Nasolacrimal duct obstruction: Does it really increase the risk of amblyopia in children.

Purpose: To report the prevalence of amblyopia risk factors in children with congenital nasolacrimal duct obstruction. Methods: A retrospective review of records of children with the diagnosis of congenital nasolacrimal duct obstruction (NLDO), who underwent probing from January 2009 to October 2011, was done. All of them underwent a complete ophthalmic evaluation including cycloplegic refraction and strabismus evaluation before probing. Results: A total of 142 children were included in this study. The mean age at presentation was 22.38 months (sample standard deviation (SSD) ‑ 15.88). Amblyopia risk factors were defined according to two sets of guidelines: The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) referral criteria guidelines and the new AAPOS Vision Screening Committee guidelines. Twenty‑eight (20%) children were found to have some form of amblyopia risk factor based on the referral criteria prescribed by AAPOS . However, on applying modified guidelines described by Donahue et al., to analyze the same cohort, 21 children were found to have amblyogenic risk factors. Of these 28 children, 13 had significant astigmatism (>1.50 D), 8 children had hypermetropia (>3.50 D), and six children had anisometropia (>1.50 D). One child had significant cataract (media opacity >1 mm). None of the children in this series had either myopia or strabismus. Conclusion: Prevalence of amblyopia risk factor was found to be 20% in our study based on the older guidelines; however, it reduces to 14.78% by applying the modified guidelines. Despite this reduction, importance of a comprehensive ophthalmic examination including cycloplegic refraction in all children presenting with NLDO cannot be overstated. A close follow‑up of these children is also essential to prevent the development of amblyopia.

Reliability and Usefulness of Refractive Measurements by PlusoptiX S09 in Children

PURPOSE: To compare the refractive measurements obtained using a photorefractor (PlusoptiX S09, PlusoptiX GmbH, Germany) with those obtained using cycloplegic refraction in children. METHODS: We assessed the refractive status of 268 eyes in 134 children. The values acquired via photorefraction with a PlusoptiX S09 device were compared with those obtained by cycloplegic retinoscopy. Hyperopia (> or =+3.5 D), myopia (> or =-3.0 D), with the rule or against the rule astigmatism (> or =-1.5 D), and oblique astigmatism (> or =-1.0 D) were set as diagnostic criteria for refractive amblyopia risk factors (RARFs). The difference in the detection of RARFs by the two methods was the main outcome measure. RESULTS: The average spherical refractive power was -0.81 +/- 1.68 D for PlusoptiX S09 versus -0.26 +/- 2.00 D for cycloplegic retinoscopy (average difference -0.54 +/- 0.61 D; p < 0.001). The average spherical equivalent was -1.20 +/- 1.62 D for PlusoptiX S09 versus -0.64 +/- 1.94 D for cycloplegic retinoscopy (average difference -0.56 +/- 0.62 D; p < 0.001). The average cylinder power was -0.79 +/- 0.93 D for PlusoptiX S09 versus -0.76 +/- 0.94 D for cycloplegic retinoscopy (average difference -0.03 +/- 0.33 D; p = 0.135). Even though cycloplegic retinoscopy is considered the gold standard, the sensitivity and specificity for detecting RARFs with the PlusoptiX S09 were 88.0% and 96.3%, respectively. CONCLUSIONS: PlusoptiX S09 is a relatively useful method for detecting RARFs, but the device tends toward myopic shift compared to cycloplegic refraction, and hyperopia is underestimated.