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077: Opaque intraocular lens for intractable diplopia—UK survey
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Volume 13 Number 1 / February 2009
abnormality were excluded. The presence or absence of glaucoma, defined as a minimum of persistently elevated IOP $ 28 mm Hg with confirmation of the diagnosis by an attending ophthalmologist, was assessed. Results: The surgical procedure in all cases was lens aspiration, posterior capsulotomy, and anterior vitrectomy with anterior smallincision techniques. Of 210 eyes (121 patients), 55 eyes (26.2%) [31 patients (25.6%)] developed aphakic glaucoma. Relative risk for later aphakic glaucoma reached a nadir at 3-4 months of age (0.22 [95% confidence interval 0.05-0.96]). Other ages had greater relative risks (from 0.81 to 3.17) with overlapping 95% CIs. Discussion: Overlapping 95% confidence intervals of relative risk limited the ability to determine age of highest risk in our cohort. The age of surgery at lowest risk in our cohort was 3–4 months of age. Conclusions: Although there was an apparent nadir of risk for surgery at 3-4 months of age, we do not recommend delaying congenital cataract surgery longer than 4 weeks of life because of amblyopia issues.
held SD-OCT in the location of the retinal hemorrhages. Furthermore when scanning from the attached hyaloid to the detached hyaloid, at the transition zone, in all cases there was evidence of a traumatic retinoschisis and possible disinsertion of the internal limiting membrane. Discussion: The presence of a posterior vitreous detachment in the location of the hemorrhages was recently described by Sturm et al using low-resolution OCT. The use of the high resolution hand-held SD-OCT confirmed this finding and the presence of a retinoschisis at the junctions of the attached and detached hyaloid, provides insight into the mechanism of these findings in SBS. The images demonstrate that trauma-induced vitreoretinal traction likely results in retinoschisis and disturbance of the blood vessels with subsequent hemorrhages. Conclusions: The handheld SD-OCT allows high-resolution imaging of the vitreoretinal interface and retina in infants with SBS and has provided insight in to the mechanism of retinal hemorrhages and retinoschisis in infants with this condition.
077 Opaque intraocular lens for intractable diplopia—UK survey. Thomas Kwok, Patrick Watts Purpose: To assess the practice of the use of an opaque intraocular lens (IOL) for intractable diplopia in the UK. Methods: A total of 892 consultant ophthalmologists in practice were sent a questionnaire requesting information on the treatment of intractable diplopia with an opaque IOL. Respondents were asked whether they would consider using an opaque IOL for intractable diplopia. Information was gathered on the numbers of lenses implanted, the type of lens used and whether the lens was implanted inside or outside the capsular bag. In addition, we asked for the causes of intractable diplopia, the success in eliminating diplopia, the use of postoperative pilocarpine and whether postoperative surveillance was part of the follow-up protocol. Results: Of the 481 (54%) completed questionnaires received, 72% would consider implanting an opaque IOL. A total of 48 surgeons had implanted 1 or more lenses. Strabismus, nerve palsies and previous retinal detachment surgery with diplopia were the main indications. Pseudophakic lenses were implanted by 38 surgeons in the bag, 2 in the sulcus, whereas 6 surgeons used iris-supported or anterior chamber angle phakic lenses. The use of postoperative pilocarpine was reported by 9 surgeons and 6 surgeons used regular ultrasound fundal surveillance. Patients were reported to be completely asymptomatic at discharge by 31 surgeons, with 15 surgeons reporting patients who were still symptomatic postoperatively. Only 1 intraoperative complication was reported. Conclusions: An opaque IOL is a safe method for treating intractable diplopia. This survey confirms that its practice is widely accepted in the UK.
079 Ohio amblyope registry. Lawrence E. Leguire The Ohio Amblyope Registry (OAR) is the first statewide registry in the United States for amblyopic children and their families. The OAR is part of the Save Our Sight Fund for children, funded by a check-off box on Ohio license plate renewal forms. Children's Hospitals throughout the state, including Akron, Dayton, Cincinnati, Columbus, and Cleveland (Cole Eye Institute, Rainbow Babies and Children's) participate in the program. Ophthalmologists and optometrists throughout the state of Ohio also participate in the OAR. The OAR provides treatment supplies, written literature, case management services and a web site (www.OhioAmblyopeRegistry.com) for children with amblyopia and their families. The purpose of the presentation will be to promote the use of the OAR and encourage others to replicate the amblyope registry in other states. The registration of thousands of amblyopic patients as well as the participation of hundreds of eye doctors throughout the state have obvious implications for research as well as clinical trials for children with amblyopia. The legislative work, initiation and ongoing experiences with such a state wide registry will be discussed. The Ohio Amblyope Registry is funded by the Ohio Department of Health Bureau of Child and Family Services Save Our Sight Program.
078 Use of the spectral domain handheld OCT in the evaluation of shaken-baby syndrome. Thomas C. Lee, Rajeev H. Muni Purpose: The nonaccidental trauma associated with shaken-baby syndrome (SBS) has been associated with retinal hemorrhages at all 3 layers and retinoschisis. The purpose of this study was to document the hand-held spectral domain ocular coherence tomography (SD-OCT) (Bioptigen) findings in shaken-baby syndrome. Methods: Three consecutive patients with SBS underwent complete eye examinations, fundus photography with the Retcam (Clarity Medical Systems), and the imaging with the hand-held SD-OCT. Results: All 3 patients had retinal findings consistent with SBS. All patients had evidence of posterior vitreous detachment on hand-
080 Vision screening in Georgia. Phoebe D. Lenhart, Marla Shainberg, Jenny Pomeroy, Laurie Irby, Amy K. Hutchinson Purpose: To present the results of three years of prekindergarten vision screenings performed by Prevent Blindness Georgia (PBGA). Strengths and limitations of the current program are identified. Methods: On-site 3-part screening performed by trained personnel consists of observation, a LEA Symbols visual acuity test, and the Random Dot E stereopsis test. Completion of the 20/40 line with each eye (and no 2 line difference between eyes) is required to pass the test. Children who do not pass are retested. Repeat failure prompts referral. A result letter is generated for each child screened. A diagnosis report form is included for the eye doctor to return to PBGA. Referred children are followed. Results: A total of 29,048 children were screened in 2007-2008 with a referral rate of 5.98% (1736). The percentage of children who completed follow-up was 50% (874/1736). Of these, 77.23% (675/ 874) received a diagnosis of amblyopia, refractive error, muscle imbalance, or other. Data for 2005-2007 were also obtained. Discussion: Prevent Blindness Georgia screens and tracks outcomes for a large number of preschool children in Georgia each year.
Journal of AAPOS
Volume 13 Number 1 / February 2009
abnormality were excluded. The presence or absence of glaucoma, defined as a minimum of persistently elevated IOP $ 28 mm Hg with confirmation of the diagnosis by an attending ophthalmologist, was assessed. Results: The surgical procedure in all cases was lens aspiration, posterior capsulotomy, and anterior vitrectomy with anterior smallincision techniques. Of 210 eyes (121 patients), 55 eyes (26.2%) [31 patients (25.6%)] developed aphakic glaucoma. Relative risk for later aphakic glaucoma reached a nadir at 3-4 months of age (0.22 [95% confidence interval 0.05-0.96]). Other ages had greater relative risks (from 0.81 to 3.17) with overlapping 95% CIs. Discussion: Overlapping 95% confidence intervals of relative risk limited the ability to determine age of highest risk in our cohort. The age of surgery at lowest risk in our cohort was 3–4 months of age. Conclusions: Although there was an apparent nadir of risk for surgery at 3-4 months of age, we do not recommend delaying congenital cataract surgery longer than 4 weeks of life because of amblyopia issues.
held SD-OCT in the location of the retinal hemorrhages. Furthermore when scanning from the attached hyaloid to the detached hyaloid, at the transition zone, in all cases there was evidence of a traumatic retinoschisis and possible disinsertion of the internal limiting membrane. Discussion: The presence of a posterior vitreous detachment in the location of the hemorrhages was recently described by Sturm et al using low-resolution OCT. The use of the high resolution hand-held SD-OCT confirmed this finding and the presence of a retinoschisis at the junctions of the attached and detached hyaloid, provides insight into the mechanism of these findings in SBS. The images demonstrate that trauma-induced vitreoretinal traction likely results in retinoschisis and disturbance of the blood vessels with subsequent hemorrhages. Conclusions: The handheld SD-OCT allows high-resolution imaging of the vitreoretinal interface and retina in infants with SBS and has provided insight in to the mechanism of retinal hemorrhages and retinoschisis in infants with this condition.
077 Opaque intraocular lens for intractable diplopia—UK survey. Thomas Kwok, Patrick Watts Purpose: To assess the practice of the use of an opaque intraocular lens (IOL) for intractable diplopia in the UK. Methods: A total of 892 consultant ophthalmologists in practice were sent a questionnaire requesting information on the treatment of intractable diplopia with an opaque IOL. Respondents were asked whether they would consider using an opaque IOL for intractable diplopia. Information was gathered on the numbers of lenses implanted, the type of lens used and whether the lens was implanted inside or outside the capsular bag. In addition, we asked for the causes of intractable diplopia, the success in eliminating diplopia, the use of postoperative pilocarpine and whether postoperative surveillance was part of the follow-up protocol. Results: Of the 481 (54%) completed questionnaires received, 72% would consider implanting an opaque IOL. A total of 48 surgeons had implanted 1 or more lenses. Strabismus, nerve palsies and previous retinal detachment surgery with diplopia were the main indications. Pseudophakic lenses were implanted by 38 surgeons in the bag, 2 in the sulcus, whereas 6 surgeons used iris-supported or anterior chamber angle phakic lenses. The use of postoperative pilocarpine was reported by 9 surgeons and 6 surgeons used regular ultrasound fundal surveillance. Patients were reported to be completely asymptomatic at discharge by 31 surgeons, with 15 surgeons reporting patients who were still symptomatic postoperatively. Only 1 intraoperative complication was reported. Conclusions: An opaque IOL is a safe method for treating intractable diplopia. This survey confirms that its practice is widely accepted in the UK.
079 Ohio amblyope registry. Lawrence E. Leguire The Ohio Amblyope Registry (OAR) is the first statewide registry in the United States for amblyopic children and their families. The OAR is part of the Save Our Sight Fund for children, funded by a check-off box on Ohio license plate renewal forms. Children's Hospitals throughout the state, including Akron, Dayton, Cincinnati, Columbus, and Cleveland (Cole Eye Institute, Rainbow Babies and Children's) participate in the program. Ophthalmologists and optometrists throughout the state of Ohio also participate in the OAR. The OAR provides treatment supplies, written literature, case management services and a web site (www.OhioAmblyopeRegistry.com) for children with amblyopia and their families. The purpose of the presentation will be to promote the use of the OAR and encourage others to replicate the amblyope registry in other states. The registration of thousands of amblyopic patients as well as the participation of hundreds of eye doctors throughout the state have obvious implications for research as well as clinical trials for children with amblyopia. The legislative work, initiation and ongoing experiences with such a state wide registry will be discussed. The Ohio Amblyope Registry is funded by the Ohio Department of Health Bureau of Child and Family Services Save Our Sight Program.
078 Use of the spectral domain handheld OCT in the evaluation of shaken-baby syndrome. Thomas C. Lee, Rajeev H. Muni Purpose: The nonaccidental trauma associated with shaken-baby syndrome (SBS) has been associated with retinal hemorrhages at all 3 layers and retinoschisis. The purpose of this study was to document the hand-held spectral domain ocular coherence tomography (SD-OCT) (Bioptigen) findings in shaken-baby syndrome. Methods: Three consecutive patients with SBS underwent complete eye examinations, fundus photography with the Retcam (Clarity Medical Systems), and the imaging with the hand-held SD-OCT. Results: All 3 patients had retinal findings consistent with SBS. All patients had evidence of posterior vitreous detachment on hand-
080 Vision screening in Georgia. Phoebe D. Lenhart, Marla Shainberg, Jenny Pomeroy, Laurie Irby, Amy K. Hutchinson Purpose: To present the results of three years of prekindergarten vision screenings performed by Prevent Blindness Georgia (PBGA). Strengths and limitations of the current program are identified. Methods: On-site 3-part screening performed by trained personnel consists of observation, a LEA Symbols visual acuity test, and the Random Dot E stereopsis test. Completion of the 20/40 line with each eye (and no 2 line difference between eyes) is required to pass the test. Children who do not pass are retested. Repeat failure prompts referral. A result letter is generated for each child screened. A diagnosis report form is included for the eye doctor to return to PBGA. Referred children are followed. Results: A total of 29,048 children were screened in 2007-2008 with a referral rate of 5.98% (1736). The percentage of children who completed follow-up was 50% (874/1736). Of these, 77.23% (675/ 874) received a diagnosis of amblyopia, refractive error, muscle imbalance, or other. Data for 2005-2007 were also obtained. Discussion: Prevent Blindness Georgia screens and tracks outcomes for a large number of preschool children in Georgia each year.
Journal of AAPOS