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Age and racial variation in central corneal thickness of preschool and school-age children
90
Abstracts
opia, and a greater angle of deviation and hyperopic refractive error than either exotropia or hypertropia. Age and racial variation in central corneal thickness of preschool and school-age children. Kathryn M. Haider, Casey Mickler, Dana Oliver, Frank J. Moya, Oscar A. Cruz, Brad Davitt Introduction: The purpose of this study was to determine variations in central corneal thickness (CCT ) of African American and Caucasian children, of both preschool and school-age years. Secondary aims were to identify any correlations between CCT and gender, axial length, intraocular pressure, family history of glaucoma, or history of prematurity. Methods: Contact ultrasound was used to measure CCT and axial length in Caucasian (n ⫽ 76) and African American (n ⫽ 61) children between the ages of 7 months and 18 years. A questionnaire was completed by the parent/guardians including past medical and family history. Statistically significant associations and differences were assessed using independent t-test, ANOVA, and linear regression. All associations were defined as significant when ␣ ⬍ 0.05 (twotailed). Results: Mean CCT was thinner in African American children (535 ⫾ 35 m) when compared with Caucasian children (559 ⫾ 38 m, p ⬍ 0.001). Among African Americans, the corneal thickness in children age 10 years to 18 years was significantly higher than all other age groups ( p ⫽ 0.03). Similar findings were noted with Caucasian children ( p ⬍ 0.005). No association was found between CCT and gender, axial length, IOP, or family history of glaucoma. Children with a history of prematurity had thinner CCT (535 ⫾ 38 m) than full-term children (552 ⫾ 38 m; p ⫽ 0.009) prior to age 10. Conclusions: Children of both racial groups have a progressive increase in CCT after approximately age 10. African American children have a thinner CCT when compared with Caucasian children at all ages. Children born prematurely have thinner CCT than fullterm children. Predictive value of trial frames in the treatment of accommodative esotropia. Nathan Hamaker, Scott E. Olitsky, Denise Hug, Laura P. Smith, Merrill Stass-Isern, Timothy Hug Purpose: To determine if correction of hyperopia with trial frames fitted in the initial office visit of a child with esotropia can be used to predict the response to spectacle correction when evaluating a child for nonaccommodative esotropia. Methods: Patients presenting with a new-onset esotropia underwent a cycloplegic refraction and were then fitted with trial frames containing their full cycloplegic correction. Their alignment was evaluated while wearing the trail frames. The patients returned for another assessment after wearing their glasses for 1 month. A comparison was then made between the predicted and actual reduction in their esotropia provided by the glasses. Patients who continued to have an esotropia of at least 10⌬ were considered to have a nonaccommodative component to their strabismus. Results: Twenty-three patients 2 to 8 years of age completed the study. Trial frames were 71% (10/14) sensitive and 100% (9/9) specific for the presence of nonaccommodative esotropia. The positive-predictive value for nonaccommodative esotropia was 100% (10/10). The negative-predictive value for nonaccommodative esotropia was 69% (9/13). Conclusions: Trial frame analysis may be helpful in predicting which patients with acquired esotropia may require surgery. A positive trial frame test may
Volume 11 Number 1 February 2007
allow the strabismus surgeon to appropriately counsel families regarding the eventual need for strabismus surgery. Quantifying diplopia in adult strabismus. Sarah R. Hatt, David A. Leske, Jonathan M. Holmes Introduction: Quantitative assessment of diplopia is important in surgical planning and reporting strabismus outcomes. The Cervical Range of Motion (CROM) method has been recently proposed as a simple, inexpensive alternative to plotting a field of binocular single vision on the Goldmann. The aim of this study was to assess the advantages and disadvantages of these two techniques. We also compared each test to a patient symptom questionnaire as a measure of patient perception of severity. Methods: Seventy-six adult patients with diplopia were assessed using the CROM, Goldmann, and a brief symptom questionnaire (0-100 scales). Discrepancy between CROM and Goldmann was defined as a ⬎20 point difference. In cases of discrepancy, the medical record was reviewed independently by two clinicians to determine the most likely reason. Diplopia scores were compared with the questionnaire using intraclass correlation coefficients (ICC). Results: Forty-nine (64%) had comparable scores (within 20 points) on CROM and Goldmann. Of the 27 showing a ⬎20-point discrepancy, 17 (63%) scored higher (worse diplopia) on the Goldmann. The most frequent reason for higher Goldmann scores was poor ability to fuse the white light on a white background (n ⫽ 10). Lower scores on the Goldmann were most often due to a deviation present for distance only (n ⫽ 6). Questionnaire scores showed better agreement with the CROM (ICC ⫽ 0.77) than the Goldmann (ICC ⫽ 0.53). Conclusions: By using real world targets in free space, at distance and near, the CROM method appears to be a more realistic representation of a patient’s diplopia than plotting a diplopia field on the Goldmann. Endophthalmitis following strabismus surgery. Krista A. Heidar, David T. Wheeler Introduction: To estimate the incidence of endophthalmitis following strabismus surgery and describe the characteristics and visual outcomes of these cases. Methods: All U.S. ophthalmologists who were 2006 AAPOS members were contacted and asked to participate in an online survey. Results: Of 897 invitations, 139 survey responses (15.4%) were received, representing 396,131 cases over 1972 years of practice. Sixteen surgeons (11.4%) reported 17 cases of endophthalmitis for an estimated incidence of 0.00429% (4.29 per 10,000 procedures). These patients presented between 2 and 10 days following surgery. Treatment consisted of vitrectomy and intravitreal antibiotics in 12, vitreous biopsy and intravitreal antibiotics in 3, sub-Tenon’s antibiotic injection in 2 cases. Culture results revealed Streptococcus in seven, Staphylococcus in four, Hemophilus in one, and unknown or not done in five cases. Visual outcomes were better than 20/40 in six, 20/80 in one, light perception or worse in seven, and unknown or unable to test due to age in three cases. No surgeon reported scleral perforation during surgery, although a perforation site was noted on subsequent retinal examination in two cases. Discussion: Endophthalmitis following strabismus surgery is a rare complication. Scleral perforation may contribute but was not noted in most cases. The visual outcomes vary from 20/20 to no light perception and probably are related to virulence of bacteria and timing of intervention, among other factors. Conclusions: Endophthalmitis is a rare but serious com-
Journal of AAPOS
Abstracts
opia, and a greater angle of deviation and hyperopic refractive error than either exotropia or hypertropia. Age and racial variation in central corneal thickness of preschool and school-age children. Kathryn M. Haider, Casey Mickler, Dana Oliver, Frank J. Moya, Oscar A. Cruz, Brad Davitt Introduction: The purpose of this study was to determine variations in central corneal thickness (CCT ) of African American and Caucasian children, of both preschool and school-age years. Secondary aims were to identify any correlations between CCT and gender, axial length, intraocular pressure, family history of glaucoma, or history of prematurity. Methods: Contact ultrasound was used to measure CCT and axial length in Caucasian (n ⫽ 76) and African American (n ⫽ 61) children between the ages of 7 months and 18 years. A questionnaire was completed by the parent/guardians including past medical and family history. Statistically significant associations and differences were assessed using independent t-test, ANOVA, and linear regression. All associations were defined as significant when ␣ ⬍ 0.05 (twotailed). Results: Mean CCT was thinner in African American children (535 ⫾ 35 m) when compared with Caucasian children (559 ⫾ 38 m, p ⬍ 0.001). Among African Americans, the corneal thickness in children age 10 years to 18 years was significantly higher than all other age groups ( p ⫽ 0.03). Similar findings were noted with Caucasian children ( p ⬍ 0.005). No association was found between CCT and gender, axial length, IOP, or family history of glaucoma. Children with a history of prematurity had thinner CCT (535 ⫾ 38 m) than full-term children (552 ⫾ 38 m; p ⫽ 0.009) prior to age 10. Conclusions: Children of both racial groups have a progressive increase in CCT after approximately age 10. African American children have a thinner CCT when compared with Caucasian children at all ages. Children born prematurely have thinner CCT than fullterm children. Predictive value of trial frames in the treatment of accommodative esotropia. Nathan Hamaker, Scott E. Olitsky, Denise Hug, Laura P. Smith, Merrill Stass-Isern, Timothy Hug Purpose: To determine if correction of hyperopia with trial frames fitted in the initial office visit of a child with esotropia can be used to predict the response to spectacle correction when evaluating a child for nonaccommodative esotropia. Methods: Patients presenting with a new-onset esotropia underwent a cycloplegic refraction and were then fitted with trial frames containing their full cycloplegic correction. Their alignment was evaluated while wearing the trail frames. The patients returned for another assessment after wearing their glasses for 1 month. A comparison was then made between the predicted and actual reduction in their esotropia provided by the glasses. Patients who continued to have an esotropia of at least 10⌬ were considered to have a nonaccommodative component to their strabismus. Results: Twenty-three patients 2 to 8 years of age completed the study. Trial frames were 71% (10/14) sensitive and 100% (9/9) specific for the presence of nonaccommodative esotropia. The positive-predictive value for nonaccommodative esotropia was 100% (10/10). The negative-predictive value for nonaccommodative esotropia was 69% (9/13). Conclusions: Trial frame analysis may be helpful in predicting which patients with acquired esotropia may require surgery. A positive trial frame test may
Volume 11 Number 1 February 2007
allow the strabismus surgeon to appropriately counsel families regarding the eventual need for strabismus surgery. Quantifying diplopia in adult strabismus. Sarah R. Hatt, David A. Leske, Jonathan M. Holmes Introduction: Quantitative assessment of diplopia is important in surgical planning and reporting strabismus outcomes. The Cervical Range of Motion (CROM) method has been recently proposed as a simple, inexpensive alternative to plotting a field of binocular single vision on the Goldmann. The aim of this study was to assess the advantages and disadvantages of these two techniques. We also compared each test to a patient symptom questionnaire as a measure of patient perception of severity. Methods: Seventy-six adult patients with diplopia were assessed using the CROM, Goldmann, and a brief symptom questionnaire (0-100 scales). Discrepancy between CROM and Goldmann was defined as a ⬎20 point difference. In cases of discrepancy, the medical record was reviewed independently by two clinicians to determine the most likely reason. Diplopia scores were compared with the questionnaire using intraclass correlation coefficients (ICC). Results: Forty-nine (64%) had comparable scores (within 20 points) on CROM and Goldmann. Of the 27 showing a ⬎20-point discrepancy, 17 (63%) scored higher (worse diplopia) on the Goldmann. The most frequent reason for higher Goldmann scores was poor ability to fuse the white light on a white background (n ⫽ 10). Lower scores on the Goldmann were most often due to a deviation present for distance only (n ⫽ 6). Questionnaire scores showed better agreement with the CROM (ICC ⫽ 0.77) than the Goldmann (ICC ⫽ 0.53). Conclusions: By using real world targets in free space, at distance and near, the CROM method appears to be a more realistic representation of a patient’s diplopia than plotting a diplopia field on the Goldmann. Endophthalmitis following strabismus surgery. Krista A. Heidar, David T. Wheeler Introduction: To estimate the incidence of endophthalmitis following strabismus surgery and describe the characteristics and visual outcomes of these cases. Methods: All U.S. ophthalmologists who were 2006 AAPOS members were contacted and asked to participate in an online survey. Results: Of 897 invitations, 139 survey responses (15.4%) were received, representing 396,131 cases over 1972 years of practice. Sixteen surgeons (11.4%) reported 17 cases of endophthalmitis for an estimated incidence of 0.00429% (4.29 per 10,000 procedures). These patients presented between 2 and 10 days following surgery. Treatment consisted of vitrectomy and intravitreal antibiotics in 12, vitreous biopsy and intravitreal antibiotics in 3, sub-Tenon’s antibiotic injection in 2 cases. Culture results revealed Streptococcus in seven, Staphylococcus in four, Hemophilus in one, and unknown or not done in five cases. Visual outcomes were better than 20/40 in six, 20/80 in one, light perception or worse in seven, and unknown or unable to test due to age in three cases. No surgeon reported scleral perforation during surgery, although a perforation site was noted on subsequent retinal examination in two cases. Discussion: Endophthalmitis following strabismus surgery is a rare complication. Scleral perforation may contribute but was not noted in most cases. The visual outcomes vary from 20/20 to no light perception and probably are related to virulence of bacteria and timing of intervention, among other factors. Conclusions: Endophthalmitis is a rare but serious com-
Journal of AAPOS