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To characterize pediatric ophthalmology exposure, surgical experience, and mentorship in U.S. ophthalmology residency programs and to describe the timing of subspecialty commitment among pediatric ophthalmology fellowship alumni. This was a cross-sectional study of two anonymous surveys (July to October 2025). Survey 1 queried program directors and coordinators from U.S. ophthalmology residency programs regarding curriculum structure, pediatric ophthalmology exposure, and surgical volume, retinopathy of prematurity (ROP) training, and mentorship access. Survey 2 queried pediatric ophthalmology fellowship alumni from Wills Eye Hospital regarding training experiences and timing of subspecialty commitment. Ordinal responses were summarized using medians and interquartile ranges. Categorical ranges were analyzed using midpoint estimation but reported using original response categories. Associations were evaluated using descriptive statistics and nonparametric tests. Survey 1 had a 61.3% response rate (76/124), and Survey 2 had a 72.5% response rate (50/69). Most programs offered dedicated pediatric ophthalmology rotations (93.4%) and formal didactics (97.4%). Median pediatric ophthalmology exposure was 10.5 weeks. Primary surgical volume most commonly ranged from 11 to 20 cases. Programs with ≥3 pediatric ophthalmology faculty members more frequently reported excellent mentorship (84%) than programs with a single faculty member (50%). Availability of ROP training did not differ by geographic setting. Among alumni, 66% reported deciding during residency, including 44% by post-graduate year-2. Programs with ≥3 faculty and 9 to 12 weeks of exposure more often reported strong mentorship. Despite widespread curricular availability, variation in mentorship capacity may contribute to recruitment gaps. Because most fellows decide during residency, structured exposure and longitudinal mentorship are modifiable factors that may support recruitment and workforce sustainability.
To evaluate the prevalence of amblyopia and/or strabismus in children with autism spectrum disorder (ASD) in tertiary referral centers across the United States and rates of surgical management of strabismus. A systematic analysis of pediatric patients diagnosed as having ASD was performed using the Sight Outcomes Research Collaborative (SOURCE) database. Prevalence, odds ratios, and the rate of surgical management for strabismus were determined compared to age-matched controls. Strabismus and/or amblyopia was present in 35% of patients with ASD and 29% of age-matched controls (odds ratio = 1.33, 95% CI = 1.254 to 1.415, P < .001). Exotropia was more common than esotropia in both the ASD and control groups. The mean age at first ophthalmologic evaluation was 5.2 years for both controls and patients with ASD and strabismus/amblyopia. However, among those without strabismus/amblyopia, patients with ASD were evaluated earlier (mean ± standard deviation [SD] = 6.7 ± 4.8 years) compared to controls (mean ± SD = 7.4 ± 5.8 years). Although the ASD population had a male predominance, females had higher rates of amblyopia and/or strabismus at 39% compared to males with ASD at 34%. In all age groups, children with ASD had significantly (P < .001) higher rates of amblyopia and/or strabismus when compared to controls. The analysis found children with ASD have a higher prevalence of strabismus and/or amblyopia, with an increasing rate of diagnosis over the past two decades. Findings support further research into both the underlying mechanisms of strabismus in neurodivergent children and overall trends in the diagnosis of ASD and concomitant ophthalmic disease.
To evaluate the binocular vision and fusion potentials in children diagnosed as having autism spectrum disorder (ASD), while also assessing visual acuity, refractive errors, and the prevalence of strabismus, in comparison with typically developing peers. This study included 57 children diagnosed as having ASD and 45 age-matched typically developing children as controls (control group). Comprehensive ophthalmologic examinations were performed in both groups, including best corrected visual acuity (BCVA), biomicroscopic evaluation of anterior and posterior segments, presence of strabismus, measurement of stereoacuity, fusional vergence amplitudes, near point of convergence, and refractive errors. Data and findings were comparatively evaluated between the two groups. The mean age was 12.10 ± 3.29 years (range: 7 to 18 years) in the ASD group and 10.91 ± 3.08 years (range: 7 to 18 years) in the control group, with no statistically significant difference between the groups (P = .080). A significantly higher prevalence of female participants was observed in the ASD group (P = .003). There was no significant difference in BCVA between the groups (P = .398). Strabismus was detected in 24.56% of the ASD group and 13.33% of the control group. Stereopsis of 480 sec/arc seconds and worse was observed in 47 (82.46%) patients in the ASD group and 4 (8.89%) patients in the control group, with a statistically significant reduction in stereopsis in the ASD group (P = .035). Emmetropia was present in 63.15% of the patients in the ASD group and 40% of the control group, whereas myopia was the most prevalent refractive error for both groups. Fusional amplitudes for convergence and divergence at near distance were found to be lower in the ASD group; however, no statistically significant differences were observed at distance fixation or in near point of convergence measurements. In children with ASD, stereoacuity and near fusion amplitudes were reduced and the near point of convergence increased. These findings are likely associated with cognitive impairments and attentional deficits characteristic of ASD, potentially rendering near vision tasks particularly challenging. Recognizing and addressing these visual function impairments may facilitate both visual and cognitive development in this patient population.
To characterize and quantify the distribution of industry payments by gender in pediatric ophthalmology. In this cross-sectional, retrospective study, the Open Payments Database was queried for industry payments to pediatric ophthalmologists in the United States from 2017 to 2023. Private research payments were compared to public research funding by the U.S. federal government. The Consumer Price Index Inflation Calculator was used to adjust for inflation. The Mann-Whitney U test was used to compare payments between groups. The primary outcomes were gender, temporal, and geographic trends in industry funding, adjusted for inflation. A total of 200 pediatric ophthalmologists received industry payments totaling $426,405.25 from 2017 to 2023. Despite representing 58.1% of the work-force, male pediatric ophthalmologists received 74.6% ($317,894.59) of total general payments. However, the median payment per ophthalmologist was $112.02 for men and $138.20 for women (P = .242). Only 24% of pediatric ophthalmologists received industry payments. The top 10 highest-paid pediatric ophthalmologists collectively received $348,801.66, representing 81.8% of the total sum. Kansas, Arizona, Missouri, Kentucky, and Colorado had the highest proportion of pediatric ophthalmologists receiving industry payments. Only three pediatric ophthalmologists (100% female) received industry research funding amounting to $7,843.09, compared to 186 investigators (33.9% female) receiving $279,545,982.00 in public funding over the study period. Both private industry payments and public research payments are limited and unevenly distributed in the field of pediatric ophthalmology. These findings add another layer of evidence to the systemic challenges faced by the subspeciality.
Myopia, particularly high myopia, is a significant risk factor for several ocular pathologies including cataract, glaucoma, and retinal detachment. Excessive axial elongation associated with high myopia can induce biomechanical stretching, increasing the risk of serious complications like posterior staphyloma and myopic maculopathy. Global meta-analyses estimate that approximately 10 million people were visually impaired due to myopic maculopathy in 2015, with 3 million being blind. Recent nationwide surveys in South Korea revealed a prevalence of 65.4% for myopia and 6.9% for high myopia in children and adolescents, highlighting the urgent need for effective management. Delaying the onset and slowing the progression of myopia during childhood and adolescence is crucial for reducing the potential lifetime risk of these complications. This consensus statement, prepared by the Korean Myopia Society for the Korean Association for Pediatric Ophthalmology and Strabismus (KAPOS), reviews the current evidence for myopia control interventions and provides management strategies applicable to the South Korean clinical setting. Key interventions covered include lifestyle modifications (outdoor time, near work adjustment), optical methods (myopia-control spectacle lenses, dual-focus soft contact lenses, orthokeratology), and pharmacologic treatment (low-concentration atropine), as well as combination therapies. The statement also addresses patient selection, treatment outcome evaluation using spherical equivalent and axial length changes, and the crucial aspects related to treatment cessation and the rebound effect.
To assess the associations of specific ocular conditions on parental concerns for child development and quality of life in multiethnic preschool-age children. We conducted a cross-sectional analysis using parental interview and comprehensive eye examination data from the Multi-Ethnic Pediatric Eye Disease Study, a population-based study of children aged 6-72 months. Parental concerns were assessed using the Parents' Evaluation of Developmental Status Screening Instrument; quality of life, via the Pediatric Quality of Life Inventory. Multivariable regression analyses were performed. Data were available for 8,265 children. Parental concerns were reported for 16.0%. Strabismus was associated with parental concerns even after adjusting for covariates (P < 0.001). Astigmatism was associated with parental concerns among children aged 36-72 months (Ptrend = 0.018). In this group, odds ratios for parental concerns were 1.33 (95% CI, 1.02-1.72) for astigmatism of 1.50 to <3.0 D, 1.39 (0.85-2.25) for ≥3.0 D, and 1.65 (1.12-2.41) for strabismus. Hyperopia, myopia, anisometropia, or amblyopia showed no association. Astigmatism of 3.0 D or greater and strabismus were also associated with a history of physician-diagnosed developmental delay (OR [95% CI] = 3.97 [1.53-10.28] and 6.58 [3.52-12.32], resp.) and with lower physical health/emotional function scores (2.3 ± 0.8 and 3.5 ± 1.3 points lower for astigmatism ≥3.0 D vs <1.5 D, and 2.0 ± 0.6 and 2.0 ± 0.9 points lower for strabismus vs no strabismus; all Ps ≤ 0.031). Both astigmatism and strabismus correlated with greater parental concerns about development and worse quality of life in preschoolers.
To investigate the effect of trainee involvement in strabismus surgery by comparing surgical outcomes of procedures performed solely by attending surgeons to those with trainee involvement. A retrospective review was performed of 110 patients with esotropia who received bilateral medial rectus recessions (BMR) and 105 patients with exotropia who received bilateral lateral rectus recessions (BLR). Trainee involvement varied from suturing muscle and scleral pass to performing the entire surgery. Success rate was defined as horizontal alignment of less than 10 prism diopters, measured 2 months postoperatively. Rates of reoperation, complications, and postoperative medication use were compared using chi-square tests, with a significance value of P < .05. This study was conducted at Rainbow Babies Children's Hospital at University Hospitals Medical Center in Cleveland, Ohio. Patients were included in the study if the proper surgery documentation was found in the electronic medical record, including primary surgeon, any secondary surgeons, and preoperative and postoperative horizontal alignment. A total of 110 patients with esotropia and 105 patients with exotropia were included in the study. Of the 215 procedures reviewed, 82 were performed solely by attending surgeons and 133 involved trainees. The success rate of attending surgeon-only procedures was 83%, versus 80.5% (P = .65) for trainee procedures. Of non-trainee cases, 34% of patients needed subsequent surgeries, compared to 22% of trainee-involved cases (P = .046). Intraoperative complications were found in only one attending surgeon-only procedure and one procedure involving residents (P = .729). The results showed no significant difference in rates of realignment, complications, and postoperative medication use of BMR and BLR procedures between attending surgeon-only cases and those involving trainees. An increased reoperation rate was seen in the non-trainee group, possibly explained by trainees operating on less complex cases. These data demonstrate that resident/fellow involvement with appropriate supervision is equally safe compared to cases performed by attending surgeons alone, thereby advocating for greater trainee participation in ophthalmic surgeries.
To better characterize the epidemiology of glaucoma following cataract surgery (GFCS) in an Australian population and to inform clinical decision-making in patients with GFCS. This was a single-center retrospective case-control study looking at the incidence, management, and outcomes of glaucoma in a cohort of eyes that underwent lensectomy surgeries for congenital cataract at the Queensland Children's Hospital between January 2014 and December 2020. Ninety-seven eyes underwent lensectomy for congenital cataract. GFCS was diagnosed in 24.7% of eyes, and mean age of diagnosis was 54.14 months. Surgical management was required in 53.6% of GFCS cases. Significant associations were found between age at lensectomy surgery and age at glaucoma diagnosis (r = 0.77, P < .001) and between requirement for glaucoma surgery and age at both lensectomy (P = .03), and glaucoma diagnosis (P = .01). At most recent review, median intraocular pressure (IOP) was 18 mmHg and median visual acuity was 0.8 logarithm of the minimum angle of resolution (logMAR) in patients with glaucoma and 0.7 logMAR in patients with glaucoma suspect. A significant correlation was noted between latest IOP and age at glaucoma diagnosis (r = 0.42, P = .03) and between most recent logMAR visual acuity and glaucoma diagnosis status (P < .01). There was also a statistically significant association between length of follow-up and glaucoma diagnosis (P = .02). These findings provide valuable long-term data on GFCS in the Australian pediatric population, aiding clinical decision-making and patient care.
Retinopathy of prematurity (ROP) is one of the leading cause of blindness in premature infants. A bibliometric analysis on intravitreal anti-vascular endothelial growth factor (VEGF) in ROP was conducted. A comprehensive search of the article on the Scopus database was conducted with the terms related to "anti-vascular endothelial growth factor and retinopathy of prematurity." Only original research and review articles published in the English language were considered. VOSviewer version 1.6.20 was used for the visualization and analysis of the data. Publication trend, productive countries, researchers' details, commonly cited documents, source and influential journals, and keyword occurrence were analyzed. A total of 329 studies were considered, of which 270 were original articles and 59 were review articles. The highest numbers of publications were seen in the year 2022. The United States, China, Turkey, India, and Taiwan were the top 5 countries that published research on the use of anti-VEGF in ROP. The most documents were published by Wei-Chi Wu (22) and Chi-Chun Lai (14), and Falavarjani et al's article had the most citations (737). A total of 2,504 keywords were identified. All keyword analysis revealed the occurrence of "retinopathy of prematurity" and "human" as a keyword was 290 and 286 times, respectively. Most articles and citations were found in Retina. The use of anti-VEGF in ROP is constantly evolving and bibliometric analysis highlights a research trend and influential authors and journals that have published significant work on it. This article can serve as a guide to conduct a literature review for future researchers.
Photoscreening devices are commonly used to identify children at risk for eye disease, although they often demonstrate low specificity as a trade-off for high sensitivity. A newly introduced photoscreening device that uses a newer mechanism, retinal birefringence scanning, purports to detect amblyopia and strabismus directly, and may theoretically increase specificity. To compare the diagnostic performance of 2 photoscreening devices, the Spot Vision Screener (Welch Allyn), hereafter referred to as a traditional autorefraction device, and the Blinq vision scanner (Rebion), hereafter referred to as a retinal birefringence scanner, for detecting amblyopia, strabismus, or visually significant refractive error (VSRE). This was a prospective, randomized, masked, diagnostic accuracy cohort study. The study included consecutive children 18 years or younger referred as a new patient to the University of California, San Francisco, pediatric ophthalmology clinic between January 2024 and February 2025 for suspected vision problems. Each participant underwent screening with the traditional autorefraction device and the retinal birefringence scanner in randomized testing order, followed by a comprehensive eye examination. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were calculated for each device relative to the clinical reference standard. Sensitivity, specificity, and AUROC of both screening devices to detect amblyopia, strabismus, or VSRE. Of 195 enrolled participants (median [IQR] age, 50 [25-66] months), 139 (mean [SD] age, 49.7 [35.6] months; 75 female [54.0%]) completed both photoscreening tests. The prevalence of amblyopia, strabismus, and VSRE was 15.1%, 32.4%, and 30.1%, respectively. The traditional autorefraction device demonstrated higher sensitivity than the retinal birefringence scanner for detecting amblyopia (29%; 95% CI, -2% to 50%; P = .03) and VSRE (41%; 95% CI, 17%-59%; P < .001), with no difference in sensitivity for detecting strabismus identified (-6%; 95% CI, -28% to 18%; P = .69). No differences in specificity were identified. Across all vision disorders, the AUROC for the retinal birefringence scanner was lower than that for the traditional autorefraction device, particularly for amblyopia (-0.13; 95% CI, -0.23 to -0.03; P = .01). In this single-site diagnostic accuracy study, the traditional autorefraction device demonstrated greater overall diagnostic sensitivity than the retinal birefringence scanner for detecting amblyopia and refractive errors, with no difference in specificity for all conditions. These findings suggest that the traditional autorefraction device may be more reliable for comprehensive pediatric vision screening.
To evaluate systemic hematological inflammatory markers in pediatric patients with newly diagnosed idiopathic intracranial hypertension (IIH) and to investigate their associations with optic nerve head involvement assessed by retinal nerve fiber layer (RNFL) thickness. This retrospective study included 33 pediatric patients with IIH and 32 age- and sex-matched controls. Complete blood count parameters were recorded at diagnosis. Derived inflammatory indices (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammatory response index [SIRI], and pan-immune-inflammation value [PIV]) were calculated. RNFL thickness was measured using optical coherence tomography, and associations with inflammatory markers, Frisén grade, and lumbar puncture opening pressure were analyzed. Neutrophil and immature granulocyte counts, as well as the SIRI and PIV, were significantly higher in the pediatric IIH group compared with the control group (all P < .05). Immature granulocyte count showed moderate and significant correlations with average and temporal RNFL thickness and Frisén grade (P ≤ .04). Neutrophil count correlated moderately with temporal RNFL and Frisén grade, whereas SIRI was weak and PIV was modestly associated with Frisén grade; PIV also correlated with temporal RNFL (P ≤ .04). Receiver operating characteristic analysis indicated that immature granulocyte count had the highest discriminative performance for pediatric IIH (area under the curve = 0.689). This study indicates that inflammatory markers, including immature neutrophil and granulocyte counts, as well as SIRI and PIV, may be elevated in pediatric IIH. Among these, immature granulocyte count showed the most consistent correlation with disease-related structural findings, suggesting its potential role as an inflammatory indicator in IIH. These results highlight possible links between systemic inflammatory parameters and IIH and related optic nerve involvement.
To characterize the features of open globe injuries (OGIs) and the visual outcomes of pediatric patients using a modified Pediatric Ocular Trauma Score (POTS). A retrospective chart review was conducted of pediatric patients presenting to a Level I Trauma Center with unilateral OGIs from 2015 to 2023. Demographic data, injury characteristics, clinical findings at presentation, surgical timing, and visual outcomes were analyzed. The POTS was calculated to assess its prognostic value. A total of 53 individuals were analyzed (mean age: 9.3 ± 5.3 years). Blunt trauma accounted for 69.8% of injuries, most of which occurred at home (54.7%). More than half (52.8%) were transferred from outside facilities, and surgical repair was performed within 48 hours in 60.4% of cases. Most injuries were zone I (83.0%). Uveal prolapse (71.7%) and traumatic cataract (39.6%) were frequently observed. At presentation, 5.7% had no light perception (NLP) and 35.8% had light perception/hand motion (LP/HM). Three-month follow-up best corrected visual acuity (BCVA) was available for 25 patients (47.2%); among these, 76% achieved a final BCVA of 0.1 or better. The POTS for all patients was 53.9 ± 19.9. For individuals with follow-up, mean POTS were correlated with final BCVA: LP/HM (47.5), CF (37.5), 0.1 to 0.5 (56.5), and 0.6 to 1.0 (70.0). This evaluation of pediatric OGIs found mainly zone I injuries causing LP/HM visual acuity. The incorporation of POTS highlights the potential for visual recovery in some patients, with 24% achieving 20/32 BCVA at 3 months of follow-up. These data support POTS as a prognostic tool for physicians managing OGIs in children.
To present safety and effectiveness data on a real-world retinopathy of prematurity (ROP) telemedicine screening model in Northern Ireland and to evaluate a novel virtual multidisciplinary team (MDT) approach to ROP decision-making. Data were collected on all ROP screens performed in Northern Ireland between May 1, 2023, and October 31, 2023. A total of 431 screens (N = 127 infants) were undertaken: 250 by imagers only, 40 by both imagers and ophthalmologists using binocular indirect ophthalmoscopy, and 141 by ophthalmologists only. A survey of MDT members (n = 17) assessed the perceived value of the virtual MDT model. Fifty-eight percent of screens were completed by ROP imagers, with 98.2% sensitivity in detecting any ROP, 100% sensitivity in detecting treatment-warranted ROP, and 100% specificity of determining absence of ROP. Ninety-eight percent of imaging screens were tolerated by infants. The MDT survey demonstrated favorable feedback, including how TeleROP-NI increases the likelihood of trainees undertaking ROP screening. This study confirms that the TeleROP-NI significantly reduced ophthalmologist workload and streamlined organizational barriers. Imaging of infants by nonclinicians is a safe and valuable practice, which allows an MDT approach to collective decision-making when treating patients in an area of medicine with serious clinical and medicolegal implications if disease is missed.
To compare the accuracy and performance of the ChatGPT-4 and ChatGPT-4 Plus (OpenAI) models in different languages in terms of questions about retinopathy of prematurity (ROP). Within the scope of the study, 15 questions about ROP were asked of both models. The questions were asked in Turkish and English, and the answers were evaluated by clinicians at five levels: "incorrect," "inadequate," "adequate," "correct," and "very correct." The reliability of the responses was analyzed using the intraclass correlation coefficient (ICC), and quality scores were compared using the t-test. According to the ICC analysis, the experts scoring the responses showed high agreement (95%). The difference between the response accuracy scores of both models (ChatGPT-4: P = .704 and ChatGPT-4 Plus: P = .999) and languages (ChatGPT-4: P = .704 and Chat-GPT-4 Plus: P = .999) was not statistically significant. The performance of the models in Turkish and English was found to have similar accuracy levels. In this study, ChatGPT-4 and Chat-GPT-4 Plus models accurately responded to ROP-related questions, and language differences did not affect performance. It was concluded that artificial intelligence-based models have the potential to overcome multilingualism and language barriers in health care settings.
To assess macular structure and function in retinopathy of prematurity (ROP). This was a prospective observational cohort study performed on children with laser-treated ROP (n = 32 eyes of 17 children, age 9.12 ± 2.60 years) and untreated ROP (n = 22 eyes of 12 children, age 10.40 ± 2.76 years), or premature children meeting ROP screening criteria but without ROP (immature retina) (n = 10 eyes of 6 children, age 9.00 ± 2.00 years), and full-term control patients (n = 42 eyes of 21 children, age 11.67 ± 2.87 years) comparing foveal function (logarithm of the minimum angle of resolution [logMAR] visual acuity, contrast sensitivity [CS]) and retinal morphology (central retinal thickness [CRT]). Linear mixed models were fit, followed by post-hoc comparisons using the Tukey-Kramer method. Visual acuity of laser-treated eyes (0.26 logMAR, 95% CI: 0.19 to 0.33) was significantly worse than that of untreated (0.06 logMAR, 95% CI: -0.02 to 0.165, P = .004) and control (-0.02 logMAR, 95% CI: -0.08 to 0.05, P < .001) eyes, but not different from immature retina eyes (0.11 logMAR, 95% CI: -0.01 to 0.22, P = .12). CS in treated eyes (1.56 log units, 95% CI: 1.48 to 1.63) was significantly worse than normal eyes (1.69 log units, 95% CI: 1.62 to 1.76, P = .05), but not different from either untreated (1.66 log units, 95% CI: 1.56 to 1.75, P = .35), or immature retina (1.65 log units, 95% CI: 1.51 to 1.78, P = .63) eyes. CRT of laser-treated eyes (330.98 µm, 95% CI: 318.18 to 343.79) was significantly greater than untreated (290.32 µm, 95% CI: 276.32 to 304.32, P < .001), immature (298.39 µm, 95% CI: 280.29 to 316.50, P = .02), and control (272.07 µm, 95% CI: 260.96 to 283.19, P < .001) eyes. In lasered-treated eyes there was a statistically significant negative correlation between logMAR and CRT (correlation = -0.39, 95% CI: -0.75 to -0.03, P = .03). Laser-treated eyes had abnormal macular structure and function compared to untreated eyes and normal control eyes. Further studies are needed to determine whether these abnormalities are attributable to increased severity of ROP in laser-treated patients, the effect of laser treatment, or both.
To determine the relationship between neighborhood-level socioeconomic status and requiring retinopathy of prematurity (ROP) treatment, using the Child Opportunity Index (COI). Electronic medical records for all patients who received ROP treatment from January 2010 to March 2024 at a tertiary care center were retrospectively reviewed. Controls were obtained by matching pediatric ophthalmology patients with the closest clinic visit date and no history of retinopathy of prematurity. Demographic and clinical information were collected. The patient's 5-digit ZIP code was used to determine the COI score and level. This study included 245 study patients and 735 matched controls, of which 110 (44.9%) and 329 (44.8%) were female, respectively. The study group had a significantly lower mean COI score (48 ± 29) compared to controls (56 ± 31, P < .001). Additionally, the study group had a higher percentage of Hispanic/Latino patients compared to the control group (51.8% vs 41.9%, respectively, P = .01). When stratified into type 1 (n = 195) and type 2 (n = 50) ROP, patients in the ROP groups continued to have lower mean COI scores (50 ± 29 and 44 ± 28, respectively) than the control group (56 ± 31; P = .01 and P = .006, respectively). The type 1 ROP group had a greater number of patients with Medi-Cal insurance compared to the control group (50.8% vs 46.4%, respectively, P = .04). Neighborhood socioeconomic status may play a critical role in the management of ROP. It is important to understand the synergistic relationship between social determinants of health when addressing health disparities and developing community-level interventions.
To evaluate the indications and long-term clinical outcomes of patients aged 18 years and younger who underwent keratoplasty surgery. In this study, the medical records of 55 eyes from 43 patients younger than 18 years who underwent keratoplasty and were registered in the Atatürk University Faculty of Medicine Research Hospital between March 2014 and May 2024 were retrospectively reviewed. Pre-operative evaluations included corrected distance visual acuity (CDVA) and anterior and posterior segment examinations. Postoperative complications, CDVA, and graft survival status were assessed. Only patients with a minimum follow-up period of 1 year were included in the study. The mean age of the patients was 14.1 years (range: 6 to 17 years), and the mean follow-up duration was 45 months (range: 12 to 124 months). Although 47 of the patients had penetrating keratoplasty (PKP), 8 had deep anterior lamellar keratoplasty (DALK). The most common indication was advanced keratoconus (60%). There was a statistically significant difference between preoperative and 1-year postoperative CDVA (P < .001). Improvement in visual acuity was observed in 81.81% of patients. The overall graft survival rate was 92.73%. This study shows that keratoconus is the most common indication for keratoplasty in pediatric cases. The study demonstrates a high rate of improvement in graft survival and visual acuity in pediatric cases.
Neurofibromatosis type 1 (NF1) is a multisystem genetic disorder caused by mutations in the NF1 gene and is commonly associated with ocular manifestations such as Lisch nodules, optic pathway gliomas, and choroidal abnormalities. Retinal structural changes are rarely reported. The authors describe a 3-year-old girl with NF1 who presented with decreased vision in her left eye. Ophthalmic imaging revealed an epiretinal fibrovascular membrane with vitreoretinal traction, cystic macular changes, and localized tractional retinal detachment (TRD) with a retinal tear. RetCam (Clarity Medical Sysetms, Inc) imaging and fluorescein angiography demonstrated vitreous opacities, fibrovascular adhesions, and vascular leakage. Systemic examination identified multiple café-au-lait spots and a plexiform neurofibroma confirmed by histopathology. The patient underwent pars plana vitrectomy with membrane removal and silicone oil tamponade, resulting in stable retinal attachment during follow-up. This case expands the spectrum of retinal manifestations associated with NF1 and highlights the importance of regular ophthalmic surveillance in affected children.
To evaluate caregivers' perspectives, challenges, and difficulties associated with at-home pupil dilation (AHPD) during the coronavirus disease 2019 (COVID-19) pandemic. In this retrospective questionnaire study, a pediatric ophthalmologist determined eligibility for AHPD in children younger than 6 years. Cyclopentolate 1% eye drops were prescribed. Age was recorded and divided into three age groups. Of 264 respondents, 73.9% (n = 195) completed AHPD, with half having undergone eye dilation in the past (53.7%, n = 116). The mean task difficulty across all groups was 3.36 ± 1.44 (range: 1 to 5). There were no statistical differences in difficulty between groups. Most caregivers stated that they would consider AHPD in the future (65.8%), and 63% reported that this practice saved time and was worth the cost and difficulty associated with AHPD. For more than 80% of responders, the cost was less than 20 United States Dollars, and 41.8% did not need to pay for their drops. The common reasons for not performing AHPD were difficulty (34.8%, n = 24), cost of the drops (30.4%, n = 21), and unclear instructions (8.7%, n = 6). AHPD can be a useful and cost-effective tool, can offer convenience, and may reduce anxiety in the office. The decision to use this approach should be individualized, considering the child's specific needs, parental comfort and ability, and the nature of the assessed ophthalmologic condition.
To evaluate vascular parameters using optical coherence tomography angiography (OCTA) in children and adolescents and to compare them with established normative data in adults, aiming to improve diagnostic accuracy and characterization of vascular pathologies in the pediatric population. A secondary objective was to assess the influence of ontogenesis on potential changes in vascular parameters. The authors selected 150 healthy children aged 6 to 15 years. Each child underwent wide-field OCTA focusing on the macula and temporal periphery (OCT Spectralis; Heidelberg Engineering). Vascular density was semi-automatically calculated using ImageJ software (National Institutes of Health). The OCTAVA macro was used simultaneously within ImageJ, specifically designed for processing OCTA images, to calculate the vascular density and the size of the foveal avascular zone. The collected data were compared across different age categories for both the central and peripheral parts of the scans and found no relationship between the child's age and vascular density. Similarly, there was no direct correlation between the size of the foveal avascular zone and the individual's age. In contrast, the width of the capillaries in the choriocapillaris showed changes during adolescence. The creation of a normative database is the first step toward understanding the anatomical relationships and pathological changes in the retina and choroid in patients treated for internal diseases and those with hereditary and degenerative diseases.