BACKGROUND: The current mainstays of treatment for type 1 retinopathy of prematurity (ROP) are laser therapy and anti-VEGF intravitreal injections (IVI) or a combination of the two. Data comparing treatment outcomes betw...BACKGROUND: The current mainstays of treatment for type 1 retinopathy of prematurity (ROP) are laser therapy and anti-VEGF intravitreal injections (IVI) or a combination of the two. Data comparing treatment outcomes between these modalities are heterogenous and limited by short-term follow-up. There is limited data on visual acuity after treatment. The purpose of this study was to investigate visual acuity, structural outcomes, and refractive error (RE) between primary laser and primary IVI in a contemporary cohort treated for ROP. METHODS: The medical records of patients treated for type 1 ROP at a tertiary care center from 2006 to 2022 were reviewed retrospectively. Demographics, treatment, visual acuity, adverse outcomes, and RE were analyzed between primary IVI and primary laser treatment groups. Adverse outcomes that were analyzed were strabismus, macular dragging, optic atrophy, retinal detachment, and amblyopia. RESULTS: A total of 179 patients (358 eyes) received treatment for type 1 ROP. Most patients received primary laser therapy (83.5%). We were able to collect formal visual acuity testing on 92 eyes. Most had vision of 20/40 or better (60%), and all patients had vision better than 20/200 in at least one eye. There was no difference in adverse ocular outcomes or RE between the primary laser and primary IVI groups. CONCLUSIONS: In contrast to prior studies, there were no differences in adverse ocular outcomes between infants treated with primary IVI and those treated with primary laser for ROP. Our study demonstrates high effectiveness of both treatments, with low rates of retinal detachment and blindness.
Yuan M, Hu D, Altamirano F
… +11 more, Hoyek S, Chaaya C, Abidi M, De Bruyn H, Fulton A, Mantagos IS, Wu C, Gonzalez E, VanderVeen DK, Patel NA, Gise R
PURPOSE: To compare visual and anatomic outcomes between primary laser photocoagulation and anti-vascular endothelial growth factor (VEGF) therapy with early or late deferred laser treatment (for reactivation or peripher...PURPOSE: To compare visual and anatomic outcomes between primary laser photocoagulation and anti-vascular endothelial growth factor (VEGF) therapy with early or late deferred laser treatment (for reactivation or peripheral avascular retina [PAR]) in management of retinopathy of prematurity (ROP). METHODS: In this retrospective cohort study, eyes were divided into three groups: primary laser, anti-VEGF with early (<4 months) deferred laser, and anti-VEGF with late (≥4 months) deferred laser (treated prophylactically for PAR per protocol or for reactivation if needed). RESULTS: A total of 260 eyes of 139 patients treated for ROP between 2013 and 2023 were included: 159 eyes in the primary group, 20 in the early-deferred group, and 81 in the late-deferred group. The primary laser group was older at first treatment (median postmenstrual age, 39.1 weeks vs 36.1 and 35.7 weeks for early- and late-deferred laser groups [P < 0.01]). Zone 1 disease was more common in anti-VEGF groups (43%-45% vs 1.9% [P < 0.01]). At median follow-up of 35 months, visual acuity was better in the early-deferred laser group (logMAR 0.14) than in the primary laser (0.18) and late-deferred laser (0.18) groups (P < 0.001; 162 eyes of 91 patients). Retinal detachment rates were not significantly different (3.1% primary laser vs 0.0% in anti-VEGF groups [P = 0.31] when excluding 2 eyes of 1 patient with numerous missed examinations and an atypical follow-up schedule due to medical instability in the early deferred laser group). At 2 years, the early-deferred laser group was more myopic (median, -1.50 D vs 0.0 D and 0.50 D [P = 0.031]). There were no differences in adverse events, strabismus, or amblyopia (P > 0.05 for all). CONCLUSIONS: Primary laser and anti-VEGF with deferred laser showed comparable anatomic outcomes. Refractive outcomes were comparable, though myopia was common in all groups. Anti-VEGF was more commonly used for posterior disease, reflecting contemporary practice patterns at this quaternary referral center.
BACKGROUND: Childhood strabismus and amblyopia may affect reading ability. Previous studies have demonstrated slower reading speed among amblyopic children compared with controls, but the relationships between strabismus...BACKGROUND: Childhood strabismus and amblyopia may affect reading ability. Previous studies have demonstrated slower reading speed among amblyopic children compared with controls, but the relationships between strabismus without amblyopia or prior treated amblyopia and reading speed have not been established. The purpose of this study was to investigate whether strabismus or history of successfully treated amblyopia independently affect binocular reading speed in adolescents and to characterize the clinical parameters associated with reading performance. METHODS: A total of 124 adolescents (10-17 years) were enrolled and divided into four groups: strabismic with prior successfully treated amblyopia, strabismic without prior amblyopia, nonstrabismic with prior successfully treated amblyopia, and control. Binocular reading speed was assessed using standardized passages from the IReST-Hebrew. Statistical analysis involved Wilcoxon tests to compare reading speeds between groups and Spearman correlations to explore associations with clinical variables. RESULTS: No statistically significant differences in binocular reading speed were found between the four groups (all P > 0.05). Subgroup analysis revealed no significant differences based on strabismus type (esotropia vs exotropia). Within-group associations were observed: in the strabismic with prior amblyopia group, a significant negative correlation existed between reading speed and arcseconds of stereopsis (r = -0.51, P = 0.01), whereas in the nonstrabismic with prior amblyopia group, reading speed correlated negatively with near point of convergence (r = -0.47, P = 0.02). CONCLUSIONS: In our study cohort, nonamblyopic adolescents with a history of strabismus, amblyopia, or both did not exhibit slower binocular reading speed than controls. These findings suggest that in adolescents without current amblyopia or after successful amblyopia treatment, reading performance is preserved.
BACKGROUND: Pediatric blepharokeratoconjunctivitis (PBKC) is a chronic inflammatory disease of the eyelid margin with secondary conjunctival and corneal involvement. The purpose of this study was to characterize the clin...BACKGROUND: Pediatric blepharokeratoconjunctivitis (PBKC) is a chronic inflammatory disease of the eyelid margin with secondary conjunctival and corneal involvement. The purpose of this study was to characterize the clinical features, visual outcomes, and treatment of PBKC in a diverse, underserved metropolitan community in the United States. METHODS: A retrospective study was conducted of patients 16 years old or younger diagnosed with PBKC, who were identified using relevant Systematized Nomenclature of Medicine - Clinical Terminology (SNOMED CT) codes and manual chart review. RESULTS: A total of 60 patients were included. Most patients were female 35 (58%) and identified as Hispanic or Latino 33 (55%). Bilateral involvement was observed in 38 patients (63%). The most common symptoms were eye redness 52 (87%), recurrent chalazia 38 (63%), tearing 30 (50%), and ocular itching 30 (50%). All patients had concurrent lid, conjunctival, and corneal involvement. Based on corneal findings, 15 (25%) had mild, 34 (57%) moderate, and 11 (18%) severe disease, with 8 (73%) of severe cases being Hispanic. Mean age at corneal involvement was 8.3 years old, with moderate and severe cases occurring about 3 years earlier than mild ones. Amblyopia only occurred in moderate-to-severe cases 11 (18%). Final visual acuity varied by severity, with improvement in moderate disease and decline in severe cases. Recurrence was observed in 37 (62%) patients, especially in severe cases 11 (100%). Severe patients received topical antibiotic or combination antibiotic/steroid drops and ointments 11 (100%), topical steroid drops 9 (82%), and oral antivirals 4 (36%) more frequently than other groups. CONCLUSIONS: The high rates of corneal complications, visual impairment, and disease recurrence in our underserved urban cohort suggest the importance of early diagnosis and consistent follow-up.
PURPOSE: To evaluate treatment outcomes and predictors of amblyopia resolution in children 3-10 years of age treated in public hospitals in Qassim province, Saudi Arabia. METHODS: The medical records of children with uni...PURPOSE: To evaluate treatment outcomes and predictors of amblyopia resolution in children 3-10 years of age treated in public hospitals in Qassim province, Saudi Arabia. METHODS: The medical records of children with unilateral amblyopia due to strabismus, anisometropia, or both, treated at four public hospitals, were reviewed retrospectively. Data was collected for records of routine clinical care (2017-2022). All patients had at least two clinical visits' records. Recorded variables included amblyopia type, baseline amblyopic-eye visual acuity, initial treatment modality, and number of follow-up visits. Complete resolution was defined as a final interocular visual acuity difference of ≤0.1 logMAR. Proportional improvement was defined as reduction in interocular visual acuity difference from baseline to final visit divided by baseline interocular difference. Multivariable logistic regression identified independent predictors of resolution. RESULTS: A total of 198 cases were reviewed. Mean patient age was 6.8 ± 2.2 years; 50.5% were male. Overall, 99 patients (50.0%) achieved complete resolution, with a mean proportional improvement of 53.9%. Worse baseline amblyopic-eye visual acuity was associated with lower odds of resolution (adjusted odds ratio = 0.60 per 0.1 logMAR of worse baseline visual acuity; P < 0.001). Compared with glasses only, patching alone was associated with poorer outcomes (aOR = 0.38; P = 0.015), whereas combined treatment showed similar outcomes. Higher number of follow-up visits independently predicted success. Age showed a borderline association, while amblyopia type was not independently associated with resolution. CONCLUSIONS: In this study of real-world amblyopia outcomes, the first of its kind in Saudi Arabia, half of the children achieved resolution, with success strongly dependent on baseline visual acuity, initial treatment modality, and continuity of follow-up.
PURPOSE: To evaluate the clinical efficacy of probing with or without bicanalicular intubation (BCI) for congenital nasolacrimal duct obstruction (CNLDO) in children at least 3 years of age and to identify factors influe...PURPOSE: To evaluate the clinical efficacy of probing with or without bicanalicular intubation (BCI) for congenital nasolacrimal duct obstruction (CNLDO) in children at least 3 years of age and to identify factors influencing surgical success. METHODS: The medical records of children treated between 2014 and 2024 at Health Sciences University Beyoğlu Eye Training and Research Hospital were reviewed retrospectively. All patients underwent probing with or without bicanalicular silicone intubation (BCI) using the square knot technique. Surgical success was defined as resolution of symptoms and a normal fluorescein dye disappearance test. RESULTS: A total of 95 children (116 eyes) were included. Mean patient age was 4.57 ± 1.98 years (range, 3-14). Mean follow-up was 15.5 ± 15.4 months. BCI was performed initially in 102 eyes. Mean tube retention was 66.8 ± 43.0 days. Overall success was 87%, increasing to 95% after reprobing and BCI in failed cases. Age, sex, obstruction type, canalicular stenosis, Rosenmüller's valve hypertrophy, and inferior turbinate infracture were not significantly associated with success (P > 0.05). Tube retention for 45-90 days was significantly associated with higher success compared with retention <45 days (P = 0.013; OR = 12.75; 95% CI, 1.72-94.48). CONCLUSIONS: In our study cohort of children undergoing surgery for CNLDO at 3 years of age and older, probing and BCI achieved high success, especially if the tube was successfully retained for at least 45 days. Reintubation in failed cases can improve outcomes.
Brown recluse spider bites to the periorbital region have been reported rarely, particularly in pediatric patients. We report the case of a 17-year-old girl who developed periorbital and facial swelling after a brown rec...Brown recluse spider bites to the periorbital region have been reported rarely, particularly in pediatric patients. We report the case of a 17-year-old girl who developed periorbital and facial swelling after a brown recluse bite to the eyelid. Symptoms began within hours of the bite and progressed over the first 48 hours, leading to significant periorbital edema, chemosis, and elevated intraocular pressure (IOP). Symptoms improved 72 hours after the bite. Management included pressure-lowering eye drops, cool compresses, antihistamines, anti-inflammatories, and intravenous and oral antibiotics. IOP normalized without surgical intervention. Systemic symptoms did not occur, and swelling resolved over 2 weeks. This case highlights the potential for conservative management in cases without systemic toxicity or tissue necrosis and emphasizes the importance of monitoring for ocular complications in periorbital envenomation.
Periocular injuries secondary to animal scratches in children can be dangerous and associated with high morbidity. We present a case of a delayed extrusion of a cat claw from the caruncle of a pediatric patient 11 days a...Periocular injuries secondary to animal scratches in children can be dangerous and associated with high morbidity. We present a case of a delayed extrusion of a cat claw from the caruncle of a pediatric patient 11 days after the initial injury. The patient was seen immediately after the injury in the emergency department, when no foreign bodies were noted. He returned to the same emergency department after partial spontaneous extrusion. The claw was removed by the ophthalmology service.
PURPOSE: To evaluate vision screening practices during well-child visits for 3- to 5-year-old children at two large academic health systems and identify potential care gaps in primary care vision screenings. METHODS: Thi...PURPOSE: To evaluate vision screening practices during well-child visits for 3- to 5-year-old children at two large academic health systems and identify potential care gaps in primary care vision screenings. METHODS: This study was performed through a retrospective cross-sectional chart review of primary care clinics at two major academic health systems. Outcome measures included vision screening attempt and success rates, testing modalities, referral outcomes, and completion of various screening requirements. Results were stratified by physician specialty and patient age. RESULTS: Among 800 well-child visits at Health System 1 (HS1) (mean age, 3.9 ± 0.8 years), screening attempt rates ranged from 4% to 90% across clinics, with an overall average of 49.5%. In the highest-performing clinic at HS1, photoscreeners were used as the primary screening method. Of 390 well-child visits at Health System 2 (HS2) (mean age, 4.0 ± 0.8 years), attempt rates ranged from 64% to 98%, with a total average of 91%. At both institutions, vision screening was attempted more frequently in pediatric clinics than in family medicine clinics (P < 0.01). Among 218 vision screening exams analyzed at HS2, none documented all screening requirements, with cover testing documented in only 38% of visits and red reflex recorded in less than 1%. CONCLUSIONS: Vision screening deficits were noted at both health systems, whether in attempt rate or adherence to guideline components. Variability across sites and incomplete documentation of examination requirements highlight the need for revised guidelines, electronic medical record optimization, and support of semiautomated tools such as photoscreeners.
PURPOSE: To evaluate the efficacy of aspherical lens spectacles compared with single-vision spectacles in controlling axial length (AL) elongation and myopic progression in children with low-to-moderate myopia over 24 mo...PURPOSE: To evaluate the efficacy of aspherical lens spectacles compared with single-vision spectacles in controlling axial length (AL) elongation and myopic progression in children with low-to-moderate myopia over 24 months. METHODS: In this randomized, single-masked, controlled trial, 138 children aged 8-12 years with spherical equivalent refraction (SER) between -0.75 and -5.00 D and astigmatism ≤1.50 D were enrolled. Participants were randomly assigned 1:1 to receive either aspherical lens spectacles incorporating highly aspherical lenslets (HAL group, n = 69) or single-vision spectacles (SVS group, n = 69). Primary outcomes were changes in AL and cycloplegic SER at 24 months. Secondary outcomes included the proportion achieving near-emmetropic growth rate (defined as annual axial elongation <0.20 mm), changes at intermediate timepoints (6, 12, 18 months), adherence metrics, and safety assessments (adverse events, visual acuity, contrast sensitivity, basic stereopsis screening). Linear mixed models were employed for primary analyses under intention-to-treat principles. RESULTS: Of 138 enrolled participants, 124 (89.86%) completed the 24-month follow-up. The HAL group demonstrated significantly less axial elongation compared with the SVS group (0.32 ± 0.18 mm vs 0.68 ± 0.22 mm, difference: -0.36 mm; 95% CI, -0.43 to -0.29 mm [P < 0.001]), representing 52.94% reduction. Myopic progression was -0.53 ± 0.38 D in the HAL group versus -1.21 ± 0.45 D in the SVS group (difference, 0.68 D; 95% CI, 0.54-0.82 D [P < 0.001]), indicating 56.20% reduction. Near-emmetropic growth rate was achieved in 44.93% of HAL participants versus 11.59% of controls (OR = 6.21; 95% CI, 2.58-14.95; P < 0.001). CONCLUSIONS: Aspherical lens spectacles significantly reduced both axial elongation and myopic progression over 24 months compared with single-vision spectacles, with an excellent safety profile. These findings support aspherical lens technology as an effective option for pediatric myopia control.
BACKGROUND: Ophthalmic manifestations in Angelman syndrome (AS)-particularly strabismus surgical outcomes and genotype-phenotype correlations-remain inadequately characterized due to limited cohort sizes in prior studies...BACKGROUND: Ophthalmic manifestations in Angelman syndrome (AS)-particularly strabismus surgical outcomes and genotype-phenotype correlations-remain inadequately characterized due to limited cohort sizes in prior studies. METHODS: This 6-year (2018-2024) retrospective cohort study analyzed 40 genetically confirmed AS patients undergoing strabismus surgery, stratified by molecular subtype: deletion (15q11.2-q13del [n = 27]) and nondeletion (UBE3A mutations/UPD15pat/imprinting defects [n = 13]). Outcomes included refractive errors, iris hypopigmentation (novel grading on a scale of 0-4 adapted from albinism criteria), and surgical efficacy. RESULTS: High astigmatism (≥2.00 DC) was significantly more prevalent in deletion patients (54% vs 19% [P = 0.004]). High myopia (> -6.00 D) occurred exclusively in deletion patients (n = 2). Severe iris hypopigmentation (grades 3-4) was unique to the deletion subgroup (33% vs. 0%; P = 0.013), linked to OCA2 codeletion. Surgical success (exodeviation ≤8/esodeviation ≤5 at 1 year) was comparable (70% vs 77%; P > 0.05), with minimal exodrift (deletion, -14.9; nondeletion, -12.3) and no reoperations. CONCLUSIONS: The 15q11.2-q13 deletions confer a distinct oculoalbinism phenotype mediated by OCA2 haploinsufficiency, featuring high myopia, severe astigmatism, and iris hypopigmentation. Standardized strabismus surgery achieves stable alignment across genotypes, supporting genotype-guided refractive surveillance and validating exotropia correction as an effective AS intervention.
BACKGROUND: Cyclic esotropia is a rare form of strabismus characterized by alternating periods of esodeviation, typically occurring in a predictable cycle. Its etiology and treatment remain incompletely understood. This...BACKGROUND: Cyclic esotropia is a rare form of strabismus characterized by alternating periods of esodeviation, typically occurring in a predictable cycle. Its etiology and treatment remain incompletely understood. This review aims to synthesize current evidence on the characteristics and treatment for cyclic esotropia. METHODS: Systematic searches were conducted in Ovid MEDLINE, Ovid Embase, Cochrane registered trials, Web of Science, and Scopus databases. The key terms used for searches were cyclic esotropia and treatment. Two independent reviewers screened the title and abstract of retrieved studies against a prepublished protocol to select relevant studies. No language restrictions were applied. RESULTS: A total of 55 studies met inclusion criteria, encompassing case reports, case series, and observational studies: 86 cases were identified. Diagnosis was primarily clinical based on cyclic patterns of deviation. Average age was 7 years, with a male:female ratio of about 50:50. Most cases (85%) had a 48 hour cycle (24 hours esotropia, followed by 24 hours of orthotropia), with the majority of the remainder being 92 hours (48 hours esotropia, followed by 48 hours of orthotropia); 12% of cases reported amblyopia. Average refraction was +0.7 sphere. Average deviations were similar for both near (36) and distance (37). Bimedial recessions were reported in 28 cases, 95% of which were successful in correcting the esotropia to <10 within 6 months. Nine of 10 cases were successfully treated to <10 using botulinum toxin type A. CONCLUSIONS: Cyclic esotropia remains an enigmatic condition, requiring greater awareness and standardized diagnostic protocols. Although surgery appears effective, more evidence is needed to optimize management and assess long-term stability. Further research should focus on pathophysiological mechanisms and therapeutic approaches.
PURPOSE: To investigate and compare the prevalence of refractive errors among students in urban and rural regions of Shigatse, a high-altitude region in China. METHODS: A school-based, cross-sectional study enrolled Tibe...PURPOSE: To investigate and compare the prevalence of refractive errors among students in urban and rural regions of Shigatse, a high-altitude region in China. METHODS: A school-based, cross-sectional study enrolled Tibetan students 7-15 years of age attending urban (Shanghai Experimental School, Shigatse City) and rural (primary and secondary schools in Sakya County) schools. Uncorrected or presenting visual acuity with glasses, best-corrected visual acuity, and noncycloplegic refraction were compared in all participants. RESULTS: Overall, 1,671 and 2,837 Tibetan students in the urban and rural groups, respectively, completed the screening tests. Myopia was the most common type of refractive error. The overall prevalences of myopia and high myopia were 71.21% and 19.76%, respectively, in the urban group compared with 48.04% and 8.85% in the rural group, showing a significant difference (P < 0.001). Uncorrected refractive errors overall were more frequent in the urban group than in the rural group (54.34% vs 44.48% [P < 0.001]), although urban myopic students were more likely to have glasses than rural myopic students (56.05% vs 24.00% [P < 0.001]). The proportions of students with refractive correction who had a component of uncorrected refractive error, despite wearing glasses, were 56.22% and 56.57% in the urban and rural groups, respectively (P = 0.916). CONCLUSIONS: The prevalence of myopia was high among both urban and rural students in this high-altitude region, though it was higher in urban areas than in rural areas.
There is a pressing need for pediatric eye care in low-income countries. Pediatric ophthalmologists from high-income countries can collaborate with local eye care teams to address pressing needs by jointly providing medi...There is a pressing need for pediatric eye care in low-income countries. Pediatric ophthalmologists from high-income countries can collaborate with local eye care teams to address pressing needs by jointly providing medical or surgical care, codeveloping training programs for local professionals, and supporting initiatives to acquire equipment or enhance infrastructure. Such efforts are maximized through long-term professional relationships with a goal of understanding and strengthening local eye care service and infrastructure. It is important that changes be sustainable so that these needs can be met on a long-term basis.
We report the case of a 22-month-old boy with retinal vascular disease caused by optic neuritis due to myelin oligodendrocyte glycoprotein antibody disease. He presented with acute disseminated encephalomyelitis without...We report the case of a 22-month-old boy with retinal vascular disease caused by optic neuritis due to myelin oligodendrocyte glycoprotein antibody disease. He presented with acute disseminated encephalomyelitis without optic nerve involvement. Despite treatment, he developed optic neuritis and vision loss within days. In addition to the usual findings of optic neuritis, he had evidence of severe retinal venous stasis including intraretinal, subretinal, preretinal, and choroidal hemorrhages that were rapidly progressive. The retinal perfusion did not recover, leading to neovascularization. This is a rare case of MOG antibody-associated disease with retinal venous stasis in which long-term follow-up revealed permanent vision loss from widespread retinal ischemia and optic atrophy. We propose that hemorrhages beyond the peripapillary region and macula can be a sign of retinal venous insufficiency related to vascular obstruction at the optic nerve head. Patients exhibiting this sign should undergo prompt antibody testing when it is associated with optic neuritis. Careful monitoring and treatment of retinal ischemia and neovascularization in severe cases is warranted to prevent late complications.
Low-dose atropine (LDA) is effective for slowing myopia progression and preventing its onset in children. It is generally considered safe. The main adverse effects are mild photophobia and blurred vision at near secondar...Low-dose atropine (LDA) is effective for slowing myopia progression and preventing its onset in children. It is generally considered safe. The main adverse effects are mild photophobia and blurred vision at near secondary to accommodative dysfunction. Esotropia is a rare adverse event that can occur in temporal association with LDA. We report a pediatric case of near-esotropia that emerged after the initiation of 0.025% low-dose atropine for myopia control and onset prevention and resolved after discontinuation; the longitudinal accommodative convergence-to-accommodation (AC/A) ratio assessments documented a transient elevation during treatment, with subsequent normalization off-therapy. To our knowledge, this is the first report documenting longitudinal AC/A ratio changes during and after low-dose atropine therapy.