Child's Visual Development Research Articles

Association Between Maternal Fasting Glucose Levels Throughout Pregnancy and Preschoolers' Refractive Errors.

We aimed to investigate the association between maternal fasting plasma glucose (FPG) trajectories during pregnancy and children's refractive errors at 6 years of age. Based on the Ma'anshan Birth Cohort (MABC) in China, a total of 1987 mother-child pairs were included in this study. Using the group-based trajectory model, trajectory fitting was performed on FPG levels during the first, second, and third trimesters of pregnancy. Children's vision was measured at 6 years of age using the standard logarithmic visual acuity E-chart and cycloplegic refraction examination. Logistic regression models and multi-informant generalized estimating equations were used to analyze the association between maternal blood glucose level and 6-year-old children's visual acuity. Children born of mothers with high level FPG trajectory had a higher risk of developing refractive error (odds ratio [OR] = 1.46 [95% CI: 1.08, 1.97]), hypermetropia (OR = 1.64 [95% CI: 1.09, 2.46]), and astigmatism (OR = 1.60 [95% CI: 1.06, 2.41]) at age 6 compared to those with low level trajectory. Maternal blood glucose level in the first (β = -.012 [95% CI: -.024, -.001]) and the second (β = -.016 [95% CI: -.025, -.006]) trimesters was associated with 6-year-old children's distance vision value. High level of FPG trajectories during pregnancy has been observed to be associated with 6-year-old children's refractive error, hypermetropia, and astigmatism. The first and the second trimesters may be critical periods for the effects of maternal blood glucose on children's vision. The long-term effect of maternal glucose metabolism on children's visual development deserves further study.

Premium intraocular lenses in children.

Multifocal and toric intraocular lenses (IOLs) or the so-called premium IOLs are currently widely used in adult patients as a one-step refractive solution following cataract surgery. However, the decision to implant a premium IOL in a pediatric patient involves multiple factors affecting the child's visual development and is associated with several dilemmas and surgical challenges. The purpose of this review is to summarize these factors and analyse the influence of each of them on the visual outcomes following premium IOL implantation. A review of literature was conducted using the relevant keywords from various databases until 31st January 2022. All pertinent studies with multifocal or toric IOL implantation in children were reviewed, and relevant articles were studied in detail for age, IOL power calculation, visual outcomes (refractive outcomes, contrast sensitivity and stereopsis) and complications such as dysphotic phenomena and others. A total of 17 relevant studies (10 case series/interventional studies and 7 case reports) on the subject were included. All studies showed a favourable refractive outcome; however, the data available was significantly less. Studies with earlier models of multifocal IOLs showed a higher incidence of IOL decentration and posterior capsule opacification; however, more recent studies with newer IOL models showed much better safety profiles. Toric IOLs showed promising results in all the studies evaluated. Premium IOLs have shown promising results in the pediatric age group. However, their long-term outcomes specifically concerning refractive shift, capsular contraction and role in the management of amblyopia needs to be explored further.

PECARE: Parental Feedback to Improve Congenital Cataract Care in Sweden.

To analyze non-directed parental feedback to health care providers responsible for pediatric cataract care in Sweden. A directed content analysis was used to analyze data consisting of text representing free comments provided by 40 parents. A deductive approach was employed by applying the model of balancing the child's inability and ability, which includes the categories mastering, collaborating, facilitating, and adapting. Parents lacked piloting and self-management support. They experienced an absence of partnership with the health care team and not being taken seriously. They also felt abandoned by health care, resulting in emotional distress. Parents highlighted the impact of their social network and the challenges involved in accepting and adapting to the changes in everyday life. This study emphasizes the consequences of the lack of a caring partnership with health care professionals. Because parents act as mediators of care to the child with congenital cataract, persistence on the part of parents and a family-centered approach are essential for the child's visual development. [J Pediatr Ophthalmol Strabismus. 2023;60(4):298-294.].

Congenital cataract in newborns: A qualitative study on parents' experiences of the surgery and subsequent care.

Having a child with congenital cataract that requires surgery, contact lens treatment, and frequent medication is a life-altering experience. The aim of this study was to provide more in-depth knowledge of parents' experiences of diagnosis, surgery, and subsequent care, in order to find the areas for improvement. Data were collected via semi-structured interviews with parents recruited from St. Erik Eye Hospital, Sweden. The children were operated for congenital cataract before 3months of age and were aged 12-24months at the time of the interviews. The interviews were analysed using qualitative content analysis with an inductive approach. Three themes emerged from the data: living in a turbulent time before the diagnosis, coping during the time of initial treatment, and managing the responsibility of their child's visual development. All parents expressed confidence in the operating unit. However, there was a clear need for reliable information on the condition, the surgery, and likely the long-term outcome in the time between receiving the preliminary diagnosis at the maternity ward and getting it confirmed by a paediatric ophthalmologist. Much of the parents' concern in this turbulent time is linked to poor information before the visit to the eye hospital. We, therefore, recommend earlier contact with the eye hospital, preferably at the time of writing the referral. Moreover, the possibility of providing up-to-date information via alternative information channels such as smartphone apps should be investigated.

Refractive error's distribution and clinical characteristics of preterm and full-term children

To observe the abnormal refractive state and clinical characteristics in preterm and full-term children in the department of pediatric ophthalmology. The ocular refraction status of 358 eyes in 51 preterm and 128 full-term children were checked by retinoscopy in dilated pupil after being used atropine eye drop． There were 157 eyes with hyperopia accounting for 61.3% in preterm children, 25 eyes with hyperopia accounting for 24.5% in full-term children. The main type of refractive errors in preterm children was astigmatism, especially high-astigmatism, mixed astigmatism. And the morbidity of astigmatism, hyper-astigmatism, mixed astigmatism in preterm children was higher than those in full-term children. Astigmatism, especially high astigmatism and complex mixed astigmatism are important reasons for low vision in preterm children. Clinically, there is close relationship between astigmatism and amblyopia. So it can not be ignored with preterm children's visual development, and refractive screening could be bring forward to two years old.

Outcomes after cataract extraction in young children with radiation-induced cataracts and retinoblastoma

An expected side effect of external beam radiation therapy for retinoblastoma is cataract formation, which impairs a child's visual development and an ophthalmologist's ability to examine the eye. When surgery is indicated, the potential complications can be vision-or life-threatening. Here we report the results of cataract extraction with intraocular lens placement in young children with retinoblastoma. A retrospective chart review of all patients at St. Jude's Children's Research Hospital who had undergone external beam radiation therapy for retinoblastoma during a 25-year period was performed. Patients who required cataract extraction with IOL placement were included. Preoperative and postoperative visual acuity and ocular complications were recorded. The chart review identified 40 patients (53 eyes) with cataracts, of whom 15 (19 eyes) had surgery. Of the 19 eyes, 2 (10.5%) developed a vitreous hemorrhage (one of which was subsequently enucleated secondary to phthisis, whereas the other resolved without further complications). A total of 12 eyes (63.2%) required Nd:YAG laser capsulotomies (mean, 3.6 months; range, 1-7 months). None developed recurrence or spread of disease. Thirteen eyes (68.4%) had improved visual acuity after cataract extraction and intraocular lens placement, 4 of which (30.8%) subsequently lost vision as the result of other complications of retinoblastoma treatment. Visual acuity outcomes were 20/20 to 20/60 in 3 eyes (15.8%); 20/70 to 20/200 in 4 (21.1%); and 20/400 or less in 10 (52.6%). One patient (5.2%) required enucleation. Patients who underwent cataract extraction after treatment for retinoblastoma had few postoperative adverse outcomes, and visual acuity improved in most patients immediately after surgery. However, some patients who showed initial improvement subsequently lost vision as the result of other complications from retinoblastoma treatment.

Vision and Eye Screening in Finland an Overview

In Finland the public health authorities recommend that a child's visual development should be checked four times during the first year of life, then once a year. During the first year attention is paid to developmental delays and to development of normal eye muscle control. Photorefractive screening of infants between ages 9 to 18 months is recommended but not yet executed except for a few limited pilot studies.At four and six years, testing includes visual acuity measurement using a line test at a distance of three meters, Hirschberg's test, and a cover test. Screening of deaf children and children with cerebral palsy requires new techniques. Screening of mentally retarded children uses informal play situations and new tests such as BUST-LH playing cards and LH-DOMINO plus involvement of day care personnel in observation. Screening at school age is for refractive errors. Introduction of the near visual acuity test has decreased the number of referrals.