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PubMed2005

One-year multicenter, double-masked, placebo-controlled, parallel safety and efficacy study of 2% pirenzepine ophthalmic gel in children with myopia.

OBJECTIVE: To evaluate the safety and efficacy of the relatively selective M(1)-antagonist, pirenzepine ophthalmic gel (gel), in slowing the progression of myopia in school-aged children. DESIGN: Parallel-group, placebo-controlled, randomized, double-masked study. PARTICIPANTS: Three hundred fifty-three healthy children, 6 to 12 years old, with a spherical equivalent (SE) of -0.75 to -4.00 diopters (D) and astigmatism of <or=1.00 D. Subjects underwent a baseline complete eye examination, and regular examinations over a 1-year period. The study was conducted at 7 academic centers and clinical practices in Asia. INTERVENTION: Subjects received 2% gel twice daily (gel/gel), 2% gel daily (evening, placebo/gel), or vehicle twice daily (placebo/placebo) in a 2:2:1 ratio, respectively, for 1 year. MAIN OUTCOME MEASURE: Spherical equivalent under cycloplegic refraction. RESULTS: At study entry, mean SE refraction was -2.4+/-0.9 D. At 12 months, there was a mean increase in myopia of 0.47 D, 0.70 D, and 0.84 D in the gel/gel, placebo/gel, and placebo/placebo groups, respectively (P<0.001 for gel/gel vs. placebo/placebo). Discontinued from the study for adverse events were 11% (31/282) of pirenzepine-treated subjects. Of the 15 serious adverse events reported in 12 subjects (all in the active groups), none was ophthalmic in nature, all subjects recovered, and only 1 (abdominal colic preceded by a flu) was judged possibly related to treatment. CONCLUSIONS: Gel (2% twice daily) was effective and relatively safe in slowing the progression of myopia over a 1-year treatment period.

Adolescent↗
PubMed2005

Refractive error and visual impairment in school-age children in Gombak District, Malaysia.

PURPOSE: To assess the prevalence of refractive error and visual impairment in school-age children in Gombak District, a suburban area near Kuala Lumpur city. DESIGN: Population-based, cross-sectional survey. PARTICIPANTS: Four thousand six hundred thirty-four children 7 to 15 years of age living in 3004 households. METHODS: Random selection of geographically defined clusters was used to identify the study sample. Children in 34 clusters were enumerated through a door-to-door survey and examined in 140 schools between March and July 2003. The examination included visual acuity measurements; ocular motility evaluation; retinoscopy and autorefraction under cycloplegia; and examination of the external eye, anterior segment, media, and fundus. MAIN OUTCOME MEASURES: Distance visual acuity and cycloplegic refraction. RESULTS: The examined population was 70.3% Malay, 16.5% Chinese, 8.9% Indian, and 4.3% of other ethnicity. The prevalence of uncorrected (unaided), presenting, and best-corrected visual impairment (visual acuity < or =20/40 in the better eye) was 17.1%, 10.1%, and 1.4%, respectively. More than half of those in need of corrective spectacles were without them. In eyes with reduced vision, refractive error was the cause in 87.0%, amblyopia in 2.0%, other causes in 0.6%, and unexplained causes in 10.4%, mainly suspected amblyopia. Myopia (spherical equivalent of at least -0.50 diopter [D] in either eye) measured with retinoscopy was present in 9.8% of children 7 years of age, increasing to 34.4% in 15-year-olds; and in 10.0% and 32.5%, respectively, with autorefraction. Myopia was associated with older age, female gender, higher parental education, and Chinese ethnicity. Hyperopia (> or =2.00 D) with retinoscopy varied from 3.8% in 7-year-olds, 5.0% with autorefraction, to less than 1% by age 15, with either measurement method. Hyperopia was associated with younger age and "other" ethnicity. Astigmatism (> or =0.75 D) was present in 15.7% of children with retinoscopy and in 21.3% with autorefraction. CONCLUSIONS: Visual impairment in school-age children in urban Gombak District is overwhelmingly caused by myopia, with a particularly high prevalence among children of Chinese ethnicity. Eye health education and screening may help address the unmet need for refractive correction.

Adolescent↗
PubMed2005

Visual acuity and the causes of visual loss in a population-based sample of 6-year-old Australian children.

PURPOSE: To describe the distribution of visual acuity and causes of visual loss in a representative sample of Australian schoolchildren. DESIGN: Population-based cross-sectional study. PARTICIPANTS: One thousand seven hundred thirty-eight predominantly 6-year old children examined during 2003 to 2004. METHODS: Logarithm of the minimum angle of resolution (logMAR) visual acuity was measured in both eyes before and after pinhole correction and with spectacles if worn. Cycloplegic autorefraction (cyclopentolate) and detailed dilated fundus examination were performed. MAIN OUTCOME MEASURES: Visual impairment was defined as any (visual acuity <20/40; <40 letters) or severe (visual acuity < or =20/200; 0-5 letters) for both better and worse eyes. Myopia was defined as spherical equivalent (SE) refraction < or =-0.50 diopters (D), and hyperopia as SE refraction > or =+2.0 D, deemed significant when > or =+3.0 D. Astigmatism was defined as cylinder > or =1.0 D and anisometropia as SE refraction difference between eyes at least 1.0 D. Amblyopia was defined as corrected visual acuity <0.3 logMAR units (<20/40; <40 letters) in the affected eye not attributable to any underlying structural abnormality of the eye or visual pathway, together with a 2-logMAR line difference between the eyes and presence of an amblyogenic risk factor. RESULTS: The mean visual acuity of this sample was 20/25 (49.3 letters). Uncorrected visual impairment was found in the better eye of 23 children (1.3%) and in the worse eye of 71 children (4.1%). The prevalence was higher in girls than boys and among children of lower socioeconomic status. Refractive error was the most frequent cause, accounting for 69.0%, followed by amblyopia (22.5%). Astigmatism was the principle refractive error causing visual impairment and was frequently uncorrected. Presenting visual impairment (using current glasses if worn) was found in the better and worse eyes of 15 children (0.9%) and 54 children (2.8%), respectively. This was mainly due to under corrected or uncorrected refractive error. CONCLUSIONS: This study has documented a relatively low prevalence of visual impairment in a population of Australian children. Uncorrected astigmatism and amblyopia were the most frequent causes.

Child↗
PubMed2005

Prevalence of myopia at 9 months in infants with high-risk prethreshold retinopathy of prematurity.

PURPOSE: To examine the prevalence of myopia and high myopia at 9 months corrected age in premature infants who participated in the multicenter randomized trial of Early Treatment for Retinopathy of Prematurity (ETROP). DESIGN: Randomized, controlled clinical trial. PARTICIPANTS: Four hundred one infants with birth weights of <1251 g in whom prethreshold ROP developed in one or both eyes and who were determined to have a significant risk (> or =15%) of poor structural outcomes without treatment, based on the risk management for ROP program. INTERVENTION: Infants with bilateral high-risk prethreshold ROP (n = 317) had 1 eye randomized to early treatment, and the fellow eye was managed conventionally. In asymmetric cases (n = 84), the eye with high-risk prethreshold ROP was randomized to early treatment or conventional management (control). Eyes randomized to early treatment at high-risk prethreshold ROP and eyes randomized to conventional management in which threshold ROP developed received peripheral retinal photocoagulation or cryotherapy. Conventionally managed eyes in which threshold ROP did not develop were observed. Cycloplegic retinoscopy data were obtained at 9 months corrected age from 321 eyes treated early and 307 eyes managed conventionally. MAIN OUTCOME MEASURES: Prevalence of myopic (spherical equivalent > or = 0.25 diopters [D]) and highly myopic (> or =5.00 D) eyes in each group. RESULTS: The prevalence of myopia (64.5% vs. 69.4%; P = 0.06) and high myopia (25.5% vs. 28.3%; P = 0.20) was similar between eyes treated at high-risk prethreshold and high-risk prethreshold eyes managed conventionally. Among high-risk eyes managed conventionally, the prevalence of myopia (78.2% vs. 53.3%) and high myopia (37.6% vs. 11.2%) was higher when threshold ROP developed than when regression without treatment occurred. Among eyes treated at high-risk prethreshold ROP, the prevalence of myopia (93.3% vs. 91.7% vs. 60.6%) and of high myopia (53.3% vs. 33.3% vs. 20.8%) was higher in eyes with abnormal angle of temporal retinal vessels or macular ectopia than in eyes with no retinal residua. This also held true for conventionally managed eyes. CONCLUSIONS: Early treatment at high-risk prethreshold did not place eyes at greater risk of myopia and high myopia than did conventional management of eyes with high-risk prethreshold ROP.

Cryotherapy↗
PubMed2006

Ophthalmic findings in Apert's syndrome after craniofacial surgery: twenty-nine years' experience.

PURPOSE: To survey the spectrum of ophthalmic morbidity in Apert's syndrome after craniofacial surgery. DESIGN: A retrospective study of patients with Apert's syndrome managed at the Australian Craniofacial Unit from 1975 to 2004. PARTICIPANTS: Sixty-one patients (31 females and 30 males) had final ophthalmic reviews at a mean age of 9.3 years (standard deviation, 9.2; range, 0.2-48.3; median, 8.2 years). METHODS: Patients were identified from the unit database, and case notes were reviewed. Cases that had < or =2 recorded variables were excluded. Demographic details, age at last ophthalmic review, and total craniofacial operations performed were documented. MAIN OUTCOME MEASURES: Best-corrected visual acuity, cycloplegic refractions, strabismus, amblyopia, corneal abnormality, fundoscopic findings, and visually evoked potentials. RESULTS: The average number of craniofacial operations performed was 2 (range, 1-4; median, 2). Visual impairment was found in 54% of patients in at least one eye and in 19% of patients in their better eye. The most common cause was amblyopia, with a prevalence of 35%. Optic atrophy caused visual impairment in 5% of patients and corneal scarring in 8%. Sixty-three percent of patients had strabismus with more esotropia than exotropia. Ametropia was found in 69% of patients (42% were hypermetropic and 27% were myopic). Anisometropia of > or =0.75 diopters was present in 16 cases (50%). CONCLUSIONS: Visual impairment is a common finding in Apert's syndrome and amblyopia is the major cause. Ametropia, astigmatism, anisometropia, and strabismus frequently occur in patients with Apert's syndrome at final ophthalmic review. Although optic atrophy was the major cause of visual loss in the era prior to craniofacial surgery, the prevalence of optic atrophy is low since the adoption of current surgical protocols. Corneal damage also contributed toward visual impairment. Early detection and adequate management of amblyopia, timely decompressive surgery before the presence of optic atrophy, and protection of the cornea should be the management goals of ophthalmologists in craniofacial units managing these patients.

Acrocephalosyndactylia↗
PubMed2006

Visual acuity in children with glaucoma.

PURPOSE: To investigate the risk factors that influence outcome of visual function in children with glaucoma. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: One hundred twenty-six patients (204 eyes) who had childhood glaucoma observed over 30 years, with a mean follow-up of 11.6 years. INTERVENTIONS: Full ophthalmologic examination, including measurement of corrected visual acuity (VA), slit-lamp and fundus examinations, intraocular pressure (IOP) measurement, and gonioscopic evaluation; periodic cycloplegic refraction and perimetry; and treatment of amblyopia. MAIN OUTCOME MEASURES: Type of glaucoma; final best-corrected VA of good (6/6-6/12), fair (6/15-6/30), or poor (< or =6/60); patient age at time of development of glaucoma complications; and percentage of IOP measurements of < or =19 mmHg, perimetry results, and cup-to-disc (C/D) ratio during follow-up. RESULTS: The most recently measured VAs of children treated for glaucoma were good in 29%, fair in 24%, and poor in 47%. The most favorable outcome was for patients with primary infantile glaucoma followed by secondary glaucoma. Amblyopia and optic nerve damage due to glaucoma were the most frequent complications affecting VA. Patients with an IOP of < or =19 mmHg on 80% of determinations had stable optic nerve C/D ratios and visual fields. CONCLUSIONS: Vision sufficient to qualify for a motor vehicle driving license was attainable in almost 30% of affected eyes. Visual acuity achieved at 6 years of age remained stable over the study period. Treatment of amblyopia is important to achieve this result.

Adolescent↗
PubMed2006

Factors associated with childhood strabismus: findings from a population-based study.

PURPOSE: To describe strabismus prevalence and associated factors in a representative sample of 6-year-old Australian children. DESIGN: Population-based cross-sectional study. PARTICIPANTS: One thousand seven hundred thirty-nine predominantly 6-year-old children resident in Sydney examined in 2003 and 2004. METHODS: Cover testing was performed at near and distance fixation, and with spectacles if worn. Logarithm of the minimum angle of resolution visual acuity was measured in both eyes before and after pinhole correction, after correcting any cylindrical refraction >0.50 diopters and with spectacles, if worn. Cycloplegic autorefraction (cyclopentolate) and detailed dilated fundus examination were performed. Each child's medical and perinatal histories were sought in a detailed parental questionnaire. MAIN OUTCOME MEASURES: Strabismus was defined as any heterotropia at near or distance fixation, or both, on cover testing. Microstrabismus was defined as a deviation of fewer than 10 prism diopters. RESULTS: Strabismus was diagnosed in 48 children (2.8% of the population), 5 of whom had previously undergone surgical correction; 26 children (54%) had esotropia, 14 (29%) had exotropia, 7 (15%) had microstrabismus, and 1 child had VIth cranial nerve palsy. Prematurity was associated with a 5-fold increase in the risk of esotropia (odds ratio, 5.0; 95% confidence interval, 1.8-14.1). Visual impairment (with presenting correction) was significantly more common in children with (22.9%) than without (1.3%) strabismus (P<0.0001). The presence of strabismus was significantly associated with hyperopia, astigmatism, anisometropia, and amblyopia (P<0.0001). CONCLUSIONS: This report documents the prevalence of strabismus and its relation to other ocular signs and visual impairment in a representative sample of Australian school children. Presence of strabismus was significantly associated with prematurity.

Child↗
PubMed2006

Refractive error and patterns of spectacle use in 12-year-old Australian children.

PURPOSE: To document the prevalence of visual impairment resulting from refractive error and to describe patterns of spectacle use in a representative sample of 12-year-old Australian school children. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Two thousand three hundred fifty-three predominantly 12-year-old children examined from 2004 through 2005. METHODS: Logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) was measured unaided and with spectacles if worn. Subjective refraction, cycloplegic autorefraction (with cyclopentolate), and detailed dilated fundus examination were performed. MAIN OUTCOME MEASURES: Myopia was defined as spherical equivalent (SE) refraction < or =-0.50 diopters (D), hyperopia as SE refraction > or =2.0 D, and astigmatism as cylinder > or =1.0 D. Uncorrected visual impairment was defined using unaided VA, and presenting visual impairment was defined using spectacle-corrected VA, if worn. Visual impairment was defined as VA <20/40 (<40 logMAR letters) for both better and worse eyes. Spectacle need was defined as uncorrected visual impairment in the better eye, improving by at least 2 lines with refraction, and undercorrection as presenting impairment in the better eye, improving by at least 2 lines with refraction. RESULTS: Uncorrected and presenting visual impairment in at least 1 eye because of refractive error was found in 10.4% and 3.7%, respectively. Spectacle use was reported by 448 children (19.0%); 204 (46.3%) had myopia, 48 (10.9%) had hyperopia, and 96 (21.8%) had astigmatism in at least 1 eye; 38.3% had no significant refractive error in either eye. Eight children were in need of spectacles and 37 children (8.3% of spectacle users) were undercorrected. Nonrefractive spectacle users were more likely to report eyestrain and headache or to have had learning difficulty at school (P<0.0001). CONCLUSIONS: This study documents a relatively low prevalence of undercorrected refractive error in a population of Australian children. Nonrefractive prescription of spectacles is common.

Adolescent↗
PubMed2006

Peripapillary retinal nerve fiber layer thickness in a population of 6-year-old children: findings by optical coherence tomography.

PURPOSE: To study the distribution of retinal nerve fiber layer (RNFL) thickness by ocular and demographic variables in a population-based study of young children. DESIGN: Population-based cross-sectional study. PARTICIPANTS: One thousand seven hundred sixty-five of 2238 (78.9%) eligible 6-year-old children participated in the Sydney Childhood Eye Study between 2003 and 2004. Mean age was 6.7 years (50.9% boys). METHODS: Detailed examination included cycloplegic autorefraction and measurement of axial length. Retinal nerve fiber layer scans using an optical coherence tomographer were performed with a circular scan pattern of 3.4-mm diameter. Multivariate analyses were performed to examine the distribution of RNFL parameters with gender, ethnicity, axial length, and refraction. MAIN OUTCOME MEASURES: Peripapillary RNFL thickness and RNFL(estimated integral) (RNFL(EI)), which measures the total cross-sectional area of ganglion cell axons converging onto the optic nerve head. RESULTS: Peripapillary RNFL thickness and RNFL(EI) were normally distributed. The mean+/-standard deviation RNFL average thickness was 103.7+/-11.4 microm and RNFL(EI) was 1.05+/-0.12 mm2. Retinal nerve fiber layer thickness was least for the temporal quadrant (75.7+/-14.7 microm), followed by the nasal (81.7+/-19.6 microm), inferior (127.8+/-20.5 microm), and superior (129.5+/-20.6 microm) quadrants. Multivariate adjusted RNFL average thickness was marginally greater in boys than in girls (104.7 microm vs. 103.2 microm; P = 0.007) and in East Asian than in white children (107.7 microm vs. 102.7 microm; P<0.0001). The RNFL was thinner with greater axial length (P(trend)<0.0001) and less positive spherical equivalent refractions (P(trend) = 0.004). CONCLUSIONS: Retinal nerve fiber layer average thickness and RNFL(EI) followed a normal distribution. Retinal nerve fiber layer thickness varied marginally with gender, but differences were more marked between white and East Asian children. Retinal nerve fiber layer thinning was associated with increasing axial length and less positive refractions.

Anthropometry↗
PubMed2006

Recessive cornea plana in the Kingdom of Saudi Arabia.

OBJECTIVE: To characterize the molecular genetics of clinically diagnosed recessive cornea plana in the Kingdom of Saudi Arabia and establish the presence of common or limited founders (ancestors who originally harbored the disease-causing mutation) in the country's historically isolated population. DESIGN: Prospective interventional case series. PARTICIPANTS: Twelve affected patients from apparently unrelated Saudi Arabian nuclear families with clinically diagnosed recessive cornea plana. METHODS: Clinical ophthalmic examination and venous blood sampling for DNA sequencing. MAIN OUTCOME MEASURES: Age, gender, keratometry, best-corrected visual acuity, ocular alignment, cycloplegic refraction, significant findings of a complete ophthalmic examination, and keratocan gene (KERA) haplotype analysis. RESULTS: All 12 individuals had classic phenotypic features of recessive cornea plana and were homozygous for 1 of 2 KERA mutations--a novel frameshift mutation (1634delC) or a previously reported nonsense mutation (R313X). Haplotype analysis was consistent with a separate distinct common founder effect for each instance. An additional Saudi KERA mutation (R279X) has been reported previously in one family. CONCLUSION: Specific for mutation in KERA, the ophthalmic phenotype of recessive cornea plana does not significantly vary with different KERA mutations. The occurrence of a rare inherited disease in a historically isolated population is not always due to a single common founder effect; it may be explained by cultural preferences such as consanguinity (intrafamilial marriage) and endogamy (intratribal marriage), which enhance expression of recessively inherited diseases.

Adolescent↗
PubMed2006

Atropine for the treatment of childhood myopia.

PURPOSE: To evaluate the efficacy and safety of topical atropine, a nonselective muscarinic antagonist, in slowing the progression of myopia and ocular axial elongation in Asian children. DESIGN: Parallel-group, placebo-controlled, randomized, double-masked study. PARTICIPANTS: Four hundred children aged 6 to 12 years with refractive error of spherical equivalent -1.00 to -6.00 diopters (D) and astigmatism of -1.50 D or less. INTERVENTION: Participants were assigned with equal probability to receive either 1% atropine or vehicle eye drops once nightly for 2 years. Only 1 eye of each subject was chosen through randomization for treatment. MAIN OUTCOME MEASURES: The main efficacy outcome measures were change in spherical equivalent refraction as measured by cycloplegic autorefraction and change in ocular axial length as measured by ultrasonography. The primary safety outcome measure was the occurrence of adverse events. RESULTS: Three hundred forty-six (86.5%) children completed the 2-year study. After 2 years, the mean progression of myopia and of axial elongation in the placebo-treated control eyes was -1.20+/-0.69 D and 0.38+/-0.38 mm, respectively. In the atropine-treated eyes, myopia progression was only -0.28+/-0.92 D, whereas the axial length remained essentially unchanged compared with baseline (-0.02+/-0.35 mm). The differences in myopia progression and axial elongation between the 2 groups were -0.92 D (95% confidence interval, -1.10 to -0.77 D; P<0.001) and 0.40 mm (95% confidence interval, 0.35-0.45 mm; P<0.001), respectively. No serious adverse events related to atropine were reported. CONCLUSIONS: Topical atropine was well tolerated and effective in slowing the progression of low and moderate myopia and ocular axial elongation in Asian children.

Administration, Topical↗
PubMed2005

Evaluation of a clinical aberrometer for lower-order accuracy and repeatability, higher-order repeatability, and instrument myopia.

BACKGROUND: Refractive surgery has stimulated the development of aberrometers, which are instruments that measure higher-order aberrations. The purpose of this study was to test one clinical aberrometer, the Complete Ophthalmic Analysis System (COAS), for its accuracy, repeatability, and instrument myopia for measuring sphere and astigmatism and its repeatability for measuring higher-order aberrations. METHODS: Aberrations of 56 normal eyes (28 subjects) were measured with and without cycloplegia using a COAS, a conventional autorefractor and by subjective refraction. We evaluated lower-order accuracy (sphere and astigmatism) of the COAS and autorefractor by comparing that data with that of subjective refraction. We also tested COAS lower- and higher-order repeatability for 5 measurements taken in less than 1 minute. We evaluated instrument myopia by comparing cycloplegic and noncycloplegic measurements of the same eye. Data were analyzed for a 5.0-mm-diameter pupil. RESULTS: Mean COAS spherical error was between -0.1 and +0.4 diopters (D), depending on cycloplegia and the kind of sphere power computation selected. Cylinder power errors were less than 0.1 D. COAS repeatability coefficients were better than 0.25 D, and instrument myopia was less than 0.4 D. These were comparable with those of autorefraction. Higher-order repeatability was sufficient to allow reliable measurement of normal third-order aberrations and spherical aberration. CONCLUSIONS: Accuracy, repeatability, and instrument myopia of the COAS are similar to those of a conventional autorefractor. Accuracy and repeatability are also similar to those of subjective refraction. Like an autorefractor, the COAS provides instantaneous, objective measurements of sphere and astigmatism, but it also measures higher-order aberrations. We found that it is capable of reliably measuring problematic higher-order aberrations and is therefore a valuable asset for modern clinical eye care.

Adult↗
PubMed2005

Contemporary issues in amblyopia treatment.

PURPOSE: The aim of this report is to review the contemporary research in amblyopia treatment and how it will affect clinical practice patterns. METHODS: Topics addressed include prescribing the optimal refractive correction, the most effective treatment, duration and intensity of treatment, regression after treatment, the upper age for treatment, and the chance of the amblyope losing his or her sound eye. RESULTS AND CONCLUSIONS: The optimal refractive correction is best determined with cycloplegic retinoscopy; pharmacologic penalization can be as effective as patching in children with moderate amblyopia; less-intense treatment regimens have been found to be as effective as more-intense treatment regimens; regression can occur in as many as 25% of all treated patients; some older amblyopes can be treated successfully; and the amblyope has a higher chance of becoming blind than the nonamblyope.

Amblyopia↗
PubMedDate not supplied

Amblyopia characterization, treatment, and prophylaxis.

Amblyopia has a 1.6-3.6% prevalence, higher in the medically underserved. It is more complex than simply visual acuity loss and the better eye has sub-clinical deficits. Functional limitations appear more extensive and loss of vision in the better eye of amblyopes more prevalent than previously thought. Amblyopia screening and treatment are efficacious, but cost-effectiveness concerns remain. Refractive correction alone may successfully treat anisometropic amblyopia and it, minimal occlusion, and/or catecholamine treatment can provide initial vision improvement that may improve compliance with subsequent long-duration treatment. Atropine penalization appears as effective as occlusion for moderate amblyopia, with limited-day penalization as effective as full-time. Cytidin-5'-diphosphocholine may hold promise as a medical treatment. Interpretation of much of the amblyopia literature is made difficult by: inaccurate visual acuity measurement at initial visit, lack of adequate refractive correction prior to and during treatment, and lack of long-term follow-up results. Successful treatment can be achieved in at most 63-83% of patients. Treatment outcome is a function of initial visual acuity and type of amblyopia, and a reciprocal product of treatment efficacy, duration, and compliance. Age at treatment onset is not predictive of outcome in many studies but detection under versus over 2-3 years of age may be. Multiple screenings prior to that age, and prompt treatment, reduce prevalence. Would a single early cycloplegic photoscreening be as, or more, successful at detection or prediction than the multiple screenings, and more cost-effective? Penalization and occlusion have minimal incidence of reverse amblyopia and/or side-effects, no significant influence on emmetropization, and no consistent effect on sign or size of post-treatment changes in strabismic deviation. There may be a physiologic basis for better age-indifferent outcome than tapped by current treatment methodologies. Infant refractive correction substantially reduces accommodative esotropia and amblyopia incidence without interference with emmetropization. Compensatory prism, alone or post-operatively, and/or minus lens treatment, and/or wide-field fusional amplitude training, may reduce risk of early onset esotropia. Multivariate screening using continuous-scale measurements may be more effective than traditional single-test dichotomous pass/fail measures. Pigmentation may be one parameter because Caucasians are at higher risk for esotropia than non-whites.

Amblyopia↗
PubMed2006

Anterior uveitis associated with treatment with intravenous cidofovir in kidney transplant patients with BK virus nephropathy.

BACKGROUND: Polyomavirus-associated nephropathy (PVAN) is an important cause of kidney dysfunction and graft loss. Different treatment regimens have been used, including low-dose intravenous cidofovir. Anterior uveitis, a complication of this treatment, has been reported after its use in patients with cytomegalovirus-associated retinitis. We analyzed the incidence and associated risk factors for this disorder in patients with PVAN. PATIENTS AND METHODS: The study included 14 kidney-transplant patients who had received low doses of cidofovir after being diagnosed with PVAN. RESULTS: Five (35%) patients developed an episode of anterior uveitis. The mean number of cidofovir doses given was 6.8 +/- 1.6 as compared with 9.1 +/- 2.1 in patients who did not develop the disease. Creatinine clearance at diagnosis of the nephropathy and after terminating treatment was lower in the uveitis patients, who had a graft survival of 40% versus 100% in the patients who did not develop eye involvement. Treatment was suspended in the affected patients, with complete resolution in 80% after the administration of topical corticoids and cycloplegics. CONCLUSIONS: Anterior uveitis secondary to low-dose treatment with cidofovir is a common complication in patients with PVAN and is associated with the degree of renal involvement. In the absence of larger studies, cidofovir should be used with caution in patients with creatinine clearance below 30 mL/min.

Adult↗
PubMed2005

Noticeable, troublesome and objectionable limits of blur.

We investigated limits at which induced blur becomes noticeable, troublesome and objectionable. We used 15 cyclopleged subjects, a Badal optometer with lines of three high contrast letters as targets, 3-6 mm artificial pupils, and 0.0-0.7 logMAR letter sizes. For 0.0 logMAR size, mean "noticeable" blur limits were +/-0.33D, +/-0.30D and +/-0.28D at 3 mm, 4 mm and 6 mm, respectively, but increased by about 70% for 0.7 logMAR letters. All limits reduced by about 17% as pupil size increased from 3 mm to 6 mm. Letter size had a significant influence on all blur limits (1.6-2.1 times), but blur direction had no significant effect. Magnitudes of "troublesome" and 'objectionable" limits were 1.6-1.8 times and 2.1-2.5 times relative to "noticeable" limits, respectively. Our results suggest criteria for troublesome and objectionable blur are relatively unaffected by letter size.

Adolescent↗
PubMed2000

Caterpillar setae-induced acute anterior uveitis: a case report.

PURPOSE: To report uveitis secondary to ocular penetration of caterpillar hairs (setae). METHODS: Case report. A documented attack of acute anterior uveitis was caused by initially overlooked penetration of caterpillar setae. RESULTS: A 66-year-old man presenting with unilateral hypertensive keratouveitis was treated with antiherpes simplex medication (along with local anti-inflammatory and cycloplegic agents) after anterior chamber paracentesis and serologic testing. Laboratory testing was negative. Resolution occurred after 5 days, and corneal clearing showed a predescemetic caterpillar seta. CONCLUSION: Patient history taken in an anterior uveitis setting should include gardening habits and searching for possible exposure to insects or arachnids.

Acute Disease↗
PubMed2001

Use of the HARK autorefractor in children.

PURPOSE: We investigated the reliability, accuracy, and repeatability of an autorefractor with the capability of over-refracting and measuring visual acuity for use in children in a prospective study. METHODS: Before and after cycloplegia, 68 children (mean +/- SD age, 10 +/- 3 years, range 5-16 years) underwent autorefraction twice with the HARK 599 Autorefractor (Humphrey Instruments Inc., San Leandro, CA), subjective over-refraction through the HARK autorefractor, and subjective refraction using a phoro-optometer. After cycloplegia, retinoscopy was performed. Results are reported for one eye (left) of each child. RESULTS: For 68 eyes of 68 children, before and after cycloplegia, correlation coefficients (R) for autorefraction reproducibility exceeded 0.95 for all comparisons of sphere and cylinder. R for spherical values for autorefraction vs. over-refraction was 0.93 and vs. subjective refraction 0.83 before cycloplegia and 0.94 and 0.97 after cycloplegia. Comparing values before and after cycloplegia, autorefraction, over-refraction, and subjective refraction, the data correlated > 0.81 for sphere and 0.75 to 0.87 for cylinder. Cycloplegic retinoscopy compared with autorefraction, over-refraction, and subjective refraction had R > 0.86 for sphere and cylinder for all comparisons except one. Cycloplegia increased the proportion of spherical equivalent values within 0.625 D of the subjective refraction from 41 of 68 eyes (61%) for auto- and over-refraction to 64 (94%) and 51 (75%) of the 68 eyes, respectively. A visual acuity of 20/30 or better was produced in 50 of 68 (73%) eyes with automated refraction before and after cycloplegia and in 62 (92%) with subjective refraction before cycloplegia and subjective refraction and retinoscopy after cycloplegia. Subjective over-refraction did not significantly improve the visual acuity. CONCLUSIONS: In children, HARK autorefraction improved in accuracy, when compared to subjective refraction, and the level of visual acuity improved after cycloplegia. Over-refraction through the instrument did not improve the results before or after cycloplegia.

Adolescent↗