Pediatric Ophthalmology Research Articles

Reducing the Waiting Time for Retinopathy of Prematurity Evaluation—A Quality Improvement Interventional Study

Aim To reduce the waiting time of babies for retinopathy of prematurity (ROP) evaluation at a tertiary care paediatric centre in Rajasthan and check its impact on follow-up. Methods It was a Quality improvement (QI) interventional study in which a QI team was made. A Fishbone root cause analysis after 1 month of observation was done to understand the reasons for the high waiting time for ROP screening in both IPD and OPD. This was followed by three plan-do-study-act (PDSA) cycles: segregation of the IPD & OPD patients by fixing two separate days and hiring a full-time paediatric ophthalmologist; distribution of informative digital/printed leaflets; timely reporting of staff, dilation of pupils, equipment availability and proper examination order. Average waiting time and maximum waiting time were measured before and after the PDSA cycles. Results After the completion of all PDSA cycles: Overall maximum waiting time for OPD and IPD patients was reduced from 130 and 138 minutes to 96 (26.2%) and 97 minutes (29.7%), respectively. The average waiting time for OPD and IPD patients was reduced from 96.2 and 92.4 minutes to 76.5 (20.5%) and 73.4 minutes (20.6%), respectively. The number of patients coming for ROP follow-up also increased. Conclusion The QI initiative using the point of care QI model (POCQI) was quite effective in reducing the maximum and average waiting time of babies undergoing ROP screening. It also increased their follow-up at our centre.

Review: Clinical findings and genetic characterization of children affected with X-linked retinoschisis in the Spanish population.

X-linked retinoschisis (XLRS) is an inherited retinal disorder due to mutations in retinoschisin 1, characterized by impaired central vision secondary to parafoveal cystic cavities and visual field loss by splitting through the retinal nerve fibre layer in the peripheral retina. It is the leading cause of juvenile macular degeneration in males, and currently there is no approved treatment but carbonic anhydrase inhibitors can be used. A retrospective review of the medical records of 17 children with confirmed XLRS seen in the Paediatric Ophthalmology Department of La Paz University Hospital from the 1st of January 2009 to the 1st of June of 2023 was conducted. Complete ophthalmological studies, genetic testing and full-field electroretinogram were performed. Topical brinzolamide was given to patients with foveoschisis, adding oral acetazolamide in those who did not improve with topical treatment alone or with very extensive foveoschisis at diagnosis. Surgical treatment was performed in retinal detahment (RD) or in no clearing hemovitreous cases. Mean age at diagnosis was 5,86 years and the most common reason for consultation was strabismus, followed by RD. The most frequently affected retinal later on Optic coherence tomography was the inner nuclear layer and throughout the follow-up we observed a decrease in central macular thickness. We found some genotype-phenotype correlation in our series and more severe phenotypes if the first amino acid of the protein is affected or in frameshift mutations. We found that medical treatment (topical and oral) improves foveoschisis, and that surgery shows poor outcomes, especially in younger patients.

State of the pediatric ophthalmology service of the Russian Federation in 2014–2022

The article presents the results of the analysis of the dynamics of the main performance indicators of the pediatric ophthalmology service from 2014 to 2022. The number of ophthalmology offices (from 6.262 in 2014 to 6.037 in 2022) and children’s ophthalmology beds (from 2.,558 to 2.094) decreased, and the number of ophthalmologists decreased by 681 individuals, 7.3% of the total, in the Russian Federation. The provision of ophthalmologists and ophthalmology beds per 10,000 individuals in 2022 is presented for individual federal districts (FDs) of the Russian Federation. To date, North Caucasus FD and Southern FD received the lowest provision with ophthalmologists per 10,000 individuals (0.69 and 0.68, respectively), whereas Northwestern FD and Far Eastern FD received the highest provision (1.03 and 0.89, respectively). The number of visits to ophthalmologists by children, including for preventive purposes, decreased, and the efficiency of preventive examinations increased, which led to an increase in the proportion of diseases detected during routine examinations by nearly three times. The paper presents the detection rate of ophthalmological diseases during preventive examinations in children by FDs in 2022. On average, the coverage of regular medical check-ups of children with ophthalmological diseases in the Russian Federation has increased (from 25.5% in 2014 to 42% in 2023), and the values of this indicator in individual FDs in 2022 are indicated. The highest and lowest coverage of regular medical check-ups were noted in the Siberian FD (54.0%) and Far Eastern FD (33%), respectively. The indicators of overall and primary morbidity of ophthalmological diseases in general and individual nosological forms, blindness, low vision, and disability were analyzed. The dynamics of surgical activity indicators in the FDs of the Russian Federation are presented.

Enhancing Paediatric and Strabismus Ophthalmology Departments in Spain Through the Inclusion of Orthoptists: Insights from a Nationwide Survey.

The absence of the orthoptic profession in Spain contrasts with its value and recognition in other countries. This study aimed to gauge Spanish ophthalmologists' interest in including and promoting orthoptists in paediatric and strabismus departments. Secondary objectives included assessing interest in requesting orthoptists, involvement in their training, and aligning their competencies with European standards. Participants were recruited via WhatsApp and flyers during the 30th SEEOP Congress in May 2023 and invited to review a report on orthoptists' significance followed by completing a 12-question online survey. Profile questions were asked via multiple-choice options. Opinions on integrating orthoptists to enhance care quality, training involvement, and alignment with European standards were rated using a Likert scale. Open-ended questions captured themes, and comments. Forty-two paediatric and strabismologists in Spain participated, mostly hospital-employed with advanced degrees, 90% supported integrating orthoptists into their teams, with 83% interested in having them in their workplace. Nearly 90% believed that collaboration between ophthalmologists and orthoptists would improve care quality and reduce waiting lists, and 83% supported promoting this within national medical organisations. Additionally, 90% advocated level 4 advanced European-standard training for orthoptists and 25% were neutral about participating in training orthoptists. Participants emphasised the importance of qualified orthoptists for treating eye movement abnormalities, distinguishing them from other eye healthcare professionals and advocating for collaboration rather than replacement. This initial survey of paediatric ophthalmologists and strabismologists in Spain highlights support for orthoptists as allied health professionals, though garnering support for their training could be challenging. These conclusions should be considered in light of methodological, sample size, and resource limitations. The survey serves as a pilot for the future, suggesting improvements to explore the feasibility of introducing orthoptists in Spain.

Analysis of pediatric ophthalmology surgical activity in metropolitan France in 2016: Its impact on training capacities

AimsTo describe pediatric ophthalmology surgery activity in private or public practice in metropolitan France in 2016 and to anticipate training needs in surgical pediatric ophthalmology. MethodsWe used the French National Health Care System database to identify all pediatric ophthalmology surgical procedures performed in 2016. The study included all children aged ≤14 years who had undergone ophthalmologic surgery. We calculated the incidence of surgeries per 100,000 inhabitants aged ≤14 years, the number of surgeons, the mean age of the practitioners, and the number of surgeons aged >55 years. ResultsIn 2016, the overall incidence of pediatric ophthalmic surgery activity was 150.42/100,000 children aged ≤14 years. Out of 17,657 pediatric surgeries, 31.3 % were done by private surgeons performing at least 20 surgeries per year, 45.9 % in public centers with ≥20 surgeries per year, and 22.8 % by surgeons (public or private centers) doing <20 surgeries per year. This analysis included 204 surgeons, with a mean age of 41.7 ± 11.2 years (60.8 % female) in the public sector and 51.0 ± 9.5 years (37.3 % female) in private practice. More than a third of the surgeries (37.7 %) were performed in children aged 6–11 years, and the most frequent procedure was strabismus surgery (42.1 %). University regions with the fewest surgeons and regions with surgeons aged >55 years were identified. Within 5 years, to maintain pediatric ophthalmic surgical activity, it will be necessary to train 46 surgeons. ConclusionsThis study demonstrated disparities in the geographic distribution of pediatric ophthalmic surgeries in France and identified regions that need increased training capacities and/or incorporate new surgeons to ensure a sufficient activity.

Orthoptic findings in trigonocephaly patients after completed visual development.

Trigonocephaly is associated with suboptimal visual outcomes in young children. However, the presence of orthoptic abnormalities after completed visual development remains unknown. The purpose of this study is to assess the prevalence of orthoptic abnormalities in trigonocephaly patients, after completed visual development. A retrospective study among non-syndromic trigonocephaly patients aged 8 years and older was conducted at the Dutch Craniofacial center. Ophthalmologic records were reviewed for refractive errors and a history of strabismus and amblyopia. Refractive errors were classified as follows: myopia: spherical equivalent (SE) ≤ -0.50 diopters (D), emmetropia: SE -0.50 D to + 0.50 D, hyperopia: ≥ + 0.50 D, astigmatism: cylinder error ≥ 1.00 D. The history of strabismus and amblyopia was assessed retrospectively. Prevalence and cumulative incidence of these abnormalities in healthy age-matched populations were retrieved from literature. We included 78 trigonocephaly patients with a median (interquartile range) age of 10.0 (9.0-12.0) years. Thirty-four (43.6%) of these patients presented with a refractive error after the age of 8 years. Specific findings in these 78 patients versus controls were hyperopia in 35.9% vs 8.4%; myopia in 6.4% vs 11.4%; astigmatism in 20.5% vs 11.9%; strabismus in 14.1% vs 2.65%; amblyopia in 6.4% vs 3.4%. Trigonocephaly patients have a two-to-threefold higher risk of hyperopia, astigmatism, amblyopia, and strabismus, as compared to healthy populations. We recommend screening and, in case of abnormalities, regular follow-up before completed visual development. In addition, we recommend long-term surveillance of visual functioning by a pediatric ophthalmologist and/or orthoptist.

Intracranial findings associated with low odds of retinal hemorrhage among children under 2 years of age at a single pediatric trauma center

BackgroundEvaluation by a pediatric ophthalmologist to look for retinal hemorrhages (RH) is often part of screening for occult injury among young children with intracranial hemorrhage (ICH) presenting to a trauma center. While important, this examination may lengthen the time a child and family remain at the hospital. ObjectiveWe sought to identify injury patterns associated with a low likelihood of RH, which may help streamline child abuse screening protocols for very young children with ICH. Methods, participants and settingWe conducted a retrospective cohort study of all children at a single Pediatric Level I Trauma Center who were <24 months of age, had ICH diagnosed between January 1, 2016, and June 30, 2021, and had a complete fundoscopic examination by a pediatric ophthalmologist. ResultsOf 177 children evaluated, 20 % had retinal hemorrhages. Odds of RH were very low among children with a single ICH directly underlying a skull fracture (uOR 0.05; 95 % CI 0.01–0.35), or with a single epidural hemorrhage (uOR 0.11; 95 % CI 0.01–0.84), compared to those with other intracranial injury patterns. Only one case in each group had RH: it was the same child, and the RH did not have the characteristics typically associated with abusive head trauma (AHT). ConclusionsA dilated fundoscopic examination by a pediatric ophthalmologist may not be necessary in children <2 years of age with a single intracranial bleed directly below a skull fracture, or a single epidural hemorrhage, when there are no additional indicators of elevated AHT risk. Level of evidencePrognostic and Epidemiological; Level III.

Diabetes mellitus as a risk factor for development retinopathy of prematurity. Review

Retinopathy of prematurity (ROP) is a complex and unresolved problem in pediatric ophthalmology, leading to visual disability. Low birth weight and prematurity are the main risk factors, and they form the basis of clinical recommendations for screening for ROP in all children under 35 weeks of gestational age and weighing less than 2000 g. However, many researchers point to other risk factors that can be divided into maternal, prenatal and perinatal. In this review, we consider maternal diabetes mellitus as a risk factor for ROP. Changes in the retina in premature infants and mothers with diabetes mellitus have some common features, since pathological angiogenesis occurs at the basis of these diseases. In addition, diabetes is a risk factor for preterm birth, and prematurity is a leading cause of neonatal morbidity, including the development of ROP. This suggests that maternal diabetes mellitus may have both direct and indirect effects on the development of ROP. To develop predictive models, an understanding of risk factors for ROP, the pathophysiology of retinal vascular diseases, and diseases of prematurity is necessary.

Dupilumab-Associated Ocular Surface Disease in PediatricAtopic Dermatitis: A Single-Center Asian Experience.

Atopic dermatitis (AD) is the most common chronic inflammatory skin disorder presenting in childhood. Dupilumab is the first approved biologic agent for the treatment of moderate-to-severe AD in pediatric populations. While generally well-tolerated, dupilumab-associated ocular surface disease (DAOSD) is a known complication. In severe cases, this may necessitate discontinuation of treatment. We aim to describe DAOSD in our cohort of Asian pediatric patients with moderate-to-severe AD on dupilumab. We performed a single-center retrospective review of children and adolescents on dupilumab for moderate-to-severe AD who developed ophthalmological complications from 2019 to 2024. Most patients had prophylactic lubricant eyedrops. Data collected and analyzed included demographics, ophthalmologic findings, treatment, and outcomes of eye condition. Of 216 patients treated with dupilumab, 16 (7.4%) developed ophthalmologist-diagnosed DAOSD. All patients had co-existing eyelid or head and neck eczema while 31.3% of these patients had pre-existing eye conditions. Eye redness (87.5%) was the most common presenting symptom, followed by pruritus (43.8%) and eye discharge (25%). The most common eye finding was conjunctivitis (87.5%), followed by limbitis (62.5%) and papillary reaction (62.5%). Two patients required temporary interruption of dupilumab. No patients required discontinuation of dupilumab treatment. The median time to resolution of eye complications was 14 weeks. In a real-world setting, the incidence and severity of DAOSD in pediatric patients appears to be lower than that of adults. Prophylactic use of lubricant eye drops, close monitoring and early referral to pediatric ophthalmologists can help reduce the incidence of severe eye disease requiring discontinuation of dupilumab.

Diagnosis and Care of Children With Cerebral/Cortical Visual Impairment: Clinical Report.

Cerebral/cortical visual impairment (CVI) is a leading cause of pediatric visual impairment in nations with developed economies and is increasing in those with developing economies. Because vision is the predominant sense used for learning, delay in diagnosis of CVI can negatively affect education, making early detection and management important. The American Academy of Pediatrics has published the policy statement "Visual System Assessment in Infants, Children, and Young Adults by Pediatricians" and an accompanying clinical report that are based on identifying potential causes of ocular visual impairment in children. Yet, routine vision screening may not accurately identify the brain-based visual impairment in children with CVI. Moreover, children with CVI often have medical complexity with other neurocognitive impairments and serious medical conditions that can make the diagnosis of CVI more difficult. Strategies are necessary for early identification of CVI to promote early diagnosis and referral for vision services that may allow a child with CVI to engage more fully in school, activities of daily living, vocational pursuits, and recreational activities. Knowledge of the characteristics of CVI as well as risk factors for CVI will assist the pediatrician in identifying children with CVI. This clinical report is complementary to previous vision screening policies, allowing both ocular and brain-based visual impairments in children to be identified and addressed. Pediatricians, other primary care physicians, pediatric ophthalmologists, neurologists, and other specialized pediatric eye care clinicians can identify children with CVI and coordinate effective evaluation, diagnosis, and referrals for vision services for these children.

Improving Sickle Cell Patient Appointment Compliance in a Hospital-Based Pediatric Ophthalmology Clinic

This quality improvement initiative aimed to reduce the no-show rate at a hospital-based tertiary sickle cell ophthalmology clinic. Missed appointments place a significant burden on the healthcare system, resulting in prolonged waiting times and underutilized clinical resources that impact the quality of care provided. Individuals with sickle cell disease commonly require multiple appointments to address the myriads of comorbidities associated with their disease. Nevertheless, the sickle cell ophthalmology clinic experienced an alarmingly high no-show rate of 49% from June to September of 2021 despite offering same-day appointments with the hematology clinic. To address this issue, we conducted a study in which we compared the baseline no-show rate with the rate after relocating both clinics to the same floor, aiming to overcome patient-related barriers. Following 3.5 months of the clinics sharing the same floor, the no-show rate decreased to 39%, reflecting a 10% improvement from the baseline rate. In summary, co-locating two related clinics can alleviate patient burdens, foster communication between multidisciplinary specialties, and contribute to an overall improvement in the quality of care and treatment provided.

Performance of Chatgpt in ophthalmology exam; human versus AI.

This cross-sectional study focuses on evaluating the success rate of ChatGPT in answering questions from the 'Resident Training Development Exam' and comparing these results with the performance of the ophthalmology residents. The 75 exam questions, across nine sections and three difficulty levels, were presented to ChatGPT. The responses and explanations were recorded. The readability and complexity of the explanations were analyzed and The Flesch Reading Ease (FRE) score (0-100) was recorded using the program named Readable. Residents were categorized into four groups based on their seniority. The overall and seniority-specific success rates of the residents were compared separately with ChatGPT. Out of 69 questions, ChatGPT answered 37 correctly (53.62%). The highest success was in Lens and Cataract (77.77%), and the lowest in Pediatric Ophthalmology and Strabismus (0.00%). Of 789 residents, overall accuracy was 50.37%. Seniority-specific accuracy rates were 43.49%, 51.30%, 54.91%, and 60.05% for 1st to 4th-year residents. ChatGPT ranked 292nd among residents. Difficulty-wise, 11 questions were easy, 44 moderate, and 14 difficult. ChatGPT's accuracy for each level was 63.63%, 54.54%, and 42.85%, respectively. The average FRE score of responses generated by ChatGPT was found to be 27.56 ± 12.40. ChatGPT correctly answered 53.6% of questions in an exam for residents. ChatGPT has a lower success rate on average than a 3rd year resident. The readability of responses provided by ChatGPT is low, and they are difficult to understand. As difficulty increases, ChatGPT's success decreases. Predictably, these results will change with more information loaded into ChatGPT.

Evaluation of the diagnostic parameters of the amblyopia and risk factors for amblyopia screening protocol in 3-year-olds according to recommendations from the French Association for Pediatric Ophthalmology and Strabismus (AFSOP) compared with reference ophthalmological examination: the ORTHOPHTALMO study

ABSTRACT Introduction: The ORTHOPHTALMO study aims to evaluate the diagnostic parameters of the screening protocol for amblyopia and risk factors for amblyopia in 3-year-olds recommended in 2019 by the French Association for Pediatric Ophthalmology and Strabismus (AFSOP). This protocol uses visual acuity, photoscreening refraction, and cover test examination performed by an orthoptist. Patient referral to an ophthalmologist is only according to recommended referral criteria. Methods: A prospective, single-center study was performed between September 2020 and June 2021 on a consecutive series of 3-year-olds consulting the Ophthalmology Centre of Clinique Rive Gauche, Toulouse, France, for vision screening. Patients were first examined by an orthoptist following the screening protocol recommended by AFSOP. All patients were then systematically examined by an ophthalmologist for cycloplegic refraction measurement (reference examination). The ophthalmologist was blinded to the referral conclusion and refraction measurements of the orthoptist. Results: A total of 300 patients (149 girls and 151 boys) were included. Examination by an orthoptist was unreliable/incomplete in 7% of cases. An abnormality was detected by the orthoptist in ≥1 of the screening tests among 42% of patients; these patients were thus considered as requiring referral to an ophthalmologist. Reference ophthalmological examination found 41% of patients required treatment. The diagnostic parameters of this screening protocol were 90% for sensitivity and 89% for specificity. Discussion: We validate the effectiveness and feasibility of the AFSOP screening protocol for detection of amblyopia and risk factors for amblyopia in 3-year-olds as well as the recommended criteria for referral to an ophthalmologist. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT04395560. Number: NCT04395560.

Social media and amblyopia: evaluating content and intent on Instagram

ABSTRACT Introduction: Social media is a widely-used avenue for the public to find health information. In particular, Instagram is a popular social media platform among adults who may have children within the amblyogenic age range, and it may be used to find amblyopia-related information. The purpose of this study is to assess the quality of the amblyopia information on Instagram. Methods: The top 200 publicly available Instagram posts about amblyopia from October to December 2022 were reviewed and scored using the Currency, Reliability, Authority, and Purpose (CRAP) test. Results: A quarter of posts were from healthcare providers (ophthalmologists, optometrists, opticians), and only 3% of posts were specifically from pediatric ophthalmologists. Most posts, however, were from businesses (51%), which were of lower quality than posts by providers. Discussion: Instagram represents a tremendous opportunity to educate the public. Better utilizing this resource may allow medical professionals to broadly spread accurate, unbiased data.

Genetic background of high myopia in children.

High myopia is a significant risk factor for irreversible vision loss and can occur in isolation or as a component of various syndromes. However, the genetic basis of early-onset high myopia remains poorly understood. We aimed to identify the causative genetic variants for high myopia in a cohort of Slovenian children. The study included children referred to a tertiary paediatric ophthalmology centre at the University Eye Clinic in Ljubljana between 2010 and 2022. The participants met the following inclusion criteria: age ≤ 15 years and high myopia ≤-5.0 D before the age of 10 years. Genetic analysis included exome sequencing and/or molecular karyotyping. Participants were categorized based on clinical presentation: high myopia with systemic involvement, high myopia with ocular involvement, and isolated high myopia. Genetic analysis of 36 probands revealed a genetic cause of high myopia in 22 (61.1%) children. Among those with systemic involvement (50.0%), genetic causes were identified in 13 out of 18 children, with Stickler's and Pitt-Hopkins being the most common syndromes. Among cases of high myopia with ocular involvement (38.9%), a genetic cause was found in 8 out of 14 probands, including (likely) pathogenic variants in genes related to retinal dystrophies (CACNA1F, RPGR, RP2, NDP). The non-syndromic ARR3- associated high myopia was identified in the isolated high myopia group. A genetic cause of high myopia was identified in 61.1% of children tested, demonstrating the value of genetic testing in this population for diagnosis and proactive counseling.

Study on the impact of refractive anisometropia on strabismus, stereopsis, and amblyopia in children.

To preliminarily explore the correlation between different types and degrees of refractive errors and strabismus, amblyopia, and stereopsis. A retrospective collection was conducted on a total of 145 patients with anisometropia who visited our hospital for strabismus and pediatric ophthalmology from January 2023 to August 2023.Based on the nature of anisometropia in both eyes, it was divided into 4 groups: Farsighted anisometropia (36 cases); myopic anisometropia (38 cases); astigmatic anisometropia (35 cases); mixed anisometropia (36 cases), and 30 children with normal vision were collected. Both groups of subjects underwent routine slit lamp and fundus examinations to exclude other organic eye diseases. The test indexes were: visual acuity, diopter, strabismus, far-stereoscopic vision, near-stereoscopic Titmus, and random static zero-order stereoscopic vision. The results of this study showed that compared with the normal control group, the incidence of strabismus was higher in the anisometropia group. When the refractive error was ≥1.00D, the far stereopsis and random dot static 0-order stereopsis in the anisometropia group decreased more significantly, and the difference between the groups was statistically significant (P < .05). Far-sighted and mixed astigmatism were more prone to amblyopia than myopia and regular astigmatism (P < .05). However, there was no statistical difference in near stereopsis Titmus between the anisometropia group and the control group (P > .05). Children with anisometropia are more likely to have strabismus, stereopsis and amblyopia than normal children.

“We are very family like”: How do relationships with colleagues affect career satisfaction for surgeons?

PurposeThe objective of this research was to explore the role of surgeon relationships with their colleagues on career satisfaction. MethodsThis qualitative study employed a thematic analysis based on the core elements of The Grounded Theory Method. Forty-two pediatric neurosurgeons, cardio-thoracic surgeons and ophthalmologists were recruited from 9 countries around the globe and interviewed in-depth about the role of their collegial relationships on their career satisfaction. Data was coded line-by-line to extract themes and to identify patterns across the interviews. ResultsCareer satisfaction was greatly enhanced by having a cohesive and healthy team. ‘Healthy’ teams were described as those that were emotionally supportive of each other, where colleagues could be trusted to back each other up, where communication was open and transparent, and where collaboration was the departmental norm. Career satisfaction was greatly diminished when there were interpersonal conflicts and personality clashes between surgeons, where there was poor departmental leadership creating a culture of fear and insecurity, when colleagues were perceived as egotistical, in competitive departments, where there was perceived to be an unequal distribution of work, and when surgeons felt alone and unsupported. ConclusionsOur study found that healthy teams had very specific qualities that could be cultivated and enhanced on surgical teams by making a conscious effort to improve the workplace culture and psychological safety among the team. In the conclusions, a number of recommendations are made on how to go about achieving this goal.

Comparison of the GoCheck Kids and Spot Screener photoscreening devices for the detection of amblyopia risk factors using 2021 AAPOS recommendations

PurposeTo compare the Spot Vision Screener (SPOT) to the GoCheck Kids mobile application (GCK) in the evaluation of amblyopia risk factors (ARFs), according to updated 2021 AAPOS guidelines for instrument-based pediatric vision screening. MethodsSPOT, GCK using horizontal and vertical images (two-photo mode), and a complete eye examination (CEE) were performed on children ages ≥1 to <7 years referred to a pediatric ophthalmologist from October 2020 to December 2022 for a failed vision screen based on manufacturer guidelines. The primary outcomes were sensitivity, specificity, and positive predictive value (PPV) for each photoscreener. ResultsOf 267 subjects included, 42% had one or more 2021 guideline ARFs after CEE. Overall, for SPOT and GCK, respectively, the sensitivity was 0.765 and 0.748, specificity was 0.769 and 0.755, and PPV was 0.728 and 0.712 (P > 0.05 for all). In participants ≥4 years old, SPOT had higher ARF sensitivity than GCK (0.900 and 0.750, resp.; P = 0.005), while among participants <4 years old, SPOT had lower sensitivity than GCK (0.487 and 0.744 respectively; P = 0.004). There were no statistically significant differences between SPOT and GCK in specificity among the younger (0.750 and 0.676 resp.) or older (0.785 and 0.823, resp.) cohorts, or in strabismus detection. The performance of the SPOT and GCK were evaluated using receiver operating characteristics (ROC) curves. Area under the curve (AUC) ranged from 0.857 to 0.980 for SPOT and 0.809-0.931 for GCK. ConclusionsOverall, SPOT, and GCK had similar values for sensitivity, specificity, and PPV to identify patients with ARFs using the 2021 AAPOS guidelines.

Prevalence of Keratoconus and Keratoconus Suspect among a sample of Iraqi Children with Refractive Errors: A Cross-Sectional Study

Background: Keratoconus (KC) is a chronic, bilateral, non-inflammatory degenerative condition with severe consequences. Objective: To assess the prevalence of KC and Keratoconus Suspect (KCS) in a pediatric population with astigmatic error ≥1 diopter (D) and non-axial myopia. Methods: Between March and October 2022, a cross-sectional study was done with a group of 6–18-year-old kids with an astigmatic error of ≥1 D or non-axial myopia who went to the pediatric ophthalmology clinic at Ibn Al-Haitham Teaching Eye Hospital in Baghdad, Iraq, for regular checkups. All patients got a thorough eye examination and corneal imaging using the Corneal Tomography System (CSO) Sirius equipment and Scheimpflug technology. Results: The majority of patients were females aged 110–14 years (55%). The frequencies of KC and SKC were 13.5 and 119.6%, respectively. The proportion of KC was substantially higher for those above the age of 14. Patients with KC exhibited considerably larger cylinder and axis measurements. Participants with inferior cones and an asymmetric Bow Tie exhibited greater rates of KC (51.2% and 29.4%, respectively). Except for Pachy-Thin and corneal volume mean values, all other metrics were considerably greater in KC and KCS patients than in control patients. Conclusions: The high prevalence of KC and KCS emphasizes the importance of this issue and the necessity for a systematic strategy for screening in pediatric age groups with refractive error.

An Analysis of Pediatric Ophthalmology Content on Instagram.

To analyze pediatric ophthalmology-related information on Instagram (Meta Platforms, Inc). A cross-sectional study queried 112 common eye terms and conditions from the American Association for Pediatric Ophthalmology and Strabismus website as hashtags on Instagram. A categorical classification system was used to analyze the top 9 posts per hashtag for likes, comments, views, and engagement level ratio (ELR). Posts were further characterized by author and content type. Analysis of the top 901 posts that met our inclusion criteria revealed a cumulative 424,608 likes, 15,793 comments, and 2,873,042 views. Authors had a total of 76,076,455 followers. Patients/families created the greatest number of posts (37.6%), followed by companies (20.2%), other (14.9%), medical organizations (12.3%), international ophthalmologists (6.1%), optometrists (5.9%), and American Board of Ophthalmology-certified ophthalmologists (3.0%). Content was mostly patient experience (42.4%), followed by educational (29.7%), self-promotional (13.5%), other (10.5%), and career-related (3.8%). Companies authored the highest number of educational posts (23.5%), followed by medical institutions (20.9%), other (19.4%), international ophthalmologists (13.8%), optometrists (13.4%), and American Board of Ophthalmology-certified ophthalmologists (4.5%) and patients (4.5%). Although pediatric ophthalmology content presented by board-certified ophthalmology Instagram authors had a greater number of followers than most other author categories, ophthalmologist authors on Instagram are still underrepresented. Additional research is warranted to help promote ophthalmologist-authored posts. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].