PURPOSE: To investigate the effects of video display terminal (VDT) use on the rate of computer vision syndrome questionnaire (CVSQ)-related symptoms and mental health among adolescents. METHODS: We conducted a retrospec...PURPOSE: To investigate the effects of video display terminal (VDT) use on the rate of computer vision syndrome questionnaire (CVSQ)-related symptoms and mental health among adolescents. METHODS: We conducted a retrospective cross-sectional study of adolescents between 2022 and 2023 who had no organic lesions in the eyes and best-corrected visual acuity of ≤logMAR 0.0 with astigmatism ≤2.50 D. Ocular examinations were performed, and a questionnaire designed to elicit VDT usage information, evaluate CVSQ-related symptoms, and assess mental health was administered. Participants were divided into three groups based on hours of daily VDT use: ≤3 hours (group 1), 3-6 hours (group 2), and ≥6 hours (group 3). RESULTS: A total of 120 participants (65 males) were included. Mean participant age was 14.22 ± 1.12 years. Mean VDT time was 4.2 hours per day. Visual fatigue (57.5%) was the most common symptom of CVS. Despite VDT use, the psychological health of adolescents remained positive, with approximately 93.3% reporting feeling cheerful. Significant differences in the incidence of double vision were found among the groups (P = 0.012), with group 3 having a significantly higher incidence compared with group 1 (P = 0.004). No correlation was observed between VDT hours and dry eye disease, accommodative function, or myopia (P > 0.05). Normal as opposed to abnormal fusional vergence facility (FVF) was associated with lower risk for visual fatigue (OR = 0.222, P = 0.015). CONCLUSIONS: In our study cohort, self-reported results showed that VDT use did not influence adolescents' mental health, but VDT use did increase ocular symptoms. Deficits in FVF can exacerbate visual fatigue, highlighting the need for preventative measures.
Despite the importance of the iridocorneal angle in childhood glaucoma, relatively few studies have been published on the outflow system in children and how surgery affects the iridocorneal angle. Using overhead-mounted...Despite the importance of the iridocorneal angle in childhood glaucoma, relatively few studies have been published on the outflow system in children and how surgery affects the iridocorneal angle. Using overhead-mounted optical coherence tomography, we investigated the iridocorneal angle of patients with childhood glaucoma after angle surgery to describe the appearance of the angle and how it may be associated with intraocular pressure (IOP) control. No eyes showed closed angle or peripheral anterior synechiae. Almost all imaged eyes (89%) had a visible open cleft, but many had inadequately controlled IOP. The presence of a cleft, residual trabecular meshwork or remnant of tissue, and open collector channels were not associated with IOP at the time of imaging, although our analysis did not control for other treatment variables that may have masked associations of IOP with anatomical features.
Myopic strabismus, also known as heavy eye syndrome, is a rare ocular motility disorder, typically presenting with bilateral esotropia and hypotropia. We present the case of a 42-year-old man who presented with progressi...Myopic strabismus, also known as heavy eye syndrome, is a rare ocular motility disorder, typically presenting with bilateral esotropia and hypotropia. We present the case of a 42-year-old man who presented with progressive hypotropia and exotropia rather than esotropia. Orbital imaging revealed a superonasal staphyloma with pathological changes in the extraocular muscles. Surgical correction involved loop myopexy between the superior rectus and medial rectus muscles combined with lateral rectus recession.
In the scotopic flash response of the full-field electroretinogram (ffERG), the downward a-wave reflects photoreceptor response and the upward b-wave is indicative of bipolar cell function. If the b-wave is equal to or s...In the scotopic flash response of the full-field electroretinogram (ffERG), the downward a-wave reflects photoreceptor response and the upward b-wave is indicative of bipolar cell function. If the b-wave is equal to or smaller than the a-wave, the waveform (and the ffERG) is termed electronegative. For pediatric inherited retinal disorders this finding narrows the differential diagnosis to certain conditions, most commonly congenital stationary night blindness if multimodal imaging is grossly normal. We describe 2 siblings with reduced vision in the setting of normal multimodal imaging. Inherited retinal disorder was suspected, and ffERG was performed. Both had electronegative ffERGs, suggesting an incomplete form of congenital stationary night blindness (cone-rod synaptic disorder). However, genetic testing (biallelic RGS9 pathogenic variants) and phenotypic reassessment confirmed an actual diagnosis of bradyopsia. This report expands the differential diagnosis for an electronegative ffERG to include bradyopsia and highlights features of this underdiagnosed pediatric inherited retinal disorder.
KBG syndrome is characterized by intellectual disability, and craniofacial and skeletal abnormalities. We report the case of a 5-year-old boy with KBG syndrome with 16q24.3 microdeletion who showed complex strabismus. Le...KBG syndrome is characterized by intellectual disability, and craniofacial and skeletal abnormalities. We report the case of a 5-year-old boy with KBG syndrome with 16q24.3 microdeletion who showed complex strabismus. Left esotropia and ptosis was first noticed by parents at 18 months of age. He also showed submucosal cleft palate, velopharyngeal insufficiency, prominent eyebrows, short fifth fingers, and fetal finger pad. Marginal reflex distances were +4 mm in the right eye and +1.5 mm in the left eye. He had 18 of left esotropia, and 12 of left hypotropia, which increased with head tilt to the right. Ductions and versions showed bilateral upgaze limitation, more on the right eye, and mild limitation of downgaze on adduction in both eyes. Anti-acetylcholine receptor antibody test, ice test, thyroid function test and the repetitive nerve stimulation test were all negative. Magnetic resonance imaging revealed normal orbital structures, including the bony orbit, oculomotor, trochlear, and abducens nerves, and extraocular muscles in both eyes.
Ocular and orbital hemorrhage are rare but serious complications of thrombolytic therapy. We present the case of an 83-year-old woman who developed a retrobulbar hemorrhage resulting in left orbital compartment syndrome...Ocular and orbital hemorrhage are rare but serious complications of thrombolytic therapy. We present the case of an 83-year-old woman who developed a retrobulbar hemorrhage resulting in left orbital compartment syndrome following tenecteplase thrombolysis for acute ischemic stroke shortly after uncomplicated bilateral strabismus surgery. The patient underwent lateral canthotomy with inferior and superior cantholysis for intraocular pressure reduction. Hemostasis was achieved after the use of topical thrombin-gelatin and thrombolytic reversal with cryoprecipitate and platelets. To our knowledge, this is the first reported case of retrobulbar hemorrhage after tenecteplase thrombolysis for acute ischemic stroke following strabismus surgery.
We report the case of a 5-year-old boy who presented with an enlarging intrastromal cyst at the site of a previous corneal laceration. The cyst was monitored biannually for 2 years, during which time it continued to enla...We report the case of a 5-year-old boy who presented with an enlarging intrastromal cyst at the site of a previous corneal laceration. The cyst was monitored biannually for 2 years, during which time it continued to enlarge and encroach on the visual axis, prompting surgical drainage. Subsequent recurrences necessitated repeating drainage twice, followed by prolonged stability. This case demonstrates successful long-term management of an intrastromal epithelial cyst with curettage and balanced salt solution irrigation.
PURPOSE: To compare the effects of prenatal methadone and buprenorphine exposure on visual outcomes in children. METHODS: The medical records of children with history of prenatal opioid exposure who participated in instr...PURPOSE: To compare the effects of prenatal methadone and buprenorphine exposure on visual outcomes in children. METHODS: The medical records of children with history of prenatal opioid exposure who participated in instrument-based vision screening using the SPOT vision screener during ongoing visits to Cincinnati Children's Hospital Medical Center's Neonatal Opioid Withdrawal Syndrome (NOWS) Clinic from 2015 to 2021 were reviewed retrospectively. Chart review identified prenatal exposures, vision screening outcome, visual diagnoses, and visual interventions in early childhood. Logistic regression models were used to examine the extent to which prenatal exposure to methadone influenced the odds of a failed vision screen during the first 3 years of life compared with prenatal exposure to buprenorphine. RESULTS: A total of 236 children were included. Of these, 79 (33%) had a failed vision screen. We compared outcomes of children with prenatal exposure to methadone versus buprenorphine, using an adjusted logistic regression model that accounted for birth weight, gestational age, sex, race, ethnicity, NOWS pharmacologic treatment, prenatal nicotine exposure, and prenatal polysubstance exposure. Children with prenatal methadone exposure were twice as likely to fail their vision screen (aOR 2.27; 95% CI, 1.25-4.16), and were more likely to be diagnosed with strabismus (P = 0.04). The most frequent diagnoses in this population were astigmatism (n = 31), strabismus (n = 17), and pseudostrabismus (n = 9). CONCLUSIONS: In our study cohort of 236 children, those with prenatal methadone exposure were more likely to have failed instrument-based vision screen than those with prenatal exposure to buprenorphine, even after accounting for confounding variables.
PURPOSE: To describe the incidence and spectrum of ophthalmic findings in pediatric patients with craniofacial linear scleroderma. METHODS: The medical records of patients <18 years of age diagnosed with craniofacial scl...PURPOSE: To describe the incidence and spectrum of ophthalmic findings in pediatric patients with craniofacial linear scleroderma. METHODS: The medical records of patients <18 years of age diagnosed with craniofacial scleroderma and attending a multidisciplinary quaternary clinic between June 2021 and November 2024 were reviewed retrospectively. The following data were extracted from the record: visual acuity, exophthalmometry, ocular motility, pachymetry, slit lamp examination, dynamic retinoscopy, intraocular pressure, cycloplegic refraction, dilated fundus examination, wide-field fundus photography, and, when available, other ophthalmic imaging (fundus fluorescein angiography, slit lamp photographs, or optical coherence tomography). The main outcome measure was presence and categorization of abnormal ophthalmic findings. RESULTS: A total of 72 pediatric patients with a mean age of 10.3 ± 4.2 years were included. Anterior segment abnormalities were identified in 53 patients (74%), most commonly dry eye disease in 46 patients (64%). Ocular adnexal abnormalities were found in 38 (53%), most commonly meibomian gland disease in 26 (36%). Posterior segment abnormalities were documented in 44 patients (61%). The most common posterior segment finding was abnormal retinal vessels (n = 23). Retinal dialysis, the most vision-threatening abnormality, was found in a single patient. CONCLUSIONS: To our knowledge, this is the largest study cohort of pediatric craniofacial scleroderma. Our findings underscore the diversity of ophthalmic involvement, including ocular adnexa, ocular surface, ocular motility, anterior segment, and posterior segment changes.
A comprehensive review of the initial 25-year experience of Ophthalmic Mutual Insurance Company claims in the field of pediatric ophthalmology and strabismus was reported in 2015. The current report is a retrospective an...A comprehensive review of the initial 25-year experience of Ophthalmic Mutual Insurance Company claims in the field of pediatric ophthalmology and strabismus was reported in 2015. The current report is a retrospective analysis of 28 new closed claims arising from 22 cases in the decade since that study. The frequency of claims declined during the study period, although claim severity continued to be high. Successes and new areas for risk management were identified. Ophthalmologists may use this information to supplement the findings of the prior study to improve quality of care for patients in this population.
We present the case of a 13-month-old girl with Down syndrome who underwent probing to alleviate nasolacrimal duct obstruction (NLDO). During the procedure, a distal portion of the deployed Crawford hook fragmented and b...We present the case of a 13-month-old girl with Down syndrome who underwent probing to alleviate nasolacrimal duct obstruction (NLDO). During the procedure, a distal portion of the deployed Crawford hook fragmented and became lodged in the right nasopharynx. Traditional intraoperative methods of visualization were unsuccessful; however, extraction of the fragment was achieved by using a nasogastric bridle magnet. This case demonstrates a novel method of metallic foreign body removal, which may be useful when exact location cannot be determined.
A 52-year-old man was referred to our strabismus clinic for evaluation of abnormal ocular motility of the right eye of 40 years' duration that resulted from childhood trauma, when he had suffered a head contusion in an a...A 52-year-old man was referred to our strabismus clinic for evaluation of abnormal ocular motility of the right eye of 40 years' duration that resulted from childhood trauma, when he had suffered a head contusion in an automobile accident. Immediately after the injury, he had ophthalmoplegia and ptosis in the right eye and was diagnosed with oculomotor nerve palsy. The present examination revealed a right exotropia of 35 and a hypotropia of 25 in the primary position at both near and far fixation. However, the right eye did not move upward on attempted supraduction; furthermore, infraduction on attempted supraduction was observed in the right eye.
PURPOSE: To identify the timing and impact of factors that influenced recent pediatric ophthalmology fellows in their subspecialty decision. METHODS: An anonymous survey was distributed to pediatric ophthalmology fellows...PURPOSE: To identify the timing and impact of factors that influenced recent pediatric ophthalmology fellows in their subspecialty decision. METHODS: An anonymous survey was distributed to pediatric ophthalmology fellows who matriculated into US fellowship programs between 2021 and 2023. The survey assessed training background, timing of exposures to the field, and influential decision-making factors. RESULTS: A total of 61 respondents completed the survey. Among US medical graduates, 18 (40%) first considered a career in pediatric ophthalmology during medical school, followed by 11 (24%) during PGY3, 8 (18%) during PGY2, 3 (7%) during PGY1 and PGY4, and 3 (4%) prior to medical school. During medical school and residency, exposure to clinical and surgical experiences as well as faculty mentorship contributed most to respondent interest in the specialty. Key motivational factors to pursue pediatric ophthalmology included the types of surgeries performed, patient population, and the opportunity to improve patient access to care. Conversely, respondents expressed concerns regarding financial compensation and perceived difficulty of the field. CONCLUSIONS: A large percentage of future pediatric ophthalmologists become interested in the field during medical school, which may thus represent a critical period to attract more trainees to pediatric ophthalmology. Strategies to foster greater interest in pediatric ophthalmology could include more early mentorship and rotation opportunities.
PURPOSE: To compare the stereoacuity outcomes and associated predictors among children with fully accommodative esotropia (FAET) and those with partially accommodative esotropia (PAET). METHODS: The medical records of al...PURPOSE: To compare the stereoacuity outcomes and associated predictors among children with fully accommodative esotropia (FAET) and those with partially accommodative esotropia (PAET). METHODS: The medical records of all children (<19 years) diagnosed with accommodative esotropia while residing in Olmsted County, Minnesota, from January 1, 1975, through December 31, 1994, were retrospectively reviewed. RESULTS: A total of 306 children with accommodative esotropia were diagnosed during the study period: 244 (79.7%) were fully accommodative, and 62 (20.3%) were partially accommodative. Children with PAET were more likely to be diagnosed at a younger age (3.6 years vs 4.1 [P = 0.026]) and have a larger mean angle of deviation at distance (26.0 vs 17.3; P < 0.001) and at near (33.3 vs 23.3 [P < 0.001]) than children with FAET. After a mean follow-up of 9.8 years (range, 0-27.9), high-grade stereoacuity (≤60 arcsec) was found in 81/230 (35%) of the 244 children with FAET compared with 8/58 (14%) of 62 with PAET at final follow-up (P = 0.002). A mean older age at reported onset (3.7 vs 3.0 years [P = 0.018]) was associated with high-grade stereoacuity in children with FAET. CONCLUSIONS: In this population-based cohort, children with FAET were more likely to present at an older age, with a smaller deviation, and achieve high-grade stereoacuity than were those with PAET. Older age at onset was significantly associated with fine stereopsis in children with FAET.
PURPOSE: To compare axial length (AL) estimates of myopic eyes obtained using an axial length estimator (ALE) and AL measurements made with the IOLMaster 700 in India and the Lenstar 900 in Vietnam. METHODS: This multice...PURPOSE: To compare axial length (AL) estimates of myopic eyes obtained using an axial length estimator (ALE) and AL measurements made with the IOLMaster 700 in India and the Lenstar 900 in Vietnam. METHODS: This multicenter retrospective cross-sectional study analyzed masked data of both eyes from myopic children (<18 years of age). Estimated AL was derived from mean keratometry and refraction values using ALE. Differences between actual and estimated ALs and their correlation were assessed using Bland-Altman plots and intraclass correlation coefficients (ICCs). RESULTS: A total of 237 myopic children (474 eyes) aged 5-16 years were included: 90 Indian and 147 Vietnamese children. ALE estimates on average exceeded actual AL measurements, with mean differences of -0.26 mm (95% limits of agreement, -1.25 to 0.73 mm) for ALE formula, and -0.21 mm (95% limits of agreement, -1.14 to 0.71 mm) for ALE data input. ICCs showed strong agreement: 0.90 (95% CI, 0.83-0.93) for actual AL versus ALE data input and 0.89 (95% CI, 0.78-0.93) for actual AL versus ALE formula. Indian children had shorter actual AL than Vietnamese children (24.56 ± 0.90 vs 24.91 ± 0.86 mm [P < 0.001]) and exhibited slightly smaller differences between actual and estimated AL (-0.13 vs -0.27 mm for ALE data input; -0.17 vs -0.31 mm for ALE formula). CONCLUSIONS: In our cohorts, ALE demonstrated strong agreement with IOLMaster 700 and Lenstar 900 AL measurements in myopic children. ALE may be a useful clinical tool for this population when direct measurements of AL are unavailable.
PURPOSE: To characterize the association between macula ganglion cell-inner plexiform layer thickness (GCT) and visual loss in children with papilledema. METHOD: The medical records of pediatric patients (<18 years of ag...PURPOSE: To characterize the association between macula ganglion cell-inner plexiform layer thickness (GCT) and visual loss in children with papilledema. METHOD: The medical records of pediatric patients (<18 years of age) presenting with papilledema at a single institution between 2012 and 2022 were reviewed retrospectively. Presenting age, sex, lumbar puncture opening pressure, and etiology were recorded in addition to initial and final best-corrected visual acuity, average peripapillary circumferential retinal nerve fiber layer (RNFL) thickness, and GCT. Clinical characteristics were compared between those with and without visual loss, defined as logMAR best-corrected visual acuity ≥0.3, Humphrey visual field mean deviation < -3.0, or abnormal Goldmann visual field. RESULTS: A total of 160 eyes of 80 patients (53 female [67%]) were included. Mean patient age was 11.5 years (range, 4-18). Mean follow-up was 19.5 months. Primary pseudotumor cerebri was the diagnosis in 68 cases (85%); secondary, in 12 (15%). Of the 160 eyes, 22 (14%) experienced visual loss (visual acuity, 14; visual fields, 8). Those with visual loss had a significantly higher lumbar puncture opening pressure (41 vs 46 cm HO [P = 0.01]) and higher initial RNFL (242 μm vs 187 μm [P = 0.04]) on univariate analysis. No difference between groups was found for baseline GCT, age, sex or etiology. Average final mean GCT was 73 μm versus 83 μm (P < 0.001) in those with vision loss versus those without, respectively; average final minimum GCT was 68 μm versus 81 μm (P < 0.001) in those with vision loss versus those without, respectively. CONCLUSIONS: In this cohort, final GCT was significantly reduced in pediatric patients with papilledema associated with visual loss compared with those without.
BACKGROUND: The prolonged monocular occlusion (PMO) test is used to eliminate tenacious proximal fusion in patients with divergence excess intermittent exotropia. The minimum necessary duration of PMO is unknown. This st...BACKGROUND: The prolonged monocular occlusion (PMO) test is used to eliminate tenacious proximal fusion in patients with divergence excess intermittent exotropia. The minimum necessary duration of PMO is unknown. This study was designed to determine whether 15 minutes of PMO test is comparable to 45 minutes of PMO. METHODS: This prospective, randomized, observational study included 22 patients (5-14 years of age) diagnosed with divergence excess intermittent exotropia. The main outcome measure was the subclassification of divergence excess intermittent exotropia. The secondary outcomes were the effect of 15 minutes and 45 minutes of PMO on the size of the deviation, the near-distance disparity, and the accommodative convergence-accommodation (AC/A) ratio estimates. RESULTS: The number of patients classified as simulated, high AC/A ratio, and true divergence excess intermittent exotropia were identical following 15 minutes and 45 minutes of PMO. There were no statistically or clinically significant differences in the size of the near and distance deviations, the near-distance disparity, or the AC/A ratio following 15 and 45 minutes of PMO. CONCLUSIONS: In our patient cohort, a period of 15 minutes of PMO was sufficient to unmask the true underlying deviation at near and properly subclassify divergence excess intermittent exotropia patients.
Pediatric glaucoma is a sight-threatening condition that requires a seamless transition from pediatric to adult healthcare. We retrospectively evaluated outcomes at the Birmingham Children Hospital transition clinic, inc...Pediatric glaucoma is a sight-threatening condition that requires a seamless transition from pediatric to adult healthcare. We retrospectively evaluated outcomes at the Birmingham Children Hospital transition clinic, including patient attrition and risk factors for post-transition surgeries. Our study cohort included 46 eyes of 28 patients (19 males) who attended the clinic from 2017 to 2023 and received follow-up care at Birmingham and Midland Eye Centre. Our analysis revealed that intraocular pressure at transition clinic is a significant (P = 0.044) predictor of the need for additional glaucoma surgery after transition. Patient retention was 92%, with only 2 patients lost to follow-up.