Edward W. Cheeseman

The effectiveness of the Spot Vision Screener in detecting amblyopia risk factors

PURPOSE To evaluate the updated Spot Vision Screener (PediaVision, Welch Allyn, Skaneateles Falls, NY) in detecting amblyopia risk factors using 2013 guidelines of American Association for Pediatric Ophthalmology and Strabismus (AAPOS). METHODS In this prospective study, patients seen from June 2012 to November 2013 were tested with the Spot prior to examination by a pediatric ophthalmologist who was masked to test results. The following data were analyzed: age, subject testability, examination findings, and systemic and ocular pathology. Children were divided into three age groups to determine gold standard results according to the AAPOS guidelines. RESULTS A total of 444 children (average age, 72 months) were included. Compared to the ophthalmologists examination, the Spot sensitivity was 87.7% and the specificity was 75.9% in detecting amblyopia risk factors. Sensitivity did not differ significantly between age groups, although the positive predictive value improved in the older age groups. CONCLUSIONS In our study cohort, the Spot provided good specificity and sensitivity in detecting amblyopia risk factors according 2013 AAPOS criteria, with minor improvements with updated versions.

Onset of oscillopsia after visual maturation in patients with congenital nystagmus.

PURPOSE To describe the clinical and oculographic characteristics of a cohort of five patients with congenital nystagmus (CN) and late-onset oscillopsia caused by a coincidental decline in other visual and/or ocular motor functions. DESIGN Retrospective, observational, case series. PARTICIPANTS Five visually mature patients with CN and recent-onset oscillopsia were evaluated clinically and with motility recordings. INTERVENTION Eye movement analysis was performed off-line by computer analysis of digitized data. Nystagmus was analyzed for null-zone characteristics, waveforms, frequency, amplitudes, and slow-phase drift velocity during foveation. Surgical and medical treatment of associated ocular conditions in four of five patients. MAIN OUTCOME MEASURES Presence of symptomatic oscillopsia and average time during foveation periods of slow-phase drift velocity less than 10 degrees /second. RESULTS One of the five patients had associated rod-cone dystrophy, and another had recurrence of childhood head posturing with return of an eccentric null zone. The remaining three patients had decompensated strabismus associated with their oscillopsia. All five patients complained of oscillopsia in primary position that was relieved in the four who received treatment. Treatment included prismatic correction in one patient and surgery in three. Recordings in primary position after treatment showed increased duration during foveation periods of slow-phase drift velocity less than 10 degrees /second and an overall decreased intensity (amplitude/frequency) of the nystagmus. CONCLUSIONS Symptomatic oscillopsia in patients with CN is unusual. This visually disturbing symptom can be precipitated by new or changing associated visual sensory conditions (e.g., decompensating strabismus, retinal degeneration). If the associated conditions can be treated, then accompanying oscillopsia may be relieved.

Photoscreeners in the pediatric eye office: compared testability and refractions on high-risk children.

PURPOSE To compare refractive data and testability of Spot (PediaVision) and Plusoptix A09 (Plusoptix, Inc) photoscreeners and to compare each device with traditional cycloplegic retinoscopy. DESIGN Prospective, interventional case series. METHODS After informed consent, patients underwent testing with the Spot and Plusoptix photoscreeners before their examination by a pediatric ophthalmologist masked to the results. Data including testability and estimated refractions were entered into a Research Electronic Data Capture database for statistical analysis. RESULTS A total of 265 children were enrolled (mean age, 6.0 ± 3.4 years). Both devices produced a computer printout result in 250 (94.3%) of the patients. The Spot photoscreener provided a refractive estimate in all computer printouts, whereas the Plusoptix, used binocularly, provided a refractive estimate in 75.2% (188/250) of the printouts. Compared with cycloplegic retinoscopy, both devices underestimated hyperopia or overestimated myopia (-1.35 diopters [D] and -0.64 D, Spot and Plusoptix, respectively) and overestimated astigmatism (0.36 D and 0.32 D, Spot and Plusoptix, respectively). The intraclass correlation coefficient for spherical equivalents indicated good agreement between cycloplegic retinoscopy and Spot (0.806) and excellent agreement between cycloplegic retinoscopy and Plusoptix (0.898). CONCLUSIONS The Spot photoscreener provided refractive data on a greater percentage of children. The photorefractors correlated with cycloplegic retinoscopy refractive findings for sphere and spherical equivalents, but underestimated hyperopia or overestimated myopia and overestimated astigmatism. The binocular refractions of Plusoptix agreed more closely with the refractions of our pediatric ophthalmologists.

Magnetic Resonance Findings at 3 Tesla in Brown Syndrome

An adolescent girl with prior right lower eyelid epiblepharon repair was referred to a tertiary care center for assessment of ipsilateral Brown syndrome. She was initially diagnosed 3 years previously and had been observed without treatment or report of bothersome symptoms. Clinical examination noted normal visual acuity and expected decreased orbital elevation with adduction. On a 3 Tesla magnetic resonance imaging study, axial (Figure 1A) and coronal (Figure 1B) fat-suppressed, post-contrast T1 imaging revealed asymmetric enlargement and enhancement of the right superior oblique tendon (arrows). Coronal T2 fat-suppressed imaging of both orbits (Figure 1C) and coned-down coronal T2 of the right orbit likewise demonstrated asymmetric signal in the superior oblique tendon (Figures 1C-1D; arrow), as well as patchy intensity in the surrounding superior orbit (Figure 1D; dashed arrow). The appearance suggests focal inflammation anterior to the trochlea as the imaging correlate of the clinically apparent Brown syndrome. First described as superior oblique tendon sheath syndrome in 1950,1 its imaging appearance has been documented in few case reports and small series.2,3 However, most studies include computed tomography or lower field strength magnetic resonance imaging examinations. The exquisite 3 Tesla, multiplanar, fat-suppressed imaging presented herein represents a unique and informative visualization of the anatomic features and pathologic appearance of the process.

Ocular Manifestations of Prematurity

The premature eye evolves through several stages prior to normal term birth. When a child enters the world prematurely, the ocular structures are still in this evolutionary stage that would normally be occurring in-utero. The immature development can be seen in the ocular adnexal structures, the anterior segment, lens, and posterior segment. Some of the most severe potential ocular outcomes from premature birth are Retinopathy of Prematurity (ROP) or serious ocular infection.