Instrument-based pediatric vision screening.

PURPOSE OF REVIEW: The purpose is to review currently available instruments for vision screening in young children. RECENT FINDINGS: Instrumentation continues to evolve. Although the current generation of photoscreeners and autorefractors strive to identify amblyopia risk factors, newer technology aims to directly identify amblyopia in young children. Acceptance of instrument-based vision screening for this population has led to increased reimbursement for the procedure in primary care practices. SUMMARY: Instrument-based vision screening in the young child is an accepted method of screening for amblyopia. Innovations in instrumentation will continue to improve its implementation.

Pediatric internuclear ophthalmoplegia.

BACKGROUND: Internuclear ophthalmoplegia (INO) is a rare eye movement disorder in the pediatric population. METHODS: We performed a retrospective review at a university-based tertiary referral ophthalmology practice from 2004 to 2012 to identify pediatric patients with INO. RESULTS: Three patients with INO were identified. Etiologies included high-grade astrocytoma, perinantal hypoxia and neonatal intracerebral hemorrhage. One of our patients, a 2 year-old girl, is the youngest reported case of INO. CONCLUSION: While rare, INO in a pediatric patient requires a full neurologic evaluation and careful follow-up to assess eye position and potentially treat amblyopia.

Pediatric intraocular lens power calculations.

PURPOSE OF REVIEW: To implant an appropriate intraocular lens (IOL) in a child, we must measure the eye well, calculate the IOL power accurately and predict the refractive change of the pseudophakic eye to maturity. The present review will concentrate on recent studies dealing with these issues. RECENT FINDINGS: Immersion A-scan biometry is superior in measuring the axial length of children. Current IOL power calculation formulas are very accurate in adults, but significantly less accurate in children. Several studies point to the high prediction errors encountered particularly in shorter eyes with all available IOL formulas. Postoperative refraction target remains controversial, but low degrees of overcorrection (i.e. hyperopia) may not adversely affect eventual best-corrected visual acuity. SUMMARY: Although pediatric IOL power calculations suffer from significant prediction error, these errors can be decreased by careful preoperative measurements. IOL power calculation formulas are most accurate in the older, more 'adult'-sized eye. The smallest eyes have the most prediction error with all available formulas. Individual circumstances and parental concerns must be factored into the choice of a postoperative refractive target.

Effect of adult strabismus on ratings of official U.S. Army photographs.

PURPOSE: To determine if strabismus affects the ratings of official U.S. Army photographs. METHODS: Photographs of seven women and seven men officers (subjects) were digitally altered to give the impression of strabismus. Four photographs of each subject were obtained: two in an orthotropic state; one in a left exotropic state; and one in a left esotropic state. The photographs were presented randomly to a panel of 38 raters. Masked to the study design, the raters rated every photograph on a 1 to 10 Likert scale. The results were grouped according to eye alignment: two orthotropic groups, one exotropic group, and one esotropic group. Comparisons of the mean ratings were made between each eye alignment group and based on the subject's gender. RESULTS: The mean rating for each orthotropic group was 5.4 and 5.5 Likert scale units with a SD of 0.8 and 0.9, respectively (group 1 and group 2). The mean rating for the exotropic group was 5.4 Likert scale units with a SD of 0.7. The mean rating for the esotropic group was 5.1 Likert scale units with a SD of 0.8. Significantly lower ratings were obtained for the esotropic group compared with the orthotropic group (p=0.028). Women received significantly lower ratings regardless of eye alignment (p=0.044). CONCLUSIONS: This study indicates that the presence of esotropia negatively affects the rating of an official U.S. Army photograph; furthermore, female gender negatively affects ratings.