PURPOSE:To characterize a novel magnetic resonance imaging (MRI) finding affecting the optic chiasm in patients with optic nerve hypoplasia (ONH). METHODS:This was a retrospective case-control study including 78 patients diagnosed as having ONH at a single institution, with an average age at MRI of 2.66 years. The control group included 70 patients of similar demographics without a diagnosis of ONH or gross abnormalities on MRI. MRI images obtained on a Siemens 3T Prisma or Siemens 1.5T Aera (Siemens Healthineers) were examined for all patients by two independent graders for presence of an optic chiasm deviation termed the Y-sign. Main outcome measures were presence of the Y-sign on MRI imaging in the coronal view. RESULTS:The Y-sign was identified in 55.1% of patients with ONH and 0% of control patients. Odds of the Y-sign were significantly higher in patients younger than 1 year (odds ratio [OR]: 3.58, 95% CI: 1.4 to 9.14; P = .008) and in patients with bilateral ONH (OR: 2.82, 95% CI: 1.08 to 7.33; P = .034). No association was found between the Y-sign and visual acuity or endocrine abnormalities (P = .11 and P = .78, respectively). However, there was a moderate effect size noted between the Y-sign and absence of the septum pellucidum (P = .052). CONCLUSIONS:The authors present a novel MRI finding seen in more than half of patients with ONH that appears to be highly specific and mildly sensitive for the condition. Results indicate that the Y-sign may be a sign for absence of the septum pellucidum, but other clinical outcomes require further investigation.
PURPOSE:To investigate the supplemental role of dichoptic mobile video games in the treatment of adults with amblyopia. METHODS:Patients aged 18 to 40 years with unilateral mild to moderate amblyopia and no prior history of amblyopia treatment were recruited after 6 weeks of optimal refractive correction. Patients were randomly assigned to two groups, each comprising 15 participants. The control group was prescribed 6 hours of daily patching. The study group played dichoptic mobile video games (stereoblocks) in addition to patching. They attended 2-hour sessions weekly for 12 weeks. Follow-up assessments included best corrected visual acuity (BCVA) for distance and near, as well as stereoacuity measurements at baseline and 1, 4, 8, and 12 weeks. RESULTS:The median age of patients was 21.5 years (range: 19.5 to 26.5 years). The distance and near BCVA in the amblyopic eye showed an improvement at the final follow-up visit (12 weeks) in both groups. There was a statistically significant difference in improvement between the two groups at the final follow-up visit, with the study group performing better (P = .04). There was no significant improvement in either of the groups in terms of stereoacuity (P = .29). In intergroup and subgroup analysis, patients with anisometropia showed a significantly better improvement compared to strabismic and mixed amblyopia. CONCLUSIONS:Video games as a supplement to patching have additional benefits to patching in terms of BCVA in adults with amblyopia. Patients with anisometropic amblyopia appear to benefit more from this combined approach compared to those with strabismic or mixed amblyopia.
PURPOSE:To perform a clinical descriptive analysis of the long-term ophthalmological sequelae present in shaken baby syndrome and to evaluate a possible correlation between the grade of initial retinal hemorrhage at diagnosis and the severity of ophthalmological sequelae at school age and whether there was an association between the resorption time of initial retinal hemorrhages and ophthalmological sequelae. METHODS:Fifty-two children aged 5 to 11 years with retinal hemorrhages and confirmed shaking injury were included. Visual acuity, fundus, macular optical coherence tomography, retinal nerve fiber layer, and visual fields were evaluated and analyzed according to initial retinal hemorrhage severity. RESULTS:In the study population, 50% of children had macular impairment seen on optical coherence tomography (epiretinal membrane, retinal atrophy, internal limiting detachment, or vitreous abnormality), 42.3% had amblyopia (18% functional amblyopia and 24% organic amblyopia), 42% had strabismus, 40% had fundus abnormality (scar visible on fundus or infrared), 37% had retinal nerve fiber layer deficiency, 8% had visual field impairment (chiasmatic or retrochiasmatic impairment), and 2% had cortical blindness. Children had significantly more ophthalmological sequelae if the retinal hemorrhages were grade 3 according to the 2011 Haute Autorité de Santé (HAS) classification (French classification of retinal hemorrhages based on their number and topography). The longer the retinal hemorrhage resorption time, the more significant the ophthalmological sequelae appeared to be. CONCLUSIONS:Shaken baby syndrome is responsible for numerous ophthalmological sequelae. Some are irreversible (epiretinal membrane), whereas others are reversible and can be rehabilitated (amblyopia). Detecting ophthalmological sequelae is important to monitor for complications that may arise and also contributes to the child's integration into society.
PURPOSE:To assess macular structure and function in retinopathy of prematurity (ROP). METHODS:This was a prospective observational cohort study performed on children with laser-treated ROP (n = 32 eyes of 17 children, age 9.12 ± 2.60 years) and untreated ROP (n = 22 eyes of 12 children, age 10.40 ± 2.76 years), or premature children meeting ROP screening criteria but without ROP (immature retina) (n = 10 eyes of 6 children, age 9.00 ± 2.00 years), and full-term control patients (n = 42 eyes of 21 children, age 11.67 ± 2.87 years) comparing foveal function (logarithm of the minimum angle of resolution [logMAR] visual acuity, contrast sensitivity [CS]) and retinal morphology (central retinal thickness [CRT]). Linear mixed models were fit, followed by post-hoc comparisons using the Tukey-Kramer method. RESULTS:Visual acuity of laser-treated eyes (0.26 logMAR, 95% CI: 0.19 to 0.33) was significantly worse than that of untreated (0.06 logMAR, 95% CI: -0.02 to 0.165, P = .004) and control (-0.02 logMAR, 95% CI: -0.08 to 0.05, P < .001) eyes, but not different from immature retina eyes (0.11 logMAR, 95% CI: -0.01 to 0.22, P = .12). CS in treated eyes (1.56 log units, 95% CI: 1.48 to 1.63) was significantly worse than normal eyes (1.69 log units, 95% CI: 1.62 to 1.76, P = .05), but not different from either untreated (1.66 log units, 95% CI: 1.56 to 1.75, P = .35), or immature retina (1.65 log units, 95% CI: 1.51 to 1.78, P = .63) eyes. CRT of laser-treated eyes (330.98 µm, 95% CI: 318.18 to 343.79) was significantly greater than untreated (290.32 µm, 95% CI: 276.32 to 304.32, P < .001), immature (298.39 µm, 95% CI: 280.29 to 316.50, P = .02), and control (272.07 µm, 95% CI: 260.96 to 283.19, P < .001) eyes. In lasered-treated eyes there was a statistically significant negative correlation between logMAR and CRT (correlation = -0.39, 95% CI: -0.75 to -0.03, P = .03). CONCLUSIONS:Laser-treated eyes had abnormal macular structure and function compared to untreated eyes and normal control eyes. Further studies are needed to determine whether these abnormalities are attributable to increased severity of ROP in laser-treated patients, the effect of laser treatment, or both.
Neurofibromatosis type 1 (NF1) is a multisystem genetic disorder caused by mutations in the NF1 gene and is commonly associated with ocular manifestations such as Lisch nodules, optic pathway gliomas, and choroidal abnormalities. Retinal structural changes are rarely reported. The authors describe a 3-year-old girl with NF1 who presented with decreased vision in her left eye. Ophthalmic imaging revealed an epiretinal fibrovascular membrane with vitreoretinal traction, cystic macular changes, and localized tractional retinal detachment (TRD) with a retinal tear. RetCam (Clarity Medical Sysetms, Inc) imaging and fluorescein angiography demonstrated vitreous opacities, fibrovascular adhesions, and vascular leakage. Systemic examination identified multiple café-au-lait spots and a plexiform neurofibroma confirmed by histopathology. The patient underwent pars plana vitrectomy with membrane removal and silicone oil tamponade, resulting in stable retinal attachment during follow-up. This case expands the spectrum of retinal manifestations associated with NF1 and highlights the importance of regular ophthalmic surveillance in affected children.
A rare case of methicillin-resistant Staphylococcus aureus (MRSA) after strabismus surgery is reported in a 7-year-old girl. The child presented with progressive pain and discharge, which was non-responsive to initial antibiotics. Surgical exploration and culture confirmed MRSA. Targeted vancomycin and linezolid led to complete resolution of the signs and symptoms. This case underscores importance of early postoperative follow-up and high clinical suspicion, coupled with prompt collaboration with microbiologists, particularly when managing unusual or drug-resistant postoperative infections.
Sinonasal myxomas are rare benign tumors that typically occur in young children, with orbital involvement in 26% of reported cases. The authors report a case manifesting solely with progressive ocular motility restrictions and diplopia. Magnetic resonance imaging revealed an expansile lesion occupying the right posterior ethmoid cavity with right orbital involvement. Surgical resection reduced the tumor size. Although rare, this case demonstrates that sinonasal myxoma should be considered in the differential diagnosis in young patients with ocular motility restrictions.
To evaluate the surgical outcomes of a combined modified Nishida's procedure with medial rectus (MR) recession augmented with lateral rectus (LR) plication in patients with long-standing complete sixth nerve palsy presenting with large-angle esotropia (ET). This retrospective interventional case series included three patients with chronic traumatic complete sixth nerve palsy and large-angle ET (70 to 75 prism diopters [PD]). Postoperatively, two patients achieved orthophoria at distance and near and one patient had a small residual ET of 5 PD at 6 months. The combination of modified Nishida's procedure with MR recession and LR plication appears to be an effective single-stage surgical approach for large-angle esotropia (approximately 70 PD) associated with complete sixth nerve palsy. The technique provides substantial alignment correction, improved abduction, resolution of diplopia, and a reduced risk of anterior segment ischemia compared to full-tendon vertical rectus transposition.
PURPOSE:To evaluate ocular motility changes after NPB macular buckling surgery (AJL Ophthalmic). Myopic traction maculopathy is a sight-threatening complication of pathologic myopia. Macular buckling surgery, particularly with the novel NPB model, has shown high anatomical success, but concerns remain regarding possible orthoptic complications. METHODS:Consecutive patients with myopic traction maculopathy who underwent NPB macular buckling surgery at Eyecare Clinic, Brescia, Italy (January 2023 to July 2024) were retrospectively analyzed. Exclusion criteria included preexisting ocular motility disorders and monocular status. Preoperative and postoperative examinations included best corrected visual acuity, axial length, orthoptic evaluation (cover tests, ocular motility, binocular vision, and stereopsis), and diplopia assessment. The minimum follow-up was 6 months. RESULTS:Forty-two patients were enrolled; 12 (29%) were excluded because they showed preoperative ocular motility alterations. The remaining 30 patients achieved complete anatomical resolution of myopic traction maculopathy after surgery. Postoperatively, 13 patients (43%) developed elevation deficits, 10 (33%) hypotropia, and 9 (30%) diplopia in primary gaze. Diplopia was managed with prismatic correction, using glasses or soft prismatic contact lenses, in 7 patients, whereas 2 declined treatment. No patient required buckle removal. CONCLUSIONS:NPB macular buckling surgery effectively resolved myopic traction maculopathy in all cases, but induced mild ocular motility abnormalities in a subset of patients. These complications-mainly elevation deficit, hypotropia, and diplopia-were manageable with prismatic correction and appear acceptable when weighed against the anatomical and visual benefits.
PURPOSE:To report clinical characteristics and treatment outcomes of ocular hypertension (OHT) and glaucoma in familial exudative vitreoretinopathy (FEVR). METHODS:This retrospective chart review included patients diagnosed as having FEVR and OHT or glaucoma at Siriraj Hospital, Bangkok, Thailand, between June 2001 and May 2021. Demographics, clinical features, treatments, and outcomes were collected. RESULTS:Among 93 patients (174 eyes) with FEVR, 6 patients (5.2%; 9 eyes, 3 bilateral cases) developed secondary OHT (6 eyes) and glaucoma (3 eyes), and all had bilateral FEVR stage 3A or greater. Median age at FEVR diagnosis was 4 months (interquartile range [IQR]: 3 to 23 months), and median age at OHT and glaucoma diagnosis was 43 months (IQR: 15 to 52 months). All eyes presented with elevated intraocular pressure (IOP). Treatment outcomes showed stable visual acuity in stage 3A; in stage 4A or higher, 3 eyes remained stable and 2 developed phthisis bulbi. OHT and glaucoma were controlled with one to two topical medications in all patients except one with a shallow anterior chamber, who required peripheral iridotomy. Median intraocular pressure decreased from 30 mmHg at presentation (IQR: 25.5 to 37.5 mmHg; n = 9) to 16 mmHg at last visit (IQR: 14 to 17.5 mmHg; n = 5). None of the eyes required glaucoma surgery. No patient experienced ocular pain. CONCLUSIONS:Secondary OHT and glaucoma is a late complication of advanced FEVR and may present as asymptomatic IOP elevation. IOP control is achievable with topical therapy or peripheral iridotomy in a shallow anterior chamber; however, visual prognosis is largely stage dependent.
PURPOSE:To investigate the incidence of visual complications in low-risk, non-treatment-requiring infants following retinopathy of prematurity (ROP) screening and determine whether workforce constraints in pediatric ophthalmology and limited resources affect compliance with current guidelines advising 4- to 6-month ophthalmic follow-up for all infants with ROP. METHODS:This retrospective case-control study included premature infants with resolved non-treatment- requiring ROP (NT-ROP) evaluated 6 to 12 months after screening and full-term infants younger than 19 months referred for ophthalmologic evaluation following failed routine vision screening. Data were collected over a 14-month period in a private practice setting. Refractive and ophthalmic outcomes were compared between groups. Outcomes included manifest strabismus in primary gaze and visually significant refractive error: myopia (>3.00 diopters [D]), hyperopia (>4.00 D), astigmatism (>3.00 cylinder), or anisometropia (>1.25 D difference). RESULTS:Sixty-three infants with NT-ROP and 39 full-term infants referred after failed routine pediatric vision screening were included. Incidence of late visual complications was low in both groups, with no significant difference observed between groups on follow-up. (P > .05). CONCLUSIONS:Infants with resolved NT-ROP did not exhibit a greater incidence of late visual complications compared to full-term infants with failed routine vision screening. These preliminary findings will require validation with larger cohorts, but suggest that for infants with mild, non-treatment-requiring ROP, routine pediatric photoscreening 4 to 6 months after ROP screening may suffice as an alternative to full cycloplegic dilated examination. This approach could improve resource allocation without compromising surveillance. Study limitations include its retrospective, single-center design and small sample size. Larger, multi-center studies are needed to validate these findings.
PURPOSE:To characterize pediatric ophthalmology exposure, surgical experience, and mentorship in U.S. ophthalmology residency programs and to describe the timing of subspecialty commitment among pediatric ophthalmology fellowship alumni. METHODS:This was a cross-sectional study of two anonymous surveys (July to October 2025). Survey 1 queried program directors and coordinators from U.S. ophthalmology residency programs regarding curriculum structure, pediatric ophthalmology exposure, and surgical volume, retinopathy of prematurity (ROP) training, and mentorship access. Survey 2 queried pediatric ophthalmology fellowship alumni from Wills Eye Hospital regarding training experiences and timing of subspecialty commitment. Ordinal responses were summarized using medians and interquartile ranges. Categorical ranges were analyzed using midpoint estimation but reported using original response categories. Associations were evaluated using descriptive statistics and nonparametric tests. RESULTS:Survey 1 had a 61.3% response rate (76/124), and Survey 2 had a 72.5% response rate (50/69). Most programs offered dedicated pediatric ophthalmology rotations (93.4%) and formal didactics (97.4%). Median pediatric ophthalmology exposure was 10.5 weeks. Primary surgical volume most commonly ranged from 11 to 20 cases. Programs with ≥3 pediatric ophthalmology faculty members more frequently reported excellent mentorship (84%) than programs with a single faculty member (50%). Availability of ROP training did not differ by geographic setting. Among alumni, 66% reported deciding during residency, including 44% by post-graduate year-2. CONCLUSIONS:Programs with ≥3 faculty and 9 to 12 weeks of exposure more often reported strong mentorship. Despite widespread curricular availability, variation in mentorship capacity may contribute to recruitment gaps. Because most fellows decide during residency, structured exposure and longitudinal mentorship are modifiable factors that may support recruitment and workforce sustainability.
PURPOSE:To better characterize the epidemiology of glaucoma following cataract surgery (GFCS) in an Australian population and to inform clinical decision-making in patients with GFCS. METHODS:This was a single-center retrospective case-control study looking at the incidence, management, and outcomes of glaucoma in a cohort of eyes that underwent lensectomy surgeries for congenital cataract at the Queensland Children's Hospital between January 2014 and December 2020. RESULTS:Ninety-seven eyes underwent lensectomy for congenital cataract. GFCS was diagnosed in 24.7% of eyes, and mean age of diagnosis was 54.14 months. Surgical management was required in 53.6% of GFCS cases. Significant associations were found between age at lensectomy surgery and age at glaucoma diagnosis (r = 0.77, P < .001) and between requirement for glaucoma surgery and age at both lensectomy (P = .03), and glaucoma diagnosis (P = .01). At most recent review, median intraocular pressure (IOP) was 18 mmHg and median visual acuity was 0.8 logarithm of the minimum angle of resolution (logMAR) in patients with glaucoma and 0.7 logMAR in patients with glaucoma suspect. A significant correlation was noted between latest IOP and age at glaucoma diagnosis (r = 0.42, P = .03) and between most recent logMAR visual acuity and glaucoma diagnosis status (P < .01). There was also a statistically significant association between length of follow-up and glaucoma diagnosis (P = .02). CONCLUSIONS:These findings provide valuable long-term data on GFCS in the Australian pediatric population, aiding clinical decision-making and patient care.
PURPOSE:To investigate the unique postoperative pattern following intermittent exotropia (IXT) surgery. METHODS:A retrospective review of patients younger than 18 years who underwent bilateral lateral rectus (BLR) recession or unilateral lateral rectus weakening and medial rectus strengthening surgery for IXT, with a postoperative follow-up period of 2 years or more was done. Patients who developed esodeviation after initially recovering to orthotropia within 1 month postoperatively were classified as having delayed-onset consecutive esotropia. The clinical characteristics of these patients were analyzed and the associated preoperative factors were assessed. RESULTS:Delayed-onset consecutive esotropia was observed in 6.4% of patients after IXT surgery. This phenomenon was observed approximately 4 months postoperatively. Risk factors were younger age, larger preoperative deviation angles, and undergoing BLR recession. Similar phenomenon of worsening of the deviation angle toward esotropia (rebound esodrift) was also observed in the patient groups with constant exotropia and continuous consecutive esotropia. Patients showing rebound esodrift shared the same risk factors as those with delayed-onset consecutive esotropia. CONCLUSIONS:This study identified patients exhibiting delayed-onset consecutive esotropia in the early postoperative period following IXT surgery. Close monitoring and suitable treatment of these patients are essential for optimal outcomes.
Retinopathy of prematurity (ROP) is one of the leading cause of blindness in premature infants. A bibliometric analysis on intravitreal anti-vascular endothelial growth factor (VEGF) in ROP was conducted. A comprehensive search of the article on the Scopus database was conducted with the terms related to "anti-vascular endothelial growth factor and retinopathy of prematurity." Only original research and review articles published in the English language were considered. VOSviewer version 1.6.20 was used for the visualization and analysis of the data. Publication trend, productive countries, researchers' details, commonly cited documents, source and influential journals, and keyword occurrence were analyzed. A total of 329 studies were considered, of which 270 were original articles and 59 were review articles. The highest numbers of publications were seen in the year 2022. The United States, China, Turkey, India, and Taiwan were the top 5 countries that published research on the use of anti-VEGF in ROP. The most documents were published by Wei-Chi Wu (22) and Chi-Chun Lai (14), and Falavarjani et al's article had the most citations (737). A total of 2,504 keywords were identified. All keyword analysis revealed the occurrence of "retinopathy of prematurity" and "human" as a keyword was 290 and 286 times, respectively. Most articles and citations were found in Retina. The use of anti-VEGF in ROP is constantly evolving and bibliometric analysis highlights a research trend and influential authors and journals that have published significant work on it. This article can serve as a guide to conduct a literature review for future researchers.
PURPOSE:To quantify eye movements and visual perception of children with autism spectrum disorder (ASD) and to compare the same parameters with children with typical development (TD). The association between eye movements and visual perception among study children was also evaluated. METHODS:Children with ASD who were verbal and children with TD as age-matched controls were recruited. All children underwent a developmental eye movement (DEM) test and Motor-Free Visual Perception Test-4 (MVPT-4) following standard protocol. RESULTS:Ninety-one children (ASD group = 54, TD group = 37) were evaluated. In the DEM test, mean scores of horizontal and vertical saccades (HT, VT) were significantly (P < .001) extended in children with ASD (mean HT = 262.22 ± 101.152 seconds, mean VT = 121.66 ± 39.72 seconds) compared to children with TD (mean HT = 80.316 ± 32.73 seconds, mean VT = 55.08 ± 16.95 seconds). The majority (88.84%) of children with ASD showed type IV error, indicating both oculomotor and automaticity disorders. Average MVPT-4 scores along with MVPT-4 domain scores were significantly lower (P < .05) in the ASD group. Although a multiple regression model with age, HT, VT, and DEM ratio could explain 71% of the variation in the visual perception score of the TD group, 42% of the variation in the same was explained in the ASD group. CONCLUSIONS:This study reports a significantly increased duration of saccades and impaired visual perception scores among children with ASD compared to those with TD. Although a strong association between MVPT-4 and DEM scores was observed in the TD group, DEM scores failed to associate strongly with visual perception scores in the ASD group.
PURPOSE:To quantify changes in ocular alignment following strabismus surgery and identify relevant variables. It was hypothesized that exotropic patients would exhibit greater postoperative exotropic drift than esotropic patients. METHODS:A retrospective chart review was conducted on all patients who underwent horizontal strabismus surgery between 2018 and 2023. Of the 629 charts reviewed, 243 were excluded due to insufficient data, nystagmus, or concomitant superior rectus, inferior rectus, or superior oblique surgery. Postoperative drift was calculated by subtracting alignment measured between postoperative days 1 to 14 and days 30 to 150. An unpaired t test was used to compare postoperative drift between exotropic and esotropic patients. Additional variables collected included preoperative magnitude of deviation, age, and surgical technique. RESULTS:A total of 386 patients met the inclusion criteria. Among 208 exotropic patients, mean postoperative drift was exotropic 9.94 △ ± 9.78 △. Among 178 esotropic patients, mean postoperative drift was esotropic 1.26 △ ± 9.81 △. Exotropic patients demonstrated significantly greater exotropic drift than esotropic patients (P < .001). CONCLUSIONS:Postoperative drift varies significantly between exotropic and esotropic patients, with exotropic patients exhibiting greater drift. These findings may inform pre- and postoperative counseling, prognostic expectations, and surgical planning. The wide range of observed postoperative drift highlights the variability in surgical outcomes.
PURPOSE:To characterize the features of open globe injuries (OGIs) and the visual outcomes of pediatric patients using a modified Pediatric Ocular Trauma Score (POTS). METHODS:A retrospective chart review was conducted of pediatric patients presenting to a Level I Trauma Center with unilateral OGIs from 2015 to 2023. Demographic data, injury characteristics, clinical findings at presentation, surgical timing, and visual outcomes were analyzed. The POTS was calculated to assess its prognostic value. RESULTS:A total of 53 individuals were analyzed (mean age: 9.3 ± 5.3 years). Blunt trauma accounted for 69.8% of injuries, most of which occurred at home (54.7%). More than half (52.8%) were transferred from outside facilities, and surgical repair was performed within 48 hours in 60.4% of cases. Most injuries were zone I (83.0%). Uveal prolapse (71.7%) and traumatic cataract (39.6%) were frequently observed. At presentation, 5.7% had no light perception (NLP) and 35.8% had light perception/hand motion (LP/HM). Three-month follow-up best corrected visual acuity (BCVA) was available for 25 patients (47.2%); among these, 76% achieved a final BCVA of 0.1 or better. The POTS for all patients was 53.9 ± 19.9. For individuals with follow-up, mean POTS were correlated with final BCVA: LP/HM (47.5), CF (37.5), 0.1 to 0.5 (56.5), and 0.6 to 1.0 (70.0). CONCLUSIONS:This evaluation of pediatric OGIs found mainly zone I injuries causing LP/HM visual acuity. The incorporation of POTS highlights the potential for visual recovery in some patients, with 24% achieving 20/32 BCVA at 3 months of follow-up. These data support POTS as a prognostic tool for physicians managing OGIs in children.
PURPOSE:To determine the relationship between neighborhood-level socioeconomic status and requiring retinopathy of prematurity (ROP) treatment, using the Child Opportunity Index (COI). METHODS:Electronic medical records for all patients who received ROP treatment from January 2010 to March 2024 at a tertiary care center were retrospectively reviewed. Controls were obtained by matching pediatric ophthalmology patients with the closest clinic visit date and no history of retinopathy of prematurity. Demographic and clinical information were collected. The patient's 5-digit ZIP code was used to determine the COI score and level. RESULTS:This study included 245 study patients and 735 matched controls, of which 110 (44.9%) and 329 (44.8%) were female, respectively. The study group had a significantly lower mean COI score (48 ± 29) compared to controls (56 ± 31, P < .001). Additionally, the study group had a higher percentage of Hispanic/Latino patients compared to the control group (51.8% vs 41.9%, respectively, P = .01). When stratified into type 1 (n = 195) and type 2 (n = 50) ROP, patients in the ROP groups continued to have lower mean COI scores (50 ± 29 and 44 ± 28, respectively) than the control group (56 ± 31; P = .01 and P = .006, respectively). The type 1 ROP group had a greater number of patients with Medi-Cal insurance compared to the control group (50.8% vs 46.4%, respectively, P = .04). CONCLUSIONS:Neighborhood socioeconomic status may play a critical role in the management of ROP. It is important to understand the synergistic relationship between social determinants of health when addressing health disparities and developing community-level interventions.
PURPOSE:To evaluate the prevalence, patterns, and associations of retinal hemorrhages (RH) and intracranial hemorrhages (ICH) in confirmed abusive head trauma (AHT) cases, with attention to instances in which RH is identified without radiographic evidence of ICH. METHODS:The authors retrospectively reviewed 137 confirmed AHT cases in children younger than 36 months treated between 2017 and 2023. Data included demographics, imaging results, skeletal surveys, and ophthalmologic examinations. Logistic regression analyses were used to identify predictors of RH and assess associations with ICH and clinical outcomes. RESULTS:ICH was present in 87.6% of cases, most commonly subdural hemorrhage (76.6%). RH was identified in 63.5% of cases, including 3 (3/137, 2.2%) without visible ICH on computed tomography, all of which demonstrated marked cerebral edema that may have obscured underlying hemorrhage. Subdural hemorrhage (odds ratio [OR]: 4.90, 95% CI: 1.83 to 13.16, P = .001) and subarachnoid hemorrhage (OR: 3.73, 95% CI: 1.32 to 10.52, P = .011) were independent predictors of RH, whereas abnormal skeletal survey (OR: 0.33, 95% CI: 0.14 to 0.77, P = .010) and mention of injuries in the chief complaint (OR: 0.31, 95% CI: 0.12 to 0.79, P = .014) were inversely associated. RH was significantly more likely in children older than 4 months (OR: 3.85, 95% CI: 1.50 to 9.87, P = .005) and was associated with increased mortality (26.4% vs 4.0%, P < .001). CONCLUSIONS:RH may occur in rare AHT cases without visible ICH, potentially due to masking by cerebral edema, supporting their continued role in clinical evaluation. The inverse association between RH and skeletal trauma suggests differing injury mechanisms, warranting further investigation.
