ABSTRACT
The authors present a case of a 16-year-old boy who sought treatment in Storm Eye Institute for orbital cellulitis complicated by central retinal artery occlusion. He was examined for severe signs of orbital cellulitis, including decreased vision and an afferent pupillary defect. Intravenous antibiotics failed to provide timely improvement, and the patient was surgically managed with endoscopic orbital decompression. An ocular examination under anesthesia revealed retinal ischemia in the affected eye, and fluorescein angiography confirmed the diagnosis of central retinal artery occlusion. The patient's vision improved slightly following resolution of the infection. Central retinal artery occlusion is a rare complication of orbital cellulitis in adults and has yet to be reported in the pediatric population.
Subject(s)
Actinomycetales Infections/etiology , Arcanobacterium/isolation & purification , Eye Infections, Bacterial/etiology , Orbital Cellulitis/etiology , Retinal Artery Occlusion/complications , Actinomycetales Infections/diagnosis , Actinomycetales Infections/therapy , Adolescent , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Decompression, Surgical , Drug Therapy, Combination , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/therapy , Fluorescein Angiography , Humans , Intraocular Pressure , Ischemia/diagnosis , Male , Orbital Cellulitis/diagnosis , Orbital Cellulitis/therapy , Retinal Artery Occlusion/diagnosis , Retinal Vessels/pathology , Vision Disorders/etiology , Visual AcuityABSTRACT
PURPOSE: To compare the vision-screening results of school-aged children tested with EyeSpy software and those of children examined by a pediatric ophthalmologist. We also compared combined results of an electronic visual acuity (EVA) tester and stereopsis testing to the results of a professional eye examination. METHODS: In this pilot study, all children were tested with an EyeSpy and ETDRS EVA tester, followed by ocular examination including stereopsis assessment and cyclopegic refraction. The order of presentation of the EVA and EyeSpy assessments was assigned randomly. The EyeSpy test was performed twice (with an occlusive eyepatch and red-blue dissociative goggles). EyeSpy registered pass or refer results for visual acuity testing at a threshold of 20/32 visual acuity and stereopsis of 300 arcsec. Similar threshold values were used in the EVA/stereopsis testing. RESULTS: The average age of 72 subjects was 11.4 +/- 2.2 years. Prevalence of visual impairment was 25 (34.7%) of 72 as reported by the professional examination. The sensitivity, specificity, and conventional positive likelihood ratio were 88%, 87%, and 6.8 when EyeSpy was used with a patch; 88%, 74%, and 3.44 when EyeSpy was used with goggles; and 88%, 94%, and 13.79 for EVA/stereospsis, respectively, compared with the gold-standard professional eye examination. EyeSpy screening results using a patch were not significantly different than those of a professional examination (p = 0.508). The 2 results concurred in 63 (87.5%) of 72 subjects. CONCLUSIONS: EyeSpy software has potential for use as a vision-screening device. The use of EyeSpy with an occlusive patch outperformed EyeSpy with dissociative glasses.
Subject(s)
Software , Video Games , Vision Disorders/diagnosis , Vision Screening/methods , Adolescent , Child , Depth Perception , Female , Humans , Male , Pilot Projects , Predictive Value of Tests , Prevalence , Reproducibility of Results , United States/epidemiology , Vision Disorders/epidemiology , Vision Disorders/physiopathology , Visual AcuityABSTRACT
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.
Subject(s)
Amblyopia/diagnosis , Amblyopia/therapy , Atropine/administration & dosage , Bandages , Eyeglasses , Vision Screening , Amblyopia/physiopathology , Child , Child, Preschool , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Infant , Male , Retrospective Studies , Risk Factors , Treatment Outcome , Visual Acuity/physiologyABSTRACT
INTRODUCTION: The incidence and severity of retinopathy of prematurity (ROP) in extremely premature infants have not been reported since publication of the Early Treatment of ROP study results. The survival rate of these infants continues to increase. We sought to determine the characteristics of ROP in a group of surviving infants <25 weeks estimated gestational age (EGA) at birth compared to a group 25 to 27 weeks EGA at birth. METHODS: Retrospective review of infants born prior to 27 weeks EGA between January 2003 and July 2007 at a level-3 nursery at a regional academic medical center. RESULTS: A total of 231 medical records were reviewed and found to have analyzable data. Of 79 infants <25 weeks EGA, 69 (87%) developed ROP, compared to 95 of 152 (62%) infants 25 to 27 weeks EGA. Type 1 ROP developed in 23% of infants in the <25 weeks EGA group, compared to 9% of infants in the 25 to 27 weeks EGA group. There was no difference in mean postmenstrual age when type 1 ROP was diagnosed. Lower birth weight predicted increased risk of type 1 ROP in the 25 to 27 weeks EGA group, but not in the <25 weeks EGA group. CONCLUSIONS: Extremely premature infants are more likely to develop ROP and type 1 ROP, but the incidence may be lower than previously reported. Birth weight may not influence the incidence of type 1 ROP in this group of infants. Type 1 ROP does not develop at an earlier postmenstrual age in the extremely premature infant.
