Oculocardiac Reflex During ROP Exams.

PURPOSE: Reducing physiologic stress including bradycardia during staging eye exams for retinopathy of prematurity (ROP) is desirable. We observed heart rate change during routine retinopathy of prematurity eye examinations and compared the response with our ongoing study of oculocardiac reflex (OCR) elicited by uniform EOM tension during strabismus surgery. PATIENTS AND METHODS: Electrocardiograph was prospectively monitored during ROP exams featuring indirect ophthalmoscopy with Alfonso lid speculum and see-through scleral depressor without topical anesthesia. Clinical data were retrieved from ROP-Check software. OCR was defined as maximally changed heart rate (HR) as a percent of baseline. Strabismus surgery patients under general anesthesia served as controls. RESULTS: From 10/2017 to 9/2020, 281 infants had ROP exams, and the median OCR was 55.9% of baseline HR (IQR 41.4% to 72.6%), the kurtosis 0.93 and skewness 1.01 representing a drop from HR 169 ± 16 bpm to 102 ± 39 bpm. In comparison, 1493 adult and pediatric strabismus surgery patients had less OCR median bradycardia 87.8% (IQR 72-98%), kurtosis 1.60 and skewness -1.18. ROP %OCR correlated with birth gestational age (%OCR = 2.5 (GA) - 11, r(279)=0.33, p<0.01) and with birthweight (%OCR = 0.02 (BW) + 38, r(279) =0.35, p<0.01). The duration of bradycardia induced by ROP exam averaged 92 ± 34 seconds (range 34-240 seconds). CONCLUSION: Bradycardia is common during eye exams in the smallest premature infants with greater degree, more rapid onset and longer duration than OCR during strabismus surgery.

Direct OPTOS Nerve Size Determination of Prevalent Optic Nerve Hypoplasia in Alaska.

BACKGROUND: Optic nerve hypoplasia (ONH), one of the most common causes of pediatric blindness in developed countries, has been difficult to directly quantify. We sought to measure optic nerve size in Alaskan pediatric patients with optic nerve hypoplasia using ultra-widefield fundus imaging. METHODS: Adult and pediatric patients underwent conventional ultra widefield fundus imaging (OPTOS, Dunfermline, Scotland) with manual image processing to determine optic nerve size validated against refractive error and nystagmus and compared to optical spectral domain tomography. De-identified cases were then compared relative to visual acuity and birth prevalence. RESULTS: In Alaska's only pediatric ophthalmology outreach clinic, 108 cases of ONH less than 20 years old were clinically identified with 80 having ultra-widefield analysis. Median horizontal optic nerve diameter for 135 normals was 1.70 (95% C.I. 1.49, 2.14) whereas in patients clinically diagnosed with optic nerve hypoplasia was 1.23 (95% C.I 0.38, 1.45). Visual acuity (20/y) was related to horizontal optic nerve diameter (x) by y = 187 x-4.1. Horizontal nerve diameter h could be estimated from vertical nerve diameter v by h = 0.73v + 0.3 even in nystagmus patients. From 108 with ONH, 6 had threshold retinopathy of prematurity, 12 profound nystagmus, 32 legally blind, 6 with septo-optic dysplasia, and 5 with fetal alcohol syndrome. ONH is very prevalent in Alaska occurring at least 8-10 per 10,000 births. CONCLUSION: Compared to vertical diameter, horizontal diameter was more distinctive of optic nerve hypoplasia and more perturbed by nystagmus. Both were independent of refractive error. When hand-held, spectral domain OCT is not convenient, ultra-widefield fundus analysis is recommended for direct estimation of optic nerve size in children and adults. Optic nerve hypoplasia is prevalent in Alaskan children.

The Positive Predictive Value of Smartphone Photoscreening in Pediatric Practices.

PURPOSE: To compare smartphone photoscreening with other commercial objective screeners for amblyopia screening for young children. METHODS: Ten pediatricians in four practices employed Nokia 1020 smartphones (Espoo, Finland) with single-axis Gobiquity software (Scottsdale, AZ) during well-child visits. Outcomes of confirmatory pediatric ophthalmology examinations were prospectively compared using American Association for Pediatric Ophthalmology and Strabismus uniform standards. RESULTS: Five percent of 6,310 in-office screenings were referred: 25% for high anisometropia, 31% for hyperopia, and 15% for myopia. The positive predictive value (PPV) in 217 follow-up examinations was 68% (95% confidence interval: 62% to 74%) by 2013 age-stratified standards and 77% (confidence interval: 71% to 83%) by 2003 American Association for Pediatric Ophthalmology and Strabismus standards. The follow-up rate was 65%. CONCLUSIONS: Smartphone photoscreening had PPV comparable with other commercial objective screeners. Simple, valid photoscreeners should help pediatricians achieve widespread compliance with screening guidelines to reduce the burden of pediatric amblyopia vision impairment. [J Pediatr Ophthalmol Strabismus. 2018;55(6):393-396.].

Outpatient, Wide-Field, Digital Imaging of Infants With Retinopathy of Prematurity.

Eight infants were closely monitored for retinopathy of prematurity (ROP) while in the neonatal intensive care unit (NICU); two required laser therapy. After discharge from the NICU, they had outpatient examination with dilated, scleral depressed ROP staging, and each had digital widefield retinal imaging (Optos, Dunfermline, United Kingdom) without lid speculum, or with lid speculum if not cooperative. Images were shared remotely using ROP-Check software (Glacier Medical Software, Anchorage, AK), from which ophthalmologists made clinical impressions. The images did not afford clear view of maturity to the ora serrata; however, posterior zone 3 was viewed, and confirmation that each eye did not need therapy was consistent. Outpatient wide-field retinal imaging may help facilitate telemedicine for ROP. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:494-497.].