Journal of Pediatric Ophthalmology & Strabismus最新文献

Purpose: To identify social determinants of health (SDOH) associated with follow-up attendance of pre-term infants with retinopathy of prematurity (ROP) after neonatal intensive care unit (NICU) discharge.

Methods: This retrospective cohort study, conducted at a single academic tertiary care center, included preterm infants screened for ROP from July 2018 to December 2022. Sociodemographic and clinical data were collected from a preexisting NICU database. Residential ZIP code was used to derive community-level SDOH indices. Multivariable logistic regression was used to determine factors associated with ophthalmology follow-up attendance within 8 weeks to 1 year after NICU discharge.

Results: Forty-two percent (303 of 723) of patients attended follow-up in the designated interval. Infants with private insurance (odds ratio [OR]: 4.47, 95% CI: 1.98 to 10.1, P < .001), maternal non-Hispanic White identity (OR: 1.80, 95% CI: 1.15 to 2.81, P = .01), ROP treatment history (OR: 3.67, 95% CI: 2.05 to 6.57, P < .001), and longer NICU stay (weeks) (OR: 1.06, 95% CI: 1.03 to 1.08, P < .001) had higher odds of attending follow-up. In an interaction effect, privately insured patients had lower odds of follow-up with each higher quartile of Social Vulnerability Index Racial and Ethnic Minority Status (OR: 0.61, 95% CI: 0.44 to 0.84, P = .002).

Conclusions: Social determinants of health, including individual and community-level factors, significantly impact access to ROP follow-up. The identified disparities and overall inadequate follow-up rate suggest a need for targeted interventions to improve vision health equity and follow-up adherence. [J Pediatr Ophthalmol Strabismus. 2025;62(3):173-181.].

Purpose: To report long-term motor and sensory outcomes after unilateral lateral rectus recession-medial rectus resection for infantile constant exotropia.

Methods: The medical records of patients who had undergone unilateral lateral rectus recession-medial rectus resection for infantile constant exotropia who were followed up postoperatively for a minimum of 4 years were reviewed retrospectively.

Results: A total of 20 patients were included. The mean age at surgery was 3.21 ± 1.54 years (range: 1.25 to 6.00 years). The mean duration of exodeviation was 2.99 ± 1.61 years (range: 9 months to 6 years). The mean angle of exodeviation was 70.1 ± 20.9 prism diopters (PD) (range: 35 to 90 PD). The median postoperative follow-up was 9.1 years (range: 4 to 24 years). Overall, 12 patients (60%) had surgical success at their last follow-up visit. Age at first surgery, cycloplegic refraction, strabismus duration, preoperative angle of deviation, presence of amblyopia, and the number of exotropia surgeries did not predict motor outcome after surgery. At the last follow-up visit, 20% of patients had residual exotropia and 15% had recurrent exotropia. Peripheral binocular single vision was achieved in 25% of patients and stereopsis in none. Age at first surgery, strabismus duration, and surgical outcome had no effect on sensory outcome.

Conclusions: In this study, 60% of patients achieved a successful long-term motor outcome and 25% achieved peripheral binocular single vision after unilateral recession-resection for infantile constant exotropia. Stereopsis outcome was nil. Age at surgery and duration of strabismus had no effect on motor and sensory outcomes. [J Pediatr Ophthalmol Strabismus. 2025;62(3):203-210.].

A 15-year-old girl presented with a painless, enlarging lesion on the left inferior conjunctiva, initially diagnosed as conjunctival hemangioma. Despite treatment with topical beta-blockers, the lesion continued to grow. Excision and histopathological examination confirmed the diagnosis of a conjunctival solitary fibrous tumor, highlighting the importance of considering rare lesions in the differential diagnosis. [J Pediatr Ophthalmol Strabismus. 2025;62(3):e35-e41.].

Purpose: To assess the medical accuracy and readability of responses provided by ChatGPT (OpenAI), the most widely used artificial intelligence-powered chatbot, regarding questions about strabismus.

Methods: Thirty-four questions were input into ChatGPT 3.5 (free version) and 4.0 (paid version) at three time intervals (day 0, 1 week, and 1 month) in two distinct geographic locations (California and Florida) in March 2024. Two pediatric ophthalmologists rated responses as "acceptable," "accurate but missing key information or minor inaccuracies," or "inaccurate and potentially harmful." The online tool, Readable, measured the Flesch-Kincaid Grade Level and Flesch Reading Ease Score to assess readability.

Results: Overall, 64% of responses by ChatGPT were "acceptable;" but the proportion of "acceptable" responses differed by version (47% for ChatGPT 3.5 vs 53% for 4.0, P < .05) and state (77% of California vs 51% of Florida, P < .001). Responses in Florida were more likely to be "inaccurate and potentially harmful" compared to those in California (6.9% vs. 1.5%, P < .001). Over 1 month, the overall percentage of "acceptable" responses increased (60% at day 0, 64% at 1 week, and 67% at 1 month, P > .05), whereas "inaccurate and potentially harmful" responses decreased (5% at day 0, 5% at 1 week, and 3% at 1 month, P > .05). On average, responses scored a Flesch-Kincaid Grade Level score of 15, equating to a higher than high school grade reading level.

Conclusions: Although most of ChatGPT's responses to strabismus questions were clinically acceptable, there were variations in responses across time and geographic regions. The average reading level exceeded a high school level and demonstrated low readability. Although ChatGPT demonstrates potential as a supplementary resource for parents and patients with strabismus, improving the accuracy and readability of free versions of ChatGPT may increase its utility. [J Pediatr Ophthalmol Strabismus. 2025;62(3):220-227.].

Purpose: To investigate whether wide-angle fluorescein angiography (FA) was useful for detecting familial exudative retinopathy (FEVR) in patients with neurodevelopmental disorder with spastic diplegia and visual defects (NEDSDV).

Methods: This was a retrospective chart review from 2013 to 2023 of all consecutive patients with NEDSDV and pathogenic or likely pathogenic CTNNB1 variants.

Results: Seven patients (four females, three males) were seen in the ophthalmology clinic (median age: 14 months). One patient presented with a retinal fold in one eye, was observed without FA, and later developed a tractional retinal detachment involving the macula in the contralateral eye. Another patient observed without FA lost vision due to vitreous hemorrhage. Five patients who lacked signs of FEVR in clinic underwent FA under anesthesia; three showed retinal neovascularization or leakage requiring treatment, one showed mild avascularity, and one was normal.

Conclusions: Despite reassuring eye examinations in the clinic, two patients with NEDSDV experienced vision loss from FEVR, and three patients were found by FA to require treatment. FA aided in the detection of FEVR in these patients. [J Pediatr Ophthalmol Strabismus. 2025;62(3):166-172.].

Purpose: To report the prevalence of visual acuity, visual field, and ocular motility problems in children with epilepsy referred to the Children's Epilepsy Surgery Service (CESS) for surgery.

Methods: This was a retrospective observational study of all children referred to the CESS in Bristol between 2015 and 2020. Data extraction included age, age at epilepsy diagnosis, epilepsy etiology (as determined by seizure semiology, neuroimaging, and electroencephalography), anti-seizure drugs, visual acuity, visual field, ocular motility, and fundus imaging.

Results: A total of 221 children with epilepsy were seen during the study period: 60% (132/221) had structural etiologies, 8% (18/221) were genetic, and in 28% (62/221) the etiology was unknown. Overall, 53% (117/221) were found to have abnormalities, particularly strabismus (16%, 36/221), visual field defects (14%, 27/198), and reduced visual acuity (12%, 26/219). Notably, 54% (63/117) of children with ophthalmic abnormalities were new diagnoses in the CESS clinic. Younger children and those with neurodevelopmental disorders were less likely to complete all vision tests.

Conclusions: Ophthalmic abnormalities were prevalent among children referred for epilepsy surgery in Bristol and more than half were previously undiag-nosed. The data support the adoption of an orthopticled vision screening service for children with medically refractory epilepsy, structural etiologies, and focal seizures, to better support their needs in the community. [J Pediatr Ophthalmol Strabismus. 2025;62(3):211-219.].

Retinal hamartomas associated with hypertrophy of the retinal pigment epithelium are often linked to phakomatoses. This case report presents a 6-year-old patient with vision loss due to tractional rhegmatogenous retinal detachment. Surgical intervention (vitrectomy) improved retinal architecture and visual acuity, although significant baseline visual acuity loss persisted, suggesting that early surgery may prevent complications and optimize outcomes. [J Pediatr Ophthalmol Strabismus. 2025;62(3):e31-e34.].