Vision In Children Research Articles

Profiling children with cerebral visual impairment in a tertiary eye care center

Background: Cerebral visual impairment (CVI) is a bilateral visual impairment that affects children in all industrialized countries. It has become more common in low-income countries as a result of the increased survival rates of children who suffer from severe neurological conditions during the perinatal period. The purpose of this study was to determine the characteristics of children with CVI in a tertiary children’s eye care center population. Methods: From October 2020 to September 2021, a cross-sectional study was conducted to select all consecutive patients with a diagnosis of cerebral visual impairment aged 6 months to 16 years. On the neurological deficit, information was gathered from the patient’s referral: parental interviews, observations, and direct assessment were used for functional vision characteristics, and an ophthalmic examination was performed for eye findings. The interviewees’ responses were matched to the ten specific behavioral characteristics shared by children with CVI. Cortical visual impairment was diagnosed using three criteria: [the vision loss is not explained by abnormalities found on the eye examination, a neurological medical diagnosis, and the child exhibits one of the unique visual and behavioral characteristics described by Roman Lantz]. A descriptive statistical analysis (frequency, mean, and range) was calculated. Results: Forty children with CVI (1.96% of total children) were seen. The mean age was 2.56 ( 1.98) years. There were 24 (60%) males. On a referral paper of 28, hypoxic-ischemic encephalopathy was the commonest cause mentioned (70.0%). Seizures were the most frequent neurological deficit at presentation. Ophthalmic and neurologic impairments were found in 42.5% of children with CVI. Based on Roman-Lantzy’s three phases of the CVI Range, 90% of children with CVI at the test time had Phase I or Phase II vision. Conclusion: According to the findings of this study, visual impairment is critical in the diagnosis of CVI. The prevalence of CVI as a cause of childhood vision impairment is significant. Hypoxic-ischemic encephalopathy is the most common cause of CVI. All children with CVI have serious neurological issues, and the majority have associated ophthalmic abnormalities.

Disruptions, adjustments and hopes: The impact of the COVID-19 pandemic on child well-being in five Majority World Countries.

Drawing on integrated data from focus groups and diary entries, we explored the impact of the COVID‐19 pandemic on child well‐being for children from five Majority World Countries. We focus on the disruptions the pandemic caused, the adjustments made in response to these, and children's vision of a post‐pandemic world. Underlying children's experiences of loss, boredom and concerns about educational progress, was an awareness of systemic inequalities that disadvantaged them or others in their community. Findings have implications on capturing children's voices through introspective and dialogical approaches that transcend cultures and for the development of preventive and responsive interventions during crises.

Prevalence, Years Lived With Disability, and Time Trends for 16 Causes of Blindness and Vision Impairment: Findings Highlight Retinopathy of Prematurity.

BackgroundCause-specific prevalence data of vision loss and blindness is fundamental for making public health policies and is essential for prioritizing scientific advances and industry research.MethodsCause-specific vision loss data from the Global Health Data Exchange was used. The burden of vision loss was measured by prevalence and years lived with disability (YLDs).FindingsIn 2019, uncorrected refractory error and cataract were the most common causes for vision loss and blindness globally. Women have higher rates of cataract, age-related macular degeneration (AMD), and diabetic retinopathy (DR) than men. In the past 30 years, the prevalence of moderate/severe vision loss and blindness due to neonatal disorders has increased by 13.73 and 33.53%, respectively. Retinopathy of prematurity (ROP) is the major cause of neonatal disorders related vision loss. In 2019, ROP caused 101.6 thousand [95% uncertainty intervals (UI) 77.5–128.2] cases of vision impairment, including 49.1 thousand (95% UI 28.1–75.1) moderate vision loss, 27.5 thousand (95% UI 19.3–36.60) severe vision loss and, 25.0 thousand (95% UI 14.6–35.8) blindness. The prevalence of new-onset ROP in Africa and East Asia was significantly higher than other regions. Variation of preterm birth prevalence can explain 49.8% geometry variation of ROP-related vision loss burden among 204 countries and territories. After adjusting for preterm prevalence, government health spending per total health spending (%), rather than total health spending per person, was associated with a reduced burden of ROP-related vision loss in 2019 (−0.19 YLDs for 10% increment). By 2050, prevalence of moderate, severe vision loss and blindness due to ROP is expected to reach 43.6 (95% UI 35.1–52.0), 23.2 (95% UI 19.4–27.1), 31.9 (95% UI 29.7–34.1) per 100,000 population.ConclusionThe global burden of vision loss and blindness highlights the prevalent of ROP, a major and avoidable cause for childhood vision loss. Advanced screening techniques and treatments have shown to be effective in preventing ROP-related vision loss and are urgently needed in regions with high ROP-related blindness rates, including Africa and East Asia.

Review of vision screening referrals in children

Background: Childhood vision screening is aimed at the detection of reduced vision due to amblyopia, thus enabling early diagnosis and timely intervention. The purpose of the study was to review the demographics and visual parameters of children referred to the ophthalmologist at Community Health Centre Ljubljana from Slovenian community-based vision screening program and define the visual outcome after treatment in children with amblyopia.
 Methods: Retrospective medical records review of children referred from community-based vision screening program for further assessment. Medical records were reviewed to determine findings from ophthalmic assessments, treatment received, and visual acuity at the final visit. The main outcome measures were the cause of visual impairment and the visual acuity at the final follow-up visit.
 Results: From 439 children (mean age 7.3 +/- 3.7 years) referred from community-based vision screening program, 75 children (17%; mean age 5.3 +/- 2.6 years) had amblyopia and received treatment. They had amblyogenic refractive error (3.67 +/- 2.44 diopters of sphere and 1.86 +/- 1.23 diopters of astigmatism) with uncorrected visual acuity on average 0.32 +/- 0.28 logMAR in the worse eye. Visual outcomes after treatment were good with a visual acuity of 0.04 +/- 0.07 logMAR in the worse eye, 60% of them had a visual acuity of 0.00 logMAR (40/40).
 Conclusion: Children with amblyopia in the presented clinical sample were mostly diagnosed and treated before the school-age. These children showed significant improvement in visual acuity in the amblyopic eye.

Technique of using Cionni capsular tension ring in the management of of ectopia lentis cases.

Background:Ectopia lentis is a condition that compromises vision in childhood by inducing either double vision or aphakic visual axis. Correction of lens status is of prime importance to prevent amblyopia or sensory strabismus.Purpose:Placing an intraocular lens (IOL) in the bag in such cases will maintain aqueous vitreous barrier but it is a difficult task.This video demonstrates the method of placing modified Cionni capsular tension ring (CTR) and placement of IOL in children.Synopsis:This video shows the management of multiple cases of ectopia lentis with more than 180 degree subluxation. Making intact rhexis is crucial and technically difficult in such cases. The way of making a proper capsulorhexis is shown. After making capsulorhexis, all the cases were managed with single loop Cionni CTR. Cionni CTR has a loop with a anterior offset of 0.4 mm to override the anterior capsule. It has two designs – right and left design, based on the position of islet in the CTR. Since the offset of the hook is tiny, there are high chances to flip the Cionni CTR. If the Cionni CTR is placed in a flipped manner, it would not give effective pull of the bag, when fixated to sclera. And also, it could be traumatic to explant and place in correct manner. Hence it is vital to place the Cionni CTR in correct orientation, so that anterior offset will orient anteriorly. This video gives guidance to the viewers about the correct way of placing different designs of Cionni CTR in different types of subluxation.Timing of passing sutures through sclera may be done either before or after placing the Cionni CTR in the bag. Both the ways are demonstrated in different cases.Highlights:Different technique of doing Cionni CTR fixation with IOL placement are demonstrated. Surgeons who wish to try this procedure can choose the option that they feel comfortable with. We conclude that choice of Cionni CTR design and technique of placement depends on surgeon’s choice and not based on the type of subluxation.Video link: https://youtu.be/zbdpP0lhykw

Growth Hormone and Visual Stimulation Restore Normal Vision in Children with Cerebral Palsy

A common problem in children affected by cerebral palsy, independently of its etiology, is the existence of visual impairment. In this retrospective study we analyzed the effects of Growth hormone (GH) administration (0,04 mg/kg/day, 5 days/week) together with visual stimulation with a tachistoscope in 42 children with cerebral palsy (22 boys, 20 girls, aged 2,48 ± 1,5 years [mean ± SD) in whom there was an evident lesion of the visual pathway. In 17 of these cases, prematurity was the responsible factor, while in the other 25 children, ischemic encephalopathy due to pre/perinatal problems was the origin of visual impairment. In addition, we analyzed three other children (1, 2 months and 1 year of age) in whom multicystic encephalopathy (due to severe hypoxia-ischemia at delivery) mainly affecting the occipital lobes was the responsible factor. Visual evoked potentials were recorded before beginning and after treatment, assessing the latency in ms of the N75, P100 and N140 waves, as well as the amplitude of the waves (µV). Treatment duration (mean ± SD) was 5.20 + 2.05 months. Completion of treatment was established by clinical criteria. The statistical significance of the data was carried out using the Wilcoxon test. The treatment induced a significant decrease in the latency of N75, P100 and N140 (p < 0.001), as well as a clear tendency to increase the amplitude of the waves (p < 0.05). Of special interest is the case of a child affected by Multicystic Encephalopathy in which the cystic cavities in the occipital lobes detected by MRI before starting treatment (15 days of age) completely disappeared in a new MRI performed 1 year later. That child is now totally independent for activities of daily living. GH treatment did not produce any adverse effects. In summary, from our results we can conclude that the administration of GH added to visual stimulation with a tachistoscope is an effective and safe method for the repair of visual deficiencies in children with cerebral palsy, regardless of the existence or not of GH deficiency.

Strategies for Success: Parent Perspectives on School-based Vision Programs

Objective: School-based vision programs (SBVPs) connect children to eyecare directly in schools with benefits for vision and academics. Whereas parental engagement is critical to SBVP success, research on parent perspectives is lacking. We report on parental suggestions about how to maximize the impact of SBVPs. Methods: Data were collected from 20 parent focus groups (90 participants) in Baltimore, MD and Chicago, IL. Focus groups were recorded, audio-transcribed, and coded using inductive thematic analysis. Results: Major themes of parental suggestions for maximizing SBVP impact were: (1) communication, (2) education, and (3) eyeglass resources. Flyers and phone calls were the most frequently suggested methods for communication. Parents requested education regarding screening outcome, instructions for eyeglass use, and eyecare recommendations. Parents also suggested eyeglass resources to assist in maintenance and multiple pairs of eyeglasses. Conclusions: This information provides a framework about what parents want to know about SBVPs and opportunities to strengthen program-parent engagement. This framework can support the mission of increasing early childhood vision screening and reducing vision loss in children and adolescents as set forth by Healthy People 2030.

Assessing the Efficacy of Low-Dose Topical Atropine (0.01%) for Controlling the Progress of Myopia among School Children

Background: It is one of the most common abnormalities of human eyes and its incidence has dramatically risen in incidence in the last few decades. Myopia may lead to irreversible vision loss. A number of studies reflect on the effectiveness of low concentration atropine in controlling myopia. Atropine is used topically as a cycloplegic for the accommodation reflex and as a mydriatic for pupillary dilatation. Since myopia is leading cause of diminution of vision in early childhood, use of atropine (0.01%) in early stages can provide regression in myopic changes in eye. This study aimed to assess the change in spherical equivalent, changes in axial and keratometry values and retinal degenerative changes in cases of myopia treated with low dose atropine.
 Methodology: The enrolled cases of myopia will undergo thorough ophthalmological examination and will be randomized into intervention and control groups. All cases in intervention group will be treated with low dose atropine (0.01%) eye drops at night and will be followed up every 6 months for examination. The control group will be provided refractive spectacles and also followed up every 6 months. The data from both groups will be compared and analysed.
 Expected Results: Significant reduction in the progression of Myopia among school going children is expected with administration of 0.01% atropine eye drops.
 Conclusion: Use of atropine (0.01%) in early stages can provide regression in myopic changes in eye.

Children's vision of the covid-19 pandemic: gender-specific views of older preschoolers and younger schoolchildren

Introduction. This article presents the results of the research project "Children's Vision of the COVID-19 pandemic" implemented in 2020. According to many experts, the COVID-19 pandemic has led to negative consequences for the physical (somatic), psychic and psychological and the health of the population. The works of foreign and domestic authors state the facts of a number of negative psychological effects of an emotional, mental and behavioral nature. However, against the background of the available research, a significant gap is found, which concerns the children's version of the perception of the situation of the pandemic and forced isolation, and above all its gender specificity in relation to the stage of early ontogenesis – senior preschool and primary school age.Materials and Methods. To collect the actual data, a projective verbal method of writing a story on the theme "The Tale of the Coronavirus" was used. In total, 138 stories were collected (68 of them were composed by girls and 70 by boys), the content analysis of which was carried out through the open coding procedure. Comparative gender analysis of the texts of the stories was conducted in seven main categories: "characteristics of the coronavirus", "origin of the coronavirus", "current (frustrated) needs", "resources for overcoming difficulties", "emotions", "key events" and "gender of the characters".Results. The data obtained showed the predominantly negative nature of children's views of the coronavirus, pronounced discomfort in most of them caused by frustration of the needs for security, freedom, positive emotions and social contacts, the predominance of a mostly anxious emotional background of the perception of the pandemic situation with a predominance of fear, as well as a special emphasis on such resources for overcoming difficulties as compliance with preventive measures and hygiene rules, medical care and restriction of activity. At the same time, the gender specificity of children's ideas about the COVID-19 pandemic was found, which consists in a more pronounced orientation towards people of their own sex, emphasizing their own role in solving the problem and focusing on active resistance to the threat in boys and focusing on the emotional side of events, emphasizing the role of others and waiting for salvation from outside in girls.Discussion and Conclusions. According to the results of the study, it is concluded that the content of ideas about the COVID-19 pandemic and self-isolation of girls and boys of senior preschool and primary school age, along with general trends, has a gender specificity, which reflects the results of differentiated gender socialization prevailing at the stages of early ontogenesis, based on the tradition of gender polarization.

Impaired vision and physical activity in childhood and adolescence: findings from the Millennium Cohort Study

Background/aimsInvestigate if impaired vision is associated with reduced levels and differences in types of physical activity (PA) to identify barriers or enablers to achieving healthy PA levels.MethodsData from the Millennium...

National Model: An approach to comprehensive eye examinations for children entering the school system

In February 2005, the Children's Vision Initiative (CVI) of the Canadian Associa­tion of Optometrists (CAO) submitted a project funding application to the Community Development and Partnerships Directorate of Social Development Canada. While the submis­sion did not ultimately meet the requirements for funding, the application process proved to be a beneficial exercise in clearly articulating CAO's approach for comprehensive eye exami­nations for children entering the school system. CVI may also use the material to apply to other government programs.

Management of post-septal complications of acute rhinosinusitis in children: A 14-year experience in a tertiary hospital

IntroductionAcute rhinosinusitis accounts for most of the cases of orbital infections and is the most common cause of periorbital oedema in children. Up to 10% of patients with orbital complications of acute rhinosinusitis may experience vision loss and other complications such as meningitis, intracranial abscess or even death. Therefore, these patients require prompt diagnosis and proper treatment. ObjectivesThis study aims to report the clinical presentation and management of post-septal orbital complications of acute rhinosinusitis in the paediatric population. Materials and methodsA retrospective medical chart review of all children aged under 18 years old who were diagnosed with post-septal orbital complications of acute rhinosinusitis at a tertiary academic hospital, between 01/2007 and 12/2020. Patients were grouped according to the Chandler Classification (groups 2–5). ResultsFifty-five children (mean age of 6.91 ± 4.61 years) fulfilled the entry criteria for post-septal orbital complications of acute rhinosinusitis, based on clinical evaluation by an otorhinolaryngologist and CT-scan findings. Forty (72.72%) patients were also evaluated by an ophthalmologist. Most patients were male (76.36%). Twenty-four patients had post-septal cellulitis (43.63%), 21 patients had a subperiosteal abscess (38.18%) and 10 patients had an orbital abscess (18.18%). Eyelid swelling was the most frequent sign, followed by fever. Microbiology varied considerably and gram-positive agents were clearly predominant. Eighteen (32.73%) patients had been treated with oral antibiotics prior to hospital admission, exhibiting a significantly higher risk of recurrence of orbital infection (p = 0.020). Ethmoid and maxillary sinuses were the most involved paranasal sinuses (90.91%). Thirty-three patients (60%) were successfully treated medically, and 22 patients (40%) required surgical drainage. Seven patients (12.73%) developed further complications and six recovered without sequelae. The mean length of hospital stay was 8.0 ± 5.0 days and recurrence of orbital infection occurred in six patients (10.91%). The absolute neutrophil blood count was significantly different amongst Chandler groups (p = 0.021), with higher counts in patients with subperiosteal abscess. The duration of hospitalization was significantly higher in patients submitted to surgery (p < 0.001). ConclusionPost-septal orbital complications of acute rhinosinusitis are infrequent but dangerous events in the paediatric population. Close collaboration with Ophtalmology is paramount, as the child's vision is at risk. Eyelid swelling and proptosis are early signs. CT-scan imaging plays an invaluable role in the diagnosis and decision-making. Predictive indicators for surgery were not found. However, emergency endoscopic nasal surgery with abscess drainage should be considered whenever vision is at risk, if there is no improvement after aggressive medical treatment, and in cases of intracranial complications.

Demographic Characteristics and Causes of Low Vision in Children: A Hospital–Based Study from Khartoum, Sudan

Purpose: To determine the demographic characteristics and causes of low vision in children who attended Alfaisal eye center, Khartoum Sudan.&#x0D; Place and Duration of Study: Alfaisal eye Center, Khartoum, Sudan, from February 2018 to October 2020.&#x0D; Study Design: Cross sectional observational study.&#x0D; Methods: Clinical record of 105 patients who visited the low vision clinic were retrieved. Demographic features, history, ocular examination, cause of low vision, refractive state of the eye (by self-luminance streak retinoscope, and auto refractometer), and type of low vision devices used by the patients were noted. Data was analyzed by using SPSS software version 20.&#x0D; Results: Mean age was 11.70 ± 2.19. Seventy three percent patients had Visual Acuity(VA) less than 6/60. Majority (59%) were male patients. Commonest refractive error associated with low vision was myopia (65.71%). Retinitis Pigmentosa, congenital glaucoma, and albinism were other major causes of pediatric low vision (19.5%). Progressive Myopia was seen in 15%. About 9.5% of children presented with cataracts, nystagmus in 9.5%, and congenital refractive error in 9.5%.The cause of low vision among children was not statistically different between males and females P=0.890. More than half of the children 78.1% used glasses and about 21.9% were corrected by telescope.&#x0D; Conclusion: Retinitis pigmentosa, albinism, and congenital glaucoma were the most common causes of pediatric low vision. Common low vision devices prescribed to these children were glasses and telescopes.&#x0D; Key Words: Retinitis Pigmentosa, Congenital glaucoma, Albinism, Myopia, Cataract.

Clinical Profile of Low Vision in Children

Introduction: Visual impairment in children is more common in developing countries like Nepal. A low vision service has been found to be effective in significantly improving their overall development and quality of life. The main aim of this study was to determine the causes of low vision in pediatric population along with their refractive error distribution and visual functions. Methods: A descriptive cross sectional study was carried out in Tribhuvan University, BP Koirala Lions Center for Ophthalmic Studies. A total of 50 low vision children were under went detail low vision examination. They were selected through purposive sampling. Data was analyzed by using the descriptive and inferential statistics with SPSS version 19.0. Results: The study findings showed, most common cause of visual impairment in low vision children was refractive error (20%), followed by congenital cataract (18%) and macular dystrophy (16%). The most commonly prescribed low vision device for distance was telescope and for near was spectacle magnifier. There was average acuity improvement of five lines in distance visual acuity with low vision devices. Conclusion: The study concluded that refractive error and congenital cataract being the commonest cause of low vision in children, which reflect poor accessibility of care service among Nepalese children. Refractive error, the major cause of visual impairment could have been managed even in primary eye care center in Nepal. Children with impairment have potential visual acuity that can be improved with low vision services.

Anwendung einer +3-Brille bei frühkindlichem Sehscreening mit dem PlusOptix A12R

Purpose. The aim of this study was to examine the benefit of +3-glasses as a supplement to the measurement of ob- jective ametropia using the PlusOptix A12R vision screener in children. Material and Methods. Experience from practice and the evaluation of the measurement results with and without the use of the +3-glasses are presented. In addition, a way of interpreting the results in practice is presented. Results. The measurement with both methods was evaluated in 1534 out of 2760 cases. The measurements showed no significant difference (z = -0.250, p = 0.802, r = -0.005), how- ever, showed greater scatter results in the measurement with +3-glasses. If you select the more positive measurement, the mean is shifted by 0.26 dpt (SD = 0.68) towards hyperopia. In addition, a lower scatter result and a significant difference to the measurement without glasses are achieved. This is in pairs between 0 D and 4.75 D, with an average of 0.27 (SD = 0.46), with 261 cases (17 %) differences of 0.75 D or more. Conclusion. If only the measurement with +3-glasses is con- sidered, there is no benefit at first. However, the professional selection between the measured values provides a more re- liable statement about the refractive status, especially about the influence of accommodative compensation of hyperopia. The cost-effective production of the glasses, a high acceptan- ce by the children, the low time required and the additional safety of the results speak for the use of the +3-glasses in early childhood vision screenings. Keywords pediatric optometry, screening, hyperopia, accommodation, +3-glasses

Hubungan Usia dan Jenis Kelamin dengan Jenis Kelainan Refraksi pada Anak di Pusat Mata Nasional Rumah Sakit Mata Cicendo

Introduction: Refractive disorder is one of the most common causes of visual impairment worldwide and becomes the second leading cause of blindness that can be cured. Uncorrected refractive error is the leading cause of vision impairment in children. An estimated 12,8 million children 5 to 15 years of age worldwide are affected. Purpose: To describe the correlation between age and sex with the refractive disorder in National Eye Center, Cicendo Eye Hospital on January – December 2015. Method: An analytical observational study. The subjects were children diagnosed with refractive disorders based on medical records at the pediatric ophthalmology and strabismus department in Cicendo Eye hospital. The data analyzed using chi-square (x2) with significances of p &lt; 0.05. Results: We found 1684 refractive error patients; 41.9% are boys and 58.1% girls. It mainly happened in 11-15 years of age (52.9%). Simple myopia and compound myopic astigmatism are mostly found in girls aged 11-15 years old. Simple hypermetropia and simple myopic astigmatism are primarily in boys aged 6-10 years old, and compound hypermetropic astigmatism in boys 0-5 years old. Conclusion: Recognition of any refractive error in children is a major step in preventing childhood vision loss, a significant public health problem. There is a correlation between age and sex with the refractive disorder (p &lt; 0.05). Keywords: refractive disorders, children, visual impairment.

Economic and educational factors played roles in the development of regional vision impairment in Shandong province, China

We analyze regional factors and spatial distribution of children's vision impairment in Shandong province, to explore the spatial changes brought by time and their influencing factors, so as to provide scientific basis for prevention of childhood vision impairment. This study covers five complete cross-sectional surveys from 2013 to 2017, involving about 29.24 million students. Spatial autocorrelation and hotspot analysis methods were used to analyze spatial features. The associated factors were analyzed by multinomial logistic regression. The vision impairment prevalence showed a trend of decreasing first and then increasing from 2013 to 2017, with slight changes. In terms of regional spatial differences, Weihai and Yantai have the highest VI rates in all years, and there was a large-scale spatial aggregation phenomenon. The southern low-value clusters, however, showed a trend of weakening from year to year. Further exploration revealed that economic factors and number of full-time teachers were verified as risk factors for regional vision impairment levels. The slight rebound of the prevalence of vision impairment and the high rate in the eastern and northern regions of Shandong province need more attention. It is suggested that relevant departments should focus on the influence of regional economic and educational factors when formulating relevant strategies.

Attributes of Soviet Childhood: History of Transformation (On the Example of Illustrative Material Children’s Magazines 1920–1990s)

The article is analyzes the images of the children's characteristics on illustrations for children’s magazines of the Soviet Union in the context of three periods: the period of experiments (1920–1930), military-sports period (1930–1950) and familytime (1950–1980). The characteristics of kids, in this case, are considered not only as certain features that are inherent for them on the images but also wider – as a child’s symbol that indicates the attitude towards childhood in certain social, cultural and political conditions. Since the visual children’s culture, and especially children’s media, are a matter of high interest now, this study and its main achievements, including contribution to the establishing correlation of the visual representation of children's characteristics and the cultural content of childhood of a certain era, have wide applicability. The article presents a cultural-semantic and socio-psychological explanation of the visual component of children’s illustrated periodicals in the conclusion section.

Impact of Persisting Amblyopia on Socioeconomic, Health, and Well-Being Outcomes in Adult Life: Findings From the UK Biobank

ObjectivesThis study aimed to investigate associations between persisting amblyopia into adulthood and its “real-life” impacts and inform the current debate about the value of childhood vision screening programs. MethodsAssociations between persisting amblyopia and diverse socioeconomic, health, and well-being outcomes were investigated in multivariable-adjusted (sex, age, ethnicity, deprivation) regression models, with 126 400 participants (aged 40-70 years) of the UK Biobank with complete ophthalmic data. Analysis by age group (cohort 1, 60-70 years; cohort 2, 50-59 years; cohort 3, 40-49 years) assessed temporal trends. ResultsOf 3395 (3%) participants with confirmed amblyopia, overall 77% (2627) had persisting amblyopia, declining from 78% in cohort 1 to 73% in cohort 3. The odds of persisting amblyopia were 5.91 (5.24-6.66) and 2.49 (2.21-2.81) times greater in cohort 1 and cohort 2, respectively, than cohort 3. The odds were also higher for more socioeconomically deprived groups and for white ethnicity. Reduced participation in sport, adverse general and mental health, and well-being were all independently associated with persisting amblyopia, with the strongest associations in the youngest cohorts. Associations with lower educational attainment and economic outcomes were only evident in the oldest cohort. ConclusionsThere has been a decline in the overall frequency of persisting amblyopia since the introduction of universal child vision screening in the United Kingdom. Nevertheless, most adults treated for amblyopia in childhood have persisting vision deficits. There was no evidence that persisting amblyopia has vision-mediated effects on educational, employment-related, or economic outcomes. The observed adverse outcomes were largely those not directly mediated by vision. Patients undergoing treatment should be counseled about long-term outcomes.

Primary congenital glaucoma surgery: outcomes and visual function

PurposeTo assess the long-term visual outcomes of children with PCG, irrespective of the type of surgical procedure, and to create visual acuity curves to help in predicting the development of visual function in these patients. The secondary aim is to identify associated factors for visual decline or loss, highlighting differences between neonatal and infantile subgroups.MethodsThe medical records of pediatric glaucoma patients from 1996 to 2017 at the University Hospital of Verona (Verona, Italy) were retrospectively reviewed. Visual acuities, surgeries, PCG subtype and etiology of vision impairment were recorded. Statistical analyses were performed to detect factors associated with vision decline.ResultsSixty-seven eyes (40 patients) were included in the study. Developmental predictive curves of visual acuity showed that children with infantile PCG had a better visual outcome than children with neonatal PCG at each step of follow-up. A good-to-moderate VA (< 1 LogMAR) was achieved in 56 eyes (83.6%), while 11 eyes (16.4%) had poor VA (≥ 1 LogMAR). The age at onset, sex, number of surgeries, intraocular pressure (IOP) control (with or without antiglaucoma drugs), axial length (AL) and corneal opacities were statistically associated with vision impairment (p < 0.01). The main cause of visual impairment was amblyopia.ConclusionsVisual outcomes of PCG significantly correlate with the age at diagnosis. Although a good long-term IOP control can often be achieved in PCG, often the visual acuity remains below the lower limits of the normal range. Poor vision in childhood is related to global developmental problems, and referral to third-level services should not be delayed to prevent vision impairment. In this regard, visual acuity curves can be a useful tool for the consultant ophthalmologist to define the visual development of children affected by PCG.