Refractive Error Research Articles

Relations between Neurocognitive Function and Visual Acuity: A Cross-Sessional Study in a Cohort of Premature Children.

Premature children with retinopathy of prematurity (ROP) have been reported to an have increased risk of visual and neurocognitive impairments, yet little is known about whether vision could affect specific neurocognition. This study aimed to clarify the correlations between neurocognition and vision in premature children. This is a nonrandomized, cross-sectional, observational study in a pediatric cohort with five groups: (1) full-term (n = 25), (2) prematurity without ROP (n = 154), (3) prematurity with ROP but without treatment (n = 39), (4) prematurity with ROP and with bevacizumab (IVB) treatment (n = 62), and (5) prematurity with ROP and with laser/laser + IVB treatment (n = 20). Neurocognitive function was evaluated by the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) around the age of 4 years. Visual acuity (VA) and refractive errors were tested. Correlations between WPPSI parameters and visual outcomes were analyzed across five groups. Among the 300 recruited children (mean age = 4.02 + 0.97 years, male = 56.3%), 297 were assessed by WPPSI-IV and 142 were assessed by vision tests. The Full-Scale Intelligence Quotient (FSIQ) index was worse in the premature groups. After adjusting for covariates, seven items, including FSIQ-Index (p = 0.047), fluid-reasoning index (p = 0.004), FR-percentile ranking (p = 0.008), object assembly (p = 0.034), picture concept (p = 0.034), zoo locations (p = 0.014) and bug search (p = 0.020), showed significant differences between groups. The better the best corrected VA (BCVA), the higher the scores on Verbal Comprehension Index (VCI), VCI-PR, and the subtest of information. Specific cognitive dysfunctions are related to the BCVA in this large cohort. Subtest performance profiles in WPPSI can be affected by prematurity, ROP treatment, and different ROP treatment. FSIQ is generally lower in premature children and even lower in children with ROP.

Professional performance of the graduate in optometry and optics in the calculation and adaptation of contact lenses

Introduction: the appearance, evolution and development of contact lenses brought with it a therapeutic method to correct refractive error, treat corneal ectasias and improve the patient s visual quality, thereby improving the profesional performance of the graduate in Optometry and Optics in this area it constitutes an aspect of singular importance within the medical sciences. Objetive: define profesional performance of graduates in Optometry and Optics in the calculation and adaptation of contact lenses. Method: a search was carried out in the Google Academic/ Scholar PUBMED, SciELO Public Health, SciELo Cuba engines. In the search strategy, the terms were used: profesional performance, contact lenses, quality of health services. A bibliographic review of 43 articles related to the topic under investigation was carried out. Results: we work to train a profesional with scientific mastery who responds to social needs, without abandoning the humanistic conception, since contemporary times demand a high leve lof performance, with the purpose of providing better care to patients visual problems. Conclusions: professional performance has been studied from different angles, highlihting the works of different authors, who offer as results of research models, methodologies and strategies as options aimed at the process of improving professional performance in different educations, whichis why it is done it is necessary to highlight the work of the graduate in Optometry and Optics in the calculation and adaptation of contact lenses base don visual health

Chromatic Light Therapy for Inhibiting Myopia Progression: Human Studies.

Myopia, a common refractive error, has been associated with various risk factors, but time outdoors has emerged as a significant protective factor against its onset. This association is believed to be mediated by the influence of sunlight on dopamine release, a neurotransmitter crucial for regulating eye growth. Recent research has explored the specific properties of light in order to identify potential interventions for myopia control in children. Low-level red light therapy has gained attention, and has shown promise in inhibiting myopia progression, although there are concerns about safety and rebound effects. Similarly, blue light stimulation aims to upregulate retinal dopamine activity, yet conclusive evidence supporting its efficacy is lacking. Moreover, researchers explored the use of the entire visible light spectrum by digitally imposing longitudinal chromatic aberration to adjust proper eye growth. Preliminary findings suggest that digitally simulated chromatic aberration could potentially serve as a myopia control strategy and highlights the need for further investigation into long-term effects. As research progresses, understanding the efficacy and safety of light-based interventions for myopia control remains crucial for informing clinical practice and optimizing patient outcomes.

Maternal Hypertensive Disorder in Pregnancy and Childhood Strabismus in Offspring

Maternal hypertensive disorder in pregnancy (HDP) might affect ocular health in offspring; however, its association with strabismus remains unclear. To examine the association of maternal HDP with overall and type-specific strabismus in offspring. In the Jiangsu Birth Cohort study, a population-based study in China, pregnant women were recruited from April 24, 2014, to November 30, 2018. A total of 6195 offspring had maternal HDP diagnosis information, of whom 3078 were excluded due to having no information on ocular alignment or due to having ocular diseases other than strabismus or refractive error. Offspring underwent ocular examinations at 3 years of age, completed May 21, 2022. Data were analyzed from May 28, 2022, through December 15, 2023. Maternal HDP, categorized into hypertension and preeclampsia or with blood pressure (BP) well controlled (systolic BP, <130; diastolic BP, <80 mm Hg) and poorly controlled (systolic BP, ≥130; diastolic BP, ≥80 mm Hg). The primary outcome was the incidence of strabismus in offspring. Poisson generalized linear mixed models were used to estimate the association between maternal HDP and strabismus. Among the included 3117 children (mean [SD] age, 36.30 [0.74] months; 1629 boys [52.3%]), 143 (4.6%) were exposed to maternal HDP and 368 (11.8%) had strabismus. Offspring exposed to maternal HDP had an 82% increased risk of overall strabismus (relative risk [RR], 1.82 [95% CI, 1.21-2.74]), an 82% increased risk of exophoria (RR, 1.82 [95% CI, 1.11-3.00]), and a 136% increased risk of intermittent exotropia (RR, 2.36 [95% CI, 1.13-4.93]) compared with unexposed offspring. When considering the type of maternal HDP, the risk for all strabismus was high for offspring exposed to preeclampsia (RR, 2.38 [95% CI, 1.39-4.09]) compared with unexposed offspring. When considering the BP control level of maternal HDP, the risk for all strabismus was high for offspring born to mothers with HDP and poorly controlled BP (RR, 2.07 [95% CI, 1.32-3.24]) compared with unexposed offspring. These findings suggest that maternal HDP is associated with an increased risk of offspring strabismus. Early screening of strabismus might be recommended for offspring with maternal HDP. Further exploration of the underlying mechanism of the association between HDP and strabismus is warranted.

Protective properties of spectacle lenses used as ultraviolet blockers

In this study, we evaluated the UV transmittance of spectacle lenses in the Turkish market, which are reported to have UV blocking properties, and tested their suitability. Samples were obtained from patients who were admitted to the ophthalmology outpatient clinic of our hospital for refractive error and who wore glasses as UV block. No limitation was made regarding the spectacle size and duration of spectacle wear. Measurements were tested by the principal investigator using an ultraviolet detector. The right and left lens were measured separately. All measurements were performed at room temperature (22-25°C) in a humidity regulated (20-40%) room without direct light. UV protection level was measured for 120 spectacles used for refractive errors. Only 28 (23.3%) of 120 glasses had protection level up to 400 nm UV. Twenty-four (20%) of the glasses had a protection level of 0 even though they were labeled as having UV blocking properties. It is clear that strict regulations need to be implemented to improve the protection levels of glasses.

Intraocular Lens (IOL) Exchange Procedure in Refractive Surprise After Ten Years of Cataract Surgery

Introduction: Postoperative refractive surprises may manifest following cataract surgery. A residual refraction difference of &gt; 2.0 D after cataract surgery was considered a refractive surprise. Treating refractive error after cataract surgery includes non-surgical and surgical options. The objective is to report clinical outcomes of intraocular lens (IOL) exchange with ciliary sulcus placement technique to manage refractive surprise. Case Presentation: A female patient aged 70 years reported experiencing blurred vision in her right eye (RE) for the past two years. History of RE cataract surgery ten years ago, however, she only had control 1-2 times after surgery. After that, the patient underwent cataract surgery on the left eye (LE), and then she complained that her RE was getting blurry. Her RE's visual acuity (VA) was 1/60 with best corrected visual acuity (BCVA) S-8.00 C-1.00 X100° to 6/10, and her LE was 7/10 with BCVA C-0.75 X60° to 10/10. The anterior segment examination of the RE was a 3-piece sulcus intraocular lens with complete continuous curvilinear capsulorhexis (CCC) intact anterior capsule, posterior capsule rupture, and the LE was in the bag IOL. Ultrasound examination of the RE revealed posterior staphyloma. She was diagnosed with OD refractive surprise, pseudophakia, posterior staphyloma, and OS pseudophakia. She underwent IOL exchange surgery on her RE. Post-operatively, the visual acuity of the RE was 7/45 using the Snellen chart. Three months post-op, the BCVA of RE was 10/10. Conclusions: In well-prepared cataract surgery, unexpected refractive outcomes such as a refractive surprise can be prevented. IOL exchange with ciliary sulcus placement technique is a treatment option for refractive surprise associated with posterior capsule rupture, and it has a good outcome.

Visual outcome in Keratoconus with spherical rigid gas permeable contact lens

Introduction: Keratoconus is a bileteral asymetric progressive ecteria of cornea commonly associated with vernal keratoconjunctivitis and Atopic dermatitis. Rigid gas permeable (RGP) contact lens is the first choice for refractive correction in keratoconic eyes. The visual outcome in Keratoconus with spherical RGP contact lens along with the mean age of presentation, gender predominance, ethnicity, associated conditions, refractive error and corneal astigmatism was evaluated. Methods: The records of the Keratoconus patients attending cornea and contact lens clinic for last 6 years were reviewed and analyzed using SPSS-14 software. Data on laterality, race, age, gender, refractive error, visual acuity (VA), associated conditions and contact lens parameters were obtained. A total of 22 patients with 38 keratoconic eyes were included in the study. Results: The mean age of Keratoconus presentation was 18.11 ± 4.45 years. Sixteen cases (72.73 %) were bilateral; 6 (27.27 %) were unilateral. Mean uncorrected visual acuity (UCVA) was 0.86 ± 0.40 Log MAR. Mean spectacle visual acuity was 0.54 ± 0.38 Log MAR. Mean visual acuity with spherical RGP contact lenses was 0.08 ± 0.14 Log MAR. The difference between mean spectacle visual acuity and mean VA with spherical RGP contact lens was statistically significant (p &lt; 0.001). Conclusion: In all stages of Keratoconus, improvement in visual acuity with spherical RGP contact lens was highly significant.

Ocular surface in patients with different degrees of myopia.

To investigate the clinical features of the ocular surface in patients with different degrees of myopia. A cross-sectional study was conducted involving 122 participants with myopia in Beijing Tongren Hospital from February to June, 2023. After completing the Ocular Surface Disease Index (OSDI) score scale, measurements were taken for refraction, biometric parameters and ocular surface parameters. The prevalence, severity and related parameters of the dry eye among different groups based on axial length (AL) were compared. Correlation analysis was performed between ocular surface parameters and refraction/biometric measurement parameters. Statistically significant differences were observed in refractive error, corneal thickness, anterior chamber depth, and subfoveal choroidal thickness among the groups (all P<0.05). With the increase in AL, the incidence and severity of dry eye increased significantly (P<0.05). Moreover, the tear film break-up time (BUT) shortened (P<0.05), and the corneal fluorescein staining (CFS) points increased significantly (P<0.05). OSDI scores were positively correlated with AL and spherical equivalent (SE; both P<0.05); BUT was negatively correlated with AL, SE, and corneal astigmatism (AST; all P<0.05); Schirmer I test (SIT) results were negatively correlated with AL and SE (both P<0.05). AL elongation is a risk factor for dry eye onset in myopic participants. The longer the AL, the more severe the dry eye is, with the increased CFS spots and tear film instability. Additionally, SE and AST exhibit negative correlations with dry eye symptom scores and ocular surface parameters.

Surgical approaches to correct corneal astigmatism at time of cataract surgery: a mini-review.

Among refractive errors, astigmatism is the most common optical aberration, where refraction changes in different meridians of the eye. It causes blurred vision at any distance and includes corneal, lenticular, and retinal astigmatism. Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism, for example, a large size surgery incision. The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery. Nowadays, three surgical approaches can be used. By placing a sutureless clear corneal incision on the steep meridian of the cornea, a preoperative corneal astigmatism less than 1.0 D can be corrected. Single or paired peripheral corneal relaxing incisions (PCRIs) provide 1.0-3.0 D corneal astigmatism correction. PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism, if more than 2.0 D, the risk of overcorrection and irregular astigmatism is increased. When toric intraocular lenses (IOLs) are unavailable in markets, PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism. Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism. Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D. These approaches can be used alone or in combination.

Scoping review: Reporting characteristics for the safety of contact lenses in the pediatric population.

Contact lenses are an increasingly popular option for correcting pediatric refractive error due to increased awareness of interventions to slow myopia progression. With limited information on the safety profiles of contact lenses in children, it is important to characterize the current understanding and promote this device's safe and effective use. This scoping review evaluates characteristics of the current literature that have examined the safety of contact lenses in pediatric patients. It provides future directions for systematic reviews and identifies any gaps in the current literature or areas for future research. Literature searches in MEDLINE via PubMed, EMBASE, The Cochrane Library, trial registries, and U.S. Food and Drug Administration clinical trial documentation were performed. Included studies (i.e., experimental and quasi-experimental studies; observational studies including prospective and retrospective cohort, case-control, and analytical cross-sectional studies, and case series of 30 or more participants) reported safety and/or complications of the use of any contact lens for correcting refractive error in children (0 to 18 years). Two independent reviewers first screened the titles and abstracts, and then full-text reports for eligibility. Conflicts in eligibility were resolved by discussions with a third reviewer. Two independent reviewers extracted data, including details about the participants, context, study methods, and key findings relevant to the review question. This scoping review included 73 studies from 10 countries using different contact lens modalities, primarily orthokeratology and soft contact lenses, in children (6 to 18 years). The most common adverse event reported by the studies was corneal staining (60% orthokeratology, 45% soft contact lens). The need for uniform reporting standards for adverse events poses challenges for comprehensive data synthesis. However, this scoping review identified a sufficient number of studies for a future systematic review to quantify the risks associated with orthokeratology and soft contact lens use in children.

Ophthalmic manifestations of NAA10-related and NAA15-related neurodevelopmental syndromes: Analysis of cortical visual impairment and refractive errors.

NAA10-related (Ogden syndrome) and NAA15-related neurodevelopmental syndrome are known to present with varying degrees of intellectual disability, hypotonia, congenital cardiac abnormalities, seizures, and delayed speech and motor development. However, the ophthalmic manifestations of NAA10 and NAA15 variants are not yet fully characterized or understood. This study analyzed the prevalence of six ophthalmic conditions (cortical visual impairment, myopia, hyperopia, strabismus, nystagmus, and astigmatism) in 67 patients with pathogenic (P) or likely pathogenic (LP) variants in the NAA10 cohort (54 inherited, 10 de novo; 65 missense, 2 frameshift) and 19 patients with (L)P variants in the NAA15 cohort (18 de novo; 8 frameshift, 4 missense, 4 nonsense, and 1 splice site). Patients were interviewed virtually or in-person to collect a comprehensive medical history verified by medical records. These records were then analyzed to calculate the prevalence of these ophthalmic manifestations in each cohort. Analysis revealed a higher prevalence of ophthalmic conditions in our NAA10 cohort compared to existing literature (myopia 25.4% vs. 4.7%; astigmatism 37.3% vs. 13.2%; strabismus 28.4% vs. 3.8%; CVI 22.4% vs. 8.5%, respectively). No statistically significant differences were identified in the prevalence of these conditions between the NAA10 and NAA15 variants. Our study includes novel neuroimaging of 13 NAA10 and 5 NAA15 probands, which provides no clear correlation between globe size and severity of comorbid ophthalmic disease. Finally, anecdotal evidence was compiled to underscore the importance of early ophthalmologic evaluations and therapeutic interventions.

Childhood visual impairment causes and barriers to accessing eye care: A suggested approach for Africa.

Childhood vision impairment (VI) has a significantly harmful effect on both health and social outcomes. To assess the causes of childhood VI, to determine obstacles to accessing eye care services and to develop a strategy for the childhood eye care system in African nations. This systematic review was conducted by searching several online databases, including; Scopus, PubMed, ProQuest, Web of Science, Google Scholar, Ebsco and Medline. They focussed on articles available between 2003 and 2023. These studies were conducted to evaluate the causes of childhood VI and to assess obstacles to accessing eye care services in African countries. The main causes of childhood VI in African nations can be avoided with timely diagnosis and an appropriate management strategy. The leading obstacles to accessing childhood eye care services were a lack of availability, accessibility and affordability. In addition to these barriers, we found that there are concerns with quality of services, primary health care system, geographic barriers, incorrect health beliefs, inappropriate parental perception, a lack of knowledge, attitudes and inadequate practices related to paediatric eye care. The main causes of childhood VI were uncorrected refractive error (RE), amblyopia, cataract and corneal opacities that can be avoided with timely diagnosis and an appropriate management strategy. While the main obstacles to accessing childhood eye care services were a lack of availability, accessibility, affordability and healthcare system.Contribution:The recommended strategy for childhood eye-care services includes models for delivery and training.

Accuracy of intraocular lens power formulas in patients with average keratometry greater than 46 diopters

ObjectiveTo compare the accuracy of Kane, Barrett Universal II, Haigis, and SRK-T formulas in eyes with average keratometry greater than 46 diopters (D). MethodsA retrospective analysis was conducted on 101 eyes of 101 patients with average keratometry greater than 46 D. The absolute prediction error (EA) was obtained for each patient one month after surgery. The mean absolute prediction error (MEA), median absolute prediction error (MedEA) and the percentage of patients with absolute refractive error less than 0.25 D, 0.50 D, and 1.00 D were calculated for each formula analyzed. ResultsThe Kane formula achieved the lowest MEA (0.53 ± 0.43) and the lowest MedEA (0.41), followed by Barrett Universal II (MEA: 0.56 ± 0.42, MedEA: 0.49), SRK-T (MEA: 0.59 ± 0.44, MedEA: 0.54), and Haigis (MEA: 0.77 ± 0.47, MedEA: 0.69), showing a significant difference in the results. It was also observed that the Kane formula was the most accurate, with the highest percentage of patients, with EA less than 0.25 D, 0.50 D, and 1.00 D (30.7%, 54.4%, and 86.1%, respectively), while the Haigis formula was the least accurate (12.9%, 33.7%, and 69.3%, respectively). ConclusionIn eyes with corneas having average keratometry greater than 46 D, the Kane formula proves to be a useful tool in intraocular lens (IOL) power calculation and demonstrates higher precision compared to the Barrett Universal II, SRK-T, and Haigis formulas.

Comparison of long-term visual quality after keratorefractive lenticule extraction and implantable collamer lens V4c for high myopia.

To compare the long-term refractive outcomes and visual quality after KLEx and EVO-ICL implantation for high myopia. Eye & ENT Hospital of Fudan University, Shanghai, China. A retrospective study. This study included 31 KLEx-treated patients (31 eyes, spherical equivalent: -7.62D ± 1.22) and 32 ICL-treated patients (32 eyes, spherical equivalent: -8.22D ± 1.18). Refractive outcomes and objective visual quality were examined. Subjective visual quality was evaluated by a customized questionnaire. Patients' satisfaction was graded. Five-year postoperatively, the efficacy (KLEx: 0.96 ± 0.20; ICL: 1.03 ± 0.20; P = 0.164) and safety indices (KLEx:1.12 ± 0.20; ICL: 1.21 ± 0.19; P = 0.067) were comparable. Statistically higher proportions of ICL-treated eyes achieved a postoperative UDVA of 20/20 or better (P = 0.035). Refractive predictability was similar between the two groups (P = 0.947), whereas more KLEx-treated eyes had myopic refractive errors (P < 0.001). Total coma was significantly higher after KLEx (P = 0.020), and greater total trefoil was observed after ICL implantation (P = 0.006). Haloes were the primary visual disturbance in both groups (KLEx: 64.5%; ICL: 93.8%). The incidences of haloes (P < 0.001), glare (P = 0.004), and starbursts (P = 0.043) were notably higher after ICL implantation. The patient's satisfaction scores were similar (KLEx: 9.10 ± 1.27; ICL: 9.10 ± 1.27; P = 0.894). For high myopia, EVO-ICL yielded better long-term refractive outcomes than KLEx. Haloes were the chief complaint in both groups, with a significantly higher incidence after ICL implantation.

A qualitative analysis on prevalence of refractive errors in children

A qualitative analysis on prevalence of refractive errors in children

Vision screening and refraction of Greenlandic schoolchildren.

To estimate the prevalence of amblyopia and refractive errors among 6-year-old children in Greenland and to assess the impact of incorporating autorefraction, stereoacuity and near visual acuity testing into vision screening. In this cross-sectional study, 517 children (238 girls and 279 boys) from 21 locations in Greenland were screened using HOTV charts for distance and near visual acuity (VA), stereoacuity test and non-cycloplegic autorefraction. Referral criteria for further ophthalmological examination included a VA of ≥0.2 logMAR on the worse-seeing eye or an interocular VA difference of ≥2 lines. Initial screening identified amblyopia (defined as VA of ≥0.3 logMAR) in 7% (unilateral) and 3% (bilateral) of children. However, subsequent ophthalmological examinations confirmed amblyopia in under 40% of referrals. Significant interocular VA differences were found in 9%. The prevalence of refractive errors at the screening was 3% for myopia (≤-0.5 dioptres), 10% for hyperopia (>+2.0 dioptres) and 14% for astigmatism (≤-1.00 dioptres), while the corresponding prevalences at the ophthalmological examination were 4% for myopia, 8% for hyperopia and 6% for astigmatism. Combining screening measurements increased the positive predictive values, thereby enhancing screening accuracy. Specifically, the incorporation of autorefraction or stereoacuity with distance VA demonstrated to be the most effective combination. Six percent of the children were prescribed glasses after the screening procedure. This study provides the first visual profile of Greenlandic schoolchildren. Incorporating autorefraction, stereoacuity and near visual acuity in vision screenings enhanced the efficacy of detection of vision anomalies. Although this may lead to more false positives, accurate screening is crucial in regions with limited ophthalmological resources.

Intraocular lens tilt and decentration after primary and delayed implantation in phacovitrectomy for macula-off rhegmatogenous retinal detachment repair.

To evaluate the tilt and decentration of intraocular lenses (IOLs) in eyes that underwent phacovitrectomy for macula-off rhegmatogenous retinal detachment (RRD) repair. In this retrospective cohort study, 63 patients with macula-off RRD who underwent phacovitrectomy were enrolled and divided into a primary implantation group (group A) and a delayed implantation group (group B) according to the time of IOL implantation. Routine ocular examinations, including optometry, were performed, and the IOL tilt and decentration were measured. Postoperative refractive prediction error and IOL tilt and decentration were compared between the two groups, and the relevant factors of IOL positions were analyzed. The mean spherical refractive prediction error (MSE) was - 0.53 ± 0.39 D in group A and - 0.09 ± 0.55 in group B. The mean absolute spherical refractive prediction error (MASE) was 0.61 ± 0.23 D in group A and 0.50 ± 0.22 D in group B. The difference in MSE (t = -3.623, P < 0.05) but not in MASE (t = 1.866, P = 0.067) between the two groups was significant. The mean IOL tilt and mean decentration were 8.54° ±3.65° and 0.55 ± 0.18 mm in group A and 10.62° ±3.29° and 0.66 ± 0.14 mm, respectively, in Group B. Differences in tilt (t = -2.373, P < 0.05) and decentration (t = -2.698, P < 0.05) between the two groups were both significant. In group B, the mean time interval between phacovitrectomy and IOL implantation (TV-I) was 25.2 ± 6.9 weeks, and the absolute values of both IOL tilt and decentration were positively correlated with TV-I. In phacovitrectomy for macula-off RRD repair, primary IOL implantation leads to a postoperative myopic shift, while delayed IOL implantation may cause greater IOL tilt and decentration.

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.

Dyskinetic Cerebral Palsy in Children: Clinical Perspectives on Common Comorbidities and Health-Related Quality of Life.

The data on specific comorbidities in children with dyskinetic cerebral palsy (DCP) is limited. We evaluated the pattern of comorbidities and health related quality of life (HRQOL) in these children and compared them between etiological and motor impairment subgroups. This cross-sectional study was conducted over 18 months in children with DCP of both sex, and age between one and 14 years. Comorbidities were assessed using standardized scales such as gross motor functioning scale (GMFCS), developmental profile-3 (DP-3), developmental behaviour checklist, sleep behaviour questionnaire (SBQ), and caregiver questionnaire. Sixty-five children with DCP were evaluated (hyperbilirubinemia n = 43, 66% and perinatal asphyxia n = 19, 29%). The majority of children were severely affected in gross motor functioning (level IV 29.2% and level V 53.8%). Epilepsy was seen in 21.5% of cases (19% in hyperbilirubinemia and 32% in asphyxia, p = 0.4). The mean age of onset of seizures was 15.4 + 20.6 months (range 2-72). Visual problems were seen in 54% of cases and included upgaze palsy, squint, refractive error, optic atrophy and cortical blindness. A significant proportion of children with hyperbilirubinemia had upgaze palsy as compared to those with perinatal asphyxia (70% vs. 32%, p 0.01). Rest of the visual problems were not significantly different between the two etiological subgroups. Drooling (87.6%), protein-energy malnutrition (66.6%), and reflux (57%) were the most common gastrointestinal problems in children with DCP. Children with DCP showed problems in social relating (33.8%), anxiety (26.2%), and self-absorbed behaviour (7.7%). However, there were no statistically significant differences between the etiological, motor impairment and age-based subgroups. Children with DCP had high scores on SBQ, suggesting sleep problems. Sleep scores were similar in the hyperbilirubinemia and perinatal asphyxia subgroups. Greater sleep problems were noted in children aged < 4y (70.6 + 10.1 vs. 56.5 + 11.3, p < 0.05 as compared to children above 4y of age) and severe motor impairments (68.2 + 11.3 vs. 57.2 + 13.1, p 0.008 as compared to mild-moderate motor impairment). Poor overall developmental scores were seen in 61.5% children and were significantly associated with GMFCS (p 0.04). The majority of children showed impairments in physical (58.5%), adaptive behaviour (58.5%), social-emotional (50.8%), cognitive (60%) and communication (52%) subscales of DP-3. Cognitive impairment was similar in the etiological (hyperbilirubinemia vs. perinatal asphyxia, p = 0.3), and motor impairment (mild-moderate vs. severe, p = 0.9) subgroups. HRQOL was significantly affected by motor impairment in positioning-transfer (p value 0.0001), and interaction-communication domains (p value 0.0001), however, there was no difference based on the etiology of hyperbilirubinemia and asphyxia. Children with DCP demonstrate several comorbidities and impaired quality of life. These are similar in hyperbilirubinemia and perinatal asphyxia cohorts, expect for significant proportion of upgaze palsy in DCP secondary to hyperbilirubinemia. Younger children have more problematic behaviour and impaired sleep quality. Severe motor disability influences the developmental outcomes, cognition, sleep and HRQOL in children with DCP.

Prevalence and Impact of Refractive Errors in School-Aged Children: A Cross-Sectional

This cross-sectional study aims to determine the prevalence and patterns of refractive errors among 700 schoolchildren aged 5-15 years in Al-Manara School, Tobruk, Libya. A comprehensive ophthalmic examination will be conducted to assess visual acuity and identify refractive errors. Academic performance will be evaluated by reviewing school records, including grades and standardized test scores. The impact of refractive errors on quality of life will be measured using a validated pediatric vision-related quality of life questionnaire. The study seeks to provide data on the burden of refractive errors and their effects on learning and daily living in this population. We hypothesize that uncorrected refractive errors will be associated with poorer academic achievement and reduced quality of life compared to peers without vision impairment. This research can highlight the need for regular vision screening and provision of spectacles for schoolchildren in Libya. Findings may guide education policy and school health programs to address this treatable cause of impaired classroom performance. The large sample size will allow for analysis of prevalence stratified by key demographics and characterization of the patterns of refractive errors in this geographic setting.