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Fangusaro J, Avery RA, Fisher MJ, Packer RJ, Walsh KS, Schouten-van Meeteren A, Karres D, Bradford D, Bhatnagar V, Singh H, Kluetz PG, Donoghue M, Duke ES. Considering Functional Outcomes as Efficacy Endpoints in Pediatric Low-Grade Glioma Clinical Trials: An FDA Educational Symposium. Clin Cancer Res 2024; 30:2303-2308. [PMID: 38358393 PMCID: PMC11147731 DOI: 10.1158/1078-0432.ccr-23-3386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/22/2023] [Accepted: 02/13/2024] [Indexed: 02/16/2024]
Abstract
In October 2022, the FDA Oncology Center of Excellence hosted an educational symposium entitled, "Considering Functional Outcomes as Efficacy Endpoints in Pediatric Low-Grade Glioma (pLGG) Clinical Trials." The symposium brought together patient advocates, regulators from the FDA and the European Medicines Agency (EMA), and an international group of academic thought leaders in the field of pediatric neuro-oncology to discuss the potential role of functional outcomes, including visual acuity, motor function, and neurocognitive performance, as endpoints in clinical trials enrolling patients with pLGG. The panel discussed challenges and opportunities regarding the selection, implementation, and evaluation of clinical outcome assessments in these functional domains and outlined key considerations for their inclusion in future clinical trial design and role in new drug development.
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Affiliation(s)
- Jason Fangusaro
- Children's Hospital of Atlanta, Emory University and the Aflac Cancer Center, Atlanta, Georgia
| | - Robert A Avery
- The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michael J Fisher
- The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Roger J Packer
- Center for Neuroscience and Behavioral Medicine and Brain Tumor Institute, Children's National Hospital, and The George Washington University School of Medicine, Washington, DC
| | - Karin S Walsh
- Center for Neuroscience and Behavioral Medicine and Brain Tumor Institute, Children's National Hospital, and The George Washington University School of Medicine, Washington, DC
| | | | - Dominik Karres
- Pediatric Medicines Office, Scientific Evidence Generation Department, Human Medicines Division, European Medicines Agency (EMA), Amsterdam, the Netherlands
| | - Diana Bradford
- Center for Drug Evaluation and Research, Office of New Drugs, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Vishal Bhatnagar
- Center for Drug Evaluation and Research, Office of New Drugs, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Harpreet Singh
- Center for Drug Evaluation and Research, Office of New Drugs, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Paul G Kluetz
- Center for Drug Evaluation and Research, Office of New Drugs, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Martha Donoghue
- Center for Drug Evaluation and Research, Office of New Drugs, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Elizabeth S Duke
- Center for Drug Evaluation and Research, Office of New Drugs, U.S. Food and Drug Administration, Silver Spring, Maryland
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Drews-Botsch C, Cotsonis G, Celano M, Hartmann EE, Zaidi J, Lambert SR. Patching in Children With Unilateral Congenital Cataract and Child Functioning and Parenting Stress. JAMA Ophthalmol 2024:2817342. [PMID: 38635258 DOI: 10.1001/jamaophthalmol.2024.0800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Importance Parents may be concerned about the adverse outcomes of occlusion therapy in children treated for unilateral congenital cataract (UCC). Objective To determine whether occlusion therapy in children treated for UCC with poor visual outcomes is negatively associated with poorer child and/or family functioning. Design, Setting, and Participants This cohort study was conducted in 2023 using data collected between 2006 and 2016 in the Infant Aphakia Treatment Study (IATS). IATS participants with a visual acuity (VA) of 20/200 or worse were included. Statistical analysis was performed from July 2022 to October 2023. Exposure Caregivers reported the mean daily minutes of patching during the 12 months prior to the VA assessment at 4.5 years of age. Patching was categorized as minimal (<15 minutes per day), moderate (15 to <120 minutes per day), or extensive (≥120 minutes per day). Main Outcome Measures At 4.25 and 10.5 years of age, caregivers reported stress associated with the parenting role using the Parenting Stress Index and the Ocular Treatment Index and child behavior problems using the Achenbach Child Behavior Checklist. Motor skills were assessed at age 54 months using the Movement Assessment Battery for Children-Second Edition. Children completed the Harter Self-Perception Profile for Children at age 10.5 years. One-way analysis of variance and χ2 tests were used to compare outcomes by amount of patching. Results Patching data were available for 47 of 53 children (88.7%) with a VA of 20/200 or worse. Among these 47 children with patching data included in the study, 20 (42.5%) were female, 27 (57.5%) were male, 12 (25.5%) were reported to have been patched fewer than 15 minutes per day, 11 (23.4%) were patched 16 to 119 minutes per day, and 24 (51.1%) were patched at least 120 minutes per day. Parenting stress, child behavior problems, motor functioning, and child self-perception were similar in all groups. For example, after adjusting for gender and insurance status, there was a nonsignificant difference between mean stress scores of 11.0 (95% CI, -4.5 to 26.5) points for parents who reported minimal patching vs parents who reported patching at least 120 minutes per day, and there was no significant difference in children's report of their global self-worth (0.0 [95% CI, -0.4 to 0.3] points). Conclusions and Relevance Occlusion therapy was not negatively associated with family or child functioning. Although the sample size was limited, these results do not support changes to the current practice guidelines.
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Affiliation(s)
- Carolyn Drews-Botsch
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Marianne Celano
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - E Eugenie Hartmann
- Rebecca D. Considine Research Institute and Vision Center, Akron Children's Hospital, Akron, Ohio
| | - Jaffer Zaidi
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
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Farassat N, Jehle V, Heinrich SP, Lagrèze WA, Bach M. The Freiburg Acuity Test in Preschool Children: Testability, Test-Retest Variability, and Comparison With LEA Symbols. Transl Vis Sci Technol 2024; 13:14. [PMID: 38502142 PMCID: PMC10959192 DOI: 10.1167/tvst.13.3.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 01/24/2024] [Indexed: 03/20/2024] Open
Abstract
Purpose To determine the testability, performance, and test-retest variability (TRV) of visual acuity (VA) assessment using the Freiburg Visual Acuity Test (FrACT) compared to the LEA Symbols Test (LEA) in preschool children. Methods In 134 preschool children aged 3.0 to 6.8 years, monocular VA of each eye was measured twice with a four-orientation Landolt C version of the FrACT and once with the LEA. FrACT runs were preceded by a binocular run for explanatory purposes. Test order alternated between subjects. Optotypes were presented on a computer monitor (FrACT) or on cards (LEA) at a distance of 3 m. Results Overall, 68% completed the FrACT (91/134 children) and 88% completed the LEA (118/134 children). Testability depended on age: FrACT, 19% (<4 years) and 87% (≥4 years); LEA, 70% (<4 years) and 95% (≥4 years). Mean ± SD VA difference between tests was 0.11 ± 0.19 logarithm of the minimum angle of resolution [logMAR], with LEA reporting better acuity. The difference depended on age (0.27 ± 0.23 logMAR [<4 years], 0.09 ± 0.18 logMAR [≥4 years], P < 0.001) and on test sequence (higher age dependence of FrACT VAs for LEA first, P < 0.001). The 95% limits of agreement for the FrACT TRV were ±0.298 logMAR. Conclusions The examiner-independent FrACT, using international reference Landolt C optotypes, can be used to assess VA in preschool children aged ≥4 years, with reliability comparable to other pediatric VA tests. Translational Relevance Use of the automated FrACT for VA assessment in preschool children may benefit objectivity and validity as it is a computerized test and employs the international reference Landolt C optotype.
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Affiliation(s)
- Navid Farassat
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Vanessa Jehle
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sven P. Heinrich
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolf A. Lagrèze
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Bach
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Rosenthal E, O’Neil J, Hoyt B, Howard M. Inter-Rater Reliability of EyeSpy Mobile for Pediatric Visual Acuity Assessments by Parent Volunteers. Clin Ophthalmol 2024; 18:235-245. [PMID: 38283182 PMCID: PMC10822126 DOI: 10.2147/opth.s440439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/14/2023] [Indexed: 01/30/2024] Open
Abstract
Purpose To assess the inter-rater test reliability of the EyeSpy Mobile visual acuity smartphone algorithm when administered to children by eye professionals and parent volunteers. Patients and Methods Visual acuity test-retest results were analyzed for 106 children assigned to one of three different screenings: (1) An eye technician and pediatric ophthalmologist using their typical visual acuity testing method on a M&S computer; (2) An eye technician and pediatric ophthalmologist using EyeSpy Mobile; (3) An eye technician and parent volunteer using EyeSpy Mobile. Results All three phases demonstrated a strong agreement between the two testers, with mean test-retest equivalency results within 0.05 logMAR (2.5 letters, 90% CI). Whether testing using their typical technique on an M&S computer or using EyeSpy Mobile, eye professionals obtained statistically closer mean test-retest results than parent volunteers by 1 letter, with equivalency results within 0.03 logMAR (1.5 letters, 90% CI). Conversely, the number of retests within 2 vision lines was statistically greater when EyeSpy mobile was used by parents as compared to eye professional's customary technique on the M&S computer. Conclusion EyeSpy Mobile provides clinically useful visual acuity test-retest results even when used by first-time parent volunteers. Adaptive visual acuity algorithms have the potential to improve reliability, lessen training requirements, and expand the number of vision screening volunteers in community settings.
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Affiliation(s)
- Elyssa Rosenthal
- Department of Ophthalmology, Phoenix Children’s, Phoenix, AZ, USA
| | - James O’Neil
- Department of Ophthalmology, Phoenix Children’s, Phoenix, AZ, USA
| | - Briggs Hoyt
- Department of Ophthalmology, Loyola University Medical Center, Maywood, IL, USA
| | - Matthew Howard
- Cleveland Clinic Neurology Residency Program, Cleveland Clinic, Cleveland, OH, USA
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Lambert SR. What we have learned from the Infant Aphakia Treatment Study: The 49th Annual Frank D. Costenbader Lecture. J AAPOS 2023; 27:253-258. [PMID: 37716436 PMCID: PMC10591921 DOI: 10.1016/j.jaapos.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/08/2023] [Indexed: 09/18/2023]
Abstract
Unilateral congenital cataracts lead to deprivation amblyopia, which can be severe. Until the 1970s, they were believed to be always associated with poor visual outcomes. However, advances in our understanding of the plasticity of the infant brain and the development of better surgical techniques allowed good visual outcomes to be obtained in a few of these patients. The Infant Aphakia Treatment Study (IATS) was conducted to provide empirical evidence regarding the best type of optical correction to be used following surgical extraction of the cataract. Specifically, infants were randomly assigned to either be left aphakic and to wear contact lenses or an intraocular lens (IOL) was implanted and the residual refractive error was corrected with spectacles. The study found that good visual acuity and stereopsis could be achieved in some patients in both treatment groups. Early cataract surgery, consistent optical correction and part-time patching of the fellow eye are important elements needed to achieve good visual outcomes. However, excess patching of the fellow eye may interfere with the development of stereopsis. More adverse events occurred after IOL implantation, particularly visual axis opacification, compared with the infants who were left aphakic. Glaucoma-related adverse events occurred in 40% of eyes after a 10-year follow-up and were not associated with IOL implantation. Further research is needed to increase the percentage of children with unilateral congenital cataracts who achieve good visual outcomes.
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Affiliation(s)
- Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.
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Kelly KR, Kumar K, Jost RM, Cheng-Patel CS, Dao LM, Luu B, Stager D, Birch EE. Objective assessment of control compared with clinical triple office control score in children with intermittent exotropia. J AAPOS 2023; 27:291-293. [PMID: 37730158 DOI: 10.1016/j.jaapos.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 09/22/2023]
Abstract
Poor control of intermittent exotropia may be used as an indication for surgery. However, control fluctuates during the day and from day to day. The standardized triple office control score (mean of three scores on a 6-point ordinal scale) is representative of repeated assessments throughout the day, but lacks validation against an objective measure of eye movements. We report the agreement between the triple office control score measured by the referring eyecare professional and lab-measured vergence instability using an EyeLink video eye tracker. Near and distance triple office control scores were moderately correlated with vergence instability. Near, but not distance, triple office control score was moderately correlated with the percentage of time intermittent exotropia was manifest during EyeLink recording. Larger triple office control scores for intermittent exotropia provide a meaningful description of larger vergence instability, supporting its use in clinical decisions and as a measure in clinical trials.
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Affiliation(s)
- Krista R Kelly
- Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas
| | | | - Reed M Jost
- Retina Foundation of the Southwest, Dallas, Texas
| | | | | | - Becky Luu
- Pediatric Ophthalmology & Adult Strabismus, Plano, Texas
| | - David Stager
- Pediatric Ophthalmology & Adult Strabismus, Plano, Texas
| | - Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas.
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Hernández-Andrés R, Luque MJ, Serrano MÁ, Scally A, Barrett BT. Factors affecting the benefit of glasses alone in treating childhood amblyopia: an analysis of PEDIG data. BMC Ophthalmol 2023; 23:396. [PMID: 37770832 PMCID: PMC10540398 DOI: 10.1186/s12886-023-03116-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND To evaluate factors associated with better outcomes from optical treatment alone in amblyopic children from 3 up to 7 years. METHODS Data extracted from two studies with similar protocols, Amblyopic Treatment Studies 5 (n = 152) and 13 (n = 128) from the Pediatric Eye Disease Investigator Group database, were used to determine by regression analysis the factors associated with improvements in visual acuity in the amblyopic eye, inter-ocular visual acuity difference and stereoacuity. Input variables were aetiology of amblyopia (anisometropic, strabismic and combined-mechanism amblyopia), treatment compliance, visual acuity, interocular visual acuity difference, stereoacuity, tropia size at distance and near, age and refractive error at baseline. RESULTS Despite the range of clinical factors considered, our models explain only a modest proportion of the variance in optical treatment outcomes. The better predictors of the degree of optical treatment success in amblyopic children are visual acuity of the amblyopic eye, interocular visual acuity difference, stereoacuity, treatment compliance and the amblyopic eye spherical-equivalent refractive error. While the aetiology of the amblyopia does not exert a major influence upon treatment outcome, combined-mechanism amblyopes experience the smallest improvement in visual acuity, tropia and stereoacuity and may need longer optical treatment periods. CONCLUSIONS While results identify the factors influencing optical treatment outcome in amblyopic children, clinicians will be unable to predict accurately the benefits of optical treatment in individual patients. Whether this is because relevant clinical or non-clinical factors (e.g. nature and volume of daily activities undertaken) influences the outcomes from optical treatment has not yet been identified and remains to be discovered.
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Affiliation(s)
- Rosa Hernández-Andrés
- Department of Optics and Optometry and Vision Science, University of Valencia, Doctor Moliner, 50, 46100, Burjassot, Spain.
| | - María Josefa Luque
- Department of Optics and Optometry and Vision Science, University of Valencia, Doctor Moliner, 50, 46100, Burjassot, Spain.
| | - Miguel-Ángel Serrano
- Department of Psychobiology, University of Valencia, Avda. Blasco Ibañez, 13, 46010, Valencia, Spain
| | - Andrew Scally
- School of Clinical Therapies, University College Cork, College Road, T12 K8AF, Cork, Republic of Ireland
| | - Brendan T Barrett
- School of Optometry & Vision Science, Phoenix South West Building, University of Bradford, BD7 1DP, Bradford, West Yorkshire, UK
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Birch EE, Morale SE, Jost RM, Cheng-Patel CS, Kelly KR. Binocular amblyopia treatment improves manual dexterity. J AAPOS 2023; 27:18.e1-18.e6. [PMID: 36567045 PMCID: PMC9974856 DOI: 10.1016/j.jaapos.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine whether deficits in manual dexterity in children with amblyopia improve after binocular amblyopia treatment and whether improvements are related to age at treatment, baseline sensory status, or amount of improvement in sensory status with treatment. METHODS Manual dexterity (Movement Assessment Battery for Children-2), visual acuity, fusion, suppression, and stereoacuity were measured at baseline and after 4-8 weeks of binocular amblyopia in 134 children with amblyopia, including 75 children in the "younger group" (aged 3 to <7 years) and 59 in the "older group" (aged 7-10 years), and in 40 age-similar control children. RESULTS Baseline manual dexterity standard scores of amblyopic children were significantly below those of controls in both the younger (8.81 ± 0.33 vs 11.80 ± 0.60 [P < 0.0001]) and older groups (7.19 ± 0.34 vs 9.75 ± 0.57 [P = 0.00013]). After 4-8 weeks of binocular amblyopia treatment, the younger group standard score improved to 9.85 ± 0.35 and the older group improved to 8.08 ± 0.39, but both groups remained significantly lower than controls (P = 0.03 and P = 0.01, resp.). Improvement in manual dexterity standard score was not associated with any baseline factors but was weakly correlated with the amount of visual acuity improvement (rs = 0.26; 95% CI, 0.09-0.41) CONCLUSIONS: Manual dexterity impairments are common among children with amblyopia. In our study cohort, binocular amblyopia treatment improved visual acuity and manual dexterity.
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Affiliation(s)
- Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | | | - Reed M Jost
- Retina Foundation of the Southwest, Dallas, Texas
| | | | - Krista R Kelly
- Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
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Anderson HA, Mathew AR, Cheng H. Evaluation of the SpotChecks contrast sensitivity test in children. Ophthalmic Physiol Opt 2023; 43:64-72. [PMID: 36164764 PMCID: PMC10087722 DOI: 10.1111/opo.13054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of this study was to determine intrasession repeatability of a worksheet style contrast sensitivity test (SpotChecks) in children and agreement with an established contrast sensitivity test (Pelli-Robson). METHODS Forty-three children aged 4 to 12 years participated in this single visit study that included two administrations of the SpotChecks binocularly, a single administration of the Pelli-Robson test and other measures of visual performance such as high-contrast visual acuity. Test order was randomised, and participants wore their habitual correction (39 unaided, 4 wearing glasses) for testing. Bland-Altman plots were used to assess the test-retest repeatability of SpotChecks and its agreement with the Pelli-Robson test. Multiple linear regressions were performed to evaluate whether contrast sensitivity was related to participant characteristics such as age, sex and near binocular visual acuity. RESULTS The mean difference in log contrast sensitivity (logCS) between two administrations of the SpotChecks was 0.01, with a coefficient of repeatability (1.96*SD of differences) of 0.14 logCS. The mean difference between SpotChecks and Pelli-Robson was 0.00 logCS with 95% limits of agreement of -0.19 to +0.20. For both tests, a statistically significant increase in logCS was associated with age (slopes were 0.02 logCS/year, p < 0.001 and 0.01 logCS/year, p = 0.02 for the SpotChecks and Pelli-Robson tests, respectively). CONCLUSIONS The SpotChecks test shows good intrasession repeatability and excellent agreement with the Pelli-Robson test in children. Contrast sensitivity showed an increase in logCS with age in children for both tests.
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Affiliation(s)
| | | | - Han Cheng
- College of Optometry, University of Houston, Houston, Texas, USA
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Hepler LE, Martin SJ, Fuglseth K, Cuddihee L, Giannulis P, Arnold RW. Acuity Comparison Methods via Timed Test-Retest Precision of Matching-Card e-ETDRS Compared to PDI Check in Treated Amblyopes and Superb Normals. CLINICAL OPTOMETRY 2023; 15:81-95. [PMID: 37159586 PMCID: PMC10163880 DOI: 10.2147/opto.s409358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/26/2023] [Indexed: 05/11/2023]
Abstract
Purpose Existing and emerging visual acuity methods like dynamic and dichoptic presentation, preferential looking and eye tracking promise to afford better and earlier assessment in children with and without amblyopia so we propose methods needed to easily evaluate and compare their metrics. Subjects and Methods Patients older than 8 years with treated amblyopia and superb vision (logMAR -0.1 to -0.3) normals performed timed, patched eETDRS with Sloan matching card at 3.00 m and PDI Check dichoptic near rivalry dynamic test to demonstrate test re-Test and compared disparate acuity with intraclass correlation (ICC) and Bland Altman 95% limits of agreement (LOA) to generate a simple method of qualifying acuity test matching. Results 26 amblyopic patients and 11 superb-vision normals performed eETDRS retest, PDI Check retest and combined ICC of 0.98, 0.60 and 0.27, respectively, and Bland Altman LOA of 0.24, 2.06 and 2.28 logMAR. The time to test one eye with eETDRS had median (interquartile range; IQR) duration of 280 (205 to 346) seconds, while the PDI Check autostereoscopic dichoptic for both eyes only took 39 (30 to 47) seconds. Optimum ICC and LOA for visual acuity comparison should be >0.95 and <0.3 logMAR, whereas "good" ICC and should be 0.75-0.89 ICC and 1.0-1.49 logMAR LOA. Conclusion Superb vision subjects (logMAR < -0.1) and treated amblyopic patients confirmed optimum comparable eETDRS, and fair test re-Test PDI Check but suppression on near dichoptic testing confirmed disparity compared to optimized eETDRS distance acuity.
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Affiliation(s)
- Lucas E Hepler
- College of Osteopathic Medicine, Pacific Northwest University, Yakima, WA, USA
| | - Samuel J Martin
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Kennedy Fuglseth
- College of Osteopathic Medicine, Pacific Northwest University, Yakima, WA, USA
| | - Laney Cuddihee
- Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USA
| | - Peter Giannulis
- Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USA
| | - Robert W Arnold
- Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USA
- Correspondence: Robert W Arnold, Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, 3500 Latouche #280, Anchorage, AK, 99508, USA, Tel +1907561-1917, Fax +1907563-5373, Email
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Kelly KR, Norouzi DM, Nouredanesh M, Jost RM, Cheng-Patel CS, Beauchamp CL, Dao LM, Luu BA, Stager DR, Tung JY, Niechwiej-Szwedo E. Temporal Eye–Hand Coordination During Visually Guided Reaching in 7- to 12-Year-Old Children With Strabismus. Invest Ophthalmol Vis Sci 2022; 63:10. [DOI: 10.1167/iovs.63.12.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Krista R. Kelly
- Retina Foundation of the Southwest, Dallas, TX, United States
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, United States
| | | | - Mina Nouredanesh
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Reed M. Jost
- Retina Foundation of the Southwest, Dallas, TX, United States
| | | | | | - Lori M. Dao
- ABC Eyes Pediatric Ophthalmology, PA, Dallas, TX, United States
| | - Becky A. Luu
- Pediatric Ophthalmology & Adult Strabismus, PA, Plano, TX, United States
| | - David R. Stager
- Pediatric Ophthalmology & Adult Strabismus, PA, Plano, TX, United States
| | - James Y. Tung
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Ontario, Canada
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Birch EE, Jost RM, Hudgins LA, Morale SE, Donohoe M, Kelly KR. Dichoptic and Monocular Visual Acuity in Amblyopia. Am J Ophthalmol 2022; 242:209-214. [PMID: 35738394 PMCID: PMC9847578 DOI: 10.1016/j.ajo.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Standard-of-care assessment for children with amblyopia includes measuring amblyopic eye best-corrected visual acuity (AE BCVA) with the fellow eye occluded. By definition, this abolishes the interocular suppression fundamental to amblyopia. Thus, measured AE BCVA may not accurately represent that eye's contribution to natural binocular viewing. We compared dichoptic and monocular AE BCVA and examined whether any differences were associated with eye-hand coordination or reading speed. DESIGN Cross-sectional study. METHODS Dichoptic and monocular AE BCVA of children aged 6-12 years (42 with amblyopia, 24 with recovered normal AE BCVA, 30 control) were measured. Stereoacuity, suppression, eye-hand coordination, and reading speed were also assessed. RESULTS Overall, 81% of amblyopic children had worse dichoptic than monocular AE BCVA (mean difference=0.15±0.11 logMAR; P < .0001), and 71% of children with recovered normal AE BCVA had worse dichoptic than monocular AE BCVA (mean difference = 0.20±0.17 logMAR, P < .0001). Controls had no significant difference. The difference between dichoptic and monocular AE BCVA was correlated with performance in standardized aiming/catching (r = -0.48, 95% CI -0.72, -0.14) and manual dexterity tasks (r = -0.37, 95% CI -0.62, -0.06), and with reading speed (r = -0.38, 95% CI -0.65, -0.03). CONCLUSIONS Dichoptic AE BCVA deficits were worse than monocular AE BCVA deficits and were associated with reduced stereoacuity and suppression, consistent with the hypothesis that binocular dysfunction plays a role. Further, impaired eye-hand coordination and slow reading were associated with dichoptic, but not monocular, AE BCVA. Some children with amblyopia may benefit from extra time for school tasks requiring eye-hand coordination or reading.
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Affiliation(s)
- Eileen E Birch
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.).
| | - Reed M Jost
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.)
| | - Lindsey A Hudgins
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.)
| | - Sarah E Morale
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.)
| | - Matthew Donohoe
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.)
| | - Krista R Kelly
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.)
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13
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Brin TA, Xu Z, Zhou Y, Feng L, Li J, Thompson B. Amblyopia is associated with impaired balance in 3–6-year-old children in China. Front Neurosci 2022; 16:993826. [PMID: 36213736 PMCID: PMC9544236 DOI: 10.3389/fnins.2022.993826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/05/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose School-age children in China have more advanced motor development than their North American counterparts. This is likely due to cultural differences in children’s regular motor activities. It is unknown whether the motor function impairments associated with binocular visual disorders (BVDs) such as amblyopia in children raised in North America exist for children raised in China. Design Prospective case-control study. Methods A major tertiary eye hospital in China tested children aged 3 to <7 (n = 63) belonging to three groups: anisometropic or strabismic amblyopia (n = 22), anisometropia or strabismus without amblyopia (n = 20), or controls (n = 21). The main outcome measure was motor function scores (Movement Assessment Battery for Children 2nd edition). Results Balance scores varied significantly across groups (F2,61 = 4.2, p = 0.02) with the amblyopia group (mean ± SD: 12.5 ± 3.0) exhibiting significantly poorer scores than controls (14.8 ± 2.3). The no-amblyopia BVD group (12.8 ± 3.1) did not differ significantly from the other groups. Manual dexterity, catching and throwing and total scores did not vary significantly across the three groups. A separate pre-planned comparison of only the amblyopia and control groups revealed significantly poorer total motor scores in the amblyopia group (10.1 ± 3.2) vs. controls (12 ± 2.4). A linear regression model was unable to significantly predict associations between total motor score and binocular function score (standardized β = −0.09, 95%, p = 0.7), amblyopia etiology (standardized β = 0.14, 95%, p = 0.4), or inter-ocular acuity difference (standardized β = −0.18, 95%, p = 0.4), in the amblyopia group. Conclusion Amblyopia is associated with motor function impairment in children raised in China. Motor deficits that may impact everyday activities have been observed in patients with amblyopia across multiple cultures.
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Affiliation(s)
- Taylor A. Brin
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Zixuan Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yusong Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lei Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jinrong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Jinrong Li,
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
- Center for Eye and Vision Research Limited, Hong Kong, Hong Kong SAR, China
- Liggins Institute, University of Auckland, Auckland, New Zealand
- *Correspondence: Benjamin Thompson,
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14
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Goldstein JE, Guo X, Boland MV, Smith KE. Visual Acuity – Assessment of Data Quality and Usability in an Electronic Health Record System. OPHTHALMOLOGY SCIENCE 2022; 3:100215. [PMID: 36275199 PMCID: PMC9574716 DOI: 10.1016/j.xops.2022.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 08/19/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022]
Abstract
Objective To examine the data quality and usability of visual acuity (VA) data extracted from an electronic health record (EHR) system during ophthalmology encounters and provide recommendations for consideration of relevant VA end points in retrospective analyses. Design Retrospective, EHR data analysis. Participants All patients with eyecare office encounters at any 1 of the 9 locations of a large academic medical center between August 1, 2013, and December 31, 2015. Methods Data from 13 of the 21 VA fields (accounting for 93% VA data) in EHR encounters were extracted, categorized, recoded, and assessed for conformance and plausibility using an internal data dictionary, a 38-item listing of VA line measurements and observations including 28 line measurements (e.g., 20/30, 20/400) and 10 observations (e.g., no light perception). Entries were classified into usable and unusable data. Usable data were further categorized based on conformance to the internal data dictionary: (1) exact match; (2) conditional conformance, letter count (e.g., 20/30+2-3); (3) convertible conformance (e.g., 5/200 to 20/800); (4) plausible but cannot be conformed (e.g., 5/400). Data were deemed unusable when they were not plausible. Main Outcome Measures Proportions of usable and unusable VA entries at the overall and subspecialty levels. Results All VA data from 513 036 encounters representing 166 212 patients were included. Of the 1 573 643 VA entries, 1 438 661 (91.4%) contained usable data. There were 1 196 720 (76.0%) exact match (category 1), 185 692 (11.8%) conditional conformance (category 2), 40 270 (2.6%) convertible conformance (category 3), and 15 979 (1.0%) plausible but not conformed entries (category 4). Visual acuity entries during visits with providers from retina (17.5%), glaucoma (14.0%), neuro-ophthalmology (8.9%), and low vision (8.8%) had the highest rates of unusable data. Documented VA entries with providers from comprehensive eyecare (86.7%), oculoplastics (81.5%), and pediatrics/strabismus (78.6%) yielded the highest proportions of exact match with the data dictionary. Conclusions Electronic health record VA data quality and usability vary across documented VA measures, observations, and eyecare subspecialty. We proposed a checklist of considerations and recommendations for planning, extracting, analyzing, and reporting retrospective study outcomes using EHR VA data. These are important first steps to standardize analyses enabling comparative research.
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Affiliation(s)
- Judith E. Goldstein
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
- Correspondence: Judith E. Goldstein, OD, 600 N Wolfe Street, Baltimore, MD 21287.
| | - Xinxing Guo
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Michael V. Boland
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Kerry E. Smith
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
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15
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Redmayne JK, Russell HC. Real-World Application of Home Visual Acuity Testing for Pediatric Teleophthalmology During the COVID-19 Pandemic. J Pediatr Ophthalmol Strabismus 2022; 59:296-302. [PMID: 35192379 DOI: 10.3928/01913913-20220131-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To review the ability of home visual acuity testing during teleophthalmology consultations to accurately assess visual acuity in pediatric patients in a real-world setting. METHODS This was a retrospective study of pediatric patients who were examined via teleophthalmology consultation due to the coronavirus disease 2019 (COVID-19) pandemic-related community restrictions between May and June 2020 at a single private ophthalmology practice. Home visual acuity findings were compared with the subsequent in-person assessment to determine agreement between measures. RESULTS Forty-three patients (86 eyes) were included in the study. The mean patient age at the time of teleophthalmology assessment was 75.9 months (range: 29 to 173 months). The correlation between home visual acuity findings and subsequent in-person assessment across all participants was 0.56 (P < .001). The upper and lower limits of agreement were 0.38 logarithm of the minimum angle of resolution (logMAR) units and -0.33 logMAR. The correlation reduced to 0.46 (P = .013) in patients younger than 5 years and increased to 0.70 (P < .001) in patients 8 years and older. CONCLUSIONS Home visual acuity assessment for teleophthalmology is of increased clinical value in older pediatric patients. In-person assessment by a trained clinician is the optimal method to determine visual acuity. Because home visual acuity assessment may be necessitated by local and global factors, further research is required regarding the optimal methods for assessment, particularly in younger patients. [J Pediatr Ophthalmol Strabismus. 2022;59(5):296-302.].
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16
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South J, Gao T, Calderwood M, Turuwhenua J, Roberts P, Lee A, Collins A, Black J. Measuring aniseikonia and investigating neuroplasticity and image factors in amblyopia (MAGNIFY): study protocol for a randomised clinical trial. Trials 2022; 23:358. [PMID: 35478070 PMCID: PMC9044861 DOI: 10.1186/s13063-022-06159-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/07/2022] [Indexed: 11/26/2022] Open
Abstract
Background Aniseikonia represents a potential barrier to neuroplasticity which may limit visual outcomes in children with anisometropic amblyopia. Full correction of refractive error is the first step in standard amblyopia treatment, which corrects for image focus but neglects image size differences. Methods The MAGNIFY study is a double-masked, randomised clinical trial investigating the effectiveness of aniseikonia correcting lenses in children at first diagnosis of significant anisometropia. We hypothesis that aniseikonia correction lenses will improve image clarity and reduce the retinal size differences producing better visual acuity and stereoacuity improvements after 15 weeks of optical treatment for children with anisometropia. Eligible children will be randomly allocated to the treatment group (aniseikonia-correcting spectacle lenses) or control group (standard spectacle lenses). Visual acuity and binocular functions will be assessed every 5 weeks during the 15-week optical treatment phase according to standard amblyopia treatment protocol. Discussion It is possible that correcting aniseikonia along with anisometropia at first diagnosis will promote binocularity as well as increase spectacle adherence by reducing visual discomfort, improving optical treatment outcomes. This could then reduce the need for additional amblyopia treatment such as patching or atropine, reducing the burden on hospital eye departments and potentially improving visual outcomes for children with amblyopia. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000061932. Registered on 24 January 2020. Protocol 15th November 2019, version one. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06159-2.
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Affiliation(s)
- Jayshree South
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.
| | - Tina Gao
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Melinda Calderwood
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Jason Turuwhenua
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.,School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Paul Roberts
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.,Medlink Innovation Limited, Auckland, New Zealand
| | - Arier Lee
- Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Andrew Collins
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Joanna Black
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
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17
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Birch EE, Hudgins LA, Jost RM, Cheng-Patel CS, Morale SE, Kelly KR. Web-based visual acuity testing for children. J AAPOS 2022; 26:61.e1-61.e5. [PMID: 34920136 PMCID: PMC9086078 DOI: 10.1016/j.jaapos.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/10/2021] [Accepted: 11/21/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate a newly developed, web-based system for at-home pediatric visual acuity testing and to compare results with standard in-office visual acuity test results. METHODS Children aged 3-12 years with and without visual deficits were enrolled (N = 65; 130 eyes). Monocular visual acuity was tested in-office using the ATS-HOTV (ages 3-6) or E-ETDRS (ages 7-12) protocol. Each child's family was emailed a link to a web-based version of the same visual acuity test for at-home testing. Equivalence was evaluated by using a linear mixed model to estimate the mean difference between in-office and at-home visual acuity test results and the corresponding two-sided 95% confidence interval. RESULTS For children tested with the ATS-HOTV protocol, the mean difference between in-office and at-home visual acuity test results was 0.01 log MAR (95% CI, -0.06 to 0.09). For children tested with the E-ETDRS protocol, the mean difference was 0.04 log MAR (95% CI, -0.06 to 0.14). CONCLUSIONS At-home, web-based ATS-HOTV and E-ETDRS visual acuity test results had excellent concordance with in-office visual acuity testing. If the burden of travel is significant, at-home testing of children's visual acuity may provide the information needed to continue care when it might otherwise be discontinued or delayed.
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Affiliation(s)
- Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | | | - Reed M Jost
- Retina Foundation of the Southwest, Dallas, Texas
| | | | | | - Krista R Kelly
- Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
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18
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Randomized clinical trial of streaming dichoptic movies versus patching for treatment of amblyopia in children aged 3 to 7 years. Sci Rep 2022; 12:4157. [PMID: 35264692 PMCID: PMC8905014 DOI: 10.1038/s41598-022-08010-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/01/2022] [Indexed: 11/14/2022] Open
Abstract
Contrast-rebalanced dichoptic movies have been shown to be an effective binocular treatment for amblyopia in the laboratory. Yet, at-home therapy is a more practical approach. In a randomized clinical trial, we compared dichoptic movies, streamed at-home on a handheld 3D-enabled game console, versus patching as amblyopia treatment. Sixty-five amblyopic children (3–7 years; 20/32–125) were randomly assigned to one of two parallel arms, binocular treatment (3 movies/week) or patching (14 h/week). The primary outcome, change in best corrected visual acuity (BCVA) at the 2-week visit was completed by 28 and 30, respectively. After the primary outcome, both groups of children had the option to complete up to 6 weeks of binocular treatment. At the 2-week primary outcome visit, BCVA had improved in the movie (0.07 ± 0.02 logMAR; p < .001) and patching (0.06 ± 0.01 logMAR; p < 0.001) groups. There was no significant difference between groups (CI95%: − 0.02 to 0.04; p = .48). Visual acuity improved in both groups with binocular treatment up to 6 weeks (0.15 and 0.18 logMAR improvement, respectively). This novel, at-home, binocular movie treatment improved amblyopic eye BCVA after 2 weeks (similar to patching), with additional improvement up to 6 weeks. Repeated binocular visual experience with contrast-rebalanced binocular movies provides an additional treatment option for amblyopia. Clincaltrials.gov identifier: NCT03825107 (31/01/2019).
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19
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Avery RA, Go C, Fisher MJ, Liu GT, Garcia A, Richter M, McGeehan B, Quinn GE, Ying GS. Comparison of Visual Acuity Results Between ATS-HOTV and E-ETDRS Testing Methods in Children With Optic Pathway Gliomas. Transl Vis Sci Technol 2022; 11:10. [PMID: 35262649 PMCID: PMC8934565 DOI: 10.1167/tvst.11.3.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose To determine if visual acuity (VA) outcomes are comparable using the amblyopia treatment study HOTV protocol (ATS-HOTV) and electronic Early Treatment of Diabetic Retinopathy Study (E-ETDRS) protocol in children with optic pathway gliomas (OPGs). Methods Children enrolled in a prospective study of OPGs were eligible if they completed both the ATS-HOTV and E-ETDRS during the same visit. The contribution of age, testing order, having neurofibromatosis type 1, visual field loss, and circumpapillary retinal nerve fiber layer thickness to VA difference were assessed using generalized estimating equations to account for the intereye correlation. Results Forty-eight children (median age, 10.3 years; range, 5.2-17.1 years; 49% female) met inclusion criteria and contributed 93 study eyes at their initial visit. Eleven patients (22 eyes) had more than one study visit, permitting longitudinal evaluation. ATS-HOTV measures of VA were higher than E-ETDRS at the initial (0.13 ± 0.36 vs. 0.23 ± 0.39 logarithm of the minimum angle of resolution [logMAR], P < 0.001) and all visits (0.13 ± 0.34 vs. 0.21 ± 0.36 logMAR, P < 0.001). VA remained significantly higher with ATS-HOTV regardless of test order, but the mean difference between tests was most profound when tested with ATS-HOTV first compared to E-ETDRS first (P < 0.001). Conclusions VA results differ significantly between the ATS-HOTV and E-ETDRS testing methods in children with OPGs. Given the wide range of ages and testing ability of children, one VA testing method should be used throughout longitudinal OPG clinical trials. Translational Relevance It is imperative that age-appropriate VA testing methods are standardized across all pediatric OPG clinical trials.
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Affiliation(s)
- Robert A. Avery
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA,Department of Ophthalmology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Cammille Go
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael J. Fisher
- Division of Neuro-Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Grant T. Liu
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA,Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Arielle Garcia
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Meg Richter
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brendan McGeehan
- Department of Ophthalmology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Graham E. Quinn
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gui-Shuang Ying
- Department of Ophthalmology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Visual acuity and refractive findings in children prescribed glasses from a school-based vision program. J AAPOS 2021; 25:344.e1-344.e7. [PMID: 34752908 DOI: 10.1016/j.jaapos.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/25/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE We report visual acuity improvement and refractive profiles in children prescribed glasses by a school-based vision program (SBVP) in Baltimore, Maryland. METHODS In this cross-sectional analysis, pre-kindergarten through 8th grade students who failed vision screening underwent an eye examination. Students prescribed glasses are included. Visual acuity improvement was the difference between presenting and best-corrected visual acuity based on noncycloplegic manifest refraction. Clinically significant refractive error (CSRE) was defined as ≥0.75 D myopia, ≥2.00 D hyperopia without strabismus, ≥1.00 D hyperopia with esodeviation, or ≥1.50 D astigmatism AND presenting visual acuity ≤20/40 or ≥2-line interocular difference with the better-seeing eye ≤20/30. Characteristics associated with greater visual acuity improvement were explored. RESULTS Of the 4,972 students, mean age was 9.4 ± 2.7 years; 77% were black, and 18% were Hispanic. Myopia, hyperopia, astigmatism, and CSRE were found in 65%, 24%, 60%, and 46% students, respectively. In the better-seeing eyes, 70% gained ≥2 lines. Of students with CSRE, improvement of at least 5 lines in the worse-seeing eye increased from 30.9% in pre-kindergarten and kindergarten to 77.3% in 7th and 8th grade (Ptrend < 0.001). Students with CSRE had a higher rate of gaining at least 2 lines' improvement in their worse-seeing eyes compared with those without (98.7% vs 80.6%). Older students as well as black and Hispanic students were more likely to have improvement of at least 2 lines. CONCLUSIONS Most students prescribed glasses from our SBVP had clinically significant visual deficits corrected.
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21
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Hertle RW, Kelleher C, Bruckman D, McNinch N, Ricker I, Bouhenni R, Wiseman K. Analysis of anomalous head posturing in patients with infantile nystagmus syndrome. J AAPOS 2021; 25:145.e1-145.e5. [PMID: 34087474 DOI: 10.1016/j.jaapos.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate anomalous head posturing in patients with INS. METHODS This was a prospective, cohort analysis of clinical and anomalous head posture (AHP) data in 34 patients with INS and an AHP. Particular outcome measures included measurement of AHP in three dimensions of pitch (anterior posterior flexion/extension), yaw (lateral rotation), and roll (lateral flexion) during best-corrected binocular acuity testing and during their subjective sense of straight. Patients were also queried as to their subjective sense of head posture in forced straight position and in their preferred AHP. The paired t test was used to determine significance in differences between measures. RESULTS A total of 34 patients (19 males [56%]) 9-56 years of age (mean, 16.5 ± 6) were included. Associated systemic or ocular system deficits were present in 30 patients (88%). AHP during best-corrected visual acuity testing averaged 16.5° ± 8.20° (range, 10°-51°), which was significantly different from the mean voluntary "comfortable" position only in the pitch and roll directions (P < 0.001). There was a significant noncongruous response during subjective response to head posturing with most sensing their head as "crooked" (76.5%) when manually straightened (P = 0.001). CONCLUSIONS The clinical AHP of patients with INS exists in all three spatial dimensions of pitch, yaw, and roll. Although the visual system may be causally related to the onset, amount, and direction of a compensatory AHP in patients with INS, its persistence over time or after surgical intervention is likely due to a combination of visual system (eg, nystagmus, strabismus) and nonvisual system (egocentric and musculo-skeletal) factors.
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Affiliation(s)
- Richard W Hertle
- Akron Children's Hospital Vision Center, Akron, Ohio; The Considine Research Institute, Akron Children's Hospital, Akron, Ohio; Northeast Ohio Medical College, Rootstown, Ohio.
| | - Cecily Kelleher
- Akron Children's Hospital Vision Center, Akron, Ohio; The Considine Research Institute, Akron Children's Hospital, Akron, Ohio
| | - David Bruckman
- Center for Populations Health Research, Cleveland Clinic, Cleveland, Ohio
| | - Neil McNinch
- The Considine Research Institute, Akron Children's Hospital, Akron, Ohio
| | - Isabel Ricker
- Akron Children's Hospital Vision Center, Akron, Ohio; The Considine Research Institute, Akron Children's Hospital, Akron, Ohio
| | - Rachida Bouhenni
- Akron Children's Hospital Vision Center, Akron, Ohio; The Considine Research Institute, Akron Children's Hospital, Akron, Ohio; Northeast Ohio Medical College, Rootstown, Ohio
| | - Kelly Wiseman
- Akron Children's Hospital Vision Center, Akron, Ohio; The Considine Research Institute, Akron Children's Hospital, Akron, Ohio
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22
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Pang Y, Allen M, Robinson J, Frantz KA. Contrast sensitivity of amblyopic eyes in children with myopic anisometropia. Clin Exp Optom 2021; 102:57-62. [PMID: 30054940 DOI: 10.1111/cxo.12817] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/15/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Yi Pang
- Illinois College of Optometry, Chicago, Illinois, USA
| | - Megan Allen
- Illinois College of Optometry, Chicago, Illinois, USA
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Findlay R, Black J, Goodman L, Chelimo C, Grant CC, Anstice N. Diagnostic accuracy of the Parr vision test, single crowded Lea symbols and Spot vision screener for vision screening of preschool children aged 4-5 years in Aotearoa/New Zealand. Ophthalmic Physiol Opt 2021; 41:541-552. [PMID: 33813777 DOI: 10.1111/opo.12816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 03/05/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Preschool children in New Zealand undergo vision screening to detect amblyopia at 4-5 years of age. The current test, the Parr vision test, does not meet international visual acuity chart guidelines and has not been validated against other commonly used paediatric vision tests. New Zealand vision screening protocols are also not targeted for detecting other eye conditions such as uncorrected refractive error, which may affect school performance. We compared the Parr vision test with the single crowded Lea symbols and the Spot vision screener for detecting ocular pathology, refractive error and amblyopic risk factors in preschool children. METHODS A cross-sectional diagnostic accuracy study recruited children aged 4-5 years via convenience sampling from the University of Auckland Optometry Clinic and through primary schools in Auckland, New Zealand. Participants received vision screening with the three different instruments administered by a lay screener. Comprehensive eye examinations were completed by a paediatric optometrist to determine the presence of vision disorders. RESULTS Of 197 children who received a comprehensive eye examination, 14 (7.1%) had amblyopic risk factors and 43 (21.8%) had significant refractive error (15.7% with astigmatism, 9.1% with hyperopia). The sensitivity for detecting any ocular condition did not differ significantly between the tests (50.0% for Parr, 43.5% for Lea, 42.5% for Spot). Specificity was significantly lower for the Parr vision test (80.8%) than for the Lea symbols (93.4%) and Spot vision screener (98.0%). Adding the Spot vision screener to measurements of visual acuity significantly improved sensitivity in detecting any ocular condition with the Parr vision test (67.5% for Parr/Spot vs 50% for Parr alone), but not with the Lea symbols (52.5% for Lea/Spot vs 43.5% for Lea alone). CONCLUSION The sensitivity of the Parr vision test for detecting ocular conditions in preschool children does not vary significantly from that achieved by the Lea symbols or the Spot vision screener. However, current New Zealand vision screening protocols could be improved by expanding the target conditions to include significant refractive error and incorporating the use of the Spot vision screener to increase the accuracy with which children with refractive error are identified. Future research should include longitudinal studies to determine the effect of preschool vision screening on later ocular and academic outcomes.
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Affiliation(s)
- Rebecca Findlay
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Joanna Black
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Lucy Goodman
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Carol Chelimo
- Department of Paediatrics - Child and Youth Health, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Cameron C Grant
- Department of Paediatrics - Child and Youth Health, School of Medicine, University of Auckland, Auckland, New Zealand.,General Paediatrics, Starship Children's Hospital, Auckland, New Zealand
| | - Nicola Anstice
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand.,Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
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Hertle RW, Curtis M, Boydstun I, Juric A, Evliyaoglu F, Ricker I. Clinical and Electrophysiological Outcomes After Eye Muscle Surgery in 81 Adults With Infantile Nystagmus Syndrome. J Pediatr Ophthalmol Strabismus 2021; 58:93-104. [PMID: 34038269 DOI: 10.3928/01913913-20210105-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To characterize the effects of eye muscle surgery on patients older than 18 years with infantile nystagmus syndrome (INS) who have had only optical treatment. METHODS This was a prospective, single-center, interventional case series analysis of clinical and electro-phyisological data before and after surgery. Outcome measures included: clinical characteristics, surgical procedure, and preoperative and postoperative binocular best corrected visual acuity (BCVA) in the null position, anomalous head posture (AHP), contrast sensitivity, strabismic deviation, and nystagmus acuity function (NAFX). Postoperative data used were collected for a minimum of 12 months after surgery. Parametric and non-parametric statistical analysis of the outcome measures was performed. RESULTS Ages ranged from 18 to 72 years (average: 36 years) and follow-up from 12 to 74 months (average: 26 months). A surgical algorithm of nine separate procedures involving at least two recti muscles on each eye was used for each patient. Most patients had associated systemic and/or ocular diagnoses, including albinism (35%), amblyopia (23%), optic nerve or retinal disorders (48%), refractive error (80%), AHP (44%), aperiodicity (27%), and strabismus (69%). There were no serious surgical complications, with a reoperation rate of 12%. There were significant group mean increases in BVCA, AHP, contrast sensitivity, strabismic deviation, and NAFX after surgery. Sixty percent of patients who were legally ineligible for driving prior to surgery became eligible after eye muscle surgery. CONCLUSIONS Adult patients with INS showed sustained improvement in many afferent and efferent measures of visual function after eye muscle surgery. [J Pediatr Ophthalmol Strabismus. 2021;58(2):93-104.].
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Morale SE, Jost RM, Hunter JS, Weakley DR, Birch EE. Normative Values, Testability, and Validity for a New Preferential Looking Stereoacuity Test. J Binocul Vis Ocul Motil 2021; 71:29-34. [PMID: 33555995 DOI: 10.1080/2576117x.2021.1874776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Age norms and testability for 3-5 year old children have been reported for the PASS III stereotest using a pointing response. We aimed to expand the normative data to children as young as 6 months, assess testability, and evaluate validity use of the PASS III as a preferential-looking test for younger children and children with special needs. Methods: 68 control children, 362 children with eye conditions, and 167 children with special needs were tested with the PASS III. Percent testable was calculated for children with and without special needs, normal tolerance limits were determined, and test validity was assessed. Results: In controls, mean PASS III stereoacuity improved from 371 arcsec at 12 months to 174 arcsec at 24 months, and 87 arcsec at 36 months. Testability in the 12, 24, and 36 months age groups were 81%, 87%, and 97% respectively and 92% for special needs children. Comparison to previously published norms and testing in a known nil stereoacuity cohort supported PASS III test validity. Compared to gold standard stereoacuity tests, accuracy of the PASS was 89%. Conclusion: Overall, preferential-looking tests using the PASS III provide a sensitive and specific measure of stereoacuity with high testability for young children and children with special needs.
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Affiliation(s)
- Sarah E Morale
- Pediatric Vision Laboratory, Retina Foundation of the Southwest , Dallas, Texas
| | - Reed M Jost
- Pediatric Vision Laboratory, Retina Foundation of the Southwest , Dallas, Texas
| | | | - David R Weakley
- Department of Ophthalmology, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Eileen E Birch
- Pediatric Vision Laboratory, Retina Foundation of the Southwest , Dallas, Texas.,Department of Ophthalmology, University of Texas Southwestern Medical Center , Dallas, Texas
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Kelly KR, Morale SE, Beauchamp CL, Dao LM, Luu BA, Birch EE. Factors Associated with Impaired Motor Skills in Strabismic and Anisometropic Children. Invest Ophthalmol Vis Sci 2021; 61:43. [PMID: 32845292 PMCID: PMC7452850 DOI: 10.1167/iovs.61.10.43] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We evaluated motor skills in children diagnosed with strabismus and anisometropia, with or without amblyopia, and explored factors associated with impairments. Methods A total of 143 strabismic and anisometropic children 3 to 13 years of age (96 amblyopic, 47 nonamblyopic) and a group of age-similar 35 control children completed Manual Dexterity, Aiming and Catching, and Balance tasks from the Movement Assessment Battery for Children, Second Edition. Raw scores were converted to standardized scores, and amblyopic and nonamblyopic children were compared to controls. Clinical and sensory factors associated with motor performance were also evaluated. Results Overall, amblyopic and nonamblyopic children were three to six times more likely than controls to be at risk for or to have a total motor impairment (≤15th percentile). Although amblyopic children scored lower than controls for the Manual Dexterity, Aiming and Catching, and Balance tasks, nonamblyopic children scored lower on Manual Dexterity only. Factors related to manual dexterity deficits include the presence of amblyopia and binocularity deficits typical of these eye conditions. Aiming, catching, and balance deficits were most pronounced in children with an infantile onset of the eye condition, a history of strabismus, and reduced binocularity. Conclusions Amblyopia and strabismus disrupt the development of motor ability in children. These findings highlight the widespread effects of discordant binocular input early in life and the visual acuity and binocularity deficits typical of these eye conditions.
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Affiliation(s)
- Krista R Kelly
- Retina Foundation of the Southwest, Dallas, Texas, United States.,Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas, United States
| | - Sarah E Morale
- Retina Foundation of the Southwest, Dallas, Texas, United States
| | | | - Lori M Dao
- ABC Eyes Pediatric Ophthalmology, PA, Dallas, Texas, United States
| | - Becky A Luu
- Pediatric Ophthalmology & Adult Strabismus, PA, Plano, Texas, United States
| | - Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas, United States.,Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas, United States
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Silverstein E, Williams JS, Brown JR, Bylykbashi E, Stinnett SS. Teleophthalmology: Evaluation of Phone-based Visual Acuity in a Pediatric Population. Am J Ophthalmol 2021; 221:199-206. [PMID: 32791067 PMCID: PMC7417903 DOI: 10.1016/j.ajo.2020.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022]
Abstract
Purpose With the recent rise of teleophthalmology due to coronavirus disease, health care needs accurate and reliable methods of checking visual acuity remotely. The visual acuity as measured by the GoCheck Kids application was compared with that of the Amblyopia Treatment Study (ATS) and the authors' clinic protocol. Design This was a prospective, comparison of visual acuity assessment methods. Methods Established patients (3-18 years of age) in the practice of a single pediatric ophthalmologist were eligible. Visual acuity was measured 1) by GoCheck Kids mobile application, by the patient's family member; 2) by HOTV-ATS, by study personnel; and 3) by regular clinic protocol, by an ophthalmic technician. To assess agreement between measurement of acuity, intraclass correlations with 95% confidence intervals (CI) were computed. Results A total of 53 children participated. The mean differences between GoCheck Kids and HOTV-ATS acuities (0.094) were significantly different (P < .001). The intraclass correlation coefficient (ICC) was 0.55 (95% CI: 0.40-0.68). The mean differences between GoCheck Kids and chart acuities (0.010) were not significantly different (P = .319; ICC: 0.59; 95% CI: 0.45-0.71). The mean differences between HOTV-ATS and chart acuities (0.084) were significantly different (P < .001; ICC: 0.66; 95% CI: 0.53-0.76). The percentages of eyes with visual acuity measured by GoCheck Kids within 1 line of the HOTV-ATS and chart acuity were 65.3% and 86.7%, respectively. Conclusions GoCheck Kids as checked by a family member provided a modest correlation of visual acuity compared to the chart screen and a fair correlation of visual acuity compared to HOTV-Amblyopia Treatment Study protocol, although most were within 1 line.
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Affiliation(s)
- Evan Silverstein
- Department of Ophthalmology, Virginia Commonwealth University, Richmond, Virginia 23298, USA.
| | - Jonathan S Williams
- Department of Ophthalmology, Louisiana State University Health, New Orleans, Louisiana 70112, USA
| | - Jeffrey R Brown
- Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298, USA
| | - Enjana Bylykbashi
- Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298, USA
| | - Sandra S Stinnett
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina 27710, USA
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Birch EE, Jost RM, Wang SX, Kelly KR. A pilot randomized trial of contrast-rebalanced binocular treatment for deprivation amblyopia. J AAPOS 2020; 24:344.e1-344.e5. [PMID: 33069871 PMCID: PMC8005476 DOI: 10.1016/j.jaapos.2020.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/18/2020] [Accepted: 07/05/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Binocular neural architecture may be preserved in children with deprivation amblyopia due to unilateral cataract. The purpose of this study was to investigate whether a contrast-rebalanced binocular treatment, recently used with success to treat the interocular suppression and amblyopia in strabismic and anisometropic children, can contribute to rehabilitation of visual acuity in children with deprivation amblyopia secondary to monocular cataract. METHODS In a pilot randomized trial, 15 children (4-13 years of age) were enrolled and randomized to continue with their current treatment only (n = 7) or to continue with their current treatment and add contrast-rebalanced binocular iPad game play 5 hours/week for 4 weeks (n = 8). The primary outcome was change in visual acuity at 4 weeks. RESULTS Although 10 of 15 participants were patching, there was little change in visual acuity during the 3 months prior to enrollment. At the 4-week primary outcome visit, the mean improvement in visual acuity for the binocular game group was significantly greater than that for the current-treatment group (0.08 ± 0.10 logMAR vs -0.03 ± 0.05 logMAR [t10.2 = 2.53, P = 0.03]). None of the children who had dense congenital cataract achieved improved visual acuity with binocular treatment. CONCLUSIONS In this study cohort, visual acuity improved over 8 weeks in children with unilateral deprivation amblyopia who played a binocular contrast-rebalanced binocular iPad game.
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Affiliation(s)
- Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas.
| | - Reed M Jost
- Retina Foundation of the Southwest, Dallas, Texas
| | - Serena X Wang
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas
| | - Krista R Kelly
- Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas
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29
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Jost RM, Kelly KR, Hunter JS, Stager DR, Luu B, Leffler JN, Dao L, Beauchamp CL, Birch EE. A randomized clinical trial of contrast increment protocols for binocular amblyopia treatment. J AAPOS 2020; 24:282.e1-282.e7. [PMID: 33045374 PMCID: PMC8328197 DOI: 10.1016/j.jaapos.2020.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Most clinical trials of contrast-rebalanced binocular amblyopia treatment used a contrast increment protocol of 10% daily with successful play. Paired with a definition of success requiring only 15-30 min/day of gameplay, this increment protocol could allow children to reach 100% fellow eye contrast in 3-9 hours; however, this may not provide adequate therapeutic time with reduced fellow eye contrast. The purpose of this study was to compare the original protocol against three alternative contrast increment protocols designed to increase the number of treatment hours. METHODS In this prospective study, 63 amblyopic children (4-10 years; amblyopic eye visual acuity, 20/40-125) were randomly assigned one of four daily contrast increment protocols for 4 weeks, all starting with 20% fellow eye contrast: 10%, 5%, 0%, or 10% for first 4 weeks then reset to 20% and repeat 10% increment for the final 4 weeks. Children played contrast-rebalanced games for 1 hour/day, 5 days/week. Best-corrected visual acuity, stereoacuity, and suppression were assessed at baseline and every 2 weeks until the 8-week outcome visit. RESULTS At baseline, mean amblyopic eye best-corrected visual acuity was 0.47 ± 0.14 logMAR (20/60), improving overall 0.14 ± 0.08 logMAR (1.4 lines; P < 0.0001) at 8 weeks. All four protocols resulted in similar improvement in visual acuity (0.13-0.16 logMAR; all Ps < 0.0002). Stereoacuity and suppression also improved (all Ps < 0.05). CONCLUSIONS None of the new protocols resulted in less improvement than the original 10% contrast increment protocol. Contrast-rebalanced binocular games yielded significant improvements in visual acuity, stereoacuity, and suppression with or without daily contrast increments.
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Affiliation(s)
- Reed M Jost
- Retina Foundation of the Southwest, Dallas, Texas.
| | | | | | - David R Stager
- Pediatric Ophthalmology & Adult Strabismus, Plano, Texas
| | - Becky Luu
- Pediatric Ophthalmology & Adult Strabismus, Plano, Texas
| | | | - Lori Dao
- ABC Eyes Pediatric Ophthalmology, Dallas, Texas
| | | | - Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas; University of Texas Southwestern Medical Center, Dallas, Texas
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Miller JM, Jang HS, Ramesh D, Gonzalez Marshall MS, Yescas S, Harvey EM. Telemedicine distance and near visual acuity tests for adults and children. J AAPOS 2020; 24:235-236. [PMID: 32739362 PMCID: PMC7392111 DOI: 10.1016/j.jaapos.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 11/26/2022]
Abstract
We describe a set of distance and near, adult and child, visual acuity tests for home use. The five charts are packaged in a PDF document and are also available as JPEG images that can be printed on standard letter paper or displayed on a monitor or handheld device. Adult distance visual acuity is tested using a modified ETDRS Chart R; child distance vision is tested using a similarly formatted HOTV logMAR chart. Testing distance is 5 or 10 feet, appropriate for home use. Near visual acuity is displayed in the range of J16 to J1 using random words (for adults) or in HOTV matching format (for young children). An Amsler Grid and HOTV matching card are included. The charts include a calibration circle. For those without a printer, sending a JPEG image as an email attachment initiates onscreen testing with a single click. Devices with smaller screens require an assistant to scroll through the display. The test can performed without assistance from a printed page.
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Affiliation(s)
- Joseph M Miller
- Department of Ophthalmology and Vision Science, The University of Arizona, Tucson, AZ; The Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ; James C. Wyant College of Optical Sciences, The University of Arizona, Tucson, AZ
| | - Hyun Soo Jang
- Department of Ophthalmology and Vision Science, The University of Arizona, Tucson, AZ
| | - Divya Ramesh
- Department of Ophthalmology and Vision Science, The University of Arizona, Tucson, AZ
| | | | - Selenne Yescas
- Department of Ophthalmology and Vision Science, The University of Arizona, Tucson, AZ
| | - Erin M Harvey
- Department of Ophthalmology and Vision Science, The University of Arizona, Tucson, AZ; The Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ.
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Leske DA, Hatt SR, Castañeda YS, Wernimont SM, Liebermann L, Cheng-Patel CS, Birch EE, Holmes JM. Eye-related quality of life and functional vision in children wearing glasses. J AAPOS 2020; 24:91.e1-91.e6. [PMID: 32113988 PMCID: PMC7667888 DOI: 10.1016/j.jaapos.2019.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/15/2019] [Accepted: 12/11/2019] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate eye-related quality of life (ER-QOL) and functional vision in children wearing glasses using the Pediatric Eye Questionnaire (PedEyeQ). METHODS Children 5-17 years of age with normal visual acuity who wore glasses for correction of refractive error and with no other eye condition or treatment and control subjects who did not wear glasses, along with 1 parent for each child, were prospectively enrolled. Children completed the Child 5-11 or 12-17 PedEyeQ (four domains); parents completed the Proxy 5-11 or 12-17 questionnaires (perceived effect on child; five domains) and also the Parent questionnaire (effect on parent themselves; four domains). Each domain was Rasch-scored (converted to 0-100), and scores between groups were compared. RESULTS A total of 40 subjects and 99 non-glasses-wearing controls, along with 1 parent for each child, were included. Children 5-11 and 12-17 years of age who wore glasses had lower PedEyeQ scores across all domains compared with controls (mean differences, -6 to -15; P ≤ 0.04 for each domain). Proxy scores were also lower for glasses wearers across age groups and domains (mean differences, -4 to -18; P ≤ 0.02), and Parent scores were lower for parents of children wearing glasses (mean differences, -6 to -18; P < 0.001 for each domain). CONCLUSIONS In this study, glasses wearers had reduced ER-QOL and functional vision compared with control subjects. Parents of children wearing glasses also experience reduced quality of life.
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Affiliation(s)
- David A Leske
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Sarah R Hatt
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | - Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
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Birch EE, Castañeda YS, Cheng-Patel CS, Morale SE, Kelly KR, Beauchamp CL, Webber A. Self-perception in Children Aged 3 to 7 Years With Amblyopia and Its Association With Deficits in Vision and Fine Motor Skills. JAMA Ophthalmol 2020; 137:499-506. [PMID: 30763432 DOI: 10.1001/jamaophthalmol.2018.7075] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Deficits in fine motor skills and slow reading speed have been reported in school-aged children and adults with amblyopia. These deficits were correlated with lower self-perception of athletic and cognitive competence. Although perceived competence and social acceptance are key determinants of developing self-perception in young children, the association of amblyopia with self-perception and the association of altered self-perception with fine motor skills to date have not been reported for young children aged 3 to 7 years. Objectives To investigate whether amblyopia is associated with altered self-perception in young children and to assess whether any differences in self-perception are associated with deficits in vision and fine motor skills. Design, Setting, and Participants In this cross-sectional study, conducted at a pediatric vision laboratory from January 10, 2016, to May 4, 2018, healthy children aged 3 to 7 years (preschool to second grade) were enrolled, including 60 children with amblyopia; 30 children who never had amblyopia but had been treated for strabismus, anisometropia, or both; and 20 control children. Main Outcomes and Measures Self-perception was assessed using the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children, which includes the following 4 specific domains: cognitive competence, peer acceptance, physical competence, and maternal acceptance (total score range, 1-4; higher scores indicate higher perceived competence or acceptance). Fine motor skills were evaluated with the Manual Dexterity and Aiming and Catching scales of the Movement Assessment Battery for Children, second edition (score range, 1-19; higher scores indicate better skill performance). Visual acuity and stereoacuity also were assessed. Results Children with amblyopia (28 girls and 32 boys; mean [SD] age, 6.3 [1.3] years) had significantly lower mean (SD) peer acceptance and physical competence scores compared with the control children (peer acceptance, 2.74 [0.66] vs 3.11 [0.36]; mean difference, 0.37; 95% CI for difference, 0.06-0.68; P = .04; and physical competence, 2.86 [0.60] vs 3.43 [0.52]; mean difference, 0.57; 95% CI for difference, 0.27-0.87; P = .009). Among the children with amblyopia, self-perception of physical competence was significantly correlated with aiming and catching skills (r = 0.43; 95% CI, 0.10-0.67; P = .001) and stereoacuity (r = -0.39; 95% CI, -0.05 to -0.65; P = .02). Children treated for strabismus or anisometropia, but who never had amblyopia, also had significantly lower mean (SD) physical competence scores compared with control children (2.89 [0.54] vs 3.43 [0.52]; 95% CI for difference, 0.23-0.85; P = .03). Conclusions and Relevance These findings suggest that lower self-perception of peer acceptance and physical competence identify the broad effects of altered visual development in the everyday life of children with amblyopia.
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Affiliation(s)
- Eileen E Birch
- Pediatric Vision Laboratory, Retina Foundation of the Southwest, Dallas, Texas.,Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas
| | - Yolanda S Castañeda
- Pediatric Vision Laboratory, Retina Foundation of the Southwest, Dallas, Texas
| | | | - Sarah E Morale
- Pediatric Vision Laboratory, Retina Foundation of the Southwest, Dallas, Texas
| | - Krista R Kelly
- Pediatric Vision Laboratory, Retina Foundation of the Southwest, Dallas, Texas
| | | | - Ann Webber
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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Holmes JM, Kulp MT, Dean TW, Suh DW, Kraker RT, Wallace DK, Petersen DB, Cotter SA, Crouch ER, Lorenzana IJ, Ticho BH, Verderber LC, Weise KK. A Randomized Clinical Trial of Immediate Versus Delayed Glasses for Moderate Hyperopia in Children 3 to 5 Years of Age. Am J Ophthalmol 2019; 208:145-159. [PMID: 31255587 DOI: 10.1016/j.ajo.2019.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/14/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare visual acuity (VA) and binocularity outcomes in moderately hyperopic children with normal VA and binocularity assigned to glasses versus observation. DESIGN Prospective randomized clinical trial (RCT). METHODS One hundred nineteen 3- to 5-year-old children with hyperopia between +3.00D and +6.00D spherical equivalent were randomly assigned to glasses versus observation (with glasses prescribed if deteriorated for subnormal distance VA or near stereoacuity, or manifest strabismus). Follow-up occurred every 6 months. At 3 years, the treatment strategy was classified as "failed" if any of the following were met, both with and without correction: subnormal distance VA or stereoacuity; manifest strabismus; or strabismus surgery during follow-up. RESULTS Of 84 (71%) children who completed the primary outcome examination, failure occurred in five (12%; 95% confidence interval [CI]: 4%-26%) of 41 assigned to glasses and four (9%; 95% CI: 3%-22%) of 43 assigned to observation (difference = 3%; 95% CI: -12%-18%; P = .72). Deterioration prior to 3 years (requiring glasses per protocol) occurred in 29% (95% CI: 19%-43%) assigned to glasses and 27% (95% CI: 17%-42%) assigned to observation. CONCLUSIONS In an RCT comparing glasses to observation for moderately hyperopic 3- to 5-year-old children with normal VA and binocularity, failure for VA or binocularity was not common. With insufficient enrollment and retention, our study was unable to determine whether immediate glasses prescription reduces failure rate, but low failure rates suggest that immediate glasses prescription for these children may not be needed to prevent failure for VA and/or binocularity.
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Birch EE, Castañeda YS, Cheng-Patel CS, Morale SE, Kelly KR, Beauchamp CL, Webber A. Self-perception of School-aged Children With Amblyopia and Its Association With Reading Speed and Motor Skills. JAMA Ophthalmol 2019; 137:167-174. [PMID: 30452518 DOI: 10.1001/jamaophthalmol.2018.5527] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Reading and eye-hand coordination deficits in children with amblyopia may impede their ability to demonstrate their knowledge and skills, compete in sports and physical activities, and interact with peers. Because perceived scholastic, social, and athletic competence are key determinants of self-esteem in school-aged children, these deficits may influence a child's self-perception. Objective To determine whether amblyopia is associated with lowered self-perception of competence, appearance, conduct, and global self-worth and whether the self-perception of children with amblyopia is associated with their performance of reading and eye-hand tasks. Design, Setting, and Participants This cross-sectional study was conducted from January 2016 to June 2017 at the Pediatric Vision Laboratory of the Retina Foundation of the Southwest and included healthy children in grades 3 to 8, including 50 children with amblyopia; 13 children without amblyopia with strabismus, anisometropia, or both; and 18 control children. Main Outcomes and Measures Self-perception was assessed using the Self-perception Profile for Children, which includes 5 domains: scholastic, social, and athletic competence; physical appearance; behavioral conduct; and a separate scale for global self-worth. Reading speed and eye-hand task performance were evaluated with the Readalyzer (Bernell) and Movement Assessment Battery for Children, 2nd Edition. Visual acuity and stereoacuity also were assessed. Results Of 50 participants, 31 (62%) were girls, 31 (62%) were non-Hispanic white, 6 (12%) were Hispanic white, 3 (6%) were African American, 4 (8%) were Asian/Pacific Islander, and 3 (6%) were more than 1 race/ethnicity, and the mean [SD] age was 10.6 [1.3] years. Children with amblyopia had significantly lower scores than control children for scholastic (mean [SD], 2.93 [0.74] vs 3.58 [0.24]; mean [SD] difference, 0.65 [0.36]; 95% CI, 0.29-1.01; P = .004), social (mean [SD], 2.95 [0.64] vs 3.62 [0.35]; mean [SD] difference, 0.67 [0.32]; 95% CI, 0.35-0.99] P < .001), and athletic (mean [SD], 2.61 [0.65] vs 3.43 [0.52]; mean [SD] difference, 0.82 [0.34]; 95% CI, 0.48-1.16; P = .001) competence domains. Among children with amblyopia, a lower self-perception of scholastic competence was associated with a slower reading speed (r = 0.49, 95% CI, 0.17-0.72; P = .002) and a lower self-perception of scholastic, social, and athletic competence was associated with worse performance of aiming and catching (scholastic r = 0.48; 95% CI, 0.16-0.71; P = .007; social r = 0.63; 95% CI, 0.35-0.81; P < .001; athletic r = 0.53; 95% CI, 0.21-0.75; P = .003). No differences in the self-perception of physical appearance (mean [SD], 3.32 [0.63] vs 3.64 [0.40]), conduct (mean [SD], 3.09 [0.56] vs 3.34 [0.66]), or global self-worth (mean [SD], 3.42 [0.42] vs 3.69 [0.36]) were found between the amblyopic and control groups. Conclusions and Relevance These findings suggest that lower self-perception is associated with slower reading speed and worse motor skills and may highlight the wide-ranging effects of altered visual development for children with amblyopia in their everyday lives.
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Affiliation(s)
- Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas.,Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas
| | | | | | | | | | | | - Ann Webber
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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Roberts TL, Manny RE, Anderson HA. Impact of Visual Cues on the Magnitude and Variability of the Accommodative Response in Children With Emmetropia and Uncorrected Hyperopia and Adults. Invest Ophthalmol Vis Sci 2019; 60:1527-1537. [PMID: 30994863 PMCID: PMC6736278 DOI: 10.1167/iovs.18-25256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose We investigated the effect of blur and disparity cues on accommodative accuracy (lag) and variability (time [RMS] and frequency domain [LFC]) in the developing visual system. Methods A total of 59 children (3–9 years, spherical equivalent refractive error [RE] = −0.3– +4.91 diopters [D]) and 10 adults (23–31 years, RE = −0.37–+1.15D) participated. Accommodation was measured in the right eye for 1 minute at 100 and 33 cm using photorefraction (25 Hz) for three conditions: blur + disparity (binocular, 20/50 optotypes), blur-only (monocular, 20/50 optotypes), disparity-only (binocular, difference-of-Gaussian stimulus). The effect blur and disparity cues have on accommodative accuracy, RMS, and LFC was assessed. Results Lag, RMS, and LFC increased (P < 0.001) from 100 to 33 cm for each condition in children and adults. In children, accommodation was most accurate and stable when blur and disparity cues remained in the stimulus and became significantly less accurate and more variable (P < 0.001) when blur or disparity cues were removed at 33 cm. In adults, accommodation was significantly less accurate and more variable only when blur was removed from the stimulus (P < 0.022). Children with RE matched to adults had less accurate and more variable accommodative responses at near than adults when cues were removed (P ≤ 0.02). Conclusions In children and adults, an increase in RMS and LFC is related to an increase in accommodative lag. Children's accommodative systems do not compensate as efficiently as adults when blur and disparity cues are removed, suggesting children <10 years old do not have a mature afferent visual pathway.
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Affiliation(s)
- Tawna L Roberts
- Byers Eye Institute, Stanford University, Palo Alto, California, United States
| | - Ruth E Manny
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Heather A Anderson
- University of Houston, College of Optometry, Houston, Texas, United States
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Abstract
SIGNIFICANCE These results demonstrate that accommodation in children is more accurate and less variable when performing a sustained near task with increased cognitive demand. In addition, children with increased uncorrected hyperopia have less stable accommodative responses, which may have visual implications during sustained near tasks. PURPOSE This study investigated accommodative accuracy (lag) and variability during sustained viewing for passive and active tasks in children and adults with emmetropia and uncorrected hyperopia. METHODS Lag and variability (root mean square [RMS] and low-frequency component) were measured in 54 children aged 3 to younger than 10 years with mean spherical equivalent of +1.31 ± 1.05 diopters (D) (range, -0.37 to +4.58 D) and 8 adults aged 22 to 32 years with mean spherical equivalent +0.65 ± 0.62 D (range, -0.13 to +1.15 D). Subjects viewed 20/50 stimuli at 33 cm during both a 10-minute passive and active task. Group 1 (<6 years or nonreaders) viewed shapes; group 2 (≥6 years and reading) and adults read passages. RESULTS Groups 1 and 2 had larger lags, RMS, and low-frequency component for passive versus active tasks (P < .001). Lag and RMS did not differ between tasks in adults (P > .05), but low-frequency component was larger during passive viewing (P = .04). Group 1 had significantly higher RMS and low-frequency component than group 2 and the adults in the passive condition had greater low-frequency component in the active condition. In children, hyperopia was independently associated with RMS and low-frequency component under passive (RMS 95% confidence interval [CI], 0.04 to 0.15; low-frequency component 95% CI, 0.00011 to 0.00065) and active (RMS 95% CI, 0.001 to 0.06; 95% CI, 0.000014 to 0.00023) viewing. CONCLUSIONS Accommodation is more accurate and less variable when children are engaged in the task. Children also have more variable accommodation than adults. In addition, children with greater hyperopia have more variable accommodation during sustained near tasks.
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Birch EE, Jost RM, De La Cruz A, Kelly KR, Beauchamp CL, Dao L, Stager D, Leffler JN. Binocular amblyopia treatment with contrast-rebalanced movies. J AAPOS 2019; 23:160.e1-160.e5. [PMID: 31103562 PMCID: PMC6698207 DOI: 10.1016/j.jaapos.2019.02.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Binocular amblyopia treatments promote visual acuity recovery and binocularity by rebalancing the signal strength of dichoptic images. Most require active participation by the amblyopic child to play a game or perform a repetitive visual task. The purpose of this study was to investigate a passive form of binocular treatment with contrast-rebalanced dichoptic movies. METHODS A total of 27 amblyopic children, 4-10 years of age, wore polarized glasses to watch 6 contrast-rebalanced dichoptic movies on a passive 3D display during a 2-week period. Amblyopic eye contrast was 100%; fellow eye contrast was initially set to a lower level (20%-60%), which allowed the child to overcome suppression and use binocular vision. Fellow eye contrast was incremented by 10% for each subsequent movie. Best-corrected visual acuity, random dot stereoacuity, and interocular suppression were measured at baseline and at 2 weeks. RESULTS Amblyopic eye best-corrected visual acuity improved from 0.57 ± 0.22 at baseline to 0.42 ± 0.23 logMAR (t26 = 8.09; P < 0.0001; 95% CI for improvement, 0.11-0.19 logMAR). Children aged 3-6 years had more improvement (0.21 ± 0.11 logMAR) than children aged 7-10 years (0.11 ± 0.06 logMAR; t25 = 3.05; P = 0.005). Children with severe amblyopia (≥0.7 logMAR) at baseline experienced greater improvement (0.24 ± 0.12 logMAR) than children with moderate amblyopia at baseline (0.12 ± 0.06 logMAR; t25 = 3.49; P = 0.002). CONCLUSIONS In this cohort, passive viewing of contrast-rebalanced dichoptic movies effectively improved visual acuity in amblyopic subjects. The degree of improvement observed was similar to that previously reported for 2 weeks of binocular games treatment and with 3-4 months of occlusion therapy.
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Affiliation(s)
- Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas.
| | - Reed M Jost
- Retina Foundation of the Southwest, Dallas, Texas
| | | | | | | | | | - David Stager
- Pediatric Ophthalmology & Adult Strabismus, Plano, Texas
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Lambert SR, DuBois L, Cotsonis G, Hartmann EE, Drews-Botsch C. Spectacle Adherence Among Four-Year-Old Children in the Infant Aphakia Treatment Study. Am J Ophthalmol 2019; 200:26-33. [PMID: 30633891 DOI: 10.1016/j.ajo.2018.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/28/2018] [Accepted: 12/29/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate spectacle adherence with impact-resistant lenses among 4-year-old children after unilateral cataract surgery in the Infant Aphakia Treatment Study. DESIGN Retrospective cohort analysis of randomized clinical trial data. METHODS Setting: Multicenter. PATIENTS One hundred and fourteen children randomized to contact lens correction or intraocular lens implantation following unilateral cataract surgery during infancy. INTERVENTION One-week diaries completed annually and retrospective telephone interviews conducted every 3 months to age 5 years to assess spectacle adherence with impact-resistant lenses. Visual acuity was assessed by a traveling examiner at age 4.5 years. MAIN OUTCOME MEASURES Spectacle adherence between ages 4 and 5 years. RESULTS Children with 20/40 or better vision in their treated eye were more likely to wear spectacles ≥80% of their waking hours than children with vision worse than 20/40 (66% vs 42%, P = .034). Reported adherence to spectacle wear correlated with reported patching (r = 0.30, P = .002). Spectacle adherence did not correlate with sex, type of healthcare insurance, or the refractive error in the treated or fellow eye. Seven patients with reduced vision in their treated eye reported <10% spectacle adherence. CONCLUSIONS These results confirm that it is possible to achieve high levels of spectacle adherence among 4-year-old children after unilateral cataract surgery during infancy. However, children with vision worse than 20/40 in their worse eye, who needed eye protection the most, had the worst adherence.
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Affiliation(s)
- Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.
| | - Lindreth DuBois
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Hamm LM, Anstice NS, Black JM, Dakin SC. Recognition acuity in children measured using The Auckland Optotypes. Ophthalmic Physiol Opt 2018; 38:596-608. [PMID: 30575072 DOI: 10.1111/opo.12590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/02/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Sloan letters displayed by the Electronic Visual Acuity (EVA) system are the gold standard for recognition acuity measurement in research settings. However, letters are not always appropriate for children. The Auckland Optotypes (TAO) are a new, open-access set of 10 pictograms available in regular and vanishing formats. We sought to assess feasibility of using both formats of TAO for measuring visual acuity (VA) in children using a Bayesian adaptive staircase, in a community setting. METHODS We tested 121 children (5-12 years old) with both formats of TAO, a handheld flipchart vision screener (Parr vision test), as well as the gold standard EVA. We measured feasibility of the three comparison tests in three ways. First, using limits of agreement (LoA) with EVA, second, calculating area under the receiver operating characteristic curve (AUC), and finally, investigating trial-by-trial responses. RESULTS Agreement between tests was within test-retest reliability of EVA measures (LoATAO regular = ±0.14, LoATAO vanishing = ±0.15, LoAP arr = ±0.16 logMAR). TAO tests were highly effective at identifying children with vision impairment (AUCTAO regular = 0.96, AUCTAO vanishing = 0.95), whereas Parr was less effective (AUCP arr = 0.82). In 5-6 year old children there was an enhanced advantage of TAO (AUCTAO regular = 0.97, AUCTAO vanishing = 0.98) over Parr (AUCP arr = 0.75). Although each child completed 16 trials, approximately 10 trials were sufficient to achieve excellent LoA, and six trials sufficient for accurate screening. CONCLUSION Threshold VA assessment and vision screening are feasible using both vanishing and regular formats of TAO.
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Affiliation(s)
- Lisa M Hamm
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, Auckland, New Zealand
| | - Nicola S Anstice
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, Auckland, New Zealand.,School of Optometry and Vision Science, University of Canberra, Canberra, Australia
| | - Joanna M Black
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, Auckland, New Zealand
| | - Steven C Dakin
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, Auckland, New Zealand.,UCL Institute of Ophthalmology, University College London, London, UK
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A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 7 to 12 Years. Ophthalmology 2018; 126:456-466. [PMID: 30352226 DOI: 10.1016/j.ophtha.2018.10.032] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare visual acuity (VA) improvement in children aged 7 to 12 years with amblyopia treated with a binocular iPad game plus continued spectacle correction vs. continued spectacle correction alone. DESIGN Multicenter randomized clinical trial. PARTICIPANTS One hundred thirty-eight participants aged 7 to 12 years with amblyopia (33-72 letters, i.e., approximately 20/200 to 20/40) resulting from strabismus, anisometropia, or both. Participants were required to have at least 16 weeks of optical treatment in spectacles if needed or demonstrate no improvement in amblyopic-eye visual acuity (VA) for at least 8 weeks prior to enrollment. METHODS Eligible participants (mean age 9.6 years, mean baseline VA of 59.6 letters, history of prior amblyopia treatment other than spectacles in 96%) were randomly assigned to treatment for 8 weeks with the dichoptic binocular Dig Rush iPad game (prescribed for 1 hour per day 5 days per week) plus spectacle wear if needed (n = 69) or continued spectacle correction alone if needed (n = 69). MAIN OUTCOME MEASURES Change in amblyopic-eye VA from baseline to 4 weeks, assessed by a masked examiner. RESULTS At 4 weeks, mean amblyopic-eye VA letter score improved from baseline by 1.3 (2-sided 95% confidence interval [CI]: 0.1-2.6; 0.026 logMAR) with binocular treatment and by 1.7 (2-sided 95% CI: 0.4-3.0; 0.034 logMAR) with continued spectacle correction alone. After adjusment for baseline VA, the letter score difference between groups (binocular minus control) was -0.3 (95% CI: -2.2 to 1.5, P = 0.71, difference of -0.006 logMAR). No difference in letter scores was observed between groups when the analysis was repeated after 8 weeks of treatment (adjusted mean: -0.1, 98.3% CI: -2.4 to 2.1). For the binocular group, adherence data from the iPad indicated that slightly more than half of the participants (58% and 56%) completed >75% of prescribed treatment by the 4- and 8-week visits, respectively. CONCLUSIONS In children aged 7 to 12 years who have received previous treatment for amblyopia other than spectacles, there was no benefit to VA or stereoacuity from 4 or 8 weeks of treatment with the dichoptic binocular Dig Rush iPad game.
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Kelly KR, Jost RM, Wang YZ, Dao L, Beauchamp CL, Leffler JN, Birch EE. Improved Binocular Outcomes Following Binocular Treatment for Childhood Amblyopia. Invest Ophthalmol Vis Sci 2018; 59:1221-1228. [PMID: 29625442 PMCID: PMC5839256 DOI: 10.1167/iovs.17-23235] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose Childhood amblyopia can be treated with binocular games or movies that rebalance contrast between the eyes, which is thought to reduce depth of interocular suppression so the child can experience binocular vision. While visual acuity gains have been reported following binocular treatment, studies rarely report gains in binocular outcomes (i.e., stereoacuity, suppression) in amblyopic children. Here, we evaluated binocular outcomes in children who had received binocular treatment for childhood amblyopia. Methods Data for amblyopic children enrolled in two ongoing studies were pooled. The sample included 41 amblyopic children (6 strabismic, 21 anisometropic, 14 combined; age 4–10 years; ≤4 prism diopters [PD]) who received binocular treatment (20 game, 21 movies; prescribed 9–10 hours treatment). Amblyopic eye visual acuity and binocular outcomes (Randot Preschool Stereoacuity, extent of suppression, and depth of suppression) were assessed at baseline and at 2 weeks. Results Mean amblyopic eye visual acuity (P < 0.001) and mean stereoacuity improved (P = 0.045), and mean extent (P = 0.005) and depth of suppression (P = 0.003) were reduced from baseline at the 2-week visit (87% game adherence, 100% movie adherence). Depth of suppression was reduced more in children aged <8 years than in those aged ≥8 years (P = 0.004). Worse baseline depth of suppression was correlated with a larger depth of suppression reduction at 2 weeks (P = 0.001). Conclusions After 2 weeks, binocular treatment in amblyopic children improved visual acuity and binocular outcomes, reducing the extent and depth of suppression and improving stereoacuity. Binocular treatments that rebalance contrast to overcome suppression are a promising additional option for treating amblyopia.
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Affiliation(s)
- Krista R Kelly
- Retina Foundation of the Southwest, Dallas, Texas, United States
| | - Reed M Jost
- Retina Foundation of the Southwest, Dallas, Texas, United States
| | - Yi-Zhong Wang
- Retina Foundation of the Southwest, Dallas, Texas, United States.,Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas, United States
| | - Lori Dao
- ABC Eyes Pediatric Ophthalmology, PA, Dallas, Texas, United States
| | | | - Joel N Leffler
- Children's Eye Care of North Texas, PA, Plano, Texas, United States
| | - Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas, United States.,Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas, United States
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Hartmann EE, Drews-Botsch C, DuBois LG, Cotsonis G, Lambert SR. Correlation of monocular grating acuity at age 12 months with recognition acuity at age 4.5 years: findings from the Infant Aphakia Treatment Study. J AAPOS 2018; 22:299-303.e2. [PMID: 30031874 PMCID: PMC7872073 DOI: 10.1016/j.jaapos.2018.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/18/2018] [Accepted: 03/24/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine whether grating acuity at age 12 months can be used to predict recognition acuity at age 4.5 years in children treated for unilateral congenital cataract enrolled in the Infant Aphakia Treatment Study (IATS). METHODS Traveling testers assessed monocular grating acuity at 12 months of age (Teller Acuity Card Test [TACT]) and recognition acuity at 4.5 years of age (Amblyopia Treatment Study Electronic Visual Acuity Testing, HOTV) in children treated for visually significant monocular cataract in the IATS. Spearman rank correlation was used to evaluate the relationship between visual acuities at the two ages in the treated eyes. RESULTS Visual acuity data at both ages were available for 109 of 114 children (96%). Grating acuity at 12 months of age and recognition acuity at 4.5 years of age were significantly correlated for the treated eyes (rspearman = 0.45; P = 0.001). At age 4.5 years, 67% of the subjects who had grating acuity at 12 months of age within the 95% predictive limits in their treated eye demonstrated recognition acuity better than 20/200. Similarly, at age 4.5 years 67% of the subjects who had grating acuity at age 12 months below the 95% predictive limits in their treated eye demonstrated recognition acuity of 20/200 or worse. CONCLUSIONS A single grating acuity assessment at age 12 months predicts recognition acuity in a child treated for unilateral congenital cataract in only two-thirds of cases. Clinicians should consider other factors, such as patching compliance and age at surgery, when using an early grating acuity assessment to modify treatment.
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Affiliation(s)
- E Eugenie Hartmann
- Department of Vision Sciences, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Carolyn Drews-Botsch
- Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lindreth G DuBois
- Department of Ophthalmology, School of Medicine, Emory University, Atlanta, Georgia
| | - George Cotsonis
- Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University, Stanford, California
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Fixation instability during binocular viewing in anisometropic and strabismic children. Exp Eye Res 2018; 183:29-37. [PMID: 30006273 DOI: 10.1016/j.exer.2018.07.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/16/2018] [Accepted: 07/09/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Strabismus or anisometropia disrupts binocularity and results in fixation instability, which is increased with amblyopia. Fixation instability has typically been assessed for each eye individually. Recently, vergence instability was reported in exotropic adults and monkeys during binocular viewing. We evaluated fixation instability during binocular viewing in children treated for anisometropia and/or strabismus. METHODS 160 children age 4-12 years with treated esotropia and/or anisometropia (98 amblyopic, 62 nonamblyopic) were compared to 46 age-similar controls. Fixation instability was recorded during binocular fixation of a 0.3 deg diameter dot for 20 s using a 500 Hz remote video binocular eye tracker (EyeLink 1000; SR Research). The bivariate contour ellipse area (BCEA; log deg2) for fixation instability was calculated for each eye (nonpreferred, preferred) and for vergence instability (left eye position - right eye position). Best-corrected visual acuity, Randot Preschool stereoacuity, and extent of suppression scotoma (Worth 4-Dot) were also obtained. RESULTS When binocularly viewing, both amblyopic and nonamblyopic children treated for anisometropia and/or strabismus had larger fixation instability and vergence instability than controls. Amblyopia primarily added to the instability of the nonpreferred eye. Anisometropic children had less nonpreferred eye instability and vergence instability than those with strabismus or combined mechanism. Nonpreferred eye instability and vergence instability were related to poorer stereoacuity and a larger suppression scotoma. Preferred eye instability was not related to any visual outcome measure. No relationships were found with visual acuity. CONCLUSIONS Fixation instability and vergence instability during binocular viewing suggests that discordant binocular visual experience during childhood, especially strabismus, interferes with ocular motor development. Amblyopia adds to instability of the nonpreferred eye. Vergence instability may limit potential for recovery of binocular vision in these children.
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Roberts TL, Kester KN, Hertle RW. Reliability and Validity of Gaze-Dependent Functional Vision Space: A Novel Metric Quantifying Visual Function in Infantile Nystagmus Syndrome. Invest Ophthalmol Vis Sci 2018; 59:1760-1768. [PMID: 29610862 PMCID: PMC5886028 DOI: 10.1167/iovs.17-23229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose This study presents test–retest reliability of optotype visual acuity (OVA) across 60° of horizontal gaze position in patients with infantile nystagmus syndrome (INS). Also, the validity of the metric gaze-dependent functional vision space (GDFVS) is shown in patients with INS. Methods In experiment 1, OVA was measured twice in seven horizontal gaze positions from 30° left to right in 10° steps in 20 subjects with INS and 14 without INS. Test–retest reliability was assessed using intraclass correlation coefficient (ICC) in each gaze. OVA area under the curve (AUC) was calculated with horizontal eye position on the x-axis, and logMAR visual acuity on the y-axis and then converted to GDFVS. In experiment 2, validity of GDFVS was determined over 40° horizontal gaze by applying the 95% limits of agreement from experiment 1 to pre- and post-treatment GDFVS values from 85 patients with INS. Results In experiment 1, test–retest reliability for OVA was high (ICC ≥ 0.88) as the difference in test–retest was on average less than 0.1 logMAR in each gaze position. In experiment 2, as a group, INS subjects had a significant increase (P < 0.001) in the size of their GDFVS that exceeded the 95% limits of agreement found during test–retest. Conclusions OVA is a reliable measure in INS patients across 60° of horizontal gaze position. GDFVS is a valid clinical method to be used to quantify OVA as a function of eye position in INS patients. This method captures the dynamic nature of OVA in INS patients and may be a valuable measure to quantify visual function patients with INS, particularly in quantifying change as part of clinical studies.
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Affiliation(s)
- Tawna L Roberts
- Children's Hospital Vision Center, Akron Children's Hospital, Akron, Ohio, United States
| | - Kristi N Kester
- Children's Hospital Vision Center, Akron Children's Hospital, Akron, Ohio, United States
| | - Richard W Hertle
- Children's Hospital Vision Center, Akron Children's Hospital, Akron, Ohio, United States.,Department of Ophthalmology, Northeastern Ohio Medical University, Rootstown, Ohio, United States
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Blur Detection, Depth of Field, and Accommodation in Emmetropic and Hyperopic Children. Optom Vis Sci 2018; 95:212-222. [PMID: 29401180 DOI: 10.1097/opx.0000000000001177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Our results demonstrate that blur detection thresholds are elevated in young children compared with adults, and poorer blur detection thresholds are significantly correlated with the magnitude of accommodative microfluctuations. Given that accommodative microfluctuations are greater with greater accommodative responses, these findings may have implications for young uncorrected hyperopes. PURPOSE This study investigated the association between subjective blur detection thresholds and accommodative microfluctuations in children 3 years to younger than 10 years old and adults. METHODS Blur detection thresholds were determined in 49 children with habitually uncorrected refractive error (+0.06 to +4.91 diopters [D] spherical equivalent) and 10 habitually uncorrected adults (+0.08 to +1.51 D spherical equivalent) using a custom blur chart with 1° sized optotypes at 33 cm. Letters were blurred by convolution using a Gaussian kernel (SDs of 0.71 to 11.31 arc minutes in √2 steps). Subjective depth of field was determined in subjects 6 years or older and adults. Accommodative microfluctuations, pupils, and lag were measured using infrared photorefraction (25 Hz). RESULTS Children had greater blur detection thresholds (P < .001), accommodative microfluctuations (P = .001), and depth of field (P < .001) than adults. In children, increased blur detection thresholds were associated with increased accommodative microfluctuations (P < .001), increased uncorrected hyperopia (P = .01), decreased age (P < .001), and decreased pupil size (P = .01). In a multiple linear regression analysis, blur detection thresholds were associated with accommodative microfluctuations (P < .001) and age (P < .001). Increased accommodative microfluctuations were associated with increased uncorrected hyperopia (P = .004) and decreased pupil size (P = .003) and independently associated with uncorrected hyperopia (P = .001) and pupil size (P = .003) when controlling for age and lag. CONCLUSIONS Children did not have adult-like blur detection thresholds or depth of field. Increased accommodative microfluctuations and decreased age were independently associated with greater blur detection thresholds in children 3 years to younger than 10 years. Larger amounts of uncorrected hyperopia in children appear to increase blur detection thresholds because the greater accommodative demand and resulting response increase accommodative microfluctuations.
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Leman R, Armitage MD, Arnold RW. The Receiver-Operator Curve for Flip-Card Surround HOTV in Younger School Children: Validation of a Simple Flip Card for School Acuity Testing. ACTA ACUST UNITED AC 2017; 55:128-35. [DOI: 10.3368/aoj.55.1.128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Rachel Leman
- University of Alaska-Anchorage School of Nursing Anchorage, Alaska
| | | | - Robert W. Arnold
- University of Alaska-Anchorage School of Nursing Anchorage, Alaska
- Ophthalmic Associates, Anchorage, Alaska
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Tsao Wu M, Armitage MD, Trujillo C, Trujillo A, Arnold LE, Tsao Wu L, Arnold RW. Portable acuity screening for any school: validation of patched HOTV with amblyopic patients and Bangerter normals. BMC Ophthalmol 2017; 17:232. [PMID: 29202721 PMCID: PMC5716052 DOI: 10.1186/s12886-017-0624-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/20/2017] [Indexed: 12/04/2022] Open
Abstract
Background We needed to validate and calibrate our portable acuity screening tools so amblyopia could be detected quickly and effectively at school entry. Methods Spiral-bound flip cards and download pdf surround HOTV acuity test box with critical lines were combined with a matching card. Amblyopic patients performed critical line, then threshold acuity which was then compared to patched E-ETDRS acuity. 5 normal subjects wore Bangerter foil goggles to simulate blur for comparative validation. Results The 31 treated amblyopic eyes showed: logMAR HOTV = 0.97(logMAR E-ETDRS)-0.04 r2 = 0.88. All but two (6%) fell less than 2 lines difference. The five showed logMAR HOTV = 1.09 ((logMAR E-ETDRS) + .15 r2 = 0.63. The critical-line, test box was 98% efficient at screening within one line of 20/40. Conclusion These tools reliably detected acuity in treated amblyopic patients and Bangerter blurred normal subjects. These free and affordable tools provide sensitive screening for amblyopia in children from public, private and home schools. Changing “pass” criteria to 4 out of 5 would improve sensitivity with somewhat slower testing for all students.
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Affiliation(s)
- Maya Tsao Wu
- Alaska Blind Child Discovery, Alaska Children's EYE & Strabismus, 3500 Latouche #280, Anchorage, Alaska, 99508, USA
| | - M Diane Armitage
- Alaska Blind Child Discovery, Alaska Children's EYE & Strabismus, 3500 Latouche #280, Anchorage, Alaska, 99508, USA
| | - Claire Trujillo
- Alaska Blind Child Discovery, Alaska Children's EYE & Strabismus, 3500 Latouche #280, Anchorage, Alaska, 99508, USA
| | - Anna Trujillo
- Alaska Blind Child Discovery, Alaska Children's EYE & Strabismus, 3500 Latouche #280, Anchorage, Alaska, 99508, USA
| | - Laura E Arnold
- Alaska Blind Child Discovery, Alaska Children's EYE & Strabismus, 3500 Latouche #280, Anchorage, Alaska, 99508, USA
| | - Lauren Tsao Wu
- Alaska Blind Child Discovery, Alaska Children's EYE & Strabismus, 3500 Latouche #280, Anchorage, Alaska, 99508, USA
| | - Robert W Arnold
- Alaska Blind Child Discovery, Alaska Children's EYE & Strabismus, 3500 Latouche #280, Anchorage, Alaska, 99508, USA.
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Attention and Visual Motor Integration in Young Children with Uncorrected Hyperopia. Optom Vis Sci 2017; 94:965-970. [PMID: 28902771 DOI: 10.1097/opx.0000000000001123] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Among 4- and 5-year-old children, deficits in measures of attention, visual-motor integration (VMI) and visual perception (VP) are associated with moderate, uncorrected hyperopia (3 to 6 diopters [D]) accompanied by reduced near visual function (near visual acuity worse than 20/40 or stereoacuity worse than 240 seconds of arc). PURPOSE To compare attention, visual motor, and visual perceptual skills in uncorrected hyperopes and emmetropes attending preschool or kindergarten and evaluate their associations with visual function. METHODS Participants were 4 and 5 years of age with either hyperopia (≥3 to ≤6 D, astigmatism ≤1.5 D, anisometropia ≤1 D) or emmetropia (hyperopia ≤1 D; astigmatism, anisometropia, and myopia each <1 D), without amblyopia or strabismus. Examiners masked to refractive status administered tests of attention (sustained, receptive, and expressive), VMI, and VP. Binocular visual acuity, stereoacuity, and accommodative accuracy were also assessed at near. Analyses were adjusted for age, sex, race/ethnicity, and parent's/caregiver's education. RESULTS Two hundred forty-four hyperopes (mean, +3.8 ± [SD] 0.8 D) and 248 emmetropes (+0.5 ± 0.5 D) completed testing. Mean sustained attention score was worse in hyperopes compared with emmetropes (mean difference, -4.1; P < .001 for 3 to 6 D). Mean Receptive Attention score was worse in 4 to 6 D hyperopes compared with emmetropes (by -2.6, P = .01). Hyperopes with reduced near visual acuity (20/40 or worse) had worse scores than emmetropes (-6.4, P < .001 for sustained attention; -3.0, P = .004 for Receptive Attention; -0.7, P = .006 for VMI; -1.3, P = .008 for VP). Hyperopes with stereoacuity of 240 seconds of arc or worse scored significantly worse than emmetropes (-6.7, P < .001 for sustained attention; -3.4, P = .03 for Expressive Attention; -2.2, P = .03 for Receptive Attention; -0.7, P = .01 for VMI; -1.7, P < .001 for VP). Overall, hyperopes with better near visual function generally performed similarly to emmetropes. CONCLUSIONS Moderately hyperopic children were found to have deficits in measures of attention. Hyperopic children with reduced near visual function also had lower scores on VMI and VP than emmetropic children.
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Kelly KR, Felius J, Ramachandran S, John BA, Jost RM, Birch EE. Congenitally Impaired Disparity Vergence in Children With Infantile Esotropia. Invest Ophthalmol Vis Sci 2017; 57:2545-51. [PMID: 27159445 PMCID: PMC4868091 DOI: 10.1167/iovs.15-18606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We examined whether congenital impairment of disparity vergence in infantile esotropia (ET) exists in children with short duration ET (≤3 months) compared with long-duration ET and healthy controls. A short duration of misalignment would allow for a substantial amount of balanced binocular input during the critical period of binocular disparity development. Methods A total of 19 children aged 5 to 12 years and treated for infantile ET with a short (≤3 months; n = 10) or long (≥5 months; n = 9) duration of constant misalignment before alignment were enrolled. A total of 22 healthy control children were enrolled as a comparison group. Eye movements during disparity vergence and accommodative vergence were recorded using an EyeLink 1000 binocular eye tracker. Mean response gain was compared between and within groups to determine the effect of duration of misalignment and viewing condition. Results Compared with controls, children with short (P = 0.002) and long (P < 0.001) duration infantile ET had reduced response gains for disparity vergence, but not for accommodative vergence (P = 0.19). Conclusions Regardless of duration of misalignment, children with infantile ET had reduced disparity vergence, consistent with a congenital impairment of disparity vergence in infantile ET. Although early correction of misalignment increases the likelihood that some level of binocular disparity sensitivity will be present, normal levels may never be achieved.
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Affiliation(s)
- Krista R Kelly
- Retina Foundation of the Southwest, Dallas, Texas, United States
| | - Joost Felius
- Retina Foundation of the Southwest, Dallas, Texas, United States 2Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | | | - Blesson A John
- Retina Foundation of the Southwest, Dallas, Texas, United States
| | - Reed M Jost
- Retina Foundation of the Southwest, Dallas, Texas, United States
| | - Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas, United States 2Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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