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Fieß A, Dautzenberg K, Gißler S, Mildenberger E, Urschitz MS, Elflein HM, Laspas P, Stoffelns BM, Pfeiffer N, Schuster AK. Prevalence of strabismus and risk factors in adults born preterm with and without retinopathy of prematurity: results from the Gutenberg Prematurity Eye study. Br J Ophthalmol 2024:bjo-2023-324698. [PMID: 38503479 DOI: 10.1136/bjo-2023-324698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/29/2024] [Indexed: 03/21/2024]
Abstract
AIM The purpose of this study was to assess the prevalence of strabismus and nystagmus and to analyse associated factors in preterm and full-term infants in adulthood. METHODS The Gutenberg Prematurity Eye Study is a retrospective cohort study with a prospective ophthalmological examination of participants born preterm and full-term (aged 18-52 years). Perinatal data were carefully assessed for risk factors and comprehensive ophthalmological examinations were conducted. The association between strabismus and nystagmus was assessed by analysing 16 different perinatal and actual risk factors in multivariable analysis. Participants were grouped into full-term controls (gestational age (GA) at birth ≥37 weeks), preterm participants without retinopathy of prematurity (ROP) and GA 33-36 weeks (group 2), GA 29-32 weeks (group 3), GA ≤28 weeks (group 4), non-treated ROP (group 5) and treated ROP (group 6). RESULTS In total, 892 eyes of 450 preterm and full-term individuals (mean age: 28.6 years, SD: ± 8.6 years, 251 females) were included. Strabismus was observed in 2.1% (3/140), 6.6% (9/137), 17.4% (16/92), 11.1% (2/18), 27.1% (13/48) and 60% (9/15) of participants and nystagmus in 0.7% (1/140), 1.5% (2/137), 4.3% (4/92), 5.6% (1/18), 10.4% (5/48) and 26.7% (4/15) of participants in the respective groups. In the multivariable regression model, strabismus was associated with GA (OR=0.90; p=0.046), anisometropia ≥1.5 diopter (OR=3.87; p=0.003), hypermetropia ≥2 diopter (OR=9.89; p<0.001) and astigmatism ≥1.5 diopter (OR=2.73; p=0.017). Esotropia was more frequent than exotropia and hypermetropia/hypometropia. Most strabismus cases occurred within the first 10 years of life. The strongest predictor associated with nystagmus was perinatal adverse events (OR=15.8; p=0.002). CONCLUSION Low GA and refraction of the eye are independent risk factors for strabismus, which typically occurs in the first 10 years of life. Perinatal adverse events are the most important factors for the presence of nystagmus in adulthood.
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Affiliation(s)
- Achim Fieß
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Kim Dautzenberg
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sandra Gißler
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eva Mildenberger
- Department of Pediatrics, Division of Neonatology, Department of Pediatrics, University Medical Center of the Johannes Gutenberg University Mainz, Germany, Mainz, Germany
| | - Michael S Urschitz
- Division of Pediatric Epidemiology, Division of Pediatric Epidemiology, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany, Mainz, Germany
| | - Heike M Elflein
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Panagiotis Laspas
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bernhard M Stoffelns
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alexander K Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Larsson E, Hellström A, Tornqvist K, Wallin A, Sunnqvist B, Sandgren Hochhard K, Lundgren P, Al-Hawasi A, Teär Fahnehjelm K, Gränse L, Holmstrom G. Ophthalmological outcome of 6.5 years children treated for retinopathy of prematurity: a Swedish register study. Br J Ophthalmol 2023; 108:137-142. [PMID: 36717199 PMCID: PMC10804019 DOI: 10.1136/bjo-2022-322022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/19/2022] [Indexed: 01/31/2023]
Abstract
AIMS To determine the ophthalmological outcome at 6.5 years of age in children treated for retinopathy of prematurity (ROP), and registered in the national Swedish National Register for ROP register. METHODS Data on ROP, treatment and ophthalmological outcome were retrieved from the register. Visual acuity (VA), refractive errors and strabismus, together with visual impairment (VI) and any significant eye problem, defined as VA >0.5 logarithm of the minimal angle of resolution (logMAR) and/or strabismus and/or any refractive error were analysed. Risk factors such as sex, gestational age (GA), birth weight SD score, number of treatments and retreatments, postnatal age and postmenstrual age at first treatment were analysed. RESULTS Follow-up data were available in 232 of 270 children born between 2007 and 2014 who had been treated for ROP. VI (VA >0.5 logMAR) was found in 32 (14%), strabismus in 82 (38%), refractive errors in 114 (52%) and significant eye problem in 143 (65%) children. Retreatment was a risk factor for VI and refractive errors. Male sex and neonatal brain lesion were risk factors for strabismus. An additional week of GA at birth reduced the risk for refractive errors, strabismus and significant eye problems. CONCLUSION The results of the present study revealed a high number of eye problems in children treated for ROP, emphasising the need for long-term follow-up. Retreatment of ROP was a risk factor for VI, and emphasises the importance of an accurate first treatment for the long-term ophthalmological outcome.
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Affiliation(s)
- Eva Larsson
- Ophthalmology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ann Hellström
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Tornqvist
- Ophthalmology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | | | | | | | - Pia Lundgren
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Abbas Al-Hawasi
- Department of biomedical and clinical science, Linköping University, Linkoping, Sweden
| | - Kristina Teär Fahnehjelm
- St Erik Eye Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Section for Eye and Vision, Karolinska Institute, Stockholm, Sweden
| | - Lotta Gränse
- Ophthalmology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Gerd Holmstrom
- Ophthalmology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Solebo AL, Teoh L, Sargent J, Rahi JS. Avoidable childhood blindness in a high-income country: findings from the British Childhood Visual Impairment and Blindness Study 2. Br J Ophthalmol 2023; 107:1787-1792. [PMID: 36229176 DOI: 10.1136/bjo-2022-321718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/27/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Addressing childhood visual disability is an international priority, with data on causes needed to plan, implement and evaluate public health and clinical care. We have examined the contribution of 'avoidable' blinding disorders to childhood visual impairment, severe visual impairment and blindness (VI/SVIBL) in the UK. METHODS National prospective observational longitudinal study, the British Childhood Visual Impairment and Blindness Study 2 (BCVIS2), of children (aged 18 years or under) newly diagnosed with vision worse than 0.48 logMAR (logarithm of the minimum angle of resolution) or equivalent in both eyes. Proportions of children with an 'avoidable' disorder comprising either a potentially preventable (isolated disorders with an effective intervention which reduces disease incidence) or treatable (isolated eye or vision disorders for which there are routinely available effective interventions able to improve vision or halt progressive visual loss) are reported. RESULTS Of the 784 children within BCVIS2, isolated potentially preventable disorders were present in only 17% (132/784) and treatable disorders in an additional 13% (99/784). The most common treatable causes were cataract, retinopathy of prematurity and glaucoma. Of the 132 children with potentially preventable disease, 64 had hypoxic-ischaemic encephalopathy. Non-accidental injury accounted for almost two-thirds (11/16, 69%) of those with VI/SVIBL due to injury. CONCLUSION Despite significant progress in the past decades in high-income countries, there remains a need to be vigilant about implementing preventive strategies and treatments. Attention to disorders that are currently neither preventable nor treatable remains a priority in these settings and will become increasingly important in lower-income and middle-income countries undergoing economic transition.
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Affiliation(s)
- Ameenat Lola Solebo
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
- NIHR Moorfields Biomedical Research Centre, London, UK
- Ophthalmology Department, Great Ormond Street Hospital, London, UK
- Ulverscroft Vision Research Group, London, UK
| | - Lucinda Teoh
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
- Ulverscroft Vision Research Group, London, UK
| | - Jenefer Sargent
- Wolfson Neurodisability Service, Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Jugnoo S Rahi
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
- NIHR Moorfields Biomedical Research Centre, London, UK
- Ophthalmology Department, Great Ormond Street Hospital, London, UK
- Ulverscroft Vision Research Group, London, UK
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Chidi-Egboka NC, Jalbert I, Wagner P, Golebiowski B. Blinking and normal ocular surface in school-aged children and the effects of age and screen time. Br J Ophthalmol 2023; 107:1613-1620. [PMID: 36002237 DOI: 10.1136/bjo-2022-321645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Baseline ocular surface characteristics in children require investigation. This study characterised blinking and relationships with ocular symptoms, tear film and digital device use. METHODS 45 children aged 6-15 years (56% female) participated in a cross-sectional study. Ocular surface symptoms (Instant Ocular Symptoms Survey, Dry Eye Questionnaire 5, Symptoms Assessment in Dry Eye, Ocular Surface Disease Index, Ocular Comfort Index and Numerical Rating Scale) and clinical indices (lipid layer thickness, tear secretion and stability, meibomian gland) were assessed. Blink rate and interblink interval were measured in situ using a wearable eye-tracking headset (Pupil Labs GmbH, Germany). Associations between blinking, ocular surface, age, and digital device use (bivariate and partial correlations) and between automated and manually counted blink rate (Bland & Altman) were examined. RESULTS Mean blink rate and interblink interval were 20.5±10.5 blinks/min and 2.9±1.9 s during conversation. There was no difference between automated and manual blink rate (p=0.78) and no relationship between blinking and digital device use, age or sex. Mean group symptoms were within normal range and not associated with clinical measurements including blinking. Greater tear volume was associated with a faster blink rate (r=0.46, p=0.001) and shorter interblink interval (r=-0.36, p=0.02). Older age was associated with improved tear volume (r=0.37, p=0.01) and stability (r=0.38, p=0.01). CONCLUSIONS Blinking characterised in situ was not impacted by age or habitual digital device use. A faster blink rate was associated with greater tear volume but not symptoms. Improved tear function was found with age suggesting that the ocular surface continues to develop through childhood.
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Affiliation(s)
- Ngozi Charity Chidi-Egboka
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter Wagner
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Blanka Golebiowski
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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Shen LL, Mangalesh S, McGeehan B, Seely KR, Tai V, Sarin N, Finkle J, Winter KP, Tran-Viet D, Freedman SF, El-Dairi MA, Ying GS, Toth CA. Biphasic change in retinal nerve fibre layer thickness from 30 to 60 weeks postmenstrual age in preterm infants. Br J Ophthalmol 2023; 107:1680-1686. [PMID: 36113954 PMCID: PMC10270321 DOI: 10.1136/bjo-2022-321621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS The optic nerve development during the critical postnatal weeks of preterm infants is unclear. We aimed to investigate the change of retinal nerve fibre layer (RNFL) in preterm infants. METHODS We used an investigational handheld optical coherence tomography (OCT) system to serially image awake preterm infants between 30 and 60 weeks postmenstrual age (PMA) at the bedside. We assessed RNFL thickness in the papillomacular bundle and nasal macular ganglion cell layer+inner plexiform layer (GCL+IPL) thickness. We applied a segmented mixed model to analyse the change in the thickness of RNFL and GCL+IPL as a function of PMA. RESULTS From 631 OCT imaging sessions of 101 infants (201 eyes), RNFL thickness followed a biphasic model between 30 and 60 weeks, with an estimated transition at 37.8 weeks PMA (95% CI: 37.0 to 38.6). RNFL thickness increased at 1.8 μm/week (95% CI: 1.6 to 2.1) before 37.8 weeks and decreased at -0.3 μm/week (95% CI: -0.5 to -0.2) afterwards. GCL+IPL thickness followed a similar biphasic model, in which the thickness increased at 2.9 μm/week (95% CI: 2.5 to 3.2) before 39.5 weeks PMA (95% CI: 38.8 to 40.1) and then decreased at -0.8 μm/week (95% CI: -0.9 to -0.6). CONCLUSION We demonstrate the feasibility of monitoring RNFL and GCL+IPL thickness from OCT during the postnatal weeks of preterm infants. Thicknesses follow a biphasic model with a transition age at 37.8 and 39.5 weeks PMA, respectively. These findings may shed light on optic nerve development in preterm infants and assist future study designs.
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Affiliation(s)
- Liangbo L Shen
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Shwetha Mangalesh
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brendan McGeehan
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kai R Seely
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Vincent Tai
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Neeru Sarin
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joanne Finkle
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katrina P Winter
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Du Tran-Viet
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mays A El-Dairi
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
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Leister N, Trieschmann U, Yücetepe S, Ulrichs C, Muenke N, Wendt S, Menzel C, Heindl LM. Nalbuphine as analgesic in preschool children undergoing ophthalmic surgery and the occurrence of emergence delirium. Br J Ophthalmol 2023; 107:1522-1525. [PMID: 35817561 DOI: 10.1136/bjo-2022-321575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Perioperative pain in children is often inadequately treated, and emergence agitation is common. The purpose of this analysis was to determine whether nalbuphine is suitable for perioperative eye pain and to analyse if it influences the occurrence of emergence delirium/agitation (EDA) in children undergoing ophthalmic surgery in general anaesthesia. METHODS Retrospective cohort analysis of 50 children in preschool age undergoing general anaesthesia for ophthalmic surgery receiving nalbuphine as a postoperative analgesic in a German university hospital from June 2020 to February 2021.Scores and values for pain and EDA were routinely recorded after awakening and during the stay in the recovery room. Data were evaluated retrospectively from the medical records. RESULTS A total of 50 children (17 girls and 33 boys) underwent general anaesthesia for ophthalmic surgery. The median age of the children included was 20.5 months (range, 1-68 months), the median body weight was 12.25 kg (range, 2.9-29 kg). All patients received ibuprofen (10 mg/kg1) during induction of anaesthesia and nalbuphine (0.1 mg/kg) at the end of surgery. All patients had an Paediatric-Anaesthesia-Emergence-Delirium-I-score (PAED-ED-I Score) of less than 6 and acceptable Face-Legs-Activity-Cry-Consolability-scores (FLACC less than 3) on waking and on leaving the recovery room. CONCLUSION Nalbuphine shows a sufficient analgesic effect for pain therapy following ophthalmic surgery in preschool children. Nalbuphine seems to reduce the incidence of EDA in children undergoing ophthalmic surgery.
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Affiliation(s)
- Nicolas Leister
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Uwe Trieschmann
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Sirin Yücetepe
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christoph Ulrichs
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nikolas Muenke
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Stefanie Wendt
- Department of Cardiothoracic Surgery and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christoph Menzel
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Dusseldorf, Cologne, Germany
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Groot ALW, Remmers JS, Lissenberg-Witte BI, de Meulenaere STJ, Talan D, Liberton NPTJ, de Graaf P, Moll AC, Saeed P, Hartong DT. Workflow and treatment results for computer-aided design and 3D-printed conformer therapy of congenital anophthalmia and microphthalmia. Br J Ophthalmol 2023; 107:1239-1245. [PMID: 35477668 DOI: 10.1136/bjophthalmol-2021-320882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To evaluate treatment with custom, three-dimensional (3D) printed conformers for socket expansion in congenital microphthalmia and anophthalmia (MICA). METHODS Retrospective analysis of prospective cohort from 2016 to 2020. All children received custom-made 3D-printed conformers increasing in size. We measured height, width, thickness, surface and volume of first and consecutive conformers, as well as horizontal palpebral fissure length (HPF) at start and follow-up visits. We analysed these parameters for severely (<45%) and moderately (>45%-75%) affected children, based on affected axial length on ultrasonography. RESULTS We included 18 cases (9 severe, 9 moderate) with a total of 174 conformers (88 severe, 86 moderate) and a mean follow-up of 2.8 years (range 1.3-4.8). The mean relative HPF increased from 77% to 93% with 16/17 cases reaching >80%, and 12/17 cases >90% symmetry. Horizontal and vertical conformer dimensions increased up to 10 months of treatment, with a steeper slope for the severe group (10.5% vs 5.5% for height and 9.0% vs 6.1% for width gain per treatment month, for severe and moderate MICA, respectively). After 10 months of treatment conformer height and width increased only slightly. No serious complications were observed. CONCLUSION 3D-design and printing of solid conformers results in highly acceptable horizontal eyelid symmetry in the treatment of congenital MICA. The mean increase in conformer height and width in the first 10 months should be about 170% for moderate and about 200% for severe MICA. The presented conformer size formulas can aid ophthalmologists and ocularists to plan conformer treatment.
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Affiliation(s)
- Annabel L W Groot
- Department of Ophthalmology, Amsterdam Orbital Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jelmer S Remmers
- Department of Ophthalmology, Amsterdam Orbital Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Simon T J de Meulenaere
- Department of Ophthalmology, Amsterdam Orbital Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Duygu Talan
- Department of Ophthalmology, Amsterdam Orbital Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Niels P T J Liberton
- Department of Medical Technology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, the Netherlands
| | - Annette C Moll
- Department of Ophthalmology, Amsterdam Orbital Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Peerooz Saeed
- Department of Ophthalmology, Amsterdam Orbital Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Dyonne T Hartong
- Department of Ophthalmology, Amsterdam Orbital Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
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Sun W, Yu M, Wu J, Han X, Jan C, Song J, Jiang W, Xu Z, Wu Z, Xu J, Hu Y, Bi H. Pseudomyopia as an independent risk factor for myopia onset: a prospective cohort study among school-aged children. Br J Ophthalmol 2023:bjo-2022-322330. [PMID: 37541767 DOI: 10.1136/bjo-2022-322330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 07/09/2023] [Indexed: 08/06/2023]
Abstract
AIM To investigate whether pseudomyopia is an independent risk factor for myopia onset based on a population-based cohort study. METHODS Non-myopic children were recruited from schools in rural and urban settings of Shangdong province, China. Baseline examinations started in September 2020 and all participants were invited for a 6-month follow-up. Pseudomyopia was defined as spherical equivalent (SE) ≤-0.50 diopters (D) before cycloplegia and >-0.50D after cycloplegia. Myopia was defined as cycloplegic SE ≤-0.50D. RESULTS A total of 2328 children (baseline age: 4-17 years) were included in the final analysis. During the 6-month follow-up, 21.1% (355/1680) pseudomyopic eyes developed myopia, and 3.8% (110/2879) non-myopic and non-pseudomyopic eyes developed myopia. After adjusting for multiple myopia risk factors, including baseline cycloplegic SE, near work and outdoor time, pseudomyopia was found to be an independent risk factor for myopia onset (relative risk=2.52, 95% CI 1.86 to 3.42). Additionally, pseudomyopic children with more myopic cycloplegic SE (p<0.001), smaller difference between cycloplegic and non-cycloplegic SE (DIFF, p<0.001), and higher binocular amplitude of accommodation (p<0.001) had higher risk of myopia development. CONCLUSION This is an important longitudinal study to prove that pseudomyopia is an independent risk factor for myopia development among school-aged children.
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Affiliation(s)
- Wei Sun
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Affiliated Eye Hospital, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Mingkun Yu
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jianfeng Wu
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Shandong Institute of Children Health and Myopia Prevention and Control, Jinan, Shandong, China
| | - Xiaotong Han
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Catherine Jan
- Department of Ophthalmology and Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
| | - Jike Song
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Shandong Institute of Eye Disease, Jinan, Shandong, China
| | - Wenjun Jiang
- Shandong Institute of Eye Disease, Jinan, Shandong, China
| | - Zihang Xu
- Ophthalmology and Optometry Medical School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Ziyun Wu
- Ophthalmology and Optometry Medical School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jing Xu
- Affiliated Eye Hospital, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yuanyuan Hu
- Affiliated Eye Hospital, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Shandong Institute of Children Health and Myopia Prevention and Control, Jinan, Shandong, China
| | - Hongsheng Bi
- Affiliated Eye Hospital, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Shandong Institute of Eye Disease, Jinan, Shandong, China
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Kirby RP, Malik ANJ, Palamountain KM, Gilbert CE. Improved screening of retinopathy of prematurity (ROP): development of a target product profile (TPP) for resource-limited settings. BMJ Open Ophthalmol 2023; 8:e001197. [PMID: 37493654 PMCID: PMC10357678 DOI: 10.1136/bmjophth-2022-001197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 06/19/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND As more preterm infants survive, complications of preterm birth, including retinopathy of prematurity (ROP), become more prevalent. ROP rates and blindness from ROP are higher in low-income and middle-income countries, where exposure to risk factors can be higher and where detection and treatment of ROP are under-resourced or non-existent. Access to low-cost imaging devices would improve remote screening capabilities for ROP. METHODS Target product profiles (TPPs) are developed early in the medical device development process to define the setting, target user and range of product requirements. A Delphi-like process, consisting of an online survey and consensus meeting, was used to develop a TPP for an ROP imaging device, collecting feedback on a proposed set of 64 product requirements. RESULTS Thirty-six stakeholders from 17 countries provided feedback: clinicians (72%), product developers (14%), technicians (6%) and other (8%). Thirty-six per cent reported not currently screening for ROP, with cited barriers including cost (44%), no training (17%) and poor image quality (16%). Among those screening (n=23), 48% use more than one device, with the most common being an indirect ophthalmoscope (87%), followed by RetCam (26%) and smartphone with image capture (26%). Consensus was reached on 53 (83%) product requirements. The 11 remaining were discussed at the consensus meeting, and all but two achieved consensus. CONCLUSIONS This TPP process was novel in that it successfully brought together diverse stakeholders to reach consensus on the product requirements for an ROP imaging devices. The resulting TPP provides a framework from which innovators can develop prototypes.
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Affiliation(s)
- Rebecca P Kirby
- Kellogg School of Management, Northwestern University, Evanston, Illinois, USA
| | - Aeesha N J Malik
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Kara M Palamountain
- Kellogg School of Management, Northwestern University, Evanston, Illinois, USA
| | - Clare E Gilbert
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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10
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Sherief ST, Taye K, Teshome T, Demtse A, Gilbert C. Retinopathy of prematurity among infants admitted to two neonatal intensive care units in Ethiopia. BMJ Open Ophthalmol 2023; 8:e001257. [PMID: 37487673 PMCID: PMC10373681 DOI: 10.1136/bmjophth-2023-001257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE This study was conducted to determine the prevalence and risk factors for retinopathy of prematurity (ROP) in two neonatal intensive care units (NICUs) in Addis Ababa, Ethiopia. METHODS AND ANALYSIS A prospective screening survey was conducted from June 2019 to June 2020 in two level 3 public NICUs. Infants with a birth weight (BW) of ≤1500 g or gestational age (GA) of ≤32 weeks and those with a BW of >1500 g and GA of >32 weeks with an unstable clinical course were included. Data on demographic and neonatal characteristics, neonatal and maternal comorbidities, and therapeutic interventions were collected. Logistic regression analysis was used to identify predictors of ROP. RESULTS Two hundred and two infants were included: mean BW: 1658g (range: 700-2400 g) and mean GA: 32.4 weeks (range: 26-34 weeks). 32.2% had any stage of ROP, and 6.4% had Type 1 ROP. Lower BW, smaller GA and total days on oxygen were independent risk factors for severe ROP (Type 1 or worse). All 13 neonates with severe ROP were treated. CONCLUSION ROP is emerging as a concern in Ethiopia. ROP screening should include neonates with BW of <1800 g or GAs of ≤33 weeks, but further studies are needed in level 2 and private NICUs. Screening guidelines need to be developed and implemented in all hospitals with NICUs.
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Affiliation(s)
- Sadik Taju Sherief
- Department of Ophthalmology, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Kalekirstos Taye
- Department of Ophthalmology, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Tiliksew Teshome
- Department of Ophthalmology, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Asrat Demtse
- Department of Paediatrics, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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11
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Kelbsch C, Spieth B, Zrenner E, Besch D, Straßer T. PandAcuity in paediatrics: a novel clinical measure of visual function based on the panda illusion. Br J Ophthalmol 2023; 107:582-586. [PMID: 34789454 PMCID: PMC10086294 DOI: 10.1136/bjophthalmol-2021-319935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/31/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To evaluate the PandAcuity test for visual function testing in a paediatric cohort and to examine its agreement with conventional visual acuity (VA) testing. METHODS PandAcuity scores were determined in 152 children (77 males) aged between 3 and 15 years after VA testing (LEATM-test, E-chart, Landolt-C-rings or numbers). The PandAcuity test consisted of illusions made up from silhouettes of animals 'hidden' within zig-zag-patterns of decreasing spatial frequencies. Correlation analyses between PandAcuity score and VA were performed. RESULTS 150 children completed the test in at least one eye, 148 in both eyes. The PandAcuity test demonstrated good test-retest reliability (intraclass correlation coefficient=0.89) between two runs. VA and PandAcuity score showed a medium to large correlation (Spearman's ρ=0.52, p<0.0001). 93% of the children's visual impairment was classified in the same range by both test types. Receiver operating characteristic analysis of predicted visual impairment showed an excellent agreement with the classification based on VA testing (AUC=0.84). CONCLUSION The PandAcuity test is rapid, simple and well accepted, rendering it a suitable supplement for the clinical assessment of VA in children. Because of its counterintuitive application (a higher number of correctly identified images means worse VA), it can be used to cross-validate conventional acuity tests to assure children's compliance.
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Affiliation(s)
- Carina Kelbsch
- University Eye Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Bettina Spieth
- University Eye Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Eberhart Zrenner
- Werner Reichardt Centre for Integrative Neuroscience (CIN), University of Tuebingen, Tuebingen, Germany
- Institute for Ophthalmic Research, University of Tuebingen, Tuebingen, Germany
| | - Dorothea Besch
- University Eye Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Torsten Straßer
- University Eye Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
- Institute for Ophthalmic Research, University of Tuebingen, Tuebingen, Germany
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12
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Ayoub L, Aring E, Gyllencreutz E, Landgren V, Svensson L, Landgren M, Grönlund MA. Visual and ocular findings in children with fetal alcohol spectrum disorders (FASD): validating the FASD Eye Code in a clinical setting. BMJ Open Ophthalmol 2023. [PMCID: PMC9990666 DOI: 10.1136/bmjophth-2022-001215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Objective Fetal alcohol spectrum disorders (FASD) is an umbrella term covering a spectrum of medical conditions caused by prenatal alcohol exposure. The FASD Eye Code is a new complementary ophthalmological diagnostic tool created to corroborate the complex FASD diagnosis. The aim of this work was to validate the FASD Eye Code by testing it on a second group of children diagnosed with FASD in a clinical setting. Methods and analysis A clinical study was carried out in a group of 21 children (13 males, 8 females, mean age 13.3 years) investigated for suspected FASD and a healthy sex-matched and age-matched control group (n=21). The participants underwent a detailed ophthalmological examination including visual perception problems (VPPs) assessment. Clinical examination results were compiled, and total scores were calculated according to the FASD Eye Code protocol (range 4–16). Results The median total score in the FASD group was 8. Eight individuals in the FASD group and none of the controls obtained a total score of ≥9 corresponding to 38% sensitivity and 100% specificity with an area under the curve of 0.90. A cut-off total score of ≥8 showed 52% sensitivity and 95% specificity. One individual in the FASD group versus 12 controls had a total score of 4, representing normal findings. No significant difference between the two groups regarding VPPs was seen. Conclusion The FASD Eye Code can be used as a complementary diagnostic tool for FASD to assist in diagnosis and to detect ophthalmological abnormalities in individuals with suspected FASD.
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Affiliation(s)
- Lucyn Ayoub
- Department of Ophthalmology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Aring
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden
| | - Emelie Gyllencreutz
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Valdemar Landgren
- Region Västra Götaland, Skaraborg Hospital, Department of Psychiatry, Skövde, Sweden,Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Leif Svensson
- Region Västra Götaland, Skaraborg Hospital, Department of Paediatrics, Unit of Neurodevelopmental Disorders, Mariestad, Sweden
| | - Magnus Landgren
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Marita Andersson Grönlund
- Department of Ophthalmology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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13
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Shen LL, Mangalesh S, Michalak SM, McGeehan B, Sarin N, Finkle J, Winter KP, Tran-Viet D, Benner EJ, Vajzovic L, Freedman SF, Younge N, Cotten CM, El-Dairi M, Ying GS, Toth C. Associations between systemic health and retinal nerve fibre layer thickness in preterm infants at 36 weeks postmenstrual age. Br J Ophthalmol 2023; 107:242-247. [PMID: 34389548 PMCID: PMC8858642 DOI: 10.1136/bjophthalmol-2021-319254] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/30/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND/AIMS Neonatal insults from systemic diseases have been implicated in the pathway of impaired neurodevelopment in preterm infants. We aimed to investigate the associations between systemic health factors and retinal nerve fibre layer (RNFL) thickness in preterm infants. METHODS We prospectively enrolled infants and imaged both eyes at 36±1 weeks postmenstrual age (PMA) using a hand-held optical coherence tomography system at the bedside in the Duke intensive care nurseries. We evaluated associations between RNFL thickness and 29 systemic health factors using univariable and multivariable regression models. RESULTS 83 infants with RNFL thickness measures were included in this study. Based on the multivariable model, RNFL thickness was positively associated with infant weight at imaging and was negatively associated with sepsis/necrotising enterocolitis (NEC). RNFL thickness was 10.4 µm (95% CI -15.9 to -4.9) lower in infants with than without sepsis/NEC in the univariable analysis (p<0.001). This difference remained statistically significant after adjustment for confounding variables in various combinations (birth weight, birthweight percentile, gestational age, infant weight at imaging and growth velocity). A 250 g increase in infant weight at imaging was associated with a 3.1 µm (95% CI 2.1 to 4.2) increase in RNFL thickness in the univariable analysis (p<0.001). CONCLUSIONS Low infant weight and sepsis/NEC were independently associated with thinner RNFL in preterm infants at 36 weeks PMA. To our knowledge, this study is the first to suggest that sepsis/NEC may affect retinal neurodevelopment. Future longitudinal studies are needed to investigate this relationship further.
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Affiliation(s)
- Liangbo L Shen
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Shwetha Mangalesh
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Suzanne M Michalak
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brendan McGeehan
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neeru Sarin
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joanne Finkle
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katrina P Winter
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Du Tran-Viet
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eric J Benner
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lejla Vajzovic
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Noelle Younge
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - C Michael Cotten
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mays El-Dairi
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cynthia Toth
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
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14
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Chattannavar G, Mohamed A, Malgi V, Kekunnaya R. Visual outcomes and safety profile of intraocular lens implantation versus aphakia in children with microspherophakia with no subluxation. BMJ Open Ophthalmol 2023. [PMCID: PMC9835943 DOI: 10.1136/bmjophth-2022-001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective To study the visual, refractive and surgical outcomes of intraocular lens (IOL) implantation versus aphakia in children with microspherophakia. Design Retrospective, comparative, non-randomised interventional study. Methods All consecutive children with microspherophakia who satisfied the inclusion criteria were included. The eyes that underwent in-the-bag IOL implantation and those that were left aphakic were included in groups A and B, respectively. The postoperative visual outcomes, IOL stability and complications during the follow-up period were studied. Results 22 eyes (13 patients, male 76%), of which 12 eyes were in group A and 10 eyes in group B. The mean±SE of age at surgery was 9.4±1.4 and 7.3±0.9 years in group A and group B, respectively (p value 0.18). The mean follow-up of group A was 0.9±0.4 years (median 0.5 years; Q1 0.04, Q3 2.16) and group B was 1.3±0.9 years (median 0.147 years; Q1 0.08, Q3 0.39) (p value 0.76). All the baseline biometric variables including best-corrected visual acuity (BCVA) were comparable in each group. The final BCVA in logMAR adjusted for follow-up was comparable in both group A (0.29±0.06) and group B (0.52±0.09) (p value 0.06). Mean predictive error of IOL power in microspherophakia was 0.17±0.43. The most common complication in group A was visual axis opacification of two eyes (16.7%, 95% CI 2.9% to 49.1%), of which one eye (8.3%, 95% CI 0.4% to 40.2%) needed membranectomy. Vitreous in anterior chamber was the most common complication in group B, seen in two eyes (20%, 95% CI 3.5% to 55.8%), of which one eye (10%, 95% CI 0.5% to 45.9%) underwent YAG laser vitreolysis. The survival analysis (p value 0.18) was comparable in each group. Conclusion In-the-bag IOL is an option, which can be considered in selected cases of microspherophakia in developing nations where regular follow-up and economic constraints are a major concern.
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Affiliation(s)
- Goura Chattannavar
- Pediatric and Neuro-ophthalmology Services, Jasti V Ramanamma Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
| | | | - Vishwesh Malgi
- Pediatric and Neuro-ophthalmology Services, Jasti V Ramanamma Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Ramesh Kekunnaya
- Pediatric and Neuro-ophthalmology Services, Jasti V Ramanamma Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
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15
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Hendricks TM, Griepentrog GJ, Hodge DO, Mohney BG. Psychosocial and mental health disorders among a population-based, case-control cohort of patients with congenital upper eyelid ptosis. Br J Ophthalmol 2023; 107:12-16. [PMID: 34281901 PMCID: PMC9311484 DOI: 10.1136/bjophthalmol-2021-319276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/05/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIM Recent studies have demonstrated adverse psychosocial and mental health disorders among children with ocular disorders. The mental health burden of children with simple congenital ptosis, however, is unknown. The purpose of this study was to compare the psychosocial and mental health findings of children with simple congenital ptosis with controls. METHODS The medical records of all children (<19 years) diagnosed with simple congenital ptosis from 1 January 1965 through 31 December 2004 while residing in Olmsted County, Minnesota were retrospectively reviewed for psychosocial and mental health morbidity. One-to-one randomly selected age-matched and gender-matched controls from the same population were similarly reviewed. RESULTS 81 children with ptosis were diagnosed at a mean age of 3.2 years (range, 1 month-16 years), 35 (43.2%) of whom were girls. An adverse psychosocial development was diagnosed in 41 (50.6%) patients with simple congenital ptosis monitored to a mean age of 21.4 years, compared with 26 (32.5%) controls (p=0.02). A mental illness was diagnosed in 31 (38.3%) patients with ptosis compared with 16 (20%) controls (p=0.01). Children with ptosis were 2.5 times more likely than controls to develop a mental illness and 2.1 times more likely to develop a psychosocial maladjustment. Patients with ptosis were also significantly more likely to have more mental health disorders (p=0.02) and a longer duration of psychotropic medication use (p=0.005). CONCLUSIONS Children diagnosed with simple congenital ptosis in this population had significantly greater psychosocial and mental health morbidity compared with controls. Children with ptosis may benefit from early psychosocial intervention.
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Affiliation(s)
- Tina M Hendricks
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Gregory J Griepentrog
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David O Hodge
- Division of Biostatistics, Mayo Clinic, Jacksonville, Florida, USA
| | - Brian G Mohney
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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16
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Li M, Lanca C, Tan CS, Foo LL, Sun CH, Yap F, Najjar RP, Sabanayagam C, Saw SM. Association of time outdoors and patterns of light exposure with myopia in children. Br J Ophthalmol 2023; 107:133-139. [PMID: 33858839 DOI: 10.1136/bjophthalmol-2021-318918] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/06/2021] [Accepted: 03/28/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIMS To evaluate the association of reported time outdoors and light exposure patterns with myopia among children aged 9 years from the Growing Up in Singapore Towards Healthy Outcomes birth cohort. METHODS We assessed reported time outdoors (min/day), light exposure patterns and outdoor activities of children aged 9 years (n=483) with a questionnaire, the FitSight watch and a 7-day activity diary. Light levels, the duration, timing and frequency of light exposure were assessed. Cycloplegic spherical equivalent (SE), myopia (SE≤-0.5 D) and axial length (AL) of paired eyes were analysed using generalised estimating equations. RESULTS In this study, 483 (966 eyes) multiethnic children (50.0% boys, 59.8% Chinese, 42.2% myopic) were included. Reported time outdoors (mean±SD) was 100±93 min/day, and average light levels were 458±228 lux. Of the total duration children spent at light levels of ≥1000 lux (37±19 min/day), 76% were spent below 5000 lux. Peak light exposure occurred at mid-day. Children had 1.7±1.0 light exposure episodes/day. Common outdoor activities were walks, neighbourhood play and swimming. Greater reported time outdoors was associated with lower odds of myopia (OR=0.82, 95% CI 0.70 to 0.95/hour increase daily; p=0.009). Light levels, timing and frequency of light exposures were not associated with myopia, SE or AL (p>0.05). CONCLUSION Reported time outdoors, light levels and number of light exposure episodes were low among Singaporean children aged 9 years. Reported time outdoors was protective against myopia but not light levels or specific light measures. A multipronged approach to increase time outdoors is recommended in the combat against the myopia epidemic.
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Affiliation(s)
- Mijie Li
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Myopia Research Group, Singapore Eye Research Institute, Singapore
| | - Carla Lanca
- Myopia Research Group, Singapore Eye Research Institute, Singapore
| | - Chuen-Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Li-Lian Foo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Chen-Hsin Sun
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Fabian Yap
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Raymond P Najjar
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Visual Neuroscience Research Group, Singapore Eye Research Institute, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore .,Myopia Research Group, Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
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17
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Dahlmann-Noor AH, Roberts C, Muthusamy K, Calder V, Hingorani M. Steroid-sparing effect of ciclosporin A 1 mg/mL: 5-year case series of 107 children and young people with vernal keratoconjunctivitis. BMJ Open Ophthalmol 2022; 7:e001040. [PMCID: PMC9756209 DOI: 10.1136/bmjophth-2022-001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background/aims To explore the steroid-sparing and other therapeutic effects of ciclosporin A (CsA) 1 mg/mL in the management of vernal keratoconjunctivitis (VKC). Methods Open retrospective single-group interventional consecutive cohort study (case series) of 107 children and young people (CYP) age 4.4–18 years with severe and/or recurrent VKC who were prescribed CsA 1 mg/mL between November 2015 and May 2021 at one institution. Review of electronic patient records, noting clinical indication for prescribing CsA 1 mg/mL, dosage prescribed at initiation and follow-up, impact on steroid usage before and after commencing CsA as well as adverse events and indications for discontinuation of treatment. Results The median number of inflammatory episodes requiring treatment with topical corticosteroids fell from 3 (IQR 2–4) during the 12 months prior to CsA 1 mg/mL to 1 (IQR 0–3) during the 12 months after, excluding steroid prescriptions with the first CsA 1 mg/mL prescription (Wilcoxon signed ranks test, two tailed, p<0.01). In the 12-month period following initiation of CsA 1 mg/mL with concomitant prescription of topical corticosteroids (n=82), daily dosage of steroids was reduced in 79 (96.3%) and discontinued in 67 (81.7%). The median number of hospital clinic visits fell from 4 (IQR 3–5) to 3 (IQR 2–5) (Wilcoxon p<0.01). Adverse events leading to discontinuation of CsA 1 mg/mL within 12 months of starting included stinging (instillation site pain) (6/107, 5.6%) and skinrash (1/107, 0.9%). Conclusion Commercial preparations of CsA 1 mg/mL, licensed for severe VKC in CYP, significantly reduce the need for concomitant topical corticosteroids and hospital clinic visits. Adverse events which may lead to discontinuation are stinging and skin rash.
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Affiliation(s)
- Annegret Hella Dahlmann-Noor
- NIHR Moorfields Biomedical Research Centre, London, UK,Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Clare Roberts
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Kirithika Muthusamy
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Melanie Hingorani
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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18
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Wang H, Li Y, Qiu K, Zhang R, Lu X, Luo L, Lin JW, Lu Y, Zhang D, Guo P, Yang Y, Jing L, Huang Y, Ma Q, Zhou R, Ou Y, Chen Q, Zhou Y, Deng D, Li C, Yam JC, Chen LJ, Pang CP, Zhang M. Prevalence of myopia and uncorrected myopia among 721 032 schoolchildren in a city-wide vision screening in southern China: the Shantou Myopia Study. Br J Ophthalmol 2022:320940. [PMID: 36198476 DOI: 10.1136/bjo-2021-320940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 09/04/2022] [Indexed: 02/05/2023]
Abstract
AIMS To explore the prevalence and risk factors for myopia and uncorrected myopia in schoolchildren in southern China. METHODS The government-led Shantou Myopia Study was conducted from September 2020 to June 2021. Non-cycloplegic refraction was performed. Uncorrected visual acuity (UCVA) was measured along with presenting visual acuity if participants wore spectacles. Spherical equivalent refraction (SER) is defined as the spherical dioptres added to half of the cylindrical dioptres. Myopia is defined as SER <-0.50 dioptre with UCVA of <20/20 in at least one eye. RESULTS This study enrolled 724 828 schoolchildren (77.8% of all schoolchildren in Shantou) from 901 schools. Data from 721 032 schoolchildren (99.5%) were analysed (mean age 11.53±3.13 years, 6-20 years, 373 230 boys and 347 802 girls). Among them, 373 459 (51.8%) had myopia: 37.1% of 465 696 children in primary schools, 75.4% of 170 164 children in junior high schools and 84.8% of 85 172 children in senior high schools. The prevalence of myopia increases non-linearly with age. Older age, female and urban living environment were independently associated with myopia prevalence and myopic SER. Among the 373 459 children with myopia, 60.0% had no refractive correction: 74.9%, 53.9% and 35.5% in primary, junior high and senior high schools, respectively. CONCLUSION The overall prevalence of myopia among schoolchildren in Shantou was 51.8%, higher than the national average in China. The proportion of uncorrected myopia is high, especially in primary schools. Our results indicate the need for public education on eye care among schoolchildren even in a municipal city.
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Affiliation(s)
- Hongxi Wang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Yuancun Li
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Kunliang Qiu
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Riping Zhang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Xuehui Lu
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Li Luo
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Jian-Wei Lin
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Yanlin Lu
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Dan Zhang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Peiting Guo
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Yong Yang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Liu Jing
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Yingzi Huang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Qian Ma
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Ruiqing Zhou
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Yunxuan Ou
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Quanwen Chen
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Youming Zhou
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Dandan Deng
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Can Li
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Jason C Yam
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Li Jia Chen
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Pui Pang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
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19
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Etherton K, Rahi JS, Petrushkin H, Dick AD, Akbarali S, Pattani R, Hau S, Lacassagne S, Liu X, Denniston AK, Solebo AL. Quantitative and qualitative assessment of anterior segment optical coherence tomography capture of disease state in childhood anterior uveitis. Br J Ophthalmol 2022:bjophthalmol-2021-320448. [PMID: 35197261 DOI: 10.1136/bjophthalmol-2021-320448] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/06/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Anterior segment optical coherence tomography (AS-OCT) assessment of anterior chamber inflammation is an emerging tool. We describe the performance of AS-OCT in a paediatric population. METHODS A mixed-methods prospective study, using routine clinical assessment as reference standard, and AS-OCT, with Tomey CASIA2 or Heidelberg Spectralis HS1, as index test, with data collected on patient perceptions of imaging. Repeatability, diagnostic indices, responsiveness to clinical change and clinical correlations of imaging-based metrics (image cell count, size, density and brightness) were assessed, with construction of receiver operated characteristic curves. Exploratory thematic analysis of responses from families was undertaken. RESULTS A total of 90 children (180 eyes) underwent imaging. Bland Altman limits of agreement for CASIA2 repeatability ranged from +17 cells (95% CI 13.6 to 21.1) to -19 cells (95% CI -15.6 to -23.2) and HS1 from +1 (95% CI 0.9 to 1.2) to -1.0 (-1.2 to -0.8) cells. CASIA2 imaging had higher sensitivity of 0.92 (95% CI 0.78 to 0.97) vs HS1 imaging 0.17 (95% CI 0.07 to 0.34), with positive correlation between clinical grade and CASIA2 cell count (coefficient 12.8, p=0.02, 95% CI 2.2 to 23.4). Change in clinical grade at follow-up examinations correlated with change in image based 'cell' count (r2=0.79, p<0.001). Patients reported a potential positive impact of seeing their disease activity. CONCLUSION Our findings suggest that OCT-based imaging holds the promise of deeper understanding of disease, improved patient experience and more granular monitoring of activity with resultant improved outcomes, but further work is needed to refine acquisition and analysis protocols.
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Affiliation(s)
- Katie Etherton
- Optometry Department, Moorfields Eye Hospital NHS Trust, London, UK
| | - Jugnoo S Rahi
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Harry Petrushkin
- Uveitis and Scleritis Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Rheumatology, Great Ormond Street Hospital for Children, London, UK
| | - Andrew D Dick
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and Institute of Ophthalmology, University College London, London, UK
| | - Saira Akbarali
- Rheumatology, Great Ormond Street Hospital for Children, London, UK
| | - Reshma Pattani
- Rheumatology, Great Ormond Street Hospital for Children, London, UK
| | - Scott Hau
- External Disease, Moorfields Eye Hospital, London, UK
| | | | - Xiaoxuan Liu
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alastair K Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHSFT, Birmingham, UK
| | - Ameenat Lola Solebo
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
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20
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Iu LPL, Yip WWK, Lok JYC, Fan MCY, Lai CHY, Ho M, Young AL. Prediction model to predict type 1 retinopathy of prematurity using gestational age and birth weight (PW-ROP). Br J Ophthalmol 2022:bjophthalmol-2021-320670. [PMID: 35177402 DOI: 10.1136/bjophthalmol-2021-320670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To develop a prediction model for type 1 retinopathy of prematurity (ROP) from an Asian population. METHODS This retrospective cohort study included 1043 premature infants who had ROP screening in a tertiary hospital in Hong Kong from year 2006 to 2018. The ROP prediction model was developed by multivariate logistic regression analyses on type 1 ROP. The cut-off value and the corresponding sensitivity and specificity were determined by receiver operating characteristic curve analysis. A validation group of 353 infants collected from another tertiary hospital in another region of Hong Kong from year 2014 to 2017 was used for external validation. RESULTS There were 1043 infants in the study group. The median gestational age (GA) was 30 weeks and 1 day and median birth weight (BW) was 1286 g. The prediction model required only GA and BW as parameters (prematurity-birth weight ROP (PW-ROP)). The area under curve value was 0.902. The sensitivity and specificity were 87.4% and 79.3%, respectively. Type 1 ROP developed in 0.9%, 17.4% and 50% of infants with PW-ROP scores<0, between 0 and <300, and ≥300 respectively (p<0.001). On external validation, our prediction model correctly predicted 95.8% of type 1 ROP (sensitivity=95.8%, specificity=74.8%) in the validation group. CONCLUSION The PW-ROP model is a simple model which could predict type 1 ROP with high sensitivity and specificity. Incorporating this model to ROP examination would help identify infants at risk for ROP treatment.
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Affiliation(s)
- Lawrence Pui Leung Iu
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China .,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Wilson Wai Kuen Yip
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Julie Ying Ching Lok
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Connie Hong Yee Lai
- Department of Ophthalmology, Queen Mary Hospital, Hong Kong, China.,Department of Ophthalmology, The University of Hong Kong, Hong Kong, China
| | - Mary Ho
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Alvin Lerrmann Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
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21
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Gore S, Grimaldi G, Mazzone G, Collin R, Savino G, Pagnoni M, Modugno A. Treatment strategies and long-term outcomes in patients with congenital microphthalmia-anophthalmia with cyst. Br J Ophthalmol 2022; 107:750-755. [PMID: 35101939 DOI: 10.1136/bjophthalmol-2020-318089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/13/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Microphthalmia and anophthalmia are rare conditions, which represent ocular maldevelopment; both may be associated with orbital cysts. Current literature recommends retention to stimulate orbital growth during socket rehabilitation but does not illustrate their potential to deform the periocular tissues. This study aims to illustrate the long-term outcomes when other elements, such as forniceal and lid development, are also considered when formulating bespoke treatment plans for patients. METHODS Retrospective case series of 78 patients attending a single prosthetics clinic between 1988 and 2020. Clinical and surgical notes, radiological imaging, clinical photographs and patient/doctor satisfaction questionnaires were used to report patient outcomes and natural history data. RESULTS 89 sockets of 78 patients (11 bilateral) were included; average age of presentation being 2.8 years (9 days to 29.5 years). Cysts were clinically detected (48%) or were incidental findings (52%). The mean follow-up time was 7.2 years (6 months to 28 years). Cysts in 46% of sockets underwent surgical excision while the remainder were retained. Satisfaction surveys were obtained for 75 patients, with cosmetic outcomes rated as 'excellent' or 'good' in 90% of cases by physicians and 97% of cases by patients or guardians. CONCLUSION The favourable long-term outcomes in this study have resulted from bespoke plans which considered periocular tissue development, regional orbital growth and orbital volume replacement. The authors contemplate cyst excision if the prosthetic fitting or retention is impeded by the cyst as this often heralds the increased risk of long-term periocular distortion.
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Affiliation(s)
- Sri Gore
- Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK .,Department of Ophthalmology, Ocularistica Italiana, Rome, Italy
| | - Gabriela Grimaldi
- Department of Ophthalmology, Ocularistica Italiana, Rome, Italy.,Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Richard Collin
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Gustavo Savino
- Opthalmology, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Mario Pagnoni
- Department of Maxillo-facial surgery, Your Face Surgery Villa Parioli Clinic, Rome, Italy
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22
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Ha A, Baek SU, Kim JS, Jeoung JW, Park KH, Kim YK. Association of progressive optic disc tilt with development of retinal nerve fibre layer defect in children with large cup-to-disc ratio. Br J Ophthalmol 2022; 107:869-875. [PMID: 35017160 DOI: 10.1136/bjophthalmol-2021-320029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/17/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Whereas myopic optic disc deformation has been posited as a risk factor for glaucomatous damage, longitudinal studies evaluating their association have been sparse. We investigated whether the optic nerve head (ONH)'s morphological alteration during myopia progression play any role in development of retinal nerve fibre layer defect (RNFLD) in children with a large vertical cup-to-disc ratio (vCDR). METHODS Sixty-five normotensive eyes of 65 children aged under 8 years with (1) vCDR ≥0.5 but no additional signs of glaucoma and (2) who could be tracked at young adulthood (18-28 years) were included. Children's spherical equivalent (SE), intraocular pressure, vCDR and optic disc tilt ratio were recorded. Rare events logistic regression analysis was employed to identify factors associated with RNFLD-development risk. RESULTS The study group's mean age was 5.4±1.3 years, its average vCDR was 0.62±0.07, and the average SE was -0.3±1.4 dioptres ((D), range -3.15 to 2.75D) at the baseline. After an average follow-up of 16.1±3.0 years, the mean vCDR was 0.64±0.09, and the mean SE, -3.2±2.2D (range -7.25 to 0.00 D). Among the 65 eyes, 12 (18.5%) developed RNFLD. A greater SE change (OR=1.737, p=0.016) and a greater increase in tilt ratio (OR=2.364, p=0.002) were both significantly associated with higher RNFLD-development risk. CONCLUSION In this cohort of Korean children with large vCDR, progressive optic disc tilt in the course of myopia progression was associated with higher RNFLD-development risk. This finding suggests that morphological alterations in the ONH during axial elongation might represent an underlying susceptibility to glaucomatous damage in large-vCDR children.
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Affiliation(s)
- Ahnul Ha
- Ophthalmology, Jeju National University Hospital, Jeju-si, Jeju-do, Korea (the Republic of).,Ophthalmology, Jeju National University, Jeju-si, Jeju-do, South Korea
| | - Sung Uk Baek
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Korea (the Republic of)
| | - Jin-Soo Kim
- Ophthalmology, Chungnam National University Sejong Hospital, Sejong, Korea (the Republic of)
| | - Jin Wook Jeoung
- Ophthalmology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
| | - Ki Ho Park
- Ophthalmology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of).,Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Young Kook Kim
- Ophthalmology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of) .,Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
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23
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Lu SY, Zhang XJ, Wang YM, Yuan N, Kam KW, Chan PP, Tam PO, Yip WW, Young AL, Tham CC, Pang CP, Yam JC, Chen LJ. Association of SIX1-SIX6 polymorphisms with peripapillary retinal nerve fibre layer thickness in children. Br J Ophthalmol 2022:bjophthalmol-2021-319756. [PMID: 35017159 DOI: 10.1136/bjophthalmol-2021-319756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/10/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE Association of SIX1-SIX6 variants with peripapillary retinal nerve fibre layer (p-RNFL) thickness had been reported in adults. This study aimed to investigate these associations in children, with further explorations by spatial, age and sex stratifications. METHODS 2878 school children aged between 6 and 9 years were enrolled from the Hong Kong Children Eye Study. Three single-nucleotide polymorphisms (SNPs) at the SIX1-SIX6 locus were genotyped. The association of each SNP with p-RNFL thickness (including global and sectoral thickness) were evaluated using multiple linear regression. RESULTS SNPs rs33912345 (p=7.7×10-4) and rs10483727 (p=0.0013) showed significant associations with temporal-inferior p-RNFL thickness. The C allele of rs33912345 was associated with a thinner temporal-inferior p-RNFL by an average of 2.44 µm, while rs10483727-T was associated with a thinner temporal-inferior p-RNFL by 2.32 µm. The association with temporal-inferior p-RNFL was the strongest in the 8-9 year-old group for rs33912345 (p=5.2×10-4) and rs10483727 (p=3.3×10-4). Both SNPs were significantly associated with temporal-inferior p-RNFL thickness in boys (p<0.0017), but not in girls (p>0.05). In contrast, rs12436579-C (β=1.66; p=0.0059), but not rs33912345-C (β=1.31; p=0.052) or rs10483727-T (β=1.19; p=0.078), was nominally associated with a thicker nasal-inferior p-RNFL. CONCLUSIONS Both rs33912345 and rs10483727 at SIX1-SIX6 were associated with p-RNFL thickness in children, especially at the temporal-inferior sector, with age-dependent and sex-specific effects. SNP rs12436579 was associated with nasal-inferior p-RNFL thickness. Our findings suggested a role of SIX1-SIX6 in RNFL variation during neural retina development in childhood.
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Affiliation(s)
- Shi Yao Lu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Yu Meng Wang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Nan Yuan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Poemen P Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China
| | - Pancy Os Tam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Wilson Wk Yip
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China .,Hong Kong Eye Hospital, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China .,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
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24
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Teoh LJ, Solebo AL, Rahi JS. Temporal trends in the epidemiology of childhood severe visual impairment and blindness in the UK. Br J Ophthalmol 2021; 107:717-724. [PMID: 34949577 DOI: 10.1136/bjophthalmol-2021-320119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/02/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIMS Understanding temporal trends in childhood visual disability is necessary for planning and evaluating clinical services and health policies. We investigate the changing epidemiology of severe visual impairment (SVI) and blindness (BL) in children in the UK in the 21st century. METHODS Comparative analysis of two national population-based epidemiological studies of incident childhood SVI/BL (ICD-10 definition; visual acuity worse than 1.0 LogMAR in the better eye). We carry out comparative analysis of studies conducted in 2000 and 2015 using identical methods. RESULTS Overall annual and cumulative incidence rates remained broadly stable in 2015 at 0.38 per 10 000 (95% CI 0.34 to 0.41) for 0-15 years old and 5.65 per 10 000 (5.16 to 6.18) by 16 years, respectively, and with annual incidence in infancy (3.52 per 10 000, 3.13 to 3.97) remaining considerably higher than any other age. Mortality among children diagnosed in infancy declined (from 61.4 to 25.6 per 1000), despite an increase (from 77% to 84%, p=0.037) in the overall proportion with significant non-ophthalmic impairments/disorders. The relative contribution of all the main groups of disorders increased over time, most notably cerebral visual impairment (from 50% to 61%). Aetiological factors operating prenatally continued to predominate, with an increased relative contribution of hereditary conditions in all children (from 35% to 57%, p<0.001). The substantially elevated rates for any ethnic minority group and those born preterm were unchanged, with amplification of increased rates associated with low birth weight. CONCLUSION The changing landscape of healthcare and increased survival of affected children, is reflected in increasing clinical complexity and heterogeneity of all-cause SVI/BL alongside declining mortality.
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Affiliation(s)
- Lucinda J Teoh
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK.,Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ameenat Lola Solebo
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK.,Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Moorfields NIHR Biomedical Research Centre, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Jugnoo S Rahi
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK .,Ulverscroft Vision Research Group, UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Moorfields NIHR Biomedical Research Centre, London, UK.,UCL Institute of Ophthalmology, London, UK
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25
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Tatara S, Ishii M, Nogami R. Birth weight and refractive state measured by Spot Vision Screener in children aged 40 months. BMJ Open Ophthalmol 2021; 6:e000808. [PMID: 34901463 PMCID: PMC8611435 DOI: 10.1136/bmjophth-2021-000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 11/08/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives Children with retinopathy of prematurity (ROP) often have myopia. Even without ROP, birth weight and refractive state are related immediately after birth, but this relationship is reduced with increasing age. Here, we examined whether refractive state and birth weight were associated in 40-month-old children. Methods and analysis Of 541 children aged 40 months in Tsubame City, Japan, who underwent a medical examination between April 2018 and March 2019, this cross-sectional study enrolled 411 whose birth weights were available (76% of all).We measured the non-cycloplegic refraction using a Spot Vision Screener and correlated this with birth weight. Children were divided into three groups according to normal (2500-3500 g), high (>3500 g) or low (<2500 g) birth weights, and mean differences in spherical equivalent (SE) between the groups were analysed. Results The average SE for the right eye was 0.34 D (95% CI 0.28 to 0.40). Average birth weight was 3032.1 g (95% CI 2990.2 to 3073.9). Birth weight did not correlate with SE for the right eye (Pearson's correlation, r=-0.015, p=0.765) or with the degree of anisometropia (Pearson's correlation, r=-0.05, p=0.355). Furthermore, the mean SE showed no significant difference across the three groups of children with different birth weights (one-way analysis of variance, p=0.939). Conclusion Data on refractive states and birth weight for 411 children of similar age in one Japanese city were analysed, showing that birth weight did not influence SE, J0, J45 and the absolute degree of anisometropia at about 40 months of age.
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Affiliation(s)
- Shunya Tatara
- Department of Orthoptics and Visual Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Vision Science, Kitasato University Graduate School of Medical Science, Sagamihara, Japan
| | - Masako Ishii
- Department of Orthoptics and Visual Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Reiko Nogami
- Division of Ophthalmology, Nogami Eye Clinic, Tsubame, Japan
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Trzcionkowska K, Termote JU, Böhringer S, van Sorge AJ, Schalij-Delfos N. Nationwide inventory on retinopathy of prematurity screening in the Netherlands. Br J Ophthalmol 2021; 107:712-716. [PMID: 34893474 PMCID: PMC10176329 DOI: 10.1136/bjophthalmol-2021-319929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/21/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE Provide up-to-date insight in incidence of retinopathy of prematurity (ROP), logistics of screening and treatment in the Netherlands and influence of the new national ROP guideline in which more stringent screening criteria were implemented and the early treatment for ROP criteria (ETROP) were emphasised. METHODS Multicentre prospective nationwide study including all preterm infants, born in the Netherlands in 2017, and considered eligible for ROP screening. Anonymised data from ophthalmologists and paediatricians were merged. Outcome data were compared with the first national ROP inventory (NEDROP-1, 2009). RESULTS In 2017, 1492 infants were live born with gestational age (GA) <32 weeks (2009: 1662); 1287 infants were eligible for screening (2009: 2033). Ophthalmologists screened 1085 infants, versus 1688 in 2009, corrected with factor 1.114 for the difference in number of live births, a 28.4% (479/1688) decrease in screened infants was seen. Among surviving infants with GA <32 week, ROP was found in 305/1492 babies, 20.4% (2009: 324/1662, 19.5%) of which 49/1492 stage ≥3, 3.3% (2009: 30/1662, 1.8%). In all infants, report on presence or absence of plus disease was provided, according to the ETROP criteria. Treatment was performed in 39 infants. Of infants with ROP stage ≥3, 3/49 (6.1%) progressed to retinal detachment (2009: 6/30, 20.0%). CONCLUSION The overall ROP incidence expressed as a percentage, remained stable but the number of infants that developed severe ROP nearly doubled. A near one-third reduction in screened infants shows satisfactory implementation of the new screening criteria. A notable decrease in retinal detachment delineates improved treatment outcome.
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Affiliation(s)
| | - Jacqueline U Termote
- Neonatology, Wilhelmina Children's Hospital-University Medical Center, Utrecht, The Netherlands
| | - Stefan Böhringer
- Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
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Khan AM, Ahmad K, Alarfaj M, Alotaibi H, AlJaloud A, Malik R. Surgical outcomes of the Aurolab aqueous drainage implant (AADI) versus the Ahmed glaucoma valve for refractory paediatric glaucoma in Middle Eastern children. BMJ Open Ophthalmol 2021; 6:e000831. [PMID: 34786485 PMCID: PMC8587650 DOI: 10.1136/bmjophth-2021-000831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022] Open
Abstract
Objective The Aurolab aqueous drainage implant (AADI) has the potential advantages of less encapsulation and greater cost-effectiveness than the Ahmed glaucoma valve (AGV). The aim of this study was to compare the surgical success and outcomes of the AADI compared to the AGV in Middle-Eastern children. Methods A comparative retrospective study of consecutive paediatric patients in a tertiary eye hospital was undertaken. Data collected included demographics, type of glaucoma, intraocular pressure (IOP), number of anti-glaucoma medications (AGMs) and any subsequent complications or further surgeries. Analysis The mean IOP, number of AGMs, surgical success and number of reoperations was compared for the two groups. Surgical success at each visit was defined as IOP of ≥6 mm Hg and ≤21 mm Hg or if the reduction of IOP was ≥20% reduced from baseline. Results A total of 126 tube surgeries (56 eyes in AADI and 70 eyes in AGV) were performed in patients aged ≤18 years from 2014 to 2019. No difference was observed in the mean IOP between the two groups except at the first month post-operative visit. After six months, the AADI group had a consistently significant lower mean number of AGMs. At last follow-up, 21 (37.5%) eyes in the AADI group were glaucoma medication-free vs 15 (21.4%) eyes in the AGV group (pp=0.047). Kaplan-Meier analysis showed equivalent cumulative probability of success at two years of 69.9% [(45.9%–84.9%)] for AADI vs 66.8% [(53.4%–77.1%])) for the AGV, respectively. Twenty-four eyes in the AGV group needed one or more subsequent surgeries, whereas 13 eyes needed one or more surgery in the AADI group. Conclusions This study shows an acceptable safety profile for the AADI in children, with a rate of failure that is comparable to the AGV, but less need for glaucoma re-operation or glaucoma medication in the first post-postoperative year.
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Affiliation(s)
- Abdullah M Khan
- Pediatric Ophthalmology Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Khabir Ahmad
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Motazz Alarfaj
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Humoud Alotaibi
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Ahmad AlJaloud
- Pediatric Ophthalmology Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rizwan Malik
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Aring E, Gyllencreutz E, Landgren V, Svensson L, Landgren M, Grönlund MA. The FASD Eye Code: a complementary diagnostic tool in fetal alcohol spectrum disorders. BMJ Open Ophthalmol 2021; 6:e000852. [PMID: 34765742 PMCID: PMC8543669 DOI: 10.1136/bmjophth-2021-000852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/03/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To create an easy-to-use complementary ophthalmological tool to support a fetal alcohol spectrum disorder (FASD) diagnosis. Methods and Analysis The FASD Eye Code was derived from 37 children with FASD evaluated along with 65 healthy age-matched and sex-matched controls. Four ophthalmological categories, which are abnormalities commonly found in children with FASD, were ranked independently on a 4-point scale, with 1 reflecting normal finding and 4 a strong presence of an abnormality: visual acuity, refraction, strabismus/binocular function and ocular structural abnormalities. The tool was validated on 33 children with attention deficit/hyperactivity disorder (ADHD), 57 children born moderate-to-late premature (MLP) and 16 children with Silver-Russell syndrome (SRS). Among children with ADHD none was born prematurely or small for gestational age (SGA) or diagnosed with FASD. Among children born MLP none was SGA, had a diagnosis of ADHD or FASD, or a history of retinopathy of prematurity. Children with SRS were all born SGA, half were born preterm and none had FASD. Children with FASD were re-examined as young adults. Results An FASD Eye Code cut-off total score of ≥10 showed an area under the curve (AUC) of 0.78 (95% CI 0.69 to 0.87), with 94% specificity and 43% sensitivity, in discriminating between FASD and controls, MLP and ADHD, corresponding to a positive likelihood ratio (LR+) of 7.5. Between FASD and controls, an AUC of 0.87 (CI 0.80 to 0.95), with 100% specificity and 43% sensitivity, was found; between FASD and SRS, an AUC of 0.60 (CI 0.45 to 0.75) was found, with 88% specificity and 43% sensitivity. A cut-off score of≥9 showed a specificity of 98% and a sensitivity of 57% for FASD versus controls, corresponding to an LR+ of 36.9. Scores in individuals with FASD were stable into young adulthood. Conclusion The FASD Eye Code has the potential to serve as a complementary tool and help to strengthen an FASD diagnosis.
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Affiliation(s)
- Eva Aring
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Deparment of Ophthalmology, Region Västra Götaland, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Emelie Gyllencreutz
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Valdemar Landgren
- Department of Paediatrics, Unit of Neurodevelopmental Disorders, Region Västra Götaland, Skaraborg Hospital, Mariestad, Sweden.,Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Leif Svensson
- Department of Paediatrics, Unit of Neurodevelopmental Disorders, Region Västra Götaland, Skaraborg Hospital, Mariestad, Sweden
| | - Magnus Landgren
- Department of Paediatrics, Unit of Neurodevelopmental Disorders, Region Västra Götaland, Skaraborg Hospital, Mariestad, Sweden.,Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Marita Andersson Grönlund
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Ophthalmology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Sand MK, Cholidis S, Rimstad K, Krekling ED, Kristianslund O, Drolsum L. Long-term outcome of primary intraocular lens implantation in bilateral congenital cataract in infants with a median age of 35 days at surgery: a case series. BMJ Open Ophthalmol 2021; 6:e000836. [PMID: 34651084 PMCID: PMC8487206 DOI: 10.1136/bmjophth-2021-000836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/19/2021] [Indexed: 11/04/2022] Open
Abstract
Objective To evaluate the long-term visual outcome and safety after bilateral cataract surgery with primary intraocular lens (IOL) implantation in infants with visually significant cataract at birth operated before 12 weeks of age. Methods and analysis Medical records of infants with congenital cataract who had bilateral surgery with primary IOL implantation before 12 weeks of age at Oslo University Hospital between 2007 and 2016 were retrospectively reviewed. Fifteen infants (30 eyes) were enrolled for a prospective study examination in 2017. Corrected distance visual acuity (CDVA) and intraocular pressure (IOP) were assessed. Visual axis opacification (VAO) was defined as opacification on the anterior or posterior surface of the IOL, capsular phimosis or fibrinous membrane. Secondary glaucoma was evaluated according to international guidelines. Results Median age at the time of primary surgery was 35 days (range, 15 to 70 days). There were no serious intraoperative complications, and all eyes had the IOL implanted in the capsular bag. After a median follow-up of 6.1 years (range, 1.5 to 10.2 years), the CDVA was 0.5 logMAR (range, 1.2 to 0.04). All eyes had surgery for VAO and the median number of surgical procedures was 2.0 (range, 1 to 5). The cumulative incidence of secondary glaucoma was 10% after 5 years of follow-up. Conclusion Primary IOL implantation before 12 weeks of age gave a satisfactory visual outcome, and the incidence of secondary glaucoma was similar to that reported after primary IOL implantation in older infants. However, the risk of VAO was high.
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Affiliation(s)
- Mari Kathrine Sand
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Department of Ophthalmology, Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Symira Cholidis
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | | | - Elise Dees Krekling
- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway (USN), Kongsberg, Norway
| | - Olav Kristianslund
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Department of Ophthalmology, Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Liv Drolsum
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Department of Ophthalmology, Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
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Mayet I, McGee SA, Ally N, Alli HD, Tikly M, Williams SE. Cost comparison between botulinum neurotoxin and surgery in the treatment of infantile esotropia in a tertiary public hospital. BMJ Open Ophthalmol 2021; 6:e000766. [PMID: 34250258 PMCID: PMC8217941 DOI: 10.1136/bmjophth-2021-000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/03/2021] [Indexed: 11/04/2022] Open
Abstract
Objective To compare the cost implications of botulinum neurotoxin (BNT) injection to surgery in infantile esotropia (IE) in a public/government funded hospital. Methods and analysis A simple costing comparison was undertaken for a randomised clinical trial in IE. Patients were randomised to receive either BNT or standard surgery. The participants in the BNT arm were further subdivided into subgroups based on their age in months and degree of esotropia in prism dioptres (PD) at presentation: G1 ≤60 PD/24 months, G2 ≤24 months/>60 PD, G3 >24 months/≤60 PD, G4 >24 months/>60 PD. The costs were calculated for each arm from primary treatment to eventual satisfactory outcome defined as orthophoria or microtropia (≤10 PD). A bottom-up costing analysis was done for single and multiple procedures for each arm. Comprehensive variable costs as well as fixed costs were calculated at each point of intervention and expressed in local currency ZAR (US$1=ZAR15.00). Costing was analysed for surgery and BNT subgroups (based on clinical success). Results There were 101 patients enrolled in the trial. 54 in the BNT arm and 47 in the surgery arm. Cost for single surgery and single BNT was ZAR 7743.04 and 1713.14, respectively. A favourable clinical outcome was achieved in 72% of surgery arm and 37% of BNT arm. The mean cost for eventual favourable outcome in BNT arm was ZAR9158.08 and in surgery arm ZAR9124.27 (p=0.26). Mean cost in G1 was ZAR6328.45, in G2 ZAR7197.45, in G3 ZAR11891.93 and G4 ZAR12882.44 (p=0.018). Conclusion BNT has a cost-benefit in IE and is a viable option in the primary treatment of IE in resource constrained regions. Clinical outcomes and economic benefit in smaller angle of esotropia and younger patients are comparable to surgery.
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Affiliation(s)
- Ismail Mayet
- Department of Neurosciences, Division of Ophthalmology, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | | | - Naseer Ally
- Department of Neurosciences, Division of Ophthalmology, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Hassan Dawood Alli
- Department of Neurosciences, Division of Ophthalmology, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Mohammed Tikly
- Dept of Rheuamatology, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Susan Eileen Williams
- Department of Neurosciences, Division of Ophthalmology, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
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Ozen Tunay Z, Idil A. Macular sensitivity assessment and fixation analysis using microperimetry in children with retinopathy of prematurity. Br J Ophthalmol 2021; 106:1767-1771. [PMID: 34108227 DOI: 10.1136/bjophthalmol-2021-319352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/29/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To investigate retinal sensitivity and fixation stability using microperimetry in children with retinopathy of prematurity (ROP). METHODS Observational case series. Totally 51 preterm children who had been followed for ROP were examined in three groups (n=17 in each group). The groups were defined as children without ROP (group 1), children with spontaneously resolved ROP (group 2) and children who had laser treatment for ROP (group 3). All subjects underwent a detailed ophthalmic examination. Macular Analyzer Integrity Assessment Microperimetry was used to analyse macular light sensitivity and fixation stability. The results were compared between groups. The measurements were also analysed according to age, gender, birth weight and gestational age. RESULTS The mean age was 10.84±0.97 years, and 27 children were female. Mean average threshold (AT) for macular sensitivity was 25.5±2.1 decibel in group 1, 26.8±3.8 decibel in group 2 and 26.3±3.0 decibel in group 3. These differences were not statistically significant between the groups (p=0.067), but AT was abnormal in 29% of the whole study population. Outputs about fixation stability were similar between the three groups but fixation was unstable in 27% of the subjects. Mean AT was better in children ≥11 years old compared with the younger ones (p=0.022). CONCLUSION Preterm children may have some abnormalities in macular light sensitivity and fixation stability. These abnormalities may be more prominent in children less than 11 years old. ROP itself or the laser treatment seems not to affect macular light sensitivity and fixation stability.
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Affiliation(s)
- Zuhal Ozen Tunay
- Ophthalmology, University of Health Sciences, Ankara, Turkey .,Ophthalmology, Ankara City Hospital, Cankaya, Ankara, Turkey
| | - Aysun Idil
- Ophthalmology Department, Ankara University Faculty of Medicine, Ankara, Turkey
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Wong YL, Yuan Y, Su B, Tufail S, Ding Y, Ye Y, Paille D, Drobe B, Chen H, Bao J. Prediction of myopia onset with refractive error measured using non-cycloplegic subjective refraction: the WEPrOM Study. BMJ Open Ophthalmol 2021; 6:e000628. [PMID: 34179509 PMCID: PMC8191615 DOI: 10.1136/bmjophth-2020-000628] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/19/2021] [Indexed: 11/15/2022] Open
Abstract
Background/aims To evaluate the predictive performance of various predictors, including non-cycloplegic refractive error, for risk of myopia onset under pragmatic settings. Methods The Wenzhou Medical University Essilor Progression and Onset of Myopia Study is a prospective cohort study of schoolchildren aged 6–10 years from two elementary schools in Wenzhou, China. Non-cycloplegic refraction, ocular biometry and accommodation measurements were performed. Myopia was defined as spherical equivalent (SE) ≤−0.5 diopter (D). ORs using multivariable logistic regression were determined. Area under the curve (AUC) evaluation for predictors was performed. Results Schoolchildren who attended both baseline and 2-year follow-up were analysed (N=1022). Of 830 non-myopic children at baseline, the 2-year incidence of myopia was 27.6% (95% CI, 24.2% to 31.3%). Female gender (OR=2.2), more advanced study grades (OR=1.5), less hyperopic SE (OR=11.5 per D), longer axial length (AL; OR=2.3 per mm), worse presenting visual acuity (OR=2.3 per decimal), longer near work time (OR=1.1 per hour/day) and lower magnitude of positive relative accommodation (PRA; OR=1.4 per D) were associated with myopia onset. PRA (AUC=0.66), SE (AUC=0.64) and AL (AUC=0.62) had the highest AUC values. The combination of age, gender, parental myopia, SE, AL and PRA achieved an AUC of 0.74. Conclusion Approximately one in four schoolchildren had myopia onset over a 2-year period. The predictors of myopia onset include lower magnitude of PRA, less hyperopic SE, longer AL and female gender. Of these, non-cycloplegic SE and PRA were the top single predictors, which can facilitate risk profiling for myopia onset.
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Affiliation(s)
| | - Yimin Yuan
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Wenzhou Medical University-Essilor International Research Centre (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Binbin Su
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Wenzhou Medical University-Essilor International Research Centre (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Yang Ding
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Wenzhou Medical University-Essilor International Research Centre (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yingying Ye
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Björn Drobe
- R&D AMERA, Essilor International, Singapore.,Wenzhou Medical University-Essilor International Research Centre (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hao Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinhua Bao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Wenzhou Medical University-Essilor International Research Centre (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
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Gad H, Al-Jarrah B, Saraswathi S, Mohamed S, Kalteniece A, Petropoulos IN, Khan A, Ponirakis G, Singh P, Khodor SA, Elawad M, Almasri W, Hendaus MA, Akobeng AK, Hussain K, Malik RA. Corneal confocal microscopy identifies a reduction in corneal keratocyte density and sub-basal nerves in children with type 1 diabetes mellitus. Br J Ophthalmol 2021; 106:1368-1372. [PMID: 33931390 DOI: 10.1136/bjophthalmol-2021-319057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/10/2021] [Accepted: 04/20/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE To assess whether alterations in stromal keratocyte density are related to loss of corneal nerve fibres in children with type 1 diabetes mellitus (T1DM). METHODS Twenty participants with T1DM and 20 age-matched healthy controls underwent corneal confocal microscopy. Corneal sub-basal nerve morphology and corneal keratocyte density (KD) were quantified. RESULTS Corneal nerve fibre density (CNFD) (p<0.001), corneal nerve branch density (p<0.001), corneal nerve fibre length (CNFL) (p<0.001) and inferior whorl length (IWL) (p<0.001) were lower in children with T1DM compared with healthy controls. Anterior (p<0.03) and mid (p=0.03) stromal KDs were lower with no difference in posterior KD (PKD) in children with T1DM compared with controls. Age, duration of diabetes, height, weight and body mass index did not correlate with anterior (AKD), mid (MKD) or PKD. Inverse correlations were found between glycated haemoglobin and PKD (r=-0.539, p=0.026), bilirubin with MKD (r=-0.540, p=0.025) and PKD (r=-0.531, p=0.028) and 25-hydroxycholecalciferol with MKD (r=-0.583, p=0.018). CNFD, CNFL and IWL did not correlate with AKD, MKD or PKD. CONCLUSION This study demonstrates a reduction in corneal nerves and anterior and mid stromal KD in children with T1DM, but no correlation between corneal nerve and keratocyte cell loss.
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Affiliation(s)
- Hoda Gad
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | | | | | - Sara Mohamed
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Alise Kalteniece
- Cardiovascular Medicine, University of Manchester, Manchester, UK
| | | | - Adnan Khan
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | | | | | | | | | | | | | | | | | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar .,Cardiovascular Medicine, University of Manchester, Manchester, UK
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Alhamzah A, Alshareef MF, Shabar R, Alfreihi SH. Superior oblique split lengthening procedure for brown syndrome, outcomes and complications. Br J Ophthalmol 2021; 106:1469-1472. [PMID: 33931387 DOI: 10.1136/bjophthalmol-2020-317831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION To evaluate the outcomes of the superior oblique split tendon lengthening (SOSL) procedure for Brown syndrome (BS). METHODS At a single institution, all patients who underwent SOSL surgery for BS from 2013 to 2019 were reviewed retrospectively. We looked at the surgical outcomes and complications in a total of 20 eyes of 18 patients. The superior oblique (SO) muscle was isolated and then extended. The tendon was then split centrally into equal halves. Two 6-0 polyglactin sutures were then placed on each end of the split tendon 6-10 mm apart. To complete the Z-cut, the split tendon was cut distal to the preplaced sutures. The sutures were then tied to produce the split Z-tendon lengthening. RESULTS Eleven (55%) out of 20 eyes were female patients. The mean age was 6.6 years (range 2-17 years). The mean follow-up was 26.8 months (range 5-72 months). The mean degree of preoperative limitation of elevation on adduction was -3.6±0.58 preoperatively and -0.75±1.25 postoperatively (p=0.0001). Preoperatively, the mean degree of vertical deviation at near was 3.5±7.62 and at distance was 3.10±7.84 prism diopters (PD), respectively. Postoperatively, the mean vertical deviation was 2.77±4.75 and 2.10±4.08 PD at near and distance, respectively. Postoperative complications included haematoma in one patient (5%), overcorrection in two patients (10%) and one patient required reoperation (5%). CONCLUSION SOSL is a safe procedure that surgeons can consider in managing patients with BS.
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Affiliation(s)
- Albanderi Alhamzah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mozon F Alshareef
- King Saud bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, Saudi Arabia
| | - Rasha Shabar
- Pediatric Surgery, Division of Pediatric Ophthalmology, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Shatha Hussein Alfreihi
- Pediatric Surgery, Division of Pediatric Ophthalmology, National Guard Health Affairs, Riyadh, Saudi Arabia .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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35
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Ntoula E, Nowinski D, Holmstrom G, Larsson E. Ophthalmological findings in children with non-syndromic craniosynostosis: preoperatively and postoperatively up to 12 months after surgery. BMJ Open Ophthalmol 2021; 6:e000677. [PMID: 33981856 PMCID: PMC8076926 DOI: 10.1136/bmjophth-2020-000677] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/29/2021] [Accepted: 04/15/2021] [Indexed: 11/16/2022] Open
Abstract
Aims Craniosynostosis is a congenital condition characterised by premature fusion of one or more cranial sutures. The aim of this study was to analyse ophthalmic function before and after cranial surgery, in children with various types of non-syndromic craniosynostosis. Methods Children referred to Uppsala University Hospital for surgery of non-syndromic craniosynostosis were examined preoperatively. Visual acuity was measured with Preferential Looking tests or observation of fixation and following. Strabismus and eye motility were noted. Refraction was measured in cycloplegia and funduscopy was performed. Follow-up examinations were performed 6–12 months postoperatively at the children’s local hospitals. Results One hundred twenty-two children with mean age 6.2 months were examined preoperatively. Refractive values were similar between the different subtypes of craniosynostosis, except for astigmatism anisometropia which was more common in unicoronal craniosynostosis. Strabismus was found in seven children, of which four had unicoronal craniosynostosis. Postoperatively, 113 children were examined, at mean age 15.9 months. The refractive values decreased, except for astigmatism and anisometropia in unicoronal craniosynostosis. Strabismus remained in unicoronal craniosynostosis. Two new cases with strabismus developed in unicoronal craniosynostosis and one in metopic, all operated with fronto-orbital techniques. No child had disc oedema or pale discs preoperatively or postoperatively. Conclusion Ophthalmic dysfunctions were not frequent in children with sagittal craniosynostosis and preoperative ophthalmological evaluation may not be imperative. Children with unicoronal craniosynostosis had the highest prevalence of strabismus and anisometropia. Fronto-orbital techniques used to address skull deformity may be related to a higher prevalence of strabismus postoperatively.
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Affiliation(s)
- Evangelia Ntoula
- Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
| | - Daniel Nowinski
- Department of Surgical Sciences/Plastic Surgery, Uppsala University, Uppsala, Sweden
| | - Gerd Holmstrom
- Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
| | - Eva Larsson
- Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
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Brin TA, Chow A, Carter C, Oremus M, Bobier W, Thompson B. Efficacy of vision-based treatments for children and teens with amblyopia: a systematic review and meta-analysis of randomised controlled trials. BMJ Open Ophthalmol 2021; 6:e000657. [PMID: 33912684 PMCID: PMC8043000 DOI: 10.1136/bmjophth-2020-000657] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/18/2021] [Accepted: 03/13/2021] [Indexed: 11/03/2022] Open
Abstract
Objective To identify differences in efficacy between vision-based treatments for improving visual acuity (VA) of the amblyopic eye in persons aged 4-17 years old. Data sources Ovid Embase, PubMed (Medline), the Cochrane Library, Vision Cite and Scopus were systematically searched from 1975 to 17 June 2020. Methods Two independent reviewers screened search results for randomised controlled trials of vision-based amblyopia treatments that specified change in amblyopic eye VA (logMAR) as the primary outcome measure. Quality was assessed via risk of bias and GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). Results Of the 3346 studies identified, 36 were included in a narrative synthesis. A random effects meta-analysis (five studies) compared the efficacy of binocular treatments versus patching: mean difference -0.03 logMAR; 95% CI 0.01 to 0.04 (p<0.001), favouring patching. An exploratory study-level regression (18 studies) showed no statistically significant differences between vision-based treatments and a reference group of 2-5 hours of patching. Age, sample size and pre-randomisation optical treatment were not statistically significantly associated with changes in amblyopic eye acuity. A network meta-analysis (26 studies) comparing vision-based treatments to patching 2-5 hours found one statistically significant comparison, namely, the favouring of a combination of two treatment arms comparing combination and binocular treatments, against patching 2-5 hours: standard mean difference: 2.63; 95% CI 1.18 to 4.09. However, this result was an indirect comparison calculated from a single study. A linear regression analysis (17 studies) found a significant relationship between adherence and effect size, but the model did not completely fit the data: regression coefficient 0.022; 95% CI 0.004 to 0.040 (p=0.02). Conclusion We found no clinically relevant differences in treatment efficacy between the treatments included in this review. Adherence to the prescribed hours of treatment varied considerably and may have had an effect on treatment success.
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Affiliation(s)
- Taylor Adrian Brin
- Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Amy Chow
- Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Caitlin Carter
- Library, University of Waterloo, Waterloo, Ontario, Canada
| | - Mark Oremus
- Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - William Bobier
- Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Benjamin Thompson
- Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada.,Center for Eye and Vision Research, 17W Science Park, Hong Kong, Hong Kong.,Liggins Institute, University of Auckland, Auckland, New Zealand
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Robertson AO, Horvat-Gitsels LA, Cortina-Borja M, Rahi JS. Distribution and associations of vision-related quality of life and functional vision of children with visual impairment. Br J Ophthalmol 2021; 106:1325-1330. [PMID: 33827860 DOI: 10.1136/bjophthalmol-2020-318473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/08/2021] [Accepted: 03/11/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are increasingly used in paediatric ophthalmology. However, little is known about the distribution of PROM scores among children and young people with visual impairment. AIM To investigate the distributions and predictors of scores on the VQoL_CYP (measuring vision-related quality of life) and FVQ_CYP (measuring functional vision). METHODS Children and young people aged 8-18 years, with visual impairment/blindness (logarithm of the minimum angle of resolution (LogMAR) worse than 0.48 in the better eye, and/or eligible visual field restriction) completed the VQoL_CYP and FVQ_CYP at home or Great Ormond Street Hospital, London, UK. Associations between VQoL_CYP and FVQ_CYP scores and sociodemographic and clinical factors were analysed using multiple linear regression models. RESULTS Among 93 participants, VQoL_CYP scores ranged from 36.6 to 78.2 (mean=57.9, SD=8.1). FVQ_CYP scores ranged from 23.5 to 70.3 (mean=48.3, SD=10.1). Only 0.4% of the variation in VQoL_CYP scores was explained, with no associations with the variables of interest. By contrast, 21.6% of the variation in FVQ_CYP scores was explained, with a gradient of worse acuity (p<0.001) and female gender (p=0.04) associated with worse self-rated functional vision. Age, ethnicity, time of onset and stability/progression of visual impairment were not associated. DISCUSSION Self-rated vision-related quality of life and functional vision are not readily predicted from sociodemographic or clinical characteristics that ophthalmologists measure/record. Routine use of PROMs in clinical practice can offer important insights. Use in research can provide valuable measures of effectiveness of interventions. The reference values provided will aid interpretation in both settings.
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Affiliation(s)
- Alexandra O Robertson
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lisanne A Horvat-Gitsels
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.,Ulverscroft Vision Research Group, London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jugnoo S Rahi
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK .,Ulverscroft Vision Research Group, London, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Bao J, Yang A, Huang Y, Li X, Pan Y, Ding C, Lim EW, Zheng J, Spiegel DP, Drobe B, Lu F, Chen H. One-year myopia control efficacy of spectacle lenses with aspherical lenslets. Br J Ophthalmol 2021; 106:1171-1176. [PMID: 33811039 PMCID: PMC9340037 DOI: 10.1136/bjophthalmol-2020-318367] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 01/23/2023]
Abstract
Aims To evaluate the 1-year efficacy of two new myopia control spectacle lenses with lenslets of different asphericity. Methods One hundred seventy schoolchildren aged 8–13 years with myopia of −0.75 D to −4.75 D were randomised to receive spectacle lenses with highly aspherical lenslets (HAL), spectacle lenses with slightly aspherical lenslets (SAL), or single-vision spectacle lenses (SVL). Cycloplegic autorefraction (spherical equivalent refraction (SER)), axial length (AL) and best-corrected visual acuity (BCVA) were measured at baseline and 6-month intervals. Adaptation and compliance questionnaires were administered during all visits. Results After 1 year, the mean changes in the SER (±SE) and AL (±SE) in the SVL group were −0.81±0.06 D and 0.36±0.02 mm. Compared with SVL, the myopia control efficacy measured using SER was 67% (difference of 0.53 D) for HAL and 41% (difference of 0.33 D) for SAL, and the efficacy measured using AL was 64% (difference of 0.23 mm) for HAL and 31% (difference of 0.11 mm) for SAL (all p<0.01). HAL resulted in significantly greater myopia control than SAL for SER (difference of 0.21 D, p<0.001) and AL (difference of 0.12 mm, p<0.001). The mean BCVA (−0.01±0.1 logMAR, p=0.22) and mean daily wearing time (13.2±2.6 hours, p=0.26) were similar among the three groups. All groups adapted to their lenses with no reported adverse events, complaints or discomfort. Conclusions Spectacle lenses with aspherical lenslets effectively slow myopia progression and axial elongation compared with SVL. Myopia control efficacy increased with lenslet asphericity. Trial registration number ChiCTR1800017683.
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Affiliation(s)
- Jinhua Bao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Adeline Yang
- Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China.,R&D AMERA, Essilor International, Singapore
| | - Yingying Huang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xue Li
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yiguo Pan
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chenglu Ding
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ee Woon Lim
- Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China.,R&D AMERA, Essilor International, Singapore
| | - Jingwei Zheng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Daniel P Spiegel
- Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China.,R&D AMERA, Essilor International, Singapore
| | - Björn Drobe
- Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China.,R&D AMERA, Essilor International, Singapore
| | - Fan Lu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China .,Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hao Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China .,Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
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Choo MM, Grigg J, Barnes EH, Khaliddin N, Kamalden TA, Ahmad Kamar A, Choo YM, Lim CT, Martin FJ. Comparative cohorts of retinopathy of prematurity outcomes of differing oxygen saturation: real-world outcomes. BMJ Open Ophthalmol 2021; 6:e000626. [PMID: 33768163 PMCID: PMC7942244 DOI: 10.1136/bmjophth-2020-000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/21/2022] Open
Abstract
Objective An ongoing third epidemic of retinopathy of prematurity (ROP) is contributed largely by developing nations. We describe a cohort of infants in a single neonatal unit where two limits of oxygen saturation were administered, to show real-world outcomes from trend in neonatology for higher oxygen to improve survival. Methods and analysis This retrospective, comparative study of prospectively collected data in an ROP screening programme included infants indicated by gestational age ≤32 weeks, birth weight <1501 g, ventilation for 7 days or requiring oxygen >1 month, who underwent dilated fundoscopic examination from age 4 weeks, every 2 weeks until full retinal vascularisation. Infants with ROP were examined weekly and treated where indicated. Data were divided into two epochs. Epoch 1 oxygen saturation targets were [88–92%], epoch 2 targets [90–95% (99%)] with allowance of increase to 20% for several hours after procedures. Outcome measures included development of ROP, treatment, mortality, sepsis and intraventricular haemorrhage. Results A total of 651 infants underwent examination between 2003 and 2016. The incidence of ROP in epoch 1 was 29.1% and epoch 2 was 29.3% (p=0.24). ROP progression doubled in epoch 2 (5 vs 11%, p=0.006), proportion of cases treated halved (14% vs 6%, p=0.0005), sepsis was halved (78.5% vs 41.2%, p<0.0001) and intraventricular haemorrhage doubled (20.2% vs 43.8%, p=0.0001) in epoch 2. Mortality was 4% and 0% in epochs 1 and 2, respectively. Conclusion Incidence of ROP did not differ, although ROP cases that worsened doubled with higher oxygen targets. ROP cases requiring treatment decreased, as did sepsis and mortality. Intraventricular haemorrhage cases doubled.
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Affiliation(s)
- May May Choo
- Ophthalmology UMERC, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - John Grigg
- Ophthalmology, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth H Barnes
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nurliza Khaliddin
- Ophthalmology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Tengku Ain Kamalden
- Opthalmology, UMERC, University of Malaya Eye Research Centre, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
| | - Azanna Ahmad Kamar
- Paediatrics, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Yao Mun Choo
- Paediatrics, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Chin Theam Lim
- Paediatrics, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Frank Joseph Martin
- Ophthalmology, The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
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Lam CS, Tang WC, Lee PH, Zhang HY, Qi H, Hasegawa K, To CH. Myopia control effect of defocus incorporated multiple segments (DIMS) spectacle lens in Chinese children: results of a 3-year follow-up study. Br J Ophthalmol 2021; 106:1110-1114. [PMID: 33731364 PMCID: PMC9340033 DOI: 10.1136/bjophthalmol-2020-317664] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/08/2021] [Accepted: 02/20/2021] [Indexed: 01/26/2023]
Abstract
Aims To determine myopia progression in children who continued to wear the defocus incorporated multiple segments (DIMS) lenses or switched from single vision (SV) to DIMS lenses for a 1-year period following a 2-year myopia control trial. Methods 128 children participated in this study. The children who had worn DIMS lenses continued to wear DIMS lenses (DIMS group), and children who had worn SV lenses switched to wear DIMS lenses (Control-to-DIMS group). Cycloplegic spherical equivalent refraction (SER) and axial length (AL) were measured at 6-month interval. Historical controls were age matched to the DIMS group at 24 months and used for comparing the third-year changes. Results Over 3 years, SER and AL changes in the DIMS group (n=65) were −0.52±0.69D and 0.31±0.26 mm; these changes were not statistically significant over time (repeated measures analysis of variance, p>0.05). SER (−0.04±0. 38D) and AL (0.08±0.12 mm) changes in the Control-to-DIMS group (n=55) in the third year were less compared with the first (mean difference=0.45 ± 0.30D, 0.21±0.11 mm, p<0.001) and second (0.34±0.30D, 0.12±0.10 mm, p<0.001) years. Changes in SER and AL in both groups over that period were significantly less than in the historical control group (DIMS vs historical control: mean difference=−0.18±0.42D, p=0.012; 0.08±0.15 mm, p=0.001; Control-to-DIMS versus historical control: adjusted mean differences=−0.30±0.42D, p<0.001; 0.12±0.16 mm, p<0.001). Conclusions Myopia control effect was sustained in the third year in children who had used the DIMS spectacles in the previous 2 years and was also shown in the children switching from SV to DIMS lenses.
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Affiliation(s)
- Carly Sy Lam
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong .,Centre for Eye and Vision Research (CEVR), Hong Kong, Hong Kong
| | - Wing Chun Tang
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Paul H Lee
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Han Yu Zhang
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Hua Qi
- Technical Research & Development Department, Hoya Corporation Vision Care Section, Shinjuku-ku, Tokyo, Japan
| | - Keigo Hasegawa
- Technical Research & Development Department, Hoya Corporation Vision Care Section, Shinjuku-ku, Tokyo, Japan
| | - Chi Ho To
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong.,Centre for Eye and Vision Research (CEVR), Hong Kong, Hong Kong
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Burnett A, Paudel P, Massie J, Kong N, Kunthea E, Thomas V, Fricke TR, Lee L. Parents' willingness to pay for children's spectacles in Cambodia. BMJ Open Ophthalmol 2021; 6:e000654. [PMID: 33718614 PMCID: PMC7908283 DOI: 10.1136/bmjophth-2020-000654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim To determine willingness to pay for children's spectacles, and barriers to purchasing children's spectacles in Cambodia. Methods We conducted vision screenings, and eye examinations as indicated, for all consenting children at 21 randomly selected secondary schools. We invited parents/guardians of children found to have refractive problems to complete a willingness to pay for spectacles survey, using a binary-with-follow-up technique. Results We conducted vision screenings on 12 128 secondary schoolchildren, and willingness to pay for spectacles surveys with 491 parents/guardians (n=491) from Kandal and Phnom Penh provinces in Cambodia. We found 519 children with refractive error, 7 who had pre-existing spectacles and 14 recommended spectacles for lower ametropias. About half (53.2%; 95% CI 44.0% to 62.1%) of parents/guardians were willing to pay KHR70 000 (US$17.5; average market price) or more for spectacles. Mean willingness-to-pay price was KHR74 595 (US$18.6; 95% CI KHR64 505 to 86 262; 95% CI US$16.1 to US$21.6) in Phnom Penh and KHR55 651 (US$13.9; 95% CI KHR48 021 to 64 494; 95% CI US$12.0 to US$16.1) in Kandal province. Logistic regression suggested parents/guardians with college education (OR 6.8; p<0.001), higher household incomes (OR 8.0; p=0.006) and those wearing spectacles (OR 2.2; p=0.01) were more likely to be willing to pay ≥US$17.5. The most common reasons for being unwilling to pay US$17.5 were related to cost (58.8%). The most common barrier to spectacle wear was fear that spectacles weaken children's eyes (36.0%). Conclusions With almost half of parents/guardians unwilling to pay for spectacles at the current average market price, financial support through a subsidised spectacle scheme might be required for children to access spectacles in Cambodia.
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Affiliation(s)
- Anthea Burnett
- Public Health Division, Brien Holden Vision Institute, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Prakash Paudel
- Public Health Division, Brien Holden Vision Institute, Sydney, New South Wales, Australia
| | - Jessica Massie
- Public Health Division, Brien Holden Vision Institute, Sydney, New South Wales, Australia
| | - Neath Kong
- Public Health Division, Brien Holden Vision Institute, Phnom Penh, Cambodia
| | - Ek Kunthea
- Public Health Division, Brien Holden Vision Institute, Phnom Penh, Cambodia
| | - Varghese Thomas
- Public Health Division, Brien Holden Vision Institute, Sydney, New South Wales, Australia
| | - Tim R Fricke
- Public Health Division, Brien Holden Vision Institute, Sydney, New South Wales, Australia.,Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Ling Lee
- Public Health Division, Brien Holden Vision Institute, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Stewart C, Coffey-Sandoval J, Reid MW, Ho TC, Lee TC, Nallasamy S. Reliability of telemedicine for real-time paediatric ophthalmology consultations. Br J Ophthalmol 2021; 106:1157-1163. [PMID: 33722800 PMCID: PMC9340009 DOI: 10.1136/bjophthalmol-2020-318385] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/30/2021] [Accepted: 02/27/2021] [Indexed: 11/23/2022]
Abstract
Background/aims To assess the accuracy of real-time telemedicine to diagnose and manage paediatric eye conditions. Methods Design: Prospective, non-inferiority study analysing agreement in diagnoses and management plans between telemedicine and in-person examinations. Setting: Paediatric ophthalmology clinic. Population: Children 0–17 years, English-speaking or Spanish-speaking, able to participate in age-appropriate manner, either previously seen by the optometrist and required ophthalmology referral or newly referred from outside source. Procedures: Paediatric optometrist conducted examinations using digital equipment and streamed live to a paediatric ophthalmologist who recorded diagnoses and management plans, then re-examined patients in-person. Subjects were masked to the fact they would see the ophthalmologist in-person, same-day. Main outcome measures: Discrepancy in management plan or diagnosis between telemedicine and in-person examinations. Non-inferiority threshold was <1.5% for management plan or <15% for diagnosis discrepancies. Results 210 patients participated in 348 examinations. 131 (62.4%) had strabismus as primary diagnosis. In these patients, excellent and almost perfect agreement was observed for angle measurements (intraclass correlation coefficients=0.98–1.00) and disease categorisation (kappa=0.94–1.00) (p<0.0001 in all cases). No primary diagnoses changed, and no management plans changed following in-person examination. 54/55 patients who consented for surgery at the initial visit did so while masked to receiving an in-person examination. Families felt comfortable with the quality of the telemedicine examination (98.5%) and would participate in another in the future (97.1%). Conclusion Paediatric ophthalmic conditions can be reliably diagnosed and managed via telemedicine. Access for underserved populations may be improved by collaboration between ophthalmologists and optometrists using this technology.
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Affiliation(s)
- Carly Stewart
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA
| | | | - Mark W Reid
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Tiffany C Ho
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA.,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Thomas C Lee
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA.,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Sudha Nallasamy
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA .,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Affiliation(s)
- Li Lian Foo
- Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Kyoko Ohno-Matsui
- Ophthalmology and Visual Science, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | | | - Tien Yin Wong
- Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Daniel S Ting
- Singapore National Eye Centre, Singapore .,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
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Jin P, Deng J, Lv M, Sun S, Zhu J, Xu X, He X, Zou H. Development of the retina and its relation with myopic shift varies from childhood to adolescence. Br J Ophthalmol 2021; 106:825-830. [PMID: 33622699 PMCID: PMC9132867 DOI: 10.1136/bjophthalmol-2020-318181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/30/2020] [Accepted: 01/19/2021] [Indexed: 11/25/2022]
Abstract
Aims To elucidate the influence of age and myopic shift on retinal development. Methods This 1-year longitudinal study included 769 participants aged 6–17 years. Cycloplegic refraction, axial length and swept-source optical coherence tomography were examined at baseline and follow-up. The thickness changes in the retina, ganglion cell complex (GCC) and outer retinal layers (ORL) in the macular region were calculated, and their relation with age and myopic shift was analysed with multiple linear regression analysis. Results The thickness of the central foveal retinal layers was increased in children (<10 years) but unchanged or decreased in adolescents (>13 years). The thickness changes in the retina, GCC and ORL decreased with age (r=−0.24,–0.23, −0.15, respectively, all p<0.01). Multiple regression analysis showed that the changes in central foveal retinal thickness (RT) and GCC thickness were independently associated with age and baseline spherical equivalent (SE), while the changes in ORL thickness were associated with age and SE changes. In children 8–9 years, a greater increase was observed in central foveal ORL thickness in those with no myopic shift (p<0.01). The thickness of the most parafoveal and perifoveal retinal layers was less increased or more decreased in children <9 years with myopic shift (p<0.05). Conclusions Retinal development and its relation with myopic shift varies from childhood to adolescence. Myopia-related retinal thinning may result from less increase in the RT in childhood rather than a decrease in RT in adolescents. Children under 9 years old could be at a critical age for future myopia-related retinal thinning.
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Affiliation(s)
- Peiyao Jin
- Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China.,Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Ocular Fundus Disease, Shanghai, China
| | - Junjie Deng
- Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Ocular Fundus Disease, Shanghai, China
| | - Minzhi Lv
- Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Sifei Sun
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Jianfeng Zhu
- Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Xun Xu
- Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China.,Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Ocular Fundus Disease, Shanghai, China
| | - Xiangui He
- Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Haidong Zou
- Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China .,Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Ocular Fundus Disease, Shanghai, China
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Chan VF, Omar F, Yard E, Mashayo E, Mulewa D, Drake L, Wepo M, Minto H. Is an integrated model of school eye health delivery more cost-effective than a vertical model? An implementation research in Zanzibar. BMJ Open Ophthalmol 2021; 6:e000561. [PMID: 33521323 PMCID: PMC7817824 DOI: 10.1136/bmjophth-2020-000561] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To review and compare the cost-effectiveness of the integrated model (IM) and vertical model (VM) of school eye health programme in Zanzibar. Methods and analysis This 6-month implementation research was conducted in four districts in Zanzibar. Nine and ten schools were recruited into the IM and VM, respectively. In the VM, teachers conducted eye health screening and education only while these eye health components were added to the existing school feeding programme (IM). The number of children aged 6–13 years old screened and identified was collected monthly. A review of project account records was conducted with 19 key informants. The actual costs were calculated for each cost categories, and costs per child screened and cost per child identified were compared between the two models. Results Screening coverage was 96% and 90% in the IM and VM with 297 children (69.5%) from the IM and 130 children (30.5%) from VM failed eye health screening. The 6-month eye health screening cost for VM and IM was US$6 728 and US$7 355. The cost per child screened for IM and VM was US$1.23 and US$1.31, and the cost per child identified was US$24.76 and US$51.75, respectively. Conclusion Both models achieved high coverage of eye health screening with the IM being a more cost-effective school eye health delivery screening compared with VM with great opportunities for cost savings.
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Affiliation(s)
- Ving Fai Chan
- Centre for Public Health, Queen's University Belfast, Faculty of Medicine Health and Life Sciences, Belfast, UK.,College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Brien Holden Vision Institute Foundation Africa Trust, Durban, South Africa
| | - Fatma Omar
- Zanzibar Ministry of Health, Zanzibar, United Republic of Tanzania
| | - Elodie Yard
- Partnership for Child Development, Imperial College London, London, UK.,Oriole Global Health, Nairobi, Kenya
| | - Eden Mashayo
- Brien Holden Vision Institute Foundation Africa Trust, Durban, South Africa
| | - Damaris Mulewa
- Partnership for Child Development, Imperial College London, London, UK
| | - Lesley Drake
- Partnership for Child Development, Imperial College London, London, UK
| | - Mary Wepo
- Brien Holden Vision Institute Foundation Africa Trust, Durban, South Africa
| | - Hasan Minto
- Brien Holden Vision Institute, Sydney, New South Wales, Australia.,Berkeley School of Optometry, University of California, Berkeley, California, USA
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Ludwig CA, Jabbehdari S, Ji M, Vail D, Al-Moujahed A, Rosenblatt T, Azad AD, Veerappan M, Callaway NF, Moshfeghi DM. Higher prevalence of fundus haemorrhages in early-screened (NEST Study) as compared to late-screened (SUNDROP Study) newborn populations. Br J Ophthalmol 2021; 106:676-680. [PMID: 33514529 DOI: 10.1136/bjophthalmol-2020-317908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To determine whether timing of ophthalmic screening influences prevalence of neonatal fundus haemorrhages. We compared the prevalence of fundus haemorrhages in two populations: term newborns screened early (less than 72 hours) and preterm newborns screened late (4-11 weeks). Additionally, we reviewed the literature on timing and prevalence of newborn haemorrhages. METHODS Retrospective observational cohort study. Infants who underwent wide-angle ophthalmic digital imaging over one overlapping year in the Newborn Eye Screen Testing (NEST) or Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) programme were included. The PubMed database was filtered to include English-language articles dating back to 1950. Nine articles were selected for review based on inclusion of the prevalence of newborn fundus haemorrhages at multiple time points. RESULTS A total of 202 patients received early imaging in the NEST cohort and 73 patients received late imaging in the SUNDROP cohort. In the NEST cohort, 20.2% of newborns had haemorrhages. In contrast, we found haemorrhages in only one case or 1.4% of the SUNDROP cohort. Using prevalence data from nine additional studies, we developed a predicted probabilities model of newborn haemorrhages. Per this model, the probability of seeing a haemorrhage if you screen an infant at 1 hour is 18.8%, at 2 weeks is 2.9% and at 1 month is 0.28%. CONCLUSION We found a significant difference in the prevalence of fundus haemorrhages between the early-screened NEST cohort and the late-screened, preterm SUNDROP cohort. Likely, this difference is due to the transient nature of most newborn haemorrhages.
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Affiliation(s)
- Cassie A Ludwig
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA.,Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Sayena Jabbehdari
- Department of Ophthalmology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Marco Ji
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Daniel Vail
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Ahmad Al-Moujahed
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Tatiana Rosenblatt
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Amee D Azad
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Malini Veerappan
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Natalia F Callaway
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Darius M Moshfeghi
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
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Duke RE, Nwachukuw J, Torty C, Okorie U, Kim MJ, Burton K, Gilbert C, Bowman R. Visual impairment and perceptual visual disorders in children with cerebral palsy in Nigeria. Br J Ophthalmol 2020; 106:427-434. [PMID: 33268343 DOI: 10.1136/bjophthalmol-2020-317768] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/27/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022]
Abstract
Cerebral palsy (CP) is the most common cause of childhood physical disability globally. This study describes the spectrum of ocular morbidity and visual impairment in a community-based (recruited by key informants) sample of children with CP in Cross River State, Nigeria. METHODS A paediatric neurologist clinically confirmed CP and assessed systemic comorbidity. Ophthalmological assessment included developmental age appropriate acuity tests, objective refraction and objective and subjective tests of perceptual visual dysfunction (PVD). RESULTS 388 children aged 4-15 years with CP were identified. Visual problems were reported by carers in only 55 (14%) cases. Binocular visual acuity impairment was seen in 20/201 by Lea symbols test (10%) and 213/388 (55%) by the mirror test. Abnormal visual fields were seen in 58/388 (14.9%); strabismus in 183 (47%) abnormal contrast sensitivity in 178 (46%) and abnormal saccades in 84 (22%), spherical refractive errors in 223 (58%), significant astigmatism in 36 (12%), accommodative dysfunction in 41 (10.6%), optic atrophy in 198 (51%). Perceptual visual disorders were present in 22 (6%) subjectively and 177 (46%) objectively. The estimated frequency of cerebral visual impairment (CVI) in children ranged from 61 (16%) to 191 (49%) if children with optic atrophy were included. CONCLUSION Children with CP have a wide spectrum of ocular morbidity and visual impairment, underestimated by carers. Children with CP require visual acuity assessments with a range of tests which account for associated comorbidities and oculomotor dysfunction. Functional vision assessments for PVD is important. CVI is common.
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Affiliation(s)
- Roseline Ekanem Duke
- Ophthalmology, Calabar Children's Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria .,Clinical Research Unit, ITD, International Centre for Eye Health, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, London, UK
| | - Justin Nwachukuw
- Ophthalmology, Calabar Children's Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Chima Torty
- Pediatric Neurology, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Uche Okorie
- Ophthalmology, Calabar Children's Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Min J Kim
- Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, London, UK
| | - Kathryn Burton
- Community Paediatrics, Cambridgeshire Community Services NHS Trust, Saint Ives, Cambridgeshire, UK
| | - Clare Gilbert
- Clinical Research Unit, ITD, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, London, UK
| | - Richard Bowman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, London, UK
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Kaushik S, Dhingra D, Arora A, Singh MP, Kaur S, Joshi G, Snehi S, Gupta G, Pandav SS. Clinical profile and outcome of early surgery in neonatal-onset glaucoma presenting over a 5-year period. Br J Ophthalmol 2020; 106:368-375. [PMID: 33268344 DOI: 10.1136/bjophthalmol-2020-317230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/26/2020] [Accepted: 11/11/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Neonatal-onset glaucoma (NOG) is a severe form of childhood glaucoma and is not always due to primary congenital glaucoma (PCG). Due to advances in neonatal care, the incidence of NOG is rising, but it remains an under-reported entity. The objective of the paper was to study the clinical profiles, surgical and visual outcomes of NOG at least 1 year following early surgery. METHODS Prospective interventional cohort study at a tertiary care referral centre. Babies with NOG, who presented between January 2013 and December 2017, had a history suggestive of disease onset within 1 month of birth, and underwent surgery by 3 months of age, were prospectively enrolled. Those who completed a 1-year follow-up after surgery were analysed. RESULTS 94 eyes of 53 babies were analysed. 35 (66%) had PCG. Neonatal congenital ectropion uveae, congenital rubella syndrome, Peter's anomaly and Sturge-Weber syndrome comprised the non-PCG group. The mean age at presentation and surgery was 24.8±21.9, and 36.7±29.9 days. Additional glaucoma surgery was required in 43 of the 94 eyes (45.7%). PCG had significantly better outcomes than other glaucomas at all time points. 28.3% of eyes had good vision (LogMar (0-0.5)), 34.7% had moderate visual impairment (LogMar 0.7-1.0) and 16% were blind (LogMar <1.62) . CONCLUSION Our study shows that NOG does not always have a dismal prognosis. A small but significant proportion could have other underlying conditions than PCG. Timely surgery and rigorous amblyopia therapy resulted in good outcomes in terms of intraocular pressure control and vision in this cohort.
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Affiliation(s)
- Sushmita Kaushik
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepika Dhingra
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Arora
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mini P Singh
- Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Savleen Kaur
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gunjan Joshi
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sagarika Snehi
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder Singh Pandav
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Cernat A, Jamieson M, Kavelaars R, Khalili S, Bhambhwani V, Mireskandari K, Moretti ME. Immediate versus delayed sequential bilateral cataract surgery in children: a cost-effectiveness analysis. Br J Ophthalmol 2020; 106:211-217. [PMID: 33218991 DOI: 10.1136/bjophthalmol-2020-316507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/02/2020] [Accepted: 10/30/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Children with bilateral cataracts may undergo immediate sequential bilateral cataract surgery (ISBCS), which involves surgery on both eyes during the same general anaesthesia, or delayed sequential bilateral cataract surgery (DSBCS), which involves operating on each eye on separate days and requires a second anaesthesia. ISBCS is viewed with caution because of the risk of bilateral endophthalmitis. Proponents of ISBCS emphasise that the incidence of serious complications is low and is outweighed by benefits such as avoidance of multiple anaesthesia, faster visual rehabilitation and potential for decreased costs. However, there is a paucity of literature regarding the cost-effectiveness of ISBCS in children. We conducted a cost-effectiveness analysis to determine whether ISBCS is more cost-effective than DSBCS from the societal and health system perspectives in Ontario, Canada, which has a universal, single-payer system. METHODS A retrospective analysis of children who underwent ISBCS or DSBCS at a tertiary referral paediatric hospital was conducted. A decision tree was constructed using TreeAge Pro 2018 software. Clear visual axis was the measure of effectiveness. A time horizon of 8 weeks postoperatively was adopted. Both direct and indirect costs were included. RESULTS Fifty-three children were included, 37 in the ISBCS group and 16 in the DSBCS group. ISBCS and DSBCS were equally effective. ISBCS resulted in cost-savings of $3,776 (95% CI:-$4,641 to $12,578) CAD, per patient, from the societal perspective and $2,200 (95% CI:-$5,615 to $10,373) CAD per patient from the health system perspective. CONCLUSION ISBCS was less costly than DSBCS from both societal and health system perspectives while being equally effective.
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Affiliation(s)
- Alexandra Cernat
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Margaret Jamieson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - RuthAnne Kavelaars
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sina Khalili
- Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vishaal Bhambhwani
- Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada.,Ophthalmology Services, Department of Surgery, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.,Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Kamiar Mireskandari
- Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada.,Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Myla E Moretti
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada .,Ontario Child Health Support Unit, Clinical Trials Unit, Hospital for Sick Children, Toronto, Ontario, Canada
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50
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Paulino JAT, Santiago APD, Santiago DE. Comparison of the detection rates for retinopathy of prematurity (ROP) of the 2013 Philippine Academy of Ophthalmology (PAO) Revised Philippine Guidelines and the 2005 PAO-Philippine Pediatric Society (PPS) Guidelines for ROP screening in the Philippine General Hospital: a 5-year review. BMJ Open Ophthalmol 2020; 5:e000448. [PMID: 33094166 PMCID: PMC7577054 DOI: 10.1136/bmjophth-2020-000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives Compare the detection rates of the 2013 Philippine Academy of Ophthalmology (PAO) guidelines for retinopathy of prematurity (ROP) screening and the 2005 PAO-Philippine Pediatric Society guidelines in identifying infants who develop ROP in the 5-year study period in the Philippine General Hospital (PGH). Secondary objectives include determination of ROP prevalence; correlation of gestational age (GA), birth weight (BW) and other risk factors to ROP; and identification of the most common intervention. Methods and analysis Retrospective cross-sectional study of ROP records between 1 December 2013 and 30 November 2018 from the Medical Retina Service of the Department of Ophthalmology and Visual Sciences of the institution was studied. Variables with p value <0.05 were considered significant. STATA V.14 was used for all analysis. Results Only 851 of 898 infants screened for ROP were included in the study. Of these 698 would have been screened based on 2005 guidelines. All 118 infants with ROP were identified by both guidelines. Detection rate was higher using the 2005 than the 2013 guidelines (16.9% vs 13.3%, p value=0.0496). ROP prevalence was 9.7%. Among those with ROP, 70% have at least one identified risk factor, topped by sepsis, pneumonia, hyaline membrane disease, blood transfusion and oxygen supplementation. Only 8% required intervention consisting of laser, anti-vascular endothelial growth factor injection, surgery or in combination. Conclusion In PGH, no infants with ROP were missed using the 2005 recommendations. There was no added benefit of increasing threshold for BW and GA as recommended by the 2013 PAO guidelines. Screening guidelines should, however, be tailored to institutional needs, requirements and experience.
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Affiliation(s)
- Jose Antonio Tan Paulino
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, Manila, Metro Manila, Philippines
| | - Alvina Pauline Dy Santiago
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, Manila, Metro Manila, Philippines.,Philippine Eye Research Institute, Manila, Philippines.,UP College of Medicine - University of the Philippines - Manila, Manila, Philippines
| | - Darby Espiritu Santiago
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, Manila, Metro Manila, Philippines.,UP College of Medicine - University of the Philippines - Manila, Manila, Philippines
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