Pediatric Eye Research Articles

The Medicaid Dilemma and Its Profound Effect on the Economic and Workforce Issues in Pediatric Ophthalmology and Ultimately on Access to Pediatric Eye Care.

To identify new patient, follow-up, and surgery appointment wait times for children seeking care at academic eye centers/children's hospitals (AEC/CHs) in the setting of very low Medicaid reimbursements and workforce issues in pediatric ophthalmology. Each state in the United States with AEC/CHs was contacted by phone or email. Using a standardized script, the authors inquired about approximate wait times for non-emergency new patient, follow-up, and surgery appointment times, as well as percentage of patients insured by Medicaid seen at the AEC/CH. Medicaid reimbursements for new patient visits, follow-up visits, sensorimotor examinations, and one-muscle strabismus surgery were examined for each state. The mean percentage of children enrolled in Medicaid across the United States was 38.0%. Appointment and Medicaid inquiry calls were conducted across 41 states. Mean wait times across the United States for new patient, follow-up, and surgery appointments were 3.9, 3.4, and 2.7 months, respectively. Mean percentage of patients insured by Medicaid at AEC/CHs was 57.1%. High Medicaid-insured states offered longer wait times for new patient appointments than low Medicaid-insured states (4.4 versus 3.5 months; P = .20). The lowest Medicaid reimbursements for new patient visit, follow-up visit, sensorimotor examination, and one-muscle strabismus surgery occurred in Illinois, California, Ohio, and Michigan, respectively. Across the United States, states with higher percentages of patients insured by Medicaid exhibited longer new patient appointment wait times, suggesting that challenges related to Medicaid reimbursements directly contribute to disparities in access to pediatric eye care. [J Pediatr Ophthalmol Strabismus. 2023;60(3):170-177.].

Pediatric eye diseases among children attending outpatient eye department of Tikrit Teaching Hospital

Pediatric ophthalmic disorders are important because of their impact on child’s development, education, future work, opportunities and quality of life, they may be due to causes that operate in prenatal period , neonatal period and childhood. This study aimed to determine the pattern of childhood eye diseases across age group among children attending out Patient eye department of Tikrit Teaching Hospital. It is a descriptive cross sectional study carried out in out Patient eye department of Tikrit Teaching Hospital .From 1st January 2010 to the end of December 2010.In this study 846 children at the ages up to 15 years were examined. A questionnaire was designed for recording personal history and detailed ocular clinical examination was done. A total of 846 children had attended the eye out patient during 2010.469(55.4%) were male and 377(44.5%) were female. Allergic conjunctivitis 229(27%),refractive error 124(14.6%), Ocular trauma 117(13.8%),infection108(12.7%),squint103(12.1%) and NLD obstruction 44(5.2%) were the most common conditions. Ocular injury was more common in males 67% and children aged 6-10 years 40%, the majority 65% being closed globe injury. Infections were seen more commonly among males 61% and children aged less than 5 years, with keratitis representing 33% of these cases. Conjunctivitis was the most common disorder followed by refractive error. Male were more commonly affected than female. Children aged 11-15 years made up largest group that affected. The prevalent childhood eye diseases can lead to absenteeism from school and are potentially blinding. Health education is important for parents to prevention of childhood eye injuries and early treatment of eye disorders.

PREVALENCE OF REFRACTIVE ERROR IN SCHOOL GOING CHILDREN OF SUNSARI DISTRICT AND BIRATNAGAR, NEPAL

Background: Uncorrected refractive error is the leading cause of visual impairment. The aim of this study was to find the prevalence of refractive error among school-going children of Sunsari district and Biratnagar metropolitan city, Nepal. Methods: A retrospective study was conducted from August 2018 to January 2020. Comprehensive eye examination was performed by an experienced optometrist and ophthalmic assistant trained in Paediatric eye care. Data was entered in software, transferred to Microsoft Excel, and analyzed by using SPSS version-20. Results: During this period a total of 186215 students were enrolled. Primary screening was done for 124993 (67%) students and Secondary screening was done for 14355(11.5%) children. The overall prevalence of refractive error was 7439 (5.9%) found mostly in male 3897 (52.4%) of 11 to 15 years of age group 4554 (61.2%) (P=0.00). The prevalence of refractive error at schools of Biratnagar was 3156 (7.9%), Dharan was 1680 (8.5%) and Itahari was 1538 (6.0%). It was mostly found in private school going children of urban areas (5.4%) (P=0.00). Myopia (53%) was the most common type of refractive error (P=0.00). Conclusions: The prevalence of refractive error was high in private school of urban area. There is a need to conduct school screening program in both urban and rural areas to rule out the refractive error and other ocular morbidities on time for better quality of life.

Special Issue “Pediatric Eye Disease: Screening, Causes and Treatment”

Clinical manifestations and courses of eye diseases in children are profoundly variable, from minor irritations, pain, infections, inflammations, ocular misalignment, refractive errors and visual impairment, to permanent blindness [...].

Evaluation of Eye Consultations Requested from the Pediatric Emergency Service: Experience of a Tertiary Center

Objective: In this study, it was aimed to evaluate the reasons for visits, demographic and clinical characteristics of patients, the methods of approach to these patients who visited the pediatric emergency service and were consulted to ophthalmology. Material and Methods: The files of patients consulted to the Ophthalmology Clinic from Pediatric Emergency Department were analyzed retrospectively. Age and gender distribution of patients, complaints at the time of visits, clinical characteristics, diagnoses, diagnostic examinations and treatment methods were recorded. Results: Of the 241 patients, 164 (68.0%) were male and 77 (32.0%) were female. The median age was 11.0 (3.0-15.0) years. According to age groups, the highest number of patients was in the 12-17 age group with 117 (48.5%) patients. The most common complaints were foreign body in eye with 30.3% (n=73), eye redness with 10.8% (n=26), sticky eye with 8.3% (n=20) and eyelid swelling with 8.3% (n=20). The most common diagnoses were foreign body (31.1%, n=75), conjunctivitis (26.1%, n=63) and corneal epithelial defect (10.0%, n=24). Considering the distribution of diagnoses by age groups, conjunctivitis was the most common in the 0-5 and 6-11 age groups, foreign body in the 12-17 age group. While medical treatment was given to 59.3% (n=143) of the patients, intervention under local anesthesia was performed for 29.5% (n=71) of the patients. Of the seven patients that were hospitalized, five of them were treated under general anesthesia and two of them received surgical operations. Conclusion: Pediatric emergency visits with eye complaints in children were most common between 12-17 years of age and the most common cause was foreign bodies in the eye. All hospitalized patients were 0-5 years old and the most common reason for hospitalization was foreign bodies. Clinicians’ awareness should be increased on common pediatric eye emergencies accordingly.

Advancing health equity in pediatric eye care: the role of school-based vision programs, research, advocacy, community engagement, and medical education

Disparities in access to pediatric vision care for school-age children remain a pressing issue in the United States. School-based vision programs (SBVPs) are regarded as a means to advance health equity, especially for disadvantaged students. While SBVPs can be beneficial, these programs are only part of the solution. Interdisciplinary collaborations are needed to strengthen the pediatric eye care delivery system and advocate for broader access to needed eye services. This discussion will frame the role of SBVPs in conjunction with research, advocacy, community engagement, and medical education to advance health equity in pediatric eye care.

Cataract Formation Following Pars Plana Vitrectomy in the Pediatric Population.

To analyze post-vitrectomy cataract formation in the pediatric population to elucidate the number of phakic children requiring cataract surgery following vitreous surgery and the perioperative factors affecting cataract development in these patients. Eyes of pediatric patients that underwent phakic pars plana vitrectomy (PPV) with no prior cataract in a 10-year period were included. Analyses evaluated relationships between patient age and time to cataract surgery, as well as contributing factors for cataract formation. Final visual outcomes were also examined. Outcomes were collected for patient age at first vitrectomy, indication for vitrectomy, use of tamponade agents, history of ocular trauma, cataract status, and time to cataract surgery from first vitrectomy. Of 44 eyes analyzed, 27 (61%) were noted to have some degree of cataract formation. Of these, 15 (56%; 34% of total eyes) underwent cataract surgery. Use of octafluoropropane (P = .04) or silicone oil (P = .03) positively correlated with the need for cataract surgery in the total study group. Patients requiring cataract surgery had worse endpoint visual acuities than those who did not undergo surgery (P = .02), although this difference becomes less significant in follow-up over 2 years (P = .30). Patients who had cataracts but did not need cataract surgery showed an improvement in visual acuity (P = .04), but this was not demonstrated in patients who did need cataract surgery (P = .90). Pediatric eye care providers should be aware of the significant risk of cataract formation following a phakic PPV. [J Pediatr Ophthalmol Strabismus. 2023;60(6):421-426.].

Incidence and clinical features of pediatric ocular trauma in a population-based cohort

PurposeTo report the incidence and clinical characteristics of pediatric ocular and adnexal injuries diagnosed over a 10-year period in Olmsted County, Minnesota. MethodsThis multicenter retrospective, population-based cohort study included all patients <19 years of age in Olmsted County diagnosed with ocular or adnexal injuries from January 1, 2000, through December 31, 2009. ResultsA total of 740 ocular or adnexal injuries occurred during the study period, yielding an incidence of 203 (95% CI, 189-218) per 100,000 children. Median age at diagnosis was 10.0 years, and 462 (62.4%) were males. Injuries presented to the emergency department or urgent care setting most frequently (69.6%) and often occurred while outdoors (31.6%) during summer months (29.7%). Common injury mechanisms included blunt force (21.5%), foreign bodies (13.8%), and sports activities (13.0%). Isolated anterior segment injuries occurred in 63.5% of injuries. Ninety-nine patients (13.8%) had visual acuity of 20/40 or worse at initial examination, and 55 patients (7.7%) had visual acuity of 20/40 or worse at final examination. Twenty-nine injuries (3.9%) required surgical intervention. Significant risk factors for reduced visual acuity and/or the development of long-term complications include male sex, age ≥12 years, outdoor injuries, sport and firearm/projectile injury mechanism, and hyphema or posterior segment injury (P < 0.05). ConclusionsMost pediatric eye injuries are minor anterior segment injuries with infrequent long-lasting effects on visual development.

Incidence, outcomes, and risk of surgical failure after development of early hypotony following Aurolab aqueous drainage implant surgery.

To report the incidence, outcomes, and risk of surgical failure after early postoperative hypotony following Aurolab Aqueous Drainage Implant (AADI) surgery for adult and pediatric refractory glaucoma. Medical records of patients who underwent AADI between January 2013 and March 2017 with a minimum of 2-years follow-up were retrospectively reviewed. Early postoperative hypotony was defined as IOP ≤5 mmHg within the first 3 months after AADI. Surgical failure of AADI was defined as IOP >21 mmHg or reduced <20% below baseline on two consecutive follow-up visits after 3 months, IOP ≤5 mmHg on two consecutive follow-up visits after 3 months, reoperation for glaucoma or a complication, or loss of light perception vision. Early postoperative hypotony was seen in 15/213 eyes (7%) in the adult group and in 6/101 eyes (6%) in the pediatric group. The onset of hypotony was significantly earlier in the pediatric group (median = 39 days post AADI, IQR = 20-58 days) compared with adult eyes (median = 51 days post AADI, IQR = 30-72 days) (P = 0.02). Eyes with early postoperative hypotony did not have an increased risk of cumulative surgical failure as compared with eyes without hypotony in both adult (33.3% vs. 23.7%; P = 0.48) and pediatric (33.3% vs. 13.7%; P = 0.16) refractory glaucoma. All eyes recovered from hypotony, though one adult eye developed retinal detachment and one pediatric eye developed corneal decompensation and lost vision. Early postoperative hypotony was an infrequent complication post AADI and occurred earlier in pediatric eyes. Early postoperative hypotony did not increase risk of surgical failure up to 2 years.

Access to Pediatric Eye Care During a Pandemic: Systematic Review and Meta-Analysis.

Visual impairment affects many children and can lead to blindness if untreated. The coronavirus disease 2019 (COVID-19) pandemic has led to various restrictions and other challenges accessing in-person medical care, including essential pediatric eye care. The aim of this article was to determine and quantify the effect that pandemics have on access to pediatric eye care. A systematic literature search was conducted using various databases, which yielded 257 articles; nine were included in the final review. All included studies reported a decrease in the number of children accessing eye care during COVID-19. Most studies described virtual triage systems, which restricted in-person care to emergent cases. The average decrease in daily pediatric visits was 67.32% and reached statistical significance in the meta-analysis (P < .01). However, out of all patients with ocular complaints, the proportion of pediatric visits was unchanged, suggesting that the decrease in access to eye care was not specific to pediatric patients. [Pediatr Ann. 2023;52(2):e68-e75.].

Unusual intraocular tumour in an infant

The prototypical paediatric eye tumour is retinoblastoma which generally necessitates enucleation for treatment. However, for benign entities local resection may be all that is necessary. We present a classic presentation of a rare cause of orbital tumour, with less than 20 reported cases to date. Ectopic lacrimal gland tissue presents with proptosis or an abnormal looking eye, often centred in the choroid or iris, forming a localised mass of lobules of lacrimal gland acini, sometimes accompanied by cystic spaces.

Where Have All the Pediatric Ophthalmologists Gone?—Pediatric Eye Care Scarcity and the Challenge of Creating Equitable Health Care Access

The current next available appointment for a child to be seen by a pediatric ophthalmologist in the San Francisco Bay Area, California, is approximately 6 months. This is similar to most other regions in the US. How do we frame this substantial difficulty in accessing pediatric eye care in the US?

Burden and clinical profile of genetic eye diseases in children in Nigeria: a descriptive cross-sectional study.

ophthalmic genetics is rapidly evolving globally but is still nascent in much of sub-Saharan Africa, with gaps in knowledge about the burden in the region. This study evaluated the burden and manifestations of genetic eye diseases in children in Ibadan, Nigeria. this was a hospital-based cross-sectional study in which new and follow-up paediatric eye clinic patients were recruited consecutively at the University College Hospital, Ibadan. Children with genetic eye diseases had comprehensive ocular and systemic examinations, and their pedigrees were charted to determine the probable modes of inheritance. The main outcome variables were the proportion of study participants with genetic eye diseases, the probable modes of inheritance, and the clinical diagnoses. Summary statistics were performed using means and standard deviations for numerical variables and proportions for categorical variables. fifty-two (12%) of 444 children had genetic eye diseases, and their mean (SD) age was 88.8 ± 50.4 months. Thirteen different phenotypic diagnoses were made following the evaluation of the 52 children, including primary congenital glaucoma (13, 25%) and familial non-syndromic cataracts (8, 15%). The probable modes of inheritance were derived from the pedigree charts, and 30 (58%) conditions were presumed to be sporadic. this study demonstrated a significant burden and a wide range of paediatric genetic eye diseases in this tertiary referral centre in Nigeria. This information provides invaluable evidence for planning ophthalmic genetic services.

An eye opener: improving attendance rates of retinopathy screening within the paediatric diabetes clinic

AbstractAims: To audit eye screening attendance rates in children pre and post implementation of a screening service offered on the same day as their diabetes clinic appointment and to identify characteristics of non‐attenders.Methods: Data were extracted from the diabetic eye screening software ‘OptoMize’ between 1 April 2018 and 31 March 2019 (pre intervention) and between 1 April 2019 and 31 March 2020 (post intervention). Attendance rates of 72 eligible participants were gained and their diabetes characteristics (age, duration of diabetes and HbA1c) were examined pre and post intervention with application of the Mood's median test in order to determine statistical significance.Results: Same day screening with routine diabetes appointments improved the eye screening attendance rate by 22%. Those with a higher HbA1c were significantly less likely to attend (p&lt;0.05) pre intervention, while post intervention, the median HbA1c of those who did not attend was lower than those who did. There was no significant difference between the age of participants for those who attended and those who did not pre and post intervention (p=0.705/0.235). Those who did not attend despite the intervention had a longer duration of diabetes than those who did, yet significance was not gained.Conclusion: This study has addressed a gap within existing knowledge and provided quantitative analysis within the field of paediatric diabetic eye screening. Findings have identified the positive impact of a ‘same day screening service’ integrated with routine diabetes care on attendance, and have also identified a clear improvement in attendance rates of those with the higher risk factors of developing sight‐threatening retinopathy. Copyright © 2023 John Wiley &amp; Sons.

Comparison of Functional Vision and Eye-Related Quality of Life between Myopic Children Treated with Orthokeratology and Single-Vision Spectacles in Southern China.

To compare eye-related quality of life between Chinese children wearing orthokeratology (OK) contact lenses and single-vision spectacles (SVS) using the Pediatric Eye Questionnaire (PedEyeQ) and to evaluate the impact of different myopia correction methods on children and their parents. Children aged 12-17 years and their parents/legal guardians were recruited. The children's myopia ranged from -0.50 to -5.00 diopters (D), and their astigmatism was <1.50 D. They had all been wearing OK contact lenses or SVS for at least 12 months. The children completed the Child PedEyeQ. One of their parents (or a legal guardian) completed the Proxy PedEyeQ and the Parent PedEyeQ. Rasch-calibrated PedEyeQ scores were calculated for each domain and were converted to a scale from 0 to 100 for statistical analysis. A total of 50 children wearing OK contact lenses, 43 children wearing SVS, and their parents/legal guardians completed the questionnaires. The scores of all Child, Proxy, and Parent PedEyeQ domains in the OK contact lens group were higher than those in the SVS group (all P < 0.05). In the mild and moderate myopia subgroups, the Child, Proxy, and Parent PedEyeQ scores in the mild myopia OK contact lens subgroup were higher than those in the mild myopia SVS group (all P < 0.05) except functional vision and bothered by eyes/vision domains for the proxy PedEyeQ. Similarly, the Child, Proxy, and Parent PedEyeQ scores in the moderate myopia OK contact lens subgroup were higher than those in the moderate myopia SVS subgroup (all P < 0.05) except impact on parent and family domain for the parent PedEyeQ. In the subgroup analysis of glasses type, no significant score difference of any Child, Proxy, and Parent PedEyeQ domain was detected between mild and moderate myopia in either the OK contact lens group or the SVS group (all P > 0.05). Compared with children wearing SVS, children wearing OK contact lenses have better functional vision and eye-related quality of life. Moreover, OK contact lens has a better correction effect, higher acceptance rates, and less impact on parents and families than SVS.

Proposal for a Common Nomenclature and Risk-Based Approach to Pediatric Eye Health Screening and Examinations: Why, Who, and How?

Proposal for a Common Nomenclature and Risk-Based Approach to Pediatric Eye Health Screening and Examinations: Why, Who, and How?

Pediatric Eye Care Treatment Rates and Community Compliance to a Spectacle Provision Program in an Underserved School District [Letter

Pediatric Eye Care Treatment Rates and Community Compliance to a Spectacle Provision Program in an Underserved School District [Letter

Photoscreener: An effective tool for vision screening of preschool children in community setting

Background: Although studies compare the accuracy of spot photoscreeners, few evaluate photoscreeners in community settings. To our knowledge, all studies from India have been purely hospital based, particularly in children under 5 years. Aim: The aim was to evaluate the effectiveness of using a commercially available photoscreener for pediatric vision screening in a community setting. Settings and Design: This cross-sectional comparative study was conducted from December 2018 to February 2019 in a north-eastern district of Delhi. Methods: The automated Spot™ Vision Screener was used to screen the vision of preschoolers. A result displayed as “complete eye exam recommended” on the photoscreener was considered as screening positive and the child was referred to the pediatric ophthalmology unit of a tertiary eyecare institution, as per predefined international guidelines. Statistical Analysis: Referral rate and positive predictive value (PPV) of using the photoscreener were considered as primary outcome measures. Results: A total of 1205 children were screened using a photo-screener. Almost 16.4% of them were identified and referred a significantly higher referral rate than that in the historic control (2.7%, P < 0.001). Nearly 51.5% of the referred children reported to the unit. The PPV of pediatric eye screening done in a community setting by the photoscreener for refractive error (RE) was 81.4%. Fifty-nine percent of the children detected with REs were found to be at risk of amblyopia. Mean spherical equivalent, sphere, and cylinder of final glass prescription were significantly different from that of photoscreener refraction. Conclusion: Photoscreener improves the referral rate and has a high PPV. It could be a standard tool to screen preschoolers in community settings.

Validation Comparison Between Near Visual Acuity Optotypes within a Pediatric Population

Near visual acuity measurement is an important aspect of pediatric eye examinations. Reduced near acuity may affect prescribed lenses or treatments, and can represent impactful visual dysfunction. The purpose of this study is to evaluate binocular near acuity using five different child-friendly common optotypes, and to contrast results among the optotypes and their consistency with binocular distance VA.

Knowledge and Awareness of the Public toward Pediatric Eye Health and Diseases in Aseer region, Saudi Arabia: A Cross-Sectional Population Study

Pediatric ophthalmic conditions are a common and a serious public health problem, as they can not only impact the child’s ability to learn, have a normal social life, and get a better quality of life, but they can also lead to complete blindness or visual impairment. Early intervention is necessary for childhood eye diseases since they can result in ongoing issues. The underlying causes of blindness in children differ significantly from region to region, depending on some factors, including socioeconomic development and access to primary healthcare services and facilities. However, it is estimated that there are over 19 million people globally with visual impairments and that there are roughly 1.4 million cases of blindness. As a result, the purpose of this study is to assess the parents’ and caregivers’ awareness in Aseer, Saudi Arabia, about various common pediatric ophthalmic diseases, including strabismus, amblyopia, refractive errors, and congenital glaucoma. By identifying the gap in knowledge and awareness, this could help create targeted educational and awareness programs geared toward the parents and the public of Aseer, Saudi Arabia, which could help prevent or reduce the prevalence of pediatric ophthalmic conditions, and boost the children’s eye health. Key words: knowledge, awareness, paediatric eye health, eye diseases, Aseer, Saudi Arabia