Strabismus and Near Point of Convergence and Amblyopia in 4–6 Year-Old Children

Purpose: To determine the prevalence of strabismus and amblyopia, and the distribution of the near point of convergence (NPC), in a population of children aged 4 to 6 years.

Methods: In this cross-sectional study, preschoolers in Mashhad were sampled using a random multistage cluster sampling approach. Examinations were done after obtaining parental consent. All participants had measurements of uncorrected visual acuity, corrected visual acuity, and non-cycloplegic refraction, and they had near and far cover tests to determine tropia and phoria.

Results: Of the 3765 selected children, 3701 participated in the study. The prevalence of tropia was 1.21% (95% confidence interval [CI]: 0.86–1.57). Near and near/far tropia was observed in 0.83% (95% CI: 0.53–1.12) and 0.39% (95% CI: 0.18–0.59), respectively. Tropia was significantly more prevalent in boys (P=0.005). The most common type of tropia was esotropia, 0.22% (95% CI: 0.07–0.37). Among participants, 63.92% (95% CI: 62.36–65.48) had phoria; prevalence of far, near, and near/far phoria was 0.22% (95% CI: 0.07–0.37), 60.47% (95% CI: 58.88–62.07), and 3.22% (95% CI: 2.65–3.8), respectively. Mean NPC was 5.1 cm (95% CI: 5.05–5.14). NPC increased by 0.08 cm per month of age (P=0.033) and was 0.10 cm higher in boys compared to girls (P=0.027). Based on NPC, 61.58% (95% CI: 59.99–63.17) were symptomatic. The prevalence of amblyopia was 0.41% (95% CI: 0.20–0.61). The type of amblyopia was anisometropic, strabismic, and isoametropic in 75%, 11.1%, and 8.5%, respectively.

Conclusion: The prevalence of amblyopia in this study population was not high; however, the prevalence of tropia was average compared to previous studies in Iran. Describing NPC in a 4- to 6-year-old Iranian population for the first time, we found that NPC increased with age in this sample.     

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.     

Enterococcus faecalis Endophthalmitis in Children – A 21 Year Study

Purpose: To report Enterococcus faecalis endophthalmitis (EFE) in children and its comparison with adults.

Methods: Retrospective study of 19 children up to 18 years age, undergoing vitrectomy for EFE at a referral eye center from January 1995 to December 2015. The results were compared to 18 adults with EFE.

Results: The mean age was 7.4 ± 3.06 years. Post-traumatic EFE was seen in 17 (89.4%) children (p < 0.05) versus postoperative EFE seen in 12 (66%) adults. Broomstick 9 (52.9%) and hypodermic needle injury 6 (35.2%) were common associations. “Optimum functional outcome” was achieved in 12 (63.1%) eyes of children and 5 (27.7%) eyes of adults (p = 0.03). Sealed and Zone II wounds, lens, and needle injuries had good outcome whereas intervention after 3 days and retinal detachment had poor outcomes (p < 0.05). The was no correlation with the Ocular Trauma Score.

Conclusion: EFE in children is rare; seen with broom stick and needle injuries, if managed early recovers optimum vision.     

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.     

Ocular Disorders in Turkish Children with Sensorineural Hearıng Loss: A Cross-Sectional Study and Literature Review

Purpose: To investigate types and frequencies of ocular disorders in children with sensorineural hearing loss (SNHL), and to emphasize the importance of ophthalmological examination in these children. Methods: A retrospective analysis of the examination records of children examined in our instutititon between January 2011 and September 2014 was performed. Ocular disorders of children with SHNL were selectively reviewed. Results: Among 55340 patients, SNHL was present in 110 (0.2%). SNHL was bilateral in 104 patients (94.5%) and unilateral in 6 (5.5%). Ninety-one cases had congenital hearing loss (83%), and 19 (17%) had acquired SNHL. Forty cases (36%) had an ocular disorder, either refractive or non-refractive or both. Seventy cases (64%) had normal ocular examination. No difference was found between congenital or acquired SNHL cases in terms of possessing an ocular disorder (p=0.0962). The most common ocular abnormality was refractive error, mainly hypermetropia (21%). There was no significant difference between the prevalences of ocular abnormalities among cases with different lateralites or severities of SNHL (p=0.051, p=0.874, respectively). Twenty-six cases (23.6%) had SNHL as a component of a genetically defined syndrome. All of them had coexisting refractive or non-refractive ocular abnormalities. Some genetic, non-syndromic abnormalities, including Achondroplasia, Celiac disease, and focal segmental glomerulosclerosis, were diagnosed in four cases, among whom refractive errors and/or strabismus were detected. Conclusions: Due to the common coexistence of ocular problems and SNHL in children, ophthalmological screening is crucial. Families and healthcare providers should be informed about the critical role of ophthalmic assesment in these children for their future quality of life.     

A Comparison of Participants and Non-Participants in the Chennai Glaucoma Study—Rural Population

Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss and blindness in elderly Americans. The etiology of this condition remains unknown and treatment options are limited. Some epidemiological findings point to a cardiovascular risk profile among persons with AMD. Documented risk factors for cardiovascular disease (such as age, smoking, hypertension, hypercholesterolemia, post-menopausal estrogen use, diabetes, and dietary intake of fats, alcohol and antioxidants) have also been associated with AMD in some studies. This raises the possibility that the causal pathways for cardiovascular disease and AMD may share similar risk factors. Future research on this hypothesis could lead to important insights into etiologic factors for AMD. Research could also identify modifiable risk factors and suggest new treatment options which could prevent AMD, slow its progression, or reduce visual loss. Susceptible individuals could then be targeted for improved health promotion and disease prevention measures for this disabling and highly prevalent disorder.     

A Study of Immunoactivity of Retinal S—Antigen in Retinoblastoma

Purposese:To study retinal S-antigen expression in human retinoblastoma and as-sess if there is a correlation between S-antigen immunoactivity and degree of retinoblastoma cell differentiations.Methods:Ten cases of Chinese retinoblastoma parafin-embedded tissues were ap-plied for this thudy.A strain of monoclonal antibody,MabA9C6,Which defines an epitope in S-antigen retained in fixed-tissue sections,was used to study S-antigen expression in 10 cases of retinoblastomas.S-antigen was localized by the biotina-vidin indirect immunoperoxidase technique and purified MabA9C6 ascites fluid was used with1100dilution.The whole procedure could be finished within a few hours.Results:The S-antigen immunosctivity was observed in different pattterns:the“normal”photorecepto elements incorporated in 3cases of growing tumors;3of 4Fleurettes and E-W rosettes;and scattered tumor cells in50%of the cases.Conclusions:The result suggests that the expression of S-antigen in retinoblas-toma may be used to assess the degree of tumor differentiation as anothe tumor marker in retinoblastoma.     

Relationship between Refractive Error and Ocular Biomet-rics in Twin Children：the Guangzhou Twin Eye Study

Purpose:.A cross-sectional study was conducted to explore the relationship between refractive error and ocular biometrics in children from the Guangzhou twin eye study.Methods:.Twin participants aged 7...     

Use of Cataract Services in Eastern Africa—A Study from Tanzania

Purpose: To establish the proportion of patients who are blind or have low vision prior to undergoing cataract surgery at tertiary referral centers in Tanzania. To assess which patient groups presenting for cataract surgery are more likely to be blind or visually impaired. Methods: Using pre-existing computerized audit systems we gathered data on pre-operative visual status, age, gender and presentation mode (walk-in or outreach) for 3765 patients undergoing 4258 cataract operations at 2 hospitals in Tanzania. Visual status was defined based on vision in the better eye. Results: 32% of operations were performed on blind patients, 37% on patients with low vision and 31% on normally sighted patients. Predictors of blindness at presentation were: female sex (OR 1.15; 95% CI 1.00–1.32); referral from a rural outreach program (OR 1.75; 95% CI 1.51–2.02) and older age (OR 1.02; 95% CI 1.01–1.02). Conclusions: It is not only the blind who present to cataract services in Tanzania. The demand for surgery amongst patients who or are normally sighted represents a positive move towards prevention, and not only cure of cataract blindness in Tanzania. However, it also highlights the need to target those left blind from cataract in order to deliver services to those most in need. Cataract programs targeting patients in rural areas and older patients are likely to increase the number of blind patients benefiting from cataract services.     

Relationship between Refractive Error and Ocular Biomet- Fics in Twin Children： the Guangzhou Twin Eye Study

Purpose： A cross-sectional study was conducted to explore the relationship between refractive error and ocular biometrics in children from the Guangzhou twin eye study. Methods： Twin participants aged 7-15 years were selected from Guangzhou Twin Eye Study. Ocular examinations included vi- sual acuity measurement, ocular motility evaluation, autore- fraction under cycloplegia, and anterior segment, media, and fundus examination. Axial length （AL）, anterior chamber depth （ACD）, and corneal curvature radius were measured us- ing partial coherence laser interferometry. A multivariate linear regression model was used for statistical analysis.Results： Twin children from Guangzhou city showed a de- creased spherical equivalent with age, whereas both AL and ACD were increased and corneal curvature radius remained unchanged. When adjusted by age and gender, the data from 77% of twins presenting with spherical equivalent changes in- dicated that these were caused by predictable variables （RZ= 0.77, P〈0.001）. Primary factors affecting children＇s refraction included axial length （β=-0.97, P〈0.001 ）, ACD （β3=0.33, P〈 0.001）, and curvature radius （β=2.10,P〈0.001）. Gifts had a higher tendency for myopic status than did boys （β=-0.26,P〈 0.001）. Age exerted no effect upon the changes in refraction （β=-0.01, P=0.25）.     

Children’s Accommodation to a Variety of Targets – A Pilot Study

ABSTRACT

Background: Previous research indicates that a significant proportion of children underaccommodate at 1/3 m. Accommodation may vary with task demand, so children may accommodate appropriately if required, for example, when reading small print. This study explores the range of accommodative responses elicited in typical children, under naturalistic conditions, to a range of targets.

Method: We identified 24 typically developing children from the University of Reading Child Database. Primary-school children attending UK Year 2 (age 6-7 years) or Year 6 (age 10-11 years) with minimum distance visual acuity of 0.200 logMAR and near visual acuity of 0.100 logMAR were recruited for participation. A remote haploscopic photorefractor was used to assess naturalistic, sustained, binocular accommodative responses to a variety of targets. At 33 cm, accommodative targets included individual letters, age-appropriate text in large print equivalent to early primary-school books, small N5 equivalent print, a visual search task (“Where’s Wally?”), a clown picture containing a range of spatial frequencies, and a children’s cartoon. Participants were given minimal instructions for task completion. The target presentation order was counterbalanced. The results reported in this study were obtained during a longer testing session involving different target types and fixation distances.

Results: The accommodative response observed with each target varied across participants to both the clown target and single letters of a size used in school reading books the accommodative responses were 2.4±0.48 D (range 0.85-2.97 D) and 2.47±0.37 D (range 1.48-3.09 D), respectively. The accommodative response to N5 print (3.06±0.52 D) was statistically better than all other targets other than the visual search and larger print tasks (P<0.05).

Conclusions: Even to demanding N5 text, accommodation is variable between participants, but is better than that to less demanding targets. Tasks experienced by children in everyday or clinical situations will stimulate an unknown amount of accommodation for near fixation.     

Orbital Cellulitis in Children—Medical Treatment Versus Surgical Management

Introduction: Ophthalmologists differ in their threshold for surgical management in paediatric patients with orbital cellulitis. We studied the management choices and outcome of children admitted with this disorder. Material and Methods: A retrospective review was performed on patients with orbital cellulitis admitted between January 2001 and December 2004 to a tertiary paediatric referral centre in Singapore. The patients were studied for age, associated systemic disease, medical treatment, drainage procedure undertaken, organism isolated and outcome. Statistical methods were applied for comparing medical treatment with surgical treatment with respect to recovery time, recurrence, and time between the presentation of patient and initiation of treatment. Results: Twenty patients were studied. Average age was 5.5 years. 5/20 (25%) had a preceding history of upper respiratory tract infection. From CT findings, we came to know that 3/20 (15%) were due to isolated ethmoiditis, 5/20 (25%) had obstruction of the osteomeatal complex of the paranasal sinuses, 2/10 (10%) had intracranial abscesses due to frontal sinusitis. 4/20 (20%) had all 4 ipsilateral paranasal sinuses infected. 2/20 (10%) had preseptal cellulitis with posterior extension into the orbit. 2/20 (10%) had orbital cellulitis related to dacryoadenitis and 2/20 (10%) had pansinusitis with orbital soft tissue stranding. 13/20 (65%) had orbital and /or endoscopic drainage. The remainder of the patients had good immediate response to sole medical treatment and did not require surgery. The most commonly isolated organism was Staphylococcus aureus 5/20 (25%). All patients recovered within a mean of 9.6 days with no complications or functional deficit. Conclusions: Paediatric orbital cellulitis can be treated conservatively or with surgical drainage. Indications for surgery include pansinusitis, large abscesses with significant mass effect, concurrent intracranial involvement, poor response to initial medical treatment and the presence of an orbital abscess and gas. Sole medical treatment worked well in children with no orbital abscess, small or medial abscesses as they tend to have a single organism infection. This is also of particular significance in young children below the age of one where endoscopic surgery can be technically difficult. Intracranial involvement occurred in association with frontal sinusitis and affected patients had the longest duration of hospitalization.     

A Study on HSV—1Corneal Potential Infection by in Situ Nucleic Acid hybridization

Purpose:To evaluate the possibility of HSV-1 corneal latency by in situ nucleic acid hybridization in animal models.Methods: 20 normal New Zealand White (NEW) rabbits were used, 14 of them were inoculated bilaterally with 3×10 PFU/ml of McKrae strain HSV-1 by in-trastromal injection. 22/28 eyes developed typical herpes simplex keratitis(HSK) diseases. At 60 day postoperation(PI) , 4 latent corneas were transplanted to one eye of 4 noninfected NZW rabbits and removed 2 weeks PI. Corneas at all time intervals of infection and two weeks after PKP were detected for presence of HSV-1 antigen and nucleic acid sequences by using clonal IgG HSV-1 antibody and biotinylated HSV-1 DNA probe individually.Results: The results showed that the HSV-1 DNA sequences were retained within the corneal epithelium and anterior stromal keratocytes during acute diseases, while the corneas during latent infection and postoperation, the HSV-1 DNA sequences were retained only within the stromal layer with negative HSV-1 antigne s     

The Influence of Parental Myopia on Children’s Myopia in Different Generations of Parent-Offspring Pairs in South Korea

Purpose: To compare the heritabilities of myopia and high myopia across three different generations in Korea. Methods: Parent-offspring pairs of different age groups were included: two parents and their offspring aged 10–19 (“young families”), two parents and their offspring aged 20–29 (“middle-aged families”), and two parents and their offspring aged 30–45 (“older families”) were selected from the 2008–2012 Korea National Health and Nutrition Examination Survey. Variance component methods were used to obtain the heritability estimates for myopia and high myopia using parent-offspring pairs from three generations. Spherical equivalents measured in the right eyes were used. Results: From the 2008–2012 data, 2,716, 1,211, and 477 offspring from 1,807 young, 956 middle-aged, and 434 older families were eligible for the study, respectively. For myopia, the additive genetic portion of phenotypic variance was smaller in the younger families (74.7% in the older families, 48.1% in the middle-aged families, and 40.1% in the young families), and the non-shared environmental portion was greater in the younger families (12.4% in older families, 24.9% in middle-aged families, and 46.5% in young families). In contrast, for high myopia, the additive genetic portion remained roughly constant at approximately 60% in all three generations. Conclusions: With myopia, the environmental portion of the phenotypic variance increased and the additive genetic portion decreased as South Korea became more urbanized. With high myopia, the additive genetic portion remained roughly constant at approximately 60%, despite the urbanization.     

A Study of Histology and Enzymatic Histochemistry on Rabbit‘s Retina in Acute Ocular Hypertension

The changes of activities of enzymes relating to energy metabolism in rabbit‘s retina in acute ocular hypertension were observed. The activities of succinate dehydrogenase and adenosine triphosphatase were found to be reduced, while the activities of the lactatic dehydrognease and glucose-6-phosphatase increased. The results revealed the metabolic disturbance of energy in retina after acute ocular hypertension might be the underlying factors relating to the defects of the functions and structures of the...