Factors Affecting Pupil Reactivity After Cycloplegia in Asian Children.

PURPOSE: The aim of this study was to evaluate the factors affecting cycloplegia, as determined by pupil reactivity, in Asian children. DESIGN: Prospective observational study. METHODS: Two-hundred sixty-eight children, aged 2 to 12 years, requiring cycloplegic refraction, were recruited. Nurses instilled 2 to 3 cycles of eye drops consisting of cyclopentolate 1%, tropicamide 0.5%, and phenylephrine 2.5%, and recorded the child's level of cooperation. Optometrists recorded pupil reactivity after the last cycle. Multivariate analysis determined factors affecting pupil reactivity including age, sex, race, number of eye drop cycles, pupil sizes before and after cycloplegia, and child's cooperation during eye drops instillation. RESULTS: The pupils in 36 children (13.4%) were found to be still reactive. On univariate analysis, children with reactive pupils also had smaller pupils after cycloplegia (6.27 ±â€Š1.16 mm vs 7.42 ±â€Š0.81 mm, P < 0.001). On multiple logistic regression analysis, for every 1-mm increase in the pupil size after cycloplegic eye drop administration, the odds of having reactive pupils decreases by 65% (odds ratio = 0.35, 95% confidence interval 0.25-0.51, P ≤ 0.001). Those who were uncooperative during administration of eye drops were 3.13 times more likely to have reactive pupils (95% confidence interval 1.21-8.13, P = 0.019), whereas age (P = 0.904), sex (P = 0.355), the number of cycles of eye drops (P = 0.462), and other psychological factors were not relevant in affecting pupil reactivity. CONCLUSIONS: Pupil reactivity, which was used as a measure of cycloplegia, was more likely to be affected by children's level of cooperation during instillation of eye drops, rather than age and sex. Two cycles of eye drops were as effective as 3 cycles in producing cycloplegia.

Amblyopia therapy in Asian children: factors affecting visual outcome and parents' perception of children's attitudes towards amblyopia treatment.

INTRODUCTION: Amblyopia treatment in the form of glasses and/or patching in children poses a great challenge to parents. This study aimed to assess the factors that influence visual outcome in amblyopia and children's perception towards treatment. METHODS: 180 children (aged 3.0-7.0 years) with newly diagnosed amblyopia were recruited. The effects of age, gender, type of amblyopia, treatment and compliance on visual outcome at one year were assessed. Parents completed a questionnaire on children's attitudes towards amblyopia treatment. RESULTS: 150 (83%) children with a mean age of 5.2 ± 0.8 years returned for follow-up at one year. 130 (87%) had refractive amblyopia and 20 (13%) had strabismic and refractive-strabismic amblyopia. Visual acuity (VA) of 6/9 or better in the amblyopic eye was achieved in 121 (81%) children. On multivariable analysis, poor responders were more likely to have initial VA of worse than 6/15 (relative risk [RR] 4.17, 95% confidence interval [CI] 1.58-11.00, p = 0.004), prescribed combined (glasses and patching) treatment (RR 2.83, 95% CI 1.02-7.83, p = 0.045) and poor compliance (RR 6.10, 95% CI 1.90-19.57, p = 0.002) after adjustment for age, gender and type of amblyopia. While 7% of children initially reacted poorly to treatment, 5% remained uncooperative at the first follow-up visit. Children had difficulty with schoolwork (5%), mood changes (6%) and social problems (2%) associated with treatment. CONCLUSION: Most children with amblyopia respond well to treatment, but more care (i.e. more parental education and closer follow-up) may be needed in children who are non-compliant and have poorer initial VA.

Factors Associated With Lack of Vision Improvement in Children With Cortical Visual Impairment.

BACKGROUND: Improvement in vision has been noted in children with cortical visual impairment (CVI), resulting from disparate types of brain injury. The purpose of our study was to determine the risk factors associated with poor recovery of vision in this group of patients. METHODS: Case records of children who were born before 2010 with at least 4 follow-up visits for CVI were reviewed for underlying etiologies of CVI, visual acuity (VA), and associated neurological and ophthalmological disorders. VA was assessed in 6 qualitative grades. Changes in VA were recorded as the difference between the grades of VA at presentation and the last follow-up visit. The outcome was calculated as a ratio of actual improvement to potential improvement in grades of qualitative VA. Multiple linear regression determined factors associated with lack of vision improvement in all children and based on etiology. RESULTS: Fifty-three children with CVI were identified. The median age at presentation was 13.6 months (range: 2.9-76.4 months) and the median follow-up was 5.8 years (1.1-16.3 years). CVI resulted from central nervous system (CNS) malformation (9.4%), hypoxic/inflammatory injury (15.1%), seizures (24.5%), and combined causes (51.0%). Vision improvement was noted in 83% of children. Lack of VA improvement was associated with older age at presentation in all children with CVI and within each etiological group except CNS malformation. None of the other investigated variables were associated with poor recovery of VA. CONCLUSIONS: Most of the children with CVI showed improvement in vision. Older age at presentation, but not etiology of CVI, was associated with poor improvement in VA.

Myopia in young patients with type 1 diabetes mellitus.

INTRODUCTION: This study aimed to evaluate the proportion of young patients with type 1 diabetes mellitus (T1DM) who have myopia, as well as the risk factors associated with myopia in this group. METHODS: In this cross-sectional study, patients aged < 21 years with T1DM for ≥ 1 year underwent a comprehensive eye examination. Presence of parental myopia, and average hours of near-work and outdoor activity were estimated using a questionnaire. Annualised glycosylated haemoglobin (HbA1c), defined as the mean of the last three HbA1c readings taken over the last year, was calculated. Multivariate analysis using genetic, environmental and diabetes-related factors was done to evaluate risk factors associated with myopia. RESULTS: Of the 146 patients (mean age 12.5 ± 3.6 years) recruited, 66.4% were Chinese and 57.5% were female. Myopia (i.e. spherical equivalent [SE] of -0.50 D or worse) was present in 96 (65.8%) patients. The proportion of patients with myopia increased from 25.0% and 53.6% in those aged < 7.0 years and 7.0-9.9 years, respectively, to 59.2% and 78.4% in those aged 10.0-11.9 years and ≥ 12.0 years, respectively. Higher levels of SE were associated with lower parental myopia (p = 0.024) and higher annualised HbA1c (p = 0.011). CONCLUSION: Compared to the background population, the proportion of myopia in young patients with T1DM was higher in those aged < 10 years but similar in the older age group. Myopia was associated with a history of parental myopia. Environmental risk factors and poor glycaemic control were not related to higher myopia risk.

The psychological impact of eyedrops administration in children.

PURPOSE: To determine the psychological effects of eyedrops administration in children. METHODS: Children requiring eyedrops for cycloplegic refraction were recruited in this cross-sectional study. Nurses administered eyedrops in 2-3 cycles spaced 5-10 minutes apart, and optometrists performed refraction 30 minutes after the last drop. Ophthalmologists, nurses, and optometrists rated the children's cooperation level at first review, after each eyedrop, at refraction, and at final review. Parents chose a personality type best describing their child, and monitored their child's anxiety using a modified Yale Preoperative Anxiety Scale (m-YPAS). Children were "uncooperative" if nurses noted significant distress during the first drop cycle. RESULTS: A total of 298 children 2-12 years of age were included. Of these, 77 (26%) experienced pre-drop distress and 39 (13%) were uncooperative with drops. Compared to cooperative children, uncooperative children tended to be younger (2.0-4.9 years vs ≥8 years; OR, 4.11; 95% CI, 1.14-14.83; P = 0.031), male (OR, 2.55; 95% CI, 1.06-6.10; P = 0.036), have had a previous negative eyedrop experience (84.2% vs 25.3%; P < 0.001) and were more anxious (m-YPAS scores, 41.4 ± 22.0 vs 30.6 ± 12.6: P < 0.001). Children described as "demanding and aggressive" were more uncooperative than "timid and anxious" children. It took longer to instill drops (3.1 vs 1.3 minutes), and perform refraction (11.6 vs 7.2 minutes) in uncooperative children. CONCLUSIONS: A small group of children were uncooperative with eyedrops and 26% experienced significant pre-drop anxiety. Factors such as age, sex, a previous negative eyedrop experience, and pre-drop anxiety, associated with uncooperativeness need to be considered when developing strategies to improve the eyedrops experience in children.

Prevalence of plateau iris in primary angle closure suspects an ultrasound biomicroscopy study.

PURPOSE: To determine the prevalence of plateau iris in a cohort of primary angle closure suspects (PACSs) using ultrasound biomicroscopy (UBM). DESIGN: Cross-sectional observational study. PARTICIPANTS: Subjects over the age of 50 years diagnosed as PACSs. INTERVENTION: Subjects were randomized to undergo laser peripheral iridotomy (LPI) in one eye. Ultrasound biomicroscopy was performed before and a week after LPI. MAIN OUTCOME MEASURES: Ultrasound biomicroscopy images were qualitatively assessed using standardized criteria. Plateau iris was defined in a quadrant by the presence of an anteriorly directed ciliary body, an absent ciliary sulcus, a steep iris root from its point of insertion followed by a downward angulation from the corneoscleral wall, presence of a central flat iris plane, and irido-angle contact. At least 2 quadrants had to fulfil the above criteria for an eye to be defined as plateau iris. RESULTS: Two hundred five subjects were enrolled; UBM images of 167 subjects were available for analysis. Plateau iris was found in 54 of 167 (32.3%) PACS eyes after LPI. Quadrantwise analysis showed that 44 of 167 (26.3%) eyes had plateau iris in 1 quadrant, 36 (21.5%) in 2 quadrants, 16 (9.5%) in 3 quadrants, and 2 (1.2%) in all 4 quadrants. Plateau iris was most commonly observed in the superior and inferior quadrants. CONCLUSIONS: Using standardized UBM criteria, plateau iris was found in about a third of PACS eyes after LPI. Prospective longitudinal studies are required to determine the clinical significance of this finding for the management of PACSs.