Journal of Pediatric Ophthalmology & Strabismus最新文献

Purpose: To assess the prevalence and risk factors of musculoskeletal pain among pediatric ophthalmologists and strabismologists in the Middle East, and their impact on their work.

Methods: A cross-sectional survey-based study was conducted using SurveyMonkey distributed via the social media WhatsApp platform among pediatric ophthalmologists and strabismologists in some countries of the Middle East. The survey captured demographics, clinical workload, ergonomic practices, musculoskeletal symptoms, risk factors, and treatment methods.

Results: Most participants (70%) had more than 10 years of experience. Pain severity was significantly higher among those working in the private sector and hospitals compared to academic settings. Neck pain (48%) and shoulder pain (24%) were significantly correlated with severity, whereas back and arm pain were not. Common triggers included orthoptic examinations and prolonged standing, showing significant correlations, whereas slit-lamp examinations did not. Physical therapy and medications were effective treatments, significantly correlating with pain relief, whereas ergonomic adjustments were underused. Musculoskeletal pain led 31% of participants to reduce working hours and 15% to avoid specific tasks, highlighting its impact on productivity. Regular exercise was low but significantly correlated with pain relief, showing an area for improvement.

Conclusions: Pediatric ophthalmologists and strabismologists in the Middle East face a high prevalence of musculoskeletal pain, primarily dull pain affecting the neck and shoulders. Occupational factors and specific tasks significantly influence pain severity. Effective pain management strategies include medication, physical therapy, and exercise. The findings emphasize the need for ergonomic interventions, comprehensive pain management, and lifestyle adjustments to enhance well-being and productivity.

Purpose: To investigate factors influencing stereopsis outcomes in patients with fully refractive accommodative esotropia (RAET) that developed within the first 6 months of life, and were successfully aligned within 10 prism diopters of orthophoria.

Methods: This retrospective study included 29 patients with RAET, aged 6 months or younger at onset. Patients were divided into two groups based on stereopsis outcomes: measurable (n = 11) and nil (n = 18). The study variables included age at esotropia onset, age at initial visit, age at first wearing of glasses, duration of misalignment, duration of treatment, cycloplegic refraction, and angle of ocular deviation. Additionally, the relationship between the timing of initial wearing of glasses (≤ 8 months) and stereopsis outcomes was analyzed.

Results: No significant differences were found between the measurable and nil groups in any of the measured variables. The frequencies of measurable stereopsis outcomes also showed no significant differences between patients with a duration of misalignment of 4 months or less (n = 7) and those with a duration of more than 4 months (n = 22) (57% [4/7] vs 32% [7/22]; P = .375, Fisher's exact test). However, the frequencies of measurable stereopsis outcomes in patients treated with first wearing of cycloplegic glasses at 8 months or younger (n = 9) were significantly higher than those treated with first wearing of cycloplegic glasses at older than 8 months (n = 20) (66% [6/9] vs 25% [5/20]; P = .048, Fisher's exact test).

Conclusions: The most important factor associated with a measurable stereopsis outcome was age at first wearing of cycloplegic glasses (≤ 8 months), with 66% of these patients achieving measurable stereopsis.

Purpose: To investigate the long-term association between childhood myopia and the risk of retinal detachment over a 10-year follow-up period.

Methods: A retrospective cohort study was conducted using the TriNetX platform, which included 66 United States health care organizations' electronic medical records. Children diagnosed as having myopia (n = 151,499) were compared to a control group of children without myopia who received routine health examinations (n = 5,073,124). Propensity score matching was applied to control for age, gender, and race, resulting in 145,814 patients in each cohort for analysis.

Results: Within the study period from October 16, 2004 to October 16, 2024, 657 children (0.5%) in the myopic cohort and 63 children (0.04%) in the control cohort developed retinal detachment. The risk difference was 0.004 (95% CI: 0.004 to 0.004, P < .001), with a risk ratio of 10.43. The odds ratio was 10.47 (95% CI: 8.09 to 13.56). The average number of retinal detachments per child between the cohorts was not statistically significant.

Conclusions: Children with myopia are at an increased risk of retinal detachment over a 10-year period. This highlights an urgent need for early detection and monitoring of these children to prevent myopia progression and retinal detachment. The findings reinforce the growing need for public health measures and clinical approaches aimed at slowing myopia progression in pediatric populations.

Purpose: To compare sevoflurane with laryngeal mask airway (LMA) and propofol infusion with an oxygen facemask in children undergoing ophthalmic examinations under anesthesia (EUA) regarding time to operating room discharge.

Methods: In this prospective, randomized, single-blind study, children aged 1 to 6 years undergoing EUA were assigned to sevoflurane with LMA (the sevoflurane group) or propofol with oxygen facemask (the propofol group). The primary outcome was operating room discharge time. Secondary outcomes included induction time, nonoperative time, total anesthesia time, surgery duration, post-anesthesia care unit stay, ophthalmologist satisfaction, respiratory adverse events/interventions, EUA interruptions, wake-up time, emergence agitation, postoperative nausea and vomiting, and pain medication use.

Results: Sixty patients were enrolled. Operating room discharge time was significantly shorter in the propofol group than the sevoflurane group (7.17 ± 3.11 vs 9.81 ± 4.38 minutes, 95% CI: 0.67 to 4.60, P = .009). Induction time (8.63 ± 4.37 vs 11.93 ± 6.26 minutes, 95% CI: 0.48 to 5.99, P = .022) and nonoperative time (15.80 ± 5.57 vs 21.67 ± 8.90 minutes, 95% CI: 2.03 to 9.71, P = .003) were shorter in the propofol group. Total anesthesia time remained shorter in the propofol group (35.53 ± 15.57 vs 43.74 ± 16.10 minutes, 95% CI: 0.02 to 16.39, P = .050). No significant differences were found in other outcomes, except more emergence agitation in the sevoflurane group (P = .029). Ophthalmologist satisfaction was high and comparable. Respiratory adverse events were low and similar in both groups.

Conclusions: Propofol with oxygen facemask resulted in shorter operating room discharge time and less emergence agitation compared to sevoflurane with LMA in pediatric ophthalmic EUAs. Both techniques yielded high ophthalmologist satisfaction and low respiratory event rates.

Purpose: To study the prevalence of refractive errors among children with cured retinoblastoma in the context of clinical variables.

Methods: A cross-sectional study was conducted in the Ophthalmology Department at Ain Shams University Hospital from September 2023 to April 2024. Cycloplegic refraction and fundus photography were performed for children with cured retinoblastoma coming to the ocular oncology clinic for follow-up.

Results: Refractive errors were studied in 49 children with cured retinoblastoma, aged 3.8 to 18 years. Refractive astigmatism was the most common error affecting 44.1% of retinoblastoma eyes (95% CI: 27% to 62%) followed by hypermetropia in 26.4%, (95% CI: 11% to 42%). Anisometropia of 1.00 diopter or greater existed in 53.8% of children with retinoblastoma (95% CI: 26% to 91%). Amblyopia due to uncorrected refractive errors existed in 28.6% of children (95% CI: 15% to 42%). A significant positive association existed between the amount of refractive astigmatism and the number of tumors per eye (r = 0.583; P < .001), the number of quadrants affected by the disease (r = 0.472; P = .005), the number of systemic chemotherapy sessions (r = 0.401; P = .028), the number of laser sessions (r = 0.489, P = .004), and the number of globe salvage modalities (r = 0.46 and P = .006). A significant negative association existed between the amount of refractive astigmatism and the posterior tumor margin to disc distance (r = -0.412; P = .015).

Conclusions: Refractive errors are common among children with retinoblastoma, with astigmatism being the most common. Uncorrected refractive errors constitute a risk factor for amblyopia in children with cured retinoblastoma. Diffuse multifocal disease, tumors nearer to the disc, longer chemotherapy duration, and more intensified local treatment are associated with higher refractive astigmatism.

Purpose: To compare the prevalence and severity of dry eye disease among children aged 6 to 12 years with and without a history of ocular infections.

Methods: Children aged 6 to 12 years who came to the pediatric eye clinic were included. A total of 400 children were screened for dry eye over a 6-month study period. Consecutive sampling was used, meaning all eligible children who attended the Pediatric Ophthalmology outpatient department during this period were included based on inclusion and exclusion criteria by using the the Ocular Surface Disease Index (OSDI) questionnaire, tear film break-up time (TBUT), and the Schirmer I test.

Results: Dry eye disease was diagnosed in 37% (n = 148) of the participants overall, and the diagnosed children with dry eye were divided into two groups (history of ocular infection and no history of ocular infection). The history of ocular infection group showed noticeably worse results on two key tests compared to the no history of ocular infection group. Their TBUT was significantly lower at 6.3 seconds (with a margin of ±1.8 seconds), and their Schirmer I test results were also reduced at 9.2 ± 2.4 mm. The no history of ocular infection group had TBUT values of 8.9 ± 2.0 seconds and Schirmer I readings of 13.1 ± 2.7 mm. Both of these differences were statistically significant (P < .001).

Conclusions: Dry eye disease seems to be common among school-aged children, especially those who have had eye infections before. On analyzing previous infections, particularly viral and bacterial conjunctivitis, it appears that there are important factors contributing to problems such as unstable tear films and reduced tear production.

Purpose: To compare conventional and inverse occlusion in the treatment of amblyopia with eccentric fixation.

Methods: This prospective randomized interventional study was conducted at a tertiary care center over a period of 1 year. Sixty patients with amblyopia (refractive or strabismic) with eccentric fixation who were older than 12 years were divided into two groups with systematic randomization: conventional occlusion (occlusion of sound eye for 6 hours/day) and inverse occlusion (occlusion of amblyopic eye for 6 hours/day). Patients with a systemic illness or neurological disorder were excluded. Follow-up data for corrected distance visual acuity (CDVA), stereopsis, and fixation pattern were taken at baseline and 1, 3, and 6 months postoperatively.

Results: At the final follow-up visit, there was significant improvement in CDVA in the amblyopic eye in both the conventional occlusion (P = .007) and inverse occlusion (P < .001) groups. The mean ± standard deviation of CDVA improved from 1.32 ± 0.3 and 1.32 ± 0.32 logMAR at baseline to 1.17 ± 0.15 and 1.10 ± 0.27 logMAR in the conventional occlusion and inverse occlusion groups, respectively. Stereoacuity improved significantly in both groups (P = .013 and .016 in the conventional and inverse occlusion groups, respectively). Improvement in fixation function was statistically significant only in the inverse occlusion group I (P = .002).

Conclusions: Both conventional and inverse occlusion therapy are effective in treating amblyopia with eccentric fixation in terms of improvement of visual acuity and stereopsis. However, for improvement in anomalous fixation pattern, inverse occlusion is preferred with no issues of compliance and functional limitation.

Purpose: To evaluate keratometric measurements of the anterior and posterior corneal surface before and after corneal cross-linking (CXL) surgery for pediatric keratoconus.

Methods: A total of 111 eyes were found eligible for CXL. Anterior and posterior corneal surface keratometry values obtained before and after CXL were analyzed.

Results: The mean anterior keratometry values were 47.99 ± 3.96 and 47.74 ± 3.63 diopters (D) before and after CXL. The mean anterior surface steep keratometry was 50.05 ± 4.70 D before CXL and 49.58 ± 4.01 D at the end of the follow-up. The mean anterior surface flat keratometry was 45.91 ± 3.31 D before CXL and 45.93 ± 3.45 D at the end of the follow-up. The mean astigmatism of the anterior surface was 3.98 ± 2.34 cylinder diopters (Dcyl) before CXL and 3.63 ± 1.86 Dcyl at the end of the follow-up. The mean posterior surface keratometry value was -7.16 ± 0.81 D before CXL and -7.27 ± 0.76 D at the end of the follow-up. The mean posterior surface steep keratometry value was -7.52 ± 0.86 D before CXL and -7.64 ± 0.81 D at the end of the follow-up. The mean posterior surface flat keratometry value was -6.81 ± 0.80 D before CXL and -6.90 ± 0.75 D at the end of the follow-up. The mean posterior surface astigmatism was 0.71 ± 0.33 Dcyl before CXL and 0.73 ± 0.34 Dcyl at the end of the follow-up. The difference was not statistically significant.

Conclusions: CXL is recommended for children with keratoconus. The treatment does not significantly alter anterior and posterior corneal surface keratometry values.

Purpose: To determine the efficacy of five types of myopia control glasses (MCG) among Indian children.

Methods: A retrospective cohort study with 1-year follow-up was done in 397 eyes of 216 children aged 4 to 17 years, with myopia between -0.75 and -10.00 diopters (D), astigmatism of 4.00 D or less, and baseline progression of 0.50 D or greater. Data from children prescribed type I (defocus incorporated multiple segments), type II (highly aspherical lenslet target), type III (cylindrical annular refractive elements), type IV (peripheral defocus reducing lenses), and type V (pediatric progressive addition lenses) MCG were analyzed. Mean change in spherical equivalence of refractive error (SER) and axial length (AL) and percentage efficacy in reducing SER and AL progression to physiological levels were compared. Subgroup analysis was done by age, gender, and amount of myopia.

Results: Mean change in SER and AL at 6 and 12 months with all MCG combined was -0.05 ± 0.23 D, -0.26 ± 0.43 D, 0.07 ± 0.11 mm, and 0.16 ± 0.18 mm, respectively. No statistically significant difference was noted between types I, II, and III. Axial and refractive efficacy at 6 and 12 months of all MCG combined was 42.34%, 43.99%, 90.41%, and 68.91%, respectively. There was no significant difference among boys and girls. The older group showed significantly better axial efficacy (P < .01) at 6 and 12 months. Refractive efficacy was significantly higher at 12 months (P < .01) among children with low myopia.

Conclusions: Types I, II, and III MCG are equally efficacious in controlling myopia progression among Indian children, with better results among older children and those with low myopia.

Purpose: To analyze the origin and quality of health information on one social media platform on the use of vision therapy in treating pediatric visual and learning disorders.

Methods: Nine hashtags were selected, and the 20 most liked videos were independently assessed using the DISCERN and Global Quality Scoring (GQS) systems, totaling 147 videos with 11,194,000 views. Across all hashtags, vision therapy content was predominantly created by behavioral optometrists (32.2%) and vision therapy clinics (21.2%).

Results: This content scored poorly on both the DISCERN and GQS scoring systems, demonstrating widespread misinformation. With the increasing influence of social media on health care decisions, misinformation may lead to misguided treatment choices, potentially delaying evidence-based care. These findings underscore the need for increased engagement from ophthalmologists and other medical professionals to provide accurate, research-backed information and counter the spread of misleading claims of vision therapy in treating pediatric and visual learning disorders.

Conclusions: Future research should explore content across multiple platforms and broaden the scope of analysis to enhance the understanding of online health misinformation.