Learning disabilities, dyslexia, and vision: a subject review--a rebuttal, literature review, and commentary.

BACKGROUND: In 1998, the American Academy of Pediatrics, the American Academy of Ophthalmology, and the American Association of Pediatric Ophthalmology and Strabismus (AAP/AAO/AAPOS) published a position paper entitled "Learning Disabilities, Dyslexia And Vision: A Subject Review," intended to support their assertion that there is no relationship between learning disabilities, dyslexia, and vision. The paper presents an unsupported opinion that optometrists (by implication) have said that vision problems cause learning disabilities and/or dyslexia and that visual therapy cures the conditions. The 1998 position paper follows two very similar and discredited papers published in 1972 and 1981. METHOD: This article critically reviews and comments on the many problems of scholarship, the inconsistencies, and the false allegations the position paper presents. Perhaps the foremost problem is that the authoring committee has ignored a veritable mountain of relevant literature that strongly argues against their assertion that vision does not relate to academic performance. It is for this reason that an overview, drawn from more than 1,400 identified references from Medline and other database sources and pertinent texts that were reviewed, is incorporated into this current article. The AAP/AAO/AAPOS paper is also examined for the Levels of Evidence that their references offer in support of their position. CONCLUSION: The AAP/AAO/AAPOS paper contains errors and internal inconsistencies. Through highly selective reference choices, it misrepresents the great body of evidence from the literature that supports a relationship between visual and perceptual problems as they contribute to classroom difficulties. The 1998 paper should be retracted because of the errors, bias, and disinformation it presents. The public assigns great trust to authorities for accurate, intellectually honest guidance, which is lacking in this AAP/AAO/AAPOS position paper.     

Pediatric anterior capsulotomy preferences of cataract surgeons worldwide: comparison of 1993, 2001, and 2003 surveys

We compared the pediatric anterior capsulotomy preferences of members of the American Society of Cataract and Refractive Surgery (ASCRS) and the American Association of Pediatric Ophthalmology and Strabismus (AAPOS) reported in 3 surveys (1993, 2001, and 2003). In 1993 and 2001, more than 50% of ASCRS respondents preferred manual anterior capsulotomy techniques; in 2001 and 2003, AAPOS respondents preferred manual and vitrector techniques. The ASCRS preferences remained unchanged when subdivided into domestic and international, as did AAPOS domestic preferences; however, more than 50% of AAPOS international preferences changed from manual alone in 2001 to a manual-vitrector combination in 2003. In 2003, more than 50% of AAPOS respondents worldwide preferred this combination: the vitrector for the very young patient and the manual anterior capsulotomy for the older child.     

Treatment of periocular capillary hemangiomas.

PURPOSE: To report the results of a survey of the members of the American Association of Pediatric Ophthalmology and Strabismus (AAPOS) regarding the treatment of periocular capillary hemangiomas. METHODS: A survey was delivered to the 600 members of AAPOS. Surveys were returned via facsimile. Results were collected in a computerized spreadsheet and then tabulated and analyzed. RESULTS: Of the 600 AAPOS members, 225 responded to the survey. The results showed that intralesional steroid injection is the most commonly used treatment modality for periorbital capillary hemangiomas. Oral steroids and excision were also commonly used in the treatment of these lesions. CONCLUSIONS: Further controlled studies are needed to determine which treatment modality offers the most benefit and least risk. More standardization based on these studies is necessary to improve treatment of periocular capillary hemangiomas.     

Prescribing eyeglass correction for astigmatism in infancy and early childhood: a survey of AAPOS members.

PURPOSE: To determine prescribing practices of pediatric ophthalmologists for astigmatism and astigmatic anisometropia in infants and young children. METHODS: A survey was sent to the 700 North American AAPOS members listed in the 2004 web site directory. RESULTS: A total of 412/700 surveys (59%) were returned. The level of astigmatism at which pediatric ophthalmologists prescribe eyeglasses for astigmatism varies considerably across the age range from birth to 3 years. The level at which 50% would prescribe glasses was > or =4.00 D from 0 to <6 months and decreased to > or =2.00 D by 2 to <3 years. Furthermore, one-fifth indicated that they would not prescribe eyeglasses for astigmatism in infants <6 months of age. Prescribing practices for astigmatic anisometropia were slightly less variable across age, with 50% of respondents indicating that they would prescribe eyeglasses for astigmatic anisometropia > or =3.00 D from 0 to <6 months, decreasing to > or =1.50 D by 2 to <3 years. CONCLUSIONS: The American Academy of Ophthalmology Preferred Practice Patterns guidelines accurately reflect prescribing practices of pediatric ophthalmologists for 1- and 2-year-old children for bilateral astigmatism and astigmatic anisometropia. However, the AAO guidelines do not accurately reflect the prescribing practices for children in the 0 to <1-year age range. For children 0 to <6 months of age, pediatric ophthalmologists indicate that they typically require a higher amount of astigmatism or astigmatic anisometropia than that recommended by the AAO guidelines, or they do not prescribe glasses at all.     

Intraocular lens implantation during infancy: perceptions of parents and the American Association for Pediatric Ophthalmology and Strabismus members

BACKGROUND: To determine whether a randomized clinical trial, the Infant Aphakia Treatment Study, comparing intraocular lens (IOL) implantation with contact lens (CL) correction for infants with a unilateral congenital cataract (UCC), is feasible by (1) ascertaining whether American Association for Pediatric Ophthalmology and Strabismus (AAPOS) members have equipoise regarding these two treatments and (2) evaluating the willingness of parents to agree to randomization. METHODS: All AAPOS members were surveyed in August 1997 and again in June 2001 regarding their use of CLs and IOL implants to correct infants vision after unilateral cataract surgery. In addition, a pilot study was begun in March 2002 to evaluate the safety of IOL implantation during infancy and the willingness of parents to randomize their children with a UCC to either IOL implantation or CL correction. RESULTS: In 1997, 89% of the 260 respondents reported that in the previous year they had treated at least one infant with a UCC, but only 4% had implanted an IOL in an infant <7 months old. Silsoft (Bausch & Lomb, Rochester, NY) CL correction was the preferred treatment choice for 84% of the respondents. In 2001, 21% of the 279 respondents had implanted an IOL in an infant. On a scale from 1 to 10 with 1 strongly favoring an IOL implant and 10 strongly favoring a CL, the median score was 7.5. Sixty-one percent of the respondents indicated that they would be willing to randomize children with a UCC to one of these two treatments. The main concerns about IOL implantation were poor predictability of power changes, postoperative complications, inflammation, and technical difficulty of surgery. The main concerns about CL correction were poor compliance, high lens loss rate, high cost, and keratitis. In our pilot study, 30 infants <7 months of age were evaluated at nine clinical centers for a visually significant UCC. Of 24 infants eligible for randomization, the parents of 17 (71%) agreed to randomization. CONCLUSIONS: Although most AAPOS members still favor CL correction after cataract surgery for a UCC, five times as many had implanted an IOL in an infant in 2001 compared with the number in 1997. Parents were almost equally divided in their preference for IOL implant versus CL correction. Given the relative equipoise of AAPOS members regarding these treatments and the willingness of more than two thirds of parents to agree to randomization, it seems likely that a randomized clinical trial comparing these two treatments could indeed be conducted.     

A Comparison of Referral Criteria used by the PlusoptiX Photoscreener

Abstract

Purpose: To evaluate the sensitivity, specificity, and predictive value of 7 different referral criteria used for the plusoptiX photoscreener on the same cohort of children.

Methods: Retrospective chart review of patients presenting to a pediatric ophthalmology clinic who underwent plusoptiX photoscreening as part of a comprehensive examination. We applied multiple referral criteria from previously published studies as well as the manufacturer’s criteria in order to calculate specificity, sensitivity, and predictive value differences between the various referral criteria. We compared all criteria to the results of a pediatric ophthalmology examination based upon the 2003 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) criteria, as well as the newly accepted revision of the AAPOS referral criteria.

Results: 109 children were examined with a thorough pediatric ophthalmic exam and with the plusoptiX photoscreener. Of these, 58 (53%) were confirmed to demonstrate amblyopia risk factors, according to 2003 AAPOS criteria. The plusoptiX referral criteria were adjusted to match 7 different published plusoptiX referral paradigms so that the differing referral paradigms could be analyzed for sensitivity and specificity. When comparing the differing plusoptiX referral paradigms to 2003 AAPOS criteria, the sensitivity/specificity of the 7 different paradigms were respectively: Matta/Silbert 98%/80%, Arthur (2) 67%/96%, Arnold 81%/96%, Arthur 81%/92%, PediaVision 80%/94%, plusoptiX 98%/41%, AAPOS 74%/86%. When comparing the 7 differing referral paradigms to the newly approved (2013) AAPOS criteria, the sensitivity/specificity were respectively: Matta/Silbert 98%/68%, Arthur (2) 73%/92%, Arnold 92%/90%, Arthur 86%/85%, PediaVision 90%/92%, plusoptiX 98%/35%, AAPOS 87%/87%.

Conclusion: There are multiple referral criteria available for the plusoptiX photoscreener. Screening programs need to evaluate their own requirements with respect to desired sensitivity and specificity and decide on the most appropriate referral criteria for their program. The “Arnold” criteria is the best at maximizing sensitivity and specificity utilizing the 2003 “AAPOS” criteria and the “Arnold” and “PediaVision” were best at maximizing sensitivity and specificity for the newly accepted AAPOS referral criteria. Screening programs will need to decide the level of sensitivity and specificity that they wish to obtain, but for most screening programs the “Arnold” criteria may be preferred.     

基于CiteSpace的间歇性外斜视的文献计量学及可视化分析

目的：通过文献计量学方法分析间歇性外斜视的研究现状和未来发展趋势。

方法：检索2003-2022年Web of Science数据库核心合集中收录的文献计量学相关文献,运用文献计量学方法,使用CiteSpace6.2.R2软件对年发文量、国家、机构、杂志、作者、参考文献和关键词进行可视化分析。

结果：2003-2022年共检索到620篇间歇性外斜视相关文献,年发文量呈稳定增加的趋势。韩国和美国为发文量最多的国家,最具有生产力的机构为梅奥诊所。发文量最多的作者为Holmes JM。刊文量最多的期刊是The Journal of American Association for Pediatric Ophthalmology and Strabismus(J AAPOS)(共计78篇文献)。关键词和突现词分析可总结出目前该领域的研究热点为间歇性外斜视的手术治疗、流行病学、正位、复发。

结论：应用CiteSpace软件进行可视化分析,可客观反映出2003-2022年间歇性外斜视文献数量变化及分布情况,间歇性外斜视的研究热点已从其手术和流行病学逐渐转移到融合和复发等方面。     

Adaptive optics imaging of the retina

Adaptive optics is a relatively new tool that is available to ophthalmologists for study of cellular level details. In addition to the axial resolution provided by the spectral-domain optical coherence tomography, adaptive optics provides an excellent lateral resolution, enabling visualization of the photoreceptors, blood vessels and details of the optic nerve head. We attempt a mini review of the current role of adaptive optics in retinal imaging. PubMed search was performed with key words Adaptive optics OR Retina OR Retinal imaging. Conference abstracts were searched from the Association for Research in Vision and Ophthalmology (ARVO) and American Academy of Ophthalmology (AAO) meetings. In total, 261 relevant publications and 389 conference abstracts were identified.     

2018美国眼科学会干眼指南解读

美国眼科学会(American Academy of Ophthalmology，AAO) 近期出台的2018年干眼(dry eye disease，DED)临床指南，对DED的定义、发病人群、分类、检测方法与治疗等做了详细介绍。本文将对该指南进行全面解读。     

Initial two years of experience with the AAO National Eyecare Outcomes Network (NEON) cataract surgery database

PURPOSE: To report the results of the first 2 years of experience with an American Academy of Ophthalmology (AAO) cataract surgery registry; to compare patient characteristics, operative procedures, and patient outcomes observed in the registry to those observed in the Cataract PORT study; and to discuss the current shortcomings and potential benefits of a national cataract surgery registry. DESIGN: Observational study of episodes of cataract surgery reported by a self-selected sample of 249 ophthalmologists. PARTICIPANTS: Seven thousand six hundred twenty-six patients undergoing cataract surgery during 1996 and 1997. METHODS: Beginning in January 1996, participation in the AAO cataract surgery registry was offered to all ophthalmologists. Participants could use software or paper data collection forms to submit a common set of data regarding patients' demographics, preoperative ophthalmologic history, physical examination and test results, functional status and symptoms, intraoperative procedures and events, and postoperative outcomes for all patients undergoing first or second eye cataract surgery. Data were transmitted to a central database, where they were aggregated and analyzed. Findings were compared with those observed in the Cataract PORT study, which was conducted in 1991 and 1992. RESULTS: Between January 1, 1996, and February 28, 1998, 249 ophthalmologists submitted data on at least one patient who underwent cataract surgery. A total of 7626 patients undergoing first or second eye surgery were enrolled, with all preoperative, intraoperative, and postoperative data forms submitted for 3342 patients (44%). The preoperative characteristics of patients reported to National Eyecare Outcomes Network (NEON) were similar to those of patients enrolled in the Cataract PORT study except for a higher reported prevalence of ocular comorbidity in NEON patients. Use of retrobulbar anesthesia was reported far less commonly, and use of topical anesthesia, phacoemulsification, and foldable intraocular lenses was reported far more often for NEON than for Cataract PORT study patients. Patient outcomes reported to NEON were similar to those observed in the Cataract PORT study. MAIN OUTCOME MEASURES: Visual acuity, VF-14, Cataract Symptom Score, surgical complications. CONCLUSIONS: During the first 2 years of NEON, ophthalmologist participation in the NEON cataract surgery database was low and consisted of a self-selected and likely nonrepresentative sample of ophthalmologists. The representativeness of patients for whom data were reported is unknown. In addition, complete data were submitted on only a minority of patients who were enrolled. Even so, the preoperative characteristics of patients on whom data were submitted to NEON were similar to those of patients enrolled in the Cataract PORT study. The initial experience with NEON demonstrates that it is technically possible to collect clinical data from, and report aggregated results to, practicing clinicians' offices. In addition, at least some practicing clinicians are willing to spend the time required to participate in the NEON registry. The NEON cataract surgery database thus has the potential to provide a practical means for tracking practice patterns and patient outcomes in real time. If a representative sample of physicians was willing to contribute data systematically and accurately over time, initiatives such as NEON could provide a means for professional societies and physicians to play a leadership role in defining and monitoring quality of care.     

The Australian optometric workforce 2005, analysed by local government areas

Background: Previous studies of the Australian optometric workforce have taken a coarse view of the distribution of optometrists, at best comparing concentrations of optometrists in city and country areas and between states and territories. A more discriminating approach recognising the size and variation in population density of the country is necessary for a more realistic insight into the optometric workforce. This study addresses the distribution of optometrists across smaller geographic units, known as local government areas (LGAs). Methods: The number of equivalent full‐time optometrists in each Australian LGA was determined using data from the Optometrists Association Australia database. Data from the Australian Bureau of Statistics and the Australian national health program (Medicare) were applied to determine the demand for services based on age distributions in LGAs and to calculate the adequacy of the number of optometrists. Results: Optometrists are concentrated in areas of high population with capital city regions and their surrounds well‐serviced but with rural and remote LGAs with low populations generally not having optometrists. The highest excesses of optometrists occur in the capital city LGAs of Melbourne, Sydney and Adelaide (64, 60 and 28.4 equivalent full‐time optometrists respectively). The highest deficits occur in Casey (Victoria), Lake Macquarie (New South Wales) and Onkaparinga (South Australia), (‐16.4, ‐15.6 and ‐13.4 equivalent full‐time optometrists, respectively). Conclusions: There are substantial variations in the distribution of optometrists across LGAs in Australia but the variation is often a poor indicator of the ease with which people can access optometric services. In metropolitan areas, people may live close to an optometric practice in a neighbouring LGA. In rural areas, an LGA may appear to have an adequate number of optometrists but some residents may be several hours from the nearest optometrist or the optometric service is provided on a part‐time basis.     

Supply, distribution, and capacity of optometrists in Indiana.

BACKGROUND: The Indiana Optometric Association and the Indiana Health Care Professional Development Commission identified a need to collect and analyze data on the health professions workforce for formulating goals and strategies to accommodate demands for health care services in Indiana. This study looks at the supply, distribution, and services of optometrists practicing in Indiana. METHODS: Data compiled by the Indiana State Department of Health, Indiana Health Care Development Commission, and the Project HOPE Center for Health Affairs were analyzed with the results of a survey of practitioner members of the Indiana Optometric Association. Supply, distribution, services, provider-to-population ratios, per capita demand, and optometric productivity were used to evaluate the current and future capacity of Indiana optometrists to the year 2010. RESULTS: An estimated 893 optometrists practiced in 86 of 92 counties and comprised 77% of the state's licensed eye and vision care workforce in 1995. Optometric workforce capacity appeared to be related to county population, but unrelated to the urban/rural classification or the per-capita income of Indiana counties. Contact lenses, disease, geriatrics, and pediatrics were the most prevalent areas of practice specialty. CONCLUSIONS: Optometrist capacity in Indiana is sufficient at both the state and county levels, and optometric services are appropriately distributed such that patient access to optometric care is geographically unburdened. Estimates regarding supply are elastic, depending on the assumptions applied.     

SpotTM视觉筛查仪在儿童斜视筛查中的应用

目的：探讨SpotTM在儿童斜视筛查中的可配合性及在斜视性弱视危险因素筛查中的筛查效率。方法：横断面研究。2015 年7-10 月在天津和平新世纪妇儿医院保健科体检的389 例儿童先后进行SpotTM及小儿眼科医师检查,依据SpotTM内设眼位异常推荐值确定出需要转诊的儿童,小儿眼科医师依据2013 年美国斜视与小儿眼科协会规定的视觉筛查转诊指南确定出具有斜视性弱视危险因素的儿童,最终评估SpotTM在斜视性弱视危险因素筛查中的敏感度、特异度、阳性预测值及阴性预测值。结果：389 例儿童入组,平均年龄（6.0±2.3）岁。97.4%的儿童能配合SpotTM检查,无法配合SpotTM检查直接转诊的10例儿童中7例患有眼部疾病。小儿眼科医师确定38例（9.8%）具有斜视性弱视危险因素;经SpotTM筛查,确定需转诊的眼位异常者49 例（12.6%）。SpotTM在斜视性弱视危险因素筛查中敏感度71.0%,特异度93.7%,阳性预测值55.3%,阴性预测值96.8%。结论：大多数儿童可配合SpotTM的检查,SpotTM在斜视性弱视危险因素的筛查中具有一定的临床应用价值。     

Changing practice for the non-medical ophthalmic hospital workforce in the UK—a snapshot survey

Background/objectivesTo obtain a picture of the current status, training and governance for advanced practice and extended roles in the ophthalmic hospital non-medical workforce.MethodsA 10 question, quantitative survey was designed with multidisciplinary members of the UK Ophthalmology Alliance and sent to the membership to obtain information on expanded non-medical roles.Results34 of the 58 UKOA member hospitals responded (58% response rate). All responding units were using registered optometrists, orthoptists and nurses to undertake expanded outpatient roles and 28/34 (82%) had expanded roles for undertaking procedures. Some units had large numbers of staff undertaking these roles. There were noticeable trends for certain professional groups to undertake certain roles. For example, nurses were undertaking most procedures, apart from lasers which were mainly delivered by optometrists. Nurses had the lowest banding and optometrists the highest for apparently similar roles. Training was mostly in-house apprenticeship style although some formal external qualifications were undertaken.ConclusionsOphthalmology is developing many innovative roles for the non-medical workforce and, with the launch of the OCCCF training, this is likely to increase. Terminology is confusing and a categorisation suitable for ophthalmology is proposed.Subject terms: Health occupations, Health care, Health services     

Vision rehabilitation for Canadians with less than 20/40 acuity: the SmartSight model

Traditionally, vision rehabilitation was directed towards patients who were blind or had very low vision. There is increasing evidence that less severe vision loss is associated with increased risk of falls, hip fractures, medication errors, poor nutrition, reduced physical activity, social isolation, clinical depression, longer hospitalizations, and mortality. The American Academy of Ophthalmology (AAO) 2003 SmartSight initiative in low vision rehabilitation outlined a model of graduated low vision interventions. This paper is a review of the AAO SmartSight model and how it can apply in the Canadian setting. All patients with visual acuity less than 20/40, a scotoma, field loss, or loss of contrast sensitivity would be offered information about available low vision rehabilitation. Eye physicians would be encouraged to communicate with other health care providers to coordinate existing services and integrate graduated services. Enhanced communication among caregivers about the consequences of vision loss, such as depression, falls, and visual hallucinations, could help ensure that all patients who would benefit receive appropriate vision rehabilitation.     

Laser-assisted intrastromal keratomileusis in a patient with systemic mastocytosis.

BACKGROUND: The U.S. Food and Drug Administration (FDA), and more recently the American Academy of Ophthalmology (AAO), list relative and absolute contraindications to laser-assisted intrastromal keratomileusis (LASIK). The AAO guidelines consider connective tissue or autoimmune diseases and systemic immunosuppresion as relative contraindications and only uncontrolled diseases and uncontrolled ocular allergy as absolute contraindications. Recent reports concluded that LASIK could be performed effectively and safely in selected patients with stable and controlled systemic diseases. Reported here is a case of successful LASIK with 3 years follow-up in the setting of systemic mastocytosis. CASE REPORT: A 42-year-old woman with moderate myopia and astigmatism underwent bilateral LASIK. Her medical history was significant for systemic mastocytosis. Five days after surgery, a diffuse lamellar keratopathy (DLK) 1+ was observed in the left eye and treated successfully with prednisolone acetate. The patient achieved visual acuity of 20/20 in each eye unaided. These findings were stable at 7, 12, 18, and 36 months after surgery. She continues to use olopatadine. CONCLUSION: Because of the rare nature of systemic mastocytosis and the anaphalactoid mechanism of release of mast cells, it may be difficult to assess the risk of undergoing LASIK. Any known or suspected triggers must be avoided. The use of an antihistamine and mast cell stabilizer, as used in this case, may have a beneficial effect.     

The development of the code of ethics for the American Academy of Ophthalmology

The circumstances leading to and the process of establishing a code of ethics for members of the American Academy of Ophthalmology are recounted by the original chairman of the Ethics Committee.     

原发性闭角型青光眼致病因素问卷分析

目的：通过问卷分析探讨原发性闭角型青光眼(primary angle-closure glaucoma,PACG)发病的危险因素。

方法：本研究通过1：2匹配病例对照,选取2015-01/2017-01在郴州市湘南学院附属医院眼科住院的原发性闭角型青光眼30例和同院其他与青光眼无共同致病因素的患者60例,进行回顾性病例对照研究。

结果：运用SPSS17.0软件进行统计分析,单因素Logistic回归分析显示居住农村、较低文化水平、高血压、用眼时间长、远视、视力疲劳、家庭关系不和谐、家庭成员有患病8个变量与PACG发病有关。多因素条件Logistic回归分析进一步表明：居住地、用眼时间、远视、视力疲劳、家庭关系5个变量是PACG发病的独立危险因素。

结论：原发性闭角型青光眼受多种致病因素的影响,分析其致病因素有利于降低原发性闭角型青光眼的发病率。     

Vitreoretinal surgery in the Ambulatory Surgery Center in the United States

There is a growing trend in the ambulatory surgery centers of the United States to perform vitreoretinal cases. Logistic and financial considerations affect health care delivery systems worldwide. This article presents the barriers that prevent or impede the performance of posterior segment surgery in the ambulatory surgery center environment and also lists some of the advantages. The author has stated that he does not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The author also does not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices. Dr. Roy is on the Board of Directors Outpatient Ophthalmic Surgery Society (OOSS) and is an American Academy of Ophthalmology (AAO) councilor.