Journal of Pediatric Ophthalmology & Strabismus最新文献

Purpose: To assess the incidence and risk factors of retinopathy of prematurity (ROP) in Cyprus and evaluate the validity of United Kingdom-based screening criteria on the population. The findings aimed to optimize ROP screening guidelines for improved neonatal care.

Methods: This was a retrospective study of 183 children undergoing ROP screening from January to December 2023 in the only tertiary neonatal intensive care unit in Cyprus.

Results: A total of 33 infants developed ROP (18%) and 11 of these had vision-threatening ROP. Nine infants received treatment and two died prior to treatment. The youngest infant with ROP was born at 24 weeks of gestation and the oldest was born at 32 weeks. Gestational age, birth weight, sepsis, and long oxygen duration have a strong association with ROP, whereas race, multiple births, blood transfusion, and other operations in the neonatal age are not associated with ROP. Every week of increase in gestational age is correlated with reduction in ROP incidence. The severe prematurity group born at 24 to 28 weeks had the highest risk of vision-threatening disease.

Conclusions: Based on the analysis of a cohort of 183 preterm infants who underwent ROP screening over 1 year in the only tertiary-level neonatal intensive care unit in Cyprus, the authors concluded that the 2008 United Kingdom ROP screening criteria are appropriate and valid for this population because no cases of treatment-requiring ROP were missed. The findings indicate that the severity of prematurity is the primary determinant of ROP risk, whereas other independent risk factors appear to have a comparatively lesser impact on the development of ROP. Importantly, this represents the first epidemiological study of ROP in Cyprus, providing a nationally representative assessment of ROP incidence and screening effectiveness.

Purpose: To determine normative corneal epithelial thickness (CET) profiles in healthy Turkish children using anterior segment optical coherence tomography (AS-OCT), and to explore regional variations and associations with demographic and refractive parameters.

Methods: This cross-sectional observational study was conducted at a tertiary eye hospital and included 86 healthy children aged 7 to 18 years. One eye per participant was randomly selected. All participants underwent complete ophthalmic examination, cycloplegic autore-fraction, and AS-OCT imaging. CET measurements were obtained from central (2-mm), paracentral (5-mm), and midperipheral (6-mm) zones across eight radial sectors. Statistical analyses included sex-based comparisons, quadrant-based thickness differences, and correlation analyses with age and refractive parameters.

Results: Mean central CET was 53.7 ± 4.6 µm. Epithelial thickness (ET) decreased toward the periphery, with inferior and inferonasal sectors being thickest and superior sectors thinnest. Males exhibited significantly greater CET in several paracentral and midperipheral sectors (P < .05). Quadrant-based comparisons revealed consistent asymmetry: ET was greater in inferior and nasal sectors compared to superior and temporal regions, whereas corneal thickness was lower in the inferior and temporal quadrants relative to superior and nasal counterparts (P < .001). Central CET showed no correlation with age or refractive error, whereas paracentral nasal and temporal sectors exhibited weak age-related thinning (P < .05).

Conclusions: This study provides normative pediatric CET data, highlighting characteristic spatial variations and subtle sex-based differences. These findings support the clinical utility of epithelial mapping in early keratoconus detection and its integration into artificial intelligence-based diagnostic systems.

Purpose: To further explore the specific cognitive and behavioral challenges that may be associated with visual difficulties by examining demographic, health, and behavioral data from the 2022 National Health Interview Survey (NHIS).

Methods: Pediatric data from the 2022 NHIS were analyzed using the JMP Pro 16 software. Univariate and multivariate analyses were performed to identify associations among variables including visual difficulties, demographics, overall health, life satisfaction, learning disabilities, and behavioral subscale scores as assessed by caregivers.

Results: Children between 2 and 17 years of age with difficulty seeing according to their caretakers were less satisfied with life and had a higher prevalence of attention-deficit/hyperactivity disorder, intellectual disability, autism, developmental delay, and learning disabilities. Controlling for these conditions, children with visual difficulties received higher scores on all behavioral subscales, suggesting an association with more behavioral challenges, as perceived by caregivers. These subscales included peer problems, hyperactivity, conduct problems, and emotional problems.

Conclusions: There was a correlation between difficulty seeing and emotional, cognitive, and behavioral challenges as reported by caregivers. Although these findings must be interpreted with caution due to their reliance on caregiver perception, pediatricians may consider ophthalmologic evaluation as part of a comprehensive assessment for children presenting with mental health or behavioral concerns, given the observed associations between visual difficulties and behavioral challenges.

Purpose: To evaluate how permitting parents to be present during their infant's retinopathy of prematurity (ROP) staging examination affects their levels of anxiety, depression, and hopelessness.

Methods: This prospective cross-sectional study was conducted at two ROP centers, each following its routine parental attendance protocol. In the parent group, parents were permitted to accompany their infants during screenings, whereas in the no parent group, they were not. Parents completed the Beck Anxiety Inventory, Beck Depression Inventory, and Beck Hopelessness Scale immediately following their infant's first ROP examination.

Results: A total of 123 parents participated, with 65 in the parent group and 58 in the no parent group. There were no significant differences between the groups regarding demographic and clinical variables, except for the proportion of mothers (P = .030). Anxiety, depression, and hopelessness did not significantly differ between the groups. Mothers exhibited higher depression scores than fathers in both groups (P = .011 for the parent group; P = .036 for the no parent group) and higher anxiety scores in the parent group (P = .029). Neonatal intensive care unit (NICU) duration positively correlated with anxiety (r = 0.33, P < .001) and depression (r = 0.25, P = .006). Gestational age and birth weight showed weak negative correlations with anxiety (r = -0.29, P = .001; r = -0.25, P = .006, respectively).

Conclusions: Witnessing ROP examinations did not significantly affect parental psychological outcomes. Notably, mothers experienced higher emotional distress than fathers, possibly due to extended NICU stays. Considering parents' opinions before including them in ROP examinations is essential for empathetic and ethical practice.

Purpose: To explore whether earlier exposure to the pediatric ophthalmology subspecialty could help foster interest and enhance recruitment efforts among medical students to more effectively develop and connect with potential, future pediatric ophthalmologists.

Methods: A 22-question survey was administered via Qualtrics to medical students at 13 different accredited medical schools.

Results: The survey garnered 392 complete responses. Demographically, respondents included 34% men and 66% women, with the largest participant category being MS-2 level (44%) in the survey. Three-quarters of students expressed potential interest in working with children as practicing physicians. Notably, only 8% of students had encountered pediatric ophthalmology rotations during their training, and 40% were uninformed about the training necessary to pursue a pediatric ophthalmology fellowship. The following associations with higher awareness of pediatric ophthalmology were found to be statistically significant: female gender identity, individuals with a family member or friend who is an ophthalmologist, and students with a personal medical history involving an ophthalmologist.

Conclusions: This study highlights the significant deficiency in medical student exposure and education concerning pediatric ophthalmology. By recognizing this knowledge gap, this study underscores the necessity of enhancing pediatric ophthalmology exposure for medical students as a viable and rewarding career option.

Purpose: To evaluate the effectiveness and safety of botulinum toxin type A (BTXA) injection with reduced volume without electromyographic guidance for the treatment of acute acquired comitant esotropia (AACE) of 25 prism diopters (PD) or less.

Methods: The authors reviewed the medical records of 60 patients with AACE of 25 PD or less, including 40 patients treated with BTXA injections (BTXA group) and 20 patients treated with Fresnel prism (Fresnel prism group). Patients in the BTXA group were injected with 5 to 6.25 U of BTXA in 0.04 mL of saline into bilateral medial rectus muscles in the absence of electromyography. Patients in the Fresnel prism group wore Fresnel prisms at a minimum amount that could eliminate diplopia. Success was defined with deviations of 10 PD or less at both distance and near fixations and with resolution of diplopia.

Results: In the BTXA group, the success rate of the first injection was 100% after 1 week, but decreased to 57.5% (23/40) after 6 months; the cumulative success rate of two injections was 77.5% (31/40) after 6 months; and one eye (0.93%, 1/108) had complicated mild ptosis. In the Fresnel prism group, the success rate was 5% (1/20) after 6 months of treatment. The difference in cumulative success rate between the two groups was significant (chi-square = 28.158, P < .01).

Conclusions: BTXA injection with reduced volume in the absence of electromyography is a simple, effective, and safe modality for patients with AACE who have a small to moderate deviation. [J Pediatr Ophthalmol Strabismus. 2025;62(4):271-277.].

The authors report a retrospective case series of three pediatric patients receiving vincristine who developed varying degrees and laterality of ptosis and abduction deficits. Treatment for these patients included use of thiamine, pyridoxine, and adjusting vincristine administration. These cases add to the variability of findings and treatment of vincristine neurotoxicity. [J Pediatr Ophthalmol Strabismus. 2025;62(4):e51-e53.].

Purpose: To determine whether inter-ocular brightness disparity during a self-directed video game on a mobile graphic device can effectively detect unilateral amblyopia.

Methods: Forty-nine children of ages 3 to 17 years participated in this prospective, non-interventional study. A series of sample image pairs were presented on an iPad (Apple, Inc) to illustrate the concept of relative brightness. Participants subsequently wore spectacles with orthogonally polarized lenses to dissociate image pairs between eyes. The video game employed a forced-choice algorithm that varied relative brightness disparity between image pairs in a stepwise manner. Participants chose the brighter of each pair of images until the end point of equal brightness was detected. The game was repeated to assess consistency. Eye examination records with acuities measured in logarithm of the minimum angle of resolution units were subsequently reviewed to compare with the video game results.

Results: The study had a mean game time of 108 seconds. Inter-ocular brightness disparity greater than 0.3 log units indicated a relative afferent brightness sense defect. The video game detected unilateral amblyopia with 88% sensitivity and 95% specificity. The positive predictive value was 78% and the negative predictive value was 98%.

Conclusions: This iPad video game can be played by children at least as young as 3 years of age. Inter-ocular brightness disparity is a sensitive and specific sign of unilateral amblyopia in a general pediatric population. The non-threatening nature and engaging format of this video game make it a promising and accessible method for early amblyopia screening. [J Pediatr Ophthalmol Strabismus. 2025;62(4):245-251.].