To Örebro University

Purpose: Previous studies have mostly focused on ophthalmological complications associated with being born extremely preterm despite that moderate-to-late preterm (MLP) account for 85% of all preterm births. The aim was to examine fundus morphology and visual function in adolescents born MLP, in comparison with controls born full-term.

Methods: A prospective population-based cohort study of 247 MLP individuals (110 girls, gestational age 32-36 weeks) with no syndromes or history of retinopathy of prematurity participated in a neonatal study in 2002-2004. Later on, they have been included in ophthalmological follow-up studies at age 8 (n=50) and 12 (n=22). In the present study, 50 adolescents (26 girls; mean age 16.5 years) were examined regarding best corrected visual acuity (BCVA), refraction, and ocular morphology, measured by optical coherence tomography (Topcon, Japan). A group of 50 adolescents (30 girls, mean age 16.7 years) born full-term served as controls. Participants with refraction outside +/-6 diopters were excluded. T-test was used for statistical analysis.

Results: The MLP-group (n=48) showed a thinner macular retinal nerve fibre layer (RNFL) inner mean in right eye (RE) (26.4±1.5 vs 27.1±1.7 μm; p=0.029) and in left eye (LE) (26.3±1.5 vs 27.0±1.5 μm; p=0.022) compared with controls. A thinner macular RNFL outer mean was found both in RE (40.2±4.4 vs 42.6±4.2 μm; p=0.011) and LE (40.3±4.0 vs 42.1±4.3 μm; p=0.034) (Fig.1A-B). A thicker central macular retinal thickness (MRT) (249.3±20.9 vs 239.9±16.4 μm; p=0.016) and a thinner total peripapillary (pp)RNFL (104.8±8.8 vs 109.1±8.3 μm; p=0.027) were found in RE. The BCVA in best eye was lower in the MLP-group (n=50) compared with controls (-0.09±0.08 vs -0.12±0.09 logMAR; p=0.022). At age 8, MLP births showed a thinner total macular volume and a thicker foveal minimum, central MRT, and central macular RNFL in RE. At age 12, a thicker foveal minimum and thinner outer macular RNFL were found in LE.

Conclusions: MLP-birth may be associated with ophthalmological macular and ppRNFL changes as well as lower BCVA in adolescence. Similar morphology findings have been shown at younger ages, thus the fundus results persist into young adulthood.

AIM: To find predictors of abnormal retinal vascularisation in moderately to late preterm newborn infants considered to have no risk of developing retinopathy of prematurity.

METHODS: Seventy-eight infants (34 girls) were recruited from a longitudinal study of otherwise healthy premature children born at a gestational age of 32 + 0-36 + 6 weeks. Retinal vessel morphology was evaluated at mean postnatal age 7 days. Insulin-like growth factor-I (IGF-I) levels were analysed in umbilical cord blood.

RESULTS: Of the 78 infants, 21 (27%) had abnormal retinal vessel morphology; they had significantly lower median (range) birth weight [1850 g, (1190-3260), vs. 2320, (1330-3580), p < 0.0001], shorter birth length [43.0 cm, (38-49), vs. 46.0, (40-50), p < 0.0001] and smaller head circumference [31.0 cm, (27.7-34.0), vs. 32.0, (27.5-36.5), p = 0.003]. They also had significantly lower gestational age [34 + 1 weeks, (32 + 2-35 + 3), vs. 34 + 6, (32 + 2-36 + 6), p = 0.004] and mean ± SD IGF-I levels (24.6 ± 17.0 μg/L vs. 46.7 ± 21.5, p < 0.0001). A higher percentage of these infants were small for gestational age (57.1% vs. 15.8%, p = 0.001), and maternal hypertension/preeclampsia rates were also higher (47.6% vs. 19.3%, p = 0.03). Step-wise logistic regression showed that birth weight was the strongest predictor of abnormal retinal vascularisation (p < 0.0001, odds ratio 0.040, 95% confidence interval 0.007-0.216).

CONCLUSION: In this population of moderately to late preterm newborns, birth weight appeared to affect the retinal vascular system.

AIMS: To characterize ophthalmological findings in a sample of Swedish children aged 4-15 years.

METHODS: A prospective cross-sectional comprehensive ophthalmological investigation was performed on a sample of 143 children (67 girls, 76 boys) aged 4-15 years.

RESULTS: Visual acuity (VA) in the better eye >or=1.0 (<or=0.0 logMAR) was found in 79% of subjects. None of the children had VA in the better eye <0.5 (>0.3 logMAR). Amblyopia was found in 0.7% of subjects. A total of 68% of the children had no refractive errors. Hyperopia (>or=2.0 dioptres [D] in spherical equivalent [SE]) was found in 9% and myopia (>or=0.5 D SE) in 6% of children. Astigmatism (>or=0.75 D) was recorded in 22% and anisometropia (>or=1.0 D SE) in 3%. A total of 8% were optically corrected. Strabismus was recorded in 3.5%. Signs of visuoperceptual problems were reported in 3% of the children.

CONCLUSION: This sample of Swedish children may serve as a comparison group regarding ophthalmological findings in children aged 4-15 years.

AIMS: To evaluate ophthalmological findings in children adopted from eastern Europe.

METHODS: A prospective study on 72/99 children, born 1990-5 and adopted from eastern Europe to western Sweden during 1993-7 was performed. The children (41 boys; mean age 7.5 years) were compared with an age and sex matched reference group ("ref") of Swedish children.

RESULTS: 78% of the adopted children had abnormal ocular findings. 26% (ref 4%) had visual acuity (VA) of the better eye < or = 0.5 (> or = 0.3 logMAR) (p = 0.0001) and 8% (ref 0%) were visually impaired (p = 0.01). Amblyopia was found in 15% (ref 2%) (p = 0.005). 22% (ref 10%) were hyperopic (> or = 2.0 D SE) (NS) and 10% (ref 1%) were myopic (> or = 0.5 D SE) (p = 0.03). Astigmatism (> or = 0.75 D) was found in 51% (ref 23%) (p = 0.004). 32% (ref 2%) had strabismus (p<0.0001), mostly esotropia. Four cases had bilateral optic nerve hypoplasia, in three of whom a history of suspected prenatal alcohol exposure was documented. One child had congenital glaucoma. Signs of visuoperceptual problems were recorded in 37% (ref 1%) (p<0.0001).

CONCLUSION: In this study, children adopted from eastern Europe had a high frequency of ophthalmological findings. Consequently, it is strongly recommended that an ophthalmological examination be performed in these children after arrival in their new home country.

AIMS: To investigate visual function and ocular features in children with attention deficit hyperactivity disorder (AD/HD) and establish whether treatment with stimulants is reflected in functioning of the visual system.

METHODS: Detailed ophthalmologic evaluations without and with stimulants were performed in 42 children (37 boys) with AD/HD, mean age 12 years, and compared with a reference group (ref; n=50; mean age 11.9 years; 44 boys). For a comparison between two groups, Mann-Whitney's U-test was used for ordered and continuous variables; for dichotomous variables, Fisher's exact test was used. For paired comparison (with and without treatment), sign test was used.

RESULTS: In all, 83% had visual acuity of >0.8 (<0.1 logMAR) without treatment, 90% with stimulants (ref 98%; P=0.032 and n.s., respectively). Heterophoria was found in 29% without, and in 27% with, stimulants (ref 10%; P=0.038 and n.s., respectively) and subnormal stereovision (>60 s of arc) in 26% (ref 6%; P=0.016) without stimulants, and in 27%, with (P=0.014). Abnormal convergence (>6 cm or absent) was noted in 24% (ref 6%; P=0.031) without treatment and in 17%, with (n.s.). Astigmatism (> or =1.0 D) was observed in 24% (ref 6%; P=0.03), and signs of visuoperceptual problems in 21% (ref 2%; P=0.007). We found smaller optic discs (n=8/38) and neuroretinal rim areas (n=7/38) (P<0.0001) and decreased tortuosity of retinal arteries (n=6/34) (P=0.0002) than that of controls.

CONCLUSIONS: Children with AD/HD had a high frequency of ophthalmologic findings, which were not significantly improved with stimulants. They presented subtle morphological changes of the optic nerve and retinal vasculature, indicating an early disturbance of the development of these structures.

78 procent av alla barn som adopterats från Östeuropa hade ögon- och synförändringar som synnedsättning, skelning, brytningsfel, medfödda missbildningar och problem med att tolka sina synintryck.Vi rekommenderar därför att samtliga barn som adopteras från Östeuropa genomgår en ögonundersökning som ett komplement till den barnmedicinska undersökningen så snart som möjligt efter ankomsten till Sverige.Ökad kännedom om hälsoproblem hos barnen är av stor betydelse för både adoptionsorganisationer, hälso- och sjukvården och skolor, och inte minst för föräldrarna. Kunskap om ett barns problem är en nödvändig förutsättning för att barnet ska få rätt hjälp i det nya hemlandet.

AIM: To evaluate ophthalmological findings in children with Silver-Russell syndrome (SRS).

METHODS: An ophthalmological evaluation including visual acuity (VA), refraction, strabismus, near point of convergence (NPC), slit-lamp examination, ophthalmoscopy, axial length measurements and full-field electroretinogram was performed on 18 children with SRS (8 girls, 10 boys; mean age 11.6 years). Fundus photographs were taken for digital image analysis. Data were compared with data on an age- and gender-matched reference group (ref) of school children (n=99).

RESULTS: Seventeen out of 18 children with SRS had ophthalmological abnormalities. Best corrected VA of the best eye was <0.1 log of the minimal angle of resolution in 11 children (ref n=98) (p<0.0001), and 11 children had refractive errors (ref n=33) (p=0.05). Anisometropia (≥1 dioptre) was noted in three of the children (ref n=3) (p=0.046). Subnormal stereo acuity and NPC were found in 2/16 (ref=0) (p=0.02). The total axial length in both eyes was shorter compared with that in controls (p<0.006 and p<0.001). Small optic discs were found in 3/16, large cup in 3/16 and increased tortuosity of retinal vessels in 4/13 children with SRS.

CONCLUSION: Children with SRS, who are severely intrauterine growth retarded, show significant ophthalmological abnormalities. Based on the present findings, ophthalmological examination is recommended in children with SRS.

AIM: To describe ophthalmological phenotypes in patients with mitochondrial disease and known genotypes.

METHODS: A retrospective study was performed on 59 patients (29 male, 30 female) with a mean age of 11.8 years who had mitochondrial disease with known DNA mutations. Fifty-seven of the 59 subjects underwent a detailed ophthalmological examination including visual acuity (VA), eye motility, refraction, slit-lamp examination, ophthalmoscopy and, in almost one-half of the cases, a full-field electroretinogram (ERG).

RESULTS: Forty-six (81%) of the patients had one or more ophthalmological findings such as ptosis (n = 16), reduced eye motility (n = 22) including severe external ophthalmoplegia (n = 9), strabismus (n = 4), nystagmus (n = 9), low VA (n = 21), refractive errors (n = 26), photophobia (n = 4), and partial or total optic atrophy (n = 25). Pigmentation in the macula and/or periphery was noted in 16 patients. In 10/27 investigated individuals with full field ERG, retinal dystrophy was recorded in six different genotypes representing Kearns-Sayre syndrome (n = 5), Leigh syndrome (n = 1), Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) (n = 1), Myoclonus epilepsy with red ragged fibres (MERRF) (n = 1), Leber hereditary optic neuropathy (n = 1) and mitochondrial myopathy (n = 1).

CONCLUSION: The results show that a majority of patients with mitochondrial disorders have ophthalmological abnormalities. We recommend that an ophthalmological examination, including ERG, be performed on all children and adolescents who are suspected of having a mitochondrial disease.

PURPOSE: This study aimed to evaluate and relate visual function, ocular dimensions and neuropaediatric findings in adoptees from Eastern Europe.

METHODS: We studied 72 of 99 children, born during 1990-95 and adopted from Eastern Europe to western Sweden during 1993-97. The children (mean age 7.5 years, range 4.8-10.5 years; 41 boys, 31 girls) were examined after a mean period of 5 years post-adoption by a multidisciplinary team. Correlations between ophthalmological findings and neuropaediatric data were analysed.

RESULTS: Bivariate and regression analyses indicate a significant positive correlation between visual acuity (VA) and perceptual organization (p < 0.001), as well as between strabismus and verbal comprehension (p < 0.02). Fetal alcohol syndrome (FAS) was correlated with low VA (p < 0.02), subnormal stereovision (p < 0.009) and small optic discs (p < 0.02). Small head circumference was related to low VA (p < 0.015) and small optic discs (p < 0.03). Furthermore, small optic discs were related to low birthweight (p < 0.005) and preterm birth (p < 0.01). Large optic cups were correlated with poorer perceptual organization (p < 0.02).

CONCLUSIONS: In this group of adoptees from Eastern Europe, ophthalmological findings were correlated to neuropaediatric findings, especially those arising from prenatal adverse events resulting in growth deficiency and central nervous system damage. Therefore, it is important and valuable with an ophthalmological examination in children adopted from Eastern Europe.

AIM: To evaluate the effects of acupuncture in patients with keratoconjunctivitis sicca (KCS).

MATERIAL AND METHODS: Twenty-five patients (20 women, five men) with KCS were randomly assigned to an acupuncture treatment group or a control group. The effects of acupuncture were evaluated by a questionnaire on symptoms, visual analogue scale recordings, registration of drop frequency, and dry eye tests. Ten acupuncture sessions were given. Follow-up was carried out after 2-3 weeks and again after a mean period of 8 months.

RESULTS: Patients receiving acupuncture felt better at the first follow-up compared with the control group (p = 0.036). However, no statistical significance could be found concerning any change, or difference, in the total number of subjective symptoms, dosage frequency or, as indicated by the dry eye tests, tear quality, tear secretion and ocular surface disease.

CONCLUSION: The results indicate that acupuncture has subjective beneficial effects in patients with KCS and could therefore be tried as a complement to ordinary treatment.

PURPOSE: To investigate strabismus, head posture, nystagmus, stereoacuity, ocular motility, near point of convergence (NPC) and accommodative convergence to accommodation ratio (AC/A) in a sample of Swedish children.

METHODS: A prospective cross-sectional study was carried out on 143 children, 4-15 years of age.

RESULTS: Heterotropia was found in five children (3.5%), four with esotropia and one with exotropia. One child with esotropia had a slight overaction of both inferior oblique muscles. Heterophoria was found in 37 children (26%) at near and/or distance fixation and it was four times more common at near than at distance. In 29 children, heterophoria was found at one distance only and orthophoria at the other. Orthophoria at both near and distance fixation was noted in 101 children (70.5%). The near point of convergence was < or =6 cm in 97% of the children and 97% had stereoacuity of 60" or better. In the whole group, the median AC/A ratio calculated with the heterophoria method was 5.6/1 prism diopters/diopters (PD/D) and with the gradient method, 1.3/1 PD/D. No anomalous head postures or nystagmus were observed and all children had normal versions.

CONCLUSION: In this study, 143 well-defined children were investigated with a battery of accurately described tests, commonly used in clinical practice. These results are in agreement with those of other studies examining one or few variables in larger populations and the authors therefore conclude that their results may be used for comparisons with different patient groups.

BACKGROUND: The ability to keep steady fixation on a target is one of several aspects of good visual function. However, there are few reports on visual fixation during childhood in healthy children.

METHODS: An infrared eye-tracking device (Orbit) was used to analyse binocular fixation behaviour in 135 non-clinical participants aged 4-15 years. The children wore goggles and their heads were restrained using a chin and forehead rest, while binocularly fixating a stationary target for 20 s.

RESULTS: The density of fixations around the centre of gravity increased with increasing age (p < 0.01), and the time of fixation without intruding movements increased with increasing age (p = 0.02), while intruding saccades decreased with increasing age (p < 0.01). The number of blinks and drifts did not differ between 4 and 15 years, and there were no significant differences with regard to gender or laterality in any of the investigated variables. No nystagmus was observed.

CONCLUSION: This study establishes values for visual fixation behaviour in a non-clinical population aged 4-15 years, which can be used for identifying children with fixation abnormalities.

Objective: To create an easy-to-use complementary ophthalmological tool to support a fetal alcohol spectrum disorder (FASD) diagnosis.

Methods and Analysis: The FASD Eye Code was derived from 37 children with FASD evaluated along with 65 healthy age-matched and sex-matched controls. Four ophthalmological categories, which are abnormalities commonly found in children with FASD, were ranked independently on a 4-point scale, with 1 reflecting normal finding and 4 a strong presence of an abnormality: visual acuity, refraction, strabismus/binocular function and ocular structural abnormalities. The tool was validated on 33 children with attention deficit/hyperactivity disorder (ADHD), 57 children born moderate-to-late premature (MLP) and 16 children with Silver-Russell syndrome (SRS). Among children with ADHD none was born prematurely or small for gestational age (SGA) or diagnosed with FASD. Among children born MLP none was SGA, had a diagnosis of ADHD or FASD, or a history of retinopathy of prematurity. Children with SRS were all born SGA, half were born preterm and none had FASD. Children with FASD were re-examined as young adults.

Results: An FASD Eye Code cut-off total score of ≥10 showed an area under the curve (AUC) of 0.78 (95% CI 0.69 to 0.87), with 94% specificity and 43% sensitivity, in discriminating between FASD and controls, MLP and ADHD, corresponding to a positive likelihood ratio (LR+) of 7.5. Between FASD and controls, an AUC of 0.87 (CI 0.80 to 0.95), with 100% specificity and 43% sensitivity, was found; between FASD and SRS, an AUC of 0.60 (CI 0.45 to 0.75) was found, with 88% specificity and 43% sensitivity. A cut-off score of≥9 showed a specificity of 98% and a sensitivity of 57% for FASD versus controls, corresponding to an LR+ of 36.9. Scores in individuals with FASD were stable into young adulthood.

Conclusion: The FASD Eye Code has the potential to serve as a complementary tool and help to strengthen an FASD diagnosis.

Objective: Fetal alcohol spectrum disorders (FASD) is an umbrella term covering a spectrum of medical conditions caused by prenatal alcohol exposure. The FASD Eye Code is a new complementary ophthalmological diagnostic tool created to corroborate the complex FASD diagnosis. The aim of this work was to validate the FASD Eye Code by testing it on a second group of children diagnosed with FASD in a clinical setting.

Methods and analysis: A clinical study was carried out in a group of 21 children (13 males, 8 females, mean age 13.3 years) investigated for suspected FASD and a healthy sex-matched and age-matched control group (n=21). The participants underwent a detailed ophthalmological examination including visual perception problems (VPPs) assessment. Clinical examination results were compiled, and total scores were calculated according to the FASD Eye Code protocol (range 4-16).

Results: The median total score in the FASD group was 8. Eight individuals in the FASD group and none of the controls obtained a total score of >= 9 corresponding to 38% sensitivity and 100% specificity with an area under the curve of 0.90. A cut-off total score of >= 8 showed 52% sensitivity and 95% specificity. One individual in the FASD group versus 12 controls had a total score of 4, representing normal findings. No significant difference between the two groups regarding VPPs was seen.

Conclusion: The FASD Eye Code can be used as a complementary diagnostic tool for FASD to assist in diagnosis and to detect ophthalmological abnormalities in individuals with suspected FASD.

Purpose: Health-Related Quality of Life (HR-QoL) among enucleated retinoblastoma (RB) survivors is scarcely studied. Perceptual Visual Dysfunctions (PVDs) are problems concerning interpretation of visual input, that to our knowledge, previously not has been studied in RB patients. This prospective cross-sectional cohort study aim to evaluate HR-QoL and PVDs in RB individuals, treated with ocular prosthesis.

Methods: Twenty-seven RB individuals were treated with ocular prosthesis at the Sahlgrenska University Hospital, Gothenburg, Sweden, between 2000-2019. All were invited to the study, 15 (10 females; mean age 15.6 years, range 6.8-27.0 years) accepted. HR-QoL was assessed using the Pediatric Quality of Life inventory (PedsQL) with patients self- and parents-proxy report. Results were compared to normative data. PVDs was examined by history taking covering five areas and results were compared with a healthy, age- and sex- matched control group. Best corrected visual acuity (BCVA) was measured.

Results: No differences were found in HR-QoL of individuals with RB compared with healthy controls, between parent proxy compared with parents of healthy children or between individuals with RB and their corresponding parents. More individuals with RB (9/15) reported PVDs in one or more areas (median 1; range 1-4) compared with 1/15 healthy controls; p=0.005 (Fig. 1). Depth perception was the most frequent reported PVD area (n=6), followed by simultaneous perception (n=5), movement (n=2), recognition (n=1) and orientation (n=1). Better HR-QoL correlated with better BCVA (r = -0.68; p=0.01) and fewer affected PVD areas (r = -0.63; p=0.01).

Conclusions: The results showed no difference in HR-QoL of the RB individuals or parent-proxy compared with healthy controls. However, enucleated RB survivors were more affected by PVDs than healthy individuals. Their HR-QoL can be negatively affected by having problems within several PVD areas, and BCVA comprise an important role in QoL. It is necessary to identify PVDs to promote the best health care in individuals with RB treated with ocular prothesis. Further research is needed to better understand the impact on QoL and the role of PVDs among these individuals.

PURPOSE: To evaluate health-related quality of life (HR-QoL), vision-related (VR-)QoL and perceptual visual dysfunction (PVD) among individuals with anophthalmia (A) and microphthalmia (M) treated with ocular prosthesis.

METHODS: The study comprised 15 individuals (mean age 6.6 years; range 1.7-14.1) with unilateral A or M. Three validated instruments measuring HR-QoL and VR-QoL were used: The Pediatric QoL Inventory (PedsQL), consisting of physical and psychosocial self-report and parent-proxy report (2-18 years); Children's Visual Function Questionnaire (CVFQ); and Effects of Youngsters' Eyesight on Quality of Life (EYE-Q). Perceptual visual dysfunctions (PVDs) were assessed by history taking according to a specific protocol.

RESULTS: A/M children and their parents showed low HR-QoL scores (PedsQL total score: 66.3; 69.6) compared with controls (83.0; 87.61) (p = 0.0035 and <0.0001, respectively, unpaired t-test). No differences were found between A/M children and parents, but parents tended to underestimate their children's emotional state. A/M children with subnormal visual acuity (VA) for age scored lower in physical health compared with A/M children with normal VA (p = 0.03, Mann-Whitney U-test). No significant VR-QoL differences between A/M children and references or between A/M children with subnormal or normal VA for age were found. More A/M children than controls exhibited PVDs in ≥1 area (7/11 versus 4/118; p < 0.0001, Fisher's exact test).

CONCLUSION: A/M individuals show poor HR-QoL and increased PVDs. No difference in QoL was found between children and parents, though the children tended to score lower in emotional well-being. A/M children with subnormal VA showed lower physical health score. These problems indicate the necessity of a thorough multidisciplinary assessment and follow-up of children with A/M.

AIM: This qualitative study explored the lived experiences of the patients with microphthalmia and anophthalmia and their parents, focusing on the healthcare, school settings and daily life challenges to improve patient management.

METHODS: In-depth interviews were conducted in Stockholm, Sweden, from October 2022 to June 2023. Participants were recruited through the St Erik Eye Hospital database (2008-2022), and the data was analysed using reflexive thematic analysis.

RESULTS: The study included 15 patients (9 female and 6 male), with a median age of 21 years (range 15-31), and 1 parent per patient. Five key themes were identified from the parental interviews and three from the patient interviews. Both groups emphasised the need for improvements in healthcare, including better physician continuity, emotional support, information provision and prosthesis functionality. Families of those with severe bilateral visual impairment highlighted the need for additional school and daily life support. While some parents had future concerns, most patients viewed their condition as a natural part of life.

CONCLUSION: Patients and parents shared insights on the psychosocial impact and suggested improvements in the healthcare and school settings, providing valuable guidance for enhancing care and management for this patient group.

We describe a second patient with the 583G>A mutation in the tRNA(phe) gene of mitochondrial DNA (mtDNA). This 17-year-old girl had a mitochondrial myopathy with exercise intolerance and an asymptomatic retinopathy. Muscle investigations showed occasional ragged red fibers, 30% cytochrome c oxidase (COX)-negative fibers, and reduced activities of complex I+IV in the respiratory chain. The mutation was heteroplasmic (79%) in muscle but undetectable in other tissues. Analysis of single muscle fibers revealed a significantly higher level of mutated mtDNA in COX-negative fibers. Our study indicates that the 583G>A mutation is pathogenic and expands the clinical spectrum of this mutation.

PURPOSE: To establish if cyclotorsion measurements obtained in a patient population using different methods of testing give equivalent results, and if the results from each test are repeatable over time.

METHODS: Twenty referrals, from the orthoptic waiting list at Sahlgrenska University Hospital, Mölndal, Sweden, with vertical deviation stated as the primary reason for referral, were examined. Subjective cyclotorsion measurements using three different methods were performed. The methods included two standard tests: a synoptophore, with slides A17a/18a, the single Maddox rod test (SMR), and a new test method: the KMScreen method. Measurements were repeated 3 times for fixing either eye, and on two separate test occasions, for repeatability within each of the methods.

RESULTS: During the first test measurements, 11 (55%) showed excyclotorsion measured with the synoptophore method, 18 (90%) with the SMR test, and 15 (75%) with the KMScreen method. During the second set of measurements, 11 (55%) showed excyclotorsion with the synoptophore method, 17 (85%) with the SMR test, and 10 (50%) with the KMScreen test. Median perceived torsional measurements at the first visit for the synoptophore, SMR, and KMScreen tests were -1°, -5°, and -1°, respectively. There were significant differences between the synoptophore and SMR (P=0.025), and the SMR and KMScreen (P=0.025), but not between the synoptophore and KMScreen (P=0.90) methods on measuring the affected eye. All three tests showed repeatable values. The 95% limits of agreement (LoAs) between visits, defined as mean torsional difference ± 1.96 SD of difference, for the synoptophore, SMR, and KMScreen methods were -0.5° ± 4.5°, -0.3° ± 5°, and -0.7° ± 3.5°, respectively. P values for differences between visits were P=0.45, P=0.75, and P=0.90, respectively, using an exact permutation test.

CONCLUSION: In this small study group, the three different methods used for testing cyclotorsion showed significantly different results. However, all methods showed significant repeatability (test-retest reliability) over time. This finding is of clinical importance when investigating cyclotorsion in patients. Clinicians need to be aware of the differences between methods when monitoring recovery or changes in patients, and in particular when planning surgical correction for cyclotorsion.

To review and evaluate the surgical outcomes of the Fells-modified Harada-Ito procedure using a dosage scale approach with long-term follow up in patients with torsional diplopia. The records of patients who underwent the modified Harada-Ito procedure by the same surgeon during 2012–2019 were retrospectively reviewed regarding pre- and post-operative data and individual dose-scale used for the surgery. The modified Harada-Ito procedure involved advancing the anterior half of the superior oblique tendon toward the inferior edge of the lateral rectus muscle by a distance determined using a five-graded scale. A total of 27 patients (mean age 57.6 years, range, 22–81 years; 10 female) were included. Evaluating surgical outcome showed a significant difference in pre- to post-operative cyclodeviation (p = <0.001). Pre-operative mean extorsion was −10.4° and mean torsional correction achieved was 7.7°. The dose-effect relationship showed a wide spread effect, yet yielded a high success rate. All but two patients were symptom free from their torsional diplopia at the last post-operative evaluation, on average 24 months after surgery. Post-operative results and the dose-effect of the modified Harada-Ito corresponded with the aimed-for correction of torsional diplopia.. Fusion evaluation and individually based pre-operative assessments proved essential in determining individual doses for successful surgical outcomes.

PURPOSE: To investigate normative subjective cyclotorsion values and cyclofusion ranges in a healthy adult population.

METHODS: A cross-sectional investigation was performed in 120 healthy, non-strabismic adults, 60 men and 60 women in the age range of 18-69 years. All subjects were assessed for cyclotorsion using the synoptophore and the single Maddox rod (SMR) methods. Cyclofusion was investigated with the synoptophore in 60 of the subjects.

RESULTS: All age groups showed low values of subjective torsion, mainly excyclotorsion with mean values of -1 degree for both methods. Reference ranges of cyclotorsion were between -0.7 and -1.5 degrees for the SMR method and between -0.7 and -1.4 degrees using the synoptophore method. There were no significant differences between gender (p = 0.48), but the effect of age was significant for both methods (p = 0.026) demonstrating a slight increase in excyclotorsion with age. Cyclofusion showed a total mean amplitude of 16 degrees, the fusion range was +7 degrees of incyclotorsion to -9 degrees of excyclotorsion.

CONCLUSIONS: Subjective reference ranges for cyclotorsion and cyclofusion reveal that low values of torsion are to be expected upon clinical investigation in non-strabismic adult individuals. Values outside of the reference range may be indicators of possible binocular abnormalities or physiological variations. The cyclotorsional measurements and prevalence in this adult population group can be regarded as normative data in clinical settings.

PURPOSE: To assess health-related quality of life (HRQoL) in patients diagnosed with cyclodeviation and to evaluate subjective change following surgical treatment using the Adult Strabismus-20 (AS-20) questionnaire.

METHODS: A prospective cohort study was performed from 2014 to 2019 on 29 adult patients with cyclodeviation and cyclodiplopia who were due to undergo corrective strabismus surgery by the same surgeon. The group was divided into two subgroups, according to the type of surgery required for fusion. All scores were analyzed for the whole sample and subgroups. Preoperative scores were compared with those of control patients.

RESULTS: Pre- and postoperative QoL scores were successfully collected from 26 patients (mean age, 56 years; 8 female) using the AS-20 questionnaire. Scores were significantly higher for control subjects than for patients in the cyclodeviation group (P = 0.0001). Postoperative scores for all 20 questionnaire questions were significantly improved for all patients (P = 0.002). There was a significant improvement in the functional subscale score (P = 0.001), but not in the psychosocial subscale score (P = 0.23). Results were enhanced by Rasch analysis.

CONCLUSIONS: Cyclodeviation patients demonstrated significantly lower scores than controls. The functional scores were significantly lower than the psychosocial scores, in contrast to other forms of strabismus. Strabismus surgery had a significant effect on quality-of-life scores in this group of adults.

BACKGROUND/AIMS: Ophthalmological abnormalities such as ptosis, strabismus, refractive errors and optic nerve hypoplasia have been reported in foetal alcohol spectrum disorders (FASD). The purpose of this study was to investigate whether retinal thickness, retinal nerve fibre layer (RNFL) and optic disc area (ODA) differ between individuals with FASD and healthy controls.

METHODS: Best-corrected visual acuity (BCVA) in terms of logarithm of the minimum angle of resolution (logMAR), refraction, and fundus variables measured by optical coherence tomography were obtained from 26 young adults with FASD (12 women, median age 23 years) and 27 controls (18 women, median age 25 years).

RESULTS: The total thickness of the peripapillary RNFL was significantly lower in the FASD group than in controls; median (range) in the right/left eye was 96.5 (60-109)/96 (59-107) µm in the FASD group and 105 (95-117)/103 (91-120) µm among controls (p=0.001 and p=0.0001). Macular RNFL and retinal thickness measurements from the FASD group were also lower in most of the nine ETDRS areas, except for the central parts. Median (range) BCVA in the best eye was 0.00 (-0.1-0.3) logMAR in the FASD group and 0.00 (-0.2-0.0) logMAR in controls (p=0.001). No significant differences between the groups were found regarding ODA or refraction.

CONCLUSION: Significant differences in peripapillary and macular RNFL, retinal thickness and BCVA were found in this group of young adults with FASD compared with healthy controls. However, there were no differences in the size of the optic disc.

Purpose: To investigate visual perception problems (VPPs), health-related quality of life (HRQoL) and vision-related quality of life (VRQoL) in young adults with foetal alcohol spectrum disorders (FASD) and to compare the results with healthy controls.

Methods: Thirty young adults with FASD (13 female; mean age 23 years) and 29 controls (20 female; mean age 25 years) participated. Five areas of VPPs were assessed by a structured history-taking. In the FASD group, VPPs were investigated both in childhood (mean age 8 years) and in early adulthood in a prospective follow-up. Health-related quality of life (HRQoL) was investigated with the Pediatric Quality of Life Inventory™ (PedsQL) and VRQoL with the 25-item Visual Function Questionnaire (VFQ-25).

Results: Visual perception problems (VPPs) in at least one area were reported by 16/30 FASD participants (53%) and 1/29 controls (3%) (p = 0.0001, Fisher's exact test), with a similar rate in the same individuals in childhood as in early adulthood (8/27 and 15/27, respectively p = 0.09, McNemar's test). PedsQL total score was lower in the FASD group (n = 20; median: 83; 95% confidence interval (CI) 76-88) compared with controls (n = 29; median: 91; 95% CI 90-95; p = 0.0001, Mann-Whitney U-test). VFQ-25 subscale general vision indicated lower VRQoL in the young adults with FASD (n = 19; median: 80; 95% CI 80-100) compared with controls (n = 29; median: 100; 95% CI 100-100; p = 0.003).

Conclusion: Young adults with FASD in the present study had more VPPs and worse VRQoL and HRQoL than healthy controls. In the FASD group, VPPs were reported in childhood as well as in early adulthood.

PURPOSE: To investigate whether ophthalmologic findings in children with fetal alcohol spectrum disorders (FASD) persist into young adulthood.

DESIGN: Prospective cohort study.

METHODS: Thirty children (13 female) adopted from eastern Europe to Sweden in the 1990s and diagnosed with FASD by a multidisciplinary team at the median age of 7.9 years were followed up by the same team 13-18 years later. Visual acuity (VA), refraction, stereoacuity, strabismus, ocular media, and fundus were investigated.

RESULTS: Median VA in right/left eye (OD/OS) was 20/32/20/32 (0.2/0.2 logMAR) in childhood and 20/22/20/20 (0.05/0.0 logMAR) in adulthood. Median (range) refraction OD/OS was +0.88/+1.25 (-8.75 to +4.75/-9.38 to +5.25) spherical equivalent diopter (D) in childhood and -0.25/-0.25 (-12 to +2.75/-13.25 to +2.63) in adulthood. Astigmatism (≥1 D) was the most common refractive error, in 13 (40%) and 14 (47%) subjects, respectively. Defective stereoacuity (>60 arc second) was noted in 20 subjects (67%) in childhood and 22 (73%) in adulthood. Heterotropia occurred in 12 subjects (40%) in childhood and 13 (43%) in adulthood. Increased tortuosity of the retinal vessels was found in 8 (27%) subjects in childhood vs 11 (37%) in adulthood. Optic nerve hypoplasia was recorded in 3 children and in 4 young adults.

CONCLUSIONS: Ophthalmologic findings such as refractive errors, strabismus, and fundus abnormalities are frequent in children with FASD and persist into early adulthood. The facial features characteristic of FAS diminish with age, making a dysmorphology evaluation in adulthood less reliable. An ophthalmologic examination is an important part of the evaluation of FASD in childhood as well as in young adulthood.

PURPOSE: To determine the prevalence of strabismus among Danish adults and to find the frequency of history of strabismus and strabismus surgery. Furthermore, to evaluate the prevalence of strabismus-associated amblyopia among participants with strabismus and to relate the results to the current national vision screening programme.

METHODS: In total, 3785 adults in the Danish Rural Eye Study underwent an interview regarding eye health, visual acuity measurement, Hirschberg test and retinal photography. Participants were categorized into groups based on their birth date in relation to the introduction of the national vision screening programme.

RESULTS: In total, the prevalence of strabismus was 1.1% (41/3785; 95% CI: 0.8-1.5); no differences were found in relation to gender or screening status. The prevalence of exotropia (XT) was 0.3% (12/3785; 95% CI: 0.2-0.6) and of esotropia (ET) 0.8% (29/3785; 95% CI: 0.5-1.1), resulting in an XT:ET ratio of 1:2.7. A history of strabismus was present in 4.6% (174/3785; 95% CI: 4.0-5.3), and a history of strabismus surgery was present in 0.8% (32/3785; 95% CI: 0.6-1.2) of the participants. Among participants with manifest strabismus, 24% had strabismus-associated amblyopia.

CONCLUSION: In this first European population-based study of strabismus prevalence in adults, the prevalence was similar to three out of five previous studies using cover test. The use of Hirschberg test may have led to an underestimation of the true prevalence. The prevalence was neither related to screening status nor gender. Our results are the first to display a predominance of ET among Caucasian Scandinavian adults.

Anophthalmia/microphthalmia (A/M) are rare congenital eye malformations. Early intervention with ocular prosthesis can stimulate orbital growth and prevent facial asymmetry. We reviewed medical records from 18 individuals with A/M (0.8-31 years) treated with ocular prosthesis at Sahlgrenska University Hospital between 2000 and 2012. A majority had other ocular findings. Seven had subnormal visual acuity in the fellow eye, one third were in contact with vision support services and half of the group wore glasses. Eleven individuals had extra-ocular findings such as cardiac defect, hearing impairment and neuropsychiatric disorders, possibly indicating syndromic conditions. We suggest that investigation of A/M children should include ultrasound of the eye, optionally visual evoked potential and magnetic resonance imaging of the CNS. The ophthalmologist should initiate treatment with prosthesis, pediatric assessment, hearing tests and genetic counseling, but should also monitor visual development of the fellow eye.

DESIGN: A population-based study of pre-adoption, arrival and post-adoption health.

AIM: To report prenatal and postnatal background factors, morbidity, growth and development in adoptees from Eastern Europe.

SUBJECTS AND METHODS: All 99 children born in Eastern Europe between 1990 and 1995 and adopted to western Sweden during 1993-1997 were invited to participate in the study. Altogether, 76 (77%) participated. Medical records from the birth countries, from the examination at arrival and from medical reports made during a mean post-adoption period of 5 years were evaluated.

RESULTS: Low birth weight (< or = 2500 g) occurred in 48%. Congenital malformations were found in 22%. The biological mothers of 33% of the children had been considered alcoholics, and 16% of the children's mothers had been diagnosed with a psychiatric disability. A high incidence of infectious diseases, neurodevelopment disorders and growth retardation had been noted during the pre-adoption period. Upon arrival in Sweden 75% were diagnosed with a medical condition, most often an infection. After a 5-year post-adoption period, small head circumference was associated with alcohol exposure during pregnancy and 46% had at least one neurodevelopment or behavioural disorder.

CONCLUSION: Adverse prenatal and perinatal factors, congenital malformations and post-adoption neurodevelopment disorders were common. Adoptees and adopters have complex needs for health support and information.

OBJECTIVES: The purposes of this investigation were to determine the frequencies of and associations between different neurodevelopmental disorders and to study the potential lasting effects of alcohol on children adopted from eastern Europe.

METHODS: In a population-based, prospective, observational, multidisciplinary, cross-sectional, cohort study of 71 children adopted from eastern Europe, children were assessed 5 years after adoption, from pediatric, neuropsychological, and ophthalmologic perspectives.

RESULTS: Fetal alcohol spectrum disorders, that is, fetal alcohol syndrome (FAS), partial FAS, and alcohol-related neurodevelopmental disorders, were identified for 52% of children; FAS was found for 30%, partial FAS for 14%, and alcohol-related neurodevelopmental disorders for 9%. Alcohol-related birth defects were found for 11% of children, all of whom also were diagnosed as having FAS. Mental retardation or significant cognitive impairment was found for 23% of children, autism for 9%, attention-deficit/hyperactivity disorder for 51%, and developmental coordination disorder for 34%.

CONCLUSIONS: Fetal alcohol spectrum disorders and neurodevelopmental disorders were common in this long-term follow-up study of children adopted from orphanages in eastern Europe. Maternal alcohol consumption during pregnancy has long-lasting adverse effects, causing structural, behavioral, and cognitive damage despite a radically improved environment.

BACKGROUND: Fetal alcohol spectrum disorders (FASD) are a global health concern. To further understand FASD in adulthood is a major public health interest.

OBJECTIVE: To describe the clinical characteristics of young adults with FASD adopted from orphanages to a socially more favourable and stable rearing environment as children.

DESIGN: Prospective observational cohort study SETTING: Western Sweden PARTICIPANTS: A population-based cohort of 37 adoptees diagnosed with FASD in childhood.

OUTCOME MEASURES: Assessment consisted of clinical evaluations of social, medical, psychiatric, neuropsychological, adaptive and ophthalmological status by a physician, ophthalmologist, orthoptist and psychologist.

RESULTS: Out of 37 adoptees with FASD, 36 (15 females) were evaluated at a median age of 22 years (range 18-28) and a mean follow-up time of 15.5 years (range 13-17). Twenty (56%) were dependent on social support. Sexual victimisation was reported by nine (26%). In 21 individuals with fetal alcohol syndrome, growth restriction in height and head circumference of approximately -1.8 SD persisted into adulthood. Of 32 examined, 22 (69%) had gross motor coordination abnormalities. High blood pressure was measured in nine (28%). Ophthalmological abnormalities were found in 29 of 30 (97%). A median IQ of 86 in childhood had declined significantly to 71 by adulthood (mean difference: 15.5; 95% CI 9.5-21.4). Psychiatric disorders were diagnosed in 88%, most commonly attention deficit hyperactivity disorder (70%). Three or more disorders were diagnosed in 48%, and 21% had attempted suicide. The median Clinical Global Impression-Severity score was 6 = 'severely ill'.

CONCLUSION: Major cognitive impairments, psychiatric morbidity, facial dysmorphology, growth restriction and ophthalmological abnormalities accompanies FASD in adulthood. Recognition of FASD in childhood warrants habilitation across the lifespan.

PURPOSE: To evaluate growth, blood pressure and ophthalmological status in preschool children born preterm to mothers with preeclampsia.

METHODS: In a prospective cohort study, 78 children (34 girls) born preterm without retinopathy of prematurity were examined regarding length/height, weight, head circumference and insulin-like growth factor I (IGF-I) at birth and at 5 years of age. At 5 years, IGF-binding protein 3 and blood pressure were also measured. A detailed ophthalmological examination including ocular dimensions, fundus morphology, visual fields, visual evoked potentials and perceptual visual dysfunction was performed. Children born to preeclamptic mothers (n = 24) were compared to children with non-preeclamptic mothers (n = 54).

RESULTS: Children exposed to preeclampsia had lower weight (p = 0.0002, mean difference -1.46, 95% CI -2.09; -0.83), length (p = 0.013, -1.10, 95% CI -1.92; -0.23) and IGF-I levels (p = 0.0002, -26.0, 95% CI -36.0; -16.1) at birth compared to non-exposed children. At 5 years of age, the preeclamptic group had larger optic cup areas (p = 0.0006, 0.32, 95% CI 0.15; 0.46, in right eye, p = 0.049, 0.18, 95% CI 0.001; 0.35, in left eye). There was no significant difference between the groups regarding other ophthalmological findings or blood pressure. Children with reduced eye motility had lower neonatal IGF-I levels (p = 0.033, 15.5, 95% CI 1.1; 30.3).

CONCLUSION: Preeclampsia was shown to affect growth and IGF-I levels, confirming previous studies. Children exposed to preeclampsia were shown to have larger optic cup areas. Furthermore, lower neonatal IGF-I levels were seen in preterm children with reduced eye motility at 5 years of age.

Purpose: The majority of all preterm birth are moderate-to-late preterm (MLP) birth, defined as birth at 32–36 weeks of gestation. These individuals have an elevated morbidity risk compared with full-term individuals; however, little is known of the ocular development. The purpose of the present study was to evaluate ocular dimensions in relation to growth and metabolic factors in MLP adolescents.

Methods: In this prospective cohort study, 50 MLP adolescents participated (26 girls; mean gestational age 35.0 weeks; mean age 16.5 years). When recruited at birth, the exclusion criteria were chromosomal abnormalities, severe malformations, syndromes, or being born to mothers with chronic diseases. A control group consisted of 50 adolescents born full-term (30 girls; 40.3 weeks; 16.7 years). Total axial length (TAL), palpebral fissure length (PFL), and intercanthal distance (ICD) were measured. The TAL was evaluated using optical biometry (IOL Master). The PFL and ICD were measured using a ruler. Head circumference, length, weight, body mass index, and serum levels of insulin-like growth factor I and insulin-like growth factor binding protein 3 were evaluated. Serum levels of the metabolic factors leptin and adiponectin were measured. The MLP and control group were compared regarding all variables using Mann Whitney U-test. Ocular dimensions were analyzed to find any possible association with growth and metabolic factors using Spearman rank correlation.

Results: The MLP group had shorter TAL and PFL, and wider ICD compared with controls, shown in Table 1. There was no significant difference regarding growth, leptin, or adiponectin. Within the MLP group, TAL correlated with length (right eye (RE) r=0.46, p<0.001; left eye (LE) r=0.48, p<0.001), head circumference (RE r=0.46, p<0.001; LE r=0.44, p=0.001), and weight (RE r=0.53, p<0.001; LE r=0.51, p<0.001). The PFL correlated with length (RE r=0.53, p<0.001; LE r=0.58, p<0.001), and leptin (RE r=-0.43, p=0.004; LE r=-0.46, p=0.002). No other significant correlation was found.

Conclusions: In the present study, being born MLP were shown to impact ocular growth including TAL, PFL, and ICD. Furthermore, these variables were found to be associated with leptin levels and general growth.

PURPOSE: To study visual function and ocular fundus morphology in relation to growth, metabolic status, and blood pressure in moderate-to-late preterm (MLP) children at 10 years of age.

DESIGN: Prospective cohort study.

METHODS: In this population-based observational study, nonsyndromic MLP children born in Gothenburg, Sweden, were examined neonatally in the years 2002-2003 concerning length, weight, head circumference, and insulin-like growth factor I (IGF-I). At 10 years of age, 33 children (10 girls) were examined regarding previously mentioned variables, and regarding visual acuity, refraction, fundus morphology, IGF binding protein 3, leptin, adiponectin, and blood pressure. An age- and sex-matched control group consisted of 28 children (9 girls).

RESULTS: Myopia was more commonly found in MLP children than in controls (P = .004, 95% CI 1.8 to 49.8). The MLP group had smaller optic disc area (P = .01, 95% CI -0.5 to -0.1), smaller rim area (P = .001, 95% CI -0.5 to -0.2), fewer branching points (P = .0001, 95% CI -5.7 to -2.1), and higher index of tortuosity of arteries (P = .03, 95% CI 0.002 to 0.03) and veins (P = .02, 95% CI 0.003 to 0.02). Refraction correlated with IGF-I (P = .0005, r_s = 0.60 in right eye, and P = .002, r_s = 0.55 in left eye) at 10 years of age. Tortuosity of arteries at assessment correlated with neonatal IGF-I levels (P = .03, r_s = -0.39). Tortuosity of veins correlated with a leptin/adiponectin ratio at assessment (P = .04, r_s = 0.37).

CONCLUSION: The findings suggest that being born MLP is associated with myopia, smaller optic disc and rim areas, and abnormal retinal vascularization. Furthermore, metabolic status and growth factors seem to have an impact on ocular development.

PURPOSE: This study aimed to evaluate visual function in children with attention-deficit/hyperactivity disorder (ADHD), to correlate these data with the morphology of the optic nerve, and to find out if and how psychostimulant medication affects visual functions.

METHODS: The visual acuity (VA) and visual fields (VFs) of 18 children with ADHD (two girls and 16 boys), aged 6-17 years, were examined before and after treatment with psychostimulants. A control group, consisting of 24 children (nine girls and 15 boys), aged 7-18 years, were examined twice to evaluate the repeatability of the tests and the learning effect. Fundus photographs were analysed by digital planimetry.

RESULTS: Visual acuity increased significantly (p = 0.0039) in the ADHD group after treatment. The difference between the two VF examinations was significantly larger in the ADHD group compared with the control group (p = 0.036). Significantly more ADHD subjects had subnormal VF results without stimulants, compared with controls (p = 0.0043), but with stimulants the difference was no longer significant.

CONCLUSIONS: Children with ADHD showed better VA and VF results with than without psychostimulant medication.

AIM: To evaluate health- and vision-related quality of life (HR- and VR-QoL) and perceptual visual dysfunction (PVD) in adolescents with hydrocephalus surgically treated in infancy.

METHODS: In total, 23 adolescents (15 males and 8 females; median age 14.9 years) with hydrocephalus and 31 controls were evaluated using validated instruments to measure HR-QoL and VR-QoL. PVDs were reported by history taking in five areas: recognition, orientation, depth, movement and simultaneous perception.

RESULTS: Adolescents with hydrocephalus and the parent proxy reports showed lower mean total Paediatric Quality of Life Inventory 4.0 scores (75.8 and 63.7, respectively) compared with controls (87.6 and 91.5), p = 0.016 and p < 0.0001. Parent-reported scores were lower than self-reported scores (p = 0.001). Adolescents with myelomeningocele (n = 10) showed lower physical health scores (p = 0.001). No VR-QoL difference was found between groups. PVDs were reported in ≥1 area by 14/23 hydrocephalus participants and 2/31 controls (p < 0.0001). Associations were found in the hydrocephalus group between VR-QoL and HR-QoL (rs = 0.47, p = 0.026) and number of PVD areas (rs = -0.6, p = 0.003).

CONCLUSION: Adolescents with hydrocephalus and their parents reported lower HR-QoL and more PVDs. These problems indicate the need for not only ophthalmological follow-ups but also evaluation of QoL and PVDs in individuals with infantile hydrocephalus.

AIM: Previous studies have shown visual evoked potential (VEP) abnormalities in infants and animals born small for gestational age (SGA) compared with controls. The current exploratory study aims to investigate whether VEP abnormalities persist in older ages.

METHODS: Pattern VEP latencies were obtained in 21 children (11 girls, 10 boys), born SGA and moderately preterm, at an average age of 5 years and 8 months. Fifty-one children (24 girls, 27 boys, mean age of 5 years and 7 months), also born moderately preterm but with normal height and weight at birth, served as controls

RESULTS: Visual evoked potential results showed no significant differences in latency between children born SGA and controls born appropriate for gestational age (AGA) for either binocular stimulation, right eye or left eye stimulation.

CONCLUSIONS: Our findings do not indicate any differences in VEP latency at preschool age for children born SGA compared with children born AGA. The results may support previous studies, suggesting that children born SGA show accelerated neurophysiologic maturation during their first year of life and that previously delayed VEP latencies after catch-up stay unchanged compared with controls.

PURPOSE: It is well established that children born very preterm are at increased risk for ocular abnormalities including altered foveal morphology. However, little is known about how children born moderate-to-late preterm (MLP), gestational age 32 + 0-36 + 6 weeks, are affected later in life. This study investigates foveal avascular zone (FAZ) area, vascular density (VD), central foveal thickness (CFT) and ganglion cell layer thickness (GCL++) of adolescents born MLP without history of retinopathy of prematurity and compare the results with full-term controls.

METHODS: In a prospective population-based cohort study, 50 adolescents (26 girls; mean age 16.5 years) born MLP were examined with optical coherence tomography (OCT) and OCT angiography (OCT-A). FAZ and VD were obtained from OCT-A scans and adjusted for ocular magnification. CFT and GCL++ were obtained from the OCT scans. The results from the MLP individuals were compared with the results from 49 healthy full-term controls (29 girls; mean age 16.7 years).

RESULTS: The results showed statistically significant differences in FAZ area (0.22 vs 0.28 mm2; p = 0.0032) and CFT (198.1 vs 187.1 μm; p = 0.0010) between the MLP group and controls. Strong correlations between FAZ area and CFT (r = -0.773, p < 0.0001) and GCL++ (r = -0.924, p < 0.0001) were found in the MLP group. There were no differences in VD.

CONCLUSIONS: Our results show that adolescents born MLP have a smaller FAZ area and an increased CFT compared with full-term controls. These results indicate that adolescents born MLP have similar parafoveal changes as children born extreme or very preterm.

PURPOSE: To describe clinical features, risk factors and complications in a cohort of Swedish children with juvenile idiopathic arthritis (JIA) screened for uveitis between 2002 and 2011.

METHODS: Medical records of 299 children with JIA (93 male, 206 female; median age 5.0 years at diagnosis) were retrospectively scrutinized focusing on subtype of JIA, onset of arthritis/uveitis, presence of antinuclear antibodies (ANA) and ophthalmological status.

RESULTS: Uveitis was found in 32 (11%) children, 78% bilaterally affected. The median age of arthritis onset in children who developed uveitis was 2.5 years (range 1-10) versus 5.0 years (range 1-15) in those who did not. Sex ratio was 3.5:1 (girl:boy). The most prevalent JIA subtype was oligoarthritis (75%). All but one child with uveitis was found to be ANA (+). The median interval between diagnosis of arthritis and uveitis was 12 months. Only one child developed uveitis between the fourth and fifth years after arthritis onset. Ocular complications were recorded in 45.6% (26/57 affected eyes) at last follow-up. On univariate analysis, both young age at arthritis onset and ANA positivity were possible predictors for developing uveitis, but on multivariate analysis, the latter was the most important predictor (HR 16.25, 95%; CI 2.19-120.44; p = 0.006, Cox regression analysis).

CONCLUSION: Almost all of the children developing JIA-associated uveitis did so within 4 years after arthritis onset, a fact that accentuates the importance of early initiation of ophthalmological screening and more frequent regular follow-ups during the first 4 years. The most important predictor for developing uveitis was ANA positivity.

PURPOSE: To evaluate the outcome of cataract surgery in adult patients with uveitis.

MATERIALS AND METHODS: In this retrospective cohort study, medical charts of patients with uveitis and matched control patients without uveitis who underwent cataract surgery at the Eye Clinic, Sahlgrenska University Hospital, Mölndal, between January 2005 and December 2009 were analyzed.

RESULTS: The study included 58 eyes with and 283 eyes without uveitis. The most common etiologies were idiopathic anterior uveitis and Fuchs' heterochromic uveitis. Postoperative visual acuity at 4 weeks was ≥0.5 decimal (0.3 logMAR) in 48 eyes with uveitis (87.3%) compared to 180 non-uveitic eyes (86.1%). Four eyes with uveitis (7.1%) and one eye without uveitis (0.5%) developed postoperative intraocular hypertension/glaucoma. Posterior capsule opacification developed in 11 eyes (19.0%) with and 28 eyes (12.4%) without uveitis.

CONCLUSION: With appropriate perioperative anti-inflammatory regimen and surveillance, modern cataract surgery using phacoemulsification and primary intraocular lens implantation can be performed in patients with uveitis without greater risk of complications, yielding similar visual outcome as in patients without uveitis.

PURPOSE: To evaluate the outcome of combined cataract surgery with primary intraocular lens (IOL) implantation and pars plana vitrectomy (PPV) in children with uveitis.

METHODS: Data regarding visual acuity (VA), inflammatory status, medical therapy, and complications was collected from the medical charts of 17 children (21 eyes) with chronic uveitis who underwent combined cataract surgery and PPV at the Eye Clinic, Sahlgrenska/Mölndal, between 2002 and 2011.

RESULTS: Seventy-six percent of the children had juvenile idiopathic arthritis. Median preoperative VA was 1.70 logMAR and median VA after 12 months was 0.17 logMAR. Postoperatively, glaucoma developed in 7 eyes, cystoid macular edema in 3 eyes, and visual axis opacification requiring treatment in 5 eyes.

CONCLUSIONS: Although combined phacoemulsification, primary IOL implantation, and PPV in children with uveitis resulted in favorable visual outcome and stable inflammation in a majority of children, the technique should so far be reserved for uveitic cases with vitreous pathology.