3D Printed Adjustable Glasses: A New Model of Corrective Lens Delivery for Pediatric Refractive Error in Underserved Communities

Purpose: Uncorrected refractive error (URE) remains a major cause of preventable vision impairment in the pediatric population with large inequities in disease burden. The present study aims to elucidate the global burden of pediatric URE and explore the current lens delivery systems which address this problem. Within this framework, we introduce a new model of corrective lens delivery that may improve upon existing models. Methods: The present study involved an extensive literature review of epidemiological data to determine the global prevalence of URE. Prevalence data was then compared against WHO data on refractionist coverage gaps divided by region. Four current models for corrective lens delivery, plus our newly proposed model, were compared across five general categories (Fit, Appearance, Pathologies Corrected, Cost to Patient, Distribution System). Results: In children, the estimated pooled prevalence (EPP) of myopia, hyperopia, and astigmatism was 11.7% (95% CI: 10.5–13.0), 4.6% (95% CI: 3.9–5.2), and 14.9% (95% CI: 12.7–17.1), respectively. The highest prevalence of astigmatism and hyperopia occurs in The Americas at double and triple the global average respectively. The regions with the poorest coverage of URE were Sub-Saharan Africa, Southeast Asia and The Americas. Existing solutions delivering coverage to these areas often lacks the ability to correct for astigmatism. Our modular glasses design provides a one-size-fits-all frame with circular lens mounts to accommodate any axis of astigmatism. 3D printed materials allow these frames to be constructed at a fraction of the cost of conventional frames. Discussion: While corrective lenses are made available through a variety of distribution models, the infrastructure to fit and deliver these glasses to remote and resource poor areas remains a major challenge leading to inequities in URE treatment. The flexibility of our glasses design allows for these glasses to be distributed in rural and urban environments alike, with minimal training required to fit and assemble, at a low cost to patients.https://digitalcommons.unmc.edu/chri_forum/1015/thumbnail.jp

Computer-Assisted Analysis of Soccer Ball Trauma of the Eye

Purpose: Sports-related eye injuries are common in the United States and around the world, particularly in youth. Over half of patients presenting with these injuries are of 18 years or younger, and sports and recreation account for nearly a quarter of all pediatric eye injuries treated in US emergency departments. Soccer is the most popular game in the world and is the leading source of sports-related eye injury in Europe and Israel. Soccer injuries cause visual impairment at a disproportionately higher rate than other sports. This study investigates the mechanisms of injury. Methods: A finite element simulation was developed to study the distribution of stresses in the eye following the impact of a soccer ball. The eye model was composed of sclera, vitreous, and retina. The retina was simulated as three layers: preretinal, intraretinal, and subretinal. Vitreoretinal adhesions were incorporated along retinal vessels. Results: The anterior pole experienced a peak stress of 69.8 kPa following impact of the soccer ball. The impact induced a pressure wave within the vitreous that traveled latitudinally along the anterior-posterior axis and repeatedly reflected from the intraocular tissue. Oscillations of high and negative pressure in the vitreous resulting from the pressure wave were greatest at the posterior pole. Stresses within the retina were highest along the retinal vasculature, especially at the distal bifurcations where the peak stress was 15.4 kPa. The subretinal layer experienced more stress than the preretinal and intraretinal layers except along the vasculature, at which the preretinal layer experienced more stress. Conclusions: The distribution of stresses within the eye quantify and expand on frequently proposed biomechanical bases for ocular injuries resulting from soccer ball trauma. High stress near the point of impact may account for commonly observed anterior segment injuries. Negative pressures within the vitreous adjacent to the posterior retina provide further support for the anterior pulling of the retina as a potential mechanism for posteriorly localized retinal lesions. These patterns of stress throughout the eye highlight the importance of eye protection in soccer and other sports, which have been demonstrated to prevent up to 90% of ocular injury.https://digitalcommons.unmc.edu/chri_forum/1035/thumbnail.jp

How Do you Find Resilience in Healthcare through Inspiration, and Where do you Find it?

Drawing from stories in his autobiography, Catching A Star: My Story of Hope, Dr. Suh will share his journey of struggle, adaptation and accomplishment, as well as the hope he gains by interacting with patients and participating in medical missions around the world.https://digitalcommons.unmc.edu/mcgoogan_speakers/1000/thumbnail.jp

Screening, Diagnosis, and Treatment of Pediatric Ocular Diseases

Vision is an important aspect of a child's quality of life and intellectual, social, and emotional development. Disruptions to vision during infancy and early childhood can cause lifelong vision impairment or blindness. However, early identification and treatment of eye disease can prevent loss of sight and its consequent long-term effects. Therefore, screening guidelines exist to guide physicians in detecting the most common threats to sight in the different stages of infancy and childhood. This review describes common causes of pediatric vision impairment, the recommended screening guidelines for diagnosing them, and current treatment modalities

An Update to Biomechanical and Biochemical Principles of Retinal Injury in Child Abuse.

Abusive head trauma (AHT) is an extreme form of physical child abuse, a subset of which is shaken baby syndrome (SBS). While traumatic injury in children is most readily observed as marks of contusion on the body, AHT/SBS may result in internal injuries that can put the life of the child in danger. One pivotal sign associated with AHT/SBS that cannot be spotted with the naked eye is retinal injury (RI), an early sign of which is retinal hemorrhage (RH) in cases with rupture of the retinal vasculature. If not addressed, RI can lead to irreversible outcomes, such as visual loss. It is widely assumed that the major cause of RI is acceleration-deceleration forces that are repeatedly imposed on the patient during abusive shaking. Still, due to the controversial nature of this type of injury, few investigations have ever sought to delve into its biomechanical and/or biochemical features using realistic models. As such, our knowledge regarding AHT-/SBS-induced RI is significantly lacking. In this mini-review, we aim to provide an up-to-date account of the traumatology of AHT-/SBS-induced RI, as well as its biomechanical and biochemical features, while focusing on some of the experimental models that have been developed in recent years for studying retinal hemorrhage in the context of AHT/SBS

Comparison of photorefraction by Plusoptix A12 and cycloplegic autorefraction in children.

BACKGROUND: Plusoptix photoscreeners are capable of measuring refractive errors of children from 1 meter distance, without cyloplegia. We aimed to compare refractive data obtained from the newest version of Plusoptix (model 12) with cycloplegic autorefraction. METHODS: We examined 111 consecutive children aged 3-7 years first by Plusoptix A12C under manifest condition and subsequently for cycloplegic refraction by Topcon KR-1 tabletop autorefractometer. Sphere, spherical equivalent, cylinder and axis of astigmatism measured by the two methods were analyzed to determine correlation, agreement and differences. RESULTS: Binocular examination of 111 children aged 4.86±1.27 years revealed good agreement between refractive data obtained by Plusoptix and cycloautorefraction, according to Bland-Altman plots. Significant (p < 0.001) and strong correlation was found between all refractive measurements (Pearsons r value of 0.707 for sphere, 0.756 for pherical equivalent, and 0.863 for cylinder). Plusoptix mean sphere, spherical equivalent and cylinder were 1.22, 0.56, and -1.32 D, respectively. Corresponding values for cycloautorefraction were 1.63, 1.00, and -1.26 D. The difference between axis of cylinder measured by the two methods was < 10° in 144 eyes (64.9%). CONCLUSIONS: Considering the significant agreement and correlation between Plusoptix photoscreener and cycloplegic autorefraction, the need for cycloplegic drops in refractive examination of children may be obviated. The mean difference between cylinder measurements are considerably trivial (0.06 D), but sphere is approximately 0.4 D underestimated by Plusoptix compared to cycloautorefraction, on average

Optic Nerve Hypoplasia: A Retrospective Analysis of Clinical Presentation and Disease Severity

PurposeThrough the establishment of relationships between optic nerve hypoplasia (ONH), optical coherence tomography (OCT) spectralis retinal nerve fiber layer (RNFL) thickness results and clinical sequelae, this study aims to identify long-term outcomes for individuals with ONH.MethodsA retrospective review of pediatric ophthalmology patients at Children's Hospital of Omaha from January 2000 to October 2018 was performed. All patients with ONH evaluated with Heidelberg Engineering's OCT Spectralis were identified. Patient records were investigated for visual acuity, presence of nystagmus, strabismus, and endocrinopathies. Statistical analysis with linear regression models, random intercepts models, and odds ratios were used to define relationships between RNFL thickness at the optic nerve head, nystagmus, strabismus, and endocrine dysfunction.ResultsThere exists a strong trend of worsening visual acuity as RNFL thickness at the optic nerve head decreases in all scanned regions. This is strongest at the temporal-superior (p=0.009) and nasal-inferior (p=0.006) regions in patients with bilateral ONH. There is insufficient evidence of a difference in prevalence of nystagmus or strabismus between subjects with unilateral or bilateral ONH. Endocrinopathy is present in 21.6% of the subjects, with no statistical difference in the type of endocrinopathy or laterality of ONH.ConclusionTrends established indicate that best-corrected visual acuity is related to RNFL thickness at the optic nerve head. Odds ratios for the prevalence of nystagmus also point to RNFL thickness as a contributing factor. These trends may have the potential to characterize ONH severity by objective measurement of clinical outcomes and RNFL thickness at the optic nerve head

Epibulbar osseous choristoma: A case report

Purpose: To present the case of a 12-year-old female with an epibulbar osseous choristoma. Observations: The patient presented with right-sided conjunctival mass, which caused her discomfort. Slit lamp examination revealed a 5×5-mm, firm nodule in the superotemporal quadrant of the bulbar conjunctiva. The nodule had feeder vessels, adhered firmly to the sclera, and lacked signs of malignancy. The patient underwent excisional biopsy under general anesthesia. During this procedure, great care was taken to avoid perforation of the globe. The pathologic sections were significant for well-circumscribed osseous tissue without atypia. Conclusions and importance: We describe diagnosis and successful surgical management of osseous choristoma the rarest subtype of ocular choristoma. With only 65 cases reported since mid-19th century, the condition remains poorly described. This report provides additional information on diagnosis and treatment of this rare condition

The UCI EyeMobile Preschool Vision Screening Program: Refractive Error and Amblyopia Results from the 2019–2020 School Year

PurposeTo introduce the University of California Irvine (UCI) EyeMobile for Children preschool vision screening program and describe the ophthalmic examination results of children who failed screening with the PlusoptiX S12C photoscreener during one school year.Patients and methodsChildren aged 30-72 months were screened with the PlusoptiX using ROC mode 3 during the 2019-2020 school year. Children who failed screening were referred for comprehensive eye examination on the EyeMobile mobile clinic. Presence of amblyopia risk factors (ARFs), amblyopia, and refractive error was determined via retrospective review of records. Amblyopia was defined as unilateral if there was ≥ 2-line interocular difference in the best-corrected visual acuity (BCVA) and as bilateral if BCVA was < 20/50 for children < 4 years old and < 20/40 for children ≥ 4 years old. ARFs were defined using 2021 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) instrument-based screening guidelines.Results5226 children were screened during the study period. Of the 546 children who failed screening, 350 (64%) obtained consent and were examined. Mean age of examined children was 4.45 years. Amblyopia was found in 8% of examined children, with unilateral amblyopia seen in 79% of amblyopic subjects. Glasses were prescribed to 246 (70.3%) children. Of the 240 children who received cycloplegic examinations, 43% had hyperopia and 30% had myopia. The positive predictive value (PPV) of the PlusoptiX screening for ARFs in children who received cycloplegic examinations was 70.4%.ConclusionA significant proportion of Orange County preschoolers with refractive errors and amblyopia have unmet refractive correction needs. The PlusoptiX S12C photoscreener is an adequate screening device for the UCI EyeMobile for Children program, although modification of device referral criteria may lead to increased PPV. Further research is necessary to understand and overcome the barriers to childhood vision care in our community