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Screening for “Plus Disease” in Retinopathy of Prematurity Using the NIDEK NM200D Camera
Journal of AAPOS Volume 10 Number 1 February 2006
Abstracts
77
Occlusion Properties of Contact Lenses for the Treatment of Amblyopia Megan E. McChesney, Martha P. Schatz, Randall S. Collins, Craig A. McCleur; Wilford Hall Medical Center, Lackland AFB, TX Introduction: A search of the literature has shown instances when contact lenses have been used in treatment of amblyopia. Contact lenses have been designed and marketed to give a cosmetically normal appearance to eyes that have been scarred or deformed. Purpose: The purpose of this study were to determine the efficacy occlusive contact lenses in limiting visual acuity in normal eyes and to determine if any peripheral fusion is available with different types of lenses. Participants: Ten healthy volunteers, ranging in age from 18 to 30, were recruited. Participants included had normal ocular health and a visual acuity correctable to 20/20 in the eye to be tested. Methods: This IRB-approved study used a total of 19 Ciba Vision DuraSoft 3 Prosthetic Soft Contact Lenses with varying iris prints, underprints, and opaque pupil sizes. Distance Snellen visual acuity, and presence of peripheral fusion with the Worth 4-dot at near, was measured with each subject wearing each contact lens style. Results: The results were collated and analyzed using a three-factor analysis of variance. Individual measured visual acuity ranged from 20/40 to 20/800 with the varying contact lenses in place. Four lens styles had a significant retention of peripheral fusion. Print type and opaque pupil size were found to be significant factors in determining visual acuity (P ⫽ 0.05). Conclusion: The results of this study suggest that visual penalization can be achieved to different levels, in some cases allowing retention of peripheral fusion, using contact lenses designed primarily for cosmetic purposes. This may have a role in certain cases of amblyopia therapy.
Infantile Orbital Cellulitis: Rising Incidence of Methicillin-Resistant Staphylococcus Aureus (MRSA) Infections Aaron M. Miller MD, Kimberly G. Yen MD, Michael T. Yen MD, Maria S. Castanes MPH, David K. Coats MD; Baylor College of Medicine and Texas Children’s Hospital, Houston, TX Introduction: Infants are particularly susceptible to infections such as orbital cellulitis, an infection of tissues posterior to the orbital septum that can lead to severe visual loss and intracranial complications. We performed a retrospective chart review to study the characteristics of orbital cellulitis in infants. Methods: A retrospective chart review was performed on all infants (⬍1 year of age) treated with a diagnosis of orbital cellulitis between December 2001 and September 2005. Results: A total of nine cases of orbital cellulitis in this age group were identified, with eight of nine having either a phlegmon or a subperiosteal abscess adjacent to the medial rectus muscle. The source of infection in all cases was suspected secondary to sinusitis. Surgical drainage was performed in four of nine, with two identifying methicillin-resistant Staphylococcus aureus (MRSA) as the inciting organism. Of the remaining five cases, MRSA was identified in blood cultures of two cases. Intravenous steroids were administered in five of nine cases, of which only one case subsequently required surgical drainage. One case was noted to have multi-organism bacteremia, resulting in cavernous sinus thrombosis, stroke, septic shock, and respiratory failure. Conclusions: Among infants with orbital cellulitis, there is a high frequency of infection with MRSA. Therefore, aggressive broad-spectrum antibiotics covering MRSA, such as vancomycin, should be promptly initiated when orbital cellulitis is suspected. Most patients in our series treated with steroids improved without surgical intervention.
Maximizing Therapeutic Effect with Progressive Addition Lenses for Accommodative Esotropia with a High AC/A Ratio Eedy Mezer MD, Chaim Stolovich MD, Aviva Meushar CO(I), Benjamin Miller MD, Ewy Meyer MD; Alberto Moscona Department of Ophthalmology/Rambam Health Care Campus, Haifa, Israel Introduction: The age-dependent efficacy of progressive-addition lenses (PAL) for accommodative esotropia with a high accommodative convergence/accommodation (AC/A) ratio have not been previously assessed. We evaluated PAL either as an initial treatment or after initiating treatment with bifocals at various ages. Methods: Thirty-four patients, who did not undergo eye muscle surgery, were included in this retrospective study. They were divided into three subgroups: 7 subjects received PAL treatment only (mean age 6 years, range 3 to 10); 15 children received bifocals (mean age 4 years) and then switched to PAL at the mean age of 8, range 4 to 11 (younger group). The older group consisted of 12 patients who started with bifocals (mean age 7 years) and at age 15 changed to PAL, range 11 to 18. Mean follow-up for the three subgroups was 57, 49, and 25 months accordingly. Results: The near deviation decreased in the PAL-only group from an average of 28 to 0 PD, in the younger group from 24 to 1 PD, and in the older group from 7 to 6 PD. Stereopsis measured at last follow-up was on average 55”, 57”, and 530” accordingly. Conclusions: PAL treatment for accommodative esotropia with a high AC/A ratio achieved good sensory results as well as a marked reduction in deviation. Significantly better results were obtained when PAL treatment was initiated at a younger age. PAL and bifocals seemed equally beneficial as the initial treatment of young children.
Screening for “Plus Disease” in Retinopathy of Prematurity Using the NIDEK NM200D Camera Monte D. Mills, Karen A. Karp, Keegan S. Sprinkle, Graham E. Quinn; Children’s Hospital of Philadelphia, Philadelphia, PA Introduction: Screening for retinopathy of prematurity (ROP) by imaging of the posterior retina may allow for remote assessment of the presence of ROP, could be performed by a non-ophthalmologist, and may expand access to screening and treatment in underserved populations. Plus disease is a hallmark of high-risk ROP and is an important indication for ablative treatment. We investigated the feasibility of using the NIDEK NM200D digital camera, with analysis of images by experienced observers, as a screening test for ROP. Methods: Ophthalmologists and non-ophthalmologists obtained images of infants undergoing routine ROP examinations. Two experienced ROP screeners, masked to the clinical findings, were asked to determine the presence of “plus disease” in images as described by the International Classification of ROP (ICROP). Results: Images were analyzed from 98 examinations on 37 infants. Only right eyes were analyzed. Ninety-five examinations had images with sufficient quality for both examiners to evaluate (97%). On five examinations, infants had clinically been diagnosed with “plus disease” by ICROP guidelines, and four of these were correctly identified in images by one or both masked screeners. Six examination images were classified as “plus disease” without clinical classification of “plus diseases” (false positives), and one with “plus disease” clinically was classified as “no plus” (false negative). Combined analysis from both examiners demonstrated sensitivity of 83% and specificity of 94%. Discussion: Photographic screening of high-risk infants for ROP with the NIDEK NM200D appears to be feasible and may allow a telemedicine approach to ROP screening in underserved areas.
Abstracts
77
Occlusion Properties of Contact Lenses for the Treatment of Amblyopia Megan E. McChesney, Martha P. Schatz, Randall S. Collins, Craig A. McCleur; Wilford Hall Medical Center, Lackland AFB, TX Introduction: A search of the literature has shown instances when contact lenses have been used in treatment of amblyopia. Contact lenses have been designed and marketed to give a cosmetically normal appearance to eyes that have been scarred or deformed. Purpose: The purpose of this study were to determine the efficacy occlusive contact lenses in limiting visual acuity in normal eyes and to determine if any peripheral fusion is available with different types of lenses. Participants: Ten healthy volunteers, ranging in age from 18 to 30, were recruited. Participants included had normal ocular health and a visual acuity correctable to 20/20 in the eye to be tested. Methods: This IRB-approved study used a total of 19 Ciba Vision DuraSoft 3 Prosthetic Soft Contact Lenses with varying iris prints, underprints, and opaque pupil sizes. Distance Snellen visual acuity, and presence of peripheral fusion with the Worth 4-dot at near, was measured with each subject wearing each contact lens style. Results: The results were collated and analyzed using a three-factor analysis of variance. Individual measured visual acuity ranged from 20/40 to 20/800 with the varying contact lenses in place. Four lens styles had a significant retention of peripheral fusion. Print type and opaque pupil size were found to be significant factors in determining visual acuity (P ⫽ 0.05). Conclusion: The results of this study suggest that visual penalization can be achieved to different levels, in some cases allowing retention of peripheral fusion, using contact lenses designed primarily for cosmetic purposes. This may have a role in certain cases of amblyopia therapy.
Infantile Orbital Cellulitis: Rising Incidence of Methicillin-Resistant Staphylococcus Aureus (MRSA) Infections Aaron M. Miller MD, Kimberly G. Yen MD, Michael T. Yen MD, Maria S. Castanes MPH, David K. Coats MD; Baylor College of Medicine and Texas Children’s Hospital, Houston, TX Introduction: Infants are particularly susceptible to infections such as orbital cellulitis, an infection of tissues posterior to the orbital septum that can lead to severe visual loss and intracranial complications. We performed a retrospective chart review to study the characteristics of orbital cellulitis in infants. Methods: A retrospective chart review was performed on all infants (⬍1 year of age) treated with a diagnosis of orbital cellulitis between December 2001 and September 2005. Results: A total of nine cases of orbital cellulitis in this age group were identified, with eight of nine having either a phlegmon or a subperiosteal abscess adjacent to the medial rectus muscle. The source of infection in all cases was suspected secondary to sinusitis. Surgical drainage was performed in four of nine, with two identifying methicillin-resistant Staphylococcus aureus (MRSA) as the inciting organism. Of the remaining five cases, MRSA was identified in blood cultures of two cases. Intravenous steroids were administered in five of nine cases, of which only one case subsequently required surgical drainage. One case was noted to have multi-organism bacteremia, resulting in cavernous sinus thrombosis, stroke, septic shock, and respiratory failure. Conclusions: Among infants with orbital cellulitis, there is a high frequency of infection with MRSA. Therefore, aggressive broad-spectrum antibiotics covering MRSA, such as vancomycin, should be promptly initiated when orbital cellulitis is suspected. Most patients in our series treated with steroids improved without surgical intervention.
Maximizing Therapeutic Effect with Progressive Addition Lenses for Accommodative Esotropia with a High AC/A Ratio Eedy Mezer MD, Chaim Stolovich MD, Aviva Meushar CO(I), Benjamin Miller MD, Ewy Meyer MD; Alberto Moscona Department of Ophthalmology/Rambam Health Care Campus, Haifa, Israel Introduction: The age-dependent efficacy of progressive-addition lenses (PAL) for accommodative esotropia with a high accommodative convergence/accommodation (AC/A) ratio have not been previously assessed. We evaluated PAL either as an initial treatment or after initiating treatment with bifocals at various ages. Methods: Thirty-four patients, who did not undergo eye muscle surgery, were included in this retrospective study. They were divided into three subgroups: 7 subjects received PAL treatment only (mean age 6 years, range 3 to 10); 15 children received bifocals (mean age 4 years) and then switched to PAL at the mean age of 8, range 4 to 11 (younger group). The older group consisted of 12 patients who started with bifocals (mean age 7 years) and at age 15 changed to PAL, range 11 to 18. Mean follow-up for the three subgroups was 57, 49, and 25 months accordingly. Results: The near deviation decreased in the PAL-only group from an average of 28 to 0 PD, in the younger group from 24 to 1 PD, and in the older group from 7 to 6 PD. Stereopsis measured at last follow-up was on average 55”, 57”, and 530” accordingly. Conclusions: PAL treatment for accommodative esotropia with a high AC/A ratio achieved good sensory results as well as a marked reduction in deviation. Significantly better results were obtained when PAL treatment was initiated at a younger age. PAL and bifocals seemed equally beneficial as the initial treatment of young children.
Screening for “Plus Disease” in Retinopathy of Prematurity Using the NIDEK NM200D Camera Monte D. Mills, Karen A. Karp, Keegan S. Sprinkle, Graham E. Quinn; Children’s Hospital of Philadelphia, Philadelphia, PA Introduction: Screening for retinopathy of prematurity (ROP) by imaging of the posterior retina may allow for remote assessment of the presence of ROP, could be performed by a non-ophthalmologist, and may expand access to screening and treatment in underserved populations. Plus disease is a hallmark of high-risk ROP and is an important indication for ablative treatment. We investigated the feasibility of using the NIDEK NM200D digital camera, with analysis of images by experienced observers, as a screening test for ROP. Methods: Ophthalmologists and non-ophthalmologists obtained images of infants undergoing routine ROP examinations. Two experienced ROP screeners, masked to the clinical findings, were asked to determine the presence of “plus disease” in images as described by the International Classification of ROP (ICROP). Results: Images were analyzed from 98 examinations on 37 infants. Only right eyes were analyzed. Ninety-five examinations had images with sufficient quality for both examiners to evaluate (97%). On five examinations, infants had clinically been diagnosed with “plus disease” by ICROP guidelines, and four of these were correctly identified in images by one or both masked screeners. Six examination images were classified as “plus disease” without clinical classification of “plus diseases” (false positives), and one with “plus disease” clinically was classified as “no plus” (false negative). Combined analysis from both examiners demonstrated sensitivity of 83% and specificity of 94%. Discussion: Photographic screening of high-risk infants for ROP with the NIDEK NM200D appears to be feasible and may allow a telemedicine approach to ROP screening in underserved areas.