Megan E. Collins

Chloral Hydrate Administered by a Dedicated Sedation Service Can Be Used Safely and Effectively for Pediatric Ophthalmic Examination

PURPOSEnTo determine safety and efficacy of oral chloral hydrate sedation (CHS) for outpatient pediatric ophthalmic procedures.nnnDESIGNnProspective, interventional case series.nnnMETHODSnSetting: King Khaled Eye Specialist Hospital.nnnSUBJECTSnChildren aged 1xa0month to 5 years undergoing CHS for ocular imaging/evaluation.nnnPROCEDURESnDetails on chloral hydrate dose administered, sedation achieved, vital signs, and adverse events were recorded.nnnOUTCOME MEASURESnPrimary outcome was percentage of patients with a sedation level ≥ 4 at 45xa0minutes post chloral hydrate administration. Secondary outcomes were time from sedation to discharge and adverse events, including changes in vital signs following chloral hydrate administration.nnnRESULTSnA total of 324 children were recruited with a mean age of 2.2 (SD: 1.3) years and mean weight of 10.9 (SD: 3.3) kg. Adequate sedation was obtained with a mean chloral hydrate first dose of 77.4 (SD: 14.7) mg/kg in 306 (94.4%) patients, with an additional 6 patients (1.9%) achieving adequate sedation with a second dose (overall adequate sedation: 96.3%). Mean reductions in heart rate, respiratory rate, and oxygen (O2) saturation from pre-sedation to 25xa0minutes post-sedation were 11.7 (SD: 14.3) beats per minute, 1.2 (SD: 2.4) breaths per minute, and 0.81% (SD: 1.2%), respectively (Pxa0<xa0.001 for all). In multivariable regression, odds of remaining sedated 45xa0minutes after chloral hydrate administration were 2.53 times higher for American Society of Anesthesiologists (ASA) class II or III patients than for ASA class I (95% confidence interval [CI]: 1.11-5.78, Pxa0= .03), 1.03 times higher per mg increase in initial dose of chloral hydrate (95% CI: 1.01-1.06, Pxa0= .006), and 2.70 times higher per unit increase in number of planned procedures (95% CI: 1.63-4.47, P < .001). Three patients developed minor adverse events: 2 cases of O2 desaturation and 1 paradoxical reaction, none requiring significant intervention. Patients were discharged a median of 90xa0minutes after chloral hydrate administration.nnnCONCLUSIONnChloral hydrate administered by a dedicated sedation service, as in this prospective assessment, can be used safely and effectively for outpatient pediatric ophthalmic procedures.

Comparison of self-refraction using a simple device, USee, with manifest refraction in adults

Background The USee device is a new self-refraction tool that allows users to determine their own refractive error. We evaluated the ease of use of USee in adults, and compared the refractive error correction achieved with USee to clinical manifest refraction. Methods Sixty adults with uncorrected visual acuity <20/30 and spherical equivalent between –6.00 and +6.00 diopters completed manifest refraction and self-refraction. Results Subjects had a mean (±SD) age of 53.1 (±18.6) years, and 27 (45.0%) were male. Mean (±SD) spherical equivalent measured by manifest refraction and self-refraction were –0.90 D (±2.53) and –1.22 diopters (±2.42), respectively (p = 0.001). The proportion of subjects correctable to ≥20/30 in the better eye was higher for manifest refraction (96.7%) than self-refraction (83.3%, p = 0.005). Failure to achieve visual acuity ≥20/30 with self-refraction in right eyes was associated with increasing age (per year, OR: 1.05; 95% CI: 1.00–1.10) and higher cylindrical power (per diopter, OR: 7.26; 95% CI: 1.88–28.1). Subjectively, 95% of participants thought USee was easy to use, 85% thought self-refraction correction was better than being uncorrected, 57% thought vision with self-refraction correction was similar to their current corrective lenses, and 53% rated their vision as “very good” or “excellent” with self-refraction. Conclusion Self-refraction provides acceptable refractive error correction in the majority of adults. Programs targeting resource-poor settings could potentially use USee to provide easy on-site refractive error correction.

In Plain Sight: Reading Outcomes of Providing Eyeglasses to Disadvantaged Children

ABSTRACT Many disadvantaged students with refractive errors, such as myopia (nearsightedness) and hyperopia (farsightedness), do not have eyeglasses, and their reduced vision may impact reading proficiency. Providing eyeglasses may increase their reading success. This article reports the findings of a study in Baltimore City in which disadvantaged second and third graders were assessed for vision problems. Of 317 students, 182 were given glasses. Those who needed glasses were given two pairs, one for home and one for school, as well as replacements if glasses were lost or broken. School staff assisted in ensuring that students wore their glasses, storing them safely, and replacing glasses when necessary. Students who received glasses improved more on Woodcock reading measures than those who never needed glasses (ES = +0.16, p < .03). The study demonstrates the potential of providing eyeglasses to disadvantaged students who need them to improve their reading performance.

Effect of Chloral Hydrate Sedation on Intraocular Pressure in a Pediatric Population

PURPOSEnTo determine the effect of oral chloral hydrate (CH) sedation on intraocular pressure (IOP) in an outpatient pediatric population.nnnDESIGNnProspective, noncomparative case series.nnnMETHODSnChildren aged 1xa0month to 5 years undergoing CH sedation for ocular imaging/evaluation at a tertiary eye hospital were included. IOP was measured using an Icare tonometer prior to sedation (in some, not all), at 25xa0minutes after sedation, and then every 10xa0minutes until sedation completion. Change in IOP over time was assessed using mixed model linear regression to account for correlation of IOP readings.nnnRESULTSnA total of 112 children were enrolled, 50.9% were female, and mean age was 2.1 (standard deviation [SD]: 1.3) years. Of the total, 83 (74.1%) participants had IOP measurement attempted prior to sedation, with 64 having presedation IOP completed. Among those completing presedation IOP, 46.9% were asleep/calm, and the rest (53.1%) were slightly/more distressed (IOP did not differ by level of agitation). Those with and without presedation IOP available had similar demographics and health status (P > .05). Heart rate, respiratory rate, and oxygen saturation all declined after sedation (P < .001). The mean dose of CH administered was 80.9 (SD: 13.2) mg/kg, and sedation was deemed adequate in 97.3% after a single dose. Mean IOP among those with presedation IOP was 19.5xa0mm Hg and, although not significant, declined to 18.7xa0mm Hg at 25xa0minutes (Pxa0= .12). There was no trend toward further decline in IOP over time (P > .05).nnnCONCLUSIONSnCH sedation for outpatient pediatric ophthalmic procedures as administered in this prospective assessment had no impact on IOP.

Newer Understanding of Eye Issues in Craniofacial Malformations

Pediatric patients with craniofacial abnormalities face unique challenges requiring early intervention and longitudinal care for their ocular and systemic problems. Non-syndromic and syndromic craniosynostoses involve asymmetric development of the cranial vault and facial bones, which frequently leads to ophthalmic manifestations, including strabismus, refractive error, and visual field losses. In recent years, ophthalmologists, craniofacial surgeons, and pediatricians involved in caring for craniosynostosis patients have found that timely surgery and monitoring, using refined devices such as spectral-domain optical coherence tomography, can lead to improved quality of life and prognosis for these patients. We review relevant literature from the past 5xa0years describing and managing ocular symptoms of craniosynostosis.