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Sean P Donahue

Publications and source records attributed to Sean P Donahue.

At least 19 recordsLinked to original sources
PubMed2006

Field evaluation of the Welch Allyn SureSight vision screener: incorporating the vision in preschoolers study recommendations.

INTRODUCTION: The prospective Vision in Preschoolers (VIP) study evaluated 11 methods of screening and proposed referral criteria for the Welch Allyn SureSight(trade mark) Vision Screener with 90% and 94% specificity. The SureSight had a higher sensitivity than most other screening techniques when these criteria were applied. We evaluated the usefulness of these criteria in a field study of healthy preschool children. METHODS: The SureSight software was altered to recommend referral using the VIP referral criteria with 90% specificity. Lions Club volunteers screened preschool children throughout Tennessee. Referred children underwent comprehensive eye examinations with cycloplegic refraction. Examination failure criteria were based upon published standards. Reanalysis using the 94% specificity criteria was then performed. Outcomes included referral rate and positive predictive value. RESULTS: The SureSight was used to screen 4,733 children, and screening was successful in 99.7% of children. The referral rate using the 90% specificity criteria was 12.2%. Most children (73%) were referred for suspected astigmatism. The positive predictive value was 30%. Using the 94% specificity criteria from the VIP study decreased the referral rate to 7.9% and substantially decreased over referral for suspected astigmatism; however, several anisometropes went undetected. Higher specificity was achieved by raising astigmatism referral criteria to 2.2 diopters while leaving the anisometropia criteria unchanged. CONCLUSIONS: The SureSight can be used successfully for preschool screening in the field provided that criteria with high specificity are incorporated into the instrument's software program. Higher rates of positive predictive value can be achieved without jeopardizing sensitivity by raising astigmatism referral criteria to 2.2 diopters.

Amblyopia↗
PubMed2006

Relationship between anisometropia, patient age, and the development of amblyopia.

PURPOSE: Previous studies evaluating the effect of anisometropia on amblyopia development have been biased because subject selection occurred as a result of decreased acuity. Photoscreening identifies anisometropic children in a manner that is not biased by acuity, and allows an opportunity to evaluate how patient age influences the prevalence and depth of amblyopia. DESIGN: Retrospective observational study of preschool children with anisometropia. METHODS: A statewide preschool photoscreening program screened 119,311 children and identified 792 with anisometropia >1.0 diopters. We correlated age with visual acuity and amblyopia depth. Results were compared with 562 strabismic children similarly identified. RESULTS: Only 14% (six of 44) of anisometropic children aged 1 year or younger had amblyopia. Amblyopia was detected in 40% (32 of 80) of 2-year-olds, 65% (119 of 182) of 3-year-olds, and 76% of 5-year-olds. Amblyopia depth also increased with age. Moderate amblyopia prevalence was 2% (ages 0 to 1), 17% (age 2), and rose steadily to 45% (ages 6 to 7). Severe amblyopia was rare for children aged 0 to 3, 9% at age 4, and 14% at age 5. Children with strabismus had a relatively stable prevalence (30% ages 0 to 2; 42% ages 3 to 4; and 44% ages 5 to 7) and depth of amblyopia. CONCLUSIONS: Younger children with anisometropia have a lower prevalence and depth of amblyopia than older children. By age 3, when most children undergo traditional screening, amblyopia has usually already developed. New vision screening technologies that allow early detection of anisometropia provide ophthalmologists an opportunity to intervene early, perhaps retarding or even preventing the development of amblyopia.

Aging↗
PubMed2006

Lions Clubs International Foundation Core Four Photoscreening: results from 17 programs and 400,000 preschool children.

INTRODUCTION: Photoscreening programs for preschool vision screening have been promoted by Lions Clubs International Foundation (LCIF) via their 17 Core Four grant project awards since 1999. Results from 15 Core Four grant programs in the United States and one in Taiwan are presented here. METHODS: Photoscreening was modeled after the Tennessee program and instituted statewide in each area. Programs were given latitude with respect to screening instrument and referral criteria, but a partnering academic institution and medical director were expected. Preschool children were screened by volunteers; referred children were examined by community optometrists and ophthalmologists who returned results to each program's coordinating center. Outcome data included number of children screened, referral rate, follow-up rate, and positive predictive value, which was generally determined using AAPOS-defined vision screening criteria. RESULTS: All but one program used the MTI photoscreener (it chose not to participate); photoscreening referral criteria were standard for 13 programs. Through December 2004, more than 400,000 preschool children had been screened. The referral rate for programs using the MTI photoscreener averaged 5.2% (range, 3.7-12.6%). The predictive value of a positive photoscreen was 80%. Overall, 54% of referred children received follow-up examinations. Follow-up rate was the largest variable: 4 programs, screening nearly 250,000 children, had follow-up rates 70% or greater; 10 programs had follow-up data from fewer than 40% of referred children. CONCLUSIONS: Volunteer-led photoscreening programs can be instituted in other locations, including overseas, with high levels of effectiveness. Limitations include the possibility of poor success and variable attention to follow-up.

Amblyopia↗
PubMed2006

Treatment of anisometropic amblyopia in children with refractive correction.

OBJECTIVE: To evaluate the effectiveness of refractive correction alone for the treatment of untreated anisometropic amblyopia in children 3 to <7 years old. DESIGN: Prospective, multicenter, noncomparative intervention. PARTICIPANTS: Eighty-four children 3 to <7 years old with untreated anisometropic amblyopia ranging from 20/40 to 20/250. METHODS: Optimal refractive correction was provided, and visual acuity (VA) was measured with the new spectacle correction at baseline and at 5-week intervals until VA stabilized or amblyopia resolved. MAIN OUTCOME MEASURES: Maximum improvement in best-corrected VA in the amblyopic eye and proportion of children whose amblyopia resolved (interocular difference of < or =1 line) with refractive correction alone. RESULTS: Amblyopia improved with optical correction by > or =2 lines in 77% of the patients and resolved in 27%. Improvement took up to 30 weeks for stabilization criteria to be met. After stabilization, additional improvement occurred with spectacles alone in 21 of 34 patients observed in a control group of a subsequent randomized trial, with amblyopia resolving in 6. Treatment outcome was not related to age, but was related to better baseline VA and lesser amounts of anisometropia. CONCLUSION: Refractive correction alone improves VA in many cases and results in resolution of amblyopia in at least one third of 3- to <7-year-old children with untreated anisometropic amblyopia. Although most cases of resolution occur with moderate (20/40-20/100) amblyopia, the average 3-line improvement in VA resulting from treatment with spectacles may lessen the burden of subsequent amblyopia therapy for those with denser levels of amblyopia.

Amblyopia↗
PubMed2006

A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic amblyopia in children.

OBJECTIVE: To compare 2 hours of daily patching (combined with 1 hour of concurrent near visual activities) with a control group of spectacle wear alone (if needed) for treatment of moderate to severe amblyopia in children 3 to 7 years old. DESIGN: Prospective randomized multicenter clinical trial (46 sites). PARTICIPANTS: One hundred eighty children 3 to 7 years old with best-corrected amblyopic-eye visual acuity (VA) of 20/40 to 20/400 associated with strabismus, anisometropia, or both who had worn optimal refractive correction (if needed) for at least 16 weeks or for 2 consecutive visits without improvement. INTERVENTION: Randomization either to 2 hours of daily patching with 1 hour of near visual activities or to spectacles alone (if needed). Patients were continued on the randomized treatment (or no treatment) until no further improvement was noted. MAIN OUTCOME MEASURE: Best-corrected VA in the amblyopic eye after 5 weeks. RESULTS: Improvement in VA of the amblyopic eye from baseline to 5 weeks averaged 1.1 lines in the patching group and 0.5 lines in the control group (P = 0.006), and improvement from baseline to best measured VA at any visit averaged 2.2 lines in the patching group and 1.3 lines in the control group (P<0.001). CONCLUSION: After a period of treatment with spectacles, 2 hours of daily patching combined with 1 hour of near visual activities modestly improves moderate to severe amblyopia in children 3 to 7 years old.

Amblyopia↗
PubMed2006

The yield and challenges of charitable state-wide photoscreening.

INTRODUCTION: State-wide cooperative programs for pediatric vision screening utilizing the MTI photoscreener and centralized interpretation were established in Alaska (The Alaska Blind Child Discovery, ABCD) and in Tennessee (Tennessee Lions Outreach). METHODS: Details of setup, implementation and interpretation of the state-wide MTI photoscreening programs are compared through 2002. The absolute numbers of children screened and the breakdown in interpretation categories are presented. RESULTS: ABCD screened 14,000 children while Tennessee Lions screened 100,800. Similarities between ABCD and Tennessee programs were funded by Lions Clubs and other charitable and public health organizations, community screening and each had coordinated centralized image interpretation and notification. The programs differed by clinic focus (Tennessee Lions organized pre-schools while ABCD used village and community health fairs and schools), parent notification (Tennessee Lions communicated through pre- schools and ABCD mailed directly to parents), and image interpretation (Tennessee used VOIC age-based and pupil-size crescents while ABCD used "delta-center crescent"). Predictive value positive was 73% for Tennessee and 89% for ABCD. Tennessee achieved better followup on referrals after a specific coordinator was employed. Image interpretation breakdown for ABCD: Tennessee Lions Outreach were anisometropia (29%:34%), high hyperopia (33%:16%), astigmatism (18%:30%), strabismus (7%:15%), myopia (5%:2%), cataract (0.7%:0.2%). Two state-wide programs detected 3216 amblyopic children at a charity borne-cost of 1.5 million dollars. If the parents persisted with appropriate amblyopia therapy, the expected societal value was estimated at 17 million dollars. Lacking societal mandate and funding, these concerted charitable efforts only achieved a community penetration rate of 10% to 14%. CONCLUSION: National adoption of preschool vision screening by a method with similar or even better validity and cost effectiveness as MTI photoscreening, ideally in the pediatric medical home, is warranted.

Alaska↗
PubMed2005

Predictive value of photoscreening and traditional screening of preschool children.

PURPOSE: To compare the usefulness of traditional vision screening and photoscreening of 3- and 4-year-old children in the pediatrician's office. METHODS: Following training of pediatricians and office staff, six pediatric clinics used both the MTI PhotoScreener (Medical Technology Industries, LLC, Riviera Beach, FL) and traditional acuity and stereopsis screening materials (HOTV charts/Random Dot E tests as recommended by established AAP-MCHB-PUPVS guidelines) during well-child exams. Clinics used one testing method for a 6-month period and switched to the other for the following 6 months, in a randomized manner. Referred children received a complete eye examination with cycloplegic refraction by local ophthalmologists or optometrists who forwarded the results to Vanderbilt Ophthalmology Outreach Center. Amblyogenic factors were defined using standardized published criteria. RESULTS: Six hundred five children were screened with the photoscreener and 447 were screened with traditional techniques. Mean time for screening was less with the photoscreener: 2.5 versus 5.9 minutes ( P < 0.01). Untestable rates were similar (18% vs 10%, respectively P = NS), but higher with the photoscreener due to one clinic's 70% unreadable rate. Referral rates were also similar: 3.8% versus 4.5%. The positive predictive value (PPV) rate differed greatly. With follow-up results obtained from 56% of referred children, 73% of photoscreening referred children (8/11 examined) had amblyogenic factors confirmed on formal eye exams, whereas all children referred using traditional screening methods (10/10 examined) were normal. CONCLUSION: Photoscreening is more time efficient than traditional screening and has a significantly higher PPV in 3- and 4-year-old children. This study was unable to validate traditional screening techniques in this preschool age group. If these results can be replicated, support for traditional vision screening must undergo intense scrutiny, and attention should be turned toward making photoscreening feasible for widespread implementation.

Amblyopia↗
PubMed2005

The relationship between anisometropia, patient age, and the development of amblyopia.

PURPOSE: Anisometropia is a common cause of amblyopia. The relationship between anisometropia, patient age, and the development of amblyopia is unknown. Photoscreening identifies children with anisometropia in a manner that is not biased by visual acuity and allows a unique opportunity to evaluate how patient age influences the prevalence and depth of anisometropic amblyopia. METHODS: A statewide preschool photoscreening program screened 120,000 children and identified 792 with anisometropia greater than 1.0 diopter. Age was correlated with visual acuity and amblyopia depth. Data were compared with those from 562 strabismic children similarly identified. RESULTS: Only 14% (6/44) of anisometropic children aged 1 year or less had amblyopia. Prevalence was 40% (32/80) for 2-year-olds, 65% (119/182) for 3-year-olds, and peaked at 76% (age 5). Amblyopia depth also increased with age. Moderate amblyopia prevalence was 2% (ages 0 to 1), 17% (age 2), and rose steadily to 45% (ages 6 to 7). Severe amblyopia was rare prior to age 4, 9% at age 4, 14% at age 5, and 9% at ages 6 to 7. In contrast, children with strabismus had a stable prevalence of amblyopia (30% at ages 0 to 2, 42% at ages 3 to 4, 44% at ages 5 to 7). CONCLUSIONS: Younger children with anisometropic refractive error have a lower prevalence and depth of amblyopia than do older children. By age 4, when most children undergo traditional screening, amblyopia has usually already developed. New vision screening technologies that allow early detection of anisometropia provide ophthalmologists an opportunity to intervene early, perhaps retarding, or even preventing, the development of amblyopia.

Age Factors↗
PubMed2004

Acute myeloid leukemia presenting as bilateral proptosis from diffuse extraocular muscle infiltration.

PURPOSE: To report a case of acute myeloid leukemia with bilateral proptosis as the sole presenting sign. DESIGN: Observational case report. METHODS: A patient with bilateral proptosis was seen in consultation by pediatric ophthalmology. RESULTS: Complete blood count, computerized tomography, and bone marrow biopsy confirmed the diagnosis of acute myeloid leukemia, with the proptosis due to diffuse infiltration of all extraocular muscles. CONCLUSION: In a child with the sudden onset of proptosis without any other systemic findings, the diagnosis of acute leukemia must be considered.

Acute Disease↗
PubMed2004

How often are spectacles prescribed to "normal" preschool children?

INTRODUCTION: Legislation to require formal eye examination prior to school entry is being considered in several states and is supported by optical trade organizations. Pediatric ophthalmologists cite anecdotal cases that suggest children receive spectacles unnecessarily, but data to support this are lacking. METHODS: Eye examination results from children referred to local eye doctors following a statewide preschool photoscreening program were reviewed to determine how often glasses were prescribed for children who did not have amblyogenic factors (those with false-positive screenings). RESULTS: Of 102,508 preschool children screened, 890 children did not have amblyogenic factors (false-positive screenings). Nevertheless, spectacles were prescribed for 174 (19.5%) of these children. Only 5/272 children (1.8%) were prescribed glasses following examination by a pediatric ophthalmologist, while glasses were prescribed for 24/205 children (11.7%) examined by comprehensive ophthalmologists and 145/413 (35.1%) of children seen by optometrists (P < 0.001). Eighty children were prescribed glasses for refractive error ranging from -0.75 sph to +2.00 sph, 32 of whom had spherical equivalent of 1D or less. CONCLUSIONS: While some preschoolers without amblyogenic factors may require spectacle correction, a significant percentage of children are probably prescribed glasses unnecessarily. Extrapolation of these data to the United States population suggests that a single mandatory eye examination prior to school entry could cost over 200,000,000 US dollars yearly for unnecessary spectacles. Vision screening programs with high referral rates, and health policy proposals supporting comprehensive preschool eye exams, must consider these unnecessary costs.

Child, Preschool↗
PubMed2004

Strabismus surgery for adults: a report by the American Academy of Ophthalmology.

OBJECTIVE: To describe the effectiveness and safety of surgical treatment of adult patients with strabismus, and to review the reported functional benefits and complications of strabismus surgery for adults. METHODS: A literature search was conducted in September 2001. It was repeated and updated in April 2003, with retrieval of relevant citations. Panel members reviewed the articles and rated them according to their relevance to the topic and methodology. RESULTS: The literature search identified 49 reports that describe the surgical treatment of strabismus in adult patients and meet predetermined review criteria. Of these reports, 2 were of randomized controlled trials, and 1 addressed the primary objective of this review. In this randomized study of adults with strabismus, direct comparison of surgical correction with botulinum toxin A chemodenervation indicated that surgical treatment was superior to botulinum toxin A in realigning the eyes (76.9% vs. 29.4%, P = 0.027). Several large case series of adults with strabismus (level III evidence) with successful surgical realignment rates of 68% to 85% have been reported. Functional benefits of surgical treatment are reported in many patients. These include elimination of diplopia, development of binocular fusion, expansion of binocular visual fields, and improvement of head position. Surgical complications, including new, postoperative diplopia (1%-14%) or scleral perforation (0.8%-1.8%), occur in a minority of patients. Unplanned reoperations (subsequent strabismus procedures that were not anticipated as part of a staged treatment) were needed in up to 21% of patients in large case series of comitant strabismus, and in up to 50% of patients with thyroid ophthalmopathy. CONCLUSIONS: Despite the paucity of level I evidence from randomized controlled trials, the existing literature suggests that surgical treatment of adults with strabismus is safe and effective in improving ocular alignment. In many cases it improves visual function, based largely on level III evidence. Risks include unplanned reoperation, postoperative diplopia, and scleral perforation. Additional level I studies of surgical treatment of adult patients would help to document the effectiveness and substantiate the safety of this treatment.

Adult↗
PubMed2003

Intraocular lens implantation during infancy: perceptions of parents and the American Association for Pediatric Ophthalmology and Strabismus members.

BACKGROUND: To determine whether a randomized clinical trial, the Infant Aphakia Treatment Study, comparing intraocular lens (IOL) implantation with contact lens (CL) correction for infants with a unilateral congenital cataract (UCC), is feasible by (1) ascertaining whether American Association for Pediatric Ophthalmology and Strabismus (AAPOS) members have equipoise regarding these two treatments and (2) evaluating the willingness of parents to agree to randomization. METHODS: All AAPOS members were surveyed in August 1997 and again in June 2001 regarding their use of CLs and IOL implants to correct infants vision after unilateral cataract surgery. In addition, a pilot study was begun in March 2002 to evaluate the safety of IOL implantation during infancy and the willingness of parents to randomize their children with a UCC to either IOL implantation or CL correction. RESULTS: In 1997, 89% of the 260 respondents reported that in the previous year they had treated at least one infant with a UCC, but only 4% had implanted an IOL in an infant <7 months old. Silsoft (Bausch & Lomb, Rochester, NY) CL correction was the preferred treatment choice for 84% of the respondents. In 2001, 21% of the 279 respondents had implanted an IOL in an infant. On a scale from 1 to 10 with 1 strongly favoring an IOL implant and 10 strongly favoring a CL, the median score was 7.5. Sixty-one percent of the respondents indicated that they would be willing to randomize children with a UCC to one of these two treatments. The main concerns about IOL implantation were poor predictability of power changes, postoperative complications, inflammation, and technical difficulty of surgery. The main concerns about CL correction were poor compliance, high lens loss rate, high cost, and keratitis. In our pilot study, 30 infants <7 months of age were evaluated at nine clinical centers for a visually significant UCC. Of 24 infants eligible for randomization, the parents of 17 (71%) agreed to randomization. CONCLUSIONS: Although most AAPOS members still favor CL correction after cataract surgery for a UCC, five times as many had implanted an IOL in an infant in 2001 compared with the number in 1997. Parents were almost equally divided in their preference for IOL implant versus CL correction. Given the relative equipoise of AAPOS members regarding these treatments and the willingness of more than two thirds of parents to agree to randomization, it seems likely that a randomized clinical trial comparing these two treatments could indeed be conducted.

Aphakia, Postcataract↗
PubMed2003

Ocular involvement in children with candidemia.

PURPOSE: To evaluate ocular findings in hospitalized children with systemic Candida species infection. DESIGN: Retrospective review of inpatient hospital consultations. METHOD: Inpatient hospital consultations performed by a pediatric ophthalmology service over a 30-month period were reviewed. RESULTS: Of 600 consultations performed by the service, 30 were to rule out ocular findings in patients with suspected or known candida infection. No patients had ocular findings consistent with endophthalmitis or chorioretinitis. One patient had nonspecific findings of multisystem organ failure, and one had vascular findings secondary to elevated pulmonary venous pressures. CONCLUSIONS: In contrast to the results of studies performed 10 to 15 years ago, ocular involvement is highly unusual in children with candidemia, but such consultations account for a substantial workload. Further attention to risk factors associated with ocular infection is warranted.

Adolescent↗
PubMed2003

Distribution of refractive error in healthy infants.

PURPOSE: Few data exist regarding the upper limits of refractive error distributions in healthy infants; the data that do exist are biased because they were selected from the records of pediatric ophthalmology practices. We sought to obtain these data to validate examination failure criteria for vision screening. METHODS: We reviewed records from all children age birth to 5 years seen at the Tennessee Lions Eye Center at Vanderbilt Children's Hospital with a billing diagnosis of nasolacrimal duct obstruction and no comorbid ocular diagnoses except for refractive error. This was to avoid referral bias for any condition that could have influenced refractive error. All patients received a complete eye examination and cycloplegic refraction. Cumulative probability distribution (CPD) plots and means for spherical and cylindrical refractive error and anisometropia were prepared. RESULTS: One hundred thirty patients were studied; mean age was 15.5 +/- 9.9 months (range, 2 days to 66 months). The mean refractive error (spherical equivalent) was +1.4 D +/- 1.1 D. CPD plot analysis showed 95% of hyperopia to be < +3.25 D. Two children had myopia </=-1.00 D. The mean astigmatism was +0.2 D +/- 0.4 D, and 74% of patients had no astigmatism. Seven children had astigmatism > +1.00 D in one eye. CPD plot analysis showed 95% of astigmatism to be < +1.50 D and 95% of meridional anisometropia to be < 1.50 D. Six children had anisometropia >/=1.50 D, and 3 children had anisometropia > 3.00 D. CONCLUSIONS: At least 95% of children have hyperopia < +3.25 D, astigmatism < +1.50 D, and anisometropia < 1.50 D. This information will prove useful in identifying the natural history and prevalence of amblyogenic factors identified during preschool vision screening.

Age Distribution↗