Chantal J. Boisvert

Theoretical strategy for choosing piggyback intraocular lens powers in young children

INTRODUCTION The normal growth of a young childs pseudophakic eye can result in a large myopic shift. Temporary polypseudophakia using piggyback intraocular lenses (IOLs) has been proposed as a means to reduce the amount of myopic shift by removing the anterior IOL when the eye becomes sufficiently myopic. Since the rate of refractive growth can be used to predict the refractive curve over time in pseudophakic children, we used this knowledge to develop a theoretical strategy for choosing IOL power combinations for temporary polypseudophakia. METHODS We used a novel Pediatric Piggyback IOL Calculator to develop a strategy for choosing the powers of the anterior and posterior IOLs. We graphed the predicted results for several combinations of piggyback IOL powers and chose the combination of IOL powers that appeared to give the best results, based on the known rate of refractive growth (5.4 D) and its standard deviation (2.4 D). We aimed for a combination to minimize the hyperopic or myopic refractive error during the first 6 years of life to facilitate amblyopia management and minimize the refractive error at age 20 years. RESULTS We found optimal results when the initial postoperative goal refraction with polypseudophakia was moderate hyperopia and the anterior IOL had approximately 20% of the total required IOL power. CONCLUSIONS This theoretical strategy can be used to determine piggyback IOL powers to use in children.

Competency checklists for strabismus surgery and retinopathy of prematurity examination.

PURPOSE To evaluate two checklist tools that are designed to guide, document, and assess resident training in strabismus surgery and examination of infants at risk for retinopathy of prematurity (ROP). METHODS A panel of staff surgeons from several teaching institutions evaluated the checklists and provided constructive feedback. All former residents who had been trained via the use of these checklist tools were asked to take self-assessment surveys on competency in strabismus surgery and ROP examination. A Likert 5-point scale was used for all evaluations, with 1 being the lowest rating and 5 the highest rating. RESULTS Six experts in strabismus and seven in ROP rated the checklists. Their comments were used to revise the checklists, which were sent to the same group for reevaluation. The mean Likert score for the final checklists was 4.9 of 5.0 for both checklists. Of 16 former residents, 9 responded to the self-assessments with a mean overall score of 4.1 (of 5.0) for strabismus surgery and 3.9 for ROP examination. CONCLUSIONS These checklist tools can be used to assess the quality of a residents training and experience in these specific ophthalmology skills. They are complementary to other curriculum and assessment tools and can serve to organize the educational experience while ensuring a uniformity of training.

Mitochondrial Impairment in Antibiotic Induced Toxic Optic Neuropathies

ABSTRACT There is growing evidence for the role of mitochondrial dysfunction in the toxic optic neuropathies. Due to the structural similarities between antibiotic targets and mitochondrial machinery, several antibiotics known to cause optic neuropathy have deleterious effects on mitochondrial function. We review the literature on the prevalence, clinical manifestations, and management of antibiotic induced toxic optic neuropathies. The effect of these antibiotics on mitochondrial function in regard to the optic nerve is discussed.