A case of primary congenital glaucoma: a diagnostic dilemma

Deep-learning approach to detect childhood glaucoma based on periocular photograph

Childhood glaucoma is one of the major causes of blindness in children, however, its diagnosis is of great challenge. The study aimed to demonstrate and evaluate the performance of a deep-learning (DL) model for detecting childhood glaucoma based on periocular photographs. Primary gaze photographs of children diagnosed with glaucoma with appearance features (corneal opacity, corneal enlargement, and/or globe enlargement) were retrospectively collected from the database of a single referral center. DL framework with the RepVGG architecture was used to automatically recognize childhood glaucoma from photographs. The average receiver operating characteristic curve (AUC) of fivefold cross-validation was 0.91. When the fivefold result was assembled, the DL model achieved an AUC of 0.95 with a sensitivity of 0.85 and specificity of 0.94. The DL model showed comparable accuracy to the pediatric ophthalmologists and glaucoma specialists in diagnosing childhood glaucoma (0.90 vs 0.81, p = 0.22, chi-square test), outperforming the average of human examiners in the detection rate of childhood glaucoma in cases without corneal opacity (72% vs. 34%, p = 0.038, chi-square test), with a bilateral corneal enlargement (100% vs. 67%, p = 0.03), and without skin lesions (87% vs. 64%, p = 0.02). Hence, this DL model is a promising tool for diagnosing missed childhood glaucoma cases.

Knowledge and attitude toward eye disorders in children among pediatricians and family physicians: a survey study

BACKGROUND

Vision-related disorders are common in children. Therefore, eye examination and thorough visual assessment by first-contact physicians are crucial in children. This study aimed to evaluate the knowledge of and attitude toward children's eye disorders among pediatricians and family physicians in the Ministry of National Guard Health Affairs-Western Region (MNGHA-WR) of Saudi Arabia.

METHODS

In this observational, cross-sectional study, we used a self-administered, web-based questionnaire. The sample size was calculated to be 148 pediatricians and family physicians (of 240 in total) currently working at MNGHA-WR. The first section of the questionnaire dwelled on demographics, while the second section addressed the physician's knowledge of and attitude toward commonly encountered ophthalmological pathologies in children. Data collected were entered into Microsoft Excel and then transferred to IBM SPSS version 22 for statistical analysis.

RESULTS

A total of 148 responses (92 family physicians and 56 pediatricians) were received. Most of the participants were residents or staff physicians (n = 105, 70.9%). The mean knowledge score of the respondents was 54.67% ± 14.5%. Participants' knowledge was further subclassified using Bloom's original cutoff points into high (n = 4, 2.7%), moderate (n = 53, 35.8%), and low (n = 91, 61.5%) levels of knowledge. Regarding practices, 120 (81%) participants performed ophthalmic examinations; however, only 39 (26.4%) conducted routine examinations as part of every child's visit. Fundus examinations were performed by 25 (16.9%) physicians. A significant deficiency in knowledge was noted in those with < 1 year of work experience (P = 0.014). Although statistically not significant (P = 0.052), family physicians possessed better knowledge than pediatricians regarding children's eye disorders. On the contrary, more pediatricians performed eye examinations than family physicians (P = 0.015). The male sex was also associated with higher rates of eye examination (P = 0.033).

CONCLUSION

An unsatisfactory level of knowledge of eye disease among participating doctors was reported. The proportion was significantly higher among residents and staff physicians. Therefore, awareness efforts should be incorporated in both family medicine and pediatrics residency programs to limit the number of cases of ocular disorders going undiagnosed in children.

Screening, Diagnosis, and Treatment of Pediatric Ocular Diseases

Vision is an important aspect of a child's quality of life and intellectual, social, and emotional development. Disruptions to vision during infancy and early childhood can cause lifelong vision impairment or blindness. However, early identification and treatment of eye disease can prevent loss of sight and its consequent long-term effects. Therefore, screening guidelines exist to guide physicians in detecting the most common threats to sight in the different stages of infancy and childhood. This review describes common causes of pediatric vision impairment, the recommended screening guidelines for diagnosing them, and current treatment modalities.

Knowledge of and attitude to eye disorders among pediatricians in North Jordan

Purpose

To assess the general knowledge of and attitude to various common eye conditions in children among pediatricians in north Jordan.

Methods

This was a descriptive cross-sectional study. An exploratory questionnaire was developed by the research team to collect the necessary qualitative information.

Results

In total, 48 pediatricians participated in the study. Around two-thirds performed eye examinations in children; however, only 10.4% (n = 5) carried out eye exams routinely as part of every child's health visit. The most common test done was assessment of red reflex, which was performed by only 60.4% (n = 29) of responders. Almost all participants (95.8%, n = 46) recognized the risk factors for retinopathy of prematurity (ROP). The majority of pediatricians (n = 46, 95.8%) would immediately refer a child with suspected glaucoma to an ophthalmologist. In regard to leukocoria, the majority recognized cataract (n = 38, 79.2%) and retinoblastoma (n = 40, 83.3%) as major causes of this condition. Almost all pediatricians (n = 46, 95.8%) would immediately refer a child with leukocoria to an ophthalmologist. On the subject of refractive errors, only 62.5% (n = 30) of physicians confirmed that refractive errors could occur in children of any age and that they may need glasses. Nonetheless, 70.8% (n = 34) stated that refractive errors could be a cause of squint in children. Amblyopia and underlying central causes of squint were a major concern for most responders with 68.8% (n = 33) and 75% (n = 36), respectively.

Conclusion

Although the knowledge of and attitude to eye disease among pediatricians were at a satisfactory level, the degree of collaboration with ophthalmologists is limited. More workshops need to be held for pediatricians.

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Knowledge of eye disease among pediatricians were at a satisfactory level.

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The degree of collaboration with ophthalmologists is limited.

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More workshops need to be held for pediatricians.

Review on the Management of Primary Congenital Glaucoma

Despite being documented in medical history from over 2400 years ago, primary congenital glaucoma (PCG), being a disease with low incidence rate, remains a challenge to ophthalmologists. The article provides a broad overview on the pathophysiology and diagnostic approach to PCG with major emphasis on the treatment options of PCG. While reviewing on the well-established treatment options, namely goniotomy, trabeculo-tomy and combined trabeculotomy-trabeculectomy, emphasis has also been made to recent updates on secondary treatments: trabeculectomy, antimetabolites, glaucoma-drainage devices and cyclodestructive procedures. It is, however, important to note that the rarity of PCG places limitations on study design, most studies are, thus, retrospective, nonrandomized and have different definitions of surgical success. Ophthalmologists need to interpret the results with critical thinking and formulate individual treatment plans for each patient. How to cite this article: Yu Chan JY, Choy BNK, Alex LK Ng, Shum JWH. Review on the Management of Primary Congenital Glaucoma. J Curr Glaucoma Pract 2015;9(3):92-99.