Combined central serous chorioretinopathy, hypermetropia, short axial length, chorioretinal folds, enlarged/thickened ocular coats, with varying association of scleral changes (CHAFES).

PURPOSE: To describe a condition with the following features: chronic central serous chorioretinopathy (CCSC), chorioretinal folds, scleral changes (including any of the following flattened or 'squared off' posterior pole, 'T sign', or thickened ocular coats), accompanied by a short axial length and hypermetropia in a series of 7 patients. METHODS: The case notes of 7 patients presenting with a combination of CSC, choroidal folds scleral changes and hypermetropia were reviewed as part of a retrospective case series. Corrected visual acuities, serial refraction, colour imaging, fluorescein and indocyanine green angiography findings, together with B-ultrasound scan features were recorded, with axial length measurements as available (< 23.3 mm was defined as short). RESULTS: The study included 14 eyes of 7 subjects (2 females and 5 males) with a primary presentation of central vision disturbance. All patients showed signs of previous or current episodes of the following features in at least one eye: CSC (5/7 bilateral); choroidal folds (6/7 bilateral), thickening of ocular coats in the 5 in whom this was measured, at least one scleral abnormality on ultrasound in at least one eye. A short axial length at final appointment was recorded in 13/14 eyes. CONCLUSIONS AND RELEVANCE: The combination of CCSC with choroidal folds, hypermetropia with apparent shortening of the eyeball associated with one or more scleral abnormalities such as a flattened or 'squared off 'appearance of the B ultrasound may be a specific ocular condition. The aetiology of this particular combination of posterior segment manifestations is unknown; the choroid could be the primary focus of disease with secondary involvement of the sclera. Alternatively, the features observed may result from a chronic inflammatory process affecting the sclera with secondary effects on the choroid, retinal pigment epithelium and retina. In our case series, the final vision was not significantly different from vision at presentation.

The effect of visual impairment on quality of life of children aged 3-16 years.

BACKGROUND: It is well known that visual impairment (VI) has a detrimental effect on Quality of Life (QoL) in adults. Little is known about the effects of VI in childhood. AIMS: To evaluate the effects of VI on QoL of children. To the authors' knowledge, this is the first study containing a comparison arm for children with VI. METHODS: QoL in children with VI (n=24, age 10.13±2.89, 18 male, 6 female) was compared with an age-matched comparison group (n=24, age 9.83±2.81, 18 male, 6 female) using the Low Vision Quality of Life Questionnaire. Factors (distance and near visual acuity and age) that could be used as predictors of QoL were assessed. These were measured with standard clinical tests. RESULTS: Children with VI had significantly lower QoL scores than the comparison group (p<0.001), resulting in a 35.6% reduction in total QoL score. QoL scores in children with VI were correlated with distance and near visual acuity (p<0.05). 38% of the variance could be predicted by these factors and age. CONCLUSIONS: Consideration of the effects of this reduced QoL must be made. Further studies are needed to establish the benefit to QoL of different habilitation strategies.