Cycloplegic Retinoscopy Research Articles

The Performance of Spot Photoscreener in 6 to 10 Weeks Infants in China: A Cross-Sectional Study.

To compare the refractive errors measured by the Spot photoscreener (with or without cycloplegia) to cycloplegic retinoscopy in 6- to 10-week-old infants. 101 right eyes from 101 healthy infants aged 6 to 10 weeks were recruited for this cross-sectional observational study. Refractive errors were measured using Spot photoscreener before and after cycloplegia, as well as cycloplegic retinoscopy. Comparisons between the refractive measurements were performed using one-way ANOVA with the post hoc Tukey HSD test or Kruskal-Wallis test with the Steel-Dwass test according to the data normality. Pearson's correlation test and 95% confidence intervals were calculated. The agreement was evaluated using a Bland-Altman plot with 95% limits of agreement of the differences. Spot photoscreener was found to underestimate the spherical equivalent by 2.33 Diopters (D) in these infants. Following the induction of cycloplegia, the spherical equivalent measured by Spot photoscreener was in excellent agreement with cycloplegic retinoscopy with the mean difference of 0.01 D. Spot photoscreener overestimated cylindrical parameter by 0.2 D with poor agreement with cycloplegic retinoscopy no matter whether cycloplegia was induced. It had good agreement with cycloplegic retinoscopy in the J0 vector than the J45 vector measurement. With the induction of cycloplegia, Spot photoscreener can accurately evaluate spherical equivalent in hyperopic infants with mild-to-moderate astigmatism. While it may provide valuable measurements of astigmatism, discrepancies in cylinder and axis should be taken into account.

Comparison of Spot Vision Screener and Tabletop Autorefractometer with Retinoscopy in the Pediatric Population.

Determining the accuracy of cycloplegic refractive error measurements made with the Spot Vision Screener (SVS, Welch Allyn Inc, Skaneateles Falls, NY, USA) is important for refractive assessment of uncooperative patients during optometric examinations. This study compared cycloplegic refractive errors measured by SVS and tabletop autorefractometer to cycloplegic retinoscopy in children. Eighty-eight eyes of 44 subjects were examined in the study. Refractive error measurements were obtained under cycloplegia using retinoscopy, SVS, and Nidek ARK-530 tabletop autorefractometer (ARK-530, Nidek, Japan). Spherical and cylindrical values, spherical equivalents (SE), and Jackson cross-cylinder values at axes of 0° (J0) and 45° (J45) were recorded. Correlations between methods were analyzed using intraclass correlation coefficient (ICC) and Bland-Altman analysis. The mean age was 7 years (range: 6 months-17 years). Sixteen (36%) of the subjects were female and 28 (64%) were male. For SE there was excellent agreement between retinoscopy and SVS (ICC: 0.924) and between retinoscopy and tabletop autorefractometer (ICC: 0.995). While there was a moderate correlation between retinoscopy and SVS for cylindrical values (ICC: 0.686), excellent correlation was detected between retinoscopy and autorefractometer (ICC: 0.966). J0 and J45 crosscylinder power values were not correlated between retinoscopy and SVS (ICC: 0.472) or retinoscopy and tabletop autorefractometer (ICC: 0.442). Retinoscopy was correlated with both SVS and tabletop autorefractometer for all parameters within ±1.96 standard deviations in Bland-Altman analysis. Cycloplegic retinoscopy is the gold standard for refractive error measurement in the pediatric population. However, it requires time and experienced professionals. This study revealed moderate to good agreement between SVS and retinoscopy, with better agreement in spherical errors than cylindrical errors. Although the SVS is intended for screening programs, it may also be useful in the pediatric eye office to estimate spherical refractive error in uncooperative patients.

Refractive Error Change and Overminus Lens Therapy for Childhood Intermittent Exotropia

Increased myopic shift was found to be associated with 1 year of overminus spectacle treatment for children with intermittent exotropia (IXT). Persistence of myopic shift after discontinuing overminus spectacles is unknown. To compare refractive error change over 3 years in children with IXT originally treated with overminus vs nonoverminus spectacles. This study was an 18-month extension of the Trial of Overminus Spectacle Therapy for Intermittent Exotropia cohort, which previously randomized children aged 3 to 10 years with IXT and baseline spherical equivalent refractive error (SER) between -6.00 diopters (D) and 1.00 D to overminus spectacles (-2.50 D for 12 months, -1.25 D for 3 months, and nonoverminus for 3 months) or nonoverminus spectacles. Children were recruited from 56 sites from July 2010 to February 2022. Data were analyzed from February 2022 to January 2024. After trial completion at 18 months, participants were followed up at 24 and 36 months. Treatment was at investigator discretion from 18 to 36 months. Change in SER (cycloplegic retinoscopy) from baseline to 36 months. Of 386 children in the Trial of Overminus Spectacle Therapy for Intermittent Exotropia, 223 (57.8%) consented to 18 months of additional follow-up, including 124 of 196 (63.3%) in the overminus treatment group and 99 of 190 (52.1%) in the nonoverminus treatment group. Of 205 children who completed 36-month follow-up, 116 (56.6%) were female, and the mean (SD) age at randomization was 6.2 (2.1) years. Mean (SD) SER change from baseline to 36 months was greater in the overminus group (-0.74 [1.00] D) compared with the nonoverminus group (-0.44 [0.85] D; adjusted difference, -0.36 D; 95% CI, -0.59 to -0.12; P = .003), with 30 of 112 (26.8%) in the overminus group having more than 1 D of myopic shift compared with 14 of 91 (15%) in the nonoverminus group (risk ratio, 1.8; 95% CI, 1.0-3.0). From 12 to 36 months, mean (SD) myopic shift was -0.34 (0.67) D and -0.36 (0.66) D in the overminus and nonoverminus groups, respectively (adjusted difference, -0.001 D; 95% CI, -0.18 to 0.18; P = .99). The greater myopic shift observed after 1 year of -2.50-D overminus lens treatment remained at 3 years. Both groups had similar myopic shift during the 2-year period after treatment weaning and cessation. The risk of myopic shift should be discussed with parents when considering overminus lens treatment. ClinicalTrials.gov Identifier: NCT02807350.

Detection of significant vision conditions in children using QuickSee wavefront autorefractor.

This study evaluated the ability of QuickSee to detect children at risk for significant vision conditions (significant refractive error [RE], amblyopia and strabismus). Non-cycloplegic refraction (using QuickSee without and with +2 dioptre (D) fogging lenses) and unaided binocular near visual acuity (VA) were measured in 4- to 12-year-old children. Eye examination findings (VA, cover testing and cycloplegic retinoscopy) were used to determine the presence of vision conditions. QuickSee performance was summarised by area under the receiver operating characteristic curve (AUC), sensitivity and specificity for various levels of RE. QuickSee referral criteria for each vision condition were chosen to maximise sensitivity at a specificity of approximately 85%-90%. Sensitivity and specificity to detect vision conditions were calculated using multiple criteria. Logistic regression was used to evaluate the benefit of adding near VA (6/12 or worse) for detecting hyperopia. A paired t-test compared QuickSee without and with fogging lenses. The mean age was 8.2 (±2.5) years (n = 174). RE ranged up to 9.25 D myopia, 8 D hyperopia, 5.25 D astigmatism and 3.5 D anisometropia. The testability of the QuickSee was 94.3%. AUC was ≥0.92 (excellent) for each level of RE. For the detection of any RE, sensitivity and specificity were 84.2% and 87.3%, respectively, using modified Orinda criteria and 94.5% and 78.2%, respectively, using the American Academy for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines. For the detection of any significant vision condition, the sensitivity and specificity of QuickSee were 81.1% and 87.9%, respectively, using modified Orinda criteria and 93% and 78.6%, respectively, using AAPOS criteria. There was no significant benefit of adding near VA to QuickSee for the detection of hyperopia ≥+2.00 (p = 0.34). There was no significant difference between QuickSee measurements of hyperopic refractive error with and without fogging lenses (difference = -0.09 D; p = 0.51). QuickSee had high discriminatory power for detecting children with hyperopia, myopia, astigmatism, anisometropia, any significant refractive error or any significant vision condition.

Unilateral Myelinated Retinal Nerve Fibers Associated with Ipsilateral Myopia, Amblyopia and Exotropia

This report describes a case of unilateral myelinated retinal nerve fibers associated with ipsilateral myopia, amblyopia and exotropia. A 3-year-old boy presented with the complaint of diminished vision in his right eye. Visual acuity testing with a picture at a distance of 2.5 m revealed 1.5 in the left eye, but right visual acuity was not available. Near visual acuity with dot cards was 0.2 in the right eye and 0.6 in the left eye. The refractive error was -7.25D and +1.50D in the right and left eyes, respectively. Fundus examination revealed extensive myelinated retinal nerve fibers in the right eye, but no abnormal findings in the left eye. The axial length was 24.10 mm and 22.90 mm in the right and left eyes, respectively. Cycloplegic retinoscopy revealed a refractive error of a −7.00D in the right eye and plane in the left eye. Glasses with full optical correction were prescribed, and the patient was evaluated one month later, presenting a best-corrected visual acuity of 0.6 in the right eye and 2.0 in the left eye with a picture at a distance of 2.5 m. Three months later, his visual acuity was 0.7 in the right eye. At this point, amblyopia treatment was started with two hours daily of left eye occlusion. One year following the initial presentation, his visual acuity improved 0.8 in the right eye. The type of fixation, the initial visual acuity, the high myopia and the high anisometropia indicated a most likely bad prognosis. However, the age of diagnosis and wearing status of glasses were advantage for treatment effect in this case. Even though this condition is associated with poor visual prognosis, intensive occlusion therapy should always be attempted, along with the prescription of a cycloplegic refraction, due to unexpected and variable responses to treatment.

COMPARISON BETWEEN AUTOREFRACTION AND RETINOSCOPY FOR SUBJECTIVE CORRECTION IN CHILDREN

The study's objective was to compare the accuracy of retinoscopy and autorefraction for subjective correction in children. The study was conducted in the Department of Ophthalmology at Nishtar Medical Hospital from June 2021 to May 2022, and it was a prospective study. The study included 60 children aged between 6 to 15 years who had asthenopic symptoms and blurring of vision. The children were given cyclopentolate 1% eyedrops thrice at intervals of 10 minutes to achieve cycloplegia. After an hour of instilling eye drops, cycloplegic retinoscopy, and autorefractometry were performed. Three values of each technique were recorded, and the average was calculated. After three days, binocular and monocular subjective refraction was performed until the best-corrected visual acuity (BCVA) was achieved. Results showed that 40.8% (49 eyes) were hypermetric, and 50% (60 eyes) were myopic based on subjective refraction. Comparison of spherical error by subjective refraction and retinoscopy showed that myopic eyes had a mean of -1.36 ± .98 and -1.08± .82 on subjective correction and retinoscopy, respectively (P=.07), and hypermetropic eyes had a mean of 2.5± .22 and 2.45± .22 on subjective correction and retinoscopy, respectively (P=0.07). Comparison of spherical error by subjective refraction and autorefractometer showed myopic eyes had a mean value of -1.51 ± 1.3 on autorefraction (P=.0001) while hypermetropic eyes had a mean of 2.39± .37 on autorefraction (P=0.0001). Mean cylindrical error values by retinoscopy were -.0729± .304, and by the subjective method, were -.167± .384 (P =0.0007). Mean cylindrical error values by autorefraction were .207± .487 compared to -.167± .384 by the subjective method (P =0.0088). In conclusion, conventional retinoscopy is the most accurate and reliable method for estimating the refractive status. However, autorefraction also has acceptable accuracy and can be used for cylindrical correction.

Comparison of the new self-contained darkroom refractive screener versus table-top autorefractor and cycloplegia retinoscopy in detecting refractive error

PurposeBy comparing the results of the new self-contained darkroom refractive screener (YD-SX-A) versus table-top autorefractor and cycloplegic retinoscopy, to evaluate the performance of the YD-SX-A in detecting refractive error in children and adolescents and then judge whether it can be used in refractive screening.MethodsCross-sectional study. 1000 participants between the ages of 6 and 18 who visited the Optometry Center of the People's Hospital of Guangxi Zhuang Autonomous Region from June to December 2022 were selected. First, participants were instructed to measure their diopter with a table-top autorefractor (Topcon KR8800) and YD-SX-A in a noncycloplegic setting. After cycloplegia, they were retinoscopy by a professional optometrist. The results measured by three methods were collected respectively. To avoid deviation, only the right eye (1000 eyes) data were used in the statistical analysis. The Bland–Altman plots were used to evaluate the agreement of diopters measured by the three methods. The receiver operating characteristic (ROC) curves was used to analysis effectiveness of detecting refractive error of YD-SX-A.ResultsThe average age of participants was 10.77 ± 3.00 years, including 504 boys (50.4%) and 496 girls (49.6%). When YD-SX-A and cycloplegia retinoscopy (CR) were compared in the myopia group, there was no statistical difference in spherical equivalent (SE) (P > 0.05), but there was a statistical difference in diopter spherical (DS) and diopter cylinder (DC) (P < 0.05). Comparing the diopter results of Topcon KR8800 and CR, the difference between each test value in the myopia group was statistically significant (P < 0.05). In the hyperopia group, the comparison between YD-SX-A and CR showed no statistically significant differences in the DC (P > 0.05), but there were significant differences in the SE and DS (P < 0.05). In the astigmatism group, the SE, DS, and DC were statistically different, and the DC of YD-SX-A was lower than that of CR and Topcon KR8800. Bland–Altman plots indicated that YD-SX-A has a moderate agreement with CR and Topcon KR8800. The sensitivity and specificity of YD-SX-A for detecting myopia, hyperopia and astigmatism were 90.17% and 90.32%, 97.78% and 87.88%, 84.08% and 74.26%, respectively.ConclusionThis study has identified that YD-SX-A has shown good performance in both agreement and effectiveness in detecting refractive error when compared with Topcon KR8800 and CR. YD-SX-A could be a useful tool for large-scale population refractive screening.

Kaleidos-based binocular vision analyzer for the estimation of refractive errors and horizontal ocular deviation in children

ABSTRACT Clinical relevance Knowing the agreement and interobserver variability of the 2WIN-S photorefractometer with cycloplegic retinoscopy and prism cover test is important for judging the clinical usefulness of the device. Background This study aims to determine an agreement and interobserver reliability between 2WIN-S photorefractometer and cycloplegic retinoscopy for estimating refractive errors and between 2WIN-S and prism cover test for measuring horizontal ocular deviation in children. Methods Two groups of 129 and 64 participants (range, 5 to 16 years) were recruited for the agreement and interobserver reliability studies, respectively. Non-cycloplegic 2WIN-S refraction was compared with cycloplegic retinoscopy for low and moderate myopia and hyperopia. Similarly, corneal reflex-function (CR-function) of 2WIN-S was compared with prism cover test for horizontal ocular deviation. Bland-Altman plots were used to depict agreement, and the intraclass correlation coefficient (ICC) was used for determining interobserver reliability of repeated measures. Results The mean differences in spherical equivalent, J0 (Cartesian astigmatism) and J45 (oblique Jackson cross-cylinder) between cycloplegic retinoscopy and 2WIN-S were 1.10 (95% CI = 0.97 to 1.21, p < 0.001), −0.06 (95% CI = −0.09 to −0.03, p < 0.001) and 0.009 (95% CI = −0.01 to 0.03, p = 0.35), respectively. The overall median difference in the horizontal ocular deviation between prism cover test and 2WIN-S was −4.5 (Interquartile range = −12.0 to 4.0). For constant strabismus, this difference was insignificant (median= −2.0, interquartile range = −11.0 to 6.7, p = 0.19) between prism cover test and 2WIN-S. The ICC was high for the spherical equivalent (0.997; p < 0.001), J0 (0.932; p < 0.001) and J45 (0.901; p < 0.001), whereas it was low-to-moderate for horizontal ocular deviation (0.50; p < 0.001). Conclusion 2WIN-S refraction was in agreement with cycloplegic retinoscopy for low and moderate myopia and hyperopia, and requires an adjustment for the consistent differences between cycloplegic retinoscopy and 2WIN-S refraction. The measurement of constant strabismus with 2WIN-S is comparable to that of prism cover test.

Effectiveness 0.05% Atropine for Controlling Myopia Progression in School Going Children

Purpose: Although there is evidence that Atropine is effective in improving myopia but there is variable response with use of 0.05% concentration. We conducted this study to find mean change in myopia progression after giving 0.05% Atropine to school going children with myopia Study Design: Quasi experimental study. Place and Duration of Study: Unit-II, Department of Ophthalmology, Mayo Hospital, Lahorefrom 3rdNovember 2020 to 3rd February 2021. Methods: One hundred children of 5 to 14 years of age with myopia greater than 0.5 D were selected by consecutive sampling.Patients with other refractive errors, other ocular diseases or ocular surgeries were excluded. Cycloplegic retinoscopy was performed and 0.05% atropine eye drops were advised once at night for 3 months. Cycloplegic retinoscope was performed and change in myopia progression (mean myopia progression rate) was calculated. Paired T-test was applied to calculate significant change in myopia. P-value≤0.05 was taken as significant. Data was stratified for age, gender and duration of myopia. Results: Mean age of children was 9.26±2.87 years. There were 40% males and Male-to-female ratio was 1:1.5. Mean duration of myopia was 13.81±6.04 months. Mean myopia at baseline was -1.02±0.30D, which was improved to -0.18±0.44 D after treatment. Mean change in myopia after treatment was -0.84±0.30 D. The change was statistically significant (p&lt;0.05). Conclusion: Atropine 0.05% is effective in reducing degrees of myopia and may help in preventing myopia progression in school going children.

Accuracy and stability of accommodation and vergence responses during sustained near tasks in uncorrected hyperopes

This study investigated the accuracy and stability of accommodative and vergence functions in children with and without hyperopia while engaged in two sustained near tasks. The sustained accommodative and vergence characteristics of participants without refractive correction (n = 92, aged 5–10 years) with and without hyperopia (defined as cycloplegic retinoscopy ≥ + 1.00D and less than + 5.00D) were measured using eccentric infrared photorefraction (PowerRef 3; PlusOptix, Germany). Binocular measures of accommodation and eye position were recorded while participants engaged in 2 tasks at 25 cm for 15 min each: (1) reading small print on an Amazon Kindle and (2) watching an animated movie on liquid crystal display screen. Comprehensive visual assessment, including measurement of presenting visual acuity, amplitude of accommodation, and stereoacuity was conducted. The magnitude of accommodative and vergence responses was not related to refractive error (P > 0.05). However, there were inter-task differences in the accuracy and stability of the accommodative responses across refractive groups (P < 0.05). The relationship between accommodation and vergence was not significant in both tasks (P > 0.05). However, increased accommodative and vergence instabilities were associated with total accommodative response (P < 0.05). Despite having greater accommodative demand, uncorrected hyperopes accommodate comparably to emmetropic controls. However, uncorrected hyperopes have increased instabilities in their accommodative and vergence responses, which may adversely impact their visual experience.

Spasm of Near Synkinetic Reflex: Outcomes of a Comprehensive Management Protocol

Objective: To find out the frequency of spasm of near reflex presenting to our clinic and outline the management outcomes. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from May to Dec 2022. Methodology: A patient who was suspected to have spasm of near reflex underwent subjective and objective refraction and detailed orthoptic evaluation. Dry and cycloplegic retinoscopy was obtained along with post-mydriatic refraction achieved after 3 days of Cycloplegic. Spasm of near reflex was categorized as mild if it resolves on administration of a weaker cycloplegic drug like cyclopentolate, moderate if administration of stronger cycloplegic i.e., atropine/homatropine is required or severe if long term home therapy of atropine 0.5% once daily is required. Results: Our study included 236 patients with suspected spasm of near reflex, among which it was confirmed in 200 only. Of the 200 patients with confirmed spasm of near reflex, there were 74 mild cases (37%), with no spasm of near reflex during their post-cycloplegic visit. Eighty-eight patients (44%) had moderate spasm of near reflex that was relieved by the post atropine examination. Whereas, 38 patients (19%) had severe spasm of near reflex, requiring long-term atropine 0.5% management. Conclusion: Spasm of near reflex is often a diagnostic dilemma which is otherwise not very difficult to treat. Most of such cases were found to be mild to moderate having good visual outcomes to once or twice application of moderate (Cyclopentolate 1%) to stronger acting Cycloplegic eye drops (Atropine 1%).

Associations between Accommodative Facility, Age, and Refractive Errors in Early, Older Adolescent Myopes and Emmetropes.

Accommodative functions are known to differ between myopes and emmetropes. It is not known whether accommodative facility differs at near between younger adolescent and older adolescent myopes and emmetropes. To examine whether accommodative facility differs at near between younger and older adolescent myopes and emmetropes. 119 participants aged between 11-21 years were recruited. Refractive error was measured using cycloplegic retinoscopy. Near monocular accommodative facility was measured for 60 seconds, using a +2.00D/-2.00D handheld flipper and N6 print at 40 cm. Participants were classified into two age groups: (i) younger adolescents (range: 11-14 years) and (ii) older adolescents (range: 15-21 years). The criterion applied to define myopia was spherical equivalent refraction: ≥-0.50D) and spherical equivalent refraction: -0.25D to +0.75D) for emmetropia. Univariate Analysis of Variance was carried out to analyze the interaction of age groups and refractive groups on near accommodative facility. Near monocular accommodative facility was significantly lower (p = 0.003) in younger adolescents (5.87 ± 3.72 cpm) compared to older adolescents (8.11 ± 4.11 cpm), indicating age as a significant main effect (F1,115 = 13.44; p = 0.0001). Younger adolescent emmetropes (4.77 ± 2.05 cpm, p = 0.005) and younger adolescent myopes (6.48 ± 4.12 cpm, p = 0.022) had significantly lower monocular near accommodative facility compared to older adolescent emmetropes (9.52 ± 3.27 cpm), but did not show any difference when compared to older adolescent myopes (p > 0.05). This indicates a significant association linking age and refractive error to near accommodative facility (F1,115 = 4.60; p = 0.03). Younger adolescent myopes and younger adolescent emmetropes had reduced monocular near accommodative facility than older adolescent emmetropes, but not when compared to older adolescent myopes.

Evaluation of a Pilot Protocol for Detecting Infant Hyperopia.

Highly hyperopic children are at greater risk for developing conditions such as strabismus, amblyopia, and early literacy and reading problems. High hyperopia is a common finding in infants in a pediatric medical practice, and early detection can be done effectively in that setting with tropicamide autorefraction. This study aimed to evaluate the effectiveness of a pilot screening program to detect high hyperopia in 2-month-old infants in a pediatric medical practice in Columbus, Ohio. Cycloplegic refractive error (1% tropicamide) was measured by retinoscopy and autorefraction with the Welch Allyn SureSight (Welch Allyn/Hillrom, Skaneateles Falls, NY) in 473 infants (55.4% female) who were undergoing their 2-month well-baby visit at their pediatrician's medical practice. Cycloplegic retinoscopy (1% cyclopentolate) was repeated at a subsequent visit in 35 infants with ≥+5.00 D hyperopia in the most hyperopic meridian during the screening. Twenty-eight infants (5.9%) had high hyperopia (spherical equivalent, ≥+5.00 D), and 61 (12.9%) had high hyperopia (≥+5.00 D in at least one meridian of at least one eye) by retinoscopy with 1% tropicamide. The mean ± standard deviation spherical equivalent tropicamide cycloplegic refractive error measured with retinoscopy was +2.54 ± 1.54 D (range, -3.25 to +7.00 D) and with SureSight was +2.29 ± 1.64 D (range, -2.90 to +7.53 D). Retinoscopy done using 1% cyclopentolate was 0.44 ± 0.54 D more hyperopic in spherical equivalent than with 1% tropicamide ( P < .001). High hyperopia was a common finding in 2-month-old infants in a pediatric medical setting that could be detected effectively by cycloplegic autorefraction using tropicamide. Greater cooperation between pediatric primary vision and medical care could lead to effective vision screenings designed to detect high hyperopia in infants.

Refractive errors and ocular findings in children and adolescents with mental disorders: a retrospective study

BackgroundAn increasing prevalence of mental disorders (MDs) has been reported among children and adolescents. However, only few studies have conducted ocular examinations, including those on refractive status, in these groups of patients. Thus, the purpose of this study was to evaluate the refractive status and ocular findings in children and adolescents with MDs compared with matched controls with similar socioeconomic backgrounds.MethodsA total of 178 participants with MDs and 200 controls were recruited between April 2021 and May 2022. All the children and adolescents underwent cycloplegic or noncycloplegic autorefraction and retinoscopy, slit-lamp biomicroscopy, and dilated fundus examinations. Ocular alignment was assessed using Hirschberg, Krimsky, or prism cover tests. The prevalence of refractive errors and ocular findings was the main outcome.ResultsTwenty-seven percent of patients with MDs and 8% of controls had ocular findings, the most common of which were conjunctivitis, keratitis, and trichiasis. For refractive status, 70% (124/178) of patients with MDs had myopia ≤-1.00 DS, and 2% (4/178) had hyperopia ≥+2.00 DS. In the control group, 70% (140/200) of patients had myopia ≤-1.00 DS, and 1% (2/200) had hyperopia ≥+2.00 DS. No differences were observed between the MD and control groups. However, the patients in the MD group (14.25±2.69 years) were significantly more susceptible to strabismus (P<0.05) and amblyopia (P<0.01) than those in the control group (13.65±3.04 years). There was a substantial difference between the two groups in the time spent on screen-based devices (P<0.001). Furthermore, mental retardation (OR=3.286, P<0.01), emotional disorders (OR=2.003, P<0.01), and adjustment disorders (OR=2.629, P<0.01) were associated with an increased risk of amblyopia. Depression (OR =1.362, P<0.01) and emotional disorders (OR=2.205, P<0.01) were associated with a higher prevalence of strabismus.ConclusionOphthalmological examinations should be performed in children and adolescents with MDs because MDs are associated with a high prevalence of refractive errors and ocular diseases. Detection and intervention of ocular and refractive findings in children and adolescents with MDs are necessary and effective in alleviating the economic burden in healthcare and improving individuals' quality of life

Refractive Changes among Diode Laser-treated Retinopathy of Prematurity Patients: A Retrospective Study.

The purpose of this study was to assess the refractive outcomes of patients who underwent indirect laser photocoagulation for prethreshold type 1 retinopathy of prematurity (ROP) and high-risk type 2 prethreshold ROP in comparison to conservatively managed low-risk prethreshold type 2 ROP. A retrospective analysis was carried out on infants screened for ROP between the years 2015 and 2020. Surviving children who had developed ROP in one or both eyes and received diode laser photocoagulation and those with conservatively managed regressed type 2 ROP who underwent at least one cycloplegic retinoscopy were included in the study. A total of 144 patients were screened for ROP between 2015 and 2020 at our institution. One hundred and thirty patients (260 eyes) fulfilled the study criteria and were included in this study. The treated group consisted of 132 eyes of 66 infants, of which 38 (14.6%) eyes had prethreshold type 1 ROP while 94 (36.2%) eyes had high-risk prethreshold type 2. The nontreated control group consisted of 128 (49.2%) eyes of 64 infants with low-risk type 2 prethreshold ROP. Earlier prematurity was found to be a significant determinant of the mean change in spherical equivalent among different gestational age groups (P = 0.035). In our cohort, we found that myopia is significantly related to Zone II ROP in comparison to Zone III ROP in the treated eyes (22% vs. 9%) (P = 0.002). No statistically significant difference was found in the final refraction among the treated eyes in relation to the birth weight or stage of prematurity. In the present study, the majority of patients who were treated with diode laser for ROP had favorable anatomical and refractive outcomes. In contrast to previous studies that had suggested a trend toward myopia in laser-treated patients, in our study, the majority (71%) were hyperopes. This study suggests that other factors such as the stage and zone of ROP possibly contribute more to the development of myopia than the laser photocoagulation itself.

Comparison of Cycloplegic Refraction Versus Dynamic Retinoscopy in Children from 5 to 12 Years of Age

Refractive errors are a noteworthy cause of visual disruption worldwide. Objective: To compare the results of dynamic and cycloplegic retinoscopy in children. Methods: A descriptive-type cross-sectional study was conducted at the university of Lahore teaching hospital on 50 patients from 5 to 12 years of age. Approval was taken from the ethical board of the institution and informed consent from patient’s parents. Patients who had any other ocular pathology other than refractive errors were excluded. To study the refraction results in children, first in a dark room, retinoscopy without cycloplegic was performed then 1% cyclopentolate eye drops were used. After that retinoscopy was done under cycloplegic effect results were compared after being converted into spherical equivalent. Paired sample t-test was applied to compare means. P &lt; .05 was taken as significant. Results: There were 25 males and 25 females. The mean age in years was 7.66 ±there were 12 myopic patients, 22 hypermetropic and 16 astigmatic patients. The mean logMar of visual acuity uncorrected was 0.5 ± 0.23 and the best corrected visual acuity was 0.1± 0.01. The mean S.E of right eye dynamic retinoscopy was 1.78±2.60, cycloplegic retinoscopy 1.52± 2.54 and of left eye was 1.72±49 and1.47± 2.34 respectively. It can be deduced that on average 0.26D more by dynamic retinoscopy. A significant correlation with r 0.96 and r 0.94 in left eye existed. Conclusion: There is a significant difference between cycloplegic retinoscopy and near retinoscopy. It was deduced that near retinoscopy showed more hypermetropic readings than cycloplegic retinoscopy

Compensation for Vitreous Chamber Elongation in Infancy and Childhood.

The ratios of diopters of change in refractive error produced per millimeter of eye elongation (D/mm) are rarely those predicted from geometric optics because of changes in other ocular components. Quantifying this optical compensation in millimeters instead of ratios reveals some important principles about eye growth and refractive error. The study purpose was to sort total vitreous chamber elongation into millimeters that either contributed (uncompensated) or did not contribute to change in refractive error (compensated). Participants were infants in the Berkeley Infant Biometry Study (n = 271, ages 3 months to 6 years) or schoolchildren in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (n = 456 emmetropes and 522 myopes, ages 6 to 14 years). Refractive error was measured using cycloplegic retinoscopy in infants (cyclopentolate 1%) and cycloplegic autorefraction in schoolchildren (tropicamide 1% or combined with cyclopentolate 1%). Axial dimensions were assessed using A-scan ultrasonography. Uncompensated millimeters were estimated from ratios of change in refractive error per millimeter of elongation using Gullstrand eye models. Compensated millimeters were the difference between measured elongation and uncompensated millimeters. Compensated millimeters exceeded uncompensated millimeters in emmetropic children across ages, but uncompensated millimeters exceeded compensated millimeters in myopic children. Compensated millimeters were highest in infancy and decreased with age, reaching less than 0.10 mm per year by age 10 years in both myopic and emmetropic children. There were no statistically significant differences in compensated millimeters between myopic and emmetropic children between ages 8 and 14 years ( P values from .17 to .73). The ability of the ocular components, primarily crystalline lens, to compensate for vitreous elongation is independent of the higher demands of myopic eye growth. The limited compensation after age 10 years suggests the target for elongation in myopia control needed to arrest myopia progression may be that seen in emmetropes or less.

The use of chloral hydrate sedation in pediatric strabismus outpatient clinic

Purpose To assess the use of oral chloral hydrate (CH) sedation in uncooperative children to perform a precise cycloplegic retinoscopy and a thorough dilated fundus examination in an outpatient strabismus and nystagmus clinic. Patients and methods A prospective study was conducted on 114 uncooperative children (119 sedation episodes) who were attending the strabismus and nystagmus outpatient clinic at Menoufia University Hospital. Children were sedated by the first dose of CH (50 mg/kg). A second dose, half-strength of the first dose, was given if no adequate sedation occurred after 30 min. The degree of sedation was graded into five categories: excellent, good, fair, poor, and failure. All demographic characteristics, sedation success, failure, and adverse events were reported and statistically analyzed. Results The mean age of children was 23.38 months (range: 5.16–62.06), and their weight ranged from 6.5 to 22 kg. The total CH dose ranged from 325 to 1500 mg. A total of 78 sedation episodes were reported by a single dose, and 41 by two doses. The percentage of the grade of sedation in our 119 episodes was as follows: excellent (56.3%), good (9.2%), fair (28.6%), poor (2.5%), and failure (3.4%). The overall success of one dose was 65.5%, which increased to 96.6% by a second supplemental dose. The most common complication was vomiting (13.4%). Other complications included prolonged drowsiness (one case) and paradoxical agitation (two cases). Spearman correlation showed a significant positive correlation between the degree of sedation and the total dose of CH (r=0.603, P&lt;0.001). Conclusion According to our study, the use of CH was found to have a high success rate with two doses, without major adverse events.

Instrument referral criteria for PlusoptiX and SureSight based on 2021 AAPOS guidelines: A population-based study.

ObjectiveThe study aims to assess two refractive instrument-based methods of vision screening (SureSight and PlusoptiX) to detect refractive amblyopia risk factors (ARFs) and significant refractive errors in Chinese preschool children and to develop referral criteria according to the 2021 AAPOS guidelines.MethodsEye examinations were conducted in children aged 61 to 72 months (n = 1,173) using a PlusoptiX photoscreener, SureSight autorefractor, and cycloplegic retinoscopy (CR). The Vision Screening Committee of AAPOS's preschool vision screening guidelines from 2021 were adopted for comparison. Paired t-test analysis and Bland–Altman plots were used to assess the differences and agreement between the PlusoptiX photoscreener, SureSight autorefractor, and CR. In addition, the validity of the cut-off values of the several ARFs measured with the SureSight and PlusoptiX was estimated using receiver operating characteristic (ROC) curves and compared to the age-based 2021 AAPOS examination failure levels.ResultsA total of 1,173 children were tested with comprehensive eye examinations. When the referral numbers based on the 2013 (43/3.67%) and 2021 (42/3.58%) AAPOS guidelines were compared, significant differences between the values of astigmatism (72.09 vs. 52.38%) and anisometropia (11.63 vs. 38.10%) were found. The 95% limits of agreement (LOA) of the spherical value and the cylindrical value between PlusoptiX and CR were 95.08 and 96.29%. It was 93.87 and 98.10% between SureSight and CR. Considering refractive failure levels, the ROC curves obtained the optimal cut-off points. However, the PlusoptiX and the SureSight showed lower efficiency in hyperopia (Youden index, 0.60 vs. 0.83) and myopia (Youden index, 078 vs. 0.93), respectively. After adjusting the above cut-off points, the optimized NES (Nanjing Eye Study) referral criteria for myopia, hyperopia, astigmatism, and anisometropia were –0.75, 1.25, –1.0, and 0.5 with PlusoptiX and –1.25, 2.75, –1.5, and 0.75 with SureSight.ConclusionsSureSight and PlusoptiX showed a good correlation with CR and could effectively detect refractive ARFs and visually significant refractive errors. There were obvious advantages in detecting hyperopia using SureSight and myopia using PlusoptiX. We proposed instrumental referral criteria for age-based preschool children based on AAPOS 2021 guidelines.

A prospective cohort study on refractive status of schoolchildren in Huangzhong District, Xining City, Qinghai Province

Objective: To determine the characteristics and progress of the visual acuity and refractive state of schoolchildren in Huangzhong District, Xining City, Qinghai Province in China. Methods: Cohort study. Department of Ophthalmology, Beijing Children's Hospital carried out a cohort study by collecting the visual acuity and refractive state of Grade 1-5 schoolchildren among 16 primary schools in Huangzhong District, Xining City, Qinghai Province in September 2020 and July 2021. Cycloplegic retinoscopy with eye drop which contained tropicamide (0.5%) and phenylephrine hydrochloride (0.5%) was performed in children with low vision(<1.0). Myopia was defined as the spherical equivalent (SE) ≤-0.5 D after cycloplegic retinoscopy. Measurement data was analyzed by t-test and enumeration data was analyzed by χ2 test. Multiple linear regression was used to analyze the influencing factors. Results: The 2 489 individuals with repeated tests in two years were included in the follow-up study, among whom the prevalence of myopia was 26.24%(653/2 489) in 2020, while 32.94% (820/2 489)respectively in 2021. The incidence of myopia in one school year from grades 1 to 5 was 11.19%(47/420), 5.44%(21/386), 6.39%(25/391), 11.52%(44/382) and 11.67%(30/257). The average SE of children in all grades in 2021 increased negatively from the previous year (Grade 1 to Grade 5 increased respectively: 0.40 D, 0.69 D, 0.62 D, 0.52 D and 0.37 D). Conclusions: The prevalence of myopia among schoolchildren in Huangzhong District, Xining City, Qinghai Province was relatively high. There were two peaks of myopia incidence in the first, fourth and fifth grades. Female, age, and the baseline of SE were the related influencing factors for myopia progression.