Pediatric Ophthalmology Research Articles

The multifaceted factors affecting the publication times of pediatric ophthalmology and strabismus articles: what has changed in two decades

AbstractExpeditious publication is an important factor when considering publishing ophthalmic research. We investigated the factors associated with shorter publication times in pediatric ophthalmology and strabismus (POS). We analyzed 2487 POS articles from 8 ophthalmology journals publishing POS articles. Time from submission to acceptance, from acceptance to publication, and from submission to publication were calculated for each article. We compared trends over time of factors affecting the publication times from 2002 to 2007 and those from 2014 to 2018. Median peer review durations were 156 days from submission to acceptance; 79 days from acceptance to publication, and 244 days from submission to publication. The American Journal of Ophthalmology, JAMA Ophthalmology, and Strabismus had the shortest submission to publication time. Authors from Africa, East Europe, Central and South America received the fastest processing time in all time categories, although most authors were based in North America and UK. All-time intervals decreased annually, significantly more during the first decade. In the study's second period, more co-authors and affiliated departments correlated with shorter review times. Manuscripts in higher Impact Factor (IF) journals had faster publication times in the first decade. Female senior authors faced longer submission-to-acceptance times in the first decade. This gender gap disappeared in the second period. A general improvement occurred with most journals, specifically those journals with a higher number of co-authors and affiliated departments, indicating an efficient collaborative authorship. Low-income regions benefited from comparatively shorter time intervals. The gender gap in senior authorship diminished over time.

Commercial Versus Compounded Preparations in Pediatric Ophthalmology.

Many conditions managed by pediatric ophthalmologists are rare diseases, and even if pharmacological treatments are available, these have often not been evaluated in children. Off-label prescribing is a common practice in pediatric ophthalmology. In addition, there is often no commercial case for the production of a medicine that may only be used for a small number of patients worldwide. Compounded preparations prepared locally are therefore still in frequent use, although it is known that production may not meet stringent quality assurance standards. For several indications, commercial preparations, evaluated in rigorous clinical trials with children, are now available. Myopia management is joining the list of these indications, with low-concentration atropine formulations derived from recent clinical trials in Australia, USA, and Europe now entering the market. This short article gives an overview of the background and recent developments of compounded and commercial preparations for use in pediatric ophthalmology.

Fewer Pediatric Ophthalmologists and an Uneven Distribution Affect Access to Pediatric Care

Fewer Pediatric Ophthalmologists and an Uneven Distribution Affect Access to Pediatric Care

Validation of the eye screening tool GoCheck Kids for the detection of amblyopia risk factors in toddlers in Flanders

PurposeTo assess the validity of the GoCheck Kids photoscreening application (Gobiquity Mobile Health, Scottdale, AZ) on iPhone, which was used (2018-2022) as standard of care by Child and Family (Kind en Gezin) to detect amblyopia risk factors in children 12-30 months of age. MethodsBetween August 2021 and May 2022, 453 children 11-16 months of age underwent a confirmatory ophthalmic examination within 2 months of GoCheck Kids photoscreening at Child and Family, Flanders, Belgium. Additionally, manual review was performed by specialists of GoCheck Kids. Diagnostic metrics were assessed using the 2013 criteria of the American Association for Pediatric Ophthalmology and Strabismus as reference. ResultsSpecificity was similar for automatic screening with or without manual review: 90.0% (95% CI, 87.6%-92.3%) and 90.3% (95% CI, 88.0%-92.7%), respectively. Sensitivity was estimated at 52.0% (95% CI, 35.6%-68.4%) for automatic grading and 56.0% (95% CI, 39.7%-72.3%) after manual review. Positive predictive values for automatic screening and manual review were, respectively, 23.2% (95% CI, 13.9-32.5) and 25.5% (95% CI, 15.8-35.1). Negative predictive values for automatic screening and manual review were, respectively, 97.0% (95% CI, 95.6-98.4) and 97.2 (95% CI, 95.8-98.6). ConclusionsIn our study cohort of children around 12 months of age, the GoCheck Kids application had a specificity of 90% for the targeted amblyopia risk factors, with sensitivity just over 50%.

Study of Visual Evoked Potentials in Schoolchildren: A Promising Aid to Pediatric Ophthalmology.

Background Visual evoked potential (VEP) is a noninvasive investigation conducted to identify abnormalities in the visual system. It is especially suitable for young children who are unable to express visual symptoms or participate in conventional vision tests. This study was undertaken to examine the VEP among schoolchildren to assess the functionality of their optic pathway. Methodology This short-term observational study was performed in the Clinical Neurophysiology Unit of the Physiology Department of a rural medical college. The study population consisted of 60 schoolchildren aged 7-12. Both eyes were examined for transient pattern reversal VEP recordingsusing a Recorders & Medicare Systems Electromyography-Evoked Potential recorder (RMS EMG-EP MARK-II Pvt. Ltd., Chandigarh, India). Results VEPs were analyzed for latency and amplitude of the main components, namely P100, N70, and N155. The results showedmarkedly extended P100 latency in33.33%, i.e., eight outof 24 eyes of standard (std.) III children. Similar latency prolongation was obtained in 36.36% (eight out of 22)eyes of std. IV, 30% (six of 20 eyes) of std. V, 13.63% (three of 22 eyes) of std. VI, and 50% (eight of 16 eyes) in std. VII and VIIIchildren. A markedly reduced P100 amplitude was observedin two of 20 eyes (10%) of std. V, two of 16 eyes (12.5%) in std. VII and VIIIchildren, amounting to a P100amplitude abnormality in5%eyesin toto. The interocular differences in all VEP parameters amongthe subjects were statistically insignificant. Conclusion In schoolchildren in whom normal latencies and amplitudes were obtained, the presence of reproducible VEPs indicated the normal functionalstatus of their visual pathway. On the other hand,in those children where alteredVEP findings were found, it hinted towardcomplementary informationthat they may have underlying ocular disordersthat were yet to be diagnosed. Hence, this study provides insight into the assessment of visual system function, which is primarily difficult in young children.

Female Leadership in Pediatric Ophthalmology: A Descriptive Analysis.

To examine female representation among current chiefs of pediatric ophthalmology services of academic medical centers and children's hospitals, as well as program directors of ophthalmology residency and pediatric ophthalmology fellowship programs in the United States. Data collection for this cross-sectional study occurred between December 2023 and February 2024, using publicly available sources to compile a list of academic medical centers and children's hospitals, as well as ophthalmology residency programs and pediatric ophthalmology fellowship programs that participated in the 2023-2024 San Francisco Match. Chi-squared analyses were performed using Excel 2021 software, where a P value less than .05 was considered statistically significant. Of the dedicated pediatric ophthalmology services across academic medical centers and children's hospitals in the United States, 38.3% (64/167) are led by a female chief. Female representation was greater at children's hospitals (40.0%, 36/90) than at academic medical centers (36.4%, 28/77), although no significant difference was observed (P = .69). Gender distribution was near equivalent at both academic training program levels, with slightly more female directors of fellowship programs (45.7%, 21/46) than ophthalmology residency programs (42.3%, 52/123) (P = .33). The authors report near equivalent female representation in the leadership of academic training programs at the residency and fellowship level. However, the proportion of female pediatric ophthalmology division chiefs lags behind the actual gender composition of the workforce. Given the increasing prevalence of female pediatric ophthalmologists, promotion of concordant representation in leadership is necessary to reflect the changing sociocultural landscape and to close the gender gap. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

Practice patterns in pediatric myopia management: Insights from a 2023 survey among Indian ophthalmologists.

This study investigates the practice patterns related to paediatric myopia among Paediatric Ophthalmologists in India, based on a 2023 survey conducted via Google Forms. The survey aimed to gather insights into physicians' perceptions and experiences concerning the clinical and treatment aspects of myopia in children. The survey reveals several key insights into current practice patterns among Paediatric Ophthalmologists in India regarding paediatric myopia management. The recommended mean age for a child's first eye checkup is 3 years, underscoring the importance of early detection. Refractive error thresholds for prescribing spectacles are set at 3.0 D for infants, 2.0 D for preschool children, and 1.0 D for school-going children older than 3 years. There is a growing trend in using 0.01% Atropine eye drops for myopia management, with a mean prescription age of 4.83 years. Notably, 80.11% of respondents prioritize documenting myopia progression regardless of the child's age. Orthokeratology and Peripheral Defocus spectacle lenses are gaining recognition, and lifestyle modifications such as increasing outdoor activities and reducing near activities are widely acknowledged as effective. While most respondents do not use progressive lenses for myopia, there is significant emphasis on axial length measurements and considering the lag of accommodation. Additionally, under-correction of myopia is favored by a notable proportion of practitioners. These findings indicate a shift towards early intervention and evidence-based strategies in myopia control. The survey highlights a shift towards early intervention and evidence-based myopia control strategies among practitioners. There is, however, room for improvement in standardizing approaches and considering additional factors like axial length and lag of accommodation. Collaborative efforts among policymakers, health regulatory bodies, and industry stakeholders are essential to enhance the accessibility and affordability of myopia control treatments and address the growing health burden associated with paediatric myopia.

Virtual Reality With Eye Tracking for Pediatric Ophthalmology: A Systematic Review.

Virtual reality presents an efficient and engaging approach to ophthalmological diagnosis and treatment in children. This systematic review investigates the current state of eye tracking technology integrated into virtual reality for the spectrum of pediatric ophthalmology. The search encompassed the MEDLINE database via PubMed, without imposing any time restrictions. A total of 20 relevant studies that met our inclusion criteria were incorporated and categorized into the following domains: diagnosis, examination, treatment, and rehabilitation use of virtual reality devices within the realm of pediatric ophthalmology. Strabismus examinations and postoperative monitoring, inherited retinal degeneration examination and visual function testing, therapy of amblyopia, glaucoma visual field testing, cerebral visual impairment rehabilitation, and neuro-ophthalmic disease examination were included in the final analysis. Pediatric ophthalmology offers a promising landscape for the integration of eye tracking technology within virtual reality, with accelerated, quantifiable, and objective examination and diagnosis, and precise, real-time measurements that are crucial in children. Virtual reality is an engaging experience, easily applied in a pediatric setting and facilitating compliance during examination and adherence to therapy. Although our systematic review provides insights into the current state of research, it is anticipated that further exploration is required for the widespread utilization of eye tracking in virtual reality within pediatric ophthalmology. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

Predictors of No-Show Status: An Analysis of Pediatric Ophthalmology Patients at an Academic Ophthalmology Department in the United States.

To identify pediatric patient and appointment characteristics associated with no-show status at a tertiary care pediatric ophthalmology clinic within a U.S. academic ophthalmology department. A cross-sectional retrospective chart review was performed for all pediatric patients with a scheduled ophthalmology appointment at the Penn State Eye Center between April 1, 2022 and March 31, 2023. A multivariate logistic regression analysis assessed associations between appointment nonattendance and patient characteristics. Of 8,083 scheduled visits, 1,445 (17.9%) were no-shows. Factors associated with no-show status included appointment type (new vs return odds ratio [OR]: 1.43, 95% CI: 1.26 to 1.63, P < .001); lower median household income (< $41,374 vs > $68,957 OR: 1.89, 95% CI: 1.40 to 2.55, P < .001; $41,374 to $68,957 vs > $68,957 OR: 1.27, 95% CI: 1.12 to 1.44, P < .001); non-private insurance (self-pay vs private: OR: 5.65, 95% CI: 3.87 to 8.24, P < .001, Medicaid vs private: OR: 2.17, 95% CI: 2.32 to 3.16, P < .001); commute distance 10 to 30 miles vs < 5 miles (OR: 1.49, 95% CI: 1.11 to 1.99, P = .008); race: unavailable vs White (OR: 2.18, 95% CI: 1.66 to 2.85, P < .001), Black vs White (OR: 1.86, 95% CI:1.53 to 2.27, P < .001), Other vs White (OR: 1.47, 95% CI: 1.27 to 1.70, P < .001); ethnicity: Hispanic vs non-Hispanic (OR: 1.92, 95% CI: 1.62 to 2.27, P < .001); and language preference: Spanish vs English (OR: 1.86, 95% CI: 1.49 to 2.32, P < .001), Nepali vs English (OR: 1.60, 95% CI: 1.06 to 2.43, P = .027), other vs English (OR: 1.83, 95% CI: 1.35 to 2.49, P < .001). Appointment reminders (phone call, P = .013); text message, P < .001; other, P = .013) all resulted in a greater propensity to show, but email communication alone did not (P = .674). Certain patient and appointment characteristics that are linked to a higher rate of no-show status can inform targeted initiatives to improve health care outcomes, resource utilization, and clinical efficiency in the pediatric ophthalmology community. [J Pediatr Ophthalmol Strabismus. 20XX;X(XX):XXX-XXX.].

Evaluating ChatGPT's efficacy and readability to common pediatric ophthalmology and strabismus-related questions.

The rise in popularity of chatbots, particularly ChatGPT by OpenAI among the general public and its utility in the healthcare field is a topic of present controversy. The current study aimed at assessing the reliability and accuracy of ChatGPT's responses to inquiries posed by parents, specifically focusing on a range of pediatric ophthalmological and strabismus conditions. Patient queries were collected via a thematic analysis and posed to ChatGPT 3.5 version across 3 unique instances each. The questions were divided into 12 domains totalling 817 unique questions. All responses were scored on the response quality by two experienced pediatric ophthalmologists in a Likert-scale format. All questions were evaluated for readability using the Flesch-Kincaid Grade Level (FKGL) and character counts. A total of 638 (78.09%) questions were scored to be perfectly correct, 156 (19.09%) were scored correct but incomplete and only 23 (2.81%) were scored to be partially incorrect. None of the responses were scored to be completely incorrect. Average FKGL score was 14.49 [95% CI 14.4004-14.5854] and the average character count was 1825.33 [95%CI 1791.95-1858.7] with p = 0.831 and 0.697 respectively. The minimum and maximum FKGL scores were 10.6 and 18.34 respectively. FKGL predicted character count, R²=.012, F(1,815) = 10.26, p = .001. ChatGPT provided accurate and reliable information for a majority of the questions. The readability of the questions was much above the typically required standards for adults, which is concerning. Despite these limitations, it is evident that this technology will play a significant role in the healthcare industry.

Assessing The Relationship Between Demand And Accessibility For Pediatric Ophthalmology Services By State In The United States.

To investigate the relationship between public demand for pediatric ophthalmology services and the accessibility of such services on a statewide basis in the United States, focusing on strabismus care. Using Google Trends data, search volumes for "strabismus" were analyzed from January 2014 to December 2023. Pediatric ophthalmologist availability was assessed via the American Academy of Ophthalmology directory, normalized for state population size to create a relative demand index. Additional metrics from the United States Census Bureau and Centers for Disease Control and Prevention provided socioeconomic and health data. Correlation coefficients were used to explore relationships between search volumes, specialist availability, vision screening, socioeconomics, and demographic factors. The data revealed variability in public interest in pediatric ophthalmology across states, with Alaska showing the highest relative search volume for strabismus. The data also indicated notable disparities in pediatric ophthalmologist density, with North Dakota, Vermont, and Wyoming having no pediatric ophthalmologists. A significant correlation was identified between pediatric ophthalmologist availability and vision screening (R = 0.486, p < 0.001). Negative correlations were observed between the relative demand index and urbanization (R = -0.388, p = 0.007), as well as the strabismus prevalence (R = -0.455, p = 0.001), indicating that urbanization and specialist distribution influence eyecare demand and access. The findings highlight disparities in accessibility and demand for pediatric ophthalmology services across the US, influenced by urbanization and distribution of healthcare professionals. The study underscores the need for targeted interventions to improve access to care and bridge gaps in pediatric ophthalmology service provision.

Impact of 5 waves of COVID-19 on pediatric ophthalmology

ObjectiveTo characterize the impact of multiple waves of COVID-19 on pediatric ophthalmology at a tertiary care hospital. MethodsMedical records were reviewed from pediatric patients seen for ophthalmic emergencies at the Montreal Children's Hospital (Montreal, Canada) from 5 COVID-19 periods: March 13 to May 31, 2020; September 20, 2020, to February 21, 2021; March 21 to May 31, 2021; August 17 to November 5, 2021; and December 19, 2021, to January 25, 2022, as well as 2 pre-COVID time periods: March 13 to May 31, in 2018 and 2019). ResultsThere was a significant reduction in ophthalmic consultations when comparing pre-COVID to all 5 COVID waves (p < 0.0001). There was an increase in the average number of daily urgent (p = 0.01) ophthalmic consultations from waves 1 to 4. Mean household income of patients was not significantly different pre-COVID compared to during the 5 COVID waves (p = 0.96). The most common referral reason was ocular trauma (38.0% of cases). There was a non-significant trend demonstrating more infectious disease presentations during waves 3 to 5 (p = 0.07). There was no difference in symptom duration prior to presentation (p = 0.54); however, there was a difference in the time between emergency room and ophthalmology assessment in waves 3 and 4 compared with wave 5 (p = 0.003). ConclusionThe number of pediatric ophthalmology consultations was less during the 5 COVID waves than pre-COVID. An increase in urgent pediatric ophthalmology consultations occurred as COVID-19 infection rates in Quebec decreased. Access to health care and time to care were preserved across waves compared with pre-pandemic.

A Systematic Review of Teleophthalmology Services Post-COVID-19 Pandemic in New Zealand, the United Kingdom, Australia, the United States of America, and Canada.

Background: This systematic review of teleophthalmology services in Australia, the United States of America (USA), Canada, and the United Kingdom (UK) during the COVID-19 pandemic is aimed to evaluate changes in teleophthalmology, comparing them to New Zealand (NZ). Methods: A literature search of electronic databases Scopus, Proquest, PubMed, Embase, Web of Science, Cochrane Library, Google Scholar, and Google was conducted using search terms: telemedicine, ophthalmology, teleophthalmology/teleophthalmology, and COVID/COVID-19/coronavirus/covid-pandemic. Studies describing teleophthalmology services created in response to COVID-19 restrictions from March 1, 2020, to January 31, 2024, were analyzed. Results: Of the articles, 37 describing 29 discrete teleophthalmology services were included. There were 15 services in the USA, seven in the UK, two in Canada, two in Australia, and three in NZ. The models of care in the USA were well described, and teleophthalmology was used for general, external, anterior segment, neuro-ophthalmology, and oculoplastic consults, as well as for grading of fundus images in the emergency department setting. In the UK, teleophthalmology was used for general eye care, oculoplastics, and pediatric ophthalmology. In Australia, teleophthalmology was used for postglaucoma surgery monitoring of Intraocular Pressure. In NZ, teleophthalmology was used for general eye consults and triaging, but no formal models were described. Conclusion: COVID-19 offered a unique opportunity for re-examination and expansion of teleophthalmology services globally. Video-based and home-screening teleophthalmology services are feasible but have limitations. Investing in multidisciplinary and community-based technology partnerships can create more equitable teleophthalmology care models (to complement and, when necessary, replace traditional in-person consults), within existing frameworks, making eye care more accessible and efficient.

Relation between binocular vision alteration and prehension movements in children: a scoping review.

To investigate, map, and synthesize evidence regarding the correlation between changes in binocular vision and fine motor skills among children. We conducted a scoping review of existing evidence, following the guidelines and checklist outlined in "Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping Reviews" (PRISMAScR). Sixteen papers were systematically included in our scoping review. A predominant focus was placed on assessing the impact of strabismus on motor skills. Most of the studies used motor test batteries for comprehensive analysis, while the remaining employed methodologies, such as questionnaires or laboratory-based tests. Vision stands as a pivotal perceptual modality essential for the optimal development of children. Alterations in visual acuity can significantly affect fine motor skills. Pediatric ophthalmology and orthoptics frequently encounter binocular vision disorders, such as amblyopia and strabismus. Our finding showed that impaired binocular vision affects fine motor skills.

Clinical and genetic spectrum of coloboma: A proposal for a comprehensive approach to pediatric patients

Purposeto analyze pediatric coloboma cases to (1) identify ophthalmological and systemic associations, (2) establish the variables with the highest probability of reaching a genetic diagnosis and worse visual prognosis and (3) propose a clinical and genetical assessment protocol. Design and methodsDescriptive, retrospective and single-center study. Patients under 18 years of age diagnosed with iris, chorio-retinal and/or optic disc coloboma under follow-up by a reference Pediatric Ophthalmology Unit have been selected from January 2012 to December 2022. A comprehensive data collection and analysis was performed to evaluate phenotype, molecular and prognosis correlations. ResultsA total of 214 patients with a mean age of 11.3 years (6.8 SD) were included (57% female). Among them, 50.9% presented with bilateral coloboma and 66.8% with other ophthalmological alterations (28.5% with microphthalmia). Systemic involvement was observed in 28%, being neurological dysfunction (24.8%) and craniofacial dysmorphic features (18.2%) the most frequent. Molecular diagnosis was reached in 19.2% and clinical exome sequencing had the highest diagnostic yield (22.2%). Bilaterality, macula involvement, short stature and neurological, craniofacial dysmorphic, cardiovascular, and renal anomalies were associated with reaching a genetic diagnosis (p < 0.05). Patients with craniofacial dysmorphic features, hearing, neurologic, cardiac abnormalities or short stature had a worse visual prognosis according with a multivariate model (p < 0.05). A diagnosis and follow-up protocol was developed. ConclusionIt is imperative to ascertain diagnostic and prognostic indicators in individuals with coloboma to facilitate genetic counseling, mitigate potential complications, and enhance the overall well-being of patients and their families

Application of Convolutional Gated Recurrent Units U-Net for Distinguishing between Retinitis Pigmentosa and Cone–Rod Dystrophy

Abstract Artificial Intelligence (AI) has gained a prominent role in the medical industry. The rapid development of the computer science field has caused AI to become a meaningful part of modern healthcare. Image-based analysis involving neural networks is a very important part of eye diagnoses. In this study, a new approach using Convolutional Gated Recurrent Units (GRU) U-Net was proposed for the classifying healthy cases and cases with retinitis pigmentosa (RP) and cone–rod dystrophy (CORD). The basis for the classification was the location of pigmentary changes within the retina and fundus autofluorescence (FAF) pattern, as the posterior pole or the periphery of the retina may be affected. The dataset, gathered in the Chair and Department of General and Pediatric Ophthalmology of Medical University in Lublin, consisted of 230 ultra-widefield pseudocolour (UWFP) and ultra-widefield FAF images, obtained using the Optos 200TX device (Optos PLC). The data were divided into three categories: healthy subjects (50 images), patients with CORD (48 images) and patients with RP (132 images). For applying deep learning classification, which rely on a large amount of data, the dataset was artificially enlarged using augmentation involving image manipulations. The final dataset contained 744 images. The proposed Convolutional GRU U-Net network was evaluated taking account of the following measures: accuracy, precision, sensitivity, specificity and F1. The proposed tool achieved high accuracy in a range of 91.00%–97.90%. The developed solution has a great potential in RP diagnoses as a supporting tool.

Excellent accuracy of trained neonatal nurses in the detection of referral-warranted retinopathy of prematurity within an established telemedicine screening programme.

To evaluate level of agreement of specialist trained retinopathy of prematurity (ROP) nurses compared with an experienced paediatric ophthalmologist in detection of referral-warranted ROP (RWROP) using wide-field digital retinal imaging. This is a prospective, observational, blinded study of neonates in a level III neonatal intensive care unit, from July 2020 to November 2022. Image capture using wide-field digital retinal imaging followed by ROP grading and staging was completed by trained ROP nurses. This was then compared with findings by an experienced paediatric ophthalmologist. The primary outcome was presence of RWROP in either eye. One hundred and ninety-five neonates (55% male) with a total of 768 screening visits were included. At the initial screen, nurse and ophthalmologist agreed about presence of RWROP for 191 of 195 neonates (98%, kappa = 0.79, P < 0.0001), with 100% sensitivity for RWROP detection. Including all 768 screening episodes, agreement was 98% for RWROP. There was disagreement in 16 screenings (2%) for 11 (6%) neonates. Of the five screenings (0.7%) that the ophthalmologist thought were RWROP and the nurse did not, three were disagreements about whether the zone was posterior zone 2 or zone 1. We found excellent levels of agreement and add evidence that interpretations by specialist trained nurses could be safely integrated into a 'hybrid ROP screening system'.

Sclerosing Perineurioma of the Orbit.

A 7-week-old boy presented to pediatric ophthalmology with a mass inferior to the medial canthus of the OS that was first noticed on day 3 of life. Crigler massages, warm compresses, and moxifloxacin HCl drops were administered without resolution of symptoms. Probing and irrigation for a presumed dacryocystocele were performed, but the nasolacrimal system was patent, and the mass persisted after the procedure. Oculoplastics was consulted for further evaluation and management. On exam, the tear lake was normal, there was no discharge to palpation of either lacrimal sac, and there was no erythema. An MRI was obtained that showed a mass with nonspecific features abutting the lacrimal sac. A gross total resection of the mass was performed, and it was sent for histopathologic evaluation. Pathology results yielded a diagnosis of sclerosing perineurioma, a rare soft tissue tumor previously unreported in the orbit.

Effective low-cost pediatric vision screening by naive nonophthalmic examiners using the 'Arclight' device.

To explore whether a low-cost ophthalmoscope (Arclight) can be used by naive nonophthalmic examiners to effectively screen for pediatric eye disease. Fifty-four children (108 eyes) were examined by five medical students using an Arclight. Gold standard examination was performed by an ophthalmologist using a slit lamp and indirect ophthalmoscope. Examinations performed included ophthalmoscopy of the optic disc, estimation of the cup-to-disc ratio (CDR), corneal light reflex test (CRT), Bruckner's reflex test (BRT), and evaluation of refractive error. We determined the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the nonophthalmologist's Arclight exam compared to the gold standard findings of comprehensive evaluation by pediatric ophthalmologists. Using the Arclight, the optic nerve exam was successfully completed in 65% of patients. CDRs above and below 0.5 could be determined with 66.7% sensitivity and 84.4% specificity. Arclight CRT measurements were significant (P < .00001) predictors of strabismus, with 80% sensitivity, 95.1%, specificity, 80% PPV, and 95.1% NPV. BRT was not a significant predictor of amblyopia, with a 34.6% sensitivity, 85.7% specificity, 69.2% PPV, and 58.5% NPV. Refractive error was estimated with a success rate of 81% for emmetropia, 38% for myopia, and 21% for hyperopia. The Arclight ease-of-use was rated on average as 4.4 (SD = 0.9) on a scale of 1 to 5, with 1 being the hardest and 5 being the easiest. Our study shows the Arclight as an affordable and effective alternative to the traditional ophthalmoscope for assessing eye disease in children. This device can improve eye health services in under-resourced regions.

Special features of postoperative long-term follow-up patients with retinopathy of prematurity

Background: Retinopathy of prematurity (ROP), leading to a high percentage of visual disability, continues to be one of the most complex and unresolved problems of pediatric ophthalmology. Some patients, despite successful surgical treatment and regression of ROP, lose their vision by the age of 25–35 years from the long-term consequences of ROP. That is why patients after surgical treatment of ROP, including those with peripheral chorioretinal dystrophy, need lifelong clinical follow-up in order to on time diagnose reactive conditions in the long-term postoperative period, leading to a significant loss of visual function. Methods: This paper presents a special case of a patient with stage 4 ROP and her long-term clinical and functional outcome. Conclusions: As a result of regular dynamic monitoring of the patient, using modern highly informative research methods, we promptly detected the formation of an exudative component of the macular area, which made it possible to prevent retinal detachment and loss of vision. Strengths of this study: This study presented a clinical case of a patient with ROP and long-term patient follow-up. This shows the importance of long-term monitoring of patients after treatment and the importance of combining treatment methods.