No abstract

Introduction Little is known about the optimum timing of surgery for dense congenital bilateral cataracts. We examined the critical period for deprivation amblyopia in a cohort of patients with dense bilateral congenital cataracts. Methods Thirty-seven infants with dense bilateral congenital cataracts extracted by 31 weeks of age were enrolled prospectively. Visual acuity outcome was assessed at ≥5 years of age. We statistically evaluated which of 4 models provided the best fit to the data: 1) no change in visual acuity outcome with delay in surgery, 2) linear decline of outcome with delay, 3) a bilinear model in which there is a critical age after which outcome depends on delay, and 4) a bilinear model in which there is a critical age before which outcome depends on delay. In addition, we reviewed medical records for associated adverse outcomes, including strabismus, nystagmus, secondary membrane formation, and glaucoma. Results A bilinear model with a critical age of 14 weeks fit the data better than a linear model (χ2=14.7; p<0.0006). During weeks 0-14, mean visual acuity decreased by 1 line with each 3 weeks delay in surgery. From 14-31 weeks, visual acuity was independent of age at surgery, averaging 20/80. Surgery after 4 weeks was associated with a higher prevalence of strabismus and nystagmus than surgery before 4 weeks while surgery during the first 4 weeks was associated with a higher prevalence of secondary membrane formation and glaucoma. Conclusion We did not find a latent period for treatment of children with dense bilateral congenital cataracts. Deprivation amblyopia may be minimized with early surgery for bilateral cataracts.

Introduction-The Randot ®

The CVFQ subscales quantified meaningful differences among pediatric patient groups who were chosen to address key research questions commonly posed in ophthalmic clinical trials.

Purpose-To provide normative pediatric visual acuity data using HOTV optotypes presented on the Electronic Visual Acuity Tester following the Amblyopia Treatment Study (ATS) protocol.Methods-Monocular testing was conducted on 384 healthy full-term children ranging from 3 to 10 years of age (mean, 5.4 years; SD = 1.8 years). A total of 373 children completed monocular testing of each eye. In addition, 23 adults (mean, 28.7 years; SD = 4.9 years) were tested for comparison. Both monocular visual acuity and interocular acuity differences were recorded.Results-Mean visual acuity improved by slightly more than one line (0.12 logMAR) from 3 years of age to adulthood, increasing from 0.08 logMAR to −0.04 logMAR (F 6,400 = 26.3, p < 2.0 × 10 −26 ). At all ages, mean interocular acuity difference was less than one line on a standard acuity chart (overall mean difference = 0.04 logMAR; SD = 0.06 logMAR).Conclusions-These results represent the first normative data reported for HOTV optotypes using the ATS protocol on the Electronic Visual Acuity Tester. These data may play an important role in clinical practice, screening, and clinical research.Accurate and reliable measurement of visual acuity in children is essential for the detection and management of pediatric eye disease. Visual acuity is also a desirable outcome measure for pediatric eye research. Yet, though the Early Treatment Diabetic Retinopathy Study (ETDRS) testing protocol is generally accepted as the gold standard of visual acuity measurement in adults, 1,2 there is no widely accepted, standardized visual acuity protocol for young children. To remedy this, the Pediatric Eye Disease Investigator Group (PEDIG) has recently developed the Electronic Visual Acuity (EVA) Tester, a computerized testing system that provides automated presentation of letter optotypes (HOTV or ETDRS). 3Corresponding author and address to which reprints should be sent: James R. Drover, PhD, Retina Foundation of the Southwest, 9900 N. Central Expressway, Suite 400, Dallas, TX, 75231, Telephone: (214) Fax: (214) 363-4538, e-mail: jdrover@retinafoundation.org. The study was conducted at The Retina Foundation of the SouthwestThe authors have no commercial interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The EVA testing system offers a number of features that make it particularly suitable for multiple-site, pediatric vision testing. Most importantly, it offers standardization of optotypes, luminance, and testing procedure across sites and requires limited tester training. 3,4 For pediatric use, it incorporates the Amblyopia Treatme...