Covid-19 First Wave Impact National Survey for HIV Clinicians by Public Health England (PHE), the British HIV Association (BHIVA) and the Children's HIV Association (CHIVA).

INTRODUCTION: This short report describes the results of a survey that was developed by Public Health England (PHE), the British HIV Association (BHIVA) and the Children's HIV Association (CHIVA) and circulated to all UK national health service HIV providers in the UK following the first wave of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus disease 2019 [COVID-19]) pandemic to assess the impact of the pandemic on HIV clinics. METHODS: The survey was created by BHIVA/CHIVA and PHE and was piloted prior to circulation to all HIV clinics within the UK on 3 July 2020. The survey questions were designed to assess the impact of the first wave of COVID-19 on HIV clinics and lead/senior HIV clinicians. Clinicians' responses were collected between 3 July 2020 and 17 September 2020. The survey responses were collated, and non-statistical analysis was performed. RESULTS: The results of the survey confirmed that services had undergone substantial changes, including a shift from face-to-face consults to predominantly virtual consultations. Some clinicians' responses suggested that the first wave had many negative effects on people living with HIV, including their ability to access mental health services. CONCLUSION: The first wave of COVID-19 caused significant changes to HIV services within the UK. There was a shift toward the use of technology in healthcare, and results from subsequent clinician surveys carried out since the first wave of COVID-19 will reflect the ongoing transformation of care towards a more virtual service.

A longitudinal evaluation of an intensive residential intervention (camp) for 12-16 year olds living with HIV in the UK: evidence of psychological change maintained at six month follow-up.

There are large numbers of young people with HIV globally, the majority of whom have perinatally acquired HIV (PAH). Despite evidence of lower levels of wellbeing in young people with PAH compared to HIV unaffected peers, there are few psychosocial interventions for this population. Residential interventions (camps) for young people with HIV have the potential for enhancing well-being and improving HIV-related outcomes. There have not been any quantitative evaluations of camps for young people with HIV. This study evaluated a week-long intensive residential intervention for 12-16 year olds living with HIV in the UK. A quantitative repeated measures design was used. Forty nine participants completed assessments before and immediately after the intervention (post-intervention) and at six month follow-up (73% retention rate; 28 (57%) female; median age 14 years, IQR 13-15 years). Self-report measures suggested improvements in both HIV knowledge and pro HIV disclosure affect and cognitions post-intervention, maintained at six month follow-up. There were improvements in antiretroviral adherence beliefs from baseline to six month follow-up, and in self-perception from baseline to post-intervention. These changes are important in their own right but may also be mediators of other outcomes such as increased ART adherence and reduced onward HIV transmission risk. The study suggests that brief residential interventions have the potential to facilitate sustained change in psychological outcomes. Research and practice implications are outlined.

Associations of strabismus surgery timing in childhood with mental health: a retrospective cohort study.

PURPOSE: To investigate the incidence of psychiatric diagnoses in relation to strabismus surgery timing among children with an early strabismus diagnosis who underwent surgery in childhood. METHODS: We conducted a retrospective cohort study using TriNetX network data from 2003-2023 on patients diagnosed with strabismus at ≤5 years of age and having strabismus surgery before 18 years of age. Cohort 1 comprised patients who underwent initial strabismus surgery at ≤6 years of age; cohort 2, patients with initial surgical intervention at ≥7 years of age. Incidence of mental health diagnoses from 7 until 18 years of age were compared between cohorts. RESULTS: In cohort 1, 59 of 688 patients (8.6%) of patients were diagnosed with at least 1 mental health disorder versus 123 of 693 patients (17.7%) in cohort 2 (risk ratio [RR] = 2.07; 95% CI, 1.546 to 2.77; P < 0.0001). Gender analysis showed that only males had a statistically significant increased rate of mental health diagnoses in cohort 2 versus cohort 1 (RR = 1.82; 95% CI, 1.284 to 2.577; P = 0.006). An increased risk for specific psychiatric diagnoses was found in cohort 2 versus cohort 1; anxiety disorders (RR = 2.19; 95% CI, 1.225-3.922; P = 0.0065), attention-deficit / hyperactivity disorder (RR = 2.18; 95% CI, 1.499-3.175; P < 0.0001), conduct disorders (RR = 2.81; 95% CI, 1.425-5.556; P = 0.0018), and adjustment disorders (RR = 2.07; 955% CI, 1.103-3.876; P = 0.0204). Depressive disorders showed no statistically significant difference between cohorts (RR = 1.00; 95% CI, 0.419-2.392; P = 0.9974). CONCLUSIONS: Compared with children having early strabismus surgery, those having surgery at a later age after an early strabismus diagnosis at ≤5 years of age may be more likely to experience a mental health disorder during childhood, although it is unclear whether such disorders are a result of delayed surgery or a driver of the decision to opt for surgery rather than continued conservative management.

An Analysis of Pediatric Ophthalmology Content on TikTok.

PURPOSE: To assess pediatric ophthalmology-related information on TikTok (ByteDance). METHODS: The 12 most commonly searched terms from the American Association for Pediatric Ophthalmology and Strabismus website were queried as TikTok hashtags. The top 20 videos for each hashtag were analyzed for views, likes, comments, saves, shares, author status and gender, content, and engagement level ratio (ELR). Subanalysis of the educational videos for quality, understandability and actionability, and medical accuracy using the modified DISCERN (mDISCERN), Patient Education Materials Assessment Tool (PEMAT), and modified Medical Information and Content Index (mMICI) was performed. RESULTS: Analysis of 222 videos revealed a cumulative 191,337,973 views. Patients/families created the most videos (60.4%), followed by optometrists (14.4%), other (laypeople/unknown) (9.0%), ophthalmologists (7.7%), non-ophthalmology physicians (4.5%), and nurses (4.1%). Content was predominantly patient experience (56.8%), followed by educational (25.2%), humor (11.7%), self-promotional (3.6%), procedures (0.9%), other (0.9%), advertisements (0.5%), and career (0.5%). Educational videos had a lower ELR than humorous (3.3 vs 8.2, P < .001) and patient experience (3.3 vs 5.3, P < .001) videos, but more saves than patient experience videos (74 vs 25, P = .009). The mDISCERN scores were greater for videos authored by ophthalmologists (3, P < .001) and optometrists (2.5, P < .001) compared to lay-people (1.5). Ophthalmologist PEMAT understandability scores were greater than non-ophthalmology providers' (95.5% vs 67.4%, P = .002). There was no difference in PEMAT actionability (P = .743) or mMICI scores among the author subgroups (P = .206). CONCLUSIONS: Pediatric ophthalmology content on Tik-Tok ranges in quality and understandability. Additional research is needed to help promote posts created by eyecare providers to ensure evidence-based medical content reaches pediatric patients and their families. [J Pediatr Ophthalmol Strabismus. 2024;61(2):90-97.].

Ocular manifestations in a 2 year-old patient with a DYNC1H1 mutation.

BACKGROUND: Mutations in the DYNC1H1 gene have been linked to multiple neurologic syndromes with a multitude of clinical manifestations, both ocular and non-ocular. Previous case reports have outlined various ocular phenotypes, including cataracts of congenital onset, infantile onset, and adult onset with lack of further ophthalmologic detail. CASE PRESENTATION: Our case report outlines, in more detail, a 24-month-old male with a heterozygous mutation in the DYNC1H1 gene who developed a white, intumescent cataract in his left eye and a posterior subcapsular cataract in his right eye with evidence of progressive axial myopia. CONCLUSIONS: Based on the findings outlined in our case we suggest eye exams at regular intervals during early childhood in patients with DYNC1H1 mutations to screen for amblyogenic ocular pathology and potential rapidly developing cataracts.

Nd:YAG laser posterior capsulotomy performed under general anesthesia in the sitting position: a novel approach.

We present a novel approach for performing an Nd:YAG laser posterior capsulotomy under general anesthesia with the patent in a seated position. We illustrate this approach in 2 cases, a young child and an adult patient with developmental delay. This technique may facilitate YAG capsulotomy in patients who cannot sit for the procedure.

Anger and substance abuse: a systematic review and meta-analysis.

OBJECTIVE: Conduct a systematic review and meta-analysis to evaluate levels of anger among substance users compared to non-user controls and to analyze the possible association between anger and psychoactive substance use (PSU). METHODS: The procedures of this review followed the Meta-Analyzes of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (MEDLINE, EMBASE, BIREME, PsycINFO) were searched. RESULTS: Twelve studies were included in the meta-analysis; 10 used the State-Trait Anger Expression Inventory (STAXI) anger trait subscale and two used the Buss-Perry-Aggression Questionnaire (BPAQ) anger subscale. The sample included 2,294 users of psychoactive substances and 2,143 non-users, all male. The mean difference in anger scale scores between users and non-users was 2.151 (95%CI 1.166-3.134, p ≤ 0.00, inconsistency index [I2] = 98.83) standard deviations. Age and abstinence duration did not moderate the difference in anger between substance users and non-users. CONCLUSION: Users of psychoactive substances had elevated anger scores compared to non-users, which represents a high risk of relapse. It is suggested that PSU treatment programs include intensive anger management modules, focusing on factors such as dealing with daily stressors, family conflicts, frustrations, and problems.

Propionibacterium acnes Endophthalmitis Following Baerveldt Glaucoma Device Implantation.

PURPOSE: The purpose of this study was to report a case of Propionibacterium acnes endophthalmitis in a patient with a Baerveldt glaucoma implant. PATIENTS AND METHODS: An 8-year-old boy presented with left eye pain, extreme photophobia, and acute anterior uveitis >6 months after Baerveldt glaucoma implantation. A diagnosis of P. acnes endophthalmitis was made after a positive culture of the explanted Baerveldt device. RESULTS: Initially, the patient was treated with intravitreal vancomycin and ceftazidime which led to mild early clinical improvement followed by deterioration of findings with recurrence of fibrin at the Baerveldt tube ostium within the anterior chamber. Repeat intravitreal injections were given to include antifungal coverage, along with intracameral moxifloxacin and subconjunctival vancomycin around the Baerveldt reservoir. Symptoms and findings again recurred, ultimately leading to the decision for complete removal of the glaucoma implant along with irrigation of the scleral bed with moxifloxacin. P. acnes was cultured from the extracted implant. The endophthalmitis resolved completely after implant removal. CONCLUSIONS: Despite the introduction of antibiotics into the intravitreal, intracameral, and subconjunctival space surrounding the Baerveldt implant, infection persisted until complete explantation of the device. Early explantation should be considered in glaucoma drainage device endophthamitis secondary to P. acnes.

The Pediatric Examination Assessment Rubric (PEAR) toolkit: reliability study.

BACKGROUND: The Pediatric Examination Assessment Rubric (PEAR) toolkit consists of an examination sheet and rubric designed to assess ophthalmology residents' performance on the pediatric eye examination. The purpose of this study was to evaluate the reliability of the PEAR toolkit. METHODS: Six ophthalmology residents (2 PGY-2, 4 PGY-3) at a single ACGME-accredited US program participated in 11 video-recorded pediatric ophthalmology patient encounters. Two pediatric ophthalmologists reviewed the videos and the residents' examination sheets to complete a PEAR evaluation. The inter-rater reliability of the rating for each of the 12 examination skills evaluated using PEAR was determined using kappa statistics, and reliability strength was categorized based on published guidelines (≤0, poor; 0-0.20, slight; 0.21-0.40, fair; 0.41-0.60, moderate; 0.41-0.60, substantial; 0.81-1.00, almost perfect). RESULTS: Eleven video encounters were completed. Of the 12 examination skills evaluated using PEAR, 9 had kappa scores with strengths of moderate to almost perfect reliability. Two examination skills, Worth 4-Dot and alignment, showed fair reliability. A kappa score could not be calculated for stereoacuity because of the lack of variability among the evaluators' raw scores. CONCLUSIONS: In our small sample of residents from a single institution, the PEAR toolkit showed inter-rater reliability.

Gender disparities among United States academic pediatric ophthalmologists: an analysis of publication productivity, academic rank, and NIH funding.

PURPOSE: To investigate gender disparitie among pediatric ophthalmologists in academic rank, publication productivity, and National Institutes of Health (NIH) funding. METHODS: In this cross-sectional analysis of pediatric ophthalmologists at 113 US academic programs, data on gender, residency graduation year, and academic rank were obtained from institutional websites between January 2019 and March 2019. The Scopus database was used to calculate h-indices and m-quotients. The NIH Research Portfolio Online Reporting Tool was used to determine NIH funding. RESULTS: We identified 389 pediatric ophthalmologists: 194 women (49.9%) and 195 men (50.1%). A binomial logistic regression model, which included career length as an independent variable, showed proportions of women to men were similar across all academic ranks (assistant professor, 64.4% vs 46.2% [P = 0.738]; associate professor, 21.7% vs 19.0% [P = 0.357]; full professor, 13.9 vs 34.9% [P = 0.119]). Women had a lower median h-index (5.0 vs 8.0 [P = 0.008]) and a shorter median career duration (12.5 vs 25.0 years [P < 0.001]), but a similar median m-quotient (0.5 vs. 0.5; P = 0.525). Among pediatric ophthalmologists who received NIH funding (20 women vs. 27 men; P = 0.826), the overall median grant-funding total for women was $804K (interquartile range (IQR) 5.0M, mean $3.8M) compared to men, $2.2M (IQR, 4.0M; mean, $3.7M; P = 0.328). CONCLUSIONS: The shorter career duration for women likely contributes to the difference in overall h-indices between genders, as m-quotients were similar. The m-quotient should be used over the h-index when comparing academic productivity across genders when disparities in career length exist.

Incorporation and immunogenicity of cleaned bovine bone in a sheep model.

This study was conducted to determine if a novel cleaning process could extract antigenic material from bovine bone thereby improving incorporation. Cleaned bovine xenograft, untreated bovine xenograft and sheep allograft were implanted into the tibia of mature sheep for 12 and 24 weeks. Inflammation, bone integration and immunological reactions were evaluated via standardized assays. Cleaned bovine bone dowels induced significantly lower inflammatory responses (p < 50.05) when compared to traditionally processed xenograft. Bone integration, measured by in situ biomechanics, was not different between cleaned bovine bone and allograft controls (p = 0.96). A transient antibody response was observed for non-treated xenografts although this response abated by 3 months.

Congenital glycosylation disorder: a novel presentation of coexisting anterior and posterior segment pathology and its implications in pediatric cataract management.

We report a case exhibiting the coexistence of anterior and posterior segment pathology in the same eye secondary to a congenital disorder of glycosylation resulting from a DPAGT1 gene mutation. This case details a novel gene mutation in a male infant found to have bilateral congenital cataracts, removed at 6 and 7 weeks of life, only to uncover bilateral retinal and optic atrophy. Our report highlights issues of surgical timing for syndrome-related pediatric cataracts, given the risks related to secondary glaucoma versus deprivation amblyopia, in an infant born with both cataracts and vision-limiting posterior segment pathology.

Immunologic analyses of bovine bone treated with a novel tissue sterilization process.

BACKGROUND: This study evaluates the efficacy of removal of xeno-antigens from bovine bone using a patented BioCleanse process for decellularization of allograft tissues for clinical implantation. BioCleanse deploys a combination of chemicals and several high pressure rinses to achieve standardized sterility assurance levels. This method produces sterile grafts without reducing allograft bone biomechanical properties and effectively removes cells, lipids, and other sources of antigenic material from human allografts for clinical use. METHODS: In this investigation, BioCleanse is evaluated for its potential in removing xenograft antigens from bovine bone grafts followed by immunologic evaluation in the subcutaneous pouch of immunocompetent rats. The alpha-galactosyl (alpha-gal) epitope with the structure Galalpha1-3Galbeta1-4GlcNAc-R constitutes a critical component of xenoantigens and its removal using BioCleanse from bovine bone was compared with tissue levels of unprocessed bone. The relative degree of antigen removal was also determined through measuring the pro-inflammatory cytokine, tumor necrosis factor (TNF)-alpha, and through the use of histologic grading of cellular infiltrates into bone. RESULTS: Compact cortical bone inhibited immune cell migration but cancellous bone demonstrated cellular increase and bone resorption in the untreated control group. The alpha-gal xenoantigen level was significantly lower in both cortical (P < 0.001) and cancellous bone (P < 0.001) compared with controls. TNF-alpha levels were significantly (P < 0.001) reduced compared with untreated controls when human acute monocytic leukemia cells were exposed to cortical or cancellous bone. CONCLUSIONS: BioCleanse effectively removed xenoantigens and inflammatory markers justifying a follow up study in primates to determine these benefits in a model that is primed with preformed xeno-antibodies responsible for hyperacute rejection in hard tissues.

Parent attitudes toward resident involvement in their child's strabismus surgery.

PURPOSE: To explore patterns in parents' understanding and preferences related to ophthalmology resident participation in their child's strabismus surgery. METHODS: Over a 4-week period, a survey was distributed at a suburban, academic eye center to English-speaking parents of children with strabismus who have not previously undergone, or were not being scheduled for, strabismus surgery. RESULTS: All of the 64 eligible parents participated in the survey. For a resident to assist or perform the surgery, 80% and 97% of parents, respectively, indicated it was important or extremely important to be asked permission beforehand; 69% indicated the attending surgeon should ask permission for the resident to perform the surgery, whereas only 11% believed a standard written consent was sufficient. Of the 64 respondents, 77% indicated that they would agree to a resident assisting with their child's operation; 36% would agree to a resident performing the surgery. CONCLUSIONS: Nearly all parents in our study indicated that they would want to be informed of resident involvement by the attending surgeon. The vast majority would consent to having an ophthalmology resident assist in their child's strabismus surgery, and more than one-third would consent to having the resident perform their child's strabismus surgery. Obtaining informed consent prior to resident involvement increases transparency and highlights the importance of ophthalmology residency education.

Developing and validating a simple and cost-effective strabismus surgery simulator.

PURPOSE: To demonstrate that a nonbiologic strabismus surgery simulator is not inferior to a biologic wet lab for teaching the key steps of strabismus surgery. METHODS: A total of 41 medical students were randomly assigned to one of two groups: biologic wet lab or nonbiologic simulator. The students trained according to the group's protocol then participated in a recorded final assessment using a realistic strabismus surgery model. Two independent reviewers, masked to training method, graded the video recordings using three scoring systems: the International Council of Ophthalmology Approved-Ophthalmology Surgical Competency Assessment Rubric for Strabismus Surgery (ICO-OSCAR), the Global Rating Scale of Objective Structured Assessment of Technical Skills (OSATS), and the Alphabetic Summary Scale (ASS). RESULTS: The primary endpoint, total ICO-OSCAR score, was 36.7 ± 2.2 for the wet lab group and 36.0 ± 2.7 for the nonbiologic group (difference in means, -0.7; one-sided 95% CI, -2.0, ∞). The lower bound of the one-sided 95% confidence interval for the difference in mean scores was -2.0, which was greater than the a priori noninferiority margin of -5.0 points. The secondary outcome measure, mean total OSATS score and ASS score, revealed no statistical significant differences between training methods (P = 0.73 and P = 0.44, resp.). CONCLUSIONS: The simple, nonbiologic strabismus surgery simulator is not inferior to the biologic wet lab with respect to total ICO-OSCAR score. It is a portable, inexpensive, and effective training tool for novice surgeons.

Anger and substance abuse: a systematic review and meta-analysis

Objective: Conduct a systematic review and meta-analysis to evaluate levels of anger among substance users compared to non-user controls and to analyze the possible association between anger and psychoactive substance use (PSU). Methods: The procedures of this review followed the Meta-Analyzes of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (MEDLINE, EMBASE, BIREME, PsycINFO) were searched. Results: Twelve studies were included in the meta-analysis; 10 used the State-Trait Anger Expression Inventory (STAXI) anger trait subscale and two used the Buss-Perry-Aggression Questionnaire (BPAQ) anger subscale. The sample included 2,294 users of psychoactive substances and 2,143 non-users, all male. The mean difference in anger scale scores between users and non-users was 2.151 (95%CI 1.166-3.134, p ≤ 0.00, inconsistency index [I2] = 98.83) standard deviations. Age and abstinence duration did not moderate the difference in anger between substance users and non-users. Conclusion: Users of psychoactive substances had elevated anger scores compared to non-users, which represents a high risk of relapse. It is suggested that PSU treatment programs include intensive anger management modules, focusing on factors such as dealing with daily stressors, family conflicts, frustrations, and problems.

A comparison of Icare PRO and Tono-Pen XL tonometers in anesthetized children.

BACKGROUND: Tonometry in the anesthetized child, vital for evaluating known or suspected glaucoma, remains limited to tonometers capable of supine recording. The Icare PRO measures intraocular pressure (IOP) in the sitting or supine patient. The purpose of this study was to compare Icare PRO and Tono-Pen tonometry during examination under anesthesia in eyes of supine children with normal eyes and glaucoma and/or corneal pathology. METHODS: In this prospective study of children undergoing examination under anesthesia, IOP was recorded in both eyes with Icare PRO and Tono-Pen immediately after mask anesthesia induction, with instrument order randomized. RESULTS: A total of 100 eyes of 50 children (median age, 58 months) were included. IOP range was 6-50 mm Hg by Icare PRO and 6-53 mm Hg by Tono-Pen. Mean IOP measured by Tono-Pen (18.9 ± 7.5) was higher than that measured by Icare PRO (16.7 ± 7.1 mm Hg) by 2.2 mm Hg (P < 0.001). The presence of corneal edema was associated with IOP measurements higher by Tono-Pen than by Icare PRO (mean difference, 8.4 mm Hg). When eyes with corneal edema were excluded from analysis, there was no correlation between central corneal thickness and the difference in IOP between the two instruments. CONCLUSIONS: IOP in eyes of supine children under anesthesia measured approximately 2 mm Hg higher by Tono-Pen than Icare PRO and this difference was greater in eyes with frank corneal edema. Icare PRO may become a valuable tool for tonometry in supine infants and children, but a confirmatory test should be considered in eyes with corneal edema.

Comparison of SureSight autorefractor and plusoptiX A09 photoscreener for vision screening in rural Honduras.

PURPOSE: To evaluate the SureSight autorefractor and compare it to the plusoptiX A09 photoscreener in the detection of amblyopia risk factors in a cohort of Honduran children examined during medical mission work and to assess the utility of both devices in the rural setting. METHODS: The medical records of patients who had undergone SureSight autorefractor screening, plusoptiX photoscreening, and a gold standard pediatric ophthalmology examination, including cycloplegic refraction, during a recent medical mission trip to Honduras were retrospectively reviewed. RESULTS: A total of 216 children were examined. Of these, 9 (4%) were found to have amblyopia risk factors based on the current referral criteria of the American Association for Pediatric Ophthalmology and Strabismus on ophthalmological examination. The plusoptiX was found to have 89% sensitivity and 80% specificity; the SureSight, using manufacturer's referral criteria, was found to have sensitivity of 89% and specificity of 71%. CONCLUSIONS: Both devices were found to be reliable vision screening devices when used on the general population of remote villages in Honduras, although the specificity of the plusoptiX A09 was higher.

Cupping reversal in pediatric glaucoma--evaluation of the retinal nerve fiber layer and visual field.

PURPOSE: To identify optic nerve head (ONH) cupping reversal and associated optical coherence tomography (OCT) and Humphrey visual field changes in pediatric glaucoma. DESIGN: Retrospective observational case series. METHODS: Sequential surgical cases of juvenile open-angle glaucoma (OAG) or primary congenital glaucoma (PCG) with sustained postoperative intraocular pressure (IOP) reduction. Group 1 had preoperative and postoperative ONH photographs and OCT; Group 2 had preoperative clinical ONH assessment and postoperative imaging. Cupping evaluation was confirmed by masked glaucoma and neuro-ophthalmology specialists. RESULTS: Of 80 cases, 9 eyes (9 children) met criteria for Group 1; 24 eyes (19 children) met criteria for Group 2. Group 1: Five of 9 eyes (56%) demonstrated cupping reversal, with preoperative vs postoperative mean IOP 34.2 ± 6.6 mm Hg vs 10.6 ± 4.1 mm Hg (P < .00001) and mean average retinal nerve fiber layer (RNFL) 71.0 ± 30 µm vs 62.8 ± 24 µm (P = .4), respectively. RNFL was stable in 4 of 5 eyes (all juvenile OAG), but thinned (Δ = -41 µm) in 1 eye with PCG. Humphrey visual fields (reliable in 2 of 3 eyes) showed no significant change. Group 2: Fourteen of 24 PCG eyes (58%) demonstrated cupping reversal, with preoperative vs postoperative mean IOP 36.1 ± 8.9 mm Hg vs 13.3 ± 2.1 mm Hg (P < .00001). Two eyes had thin RNFL postoperatively despite healthy-appearing ONH. Postoperative RNFL showed statistically significant linear correlation with preoperative (but not postoperative) cup-to-disc ratio. Limitations include small numbers, few reliable Humphrey visual fields, and absent preoperative imaging (Group 2). CONCLUSION: Some eyes with IOP reduction and ONH cupping reversal show continued RNFL thinning postoperatively. The preoperative ONH cup-to-disc ratio predicted the postoperative RNFL better than the postoperative "reversed and smaller" cup-to-disc ratio. Cupping reversal in pediatric glaucoma may not predict improved ONH health and deserves further study.

Degradation of swept-parameter VEP responses by neutral density filters in amblyopic and normal subjects.

PURPOSE: To determine whether objective visual function, measured by swept-parameter visual evoked potential (sVEP), is preferentially degraded by neutral density filtration (NDF) in normal control and fellow eyes compared to amblyopic eyes, and to determine whether the response to NDF is a function of stimulus type, using grating and vernier stimuli. METHODS: Monocular Snellen acuity and both grating and vernier sVEP responses were measured in each eye of 23 children or adolescents with amblyopia and 21 visually and neurologically normal children or adolescents. Acuity and sVEP responses were measured with and without a 2.0 log unit neutral density filter before the viewing eye. RESULTS: Suprathreshold sVEP grating responses were more sensitive than vernier to degradation by amblyopia in the unfiltered state and to NDF-induced preferential degradation of responses from fellow and normal control eyes. For threshold measurements, on the other hand, vernier responses were more sensitive to degradation by amblyopia in the unfiltered state and to NDF-induced preferential depression. Threshold vernier responses of amblyopic eyes were paradoxically enhanced by NDF. CONCLUSIONS: Neutral density filtration causes preferential degradation of both threshold and suprathreshold sVEP responses in normal control eyes and fellow eyes of amblyopes, compared to amblyopic eyes. The degradation is stimulus specific and dependent upon whether threshold or suprathreshold responses are measured. Grating responses are more likely to identify suprathreshold abnormalities, while vernier stimuli are more likely to detect threshold abnormalities. These findings may be used to optimize the stimulus parameters and design of future studies utilizing evoked potential techniques in amblyopic subjects.