Longitudinal analysis of carotenoid content in preterm human milk.

To describe the variability in carotenoid content of human milk (HM) in mothers of very to extremely low birth weight preterm infants throughout lactation and to explore the relationship between lutein in HM and the occurrence of retinopathy of prematurity (ROP) in preterm infants. We recruited healthy mothers along with their preterm infants that were born at gestational age 24 + 2 to 29 + 6 weeks or with a birth weight under 1500 g and were exclusively breastfed HM. Each participant provided up to 7 HM samples (2-10 ml) on day 0-3 and once a week until 6 weeks. Additionally, when possible, a blood sample was collected from the infant at week 6. Concentrations of the major carotenoids (lutein, zeaxanthin, beta-carotene, and lycopene) in all HM and blood samples were assessed and compared. Thirty-nine mother-infant dyads were included and 184 HM samples and 21 plasma samples were provided. Mean lutein, zeaxanthin, beta-carotene, and lycopene concentration decreased as lactation progressed, being at their highest in colostrum samples (156.9 vs. 66.9 vs. 363.9 vs. 426.8 ng/ml, respectively). Lycopene (41%) and beta-carotene (36%) were the predominant carotenoids in colostrum and up to 2 weeks post-delivery. Inversely, the proportion of lutein and zeaxanthin increased with lactation duration to account for 45% of the carotenoids in mature HM. Lutein accounted for 58% of the carotenoids in infant plasma and only 28% in HM. Lutein content of transition and mature HM did not differ between mothers of ROP and non-ROP infants.Conclusion Carotenoid content of HM was dynamic and varied between mothers and as lactation progressed. Infant plasma displayed a distinct distribution of carotenoids from HM.

Evaluating distance stereoacuity in children 4-17 years of age with a novel digital application.

Distance stereoacuity measurement enables the evaluation and management of binocular vision disorders. Here, we compare the results obtained using standard tests for distance stereoacuity measurement with the novel STab test. We tested 87 children (4-17 years of age) using different tests for the quantification of stereopsis at distance: Distance Randot Stereotest (DRS), M&S random dots (M&S), and STab. A strong correlation was demonstrated between M&S-DRS (0.8), M&S-STab (0.81), DRS-STab (0.85) (all P < 0.0001). The limit of agreement between M&S and DRS was 0.45; between M&S and STab, 0.47; and between DRS and STab, 0.38. Our results suggest that all three methods can be used interchangeably.

Subjective versus objective refraction in healthy young adults.

PURPOSE: To evaluate objective and subjective refraction differences in healthy young adults. METHODS: Data concerning candidates for the Israeli Air Force Flight Academy, as well as active air force pilots in all stages of service who underwent a routine health checkup between the years 2018 and 2019 were retrospectively analyzed. Objective refraction measured using a single autorefractometer was compared with subjective refraction measured by an experienced military optometrist during the same visit. The results were converted to power vectors (spherical equivalent [SE], J0, and J45). To interpret astigmatism using power vector values, the cylinder power (Cp) was determined. RESULTS: This study included 1,395 young adult participants. The average age was 22.17 years (range, 17-39, 84.8% males). The average SE was - 0.65 ± 1.19 diopter (D) compared with - 0.71 ± 0.91D in the auto- and subjective refraction, respectively (p = 0.001). Cp was 0.91 ± 0.52D and 0.67 ± 0.40D, respectively (p < 0.001). This difference was more common in older participants (p < 0.001). J0 and J45 value differences were not significant. The absolute SE value of subjective refraction was lower in the myopic (p < 0.001) and hyperopic (p < 0.001) patients. CONCLUSIONS: Young hyperopic participants tended to prefer "less plus" in subjective refraction compared with autorefraction. Young myopic participants tended to prefer "less minus" in subjective refraction compared with autorefraction. All participants, but mainly older participants, preferred slightly "less Cp" than that measured using autorefraction; The astigmatic axis did not differ significantly between the methods.

Predictors of disease course and long-term outcomes of idiopathic intracranial hypertension in children and adolescents.

This study aimed to identify predictors for unfavorable disease course and clinical and visual outcomes in pediatric patients with idiopathic intracranial hypertension (IIH). Employing a multi-tiered approach, we retrospectively analyzed clinical, ophthalmic, and neuroimaging data from patients diagnosed with IIH between 2003 and 2021. Of the 97 patients included, 56 (58%) were females. The median age was 12 years [Interquartile range (IQR) 9, 14], and the median follow-up time was 39.0 months (IQR 14.8, 90.9). Forty-two (43%) patients had an unfavorable disease course, 28 (29%) had persistence of headache at last follow-up, and 16 (18%) had a poor visual outcome, most of them with mild visual disturbances. Poor visual outcome was more common in females compared to males [16/47 (34%) vs. 0/39, p < 0.001)]. On multivariate regression analysis, female sex and disease recurrence were significantly associated with poor visual outcomes (OR: 18.5, CI:1.3-270, P = 0.03, and OR: 5.1, CI: 1.2-22.5, P = 0.03, respectively). Patients with persistent headaches exhibited lower incidence of papilledema, lower opening pressure, and fewer neuroimaging markers indicating elevated intracranial pressure. CONCLUSIONS: This study provides insights into predictive factors for an unfavorable disease course, persistent headaches, and poor visual outcomes in patients with childhood IIH. Patients with persistent headaches may have a variant of a chronic pain syndrome warranting a different therapeutic approach. WHAT IS KNOWN: • Childhood-onset Idiopathic Intracranial hypertension (IIH) is a heterogenous disease. The knowledge on disease trajectory and long-term outcomes and its predictors is limited. WHAT IS NEW: • A higher opening pressure and factors suggestive of the metabolic syndrome predict an unfavorable disease course whereas female sex and disease recurrence are significantly associated with poor visual outcomes • A third of the patients diagnosed with IIH experience ongoing headaches despite achieving favorable visual outcomes. This subset, characterized by lower disease-severity indicators at onset may represent a distinct subgroup warranting a different therapeutic approach.

Congenital ptosis repair in children: comparison of frontalis muscle suspension surgery and levator muscle surgery.

PURPOSE: Comparing the surgical and refractive outcomes of congenital ptosis repair by different surgical techniques. METHODS: This longitudinal cohort study reviewed medical records of 101 patients who underwent congenital ptosis repair, from 2006 to 2022 in a single center. Analysis was performed for demographic background, co-morbidities, pre-operative and post-operative ocular examinations and refraction, complications, reoperations, and success rates. RESULTS: Following exclusion criteria, we remained with 80 patients (103 eyes) who underwent either frontalis muscle suspension surgery (FMS) (55 eyes) or levator muscle surgery (LM) (48 eyes). Patients in the FMS group were younger (mean age of 3.1 vs. 6.0 years, p < 0.001) and had worse pre-operative ocular assessments including prevalence of visual axis involvement, chin-up head position, ptosis severity, and levator muscle function (LF) (p < 0.001). Both groups had a 25% rate of reoperation, however while in the LM group reoperation was required solely due to undercorrection, in the FMS group various indications prompted reoperation. Success rate was higher in the FMS group (87.3% vs. 60.4%, p = 0.002). While pre-operative astigmatism was higher in the LM group (p = 0.019), no significant differences were observed post-operatively. Spherical and spherical equivalent changes over time were significant only in the FMS group (p = 0.010 and p = 0.004, respectively). CONCLUSIONS: Within our cohort, a higher success rate of congenital ptosis repair was observed among patients who underwent FMS compared to LM, despite similar reoperation rates. In cases of severe ptosis and moderate LF, LM demonstrated a lower-than-anticipated success rate. Astigmatic changes following ptosis repair were not consistent in either group.

Ocular injury from foam dart (Nerf) blasters: a case series.

To report clinical outcomes following ocular injury from foam dart (nerf) blasters - a spring-loaded toy guns that fire foam-coated darts or bullets at a relatively low velocity. These guns gained popularity in recent years among children and adolescents. Eleven patients with ocular injuries from foam dart blasters were included in this retrospective, single-center study. Visual acuity (VA), intraocular pressure (IOP), and anterior segment, glaucoma-related, and vitreoretinal complications were recorded at each visit. The average age at presentation was 13.4 years and 82% were male. Mean initial VA was 6/12 (range 6/6 - 1/18); On initial examination, nine patients (82%) had hyphema, three (27%) had corneal abrasions, three (27%) had vitreous hemorrhage, and two (18%) had traumatic mydriasis. Four patients (36%) experienced glaucoma-related complications, including three (27%) with angle recession and three (27%) with increased IOP. Three patients (27%) were diagnosed with posterior segment injuries, including three (27%) with commotio retinae and one (9%) with severe retinal photoreceptor damage. No patients required surgical intervention. CONCLUSION: Foam dart blasters can cause severe blunt ocular trauma and permanent visual loss, illustrating the need for eye protection when handling these toys. WHAT IS KNOWN: • Foam dart blasters, a blanket term for spring-loaded toy guns that fire foam-coated darts or bullets at a relatively low velocity, have gained popularity in recent years among pediatric populations, with an increase in associated ocular injuries. • To date, scattered case reporting provides insufficient insight into the full clinical spectrum of injury and prognosis of foam dart blasters related ocular injury. WHAT IS NEW: • This case series characterizes the myriad foam dart blasters injuries that may afflict the eye, most of which are self-limiting, but some of which may result in poor visual outcomes and lifelong disability in pediatric patients. • We strongly recommend that all users wear eye protection while using foam dart blasters.

A rare genotype of biallelic mosaic variants in BCOR gene causing a bilateral ocular anterior segment dysgenesis and cataracts.

Oculofaciocardiodental (OFCD) syndrome is a rare X-linked dominant syndrome characterized by the involvement of the eyes, face, teeth, and heart with variable expressivity. The syndrome is caused by loss-of-function variants in the BCOR gene located on the X chromosome. OFCD affects only females with presumed embryonic lethality among males. We report a first case of a female with biallelic mosaic variants in BCOR gene, leading to a severe ocular phenotype including anterior segment dysgenesis, cataracts, and retinal involvement. The unique condition of biallelic mosaic loss-of-function mutations leads to a variable expression of an allele with the pathogenic variant, independent of the X-Inactivation pattern. This novel mechanism of co-existent biallelic mosaicism should be suspected in unexplained severe cases of OFCD.

Short-Term Vision-Related Ocular Side Effects of Treatment with Dexmethylphenidate for Attention-Deficit/Hyperactivity Disorder.

Objective: To evaluate the short-term effect of dexmethylphenidate (D-MPH) on visual acuity (VA), pupil size, anterior chamber depth, and accommodation-convergence reflex in children treated with D-MPH for attention-deficit/hyperactivity disorder (ADHD). Method: Prospective cohort study including 15 patients aged 8-16 (11.58 ± 2.39) treated with D-MPH for ADHD. Patients were questioned for subjective complaints such as blurred vision and photosensitivity. An ophthalmic evaluation was performed twice; before and 1.5 hours after D-MPH administration. The examination included evaluation of best corrected visual acuity at distance and near, accommodation range, convergence range, 3D vision test (stereopsis), and anterior segment optical coherence tomography. Results: A significant association between change in pupil diameter and D-MPH treatment dose was demonstrated (p = 0.01). In addition, a positive correlation between complaints about blurred vision and pupil's size change was found (p < 0.05). There were no significant changes in VA, convergence range, stereopsis, accommodation range, or anterior chamber measures. Conclusions: Our findings provide support for the effect of stimulants on pupil diameter in a dose-dependent manner. No clinically significant differences in visual functions were found 1.5 hours after consumption of D-MPH. Institutional review board clinical trial refference no. 0122-17-TLV.

Elevated lumbar puncture opening pressure in aseptic meningitis.

OBJECTIVES: Elevated lumbar puncture opening pressure (ELPOP) is a reported but understudied phenomenon in aseptic meningitis. This study aimed to characterize the features of ELPOP in aseptic meningitis patients. METHODS: An observational, retrospective, single-center study was conducted. We included all adult patients diagnosed with aseptic meningitis or meningoencephalitis from October 2015 to May 2017, for whom lumbar puncture opening pressure (LP OP) was measured. OP > 25 cm H2O was documented as ELPOP. Patients' demographic characteristics, clinical data, laboratory and cerebrospinal fluid (CSF) results, as well as optic disc appearance were analyzed. RESULTS: Among 116 patients (61 males) included, 16 patients (14 %) had ELPOP (11 males). The average age of those patients was 32.4 years (SD = 9.8), and the mean OP was 31.7 cm H2O (SD = 6.02) as opposed to the mean normal LPOP (NLPOP) of16.13 cm H2O (SD = 4.15). Body mass index (BMI) was significantly higher in the ELPOP group (p = 0.0081). Funduscopic examination was documented in 15/16 patients in the ELPOP group and revealed swollen optic discs in 6 (40 %) patients. Fundus examination was performed in 62 patients in the NLPOP group, of whom 2 (3.2 %) had a swollen disc. There was no difference in CSF content between groups. CONCLUSIONS: This study fills the void of information lacking on the frequency of ELPOP in aseptic meningitis. Its association with increased BMI may be related to the pathogenesis. LP OP should be measured in all patients with aseptic meningitis. Additional research is needed to determine the threshold of tolerated intracranial pressure (ICP).

Surfboard Related Orbital and Periocular Injury.

PURPOSE: The objective of this study is to present the complexity of surfboard related orbital and periocular injuries and to discuss the different prevention aspects of such injuries. METHODS: A retrospective review was performed on surfing related orbital and periocular injuries cases in a single tertiary medical center over a period of 10 years. RESULTS: Six patients at a mean age of 34 (range 20-50) years were evaluated. All were amateur surfers. Five patients had an orbital fracture, 3 had a full thickness eyelid laceration, 3 had lacrimal drainage system damage and 3 had intraocular findings related to trauma, but no perforation of the globe was observed. Two patients had complete optic nerve avulsion or transection, 1 of them had extraocular muscle transection. Five patients underwent surgery and 2 required an additional surgical intervention. At the end of follow-up, 3 patients had an unrepairable lacrimal drainage damage, 2 had a malposition of an eyelid, 2 eyes remained blind, 1 patient had a hypoglobus, and 1 had hypoesthesia in distribution of infraorbital nerve. CONCLUSIONS: Surfboard related orbital injuries may cause a severe orbital injury, which may debilitate and disable a previously active and healthy group of young people. Hence, protective gear wear should be more vigorously encouraged as already been done in other sports.

A novel device for assessment of amblyopic risk factors in preverbal and verbal children-a pilot study.

OBJECTIVES: This paper evaluates the accuracy of the Eye-N-JOY (ENJ), a novel device (Patent no. US 9844317 B2), for identifying the presence of amblyopic risk factors. This device was developed to assess both visual acuity, ocular alignment, and eye movement; all while watching images on a tablet screen. METHODS: A prospective, single-center, comparison study. Participants were examined by the ENJ first and then underwent a comprehensive full eye examination by pediatric ophthalmologists including cycloplegic refraction. Both the technician operating the ENJ and the physicians were masked to each other's findings. Children aged 18-72 months (1.5 to 6 years) attending a tertiary medical center for a full standard pediatric ophthalmology examination were included. The visual acuity and alignment were compared between the ENJ and the gold standard full ophthalmologic examination. The differences were noted, and the sensitivity and specificity were calculated. RESULTS: A total of 51 children were enrolled, 33 (64.7%) girls, aged 18-72 months. All children successfully completed the examination by the ENJ. No significant difference between the ENJ and the reference examination was detected in visual acuity measurements in both eyes (Pv = 0.553 for the right eye and 0.803 for the left). Overall agreement between all referral indications between the ENJ and reference examination was 84.3%, with 90.9% agreement in VA referral criteria and 90.1% in alignment referral criteria. CONCLUSIONS: Eye-N-Joy can reliably examine both visual acuity and ocular misalignment in verbal and pre-verbal children.

Glaucoma Publication Trends in Leading General Ophthalmology Journals During the Past Quarter Century: Where Are the Clinical Trials?

PRCIS: During the past quarter century, the rate of glaucoma-related publication in general ophthalmology journals increased due to higher representation in "experimentally oriented" journals. The rate of glaucoma randomized controlled clinical trial (RCT) articles decreased during the same time period. PURPOSE: To evaluate trends in rate of glaucoma publications in leading general ophthalmology journals over the past quarter century. MATERIALS AND METHODS: Q1 ophthalmology journals Web sites were reviewed. Only journals not limited to certain subspecialty were considered "general" and included in the analysis. In addition we categorized journals orientation as either "clinical" or "experimental." The PubMed search engine was used to collect publications from the selected journals between January 1, 1995 to December 31, 2019. Publications captured by "glaucoma" or "ocular hypertension" filters were considered glaucoma related. The fraction of glaucoma articles out of total number of articles within each year for each journal was calculated. A linear mixed effects model was applied to detect trends in glaucoma publication rates during the study period. RESULTS: Eight journals were included: 4 "clinically oriented" and 4 "experimentally oriented." The PubMed search yielded 72,750 publications, of which 9329 (12.8%) considered "glaucoma related." Percentage of glaucoma publications remained stable within "clinically oriented" journals, and significantly increased within "experimentally oriented" journals (annual change of 0.3%, P<0.001). The number of glaucoma-related RCTs decreased significantly in each (annual change of -0.21% and -0.13%, respectively, P<0.05). CONCLUSIONS: There has been a significant rise in the rates of glaucoma publications in "experimentally oriented" journals, while their representation in "clinically oriented" journals remained stable over the past quarter century. This change might be due to the increasing efforts to develop more advanced methods for evaluation and treatment in glaucoma, although still unable to address clinical demands. The decrease in glaucoma-related RCT articles might indicate reduced funding for such research.

Peripapillary hyperreflective ovoid mass-like structures-a novel entity as frequent cause of pseudopapilloedema in children.

BACKGROUND: Optic nerve head drusen (ONHD) are considered the most common cause for pseudopapilloedema in children. We aimed to investigate and further characterize a new type of optic nerve head lesion on enhanced depth imaging optical coherence tomography (EDI-OCT) named peripapillary hyperreflective ovoid mass-like structures (PHOMS), and ONHD in asymptomatic children with pseudopapilloedema. METHODS: Retrospective cohort study including 64 eyes from 32 patients with pseudopapilloedema due to PHOMS and/or ONHD. Mean age was 9.0 ± 3.1 years. PHOMS and ONHD were identified and classified on EDI-OCT and infrared images. Ultrasound images were classified for the presence of hyperechogenic structures of the optic nerve head. RESULTS: On EDI-OCT, PHOMS were detected in 63 out of 64 eyes (98.4%). In 60 eyes (93.8%), small hyperreflective foci inside the PHOMS were present. In all cases, we identified a new ring sign visible on infrared images, corresponding clearly to the edge of the PHOMS as seen on EDI-OCT. On ultrasound, we describe a new feature of PHOMS appearing as small hyperechogenic structures without posterior shadowing. In 13 eyes (20.3%), ONHD were present on EDI-OCT and ultrasound. CONCLUSION: This is the first study showing that PHOMS are the most common cause for pseudopapilloedema in children. PHOMS is a new entity of optic nerve head lesions. It might be a precursor of buried optic nerve head drusen, which can lead to visual field defects, haemorrhages and CNV. This study offers new tools to identify and follow-up these lesions early in childhood using EDI-OCT.

Predictors of traumatic eye injuries at high-risk for ophthalmic complications in children.

Eye injuries are important cause of ocular morbidity in children. There is lack of data regarding predictors for high-risk injuries that will result in ophthalmic complications. Most cases are managed by the emergency department (ED) physicians without immediate ophthalmologist evaluation. Our aim was to identify predictors for ophthalmological complications and to imply indications for early ophthalmologic consultation in the ED. A retrospective chart review of 834 patients ages 0-18 years who presented to the emergency department at Tel Aviv Medical Center between 2015 and 2018 following traumatic eye injuries was performed. All cases which later needed ophthalmological care were considered as high-risk for ophthalmic complications. An increased rate of eye injury was revealed over the years, but high-risk injury rate was stable. High-velocity mechanism, sport injury, orbital, anterior chamber, and retinal involvement were all significantly more common in the high-risk group compared to the low risk group. Only 10 patients, which represent 1.2% of all the patients, had decreased visual acuity on the last follow up, with significantly more injuries of high-velocity mechanism and anterior chamber involvement, in comparison to patients with normal visual acuity on the last follow up.Conclusion: High-velocity mechanism by itself, even with normal visual acuity and eye examination by the ED physician, should prompt to consider an urgent ophthalmologist consult. What is Known: •Traumatic eye injuries are an important cause of ocular morbidity in children. • Most injuries can be handled by a trained ED physician, but there are indications for an urgent ophthalmologist consultation. • It is crucial to discriminate between low and high-risk ocular injuries. What is New: • High-velocity mechanisms stand out as the most likely risk factor for final impaired visual acuity. • Normal visual acuity on presentation is not reassuring. • We recommend urgent ophthalmologist consultation in cases of high-velocity injury, even if visual acuity is preserved at presentation.

Reduced stereoacuity as a predictor for clinically significant convergence insufficiency.

BACKGROUND: Stereoacuity relies on accurate binocular alignment. Convergence insufficiency (CI) a binocular motor disorder, interferes with near work. OBJECTIVE: To investigate the association between convergence amplitude (CA) and stereoacuity in a large paediatric cohort. METHODS: Retrospective chart review included patients aged 6-17 years; excluded patients with amblyopia, manifest strabismus or visual acuity <20/30 in either eye. Stereoacuity, measured by Randot test was defined as normal (≤40arcsec), subnormal (50-400arcsec) and poor (>400 arcsec). CA, measured using base out prism bar was defined by fusion break point (BP) and recovery point (RP), as none (BP=0), poor (BP <20 prism diopter (PD)), borderline (BP <30 PD or RP <20 PD), good (BP ≥30 PD and RP ≥20 PD) and excellent (does not break at 40PD). RESULTS: In 2200 subjects included, we found an increased prevalence of normal stereoacuity as convergence ability improves (χ2 test, p<0.001) with a negative correlation between stereoacuity and BP (Pearson correlation -0.13, p<0.001).CI was significantly associated with below normal stereopsis OR 1.86 (95% CI 1.3 to 2.7, p<0.001). Conversely, prevalence of CI was similar, whether or not CI-symptoms were reported. Follow-up data of at least 2.5 years from presentation was available for a small subgroup of 21 patients treated for CI. Convergence improved in 14 (66%), rate of normal stereoacuity increased from 29% at baseline to 76% at last follow-up (p=0.006). CONCLUSIONS: CA affects stereoacuity function in children. Evaluation of CA is required in all cases with poor stereoacuity, especially when other etiologies are amiss. The role of convergence improvement exercise on stereoacuity warrants further investigation.

Visual function tests including the role of optical coherence tomography in neurofibromatosis 1.

Optic pathway glioma (OPG) is a common and significant complication of neurofibromatosis 1 (NF-1) that might lead to vision loss. The main reason to treat OPG is to preserve vision. Tumor location along the visual pathway largely dictates the presenting signs and symptoms. Clinical ophthalmic evaluation is focused on optic nerve functions including evaluation of pupils' reaction to light, visual acuity, color vision, and visual field, as well as optic nerve appearance. An important relatively new ancillary test is optic coherence tomography (OCT) that measures the volume of retinal nerve fiber layer around the optic nerve and the ganglion cell layer-inner plexiform layer (GCL-IPL) of the macula, both proved to be strongly associated with losing vision in OPG. Accurate evaluation of vision functions plays a critical role in the decision of treatment. In this review, we describe the ophthalmological assessment including new biomarkers in clinical use. We also outline prognostic factors and current recommendations for surveillance and indications for treatment.

The Clinical Utility of Inpatient Brain Magnetic Resonance Imaging in Children.

The clinical applicability and yield of brain magnetic resonance imaging (MRI) in the setting of an inpatient pediatric department has not been investigated. The authors performed a retrospective chart review of nontraumatic/nonneurosurgical children who underwent brain MRI during their hospitalization in a general pediatric department over a 5-year period. Of the 331 children who underwent brain MRI, 148 (45%) had abnormal findings. High-risk headaches and focal seizures were significantly correlated with findings on brain MRI. Diagnostic and therapeutic yields were most significant in acute demyelinating events, acute cerebrovascular disorders, high-risk headaches when supported by neurologic and ophthalmologic findings, focal seizures with evidence of multifocal epileptic activity on an electroencephalogram and ophthalmic complaints when accompanied by cranial nerve palsy and optic nerve impairment. Since the contributions of a brain MRI in hospitalized children is pivotal in specific clinical situations, a judicious decision-making process should be done before its scheduling, in order to optimize clinical care.

Pediatric Publication Trends in Leading General Ophthalmology Journals for 20 Years.

PURPOSE: To evaluate trends in the representation of pediatric-related articles in leading general ophthalmology journals for 20 years. METHODS: A list of all relevant publications from five top-ranking general ophthalmology journals (Ophthalmology, JAMA Ophthalmology, American Journal of Ophthalmology, British Journal of Ophthalmology, and Acta Ophthalmologica) between January 1997 and December 2016 was retrieved using the PubMed search engine. Articles captured by the age filter "child: birth-18 years" were considered pediatric. The annual pediatric publication rate was calculated as the fraction of pediatric articles out of the total number of articles within each year for every journal. A linear mixed effects model was applied to determine the trend in the pediatric publication rate during the study period. RESULTS: A total of 37,181 publications were included in the analysis, of which 7,828 (21.1%) were classified as "pediatric." During the study period, there was a statistically significant decrease in pediatric publication rates, with an annual absolute decrease of 0.23% (P = .01), yielding relative reduction by approximately 18% over the past two decades. CONCLUSIONS: Representation of pediatric articles progressively decreased in general ophthalmology journals. This trend has major implications regarding exposure of non-pediatric ophthalmologists to the new developments in pediatric management. In addition, this may imply a difficulty to publish pediatric-related articles in high-ranking general ophthalmology journals. [J Pediatr Ophthalmol Strabismus. 2020;57(2):78-84.].

Accuracy of the Ultrasound Biomicroscopy Bag/Balloon Technique in Locating Horizontal Extraocular Muscle Insertions Before and After Strabismus Surgery.

PURPOSE: To investigate the accuracy of high frequency ultrasound biomicroscopy using the bag/balloon technique to locate recti muscle insertions before and after strabismus surgery. METHODS: This was a prospective masked study. The distance from the limbus to horizontal recti muscle insertions was measured by caliper intraoperatively and ultrasound biomicroscopy preoperatively and during follow-up. Accuracy was defined as the difference between ultrasound biomicroscopy and caliper measurements. RESULTS: Thirty-nine muscles (19 medial rectus and 20 lateral rectus) of 22 patients were included. The mean age of the patients was 34.7 ± 15.5 years (range: 18 to 78 years). Follow-up measurements were available for 25 muscles: 12 muscles were recessed and 13 were resected/advanced. Twelve of the included muscles underwent prior surgery. There was a strong correlation between preoperative mean ultrasound biomicroscopy and caliper measurements (P < .001, rp = 0.872) without significant difference between the accuracy of identification of medial rectus and lateral rectus muscles (P = .116 and .377, respectively). On average, postoperative ultrasound biomicroscopy measurements of recessed muscles were 1.15 mm greater than caliper measurements at the end of surgery (P = .003), whereas the mean difference in the resected muscles was not statistically significant (-0.07 mm, P > .999). Overall, in 16 of 25 muscles (64%), the differences between the postoperative measurements and the end of surgery measurements were less than 1 mm. There was no correlation between the accuracy and the time of ultrasound biomicroscopy after surgery (P = .516). CONCLUSIONS: The ultrasound biomicroscopy bag/balloon technique is an accurate and reliable method of locating recti muscle insertions before and after strabismus surgery. Ultrasound biomicroscopy may assist strabismologists in planning repeated operations. [J Pediatr Ophthalmol Strabismus. 2020;57(1):12-20.].