Amblyopia Care Trends Following Widespread Photoscreener Adoption.

Importance: Amblyopia can result in permanent vision loss if not properly treated before age 7 years. In 2017, the US Preventive Services Task Force recommended that vision screening should occur at least once in all children aged 3 to 5 years to detect amblyopia. Objective: To understand trends and factors associated with screening, referral, or diagnosis of amblyopia before and after photoscreening expansion across a relatively large health care system in late 2017. Design, Setting, and Participants: This is a retrospective cohort study of electronic health record data from patients with a well child care visit at approximately age 3 years (ages 2.75-3.25 years) in a relatively large, multispecialty group practice in Northern California and linked census data between 2015 and 2022. Data were extracted and analyzed from October 2022 through August 2023. Exposures: Patient sex, race and ethnicity, immunization records, previous well child care visits, and census-level median household income. Main Outcomes and Measures: Vision screening, pediatric ophthalmology referral, or amblyopia diagnosis, compared using adjusted odds ratios (AORs). Results: The study included 2015-2017 data from 23 246 patients aged 3 years with at least 1 well child care visit (11 206 [48.2%] female) compared with 2018-2022 postexpansion data from 34 281 patients (16 517 [48.2%] female). The screening rate increased from 5.7% (424 of 7505) in 2015 to 72.1% (4578 of 6354) in 2022. The referral rate increased from 17.0% (1279 of 7505) in 2015 to 23.6% (1836 of 7792) in 2018. The diagnosis rate was 2.7% (200 of 7505) in 2015, peaked at 3.4% (263 of 7792) in 2018, and decreased to 1.4% (88 of 6354) in 2022. Compared with White patients, patients who were Asian, Black, or Hispanic were less likely to be screened (Asian: AOR, 0.80; 95% CI, 0.72-0.88; Black: AOR, 0.71; 95% CI, 0.53-0.96; Hispanic: AOR, 0.88; 95% CI, 0.80-0.97). Compared with White patients, patients who were Asian or Hispanic were more likely to be referred (Asian: AOR, 1.49; 95% CI, 1.36-1.62; Hispanic: AOR, 1.32; 95% CI, 1.18-1.48) and were more likely to be diagnosed (Asian: AOR, 1.29; 95% CI, 1.07-1.56; Hispanic: AOR, 1.67; 95% CI, 1.33-2.11). Conclusions and Relevance: In this study, increased availability of photoscreeners was associated with an increase in overall rates of vision screening for children aged 3 years in a relatively large health care system. Given that US rates of visual impairment are predicted to increase, additional targeted interventions would be needed to address remaining disparities in amblyopia care along patient- and clinician-level factors.

Patching for Amblyopia: A Novel Occlusion Dose Monitor for Glasses Wearers to Track Adherence.

PURPOSE: To evaluate the acceptability of a novel occlusion dose monitor (ODM) for glasses wearers with amblyopia. The novel ODM consists of a patch worn over the glasses, a logger affixed to the glasses frame, and a system that processes the logged data for interpretation by an algorithm. METHODS: In this pilot study, pediatric amblyopes (ages 2-8) were recruited for a cosmesis test of a sham logger for a 1-week period. Patients were then recruited to test a functional ODM for a 2-week period and their parents were asked to document patch wear in a diary. Feedback was solicited using a modified Pediatric Eye Disease Investigator Group (PEDIG) Amblyopia Treatment Index (ATI). RESULTS: Five children tested the sham logger and eight children tested the functional ODM. Early feedback recommended esthetic modifications including the use of colored shrink wrap to affix the logger to the glasses' frame. The modified patch did not reduce patients' willingness to wear the patch as compared to a standard patch. ODM-recorded wear correlated with diary-recorded wear. The specific timestamps for wear were identical for patients with good ODM-diary concordance. CONCLUSIONS: The novel ODM is acceptable for parents and children and correlates with diary records of patch wear.

Childhood visual impairment: normal and abnormal visual function in the context of developmental disability.

Abnormal or failed development of vision in children may give rise to varying degrees of visual impairment and disability. Disease and organ-specific mechanisms by which visual impairments arise are presented. The presentation of these mechanisms, along with an explanation of established pathologic processes and correlative up-to-date clinical and social research in the field of pediatrics, ophthalmology, and rehabilitation medicine are discussed. The goal of this article is to enhance the practitioner's recognition and care for children with developmental disability associated with visual impairment.

Orbital surface coil imaging predicts surgical anatomy of medial rectus muscle in consecutive exotropia: a case report.

A 51-year-old woman with consecutive exotropia after surgery for esotropia underwent magnetic resonance imaging (MRI) of her orbits by orbital surface coil. Imaging demonstrated an 8.0 mm segment of very thin tissue that spanned the distance from a normal-looking medial rectus muscle proximally to the sclera distally. Surgical treatment revealed anatomic pathology of the medial rectus muscle consistent with spatial relationships of stretched scar and muscle that were predicted by MRI.

Congenital solitary eyelid trichoepithelioma.

Trichoepitheliomas are unusual, benign tumors of hair follicle origin. They may present in children and adults as acquired lesions on the body and face, but they rarely involve the eyelids. Solitary trichoepitheliomas have not previously been reported in infants. We present a first report of congenital solitary eyelid trichoepithelioma in an infant and review the classification of trichoepitheliomas.