Computer-assisted evaluation of retinal vessel tortuosity in children with sickle cell disease without retinopathy.

OBJECTIVE: We assessed the predictive efficacy of automatically quantified retinal vascular tortuosity from the fundus pictures of patients with sickle cell disease (SCD) without evident retinopathy. METHODS: Retinal images were obtained from 31 healthy and 31 SCD participants using fundus imaging and analyzed using a novel computational automated metric assessment. The local and global vessel tortuosity and their relationship with systemic disease parameters were analyzed based on the images. RESULTS: SCD arteries had an increased local tortuosity index compared to the controls (0.0007 ± 0.0019 vs. 0.0006 ± 0.0014, p = 0.019). Furthermore, the SCD patients had wider vessel caliber mainly in the arteries (14.68 ± 5.3 vs. 14.06 ± 5.3, p < 0.001). The SCD global tortuosity did not differ significantly from that of the controls (p = 0.598). The female participants had significantly reduced retinal vessel tortuosity indices compared to the male participants (p = 0.018). CONCLUSION: Retinal arterial tortuosity and caliber were reliable and objective measures that could be used as a non-invasive prognostic and diagnostic indicator in sickle cell retinopathy. Further studies are required to correlate these local vascular parameters to systemic risk factors and monitor their progression and change over time.

Optical Coherence Tomography Angiography of Macular Microangiopathy in Children With Sickle Cell Disease.

In this study, we identified the presence of sickle cell maculopathy and determined correlations between hemolysis indicators and systemic and ocular manifestations in children with sickle cell disease (SCD). Thirty-three patients with SCD 5 to 18 years of age underwent optical coherence tomography angiography (OCTA) as part of a thorough eye examination. The hematological indices and clinical data (hemoglobin, fetal hemoglobin, mean corpuscular volume, and frequency of sickle cell-associated complications and therapy) were collected. The SCD group contained 33 patients (66 eyes), and the control group contained 36 healthy participants (72 eyes). The SCD group had significantly thinner parafoveal thickness ( P =0.041) and significantly smaller parafoveal volume ( P =0.041) than the controls. The SCD group had lower deep capillary plexus density than the controls ( P =0.029). The SCD group had significantly smaller flow areas than the controls ( P <0.001). The foveal avascular zone (FAZ) perimeter, foveal density, and FAZ area in the entire retina did not differ significantly between the groups ( P >0.05). The platelet level was negatively correlated with parafoveal and perifoveal thickness and density. OCTA detected early macular microvascular changes in children and adolescents with asymptomatic SCD.

Optic disc characteristics on digital fundus photographs in Saudi children.

OBJECTIVES: To assess the optic disc parameters in healthy Saudi children. METHODS: This study recruited 85 children who were medically free, born full-term, cooperative, and aged 3-17 years. The children underwent a thorough ophthalmological examination (visual acuity, refraction post-cycloplegia, fundus photography) at the ophthalmology clinic of King Abdulaziz University Hospital, Jeddah. Fundus photographs obtained by a fundus camera were evaluated by the Retinal Size Tool program. RESULTS: Forty-eight participants were male (56.5%). The mean birth weight was 2.97±0.8 kg and the median gestational age was 39 weeks (range, 37-40 weeks). The median areas of the neuroretinal rim, cup, and optic disc were 1.82 mm2 (range, 0.84-2.83 mm2), 0.47 mm2 (range, 0.18-1.25 mm2), and 2.33 mm2 (range, 1.15-3.52 mm2), respectively. The older age group had smaller neuroretinal areas compared to the younger age groups. The variables demonstrated no apparent correlation to axial length, refraction, or birth parameters. The cup size increased together with the optic disc (r=0.659, p<0.001). Sex and refraction did not correlate with any of the studied factors. CONCLUSION: This study yielded normative data for the optic disc parameters of healthy Saudi children. The data can be used as a reference in the pediatric ophthalmology clinic to aid the identification of optic disc abnormalities.

Pediatric optic nerve and globe measurements on magnetic resonance imaging: establishing norms for children.

BACKGROUND: Normal optic nerve diameter (OND) and optic nerve sheath diameter (ONSD) may be beneficial for describing optic nerve pathway abnormality reflecting increased intracranial pressure. Nonetheless, magnetic resonance imaging (MRI) measurement of the normal ONSD range and its associations with clinical factors and eyeball transverse diameter (ETD) are not well established in children. PURPOSE: To establish normal OND, ONSD, ETD, and OND/ONSD and ONSD/ETD measurements in children and their associations with age and sex. MATERIAL AND METHODS: We evaluated and analyzed 336 brain MRI studies of children aged 0.5 months to 18 years. We measured a total of 672 optic nerves. The OND and ONSD were measured 1 cm anterior to the optic foramina and 3 mm behind the optic disc on an axial T2 sequence. RESULTS: The mean OND 3 mm and 1 cm, ONSD 3 mm and 1 cm, and ETD were 0.23 ± 0.05 mm and 0.16 ± 0.04 mm, 0.53 ± 0.08 mm and 0.38 ± 0.06 mm, and 2.3 ± 0.13, respectively. Only ONSD 1 cm was independent of age (P = 0.247). ONSD 3 mm and ETD were significantly wider in boys compared to girls and significantly influenced by age (both P < 0.001). Age at scan and ETD were significantly correlated (P < 0.001). CONCLUSION: We established MRI-based OND, ONSD, ETD, and ONSD/ETD and OND/ONSD ratio normative values in children, which can be helpful in pediatric populations with disease.

YouTube as a source of information for retinopathy of prematurity in the Arabic language.

Retinopathy of prematurity (ROP) is a leading cause of blindness in infants thus it is important to raise awareness about this disease. As online platforms are a popular source of medical information; the purpose of this study is to evaluate the credibility of the content of YouTube videos on ROP in the Arabic language. The first 40 relevant videos were included and were independently reviewed by two ophthalmologists employing six assessment tools: reliability, accuracy, quality, comprehensiveness, overall viewer experience, and usefulness. Out of the 40 videos that were analysed, only 29 were considered useful. The mean DISCERN score of the videos was 32 indicating poor quality. Furthermore, 70% of the videos were completely accurate, but only 5% were fully comprehensive. Regarding the global quality score, only four videos were of excellent quality/flow (10%), while 15 were generally poor with the poor flow (37.5%). Viewer experience was assessed as fair to very poor in 22 videos (55%). The overall quality of the content in YouTube videos was poor, rendering this platform an unreliable source of information about ROP. However, given its high level of engagement, the medical community could hone its potential for raising awareness about ROP by creating entertaining useful content.

Optical coherence tomography angiography evaluation of retinal and optic disc alterations in children with type 1 diabetes without retinopathy.

PURPOSE: To determine the earliest characteristics of retinal and optic disc alterations in diabetic children without diabetic retinopathy (DR) changes by using optical coherence tomography angiography (OCTA). SETTINGS AND DESIGN: This was a prospective, non-interventional case-control study that involved 25 patients with type 1 diabetes mellitus (T1DM) without clinical signs of DR and a demographically similar group of 25 healthy children as the control. METHODS: The retina and optic disc were examined using OCTA. STATISTICAL ANALYSIS USED: Correlations between the OCTA parameters and clinical predictors were evaluated. RESULTS: Twenty-five patients (median age: 14 years, interquartile range [IQR]: 13-15.9 years; 12/25 [48%] girls) with T1DM and 25 age-matched controls were enrolled. The patients had a tendency toward thinner fovea (232.5 Symbolm) as compared to the controls (244.3 Symbolm) (P = 0.142). Superficial vascular density was significantly lower in the DM group compared to the controls (48.90 ± 2.3 vs. 50.91 ± 3.1, P = 0.015). However, no such differences were observed at deeper vascular densities. The patients also had lower whole-disc (48.65 vs. 50.21, P = 0.029), disc interior (49.14 vs. 52.11, P = 0.044), superior (50.67 vs. 53.45, P = 0.039), and peripapillary capillary densities (50.49 vs. 52.68, P = 0.033). There was no statistical correlation between retinal/optic disc angiography parameters and clinical predictors. CONCLUSION: In diabetic children without visual impairment or DR, signs of microvasculopathy were found in the superficial macular vascular density and inside the disc.

Retinal Detachment Following Cataract Surgery: A Systematic Review and Meta-analysis of Incidence, Preoperative Risk Factors, and Postoperative Complications.

Cataract surgery is the most common surgical operation in the developed world, for treating cataracts, currently the leading cause of blindness worldwide. Retinal detachment (RD) is a potentially sight-threatening adverse effect of cataract surgery. The overall RD case numbers are high due to the common practice of cataract surgery. The Medline, Scopus, and Directory of Open Access Journals databases were searched for relevant articles using the keywords (phacoemulsification OR cataract surgery) AND (retinal detachment, detached retina). The included studies involved 5,480,448 patients, where 36,886 had RD (pooled incidence: 0.66 events per 100 patients, 95% CI 0.43 to 1.00). Male patients had significantly higher odds of developing RD than female patients (odds ratio = 1.73, 95% CI 1.68 to 1.78, P < 0.001). The RD incidence rate across locations was not significantly different. RD is one of the most significant complications following cataract surgery. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Normative optical coherence tomography reference ranges of the optic nerve head, nerve fiber layer, and macula in healthy Saudi children.

OBJECTIVES: To use the Cirrus high-definition (HD)-OCT to establish normative data for the macula and optic disc in healthy Saudi children and to examine the effect of age and gender on these parameters. METHODS: This retrospective study was carried out at King Abdulaziz University Hospital (KAUH), Saudi Arabia from November 2022 to April 2023. The study involved 135 full-term and healthy Saudi children aged 4-18 years who were evaluated at the KAUH ophthalmology clinic. Detailed demographic and ocular disease history data were obtained from the patients' medical records. The main outcome measures of the study included measurements of retinal nerve fiber layer (RNFL) thickness, macular thickness, and optic nerve head (ONH). RESULTS: The mean macular volume was 9.9 mm3, the mean macular thickness was 275.9 µm, and the mean central subfield thickness was 240.6 µm. There was no significant association between age and the macular values, except for the superior inner macula. Boys had significantly thicker central macula than girls, while the RNFL quadrants were not different between age groups and genders. The mean values for RNFL thickness, disc area, rim area, and cup volume were 93.9 µm, 2 mm2, 1.6 mm2, and 0.3 mm3, respectively. The vertical ratio of cup to disc was 0.4. CONCLUSION: Normative values for macular and optic nerve measures among Saudi children were established using the Cirrus HD-OCT device to serve as a reference.

Validation of three weight gain-based algorithms as a screening tool to detect retinopathy of prematurity: A multicenter study.

Purpose: Screening guidelines for retinopathy of prematurity (ROP) are updated frequently to help clinicians identify infants at risk of type 1 ROP. This study aims to evaluate the accuracy of three different predictive algorithms-WINROP, ROPScore, and CO-ROP-in detecting ROP in preterm infants in a developing country. Methods: This retrospective study was conducted on 386 preterm infants from two centers between 2015 and 2021. Neonates with gestational age ≤30 weeks and/or birth weight ≤1500 g who underwent ROP screening were included. Results: One hundred twenty-three neonates (31.9%) developed ROP. The sensitivity to identify type 1 ROP was as follows: WINROP, 100%; ROPScore, 100%; and CO-ROP, 92.3%. The specificity was 28% for WINROP, 1.4% for ROPScore, and 19.3% for CO-ROP. CO-ROP missed two neonates with type 1 ROP. WINROP provided the best performance for type 1 ROP with an area under the curve score at 0.61. Conclusion: The sensitivity was at 100% for WINROP and ROPScore for type 1 ROP; however, specificity was quite low for both algorithms. Highly specific algorithms tailored to our population may serve as a useful adjunctive tool to detect preterm infants at risk of sight-threatening ROP.

Adherence to Follow-Up and the Related Factors of Paediatric Glaucoma at a Tertiary Care Centre in Western Saudi Arabia.

INTRODUCTION: Glaucoma is a main cause of blindness globally. In Saudi Arabia, congenital glaucoma is believed to affect 1 in every 2500 live births. In this study, we identified the adherence and evaluated the factors associated with non-compliance (non-adherence) to recommended follow-up appointments at King Abdulaziz University Hospital, a tertiary centre in Jeddah, Saudi Arabia. METHODS: The medical records of paediatric patients diagnosed with glaucoma between 2009 and April 2022 were reviewed retrospectively. Demographic information, visit dates, scheduled follow-ups, and specific patients' glaucoma histories were all extracted from the records. Patients were categorized as adherent, non-adherent, or lost to tertiary follow-up (LTTF). RESULTS: Of 91 patients, 52 (57.1%) were adherent, 20 (22%) were non-adherent, and 19 (20.9%) were LTTF. Most adherent patients were Saudi (59.3% adherent, 26.5% non-adherent, 14.2% LTTF) (P = 0.02). Adherent patients were far likelier to live further away from the ophthalmology clinic (P = 0.03). The frequency of clinical encounters was statistically significantly different between adherence statuses. The non-adherent group had a higher average number of prescribed ocular medications (P = 0.03). The adherent patients had more frequent visits with elevated intraocular pressure (P = 0.02). CONCLUSION: A significantly high percentage of paediatric glaucoma patients were non-adherent to follow-up visits. When determining the non-compliance risk among paediatric glaucoma patients, physicians must consider the factors contributing to adherence status, which include nationality, distance to the ophthalmology clinic, and number of prescribed ocular medications.

Ocular manifestations of children with atopic dermatitis in Saudi Arabia.

AIM: To examine the incidence of ocular abnormalities in children with atopic dermatitis (AD) in Saudi Arabia and its association with the severity of AD. METHODS: This is a cross-sectional study on 50 children with AD who were between 5 and 16 years of age. The severity of AD was evaluated using the SCORing Atopic Dermatitis (SCORAD) index. All the children underwent slit lamp exams, visual acuity assessment, intraocular pressure measurement, and corneal topography. The children were considered to have an ophthalmic abnormality if one or more of the following signs were present: glaucoma, keratoconus suspicion, in addition to lid, conjunctival, corneal, lenticular, or retinal abnormalities. RESULTS: Based on the SCORAD severity index, 14% of children had mild AD (7/50), 38% had moderate AD (19/50), and nearly half had severe AD. More than half the children exhibited facial involvement, and half had peri-orbital signs. The mean SCORAD index was 35.75. The mean age was 10.48±3.6y, and the cohort showed a slight male predominance (54% males). Both eyes of the 50 children in the cohort were studied. Based on the ocular examinations, 92% of the patients showed ocular abnormalities: lid abnormalities (27/50) followed by keratitis (22/50). Four patients had moderate risk for keratoconus in one eye and eight patients were suspected to have keratoconus. However, SCORAD severity index was not associated with age, sex, or the number or presence of ophthalmic abnormalities. CONCLUSION: This is the first study in Saudi Arabia to evaluate the prevalence of ocular manifestations in children with AD. The results indicate that the majority of children with AD have ocular abnormalities that mainly include lid abnormalities. Based on these findings, larger scale studies are needed to affirm whether regular screening for ophthalmic abnormalities would be beneficial for children with AD in terms of early intervention and prevention of sight-threatening complications.

Computer-assisted evaluation of retinal vessel tortuosity in moderate-to-late preterm children.

PURPOSE: Since very preterm children often have increased retinal tortuosity that may indicate decisive architectural changes in the systemic microvascular network, we used a new semi-automatic software to measure retinal vessel tortuosity on fundus digital images of moderate-to-late preterm (MLP) children. METHODS: In this observational case-control study, the global and local tortuosity parameters of retinal vessels were evaluated on fundus photographs of 36 MLP children and 36 age- and sex-matched controls. The associations between birth parameters and parameters reflecting retinal vessel tortuosity were evaluated using correlation analysis. RESULTS: Even after incorporation of anatomical factors, the global and local tortuosity parameters were not significantly different between groups. The MLP group showed a smaller arteriolar caliber (0.53 ± 0.2) than the controls (0.56 ± 0.2; p = 0.013). Other local tortuosity parameters, such as vessel length, distance to fovea, and distance to optic disc, were not significantly different between arteries and veins. Tortuosity in both groups was higher among vessels closer to the fovea (r = -0.077, p < 0.001) and the optic disc (r = -0.0544, p = 0.009). Global tortuosity showed a weakly positive correlation with gestational age and a weakly negative correlation with birth weight in both groups. CONCLUSION: MLP patients did not display increased vessel tortuosity in comparison with the controls; however, the arteriolar caliber in the MLP group was smaller than that in children born full-term. Larger studies should confirm this finding and explore associations between cardiovascular and metabolic status and retinal vessel geometry in MLP children.

Jeddah Retinopathy of Prematurity (JED-ROP) Screening Algorithm.

Background. The Jeddah retinopathy of prematurity (JED-ROP) algorithm, which is more specific to the population in Saudi Arabia, was established to decrease the number of infants screened without missing type 1 ROP cases. Methods. The data reviewed were birth weight (BW), gestational age (GA), weekly postnatal weight gain (PWG), and relevant perinatal risk factors. The sensitivities and specificities for detecting type 1 ROP were calculated. Results. Of the 502 infants included in the study, 148 developed ROP. The JED-ROP algorithm demonstrated 100% sensitivity and 38.9% specificity for recommending the screening of infants with GA ≤30 weeks and BW <1501 g and blood transfused <6 weeks and/or 3-week PWG <100 g in the type 1 ROP group. Conclusion. The JED-ROP algorithm can reduce the number of infants requiring ROP screening by 35.7% without missing type 1 ROP. The algorithm can be an adjunct to current national screening guidelines.

Evaluation of the Effect of Blood Transfusion on Retinopathy of Prematurity at a Tertiary Care Center in Western Saudi Arabia.

Introduction We aim to study if there is an association between blood transfusions and the development and severity of retinopathy of prematurity (ROP). We also aim to explore the association with other clinical outcomes. Methods A cohort of 291 infants admitted to our neonatal intensive care unit (NICU) was retrospectively analyzed. The number and volume of RBC transfusions on Day 7 and Day 30 were recorded. Clinical outcomes including ROP, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and sepsis were noted. Results The mean gestational age (GA) and birth weight (BW) of the evaluated infants were 28 ± 2.2 weeks and 1062 ± 242 g, respectively. One hundred and eighteen infants were transfused at a median of nine days post GA. Compared to non-transfused infants, those who were transfused had a lower GA, a lower BW, a longer stay in the NICU, and received significantly more artificial ventilation. These infants also had a higher number of comorbidities, including sepsis and intraventricular hemorrhage. The number and volume of RBCs at Day 30 were significantly higher in infants with any stage of ROP than in those without ROP. Conclusion A higher frequency and volume of RBC transfusion were associated with an increased risk of ROP development. Whether this is a direct consequence of blood transfusion or the infants being at risk due to prematurity or low BW remains to be determined.

"Smart Optometry" phone-based application as a visual acuity testing tool among pediatric population.

OBJECTIVES: To evaluate the validity of a smartphone-based application for visual acuity (VA) testing in children and to compare parent and clinician-performed VA to standard VA assessment. METHODS: A cohort of 100 children aged <18 years old was recruited. Subjects were randomly assigned to either start with conventional distance VA chart screening or the smartphone VA assessment twice by both the clinician and the caregiver if applicable. Near VA scores were assessed using the near vision E chart. Accuracy and reliability values were analyzed. RESULTS: One hundred patients with an average age of 9.92 ± 3.0 years old were enrolled. The difference between conventional distance and application logMAR values was -0.023, and the difference between near vision and application logMAR values was -0.004. "Smart Optometry" had a sensitivity of 89.3% in detecting subnormal VA compared with conventional vision testing methods. Sensitivity in detecting subnormal VA was found to be higher in younger age groups up to 91.7% in comparison with the older age groups. The interclass correlation of application-measured VA scores by the caregivers and the clinician were 0.77 (95% CI; 0.67-0.83) using single measures and 0.87 (95%CI; 0.8-0.9) using average measures. CONCLUSION: "Smart Optometry" phone application was found to be an acceptable home-based VA testing tool with good inter-rater reliability for young children showing good sensitivity in detecting subnormal VA, but lower sensitivity in detecting amblyopia.

Myopia control with soft multifocal contact lenses: 18-month follow-up.

PURPOSE: The study aimed to establish the outcome of multifocal contact lenses (MFCL) (Multistage + 1.50D and Proclear + 3.00D) on myopia progression and axial length elongation over an 18-month period. METHODS: Thirty myopic schoolchildren (5 males and 25 females) aged between 13 and 15 years were randomly assigned to wear either single vision contact lens (SVCL), Multistage MFCL + 1.50D, or Proclear +3.00D MFCL for 1½ years using a double-masked design. Cycloplegic refraction, corneal curvature, and axial length were measured. RESULTS: Myopia progression was controlled by 38.6% and 66.6% in children wearing Multistage + 1.50D and Proclear +3.00D MFCL, respectively, in comparison to children wearing SVCL over an 18-month period. In terms of axial elongation, this study found a 31.1% and 63.2% control in axial elongation over 18 months of treatment in comparison to the SVCL group. No statistical significant difference in corneal curvature was found between initial and last visits for all the three groups (SVCL, P = 0.90; Multistage + 1.50 MFCL, P = 0.78, and Proclear + 3.00 MFCL, P = 0.05). CONCLUSION: Proclear +3.00D MFCL was revealed to cause slow development of myopia and axial elongation among myopic schoolchildren. MFCL with higher add powers could be more effective on myopia progression in comparison with moderate add powers.

Retinopathy of prematurity in Saudi Arabia: Exploring maternal risk factors.

PURPOSE: Retinopathy of prematurity (ROP) is a preventable blinding disorder affecting preterm infants. To date, maternal risk factors have not been studied in Saudi Arabia. This study aims to identify possible maternal risk factors for any stage and type 1 ROP. MATERIALS AND METHODS: A total of 295 preterm infants screened for ROP between November 2013 and December 2018 at a Saudi Arabian tertiary-care hospital were included. We included infants with a gestational age ≤ 32 weeks and/or birth weight (BW) ≤1500 g. We analyzed 28 maternal and neonatal risk factors. RESULTS: The incidence of ROP at any stage and Type 1 were 31.9% and 7%, respectively. In the univariate analysis, the only maternal factor associated with any stage of ROP was spontaneous vaginal delivery (P = 0.049), but no maternal factor was an independent risk factor for type 1 ROP. Multivariate logistic regression analysis identified lower BW, lower gestational age and longer neonatal intensive care unit stay as independent risk factors for the development of ROP at any stage (P < 0.05). For Type 1 ROP, lower BW, and intraventricular hemorrhage were significant independent risk factors (P < 0.05). CONCLUSION: The only maternal risk factor related to ROP was spontaneous vaginal delivery, which increased the risk of any stage of ROP. The single most predictive risk factor for any stage of ROP and Type 1 ROP was low BW. These findings emphasize the role of the obstetrician in promoting health care and modifying maternal risk factors to prevent preterm births related to a low BW.

Pediatric spectacle prescription: Understanding practice patterns among ophthalmologists and optometrists in Saudi Arabia.

PURPOSE: This study aims to understand the approach to prescribing spectacles for children and the interpretation of refractive errors among ophthalmologists/optometrists in Saudi Arabia. METHODS: A cross-sectional survey was conducted between September and November 2018 using a database of online registrants for ophthalmologists and optometrists practicing in Saudi Arabia. The survey included 10 multiple-choice questions designed to elicit information about how ophthalmologists and optometrists deal with commonly encountered case scenarios covering different practical aspects of pediatric refraction. The responses were compared using the proportion of pediatric clientele received in the respondents' practices (Group A: <25%, Group B: 25%) and drawing upon concepts from the published literature. RESULTS: One hundred and three participants, including ophthalmologists, specialists/registrars, and optometrists from across Saudi Arabia, participated in this survey. Approximately 25% were classified as Group A. Large discrepancies were observed between the participants' responses and actual practices based on guideline recommendations. Responses varied significantly between Groups A and B on certain issues pertaining to pseudomyopia (P < 0.001), anisometropia (P = 0.033), and high astigmatism (P = 0.023). CONCLUSION: Practice patterns regarding pediatric spectacle prescription varied among ophthalmologists and optometrists in Saudi Arabia. The approach to managing refractive errors in children was better among ophthalmologists/optometrists servicing a larger pediatric clientele, suggesting the need to increase awareness among all groups of ophthalmologists/optometrists.

Screening premature infants for retinopathy of prematurity in a tertiary hospital in Saudi Arabia.

BACKGROUND: Early detection of retinopathy of prematurity (ROP) in preterm infants is critical, especially with advancements in neonatal care and improved survival rates. However, a balance should be found between not missing any ROP requiring treatment and minimizing workload, saving resources, and reducing unnecessary examinations to fragile neonates. OBJECTIVE: Ascertain whether our current inclusion criteria in screening ROP could be modified to ≤1250 g (while keeping the gestational age at ≤30 6/7 weeks) to reduce the number of screened babies without missing any type I ROP requiring treatment. DESIGN: Retrospective, record-based study. SETTING: Referral center. MAIN OUTCOME MEASURES: ROP outcome and risk factors. PATIENTS AND METHODS: Neonates screened for ROP in the neonatal intensive care unit of our institution between January 2016 and November 2018 were included. Data collected for each neonate included demographics, ROP details and risk factors. We used a revised version of ROP screening guidelines by the American Academy of Pediatrics. SAMPLE SIZE AND CHARACTERISTICS: 155 neonates (median birth weight, 1035 g; range, 527-1982 g; and gestational age range, 23-39 weeks). RESULTS: Of 1393 live births, 155 babies met the inclusion criteria. ROP occurred in 60/155 (38.7%) screened babies while sixteen developed threshold ROP. All 16 babies who required treatment had both a birthweight ≤1000 g and a gestational age of ≤30 weeks. Using the screening recommendations of the Canadian Policy, more infants would have been screened without diagnosing a case of ROP of any stage, and no case of ROP requiring treatment would have been missed compared to the AAP recommendations. CONCLUSION: ROP requiring treatment is a rare occurrence in premature infants with a gestational age >30 weeks and body weight >1000 g at our institute. Nonetheless, this is not an attempt to alter national screening guidelines. A multicenter prospective study with an adequate sample size is needed to assess whether guidelines for ROP screening should be altered in this category of neonates. LIMITATIONS: Retrospective design. CONFLICT OF INTEREST: None.

Saudi Children's Perception of Strabismus: A Hospital-Based Study.

PURPOSE: Children with strabismus may face difficulties interacting with their peers in elementary school. This study investigates the psychosocial effect of different types of strabismus on Saudi children's selection of a playmate. METHODS: Photographs of orthotropic children were digitally modified to simulate various magnitudes of strabismus. Orthotropic children with normal visual acuity viewed 18 sets of paired photographs and were asked to choose a playmate from each pair. Parents were asked to fill out a questionnaire on their socioeconomic background and to determine whether surgery should be indicated in strabismic patients for psychosocial reasons. Parents were also asked to rate their perception of seven personal characteristics of two images of the same child (one orthotropic and one strabismic). RESULTS: Two hundred and thirty-three children, aged 3-15 years (mean age: 9.94 [3.6] years), were studied. Children aged ≤6 years were significantly more likely not to distinguish between orthotropic children and those with strabismus (P < 0.001). Out of 233 participants, 69.6% were significantly in favor of orthotropic faces as opposed to 30.4% (P < 0.0001). Children perceived esotropia as less disturbing than exotropia and hypertropia (P < 0.001). Smaller magnitudes of strabismus were significantly preferred over larger angles (P < 0.001). Parents judged strabismic faces more negatively than orthotropic faces on all seven characteristics. Almost 88.4% of the adults thought that strabismic patients should undergo surgery for correction. CONCLUSIONS: Our findings suggest that children with apparent strabismus are perceived negatively and might be subjected to social alienation at a young age. Therefore, there is a need for strategies to address negative social bias toward children with strabismus and to enhance their peer acceptance in our society.