Cycloplegic Retinoscopy Research Articles

Extraordinarily Low Prevalence of Refractive Error and Visual Impairment in Primary and Secondary School Learners in Kabwe District, Zambia

Objective: Kabwe District is largely an urban town in the Central Province of Zambia. We aimed to determine the prevalence of refractive errors and visual impairment in primary and secondary school learners in this District.
 Method: A cross-sectional survey of 41 primary and secondary schools in Kabwe District. The examination included visual acuity (VA) testing, cycloplegic retinoscopy with subjective refinement if indicated, ocular motility testing and anterior segment and fundus examinations in visually impaired children.
 Results: There was an estimated total of 32,971 learners who were eligible to participate of which 23,915 (72.5%) were enrolled into the survey. Of the 2,424 learners examined by the mobile ophthalmic team, 418 were refracted representing 17.2 %. Of the 418 learners refracted, 359 were diagnosed with refractive errors and prescribed spectacles. The mean spherical equivalent in the right eyes was 0.57 diopter (D) (95% confidence interval [CI], 0.49 - 0.75), and the mean spherical equivalent in the left eyes was 0.59 (95% CI, 0.50 - 0.71). The prevalence of hyperopia was 0.9% (95% CI, 0.4 - 1.3; 207 subjects), and the prevalence of myopia was 0.5% (95% CI, 0.1-1.0; 119 subjects). The majority of learners (98.3%; 95% CI, 97.0 -99.0) had normal unaided binocular VA (at least 6/9 in their better eye). The overall prevalence of any visual impairment (presenting VA 6/9 in the better eye) was 1.7% (95% CI, 1.0 -2.5; 418 subjects) and the overall refractive error prevalence was 1.5% (95% CI, 1.0 -2.3; 359 subjects). In multivariate logistic regression analysis, age (P 0.001) was a significant predictor and female gender (P 0.06) was a borderline significant predictor of the presence of any visual impairment.
 Conclusions: Visual impairment is not a public health concern in this school-aged population in Kabwe District. The prevalence of uncorrected significant refractive errors among learners is not too high to justify a regular school eye screening programme in schools in Kabwe District.

Prevalence of Eye Diseases among Primary and Secondary School Learners in Kabwe District - Zambia

Objective: To determine the pattern and magnitude of eye diseases among primary and secondary school learners in Kabwe District in Zambia.
 Method: A cross-sectional study of 41 primary and secondary schools in Kabwe District. The examination included visual acuity (VA) testing, cycloplegic retinoscopy with subjective refinement if indicated, ocular motility testing, anterior segment and fundus examinations m visually impaired children.
 Results: There was an estimated total of 32,971 learners who were eligible to participate of which a total of23,915 (72.5%) were enrolled into the study. The prevalence of eye diseases was 8.3%, with allergic conjunctivitis 5.7% followed by refractive error 1.5% and the least was pengicular disorder at 0.008%. None of those with refractive errors had an eye examination in the past. Glaucoma was diagnosed in three learners (0.01 %).
 Conclusion: The survey found a moderate prevalence of eye diseases among the learners in Kabwe District with allergic conjunctivitis being the most prevalent cause followed by exceptionally low prevalence of refractive errors.

Prevalence of Eye Diseases among Primary and Secondary School Learners in Kabwe District - Zambia

Objective: To determine the pattern and magnitude of eye diseases among primary and secondary school learners in Kabwe District in Zambia.
 Method: A cross-sectional study of 41 primary and secondary schools in Kabwe District. The examination included visual acuity (VA) testing, cycloplegic retinoscopy with subjective refinement if indicated, ocular motility testing, anterior segment and fundus examinations m visually impaired children.
 Results: There was an estimated total of 32,971 learners who were eligible to participate of which a total of23,915 (72.5%) were enrolled into the study. The prevalence of eye diseases was 8.3%, with allergic conjunctivitis 5.7% followed by refractive error 1.5% and the least was pengicular disorder at 0.008%. None of those with refractive errors had an eye examination in the past. Glaucoma was diagnosed in three learners (0.01 %).
 Conclusion: The survey found a moderate prevalence of eye diseases among the learners in Kabwe District with allergic conjunctivitis being the most prevalent cause followed by exceptionally low prevalence of refractive errors.

Extraordinarily Low Prevalence of Refractive Error and Visual Impairment in Primary and Secondary School Learners in Kabwe District, Zambia

Objective: Kabwe District is largely an urban town in the Central Province of Zambia. We aimed to determine the prevalence of refractive errors and visual impairment in primary and secondary school learners in this District.
 Method: A cross-sectional survey of 41 primary and secondary schools in Kabwe District. The examination included visual acuity (VA) testing, cycloplegic retinoscopy with subjective refinement if indicated, ocular motility testing and anterior segment and fundus examinations in visually impaired children.
 Results: There was an estimated total of 32,971 learners who were eligible to participate of which 23,915 (72.5%) were enrolled into the survey. Of the 2,424 learners examined by the mobile ophthalmic team, 418 were refracted representing 17.2 %. Of the 418 learners refracted, 359 were diagnosed with refractive errors and prescribed spectacles. The mean spherical equivalent in the right eyes was 0.57 diopter (D) (95% confidence interval [CI], 0.49 - 0.75), and the mean spherical equivalent in the left eyes was 0.59 (95% CI, 0.50 - 0.71). The prevalence of hyperopia was 0.9% (95% CI, 0.4 - 1.3; 207 subjects), and the prevalence of myopia was 0.5% (95% CI, 0.1-1.0; 119 subjects). The majority of learners (98.3%; 95% CI, 97.0 -99.0) had normal unaided binocular VA (at least 6/9 in their better eye). The overall prevalence of any visual impairment (presenting VA 6/9 in the better eye) was 1.7% (95% CI, 1.0 -2.5; 418 subjects) and the overall refractive error prevalence was 1.5% (95% CI, 1.0 -2.3; 359 subjects). In multivariate logistic regression analysis, age (P 0.001) was a significant predictor and female gender (P 0.06) was a borderline significant predictor of the presence of any visual impairment.
 Conclusions: Visual impairment is not a public health concern in this school-aged population in Kabwe District. The prevalence of uncorrected significant refractive errors among learners is not too high to justify a regular school eye screening programme in schools in Kabwe District.

Does methylphenidate treatment affect functional and structural ocular parameters in patients with attention deficit hyperactivity disorder? - A prospective, one year follow-up study.

Purpose:Methylphenidate hydrochloride, which blocks the reuptake mechanisms of dopamine and norepinephrine, is used in attention deficit hyperactivity disorder (ADHD) treatment. Methylphenidate has many general side effects including ocular findings. In this study, we investigated the long-term effects of methylphenidate treatment on functional and structural ocular parameters.Methods:In this prospective study, children with ADHD were evaluated. All patients underwent a detailed ophthalmic examination before methylphenidate treatment. All patients were examined in the 3rd, 6th, 9th, 12th months of methylphenidate treatment. Visual acuities, color vision, pupil diameters, static, dynamic and cycloplegic retinoscopy, intraocular pressure (IOP), anterior chamber depth (ACD), axial length (AL) were evaluated and recorded.Results:A total of 22 children were included in this study. The best-corrected visual acuities (BCVA) of all patients for both eyes were 0.0 logMAR, and 90.9% of patients had blue–purple color weakness before the treatment. After 1 year of treatment, none of the patients had any change in BCVA and color vision. However, an increase in myopic values of static retinoscopy and a decrease in hyperopic values of cycloplegic retinoscopy were found. Additionally, accommodation capacities were found to be decreased and AL was found to be increased significantly for both eyes. Pupil diameter, IOP, and ACD values did not change significantly.Conclusion:Our results suggest that patients with ADHD may have blue color vision deficiencies because of the decreased retinal dopamine levels. Additionally, structural and ocular parameters, especially accommodation capacity, may be affected by methylphenidate treatment.

Cycloplegic Autorefraction as a Substitute for Cycloplegic Retinoscopy in the Pediatric Population.

To evaluate whether cycloplegic autorefraction can provide similar results as cycloplegic retinoscopy, allowing more comprehensive ophthalmologists to be comfortable in managing pediatric refractive error and refractive amblyopia. This retrospective chart review was performed to determine the mean difference in sphere, cylinder, and axis between cycloplegic autorefraction and retinoscopy, both of which were obtained on the same eye at least 30 minutes after cycloplegia and dilation with a mixed solution of tropicamide, cyclopentolate, and phenylephrine. A total of 34 eyes (18 right, 16 left) from 18 patients were included in the analysis. Mean sphere difference between cycloplegic autorefraction and retinoscopy was 0.044 ± 0.278 diopters (D) (95% CI: -1.275 to 1.363 D), mean cylinder difference was -0.081 ± 0.236 D (95% CI: -0.706 to 0.544 D), and mean axis difference was 7.059 ± 19.676 degrees (95% CI: -32.527 to 38.878 degrees). Mean differences in sphere, cylinder, and axis were not statistically significant (P = .362, .0541, and .377, respectively). In this small sample population, cycloplegic autorefraction was comparable to cycloplegic retinoscopy. Recognition of amblyopia should still prompt evaluation by a pediatric ophthalmologist. Further research is necessary to confirm whether uncomplicated refractive error in children may be sufficiently detected and managed by a comprehensive ophthalmologist. [J Pediatr Ophthalmol Strabismus. 2022:59(6):422-427.].

Assessment of Refractive Status of 5-15 Years Old Children Attending Government Schools of Rural Agra

Introduction: In children uncorrected refractive errors have a profound effect on educational and psychosocial development hence it is necessary to estimate the prevalence both at the community and at the school level to aid planning and implementation of refractive error services in children. Objective: To determine the refractive status of 5 to 15 years old children attending government schools of rural areas of district Agra, Uttar Pradesh (UP), India. Method: Study conducted on 902 students of age group 5-15 years of randomly selected government schools of Bichpuri Block of district Agra. Children underwent visual acuity assessment and torch light examination, height and weight measurement. Children with VA ≤6/9 were further examined and cycloplegic retinoscopy, fundus examination, slit lamp examination and post mydriatic refraction was done. On the basis of values of cycloplegic refraction and post mydriatic refraction, refractive error was classified as myopia, hypermetropia and astigmatism. Statistical Analysis was done by applying Chi square test. Result: Out of 902 children, 125 children (13.86 %) were having refractive error of which 76 were myopic (8.43%), 39 were astigmatic (4.32%) and 10 were hypermetropic (1.11%). There was an increase in the overall prevalence of refractive error with advancing age. There was no significant association of refractive error with gender and nutritional status. Conclusion: Vision screening of school children is very useful for early detection and correction of refractive errors. Screening of the refractive errors in school should be carried out periodically and regularly.

Prevalence and related factors of myopic retinopathy – a hospital-based cross-section study in Vietnam

ABSTRACT Clinical relevance Myopia prevention and anti-myopia treatment is of great importance in South East Asia. Background To evaluate the prevalence and related factors of myopic retinopathy in Vietnam. Methods A cross-sectional study was conducted on 168 eyes of 88 patients with high myopia presenting to the Refraction Department of Vietnam National Eye Hospital. Inclusion criteria were high myopia (≤−6.00D with cycloplegic retinoscopy). Consecutive presenting patients recruited between January 2020 and August 2020 consented to participate. Results Participant age range was 12–47 years. Peripapillary atrophy was present in 70.2% of participants, most commonly atrophy of one-quarter of the disc (38.7%). Central retinal changes were present in 66.1% of participants, subclassified as tessellated fundus in 60.7%, diffuse chorioretinal atrophy in 4.2% and patchy chorioretinal atrophy in 1.2%. Peripheral retinal lesions were present in 43.5% of participants, consisting of white-without-pressure in 32.1%, lattice degeneration in 16.1%, snail track degeneration in 4.2% and microcystoid degeneration in 1.2%. Myopia ≤−8.00D and axial length ≥26.5 mm were associated with additional risk of posterior ocular complications. Furthermore, age ≥19 years increased risk of central myopic retinopathy and ≥10 years since initial myopia diagnosis increased the risk of peripapillary atrophy and central retinal changes. Other factors such as the age of onset of myopia and family myopia history did not appear to alter the risk of peripheral retina damage. Conclusions Retinal disorders were common in Vietnamese people with high myopia. Within the current cohort with high myopia, myopia ≤−8.00D and axial length ≥26.5 mm were associated with a significant further elevation of risk.

Amblyopia screening for first and second-grade children in Jordan.

To share the results of a national screening program for amblyopia in school children in the north of Jordan. This is a prospective national screening study for amblyopia. The program rolls first and second-grade children (6 to 7 years old) in the north of Jordan. The eye examination included: best-corrected visual acuity, cover-uncover test, and cycloplegic retinoscopy. Monocular visual acuity was tested using an ETDRS visual acuity chart without correction. Moreover, children were tested with full cycloplegic refraction when the test criteria were met. Unilateral amblyopia was defined as a best-corrected visual acuity difference of 2 or more lines. In comparison, bilateral amblyopia was defined as a best-corrected visual acuity of 20/40 or worse in the best eye. The prevalence of amblyopia for the total sample tested (n=17 203) was 2.78% (n=479). The most common cause of amblyopia was hypermetropia (64.45%), followed by previous ocular surgeries (15.1%), myopia (10.43%), strabismus (9.39%), and congenital cataract (0.63%). This is the first and only study, identifing modifiable risk factors in Jordanian children with amblyopia. In their first couple of years of elementary education, many Jordanian children are affected by amblyopia and pass unnoticed. A more governmental effort is needed into screening programs to improve vision in the Jordanian population.

Prevalence of Visual Disorders among Urban Palestinian Preschool Children

Background: Childhood blindness is a major public health concern since 40% of visual disorders that can cause blindness among children are preventable. Vision screening programs among preschool children have been implemented in several countries as a tool for early detection and intervention of visual disorders. In Palestine, there is a lack of scientific data on the prevalence of visual disorders among children. In addition, vision-screening programs that are currently implemented are neither validated nor effective. Objective: Using validated vision screening protocols, a cross-sectional study is conducted to determine the prevalence of visual disorders among urban Palestinian preschool children between the ages of 3 to 5 years in Nablus city. Methods: All children attending eight preschools selected using single-stage cluster sampling technique, underwent a validated vision screening administered by trained eye care professionals. The screening protocol was based on a combination of clinical assessment adopted from the Modified Clinical Technique and the Vision in Preschoolers studies, including assessment of visual acuity, ocular alignment, depth perception, color vision, non-cycloplegic retinoscopy, and ocular health. A pass-fail criterion was used to refer all children who did not attend the vision screening for comprehensive eye examination, including cycloplegic retinoscopy and a dilated fundus exam. A chi-squared test was used to determine any association between visual disorders and their independent risk factors. Results: A total number of 764 children underwent vision screening. Out of the 290 children who did not attend the vision screening, 127 children responded to the referral call for comprehensive eye examinations. Refractive error was the most prevalent visual disorder with a prevalence of (29.37%), followed by amblyopia (4.10%), color vision deficiency (1.24%), strabismus (1.24%), and ocular health abnormalities (0.70%). There was no age (p=0.35) and gender (p=0.32) variation in children having refractive errors. Anisometropia was the leading cause for amblyopia (1.32%, n=7), followed by significant refractive error (1.13%, n=6) and strabismus (0.37%, n=2). Conclusion: Refractive error was the most prevalent visual disorder affecting Palestinian preschoolers in Nablus. Anisometropia and significant refractive errors were found to be the major causes of amblyopia. Effective nationwide preschool vision screening programs should be implemented in Palestine to screen amblyogenic risk factors.

Correlation and agreement between the Mohindra and cycloplegic retinoscopy techniques in children.

As an objective technique to assess refractive status, retinoscopy is particularly useful in children. The Mohindra technique (RM) is an alternative for those patients not good candidates for cycloplegic retinoscopy (RC). The aim of the present research was to compare both techniques and to determine the correlation and agreement of their measurements. A total of 47 boys and girls of ages ranging from 3 to 11 years old were included in the study. Cycloplegic (cyclopentolate 1%) and Mohindra retinoscopy were conducted in both eyes, and refraction was also assessed with an autorefractometre (AR). The results from the three techniques were compared and a correction factor between RM and RC was calculated. Statistically significant differences were found between RM and RC (median of -0.42 D; p < 0.001) and between RM and AR (median of -0.42 D; p = 0.008), but not between RC and AR (median of 0.00 D; p = 0.758). A strong correlation was found between RM and RC (rho = 0.846; p < 0.001), although the Bland-Altman test revealed a larger difference between these techniques in patients with larger hyperopic refractive errors, with a correction factor of RC = 1.15 RM + 0.42. The Mohindra technique may be considered a valid alternative to cycloplegic retinoscopy in patients of young age, with a good correlation between both techniques, albeit less agreement in patients with high hyperopic refractions.

Clinical Profile of Refractive Errors Associated with Screen Time in Children Aged 5-15 Years in a Tertiary Care Hospital of Southern India during COVID Pandemic: A Prospective Study

Introduction: Refractive errors cannot be prevented, but it is important to detect them early to improve the quality of life and prevention of blindness. Refractive errors screening in children during COVID pandemic was difficult task as they were high-risk group. Increased near activity due to online classes and smart devices usage may increase the uncorrected refractive errors. The study emphasizes on the refractive errors screening during COVID pandemic. Aim: To study the clinical profile of refractive errors of the children aged 5-15 years in a tertiary care hospital in COVID pandemic in association with screen time, outdoor activity, type of gadget, amblyopia and educational status of mother. Materials and methods:This was a hospital based prospective analytical study conducted in children 5-15 yrs attending the Ophthalmology Outpatient Department of ESIC Medical College and Hospital from May 2021 to October 2021.Children were screened for refractive errors and compared with the refractive errors data of different children of same age referred from Paediatric Outpatient Department and who attended to Ophthalmology Outpatient Department for regular eye checkup in pre-pandemic time. Unaided visual acuity of all children were measured with the help of Snellen’s chart. Children with refractive errors underwent Cycloplegic Retinoscopy followed by post-mydriatic test. Screen time and outdoor activity duration were recorded. Interpretation and analysis of obtained results was carried out using Statistical Package for Social Sciences version 22.0 for descriptive statistics. Non-parametric tests like Pearson Chi-square test were used to express the qualitative data.Data with p-value less than 0.05 was considered statistically significant. Results: A total of 790 children were screened out of which 358 (45.3%) presented with refractive error when compared with the pre pandemic prevalence 276 (34.9%) out of 790 children screened, presented with the refractive error. A total of 118 (33%) of the children presented with increased blink rate associated with increased screen time and dry eye. Rate of progression of more than 1D was observed in 44 (12.29%) of which Myopia 28 (7.8%) Astigmatism 10 (2.7%) and hypermetropia 6 (1.6%) in 6 months. A total of 286 (79.8%) children presented with myopia and 24 (6.7%) presented with hypermetropia, 48 (13.4%) presented with astigmatism. A total of 258 (72.06%) presented with screen time for 4-7 hrs, and 32 (8.9%) children presented with amblyopia. Conclusion: Refractive errors increased due to smart classes in schools or use of laptops, television viewing, computers or mobiles. Hence, this reinforces the need to screen all the school going children and children with the history of gadgets use

Can photoscreening effectively detect amblyogenic risk factors in children with neurodevelopmental disability?

Purpose:To analyze whether photoscreening can effectively detect amblyogenic risk factors in children with neurodevelopmental disability.Methods:A prospective study of 52 children attending a special school for children with neurodevelopmental disability from December 2017 to May 2018. All were initially tested with a photoscreening device: Welch Allyn® Spot® Vision Screener: model VS100 (Spot®) and further evaluated at a later date by a pediatric ophthalmologist, with a complete ocular evaluation including squint assessment, cycloplegic retinoscopy, and dilated fundus examination. The key parameters studied were demographic features, type of neurodevelopmental disability, refraction, ocular alignment, media clarity, any other ocular morbidity, and time taken for examination. The presence of amblyogenic risk factors (ARF) was analyzed as per the 2013 guidelines of the American Association for Pediatric Ophthalmology and Strabismus.Results:The mean age was 10.5 years (range: 1–17.5 years). Males (73.1%) outnumbered females (26.9%). The most common neurodevelopmental disability was cerebral palsy. Simple myopic astigmatism was the most common type of refractive error. Presence of ARF in our study was 73.1%. The sensitivity and specificity of photoscreening in detecting ARF were 96.5% and 63.61%, respectively, with a positive predictive value of 80% and negative predictive value of 92.31%. The predictive ability of photoscreening was 79.9% as per the area under curve. The average time taken for photoscreening was less than 60 s.Conclusion:Photoscreening can detect ARF with high sensitivity and reasonable specificity and is a handy, useful, and time-saving tool in screening children with neurodevelopmental disability.

Detection of Significant Hyperopia in Preschool Children Using Two Automated Vision Screeners.

Moderate to high uncorrected hyperopia in preschool children is associated with amblyopia, strabismus, reduced visual function, and reduced literacy. Detecting significant hyperopia during screening is important to allow children to be followed for development of amblyopia or strabismus and implementation of any needed ophthalmic or educational interventions. This study aimed to compare the sensitivity and specificity of two automated screening devices to identify preschool children with moderate to high hyperopia. Children in the Vision in Preschoolers (VIP) study were screened with the Retinomax Autorefractor (Nikon, Inc., Melville, NY) and Plusoptix Power Refractor II (Plusoptix, Nuremberg, Germany) and examined by masked eye care professionals to detect the targeted conditions of amblyopia, strabismus, or significant refractive error, and reduced visual acuity. Significant hyperopia (American Association for Pediatric Ophthalmology and Strabismus definition of hyperopia as an amblyopia risk factor), based on cycloplegic retinoscopy, was >4.00 D for age 36 to 48 months and >3.50 D for age older than 48 months. Referral criteria from VIP for each device and from a distributor (PediaVision) for the Power Refractor II were applied to screening results. Among 1430 children, 132 children had significant hyperopia in at least one eye. Using the VIP referral criteria, sensitivities for significant hyperopia were 80.3% for the Retinomax and 69.7% for the Power Refractor II (difference, 10.6%; 95% confidence interval, 7.0 to 20.5%; P = .04); specificities relative to any targeted condition were 89.9 and 89.1%, respectively. Using the PediaVision referral criteria for the Power Refractor, sensitivity for significant hyperopia was 84.9%; however, specificity relative to any targeted condition was 78.3%, 11.6% lower than the specificity for the Retinomax. Analyses using the VIP definition of significant hyperopia yielded results similar to when the American Association for Pediatric Ophthalmology and Strabismus definition was used. When implementing vision screening programs for preschool children, the potential for automated devices that use eccentric photorefraction to either miss detecting significant hyperopia or increase false-positive referrals must be taken into consideration.

Correlación y concordancia entre la técnica de retinoscopia de Mohindra y la retinoscopia con ciclopléjico en la infancia

PurposeAs an objective technique to assess refractive status, retinoscopy is particularly useful in children. The Mohindra technique (RM) is an alternative for those patients not good candidates for cycloplegic retinoscopy (RC). The aim of the present research was to compare both techniques and to determine the correlation and agreement of their measurements. Material and MethodsA total of 47 boys and girls of ages ranging from 3 to 11 years old were included in the study. Cycloplegic (cyclopentolate 1%) and Mohindra retinoscopy were conducted in both eyes, and refraction was also assessed with an autorefractometre (AR). The results from the three techniques were compared and a correction factor between RM and RC was calculated. ResultsStatistically significant differences were found between RM and RC (median of -0.42 D; p<0.001) and between RM and AR (median of -0.42 D; p=0.008), but not between RC and AR (median of 0.00 D; p=0.758). A strong correlation was found between RM and RC (rho=0.846; p<0.001), although the Bland-Altman test revealed a larger difference between these techniques in patients with larger hyperopic refractive errors, with a correction factor of RC=1.15 RM + 0.42. ConclusionsThe Mohindra technique may be considered a valid alternative to cycloplegic retinoscopy in patients of young age, with a good correlation between both techniques, albeit less agreement in patients with high hyperopic refractions.

Refractive Error Profile of Preterm Infants at 1-Year Follow-up in a Tertiary Care Hospital.

To study the refractive outcome in preterm infants with and without retinopathy of prematurity (ROP) in a tertiary care hospital in North India. This prospective study was conducted on 300 consecutive premature infants with a birth weight of 2 kg or less and a gestational age of 34 weeks or less at birth. The infants were divided into three groups (no ROP, spontaneously regressed ROP, and laser-treated ROP) and were followed up at 1 year of age to assess the presence and type of refractive error in each group. The refractive error data were available for 277 neonates (554 eyes). On cycloplegic retinoscopy at 1 year of follow-up, the incidence of myopia was 12.29%, 29.55%, and 48.83% in all three groups, respectively, being most common in the laser-treated group, and the values were statistically significant (P < .05). Moreover, high myopia was most prevalent in the laser-treated group (23.25%). A correlation between birth weight and gestational age with spherical equivalent showed that a low birth weight and a low gestational age are more commonly found in infants with a more negative spherical equivalent. Infants with laser-treated ROP have a higher incidence of myopia than those with spontaneously regressed ROP or no ROP. [J Pediatr Ophthalmol Strabismus. 2022;59(3):151-155.].

Posterior Polymorphous Corneal Dystrophy in a Pediatric Population.

The aim of this study was to evaluate the clinical and topographic features of posterior polymorphous corneal dystrophy (PPCD) in children aged 15 years or younger with a long-term follow-up. Retrospective case series. A retrospective chart review of patients who were diagnosed with PPCD at Boston Children's Hospital from 1999 to 2020 was performed. Data collected included age at the time of diagnosis, slit lamp findings, cycloplegic refraction, best-corrected visual acuity, central corneal thickness, specular microscopy, and corneal topography findings whenever available. Twenty-seven eyes of 19 patients were included (11 unilateral and 8 bilateral cases). Ten patients were girls (52.6%). Left eye was affected in 14 eyes. The mean age at the time of diagnosis was 8.5 ± 3.3 years, with a mean follow-up of 5.3 years. In unilateral cases, there was a statistically significant difference in the endothelial cell density (P = 0.01), coefficient variation (P = 0.03), and hexagonality (P = 0.01) between the affected and the contralateral unaffected eyes. The mean best-corrected visual acuity at initial presentation was 0.8 ± 0.2 compared with 0.9 ± 0.08 in unaffected eyes (P = 0.04). The mean astigmatism was higher in the affected eye (+1.7 diopters) compared with (+1.00) the unaffected eye (P = 0.07). At initial presentation, 7 of 27 eyes had amblyopia, which resolved, either partially or completely, in 5 eyes after treatment. PPCD can present early in children with astigmatism and anisometropic amblyopia. A careful slit lamp examination for children presenting with anisoastigmatism is necessary to diagnose PPCD. Contrary to adults, presentation is often unilateral. Such patients should be followed up regularly with cycloplegic retinoscopy to prevent and treat refractive amblyopia if present.

Comparing School-Aged Refraction Measurements Using the 2WIN-S Portable Refractor in Relation to Cycloplegic Retinoscopy: A Cross-Sectional Study.

Purpose To assess the repeatability and agreement of refractive measurements using 2WIN-S photoscreening with the gold-standard cycloplegic retinoscope refraction. Design Single centre, cross-sectional study. Methods Spherical, cylindrical, axis, and spherical equivalent of 194 bilateral eyes of 97 children were assessed using a retinoscope and 2WIN-S. One week later, another operator repeated the 2WIN-S measurements. The primary outcome measures were to assess the repeatability and agreement between spherical equivalent, J0, and J45 readings of 2WIN-S. The repeatability of measurements was assessed by the within-subject standard deviation (2.77 Sw) and intraclass correlation coefficient (ICC). The agreement between devices was assessed using 95% limits of agreement. The extent of the agreement between cycloplegic retinoscopy and noncycloplegic 2WIN-S measurements was assessed using Bland–Altman analysis. Results The mean age ± SD was 10.3 ± 2.46 year (range, 4–14 years). The sphere, cylinder, and spherical equivalent measurements were found to be consistent with both apparatus (r value >0.86). ICC for SE, J0, and J45 was 0.900, 0.666, and 0.639, respectively; Sw for SE, J0, and J45 was 0.61D, 0.30D, and 0.31D, respectively; Bland–Altman analysis of retinoscopy with cycloplegia and 2WIN-S for SE was 184/194 (95%) in 95% confidence interval, and the mean value was 0.46. J0 was 184/194 (95%), and the mean value is −0.04. J45 was 181/194 (93%), and the mean value is −0.15. Conclusion The objective refractive measurement of 2WIN-S had good reliability and high agreement with the gold-standard retinoscopy refraction in children and adolescents. While consistency was observed, it is essential to take into consideration that it is a screening tool.

Spot Refractive Screening With or Without Maximum Atropine Cycloplegia in Preschool Chinese Children.

To evaluate averaged, repeat Spot Vision Screener (Welch Allyn) refractive screening with and without maximal atropine cycloplegia in preschool Chinese children. Refractive errors of 450 preschool children aged 3 to 6 years were measured by cycloplegic retinoscopy as the gold standard. The Spot Vision Screener was used to examine the refractive errors of these children before and after cycloplegia. The differences between the two methods were assessed using the Wilcoxon test and Bland-Altman plot. The accuracy of the Spot Vision Screener in detecting refractive errors was evaluated by receiver operating characteristic curve analysis. Before cycloplegia, the Spot Vision Screener provided statistically significantly lower values of sphere (median difference: 1.50 diopters [D], 95% CI: 1.38 to 1.63 D) and spherical equivalent (median difference: 1.56 D, 95% CI: 1.50 to 1.69 D). For hyperopia of greater than 3.00 D spherical value (n = 118), the median difference between the Spot Vision Screener and cycloplegic retinoscopy was 2.63 D (95% CI: 2.50 to 2.88 D). The Bland-Altman plot showed that the difference between the results of the two examination methods was large. The sensitivity of the Spot Vision Screener for detecting refractive errors increased after the screening criteria were optimized. The Spot Vision Screener was efficient in detecting anisometropia in Chinese preschool children. The Spot Vision Screener without cycloplegia underestimated the spherical value of hyperopia and the difference was larger when the cycloplegic hyperopia increased. The performance of the Spot Vision Screener without cycloplegia in detecting cycloplegic hyperopia was not complete. The instrument referral criteria of the Spot Vision Screener should be adjusted according to clinical practice, but it is not simple and users should do it with expert assistance. [J Pediatr Ophthalmol Strabismus. 2021;58(3):146-153.].

Spasm of the near reflex: a common diagnostic dilemma?

To report the clinical characteristics and diagnostic procedures used in patients with spasm of the near reflex (SNR), in order to present common investigation strategies and diagnostic pitfalls. Retrospective case series of twenty-two patients, mainly children, with SNR or accommodation spasm (AS). AS was diagnosed on the basis of blurred vision and a difference of ≥2 dioptres between manifest and cycloplegic retinoscopy. If esotropia and miosis were present, the patients were diagnosed with SNR. All patients underwent visual acuity testing, orthoptic evaluation, assessment of refraction before and after cycloplegia, and dilated fundoscopy. Additional diagnostic investigations, such as neuroimaging, lumbar puncture (LP), electrophysiology and blood tests, were also recorded. Screen use among children was assessed in hours per day. There were 19 female and 3 male patients (age range 7-33y, median=10y). Seventeen patients had AS and 5 patients had SNR, with episodic blurry vision and headaches being the most common symptoms. Brain neuroimaging was performed in six patients (27%), although only one had a history of brain trauma. Two of those patients underwent visual evoked potentials and three also underwent LP and received intravenous steroid therapy. The majority of patients (90%) reported prolonged daily screen time (>2h/d), and in 55% of cases there were concurrent social problems or psychological triggers. Treatment consisted of careful explanation of the condition, atropine 1% eye drops and full cycloplegic correction by means of bifocal glasses. The diagnosis of SNR and AS may be challenging, because symptoms are usually intermittent and nonspecific, and a large number of patients are often subjected to redundant and potentially time-consuming examinations and treatment, that may exaggerate the underlying psychological disorder. Hence, detailed clinical testing and assessment of psychosocial profile is necessary, in order to avoid unnecessary investigations. Neuroimaging should be performed only in selected cases. Finally, due to prolonged screen use SNR and AS may become more frequent in the future.