Artificial intelligence-aided diagnosis and treatment in the field of optometry

With the rapid development of computer technology, the application of artificial intelligence (AI) to ophthalmology has gained prominence in modern medicine. As modern optometry is closely related to ophthalmology, AI research on optometry has also increased. This review summarizes current AI research and technologies used for diagnosis in optometry, related to myopia, strabismus, amblyopia, optical glasses, contact lenses, and other aspects. The aim is to identify mature AI models that are suitable for research on optometry and potential algorithms that may be used in future clinical practice.     

Amblyopia & Strabismus Questionnaire: design and initial validation

Literature on the benefits of screening and treatment of amblyopia emphasizes the costs of insufficiently treated amblyopic patients who lose their better eye. However, patients with insufficiently treated amblyopia and strabismus who do not lose their better eye only experience a slight decrease in their quality of life, and such patients occur more frequently. We designed and validated a questionnaire for amblyopia and strabismus in order to assess the decrease in quality of life of such patients. Complaints were collected from outpatients and reduced to five domains, pertaining to distance estimation, visual disorientation, problems with social contacts and cosmetic problems, diplopia, and fear of losing the better eye. For these domains 26 questions were formulated that constitute the Amblyopia & Strabismus Questionnaire (A&SQ). The A&SQ, the National Eye Institute Visual Function Questionnaire-25 (VFQ-25) and the Short Form-12 Health Survey (SF-12) were presented to 53 healthy controls, 68 outpatients and a cohort of 174 outpatients born between 1962 and 1972 and treated between 1968 and 1974 for amblyopia and strabismus. The quality of life was best in healthy controls and worst in current outpatients, not only on the SF-12 and the VFQ-25 but also on the A&SQ, demonstrating an acceptable construct validity of the A&SQ. The decrease in the quality of life as measured by the A&SQ was most outspoken in our outpatient group of amblyopia and strabismus patients, less in the cohort that had been treated 30 years previously and least in the healthy controls, demonstrating an acceptable discriminatory validity of the A&SQ.     

Botulinum toxin type A: new therapeutic directions

Intramuscular injections of botulinum toxin type A (BTX-A) have been used successfully to treat disorders such as cerebral palsy and cervical dystonia for many years. New and exciting directions for the toxin are currently under clinical investigation for a number of unlicensed indications including tension-type headache, myofascial pain and hyperhidrosis. Although research on BTX-A is prolific, there is still much to be learnt regarding the toxin's mode of action, clinical application and perhaps more importantly, its place in the overall treatment strategy implemented by physicians to ensure treatment is a success for both the patient and the physician. This review will focus on these issues, by outlining some of the future directions for BTX-A research.     

Traction Sutures in the Management of Long-Standing Third Nerve Palsy

PURPOSE: To determine the results of surgical exploration soon after orbital trauma in comparison with surgery half a year or longer after trauma. METHODS: A retrospective study was done on 41 patients with motility disorders after trauma. Full ophthalmologic and orthoptic investigation was done in all patients. CT-scans and/or X-ray photographs were also made. The 41 patients were divided into two groups. One group of 13 patients did not need surgical repair. One group of 28 patients needed an operation. RESULTS: In 13 patients there was an orbital fracture but no surgical repair was needed. In 28 patients surgical repair was done. In 8 patients the operation was performed half a year or longer after trauma, 15 patients underwent surgery within two weeks after trauma, and 5 patients within two months. CONCLUSION: The best final results were obtained when the operation was done soon after trauma; however, the results in the patients who were operated late were fairly good too.     

Orbital Cellulitis after Faden Operation on the Medial Rectus

Background Orbital cellulitis after strabismus surgery is uncommon, may cause blindness and may lead to death. Very few cases have been described in detail due to the low incidence of this complication. Methods We report the first case of orbital cellulitis following Faden operation on the medial rectus muscle. We believe that the infection was due to asymptomatic ethmoid sinusitis. Our case is compared with other cases previously reported. Results A two-year-old boy was surgically treated for residual esotropia after two botulinum toxin A injections. Two days after surgery, signs of orbital cellulitis developed in his right orbit. CT-scan disclosed right ethmoid sinusitis that spread to the orbit after surgery. After intravenous antibiotic treatment, the infection resolved with full restoration of visual acuity and ocular motility. Conclusion Despite adequate measures to prevent infection, orbital cellulitis may complicate strabismus surgery. Patients must be instructed to recognize early symptoms of this severe infection and call the surgeon immediately. Diagnosis may be confirmed by CT-scanning of the orbits. Prompt treatment with intravenous antibiotics usually leads to full recovery.     

Emmetropisation in normal and strabismic children and the associated changes of anisometropia

The purpose of this study was to measure whether emmetropisation failed in children who had strabismus irrespective of their refraction in infancy, and to record simultaneous changes in anisometropia. We also report how often hypermetropia increased before these children presented with esotropia. A total of 2920 infants had a cycloplegic retinoscopy at age 5-7 months and again at 42 months or when defective vision was identified. Changes of refraction in 210 children with strabismus are compared with the remaining 2710 who did not. When the spherical equivalent of the fixing eyes was > +2.75 D in infancy, hypermetropia decreased less in both eyes of those who had microtropia (p <. 001) and heterotropia (p <. 001) than in normal children. When it was < +2.75 D, the spherical and/or cylindrical refraction more often remained outside the ‘normal’ range in both eyes of those who had microtropia and heterotropia (p <. 05). Emmetropisation was deficient in both eyes of at least 80% of these strabismic children irrespective of their refraction in infancy. Furthermore, in the strabismic children, the mean change of refraction was less (p <. 05) in their fellow eyes than in their fixing eyes, the difference between the two eyes being on average three times greater than that in those who had normal vision. Thus, anisometropia increased in 53% of those who had strabismus but remained within normal limits (< ca. 0.75 D spherical equivalent) in 94 % of those who did not.‘Abormal’ anisometropia in infancy did not, per se, permanently affect vision because 72% of all those who had it did not have strabismus. Finally, the spherical hypermetropia of fixing eyes increased in only 35% of the children with esotropia – similar to the incidence in those who had a microtropia (p =. 36). This does not obviously support the concept that increasing hypermetropia causes accommodation to increase before convergence.     

Ophthalmic Manifestations in Children and Young Adults with Down Syndrome and Congenital Heart Defects

ABSTRACT

Purpose: To investigate whether different types of ocular manifestations are associated with congenital heart disease (CHD) in a large Caucasian population of children and young adults with Down syndrome (DS).

Methods: Population-based, case-control study which included 185 subjects with DS (mean age 13.2?±?7.9 years), who reported presence or absence of CHD; DS with CHD group (51 subjects, mean age 10.6?±?5.6 years) and DS without CHD (134 subjects, mean age 14.2?±?8.4 years).

Results: In our sample with DS and CHD, strabismus was found in 15 subjects (29.4%), nystagmus in 1 (2.0%), epiblepharon in 21 (41.2%) and Brushfield spots in 15 (31.3%). In the DS without CHD group, strabismus was found in 38 participants (28.4%), nystagmus in 13 (9.7%), epiblepharon in 31 (23.5%) and Brushfield spots in 21 (16.0%). Only the variables epiblepharon and presence of Brushfield spots differed significantly between the two groups (p?=?0.02 and p?=?0.03, respectively). Hyperopia was present in 26 participants (53.1%) in the DS with CHD group, and in 65 (57.0%) in the DS without CHD group. Oblique astigmatism was present in 25 (52.1%) in the DS with CHD group and in 61 (53.5%) in the DS without CHD group.

Conclusions: Frequencies of DS participants presenting with strabismus, nystagmus, hyperopia and oblique astigmatism were not statistically different between those with CHD and those without CHD in this sample. Further studies are needed to confirm if there are associations between the presence of Brushfield spots or epiblepharon and CHD in patients with DS.     

The Prevalence of Anisometropia,Amblyopia and Strabismus in Schoolchildren of Shiraz,Iran

Purpose: To determine the prevalence of amblyopia, anisometropia, and strabismus in schoolchildren of Shiraz, Iran.

Materials and Methods: A random cluster sampling was used in a cross-sectional study on schoolchildren in Shiraz. Cycloplegic refraction was performed in elementary and middle school children and high school students had non-cylcoplegic refraction. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded for each participant. Anisometropia was defined as spherical equivalent (SE) refraction difference 1.00D or more between two eyes. Amblyopia was distinguished as a reduction of BCVA to 20/30 or less in one eye or 2-line interocular optotype acuity differences in the absence of pathological causes. Cover test was performed for investigating of strabismus.

Results: Mean age of 2638 schoolchildren was 12.5 years (response rate?=?86.06%). Prevalence of anisometropia was 2.31% (95% confidence interval [CI], 1.45 to 3.16). 2.29% of schoolchildren (95% CI, 1.46 to 3.14) were amblyopic. The prevalence of amblyopia in boys and girls was 2.32% and 2.26%, respectively (p?=?0.945). Anisometropic amblyopia was found in 58.1% of the amblyopic subjects. The strabismus prevalence was 2.02% (95% CI, 1.18 to 2.85). The prevalence of exotropia and esotropia was 1.30% and 0.59%, respectively.

Conclusions: Results of this study showed that the prevalence of anisometropia, amblyopia, and strabismus are in the mid range. The etiology of amblyopia was often refractive, mostly astigmatic, and non-strabismic. Exotropia prevalence increased with age and was the most common strabismus type.     

About Natural Double Vision

Vitreoretinal surgery has long been recognized as a significant cause of secondary strabismus. These cases can be difficult to manage due to the previous surgery and the altered status of the visual function. External scleral buckling procedures are most commonly associated with its development; however recent research shows that pars plana vitrectomy procedures also have a risk of causing the condition. Many factors may play a role in the development of the strabismus: mechanical, extraocular muscle changes, local anesthetic administration, and sensory alteration. Treatment options include occlusion, prisms, botulinum toxin, and surgery. Vitreoretinal surgeons should be aware of the distinct of strabismus development following surgery. With increased recognition, the condition can be managed more effectively.     

An Audit of The Royal College of Ophthalmologists Strabismic Amblyopia Treatment Protocol: A Departmental Review

Introduction: Children presenting with strabismus and mixed (anisometropic/strabismic) amblyopia are managed by a local protocol as per guidelines from the Royal College of Ophthalmologists. Decisions regarding intervention for occlusion are currently delayed until a 22 week review allowing for refractive adaptation, with intermediate reviews at 6 and 14 weeks. Purpose: The purpose of this audit was to determine adherence to the protocol and the benefit of the 14 week review. Materials and Methods: We performed a prospective data collection of all children attending the orthoptic department with strabismus without pathology, both with and without unequal vision, from October 2007 to July 2008 managed using the protocol. Results: 26 patients were eligible. Mean age at presentation was 3.3 years (1.4 to 6.5). Cycloplegic spherical equivalent (SE) mean was 2.6 dioptres (?2.25 to +7.25). Five patients failed to comply with the protocol; one patient was listed surgery, four patients commenced premature occlusion. At presentation 8 patients had equal vision (defined as < 0.1 logMAR difference) between the two eyes or would only perform BEO vision, by week 14, over 60% were found to have a difference in vision between the eyes, despite refraction correction (mean 0.4 logMAR, range 0 to 1.4 logMAR). In a subgroup of patients (n = 8 at 6 weeks) with a small discrepancy of vision between the eyes (0.1 to 0.5 logMAR) there was no progressive worsening of vision during the period of observation and 50% of patients improved spontaneously, although two patients were lost to follow up. In the subgroup (n = 10 at 6 weeks) with a large discrepancy between the eyes (> 0.5 logMAR), all patients ultimately required occlusion, and there was minimal improvement in only three patients. Conclusion: Recorded vision at 6 weeks is more informative for making treatment decisions than that recorded at presentation. The 14 week review confers no benefit to those with reliable and improving visual acuity. Those patients presenting with a large discrepancy in visual acuity do not improve after 14 weeks and we feel that these patients could be occluded at 6 weeks. We propose a new algorithm for the treatment of this patient group.