PURPOSE: To assess the driving performance and visual attention of amblyopic drivers using a driving simulator integrated with eye tracking technology in an urban setting. METHODS: A total of 30 participants were enrolle...PURPOSE: To assess the driving performance and visual attention of amblyopic drivers using a driving simulator integrated with eye tracking technology in an urban setting. METHODS: A total of 30 participants were enrolled: 14 amblyopic patients (all anisometropic and one also with strabismus) and 16 controls. Participants completed a simulated urban driving task while their eye movements and driving performance were recorded using a DriveSafety DS-600c simulator integrated with an infrared eye tracker. Driving performance (speed, brake reaction time / deceleration at pedestrian crossings, lane position variability, steering variability) and eye movement parameters (fixations, gaze distribution, saccades) were compared between amblyopic and control participants. In addition, pooling data from both groups, we assessed for correlations between eye movement parameters and driving performance. RESULTS: Amblyopic and nonamblyopic drivers performed similarly on driving tasks and had comparable eye movement recordings. Some nonsignificant tendencies were noted among amblyopic drivers, including slower driving speeds, longer brake reaction times, and increased steering variability. We identified potential tendencies for correlations between eye tracking metrics and driving performance: increased fixation frequency was associated with greater lane position variability, and larger saccadic movements correlated with improved lane stability and faster hazard response; however, these correlations were not statistically significant. CONCLUSIONS: In our study cohort, simulated driving performance and attention in subjects with anisometropic amblyopia under a standardized, relatively low-complexity urban scenario were similar to findings for nonamblyopic drivers, suggesting that amblyopia did not prevent safe driving in that context. Trends toward correlations between eye tracking and driving simulation parameters were observed, underscoring the potential of combining both approaches in future research in addition to testing a larger sample size, with a more challenging driving scenario.
PURPOSE: To describe the outcome of surgical management of overcorrection after nasal transposition of split lateral rectus (NTSLR) for oculomotor nerve palsy. METHODS: The medical records of patients who underwent surgi...PURPOSE: To describe the outcome of surgical management of overcorrection after nasal transposition of split lateral rectus (NTSLR) for oculomotor nerve palsy. METHODS: The medical records of patients who underwent surgical revision for overcorrection after NTSLR from January 2014 to January 2024 were reviewed retrospectively. Details of the surgical overcorrection were analyzed. Ductions, versions, and angles of strabismus were evaluated before and after surgical revision. RESULTS: Nine patients were identified. Median patient age was 37 years (IQR, 28-49; range, 8-60). Median preoperative angle of esotropia was 30 (IQR, 20-30; range, 15- 40). Median time between the first surgery and reoperation was 14 days (IQR, 7-40; range, 5-102). During revision, both halves of the lateral rectus were recessed 6 mm. The average follow-up after second surgery was 7.5 months. Median angle of esotropia decreased to 10 (IQR, 5-30; 15 exotropia to 30 esotropia) at last follow-up. Five patients (55%) were aligned within 15 of orthotropia; all of these patients had surgical revision performed within the first 2 postoperative weeks. In 4 patients, the angle of deviation was unchanged or changed by only 5 after surgical revision, and all of these surgical revisions were performed at least 1 month after the initial surgery. There was a statistically significant negative correlation between the amount of correction achieved and the time between the first surgery and revision (r = -0.87, P = 0.0022). CONCLUSIONS: In our small study cohort, revision surgery following overcorrection after NTSLR by recessing the transposed lateral rectus muscle along the border of the medial rectus muscle was successful only when performed within the first 2 weeks of initial surgery.
Group A Streptococcus (GAS) is a rare cause of endogenous endophthalmitis among both children and adults, with only a handful of cases described in the current literature. We report the case of a previously healthy 3-yea...Group A Streptococcus (GAS) is a rare cause of endogenous endophthalmitis among both children and adults, with only a handful of cases described in the current literature. We report the case of a previously healthy 3-year-old girl who was diagnosed with unilateral endogenous GAS endophthalmitis with severe anterior involvement, after presenting with unilateral eye pain and injection, polyarthralgia, and skin changes thought to be inflammatory in nature. This case highlights the atypical manifestations of GAS bacteremia that can masquerade as a systemic autoimmune process.
BACKGROUND: Children with autism spectrum disorder (ASD) have higher rates of visual disorders, such as amblyopia and strabismus, but the impact of these disorders on autism symptoms is unknown. We assessed adaptive, soc...BACKGROUND: Children with autism spectrum disorder (ASD) have higher rates of visual disorders, such as amblyopia and strabismus, but the impact of these disorders on autism symptoms is unknown. We assessed adaptive, social, and repetitive behaviors in children with ASD with and without binocular vision disorders (amblyopia and strabismus). METHODS: Children aged 3-17 years were categorized into one of two groups: ASD with comorbid amblyopia or strabismus (ASD+/BVD+) or ASD without a visual disorder (ASD+/BVD-). All participants underwent a complete ophthalmologic examination to inform group assignment. Parents or guardians completed standardized questionnaires to assess participants' adaptive functioning (Vineland Adaptive Behavior Scales, 3rd ed [VABS-III]), social responsiveness (Social Responsiveness Scale, 2nd ed [SRS-2]), and repetitive behaviors (Repetitive Behavior Scale-Revised [RBS-R]). ASD+/BVD+ and ASD+/BVD- groups were compared using multivariable regression analysis correcting for age and sex. RESULTS: We recruited 14 children in the ASD+/BVD+ group and 29 children in the ASD+/BVD- group. Groups were matched on age, sex, IQ, and overall autism severity. ASD+/BVD+ children had lower scores on the VABS-III Composite and Socialization domain. On the RBS-R, ASD+/BVD+ children exhibited greater insistence on sameness. There were no differences between groups on SRS-2 scores. CONCLUSIONS: Our findings suggest that children with ASD and comorbid amblyopia or strabismus have worse adaptive behaviors than children with ASD without visual disorders, particularly with regard to socialization.
A congenital external lacrimal fistula appears as a small aperture inferonasal to the inner canthus, exuding clear fluid. It is thought to arise from an accessory duct connected to the lacrimal sac. Various operations ha...A congenital external lacrimal fistula appears as a small aperture inferonasal to the inner canthus, exuding clear fluid. It is thought to arise from an accessory duct connected to the lacrimal sac. Various operations have been described for ablation of congenital lacrimal fistula, but no prior study has documented spontaneous closure. We describe a child whose congenital lacrimal fistula resolved after 5 years of observation, obviating the need for a surgical procedure.
PURPOSE: To investigate the association between the severity and distribution of retinal findings, systemic morbidity, and socioeconomic factors with mortality risk in pediatric patients with abusive head trauma (AHT) an...PURPOSE: To investigate the association between the severity and distribution of retinal findings, systemic morbidity, and socioeconomic factors with mortality risk in pediatric patients with abusive head trauma (AHT) and retinal hemorrhages. METHODS: This retrospective study analyzed data from children diagnosed with AHT who underwent RetCam fundus photography over a 10-year period at Arkansas Children's Hospital. Retinal hemorrhages were graded based on extent (region 1 or 2), spread (A-C), and morphology (intraretinal or extraretinal). Based on these three factors, the overall retinal involvement was classified into three grades (1-3). Logistic regression analyzed associations between retinal findings and mortality risk, adjusting for age, sex, race/ethnicity, socioeconomic measures (as determined by the Childhood Opportunity Index), and clinical variables. RESULTS: A total of 182 eyes of 91 children were included. Eighteen children (20%) died. A higher grade of retinal hemorrhages was significantly associated with increased mortality risk (P = 0.0004), with mortality rates of 7% in grade 1, 18% in grade 2, and 53% in grade 3. Greater hemorrhage spread also correlated with a markedly increased mortality risk (odds ratio for grade C = 17.43). Additionally, hypoxic-ischemic injury was a strong predictor of mortality (odds ratio = 115.4). Hemorrhage morphology and demographic and socioeconomic factors were not significantly associated with mortality risk. CONCLUSIONS: In pediatric AHT, the grade and extent of retinal hemorrhages serve as strong predictors of mortality. These findings highlight the prognostic value of detailed retinal examinations in assessing survival outcomes in this population.
PURPOSE: To describe the scleral adjustment (SA) method, a double-pass, knot-free adjustable suture technique for strabismus surgery, and evaluate its clinical outcomes. METHODS: The medical records of 14 consecutive pat...PURPOSE: To describe the scleral adjustment (SA) method, a double-pass, knot-free adjustable suture technique for strabismus surgery, and evaluate its clinical outcomes. METHODS: The medical records of 14 consecutive patients treated with the SA method between December 2024 and May 2025 with ≥3-month follow-up were reviewed retrospectively. Suspension sutures from each muscle end were passed twice through the sclera near the original insertion. After initial surgery, patients returned to the operating room for binocular adjustment in an upright position. RESULTS: Mean patient age was 60 ± 19 years, with mean number of adjustments performed per case of 1.4. Postoperative alignment was within 10 in all patients and remained stable. The SA method enabled precise microadjustments and facilitated simplified adjustments. No intraoperative or postoperative complications were observed. CONCLUSIONS: The SA method is technically simple, avoids knot manipulation during adjustment, and enables precise microadjustments with secure fixation. Favorable outcomes in our small cohort suggest that it is a reliable alternative to sliding knot and bowtie techniques, with potential for mainstream application.
Pulled-in-two syndrome (PITS) is a rare but serious complication of strabismus surgery, with a reported incidence of once every decade among strabismus surgeons. It occurs more commonly in patients of advanced age and th...Pulled-in-two syndrome (PITS) is a rare but serious complication of strabismus surgery, with a reported incidence of once every decade among strabismus surgeons. It occurs more commonly in patients of advanced age and those with cranial nerve palsies or who have undergone prior surgeries. We present a case of PITS in a young female, diagnosed following surgery with a hereditary myosin myopathy.
A 16-year-old girl with major depressive disorder suffered from a recurrent polymicrobial conjunctivitis, culture-positive for Escherichia coli, that persisted over several months despite evaluation by multiple specialis...A 16-year-old girl with major depressive disorder suffered from a recurrent polymicrobial conjunctivitis, culture-positive for Escherichia coli, that persisted over several months despite evaluation by multiple specialists and appropriate antibiotic treatment. Ultimately, a brown malodorous mass, concerning for possible fecal matter, was noted in the inferior fornix of the left eye and sent for pathology review. Pathology results of the mass revealed degenerated vegetable matter debris with associated bacterial colonies consistent with fecal matter. Discussions were held with the patient, her parents, and her primary care provider. The decision was made to involve psychiatry to ensure the self-harm behavior did not continue and further place the patient at risk of vision loss. This report emphasizes that ophthalmic issues can sometimes be manifestations of an underlying psychiatric condition, highlighting the importance of a multidisciplinary treatment approach.
Post-strabismus surgery endophthalmitis (PSSE) is a rare but significant complication, which is most commonly associated with medial rectus recession. We report a case of PSSE in a child who had completed chemotherapy 1...Post-strabismus surgery endophthalmitis (PSSE) is a rare but significant complication, which is most commonly associated with medial rectus recession. We report a case of PSSE in a child who had completed chemotherapy 1 year prior to surgery. Despite vaccination, Haemophilus influenzae was cultured from the vitreous. Although infrequent, scleral perforation during surgery can occur without immediate detection. PSSE is typically caused by Staphylococcus aureus, Streptococcus pneumoniae, and H. influenzae, common pathogens found in the respiratory tract of children.
We report 2 patients with unilateral concurrent optic nerve pit and coloboma complicated by subretinal fluid. Further examination revealed bilateral incomplete retinal peripheral vascularization in 1 case. Laser indirect...We report 2 patients with unilateral concurrent optic nerve pit and coloboma complicated by subretinal fluid. Further examination revealed bilateral incomplete retinal peripheral vascularization in 1 case. Laser indirect ophthalmoscopy and the use of carbonic anhydrase inhibitors stabilized fluid levels and prevented worsening visual symptoms in both cases.
We report the case of a previously healthy 33-month-old boy with vitamin A deficiency (VAD) who presented with bilateral eye swelling, redness, and photophobia of 1 month's duration following multiple misdiagnoses. After...We report the case of a previously healthy 33-month-old boy with vitamin A deficiency (VAD) who presented with bilateral eye swelling, redness, and photophobia of 1 month's duration following multiple misdiagnoses. After confirming VAD with serum vitamin A level testing, he was treated with vitamin A, and his eye complaints improved. However, he continues to have a corneal scar and is currently undergoing amblyopia treatment.
BACKGROUND: Optic pathway gliomas (OPGs) are among the most frequent central nervous system tumors in children with neurofibromatosis type 1 (NF1), yet their prevalence has not been systematically synthesized. Pooled pre...BACKGROUND: Optic pathway gliomas (OPGs) are among the most frequent central nervous system tumors in children with neurofibromatosis type 1 (NF1), yet their prevalence has not been systematically synthesized. Pooled prevalence estimates are important to inform clinical surveillance practices, particularly given the critical role of early symptom detection in preserving vision and the debate regarding magnetic resonance imaging (MRI) surveillance in asymptomatic patients. The purpose of this study was to investigate the prevalence of OPG in children (<18 years) with NF1 based on pooled data in the literature and describe its variability. METHODS: The databases of PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched without language or date restrictions. Eligible studies reported OPG prevalence in patients with NF1 <18 years of age. Two reviewers independently screened studies, extracted data, and assessed quality. Studies meeting minimum methodological quality were included in our meta-analysis, and subgroup and meta-regression analyses were performed. RESULTS: A total of 38 studies encompassing 6,314 patients were included in the qualitative synthesis; 27 studies (5,485 patients) were subject to meta-analysis. The pooled prevalence of optic pathway gliomas was 17% (95% CI, 14%-20%), with low certainty according to GRADE. Subgroup analysis found no significant association in reported rates across MRI surveillance strategies, and a focused meta-regression directly comparing routine and symptom-based approaches showed similar results. Analyses by continent, sample size, and quality score revealed no significant differences. CONCLUSIONS: Our results provide the first pooled evidence prevalence estimate of OPG in children and adolescents with NF1 and highlight the importance of close monitoring, reinforcing guidelines that favor a symptom-based MRI approach and suggesting no clear advantage of routine imaging.
PURPOSE: To determine the frequency of amblyopia in preschoolers and school-age children with alternating esotropia. METHODS: This retrospective, cross-sectional, single-center study analyzed the preoperative medical rec...PURPOSE: To determine the frequency of amblyopia in preschoolers and school-age children with alternating esotropia. METHODS: This retrospective, cross-sectional, single-center study analyzed the preoperative medical records of patients 3-10 years of age with confirmed alternating esotropia evaluated between 2012 and January 2024. Patients with motor or cognitive disabilities, ocular pathologies, or craniofacial anomalies were excluded, as were those with prior ocular surgeries or vertical deviations. Comprehensive ophthalmic examinations assessed refractive error, visual acuity, angle of deviation, and density of amblyopia. RESULTS: A total of 767 subjects (mean age, 6.9 ± 1.8 years; 41.4% female) with alternating esotropia were included. Of these, 151 (19.7%) were diagnosed with varying degrees of amblyopia: mild in 87 patients (57.6%), moderate in 60 (39.8%), and severe in 4 (2.7%). Thirty-seven of the amblyopic patients (24.5%) showed evidence of anisometropia; specifically, 32 (21.2%) had anisohyperopia, 4 (2.7%) had anisomyopia, and 1 (0.7%) had anisoastigmatism. Of the 616 nonamblyopic participants, 36 individuals (5.8%) had anisometropia. CONCLUSIONS: The alternating nature of esotropia does not necessarily ensure the absence of amblyopia in children who are candidates for strabismus surgery. The high prevalence of amblyopia highlights the importance of thorough assessment and careful attention to the detection of amblyopia in this patient population.
BACKGROUND: Surgical and nonsurgical treatments of childhood intermittent exotropia (IXT) often have unsatisfactory results due to poor sensory status. Dichoptic 3D movies may offer a novel treatment designed to reduce s...BACKGROUND: Surgical and nonsurgical treatments of childhood intermittent exotropia (IXT) often have unsatisfactory results due to poor sensory status. Dichoptic 3D movies may offer a novel treatment designed to reduce suppression, encourage fusion, and engage stereoacuity. Our aim was to assess whether 3D movies are superior to 2D sham movies treatment in treating children with IXT. METHODS: In this masked, pilot randomized clinical trial, 41 children aged 3-13 years with spontaneously manifested IXT (triple office distance control score ≥3.00; mean, 3.64 ± 0.72) were assigned to watch dichoptic 3D animated movies or 2D sham movies (3 movies/week, ∼5 hours) for 4 weeks. After completing their treatment assignment, children returned to the masked pediatric eye specialist to reassess IXT control and ocular alignment, with change in triple office distance control score as the primary outcome. Distance and near stereoacuity were also assessed. RESULTS: After 4 weeks of treatment, the 3D movie group showed a significant improvement in mean triple office distance control score (1.39 ± 1.00; P = 0.0002; n = 14); the 2D sham movie group did not (0.62 ± 1.36; P = 0.11; n = 14). The 3D movie group had significantly more improvement in distance control than the sham group (P = 0.049), but near control, ocular alignment, and stereoacuity did not change for either group. CONCLUSIONS: In our study cohort, at-home dichoptic 3D animated movie treatment significantly improved IXT triple office distance control scores after 4 weeks, indicating that it might provide an alternative nonsurgical treatment for childhood intermittent exotropia.