Journal of Aapos最新文献

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 potential tendencies for 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 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.

A congenital external lacrimal fistula appears as a small aperture inferonasal to the inner canthus, exuding clear fluid. It is thought to arise from an accessory duct connected to the lacrimal sac. Various operations have been described for ablation of congenital lacrimal fistula, but no prior study has documented spontaneous closure. We describe a child whose congenital lacrimal fistula resolved after 5 years of observation, obviating the need for a surgical procedure.

Group A Streptococcus (GAS) is a rare cause of endogenous endophthalmitis among both children and adults, with only a handful of cases described in the current literature. We report the case of a previously healthy 3-year-old girl who was diagnosed with unilateral endogenous GAS endophthalmitis with severe anterior involvement, after presenting with unilateral eye pain and injection, polyarthralgia, and skin changes thought to be inflammatory in nature. This case highlights the atypical manifestations of GAS bacteremia that can masquerade as a systemic autoimmune process.

Purpose: To investigate the association between the severity and distribution of retinal findings, systemic morbidity, and socioeconomic factors with mortality risk in pediatric patients with abusive head trauma (AHT) and retinal hemorrhages.

Methods: This retrospective study analyzed data from children diagnosed with AHT who underwent RetCam fundus photography over a 10-year period at Arkansas Children's Hospital. Retinal hemorrhages were graded based on extent (region 1 or 2), spread (A-C), and morphology (intraretinal or extraretinal). Based on these three factors, the overall retinal involvement was classified into three grades (1-3). Logistic regression analyzed associations between retinal findings and mortality risk, adjusting for age, sex, race/ethnicity, socioeconomic measures (as determined by the Childhood Opportunity Index), and clinical variables.

Results: A total of 182 eyes of 91 children were included. Eighteen children (20%) died. A higher grade of retinal hemorrhages was significantly associated with increased mortality risk (P = 0.0004), with mortality rates of 7% in grade 1, 18% in grade 2, and 53% in grade 3. Greater hemorrhage spread also correlated with a markedly increased mortality risk (odds ratio for grade C = 17.43). Additionally, hypoxic-ischemic injury was a strong predictor of mortality (odds ratio = 115.4). Hemorrhage morphology and demographic and socioeconomic factors were not significantly associated with mortality risk.

Conclusions: In pediatric AHT, the grade and extent of retinal hemorrhages serve as strong predictors of mortality. These findings highlight the prognostic value of detailed retinal examinations in assessing survival outcomes in this population.

Purpose: To describe the scleral adjustment (SA) method, a double-pass, knot-free adjustable suture technique for strabismus surgery, and evaluate its clinical outcomes.

Methods: The medical records of 14 consecutive patients treated with the SA method between December 2024 and May 2025 with ≥3-month follow-up were reviewed retrospectively. Suspension sutures from each muscle end were passed twice through the sclera near the original insertion. After initial surgery, patients returned to the operating room for binocular adjustment in an upright position.

Results: Mean patient age was 60 ± 19 years, with mean number of adjustments performed per case of 1.4. Postoperative alignment was within 10^Δ in all patients and remained stable. The SA method enabled precise microadjustments and facilitated simplified adjustments. No intraoperative or postoperative complications were observed.

Conclusions: The SA method is technically simple, avoids knot manipulation during adjustment, and enables precise microadjustments with secure fixation. Favorable outcomes in our small cohort suggest that it is a reliable alternative to sliding knot and bowtie techniques, with potential for mainstream application.

A 16-year-old girl with major depressive disorder suffered from a recurrent polymicrobial conjunctivitis, culture-positive for Escherichia coli, that persisted over several months despite evaluation by multiple specialists and appropriate antibiotic treatment. Ultimately, a brown malodorous mass, concerning for possible fecal matter, was noted in the inferior fornix of the left eye and sent for pathology review. Pathology results of the mass revealed degenerated vegetable matter debris with associated bacterial colonies consistent with fecal matter. Discussions were held with the patient, her parents, and her primary care provider. The decision was made to involve psychiatry to ensure the self-harm behavior did not continue and further place the patient at risk of vision loss. This report emphasizes that ophthalmic issues can sometimes be manifestations of an underlying psychiatric condition, highlighting the importance of a multidisciplinary treatment approach.

Pulled-in-two syndrome (PITS) is a rare but serious complication of strabismus surgery, with a reported incidence of once every decade among strabismus surgeons. It occurs more commonly in patients of advanced age and those with cranial nerve palsies or who have undergone prior surgeries. We present a case of PITS in a young female, diagnosed following surgery with a hereditary myosin myopathy.