Diplopia after orbital trauma: predicting need for surgical treatment

Volume 21 Number 4 / August 2017 sensitivity of 97.5%(95% CI, 96.3%-98.4%) and a specificity of 45.1% (43.6%-46.6%) for detecting severe ROP. It did not detect 23 (2.4%) infants with severe ROP. CO-ROP would have reduced infants receiving exams by 29%. Discussion: The CO-ROP model demonstrated high but not 100% sensitivity for severe ROP. The model requires all 3 criteria to be met in order to signal a need for examinations, but some infants with BW, GA, or WG-28 above the thresholds developed severe ROP. Conclusions: The CO-ROP model is less sensitive and specific when applied to a larger and more diverse population of neonates and needs to be revised before considering implementation into clinical practice. 056 Incidence and early course of retinopathy of prematurity: findings from the G-ROP study. Graham E. Quinn, Gil Binenbaum, Edward F. Bell, Pamela Donohue, David Morrison, Lauren A. Tomlinson, Gui-shuang Ying Introduction: We determined the incidence, onset, and early course of retinopathy of prematurity (ROP) for infants examined from 20062012 in the Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study. Methods: Retrospective cohort study of infants undergoing serial ROP examinations at 30 hospitals in the US and Canada. Outcomes included most severe ROP in either eye, classified as no ROP, mild ROP, type 2 ROP, or type 1 ROP (per Early Treatment for ROP criteria); onset in postmenstrual age (PMA) for zone I and stage of ROP, plus disease, and treatment. Results: Mean BW  SD of the 7,483 infants was 1099  359 g, GA 28  3 weeks. A total of 3,224 infants (43.1%) developed ROP, of whom 459 (6.1%) developed type 1 and 472 (6.3%) type 2 ROP. A total of 514 (6.9%) were treated in one or both eyes. Only 147 (2%) infants had zone I disease. Mean PMA at diagnosis of stage 1 was 34.8  2.9 weeks; stage 2, 35.4  2.7; stage 3, 36.7  2.8; and type 1, 36.5  2.6 (range, 30-45). The mean PMA at type 1 was similar among infants with GA #26, 26-30, or $31 weeks (36.1, 38.7, 37.5, resp.); 98.1% of type 1 or 2 ROP occurred in infants with BW of \1251 g. Discussion: This is the largest report to date of detailed ROP data on infants meeting current screening guidelines. Conclusions: More than 40% develop some stage of ROP with most ROP regressing without treatment; however, \12.5% developed severe ROP, occurring largely in \1251g BW infants. 057 Diplopia after orbital trauma: predicting need for surgical treatment. Tyler B. Risma, Tony Klauer, Erin Shriver, Scott A. Larson Introduction: Diplopia after orbital trauma can result in persistent strabismus by multiple mechanisms. We analyzed a cohort of patients with orbital trauma to identify the factors associated with persistent strabismus requiring treatment. Methods: We identified patients seen at the University of Iowa between 1995 and 2015 with orbital trauma and diplopia (N 5 404). Data from 257 patients were collected and included in this report. Results: In our cohort 45% had no surgery, 35% had orbital fracture repair alone, 6% had strabismus surgery alone, and 14% both orbital and strabismus surgery. Horizontal deviations at initial evaluation were most likely to resolve. Vertical deviations were less likely to spontaneously improve compared to those who had orbital surgery (P 5 0.007), strabismus surgery (P 5 0.03) or both (P \ 0.0001). The initial amount of vertical deviation was correlated with the need for both orbital and/or strabismus surgery (ANOVA \ 0.0001).

Journal of AAPOS

e19 Discussion: To our knowledge, this is the largest study correlating strabismus measurements and the need for different types of surgery in the setting of orbital trauma. These findings can help clinicians identify patients who may require orbital or strabismus surgery after orbital trauma. Conclusions: Vertical deviations of 8D were more likely to require orbital fracture repair and/or strabismus surgery whereas horizontal deviations were more likely to resolve spontaneously. 058 The squint-scope (pat. pend.)—a new abductor fixation device prototype—provides better access for inspection of the temporal fundus in children with large angle esotropia. Jon Peiter Saunte, Max Bonne Introduction: Squint-Scope: a new fixation device prototype printed on a 3-D printer improves access for eye exam in small children or uncooperative adult patients. Methods: Presentation of the 3-D printed prototype Squint-Scope a periscope with two mirrors and an integrated base-out prism with an attached iPod. The patient is allowed to watch a cartoon on the iPod through the handheld Squint-Scope , thus the other eye is abducted and available for examination. Squint-Scope can be used in front of both eyes alternatively, driving the nonfixation eye in abduction, and by holding the Squint-Scope in a vertical position, the nonfixating eye is driven in up- or downgaze; the superior or inferior part of fundus then available for examination. Results: The Squint-Scope prototype was tested during 6 months in a clinical setting. In children or mentally disabled patients with large angle esotropia (ET) it was proven helpful in the examination of cornea and retina, especially by allowing examination of the temporal part of retina in esotropic eyes, thus avoiding need for eye examination under general anesthesia in 3 children. Discussion: Examination of the anterior segment and fundus in children with large angle ET can be challenging. To keep a good relation with an uncooperative child during an eye examination can be difficult. When children focuse in this device, the cartoon on show in the iPod can keep children busy for a long time. The prototype is not commercially available at present. Conclusions: Examination of the anterior segment and fundus in children with large angle ET can be challenging. The prototype of the Squint-Scope (1) distracts children and keeps them calm during examination by the ophthalmologist, (2) provides better access for examination of the anterior segment and fundus in children, and (3) saves time in the clinic and in some cases further eye examinations under general anesthesia can be avoided. 059 Utilization of geographic information systems software to analyze vision screening results from a socioeconomic perspective. Ronela K. Tavoc, Leila Khazaeni, Jennifer A. Dunbar Introduction: Photoscreening reaches children in large geographic areas. Geographic information system (GIS) software can describe different geographic units visually by superimposing socioeconomic data on maps. Using GIS software, we demonstrate the geographic relationships between vision screening referral rates, median income, ethnicity and pediatric population in our vision screening program. Methods: Laypersons used the SPOT photo screener (Welch Allyn, Skaneateles Falls, NY) to screen children ages 0-8 from 9/2015 to 12/2016. Date of birth, ethnicity, gender, screening result and follow-up data were collected. ArcGISOnline (Esri, Redlands, CA) was used to geolocate screening sites and to display the median