WHAT’S REALLY NEW

LIONEL KOWAL

Stereopsis and long-term stability of alignment in ET.

Birch et al JAAPOS. 2004

 Random-dot stereoacuity was assessed within 3 months of initial surgical alignment in 70 children with infantile ET and within 3 months of initial optical correction in 66 children with accommodative ET. At > or = 5 years of age, adverse outcomes were assessed including loss of alignment, amblyopia, and nil stereopsis.

Stereopsis and long-term stability of alignment in ET.

Birch et al JAAPOS. 2004

 : In the infantile ET cohort, early nil stereopsis was associated with a 3.6 times (95% confidence interval [CI] 2.4 to 4.1) greater risk of surgery for recurrent ET or consecutive exotropia and a 4.2 times (95% CI 3.3 to 4.4) greater risk for nil stereopsis at > or = 5 years of age.

Stereopsis and long-term stability of alignment in ET.

Birch et al JAAPOS. 2004

 In the accommodative ET cohort, early nil stereopsis was associated with a 17.4 times (95% CI 3.3 to 32.2) greater risk of surgery for ET and a 32.2 times (95% CI 15.8 to 35.6) greater risk for nil stereopsis at > or = 5 years of age.

Stereoacuity in unilateral visual impairment detected at preschool screening: outcomes from a randomized controlled trial. IOVS 2005

Richardson SR ,… Clarke MP

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 Treatment for reduced visual acuity due to refractive error or amblyopia is believed to result in improved stereoacuity. This study was undertaken to investigate the effect on stereoacuity of treatment for unilateral visual impairment detected at preschool vision screenings,

Stereoacuity in unilateral visual impairment detected at preschool screening: outcomes from a randomized controlled trial. IOVS 2005

Richardson SR ,… Clarke MP

.

 Children identified through preschool vision screening were recruited and randomized to one of three groups:  1.no treatment   2. glasses only 3. full treatment with glasses and occlusion …. for 12 mo, after which full treatment was given when indicated.

 VA and Randot stereo were assessed at recruitment and at 12- and 18-mo follow-ups

Stereoacuity in unilateral visual impairment detected at preschool screening: outcomes from a randomized controlled trial. IOVS 2005

Richardson SR ,… Clarke MP

.

 177 children were recruited / randomized. Comparison of stereo showed an immediate median improvement of 30 seconds of arc in each group from refractive correction. Age significantly affected stereo performance at recruitment (mean age 4 ) but not at follow-up (mean age 5). Deferring treatment did not affect final stereo.

Risk factors for accommodative ET among hypermetropic children.

Birch EE …. IOVS 2005

 Family history study : 95 consecutive patients, aged 18 to 60 mo, with accommodative ET.  Binocular sensory function study : a subgroup of 41 children in the family history study within 1 month of onset, while the esodeviation was still intermittent.  Hypermetropia study: 345 consecutive patients, ages 1 to 8y, +2.00 D or greater and no ET before age 12 mo.

Risk factors for accommodative ET among hypermetropic children.

Birch EE …. IOVS 2005

 Family history study : 23% of children with accom ET had an affected first-degree relative  Sensory function study: RDS abnormal in 41% of children. Abnormal motion VEP, W4D, or positive 4∆ BO responses not predictive  Hypermetropia study: mean spherical equivalent of < +3.00 D and significant anisometropia had 8-fold increased risk for accomm ET over nonanisometropic patients.

Risk factors for accommodative ET among hypermetropic children.

Birch EE …. IOVS 2005

 A positive family history, subnormal RDS, and hypermetropic anisometropia each pose significant risk for development of accomm ET.  Detection of these risk factors should help to identify those children who are probably most likely to benefit from early spectacle correction or preventive treatment.

PHOTOREFRACTIVE KERATECTOMY FOR ANISOMETROPIC AMBLYOPIA IN CHILDREN Evelyn A. Paysse MD Trans Am Ophthalmol Soc 2004  Factors associated with conventional anisometropic amblyopia treatment failure were  poor compliance (P= .004)  age 6 years or older (P= .01),  astigmatism ≥1.5 diopters (P= .0002),  initial VA 20/200 or worse (P= .02).

PHOTOREFRACTIVE KERATECTOMY FOR ANISOMETROPIC AMBLYOPIA IN CHILDREN Evelyn A. Paysse MD  The refractive goal for each child was to reduce the anisometropia to 3 DS or less, up to a maximum myopic treatment of 11.50 DS and a maximum hyperopic treatment of 5.25 DS

PHOTOREFRACTIVE KERATECTOMY FOR ANISOMETROPIC AMBLYOPIA IN CHILDREN Evelyn A. Paysse MD Trans Am Ophthalmol Soc 2004  2 y after PRK, the mean reduction in refractive error was 9.7 ±2.6 DS for myopes and 3.4 ±1.3 DS for hyperopes.  Cyclo refraction in 9 of 11 treated eyes was within 3 DS of that in the fellow eye.   Uncorrected vision in the amblyopic eye improved by ≥2 lines in 7 / 9 children BCVA improved by ≥2 lines in 6/9 children.  Stereo improved in 5 / 9 children.

Optic nerve hypoplasia and small eyes in presumed amblyopia P Lempert, MD

JAAPOS 2000  275 patients diagnosed with amblyopia and 88 healthy or glaucomatous subjects.

 All subjects underwent complete examinations, including cycloplegic refraction, slit lamp examination, ophthalmoscopy, and retinal imaging.  Axial lengths were determined on 263 amblyopic and 88 healthy and glaucomatous subjects by ultrasonic biometry.

Optic nerve hypoplasia and small eyes in presumed amblyopia P Lempert, MD

JAAPOS 2000  Optic disc areas were determined by magnification correction of disc images performed with formulas.

 Dysversion of the optic disc was determined by simultaneous viewing of disc photographs, digitized images of both eyes, or both.

Optic nerve hypoplasia and small eyes in presumed amblyopia P Lempert, MD

JAAPOS 2000  The mean disc area of eyes presumed to be amblyopic was 1.72 mm 2 and 1.95 mm 2 for nonamblyopic eyes (

P

= .0017).  The mean disc area for 176 optic discs of glaucomatous and healthy eyes was 2.61 mm 2 .  The mean axial length for eyes in the general population is 23.65 mm.

Optic nerve hypoplasia and small eyes in presumed amblyopia P Lempert, MD

JAAPOS 2000  Mean axial length for eyes in the general population is 23.65 mm.  Healthy and glaucoma group 23.89 mm.  Eyes with poorer vision [assumed amblyopic] averaged 22.42 mm. Nonamblyopic fellow eyes averaged 22.83 mm (

P

= .022).  Differences between eyes in the healthy population and eyes that are presumably amblyopic, as well as the healthy and fellow eyes, are highly significant (

P

< .0001)

Presumed sinus-related strabismus.

Ludwig IH Trans Am Ophthalmol Soc. 2004

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 Patients with idiopathic acquired (nonaccommodative) esotropia and/or hypotropia were questioned in detail…….

 Occult sinus disease may cause acquired strabismus. Perhaps sinusitis leads to inflammation and secondary contracture in adjacent extraocular muscles.

Isoametropic amblyopia due to high hyperopia in children.

Cruz OA

JAAPOS . 2004

  number of healthy children with ≥ +4.5 DS SE [with no anisometropia ≥ 1.5 DS] was 418 Of these, 36 had bilateral amblyopia (≤6/12)  Estimated prevalence of isoametropic amblyopia of 8.6% in children with at least 4.5 DS of hyperopia in one or both eyes.

Isoametropic amblyopia due to high hyperopia in children.

Cruz OA

JAAPOS . 2004

 Isoametropic amblyopes presented @ a later age (5 y 1m) than the overall group of hyperopes (3y 5m).  Less strabismus in this group (64%) than all the high hyperopes (81%).  Amblyopia responded well to treatment with glasses, and patching in 13 (36%) cases.  Surgery for residual strabismus was necessary in very few cases (2 of 36, 5.5%).