Objective: To compare the prevalence of amblyopia, strabismus, and significant refractive error among African-American, American Indian, Asian, Hispanic, and non-Hispanic white preschoolers in the Vision In Preschoolers study.Design: Multicenter, cross-sectional study.Participants: Three- to 5-year old preschoolers (n = 4040) in Head Start from 5 geographically disparate areas of the United States.Methods: All children who failed the mandatory Head Start screening and a sample of those who passed were enrolled. Study-certified pediatric optometrists and ophthalmologists performed comprehensive eye examinations including monocular distance visual acuity (VA), cover testing, and cycloplegic retinoscopy. Examination results were used to classify vision disorders, including amblyopia, strabismus, significant refractive errors, and unexplained reduced VA. Sampling weights were used to calculate prevalence rates, confidence intervals, and statistical tests for differences.Main Outcome Measures: Prevalence rates in each racial/ethnic group.Results: Overall, 86.5% of children invited to participate were examined, including 2072 African-American, 343 American Indian (323 from Oklahoma), 145 Asian, 796 Hispanic, and 481 non-Hispanic white children. The prevalence of any vision disorder was 21.4% and was similar across groups (P = 0.40), ranging from 17.9% (American Indian) to 23.3% (Hispanic). Prevalence of amblyopia was similar among all groups (P = 0.07), ranging from 3.0% (Asian) to 5.4% (non-Hispanic white). Prevalence of strabismus also was similar (P = 0.12), ranging from 1.0% (Asian) to 4.6% (non-Hispanic white). Prevalence of hyperopia >3.25 diopter (D) varied (P = 0.007), with the lowest rate in Asians (5.5%) and highest in non-Hispanic whites (11.9%). Prevalence of anisometropia varied (P = 0.009), with the lowest rate in Asians (2.7%) and highest in Hispanics (7.1%). Myopia >2.00 D was relatively uncommon (<2.0%) in all groups with the lowest rate in American Indians (0.2%) and highest rate in Asians (1.9%). Prevalence of astigmatism >1.50 D varied (P = 0.01), with the lowest rate among American Indians (4.3%) and highest among Hispanics (11.1%).Conclusions: Among Head Start preschool children, the prevalence of amblyopia and strabismus was similar among 5 racial/ethnic groups. Prevalence of significant refractive errors, specifically hyperopia, astigmatism, and anisometropia, varied by group, with the highest rate of hyperopia in non-Hispanic whites, and the highest rates of astigmatism and anisometropia in Hispanics.Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Author: Ophthalmology
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对已发表的文献进行系统性回顾及meta分析， Wan (p. 2197) 等对已发表的研究文章进行系统性的回顾及meta分析，评估比较局部使用环孢霉素及安慰剂对治疗过敏性结膜炎的有效性及安全性分析。
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We thank Carifi et al for their interest in our recent study describing cataract surgery in patients with nanophthalmos. We fully agree that anterior chamber depth is important in planning cataract surgery in nanophthalmos and anterior chamber depth v…
A Simple Vista en Este Número
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Editorial Board
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ABCDEF Guide
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Detection of Glaucoma with an Optical Coherence Tomography-derived Neuroretinal Rim Parameter
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In response to the correspondence entitled “Recognizing the KCNV2-Related Retinal Phenotype,” we thank Khan et al for the comments that extend and clarify the unique clinical features of cone dystrophy with supranormal rod response (CDSRR) in youn…
Recognizing the KCNV2-Related Retinal Phenotype
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Diffuse Choroidal Hemangioma Management with Plaque Radiotherapy in 5 Cases
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We are grateful to Dr. Hwang for providing lucid remarks on the potential instability of Bruch’s membrane opening (BMO) in myopic eyes. We have argued that the BMO is a true anatomic border from which neuroretinal rim measurements can be made; howeve…
Effectively Implementing Evidence-Based Medicine
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Assessing the Cone Photoreceptor Mosaic in Eyes with Pseudodrusen and Soft Drusen In Vivo Using Adaptive Optics Imaging – Corrected Proof
Purpose: To investigate the cone photoreceptor mosaic in eyes with pseudodrusen as evidenced by the presence of subretinal drusenoid deposits (SDD) and conventional drusen using adaptive optics (AO) imaging integrated into a multimodal imaging approach.Design: Observational case series.Participants: Eleven patients (11 eyes) with pseudodrusen and 6 patients (11 eyes) with conventional drusen.Methods: Consecutive patients were examined using near-infrared reflectance (IR) confocal scanning laser ophthalmoscopy (SLO) and eye-tracked spectral-domain optical coherence tomography (SD-OCT) and flood-illuminated retinal AO camera of nonconfluent pseudodrusen or conventional drusen. Correlations were made between the IR-SLO, SD-OCT, and AO images. Cone density analysis was performed on AO images within 50 × 50-μm windows in 5 regions of interest overlying and in 5 located between SDD or conventional drusen with the same retinal eccentricity.Main Outcome Measures: Cone densities in the regions of interest.Results: The pseudodrusen correlated with subretinal accumulations of material in SD-OCT imaging and this was confirmed in the AO images. Defects in the overlying ellipsoid zone band as seen by SD-OCT were associated with SDD but not conventional drusen. The mean ± standard deviation cone density was 8964±2793 cones/mm² between the SDD and 863±388 cones/mm² over the SDD, a 90.4% numerical reduction. By comparison the mean cone packing density was 9838±3723 cones/mm² on conventional drusen and 12 595±3323) cones/mm² between them, a 21.9% numerical reduction. The difference in cone density reduction between the two lesion types was highly significant (P < 0.001).Conclusions: The pseudodrusen in these eyes correlated with subretinal deposition of material in multiple imaging modalities. Reduced visibility of cones overlying SDD in the AO images can be because of several possible causes, including a change in their orientation, an alteration of their cellular architecture, or absence of the cones themselves. All of these explanations imply that decreased cone photoreceptor function is possible, suggesting that eyes with pseudodrusen appearance may experience decreased retinal function in age-related macular degeneration independent of choroidal neovascularization or retinal pigment epithelial atrophy.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
In Vivo Confocal Microscopy Analyses of Corneal Microstructural Changes in a Prospective Study of Collagen Cross-linking in Keratoconus – Corrected Proof
Purpose: To use in vivo confocal microscopy (IVCM) to quantitatively analyze microstructural changes over time, after corneal collagen cross-linking for keratoconus.Design: Prospective cohort study.Participants: A total of 38 eyes of 38 patients undergoing collagen cross-linking for keratoconus.Methods: Prospective, clinical cohort study of corneal collagen cross-linking in progressive keratoconus. Laser scanning IVCM performed preoperatively and at 1, 3, 6, and 12 months postoperatively.Main Outcome Measures: Density of corneal sub-basal nerves, anterior and posterior keratocytes, and corneal endothelium.Results: Compared with baseline values, the mean sub-basal nerve density decreased significantly at 1, 3, and 6 months postoperatively (P < 0.01); however, this returned to preoperative values at 12 months (P = 0.57). One month postoperatively, there was complete absence of keratocyte nuclei in 86% of corneas. Anterior stromal edema with hyper-reflective cytoplasm and extracellular lacunae in a honeycomb-like appearance was observed and persisted at 3 months postoperatively. Scattered, presumed fragmented keratocyte nuclei, were observed at 1 and 3 months, but by 6 months, keratocyte repopulation of the anterior stroma was apparent. Quantitative analysis confirmed a significant decrease in the mean anterior keratocyte density 1, 3, and 6 months postoperatively (P ≤ 0.01) with return to baseline values at 12 months postoperatively (P = 0.57). The demarcation between treated and untreated corneal stroma appeared as a region where normal keratocytes transitioned into elongated, hyper-reflective, needle-like structures and then into large hyper-reflective stromal bands. There was no significant change in posterior keratocyte density or endothelial density at any postoperative time point.Conclusions: This prospective IVCM study revealed complete loss of the sub-basal nerve plexus and loss of anterior stromal keratocytes in the early postoperative period, with complete regeneration of the sub-basal nerve plexus and keratocyte repopulation by 12 months postoperatively. The posterior stroma and corneal endothelium were unaffected.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Intraoperative Refractive Biometry for Predicting Intraocular Lens Power Calculation after Prior Myopic Refractive Surgery – Corrected Proof
Purpose: To evaluate a new method of intraoperative refractive biometry (IRB) for intraocular lens (IOL) power calculation in eyes undergoing cataract surgery after prior myopic LASIK or photorefractive keratectomy.Design: Retrospective consecutive cases series.Participants: We included 215 patients undergoing cataract surgery with a history of myopic LASIK or photorefractive keratectomy.Methods: Patients underwent IRB for IOL power estimation. The Optiwave Refractive Analysis (ORA) System wavefront aberrometer was used to obtain aphakic refractive measurements intraoperatively and then calculate the IOL power with a modified vergence formula obtained before refractive surgery. Comparative effectiveness analysis was done for IRB predictive accuracy of IOL power determination against 3 conventional clinical practice methods: surgeon best preoperative choice (determined by the surgeon using all available clinical data), the Haigis L, and the Shammas IOL formulas.Main Outcome Measures: Median absolute error of prediction and percentage of eyes within ±0.50 diopters (D) and ±1.00 D of refractive prediction error.Results: In 246 eyes (215 first eyes and 31 second eyes) IRB using ORA achieved the greatest predictive accuracy (P < 0.0001), with a median absolute error of 0.35 D and mean absolute error of 0.42 D. Sixty-seven percent of eyes were within ±0.5 D and 94% were within ±1.0 D of the IRB’s predicted outcome. This was significantly more accurate than the other preoperative methods: Median absolute error was 0.6, 0.53, and 0.51 D for surgeon best choice, Haigis L method, and Shammas method, respectively.Conclusions: The IOL power estimation in challenging eyes with prior LASIK/photorefractive keratectomy was most accurately predicted by IRB/ORA.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.