- Email: [email protected]
Intermittent angle closure in pediatrics: identification and treatment
e30 no or underdosed lubricants. 12 had lagophthalmos, 5 with corneal exposure, of who 3 had no ophthalmology consultation, 2 no lubricants, 1 underdosed. Revision and implementation of annual mandatory education was undertaken. Discussion: Despite broadly implemented protocols and reduction in adverse events, the effect was not sustained. Clinician knowledge waned, leaving patients at risk for vision-threatening complications. Conclusions: Patient safety initiatives require multidisciplinary collaboration, ongoing surveillance, and continuing education to maintain provider awareness and compliance. 095 Intermittent angle closure in pediatrics: identification and treatment. Sylvia L. Groth, Kristin Crosnoe, William E. Sponsel Introduction: Intermittent angle closure (IAC) in pediatric patients is difficult to diagnose and treat. Frontal headaches are a prime indicator of IAC, though they should be correlated with gonioscopy and visual field findings; both of which are challenging in the pediatric population. This study evaluates the symptom relief and change in FDT mean deviation (MD) in pediatric patients after laser peripheral iridotomy (LPI) for IAC. Methods: Case–control study of subjects \18 years of age diagnosed with presumed IAC undergoing LPI from 2010-2015 at a single clinical site with pre- and post-laser FDTs. Resolution of symptoms was primary outcome. Secondary outcomes were change in MD on FDT and IOP. Control group of pediatric glaucoma patients was used to adjust for the learning effect in FDT results. Student t-test analyzed the results. Results: 27 eyes (14 patients; range, 8-15 years) qualified. All treated subjects had resolution of frontal headache. Pre-laser MD was 8.4 1.0dB and post-laser 3.5 0.5 (P \ 0.0001). No change in IOP. Control group of 22 eyes (range, 7-14 years) had MD on first field of 6.70.9 dB and 5.50.8 on second (P \ 0.05). Mean change in the treatment group was +4.8 versus +1.1 dB in the control group (P 5 0.0009). Discussion: LPI treatment of pediatric patients with complaints of frontal headache as result of IAC provides both symptomatic relief and potential recovery of visual function. Using FDT perimetry and gonioscopy we believe there can be confident diagnosis and resolution of this condition. Notably, the gonioscopy findings are atypical yet convincingly result in periodic angle closure. Conclusions: This study suggests that pediatric patients with headache should be evaluated for IAC and could benefit from LPI treatment, based on child cooperation.
096 A randomized controlled trial of art observation training to improve medical student ophthalmology skills. Jaclyn Gurwin, Karen E. Revere, Stephanie M. Davidson, Suzannah Niepold, Rebecca Mitchell, Barbara Bassett, Horace DeLisser, Gil Binenbaum Introduction: We sought to evaluate the effects of formal observation training in the visual arts on the general and ophthalmological observational skills of medical students. Methods: We collaborated with the Philadelphia Museum of Art (PMA) to conduct a randomized, controlled, single-masked trial of 36 first-year medical students, randomized 1:1 into art-training and control groups. The art-training group received six custom-designed 1.5-hour art observation sessions at PMA. All subjects completed pre and post testing, in which they described works of art, retinal pathology images, and external photos of eye diseases. Written descriptions were graded for observational and descriptive abilities by
Volume 21 Number 4 / August 2017 reviewers masked to group assignment and pre/post-status, using an a priori rubric. Results: Observational skills, as measured by description testing, improved significantly in the training group (mean change, +19.1 points) compared to the control group ( 13.5) (P 5 0.001), and there were significant improvements for each art and clinical subscore. In a post-study questionnaire, students reported applying the skills they learned in the museum in clinically meaningful ways at school. Discussion: Observation is a key component of ophthalmological examination and diagnosis. It is a difficult but pivotal skill to teach especially for beginner students and residents who must rely on their descriptive abilities to convey exam findings. It is encouraging to learn that principles from the field of visual arts, which is reputed to excel in teaching observation and descriptive abilities, can be successfully applied to medical training. Conclusions: Art observation training for medical students can improve clinical ophthalmology observational skills. Further studies can examine the impact on clinical care. 097 What does electrophysiology tell us about vision in patients with albinism? Zhaohui Hu, Wanda Pfeifer, Taylor Kehoe, Andrew Kemerley, Kai Wang, Arlene V. Drack Introduction: Albinism patients have abnormal foveal anatomy, but correlation with function is incompletely understood. We correlated electroretinogram(ERG), optical coherence tomography(OCT) and visual acuity(VA) in albinism patients and compared with age-matched controls. Methods: Prospective study of full field(ff) and multifocal(mf) ERG correlated with macula OCT and VA from chart review. Nonparametric permutation testing was utilized to determine significance. Results: Thirteen albinism patients (7 male; mean age, 15 years; range, 6-46 years) and 16 controls (5 male; mean age, 23 years; range, 9-47 years). Multifocal (mf) ERG: 9 of 13 patients had ring 1 amplitudes within 1 standard deviation of controls (75 25 nV/deg2), even in the absence of a fovea on OCT. There was no significant correlation between VA and mfERG amplitudes (highest r 5 0.19, P 5 0.27, Ring 1). Fullfield (ff) ERG: Patients averaged higher amplitudes on 30 Hz flicker (P 5 0.05), a-waves all conditions (P 5 0.02), and b-waves light adapted 3.0 (P 5 0.022) than controls, but there was overlap in amplitudes between the groups. FfERG amplitudes did not correlate with VA. OCT and VA: In patients, thicker central macula correlated with lower mfERG amplitudes (r 5 0.61, P \ 0.05) and lower awave amplitudes on ffERG (r 5 0.634, P 5 0.024). There was no correlation between macular thickness and VA (r 5 0.179, P 5 0.28). Discussion: Neither ERG amplitudes nor foveal thickness correlate with VA in albinism, although they negatively correlate with each other. FfERG amplitudes averaged higher in patients than controls, however there was wide variation in both groups. Conclusions: ERG is not helpful for diagnosis or prognosis in albinism; foveal thickness does not correlate with visual acuity. 098 Amblyopic eye accommodative response does not predict the success of amblyopia treatment. Reed M. Jost, Eileen E. Birch Introduction: While patching treatment is effective in improving visual acuity of most amblyopic children, some fail to respond and many are left with residual amblyopia. On the basis of a recent report that approximately half of amblyopic children experience significant accommodative error when the fellow eye is patched, it has been suggested that treatment that enhances retinal image quality (eg, bifocals) may increase the magnitude of visual acuity improvement with patching. Here, we assess the relationship of amblyopic eye
Journal of AAPOS
096 A randomized controlled trial of art observation training to improve medical student ophthalmology skills. Jaclyn Gurwin, Karen E. Revere, Stephanie M. Davidson, Suzannah Niepold, Rebecca Mitchell, Barbara Bassett, Horace DeLisser, Gil Binenbaum Introduction: We sought to evaluate the effects of formal observation training in the visual arts on the general and ophthalmological observational skills of medical students. Methods: We collaborated with the Philadelphia Museum of Art (PMA) to conduct a randomized, controlled, single-masked trial of 36 first-year medical students, randomized 1:1 into art-training and control groups. The art-training group received six custom-designed 1.5-hour art observation sessions at PMA. All subjects completed pre and post testing, in which they described works of art, retinal pathology images, and external photos of eye diseases. Written descriptions were graded for observational and descriptive abilities by
Volume 21 Number 4 / August 2017 reviewers masked to group assignment and pre/post-status, using an a priori rubric. Results: Observational skills, as measured by description testing, improved significantly in the training group (mean change, +19.1 points) compared to the control group ( 13.5) (P 5 0.001), and there were significant improvements for each art and clinical subscore. In a post-study questionnaire, students reported applying the skills they learned in the museum in clinically meaningful ways at school. Discussion: Observation is a key component of ophthalmological examination and diagnosis. It is a difficult but pivotal skill to teach especially for beginner students and residents who must rely on their descriptive abilities to convey exam findings. It is encouraging to learn that principles from the field of visual arts, which is reputed to excel in teaching observation and descriptive abilities, can be successfully applied to medical training. Conclusions: Art observation training for medical students can improve clinical ophthalmology observational skills. Further studies can examine the impact on clinical care. 097 What does electrophysiology tell us about vision in patients with albinism? Zhaohui Hu, Wanda Pfeifer, Taylor Kehoe, Andrew Kemerley, Kai Wang, Arlene V. Drack Introduction: Albinism patients have abnormal foveal anatomy, but correlation with function is incompletely understood. We correlated electroretinogram(ERG), optical coherence tomography(OCT) and visual acuity(VA) in albinism patients and compared with age-matched controls. Methods: Prospective study of full field(ff) and multifocal(mf) ERG correlated with macula OCT and VA from chart review. Nonparametric permutation testing was utilized to determine significance. Results: Thirteen albinism patients (7 male; mean age, 15 years; range, 6-46 years) and 16 controls (5 male; mean age, 23 years; range, 9-47 years). Multifocal (mf) ERG: 9 of 13 patients had ring 1 amplitudes within 1 standard deviation of controls (75 25 nV/deg2), even in the absence of a fovea on OCT. There was no significant correlation between VA and mfERG amplitudes (highest r 5 0.19, P 5 0.27, Ring 1). Fullfield (ff) ERG: Patients averaged higher amplitudes on 30 Hz flicker (P 5 0.05), a-waves all conditions (P 5 0.02), and b-waves light adapted 3.0 (P 5 0.022) than controls, but there was overlap in amplitudes between the groups. FfERG amplitudes did not correlate with VA. OCT and VA: In patients, thicker central macula correlated with lower mfERG amplitudes (r 5 0.61, P \ 0.05) and lower awave amplitudes on ffERG (r 5 0.634, P 5 0.024). There was no correlation between macular thickness and VA (r 5 0.179, P 5 0.28). Discussion: Neither ERG amplitudes nor foveal thickness correlate with VA in albinism, although they negatively correlate with each other. FfERG amplitudes averaged higher in patients than controls, however there was wide variation in both groups. Conclusions: ERG is not helpful for diagnosis or prognosis in albinism; foveal thickness does not correlate with visual acuity. 098 Amblyopic eye accommodative response does not predict the success of amblyopia treatment. Reed M. Jost, Eileen E. Birch Introduction: While patching treatment is effective in improving visual acuity of most amblyopic children, some fail to respond and many are left with residual amblyopia. On the basis of a recent report that approximately half of amblyopic children experience significant accommodative error when the fellow eye is patched, it has been suggested that treatment that enhances retinal image quality (eg, bifocals) may increase the magnitude of visual acuity improvement with patching. Here, we assess the relationship of amblyopic eye
Journal of AAPOS