Childhood esotropia: child and parent concerns.

PURPOSE: To identify specific health-related quality of life (HRQOL) concerns affecting children with esotropia as expressed by children or one of their parents (proxy) and concerns affecting the parents themselves. METHODS: Sixty children with esotropia (0-17 years of age) and 1 parent for each child were prospectively enrolled. Individual semistructured interviews were conducted with children aged 5-17 years (n = 40) and 1 parent each for child ages 0-17 years. Transcripts of recorded interviews were evaluated using NVivo software. Specific concerns were identified from both child and parent interviews and coded. From these specific codes, broad themes were identified. Frequency of each theme was calculated, along with the frequency of specific codes within each theme. RESULTS: Regarding the child's experience 6 broad themes were identified: visual function (mentioned by 32 of 40 children (80%) and by 50 of 60 parents (proxy assessment of child, 83%), treatment (78% and 85%), emotions (65% and 67%), social (58% and 68%), physical (58% and 32%), and worry (45% and 7%). Regarding the parents' own experience, 5 broad themes were identified: treatment (59 of 60 parents, 98%), worry (97%), emotions (82%), compensation for condition (80%), and affects family (23%). CONCLUSIONS: A wide range of concerns were identified from interviews of children with esotropia and their parents. Concerns reflect the impact of esotropia in physical, emotional, and social domains, and specific concerns will be used for the development of questionnaires to quantify the effects of esotropia on children's and parents' quality of life.

Normative reference ranges for the retinal nerve fiber layer, macula, and retinal layer thicknesses in children.

PURPOSE: To establish a normative database of peripapillary retinal nerve fiber layer (RNFL) thickness, macular thickness, and retinal layer thickness in healthy North American children, using spectral-domain optical coherence tomography (SD OCT). DESIGN: Prospective cross-sectional study. METHODS: This institutional study enrolled 83 healthy children (aged 5-15 years) as volunteer research subjects at the Retina Foundation of the Southwest (Dallas, Texas); all had normal visual acuity. Imaging was accomplished with the Spectralis SD OCT. Peripapillary RNFL thickness and macular thickness were assessed for 1 eye of each child using the Heidelberg Spectralis SD OCT software. Thicknesses of individual retinal layers and layer combinations were assessed using custom software to segment the line scans obtained with the Spectralis SD OCT. RESULTS: Average global peripapillary RNFL thickness was 107.6 ± 1.2 µm and average central subfield macular thickness was 271.2 ± 2.0 µm. Peripapillary RNFL thickness was thicker than has been reported in adults, particularly the superior and inferior sectors, and central subfield macular thickness was significantly correlated with age. While the thickness of most retinal layers was comparable with those of adults, the outer segment layer was 36% thinner in children than in adults. CONCLUSIONS: SD OCT can be used to assess peripapillary RNFL thickness, macular thickness, and retinal layer thickness in children as young as 5 years. Pediatric means and normative reference ranges are provided for each measurement. The values presented herein can be used as a standard with which to compare those of children suspected of having retinal or optic nerve abnormalities.

Normative pediatric visual acuity using single surrounded HOTV optotypes on the Electronic Visual Acuity Tester following the Amblyopia Treatment Study protocol.

PURPOSE: To provide normative pediatric visual acuity data using HOTV optotypes presented on the Electronic Visual Acuity Tester following the Amblyopia Treatment Study (ATS) protocol. METHODS: Monocular testing was conducted on 384 healthy full-term children ranging from 3 to 10 years of age (mean, 5.4 years; SD, 1.8 years). A total of 373 children completed monocular testing of each eye. In addition, 23 adults (mean, 28.7 years; SD, 4.9 years) were tested for comparison. Both monocular visual acuity and interocular acuity differences were recorded. RESULTS: Mean visual acuity improved by slightly more than one line (0.12 logMAR) from 3 years of age to adulthood, increasing from 0.08 logMAR to -0.04 logMAR (F(6,400) = 26.3, p < 2.0 x 10(-26)). At all ages, mean interocular acuity difference was less than one line on a standard acuity chart (overall mean difference = 0.04 logMAR; SD, 0.06 logMAR). CONCLUSIONS: These results represent the first normative data reported for HOTV optotypes using the ATS protocol on the Electronic Visual Acuity Tester. These data may play an important role in clinical practice, screening, and clinical research.

Validity and reliability of the Children's Visual Function Questionnaire (CVFQ).

PURPOSE: The Children's Visual Function Questionnaire (CVFQ) is a vision-specific quality-of-life instrument designed for use with children up to 7 years of age. The goal of this study was to assess the construct validity of CVFQ subscales by examining their sensitivity to four research questions commonly posed in ophthalmic clinical trials. METHODS: CVFQ Competence, Personality, Family Impact, and Treatment Difficulty subscale scores were compared for groups of pediatric patients with unilateral versus bilateral disease (35 bilateral and 38 unilateral cataract), different severity of visual impairment (61 retinopathy of prematurity [ROP] grouped by acuity), difficulty of treatment regimen (22 optical, 44 surgery, 38 surgery with optical, and 35 surgery with optical and occlusion), and alternative treatments for the same condition (24 intraocular lenses, 37 aphakic contact lenses). RESULTS: Patients treated for bilateral cataracts had significantly worse Competence subscale scores than patients treated for unilateral cataract, and patients with bilateral severe ROP (visual acuity 20/200 or poorer in both eyes) had significantly worse Competence subscale scores than other patients with ROP. Treatment Difficulty subscale scores were worse for patients with unilateral cataracts than for those with bilateral cataracts, worse for patients treated with occlusion therapy than for those treated with surgery or optical correction, and worse for those treated with an aphakic contact lens than for those treated with an intraocular lens. Family Impact subscale scores were worse for patients with unilateral cataracts than for those with bilateral cataracts, worse for patients treated with surgery than for those treated with optical correction, and worse for those with severe bilateral ROP than for any other patients with ROP. CONCLUSIONS: The CVFQ subscales quantified meaningful differences among pediatric patient groups who were chosen to address key research questions commonly posed in ophthalmic clinical trials.