PURPOSE:To evaluate whether a multifocal contact lens improves central-peripheral rivalry-type (CPR-type) diplopia in patients with epiretinal membrane and other maculopathies. METHODS:Seventeen consecutive adult patients with epiretinal membrane or macular hole and CPR-type diplopia were enrolled. A multifocal, center-distance contact lens, with +2.50 bifocal power, was applied to the eye with macular disease. Measurements of diplopia (optotype-frame test), metamorphopsia (M-Charts, Amsler grid), and aniseikonia (Awaya test) were obtained prior to contact lens placement on the affected eye and repeated 30 minutes after contact lens placement. RESULTS:Median best-corrected visual acuity in the affected eye(s) was 20/20 Snellen before and after multifocal contact lens placement. Diplopia improved in 10 patients (59%), from describing double letters in a single frame or a single letter in a double frame (both indicating central-peripheral rivalry) to a single letter in a single frame. Sixteen patients (94%) reported subjective improvement in M-Chart metamorphopsia (mean of 0.46 before treatment to 0.19 with the multifocal contact lens [mean difference, 0.27; 95% CI, 0.15-0.33; P ≤ 0.001]). Thirteen (76%) showed improvement on the Amsler grid: perceived grid distortion changed from a mean of 111.8 boxes to 38.2 boxes (mean difference, 73.6; 95% CI, 16.67-30.5; P = 0.024). Additionally, 10 (59%) demonstrated improvement in Awaya test aniseikonia, with a mean change from 4.4% to 3.6% (mean difference, -0.82; 95% CI, -1.66 to 0.02; P = 0.53). CONCLUSIONS:Multifocal contact lenses present a promising alternative for alleviating CPR-type diplopia and reducing metamorphopsia associated with epiretinal membrane and macular hole by functionally masking the periphery while maintaining clear central vision.

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 validate a custom smartphone application for at-home visual acuity (VA) measurement in children. METHODS:A total of 452 children aged 3-17.5 years participated. Certified examiners measured in-office test-retest VA (logMAR) using gold-standard Amblyopia Treatment Study HOTV (3-to-6-year-olds, younger cohort) or electronic Early Treatment of Diabetic Retinopathy Study (7-to-17.5-year-olds, older cohort) protocols at 3-4.5 m and app-based VA at 1.5 m. Caregivers measured at-home app-based VA at 1.5 m. RESULTS:Comparing at-home app-based with gold-standard VA, in eyes 20/40 or better, 95% (143/151) and 93% (91/98) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = -0.03, older = -0.04; 95% limits-of-agreement half-width (LOA): younger = ±0.26, older = ±0.22). In eyes 20/50 or worse, 66% (42/64) and 75% (76/101) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.11, older = 0.13, LOA: younger = ±0.50, older = ±0.51). Comparing in-office app-based VA with gold-standard VA, in eyes 20/40 or better, 98% (160/164) and 94% (99/105) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = -0.03, older = -0.03; LOA: younger = ±0.22; older = ±0.24). In eyes 20/50 or worse, 85% (60/71) and 91% (101/111) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.04; older = 0.04; LOA: younger = ±0.39; older = ±0.24). For gold-standard test-retest, in eyes 20/40 or better, 99% (163/164) and 99% (104/105) of the younger and older cohorts had retest within 2 lines, respectively (mean differences: younger = 0.00; older = 0.01; LOA: younger = ±0.17; older = ±0.11). For 20/50 or worse, 92% (66/72) and 100% (111/111) in the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.01; older = 0.02; LOA: younger = ±0.35; older = ±0.15). CONCLUSIONS:Our app demonstrated good concordance with the gold standard at home and in the office for eyes with VA of 20/40 or better. However, concordance decreased considerably for eyes with VA 20/50 or worse, particularly at home.

There is a pressing need for pediatric eye care in low-income countries. Pediatric ophthalmologists from high-income countries can collaborate with local eye care teams to address pressing needs by jointly providing medical or surgical care, codeveloping training programs for local professionals, and supporting initiatives to acquire equipment or enhance infrastructure. Such efforts are maximized through long-term professional relationships with a goal of understanding and strengthening local eye care service and infrastructure. It is important that changes be sustainable so that these needs can be met on a long-term basis.

PURPOSE:To evaluate change in astigmatism after postoperative healing was completed through 5 years following pediatric lensectomy with primary IOL implantation DESIGN: Post hoc analysis of a prospective cohort study PARTICIPANTS: Children <13 years of age who had early postoperative (60 days to 1.5 years postoperatively) and 5-year refraction data (4-6 years postoperatively). MAIN OUTCOME MEASURE:Change in astigmatism. METHODS:Change in astigmatism was calculated in 2 ways: (1) using clinical notation for astigmatism without regard to axis change and (2) using cylinder conversion to power vectors (J0, J45) to include the impact of axis changes. With conversion back to clinical notation, we calculated the change in the astigmatic component of the refraction between the early postoperative exam and 5 years. RESULTS:Among 213 children, mean (SD) age was 5.4 (3.2) years; among 266 study eyes, 153 (58%) were from bilateral cases. Mean clinical astigmatism was + 1.24 D (95% confidence interval [CI] 1.11-1.38 D) at early postoperative exams and + 1.61 D (95% CI: 1.47-1.75 D) at 5 years (mean change: +0.37 D, 95% CI: 0.26 to 0.48 D). Using power vector conversions, the mean change in astigmatism was 1.06 D (95% CI: 0.95-1.18 D). The proportions of children with astigmatism > 0.50 D postoperatively (N = 185) who had a change ≥ 1.00 D and ≥ 2.00 D were 47% (95% CI: 40%-55%) and 16% (95% CI: 11%-22%), respectively. Change in astigmatism was not associated with age at lensectomy (0.00 D per 1 year older, 95% CI: -0.04 to 0.04, p = .92) when analyzed with power vector conversions. CONCLUSIONS:When disregarding axis change, there was less than 0.50D increase in clinically determined astigmatism 5 years after cataract surgery. However, analysis of astigmatism change using power vectors with conversion back to clinical notation (accounting for change in magnitude and axis), about 1 in 6 eyes had a change of 2.00 D or more in the astigmatic component of their refraction. This suggests that toric IOLs may not be appropriate for pediatric cataract surgery.

Importance:Specialized ophthalmology terminology limits comprehension for nonophthalmology clinicians and professionals, hindering interdisciplinary communication and patient care. The clinical implementation of large language models (LLMs) into practice has to date been relatively unexplored. Objective:To evaluate LLM-generated plain language summaries (PLSs) integrated into standard ophthalmology notes (SONs) in improving diagnostic understanding, satisfaction, and clarity. Design, Setting, and Participants:Randomized quality improvement study conducted from February 1, 2024, to May 31, 2024, including data from inpatient and outpatient encounters in a single tertiary academic center. Participants were nonophthalmology clinicians and professionals and ophthalmologists. The single inclusion criterion was any encounter note generated by an ophthalmologist during the study dates. Exclusion criteria were (1) lack of established nonophthalmology clinicians and professionals for outpatient encounters and (2) procedure-only patient encounters. Intervention:Addition of LLM-generated plain language summaries to ophthalmology notes. Main Outcomes and Measures:The primary outcome was survey responses from nonophthalmology clinicians and professionals assessing understanding, satisfaction, and clarity of ophthalmology notes. Secondary outcomes were survey responses from ophthalmologists evaluating PLS in terms of clinical workflow and accuracy, objective measures of semantic quality, and safety analysis. Results:A total of 362 (85%) nonophthalmology clinicians and professionals (33.0% response rate) preferred the PLS to SON. Demographic data on age, race and ethnicity, and sex were not collected. Nonophthalmology clinicians and professionals reported enhanced diagnostic understanding (percentage point increase, 9.0; 95% CI, 0.3-18.2; P = .01), increased note detail satisfaction (percentage point increase, 21.5; 95% CI, 11.4-31.5; P < .001), and improved explanation clarity (percentage point increase, 23.0; 95% CI, 12.0-33.1; P < .001) for notes containing a PLS. The addition of a PLS was associated with reduced comprehension gaps between clinicians who were comfortable and uncomfortable with ophthalmology terminology (from 26.1% [95% CI, 13.7%-38.6%; P < .001] to 14.4% [95% CI, 4.3%-24.6%; P > .06]). PLS semantic analysis found high meaning preservation (bidirectional encoder representations from transformers score mean F1 score: 0.85) with greater readability than SONs (Flesch Reading Ease: 51.8 vs 43.6; Flesch-Kincaid Grade Level: 10.7 vs 11.9). Ophthalmologists (n = 489; 84% response rate) reported high PLS accuracy (90% [320 of 355] a great deal) with minimal review time burden (94.9% [464 of 489] ≤1 minute). PLS error rate on ophthalmologist review was 26% (126 of 489). A total of 83.9% (104 of 126) of errors were deemed low risk for harm and none had a risk of severe harm or death. Conclusions and Relevance:In this study, use of LLM-generated PLSs was associated with enhanced comprehension and satisfaction among nonophthalmology clinicians and professionals, which might aid interdisciplinary communication. Careful implementation and safety monitoring are recommended for clinical integration given the persistence of errors despite physician review.

BACKGROUND:Patients with thyroid eye disease may develop dysthyroid optic neuropathy (DON), which is commonly treated via orbital decompression surgery. This study aims to identify preoperative factors that can predict postoperative best corrected visual acuity (BCVA) in patients with DON and to classify recovery rates based on these prognostic factors. METHODS:We retrospectively assessed thirty-two patients (51 orbits) diagnosed with DON who underwent orbital decompression. RESULTS:Univariate and multivariate mixed effects analysis revealed that preoperative BCVA was the strongest predictor of postoperative BCVA (p < 0.0001). Other significant prognostic factors were extraocular muscle hypertrophy (p = 0.01), visual field mean deviation (p = 0.009), retinal nerve fiber layer thickness (p = 0.01), and afferent pupillary defect (p < 0.0001). We then stratified outcomes by the strongest prognostic factor, preoperative BCVA, which demonstrated that 17 of 19 (89.5%) orbits with preoperative BCVA < logMAR 0.20 (20/32 Snellen) achieved acceptable final vision (defined as better than logMAR 0.40 or 20/50 Snellen), compared to 16 of 20 (80%) orbits with preoperative BCVA logMAR 0.20-0.60 (20/32-20/80 Snellen), and only 3 of 11 (27.3%) orbits with preoperative BCVA > logMAR 0.60 (20/80 Snellen). Patients with preoperative BCVA of logMAR 0.60 (20/80 Snellen) or better had > 80% chance of recovering with acceptable final vision after surgery, compared to a < 30% chance for patients with preoperative BCVA worse than logMAR 0.60 (20/80 Snellen). CONCLUSIONS:These results highlight preoperative BCVA as the strongest predictor of DON outcome and suggest that earlier intervention prior to substantial BCVA deterioration may yield better results. LEVEL OF EVIDENCE:3: Retrospectively Registered.

PURPOSE:To evaluate 5-year visual acuity (VA) outcomes by age at surgery and laterality among infants left aphakic at initial lensectomy. DESIGN:Prospective Pediatric Eye Disease Investigator Group cataract registry. PARTICIPANTS:A total of 149 infants (203 eyes; 123 with bilateral surgery) underwent surgery before 12 months of age (median, 1.8; range, 0.6-11.6 months) for nontraumatic cataract without preexisting glaucoma or anterior/posterior segment anomalies who were left aphakic. METHODS:Records were reviewed annually for 5 years after surgery. Children were grouped by age at first surgery (<2 months, 2 to <6 months, and 6 to <12 months). Analyses accounted for nonindependence of eye pairs. MAIN OUTCOME MEASURES:Mean VA and proportion of eyes with VA better than 20/200. RESULTS:Eighty-nine (60%) infants were female, 114 infants (77%) were White, 17 infants (11%) were Black, and 21 infants (14%) were Hispanic or Latino. In unilateral cases (N = 80), surgery before 2 months of age was associated with better mean VA at 5 years than with surgery between 2 and <6 months of age (0.79 vs 1.13 logarithm of the minimum angle of resolution [logMAR], difference = 0.34 [95% CI, 0.08-0.59], P = 0.01). In bilateral cases (N = 123), age at surgery was not associated with 5-year VA outcomes (P = 0.18). A larger proportion of bilaterally operated eyes had VA better than 20/200 compared with undergoing unilateral surgery before 2 months (87% vs 61%; difference = 26% [95% CI, 8%-43%]; P = 0.004) and 2 to <6 months of age (95% vs 23%; difference = 72% [95% CI, 55%-90%]; P < 0.001). CONCLUSIONS:For bilateral surgery in the first year of life, 5-year VA did not differ by age at surgery. However, for unilateral cataract, 5-year VA was better with surgery before 2 months of age compared with 2 to <6 months. These observations may inform surgical decision-making when treating a cataract in the first 2 months of life. Given the increased risk for glaucoma with early cataract surgery, the surgeon may choose a modest delay in the timing of surgery, accepting a decrease in the VA outcome for unilateral cases. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found after the references.

Purpose To report both the incidence of pediatric keratoconus (PKC) in a population-based cohort and the risk for undergoing corneal surgery over a 20-year period at a single institution. Methods The medical records of all patients <19 years of age diagnosed with keratoconus while residing in Olmsted County, Minnesota, from January 1, 1975, through December 31, 2019, were retrospectively reviewed. The records of patients <19 years with keratoconus examined at our institution from January 1, 2001, through December 31, 2020, were also reviewed. Results The incidence of PKC in this population over the 45-year study period was 2.48 cases per 100,000 people per year (95% CI, 1.67-3.29). The mean age at diagnosis was 15.25 years (range, 7-18) years, and 28 (77.8%) were male. During a mean follow-up of 2.8 years (range, 0-17.3 years), 33 of 71 patients managed at our institution (46%) underwent at least one corneal procedure. In this cohort, the Kaplan-Meier risk of requiring a procedure by 10 years following diagnosis was 60%. Conclusions The incidence of PKC in Olmsted County, Minnesota, over a 45-year period was 2.48 cases per 100,000 people per year. Nearly half of the patients managed at our institution over the past 20 years required a procedure during follow-up.

Straatsma syndrome is an uncommon ocular condition generally comprised of myelinated retinal nerve fiber layer, myopia, and amblyopia. Associated ocular disorders include strabismus, nystagmus, optic nerve hypoplasia, and iris heterochromia. We report the case of a 6-year-old girl with unilateral Straatsma syndrome and an acquired cataract that required surgical extraction.

Background Specialized terminology employed by ophthalmologists creates a comprehension barrier for non-ophthalmology providers, compromising interdisciplinary communication and patient care. Current solutions such as manual note simplification are impractical or inadequate. Large language models (LLMs) present a potential low-burden approach to translating ophthalmology documentation into accessible language. Methods This prospective, randomized trial evaluated the addition of LLM-generated plain language summaries (PLSs) to standard ophthalmology notes (SONs). Participants included non-ophthalmology providers and ophthalmologists. The study assessed: (1) non-ophthalmology providers' comprehension and satisfaction with either the SON (control) or SON+PLS (intervention), (2) ophthalmologists' evaluation of PLS accuracy, safety, and time burden, and (3) objective semantic and linguistic quality of PLSs. Results 85% of non-ophthalmology providers (n=362, 33% response rate) preferred the PLS to SON. Non-ophthalmology providers reported enhanced diagnostic understanding (p=0.012), increased note detail satisfaction (p<0.001), and improved explanation clarity (p<0.001) for notes containing a PLS. The addition of a PLS narrowed comprehension gaps between providers who were comfortable and uncomfortable with ophthalmology terminology at baseline (intergroup difference p<0.001 to p>0.05). PLS semantic analysis demonstrated high meaning preservation (BERTScore mean F1 score: 0.85) with greater readability (Flesch Reading Ease: 51.8 vs. 43.6, Flesch-Kincaid Grade Level: 10.7 vs. 11.9). Ophthalmologists (n=489, 84% response rate) reported high PLS accuracy (90% "a great deal") with minimal review time burden (94.9% ≤ 1 minute). PLS error rate on initial ophthalmologist review and editing was 26%, and 15% on independent ophthalmologist over-read of edited PLSs. 84.9% of identified errors were deemed low risk for patient harm and 0% had a risk of severe harm/death. Conclusions LLM-generated plain language summaries enhance accessibility and utility of ophthalmology notes for non-ophthalmology providers while maintaining high semantic fidelity and improving readability. PLS error rates underscore the need for careful implementation and ongoing safety monitoring in clinical practice. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Heed Ophthalmic Foundation ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Institutional Review Board of Mayo Clinic gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript

PurposeTo report a novel surgical technique to correct excyclotropia, consisting of a superior oblique anterior fibers plication (SOAFP) with or without a hemihangback anterior knot, allowing access for postoperative adjustment.MethodsA retrospective interventional case series was conducted. Fourteen patients, 21-92 years of age, underwent SOAFP (18 eyes, 14 eyes on adjustable), at the Mayo Clinic in Rochester, Minnesota. SOAFP was the only procedure performed in 12 eyes; in 6 it was performed in conjunction with up to four horizontal rectus muscle recession, resection, and/or plication. Ocular alignment was assessed with prism and alternate cover and double Maddox rod tests; preoperatively, at initial and final (closest to 6-8 weeks) postoperative visits.ResultsPreoperative torsion ranged from 2° to 30° of extorsion (mean, 10.14 ± 7.01). A SOAFP of 2–30 mm (mean, 8.93 ± 5.63) was performed. At the initial postoperative examination, mean intorsional shift was 11.18 ± 7.37, accounting for 1.86° ± 1.04° of correction per millimeter of plication. Three eyes were adjusted after the initial visit to obtain a stronger plication effect targeting of 5° intorsion. At the final visit, 61 ± 23 days postoperatively, mean extorsion was 1.21° ± 2.29°, ranging from 5° of extorsion to 3 of intorsion. Mean final intorsional shift was 9.14 ± 7.53°, accounting for a 1.16 ± 0.50° of correction per millimeter of plication. Of our 14 patients, 13 had improvement in diplopia.ConclusionsIn our study cohort, SOAFP allowed for targeted and easily adjustable correction of extorsion.

PURPOSE:To report refractive change at 5 years of age in children with pseudophakic eyes operated on before 2 years of age. DESIGN:Retrospective case series at 10 Infant Aphakia Treatment Study (IATS) sites. PARTICIPANTS:Children who underwent cataract surgery with primary intraocular lens (IOL) placement during the IATS enrollment years, including infants 1 to younger than 7 months of age with bilateral cataract and all children 7 to 24 months of age, regardless of laterality. METHODS:Change in spherical equivalent refractive error (in diopters [D]) was calculated from 1 month after surgery to 5 years of age and was compared for patients with unilateral and bilateral (first eye only) cataract and for children 1 to < 7 months versus 7-24 months of age at surgery. MAIN OUTCOME MEASURES:Refractive change (D) from surgery to 5 years of age. RESULTS:Ninety-six children were included: 50 children with unilateral cataract (surgery at age 7-24 months) and 46 children with bilateral cataract (n = 20 with surgery at age 1 to < 7 months; n = 26 with surgery at age 7-24 months). Median refractive change was significantly greater for eyes in the bilateral group undergoing surgery at age 1 to < 7 months (7.50 D; range, 2.5 to 15 D) versus age 7 to 24 months (1.94 D; range, -1.88 to 7.75 D; P < 0.001). For children 7-24 months of age at surgery, median change was similar between those with unilateral cataract (3.25 D; range, -1.75 to 13.5 D) versus bilateral cataract (1.94 D; range, -1.88 to 7.75 D; P = 0.053). By 5 years of age, no eyes in the 1 to < 7 month age group had less than 2.5 D myopic shift, but in the 7-24 month age group, 62% of patients with bilateral cataract and 38% of patients with unilateral cataract showed less than 2.5 D myopic shift. CONCLUSIONS:Greater magnitude and variability in refractive change was found in pseudophakic eyes undergoing surgery at 1 to < 7 months of age and for patients with unilateral cataract, which should be considered when choosing IOL power and initial postoperative target refraction for infants and toddlers. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Axenfeld-Rieger Syndrome (ARS) type 1 is a rare autosomal dominant condition characterized by anterior chamber anomalies, umbilical defects, dental hypoplasia, and craniofacial anomalies, with Meckel's diverticulum in some individuals. Here, we describe a clinically ascertained female of childbearing age with ARS for whom clinical targeted sequencing and deletion/duplication analysis followed by clinical exome and genome sequencing resulted in no pathogenic variants or variants of unknown significance in PITX2 or FOXC1. Advanced bioinformatic analysis of the genome data identified a complex, balanced rearrangement disrupting PITX2. This case is the first reported intrachromosomal rearrangement leading to ARS, illustrating that for patients with compelling clinical phenotypes but negative genomic testing, additional bioinformatic analysis are essential to identify subtle genomic abnormalities in target genes.

ObjectiveTo determine the appropriateness of ophthalmology recommendations from an online chat-based artificial intelligence model to ophthalmology questions.Patients and MethodsCross-sectional qualitative study from April 1, 2023, to April 30, 2023. A total of 192 questions were generated spanning all ophthalmic subspecialties. Each question was posed to a large language model (LLM) 3 times. The responses were graded by appropriate subspecialists as appropriate, inappropriate, or unreliable in 2 grading contexts. The first grading context was if the information was presented on a patient information site. The second was an LLM-generated draft response to patient queries sent by the electronic medical record (EMR). Appropriate was defined as accurate and specific enough to serve as a surrogate for physician-approved information. Main outcome measure was percentage of appropriate responses per subspecialty.ResultsFor patient information site-related questions, the LLM provided an overall average of 79% appropriate responses. Variable rates of average appropriateness were observed across ophthalmic subspecialties for patient information site information ranging from 56% to 100%: cataract or refractive (92%), cornea (56%), glaucoma (72%), neuro-ophthalmology (67%), oculoplastic or orbital surgery (80%), ocular oncology (100%), pediatrics (89%), vitreoretinal diseases (86%), and uveitis (65%). For draft responses to patient questions via EMR, the LLM provided an overall average of 74% appropriate responses and varied by subspecialty: cataract or refractive (85%), cornea (54%), glaucoma (77%), neuro-ophthalmology (63%), oculoplastic or orbital surgery (62%), ocular oncology (90%), pediatrics (94%), vitreoretinal diseases (88%), and uveitis (55%). Stratifying grades across health information categories (disease and condition, risk and prevention, surgery-related, and treatment and management) showed notable but insignificant variations, with disease and condition often rated highest (72% and 69%) for appropriateness and surgery-related (55% and 51%) lowest, in both contexts.ConclusionThis LLM reported mostly appropriate responses across multiple ophthalmology subspecialties in the context of both patient information sites and EMR-related responses to patient questions. Current LLM offerings require optimization and improvement before widespread clinical use.

Importance:Glaucoma can develop following cataract removal in children.Objective:To assess the cumulative incidence of glaucoma-related adverse events (defined as glaucoma or glaucoma suspect) and factors associated with risk of these adverse events in the first 5 years after lensectomy prior to 13 years of age.Design, Setting, and Participants:This cohort study used longitudinal registry data collected at enrollment and annually for 5 years from 45 institutional and 16 community sites. Participants were children aged 12 years or younger with at least 1 office visit after lensectomy from June 2012 to July 2015. Data were analyzed from February through December 2022.Exposures:Usual clinical care after lensectomy.Main Outcomes and Measures:The main outcomes were cumulative incidence of glaucoma-related adverse events and baseline factors associated with risk of these adverse events.Results:The study included 810 children (1049 eyes); 443 eyes of 321 children (55% female; mean [SD] age, 0.89 [1.97] years) were aphakic after lensectomy, and 606 eyes of 489 children (53% male; mean [SD] age, 5.65 [3.32] years) were pseudophakic. The 5-year cumulative incidence of glaucoma-related adverse events was 29% (95% CI, 25%-34%) in 443 eyes with aphakia and 7% (95% CI, 5%-9%) in 606 eyes with pseudophakia; 7% (95% CI, 5%-10%) of aphakic eyes and 3% (95% CI, 2%-5%) of pseudophakic eyes were diagnosed as glaucoma suspect. Among aphakic eyes, a higher risk for glaucoma-related adverse events was associated with 4 of 8 factors, including age less than 3 months (vs ≥3 months: adjusted hazard ratio [aHR], 2.88; 99% CI, 1.57-5.23), abnormal anterior segment (vs normal: aHR, 2.88; 99% CI, 1.56-5.30), intraoperative complications at time of lensectomy (vs none; aHR, 2.25; 99% CI, 1.04-4.87), and bilaterality (vs unilaterality: aHR, 1.88; 99% CI, 1.02-3.48). Neither of the 2 factors evaluated for pseudophakic eyes, laterality and anterior vitrectomy, were associated with risk of glaucoma-related adverse events.Conclusions and Relevance:In this cohort study, glaucoma-related adverse events were common after cataract surgery in children; age less than 3 months at surgery was associated with elevated risk of the adverse events in aphakic eyes. Children with pseudophakia, who were older at surgery, less frequently developed a glaucoma-related adverse event within 5 years of lensectomy. The findings suggest that ongoing monitoring for the development of glaucoma is needed after lensectomy at any age.

PURPOSE:To report the incidence and clinical characteristics of pediatric ocular and adnexal injuries diagnosed over a 10-year period in Olmsted County, Minnesota.METHODS:This multicenter retrospective, population-based cohort study included all patients <19 years of age in Olmsted County diagnosed with ocular or adnexal injuries from January 1, 2000, through December 31, 2009.RESULTS:A total of 740 ocular or adnexal injuries occurred during the study period, yielding an incidence of 203 (95% CI, 189-218) per 100,000 children. Median age at diagnosis was 10.0 years, and 462 (62.4%) were males. Injuries presented to the emergency department or urgent care setting most frequently (69.6%) and often occurred while outdoors (31.6%) during summer months (29.7%). Common injury mechanisms included blunt force (21.5%), foreign bodies (13.8%), and sports activities (13.0%). Isolated anterior segment injuries occurred in 63.5% of injuries. Ninety-nine patients (13.8%) had visual acuity of 20/40 or worse at initial examination, and 55 patients (7.7%) had visual acuity of 20/40 or worse at final examination. Twenty-nine injuries (3.9%) required surgical intervention. Significant risk factors for reduced visual acuity and/or the development of long-term complications include male sex, age ≥12 years, outdoor injuries, sport and firearm/projectile injury mechanism, and hyphema or posterior segment injury (P < 0.05).CONCLUSIONS:Most pediatric eye injuries are minor anterior segment injuries with infrequent long-lasting effects on visual development.

PURPOSE:To summarize recent literature and provide an update on the role of intraocular lens implantation in children.DESIGN:AOC/AACO/AAO 2022 Symposium Summary.INTERVENTION:None.RESULTS:Literature review surrounding the use of intraocular lenses in children. Attention was given to multicenter study efforts including the Infant Aphakia Treatment Study, the Toddler Aphakia and Pseudophakia Study, and the Pediatric Eye Disease Investigator Group Cataract Registry.CONCLUSIONS:Intraocular lenses are a valuable tool in the care of children with lens abnormalities. Recent studies and advancements in fixation techniques have complimented our care and highlighted age and ocular dependent risks. Thorough initial clinical assessment and long-term postoperative management are critical in maximizing outcomes.

Pediatric Cataract Surgery continues to evolve as technology improves. As pediatric surgeons, we are interested in simplicity and safety but must also be aware of the emergence of innovative techniques designed for adult eyes and know when it is appropriate to modify them for our unique purposes or reject them as potentially harmful to kids’ eyes. In this video-based workshop, brief videos will be presented for the panel to comment on. Interaction between panelists and the audience will provide debate on what to start doing differently in 2022 and what to be cautious about in your OR back home.

Children aged 0 to <13 years undergoing lens removal were enrolled into a prospective registry. We report the incidence of glaucoma/glaucoma suspect (“glaucoma-related adverse events”) within 5 years of cataract surgery and associated risk factors.