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Partial muscle recession for small-angle vertical strabismus
Volume 19 Number 4 / August 2015 Discussion: This study is the first to evaluate automated vision screening in the medical home and nearly identically replicates previously reported studies from day care settings and preschools. Conclusions: SPOT and PlusOptix are each effective for the detection of ARFs when used in the pediatric outpatient setting. 008 Colorado ROP screening model: a multi-institutional validation study. Jennifer H. Cao, Anne Lynch, Ashlee M. Cerda, Brandie Wagner, Ryan K. Wong, Irena Tsui, Charlotte Gore, Shira Robbins, Michael A. Puente, Jr. David Kauffman, Lingkun Kong, David G. Morrison, Emily A. McCourt Introduction: The purpose of this study was to perform a validation of the Colorado Retinopathy of Prematurity screening model (CO-ROP) in a multi-institutional academic setting. The CO-ROP model signals an alarm for ROP examination in an infant with gestational age of less than or equal to 30 weeks, and birth weight less than or equal to 1500 grams, and a net weight gain less than or equal to 650 grams between birth and 1 month of age. Methods: Retrospective review of 1,362 infants undergoing retinopathy of prematurity (ROP) examinations at the University of Colorado, University of California Los Angeles, University of California San Diego, Baylor College of Medicine, and Vanderbilt University. Sensitivity and specificity of detecting ROP using CO-ROP and 95% confidence intervals were calculated. Results: The CO-ROP model resulted in a sensitivity of 99.1% (95%CI 97.3-100%) for Type I ROP, 100% (95%CI 89.1-100%) for Type 2 ROP, and 96.8% (95%CI 95.1-98.6%) for all grades of ROP. Implementing the CO-ROP model would have eliminated 290 (21.3%) infants otherwise screened for ROP using 2013 guidelines. One infant with Type 1 ROP was missed. Discussion: Compared to current 2013 screening criteria, the COROP model resulted in improved efficiency, but did miss one infant with Type 1 ROP. Conclusions: The CO-ROP model uses net weight gain to improve ROP screening efficiency. In this multi-institutional study, we have validated the excellent sensitivity and improved specificity of the model when compared to current 2013 screening criteria. 009 Partial muscle recession for small-angle vertical strabismus. Catherine S. Choi, Jasleen K. Singh, Steven M. Archer Introduction: There are few reliable treatment options for small vertical deviations in patients who prefer to be spectacle-free. A partial tendon recession procedure is one surgical option, and this study evaluated its effectiveness in correcting small vertical deviations. Methods: This is a retrospective chart review of 52 procedures in 43 patients. Change in vertical deviation in primary position was evaluated, as was prism diopter change per millimeter of partial tendon recession. Separate analyses were performed to compare outcomes in patients with Graves eye disease and those who underwent reoperations on the same muscle. Results: The average preoperative vertical deviation was 4.6D of deviation (SD, 2.0D) and the average postoperative vertical deviation was 0.04D (SD, 2.4D), P \ 0.0001. There was an average of 1.5D of change per millimeter of partial tendon recession. 64% of postoperative patients were orthophoric in the overall sample. 60% of Graves patients were orthophoric postoperatively versus 65% of non-Graves patients. 29% of the reoperated patients were orthophoric postoperatively versus 69% of nonreoperated patients. Discussion: Preoperative vertical deviation had a more significant correlation with postoperative alignment than did the actual amount
Journal of AAPOS
e11 of surgical recession. Our results also suggest outcomes in reoperated muscles are less predictable. There was no significant difference in postoperative outcome between patients with Graves disease and those without. Conclusions: In this sample of patients, a partial tendon recession effectively corrected small vertical deviations and is a treatment option to consider in patients who prefer spectacle independence. 010 The association between patching adherence and visual acuity at age 4.5 in the Infant Aphakia Treatment Study. Carolyn D. Drews-Botsch, Marianne Celano, Eugenie E. Hartmann, Scott R. Lambert Introduction: We examined the relationship between patching and visual acuity at age 4.5 years in the Infant Aphakia Treatment Study. Methods: Cataract extraction was performed between 28 and 209 days of age on 114 infants with a unilateral congenital cataract. 57 were randomized to receive an IOL; the remaining 57 were left aphakic. Recognition acuity was assessed at age 41/2. Patching was prescribed until age 5. Adherence to prescribed patching was assessed using quarterly telephone interviews and annual patching diaries. Occlusion was the average number of hours of patching reported on at least 3 adherence assessments within 5 age bands: 0 to \12 months of age, 12 to \24 months, 24 to \36 months, 26 to \48 months, 48 to \60 months. Results: Hours of patching at each time point was correlated with patching at all other time points. Few (n 5 5) caregivers reported averaging more than 3 hours of patching in years 3-5 if they had not done so in the first 2 years. Patching was strongly correlated with acuity. Correlation coefficients ranged from 0.32 for patching in the 5th year of life to 0.42 for patching in the 2nd year, were similar for pseudophakic and aphakic children, and were not confounded by adverse events, age at surgery, gender, race or type of insurance. Discussion: We affirm the importance of patching to visual acuity in children after unilateral cataract extraction in infancy. Conclusions: Patching in the first years after surgery may be particularly important as caregivers who are able to adhere to patching in infancy are more likely to adhere to prescribed patching later. 011 Ocular complications in children with diabetes mellitus. Megan M. Geloneck, Brian J. Forbes, James Shaffer, Gil Binenbaum Introduction: The effectiveness of annual diabetic eye exams in children is unclear. We sought to determine the prevalence and onset of ocular pathology in children with diabetes mellitus(DM), identify risk factors for ocular disease, and recommend a screening regimen for asymptomatic children. Methods: Retrospective consecutive cohort study of children age\18 years with type 1 or 2 DM examined over a 4 year period. Primary outcomes were diabetic retinopathy, cataract, high refractive error, and strabismus. Hemoglobin A1C(HA1C), age at diagnosis and duration of DM were evaluated as risk factors for ocular disease. Results: 370 children (mean age 11.2 3.7 years, range, 1-17.5) had 693 examinations, with mean DM duration 5.2 3.7 years (range, 0.116.2 years), mean HA1C 8.6 1.9 (range, 5 to $14). No children had diabetic retinopathy (0%, 95% CI, 0%-1%). 12(3.3%) had cataract, 5 of which required extraction and were identified by decreased vision, not diabetic screening. Youngest age at cataract diagnosis was 7.5 years, 4.5 years after DM diagnosis. 19 had strabismus, only one of which was microvascular paralytic strabismus. 41 (11%) had high
Journal of AAPOS
e11 of surgical recession. Our results also suggest outcomes in reoperated muscles are less predictable. There was no significant difference in postoperative outcome between patients with Graves disease and those without. Conclusions: In this sample of patients, a partial tendon recession effectively corrected small vertical deviations and is a treatment option to consider in patients who prefer spectacle independence. 010 The association between patching adherence and visual acuity at age 4.5 in the Infant Aphakia Treatment Study. Carolyn D. Drews-Botsch, Marianne Celano, Eugenie E. Hartmann, Scott R. Lambert Introduction: We examined the relationship between patching and visual acuity at age 4.5 years in the Infant Aphakia Treatment Study. Methods: Cataract extraction was performed between 28 and 209 days of age on 114 infants with a unilateral congenital cataract. 57 were randomized to receive an IOL; the remaining 57 were left aphakic. Recognition acuity was assessed at age 41/2. Patching was prescribed until age 5. Adherence to prescribed patching was assessed using quarterly telephone interviews and annual patching diaries. Occlusion was the average number of hours of patching reported on at least 3 adherence assessments within 5 age bands: 0 to \12 months of age, 12 to \24 months, 24 to \36 months, 26 to \48 months, 48 to \60 months. Results: Hours of patching at each time point was correlated with patching at all other time points. Few (n 5 5) caregivers reported averaging more than 3 hours of patching in years 3-5 if they had not done so in the first 2 years. Patching was strongly correlated with acuity. Correlation coefficients ranged from 0.32 for patching in the 5th year of life to 0.42 for patching in the 2nd year, were similar for pseudophakic and aphakic children, and were not confounded by adverse events, age at surgery, gender, race or type of insurance. Discussion: We affirm the importance of patching to visual acuity in children after unilateral cataract extraction in infancy. Conclusions: Patching in the first years after surgery may be particularly important as caregivers who are able to adhere to patching in infancy are more likely to adhere to prescribed patching later. 011 Ocular complications in children with diabetes mellitus. Megan M. Geloneck, Brian J. Forbes, James Shaffer, Gil Binenbaum Introduction: The effectiveness of annual diabetic eye exams in children is unclear. We sought to determine the prevalence and onset of ocular pathology in children with diabetes mellitus(DM), identify risk factors for ocular disease, and recommend a screening regimen for asymptomatic children. Methods: Retrospective consecutive cohort study of children age\18 years with type 1 or 2 DM examined over a 4 year period. Primary outcomes were diabetic retinopathy, cataract, high refractive error, and strabismus. Hemoglobin A1C(HA1C), age at diagnosis and duration of DM were evaluated as risk factors for ocular disease. Results: 370 children (mean age 11.2 3.7 years, range, 1-17.5) had 693 examinations, with mean DM duration 5.2 3.7 years (range, 0.116.2 years), mean HA1C 8.6 1.9 (range, 5 to $14). No children had diabetic retinopathy (0%, 95% CI, 0%-1%). 12(3.3%) had cataract, 5 of which required extraction and were identified by decreased vision, not diabetic screening. Youngest age at cataract diagnosis was 7.5 years, 4.5 years after DM diagnosis. 19 had strabismus, only one of which was microvascular paralytic strabismus. 41 (11%) had high