Abnormal Acuity Research Articles

Myopia and Environmental Risk Factors: A Comprehensive Study

Background: The global rise in the prevalence of myopia calls for evidence-based strategies to be devised to reduce the incidence and delay the progression of Myopia. The aim is to determine the relationship between myopia incidence and some environmental factors. Methods: A cross-section observational study was conducted at Alzahraa Teaching Hospital from May 2023 to December 2023. Primary school students of both genders. All students were enrolled in the study after an agreement with their parents/guards. Data was collected using a pre-constructed data collection sheet (questionnaire) including three sections, the first section was sent to the families to fill and sign the consent for participation and provide the required data including the demographic variables, family history and medical history of the students, time outdoors, prolonged near work/increased study hours, high BMI, use of LED lamps for homework, less sleeping hours, low Vitamin D levels, less participation in sports and low socioeconomic status. The second part included the general examination of the students, school grades and education performance (assessed according to the student school Cards). The third section involved the ophthalmological examination, visual acuity and ophthalmoscopic examination. Results: A total of 100 students were enrolled in this study, they were equally distributed according to gender, 50 boys and 50 girls. The age of students ranged between 6 and 12 years. Only 12 students had positive past medical and surgical history. A family history of myopia was reported in 20% of the studied group, 20 children were wearing spectacles and a history of past eye complaints was reported in 9 (9%) of children. The refractive errors were 45% hypermetropia, 39% myopia and 16% astigmatism. Abnormal visual acuity was detected in 35%. Myopia was significantly higher in children with family history (p=0.007). A statistically significant relationship was found between large time outdoors and myopia (OR=4.52, p=0.02). A statistically significant relationship was found between prolonged near-work/increased study hours and myopia (OR=4.52, p=0.02). A statistically significant relationship was found between using LED lamps for homework and myopia (OR=10.33, p<0.0001). A statistically significant relationship was found between fewer sleeping hours and myopia (OR=7.5, p<0.0001). Conclusion: Prevention of the onset of myopia and delay in the progression of myopia can be altered by modifying the contributing environmental risk factors. Raise outdoor time with adequate sunlight exposure, rural environment, less duration of near work, use of incandescent lamp and normal sleeping rhythms with adequate regular sleeping hours can prevent the onset and progression of myopia. Myopia is associated with high BMI, watching television and playing digital devices. High socioeconomic status associated with more indoor activity, increased academic pressure, sedentary lifestyle contribute to the prevalence of myopia.

CP-06. PEDIATRIC CRANIOPHARYNGIOMA: SINGLE CENTER RETROSPECTIVE STUDY OF SURVIVAL, ENDOCRINOLOGIC, AND VISION OUTCOMES IN 90 PATIENTS

Abstract BACKGROUND Craniopharyngioma is histologically benign. However, due to its location, morbidity is high and may be impacted by therapeutic approach. METHODS A retrospective study of patients treated for craniopharyngioma at Seattle Children’s Hospital from 1996-2023 was performed. Surgical approach, extent of resection, subsequent surgery, radiation and medical therapies, and serial surveillance magnetic resonance imaging for progression were reviewed. Five-year overall survival (OS) and progression free survival (PFS) were calculated and morbidity including endocrine and vision dysfunction was described. RESULTS 90 patients were included of which 53(58.9%) were male. Median age at diagnosis was 8.70 (range 1.39-25.17) years. Surgical approach included endoscopic (N=24), craniotomy (N=64), and combined (N=2). Extent of resection was biopsy N=2, subtotal resection N=7, near total resection N=38, gross total resection N=30. Pathology was adamantinomatous subtype in all cases and 68 had a documented CTNNB1 alteration and 3 had a BRAF alteration in those with molecular analysis. 5-year OS was 96.1% (SE 0.13) and 5-year PFS was 51.9% (SE0.21), with median follow-up of 97 months. Transcranial compared to endoscopic endonasal approach was associated with increased risk of progression (62% vs 30%, OR 1.23). 34 patients were treated with radiation upfront (N=19) or at progression (N=15). 55% of patients at diagnosis and an additional 30% in follow up had pituitary hormone dysfunction. Hypothalamic obesity was documented in 31% of patients and varied by surgical approach. At presentation, ophthalmologic abnormalities included optic nerve edema (18%) and optic nerve pallor (24%) and 30% had abnormal visual acuity. Following initial surgery, 50% had improvement in visual acuity, 35% stable and 15% had worsened visual acuity. CONCLUSIONS Upfront surgical strategy may impact risk of disease recurrence; however, its relationship to long term morbidity is not clear. Further work to delineate therapeutic strategies and their relationship to morbidity in this patient population is needed.

NFS-24. TUMOR VOLUME IN NEWLY DIAGNOSED OPTIC PATHWAY GLIOMAS ASSOCIATED WITH NF1 (NF1-OPG): PRELIMINARY RESULTS FROM THE INTERNATIONAL MULTICENTER NF1-OPG NATURAL HISTORY STUDY

Abstract BACKGROUND NF1-OPGs are amorphous tumors involving either single or multiple locations (optic nerve, chiasm, tract) along the anterior visual pathway (AVP). In this prospective study, we investigated how volumetric MRI measures of the AVP as well as other clinical variables are associated with treatment decisions in children with newly diagnosed NF1-OPGs. METHODS Children with newly diagnosed NF1-OPG whose MRI included a T1-weighted volumetric sequence without significant artifact at their enrollment visit were eligible for inclusion. All subjects underwent a quantitative ophthalmic exam to determine if visual acuity (VA) was normal. The neuro-oncologist/NF1 expert determined whether the subject would be observed or undergo treatment at that baseline visit. Volumetric MRI analysis was automatically performed using a deep learning network that measured AVP volume (mm3). Non-parametric group comparisons and multivariable logistic regression models evaluated the impact of age at enrollment, sex, NF1 inheritance type, AVP volume, and VA on the decision for immediate treatment with chemotherapy versus observation. RESULTS One-hundred twenty-three subjects met inclusion criteria. Subjects assigned to observation (N=112, 44% female) and subjects immediately treated with chemotherapy (N=11, 80% female) at enrollment were of similar age (2.7 and 2.8 years, respectively) and inheritance (p > 0.05). Abnormal VA was present more often in the treatment group (46%) compared to the observation group (17%, p <0.001). AVP volume was significantly greater in the treatment group (4,181.1mm3) compared to the observation group (1,819.8mm3, p <0.001). AVP volume, sex, and VA reached significance in univariable regression, however, in the multivariable regression model only the AVP volume (p < 0.001) was significantly associated with treatment initiation. DISCUSSION Children with greater NF1-OPG AVP volumes are treated more often compared with those with lower volumes. Volumetric measures of NF1-OPGs are a valuable metric in understanding treatment patterns and are positioned to help inform clinical decision making.

Evaluation of 3D tablet-based stereoacuity test ASTEROID in children with normal and abnormal visual acuity

PurposeTo assess the utility of 3D, tablet-based, glasses-free Accurate STEReotest (ASTEROID) in children compared with the Titmus test. MethodsChildren aged 5-13 years were enrolled in a single-center, nonrandomized, observational comparison study and analyzed by age (5-7 vs 8-13 years) and visual acuity (20/25 or better in both eyes vs abnormal). Each participant underwent both the ASTEROID and Titmus stereoacuity tests. Stereoacuity was defined as fine (≤60 arcsec), moderate (61–200 arcsec), coarse (201–1199 arcsec), or very coarse to nil (≥1200 arcsec). Agreement between the tests was assessed using a weighted kappa (κ) statistic based on all four categories. ResultsA total of 112 children were included: 28 aged 5-7 with normal visual acuity, 30 aged 5-7 with abnormal visual acuity, 34 aged 8-13 with normal visual acuity, and 20 aged 8-13 with abnormal visual acuity. Mean ASTEROID score was 688 ± 533 arcsec (range, 13–1200 arcsec). Agreement between ASTEROID and Titmus test scores for participants overall was moderate (κ = 0.52). By subgroup, agreement was fair for children 5-7 with abnormal visual acuity (κ = 0.31), moderate for children 5-7 with normal visual acuity (κ = 0.47) and children 8-13 with normal visual acuity (κ = 0.42), and substantial for children 8-13 with abnormal visual acuity (κ = 0.76). Where ASTEROID and Titmus score group varied, ASTEROID score was poorer in 94% (47/50) of cases. ConclusionsASTEROID is a digital, tablet-based test that evaluates global stereopsis, does not require glasses, and provides a continuum of scores. Among children, ASTEROID has good agreement with the Titmus test; however, it may be more sensitive at detecting stereovision deficits. Further study is necessary to determine which test is more accurate.

An analysis of the etiology composition and clinical characteristics of bilateral optic disc swelling

Objective: To investigate the etiology composition and clinical characteristics of bilateral optic disc swelling(ODS). Methods: The medical records of all newly diagnosed bilateral ODS patients admitted to the neurology ward of Beijing Tongren Hospital from January 2017 to June 2021 were retrospectively searched to classify the etiology, obtain demographic and clinical information, and compare the differences in clinical characteristics. Results: A total of 131 patients with bilateral ODS were included, including 56 males and 75 females, aged 15-73 (39±14) years. The most common cause of the bilateral ODS was increased intracranial pressure (ICP)(56/131, 42.7%), followed by optic neuritis (ON)(40/131, 30.5%). Other causes included vascular optic neuropathy (13/131, 9.9%), pseudopilledema (9/131, 6.9%); uveitis (6/131, 4.6%), toxic optic neuropathy (3/131, 2.3%) and unknown causes (4/131, 3.1%). Idiopathic intracranial hypertension (IIH) (43/56, 76.8%) was the most common etiology for papilledema. In the comparison of the two main causes of intracranial hypertension and the clinical characteristics of ON in ODS, there was no statistically significant difference in the incidence of age, gender, complaints of ocular pain or headache, and hemorrhage of optic disc(P>0.05). Visual acuity abnormalities and low vision were more common in ON group than the increased ICP group[36/40(90%) vs 33/56(58.9%), P=0.001; 35/80(43.8%) vs 22/112(19.6%), P<0.001], while severe papilledema was more common in increased ICP group[38/112(33.9%)vs 9/80(11.3%), P<0.001]. Conclusions: The most common cause for bilateral ODS is increased ICP, but it can also be triggered by a variety of other causes. Optic neuritis(ON) is the most important differentiating disease in the study of Chinese patients.

Larger Tumor Volume is Associated with Visual Acuity Loss and Axonal Degeneration in Children with Optic Pathway Gliomas Secondary to Neurofibromatosis Type 1

Abstract BACKGROUND We investigated whether volumetric magnetic resonance imaging (MRI) measures of the anterior visual pathway (AVP) in optic pathway gliomas secondary to Neurofibromatosis type 1 (NF1-OPG) are associated with visual acuity (VA) loss and axonal loss, as measured using optical coherence tomography (OCT). METHODS Children with NF1-OPGs enrolled in a prospective study of VA and OCT measures of the circumpapillary retinal nerve fiber layer (cpRNFL) thickness were eligible if they had undergone 3-Tesla MRI that included a T1-weighted volumetric sequence. The linear dimension and volume of the optic nerves, chiasm and optic tracts were measured using our semi-automated algorithm. The combined volume of these components comprising the proximal AVP was used as a surrogate of total tumor burden. Regression models for VA and cpRNFL thickness were reported on a per-eye basis. RESULTS Fifty-two study eyes (26 children, mean 7.1 years) met inclusion criteria, of which 40% (N=21 eyes) had abnormal VA. In regression analysis, only total AVP volume demonstrated a significant relationship to axonal loss, such that for every 1 ml increase in AVP volume, cpRNFL declined by 5.4 microns (p = 0.01). Total AVP volume &amp;gt; 1.75 ml predicted both axonal loss and abnormal VA (positive predictive value of 83.3% and 70.8%, respectively; negative predictive value of 80.0% and 88.0%, respectively). CONCLUSIONS Volumetric measures of NF1-OPGs identified children with VA loss and axonal degeneration. Total tumor burden, as measured by AVP volume, had the strongest relationship with axonal injury. NF1-OPG volumetric measures may be helpful in making treatment decisions.

Association between prenatal exposure to trace elements mixture and visual acuity in infants: A prospective birth cohort study

BackgroundPrenatal environmental factors may affect the development of the offspring and can bring long lasting consequences to the offspring's health. To date, only few studies have reported inconclusive association between prenatal single trace element exposure and visual acuity, and no studies have investigated the association between prenatal exposure to trace elements mixture and visual acuity in infants. MethodsIn the prospective cohort study, grating acuity in infants (12 ± 1 months) was measured by Teller Acuity Cards II. Concentrations of 20 trace elements in maternal urine samples collected in early-trimester were measured by Inductively Coupled Plasma Mass Spectrometry. Elastic net regression (ENET) was applied to select important trace elements. Nonlinear associations of the trace elements levels with abnormal grating were explored using the restricted cubic spline (RCS) method. The associations between selected individual elements and abnormal grating acuity were further appraised using the logistic regression model. Then Bayesian Kernel Machine Regression (BKMR) was used to estimate the joint effects of mixture and interactions between trace elements combining with NLinteraction. ResultsOf 932 mother-infant pairs, 70 infants had abnormal grating acuity. The ENET model produced 8 trace elements with non-zero coefficients, including cadmium, manganese, molybdenum, nickel, rubidium, antimony, tin and titanium. RCS analyses identified no nonlinear associations of the 8 elements with abnormal grating acuity. The single-exposure analyses using logistic regression revealed that prenatal molybdenum exposure possessed a significantly positive association with abnormal grating acuity (odds ratio [OR]: 1.44 per IQR increase, 95% confidence interval [CI]: 1.05, 1.96; P = 0.023), while prenatal nickel exposure presented with a significantly inverse association with abnormal grating acuity (OR: 0.64 per IQR increase, 95% CI: 0.45, 0.89; P = 0.009). Similar effects were also observed in BKMR models. Moreover, the BKMR models and NLinteraction method identified potential interaction between molybdenum and nickel. ConclusionsWe established that prenatal exposure to high concentration of molybdenum and low concentration of nickel was associated with the increased risk of abnormal visual acuity. Potential interaction may exist between molybdenum and nickel on abnormal visual acuity.

Diagnostic accuracy of retinal optical coherence tomography in children with a newly diagnosed brain tumour.

To estimate the diagnostic accuracy of circumpapillary retinal nerve fibre layer (RNFL) thickness and macular ganglion cell layer-inner plexiform layer (GCL-IPL) thickness measurements to discriminate an abnormal visual function (i.e. abnormal age-based visual acuity and/or visual field defect) in children with a newly diagnosed brain tumour. This cross-sectional analysis of a prospective longitudinal nationwide cohort study was conducted at four hospitals in the Netherlands, including the national referral centre for paediatric oncology. Patients aged 0-18 years with a newly diagnosed brain tumour and reliable visual acuity and/or visual field examination and optical coherence tomography were included. Diagnostic accuracy was evaluated with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Of 115 patients included in the study (67 [58.3%] male; median age 10.6 years [range, 0.2-17.8 years]), reliable RNFL thickness and GCL-IPL thickness measurements were available in 92 patients (80.0%) and 84 patients (73.0%), respectively. The sensitivity for detecting an abnormal visual function was 74.5% for average RNFL thickness and 41.7% for average GCL-IPL thickness at a specificity of 44.5% and 82.9%, respectively. The PPV and NPV were 33.0% and 82.6% for the average RNFL thickness and 57.1% and 82.2% for the average GCL-IPL thickness. An abnormal visual function was discriminated correctly by using the average RNFL thickness in seven out of ten patients and by using the average GCL-IPL thickness in four out of ten patients. The relatively high NPVs signified that patients with normal average RNFL thickness and average GCL-IPL thickness measurements had a relative high certainty of a normal visual function.

Risk factors for treatment-refractory and relapsed optic pathway glioma in children with neurofibromatosis type 1.

Nearly one-third of patients with neurofibromatosis type 1-associated optic pathway glioma (NF1-OPG) fail frontline chemotherapy; however, little is known about risk factors for treatment failure. We performed a retrospective multi-institutional cohort study to identify baseline risk factors for treatment-refractory/relapsed disease and poor visual outcome in children with NF1-OPG. Refractory/relapsed NF1-OPG was defined as a requirement of two or more treatment regimens due to progression or relapse. Of 111 subjects eligible for inclusion, adequate clinical and visual data were available for 103 subjects from 7 institutions. Median follow-up from the initiation of first chemotherapy regimen was 95 months (range 13-185). Eighty-four (82%) subjects received carboplatin-based frontline chemotherapy. Forty-five subjects (44%) experienced refractory/relapsed disease, with a median time of 21.5 months (range 2-149) from the initiation of first treatment to the start of second treatment. The proportion of patients without refractory/relapsed disease at 2 and 5 years was 78% and 60%. In multivariable analyses, age less than 24 months at initial treatment, posterior tumor location, and familial inheritance were associated with refractory/relapsed NF1-OPG by 2 years. Both age less than 24 months and posterior tumor location were associated with refractory/relapsed NF1-OPG by 5 years. Subjects with moderate to severe vision loss at last follow-up were more likely to have posterior tumor location, optic disc abnormalities, or abnormal visual acuity at initial treatment. Young age, posterior tumor location, and optic disc abnormalities may identify patients with the greatest likelihood of refractory/relapsed NF1-OPG and poor visual outcomes, and who may benefit from newer treatment strategies.

Radiographic Optic Nerve Findings and Their Clinical Implications in the Setting of Craniomaxillofacial Trauma

Purpose: Computed tomography (CT) scans obtained in the setting of facial trauma often report aberrations in neural anatomy, such as optic nerve stretching. While these findings have not yet been correlated with clinical findings, they raise concern for traumatic optic neuropathy (TON). This study aims to correlate radiographic optic nerve abnormalities with clinical findings in the setting of craniomaxillofacial trauma. Methods: Patient charts were queried based on ICD-9 codes for the presence of an orbital fracture. Patients were included if the CT report mentioned an anatomic abnormality of the optic nerve. Patients who expired within 24 hours of arrival, had an open globe injury, or who were not able to participate in a visual exam were excluded. An additional matched cohort of patients with orbital fractures and without optic nerve abnormalities was selected. The primary endpoint was a clinical diagnosis of TON, and secondary endpoints included the need for ophthalmologic intervention and the presence of abnormal visual acuity. Results: One-hundred and eight patients were included in the study (54 per group). Radiographic optic nerve stretching was not associated with an increased risk of TON (OR: 2.22, 95% CI: 0.71-7.02); however, it was associated with increased risk for abnormal visual acuity (OR: 2.24, 95% CI: 1.01-4.99). There was no increased need for any ophthalmologic intervention (OR: 1.93, 95% CI: 0.86-4.31). Conclusions: Alterations in orbital anatomy on CT are common after orbital fracture and may inappropriately raise concern for TON. This in turn may prompt interfacility transfer and/or emergent ophthalmology consultation. This study demonstrates that radiographic stretching of the optic nerve does not increase the odds for TON in the setting of orbital fractures. While patients with abnormal optic nerve findings did have a higher rate of abnormal visual acuity, this is a common, multifactorial finding in this setting.

Novel genetic mutations in genes AGBL5 and TULP1 for presumed unilateral retinitis pigmentosa managed with low vision rehabilitation: A case report and review

Background: Retinitis pigmentosa is a group of hereditary retinal diseases characterized by the degeneration of rod and cone photoreceptors. It commonly results in night blindness followed by tunnel vision and central vision reduction. The classic triad of clinical signs includes pigmented bone spicules, waxy disc pallor, and arterial attenuation. Unilateral retinitis pigmentosa is rare and can be supported with ancillary testing including genetic and laboratory studies to rule out differential diagnoses. Case Report: A 68-year-old Hispanic female was referred to the low vision rehabilitation clinic due to progressive vision loss in the left eye (OS) that began 15 years ago. The vision was normal in the right eye (OD). Additionally, she suffered from hearing loss in the right ear since age 3. Examination revealed abnormal visual acuity, visual field, fundus appearance, optical coherence tomography, and electrodiagnostic test results in the OS only. Laboratory studies ruled out various infectious, autoimmune, traumatic, and toxic drug etiologies. Genetic testing revealed novel mutations in genes associated with retinitis pigmentosa. Conclusion: The genetic testing results along with the clinical examination and electrodiagnostic evaluation supports the diagnosis of unilateral retinitis pigmentosa.

Neurofibromatosis Type 1-Associated Optic Pathway Glioma in Children: A Follow-Up of 10 Years or More

This study reports on neurofibromatosis type 1 (NF1)-associated optic pathway gliomas (OPGs) and a follow-up period of at least 10 years in a cohort of children. OPGs are a common manifestation of NF1 and can cause significant visual morbidity. Long-term follow-up in children with NF1-associated OPGs has not been reported previously. Retrospective observational case series. This study included children with a documented follow-up of at least 10 years. Three final outcomes were evaluated: visual acuity (VA) per eye (i.e., in the more severely affected eye), VA per patient (i.e., VA when both eyes were open), and the presence of optic nerve head pallor. A total of 45 children were included, followed for a mean of 14 years (range, 10-21 years). At the end of follow-up, abnormal VA (considered moderate to severe impairment) in the more severely affected eye was present in 36% of the patients and in both eyes in 11%. Optic nerve head pallor of 1 or both nerves was present in 62%. In multivariate analysis, only initial VA and optic nerve head appearance at presentation were found to predict the final outcomes. All patients, except for 1, were asymptomatic at presentation and had normal VA and nerves that appeared normal, preserved their good vision in both eyes. Only 1 patient, who had normal VA and normal appearing nerves at presentation, had moderate to severe VA loss at long term follow-up. In this study, children with NF1-associated OPG whose examination signs and symptoms were normal had a normal initial examination and excellent long-term visual and anatomical outcomes. VA and the appearance of the optic nerve head at presentation predict long-term outcome.

Ocular manifestations in SCD patients: role of fundus fluorescein angiography in the detection of sickle retinopathy

Background Sickle cell retinopathy comprises a constellation of abnormal signs in the retinas of patients with sickle cell disease (SCD). The aim was to detect ophthalmological complications in patients with SCD, particularly macular microvascular alteration, using fundus fluorescein angiography (FFA), and to assess the role of potentially contributory clinicopathological factors including transcranial Doppler, genotypes, hydroxyurea, transfusion therapy, and finally, iron overload state on the development of sickle eye. Patients and methods This cross-sectional study included 30 patients with SCD randomly recruited from the Paediatric Haematology Clinic of Ain Shams University Children’s Hospital, Cairo, Egypt. Complete blood count, transcranial Doppler, and FFA were done. Results Of 30 patients, five had abnormal/conditional transcranial results. The FFA finding was normal in 60 eyes (all 30 SCD patients), and only one patient had abnormal visual acuity. This was a 29-year-old girl who was on simple blood transfusion and hydroxyurea treatment for recurrent cerebral strokes and vaso-occlusive crises, yet her FFA finding was normal. Conclusion The authors could not demonstrate any retinal microvascular alternations using FFA among patients with SCD. The authors related the results to their young age and the fact that all were on hydroxyurea therapy with fair compliance. Further studies using a large sample size are warranted to illustrate the utility of FFA as a tool for early detection of sickle retinopathy.

Binocular Treatment for Childhood Amblyopia

Amblyopia (‘lazy eye’) is the leading cause of monocular visual impairment in children. In addition to abnormal visual acuity, amblyopia can result in functional impairments in reading and fine motor abilities, and low self-esteem. The most common treatment is to patch the stronger eye to force use of the amblyopic eye, but normal visual acuity is not always achieved and normal binocular vision is rarely recovered. Patching can also be uncomfortable and an emotional burden for the child, resulting in low adherence. Recent advances in the treatment of childhood amblyopia have focused on binocular therapies consisting of games and movies that may reduce interocular suppression so the child can experience binocular vision. Laboratory and clinical trial data have shown improvements in visual acuity and binocular outcomes with as little as 2 to 4 weeks of binocular treatment in amblyopic children and adults. However, a few clinical trials have poor results with binocular treatment, possibly due to low adherence, small tropias, or a high prevalence of intractable amblyopia in older, previously treated participants. Although binocular treatments show promise, particularly in younger children, more research must be conducted to determine the most effective way to implement binocular treatment for maximum visual improvement, and to tease apart the mechanisms by which visual improvement occurs. Advanced binocular treatments have the potential to be added to the repertoire of standard-of-care treatment for childhood amblyopia, but questions remain to be answered before they can be used nationally and internationally in clinical settings.

Alterations in visual acuity and visual development in infants 1-24 months old either exposed to or infected by Zika virus during gestation, with and without microcephaly

To evaluate visual acuity and visual acuity development in children from the state of São Paulo, Brazil, who were exposed to the Zika virus (ZIKV) gestationally. Children who had been exposed to ZIKV during gestation and age-matched control subjects received visual acuity and funduscopic examination. ZIKV exposure was confirmed by maternal quantitative polymerase chain reaction testing or serology assay. The ZIKV group was divided into two subgroups: exposed (ZE), with only the mother having confirmed ZIKV infection, and infected (ZI), with confirmed infection. Visual acuity development was compared with prior norms and quantified by measuring visual acuity correlation with age. A total of 110 children were included: 47 who had been exposed to ZIKV (ZE, 23; ZI, 24) and 63 controls. Abnormal visual acuity was found in 5 of 24 ZI children. Of the 4 children with microcephaly, only 2 had visual acuity loss (only 1 also had abnormal funduscopic findings). There was significant correlation between age and visual acuity in both the control group (R2=0.8; P<0.0000) and the ZE subgroup (R2=0.6; P<0.0000). However, visual acuity did not correlate with age in the ZI subgroup (R2=0.04; P=0.38). Furthermore, the increment in octaves/month was much lower in the ZI subgroup. Our data indicate that visual acuity losses only occur in infants who suffered gestational-infection, not simply exposure. Lack of correlation between age and visual acuity in the ZI subgroup suggests a slowing of visual development even in the absence of microcephaly. This result may have broad implications for the deleterious effects of ZIKV on the central nervous system.

Preoperative visual evoked potential in the prediction of visual outcome after pituitary macroadenomas surgery.

The purpose of the present study is to investigate longitudinal changes in Visual evoked potential (VEP) parameters as an objective test after transsphenoidal surgery, its correlation with subjective tests and clinical value of VEP in the prediction of visual outcome. Fifty patients with pituitary macroadenoma who underwent surgical removal of the tumor recruited in this study. All the patients underwent ophthalmic examination, static automated perimetry (SAP), VEP and magnetic resonance imaging (MRI) preoperatively and 3months after surgery. Fifty patients with pituitary macroadenoma (size: 25.1 ± 9.9mm) were recruited in the study. Before surgery, the pattern of VEP showed a prolonged latency with reduced amplitude in eyes with abnormal visual acuity or abnormal visual field. The P100 wave latencies and amplitudes showed significant correlation with visual acuity and SAP scores. After surgery, visual acuity and visual field improvements were seen in 51% and 65.6% of eyes, respectively. Mean SAP and visual acuity scores increased significantly (p < 0.01), P100 wave latency declined and amplitude improved after surgery but not significantly. The mean age of patients, size of tumors and preoperative P100 wave latency were significantly lower in eyes with visual field and acuity improvement. VEP is a helpful quantitative and objective complementary test to visual acuity and SAP exams for assessing pre-operative visual abnormalities and post-operative visual outcome in patients with pituitary macroadenoma.

Uveitis Presented as a Case of Ocular Syphilis – A Rare Presentation

Ocular syphilis is one of the clinical presentation or complication of syphilis. Uveitis is the most common ocular diagnosis of the condition but any component of the eyes can be affected. Serology test that include both treponemal and non-treponemal antibody detections play an important role for supporting the diagnosis. This condition is considered as part of neurosyphilis and the recommended treatment follows the treatment for neurosyphilis.&#x0D; We reported a 47-year-old man presented with chronic episode of blurring of vision associated with floaters involving both eyes. Both eyes showed abnormal visual acuity with involvement of optic disc on the left eye. Serology tests for non-treponemal antibody and treponemal antibody test were positive. He was diagnosed as a case of bilateral posterior uveitis with left eye neuroretinitis. He was successfully treated with intravenous aqueous crystalline penicillin 3 million unit every four hour daily for 14 days.&#x0D; J MEDICINE JUL 2019; 20 (1) : 52-54

Combining visual sensory functions and visuospatial orienting functions in children with visual pathology: A longitudinal study

BackgroundPeripheral and central visual processing development highly depends on the integrity of the visual sensory system and the allocation of visuospatial attention. MethodWe quantitatively followed visual sensory functions (VSF) and visuospatial orienting functions (VOF) over two years in 77 children (1–13 years) with different types of visual pathology. ResultsWithin the clinical groups, VSF were relatively constant over two years, except visual acuity, and VOF were characterized by longer reaction time, shorter fixation duration, and lower fixation accuracy than normal for their age. Children with peripheral pathology had high rates of abnormal VSF, of changes to abnormal visual acuity at 1–6 years, and larger and more abnormal VOF (fixation inaccuracy). Children with central pathology had relatively good VSF, whereas two-third had delayed orienting reaction times that differed from other groups mainly at 1–6 years. ConclusionThe distinct patterns of quantitative VSF and VOF over time between the visual pathology groups, and the finding that both methods provided complementary information, argues for combining both types of assessments to provide comprehensive monitoring of visual functioning in children from a young age.

Correlation of peripapillary retinal nerve fibre layer thickness with visual acuity in paediatric patients affected by optic pathway glioma.

To evaluate peripapillary retinal nerve fibre layer (RNFL) thickness, measured by spectral-domain optical coherence tomography (SD-OCT), as a surrogate of visual function in a population of paediatric patients affected by optic pathway glioma (OPG) associated with neurofibromatosis type 1 (NF1). A total of 38 paediatric patients (66 eyes) affected by MRI-proven OPG were included. Each patient underwent complete ophthalmological examination, including age-appropriate visual acuity (VA) assessment and RNFL analysis by SD-OCT. Visual acuity was classified as normal or pathologic using age-based normative data. Visual acuity was correlated to mean RNFL thickness of the whole peripapillary area and of each single analyzed sector (nasal, superior, temporal, inferior). Visual acuity was normal in 43 (65%) and pathologic in 23 (35%) eyes. Mean parapapillary RNFL thickness of each analyzed sector was significantly lower in eyes with abnormal VA (p<0.05). The best balanced cut-off value of global RNFL thickness allowing to discriminate between eyes with normal and pathologic VA was 76.25μm (91%, 76%, 67% and 94% of sensitivity, specificity, positive and negative predicting value, respectively). Considering best balanced cut-off values of other analyzed RNFL sectors, the superior (p=0.0029) and the inferior (p=0.0024) sectors reached the higher sensitivity (87% and 87%, respectively) and specificity (81% and 79%, respectively). Retinal nerve fibre layer thickness is directly related to VA in children affected by NF1-related OPG, and should be considered as a potential surrogate marker of VA. Retinal nerve fibre layer thickness cut-off values can be used in paediatric patients to discriminate false-positive results obtained by VA measurement.

Fitness to drive among commercial intercity drivers in Benin-City, Edo State

Background : Unfit drivers are prone to road traffic accident, therefore their health is paramount in ensuring the safety of road users. To determine the fitness to drive among commercial intercity bus drivers in Benin City, Edo State Material and methods : A descriptive cross-sectional study was conducted among 194 commercial intercity drivers. The respondents were selected using systematic random sampling technique. Data was collected with the aid of an interviewer-administered questionnaire. Estimation of the alcohol level, visual acuity, blood pressure and body mass index was done for respondents using an Alcomate breathalyzer, Snellen’s chart, sphygmomanometer, measuring tape/weighing scale, respectively. IBM SPSS version 21 software was utilized for data analysis. Level of significance was set at p < 0.05. Results : The mean age of respondents was 40.5 ± 7.3 years. Eighty-seven (44.8%) of the respondents had blood alcohol level greater than the legally acceptable limit, 12 (6.2%) were observed to be visually impaired while 4 (2.1%) were hypertensive. Based on these indices, 95 (49.0%) of the respondents were unfit to drive. Conclusion : Almost half of the drivers were unfit to drive based on their abnormal blood alcohol level, visual acuity and high blood pressure. This emphasizes the need for proper pre-medical and periodic medical examination of drivers to ensure their fitness to drive. This will minimize the occurrence of road traffic accidents and their sequelae. Keywords : Fitness to drive; Commercial intercity drivers; Benin City