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Nouraeinejad A. The effect of amblyopia on saccadic eye movements. Int J Neurosci 2024; 134:310-311. [PMID: 35815630 DOI: 10.1080/00207454.2022.2100775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
The effect of amblyopia on several sensory and perceptual functions has been widely studied. However, relatively fewer studies have evaluated the influence of amblyopia on visuomotor aspects. This concise but comprehensive collection of materials is to show how saccadic eye movements are severely affected by amblyopia and therefore spatiotemporal coordination between the visual and motor systems is distorted. The author hopes that recognition of these saccade deficits in amblyopia can help all eye professionals and neurologists to consider validated clinical tests related to saccadic eye movements in patients with amblyopia as these tests are not presently performed in routine clinical eye examinations.
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Affiliation(s)
- Ali Nouraeinejad
- Faculty of Brain Sciences, Institute of Ophthalmology, University College London (UCL), London, UK
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Csizek Z, Budai A, Nemes VÁ, Hegyi P, Szabó I, Pusztai Á, Piñero DP, Jandó G, Mikó-Baráth E. [Mobile device-based childhood vision screening for early detection of amblyopia]. Orv Hetil 2024; 165:620-628. [PMID: 38643477 DOI: 10.1556/650.2024.33033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/27/2024] [Indexed: 04/23/2024]
Abstract
Bevezetés: Az amblyopia vagy tompalátás binokuláris eredetű
fejlődési zavar, amelyet a legtöbbször egy szemet érintő, lencsével nem
korrigálható látásromlásként definiálnak. Magas prevalenciájával világszerte
népegészségügyi problémát jelent, így a kisgyermekkori látásszűrések fontos
célja az amblyopia megelőzése. Célkitűzés: Célunk egy
mobilapplikáció-alapú térlátásvizsgáló teszt (EuvisionTab®
sztereoteszt, ETS) értékelése, mellyel a tompalátás és rizikófaktorai
(kancsalság, törési hibák) időben kiszűrhetők. Módszer:
Vizsgálataink során nemzetközileg ismert klinikai sztereoteszteket (Lang II,
TNO, Stereo Fly, Frisby) hasonlítottunk össze az EuvisionTab sztereoteszt
különböző verzióival gyermekek körében (n = 453, átlagéletkor: 7,45 év). A
random pontokból álló EuvisionTab sztereoteszt esetén 4 különböző beállítást
alkalmaztunk, a dinamizmust, a pontsűrűséget (denzitást), illetve a vizuális
zajt változtatva. A tesztek hatékonyságát ’receiver-operating characteristic’
(ROC) módszerrel értékeltük, melynek legfontosabb mérőszáma a görbe alatti
terület (AUC). Eredmények: Az EuvisionTab sztereotesztek nagy
szenzitivitásúnak bizonyultak a klasszikus klinikai tesztekhez viszonyítva,
specificitásuk viszont több esetben elmaradt tőlük. Az amblyopia esetében a
legjobb szenzitivitást (91%) a kis denzitású, vizuális zajt tartalmazó dinamikus
teszt érte el, míg a legjobb specificitásértéket (89%) a statikus nagy denzitású
esetében kaptuk. A hagyományos klinikai tesztek közül a legjobb szenzitivitással
(88%) a TNO rendelkezett, míg a legjobb specificitással (98%) a Lang-teszt. A
ROC-analízis alapján minden alkalmazott sztereoteszt jó vagy kiválóan alkalmas
(ROC-AUC>0,80) az amblyopia szűrésére, míg a kancsalság esetén a TNO, a
Stereo Fly, valamint az EuvisionTab tesztek feleltek meg ennek a kritériumnak.
Következtetés: Az EuvisionTab sztereotesztek megfelelőnek
bizonyultak az amblyopia szűrésére, nagy szenzitivitással rendelkeznek. A
módszer további előnyei a véletlenszerű ingersorozat, a rugalmas
paraméterbeállítások, a statisztikai alapú döntéshozatal, a kényelmes
dokumentáció, valamint a könnyű és gyors kivitelezhetőség. Ezek alapján a
legmodernebb látásszűrési protokoll részévé válhat. Orv Hetil. 2024; 165(16):
620–628.
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Affiliation(s)
- Zsófia Csizek
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Élettani Intézet Pécs, Szigeti út 12., 7624 Magyarország
- 4 Semmelweis Egyetem, Általános Orvostudományi Kar, Gyermekgyógyászati Klinika Budapest Magyarország
| | - Anna Budai
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Élettani Intézet Pécs, Szigeti út 12., 7624 Magyarország
| | - Vanda Ágnes Nemes
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Élettani Intézet Pécs, Szigeti út 12., 7624 Magyarország
- 5 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Idegtudományi Centrum Pécs Magyarország
| | - Péter Hegyi
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Élettani Intézet Pécs, Szigeti út 12., 7624 Magyarország
| | - István Szabó
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Élettani Intézet Pécs, Szigeti út 12., 7624 Magyarország
- 5 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Idegtudományi Centrum Pécs Magyarország
| | - Ágota Pusztai
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ, Szemészeti Klinika Pécs Magyarország
| | - David P Piñero
- 3 Department of Optics, Pharmacology and Anatomy, University of Alicante Alicante Spain
| | - Gábor Jandó
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Élettani Intézet Pécs, Szigeti út 12., 7624 Magyarország
- 5 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Idegtudományi Centrum Pécs Magyarország
| | - Eszter Mikó-Baráth
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Élettani Intézet Pécs, Szigeti út 12., 7624 Magyarország
- 5 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Idegtudományi Centrum Pécs Magyarország
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Errera C, Romann J, Solecki L, Gaucher D, Ballonzoli L, Bourcier T, Sauer A. Retinal microvascular changes in unilateral functional amblyopia detected by oct-angiography and follow-up during treatment. Eur J Ophthalmol 2024; 34:399-407. [PMID: 37464746 DOI: 10.1177/11206721231188987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To evaluate the macular microvascular changes using optical coherence tomographic angiography (OCT-A) in children with unilateral amblyopia and their reversibility during treatment. METHODS Patients with unilateral strabismic or anisometropic amblyopia or residual amblyopia from early congenital cataract surgery, examined between October 2019 and March 2021, were included. Vessel density and perfusion density in the superficial capillary plexus and area, perimeter and circularity of the foveal avascular zone (FAZ) were analysed using OCT-A in amblyopic eyes, contralateral eyes and control group healthy eyes. Correlation analyses between the microvascular parameters and the visual acuity were performed. In a pilot study on a few patients from the amblyopic cohort, longitudinal follow-up during treatment was also performed. RESULTS A total of 128 eyes of 64 patients were included: 32 amblyopic eyes compared with 32 contralateral eyes and 64 control eyes. Vessel density and perfusion density in the superficial capillary plexus were significantly lower in amblyopic eyes compared to control eyes in 6 × 6 mm (p < 0.02) and 3 × 3 mm (p < 0.01) scans. Correlation analyses showed a linear decrease in vessel density and perfusion density with decreasing visual acuity. The microvascular changes observed were reversible with the occlusion treatment of amblyopia (p < 0.001). CONCLUSIONS The study found a decrease in vessel density and perfusion density in the macula of children with unilateral functional amblyopia. These microvascular changes were correlated with visual acuity and appeared to be reversible with treatment of amblyopia. On the whole, OCT-A appears to be a relevant complementary examination when it comes to diagnosing and monitoring functional amblyopia.
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Affiliation(s)
- Charlotte Errera
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Julia Romann
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Lauriana Solecki
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - David Gaucher
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Laurent Ballonzoli
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Tristan Bourcier
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Arnaud Sauer
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, Strasbourg, France
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Gaier ED, Bear MF. Comments on: Partial Recovery of Amblyopia After Fellow Eye Ischemic Optic Neuropathy: Response. J Neuroophthalmol 2024; 44:e210-e211. [PMID: 37792479 PMCID: PMC10920390 DOI: 10.1097/wno.0000000000001996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Affiliation(s)
- Eric D Gaier
- Department of Ophthalmology (EDG), Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology (EDG), Boston Children's Hospital, Boston, Massachusetts; Department of Ophthalmology (EDG), Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Picower Institute for Learning and Memory (EDG, MFB), Massachusetts Institute of Technology, Cambridge, Massachusetts
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Großpötzl M, Kloeckl L, Guttmann A, Kruger M, Gran J, Hoeflechner L, Brandner M, Gaugl H, Ivastinovic D, Lindner M, Riedl R, Wedrich A, Lindner E. Protective Effect of Amblyopia on Age-Related Macular Degeneration. Am J Ophthalmol 2024; 259:1-6. [PMID: 37437833 DOI: 10.1016/j.ajo.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/24/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Our aim was to evaluate whether patients with age-related macular degeneration (AMD) and cooccurrent amblyopia are more likely to have diseases diagnosed on both the ipsilateral and the contralateral side in a large Austrian database. DESIGN Retrospective cross-sectional study. METHODS Setting: Institutional practice. PATIENT POPULATION Medical records of all patients who visited the Department of Ophthalmology of the Medical University of Graz between December 1996 and June 2021 were searched for the co-occurrence of AMD and amblyopia. MAIN OUTCOME MEASURES Data from patients with AMD diagnosed on 1 eye side were used for further analysis. Spectral-domain optical coherence tomography images were analyzed to confirm the lateral asymmetry of AMD. RESULTS A total of 327,443 patients were screened for the co-occurrence of AMD and amblyopia. Of them, 8742 patients had AMD diagnosed on 1 eye side and 5051 patients had unilateral amblyopia. In total, 163 patients were found to have AMD diagnosed on 1 side and unilateral amblyopia in combination. Of these, 126 patients had AMD and amblyopia on contralateral sides and 37 had AMD and amblyopia on the ipsilateral side (P < .001). CONCLUSIONS Less amblyopic patients had AMD diagnosed on the amblyopic eye compared with the nonamblyopic eye. In cases of lateral asymmetry, the nonamblyopic eye is more likely to have the more advanced form of AMD.
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Affiliation(s)
- Manuel Großpötzl
- From the Department of Ophthalmology (M.G., L.K., A.G., M.K., J.G., L.H., M.B., H.G., D.I., A.W., E.L.)
| | - Lorenz Kloeckl
- From the Department of Ophthalmology (M.G., L.K., A.G., M.K., J.G., L.H., M.B., H.G., D.I., A.W., E.L.)
| | - Andreas Guttmann
- From the Department of Ophthalmology (M.G., L.K., A.G., M.K., J.G., L.H., M.B., H.G., D.I., A.W., E.L.)
| | - Michael Kruger
- From the Department of Ophthalmology (M.G., L.K., A.G., M.K., J.G., L.H., M.B., H.G., D.I., A.W., E.L.)
| | - Jakob Gran
- From the Department of Ophthalmology (M.G., L.K., A.G., M.K., J.G., L.H., M.B., H.G., D.I., A.W., E.L.)
| | - Lukas Hoeflechner
- From the Department of Ophthalmology (M.G., L.K., A.G., M.K., J.G., L.H., M.B., H.G., D.I., A.W., E.L.)
| | - Martina Brandner
- From the Department of Ophthalmology (M.G., L.K., A.G., M.K., J.G., L.H., M.B., H.G., D.I., A.W., E.L.)
| | - Heike Gaugl
- From the Department of Ophthalmology (M.G., L.K., A.G., M.K., J.G., L.H., M.B., H.G., D.I., A.W., E.L.)
| | - Domagoj Ivastinovic
- From the Department of Ophthalmology (M.G., L.K., A.G., M.K., J.G., L.H., M.B., H.G., D.I., A.W., E.L.)
| | | | - Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation (R.R.), Medical University of Graz, Graz, Austria
| | - Andreas Wedrich
- From the Department of Ophthalmology (M.G., L.K., A.G., M.K., J.G., L.H., M.B., H.G., D.I., A.W., E.L.)
| | - Ewald Lindner
- From the Department of Ophthalmology (M.G., L.K., A.G., M.K., J.G., L.H., M.B., H.G., D.I., A.W., E.L.).
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Nikdel M, Ghadimi H, Tavakoli M, Suh DW. Assessment of the Responses of the Artificial Intelligence-based Chatbot ChatGPT-4 to Frequently Asked Questions About Amblyopia and Childhood Myopia. J Pediatr Ophthalmol Strabismus 2024; 61:86-89. [PMID: 37882183 DOI: 10.3928/01913913-20231005-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
PURPOSE To assess the responses of the ChatGPT-4, the forerunner artificial intelligence-based chatbot, to frequently asked questions regarding two common pediatric ophthalmologic disorders, amblyopia and childhood myopia. METHODS Twenty-seven questions about amblyopia and 28 questions about childhood myopia were asked of the ChatGPT twice (totally 110 questions). The responses were evaluated by two pediatric ophthalmologists as acceptable, incomplete, or unacceptable. RESULTS There was remarkable agreement (96.4%) between the two pediatric ophthalmologists on their assessment of the responses. Acceptable responses were provided by the ChatGPT to 93 of 110 (84.6%) questions in total (44 of 54 [81.5%] for amblyopia and 49 of 56 [87.5%] questions for childhood myopia). Seven of 54 (12.9%) responses to questions on amblyopia were graded as incomplete compared to 4 of 56 (7.1%) of questions on childhood myopia. The ChatGPT gave inappropriate responses to three questions about amblyopia (5.6%) and childhood myopia (5.4%). The most noticeable inappropriate responses were related to the definition of reverse amblyopia and the threshold of refractive error for prescription of spectacles to children with myopia. CONCLUSIONS The ChatGPT has the potential to serve as an adjunct informational tool for pediatric ophthalmology patients and their caregivers by demonstrating a relatively good performance in answering 84.6% of the most frequently asked questions about amblyopia and childhood myopia. [J Pediatr Ophthalmol Strabismus. 2024;61(2):86-89.].
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Stults CD, Liang SY, Wilcox J, Nyong’o OL. Amblyopia Care Trends Following Widespread Photoscreener Adoption. JAMA Ophthalmol 2024; 142:188-197. [PMID: 38300546 PMCID: PMC10835608 DOI: 10.1001/jamaophthalmol.2023.6434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/28/2023] [Indexed: 02/02/2024]
Abstract
Importance Amblyopia can result in permanent vision loss if not properly treated before age 7 years. In 2017, the US Preventive Services Task Force recommended that vision screening should occur at least once in all children aged 3 to 5 years to detect amblyopia. Objective To understand trends and factors associated with screening, referral, or diagnosis of amblyopia before and after photoscreening expansion across a relatively large health care system in late 2017. Design, Setting, and Participants This is a retrospective cohort study of electronic health record data from patients with a well child care visit at approximately age 3 years (ages 2.75-3.25 years) in a relatively large, multispecialty group practice in Northern California and linked census data between 2015 and 2022. Data were extracted and analyzed from October 2022 through August 2023. Exposures Patient sex, race and ethnicity, immunization records, previous well child care visits, and census-level median household income. Main Outcomes and Measures Vision screening, pediatric ophthalmology referral, or amblyopia diagnosis, compared using adjusted odds ratios (AORs). Results The study included 2015-2017 data from 23 246 patients aged 3 years with at least 1 well child care visit (11 206 [48.2%] female) compared with 2018-2022 postexpansion data from 34 281 patients (16 517 [48.2%] female). The screening rate increased from 5.7% (424 of 7505) in 2015 to 72.1% (4578 of 6354) in 2022. The referral rate increased from 17.0% (1279 of 7505) in 2015 to 23.6% (1836 of 7792) in 2018. The diagnosis rate was 2.7% (200 of 7505) in 2015, peaked at 3.4% (263 of 7792) in 2018, and decreased to 1.4% (88 of 6354) in 2022. Compared with White patients, patients who were Asian, Black, or Hispanic were less likely to be screened (Asian: AOR, 0.80; 95% CI, 0.72-0.88; Black: AOR, 0.71; 95% CI, 0.53-0.96; Hispanic: AOR, 0.88; 95% CI, 0.80-0.97). Compared with White patients, patients who were Asian or Hispanic were more likely to be referred (Asian: AOR, 1.49; 95% CI, 1.36-1.62; Hispanic: AOR, 1.32; 95% CI, 1.18-1.48) and were more likely to be diagnosed (Asian: AOR, 1.29; 95% CI, 1.07-1.56; Hispanic: AOR, 1.67; 95% CI, 1.33-2.11). Conclusions and Relevance In this study, increased availability of photoscreeners was associated with an increase in overall rates of vision screening for children aged 3 years in a relatively large health care system. Given that US rates of visual impairment are predicted to increase, additional targeted interventions would be needed to address remaining disparities in amblyopia care along patient- and clinician-level factors.
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Affiliation(s)
- Cheryl D. Stults
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, Palo Alto, California
| | - Su-Ying Liang
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, Palo Alto, California
| | - Joseph Wilcox
- Center for Health Systems Research, Sutter Health, Walnut Creek, California
| | - Omondi L. Nyong’o
- Crescendo MD, Portola Valley, California
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
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Daungsupawong H, Wiwanitkit V. Chatbot ChatGPT-4 and Frequently Asked Questions About Amblyopia and Childhood Myopia. J Pediatr Ophthalmol Strabismus 2024; 61:151. [PMID: 38529748 DOI: 10.3928/01913913-20240124-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
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Boutaj T, Tabchi M. [Choroidal melanoma found incidentally in an amblyopic eye]. Pan Afr Med J 2024; 47:79. [PMID: 38708135 PMCID: PMC11068467 DOI: 10.11604/pamj.2024.47.79.42795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/10/2024] [Indexed: 05/07/2024] Open
Abstract
We report the case of a 37-year-old patient with profound amblyopia of the left eye from childhood, who attended a consultation as part of diabetic retinopathy screening following a recent diagnosis of diabetes. Ophthalmological examination revealed a visual acuity of 10/10 in the right eye and 1/10 in the left eye. The anterior segment was normal. Fundus examination of the left eye showed a large achromatic mass in the temporal retina, surrounded by a serous retinal detachment with interpapillomacular folds (A). Ocular ultrasound revealed a hyperechoic mushroom-shaped choroidal process with vascularity on colour Doppler ultrasound (B). Orbital Magnetic Resonance Imaging (MRI) revealed left circumscribed intra-orbital process, with mean signal intensity after gadolinium injection (C). After a multidisciplinary meeting, the diagnosis of choroidal melanoma was strongly suspected. Assessment of extent including brain MRI, thoraco-abdominopelvic Computed Tomography (CT) scan and abdominal ultrasound was normal. Given the size of the mass, conservative treatment was not possible. The patient underwent an enucleation and was referred to the oncology department for further management, after anatomopathological confirmation of the surgical specimen.
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Affiliation(s)
- Taha Boutaj
- Service d'Ophtalmologie “A”, Centre Hospitalier Universitaire Ibn Sina, Hôpital des Spécialités, Mohammed V University, Rabat, Maroc
| | - Manal Tabchi
- Service d'Ophtalmologie “A”, Centre Hospitalier Universitaire Ibn Sina, Hôpital des Spécialités, Mohammed V University, Rabat, Maroc
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Fernandes A, Pinto N, Tuna AR, Brardo FM, Pato MV. Pattern electroretinography response in amblyopic adults. Int Ophthalmol 2024; 44:86. [PMID: 38363441 PMCID: PMC10873232 DOI: 10.1007/s10792-024-03042-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/13/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Amblyopia is generally a unilateral disorder, defined by at least a difference of two lines of visual acuity between both eyes with the best-corrected visual acuity, a decrease in contrast sensitivity, and a decrease in stereopsis. Pattern electroretinogram (PERG) is a noninvasive technique that provides a retinal biopotential and is a highly sensitive indicator of changes in the macular area. Our aim was to evaluate if there are differences in the retinal response of an amblyopic eye compared with a normal eye (NE). METHODS We evaluated twenty-four adult volunteers, twelve amblyopes (mean 43.42 ± 12.72 years old), and twelve subjects with NE (mean 35.58 ± 12.85 years old). None of the subjects in the two groups had comorbidities. A complete optometric examination was performed including parameters such as visual acuity (VA) by far and near with ETDRS chart, eye alignment with cover test, and evaluation of retinal cells response with PERG. RESULTS The refractive error found in the NE group of subjects had a mean of - 0.95 ± 1.65D, while the amblyopic group showed a mean of - 2.03 ± 4.29D. The VA in amblyopic eyes had a mean of 0.38 ± 0.20 logMAR. Analyzing PERG data, we observed significant differences in the P50-N95 amplitudes of the amblyopic group compared with the NE group (p < 0.0001-amblyopic eye vs. NE; p = 0.039-fellow eye vs. NE). DISCUSSION These findings suggest that amblyopic patients may also present other impairments beyond the visual cortex. PERGs seem to be an important complementary examination in the diagnosis of other impairments in amblyopia.
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Affiliation(s)
- Andresa Fernandes
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
- Faculty of Health Sciences, Rua Marquês de Ávila E Bolama, CICS-Health Sciences Research Centre, University of Beira Interior, 6201-001, Covilhã, Portugal.
| | - Nuno Pinto
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
- Faculty of Health Sciences, Rua Marquês de Ávila E Bolama, CICS-Health Sciences Research Centre, University of Beira Interior, 6201-001, Covilhã, Portugal
| | - Ana Rita Tuna
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
- Faculty of Health Sciences, Rua Marquês de Ávila E Bolama, CICS-Health Sciences Research Centre, University of Beira Interior, 6201-001, Covilhã, Portugal
| | - Francisco Miguel Brardo
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
- Faculty of Health Sciences, Rua Marquês de Ávila E Bolama, CICS-Health Sciences Research Centre, University of Beira Interior, 6201-001, Covilhã, Portugal
- Department of Physics, University of Beira Interior, Covilhã, Portugal
| | - Maria Vaz Pato
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
- Faculty of Health Sciences, Rua Marquês de Ávila E Bolama, CICS-Health Sciences Research Centre, University of Beira Interior, 6201-001, Covilhã, Portugal
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Guimaraes S, Vieira MJ, Boas JMV. Predicting myopic changes in children wearing glasses using the Plusoptix photoscreener. Int Ophthalmol 2024; 44:84. [PMID: 38363427 PMCID: PMC10873442 DOI: 10.1007/s10792-024-02954-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 12/04/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION With high increase in myopia prevalence, we aimed to assess whether Plusoptix_A09 can be used in myopic children over spectacles to predict visual acuity (VA) and myopic refraction changes. METHODS Myopic children underwent a complete ophthalmological examination. Plusoptix_A09 was performed over spectacles. VA changes, refraction changes and time since previous glasses prescription, were determined. Age, current or past history of amblyopia, presence of strabismus and self-perception of VA changes were registered. RESULTS In total, 199 patients were included. Spherical power (SP) and spherical equivalent (SE) measured by Plusoptix_A09 over spectacles predicted both VA changes (p < 0.001) and refraction changes (p < 0.001). Values of SP < - 0.06D or SE < - 0.22D indicated a VA decrease (AUC > 0.9, p < 0.01) for sensitivity and specificity of 85.1%, 82.1% and 82.6%, 83.3%, respectively. Age and ophthalmological comorbidities did not influence Plusoptix_A09 measurements (p > 0.05). Plusoptix_A09 over spectacles was a stronger predictor of VA changes when compared to children's self-perception, either in 4-9-year-old patients (p < 0.001 versus p = 0.628) and in 10-18-year-old children (OR < = 0.066 versus OR = 0.190). A decrease in SP and SE of - 0.10D in Plusoptix_A09 predicted a myopia progression of - 0.04D and - 0.05D, respectively. CONCLUSION/RELEVANCE This study unveiled new features for the Plusoptix, a worldwide available photoscreener used in amblyopia screening. When Plusoptix is performed in children with their glasses on, it can rapidly predict myopia progression. For each decrease of - 0.10D in Plusoptix, a myopia progression of -0.05D is expected. Moreover, Plusoptix is more reliable than children's self-perception of visual acuity changes, making it a useful tool either in primary care or ophthalmology practice.
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Affiliation(s)
- Sandra Guimaraes
- FP-I3ID (Instituto de Investigação, Inovação e Desenvolvimento da Universidade Fernando Pessoa), Porto, Portugal.
- HE-UFP (Hospital-Escola da Universidade Fernando Pessoa), Av. Fernando Pessoa 150, São Cosme, 4420-096, Portugal.
- FCS-UFP (Faculdade de Ciências da Saúde da da Universidade Fernando Pessoa), Porto, Portugal.
| | - Maria João Vieira
- HE-UFP (Hospital-Escola da Universidade Fernando Pessoa), Av. Fernando Pessoa 150, São Cosme, 4420-096, Portugal
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12
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Sherief ST, Muhe LM, Mekasha A, Demtse A, Ali A. Prevalence and causes of ocular disorders and visual impairment among preterm children in Ethiopia. BMJ Paediatr Open 2024; 8:e002317. [PMID: 38325900 PMCID: PMC10860044 DOI: 10.1136/bmjpo-2023-002317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE The aim of this study was to determine the prevalence, causes of ocular disorders and visual impairment among preterm children previously admitted to neonatal intensive care units in Addis Ababa, Ethiopia. METHODS AND ANALYSIS A prospective screening survey was conducted from February to June 2019 at the paediatric eye clinic of Menelik II Hospital. Children who were preterm at birth and who attended the eye clinic were included in the study. Data on demographic and neonatal characteristics, neonatal and maternal comorbidities and ocular disorders were collected. OR and univariate analysis were used to identify predictors of ocular diseases and visual impairment. RESULTS There were 222 children included in the study with a mean age at presentation of 2.62 years (range 2.08-6.38 years), mean gestational age 34.11 weeks (range 30-36) weeks and mean birth weight 1941.72 g (range 953-3500 g). Nearly two-thirds had ocular disorders with refractive error (51.8%), strabismus (11.3%) and a history of retinopathy of prematurity (ROP) (7.2%) being more common. One-fourth of the children had visual impairment, and the prevalence of amblyopia was 40.1%. Uncorrected refractive errors, strabismus and ROP were causes for visual impairment. CONCLUSION Visual impairment and amblyopia are common in Ethiopia. There is a need to develop a screening protocol for ocular disorders for preterm children to enhance early detection and prevention of childhood visual impairment.
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Affiliation(s)
- Sadik Taju Sherief
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
- Child Health Evaluative Sciences Program and Centre for Global Child Health, SickKids Research Institute, Toronto, Ontario, Canada
| | - Lulu M Muhe
- Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Amha Mekasha
- Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Asrat Demtse
- Paediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asim Ali
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
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13
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Çiçek N, Demirayak B, Yigit FU. Evaluation of the macular sensitivity and retinal ganglion cell layer in unilateral amblyopia. Indian J Ophthalmol 2024; 72:232-235. [PMID: 38273685 PMCID: PMC10941918 DOI: 10.4103/ijo.ijo_3382_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 07/16/2023] [Accepted: 08/04/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE To assess macular sensitivity and fixation pattern obtained by microperimetry and ganglion cell complex (GCC) obtained by optical coherence tomography (OCT) in cases with unilateral amblyopia and to compare with control. METHODS The study was conducted with 30 patients with amblyopia, aged 5-18 years, and 30 control eyes of healthy children in the same age group. Participants underwent full ophthalmological examination. Macular sensitivity, stabilization, and location of fixation values were measured using microperimetry. The GCC values were obtained by OCT. Measurements were compared between amblyopic eyes, fellow eyes, and controls. Any correlation between GCC, macular sensitivity, and fixation was investigated. P < 0.05 was considered statistically significant. RESULTS The mean age was 10.13 ± 3.49 years in the amblyopia group and 11.53 ± 2.7 years in the control group. Three groups were formed: amblyopic eyes (Group 1, n = 30), fellow eyes (Group 2, n = 30), and control eyes (Group 3, n = 30). The macular sensitivity values were found highest in the control group (P = 0.007). Bivariate contour ellipse area 1, which is the numerical value of fixation stabilization, was measured to be the lowest in the control group (P < 0.0001). In the analysis among the three groups, no significant difference was observed in terms of the GCC (P = 0.229). In the correlation analyses, a significant correlation was detected between macular sensitivity and GCC values in amblyopic eyes. CONCLUSION In amblyopic eyes, the macular sensitivity was significantly lower and the GCC thickness was found to be in a positive correlation with macular sensitivity.
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Affiliation(s)
- Nilay Çiçek
- Department of Ophthalmology, Corlu State Hospital, Tekirdağ
| | - Bengi Demirayak
- Department of Ophthalmology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul
| | - Fadime U Yigit
- Department of Ophthalmology, Haliç University, İstanbul, Turkey
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14
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Nada MM, El Gohary AM, Azmy RM, ElSayed YM, Abdelkader B. Assessment of amblyopic children undergoing occlusion therapy by pattern visual evoked potentials and contrast sensitivity tests. Eur J Ophthalmol 2024; 34:281-286. [PMID: 37081780 DOI: 10.1177/11206721231171423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Background: Amblyopia is a case where one or less commonly, both eyes have impaired visual performance, even with the best optical correction and no visible disease of the visual system. Objectives: To assess contrast sensitivity tests (CST) and pattern visual evoked potentials (PVEP) results in amblyopic children who have already started occlusion therapy for durations ranging from 6 to 12 months. Methods: This cross-sectional study was conducted on 200 eyes of 50 patients with monocular amblyopia and 50 age and sex matched controls. Both patients and controls underwent ophthalmological assessment, PVEP, and CST. Results: There was no statistically significant difference in the results of P100 latencies of qualitative PVEP in amblyopic eyes compared to non-amblyopic eyes and control eyes, while the qualitative CST showed a highly statistically significant difference, being affected in 98% of amblyopic eyes compared to unaffected eyes (4%) and control eyes (4%). The maximum contrast level and minimal contrast level of quantitative CST were significantly lower in amblyopic eyes compared to non-amblyopic and control eyes. The cutoff value of maximal contrast level at mean frequencies of 2.5 ± 0.9 Hz, and a range of (1.1-4.1) for amblyopic eyes is ≤21 dB, while the cutoff value of minimal contrast level at mean frequencies of 13.4 ± 2.6 Hz, and a range of (6.7-18) for amblyopic eyes is ≤12 dB. Conclusion: Detection of amblyopia by CST is a noninvasive and easy procedure, which represents a promising tool to support the diagnosis of amblyopia.
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Affiliation(s)
- Mona M Nada
- Clinical neurophysiology unit, neurology department, faculty of medicine, Cairo University, Cairo, Egypt
| | - Amira M El Gohary
- Clinical neurophysiology unit, neurology department, faculty of medicine, Cairo University, Cairo, Egypt
| | - Radwa M Azmy
- Clinical neurophysiology unit, neurology department, faculty of medicine, Cairo University, Cairo, Egypt
| | - Yasmine M ElSayed
- Opthalmology department, faculty of medicine, Cairo University, Cairo, Egypt
| | - Bodour Abdelkader
- Clinical neurophysiology unit, neurology department, faculty of medicine, Cairo University, Cairo, Egypt
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15
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Kashchenko MA, Kashchenko TP, Magaramova MD, Pedanova EK, Golyakhovskiy SE. [The effect of pleoptic treatment on the stability of visual fixation in children and adolescents with amblyopia of various degrees]. Vestn Oftalmol 2024; 140:32-35. [PMID: 38450464 DOI: 10.17116/oftalma202414001132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE This study assesses the effect of pleoptic treatment on the stability of visual fixation in children and adolescents with amblyopia of various degrees. MATERIAL AND METHODS The effect of the treatment in 35 children (35 eyes) with amblyopia of various degrees was evaluated using the MP-1 Microperimeter. The stability was determined by two criteria - number of fixation point hits in the 2° zone and the width of the field of fixation. Children underwent a standard course of treatment. RESULTS There was an improvement in the stability of visual fixation after treatment. The number of fixation point hits in the 2° zone increased from 44.8±4.1% to 52.6±3.8%. At the same time, the width of the field of fixation after treatment decreased from 6.5±0.7° to 5.2±0.5°. Visual acuity with correction in children with amblyopia correlates with the number of fixation point hits in the 2° zone (direct high correlation "+0.7") and width of the field of fixation (inverse high correlation "-0.7") both before and after the treatment. CONCLUSION Stabilization of visual fixation was observed in patients with amblyopia of varying degrees after the pleoptic treatment.
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Affiliation(s)
- M A Kashchenko
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - T P Kashchenko
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - M D Magaramova
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - E K Pedanova
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - S E Golyakhovskiy
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
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16
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Andaluz-Scher LE, Farhat OJ, Ness PJ, Simon JW. Late Recurrence of Anisometropic Amblyopia. J Pediatr Ophthalmol Strabismus 2024; 61:e11-e12. [PMID: 38306235 DOI: 10.3928/01913913-20231214-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
A 15-year-old boy whose anisometropic amblyopia was effectively treated with glasses was examined. Despite years of stability, his visual acuity decreased from 20/20 to 20/60 with poor glasses compliance. Although amblyopia recurrence is well recognized, this case emphasizes potential late recurrence after prolonged success. Fortunately, he improved to 20/20 after improved compliance. [J Pediatr Ophthalmol Strabismus. 2024;61(1):e11-e12.].
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Crossland MD, Dekker TM, Dahlmann-Noor A, Jones PR. Can children measure their own vision? A comparison of three new contrast sensitivity tests. Ophthalmic Physiol Opt 2024; 44:5-16. [PMID: 37728235 DOI: 10.1111/opo.13230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To investigate the feasibility of children measuring their own contrast sensitivity using a range of tablet- and paper-based tests. METHODS Forty children aged 5-15 years with amblyopia (N = 10), bilateral vision impairment (N = 10) or good vision (N = 20) measured their own vision on a screen-based optotype test (Manifold), a gamified vision test (PopCSF) and a paper-based test (Spotchecks) in a laboratory with minimal supervision. Completion rate, test-retest repeatability, test duration and participants' preferences were recorded for each test. RESULTS Most participants (36/40) were able to perform all three tests. All tests were correlated with clinically measured visual acuity and contrast sensitivity (p < 0.001). The 95% coefficient of repeatability was 0.30 dB for Manifold, 0.29 dB for PopCSF and 0.13 dB for Spotchecks. All tests differentiated between children with reduced contrast sensitivity and control participants. PopCSF and Spotchecks were also able to differentiate between children with amblyopia and those with good vision. Median test time was 152, 130 and 202 s for Manifold, PopCSF and Spotchecks, respectively. Twenty-two participants preferred the PopCSF test, 10 preferred Spotchecks and 6 preferred Manifold. Thirty-nine out of the 40 children (98%) said they would measure their own vision at home using at least one of these tests every month. CONCLUSIONS Children and young people can test their own contrast sensitivity with repeatable results. Of these three tests, the most repeatable was Spotchecks, the quickest was PopCSF and participants' favourite was PopCSF. Nearly all of the participants said they would be willing to use at least one of the three tests at home.
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Affiliation(s)
- Michael D Crossland
- NIHR Moorfields Biomedical Research Centre, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Tessa M Dekker
- NIHR Moorfields Biomedical Research Centre, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Annegret Dahlmann-Noor
- NIHR Moorfields Biomedical Research Centre, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Pete R Jones
- UCL Institute of Ophthalmology, London, UK
- Department of Optometry and Visual sciences, City, University of London, London, UK
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Daly MY, Codina CJ, Arblaster GE. Is there value in measuring near visual acuity during occlusion therapy for amblyopia? Strabismus 2023; 31:237-243. [PMID: 37921023 DOI: 10.1080/09273972.2023.2271088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Introduction: The purpose of this study was to investigate near and distance visual acuity (VA) prior to, during and on completion of occlusion therapy for amblyopia. Method: Fifty-four patients aged 4-7 years (mean 4.9; ±0.44) with untreated strabismic, anisometropic or mixed amblyopia were recruited to the study following refractive adaptation where applicable. All patients underwent conventional occlusion (patching). Uniocular near and distance VA was tested using age and ability appropriate Crowded LogMAR VA tests prior to, during and upon conclusion of occlusion therapy. Results: In amblyopic eyes, there was no significant difference between near and distance VA prior to occlusion therapy with LogMAR Crowded (p = .66; mean distance VA at 3 m = 0.6 LogMAR; mean near VA at 40 cm = 0.58 LogMAR), or with LogMAR Crowded Kay Picture test (p = .78, mean distance VA at 3 m = 0.44 LogMAR; mean near VA at 33 cm = 0.46 LogMAR;). No significant difference was found between near and distance VA at any visit during occlusion therapy, or on completion of occlusion therapy with LogMAR Crowded (p = .86, mean final distance VA at 3 m = 0.266 LogMAR; mean final near VA at 40 cm = 0.25 LogMAR) or LogMAR Crowded Kay Pictures (p = .74, mean final distance VA at 3 m = 0.16 LogMAR; mean final near VA at 33 cm = 0.16 LogMAR). There was no significant difference in the VA of the fellow (non-amblyopic) eyes prior to and on completion of occlusion therapy with LogMAR Crowded at distance (3 m) or near (40 cm) (p = .05, p = .40 respectively); or with LogMAR Crowded Kay Pictures at distance (3 m) or near (33 cm) (p = .89, p = .35 respectively). Discussion: Improvement in VA of amblyopic eyes did not significantly differ between near and distance testing proximites at any point during the course of occlusion therapy for amblyopia in our study. These findings may aid clinicians with appropriate test selection and help with clinical time pressures. Where patient concentration does not allow for uniocular distance vision, uniocular near vision may be used to diagnose amblyopia, and vice versa. This could prevent delay in the treatment of amblyopia.
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Liinamaa MJ, Leiviskä IL, Saarela VO. Prevalence of residual amblyopia in adulthood and its association on educational outcome and quality of life in the Northern Finland Birth Cohort. Acta Ophthalmol 2023; 101:747-754. [PMID: 36924319 DOI: 10.1111/aos.15660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/02/2023] [Accepted: 02/26/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE The purpose of the current study was to evaluate the prevalence of residual amblyopia in adults in a population screened and treated in childhood. We also wanted to evaluate the association of amblyopia on school success, level of education, and quality of life. METHODS This is a follow-up study of 2708 subjects of the Northern Finland Birth Cohort. At the age of 46, the subjects took part in ophthalmic examinations, including the measurement of best-corrected visual acuity (BCVA) and refraction. Residual amblyopia was defined as BCVA 20/30 or less (logMAR ≥0.2) in one or both eyes or a two-line interocular visual acuity difference and absence of any pathological ocular factors. The quality of life was assessed with a 15D questionnaire, and educational outcome, school success, and episodic memory with a CANTAB-PAL (paired associates learning) test were evaluated. RESULTS The prevalence of amblyopia in the current adult population aged 46 years was 1.3% (n = 36). At 14 years, the amblyopia subjects had had significant differences in mean spherical equivalent between the amblyopic and fellow eye and strabismus more often than controls. No significant differences were observed in the CANTAB-PAL test or in educational outcome. However, amblyopia subjects had significant difficulties in the 15D questionnaire in terms of vision (54% vs. 34%, p = 0.01). CONCLUSION Due to screening and treatment in childhood, the number of adults with residual amblyopia was low. Despite minor visual impairment and discomfort, they cope very well in life in terms of educational outcome and quality of life.
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Affiliation(s)
- M Johanna Liinamaa
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
- MRC Oulu, University of Oulu, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Ilmari L Leiviskä
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
- MRC Oulu, University of Oulu, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Ville O Saarela
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
- MRC Oulu, University of Oulu, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
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Yahalomi T, Elbaz U. [PETERS ANOMALY AND PETERS PLUS SYNDROME]. Harefuah 2023; 162:616-618. [PMID: 37965860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Peters anomaly is characterized by a defect in the development of the anterior segment of the eye during fetal development (Anterior segment dysgenesis). This anomaly presents a broad clinical presentation ranging from minimal peripheral corneal opacity to extensive adhesions of the iris and lens with dense central corneal opacity that impairs vision. Peters Plus Syndrome is a recessive autosomal syndrome manifested by Peters anomaly, along with systemic disorders such as brachydactyly (short fingers and toes), short stature, a developmental delay, dysmorphic facial features, and may accompanied with heart and genitourinary malformations. The most common sign of Peters' anomaly is corneal opacity that appears at birth. This opacity can cause blockage of the central visual axis and cause the development of a deprivational amblyopia. In addition, the patient may suffer from glaucoma due to malformations in the angle structures as well as a shallow anterior chamber. Treatments are aimed at clearing the central visual axis as soon as possible in order to allow the visual system to mature and to avoid the development of amblyopia. Full-thickness corneal transplantation combined with Cataract surgery if necessary is the current standard of care. Optical iridoplasty is a milder surgical alternative in cases where the corneal opacity is not significant.
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Affiliation(s)
- Tal Yahalomi
- Department of Ophthalmology, Samson Assuta Ashdod Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Uri Elbaz
- Department of Ophthalmology, Rabin Medical Center, Schneider Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Green CP, Lai MJ, Gore RA, Wu CM, Zhang QE, Sharpe JE, Elias RJ, Wasserman BN. Novel Virtual Vision Screening Program: Give Kids Sight Day 2020. J Pediatr Ophthalmol Strabismus 2023; 60:390-395. [PMID: 36803240 DOI: 10.3928/01913913-20230118-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
PURPOSE To determine whether a low-technology novel virtual vision screening protocol can reliably screen pediatric visual acuity. METHODS Give Kids Sight Day (GKSD), an annual out-reach program, aims to provide free vision screening and ophthalmic care to underserved children in Philadelphia, Pennsylvania. Children were screened virtually through the low-technology protocol. Based on screening results, 152 children were provided in-person eye examinations. Data from in-person examinations were compared to data from virtual screenings for 151 children who were seen in-person. RESULTS Of 475 children screened virtually, 152 children were seen in-person for examination, and 151 children were included in the analysis. Results from 151 children (mean age: 10.7 years, age range: 5 to 18 years, 43% female, 28% speaking a non-English language) were reviewed. There was a moderate correlation (R = .64, P < .0001; n = 100 children) between screening and in-person visual acuity without refractive correction and a strong correlation (R = 0.82, P < .0001; n = 18 children) between screening and in-person visual acuity with refractive correction. Of the 140 children who were seen in-person, 133 children were provided glasses prescriptions. Seventeen children required a referral to a pediatric ophthalmologist for evaluation of ophthalmic conditions, most commonly strabismus (5.3%) and amblyopia (4%). CONCLUSIONS The GKSD virtual visual acuity testing demonstrated good correlation with in-person visual acuity testing, supporting the virtual screening approach as a useful tool for future applications in widespread community vision outreach programs. Further studies are needed to refine virtual ophthalmic screening to optimize its applications in bridging the gaps in ophthalmic care. [J Pediatr Ophthalmol Strabismus. 2023;60(6):390-395.].
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Pan Y, Zhang H, Ye X, Li S, Li X, Li Z, Ying X. Study on the relationship between scoliosis and vision problems: A narrative review. Medicine (Baltimore) 2023; 102:e35178. [PMID: 37861544 PMCID: PMC10589577 DOI: 10.1097/md.0000000000035178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/21/2023] [Indexed: 10/21/2023] Open
Abstract
Adolescent scoliosis is one of the most common surgical disorders of the pediatric spine. With timely detection and early treatment, most scoliotic children can avoid major and expensive surgery. Vision problems are also frequently found at an early age and can take a toll on individuals quality of life. However, scoliosis, a severe health hazard to adolescents, is often accompanied by vision problems clinically, including myopia, astigmatism, strabismus, amblyopia, horizontal paralysis, and blindness. And people with genetic defects have a higher probability of suffering both spinal problems and vision problems than those with nongenetic defects. However, many individuals viewed scoliosis and vision problems as 2 irrelevant diseases. This review searched PubMed, China National Knowledge Infrastructure, and Web of Science for studies on adolescent, scoliosis, eye diseases, myopia, strabismus, spinal disorders, and vision problems for almost 3 decades, and thus confirmed the potential relationship between adolescent scoliosis and vision problems.
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Affiliation(s)
- Yingsen Pan
- The 3rd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Haoyang Zhang
- The 3rd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xin Ye
- Tuina Department, The 3rd Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shuailin Li
- Tuina Department, The 3rd Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaoming Li
- Tuina Department, The 3rd Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zengtu Li
- Tuina Department, The 3rd Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaoming Ying
- Tuina Department, The 3rd Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Argilés M, Gispets J, Lupón N, Sunyer-Grau B, Rovira-Gay C, Pérez-Ternero M, Berta-Cabañas M. Impact of strabismus and binocular dysfunctions in the developmental eye movement test and test of visual perception skills: A multicentric and retrospective study. J Optom 2023; 16:277-283. [PMID: 37142504 PMCID: PMC10518761 DOI: 10.1016/j.optom.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/29/2023] [Accepted: 04/16/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To compare the performance in the Developmental Eye Movement test (DEM) and the Test of Visual Perceptual Skills (TVPS) between three groups: individuals with strabismus and amblyopia, patients with binocular and accommodative dysfunctions, and subjects with normal binocular and accommodative function. METHODS A multicentric, retrospective study including 110 children aged 6-14 years old was conducted to investigate the potential impact of strabismus, amblyopia, and different binocular conditions in DEM results (adjusted time in vertical and horizontal parts) and TVPS (percentiles in the seven sub-skills). RESULTS No significant differences were found in the different subtests of the vertical and horizontal DEM and all the sub-skills in the TVPS between the three groups of the study. We found high variability of performance in the DEM test between participants with strabismus and amblyopia compared with binocular and accommodative problems. CONCLUSION DEM and TVPS scores have not been found to be influenced by the presence of strabismus with or without amblyopia, nor by binocular and accommodative dysfunctions. A slightly correlation tendency with horizontal DEM and degree of exotropia deviation was observed.
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Affiliation(s)
- Marc Argilés
- Department of Optics and Optometry, Universitat Politècnica de Catalunya, Terrassa E08222, Spain; Centre for Sensors, Instruments and Systems Development, Universitat Politècnica de Catalunya, Terrassa E08222, Spain.
| | - Joan Gispets
- Department of Optics and Optometry, Universitat Politècnica de Catalunya, Terrassa E08222, Spain
| | - Núria Lupón
- Department of Optics and Optometry, Universitat Politècnica de Catalunya, Terrassa E08222, Spain
| | - Bernat Sunyer-Grau
- Department of Optics and Optometry, Universitat Politècnica de Catalunya, Terrassa E08222, Spain
| | - Cristina Rovira-Gay
- Department of Optics and Optometry, Universitat Politècnica de Catalunya, Terrassa E08222, Spain; Centre for Sensors, Instruments and Systems Development, Universitat Politècnica de Catalunya, Terrassa E08222, Spain
| | - Marta Pérez-Ternero
- Department of Optics and Optometry, Universitat Politècnica de Catalunya, Terrassa E08222, Spain
| | - Marina Berta-Cabañas
- Department of Optics and Optometry, Universitat Politècnica de Catalunya, Terrassa E08222, Spain
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Rajesh AE, Davidson O, Lacy M, Chandramohan A, Lee AY, Lee CS, Tarczy-Hornoch K. Race, Ethnicity, Insurance, and Population Density Associations with Pediatric Strabismus and Strabismic Amblyopia in the IRIS® Registry. Ophthalmology 2023; 130:1090-1098. [PMID: 37331481 PMCID: PMC10527204 DOI: 10.1016/j.ophtha.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
PURPOSE To evaluate the associations of sociodemographic factors with pediatric strabismus diagnosis and outcomes. DESIGN Retrospective cohort study. PARTICIPANTS American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) patients with strabismus diagnosed before the age of 10 years. METHODS Multivariable regression models evaluated the associations of race and ethnicity, insurance, population density, and ophthalmologist ratio with age at strabismus diagnosis, diagnosis of amblyopia, residual amblyopia, and strabismus surgery. Survival analysis evaluated the same predictors of interest with the outcome of time to strabismus surgery. MAIN OUTCOME MEASURES Age at strabismus diagnosis, rate of amblyopia and residual amblyopia, and rate of and time to strabismus surgery. RESULTS The median age at diagnosis was 5 years (interquartile range, 3-7) for 106 723 children with esotropia (ET) and 54 454 children with exotropia (XT). Amblyopia diagnosis was more likely with Medicaid insurance than commercial insurance (odds ratio [OR], 1.05 for ET; 1.25 for XT; P < 0.01), as was residual amblyopia (OR, 1.70 for ET; 1.53 for XT; P < 0.01). For XT, Black children were more likely to develop residual amblyopia than White children (OR, 1.34; P < 0.01). Children with Medicaid were more likely to undergo surgery and did so sooner after diagnosis (hazard ratio [HR], 1.23 for ET; 1.21 for XT; P < 0.01) than those with commercial insurance. Compared with White children, Black, Hispanic, and Asian children were less likely to undergo ET surgery and received surgery later (all HRs < 0.87; P < 0.01), and Hispanic and Asian children were less likely to undergo XT surgery and received surgery later (all HRs < 0.85; P < 0.01). Increasing population density and clinician ratio were associated with lower HR for ET surgery (P < 0.01). CONCLUSIONS Children with strabismus covered by Medicaid insurance had increased odds of amblyopia and underwent strabismus surgery sooner after diagnosis compared with children covered by commercial insurance. After adjusting for insurance status, Black, Hispanic, and Asian children were less likely to receive strabismus surgery with a longer delay between diagnosis and surgery compared with White children. 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)
- Anand E Rajesh
- Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Oliver Davidson
- Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Megan Lacy
- Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Arthika Chandramohan
- Department of Ophthalmology, Southern California Permanente Medical Group, San Diego, California
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington.
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Kavitha V, Gangrade AK, Heralgi MM, Haragoppa S. Ocular abnormalities in children with developmental delay. Indian J Ophthalmol 2023; 71:3328-3334. [PMID: 37787230 PMCID: PMC10683688 DOI: 10.4103/ijo.ijo_3358_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 10/04/2023] Open
Abstract
Purpose To describe the presence of ocular abnormalities in children with developmental delay (DD) and compare with normal children; to analyze associated risk factors, systemic problems, and the possible treatment that can be delivered. Methods This was a cross sectional, observational study. We included children between one and 18 years, diagnosed as developmental delay in DD group, and next immediate age- and sex-matched children without developmental delay on the same day or during the same period in the control group. Detailed history and neuroimaging findings were noted. Uncorrected visual acuity, best-corrected visual acuity for distance and near, cycloplegic refraction, anterior, and posterior segment examination was carried out. Various ocular problems, delayed visual maturation (DVM), and cortical visual impairment (CVI) were diagnosed based on examination. Data were analyzed statistically, and P value <0.05 was considered as statistically significant. Results Ninety-four children were included in each group. Mean age was 4.97 ± 3.84 years, and 64.89% were males. In DD group: Most common abnormal neuroimaging finding was gliotic changes; systemic associations: 39 children; 83 children had ocular problems: refractive error-70, strabismus-39, cataract-five, amblyopia-16; DVM-13; CVI-13 children; glasses and vision stimulation were advised in 39 and 65 children, respectively; whereas, in control group: refractive error-36, strabismus-15, cataract-two; amblyopia-20 children. Conclusion 88.29% of developmental delay children had ocular abnormalities, commonest was refractive error (74.47%); these values were higher than in control group; common risk factors were low birthweight and consanguineous marriage; epilepsy was the most common systemic association.
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Affiliation(s)
- V Kavitha
- Department of Pediatric Ophthalmology, Sankara Eye Hospital, Harakere, Shimoga, Karnataka, India
| | - Aashish K Gangrade
- Department of Pediatric Ophthalmology, Sankara Eye Hospital, Harakere, Shimoga, Karnataka, India
| | - Mallikarjun M Heralgi
- Department of Cornea and Refractive Services, Sankara Eye Hospital, Harakere, Shimoga, Karnataka, India
| | - Sneha Haragoppa
- Department of Pediatric Ophthalmology, Dr. Sneha Eye Care Centre, Belagavi, Karnataka, India
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26
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Dahal M, Dahal HN, Gautam P, Shrestha JB, Khanal S. Pattern visual evoked potential and foveal sensitivity in amblyopia. Doc Ophthalmol 2023; 147:109-119. [PMID: 37639170 DOI: 10.1007/s10633-023-09948-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE Amblyopic eyes show impaired visual functions such as poor visual acuity and reduced foveal sensitivity. The purpose of this study was to determine the association between foveal threshold and visual evoked potentials (VEP) in strabismic and anisometropic amblyopia. METHODS Forty-five subjects (age range: 7-28 years, 43.3% female) including 15 strabismic and 15 anisometropic amblyopes, and 15 age-similar control subjects participated in this study. Each subject had pattern visual evoked potentials and foveal threshold recorded in each eye using RetiScan (Roland Consult, Germany) and Humphrey Visual Field Analyzer II (HFA II; Carl Zeiss Meditec Inc., Dublin, CA), respectively. These outcomes were compared among the amblyopic eyes, their fellow eyes, and the control eyes. RESULTS Compared to the amblyopic eyes (Mean ± SD: 33.4 ± 3.48 dB), the foveal threshold was higher in fellow eyes (37.0 ± 2.04 dB, p = 0.0002) and in control eyes (38.7 ± 0.96 dB, p < 0.0001). Strabismic amblyopes had a lower foveal threshold than anisometropic amblyopes (31.8 ± 3.86 vs. 35.0 ± 2.17 dB, p = 0.005). Relative to the P100 peak time in fellow eyes (1° checks:116.1 ± 9.00 ms; 0.25° checks:118.8 ± 5.67 ms), amblyopic eyes had delayed P100 peak times for both 1° (122.7 ± 11.4 ms, p < 0.0001) and 0.25° (130.4 ± 11.2 ms, p < 0.0001) check sizes. There were also significant differences in P100 peak time between amblyopic and control eyes (1°:122.7 ± 11.4 vs.112.4 ± 5.01 ms, p = 0.15; 0.25°:130.4 ± 11.2 vs.113.9 ± 5.71 ms, p < 0.0001) and between fellow and control eyes (0.25°:118.8 ± 5.67 vs.113.9 ± 5.71 ms, p = 0.009). Amblyopic eyes exhibited lower N75-P100 amplitudes than fellow eyes (1°:12.6 ± 7.96 vs.15.9 ± 8.82 µV, p = 0.01; 0.25°:10.6 ± 6.11 vs. 15.8 ± 10.6 µV, p = 0.001) and control eyes (0.25°: p = 0.0008). Foveal threshold correlated negatively with P100 peak time (1°: r = -0.45, p = 0.002 and 0.25°: r = -0.58, p < 0.0001) and positively with N75-P100 amplitude responses (1°: r = 0.42, p = 0.004 and 0.25°: r = 0.52, p = 0.002). CONCLUSIONS Amblyopic eyes showed reduced pattern VEP amplitudes and delayed peak times with significant associations with the foveal sensitivity. However, the VEP measures overlapped extensively between amblyopic and control eyes with no apparent criterion value for optimal discrimination, suggesting that foveal sensitivity might be a better discriminator of amblyopia than pattern VEP.
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Affiliation(s)
- Manisha Dahal
- B.P. Koirala Lions Centre for Ophthalmic Studies, Department of Ophthalmology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | - Hira Nath Dahal
- B.P. Koirala Lions Centre for Ophthalmic Studies, Department of Ophthalmology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Pragati Gautam
- B.P. Koirala Lions Centre for Ophthalmic Studies, Department of Ophthalmology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Jyoti Baba Shrestha
- B.P. Koirala Lions Centre for Ophthalmic Studies, Department of Ophthalmology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Safal Khanal
- Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, AL, USA
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Mudie LI, Pickett K, Ross K, McCourt E, Enzenauer R. Performance of the Spot Vision Screener in children with Down syndrome and other special needs. J AAPOS 2023; 27:274.e1-274.e7. [PMID: 37717620 DOI: 10.1016/j.jaapos.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/28/2023] [Accepted: 07/06/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Amblyopia is a common cause of monocular vision impairment and disproportionally affects developmentally delayed children. Photoscreeners have been suggested as a method to detect amblyopia risk factors (ARFs) in children with developmental disabilities who may not be amenable to traditional vision screening methods. The Spot Vision Screener is a commonly used photoscreener for detecting ARF and has shown excellent sensitivity and accuracy in the general pediatric population. The purpose of this study was to evaluate its accuracy in children with Down syndrome and other special needs. METHODS Children with various disabilities or delays were recruited from outpatient clinics at the Children's Hospital of Colorado. Participants had their photograph taken with Spot before and after pupil dilation and cycloplegia. Images were compared to results of a comprehensive clinical eye examination. RESULTS A total of 100 children participated in the study. Images could not be obtained in 12 children; 5 children did not attend their clinical examination. The overall sensitivity of Spot was 90%, with a positive predictive value of 80% in undilated subjects. The area under the receiver operator curve (AUROC) was 0.68 (95% CI, 0.57-0.79), which did not differ significantly from the AUROC after dilation/cycloplegia (0.68; 95% CI, 0.54-0.81). CONCLUSIONS The Spot Vision Screener could be used by primary care clinics and vision screening programs with a high sensitivity to determine which patients with Down syndrome and special needs should be referred for clinical examination.
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Affiliation(s)
- Lucy I Mudie
- Department of Ophthalmology, University of Colorado, Aurora, Colorado; Center for Research Outcomes in Children's Surgery, Children's Hospital of Colorado, Aurora, Colorado
| | - Kaci Pickett
- Center for Research Outcomes in Children's Surgery, Children's Hospital of Colorado, Aurora, Colorado
| | - Kaylene Ross
- Center for Research Outcomes in Children's Surgery, Children's Hospital of Colorado, Aurora, Colorado
| | - Emily McCourt
- Department of Ophthalmology, University of Colorado, Aurora, Colorado; Center for Research Outcomes in Children's Surgery, Children's Hospital of Colorado, Aurora, Colorado
| | - Robert Enzenauer
- Department of Ophthalmology, University of Colorado, Aurora, Colorado; Center for Research Outcomes in Children's Surgery, Children's Hospital of Colorado, Aurora, Colorado.
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Blanca CP, Isabel PC, Sergio IM, Candela CL, Honorio BG, Enrique EG. Straatsma Syndrome and cataract: case report and review of the literature. Rom J Ophthalmol 2023; 67:416-418. [PMID: 38239417 PMCID: PMC10793372 DOI: 10.22336/rjo.2023.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 01/22/2024] Open
Abstract
Straatsma Syndrome is known as unilateral myopia, amblyopia, and myelinated retinal nerve fibers (MRNF). The syndrome can be associated with other findings such as nystagmus, strabismus, and optic nerve hypoplasia among others. However, no cases associated with cataract have been reported. The visual prognosis depends on the myelinated retinal nerve fibers extension, the early amblyopia therapy, and the coexistence of other signs. We present the case of a 4-year-old girl with Straatsma Syndrome and cataract in the left eye. Despite the cataract surgical treatment with the refractive error correction and the amblyopia therapy, no visual improvement has been reported. Abbreviations: MRNF = Myelinated retinal nerve fibers, LE = Left eye, PD = Prism dioptres, BCVA = Best-corrected visual acuity, RE = Right eye, HM = Hand movement, CF = Counting fingers.
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Affiliation(s)
- Casado-Pelaez Blanca
- Department of Ophthalmology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pascual-Camps Isabel
- Department of Ophthalmology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Inat-Moreno Sergio
- Department of Ophthalmology, La Fe University and Polytechnic Hospital, Valencia, Spain
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AttaAllah HR, Abdelaziz STA, Mohamed AAM, Ibrahiem MFK. Assessment of macular microvascular changes in children following treatment of anisometropic myopic amblyopia using optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 2023; 261:2689-2699. [PMID: 37052667 PMCID: PMC10432315 DOI: 10.1007/s00417-023-06055-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
PURPOSE To evaluate macular microvascular changes in the form of foveal avascular zone (FAZ) area and vessel density in the superficial, deep capillary plexuses, and choriocapillaris using optical coherence tomography angiography (OCTA) in children with anisometropic myopic amblyopia before and after treatment. METHODS This prospective observational study included 32 patients younger than 12 years old with anisomyopic amblyopia. OCTA was done before patients' treatment with optical correction with or without patching and was repeated after successful amblyopia treatment. Outcomes included superficial, deep, and choriocapillaris vessel density (VD) and superficial and deep FAZ areas. RESULTS The study included 13 males (40.6%) and 19 females (59.4%), and the mean age was 9.52 ± 1.33 years. Fifty-three percent (53%) of patients needed only optical correction, and the remaining 47% needed additional patching therapy. After successful treatment, there was a significant improvement in amblyopic eyes in best-corrected visual acuity (p < 0.001), with higher VD values in superficial capillary plexuses (p < 0.001), deep capillary plexuses (p < 0.001), and foveal choriocapillaris (p = 0.030). In the glasses with patching subgroup, the difference between pre-treatment and post-treatment parameters revealed a significant improvement in vessel density in superficial retinal plexuses (foveal and parafoveal; p values 0.023 and < 0.001, respectively) and deep retinal plexuses (whole image, foveal, and parafoveal; p values 0.003, < 0.001, and 0.002, respectively). While amblyopic eyes treated with glasses alone had a significantly greater difference in choriocapillaris foveal VD (p value = 0.022). CONCLUSION After effective amblyopia treatment, amblyopic eyes exhibited improved best-corrected visual acuity and better macular perfusion along the superficial, deep vascular density, and choriocapillaris foveal VD. CLINICAL TRIAL REGISTRATION CinicalTrials.gov Identifier: NCT05223153.
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Affiliation(s)
- Heba Radi AttaAllah
- Ophthalmology department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Sahar Torky Abdelrazik Abdelaziz
- Ophthalmology department, Faculty of Medicine, Minia University, Minia, Egypt.
- Ophthalmology department, Minia University Hospital, Minia University, Minia, 61111, Egypt.
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Hunter DG. Comment on "The blinq TM Vision Screener in Detection of Amblyopia and Strabismus". Am J Ophthalmol 2023; 253:255. [PMID: 37031904 DOI: 10.1016/j.ajo.2023.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/14/2023] [Indexed: 04/11/2023]
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Sii SSZ, Chean CS, Kuht H, Bunce C, Thomas MG, Rufai SR. Home-based screening tools for amblyopia: a systematic review. Eye (Lond) 2023; 37:2649-2658. [PMID: 36828959 PMCID: PMC9951845 DOI: 10.1038/s41433-023-02412-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/15/2022] [Accepted: 01/18/2023] [Indexed: 02/26/2023] Open
Abstract
Amblyopia is an important public health concern. While home-based screening may present an effective solution, this has not been rigorously assessed in a systematic review. A systematic review was performed using Ovid MEDLINE, PubMed, The Cochrane Library, Embase, Web of Science Core Collection, and Clinicaltrials.gov. All studies reporting the diagnostic accuracy of home-based screening tools for amblyopia among children were included. Studies involving orthoptist or ophthalmologist-led screening and adult subjects were excluded. The main outcome measure was the diagnostic accuracy expressed as sensitivity and specificity. Among 3670 studies identified, 28 were eligible for inclusion in our systematic review. The age range of patients were less than 1 month to 16 years old. 7 studies used internet-based tools, 16 used smartphone/tablet applications, 3 used digital cameras, and 3 used home-based questionnaires and visual acuity tools. All studies included a reference standard except one, which was a longitudinal study. 21 studies had full ophthalmological examination whilst 6 studies had validated visual acuity measurement tools as gold standards. Of the 27 studies which compared against a reference test, only 25 studies reported sensitivity and specificity values. Using the QUADAS-2 tool, 50% of studies were deemed to have applicability concern due to patient selection from tertiary centres and unclear methods for recruitment. There is a need to improve the quality of diagnostic accuracy studies, standardise thresholds for detecting amblyopia, and ensure consistent reporting of results. Further research is needed to evaluate the suitability of these tools for amblyopia screening.
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Affiliation(s)
| | - Chung Shen Chean
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Helen Kuht
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Catey Bunce
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Mervyn G Thomas
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK.
| | - Sohaib R Rufai
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK.
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK.
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Peterseim MM. Reply to Comment on "The Rebion blinq™ Vision Screener in Detection of Amblyopia and Strabismus". Am J Ophthalmol 2023; 253:256. [PMID: 37031906 DOI: 10.1016/j.ajo.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/11/2023]
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Horwood A, Heijnsdijk E, Kik J, Sloot F, Carlton J, Griffiths HJ, Simonsz HJ. A population-level post-screening treatment cost framework to help inform vision screening choices for children under the age of seven. Strabismus 2023; 31:220-235. [PMID: 37870065 DOI: 10.1080/09273972.2023.2268128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
PURPOSE/BACKGROUND Visual acuity (VA) screening in children primarily detects low VA and amblyopia between 3 and 6 years of age. Photoscreening is a low-cost, lower-expertise alternative which can be carried out on younger children and looks instead for refractive amblyopia risk factors so that early glasses may prevent or mitigate the conditions. The long-term benefits and costs of providing many children with glasses in an attempt to avoid development of amblyopia for some of them needs clarification. This paper presents a framework for modeling potential post-referral costs of different screening models once referred children reach specialist services. METHODS The EUSCREEN Screening Cost-Effectiveness Model was used together with published literature to estimate referral rates and case mix of referrals from different screening modalities (photoscreening and VA screening at 2, 3-4 years and 4-5 years). UK 2019-20 published National Health Service (NHS) costings were used across all scenarios to model the comparative post-referral costs to the point of discharge from specialist services. Potential costs were compared between a) orthoptist, b) state funded ophthalmologist and c) private ophthalmologist care. RESULTS Earlier VA screening and photoscreening yield higher numbers of referrals because of lower sensitivity and specificity for disease, and a different case mix, compared to later VA screening. Photoscreening referrals are a mixture of reduced VA caused by amblyopia and refractive error, and children with amblyopia risk factors, most of which are treated with glasses. Costs relate mainly to the secondary care providers and the number of visits per child. Treatment by an ophthalmologist of a referral at 2 years of age can be more than x10 more expensive than an orthoptist service receiving referrals at 5 years, but outcomes can still be good from referrals aged 5. CONCLUSIONS All children should be screened for amblyopia and low vision before the age of 6. Very early detection of amblyopia refractive risk factors may prevent or mitigate amblyopia for some affected children, but population-level outcomes from a single high-quality VA screening at 4-5 years can also be very good. Total patient-journey costs incurred by earlier detection and treatment are much higher than if screening is carried out later because younger children need more professional input before discharge, so early screening is less cost-effective in the long term. Population coverage, local healthcare models, local case-mix, public health awareness, training, data monitoring and audit are critical factors to consider when planning, evaluating, or changing any screening programme.
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Affiliation(s)
- Anna Horwood
- Department of Psychology, University of Reading, Reading, UK
| | - Eveline Heijnsdijk
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jan Kik
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Frea Sloot
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jill Carlton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Huibert J Simonsz
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Monahan SR, Smith SM, Gammeltoft ET, Trivedi RH, Wilson ME, Bowsher JD, Peterseim MMW. The blinq™ Vision Screener in Detection of Amblyopia and Strabismus. Am J Ophthalmol 2023; 250:20-24. [PMID: 36682517 DOI: 10.1016/j.ajo.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE The blinq (Rebion Inc) is a new screening device designed to directly detect amblyopia and strabismus rather than amblyopia risk factors. We performed an independent assessment of the effectiveness of the blinq in detecting amblyopia and strabismus. DESIGN Prospective clinical validity analysis of a screening device based on sensitivity and specificity. METHODS Children presenting for examination in the pediatric ophthalmology clinic underwent screening with the blinq before examination by a pediatric ophthalmologist blinded to the screening results. Results of the blinq and examination findings of strabismus or amblyopia were compared. RESULTS In our cohort of 267 children with an average age of 6.3 years, the sensitivity of the blinq to detect amblyopia or any constant strabismus was 87.5% (78.2%-93.8%) and specificity was 51.3% (43.9%-58.7%). Using the previously described "appropriate referral gold standard" criteria, including children with intermittent strabismus and high refractive error, the sensitivity increased to 91.3% and the specificity to 63.2%. We found a high number of children (44 [16%]) upon whom the blinq timed out and were included as automatic referrals. CONCLUSIONS Our results support use of the blinq as a screening device to detect amblyopia and strabismus in children.
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Affiliation(s)
- Savannah Reaves Monahan
- From the Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - Samantha M Smith
- From the Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | | | - Rupal H Trivedi
- From the Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - M Edward Wilson
- From the Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - James D Bowsher
- From the Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
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Feng K, Yu X, Zhang J, Yang Z, Chen X, Kang G. Evaluation of Retinal Microvascular Features in Patients with Amblyopia Based on Optical Coherence Tomography Angiography: A Systematic Review and Meta-Analysis. Ophthalmic Res 2023; 66:862-877. [PMID: 36917963 DOI: 10.1159/000529857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/10/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND The performance of optical coherence tomography angiography (OCTA) in macular microvasculature of patients with amblyopia has been widely studied, but these studies have yielded different and controversial results. OBJECTIVES The aim of this study is to investigate retinal microvascular features in patients with amblyopia undergoing OCTA. METHODS PubMed, Embase, and Web of Science were searched for published articles comparing the retinal microvascular features between individuals with amblyopia and controls until April 2022. The mean difference with a 95% confidence interval was used to assess continuous variables. RESULTS The analysis included 17 studies. The whole vessel density of the superficial capillary plexus (SCPVD) was lower in amblyopic eyes (AE) than in normal eyes (NE) in 3 × 3 mm2 scans, while the perifoveal vessel density of superficial and deep capillary plexus was lower in 6 × 6 mm2 scans. The whole, parafoveal vessel density of deep capillary plexus (DCPVD) and parafoveal SCPVD were lower in both scans. The comparison between AE and fellow eyes (FE) revealed no statistical difference in all quadrants except the parafoveal and perifoveal SCPVD and the foveal DCPVD. Additionally, SCPVD in all quadrants except the fovea and DCPVD in all quadrants except the parafoveal were higher in FE compared to NE. No significant difference was found in the foveal avascular area between AE and NE, AE and FE, or NE and FE. CONCLUSIONS The retinal vessel density of superficial and deep capillary plexus in AE and FE was lower than in NE, and differences were more likely discovered using 6 × 6 mm2 scans. Consequently, OCTA might be explored as a diagnostic tool to identify and monitor patients with amblyopia.
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Affiliation(s)
- Kangchun Feng
- Department of Ophthalmology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xuelin Yu
- Department of Ophthalmology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jingyue Zhang
- Department of Ophthalmology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zhenghua Yang
- Department of Ophthalmology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xing Chen
- Department of Ophthalmology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Gangjing Kang
- Department of Ophthalmology, Affiliated Hospital of Southwest Medical University, Luzhou, China
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Rao T, Zou W, Hu X, He H, Luo W, You Z. Evaluation of retinal microcirculation alterations using optical coherence tomography angiography in patients with hyperopia ametropic amblyopia: A case-control study. Medicine (Baltimore) 2023; 102:e33196. [PMID: 36897692 PMCID: PMC9997812 DOI: 10.1097/md.0000000000033196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/14/2023] [Indexed: 03/11/2023] Open
Abstract
Given that there are controversial findings regarding vessel density in amblyopia, we quantified retinal microcirculation using optical coherence tomography angiography and compared it between hyperopic ametropic amblyopia eyes and age-matched control eyes. This case-control study was conducted from March 2021 to March 2022 at the Affiliated Eye Hospital of Nanchang University, Nanchang, China. Both groups included 72 eyes. Foveal avascular zone area, circularity and perimeter, perfusion density and vessel density of macular superficial retinal capillary plexus, macular thickness, macular volume, peripapillary retinal nerve fiber layer thickness, and ganglion cell-inner plexiform layer thickness were compared between hyperopia ametropic amblyopia eyes and age-matched control eyes. Additionally, best-corrected visual acuity, maximum corneal curvature, minimum corneal curvature, and anterior chamber depth were measured. In the hyperopia ametropic amblyopia eyes and control eyes, vessel density was 7.51 ± 2.13 and 9.91 ± 2.71 mm-1 in the central, 17.20 ± 1.38 and 18.25 ± 1.37 mm-1 in the inner, and 17.90 ± 0.88 and 18.43 ± 0.97 mm-1 in the full regions, respectively. The perfusion densities were 0.17 ± 0.06 and 0.23 ± 0.07 in the central, 0.41 ± 0.05 and 0.44 ± 0.03 in the inner, and 0.44 ± 0.03 and 0.46 ± 0.02 in the full regions, respectively. The central macular thicknesses of hyperopia ametropic amblyopia and control eyes were 240.04 ± 20.11 and 235.08 ± 24.41 µm, respectively. Foveal avascular zone perimeter and circularity (P < .043 and P = .001) significantly differed between the 2 groups. Hyperopia ametropic amblyopia eyes showed lower appreciably in vessel and perfusion densities, which could be one of the major pathophysiological mechanisms of hyperopia ametropic amblyopia and provide a new direction for the diagnosis and treatment of amblyopia.
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Affiliation(s)
- Ting Rao
- Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Wen Zou
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, China
| | - Xiaoqin Hu
- Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Hai He
- Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Wei Luo
- Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Zhipeng You
- Affiliated Eye Hospital of Nanchang University, Nanchang, China
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Peterseim MMW, Trivedi RH, Monahan SR, Smith SM, Bowsher JD, Alex A, Wilson ME, Wolf BJ. Effectiveness of the Spot Vision Screener using updated 2021 AAPOS guidelines. J AAPOS 2023; 27:24.e1-24.e7. [PMID: 36642243 PMCID: PMC10251219 DOI: 10.1016/j.jaapos.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To evaluate the Spot Vision Screener according to updated 2021 AAPOS Vision Screening Committee guidelines for instrument-based pediatric vision screen validation. METHODS As part of an IRB-approved ongoing prospective study, children were screened with the Spot prior to a complete examination. RESULTS Spot screening was successful in 1,036 of 1,090 children (95%). Forty-eight percent of participants were referred for further screening using the Spot manufacturer guidelines, and 40% of all children were found to have a 2021 amblyopia risk factor or visually significant refractive error by gold standard examination. The Spot recommendation compared reasonably well to the 2021 criteria, with an overall sensitivity of 0.88 and a specificity of 0.78. Applying updated guidelines to the Spot for hyperopia, anisometropia, and astigmatism yielded moderate-to-poor sensitivity (0.27-0.77) but excellent specificity (>0.9). The area under the curve of the receiver operating characteristic analysis demonstrates overall good prediction performance for the Spot for each diagnosis-myopia, hyperopia, astigmatism, anisometropia (range, 0.87-0.97). Results of our study suggest increasing the instrument referral criterion for astigmatism from 1.5 D (manufacturer thresholds of the screener used in this study) to 2 D in older children. Decreasing the anisometropia cut-off from 1 D to 0.75 D would improve sensitivity from 0.59 to >0.8. CONCLUSIONS In our study population, the overall predictive ability of the Spot is good, with a sensitivity of 0.88 and a specificity of 0.78. We recommend specific device refractive referral criteria to maximize screening effectiveness using the updated AAPOS guidelines.
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Affiliation(s)
| | - Rupal H Trivedi
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Samantha M Smith
- Medical University of South Carolina, Charleston, South Carolina
| | - James D Bowsher
- Medical University of South Carolina, Charleston, South Carolina
| | - Anastasia Alex
- Medical University of South Carolina, Charleston, South Carolina
| | - M Edward Wilson
- Medical University of South Carolina, Charleston, South Carolina
| | - Bethany J Wolf
- Medical University of South Carolina, Charleston, South Carolina
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Asare AO, Maurer D, Wong AMF, Saunders N, Ungar WJ. Cost-effectiveness of Universal School- and Community-Based Vision Testing Strategies to Detect Amblyopia in Children in Ontario, Canada. JAMA Netw Open 2023; 6:e2249384. [PMID: 36598785 PMCID: PMC9857467 DOI: 10.1001/jamanetworkopen.2022.49384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Screening for amblyopia in primary care visits is recommended for young children, yet screening rates are poor. Although the prevalence of amblyopia is low (3%-5%) among young children, universal screening in schools and mandatory optometric examinations may improve vision care, but the cost-effectiveness of these vision testing strategies compared with the standard in primary care is unknown. OBJECTIVE To evaluate the relative cost-effectiveness of universal school screening and mandated optometric examinations compared with standard care vision screening in primary care visits in Toronto, Canada, with the aim of detecting and facilitating treatment of amblyopia and amblyopia risk factors from the Ontario government's perspective. DESIGN, SETTING, AND PARTICIPANTS An economic evaluation was conducted from July 2019 to May 2021 using a Markov model to compare 15-year costs and quality-adjusted life-years (QALYs) between school screening and optometric examination compared with primary care screening in Toronto, Canada. Parameters were derived from published literature, the Ontario Schedule of Benefits and Fees, and the Kindergarten Vision Testing Program. A hypothetical cohort of 25 000 children aged 3 to 5 years was simulated. It was assumed that children in the cohort had irreversible vision impairment if not diagnosed by an optometrist. In addition, incremental costs and outcomes of 0 were adjusted to favor the reference strategy. Vision testing programs were designed to detect amblyopia and amblyopia risk factors. MAIN OUTCOMES AND MEASURES For each strategy, the mean costs per child included the costs of screening, optometric examinations, and treatment. The mean health benefits (QALYs) gained were informed by the presence of vision impairment and the benefits of treatment. Incremental cost-effectiveness ratios were calculated for each alternative strategy relative to the standard primary care screening strategy as the additional cost required to achieve an additional QALY at a willingness-to-pay threshold of $50 000 Canadian dollars (CAD) ($37 690) per QALY gained. RESULTS School screening relative to primary care screening yielded cost savings of CAD $84.09 (95% CI, CAD $82.22-$85.95) (US $63.38 [95% CI, US $61.97-$64.78]) per child and an incremental gain of 0.0004 (95% CI, -0.0047 to 0.0055) QALYs per child. Optometric examinations relative to primary care screening yielded cost savings of CAD $74.47 (95% CI, CAD $72.90-$76.03) (US $56.13 [95% CI, $54.95-$57.30]) per child and an incremental gain of 0.0508 (95% CI, 0.0455-0.0561) QALYs per child. At a willingness-to-pay threshold of CAD $50 000 (US $37 690) per QALY gained, school screening and optometric examinations were cost-effective relative to primary care screening in only 20% and 29% of iterations, respectively. CONCLUSIONS AND RELEVANCE In this study, because amblyopia prevalence is low among young children and most children in the hypothetical cohort had healthy vision, universal school screening and optometric examinations were not cost-effective relative to primary care screening for detecting amblyopia in young children in Toronto, Canada. The mean added health benefits of school screening and optometric examinations compared with primary care screening did not warrant the resources used.
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Affiliation(s)
- Afua Oteng Asare
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Program of Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- John Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City
| | - Daphne Maurer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Agnes M. F. Wong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Program of Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Saunders
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Wendy J. Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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Comberiati AM, Graziani M, Malvasi M, Trovato Battagliola E, Compagno S, Malvasi VM, Migliorini R, Salducci M. Effectiveness of diagnosis and early treatment of ocular motility alterations in premature infants. Clin Ter 2023; 174:48-52. [PMID: 36655644 DOI: 10.7417/ct.2023.5008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Objective Prematurity often results in important developmental sequelae of brain structures, particularly those involved in processing visual information, such as the optic nerve, primary visual cortex and visuomotor integration areas. The aim of this study is to analyse the functionality of the sensory and motor pathways of the visual system by means of an orthoptic-ophthalmological assessment. Materials and methods In this retrospective study, 151 records were examined, covering a period from 2000 to 2020, of preterm patients with gestational age < 32 weeks and birth weight ≤ 1,500 g up to an average age of about 8 years, referred to the Centre for Paediatric Ophthalmology and Strabology of the Ophthalmology Clinic of the Policlinico Umberto I, La Sapienza University of Rome, who underwent a complete ophthalmological and orthoptic assessment including the following tests measurement of ocular deviations according to the Hirschberg method, Lang I-II test, Titmus Stereotest, objective convergence assessment and ocular motility examination. Results From the charts reviewed, 24.5% (37/151) of patients had Retinopathy of the Premature (ROP); while 38% of the whole sample (57/151) had strabismic amblyopia, of the latter only 31.5% (18/57) had ROP. In 8% of patients (12/151) the stereoscopic sense was absent, in 45% (8/151) stereopsis was gross (> 60 seconds of arc). In addition, 20.52 % (31/151) had a manifest eye deviation. 7.28% (11/151) had hypermetropia in the right eye (RE); 7.95% (12/151) hypermetropia in the left eye (OS); 3.31% of the patients (5/151) had myopia in the RE; 2% (3/151), myopia in the left eye (LE). In addition, the study of ocular motility revealed varying degrees of alteration poorly correlated with prematurity status. Conclusion It was found that amblyopia, stereopsis and objective convergence are more affected by ROP than strabismus, refractive defects and ocular motility, indicating that premature children are particularly susceptible to ophthalmological and orthoptical alterations.
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Affiliation(s)
- A M Comberiati
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | - M Graziani
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | - M Malvasi
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | | | - S Compagno
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | - V M Malvasi
- Department of Odontostomatological and Maxillo-Facial Sciences, University Sapienza of Rome
| | - R Migliorini
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | - M Salducci
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
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Kane SA, Gaspich M, Kane J, Weitzman SA, Hofeldt A. Automated vision screening of children using a mobile graphic device. Eye (Lond) 2023; 37:30-33. [PMID: 34873296 PMCID: PMC9829910 DOI: 10.1038/s41433-021-01862-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/01/2021] [Accepted: 11/12/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND/OBJECTIVE Can measuring interocular brightness disparity, acuity, and colour vision classify children with amblyopia? SUBJECTS/METHODS Two hundred eight subjects (3-14 years) were recruited for a prospective, observational protocol to measure interocular brightness disparity, uniocular acuities with and without a pinhole, and colour vision using an iPad. Subjects looked through polarizing filters and chose the brighter of two spaceships to measure interocular brightness disparity. The differential brightness of image pairs was varied through a staircase algorithm until equal brightness was perceived. Acuities and colour vision were tested with tumbling Es and AO-HRR colour plates, respectively. Unilateral amblyopia was later confirmed in two subjects. RESULTS Binocular brightness balance on the iPad detected amblyopes with 100% sensitivity and specificity. Using 20/30 as cutoff for normal acuity, 1 of the amblyopes was detected, and non-amblyopes were excluded by visual acuity pinhole testing. The mean difference between iPad and E-Chart visual acuities with pinhole was 0.02 logMAR with limits of agreement from -0.08 to +0.11 logMAR. iPad and printed plates Colour vision testing produced identical results. Testing times were brief and exit pleasure responses were positive. Mean and range testing times for Brightness Sense, Colour vision, and Visual Acuity were 32.7 s (range = 12-63 s), 52.8 min (range = 17-95 s), and 88.75 s (range = 41-188 s), respectively. CONCLUSIONS Interocular brightness disparity, acuity, and colour vision can be measured in children as young as 3 years old solely through playing a game on a mobile device. Interocular brightness disparity is a sensitive and specific method to detect unilateral amblyopia.
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Affiliation(s)
- Steven A Kane
- Vagelos College of Physicians and Surgeons, Columbia University, The Edward S. Harkness Eye Institute, 635 West 165th Street, Room 372, New York, USA.
| | | | | | - Sarah A Weitzman
- New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Albert Hofeldt
- New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
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Rosenblatt A, Stolovitch C, Gomel N, Bachar Zipori A, Mezad-Koursh D. A novel device for assessment of amblyopic risk factors in preverbal and verbal children-a pilot study. Eye (Lond) 2022; 36:2312-2317. [PMID: 34853432 PMCID: PMC9674697 DOI: 10.1038/s41433-021-01860-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 10/15/2021] [Accepted: 11/12/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES This paper evaluates the accuracy of the Eye-N-JOY (ENJ), a novel device (Patent no. US 9844317 B2), for identifying the presence of amblyopic risk factors. This device was developed to assess both visual acuity, ocular alignment, and eye movement; all while watching images on a tablet screen. METHODS A prospective, single-center, comparison study. Participants were examined by the ENJ first and then underwent a comprehensive full eye examination by pediatric ophthalmologists including cycloplegic refraction. Both the technician operating the ENJ and the physicians were masked to each other's findings. Children aged 18-72 months (1.5 to 6 years) attending a tertiary medical center for a full standard pediatric ophthalmology examination were included. The visual acuity and alignment were compared between the ENJ and the gold standard full ophthalmologic examination. The differences were noted, and the sensitivity and specificity were calculated. RESULTS A total of 51 children were enrolled, 33 (64.7%) girls, aged 18-72 months. All children successfully completed the examination by the ENJ. No significant difference between the ENJ and the reference examination was detected in visual acuity measurements in both eyes (Pv = 0.553 for the right eye and 0.803 for the left). Overall agreement between all referral indications between the ENJ and reference examination was 84.3%, with 90.9% agreement in VA referral criteria and 90.1% in alignment referral criteria. CONCLUSIONS Eye-N-Joy can reliably examine both visual acuity and ocular misalignment in verbal and pre-verbal children.
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Affiliation(s)
- Amir Rosenblatt
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chaim Stolovitch
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Gomel
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Bachar Zipori
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Mezad-Koursh
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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McVeigh EM, Ludden SM, Mohamed S, Shah N, Mulholland PJ, Dahlmann-Noor A. Preliminary clinical validation of a new picture-based visual acuity test in children with amblyopia: a comparison of The Auckland Optotypes and crowded logMAR letters. Eye (Lond) 2022; 36:2341-2345. [PMID: 34987195 PMCID: PMC9674699 DOI: 10.1038/s41433-021-01840-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/AIMS Amblyopia is the most common visual deficit in children and accurate visual acuity (VA) assessment is essential for diagnosis. While ETDRS high-contrast logMAR VA is the reference standard test for adults, less agreement exists for pre-literate children. A new picture optotype acuity test (The Auckland Optotypes [TAO]) has shown favourable comparison to letter acuity charts but has not yet been evaluated in children with amblyopia. This study aimed to compare VA obtained using TAO to crowded logMAR letters in children age 5-8 years with amblyopia. METHODS Children with amblyopia (n = 54 [20.37% strabismic, 18.52% anisometropic, 61.11% mixed], mean age 78.30 ± 11.72 months) were recruited from paediatric ophthalmology/orthoptic clinics at Moorfields Eye Hospital NHS Foundation Trust, London, and Cambridge Community Services NHS Trust, Bedford. Best-corrected VA was measured in both the amblyopic eye (AE) and fellow eye (FE) using TAO and a crowded letter acuity chart. Bland-Altman analysis was used to measure 95% limits of agreement (LoA) for VA measures captured (AE, FE and interocular difference [IOD]). RESULTS Good agreement between TAO and letter VA measurement was observed (mean bias: AE -0.01, FE 0.01, IOD -0.02). For AE measures 95% LoA were from -0.25 to 0.24 logMAR, this being similar for FE (-0.24 to 0.25) and IOD measures (-0.30 to 0.27). CONCLUSION TAO and letters elicited similar VA in children with amblyopia. TAO could be a useful picture-based chart for paediatric vision assessment.
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Affiliation(s)
- Emma M McVeigh
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Optometry Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Siobhán M Ludden
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Orthoptic Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- HSE Grangegorman Eye Clinic, Dublin, Ireland
| | - Sahra Mohamed
- Community Eye Service, Cambridge Community Services, Bedford, UK
| | - Nilpa Shah
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Optometry Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Pádraig J Mulholland
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Optometry Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Annegret Dahlmann-Noor
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
- Community Eye Service, Cambridge Community Services, Bedford, UK.
- Paediatric Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
- Moorfields at Bedford Hospital, Kempston Road, Bedford, UK.
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Schott B, Seery C, Wagner RS, Guo S. Cycloplegic Autorefraction as a Substitute for Cycloplegic Retinoscopy in the Pediatric Population. J Pediatr Ophthalmol Strabismus 2022; 59:422-427. [PMID: 35446196 DOI: 10.3928/01913913-20220321-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate whether cycloplegic autorefraction can provide similar results as cycloplegic retinoscopy, allowing more comprehensive ophthalmologists to be comfortable in managing pediatric refractive error and refractive amblyopia. METHODS This retrospective chart review was performed to determine the mean difference in sphere, cylinder, and axis between cycloplegic autorefraction and retinoscopy, both of which were obtained on the same eye at least 30 minutes after cycloplegia and dilation with a mixed solution of tropicamide, cyclopentolate, and phenylephrine. RESULTS A total of 34 eyes (18 right, 16 left) from 18 patients were included in the analysis. Mean sphere difference between cycloplegic autorefraction and retinoscopy was 0.044 ± 0.278 diopters (D) (95% CI: -1.275 to 1.363 D), mean cylinder difference was -0.081 ± 0.236 D (95% CI: -0.706 to 0.544 D), and mean axis difference was 7.059 ± 19.676 degrees (95% CI: -32.527 to 38.878 degrees). Mean differences in sphere, cylinder, and axis were not statistically significant (P = .362, .0541, and .377, respectively). CONCLUSIONS In this small sample population, cycloplegic autorefraction was comparable to cycloplegic retinoscopy. Recognition of amblyopia should still prompt evaluation by a pediatric ophthalmologist. Further research is necessary to confirm whether uncomplicated refractive error in children may be sufficiently detected and managed by a comprehensive ophthalmologist. [J Pediatr Ophthalmol Strabismus. 2022:59(6):422-427.].
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Wang G, Liu L. Amblyopia: progress and promise of functional magnetic resonance imaging. Graefes Arch Clin Exp Ophthalmol 2022; 261:1229-1246. [PMID: 36282454 DOI: 10.1007/s00417-022-05826-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 08/14/2022] [Accepted: 09/02/2022] [Indexed: 11/28/2022] Open
Abstract
Amblyopia is a neurodevelopmental disorder characterized by functional deficits in the visual cortex. Functional magnetic resonance imaging (fMRI) is the most commonly used neuroimaging technique for investigating amblyopia. Herein, we systematically searched a PubMed database from inception to December 2021 to highlight the current progress and promises about fMRI technology in amblyopia; amblyopia's neural mechanism, the comparison of different types of amblyopia, and the evaluation of the therapeutic effect were explored. Relevant articles published in English and appropriate cross-references were considered for inclusion, including basic studies, imaging techniques, clinical diagnostic and therapeutic studies, case series, and reviews.
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Affiliation(s)
- Guiqu Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Longqian Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Birch EE, Jost RM, Hudgins LA, Morale SE, Donohoe M, Kelly KR. Dichoptic and Monocular Visual Acuity in Amblyopia. Am J Ophthalmol 2022; 242:209-214. [PMID: 35738394 PMCID: PMC9847578 DOI: 10.1016/j.ajo.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Standard-of-care assessment for children with amblyopia includes measuring amblyopic eye best-corrected visual acuity (AE BCVA) with the fellow eye occluded. By definition, this abolishes the interocular suppression fundamental to amblyopia. Thus, measured AE BCVA may not accurately represent that eye's contribution to natural binocular viewing. We compared dichoptic and monocular AE BCVA and examined whether any differences were associated with eye-hand coordination or reading speed. DESIGN Cross-sectional study. METHODS Dichoptic and monocular AE BCVA of children aged 6-12 years (42 with amblyopia, 24 with recovered normal AE BCVA, 30 control) were measured. Stereoacuity, suppression, eye-hand coordination, and reading speed were also assessed. RESULTS Overall, 81% of amblyopic children had worse dichoptic than monocular AE BCVA (mean difference=0.15±0.11 logMAR; P < .0001), and 71% of children with recovered normal AE BCVA had worse dichoptic than monocular AE BCVA (mean difference = 0.20±0.17 logMAR, P < .0001). Controls had no significant difference. The difference between dichoptic and monocular AE BCVA was correlated with performance in standardized aiming/catching (r = -0.48, 95% CI -0.72, -0.14) and manual dexterity tasks (r = -0.37, 95% CI -0.62, -0.06), and with reading speed (r = -0.38, 95% CI -0.65, -0.03). CONCLUSIONS Dichoptic AE BCVA deficits were worse than monocular AE BCVA deficits and were associated with reduced stereoacuity and suppression, consistent with the hypothesis that binocular dysfunction plays a role. Further, impaired eye-hand coordination and slow reading were associated with dichoptic, but not monocular, AE BCVA. Some children with amblyopia may benefit from extra time for school tasks requiring eye-hand coordination or reading.
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Affiliation(s)
- Eileen E Birch
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.).
| | - Reed M Jost
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.)
| | - Lindsey A Hudgins
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.)
| | - Sarah E Morale
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.)
| | - Matthew Donohoe
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.)
| | - Krista R Kelly
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.)
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Abstract
PURPOSE To examine the choroidal structure in children with anisometropic amblyopia using the binarization method. METHODS Thirty children with unilateral anisometropic amblyopia and 30 healthy age- and sex-matched controls were included in the study. Choroidal thickness was measured with optical coherence tomography. The choroidal layer was examined with the binarization method using ImageJ software (National Institutes of Health). The total choroidal area, stromal area, luminal area, luminal area to stromal area ratio, and choroidal vascular index were calculated. The values were compared by correlating the spherical equivalent (SE) (determined by an autorefractometer) with anterior chamber depth, axial length, central corneal thickness (measured by optical biometry), and choroidal thickness values. RESULTS Mean SE values were 3.75 ± 2.16 diopters (D) in the amblyopic eyes, 2.39 ± 2.09 D in the fellow eyes, and -0.27 ± 0.53 D in the control eyes. Best corrected visual acuity (BCVA) was 0.29 ± 0.11 logarithm of the minimum angle of resolution (logMAR) in the amblyopic eyes, 0.02 ± 0.04 logMAR in the fellow eyes, and 0 ± 0 logMAR in the control eyes. Choroidal thickness values were 351 ± 47 µm in the amblyopic eyes, 333 ± 55 µm in the fellow eyes, and 324 ± 51 µm in the control eyes. Luminal area to stromal area ratio values were 1.73 ± 0.13 in the amblyopic eyes, 1.76 ± 0.15 in the fellow eyes, and 2.02 ± 0.25 in the control eyes. Choroidal vascular index values were 63% ± 0.02 in the amblyopic eyes, 64% ± 0.02 in the fellow eyes, and 66% ± 0.03 in the control eyes. BCVA, SE, choroidal thickness, luminal area to stromal area ratio, and choroidal vascular index were significantly different in each group. The total choroidal area, luminal area, and stromal area were similar in all eyes. No correlation was found between choroidal vascular index and choroidal thickness, anterior chamber depth, axial length, and central corneal thickness. CONCLUSIONS In children with anisometropic amblyopia, the total choroidal area was relatively larger in both the amblyopic and the fellow eyes compared to the control eyes. Due to the higher stromal area and lower luminal area, both the amblyopic and the fellow eyes also had lower choroidal vascular index values than control eyes. [J Pediatr Ophthalmol Strabismus. 2022;59(5):320-325.].
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Yang CC, Ji KB, Yu YF. Analysis of Retinal Microvasculature Features in Amblyopic Eyes: A Meta-Analysis. Ophthalmic Res 2022; 66:131-143. [PMID: 35998587 DOI: 10.1159/000526531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/10/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Amblyopia is a common cause of visual disorder with several changes in retinal structure and vessel. To date, alterations in retinal microvasculature features in amblyopia have yielded inconsistent results. OBJECTIVES This meta-analysis aimed to evaluate retinal vessel density (VD) in amblyopic patients using optical coherence tomography angiography (OCTA). METHODS PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for published articles comparing retinal microvasculature characteristics in patients with amblyopia and controls. Continuous variable outcomes were assessed using the mean difference (MD) with a 95% confidence interval. Review Manager Version 5.30 was used for the analysis. RESULTS Thirteen qualified articles were pooled in this meta-analysis. Compared with controls, the foveal whole en face VD of superficial capillary plexus (SCP) and deep capillary plexus (DCP) of patients as measured by 3 × 3-mm scans were significantly lower in amblyopia eyes (MD: -1.37, p = 0.0003; MD: 1.70, p < 0.00001, respectively). Similarly, in the 6 × 6-mm scans, foveal whole en face VD of the SCP and DCP were remarkably lower in amblyopia eyes than in controls (MD: -2.24, p = 0.03; MD: -5.08, p = 0.04, respectively). The parafoveal VD of SCP in 3 × 3-mm scans (MD: -1.96, p < 0.00001) was also lower in amblyopic patients than in controls. Similarly, in 6 × 6-mm scans, amblyopia eyes showed a significant decrease and a trending decrease in the parafoveal VD of the SCP (MD: -3.85, p = 0.007) and DCP (MD: -3.03, p = 0.10), respectively. For whole radial peripapillary capillary (RPC), VD was significantly reduced in amblyopic patients compared to controls (MD = -0.83, p < 0.00001). In addition, the deep foveal avascular zone (FAZ) was larger in amblyopic eyes than in the controls (MD = 0.55, p = 0.007). CONCLUSIONS Our data suggest that whole foveal and parafoveal VD and RPC whole VD were reduced in patients with amblyopia. Moreover, our results reveal that the FAZ is larger in amblyopic patients. Consequently, OCTA may have the potential for diagnosing and monitoring patients with amblyopia.
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Affiliation(s)
- Chong-Chao Yang
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Kai-Bao Ji
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China,
| | - Yi-Feng Yu
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Matsuo T, Matsuo C, Kayano M, Mitsufuji A, Satou C, Matsuoka H. Photorefraction with Spot Vision Screener versus Visual Acuity Testing as Community-Based Preschool Vision Screening at the Age of 3.5 Years in Japan. Int J Environ Res Public Health 2022; 19:ijerph19148655. [PMID: 35886507 PMCID: PMC9321534 DOI: 10.3390/ijerph19148655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/04/2022]
Abstract
Nationwide in Japan, a community-based vision-screening program in 3.5-year-old children is conducted in three steps: questionnaires and home visual acuity testing as the primary screening; visual acuity testing by nurses and pediatricians’ inspection in community health centers as the secondary screening; and examinations by ophthalmologists as the tertiary screening. In this study, we introduced photorefraction with a Spot vision screener in addition to visual acuity testing to answer the clinical question of whether photorefraction could better detect eye diseases and potentially replace visual acuity testing. Photorefraction was performed on 813 consecutive 3.5-year-old children in a center. The children were sent to tertiary examinations, which were based on the Spot vision screener standard, in addition to the visual acuity testing standard: failure in either eye to pass 0.5 visual acuity in a center. A notice to visit ophthalmologists was issued for 95 children (11%), and documents with the diagnosis were sent back to the Heath Office for 76 children (80%). The rate of children with anisometropic or ametropic amblyopia or accommodative esotropia as treatment-requiring diseases was highest in cases of no pass at both standards (10/15 = 66%), and higher in cases of no pass only at the Spot vision screener standard (13/45 = 28%), compared with cases of no pass only at the visual acuity testing standard (6/33 = 18%, p = 0.0031). Photorefraction, in addition to visual acuity testing and inspection led to additional eye diseases detection at 3.5 years. Visual acuity testing at home would not be omitted in the introduction of photorefraction.
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Affiliation(s)
- Toshihiko Matsuo
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama 700-8558, Japan;
- Department of Ophthalmology, Okayama University Hospital, Okayama 700-8558, Japan
- Correspondence:
| | - Chie Matsuo
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama 700-8558, Japan;
| | - Masami Kayano
- Okayama City Government Health Office, Okayama 700-8546, Japan; (M.K.); (A.M.); (C.S.); (H.M.)
| | - Aya Mitsufuji
- Okayama City Government Health Office, Okayama 700-8546, Japan; (M.K.); (A.M.); (C.S.); (H.M.)
| | - Chiyori Satou
- Okayama City Government Health Office, Okayama 700-8546, Japan; (M.K.); (A.M.); (C.S.); (H.M.)
| | - Hiroaki Matsuoka
- Okayama City Government Health Office, Okayama 700-8546, Japan; (M.K.); (A.M.); (C.S.); (H.M.)
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Hao L, Ma Z, Song C, Zhu S. A rare case of congenital pupillary abnormality: a case report. BMC Ophthalmol 2022; 22:201. [PMID: 35501768 PMCID: PMC9063307 DOI: 10.1186/s12886-022-02422-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital anomalies of the pupil are quite varied, including abnormal size, shape, color, response to stimulus, and function. We are here reporting an unusual case presented with the absence of pupillary opening with folds of iris tissue at the center. Only an extremely small pupil (diameter < 0.5 mm) could be observed during the operation. CASE PRESENTATION A 15-year-old male patient visited our outpatient clinic due to vision difficulty in his right eye for more than ten years. The best-corrected visual acuity was 2.0 logMAR and 0 logMAR for the right and left eye, respectively. There were amblyopia, astigmatism and constant exotropia in his right eye. Ophthalmic examination of the right eye showed flat iris root, minimal iris pigmentation, and the pupil area was entirely covered by iris tissue. Lens status and fundus evaluation could not be commented. The left eye was found to be within normal limit. Based on ophthalmic examination, the admission diagnosis was given as acorea. Pupilloplasty was performed on the right eye due to the situation that the iris tissue blocked the visual axis, which led to visual impairment and stimulus deprivation amblyopia. However, an extremely small pupil at the center of his pupillary area was observed during the operation. The postoperative course was favorable, and a normal pupil was secured. Hospital discharge diagnosis was given as microcoria, and amblyopia treatment was followed. CONCLUSIONS We report a rare case of congenital pupillary abnormality. The further diagnosis was given as microcoria, which should be differentiated from acorea. For this kind of pupil disorder which blocks the visual axis, early diagnosis and treatment can help prevent the development of stimulus deprivation amblyopia.
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Affiliation(s)
- Lancao Hao
- Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Zicheng Ma
- Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Chenjie Song
- Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Siquan Zhu
- Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
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Calleja-García C, Muñoz-Gallego A, Dorado-López-Rosado A, López-López C, Tejada-Palacios P. Ophthalmological manifestations in 6 patients diagnosed with Williams-Beuren syndrome and literature review. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:276-280. [PMID: 35292219 DOI: 10.1016/j.oftale.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/06/2021] [Indexed: 06/14/2023]
Abstract
Medical history of 6 patients diagnosed with Williams-Beuren Syndrome (SWB) in pediatric age was revised. All the patients presented characteristic elf facies and cardiovascular abnormalities. All presented good visual acuity, except one case of unilateral amblyopia. The most frequent refractive error was hyperopia (n = 6; 100%) and astigmatism (n = 5; 83.3%). Ocular motility alterations were found in 2 patients (1 case of exophoria with hyperfunction of right inferior oblique and another of congenital endotropia with bilateral hyperfunction of inferior oblique). On the cognitive function, 66.7% (n = 4) had visoperceptive disorders. Other findings were epicanthus (n = 6; 100%) and congenital obstruction of the nasolacrimal duct with unilateral epiphora (n = 1; 16.7%). SWB is a rare disorder with complex ophthalmological and systemic manifestations. For this reason, ophthalmological follow-up of these children is recommended.
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Affiliation(s)
- C Calleja-García
- Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Muñoz-Gallego
- Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | | | - C López-López
- Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Tejada-Palacios
- Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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