Lifestyle Factors in Myopic Spanish Children.

BACKGROUND: Childhood myopia represents a global concern with increasing prevalence in recent decades. Lifestyle factors significantly impact myopia. AIM: To evaluate lifestyle factors in myopic children from a metropolitan area in Europe. METHODS: This was a descriptive study including myopic subjects aged 4-18 years. Patient demographic and clinical data were collected, including cycloplegic refraction in spherical equivalent refraction (SER) and axial length (AL). In addition, a questionnaire on lifestyle factors was conducted between September 2022 and April 2023. RESULTS: A total of 321 myopic children were included, aged 10.72 ± 3.05 years, of whom 51.4% were boys, with SER -2.25 ± 1.9 D and AL 24.54 ± 0.98 mm. The mean age of myopia onset was 7.69 ± 3.05 years. A total of 59.8% had family history of myopia. Those children who had <2 h/day of screen time (on weekdays) presented SER -2 ± 1.91 D, compared to those who had >2 h/day, SER: -2.50 ±1.88 D (p = 0.009). Children who spent <2 h/day doing near work after school were less myopic compared to those who spent >2 h/day (SER: -1.75 ± 1.83 vs. SER: -2.75 ± 1.82, respectively, p = 0.03). However, no significant association was observed between SER and AL and time spent outdoors nor between SER and AL and academic performance (p > 0.05). CONCLUSIONS: Screen time and near-work time appear to be lifestyle factors related to myopia.

Lower tear meniscus height measured by optical coherence tomography in children.

INTRODUCTION: While optical coherence tomography (OCT) measurements of the lower tear meniscus height (LTMH) have been reported in adults, here we obtained LTMH measurements through Fourier Domain OCT in healthy children and compared these with values obtained in healthy adults. METHODS: Participants were children 7-17 years of age and a control group of adults 20-40 years of age. Inclusion criteria were no abnormal eye conditions or the use of contact lenses. Candidates who fulfilled the TFOS DEWS II criteria for dry eye disease (DED) were excluded. All subjects underwent LTMH measurement (OCT Spectralis) and tests for non-invasive tear break-up time and ocular surface staining. Participants also completed the ocular surface disease index questionnaire. RESULTS: A total of 86 children and 27 adults were included. Mean LTMH values in the children and adult groups were 217.40 ± 71.40 µm and 225.0 ± 54.86 µm, respectively; p = 0.53. However, 59.3% of the children had an LTMH ≤210 µm suggestive of DED, compared with only 33.3% of adults (p = 0.02). For the children, no significant differences in LTMH were observed with sex or for those more or less than 12 years of age. CONCLUSIONS: Optical coherence tomography-derived LTMH measurements were obtained in healthy children. While values were similar in children and adults, a greater proportion of children had an LTMH compatible with a diagnosis of DED. More studies in different paediatric populations are required to establish a complete set of normative LTMH measurements.

A comparative multicentric long-term study of un-augmented modified Nishida procedure vs augmentation in unilateral sixth nerve palsy.

PURPOSE: To compare the effectiveness of three procedures: modified Nishida procedure alone vs modified Nishida procedure combined with medial rectus recession (MRc) vs modified Nishida procedure combined with MRc and botulinum toxin (BT) for severe unilateral sixth nerve palsy. DESIGN: Consecutive, interventional case series. METHODS: The medical records of a consecutive series of patients with severe unilateral sixth nerve palsy who underwent modified Nishida procedure in multiple centres were reviewed. Surgical technique was decided preoperatively at the surgeon's discretion. The preoperative and postoperative findings were compared. RESULTS: Of the 43 patients with abducens palsy that received the procedure, 32 were included (mean age 38.6 ± 19.8 years). Mean preoperative deviation was 63.0 ± 27.3 prism dioptres (PD) and mean limitation of abduction -4.5 ± 1.2. Five patients underwent a modified Nishida procedure alone, 24 patients had an additional MRc and 3 patients were also injected with BT. Overall, the average correction of modified Nishida technique by itself was 29.4 ± 6.6 PD (range 20-36) and adding a MRc corrected 62.6 ± 23.8 PD (range 24-120). Modified Nishida procedure, MRc and BT altogether corrected 95.0 ± 18.0 PD (range 75-110). No postoperative complications were observed in any of the patients. CONCLUSIONS: Excellent outcomes with fewer complications are obtained with modified Nishida procedure alone. The need for additional procedures such as MRc and BT which increase the effect in primary position can be determined depending on passive duction and preoperative horizontal deviation.

Abducens and Trochlear Nerve Palsies After COVID-19 Vaccination: Report of Two Cases.

The authors report two cases of an abducens palsy and a trochlear nerve palsy, respectively, in two patients who received a coronavirus disease 2019 (COVID-19) vaccine 2 weeks previously. Given the lack of other symptoms, normal test results, and spontaneous resolution of the diplopia, a likely association with the COVID-19 vaccine was suggested. [J Pediatr Ophthalmol Strabismus. 2022;59(5):e50-e53.].

Blue Cone Monochromatism: A Case Report with Opsoclonus and Light Exposure.

Blue cone monochromatism (BCM) is a rare X-linked congenital vision disorder that is characterized by a cone dysfunction. We present a case of a 3-year-old boy referred to our department with abnormal eye movements since birth, impaired vision, and difficulties in distinguishing colors. A tendency to stare at the sun was noted. Examination revealed severe loss of visual acuity, high myopia, and opsoclonus. A mutation screening of OPN1LW / OPN1MW gene cluster was performed showing a nucleotide substitution encoding a Cys203Arg (C203R) missense mutation. The diagnosis of BCM in this case was clear and the patient harbored the most frequent genetic alteration. Opsoclonus and continued voluntary light exposure are novel features that have not been previously reported in BCM.

Effects of Corneal Biomechanical Properties on Rebound Tonometry (Icare200) and Applanation Tonometry (Perkins) Readings in Patients With Primary Congenital Glaucoma.

OBJECTIVE: The aim was to assess the influence of corneal biomechanics on intraocular pressure (IOP) measurements made with the Icare200 (IC200) rebound tonometer and the Perkins handheld applanation tonometer in patients with primary congenital glaucoma (PCG). MATERIALS AND METHODS: A total of 40 PCG patients and 40 healthy controls, age, and sex-matched, were recruited. IOP was measured with the Ocular Response Analyzer (IOPc, IOPg), IC200 and Perkins. The variables age, IOP, corneal hysteresis (CH), corneal resistance factor (CRF), central corneal thickness (CCT), best-corrected visual acuity, spherical equivalent, medications, and glaucoma surgeries were recorded for each subject. Univariate and multivariate analysis were used to detect effects of variables on IOP measurements. RESULTS: Mean CCT was 545.65±71.88 µm in PCG versus 558.78±27.58 µm in controls (P=0.284). CH and CRF were significantly lower in PCG group than in control group: mean CH 8.11±1.69 versus 11.15±1.63 mm Hg (P<0.001), and mean CRF 9.27±2.35 versus 10.71±1.75 mm Hg (P=0.002). Mean differences between IOP IC200-Perkins were 0.79±0.53 mm Hg in PCG versus 0.80±0.23 mm Hg in controls (P<0.001) and mean differences IC200-IOPc were -0.89±5.15 mm Hg in PCG (P<0.001) versus 1.60±3.03 mm Hg in controls (all P<0.009). Through multivariate analysis, CRF showed positive association and CH negative association with IOP measured with Perkins or IC200 in both subject groups. No association was detected for CCT, age, or sex. CONCLUSION: CH and CRF were identified as the main factors interfering with IOP measurements made with both tonometers in patients with PCG and healthy controls.

Minimal detectable change of the disc-fovea angle for ocular torsion assessment.

PURPOSE: The disc-fovea angle (DFA) is used as a relevant indicator of ocular torsion change in cyclovertical strabismus. However, interpretation of the variation in time must differentiate whether a real change has occurred or if the disparity is due to random measurement error. The aim of the study was to obtain the minimal detectable change (MDC) of the DFA. It represents the minimal variation between two measurements that may be considered a real ocular torsion change. METHODS: A prospective cross-sectional study was conducted in San Carlos Clinical Hospital of Madrid, Spain. Sixty healthy right eyes from 60 patients (31 men and 29 women) were recruited. Three digital fundus photographs were obtained, and between measurements, the patient moved their head away from the head support and then returned. Two observers quantified the DFA with software designed with MATLAB. Test-retest and interrater reliability were calculated. RESULTS: Mean participant age was 56.1 years (SD 16.6, range 25-85). Mean DFA was 8.1° (SD 3.5, range 1.3-18.5). Test-retest reliability for Observer 1 (Ob1), Observer 2 (Ob2) and interrater reliability were excellent (ICC 0.80, 0.83 and 0.95, respectively). Precision was 2.9° (Ob1) and 3.0° (Ob2), and the MDC95 was 4.1° (Ob1) and 4.2° (Ob2). Bland-Altman analysis revealed an absence of bias and a homoscedastic distribution of the differences. CONCLUSIONS: The MDC of the DFA in fundus photography was 4°, which represents the minimal change that may be considered a real change in ocular torsion. This result may improve the interpretation of ocular torsion changes in surgery and clinical scenarios.

Anterior-segment optical coherence tomography of filtering blebs in the early postoperative period of ab externo SIBS microshunt implantation with mitomycin C: Morphological analysis and correlation with intraocular pressure reduction.

PURPOSE: To analyse the morphological evolution of filtering blebs with anterior-segment OCT (AS-OCT) and its correlation with intraocular pressure after ab externo SIBS microshunt implantation with mitomycin C (MMC) during a 3-month follow-up period. METHODS: Twenty-eight filtering blebs of 28 patients with open-angle glaucoma were measured horizontally and vertically in the sub-Tenon space with AS-OCT after ab externo SIBS microshunt implantation with MMC. The intraocular pressure (IOP) was monitored simultaneously at each visit. Maturation of and morphological changes in the blebs and correlations with the IOP were recorded. RESULTS: The average median preoperative IOP of 20.7 (range, 12-30) mmHg decreased to 8.5 (range, 4-17), 8.9 (range, 5-17), 10.4 (range, 8-16) and 10.9 (range, 9-15) mmHg at 24 hr, 1 week, 1 month and 3 months, respectively (p < 0.001). A multiform morphology on AS-OCT prevailed at all time points, with a 3.5% rate of a uniform bleb morphology at the first week. The horizontal and vertical diameters of the blebs increased from baseline to the third month. The horizontal expansion (406 ± 127 µm on day 7, p = 0.04, 712 ± 211 µm on day 30, p = 0.02 and 952 ± 218 µm on day 90, p < 0.001) was greater than the vertical expansion (16 ± 18 µm, p = 0.3 on day 1, 63 ± 27 µm, p = 0.02 on day 30 and 137 ± 34 µm, p < 0.001 on day 90) without correlation with the IOP (r = -0.3, p = 0.2). CONCLUSION: Anterior-segment OCT (AS-OCT) of the filtering blebs formed after ab externo SIBS microshunt implantation showed progressive horizontal and vertical expansion of the blebs in the sub-Tenon space, with a significant peak at the first month not significantly correlated with the decrease in the IOP.

Impact of ocular dominance on circumpapillary and macular retinal nerve fibre layer thickness and ganglion cell layer thickness in a healthy pediatric population.

OBJECTIVE: This study was designed to evaluate potential differences in circumpapillary retinal nerve fibre layer (cpRNFL) thickness and segmented macular retinal layers between dominant and nondominant eyes on spectral-domain optical coherence tomography in a pediatric population. DESIGN: Cross-sectional study. PARTICIPANTS: 89 healthy children attending a general pediatric clinic. METHODS: Participants underwent sighting dominant testing and macular and cpRNFL spectral-domain optical coherence tomography. Segmented macular layer thicknesses and cpRNFL thickness were compared for individual patients based on their ocular dominance. RESULTS: Ocular dominance occurred particularly in the right eye (64.7%). Dominant and nondominant eyes did not differ significantly in axial length or spherical equivalent refraction; axial length: 22.99 ± 1.17 mm versus 22.98 ± 1.19 mm; p = 0.51 and spherical equivalent refraction: -0.09 ± 2.68 D versus 0.32 ± 2.93 D; p = 0.41. In the comparison of the macular ganglion layer the average thickness in the 1 mm central Early Treatment Diabetic Retinopathy Study area was significantly different between the dominant and nondominant eye (16.56 ± 6.02 µm vs 17.58 ± 8.32 µm; p = 0.02). However, when compensating with Bonferroni, this difference was no longer statistically significant. There were no differences in the analyses of average global and sectorial cpRNFL thickness in dominant and nondominant eyes. CONCLUSION: Dominant eyes demonstrated no significantly thicker average macular retinal nerve fiber layer (mRNFL), Ganglion cell layer (GCL) thickness or cpRNFL thickness. No ocular characteristic was found to be associated with the relative dominance of an eye in eyes with low anisometropia.

Inferior oblique recession associated to partial temporal inferior rectus recession in unilateral congenital superior oblique palsy.

PURPOSE: To evaluate the effectiveness of inferior oblique recession with contralateral partial temporal inferior rectus recession in patients with decompensated congenital unilateral superior oblique palsy (SOP) in correcting moderate vertical deviations in primary position. METHODS: The medical records of patients with SOP who underwent inferior oblique recession with contralateral partial temporal inferior rectus recession were reviewed retrospectively. Vertical deviation in primary position, subjective torsion, diplopia, residual deviation, and the deviation decrease were evaluated. RESULTS: Four patients (three males and one female, age range 29-56 years) with congenital unilateral SOP and mean vertical deviation of 21.0 ± 5.3PD (range 14-25D) in primary position were included. Mean correction of hypertropia in primary position with this technique was 15.5 ± 5.3PD (range 10-20PD). The mean hypertropia on gaze to the contralateral side changed from 30.0 ± 10.8D before surgery to 9.3 ± 7.9D after surgery. Torsion had a mean change of 4.8° of incyclodeviation. Preoperatively, all patients had head tilt and diplopia, which was resolved in all but one patient, who will need surgery. Patients were followed an average of 18 months. No adverse events were reported in any subjects. CONCLUSION: When performing recession of inferior oblique muscles in SOP associated to a full recession of the contralateral inferior rectus, there is a risk of overcorrection in those with moderate angles. Performing a partial recession in the contralateral inferior rectus eye corrected up to 20PD in primary position in our series, reducing this risk.

Bilaterally recurrent benign abducens nerve palsy in a child.

Benign abducens nerve palsy with recurrent episodes in children is rare. In most cases, there are two episodes, the same eye is affected, and recovery is spontaneous. We present a patient with multiple episodes in both eyes, including bilateral simultaneous involvement, who was treated with botulinum toxin.

Corneal Endothelial Cell Loss After PRESERFLO™ MicroShunt Implantation in the Anterior Chamber: Anterior Segment OCT Tube Location as a Risk Factor.

INTRODUCTION: To analyze the effects of PRESERFLO on corneal endothelial cell density (ECD). METHODS: Forty-six eyes that underwent PRESERFLO implantation were followed up for 12 months. Specular microscopy was performed preoperatively and at 1, 3, 6, and 12 months postoperatively to measure central ECD and mean monthly reduction (MMR). Anterior segment optical coherence tomography (AS-OCT) was applied to measure the tube-endothelium (TE < 200 µm, 201-500 µm, > 500 µm) distance. The relationship between TE distance and ECD was analyzed with a linear mixed-effects model. RESULTS: Central ECD decreased significantly at 1 year (7.4%, p = 0.04), with an MMR of -15 ± 25 cells/mm2. Regarding TE distance groups, there was an 18% ECD reduction in the < 200 µm group vs. 1% in the > 500 µm group (p = 0.08). Endothelial cell loss was related to TE distance (mean 482.9 ± 238 µm), with a higher rate at 1 month in comparison to 12 months for the same tube position in the anterior chamber (-174.8 ± 65.2 cells/mm2 at 1 month vs. 30.2 ± 11.3 cells/mm2 at 12 months, p < 0.01). From month 6, tubes located > 600 µm from the endothelium showed EC loss close to zero. CONCLUSIONS: The PRESERFLO implant is associated with a loss of EC from the immediate postoperative period that continues over time at lower rates. A shorter TE distance appears to cause more severe ECD loss.

Changes to Corneal Topography and Biometrics After PRESERFLO Microshunt Surgery for Glaucoma.

PRECIS: Glaucoma surgery with PRESERFLO Microshunt shows mild and transient changes in the corneal astigmatism, corneal elevation and biometrics in the early postoperative period. Posterior corneal elevation (PCE) tends to be higher in primary open angle glaucoma (POAG). PURPOSE: The aim was to determine the changes in the corneal keratometry, astigmatism and elevation, refraction, axial length (AL) and anterior chamber depth and volume after the implantation of the PRESERFLO Microshunt in patients with POAG in the early postoperative period. PATIENTS AND METHODS: Patients diagnosed with POAG who underwent an ab externo (polystyrene-block-isobutylene-block-styrene) microshunt implantation were recruited. The central corneal thickness, the intraocular pressure (IOP), best-corrected visual acuity, refraction, biometrics, and corneal topography with a Scheimpflug topographer were analyzed preoperatively and 24 hours, 1 week, 1 month, and 3 months after surgery. RESULTS: A total of 30 eyes of 29 patients were included. In 24 eyes the device was implanted as a stand-alone procedure and in 6 eyes it was combined with cataract surgery. The results were analyzed separately. The IOP decreased from 21.8±5.2 and 16.5±1.5 mm Hg at baseline to 10.9±1.8 and 10.1±1.1 mm Hg at 3 months in the noncombined and combined groups (P<0.01). The anterior surface astigmatism, posterior surface astigmatism, and total corneal astigmatism increased in each group 0.4±0.3/0.2±1.0 D, 0.08±0.1/0.03±0.1 D and 0.4±0.3/0.2±0.9 D, respectively, at 3 months. The anterior corneal elevation and PCE (ACE max, ACE min, PCE max) increased in the first week (P=0.01) with no significant changes at 3 months in the noncombined group. The changes observed in the combined group were not significant. The AL decreased to 0.13±0.23 and 0.2±0.07 mm in each group (P=0.01). There was a significant correlation between the IOP and the maximum elevation of the posterior surface of the cornea at the preoperative examination (r=0.93, P=0.02). CONCLUSIONS: The PRESERFLO Microshunt implant for glaucoma surgery induces mild and transient changes in corneal astigmatism, AL and anterior chamber depth in the early postoperative period.

Reproducibility of macular retinal nerve fiber layer and ganglion cell layer thickness measurements in a healthy pediatric population.

PURPOSE: To evaluate the reproducibility of Spectralis spectral domain-OCT segmented ganglion cell layer (GCL) and macular retinal nerve fiber layer (mRNFL) measurements in a healthy children population. METHODS: An observational, cross-sectional study was carried out on 79 children to measure the intraobserver reproducibility and the repeatability between a novel and an experienced operator of the segmented macular GCL and mRNFL. Interobserver and intraobserver reproducibility were defined by the intraclass correlation coefficient (ICC) and coefficients of variation (COV). Kruskal-Wallis test was used to determine statistical significance in the COV of three age groups children (younger than 6 years, between 6 and 12, and older than 12 years old). RESULTS: The results from the intraoperator GCL thickness analysis were highly reproducible (COV < 6%) and reliable (ICCs > 0.81). When the measurements were compared between a novel and an experienced examiner lower ICCs and higher COV were found. COVs ranged from 1.85% (total volume area) to 5.57% at the central ETDRS subfield while the ICC vary from 0.632 (outer inferior) to 0.832 (inner inferior). The repeatability and reproducibility of the mRNFL thickness were lower, with ICCs ranging from 0.428 to 0.872 in the interobserver analysis and from 0.897 to 0.346 in the interobserver one. CONCLUSION: In the present study, we establish substantial reliability of the GCL thickness in children with Spectralis® SD-OCT in all the sectors, albeit lower than the reported in the literature with other SD-OCTs and in adults. The reproducibility and repeatability of the mRNFL were significantly lower. We were unable to find consistent statistical significant differences between the COV of the three age groups.

Validity and Reliability of Semiautomatic Ocular Cycloposition Measurement With Spectralis Optical Coherence Tomography.

PURPOSE: Disc-fovea angle determined by fundus photography (P-DFA) is considered the gold standard for cycloposition assessment. Fovea-to-disc alignment (FoDi) software of the spectral-domain optical coherence tomography (SD-OCT) (Spectralis) also measures the DFA (O-DFA) based on subject fixation and offers important clinical advantages. This study aimed to analyze the validity and reliability of measuring cycloposition using OCT and to determine its performance in eyes with poor foveal definition. DESIGN: Validity and reliability analysis. METHODS: In 60 eyes with normal foveal definition and 32 eyes with poorly defined fovea, ocular cycloposition was assessed by 2 observers using 5 fundus photographs and 5 FoDi analyses each. Patients were repositioned after every capture. RESULTS: Cycloposition assessed by O-DFA was 7.6 ± 3.5-degrees, and P-DFA was 7.9 ± 3.8-degrees. The concordance between methods was good (intraclass correlation coefficient [ICC], 0.71), with absolute differences ranging from zero to 4-degrees in 85% of the subjects. The precision was 1.4-degrees for O-DFA and 3.0-degrees for P-DFA. Repeatability and reproducibility were excellent in both techniques. In the group of patients with poor foveal definition, the precision of P-DFA changed from 3.0-degrees to 4.8-degrees, whereas the O-DFA remained stable. CONCLUSIONS: OCT had a good agreement with the fundus photography method. O-DFA showed better precision than P-DFA. O-DFA repeatability and reproducibility were excellent and unconditioned by foveal status.

Practice patterns to decrease myopia progression differ among paediatric ophthalmologists around the world.

INTRODUCTION: Myopia is a worldwide epidemic. Plethora of treatments are offered to decrease myopia progression. In this study, we compared between different geographical areas worldwide the practice patterns used by paediatric ophthalmologists to decrease the progression of myopia. METHODS: Global responses to a questionnaire were analysed (n=794) for demographic variations. Pharmacological, optical and behavioural categories were defined as effective or ineffective based on the current scientific peer reviewed literature. RESULTS: Treatment rates varied significantly between geographical regions (mean 57%, range 39%-89%, p<0.001). Nearly all participants who treat myopia used at least one form of effective treatment, regardless of location (98%, p=0.16). Among those prescribing pharmacological treatments, European physicians offered the lowest rate of effective treatment compared with other regions (85% vs mean 97%). Rates of effective optical treatment varied significantly between locations (p<0.001), from 16% (Central-South America) to 56% (Far East). Most treating respondents advocated behavioural modifications (92%), between 87% (North America) and 100% (Central Asia). Nearly all respondents used combinations of treatment modalities (95%)-mostly pharmacological, optical and behavioural combination. However, combination rates varied significantly between regions (p<0.001). DISCUSSION: The utility of treatment to decrease myopia progression differs significantly across the world both in type, combination and efficacy. CONCLUSION: Paediatric ophthalmologists involvement and proficiency in myopia progression treatment varies around the world. This may entail promoting continuous medical education and other incentives to increase the number and proficiency of paediatric ophthalmologist to have a more effective impact to control the myopia epidemic in children.

Correlation Between Optical Coherence Tomography and Magnetic Resonance Imaging of Rectus Muscle Thickness Measurements in Graves' Ophthalmopathy.

PURPOSE: To assess the correlation between optical coherence tomography (OCT) and magnetic resonance imaging (MRI) measurements of extraocular rectus muscle thickness in patients with Graves' ophthalmopathy. METHODS: This was a cross-sectional observational study conducted in 62 eyes of 31 patients with Graves' ophthalmopathy. The disease phase was inactive in 20 patients and active in the remaining 11. The OCT measurements obtained were: medial rectus thickness at 7.2 and 9.2 mm from the limbus and lateral rectus thickness at 8.5 mm from the limbus. MRI measurements were maximum transversal diameter (T-MRI), craniocaudal diameter (CC-MRI), and muscle area (A-MRI). RESULTS: For the whole patient cohort, correlation emerged between the OCT-MR and T-MRI measurements (R = 0.428 to 0.576; P ≤ .002), A-MRI (R = 0.562 to 0.674; P < .001), and CC-MRI (R = 0.286 to 0.293; P ≤ .046). In patients with clinically active Graves' ophthalmopathy, correlations with T-MRI (R = 0.576 to 0.604; P ≤ .010) and A-MRI (R = 0.678 to 0.706; P < .001) were higher. No correlations were detected between OCT and MRI measurements of lateral rectus thickness (P ≥ .177), regardless of disease phase. CONCLUSIONS: The correlations observed suggest OCT could be a complementary assessment or screening method to detect thickening of the anterior portion of the medial rectus muscle in patients with Graves' ophthalmopathy, which may be especially useful when MRI is not available. [J Pediatr Ophthalmol Strabismus. 2019;56(5):319-326.].

The Use of Botulinum Toxin in Strabismus Treatment.

There is a long and extensive experience with the use of Botulinum Toxin type A (BoNT-A) injection in the treatment of different types of strabismus and oculomotor palsies. The frequency of its use varies depending on the country and institution. It is a short procedure, may reduce general anesthesia exposure, causes minimal scarring compared to surgery, and can be proposed as an early treatment in unstable strabismus. Over many years, the experience of using BoNT-A indications has been refined and new applications have been reported. The use of BoNT-A in the postoperative period, after strabismus surgery or during surgery, can also be beneficial.

Correction to: Current trends among pediatric ophthalmologists to decrease myopia progression-an international perspective.

The published online version contains a mistake in the capturing of figures.