A Comparative Study of Two Photoscreening Devices With Manual Vision Screening Involving Preschool Children.

PURPOSE: To compare referral results from two photoscreening devices that are in wide use relative to a manual screening test protocol in preschool children. METHODS: Children aged 3 to 5 years who attended preschools in two counties within the State of Michigan (N = 1,085) took part in the State's vision screening program, which included the Lea Symbols and Stereo Butterfly tests, during a 3-month period. All who failed this screening or were unable to be tested, and 20% of those who passed, were then invited to undergo testing with the Plusoptix Vision Screener Model S-12C (Plusoptix, Inc) and Welch Allyn SPOT Vision Screener Model VS-100 (Hill-Rom, Inc) photoscreening devices. Screening was conducted by State-trained technicians. With the State's test results considered the gold standard for screening, sensitivity and specificity of the two photo-screening devices were calculated. McNemar's test and logistic regression were used to evaluate the findings. RESULTS: A total of 1,085 children took part in the State's screening program. Their mean ± standard deviation age was 48.8 ± 7.2 months, with a 51:49 female-to-male ratio, and a similar percentage were Black (34.1%) or White (33.3%). The sensitivity of the SPOT and Plusoptix screening was 61.0% and 65.2%, respectively. The specificity of the SPOT and Plusoptix screening was 92.9% and 82.4%, respectively. For 84 children who were unable to be tested by the State's screening, the SPOT and Plusoptix devices completed the screening on the majority (86.9% and 73.8%, respectively). CONCLUSIONS: The photoscreening devices yielded numerous false-negative results and fewer false-positive results. Their ability to screen many children who could not be screened by manual testing indicates a useful application. [J Pediatr Ophthalmol Strabismus. 2022;59(1):46-52.].

Use of data mining at the Food and Drug Administration.

OBJECTIVES: This article summarizes past and current data mining activities at the United States Food and Drug Administration (FDA). TARGET AUDIENCE: We address data miners in all sectors, anyone interested in the safety of products regulated by the FDA (predominantly medical products, food, veterinary products and nutrition, and tobacco products), and those interested in FDA activities. SCOPE: Topics include routine and developmental data mining activities, short descriptions of mined FDA data, advantages and challenges of data mining at the FDA, and future directions of data mining at the FDA.

The role and efficacy of secondary intraocular lenses in the treatment of monocular infantile cataracts.

PURPOSE: To determine if and when a secondary intraocular lens (IOL) can be beneficial to the successful treatment of a monocular infantile cataract. METHODS: This retrospective study reviewed medical records of children undergoing treatment of a monocular congenital cataract from 1996 to 2009 at one pediatric ophthalmology practice. Patients had unilateral cataracts removed by age 8 months and a secondary IOL inserted prior to 6 years of age. At the final visit, the children had to perform linear Snellen visual acuity testing. RESULTS: Of 11 identified patients, 8 had treatment onset by age 4 months and 3 between 5 and 7 months of age. These 3 children had final acuities of 20/500 (n=2) and hand motion (n=1). Those undergoing treatment prior to age 5 months had Snellen acuities of 20/30 to 20/400. The best results were obtained by patients who were compliant with contact lenses and patching before insertion of a secondary IOL. CONCLUSIONS: If treatment of a monocular congenital cataract begins by 4 months of age (ie, the critical period for visual development) and patients remain compliant with occlusion therapy and an aphakic contact lens, then they will likely do well after IOL implantation. Furthermore, it appears that insertion of a secondary IOL will maintain vision that was established with a contact lens and patching and perhaps prevent deterioration that might still occur if compliance issues develop. However, secondary IOL placement will not dramatically improve the final visual result from that developed with occlusion and a contact lens.

Masked bilateral superior oblique palsy in children.

PURPOSE: Following surgery on an eye for unilateral superior oblique palsy, it is a well-recognized postoperative occurrence for the unoperated eye to develop superior oblique palsy, commonly referred to as masked bilateral superior oblique palsy. The purpose of this study was to describe this postoperative finding in children following unilateral inferior oblique weakening surgery. METHODS: A retrospective review of records of children who underwent unilateral inferior oblique weakening surgery at Children's Hospital of Michigan, Detroit, Michigan, from 1987 to 2005, including information on the development of masked bilateral superior oblique palsy with contralateral inferior oblique overaction requiring a second surgical intervention. RESULTS: Of 50 children (25 boys and 25 girls, mean age: 5.6 years) who underwent unilateral inferior oblique weakening surgery (47 recessions and 3 myectomies), 9 (18%) manifested masked bilateral superior oblique palsy postoperatively, requiring subsequent surgical weakening of the inferior oblique muscle in the unoperated eye. Preoperative primary position hypertropia in children who were eventually diagnosed as having masked bilateral superior oblique palsy (5.56±4.22 prism diopters [PD]) was significantly smaller compared to children with unilateral superior oblique palsy (10.4±6.5 PD, P=.012), and preoperative primary position hypertropia of less than 5 PD was associated with an odds ratio of 8.2 (95% confidence interval: 1.7 to 38.5, P=.008) for requiring reoperation. CONCLUSIONS: Masked bilateral superior oblique palsy is a possible outcome after surgery for the correction of pediatric unilateral superior oblique palsy. Parents should be informed of this possible outcome, especially when primary position hypertropia is less than 5 PD.

Accuracy and reliability of GPS devices for measurement of sports-specific movement patterns related to cricket, tennis, and field-based team sports.

The aim of this study was to determine the accuracy and reliability of 5, 10, and 15 Hz global positioning system (GPS) devices. Two male subjects (mean ± SD; age, 25.5 ± 0.7 years; height, 1.75 ± 0.01 m; body mass, 74 ± 5.7 kg) completed 10 repetitions of drills replicating movements typical of tennis, cricket, and field-based (football) sports. All movements were completed wearing two 5 and 10 Hz MinimaxX and 2 GPS-Sports 15 Hz GPS devices in a specially designed harness. Criterion movement data for distance and speed were provided from a 22-camera VICON system sampling at 100 Hz. Accuracy was determined using 1-way analysis of variance with Tukey's post hoc tests. Interunit reliability was determined using intraclass correlation (ICC), and typical error was estimated as coefficient of variation (CV). Overall, for the majority of distance and speed measures, as measured using the 5, 10, and 15 Hz GPS devices, were not significantly different (p > 0.05) to the VICON data. Additionally, no improvements in the accuracy or reliability of GPS devices were observed with an increase in the sampling rate. However, the CV for the 5 and 15 Hz devices for distance and speed measures ranged between 3 and 33%, with increasing variability evident in higher speed zones. The majority of ICC measures possessed a low level of interunit reliability (r = -0.35 to 0.39). Based on these results, practitioners of these devices should be aware that measurements of distance and speed may be consistently underestimated, regardless of the movements performed.

Secondary or new compensatory head posture after Anderson-Kestenbaum surgery.

PURPOSE: To report clinical findings and surgical management of 4 patients with congenital nystagmus who presented with a new or reversal of their original horizontal compensatory head posture (CHP) after Anderson-Kestenbaum (A-K) surgery. METHOD: Retrospective chart review. RESULTS: All 4 patients demonstrated a 40°-45° horizontal face turn at the time of their initial surgery and 3 underwent 20% and one 30% augmented A-K surgery to correct the CHP. The new CHP or reversal of the original CHP was observed at a mean of 4 years (range 1-9 years) after the initial surgery. The reversed CHPs measured 20°, 40°, 20°, and 20°, respectively. These new or residual CHPs were surgically managed in 3 patients and an acceptable head position was achieved in all patients. CONCLUSIONS: This series of patients points out the occurrence of secondary null points and reversed CHP after surgical correction of initial CHP.

Polyomic profiling reveals significant hepatic metabolic alterations in glucagon-receptor (GCGR) knockout mice: implications on anti-glucagon therapies for diabetes.

BACKGROUND: Glucagon is an important hormone in the regulation of glucose homeostasis, particularly in the maintenance of euglycemia and prevention of hypoglycemia. In type 2 Diabetes Mellitus (T2DM), glucagon levels are elevated in both the fasted and postprandial states, which contributes to inappropriate hyperglycemia through excessive hepatic glucose production. Efforts to discover and evaluate glucagon receptor antagonists for the treatment of T2DM have been ongoing for approximately two decades, with the challenge being to identify an agent with appropriate pharmaceutical properties and efficacy relative to potential side effects. We sought to determine the hepatic & systemic consequence of full glucagon receptor antagonism through the study of the glucagon receptor knock-out mouse (Gcgr-/-) compared to wild-type littermates. RESULTS: Liver transcriptomics was performed using Affymetric expression array profiling, and liver proteomics was performed by iTRAQ global protein analysis. To complement the transcriptomic and proteomic analyses, we also conducted metabolite profiling (~200 analytes) using mass spectrometry in plasma. Overall, there was excellent concordance (R = 0.88) for changes associated with receptor knock-out between the transcript and protein analysis. Pathway analysis tools were used to map the metabolic processes in liver altered by glucagon receptor ablation, the most notable being significant down-regulation of gluconeogenesis, amino acid catabolism, and fatty acid oxidation processes, with significant up-regulation of glycolysis, fatty acid synthesis, and cholesterol biosynthetic processes. These changes at the level of the liver were manifested through an altered plasma metabolite profile in the receptor knock-out mice, e.g. decreased glucose and glucose-derived metabolites, and increased amino acids, cholesterol, and bile acid levels. CONCLUSIONS: In sum, the results of this study suggest that the complete ablation of hepatic glucagon receptor function results in major metabolic alterations in the liver, which, while promoting improved glycemic control, may be associated with adverse lipid changes.

Functional results of the surgical repair of a lacerated canaliculus in children.

PURPOSE: This study examined the functional success of surgical repair of lacerated canaliculi in a pediatric population. METHODS: A retrospective chart review was performed on 46 patients who had surgical repair of a lacerated canaliculus. Functional success was defined as no tearing or discharge present at the end of treatment. RESULTS: Forty-four of the 46 patients had repair with a Crawford tube. Of these, 39 presented for postoperative follow-up. Two patients had some tearing present at the time of tube removal. Eight patients whose tube fell out or was pulled out by the patient had no symptoms at their last visit. Fourteen patients were able to be contacted by phone for follow-up more than a year after treatment and 13 were symptom free. The child with reported discharge was more than 2 years post treatment and had not scheduled any return appointments to seek treatment. CONCLUSION: Surgical repair of a lacerated canaliculus using a Crawford silicone tube in the pediatric population has an excellent chance of having a good functional outcome with no tearing or discharge present.

Progression of type 2 to type 1 retinopathy of prematurity in the Early Treatment for Retinopathy of Prematurity Study.

OBJECTIVE: To examine the frequency and timing of progression from type 2 to type 1 retinopathy of prematurity (ROP) in the Early Treatment for Retinopathy of Prematurity Study. METHODS: Infants with prethreshold ROP that was no worse than low risk in 1 or both eyes, based on the RM-ROP2 model, were examined every 2 to 4 days for at least 2 weeks. Using the Early Treatment for Retinopathy of Prematurity Study-defined classification of eyes as having type 1 or type 2 prethreshold ROP, we analyzed the time to conversion from type 2 to type 1. Data were analyzed for 1 randomly selected eye for each child. RESULTS: Of 294 eyes at first diagnosis of type 2 ROP, 65 (22.1%) progressed to type 1 (mean [SD] interval, 9.0 [6.6] days; median, 7.0 days). Of 217 eyes with type 2 ROP that had an examination in less than 7 days, 25 (11.5%) were diagnosed with type 1 ROP in less than 7 days. Of 200 eyes that continued to have type 2 disease at the first follow-up examination and underwent a subsequent examination, 24 (15.7% of the 153 eyes that had an examination in <7 days) developed type 1 ROP in less than 7 days. The risk of progression from type 2 to type 1 in less than 7 days was greatest between 33 and 36 weeks' postmenstrual age, regardless of zone of retinopathy. CONCLUSIONS: Type 1 ROP can be identified with weekly examinations in most eyes with initial diagnosis of type 2 ROP; a small subset progresses to type 1 in less than 7 days. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00027222.

The role of the random dot Stereo Butterfly test as an adjunct test for the detection of constant strabismus in vision screening.

BACKGROUND: A goal of vision screening is the detection of amblyopia risk factors, including strabismus. The random dot Stereo Butterfly test requires no instruction, has a simple pass/fail response with no monocular clues, and is easily administered. The purpose of this study was to determine whether this test could be used as a cost-effective and reliable component of preschool vision screening. METHODS: The Stereo Butterfly was presented to children with no previous history of ocular problems or treatment. The test was presented with the use of polarized glasses at a 16-inch testing distance. A "pass" was recorded if the patient reported seeing a butterfly; a "refer" was denoted otherwise. Vision and motility measurements were recorded, and the patient underwent a complete eye examination with cycloplegic refraction. RESULTS: A total of 281 children 3 to 6 years of age were tested: 221 children passed the test. Of those who passed, 7 (3.2%) had intermittent strabismus, 1 had a small-angle constant strabismus, 60 failed screening for constant strabismus (of whom 24 [40%] had constant strabismus), and 6 were false-negative results. The sensitivity of the Stereo Butterfly for detecting constant strabismus was 96%; the specificity, 86%. CONCLUSIONS: The Stereo Butterfly test may be a valuable adjunctive tool in vision screening programs for the detection of manifest strabismus because it is easy to administer and effectively detects constant strabismus. It has a high specificity for detection of constant strabismus but, if used alone, the low positive predictive value would allow for many false-positive results.

Improved image analysis workflow for 2-D gels enables large-scale 2-D gel-based proteomics studies--COPD biomarker discovery study.

2-D gel electrophoresis has been used for more than three decades to study the protein complement of organisms, tissues, and cells. Three issues are holding back large-scale proteomics studies: low-throughput, high technical variation, and study designs lacking statistical power. We identified image analysis as the central factor connecting these three issues. By developing an improved image analysis workflow we shortened project timelines, decreased technical variation, and thus enabled large-scale proteomics studies that are statistically powered. Rather than detecting protein spots on each gel image and matching spots across gel images, the improved workflow is based on aligning images first, then creating a consensus spot pattern and finally propagating the consensus spot pattern to all gel images for quantitation. This results in a data table without gaps. As an example we show here a study aimed at discovering circulating biomarkers for chronic obstructive pulmonary disease (COPD). Eight candidate biomarkers were identified by comparing plasma from 24 smokers with COPD and 24 smokers without COPD. Among the candidates are proteins such as plasma retinal-binding protein (RETB) and fibrinogen that had previously been linked to the disease and are frequently monitored in COPD patients, as well as other proteins such as apolipoprotein E (ApoE), inter-alpha-trypsininhibitor heavy chain H4 (ITIH4), and glutathione peroxidase.

Twenty-year follow-up of surgery for intermittent exotropia.

PURPOSE: We sought to evaluate the 20-year follow-up of intermittent exotropia surgery performed before the age of 10 years to determine the stability of alignment and the effect of strabismus on visual function. METHODS: Patients meeting the inclusion criteria were identified from surgical logs, contacted, and examined. The history obtained assessed the effect of their strabismus on education, career choices, driving, and reading ability. Histories were also obtained from adults presenting with exotropia to determine what type of strabismus, if any, they had younger in life. RESULTS: Thirty patients were examined more than 20 years after exotropia surgery. All had good alignment on the study examination. Twenty-one of 30 had required only a single surgery, 7 had undergone 2 surgeries, and 2 had 3. The average age at the last office visit prior to the study was 11.8 years; the average age at the study visit was 29.4 years. Of 66 adults presenting with exotropia, 9% had a previous history of exotropia surgery, and 32% had a history of an untreated exodeviation in childhood. CONCLUSIONS: When intermittent exotropia was surgically aligned and stable to about 11 years of age, it tended to remain so, at least until age 30. Few adults presenting with exotropia had a history of exotropia surgery as a child.

Excimer laser in myocardial infarction: a comparison between STEMI patients with established Q-wave versus patients with non-STEMI (non-Q).

Patients sustaining acute myocardial infarction (AMI) often require urgent percutaneous revascularization within the first 24 h from onset of the infarction due to continuous ischemia and hemodynamic instability. Upon arrival to the cardiac catheterization, the electrocardiogram of AMI patients may exhibit acute ST-elevation (STEMI) with or without accompanying Q-wave or depression of the ST segment (non-STEMI or non-Q-wave infarction). Data comparing acute outcome of device application in patients presenting for urgent revascularization with established Q-wave myocardial infarction (QWMI) versus those with non-STEMI (NQMI) are sparse. Excimer laser is a revascularization modality applied for debulking of atherosclerotic plaque and vaporization of associated thrombus in the setting of AMI. One hundred fifty-one AMI patients with continuous chest pain and ischemia who enrolled into a multicenter study and underwent urgent revascularization were divided for the purpose of a retrospective analysis into two groups. One group presented with established electrocardiographic Q-wave, whereas the other had ST-depression (NQMI). In comparison with the NQMI group, the QWMI patients had a higher incidence of failed thrombolytic therapy (17% vs 3, p = 0.006), cardiogenic shock (20 vs 6%, p = 0.01), left anterior descending as a culprit infarct-related vessel (46 vs 14%, p < 0.0001), a higher incidence of TIMI 0 flow (48 vs 24%, p = 0.04), a heavier thrombus burden (grade 4 TIMI thrombus, 58 vs 23%; p = 0.0001), and higher CPK (1272 +/- 2180 vs 404 +/- 577, p = 0.001) and troponin levels (62 +/- 95 vs 14 +/- 48, p = 0.0003). Both groups underwent laser angioplasty and stenting for relief of continuous chest pain and ischemia within 24 h of infarction onset. Quantitative coronary arteriography in an independent core laboratory measured similar improvement in baseline minimal luminal diameter and percent diameter stenosis by application of laser energy in both groups. Among the QWMI patients, a significantly higher acute gain was recorded with the laser treatment in lesions containing a large/extensive thrombus burden as compared with lesions containing only a small clot burden (1.2 +/- 0.7 vs 0.8 +/- 0.5, p = 0.01). Such a phenomenon was not detected among the NQMI patients (1.0 +/- 0.5 vs 0.8 +/- 0.6, p=ns). Baseline TIMI flow grade (0.9 +/- 1.0 for QWMI vs 1.5 +/- 1.2 for NQMI, p = 0.0001) increased with laser emission to 2.8 +/- 0.5 and subsequently reached a final level of TIMI 3 in both groups. In comparison with the QWMI patients, there was a trend toward a reduced rate of major adverse coronary events among the NQMI patients (12% QWMI vs 4% NQMI, p = 0.09). Significant differences in baseline clinical characteristics, extent of myocardial damage, location of infarct related vessel, thrombus burden, and TIMI flow exist between QWMI and NQMI patients who require urgent intervention. However, application of excimer laser results in similar high procedural success and low complication rates in both groups. Maximal acute laser gain is achieved among QWMI patients whose lesions are laden with a heavy thrombus burden.

Age-adjustment and related epidemiology rates in education and research.

A quick review of introductory textbooks reveals that while gerontology authors and instructors introduce some aspect of demography and epidemiology data, there is limited focus on age adjustment or other important epidemiology rates. The goal of this paper is to reintroduce a variety of basic epidemiology strategies such as incidence, prevalence, crude, age-specific and age-adjustment rates into the gerontology classroom. Background information and formulas for each rate, as well as examples of how they can be applied are provided. A recent change, encouraged by the U.S. Department of Health and Human Services, from a 1940 to a 2000 "standard million population" for ageadjusted rates, is reviewed. Finally, a teaching module with answers is provided for use in the gerontology classroom.

Lions Clubs International Foundation Core Four Photoscreening: results from 17 programs and 400,000 preschool children.

INTRODUCTION: Photoscreening programs for preschool vision screening have been promoted by Lions Clubs International Foundation (LCIF) via their 17 Core Four grant project awards since 1999. Results from 15 Core Four grant programs in the United States and one in Taiwan are presented here. METHODS: Photoscreening was modeled after the Tennessee program and instituted statewide in each area. Programs were given latitude with respect to screening instrument and referral criteria, but a partnering academic institution and medical director were expected. Preschool children were screened by volunteers; referred children were examined by community optometrists and ophthalmologists who returned results to each program's coordinating center. Outcome data included number of children screened, referral rate, follow-up rate, and positive predictive value, which was generally determined using AAPOS-defined vision screening criteria. RESULTS: All but one program used the MTI photoscreener (it chose not to participate); photoscreening referral criteria were standard for 13 programs. Through December 2004, more than 400,000 preschool children had been screened. The referral rate for programs using the MTI photoscreener averaged 5.2% (range, 3.7-12.6%). The predictive value of a positive photoscreen was 80%. Overall, 54% of referred children received follow-up examinations. Follow-up rate was the largest variable: 4 programs, screening nearly 250,000 children, had follow-up rates 70% or greater; 10 programs had follow-up data from fewer than 40% of referred children. CONCLUSIONS: Volunteer-led photoscreening programs can be instituted in other locations, including overseas, with high levels of effectiveness. Limitations include the possibility of poor success and variable attention to follow-up.