Refractive features and amblyopia in Duane's Retraction Syndrome: A review of the 582 patients / Características refractivas y ambliopía en el síndrome de retracción de Duane: una revisión de los 582 pacientes

Purpose: To report the visual and refractive characteristics and the prevalence of amblyopia in patients with different types of Duane's Retraction Syndrome (DRS). Method: This retrospective study was performed on hospital records of 582 DRS patients at Farabi Hospital, Iran, from 2012 to March 2022. Results: The mean age of patients was 19.4 ± 11.9 (range, 3–70) years [335 (57.6 %) females and 247 (42.4 %) males (P < .001)]. DRS type I, II, III, and IV were presented in 347 (59.6 %), 148 (25.4 %), 82 (14.1 %), and 5 (0.9 %) patients, respectively. There were 530 (91.1 %) patients with unilateral and 52 (8.9 %) with bilateral involvement. In the unilateral patients, the DRS eyes' corrected distance visual acuity (CDVA) and astigmatism were significantly worse than the Non-DRS Eyes (P < .001). The mean amount of all refractive and visual parameters in bilateral patients' right or left eyes was significantly lower than in unilateral patients' non-DRS eyes (all P < .05). Anisometropia was observed in 75(12.9 %) of the patients. Amblyopia was observed in 18.5 % (98 patients) and 36.5 % (19 patients) of unilateral and bilateral DRS patients, respectively (P < .001). In unilateral patients, amblyopia was found in 57 (16.4 %) patients with Type I, 22 (14.9 %) patients with Type II, 16 (19.5 %) patients with Type III, and 3 (60 %) patients with Type IV. Forty-four (37.6 %) of patients with amblyopia had anisometropia. Conclusion: This large-scale study indicates that DRS types differ in terms of refractive error, visual acuity, and the prevalence of amblyopia and anisometropia. Clinicians should be aware of the clinical features associated with different types of DRS.(AU)

High Magnesium Promotes the Recovery of Binocular Vision from Amblyopia via TRPM7.

Abnormal visual experience during the critical period can cause deficits in visual function, such as amblyopia. High magnesium (Mg2+) supplementary can restore ocular dominance (OD) plasticity, which promotes the recovery of amblyopic eye acuity in adults. However, it remains unsolved whether Mg2+ could recover binocular vision in amblyopic adults and what the molecular mechanism is for the recovery. We found that in addition to the recovery of OD plasticity, binocular integration can be restored under the treatment of high Mg2+ in amblyopic mice. Behaviorally, Mg2+-treated amblyopic mice showed better depth perception. Moreover, the effect of high Mg2+ can be suppressed with transient receptor potential melastatin-like 7 (TRPM7) knockdown. Collectively, our results demonstrate that high Mg2+ could restore binocular visual functions from amblyopia. TRPM7 is required for the restoration of plasticity in the visual cortex after high Mg2+ treatment, which can provide possible clinical applications for future research and treatment of amblyopia.

Longitudinal evaluation of macular vascular density alterations in unilateral amblyopic children undergoing therapy: An optical coherence tomographic angiography study.

Importance: Understanding the pathophysiology of the macula in amblyopic eyes is an active research area. Objective: To correlate macular retinal vascular density changes with best-corrected visual acuity changes following occlusion therapy for amblyopia in children. Design: A prospective cohort study of children visiting the Pediatric Ophthalmology Division of our institution between January 2020 and January 2022 was conducted. Setting: A specialist eye hospital in Saudi Arabia. Participants: Thirty children with unilateral amblyopia. Exposure: Occlusion therapy for amblyopia.Main Outcome and Measures: Best corrected visual acuity (logMAR) before and at each of the four optical coherence tomographic angiographies was compared in amblyopic and fellow eyes. The effect of pretreatment determinants on the correlation between best-corrected visual acuity and retinal vascular density changes was reviewed. Results: In this cohort of 30 amblyopic and 30 fellow eyes from 30 children (mean age 8.7 ± 1.4 years; male: female 18:12. The best-corrected visual acuity improved from a median of 0.6 (interquartile range 0.5; 1.1) pretreatment to a median of 0.4 (interquartile range 0.2; 0.6) posttreatment in amblyopic eyes, and from a median of 0.1 to 0.05 in the fellow eyes. The total percentage change in retinal vascular density in the amblyopic eye was significantly higher than that in the fellow eye (Z = -1.92, P = 0.05). The change in best-corrected visual acuity in the amblyopic eye after a median of 98 months (interquartile range, 69-126 months) of intervention was significantly correlated with the refraction-adjusted change in retinal vascular density (B = -0.03, 95 % confidence interval -0.04, -0.02, P < 0.001) and was influenced by strabismus (B = -0.46, 95 % confidence interval -0.59, -0.34, P < 0.001), type of amblyopia (B = 0.24, 95 % confidence interval 0.12, 0.36, P < 0.001), duration of occlusion (B = -0.43, 95 % confidence interval -0.65, -0.22, P < 0.001), and occlusion compliance (B = 0.24, 95 % confidence interval 0.11, 0.36, P < 0.001). Conclusions: and Relevance: The RVD in amblyopic eyes in the first six months of therapy was significantly lower than that in fellow eyes, but not in subsequent assessments.

Continued care and provision of glasses are necessary to improve visual and academic outcomes in children: Experience from a cluster-randomized controlled trial of school-based vision screening.

OBJECTIVE: To assess the effectiveness of a kindergarten vision screening program by randomly assigning schools to receive or not receive vision screening, then following up 1.5 years later. METHODS: Fifty high-needs elementary schools were randomly assigned to participate or not in a vision screening program for children in senior kindergarten (SK; age 5‒6 years). When the children were in Grade 2 (age 6‒7 years), vision screening was conducted at all 50 schools. RESULTS: Contrary to expectations, screened and non-screened schools did not differ in the prevalence of suspected amblyopia in Grade 2 (8.6% vs. 7.5%, p = 0.10), nor prevalence of other visual problems such as astigmatism (45.1% vs. 47.1%, p = 0.51). There was also no difference between screened and non-screened schools in academic outcomes such as the proportion of children below grade level in reading (33% vs. 29%) or math (44% vs. 38%) (p = 0.86). However, more children were wearing glasses in screened than in non-screened schools (10.2% vs. 7.8%, p = 0.05), and more children reported their glasses as missing or broken (8.3% vs. 4.7%, p = 0.01), suggesting that SK screening had identified successfully those in need of glasses. Examination of individual results revealed that 72% of children diagnosed and treated for amblyopia in SK no longer had amblyopia in Grade 2. CONCLUSION: The prevalence of amblyopia and other visual problems was not reduced in Grade 2 by our SK vision screening program, perhaps because of poor treatment compliance and high attrition. The results suggest that a single screening intervention is insufficient to reduce visual problems among young children. However, the data from individuals with amblyopia suggest that continuing vision care and access to glasses benefits children, especially children from lower socioeconomic class.

RéSUMé: OBJECTIF: Évaluer l'efficacité d'un programme de dépistage visuel à l'école maternelle (EM) en assignant aléatoirement des écoles à participer ou non à un tel programme, puis en faisant un suivi un an et demi après. MéTHODES: Cinquante écoles primaires pour étudiants et étudiantes ayant des besoins importants ont été assignées aléatoirement à participer ou non à un programme de dépistage visuel auprès des enfants fréquentant la maternelle (EM; 5‒6 ans). Lorsque ces enfants étaient en 2e année (6‒7 ans), un dépistage visuel a été effectué dans les 50 écoles. RéSULTATS: Contre toute attente, il n'y a pas eu de différence entre les écoles ayant participé ou non au dépistage dans la prévalence de l'amblyopie présumée en 2e année (8,6 % contre 7,5 %, p = 0,10), ni dans la prévalence d'autres problèmes de vision comme l'astigmatisme (45,1 % contre 47,1 %, p = 0,51). Il n'y a pas eu non plus de différence dans les résultats scolaires des deux groupes d'écoles, comme la proportion d'enfants dont le niveau en lecture (33 % contre 29 %) ou en mathématiques (44 % contre 38 %), p = 0,86, ne correspondait pas à leur année d'étude. Cependant, le nombre d'enfants portant des lunettes était plus élevé dans les écoles ayant participé au dépistage que dans les autres écoles (10,2 % contre 7,8 %, p = 0,05), ainsi que le nombre d'enfants disant avoir perdu ou brisé leurs lunettes (8,3 % contre 4,7 %, p = 0,01), ce qui indique que le dépistage en maternelle a identifié avec succès les enfants ayant besoin de lunettes. L'examen des résultats individuels a révélé que 72 % des enfants diagnostiqués et traités pour l'amblyopie en maternelle ne présentaient plus d'amblyopie en 2e année. CONCLUSION: Notre programme de dépistage visuel à l'école maternelle n'a pas réduit la prévalence de l'amblyopie et d'autres problèmes de vision en 2e année, peut-être en raison du manque d'assiduité au traitement et d'une attrition importante. Les résultats indiquent qu'une seule intervention de dépistage ne suffit pas à réduire les problèmes de vision chez les jeunes enfants. Cependant, les données individuelles des sujets présentant une amblyopie indiquent qu'il est avantageux pour les enfants, et surtout ceux de la classe socioéconomique inférieure, de continuer de recevoir des soins de la vue et d'avoir accès à des lunettes.

Clinical features and surgical management of traumatic acquired isolated superior rectus palsy.

PURPOSE: Isolated acquired superior rectus palsy (ASRP) is extremely rare. The goal of this report is to describe the clinical manifestations and surgical protocols for treatment of isolated traumatic ASRP. DESIGN: Retrospective observational case series. METHOD: Records of patients presenting with traumatic isolated ASRP from 2011 to 2020 were retrospectively reviewed. Variables analyzed included nature of the damage, ocular alignment, ocular motility, binocular vision, fundus photography, imaging and surgical treatment. RESULT: Of the 23,498 strabismus surgeries performed, 16 (0.07%) were identified as being attributable to traumatic isolated ASRP. Iatrogenic injury during orbital/brain tumorectomy was the most common cause for ASRP, followed by injury resulting from a sharp object, blunt instrument, car accident, dog bite, accidental fall and explosion. The main clinical features were hypotropia and deficient supraduction of the affected eye, accompanied by exotropia, extorsion, decreased vision and ptosis. The imaging examination showed the superior orbital wall fracture in 3 cases and superior rectus rupture in 7 cases. Inferior rectus recession and/or superior rectus resection comprised the major surgical procedures employed for these cases. Vertical deviations were reduced from 45.60 ± 17.52 PD preoperatively to 12.20 ± 12.97 PD postoperatively after an average of 22.70 months at follow-up, with a success rate of 50%. CONCLUSION: Traumatic isolated ASRP comprised only 0.07% of cases receiving strabismus surgery at our hospital. Orbital imaging is essential to identify whether muscle rupture, orbital fractures and/or other possible disorders are present. Superior rectus resection and inferior rectus recession represented the most frequently used surgical procedures.

Afectación ocular como primera y única manifestación del síndrome de Bardet-Biedl: presentación de un caso / Ocular impairment as the first and only manifestation of Bardet–Biedl syndrome: A case report

El síndrome de Bardet-Biedl (SBB) es una ciliopatía que se asocia principalmente a distrofia retiniana, disfunción renal, polidactilia posaxial, obesidad, déficit cognitivo e hipogonadismo. Los síntomas vinculados a la distrofia retiniana no suelen aparecer hasta la primera década de vida, por lo que la detección tiende a retrasarse. La afectación ocular puede ser la forma inicial de manifestación de este síndrome, incluso puede ser la única, por lo que se debería tener en cuenta en el diagnóstico diferencial de una ambliopía en un niño que no mejora a pesar del correcto cumplimiento del tratamiento. Se presenta un caso de baja agudeza visual (AV) en una paciente pediátrica como manifestación inicial que lleva al diagnóstico del SBB y que es, además, el único síntoma que exhibe hasta la fecha, a pesar de tratarse de una enfermedad multisistémica.(AU)

Bardet–Biedl syndrome is a ciliopathy mainly associated with retinal dystrophy, renal dysfunction, post-axial polydactyly, obesity, cognitive deficit and hypogonadism. The symptoms associated with retinal dystrophy do not usually appear until the first decade of life, so the diagnosis is usually delayed. Ocular involvement may be the initial form of manifestation of this syndrome, it may even be the only one, so it should be taken into account in the differential diagnosis of amblyopia in a child who does not improve despite correct compliance with treatment. A case of low visual acuity in a pediatric patient is presented as an initial manifestation that leads to the diagnosis of Bardet–Biedl syndrome, and which is also the only symptom that the patient presents to date, despite being a multisystem disease.(AU)

[Wavefront characteristics in amblyopia of different etiologies in children]. / Osobennosti volnovogo fronta pri ambliopii razlichnogo geneza u detei.

Purpose. The study investigates corneal and higher-order internal aberrations in patients with amblyopia of different etiologies and their relationship with visual acuity, refraction, axial length, and fixation parameters. MATERIAL AND METHODS: Forty-five patients (90 eyes) were examined. All patients were divided into five groups: 1 - with dysbinocular amblyopia; 2 - with refractive amblyopia; 3 - with anisometropic amblyopia; 4 - with relative amblyopia due to congenital myopia; 5 (control) - fellow eyes without amblyopia. Aberrometry was performed using the OPD-Scan III device (Nidek, Japan). Fixation parameters were studied on the MP-3 microperimeter (Nidek, Japan). Correlation analysis was performed using Pearson's linear correlation coefficient (r). RESULTS: In amblyopia associated with congenital myopia, a significant increase in corneal and internal aberrations RMS, Total HOA, astigmatism (V) (0.65±0.26; 1.01±0.31; 4.22±1.17; -2.17±0.72; 0.86±0.3, respectively; control group - 0.44±0.19; 0.58±0.27; 1.0±0.75; -0.94±0.89; 0.47±0.65) and internal spherical aberration (0.06±0.02; control group - 0.04±0.03) was found. In dysbinocular amblyopia, a significant increase in internal aberrations Trefoil (V) and Coma (H) (0.75±0.52 and 0.17±0.35, respectively; control group - 0.05±0.28 and -0.07±0.21) was found, which correlated with a decrease in fixation density in the 2° ring (r= -0.40, r= -0.41). CONCLUSIONS: The increased level of higher-order aberrations in amblyopia associated with congenital myopia is due to the anatomical and optical features of the eyes. The increase in internal aberrations Trefoil (V) and Coma (H) in dysbinocular amblyopia is associated with a mismatch of the optical elements of the eye due to impaired fixation, i.e., it is not the cause, but the consequence of amblyopia.

A floating ball inside the eye in smartphone slit-lamp imaging: A case report of a pediatric vitreous cyst and a literature review.

An 8-year-old male patient was presented with a chief complaint of visual perception of a spherical object located in the visual field of his right eye. According to the patient's prior medical records, they exhibited a sole incident of minor visual impairment in the right eye, characterized by blurred vision (best-corrected visual acuity: 8/10), which first manifested during preschool assessments at the age of 5 years. During the fundoscopic examination of the patient, a pigmented, lobulated, and mobile vitreous cyst was observed in the right eye, whereas the examination of the patient's left eye revealed no abnormalities. A video of a smartphone slit-lamp imaging was also captured to facilitate subsequent examinations and patient follow-up.

Effectiveness of optical treatment in amblyopia and validation of measuring spectacle compliance with the ODM.

PURPOSE: The improvement in visual acuity (VA) was determined during optical treatment in children with amblyopia before their participation in a randomised clinical trial comparing the effect of dichoptic video gaming using virtual reality goggles with occlusion therapy. METHODS: Children aged 4-12 years with an interocular VA difference ≥0.20 logMAR and an amblyogenic factor: strabismus <30Δ, ≥1.00 D anisometropia, astigmatism ≥1.50 D and/or hypermetropia ≥1.50 D were eligible for 16 weeks of optical treatment. Children with previous amblyopia treatment were excluded. Compliance with spectacle wear was measured electronically over 1 week using the occlusion dose monitor (ODM). The reliability of these measurements was verified. The main outcome was an increase in amblyopic eye VA from baseline to 16 weeks. RESULTS: Sixty-five children entered the optical treatment period. Mean age was 6.0 ± 2.2 years (range: 4-12 years; IQR 4.5-6.7 years). Amblyopia was caused by anisometropia in 53 (82%) children, strabismus in 6 (9%) and combined mechanism in 6 (9%). After optical treatment, mean VA improved by 0.20 logMAR (SD 0.28; p < 0.001) and 0.07 in the amblyopic and fellow eye, respectively (SD 0.20; p = 0.03). This resulted in 24 children (37%) with an interocular VA difference <0.20 logMAR and in 17% of children with VA at the start of 0.30 logMAR or worse. Poor VA in the amblyopic eye at baseline (p = 0.001) and high anisometropia (p = 0.001) were associated with VA improvement. On average, spectacles were worn 9.7 ± 2.4 h/day (range: 2.3-13.6 h); mean compliance was 73% ± 18% of estimated wake time. Only ambient temperature ≥ 31°C or when spectacles were worn on top of the head prevented a reliable ODM measurement. CONCLUSIONS: VA improved by two lines resulting in more than a third of the children being treated sufficiently with spectacles alone and no longer being classified as amblyopic. The ODM proved to be a reliable method of measuring compliance with spectacle wear.

Ocular vestibular evoked myogenic potentials in different types of amblyopia.

CLINICAL RELEVANCE: The visual system plays an important role in the development of the vestibular-ocular reflex (VOR). In clinical practice, the ocular vestibular evoked myogenic potential (oVEMP) test is used to assess contralateral VOR. BACKGROUND: This study sought to compare the oVEMP in patients with anisometropic, strabismic, and mixed amblyopia using unilateral and bilateral (simultaneous binaural) stimulation. METHODS: Forty-two amblyopic patients (20 males and 22 females) with a mean age of 10.48 ± 4.00 years (range: 5 - 20 years) were examined. The Titmus stereopsis test, alternate cover test, and best-corrected visual acuity were evaluated. Patients were divided into three groups: anisometropic, strabismic, and mixed amblyopia. The oVEMP responses including the amplitude of electrical activity (n1-p1 complex) and the latencies (n1 and p1) of the VOR responses were recorded under unilateral and bilateral stimulations. RESULTS: In the anisometropic and strabismic group, n1 latency was significantly faster in the non-amblyopic eyes compared to amblyopic eyes (Z = -2.04, p = 0.042, andZ = -2.54, p = 0.024 respectively). Mean p1 latency was significantly faster in the non-amblyopic eyes compared to the amblyopic eyes of the strabismic group (Z = -2.31, p = 0.011)In all groups, the p1 latency was faster in the non-amblyopic eye compared to bilateral stimulation (all, p < 0.05). In all groups, the n1-p1 amplitude was not significantly different between the two eyes, and between each eye and bilateral stimulation (all, p > 0.05). No significant correlation was found between the depth of amblyopia and n1 and p1 responses (all, p > 0.05). In all groups there was no significant difference in the latency of n1 and p1 between the amblyopic eye and bilateral stimulation (all, p > 0.05). CONCLUSION: Regardless of its type, amblyopia affects vestibular-ocular reflex responses. Further research is warranted to clarify the effect of the disease and its treatment on the ocular-vestibular system.

Myopic Posterior Persistent Fetal Vasculature: A Rare Presentation.

Persistent fetal vasculature (PFV) is a rare ocular developmental disorder resulting from incomplete apoptosis of the embryonic hyaloid vasculature during the in-utero period. Variability in the development and regression of hyaloid vasculature is responsible for the wide range of clinical presentation of the disorder. PFV may manifest as anterior segment abnormalities (cataract, glaucoma, microphthalmia, elongated ciliary process with central traction, retrolental membrane, and shallow anterior chamber), posterior segment abnormalities (vitreous stalk, preretinal membranes, optic hypoplasia, and retinal folds), or with a combined anteroposterior disease. The most common associated clinical feature is leukocoria with microphthalmia and usually unilateral presentation. Most of the cases have poor visual prognosis and present early in childhood. Association with myopia is a very rare and atypical presentation, especially unilateral cases which may present later in life and have a good visual prognosis. Hereby, we present a case of a 27-year-old young adult male with unilateral atypical myopic posterior PFV with anisometropic amblyopia and good functional vision in the right eye.

Non-invasive brain stimulation and vision rehabilitation: a clinical perspective.

Non-invasive brain stimulation techniques allow targeted modulation of brain regions and have emerged as a promising tool for vision rehabilitation. This review presents an overview of studies that have examined the use of non-invasive brain stimulation techniques for improving vision and visual functions. A description of the proposed neural mechanisms that underpin non-invasive brain stimulation effects is also provided. The clinical implications of non-invasive brain stimulation in vision rehabilitation are examined, including their safety, effectiveness, and potential applications in specific conditions such as amblyopia, post-stroke hemianopia, and central vision loss associated with age-related macular degeneration. Additionally, the future directions of research in this field are considered, including the need for larger and more rigorous clinical trials to validate the efficacy of these techniques. Overall, this review highlights the potential for brain stimulation techniques as a promising avenue for improving visual function in individuals with impaired vision and underscores the importance of continued research in this field.

A case of reverse amblyopia in a myopic anisometropic patient: an atypical presentation.

We herein report a case of a 4-year-old female patient who presented with anisometropic amblyopia with initial visual acuity recorded at 20/400 OD and 20/100 OS. The patient was recommended for patching. Eighteen months later, the patient presented with visual acuity of 20/60 OD and 20/80 and reverse amblyopia was noted. In settings of amblyopia, where alternate patching may be used, it is most likely that reverse amblyopia, if present, will affect the more myopic eye. However, unexpectedly, in this case, reverse amblyopia occurred in the less myopic eye. With discontinuation of occlusion therapy and continued use of optical correction, the patients reverse amblyopia resolved and the visual equity equalized. To our knowledge, this is the first case described in the literature demonstrating such an occurrence. Awareness of this rare presentation by clinicians is of great importance to aid in correctly diagnosing and treating such patients.

Leveraging neural plasticity for the treatment of amblyopia.

Amblyopia is a form of visual cortical impairment that arises from abnormal visual experience early in life. Most often, amblyopia is a unilateral visual impairment that can develop as a result of strabismus, anisometropia, or a combination of these conditions that result in discordant binocular experience. Characterized by reduced visual acuity and impaired binocular function, amblyopia places a substantial burden on the developing child. Although frontline treatment with glasses and patching can improve visual acuity, residual amblyopia remains for most children. Newer binocular-based therapies can elicit rapid recovery of visual acuity and may also improve stereoacuity in some children. Nevertheless, for both treatment modalities full recovery is elusive, recurrence of amblyopia is common, and improvements are negligible when treatment is administered at older ages. Insights derived from animal models about the factors that govern neural plasticity have been leveraged to develop innovative treatments for amblyopia. These novel therapies exhibit efficacy to promote recovery, and some are effective even at ages when conventional treatments fail to yield benefit. Approaches for enhancing visual system plasticity and promoting recovery from amblyopia include altering the balance between excitatory and inhibitory mechanisms, reversing the accumulation of proteins that inhibit plasticity, and harnessing the principles of metaplasticity. Although these therapies have exhibited promising results in animal models, their safety and ability to remediate amblyopia need to be evaluated in humans.

A 360° View for Large Language Models: Early Detection of Amblyopia in Children using Multi-View Eye Movement Recordings.

Amblyopia is a neurodevelopmental visual disorder that affects approximately 3-5% of children globally and it can lead to vision loss if it is not diagnosed and treated early. Traditional diagnostic methods, which rely on subjective assessments and expert interpretation of eye movement recordings presents challenges in resource-limited eye care centers. This study introduces a new approach that integrates the Gemini large language model (LLM) with eye-tracking data to develop a classification tool for diagnosis of patients with amblyopia. The study demonstrates: (1) LLMs can be successfully applied to the analysis of fixation eye movement data to diagnose patients with amblyopia; and (2) Input of medical subject matter expertise, introduced in this study in the form of medical expert augmented generation (MEAG), is an effective adaption of the generic retrieval augmented generation (RAG) approach for medical applications using LLMs. This study introduces a new multi-view prompting framework for ophthalmology applications that incorporates fine granularity feedback from pediatric ophthalmologist together with in-context learning to report an accuracy of 80% in diagnosing patients with amblyopia. In addition to the binary classification task, the classification tool is generalizable to specific subpopulations of amblyopic patients based on severity of amblyopia, type of amblyopia, and with or without nystagmus. The model reports an accuracy of: (1) 83% in classifying patients with moderate or severe amblyopia, (2) 81% in classifying patients with mild or treated amblyopia; and (3) 85% accuracy in classifying patients with nystagmus. To the best of our knowledge, this is the first study that defines a multi-view prompting framework with MEAG to analyze eye tracking data for the diagnosis of amblyopic patients.

Parental Awareness of the Preschool Orthoptics Visual Screening in Brunei-Muara District and Factors Contributing to Defaulters.

Background: The preschool orthoptics visual screening program began in Brunei Darussalam in 2004 to detect amblyopia, a common cause of treatable visual disorders in children. Amblyopia can be asymptomatic, easily missed, and cause permanent adverse visual consequences; hence, it is necessary to be screened. The parental role in ensuring timely visual screening is pivotal to their child's visual well-being and educational success. This study explored parental awareness and reasons for their nonattendance. Methods: A cross-sectional study of 401 parents was conducted in the Brunei-Muara district in private kindergarten schools and maternal and child health clinics. A self-designed and self-administered questionnaire was used. Data collected was analysed using RStudio in the form of descriptive and analytic statistics. Results: The study findings showed that 52.8% defaulted their screening and there was a significant association between parental awareness and the defaulters (p < 0.05). Only 39.9% of parents were aware of the screening service availability, and 50.1% had not taken their children for an eye check. The most significant sociodemographic factor that influenced awareness of the importance of vision screening was parental employment status (p = 0.013), revealing a 4.43 times higher likelihood of default if the father was unemployed. This study found that with each additional child, parents are 1.25 times less likely to seek eye screening (p < 0.05). Conclusions: The main reason for nonattendance was a lack of awareness of the situation and parents believed that their children were seeing well. Mitigating child visual screening defaults requires a community-focused approach.

Binocular receptive-field construction in the primary visual cortex.

ON and OFF thalamic afferents from the two eyes converge in the primary visual cortex to form binocular receptive fields. The receptive fields need to be diverse to sample our visual world but also similar across eyes to achieve binocular fusion. It is currently unknown how the cortex balances these competing needs between receptive-field diversity and similarity. Our results demonstrate that receptive fields in the cat visual cortex are binocularly matched with exquisite precision for retinotopy, orientation/direction preference, orientation/direction selectivity, response latency, and ON-OFF polarity/structure. Specifically, the average binocular mismatches in retinotopy and ON-OFF structure are tightly restricted to 1/20 and 1/5 of the average receptive-field size but are still large enough to generate all types of binocular disparity tuning. Based on these results, we conclude that cortical receptive fields are binocularly matched with the high precision needed to facilitate binocular fusion while allowing restricted mismatches to process visual depth.

Unveiling novel LRP5 pathogenic variant in familial exudative vitreoretinopathy: Diverse phenotypic expressions in a mother-daughter duo.

PURPOSE: This report aims to delineate distinct phenotypes of Familial Exudative Vitreoretinopathy (FEVR) observed in a mother and her daughter, both harboring a novel LRP5 pathogenic variation. METHODS: The investigation involves a retrospective review of medical records accompanied by multimodal imaging. Molecular characterization was performed using whole exon sequencing, and the pathogenic variant was subsequently confirmed through Sanger sequencing. RESULT: A 6-year-old girl diagnosed with anisometropic amblyopia exhibited macular dragging and peripheral avascular retina in her right eye. Whole exon sequencing identified a previously unreported heterozygous missense LRP5 pathogenic variation, Glu528Lys. Simultaneously, her 43-year-old mother also carried the same mutation, manifesting peripheral exudations, avascular areas, and multiple microaneurysms. Notably, both cases presented distinctive phenotypes of FEVR. CONCLUSION: Our findings underscore the diversity in clinical presentations associated with FEVR, emphasizing the pivotal role of genetic evaluation. Despite variations in severity between the eyes of the same patient, it is crucial to remain vigilant for potential progression to a pathological status in the seemingly normal eye. Additionally, this study contributes to expanding the genetic spectrum of FEVR.

Prevalence of visual impairment and estimation of refractive errors among school children in Kakamega, Kenya.

AIM: To investigate the prevalence of visual impairment (VI) and provide an estimation of uncorrected refractive errors in school-aged children, conducted by optometry students as a community service. METHODS: The study was cross-sectional. Totally 3343 participants were included in the study. The initial examination involved assessing the uncorrected distance visual acuity (UDVA) and visual acuity (VA) while using a +2.00 D lens. The inclusion criteria for a subsequent comprehensive cycloplegic eye examination, performed by an optometrist, were as follows: a UDVA<0.6 decimal (0.20 logMAR) and/or a VA with +2.00 D ≥0.8 decimal (0.96 logMAR). RESULTS: The sample had a mean age of 10.92±2.13y (range 4 to 17y), and 51.3% of the children were female (n=1715). The majority of the children (89.7%) fell within the age range of 8 to 14y. Among the ethnic groups, the highest representation was from the Luhya group (60.6%) followed by Luo (20.4%). Mean logMAR UDVA choosing the best eye for each student was 0.29±0.17 (range 1.70 to 0.22). Out of the total, 246 participants (7.4%) had a full eye examination. The estimated prevalence of myopia (defined as spherical equivalent ≤-0.5 D) was found to be 1.45% of the total sample. While around 0.18% of the total sample had hyperopia value exceeding +1.75 D. Refractive astigmatism (cil<-0.75 D) was found in 0.21% (7/3343) of the children. The VI prevalence was 1.26% of the total sample. Among our cases of VI, 76.2% could be attributed to uncorrected refractive error. Amblyopia was detected in 0.66% (22/3343) of the screened children. There was no statistically significant correlation observed between age or gender and refractive values. CONCLUSION: The primary cause of VI is determined to be uncorrected refractive errors, with myopia being the most prevalent refractive error observed. These findings underscore the significance of early identification and correction of refractive errors in school-aged children as a means to alleviate the impact of VI.

[Bibliometric study and analysis of citation networks of visual screening in primary care]. / Estudio bibliométrico y análisis de redes de citación de los screening visuales en atención primaria.

AIM: Screenings make it possible to detect anomalies that can be treated and identify patients who require referral to a specialist. The objective is to identify the different areas of research and determine the most cited publications on screening in primary care. METHODS: An analysis of publications and visualization of citation networks has been carried out using the Citation Network Explorer software. The bibliographic search was carried out with the Web of Science (WOS) database using the search term: "screening AND (vision OR eye OR ocular OR visual)". RESULTS: We analyzed 16707 publications in all fields, 23919 citation networks have been found. The number of publications has increased, with 2021 being the year with the highest number. The majority are scientific articles and the predominant language is English. The most cited article is a global meta-analysis on the prevalence of glaucoma, showing the importance of screening for its early detection since it is essential to avoid blindness. Using the clustering function we found 8 groups with a significant number of publications where we have bibliography on certain eye diseases: glaucoma, diabetic retinopathy, pediatric amblyopia, keratoconus and dry eye. CONCLUSIONS: The main areas of study in relation to screening are the detection of diseases such as glaucoma, retinopathy of prematurity, keratoconus and dry eye. As well as the detection through visual analysis of childhood amblyopia and vision loss in elderly patients. It also gives importance to performing ocular motility tests in problems of acquired brain damage.