Hae Ri Yum

Background/Objectives: To determine the clinical features of different types of intermittent exotropia according to the distance and near angles of exodeviation. Methods: This study included 5331 patients with intermittent exotropia. The patients were divided into three groups according to the near-distance differences in their exodeviations: (1) Basic-type: difference between distant and near angles of the exodeviation < 10 prism diopters (PD); (2) Convergence insufficiency (CI)-type: near-distance angle ≥ 10 PD; (3) Divergence excess (DE)-type: distance-near angle ≥ 10 PD. The main outcome measures were demographics, clinical characteristics of exotropia, subjective symptoms, medical history, and family history. Results: Overall, 4599 (86.2%) patients had basic-type exotropia, 500 (9.4%) had CI-type, and 232 (4.4%) had DE-type exotropia. Older age and greater magnitude of myopia were associated with CI-type exotropia. A-pattern exotropia, superior oblique (SO) overaction, good fusional control, good stereoacuity, and diplopia were most common in CI-type exotropia. SO underaction and photophobia were most frequently observed in DE-type exotropia compared to the other types. Conclusions: The clinical characteristics varied among the different types of intermittent exotropia. CI-type exotropia was most frequently associated with older age and greater myopia. DE-type exotropia was associated with frequent photophobia.

Purpose: To compare the effects on axial elongation and associated factors between orthokeratology lenses and 0.025% low-concentration atropine eye drops.Methods: A retrospective analysis was conducted on the medical records of children matched by sex and age, with a spherical equivalent difference within 0.125 diopters, who were followed for more than 2 years after starting treatment with orthokeratology lenses or 0.025% low-concentration atropine eye drops. The results of refractive error and axial length were analyzed using an independent t-test, paired t-test, Pearson correlation test, and multiple regression analysis.Results: Seventy-four patients (92 eyes) were included in this study. Before treatment, the axial length was 24.44 ± 0.91 mm in the orthokeratology lenses group and 24.67 ± 0.80 mm in the low-concentration atropine eye drops group. There were no statistically significant differences between the two groups in age at the start of treatment, sex, spherical equivalent, and axial length before treatment. At the 2-year follow-up, the mean axial length change was 0.53 ± 0.30 mm in the orthokeratology lenses group and 0.49 ± 0.26 mm in the low-concentration atropine eye drops group, respectively. There were no statistically significant differences between the two groups in the mean axial length change. Additionally, the age at the start of treatment showed a significant negative correlation with the axial length change in both the orthokeratology lenses group and the low-concentration atropine eye drops group (p = 0.001, p = 0.011, respectively).Conclusions: There was no significant difference in axial elongation for 2 years between orthokeratology lenses and 0.025% low-concentration atropine eye drops treatment groups. Since younger age was associated with faster eye growth, it is important to actively consider treatment in cases of early onset myopia.

Purpose: To compare axial length (AL), keratometry (K), and refractive measurements using Myopia Master, Lenstar, and KR-1 autorefractor.Methods: The study involved 44 eyes of 44 children who visited our clinic. We compared AL, flat K, steep K, mean K, and spherical equivalent (SE) measured by Myopia Master, Lenstar, and KR-1. We utilized a paired t-test and RM-ANOVA to compare mean differences and used Bland–Altman plots, intraclass correlation coefficients (ICCs), and Pearson correlation tests for agreement analysis.Results: The mean ALs (mm) measured with Myopia Master and Lenstar were 24.59 ± 0.91 mm and 24.60 ± 0.91 mm, respectively, with no statistical differences (p = 0.085). Both the ICC and Pearson correlation coefficient were 0.999. The mean SEs (D) measured with Myopia Master and KR-1 were -3.32 ± 1.75 D and -3.18 ± 1.68 D, respectively, with significant differences (p < 0.001). The ICC was 0.996 and the Pearson correlation coefficient was 0.995. The mean K (D) values measured by Myopia Master, KR-1, and Lenstar were 43.15 ± 1.59 D, 43.38 ± 1.58 D, and 43.32 ± 1.63 D, respectively, and differed significantly (p < 0.001).Conclusions: While statistical differences emerged in SEs between Myopia Master and KR-1, the differences were not clinically significant and the tools may be used interchangeably due to their good agreement. However, measured K values differed among Myopia Master, KR-1, and Lenstar, so these tools are not interchangeable. Based on the results from paired t-tests, ICCs, and Pearson correlations, AL measurements were in good agreement between Myopia Master and Lenstar but caution should be exercised due to the wider range of measured values.

Objectives: The aim of this study was to evaluate the combined effect of dual-focus soft contact lenses (CLs) and 0.05% atropine in the control of myopia. Methods: A retrospective study was conducted on 142 myopic children aged 7 to 13 years. A single nightly instillation of 0.05% atropine at bedtime was prescribed if the rate of myopia progression exceeded −1.00 D/year. After 1 year of treatment, patients who exhibited myopia progression of more than 0.75 D/year or an increase in axial length of more than 0.25 mm/year were additionally treated with dual-focus soft CLs (MiSight) alongside 0.05% atropine (Combination group, n=71). By contrast, patients who showed myopia progression of less than 0.50 D/year and axial elongation of less than 0.20 mm/year continued treatment with 0.05% atropine only (Monotherapy group, n=71). Subjects in the combination group were further divided into high myopia and low/moderate myopia subgroups, using a cutoff of −6 D. Results: Myopia progression and axial elongation were significantly slower after the addition of dual-focus soft CLs to 0.05% atropine in the combination group (P=0.001 and P=0.012, respectively). The combination group exhibited statistically significantly faster myopia progression than the monotherapy group before the addition of dual-focus soft CLs (both PP=0.504 and P=0.479, respectively). The inhibition of axial elongation was more pronounced in the low/moderate myopia group compared with the high myopia group (P=0.028). Conclusions: The combination of dual-focus soft CLs and 0.05% atropine is an effective treatment strategy for controlling myopia in children with rapidly progressing myopia. The additive effect was greater in children with low/moderate myopia than in those with high myopia.

Purpose: We present a case of alitretinoin-induced pseudotumor cerebri.Case summary: A 28-year-old woman presented with a 1-month history of bilateral papilledema and intermittent blurred vision in the left eye. She had been taking alitretinoin (9-cis-retinoic acid, AlitocⓇ; GlaxoSmithKline) for atopic dermatitis and hand eczema. Although visual acuity remained intact in both eyes, mild central scotoma was detected bilaterally. Optical coherence tomography revealed increased retinal nerve fiber layer thickness in both eyes. Enhanced magnetic resonance imaging revealed no abnormalities except for bilateral flattening of the posterior sclera. Cerebrospinal fluid exhibited an elevated opening pressure (220 mmH2O) and a normal composition. Following the discontinuation of alitretinoin, the intermittent blurred vision, papilledema, and central scotoma improved significantly within 2 months.Conclusions: Alitretinoin use should be monitored carefully for a potential development of pseudotumor cerebri, particularly in patients with pre-existing risk factors.mmH2O) and a normal composition. Following

Purpose: To evaluate the diagnostic performance of the Welch Allyn Spot Vision photoscreener in preschool children for detecting exotropia, the most prevalent type of strabismus among Asian children. Methods: Children aged 3–6 years were screened using the Spot Vision photoscreener and then underwent a complete ophthalmologic examination on the same day. A child with exodeviation ≥8 Δ in the primary position using the cover‐uncover test and the alternate prism cover test was confirmed to have exotropia. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the photoscreener in detecting exotropia were calculated. Subgroup analyses were performed according to the angle of deviation (≥25 Δ vs. p = 0.02) and a higher proportion of poor fusional control ( p = 0.004). The photoscreener had low sensitivity even in detecting exotropia ≥25 Δ or those with poor fusional control (35.2% and 43.6%, respectively). Approximately 65% (42 out of 64) of the children with a significant exodeviation which needed strabismus surgery were not identified by the Spot Vision Photoscreener. Conclusions: The Spot Vision photoscreener has low sensitivity for detecting exodeviation. It should not be used alone for assessing exotropia in preschool‐aged children.

Purpose: The outbreak of coronavirus disease 2019 (COVID-19) has caused many children to stay indoors. Increased near work and insufficient outdoor activities are considered important risk factors for myopic progression. This study aimed to compare the changes in myopic progression before and after COVID-19 in children treated with low-concentration atropine. Methods: The records of 103 eyes of 103 children who were treated with low-concentration atropine eye drops were retrospectively reviewed. We classified children according to the concentration of atropine eye drops and children’s age. The beginning of the pre-COVID-19 period was set from January 2019 to May 2019, and the endpoint was set in March 2020. The beginning of the post-COVID-19 period was set in March 2020, and the endpoint was set from January 2021 to March 2021. We evaluated the questionnaires administered to children’s parents. Results: A significant myopic progression was observed in the post-COVID-19 period compared to the pre-COVID-19 period in the 0.05% and 0.025% atropine groups (P < 0.001 and P = 0.020, respectively). For children aged 5 to 7 and 8 to 10 years, the axial elongations were significantly faster in the post-COVID-19 period than in the pre-COVID-19 period (P = 0.022 and P = 0.005, respectively). However, the rates of axial elongation and myopic progression were not significantly different between pre- and post-COVID-19 in children aged 11 to 15 years (P = 0.065 and P = 0.792, respectively). The average time spent using computers and smartphones and reading time were significantly increased, and the times of physical and outdoor activity were significantly decreased in the post-COVID-19 period compared to the pre-COVID-19 period. Conclusions: The rates of myopic progression have increased substantially after the spread of COVID-19 with an increase in the home confinement of children. Therefore, it is necessary to control the environmental risk factors for myopia, even in children undergoing treatment for the inhibition of myopic progression.

Enlarged optic disc cupping and interocular cup-to-disc ratio (CDR) asymmetry are often important indicators of glaucoma. Clinically, we occasionally encounter children with large CDR and interocular CDR asymmetry during vision screening. This study aimed to report longitudinal change of ocular parameters in children with large cup-to-disc ratio (CDR) and interocular CDR asymmetry.

Purpose: To compare the surgical outcomes between modified bilateral lateral rectus muscle (BLR) recession and augmented unilateral recession-resection (R&R) for the convergence insufficiency intermittent exotropia (IXT). Methods: 37 patients with convergence insufficiency IXT were divided into two groups: 13 patients (underwent BLR recession) and 24 patients (underwent unilateral R&R). Success was defined as within 10 prism diopters (PD) at distance and near, and within 10 PD of the difference between them at postoperative 12 months. Results: After the patch test, the preoperative distance deviation angle in the BLR group was 29.9 +/- 8.4 PD, and the near deviation angle was 42.3 +/- 9.7 PD; the difference between them was 12.5 +/- 3.2 PD. In the R&R group, the preoperative distance deviation angle was 26.7 +/- 5.8 PD, and the near deviation angle was 41.5 +/- 7.4 PD; the difference between them was 14.8 +/- 4.3 PD (p = 0.235, p = 0.987, and p = 0.123). At the 12-month follow-up in the BLR group, the distance angle was 3.8 +/- 5.1 PD, and the near deviation angle was 4.9 +/- 6.1 PD; the difference between them was 2.9 +/- 5.9 PD. In the R&R group, the postoperative distance deviation angle was 4.7 +/- 6.1 PD, and the near deviation angle was 7.9 +/- 6.6 PD; the difference between them was 3.65 +/- 5.1 PD (p = 0.708, p = 0.162, and p = 0.632, respectively). The surgical success rate did not differ significantly between groups at 12 months postoperatively (76.9%: BLR group and 70.8%: R&R group; p = 0.690). Conclusions: Modified BLR recession showed a similar surgical success rate to augmented unilateral R&R, and was effective in reducing both distance and near exodeviation, and in decreasing the difference between distance and near deviation in convergence insufficiency IXT.