Strabismus and Binocular Functions in a Sample of Swedish Children Aged 4–15 Years

Purpose: To investigate strabismus, head posture, nystagmus, stereoacuity, ocular motility, near point of convergence (NPC) and accommodative convergence to accommodation ratio (AC/A) in a sample of Swedish children. Methods: A prospective cross-sectional study was carried out on 143 children, 4–15 years of age. Results: Heterotropia was found in five children (3.5%), four with esotropia and one with exotropia. One child with esotropia had a slight overaction of both inferior oblique muscles. Heterophoria was found in 37 children (26%) at near and/or distance fixation and it was four times more common at near than at distance. In 29 children, heterophoria was found at one distance only and orthophoria at the other. Orthophoria at both near and distance fixation was noted in 101 children (70.5%). The near point of convergence was ≤6 cm in 97% of the children and 97% had stereoacuity of 60″ or better. In the whole group, the median AC/A ratio calculated with the heterophoria method was 5.6/1 prism diopters/diopters (PD/D) and with the gradient method, 1.3/1 PD/D. No anomalous head postures or nystagmus were observed and all children had normal versions. Conclusion: In this study, 143 well-defined children were investigated with a battery of accurately described tests, commonly used in clinical practice. These results are in agreement with those of other studies examining one or few variables in larger populations and the authors therefore conclude that their results may be used for comparisons with different patient groups.     

Television Video Games in the Treatment of Amblyopia in Children Aged 4–7 Years

Aim: To investigate the role of television video games in childhood amblyopia treatment.

Method: This prospective, randomized, interventional study included 40 patients between 4-7 years of age, with unilateral amblyopia (visual acuity in amblyopic eye between 1-0.6 LogMAR equivalents) attending the squint clinic at a tertiary eye hospital.

All patients were prescribed optimal spectacle correction and occlusion therapy, i.e. full time patching according to patient’s age, was initiated after six weeks.; full-time patching according to patient’s age was initiated after 6 weeks. Subjects were randomly divided into two groups of 20 each. Patients in the first group, Group A (control), were prescribed patching alone. Patients in the second group, Group B (study), were made to play action video games, with the help of a commercial television set, along with patching. They attended 12 half-hour sessions each, at weekly intervals. Follow-up assessments included best corrected visual acuity (BCVA) (both distance and near) and stereoacuity measurements at 3, 6, 9, and 12 weeks.

Results: The mean age of patients was 6.03 ± 1.14 years. The distance BCVA in the amblyopic eye showed a significant improvement at final follow-up (12 weeks) in both groups: from 0.84 ± 0.19 to 0.55 ± 0.21 LogMAReq in Group A and 0.89 ± 0.16 to 0.46 ± 0.22 LogMAReq in Group B. However, improvement in BCVA was significantly better in group B at all visits (P=0.002, 12 weeks). The study group also had a significantly better outcome in terms near visual acuity improvement (P = 0.006, 12 weeks). There was also greater stereoacuity improvement in group B, with 7 patients improving to 100 secs of arc or better.

Conclusion: Video games supplemental to occlusion may be considered favorable for visual development in amblyopic children, and the study encourages further research on this subject.     

Prevalence and Etiology of Amblyopia in Southern India: Results from Screening of School Children Aged 5–15 years

Abstract

Purpose: To determine the prevalence and etiology of amblyopia in school children.

Methods: A total of 4020 school children aged between 5 and 15 years were screened in a population-based, cross-sectional study. Best corrected visual acuity and detailed ophthalmic evaluation were performed in all participants. Amblyopia associated with degraded visual input due to high refractive error was labeled ametropic amblyopia. Anisometropic amblyopia was diagnosed in participants with interocular refractive error difference ≥1 diopter. Strabismic amblyopia included that due to conflicting visual inputs between the eyes due to squint. Stimulus deprivation amblyopia was defined as amblyopia due to obstruction of the visual axis.

Results: Prevalence of amblyopia was 1.1% (n?=?44). The number of boys with amblyopia (n?=?25, 57%) was slightly higher than the number of girls with amblyopia (n?=?19, 43%; p?=?0.6). A total of 28 (63.7%) children had mild to moderate amblyopia, whereas 16 (36.3%) had severe amblyopia. Underlying amblyogenic causes were ametropia (50%), anisometropia (40.9%), strabismus (6.8%), visual deprivation (4.5%) and combined causes (2.2%). No statistically significant difference was noted in the prevalence of amblyopia between rural (1.2%) and urban (0.9%) children (p?=?0.5).

Conclusion: In this study, the prevalence of amblyopia was 1.1% of the school children. Ametropia and anisometropia were the most common causes of amblyopia. We did not find any significant difference in amblyopia prevalence between rural and urban school children.     

Comitant Horizontal Strabismus in South African Black and Mixed Race Children—A Clinic-based Study

Purpose: To examine the types of comitant horizontal strabismus in children belonging to the two largest ethnic groups of the Western Cape, South Africa.

Methods: Retrospective review of 2371 children presenting with comitant horizontal strabismus to a single, large, pediatric tertiary referral center in Cape Town, South Africa, between 1997 and 2007.

Results: 81% of children were of mixed race and 19% were black. The overall esotropia:exotropia ratio was 73:27. For black children this was 85:15 and for mixed race, 71:29. The overwhelming majority of black children had congenital esotropias (74%), whereas accommodative esotropia was rare (9%). In mixed race children, esotopias were more equally divided between congenital (46%) and accommodative types (35%). Exotropias were uncommon in black children, and were mainly constant (61%). Intermittent exotropias predominated in mixed race children (55%).

Conclusion: Congenital esotropia remains common in South African black children, and of the few who presented with exotropia, most had constant type. Accommodative esotropias were more prevalent in South African mixed race children, but in smaller proportions than in other studies. Exotropias were mostly intermittent in this ethnic group, and showed a similar profile to that in white American children.     

Development of PVEP in Infants and Children

The development of components of VEP was studied in 150 infants and children between 2 weeks and 9 years of age participated as subjects. Ten adult subjects, 25 ito 35 years of age were also studied. The results indicated that the VEP had a simple wave form, consisting of only a slowly rising positive wave to 140‘, 70‘ and 35‘ checks from infants of 2 to 8 weeks following birth. P_1 wave appeared in response to 17.5‘ check stimulus at 10 weeks following birth. The latencies of P_1 components shortened d...     

Preservation and Observation of Anterior Ciliary Vessels in Rectus Muscles during Strabismus Surgery

Purpose :To observe the form and number of the anterior ciliary vessels (ACV) in rectus muscles. To train technician in preservation and obsevation of ACV, so preservation can be done in caes with a risk of anterior segment ischemia (ASI). Methods:Curved foreign knife, iris hook, plastic rubber band and standard operating loupes (3x. ) or microscope were used in the surgery on 34 cases of comitant strabismus and 18 cases of paralytic strabismus.Results:The ACVs per muscle in medial, lateral, superior, inferior rectus were 3. 08,3. 26,3. 50 and 3. 50 respectively in 89 muscles of 52 surgical strabismus cases. All ACVs in 16 rectus muscles and 90 out of 220 ACVs in 73 rectus muscles were too small or too short to be dissected. The success rate of ACV preservation was 91. 5% (119/130). 105 out of 130 vessels were saved using loupe magnification and 14 pit pf 130 vessels were saved under operating microscope. Conclusions :The number of ACV in rectus muscles are more than 2 in our observation cases. The ACV     

Ten-Year Results of Home Vision-Screening Test in Children Aged 3–6 Years in Seoul,Korea

Abstract

Purpose: To characterize the prevalence of refractive error and amblyopia among three- to six-year-old children during the period from 2002 to 2011. Methods: About 31,400 children annually (from 16,592 to 40,816) during the period from 2002 to 2011 were enrolled. The preschool vision screening was performed by the Korean Foundation for the Prevention of Blindness (KFPB) annually during a period that extended from March to September. We reviewed the KFPB annual report about the home vision-screening test as performed during the period from 2002 to 2011. Changes in the prevalence and types of refractive error, strabismus, and amblyopia that manifested throughout this period were analyzed. Results: The prevalence of refractive errors ranged from 1.10% in 2002 to 0.42% in 2011. The prevalence of hyperopia and myopia changed little throughout the 10-year study period. Myopia and hyperopia were equally common among the population examined (χ²-test, p?=?0.137). The prevalence of anisometropia decreased over time. The annual prevalence of amblyopia ranged from 0.39% to 0.06%, while the overall prevalence of amblyopia dropped from 0.25% in 2002 to 0.06% in 2011. The prevalence of strabismus was highest in 2006 (0.30%) and had decreased by 0.06% in 2011. The type of strabismus showed no significant difference over time (χ²-test, p?=?0.579). Conclusions: The prevalence of amblyopia, refractive error, anisometropia, and strabismus was lower in 2011 than in early 2000. The prevalence of hyperopia and myopia as well as strabismus remained similar throughout the study period.     

The Study of Corneal Topography in Myopic and Hyperopic Children

Purpose: To compare the differences of corneal topographies in myopic and hyperopic children and study the effect of Atropin on their changes. Methods : The refractive components of 136 eyes with different refractive conditions were measured with A-Scan and their corneal topographies with and without cycloplegia were obtained respectively. Results: The mean corneal power of zones 3mm (MD3, P=0.031) and minor keratometer K2 (P=0.003) of myopia are greater than those of hyperopia without cycloplegia. MD3 (.P=0.009) and Keratometer K1 (P = 0.025) increased in hyperopic eyes, while MD3 (P=0.033), K1 (P= 0.035) and K2 (P= 0.002) decreased in myopic eyes significantly after cycloplegia. Similarly, the mean corneal power of zones 5mm (MD5) and 7mm (MD7) in myopic eyes decreased dramatically (P≤0.001). Conclusions: The corneal power was found to be greater in myopia than that in hyperopia. The effect of Atropin on corneal shape of myopia and hyperopia was in the opposite direction. Eye Science 2005;21:15-19.     

Paul of Aegina (c. 625–690 AD), the Origins of the Early Correction of Pediatric Strabismus in Byzantine Empire

The eminent Greek physician Paul of Aegina, native of the Saronic island Aegina and pupil of the Alexandrian School, understood both exotropia and endotropia, his designation for esotropia and proposed therapeutic measures for their treatment during baby or toddler age. He had introduced an innovative method for the newborns to have a straight vision, “the congenital strabismus of the newborns must be treated with the placement of a facial mask (with 2 open holes in the middle axes of the eyes), so that the babies could only see in a straight line”, combined with a small oil lamp to assure a direct eye alignment. Although not even a diagram of the masks was saved until nowadays, Paul was the first to suggest the early correction of the eyes deviation, and considered to be the father of orthoptics.     

Implementation of an Educational Cartoon (“the Patchbook”) and Other Compliance-Enhancing Measures by Orthoptists in Occlusion Treatment of Amblyopia

Purpose: This implementation study evaluated orthoptists’ use of an educational cartoon (“the Patchbook”) and other measures to improve compliance with occlusion therapy for amblyopia.

Methods: Participating orthoptists provided standard orthoptic care for one year, adding the Patchbook in the second year. They attended courses on compliance and intercultural communication by communication skills training. Many other compliance-enhancing measures were initiated. Orthoptists’ awareness, attitude, and activities regarding noncompliance were assessed through interviews, questionnaires, and observations. Their use of the Patchbook was measured. The study was performed in low socio-economic status (SES) areas and in other areas in the Netherlands. It was attempted to integrate education on compliance into basic and continuing orthoptic training.

Results: The Patchbook was used by all 9 orthoptists who participated in low-SES areas and 17 of 23 orthoptists in other areas. Courses changed awareness and attitude about compliance, but this was not sustained. Although orthoptists estimated compliance during patching at 70%, three-quarters never suspected noncompliance during a full day of observation in any of their patients. Explanations to parents who spoke Dutch poorly were short. In the second year, explanations to children were longer. Implementation of all 7 additional compliance-enhancing measures failed. Education on compliance was not integrated into orthoptists’ training.

Conclusion: Almost all orthoptists used the Patchbook and, as another study demonstrated, it proved to be very effective, especially in low-SES areas. Duration of explanation was inversely proportional to parents’ fluency in Dutch. Noncompliance was rarely suspected by orthoptists. Although 7 additional compliance-enhancing measures had been conceived and planned with the best intentions, they were not realized. These required extra, unpaid time from the orthoptists, which is especially scarce in hospitals in low-SES areas where the educational cartoon is most needed.     

Is the 15∆ Base in Prism Test Reliable for Detection of Amblyopia in Anisometropic Patients?

ABSTRACT

Purpose: The 15? base in prism test (15?BIPT) introduced by Gobin is often used in The Netherlands to detect fixation preference, especially in young and preverbal children in whom a reliable measurement of the visual acuity (VA) is difficult. It is assumed that the fixation preference detected by the 15?BIPT can be used to predict the presence of amblyopia. The aim of this retrospective case note review was to investigate the accuracy of the 15?BIPT in detection of amblyopia in anisometropic patients.

Methods: Four hundred and twelve files of anisometropic patients visiting the orthoptic department of The Rotterdam Eye Hospital were analyzed. Amblyopia was defined as an intraocular difference in VA of 2 or more Snellen lines. The sensitivity, specificity, and positive and negative predictive values of the 15?BIPT were calculated and the receiver operating characteristic (ROC) curve was plotted.

Results: One hundred and fifty-two patients ranging from 3.3–13.1 years of age (median 5.4 years) met the inclusion criteria. One hundred and two patients were diagnosed with amblyopia. Best-corrected median VA of the best eye was 1.0 (range 0.5–1.2) and the worst eye 0.70 (range 0.05–1.2). Sensitivity of the 15?BIPT (based on detecting amblyopia) was 34.3%. Specificity was 88.0%. The positive predictive value was 85.4% versus a negative predictive value of 39.6%. The area under the ROC curve (AUC) was 0.65 (95% CI 0.56–0.74).

Conclusion: The low sensitivity, large number of false negatives and the AUC show that the 15?BIPT can be considered a poor test for detecting amblyopia in anisometropic patients.     

Trends in Eye Injuries and Associated Medical Costs among Children in the United States, 2002–2014

Purpose: To describe the trends in eye injuries and associated medical costs among children in the United States.

Methods: Data were from the 2002–2014 Medical Expenditure Panel Survey (MEPS). Eye injuries in children aged <18 years were identified by the International Classification of Diseases-9 (ICD-9) codes. The trends of cumulative incidence of eye injury, total costs, and average costs were estimated from 2002-2014 MEPS data. All costs were adjusted to 2014 US dollars. Analyses accounted for the complex stratified multistage survey design of the MEPS. We used MarketScan data (2010–2013) to validate outpatient cost estimates.

Results: The 3-year average cumulative incidence of eye injuries declined from 0.56% in 2002–2004 to 0.31% in 2012–2014 (Trend p < 0.001). The average annual total costs decreased from $193 million during 2002–2004 to $66 million during 2012–2014 (p < 0.001).

Conclusion: The MEPS data showed that among children aged <18 years, the incidence of eye injuries and associated financial burden substantially declined during 2002–2014, highlighting the progress in preventing children eye injuries. Continuing efforts are needed to further reduce the burden in this population.     

The Study of G6PD in Erythrocyte and Lens in Senile and Presenile Cataract

The G6PD activity of erythrocytes in 113 male patients with senile and presenile cataract and 86 controls, and G6PD activity of lens in 30 patients with senile cataract and 42 controls were reported. The cataractous group had higher frequency of G6PD deficiency and lower average G6PD level in erythrocytes and lenses, but with out statistical significance. The frequency of G6PD deficiency of erythrocytes in presenile cataractous group was higher than that of senile cataractous group but with no statistical significance too. However, the average G6PD level of erythrocytes in presenile cataractous group was lower than that of senile cataractous group and with statistical significance (P<0.05). The G6PD activity of lenses only presenile in the cortex and have a positive correlation with that of erythrocytes. There was a case with deficiency of G6PD both of erythrocytes and cataractous lenses in both eyes. The results indicate that the deficiency of G6PD might be one of the cataractous pathogenetic factor for presenile cataract. Measurement of G6PD activity of erythrocytes among population might be of significance in finding the risk factor for cataract.     

Amblyopia treatment and quality of life: the child’s perspective on atropine versus patching

ABSTRACT

Background: The impact on children of patching versus atropine treatment for amblyopia was assessed using children’s perspective Health-Related Quality of Life (HRQoL) scores in 5 to 7-year olds.

Methods: Forty-six children on the threshold of commencing either patching or atropine treatment for amblyopia were recruited. Treatment was prescribed for uniocular amblyopia of visual acuity (VA) 0.2 logMAR or worse. After four weeks of their chosen treatment, each child completed the Child Amblyopia Treatment Quality-of-Life Questionnaire (CAT-QoL). The Pediatric Quality of Life Inventory (PedsQL?), Young Child (5–7) Self-Report version, was completed before and after four weeks of treatment. Quality of life scores were compared between the two treatment groups.

Results: Sixty-one percent (n = 28) of participants were male and 56.5% (n = 26) were white British. The CAT-QoL has a range of 0–16, with 16 being the worst quality of life. No significant difference was found between the patching group (n = 30, mean age 69.7 months) and the atropine group (n = 16, mean age 69.3 months) for CAT-QoL quality of life scores (Patch median = 6.3, Atropine median = 5.6, U = 199, p = .341, 95% CI of the median difference of ?2.3 to 0.9). The Young Child (5–7) Self-Report version of the PedsQL? has a ‘total score’ range of 0–100, with 0 being the worst quality of life. There was also no significant difference in PedsQL? quality of life total scores (Patch median = 80, Atropine median = 83.33, U = 239.5, p = .991, 95% CI of the median difference ?13.33 to 10) after four weeks of treatment.

Conclusion: Amblyopic children reported that patching and atropine treatments did not have a significant impact on their quality of life. Patching and atropine should continue to be offered as first-line treatments for amblyopia, as children appear to tolerate both well and do not favor one over the other.     

Effects of Bilateral Superior Oblique “Hang-Back” Recession in Treatment of A-pattern Strabismus with Superior Oblique Overaction

Purpose: To investigate the efficacy and safety of bilateral hang-back recession of superior oblique (SO) muscles in the treatment of A-pattern strabismus with superior oblique overaction (SOOA).

Methods: Thirty-one (31) patients (62 eyes) with A-pattern horizontal deviation and SOOA underwent hang-back recession of SO and retrospective analysis of the surgical amount of hang-back recession of SO, preoperative and postoperative A-pattern, ocular motility, and corrected objective torsion. Patients were evaluated before and 6 to 9 months after surgery.

Results: The average A-pattern horizontal deviation was 27.58 ±11.47 prism diopters (PD) before surgery and 3.48 ± 3.70 PD after surgery (n=31, P<0.05). The mean corrected A-pattern was horizontal deviation 24.10 ± 10.32 PD. The average scale of SOOA on a scale of +1 to +4 was +3.05 ± 0.80 before surgery and +0.42 ± 0.50 after surgery in 62 eyes (P<0.05). The mean corrected objective torsion was 4.91°± 4.53°. The surgical amount of SO hang-back recession ranged from 4 to 10 mm (mean: 7.62 ± 1.18 mm), which was related to the preoperative A-pattern and corrected A-pattern. There were no surgical complications.

Conclusions: SO hang-back recession is a safe and efficient option for A-pattern caused by SOOA.