Journal of Aapos最新文献

Background: Following hospital discharge, infants needing continued retinopathy of prematurity (ROP) examinations are vulnerable to being lost to follow-up. Social determinants of health (SDOH) may further impede access to outpatient follow-up. The purpose of this study was to evaluate the association of clinical, demographic, and socioeconomic factors with timely first outpatient ROP follow-up.

Methods: This retrospective study reviewed all infants examined for ROP inpatient between September 17, 2013, and December 31, 2023. We included only infants requiring continued outpatient ROP examination(s) at our institution. The primary outcome was "on-time" follow-up to the first outpatient visit, defined as returning within 3 days after the recommended follow-up date. Multivariable analysis was performed.

Results: Of 1,424 infants examined for ROP, 532 (37.4%) required outpatient ROP examination(s) (mean birth weight, 925 g; mean gestational age, 26.9 weeks, mean postmenstrual age at last inpatient examination, 41.5 weeks). Although 525 (98.7%) infants followed up outpatient, only 432 (81.2%) had "on-time" follow-up. On multivariable analysis, not following up on-time increased with recommended follow-up >14 days versus <7 days (OR = 3.9, P = 0.004), English-language preference (OR = 3.6, P = 0.04), no treatment before hospital discharge (OR = 2.4, P = 0.01), public (ie, Medicaid) versus private insurance (OR = 1.9, P = 0.02), and higher area deprivation index (OR = 1.1, P = 0.003).

Conclusions: Higher risk of delayed/missed first outpatient ROP follow-up was associated with less severe disease (ie, longer recommended follow-up intervals and no ROP treatment before discharge) and SDOH (ie, having public insurance and residence in socioeconomically disadvantaged neighborhoods). Elucidating clinical, demographic, and socioeconomic factors associated with outpatient ROP follow-up nonadherence may help inform targeted efforts for improvement.

Background: Early enucleation has been linked to infantile nystagmus, or a pattern resembling fusion maldevelopment nystagmus syndrome (FMNS). We evaluated nystagmus characteristics and risk factors in a large cohort of children treated for retinoblastoma (RB).

Methods: The medical records of children who underwent unilateral enucleation for RB between 2009 and 2021 were retrospectively reviewed. Nystagmus type-FMNS or infantile nystagmus syndrome (INS)-was determined clinically. Potential risk factors included age at presentation, age at enucleation, visual acuity, laterality, and genetic status.

Results: Of 149 children who underwent enucleation of one eye (114 with unilateral, 35 with bilateral RB), 13 (9%) developed nystagmus over a mean follow-up of 67 months. Twelve showed INS and 1 had probable FMNS. All affected children carried a pathogenic RB1 variant, compared with 25% of those without nystagmus (P < 0.0001). Nystagmus onset occurred at a mean age of 3.75 months and was linked to earlier RB diagnosis (mean, 4.7 vs 29 months [P < 0.0001]), earlier enucleation (P < 0.0001), and poorer visual acuity (P < 0.0001). Of 11 infants enucleated before 6 months (median, 3 months), only 2 (18%) developed nystagmus despite healthy fellow foveas, with one showing FMNS features.

Conclusions: In our study cohort, nystagmus occurred in a minority of children, predominantly at presentation rather than as a consequence of enucleation, and was strongly associated with RB1 mutation and early disease onset. These findings provide reassurance for families that unilateral enucleation in infancy rarely induces nystagmus when the fellow eye is healthy.

Purpose: To determine the level of minority representation at the 2024 annual meeting of the American Association of Pediatric Ophthalmology and Strabismus (AAPOS).

Methods: The abstract submissions process for the 2024 AAPOS annual meeting allowed self-reporting of authors' status as underrepresented in medicine (URiM). The choice "decline to answer" (DTA) was available for all questions. The different groups' submission outcomes (paper, poster, and workshop) were compared. URiM was defined as having one or more of the following identities: Black or African American; Hispanic or Latino; American Indian or Alaska Native; Native Hawaiian or other Pacific Islander; and lesbian, gay, bisexual, transgender, or queer.

Results: In research abstracts, 17% of all authors and 13.7% of presenting authors identified as URiM (16% and 17% chose DTA, resp.). There were no significant differences in the proportion of abstracts accepted as a paper or poster presentation between URiM and non-URiM authors (P > 0.7 for all comparisons). Female presenting authors were more likely to have an accepted abstract than males (81.6% vs 66.4% [P = 0.0015]). Subgroup analysis showed no differences between URiM and non-URiM in paper presentations. In workshop abstracts, 39.6% of panelists and 10.4% of organizers identified as URiM, respectively. There were no significant differences in workshop abstract acceptance rates between URiM and non-URiM presenting authors (P > 0.1 for all comparisons).

Conclusions: The current AAPOS approach toward meeting representation, which includes masked evaluation of abstracts for presentation, appears to be equitable toward URiM presenters.

Background: Residual amblyopia is associated with difficulties with eye-hand coordination, aiming and catching, balance, and gait. Whether these motor skill difficulties have an impact on physical activity and health is poorly understood.

Methods: In this cross-sectional study, 132 children 8-13 years of age completed the self-report Physical Activity Questionnaire for Children: 59 amblyopic children, 29 children with strabismus or anisometropia who were never amblyopic or were no longer amblyopic after treatment (nonamblyopic), and 44 control children. Subsets of children in each group also completed BMI measurement, a self-perception of athletic competence questionnaire, motor skills assessment, and the PedEyeQ Functional Vision domain questionnaire. A subset of parents rated their child's physical activity as sedentary, light, moderate, or very active.

Results: Overall, 63% were non-Hispanic White and 54% were female, with a mean age of 9.9 ± 1.7 years. Of the 59 amblyopic children, 46% had anisometropia, 31% had been treated for strabismus, and 24% had both. Neither a significant difference in overall physical activity nor BMI was identified among children with amblyopia, nonamblyopic children, and controls (F_2,129 = 1.12, P = 0.33; F_2,68 = 0.43, P = 0.65, resp.). Responses from both children and their parents were consistent with light to moderate levels of physical activity in all three groups. Children with amblyopia had deficits in motor skills, self-perception of athletic competence, and functional vision relative to controls (F_2,98 = 11.51, P < 0.0001; F_2,95 = 3.47, P = 0.04; F_2,129 = 20.20, P < 0.0001, resp.).

Conclusions: Despite significant impairments in motor skills, and differences in athletic self-perception and functional vision, children with amblyopia maintain overall physical activity levels and BMI comparable to their control peers.

Purpose: To assess the associations of specific ocular conditions on parental concerns for child development and quality of life in multiethnic preschool-age children.

Methods: We conducted a cross-sectional analysis using parental interview and comprehensive eye examination data from the Multi-Ethnic Pediatric Eye Disease Study, a population-based study of children aged 6-72 months. Parental concerns were assessed using the Parents' Evaluation of Developmental Status Screening Instrument; quality of life, via the Pediatric Quality of Life Inventory. Multivariable regression analyses were performed.

Results: Data were available for 8,265 children. Parental concerns were reported for 16.0%. Strabismus was associated with parental concerns even after adjusting for covariates (P < 0.001). Astigmatism was associated with parental concerns among children aged 36-72 months (P_trend = 0.018). In this group, odds ratios for parental concerns were 1.33 (95% CI, 1.02-1.72) for astigmatism of 1.50 to <3.0 D, 1.39 (0.85-2.25) for ≥3.0 D, and 1.65 (1.12-2.41) for strabismus. Hyperopia, myopia, anisometropia, or amblyopia showed no association. Astigmatism of 3.0 D or greater and strabismus were also associated with a history of physician-diagnosed developmental delay (OR [95% CI] = 3.97 [1.53-10.28] and 6.58 [3.52-12.32], resp.) and with lower physical health/emotional function scores (2.3 ± 0.8 and 3.5 ± 1.3 points lower for astigmatism ≥3.0 D vs <1.5 D, and 2.0 ± 0.6 and 2.0 ± 0.9 points lower for strabismus vs no strabismus; all Ps ≤ 0.031).

Conclusions: Both astigmatism and strabismus correlated with greater parental concerns about development and worse quality of life in preschoolers.

Purpose: To assess the driving performance and visual attention of amblyopic drivers using a driving simulator integrated with eye tracking technology in an urban setting.

Methods: A total of 30 participants were enrolled: 14 amblyopic patients (all anisometropic and one also with strabismus) and 16 controls. Participants completed a simulated urban driving task while their eye movements and driving performance were recorded using a DriveSafety DS-600c simulator integrated with an infrared eye tracker. Driving performance (speed, brake reaction time / deceleration at pedestrian crossings, lane position variability, steering variability) and eye movement parameters (fixations, gaze distribution, saccades) were compared between amblyopic and control participants. In addition, pooling data from both groups, we assessed for correlations between eye movement parameters and driving performance.

Results: Amblyopic and nonamblyopic drivers performed similarly on driving tasks and had comparable eye movement recordings. Some nonsignificant tendencies were noted among amblyopic drivers, including slower driving speeds, longer brake reaction times, and increased steering variability. We identified some potential correlations between eye-tracking metrics and driving performance: increased fixation frequency was associated with greater lane position variability, and larger saccadic movements correlated with improved lane stability and faster hazard response; however, these correlations were not statistically significant.

Conclusions: In our study cohort, simulated driving performance and attention in subjects with anisometropic amblyopia under a standardized, relatively low-complexity urban scenario were similar to findings for nonamblyopic drivers, suggesting that amblyopia did not prevent safe driving in that context. Trends toward correlations between eye tracking and driving simulation parameters were observed, underscoring the potential of combining both approaches in future research in addition to testing a larger sample size, with a more challenging driving scenario.

Purpose: To describe the outcome of surgical management of overcorrection after nasal transposition of split lateral rectus (NTSLR) for oculomotor nerve palsy.

Methods: The medical records of patients who underwent surgical revision for overcorrection after NTSLR from January 2014 to January 2024 were reviewed retrospectively. Details of the surgical overcorrection were analyzed. Ductions, versions, and angles of strabismus were evaluated before and after surgical revision.

Results: Nine patients were identified. Median patient age was 37 years (IQR, 28-49; range, 8-60). Median preoperative angle of esotropia was 30^Δ (IQR, 20^Δ-30^Δ; range, 15^Δ- 40^Δ). Median time between the first surgery and reoperation was 14 days (IQR, 7-40; range, 5-102). During revision, both halves of the lateral rectus were recessed 6 mm. The average follow-up after second surgery was 7.5 months. Median angle of esotropia decreased to 10^Δ (IQR, 5^Δ-30^Δ; 15^Δ exotropia to 30^Δ esotropia) at last follow-up. Five patients (55%) were aligned within 15^Δ of orthotropia; all of these patients had surgical revision performed within the first 2 postoperative weeks. In 4 patients, the angle of deviation was unchanged or changed by only 5^Δ after surgical revision, and all of these surgical revisions were performed at least 1 month after the initial surgery. There was a statistically significant negative correlation between the amount of correction achieved and the time between the first surgery and revision (r_s = -0.87, P = 0.0022).

Conclusions: In our small study cohort, revision surgery following overcorrection after NTSLR by recessing the transposed lateral rectus muscle along the border of the medial rectus muscle was successful only when performed within the first 2 weeks of initial surgery.

Purpose: To evaluate the results of a quality improvement study designed to enhance retinopathy of prematurity (ROP) clinic workflow at a large academic children's hospital by having care givers predilate the eyes of children prior to their screening.

Methods: The study was conducted prospectively from February 1, 2023, to May 31, 2024. Predilation drops were prescribed for caregivers to administer 90-minutes prior to ROP appointments. A discounted mail order pharmacy option was made available to ensure access to dilation drops at a maximum of $40 regardless of insurance status. Primary outcome was median clinic time (check-in to check-out) for ROP patients, with additional analysis of adverse events and clinic time variations by insurance type.

Results: A total of 918 ROP examination visits were included. All patients who underwent ROP evaluation at the clinic during the study period were eligible; no exclusion criteria were applied. The median clinic time decreased from 81.7 minutes to 61.9 minutes, saving 19.8 minutes per visit (P < 0.001). Predilation rates increased to 52% of patients by the study's conclusion. There were no significant differences in time savings across insurance types (P = 0.536), and no adverse events were reported.

Conclusions: In this study, integrating predilation drops into our workflow reduced clinic time for ROP screening visits. The intervention was equitable across diverse patient populations, including those with differing insurance and socioeconomic statuses, and no adverse events were recorded.

Background: Children with autism spectrum disorder (ASD) have higher rates of visual disorders, such as amblyopia and strabismus, but the impact of these disorders on autism symptoms is unknown. We assessed adaptive, social, and repetitive behaviors in children with ASD with and without binocular vision disorders (amblyopia and strabismus).

Methods: Children aged 3-17 years were categorized into one of two groups: ASD with comorbid amblyopia or strabismus (ASD+/BVD+) or ASD without a visual disorder (ASD+/BVD-). All participants underwent a complete ophthalmologic examination to inform group assignment. Parents or guardians completed standardized questionnaires to assess participants' adaptive functioning (Vineland Adaptive Behavior Scales, 3rd ed [VABS-III]), social responsiveness (Social Responsiveness Scale, 2nd ed [SRS-2]), and repetitive behaviors (Repetitive Behavior Scale-Revised [RBS-R]). ASD+/BVD+ and ASD+/BVD- groups were compared using multivariable regression analysis correcting for age and sex.

Results: We recruited 14 children in the ASD+/BVD+ group and 29 children in the ASD+/BVD- group. Groups were matched on age, sex, IQ, and overall autism severity. ASD+/BVD+ children had lower scores on the VABS-III Composite and Socialization domain. On the RBS-R, ASD+/BVD+ children exhibited greater insistence on sameness. There were no differences between groups on SRS-2 scores.

Conclusions: Our findings suggest that children with ASD and comorbid amblyopia or strabismus have worse adaptive behaviors than children with ASD without visual disorders, particularly with regard to socialization.