Near compared with distance visual acuity in amblyopic eyes

Volume 15 Number 1 / February 2011 5%. The positive and negative predictive values were 80% and 92% respectively. Only 2.5% of patients did not cooperate with screening device. Conclusions: Sensitivity and specificity suggests the instrument is accurate as noncycloplegic screening device in children with ID. Children with ID will benefit from mass screenings and PlusoptiX S04 is a quick, noninvasive, portable device that may be useful in special education schools. 052 A scoring system for retinal hemorrhages in shaken baby syndrome. Manpreet S. Chhabra, Dean Bonsall, Amy Cassedy, Scott Schoenberger, Robert North, Constance E. West Purpose: There is currently no standardized scoring system for retinal hemorrhages in shaken baby syndrome. We did a study to measure the inter and intra-observer reliability of the proposed scoring system in shaken baby syndrome amongst the pediatric ophthalmologists. Methods: Ninety-five Pediatric Ophthalmologists at the American Association for Pediatric Ophthalmology and Strabismus Annual meeting in 2009 participated in an electronic survey where they were required to grade fundus photographs from shaken baby syndrome babies against two selected standardized pictures A and B. The participants were required to grade these photographs as normal, better than A but not normal, same as A, between A & B, same as B and worse than B. The survey was divided into four parts with Part 1 consisting of 20 pictures to be graded, Part 2 being a standard questionnaire consisting of participant's demographic, professional and practice type questions, Part 3 consisted of 20 pictures including 15 pictures graded in Part 1 but in a different order and one final question about the criteria used to grade each picture. Results: Ninety-seven percent of the participants were licensed physicians with 14.8 mean number of years in practice. Two pictures were excluded from the statistical analysis because of technical difficulties. Kendall's coefficient of concordance was used as the statistical measure of inter-observer reliability and had a fairly high value (0.82). The intra-observer reliability was also found to be fairly high with overall average of 85% pre and post-agreement on the common pictures. The top criterion used to grade the pictures was the number of hemorrhages. Discussion: The proposed scoring system for retinal hemorrhages in shaken baby syndrome showed a high inter and intra-observer reliability. Conclusions: More studies at multiple centers are needed to validate our results. 053 The long-term survival analysis of bilateral lateral rectus recession versus unilateral recession–resection procedure for intermittent exotrpia. Jin Choi, Ji Woong Chang, Seong-Joon Kim Introduction: In patients with intermittent exotropia, decisions about optimal surgical procedures are complex and the comparison of long-term results among the surgical procedures is not fully identified. The purpose of this study is to compare the long-term surgical outcomes of bilateral lateral rectus recession (BLR) versus unilateral recession-resection procedure (RR) for the patients with intermittent exotropia. Methods: We reviewed the medical records of patients who underwent intermittent exotropia surgery between 2002 and 2006 and had $ 2 years' follow-up. Surgical outcomes at post-operative 6 months, 1 year, 2 years and the last follow-up were compared between BLR group RR group. Satisfactory outcome was defined to have ocular

Journal of AAPOS

e15 alignment between 10Δ exophoria/tropia and 10Δ esophoria/tropia, whereas recurrence to have exophoria/tropia $ 10Δ. Results: Of the 149 patients, 60 underwent BLR and 89 underwent RR. The mean follow-up period was 3.6 and 4.0 years in BLR and RR group. At 6 months, 1 year and 2 years after surgery, 72%, 73% and 72% of patients in BLR group, and 76%, 63% and 54% of patients in RR group had a satisfactory outcome (p . 0.05). By the last followup, 63% in BLR group and 27% in RR group had a satisfactoy outcome (p 5 0.00). Esotropia $ 10Δ after post-operative 1 year persisted in 1 patient in BLR group and 2 patietns in RR group. The cumulative probability of surgical success was higher in BLR group than RR group (p 5 0.002). The median recurrence time was 29 and 40 months in BLR and RR group, each. Conclusions: The surgical outcomes by the 2 years after surgery for intermittent exotropia were not different betweent BLR and RR. However, the final satistactory outcome were better in BLR than RR. This may be caused by the difference of recurrence rate post-two years of surgery: continuous recurrence of exotropia occurred in the RR group while recurrence was low in the BLR group. 054 Near compared with distance visual acuity in amblyopic eyes. Alex Christoff, Michael X. Repka, Brett Kaminski, Jonathan M. Holmes, Pediatric Eye Disease Investigator Group Purpose: Based on principles of geometrical optics, it is expected that visual acuity would be the same at distance and near. However, some studies have found poorer vision in amblyopic eyes at near, while others have found better vision at near. We compared monocular distance with near visual acuity in amblyopic eyes of children with amblyopia. Methods: We evaluated 129 subjects 2 to 6 years of age in a randomized trial of amblyopia therapy for moderate amblyopia (20/40 to 20/ 80) due to anisometropia, strabismus, or both. Prior to initiating the protocol-prescribed therapy, subjects had best-corrected visual acuity measured with standardized protocols at 3 m and 0.4 m using single-surrounded HOTV optotypes. Results: The mean amblyopic eye visual acuity was similar at distance and near (mean 5 0.45 logMAR at distance versus 0.45 logMAR at near, mean difference 5 10.00, 95% CI, 0.03 to 0.03). Eighty-six (67%) subjects tested within one logMAR line at distance and near, 19 (15%) tested more than one logMAR line better at distance, and 24 (19%) tested more than one logMAR line better at near The mean acuity difference between distance and near did not differ by cause of amblyopia, age, or spherical equivalent refractive error. Discussion: Amblyopic eye visual acuity is similar when measured at distance and near. Conclusions: Individual differences between distance and near visual acuity may reflect test–retest variability, as we found no systematic difference. 055 Differential lateral rectus (LR) compartmental contraction: A novel mechanism accounts for impaired ocular counter-rolling (OCR) in superior oblique (SO) palsy. Robert A. Clark, Joseph L. Demer Purpose: Recent orbital histology demonstrates that the LR has superior and inferior zones with distinct innervation patterns. We used magnetic resonance imaging (MRI) to investigate zonal activity in the LR during head tilt. Methods: Surface coil coronal MRI in target-controlled central gaze was obtained in 90 right and left head tilts in 6 normal subjects and 9 patients with unilateral SO palsy manifested by significant SO