儿童配戴角膜塑形镜后早期角膜生物力学变化特征

目的：探讨近视儿童配戴角膜塑形镜后早期角膜生物力学变化特征及相关因素。方法：前瞻性临床 研究。收集山东第一医科大学附属眼科医院2018年6月至2019年12月配戴角膜塑形镜的中低度近 视患者55例（109眼），男28例，女27例，年龄（12.1±3.7）岁，等效球镜度（SE）为（-2.97±1.56）D。 在配戴前及戴镜后1 d、1周、1个月，采用可视化角膜生物力学分析仪（Corvis ST）检查患者角膜生 物力学相关参数，如变形幅度比（DAR）、综合半径（IR）、水平方向Ambrosio相关厚度（ARTh）、硬 度参数（SP-A1）以及Corvis生物力学指数（CBI）；Pentacam检查角膜曲率；角膜光学相干断层扫描 （OCT）检查中央角膜厚度（CCT）和中央角膜上皮厚度（CET）。采用单因素方差分析比较不同时间 点角膜生物力学指标、屈光度和角膜形态的变化；采用Pearson检验进行各生物力学指标间的相关分 析。结果：所有患者在配戴角膜塑形镜后裸眼视力（UCVA）明显提高，1个月时均达到0 LogMAR。 CBI在配戴后1个月内逐渐上升，1个月时最高，配戴后1 d、1周、1个月较配戴前差异有统计学意义 （F=11.52, P<0.001）。IR在配戴后上升，1周时处于最高值，配戴前后比较差异有统计学意义（F=3.11, P=0.027）。ARTh在配戴后下降，1周时最低，配戴前后差异有统计学意义（F=29.82, P<0.001）。CBI 与SE呈正相关（r=0.21, P=0.003），与CET呈负相关（r=-0.16，P=0.041）；与CCT无明显相关性。结论： 儿童配戴角膜塑形镜后1个月内，角膜生物力学特性有下降趋势，主要的变化指标为CBI。SE越低， CET越厚；CBI改变越小，角膜的安全性越高。     

应用Corvis ST新参数分析圆锥角膜生物力学特性

目的：应用可视化角膜生物力学分析仪（Corvis ST）新参数分析临床期圆锥角膜、亚临床期圆锥角膜及正常角膜的生物力学特性,评价其在圆锥角膜诊断中的价值。方法：病例对照研究。选取2019年 1月至2021年1月在襄阳爱尔眼科医院就诊的圆锥角膜患者68例（68眼）,其中亚临床期圆锥角膜（SKC） 28例（28眼）为SKC组,临床期圆锥角膜（CKC）40例（40眼）为CKC组;选取同一时间段在本院屈光手术中心接受角膜屈光手术的近视患者60例（60眼）作为对照组。使用Corvis ST进行检测,分析变形幅度比（DAR）、综合半径（IR）、水平方向Ambrosio相关厚度（ARTh）、硬度参数（SP-A1）、Corvis 生物力学指数（CBI）等参数。采用方差分析、Kruskal-Wallis H检验、Mann-Whitney U检验对数据 进行统计分析,绘制受试者工作特征曲线（AUC）。结果：SKC组的IR、CBI高于对照组,差异有统 计学意义（U=2.461,P=0.042;U=2.450,P=0.043）,2组的DAR、ARTh、SP-A1差异无统计学意义; CKC组的DAR、IR、CBI均高于对照组,差异有统计学意义（U=7.645,P<0.001;U=8.477,P<0.001; U=8.965,P<0.001）,但ARTh、SP-A1低于对照组（U=-8.593,P<0.001;U=-7.517,P<0.001）。在 SKC组,IR、CBI具有较好诊断效率,其AUC分别为0.669（敏感度为50.0%、特异度为77.5%）、0.656 （敏感度为67.9%、特异度为60.0%）。在CKC组,DAR、IR、CBI具有良好诊断效率,其AUC分别为 0.956（敏感度为90.0%、特异度为93.3%）、0.968（敏感度为92.5%、特异度为91.7%）、1.000（敏感度 为100.0%、特异度为100.0%）。结论：SKC生物力学特性较健康角膜部分参数有改变,其中IR、CBI 对SKC具有较好的诊断效率;CKC生物力学特性较健康角膜明显改变,其中DAR、IR、CBI对KC均 具有良好的诊断效率。     

多媒体视觉训练系统治疗儿童弱视疗效观察

目的:探讨多媒体视觉训练系统治疗儿童弱视的效果。方法:采用"多媒体视觉训练系统"治疗4～14岁儿童弱视患者38例68眼,治疗时间1疗程(3mo),对弱视的类型、程度、注视性质、治疗年龄与疗效的关系进行观察。结果:治疗1疗程后有效51眼,总有效率75%,其中基本治愈15眼(22%),进步36眼(53%),无效17眼(25%)。屈光不正性弱视、轻度弱视、中心注视性弱视和年龄4～6岁的弱视治疗有效率最高。结论:多媒体视觉训练系统将弱视训练与电脑游戏相结合,使弱视训练较传统方法有较强的趣味性和娱乐性,提高了弱视儿童的治疗积极性和顺应性,其治疗效果与传统的治疗方法相同。     

Unilateral traumatic cataract in children

A survey is presented of the course of unilateral traumatic cataract in 15 children of 8 years of age and below, admitted consecutively to the Ophthalmological Department of the Odense University Hospital over a period of 9 years. The follow-up examination revealed that four patients had visual acuity of more than 6/18, and of these two retained binocular single vision and used contact lenses. The size of the material does not permit any conclusive statements to be made. Thus it is impossible to select the patients who will have either a good or a poor final result from the treatment, with regard to vision and binocular single vision.     

近视患者Corvis ST角膜生物力学参数与眼部其他生物测量参数的相关分析

目的　分析近视患者Corvis ST测得的角膜生物力学参数与眼部其他生物测量参数的相关性。方法　收集自2019年3月至12月于西安交通大学第一附属医院眼科就诊，拟行角膜屈光手术的192例近视患者的临床资料，全部选择右眼进行研究；年龄18～51岁，Corvis ST测得的眼压为13~17 mmHg（1 kPa=7.5 mmHg），等效球镜度（SE）为-1.50～-11.62 D。研究纳入Corvis ST测量的角膜变形基础参数包括:第一次压平速率（A1V)、第一次压平长度（A1L)、第一次压平时间(A1T)、第二次压平速率（A2V)、第二次压平长度(A2L)、第二次压平时间(A2T)、最大压陷时间（HCT）、最大压陷曲率半径（HCR）、最大压陷时两峰间距离（PD）；整合参数包括:2 mm处变形幅度的比值（DA 2 ratio）、综合半径（IR）、最薄点厚度/厚度变化率（ARTh）、第一次压平时角膜硬度参数（SP-A1）、Corvis生物力学指数（CBI）和生物力学/断层扫描地形图指数（TBI）。眼部其他生物测量参数包括:中央角膜厚度（CCT）、SE、眼轴长度（AL）、平均角膜前表面曲率（Km)、角膜水平直径（CD）。使用Spearman相关分析方法评估Corvis ST角膜生物力学参数与眼部其他生物测量参数的相关性。结果　CCT与除HCT之外的其他Corvis ST角膜生物力学参数均相关（均为P<0.05）；SE与A2L、A2V、PD、HCR、DA 2 ratio、IR均相关（均为P<0.05）；AL与A2T、HCT呈负相关，与A2V、PD呈正相关（均为P<0.05）；Km与PD、HCR、A2L均呈负相关（均为P<0.05）；CD仅与A1V、ARTh、CBI存在弱的相关性（均为P<0.05）；CBI仅与CCT、CD相关（均为P<0.05）；TBI仅与CCT相关（P<0.001）。结论　近视患者Corvis ST角膜生物力学参数与眼部其他生物测量参数存在相关性，在临床应用这些数据时需要综合考虑。     

Timing of uveitis onset in oligoarticular juvenile idiopathic arthritis (JIA) is the main predictor of severe course uveitis

Purpose: Aim of the present study was to validate a statistical model to predict a severe course of anterior uveitis (AU) in patients with juvenile idiopathic arthritis (JIA). Methods: Consecutive patients with newly diagnosed uveitis have been followed for at least 1 year with a standardized protocol. For each patient, demographic, clinical and laboratory characteristics, including time interval between arthritis and uveitis onset, α₂‐globulins level at arthritis onset, number of uveitis relapses/year, ocular complications and therapy and visual acuity, have reported. The validation procedure included the assessment of sensitivity, specificity and efficiency of previously published statistical model (Zulian et al. J Rheumatol 2002; 29: 2446–2453) in a new inception cohort of patients during a short length follow‐up. Results: Sixty patients with JIA, followed at 14 paediatric rheumatology–ophthalmology centres in Italy, entered the study. The mean age at arthritis onset was 4.4 years (range 1.2–15.8 years), and the mean interval time between arthritis and uveitis onset was 1.8 years (range: 0.0–14.2 years). After the first AU, patients, followed for a mean of 3.2 years, had a mean of 2.9 uveitis relapses. Twenty‐two patients (36.7%) presented at least one complication. Using a probability cut‐off value = 0.7, the statistical model revealed 80% sensitivity, 58% specificity and 65% efficiency. Conclusion: The time interval between arthritis and uveitis onset resulted as the main predictor of severe course uveitis in JIA. The statistical model was able to predict the development of a severe course in 8 of 10 patients.     

Comparative assessment of hemodynamic risk factors of glaucomatous optic neuropathy progress

Comparative evaluation of the significance of hemodynamic factors of risk of progress of glaucomatous optic neuropathy has been carried out: blood flow velocity, blood flow resistance, blood pressure in the orbital artery-central retinal artery system, perfusion ocular pressure in connection with stabilization of glaucomatous process, and intraocular pressure were analyzed for a period of up to 16 years. The most significant factors were blood pressure in the orbital artery-central retinal artery system and perfusion ocular pressure, but not blood flow velocity. The leading factor indicating the risk of progress of optic neuropathy in primary glaucoma is ocular perfusion pressure. Measurements of opthalmodynamometric pressure can be used for evaluation of perfusion pressure and recommended for wide clinical application for predicting the course of primary glaucoma.     

Drug delivery options for the treatment of ocular inflammation

Treatments available for ocular inflammatory diseases and their associated complications have expanded significantly over the course of the last ten years. While corticosteroids are a mainstay of therapy for uveitis and macular edema, the methods of delivering corticosteroids have evolved. Intravitreal triamcinolone acetonide provides a local therapy for persistent cystoid macular edema (CME) and posterior uveitis. Other intravitreal therapies, such as bevacizumab and methotrexate, have also been used successfully in uveitic CME. Sustained release intravitreal implants, including the fluocinolone acetonide implant and the dexamethasone drug delivery system, offer an alternative therapy for chronic, recalcitrant posterior uveitis and CME. Their design was inspired by the ganciclovir implant, which prevented the progression of CMV retinitis in AIDS patients. Technological advances in drug delivery have supplied new treatments for patients with ocular inflammatory disease.     

Drug Delivery Options for the Treatment of Ocular Inflammation

Treatments available for ocular inflammatory diseases and their associated complications have expanded significantly over the course of the last ten years. While corticosteroids are a mainstay of therapy for uveitis and macular edema, the methods of delivering corticosteroids have evolved. Intravitreal triamcinolone acetonide provides a local therapy for persistent cystoid macular edema (CME) and posterior uveitis. Other intravitreal therapies, such as bevacizumab and methotrexate, have also been used successfully in uveitic CME. Sustained release intravitreal implants, including the fluocinolone acetonide implant and the dexamethasone drug delivery system, offer an alternative therapy for chronic, recalcitrant posterior uveitis and CME. Their design was inspired by the ganciclovir implant, which prevented the progression of CMV retinitis in AIDS patients. Technological advances in drug delivery have supplied new treatments for patients with ocular inflammatory disease.     

Treatment of superior oblique paresis after posterior segment surgery

PURPOSE: The purpose of this study is to report our experience in the treatment of patients with paresis of the superior oblique after posterior segment surgery. PATIENTS: and method: Between 1997 and 1998, we cared for four cases at the ophthalmology department of the Casablanca University Hospital. All four patients were men (mean age 44 years, range 31-67 years) with vertical diplopia. Our management scheme was based on prismotherapy and intensive motor and sensory orthoptic rehabilitation. RESULTS: A satisfactory clinical course was achieved in 3 patients after a mean 20 rehabilitation sessions. In the last case with a cyclotorsion, surgery was required after failure of medical treatment. CONCLUSION: Our therapeutic scheme appears to be effective only in case of deficient verticality.     

Safety and efficacy of brimonidine in children with glaucoma.

PURPOSE: Brimonidine is a relatively selective alpha-agonist, which reduces intraocular pressure (IOP) by decreasing aqueous production and increasing uveoscleral outflow. Brimonidine passes through the blood-brain barrier, potentially causing central nervous system (CNS) toxicity. There have been reports of bradycardia, hypotension, hypothermia, hypotonia, and apnea in infants after topical brimonidine. METHODS: We reviewed the IOP data and side effects of children at the Duke University Eye Center placed on brimonidine from June 1997 to October 2000. Brimonidine 0.2% was used for patients whose glaucoma was uncontrolled on maximal tolerated medical therapy. A monocular trial was performed whenever possible, and brimonidine was not prescribed for infants. Included were 32 eyes of 30 patients with uncontrolled IOP and varied glaucoma diagnoses. RESULTS: The mean patient age was 10.5 years, with a mean follow-up on brimonidine of 10.8 months. Most patients were on other glaucoma medications. In 11 of the 32 eyes the IOP data could be interpreted, and in these eyes the IOP decreased from a mean of 22.5 +/- 4.9 mm Hg to a mean of 20.8 +/- 4.0 mm Hg (a mean decrease of 6.7% +/- 10%, P =.04) on brimonidine after a mean follow-up of 11.0 +/- 6.9 months. Two young children (ages 2.4 and 3.7 years) repeatedly were unarousable soon after the administration of brimonidine. Five other children experienced extreme fatigue after brimonidine administration. All symptoms resolved after brimonidine was discontinued. DISCUSSION/CONCLUSIONS: Brimonidine should be used with caution in young children because of the potential for CNS depression. In selected patients, brimonidine has a substantial ocular hypotensive effect.     

Polytetrafluoroethylene as a wrapping material for a hydroxyapatite orbital implant

PURPOSE: Porous coralline hydroxyapatite orbital implants have been used with great success in anophthalmic sockets. We used a substitute for donor sclera as a wrapping tissue. METHODS: Orbital implants were wrapped with polytetrafluoroethylene (PTFE) instead of homologous donor tissue in five patients after enucleation. RESULTS: The postoperative course was uneventful in three cases. Complications occurred in two cases: one with implant exposure, and one with severe implant infection leading to its eventual removal. CONCLUSIONS: PTFE is inferior to other wrapping tissue.     

正常角膜生物力学参数与角膜直径的相关性分析

目的　探究正常角膜生物力学指标与角膜直径的相关性。方法　前瞻性研究。选取2019年6月至2020年4月在云南省第二人民医院拟行角膜屈光手术的患者215例（215眼）为研究对象,中央角膜厚度为520~550 μm。所有患者均行Pentacam HR检测角膜水平直径（白到白）（HWTW）、角膜扩张综合偏差分析指数（BAD-D）;Corvis ST检测第一次压平硬度指数（SPA1）、综合半径（IR）、水平方向Ambrosio相关厚度（ARTh）、角膜顶点2 mm位置间形变幅度比（DAR）、角膜生物力学指数（CBI）,计算综合分析指数（TBI）。将HWTW与其他参数进行相关性分析。结果　共入选患者215例（215眼）,年龄（22.96±6.62）岁,其中HWTW≤11.0 mm者52眼,HWTW为11.1~11.5 mm者57眼,HWTW为11.6~12.0 mm者55眼,HWTW>12.0 mm者51眼。角膜直径为10.50~12.60（11.56±0.54）mm,CBI为0.00~0.98［0.09（0.01, 0.41）］,BAD-D为-0.04~2.36（1.05±0.51）,TBI为0.00~0.73［0.23（0.03, 0.35）］。HWTW与SPA1、ARTh均呈正相关（r=0.151,P=0.027;r=0.584,P=0.000）,与CBI、BAD-D、TBI均呈负相关（r=-0.437、-0.627、-0.338,均为P=0.000）。结论　CBI、BAD-D、TBI与角膜直径具有显著相关性,随着角膜直径的减小,CBI、BAD-D、TBI值增大,在角膜直径相对较小的中国人群中,应该充分考虑角膜直径对检测结果的影响。     

A 9 year-old girl with herpes simplex virus type 2 acute retinal necrosis treated with intravitreal foscarnet

A 9-year-old girl presented with a 2-week history of redness in the left eye. Examination revealed vitritis, retinal whitening, vasculitis, and optic nerve head edema. Polymerase chain reaction testing of the aqueous fluid revealed herpes simplex virus type 2. The retinitis was controlled with intravenous acyclovir and intravitreal foscarnet. The clinical course was complicated by retinal neovascularization and vitreous hemorrhage, which was treated by pars plana vitrectomy and endolaser. While there are few case reports of herpes simplex virus type 2 retinitis in children, this one is unique for the following reasons: it is the first reported case of herpes simplex virus type 2 retinitis in a child less than 10 years old without a previous history of neonatal infection or central nervous system involvement; no other children have been reported to have been treated with intravitreal foscarnet; and retinal neovascularization complicated the recovery.     

Photodynamic therapy in adult-onset foveomacular vitelliform dystrophy

CASE REPORT: We present the case of a patient who underwent photodynamic therapy (PDT) for adult-onset foveomacular vitelliform dystrophy (AFVD) at another clinic, having been misdiagnosed as having a choroidal neovascular membrane. Two years post-treatment, the patient had severe central visual loss and showed angiographic signs of choroidal hypoperfusion. DISCUSSION: AFVD is a rare clinical entity, usually having a fair visual prognosis, although some cases may show episodes of severe visual loss during their clinical course. Optical coherence tomography (OCT) is valuable in revealing the distinct images of AFVD from the features of a choroidal neovascular membrane. PDT using verteporfin may have negative long term effects if used in patients with AFVD.     

Contact lens status in ametropia correction:a prospective study

Background : Optical devices such as spectacles and contact lenses have been used to correct ametropia for many years. Recently, surgical means of correction such as photorefractive keratectomy have been introduced. All of these forms of correction are readily available in Saudi Arabia. The purpose of this study was to determine the proportion of contact lens use in ametropia correction. This survey also presents an insight into patient satisfaction with their correction and their willingness to change to another form of correction in the future. This will serve as a guide for eye care practitioners and manufacturers. Method : Five hundred and seventy four subjects responded to questionnaires randomly distributed among hospital patients, students and staff of King Saud University. Results : Data revealed that spectacle wearers constituted 74.5 per cent of the sample population, followed by contact lens wearers (21.8 per cent) and those who had undergone photorefractive keratectomy (3.7 per cent). On the whole, 50 per cent of the population sample would change to another form of correction. Among contact lens wearers, 9.5 per cent would prefer to change to PRK and 0.4 per cent to spectacles, while 17.9 per cent of spectacle wearers would consider changing to contact lenses. Conclusion : Contact lenses constitute a minor proportion of ametropia corrections. Spectacles remain the most popular form of ametropia correction at the moment, but for the future, there is greater tendency towards contact lenses and PRK.     

Features of the development of a welfare system for visually disabled people in Denmark

PURPOSE: To describe the development of a formal system of welfare for blind and partially sighted people in Denmark. METHODS: The principal laws in Denmark relating to a formal system of welfare for blind and partially sighted people are noted and commented on. No such collection of laws has been found in the literature. The history of aid to visually disabled people in Denmark is described, as are the Danish classifications of visual impairment. DEVELOPMENT: Formalized welfare for blind and partially sighted people was started in Denmark in 1811, as a private initiative by the Kjaede Order. Later, the Danish state took over responsibility, and in 1858 the Royal Danish Institute for the Blind was established. Since then a series of laws concerning welfare for blind and partially sighted people have been issued in accordance with economic and social development in Denmark. In 1858 the Braille writing system for blind people was introduced. The Danish Association of the Blind was founded in 1911 and has profoundly influenced subsequent legislation. During the last 10 years, several visual centres have been established. Since 1968 prevention of blindness has also played a prominent role in Denmark. CONCLUSION: Great steps have been taken towards improving the welfare of blind and partially sighted people. However, being blind is still very difficult. Modern technologies and hectic lifestyles have created new problems for blind people. The obligations of the Danish state towards visually disabled people have, therefore, increased in recent years.     

The accreditation of university teachers: an optometric viewpoint

The issue of whether university teachers should be required to gain a formal teaching qualification is currently under debate. In the United Kingdom, the development of an accreditation system for university teachers is well advanced. In the future, Australian university teachers may be required to either:

• 1 prove their teaching competency
• 2 undertake teaching courses as part of their induction program.

Of the current full-time academic staff of the optometry schools in Australia and New Zealand, about 15 per cent have undertaken university courses on higher education teaching: two of 10, one of 12, one of six and one of six for the optometry schools at the Queensland University of Technology, The University of New South Wales, The University of Melbourne and The University of Auckland, respectively. In terms of undergraduate optometry students' views, of those who responded (43 per cent of QUT third and fourth year students) to a survey on a range of teaching and learning issues, 20 out of 26 thought that a teaching qualification should be a requirement, while only six thought that it was not necessary. It has been suggested that an accredited training system is one way of ensuring that university teachers have the skills to deal with a dynamic teaching environment and the challenges of the future. The quality of teaching in universities has particular relevance to the optometric profession both in terms of undergraduate students and postgraduate experiences.     

长期配戴角膜塑形镜对患者角膜和视觉质量的影响

目的:探讨长期配戴角膜塑形镜对角膜形态、角膜生物力学以及客观视觉质量的影响。方法:回顾性研究。收集2019-10/2020-12在我院配戴角膜塑形镜2a的近视患者33例60眼,其中男19例35眼,女14例25眼,平均年龄11.80±1.51岁,平均等效球镜为-3.25±0.69D。收集患者配戴前和配戴2a时的相关数据资料。利用Pentacam三维眼前节分析系统测量角膜最薄点中心3mm区域前后表面曲率半径(ARC和PRC)、角膜最薄点厚度(THP)、角膜扩张综合偏差分析指数(BADD)。Corvis ST生物力学分析仪测量非接触生物力学校正眼压(bIOP)、最大形变幅度(DA)、最大反向半径(HCR)、顶点和1mm间形变幅度比值(DR)、硬度参数(SPA1)、角膜生物力学参数(CBI)。运用Pentacam与Corvis ST联合诊断系统分析得出断层扫描生物力学指数(TBI)。OQAS-Ⅱ客观视觉质量分析系统测量调制传递函数截止频率(MTF cutoff)、斯特烈尔比(SR)、客观散射系数(OSI)以及OV值(OV100%、OV20%和OV9%)。对患者配戴角膜塑形镜前和连续配戴角膜塑形镜2a的上述各项参数进行比较。结果:配戴角膜塑形镜2a与配戴前相比ARC增高、THP降低、BADD增高,比较有差异(t=-9.38、2.85、-13.08,均P<0.05),PRC与配戴前相比无差异(t=-1.49,P>0.05);配戴角膜塑形镜2a与配戴前相比DA增高、HCR降低,比较有差异(t=-2.37、2.28,均P<0.05),bIOP、DR、SPA1、CBI、TBI分别与配戴前相比无差异(t=1.36、-1.87、1.27、-0.95、-1.49,均P>0.05);配戴角膜塑形镜2a SR较配戴前增高,OV20%和OV9%较配戴前均降低,比较有差异(t=-5.31、8.37、2.34,均P<0.05),MTF cutoff、OSI、OV100%与配戴前相比无差异(t=-1.57、-1.35、1.11,均P>0.05)。结论:长期配戴角膜塑形镜改变角膜前表面形态,对角膜生物力学无明显影响,患者日间客观视觉质量提高,而夜间视觉质量下降。     

Optic-nerve gliomas, chiasmal gliomas and neurofibromatosis type 1

PURPOSE OF REVIEW: To review the most recent literature describing the natural history and disease progression patterns of optic-pathway gliomas in neurofibromatosis type 1 (NF1) patients. To aid in clarifying the current treatment patterns and follow-up recommendations. RECENT FINDINGS: Contrary to prior documentation, current literature reveals that optic-pathway gliomas in NF1 can be diagnosed after the age of 6, and may progress until the age of 12. The disease progression occurs most frequently in the first two years following diagnosis. SUMMARY: Optic-pathway gliomas in NF1 can display a variety of manifestations and exhibit an unpredictable disease course. No specific characteristics have been found thus far to predict an aggressive compared with indolent disease course. Recently primary diagnoses of optic-pathway gliomas have been made in children aged six or older, and have been shown to progress until the age of 12. Although large-scale studies are required to change current follow-up recommendations, the data suggest that NF1 patients should be vigilantly evaluated for optic-pathway gliomas past the age of 12.