[The impact of district nurses in screening visual impairments]. / A védonok szerepe a gyermekkori látásproblémák felismerésében.

INTRODUCTION: The children's physical and mental health is determinative for the whole society. Parents, teachers, district nurses, and doctors share the duty to ensure their uninterrupted visual development. District nurses compose key elements in connecting families and health care providers, since they have the chance to detect any visual anomalies, and to refer the children to a pediatrician, ophthalmologist, or a neurologist. Their team work yields advantages to the whole community as beyond preserving good vision, children get a real chance of right physical and mental development. OBJECTIVE: Our aim was to recollect district nurses' areas of activity and to collect data about their present status in visual screening programs. Furthermore, to assess their screening methods and circumstances, and to reshape their continuous learning programs linked to the universities. METHOD: Questionnaires were sent online anonymously to district nurses in practice, in order to collect data referring to their focuses during the visual screening methods. Administration of online parental tutorials was assessed, and measures of professional support in nurses' education was debated. RESULTS: Visual screening among infants looks for potential strabismus, and among school-age children looks for potential refractive errors. Vision tests and stereo tests are usually available as screening tools, but pen lights are underused. Only a few nurses suggest online tutorials to enhance patient education, but nurses are highly motivated in postgraduate courses about vision screening. CONCLUSION: Our results reflect good adherence to the screening protocols but there is some uncertainty in some fields. In harmony with the results, adequate technical and educational support and specific training were compiled for postgraduate district nurses. Coaching and training in visual screening (in the form of seminars or e-learning) should be available in spring 2023. Orv Hetil. 2023; 164(3): 88-95.

[Application of corticosteroid eye drops for allergic eye diseases in children]. / A kortikoszteroidtartalmú szemcseppek alkalmazása gyermekkori allergiás szembetegségek kezelésében.

The prevalence of allergic diseases has been increasing recently. Allergy has various symptoms. Allergic eye diseases (seasonal and perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, giant papillary conjunctivitis, contact blepharoconjunctivitis) are common in atopic patients. Treatment options for allergic conjunctivitis include local and systemic antihistamines, mast cell stabilizers, dual-action agents, vasoconstrictors and corticosteroids. Treatment seems easy, but inappropriate therapy - in extreme cases - can lead to vision loss. Corticosteroid eyedrops provide effective relief of symptoms, however, their use is limited due to their severe side effects. Both steroid-induced cataract and steroid-induced glaucoma are dangerous for vision. The characteristics, frequency and risks of these side effects have been studied widely in adults, but there are very few studies focused on children. According to the present studies, the side effects of topically administered corticosteroids appear more often in children than in adults. Orv Hetil. 2019; 160(9): 329-337.

The Effect of Axial Length on the Thickness of Intraretinal Layers of the Macula.

PURPOSE: The aim of this study was to evaluate the effect of axial length (AL) on the thickness of intraretinal layers in the macula using optical coherence tomography (OCT) image analysis. METHODS: Fifty three randomly selected eyes of 53 healthy subjects were recruited for this study. The median age of the participants was 29 years (range: 6 to 67 years). AL was measured for each eye using a Lenstar LS 900 device. OCT imaging of the macula was also performed by Stratus OCT. OCTRIMA software was used to process the raw OCT scans and to determine the weighted mean thickness of 6 intraretinal layers and the total retina. Partial correlation test was performed to assess the correlation between the AL and the thickness values. RESULTS: Total retinal thickness showed moderate negative correlation with AL (r = -0.378, p = 0.0007), while no correlation was observed between the thickness of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCC), retinal pigment epithelium (RPE) and AL. Moderate negative correlation was observed also between the thickness of the ganglion cell layer and inner plexiform layer complex (GCL+IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL) and AL which were more pronounced in the peripheral ring (r = -0.402, p = 0.004; r = -0.429, p = 0.002; r = -0.360, p = 0.01; r = -0.448, p = 0.001). CONCLUSIONS: Our results have shown that the thickness of the nuclear layers and the total retina is correlated with AL. The reason underlying this could be the lateral stretching capability of these layers; however, further research is warranted to prove this theory. Our results suggest that the effect of AL on retinal layers should be taken into account in future studies.

A morphological study of retinal changes in unilateral amblyopia using optical coherence tomography image segmentation.

OBJECTIVE: The purpose of this study was to evaluate the possible structural changes of the macula in patients with unilateral amblyopia using optical coherence tomography (OCT) image segmentation. PATIENTS AND METHODS: 38 consecutive patients (16 male; mean age 32.4±17.6 years; range 6-67 years) with unilateral amblyopia were involved in this study. OCT examinations were performed with a time-domain OCT device, and a custom-built OCT image analysis software (OCTRIMA) was used for OCT image segmentation. The axial length (AL) was measured by a LenStar LS 900 device. Macular layer thickness, AL and manifest spherical equivalent refraction (MRSE) of the amblyopic eye were compared to that of the fellow eye. We studied if the type of amblyopia (strabismus without anisometropia, anisometropia without strabismus, strabismus with anisometropia) had any influence on macular layer thickness values. RESULTS: There was significant difference between the amblyopic and fellow eyes in MRSE and AL in all subgroups. Comparing the amblyopic and fellow eyes, we found a statistically significant difference only in the thickness of the outer nuclear layer in the central region using linear mixed model analysis keeping AL and age under control (p = 0.032). There was no significant difference in interocular difference in the thickness of any macular layers between the subgroups with one-way between-groups ANCOVA while statistically controlling for interocular difference in AL and age. CONCLUSIONS: According to our results there are subtle changes in amblyopic eyes affecting the outer nuclear layer of the fovea suggesting the possible involvement of the photoreceptors. However, further studies are warranted to support this hypothesis.

Effect of diet and physical exercise treatment on insulin resistance syndrome of schoolchildren.

BACKGROUND: Insulin resistance syndrome (IRS) of schoolchildren may contribute to cardiovascular diseases (CVD) of young adults. The investigation of different steps, baseline screening parameters and treatment of IRS may help the prevention. METHODS: Schoolchildren (53 boys and 61 girls age 5-17 years) because of adverse family history of CVD, hypertension, and obesity were investigated. Patients were divided into 3 groups according to baseline plasma glucose level (PGL) 120 and 180 min. after glucose consumption (GC): (1) PGL < or = 5.5 mmol/L 180 min. after GC, (2) PGL > or = 5.5 mmol/L 180 min. but < or = 7.8 mmol/L 120 min. after GC (3) PGL > or = 7.8 mmol/L 120 min. after GC. Body mass index (BMI), blood pressure (BP) and parameters of glucose and lipid metabolism were measured at baseline and after two year's lifestyle modification. RESULTS: No significant difference was found in the prevalence of cardiovascular risk factors (CRF) between groups 2 and 3. Fasting PGL > 5.5 mmol/L was found in 1, 2, and 6 cases; HOMA index > 4.4 in 7 (24%), 21 (37%), and 9 (35%) subjects; OGIS index < 400 in 3(10%), 29(51%) and 11 (42%) schoolchildren of groups 1, 2, 3, respectively. Lifestyle modification significantly improved BMI, systolic BP, serum triglyceride and HDL-cholesterol levels and insulin sensitivity. CONCLUSIONS: PGL measured 180 minutes after GC may define an important subgroup of pre-diabetic children. The similar prevalance of CRF in both praediabetic groups underlines the importance of this subgroup. Lifestyle modification for two years improves CRF in this population.

A comparison of macular structure imaged by optical coherence tomography in preterm and full-term children.

PURPOSE: Macular anatomic abnormalities were examined by optical coherence tomography (OCT) imaging in premature children and compared with those of full-term children. METHODS: In a prospective case-control study, premature patients 7 to 14 years of age were divided into three groups (group I, laser-treated retinopathy of prematurity [ROP]; group II, spontaneously regressed ROP; group III, no ROP), and age-matched children (group IV). All the eligible 74 eyes had normal-appearing posterior pole, myopia < or =3 D, and best corrected visual acuity 1.0. When both eyes of a subject were eligible for the study, one eye was randomly selected (10 eyes of 10 children in each group). Retinal thicknesses of the macula measured by OCT3 were compared. The correlation between central foveal thickness and prematurity (gestational age at birth < or = 30 weeks; birth weight < or = 1250 g) or ROP was determined. RESULTS: The mean foveal and central retinal thicknesses decreased significantly in group I (laser-treated ROP) and group IV (term birth). Significant differences in central retinal thickness were found between the premature groups and full-term children (Mann-Whitney U test). The cutoff point of central retinal thickness, determined by receiver operating characteristic curve was 209 microm. The general estimating equation model statistics found a significant effect of ROP severity (P = 0.003), P value for the category of prematurity was 0.063. CONCLUSIONS: The central retinal thickness was significantly higher in the preterm groups than in the full-term group. This subtle macular modification may be related mainly to ROP. Prematurity had only a marginally significant role.