Prescribing patterns for paediatric hyperopia among paediatric eye care providers.

PURPOSE: To survey paediatric eye care providers to identify current patterns of prescribing for hyperopia. METHODS: Paediatric eye care providers were invited, via email, to participate in a survey to evaluate current age-based refractive error prescribing practices. Questions were designed to determine which factors may influence the survey participant's prescribing pattern (e.g., patient's age, magnitude of hyperopia, patient's symptoms, heterophoria and stereopsis) and if the providers were to prescribe, how much hyperopic correction would they prescribe (e.g., full or partial prescription). The response distributions by profession (optometry and ophthalmology) were compared using the Kolmogorov-Smirnov cumulative distribution function test. RESULTS: Responses were submitted by 738 participants regarding how they prescribe for their hyperopic patients. Most providers within each profession considered similar clinical factors when prescribing. The percentages of optometrists and ophthalmologists who reported considering the factor often differed significantly. Factors considered similarly by both optometrists and ophthalmologists were the presence of symptoms (98.0%, p = 0.14), presence of astigmatism and/or anisometropia (97.5%, p = 0.06) and the possibility of teasing (8.3%, p = 0.49). A wide range of prescribing was observed within each profession, with some providers reporting that they would prescribe for low levels of hyperopia while others reported that they would never prescribe. When prescribing for bilateral hyperopia in children with age-normal visual acuity and no manifest deviation or symptoms, the threshold for prescribing decreased with age for both professions, with ophthalmologists typically prescribing 1.5-2 D less than optometrists. The threshold for prescribing also decreased for both optometrists and ophthalmologists when children had associated clinical factors (e.g., esophoria or reduced near visual function). Optometrists and ophthalmologists most commonly prescribed based on cycloplegic refraction, although optometrists most commonly prescribed based on both the manifest and cycloplegic refraction for children ≥7 years. CONCLUSION: Prescribing patterns for paediatric hyperopia vary significantly among eye care providers.

Using synchronous distance education to deliver a weight loss intervention: A randomized trial.

OBJECTIVE: To implement a randomized trial to evaluate the effectiveness of a weight loss program delivered using synchronous distance education compared with a wait-list control group with 6-month follow-up. METHODS: Adults with a body mass index (BMI) ≥25 were randomized to the intervention (n = 42) or wait-list control group (n = 38). The intervention group participated in a synchronous, online, 15-week weight loss program; weight loss was the primary outcome. Secondary measures included height, BMI, and confidence in ability to be physically active and eat healthy. Assessments occurred at three and four time points in the intervention and control group, respectively. RESULTS: Participants who completed the program lost significantly more weight (1.8 kg) than those in the wait-list control group (0.25 kg) at week 15 [F(1,61) = 6.19, P = 0.02] and had a greater reduction in BMI (0.71 vs. 0.14 kg/m(2) ), [F(1,61) = 7.45, P = 0.01]. There were no significant differences between the intervention and the wait-list control groups for change in confidence in ability to be physically active or eat healthy. Weight loss was maintained at 6 months. CONCLUSIONS: Use of synchronous distance education is a promising approach for weight loss. The results of this study will help to inform future research that employs Web-based interventions.

Effect of Amblyopia Treatment on Macular Thickness in Eyes With Myopic Anisometropic Amblyopia.

PURPOSE: To determine whether abnormal macular thickness in myopic anisometropic amblyopia differed after amblyopia treatment. Furthermore, to investigate whether effect of treatment on macular thickness was associated with subject age or improvement in stereoacuity. METHODS: Seventeen children (mean age: 9.0 [±3.0] years, ranging from 5.7-13.9 years) with myopic anisometropic amblyopia (visual acuity [VA] in amblyopic eyes: 20/80-20/400) were recruited and treated with 16-week refractive correction, followed by an additional 16-week refractive correction and patching. Macular thickness, best-corrected VA, and stereoacuity were measured both before and after amblyopia treatment. Factorial repeated-measures analysis of variance was performed to determine whether macular thickness in amblyopic eyes changed after amblyopia treatment. RESULTS: Mean baseline VA in the amblyopic eye was 1.0 ± 0.3 logMAR and improved to 0.7 ± 0.3 after amblyopia treatment (P < 0.0001). The interaction between eye and amblyopia treatment was statistically significant for average foveal thickness (P = 0.040). There was no treatment effect on fellow eyes (P = 0.245); however, the average foveal thickness in the amblyopic eye was significantly reduced after amblyopia treatment (P = 0.049). No statistically significant interactions were found for the other macular thickness parameters (P > 0.05). CONCLUSIONS: Abnormal central macula associated with myopic anisometropic amblyopia tended to be thinner following amblyopia treatment with no significant changes in peripheral macular thickness.

A prospective pilot study of treatment outcomes for amblyopia associated with myopic anisometropia.

OBJECTIVES: To determine the efficacy of refractive correction alone and patching treatment with near activities on amblyopia associated with myopic anisometropia in children aged 4 to less than 14 years. The associations of visual acuity (VA) improvement with age,degree of anisometropia, patching compliance, presence of strabismus, and presence of eccentric fixation were also investigated. METHODS: Seventeen amblyopic children were recruited(range of VA in the amblyopic eye, 20/80 to 20/400). Visual acuity was assessed at 4, 8, 12, and 16 weeks while participants wore spectacles and/or contact lenses for full refractive correction. Patching treatment was initiate dat the 16-week visit. The primary outcome was VA after 16 weeks of refractive correction alone and final VA after 16 weeks of patching. RESULTS: The mean (SD) baseline VA in the amblyopiceye was 0.96 (0.27) logMAR, which improved to a mean(SD) of 0.84 (0.24) logMAR with refractive correction and to a mean (SD) of 0.71 (0.30) logMAR after the addition of patching (P.001). Comparing the final VA with the baseline VA, we found that VA improvement averaged 2.59 lines. The final VA in the amblyopic eye was associated with the baseline VA in the amblyopic eye(P.001), the magnitude of anisometropia (P.001),and the level of patching compliance (P=.04). The improvement in VA with patching was inversely associated with participants' age (P=.03) and presence of eccentric fixation (P=.02). CONCLUSION: Both refractive correction and patching significantly improved the VA of the amblyopic eye associated with myopic anisometropia, with 88% of participants' eyes improving 2 lines or more. Further improvement in VA was observed when patching plus near activities was added to refractive correction and patients were followed for 16 more weeks. We recommend that clinicians treat myopic anisometropic amblyopia with refractive correction and patching plus near activities.

A prospective study of macular thickness in amblyopic children with unilateral high myopia.

PURPOSE: To compare macular thickness of the normal fellow eye to that of the amblyopic eye using optical coherence tomography (OCT) in children with unilateral high myopia. Relationships between macular thickness and magnitude of myopic anisometropia, axial length, and visual acuity (VA) were investigated. METHODS: Thirty-one children with a mean age of 9.56 years were recruited. Macular thickness, axial length, best-corrected VA, and refraction were measured. Paired t-test was performed to compare the macular thickness of the amblyopic eye to that of the fellow eye. Partial correlations were used to test the relationships between interocular difference in macular thickness and anisometropia, axial length, and VA. RESULTS: Average (± SD) LogMAR VA in the amblyopic eye was 0.96 ± 0.31. Mean spherical equivalent in amblyopic eyes was -10.79 ± 3.40 diopters. A statistically significant difference in macular thickness was found between amblyopic and fellow eyes, with amblyopic eyes having greater foveal thickness but reduced inner and outer macular thickness. Only the nasal outer macular thickness had a statistically significant association with the magnitude of anisometropia. CONCLUSIONS: Amblyopic children with unilateral high myopia tend to have a thicker fovea and thinner inner and outer macula in the amblyopic eye compared to the normal fellow eye. The findings indicate that anatomic changes may be present in the retinas of amblyopic children with unilateral high myopia. Future study is warranted to determine whether the mechanism of the macular changes is due to high myopia, amblyopia, or a combination of the two.

Proportion of refractive errors in a Polish immigrant population in Chicago.

PURPOSE: This retrospective record review was conducted to investigate the proportion of patients with refractive error in a Polish immigrant population residing in an urban environment. Illinois has more than 1 million people of Polish descent as citizens, and Chicago is considered to have the second largest population of Polish descent in the world, outside of Warsaw, Poland. METHODS: Six hundred seventy-five records (271 men/404 women) of Polish immigrants were reviewed from a practice with >92% Polish immigrants in the patient base. The patients ranged in age from 3 to 94 years. Refractive status for each eye, and the existence of any strabismus or amblyopia, was recorded. RESULTS: The proportion of myopia [spherical equivalent at least -0.75 diopter (D)] was found to be 35.1%, whereas the proportion of hyperopia (spherical equivalent > or =+0.75 D) was found to be 38.4%. Fifteen percent of the patients exhibited astigmatism > or =1.00 D. Amblyopia was present in 9% of the patients, whereas the prevalence of strabismus was found to be 3%, with 76% of the strabismics exhibiting esotropia. In the 0- to 18-year age range and the 19- to 45-year age range, the most common refractive error was low myopia (43.9 and 36.9%), whereas in the patients >45 years of age, it was low hyperopia (31.2%). CONCLUSIONS: Refractive error data are presented for a population base that has not been previously reported, although Polish Americans comprise 3% of the US population. Myopia is more common in young Polish patients than in the general US population. The strong hyperopic shift in older patients may either be normal aging or the product of increased near work in the young. The high rates of amblyopia call for more aggressive education and treatment.

Diagnosing and managing functional visual complications after brain injury.

BACKGROUND: Brain injury caused by an arteriovenous malformation (AVM) hemorrhage is an uncommon occurrence in a teenager. An AVM is a congenital anomaly of unknown etiology, often described as a tangle of arteries and veins that may vary in length and width leading to a loss of capillary bed. The vessels can break down with time and cause hemorrhage or aneurysm. Hemorrhage occurs in a significant number of patients with AVM. Intracranial hemorrhage causes brain injury, which can lead to systemic and ocular complications, neurologic deficits, and death. CASE REPORT: A 15-year-old girl presented to our clinic with a chief complaint of horizontal diplopia while reading, lasting from seconds to 5 minutes. Nine months before the examination she had a ruptured cerebral AVM, then surgery to control the bleeding. She spent 6 weeks in a coma after surgery and woke up a hemiplegic. There were no visual problems before the bleeding. Our evaluation showed accommodative insufficiency, oculomotor dysfunction, dry eye syndrome, and a right beating latent nystagmus in both eyes. Perceptual testing showed a severe visual sequential memory deficit. The patient was given a reading prescription to aid with accommodation and was to use artificial tears and lacrilube ointment. At the follow-up examination, she reported increased efficiency and fewer episodes of diplopia while reading with bifocals and fewer dry eye symptoms since using the artificial tears. CONCLUSIONS: After a brain injury, a young adult can present with perceptual and visual efficiency problems as well as nystagmus. It is important to test all areas that may be affected by this type of event and to investigate all complaints thoroughly with continued follow-up care. A latent nystagmus was discovered during thorough near point testing. The visual perceptual testing helped to confirm the visual sequential memory deficit, which may otherwise have been overlooked. It is believed that the diplopic complaint and poor oculomotor skills were directly related to the newly acquired nystagmus.

An optometric approach to patients with sensory integration dysfunction.

BACKGROUND: Sensory integration dysfunction is a neurologic condition that can cause children to process environmental sensations in an inappropriate way. As a result, they may either seek out strong sensations or avoid even mild sensations. Some of the characteristics of these children may be hyperactivity, poor awareness of pain, high risk taking, listening to loud sounds, clumsiness, poor fine motor skills, poor gross motor skills, poor visual tracking, problems with sequencing, and problems with balance. Sensory integration dysfunction often is related to children with developmental disabilities, autism, and attention deficits. METHODS: Two children from the same family were examined for general eye examinations because of a history of sensory integration problems. J.H., an 11-year-old girl, and her 6-year-old half-brother, A.T., returned to the clinic for visual-perceptual testing: the Test of Variables of Attention (TOVA), the Developmental Eye Movement Test (DEM), and the Visagraph (Compevo AB, Stockholm, Sweden). The use of yoked prisms with these children was also explored. RESULTS: Both children showed oculomotility problems based on the DEM and Visagraph results. Whereas J.H. performed well on the visual-perceptual profile overall, A.T. showed problems in many areas such as reversals, visual spatial relations, visual sequential memory, visual form constancy, and attention. Both children were low hyperopes and showed positive postural and balance changes when tested with yoked prisms. CONCLUSIONS: Children with sensory integration dysfunction can have a number of signs and symptoms that may bring them to the optometrist's office. It is important to thoroughly test their visual, perceptual, and oculomotor systems to determine the best way to help these patients. The use of vision therapy and yoked prisms can be beneficial treatment options for many of these patients.

Validity and reliability of the Test of Early Reading Ability-Second Edition with preschool age children.

Criterion validity and test-retest reliability across the two forms of the Test of Early Reading Ability-Second Edition were examined. 18 preschool age children, 4 boys and 14 girls, between the ages of 37 and 59 mo. (M = 48.5, SD = 7.6) were randomly administered Forms A and B as well as the sound-blending, letter-word identification, spelling, and sound-awareness reading subtests from the 2001 Woodcock Johnson-III. Correlations were moderate between the children's performance on the Test of Early Reading Ability-2 Forms A and B and their reading subtest scores from the Woodcock Johnson-III and also between Forms A and B of the Test of Early Reading Ability-2. However, Forms A and B of the Test of Early Reading Ability-2 were not clinically equivalent.

Outbreak of Vibrio parahaemolyticus gastroenteritis associated with Alaskan oysters.

BACKGROUND: Vibrio parahaemolyticus, the leading cause of seafood-associated gastroenteritis in the United States, typically is associated with the consumption of raw oysters gathered from warm-water estuaries. We describe a recognized outbreak of V. parahaemolyticus infection associated with the consumption of seafood from Alaska. METHODS: After we received reports of the occurrence of gastroenteritis on a cruise ship, we conducted a retrospective cohort study among passengers, as well as active surveillance throughout Alaska to identify additional cases, and an environmental study to identify sources of V. parahaemolyticus and contributors to the outbreak. RESULTS: Of 189 passengers, 132 (70 percent) were interviewed; 22 of the interviewees (17 percent) met our case definition of gastroenteritis. In our multiple logistic-regression analysis, consumption of raw oysters was the only significant predictor of illness; the attack rate among people who consumed oysters was 29 percent. Active surveillance identified a total of 62 patients with gastroenteritis. V. parahaemolyticus serotype O6:K18 was isolated from the majority of patients tested and from environmental samples of oysters. Patterns on pulsed-field gel electrophoresis were highly related across clinical and oyster isolates. All oysters associated with the outbreak were harvested when mean daily water temperatures exceeded 15.0 degrees C (the theorized threshold for the risk of V. parahaemolyticus illness from the consumption of raw oysters). Since 1997, mean water temperatures in July and August at the implicated oyster farm increased 0.21 degrees C per year (P<0.001 by linear regression); 2004 was the only year during which mean daily temperatures in July and August at the shellfish farm did not drop below 15.0 degrees C. CONCLUSIONS: This investigation extends by 1000 km the northernmost documented source of oysters that caused illness due to V. parahaemolyticus. Rising temperatures of ocean water seem to have contributed to one of the largest known outbreaks of V. parahaemolyticus in the United States.

Unusual eye movements in a patient with complex partial seizure disorder.

BACKGROUND: A complex partial seizure can cause a variety of visual system signs and symptoms, including visual hallucinations, dilated pupils, and changes in vision. Little information is known about the influence of this disorder on the visual system during nonseizure moments. This case report examines the unusual eye movements-during these nonseizure times-of a patient diagnosed with complex partial seizure disorder. CASE REPORT: An 8-year-old boy was referred to the clinic by his pediatric neurologist for a comprehensive examination to rule out a visual cause for the abnormal eye movements observed by the patient's mother. Ocular examination revealed periodic, spontaneous, versional eye movements to the left and right, accompanied by a small widening of the fissures and turning of the head. No vergence or accommodative problems were detected, but Developmental Eye Movement (DEM) and Visagraph testing showed mild dysfunction. Ocular health was unremarkable, while radiology studies and neurological evaluation yielded no observable pathology. CONCLUSION: Complex partial seizure disorder can affect the visual system in a wide variety of ways. The precise role, if any, that complex partial seizure disorder plays in ocular motility control during nonseizure moments is unknown. The most-plausible etiology of the observed ocular movements in this patient is the presence of a tic disorder. Patients with unknown eye movement disorders deserve a thorough evaluation, including a search for systemic causes.