Strabismus surgery alleviates functional and psychosocial problems.

Strabismus is a common condition affecting both children and adults. Strabismus patients may experience double vision, abnormal head position and loss of stereovision. The psychosocial negative impact of strabismus may be severe, affect self-esteem, social relationships, and job opportunities. Strabismus is a congenital condition or a result of an illness in later life and surgical treatment should be considered as reconstructive surgery and not downrated as just ¼a cosmetic procedure«. Strabismus surgery is safe, effective and addresses functional as well as psychosocial problems.

Botulinum Toxin A Injection for Convergence Insufficiency.

PURPOSE: To evaluate the effects of botulinum toxin A injection in one or both lateral rectus muscles in patients with convergence insufficiency previously managed with non-surgical and/or surgical options other than botulinum toxin A injection. METHODS: All patients with symptomatic convergence insufficiency treated with botulinum toxin A injection to one or both lateral rectus muscles from 2013 to 2018 at the Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen University Hospital were retrospectively reviewed. All patients had near symptoms and were previously treated with a combination of convergence exercises, prisms, and/or surgery. Patients with previous botulinum toxin A injection in an extraocular muscle were excluded. Reading symptoms and deviation at near and distance were recorded at baseline and after 1 and 6 months. RESULTS: Twenty-three patients with convergence insufficiency were included (8 men and 15 women). Follow-up was conducted after a median of 47 days (interquartile range [IQR]: 31.5 to 72.5 days) and 174 days (IQR: 139 to 267 days). At baseline, median near angle of deviation was 18 PD of exophoria (IQR: 13 to 21 PD). The near deviation was reduced to 10 PD of exophoria (IQR: 7 to 17 PD) at first follow-up visit and 14 PD of exophoria (IQR: 12 to 18 PD) at last follow-up visit. Thirteen of 23 patients (57%) and 3 of 13 patients (23%) reported improvement in reading symptoms at first and last follow-up visit, respectively, compared to baseline. CONCLUSIONS: Botulinum toxin A injection may be useful in patients with convergence insufficiency. However, some patients may require repeated injections. [J Pediatr Ophthalmol Strabismus. 2023;60(2):108-113.].

Laser pointer maculopathy - on the rise?

PURPOSE: To report symptoms and ocular pathology in 13 patients exposed to light from laser pointers. METHODS: We conducted a multi-centre consecutive case series from eight ophthalmology departments. RESULTS: Eleven boys aged 9-15 years and two girls aged 7 (sister of one of the aforementioned boys) and 12 years, respectively, were included. Laser wavelengths were 572 nm (green), 450 nm (blue), and red laser of unknown wavelength. Output powers were between 5 and 5000 mW. Evaluation included slit lamp examination, colour fundus photography (CFP), and optical coherence tomography (OCT). All subjects complained of unilateral vision loss. Initial visual acuities in exposed eyes ranged from 0.05 to 1.0 Snellen equivalent or better. Nine subjects showed pathology on CFP and OCT abnormalities. One subject had a macular hole, which closed after vitrectomy. Long-term visual acuity ranged from 0.3 to 1.0 Snellen equivalent or better. CONCLUSION: High-powered laser pointers have become readily available on the internet, and they have the potential to induce lasting visual loss. More than half of the published laser pointer maculopathy cases since the first incidence in 1999 have been published in 2014-2017. We suspect that incidence of exposure and subsequent visual loss is rising, and we encourage national legislators to regulate this market.

Strabismus Incidence in a Danish Population-Based Cohort of Children.

Importance: To our knowledge, there have been few population-based studies of strabismus incidence conducted. Our population-based study provides valuable data for health services planning and identifying research needs. Objective: To determine the incidence and age distribution of strabismus, overall and by subtype, among children 7 years or younger. Design, Setting, and Participants: This population-based cohort study was conducted with data from 96 842 children enrolled in the Danish National Birth Cohort. Main Outcomes and Measures: Age-specific incidence and cumulative incidence and median age at the detection of strabismus, overall and by subtype. Results: The study cohort included 96 842 children born between 1996 and 2008 who are predominantly Caucasian and is composed of approximately 30% of births in Denmark, with a boy-girl ratio of 51:49. Overall, 1309 cases of strabismus were identified in the cohort. We found an overall cumulative strabismus incidence of 2.56% (95% CI, 2.42-2.69) at 7 years. The overall incidence was similar among boys and girls. Two hundred sixteen participants (16.5%) (95% CI, 14.5-18.6) had congenital esotropia, 177 (13.5%) (95% CI, 11.7-15.5) had fully accommodative esotropia, 252 (19.3%) (95% CI, 17.1-21.5) had partially accommodative esotropia, and 181 (13.8%) (95% CI, 12.0-15.8) had exotropia. The esotropia:exotropia ratio was 5.4:1 (95% CI, 3.4:1 to 7.5:1). Age-specific incidence curves for congenital esotropia, fully accommodative esotropia, partially accommodative esotropia, and all exotropia revealed interactions between strabismus subtype and age, suggesting that the different subtypes had different age-specific patterns of incidence (P < .001 for all comparisons between pairs of curves). The median age at detection for the 4 subtypes was 0, 32.0, 26.1, and 16.6 months, respectively. Conclusions and Relevance: In a national, population-based cohort study, we found a cumulative incidence of strabismus consistent with those reported in smaller European and American cohorts, but a somewhat higher esotropia:exotropia ratio than those that, to our knowledge, are typically reported by English and American studies. Patterns of incidence by age differed for different strabismus subtypes, indicating differences in age at onset and thereby implying differences in the underlying etiology.

Ophthalmic nepafenac use in the Netherlands and Denmark.

PURPOSE: To describe nepafenac use in the Netherlands and Denmark with reference to its approved indications. For context, we also describe the use of ketorolac and diclofenac. METHODS: We identified users in the PHARMO Database Network (the Netherlands, 2008-2013) and the Danish national health registers (Denmark, 1994-2014). We described prevalence of cataract surgery and duration of use in patients with cataract surgery with and without diabetes. RESULTS: In the Netherlands, 9530 nepafenac users (mean age, 71 years; 60% women) contributed 12 691 therapy episodes, of which 21% had a recently recorded cataract surgery. Of 2266 episodes in adult non-diabetic patients with cataract surgery, 60% had one bottle dispensed (treatment duration ≤21 days). Of 441 episodes in adult diabetic patients with cataract surgery, 90% had up to two bottles dispensed (≤60 days). Denmark had 60 403 nepafenac users (mean age, 72 years; 58% women) and 73 648 episodes (41% had recorded cataract surgery). Of 26 649 nepafenac episodes in adult non-diabetic patients with cataract surgery, 92% had one bottle dispensed. Of 3801 episodes in adult diabetic patients with cataract surgery, 99.8% had up to two bottles dispensed. Use patterns of nepafenac, ketorolac and diclofenac were roughly similar in the Netherlands, but not in Denmark. CONCLUSION: Less than half of therapy episodes were related to cataract surgery; around 90% of episodes with surgery were within the approved duration. Underrecording of ophthalmic conditions and procedures was a challenge in this study.

[The effect of blood pressure on the development of glaucoma].

Compromised autoregulation of ocular blood flow is a plausible consequence of hypertension, and studies indicate that hypertension can lead to progression of glaucoma. Initiating antihypertensive therapy in subjects with long-standing hypertension could deteriorate ocular blood flow leading ultimately to glaucomatous damage. Evidence on this topic is still equivocal but until adequate knowledge on the field has been established we recommend referral of patients disposed for glaucoma to ophthalmologic examination when initiating antihypertensive medication.

Perinatal risk factors for strabismus.

BACKGROUND: Little is known about the aetiological factors underlying strabismus. We undertook a large cohort study to investigate perinatal risk factors for strabismus, overall and by subtype. METHODS: Orthoptists reviewed ophthalmological records for Danish National Birth Cohort (DNBC) children examined for strabismus in hospital ophthalmology departments or by ophthalmologists in private practice. Information on perinatal characteristics was obtained from national registers. We used log-linear binomial regression and polytomous logistic regression to estimate risk ratios for strabismus overall and by strabismus subtype, respectively. RESULTS: Among 96,842 DNBC children born in Denmark between 1996 and 2003, we identified 8783 children who had been evaluated for strabismus. Ophthalmological records were available for 5655 of these children, of whom 1321 were diagnosed with strabismus. In multivariable analysis, low birth weight, prematurity, large head circumference and presence of congenital abnormalities were all associated with increased risk of strabismus. Presence of congenital abnormalities was more strongly associated with exotropia than with esotropia. Of 183 exotropia cases, 40 (22%) had congenital abnormality. Although not associated with esotropia, delivery by Caesarean section was associated with exotropia (relative risk = 1.65; 95% confidence interval 1.16-2.34). After adjustment for birth weight, Apgar score at 5 min, multiple gestation and parental ages were not associated with strabismus overall. CONCLUSIONS: Congenital abnormalities, low birth weight, prematurity and large head circumference were independent risk factors for strabismus. Differences in risk factors for esotropia and exotropia suggest that strabismus subtypes may have different underlying aetiologies. The proportion of exotropic children with congenital abnormalities suggests that a large angle constant exotropia in an infant should alert physicians to the possibility of a congenital abnormality.

In-utero exposure to smoking, alcohol, coffee, and tea and risk of strabismus.

In a prospective, population-based cohort study, the authors investigated the effect of in-utero exposure to maternal smoking and consumption of alcohol, coffee, and tea on the risk of strabismus. They reviewed medical records for children in the Danish National Birth Cohort identified through national registers as possibly having strabismus. Relative risk estimates were adjusted for year of birth, social class, maternal smoking, maternal age at birth, and maternal coffee and tea consumption. The authors identified 1,321 cases of strabismus in a cohort of 96,842 Danish children born between 1996 and 2003. Maternal smoking was associated with a significantly elevated risk of strabismus in the child, increasing with number of cigarettes smoked per day (<5 cigarettes/day: relative risk (RR) = 0.95, 95% confidence interval (CI): 0.80, 1.14; 5-<10 cigarettes/day: RR = 1.38, 95% CI: 1.12, 1.70; > or =10 cigarettes/day: RR = 1.90, 95% CI: 1.57, 2.30). Nicotine replacement therapy was not associated with strabismus risk (RR = 1.22, 95% CI: 0.92, 1.61). Light maternal alcohol consumption was inversely associated with strabismus risk, whereas maternal coffee and tea drinking were not associated with strabismus risk. In conclusion, smoking during pregnancy is associated with an increased risk of strabismus in the offspring. Conversely, light alcohol consumption is associated with decreased risk.