Baseline characteristics of the Infant Aphakia Treatment Study Population: how well can they predict recognition visual acuity at 4.5 years?

Volume 19 Number 4 / August 2015 058 Baseline characteristics of the Infant Aphakia Treatment Study Population: how well can they predict recognition visual acuity at 4.5 years? E. Eugenie Hartmann, Michael J. Lynn, Scott R. Lambert Introduction: The intensive protocol for treatment of monocular congenital/infantile cataracts, which includes surgery, optical correction and years of occlusion therapy, is a significant financial and emotional investment for families and clinicians. The purpose of our present analysis was to identify patient baseline characteristics that predict recognition acuity at 4.5 years of age in the Infant Aphakia Treatment Study. Methods: A total of 114 infants were enrolled in the Infant Aphakia Treatment Study. All participants underwent cataract surgery between 1 and 7 months of age. Recognition acuity was assessed monocularly using the Amblyopia Treatment Study HOTV testing protocol at 4.5 years of age. Participant baseline characteristics were specified and the relationship between these factors and visual acuity at 4.5 years was evaluated using linear regression. Results: Characteristics evaluated included (1) characteristics of the treated eye; (2) physiological characteristics of infant and (3) sociological characteristics of family. Only age at surgery and presence of private insurance were individually associated with visual acuity. The multivariate analysis demonstrated that only the availability of private insurance was statistically significant and accounted for 12% of the variance. Discussion: This analysis concurs with previous studies that early surgery is important for good visual outcomes in patients with unilateral congenital cataracts. Previously we found an association between private insurance and adherence to patching, which may in part explain the present findings. Conclusions: However, the multivariate analysis accounts for only 12% of the variance, suggesting that predicting visual outcome for these patients is complicated at best, requiring more information than is available at baseline. 059 Long-term success in surgically and nonsurgically managed intermittent exotropia. Sarah R. Hatt, David A. Leske, Jonathan M. Holmes Introduction: Previous authors have reported high recurrence rates following surgery for childhood intermittent exotropia (IXT). In addition it is possible that some cases may resolve without surgery. We compared long-term success in surgically and non-surgically managed patients. Methods: Children with IXT and 5 years follow-up (minimum 3 years) from their first surgery were retrospectively identified. A cohort of comparable non-surgical patients was identified by matching each surgical patient for age at onset and age at the 5-year examination. At the exam closest to 5 years follow-up, success was defined as no manifest tropia on examination or by history, no new monofixation (stereoacuity subnormal for age) and no additional surgery. Success rates were compared between surgical and nonsurgical groups. Results: 33 children with IXT had surgical correction and 5 years postoperative follow-up, and were matched with 33 non-surgical patients (total follow-up 7.2  2.6 years vs 6.8  2.3 years). There were no significant differences between groups for baseline angle of deviation (P . 0.4). The success rate at 5 years was 30% in the surgical group and 12% in the nonsurgical group (P 5 0.1; difference 18%, 95% CI 1% to 37%). Discussion: After an average of 7 years follow-up, the majority of both surgical and nonsurgical patients continue to demonstrate a

Journal of AAPOS

e25 constant or intermittent manifest deviation. Only a small proportion of patients in both groups met our definition for success. Conclusions: In childhood intermittent exotropia, long-term success is difficult to achieve with surgical intervention, and some patients managed non-surgically will spontaneously resolve. 060 Pediatric spectral domain optical coherence tomography (SD-OCT) normative data for novel optic nerve parameters using the Heidelberg Spectralis. Gena Heidary, Frank Weng, Linda R. Dagi Introduction: SD-OCT normative data for optic nerve volume (ONV) and the peripapillary papillomacular bundle thickness have not been reported, yet these parameters are relevant for neuroophthalmic disease. The purpose of this study was to determine pediatric norms for these parameters and expand the dataset for typical OCT parameters. Methods: Single center, cross-sectional, prospective study of subjects aged 4-18 years. Using the Heidelberg Spectralis NSite software, ONV and peripapillary retinal nerve fiber layer (rNFL) thickness measurements were obtained. Inclusion criteria were normal acuity and dilated examination, birth $37 weeks, and refractive error between 4 D and + 4 D. Results: A total of 150 patients (58% female) including 31% African American, 41% Hispanic, and 21% Caucasian or Asian patients participated. Five equal-sized age bins were represented. Mean total ONV (with standard deviation) was 2.48  0.32 mm3. Average peripapillary rNFL thickness measurements were as follows: global thickness, 104.65  8.53 mm; peripapillary papillomacular bundle, 57.03  8.61 mm; nasal superior, 120.91  20.89 mm; nasal, 75.31  14.32 mm; nasal inferior, 120.66  22.96 mm; temporal inferior, 150.13  17.46 mm; temporal, 73.93  10.74 mm; and temporal superior, 148.43  30.54. Discussion: This normative database using the Heidelberg Spectralis is from the largest reported cohort of pediatric patients with substantive distribution across age and diverse ethnicities. We introduce pediatric norms for ONV and peripapillary papillomacular bundle thickness. Conclusions: Normative data for SD-OCT ONV and rNFL thickness measurements are now available to enhance our ability to manage pediatric neuro-ophthalmic disease. 061 Treatment of symptomatic convergence insufficiency (CI) with home-based computerized vergence system (CVS) therapy in children age 5 to 18 years. Pamela A. Huston, Darren L. Hoover Introduction: To evaluate the efficacy of a home-based computer orthoptic program (CVS) for symptomatic CI in children. Methods: A retrospective review of 185 subjects age 5-18 years who were prescribed 9 or 15 minutes of daily convergence exercises with the CVS program, 5 days per week for the initial 6 weeks. All patients reported at least 1 of the following: asthenopia with reading, diplopia at near. All subjects had a near exophoria at least 4D greater than at distance, and access to a computer with a CD/DVD player. Objective measures were near point of convergence (NPC) and near convergence amplitude (NCA) at baseline, intermediate, and final examinations. Subjective measures were presence or absence of diplopia and asthenopia with reading at baseline and final examinations. Results: A total of 74 subjects (40%) reported diplopia and all subjects reported asthenopia. Baseline measurements were a mean NPC of 6 cm and NCA of 20D. 89% of subjects achieved good or excellent compliance during the initial 6 weeks of therapy. CVS therapy duration averaged 18 weeks. Therapy was discontinued