Association of Maternal and Paternal Astigmatism With Child Astigmatism in the Hong Kong Children Eye Study.

Importance: Parental astigmatism is a factor associated with risk for development of child astigmatism; however, the magnitude of the association has not been determined. Objective: To determine the association between parental and child astigmatism. Design, Setting, and Participants: This population-based, cross-sectional study included participants from familial trios, each comprising a child aged 6 to 8 years and both parents, recruited from the Hong Kong Children Eye Study. No restriction criteria were set on the children in terms of refractive status. Data were analyzed from February to June 2022. Exposures: Cycloplegic autorefraction and autokeratometry were conducted on the children, whereas noncycloplegic autorefraction and autokeratometry were conducted on their parents. The children were categorized into 6 groups on the basis of the severity of astigmatism of both parents. Information on parental education, family income, and children's outdoor and near work time were obtained by questionnaires. Main Outcomes and Measures: The primary outcome was the odds of child astigmatism among the 6 categories of children. Associations of factors with child astigmatism were evaluated by logistic regression analyses. Results: A total of 17 124 participants from 5708 trios (2964 boys and 2754 girls) at a mean (SD) age of 7.32 (0.87) years, and 11 416 parents were examined. Astigmatism of 1.0 D or greater in both parents was associated with greater odds of refractive astigmatism (RA) (odds ratio [OR], 1.62; 95% CI, 1.15-2.26) and corneal astigmatism (CA) (OR, 1.94; 95% CI, 1.50-2.50) in the child. The respective ORs increased to 3.10 (95% CI, 1.34-7.21) and 4.31 (95% CI, 1.76-10.55) when both parents had astigmatism 2.0 D or greater. Higher parental astigmatism conferred higher risks for both RA and CA in children (P for trend <.001). Parental astigmatism was significantly associated with greater odds of corresponding child astigmatism (maternal RA: OR, 0.76; 95% CI, 0.68-0.84; paternal RA: OR, 0.82; 95% CI, 0.74-0.91; maternal CA: OR, 1.70; 95% CI, 1.51-1.93; paternal CA: OR, 1.33; 95% CI, 1.19-1.49). Conclusions and Relevance: The findings of this cross-sectional study suggest that parental astigmatism may confer an independent and dose-dependent association with child astigmatism. Children with parents with astigmatism should have early eye examinations for timely detection of astigmatism to facilitate age-appropriate vision correction and visual development.

Nerve injuries in orthopaedics: is there anything more we need to tell our patients?

BACKGROUND: Perioperative nerve injuries are uncommon in most elective orthopaedic operations. However, despite the low incidence, patients tend to be most unforgiving when this complication occurs. The present study aims to determine the adequacy of the consent process, and seeks to identify deficiencies. METHODS: All elective patients who experienced a perioperative nerve palsy between 1996 and 2003 were retrospectively identified. A telephone questionnaire assessed recall of the consent and risks discussed. Patients were asked what they would have liked to have been advised, and whether this would affect their decision for operation. RESULTS: Twenty-four of the 32 patients were contacted. From the questionnaire, 66.7% recalled discussing the risks of the operation. 66.7% would have liked to have discussed, in particular, risk of nerve palsy at time of consent. However, 83.3% of patients, knowing fully the risk of nerve injury, would still have proceeded with the operation. Of the 24 cases, only three had documentation of the risks discussed during consent. CONCLUSION: The need to adequately provide informed consent for nerve dysfunction is present. The present study demonstrates a dilemma between the provision of information and the creation of fear in the minds of recipients of surgery.