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Yu VK, Tarczy-Hornoch K, Cotter SA, Torres M, Jiang X, Varma R. Prevalence of Comprehensive Eye Examination in Preschool Children With Eye Conditions. AJPM Focus 2024; 3:100184. [PMID: 38283739 PMCID: PMC10818075 DOI: 10.1016/j.focus.2024.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Introduction The purpose of this study is to assess the prevalence of comprehensive eye examinations in multiethnic preschool children, including children with visually significant eye conditions, and identify factors associated with comprehensive eye examinations. Methods A sample of 9,197 African American, Hispanic, Asian American, and non-Hispanic White children aged 6-72 months was recruited for the Multi-Ethnic Pediatric Eye Disease Study from 2003 to 2011. Logistic regression performed in 2022 identified independent factors associated with parent-reported history of comprehensive eye examinations. The proportion of children with previous comprehensive eye examinations and the proportion with undetected amblyopia or strabismus were measured. Results The prevalence of comprehensive eye examinations was 6.3% overall and 38.3%, 24.8%, 19.1%, 15.1%, and 9.8% among children with strabismus, amblyopia, significant anisometropia, hyperopia, and astigmatism, respectively. Children without prior comprehensive eye examinations were more likely to have undetected amblyopia or strabismus than those with comprehensive eye examination history (ps<0.001). The prevalence of comprehensive eye examinations was higher among older children. Prevalence varied by race/ethnicity, with 8.1%, 7.9%, 6.3%, and 4.9% of non-Hispanic White, Asian American, African American, and Hispanic children having had prior comprehensive eye examinations, respectively; however, the differences did not remain after adjusting for other associated factors. Older age, a primary caregiver with a college/university degree or higher, having vision insurance, gestational age <33 weeks, neurodevelopmental disorder diagnosis, strabismus, and ocular disease history were all statistically significantly associated with a relatively higher prevalence of comprehensive eye examinations in multivariable analyses. Conclusions Comprehensive eye examinations were uncommon among preschool children, including those with treatable vision disorders. Interventions, such as parent education and vision insurance, are needed to imaprove comprehensive eye examination access and utilization for at-risk preschool children.
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Affiliation(s)
- Victoria K. Yu
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle, Washington
- Seattle Children's Hospital, Seattle, Washington
| | - Susan A. Cotter
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California
| | - Mina Torres
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California
| | - Xuejuan Jiang
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of University of Southern California, Los Angeles, California
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California
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Sims DT, Gillette TB, Lam JG, Liu D, Lee C, Ding L, Tarczy-Hornoch K, Cabrera MT. Anisometropia and Amblyopia Outcomes in Early Versus Late Resolution of Congenital Nasolacrimal Duct Obstruction in Older Infants. Ophthalmic Plast Reconstr Surg 2024; 40:39-42. [PMID: 38241617 PMCID: PMC10799212 DOI: 10.1097/iop.0000000000002496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
PURPOSE Congenital nasolacrimal duct obstruction is a known risk factor for amblyopia and anisometropia. The purpose of this study was to investigate whether the rate of anisometropia and amblyopia development differed based on the age at CNLDO resolution in older infants. METHODS This retrospective chart review at a single tertiary children's hospital from 2007 to 2017 compared early versus late spontaneous resolution (cutoff 12 months) and intervention (cutoff 15 months) groups presenting at ≥9 months of age, comparing visual outcomes, including anisometropia (≥1 D of sphere or cylinder) and amblyopia (≥2 levels difference in Teller acuity or optotype testing). Parents/guardians were contacted by phone for missing data on spontaneous resolution or intervention status. RESULTS A total of 462 patients were included (152 early; 310 late group). The early group presented at a median age of 12.0 (interquartile range: 10.0, 13.0) months, while the late group presented at 21.0 (interquartile range: 15.0, 32.0) months. Unilateral disease occurred in 62% and 59%, respectively. Anisometropia was seen in (12/102) 12% of early versus (25/243) 10% of late patients (p = 0.686, 95% CI: -0.059, 0.088), and amblyopia in (4/131) 3% of early versus (14/286) 5% of late patients (p = 0.322, 95% CI: -0.061, 0.018). In patients presenting <24 months without undergoing surgery, spontaneous resolution occurred in 76% between 12 and 24 months (n = 41). CONCLUSIONS Anisometropia and amblyopia rates did not significantly differ between early and delayed intervention for congenital nasolacrimal duct obstruction in this retrospective cohort presenting beyond 9 months of age to a children's hospital. This study found frequent late spontaneous resolution.
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Affiliation(s)
- Deion T. Sims
- University of Washington School of Medicine, Seattle, WA, USA
| | - Thomas B. Gillette
- Department of Ophthalmology, University of South Florida, Tampa, FL, USA
| | - Jocelyn G. Lam
- Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA
| | - Darren Liu
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Calvin Lee
- College of Medicine, Washington State University, Spokane, WA, USA
| | - Leona Ding
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Department of Ophthalmology, Seattle Children’s Hospital, Seattle, WA, USA
| | - Michelle T. Cabrera
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Department of Ophthalmology, Seattle Children’s Hospital, Seattle, WA, USA
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Meier K, Pettet M, Garrison T, Tarczy-Hornoch K, Boynton GM, Fine I. Poster Session I: Binocular contrast integration: Cortical and behavioral signals reflect different computations. J Vis 2023; 23:30. [PMID: 38109618 DOI: 10.1167/jov.23.15.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
PURPOSE Although binocular contrast perception under dichoptic viewing conditions has been extensively characterized behaviorally, little is known about how the signals from each eye are combined in cortex. Here we compared simultaneously-collected behavioral and EEG measures of dichoptic contrast perception. METHODS Observers (n=16) dichoptically viewed a 2-cpd grating flickering at 7.5 Hz and rotating slowly (1º/s). The contrast of the grating shown to each eye modulated sinusoidally over time at independent rates (1/6 and 1/8 Hz). We recorded EEG activity while observers positioned a joystick lever to report perceived contrast as it changed over time. ANALYSIS A multiband filter was used to isolate the SSVEP responses to 7.5 Hz signals from electrode Oz (occipital pole), and the standard deviation of this signal provided a measure of neural response amplitude as a function of contrast. RESULTS A simple model was fit to VEP and behavioral responses, [(L^m+R^m)/2]^(1/m)], which essentially characterized whether responses were better fit by a mean (m≈1) or a max (m>1) model. VEP responses (m = 1.0; MSE = 0.013) were well fit by a mean model, suggesting the EEG signal may have been driven by the input layers of V1. In contrast, behavioral responses (m = 8.8; MSE = 0.011) were well fit by a model that was heavily shifted towards a max model, suggesting a significant non-linear transformation of the contrast signal between the input layers of V1 and conscious perception.
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Affiliation(s)
| | - Mark Pettet
- Department of Psychology, University of Washington
| | | | | | | | - Ione Fine
- Department of Psychology, University of Washington
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Tarczy-Hornoch K. Scrolling ahead. J AAPOS 2023; 27:315. [PMID: 37931835 DOI: 10.1016/j.jaapos.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023]
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Chang K, Li X, Meier K, Tarczy-Hornoch K, Boynton GM, Fine I. Poster Session I: Non-rivalrous interocular contrast integration across the human visual cortex hierarchy. J Vis 2023; 23:29. [PMID: 38109619 DOI: 10.1167/jov.23.15.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
Here, using functional MRI, we measured interocular interactions as a function of contrast presented to each eye under non-rivalrous dichoptic viewing conditions. METHODS Activity was measured from early visual cortex (V1 - V3) while participants (n = 5) viewed dichoptic gratings (2-cpd) that independently varied in contrast over time in each eye at 1/6 and 1/8 Hz. We fit a model [((L^m+R^m ))/2]^(1/m) to quantify how the neural response was driven by the contrast in each eye (L and R), where m = 1 represents simple averaging, and as m → ∞ the model shifts towards a max rule, where responses are driven by the eye presented with highest contrast. RESULTS Across all visual areas, responses were much closer to a max than a mean model, suggesting that neural responses were primarily driven by the eye presented with highest contrast. Within V1, similar findings have been described using a normalization model (Moradi & Heeger, 2009). The magnitude of m increased across the visual hierarchy (V1: m = 1.82; R2 = 0.32; V2: m = 12.94, R2 = 0.28; V3: m = 13.31, R2 = 0.27). CONCLUSIONS The neural response integrating signals from each eye approaches a simple maximum as the contrast signal propagates from V1 through V3. This is consistent with previous behavioral data showing that visually typical observers tend to report perceiving the maximum contrast presented to each eye (Meier et al., 2023).
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Affiliation(s)
| | - Xiyan Li
- Department of Psychology, University of Washington
- Department of Psychology, University of California, San Diego
| | | | | | | | - Ione Fine
- Department of Psychology, University of Washington
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Rajesh AE, Davidson O, Lacy M, Chandramohan A, Lee AY, Lee CS, Tarczy-Hornoch K. Race, Ethnicity, Insurance, and Population Density Associations with Pediatric Strabismus and Strabismic Amblyopia in the IRIS® Registry. Ophthalmology 2023; 130:1090-1098. [PMID: 37331481 PMCID: PMC10527204 DOI: 10.1016/j.ophtha.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
PURPOSE To evaluate the associations of sociodemographic factors with pediatric strabismus diagnosis and outcomes. DESIGN Retrospective cohort study. PARTICIPANTS American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) patients with strabismus diagnosed before the age of 10 years. METHODS Multivariable regression models evaluated the associations of race and ethnicity, insurance, population density, and ophthalmologist ratio with age at strabismus diagnosis, diagnosis of amblyopia, residual amblyopia, and strabismus surgery. Survival analysis evaluated the same predictors of interest with the outcome of time to strabismus surgery. MAIN OUTCOME MEASURES Age at strabismus diagnosis, rate of amblyopia and residual amblyopia, and rate of and time to strabismus surgery. RESULTS The median age at diagnosis was 5 years (interquartile range, 3-7) for 106 723 children with esotropia (ET) and 54 454 children with exotropia (XT). Amblyopia diagnosis was more likely with Medicaid insurance than commercial insurance (odds ratio [OR], 1.05 for ET; 1.25 for XT; P < 0.01), as was residual amblyopia (OR, 1.70 for ET; 1.53 for XT; P < 0.01). For XT, Black children were more likely to develop residual amblyopia than White children (OR, 1.34; P < 0.01). Children with Medicaid were more likely to undergo surgery and did so sooner after diagnosis (hazard ratio [HR], 1.23 for ET; 1.21 for XT; P < 0.01) than those with commercial insurance. Compared with White children, Black, Hispanic, and Asian children were less likely to undergo ET surgery and received surgery later (all HRs < 0.87; P < 0.01), and Hispanic and Asian children were less likely to undergo XT surgery and received surgery later (all HRs < 0.85; P < 0.01). Increasing population density and clinician ratio were associated with lower HR for ET surgery (P < 0.01). CONCLUSIONS Children with strabismus covered by Medicaid insurance had increased odds of amblyopia and underwent strabismus surgery sooner after diagnosis compared with children covered by commercial insurance. After adjusting for insurance status, Black, Hispanic, and Asian children were less likely to receive strabismus surgery with a longer delay between diagnosis and surgery compared with White children. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Anand E Rajesh
- Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Oliver Davidson
- Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Megan Lacy
- Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Arthika Chandramohan
- Department of Ophthalmology, Southern California Permanente Medical Group, San Diego, California
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington.
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Meier K, Tarczy-Hornoch K, Boynton GM, Fine I. Characterizing amblyopic perception under non-rivalrous viewing conditions. Sci Rep 2023; 13:7993. [PMID: 37198211 PMCID: PMC10189719 DOI: 10.1038/s41598-023-31301-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/09/2023] [Indexed: 05/19/2023] Open
Abstract
Current assessments of interocular interactions in amblyopia often use rivalrous stimuli, with conflicting stimuli in each eye, which does not reflect vision under typical circumstances. Here we measure interocular interactions in observers with amblyopia, strabismus with equal vision, and controls using a non-rivalrous stimulus. Observers used a joystick to continuously report the perceived binocular contrast of dichoptic grating stimuli, identical except that the stimulus was contrast-modulated independently in each eye over time. Consistent with previous studies, a model predicting the time-course of perceived contrast found increased amblyopic eye attenuation, and reduced contrast normalization of the fellow eye by the amblyopic eye, in amblyopic participants compared to controls. However, these suppressive interocular effects were weaker than those found in previous studies, suggesting that rivalrous stimuli may overestimate the effects of amblyopia on interocular interactions during naturalistic viewing conditions.
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Affiliation(s)
- Kimberly Meier
- Department of Psychology, University of Washington, Seattle, WA, USA.
| | | | | | - Ione Fine
- Department of Psychology, University of Washington, Seattle, WA, USA
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Legocki AT, Lee AY, Ding L, Moshiri Y, Zepeda EM, Gillette TB, Grant LE, Shariff A, Touch P, Lee CS, Tarczy-Hornoch K, Cabrera MT. Multivariate Models to Diagnose Early Referral-Warranted Retinopathy of Prematurity With Handheld Optical Coherence Tomography. Transl Vis Sci Technol 2023; 12:26. [PMID: 37223917 PMCID: PMC10214879 DOI: 10.1167/tvst.12.5.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/23/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose The purpose of this study was to create multivariate models predicting early referral-warranted retinopathy of prematurity (ROP) using non-contact handheld spectral-domain optical coherence tomography (OCT) and demographic data. Methods Between July 2015 and February 2018, infants ≤1500 grams birth weight or ≤30 weeks gestational age from 2 academic neonatal intensive care units were eligible for this study. Infants were excluded if they were too unstable to participate in ophthalmologic examination (2), had inadequate image quality (20), or received prior ROP treatment (2). Multivariate models were created using demographic variables and imaging findings to identify early referral-warranted ROP (referral-warranted ROP and/or pre-plus disease) by routine indirect ophthalmoscopy. Results A total of 167 imaging sessions of 71 infants (45% male infants, gestational age 28.2+/-2.8 weeks, and birth weight 995.6+/-292.0 grams) were included. Twelve of 71 infants (17%) developed early referral-warranted ROP. The area under the receiver operating characteristic curve (AUC) was 0.94 for the generalized linear mixed model (sensitivity = 95.5% and specificity = 80.7%) and 0.83 for the machine learning model (sensitivity = 91.7% and specificity = 77.8%). The strongest variables in both models were birth weight, image-based Vitreous Opacity Ratio (an estimate of opacity density), vessel elevation, and hyporeflective vessels. A model using only birth weight and gestational age yielded an AUC of 0.68 (sensitivity = 77.3% and specificity = 63.4%), and a model using only imaging biomarkers yielded 0.88 (sensitivity = 81.8% and specificity = 84.8%). Conclusions A generalized linear mixed model containing handheld OCT biomarkers can identify early referral-warranted ROP. Machine learning produced a less optimal model. Translational Relevance With further validation, this work may lead to a better-tolerated ROP screening tool.
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Affiliation(s)
- Alex T. Legocki
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- The Roger and Angie Karalis Johnson Retina Center, Seattle, WA, USA
| | - Leona Ding
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Yasman Moshiri
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Emily M. Zepeda
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
| | - Thomas B. Gillette
- Department of Ophthalmology, University of South Florida Eye Institute, Tampa, FL, USA
| | - Laura E. Grant
- Department of Ophthalmology, Millman-Derr Center for Eye Care, Rochester Hills, MI, USA
| | - Ayesha Shariff
- Department of Ophthalmology, New Mexico Veterans Affairs Medical Center, University of New Mexico, Albuquerque, NM, USA
| | - Phanith Touch
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Cecilia S. Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- The Roger and Angie Karalis Johnson Retina Center, Seattle, WA, USA
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, WA, USA
| | - Michelle T. Cabrera
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, WA, USA
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Lawson SE, Tam EK, Zheng Y, Liu T, Monger TR, Lee KE, Legocki A, Kelly J, Ding L, Wang RK, Tarczy-Hornoch K, Cabrera MT. Semi-Automated Analysis of Foveal Maturity in Premature and Full-Term Infants Using Handheld Swept-Source Optical Coherence Tomography. Transl Vis Sci Technol 2023; 12:5. [PMID: 36881403 PMCID: PMC10010441 DOI: 10.1167/tvst.12.3.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Purpose To develop a semi-automated method of measuring foveal maturity using investigational handheld swept source-optical coherence tomography (SS-OCT). Methods In this prospective, observational study, full-term newborns and preterm infants undergoing routine retinopathy of prematurity screening were imaged. Semi-automated analysis measured foveal angle and chorioretinal thicknesses at the central fovea and average two-sided parafovea by three-grader consensus, correlating with OCT features and demographics. Results One hundred ninety-four imaging sessions from 70 infants were included (47.8% girls, 37.6 ± 3.4 weeks postmenstrual age, 26 preterm infants with birth weight 1057 ± 325.0, gestational age 29.0 ± 3.0 weeks). Foveal angle (96.1 ± 22.0 degrees) steepened with increasing birth weight (P = 0.003), decreasing inner retinal layer thickness, and increasing gestational age, postmenstrual age, and foveal and parafoveal choroidal thickness (all P < 0.001). Inner retinal fovea/parafovea ratio (0.4 ± 0.2) correlated with increasing inner foveal layers, decreasing postmenstrual age, gestational age, and birth weight (all P < 0.001). Outer retinal F/P ratio (0.7 ± 0.2) correlated with ellipsoid zone presence (P < 0.001), increased gestational age (P = 0.002), and birth weight (P = 0.003). Foveal (447.8 ± 120.6 microns) and parafoveal (420.9 ± 109.2) choroidal thicknesses correlated with foveal ellipsoid zone presence (P = 0.007 and P = 0.01, respectively), postmenstrual age, birth weight, gestational age, and decreasing inner retinal layers (all P < 0.001). Conclusions Foveal development is dynamic and partially observed through semi-automated analysis of handheld SS-OCT imaging. Translational Relevance Semi-automated analysis of SS-OCT images can identify measures of foveal maturity.
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Affiliation(s)
- Sumner E Lawson
- University of Washington School of Medicine, Seattle, WA, USA
| | - Emily K Tam
- Division of Ophthalmology Seattle Children's Hospital, Seattle, WA, USA.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Yujiao Zheng
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Teng Liu
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Tatiana R Monger
- Division of Ophthalmology Seattle Children's Hospital, Seattle, WA, USA
| | - Karen E Lee
- Pediatric Ophthalmology Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Alex Legocki
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - John Kelly
- Division of Ophthalmology Seattle Children's Hospital, Seattle, WA, USA
| | - Leona Ding
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Ruikang K Wang
- Department of Ophthalmology, University of Washington, Seattle, WA, USA.,Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Kristina Tarczy-Hornoch
- Division of Ophthalmology Seattle Children's Hospital, Seattle, WA, USA.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Michelle T Cabrera
- Division of Ophthalmology Seattle Children's Hospital, Seattle, WA, USA.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
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Mestre C, Neupane S, Manh V, Tarczy-Hornoch K, Candy TR. Vergence and accommodation responses in the control of intermittent exotropia. Ophthalmic Physiol Opt 2023. [PMID: 36692334 DOI: 10.1111/opo.13093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE Individuals with different types of intermittent exotropia (IXT) may use neurally coupled accommodation and vergence responses differently from those without exotropia to achieve eye alignment. This study examined the relationship between simultaneously recorded accommodation and vergence responses in children and young adults with a range of types of IXT while aligned and deviated. METHODS Responses of 29 participants with IXT (4-31 years) and 24 age-matched controls were recorded using simultaneous eye-tracking and eccentric photorefraction while they watched a movie in binocular or monocular viewing at varying viewing distances. Gradient response AC/A ratios and fusional vergence ranges were also assessed. Eight participants had divergence or pseudo-divergence excess type IXT, 5 had convergence insufficiency and 16 had basic IXT. RESULTS Control and IXT participants accommodated similarly both in monocular and binocular-aligned conditions to visual targets at 80 and 33 cm. When deviated in binocular viewing, most participants with IXT exhibited changes in accommodation <0.5D relative to alignment. Gradient response AC/A ratios were similar for control [0.56 MA/D (IQR: 0.51 MA/D)] and IXT participants [0.42 MA/D (0.54 MA/D); p = 0.60]. IXT participants showed larger vergence to accommodation ratios with changes from distance to near fixation [1.19 MA/D (1.45 MA/D)] than control participants [0.78 MA/D (0.60 MA/D); p = 0.02], especially among IXT participants with divergence or pseudo-divergence excess. Participants with IXT exhibited typical fusional divergence ranges beyond their dissociated position [8.86 Δ (7.10 Δ)] and typical fusional convergence ranges from alignment [18 Δ (15.75 Δ)]. CONCLUSIONS This study suggests that control of IXT is typically neither driven by accommodative convergence alone nor associated with over-accommodation secondary to fusional convergence efforts. These simultaneous measurements confirmed that proximal vergence contributed significantly to IXT control, particularly for divergence or pseudo-divergence excess type IXT. For IXT participants in this study, achieving eye alignment did not conflict with having clear vision.
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Affiliation(s)
- Clara Mestre
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | - Sonisha Neupane
- Department of Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Vivian Manh
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kristina Tarczy-Hornoch
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
| | - T Rowan Candy
- School of Optometry, Indiana University, Bloomington, Indiana, USA
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11
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Meier K, Tarczy-Hornoch K, Boynton GM, Fine I. Using dynamic contrast estimation to assess amblyopia. J Vis 2022. [DOI: 10.1167/jov.22.14.4465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
| | | | | | - Ione Fine
- Department of Psychology, University of Washington
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Tarczy-Hornoch K. From print to printable. J AAPOS 2022; 26:285-286. [PMID: 36283599 DOI: 10.1016/j.jaapos.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/29/2022]
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Abstract
Occlusion therapy has a long history as the gold standard treatment for amblyopia. Over the past two decades, large multicenter randomized controlled trials and objective dose-monitoring studies have characterized the effects of refractive correction, patching, and atropine penalization, providing insights into the impact of factors such as age and treatment dose. More recent approaches, whose development has been accelerated by advances in technology, are designed to provide different stimulation to the amblyopic eye and the fellow eye. This review explores a variety of such dichoptic approaches, categorized according to whether they primarily feature requisite use of the amblyopic eye in the face of fellow-eye masking, integration of visual information from both eyes, or reduction of stimulus salience in the fellow eye. It is still unclear whether dichoptic treatments are superior to traditional, low-cost treatment methods or whether their therapeutic mechanisms are fundamentally different from those of established treatments. Expected final online publication date for the Annual Review of Vision Science, Volume 8 is September 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Kimberly Meier
- Department of Psychology, University of Washington, Seattle, Washington, USA;
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Scoville NM, Legocki AT, Touch P, Ding L, Moshiri Y, Bays-Muchmore C, Qiao E, Zhou K, Zhong J, Tarczy-Hornoch K, Wang RK, Cabrera MT. Vitreous opacities in infants born full-term and preterm by handheld swept-source optical coherence tomography. J AAPOS 2022; 26:20.e1-20.e7. [PMID: 34973449 PMCID: PMC8976744 DOI: 10.1016/j.jaapos.2021.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/28/2021] [Accepted: 09/13/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare vitreous opacity density in infants born at term and in infants born prematurely using an investigational handheld swept-source optical coherence tomography (SS-OCT). METHODS Infants born at term underwent imaging once between 12 and 48 hours after birth; infants born prematurely were imaged at each routine retinopathy of prematurity (ROP) examination. Three masked, trained graders analyzed images. Semiautomated methods were used to quantify vitreous opacity density, which was correlated with ROP severity based on indirect ophthalmoscopy, other SS-OCT findings, and medical comorbidities. RESULTS Between April 2018 and June 2019, 251 SS-OCT imaging sessions were performed on 78 infants (49% female; 36% preterm, with mean birth weight of 1018 ± 338 g and gestational age of 28.6 ± 3.2 weeks). All SS-OCT sessions produced images of adequate quality. Punctate vitreous opacities were present in 25 of 28 term infants (89%) and 41 of 50 premature infants (82%). Dice coefficient and F1 scores for intergrader agreement were 0.99 ± 0.03 and 0.77 ± 0.31, respectively. Vitreous opacity density was 0.118 ± 0.187 in prematurely born infants and 0.031 ± 0.118 in infants born at term (P = 0.009). In the former, vitreous opacity density was associated with ROP zone (P = 0.044) and stage (P = 0.031), intraventricular hemorrhage (P = 0.028), subchorionic hemorrhage (P = 0.026), and African American race (P = 0.023). In the latter, vitreous opacity density was associated with maternal diabetes (P = 0.049). CONCLUSIONS Our investigational handheld SS-OCT achieved high-quality vitreoretinal images. In our study cohort, punctate vitreous opacities were a frequent finding in infants born at term and those born prematurely, with increased density in those born prematurely, particularly those with severe ROP.
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Affiliation(s)
| | - Alex T Legocki
- Department of Ophthalmology, University of Washington, Seattle
| | - Phanith Touch
- Department of Ophthalmology, University of Washington, Seattle
| | - Leona Ding
- Department of Ophthalmology, University of Washington, Seattle
| | - Yasman Moshiri
- Department of Ophthalmology, University of Washington, Seattle
| | | | - Erica Qiao
- Department of Ophthalmology, University of Washington, Seattle
| | - Kanheng Zhou
- Department of Ophthalmology, University of Washington, Seattle; Department of Bioengineering, University of Washington, Seattle
| | - Junping Zhong
- Department of Ophthalmology, University of Washington, Seattle; Department of Bioengineering, University of Washington, Seattle
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle; Division of Ophthalmology, Seattle Children's Hospital, Seattle
| | - Ruikang K Wang
- Department of Ophthalmology, University of Washington, Seattle; Department of Bioengineering, University of Washington, Seattle
| | - Michelle T Cabrera
- Department of Ophthalmology, University of Washington, Seattle; Division of Ophthalmology, Seattle Children's Hospital, Seattle.
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15
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Tarczy-Hornoch K. Journal of AAPOS: taking the helm. J AAPOS 2021; 25:321. [PMID: 34767980 DOI: 10.1016/j.jaapos.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
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16
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Scoville NM, Feng S, Taylor MR, Herlihy E, Wilkes JJ, Chisholm KM, Tarczy-Hornoch K. Bilateral Pseudo-hypopyon as Presenting Symptom of Acute Monocytic Leukemia in an 8-Month-Old Infant. J Pediatr Ophthalmol Strabismus 2021; 58:e30-e33. [PMID: 34592122 DOI: 10.3928/01913913-20210708-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A previously healthy 8-month-old female infant presenting with lethargy and bilateral eye redness and cloudiness had bilateral hypopyon uveitis, which persisted despite topical steroids. Cytology of the anterior chamber and cerebrospinal fluid and flow cytometry of cerebrospinal fluid revealed malignant cells consistent with acute monocytic leukemia. Bone marrow aspirates and biopsies showed no evidence of disease. She was treated with systemic and intrathecal chemotherapy, with subsequent remission and resolution of pseudo-hypopyon. Anterior chamber involvement is a rare presentation of acute myeloid leukemia and may indicate concurrent central nervous system involvement. This has important therapeutic implications, because additional treatment modalities such as intrathecal chemotherapy, local chemotherapy, and ocular radiation may be required to overcome the "pharmacologic sanctuary" created by the blood-ocular barrier. [J Pediatr Ophthalmol Strabismus. 2021;58(5):e30-e33.].
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Legocki AT, Moshiri Y, Zepeda EM, Gillette TB, Shariff A, Grant LE, Ding L, Lee AY, Lee CS, Tarczy-Hornoch K, Cabrera MT. Dome-shaped macula in premature infants visualized by handheld spectral-domain optical coherence tomography. J AAPOS 2021; 25:153.e1-153.e6. [PMID: 34044111 PMCID: PMC8328941 DOI: 10.1016/j.jaapos.2020.12.007] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/07/2020] [Accepted: 12/19/2020] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe dome-shaped macula and associated clinical findings in premature infants. METHODS This prospective, observational cohort study included a consecutive sample of premature infants screened for retinopathy of prematurity (ROP) with 9-month follow-up. Handheld spectral domain optical coherence tomography (SD-OCT) was performed at the time of ROP screening. Images were assessed for dome-shaped macula, cystoid macular edema, epiretinal membrane, vitreous bands, and punctate hyperreflective vitreous opacities. Dome height measurements were performed in a subset of images. Teller visual acuity and cycloplegic refraction were performed at an adjusted age of 8-10 months. RESULTS Of 37 infants (74 eyes; 49% male; mean gestational age 27.8 ± 3.2 weeks; mean birth weight 949 ± 284 g), 24/37 (65%) demonstrated dome-shaped macula in at least one eye (13 both eyes, 5 right eye only, and 6 left eye only). Of the 74 eyes, 26 (35%) could be reliably measured, with a mean dome height of 139.0 ± 72.3 μm (range, 54-369 μm). Presence of dome-shaped macula was associated with a diagnosis of ROP (P = 0.02; OR, 3.03; 95% CI, 1.18-7.82) and pre-plus or plus disease (P = 0.02; OR, 4.20; 95% CI, 1.05-16.78). Infants with dome-shaped macula had lower birth weight compared with those without (877 vs 1081 g; P = 0.04). No associations with other demographics, OCT findings, and 9-month refractive outcomes were found. CONCLUSIONS Dome-shaped macula was frequently identified by handheld SD-OCT in premature infants, especially those with lower birth weight and severe ROP. The long-term clinical significance of this finding is unknown.
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Affiliation(s)
- Alex T Legocki
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Yasman Moshiri
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Emily M Zepeda
- Department of Ophthalmology, Dean McGee Eye Institute, Oklahoma City, Oklahoma
| | - Thomas B Gillette
- Department of Ophthalmology, University of South Florida Eye Institute, Tampa, Florida
| | - Ayesha Shariff
- Department of Ophthalmology, Case Western Reserve University, Cleveland, Ohio
| | - Laura E Grant
- Department of Ophthalmology, Henry Ford Hospital, Detroit, Michigan
| | - Leona Ding
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle, Washington; Department of Ophthalmology, Seattle Children's Hospital, Seattle, Washington
| | - Michelle T Cabrera
- Department of Ophthalmology, University of Washington, Seattle, Washington; Department of Ophthalmology, Seattle Children's Hospital, Seattle, Washington.
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18
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Kelly JP, Phillips JO, Saneto RP, Khalatbari H, Poliakov A, Tarczy-Hornoch K, Weiss AH. Cerebral Visual Impairment Characterized by Abnormal Visual Orienting Behavior With Preserved Visual Cortical Activation. Invest Ophthalmol Vis Sci 2021; 62:15. [PMID: 33984120 PMCID: PMC8132015 DOI: 10.1167/iovs.62.6.15] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Children with cerebral visual impairment (CVI) often have abnormal visual orienting behaviors due to impaired or damaged visual cortex. Alternatively, visual-cortical function is intact but visual information is not transformed downstream into an appropriate oculomotor output (visuomotor dysfunction). We examined visual, anatomic, and oculomotor assessments to distinguish visuomotor dysfunction from CVI associated with severely reduced visual-cortical response. Methods We reviewed the medical records from children with CVI having abnormal visual orienting behaviors, normal ocular examinations, and born near term. Relevant data were visual evoked potentials (VEPs), Teller card acuity, eye movements recorded by video-oculography (VOG), and neuroimaging (magnetic resonance imaging [MRI]) including diffusion tensor imaging (DTI) tractography. Results Thirty subjects had visuomotor dysfunction based on a normal VEP; of these 33% had a normal MRI and 67% had white matter abnormalities associated with metabolic disease and/or decreased volume of brain parenchyma. VOG recordings showed smooth pursuit gains were uniformly reduced and saccades were dysmetric but followed the main sequence. Ten subjects had severe CVI based on VEPs at noise levels; visual acuities and MRI findings overlapped those of the visuomotor dysfunction group. Developmental delay, seizures, microcephaly, and hypotonia were common across all groups. All subjects with an abnormal conventional MRI had abnormal metrics on DTI tractography from the occipital lobe. Conclusions A subset of patients with CVI have abnormal visual orienting behaviors despite a normal VEP (visuomotor dysfunction). A majority have abnormal white matter metrics on tractography suggesting a downstream defect in sensorimotor transformation. Clinically, visuomotor dysfunction is indistinguishable from severe CVI.
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Affiliation(s)
- John P Kelly
- Roger H. Johnson Vision Clinic, Seattle Children's Hospital, Division of Ophthalmology, Seattle, Washington, United States.,University of Washington, Department of Ophthalmology, Seattle, Washington, United States
| | - James O Phillips
- Roger H. Johnson Vision Clinic, Seattle Children's Hospital, Division of Ophthalmology, Seattle, Washington, United States.,University of Washington School of Medicine, Department of Otolaryngology, Seattle, Washington, United States
| | - Russell P Saneto
- Seattle Children's Hospital, Department of Neurology/Division of Pediatric Neurology, Neuroscience Institute, Seattle, Washington, United States
| | - Hedieh Khalatbari
- Seattle Children's Hospital, Department of Radiology, Seattle, Washington, United States
| | - Andrew Poliakov
- Seattle Children's Hospital, Department of Radiology, Seattle, Washington, United States
| | - Kristina Tarczy-Hornoch
- Roger H. Johnson Vision Clinic, Seattle Children's Hospital, Division of Ophthalmology, Seattle, Washington, United States.,University of Washington, Department of Ophthalmology, Seattle, Washington, United States
| | - Avery H Weiss
- University of Washington, Department of Ophthalmology, Seattle, Washington, United States
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19
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Kelly JP, Tarczy-Hornoch K, Phillips JO, Weiss AH. A reduced visual pathway response in infantile nystagmus syndrome. J AAPOS 2021; 25:9.e1-9.e6. [PMID: 33601041 DOI: 10.1016/j.jaapos.2020.09.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/04/2020] [Accepted: 09/20/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate visual cortical responses in children with infantile nystagmus syndrome (INS) and the potential contribution of foveation periods. METHODS The medical records of children with INS who had visual evoked potential (VEP) recordings to reversing checkerboards and onset of horizontal gratings were reviewed retrospectively. VEP recordings underwent objective selective averaging for extraction of brief periods having consistent amplitude and timing with the stimulus presentation. VEP amplitude, latency, and signal-to-noise ratios (SNR) were compared to results from published age-matched controls under the same conditions. Relative foveation in INS subjects was determined from the proportion of time a video-oculography recording met eye position and velocity criteria. RESULTS A total of 26 children met inclusion criteria. Selective averaging increased VEP amplitude and SNR in INS by 270%-420% compared to standard averaging (P < 0.0001). The INS change in VEP response was greater for reversing checkerboard stimulation than horizontal-grating onset and was significantly greater than that in controls (P < 0.001). Latency was not changed by selective averaging. Relative foveation was correlated with increasing VEP amplitude (P = 0.02) and number of trials chosen for selective averaging (P < 0.01). After selective averaging, relative foveation correlated with VEP amplitude to reversing checkerboards only (P = 0.007). CONCLUSIONS Nystagmus likely causes a reduced visual cortical response in children with INS. A significantly larger response can be extracted from brief periods during nystagmus eye movements, supporting the hypothesis that the INS visual system generates a larger cortical signal during brief foveation periods.
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Affiliation(s)
- John P Kelly
- Division of Ophthalmology, Roger H. Johnson Vision Lab, Seattle Children's Hospital, Seattle, Washington; Department of Ophthalmology, University of Washington Medical Center, Seattle.
| | - Kristina Tarczy-Hornoch
- Division of Ophthalmology, Roger H. Johnson Vision Lab, Seattle Children's Hospital, Seattle, Washington; Department of Ophthalmology, University of Washington Medical Center, Seattle
| | - James O Phillips
- Division of Ophthalmology, Roger H. Johnson Vision Lab, Seattle Children's Hospital, Seattle, Washington; Department of Otolaryngology, University of Washington Medical Center, Seattle
| | - Avery H Weiss
- Division of Ophthalmology, Roger H. Johnson Vision Lab, Seattle Children's Hospital, Seattle, Washington; Department of Ophthalmology, University of Washington Medical Center, Seattle
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Jiang X, Tarczy-Hornoch K, Cotter SA, Matsumura S, Mitchell P, Rose KA, Katz J, Saw SM, Varma R. Association of Parental Myopia With Higher Risk of Myopia Among Multiethnic Children Before School Age. JAMA Ophthalmol 2021; 138:501-509. [PMID: 32191277 DOI: 10.1001/jamaophthalmol.2020.0412] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Parental myopia is an important risk factor for preschool myopia in Asian children. Further investigation of the association between parental myopia and early-onset myopia risk in other racial/ethnic groups, such as African American and Hispanic white children, could improve understanding of the etiology and treatment of this condition. Objective To investigate the association of parental myopia with refractive error and ocular biometry in multiethnic children aged 6 to 72 months. Design, Setting, and Participants This cohort study pooled data from children in 3 population-based studies with comparable design from the US, Singapore, and Australia. Parental myopia was defined as the use of glasses or contact lenses for distance viewing by the child's biological parent(s). Multivariable regressions were conducted to assess the association of parental myopia. Data were collected from 2003 to 2011 and analyzed from 2017 to 2019. Main Outcomes and Measures Cycloplegic refraction and prevalence of myopia (spherical equivalent refractive error of≤-0.5 diopters [D]) in the more myopic eye. Results The analysis cohort included 9793 children, including 4003 Asian, 2201 African American, 1998 Hispanic white, and 1591 non-Hispanic white participants (5106 boys [52.1%]; mean [SD] age, 40.0 [18.9] months). Compared with children without parental myopia, the odds ratios for early-onset myopia were 1.42 (95% CI, 1.20-1.68) for children with 1 parent with myopia, 2.70 (95% CI, 2.19-3.33) for children with 2 parents with myopia, and 3.39 (95% CI, 1.99-5.78) for children with 2 parents with childhood-onset myopia. Even among children without myopia, parental myopia was associated with a greater ratio of axial length to corneal curvature radius (regression coefficient for myopia in both parents, 0.023; P < .001) and more myopic refractive error (regression coefficient for myopia in both parents, -0.20 D; P < .001). Effects of parental myopia were observed in all 4 racial/ethnic groups and across age groups except those younger than 1 year. However, parental myopia was not associated with the age-related trends of refractive error (regression coefficient for children without parental myopeia, 0.08; for children with 2 parents with myopia, 0.04; P = .31 for interaction) and ratio of axial length to corneal curvature radius (regression coefficient for children without parental myopeia, 0.031; for children with 2 parents with myopia, 0.032; P = .89 for interaction) beyond infancy. Conclusions and Relevance Parental myopia, especially childhood-onset parental myopia, was associated with a greater risk of early-onset myopia in Asian, Hispanic, non-Hispanic white, and African American children. The observed associations of parental myopia in children as early as 1 year of age and in children without myopia suggests that genetic susceptibility may play a more important role in early-onset myopia and that parental myopia may contribute to myopia in children by setting up a more myopic baseline before school age.
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Affiliation(s)
- Xuejuan Jiang
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle.,Department of Ophthalmology, Seattle Children's Hospital, Seattle, Washington
| | - Susan A Cotter
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton
| | | | - Paul Mitchell
- Centre for Vision Research, Westmead Institute, Sydney, Australia
| | - Kathryn A Rose
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles
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Fisher MJ, Liu GT, Ferner RE, Gutmann DH, Listernick R, de Blank P, Zeid J, Ullrich NJ, Heidary G, Bornhorst M, Stasheff SF, Rosser T, Borchert M, Ardern-Holmes S, Flaherty M, Hummel TR, Motley WW, Bielamowicz K, Phillips PH, Bouffet E, Reginald A, Wolf DS, Peragallo J, Van Mater D, El-Dairi M, Sato A, Tarczy-Hornoch K, Klesse L, Hogan N, Foreman N, McCourt E, Allen J, Ranka M, Campen C, Beres S, Moertel C, Areaux R, Stearns D, Orge F, Crawford J, O’Halloran H, Brodsky M, Esbenshade AJ, Donahue S, Cutter G, Avery RA. NFB-09. ENROLLMENT AND CLINICAL CHARACTERISTICS OF NEWLY DIAGNOSED, NEUROFIBROMATOSIS TYPE 1 ASSOCIATED OPTIC PATHWAY GLIOMA (NF1-OPG): PRELIMINARY RESULTS FROM AN INTERNATIONAL MULTI-CENTER NATURAL HISTORY STUDY. Neuro Oncol 2020. [PMCID: PMC7715986 DOI: 10.1093/neuonc/noaa222.613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Because treatment and clinical management decisions for children with NF1-OPG remain challenging, we sought to establish evidence-based guidelines. We prospectively enrolled children with newly-diagnosed NF1-OPGs, and gathered standardized clinical neuro-oncology and ophthalmology assessments. METHODS Only children with NF1 and newly diagnosed OPGs, confirmed by central review, were eligible. Indications for obtaining the initial MRI, as well as factors associated with the decision to treat with chemotherapy or observe without treatment, were obtained. Quantitative visual acuity (VA), other ophthalmic features, and imaging were captured at standard time points. Goal enrollment is 250 subjects. RESULTS One-hundred thirty-three children (52% female) from 20 institutions met inclusion criteria, and were included in this preliminary analysis. Eighty-six percent of subjects were able to perform quantitative VA testing at enrollment. The most common reasons for the diagnostic MRI included screening related to NF1 diagnosis (36.8%), ophthalmologic concerns (29.3%), and non-ophthalmologic concerns (24.8%), such as headache. To date, twenty subjects have initiated treatment with chemotherapy, twelve (9%) at the time of the initial OPG diagnosis. Median age at OPG diagnosis was 3.1 years. Age and sex distribution were similar in subjects immediately entering the observation and treatment arms (median age 3.0 versus 3.5 years, respectively). CONCLUSION Most children with NF1-OPGs are observed at time of their initial OPG diagnosis, rather than treated. Importantly, a large proportion of children are able to complete quantitative VA testing at enrollment. Once enrollment is complete, these data will help to establish evidence-based guidelines for clinical management of NF1-OPGs.
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Affiliation(s)
| | - Grant T Liu
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rosalie E Ferner
- Guy’s and St, Thomas’ Hospitals NHS Foundation Trust, London, England, United Kingdom
| | - David H Gutmann
- Washington University School of Medicine, St. Louis, MO, USA
| | - Robert Listernick
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Peter de Blank
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Janice Zeid
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | | | | | | | | | - Tena Rosser
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Mark Borchert
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Maree Flaherty
- The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Trent R Hummel
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - W Walker Motley
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Eric Bouffet
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - David S Wolf
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | | | | | | | | | | | - Laura Klesse
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nick Hogan
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Jeffrey Allen
- New York University Langone Health, New York, NY, USA
| | - Milan Ranka
- New York University Langone Health, New York, NY, USA
| | | | | | | | - Ray Areaux
- University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, USA
| | - Duncan Stearns
- University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Faruk Orge
- University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - John Crawford
- Rady Children’s Hospital, University of California San Diego, San Diego, CA, USA
| | - Henry O’Halloran
- Rady Children’s Hospital, University of California San Diego, San Diego, CA, USA
| | | | | | - Sean Donahue
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gary Cutter
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A Avery
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Tarczy-Hornoch K. Gender equality: reflections on an elusive goal. J AAPOS 2020; 24:329-330. [PMID: 33276096 DOI: 10.1016/j.jaapos.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 11/27/2022]
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23
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Legocki AT, Zepeda EM, Gillette TB, Grant LE, Shariff A, Touch P, Lee AY, Ding L, Estrada MM, Tarczy-Hornoch K, Lee CS, Mayock DE, Pepple KL, Cabrera MT. Vitreous Findings by Handheld Spectral-Domain OCT Correlate with Retinopathy of Prematurity Severity. Ophthalmol Retina 2020; 4:1008-1015. [PMID: 32446843 DOI: 10.1016/j.oret.2020.03.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the association between retinopathy of prematurity (ROP) and vitreous findings in premature infants detected by handheld spectral-domain (SD) OCT. DESIGN Prospective, observational cohort study. PARTICIPANTS Consecutive sample of 92 premature infants requiring ROP screening at 2 academic neonatal intensive care units between July 2015 and March 2018. METHODS Infants underwent handheld SD OCT at the time of routine ROP examinations. Two masked, trained graders analyzed right-eye vitreoretinal findings, including semiautomated quantification of punctate hyperreflective vitreous opacities within 5 foveal or parafoveal B-scans (vitreous opacity ratio). MAIN OUTCOME MEASURES Excluding posttreatment data, vitreous findings were compared with clinical ROP diagnoses. RESULTS Agreement between image graders for all vitreoretinal findings was 91% (κ = 0.86; 95% confidence interval, 0.82-0.90; P < 0.001). Among 92 infants undergoing 280 imaging sessions (52% male; mean gestational age, 28.3 ± 2.8 weeks; mean birthweight, 1014.5 ± 285.0 g), 36 of 92 (39%) demonstrated ROP. Punctate hyperreflective vitreous opacities were identified in 61 of 92 infants (66%). The presence of punctate hyperreflective vitreous opacities at least once was associated with a diagnosis of ROP (62% vs. 29% without opacities; P = 0.003), maximum ROP stage (P = 0.001), preplus or plus disease (24% vs. 5%; P = 0.005), and type 1 disease (14% vs. 2%; P = 0.03). Among 29 infants (45 imaging sessions) with right-eye punctate hyperreflective vitreous opacities, the vitreous opacity ratio from 2 graders (F1 score, 0.82 ± 0.36; Dice coefficient, 0.97 ± 0.04) correlated with ROP stage (P = 0.02). Tractional vitreous bands on imaging correlated with plus disease status (29% vs. 5% without bands; P = 0.05). CONCLUSIONS Punctate hyperreflective vitreous opacities and tractional vitreous bands predict the presence and severity of ROP. Further studies should explore handheld OCT as a noninvasive ROP screening tool.
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Affiliation(s)
- Alex T Legocki
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Emily M Zepeda
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Thomas B Gillette
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Laura E Grant
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Ayesha Shariff
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Phanith Touch
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Leona Ding
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Marcela M Estrada
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle, Washington; Department of Ophthalmology, Seattle Children's Hospital, Seattle, Washington
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Dennis E Mayock
- Department of Pediatrics, University of Washington, Seattle, Washington; Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Kathryn L Pepple
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Michelle T Cabrera
- Department of Ophthalmology, University of Washington, Seattle, Washington; Department of Ophthalmology, Seattle Children's Hospital, Seattle, Washington.
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Meier K, Tarczy-Hornoch K, Fine I, Boynton GM. Using dynamic contrast estimation to assess interocular summation for non-rivalrous stimuli in typical and atypical binocular vision. J Vis 2019. [DOI: 10.1167/19.15.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - Ione Fine
- Department of Psychology, University of Washington
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Zepeda EM, Shariff A, Gillette TB, Grant L, Ding L, Tarczy-Hornoch K, Cabrera MT. Vitreous Bands Identified by Handheld Spectral-Domain Optical Coherence Tomography Among Premature Infants. JAMA Ophthalmol 2019; 136:753-758. [PMID: 29799932 DOI: 10.1001/jamaophthalmol.2018.1509] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Handheld spectral-domain optical coherence tomography (SD-OCT) can provide insights into the complex interactions occurring at the vitreoretinal interface in retinopathy of prematurity (ROP) to enhance our understanding of ROP pathology. Objective To characterize vitreous bands in premature infants with use of handheld SD-OCT. Design, Setting, and Participants Prospective cohort study conducted from July 7, 2015, to February 28, 2017, at 2 university-based neonatal intensive care units. Seventy-three premature infants who required routine ROP screening examination were recruited. Informed consent was obtained from all legal guardians. Trained graders who were masked to the clinical assessment analyzed each SD-OCT scan of the right eye for vitreoretinal findings. A third trained grader mediated disagreements. Main Outcomes and Measures Associations between the presence of vitreous bands in premature infants with ROP diagnoses and the presence of other vitreoretinal SD-OCT findings were investigated. Results Of the 73 infants recruited, 6 infants' parents withdrew their children from the study, and 2 infants were too hemodynamically unstable for imaging, leaving a total of 65 participants. Of these, 32 (49%) were female, 36 (55%) were white, 10 (15%) were Hispanic, 3 (5%) were Native American, 4 (6%) were African American, 4 (7%) were Asian/Pacific Islander, and 8 (12%) were other. The mean (SD) gestational age was 28 (2.7) weeks, the mean (SD) birth weight was 997 g (286 g), and the mean (SD) postmenstrual age at imaging was 34 (3) weeks (mean [SD] total of 3 [2] imaging sessions). Comparing the 24 infants (37%) who had a right eye vitreous band at any time with the 41 (63%) who did not, no difference in mean birth weight, gestational age, postmenstrual age at imaging, sex, or race/ethnicity was identified. No associations with ROP stage (eg, in 6 [25%] infants with vitreous bands vs 4 [9.8%] in those without; P = .23), presence of plus disease (2 [8%] vs 2 [5%]; P = .84), or type 1 ROP (3 [12%] vs 3 [7%]; P = .66) were identified. Vitreous bands were associated with epiretinal membrane detected on SD-OCT (P = .001) with an odds ratio of 9.4 (95% CI, 2.8-31.3) in 15 [62%] infants with vitreous bands vs 6 [15%] in those without. Vitreous bands were also associated with cystoid macular edema (in 15 [62%] infants with vitreous bands vs 1 [27%] in those without; P = .005) with an odds ratio of 4.5 (95% CI, 1.5-13.3). Conclusions and Relevance In this study, the development of vitreous bands was associated with both cystoid macular edema and epiretinal membrane. These findings suggest a tractional pathogenesis to these entities among premature infants. This study did not find a direct association between vitreous bands and severe ROP. Additional study is needed to determine whether vitreous bands represent subclinical hyaloidal organization leading to retinal detachment in advanced ROP.
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Affiliation(s)
- Emily M Zepeda
- Department of Ophthalmology, University of Washington, Seattle
| | - Ayesha Shariff
- Department of Ophthalmology, Case Western Reserve University, Cleveland, Ohio
| | - Thomas B Gillette
- Department of Ophthalmology, University of Washington, Seattle.,Department of Ophthalmology, Seattle Children's Hospital, Seattle, Washington
| | - Laura Grant
- Department of Ophthalmology, Henry Ford Hospital, Detroit, Michigan
| | - Leona Ding
- Department of Ophthalmology, University of Washington, Seattle
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle.,Department of Ophthalmology, Seattle Children's Hospital, Seattle, Washington
| | - Michelle T Cabrera
- Department of Ophthalmology, University of Washington, Seattle.,Department of Ophthalmology, Seattle Children's Hospital, Seattle, Washington
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Moshiri Y, Legocki AT, Zhou K, Cabrera MT, Rezaei KA, Tarczy-Hornoch K, Wang RK. Handheld swept-source optical coherence tomography with angiography in awake premature neonates. Quant Imaging Med Surg 2019; 9:1495-1502. [PMID: 31667136 DOI: 10.21037/qims.2019.09.01] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 12/21/2022]
Abstract
Background Retinopathy of prematurity (ROP) can lead to retinal detachment and severe vision loss and is a common cause of childhood blindness. Optical coherence tomography angiography (OCTA) is a non-invasive imaging modality that can be used to detect potential abnormalities in the microvasculature in this population. The objective of this study is to assess the feasibility of a newly developed handheld swept source OCT (SS-OCT) device to successfully acquire structural vitreoretinal and retinal microvascular images in awake premature infants. Methods OCT and OCTA images were acquired at the time of routine ROP examinations from awake, unsedated preterm infants in the Neonatal Intensive Care Unit using a clinical research prototype handheld probe integrated with an SS-OCT system working at 1,060 nm wavelength and an imaging speed of 200,000 A-scans per second (200 kHz), enabling volume OCT and OCTA scans. Each volume was acquired with approximately 36˚ field of view (~6.3×6.3 mm in infants) in 4.8 s. Quality of acquired OCT and OCTA volume images, microvascular information, and vitreoretinal features were determined by 3-masked grader consensus. Results Twelve infants (5 females, mean gestational age 28.3 weeks, median birth weight 901 g, stages 0 to 3 ROP) underwent a total of 73 individual eye imaging sessions. High-quality OCT images of the fovea and the optic nerve were present in 69/73 (94.5%) and 56/73 (76.7%) scans, respectively. Vitreous bands were observed in 10/73 (13.7%); punctate hyperreflective vitreous opacities in 47/73 (64.4%); epiretinal membrane (ERM) in 6/73 (8.2%); and cystoid macular edema (CME) in 12/73 (16.4%) scans. Mild vessel elevation was noted in 3/73 (4.1%) images, and severe vessel elevation in 4/73 (5.5%) scans. OCTA images obtained in 8 awake infants revealed good quality images of the foveal microvasculature in 11/19 (58%) eye imaging sessions for 6/8 (75%) infants; and peripapillary microvasculature in 14/19 (74%) eye imaging sessions for 5/8 (63%) infants. Conclusions The SS-OCTA handheld device can capture important vitreoretinal characteristics such as peripapillary and foveal microvasculature, as well as hyperreflective punctate vitreous opacities and tractional vitreous bands, which may predict ROP severity. These images were captured in awake, premature infants without the use of direct ocular contact, an eyelid speculum, or sedation.
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Affiliation(s)
- Yasman Moshiri
- Department of Ophthalmology, University of Washington, Seattle, WA 98195, USA
| | - Alex T Legocki
- Department of Ophthalmology, University of Washington, Seattle, WA 98195, USA
| | - Kanheng Zhou
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Michelle T Cabrera
- Department of Ophthalmology, University of Washington, Seattle, WA 98195, USA.,Department of Ophthalmology, Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Kasra A Rezaei
- Department of Ophthalmology, University of Washington, Seattle, WA 98195, USA
| | | | - Ruikang K Wang
- Department of Ophthalmology, University of Washington, Seattle, WA 98195, USA.,Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
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Jiang X, Tarczy-Hornoch K, Stram D, Katz J, Friedman DS, Tielsch JM, Matsumura S, Saw SM, Mitchell P, Rose KA, Cotter SA, Varma R. Prevalence, Characteristics, and Risk Factors of Moderate or High Hyperopia among Multiethnic Children 6 to 72 Months of Age: A Pooled Analysis of Individual Participant Data. Ophthalmology 2019; 126:989-999. [PMID: 30822446 DOI: 10.1016/j.ophtha.2019.02.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/15/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To describe the prevalence, ocular characteristics, and associated risk factors of moderate to high hyperopia in early childhood. DESIGN Pooled analysis of individual participant data from population-based studies. PARTICIPANTS Six- to 72-month-old multiethnic children who participated in 4 population-based studies of pediatric eye diseases. METHODS The pooled studies conducted comparable parental interviews and ocular examinations including cycloplegic autorefraction. Presence of hyperopia was defined based on cycloplegic refractive error in the worse eye. Multivariate analyses were performed to evaluate the association of potential risk factors with hyperopia risk. MAIN OUTCOME MEASURES Prevalence and odds ratios of moderate to high hyperopia (≥4.0 diopters [D]). RESULTS Cycloplegic refraction was completed in 15 051 children 6 to 72 months of age. Among these children, the overall prevalence of moderate to high hyperopia (≥4.0 D) in the worse eye was 3.2% (95% confidence interval, 2.9%-3.5%), accounting for 15.6% of all hyperopia (≥2.0 D). Among children with moderate to high hyperopia, both eyes were affected in 64.4%, 28.9% showed spherical anisometropia of 1.0 D or more, and 19.5% showed astigmatism of 1.5 D or more. Among 36- to 72-month-old children with moderate to high hyperopia, 17.6% wore glasses. Prevalence of moderate to high hyperopia was slightly less in 12- to 23-month-old children and was relatively stable in children 24 months of age and older. Non-Hispanic and Hispanic white race and ethnicity, family history of strabismus, maternal smoking during pregnancy, and being a participant in the United States studies were associated with a higher risk of moderate to high hyperopia (P < 0.05). CONCLUSIONS By assembling similarly designed studies, our consortium provided robust estimates of the prevalence of moderate to high hyperopia in the general population and showed that in 6- to 72-month-old children, moderate to high hyperopia is not uncommon and its prevalence does not decrease with age. Risk factors for moderate to high hyperopia differ from those for low to moderate hyperopia (2.0-<4.0 D) in preschool children, with family history of strabismus and maternal smoking during pregnancy more strongly associated with moderate to high hyperopia than low to moderate hyperopia.
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Affiliation(s)
- Xuejuan Jiang
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California.
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle, Washington; Department of Ophthalmology, Seattle Children's Hospital, Seattle, Washington
| | - Douglas Stram
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David S Friedman
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Saiko Matsumura
- Singapore Eye Research Institute, Singapore, Republic of Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore, Republic of Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
| | - Paul Mitchell
- Centre for Vision Research, Westmead Institute, Sydney, Australia
| | - Kathryn A Rose
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Susan A Cotter
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California
| | - Rohit Varma
- Southern California Eyecare and Vision Research Institute, CHA Medical Group PC, Hollywood Presbyterian Medical Center, Los Angeles, California
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Zhang X, Wang Y, Ulrich JN, Yang Y, Ding L, Yang Y, Xu D, Tarczy-Hornoch K, Cabrera MT. Evaluation of retinopathy of prematurity incidence with telemedicine confirmation in Gansu, China: a pilot study. Ophthalmic Epidemiol 2017; 25:120-125. [PMID: 29095074 DOI: 10.1080/09286586.2017.1368671] [Citation(s) in RCA: 3] [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: 12/18/2022]
Abstract
PURPOSE To determine the incidence of retinopathy of prematurity (ROP) in Gansu, China by combining bedside examinations with remote RetCam (Clarity Medical Systems, Pleasanton, CA, USA) diagnosis. METHODS ROP screening via indirect ophthalmoscopy followed by RetCam imaging was performed from 2014 to 2015. Three ROP-experienced ophthalmologists interpreted images remotely. Incidence of ROP was determined by combining bedside and telemedicine diagnoses. RESULTS Of 139 examined infants and 137 complete records, 20 (14.6%) patients developed ROP, with 11 (8.0%) stage 1, six (4.4%) stage 2, and three (2.2%) stage 3 based on combined diagnoses. Perinatal asphyxia was significantly associated with ROP incidence (p = 0.01). ROP incidence by combined diagnosis (20/137 or 14.6%) versus clinician diagnosis alone (21/137 or 15.3%, p = 0.50) was similar. Telemedicine changed diagnoses in 4/21 (19.0%) ROP cases. CONCLUSIONS Telemedicine may be helpful in confirming ROP incidence and may serve as a training and support model for less experienced and professionally isolated ROP examiners.
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Affiliation(s)
- Xinxin Zhang
- a University of North Carolina School of Medicine , Chapel Hill , NC , USA
| | - Yuping Wang
- b Department of Ophthalmology , Second Hospital of Lanzhou University , Lanzhou , China
| | - J Niklas Ulrich
- c Department of Ophthalmology , University of North Carolina Kittner Eye Center , Chapel Hill , NC , USA
| | - Yi Yang
- b Department of Ophthalmology , Second Hospital of Lanzhou University , Lanzhou , China
| | - Leona Ding
- d Department of Ophthalmology , University of Washington , Seattle , WA , USA
| | - Yi Yang
- a University of North Carolina School of Medicine , Chapel Hill , NC , USA.,e University of North Carolina Gillings School of Global Public Health , Chapel Hill , NC , USA
| | - Ding Xu
- f Department of Neonatology , Second Hospital of Lanzhou University , Lanzhou , China
| | - Kristina Tarczy-Hornoch
- d Department of Ophthalmology , University of Washington , Seattle , WA , USA.,g Department of Ophthalmology , Seattle Children's Hospital , Seattle , WA , USA
| | - Michelle T Cabrera
- d Department of Ophthalmology , University of Washington , Seattle , WA , USA.,g Department of Ophthalmology , Seattle Children's Hospital , Seattle , WA , USA
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Varma R, Tarczy-Hornoch K, Jiang X. Visual Impairment in Preschool Children in the United States: Demographic and Geographic Variations From 2015 to 2060. JAMA Ophthalmol 2017; 135:610-616. [PMID: 28472231 DOI: 10.1001/jamaophthalmol.2017.1021] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Visual impairment (VI) in early childhood can significantly impair development. Objective To determine demographic and geographic variations in VI in children aged 3 to 5 years in the United States in 2015 and to estimate projected prevalence through 2060. Design, Setting, and Participants Descriptive study reporting statistics estimated based on prevalence data from 2 major population-based studies conducted in the United States between 2003 and 2011. Using US census projections, prevalence of VI and cause-specific VI in the better eye were reported by race/ethnicity, state and region, and per capita prevalence of VI by state. The study included preschool children in the United States. Analyses for this study were conducted between February 2016 and March 2017. Main Outcomes and Measures Prevalence of VI among children aged 3 to 5 years in the United States. Results In 2015, more than 174 000 children aged 3 to 5 years in the United States were visually impaired. Almost 121 000 of these cases (69%) arose from simple uncorrected refractive error, and 43 000 (25%) from bilateral amblyopia. By 2060, the number of children aged 3 to 5 years with VI is projected to increase by 26%. In 2015, Hispanic white children accounted for the highest number of VI cases (66 000); this group will remain the most affected through 2060, with an increasingly large proportion of cases (37.7% in 2015 and 43.6% in 2060). The racial/ethnic group with the second most VI is projected to shift from non-Hispanic white children (26.3% in 2015 decreasing to 16.5% in 2060) to African American children (24.5% in 2015 and 22.0% in 2060). From 2015 to 2060, the states projected to have the most children with VI are California (26 600 in 2015 and 38 000 in 2060), Texas (21 500 in 2015 and 29 100 in 2060), and Florida (10 900 in 2015 and 13 900 in 2060). Conclusions and Relevance These data suggest that the number of preschool children with VI is projected to increase disproportionally, especially among minority populations. Vision screening for refractive error and related eye diseases may prevent a high proportion of preschool children from experiencing unnecessary VI and associated developmental delays.
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Affiliation(s)
- Rohit Varma
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles2Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle4Seattle Children's Hospital, Seattle, Washington
| | - Xuejuan Jiang
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles2Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
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Walton MMG, Pallus A, Fleuriet J, Mustari MJ, Tarczy-Hornoch K. Neural mechanisms of oculomotor abnormalities in the infantile strabismus syndrome. J Neurophysiol 2017; 118:280-299. [PMID: 28404829 DOI: 10.1152/jn.00934.2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 12/12/2016] [Revised: 04/03/2017] [Accepted: 04/07/2017] [Indexed: 02/08/2023] Open
Abstract
Infantile strabismus is characterized by numerous visual and oculomotor abnormalities. Recently nonhuman primate models of infantile strabismus have been established, with characteristics that closely match those observed in human patients. This has made it possible to study the neural basis for visual and oculomotor symptoms in infantile strabismus. In this review, we consider the available evidence for neural abnormalities in structures related to oculomotor pathways ranging from visual cortex to oculomotor nuclei. These studies provide compelling evidence that a disturbance of binocular vision during a sensitive period early in life, whatever the cause, results in a cascade of abnormalities through numerous brain areas involved in visual functions and eye movements.
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Affiliation(s)
- Mark M G Walton
- Washington National Primate Research Center, University of Washington, Seattle, Washington;
| | - Adam Pallus
- Washington National Primate Research Center, University of Washington, Seattle, Washington.,Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Jérome Fleuriet
- Washington National Primate Research Center, University of Washington, Seattle, Washington.,Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Michael J Mustari
- Washington National Primate Research Center, University of Washington, Seattle, Washington.,Department of Ophthalmology, University of Washington, Seattle, Washington.,Department of Biological Structure, University of Washington, Seattle, Washington; and
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle, Washington.,Seattle Children's Hospital, Seattle, Washington
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Kelly JP, Tarczy-Hornoch K, Herlihy E, Weiss AH. Occlusion therapy improves phase-alignment of the cortical response in amblyopia. Vision Res 2015; 114:142-50. [DOI: 10.1016/j.visres.2014.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 11/10/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
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Abstract
PURPOSE The purpose of this study was to compare the accommodative performance of the amblyopic eye of children with unilateral amblyopia to that of their nonamblyopic eye, and also to that of children without amblyopia, during both monocular and binocular viewing. METHODS Modified Nott retinoscopy was used to measure accommodative performance of 38 subjects with unilateral amblyopia and 25 subjects with typical vision from 3 to 13 years of age during monocular and binocular viewing at target distances of 50, 33, and 25 cm. The relationship between accommodative demand and interocular difference (IOD) in accommodative error was assessed in each group. RESULTS The mean IOD in monocular accommodative error for amblyopic subjects across all three viewing distances was 0.49 diopters (D) (95% confidence interval [CI], ±1.12 D) in the 180° meridian and 0.54 D (95% CI, ±1.27 D) in the 90° meridian, with the amblyopic eye exhibiting greater accommodative errors on average. Interocular difference in monocular accommodative error increased significantly with increasing accommodative demand; 5%, 47%, and 58% of amblyopic subjects had monocular errors in the amblyopic eye that fell outside the upper 95% confidence limit for the better eye of control subjects at viewing distances of 50, 33, and 25 cm, respectively. CONCLUSIONS When viewing monocularly, children with unilateral amblyopia had greater mean accommodative errors in their amblyopic eyes than in their nonamblyopic eyes, and when compared with control subjects. This could lead to unintended retinal image defocus during patching therapy for amblyopia.
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Affiliation(s)
- Vivian Manh
- Seattle Children's Hospital, Division of Ophthalmology, Seattle, Washington, United States
| | - Angela M Chen
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California, United States
| | | | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California, United States
| | - T Rowan Candy
- Indiana University School of Optometry, Bloomington, Indiana, United States
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Xie JZ, Tarczy-Hornoch K, Lin J, Cotter SA, Torres M, Varma R. Color vision deficiency in preschool children: the multi-ethnic pediatric eye disease study. Ophthalmology 2014; 121:1469-74. [PMID: 24702753 PMCID: PMC4839481 DOI: 10.1016/j.ophtha.2014.01.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/13/2014] [Accepted: 01/14/2014] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the sex- and ethnicity-specific prevalence of color vision deficiency (CVD) in black, Asian, Hispanic, and non-Hispanic white preschool children. DESIGN Population-based, cross-sectional study. PARTICIPANTS The Multi-Ethnic Pediatric Eye Disease Study is a population-based evaluation of the prevalence of vision disorders in children in Southern California. A total of 5960 subjects 30 to 72 months of age were recruited for the study, of whom 4177 were able to complete color vision testing (1265 black, 812 Asian, 1280 Hispanic, and 820 non-Hispanic white). METHODS Color vision testing was performed using Color Vision Testing Made Easy color plates (Home Vision Care, Gulf Breeze, FL), and diagnostic confirmatory testing was performed using the Waggoner HRR Diagnostic Test color plates (Home Vision Care). MAIN OUTCOME MEASURES Testability of color vision in preschool children between 30 and 72 months of age and prevalence of CVD stratified by age, sex, and ethnicity. RESULTS Testability was 17% in children younger than 37 months of age, increasing to 57% in children 37 to 48 months of age, 89% in children 49 to 60 months of age, and 98% in children 61 to 72 months of age. The prevalence of CVD among boys was 1.4% for black, 3.1% for Asian, 2.6% for Hispanic, and 5.6% for non-Hispanic white children; the prevalence in girls was 0.0% to 0.5% for all ethnicities. The ethnic difference in CVD was statistically significant between black and non-Hispanic white children (P = 0.0003) and between Hispanic and non-Hispanic white children (P = 0.02). In boys, most CVD cases were either deutan (51%) or protan (34%); 32% were classified as mild, 15% as moderate, and 41% as severe. CONCLUSIONS Testability for CVD in preschool children is high by 4 years of age. The prevalence of CVD in preschool boys varies by ethnicity, with the highest prevalence in non-Hispanic white and lowest in black children.
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Affiliation(s)
- John Z Xie
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California; Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Jesse Lin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California
| | - Mina Torres
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Rohit Varma
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois; Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California.
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McKean-Cowdin R, Cotter SA, Tarczy-Hornoch K, Wen G, Kim J, Borchert M, Varma R. Prevalence of amblyopia or strabismus in asian and non-Hispanic white preschool children: multi-ethnic pediatric eye disease study. Ophthalmology 2013; 120:2117-24. [PMID: 23697956 DOI: 10.1016/j.ophtha.2013.03.001] [Citation(s) in RCA: 209] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 02/28/2013] [Accepted: 03/01/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To determine the age- and race-specific prevalence of amblyopia in Asian and non-Hispanic white children aged 30 to 72 months and of strabismus in children aged 6 to 72 months. DESIGN Cross-sectional survey. PARTICIPANTS A population-based, multiethnic sample of children aged 6 to 72 months was identified in Los Angeles and Riverside counties in California to evaluate the prevalence of ocular conditions. METHODS A comprehensive eye examination and in-clinic interview were conducted with 80% of eligible children. The examination included evaluation of ocular alignment, refractive error, and ocular structures in children aged 6 to 72 months, as well as a determination of optotype visual acuity (VA) in children aged 30 to 72 months. MAIN OUTCOME MEASURES The proportion of 6- to 72-month-old participants with strabismus and 30- to 72-month-olds with optotype VA deficits and amblyopia risk factors consistent with study definitions of amblyopia. RESULTS Strabismus was found in 3.55% (95% confidence interval [CI], 2.68-4.60) of Asian children and 3.24% (95% CI, 2.40-4.26) of non-Hispanic white children, with a higher prevalence with each subsequent older age category from 6 to 72 months in both racial/ethnic groups (P=0.0003 and 0.02, respectively). Amblyopia was detected in 1.81% (95% CI, 1.06-2.89) of Asian and non-Hispanic white children; the prevalence of amblyopia was higher for each subsequent older age category among non-Hispanic white children (P=0.01) but showed no significant trend among Asian children (P=0.30). CONCLUSIONS The prevalence of strabismus was similar in Asian and non-Hispanic white children and was found to be higher among older children from 6 to 72 months. The prevalence of amblyopia was the same in Asian and non-Hispanic white children; prevalence seemed to be higher among older non-Hispanic white children but was relatively stable by age in Asian children. These findings may help clinicians to better understand the patterns of strabismus and amblyopia and potentially inform planning for preschool vision screening programs. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Roberta McKean-Cowdin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
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Abstract
PURPOSE To measure accommodative performance as a function of refractive error in very young children. METHODS This was a prospective study of accommodation lag in multiethnic typically developing children ages 5 to 24 months. Accommodation lag was measured by means of a modified bell retinoscopy technique. Refraction was measured by cycloplegic retinoscopy, and right and left eye results were averaged. The study compared accommodative performance to cycloplegic spherical equivalent and astigmatic refractive error. RESULTS Analysis of data from 189 of 203 subjects revealed that larger lags and lower gain of the accommodative response were more common in younger children, although most children of all ages accommodated well, with 95% having lags <1.25 D. Larger accommodation lags were associated with greater spherical equivalent refractive error, although only with hyperopia ≥4.0 D were lags ≥1.25 D observed in a majority of children. Larger lags in the more hyperopic meridian were seen with increasing hyperopic with-the-rule astigmatism, but lag in the more hyperopic meridian varied little with the amount of myopic or mixed astigmatism. CONCLUSIONS Most 5- to 24-month-old children accommodate well over a range of moderate hyperopic refractive errors, but hyperopia ≥4.0 D is rarely associated with normal accommodative performance. Hyperopic and mixed or myopic astigmatic children show different patterns of accommodation, which may explain the patterns of visual acuity deficits seen in these children.
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Affiliation(s)
- Kristina Tarczy-Hornoch
- Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Chen VJ, Tarczy-Hornoch K. Functional magnetic resonance imaging of binocular interactions in visual cortex in strabismus. J Pediatr Ophthalmol Strabismus 2011; 48:366-74. [PMID: 21117523 DOI: 10.3928/01913913-20101118-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 11/28/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To observe changes in primary visual cortical activation associated with perceptual suppression in individuals with strabismus, using functional magnetic resonance imaging (fMRI). METHODS In Phase 1, pilot data were collected from 1 control and 8 strabismic participants, including 5 with amblyopia. In Phase 2, results were collected from 7 participants with strabismus (2 recalled and 5 new), including 2 with amblyopia. fMRI compared primary visual cortex activation in two conditions: visual stimuli presented to both eyes, to evoke perceptual suppression of one eye in individuals with strabismus, and visual stimulation presented only to one eye. RESULTS Visual cortical activity modulations positively correlated with perceptual suppression were seen in 3 of 5 non-amblyopic Phase 2 study participants, but not in amblyopic subjects. CONCLUSION Cortical activity modulations correlated with modulation of strabismic suppression are detectable in non-amblyopic individuals using fMRI, suggesting a neural basis for strabismic suppression in primary visual cortex.
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Affiliation(s)
- Vincent J Chen
- Department of Radiology and Vision Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA
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McKean-Cowdin R, Varma R, Cotter SA, Tarczy-Hornoch K, Borchert MS, Lin JH, Wen G, Azen SP, Torres M, Tielsch JM, Friedman DS, Repka MX, Katz J, Ibironke J, Giordano L. Risk factors for astigmatism in preschool children: the multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies. Ophthalmology 2011; 118:1974-81. [PMID: 21856010 DOI: 10.1016/j.ophtha.2011.06.031] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 06/23/2011] [Accepted: 06/23/2011] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To evaluate risk factors for astigmatism in a population-based sample of preschool children. DESIGN Population-based cross-sectional study. PARTICIPANTS Population-based samples of 9970 children ages 6 to 72 months from Los Angeles County, California, and Baltimore, Maryland. METHODS A cross-sectional study of children participating in the Multiethnic Pediatric Eye Disease Study and the Baltimore Eye Disease Study was completed. Data were obtained by clinical examination or by in-person interview. Odds ratios and 95% confidence intervals (CI) were calculated to evaluate potential associations between clinical, behavioral, or demographic factors and astigmatism. MAIN OUTCOME MEASURES Odds ratios (ORs) for various risk factors associated with astigmatism. RESULTS Participants with myopia (≤-1.0 diopters) were 4.6 times as likely to have astigmatism (95% CI, 3.56-5.96) than those without refractive error, whereas participants with hyperopia (≥+2.00 diopters) were 1.6 times as likely (95% CI, 1.39-1.94). Children 6 to <12 months of age were approximately 3 times as likely to have astigmatism than children 5 to 6 years of age (95% CI, 2.28-3.73). Both Hispanic (OR, 2.38) and African-American (OR, 1.47) children were as likely to have astigmatism than non-Hispanic white children. Furthermore, children whose mothers smoked during pregnancy were 1.46 times (95% CI, 1.14-1.87) as likely to have astigmatism than children whose mothers did not smoke. CONCLUSIONS In addition to infancy, Hispanic and African-American race/ethnicity and correctable/modifiable risk factors such as myopia, hyperopia, and maternal smoking during pregnancy are associated with a higher risk of having astigmatism. Although the prevalence of smoking during pregnancy is typically low, this association may suggest etiologic pathways for future investigation. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
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Affiliation(s)
- Roberta McKean-Cowdin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Cotter SA, Varma R, Tarczy-Hornoch K, McKean-Cowdin R, Lin J, Wen G, Wei J, Borchert M, Azen SP, Torres M, Tielsch JM, Friedman DS, Repka MX, Katz J, Ibironke J, Giordano L. Risk factors associated with childhood strabismus: the multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies. Ophthalmology 2011; 118:2251-61. [PMID: 21856012 DOI: 10.1016/j.ophtha.2011.06.032] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 06/23/2011] [Accepted: 06/23/2011] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To investigate risk factors associated with esotropia or exotropia in infants and young children. DESIGN Population-based cross-sectional prevalence study. PARTICIPANTS Population-based samples of 9970 children 6 to 72 months of age from California and Maryland. METHODS Participants were preschool African-American, Hispanic, and non-Hispanic white children participating in the Multi-Ethnic Pediatric Eye Disease Study and the Baltimore Eye Disease Study. Data were obtained by parental interview and ocular examination. Odd ratios and 95% confidence intervals were calculated to evaluate the association of demographic, behavioral, and clinical risk factors with esotropia and exotropia. MAIN OUTCOME MEASURES Odds ratios (ORs) for various risk factors associated with esotropia or exotropia diagnosis based on cover testing. RESULTS In multivariate logistic regression analysis, esotropia was associated independently with prematurity, maternal smoking during pregnancy, older preschool age (48-72 months), anisometropia, and hyperopia. There was a severity-dependent association of hyperopia with the prevalence of esotropia, with ORs increasing from 6.4 for 2.00 diopters (D) to less than 3.00 D of hyperopia, to 122.0 for 5.00 D or more of hyperopia. Exotropia was associated with prematurity, maternal smoking during pregnancy, family history of strabismus, female sex, astigmatism (OR, 2.5 for 1.50 to <2.50 D of astigmatism, and 5.9 for ≥2.5 D of astigmatism), and anisoastigmatism in the J0 component (OR, ≥2 for J0 anisoastigmatism of ≥0.25 D). CONCLUSIONS Prematurity and maternal smoking during pregnancy are associated with a higher risk of having esotropia and exotropia. Refractive error is associated in a severity-dependent manner to the prevalence of esotropia and exotropia. Because refractive error is correctable, these risk associations should be considered when developing guidelines for the screening and management of refractive error in infants and young children. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Susan A Cotter
- Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Fozailoff A, Tarczy-Hornoch K, Cotter S, Wen G, Lin J, Borchert M, Azen S, Varma R. Prevalence of astigmatism in 6- to 72-month-old African American and Hispanic children: the Multi-ethnic Pediatric Eye Disease Study. Ophthalmology 2011; 118:284-93. [PMID: 20888047 DOI: 10.1016/j.ophtha.2010.06.038] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 06/29/2010] [Accepted: 06/29/2010] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To determine the age-, gender-, and ethnicity-specific prevalence of astigmatism in African American and Hispanic children aged 6 to 72 months. DESIGN Population-based, cross-sectional study. PARTICIPANTS The Multi-Ethnic Pediatric Eye Disease Study is a population-based evaluation of the prevalence of vision disorders in children ages 6 to 72 months in Los Angeles County, California. Seventy-seven percent of eligible children completed a comprehensive eye examination. This report provides the results from 2994 African American and 3030 Hispanic children. METHODS Eligible children in 44 census tracts were identified during an in-home interview and scheduled for a comprehensive eye examination and in-clinic interview. Cycloplegic autorefraction was used to determine refractive error. MAIN OUTCOME MEASURES The proportion of children with astigmatism defined as cylindrical refractive error ≥ 1.50 diopters (D) in the worse eye. The astigmatism type was defined as with-the-rule (WTR) (+ cylinder axis 90 ± 15 degrees) and against-the-rule (ATR) (+ cylinder axis 180 ± 15 degrees); all other orientations were considered oblique (OBL). The prevalence of astigmatism and its types were also determined for worse eye cylindrical refractive error ≥ 3.00 D. RESULTS Prevalence of astigmatism ≥ 1.50 D was higher in Hispanic children compared with African American children (16.8% vs. 12.7%, respectively; P<0.0001). Hispanic children also showed a higher prevalence of astigmatism ≥ 3.00 D than African American children (2.9% vs. 1.0% respectively; P<0.0001). The prevalence of astigmatism ≥ 1.50 D showed a significant decreasing trend with age (P<0.0001). The prevalence of WTR, ATR, and OBL astigmatism ≥ 1.50 D was 13.9%, 0.6%, and 2.2%, respectively, in Hispanic children, and 7.8%, 2.2%, and 2.7%, respectively, in African American children. CONCLUSIONS We observed ethnicity-related differences in astigmatism prevalence in preschool children. The age-related decrease in astigmatism prevalence in preschool children likely reflects emmetropization.
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Affiliation(s)
- Arezoo Fozailoff
- Department of Ophthalmology, Doheny Eye Institute, 1450 San Pablo St, Room 4900, Los Angeles, CA 90033, USA
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Wen G, McKean-Cowdin R, Varma R, Tarczy-Hornoch K, Cotter SA, Borchert M, Azen S. General health-related quality of life in preschool children with strabismus or amblyopia. Ophthalmology 2010; 118:574-80. [PMID: 20884059 DOI: 10.1016/j.ophtha.2010.06.039] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 06/30/2010] [Accepted: 06/30/2010] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To explore the associations of general health-related quality of life (GHRQOL) with strabismus or amblyopia in preschool children. DESIGN Population-based study. PARTICIPANTS Sample of children aged 25 to 72 months in the Multi-ethnic Pediatric Eye Disease Study (MEPEDS). METHODS The Pediatric Quality of Life Inventory (PedsQL), a measure of GHRQOL, was administered to the parents of the children. MAIN OUTCOME MEASURES The PedsQL consists of 4 subscales (physical, emotional, social, and school functioning) and 3 composite scores (physical summary, psychosocial summary, and total). Regression models were used to evaluate the associations of GHRQOL with strabismus (in children 25-72 months) or amblyopia (in children 30-72 months). RESULTS Of the 4218 children aged ≥25 months, 121 (2.9%) were diagnosed with strabismus. Significant differences were found in all 3 composite scores between children with and without strabismus, before and after controlling for gender, age, race, family income, systemic health conditions, and prior knowledge of strabismus diagnosis (P<0.05). These differences were present in esotropes, exotropes, children with intermittent strabismus, and children with constant strabismus. A total of 3318 children were aged ≥30 months, and 71 children (2.1%) had amblyopia. There were no significant differences in any PedsQL scores between children with and without amblyopia, even after adjusting for gender, age, race, and family income (P>0.05). CONCLUSIONS Strabismus was associated with significantly worse GHRQOL in preschool children. Although we did not find any detectable association between amblyopia and GHRQOL, further study using vision-specific instruments is required to explore the impact of both strabismus and amblyopia on pediatric quality of life.
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Affiliation(s)
- Ge Wen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Nazarian-Mobin SS, Simms K, Urata MM, Tarczy-Hornoch K, Hammoudeh JA. Misleading presentation of an orbital lymphangioma. ACTA ACUST UNITED AC 2009; 109:e82-5. [PMID: 20031456 DOI: 10.1016/j.tripleo.2009.08.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 08/31/2009] [Indexed: 11/26/2022]
Abstract
We describe a 2-year-old patient with an orbital lymphangioma who presented with massive proptosis. We highlight the importance of magnetic resonance imaging in evaluating such patients, because physical examination can be misleading. We also demonstrate the difficulties of managing recurrent hemorrhages when only subtotal excision is possible, as is frequently the case.
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Affiliation(s)
- Sheila S Nazarian-Mobin
- Division of Plastic Surgery, University of Southern California, Children's Hospital Los Angeles, Los Angeles, California 90027, USA.
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Borchert M, Tarczy-Hornoch K, Cotter SA, Liu N, Azen SP, Varma R. Anisometropia in Hispanic and african american infants and young children the multi-ethnic pediatric eye disease study. Ophthalmology 2009; 117:148-153.e1. [PMID: 19818509 DOI: 10.1016/j.ophtha.2009.06.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 04/25/2009] [Accepted: 06/04/2009] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To determine anisometropia prevalence and associated risk factors in Hispanic and African American preschoolers. DESIGN Population-based, cross-sectional study. PARTICIPANTS We included 3030 Hispanic and 2994 African American children aged 6 to 72 months from Inglewood, California. METHODS Retinomax autorefraction was performed on all participants after cycloplegia. Anisometropia was defined by difference in spherical equivalent (SE), by difference in plus cylinder in any axis (cylindrical), and by difference in cylinder axis vectors (vertical Jackson cross cylinder vector [J0] and oblique Jackson cross cylinder vector [J45] between the eyes. Strabismus was determined by prism-cover testing. A parental questionnaire explored potential risk factors including developmental delay, prematurity, prenatal exposure, and family history. MAIN OUTCOME MEASURES Anisometropia prevalence stratified by age, gender, and ethnicity. The association of anisometropia with strabismus and other biological risk factors was assessed. RESULTS The prevalence of SE anisometropia > or =1.0 diopter (D) was 4.3% for Hispanics and 4.2% for African Americans. Prevalence of cylindrical anisometropia > or =1.0 D was 5.6% and 4.5%, respectively. Prevalence of cylindrical or SE anisometropia > or =3.0 D was < or =0.4% for both ethnic groups. Cylinder vector anisometropia > or =0.5 was twice as common as cylindrical anisometropia > or =1.0 D. The SE anisometropia decreased at age 1 year in Hispanics (P = 0.0016) but not African Americans. Cylindrical anisometropia decreased in the first year of life in both ethnic groups (P < or = 0.001). There was no trend in SE or cylindrical anisometropia beyond 1 year of age, but cylinder vector anisometropia steadily decreased beyond 1 year of age in both ethnic groups. Cylinder vector anisometropia was more prevalent among African Americans, but there was no difference in other measurements of anisometropia between ethnic groups. Anisometropia did not vary by gender. Strabismus was associated with all types of anisometropia. No association of anisometropia with gestational age, birth weight, cerebral palsy, family history, or prenatal exposure could be identified. CONCLUSIONS Spherical and cylindrical anisometropia (> or =1.0 D) each affect 4% to 6% of Hispanic and African American preschoolers. Anisometropia > or =3.0 D is rare. Except for cylinder axis vector, the prevalence of anisometropia does not diminish beyond 1 year of age. Strabismus is associated with all forms of anisometropia. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
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Affiliation(s)
- Mark Borchert
- Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033-922, USA
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Abstract
PURPOSE To describe a surgical procedure for loosening or tightening the superior oblique (SO) tendon that enables bedside adjustment following the surgery, with surgical outcome reported. METHODS A permanent suture separates the two cut ends of the SO tendon, with a sliding noose for adjustment. The noose is accessed by having the patient look up or straight ahead, not down, during adjustment at the bedside. Records of 17 patients who underwent this surgery between June 2000 and January 2003 were reviewed and analyzed for outcome. RESULTS Seventeen patients, 18 eyes, mean age 43.7 years (range 5.9 to 71 years) had SO surgery with postoperatively adjustable sutures. Twelve eyes of 11 patients had a loosening procedure, and six eyes had a tightening procedure. Seven of the patients had had precious eye muscle surgery, four having had previous surgery on the same SO tendon. All but one patient returned for the follow-up examination, ranging from 1.5 to 7 months postoperatively. Torsional imbalances in 12 patients improved in all but two. In four patients with a preoperative A pattern, the A pattern improved from 16 PD to 0 PD on average. In eight patients with vertical misalignment in straight ahead gaze who had no other cyclovertical muscle surgery simultaneously, the mean reduction was 7 PD. All patients except one had improvement in preoperative symptoms. CONCLUSION Both loosening and tightening procedures can be performed successfully using a postoperative adjustment technique for the SO tendon.
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Affiliation(s)
- Nitza Goldenberg-Cohen
- The Zanvyl Krieger Children's Eye Center at The Wilmer Institute The Johns Hopkins University School of Medicine, Baltimore, MD 21287-9028, USA
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Abstract
PURPOSE To summarize the study design of the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS). METHODS The objectives of the MEPEDS are to: (1) estimate age- and ethnicity-specific prevalence of strabismus, amblyopia, and refractive error; (2) evaluate the association of selected risk factors with these ocular disorders; and (3) evaluate the association of ocular conditions on limitations in health-related functional status in a population-based sample of 12,000 children aged 6-72 months from four ethnic groups--African-American, Asian-American, Hispanics/Latinos and non-Hispanic White. Each eligible child undergoes an eye examination, which includes an interview with his/her parent. The interview includes an assessment of demographic, behavioral, biological, and ocular risk factors and health-related functional status. The examination includes fixation preference testing, visual acuity, stereoacuity, axial length measurement, cycloplegic refraction, keratometry, eye alignment, and anterior and posterior segment examination.
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Affiliation(s)
- Rohit Varma
- Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033-9224, USA.
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Cotter SA, Tarczy-Hornoch K, Song E, Lin J, Borchert M, Azen SP, Varma R. Fixation preference and visual acuity testing in a population-based cohort of preschool children with amblyopia risk factors. Ophthalmology 2008; 116:145-53. [PMID: 18962921 DOI: 10.1016/j.ophtha.2008.08.031] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 08/08/2008] [Accepted: 08/12/2008] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To compare the clinical assessment of fixation preference (FP) to visual acuity (VA) in a population-based sample of preschool children with amblyopia risk factors. DESIGN Evaluation of diagnostic test in a population-based study. PARTICIPANTS 243 children with anisometropia and/or strabismus, aged 30 to 72 months, living in Los Angeles County, CA [corrected] METHODS Before measuring VA, FP testing was performed at near and usually without correction, using the binocular fixation pattern in children with strabismus >10 prism diopters (Delta), or the induced tropia test for children with strabismus <or=10Delta or without strabismus. We determined the sensitivity and specificity of FP testing for predicting unilateral amblyopia, defined by optotype VA, among children with amblyopia risk factors. MAIN OUTCOME MEASURE Grade of FP. RESULTS Sensitivity of FP testing for amblyopia among children with anisometropia was 20% (9/44) and specificity was 94% (102/109). Among strabismic children, sensitivity was 69% (9/13; worse in children 30-47 than 48-72 months old) and specificity was 79% (70/89), with similar findings for esotropia and exotropia. CONCLUSION The ability of FP testing to correctly identify amblyopia in preschool children with amblyopia risk factors is poor. Clinicians should be wary of using FP as a surrogate measure of interocular difference in VA in young children. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Susan A Cotter
- Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033-9224, USA
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Tarczy-Hornoch K, Smith B, Urata M. Amblyogenic anisometropia in the contralateral eye in unicoronal craniosynostosis. J AAPOS 2008; 12:471-6. [PMID: 18534879 DOI: 10.1016/j.jaapos.2008.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 03/08/2008] [Accepted: 03/10/2008] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe the prevalence and nature of anisometropic refractive errors in children with unilateral coronal craniosynostosis. METHODS Retrospective chart review of children with unilateral coronal craniosynostosis who underwent ophthalmic evaluation, including refraction. RESULTS Refraction was available for 25 of 61 children with unilateral coronal craniosynostosis. Of the 25, 56% had amblyogenic anisometropia. Of these, 79% had the greater refractive error contralateral to the coronal synostosis, mostly (91%) consisting of greater with-the-rule astigmatism in the contralateral eye. Seventy-two percent of Hispanic children had amblyogenic anisometropia, compared with only 14% of non-Hispanic children (p= 0.02). Although Hispanic children tended to receive both surgery and ophthalmic evaluation at older ages than non-Hispanic children, these factors did not appear to account for the difference between ethnicities. There was no detectable association between anisometropia and the timing of fronto-orbital advancement surgery. CONCLUSIONS Children with unilateral coronal craniosynostosis are at increased risk of developing amblyogenic levels of anisometropia in the eye contralateral to the synostosis and require early evaluation and refraction even in the absence of strabismus.
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Borchert M, Wang Y, Tarczy-Hornoch K, Cotter S, Deneen J, Azen S, Varma R. Testability of the Retinomax autorefractor and IOLMaster in preschool children: the Multi-ethnic Pediatric Eye Disease Study. Ophthalmology 2007; 115:1422-5, 1425.e1. [PMID: 18164067 DOI: 10.1016/j.ophtha.2007.10.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Revised: 09/14/2007] [Accepted: 10/25/2007] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To determine the testability of Retinomax and IOLMaster ocular biometry in preschool children. DESIGN Population-based study of inner city preschool children in Los Angeles County. PARTICIPANTS Two thousand five hundred forty-five Hispanic and 2178 African American children 6 to 72 months old. METHODS Subjects were identified by door-to-door screening within previously identified contiguous census tracts. Pediatric ophthalmologists or optometrists performed comprehensive eye examinations on all subjects. Refractive error and keratometry measurements were attempted on all subjects with the Retinomax autorefractor after cycloplegia. Axial length measurements with the IOLMaster partial coherence interferometer were attempted on those subjects ages 30 to 72 months. MAIN OUTCOME MEASURES Ability to obtain high confidence autorefraction readings or axial length measurements on both eyes. RESULTS Overall, 89% were testable in both eyes with the Retinomax device, and 91% of the children were testable with the IOLMaster. Testability rose sharply with age, so that by age 36 months 98% of children were testable with the Retinomax device and 90% were testable with IOLMaster. There were no consistent gender- or ethnicity-related differences in testability overall or when stratified by age for either device. CONCLUSIONS Young children can be reliably tested for ocular biometry with the Retinomax and IOLMaster devices. This may impact strategies for management of cataracts and refractive errors in preschool children.
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Affiliation(s)
- Mark Borchert
- Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033-9224, USA.
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Cotter SA, Tarczy-Hornoch K, Wang Y, Azen SP, DiLauro A, Borchert M, Varma R. Visual acuity testability in African-American and Hispanic children: the multi-ethnic pediatric eye disease study. Am J Ophthalmol 2007; 144:663-7. [PMID: 17868633 PMCID: PMC2099260 DOI: 10.1016/j.ajo.2007.07.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 07/11/2007] [Accepted: 07/13/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the age- and gender-specific testability rates for the Amblyopia Treatment Study (ATS) HOTV visual acuity testing protocol using the electronic visual acuity (EVA) tester in African-American and Hispanic preschool children. DESIGN Population-based, cross-sectional study. METHODS Measurement of presenting monocular distance visual acuity using the ATS HOTV protocol was attempted in all African-American and Hispanic children aged 30 to 72 months from the population-based Multi-Ethnic Pediatric Eye Disease Study (MEPEDS). Children able to be tested monocularly in both eyes were considered able. Age-, gender-, and ethnicity-specific testability rates were calculated. Comparisons of testability among different groups were performed using Chi-square analyses and the Cochran trend test. RESULTS Testing was attempted on 3,126 children (1,471 African-American, 1,655 Hispanic; 50% female). Overall, 84% (83% African-American, 85% Hispanic; 86% female, 82% male) were testable. Older children were more likely to complete testing successfully than younger children (P < .0001). Age-specific testability in children 30 to 36 months of age, 37 to 48 months of age, 49 to 60 months of age, and 61 to 72 months of age was 39%, 84%, 98%, and 100%, respectively. After stratifying by age, there were no ethnicity-related differences in children testable (P = .12). Girls (86%) were slightly more likely to be testable than boys (82%; P > .003). CONCLUSIONS Monocular threshold visual acuity testing using the ATS HOTV protocol on the EVA tester (Jaeb Center for Health Research, Tampa, Florida, USA) can be completed by most African-American and Hispanic preschool children, particularly those older than 36 months of age. This protocol therefore may be used in minority preschool children as an integral part of the diagnosis and management of amblyopia and other forms of visual impairment.
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Affiliation(s)
- Susan A. Cotter
- Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA; 1450 San Pablo Street, Los Angeles, CA 90033, Phone: 323-442-6411, Fax: 323-442-6412
| | - Kristina Tarczy-Hornoch
- Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA; 1450 San Pablo Street, Los Angeles, CA 90033, Phone: 323-442-6411, Fax: 323-442-6412
| | - Ying Wang
- Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA; 1450 San Pablo Street, Los Angeles, CA 90033, Phone: 323-442-6411, Fax: 323-442-6412
| | - Stanley P. Azen
- Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA; 1450 San Pablo Street, Los Angeles, CA 90033, Phone: 323-442-6411, Fax: 323-442-6412
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Anne DiLauro
- Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA; 1450 San Pablo Street, Los Angeles, CA 90033, Phone: 323-442-6411, Fax: 323-442-6412
| | - Mark Borchert
- Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA; 1450 San Pablo Street, Los Angeles, CA 90033, Phone: 323-442-6411, Fax: 323-442-6412
| | - Rohit Varma
- Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA; 1450 San Pablo Street, Los Angeles, CA 90033, Phone: 323-442-6411, Fax: 323-442-6412
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Abstract
Hyperopia is present in a small proportion of children aged between 6 and 12 months, with ethnicity likely affecting prevalence, and higher prevalences in certain subgroups, especially those with a family history of hyperopia or accommodative esotropia. Around a fifth of children who are hyperopic in infancy go on to develop strabismus, while an unknown proportion develop bilateral ametropic amblyopia; persistent hyperopia appears to be a harbinger of future pathology. Early prophylactic spectacle correction of hyperopia has failed to prevent strabismus in three of four studies, but showed reduced incidence of strabismus in one study, and yielded improved visual acuity outcomes in two studies by one investigator. Currently our ability to detect or measure refractive error with automated instruments easily adaptable to a screening setting has outpaced our knowledge of how best to identify the subset of hyperopes who are really at risk, and how to manage isolated early hyperopia once it has been identified.
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Affiliation(s)
- Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Southern California/Childrens Hospital Los Angeles, Los Angeles, California, USA.
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