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Ruiz Guijosa A, Morales LF, Martínez de la Casa JM, Escribano J, García Feijoo J. Primary congenital glaucoma in two siblings with different compound heterozygous CYP1B1 genotypes. Ophthalmic Genet 2024:1-4. [PMID: 38450436 DOI: 10.1080/13816810.2024.2324044] [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: 04/15/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To describe the inheritance pattern and clinical variability of primary congenital glaucoma (PCG) in a family with two affected siblings. MATERIALS AND METHODS Two sisters diagnosed at birth with bilateral PCG, whose father had bilateral PCG and mother had bilateral microphthalmus, were subjected to a familial genetic study and ophthalmologic follow-up including intraocular pressure (IOP) measurement, and collection of biometric and cup-to-disc ratio data. RESULTS The inheritance pattern was autosomal recessive in compound heterozygosis. The sisters were found to be carriers of three pathogenic allele variants of the CYP1B1 gene: c.317C>A (p.Ala106Asp) and c.1345delG (p.Asp449MetfsTer8) in one patient (10 years) and c.1345delG (p.Asp449MetfsTer8) and c.202_209delCAGGCGGC (p.Gln68Serfs153Ter) in her older sister (12 years). Surgical histories included: three goniotomies and two Ahmed valves in each eye, and two trabeculectomies and a pupilloplasty in the right eye in the 10-year old; and one goniotomy, trabeculectomy and three Ahmed valves in each eye in the older sister. Currently, both sisters have a controlled intraocular pressure of 18-20 mmHg in both eyes. The father is blind in both eyes and carries two variants c.317C>A (p.Ala106Asp) and c.202_209delCAGGCGGC (p.Gln68Serfs153Ter). The mother with a single variant c.1345delG (p.Asp440MetfsTer8) has a prosthetic right eye and microphthalmus left eye. CONCLUSIONS The sisters were found to show two different allelic CYP1B1 variants (compound heterozygosis) with different repercussions on the clinical severity of PCG. These findings highlight the importance of genetic screening of affected families.
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Affiliation(s)
- Alexandra Ruiz Guijosa
- Ophthalmology Unit, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Madrid, Spain
| | - Laura Fernández Morales
- Ophthalmology Unit, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Madrid, Spain
- Ophthalmology Unit, Hospital Universitario Quiron, Madrid, Spain
| | - José María Martínez de la Casa
- Ophthalmology Unit, Hospital Clinico San Carlos, Department of Ophthalmology and ORL, Faculty of Medicine, Universidad Complutense de Madrid, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Madrid, Spain
- Instituto de Investigaciones Oftalmologicas Ramon Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Julián García Feijoo
- Ophthalmology Unit, Hospital Clinico San Carlos, Department of Ophthalmology and ORL, Faculty of Medicine, Universidad Complutense de Madrid, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Madrid, Spain
- Instituto de Investigaciones Oftalmologicas Ramon Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
- Cooperative Research Network on Age-Related Ocular Disease, and Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain
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Panos GD, Massa H. Editorial: Updates in ocular therapeutics and surgery, volume II. Front Med (Lausanne) 2024; 11:1370515. [PMID: 38390573 PMCID: PMC10882711 DOI: 10.3389/fmed.2024.1370515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Affiliation(s)
- Georgios D Panos
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
- Division of Ophthalmology and Visual Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Horace Massa
- Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
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Tang T, Zhao H, Liu D, Li X, Wang K, Li Y, Zhao M. Axial length to corneal radius of curvature ratio and refractive error in Chinese preschoolers aged 4-6 years: a retrospective cross-sectional study. BMJ Open 2023; 13:e075115. [PMID: 38159956 PMCID: PMC10759075 DOI: 10.1136/bmjopen-2023-075115] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE This study aims to investigate the associations of axial length to corneal radius of curvature (AL/CRC) ratio with refractive error and to determine the effect of AL/CRC ratio on hyperopia reserve and myopia assessment among Chinese preschoolers. METHODS This was a retrospective cross-sectional study that evaluated subjects aged 4-6 years. AL and CRC were obtained using a non-contact ocular biometer. Correlation analysis was performed to explore the associations of AL/CRC ratio with spherical equivalent refractive error (SER). The accuracy of AL/CRC ratio for hyperopia reserve and myopia assessment was analysed using cycloplegic refraction by drawing receiver operating characteristic (ROC) curves. RESULTS The analysis included 1024 participants (537 boys, 52.4%). The mean AL/CRC ratios in hyperopes, emmetropes and myopes were 2.90±0.06, 2.95±0.05 and 3.08±0.07, respectively. The SER was found to be more strongly correlated with AL/CRC ratio (ρ=-0.66, p<0.001) than either AL or CRC alone (ρ=-0.52, p<0.001; ρ=-0.03, p=0.33, respectively). AL/CRC was correlated with SER in hyperopes (ρ=-0.54, p<0.001), emmetropes (ρ=-0.33, p<0.001) and myopes (r=-0.67, p<0.001). For low hyperopia reserve assessment, the area under the ROC curves of AL/CRC ratio was 0.861 (95% CI 0.829 to 0.892), the optimal cut-off value of the AL/CRC ratio was ≥2.955. For myopia assessment, the area under the ROC curves of AL/CRC ratio was 0.954 (95% CI 0.925 to 0.982), the optimal cut-off value of the AL/CRC ratio was ≥2.975. CONCLUSIONS The SER showed a better correlation with AL/CRC ratio than either AL or CRC alone, especially in myopes, among children aged 4-6 years. These findings indicate that when cycloplegic refraction is unavailable, AL/CRC ratio could be used as an alternative indicator for identifying low hyperopia reserve and myopia among preschoolers, helping clinicians and parents screen children with low hyperopia reserve before primary school in a timely manner.
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Affiliation(s)
- Tao Tang
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Heng Zhao
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Duanke Liu
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Xuewei Li
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Kai Wang
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Yan Li
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Mingwei Zhao
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
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Theis J, Chen AM, Burgher AP, Greenspan LD, Morgenstern A, Salzano AD, Yap TP, Scheiman M, Roberts TL. Ocular motor disorders in children and adults with mTBI: a scoping review protocol. BMJ Open 2023; 13:e073656. [PMID: 37857540 PMCID: PMC10603508 DOI: 10.1136/bmjopen-2023-073656] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Ocular motor function is susceptible to neurological injury because it requires a large portion of brain circuitry including every lobe of the brain, brainstem, thalamus, basal ganglia, cerebellum, cranial nerves and visual tracts. While reports of a high frequency of ocular motor dysfunctions after mild traumatic brain injury (mTBI) span multidisciplinary journals, there is no scoping review of the signs, diagnostic assessments and criteria, and appropriate management of ocular motor disorders post-mTBI. Post-mTBI ocular motor dysfunction has been reported to respond to active treatment. The objective of this scoping review is to map the available evidence on the diagnostic assessment and treatment modalities currently used in the management of mTBI-related ocular motor disorders in children and adults. This scoping review also aims to identify gaps in the current literature and provide suggestions for future research. METHODS AND ANALYSIS This review will include populations with reported concussion and/or mTBI without restrictions on age, race, sex or time since injury. The review will evaluate the reported symptoms related to ocular motor dysfunction, types of assessments and diagnostic criteria used, reported treatments, and the level of evidence supporting the reported treatments. This review will exclude literature on brain injury of non-traumatic aetiology and moderate/severe traumatic brain injury. Ocular motor dysfunction after mTBI appears in journals across multiple disciplines. Thus, multiple databases will be evaluated including Pubmed, Embase, PEDro, OVID, Clinical Key, Google Scholar and REHABDATA. Literature will be searched from inception to present day. Evidence sources will include experimental study designs including randomised controlled trials, non-randomised controlled trials and interrupted time-series. Additionally, analytical observational studies including prospective and retrospective cohort studies, case series, cross-sectional studies and clinical practice guidelines will be considered for inclusion. Data will be extracted on clinical presentation, frequency, assessment, diagnostic criteria management strategies and outcomes of concussion and mTBI-related ocular motor disorders. ETHICS AND DISSEMINATION This scoping review will use data from existing publications and does not require ethical approval by an institutional review board. Results will be disseminated through publication in a peer-reviewed scientific journal and presented at relevant conferences and as part of future workshops with professionals involved with diagnosis and management of patients with mTBI.
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Affiliation(s)
- Jacqueline Theis
- Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences F Edward Hébert School of Medicine, Bethesda, Maryland, USA
- Concussion Care Centre of Virginia, Richmond, Virginia, USA
| | - Angela M Chen
- Southern California College of Optometry, Marshall B Ketchum University, Fullerton, California, USA
| | - Allegra P Burgher
- Southern California College of Optometry, Marshall B Ketchum University, Fullerton, California, USA
| | - Lynn D Greenspan
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania, USA
| | - Andrew Morgenstern
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Aaron D Salzano
- College of Optometry, Pacific University, Forest Grove, Oregon, USA
| | | | - Mitchell Scheiman
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania, USA
| | - Tawna L Roberts
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Stanford, California, USA
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Chan SCY, Shah PR, Tan K, Ford B, Webber A, Keay L. Integration of hospital and community care for paediatric ophthalmology: A mixed-methods study. Ophthalmic Physiol Opt 2023; 43:997-1006. [PMID: 37150970 DOI: 10.1111/opo.13160] [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: 01/02/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND To explore collaborative care models for paediatric eye care that integrate hospital and community-based care to address access blocks. METHODS Sequential referrals to a tertiary paediatric ophthalmology clinic between April and October 2019 and subsequent encounters up until July 2020 at a major metropolitan public children's hospital in Sydney, Australia, were reviewed to identify those cases suitable for community care. Semi-structured phone interviews were conducted with eye health service providers, including ophthalmologists, orthoptists and optometrists, as well as service users to explore their perspectives on potential changes to service delivery. Qualitative data were analysed deductively using the Levesque model for access to healthcare and Consolidated Framework for Implementation Research (CFIR) to inform implementation strategies for future models of care. RESULTS One-third of the 439 audited referrals (30.5%; 134/439) were identified as suitable for community management. Interviews revealed five themes relating to potential models of care, which would support and promote access: integrated health systems, standardised quality of care, interprofessional trust, multidisciplinary governance and patient-centred care. Key recommendations for future implementation included: (i) identifying and preparing clinical champions, (ii) conducting educational meetings, (iii) conducting local needs assessments and (iv) informing local opinion leaders. CONCLUSIONS This audit highlights access blocks and poor targeting of referrals to tertiary paediatric ophthalmology services in a metropolitan hospital. Integration with community practitioners was identified as an acceptable way to streamline services, and strategies that may support successful implementation in this setting were identified.
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Affiliation(s)
- Stephen C Y Chan
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Parth R Shah
- Department of Paediatric Ophthalmology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Kimberley Tan
- Department of Paediatric Ophthalmology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Belinda Ford
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ann Webber
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- School of Optometry & Vision Science, Queensland University of Technology, Brisbane City, Queensland, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Singh V, Lallu J, Ramachandran N, Kim BZ, McKelvie J. Orthokeratology-related Acanthamoeba keratitis in a 13-year-old. Clin Exp Optom 2023; 106:800-802. [PMID: 35999057 DOI: 10.1080/08164622.2022.2111203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/15/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022] Open
Affiliation(s)
- Vidit Singh
- Department of Ophthalmology, Waikato DHB Hospital, Hamilton, New Zealand
| | - Jagrut Lallu
- Department of Optometry, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Optometry, School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
| | | | - Bia Z Kim
- Department of Ophthalmology, Waikato DHB Hospital, Hamilton, New Zealand
| | - James McKelvie
- Department of Ophthalmology, Waikato DHB Hospital, Hamilton, New Zealand
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Al-Bakri M, Skovgaard AM, Bach-Holm D, Larsen DA, Siersma V, Kessel L. School performances in children with cataract: results from a population-based cohort study. BMJ Open 2023; 13:e072984. [PMID: 37532485 PMCID: PMC10401207 DOI: 10.1136/bmjopen-2023-072984] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES Childhood cataract is a chronic condition that may interfere with the child's learning capacities. We aimed to investigate whether childhood cataract influences academic development by comparing school performance in reading and mathematics in children with cataract to a matched control group. DESIGN Nationwide registry-based cohort study. SETTINGS Two surgical centres that perform all treatments for childhood cataract in Denmark. PARTICIPANTS Children born between 2000 and 2009 diagnosed with cataract before 10 years of age (n=275) and an age-matched and sex-matched control group (n=2473). MAIN OUTCOME MEASURES School performance was assessed as test scores in national tests performed at regular intervals from grade 2 to grade 8 in reading and mathematics. Analyses were corrected for birth origin, child somatic and mental disorder and parental socioeconomic status and mental disorders. RESULTS Of 275 children, 85 (30.9%) were operated for bilateral cataract, 79 (28.7%) unilateral cataract and 111 (40,4%) were not operated. We found that children with cataract have lower participation rate in the tests (62.5%) compared with the control cohort (77.2%) (p value=0.0001). After adjusting the pooled analyses for birth origin, somatic and mental disease in the child and parental socioeconomic status and mental disorders, we found that the children with cataract scored significantly lower in mathematics compared with those without cataract (mean difference=-4.78, 95% CI: -8.18 to -1.38, p value=0.006), whereas no difference was found regarding scores in reading (p=0.576). The lower score in mathematics was driven by children who had been operated for bilateral cataract (p-value=0.004). CONCLUSION Children with cataract without somatic or neurodevelopmental comorbidities or psychosocial adversities seem to do well in school, whereas children operated for bilateral cataract have higher frequencies of difficulties in mathematical tasks.
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Affiliation(s)
- Moug Al-Bakri
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Anne Mette Skovgaard
- National Institute of Public Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Daniella Bach-Holm
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Line Kessel
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Lo-Cao E, Crofts S, Geering K, Jamieson RV, Grigg JR. Spectrum of ocular disease in children aged between 0 and 3 years at an Australian paediatric tertiary hospital. Clin Exp Ophthalmol 2023; 51:546-558. [PMID: 37147905 DOI: 10.1111/ceo.14237] [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: 12/10/2022] [Revised: 04/07/2023] [Accepted: 04/22/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Childhood ocular disease can be a significant health burden to the child, family and society. Previous studies have examined the spectrum of paediatric ocular disease presenting to tertiary hospitals; however, these studies have broader age ranges, smaller sample sizes, and are largely based in developing countries. This study aims to assess the spectrum of ocular disease in the first 3 years of life presenting to the eye department of an Australian tertiary paediatric hospital. METHODS The records of 3337 children who had their initial presentation at the eye clinic between the age of 0 and 36 months were reviewed, spanning 6.5 years from 1st July 2012 to 31st December 2018. RESULTS The most common primary diagnoses overall were strabismic amblyopia (6.0%), retinopathy of prematurity (5.0%) and nasolacrimal duct obstruction (4.5%). Bilateral visual impairment was more common in younger children, while unilateral visual impairment was more common in older children. The proportion of all children presenting with visual impairment was 10.3%, with 5.7% of all children presenting with bilateral visual impairment and 4.6% presenting with unilateral visual impairment. In children with visual impairment, the most common sites of primary abnormality were lens (21.4%), retina (17.3%), and cerebral and visual pathways (12.1%). The most common primary diagnoses in children with visual impairment were cataract (21.4%), strabismic amblyopia (9.3%) and retinoblastoma (6.5%). CONCLUSIONS The spectrum of eye disease and vision impairment presenting in the first 3 years of life facilitates health care planning, greater community education about vision impairment and importance of early intervention, and guidance for appropriate resource allocation. Health systems can apply these findings to aid in early identification and intervention to reduce preventable blindness and institute appropriate rehabilitation services.
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Affiliation(s)
- Edward Lo-Cao
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
- Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Stephanie Crofts
- Department of Orthoptics, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Katie Geering
- Department of Orthoptics, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Robyn V Jamieson
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
- Eye Genetics Research Unit, Children's Medical Research Institute, Save Sight Institute, The University of Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
- Discipline of Genetic Medicine, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - John R Grigg
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
- Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Eye Genetics Research Unit, Children's Medical Research Institute, Save Sight Institute, The University of Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
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Panos GD, Deshmukh R. Editorial: Reviews in: ophthalmology 2022. Front Med (Lausanne) 2023; 10:1255856. [PMID: 37588004 PMCID: PMC10425287 DOI: 10.3389/fmed.2023.1255856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 08/18/2023] Open
Affiliation(s)
- Georgios D. Panos
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
- Division of Ophthalmology and Visual Sciences, Faculty of Medicine and Health Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Rashmi Deshmukh
- Cornea and Refractive Surgery Service, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
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Liu J, Ye Q, Xiao C, Zhuang Y, Feng L, He Y, Xu Z, Zhou Y, Chen X, Yao Y, Jiang R, Pang Y, Yu W, Wen Y, Yuan J, Thompson B, Li J. Impact of COVID-19 pandemic control measures on amblyopia treatment: a retrospective study of records from a tertiary eye hospital in China. BMJ Open 2023; 13:e071839. [PMID: 37407054 PMCID: PMC10335509 DOI: 10.1136/bmjopen-2023-071839] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/23/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES Amblyopia is the most common cause of unilateral visual impairment in children and requires long-term treatment. This study aimed to quantify the impact of pandemic control measures on amblyopia management. DESIGN AND SETTING This was a retrospective cohort study of data from a large amblyopia management database at a major tertiary eye care centre in China. PARTICIPANTS Outpatients with amblyopia who visited the hospital from 1 June 2019, through 28 February 2022. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the number of first and follow-up in-person visits to the hospital for amblyopia treatment. Secondary outcomes included the time interval between consecutive visits and improvement of vision (visual acuity, contrast sensitivity and stereopsis). Patient records were grouped into prepandemic and during pandemic periods. RESULTS A total of 10 060 face-to-face visits for 5361 patients (median age 6.7 years, IQR 5.4, 8.9) that spanned two lockdown periods were included in the analysis, of which 28% were follow-up visits. Pandemic control measures caused a sharp decline in the number of outpatient visits (3% and 30% of prepandemic levels in the months directly after the start of the first (2020) and second (2021) periods of pandemic control measures, respectively). However, these drops were followed by pronounced rebounds in visits that exceeded prepandemic levels by 51.1% and 108.5%, respectively. The interval between consecutive visits increased significantly during the pandemic from a median (IQR) of 120 (112, 127) days in 2019 to 197 (179, 224) in 2020 (p<0.001) and 189 (182, 221) in 2021 (p<0.001). There were no significant differences in the improvement of visual function or treatment compliance between the prepandemic and postpandemic groups. CONCLUSIONS The number of amblyopia patient hospital visits spiked well above prepandemic levels following lockdown periods. This pattern of patient behaviour can inform planning for amblyopia treatment services during and after public health-related disruptions.
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Affiliation(s)
- Jing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Qingqing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Chutong Xiao
- Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, California, USA
| | - Yijing Zhuang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Lei Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Yunsi He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Zixuan Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Yusong Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Xiaolan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Ying Yao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Rengang Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Yangfei Pang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Wentong Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Yun Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Junpeng Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Jinrong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
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Pilling RF, Allen L, Anketell P, Bullaj R, Harwood J, Little S. Visual Behaviours (ViBes) in Cerebral Visual Impairment: Validating a Descriptive Tool to Support Diagnosis and Monitoring. Br Ir Orthopt J 2023; 19:44-51. [PMID: 37332843 PMCID: PMC10275135 DOI: 10.22599/bioj.290] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/05/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Cerebral visual impairment (CVI) is the most common cause of visual impairment in children in the UK. Diagnosis is based on identification of visual behaviours (ViBes) relating to visual dysfunction. Examination techniques and inventories have been developed to elicit these in children with a developmental age of two years or more. The absence of a structured approach to recording visual behaviours in children with complex needs is a barrier to diagnosis. The aim of the study was to develop a matrix of visual behaviours seen in pre-verbal and pre-motor children with visual impairment and establish its content validity and inter-rater reliability. Methods ViBe content validation:: Visual behaviour descriptors relating to visual function were collated and categorised by expert consensus of vision professionals into a matrix composed of three functions (attention, field/fixation, motor response) and five levels (0 = no awareness; 1 = visual awareness; 2 = visual attention; 3 = visual detection; 4 = visual understanding).ViBe inter-rater reliability:: The participants (two orthoptists, an optometrist, an ophthalmologist and two qualified teachers of the visually impaired) used the ViBe matrix to independently score each of 17 short video clips of children demonstrating visual behaviours seen in CVI. Results The ViBe matrix will be presented. Cohen's kappa for the matrix was 0.67, demonstrating moderate-to-strong inter-rater reliability. Conclusion The development of standardised descriptors can support clinicians and teachers in identifying areas of concern for children with complex needs. In addition, the ViBe matrix could be utilised in research, clinical and diagnostic reports to clearly communicate the areas of visual dysfunction and track progress resulting from interventions. Key Points The absence of a structured approach to recording visual behaviours in children with complex needs is a barrier to diagnosis.The ViBe matrix offers descriptors relating to visual behaviours and has demonstrated acceptable inter-rater reliability.The tool may support the identification and diagnosis of cerebral visual impairment in a population of children who cannot access standard testing.
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Milde N, Rasmussen A, Nissen K, Kessel L. Support needs around the time of diagnosis of parents caring for an infant with visual impairment or blindness in Denmark: a qualitative study. BMJ Open 2023; 13:e067805. [PMID: 36810175 PMCID: PMC9945031 DOI: 10.1136/bmjopen-2022-067805] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE The whole family is affected when an infant is diagnosed with visual impairment or blindness. We aimed to describe the support needs of parents around the time of diagnosis. DESIGN We used a descriptive qualitative method based on the theory of critical psychology and conducted five semistructured interviews with a total of eight parents of children under the age of 2 years who had been diagnosed with blindness or visual impairment before the age of 1 year. Thematic analysis was used to extract primary themes. SETTING The study was initiated by a tertiary hospital centre specialised in the ophthalmic management of children and adults with visual impairment. PARTICIPANTS Eight parents representing five families caring for a child under the age of 2 years with visual impairment or blindness participated in the study. The parents were recruited from the Department of Ophthalmology at Rigshospitalet, Denmark in relation to appointments in the clinic or by phone or email. RESULTS We identified three themes: (1) recognition and reactions during the time of diagnosis; (2) family, network and struggles; and (3) interaction with healthcare professionals. CONCLUSION The main lesson for healthcare professionals is to bring hope at a time when all hope may seem to be lost. Second, a need to direct attention to families with no or sparse supportive networks. Third, coordinating appointments between hospital departments and at-home therapies and reducing the number of appointments to allow parents time to establish a family relation with their child. Parents respond well to competent healthcare professionals who keep them informed and who see their child as an individual rather than as a diagnosis.
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Affiliation(s)
- Nina Milde
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Annette Rasmussen
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Kamilla Nissen
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet - KennedyCenter, Glostrup, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Costagliola G, Vallario MP, Santangelo A, Foiadelli T, Ragone MC, Battini R, Tinelli F, Di Cicco ME, Bonuccelli A, Gaeta G, Iozzi C, Peroni DG, Operto FF, Consolini R, Orsini A. Neurovisual Manifestations in Children with Mild COVID-19: An Association to Remember. Neuroophthalmology 2023; 47:75-78. [PMID: 36891409 PMCID: PMC9988337 DOI: 10.1080/01658107.2023.2174560] [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: 06/15/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 02/18/2023] Open
Abstract
Neurovisual involvement has been reported in a number of patients with severe SARS-CoV-2 disease (COVID-19), mainly among adult patients. In children, such involvement has been reported in rare cases, often in those presenting with severe forms of COVID-19. The aim of this work is to explore the association between mild COVID-19 and neurovisual manifestations. We report the cases of three previously healthy children who developed neurovisual manifestations following mild acute COVID-19, analysing the clinical phenotype, the latency between the onset of acute COVID-19 and neurovisual involvement, and the kinetic of resolution. Our patients developed different clinical patterns, including visual impairment and ophthalmoplegia. In two cases, these clinical features occurred during acute COVID-19, while in the third patient their development was delayed after 10 days from disease onset. Furthermore, the dynamics of resolution were different, with one patient showing remission after 24 hours, the second after 30 days, and the third showing persistence of the strabismus after 2 months of follow-up. The spreading of COVID-19 among the paediatric population will probably lead to an increase of atypical disease forms, including those presenting with neurovisual involvement. Therefore, a better knowledge of the pathogenic and clinical features of these manifestations is warranted.
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Affiliation(s)
- Giorgio Costagliola
- Pediatric Immunology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Michele Pio Vallario
- Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Andrea Santangelo
- Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Maria Cristina Ragone
- Ophthalmology Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Roberta Battini
- Department of Neuroscience, IRCSS Fondazione StellaMaris, Calambrone, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Tinelli
- Department of Neuroscience, IRCSS Fondazione StellaMaris, Calambrone, Italy
| | - Maria Elisa Di Cicco
- Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alice Bonuccelli
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Giovanni Gaeta
- Department of Pediatrics, Pediatric Department, Cecina Hospital, Cecina, Italy
| | - Chiara Iozzi
- Department of Pediatrics, Pediatric Department, Cecina Hospital, Cecina, Italy
| | - Diego Giampiero Peroni
- Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy
| | - Rita Consolini
- Pediatric Immunology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
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O’Connell A, Stephenson KAJ, Flitcroft I. Risk of Neurotoxicity with Multiple General Anaesthetics for Examination Under Anaesthesia in Paediatric Ophthalmology - A Cause for Concern? Clin Ophthalmol 2023; 17:291-302. [PMID: 36711257 PMCID: PMC9880563 DOI: 10.2147/opth.s387098] [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: 10/04/2022] [Accepted: 12/20/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose To evaluate the impact of clinical protocol change via active minimisation on the number of general anaesthetic (GA)/sedation episodes for diagnostic ophthalmic purposes at Children's Health Ireland at Temple Street (CHI-TS), Dublin, Ireland, from 2016 to 2019, inclusive. Change was implemented following published cautionary principles in 2016 by the FDA regarding the potential neurotoxic risk from multiple GA exposure in children. Methods Retrospective analysis of electronic operating theatre records was completed using procedure codes "Ophthalmological examination" and "Examination of fundi". Available records for patients undergoing multiple examination under anaesthesia (EUA) procedures were assessed for demographics, indication. Comparison was made regarding overall EUA numbers and breakdown for each year, before and after the new departmental approach. From 2018 onward, a patient-centred, departmental strategy of active minimisation of EUA was adopted, using strategies of "training, technology and patience". A literature review was conducted using online databases. Results A total of 450 EUAs were performed over the 4 years investigated. In the former 2 years of the study period, prior to departmental policy change, EUAs represented 32% (304 of 948 total theatre episodes) of the ophthalmic theatre caseload. In the latter 2 years of this study period, this proportion fell to 19% (146 EUAs of 783 theatre episodes). Total theatre case numbers were comparable in both time periods. Eighteen children had multiple EUAs (ie, ≥2 EUAs, mean 6.5, SD 2.9) for life/sight threatening indications, totalling 116 EUAs (25.7%). Conclusion A significant reduction in diagnostic EUA volume was accomplished resulting in reduced individual patient risk and increased capacity for surgical interventions. A detailed description of this methodology is included for the purposes of replication at comparable units. EUA will continue to play a crucial role in the management of life/sight threatening conditions but the application of a cautionary principle to reduce EUA, where possible, is appropriate to reduce potential for neurotoxicity.
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Affiliation(s)
- Ann O’Connell
- Ophthalmology Department, Children’s Health Ireland at Temple Street Hospital, Dublin, Ireland,Correspondence: Ann O’Connell, Children’s Health Ireland at Temple Street, Dublin, Ireland, Tel +353 1 8784200, Email
| | - Kirk A J Stephenson
- Ophthalmology Department, Children’s Health Ireland at Temple Street Hospital, Dublin, Ireland
| | - Ian Flitcroft
- Ophthalmology Department, Children’s Health Ireland at Temple Street Hospital, Dublin, Ireland
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Ma J, Zhu H, Guo W, Li R, Shen S, Wang Y, Huang D, Zhang X, Fu Z, Zhao A, Chen D, Si J, Zhang J, Xu S, Wang L, Liu H. Association of different digital media experiences with paediatric dry eye in China: a population-based study. BMJ Open 2022; 12:e062850. [PMID: 36450435 PMCID: PMC9717351 DOI: 10.1136/bmjopen-2022-062850] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To investigate the ocular surface effects of different digital media experiences in Chinese elementary school students. DESIGN Population-based cross-sectional study was used. SETTING 14 randomly selected primary schools in Yuhuatai District, Nanjing, China PARTICIPANTS: 2,694 students between 7 and 8-year-old. OUTCOME MEASURES Prevalence of and risk factors for different types of dry eye disease,and different digital media experience with different ocular signs. RESULTS The prevalence of 'symptomatic DED' was 8.7% (95% CI 7.6% to 9.8%) and 'definite DED' prevalence rate was 5.5% (95% CI 4.7% to 6.4%). In multivariable logistic regression model, allergic conjunctivitis (OR=4.33, 95% CI (3.01 to 6.23), p<0.001), more than 1 hour per day on outdoor activity (OR=0.69, 95% CI (0.49 to 0.99), p=0.043), smartphone (OR=2.73, 95% CI (1.51 to 4.91), p=0.001), tablet (OR=2.09, 95% CI (1.07 to 4.07), p=0.030) and homework (OR=1.86, 95% CI (1.22 to 2.83), p=0.004) were independently associated with 'definite DED', while allergic conjunctivitis (OR=5.58, 95% CI (4.12 to 7.55), p<0.001), more than 1 hour per day on outdoor activity (OR=0.72, 95% CI (0.53 to 0.97), p=0.028), smartphone (OR=2.60, 95% CI (1.55 to 4.35), p<0.001), tablet (OR=1.84, 95% CI (1.02 to 3.34), p=0.044) and homework (OR=2.57, 95% CI (1.84 to 3.60), p<0.001) were independently associated with 'symptomatic DED'. CONCLUSIONS Using smartphones or tablets for an average of more than 1 hour per day through the course of a year is independently associated with paediatric DED.
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Affiliation(s)
- Junxin Ma
- Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Ophthalmology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hui Zhu
- Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei Guo
- Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Rui Li
- Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shiya Shen
- Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yun Wang
- Pediatrics, Women's Hospital of Nanjing Medical University, Nanjing, China
| | - Dan Huang
- Department of Child Healthcare, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xiaohan Zhang
- Ophthalmology, Wuxi Children's Hospital, Wuxi, China
| | - Zhujun Fu
- Department of Ophthalmology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Andi Zhao
- Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Danni Chen
- Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiahao Si
- The Fourth School of Clinical Medicine of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiyu Zhang
- The Fourth School of Clinical Medicine of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shasha Xu
- The Fourth School of Clinical Medicine of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Liyuan Wang
- The Fourth School of Clinical Medicine of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hu Liu
- Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Gyllensten H, Humayun J, Sjöbom U, Hellström A, Löfqvist C. Costs associated with retinopathy of prematurity: a systematic review and meta-analysis. BMJ Open 2022; 12:e057864. [PMID: 36424118 PMCID: PMC9693652 DOI: 10.1136/bmjopen-2021-057864] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To review and analyse evidence regarding costs for retinopathy of prematurity (ROP) screening, lifetime costs and resource use among infants born preterm who develop ROP, and how these costs have developed over time in different regions. DESIGN Systematic review and meta-analysis DATA SOURCES: PubMed and Scopus from inception to 23 June 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Included studies presented costs for ROP screening and the lifetime costs (including laser treatment and follow-up costs) and resource use among people who develop ROP. Studies not reporting on cost calculation methods or ROP-specific costs were excluded. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened for inclusion and extracted data, including items from a published checklist for quality assessment used for bias assessment, summary and random-effects meta-analysis for treatment costs. Included studies were further searched to identify eligible references and citations. RESULTS In total, 15 studies reported ROP screening costs, and 13 reported lifetime costs (either treatment and/or follow-up costs) for infants with ROP. The range for screening costs (10 studies) was US$5-US$253 per visit, or US$324-US$1072 per screened child (5 studies). Costs for treatment (11 studies) ranged from US$38 to US$6500 per child. Four studies reported healthcare follow-up costs (lifetime costs ranging from US$64 to US$2420, and 10-year costs of US$1695, respectively), and of these, three also reported lifetime costs for blindness (range US$26 686-US$224 295) using secondary cost data. Included papers largely followed the quality assessment checklist items, thus indicating a low risk of bias. CONCLUSION The costs of screening for and treating ROP are small compared with the societal costs of resulting blindness. However, little evidence is available for predicting the effects of changes in patient population, screening schedule or ROP treatments. PROSPERO REGISTRATION NUMBER CRD42020208213.
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Affiliation(s)
- Hanna Gyllensten
- Institute of Health and Care Sciences, University of Gothenburg, Goteborg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Goteborg, Sweden
| | - Jhangir Humayun
- Institute of Health and Care Sciences, University of Gothenburg, Goteborg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Goteborg, Sweden
| | - Ulrika Sjöbom
- Institute of Health and Care Sciences, University of Gothenburg, Goteborg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Goteborg, Sweden
| | - Ann Hellström
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Goteborg, Sweden
| | - Chatarina Löfqvist
- Institute of Health and Care Sciences, University of Gothenburg, Goteborg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Goteborg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Goteborg, Sweden
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Carlsen Misic M, Eriksson M, Normann E, Pettersson M, Blomqvist Y, Olsson E. Clonidine as analgesia during retinopathy of prematurity screening in preterm infants (cloROP): protocol for a randomised controlled trial. BMJ Open 2022; 12:e064251. [PMID: 36137627 PMCID: PMC9511565 DOI: 10.1136/bmjopen-2022-064251] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Preterm infants are at risk of negative consequences from stress and pain at the same time as they often are in need of intensive care that includes painful interventions. One of the frequent painful procedures preterm infants undergo is eye examination screening to detect early signs of ROP (retinopathy of prematurity). These examinations are both stressful and painful, and despite a multitude of research studies, no conclusive pain-relieving treatment has been demonstrated. The main aim of this trial is to investigate the analgesic effect of clonidine during ROP eye examinations. METHODS AND ANALYSIS The planned study is a multicentre randomised controlled trial with a crossover design. Infants will be recruited from two different neonatal intensive care units (NICUs) in Sweden. Infants born before gestation week 30 (and therefore eligible for ROP screening) and cared for in either of the NICUs will be eligible for inclusion in the study. The primary outcome will be Premature Infant Pain Profile-Revised score within 30 s after starting the examination. Secondary outcomes will be changes in the galvanic skin response parameters (area small peaks, area huge peaks, peaks per second and average rise time) within 30 s after starting the eye examination, together with the number and evaluation of adverse events reported within 72 hours after the examination and the examining physician's assessment of how easy the infant was to examine. ETHICS AND DISSEMINATION Approval from the Swedish Ethical Review Authority and the Swedish Medical Products Agency has been obtained for the study. Parents of eligible infants will be getting both verbal and written information about the study including that participation is voluntary. Data will be collected and treated in accordance with the European general data protection regulations. The results will be reported on group level and published in a scientific journal. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT04902859).EudraCT (2021-003005-21).
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Affiliation(s)
- Martina Carlsen Misic
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Erik Normann
- University Hospital, Neonatal Intensive Care Unit, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Miriam Pettersson
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ylva Blomqvist
- University Hospital, Neonatal Intensive Care Unit, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emma Olsson
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Hellström A, Jacobson L, Al-Hawasi A, Hellström-Westas L, Rakow A, Johnson M, Sävman K, Holmstrom G, Larsson E, Gränse L, Saric M, Sunnqvist B, Smith L, Hård AL, Morsing E, Lundgren P. Retrospective evaluation of ophthalmological and neurological outcomes for infants born before 24 weeks gestational age in a Swedish cohort. BMJ Open 2022; 12:e055567. [PMID: 35922112 PMCID: PMC9353003 DOI: 10.1136/bmjopen-2021-055567] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To retrospectively evaluate ophthalmological and neurological outcomes in a Swedish cohort of infants born before 24 weeks gestational age (GA) and explore risk factors for visual impairment. SETTING Eye and paediatric clinics in Sweden. PARTICIPANTS Infants screened for retinopathy of prematurity (ROP) (n=399), born before 24 weeks GA, 2007-2018. Cases were excluded if ophthalmological follow-up records could not be traced. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were ophthalmological, including visual acuity (VA), refractive error, strabismus, nystagmus and cerebral visual impairment (CVI). Secondary outcomes comprised neonatal and neurological morbidities. Data were retrospectively retrieved from medical records. RESULTS The 355 assessed children had a median GA of 23 weeks and 2 days and a median birth weight of 565 g. At the last available ophthalmological examination, the median age was 4.8 years (range 0.5-13.2 years). Nystagmus was recorded in 21.1%, strabismus in 34.8%, and 51.0% wore spectacles. Seventy-three of 333 (21.9%) were visually impaired, defined as being referred to a low vision clinic and/or having a VA less than 20/60 at 3.5 years of age or older. ROP treatment was a significant risk factor for visual impairment (OR 2.244, p=0.003). Visually impaired children, compared with children without visual impairment, more often had neurological deficits such as intellectual disability 63.8% versus 33.3% (p<0.001), epilepsy 21.1% versus 7.5% (p=0.001) and autism spectrum disorders 32.8% versus 20.9% (p=0.043). Nine of the 355 children had been diagnosed with CVI. CONCLUSIONS Children born before 24 weeks GA frequently had visual impairment in association with neurological deficits. CVI was rarely diagnosed. A multidisciplinary approach for the evaluation and habilitation of these vulnerable infants is warranted. National follow-up guidelines need to be developed and implemented.
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Affiliation(s)
- Ann Hellström
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Lena Jacobson
- Department of Clinical Neuroscience, Section for Eye and Vision, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Neuropediatric Department, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Abbas Al-Hawasi
- Department of Biomedical and Clinical Science, Linköping University, Linköping, Sweden
| | | | - Alexander Rakow
- Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden
| | - Mats Johnson
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Sävman
- Region Västra Götaland, Department of Neonatology, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute for Clinical Sciences, Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gerd Holmstrom
- Department of Surgical Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Eva Larsson
- Department of Surgical Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Lotta Gränse
- Department of Clinical Sciences, Ophthalmology, Skåne University Hospital Lund, Lund, Sweden
| | - Marie Saric
- Department of Clinical Sciences, Ophthalmology, Umeå Universitet Medicinska fakulteten, Umea, Sweden
| | | | - Lois Smith
- The Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna-Lena Hård
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Eva Morsing
- Department of Pediatrics, Clinical Sciences, Skåne University Hospital Lund, Lund, Sweden
| | - Pia Lundgren
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
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Cortés-Albornoz MC, Ramírez-Guerrero S, Rojas-Carabali W, de-la-Torre A, Talero-Gutiérrez C. Effects of remote learning during the COVID-19 lockdown on children's visual health: a systematic review. BMJ Open 2022; 12:e062388. [PMID: 35922104 PMCID: PMC9352565 DOI: 10.1136/bmjopen-2022-062388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Increased exposure to digital devices as part of online classes increases susceptibility to visual impairments, particularly among school students taught using e-learning strategies. This study aimed to identify the impact of remote learning during the COVID-19 lockdown on children's visual health. DESIGN Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Scopus, PubMed and ScienceDirect databases from the year 2020 onwards. ELIGIBILITY CRITERIA We included cross-sectional, case-control, cohort studies, case series and case reports, published in English, Spanish or French, that approached the effects of remote learning during the COVID-19 lockdown on visual health in neurotypical children. DATA EXTRACTION AND SYNTHESIS We included a total of 21 articles with previous quality assessments using the Joanna Briggs checklist. Risk of bias assessment was applied using the National Institutes of Health quality assessment tool for before-and-after studies with no control group; the tool developed by Hoy et al to assess cross-sectional studies; the Murad et al tool to evaluate the methodological quality of case reports and case series; and the Newcastle-Ottawa Scale for cohort studies. RESULTS All but one study reported a deleterious impact of the COVID-19 lockdown on visual health in children. Overall, the most frequently identified ocular effects were refractive errors, accommodation disturbances and visual symptoms such as dry eye and asthenopia. CONCLUSIONS Increased dependence on digital devices for online classes has either induced or exacerbated visual disturbances, such as rapid progression of myopia, dry eye and visual fatigue symptoms, and vergence and accommodation disturbances, in children who engaged in remote learning during the COVID-19 lockdown. PROSPERO REGISTRATION NUMBER CRD42022307107.
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Affiliation(s)
- María Camila Cortés-Albornoz
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogota D.C, Colombia
| | - Sofía Ramírez-Guerrero
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogota D.C, Colombia
| | - William Rojas-Carabali
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogota D.C, Colombia
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogota D.C, Colombia
| | - Claudia Talero-Gutiérrez
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogota D.C, Colombia
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Knight LSW, Ridge B, Staffieri SE, Craig JE, Prem Senthil M, Souzeau E. Quality of life in children with glaucoma: a qualitative interview study in Australia. BMJ Open 2022; 12:e062754. [PMID: 35858727 PMCID: PMC9305814 DOI: 10.1136/bmjopen-2022-062754] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Childhood glaucoma is a chronic vision-threatening condition that may significantly impact an individual's psychosocial well-being. There is a paucity of literature investigating the quality of life (QoL) in children with glaucoma. The aim of this study was to investigate and report on the QoL issues encountered by children with glaucoma. DESIGN This is a qualitative interview study. Data were collected through semistructured interviews. NVivo V.12 software (QSR International Pty Ltd, Melbourne, Australia) was used to analyse and code data to identify QoL themes. The prominence of QoL themes was determined by the number of children who raised issues connected to the corresponding theme. SETTING Interviews were conducted via telephone or videoconferencing between April 2020 and July 2021. PARTICIPANTS Eighteen children with glaucoma, aged 8-17 years, who resided in Australia, were recruited from the Australian and New Zealand Registry of Advanced Glaucoma. RESULTS Median child age was 12.1 years (IQR: 9.7-14.5 years) and 33% were female. Seven QoL themes were identified: 'coping', 'inconveniences' and 'emotional well-being' were more prominent themes than 'symptoms', 'ocular health concerns', 'social well-being' and 'autonomy'. Adaptive coping strategies included resilience throughout clinical examinations and establishing positive relationships with ophthalmologists. These minimised inconveniences related to clinic waiting times and pupillary dilatation. External to the clinical setting, children often dissociated from their glaucoma but struggled with glare symptoms and feeling misunderstood by fellow peers. Older children aged 13-17 years commonly disengaged from their glaucoma care and expressed an unwillingness to attend ophthalmic appointments. Older children further raised issues with career options, obtaining a driver's licence and family planning under the theme of autonomy. CONCLUSIONS The psychosocial impact of childhood glaucoma extends beyond the clinical environment and was minimised using coping strategies. Older children may require additional social and ophthalmic support as they transition into adulthood.
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Affiliation(s)
- Lachlan S W Knight
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Department of Ophthalmology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Bronwyn Ridge
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Sandra E Staffieri
- Department of Ophthalmology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Ophthalmology, University of Melbourne, Department of Surgery, Parkville, Victoria, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Mallika Prem Senthil
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Emmanuelle Souzeau
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, South Australia, Australia
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21
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Rufai SR, Jeelani NUO, Bowman R, Bunce C, Proudlock FA, Gottlob I. Recognition of intracranial hypertension using handheld optical coherence tomography in children (RIO Study): a diagnostic accuracy study protocol. BMJ Open 2022; 12:e048745. [PMID: 35017232 PMCID: PMC8753392 DOI: 10.1136/bmjopen-2021-048745] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Paediatric intracranial hypertension (IH) is a rare but serious condition that can pose deleterious effects on the brain and vision. Estimating intracranial pressure (ICP) in children is difficult. Gold standard direct ICP measurement is invasive and carries risk. It is impractical to routinely perform direct ICP measurements over time for all children at risk of IH. This study proposes to assess the diagnostic accuracy of handheld optical coherence tomography (OCT), a non-invasive ocular imaging method, to detect IH in children. METHODS AND ANALYSIS This is a prospective study evaluating the diagnostic accuracy of handheld OCT for IH in at risk children. Inclusion criteria include clinical and/or genetic diagnosis of craniosynostosis, idiopathic intracranial hypertension, space occupying lesion or other conditions association with IH and age 0-18 years old. Exclusion criteria include patients older than 18 years of age and/or absence of condition placing the child at risk of IH. The primary outcome measures are handheld OCT and 48-hour ICP assessments, which will be used for diagnostic accuracy testing (sensitivity, specificity, positive predictive value, negative predictive value and accuracy). Main secondary outcome measures include visual acuity, fundoscopic examination, contrast sensitivity, visual field testing and visual evoked potentials, wherever possible. ETHICS AND DISSEMINATION Ethical approval was granted for this study by the East Midlands Nottingham 2 Research Ethics committee (UOL0348/IRAS 105137). Our findings will be disseminated through presentation at relevant meetings, peer-reviewed publication and via the popular media. TRIAL REGISTRATION NUMBER ISRCTN52858719.
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Affiliation(s)
- Sohaib R Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- Ulverscroft Eye Unit, University of Leicester, Leicester, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Noor Ul Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Richard Bowman
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catey Bunce
- Clinical Trials Unit, Royal Marsden Hospital NHS Trust, London, UK
| | | | - Irene Gottlob
- Ulverscroft Eye Unit, University of Leicester, Leicester, UK
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22
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Abstract
Primary congenital glaucoma (PCG) is a rare and severe form of glaucoma and is usually transmitted as an autosomal-recessive disease. However, PCG is more common in certain ethnic and geographic groups where consanguineous relationships are common. The importance of this review is to inspect the mutations in the cytochrome P450 1B1 gene (CYP1B1) and to highlight the interest of the genetic study of CYP1B1 mutations. An in-depth study was carried out by the following search engines: PubMed, Scopus, clinic key and direct science for articles that have been published from 2011 until 2020. One hundred and sixty-one mutations were found in 1641 tested patients and three families, including 78 novel mutations. We identified a no significant difference in the sex ratio and the bilaterality was reported in the majority of patients. We have shown through this study that inbreeding plays an important role in the pathogenesis of PCG transmission compared to the sporadic mutations that have been found in some cases. The majority of the included studies were from ASIA (64.3%), followed by Europe (17.85%), America (10.71%) and Africa (7.14%). The first and most common mutation in our study is 182 G>A (p.Gly61Glu). It was identified in Iran, Portugal and Saudi Arabia and for the first time in Brazil and Vietnam. The greatest number of mutations in common is p.Gly61Glu. Mainly within five countries: Iran, Portugal, Saudi Arabia, Brazil and Vietnam. The first step in PCG screening should be a genetic test looking for founder and common mutation coupled with a clinical examination.
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Affiliation(s)
| | | | - Loubna El Maaloum
- Faculty of Medicine and Pharmacy, Hassan II Ain Chock University, Casablanca, Morocco
| | - Hind Dehbi
- Faculty of Medicine and Pharmacy, Hassan II Ain Chock University, Casablanca, Morocco
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Pirlich N, Grehn F, Mohnke K, Maucher K, Schuster A, Wittenmeier E, Schmidtmann I, Hoffmann EM. Anaesthetic protocol for paediatric glaucoma examinations: the prospective EyeBIS Study protocol. BMJ Open 2021; 11:e045906. [PMID: 34610927 PMCID: PMC8493900 DOI: 10.1136/bmjopen-2020-045906] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Neonates and young infants with diagnosed or highly suspected glaucoma require an examination under anaesthesia to achieve accurate intraocular pressure (IOP) measurements, since crying or squinting of the eyes may increase IOP and lead to falsely high values. IOP considerably depends on perioperative variables such as haemodynamic factors, anaesthetics, depth of anaesthesia and airway management. The aim of this paper is to report the design and baseline characteristics of EyeBIS, which is a study to develop a standardised anaesthetic protocol for the measurement of IOP under anaesthesia in childhood glaucoma, by investigating the link between the magnitude of IOP and depth of anaesthesia. METHODS AND ANALYSIS This is a single-centre, prospective cohort study in 100 children with diagnosed or highly suspected glaucoma all undergoing ophthalmological examination under general anaesthesia. 20 children, who undergo general anaesthesia for other reasons, are included as controls. The primary outcome measure is the establishment of a standardised anaesthetic protocol for IOP measurement in childhood glaucoma by assessing the relationship between IOP and depth of anaesthesia (calculated as an electroencephalography variable, the bispectral index), with special emphasis on airway management and haemodynamic parameters. The dependence of IOP under anaesthesia on airway management and haemodynamic parameters will be described, using a mixed linear model. Restricting the model to patients with healthy eyes will allow to determine a 95% reference region, in which 95% of the measurement values of patients with healthy eyes can be expected. ETHICS AND DISSEMINATION The study has been approved by the local ethics committee of the Medical Association of Rhineland-Palatine (Ethik-Kommisssion der Landesaerztekammer Rheinland-Pfalz), Germany (approval number: 2019-14207). This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at national and international scientific meetings and data sharing with other investigators. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03972852).
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Affiliation(s)
- Nina Pirlich
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Franz Grehn
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Katja Mohnke
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Konrad Maucher
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alexander Schuster
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eva Wittenmeier
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Esther M Hoffmann
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
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24
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Pease A, Goodenough T, Borwick C, Watanabe R, Morris C, Williams C. Development of a core outcome set for evaluative research into paediatric cerebral visual impairment (CVI), in the UK and Eire. BMJ Open 2021; 11:e051014. [PMID: 34588256 PMCID: PMC8483040 DOI: 10.1136/bmjopen-2021-051014] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Cerebral visual impairment (CVI) comprises a heterogeneous group of brain-related vision problems. A core outcome set (COS) represents the most important condition-specific outcomes according to patients, carers, professionals and researchers. We aimed to produce a COS for studies evaluating interventions for children with CVI, to increase the relevance of research for families and professionals and thereby to improve outcomes for affected children. DESIGN We used methods recommended by the Core Outcome Measures in Effectiveness Trials Initiative. These included a proportionate literature review of outcomes used in previous studies; qualitative interviews with children and families; a two-round Delphi survey involving parents, children and professionals and a consensus meeting to ratify the most important outcomes. SETTING Telephone interviews and online Delphi surveys of participants who all lived in UK or Eire. PARTICIPANTS Eighteen parents and six young people were interviewed. Delphi participants (n=80 did both rounds) included professionals working with children who have CVI (teachers, orthoptists, ophthalmologists, optometrists, qualified teachers for visually impaired, family members (parents and siblings) and affected children. RESULTS The literature review included 13 studies yielding 37 outcomes. Qualitative interviews provided 22 outcomes. After combining and refining similar items, the first round contained 23 outcomes and the second 46. At the consensus meeting, 5 attendees recommended 27 outcomes for inclusion in the CVI COS, of which 15 were ratified as most important, including 4 related to vision; 1 to family well-being; 1 to adults around the child being informed about CVI and the rest to the child's abilities to engage with people and surroundings. CONCLUSIONS Good engagement from participants led to the development of a COS. Future research will be useful to identify the best ways to measure COS items and potentially to update this COS as more interventions for CVI are developed. TRIAL REGISTRATION NUMBER ISRCTN13762177.
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Affiliation(s)
- Anna Pease
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Cath Borwick
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Rose Watanabe
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Cathy Williams
- Bristol Medical School, University of Bristol, Bristol, UK
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25
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Sii S, Chean CS, Kuht HJ, Thomas MG, Rufai SR. Home-based screening tools for amblyopia: a systematic review protocol. BMJ Open 2021; 11:e051830. [PMID: 34452969 PMCID: PMC8404433 DOI: 10.1136/bmjopen-2021-051830] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Amblyopia is an important public health concern associated with functional vision loss and detrimental impact on the physical and mental well-being of children. The gold standard for diagnosis of amblyogenic conditions currently involves screening by orthoptists and/or ophthalmologists. The bloom of technology enables the use of home-based screening tools to detect these conditions at an early stage by the layperson in community, which could reduce the burden of screening in the community, especially during restrictions associated with the COVID-19 pandemic. Here, we propose a systematic review aiming to evaluate the accuracy and reliability of home-based screening tools compared with the existing gold standard. METHODS AND ANALYSIS We aim to search for studies involving home-based screening tools for amblyopia among children aged under 18 years. Oxford Centre for Evidence-Based Medicine Level 4 evidence and above will be included, without language or time restrictions. The following platforms will be searched from inception to 31 August 2021: PubMed, Medline, The Cochrane Library, Embase, Web of Science Core Collection and Clinicaltrials.gov. Two independent reviewers will identify studies for inclusion based on a screening questionnaire. The search and screening will start on 14 August 2021 until 1 October 2021. We aim to complete our data analysis by 30 November 2021. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool for diagnostic accuracy studies only. Our primary outcome measure is the diagnostic accuracy of home-based screening tools, while secondary outcome measures include validity, feasibility, reproducibility and cost-effectiveness, where available. ETHICS AND DISSEMINATION Ethical approval is not necessary as no primary data will be collected. The findings will be disseminated through presentations at scientific meetings and peer-reviewed journal publication. PROSPERO REGISTRATION NUMBER CRD42021233511.
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Affiliation(s)
- Samantha Sii
- Department of Ophthalmology, Kettering General Hospital NHS Trust, Kettering, UK
| | - Chung Shen Chean
- Department of Ophthalmology, Northampton General Hospital, Northampton, UK
| | - Helen J Kuht
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Mervyn G Thomas
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Sohaib R Rufai
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK
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26
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Abstract
OBJECTIVES To evaluate the diagnostic capability of optical coherence tomography (OCT) in children aged under 18 years old with intracranial hypertension (IH). DESIGN Systematic review. METHODS We conducted a systematic review using the following platforms to search the keywords 'optical coherence tomography' and 'intracranial hypertension' from inception to 2 April 2020: Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PubMed and Web of Science, without language restrictions. Our search returned 2729 records, screened by two independent screeners. Studies were graded according to the Oxford Centre for Evidence-Based Medicine and National Institutes of Health Quality Assessment Tool for observational studies. RESULTS Twenty-one studies were included. Conditions included craniosynostosis (n=354 patients), idiopathic IH (IIH; n=102), space-occupying lesion (SOL; n=42) and other pathology (n=29). OCT measures included optic nerve parameters, rim parameters (notably retinal nerve fibre layer thickness) and retinal parameters. Levels of evidence included 2b (n=13 studies), 3b (n=4) and 4 (n=4). Quality of 10 studies was fair and 11 poor. There was inconsistency in OCT parameters and reference measures studied, although OCT did demonstrate good diagnostic capability for IH in craniosynostosis, IIH and SOL. CONCLUSIONS This systematic review identified various studies involving OCT to assist diagnosis and management of IH in children with craniosynostosis, IIH, SOL and other pathology, in conjunction with established clinical measures of intracranial pressure. However, no level 1 evidence was identified. Validating prospective studies are, therefore, required to determine optimal OCT parameters in this role and to develop formal clinical guidelines. PROSPERO REGISTRATION NUMBER CRD42019154254.
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Affiliation(s)
- Sohaib R Rufai
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
- UCL Great Ormond Street Institute of Child Health and Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK
| | - Michael Hisaund
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Noor Ul Owase Jeelani
- UCL Great Ormond Street Institute of Child Health and Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Rebecca J McLean
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
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27
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Arima M, Inoue H, Nakao S, Misumi A, Suzuki M, Matsushita I, Araki S, Yamashiro C, Takahashi K, Ochiai M, Yoshida N, Hirose M, Kishimoto J, Todaka K, Hasegawa S, Kimura K, Kusuhara K, Kondo H, Ohga S, Sonoda KH. Study protocol for a multicentre, open-label, single-arm phase I/II trial to evaluate the safety and efficacy of ripasudil 0.4% eye drops for retinopathy of prematurity. BMJ Open 2021; 11:e047003. [PMID: 34315793 PMCID: PMC8317081 DOI: 10.1136/bmjopen-2020-047003] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Retinopathy of prematurity (ROP) is a vascular proliferative disorder that occurs in preterm infants. Existing treatments are only indicated in severe ROP cases due to the high invasiveness and the potential risk of irreversible side effects. We previously elucidated that ripasudil, a selective inhibitor of the Rho-associated protein kinase, has the ability to inhibit abnormal retinal neovascularisation in animal models. In addition, ripasudil eye drops (Glanatec ophthalmic solution 0.4%) have been already used for the treatment of glaucoma. Since eye drop therapy is less invasive, early intervention for ROP is possible. The purpose of this phase I/II trial is to evaluate the safety and efficacy of ripasudil eye drops for preterm infants with ROP. METHODS AND ANALYSIS This is a multicentre, open-label, single-arm phase I/II trial. To evaluate the safety and efficacy of ripasudil as much as possible, ripasudil will be administered to all enrolled preterm infants with zone I/II, stage 1, or worse ROP. The safety and efficacy of ripasudil in treated patients will be assessed in comparison to a historical control group. Because this is the first trial of ripasudil in preterm infants, a dose-escalation study (once daily for 1 week, then two times per day for 2 weeks) will be conducted in phase I. After obtaining approval from the independent data and safety monitoring board to continue the trial after the completion of phase I, phase II will be conducted. In phase II, ripasudil eye drops will be administered two times per day for 12 weeks. The primary endpoint in phase II is also safety. Efficacy and pharmacokinetics will be evaluated as secondary endpoints. ETHICS AND DISSEMINATION This study protocol was approved by the institutional review board at each of the participating centres. Data will be presented at international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBERS NCT04621136 and jRCT2071200047.
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Affiliation(s)
- Mitsuru Arima
- Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Hirosuke Inoue
- Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shintaro Nakao
- Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Ophthalmology, National Kyushu Medical Center, Fukuoka, Japan
| | - Akiko Misumi
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Maya Suzuki
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Itsuka Matsushita
- Ophthalmology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shunsuke Araki
- Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Chiemi Yamashiro
- Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kazumasa Takahashi
- Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Masayuki Ochiai
- Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Masayuki Hirose
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Junji Kishimoto
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Koji Todaka
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Shunji Hasegawa
- Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kazuhiro Kimura
- Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Koichi Kusuhara
- Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hiroyuki Kondo
- Ophthalmology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shouichi Ohga
- Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koh-Hei Sonoda
- Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Marmoy OR, Hodson-Tole E, Thompson DA. Photopic negative response (PhNR) in the diagnosis and monitoring of raised intracranial pressure in children: a prospective cross-sectional and longitudinal protocol. BMJ Open 2021; 11:e047299. [PMID: 34285008 PMCID: PMC8292810 DOI: 10.1136/bmjopen-2020-047299] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Raised intracranial pressure (rICP) can be a consequence of a variety of neurological disorders. A significant complication of rICP is visual impairment, due to retinal ganglion cell (RGC) dysfunction. In children, subjective measurements to monitor this, such as visual field examination, are challenging. Therefore, objective measurements offer promising alternatives for monitoring these effects. The photopic negative response (PhNR) is a component of the flash electroretinogram produced by RGCs; the cells directly affected in rICP-related vision loss. This project aims to assess the clinical feasibility and diagnostic efficacy of the PhNR in detecting and monitoring paediatric rICP. METHODS AND ANALYSIS Section 1 is a cross-sectional study; group 1 young persons with disorders associated with rICP and a comparator group 2 of age-matched children without rICP. Both groups will undergo a PhNR recording alongside a series of structural and functional ophthalmic investigations, with the rICP group also having measurement of intracranial pressure.Section 2 is a longitudinal study of the relationship between the PhNR and directly recorded intracranial pressure measurements, through repeated measures. PhNR amplitudes and peak times will be assessed against optical coherence tomography parameters, mean deviation of visual fields, other electrophysiology and ICP measurement through regression analyses.Group differences between PhNR measurements in the rICP and control groups will be performed to determine clinically relevant cut-off values and calculation of diagnostic accuracy. Longitudinal analysis will assess PhNR amplitude against ICP measurements through regression analysis. Feasibility and efficacy will be measured through acceptability, practicality and sensitivity outcomes. ETHICS AND DISSEMINATION Favourable opinion from a research ethics committee has been received and the study approved by Manchester Metropolitan University, the Health Research Authority and the Great Ormond Street Institute of Child Health (GOS-ICH) Research and Development office. This project is being undertaken as a doctoral award (ORM) with findings written for academic thesis submission, peer-reviewed journal and conference publications.
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Affiliation(s)
- Oliver Rajesh Marmoy
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
- GOS-ICH, University College London, London, UK
| | - Emma Hodson-Tole
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Dorothy Ann Thompson
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- GOS-ICH, University College London, London, UK
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Al-Jabri S, Rowe FJ, Kirkham JJ. Core outcome set for three ophthalmic conditions: a healthcare professional and patient consensus on core outcome sets for amblyopia, ocular motility and strabismus (COSAMS Study). BMJ Open 2021; 11:e042403. [PMID: 33980515 PMCID: PMC8118006 DOI: 10.1136/bmjopen-2020-042403] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Amblyopia, strabismus and ocular motility disorders are common conditions with significant impact on visual function, appearance and quality of life. We aimed to establish a core set of outcomes for each of the three conditions for use in clinical trials and routine clinical practice. DESIGN A comprehensive databank of outcomes was developed from a systematic review of the literature and a series of focus groups with healthcare professionals, researchers, patients and carers. The databank of outcomes was scored in a two-round Delphi Survey completed by two stakeholder groups: healthcare professionals/researchers and patients/carers. Results of the online Delphi were discussed at a face-to-face consensus meeting where the core outcome sets were finalised. SETTING UK-wide consultation. PARTICIPANTS Researchers, clinicians, patients and carers. OUTCOME MEASURES Core outcome sets. RESULTS For amblyopia, strabismus and ocular motility, 40/42/33 participants contributed to both rounds of the Delphi; six/nine/seven members attended consensus meetings, respectively. Consensus was reached on ten core outcomes for both amblyopia and ocular motility and nine for strabismus. All three conditions shared the core outcomes: adverse events, cost, vision-related quality of life and ocular alignment. The strabismus and ocular motility disorder core sets included, in addition, measuring the deviation, binocular vision, ocular movement, patient satisfaction and symptoms. The amblyopia set, distinct from the sets for the other two conditions, included best corrected distance and near visual acuity, spherical and cylindrical refraction, compliance and treatment-related and functionality/long-term impacts. CONCLUSIONS The study used robust consensus methods to develop a core outcome set for three ophthalmic conditions. Implementation of these core outcome sets in clinical trials and routine clinical practice will ensure that the outcomes being measured and reported are relevant to all stakeholders. This will enhance the relevance of study findings and enable comparison of results from different studies.
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Affiliation(s)
- Samiya Al-Jabri
- Institute of Population Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
| | - Fiona J Rowe
- Institute of Population Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
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Williams C, Pease A, Goodenough T, Breheny K, Gaunt D, Sinai P, Watanabe R. Improving outcomes for primary school children at risk of cerebral visual impairment (the CVI project): protocol of a feasibility study for a cluster-randomised controlled trial and health economic evaluation. BMJ Open 2021; 11:e044830. [PMID: 33952548 PMCID: PMC8103402 DOI: 10.1136/bmjopen-2020-044830] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cerebral visual impairment (CVI) refers to a spectrum of brain-related vision problems. CVI is associated with poor educational and mental health outcomes. An intervention has been developed to help children with CVI, involving input from clinicians, teachers and parents. The effectiveness of this intervention needs to be evaluated. This study aims to guide any refinements to the intervention or the design of a future cluster-randomised trial that may be needed. METHODS AND ANALYSIS This study will include all methods anticipated for a future cluster-randomised controlled trial. Eight primary schools will be recruited and randomised to receive the intervention or carry on with usual practice. The intervention will comprise an information pack for schools and access to a local paediatric ophthalmology clinic (who are prepared to assess them for CVI), for up to 5% of participating children. Outcome assessments will be carried out at baseline (before randomisation) and after 4-5 months of intervention period. Assessments will include children's self-reported quality of life, their learning ability and behaviour as reported by teachers, and family functioning reported by parents. Cost data will include service use, family expenditure on additional support (eg, private appointments and administration) and school spending and resource used in helping children with special educational needs or disability. A process evaluation (PE) will collect additional data relating to the implementation of the intervention and the trial processes, in the school and clinic settings. The protocol for the PE will be reported separately. ETHICS AND DISSEMINATION Ethical permission was obtained from the University of Bristol Faculty of Health Sciences Ethical Committee. The results will inform the design of a future trial to assess the effectiveness and cost-effectiveness of the intervention and will be shared with participants, CVI-support groups and peer-viewed journals. TRIAL REGISTRATION NUMBER ISRCTN13762177; Pre-results.
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Affiliation(s)
- Cathy Williams
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Anna Pease
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Katie Breheny
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Daisy Gaunt
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Parisa Sinai
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Rose Watanabe
- Bristol Medical School, University of Bristol, Bristol, UK
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Pease A, Goodenough T, Sinai P, Breheny K, Watanabe R, Williams C. Improving outcomes for primary school children at risk of cerebral visual impairments (the CVI project): study protocol for the process evaluation of a feasibility cluster-randomised controlled trial. BMJ Open 2021; 11:e044856. [PMID: 33952549 PMCID: PMC8103382 DOI: 10.1136/bmjopen-2020-044856] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Brain-related visual impairments, also known as cerebral visual impairment (CVI), are related to damage or poor function in the vision-related areas of the brain. There is broad agreement that CVI is an appropriate term to describe visual impairments that are not accounted by disorders of the eye or optic nerve, but differences remain as to which impairments can be included in this term. The CVI project is a programme of work that includes the development of a complex intervention to share knowledge with teachers, so that they can make both targeted and universal changes to support children with CVI. A feasibility study for a cluster-randomised controlled trial to evaluate this intervention is underway. This paper describes the protocol for an accompanying process evaluation to explore how the intervention is implemented and provide context for the interpretation of the feasibility trial outcomes. METHODS AND ANALYSIS A logic model has been developed to guide data collection. Both qualitative and quantitative data will be collected to assess the feasibility and acceptability of the intervention, the study design and explore how any changes that occur are brought about. Interviews with key primary school staff and parents will investigate responses to the intervention and trial processes. Surveys will collect data on intervention implementation and knowledge of CVI. Photographs of classroom walls will document any changes to visual clutter and document analysis will look for changes to school special educational needs and disability (SEND) policies. ETHICS AND DISSEMINATION Ethical approval was granted by the University of Bristol Faculty of Health Sciences Ethics Committee. Findings will contribute to the development of a full-scale cluster-randomised controlled trial to assess the effectiveness of the intervention with adequate statistical power. The results will also support the refinement of the intervention and its underlying theory.
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Affiliation(s)
- Anna Pease
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Parisa Sinai
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Breheny
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Rose Watanabe
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Cathy Williams
- Bristol Medical School, University of Bristol, Bristol, UK
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Wood M, Gray J, Raj A, Gonzalez-Martin J, Yeo DCM. The Impact of the First Peak of the COVID-19 Pandemic on a Paediatric Ophthalmology Service in the United Kingdom: Experience from Alder Hey Children's Hospital. Br Ir Orthopt J 2021; 17:56-61. [PMID: 34278219 PMCID: PMC8269790 DOI: 10.22599/bioj.164] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/04/2021] [Indexed: 12/04/2022] Open
Abstract
Objective: The COVID-19 pandemic has led to significant service loss across the NHS, and ophthalmology is one of the greatest affected specialties. We attempt to quantify the impact of the first peak of the COVID-19 pandemic on a paediatric ophthalmology unit in a children’s hospital in the United Kingdom (UK) and report lessons learnt to aid in the recovery of the service. Methods and Analysis: Two eight-week periods of clinical activity were compared; one during the first UK peak of the COVID-19 pandemic and the other during a similar period the previous year. Four areas of clinical activity were included in the study: outpatient clinic appointments, theatre activity, outpatient referrals to ophthalmology and ward reviews. Appointment data was collected from departmental databases. Results: During the first peak of the pandemic, outpatient clinic appointments were reduced by 87.2%, ophthalmic surgery by 90.9%, outpatient referrals to ophthalmology by 50.2% and ward reviews by 50%. The number of actual cancelled appointments was 1377, of which 6.8% were triaged as suitable for teleophthalmology. Conclusion: The COVID-19 pandemic has dramatically restricted clinical activity in the ophthalmology service. Paediatric ophthalmology is vulnerable to capacity issues and the consequences of delayed or cancelled appointments. Departments must adapt quickly and maximise capacity to help reduce the backlog and treat patients effectively and safely. Solutions such as teleophthalmology have potential although can be difficult in the paediatric population.
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Affiliation(s)
- Megan Wood
- Alder Hey Children's NHS Foundation Trust, GB
| | - Judith Gray
- Alder Hey Children's NHS Foundation Trust, GB
| | - Ankur Raj
- Alder Hey Children's NHS Foundation Trust, GB
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Ranjan R, Das A, Prema S, Shah PK, Venkatapathy N. Coincidental ocular findings during retinopathy of prematurity telescreening of 9105 neonates. Eur J Ophthalmol 2021; 32:563-574. [PMID: 33719645 DOI: 10.1177/11206721211001318] [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: 11/16/2022]
Abstract
PURPOSE To describe the magnitude and spectrum of abnormal ocular findings other than retinopathy of prematurity (ROP) detected during an ROP telescreening programme. METHODS Retrospective review of the records of all premature babies screened for ROP from August 2015 to December 2019. RESULTS A total 9105 babies were screened during the study period with total 17,075 imaging sessions. Non-ROP ocular abnormalities were seen in 566 eyes of 383 babies (4.2%) including 207 male (54%) and 176 female babies (46%). Posterior segment abnormalities were seen in 88.2% babies (338/383) with haemorrhage being the most common (77%, 295/383). Anterior segment pathologies were seen in 12% babies (46/383) with congenital cataract being the most common pathology requiring surgical intervention. Other findings included globe abnormalities in 0.8% babies (3/383), adnexal disorders in 0.5% babies (2/383) and squint in 0.3% babies (1/383). Rare life-threatening conditions such as retinoblastoma and lipaemia retinalis were also detected. Eighty-seven babies (22.7%) were diagnosed with referral-warranted non-ROP pathologies, with an overall prevalence of 1% (87/9105). Prompt surgical intervention was advised for 7.3% babies (28/383), 3.4% babies (13/383) were treated medically and 4.2% babies (16/383) needed visual rehabilitation for non-amenable pathologies. CONCLUSION This is the largest study describing the magnitude and spectrum of neonatal ocular pathologies other than ROP in a cohort of premature babies. Digital imaging has a significant impact on early detection and timely intervention for various vision as well as life-threatening non-ROP pathologies, which would have been missed or delayed otherwise.
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Affiliation(s)
- Ratnesh Ranjan
- Department of Paediatric Retina & Ocular Oncology, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Abhishek Das
- Department of Paediatric Retina & Ocular Oncology, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Subramaniam Prema
- Department of Paediatric Retina & Ocular Oncology, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Parag K Shah
- Department of Paediatric Retina & Ocular Oncology, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Narendran Venkatapathy
- Department of Paediatric Retina & Ocular Oncology, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Kong Q, Ming WK, Mi XS. Refractive outcomes after intravitreal injection of antivascular endothelial growth factor versus laser photocoagulation for retinopathy of prematurity: a meta-analysis. BMJ Open 2021; 11:e042384. [PMID: 33568373 PMCID: PMC7878142 DOI: 10.1136/bmjopen-2020-042384] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To determine the effects of the intraocular injection of antivascular endothelial growth factor (anti-VEGF) drugs on the refractive status of infants with retinopathy of prematurity (ROP). DESIGN Systematic review and meta-analysis of the refractive status of infants with ROP who receive anti-VEGF drugs. DATA SOURCES The PubMed, Web of Science and Embase databases and the ClinicalTrials.gov website were searched up to June 2020. ELIGIBILITY CRITERIA WHEN SELECTING STUDIES We included randomised controlled trials (RCTs) and observational studies that compared refractive errors between anti-VEGF drug and laser therapies. DATA EXTRACTION AND SYNTHESIS Data extraction and risk-of-bias assessments were conducted by two independent reviewers. We used a random-effect model to pool outcomes. The outcome measures were the spherical equivalents, axial length (AL), anterior chamber depth (ACD) and lens thickness (LT). RESULTS Thirteen studies involving 1850 eyes were assessed: 914 in the anti-VEGF drug group, and 936 in the control (laser) group. Children who received anti-VEGF drug treatment had less myopia than those who received laser therapy (mean difference=1.80 D, 95% CI 0.97 to 2.63, p<0.0001, I2=78%). The AL, ACD and LT did not reach statistical significance difference between the two groups. The current evidence indicates that the refractive safety in children with ROP is better for anti-VEGF drug treatment than for laser therapy. CONCLUSIONS This meta-analysis indicates that anti-VEGF drug therapy results in less myopia compared with laser therapy. However, there are relatively few published articles on refractive errors in ROP, and so high-quality and powerful RCTs are needed in the future. PROSPERO REGISTRATION NUMBER CRD42020160673.
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Affiliation(s)
- Qihang Kong
- Department of Ophthalmology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wai-Kit Ming
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Xue-Song Mi
- Department of Ophthalmology, the First Affiliated Hospital of Jinan University, Guangzhou, China
- Changsha Academician Expert Workstation, Aier Eye Hospital Group, Changsha, China
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López Ulloa JA, Burn H, Beauregard AM. Causes of Blindness and Visual Impairment in Early Childhood at a Low Vision Service in Mexico City: A 15-year Review. Ophthalmic Epidemiol 2021; 28:420-427. [PMID: 33522330 DOI: 10.1080/09286586.2020.1869271] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To evaluate the causes of blindness and visual impairment in children aged 0-7 years attending a Low Vision Centre in Mexico City, Mexico.Methods: Clinical records for patients aged 0-7 years attending the Centre from 2001 to 2015 were retrospectively reviewed. Causes of blindness and visual impairment, affected anatomy, and suspected time period of insult were recorded.Results: 1487 patients were included, 45.9% girls and 54.1% boys. Mean age of presentation was 39 months (SD 27.9 months). 36.0% had associated co-morbidities in addition to their ophthalmic pathology. 39.7% presented with developmental or psychomotor delay. Leading diagnoses were Retinopathy of Prematurity (ROP) (19.6%), optic nerve atrophy (11.5%), and congenital cataract (9.5%). The most affected anatomical regions were retina (33.8%), optic nerve (16.6%), and lens (10.5%). Half of all cases (50.9%) had insults in the prenatal period. Children with developmental delay were more likely to present before the age of one. There is a significant difference in risk of delayed presentation according to diagnosis. Only 13.5% of children with optic nerve atrophy presented to the Centre before the age of one, compared to 28.4% of children with ROP and 23.4% of children with cataract.Conclusion: The most common diagnoses for blindness and visual impairment among children were ROP, optic nerve atrophy, and congenital cataract. Late presentation to the Centre was common. There were significant differences in risk of delayed presentation depending on diagnosis. Co-existing systemic conditions and developmental and psychomotor delay were also common among patients attending the Centre.
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Affiliation(s)
- Juan Alberto López Ulloa
- Instituto de Oftalmología Conde de Valenciana, Mexico City, Mexico.,Centro Mexicano de Salud Visual Preventiva, Mexico City, Mexico
| | - Helen Burn
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, UK
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Oladimeji OI, Adeodu OO, Onakpoya OH, Adegoke SA. Prevalence of ocular abnormalities in relation to sickle cell disease severity among children in South-western, Nigeria. Eur J Ophthalmol 2020; 31:2659-2665. [PMID: 32907376 DOI: 10.1177/1120672120957615] [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: 11/16/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) ranks high among genetic disorders worldwide. It is characterised by repeated vaso-occlusion with resultant end-organ damage. This process can occur in all vascular beds in the body, including ocular blood vessels and may cause irreversible blindness in advanced stages. Little is known of the relationship between the prevalence of ocular abnormalities among children with SCD and their disease severity. METHODS A descriptive cross-sectional study was carried out at the Paediatric Haematology Clinics and the Eye Centre of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife. Children with SCD in steady state were recruited from the Haematology Clinics and examined for ocular abnormalities at the Eye Centre of the hospital. The subjects SCD severity grade was determined using a previously validated scoring system. RESULTS One hundred and twenty (120) children aged 5 to 15 years were examined. Of these, 72 had one or more ocular abnormalities giving the prevalence of ocular abnormalities among them to be 60.0%. Though a higher proportion of children with moderate disease, 23 (65.7%) of 35, compared to those with mild disease, 49 (57.6%) of 85 had ocular abnormalities, this difference was not statistically significant, p = 0.412. CONCLUSION Ocular abnormalities among Nigerian children with SCD are common even in steady-state, but not significantly associated with disease severity. Periodic screening for ocular abnormalities should thus be done on them irrespective of disease severity.
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Affiliation(s)
- Oluwatoyin I Oladimeji
- Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria
| | - Oluwagbemiga O Adeodu
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
| | | | - Samuel A Adegoke
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
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Braimah IZ, Enweronu-Laryea C, Sackey AH, Kenu E, Agyabeng K, Ofori-Adjei IODB, Beyuo V, Oku A, Essuman VA. Incidence and risk factors of retinopathy of prematurity in Korle-Bu Teaching Hospital: a baseline prospective study. BMJ Open 2020; 10:e035341. [PMID: 32759242 PMCID: PMC7409996 DOI: 10.1136/bmjopen-2019-035341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the incidence of retinopathy of prematurity (ROP) and any associated risk factors among preterm infants at the Neonatal Intensive Care Unit (NICU) of Korle-Bu Teaching Hospital (KBTH). DESIGN Prospective study. SETTING Level 3 NICU of KBTH from June 2018 to February 2019. PARTICIPANTS Eligible infants with birth weight (BW) less than 2 kg or gestational age (GA) less than 37 weeks were examined at scheduled intervals until full maturity of their retina. OUTCOME MEASURES The primary outcome measure was cumulative incidence of ROP and secondary outcome measure was risk factors associated with ROP. RESULTS Of the 401 infants, 222 were females (55.4%), mean±SD GA was 32.3±2.4 weeks (median 32, IQR 31 to 34) and mean BW 1.6±0.4 kg (median 1.5, IQR 1.3 to 1.9). The cumulative incidence of ROP was 13.7% (95% CI: 10.5 to 17.5%), with 1.8% (seven infants) having type 1 ROP. Increased risk of ROP was observed in babies with supplemental oxygen exposure (p<0.001), BW less than 1.5 kg (p=0.019), confirmed neonatal sepsis (p=0.001), nasogastric tube feeding (p=0.03) and poor pupillary dilation (0.032). A reduced risk of ROP was observed in boys (p=0.004) and after delivery by caesarean section (p=0.019). CONCLUSION The rates of ROP at KBTH are comparable to other NICUs in sub-Saharan Africa. Birth weight less than 1.5 kg, confirmed neonatal sepsis, nasogastric tube feeding and poor pupil dilation were independently associated with increased incidence of ROP. ROP screening should be a part of the routine service for premature infants in Ghana.
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Affiliation(s)
- Imoro Zeba Braimah
- Surgery (Eye), University of Ghana Medical School, College of Health Sciences, Accra, Ghana
- Lions International Eye Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Christabel Enweronu-Laryea
- Child Health, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
- Child Health, Korle Bu Teaching Hospital, Accra, Ghana
| | - Adziri Harold Sackey
- Child Health, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
- Child Health, Korle Bu Teaching Hospital, Accra, Ghana
| | - Ernest Kenu
- Epidemiology, School of Public health, University of Ghana College of Health Sciences, Accra, Ghana
| | - Kofi Agyabeng
- Bio-statistics, School of Public Health, University of Ghana College of Health Sciences, Accra, Ghana
| | | | - Vera Beyuo
- Lions International Eye Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Aaron Oku
- Lions International Eye Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Vera Adobea Essuman
- Surgery (Eye), University of Ghana Medical School, College of Health Sciences, Accra, Ghana
- Lions International Eye Centre, Korle Bu Teaching Hospital, Accra, Ghana
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Hvid K, Nissen KR, Bayat A, Roos L, Grønskov K, Kessel L. Prevalence and causes of infantile nystagmus in a large population-based Danish cohort. Acta Ophthalmol 2020; 98:506-513. [PMID: 32067411 DOI: 10.1111/aos.14354] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 08/21/2019] [Accepted: 12/31/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of this study was to provide a population-based estimate on the prevalence of infantile nystagmus and to describe the causes in the Capital Region of Denmark. METHODS Review of medical records of children with infantile nystagmus born in the period 1 January 2010 through 31 December 2017 and living in the Capital Region of Denmark. We used birth registry data from Statistics Denmark and the National Danish Birth Registry to calculate the prevalence of nystagmus in children born at term and prematurely. RESULTS A total of 103 patients (52 males/51 females) with infantile nystagmus were included. The overall prevalence of infantile nystagmus was 6.1 per 10 000 live births. It was higher in premature children (28.4/10 000 live births) than children born at term (4.4/10 000), p < 0.0001, and highest in children born extremely preterm, (97.3/10 000). The most common cause of infantile nystagmus was ocular disease (44%) followed by idiopathic nystagmus (32%), neurological disorders and genetic syndromes (20%) and prematurity without retinopathy of prematurity as the only cause (4%). CONCLUSIONS In this study, we provide the prevalence of infantile nystagmus based on national medical records in which all residents are accounted for. Our findings show a prevalence of 6.1 per 10 000 live births but six times higher among children born preterm than born at term. Ocular disease was the leading cause of infantile nystagmus with albinism and ocular malformations as the most frequent. In 1/3 of patients, no cause could be identified.
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Affiliation(s)
- Karen Hvid
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla Rothe Nissen
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan Bayat
- Danish Epilepsy Centre, Dianalund, Denmark.,Department of Pediatrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Laura Roos
- Department of Clinical Genetics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Karen Grønskov
- Department of Clinical Genetics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Deshmukh AV, Badakere A, Sheth J, Bhate M, Kulkarni S, Kekunnaya R. Pivoting to teleconsultation for paediatric ophthalmology and strabismus: Our experience during COVID-19 times. Indian J Ophthalmol 2020; 68:1387-1391. [PMID: 32587172 PMCID: PMC7574089 DOI: 10.4103/ijo.ijo_1675_20] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 01/17/2023] Open
Abstract
Purpose: The objective is to analyse and report the data of teleconsultations provided to paediatric ophthalmology and strabismus patients during COVID-19 times and to elaborate our experience for guiding future teleconsultation practices to General, paediatric Ophthalmologists and Strabismologists. Methods: Retrospective analysis of electronic medical record data of teleconsultations provided in the department of Strabismus, Paediatric and Neuro-ophthalmology was done. Patients with optic nerve related disorders were excluded. Study period was one month. Statistical analysis of collected data was done using Microsoft excel. Results: A total of 198 patients were provided teleconsultations (an average of seven teleconsultations/day). The final analysis included 161 patients after excluding optic nerve related disorders. The median age was seven years. We had a near equal gender distribution (53% males and 47% females) of whom a third were new cases. Video calling was used in 14%, review of clinical photos shared was used in 53%. Rest of the 33% were given telephonic advice. Allergic conjunctivitis (14%), pseudophakia (9%), strabismus (12%), status post strabismus surgery (8%), cranial nerve palsies (11%) were common diagnoses. 19% (n = 30) were advised/needed visit in emergency services on same or next day. Conclusion: Our experience of teleconsultation during COVID-19 times for paediatric ophthalmology and strabismus patients was very encouraging. Pivoting teleconsultation platform can provide primary eye care to most of the patients and work as essential forward triage for rest. As we continue to further explore the currently available avenues in multimedia such as video conferencing and web/mobile based applications, we believe that tele-ophthalmology platform can provide a reliable service in patient care.
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Affiliation(s)
- Ajinkya V Deshmukh
- Child Sight Institute, Jasti V Ramanamma's Children's Eye Care Center, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Akshay Badakere
- Child Sight Institute, Jasti V Ramanamma's Children's Eye Care Center, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Jenil Sheth
- Child Sight Institute, Jasti V Ramanamma's Children's Eye Care Center, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Manjushree Bhate
- Child Sight Institute, Jasti V Ramanamma's Children's Eye Care Center, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Sampada Kulkarni
- Child Sight Institute, Jasti V Ramanamma's Children's Eye Care Center, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Ramesh Kekunnaya
- Child Sight Institute, Jasti V Ramanamma's Children's Eye Care Center, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
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40
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Abstract
INTRODUCTION Intracranial hypertension (ICH) in children can have deleterious effects on the brain and vision. It is notoriously difficult to estimate intracranial pressure (ICP) in children and existing methods deliver suboptimal diagnostic accuracy to be used as screening tools. Optical coherence tomography (OCT) may represent a valuable, non-invasive surrogate measure of ICP, as has been demonstrated in a number of associated conditions affecting adults. More recently, OCT has been employed within the paediatric age group. However, the role of OCT in detecting ICH in children has not been rigorously assessed in a systematic review for all relevant conditions. Here, we propose a systematic review protocol to examine the role of OCT in the detection of ICH in children. METHODS AND ANALYSIS Electronic searches in the Cochrane Central Register of Controlled Trials, Medline, Embase, Web of Science and PubMed will identify studies featuring OCT in detecting ICH in children. Two independent screeners will identify studies for inclusion using a screening questionnaire. The systematic search and screening will take place between 2 April 2020 and 1 June 2020, while we aim to complete data analysis by 1 September 2020. Quality assessment will be performed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The primary outcome measure is the sensitivity and specificity of OCT in detecting ICH in children. Secondary outcomes measures include conditions associated with ICH per study, direct ICP monitoring, sensitivity and specificity of other measures for ICP and OCT parameters used. ETHICS AND DISSEMINATION Ethical approval is not required for the proposed systematic review as no primary data will be collected. The findings will be disseminated through presentations at scientific meetings and peer-reviewed journal publication. PROSPERO REGISTRATION NUMBER CRD42019154254.
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Affiliation(s)
- Sohaib R Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Noor Ul Owase Jeelani
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
- Developmental Biology & Cancer Dept, UCL GOS Institute of Child Health, London, United Kingdom
| | - Rebecca J McLean
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, United Kingdom
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41
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Zuccarelli M, Vella-Szijj J, Serracino-Inglott A, Borg JJ. Treatment of Leber's hereditary optic neuropathy: An overview of recent developments. Eur J Ophthalmol 2020; 30:1220-1227. [PMID: 32552047 DOI: 10.1177/1120672120936592] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Leber's hereditary optic neuropathy (LHON) is a rare, maternally-inherited optic neuropathy caused by mitochondrial DNA point mutations and which can cause blindness. Currently, Raxone (idebenone) is the only available medicinal product authorised to treat LHON within the European Union and LHON remains an unmet medical need. The aim of this article was to summarise interventional clinical trials published over the past 5 years (between 2014 and 2019) with the primary purpose of treating LHON. Therapeutic approaches discussed include modulating agents of the mitochondrial electron transport chain such as Raxone, cysteamine bitartrate and KH176, inhibitors of apoptosis such as elamipretide, gene therapy medicinal products such as GS010 and scAAV2P1ND4 and retinal tissue regeneration medicinal products such as bone marrow-derived stem cells.
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Affiliation(s)
- Marta Zuccarelli
- Medicines Authority, San Ġwann, Malta.,Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Janis Vella-Szijj
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Anthony Serracino-Inglott
- Medicines Authority, San Ġwann, Malta.,Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - John-Joseph Borg
- Medicines Authority, San Ġwann, Malta.,Department of Biology, University of Tor Vergata, Rome, Italy
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42
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Hopkins A, Simmons I. Fifteen-minute consultation: Managing a child with a new-onset squint. Arch Dis Child Educ Pract Ed 2020; 105:147-151. [PMID: 31375504 DOI: 10.1136/archdischild-2019-317817] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/21/2019] [Accepted: 07/24/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To provide a systematic approach to the child with a new squint. METHOD Review of the current available literature. CONCLUSION Squint is a common presentation in the paediatric population. Although the parents' primary concern may be cosmetic, a new squint in childhood may be the first sign of a serious or life-threatening ocular or neurological pathology. Thorough assessment and timely referral are essential.
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Affiliation(s)
| | - Ian Simmons
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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43
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Abstract
OBJECTIVES The aim of our study is to give insight into congenital ectopia lentis (CEL) patients' care-seeking behaviour and explore the factors affecting their follow-up visits. DESIGN Cross-sectional study; in-depth and face-to-face semistructured interview. SETTING A large-scale ophthalmology hospital in China. PARTICIPANTS 35 patients with CEL and their parents from May 2017 to August 2017. MAIN OUTCOME MEASURES Themes and categories. The interviews were audio-recorded, transcribed verbatim, coded and analysed using grounded theory. Data collection was closed when new themes did not emerge in subsequent dialogues. RESULTS The factors affecting the timely visits included insufficient awareness of CEL, shame on hereditary disease, lack of effective doctor-patient communication, lack of reliable information online and daily stressors. CONCLUSION Continuing medical education of severe and rare disease, reforming the pattern of medical education, constructing an interactive platform of the disease on the internet and improving healthcare policy are effective ways to improve the diagnosis and treatment status of CEL in China.
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Affiliation(s)
- Jianqiang Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ni Gong
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Qianzhong Cao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yijing Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yitingxue Cai
- School of Sociology and Anthropology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Charlotte Aimee Young
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Jing Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yiyao Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Danying Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
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44
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Welinder L, Bender L, Eriksen HH, Nissen KR, Ebbesen F. As-indicated versus routine vision screening of preterm children: a 17-year retrospective regional study. Acta Ophthalmol 2020; 98:166-171. [PMID: 31421027 DOI: 10.1111/aos.14227] [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: 01/13/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate outcomes of routine vision screening compared to as-indicated ophthalmological investigation of all children born preterm in a Danish region from 1997 to 2014. METHODS All children born preterm (gestation age < 32 weeks or birthweight < 1500 g) screened for retinopathy of prematurity (ROP) were divided into two groups. From 1997 to 2009, only children treated for ROP or referred for visual problems received ophthalmological investigation (as-indicated group). From 2010 to 2014, all ROP-screened infants were offered ophthalmological investigation at 6 months and 3 years of age (screening group). RESULTS A total of 560 children were included in the as-indicated period, 41 and 87 were referred for ophthalmological investigation at 6 months and 3 years, respectively. In the screening period, 295 children were included, 251 and 150 of whom underwent vision evaluation at 6 months and 3 years, respectively. Mean visual acuity was 4.1 cycles per degree with Teller acuity cards at 6 months and 0.78 decimal at 3 years. At 3 years, 2.7%(n = 11) in the as-indicated versus 3.5%(n = 10) screening group had visual acuity < 6/18 (p = 0.24). Cerebral palsy (n = 28) and epilepsy (n = 5) were significantly related to vision impairment (p = 0.001/0.006), while treated ROP was not (n = 13). Refractive error was common at 3 years (61%), especially astigmatism (50%). Gestational age, birthweight and ROP were not associated with vision impairment or refractive error. CONCLUSION Screening preterm children at 6 months and 3 years did not reveal more visually impaired children compared to examination when indicated.
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Affiliation(s)
- Lotte Welinder
- Department of Ophthalmology Aalborg University Hospital Aalborg Denmark
| | - Lars Bender
- Department of Paediatrics Aalborg University Hospital Aalborg Denmark
| | | | - Kamilla Rothe Nissen
- Department of Ophthalmology Rigshospitalet University Hospital Copenhagen Denmark
| | - Finn Ebbesen
- Department of Paediatrics Aalborg University Hospital Aalborg Denmark
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45
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Jones R, Al-Hayouti H, Oladiwura D, Karim R, Sawczenko A, Dahlmann-Noor A. Optic atrophy in children: Current causes and diagnostic approach. Eur J Ophthalmol 2020; 30:1499-1505. [PMID: 31910664 DOI: 10.1177/1120672119899378] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Optic atrophy is one of the leading causes of sight impairment in children. It frequently poses a diagnostic challenge, as it can be caused by many ocular and systemic conditions. We aimed to determine the current causes of optic atrophy at our centre and to describe the use of investigations, including molecular genetic testing. METHODS We reviewed the medical records of children with optic atrophy seen at Moorfields Eye Hospital between 2010 and 2015. We recorded demographic data, reason for referral, history, investigations and diagnosis. RESULTS We studied 143 cases aged below 16 years. A cause could be identified in all cases. Taking a full history was the most important part of the diagnostic workup, identifying a cause in 96 (67%) children. A developmental disorder of the brain and/or optic nerve, sometimes with retinal involvement, was the commonest cause (n = 33, 23%), followed by inheritable optic neuropathies (n = 27, 19%). Other causes included perinatal insults (n = 18, 13%), post-infectious or post-inflammatory conditions (n = 18, 13%), accidental or abusive trauma (n = 14, 10%) and inheritable retinal dystrophies (n = 13, 9%). Rare conditions included neurodegenerative disorders (n = 7, 5%), skeletal developmental disorders such as rickets (n = 4, 3%), tumours (n = 4, 3%), ischaemic events including large optic nerve head drusen (n = 4, 3%) and toxic events/metabolic conditions (n = 1, 0.7%). CONCLUSION In this series, an underlying cause could be identified in all cases. Taking a comprehensive antenatal, perinatal, postnatal and family history will indicate a probable diagnosis in two-thirds of children, and targeted ancillary tests may identify the cause in most remaining cases.
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Affiliation(s)
| | - Huda Al-Hayouti
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | | | - Rushmia Karim
- Paediatric Service, Moorfields Eye Hospital, London, UK
| | | | - Annegret Dahlmann-Noor
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.,Paediatric Service, Moorfields Eye Hospital, London, UK
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46
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Bell SJ, Oluonye N, Harding P, Moosajee M. Congenital cataract: a guide to genetic and clinical management. Ther Adv Rare Dis 2020; 1:2633004020938061. [PMID: 37180497 PMCID: PMC10032449 DOI: 10.1177/2633004020938061] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/05/2020] [Indexed: 05/13/2023]
Abstract
Worldwide 20,000-40,000 children with congenital or childhood cataract are born every year with varying degrees and patterns of lens opacification with a broad aetiology. In most cases of bilateral cataract, a causative genetic mutation can be identified, with autosomal dominant inheritance being most common in 44% of cases. Variants in genes involve lens-specific proteins or those that regulate eye development, thus giving rise to other associated ocular abnormalities. Approximately 15% of cases have systemic features, hence paediatric input is essential to minimise comorbidities and support overall development of children at high risk of visual impairment. In some metabolic conditions, congenital cataract may be the presenting sign, and therefore prompt diagnosis is important where there is an available treatment. Multidisciplinary management of children is essential, including ophthalmic surgeons, orthoptists, paediatricians, geneticists and genetic counsellors, and should extend beyond the medical team to include school and local paediatric visual support services. Early surgery and close follow up in ophthalmology is important to optimise visual potential and prevent amblyopia. Routine genetic testing is essential for the complete clinical management of patients, with next-generation sequencing of 115 genes shown to expedite molecular diagnosis, streamline care pathways and inform genetic counselling and reproductive options for the future. Lay abstract Childhood cataract: how to manage patients Cataract is a clouding of the lens in the eye. Cataract occurring in children has many different causes, which may include infections passed from mother to child during pregnancy, trauma, medications and exposure to radiation. In most cases of cataract occurring in both eyes, a genetic cause can be found which may be inherited from parents or occur sporadically in the developing baby itself while in the womb. Cataracts may occur on their own, with other eye conditions or be present with other disorders in the body as part of a syndrome. Genetic testing is important for all children with cataract as it can provide valuable information about cause, inheritance and risk to further children and signpost any other features of the disease in the rest of the body, permitting the assembly of the correct multidisciplinary care team. Genetic testing currently involves screening for mutations in 115 genes already known to cause cataract and has been shown to expedite diagnosis and help better manage children. Genetic counselling services can support families in understanding their diagnosis and inform future family planning. In order to optimise vision, early surgery for cataract in children is important. This is because the brain is still developing and an unobstructed pathway for light to reach the back of the eye is required for normal visual development. Any obstruction (such as cataract) if left untreated may lead to permanent sight impairment or blindness, even if it is removed later. A multidisciplinary team involved in the care of a child with cataract should include ophthalmic surgeons, orthoptists, paediatricians, geneticists and genetic counsellors, and should extend beyond the medical team to include school and local child visual support services. They will help to diagnose and manage systemic conditions, optimise vision potential and help patients and their families access best supportive care.
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Affiliation(s)
| | - Ngozi Oluonye
- Department of Genetics, Moorfields Eye Hospital,
London, UK
- Department of Ophthalmology, Great Ormond Street
Hospital for Children, London, UK
| | | | - Mariya Moosajee
- UCL Institute of Ophthalmology 11-43 Bath Street
London EC1V 9EL, UK
- Department of Genetics, Moorfields Eye Hospital,
London, UK
- Department of Ophthalmology, Great Ormond Street
Hospital for Children, London, UK
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47
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Nishimura M, Wong A, Cohen A, Thorpe K, Maurer D. Choosing appropriate tools and referral criteria for vision screening of children aged 4-5 years in Canada: a quantitative analysis. BMJ Open 2019; 9:e032138. [PMID: 31558460 PMCID: PMC6773298 DOI: 10.1136/bmjopen-2019-032138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To assess the diagnostic accuracy of five vision screening tools used in a school setting using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). DESIGN We compared the results of the five best evidence-based screening tools available in 2014 to the results of a comprehensive eye exam with cycloplegic refraction by a licenced optometrist. Screening included Cambridge Crowded Acuity Cards, Plusoptix S12 and Spot photoscreeners, Preschool Randot Stereoacuity Test and the Pediatric Vision Scanner (PVS). Referral criteria followed AAPOS (2013) guidelines and published norms. SETTING A large school in Toronto, Canada, with 25 split classrooms of junior kindergarten (JK: 4 year olds) and senior kindergarten (SK: 5 year olds) children. PARTICIPANTS Over 2 years, 1132 eligible children were enrolled at the school. After obtaining parental consent, 832 children were screened. Subsequently, 709 children had complete screening and optometry exam data. MAIN OUTCOME MEASURES The presence/absence of a visual problem based on optometrist's assessment: amblyopia, amblyopia risk factors (reduced stereoacuity, strabismus and clinically significant refractive errors) and any other ocular problem (eg, nystagmus). RESULTS Overall, 26.5% of the screened children had a visual problem, including 5.9% with amblyopia. Using all five tools, screening sensitivity=84% (95% CI 78 to 89), specificity=49% (95% CI 44 to 53), PPV=37% (95% CI 33 to 42), and NPV=90% (95% CI 86 to 93). The odds of having a correct screening result in SK (mean age=68.2 months) was 1.5 times those in JK (mean age=55.6 months; 95% CI 1.1 to 2.1), with sensitivity improved to 89% (95% CI 80 to 96) and specificity improved to 57% (95% CI 50 to 64) among SK children. CONCLUSIONS A school-based screening programme correctly identified 84% of those kindergarten children who were found to have a visual problem by a cyclopleged optometry exam. Additional analyses revealed how accuracy varies with different combinations of screening tools and referral criteria.
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Affiliation(s)
- Mayu Nishimura
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Agnes Wong
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Cohen
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Daphne Maurer
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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48
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Mukhija R, Pujari A, Singh R, Nayak S, Singh V, Tandon R. Role of ultrasonography in childhood eye diseases in a tertiary care setting: indications and scope. Trop Doct 2019; 50:3-8. [PMID: 31530105 DOI: 10.1177/0049475519875016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/17/2022]
Abstract
We sought to evaluate the role and diagnostic potential of ocular B-scan ultrasonography in childhood eye disease in an observational cross-sectional study; 1091 patients with a total of 1445 eyes examined were studied. Cataract was the single most common indication for ultrasound followed by corneal pathology, ocular trauma, posterior segment pathology, primary congenital glaucoma, leukocoria, orbital pathology and other disease. Ultrasonography resulted in a change in diagnosis in 198 cases (18%). We conclude that B-scan ultrasonography plays an important adjunctive role in the management of childhood eye disease.
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Affiliation(s)
- Ritika Mukhija
- Senior Resident, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Amar Pujari
- Senior Resident, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Singh
- Senior Resident, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shreya Nayak
- Junior Resident, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vipul Singh
- Junior Resident, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Professor, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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49
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Abstract
PURPOSE To determine the prevalence rate of amblyopia and strabismus in Chinese Hani ethnic school-aged children. METHODS All grade 1 and grade 7 students in Mojiang Hani Autonomous County, located in southwest China, were invited for comprehensive eye examinations performed by experienced ophthalmologists and optometrists, including visual acuity, ocular alignment and movements, cycloplegic autorefraction, anterior segment and fundus examinations. Standard definitions of amblyopia and strabismus were applied to calculate their prevalence rate. RESULTS A total of 1656 (91.0% response rate) grade 1 Hani students and 1394 (92.8% response rate) grade 7 Hani students participated in the study. Amblyopia was present in 25 Hani students (0.82%, 95% CI 0.55% to 1.20%), with no significant differences in grade (p=0.42) and gender (p=0.69). Among these 25 amblyopic children, 17 had unilateral amblyopia and eight had bilateral amblyopia, including 16 anisometropic, eight binocular refractive and one strabismic. Strabismus was found in 59 Hani students (1.93%, 95% CI 1.50% to 2.48%), including 47 with intermittent exotropia, six with constant exotropia, five with constant esotropia and one with unilateral superior oblique palsy. The prevalence rate of strabismus was higher in grade 7 students than grade 1 students with borderline significance (2.44%vs1.50%, p=0.07), but was similar by gender (2.16% in boys vs 1.68% in girls, p=0.36). CONCLUSION The prevalence of amblyopia and strabismus in Chinese Hani school children are both lower than that previously reported for Chinese Han children in China and for many other racial/ethnic populations from non-China studies. Refractive error is the major cause for amblyopia and intermittent exotropia is the primary strabismus type.
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Affiliation(s)
- Hui Zhu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Chenwei Pan
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Qigang Sun
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Dan Huang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zhujun Fu
- Department of Ophthalmology, Nanjing Children’s Hospital, Nanjing, China
| | - Jing Wang
- Training Department, Jinling Vision Care Center for Children and Adolescents, Nanjing, China
| | - Xuejuan Chen
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zijing Wang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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50
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Chong C, McGhee CNJ, Dai SH. Causes of childhood low vision and blindness in New Zealand. Clin Exp Ophthalmol 2019; 47:165-170. [PMID: 30430722 DOI: 10.1111/ceo.13443] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 07/04/2018] [Revised: 09/12/2018] [Accepted: 09/26/2018] [Indexed: 11/29/2022]
Abstract
IMPORTANCE This is the first national study on childhood visual impairment in a developed nation, New Zealand, describing prevalence, aetiology and preventable causes of low vision and blindness in children. BACKGROUND Causes of childhood blindness vary between regions. This study aimed to present region-specific data on epidemiology of childhood blindness affecting a developed nation, New Zealand. DESIGN Retrospective data analysis. PARTICIPANTS All children enrolled with the Blind and Low Vision Education Network New Zealand (BLENNZ) with best-corrected visual acuity ≤6/18, or binocular visual field <10°. METHODS 1000 out of 1321 children with visual impairment enrolled with BLENNZ were included. The principal cause of visual loss was determined, and the severity of visual loss categorized as low vision, or blindness according to the World Health Organization criteria. MAIN OUTCOME MEASURES Main outcome measures were degree of visual impairment, aetiology of visual impairment and treatment modalities for visual rehabilitation. RESULTS The calculated prevalence of childhood blindness and low vision was 0.05% and 0.06%. Principle causes of blindness were cortical visual impairment (31.5%), optic nerve atrophy (16.5%) and optic nerve hypoplasia (9.0%). The main preventable causes of blindness were neonatal trauma/asphyxia (31.5%), retinopathy of prematurity (18.2%) and non-accidental injury (10.3%). CONCLUSIONS AND RELEVANCE This is the first national report on prevalence of childhood low vision and blindness in New Zealand. The prevalence and leading causes of low vision and blindness found in this study were comparable to other developed nations; however, preventable causes of low vision and blindness appeared unique to New Zealand.
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Affiliation(s)
- CheeFoong Chong
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Shuan H Dai
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
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