A 7-year-old boy with a history of Duane retraction syndrome was found to have an anomalous orbital band arising from the right lateral rectus muscle. Surgical removal of this band to correct exotropia resulted in postoperative optic neuropathy and hypoesthesia in the distribution of the superior branch of the trigeminal nerve. This case demonstrates a rare complication of orbital surgery in patients with Duane retraction syndrome. It serves as a reminder to evaluate patients with congenital cranial dysinnervation disorders for additional structural defects and consider orbital imaging in patients with atypical pattern restrictive strabismus.
PURPOSE:To summarize ophthalmologists' perspective toward, and experience with, telemedicine ROP (tele-ROP) care. METHODS:A questionnaire was created and distributed electronically. RESULTS:Survey results revealed that only 20% of 226 respondents perform tele-ROP care, whereas 73% of respondents provided in-person ROP care. The most common challenges reported with tele-ROP care were poor image quality and difficulty interpreting photographs. Most respondents who provided tele-ROP care had a contract for services. Only 40% were satisfied with their tele-ROP care reimbursement. CONCLUSIONS:A minority of survey respondents (n = 45 [20%]) offer tele-ROP care. Respondents who provide tele-ROP care reported poor image quality and difficulty interpreting photographs were the most common challenges with tele-ROP care.
Gyrate atrophy (GA) is a rare autosomal recessive disease caused by a defect in the enzyme ornithine aminotransferase (OAT). We report a case of a 4-year-old boy with GA of the choroid and retina. Following initiation of an arginine-restricted diet and targeted supplementation, there was rapid improvement in his cystoid macular edema (CME) and foveoschisis. We also report clinical and imaging findings from his 2-year-old sister, who carries the same genetic variant. This report highlights the potential for early metabolic intervention to produce rapid anatomical improvement in GA-associated CME. Further studies are needed to determine which mutations respond better to specific treatments.
Purpose To evaluate demographic and socioeconomic factors associated with pediatric ophthalmology referrals from the UC San Diego (UCSD) EyeMobile, a school-based mobile vision program. Methods The records of children screened from 2021 to 2025 were reviewed retrospectively. Children who failed a screening received a comprehensive eye examination by an optometrist. Referrals to a pediatric ophthalmologist were made for those with potentially significant ocular pathology and no established eye care provider. Socioeconomic status was assessed using the national Child Opportunity Index (COI), analyzed as continuous scores and quintiles. Referral rates were compared across quintiles using two-proportion z tests, and multivariable logistic regression was used to identify factors associated with referrals. Results Of 42,166 children screened during the study period, 5,657 (14.1%) received a comprehensive examination, and 217 (0.51%) were referred to an ophthalmologist. Leading reasons for reasons included significant refractive errors (39.2%), strabismus (18.4%), and suspicion for keratoconus (14.3%). Referral rates were 0.69% in Very Low COI areas and 0.34% in Very High COI areas. There was a 7.6% reduced odds of referral per 10-point increase in COI (OR = 0.934, P = 0.033). Compared with White children, Black (OR = 2.30, P = 0.012) and Hispanic children (OR = 2.03, P = 0.011) had significantly higher odds of referral. Conclusions Lower socioeconomic status and minority race/ethnicity were independently linked to higher odds of pediatric ophthalmology referral, highlighting the disproportionate disease burden in underserved groups. Mobile screening programs may help with timely identification of at-risk children and improve health equity.
PURPOSE:To report the outcomes and complications of Yamane intrascleral IOL fixation surgery in a cohort of pediatric patients with inadequate capsular support. METHODS:The medical records of patients who underwent IOL implantation using the Yamane technique, with a minimum follow-up of 1 year, were reviewed retrospectively. Demographic data, patient age at time of surgery, accompanying pathologies, detailed ophthalmological examination findings, and complications were analyzed. RESULTS:A total of 11 eyes of 7 patients (5 females) were included. Mean age at time of surgery was 6.5 ± 3.2 years, with mean follow-up of 1.81 ± 0.94 years. The Yamane technique was performed in 5 cases for Marfan syndrome-related lens subluxation, in 1 patient for traumatic cataract, and in 1 because of surgical aphakia. The preoperative median best-corrected visual acuity was 0.70 logMAR (IQR, 0.30-1.00) in 4 patients, while fix-and-follow was the only measurable parameter in 3 patients before surgery. Postoperatively, median visual acuity improved to 0.40 logMAR (IQR, 0.22-0.52; P = 0.04), and the IOL was observed to be centrally positioned in all eyes over long-term follow-up. Early postoperative inflammatory membranes occurred in 2 patients and resolved; no further complications were observed during follow-up. CONCLUSIONS:In our small cohort of pediatric cases with inadequate capsular support, the Yamane technique resulted in good long-term outcomes, with few complications.
Purpose To evaluate the efficacy of diquafosol 3% in preventing and treating dry eye associated with orthokeratology in children Methods First-time pediatric orthokeratology wearers were enrolled in this prospective, randomized clinical trial. Participants were randomized into the treatment group (3% diquafosol sodium four times daily from the prefitting period) and control group (no additional treatment). Noninvasive tear film parameters (first break-up time [NIBUT], average NIBUT, tear meniscus height, and lipid layer thickness), corneal staining grade, uncorrected visual acuity (UCVA), and Ocular Surface Disease Index (OSDI) were compared at baseline, before lens wear, and at 1 week, 1 month, and 3 months Results A total of 64 children (128 eyes) completed the study. During the prefitting period, all tear film parameters improved significantly in the treatment group (all P < 0.001). At 3 months, the treatment group demonstrated significantly higher first NIBUT, average NIBUT, tear meniscus height, and lipid layer thickness (all P < 0.001), with lower OSDI scores (P < 0.05) and higher UCVA (P < 0.001). Corneal staining was significantly lower in the treatment group at 1 week (P < 0.05) but not at 1 or 3 months. Mild adverse events included transient discharge (3 children, treatment group) and conjunctival congestion (5 eyes, control group). There were no serious adverse events Conclusions Prophylactic and therapeutic use of diquafosol 3% improved tear film stability, tear secretion, and dry eye symptoms in children undergoing orthokeratology. Early initiation during the prefitting period may establish a more favorable ocular surface before lens wear
Background Surgical management of incomitant strabismus, characterized by gaze-dependent misalignment, is challenging. The Scott procedure, which involves the combined recession-resection of the same extraocular rectus muscle, avoids posterior scleral suturing beyond the globe’s equator and allows for postoperative adjustment. However, long-term outcomes and optimal surgical dosing remain unclear. This study is the largest series to date that reports outcomes of a 2:1 same-muscle recession-resection dosing strategy. Methods A retrospective chart review (January 2014 to August 2024) identified patients with ≥5Δ difference between primary and diplopic gazes who underwent a 2:1 Scott procedure. All procedures were performed by a single surgeon at a tertiary referral center. Results Thirty-five patients met inclusion criteria, including 16 (46%) with prior strabismus surgery. The inferior rectus muscle was most commonly treated (n = 16), followed by the medial rectus (n = 11), lateral rectus (n = 8), and superior rectus (n = 2) muscles. The amount of recession and resection was 5.3 ± 1 mm and 2.5 ± 0.5 mm, respectively. Preoperative incomitance improved from 9.5Δ ± 6Δ to 1Δ ± 2Δ (P < 0.0001) in 34 of 35 patients (97%). Improvement in incomitance was comparable across rectus muscles (P = 0.5) and between small and large (<10Δ and ≥10Δ) preoperative incomitance (P = 0.48). Four patients (12.5%) required reoperation, with no increased reoperation risk related to strabismus surgical history or degree of preoperative deviation/incomitance. Conclusions In this patient cohort, the 2:1 dosage for same-muscle recession-resection demonstrated significant improvement in incomitance across various rectus muscles, preoperative deviations, and history of strabismus surgery. This approach provides surgeons with a straightforward and pragmatic means to manage incomitant strabismus.
Purpose To evaluate the prevalence and occupational risk factors for upper extremity musculoskeletal disorders related to prism use among US orthoptists and pediatric ophthalmologists, focusing on grip style, wrist posture, and usage patterns. Methods A cross-sectional, self-administered 22-item questionnaire was distributed electronically via professional listservs between April 4 and May 6, 2025. Information on demographics, practice patterns, prism use characteristics, grip type, wrist posture, and musculoskeletal symptom history was collected. Associations between occupational factors and musculoskeletal disorder symptoms were assessed using χ2 tests, independent t tests, and logistic regression. Results A total of 64 participants (41 orthoptists, 23 pediatric ophthalmologists) completed the survey. Musculoskeletal disorder symptoms were reported by 61% of respondents, with 45% reporting onset only after starting their career. Common diagnoses included carpal tunnel syndrome, tendinitis, arthritis, and De Quervain’s tenosynovitis. While no occupational exposure variables reached statistical significance, trends suggested higher musculoskeletal disorder prevalence with greater daily prism use, and grip types involving ≥35° wrist extension. Conclusions Our survey results indicate a high prevalence of upper extremity musculoskeletal disorder symptoms, with grip type and wrist posture emerging as potential risk factors. These findings underscore the need for ergonomic education, redesign of handheld tools, and further observational research to mitigate occupational strain in pediatric ophthalmology.
PURPOSE:To investigate the proportion of parental consent for resident participation in their child's strabismus surgery when provided with complete informed consent. METHODS:We conducted a prospective observational study evaluating English-speaking parents of pediatric patients undergoing first-time strabismus surgery by a single surgeon at a tertiary academic center. During the consent process, parents were read a script explaining the possible resident roles during surgery. Following the surgery, parents were asked to explain their decision to consent or decline. RESULTS:Of 100 parents included in the study, 89 consented to resident participation. Themes associated with consent included trust in the primary surgeon, support for education, and personal experience with hands-on learning. Reasons for declining included preference for the experienced surgeon and concerns about surgical intricacy. CONCLUSIONS:Full disclosure of resident participation in pediatric strabismus surgery does not significantly reduce parental consent. Transparent communication may enhance trust while preserving critical training opportunities for residents.
PURPOSE:To evaluate outpatient ophthalmic follow-up after hospital discharge in children with abusive head trauma (AHT) and identify factors associated with follow-up adherence, and, secondarily, to describe ophthalmic findings in patients who returned for follow-up. METHODS:The medical records of pediatric patients with AHT who received inpatient ophthalmic evaluation and were advised to obtain outpatient follow-up were reviewed retrospectively. Completion of recommended follow-up was assessed. Demographic characteristics, neighborhood socioeconomic context measured by the Child Opportunity Index (COI), and geographic access to pediatric ophthalmology care were examined in relation to follow-up adherence. RESULTS:Of 74 patients recommended for outpatient follow-up, 36 (49%) completed ophthalmic follow-up. Most patients (69.9%) resided in very low or low COI neighborhoods. Median distance to the nearest pediatric ophthalmologist was 30.9 miles (IQR, 10.0-57.7). COI distribution was not associated with follow-up adherence (P = 0.37). Distance to the nearest pediatric ophthalmologist did not differ between patients completing follow-up and those who did not (P = 0.10). However, children in very low-, low-, or moderate-opportunity neighborhoods lived farther from care than those in high or very high-opportunity neighborhoods (median, 38.6 miles [IQR, 19.6-59.6] vs 5.3 miles [IQR, 3.3-13.1], resp.) (P < 0.001 [Mann-Whitney U test]). Among patients who completed follow-up, 15 (41.7%) had ophthalmic complications. CONCLUSIONS:Outpatient ophthalmic follow-up after AHT is inconsistent despite frequent detection of visual abnormalities when follow-up occurs. Limited access to pediatric ophthalmologists may contribute to gaps in continuity of care. Strategies to improve follow-up are needed for this vulnerable population.
Background Occlusion therapy for severe amblyopia is challenging because of low visual function of the unoccluded eye and lengthy duration of daily therapy, which may then be hindered by low adherence. This study evaluates real-world effectiveness of a binocular digital treatment in patients with severe amblyopia. Methods The records of children <18 years with best-corrected visual acuity (BCVA) of 20/100 or worse in their amblyopic eye who were prescribed Luminopia in the PUPiL Registry were retrospectively analyzed. The treatment utilizes contrast reduction and dichoptic masking overlayed on patient-selected programming. Primary outcome was BCVA improvement from baseline to last follow-up. Secondary outcomes included associations between BCVA improvement and total treatment hours, prior amblyopia treatment, age, and amblyopia type. Statistical analyses included correlation, t tests, and regression analyses. Results In 57 children with severe amblyopia (mean age, 7.1 ± 2.6 years), mean BCVA improved 1.8 lines (95% CI, 1.0-2.6), with average treatment of 166 hours over 11.8 months. Of the 57 patients, 26 (46%) achieved ≥2-line gains. Treatment-naive patients showed greater improvement (n = 7; 4.4 lines [95% CI, 2.1-6.7]) versus previously treated patients (n = 50; 1.5 lines [95% CI, 0.6-2.3; P = 0.0183]). Worse baseline BCVA (Spearman r = 0.33, P = 0.013) and greater treatment hours (Spearman r = 0.51, P < 0.001), but not age or amblyopia type, were associated with greater BCVA improvement. Conclusions Luminopia demonstrated significant improvements in Registry patients with severe amblyopia, particularly in treatment-naive patients, supporting its use as a viable treatment option that may address key limitations of traditional approaches.
PURPOSE:To generate normative scleral thickness data for children aged 0-36 months. METHODS:Children ≤36 months of age undergoing examination under anesthesia for retinoblastoma management were prospectively included in this single-center study. Scleral thickness was measured using ultrasound biomicroscopy. Four readings were taken for each eye, one in each quadrant at the 130, 430, 730, and 1030 meridians, avoiding the insertion of the rectus muscles. Overall scleral thickness (OST) was analyzed for correlation with laterality, sex, and age in months (<12, 12-24, 24-36). RESULTS:A total of 28 children (43 eyes) were included, with a mean age of 17.5 months (range, 5-36). Mean OST was 0.47 ± 0.05 mm for the right eye and 0.45 ± 0.06 mm for the left eye (P = 0.2). No significant difference was observed across quadrants of the right eye (P = 0.3) or left eye (P = 0.6). The mean OST was similar between males and females (0.46 vs 0.45 mm [P = 0.7]). No significant differences in age groups were observed in mean OST (P = 0.9). CONCLUSIONS:The mean scleral thickness was 0.46 ± 0.06 mm and was comparable between eyes. Scleral thickness was uniform across all quadrants, and no significant variations were observed in sex or age up to 36 months.
Background Retinal hemorrhages (RH) are commonly seen with abusive head trauma (AHT). This study evaluates pediatric patients who had neuroimaging and an ophthalmologic examination in an attempt to correlate the etiology of presentation with the presence and pattern of RH and intracranial pathology. Methods A retrospective review was performed on hospitalized patients under 5 years of age who underwent neuroimaging and ocular examination. The presence of intracranial pathology, RH, and diagnoses of AHT versus accidental trauma were recorded. Fundus photographs were evaluated with a published scale for RH grading. Results Seventy-six patients were categorized as AHT, 79% of whom had acute intracranial hemorrhage (ICH). Fifty-eight percent had RH with acute ICH. Thirty-three patients were categorized as accidental trauma. None of the accidental trauma patients had RH, but 76% had acute ICH. Sixty-five percent of AHT patients had RH, with 57% of these categorized as grade 2Bii or worse. There was a significant difference when comparing the occurrence of acute ICH with RH among AHT patients (n = 44) versus accidental trauma patients (n = 0/33 [P < 0.001]). There were more accidental trauma patients with acute ICH and without RH (n = 25/33) versus AHT patients with acute ICH and without RH (n = 16/76 [P < 0.001]). Conclusions Among children who underwent both neuroimaging and eye examination, the majority of RH were in AHT patients. In all groups, there were numerous cases of intracranial pathology without RH, suggesting that intracranial pathology alone does not typically cause RH. Using a published scale for RH grade, our results support including AHT in the differential diagnosis when RH are seen in children under 5 years of age with signs of trauma.
BACKGROUND:Steroid treatment can be crucial in treating morbidity and reducing mortality in preterm infants. The literature describes differing effects of antenatal (ANS) versus postnatal steroids (PNS) in the development of retinopathy of prematurity (ROP). The purpose of this study was to investigate the relationship between steroid use and development of ROP in Canadian neonates. METHODS:Data were obtained from the Canadian Neonatal Network (CNN), a national database of all 32 level III neonatal intensive care units (NICUs) in Canada. A total of 20,255 neonates met inclusion criteria, with admission to a CNN NICU under the gestational age of 31 weeks or <1,250 g, with ROP screening. Unadjusted and adjusted odds ratios based on confounders from conditional logistic regression were determined for the risk of developing any ROP, type 1 ROP, and non-type 1 ROP, depending on ANS and PNS use. RESULTS:Using ANS only as the reference group, neonates receiving only PNS had the highest odds of type 1 ROP and ROP requiring intervention (adjusted OR = 2.68; 95% CI, 1.55-4.64), followed by neonates receiving both ANS and PNS with an adjusted odds ratio of 2.51 (95% CI, 1.49-4.25). CONCLUSIONS:Receipt of PNS was associated with type 1 or treated ROP, suggesting the need for closer monitoring for ROP; however, confounding by indication bias cannot be ruled out.
PURPOSE:To evaluate early postoperative prediction error (PE) following Yamane flanged intrascleral haptic fixation of an intraocular lens (IOL) in pediatric eyes and to describe subsequent refractive shift over time. METHODS:The medical records of consecutive pediatric patients who underwent Yamane flanged intrascleral-haptic fixation at a single tertiary eye care center were reviewed retrospectively. The primary outcome was PE at 4 weeks postoperatively, defined as achieved spherical equivalent (SE) minus intended target refraction. Secondary outcomes included refractive shift, defined as the change in SE, from 4 weeks to 6 months, absolute prediction error (APE), refractive accuracy, and best-corrected distance visual acuity (BCDVA). RESULTS:A total of 20 eyes from 12 consecutive pediatric patients (<15 years) were included. Mean age at surgery was 8.8 ± 2.4 years. At 4 weeks, mean PE was +0.90 ± 1.31 D, indicating an initial hyperopic offset relative to the intended target. From 4 weeks to 6 months, a mean myopic refractive shift of -0.54 D was observed. Median APE improved from 0.96 D at 4 weeks to 0.65 D at 6 months, and the proportion of eyes within ±1.0 D of target increased from 45% to 60%. Mean BCDVA significantly improved from 0.90 ± 0.24 to 0.45 ± 0.23 logMAR (P < 0.001). CONCLUSIONS:In our small study pediatric cohort, Yamane flanged intrascleral haptic fixation yielded significant visual improvement. Early hyperopic PE was common, with partial refractive shift toward the intended target refraction over time.
BACKGROUND:Written patient education material (PEM) adhering to health literacy standards has been shown to improve parent understanding and clinic follow-up attendance rates in infants with retinopathy of prematurity (ROP). Video education can further improve patient understanding in patients with limited literacy or health literacy. We investigated the efficacy of a multimedia education program to improve parent knowledge of ROP and follow-up attendance. METHODS:We created novel multimedia PEM consisting of a video, a handout, and a website (ROPeducation.com) in English and Spanish that adhere to national health literacy guidelines. A total of 304 parents of infants at risk for ROP were included in this repeated-measures study. Surveys assessing knowledge of ROP were administered before and after parents viewed our materials. Follow-up attendance was tracked using electronic medical records. RESULTS:Participants demonstrated significant increases in knowledge scores after receiving multimedia PEM (94.3% vs 62.3% [P < 0.001]). Parents who received multimedia PEM had higher post-education knowledge scores than those receiving the standard AAPOS handout (94.3% vs 83.7% [P = 0.005]). Follow-up attendance significantly improved in the multimedia PEM group compared with baseline attendance (91.5% vs 68.2% [P = 0.01]). The odds of follow-up attendance were also increased as a function of family income (P = 0.01). In whole-dataset adjusted analysis, only income remained significantly associated with follow-up attendance (adjusted OR = 1.29 [95% CI, 1.04, 1.53]); however, a significant association (P = 0.047) of multimedia PEM with follow-up persisted in the higher-income stratum of patients even after adjustment for income. CONCLUSIONS:Multimedia PEM adhering to health literacy standards significantly improves ROP knowledge compared with that preceding receipt of PEM. Among higher-income families, the video, handout, and website created for this study improved follow-up attendance rates in infants with ROP even after adjustment for income.
PURPOSE:To evaluate the surgical outcomes of augmented-dose surgery using a three-horizontal-muscle approach to treat acute acquired comitant esotropia (AACE) with large deviation. METHODS:The medical records of AACE patients with a mean distance and near deviation ≥55Δ who underwent one-stage three-horizontal-muscle augmented-dose surgery were reviewed. The surgical target angle was augmented by an additional 10Δ over the average of the near and distance deviations. Primary outcomes included surgical success rate and sensory success rate. Secondary outcomes included duction limitation and lateral incomitance. Surgical success was defined as the elimination of diplopia and deviations ≤10Δ, assessed with the prism and alternate cover test at both near and distance. Sensory success was defined as stereoacuity ≤600 arcsec. RESULTS:Twenty-one patients were included. The mean preoperative distance deviation was 69.00Δ ± 9.72Δ. The mean postoperative follow-up period was 10.67 months (range, 2-39). At the last postoperative visit, the mean distance deviation was 1.48Δ ± 2.23Δ; the surgical success rate was 95.2%; the sensory success rate was 90.5%; no patient showed significant limitation of eye movement or lateral incomitance. CONCLUSIONS:The augmented-dose surgery on three horizontal muscles achieved favorable outcomes in our small cohort of patients with AACE with large deviation, without inducing significant secondary eye movement limitation or lateral incomitance.
Background Toy-related ocular injuries are a significant cause of preventable eye trauma in children. This study examined the epidemiologic trends and risk factors associated with toy-related eye injuries in US children. Methods Data from the National Electronic Injury Surveillance System (NEISS) were analyzed for pediatric toy-related ocular injuries (code 77: eyeball) between 2003 and 2022. Descriptive statistics and multivariable logistic regression were used to identify risk factors and trends. Results An estimated 131,094 toy-related ocular injuries occurred in children presenting to US EDs from 2003 to 2022. The annual incidence rate of 8.9 per 100,000 remained statistically stable during the study period. Common diagnoses included contusions/abrasions (56.4%), “Others/Not Stated” diagnoses (27.1%), and dermatological/conjunctival injuries (5.3%). Free-text review showed that the “Others/Not Stated” diagnoses included injury, pain, hyphema, subconjunctival hemorrhage, iritis, trauma, and chemical exposure. Vision-threatening conditions, including blunt eye trauma, ruptured globe, vision disturbance, retinal detachment, and commotio retinae, were uncommon. Toy guns with projectiles (9.2%), balls (4.4%), and nonprojectile toy weapons (3.3%) were frequently implicated. In multivariable analysis, younger age and male sex were associated with higher odds of injury, whereas Black or African American race (vs White race) was associated with lower odds. Injuries occurring outside the home and those requiring hospital admission were less likely to be toy-related. Conclusions Despite efforts to improve toy safety, the relatively constant number of toy-related ocular injuries and the higher prevalence of certain types of toys associated with these injuries highlight the need for increased education and awareness.
