J AAPOS [JOURNAL]
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200 papers
Posterior capsule opacification in children: comparison of posterior continuous curvilinear capsulorhexis alone and pars plana posterior capsulectomy with anterior vitrectomy.
Orazbekov L, Ruslanuly K, Kurakbay A … +2 more , Zhurgumbayeva G, Bakhytbek R
J AAPOS · 2025 Dec · PMID 41276154 · Publisher ↗
PURPOSE: To compare the incidence, timing, and visual outcomes of posterior capsule opacification (PCO) following pediatric cataract surgery comprising either posterior continuous curvilinear capsulorhexis without anteri...
PURPOSE: To compare the incidence, timing, and visual outcomes of posterior capsule opacification (PCO) following pediatric cataract surgery comprising either posterior continuous curvilinear capsulorhexis without anterior vitrectomy (PCCC-) or pars plana posterior capsulectomy with anterior vitrectomy (PPPC+). METHODS: The medical records of pediatric patients undergoing surgery for congenital cataract at a single tertiary care facility from January 2013 to December 2022 were reviewed retrospectively. All eyes underwent primary intraocular lens implantation at the time of cataract surgery. A total of 643 eyes underwent PCCC- and 628 underwent PPPC+. Outcomes included PCO incidence, age at diagnosis, time to development, and best-corrected visual acuity (BCVA). RESULTS: PCO incidence was significantly higher in the PCCC- group than in the PPPC+ group (144 [22.4%] vs 62 [9.9%] P < 0.001). Patients who developed PCO underwent initial cataract surgery at a mean age of 2.73 ± 2.04 years in the PCCC- group and 2.03 ± 1.63 years the PPPC+ group (P = 0.02). Age at PCO diagnosis was 3.87 ± 1.92 years in the PCCC- group and 5.28 ± 2.83 years in the PPPC+ group (P = 0.001). Time to PCO development was 1.84 ± 1.13 years in the PCCC- group and 2.56 ± 1.56 years in the PPPC+ group (P = 0.003). Of the 206 patients who developed PCO, 121 patients (58.7%) were cooperative for optotype testing. Preoperative BCVA was similar between groups (1.72 ± 0.59 and 1.68 ± 0.46 logMAR for PPPC- and PCCC+, resp. [P = 0.865]); postoperative BCVA improved significantly within each group (P < 0.001), with no intergroup difference (0.88 ± 0.40 and 0.93 ± 0.46 logMAR for PPPC- and PCCC+, resp. [P = 0.612]). The other 85 noncooperative children (41.3%) showed postoperative improvement in ability to fix and follow objects in both the PCCC- group and the PPPC+ group (9.6% to 92.3% and 6.1% to 90.9% [both P < 0.001]). CONCLUSIONS: Combined capsulectomy and anterior vitrectomy markedly reduces and delays PCO compared to PCCC alone, with equivalent visual gains.
External validation of an artificial intelligence-based model for retinopathy of prematurity screening using Phoenix ICON retinal images.
Derks LA, Tekin YS, Loudon SE … +4 more , Vingerling JR, Coyner AS, Campbell JP, Tjiam AM
J AAPOS · 2025 Dec · PMID 41276153 · Publisher ↗
PURPOSE: To assess the performance of a RetCam-trained artificial intelligence (AI) algorithm for the autonomous detection of severe retinopathy of prematurity (ROP) using retinal images acquired with the smaller field-o...
PURPOSE: To assess the performance of a RetCam-trained artificial intelligence (AI) algorithm for the autonomous detection of severe retinopathy of prematurity (ROP) using retinal images acquired with the smaller field-of-view Phoenix ICON retinal camera. METHODS: Retrospective external validation was performed using Phoenix ICON retinal images captured during ROP screening examinations in a Dutch cohort of infants born in 2021. Images of insufficient quality were excluded via automated quality assessment. Model performances for more-than-mild ROP (MTM-ROP)-type 1 or 2 ROP, or any ROP with pre-plus disease-and for type 1 ROP alone, were expressed as area under the precision-recall curve (AUPRC), sensitivity and specificity. RESULTS: A total of 4,411 images from 66 infants were captured during 419 individual eye examinations, averaging 67 ± 65 images per infant and 10 ± 6 images per eye examination. Sixty examinations (14.3%) had all images excluded in automated quality assessment. When using the best performance between both eyes to assess infant-level performance, AUPRC was 0.911 (95% CI, 0.638-1.000), sensitivity was 82.0% (95% CI, 73.0-89.0) and specificity was 77.0% (95% CI, 68.1-84.4) for MTM-ROP. For type 1 ROP alone, AUPRC was 0.983 (95% CI, 0.964-1.000), sensitivity was 100.0% (95% CI, 94.7-100.0), and specificity was 72.4% (95% CI, 64.4-79.5). CONCLUSIONS: The algorithm's performance with Phoenix ICON is similar to its performance with RetCam. All infants with treatment-requiring type 1 ROP were detected by the algorithm. The presence of eye examinations without images of sufficient quality underlines the need for imaging protocols, especially when using this algorithm, with a smaller field-of-view camera.
Predictors of persistent avascular retina in retinopathy of prematurity treated with intravitreal ranibizumab.
Chen JG, Mo KX, Huang QQ … +1 more , Ruan GY
J AAPOS · 2025 Dec · PMID 41276152 · Publisher ↗
PURPOSE: To identify predictive factors for persistent avascular retina (PAR) following primary intravitreal ranibizumab (IVR) monotherapy in retinopathy of prematurity (ROP). METHODS: The medical records of 69 infants (...
PURPOSE: To identify predictive factors for persistent avascular retina (PAR) following primary intravitreal ranibizumab (IVR) monotherapy in retinopathy of prematurity (ROP). METHODS: The medical records of 69 infants (128 eyes) with type 1 or aggressive ROP treated with IVR at a single center between July 2019 and March 2021 were reviewed retrospectively. Retinal vascular outgrowth speed (RVOS) was quantitatively assessed 2 months after IVR. Clinical parameters were evaluated, including birth weight, gestational age, cumulative clock hours of ROP lesions (ROP CCH), postmenstrual age (PMA) at IVR, ROP severity, and postnatal age (PNA) at IVR. Significant predictors from univariate analysis were incorporated into a multivariable logistic regression model presented as a nomogram. RESULTS: The mean RVOS was 0.9 ± 0.6 disk diameters (DD)/month at 2 months post-IVR, with significantly faster vascular outgrowth in treated eyes compared to untreated fellow eyes (P < 0.05). Complete retinal vascularization was achieved in 69 eyes (53.9%) by 64 weeks PMA (±2 week), whereas PAR persisted in 59 eyes (46.1%). Multivariable analysis revealed four independent PAR predictors: slower RVOS (OR = 0.024 for faster RVOS), larger ROP CCH (OR = 2.263), later PNA at IVR (OR = 1.041), and advanced ROP severity (OR = 31.67). The developed nomogram showed excellent discrimination (AUC = 0.948) and calibration (P = 0.055). CONCLUSIONS: Slower RVOS, advanced ROP severity, larger ROP CCH, and later PNA at IVR were independent PAR predictors. The nomogram reliably stratified risk for post-IVR management.
Blended collagenopathy and optic atrophy: a novel phenotype.
Raghu N, Dhillon HK
J AAPOS · 2025 Dec · PMID 41276151 · Publisher ↗
We report 3 siblings born to consanguineous parents who presented with visual loss secondary to bilateral optic atrophy, along with consistent systemic features, such as dysmorphic facies, sensorineural hearing loss, ske...
We report 3 siblings born to consanguineous parents who presented with visual loss secondary to bilateral optic atrophy, along with consistent systemic features, such as dysmorphic facies, sensorineural hearing loss, skeletal anomalies, and global developmental delay. Imaging revealed severe optic canal narrowing with associated nerve compression. Genetic analysis in the eldest sibling identified likely pathogenic heterozygous variants in both COL2A1 and COL11A2 genes, indicating a dual collagenopathy phenotype. This case series underscores the importance of considering blended genetic diagnoses in complex phenotypes and highlights the role of optic canal stenosis as a significant cause of vision loss in collagen-related skeletal dysplasias.
Predictors of nonsurgical consecutive exotropia following accommodative esotropia.
ElHilali H, Awadein A, Radwan R … +2 more , Gouda J, Fouad HM
J AAPOS · 2025 Dec · PMID 41276150 · Publisher ↗
PURPOSE: To identify the incidence of and risk factors for development of spontaneous consecutive exotropia during management of fully accommodative esotropia with optical correction. METHODS: The medical records of pati...
PURPOSE: To identify the incidence of and risk factors for development of spontaneous consecutive exotropia during management of fully accommodative esotropia with optical correction. METHODS: The medical records of patients who presented with an initial diagnosis of fully accommodative esotropia and converted to exotropia during their management were reviewed retrospectively. Patients with a minimum of 3 years' follow-up were included. The following data were extracted from the record: age of onset, refractive error, glasses prescription, angles of deviation, visual acuity, and stereoacuity. RESULTS: A total of 178 children with fully accommodative esotropia were identified. Mean age of esotropia onset was 2.3 ±1.4 years; of initial glasses prescription, 2.9 ± 1.5 years. We calculated the mean spherical equivalent by averaging the values of both eyes for each patient. Mean spherical equivalent of both eyes was +4.3 ± 1.8 D. The mean follow-up was 6.9 ± 3.7 years. Consecutive exotropia developed in 31 children (17.4%) at a mean of 3.5 ± 3.6 years after prescription of spectacles. Children who developed consecutive exotropia had a higher initial spherical error (P = 0.02), higher initial cylindrical error (P = 0.01), and higher prevalence of neurological problems (P = 0.01) on multivariable analysis. Higher prevalence of amblyopia (P < 0.001) and vertical deviation (P < 0.001) were detected in the spontaneous exodeviation group on univariate analysis only. There was no statistically significant difference between spontaneous exotropia following accommodative esotropia and accommodative esotropia groups as a whole in terms of age of onset, the age of initiation of spectacles, angles of deviation, stereoacuity, or the time of initiation of reduction of hyperopic prescription. CONCLUSIONS: High hyperopia (≥5 D), high astigmatic errors (≥1.5 D), and presence of neurological problems are risk factors for development of spontaneous exotropia among accommodative esotropia patients. Long-term follow-up is recommended for patients who have identifiable risk factors.
Enhancing patient and parent education in pediatric ophthalmology using artificial intelligence: a report by the AAPOS Public Information Committee.
Dihan QA, Brown AD, Alzein AF … +10 more , Zaldivar AT, Montgomery KE, Khodeiry MM, ElSheikh RH, Attzs M, Mocan MC, Fredrick D, Jordan CO, Collinge J, Elhusseiny AM
J AAPOS · 2025 Dec · PMID 41274543 · Publisher ↗
BACKGROUND: Parental health literacy significantly affects pediatric ophthalmology follow-up care and adherence to treatment regimens. Yet patient education materials (PEMs) often exceed the American Medical Association'...
BACKGROUND: Parental health literacy significantly affects pediatric ophthalmology follow-up care and adherence to treatment regimens. Yet patient education materials (PEMs) often exceed the American Medical Association's recommended 6th-grade reading level. Large-language models (LLMs) can improve the readability of PEMs without sacrificing quality. This study evaluated the baseline readability, quality, and accuracy of PEMs by the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) and assessed how LLMs may improve these PEMs. METHODS: This cross-sectional study analyzed 111 PEMs from the AAPOS website. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL) and Simple Measure of Gobbledygook (SMOG). Quality and understandability were evaluated using the DISCERN and the Patient Education Materials Assessment Tool (PEMAT), respectively. Accuracy was assessed using the Likert misinformation scale. Each PEM was separately rewritten by ChatGPT-4 and Gemini Advanced after initial analysis. Changes were analyzed. RESULTS: Baseline PEMs were written on average at a 9th-grade reading level (SMOG, 9.0 ± 1.6; FKGL, 9.6 ± 2.1), with only 3.6% meeting the 6th-grade recommendation. ChatGPT-4 rewrites improved readability to a 7th-grade level without compromising quality, while Gemini Advanced rewrites met the 6th-grade threshold but showed modestly reduced quality (DISCERN: 3; P < 0.001). Both models enhanced understandability (ChatGPT-4, 90.9%; Gemini Advanced, 91.3%; [P < 0.001]), and their rewrites contained no misinformation (Likert = 1). CONCLUSIONS: AAPOS PEMs were high in quality and accurate at baseline, but written at a high school level. As supplemental tools, LLMs can improve PEMs' readability and understandability. PEMs should be thoroughly reviewed by physicians to ensure optimal safety and education.
Short stature in children with primary congenital glaucoma-a retrospective cross-sectional study.
Babgi R, AlObaida I, Al Owaifeer AM … +3 more , Malik R, AlQahtani DS, Al Noaim K
J AAPOS · 2025 Dec · PMID 41274542 · Publisher ↗
BACKGROUND: In our practice, we have observed that many children with primary congenital glaucoma (PCG) seem to have short stature. The purpose of this study was to investigate whether there is an association between PCG...
BACKGROUND: In our practice, we have observed that many children with primary congenital glaucoma (PCG) seem to have short stature. The purpose of this study was to investigate whether there is an association between PCG and short stature in children. METHODS: The medical records of children with PCG (mean age, 41.1 ± 18.9 months) who presented to our tertiary eye care center from January 2014 to December 2020 were reviewed retrospectively. Baseline characteristics, heights and weights of children were extracted from the record and plotted on standard height/weight charts. Z scores for height and weight were calculated, and short stature and low weight were classified as moderate or severe. RESULTS: This pilot study included 93 patients with PCG, 43 (46%) males and 50 (54%) females. Forty-three children (46%) had evidence of moderate or severely short stature (Z score < -2), with a roughly equal distribution by sex. Twenty-seven children (29%) had evidence of severe short stature (Z score < -3). Despite short stature, children tended not to be underweight: only 6 children (6%) were moderately or severely underweight. CONCLUSIONS: Our study suggests that children with PCG may be of shorter stature, but of normal weight for age. These findings warrant further evaluation in a larger detailed prospective study controlling for potential confounders such as socioeconomic status.
Evaluating the G-ROP criteria sensitivity for type 1 ROP in a North American cohort.
Pang O, Habib N, Conley J … +2 more , Fletcher-Morehouse L, Geddie B
J AAPOS · 2025 Dec · PMID 41274541 · Publisher ↗
BACKGROUND: Current screening criteria for retinopathy of prematurity (ROP) follow the American Academy of Pediatrics (AAP) guidelines. However, the Postnatal Growth and Retinopathy (G-ROP) study has proposed newer crite...
BACKGROUND: Current screening criteria for retinopathy of prematurity (ROP) follow the American Academy of Pediatrics (AAP) guidelines. However, the Postnatal Growth and Retinopathy (G-ROP) study has proposed newer criteria, showing 100% sensitivity for detecting type 1 ROP while reducing the number of infants requiring dilated retinal examinations by 30%. The purpose of this study was to validate the G-ROP criteria in a midsized Midwestern children's hospital. METHODS: We conducted a retrospective cohort study of infants screened for ROP between January 2018 and December 2022 under AAP guidelines. We then applied the G-ROP criteria to the same cohort and evaluated the sensitivity and specificity of these guidelines for detecting type 1 ROP requiring treatment. RESULTS: A total of 687 infants were included. The average gestational age 28 weeks; the average birthweight, 1022.5 g. Of the 687 infants screened by standard of care (SOC) criteria, 448 (65.2%) met G-ROP criteria. Using SOC criteria, 34 infants (4.9%) developed type 1 ROP necessitating treatment. However, when using G-ROP screening criteria, 33 of 448 (7.4%) with type 1 ROP were identified. The sensitivity of G-ROP for detecting type 1 ROP was 97.1%, but 1 infant who required treatment was missed. CONCLUSIONS: G-ROP criteria demonstrated high sensitivity but did not match the 100% sensitivity from earlier studies. The single infant with type 1 ROP missed by G-ROP screening had a medical history of twin-to-twin transfusion syndrome. The physiologic factors of twin-to-twin transfusion syndrome could be important to explore when considering ROP screening criteria.
One-stage versus two-stage surgical correction of blepharophimosis-ptosis-epicanthus inversus syndrome: a retrospective comparative study.
Swaify IY, El Essawy RA, Abdelfattah RA … +1 more , Abdelbaky SH
J AAPOS · 2025 Dec · PMID 41265558 · Publisher ↗
PURPOSE: To compare the surgical outcomes of one-stage and two-stage correction of blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) in children <3 years of age. METHODS: This retrospective comparative study in...
PURPOSE: To compare the surgical outcomes of one-stage and two-stage correction of blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) in children <3 years of age. METHODS: This retrospective comparative study included children <3 years with BPES who underwent surgical correction at Cairo University. Medial canthoplasty was performed using the Y-V, C-U, or five-flap technique, while ptosis was corrected by frontalis suspension using polytetrafluoroethylene sling. Patients were divided into one-stage and two-stage groups. Surgical outcomes were assessed based on horizontal palpebral fissure length (HPFL), interpalpebral fissure height (IPFH), inner intercanthal distance (IICD) and IICD/HPFL ratio. RESULTS: Twenty-four patients were included: 11 in the one-stage group and 13 in the two-stage group. Both groups showed significant postoperative improvements in HPFL, IPFH, IICD and IICD/HPFL (P < 0.005), with no statistically significant difference between them. The two-stage group had a higher proportion of patients with good blepharophimosis outcome (46% vs 27%), whereas the one-stage group showed a higher proportion of good ptosis outcomes (64% vs 46%); however, these differences were not statistically significant. Complications were minimal and comparable between both groups. CONCLUSIONS: Outcomes of one- and two-stage approaches were comparable in our cohort. One-stage correction may be preferable in patients with severe ptosis, although two-stage repair may better address severe blepharophimosis.
Endoscopic and surgical evaluation of epiphora in children with Down syndrome.
Nakamura J, Asano M, Ohno T … +3 more , Goto S, Mizuki N, Matsumura N
J AAPOS · 2025 Dec · PMID 41265557 · Publisher ↗
PURPOSE: To examine the clinical characteristics and surgical outcomes of patients with Down syndrome (DS) presenting with primary epiphora. METHODS: The medical records of children with DS referred to a tertiary academi...
PURPOSE: To examine the clinical characteristics and surgical outcomes of patients with Down syndrome (DS) presenting with primary epiphora. METHODS: The medical records of children with DS referred to a tertiary academic children's hospital between 2013 and 2023 were reviewed, and 63 patients with primary epiphora were included in our analysis. Clinical characteristics, diagnostic findings, and surgical intervention outcomes were analyzed. RESULTS: Forty-two patients (67%) had epiphora since birth, and 12 patients (19%) developed symptoms after the first year of life. Of the 40 patients who underwent lacrimal syringing, 28 (70%) showed passage, and 12 showed obstruction. Surgical intervention was performed in 18 patients. Either office-based probing under local anesthesia or endoluminal lacrimal duct recanalization (ELDR) with stent intubation under general anesthesia was performed. In the 18 patients who underwent surgery, surgical outcomes were as follows: complete resolution of symptoms in 7 patients, partial resolution in 10 patients, and failure in 1 patient. Dacryoendoscopy revealed dense white fibrous tissue obstructing the mucosal surface of the nasolacrimal duct in several cases, indicating chronic inflammatory changes. CONCLUSIONS: Dacryoendoscopic findings revealed not only stenotic lacrimal passages due to developmental anomalies of the lacrimal drainage system but also fibrous obstruction secondary to chronic inflammation. Surgical intervention limited to probing or ELDR resulted in only partial symptom improvement in two-thirds of patients, without achieving complete resolution.
Examining key factors on the road to leadership positions among pediatric ophthalmology faculty.
Rudd Zhong Manis J, Bicknell BT, Chishom H … +8 more , Heo Y, Dzubinski L, Liang A, Aaserud T, Massoumi S, Srikantha T, Tauscher R, Brooks SE
J AAPOS · 2025 Dec · PMID 41265556 · Publisher ↗
PURPOSE: To identify key factors associated with attaining leadership positions among US academic pediatric ophthalmologists, with a focus on gender, fellowship training, years of practice, research productivity, and var...
PURPOSE: To identify key factors associated with attaining leadership positions among US academic pediatric ophthalmologists, with a focus on gender, fellowship training, years of practice, research productivity, and variables related to their academic institutions. METHODS: This cross-sectional study reviewed publicly available data accessed through institutional websites. Faculty-specific variables included gender, years since residency graduation, academic rank, leadership roles, and research productivity (eg, H-index, number of publications). Institutional variables included public/private designation and location within US census regions. Research metrics were derived from Scopus. Descriptive statistics, Pearson's χ, the Fischer exact test, and the t test were used for statistical analysis, with significance at P < 0.05. RESULTS: Of 125 US-based ophthalmology programs, 517 pediatric ophthalmology faculty were characterized. Women comprised 54.6% of faculty. Academic rank and H-index were strongly associated with leadership positions (P < 0.001 and P = 0.008, resp.) in multivariable analysis, whereas years since fellowship completion, gender, number of fellowships, and advanced degrees were not. Women full professors had fewer years since fellowship than men (24 vs 36 years [P < 0.001]). Female leadership distribution mirrored faculty averages by region. CONCLUSIONS: Academic rank and research productivity by H-Index are critical factors for achieving leadership roles for academic pediatric ophthalmologists, whereas years since fellowship graduation was not. Underrepresentation of women in full professor and senior leadership roles may reflect a lag in promotions corresponding to the increasing presence of women in pediatric ophthalmology in recent decades.
Virtual reality field testing in children with normal eyes and glaucoma: comparison of game-based versus Humphrey visual field-equivalent algorithms.
Wang B, Naithani R, Alvarez S … +4 more , Cheung N, Liu J, El-Dairi M, Freedman SF
J AAPOS · 2025 Dec · PMID 41265555 · Publisher ↗
BACKGROUND: Virtual reality-based field (VRF) perimetry presents an alternative to standard automated perimetry, offering both game-based and Humphrey-equivalent algorithms. Comparative performance of these two algorithm...
BACKGROUND: Virtual reality-based field (VRF) perimetry presents an alternative to standard automated perimetry, offering both game-based and Humphrey-equivalent algorithms. Comparative performance of these two algorithms is not well-documented. We evaluated the performance of children with healthy eyes and those with known or suspected glaucoma using both VRF algorithms. METHODS: Pediatric patients (children with healthy eyes and with known or suspected glaucoma) were prospectively enrolled to take VisuALL VRF (Olleyes) using a game-based test and a Humphrey-equivalent test; a subset of 49 eyes were also tested with table-top Humphrey visual field (HVF) perimetry. The two algorithms were evaluated based on test duration, foveal sensitivity, mean deviation (MD), pattern standard deviation (PSD), and patient preference, assessed by means of a questionnaire. RESULTS: A total of 71 eyes of 36 participants were included: 42 healthy control eyes, 4 glaucoma suspects, and 25 with known childhood glaucoma. Mean patient age was 10.9 ± 2.6 years (range, 6-17). For game-based versus Humphrey-equivalent algorithms, average MD (-2.78 ± 6.5 vs -3.41 ± 6.4 dB) and foveal sensitivity (30.3 ± 9.0 vs 31.3 ± 6.6 dB) were not statistically significantly different (P = 0.39 vs 0.79, resp.). Comparison using linear mixed-effects modeling showed a positive correlation between visual field parameters from the two VRF test types for both MD (P < 0.001) and PSD (P < 0.001). Test duration was longest for game-based VRF (5.7 min ± 1.8 min) compared with Humphrey-equivalent VRF perimetry (2.6 min ± 0.4 min) and HVF (4.2 ± 1.1 min), but most participants preferred it. CONCLUSIONS: Game-based and Humphrey-equivalent VRFs showed good correlation with respect to one another for visual field parameters for both healthy eyes and those with known or suspected glaucoma. Most children preferred the game-based VRF despite its longer duration.
Effectiveness of the KidsVisionCheck mobile application in screening for amblyopia risk factors and visually significant refractive error.
Ganeshan M, Chung A, Silverstein E
J AAPOS · 2025 Dec · PMID 41167548 · Publisher ↗
KidsVisionCheck (KVC), a free photoscreening mobile application for iOS and Android released in 2022, aims to detect amblyopia risk factors (ARFs) in children. We evaluated its performance in a convenience sample of 120...
KidsVisionCheck (KVC), a free photoscreening mobile application for iOS and Android released in 2022, aims to detect amblyopia risk factors (ARFs) in children. We evaluated its performance in a convenience sample of 120 pediatric ophthalmology clinic patients 12 months to 12 years of age. Patients were screened without optical correction using the application on an iPhone 14 Pro Max running iOS. Screening was followed by a dilated fundus examination with cycloplegic refraction. The 2021 AAPOS Vision Screening guidelines were used to assess for ARFs and visually significant refractive errors. The sensitivity of the application was 69.7%; the specificity, 58.7%. The positive predictive value in this patient population enriched for ophthalmic pathology was 52.4%, and the negative predictive value was 75.7%. KidsVisionCheck performed worse on these metrics than FDA-approved commercial instrument-based vision screeners.
Optic nerve hypoplasia/dysplasia in Coffin-Siris syndrome: a case series.
Rahman S, Sun V, Saint-Martin C … +1 more , Toffoli D
J AAPOS · 2025 Dec · PMID 41167547 · Publisher ↗
We report 4 patients with Coffin-Siris syndrome (CSS), all exhibiting midline brain abnormalities and all showing either optic nerve hypoplasia or dysplasia. Each of the patients has a unique pathogenic variant in CSS-re...
We report 4 patients with Coffin-Siris syndrome (CSS), all exhibiting midline brain abnormalities and all showing either optic nerve hypoplasia or dysplasia. Each of the patients has a unique pathogenic variant in CSS-related genes, including SMARCA4, SMARCB1, SMARCE1, and ARID2, all of which encode components of the BRG1/BRM-associated factor chromatin remodeling complex. The diversity of mutations highlights the molecular heterogeneity of CSS and its potential link to shared developmental pathways affecting the optic nerve.
Oral fluorescein angiography allows for more precise detection of sickle cell retinopathy in pediatric patients.
Lindquist M, Stafie ST, Ward C … +2 more , Dassler A, Mustafi D
J AAPOS · 2025 Dec · PMID 41167546 · Full text
This study compares oral ultrawide-field fluorescein angiography (UWF-FA) to fundus photography in the detection of sickle cell retinopathy (SCR) and discusses the impact of genotype on SCR development. Thirty-two patien...
This study compares oral ultrawide-field fluorescein angiography (UWF-FA) to fundus photography in the detection of sickle cell retinopathy (SCR) and discusses the impact of genotype on SCR development. Thirty-two patients with sickle cell disease (SCD), 7-21 years of age, who underwent SCR screening with both imaging modalities were included. Four retina specialists masked to clinical information assessed SCR severity using the Goldberg classification system; their findings were compared to grades by an unmasked pediatric vitreoretinal specialist. In evaluating the UWF-FA images, the masked graders identified SCR in all 16 cases, as did the unmasked grader, but using fundus photographs they indicated the presence of SCR in only 75% of the same cases. SCR was more prevalent among HbSC (83%) and Hb-beta thalassemia trait (100%) patients compared with HbSS (38%).
A case of unilateral progression of myopia after strabismus surgery.
Nishanth S, M S, S V … +4 more , Kumaramanickavel G, Gijs M, Berendschot TTJM, Bauer NJC
J AAPOS · 2025 Dec · PMID 41138974 · Publisher ↗
We report the case of a 6-year-old boy with stable bilateral simple myopia who underwent strabismus surgery of the left eye for intermittent exotropia. One month following surgery, myopia had progressed to 2.5 D in the o...
We report the case of a 6-year-old boy with stable bilateral simple myopia who underwent strabismus surgery of the left eye for intermittent exotropia. One month following surgery, myopia had progressed to 2.5 D in the operated eye, increasing to 4.5 D by 1 year. Myopic progression was stabilized following treatment with low-dose atropine. The refractive error in the unoperated right eye showed mild increase. The mechanisms that may have precipitated postoperative progressive myopia in this case are discussed.
Multiple, bilateral choroidal macrovessels with visible pulsations in an infant with trisomy 18.
House RD, Wang W, Law MX … +2 more , Kelly MP, Prakalapakorn SG
J AAPOS · 2025 Dec · PMID 41135860 · Publisher ↗
We present a novel finding of multiple, bilateral prominent choroidal macrovessels with pulsations visible on funduscopic examination and confirmed by optical coherence tomography in a 9-day-old infant with trisomy 18.
We present a novel finding of multiple, bilateral prominent choroidal macrovessels with pulsations visible on funduscopic examination and confirmed by optical coherence tomography in a 9-day-old infant with trisomy 18.
Progression of acute comitant esotropia into cyclical esotropia in a 7-year-old child.
Mohan M, Jacob SC
J AAPOS · 2025 Dec · PMID 41115500 · Publisher ↗
We report the case of a 7-year-old girl who, following prolonged screen exposure, developed acute comitant esotropia, which progressed within 1 month to a cyclical pattern. For 4 months the cycles followed a 48-hour patt...
We report the case of a 7-year-old girl who, following prolonged screen exposure, developed acute comitant esotropia, which progressed within 1 month to a cyclical pattern. For 4 months the cycles followed a 48-hour pattern, afterward progressing to episodes of esotropia lasting for 2 to 3 days interspersed with a day of orthophoria, for another 2 months. Subsequently, the patient developed suppression and constant esotropia. Once the strabismus angles stabilized and remained reproducible, she underwent a 5.5 mm bilateral medial rectus recession. Postoperatively, she achieved orthophoria with restored binocularity and full stereopsis for both distance and near.
Incidence and characterization of retinal findings after SARS-CoV-2 infection in children.
Zontag N, Perkins J, Wong BM … +1 more , Levin AV
J AAPOS · 2025 Dec · PMID 41101384 · Publisher ↗
PURPOSE: To determine whether SARS-CoV-2 infection is associated with retinal hemorrhage in young children. METHODS: The medical records of children <8 years of age treated in the University of Rochester healthcare syste...
PURPOSE: To determine whether SARS-CoV-2 infection is associated with retinal hemorrhage in young children. METHODS: The medical records of children <8 years of age treated in the University of Rochester healthcare system between July 1, 2020, and July 1, 2024, who underwent ophthalmologic examination, within 28 days of a COVID-19 diagnosis were reviewed retrospectively. RESULTS: A total of 8,196 children were diagnosed with COVID-19 during the study period. Of these, 56 had a dilated ocular examination within 28 days of their COVID-19 diagnosis. All fundus examinations were normal except for 1 patient with optic nerve edema. Our findings suggest with 95% confidence, that the true incidence of retinal hemorrhage in children <8 years old following COVID-19 infection is likely to be <9.09% at 14 days, 7.69% at 21 days, and 5.35% at 28 days. CONCLUSIONS: Our data, along with a review of the literature, suggest that there is little if any evidence that SARS-CoV-2 infection causes retinal hemorrhage in young children.
Factors influencing the timing of complete retinal vascularization in infants screened for retinopathy of prematurity.
Kuziel J, Strampe M, VandeLune J … +3 more , Zirbes C, Larson S, Dumitrescu A
J AAPOS · 2025 Dec · PMID 41067499 · Publisher ↗
BACKGROUND: Premature infants screened for retinopathy of prematurity (ROP) reach complete retinal vascularization at various postmenstrual ages (PMAs). The purpose of this study was to evaluate the factors that affect t...
BACKGROUND: Premature infants screened for retinopathy of prematurity (ROP) reach complete retinal vascularization at various postmenstrual ages (PMAs). The purpose of this study was to evaluate the factors that affect the age at which the infant eyes reach retinal vascular maturity. METHODS: We reviewed patients screened for ROP at our institution between December 13, 2007, and December 30, 2020. Data extracted included demographics, gestational age (GA) and birth weight (BW), ROP examinations, age and weight at retinal maturity, surgical procedures, ventilation status, antibiotic treatment, positive blood cultures, blood transfusions, and central line placement. RESULTS: A total of 1,971 patients were analyzed. The mean GA at birth was 28 weeks, and the mean BW was 1,096 g. Mean PMA for retinal maturity was 44.90 weeks. Mean PMA at retinal maturity was higher for infants born at an earlier GA (P < 0.0001). Additionally, infants who underwent nonocular surgery reached retinal maturity at significantly high PMA (P < 0.0001). Infants with stage 1 ROP or greater had a significantly longer time from birth to retinal maturity (P < 0.0001) and those with stage 2 or 3 disease reached retinal maturity at even older chronological ages (P < 0.0001). Chronological age at retinal maturity was also higher for children with positive blood cultures or who received transfusions ≥5 units (P < 0.0001). CONCLUSIONS: Postmenstrual age at retinal maturity and chronological age at retinal maturity both vary widely among infants at risk of ROP, and are associated with a variety of ocular and systemic clinical predictors.
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