PURPOSE:To report testability and test-retest reliability of the SpotChecks contrast sensitivity (CS) test in amblyopic and nonamblyopic eyes of children with unilateral amblyopia. METHODS:Children aged 3-12 years with unilateral amblyopia due to strabismus and/or anisometropia were recruited as part of a randomized trial. SpotChecks was administered twice in the left eye at 8 weeks post-randomization. This single-use paper test has a measurable CS threshold range of 0.90 to 2.09 logCS (24 lines, 1 line = 0.05 logCS). Testability was defined as the completion of a pre-test. Bland-Altman analysis was used to evaluate test-retest reliability. RESULTS:In children aged 3-6 years, 81% (117/145) passed the pre-test: 17 of 34 (50%) 3-year-olds, 39 of 46 (85%) 4-year-olds, 33 of 37 (89%) 5-year-olds, and 28 of 28 (100%) 6-year-olds. Fifty-four of 117 (46%) who passed the pre-test had matching test pairs for analysis. In children aged 7-12 years, all 45 passed the pre-test. Twenty-two of 45 (49%) who passed the pre-test had matching test pairs for analysis. Among 76 test-retest pairs (40 amblyopic and 36 nonamblyopic eyes), the mean difference (95% CI) was 0.01 (-0.02 to 0.03) logCS and the half-width of the 95% limits of agreement was ±0.20 (0.16-0.24) logCS. Results were similar between amblyopic and nonamblyopic eyes, as well as within age cohorts. CONCLUSIONS:Children aged 6-12 years were more likely to be testable. Regardless of age, half of all test-retest pairs were completed incorrectly, possibly due to examiner or participant-related factors. A greater than 4-line (0.20 logCS) change on the SpotChecks contrast sensitivity test is required to detect a change in contrast sensitivity function beyond measurement error in children 3-12 years of age with unilateral amblyopia. TRIAL REGISTRATION:Clinicaltrials.Gov, registered 14 July 2022, NCT05462821.

Background: Changes in the biochemical and protein composition of ocular fluid may reflect inflammation due to disruption of the blood-retinal barrier (BRB), as in uveitis. Tear fluid is studied as a source of biomarker discovery in ocular and non-ocular diseases. Tear sampling is non-invasive and tolerated by children. Objectives: We aim to compare proteins in tears and aqueous humor (AH) of children with and without uveitis. Methods: Our cross-sectional study collected tears and AH in 4 patients with uveitis (1 JIA-uveitis, 1 chronic anterior uveitis, 2 ADNIV) and 3 pediatric non-inflammatory controls. Tears were collected by Schirmer strip, and AH during routine eye surgery. Advanced proteomic strategies (iTRAQ labeling and nanoLC-MS/MS) quantified proteins and normalized by total peptide amount. Log of the mean of the ratios was derived from 2 abundance readings per protein/subject. We used Wilcoxon rank sum exact test to compare proteins in tears and AH of uveitis patients and controls (P-value <0.05). Results: Seven patients (71% females, median age 17 y [R 2-59] at collection) contributed 10 paired tear and AH samples. 145 proteins were identified at medium 95% or higher FDR confidence with at least 1 high confidence peptide. Protein abundance was significantly different in tears vs AH of children with uveitis (median 607.8 vs 5012.0, P value 0.009), but not in controls (median 634 vs 121, P value 0.175) (Figure 1A/1B). Further analysis only included proteins detected in 100% of samples. Proteomic analysis showed significantly different expression of 31 of 63 (49%) proteins in tears and AH of children with uveitis, and of 10 of 18 proteins (45%) in controls (Figure 2A/2B). Some of these proteins have already been reported to be associated with the immune response or as inflammatory markers (Immunoglobulins heavy constant alpha 1, protein S100A9, and lysozyme), in the retinal pigment epithelium (Pigment epithelium derived factor), and in inflammatory uveitis (as vitamin D-binding protein, lactotransferrin, ceruloplasmin or apoliprotein I). Conclusion: Uveitis is a vision-threatening disease that warrants exploration of techniques for early detection. The eye is an immune-privileged organ immunologically shielded by the BRB. Around 50% of proteins overlapped in tear fluid and AH. Of those that were differentially expressed, mammoglobin-B, cystatin-S, and secretoglobin family 1D member have been reported in pediatric uveitis tear biomarker studies. Lysozyme, lactoferrin, lipocalin, albumin, and lactotransferrin are common major tear proteins. As tear sampling is feasible in children compared to AH, use of tears in uveitis biomarker studies is promising. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.Figure 1Differences in protein abundance in children with uveitis 1A and control group 1B Figure 2Significant different protein expression in tears and aqueous humor in children with and without uveitis.

Low-dose and very low-dose intravitreal bevacizumab (IVB) have been reported to be successful in short-term treatment of type 1 retinopathy of prematurity (ROP), down to an initial dose of 0.004 mg. We now report 12-month outcomes for these infants.Masked, multicenter, dose de-escalation study.One hundred twenty prematurely born infants with type 1 ROP.A cohort of 120 infants with type 1 ROP in at least 1 eye from 2 sequential dose de-escalation studies of low-dose IVB (0.25 mg, 0.125 mg, 0.063 mg, and 0.031 mg) or very low-dose IVB (0.016 mg, 0.008 mg, 0.004 mg, and 0.002 mg) to the study eye; the fellow eye (if also type 1) received 1 dose level higher of IVB. After primary success or failure at 4 weeks, clinical management was at investigator discretion, including all additional treatment.Reactivation of severe ROP by 6 months corrected age, additional treatments, retinal and other ocular structural outcomes, and refractive error at 12 months corrected age.Sixty-two of 113 study eyes (55%) and 55 of 98 fellow eyes (56%) received additional treatment. Of the study eyes, 31 (27%) received additional ROP treatment, and 31 (27%) received prophylactic laser therapy for persistent avascular retina. No trend toward a higher risk of additional ROP treatment related to initial IVB doses was found. However, time to reactivation among study eyes was shorter in eyes that received very low-dose IVB (mean, 76.4 days) than in those that received low-dose IVB (mean, 85.7 days). At 12 months, poor retinal outcomes and anterior segment abnormalities both were uncommon (3% and 5%, respectively), optic atrophy was noted in 10%, median refraction was mildly myopic (-0.31 diopter), and strabismus was present in 29% of infants.Retinal structural outcomes were very good after low- and very low-dose IVB as initial treatment for type 1 ROP, although many eyes received additional treatment. The rate of reactivation of severe ROP was not associated with dose; however, a post hoc data-driven analysis suggested that reactivation was sooner with very low doses.

ImportanceThe Pediatric Eye Disease Investigator Group Cataract Registry provides a multicenter assessment of visual outcomes and complications after lensectomy for traumatic pediatric cataract.ObjectiveTo report visual acuity (VA) and the cumulative proportion with strabismus, glaucoma, and other ocular complications by 15 months after lensectomy for traumatic cataract among children younger than 13 years at the time of surgery.Design, Setting, and ParticipantsFrom June 18, 2012, to July 8, 2015, 1266 eyes of 994 children from 33 pediatric eye care practices seen within 45 days after lensectomy were enrolled in a multicenter, prospective observational registry. Of these, 74 eyes of 72 participants undergoing lensectomy for traumatic cataract were included in a cohort study. Follow-up was completed by November 2, 2015, and data were analyzed from March 20, 2018, to July 7, 2020.ExposuresLensectomy after ocular trauma.Main Outcomes and MeasuresBest-corrected VA from 9 to 15 months after lensectomy for traumatic cataract (for those 3 years or older) and the cumulative proportion with strabismus, glaucoma, and other ocular complications by 15 months.ResultsOf 994 participants in the registry, 84 (8%) had traumatic cataract. The median age at lensectomy for 72 participants examined within 15 months after surgery was 7.3 (range, 0.1-12.6) years; 46 (64%) were boys. An intraocular lens was placed in 57 of 74 eyes (77%). In children 3 years or older at outcome, the median best-corrected VA was 20/250 (range, 20/20 to worse than 20/800) in 6 eyes with aphakia and 20/63 (range, 20/20 to 20/200) in 26 eyes with pseudophakia. Postoperative visual axis opacification was reported in 18 of 27 eyes with pseudophakia without primary posterior capsulotomy (15-month cumulative proportion, 77%; 95% CI, 58%-92%). The cumulative proportion with strabismus was 43% (95% CI, 31%-58%) in 64 participants with ocular alignment data; exotropia was present in 14 of 23 participants (61%). The cumulative proportion with glaucoma was 6% (95% CI, 2%-16%).Conclusions and RelevanceTrauma was not a common cause of pediatric cataract requiring surgery. For children with traumatic cataract, substantial ocular morbidity including permanent vision loss was found, and long-term eye and vision monitoring are needed for glaucoma, strabismus, and capsular opacification.

ImportanceThis is the first large-scale randomized clinical trial evaluating the effectiveness and safety of overminus spectacle therapy for treatment of intermittent exotropia (IXT).ObjectiveTo evaluate the effectiveness of overminus spectacles to improve distance IXT control.Design, Setting, and ParticipantsThis randomized clinical trial conducted at 56 clinical sites between January 2017 and January 2019 associated with the Pediatric Eye Disease Investigator Group enrolled 386 children aged 3 to 10 years with IXT, a mean distance control score of 2 or worse, and a refractive error between 1.00 and -6.00 diopters (D). Data analysis was performed from February to December 2020.InterventionsParticipants were randomly assigned to overminus spectacle therapy (-2.50 D for 12 months, then -1.25 D for 3 months, followed by nonoverminus spectacles for 3 months) or to nonoverminus spectacle use.Main Outcomes and MeasuresPrimary and secondary outcomes were the mean distance IXT control scores of participants examined after 12 months of treatment (primary outcome) and at 18 months (3 months after treatment ended) assessed by an examiner masked to treatment group. Change in refractive error from baseline to 12 months was compared between groups. Analyses were performed using the intention-to-treat population.ResultsThe mean (SD) age of 196 participants randomized to overminus therapy and 190 participants randomized to nonoverminus treatment was 6.3 (2.1) years, and 226 (59%) were female. Mean distance control at 12 months was better in participants treated with overminus spectacles than with nonoverminus spectacles (1.8 vs 2.8 points; adjusted difference, -0.8; 95% CI, -1.0 to -0.5; P < .001). At 18 months, there was little or no difference in mean distance control between overminus and nonoverminus groups (2.4 vs 2.7 points; adjusted difference, -0.2; 95% CI, -0.5 to 0.04; P = .09). Myopic shift from baseline to 12 months was greater in the overminus than the nonoverminus group (-0.42 D vs -0.04 D; adjusted difference, -0.37 D; 95% CI, -0.49 to -0.26 D; P < .001), with 33 of 189 children (17%) in the overminus group vs 2 of 169 (1%) in the nonoverminus group having a shift higher than 1.00 D.Conclusions and RelevanceChildren 3 to 10 years of age had improved distance exotropia control when assessed wearing overminus spectacles after 12 months of overminus treatment; however, this treatment was associated with increased myopic shift. The beneficial effect of overminus lens therapy on distance exotropia control was not maintained after treatment was tapered off for 3 months and children were examined 3 months later.Trial RegistrationClinicalTrials.gov Identifier: NCT02807350.

We evaluated whether overminus spectacles improve control of intermittent exotropia (IXT).

Importance:Lower bevacizumab dosages are being used for type 1 retinopathy of prematurity, but there are limited data on long-term ocular outcomes with lower doses. Objective:To evaluate ocular outcomes at 12 months' corrected age for eyes that received a dose of 0.625 mg, 0.25 mg, 0.125 mg, 0.063 mg, or 0.031 mg of bevacizumab for type 1 retinopathy of prematurity. Design, Setting, and Participants:This prospective cohort study used a masked, multicenter, phase 1 dose de-escalation study design and was conducted from April 2016 to October 2017. Study eyes were treated with a dose of 0.25, 0.125, 0.063, or 0.031 mg of bevacizumab; fellow eyes were treated with a dosage 1 level higher than the study eye. Additional treatment after 4 weeks was at investigator discretion. Data analysis occurred from November 2018 to March 2019. Interventions:Intravitreous bevacizumab injections of 0.625 mg to 0.031 mg. Main Outcomes and Measures:Visual fixation, amblyopia, alignment, nystagmus, cycloplegic refraction, and ocular examinations were assessed at 12 months' corrected age as preplanned secondary outcomes. The primary outcome 4 weeks after treatment and secondary outcomes after 6 months' corrected age have been previously reported. Results:Forty-six of 61 infants (75%) had a 12-month follow-up examination (46 study eyes and 43 fellow eyes; median [interquartile range] birth weight, 650 [590-760] g). Of 87 eyes with a cycloplegic refraction, 12 (14% [95% CI, 7%-27%]) had myopia of more than -5.00 D spherical equivalent; 2 (2%; [95% CI, 0%-8%]) had hyperopia greater than 5.00 D spherical equivalent; and 5 infants (11% [95% CI, 4%-24%]) had anisometropia greater than 1.50 D spherical equivalent. Abnormalities of the cornea, lens, or anterior segment were reported in 1 eye (1% [95% CI, 0%-6%]), 3 eyes (3% [95% CI, 1%-10%]), and 3 eyes (3% [95% CI, 1%-10%]), respectively. Optic nerve atrophy was identified in 11 eyes (13% [95% CI, 6%-26%]), and 1 eye (1% [95% CI, 0%-6%]) had total retinal detachment. Strabismus was reported in 13 infants (30% [95% CI, 17%-45%]), manifest nystagmus in 7 infants (15% [95% CI, 6%-29%]), and amblyopia in 3 infants (7% [95% CI, 1%-18%]). Overall, 98% of infants had central fixation in each eye (44 of 45 eyes). Conclusions and Relevance:In this study of low-dose bevacizumab, the secondary outcomes of high myopia, strabismus, retinal detachment, nystagmus, and other ocular abnormalities at 1 year were consistent with rates reported in other studies with higher dosages. Trial Registration:ClinicalTrials.gov identifier: NCT02390531.

This workshop will provide attendees an opportunity to learn firsthand about the current pediatric optometry residency programs housed entirely in a medical institution, including the necessary components for creating new training programs, and the pediatric MD-OD working relationships in these institutions.

Importance:Cataract is an important cause of visual impairment in children. Outcomes reported from a large clinical disease-specific registry can provide real-world estimates of visual outcomes and rates of adverse events in clinical practice.Objective:To describe visual acuity and refractive error outcomes, as well as rates of amblyopia, glaucoma, and additional eye surgery, during the first year after lensectomy in children.Design, Setting, and Participants:A prospective observational study was conducted from June 18, 2012, to July 8, 2015, at 61 pediatric eye care practices among 880 children younger than 13 years at the time of lensectomy in at least 1 eye with follow-up within 15 months after surgery. Statistical analysis was performed from December 12, 2016, to December 14, 2018.Exposures:Lensectomy with or without implantation of an intraocular lens.Main Outcomes and Measures:Visual acuity as well as rates of amblyopia, glaucoma, suspected glaucoma, and other intraocular surgery.Results:Among the 880 children (432 girls and 448 boys; mean [SD] age at annual follow-up, 4.9 [3.8] years) in the study, lens surgery was bilateral in 362 (41.1%; 95% CI, 37.9%-44.4%) children and unilateral in 518 (58.9%; 95% CI, 55.6%-62.1%). An intraocular lens was implanted in 654 of 1132 eyes (60.2%; 95% CI, 57.0%-63.4% [proportions reported for eye-level outcomes account for the potential correlation induced by enrolling both eyes of some individuals; for participants who received bilateral surgery, these numbers will differ from the quotient of the number of cases divided by the total sample size]). Amblyopia was identified in 449 children (51.0%; 95% CI, 47.7%-54.3%). In children age 3 years or older, mean visual acuity was 0.30 logMAR (about 20/40) in 153 bilateral pseudophakic eyes, 0.49 logMAR (about 20/63) in 141 unilateral pseudophakic eyes, 0.47 logMAR (about 20/63) in 21 bilateral aphakic eyes, and 0.61 logMAR (about 20/80) in 17 unilateral aphakic eyes. Mean visual acuity improved with older age at surgery in eyes with bilateral pseudophakia by 0.2 logMAR line (99% CI, 0.02-0.4; P = .005) and by 0.3 logMAR line (99% CI, 0.04-0.60; P = .004) in eyes with unilateral pseudophakia. A new diagnosis of glaucoma or suspected glaucoma was made in 67 of 1064 eyes that did not have glaucoma prior to lensectomy (5.9%; 95% CI, 4.6%-7.7%); 36 of 273 eyes with bilateral aphakia (13.2%; 95% CI, 9.0%-19.0%), 5 of 308 eyes with bilateral pseudophakia (1.5%; 95% CI, 0.6%-4.2%), 14 of 178 eyes with unilateral aphakia (7.9%; 95% CI, 4.7%-12.8%), and 12 of 305 eyes with unilateral pseudophakia (3.9%; 95% CI, 2.2%-6.8%). Additional intraocular surgery, most commonly vitrectomy or membranectomy to clear the visual axis, was performed in 189 of 1132 eyes (17.0%; 95% CI, 14.8%-19.6%).Conclusions and Relevance:Amblyopia was frequently observed during the first year after lensectomy in this cohort of children younger than 13 years. For children age 2 years or older at surgery visual acuity was typically less than normal for age and was worse with unilateral cataract. Management of visual axis obscuration was the most common complication requiring surgical intervention during the first year after surgery.

We report the case of a 6-year-old boy who presented with an 18-month history of a left lower eyelid lesion that was refractory to medical management. The lesion was excised, and microscopic examination and immunohistochemistry revealed a cellular neurothekeoma. Clinical presentation of such lesions is similar to a chalazion or epidermal inclusion cyst. Cellular neurothekeoma is benign and has a low risk of recurrence after excision with clear margins. Cellular neurothekeoma of the eyelid is extremely rare, with only 5 previously reported cases. This is, to our knowledge, the first report of cellular neurothekeoma of the eyelid presenting in a boy.

Purpose: To evaluate the short-term effectiveness of overminus spectacles in improving control of childhood intermittent exotropia (IXT).Design: Randomized, clinical trial.Participants: A total of 58 children aged 3 to <7 years with IXT. Eligibility criteria included a distance control score of 2 or worse (mean of 3 measures during a single examination) on a scale of 0 (exophoria) to 5 (constant exotropia) and spherical equivalent refractive error between-6.00 diopters (D) and +1.00 D.Methods: Children were randomly assigned to overminus spectacles (-2.50 D over cycloplegic r efraction) or observation (non-overminus spectacles if needed or no spectacles) for 8 weeks.Main Outcome Measures: The primary outcome was distance control score for each child (mean of 3 measures during a single examination) assessed by a masked examiner at 8 weeks. Outcome testing was conducted with children wearing their study spectacles or plano spectacles for the children in the observation group who did not need spectacles. The primary analysis compared mean 8-week distance control score between treatment groups using an analysis of covariance model that adjusted for baseline distance control, baseline near control, prestudy spectacle wear, and prior IXT treatment. Treatment side effects were evaluated using questionnaires completed by parents.Results: At 8 weeks, mean distance control was better in the 27 children treated with overminus spectacles than in the 31 children who were observed without treatment (2.0 vs. 2.8 points, adjusted difference = -0.75 points favoring the overminus group; 2-sided 95% confidence interval, -1.42 to -0.07 points). Side effects of headaches, eyestrain, avoidance of near activities, and blur appeared similar between treatment groups.Conclusions: In a pilot randomized clinical trial, overminus spectacles improved distance control at 8 weeks in children aged 3 to < 7 years with IXT. A larger and longer randomized trial is warranted to assess the effectiveness of overminus spectacles in treating IXT, particularly the effect on control after overminus treatment has been discontinued. (C) 2016 by the American Academy of Ophthalmology.

To evaluate the short-term effectiveness of overminus spectacles in improving control of childhood intermittent exotropia (IXT).

Laundry and dishwasher detergent "pods" were introduced to the United States market in 2010 and are sold by several manufacturers. They represent a high percentage of household cleaning product exposure in the United Kingdom. We present a consecutive case series of 10 children seen in a 9-month period with corneal injuries from exposure to liquid detergent pods.

Primary uveal melanoma is extremely rare in children and also among blacks. Uveal melanomas may be associated with various preexisting conditions, including congenital ocular melanocytosis and dysplastic nevus syndrome. We report the case of a 4-year-old black girl who presented with pronounced proptosis and no light perception secondary to a massive intraocular tumor with extrascleral extension. Biopsy of the tumor confirmed the diagnosis of primary uveal melanoma, and the patient was treated by enucleation and external beam radiation therapy. Although metastatic disease was ruled out at the time, the patient died approximately 3 months later.