Longitudinal follow-up of hypermetropic children identified during preschool vision screening.

PURPOSE: Early childhood hypermetropia is an important risk factor for the development of amblyopia and esotropia. Understanding the natural history of these complications aids in management decisions. METHODS: A retrospective observational review was undertaken of 149 patients referred from a preschool photoscreening program who were determined to have hypermetropia of >or=+3.75 D spherical equivalent on criterion standard examination and were treated/followed by one group of academic pediatric ophthalmologists. The prevalence and incidence of accommodative esotropia and amblyopia were determined. RESULTS: At presentation 19% of hypermetropic children had amblyopia, 32% had esotropia, and 13% had both. Follow-up data of 108 patients during a mean of 40 months showed that 20 (24%) of 83 initially nonamblyopic patients developed amblyopia and that 22 (33%) of 67 initially nonstrabismic patients developed accommodative esotropia. Of patients initially managed with observation, 38% (6 of 16) developed amblyopia, and 31% (5 of 16) developed accommodative esotropia as compared with 21% (14 of 67) and 33% (17 of 51), respectively, for those given full or partial refractive correction. For patients without amblyopia or strabismus at presentation, only 20% developed amblyopia and 35% esotropia. Strabismic patients responded well to treatment, with no cases developing partially accommodative strabismus requiring surgery during follow-up. CONCLUSIONS: In this case series we found a high prevalence of amblyopia and strabismus. The results support the importance of early preschool vision screening and spectacle correction of moderate to high hypermetropia (>+3.50 D) to reduce the risk of amblyopia, although more research is needed.

Intravitreal bevacizumab as adjunctive treatment for retinopathy of prematurity.

BACKGROUND: While laser photocoagulation remains the standard of care in the treatment of advanced retinopathy of prematurity (ROP), regression is not seen in all cases (especially in aggressive posterior disease) following laser alone. We report the results of the use of the anti-vascular endothelial growth factor monoclonal antibody bevacizumab in eyes with ROP at high risk for progression. METHODS: Records of all infants with ROP treated with bevacizumab were reviewed. Bevacizumab was given when conventional laser therapy was not possible in patients with poor pupillary dilation from iris rubeosis, dense vitreous hemorrhage, or increasing vascular activity and vitreoretinal traction despite completed laser therapy. We recorded birth weight, gestational age at birth, severity of ROP, anatomic result, any additional ophthalmic interventions, and early or late adverse systemic effects. RESULTS: Thirteen eyes of 7 infants (median gestational age, 25 weeks; median birth weight, 700 g; follow-up, 9 months [range, 2-17]) were treated with an intravitreal injection of 0.75 mg bevacizumab under sterile conditions by 1 surgeon following detailed discussion with family and attending neonatologists. Injection was not used as monotherapy in any case. Definitive treatment (laser or vitrectomy) was completed successfully within 72 hours of injection. No systemic complication attributable to bevacizumab treatment has been recorded within 2 to 17 months of follow-up. CONCLUSIONS: Treatment with bevacizumab may be used to improve visualization for more definitive laser or surgical treatment and may facilitate disease regression without obvious systemic toxicity. Optimization of dosing, timing, and indications will require additional study.

Amblyopia therapy in children identified by photoscreening.

PURPOSE: To determine the efficacy of amblyopia treatment in children identified through a community photoscreening program. DESIGN: Case series. PARTICIPANTS: We included 125 children diagnosed with amblyopia after referral from a photoscreening program. METHODS: Retrospective chart review of 125 amblyopic children identified by photoscreening and treated in a single academic pediatric ophthalmology group practice. Treatment regimens included spectacles, patching, and/or atropine penalization. Successful treatment was defined as > or =3 Snellen line equivalent improvement in visual acuity and/or 20/30 visual acuity in the amblyopic eye in literate children. Successful treatment in initially preliterate children was defined as 20/30 or better visual acuity in the amblyopic eye. MAIN OUTCOME MEASURES: Percentage of successfully treated amblyopic children. RESULTS: Of 901 children evaluated after being referred from photoscreening, 551 had amblyopiogenic risk factors without amblyopia, 185 were diagnosed with amblyopia, and 165 were false positives. Of 185 children with amblyopia, 125 met inclusion criteria for analysis and 78% (97 of 125) were successfully treated. CONCLUSIONS: The success rate of amblyopia treatment in children identified through our photoscreening program is high. This study supports the role of photoscreening programs in the prevention of amblyopia-related vision loss. Such early screening may translate to true visual acuity improvement. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

The age-dependent effect of anisometropia magnitude on anisometropic amblyopia severity.

INTRODUCTION: Anisometropia is an important cause of amblyopia. The relationship between anisometropia depth and amblyopia magnitude is not well characterized, as previous studies have been limited to patients identified because of their amblyopia. We analyzed results from anisometropic patients identified with photoscreening to eliminate this selection bias. METHODS: We performed a retrospective observational study of preschool children with anisometropia >1.0 D identified during a statewide photoscreening program. Nine hundred seventy-four children with anisometropia were detected over a 9-year period. Visual acuity, cycloplegic refraction data, and patient age from a formal follow-up examination were analyzed. Effect of anisometropia magnitude on amblyopia was measured by ordinal logistic regression, taking age into account. RESULTS: Six hundred forty (65.7%) children had amblyopia > or =2 lines. Three hundred sixty-four (37.4%) had > or =4 lines amblyopia. There was a statistically significant increase in risk of amblyopia with increasing magnitude of anisometropia. Calculated odds ratios for amblyopia with maximal meridional anisometropia of > or =2 to <4 D compared with >1 to <2 D was 2.13 (95% CI [1.63, 2.78], p < 1 x 10(-7)), and 2.34 (95% CI [1.67, 3.28], p < 1 x 10(-6)) when comparing > or =4 D to > or =2 to <4 D. Odds ratios for spherical equivalent anisometropia were also highly statistically significant. CONCLUSIONS: Children with higher magnitudes of anisometropia had higher prevalence and greater depth of amblyopia. Older children had an increased risk of amblyopia compared with younger children for moderate levels of anisometropia. Low magnitude anisometropia in young children may not predispose to amblyopia; these findings have implications for vision screening criteria at various ages.