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Amblyopia and strabismus decreased over the last decade among young adults in Israel
e32 Questions remain about the clinical utility/practicality/generalizability of this methodology, both in pediatric and adult glaucoma management. Purpose: To evaluate clinical indications for home rebound tonometry in childhood glaucoma; and to assess provider and patient/ parental attitudes towards this methodology. Methods: Ongoing prospective study of long-term parent-measured home-based Icare rebound tonometry (Icare, Finland Oy) in pediatric glaucoma (Icare Lending Library Project, ILLP). Ongoing prospective survey of physician and parental attitudes towards home tonometry using a secure, webbased application. Results: Enrolled to date in ILLP: 21 patients (13 female), mean age 12.1 years (11 months-31years), mean home tonometry duration 5.9 months. Glaucoma diagnoses (by patient) include: primary congenital (7 [33%]), post-cataract removal (8 [38%]), Sturge-Weber (2 [9.5%]), and other (4 [19%]). Clinical indications ($1/patient) for home tonometry in ILLP include capturing/monitoring: (1) suspected IOP peaks/ fluctuations (81%), (2) postoperative IOP (38%), and (3) IOP postmedication changes (14%). ILLP monitoring prompted/validated glaucoma-related surgery in 8 (38%). Survey of 100 ophthalmologists managing pediatric glaucoma revealed: (1) 40% response rate to date; (2) 92% use Icare; (3) 8.3% lend Icare for home tonometry; (4) biggest barrier to home tonometry is tonometer cost (85%); (5) biggest benefit is improved ability to monitor IOP fluctuations(44%); (6) most (81%) believe home monitoring will improve pediatric glaucoma management; and (7) 47% estimate 16%-30% of pediatric glaucoma patients would benefit from home tonometry. Discussion/Conclusions: Home tonometry (short- and longer-term) can aid management of selected cases of pediatric glaucoma, both pre- and postoperatively. Pediatric glaucoma specialists are gaining experience with both rebound tonometry and home tonometry, but instrument cost represents a barrier. 103 Amblyopia and strabismus decreased over the last decade among young adults in Israel. Eedy Mezer, Yinon Shapira, Yossy Machluf, Michael Mimouni, Yoram Chaiter Introduction: To estimate the prevalence of amblyopia, strabismus and amblyopia risk factors (ARFs) among young adults in Israel, and analyze secular trends. Methods: We designed a cross-sectional study and after excluding 288 due to decreased vision secondary to ocular organic causes we included 107,608 subjects aged 17.4 0.6 years born 19711994. We examined trends in the severity of amblyopia as well as anisometropia, strabismus in unilateral amblyopia, and isoametropia in bilateral amblyopia. Results: The prevalence of amblyopia over a period of 23 years of birth declined by 33%. This decline can be attributable to a drop in unilateral amblyopia from 1% to 0.6%, while bilateral amblyopia prevalence remained the same (0.2%). The decline in unilateral amblyopia was noted in mild and moderate amblyopia, but not in severe amblyopia. Strabismic amblyopia was detected in 6.7-9.5% of the entire young adults population in the different birth years, without a significant secular trend Strabismus or anisometropia were detected in 6%-12% and 11%-20% of subjects with unilateral amblyopia, respectively, without significant secular trends. Isoametropia occurred in 46%-59% of bilateral amblyopia cases without a significant secular trend. Prevalence of strabismus in the study population decreased by 60% in the recent birth years. In subjects with strabismus, the prevalence of mild amblyopia increased, while moderate and severe amblyopia remained stable.
Volume 21 Number 4 / August 2017 Discussion: The prevalence of unilateral mild and moderate amblyopia as well as of strabismus decreased significantly over close to a generation.The prevalence of strabismic, bilateral and unilateral severe amblyopia remained stable. Conclusions: The continued improvements in the national screening program of children similar to other countries and the improved utility of treatment for amblyopia due to an increase in the number of fellowship trained pediatric ophthalmologists may have contributed to these trends. This data may provide support for similar programs elsewhere. 104 Pediatric ophthalmoplegia and ptosis associated with epidermolysis bullosa simplex-muscular dystrophy and PLEC mutations. W. Walker Motley, Wejdan Al-Thawabieh, Anne W. Lucky, Brenda Wong Introduction: A previous case report described ptosis and ophthalmoplegia in a single patient with epidermolysis bullosa simplexmuscular dystrophy (EBS-MD). The aim of the present study was to evaluate ocular issues in a larger series of patients with this rare autosomal recessive systemic disease. Methods: Medical records of patients with EBS-MD seen at one institution from 2000 to 2015 were retrospectively reviewed. Patients with genetic mutations in PLEC and documented eye exams were included. Results: Six patients with EBS-MD and PLEC mutations were identified. Bilateral ptosis was observed in 3 patients and bilateral ophthalmoplegia was present in 2 patients. Exotropia and blepharitis were present in 1 patient each. No patients had ocular surfaces defects or other significant eye issues. Discussion: This is the largest case series study to report eye issues of patients with EBS-MD. Bilateral ptosis and ophthalmoplegia appear to be common in this disease and were observed as early as age 6. These ocular issues do not appear to be associated with other subtypes of epidermolysis bullosa. Ptosis and ophthalmoplegia occurred after the onset of skin blistering but preceded systemic signs of muscular dystrophy. Conclusions: Ptosis and ophthalmoplegia may be helpful signs in the early diagnosis of muscular dystrophy in patients with epidermolysis bullosa simplex and should prompt evaluation for PLEC mutations. 105 No more scope, scar, or tears: non-endoscopic endonasal dacryocystorhinostomy in children. Eric K. Newcott, Damien Yeo, Thomas Betts, Daniel Morris, Patrick Watts Introduction: Congenital nasolacrimal duct obstruction that fails to resolve spontaneously by 12 months of age is treated with probing, intubation, or balloon dilation of the nasolacrimal duct. When probing fails, external approach, or in some cases endoscopic-endonasal, dacryocystorhinostomy may be offered. In this study we report a case series of children undergoing non-endoscopic-endonasal (without an endoscope) dacryocystorhinostomy (ENDCR). Methods: Children undergoing an ENDCR for failed probing and intubation were identified from the surgical database and retrospectively reviewed. Data was collected on sex, laterality, age at surgery, previous surgical procedure, and postoperative outcomes. Results: There were 5 patients (4 male) who had a total of 6 ENDCR procedures. The mean age at time of ENDCR was 5.2 years. All patients required previous interventions: syringe and probe and/or probe and intubation. Mean postoperative removal of silicon tubes was 4.7 months. Total average postoperative follow-up: 6.7 months.
Journal of AAPOS
Volume 21 Number 4 / August 2017 Discussion: The prevalence of unilateral mild and moderate amblyopia as well as of strabismus decreased significantly over close to a generation.The prevalence of strabismic, bilateral and unilateral severe amblyopia remained stable. Conclusions: The continued improvements in the national screening program of children similar to other countries and the improved utility of treatment for amblyopia due to an increase in the number of fellowship trained pediatric ophthalmologists may have contributed to these trends. This data may provide support for similar programs elsewhere. 104 Pediatric ophthalmoplegia and ptosis associated with epidermolysis bullosa simplex-muscular dystrophy and PLEC mutations. W. Walker Motley, Wejdan Al-Thawabieh, Anne W. Lucky, Brenda Wong Introduction: A previous case report described ptosis and ophthalmoplegia in a single patient with epidermolysis bullosa simplexmuscular dystrophy (EBS-MD). The aim of the present study was to evaluate ocular issues in a larger series of patients with this rare autosomal recessive systemic disease. Methods: Medical records of patients with EBS-MD seen at one institution from 2000 to 2015 were retrospectively reviewed. Patients with genetic mutations in PLEC and documented eye exams were included. Results: Six patients with EBS-MD and PLEC mutations were identified. Bilateral ptosis was observed in 3 patients and bilateral ophthalmoplegia was present in 2 patients. Exotropia and blepharitis were present in 1 patient each. No patients had ocular surfaces defects or other significant eye issues. Discussion: This is the largest case series study to report eye issues of patients with EBS-MD. Bilateral ptosis and ophthalmoplegia appear to be common in this disease and were observed as early as age 6. These ocular issues do not appear to be associated with other subtypes of epidermolysis bullosa. Ptosis and ophthalmoplegia occurred after the onset of skin blistering but preceded systemic signs of muscular dystrophy. Conclusions: Ptosis and ophthalmoplegia may be helpful signs in the early diagnosis of muscular dystrophy in patients with epidermolysis bullosa simplex and should prompt evaluation for PLEC mutations. 105 No more scope, scar, or tears: non-endoscopic endonasal dacryocystorhinostomy in children. Eric K. Newcott, Damien Yeo, Thomas Betts, Daniel Morris, Patrick Watts Introduction: Congenital nasolacrimal duct obstruction that fails to resolve spontaneously by 12 months of age is treated with probing, intubation, or balloon dilation of the nasolacrimal duct. When probing fails, external approach, or in some cases endoscopic-endonasal, dacryocystorhinostomy may be offered. In this study we report a case series of children undergoing non-endoscopic-endonasal (without an endoscope) dacryocystorhinostomy (ENDCR). Methods: Children undergoing an ENDCR for failed probing and intubation were identified from the surgical database and retrospectively reviewed. Data was collected on sex, laterality, age at surgery, previous surgical procedure, and postoperative outcomes. Results: There were 5 patients (4 male) who had a total of 6 ENDCR procedures. The mean age at time of ENDCR was 5.2 years. All patients required previous interventions: syringe and probe and/or probe and intubation. Mean postoperative removal of silicon tubes was 4.7 months. Total average postoperative follow-up: 6.7 months.
Journal of AAPOS