IMPORTANCE This is the first large-scale randomized clinical trial evaluating the effectiveness and safety of overminus spectacle therapy for treatment of intermittent exotropia (IXT).OBJECTIVE To evaluate the effectiveness of overminus spectacles to improve distance IXT control. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial conducted at 56 clinical sites between January 2017 and January 2019 associated with the Pediatric Eye Disease Investigator Group enrolled 386 children aged 3 to 10 years with IXT, a mean distance control score of 2 or worse, and a refractive error between 1.00 and −6.00 diopters (D). Data analysis was performed from February to December 2020.INTERVENTIONS Participants were randomly assigned to overminus spectacle therapy (−2.50 D for 12 months, then −1.25 D for 3 months, followed by nonoverminus spectacles for 3 months) or to nonoverminus spectacle use. MAIN OUTCOMES AND MEASURESPrimary and secondary outcomes were the mean distance IXT control scores of participants examined after 12 months of treatment (primary outcome) and at 18 months (3 months after treatment ended) assessed by an examiner masked to treatment group. Change in refractive error from baseline to 12 months was compared between groups. Analyses were performed using the intention-to-treat population. RESULTSThe mean (SD) age of 196 participants randomized to overminus therapy and 190 participants randomized to nonoverminus treatment was 6.3 (2.1) years, and 226 (59%) were female. Mean distance control at 12 months was better in participants treated with overminus spectacles than with nonoverminus spectacles (1.8 vs 2.8 points; adjusted difference, −0.8; 95% CI, −1.0 to −0.5; P < .001). At 18 months, there was little or no difference in mean distance control between overminus and nonoverminus groups (2.4 vs 2.7 points; adjusted difference, −0.2; 95% CI, −0.5 to 0.04; P = .09). Myopic shift from baseline to 12 months was greater in the overminus than the nonoverminus group (−0.42 D vs −0.04 D; adjusted difference, −0.37 D; 95% CI, −0.49 to −0.26 D; P < .001), with 33 of 189 children (17%) in the overminus group vs 2 of 169 (1%) in the nonoverminus group having a shift higher than 1.00 D.CONCLUSIONS AND RELEVANCE Children 3 to 10 years of age had improved distance exotropia control when assessed wearing overminus spectacles after 12 months of overminus treatment; however, this treatment was associated with increased myopic shift. The beneficial effect of overminus lens therapy on distance exotropia control was not maintained after treatment was tapered off for 3 months and children were examined 3 months later.

Purpose To evaluate the short-term effectiveness of overminus spectacles in improving control of childhood intermittent exotropia (IXT) Design Randomized clinical trial Participants 58 children 3 to <7 years old with IXT. Eligibility criteria included a distance control score of 2 or worse (mean of 3 measures during a single examination) on a scale of 0 (exophoria) to 5 (constant exotropia), and spherical equivalent refractive error between −6.00 diopters (D) and +1.00D Intervention Children were randomly assigned to either overminus spectacles (−2.50D over cycloplegic refraction) or observation (non-overminus spectacles if needed, or no spectacles) for 8 weeks. Main Outcome Measures The primary outcome was distance control score for each child (mean of 3 measures during a single examination) assessed by masked examiner at 8 weeks. Outcome testing was conducted with children wearing their study spectacles, or plano spectacles for observation group children who did not need spectacles. The primary analysis compared mean 8-week distance control score between treatment groups using an analysis of covariance model which adjusted for baseline distance control, baseline near control, pre-study spectacle wear, and prior IXT treatment. Treatment side effects were evaluated using questionnaires completed by parents. Results At 8 weeks, mean distance control was better in the 27 children treated with overminus spectacles than in the 31 children who were observed without treatment (2.0 vs 2.8 points, adjusted difference = −0.75 points favoring the overminus group; two-sided 95% confidence interval = −1.42 to −0.07 points). Side effects of headaches, eyestrain, avoidance of near activities, and blur appeared similar between treatment groups. Conclusions In a pilot randomized clinical trial, overminus spectacles improved distance control at 8 weeks in children 3 to <7 years old with IXT. A larger and longer randomized trial is warranted to assess the effectiveness of overminus spectacles in treating IXT, particularly the effect on control after overminus treatment has been discontinued.

IMPORTANCECataract is an important cause of visual impairment in children. Data from a large pediatric cataract surgery registry can provide real-world estimates of visual outcomes and the 5-year cumulative incidence of adverse events. OBJECTIVE To assess visual acuity (VA), incidence of complications and additional eye operations, and refractive error outcomes 5 years after pediatric lensectomy among children younger than 13 years. DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study used data from the Pediatric Eye Disease Investigator Group clinical research registry. From June 2012 to July 2015, 61 eye care practices in the US, Canada, and the UK enrolled children from birth to less than 13 years of age who had undergone lensectomy for any reason during the preceding 45 days. Data were collected from medical record reviews annually thereafter for 5 years until September 28, 2020. EXPOSURES Lensectomy with or without implantation of an intraocular lens (IOL).MAIN OUTCOMES AND MEASURES Best-corrected VA and refractive error were measured from 4 to 6 years after the initial lensectomy. Cox proportional hazards regression was used to assess the 5-year incidence of glaucoma or glaucoma suspect and additional eye operations. Factors were evaluated separately for unilateral and bilateral aphakia and pseudophakia.RESULTS A total of 994 children (1268 eyes) undergoing bilateral or unilateral lensectomy were included (504 [51%] male; median age, 3.6 years; range, 2 weeks to 12.9 years). Five years after the initial lensectomy, the median VA among 701 eyes with available VA data (55%) was 20/63 (range, 20/40 to 20/100) in 182 of 316 bilateral aphakic eyes (58%), 20/32 (range, 20/25 to 20/50) in 209 of 386 bilateral pseudophakic eyes (54%), 20/200 (range, 20/50 to 20/618) in 124 of 202 unilateral aphakic eyes (61%), and 20/65 (range, 20/32 to 20/230) in 186 of 364 unilateral pseudophakic eyes (51%). The 5-year cumulative incidence of glaucoma or glaucoma suspect was 46% (95% CI, 28%-59%) in participants with bilateral aphakia, 7% (95% CI, 1%-12%) in those with bilateral pseudophakia, 25% (95% CI, 15%-34%) in those with unilateral aphakia, and 17% (95% CI, 5%-28%) in those with unilateral pseudophakia. The most common additional eye surgery was clearing the visual axis, with a 5-year cumulative incidence of 13% (95% CI, 8%-17%) in participants with bilateral aphakia, 33% (95% CI, 26%-39%) in those with bilateral pseudophakia, 11% (95% CI, 6%-15%) in those with unilateral aphakia, and 34% (95% CI, 28%-39%) in those with unilateral pseudophakia. The median 5-year change in spherical equivalent refractive error was −8.38 D (IQR, −11.38 D to −2.75 D) among 89 bilateral aphakic eyes, −1.63 D (IQR, −3.13 D to −0.25 D) among 130 bilateral pseudophakic eyes, −10.75 D (IQR, −20.50 D to −4.50 D) among 43 unilateral aphakic eyes, and −1.94 D (IQR, −3.25 D to −0.69 D) among 112 unilateral pseudophakic eyes. CONCLUSIONS AND RELEVANCEIn this cohort study, development of glaucoma or glaucoma suspect was common in children 5 ye...

The cultural practice of rotating corn, Zea mays L., with soybean, Glycine max (L.) Merrill, to manage larval injury by the western corn rootworm, Diabrotica virgifera virgifera LeConte, was used extensively throughout east central Illinois and northern Indiana until the mid-1990s. The effectiveness of this management tactic diminished due to a shift in the ovipositional behavior of the western corn rootworm. The variant western corn rootworm has since spread as far as northwestern Illinois, southern Wisconsin, southern Michigan, and eastern Ohio. The objective of this study was to evaluate the influence of four cropping systems on adult and egg densities of the western corn rootworm and to quantify the level of root injury in rotated corn after each system. The four cropping systems used included: 1) corn; 2) soybean; 3) double-cropped winter wheat, Triticum aestivum L., followed by soybean; and 4) winter wheat. Research trials were conducted near Monmouth (northwestern), DeKalb (northern), and Urbana (east central), IL, during 2003 and 2004. Results indicated variant western corn rootworm adults can be found in all four treatments at each location and consequently no crop was immune to oviposition or root injury by corn rootworm larvae in rotated corn the following season. Adults were found primarily in corn and soybean, whereas egg densities were greatest in corn plots in all three locations in both years of the study. Root injury by larvae was most abundant in corn following corn at all three sites. Of the four systems evaluated, the use of wheat demonstrated the most potential for preventing yield reducing levels of root injury in rotated corn.

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