Referral outcomes from a vision screening program for school-aged children.

OBJECTIVE: To assess ocular diagnoses and follow-up patterns of children referred for a comprehensive eye examination after a school-based vision screening program. DESIGN: Retrospective chart review. PARTICIPANTS: Students in grades K-5 from the School District of Philadelphia public schools screened by The Wills Eye Vision Screening Program for Children between January 2014 and June 2015. METHODS: Children with subnormal best-corrected visual acuity or other ocular conditions were referred to the Wills Eye pediatric ophthalmology service. A social worker assisted parents/guardians of referred children in scheduling an appointment and navigating insurance/payment issues. Measured outcomes included demographic information, ocular diagnoses, treatments, and follow-up patterns. RESULTS: Of 10 726 children screened, 509 (5%) were referred for a follow-up eye examination. Of these 509 children, only 127 (25%) completed a referral eye examination with parental consent. Most children (58%) were diagnosed with more than one eye condition, including refractive error (76%), amblyopia (43%), strabismus (16%), and anisometropia (13%). Other conditions included macular hypoplasia, ptosis, and other congenital anomalies. CONCLUSIONS: This program discovered and addressed potentially vision-threatening conditions in underserved children susceptible to amblyopia by offering social worker services and financial support to enable referred children to complete an eye examination. Contact by the social worker required consent. Obtaining such consent proved to be a barrier to connecting children with the recommended consultation.

Central Corneal Thickness in Childhood Cataract.

PURPOSE: We explored elevated central corneal thickness (CCT) in children with cataracts as possibly reflecting preexisting corneal malformation related to specific cataract morphology. METHODS: All children consecutively seen during the study periods who had cataracts and corneal pachymetry as part of their routine care were enrolled at academic centers in large cities of Canada and the United States. Study data collected included age, sex, CCT, and cataract morphology. Differences among cataract morphology groups with respect to mean CCT measurements were evaluated and compared with a historical control thickness of 558 µm. RESULTS: A total of 96 children were enrolled in this study. The average subject age was 5.1 years, and 55 children (57%) were female. The mean CCT value for all subjects was 566.1 µm. There was little evidence to conclude that the cataract morphology groups differed from each other (P = 0.65) or from controls with respect to CCT. CONCLUSIONS: In children, CCT is likely independent of cataract morphology. This implies that factors other than preoperative malformation are more likely related to elevated CCT observed in children with aphakia and pseudophakia.

Giant Ocular Horn Occurring in a 10-Year-Old Female.

Cutaneous horns uncommonly involve the periocular region. Involvement of the ocular surface is particularly rare. The authors present a patient who underwent a perinatal buccal mucosal graft for corneal perforation due to congenital corneal ectasia, most likely resulting from Peters anomaly. She developed a giant ocular horn 10 years later.

Technique for Tube Extender Implantation.

PURPOSE: To describe a novel technique to facilitate Tube Extender implantation. MATERIALS AND METHODS: Two Tube Extender implantations were performed on 2 eyes of 2 patients. RESULTS: Before implanting the Tube Extender onto the cut tube of the glaucoma drainage device, a 30-G cannula, coated with viscoelastic, is threaded through the distal end of the extender and emerges from the proximal end. The cannula, with the extender laced over it, is then inserted into the cut tube, and the surgeon slides the Tube Extender down the cannula for insertion onto the cut tube. CONCLUSIONS: Retraction of the glaucoma drainage device from the anterior chamber occurs for various reasons, often the growth of the globe in pediatric patients. Tube Extenders can be implanted to lengthen the glaucoma drainage device to reenter the anterior chamber. However, the surgical technique can often be technically difficult to perform due to the flexibility of the glaucoma drainage device tube. We present a novel technique for Tube Extender implantation that makes the procedure easier to perform.

Severe retinal hemorrhages in infants with aggressive, fatal Streptococcus pneumoniae meningitis.

Retinal hemorrhages in children occasionally accompany bacterial meningitis, usually due to hemophilus or meningococcal organisms. The hemorrhages may be intraretinal, usually in the posterior pole of the eye and few in number, or, more uncommonly, subhyaloid or vitreous. Pathogenesis may include vasculitis, disseminated intravascular coagulation, or intracranial hypertension. We report 2 cases of bilateral severe retinal hemorrhages in fatal Streptococcus pneumoniae meningitis.

Nonophthalmologist accuracy in diagnosing retinal hemorrhages in the shaken baby syndrome.

Nonophthalmologists did not attempt to (36%) or were "unable to" (19%) examine the fundus in 72 children with shaken baby syndrome. When the retina was examined, nonophthalmologists were accurate in recognizing the absence or presence of retinal hemorrhage in 87%. However, false-negative examinations occurred in 13%. Ophthalmology consultation should be an integral part of the evaluation of children with suspected abuse.