Pediatric nasolacrimal duct obstruction.

PURPOSE OF REVIEW: Review the current management for pediatric nasolacrimal duct obstruction and congenital dacryocele. RECENT FINDINGS: Early probing in the office, and probing beyond 1 year of age in a facility with general anesthesia are equally effective. Congenital nasolacrimal duct obstruction is associated with anisometropic amblyopia. Infants with unilateral dacryocele are at risk for developing a dacryocele on the unaffected side. SUMMARY: The decision to probe early in the office or continue medical management and probe beyond a year of age in a facility with a general anesthetic is at the discretion of the ophthalmologist. Failed probings should be treated in a facility under general anesthesia with a balloon catheter or intubation. Children with congenital nasolacrimal duct obstruction need to be followed to make certain they do not develop anisometropic amblyopia.

Visual acuity improvement in the amblyopic eye of a 50-year-old man following strabismus surgery.

It is generally believed that the visual acuity of an amblyopic eye cannot improve significantly in adulthood. However, there have been reports of this occurring following visual loss in the fellow eye. Best-corrected visual acuity improvement in amblyopic eyes of children with strabismic amblyopia following strabismus surgery has also been reported. We present the case of an adult whose visual acuity in his amblyopic eye improved 4 Snellen lines over 28 months following strabismus surgery.

Factors Affecting the Perception of Strabismus Among Pediatric Ophthalmologists.

PURPOSE: To define potential factors that influence the perceived urgency of strabismus surgery with a specific focus on the contributions of gender, degree of strabismus, and direction of strabismus. METHODS: An electronic survey was sent to members of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Respondents provided demographic information and ranked eight photographs of adults digitally altered to create varying degrees of strabismus according to perceived urgency for surgery. RESULTS: Pediatric ophthalmologists ranked deviations of increasing size with increasing treatment urgency. Men were perceived with higher urgency for treatment compared to women in the smaller angles of strabismus. No consistent preference for type of deviation was found. CONCLUSIONS: The gender of the patient and the amount of misalignment may influence the urgency of surgical management among strabismus surgeons. [J Pediatr Ophthalmol Strabismus. 2023;60(4):257-262.].

Economic Impact of the COVID-19 Pandemic Post-Mitigation on Pediatric Ophthalmologists.

PURPOSE: To create a survey to assess the economic impact that the coronavirus disease 2019 (COVID-19) pandemic post-mitigation (post-shutdown) has had on pediatric ophthalmologists. METHODS: A 14-question survey was disseminated to United States-based pediatric ophthalmologists on the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) discussion board and on social media. Demographic data and data on the economic effect of the COVID-19 pandemic post-mitigation were collected. RESULTS: A total of 129 pediatric ophthalmologists completed the survey. Eighty-four (65.1%) respondents reported a clinical revenue decrease of greater than 10%, 83 (64.3%) a surgical decrease of greater than 10%, and 66 (51.2%) an income decrease of greater than 10%. Fifteen (11.6%) respondents reported limiting the number of Medicaid patients. This was more prevalent among those in private practice (P = .027). Twenty-seven (20.9%) pediatric ophthalmologists responded that they planned to retire earlier than anticipated because of the pandemic and 2 (1.6%) responded that they have retired since the start of the pandemic. Six (4.7%) respondents reported that they have sold their practice since the start of the COVID-19 pandemic. CONCLUSIONS: Pediatric ophthalmologists continue to face economic challenges introduced by the COVID-19 pandemic. Reduced revenue may represent a new normal for the near future in pediatric ophthalmology. These unprecedented economic upheavals come at a time when the field of pediatric ophthalmology already faces difficulties with low reimbursement and attracting new trainees. This multitude of issues may escalate into a crisis in providing appropriate pediatric ophthalmic care. [J Pediatr Ophthalmol Strabismus. 2022;59(5):291-295.].

Rate of Spontaneous Resolution of Congenital Nasolacrimal Duct Obstruction Prior to Scheduled Probing in Children Older Than 1 Year.

The authors conducted a 10-year retrospective review of all patients within one physician's practice to determine the frequency of spontaneous resolution of congenital nasolacrimal duct obstruction in children older than 1 year during the interval between scheduling and date of probing. This review found 4.4% of eyes resolved within an average interval period of 39 days. [J Pediatr Ophthalmol Strabismus. 2019;56:e31-e33.].

Unilateral clinical anophthalmia with optic nerve hypoplasia in the fellow eye.

We present the clinical and radiologic findings of two cases of clinical anophthalmia in one eye and optic nerve hypoplasia in the other eye. We propose possible causes of this rare finding.

Risk factors for amblyopia in congenital anterior lens opacities.

PURPOSE: We sought to identify the features of congenital anterior lens opacities (CALOs), which are associated with increased risk for amblyopia. METHODS: We undertook a retrospective study of 59 patients with CALO from 3 clinical practices. The following variables were examined: type (polar, subcapsular, or pyramidal), location (central, paracentral, or peripheral), diameter, presence of adherent iris tissue, anisometropia (spherical equivalent), unilateral versus bilateral, and presence or absence of amblyopia. Pearson chi-square and independent sample t-tests were conducted to evaluate if any of the aforementioned variables were independently associated with amblyopia. Relative risk was then calculated for significantly related variables (P < 0.05). RESULTS: Amblyopia was present in 17 of 59 patients (28.8%). Patients with amblyopia had a mean anisometropia of 1.23 diopters whereas nonambyopic patients had a mean anisometropia of 0.25 (P = 0.023). The relative risk for amblyopia with anisometropia of one diopter or greater was 6.5 (95% confidence interval = 3.79-7.45). The mean cataract size in the amblyopic eyes was 1.22 mm (range, 0.7-2.0 mm). Mean cataract size in the nonamblyopic eyes was 0.95 mm (range, 0.5-2.0 mm). This difference in mean cataract size was significant with independent sample t-tests (P = 0.02); however, this difference did not remain significant with logistic regression. Cataract size was not a significant relative risk factor for amblyopia. CONCLUSIONS: Our overall incidence of amblyopia was 28.8%. The only variable associated with increased relative risk for amblyopia in this group of patients was anisometropia. Patients with CALO who have anisometropia of 1 diopter or greater are 6.5 times more likely to develop amblyopia.

Visual outcome and success of amblyopia treatment in unilateral small posterior lens opacities and lenticonus initially treated nonsurgically.

PURPOSE: We sought to assess the success of amblyopia treatment in patients with small posterior lens opacities as well as the factors associated with a good visual outcome. METHODS: This was a retrospective study of patients with posterior lens opacities that initially were thought to be too small in size to warrant cataract surgery. The following variables were examined: cataract type, location, diameter, persistent hyaloid vessel, anisometropia, strabismus, and age of detection. Success of treatment of amblyopia was defined as improvement by at least 0.3 logMAR units. Good visual outcome was defined as 20/40 or better. Amblyopia was treated by glasses, patching, and/or atropine. Patients who failed with conservative treatment or had an increase in cataract size underwent surgery. RESULTS: Forty-eight (91%) of 53 eyes were amblyopic. Thirty amblyopic eyes had pre- and post-treatment Snellen acuities. Twenty (67%) had their visual acuity (VA) improved by 0.3 logMAR units or greater. None of the measured variables were associated with successful amblyopia treatment. Twenty-five (49%) of 51 patients had a final VA of 20/40 or better. The only variable associated with good visual outcome was cataract type: 18 of 25 (72%) posterior subcapsular cataract and 6 of 23 (32%) posterior lenticonus eyes achieved VA of 20/40 or better (P = 0.008). Six patients who went on to have cataract surgery experienced a larger improvement in BCVA (4.50 logMar units +/- 2.52 lines) compared with patients treated without cataract surgery (2.36 logMar units +/- 3.11 lines). DISCUSSION: Amblyopia treatment was successful in most cases. A small group of patients who underwent cataract surgery experienced a greater VA improvement; however, it was not statistically significant. Further studies are needed to determine which patients would benefit from cataract surgery.

Unilateral keratitis following death of a twin as the presenting sign of herpetic infection in a neonate.

Neonatal herpes simplex virus (HSV) manifests as a disease limited to skin, eyes, and/or mucous membranes, central nervous system disease with/without skin involvement, or disseminated infection. Given the high morbidity and mortality of untreated neonatal HSV, early recognition and prompt treatment are important. We report two cases of unilateral HSV keratitis, after Cesarean section, in neonates whose twin had died. Both mothers denied history of HSV. Ophthalmic diagnosis led to full systemic workup and appropriate treatment.