Uniocular childhood blindness: a prospective study

Comparison of Two Scoring Systems in Pediatric Open Globe Injuries

PURPOSE

The aim of this study is to determine the demographic characteristics of pediatric open globe injuries, evaluate the ocular trauma scores (OTS), and predict the visual outcomes.

METHODS

All patients with pediatric open globe injuries who applied to Department of Ophthalmology, Faculty of Medicine, Mersin University between January 2018 and December 2019 were included in this study. Age, gender, type of injury, time of admission, time to surgery, OTS, and pediatric ocular trauma score (POTS) were calculated for each patient. The relation between these findings and final visual acuity (VA) after 12 months of follow-up was examined.

RESULTS

Forty-two eyes of 41 patients were included in this study. The most common injuries observed were sharp objects such as knives (23.8%) and stones (23.8%). The wound locations were zone I in 36 patients (85.7%) and zone II in 6 patients (14.3%). The most common concomitant eye pathologies were iris prolapse in 37 (88.1%) and hyphema in 29 (69.1%). The mean original OTS was 77.21 and the mean POTS was 46.78. Association between OTS/POTS and final VA was very good (Kendall Tau-b = 0.665, P < 0.001, Kendall Tau-b = 0.505, P < 0.001, respectively). The level of agreement between the predicted VA for OTS and that for POTS was almost perfect (kappa = 0.8726).

CONCLUSIONS

This study shows that the original OTS is still the gold standard in pediatric cases.

Epidemiology of Pediatric Open Globe Injuries in a University Hospital in Thailand

Objective: To describe the epidemiology, clinical characteristics, and clinical outcomes of pediatric traumatic open globe injuries and to determine the risk factors for poor visual outcome.

Methods: The medical records of patients aged younger than 15 years of age who were diagnosed with open globe injuries from January 2005 to December 2015 were retrospectively reviewed. The patients’ demographic data were collected, including age, sex, injury date, place of injury, mechanism of injury, cause of injury, and the activity related to the injury. Clinical data were recorded, including initial visual acuity (VA), wound size, wound location, associated ocular findings at presentation, and complications. The prognostic factors for a poor visual outcome were assessed.

Results: In total, 46 pediatric patients were included in this study. The mean age was 6.8 years old. Most patients were male (65.2%). The most common type of injury was penetrating injury (60.9%) and mostly occurred during playing (60.9%). Household appliances/furniture and scissors/knives were common causes of injuries (17.4%, 15.2%, respectively). Poor final VA worse than 6/60 was found in 17 patients (37%). Wound location and retinal detachment (RD) at the time of presentation were significant prognostic factors for a poor visual outcome according to the univariate analysis (p = 0.008, <0.001). Only wound location at zone II and III was found to be significantly correlated with poor final VA in the multivariate analysis (adjusted risk ratio (RR) = 2.87, 95% confidence interval (CI), 1.26-6.55, p = 0.012). Traumatic cataract was the most common associated injury (45.7%).

Conclusions: One-third of pediatric patients with open globe injuries had a poor visual outcome. Wound location at zone II and III significantly correlated with a poor visual outcome in pediatric open globe injuries. The parents and caregivers should be made aware of the seriousness of open globe injuries in order to prevent children from possible injuries.

Prediction of visual outcomes after open globe injury in children: a 17-year Canadian experience

PURPOSE

To analyze the predictive value of ocular trauma scoring systems for open globe injury in children, to determine risk factors for poor visual outcome, and to assess circumstances under which trauma occurs.

METHODS

The medical records of patients <18 years of age who presented with open globe injuries from January 1992 to December 2009 were examined retrospectively. Information recorded included demographic profile; date, time, and place of injury; cause and extent of injury; complications; and final best-corrected visual acuity. Injuries were classified by Ocular Trauma Classification Group guidelines.

RESULTS

A total of 131 patients were included. Final best-corrected visual acuity was ≥20/40 in 74 patients (56.5%) after mean follow-up of 24.8 months. Injuries occurred more commonly in boys (98/131), and 45% of injuries occurred in children aged ≤5 years (P = 0.001). Injuries were more common indoors (P = 0.003), in the afternoon (P < 0.001), and on Saturdays and Mondays (P = 0.004). Multiple regression analysis identified risk factors for final best-corrected visual acuity <20/40: age <5 years, injuries with retrolimbal involvement, wound length >5 mm, globe rupture, vitreous hemorrhage, and retinal detachment (P < 0.05).

CONCLUSIONS

Visual outcomes after pediatric open globe injury in this study compare favorably to results reported previously. Knowledge of weekly fluctuations in occurrence may help guide development of prevention strategies. Age <5 years is an independent risk factor for a poorer outcome. The ocular trauma score is useful in assessing prognosis after pediatric open globe injury.

Prevalence, clinical features, and causes of vision loss among patients with ocular toxocariasis

BACKGROUND

To describe the prevalence, clinical features, and causes of vision loss among patients with ocular toxocariasis seen at a uveitis referral center.

METHODS

A review was completed of the charts of patients with ocular toxocariasis who were examined between 1977 and 1996 at the Francis I. Proctor Foundation of the University of California at San Francisco. The prevalence of ocular toxocariasis among all uveitis patients seen at the center was determined. Demographic features, symptoms, and signs in all patients were evaluated.

RESULTS

Ocular toxocariasis occurred in 22 (1.0%) of 2,185 uveitis patients. The mean patient age was 16.5 years. Inflammation was usually unilateral (90.9%). Toxocara uveitis presented as a granuloma in the peripheral retina in 50% of cases, as a granuloma in the macula in 25% of cases, and as a moderate to severe vitreous inflammation mimicking endophthalmitis in 25% cases. The primary causes of vision loss were vitritis (52.6%), cystoid macular edema (47.4%), and traction retinal detachment (36.8%).

CONCLUSIONS

Ocular toxocariasis is an uncommon cause of uveitis that mainly affects younger patients. Inflammation is typically unilateral and presents as either a granuloma in the peripheral or posterior retina or a moderate to severe vitreous inflammation mimicking endophthalmitis.

School vision screening, ages 5-16 years: the evidence-base for content, provision and efficacy

The optometric profession in the UK has a major role in the detection, assessment and management of ocular anomalies in children between 5 and 16 years of age. The role complements a variety of associated screening services provided across several health care sectors. The review examines the evidence-base for the content, provision and efficacy of these screening services in terms of the prevalence of anomalies such as refractive error, amblyopia, binocular vision and colour vision and considers the consequences of their curtailment. Vision screening must focus on pre-school children if the aim of the screening is to detect and treat conditions that may lead to amblyopia, whereas if the aim is to detect and correct significant refractive errors (not likely to lead to amblyopia) then it would be expedient for the optometric profession to act as the major provider of refractive (and colour vision) screening at 5-6 years of age. Myopia is the refractive error most likely to develop during primary school presenting typically between 8 and 12 years of age, thus screening at entry to secondary school is warranted. Given the inevitable restriction on resources for health care, establishing screening at 5 and 11 years of age, with exclusion of any subsequent screening, is the preferred option.

A cost-benefit analysis of vision screening methods for preschoolers and school-age children

INTRODUCTION

The purpose of this study was to determine costs and benefits of visual acuity screening (VAS) or photoscreening (PS) in children.

METHODS

A societal-perspective, decision-analytic model compared VAS and PS conducted in three age groups: children 6 to 18 months, 3 to 4 years, and 7 to 8 years old. Literature estimates of sensitivity, specificity, and prevalence were used. Cost estimates and referral rates for surgical treatment were derived from a managed care database and the United States Social Security Administration.

RESULTS

All the benefit-to-cost ratios exceeded 1.0, meaning that all screening programs studied had benefits that exceeded the cost of screening. The total net benefit was highest for PS in children of 3 to 4 years of age (19,412 US dollars) and the least for VAS in children 7 to 8 years of age (15,179 US dollars). The benefit-to-cost ratio was highest for the VAS in children 3 to 4 years of age (162 US dollars) and least for PS in infants 6 to 18 month old (140 US dollars). Sensitivity of the PS instrument and VAS charts were the most influential variables in determining the most cost-beneficial program.

CONCLUSIONS

Based on the best available data, the net benefit of PS in 3 to 4 year old preschool children is greater than VAS in children 7 to 8 years of age, PS in toddlers, and VAS in children 3 to 4 years of age.

Visual acuity, residual amblyopia and ocular pathology in a screened population of 12-13-year-old children in Sweden

PURPOSE

To establish the distribution of visual acuity and the prevalence of residual amblyopia and other ocular disorders in a vision-screened population group of 12-13-year-old children.

METHODS

In total 1046 children were examined in a field study in Sweden. The examination included visual acuity, stereopsis, cover testing, red reflex, refractive retinoscopy and examination of the posterior pole. In selected cases VEP was also performed.

RESULTS

Visual acuity > or =1.0 in at least one eye was present in 98% of cases. Residual amblyopia (< or =0.5) was found in 1.1% of the population. Manifest strabismus was found in 2.7%. There were only a small number of ocular opacities and posterior pole abnormalities. Ocular albinism was found in 7 cases. In 15 children the cause of subnormal VA was unexplained.

CONCLUSION

Results for visual acuity, residual amblyopia and other ocular disorders are very similar to previous Nordic, vision-screened populations.