Center, Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hua-Wei Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Zhejiang Spine Research Center, Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhi-Yue Dai
- Ophthalmology Department, The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Center for Clinical Medical Research (Eye Diseases), Zhengzhou Second Hospital, Zhengzhou, China
| | - Xin-Ping Yu
- Ophthalmology Department, The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Center for Clinical Medical Research (Eye Diseases), Zhengzhou Second Hospital, Zhengzhou, China
| | - Xiang-Yang Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Zhejiang Spine Research Center, Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325000, Zhejiang, China.
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Wang Y, Xu M, Yu H, Xu J, Hou F, Zhou J, Yu X. Health-related quality of life correlated with the clinical severity of intermittent exotropia in children. Eye (Lond) 2019; 34:400-407. [PMID: 31406354 DOI: 10.1038/s41433-019-0557-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/16/2019] [Accepted: 07/01/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECT To evaluate whether the results of the health-related quality of life (HRQOL) is associated with the various clinical aspects of intermittent exotropia in children. METHODS The HRQOL of children and their parents was evaluated prospectively using the Intermittent Exotropia Questionnaire (IXTQ). The deviation angle, stereo function, sensory fusion, and strabismus control were measured. RESULTS Two hundred and sixty six children with intermittent exotropia (aged 5-17 years) were included in the study. Child HRQOL was significantly correlated with clinical severity; lower IXTQ scores were associated with a larger deviation (p < 0.001 both for distance and near) and poorer Newcastle control scores (p < 0.001). Proxy child HRQOL was significantly correlated with the deviation (p < 0.001), Newcastle control scores (p < 0.001) and stereo function (p < 0.05). Parent HRQOL was associated with their child's deviation (p < 0.01) and stereo function (p < 0.005). Multiple linear regression analysis suggested that the deviation angle at distance and the Newcastle control score at home were associated with the child's HRQOL. CONCLUSION Both the child and their parents' HRQOL showed a trend toward correlating with clinical severity. Large deviation, poor control, and poor stereo function were significantly associated with lower IXTQ scores. The deviation angle at distance and exotropia control at home were associated with the child's HRQOL.
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Affiliation(s)
- Yuanyuan Wang
- Department of Ophthalmology, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Meiping Xu
- The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huanyun Yu
- The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinling Xu
- The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fang Hou
- The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiawei Zhou
- The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinping Yu
- The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Su T, He Y, Liu S, Wu X, Wen D, Wang J, Hu S, Min X. Transient Increase of Wavefront Aberrations after Horizontal Rectus Muscle Surgery in Exotropia. Curr Eye Res 2019; 44:1393-1398. [PMID: 31256683 DOI: 10.1080/02713683.2019.1638417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aims: Wavefront aberration (WA) has become one of the important indicators for measuring the visual quality. Whether strabismus surgery affects the WA remain controversial. This study aims to investigate the postoperative alterations of WA in patients who underwent horizontal rectus muscle surgery.Methods: A total of 34 patients were enrolled and divided into two groups: bilateral lateral rectus recession (BLR) group and unilateral lateral rectus recession and medial rectus resection (R&R) group. The WA was examined 1 day before surgery, 3 days, and 6 weeks after surgery using the iTrace Visual Function Analyzer (Tracey Technologies).Results: Significant increases in total WA, lower-order aberration (LOA) and higher-order aberration (HOA) of both groups were detected in 3 days after surgery (P < 0.05), while no significant differences in 6 weeks after surgery. Significant increases in astigmatism, secondary astigmatism, and trefoil of both groups were detected in 3 days after surgery (P < 0.05), while no significant differences in individual order of LOA and HOA in 6 weeks postoperatively. Z22, Z33, and Z42 of both groups increased significantly 3 days after surgery (P < 0.05) and returned to baseline level 6 weeks after surgery, while the rest Zernike coefficients remained the same postoperatively. When comparing the differences between the two groups, there were no statistically significant differences in these parameters between baseline and each follow-up visit postoperatively.Conclusions: The increase of WA restored to pre-operative level in 6 weeks after surgery, indicating the influences of horizontal rectus muscle surgery to WA were transient and reversible.
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Affiliation(s)
- Ting Su
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen, Fujian, China.,Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ye He
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shuangzhen Liu
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoying Wu
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Dan Wen
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jieyue Wang
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shengfa Hu
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoshan Min
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Hashemi H, Pakzad R, Heydarian S, Yekta A, Aghamirsalim M, Shokrollahzadeh F, Khoshhal F, Pakbin M, Ramin S, Khabazkhoob M. Global and regional prevalence of strabismus: a comprehensive systematic review and meta-analysis. Strabismus 2019; 27:54-65. [PMID: 31012389 DOI: 10.1080/09273972.2019.1604773] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose: Despite the importance of information on the prevalence of strabismus, which can be effective in planning preventive and curative services, no study has addressed its prevalence comprehensively. In this study, a systematic search was done to estimate the regional and global prevalence of strabismus in different age and sex groups and factors affecting prevalence heterogeneity. Methods: A comprehensive and systematic search was done in different international databases, including Web of Science, Scopus, PubMed, Embase, etc. to find published articles on the total prevalence of strabismus and the prevalence of exotropia and esotropia. A binomial distribution was used to calculate the prevalence and 95% confidence interval (CI). The Cochran's Q-test and I2 were applied to evaluate heterogeneity and a random-effects model was used to assess the pooled prevalence. The Begg's test was administered to investigate publication bias and finally, a meta-regression method was applied to determine the factors affecting the heterogeneity among studies. Results: Of 7980 articles, 56 articles with a total sample size of 229,396 were analyzed. Many of these articles (n = 14) were from the Regional Office for the Americas. The estimated of pooled prevalence (95% CI) of any strabismus, exotropia, and esotropia was 1.93% (1.64-2.21), 1.23% (1.00-1.46), and 0.77% (0.59-0.95), respectively. The heterogeneity in prevalence of strabismus and its subtypes according to I2 was above 95% (p value <.001 for all). Age had a direct effect on heterogeneity in the prevalence of exotropia (b: 3.491; p: 0.002). Moreover, WHO region had a significant direct effect on heterogeneity in the prevalence of strabismus (b: 0.482; p < .001) and esotropia (b: 0.168; p: 0.027), and publication year had a significant direct effect on heterogeneity in the prevalence of exotropia (b: 0.059; p: 0.045). Sample size and publication year did not have any association with strabismus nor with other variables. There was no publication bias according to the Begg's test. Conclusion: The prevalence of strabismus varies widely in the world. As for factors affecting heterogeneity in the prevalence of strabismus, the results showed that age affected heterogeneity in the prevalence of exotropia, WHO region affected heterogeneity in the prevalence of strabismus and esotropia, and publication year affected heterogeneity in the prevalence of exotropia. Information about the global prevalence of strabismus can help health care planners design interventions and prioritize resource allocation.
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Affiliation(s)
- Hassan Hashemi
- a Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital , Tehran
| | - Reza Pakzad
- b Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences , Ilam
| | - Samira Heydarian
- c Department of rehabilitation science, School of Allied Medical Sciences, Mazandaran University of Medical Sciences , Sari
| | - Abbasali Yekta
- d Refractive Errors Research Center, Mashhad University of Medical Sciences , Mashhad
| | | | | | - Fahimeh Khoshhal
- f Department of Pediatrics, Dezful University of Medical Sciences , Dezful
| | - Mojgan Pakbin
- a Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital , Tehran
| | - Shahroukh Ramin
- g Department of Optometry, Shahid Beheshti University of Medical Sciences , Tehran
| | - Mehdi Khabazkhoob
- h Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences , Tehran
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Zhu H, Pan C, Sun Q, Huang D, Fu Z, Wang J, Chen X, Wang Z, Liu H. Prevalence of amblyopia and strabismus in Hani school children in rural southwest China: a cross-sectional study. BMJ Open 2019; 9:e025441. [PMID: 30782934 PMCID: PMC6398674 DOI: 10.1136/bmjopen-2018-025441] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To determine the prevalence rate of amblyopia and strabismus in Chinese Hani ethnic school-aged children. METHODS All grade 1 and grade 7 students in Mojiang Hani Autonomous County, located in southwest China, were invited for comprehensive eye examinations performed by experienced ophthalmologists and optometrists, including visual acuity, ocular alignment and movements, cycloplegic autorefraction, anterior segment and fundus examinations. Standard definitions of amblyopia and strabismus were applied to calculate their prevalence rate. RESULTS A total of 1656 (91.0% response rate) grade 1 Hani students and 1394 (92.8% response rate) grade 7 Hani students participated in the study. Amblyopia was present in 25 Hani students (0.82%, 95% CI 0.55% to 1.20%), with no significant differences in grade (p=0.42) and gender (p=0.69). Among these 25 amblyopic children, 17 had unilateral amblyopia and eight had bilateral amblyopia, including 16 anisometropic, eight binocular refractive and one strabismic. Strabismus was found in 59 Hani students (1.93%, 95% CI 1.50% to 2.48%), including 47 with intermittent exotropia, six with constant exotropia, five with constant esotropia and one with unilateral superior oblique palsy. The prevalence rate of strabismus was higher in grade 7 students than grade 1 students with borderline significance (2.44%vs1.50%, p=0.07), but was similar by gender (2.16% in boys vs 1.68% in girls, p=0.36). CONCLUSION The prevalence of amblyopia and strabismus in Chinese Hani school children are both lower than that previously reported for Chinese Han children in China and for many other racial/ethnic populations from non-China studies. Refractive error is the major cause for amblyopia and intermittent exotropia is the primary strabismus type.
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Affiliation(s)
- Hui Zhu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Chenwei Pan
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Qigang Sun
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Dan Huang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zhujun Fu
- Department of Ophthalmology, Nanjing Children’s Hospital, Nanjing, China
| | - Jing Wang
- Training Department, Jinling Vision Care Center for Children and Adolescents, Nanjing, China
| | - Xuejuan Chen
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zijing Wang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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Mohney BG, Cotter SA, Chandler DL, Holmes JM, Wallace DK, Yamada T, Petersen DB, Kraker RT, Morse CL, Melia BM, Wu R. Three-Year Observation of Children 3 to 10 Years of Age with Untreated Intermittent Exotropia. Ophthalmology 2019; 126:1249-1260. [PMID: 30690128 DOI: 10.1016/j.ophtha.2019.01.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To describe the course of intermittent exotropia (IXT) in children followed up without treatment for 3 years. DESIGN Observation arm from randomized trial of short-term occlusion versus observation. PARTICIPANTS One hundred eighty-three children 3 to 10 years of age with previously untreated IXT and 400 seconds of arc (arcsec) or better near stereoacuity. METHODS Participants were to receive no treatment unless deterioration criteria were met at a follow-up visit occurring at 3 months, 6 months, or 6-month intervals thereafter for 3 years. MAIN OUTCOME MEASURES The primary outcome was deterioration by 3 years, defined as meeting motor criterion (constant exotropia ≥10 prism diopters [Δ] at distance and near) or near stereoacuity criterion (≥2-octave decrease from best previous measure). For the primary analysis, participants also were considered to have deteriorated if treatment was prescribed without meeting either deterioration criterion. RESULTS The cumulative probability of protocol-specified deterioration by 3 years was 15% (95% confidence interval, 10%-22%), but that was likely an overestimate, partly because of misclassification. Among 25 deteriorations, 2 met motor deterioration, 11 met stereoacuity deterioration, and 12 started treatment without meeting either criteria (7 for social concern, 1 for diplopia, 4 for other reasons). Among the 132 participants who completed the 3-year visit and had not been treated during the study, only 1 (<1%) met motor or stereoacuity deterioration criteria at 3 years. Of the 4 participants completing the 3-year visit who met deterioration criteria previously and had not started treatment, none still met deterioration criteria. Between the baseline and 3-year examination for these 132 patients, improvement occurred in distance and near stereoacuity (mean improvement, 0.14 and 0.14 logarithm of arcsec; P ≤ 0.001 and P ≤ 0.001, respectively), distance exotropia control (mean improvement, 0.6 points; P ≤ 0.001), and distance exodeviation magnitude (mean improvement, 2.2 Δ; P = 0.002). CONCLUSIONS Among children 3 to 10 years of age with IXT for whom surgery was not considered to be the immediately necessary treatment, stereoacuity deterioration or progression to constant exotropia over 3 years was uncommon, and exotropia control, stereoacuity, and magnitude of deviation remained stable or improved slightly.
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Affiliation(s)
| | | | - Brian G Mohney
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
| | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California
| | | | | | - David K Wallace
- Department of Ophthalmology, Indiana University, Indianapolis, Indiana
| | - Tomohiko Yamada
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | - Rui Wu
- Jaeb Center for Health Research, Tampa, Florida
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Abstract
Introduction: The purpose of this study was to establish the prevalence of amblyopia in children, aged 4 to 10 years, in Bulgaria, who underwent a complete eye examination.Methods: The study was designed as cross-sectional epidemiological study, and the results were calculated in percentages. A complete ophthalmological examination was performed on 1,675 children, aged 4 to 10 years (mean age 7.7 years), during the period 01 Feb 2017-21 April 2017, in five cities, in the western part of Bulgaria. All children were verbal, none of them had a neurologic deficit or mental development delay and a complete examination was successfully performed. The ophthalmological examination consisted of: autorefractometry (using pediatric autorefractor with infrared photoretinoscopy), visual acuity, best-corrected visual acuity (BCVA) and visual acuity with pinhole occluder, cover/uncover and alternate cover test, Worth four-dot test, stereopsis, biomicroscopy and funds examination. Amblyopia was defined as reduction of the BCVA for near and far distances under 40/60 on one or on both eyes in the absence of any pathology of the eye, excluding a pathology leading to stimulus deprivation amblyopia, and in the presence of an amblyogenic factor.Results: Out of 1,675 children, 42 (2.5%) were diagnosed with amblyopia: 7% had strabismic amblyopia (3), 59% had anisometropic amblyopia (25), 31% had isoametropic amblyopia (13), and 3% deprivation amblyopia (1). Unilateral amblyopia was diagnosed in 73% (27) of the cases and bilateral amblyopia in 27% (15). For 45% (754) of the children, it was their first visit to an ophthalmologist.Conclusions: The prevalence of amblyopia among these patients (2.5%) is correlating well with the expected, based on data from other authors, between 1.5% and 3.5%. The fact that nearly half of the children (45%) have not been examined by an ophthalmologist is, however, alarming. The lack of a national screening program in Bulgaria could be the main reason. Other factors include: insufficient number of pediatric ophthalmologists in the country and the lack of awareness among the parents.
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Affiliation(s)
- Stela Petrova Dikova
- Department of Ophthalmology, Medical University - Sofia, Sofia, Bulgaria.,Department of Ophthalmology, XX DCC, Sofia, Bulgaria
| | - Stefan Atanasov Dragoev
- Department of Ophthalmology, Medical University - Sofia, Sofia, Bulgaria.,Department of Ophthalmology, Children's Eye Hospital "Visus", Sofia, Bulgaria
| | - Violeta Silvi Chernodrinska
- Department of Ophthalmology, Medical University - Sofia, Sofia, Bulgaria.,Department of Ophthalmology, Children's Eye Hospital "Visus", Sofia, Bulgaria.,Pediatric Ophthalmology Department, University Hospital Aleksandrovska, Sofia, Bulgaria
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Hashemi H, Pakzad R, Yekta A, Bostamzad P, Aghamirsalim M, Sardari S, Valadkhan M, Pakbin M, Heydarian S, Khabazkhoob M. Global and regional estimates of prevalence of amblyopia: A systematic review and meta-analysis. Strabismus 2018; 26:168-183. [PMID: 30059649 DOI: 10.1080/09273972.2018.1500618] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Amblyopia is one of the most important causes of vision impairment in the world, especially in children. Although its prevalence varies in different parts of the world, no study has evaluated its prevalence in different geographical regions comprehensively. The aim of the present study was to provide global and regional estimates of the prevalence of amblyopia in different age groups via a systematic search.Methods: In this study, international databases, including Embase, Scopus, PubMed, Web of Science, and other relevant databases, were searched systematically to find articles on the prevalence of amblyopia in different age groups published in English. The prevalence and 95% CI were calculated using binomial distribution. The Cochran's Q-test and I2 statistic were applied to assess heterogeneity, a random-effects model was used to estimate the pooled prevalence, and a meta-regression method was utilized to investigate the factors affecting heterogeneity between studies.Results: Of 1252 studies, 73 studies were included in the analysis (sample volume: 530,252). Most of these studies (n = 25) were conducted in the WHO-Western Pacific Regional Office. The pooled prevalence estimate of amblyopia was 1.75% (95% CI: 1.62-1.88), with the highest estimate in European Regional Office (3.67%, 95% CI: 2.89-4.45) and the lowest in African Regional Office (0.51%, 95% CI: 0.24-0.78). The most common cause of amblyopia was anisometropia (61.64%). The I2 heterogeneity was 98% (p < 0.001). According to the results of univariate meta-regression, the variables of WHO region (b: 0.566, p < 0.001), sample size (b: -0.284 × 10-4, p: 0.025), and criteria for definition of amblyopia (b: -0.292, p: 0.010) had a significant effect on heterogeneity between studies, while age group, publication date, and cause of amblyopia had no significant effect on heterogeneity.Conclusion: The prevalence of amblyopia varies in different parts of the world, with the highest prevalence in European countries. Geographical location and criteria for definition of amblyopia are among factors contributing to the difference across the world. The results of this study can help stakeholders to design health programs, especially health interventions and amblyopia screening programs.
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Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam
| | - Abbasali Yekta
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad
| | | | | | - Sara Sardari
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran
| | - Mehrnaz Valadkhan
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran
| | - Mojgan Pakbin
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran
| | - Samira Heydarian
- Department of rehabilitation science, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran
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Qian X, Li Y, Ding G, Li J, Lv H, Hua N, Wei N, He L, Wei L, Li X, Wang J. Compared performance of Spot and SW800 photoscreeners on Chinese children. Br J Ophthalmol 2018; 103:517-522. [DOI: 10.1136/bjophthalmol-2018-311885] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/24/2018] [Indexed: 11/03/2022]
Abstract
PurposeTo evaluate the effectiveness of Spot photoscreener and SW800 vision screener in detecting amblyopia risk factors in Chinese children between 4 and 6 years of age.MethodsOne hundred and thirteen children (226 eyes) underwent complete ophthalmologic examination, cycloplegic retinoscopy refraction, prism cover tests and photoscreen using both Spot (v2.1.4) and SW800 (v1.0.1.0) photoscreeners. The agreement of results obtained from photoscreener and retinoscopy was evaluated by paired t-test as well as Pearson correlation test. The sensitivity and specificity of detecting amblyopia risk factors were calculated based on the American Association of Pediatric Ophthalmology and Strabismus 2013 guidelines. The overall effectiveness of detecting amblyopia risk factors by using either photoscreener was analysed by receiver operating characteristic (ROC) curves.ResultsA strong linear agreement was observed between Spot and retinoscopy (p<0.01) in aspects of spherical equivalent (SE, Pearson’s r=0.95), dioptre sphere (DS, r=0.97), dioptre cylinder (DC, r=0.84) and horizontal deviation (Hdev, r=0.91), with overall −0.17 D myopic shift of SE. Significant correlation was also shown between SW800 and retinoscopy (p<0.01) in aspects of SE (r=0.90), DS (r=0.93), DC (r=0.82) and Hdev (r=0.80), with overall −0.12 D myopic shift of SE. The overall sensitivity and specificity in detecting amblyopia risk factors were 94.0% and 80.0% for Spot and 88.8% and 81.1% for SW800.ConclusionThe measurements of Spot and SW800 photoscreener showed a strong agreement with cycloplegic retinoscopy refraction and prism cover tests. The performance of both screeners in detecting individual amblyopia risk factors is satisfactory. ROC analysis indicates that the Spot and SW800 performed very similarly in detecting amblyopia risk factors.
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Descriptive Study of Conjunctival Cysts: A Rare Complication after Strabismus Surgery. J Ophthalmol 2018; 2018:1076818. [PMID: 30046458 PMCID: PMC6038475 DOI: 10.1155/2018/1076818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/11/2018] [Accepted: 04/08/2018] [Indexed: 12/03/2022] Open
Abstract
Aim Conjunctival cyst is one of the uncommon complications of strabismus surgery. It is important for surgeons and patients to be aware of and take precautions to minimize the risk. This study aimed to explore the clinical manifestations, etiology, and prognosis of conjunctival cyst at the operative site after strabismus surgery. Methods The data of 1675 patients were included in our retrospective analysis, who underwent strabismus surgery at the Xiangya Hospital of Central South University between 2010 and 2016. During the postoperative follow-up, conjunctival cyst was found in 7 cases (7 eyes; 0.4% detective rate of all cases). The clinical characteristics, prognosis, and follow-up data were recorded together with the results of pathological and bacteriological tests. Results Seven patients between the age of 3 years 8 months and 39 years, with the mean age of 12.71 years (12.71 ± 12.59, years of age), were included in the study. Strabismus surgery affected 13 recti, 8 medial and 5 lateral recti, and 3 obliques (all inferior oblique). Conjunctival cyst was detected in seven patients between 10 days and 6 months postoperatively (42.57 ± 61.11, detected days). In six cases, the cyst was detected at the nasal (3 cases) or temporal side (other 3 cases), and at the fornix in one case. Four out of 7 patients underwent cyst excision, and methicillin-resistant Staphylococcus aureus (MRSA) was detected in one patient. Conclusions Conjunctival cyst is a rare postoperative complication of strabismus surgery, conjunctival epithelium implantation should be the primary cause, and infection might exaggerate the situation. A longer duration of the surgical procedure could increase the possibility of infection, which could be accompanied with a greater tendency to the occurrence of conjunctival cyst.
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Han D, Jiang D, Zhang J, Pei T, Zhao Q. Clinical study of the effect of refractive status on stereopsis in children with intermittent exotropia. BMC Ophthalmol 2018; 18:143. [PMID: 29921242 PMCID: PMC6011197 DOI: 10.1186/s12886-018-0822-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 06/13/2018] [Indexed: 11/12/2022] Open
Abstract
Background Many studies have shown that patients with intermittent exotropia have different degrees of damage to their stereopsis function. The purpose of this study is to explore the effect of different refractive status on stereopsis in children with intermittent exotropia(IXT). Methods We assessed 90 children of ages 4~ 16 years with intermittent exotropia at the Second Affiliated Hospital of Dalian Medical University during the years 2016–2017. According to their refractive status, the patients were divided into hyperopia group(spherical equivalent > or = − 1.00 diopters), myopia group(spherical equivalent < or = − 1.00 diopters), emmetropia group (spherical equivalent diopter: within ±1.00DS) and anisometropia group(binocular equivalent spherical difference > or = 1.50 diopter). The distant stereopsis of the patient was checked by the synoptophore, and the near stereopsis of the patients was checked by the Titmus stereogram. Then, we compared the difference between distant stereopsis and near stereopsis in the four groups. Results (1)The retention rates of distant stereopsis in the hyperopia group, emmetropia group, myopia group and anisometropia group were 33.3, 45.2, 34.6, and 33.3%, respectively. There was no significant difference between the groups with different refractive status. (2)The retention rates of near stereopsis in the hyperopia group, emmetropia group, myopia group and anisometropia group were 66.7, 83.9, 80.8, and 55.6%, respectively. There were statistically significant differences between the emmetropia group and the anisometropia group (P = 0.030). (3)The retention rate of distant stereopsis in children with intermittent exotropia was 37.8%, and the retention rate of near stereopsis was 74.4%. The difference between the two groups was statistically significant (P = 0.019). Conclusions The damage to distant stereopsis in children with intermittent exotropia is more serious than that to near stereopsis. The damage to near stereopsis in children with intermittent exotropia and anisometropiais more serious.
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Affiliation(s)
- Dong Han
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Danni Jiang
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jiahuan Zhang
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tianxu Pei
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qi Zhao
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
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Han KE, Baek SH, Kim SH, Lim KH. Prevalence and risk factors of strabismus in children and adolescents in South Korea: Korea National Health and Nutrition Examination Survey, 2008-2011. PLoS One 2018; 13:e0191857. [PMID: 29444106 PMCID: PMC5812601 DOI: 10.1371/journal.pone.0191857] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 01/05/2018] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate the prevalence and risk factors associated with horizontal strabismus in children and adolescents in South Korea. Methods A total of 5,935 children and adolescents 5–18 years of age who participated in the fourth and fifth Korean National Health and Nutrition Examination Survey (KNHANES IV-V) from July 2008 to December 2011 were evaluated and the prevalence of horizontal strabismus was estimated. Univariate and multivariate logistic regression analyses were conducted to determine the association between demographic, socioeconomic and clinical risk factors and clinically significant exodeviation (≥15 prism diopters [PD]) and esodeviation (≥10 PD). Results Among 5,935 eligible subjects, 84 subjects had clinically significant exodeviation and 13 had clinically significant esodeviation. The overall prevalence of clinically significant horizontal strabismus was 1.6% (95% confidence interval [CI], 1.2–2.1): 1.3% (95% CI, 1.0–1.7) for clinically significant exodeviation and 0.3% (95% CI, 0.1–0.6) for clinically significant esodeviation. Clinically significant exodeviation was associated with amblyopia (adjusted odds ratio [aOR], 6.45; 95% CI, 2.14–19.44), family history of strabismus (aOR, 4.91; 95% CI, 1.71–14.08) and astigmatism ≥1.0 D (aOR, 1.84; 95% CI, 1.13–2.98). Clinically significant esodeviation was associated with hyperopia (aOR, 12.16; 95% CI, 1.31–113.04) and amblyopia (aOR, 4.70; 95% CI, 1.12–19.81). Other demographic, socioeconomic, and clinical variables were not associated with strabismus. Conclusion This study provides data on the prevalence and independent risk factors for clinically significant exodeviation and esodeviation in a representative population of children and adolescents in South Korea.
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Affiliation(s)
- Kyung Eun Han
- Department of Ophthalmology, Ewha Womans University College of Medicine, Mok-dong Hospital, Seoul, South Korea
| | - Seung-Hee Baek
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Seung-Hyun Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Key Hwan Lim
- Department of Ophthalmology, Ewha Womans University College of Medicine, Mok-dong Hospital, Seoul, South Korea
- * E-mail:
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Wallace DK, Repka MX, Lee KA, Melia M, Christiansen SP, Morse CL, Sprunger DT. Amblyopia Preferred Practice Pattern®. Ophthalmology 2018; 125:P105-P142. [DOI: 10.1016/j.ophtha.2017.10.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022] Open
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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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Wallace DK, Christiansen SP, Sprunger DT, Melia M, Lee KA, Morse CL, Repka MX. Esotropia and Exotropia Preferred Practice Pattern®. Ophthalmology 2017; 125:P143-P183. [PMID: 29108746 DOI: 10.1016/j.ophtha.2017.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- David K Wallace
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephen P Christiansen
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
| | - Derek T Sprunger
- Indiana University Health Physicians, Midwest Eye Institute, Indianapolis, Indiana
| | | | - Katherine A Lee
- Pediatric Ophthalmology, St. Luke's Health System, Boise, Idaho
| | | | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
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Pan CW, Chen X, Zhu H, Fu Z, Zhong H, Li J, Huang D, Liu H. School-based assessment of amblyopia and strabismus among multiethnic children in rural China. Sci Rep 2017; 7:13410. [PMID: 29042639 PMCID: PMC5645399 DOI: 10.1038/s41598-017-13926-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 10/04/2017] [Indexed: 11/09/2022] Open
Abstract
We aimed to determine the prevalence and possible ethnic variations in strabismus and amblyopia among multiethnic school-aged children in rural China. A total of 9,263 children (4,347 Han, 3,352 Yi, 799 Dai and 765 Bai) aged 6 to 14 years were analyzed. Comprehensive eye examinations including monocular distance visual acuity, anterior segment examination, autorefraction, cover testing and ocular motility were conducted. Manifested strabismus was detected in 3.53% of the overall population. The prevalence of strabismus was 3.29% in Han, 4.12% in Yi, 2.25% in Dai, and 3.66% in Bai ethnic groups with marginally inter-ethnic differences (P = 0.046). There was an increasing trend in the prevalence of strabismus with increasing age (P < 0.001). Amblyopia affected 132 children (1.43%) overall, with no statistical differences in gender and age. The prevalence of amblyopia was highest in Dai ethnic group (2.00%) and lowest in ethnic Yi ethnic group (1.04%) with no significant difference being detected (P = 0.062). Refractive error and strabismus were the two major factors associated with amblyopia. No significant ethnic differences in strabismus and amblyopia among Chinese ethnic minorities were observed. Refractive error and strabismus were the major causes for amblyopia in rural Chinese children.
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Affiliation(s)
- Chen-Wei Pan
- School of Public Health, Medical College of Soochow University, Suzhou, China.,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, China
| | - Xuejuan Chen
- Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Zhu
- Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhujun Fu
- Department of Ophthalmology, Nanjing Children's Hospital, Nanjing, China
| | - Hua Zhong
- Department of Ophthalmology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jun Li
- Department of Ophthalmology, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Dan Huang
- Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hu Liu
- Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Abstract
PURPOSE The Intermittent Exotropia Questionnaire (IXTQ) is a child, proxy, and parent report of health-related quality of life specific to children with intermittent exotropia (IXT). The present study aimed to develop a Chinese-language version of the IXTQ (CIXTQ) and evaluate its validity and reliability when used in Chinese IXT children and their parents. METHODS The IXTQ was translated into Chinese. One hundred seventy-five IXT children (2 to 17 years old) and 151 orthotropic control children (2 to 17 years old) along with one of their parents were recruited. Children 5 to 17 years old completed the 5- to 7-year-old or the 8- to 17-year-old child questionnaire of the CIXTQ according to their age. Parents of all children (2 to 17 years old) completed the proxy and parent questionnaires of the CIXTQ. Psychometric properties of the CIXTQ were examined for floor and ceiling effects, construct validity, item-internal consistency, discriminative validity, Cronbach α coefficient and test-retest reliability. RESULTS No items were found to have strong floor or ceiling effects. Principal component analysis identified that the CIXTQ had a similar structure to the original English version. The median scores of each questionnaire in the CIXTQ among children with IXT and their parents were significantly lower than those among control subjects (P < .001). Cronbach α coefficients ranged from 0.869 to 0.931, and test-retest reliabilities ranged from 0.898 to 0.981, for each questionnaire in the CIXTQ. CONCLUSIONS The CIXTQ is a useful tool to evaluate the influence of IXT on health-related quality of life among Chinese IXT children and their parents.
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Kindlicher Strabismus in Deutschland: Prävalenz und Risikogruppen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:849-855. [DOI: 10.1007/s00103-017-2578-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Hashemi H, Nabovati P, Yekta A, Ostadimoghaddam H, Behnia B, Khabazkhoob M. The Prevalence of Strabismus, Heterophorias, and Their Associated Factors in Underserved Rural Areas of Iran. Strabismus 2017; 25:60-66. [DOI: 10.1080/09273972.2017.1317820] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Payam Nabovati
- Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Abbasali Yekta
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Ostadimoghaddam
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bardia Behnia
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Li SM, Kang MT, Wu SS, Meng B, Sun YY, Wei SF, Liu L, Peng X, Chen Z, Zhang F, Wang N. Studies using concentric ring bifocal and peripheral add multifocal contact lenses to slow myopia progression in school-aged children: a meta-analysis. Ophthalmic Physiol Opt 2016; 37:51-59. [PMID: 27880992 DOI: 10.1111/opo.12332] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/06/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the effect of soft contact lens with concentric ring bifocal and peripheral add multifocal designs on controlling myopia progression in school-aged children. METHODS We systematically searched MEDLINE, EMBASE, Cochrane Library and reference lists of included trials. Methodological quality of included trials was assessed using Jadad Scale and Newcastle-Ottawa Quality Assessment Scale items. RESULTS We identified five randomised controlled trials (RCTs) and three cohort studies with a total of 587 myopic children. Compared with the control group, concentric ring bifocal soft contact lenses showed less myopia progression with a weighted mean difference (WMD) of 0.31 D (95% CI, 0.05~0.57 D, p = 0.02) and less axial elongation with a WMD of -0.12 mm (95% CI, approximately -0.18 to -0.07 mm, p < 0.0001) at 12 months. Relative to the control group, peripheral add multifocal soft contact lenses showed less myopia progression with a WMD of 0.22 D (95% CI 0.14~0.31 D, p < 0.0001) and less axial elongation of -0.10 mm (95% CI -0.13~0.07 mm, p < 0.0001) at 12 months, respectively. The soft contact lenses with concentric ring bifocal and peripheral add multifocal designs produced additional myopia control rates of 30~38% for slowing myopia progression and 31~51% for lessening axial elongation within 24 months. CONCLUSIONS Both concentric ring bifocal and peripheral add multifocal soft contact lenses are clinically effective for controlling myopia in school-aged children, with an overall myopia control rates of 30~50% over 2 years. Concentric ring bifocal soft contact lenses seem to have greater effect than peripheral add multifocal soft contact lenses.
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Affiliation(s)
- Shi-Ming Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Meng-Tian Kang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Shan-Shan Wu
- National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bo Meng
- National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yun-Yun Sun
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Shi-Fei Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Luoru Liu
- Anyang Eye Hospital, Henan Province, China
| | - Xiaoxia Peng
- Department of Biostatistics and Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Zhuo Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China.,Lakewood Eye Care, Houston, USA
| | - Fengju Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
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Gupta M, Rana SK, Mittal SK, Sinha R. Profile of Amblyopia in School going (5-15 years) Children at State Level Referral Hospital in Uttarakhand. J Clin Diagn Res 2016; 10:SC09-SC11. [PMID: 28050460 PMCID: PMC5198413 DOI: 10.7860/jcdr/2016/16026.8866] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 01/04/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Amblyopia is one of the common causes of childhood visual impairment. The prevalence of amblyopia usually varies according to the age group of the studied population and the factors prevailing in that region. The upper limit of the critical time when amblyopia can develop is around eight years of age and it can be permanent if corrective measures are not taken in time. AIM The purpose of study was to know the profile and pattern of amblyopia in children aged 5-15 years with refractive error in Uttarakhand and to compare it with national and regional (South Asian) studies. MATERIALS AND METHODS In the present retrospective cross-sectional study, 360 children from 5-15 yrs of age who attended the OPD during the period between September 2014 to February 2015, had undergone detailed Ophthalmic examination. The children having vision < 6/12 with out organic lesion were included in the study. The children with strabismus, previous ocular surgery and ocular diseases were excluded. Chi-Square test was done for statistical analysis (IBM SPSS Version 23). RESULTS The percentage of amblyopia was 8.6% (n=31) with insignificant gender variation (p-value>0.05). Amblyopia due to astigmatism (combined) was in 41.93% (n=13) followed by Hypermetropia [32.25% (n=10)] and least in myopia [25.8% (n=8)]. In 51.61% cases age of presentation was 5-10 years while rest belonged to > 10 years of age. Binocular amblyopia was more (58.06%) then unilateral amblyopia (41.93%). CONCLUSION Refractory errors are second most common cause of paediatrc amblyopia. Amblyopia and associated strabismus can have devastating psychosocial and economical fall outs. Our study emphasizes the need of visual screening of school children and prescribing them correct spectacles at appropriate time.
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Affiliation(s)
- Manisha Gupta
- Associate Professor, Department of Ophthalmology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Patel Nagar, Dehradun, Uttarakhand, India
| | - Sudhir Kumar Rana
- Professor and Head, Department of Paediatrics, Shri Guru Ram Rai Institute of Medical and Health Sciences, Patel Nagar, Dehradun, Uttarakhand, India
| | - Sanjiv Kumar Mittal
- Professor and Head, Department of Paediatrics, Shri Guru Ram Rai Institute of Medical and Health Sciences, Patel Nagar, Dehradun, Uttarakhand, India
| | - R.N.P. Sinha
- Professor, Department of Ophthalmology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Patel Nagar, Dehradun, Uttarakhand, India
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