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Survey of childhood glaucoma suspects in a tertiary center
e40 was found to exceed the mean from the control population (176.2 3.55 and 16.87 5.17) by a significant degree (P \ 0.05). Discussion: In this group of patients with V-pattern strabismus, the position of the rectus muscles appears to be excyclorotated within the globe. These patients do not display external features suggestive of this. Such patients may represent a forme fruste of a craniofacial disorder. Conclusions: The anatomical configuration of the extraocular muscles may play a significant role in the etiology of alphabet pattern strabismus. This should be borne in mind when planning management. 147 Survey of childhood glaucoma suspects in a tertiary center. Carla J. Osigian Probst, Matthew B. Greenberg, Kara M. Cavuoto, Ta Chen Chang Introduction: We investigated the baseline characteristics of childhood glaucoma suspects (age .10 years) in order to identify highrisk features for conversion to childhood glaucoma. Methods: We retrospectively identified the medical records of childhood glaucoma suspects based on claims data between 2002 and 2012. Records were included if the patient failed to meet glaucoma diagnosis criteria at the initial visit and follow-up was .6 months, and were excluded if either eye had undergone incisional surgery. Results: Of the 108 charts reviewed, 44 patients had at least 1 episode of intraocular pressure (IOP) of .21 mm Hg. Of these patients, 39 did not develop glaucoma, while 5 (11.4%) converted to childhood glaucoma based on the Childhood Glaucoma Research Network definition during the follow-up period. Two of the total 108 patients (1.9%) had neither glaucoma nor elevated eye pressure, but had high-risk syndromes associated with childhood glaucoma (one Peters anomaly, one retinopathy of prematurity). 62 (57.4%) remained glaucoma suspects without high-risk syndromes nor history of elevated eye pressure. The follow-up durations were similar in the glaucoma, hypertensive, syndrome, and suspect groups (30-46 months, P 5 0.774). The maximum (35 10 mm Hg) and average (27 2.3 mm Hg) IOP in the glaucoma group were higher than the rest (P \ 0.0001 for both). No normotensive childhood glaucoma suspects converted to glaucoma. Discussion: Elevated IOP in childhood glaucoma suspects is associated with conversion to glaucoma. Conclusions: Childhood glaucoma suspects without elevated IOP are probably at low risk of converting to glaucoma. 148 Prism adaptation and the surgical management of acquired esotropia. Clare Quigley, Fergus Doyle, Maria Cairns, Elizabeth McElnea, Paul Mullaney Introduction: Acquired esotropia is one of the most common causes of strabismus in childhood. Prism adaptation may be used to determine the angle to be corrected surgically. Methods: Patients from two centers who underwent prism adaptation were retrospectively evaluated. Twenty-one patients completed follow-up at 5 months. These patients either showed a requirement for prisms that changed; prism-builders, or which remained stable during adaptation; prism-nonbuilders. Results: The motor success rate, an esodeviation #10D, for all patients was 66%. Prism-builders (n 5 10, 48%) had a higher rate of successful outcome versus prism-nonbuilders (n 5 11, 52%), 90% versus 54%, P 5 0.07. Larger initial angle of eso-deviation and involvement of the right eye were inversely associated with successful surgical outcome.
Volume 20 Number 4 / August 2016 Discussion: Prism adaptation may be useful in highlighting patients who may benefit from a higher surgical dose by identifying prismbuilders, who make up almost half of patients. Those whose esodeviation "built" had particularly high success rates. Conclusions: Prism adaptation is resource intensive but may have use in tailoring surgical management of paediatric esotropia. Interestingly it highlights a novel association for further investigation; children who respond to adaptation with a growth in angle of deviation tend to do well. 149 Analysis of discrepancy between diagnostic clinical examination and corresponding evaluation of digital images in the e-ROP study. Graham E. Quinn, Anna Ells, Antonio Capone, Jr. Ebenezer Daniel, P. Lloyd Hildebrand, G. Baker Hubbard, Gui-shuang Ying Introduction: Telemedicine in retinopathy of prematurity (ROP), including the "Telemedicine approaches to evaluating acute-phase ROP (e-ROP)" study, use ophthalmologists' examination findings as the standard for the accuracy of grading digital retinal images. This assumes an accurate diagnosis; studies suggest substantial ROP diagnosis variability among clinicians using indirect ophthalmoscopy. This report characterizes the false negative and false positive results in e-ROP image evaluation. Methods: Secondary analysis of an observational cohort study data. Consensus review by four ROP experts of 188 image sets of discrepancies for stage 3 ROP, zone I ROP or plus disease between results of examination and remote image set grading by trained readers. If .100 cases, 40 were randomly selected. Results: Among false negatives on image grading by trained readers, 56.3% of 32 reviews agreed with examination that ROP was present in zone I, 45.0% of 40 that stage 3 ROP was present, but only 5% of 20 for presence of plus disease. Among false positives, 90.0% of 40 agreed with trained readers that zone I ROP was present when not noted on exam, 57.5% of 40 with stage 3 ROP, and 25% of 16 for plus disease. Discussion: Consensus review of discordant cases in e-ROP documented both agreement and disagreements between the clinical examination and image grading. Significant abnormalities were sometimes noted in one modality that were not noted on the other. Conclusions: This report highlights limitations and advantages of both remote evaluation of fundus images and bedside clinical examination of infants at risk for ROP. 150 Reduced VEP amplitudes in 12-year-old children born moderately to late premature. Lina Raffa, Josefin Nilsson, Jovanna Dahlgren, Marita Andersson Gronlund Introduction: The relation between visual evoked potentials (VEPs) and retinal nerve fiber layer (RNFL) thickness were studied in moderate-to-late preterm (MLP) children. Methods:Visual acuity (VA), refraction expressed as spherical equivalent, birth anthropometric measurements, and VEPs (60 arcmin checks) were obtained from 22 12-year-old MLP (11 males) and 21 full-term controls. RNFL parameters were examined by spectral domain optical coherence tomography (SD-OCT). Results: VEP amplitudes (P100) were smaller in the MLP group (Oz 18.7 8.2 mV right eye [RE)] 17.6 8 mV left eye [LE]) than in controls (30 14.8 mV RE; 30.6 12.7 mV LE); P 5 0.013 and 0.003, respectively. No differences in VEP latencies were found. There were no statistically significant differences between the MLP and controls in VA, refraction, or RNFL thickness. Gender differences were found in some RNFL measurements in both groups. VEP amplitudes did not
Journal of AAPOS
Volume 20 Number 4 / August 2016 Discussion: Prism adaptation may be useful in highlighting patients who may benefit from a higher surgical dose by identifying prismbuilders, who make up almost half of patients. Those whose esodeviation "built" had particularly high success rates. Conclusions: Prism adaptation is resource intensive but may have use in tailoring surgical management of paediatric esotropia. Interestingly it highlights a novel association for further investigation; children who respond to adaptation with a growth in angle of deviation tend to do well. 149 Analysis of discrepancy between diagnostic clinical examination and corresponding evaluation of digital images in the e-ROP study. Graham E. Quinn, Anna Ells, Antonio Capone, Jr. Ebenezer Daniel, P. Lloyd Hildebrand, G. Baker Hubbard, Gui-shuang Ying Introduction: Telemedicine in retinopathy of prematurity (ROP), including the "Telemedicine approaches to evaluating acute-phase ROP (e-ROP)" study, use ophthalmologists' examination findings as the standard for the accuracy of grading digital retinal images. This assumes an accurate diagnosis; studies suggest substantial ROP diagnosis variability among clinicians using indirect ophthalmoscopy. This report characterizes the false negative and false positive results in e-ROP image evaluation. Methods: Secondary analysis of an observational cohort study data. Consensus review by four ROP experts of 188 image sets of discrepancies for stage 3 ROP, zone I ROP or plus disease between results of examination and remote image set grading by trained readers. If .100 cases, 40 were randomly selected. Results: Among false negatives on image grading by trained readers, 56.3% of 32 reviews agreed with examination that ROP was present in zone I, 45.0% of 40 that stage 3 ROP was present, but only 5% of 20 for presence of plus disease. Among false positives, 90.0% of 40 agreed with trained readers that zone I ROP was present when not noted on exam, 57.5% of 40 with stage 3 ROP, and 25% of 16 for plus disease. Discussion: Consensus review of discordant cases in e-ROP documented both agreement and disagreements between the clinical examination and image grading. Significant abnormalities were sometimes noted in one modality that were not noted on the other. Conclusions: This report highlights limitations and advantages of both remote evaluation of fundus images and bedside clinical examination of infants at risk for ROP. 150 Reduced VEP amplitudes in 12-year-old children born moderately to late premature. Lina Raffa, Josefin Nilsson, Jovanna Dahlgren, Marita Andersson Gronlund Introduction: The relation between visual evoked potentials (VEPs) and retinal nerve fiber layer (RNFL) thickness were studied in moderate-to-late preterm (MLP) children. Methods:Visual acuity (VA), refraction expressed as spherical equivalent, birth anthropometric measurements, and VEPs (60 arcmin checks) were obtained from 22 12-year-old MLP (11 males) and 21 full-term controls. RNFL parameters were examined by spectral domain optical coherence tomography (SD-OCT). Results: VEP amplitudes (P100) were smaller in the MLP group (Oz 18.7 8.2 mV right eye [RE)] 17.6 8 mV left eye [LE]) than in controls (30 14.8 mV RE; 30.6 12.7 mV LE); P 5 0.013 and 0.003, respectively. No differences in VEP latencies were found. There were no statistically significant differences between the MLP and controls in VA, refraction, or RNFL thickness. Gender differences were found in some RNFL measurements in both groups. VEP amplitudes did not
Journal of AAPOS