Rae R. Fellows

Strabismus Surgery and Its Effect Upon Infant Development in Congenital Esotropia

Parents of children with congenital esotropia have reported improvements in their childs fine motor development and visual functions after surgery. Eighteen patients with congenital esotropia were tested pre- and post-operatively with The Bayley Scales of Infant Development to determine if these observations were valid. A three-point increase in the Bayley raw score of strabismus patients was noted after operation that is significant at the 0.01 level, as compared to the performance of age-matched controls. An improvement in fine motor skills was observed in 35% of the children, and visually directed reaching and grasping increased in 41%. Item #87 on the Bayley, which requires the child to recognize depressions without monocular clues, appears to be related specifically to depth perception. On this item, the study population showed the greatest improvement.

Prevalence and course of strabismus through age 6 years in participants of the Early Treatment for Retinopathy of Prematurity randomized trial

PURPOSE To present strabismus data for children who participated in the Early Treatment for Retinopathy of Prematurity (ETROP) randomized trial. METHODS The prevalence of strabismus, categorized as present or absent, was tabulated for all children with history of high-risk prethreshold retinopathy of prematurity (ROP) who participated in the ETROP randomized trial and were examined at 9 months to 6 years of age. Relationships among strabismus and demographic measures, eye characteristics, and neurodevelopmental factors were analyzed. RESULTS Among the 342 children evaluated at 6 years, the prevalence of strabismus was 42.2%. Even with favorable acuity scores in both eyes, the prevalence of strabismus was 25.4%, and with favorable structural outcomes in both eyes the prevalence of strabismus was 34.2%. Of children categorized as visually impaired as the result of either ocular or cerebral causes, 80% were strabismic at the 6-year examination. Of 103 study participants who were strabismic at 9 months, 77 (74.8%) remained so at 6 years. Most strabismus was constant at both the 9-month (62.7%) and the 6-year examination (72.3%). After multiple logistic regression analysis, risk factors for strabismus were abnormal fixation behavior in one or both eyes (P < 0.001), history of amblyopia (P < 0.003), unfavorable structural outcome in one or both eyes (P = 0.025), and history of anisometropia (P = 0.04). Strabismus surgery was performed for 53 children. By 6 years, the cumulative prevalence of strabismus was 59.4%. CONCLUSIONS Most children with a history of high-risk prethreshold ROP develop strabismus at some time during the first 6 years of life.

Screening for Vision Problems, Including Usher's Syndrome, Among Hearing Impaired Students

The purpose of this article is to emphasize the importance of screening for vision problems and for Ushers Syndrome among hearing impaired students, and to provide an outline of a vision screening program in central Ohio. The screening program utilizes a dilated ophthalmological exam and an electro-retinogram (ERG), recorded with EEG skin electrodes, for the detection of vision problems and particularly Ushers Syndrome. The program also involves an interagency network of school, health care and support personnel to meet the needs and follow-up care of students identified with vision problems. The initial vision screening of 210 hearing impaired students, from residential and public school programs, revealed that 44 percent have significant vision problems, and that approximately 1 to 2 percent have Ushers Syndrome.

Clinical assessment of visual function in the young child: a prospective study of binocular vision

Binocular vision was evaluated in 12 children with infantile esotropia before and after corrective surgery. Stereopsis was measured by the eye movement/global stereopsis method. Also in a subgroup of four infants, binocular and monocular pattern VERs were recorded to evaluate binocular summation. Results revealed 50% of the infantile esotropia children who had corrective surgery before one year of life developed gross stereopsis two weeks following surgery. In addition, of four infants who showed no evidence of stereopsis, 50% showed some degree of binocular summation following surgery. The importance of prospective studies of binocular vision in infantile esotropia is discussed within the context of new tests that can be used to objectively assess binocularity in the preverbal child.

A comparison of cryotherapy versus diode laser retinopexy in 100 consecutive infants treated for threshold retinopathy of prematurity.

PURPOSE The purpose of this paper is to present a series of patients who were treated for threshold retinopathy of prematurity with either cryotherapy or diode laser. Complications and unfavorable outcomes during the first year after treatment will be compared for the two procedures. METHODS The clinical courses of a consecutive series of 100 infants (192 eyes) were reviewed. All infants had their threshold status confirmed by a second examiner. Infants were treated with cryotherapy through 1993 and with diode laser thereafter. One hundred two eyes of 54 patients were treated with cryotherapy. Ninety eyes of 46 patients were treated with laser retinopexy. Two of the patients who were treated with laser (4 eyes) did not survive to the 3-month follow-up visit, and their results are not included here. The two groups of infants were comparable in their birth weight, adjusted gestational age at treatment, and severity of disease as determined by zone and sectors of stage 3 retinopathy of prematurity. RESULTS Unfavorable outcome (total retinal detachment) was seen in 25.4% of eyes treated with cryotherapy (26 of 102), as compared with 15% of eyes treated with laser (13 of 86). Two cataracts were seen in our patients: one patient 22 weeks after cryotherapy, and the other 7 months after diode laser. CONCLUSIONS No statistically significant difference was found in the rate of retinal detachments in the two groups (X2 = 3.05; P = .08).

Retinopathy of prematurity in infants weighing less than 500 grams at birth enrolled in the early treatment for retinopathy of prematurity study

PURPOSE To describe patient characteristics, classification, and onset of prethreshold retinopathy of prematurity (ROP), and ocular findings at 6 months corrected age in infants with birth weights <500 g who were enrolled in the Early Treatment for Retinopathy of Prematurity (ETROP) Study. DESIGN Multicenter randomized clinical trial. PARTICIPANTS Sixty-three infants with birth weights <500 g who developed ROP and were enrolled in the ETROP Study. METHODS Infants <1251 g at birth were logged at 26 study centers from October 1, 2000, to September 30, 2002, and underwent examinations for ROP. Infants who developed ROP and whose parents/legal guardians consented were enrolled in the ETROP Study. Infants who developed high-risk prethreshold ROP were randomized; 1 eye was treated early with peripheral retinal ablation and the other eye was managed conventionally, or, in asymmetric cases, the high-risk eye was randomized to early peripheral retinal ablation or conventional management. All eyes reaching prethreshold ROP were examined when infants reached 6 months corrected age. MAIN OUTCOME MEASURES Retinopathy of prematurity incidence, characteristics, and ocular findings among participants. RESULTS Thirty-four infants reached prethreshold or worse severity in 1 or both eyes. Retinopathy of prematurity was located in zone I in 43.3% of all prethreshold eyes, and plus disease was present in 46.7%. Median postmenstrual age for diagnosis of all prethreshold ROP was 36.1 weeks, but earlier (35.1 weeks) for eyes that developed high-risk prethreshold ROP. In the 27 surviving infants with prethreshold ROP, ophthalmic examination at 6 months corrected age showed a normal posterior pole in 22 (81.5%), a favorable structural outcome with posterior pole abnormalities in 4 (14.8%), and an unfavorable structural outcome (stage 4B) in 1 (3.7%). One infant developed amblyopia, 4 infants developed nystagmus, 4 infants developed strabismus, and 8 infants developed myopia >-5.00 diopters. CONCLUSIONS This is the first report on characteristics of prethreshold ROP in infants with birth weights <500 g. These infants are at high risk for developing prethreshold ROP, although many initially achieve a favorable structural outcome. They are at risk of developing strabismus, nystagmus, high myopia, and abnormal retinal structure and should therefore receive continued long-term follow-up. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Glaucoma in the Early Treatment for Retinopathy of Prematurity (ETROP) study

PURPOSE To report the clinical characteristics of infants with severe retinopathy of prematurity (ROP) and glaucoma-based on review of the Early Treatment for Retinopathy of Prematurity (ETROP) study. METHODS All infants randomized in the ETROP trial were included. Each infant developed high-risk prethreshold ROP in at least one eye. Infants were examined until 6 years postnatal age. The following data were collected: corneal clarity, depth of the anterior chamber, status of the optic nerve and cup/disk ratio, retinal structure, and visual acuity. The diagnosis of glaucoma was based on the investigators best clinical judgment. All infants diagnosed with glaucoma were included in the study. RESULTS A total of 12 of 718 eyes (1.67%) were diagnosed with glaucoma. Of these, 5 were first reported as having glaucoma at 9 months, 2 at 2 years, 1 each at 3 and 4 years, and 3 at 5 years. The anterior segment was shallow in 7 eyes. Three eyes had normal retinal structure, 1 had macular dragging, and 8 had retinal detachments involving the fovea (stage 4B or worse). At the 6-year follow-up examination only one eye with glaucoma had measurable vision. CONCLUSIONS Although earlier treatment of significant ROP has resulted in better retinal structure and visual acuity outcomes, nearly 2% of the eyes with high-risk prethreshold ROP developed glaucoma at some point during the first 6 years of life.

β-Blocking and Racial Variation in the Severity of Retinopathy of Prematurity

AMD and this variant in other ethnic groups, and thus the possibility for systemic errors in other groups, remains largely unexplored. As our results highlight, predictive genetic testing for complex diseases faces many challenges. Until we fully understand how a particular genetic variant acts on disease susceptibility, great care must be taken when translating genetic tests from one race-ethnicity to another.

Correlation of recognition visual acuity with posterior retinal structure in advanced retinopathy of prematurity

OBJECTIVE To compare Early Treatment Diabetic Retinopathy Study visual acuity outcome with retinal structural outcome at the 6-year follow-up examination of infants randomized in the Early Treatment for Retinopathy of Prematurity study. METHODS We compared the results in 606 eyes of subjects in whom both functional (visual acuity) and retinal structural assessments were obtained at age 6 years. Visual acuity assessments were performed by masked testers, and retinal examinations were performed by certified ophthalmologists. MAIN OUTCOME MEASURES Visual acuity and retinal structure at age 6 years. RESULTS Concordant outcomes occurred in 462 eyes (76.2%): 402 eyes had favorable functional and structural outcomes and 60 eyes had unfavorable functional and structural outcomes. Discordant outcomes occurred in 92 eyes (15.2%): 86 eyes had unfavorable functional and favorable structural outcomes and 6 eyes had favorable functional and unfavorable structural outcomes. Of the 86 eyes with unfavorable functional and favorable structural outcomes, 43 had optic atrophy (23 eyes) and/or retinal abnormalities that were less severe than those considered to be unfavorable (32 eyes). In 52 eyes (8.6%), retinal structure could not be assessed or the visual acuity was untestable. CONCLUSION Posterior pole appearance correlates well with visual acuity in 6-year-old infants with a history of advanced retinopathy of prematurity. APPLICATION TO CLINICAL PRACTICE When the retinal structure is normal but visual acuity is poor in infants with a history of severe retinopathy of prematurity, other diagnoses such as optic atrophy and cortical visual impairment could at least partially account for the discrepancy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00027222.

Retinopathy of Prematurity in Discordant Twins

Discordant twins may be at increased risk for retinopathy of prematurity (ROP) because of factors related to their unequal growth. Discordancy is defined as a difference of 15% or more in the birth weights of the two infants. We examined the data in 26 sets of discordant twins from six NICUs, including birthweight, gestational age, sex, and highest grade of ROP. Thirty-eight percent (10) of the lower birthweight infants had higher grades of ROP than their twin. Twenty-three percent (6) of the heavier birthweight twins had higher grades of ROP than their smaller siblings. Three infants reached threshold, and five were prethreshold. In every case, their twin siblings had mild or no ROP. Thirty-eight percent of the twins (10) had the same ROP outcome.