Parental Home Vision Testing of Children During Covid-19 Pandemic.

BACKGROUND: The Covid-19 pandemic necessitated social distancing restrictions, which placed limitations on access to ophthalmic care to only those who had an imminent risk of sight loss. All other face-to-face consultations were converted to telephone consultations or were postponed. We investigated whether parents were able to test their child's vision using available home vision testing applications, with an aim to aid decision making during a telephone consultation. METHODS: Families with follow-up consultations at Birmingham Children's Hospital were asked to test their child's vision at home. Instructions for the use of Peek acuity, or iSight Pro, were emailed to a parent. Parents chose to use a particular app based on available devices at home. Parents were asked to test uniocular visual acuity twice. Home versus hospital acuity was correlated. Home acuity test-retest reliability was acquired. Parental feedback was obtained through questionnaires. RESULTS: One hundred and three families were contacted, 15 families completed home vision testing. Ten families used Peek acuity, five families used iSight Pro. Uniocular visual acuity test-retest reliability was 0.03 LogMAR. Home-hospital acuity testing had a bias of 0.14 LogMAR, hospital acuity yielding a lower LogMAR score. Most families who completed testing found it easy to do; however, some struggled, and 81 families did not undertake home vision testing. CONCLUSIONS: Uptake of home vision testing was limited by parental engagement, most likely influenced by the current pandemic. Most families who undertook home vision testing were able to generate results that could be used for clinical decision making. Extending the impact of parental vision testing will require education by clinicians and further study to increase sample sizes and to improve confidence.

Long-term Efficacy of Mitomycin C Augmented Trabeculectomy in a Mixed Pediatric Glaucoma Cohort.

PRECIS: This paper reports a retrospective consecutive case series investigating the efficacy of Mitomycin C-augmented trabeculectomy in the treatment of primary and secondary pediatric glaucoma in a mixed etiology, multiethnic cohort of patients. PURPOSE: To evaluate the long-term efficacy and safety of Mitomycin C-augmented trabeculectomy in a mixed, tertiary-referral, pediatric glaucoma cohort. METHODS: Retrospective consecutive review of all children (37 eyes) undergoing Mitomycin C-augmented trabeculectomy by a single surgeon between 2008 and 2016. Seventeen eyes (45.9%) had primary congenital glaucoma, and 20 eyes (54.1%) had secondary glaucoma. The median age at surgery was 11 months (range, 2 to 146). The mean follow-up was 69.2±4.7 months (range, 3.5 to 107.9). RESULTS: Overall, trabeculectomy was successful in 80.6% of eyes at 12 months, 60.5% at 3 years, and 57.5% at 5 years. 45.9% cases (17 eyes) required further laser or surgery for uncontrolled intraocular pressure (IOP) and were therefore deemed as failures. The time to failure ranged from 0.4 to 65.1 months (mean, 22.2±5.1 mo). The proportion of children achieving visual acuity of 1.0 LogMAR equivalent or better increased from 43.2% preoperatively to 63.6% at 1 year and 68% at 5 years. The mean IOP reduced from 24.85±0.88 mm Hg preoperatively to 15.14±0.94 mm Hg at 3 months (39% reduction) and 17.42±1.08 mm Hg at 5 years (30% reduction). IOP-lowering medication requirement reduced from 4.14±0.20 agents preoperatively to 0.84±0.22 at 3 months (80% reduction) and 1.78±0.36 at 5 years (57% reduction). There were no sight-threatening complications such as hyphaema, bleb leak, chronic hypotony, endophthalmitis, retinal detachment, or loss of light perception. CONCLUSIONS: This study provides valuable evidence that Mitomycin C-augmented trabeculectomy is safe and effective as a treatment of primary or secondary pediatric glaucoma, with particularly encouraging results in cases of secondary glaucoma. Trabeculectomy offers the potential for delaying or avoiding glaucoma drainage device surgery in a significant proportion of children.

Routine Orthoptic-led Paediatric Fundus Digital Imaging: Benefits to Patients and Healthcare System.

AIMS: Dilated fundus examinations are a vital, yet time-consuming and sometimes distressing part of paediatric ophthalmology examinations. Limited resources, personnel and time can result in prolonged waiting time and increase risk from delayed diagnosis and treatment. Using a Nikon D80 TopCon TRC-NW6S non-mydriatic fundus camera (TopCon (GB) Ltd, Newbury), we aimed to demonstrate the safety and efficacy of orthoptic-led fundus digital imaging and the potential time and cost benefits to the healthcare system. METHODS: We conducted a retrospective review of all digital fundus images taken over a six month period in 2012 (n = 616, age range 2.1-16.5 years, mean age 8.7 years). RESULTS: Overall success rate for paediatric fundus digital imaging was 97%. Successful images were achieved in 87% of patients without the need for pupil dilation. Images were taken for a variety of clinical reasons. 45% of patients were discharged immediately, many with copies of photographs to facilitate follow-up with community optometrists. CONCLUSIONS: Orthoptic-led fundus digital imaging is an innovative, speedy, safe and efficient method of documenting fundal appearance, enabling serial documentation of stability/progression of ocular disease. It allows adequate examination of routine patients, freeing up time within busy clinics. Paediatric fundus digital imaging brings a potential positive cost benefit to healthcare systems under pressure, and facilitates skill development for allied health professionals.