Bio


Scott R. Lambert, M.D. is a Professor of Ophthalmology and Pediatrics who specializes in treating eye diseases in children and adults with strabismus. Prior to joining the faculty at Stanford in 2016, he was the R. Howard Dobbs Professor of Ophthalmology at Emory University and the Chief of Ophthalmology at Children’s Healthcare of Atlanta. Dr. Lambert graduated from medical school at Yale University and completed a residency in ophthalmology at the University of California, San Francisco. He then completed a fellowship in pediatric ophthalmology at the Hospital for Sick Children in London and in adult strabismus in San Francisco.

Dr. Lambert is the co-editor of two books published in 2016-- the 5th edition of the leading textbook in his field--Pediatric Ophthalmology and Strabismus and a book on Congenital Cataracts. He is the author or co-author of more than 200 articles in peer-reviewed journals on a broad range of topics including the treatment of congenital cataracts, strabismus in adults and children, optic disc abnormalities and corneal disorders in children. He has been an invited speaker at pediatric ophthalmology conferences throughout the world including North America, South America, Europe, Asia, Africa, the Middle East and Australia.

He has been actively involved in research throughout his entire career and is currently serving as the chairman of the Infant Aphakia Treatment Study—a NIH funded randomized clinical trial comparing the optical treatment of infants after cataract surgery with contact lenses vs. intraocular lenses. From 2013-2015 he served on the executive committee of the Pediatric Eye Disease Investigators Group--a large group of pediatric ophthalmologists who investigate new treatments for ocular disorders in children. He has received the Senior Honor award from the American Academy of Ophthalmology and served as the chairman of their Pediatric Ophthalmic Technology Assessment Committee. He has received a lifetime achievement award from the American Association for Pediatric Ophthalmology and Strabismus. In 2019 he was chosen as one of the "Best Doctors in the Bay Area" by the San Francisco Magazine.

He is happily married and has five children. He enjoys hiking, swimming, tennis and running.

Clinical Focus


  • adult strabismus
  • pediatric strabismus
  • pediatric cataracts
  • congenital cataracts
  • pediatric nasolacrimal duct disorders
  • pediatric ocular trauma
  • retinal dystrophy in children
  • Pediatric Ophthalmology and Strabismus Specialist

Academic Appointments


Administrative Appointments


  • Chief of Ophthalmology, Lucille Packard Children's Hospital (2018 - Present)
  • Chairman, Infant Aphakia Treatment Study (2004 - 2019)
  • Chairman of the Pediatric Ophthalmic Technology Assessment Committee, American Academy of Ophthalmology. (2012 - 2018)

Honors & Awards


  • Life-time Achievement Award, American Association for Pediatric Ophthalmology and Strabismus (2017)
  • Senior Achievement Award, American Academy of Ophthalmology (2010)
  • Claud Worth Silver Medal, British Isles Paediatric, Ophthalmology & Strabismus Association (2003)
  • Martha Leffler Lincoln Memorial Lectureship, Johns Hopkins University (2003)
  • Lew R. Wasserman Merit Award, Research to Prevent Blindness (1997)

Boards, Advisory Committees, Professional Organizations


  • Data and Safety Monitoring Board, Cystic Fibrosis Foundation Therapeutics (2012 - Present)
  • International Committee, American Association for Pediatric Ophthalmology and Strabismus (2015 - Present)

Professional Education


  • Medical Education: Yale School Of Medicine (1983) CT
  • Residency: UCSF Ophthalmology Residency (1987) CA
  • Board Certification: American Board of Ophthalmology, Ophthalmology (1989)
  • Fellowship: Smith-Kettlewell InstVisSci (1988) CA
  • Fellowship: Hospital For Sick Children (1988) UK
  • Internship: Stanford University (1984)
  • BS, Stanford University, Biology (1979)

Current Research and Scholarly Interests


My research has focused on improving the visual outcomes of children with congenital cataracts. I organized a randomized clinical trial, the Infant Aphakia Treatment Study to compare the visual outcomes of infants optically corrected with a contact lens vs. an intraocular lens after unilateral cataract surgery. A second area of research has been ocular growth after cataract surgery.

All Publications


  • Cost-Effectiveness of Addressing Retinopathy of Prematurity in Rwanda. Ophthalmic epidemiology Alder, C. J., Mutangana, F., Phillips, V., Becker, E. R., Fleming, N. S., Isenberg, S. J., Lambert, S. R., Frank, T. D. 2024: 1-9

    Abstract

    With the expansion of neonatal care in sub-Saharan Africa (SSA), an increasing number of premature babies are at risk to develop retinopathy of prematurity (ROP). Previous studies have quantified the cost-effectiveness of addressing ROP in middle-income countries, but few have focused on SSA. This study estimates the cost of a national program for ROP screening and anti-VEGF injection treatment in Rwanda compared to the status quo.Medical cost data were collected from King Faisal Hospital in Rwanda (July 2022). Societal burden of vision loss included lost productivity and quality-adjusted life years (QALYs). Published data on epidemiology and natural history of ROP were used to estimate burden and sequelae of ROP in Rwanda. Cost of a national program for screening and treating a one-year birth cohort was compared to the status quo using a decision analysis model.Cost of ROP screening and treatment was $738 per infant. The estimated equipment cost necessary for the startup of a national program was $58,667. We projected that a national program could avert 257 cases of blindness in the cohort and increase QALYs compared to the status quo. Screening and treatment for ROP would save an estimated $270,000 for the birth cohort from reductions in lost productivity.The cost of screening and anti-VEGF treatment for ROP is substantially less than the indirect cost of vision loss due to ROP. Allocating additional funding towards expansion of ROP screening and treatment is cost-saving from a societal perspective compared to current practice.

    View details for DOI 10.1080/09286586.2024.2372803

    View details for PubMedID 39146466

  • The impact of a multidisciplinary intervention to reduce severe retinopathy of prematurity in Kampala, Uganda. Journal of perinatology : official journal of the California Perinatal Association Nakibuuka, V., Vaucher, Y. E., Namakula, L., Kasozi, S., Zhang, J., Ells, A. L., Blair, M. P., Isenberg, S. J., Lambert, S. R., Rodriguez, S. H. 2024

    Abstract

    To address the threat of retinopathy of prematurity (ROP) in Sub-Saharan Africa (SSA), the Stop Infant Blindness in Africa (SIBA) project introduced a comprehensive program, including subspecialty training and oxygen management equipment.A before-and-after retrospective cohort study compared preterm infants < 1750 g or < 34 weeks' gestation before (2022) and after (2023) program implementation. Outcomes included: the proportion with severe ROP, the proportion with Zone III vascularization on first examination, and factors associated with severe ROP.Overall, 140 infants were screened before and 122 after program implementation. The proportion with Zone III vascularization increased from 16.1% (N = 11) pre-intervention to 44.9% (N = 32) post-intervention (p = 0.001). The proportion with severe ROP decreased from 27.8% (N = 19) to 12.8% (N = 9, p = 0.03). Factors predicting severe ROP on adjusted analyses were gestational age and blood transfusion.In SSA, introduction of a comprehensive program to prevent and treat ROP can decrease the risk of severe ROP.

    View details for DOI 10.1038/s41372-024-02079-y

    View details for PubMedID 39080403

    View details for PubMedCentralID 7995672

  • Complications, Visual Acuity, and Refractive Error Three Years After Secondary Intraocular Lens implantation for Pediatric Aphakia. Ophthalmology Wang, S., Repka, M. X., Sutherland, D. R., Hatt, S. R., Traboulsi, E. I., Lambert, S. R., Melia, B. M., Kraker, R. T., Holmes, J. M., Cotter, S. A. 2024

    Abstract

    To report the cumulative incidence of complications and describe refractive error and visual acuity (VA) outcomes in children undergoing secondary intraocular lens (IOL) implantation following previous surgery for non-traumatic cataract.Pediatric cataract registry.80 children (108 eyes: 60 bilateral, 48 unilateral) undergoing lensectomy at <13 years of age, followed by secondary IOL implantation at median age (range) of 2.7 (0.6 to 5.0) years for bilateral and 2.1 (0.5 to 6.4) for unilateral cases.Annual data collection from medical record review through 5 years following lensectomy.Cumulative incidence of newly emergent complications following secondary IOL implantation; refractive error and VA by 5 years after lensectomy.Median (interquartile range [IQR]) follow-up following secondary IOL implantation was 2.5 years (0.8 to 3.3 years). A common complication following secondary IOL implantation was a glaucoma-related adverse event (GRAE: glaucoma or glaucoma suspect); the cumulative incidence was 17% (95% CI: 3%-29%) in bilateral and 12% (95% CI: 0%-23%) in unilateral cases. The cumulative incidence of surgery for visual axis opacification was 2% (95% CI: 0%-7%) for bilateral and 4% (95% CI: 0%-10%) for unilateral cases. Median prediction error (IQR) within 90 days of implantation was 0.88 D (-0.50 D to +3.00 D) less hyperopic than intended among 21 eyes for bilateral cases and 1.50 D (-0.25 D to +2.38 D) less among 19 unilateral cases. Median (IQR) spherical equivalent refractive error at 5 years (median 5.1 years of age) in eyes receiving a secondary IOL was +0.50 D (-2.38 D to +2.94 D) for 48 bilateral and +0.06 D (-2.25 D to +0.75 D) for 22 unilateral cases. Median (IQR) monocular VA at 5 years was 20/63 (20/50-20/100) for bilateral (n=42) and 20/400 (20/160-20/800) for unilateral (n=33) cases.Eyes with secondary IOL implantation have an ongoing risk of new glaucoma-related adverse events. Five years after lensectomy (approximately 2.5 years after secondary IOL implantation), average refractive error was less hyperopic than desired given the anticipated further myopic shift before refraction stabilizes.

    View details for DOI 10.1016/j.ophtha.2024.05.011

    View details for PubMedID 38754556

  • Patching in Children With Unilateral Congenital Cataract and Child Functioning and Parenting Stress. JAMA ophthalmology Drews-Botsch, C., Cotsonis, G., Celano, M., Hartmann, E. E., Zaidi, J., Lambert, S. R. 2024

    Abstract

    Importance: Parents may be concerned about the adverse outcomes of occlusion therapy in children treated for unilateral congenital cataract (UCC).Objective: To determine whether occlusion therapy in children treated for UCC with poor visual outcomes is negatively associated with poorer child and/or family functioning.Design, Setting, and Participants: This cohort study was conducted in 2023 using data collected between 2006 and 2016 in the Infant Aphakia Treatment Study (IATS). IATS participants with a visual acuity (VA) of 20/200 or worse were included. Statistical analysis was performed from July 2022 to October 2023.Exposure: Caregivers reported the mean daily minutes of patching during the 12 months prior to the VA assessment at 4.5 years of age. Patching was categorized as minimal (<15 minutes per day), moderate (15 to <120 minutes per day), or extensive (≥120 minutes per day).Main Outcome Measures: At 4.25 and 10.5 years of age, caregivers reported stress associated with the parenting role using the Parenting Stress Index and the Ocular Treatment Index and child behavior problems using the Achenbach Child Behavior Checklist. Motor skills were assessed at age 54 months using the Movement Assessment Battery for Children-Second Edition. Children completed the Harter Self-Perception Profile for Children at age 10.5 years. One-way analysis of variance and chi2 tests were used to compare outcomes by amount of patching.Results: Patching data were available for 47 of 53 children (88.7%) with a VA of 20/200 or worse. Among these 47 children with patching data included in the study, 20 (42.5%) were female, 27 (57.5%) were male, 12 (25.5%) were reported to have been patched fewer than 15 minutes per day, 11 (23.4%) were patched 16 to 119 minutes per day, and 24 (51.1%) were patched at least 120 minutes per day. Parenting stress, child behavior problems, motor functioning, and child self-perception were similar in all groups. For example, after adjusting for gender and insurance status, there was a nonsignificant difference between mean stress scores of 11.0 (95% CI, -4.5 to 26.5) points for parents who reported minimal patching vs parents who reported patching at least 120 minutes per day, and there was no significant difference in children's report of their global self-worth (0.0 [95% CI, -0.4 to 0.3] points).Conclusions and Relevance: Occlusion therapy was not negatively associated with family or child functioning. Although the sample size was limited, these results do not support changes to the current practice guidelines.

    View details for DOI 10.1001/jamaophthalmol.2024.0800

    View details for PubMedID 38635258

  • Rates of Reoperation in Duane Retraction Syndrome. Ophthalmology science Lim, H. W., Hwang, B., Archambault, C., Lambert, S. R. 2024; 4 (5): 100479

    Abstract

    To investigate the types of strabismus surgeries performed and the reoperation rate in patients with Duane retraction syndrome (DRS).Retrospective cohort analysis.An insurance claims data set was used to identify patients diagnosed with DRS between 2007 and 2021.We recorded the type of strabismus surgery performed and the timing and frequency of reoperations. The hazard ratios (HRs) for reoperation were estimated according to the surgical methods using Cox regression analysis.Of the 9435 patients diagnosed with DRS, 1023 (10.8%) underwent ≥ 1 strabismus operation. The median age at surgery was 5.0 years, and patients were followed for an average of 3.8 ± 3.0 years after their initial strabismus surgery. Most of the surgeries only involved horizontal muscle(s) (n = 734 [71.7%]). However, some patients underwent surgeries on vertical muscle(s) (n = 132 [12.9%]), vertical muscle(s) with transposition (n = 102 [10.0%]), and horizontal muscle with transposition (n = 51 [5.0%]). The estimated 5-year rate of reoperation was 18.2% (95% confidence interval [CI], 15.0%-22.2%). Compared with surgery on horizontal muscle(s) only, vertical muscle surgery (HR, 2.01; 95% CI, 1.30-3.11; P = 0.002) and vertical muscle surgery coupled with transposition (HR, 1.79; 95% CI, 1.06-3.02; P = 0.03) had an increased risk of reoperation.Strabismus surgery on ≥ 1 horizontal muscles is the most common type of strabismus surgery performed on patients with DRS. Approximately 1 in 7 patients with DRS who had strabismus surgery underwent a reoperation. Patients who underwent vertical muscle surgery had a higher risk of undergoing a reoperation.Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

    View details for DOI 10.1016/j.xops.2024.100479

    View details for PubMedID 38827492

    View details for PubMedCentralID PMC11141251

  • What we have learned from the Infant Aphakia Treatment Study: The 49th Annual Frank D. Costenbader Lecture. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Lambert, S. R. 2023

    Abstract

    Unilateral congenital cataracts lead to deprivation amblyopia, which can be severe. Until the 1970s, they were believed to be always associated with poor visual outcomes. However, advances in our understanding of the plasticity of the infant brain and the development of better surgical techniques allowed good visual outcomes to be obtained in a few of these patients. The Infant Aphakia Treatment Study (IATS) was conducted to provide empirical evidence regarding the best type of optical correction to be used following surgical extraction of the cataract. Specifically, infants were randomly assigned to either be left aphakic and to wear contact lenses or an intraocular lens (IOL) was implanted and the residual refractive error was corrected with spectacles. The study found that good visual acuity and stereopsis could be achieved in some patients in both treatment groups. Early cataract surgery, consistent optical correction and part-time patching of the fellow eye are important elements needed to achieve good visual outcomes. However, excess patching of the fellow eye may interfere with the development of stereopsis. More adverse events occurred after IOL implantation, particularly visual axis opacification, compared with the infants who were left aphakic. Glaucoma-related adverse events occurred in 40% of eyes after a 10-year follow-up and were not associated with IOL implantation. Further research is needed to increase the percentage of children with unilateral congenital cataracts who achieve good visual outcomes.

    View details for DOI 10.1016/j.jaapos.2023.08.001

    View details for PubMedID 37716436

  • Anterior segment ischemia following strabismus surgery in a young adult using gender-affirming estrogen hormone therapy. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Al-Lozi, A., Koo, E. B., Lambert, S. R., Levin, M. H., Velez, F., Do, D. V., Shue, A. 2023

    Abstract

    Well-known risk factors for anterior segment ischemia (ASI) following strabismus surgery include ipsilateral surgery on three or more rectus muscles, older age, and vasculopathy. ASI is rarely reported in young patients following uneventful strabismus surgery on two ipsilateral rectus muscles. We report a 30-year-old transgender female on long-term estrogen therapy who underwent strabismus surgery involving recessions of both lateral rectus muscles, the right inferior rectus muscle, and the left superior rectus muscle. The left eye developed severe ASI with hypotony maculopathy that was resistant to topical medications, oral steroids, anterior chamber reformation, and intravitreal steroid injection. Following phacoemulsification with intraocular lens and capsular tension ring insertion 1 year later, intraocular pressure and hypotony maculopathy improved.

    View details for DOI 10.1016/j.jaapos.2023.05.004

    View details for PubMedID 37355012

  • Risk Ractors for Strabismus Surgery after Pediatric Cataract Surgery in the United States. Ophthalmology science Hwang, B., Oke, I., Lambert, S. R. 2023; 3 (2): 100271

    Abstract

    Purpose: To determine the cumulative incidence of strabismus surgery after pediatric cataract surgery and identify the associated risk factors.Design: US population-based insurance claims retrospective cohort study.Participants: Patients ≤ 18 years old who underwent cataract surgery in 2 large databases: Optum Clinformatics Data Mart (2003-2021) and IBM MarketScan (2007-2016).Methods: Individuals with at least 6 months of prior enrollment were included, and those with a history of strabismus surgery were excluded. The primary outcome was strabismus surgery within 5 years of cataract surgery. The risk factors investigated included age, sex, persistent fetal vasculature (PFV), intraocular lens (IOL) placement, nystagmus and strabismus diagnoses before cataract surgery, and cataract surgery laterality.Main Outcome Measures: Kaplan-Meier estimated cumulative incidence of strabismus surgery 5 years after cataract surgery and hazard ratios (HRs) with 95% confidence intervals (CIs) from multivariable Cox proportional hazards regression models.Results: Strabismus surgery was performed on 271/5822 children included in this study. The cumulative incidence of strabismus surgery within 5 years after cataract surgery was 9.6% (95% CI, 8.3%-10.9%). Children who underwent strabismus surgery were more likely to be of younger age at the time of cataract surgery, of female sex, have a history of PFV or nystagmus, have a pre-existing strabismus diagnosis, and less likely to have an IOL placed (all P < 0.001). Factors associated with strabismus surgery in the multivariable analysis included age 1 to 4 years (HR, 0.50; 95% CI, 0.36-0.69; P < 0.001) and age > 5 years (HR, 0.13; 95% CI, 0.09-0.18; P<0.001) compared with age < 1 year at time of cataract surgery, male sex (HR, 0.75; 95% CI, 0.59-0.95; P<0.001), IOL placement (HR, 0.71; 95% CI, 0.54-0.94; P= 0.016), and strabismus diagnosis before cataract surgery (HR, 4.13; 95% CI, 3.17-5.38; P < 0.001). Among patients with strabismus diagnosis before cataract surgery, younger age at cataract surgery was the only factor associated with increased risk of strabismus surgery.Conclusions: Approximately 10% of patients will undergo strabismus surgery within 5 years after pediatric cataract surgery. Children of younger age, female sex, and with a pre-existing strabismus diagnosis undergoing cataract surgery without IOL placement are at greater risk.Financial Disclosures: The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    View details for DOI 10.1016/j.xops.2023.100271

    View details for PubMedID 36864829

  • Inferior rectus transposition as a secondary surgery in patients with acquired abducens nerve palsy. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Marchione, G., Lambert, S. R. 2023

    Abstract

    We report the outcomes in 2 patients with acquired abducens nerve palsy with residual esotropia following superior rectus transposition and medial rectus recession who subsequently underwent inferior rectus transposition as a second procedure. Both patients showed improved abduction and reduced esotropia, with no induced cyclotorsion or vertical deviation. Inferior rectus transposition as a secondary procedure in these 2 patients with abducens nerve palsy appeared to augment the effect of prior superior rectus transposition and medial rectus recession.

    View details for DOI 10.1016/j.jaapos.2023.03.002

    View details for PubMedID 37054964

  • Causes of Childhood Blindness in the United States using the IRIS Registry (Intelligent Research in Sight). Ophthalmology Lim, H. W., Pershing, S., Moshfeghi, D. M., Heo, H., Haque, M. E., Lambert, S. R., IRIS Registry Analytic Center Consortium, Pershing, S., Hyman, L., Haller, J. A., Lee, A. Y., Lee, C. S., Lum, F., Miller, J. W., Lorch, A. 2023

    Abstract

    PURPOSE: To investigate causes of childhood blindness in the United States using the IRIS Registry (Intelligent Research in Sight).DESIGN: Cross-Sectional Study.PARTICIPANTS: Patients ≤18 years of age with visual acuity 20/200 or worse in their better seeing eye in the IRIS Registry during 2018.METHODS: Causes of blindness were classified by anatomical site and specific diagnoses.MAIN OUTCOME MEASURES: Percentages of causes of blindness.RESULTS: Of 81,164 children with 2018 visual acuity data in the IRIS Registry, 961 (1.18%) had visual acuity 20/200 or worse in their better-seeing eye. Leading causes of blindness were retinopathy of prematurity (ROP) in 301 (31.3%), nystagmus in 78 (8.1%), and cataract in 64 (6.7%) patients. The retina was the leading anatomic site (47.7%) followed by optic nerve (11.6%) and lens (10.0%). A total of 52.4% of patients had treatable causes of blindness.CONCLUSIONS: This analysis offers a unique cross-sectional view of childhood blindness in the US using a clinical data registry. More than one-half of blind patients had a treatable cause of blindness.

    View details for DOI 10.1016/j.ophtha.2023.04.004

    View details for PubMedID 37037315

  • Retinopathy of Prematurity in the 21st Century and the Complex Impact of Supplemental Oxygen. Journal of clinical medicine Rodriguez, S. H., Ells, A. L., Blair, M. P., Shah, P. K., Harper, C. A., Martinez-Castellanos, M. A., Prakalapakorn, S. G., Denis, E., Lusobya, R. C., Greenwald, M. J., Isenberg, S. J., Lambert, S. R., Vaucher, Y. E., Carroll, A., Namakula, L. 2023; 12 (3)

    Abstract

    Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. Not only do the epidemiologic determinants and distributions of patients with ROP vary worldwide, but clinical differences have also been described. The Third Edition of the International Classification of ROP (ICROP3) acknowledges that aggressive ROP (AROP) can occur in larger preterm infants and involve areas of the more anterior retina, particularly in low-resource settings with unmonitored oxygen supplementation. As sub-specialty training programs are underway to address an epidemic of ROP in sub-Saharan Africa, recognizing characteristic retinal pathology in preterm infants exposed to unmonitored supplemental oxygen is important to proper diagnosis and treatment. This paper describes specific features associated with various ROP presentations: oxygen-induced retinopathy in animal models, traditional ROP seen in high-income countries with modern oxygen management, and ROP related to excessive oxygen supplementation in low- and middle-income countries: oxygen-associated ROP (OA-ROP).

    View details for DOI 10.3390/jcm12031228

    View details for PubMedID 36769876

  • Pediatric Eye Evaluations Preferred Practice Pattern. Ophthalmology Hutchinson, A. K., Morse, C. L., Hercinovic, A., Cruz, O. A., Sprunger, D. T., Repka, M. X., Lambert, S. R., Wallace, D. K., American Academy of Ophthalmology Preferred Practice Pattern Pediatric Ophthalmology/Strabismus Panel 2022

    View details for DOI 10.1016/j.ophtha.2022.10.030

    View details for PubMedID 36543602

  • Esotropia and Exotropia Preferred Practice Pattern®. Ophthalmology Sprunger, D. T., Lambert, S. R., Hercinovic, A., Morse, C. L., Repka, M. X., Guyton, D. L., Hutchinson, A. K., Cruz, O. A., Wallace, D. K. 2022

    View details for DOI 10.1016/j.ophtha.2022.11.002

    View details for PubMedID 36526451

  • Amblyopia Preferred Practice Pattern. Ophthalmology Cruz, O. A., Repka, M. X., Hercinovic, A., Cotter, S. A., Lambert, S. R., Hutchinson, A. K., Sprunger, D. T., Morse, C. L., Wallace, D. K. 2022

    View details for DOI 10.1016/j.ophtha.2022.11.003

    View details for PubMedID 36526450

  • Risk Factors for Retinal Detachment RepairAfter Pediatric Cataract Surgery inthe United States. Ophthalmology science Oke, I., Hwang, B., Heo, H., Nguyen, A., Lambert, S. R. 2022; 2 (4): 100203

    Abstract

    Purpose: To determine the cumulative incidence of retinal detachment (RD) repair following pediatric cataract surgery and identify the associated risk factors.Design: US population-based insurance claims retrospective cohort study.Participants: Patients ≤ 18 years old who underwent cataract surgery in 2 large databases: Optum Clinformatics (2003-2021) and IBM MarketScan (2007-2016).Methods: Individuals with ≥ 6months of prior enrollment were included, and those with a history of RD, RD repair, traumatic cataract, spherophakia, or ectopia lentis were excluded. The primary outcome was time between initial cataract surgery and RD repair. The risk factors investigated included age, sex, persistent fetal vasculature (PFV), prematurity, intraocular lens (IOL) placement, and pars plana lensectomy approach.Main Outcome Measures: Kaplan-Meier estimated cumulative incidence of RD repair 5years after cataract surgery and hazard ratios (HRs) with 95% confidence intervals (CIs) from multivariable Cox proportional hazards regression models.Results: Retinal detachment repair was performed on 47 of 3289 children included in this study. The cumulative incidence of RD repair within 5years of cataract surgery was 2.0% (95% CI, 1.3%-2.6%). Children requiring RD repair were more likely to have a history of prematurity or PFV and less likely to have an IOL placed (all P<0.001). Factors associated with RD repair in the multivariable analysis included a history of prematurity (HR, 6.89; 95% CI, 3.26-14.56; P < 0.001), PFV diagnosis (HR, 8.20; 95% CI, 4.11-16.37; P < 0.001), and IOL placement (HR, 0.44; 95% CI, 0.21-0.91; P=0.03). Age at surgery, sex, and pars plana lensectomy approach were not significantly associated with RD repair after adjusting for all other covariates.Conclusions: Approximately 2% of patients will undergo RD repair within 5years of pediatric cataract surgery. Children with a history of PFV and prematurity undergoing cataract surgery without IOL placement are at the greatest risk.

    View details for DOI 10.1016/j.xops.2022.100203

    View details for PubMedID 36531585

  • Refractive Growth of the Crystalline Lens in the Infant Aphakia Treatment Study. Ophthalmology science McClatchey, T. S., Lambert, S. R., Morrison, D. G., Kruger, S. J., Wilson, L. B., McClatchey, S. K., Infant Aphakia Treatment Study Group, Lambert, S. R., DuBois, L., Nizam, A., Long, Q., Lynn, M. J., Bridgman, B., Celano, M., Cleveland, J., Cotsonis, G., Drews-Botsch, C., Freret, N., Lu, L., Swanson, S., Tutu-Gxashe, T., Hartmann, E. E., Carrigan, A. K., Edwards, C., Busettini, C., Hayley, S., Lewis, E., Joost Felius, A. K., Lambert, S. R., Buckley, E. G., Plager, D. A., Wilson, M. E., DuBois, L., Drews-Botsch, C., Hartmann, E. E., Everett, D. F., Lynn, M. J., Long, Q., Nizam, A., Felius, J., Bozic, M., Holleschau, A., Russell, B., Ward, M., Wilson, M. E., Bozic, M., Bradham, C., Vanderveen, D. K., Mansfield, T. A., Miller, K. B., Winter, T., Christiansen, S. P., Bothun, E. D., Holleschau, A., Jedlicka, J., Winters, P., Lang, J., Anderson, J. S., Traboulsi, E. I., Crowe, S., Cimino, H. H., Orge, F., Kwiatkowski, M., Colon, B., Meador, A., Yen, K. G., Castanes, M., Sanchez, A., York, S., Malone, S., Olfson, M., Romany, G., Wheeler, D. T., Stout, A. U., Rauch, P., Beaudet, K., Berg, P., Wilson, L., Lambert, S. R., Hutchinson, A. K., Dubois, L., Robb, R., Shainberg, M. J., Buckley, E. G., Freedman, S. F., Duncan, L., Phillips, B. W., Petrowski, J. T., Jones, S., Morrison, D., Owings, S., Biernacki, R., Franklin, C., Ruark, S., Plager, D. A., Neely, D. E., Whitaker, M., Bates, D., Donaldson, D., Kruger, S., Tibi, C., Vega, S., Weakley, D. R., Stager, D. R., Felius, J., Dias, C., Sager, D. L., Brantley, T., Miller, B., Lutz, E., Davis, L., Hardy, R., Birch, E., Cheng, K., Hertle, R., Kollman, C., Yeargin-Allsopp, M., McDowell, C., Everett, D. F., Beck, A. 2022; 2 (4): 100208

    Abstract

    Objective: To compare the rate of refractive growth (RRG3) of the crystalline lens ("lens") versus the eye excluding the lens ("globe") for the fellow, noncataractous eyes of participants in the Infant Aphakia Treatment Study.Design: Retrospective cohort study.Subjects: A total of 114 children who had unilateral cataract surgery as infants were recruited. Biometric and refraction data were obtained from the normal eyes at surgery and at 1, 5, and 10 years. Subjects were included if complete data (axial length [AL], corneal power, and refraction) were available at surgery and at 10 years of age.Methods: At surgery and at 1, 5, and 10 years, AL, corneal power, and cycloplegic refraction were measured in the normal eyes. For each eye, the RRG3 was defined by linear regression of refraction at the intraocular lens (IOL) plane against log10 (age+ 0.6 years). The RRG3 for the globe was based on IOL power for emmetropia; the RRG3 for the lens was based on IOL power calculated to give the observed refractions. Intraocular lens powers were calculated with the Holladay 1 formula. The means were compared with a paired 2-tailed t test, and linear regression was used to look for a correlation between RRG3 of the lens globe.Main Outcome Measures: The RRG3 of the lens and globe.Results: Complete data were available for 107 normal eyes. The mean RRG3 of the lenses was-12.0 ± 2.5 diopters (D) and the mean RRG3 of the globes was-14.1 ± 2.7 D (P < 0.001). The RRG3 of the lens correlated with the RRG3 of the globe (R 2 = 0.25, P < 0.001).Conclusions: The RRG3 was 2 D more negative in globes compared with lenses in normal eyes. Globes witha greater rate of growth tended to have lenses with a greater rate of growth.

    View details for DOI 10.1016/j.xops.2022.100208

    View details for PubMedID 36531580

  • Strabismus and Nystagmus in Patients with Pediatric Cataracts: Study using Insurance Claims Data. American journal of ophthalmology Kim, S. J., Slinger, K., Lambert, S. R., Koo, E., Shue, A., Roberts, T. L. 2022

    Abstract

    To describe the characteristics and prevalence of strabismus and nystagmus in children diagnosed with cataracts using a national insurance claims database.Population-based retrospective cohort study METHODS: Patients <13 years diagnosed with cataracts (traumatic cataracts excluded) and enrolled continuously in their healthcare program for ≥5 years after their first cataract diagnosis were identified in a retrospective review of 66 million charts in Optum's de-identified Clinformatics Data Mart Database between 2003 and 2015. Patients were categorized based on age of their first diagnosed cataract, and if cataract surgery was performed. Clinical and demographic factors associated with the occurrence of strabismus and nystagmus were evaluated.Of 1,636 children diagnosed with cataract, 434 (26.5%) and 109 (6.7%) were diagnosed with strabismus and nystagmus, respectively. Both strabismus and nystagmus were more common in those who underwent cataract surgery (P <0.001) and in patients diagnosed with cataract ≤ 12 months of age (P <0.001). Survival analysis demonstrated that strabismus and nystagmus may be diagnosed 8 years following the initial cataract diagnosis. Cox proportional hazard regression analyses revealed strabismus was associated with cataract surgery, nystagmus, and the diagnosis with cataract ≤ 12 months and cataract surgery > 12 months.As strabismus and nystagmus occur more frequently in children diagnosed with cataracts necessitating cataract surgery, regular long-term follow-up is crucial for these children to monitor for the development of strabismus and nystagmus.

    View details for DOI 10.1016/j.ajo.2022.11.014

    View details for PubMedID 36410473

  • The contribution of intraocular lens calculation accuracy to the refractive error predicted at 10 years in the Infant Aphakia Treatment Study. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Oke, I., VanderVeen, D. K., McClatchey, T. S., Lambert, S. R., McClatchey, S. K., Infant Aphakia Treatment Study Group 2022

    Abstract

    PURPOSE: To determine the relative contribution of intraocular lens (IOL) calculation accuracy and ocular growth variability to the long-term refractive error predicted following pediatric cataract surgery.METHODS: Pseudophakic eyes of children enrolled in the Infant Aphakia Treatment Study (IATS) were included in this study. Initial absolute prediction error (APE) and 10-year APE were calculated using the initial biometry, IOL parameters, postoperative refractions, and mean rate of refractive growth. The cohort was divided into children with a low-initial APE (≤1.0 D) and a high-initial APE ( >1.0 D). The 10-year APE was compared between the two groups using the Mann-Whitney U test. Linear regression was used to estimate the variability in prediction error explained by the initial IOL calculation accuracy.RESULTS: Forty-two children with IOL placement in infancy were included. Seventeen eyes had a low initial APE, and 25 eyes had a high initial APE. There was no significant difference in APE 10 years following surgery between individuals with a low initial APE (median, 2.67 D; IQR, 1.61-4.12 D) and a high initial APE (median, 3.45 D; IQR, 1.64-5.10 D) (P = 0.7). Initial prediction error could explain 12% of the variability in the prediction error 10 years following surgery.CONCLUSIONS: IOL calculation accuracy contributed minimally to the refractive error predicted 10 years after cataract surgery in the setting of high variability in the rate of refractive growth.

    View details for DOI 10.1016/j.jaapos.2022.09.008

    View details for PubMedID 36404442

  • Retinopathy of Prematurity Treatment Trends from 2003 to 2020 in the United States OPHTHALMOLOGY Khan, S. I., Ryu, W., Wood, E. H., Moshfeghi, D. M., Shah, J., Lambert, S. R. 2022; 129 (10): 1216-1218
  • Retinopathy of Prematurity Treatment Trends from 2003 to 2020 in the United States OPHTHALMOLOGY Khan, S. I., Ryu, W., Wood, E. H., Moshfeghi, D. M., Shah, J., Lambert, S. R. 2022; 129 (10): 1216-1218
  • Anterior segment optical coherence tomography findings in the Infant Aphakia Treatment Study (IATS): a secondary analysis of a randomized clinical trial. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Beck, A. D., Freedman, S. F., Nizam, A., Lambert, S. R., Infant Aphakia Treatment Study Group 2022

    Abstract

    PURPOSE: To correlate the diagnosis of glaucoma among children in the Infant Aphakia Treatment Study (IATS) by age 10 years with anterior segment optical coherence tomography (AS-OCT) findings.METHODS: A multicenter randomized controlled trial of 114 infants with unilateral congenital cataract who were 1-6 months of age at surgery. Data on long-term glaucoma-related status and outcomes were collected when children were 10.5 years old. Participants were randomized at cataract surgery to either primary intraocular lens (IOL) or no IOL implantation (contact lens [CL]). AS-OCT findings in eyes with glaucoma were compared to eyes which did not have glaucoma and to the fellow eyes, between fellow and treated eyes, and between the IOL and CL groups.RESULTS: There were no significant differences in the mean nasal and temporal anterior chamber angle (ACA) or mean nasal and temporal angle opening distance (AOD) for nonglaucomatous, glaucomatous, and fellow eyes (P = 0.31, 0.16, 0.43, 0.08 resp.). There were also no significant differences in mean nasal and temporal ACA and AOD between fellow and treated eyes (P = 0.44, 0.67, 0.57, 0.38 resp.), or between IOL and CL groups (P = 0.36, 0.35, 0.49, 0.44, resp.).CONCLUSIONS: AS-OCT confirmed that eyes with glaucoma in IATS had predominantly open angles with similar ACA and AOD to eyes without glaucoma and to fellow eyes. Furthermore, congenital cataract surgery with or without an IOL did not result in a significant difference in ACA or AOD compared to fellow eyes in IATS.

    View details for DOI 10.1016/j.jaapos.2022.05.016

    View details for PubMedID 36122874

  • Myopic Shift at 10-Year Follow-up in the Infant Aphakia Treatment Study OPHTHALMOLOGY Weakley, D. R., Nizam, A., Vanderveen, D. K., Wilson, M., Kruger, S., Lambert, S. R., Infant Aphakia Treatment Study Grp 2022; 129 (9): 1064-1065
  • Relapse and Remission in Children With Chronic Noninfectious Uveitis Treated With Methotrexate. The Journal of rheumatology McCracken, C., Shantha, J. G., Yeh, S., Jenkins, K., Rouster-Stevens, K. A., Lambert, S. R., Prahalad, S., Drews-Botsch, C., Angeles-Han, S. T. 2022

    Abstract

    Pediatric chronic noninfectious uveitis (NIU) can lead to sight-threatening complications and often requires long-term immunosuppression. Uveitis occurs in isolation (ie, idiopathic NIU), or is associated with systemic diseases, most commonly juvenile idiopathic arthritis (JIA).

    View details for DOI 10.3899/jrheum.220007

    View details for PubMedID 35970521

  • Effective lens position and pseudophakic refraction prediction error at 10 years of age in the Infant Aphakia Treatment Study. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus VanderVe En, D. K., McClatchey, T. S., McClatchey, S. K., Nizam, A., Lambert, S. R., Infant Aphakia Treatment Study Group 2022

    Abstract

    BACKGROUND: The refraction prediction error (PE) for infants with intraocular lens (IOL) implantation is large, possibly related to an effective lens position (ELP) that is different than in adult eyes. If these eyes still have nonadult ELPs as they age, this could result in persistently large PE. We aimed to determine whether ELP or biometry at age 10 years correlated with PE in children enrolled in the Infant Aphakia Treatment Study (IATS).METHODS: We compared the measured refraction of eyes randomized to primary IOL implantation to the "predicted refraction" calculated by the Holladay 1 formula, based on biometry at age 10 years. Eyes with incomplete data or IOL exchange were excluded. The PE (predicted - measured refraction) and absolute PE were calculated. Measured anterior chamber depth (ACD) was used to assess the effect of ELP on PE. Multiple regression analysis was performed on absolute PE versus axial length, corneal power, rate of refractive growth, refractive error, and best-corrected visual acuity.RESULTS: Forty-three eyes were included. The PE was 0.63 ± 1.68 D; median absolute PE, 0.85 D (IQR, 1.83 D). The median absolute PE was greater when the measured ACD was used to calculate predicted refraction instead of the standard A-constant (1.88 D [IQR, 1.72] D vs 0.85 D [IQR, 1.83], resp. [P = 0.03]). Absolute PE was not significantly correlated with any other parameter.CONCLUSIONS: Variations in ELP did not contribute significantly to PE 10 years after infant cataract surgery.

    View details for DOI 10.1016/j.jaapos.2022.04.010

    View details for PubMedID 35868622

  • Long-term strabismus outcomes after unilateral infantile cataract surgery in the Infant Aphakia Treatment Study. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Bothun, E. D., Shainberg, M. J., Christiansen, S. P., Vanderveen, D. K., Neely, D. E., Kruger, S. J., Cotsonis, G., Lambert, S. R., Infant Aphakic Treatment Study 2022

    Abstract

    PURPOSE: To characterize long-term strabismus outcomes in children in the Infant Aphakia Treatment Study (IATS).METHODS: This study was a secondary data analysis of long-term ocular alignment characteristics of children aged 10.5 years who had previously been enrolled in a randomized clinical trial evaluating aphakic management after unilateral cataract surgery between 1 and 6 months of age.RESULTS: In the IATS study, 96 of 109 children (88%) developed strabismus through age 10.5 years. Half of the 20 children who were orthophoric at distance through age 5 years maintained orthophoria at distance fixation at 10.5 years. Esotropia was the most common type of strabismus prior to age 5 years (56/109 [51%]), whereas exotropia (49/109 [45%]) was the most common type of strabismus at 10.5 years (esotropia, 21%; isolated hypertropia, 17%). Strabismus surgery had been performed on 52 children (48%), with 18 of these (35%) achieving microtropia <10Delta. Strabismus was equally prevalent in children randomized to contact lens care compared with those randomized to primary intraocular lens implantation (45/54 [83%] vs 45/55 [82%]; P = 0.8). Median visual acuity in the study eye was 0.56 logMAR (20/72) for children with orthotropia or microtropia <10Delta versus 1.30 logMAR (20/400) for strabismus ≥10Delta (P = 0.0003).CONCLUSIONS: Strabismus-in particular, exotropia-is common irrespective of aphakia management 10 years following infant monocular cataract surgery. The delayed emergence of exotropia with longer follow-up indicates a need for caution in managing early esotropia in these children. Children with better visual acuity at 10 years of age are more likely to have better ocular alignment.

    View details for DOI 10.1016/j.jaapos.2022.05.003

    View details for PubMedID 35843488

  • Retinopathy of Prematurity Treatment Trends from 2003-2020 in the United States. Ophthalmology Khan, S. I., Ryu, W. Y., Wood, E. H., Moshfeghi, D. M., Shah, J. K., Lambert, S. R. 2022

    Abstract

    We used population-based data obtained from Optum's Clinformatics Data Mart Database to characterize recent trends in retinopathy of prematurity (ROP) treatments and outcomes in the United States. Laser photocoagulation was utilized more frequently every year compared to anti-VEGF.

    View details for DOI 10.1016/j.ophtha.2022.06.008

    View details for PubMedID 35714734

  • Ocular Motor Nerve Palsy After Traumatic Brain Injury: A Claims Database Study. Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society Heo, H., Lambert, S. R. 2022

    Abstract

    Traumatic brain injury (TBI) is one of the common causes of ocular motor nerve (oculomotor nerve [CN3], trochlear nerve [CN4], and abducens nerve [CN6]) palsies, but there has been no large study of ocular motor nerve palsy caused by TBI. This study aimed to investigate the characteristics of and differences in ocular motor nerve palsy after TBI, according to patient age and severity of TBI.This was a population-based retrospective cohort study that included patients who had ocular motor nerve palsy after TBI with ≥6 months of continuous enrollment using claims data from the IBM MarketScan Research Databases (2007-2016). We assessed sex, age at the first diagnosis of TBI, the severity of TBI, and the rates of strabismus procedures according to the age and severity of TBI. The rates of muscle transposition surgery and chemodenervation in CN3, CN4, and CN6 palsy were investigated.A total of 2,606,600 patients with TBI met the inclusion criteria. Among them, 1,851 patients (0.071%) had ocular motor nerve palsy after TBI. The median age of the patients was 39 (Q1-Q3: 19-54) years, and 42.4% of the patients were female. The median continuous enrollment period after the first diagnosis of TBI was 22 (Q1-Q3: 12-38) months. Of the 1,350,843 children with TBI, 454 (0.026%) had ocular motor nerve palsy. Of the 1,255,757 adults with TBI, 1,397 (0.111%) had ocular motor nerve palsy. Among these 1,851 patients, CN4 palsy (697, 37.7%) occurred most frequently, and strabismus procedures were performed in 237 patients (12.8%). CN6 palsy developed most frequently in children. More children (16.5%) underwent strabismus surgeries than adults (11.6%) (P = 0.006). The proportion of CN4 palsy (52.3%) was higher while the proportion of CN3 palsy (15.5%) was lower in patients with mild TBI than in patients with moderate-to-severe TBI (P < 0.001).CN4 palsy developed most frequently among patients of all ages, and only approximately 13% of the patients underwent strabismus procedures for ocular motor nerve palsy after TBI. The rate of development of ocular motor nerve palsy was approximately 4.3 times lower in children than adults, and children most frequently had CN6 palsy after TBI.

    View details for DOI 10.1097/WNO.0000000000001635

    View details for PubMedID 36166785

  • The accuracy of intraocular lens calculation varies by age in the Infant Aphakia Treatment Study. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Oke, I., VanderVeen, D. K., McClatchey, T. S., Lambert, S. R., McClatchey, S. K., Infant Aphakia Treatment Study Group 2022

    Abstract

    Refraction predictions from intraocular lens (IOL) calculation formulae are inaccurate in children. We sought to quantify the relationship between age and prediction error using a model derived from the biometry measurements of children enrolled in the Infant Aphakia Treatment Study (IATS) when they were ≤7 months of age. We calculated theoretical predicted refractions in diopters (D) using axial length, average keratometry, and IOL powers at each measurement time point using the Holladay 1 formula. We compared the predicted refraction to the actual refraction and calculated the absolute prediction error (APE). We found that the median APE was 1.60 D (IQR, 0.73-3.11 D) at a mean age (corrected for estimated gestational age) of 0.20 ± 0.14 years and decreased to 1.11 D (IQR, 0.42-2.20 D) at 10.60 ± 0.27 years. We analyzed the association of age with APE using linear mixed-effects models adjusting for axial length, average keratometry, and IOL power and found that as age doubled, APE decreased by 0.25 D (95% CI, 0.09-0.40 D). The accuracy of IOL calculations increases with age, independent of biometry measurements and IOL power.

    View details for DOI 10.1016/j.jaapos.2022.02.004

    View details for PubMedID 35534321

  • Incidence of infectious complications following strabismus surgery. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Heo, H., Ryu, W. Y., Chandramohan, A., Lambert, S. R. 2022

    View details for DOI 10.1016/j.jaapos.2022.01.006

    View details for PubMedID 35436601

  • Myopic Shift at 10 Years Follow-up in the Infant Aphakia Treatment Study. Ophthalmology Weakley, D. R., Nizam, A., VanderVeen, D. K., Wilson, M. E., Kruger, S., Lambert, S. R., Infant Aphakia Treatment Study Group 2022

    Abstract

    We studied the myopic shift and anisometropia at 10.6 (+/-0.3) years of age in the Infant Aphakia Treatment Study. We found myopic shift continues in the operated eye from 5-10.5 years at a lower rate than that prior to age five years while anisometropia increases proportionally. The Infant Aphakia Treatment Study (IATS) is a randomized clinical trial initially designed to compare outcomes in infants under seven months of age who underwent primary implantation of an intraocular lens (IOL) versus being left aphakic and receiving a contact lens correction following cataract surgery in infancy.1 Patients were enrolled from 2004 through 2009 with the last 10-year follow-up exam completed in 2019. The study design was approved by the institutional review boards of the 12 participating sites and followed the tenets of the Declaration of Helsinki. The off-label use of the AcrySof SN60AT and MA60AC IOLs (Alcon Laboratories, Fort Worth Tx.) was covered under the United States Food and Drug Administration investigational device exemption. The trial is registered at www.ClinicalTrials.gov (identifier, NCT00212134).

    View details for DOI 10.1016/j.ophtha.2022.04.004

    View details for PubMedID 35398306

  • Current management of infantile cataracts. Survey of ophthalmology Lenhart, P. D., Lambert, S. R. 2022

    Abstract

    Infantile cataracts remain one of the most treatable causes of lifelong visual impairment. While the chance of improving vision for children with infantile cataracts has never been better, significant global and socioeconomic disparities still exist in the early management of infantile cataracts. Recent epidemiological studies reveal a stable prevalence of infantile cataracts in high-income countries and highlight challenges in determining the prevalence of infantile cataracts in low income countries. Detailed descriptions of cataract morphology may inform us as to etiology, provide guidance with regards to surgical approach, and have prognostic value. Molecular genetics is providing new insights into the hereditary bases and potential systemic associations of infantile cataracts. For visually significant infantile cataracts requiring surgery to clear the visual axis, surgical techniques continue to evolve based on the experiences and research efforts of skilled teams worldwide. The most common complications of cataract surgery performed in infancy are visual axis opacification and, in about a third of patients, the long-term development of glaucoma. While overall visual outcomes are better for children with unilateral cataracts given the presence of a healthy fellow eye, better visual outcomes in operated eyes are achieved in the setting of early presentation, bilateral infantile cataracts, absence of nystagmus or strabismus, and consistent amblyopia therapy. While intraocular lenses for infants less than 6 months can result in good visual outcomes, contact lenses may be preferred in situations in which they are available and practical. Many studies have demonstrated the benefits of early surgery for infantile cataract. We must strive for the continued evolution of technologies and strategies that have the potential to further improve these outcomes.

    View details for DOI 10.1016/j.survophthal.2022.03.005

    View details for PubMedID 35307324

  • Referral patterns for infantile cataracts in two regions of the United States. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Huang, L. C., Kumar, P., Fredrick, D. R., Alcorn, D. M., Koo, E. B., Stell, L., Lambert, S. R. 1800

    Abstract

    BACKGROUND: Delayed treatment of congenital or infantile cataracts can cause deprivation amblyopia. Prompt diagnosis and surgical intervention is critical for optimal outcomes. This study assessed referral patterns for congenital or infantile cataracts in two regions of the United States.METHODS: The medical records of children 0-1 years of age with congenital or infantile cataracts at Stanford University (2008-2018) and Emory University (2010-2015) were reviewed retrospectively.RESULTS: A total of 111 children were included. Of these, 82 (74%) were initially evaluated by a primary care doctor, of whom 40 (49%) were referred directly to a pediatric cataract surgeon. Of 61 newborns 0-2 months of age, 9 (15%) were initially referred to an eye care provider before 6 weeks of age, but the initial evaluation by a pediatric cataract surgeon was delayed until after 6 weeks of age. Referral patterns were similar between the two institutions (P = 0.06).CONCLUSIONS: Many children with congenital of infantile cataracts are initially referred by a primary care doctor to an eye care provider who does not perform pediatric cataract surgery. Nevertheless, the majority of newborn infants with cataracts were evaluated by a pediatric cataract surgeon before 6 weeks of age.

    View details for DOI 10.1016/j.jaapos.2021.09.006

    View details for PubMedID 34973446

  • Risk Factors for Reoperation after Strabismus Surgery among Patients with Thyroid Eye Disease. American journal of ophthalmology Hwang, B., Heo, H., Lambert, S. R. 2021

    Abstract

    PURPOSE: To examine risk factors for strabismus surgery reoperation in patients with thyroid eye disease (TED).DESIGN: Retrospective cohort study METHODS: An insurance claims database was used to identify patients with TED who underwent at least one strabismus operation between 2003 and 2019. We recorded specific muscles operated on, as well as the timing and frequency of reoperations. Cox regressions were used to estimate associations between time to reoperation and patient and primary surgery characteristics.RESULTS: Of the 448 patients who met inclusion criteria, 111 (24.8%) underwent a reoperation. Patients were followed for an average of 5.4 ± 3.0 years after their initial strabismus surgery. The rates of reoperation among patients whose initial surgery involved horizontal muscles only, vertical muscles only, and horizontal and vertical muscles were 29/120 (24.2%), 33/169 (19.5%), and 49/159 (30.8%) respectively (p = .05). The number of muscles operated on initially was the only independent predictor for undergoing a strabismus surgery reoperation (Odds Ratio [OR] 1.27; 95% CI 1.03-1.57; p = 0.03). The number of muscles operated on initially was also associated with shorter time to first reoperation (Hazard Ratio [HR] 1.22; 95% CI 1.02-1.46; p = 0.03). Age at first surgery, time between diagnosis of TED and first strabismus surgery, gender, race, and use of adjustable sutures were not associated with time to reoperation.CONCLUSIONS: Approximately 1 in 4 patients with TED require reoperation after strabismus surgery. The number of muscles operated on was the only independent predictor for both undergoing a reoperation and time to first reoperation.

    View details for DOI 10.1016/j.ajo.2021.11.022

    View details for PubMedID 34843685

  • Development and Preliminary Validation of a Virtual Reality Approach for Measurement of Torsional Strabismus. Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society Bindiganavale, M., Buickians, D., Lambert, S. R., Bodnar, Z. M., Moss, H. E. 2021

    Abstract

    BACKGROUND: Double Maddox rod (DMR), the gold-standard method for in-office measurement of cyclodeviation, requires an examiner and specialized equipment. The objective of this study was to develop a virtual reality (VR) technique for measurement of cyclodeviation and validate this against the DMR.METHODS: A VR-DMR was implemented using a smartphone and commercially available VR viewer. The app displayed a line to each eye and accepted touch inputs from the user to rotate the lines into perceived alignment. VR-DMR cyclodeviation measurements were compared with traditional DMR (T-DMR) cyclodeviation measurements in adults with and without strabismus and children without strabismus.RESULTS: Thirty-one subjects were studied (age 5-88 years, 20 with strabismus). VR-DMR had similar test-retest reliability as T-DMR. VR-DMR was highly correlated with T-DMR (r2 = 0.94, linear regression slope 1.12) with a slight positive bias (linear regression y intercept 1°). VR-DMR was preferred by 54% of subjects with 29% having no preference.CONCLUSIONS: A VR method of ocular cyclodeviation measurement using sensory techniques was implemented using commercially available hardware. VR measurements compared favorably with gold-standard DMR measurements, and user feedback was positive. The VR methodology has application for in office and home use by nonexperts for purposes of strabismus monitoring.

    View details for DOI 10.1097/WNO.0000000000001451

    View details for PubMedID 34812760

  • Types of Surgery Performed and Reoperation Rate for Congenital Superior Oblique Palsy: a Claims Database Study. Acta ophthalmologica Heo, H., Lambert, S. R. 2021

    Abstract

    PURPOSE: To investigate types of surgeries performed to treat a presumed congenital superior oblique palsy (SOP) and the reoperation rate.METHODS: This was a population-based retrospective cohort study using claims data from the United States. Patients who underwent strabismus surgery for a presumed congenital SOP with ≥ 3months of continuous enrolment after the initial surgery were included. We investigated age, surgical methods and the time interval between the initial surgery and reoperation. The hazard ratios for reoperation were estimated according to the surgical methods using Cox regression analysis.RESULTS: A total of 3,998 patients underwent surgery for presumed congenital SOP; 2,981 (74.6%) on only one vertical muscle (excluding superior oblique). Reoperation was performed on 427 patients (10.7%). Compared to patients who underwent unilateral surgery on one vertical muscle (excluding superior oblique muscle), patients who underwent surgery that included the superior oblique muscle (unilateral 2.08; 95% CI, 1.61-2.67, p<0.001; bilateral 2.44; 95% CI, 1.40-4.28, p=0.002) and two or more vertical muscles (excluding the superior oblique muscle) (unilateral 2.99; 95% CI, 2.00-4.49, p<0.001; bilateral 1.68; 95% CI, 1.23-2.28, p=0.001) had increased hazard ratios for reoperation. The median period between the initial surgery and reoperation was 168.0 [Q1-Q3 84.0-407.8] days and negatively correlated with patient age at initial surgery (r=-0.199, p<0.001).CONCLUSION: The reoperation rate for presumed congenital SOP was 10.7%. Patients who underwent surgery on two or more vertical muscles or the superior oblique muscle had an increased risk of reoperation.

    View details for DOI 10.1111/aos.15053

    View details for PubMedID 34693629

  • Trends in congenital nasolacrimal duct obstruction surgical procedures in the United States from 2003 to 2016. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Muminovic, I., Ryu, W. Y., Lambert, S. R. 2021

    Abstract

    In this population-based retrospective cohort study, the Optum claims dataset was used to identify children <4 years of age with the diagnosis of nasolacrimal duct obstruction during the period 2003-2016. A total of 156,044 children were identified, of whom 16,538 (9.43%) underwent a surgical procedure. There was a downward trend for the frequency of all types of treatments but particularly for facility-based probings.

    View details for DOI 10.1016/j.jaapos.2021.06.002

    View details for PubMedID 34600104

  • Endophthalmitis after pediatric cataract surgery in the United States: report using an insurance claims database. Journal of cataract and refractive surgery Nguyen, A. M., Roberts, T. L., Ryu, W. Y., Lambert, S. R. 2021; 47 (9): 1161-1166

    Abstract

    PURPOSE: To describe the characteristics and incidence of children developing endophthalmitis within the first 90 days following pediatric cataract surgery.SETTING: Deidentified commercial and Medicare Advantage health claims across the United States.DESIGN: Population-based retrospective cohort study.METHODS: In a retrospective review of approximately 58 million charts in Optum's deidentified Clinformatics Data Mart Database, patients aged <13 years who underwent cataract surgery in one or both eyes with or without primary intraocular lens (IOL) implantation between 2003 and 2017 were identified. Excluded were patients with traumatic cataract, <90 days of continuous insurance coverage, a prior diagnosis of endophthalmitis, and a diagnosis of endophthalmitis occurring after 90 days of cataract surgery. The main outcome measure was the incidence of endophthalmitis occurring within the first 90 days of cataract surgery and the odds ratio for developing endophthalmitis according to demographic and intraoperative factors.RESULTS: Cataract surgery was performed on 789 eyes (52.6% male), with a median age of 4 (interquartile range 1-8) years. The rate of IOL implantation at the time of cataract surgery was 66.8%. Endophthalmitis was diagnosed in 4 of 789 eyes (0.51%). The median time to diagnosis of endophthalmitis was 6.5 days (range: 5-44 days). There was no significant association between endophthalmitis and age, sex, or primary IOL implantation.CONCLUSIONS: In this large insurance claims database, the incidence of endophthalmitis following pediatric cataract surgery reported was more than the rate previously reported by any study with patients of a similar age.

    View details for DOI 10.1097/j.jcrs.0000000000000602

    View details for PubMedID 34468453

  • Adjustable Sutures in the Treatment of Strabismus: A Report by the American Academy of Ophthalmology. Ophthalmology Heidary, G., Aakalu, V. K., Binenbaum, G., Chang, M. Y., Morrison, D. G., VanderVeen, D. K., Lambert, S. R., Trivedi, R. H., Galvin, J. A., Pineles, S. L. 2021

    Abstract

    PURPOSE: To review the scientific literature that evaluates the effectiveness of adjustable sutures in the management of strabismus for adult and pediatric patients.METHODS: Literature searches were performed in the PubMed database through April 2021 with no date limitations and were restricted to publications in English. The searches identified 551 relevant citations, of which 55 were reviewed in full text. Of these, 17 articles met the inclusion criteria and were assigned a level of evidence rating by the panel methodologist. The search included all randomized controlled studies regardless of study size and cohort studies of 100 or more patients comparing the adjustable versus nonadjustable suture technique, with a focus on motor alignment outcomes or reoperation rates.RESULTS: The literature search yielded no level I studies. Of the 17 articles that met the inclusion criteria, 11 were rated level II and 6 were rated level III. Among the 12 studies that focused on motor alignment outcomes, 4 small randomized clinical trials (RCTs) did not find a statistically significant difference between groups, although they were powered to detect only very large differences. Seven of 8 nonrandomized studies found a statistically significant difference in motor alignment success in favor of the adjustable suture technique, both overall and in certain subgroups of patients. Successful motor alignment was seen in both exotropia (in 3 studies that were not limited to children) and esotropia (in 1 study of adults and 2 of children). The majority of included studies that reported on reoperation rates found the rates to be lower in patients who underwent strabismus surgery with adjustable sutures, but this finding was not uniformly demonstrated.CONCLUSIONS: Although there are no level I studies evaluating the effectiveness of adjustable sutures for strabismus surgery, the majority of nonrandomized studies that met the inclusion criteria for this assessment reported an advantage of the adjustable suture technique over the nonadjustable technique with respect to motor alignment outcomes. This finding was not uniformly demonstrated among all studies reviewed and warrants further investigation in the development and analysis of adjustable suture techniques.

    View details for DOI 10.1016/j.ophtha.2021.07.026

    View details for PubMedID 34446304

  • Outcomes After Corneal Crosslinking for Keratoconus in Children and Young Adults. Cornea Saleh, S., Koo, E. B., Lambert, S. R., Manche, E. E. 2021

    Abstract

    PURPOSE: The aim of this study was to assess the effect of corneal crosslinking on vision and keratometry in children and young adults with progressive keratoconus.METHODS: A retrospective medical records review of patients aged 22 years or younger with keratoconus who underwent corneal crosslinking between January 2013 and November 2019 at Byers Eye Institute at Stanford University was conducted. Outcome measures included logarithm of the Minimum Angle of Resolution corrected distance visual acuity (CDVA); keratometry, including maximum keratometry (Kmax); pachymetry; and total wavefront aberration. Measurements were taken at baseline and at 12 and 24 months postoperatively.RESULTS: Fifty-seven eyes of 49 patients aged 12 to 22 years were assessed. The mean preoperative CDVA was logarithm of the Minimum Angle of Resolution 0.38 ± 0.32 (20/48), with a mean postoperative CDVA of 0.29 ± 0.31 (20/39) and 0.31 ± 0.31 (20/41) at 12 and 24 months postoperatively, respectively. Compared with preoperative mean Kmax, there was an improvement of -0.8 diopters (D) to a mean postoperative Kmax of 59.1 ± 9.1 D at 12 months and -1.3 D to 59.7 ± 8.8 D at 24 months. Subanalysis excluding the second eye of patients who underwent bilateral crosslinking showed similar results. Linear mixed modeling showed significant improvement in Kmax at both 12 and 24 months postoperatively. Minimum central corneal thickness initially decreased but stabilized at 24 months after crosslinking. Total wavefront aberration remained stable.CONCLUSIONS: Corneal crosslinking stabilizes, and in some cases improves, visual and corneal parameters in pediatric and young adult patients with keratoconus. The procedure is safe and well-tolerated and may prevent keratoconus progression in young patients.

    View details for DOI 10.1097/ICO.0000000000002730

    View details for PubMedID 33859086

  • Incidence of Retinal Detachment Following Lens Surgery in Children and Young Adults with Non-Traumatic Ectopia Lentis. Journal of cataract and refractive surgery Heo, H., Lambert, S. R. 2021

    Abstract

    PURPOSE: To determine the incidence of retinal detachment following lens surgery in children and young adults with non-traumatic ectopia lentis.SETTING: Population-based claims data.DESIGN: Population-based retrospective cohort study METHODS:: A total of 210 patients (298 eyes) with non-traumatic ectopia lentis aged ≤ 30 years who had undergone lens surgery with or without intraocular lens (IOL) implantation and had ≥ 1 year of continuous enrollment after lens surgery were identified from the Optum deidentified Clinformatics Data Mart Database (2003-2019) and IBM MarketScan Databases (2007-2016). We assessed sex, age, etiology of ectopia lentis, IOL implantation and postoperative retinal detachment in both databases, separately. Univariate and multivariate analyses were conducted to identify the risk factors for postoperative retinal detachment.RESULTS: IOL implantation was coupled with lens surgery in 151 (49.8%) eyes that underwent lens surgery for non-traumatic ectopia lentis. Median follow-up was 32 months in aphakic eyes and 29 months in pseudophakic eyes. Patients undergoing IOL implantation were older at the time of lens surgery (median age: no IOL, 6 years; IOL, 16 years; P < .001). Retinal detachment developed in 14 eyes (4.7%) (no IOL, 5 (3.4%); IOL, 9 (6.0%); P = .30). Older age was the baseline characteristic that correlated most closely with the risk of retinal detachment (P = .05).CONCLUSIONS: The rate of retinal detachment was similar with or without IOL implantation after lens surgery for non-traumatic ectopia lentis in children and young adults.

    View details for DOI 10.1097/j.jcrs.0000000000000667

    View details for PubMedID 33929802

  • Blindness Secondary to Retinopathy of Prematurity in Sub-Saharan Africa. Ophthalmic epidemiology Herrod, S. K., Adio, A., Isenberg, S. J., Lambert, S. R. 2021: 1–8

    Abstract

    Purpose: Retinopathy of Prematurity (ROP) has been suggested to be increasing in Africa. However, it was only previously documented as a cause of blindness in 8 of 48 (16.7%) sub-Saharan African countries. The purpose of this study was to better understand the magnitude and breadth of blindness from ROP in sub-Saharan Africa.Methods:A questionnaire was sent to 455 ophthalmologists practicing in sub-Saharan Africa; the questionnaire was available in English, French and Portuguese.Results:Responses were received from 132 of 455 (29%) ophthalmologists to whom the survey was sent. Eighty-three respondents were identified as ROP-involved ophthalmologists and were from 26 of 48 (54%) sub-Saharan African countries. Ophthalmologists in 23 countries reported that they examined at least one child who was blind from ROP during the last 5years. Sixteen of these countries had not previously reported cases of blindness from ROP in the literature. The perceived occurrence of Type 1 or more severe ROP was reported to be increasing by 31 of 77 (40%) ROP-involved ophthalmologists. ROP-involved pediatric ophthalmologists and retinal surgeons reported the number of infants they examined annually with Type 1 or more severe ROP increased from a median of 1 (range: 0-15) to a median of 4 (range: 0-40) from 2015 to 2019. ROP was estimated to be the cause of blindness for 10% of all blind children examined by ROP-involved pediatric ophthalmologists and retinal surgeons during 2019.Conclusions:ROP is becoming a more important and widespread cause of childhood blindness in sub-Saharan Africa.

    View details for DOI 10.1080/09286586.2021.1910315

    View details for PubMedID 33818253

  • Oxygen management among infants in neonatal units in sub-Saharan Africa: a cross-sectional survey. Journal of perinatology : official journal of the California Perinatal Association Herrod, S. K., Stevenson, A., Vaucher, Y. E., Lambert, S. R., Isenberg, S. J., Yap, V. L., Ezeaka, V. C., Carlo, W. A. 2021

    Abstract

    OBJECTIVES: To provide more comprehensive data on the management of oxygen supplementation in neonates in sub-Saharan Africa.STUDY DESIGN: An online survey on the management of oxygen supplementation for infants in neonatal units was sent to 278 healthcare personnel in sub-Saharan Africa.RESULTS: One hundred and nine responses from 82 neonatal care units in 54% (26/48) sub-Saharan African countries were received. All units had the capacity to provide oxygen supplementation. However, only 50% (38/76) had access to blend oxygen with medical air and 1% (1/75) had the capacity to blend oxygen/air for every infant. Although 96% (72/75) of units could monitor oxygen saturation, monitoring was mostly intermittent and only 32% (24/75) were able to monitor oxygen saturation in every infant receiving oxygen supplementation.CONCLUSIONS: Findings indicate that oxygen supplementation is inadequately managed in neonatal units in sub-Saharan Africa, which may put infants at risk of developing severe ROP.

    View details for DOI 10.1038/s41372-021-01040-7

    View details for PubMedID 33772113

  • Effect of age on reoperation rate in children undergoing exotropia surgery. Acta ophthalmologica Heo, H., Lambert, S. R. 2021

    Abstract

    PURPOSE: To determine the effect of age on the reoperation rate in children undergoing exotropia surgery.METHODS: This was a population-based retrospective cohort study using claims data that included children≤12years who had undergone exotropia surgery as the first strabismus operation and had≥3years of continuous enrolment were selected from the Optum de-identified Clinformatics Data Mart Database (2003-2019). Patient age at the first exotropia surgery was grouped into three categories; 0-3, 4-6, and 7-12years. We assessed the sex, race, age, surgical methods, continuous enrolment period after the first surgery, and the time between the first surgery and reoperation. Cox regression analysis was used to estimate the risk of reoperation at different ages. The hazard ratio of reoperation in children undergoing exotropia surgery according to the age at the first exotropia surgery.RESULTS: Among 2015 children, 312 (15.5%) underwent one or more reoperations. A reoperation was more often performed for recurrent exotropia (n=231) than for consecutive esotropia (n=81). The time between the first surgery and reoperation was shorter for reoperation for consecutive esotropia (376days) than for recurrent exotropia (672days) (p<0.001). Younger children showed a higher reoperation hazard ratio than older children (p<0.001). In reoperation for consecutive esotropia, the patients aged 0-3years showed a high hazard ratio (2.82; 95% CI, 1.59-5.01).CONCLUSION: Children undergoing exotropia surgery at a younger age have a higher reoperation rate than those undergoing surgery at an older age.

    View details for DOI 10.1111/aos.14771

    View details for PubMedID 33529446

  • VISION 2020: what remains to be done after the COVID-19 pandemic? The Lancet. Child & adolescent health Lambert, S. R. 2021

    View details for DOI 10.1016/S2352-4642(20)30391-6

    View details for PubMedID 33524321

  • Comprehensive assessment of quality of life, functioning and mental health in children with juvenile idiopathic arthritis and non-infectious uveitis. Arthritis care & research McDonald, J., Cassedy, A., Altaye, M., Andringa, J., Cooper, A. M., Drews-Botsch, C., Engelhard, G. J., Hennard, T., Holland, G. N., Jenkins, K., Lambert, S. R., Lipscomb, J., McCracken, C., McCurdy, D. K., Mwase, N., Prahalad, S., Shantha, J., Stahl, E., Miraldi Utz, V., Walker, A. A., Yeh, S., Angeles-Han, S. T. 2021

    Abstract

    OBJECTIVE: Pediatric uveitis can lead to sight-threatening complications and impact quality of life (QOL) and functioning. We aim to examine health-related QOL (HRQOL), mental health, physical disability, vision-related functioning (VRF), and vision-related QOL (VRQOL) in children with juvenile idiopathic arthritis (JIA), JIA-associated uveitis (JIA-U), and other non-infectious uveitis. We hypothesize that there will be differences based on the presence of eye disease.METHODS: A multicenter cross-sectional study was conducted at four sites. Patients with JIA, JIA-U, or non-infectious uveitis were enrolled. Patients and parents completed the PedsQL (HRQOL), RCADS (anxiety/depression), CHAQ (physical disability), and EYE-Q (VRF/VRQOL). Clinical characteristics and patient-reported outcome measures (PROMs) were compared by diagnosis.RESULTS: Of 549 patients, 332 had JIA, 124 JIA-U, and 93 other uveitis. Children with JIA-U had worse EYE-Q scores compared to JIA only. In children with uveitis, those with anterior uveitis (JIA-U and uveitis only) had less ocular complications, better EYE-Q scores, and worse CHAQ and PedsQL physical summary scores compared to those with non-anterior disease. In children with anterior uveitis, those with JIA-U had worse PedsQL physical summary and CHAQ scores than anterior uveitis only. Further, EYE-Q scores were worse in children with bilateral uveitis and more visual impairment. There were no differences in RCADS scores among groups.CONCLUSION: We provide a comprehensive outcome assessment of children with JIA, JIA-U, and other uveitis diagnoses. Differences in QOL and function were noted based on underlying disease. Our results support the addition of a vision-specific measure to better understand the impact of uveitis.

    View details for DOI 10.1002/acr.24551

    View details for PubMedID 33421338

  • The rate of superior oblique surgery in children with Brown syndrome according to claims data. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Heo, H., Lambert, S. R. 2021

    Abstract

    To determine the rate of superior oblique surgery and how often it is combined with surgery on other extraocular muscles or associated with subsequent strabismus surgeries in children and young adults with Brown syndrome.This was a population-based retrospective cohort study using the Optum deidentified Clinformatics Data Mart Database (2004-2018) for patients ≤18 years of age diagnosed with Brown syndrome who underwent superior oblique surgery as their first strabismus surgery and had at least 6 months of continuous enrollment. We assessed sex, age, and the number of included patients by year and by age. Combined and subsequent strabismus surgeries were also investigated.Of 1,007 patients diagnosed with Brown syndrome, 115 (11.4%) underwent superior oblique surgery. The rate of superior oblique surgery was relatively constant between 2004 to 2018. The superior oblique surgery rate was highest in children ≤2 years of age with a decreasing rate as age increased. In 45 of 115 patients (39.1%), other extraocular muscles were operated on in addition to the superior oblique muscle. Of 88 patients who underwent superior oblique surgery without concurrent vertical muscle surgery as the first operation, 11 patients (12.5%) subsequently underwent an additional vertical muscle surgery because of newly developed or worsening vertical misalignment.In this study cohort, superior oblique surgery was performed on 11.4% of children and adolescents with Brown syndrome. The number of patients with Brown syndrome and the rate of superior oblique surgery decreased as age increased to age 10 years.

    View details for DOI 10.1016/j.jaapos.2021.03.009

    View details for PubMedID 34252517

  • Glaucoma-Related Adverse Events at 10 Years in the Infant Aphakia Treatment Study: A Secondary Analysis of a Randomized Clinical Trial. JAMA ophthalmology Freedman, S. F., Beck, A. D., Nizam, A., Vanderveen, D. K., Plager, D. A., Morrison, D. G., Drews-Botsch, C. D., Lambert, S. R., Infant Aphakia Treatment Study Group 2020

    Abstract

    Importance: Glaucoma-related adverse events constitute serious complications of cataract removal in infancy, yet long-term data on incidence and visual outcome remain lacking.Objective: To identify and characterize incident cases of glaucoma and glaucoma-related adverse events (glaucoma + glaucoma suspect) among children in the Infant Aphakia Treatment Study (IATS) by the age of 10.5 years and to determine whether these diagnoses are associated with optic nerve head (ONH) and peripapillary retinal nerve fiber layer (RNFL) assessment.Design, Setting, and Participants: Analysis of a multicenter randomized clinical trial of 114 infants with unilateral congenital cataract who were aged 1 to 6 months at surgery. Data on long-term glaucoma-related status and outcomes were collected when children were 10.5 years old (July 14, 2015, to July 12, 2019) and analyzed from March 30, 2019, to August 6, 2019.Interventions: Participants were randomized at cataract surgery to either primary intraocular lens (IOL), or aphakia (contact lens [CL]). Standardized definitions of glaucoma and glaucoma suspect were created for IATS and applied for surveillance and diagnosis.Main Outcomes and Measures: Development of glaucoma and glaucoma + glaucoma suspect in operated-on eyes up to age 10.5 years, plus intraocular pressure, axial length, RNFL (by optical coherence tomography), and ONH photographs.Results: In Kaplan-Meier analysis, for all study eyes combined (n=114), risk of glaucoma after cataract removal rose from 9% (95% CI, 5%-16%) at 1 year, to 17% (95% CI, 11%-25%) at 5 years, to 22% (95% CI, 16%-31%) at 10 years. The risk of glaucoma plus glaucoma suspect diagnosis after cataract removal rose from 12% (95% CI, 7%-20%) at 1 year, to 31% (95% CI, 24%-41%) at 5 years, to 40% (95% CI, 32%-50%) at 10 years. Risk of glaucoma and glaucoma plus glaucoma suspect diagnosis at 10 years was not significantly different between treatment groups. Eyes with glaucoma (compared with eyes with glaucoma suspect or neither) had longer axial length but relatively preserved RNFL and similar ONH appearance and visual acuity at age 10 years.Conclusions and Relevance: Risk of glaucoma-related adverse events continues to increase with longer follow-up of children following unilateral cataract removal in infancy and is not associated with primary IOL implantation. Development of glaucoma (or glaucoma suspect) after removal of unilateral congenital cataract was not associated with worse visual acuity outcomes at 10 years.Trial Registration: ClinicalTrials.gov Identifier: NCT00212134.

    View details for DOI 10.1001/jamaophthalmol.2020.5664

    View details for PubMedID 33331850

  • Complications at 10 Years of Follow-up in the Infant Aphakia Treatment Study OPHTHALMOLOGY Plager, D. A., Bothun, E. D., Freedman, S. F., Wilson, M., Lambert, S. R. 2020; 127 (11): 1581–83
  • Assessing the validity and reliability of the Effects of Youngsters' Eyesight on Quality of Life (EYE-Q) questionnaire among children with uveitis. Arthritis care & research Cassedy, A., Altaye, M., Andringa, J., Cooper, A. M., Drews-Botsch, C., Engelhard, G. J., Hennard, T., Holland, G. N., Jenkins, K., Lambert, S. R., Lipscomb, J., McCracken, C., McCurdy, D. K., McDonald, J., Mwase, N., Prahalad, S., Stahl, E., Miraldi Utz, V., Walker, A. A., Yeh, S., Angeles-Han, S. T. 2020

    Abstract

    PURPOSE: The Effects of Youngsters' Eyesight on Quality of Life (EYE-Q) questionnaire measures vision-related functioning (VRF) and vision-related quality of life (VRQOL) in children with uveitis. Our aim was to revise the Alpha version of the EYE-Q to refine VRF and VRQOL subscales and assess the validity of the EYE-Q.METHODS: Children with juvenile idiopathic arthritis (JIA), JIA-associated uveitis, and other non-infectious uveitis were enrolled. Patients and parents completed the EYE-Q, PedsQL (overall QOL), and CHAQ (physical functioning). The Development site completed the Alpha version of the EYE-Q, and the Composite sites completed the Beta version. We compared item-subscale correlations, internal consistency, construct and discriminant validity amongst the different versions.RESULTS: Of the 644 patients enrolled, 61.6% completed the Alpha version, and 38.4% the Beta version of the EYE-Q. Mean patient age was 11.1 (SD = 4.2) years, and 70% were female. Fewer white patients (73.5%) completed the Alpha version compared to the Beta version (86.2%, p <0.001). With the exception of patient-reported VRF, both versions had similar item-subscale correlations. Version comparisons on scale internal consistencies indicated significant differences for parent- and patient-reported VRF, but each scale had a Cronbach's Alpha >0.80 Beta. When data were combined, the EYE-Q showed significant differences between JIA-only and uveitis patients on all parent and patient scores, except for patient-reported VRF.CONCLUSION: The EYE-Q appears to be a valid measure of VRF and VRQOL in pediatric uveitis. Our results suggest it may be used as an outcome measure in multi-center pediatric uveitis studies.

    View details for DOI 10.1002/acr.24491

    View details for PubMedID 33085849

  • Outcomes of Secondary Intraocular Lens Implantation in the Infant Aphakia Treatment Study. Journal of cataract and refractive surgery VanderVeen, D. K., Drews-Botsch, C. D., Nizam, A., Bothun, E. D., Wilson, L. B., Wilson, M. E., Lambert, S. R., Infant Aphakia Treatment Study 2020

    Abstract

    PURPOSE: To report outcomes of secondary intraocular lens (IOL) implantation in the Infant Aphakia Treatment Study (IATS) SETTING:: Multicenter clinical practice DESIGN:: Secondary analysis of patients enrolled in a randomized clinical trial METHODS:: Details regarding all secondary IOL surgeries conducted in children enrolled in the IATS were compiled. We evaluated visual outcomes, refractive outcomes, and adverse events at age 10 years. Comparisons were made to eyes that remained aphakic and to eyes randomized to primary IOL placement.RESULTS: 55/57 patients randomized to aphakia with contact lens correction were seen for the 10 year study visit; 24/55 eyes (44%) had secondary IOL surgery. Median age at IOL surgery was 5.4 years (range 1.7 to 10.3 years). Mean absolute prediction error was 1.0 ± 0.7D. At age 10 years, the median log MAR VA was 0.9 (range 0.2 to 1.7), similar to VA in the 31 eyes still aphakic (0.8, range 0.1 to 2.9); the number of eyes with stable or improved VA scores between the 4 and 10 year study visits was also similar (78% secondary IOL eyes, 84% aphakic eyes). For eyes undergoing IOL implantation after the 4.5 year study visit (n=22), the mean refraction at age 10 years was -3.2 ±2.7D (range -9.9D to 1.1D), compared to -5.5 ±6.6 D (n=53, range -26.5 to 3.0D) in eyes with primary IOL (p=0.03).CONCLUSIONS: Delayed IOL implantation allows a more predictable refractive outcome at age 10 years, though the range of refractive error is still large.

    View details for DOI 10.1097/j.jcrs.0000000000000412

    View details for PubMedID 32925650

  • Rate of ocular trauma in children operated on for unilateral cataract in infancy-data from the Infant Aphakia Treatment Study. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Traboulsi, E. I., Drews-Botsch, C. D., Christiansen, S. P., Stout, A. U., Hartmann, E. E., Lambert, S. R., IATS Investigator Group 2020

    View details for DOI 10.1016/j.jaapos.2020.06.005

    View details for PubMedID 32882364

  • Outcomes of Bilateral Cataract Surgery in Infants 7 to 24 Months of Age: Toddler Aphakia and Pseudophakia Study (TAPS). Ophthalmology Bothun, E. D., Wilson, M. E., Yen, K. G., Anderson, J. S., Weil, N. C., Loh, A. R., Morrison, D., Freedman, S. F., Plager, D. A., Vanderveen, D. K., Traboulsi, E. I., Hodge, D. O., Lambert, S. R., Toddler Aphakia and Pseudophakia Study (TAPS) 2020

    Abstract

    PURPOSE: To evaluate outcomes of bilateral cataract surgery in children ages 7-24 months and compare rates of adverse events (AE) to other Toddler Aphakia and Pseudophakia Study (TAPS) registry outcomes.DESIGN: Retrospective clinical study at 10 IATS sites. Statistical analyses comparing this cohort to previously reported TAPS registry cohorts.PARTICIPANTS: Children enrolled in the TAPS registry between 2004 and 2010.INTERVENTION: Children underwent bilateral cataract surgery with or without intraocular lens (IOL) placement at age 7-24 months with 5 years of post-surgical follow-up.MAIN OUTCOME MEASURES: Visual acuity, occurrence of strabismus, adverse events (AE), reoperations.RESULTS: 40 children (76 eyes) who underwent bilateral cataract surgery with primary posterior capsulectomy were identified with a median age at cataract surgery of 13 months (7-23); 68% received a primary intraocular lens (IOL). Recurrent visual axis opacification (VAO) occurred in 7.5% and was associated only with the use of an IOL (Odds Ratio 6.10, p=0.005). Glaucoma suspect (GS) was diagnosed in 2.5%, but no child developed glaucoma. In this bilateral cohort, AEs (8/40, 20%), including glaucoma or GS and VAO, and reoperations occurred in a similar proportion to that of the published unilateral TAPS cohort. When analyzed with children 1-7 months at bilateral surgery, the incidence of AEs and glaucoma or GS correlated strongly with age at surgery (p=0.011/0.004) and glaucoma correlated with microcornea (p=0.040) but not with IOL insertion (p=0.15).CONCLUSIONS: Follow-up to age 5 years after bilateral cataract surgery in children 7-24 months reveals a low rate of VAO and very rare glaucoma or GS diagnosis compared to infants with cataracts operated < 7 months of age despite primary IOL implantation in most children in the 7-24 months group. The use of an IOL increases the risk of VAO irrespective of age at surgery.

    View details for DOI 10.1016/j.ophtha.2020.07.020

    View details for PubMedID 32679160

  • Reversal of severe vergence anomaly associated with convergence insufficiency. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Houston, C. A., Huang, L. C., Fredrick, D. R., Lambert, S. R. 2020

    Abstract

    Central disruption of fusion refers to a subject's inability to align images, resulting in constant diplopia. Severely reduced vergences, or vergence anomalies, producing markedly decreased fusional amplitudes resembling fusional disruption have not been reported previously with convergence insufficiency. We report 3 patients with severe vergence anomaly in the setting of convergence insufficiency.

    View details for DOI 10.1016/j.jaapos.2020.04.004

    View details for PubMedID 32621987

  • The Myopic Shift in Aphakic Eyes in the Infant Aphakia Treatment Study After 10 Years of Follow-up. Eye & contact lens Lambert, S. R., Nizam, A., DuBois, L., Cotsonis, G., Weakley, D. R., Wilson, M. E., Infant Aphakia Treatment Study Group 2020

    Abstract

    OBJECTIVES: To report the myopic shift in the aphakic eyes of a cohort of children who underwent unilateral cataract surgery during infancy and were then followed longitudinally for 10.5 years.METHODS: One-half of the children enrolled in the Infant Aphakia Treatment Study (IATS) were randomized to aphakia and contact lens correction after unilateral cataract surgery. They then underwent ocular examinations using standardized protocols at prescribed time intervals until age 10.5 years.RESULTS: Thirty of 57 children randomized to aphakia remained aphakic at age 10.5, having undergone unilateral cataract surgery at a median age of 1.6 (IQR: 1.1-3.1) months. The median refractive error (RE) in the 57 eyes randomized to aphakia immediately after cataract surgery was 19.01 D (IQR: 16.98-20.49) compared to 10.38 D (IQR: 7.50-14.00) for the 30 eyes that remained aphakic at age 10.5 years. The mean change in RE in aphakic eyes was -2.11 D/year up to age 1.5 years, -0.68 D/year from 1.5 to 5.0 years, and -0.35 D/year from age 5 to 10.5 years. At age 10.5 years, 18 patients continued to wear a contact lens correction (silicone elastomer, n=6; gas permeable, n=6; hydrogel, n=5; and silicone hydrogel, n=1) (median RE, 12.50 D), 9 wore only spectacles (median RE, 4.00 D), and 4 wore no correction (median RE, 11.25 D) to correct their aphakic eye.CONCLUSIONS: The RE in aphakic eyes decreased by 44% from infancy to age 10.5 years. About two-thirds of children who remained aphakic at age 10.5 years continued to wear a contact lens.

    View details for DOI 10.1097/ICL.0000000000000718

    View details for PubMedID 32568929

  • Comparison of stereopsis at ages 41/2 and 101/2 in the Infant Aphakia Treatment Study Hartmann, E., Drews-Botsch, C., DuBois, L., Cotsonis, G., Lambert, S. R. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
  • Current Management of Retinopathy of Prematurity in Sub-Saharan Africa Lloyd, T., Lambert, S. R., Isenberg, S., Matheson, R. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
  • Accuracy of Autorefraction in Children: A Report by the American Academy of Ophthalmology. Ophthalmology Wilson, L. B., Melia, M., Kraker, R. T., VanderVeen, D. K., Hutchinson, A. K., Pineles, S. L., Galvin, J. A., Lambert, S. R. 2020

    Abstract

    PURPOSE: The purpose of this assessment is to evaluate the accuracy of autorefraction compared with cycloplegic retinoscopy in children.METHODS: Literature searches were last conducted in October 2019 in the PubMed and the Cochrane Library databases for studies published in English. The combined searches yielded 118 citations, of which 53 were reviewed in full text. Of these, 31 articles were deemed appropriate for inclusion in this assessment and subsequently assigned a level of evidence rating by the panel methodologists. Four articles were rated level I, 11 were rated level II, and 16 were rated level III articles. The 16 level III articles were excluded from this review.RESULTS: Thirteen of the 15 studies comparing cycloplegic autorefraction with cycloplegic retinoscopy found a mean difference in spherical equivalent or sphere of less than 0.5 diopters (D); most were less than 0.25 D. Even lower mean differences were found when evaluating the cylindrical component of cycloplegic autorefraction versus cycloplegic retinoscopy. Despite low mean variability, there was significant individual measurement variability; the 95% limits of agreement were wide and included clinically relevant differences. Comparisons of noncycloplegic with cycloplegic autorefractions found that noncyloplegic refraction tends to over minus by 1 to 2 D.CONCLUSIONS: Cycloplegic autorefraction is appropriate to use in pediatric population-based studies. Cycloplegic retinoscopy can be valuable in individual clinical cases to confirm the accuracy of cycloplegic autorefraction, particularly when corrected visual acuity is worse than expected or the autorefraction results are not consistent with expected findings.

    View details for DOI 10.1016/j.ophtha.2020.03.004

    View details for PubMedID 32317177

  • Globe Axial Length Growth at Age 10.5 Years in the Infant Aphakia Treatment Study. American journal of ophthalmology Wilson, M. E., Trivedi, R. H., Weakley, D. R., Cotsonis, G. A., Lambert, S. R., Infant Aphakia Treatment Study Group 2020

    Abstract

    PURPOSE: To report the change in globe axial length (AL) from the time of unilateral cataract surgery at age 1-7 months to age 10.5 years for infants enrolled in the Infant Aphakia Treatment Study, and to compare AL growth of operated eyes with that of fellow unoperated eyes.DESIGN: Comparative case series.METHODS: Axial length growth was analyzed relative to treated versus fellow eye, contact lens [CL] vs. intraocular lens [IOL], visual acuity (VA) outcome, and the need for surgery for visual axis opacification. Eyes with glaucoma or glaucoma suspect were excluded from the primary analysis but reported separately.RESULTS: Fifty-seven patients have reliable AL data available at both visits. AL was shorter in treated eyes pre-operatively (P<0.0001) and at 10.5 years of age (P=0.021) but AL growth was not different (4.7 mm, P=0.99). The growth (70.2% up to age 5 and 29.8% from 5-10.5) was similar in the CL and the IOL group (P=0.79). Eyes grew 4.4mm when visual acuity (VA) was better than 20/200, and 5.2mm when VA was 20/200 or worse (P = 0.076). Eyes receiving additional surgery grew more than eyes not receiving additional surgery (P=0.052). Patients with glaucoma showed significantly more eye growth (7.3 mm) than those without glaucoma (4.7 mm) and glaucoma suspects (5.1 mm) (P<0.05).CONCLUSIONS: Eyes with glaucoma or poor VA often grew longer than the fellow eye. Overall, treated eyes grew similarly in the IOL and CL groups and also kept pace with the growth of the fellow eyes.

    View details for DOI 10.1016/j.ajo.2020.04.010

    View details for PubMedID 32304705

  • Multiexon deletion alleles of ATF6 linked to achromatopsia. JCI insight Lee, E., Chiang, W. J., Kroeger, H., Bi, C. X., Chao, D. L., Skowronska-Krawczyk, D., Mastey, R. R., Tsang, S. H., Chea, L., Kim, K., Lambert, S. R., Grandjean, J. M., Baumann, B., Audo, I., Kohl, S., Moore, A. T., Wiseman, R. L., Carroll, J., Lin, J. H. 2020; 5 (7)

    Abstract

    Achromatopsia (ACHM) is an autosomal recessive disease that results in severe visual loss. Symptoms of ACHM include impaired visual acuity, nystagmus, and photoaversion starting from infancy; furthermore, ACHM is associated with bilateral foveal hypoplasia and absent or severely reduced cone photoreceptor function on electroretinography. Here, we performed genetic sequencing in 3 patients from 2 families with ACHM, identifying and functionally characterizing 2 mutations in the activating transcription factor 6 (ATF6) gene. We identified a homozygous deletion covering exons 8-14 of the ATF6 gene from 2 siblings from the same family. In another patient from a different family, we identified a heterozygous deletion covering exons 2 and 3 of the ATF6 gene found in trans with a previously identified ATF6 c.970C>T (p.Arg324Cys) ACHM disease allele. Recombinant ATF6 proteins bearing these exon deletions showed markedly impaired transcriptional activity by qPCR and RNA-Seq analysis compared with WT-ATF6. Finally, RNAscope revealed that ATF6 and the related ATF6B transcripts were expressed in cones as well as in all retinal layers in normal human retina. Overall, our data identify loss-of-function ATF6 disease alleles that cause human foveal disease.

    View details for DOI 10.1172/jci.insight.136041

    View details for PubMedID 32271167

  • Re: Lambert et al.: Intraocular lens implantation during early childhood: a report by the American Academy of Ophthalmology (Ophthalmology. 2019;126:1454-1461) REPLY OPHTHALMOLOGY Lambert, S. R., Vanderveen, D. K., Aakalu, V. K., Kim, S. J. 2020; 127 (1): E8–E9
  • Beyond Visual Acuity-The Importance of Studying Motor Skills and Self-perception in Children Treated for Unilateral Congenital Cataract. JAMA ophthalmology Drews-Botsch, C. D., Lambert, S. R. 2020

    View details for DOI 10.1001/jamaophthalmol.2020.4332

    View details for PubMedID 33091106

  • FRefractive growth variability in the Infant Aphakia Treatment Study. Journal of cataract and refractive surgery McClatchey, S. K., McClatchey, T. S., Cotsonis, G. n., Nizam, A. n., Lambert, S. R. 2020

    Abstract

    Prediction of refraction after cataract surgery in children is limited by the variance in rate of refractive growth (RRG3). This study compared RRG3 in aphakic and pseudophakic eyes to their fellow, normal eyes in the Infant Aphakia Treatment Study (IATS).12 clinical sites in the United States.Randomized clinical trial.Infants randomized to unilateral cataract extraction had RRG3 calculated based on biometric data (axial length and keratometry) at cataract surgery and at 10 years of age, for both the normal and cataract eyes. Subjects were included if complete biometric data from both eyes was available both at surgery and at 10 years. Variance in RRG3 was compared between the groups with Pitman's test for equality of variance between correlated samples.Longitudinal biometric data was available for 103 of the 114 patients enrolled. RRG3 for normal eyes was -15.0 (3.0) D (reported as mean (standard deviation)), for aphakic eyes -17.7 (6.2) D, and for pseudophakic eyes -16.7 (6.2) D (P < 0.0001 for comparison of variances in RRG3 between normal and all operated eyes). Further analysis found differences in the variance in axial length growth (P < 0.0001) between operated and normal eyes; the variance in keratometry measurement change did not reach significance.The standard deviation in the rate of refractive growth of normal eyes in our study is half of that found in eyes that underwent cataract surgery.

    View details for DOI 10.1097/j.jcrs.0000000000000482

    View details for PubMedID 33181631

  • Complications at 10 years follow-up in the Infant Aphakia Treatment Study. Ophthalmology Plager, D. A., Bothun, E. n., Freedman, S. n., Wilson, M. E., Lambert, S. n. 2020

    View details for DOI 10.1016/j.ophtha.2020.04.046

    View details for PubMedID 32437863

  • Long-term Effect of Intraocular Lens vs Contact Lens Correction on Visual Acuity After Cataract Surgery During Infancy: A Randomized Clinical Trial. JAMA ophthalmology Lambert, S. R., Cotsonis, G. n., DuBois, L. n., Nizam Ms, A. n., Kruger, S. J., Hartmann, E. E., Weakley, D. R., Drews-Botsch, C. n. 2020

    Abstract

    Although intraocular lenses (IOLs) are often implanted in children, little is known whether primary IOL implantation or aphakia and contact lens correction results in better long-term visual outcomes after unilateral cataract surgery during infancy.To compare long-term visual outcomes with contact lens vs IOL correction following unilateral cataract surgery during infancy.This multicenter randomized clinical trial enrolled 114 infants with a unilateral congenital cataract who underwent cataract surgery with or without primary IOL implantation between 1 and 6 months of age. Data on long-term visual outcomes were collected when the children were age 10.5 years (July 14, 2015, to July 12, 2019) and analyzed from March 30 through August 6, 2019.Intraocular lens implantation at the time of cataract surgery.Best-corrected visual acuity using the electronic Early Treatment Diabetic Retinopathy Study (E-ETDRS) testing protocol. Analysis was performed on an intention-to-treat basis.Best-corrected visual acuity was measured at age 10.5 years for 110 of the 114 patients (96%) enrolled as infants. The participants included 58 girls (53%) and 52 boys (47%). Overall, 27 of the children (25%) had good (logMAR 0.30 [Snellen equivalent, 20/40] or better) visual acuity in the treated eye (12 [22%] in the IOL group and 15 [27%] in the aphakia group), but 50 children (44%) had a visual acuity of logMAR 1.00 (Snellen equivalent, 20/200) or worse (25 [44%] in the IOL group and 25 [44%] in the aphakia group). The median logMAR acuity in the treated eye was similar in children randomized to receive an IOL at the time of cataract extraction (0.89; interquartile range [IQR], 0.33-1.43 [Snellen equivalent, 20/159]) and those who remained aphakic (0.86; IQR, 0.30-1.46 [Snellen equivalent, 20/145]) (IQR, 0.30-1.46; P = .82). Although the overall difference in median visual acuity between the 2 groups was small, the estimate was imprecise (99% CI for the difference in medians was -0.54 to 0.47).As in previous phases of the study, visual acuity outcomes were highly variable with only 27 children (25%) achieving excellent visual acuity in their treated eye and 50 children (44%) having poor vision in the treated eye. Implanting an IOL at the time of cataract extraction was neither beneficial nor detrimental to the visual outcome.ClinicalTrials.gov Identifier: NCT00212134.

    View details for DOI 10.1001/jamaophthalmol.2020.0006

    View details for PubMedID 32077909

  • Oculocerebrorenal syndrome of Lowe: Survey of ophthalmic presentations and management. European journal of ophthalmology Ma, X. n., Ning, K. n., Jabbehdari, S. n., Prosseda, P. P., Hu, Y. n., Shue, A. n., Lambert, S. R., Sun, Y. n. 2020: 1120672120920544

    View details for DOI 10.1177/1120672120920544

    View details for PubMedID 32340490

  • Current management of retinopathy of prematurity in sub-Saharan Africa. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Lloyd, T. n., Isenberg, S. n., Lambert, S. R. 2020

    Abstract

    To survey current oxygen management, screening criteria, and methods for treating retinopathy of prematurity (ROP) in sub-Saharan Africa.An online survey was sent to ophthalmologists and neonatologists practicing in sub-Saharan Africa.Ophthalmologists and neonatologists from 15 of 49 countries (31%) in sub-Saharan Africa responded. Neonatologists reported treating a median of 15 infants with supplemental oxygen per week but only had a median of 3.5 oxygen-measuring devices and a median of zero oxygen blenders in their units. Ophthalmologists reported screening a median of 5 infants per week for ROP and treating 2 infants each month for ROP. Most ophthalmologists (24/27 [89%]) had access to anti-vascular endothelial growth factor drugs to treat ROP, but only 13 of 27 (48%) had access to a laser.Survey results reveal an urgent need for additional oxygen- management equipment in hospitals in sub-Saharan Africa.

    View details for DOI 10.1016/j.jaapos.2020.03.002

    View details for PubMedID 32505534

  • Reply. Ophthalmology Lambert, S. R., Vanderveen, D. K., Aakalu, V. K., Kim, S. J. 2020; 127 (1): e8–e9

    View details for DOI 10.1016/j.ophtha.2019.09.040

    View details for PubMedID 31864484

  • Reply. Ophthalmology Lambert, S. R., Vanderveen, D. K., Kim, S. J. 2020; 127 (1): e6–e7

    View details for DOI 10.1016/j.ophtha.2019.09.017

    View details for PubMedID 31864482

  • Binocular Treatment of Amblyopia: A Report by the American Academy of Ophthalmology. Ophthalmology Pineles, S. L., Aakalu, V. K., Hutchinson, A. K., Galvin, J. A., Heidary, G., Binenbaum, G., VanderVeen, D. K., Lambert, S. R. 2019

    Abstract

    PURPOSE: To review the published literature assessing the efficacy of binocular therapy for the treatment of amblyopia compared with standard treatments.METHODS: Literature searches with no date restrictions and limited to the English language were conducted in January 2018 and updated in April 2019 in the PubMed database and the Cochrane Library database with no restrictions. The search yielded 286 citations, and the full text of 50 articles was reviewed. Twenty articles met the inclusion criteria for this assessment and were assigned a level of evidence rating by the panel methodologist. Six studies were rated level I, 1 study was rated level II, and 13 studies were rated level III because of the impact on the development and popularization of this technology.RESULTS: Two of the level I and II studies reviewed described a significant improvement in visual acuity in the binocular group versus standard patching standard treatment (the total number of patients in these 2 studies was 147). However, the 5 studies that failed to show a visual improvement from binocular therapy compared with standard treatments were larger and more rigorously designed (the total number of patients in these 5 studies was 813). Level I and II studies also failed to show a significant improvement over baseline in sensory status, including depth of suppression and stereopsis of those treated with binocular therapy. Several smaller level III case series (total number of patients in these 13 studies was 163) revealed more promising results than the binocular treatments studied in the level I and II studies, especially using treatments that are more engaging and are associated with better compliance.CONCLUSIONS: There is no level I evidence to support the use of binocular treatment as a substitute for current therapies for amblyopia (including patching and optical treatment). Furthermore, 2 large randomized controlled trials showed inferior performance compared with standard patching treatment. On the basis of this review of the published literature, binocular therapy cannot be recommended as a replacement for standard amblyopia therapy. However, more research is needed to determine the potential benefits of proposed binocular treatments in the future.

    View details for DOI 10.1016/j.ophtha.2019.08.024

    View details for PubMedID 31619356

  • Outcomes of Unilateral Cataracts in Infants and Toddlers 7 to 24 Months of Age Toddler Aphakia and Pseudophakia Study (TAPS) OPHTHALMOLOGY Bothun, E. D., Wilson, M., Traboulsi, E., Diehl, N. N., Plager, D. A., Vanderveen, D. K., Freedman, S. F., Yen, K. G., Weil, N. C., Loh, A. R., Morrison, D., Anderson, J. S., Lambert, S. R., Toddler Aphakia Pseudophakia Study 2019; 126 (8): 1189–95
  • Frequency of office based probing for treatment of nasolacrimal duct obstruction Muminovic, I., Ryu, W., Lambert, S. R. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019
  • Secondary IOL Implantation among aphakic children in the Infant Aphakia Treatment Study Drews-Botsch, C., Nizam, A., Wilson, E., Vanderveen, D., Lambert, S. R. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019
  • Intraocular Lens Implantation during Early Childhood: A Report by the American Academy of Ophthalmology. Ophthalmology Lambert, S. R., Aakalu, V. K., Hutchinson, A. K., Pineles, S. L., Galvin, J. A., Heidary, G., Binenbaum, G., VanderVeen, D. K. 2019

    Abstract

    PURPOSE: To compare the visual outcomes and adverse events associated with optical correction using an intraocular lens (IOL), contact lenses, or spectacles after cataract surgery in children 2 years of age or younger.METHODS: Literature searches were conducted in PubMed, the Cochrane Library, and the databases of clinical trials in February 2019, without date or language restrictions. The search resulted in 194 potentially relevant citations, and 34 were selected for full-text review. Fourteen studies were determined to be relevant to the assessment criteria and were selected for inclusion in this assessment. The panel methodologist then assigned a level of evidence rating to these studies.RESULTS: Intraocular lenses were associated with visual outcomes similar to outcomes for contact lenses or spectacles for children who had both bilateral and unilateral cataracts. Intraocular lenses were also associated with an increased risk of visual axis opacities. All treatments were associated with a similar incidence of glaucoma. Although ocular growth was similar for all treatments, infants younger than 6 months who underwent IOL implantation had large myopic shifts that often resulted in high myopia or severe anisometropia later in childhood. Corneal endothelial cell counts were lower in eyes that underwent IOL implantation. The incidence of strabismus was similar with all treatments.CONCLUSIONS: Intraocular lens implantation is not recommended for children 6 months of age or younger because there is a higher incidence of visual axis opacities with this treatment compared with aphakia. The best available evidence suggests that IOL implantation can be done safely with acceptable side effects in children older than 6 months of age. However, the unpredictability of ocular growth means that these children will often have large refractive errors later in childhood that may necessitate an IOL exchange or wearing spectacles or contact lenses with a large refractive correction. In addition, the training and experience of the surgeon as well as ocular and systemic comorbidities should be taken into consideration when deciding whether IOL implantation would be appropriate.

    View details for DOI 10.1016/j.ophtha.2019.05.009

    View details for PubMedID 31230794

  • Visual Acuity and Ophthalmic Outcomes in the Year After Cataract Surgery Among Children Younger Than 13 Years. JAMA ophthalmology Writing Committee for the Pediatric Eye Disease Investigator Group (PEDIG), Repka, M. X., Dean, T. W., Kraker, R. T., Bothun, E. D., Morrison, D. G., Lambert, S. R., Stahl, E. D., Wallace, D. K. 2019

    Abstract

    Importance: Cataract is an important cause of visual impairment in children. Outcomes reported from a large clinical disease-specific registry can provide real-world estimates of visual outcomes and rates of adverse events in clinical practice.Objective: To describe visual acuity and refractive error outcomes, as well as rates of amblyopia, glaucoma, and additional eye surgery, during the first year after lensectomy in children.Design, Setting, and Participants: A prospective observational study was conducted from June 18, 2012, to July 8, 2015, at 61 pediatric eye care practices among 880 children younger than 13 years at the time of lensectomy in at least 1 eye with follow-up within 15 months after surgery. Statistical analysis was performed from December 12, 2016, to December 14, 2018.Exposures: Lensectomy with or without implantation of an intraocular lens.Main Outcomes and Measures: Visual acuity as well as rates of amblyopia, glaucoma, suspected glaucoma, and other intraocular surgery.Results: Among the 880 children (432 girls and 448 boys; mean [SD] age at annual follow-up, 4.9 [3.8] years) in the study, lens surgery was bilateral in 362 (41.1%; 95% CI, 37.9%-44.4%) children and unilateral in 518 (58.9%; 95% CI, 55.6%-62.1%). An intraocular lens was implanted in 654 of 1132 eyes (60.2%; 95% CI, 57.0%-63.4% [proportions reported for eye-level outcomes account for the potential correlation induced by enrolling both eyes of some individuals; for participants who received bilateral surgery, these numbers will differ from the quotient of the number of cases divided by the total sample size]). Amblyopia was identified in 449 children (51.0%; 95% CI, 47.7%-54.3%). In children age 3 years or older, mean visual acuity was 0.30 logMAR (about 20/40) in 153 bilateral pseudophakic eyes, 0.49 logMAR (about 20/63) in 141 unilateral pseudophakic eyes, 0.47 logMAR (about 20/63) in 21 bilateral aphakic eyes, and 0.61 logMAR (about 20/80) in 17 unilateral aphakic eyes. Mean visual acuity improved with older age at surgery in eyes with bilateral pseudophakia by 0.2 logMAR line (99% CI, 0.02-0.4; P=.005) and by 0.3 logMAR line (99% CI, 0.04-0.60; P=.004) in eyes with unilateral pseudophakia. A new diagnosis of glaucoma or suspected glaucoma was made in 67 of 1064 eyes that did not have glaucoma prior to lensectomy (5.9%; 95% CI, 4.6%-7.7%); 36 of 273 eyes with bilateral aphakia (13.2%; 95% CI, 9.0%-19.0%), 5 of 308 eyes with bilateral pseudophakia (1.5%; 95% CI, 0.6%-4.2%), 14 of 178 eyes with unilateral aphakia (7.9%; 95% CI, 4.7%-12.8%), and 12 of 305 eyes with unilateral pseudophakia (3.9%; 95% CI, 2.2%-6.8%). Additional intraocular surgery, most commonly vitrectomy or membranectomy to clear the visual axis, was performed in 189 of 1132 eyes (17.0%; 95% CI, 14.8%-19.6%).Conclusions and Relevance: Amblyopia was frequently observed during the first year after lensectomy in this cohort of children younger than 13 years. For children age 2 years or older at surgery visual acuity was typically less than normal for age and was worse with unilateral cataract. Management of visual axis obscuration was the most common complication requiring surgical intervention during the first year after surgery.

    View details for PubMedID 31095258

  • Third-Party Coverage for Aphakic Contact Lenses for Children. Translational vision science & technology Kruger, S. J., Vanderveen, D. K., Freedman, S. F., Bothun, E., Drews-Botsch, C. D., Lambert, S. R., Infant Aphakia Study Group 2019; 8 (3): 41

    View details for DOI 10.1167/tvst.8.3.41

    View details for PubMedID 31231593

  • Use of Orthokeratology for the Prevention of Myopic Progression in Children A Report by the American Academy of Ophthalmology OPHTHALMOLOGY VanderVeen, D. K., Kraker, R. T., Pineles, S. L., Hutchinson, A. K., Wilson, L. B., Galvin, J. A., Lambert, S. R., Al-Rajhi, A. 2019; 126 (4): 623–36
  • Timing of infliximab and adalimumab initiation despite methotrexate in children with chronic non-infectious anterior uveitis EYE McCracken, C., Yeh, S., Jenkins, K., Travers, C., Stryker, D., Tommasello, S., Rouster-Stevens, K. A., Lambert, S. R., Prahalad, S., Drews-Botsch, C., Angeles-Han, S. T. 2019; 33 (4): 629–39
  • Spectacle Adherence Among Four-Year-Old Children in the Infant Aphakia Treatment Study AMERICAN JOURNAL OF OPHTHALMOLOGY Lambert, S. R., Dubois, L., Cotsonis, G., Hartmann, E., Drews-Botsch, C., Infant Aphakia Treatment Study Grp 2019; 200: 26–33
  • Outcomes of Unilateral Cataracts in Infants and Toddlers age 7 to 24 Months: Toddler Aphakia and Pseudophakia Study (TAPS). Ophthalmology Bothun, E. D., Wilson, M. E., Traboulsi, E. I., Diehl, N. N., Plager, D. A., Vanderveen, D. K., Freedman, S. F., Yen, K. G., Weil, N. C., Loh, A. R., Morrison, D., Anderson, J. S., Lambert, S. R., Toddler Aphakia and Pseudophakia Study 2019

    Abstract

    PURPOSE: To evaluate outcomes of unilateral cataract surgery in children ages 7 to 24 months DESIGN: Retrospective case series at 10 Infant Aphakia Treatment Study (IATS) sites.PARTICIPANTS: The Toddler Aphakia and Pseudophakia Study (TAPS) is a registry of children treated by surgeons who participated in the Infant Aphakia Treatment Study.INTERVENTION: Children underwent unilateral cataract surgery with or without intraocular lens (IOL) placement during the IATS enrollment years of 2004 and 2010.MAIN OUTCOME MEASURES: Intraoperative complications, adverse events, visual acuity, strabismus.RESULTS: 56 children were included with a mean post-operative follow-up of 47.6 months. Median age at cataract surgery was 13.9 months (range 7.2 - 22.9). 92% received a primary IOL. Intraoperative complications occurred in 4 patients (7%). At 5 years of age, visual acuity of treated eyes was very good (>20/40) in 11% and poor (<20/200) in 44%. Adverse events were identified in 24% with a 4% incidence of glaucoma suspect. An additional unplanned intraocular surgery occurred in 14% of children. Neither adverse events (AE) or intraocular reoperations were more common for children with surgery at age 7 to 12 months than those who had surgery at 13 to 24 months (AE 21% vs. 25% (p = 0.60), reoperations 13% verses 16% (p=1.00).CONCLUSIONS: Although most children had IOL implantation concurrent with unilateral cataract removal, the incidence of complications, reoperations, and glaucoma was low when surgery is performed between 7 and 24 months of age, and compared favorably to same-site IATS data for infants operated before 7 months of age. Our study shows that IOL implantation is relatively safe in children over 6 months and less than two years of age.

    View details for PubMedID 30880109

  • A Randomized Trial Comparing Bilateral Lateral Rectus Recession versus Unilateral Recess and Resect for Basic-Type Intermittent Exotropia OPHTHALMOLOGY Donahue, S. P., Chandler, D. L., Holmes, J. M., Arthur, B. W., Paysse, E. A., Wallace, D. K., Petersen, D. B., Melia, B., Kraker, R. T., Miller, A. M., Miller, A. M., Jackson, J. L., Arguijo, L., Curtin, K. M., Dillon, A. C., LaRiviere, S. S., Olvera, M. N., Ramos, C. R., Robertson, L. E., South, J. S., Paysse, E. A., Coats, D. K., Yen, K. G., Romany, G., Bhatt, A. R., Edmond, J. C., Edmond, J. C., Homann, M. J., Hussein, M. A., Kong, L., Steinkuller, P. G., Crouch, E. R., Crouch, E. R., Ventura, G. G., Sala, N. A., Sala, A., Hodde, R. M., Johnson, C., Romeo, J. M., Zeto, V., Donahue, S. P., Estes, R. L., Morrison, D. G., Ruark, S. T., Biernacki, R. J., Campbell, M. K., Fraine, L. A., Fukuda, N. J., Haskins, K. J., Kane, J. M., Arthur, B. W., Law, C., MacSween, L. E., Churchill, S. D., Hoover, D. L., Huston, P. A., Soros, K. E., Petersen, D. B., Pickens, T. S., McMurtrey, J. R., Morrell, B. A., Karr, D. J., Summers, A. I., Kuo, A. F., Wilson, L. B., Rauch, P. K., Berg, P. H., Bubnov, Y. M., Casey, G. A., Gronemyer, D. S., Lenius, L. M., Narain, S., Nelson, R. N., Romo, A., Stout, A. U., Woodruff, K. M., Ticho, B. H., Clausius, D. A., Allen, M., Giers, S. L., Horan, L. A., Shah, B. K., Areaux, R. G., Anderson, J. S., Bothun, E. D., Holleschau, A. M., Hogue, K. M., Kramer, A. M., Merrill, K. S., Schweigert, A. I., Orge, F. H., Grigorian, A. P., Richards, L., Baird, A. M., Bontempo, V. M., Colon, B. J., Grigorian, F., Mar, N., Schoeck, S. E., Silbert, D. I., Modjesky, H., Gehman, L. K., Leckemby, G. L., Shady, P. R., Erzurum, S., Plessinger, V., Barrett, G. C., Colon, B. J., Dinani, Z., McOwen, D., Repka, M. X., Park, H. S., Liu, X., Christoff, A., Goodman, C. R., Cheeseman, E. W., Peterseim, M. M., Bradham, C. U., Saunders, R. A., Teed, R. W., Marsh, J. D., Waters, A. L., Ariss, M. M., Dent, R. J., Cline, C. J., Grigorian, A. P., Lowery, R. S., Phillips, P. H., Cupit, S. L., To, K. D., Tolleson, L. R., Holmes, J. M., Mohney, B. G., Wernimont, S. M., Hatt, S. R., Holmquist, J. A., Karlsson, V. X., Klaehn, L. D., Kroening, R. M., Liebermann, L., Nielsen, R. A., Priebe, D. M., Taylor, L. M., Treichel, E. J., Glaser, S. R., Yost, K. L., Andrade, D. B., Flores, O. R., Graham, L. L., Guretzky, T. J., Morrison, N. A., Pacheco, M. M., Shabanowitz, A. C., Bartiss, M. J., McGaw, T. F., Kelly, L. M., Poindexter, K. P., Enyedi, L. B., House, R. J., Duncan, L. B., Holgado, S., Jones, S. K., Kashyap, N., Mestler, A. P., Plekan, T. A., Priestley, Y. M., Collins, M. Z., Jensen, A. A., Flanagan, M. A., Bhatti, S., Black, K. A., McCarus, C. L., Narain, S., Traboulsi, E., Ghasia, F. F., Rychwalski, P. J., Borer, A. M., Crowe, S. W., Tien, D. R., Chan, T. L., Garner, S. J., Lees, S. M., McGuinness, M. B., Pepper, N. T., Yoon-Huang, G. H., Herlihy, E. P., Tews, L. A., Brady, J. L., Gladstone, A., Whitehead, G. F., Nye, C. N., Shea, C. J., Stillman, S. M., Eglet, V. P., Rahmani, B., Ranaivo, H., Farrell, B. P., Johnson, D. M., Klauer, A. J., Magwire, K. M., Talip, E. A., Tzanetakos, V., Bradfield, Y. S., Adler, A. M., Anderson, K. A., Morton, G. V., Hutchinson, A. K., Peragallo, J. H., Lambert, S. R., Brower, J. L., Couser, N. L., Shainberg, M. J., Haider, K. M., Neely, D. E., Whitaker, M. E., Donaldson, D. L., Galli, J. G., Wang, J., Davis, P. L., Anderson, K. A., Bloomquist, C. S., Rudaitis, I. M., Twite, J. M., Frempong, T. A., Raab, E. L., Rambharose, N., Williamson, J. E., Forbes, B. J., Binenbaum, G., Richter, M. M., Garvin, C. B., Hong, B., Karp, K. A., News, M. A., Cronin, T. H., Levada, A. J., Heaton, S. H., Abrams, M. J., Capobianco, C., Kraker, R. T., Beck, R. W., Austin, D. S., Boyle, N. M., Conner, C. L., Chandler, D. L., Connelly, P., Dean, T. W., Donahue, Q., Fimbel, B. P., Hardt, G. M., Hoepner, J. E., Kaplon, J. D., Lazar, E. L., Melia, B., Alvarez, G., Rojas, D. E., Shah, J. A., Wu, R., Holmes, J. M., Donahue, S. P., Cotter, S. A., Mohney, B. G., Beck, R. W., Birch, E. E., Chandler, D. L., Christiansen, S. P., Hatt, S. R., Kraker, R. T., Leske, D. A., Melia, M., O'Hara, M., Pang, Y., Repka, M. X., Romanchuck, K., Tamkins, S. M., Wallace, D. K., Wheeler, D. T., Birch, E. E., Chandler, D. L., Chen, A. M., Christiansen, S. P., Cotter, S. A., Crouch, E. R., Donahue, S. P., Erzurum, S., Fang, C. C., Hatt, S. R., Holmes, J. M., Hoover, D. L., Kong, L., Kraker, R. T., Lazar, E. L., Lorenzana, I., McMurtrey, J., Melia, M., Mohney, B. G., Patel, R., Pollack, K., Repka, M. X., Sala, A., Scheiman, M. M., Superstein, R., Tamkins, S. M., Yamada, T., Wallace, D. K., Astle, W. F., Beck, R. W., Birch, E. E., Chen, A. M., Christian, M. L., Cotter, S. A., Crouch, E. R., Crouch, E. R., Donahue, S. P., Enyedi, L. B., Erzurum, S., Everett, D. F., Freedman, S. F., Good, W. V., Holmes, J. M., Hoover, D. L., Jackson, J. L., Kraker, R. T., Lambert, S. R., Lee, K. A., Manh, V. M., Manny, R. E., Miller, A. M., Petersen, D. B., Repka, M. X., Rogers, D. L., Schweinler, B. R., Silver, J. L., Weise, K. K., Verderber, L. C., Everett, D. F., Diener-West, M., Baker, J. D., Davis, B., Phelps, D. L., Poff, S. W., Saunders, R. A., Tychsen, L., Pediat Eye Dis Investigator Grp 2019; 126 (2): 305–17

    Abstract

    To compare long-term outcomes after bilateral lateral rectus recession (BLRc) or unilateral lateral rectus recession combined with medial rectus resection in the same eye (R&R) for primary treatment of childhood intermittent exotropia (IXT).Multicenter, randomized clinical trial.One hundred ninety-seven children 3 to younger than 11 years of age with basic-type IXT, a largest deviation by prism and alternate cover test at any distance of 15 to 40 prism diopters (PD), and near stereoacuity of at least 400 seconds of arc.Random assignment to BLRc or R&R and masked examinations conducted every 6 months after surgery for 3 years.Proportion of participants meeting suboptimal surgical outcome by 3 years, defined as: (1) exotropia of 10 PD or more at distance or near using simultaneous prism and cover test (SPCT); or (2) constant esotropia of 6 PD or more at distance or near using SPCT; (3) loss of 2 octaves or more of stereoacuity from baseline, at any masked examination; or (4) reoperation without meeting any of these criteria.Cumulative probability of suboptimal surgical outcome by 3 years was 46% (43/101) in the BLRc group versus 37% (33/96) in the R&R group (treatment group difference of BLRc minus R&R, 9%; 95% confidence interval [CI], -6% to 23%). Reoperation by 3 years occurred in 9 participants (10%) in the BLRc group (8 of 9 met suboptimal surgical outcome criteria) and in 4 participants (5%) in the R&R group (3 of 4 met suboptimal surgical outcome criteria; treatment group difference of BLRc minus R&R, 5%; 95% CI, -2% to 13%). Among participants completing the 3-year visit, 29% (25 of 86) in the BLRc group and 17% (13 of 77) in the R&R group underwent reoperation or met suboptimal surgical outcome criteria at 3 years (treatment group difference of BLRc minus R&R, 12%; 95% CI, -1% to 25%).We did not find a statistically significant difference in suboptimal surgical outcome by 3 years between children with IXT treated with BLRc compared with those treated with R&R. Based on these findings, we are unable to recommend one surgical approach over the other for childhood IXT.

    View details for PubMedID 30189281

  • Partial scleral buckle removal during strabismus surgery after retinal detachment repair JOURNAL OF AAPOS Kumar, P., Hoover, D. L., Lambert, S. R. 2019; 23 (1): 16–18
  • Spectacle Adherence among four-year-old Children in the Infant Aphakia Treatment Study. American journal of ophthalmology Lambert, S. R., DuBois, L., Cotsonis, G., Hartmann, E. E., Drews-Botsch, C., Infant Aphakia Treatment Study Group 2019

    Abstract

    PURPOSE: To evaluate spectacle adherence with impact resistant lenses among 4-year-old children after unilateral cataract surgery in the Infant Aphakia Treatment Study.DESIGN: Retrospective cohort analysis of randomized clinical trial data.METHODS: SETTING: Multicenter.PATIENTS: 114 children randomized to contact lens correction or intraocular lens implantation following unilateral cataract surgery during infancy.INTERVENTION: One week diaries completed annually and retrospective telephone interviews conducted every 3 months to age 5 years to assess spectacle adherence with impact resistant lenses using. Visual acuity was assessed by a traveling examiner at age 4.5 years.MAIN OUTCOME MEASURES: Spectacle adherence between ages 4 to 5 years.RESULTS: Children with 20/40 or better vision in their treated eye were more likely to wear spectacles ≥80% of their waking hours than children with vision worse than 20/40 (66% vs 42%, p=0.034). Reported adherence to spectacle wear correlated with reported patching (r=0.30, p=0.002). Spectacle adherence did not correlate with gender, type of healthcare insurance or the refractive error in the treated or fellow eye. Seven patients with reduced vision in their treated eye reported <10% spectacle adherence.CONCLUSIONS: These results confirm that it is possible to achieve high levels of spectacle adherence among 4-year-old children after unilateral cataract surgery during infancy. However, children with vision worse than 20/40 in their worse eye, who needed eye protection the most, had the worst adherence.

    View details for PubMedID 30633891

  • Partial scleral buckle removal during strabismus surgery after retinal detachment repair. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Kumar, P., Hoover, D. L., Lambert, S. R. 2019

    Abstract

    PURPOSE: To describe outcomes after partial scleral buckle removal at the time of strabismus surgery.METHODS: The medical records of consecutive patients with symptomatic diplopia who underwent strabismus surgery after scleral buckling by two surgeons were reviewed retrospectively. All patients underwent forced duction testing and had a segment of the scleral buckle removed intraoperatively. Pre- and postoperative ocular motility and alignment were compared. The outcome was considered successful if residual horizontal deviation was ≤8Delta, vertical deviation ≤2Delta, and cyclotropia <5°.RESULTS: A total of 12 patients (mean age, 51 years; range, 14-71 years) with a mean horizontal deviation of 16Delta (range, 2Delta-40Delta) and mean vertical deviation of 10Delta (range, 2Delta-20Delta) were included. Three patients underwent 2 strabismus surgeries. All patients underwent intraoperative removal of a segment of the scleral buckle near a muscle being advanced or recessed at the time of surgery. An adjustable suture technique was used in 13 of 15 surgeries (86%). Orthotropia was achieved in 7 patients (58%); surgical success, in 11 (92%). Subjective resolution of diplopia was achieved in all patients, in 2 with the aid of prisms. Mean follow-up was 12.4 months (range, 1-75). No patient had retinal redetachment.CONCLUSIONS: In this case series, removal of a segment of the scleral buckle facilitated advancement or recession of a rectus muscle and was associated with good outcomes without retinal redetachment.

    View details for PubMedID 30625364

  • Outcomes of Bilateral Cataracts Removed in Infants 1 to 7 Months of Age Using the Toddler Aphakia and Pseudophakia Treatment Study Registry. Ophthalmology Bothun, E. D., Wilson, M. E., Vanderveen, D. K., Plager, D. A., Freedman, S. F., Trivedi, R. H., Traboulsi, E. I., Anderson, J. S., Loh, A. R., Yen, K. G., Weil, N. C., Morrison, D. n., Lambert, S. R. 2019

    Abstract

    To evaluate outcomes of bilateral cataract surgery in infants 1 to 7 months of age performed by Infant Aphakia Treatment Study (IATS) investigators during IATS recruitment and to compare them with IATS unilateral outcomes.Retrospective case series review at 10 IATS sites.The Toddler Aphakia and Pseudophakia Study (TAPS) is a registry of children treated by surgeons who participated in the IATS.Children underwent bilateral cataract surgery with or without intraocular lens (IOL) placement during IATS enrollment years 2004 through 2010.Visual acuity (VA), strabismus, adverse events (AEs), and reoperations.One hundred seventy-eight eyes (96 children) were identified with a median age of 2.5 months (range, 1-7 months) at the time of cataract surgery. Forty-two eyes (24%) received primary IOL implantation. Median VA of the better-seeing eye at final study visit closest to 5 years of age with optotype VA testing was 0.35 logarithm of the minimum angle of resolution (logMAR; optotype equivalent, 20/45; range, 0.00-1.18 logMAR) in both aphakic and pseudophakic children. Corrected VA was excellent (<20/40) in 29% of better-seeing eyes, 15% of worse-seeing eyes. One percent showed poor acuity (≥20/200) in the better-seeing eye, 12% in the worse-seeing eye. Younger age at surgery and smaller (<9.5 mm) corneal diameter at surgery conferred an increased risk for glaucoma or glaucoma suspect designation (younger age: odds ratio [OR], 1.44; P = 0.037; and smaller cornea: OR, 3.95; P = 0.045). Adverse events also were associated with these 2 variables on multivariate analysis (younger age: OR, 1.36; P = 0.023; and smaller cornea: OR, 4.78; P = 0.057). Visual axis opacification was more common in pseudophakic (32%) than aphakic (8%) eyes (P = 0.009). Unplanned intraocular reoperation occurred in 28% of first enrolled eyes (including glaucoma surgery in 10%).Visual acuity after bilateral cataract surgery in infants younger than 7 months is good, despite frequent systemic and ocular comorbidities. Although aphakia management did not affect VA outcome or AE incidence, IOL placement increased the risk of visual axis opacification. Adverse events and glaucoma correlated with a younger age at surgery and glaucoma correlated with the presence of microcornea.

    View details for DOI 10.1016/j.ophtha.2019.10.039

    View details for PubMedID 31987642

  • Incidence of strabismus and amblyopia among children initially diagnosed with pseudostrabismus using the Optum® dataset. American journal of ophthalmology Ryu, W. Y., Lambert, S. R. 2019

    Abstract

    To determine the frequency of strabismus among children initially diagnosed with pseudostrabismus using big data.Population-based retrospective cohort study.Setting: Population-based retrospective cohort study using claims data.17,885 children diagnosed with pseudostrabismus at age ≤3 years who were later diagnosed with strabismus using the Optum© de-identified Clinformatics® Data Mart Database (2003-2016). We excluded patients diagnosed with strabismus before the diagnosis of pseudostrabismus or diagnosed simultaneously with strabismus and pseudostabismus.We assessed age, refractive error, and presence of amblyopia. Patients with pseudostrabismus were compared to a group of patients from the Optum dataset diagnosed with esotropia, exotropia, and unspecified heterotropia who had not been previously diagnosed with pseudostrabismus.Incidence of strabismus, among patients initially diagnosed with pseudostrabismus versus those without an initial diagnosis of pseudostrabismus.Strabismus was diagnosed in 9.6% (n=1,725) of children initially diagnosed with pseudostrabismus at a median age of 1.65 years (IQR; 1.19 - 2.46) compared to 1.7% (136,047 of 7,787,743) of children in the control group (P<.001). Strabismus was diagnosed more than a year later in the pseudostrabismus group (3.32 years; IQR, 2.28 - 4.74) compared to the control group (2.28 years; IQR, 1.43 - 3.16) (P<0.001). Esotropia was the most common type of strabismus in both groups (pseudostrabismus, 69.7%; control, 62.1%). 377 children (21.9%) in the pseudostrabismus group underwent strabismus surgery compared to 12.1% of children in the control group (P<.001).Young children diagnosed with pseudostrabismus are at increased risk of developing strabismus and undergoing strabismus surgery.

    View details for DOI 10.1016/j.ajo.2019.10.036

    View details for PubMedID 31730842

  • Parenting Stress and Adherence to Occlusion Therapy in the Infant Aphakia Treatment Study: A Secondary Analysis of a Randomized Clinical Trial. Translational vision science & technology Drews-Botsch, C., Celano, M., Cotsonis, G., DuBois, L., Lambert, S. R., Infant Aphakia Treatment Study Group 2019; 8 (1): 3

    Abstract

    Purpose: Using data from the Infant Aphakia Treatment Study, we examined the relationship between adherence to patching and parenting stress.Methods: Caregivers completed the Parenting Stress Index 3 months after surgery (n = 106), after a visual acuity assessment at 12 months of age (n = 97), and at 4.25 (n = 96) years of age. Patching was reported in quarterly telephone interviews and annual 7-day patching diaries, and averaged across all assessments prior to and in the 6 months following the first stress assessment, and for 6 months before and after the other two stress assessments. The association was assessed using linear regression.Results: Caregivers reporting the highest stress levels 3 months after surgery (i.e., 75th percentile) subsequently reported approximately three-quarters (0.87, 95% confidence interval -1.3 to -0.34) of an hour a day less patching than caregivers reporting the least stress (i.e., the 25th percentile) after controlling for prior patching and other confounders. The association was in the same direction, but not statistically significant, after the second stress assessment and was not apparent at 4.25 years of age. In contrast to our hypothesis, we did not find evidence that higher levels of patching were associated with subsequent increases in parenting stress.Conclusions: Three months after surgery, higher levels of parenting stress are associated with poorer adherence to patching, and thus stress may contribute to early adherence to patching.Translational Relevance: Clinicians may wish to provide support to caregivers exhibiting high levels of stress since it may impact their ability to adhere to prescribed patching.

    View details for PubMedID 30627478

  • Five-Year Postoperative Outcomes of Bilateral Aphakia and Pseudophakia in Children up to 2Years of Age: A Randomized ClinicalTrial. American journal of ophthalmology Lambert, S. R., Bothun, E. D., Plager, D. A. 2018

    View details for DOI 10.1016/j.ajo.2018.09.042

    View details for PubMedID 30579617

  • Timing of infliximab and adalimumab initiation despite methotrexate in children with chronic non-infectious anterior uveitis. Eye (London, England) McCracken, C., Yeh, S., Jenkins, K., Travers, C., Stryker, D., Tommasello, S., Rouster-Stevens, K. A., Lambert, S. R., Prahalad, S., Drews-Botsch, C., Angeles-Han, S. T. 2018

    Abstract

    AIMS: Methotrexate (MTX) is standard treatment in pediatric chronic anterior uveitis (CAU). Addition of tumor necrosis factor-alpha inhibitors (TNFi) is often needed. We describe the timing and risk factors for TNFi usein children with CAU on MTX.METHODS: In this retrospective study, we reviewed 51 records, and 46 met inclusion criteria. Primary outcome was the addition of TNFi dueto active CAU per Standardization of Uveitis Nomenclature criteria. Time to TNFi and factors associated with their addition were assessed using survival analysis models.RESULTS: Of 46 children treated with MTX for uveitis (36 juvenile idiopathic arthritis-associated uveitis, 10 idiopathic CAU), 72% had ocular complications. MTX was started a median of 5.0 months, and TNFi 43 months from uveitis diagnosis. Kaplan-Meier estimates suggest that cumulatively, 12% (95% CI: 4-23%) start TNFi within 6 months of MTX, 21% (12-37%) within 1 year, and 39% (24-54%) within 2 years. On Cox Proportional Hazard regression analysis, children with idiopathic CAU required TNFi earlier in their uveitis course (at 3 months (Hazard Ratio 6.06; 95% confidence interval (1.25-29.41))). Females appeared less likely to require TNFi early. Children treated in 2012 and later were more likely to receive TNFi earlier than those treated before 2012.CONCLUSION: Little is known about optimal time to initiate treatment or factors associated with the need to add TNFi in children on MTX. Children with idiopathic CAU and males required TNFi earlier in their course. Factors associated with these potential risk factors for TNFi warrant further investigation.

    View details for PubMedID 30487588

  • Orthokeratology for the Prevention of Myopic Progression in Children A report by the American Academy of Ophthalmology. Ophthalmology VanderVeen, D. K., Kraker, R. T., Pineles, S. L., Hutchinson, A. K., Wilson, L. B., Galvin, J. A., Lambert, S. R. 2018

    Abstract

    OBJECTIVE: To review the published evidence to evaluate the ability of orthokeratology (Ortho-K) treatment to reduce myopic progression in children and adolescents compared with the use of spectacles or daytime contact lenses for standard refractive correction.METHODS: Literature searches of the PubMed database, the Cochrane Library, and the databases of clinical trials were last conducted on May 23, 2017 with no date restrictions but limited to articles published in English. These searches yielded 162 citations, of which 13 were deemed clinically relevant for full-text review and inclusion in this assessment. The panel methodologist then assigned a level of evidence rating to the selected studies.RESULTS: The 13 articles selected for inclusion include 3 prospective, randomized clinical trials; 7 nonrandomized, prospective comparative studies; and 3 retrospective case series. One study provided level I evidence, 11 studies provided level II evidence, and 1 study provided level III evidence. Most studies were performed in populations of Asian ethnicity. Change in axial length was the primary outcome for 10 of 13 studies, and change in refraction was the primary outcome for 3 of 13 studies. In these studies, Ortho-K typically reduced axial elongation by approximately 50% over a 2-year study period. This corresponds to average axial length change values of about 0.3 mm for Ortho-K patients compared with 0.6 mm for control patients, which corresponds to a typical difference in refraction of about 0.5 D. Younger-age groups and individuals with larger than average pupil size may have a greater effect with Ortho-K. Rebound can occur after discontinuation or change to alternative refractive treatment.CONCLUSIONS: Orthokeratology may be effective in slowing myopic progression for children and adolescents, with a potentially greater effect when initiated at an early age (6-8 years). Safety remains a concern because of the risk of potentially blinding microbial keratitis from contact lens wear.

    View details for PubMedID 30476518

  • Intraocular lens implantation in young children. The Lancet. Child & adolescent health Lambert, S. R. 2018

    View details for PubMedID 30389449

  • Adrenal Suppression from Topical and Subconjunctival Steroids after Pediatric Cataract Surgery. Ophthalmology Lambert, S. R., Shah, S. 2018; 125 (10): 1644–45

    View details for DOI 10.1016/j.ophtha.2018.06.012

    View details for PubMedID 30243335

  • Re: Weakley et al.: Myopic shift 5 years after intraocular lens implantation in the infant aphakia treatment study (Ophthalmology. 2017;124:822-827) REPLY OPHTHALMOLOGY Weakley, D. R., Lynn, M. J., Dubois, L., Cotsonis, G., Wilson, M., Buckley, E. G., Plager, D. A., Lambert, S. R. 2018; 125 (10): E69–E70

    View details for PubMedID 30243340

  • Unilateral retinitis pigmentosa in children. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Mercado, C. L., Pham, B. H., Beres, S., Marmor, M. F., Lambert, S. R. 2018

    Abstract

    BACKGROUND: Retinitis pigmentosa (RP) is a group of rare inherited retinal disorders characterized by diffuse progressive degeneration of the retina that typically presents bilaterally. Unilateral RP has not often been reported in children. We present a series of cases that illustrate discrimination between unilateral and asymmetric disease and between dystrophy and acquired degeneration.METHODS: Four patients (9-15 years of age; 3 females) were referred to our institution for possible unilateral RP based on fundus appearance and unilateral symptoms. All underwent full-field electroretinography (ERG), spectral domain optical coherence tomography (SD-OCT), widefield and color fundus photography, and fundus autofluorescence (FAF) imaging. Genetic testing and a vitamin and essential fatty acids panel were also conducted in 1 patient.RESULTS: Unilateral retinal degeneration was confirmed in 2 patients, whose fellow eyes showed no abnormalities on ERG or imaging. The other 2 patients were found to have highly asymmetric retinal degeneration based on ERG, wide-angle images, and repeated examinations (range, 0.3-9.8 years). Genetic testing and blood testing in 1 unilateral case were negative.CONCLUSIONS: Childhood-onset "unilateral RP" remains a difficult and uncertain diagnosis. ERG testing and longitudinal and widefield fundus examination are necessary to exclude asymmetrical disease. Although unilateral degeneration may exist in some children, its inherited or acquired etiology remains poorly understood.

    View details for PubMedID 30243749

  • Ophthalmic Technology Assessment: The Use of Beta-Blockers for the Treatment of Periocular Hemangiomas in Infants. Ophthalmology Hutchinson, A. K., Kraker, R. T., Pineles, S. L., VanderVeen, D. K., Wilson, L. B., Galvin, J. A., Lambert, S. R. 2018

    Abstract

    OBJECTIVE: To review the published literature assessing the efficacy of beta-blockers for the treatment of periocular hemangioma in infants.METHODS: Literature searches were conducted in May 2018 in PubMed with no date restrictions and limited to studies published in English and in the Cochrane Library database without any restrictions. The combined searches yielded 437 citations. Of these,16 articles were deemed appropriate for inclusion in this assessment and assigned a level of evidence rating by the panel methodologist.RESULTS: None of the 16 studies included in this assessment were rated level I, 3 were rated level II, and 13 were rated level III. The most common treatment regimen was 2 mg/kg daily oral propranolol, but intralesional and topical beta-blockers were also used. Treatment effect was most often measured in terms of reduction in the size of the lesions, which occurred in the majority of patients. Beta-blockers were consistently shown to reduce astigmatism, but this reduction was shown to be statistically significant in only 2 series. The effect of beta-blockers on amblyopia was not adequately documented. Beta-blockers were generally well tolerated and had mild side effects (fatigue, gastrointestinal upset/diarrhea, restlessness/sleep disturbances, minor wheezing, and cold extremities). Complications severe enough to require cessation of treatment occurred in only 2 patients out of a total of 229 who received beta-blockers.CONCLUSIONS: There is limited evidence to support the safety and efficacy of both topical and systemic beta-blockers to promote regression of periocular hemangiomas. Additional research may confirm the best dosage and route of administration to maximize efficacy in reducing induced astigmatism and amblyopia associated with periocular hemangiomas while minimizing side effects.

    View details for PubMedID 30075202

  • Correlation of monocular grating acuity at age 12 months with recognition acuity at age 4.5 years: findings from the Infant Aphakia Treatment Study. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Hartmann, E. E., Drews-Botsch, C., DuBois, L. G., Cotsonis, G., Lambert, S. R., Infant Aphakia Treatment Study Group 2018

    Abstract

    PURPOSE: To determine whether grating acuity at age 12 months can be used to predict recognition acuity at age 4.5 years in children treated for unilateral congenital cataract enrolled in the Infant Aphakia Treatment Study (IATS).METHODS: Traveling testers assessed monocular grating acuity at 12 months of age (Teller Acuity Card Test [TACT]) and recognition acuity at 4.5 years of age (Amblyopia Treatment Study Electronic Visual Acuity Testing, HOTV) in children treated for visually significant monocular cataract in the IATS. Spearman rank correlation was used to evaluate the relationship between visual acuities at the two ages in the treated eyes.RESULTS: Visual acuity data at both ages were available for 109 of 114 children (96%). Grating acuity at 12 months of age and recognition acuity at 4.5 years of age were significantly correlated for the treated eyes (rspearman = 0.45; P = 0.001). At age 4.5 years, 67% of the subjects who had grating acuity at 12 months of age within the 95% predictive limits in their treated eye demonstrated recognition acuity better than 20/200. Similarly, at age 4.5 years 67% of the subjects who had grating acuity at age 12 months below the 95% predictive limits in their treated eye demonstrated recognition acuity of 20/200 or worse.CONCLUSIONS: A single grating acuity assessment at age 12 months predicts recognition acuity in a child treated for unilateral congenital cataract in only two-thirds of cases. Clinicians should consider other factors, such as patching compliance and age at surgery, when using an early grating acuity assessment to modify treatment.

    View details for PubMedID 30031874

  • Assessing Whether the Cataracts Associated With Atopic Dermatitis are Associated With Steroids or Inflammatory Factors. JAMA ophthalmology Lambert, S. R., Teng, J. M. 2018

    View details for PubMedID 29879288

  • Contact Lens Correction of Aphakia in Children: A Report by the American Academy of Ophthalmology. Ophthalmology Lambert, S. R., Kraker, R. T., Pineles, S. L., Hutchinson, A. K., Wilson, L. B., Galvin, J. A., VanderVeen, D. K. 2018

    Abstract

    PURPOSE: To review the published literature to assess the visual outcomes and adverse events associated with the 2 most commonly used contact lenses for treating aphakia in children: silicone elastomer (SE) and rigid gas permeable (RGP).METHODS: Literature searches were last conducted in January 2018 in the PubMed, Cochrane Library, and ClinicalTrials.gov databases with no date or language restrictions. These combined searches yielded 167 citations, 27 of which were reviewed in full text. Of these, 10 articles were deemed appropriate for inclusion in this assessment and subsequently assigned a level of evidence rating by the panel methodologist.RESULTS: The literature search identified 4 level II studies and 6 level III studies. There were insufficient data to compare visual outcomes for eyes treated using SE lenses versus RGP lenses. Silicone elastomer lenses have the advantage that they can be worn on an extended-wear basis, but they were associated with more adverse events than RGP lenses. These adverse events included microbial keratitis, corneal infiltrates, corneal edema, corneal scars, lenses adhering to the cornea, superficial punctate keratopathy, lid swelling, and conjunctival hyperemia. The lens replacement rate was approximately 50% higher for RGP lenses in the only study that directly compared SE and RGP lenses.CONCLUSIONS: Limited evidence was found in the literature on this topic. Silicone elastomer and RGP contact lenses were found to be effective for treating aphakia in children. Silicone elastomer lenses are easier to fit and may be worn on an extended-wear basis. Rigid gas permeable lenses must be removed every night and require a more customized fit, but they are associated with fewer adverse events. The choice of which lens a practitioner prescribes should be based on the particular needs of each patient.

    View details for PubMedID 29631901

  • Lens regeneration in children NATURE Vavvas, D. G., Dryja, T. P., Wilson, M., Olsen, T. W., Shah, A., Jurkunas, U., Pineda, R., Poulaki, V., Palioura, S., Veldman, P., Moreno-Montanes, J., Pinazo-Duran, M. D., Carlos Pastor, J., Tsilimbaris, M., Rhee, D., Colby, K., Hunter, D. G., Thanos, S., Sakamoto, T., Pasquale, L. R., Miller, J. W., VanderVeen, D., Lambert, S. R. 2018; 556 (7699): E2–E3

    View details for PubMedID 29620729

  • Association of Contact Lens Adherence With Visual Outcome in the Infant Aphakia Treatment Study A Secondary Analysis of a Randomized Clinical Trial JAMA OPHTHALMOLOGY Cromelin, C. H., Drews-Botsch, C., Russell, B., Lambert, S. R., Infant Aphakia Treatment Study Grp 2018; 136 (3): 279–85

    Abstract

    Although contact lenses have been used for decades to optically correct eyes in children after cataract surgery, there has never been a prospective study looking at contact lens adherence in children with aphakia, to our knowledge.To evaluate contact lens adherence and its association with visual outcome in a cohort of children treated for unilateral cataract surgery.Secondary analysis of a multicenter randomized clinical trial of 57 infants born from August 22, 2004, to April 25, 2008, who were randomized to 1 of 2 treatments and followed up to age 5 years. Data analysis was performed from August 9, 2016, to December 7, 2017.Unilateral cataract extraction and randomization to implantation of an intraocular lens vs contact lens to correct aphakia.Contact lens adherence was assessed by a 48-hour recall telephone interview that was administered every 3 months starting 3 months after surgery to age 5 years. A traveling examiner assessed visual acuity in patients at aged 4.5 years. Adherence to prescribed contact lens use was estimated as the mean percentage of waking hours as reported in 2 or more interviews for each year of life.Of 57 infants who were randomized to contact lens treatment, 32 (56%) were girls, and 49 (86%) were white. A total of 872 telephone interviews were completed. In year 1, a median of 95% participants wore their contacts lenses nearly all waking hours (interquartile range [IQR], 84%-100%); year 2, 93% (IQR, 85%-99%); year 3, 93% (IQR, 85%-99%); year 4, 93% (IQR, 75%-99%); and year 5, 89% (IQR, 71%-97%). There was a tendency for poorer reported adherence at older ages (F = 3.86, P < .001). No differences were identified when the results were analyzed by sex, insurance coverage, or age at cataract surgery. Using linear regression, children who wore the contact lens for a greater proportion of waking hours during the entire study period tended to have better visual acuity at age 4.5 years, even after accounting for adherence to patching (partial correlation = -0.026; P = .08).These results confirm that it is possible to achieve a high level of aphakic contact lens adherence over a 5-year period in children.clinicaltrials.gov Identifier: NCT00212134.

    View details for PubMedID 29423513

    View details for PubMedCentralID PMC5862145

  • Global Practice Patterns in the Management of Infantile Cataracts. Eye & contact lens Koo, E. B., VanderVeen, D. K., Lambert, S. R. 2018

    Abstract

    OBJECTIVES: Surveys are an important tool to assess the impact of research on physicians' approach to patient care. This survey was conducted to assess current practice patterns in the management of infantile cataracts in light of the findings of the Infant Aphakia Treatment Study.METHODS: Pediatric ophthalmologists were emailed a link to the survey using newsletters from American Association of Pediatric Ophthalmology and Strabismus, World Society of Pediatric Ophthalmology and Strabismus, and the Pediatric Listserv. The 17-question survey was anonymous and active during July to August 2016.RESULTS: One hundred twenty-five respondents (North America, 65%; Asia, 12%; Europe, 9%; and other, 14%) reported operating on pediatric cataracts. Most practice in a university setting (55%). There was a strong consensus that unilateral cataract surgery should be performed between ages 4 to 6 weeks and aphakic contact lenses should be used to optically correct their eyes, particularly in children ≤6 months of age. For bilateral cataracts, there was a trend for surgeons to perform cataract surgery at an older age than unilateral cataract surgery. Surgeons who performed less than 5 versus greater than 20 pediatric cataract surgeries/year were more likely to use aphakic contact lenses in children undergoing cataract surgery more than 6 months of age (62% vs. 35%, P=0.04). Most respondents (73%) indicated that the Infant Aphakia Treatment Study had changed how they manage unilateral congenital cataracts.CONCLUSION: Most pediatric cataract surgeons perform congenital cataract surgery between ages 4 to 6 weeks and use aphakic contact lenses for initial optical correction in infants less than 6 months. Surgeons have equal preference for intraocular lenses and contact lenses in infants more than 6 months of age.

    View details for PubMedID 29369235

  • Long-term follow-up after vertical extraocular muscle surgery to correct abnormal vertical head posture STRABISMUS Kumar, P., Lambert, S. R. 2018; 26 (3): 150–54

    Abstract

    To report outcomes of vertical extraocular muscle surgery to correct abnormal vertical head posture in children with horizontal infantile nystagmus.Retrospective case series of seven patients evaluated at one institution with abnormal vertical head position (chin-up or chin-down) in the setting of horizontal infantile nystagmus. All patients underwent bilateral vertical extraocular muscle surgery with the same surgeon. Pre- and postoperative vertical head position under binocular viewing conditions was the primary outcome measure. Secondary outcomes included visual acuity, stereopsis, degree of cyclotorsion, and residual ocular alignment.Seven children with infantile nystagmus syndrome, ranging in age from 4 months to 5 years at presentation, underwent extraocular muscle surgery to correct chin-down or chin-up head position associated with a null position in the setting of horizontal nystagmus. Five children had other ocular pathology (albinism, n = 4; cone-rod dystrophy, n = 1). Five of the seven patients had combined vertical recti and oblique muscle surgery. Three of the patients had additional extraocular muscle surgery to correct horizontal misalignment (exotropia, n = 2; esotropia, n = 1). One patient underwent a separate Kestenbaum procedure (bilateral horizontal resection/recession) to correct concomitant horizontal face turn. Median postoperative follow-up was 8.0 years (range 1-9.5 years). Postoperatively, three patients had complete resolution of their abnormal head position, and three had an improvement in their head posture, with a mean reduction in original vertical head position of 25 degrees. One of these patient had a reversal of their head position from a chin-up to a small chin-down position. Only one patient had no clinically significant improvement in their head position. No patients had signs or symptoms of cyclotorsion postoperatively.Combined vertical recti and oblique muscle surgery can successfully improve and even resolve vertical head posture, and prevents cyclorotary disorders postoperatively.

    View details for PubMedID 30060686

  • Atropine for the Prevention of Myopia Progression in Children A Report by the American Academy of Ophthalmology OPHTHALMOLOGY Pineles, S. L., Kraker, R. T., VanderVeen, D. K., Hutchinson, A. K., Galvin, J. A., Wilson, L. B., Lambert, S. R. 2017; 124 (12): 1857–66

    Abstract

    To review the published literature on the efficacy of topical atropine for the prevention of myopic progression in children.Literature searches were last conducted in December 2016 in the PubMed database with no date restrictions, but were limited to studies published in English, and in the Cochrane Library database without any restrictions. The combined searches yielded 98 citations, 23 of which were reviewed in full text. Of these, 17 articles were deemed appropriate for inclusion in this assessment and subsequently were assigned a level of evidence rating by the panel methodologist.Seventeen level I, II, and III studies were identified. Most of the studies reported less myopic progression in children treated with atropine compared with various control groups. All 8 of the level I and II studies that evaluated primarily myopic progression revealed less myopic progression with atropine (myopic progression ranging from 0.04±0.63 to 0.47±0.91 diopters (D)/year) compared with control participants (myopic progression ranging from 0.38±0.39 to 1.19±2.48 D/year). In studies that evaluated myopic progression after cessation of treatment, a rebound effect was noted. Several studies evaluated the optimal dosage of atropine with regard to myopic progression, rebound after treatment cessation, and minimization of side effects. Lower dosages of atropine (0.5%, 0.1%, and 0.01%) were found to be slightly less effective during treatment periods of 1 to 2 years, but they were associated with less rebound myopic progression (for atropine 0.01%, mean myopic progression after treatment cessation of 0.28±0.33 D/year, compared with atropine 0.5%, 0.87±0.52 D/year), fewer side effects, and similar long-term results for myopic progression after the study period and rebound effect were considered. The most robust and well-designed studies were carried out in Asian populations. Studies involving patients of other ethnic backgrounds failed to provide sufficient evidence of an effect of atropine on myopic progression.Level I evidence supports the use of atropine to prevent myopic progression. Although there are reports of myopic rebound after treatment is discontinued, this seems to be minimized by using low doses (especially atropine 0.01%).

    View details for PubMedID 28669492

  • Population-Based Incidence of Strabismus Why Is It Important? JAMA OPHTHALMOLOGY Lambert, S. R. 2017; 135 (10): 1053–54

    View details for PubMedID 28859195

  • Anisometropia at Age 5 Years after Unilateral Intraocular Lens Implantation During Infancy in the Infant Aphakia Treatment Study (IATS). American journal of ophthalmology Weakley, D., Cotsonis, G., Wilson, M. E., Plager, D. A., Buckley, E. G., Lambert, S. R. 2017

    Abstract

    To report the prevalence of anisometropia at age 5 years after unilateral intraocular lens (IOL) implantation in infants.Prospective randomized clinical trial METHODS: Fifty-seven infants in the Infant Aphakia Treatment Study (IATS) with a unilateral cataract were randomized to IOL implantation with an initial targeted postoperative refractive error of either +8D (infants 28 to <48 days of age) or +6D (infants 48-210 days of age). Anisometropia was calculated at age 5 years. Six patients were excluded from the analyses.Median age at cataract surgery was 2.2 months (IQR, 1.2, 3.5 months). The mean age at the age 5 year follow-up visit was 5.0 ± 0.1 years (range, 4.9 - 5.4 years). The median refractive error at the age 5 year visit of the treated eyes was -2.25 D (IQR -5.13, +0.88 D) and of the fellow eyes +1.50 D (IQR +0.88, +2.25). Median anisometropia was -3.50 D (IQR -8.25, -0.88 D); range (-19.63 to +2.75D). Patients with glaucoma in the treated eye (n=9) had greater anisometropia (glaucoma, median -8.25 D; IQR -11.38, -5.25 D vs. no glaucoma median -2.75; IQR -6.38, -0.75 D; p=0.005) CONCLUSIONS: The majority of pseudophakic eyes had significant anisometropia at age 5 years. Anisometropia was greater in patients that developed glaucoma. Variability in eye growth and myopic shift continue to make refractive outcomes challenging for IOL implantation during infancy.

    View details for DOI 10.1016/j.ajo.2017.05.008

    View details for PubMedID 28526552

  • Anti-Vascular Endothelial Growth Factor Therapy for Primary Treatment of Type 1 Retinopathy of Prematurity: A Report by the American Academy of Ophthalmology. Ophthalmology VanderVeen, D. K., Melia, M., Yang, M. B., Hutchinson, A. K., Wilson, L. B., Lambert, S. R. 2017; 124 (5): 619-633

    Abstract

    To review the available evidence on the ocular safety and efficacy of anti-vascular endothelial growth factor (VEGF) agents for the treatment of retinopathy of prematurity (ROP) compared with laser photocoagulation therapy.A literature search of the PubMed and Cochrane Library databases was conducted last on September 6, 2016, with no date restrictions and limited to articles published in English. This search yielded 311 citations, of which 37 were deemed clinically relevant for full-text review. Thirteen of these were selected for inclusion in this assessment. The panel methodologist assigned ratings to the selected articles according to the level of evidence.Of the 13 citations, 6 articles on 5 randomized clinical trials provided level II evidence supporting the use of anti-VEGF agents, either as monotherapy or in combination with laser therapy. The primary outcome for these articles included recurrence of ROP and the need for retreatment (3 articles), retinal structure (2 articles), and refractive outcome (1 article). Seven articles were comparative case series that provided level III evidence. The primary outcomes included the effects of anti-VEGF treatment on development of peripheral retinal vessels (1 article), refractive outcomes (1 article), or both structural and refractive or visual outcomes (5 articles).Current level II and III evidence indicates that intravitreal anti-VEGF therapy is as effective as laser photocoagulation for achieving regression of acute ROP. Although there are distinct ocular advantages to anti-VEGF pharmacotherapy for some cases (such as eyes with zone I disease or aggressive posterior ROP), the disadvantages are that the ROP recurrence rate is higher, and vigilant and extended follow-up is needed because retinal vascularization is usually incomplete. After intravitreal injection, bevacizumab can be detected in serum within 1 day, and serum VEGF levels are suppressed for at least 8 to 12 weeks. The effects of lowering systemic VEGF levels on the developing organ systems of premature infants are unknown, and there are limited long-term data on potential systemic and neurodevelopmental effects after anti-VEGF use for ROP treatment. Anti-VEGF agents should be used judiciously and with awareness of the known and unknown or potential side effects.

    View details for DOI 10.1016/j.ophtha.2016.12.025

    View details for PubMedID 28341474

  • Outcomes after superior rectus transposition and medial rectus recession versus vertical recti transposition for sixth nerve palsy. American journal of ophthalmology Lee, Y., Lambert, S. R. 2017

    Abstract

    To compare the effectiveness of superior rectus transposition and medial rectus recession (SRT/MRc) vs inferior and superior rectus transposition (VRT) for acquired sixth nerve palsy.Consecutive, interventional case series.The medical records of a consecutive series of patients with acquired sixth nerve palsy who underwent VRT or SRT/MRc by a single surgeon were reviewed. The preoperative and postoperative findings were compared between the 2 groups.Eight patients (mean age, 46.8 years) underwent SRT/MRc and 8 patients underwent VRT (mean age, 51.1 years). Lateral fixation was performed on all but 4 patients in the VRT group. Preoperative esotropia in primary position and abduction deficit were similar in both groups (SRT/MRc, 41.9 prism diopter [PD], -4.6; VRT, 55.6 PD, -4.5; P = .195, 1.0). The SRT/MRc group underwent a mean MR recession of 6 (range, 5-7) mm. Four patients in the VRT later underwent MR recession (mean 5.3 mm, range 5-6 mm). In addition, 5 patients in the VRT group had 1 or more botulinum toxin injections in the medial rectus muscle. No additional procedures were performed in the SRT/MR group. Fewer additional procedures were performed with SRT/MR (SRT/MR, 0; VRT, 1.8 ± 1.2; P < .010). At last follow-up, residual esotropia (SRT/MRc, 7.1 PD; VRT, 10.3 PD; P = .442) was similar in both groups, but abduction was better in the SRT/MRc group (SRT/MR, -3.0 ± 0.7; VRT, -3.8 ± 0.4; P = .038). There were no new persistent vertical deviations or torsional diplopia.Final outcomes were similar with SRT/MRc vs VRT. However, fewer additional surgical procedures were needed with SRT/MR.

    View details for DOI 10.1016/j.ajo.2017.02.019

    View details for PubMedID 28249714

  • Myopic Shift 5 Years after Intraocular Lens Implantation in the Infant Aphakia Treatment Study. Ophthalmology Weakley, D. R., Lynn, M. J., DuBois, L., Cotsonis, G., Wilson, M. E., Buckley, E. G., Plager, D. A., Lambert, S. R. 2017

    Abstract

    To report the myopic shift at 5 years of age after cataract surgery with intraocular lens (IOL) implantation for infants enrolled in the Infant Aphakia Treatment Study (IATS).Refractions were performed at 1 month and every 3 months postoperatively until age 4 years and then at ages 4.25, 4.5, and 5 years. The change in refraction over time was estimated by linear mixed model analysis.Intraocular lens implantation was completed in 56 eyes; 43 were analyzed (median age, 2.4 months; range, 1.0-6.8 months). Exclusions included 11 patients with glaucoma, 1 patient with Stickler syndrome, and 1 patient with an IOL exchange at 8 months postoperatively. The mean rate of change in a myopic direction from 1 month after cataract surgery to age 1.5 years was 0.35 diopters (D)/month (95% confidence interval [CI], 0.29-0.40 D/month); after age 1.5 years, the mean rate of change in a myopic direction was 0.97 D/year (95% CI, 0.66-1.28 D/year). The mean refractive change was 8.97 D (95% CI, 7.25-10.68 D) at age 5 years for children 1 month of age at surgery and 7.22 D (95% CI, 5.54-8.91 D) for children 6 months of age at surgery. The mean refractive error at age 5 years was -2.53 D (95% CI, -4.05 to -1.02).After IOL implantation during infancy, the rate of myopic shift occurs most rapidly during the first 1.5 years of life. Myopic shift varies substantially among patients. If the goal is emmetropia at age 5 years, then the immediate postoperative hypermetropic targets should be +10.5 D at 4 to 6 weeks and +8.50 D from 7 weeks to 6 months. However, even using these targets, it is likely that many children will require additional refractive correction given the high variability of refractive outcomes.

    View details for DOI 10.1016/j.ophtha.2016.12.040

    View details for PubMedID 28215452

  • Globe Axial Length Growth at Age 5 Years in the Infant Aphakia Treatment Study. Ophthalmology Wilson, M. E., Trivedi, R. H., Weakley, D. R., Cotsonis, G. A., Lambert, S. R. 2017

    Abstract

    To report the longitudinal change in axial length (AL) from the time of unilateral cataract surgery at age 1 to 7 months to age 5 years, and to compare AL growth of operated eyes with that of fellow unoperated eyes.Comparative case series.Infants enrolled in the Infant Aphakia Treatment Study (IATS).The AL at baseline and age 5 years and change in AL were analyzed relative to treated versus fellow eye, visual outcome, and treatment modality (contact lens [CL] vs. intraocular lens [IOL]). Eyes with glaucoma or glaucoma suspect were excluded from primary analysis but reported separately.The AL growth from preoperative to age 5 years.Seventy patients were eligible; however, AL data for both eyes were available for 64 patients at baseline and 69 patients at age 5 years. The AL was significantly different between treated and fellow eyes preoperatively (18.1 vs. 18.7 mm, P < 0.0001) and at the final follow-up (21.4 vs. 22.1 mm, P = 0.0004). The difference in AL growth between treated and fellow eyes was not significant (3.3 vs. 3.5 mm, P = 0.31). The change in AL in eyes was similar with both treatments (CL 3.2 mm and IOL 3.4 mm, P = 0.53) and did not correlate with visual outcomes (P = 0.85). Eyes receiving additional surgery to clear the visual axis opacification grew significantly more compared with eyes not receiving surgery to clear the visual axis (3.8 vs. 2.7 mm, P = 0.013). Patients with glaucoma showed significantly more eye growth (5.7 mm) than those without glaucoma (3.3 mm) and glaucoma suspects (4.3 mm).Eyes treated for monocular cataract in infancy have axial growth similar to that of fellow eyes, despite having a shorter AL at the time of surgery. The change in AL in eyes was similar with both treatments (CL and IOL), did not correlate with visual outcomes, and was higher in eyes receiving additional surgery to clear the visual axis or eyes diagnosed with glaucoma.

    View details for DOI 10.1016/j.ophtha.2017.01.010

    View details for PubMedID 28196730

  • Comparison of the rate of refractive growth in aphakic eyes versus pseudophakic eyes in the Infant Aphakia Treatment Study JOURNAL OF CATARACT AND REFRACTIVE SURGERY Lambert, S. R., Cotsonis, G., DuBois, L., Wilson, M. E., Plager, D. A., Buckley, E. G., McClatchey, S. K. 2016; 42 (12): 1768-1773

    Abstract

    To compare the rate of refractive growth (RRG) between aphakic eyes and pseudophakic eyes in the Infant Aphakia Treatment Study (IATS).Twelve clinical sites across the United States.Randomized clinical trial.Patients randomized to unilateral cataract extraction with contact lens correction versus intraocular lens (IOL) implantation in the IATS had their rate of refractive growth (RRG3) calculated based on the change in refraction from the 1-month postoperative examination to age 5 years. The RRG3 is a logarithmic formula designed to calculate the RRG in children. Two-group t tests were used to compare the mean refractive growth between the contact lens group and IOL group and outcomes based on age at surgery and visual acuity.Longitudinal refractive data were studied for 108 of 114 patients enrolled in the IATS (contact lens group, n = 54; IOL group, n = 54). The mean RRG3 was similar in the contact lens group (-18.0 diopter [D] ± 11.0 [SD]) and the IOL group (-19.0 ± 9.0 D) (P = .49). The RRG3 value was not correlated with age at cataract surgery, glaucoma status, or visual outcome in the IOL group. In the aphakia group, only visual outcome was correlated with refractive growth (P = .01).Infants' eyes had a similar rate of refractive growth after unilateral cataract surgery whether or not an IOL was implanted. A worse visual outcome was associated with a higher RRG in aphakic, but not pseudophakic, eyes.None of the authors has a financial or proprietary interest in any material or method mentioned.

    View details for DOI 10.1016/j.jcrs.2016.09.021

    View details for Web of Science ID 000391518100011

    View details for PubMedID 28007108

    View details for PubMedCentralID PMC5189691

  • Difluprednate versus prednisolone acetate for inflammation following cataract surgery in pediatric patients: a randomized safety and efficacy study. Eye (London, England) Wilson, M. E., Lambert, S. R., Plager, D. A., Vanderveen, D., Roarty, J., O'Halloran, H. 2016

    View details for DOI 10.1038/eye.2016.244

    View details for PubMedID 27813524

  • Strabismus surgery outcomes in the Infant Aphakia Treatment Study (IATS). Journal of AAPOS Bothun, E. D., Lynn, M. J., Christiansen, S. P., Kruger, S. J., VanderVeen, D. K., Neely, D. E., Lambert, S. R. 2016

    Abstract

    To report strabismus surgery frequency and outcomes after monocular infantile cataract surgery with or without IOL implantation.The Infant Aphakia Treatment Study (IATS) is a randomized, multicenter clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with a unilateral congenital cataract. This report is a secondary outcome analysis of ocular motor data from IATS patients who underwent strabismus surgery prior to age 5 years.Strabismus surgery was performed in 45 (39%) patients (contact lens group [CL], 37%; IOL group, 42% [P = 0.70]). The indications for strabismus surgery were esotropia (62%), exotropia (33%), and hypertropia (4%). Infants who underwent cataract surgery at a younger age were less likely to undergo strabismus surgery (28-48 days, 12/50 [24%]; 49-210 days, 33/64 [52%]; P = 0.0037). Of the 42 patients who underwent strabismus surgery, 14 (33%) had a postoperative distance alignment within 8(Δ) of orthotropia at age 5 years. The 5-year visual acuity of children with strabismus was the same whether or not strabismus surgery had been performed (1.10 logMAR with surgery vs 1.00 without [P = 0.71]).In this study cohort, cataract surgery performed in the first 6 weeks of life was associated with a reduced frequency of strabismus surgery. Strabismus surgery outcomes in this population are guarded. Surgical improvement of strabismus does not appear to influence long-term visual acuity.

    View details for DOI 10.1016/j.jaapos.2016.09.014

    View details for PubMedID 27815186

  • Factors associated with stereopsis and a good visual acuity outcome among children in the Infant Aphakia Treatment Study. Eye (London, England) Lambert, S. R., Dubois, L., Cotsonis, G., Hartmann, E. E., Drews-Botsch, C. 2016; 30 (9): 1221-1228

    Abstract

    PurposeTo identify factors associated with stereopsis in children with good visual acuity after unilateral congenital cataract surgery in the Infant Aphakia Treatment Study.Patients and methodsInfants with a unilateral congenital cataract (n=114) were randomized to IOL implantation or contact lens correction after cataract surgery. At age 4.5 years, a masked examiner assessed HOTV acuity and stereopsis. Adherence to patching was assessed using 48-h recall telephone interviews and 7-day diaries throughout the first 5 years of life. Ocular motility was evaluated at age 5 years. Baseline, postoperative, and adherence findings were compared between patients with 20/40 or better acuity in their treated eyes with or without stereopsis.ResultsThirty (27%) of 112 patients who were evaluated at age 4.5 years had 20/40 or better acuity in their treated eye. Stereopsis was present on one or more tests in 15 of these 30 (50%) children. Baseline characteristics and postoperative findings did not differ between patients with or without stereopsis. Children with stereopsis were more likely to be orthotropic at distance (P=0.003) and were patched for fewer hours per day throughout the first 5 years of life and the difference increased over time (P<0.001). On average children with stereopsis were patched for 3.4 h/day during the first year of life and patching steadily decreased to 1.8 h/day by age 4 years.ConclusionAmong children with good vision following unilateral congenital cataract surgery, orthophoria and fewer hours of patching, particularly during years 2, 3, and 4, are associated with some evidence of stereopsis.

    View details for DOI 10.1038/eye.2016.164

    View details for PubMedID 27472216

  • Difluprednate versus prednisolone acetate for inflammation following cataract surgery in pediatric patients: a randomized safety and efficacy study. Eye (London, England) Wilson, M. E., O'Halloran, H., Vanderveen, D., Roarty, J., Plager, D. A., Markwardt, K., Gedif, K., Lambert, S. R. 2016; 30 (9): 1187-1194

    Abstract

    PurposeTo evaluate safety and efficacy of difluprednate 0.05% ophthalmic emulsion for treatment of postoperative inflammation after cataract surgery in pediatric patients.MethodsThis was a phase 3B, multicentre, randomized, double-masked, active-controlled study of patients aged 0-3 years who underwent uncomplicated cataract surgery in one eye, with/without intraocular lens implantation. Patients were randomized to receive difluprednate 0.05% four times daily or prednisolone acetate 1% for 14 days post surgery, followed by tapering for 14 days. Safety included evaluation of adverse events. Primary efficacy was the proportion of patients with an anterior cell grade of 0 (no cells) at day 14; secondary efficacy was a global inflammation score.ResultsForty patients were randomized to each treatment group. Adverse drug reactions included corneal oedema (difluprednate 0.5%, n=1; prednisolone acetate 1%, n=0) and increased intraocular pressure or ocular hypertension (n=2/group). Mean intraocular pressure values during treatment were 2-3 mm Hg higher with difluprednate 0.05% compared with prednisolone acetate 1%; mean values were similar between groups by the first week after treatment cessation. At 2 weeks post surgery, the incidence of complete clearing of anterior chamber cells was similar between groups (difluprednate 0.05%, n=30 (78.9%); prednisolone acetate 1%, n=31 (77.5%). Compared with prednisolone acetate 1%, approximately twice as many difluprednate 0.05%-treated patients had a global inflammation assessment score indicating no inflammation on day 1 (n=12 (30.8%) vs n=7 (17.5%) and day 8 (n=18 (48.7%) vs n=10 (25.0%).ConclusionsDifluprednate 0.05% four times daily showed safety and efficacy profiles similar to prednisolone acetate 1% four times daily in children 0-3 years undergoing cataract surgery.

    View details for DOI 10.1038/eye.2016.132

    View details for PubMedID 27367745

  • Associated systemic and ocular disorders in patients with congenital unilateral cataracts: the Infant Aphakia Treatment Study experience. Eye (London, England) Traboulsi, E. I., Vanderveen, D., Morrison, D., Drews-Botsch, C. D., Lambert, S. R. 2016; 30 (9): 1170-1174

    Abstract

    PurposeFive-year prospective data on children enrolled in the Infant Aphakia Treatment Study (IATS) provided an opportunity to explore ocular and systemic associations in patients with a unilateral congenital cataract.MethodsInfants <7 months of age with a unilateral cataract were eligible for IATS screening. We reviewed data pertaining to the exclusion of patients as well as data collected on standardized study forms used at any time for documentation of ocular or systemic disorders.ResultsOverall, 227 infants were referred for possible enrollment. Of these, 10 had insignificant cataracts and 32 refused to participate. Of those excluded, 3 were premature, 27 had significant ocular disease (usually persistent fetal vasculature (PFV) or corneal diameter <9 mm), and 4 had systemic disorders. An additional 26 were excluded at the time of the first EUA, most often because of PFV or variants thereof. On follow-up, in the 114 enrolled patients, the following disorders were diagnosed: Stickler syndrome (1), mitochondrial disease (1), autism (1), and presumed congenital rubella syndrome (1). No patient developed a cataract in the fellow eye.DiscussionSome conditions that can feature unilateral cataracts are diagnosed at birth or very early in life, but others may be diagnosed at varying periods thereafter. PFV and its variants are the most common associated ocular findings in about a quarter of cases of unilateral congenital cataracts.ConclusionAlthough patients with a unilateral cataract may have significant associated abnormalities in the affected eye, most commonly PFV and its variants, the prevalence of associated significant systemic disease is quite low.

    View details for DOI 10.1038/eye.2016.124

    View details for PubMedID 27315350

  • Assessment of Adherence to Visual Correction and Occlusion Therapy in the Infant Aphakia Treatment Study. Contemporary clinical trials communications Drews-Botsch, C., Cotsonis, G., Celano, M., Lambert, S. R. 2016; 3: 158-166

    Abstract

    Occlusion therapy throughout early childhood is believed to be efficacious in treating deprivation amblyopia but has not been rigorously assessed in clinical trials. Further, tools to assess adherence to such therapy over an extended period of time are lacking. Using data from the Infant Aphakia Treatment Study, a randomized clinical trial of treatment for unilateral congenital cataract, we examined the use of quarterly 48-hour recall interviews and annual 7-day prospective diaries to assess reported hours of patching in 114 children throughout the first 5 years of life. Consistency of data reported was assessed using correlation coefficients and intraclass correlation coefficients. Both interview and diary data showed excellent consistency with Cronbach's Alpha's ranging from 0.69 to 0.88 for hours of patching and 0.60 to 0.73 for hours of sleep. However, caregivers reported somewhat more adherence in prospective diaries than retrospective interviews. Completion rates, on the other hand, were substantially higher for telephone interviews than prospective diaries. For example, after four years of surgery response rates to telephone interviews exceeded 75% versus completion rates of only 54% for diaries. In situations where occlusion dose monitors cannot be used for assessing adherence to occlusion therapy, such as in infants or over an extended period of time, quantitative assessments of occlusion therapy can be obtained by parental report, either as a series of prospective diaries or a series of recall interviews.

    View details for PubMedID 27981259

  • Association Between Occlusion Therapy and Optotype Visual Acuity in Children Using Data From the Infant Aphakia Treatment Study: A Secondary Analysis of a Randomized Clinical Trial. JAMA ophthalmology Drews-Botsch, C., Celano, M., Cotsonis, G., Hartmann, E. E., Lambert, S. R. 2016; 134 (8): 863-869

    Abstract

    Patching has been a mainstay in treating unilateral congenital cataract. However, its efficacy has not been rigorously assessed.To examine the association between patching and visual acuity in a cohort of children treated for unilateral congenital cataract.This study was a secondary analysis of a randomized clinical trial (Infant Aphakia Treatment Study) of infants born from August 1, 2004, through December 31, 2008, who were treated with 1 of 2 treatments for unilateral congenital cataract and followed up to 5 years of age. Data analysis was performed from March 1, 2013, to March 1, 2016.Cataract extraction and randomization to receipt of an intraocular lens vs being left aphakic for the first 5 years of life.Caregivers reported patching in the previous 48 hours in quarterly semistructured telephone interviews. The mean number of hours of patching per day was calculated from surgery to the first birthday (n = 92) and between 12 and 48 months of age (n = 102). Monocular optotype acuity was assessed at 4½ years of age by a traveling examiner using the Aphakia Treatment Study HOTV protocol.The Infant Aphakia Treatment Study enrolled 114 children; 57 were randomized to each treatment group. At 4½ years of age, optotype visual acuity was assessed in 112 children. The current analyses exclude an additional 3 children (2 who had adverse events that limited visual potential and 1 who had Stickler syndrome), leaving 109 total children analyzed (59 female [54.1%] and 92 white [84.4%]). Caregivers reported patching their children a mean (SD) of 3.73 (1.47) hours per day in the first year of life and 3.43 (2.04) hours per day thereafter. An association between reported patching and treatment was not identified (mean difference in first year, -0.29 hours per day; 95% CI, -0.90 to 0.33 hours per day; mean difference between 12 and 48 months of age, -0.40 hours per day; 95% CI, -1.20 to 0.40 hours per day). Visual acuity was associated with reported hours of patching in the first year of life (r = -0.32; 95% CI, -0.49 to -0.13) and between 12 and 48 months of age (r = -0.36; 95% CI, -0.52 to -0.18). However, patching accounted for less than 15% of the variance in logMAR acuity at 4½ years of age.These results support the association of occlusion throughout the preschool years with improved visual acuity in infants treated for unilateral congenital cataract. However, similar visual outcomes were achieved with varying amounts of patching. These conclusions should be interpreted in the context of limitations related to generalizability from incomplete data collected in a clinical trial.clinicaltrials.gov Identifier: NCT00212134.

    View details for DOI 10.1001/jamaophthalmol.2016.1365

    View details for PubMedID 27228110

    View details for PubMedCentralID PMC4982828

  • Cataract secondary to self-inflicted blunt trauma in children with autism spectrum disorder. Journal of AAPOS Lee, Y., Lenhart, P. D., Lambert, S. R. 2016; 20 (4): 361-362

    Abstract

    We report 3 cases of bilateral cataract secondary to self-inflicted blunt eye trauma in children with autism spectrum disorder (ASD). All 3 children hit their foreheads, orbits, or globes repeatedly for long periods of time and developed cataracts. Clinicians must be aware of this phenomenon to diagnose ocular pathology early and to provide adequate education, counseling, and services to affected patients and their families and to put appropriate postoperative care mechanisms in place to prevent permanent ocular damage.

    View details for DOI 10.1016/j.jaapos.2016.02.013

    View details for PubMedID 27223635

    View details for PubMedCentralID PMC5003638

  • The Infant Aphakia Treatment Study Contact Lens Experience to Age of 5 Years. Eye & contact lens Russell, B., DuBois, L., Lynn, M., Ward, M. A., Lambert, S. R. 2016: -?

    Abstract

    To describe our experience treating a cohort of unilateral aphakic infants with contact lenses in the Infant Aphakia Treatment Study (IATS).Fifty-seven of the 114 infants in the IATS were randomized to contact lens wear; all were followed until age 5 years, although a few had lapses in care. An examination under anesthesia, including keratometry, was performed at the time of enrollment and at approximately 1 year of age; keratometry was performed again at 5 years of age. A traveling examiner assessed visual acuity at approximately 1 year of age and again at 4.5 years of age.Twenty-four treated eyes (46%) wore silicone elastomer (SE) contact lenses, 11 eyes (19%) rigid gas permeable (GP) contact lenses and 17 eyes (29%) wore both lens types at various points of time. Median logMAR visual acuity was +0.70 (interquartile range (IQR), +0.30 to 1.20) in the SE group and 2.03 (IQR, +0.20 to 2.28) in the GP group at age 4.5 years. The mean (±SD) keratometric power of the treated eyes was 46.3±2.8 diopter (D) at baseline, 44.6±2.3 D at 1 year of age, and 44.3±1.7 D at 5 years of age. Keratometric astigmatism of treated eyes was 1.98±1.37 D at baseline, 1.62±0.98 D at 1 year of age, and 2.00±1.00 D at 5 years of age. Thirteen contact lens-related adverse events occurred among 7 patients after age 1 year.A cohort of infants with unilateral aphakia successfully wore contact lenses with relatively few adverse events.

    View details for PubMedID 27466719

  • MULTIMODAL IMAGING OF A FAMILY WITH SPINOCEREBELLAR ATAXIA TYPE 7 DEMONSTRATING PHENOTYPIC VARIATION AND PROGRESSION OF RETINAL DEGENERATION. Retinal cases & brief reports Levinson, J. D., Yan, J., Lambert, S. R., Shankar, S. P. 2016; 10 (3): 267-272

    Abstract

    To report the variability and progression of clinical presentation in three family members with spinocerebellar ataxia Type 7 including early recognizable features on retinal imaging and magnetic resonance imaging.Retrospective case series.The proband, Patient 1 (mother) presented at age 26 with light perception vision. Initial examination was significant for optic disc pallor, vascular attenuation, and central macular atrophy. Two years later, her vision declined to no light perception, and fundus examination demonstrated marked progression of macular atrophy and peripheral bone spicule formation. Seven years after the onset of vision loss, neurologic examination demonstrated ataxia, dysarthria, and slowed saccades. Genetic testing of ATXN7 identified heterozygous 61-CAG trinucleotide repeat expansion confirming the diagnosis of spinocerebellar ataxia Type 7. Patient 2 (son) presented at age 11 with visual acuity of 20/300 bilaterally and decreased color vision. Funduscopic examination was notable for disc pallor, vascular attenuation, and peripheral pigmentary changes. Electroretinography demonstrated diminished rod and cone function, and Goldmann visual field testing revealed paracentral scotoma. Patient 3 (daughter) presented at age 14 with visual acuity of 20/50 bilaterally and minimal funduscopic changes. The only significant ophthalmic finding was retinal thinning with atrophy of the outer nuclear layer and subfoveal ellipsoid zone on optical coherence tomography. Early cerebellar volume loss was also noted on magnetic resonance imaging.The clinical presentation of spinocerebellar ataxia Type 7 can vary widely even within the same family. In individuals with vision loss and normal fundus examination, careful evaluation of optical coherence tomography and brain magnetic resonance imaging facilitates early diagnosis and genetic testing.

    View details for DOI 10.1097/ICB.0000000000000248

    View details for PubMedID 26584329

    View details for PubMedCentralID PMC4871792

  • The timing of surgery for congenital cataracts Minimizing the risk of glaucoma following cataract surgery while optimizing the visual outcome JOURNAL OF AAPOS Lambert, S. R. 2016; 20 (3): 191-192

    View details for DOI 10.1016/j.jaapos.2016.04.003

    View details for Web of Science ID 000378186200001

    View details for PubMedID 27180288

    View details for PubMedCentralID PMC5018898

  • Use of the Delphi process in paediatric cataract management BRITISH JOURNAL OF OPHTHALMOLOGY Serafino, M., Trivedi, R. H., Levin, A. V., Wilson, M. E., Nucci, P., Lambert, S. R., Nischal, K. K., Plager, D. A., Bremond-Gignac, D., Kekunnaya, R., Nishina, S., Tehrani, N. N., Ventura, M. C. 2016; 100 (5): 611-615

    Abstract

    To identify areas of consensus and disagreement in the management of paediatric cataract using a modified Delphi approach among individuals recognised for publishing in this field.A modified Delphi method.International paediatric cataract experts with a publishing record in paediatric cataract management.The process consisted of three rounds of anonymous electronic questionnaires followed by a face-to-face meeting, followed by a fourth anonymous electronic questionnaire. The executive committee created questions to be used for the electronic questionnaires. Questions were designed to have unit-based, multiple choice or true-false answers. The questionnaire included issues related to the preoperative, intraoperative and postoperative management of paediatric cataract.Consensus based on 85% of panellists being in agreement for electronic questionnaires or 80% for the face-to-face meeting, and near consensus based on 70%.Sixteen of 22 invited paediatric cataract surgeons agreed to participate. We arrived at consensus or near consensus for 85/108 (78.7%) questions and non-consensus for the remaining 23 (21.3%) questions.Those questions where consensus was not reached highlight areas of either poor evidence or contradicting evidence, and may help investigators identify possible research questions.

    View details for DOI 10.1136/bjophthalmol-2015-307287

    View details for Web of Science ID 000375333000007

    View details for PubMedID 26420824

  • Evaluating the evidence for and against the use of IOLs in infants and young children EXPERT REVIEW OF MEDICAL DEVICES Kumar, P., Lambert, S. R. 2016; 13 (4): 381-389

    Abstract

    Congenital cataracts account for 5-20% of childhood blindness worldwide. In the US, the prevalence of visually significant infantile cataracts is anywhere from 3-4 per 10,000 live births. Infantile cataracts need to be removed early in life in order to prevent the onset of deprivation amblyopia. As a result, cataract surgery is usually performed between age 4-8 weeks depending on the laterality and severity of the cataract. Given advances in the field, pediatric cataract surgery is now a safe and effective intervention for infants, but good visual outcomes require occlusion therapy and optical correction. This review will address current perspectives on the use of intraocular lenses to optically correct infants and young children after cataract surgery, as well as novel designs for intraocular lenses and directions for future research.

    View details for DOI 10.1586/17434440.2016.1153967

    View details for Web of Science ID 000372805000002

    View details for PubMedID 26878234

    View details for PubMedCentralID PMC4860524

  • Should Glasses Be Prescribed for All Children with Moderate Hyperopia? OPHTHALMOLOGY Lambert, S. R. 2016; 123 (4): 676-678

    View details for DOI 10.1016/j.ophtha.2015.12.035

    View details for Web of Science ID 000372718300009

    View details for PubMedID 27012695

  • Clinical Models and Algorithms for the Prediction of Retinopathy of Prematurity A Report by the American Academy of Ophthalmology OPHTHALMOLOGY Hutchinson, A. K., Melia, M., Yang, M. B., VanderVeen, D. K., Wilson, L. B., Lambert, S. R. 2016; 123 (4): 804-816

    Abstract

    To assess the accuracy with which available retinopathy of prematurity (ROP) predictive models detect clinically significant ROP and to what extent and at what risk these models allow for the reduction of screening examinations for ROP.A literature search of the PubMed and Cochrane Library databases was conducted last on May 1, 2015, and yielded 305 citations. After screening the abstracts of all 305 citations and reviewing the full text of 30 potentially eligible articles, the panel members determined that 22 met the inclusion criteria. One article included 2 studies, for a total of 23 studies reviewed. The panel extracted information about study design, study population, the screening algorithm tested, interventions, outcomes, and study quality. The methodologist divided the studies into 2 categories-model development and model validation-and assigned a level of evidence rating to each study. One study was rated level I evidence, 3 studies were rated level II evidence, and 19 studies were rated level III evidence.In some cohorts, some models would have allowed reductions in the number of infants screened for ROP without failing to identify infants requiring treatment. However, the small sample size and limited generalizability of the ROP predictive models included in this review preclude their widespread use to make all-or-none decisions about whether to screen individual infants for ROP. As an alternative, some studies proposed approaches to apply the models to reduce the number of examinations performed in low-risk infants.Additional research is needed to optimize ROP predictive model development, validation, and application before such models can be used widely to reduce the burdensome number of ROP screening examinations.

    View details for DOI 10.1016/j.ophtha.2015.11.003

    View details for Web of Science ID 000372718300025

    View details for PubMedID 26832657

  • Diffuse bilateral retinal hemorrhages in an infant with a coagulopathy and prolonged cardiopulmonary resuscitation JOURNAL OF AAPOS Levinson, J. D., Pasquale, M. A., Lambert, S. R. 2016; 20 (2): 166-168

    Abstract

    We report a case of diffuse bilateral retinal and optic nerve sheath hemorrhages in an 8-week-old boy who was found unresponsive. The child underwent prolonged cardiopulmonary resuscitation and was noted on admission to have a coagulopathy. An autopsy determined the cause of death to be a myocardial infarct in the distribution of an anomalous coronary artery. This case demonstrates the difficulty that may occur in establishing whether child abuse caused death in the setting of another potential cause of mortality.

    View details for DOI 10.1016/j.jaapos.201.5.11.003

    View details for Web of Science ID 000374620500016

    View details for PubMedID 26988775

    View details for PubMedCentralID PMC4833622

  • Sensorimotor outcomes by age 5 years after monocular cataract surgery in the Infant Aphakia Treatment Study (IATS) JOURNAL OF AAPOS Bothun, E. D., Lynn, M. J., Christiansen, S. P., Neely, D. E., VanderVeen, D. K., Kruger, S. J., Lambert, S. R. 2016; 20 (1): 49-53

    Abstract

    To evaluate sensorimotor outcomes among children in the Infant Aphakia Treatment Study (IATS).Secondary outcome analysis was performed in this randomized, multicenter, clinical trial comparing treatment of unilateral aphakia with a primary intraocular lens (IOL) or contact lens (CL) correction. The alignment characteristics and sensory status of children through age 5 years were evaluated.In the IATS study, 91 of 112 children (81%) developed strabismus through age 5 years. Of 34 infants who were orthotropic at near 12 months after cataract surgery, at age 5 years 14 (41%) were orthotropic at distance, and 15 (44%) were orthotropic at near at age 5 years without strabismus surgery. Eight of 56 children (14%) in the CL group and 13 of 56 (23%) in the IOL group were orthotropic at distance (P = 0.33) at 5 years of age and had no history of strabismus surgery. Thirteen of 48 (27%) who underwent cataract surgery prior to 49 days of age compared to 8 of 64 (13%) who had surgery after 49 days were orthotropic (P = 0.085). Median visual acuity in the operative eye was 0.4 logMAR (20/50) for children with orthotropia or microtropia (<10(Δ)) versus 1.10 logMAR (20/252) for strabismus ≥10(Δ) (P = 0.0001). Stereopsis was detected in 12 of 21 children (57%) with orthotropia versus 16 of 89 (18%) children with strabismus (P = 0.0006).IOL placement does not reduce the development of strabismus after monocular congenital cataract surgery. Improved ocular alignment by age 5 years correlated strongly with improved visual acuity and stereopsis.

    View details for DOI 10.1016/j.jaapos.2015.11.002

    View details for Web of Science ID 000371187200011

    View details for PubMedID 26917072

    View details for PubMedCentralID PMC4869943

  • Improved Vision and Contact Lens Wear Time With Piggy-Back Contact Lens Systems in Children After Penetrating Corneal Trauma. Eye & contact lens Cromelin, C., Russell, B., Lambert, S. R. 2016: -?

    Abstract

    Consecutive case series of children treated successfully with "piggy-back" (PB) contact lens systems after corneal trauma.We reviewed the medical record of all children ages 4 to 14 years treated at the Emory Eye Center between January 11, 2003 and January 11, 2013 with PB contact lens systems.Four children with a history of corneal penetrating trauma were treated with a PB lens system, with a mean age of 7±0.08 (range: 6-8) years. Best-corrected spectacle vision was count fingers in two children and logMAR +0.70 (Snellen equivalent 20/100) and logMAR +0.6 (Snellen equivalent 20/80) in the remaining two. The PB lens system was introduced with a mean of 15.7±6.5 (range: 9-22) months after the injury. All patients were initially fitted with gas-permeable (GP) lenses. Each child achieved 11 or more hours of daily contact lens wear time in PB systems. The mean best-corrected logMAR visual acuity using the PB system was 0.26±0.21 (Snellen equivalent 20/36). The mean improvement in best-corrected logMAR between GP and PB lens systems was +0.21±0.11, which corresponds to an improvement of greater than two lines on the Snellen chart.Piggy-back contact lens systems can be helpful to improve vision and contact lens wearing time in children with irregular astigmatism after corneal trauma, who are intolerant of GP contact lenses.

    View details for PubMedID 26808698

  • Changes in Ocular Growth after Pediatric Cataract Surgery. Developments in ophthalmology Lambert, S. R. 2016; 57: 29-39

    Abstract

    The human eye undergoes extensive changes during early childhood, including axial elongation, corneal flattening and reduced lens power. Animal studies have shown that removing the crystalline lens during infancy retards axial elongation. Axial elongation has been studied in children after cataract extraction both directly and indirectly. Children with a unilateral congenital cataract generally have a shorter axial length in their cataractous eye than in their fellow eye. This difference usually persists after cataract surgery. While some studies have reported a modest reduction in axial elongation after cataract extraction, the magnitude of this effect is much less than what has been reported in animal models. Choosing an intraocular lens (IOL) power for implantation into a child's eye is complicated by continued ocular growth, the inaccuracy of IOL power calculation formulas for small eyes, and the difficulty of accurately measuring the biometrics of a child's eye. In addition, given the fixed position of an IOL in the eye, increasing elongation of the posterior segment of the eye relative to the anterior segment magnifies the myopic shift that occurs with ocular growth. The targeted refractive error in young children undergoing IOL implantation should be an undercorrection in anticipation of a future myopic shift.

    View details for DOI 10.1159/000442498

    View details for PubMedID 27043390

  • Corneal Changes in Children after Unilateral Cataract Surgery in the Infant Aphakia Treatment Study OPHTHALMOLOGY Morrison, D. G., Lynn, M. J., Freedman, S. F., Orge, F. H., Lambert, S. R. 2015; 122 (11): 2186-2192

    Abstract

    We report endothelial cell (EC) characteristics and central corneal thickness (CCT) from the Infant Aphakia Treatment Study (IATS) patients at the 5-year examination.Randomized, controlled trial of the treatment of unilateral cataract with aphakic contact lens (CL) versus primary intraocular lens (IOL) implant.A total of 114 infants with unilateral cataract.The EC density, coefficient of variation (CV), and percent hexagonal cells were measured by noncontact specular microscopy. The CCT was measured using contact pachymetry. Fellow eyes served as controls.Mean differences between treated and fellow eyes of CL and IOL groups were compared with a paired t test. A 1-way analysis of variance model and the Tukey-Kramer multiple comparison procedure were used to assess the effect of a diagnosis of glaucoma or glaucoma suspect.A total of 105 subjects (52 with CLs, 53 with IOLs) had specular microscopy or corneal thickness data recorded. Mean EC densities were higher in aphakic eyes compared with fellow eyes (3921 vs. 3495 cells/mm2, P<0.0001). Mean CV was higher (27 vs. 24, P=0.0002) and mean percent hexagonal cells was lower (72% vs. 76%, P=0.002) in aphakic eyes compared with fellow eyes. Mean CCT of aphakic eyes was higher than in controls (637 vs. 563 μm, P<0.0001). There was no difference in EC density in eyes treated with IOLs compared with fellow eyes (3445 and 3487 cells/mm2, P=0.68). Means for CV (25 vs. 24, P=0.07) and percent hexagonal cells (74 vs. 76%, P=0.27) were also not significantly different. Mean CCT was higher in eyes with IOLs (605 vs. 571 μm, P<0.0001) compared with fellow eyes. Compared with treated eyes without glaucoma or glaucoma suspect, treated eyes with glaucoma had lower EC density (3289 vs. 3783 cells/mm2, P=0.03) and treated eyes with glaucoma suspect had greater mean corneal thickness (660 vs. 612 μm, P=0.0036).Cataract extraction during infancy with IOL implantation was not associated with a reduced EC count in treated compared with fellow eyes, although CCT was increased. Extended-wear aphakic CLs may cause corneal polymegathism with increased EC density and CCT. Glaucoma diagnosis was associated with reduced EC counts and increased CCT.

    View details for DOI 10.1016/j.ophtha.2015.07.011

    View details for Web of Science ID 000363491800019

    View details for PubMedID 26271843

    View details for PubMedCentralID PMC4624013

  • Neonatal aphakia is associated with altered levels of dopamine metabolites in the non-human primate retina. Experimental eye research Iuvone, P. M., Haque, R., Fernandes, A., Lambert, S. R. 2015; 140: 187-189

    Abstract

    Neonatal aphakia is associated with retardation of the axial elongation of the neonatal eye. In contrast, form deprivation increases axial elongation, an effect that has been associated with decreased retinal dopamine metabolism. The present investigation was conducted to test the hypothesis that neonatal aphakia induces an effect on the levels of retinal dopamine opposite to form deprivation. Lensectomy and vitrectomy were performed on the right eyes of rhesus monkeys at approximately 1 week of age; their left eyes were unmanipulated. Axial length was measured by A-scan ultrasonography. Prior to surgery, mean axial length of the right and left eyes was identical. Following lens removal, both eyes continued to elongate, however the aphakic eyes elongated at a slower rate resulting in a significant shorter axial length compared to that of the unmanipulated eye. Removal of the crystalline lens had no effect on steady-state dopamine levels in either central or peripheral retina. However, levels of the dopamine metabolites, 3,4-dihydroxyphenylacetic acid and homovanillic acid were significantly elevated in central retina, but not in the peripheral retina of aphakic eyes. Our results support the hypothesis that dopamine is a component of the retinal signaling pathways that are involved in the regulation of eye growth and emmetropization.

    View details for DOI 10.1016/j.exer.2015.09.002

    View details for PubMedID 26368851

    View details for PubMedCentralID PMC4624564

  • The Association of Race With Childhood Uveitis AMERICAN JOURNAL OF OPHTHALMOLOGY Angeles-Han, S. T., McCracken, C., Yeh, S., Jenkins, K., Stryker, D., Travers, C., Rouster-Stevens, K., Vogler, L. B., Lambert, S. R., Drews-Botsch, C., Prahalad, S. 2015; 160 (5): 919-928

    Abstract

    To identify risk factors for a severe uveitis course among children with noninfectious uveitis.Retrospective cohort study.This was a retrospective analysis of a prospectively collected database. Records of 94 children with uveitis were reviewed at enrollment and every 3-6 months (2011-2015). Severe uveitis was defined as a history of ocular complications or a visual acuity (VA) of ≤20/200. Children were compared by disease, VA, complications, and race. Regression models were used to model risk factors for severe disease. When examining race, we focused on non-Hispanic African-American and non-Hispanic white children only.Of 85 children with uveitis and complete ocular examinations, 27 (32%) had a history of a VA of ≤20/200. A subanalysis of non-Hispanic African-American and white children showed an increased prevalence of VA ≤20/200 in non-Hispanic African-Americans (18/25; 72% vs 4/43; 9%). Non-Hispanic African-Americans were more likely to be diagnosed at an older age (P = .030) and to have intermediate uveitis (P = .026), bilateral disease (P = .032), a history of VA ≤20/50 (P = .002), VA ≤20/200 (P < .001), and a higher rate of complications (P < .001). On multivariable analysis, non-Hispanic African-American race was a significant predictor of blindness (OR = 31.6, 95% CI 5.9-168.5, P < .001), after controlling for uveitis duration. Non-Hispanic African-Americans also developed 2.2 times more unique complications per year of disease than non-Hispanic whites when controlling for uveitis type and duration.There appear to be racial differences in the outcomes of children with uveitis. Non-Hispanic African-American children with non-juvenile idiopathic arthritis-associated uveitis may have worse visual outcomes with increased vision loss and ocular complications. These findings highlight the need for future studies in minority populations.

    View details for DOI 10.1016/j.ajo.2015.08.002

    View details for Web of Science ID 000363914800011

    View details for PubMedID 26255577

    View details for PubMedCentralID PMC4661073

  • Neonatal aphakia is associated with altered levels of dopamine metabolites in the non-human primate retina EXPERIMENTAL EYE RESEARCH Iuvone, P. M., Hague, R., Fernandes, A., Lambert, S. R. 2015; 140: 187-189
  • Using the Effects of Youngsters' Eyesight on Quality of Life Questionnaire to Measure Visual Outcomes in Children With Uveitis ARTHRITIS CARE & RESEARCH Angeles-Han, S. T., Yeh, S., McCracken, C., Jenkins, K., Stryker, D., Myoung, E., Vogler, L. B., Rouster-Stevens, K., Lambert, S. R., Harrison, M. J., Prahalad, S., Drews-Botsch, C. 2015; 67 (11): 1513-1520

    Abstract

    The Effects of Youngsters' Eyesight on Quality of Life (EYE-Q) is a novel measure of vision-related quality of life (QOL) and function in children. We aim to determine the validity of the EYE-Q in childhood uveitis.We abstracted medical record data on arthritis and uveitis in a convenience sample of children with juvenile idiopathic arthritis (JIA) and/or uveitis. In addition to the EYE-Q, parents and patients completed questionnaires on overall QOL (Pediatric Quality of Life Inventory [PedsQL]), and physical functioning (Childhood Health Assessment Questionnaire [C-HAQ]).Among 57 children (8 JIA, 24 JIA and uveitis, 25 uveitis alone), 102 ocular examinations were performed within 1 month of completing questionnaires. Uveitis patients had bilateral disease (69%), anterior involvement (78%), synechiae (51%), and cataracts (49%). Children with vision loss in their better eye (visual acuity [VA] 20/50 or worse) had worse EYE-Q (P = 0.006) and PedsQL (P = 0.028) scores, but not C-HAQ scores. The EYE-Q moderately correlated with logMAR VA (rs  = -0.43), PedsQL (rs  = 0.43), and C-HAQ (rs  = -0.45), but was not correlated with anterior chamber cells or intraocular pressure. The PedsQL and C-HAQ did not correlate with VA or cells. There were strong correlations between the parent and child EYE-Q (rs  = 0.62). Cronbach's α for the child report was 0.91. The EYE-Q had strong test-retest reliability (rs  = 0.75).The EYE-Q may be an important tool in the assessment of visual outcomes in childhood uveitis and an improvement over general measures in detecting changes in vision-related function.

    View details for DOI 10.1002/acr.22627

    View details for Web of Science ID 000363688600004

    View details for PubMedID 26037544

    View details for PubMedCentralID PMC4624475

  • Glaucoma-Related Adverse Events in the First 5 Years After Unilateral Cataract Removal in the Infant Aphakia Treatment Study. JAMA ophthalmology Freedman, S. F., Lynn, M. J., Beck, A. D., Bothun, E. D., Örge, F. H., Lambert, S. R. 2015; 133 (8): 907-914

    Abstract

    Glaucoma-related adverse events constitute major sight-threatening complications of cataract removal in infancy, yet their relationship to aphakia vs primary intraocular lens (IOL) implantation remains unsettled.To identify and characterize cases of glaucoma and glaucoma-related adverse events (glaucoma + glaucoma suspect) among children in the Infant Aphakia Treatment Study by the age of 5 years.A multicenter randomized clinical trial of 114 infants with unilateral congenital cataract in referral centers who were between ages 1 and 6 months at surgery. Mean follow-up was 4.8 years. This secondary analysis was conducted from December 23, 2004, to November 13, 2013.Participants were randomized at cataract surgery to either primary IOL or no IOL implantation (contact lens). Standardized definitions of glaucoma and glaucoma suspect were created for the Infant Aphakia Treatment Study and applied for surveillance and diagnosis.Development of glaucoma and glaucoma + glaucoma suspect in operated on eyes for children up to age 5 years, plus intraocular pressure, visual acuity, and axial length at age 5 years.Product limit estimates of the risk for glaucoma and glaucoma + glaucoma suspect at 4.8 years after surgery were 17% (95% CI, 11%-25%) and 31% (95% CI, 24%-41%), respectively. The contact lens and IOL groups were not significantly different for either outcome: glaucoma (hazard ratio [HR], 0.8; 95% CI, 0.3-2.0; P = .62) and glaucoma + glaucoma suspect (HR, 1.3; 95% CI, 0.6-2.5; P = .58). Younger (vs older) age at surgery conferred an increased risk for glaucoma (26% vs 9%, respectively) at 4.8 years after surgery (HR, 3.2; 95% CI, 1.2-8.3), and smaller (vs larger) corneal diameter showed an increased risk for glaucoma + glaucoma suspect (HR, 2.5; 95% CI, 1.3-5.0). Age and corneal diameter were significantly positively correlated. Glaucoma was predominantly open angle (19 of 20 cases, 95%), most eyes received medication (19 of 20, 95%), and 8 of 20 eyes (40%) underwent surgery.These results suggest that glaucoma-related adverse events are common and increase between ages 1 and 5 years in infants after unilateral cataract removal at 1 to 6 months of age; primary IOL placement does not mitigate their risk but surgery at a younger age increases the risk. Longer follow-up of these children may further characterize risk factors, long-term outcomes, potential differences between eyes having primary IOL vs aphakia, and optimal timing of unilateral congenital cataract removal.clinicaltrials.gov Identifier: NCT00212134.

    View details for DOI 10.1001/jamaophthalmol.2015.1329

    View details for PubMedID 25996491

    View details for PubMedCentralID PMC4547792

  • Structural changes of the anterior chamber following cataract surgery during infancy JOURNAL OF CATARACT AND REFRACTIVE SURGERY Nguyen, M., Shainberg, M., Beck, A. D., Lambert, S. R. 2015; 41 (8): 1784-1786

    View details for Web of Science ID 000362998800033

    View details for PubMedID 26432141

  • Reply: To PMID 25266841. Journal of AAPOS Lambert, S. R., Lenhart, P. D., Leon, M., Hutchinson, A. K. 2015; 19 (4): 393-?

    View details for DOI 10.1016/j.jaapos.2015.05.008

    View details for PubMedID 26296787

  • Glaucoma-Related Adverse Events in the First 5 Years After Unilateral Cataract Removal in the Infant Aphakia Treatment Study JAMA OPHTHALMOLOGY Freedman, S. F., Lynn, M. J., Beck, A. D., Bothun, E. D., Oerge, F. H., Lambert, S. R. 2015; 133 (8): 907-914
  • Characteristics of a cohort of children with Juvenile Idiopathic Arthritis and JIA-associated Uveitis PEDIATRIC RHEUMATOLOGY Angeles-Han, S. T., McCracken, C., Yeh, S., Jenkins, K., Stryker, D., Rouster-Stevens, K., Vogler, L. B., Lambert, S. R., Drews-Botsch, C., Prahalad, S. 2015; 13

    Abstract

    Juvenile idiopathic arthritis-associated uveitis (JIA-U) can lead to poor visual outcomes and impact a child's quality of life (QOL) and function. Our aim is to identify risk markers of JIA-U and examine differences in the QOL of children with JIA and JIA-U.Rheumatology and ophthalmology record reviews and questionnaires were completed every 4-6 months on 287 children with JIA. We collected arthritis, uveitis, and QOL data. We examined data through last study visit.There were 52/287 (18%) children with JIA-U who were younger at arthritis diagnosis, had oligoarticular persistent JIA, and ANA positive. Confirmed uveitis predictors were age at JIA diagnosis (OR = 0.86) and oligoarticular subtype (OR = 5.92). They had worse vision specific QOL and function, but similar general QOL. Blindness occurred in 17.5% of children but was more common in African American children compared to non-Hispanic Caucasian children ((5/7 (71%) vs. 2/29 (7%), p <0.001) despite a similar uveitis prevalence (22% vs. 16%). Both races had similar complications, although band keratopathy was more frequent in African Americans (75% vs. 15.6%, p = 0.003).We confirm young age at JIA diagnosis and the oligoarticular JIA subtype as predictors of uveitis development. Although we were unable to identify predictors of ocular complications or blindness, AA children appeared to have a more severe disease course manifested by increased ocular complications, vision loss and blindness. Potential causes that warrant additional study include underlying disease severity, access to medical care and referral bias. Further investigation of the risk factors for vision-compromising uveitis and its' long-term effects should be conducted in a large racially diverse population.

    View details for DOI 10.1186/s12969-015-0018-8

    View details for Web of Science ID 000355398900001

    View details for PubMedID 26031738

    View details for PubMedCentralID PMC4450472

  • Outcomes after Intravitreal Bevacizumab versus Laser Photocoagulation for Retinopathy of Prematurity A 5-Year Retrospective Analysis OPHTHALMOLOGY Hwang, C. K., Hubbard, G. B., Hutchinson, A. K., Lambert, S. R. 2015; 122 (5): 1008-1015

    Abstract

    To determine the relative effectiveness, major complications, and refractive errors associated with intravitreal bevacizumab (IVB) versus panretinal photocoagulation (PRP) to treat type 1 retinopathy of prematurity (ROP).Retrospective case series.Consecutive infants with type 1 ROP who received either IVB or PRP and had at least 6 months of follow-up.The data from infants treated with either IVB or PRP for type 1 ROP between 2008 and 2012 were recorded from 2 medical centers in Atlanta, Georgia.Recurrence rate, complication rate, and refractive error.A total of 54 eyes (28 patients) with type 1 ROP were evaluated: 22 eyes (11 patients) received IVB, and 32 eyes (17 patients) received PRP. Among the 22 eyes treated with IVB, 16 eyes had zone I ROP and 6 eyes had posterior zone II ROP. The number of zone I and II ROP eyes treated with PRP were 5 and 27, respectively. Mean gestational age, birth weight, postmenstrual age at initial treatment, and follow-up period for the infants receiving IVB were 24.2 weeks, 668.1 g, 35.1 weeks, and 21.7 weeks, respectively, and for the infants receiving PRP, these were 24.8 weeks, 701.4 g, 36.1 weeks, and 34.5 weeks, respectively. Retinopathy of prematurity recurred in 3 (14%) of 22 IVB-treated eyes and in 1 (3%) of 32 PRP-treated eyes. Neither retinal detachment nor macular ectopia developed in any of the IVB-treated eyes. In PRP-treated eyes, retinal detachment developed in only 1 eye and macular ectopia developed in 5 eyes. Mean spherical equivalent and postgestational age at the last refraction for IVB-treated eyes were -2.4 diopters (D) and 22.4 months, respectively, and for PRP-treated eyes, these were -5.3 D and 37.1 months, respectively. Mean spherical equivalent for zone I ROP eyes treated with IVB and PRP were -3.7 D and -10.1 D, respectively, and for zone II ROP eyes, these were 0.6 D and -4.7 D, respectively.Both IVB and PRP are effective treatment options for type 1 ROP with low complication rates. IVB was associated with less myopia than PRP, although longer follow-up was available for PRP.

    View details for DOI 10.1016/j.ophtha.2014.12.017

    View details for Web of Science ID 000353337600028

    View details for PubMedID 25687024

    View details for PubMedCentralID PMC4414677

  • Global challenges in the management of congenital cataract: proceedings of the 4th International Congenital Cataract Symposium held on March 7, 2014, New York, New York. Journal of AAPOS Lenhart, P. D., Courtright, P., Wilson, M. E., Lewallen, S., Taylor, D. S., Ventura, M. C., Bowman, R., Woodward, L., Ditta, L. C., Kruger, S., Haddad, D., El Shakankiri, N., Rai, S. K., Bailey, T., Lambert, S. R. 2015; 19 (2): e1-8

    Abstract

    Childhood cataracts have become a leading cause of preventable childhood blindness in many areas of the world. Here we summarize regional focus group discussions from the 4th Annual International Congenital Cataract Symposium on the current situation, challenges, and recommendations for the management of congenital cataracts in sub-Saharan Africa, the Middle East and North Africa, South Asia, Central America, South America, and developed nations. Strategies for managing congenital cataracts must be adapted and developed according to regional conditions. A basic framework for acceptable outcomes must focus on developing systems to address the critical components of education, access, quality care, and good follow-up.

    View details for DOI 10.1016/j.jaapos.2015.01.013

    View details for PubMedID 25892047

    View details for PubMedCentralID PMC4423595

  • The Infant Aphakia Treatment Study: Further on intra- and postoperative complications in the intraocular lens group JOURNAL OF AAPOS Lambert, S. R., Plager, D. A., Buckley, E. G., Wilson, M. E., DuBois, L., Drews-Botsch, C. D., Hartmann, E. E., Lynn, M. J. 2015; 19 (2): 101-103

    View details for DOI 10.1016/j.jaapos.2015.01.012

    View details for Web of Science ID 000353664400001

    View details for PubMedID 25892038

    View details for PubMedCentralID PMC4927330

  • Cost of Intraocular Lens versus Contact Lens Treatment after Unilateral Congenital Cataract Surgery in the Infant Aphakia Treatment Study at Age 5 Years OPHTHALMOLOGY Kruger, S. J., DuBois, L., Becker, E. R., Morrison, D., Wilson, L., Wilson, M. E., Lambert, S. R. 2015; 122 (2): 288-292

    Abstract

    To analyze differences in the cost of treatment for infants randomized to primary intraocular lens (IOL) implantation versus optical correction with a contact lens (CL) after unilateral cataract surgery in the Infant Aphakia Treatment Study (IATS).Retrospective cost analysis of a prospective, randomized clinical trial based on Georgia Medicaid reimbursement data as well as actual costs of supplies used during the study, adjusted for inflation.The IATS is a multicenter (n = 12), randomized clinical trial comparing the optical treatment of aphakia with either primary IOL implantation (n = 57) or CL correction (n = 57) in 114 infants with unilateral congenital cataract.One hundred fourteen infants underwent unilateral cataract surgery and were either corrected optically by primary IOL implantation at the time of surgery or were corrected with a CL after surgery.The mean cost of cataract surgery and all additional surgeries, examinations, and supplies used up to 5 years of age.The 5-year treatment cost of an infant with a unilateral congenital cataract corrected optically with an IOL was $27 090 versus $25 331 for a patient treated with a CL after initial cataract surgery. The total cost of supplies was $3204 in the IOL group versus $7728 in the CL group.Unilateral cataract surgery in infancy coupled with primary IOL implantation is approximately 7% more expensive than aphakia and CL correction. Patient costs are more than double with CL versus IOL treatment.

    View details for DOI 10.1016/j.ophtha.2014.08.037

    View details for Web of Science ID 000348290000020

    View details for PubMedID 25439604

    View details for PubMedCentralID PMC4306643

  • Predictors of Good Motor and Sensory Outcomes Following Strabismus Surgery for Patients with Third Nerve Palsies. Neuro-ophthalmology Peragallo, J. H., Bruce, B. B., Hutchinson, A. K., Lenhart, P. D., Biousse, V., Newman, N. J., Lambert, S. R. 2015; 39 (1): 12-16

    Abstract

    Strabismus from third nerve palsy (3NP) is difficult to treat. Our goal was to explore factors associated with successful surgical outcomes in 3NP. Institutional records of all adult patients (>18 years) from 1988 to 2012 with 3NP who underwent strabismus surgery or botulinum toxin injections were retrospectively reviewed. Success was defined as absence of diplopia, vertical deviation ≤2 prism dioptres (PD), and horizontal deviation ≤10 PD. Fifty-six patients from four surgeons were included. Thirty (54%) were female; mean age was 48 (range: 20-80). Forty-four (79%) had unilateral 3NP; 9 (16%) had other ocular motor nerve palsies. 3NP were complete in 24 (43%). Underlying aetiology was idiopathic/microvascular in 5 (9%), traumatic in 13 (23%), neoplastic in 12 (21%), aneurysmal in 10 (18%), and other central nervous system related in 16 (29%). Trauma was associated more frequently with aberrant regeneration than other aetiologies: 9/13 (69%) versus 4/43 (9%) (p < 0.01). Ten patients (18%) had >1 surgery. Surgical success was achieved in 28/56 (50%). Success rate was unaffected by aetiology, degree of palsy, pupillary involvement, presence of aberrant regeneration, or number of other cranial nerves involved. However, adjustable sutures were used in 27 patients (48%), and there was a trend toward higher success rates when adjustable versus nonadjustable sutures were used (63% versus 38%; p = 0.06). Unlike with sixth nerve palsies, the aetiology and degree of 3NP does not appear to affect the success rates or number of procedures performed. Strabismus surgeries for 3NP with adjustable sutures may be associated with better outcomes.

    View details for PubMedID 27928324

  • Baseline Characteristics of the Infant Aphakia Treatment Study Population: Predicting Recognition Acuity at 4.5 Years of Age INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Hartmann, E. E., Lynn, M. J., Lambert, S. R. 2015; 56 (1): 388-395

    View details for DOI 10.1167/iovs.14-15464

    View details for Web of Science ID 000351519800042

    View details for PubMedID 25503455

  • Stereopsis Results at 4.5 Years of Age in the Infant Aphakia Treatment Study AMERICAN JOURNAL OF OPHTHALMOLOGY Hartmann, E. E., Stout, A. U., Lynn, M. J., Yen, K. G., Kruger, S. J., Lambert, S. R. 2015; 159 (1): 64-70

    Abstract

    To determine whether stereopsis of infants treated for monocular cataracts varies with the type of optical correction used.Randomized prospective clinical trial.The Infant Aphakia Treatment Study randomized 114 patients with unilateral cataracts at age 1-7 months to either primary intraocular lens (IOL) or contact lens correction. At 4.5 years of age a masked examiner assessed stereopsis on these patients using 3 different tests: (1) Frisby; (2) Randot Preschool; and (3) Titmus Fly.Twenty-eight patients (25%) had a positive response to at least 1 of the stereopsis tests. There was no statistically significant difference in stereopsis between the 2 treatment groups: Frisby (contact lens, 6 [11%]; IOL, 7 [13%]; P = .99), Randot (contact lens, 3 [6%]; IOL, 1 [2%]; P = .62), or Titmus (contact lens, 8 [15%]; IOL, 13 [23%]; P = .34). The median age at surgery for patients with stereopsis was younger than for those without stereopsis (1.2 vs 2.4 months; P = .002). The median visual acuity for patients with stereopsis was better than for those without stereopsis (20/40 vs 20/252; P = .0003).The type of optical correction did not influence stereopsis outcomes. However, 2 other factors did: age at surgery and visual acuity in the treated eye at age 4.5 years. Early surgery for unilateral congenital cataract and the presence of visual acuity better than or equal to 20/40 appear to be more important than the type of initial optical correction used for the development of stereopsis.

    View details for DOI 10.1016/j.ajo.2014.09.028

    View details for Web of Science ID 000347747500009

    View details for PubMedID 25261241

    View details for PubMedCentralID PMC4262546

  • Baseline characteristics of the infant aphakia treatment study population: predicting recognition acuity at 4.5 years of age. Investigative ophthalmology & visual science Hartmann, E. E., Lynn, M. J., Lambert, S. R. 2014; 56 (1): 388-395

    Abstract

    To identify patient baseline characteristics that predict recognition acuity at 4.5 years of age in the Infant Aphakia Treatment Study, a study of patients with monocular infantile cataracts.We analyzed baseline characteristics of the 114 infants enrolled in the Infant Aphakia Treatment Study to determine which were most predictive of visual outcome at 4.5 years of age. All infants underwent cataract surgery between 1 and 7 months of age. Monocular acuity was assessed at 4.5 years of age by a traveling examiner using the Amblyopia Treatment Study HOTV protocol.Age at cataract surgery was weakly associated with visual acuity (Spearman rank correlation coefficient = 0.19, P = 0.041) with median visual acuity better among the younger patients (28-48 days: 0.50 logMAR, 49-210 days: 1.10 logMAR, P = 0.046). Patients from families with private insurance had significantly better median visual acuity (0.60 vs. 1.40 logMAR, P = 0.0004). No other baseline characteristic revealed a significant bivariate relationship with visual acuity. A multiple linear regression relating visual acuity to all baseline characteristics demonstrated that only the availability of private insurance was statistically significant, accounting for 12% of the variance.This analysis concurs with previous studies that early surgery is important for good visual outcomes in patients with unilateral infantile cataracts. The fact that only one baseline variable (private insurance) contributed to the multivariate analysis, accounting for 12% of the variance, suggests that predicting visual outcome for these patients is complicated at best, and cannot be estimated from baseline characteristics alone. (ClinicalTrials.gov number, NCT00212134.).

    View details for DOI 10.1167/iovs.14-15464

    View details for PubMedID 25503455

    View details for PubMedCentralID PMC4296771

  • The Role of Magnetic Resonance Imaging in Diagnosing Optic Nerve Hypoplasia AMERICAN JOURNAL OF OPHTHALMOLOGY Lenhart, P. D., Desai, N. K., Bruce, B. B., Hutchinson, A. K., Lambert, S. R. 2014; 158 (6): 1164-1171

    Abstract

    To establish objective lower limits of normal optic nerve (ON) size in children based on high-resolution orbital magnetic resonance imaging (MRI).Case-control study of patients with ON hypoplasia vs normal controls.A neuroradiologist made 4 measurements of each ON at 2 locations (5 mm posterior to the optic disc and just posterior to the optic canal) in patients with ON hypoplasia and controls aged 0-17 years from an academic eye center and children's hospital. Primary analyses were performed using mixed linear models.Measurements were made in 26 cases of clinically confirmed ON hypoplasia and 31 controls (median age: ON hypoplasia, 1 year; controls, 5.5 years). Nine of 26 cases (35%) and 19 of 31 controls (61%) underwent high-resolution T2-weighted imaging of the orbits. Mean ON diameter was 1.36 mm (95% CI: 1.19-1.54; P < .001) smaller for clinically hypoplastic ONs than for controls. Optic nerve diameter increased by 0.05 mm per year of age (95% CI: 0.03-0.07; P < .001). A lower bound to the 95% prediction interval for normal optic nerves was (2.24 mm + 0.052 × [age in years]) mm and excluded all but 1 case.Age was independently associated with normal ON size by MRI and should be taken into consideration when evaluating ON hypoplasia, based on MRI criteria. We have provided a formula to assist clinicians in objectively determining if ON hypoplasia is present.

    View details for DOI 10.1016/j.ajo.2014.08.013

    View details for Web of Science ID 000345820400010

    View details for PubMedID 25128595

    View details for PubMedCentralID PMC4252492

  • In reply. JAMA ophthalmology Lambert, S. R., Lynn, M. J., Hartmann, E. E. 2014; 132 (12): 1492-1493

    View details for DOI 10.1001/jamaophthalmol.2014.3542

    View details for PubMedID 25256439

    View details for PubMedCentralID PMC4928636

  • Reply: To PMID 25077835. American journal of ophthalmology Plager, D. A., Lynn, M. J., Lambert, S. R., Buckley, E. G., Wilson, M. E. 2014; 158 (6): 1361-1362

    View details for DOI 10.1016/j.ajo.2014.09.019

    View details for PubMedID 25457713

  • Complications in the First 5 Years Following Cataract Surgery in Infants With and Without Intraocular Lens Implantation in the Infant Aphakia Treatment Study AMERICAN JOURNAL OF OPHTHALMOLOGY Plager, D. A., Lynn, M. J., Buckley, E. G., Wilson, M. E., Lambert, S. R. 2014; 158 (5): 892-898

    Abstract

    To compare rates and severity of complications between infants undergoing cataract surgery with and without intraocular lens (IOL) implantation.Prospective randomized clinical trial.A total of 114 infants were enrolled in the Infant Aphakia Treatment Study, a randomized, multi-center (12) clinical trial comparing the treatment of unilateral aphakia in patients under 7 months of age with a primary IOL implant or contact lens. The rate, character, and severity of intraoperative complications, adverse events, and additional intraocular surgeries during the first 5 postoperative years in the 2 groups were examined.There were more patients with intraoperative complications (28% vs 11%, P = .031), adverse events (81% vs 56%, P = .008), and more additional intraocular surgeries (72% vs 16%, P < .0001) in the IOL group than in the contact lens group. However, the number of patients with adverse events in the contact lens group increased (15 to 24) in postoperative years 2-5 compared to the first postoperative year, while it decreased (44 to 14) in years 2-5 compared to the first postoperative year in the IOL group. If only one half of the patients in the contact lens (aphakic) group eventually undergo secondary IOL implantation, the number of additional intraocular surgeries in the 2 groups will be approximately equal.The increased rate of complications, adverse events, and additional intraocular surgeries associated with IOL implantation in infants <7 months of age militates toward leaving babies aphakic if it is considered likely that the family will be successful with contact lens correction.

    View details for DOI 10.1016/j.ajo.2014.07.031

    View details for Web of Science ID 000343783400006

    View details for PubMedID 25077835

    View details for PubMedCentralID PMC4547784

  • The cost-effectiveness of different strategies to evaluate optic disk drusen in children JOURNAL OF AAPOS Leon, M., Hutchinson, A. K., Lenhart, P. D., Lambert, S. R. 2014; 18 (5): 449-452

    Abstract

    To compare the costs of diagnostic work-up for optic disk drusen where ophthalmic ultrasound was performed prior to imaging and invasive studies with those where ophthalmic ultrasound was performed after such studies.The medical records of patients <18 years of age evaluated at a tertiary referral center between 2007 and 2012 for "swollen" optic nerves were retrospectively reviewed. The main outcome measure was cost of diagnostic work-up according to Georgia Medicaid global reimbursement rates.A total of 46 children with a B-scan ultrasound-confirmed diagnosis of calcified optic disk drusen were included. Neuroimaging was performed in 23 patients, of whom 20 had the study prior to ophthalmic ultrasound. The mean cost of evaluations for patients undergoing ancillary testing prior to ophthalmic ultrasound was $1,173; for those undergoing ancillary testing after, $305.Because optic disk drusen can mimic the appearance of papilledema, it is more cost-effective to perform ophthalmic ultrasonography prior to neuroimaging, especially when the patient is asymptomatic. If ophthalmic ultrasonography confirms the presence of drusen, it is more cost-effective to reassess the clinical picture before proceeding with further tests.

    View details for DOI 10.1016/j.jaapos.2014.06.006

    View details for Web of Science ID 000343854200009

    View details for PubMedID 25266841

    View details for PubMedCentralID PMC4254085

  • Author reply: To PMID 23419803. Ophthalmology Bothun, E. D., Lynn, M. J., Lambert, S. R. 2014; 121 (10)

    View details for DOI 10.1016/j.ophtha.2014.05.011

    View details for PubMedID 24909820

    View details for PubMedCentralID PMC4945164

  • The effects of surgical factors on postoperative astigmatism in patients enrolled in the Infant Aphakia Treatment Study (IATS) JOURNAL OF AAPOS Wall, P. B., Lee, J. A., Lynn, M. J., Lambert, S. R., Traboulsi, E. I. 2014; 18 (5): 441-445

    Abstract

    To evaluate the effect of surgical factors on postoperative astigmatism in infants undergoing cataract extraction with or without intraocular lens (IOL) implantation.The Infant Aphakia Treatment Study is a multicenter clinical trial in which 114 infants with unilateral congenital cataracts were randomized to undergo cataract extraction with IOL placement or contact lens aphakic correction. Surgical videos were reviewed with regard to incision type and location, whether the incision was extended, the number of sutures placed, and technique of closure. Corneal astigmatism was measured using a handheld keratometer prior to surgery and at 1 year of age.Corneal astigmatism decreased from a mean of 1.92 D at baseline to 1.62 D at age 1 year in the contact lens group but remained almost unchanged from 2.00 D to 2.09 D in the IOL group (P = 0.023). There was no statistical difference between the amount of corneal astigmatism with regard to incision type (P = 0.214) and no increase in astigmatism with extension of the incision to facilitate IOL placement (P = 0.849) at 1 year. The number of sutures and technique of closure did not influence the amount of astigmatism at 1 year.At the age of 1 year following cataract extraction in infants, contact lens correction and the lack of IOL placement are associated with a significant decrease in postoperative corneal astigmatism compared to IOL placement. No other surgical factors considered in this study had a statistically significant effect on corneal astigmatism.

    View details for DOI 10.1016/j.jaapos.2014.06.016

    View details for Web of Science ID 000343854200007

    View details for PubMedID 25266831

    View details for PubMedCentralID PMC4547783

  • Postoperative Glaucoma Following Infantile Cataract Surgery An Individual Patient Data Meta-analysis JAMA OPHTHALMOLOGY Mataftsi, A., Haidich, A., Kokkali, S., Rabiah, P. K., Birch, E., Stager, D. R., Cheong-Leen, R., Singh, V., Egbert, J. E., Astle, W. F., Lambert, S. R., Amitabh, P., Khan, A. O., Grigg, J., Arvanitidou, M., Dimitrakos, S. A., Nischal, K. K. 2014; 132 (9): 1059-1067

    Abstract

    Infantile cataract surgery bears a significant risk for postoperative glaucoma, and no consensus exists on factors that may reduce this risk.To assess the effect of primary intraocular lens implantation and timing of surgery on the incidence of postoperative glaucoma.We searched multiple databases to July 14, 2013, to identify studies with eligible patients, including PubMed, MEDLINE, EMBASE, ISI Web of Science, Scopus, Central, Google Scholar, Intute, and Tripdata. We also searched abstracts of ophthalmology society meetings.We included studies reporting on postoperative glaucoma in infants undergoing cataract surgery with regular follow-up for at least 1 year. Infants with concurrent ocular anomalies were excluded.Authors of eligible studies were invited to contribute individual patient data on infants who met the inclusion criteria. We also performed an aggregate data meta-analysis of published studies that did not contribute to the individual patient data. Data were pooled using a random-effects model.Time to glaucoma with the effect of primary implantation, additional postoperative intraocular procedures, and age at surgery.Seven centers contributed individual patient data on 470 infants with a median age at surgery of 3.0 months and median follow-up of 6.0 years. Eighty patients (17.0%) developed glaucoma at a median follow-up of 4.3 years. Only 2 of these patients had a pseudophakic eye. The risk for postoperative glaucoma appeared to be lower after primary implantation (hazard ratio [HR], 0.10 [95% CI, 0.01-0.70]; P = .02; I(2) = 34%), higher after surgery at 4 weeks or younger (HR, 2.10 [95% CI, 1.14-3.84]; P = .02; I(2) = 0%), and higher after additional procedures (HR, 2.52 [95% CI, 1.11-5.72]; P = .03; I(2) = 32%). In multivariable analysis, additional procedures independently increased the risk for glaucoma (HR, 2.25 [95% CI, 1.20-4.21]; P = .01), and primary implantation independently reduced it (HR, 0.10 [95% CI, 0.01-0.76]; P = .03). Results were similar in the aggregate data meta-analysis that included data from 10 published articles.Although confounding factors such as size of the eye and surgeon experience are not accounted for in this meta-analysis, the risk for postoperative glaucoma after infantile cataract surgery appears to be influenced by the timing of surgery, primary implantation, and additional intraocular surgery.

    View details for DOI 10.1001/jamaophthalmol.2014.1042

    View details for Web of Science ID 000343059600006

    View details for PubMedID 24921712

  • Nystagmus and Related Fixation Instabilities Following Extraction of Unilateral Infantile Cataract in the Infant Aphakia Treatment Study (IATS) INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Felius, J., Busettini, C., Lynn, M. J., Hartmann, E. E., Lambert, S. R. 2014; 55 (8): 5332-5337

    Abstract

    To study eye movements in a large group of children after the removal of unilateral infantile cataract, and to compare fixation instabilities between treatment groups with or without IOL implantation.The Infant Aphakia Treatment Study (IATS) is a randomized, multicenter clinical trial comparing IOL to contact lens (CL) treatment with a unilateral infantile cataract in participants who underwent cataract surgery at 1 to 6 months of age. At age 4.5 years, eye movements were recorded in 103 participants, using a high-speed video camera while the child performed a fixation task. The recordings were inspected by masked readers for the presence of fixation instabilities (nystagmus and saccadic oscillations).Overall, fixation instabilities were observed in 50 (60%) of 83 children who had evaluable recordings, with no differences between treatment groups (27 [64%] of 42 in the IOL group, 23 [56%] of 41 in the CL group; P = 0.51). Nystagmus was seen in 38% and saccadic oscillations in 31%, with no differences between treatment groups (P > 0.33). Children without a fixation instability had better visual acuity (P = 0.04).Nystagmus and saccadic oscillations are well-known consequences of infantile cataracts, presumably the result of visual deprivation during the critical period of visual development. After early cataract extraction, successful optical correction may reduce further form deprivation and minimize the incidence of these fixation instabilities. In this study, no differences in the presence of fixation instabilities were found between the two treatment strategies (CL or IOL) for optical correction after cataract removal. (ClinicalTrials.gov number, NCT00212134.).

    View details for DOI 10.1167/iovs.14-14710

    View details for Web of Science ID 000343145500087

    View details for PubMedID 25097243

    View details for PubMedCentralID PMC4580212

  • Comparison of Contact Lens and Intraocular Lens Correction of Monocular Aphakia During Infancy A Randomized Clinical Trial of HOTV Optotype Acuity at Age 4.5 Years and Clinical Findings at Age 5 Years JAMA OPHTHALMOLOGY Lambert, S. R., Lynn, M. J., Hartmann, E. E., DuBois, L., Drews-Botsch, C., Freedman, S. F., Plager, D. A., Buckley, E. G., Wilson, E. 2014; 132 (6): 676-682

    Abstract

    The efficacy and safety of primary intraocular lens (IOL) implantation during early infancy is unknown.To compare the visual outcomes of patients optically corrected with contact lenses vs IOLs following unilateral cataract surgery during early infancy.The Infant Aphakia Treatment Study is a randomized clinical trial with 5 years of follow-up that involved 114 infants with unilateral congenital cataracts at 12 sites. A traveling examiner assessed visual acuity at age 4.5 years.Cataract surgery with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Treatment was determined through random assignment.HOTV optotype visual acuity at 4.5 years of age.The median logMAR visual acuity was not significantly different between the treated eyes in the 2 treatment groups (both, 0.90 [20/159]; P = .54). About 50% of treated eyes in both groups had visual acuity less than or equal to 20/200. Significantly more patients in the IOL group had at least 1 adverse event after cataract surgery (contact lens, 56%; IOL, 81%; P = .02). The most common adverse events in the IOL group were lens reproliferation into the visual axis, pupillary membranes, and corectopia. Glaucoma/glaucoma suspect occurred in 35% of treated eyes in the contact lens group vs 28% of eyes in the IOL group (P = .55). Since the initial cataract surgery, significantly more patients in the IOL group have had at least 1 additional intraocular surgery (contact lens, 21%; IOL, 72%; P < .001).There was no significant difference between the median visual acuity of operated eyes in children who underwent primary IOL implantation and those left aphakic. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group. When operating on an infant younger than 7 months of age with a unilateral cataract, we recommend leaving the eye aphakic and focusing the eye with a contact lens. Primary IOL implantation should be reserved for those infants where, in the opinion of the surgeon, the cost and handling of a contact lens would be so burdensome as to result in significant periods of uncorrected aphakia.clinicaltrials.gov Identifier: NCT00212134

    View details for DOI 10.1001/jamaophthalmol.2014.531

    View details for Web of Science ID 000337889000004

    View details for PubMedID 24604348

  • Reply: To PMID 24011524. American journal of ophthalmology VanderVeen, D. K., Trivedi, R. H., Nizam, A., Lynn, M. J., Lambert, S. R. 2014; 157 (6): 1332-1333

    View details for DOI 10.1016/j.ajo.2014.02.053

    View details for PubMedID 24881851

  • The role of preoperative biometry in selecting initial contact lens power in the Infant Aphakia Treatment Study JOURNAL OF AAPOS Trivedi, R. H., Lambert, S. R., Lynn, M. J., Wilson, M. E. 2014; 18 (3): 251-254

    Abstract

    To investigate the role of preoperative biometry for selecting initial contact lens power.Patients randomized to receive contact lenses in the Infant Aphakia Treatment Study (IATS) were retrospectively analyzed. Inclusion criteria were availability of both a preoperative immersion axial length measurement and a 1-month postoperative refractive value. The target contact lens power for distance was determined using 1-month postoperative spherical equivalent refraction (after adjusting for a vertex distance) over the known contact lens power. We compared targeted contact lens power for distance with three other treatment techniques: (1) 30 D contact lens (32 D minus 2 D overcorrection for near vision based on IATS protocol); (2) regression-estimated contact lens power of 84.4 - 3.2 × axial length; and (3) IOL power calculated using the Sanders-Retzlaff-Kraff (SRK/T) regression formula with a modified A-constant (112.176). Prediction error (targeted minus estimated contact lens power) and its absolute values were calculated.A total of 34 eyes of 34 patients met inclusion criteria. Age at the time of cataract surgery was 2.4 ± 1.7 months. Follow-up refraction was performed at 31 ± 3 days after surgery. Target contact lens power for distance was 26.0 ± 4.5 D for the IATS cohort (which excluded infants with corneal diameter <9 mm). The mean prediction error was -4.0, -1.0, and -2.0 D and mean absolute prediction error was 4.4, 2.2, and 2.9 D, respectively, for 30 D contact lens, regression, and SRK/T-estimated power.Preoperative biometry can be used to estimate contact lens power for distance if an accurate refraction cannot be obtained initially.

    View details for DOI 10.1016/j.jaapos.2014.01.012

    View details for Web of Science ID 000337715900009

    View details for PubMedID 24924278

    View details for PubMedCentralID PMC4080905

  • Functional and Motor Outcomes of Strabismus Surgery for Chronic Isolated Adult Sixth Nerve Palsy. Neuro-ophthalmology Peragallo, J. H., Bruce, B. B., Hutchinson, A. K., Lenhart, P. D., Biousse, V., Newman, N. J., Lambert, S. R. 2014; 38 (6): 320-325

    Abstract

    Abducens nerve palsy is the most common acquired ocular motor nerve palsy in adults. Chronic cases of abducens palsy often require surgical intervention to relieve disabling diplopia. The goal of this study was to identify factors associated with surgical outcomes in isolated abducens palsy. Medical records of all adult patients from 1988 to 2012 with abducens palsies who underwent strabismus procedures were retrospectively reviewed. Motor alignment, extraocular motility, and sensory outcomes were recorded. Success was defined as absence of diplopia without prisms or face turn, vertical deviation ≤2 prism dioptres (PD), and horizontal deviation ≤10 PD. Eighty-one patients (age range: 20-86 years) met inclusion criteria. Success was achieved in 58% of patients. Final success rates for abducens palsy were 50% for neoplastic, 59% traumatic, 57% for microvascular/unknown, and 67% for other central nervous system causes (p > 0.05). Patients with an underlying neoplastic or traumatic aetiology required more than one strabismus procedure more often than those with microvascular/idiopathic or other central nervous system causes (48% vs. 24%; p = 0.03). For complete abducens palsies, patients who underwent Hummelsheim-type procedures had a higher success rate than those who underwent a full-tendon vertical rectus muscle transposition. (78% versus 35%; p = 0.049). Success rates for strabismus procedures in patients with abducens palsies are similar across all aetiologies. Frequency of re-operation is higher among those patients with neoplastic or traumatic aetiologies for their abducens palsies. Hummelsheim-type procedures have a higher success rate for complete abducens palsies than full-tendon vertical rectus transpositions.

    View details for PubMedID 27928319

  • Strabismus surgery outcomes after scleral buckling procedures for retinal reattachment. Strabismus Chang, J. H., Hutchinson, A. K., Zhang, M., Lambert, S. R. 2013; 21 (4): 235-241

    Abstract

    To investigate the outcomes of strabismus surgery in patients with a prior history of a scleral buckling procedure for retinal reattachment.We reviewed the medical records of 18 patients who underwent strabismus surgery following a scleral buckling procedure and investigated the effect of multiple variables on postoperative alignment after strabismus surgery including gender, age, surgeon, number of strabismus surgeries, adjustable suture use, previous pars plana vitrectomy, preoperative best-corrected visual acuity, and scleral buckle removal. Outcomes were considered successful if there was ≤ 10 prism diopters (PD) residual horizontal and/or ≤ 4 PD residual vertical deviations. Statistical analyses were performed using Fisher's exact test, Mann-Whitney test, and nominal logistic regression.Success using our criteria of motor alignment was achieved in 6 of 18 eyes (33%). A higher rate of success was found in the scleral buckle removal group (success with buckle removal, 62.5%; success without buckle removal, 10.0%; p = 0.04). Nominal logistic regression analysis showed scleral buckle removal was the most significant factor associated with successful surgical alignment (p = 0.03; odds ratio = 16.67). Although the success rate was higher in the adjustable suture group (50% in adjustable group vs 14.3% in non-adjustable group: Fisher's exact test, p = 0.30), this difference was not statistically significant. No retinal redetachments occurred after scleral buckle removal.These results suggest that scleral buckles can be safely removed in selected patients with strabismus following retinal reattachment surgery and scleral buckle removal may improve ocular alignment following strabismus surgery.

    View details for DOI 10.3109/09273972.2013.851260

    View details for PubMedID 24299332

    View details for PubMedCentralID PMC4562672

  • Predictability of Intraocular Lens Power Calculation Formulae in Infantile Eyes With Unilateral Congenital Cataract: Results from the Infant Aphakia Treatment Study AMERICAN JOURNAL OF OPHTHALMOLOGY VanderVeen, D. K., Trivedi, R. H., Nizam, A., Lynn, M. J., Lambert, S. R. 2013; 156 (6): 1252-1260

    Abstract

    To compare accuracy of intraocular lens (IOL) power calculation formulae in infantile eyes with primary IOL implantation.Comparative case series.The Hoffer Q, Holladay 1, Holladay 2, Sanders-Retzlaff-Kraff (SRK) II, and Sanders-Retzlaff-Kraff theoretic (SRK/T) formulae were used to calculate predicted postoperative refraction for eyes that received primary IOL implantation in the Infant Aphakia Treatment Study. The protocol targeted postoperative hyperopia of +6.0 or +8.0 diopters (D). Eyes were excluded for invalid biometry, lack of refractive data at the specified postoperative visit, diagnosis of glaucoma or suspected glaucoma, or sulcus IOL placement. Actual refraction 1 month after surgery was converted to spherical equivalent and prediction error (predicted refraction - actual refraction) was calculated. Baseline characteristics were analyzed for effect on prediction error for each formula. The main outcome measure was absolute prediction error.Forty-three eyes were studied; mean axial length was 18.1 ± 1.1 mm (in 23 eyes, it was <18.0 mm). Average age at surgery was 2.5 ± 1.5 months. Holladay 1 showed the lowest median absolute prediction error (1.2 D); a paired comparison of medians showed clinically similar results using the Holladay 1 and SRK/T formulae (median difference, 0.3 D). Comparison of the mean absolute prediction error showed the lowest values using the SRK/T formula (1.4 ± 1.1 D), followed by the Holladay 1 formula (1.7 ± 1.3 D). Calculations with an optimized constant showed the lowest values and no significant difference between the Holladay 1 and SRK/T formulae (median difference, 0.3 D). Eyes with globe AL of less than 18 mm had the largest mean and median prediction error and absolute prediction error, regardless of the formula used.The Holladay 1 and SRK/T formulae gave equally good results and had the best predictive value for infant eyes.

    View details for DOI 10.1016/j.ajo.2013.07.014

    View details for Web of Science ID 000327674900024

    View details for PubMedID 24011524

  • Fibrin Glue for Closure of Conjunctival Incision in Strabismus Surgery A Report by the American Academy of Ophthalmology OPHTHALMOLOGY Yang, M. B., Melia, M., Lambert, S. R., Chiang, M. F., Simpson, J. L., Buffenn, A. N. 2013; 120 (9): 1935-1941

    Abstract

    To evaluate the severity of postoperative inflammation, degree of patient discomfort, adequacy of wound closure, and length of operating time when using fibrin glue compared with sutures to close limbal conjunctival incisions after strabismus surgery.Literature searches of the PubMed and Cochrane Library databases were last conducted on January 24, 2013, and resulted in 24 citations, including 2 not in the English language. All citations were reviewed in full text. Five studies compared fibrin glue (68 eyes) with sutures (74 eyes) for closure of limbal conjunctival incisions in patients undergoing strabismus surgery and were included in this assessment; no studies were found that evaluated fornix incisions. A quality rating was assigned to each study using criteria specifically developed for this assessment.No level I studies were found, and 5 level II studies were identified. There was significantly less postoperative inflammation and patient discomfort for 1 to 3 weeks after strabismus surgery for eyes treated with fibrin glue compared with sutures. In 3 studies that evaluated wound apposition, 2 of 50 eyes (4%) with conjunctival incisions that were initially closed using fibrin glue subsequently developed a wound gap that required suture repair. In the 2 studies that compared surgical time, fibrin glue required 1 to 5 minutes less time than suturing in 1 study and 55% less time (3.8 vs. 8.4 minutes) in a second study. These 5 studies did not evaluate the cost-effectiveness or risk of viral transmission from fibrin glue.Studies in the literature suggest that the off-label use of fibrin glue to close limbal conjunctival incisions in strabismus surgery resulted in less postoperative inflammation and required shorter operating time compared with sutures, but it increased the percentage of wounds requiring subsequent repair with sutures.The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    View details for DOI 10.1016/j.ophtha.2013.05.008

    View details for Web of Science ID 000324045800051

    View details for PubMedID 23820078

  • Reply: To PMID 23639132. American journal of ophthalmology Lambert, S. R., Superak, H. M., Lynn, M. J., Beck, A. D. 2013; 156 (3): 629-?

    View details for DOI 10.1016/j.ajo.2013.06.002

    View details for PubMedID 23953163

  • Long-term Risk of Glaucoma After Congenital Cataract Surgery AMERICAN JOURNAL OF OPHTHALMOLOGY Lambert, S. R., Purohit, A., Superak, H. M., Lynn, M. J., Beck, A. D. 2013; 156 (2): 355-361

    Abstract

    To report the long-term risk of glaucoma development in children following congenital cataract surgery.Retrospective interventional consecutive case series.We retrospectively reviewed the records of 62 eyes of 37 children who underwent congenital cataract surgery when <7 months of age by the same surgeon using a limbal approach. The Kaplan-Meier method was used to calculate the probability of an eye's developing glaucoma and/or becoming a glaucoma suspect over time.The median age of surgery was 2.0 months and the median follow-up after cataract surgery was 7.9 years (range, 3.2-23.5 years). Nine eyes (14.5%) developed glaucoma a median of 4.3 months after cataract surgery and an additional 16 eyes (25.8%) were diagnosed as glaucoma suspects a median of 8.0 years after cataract surgery. The probability of an eye's developing glaucoma was estimated to be 19.5% (95% CI: 10.0%-36.1%) by 10 years after congenital cataract surgery. When the probability of glaucoma and glaucoma suspect were combined, the risk increased to 63.0% (95% CI: 43.6%-82.3%).Long-term monitoring of eyes after congenital cataract surgery is important because we estimate that nearly two thirds of these eyes will develop glaucoma or become glaucoma suspects by 10 years after cataract surgery.

    View details for DOI 10.1016/j.ajo.2013.03.013

    View details for Web of Science ID 000322748200021

    View details for PubMedID 23639132

    View details for PubMedCentralID PMC3720778

  • One-Year Strabismus Outcomes in the Infant Aphakia Treatment Study OPHTHALMOLOGY Bothun, E. D., Cleveland, J., Lynn, M. J., Christiansen, S. P., VanderVeen, D. K., Neely, D. E., Kruger, S. J., Lambert, S. R. 2013; 120 (6): 1227-1231

    Abstract

    To evaluate the characteristics of strabismus in infants who underwent cataract surgery with and without intraocular lens (IOL) implantation.Secondary outcome analysis in a prospective, randomized clinical trial.The Infant Aphakia Treatment Study is a randomized, multicenter (n = 12), clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with a unilateral congenital cataract.Infants underwent cataract surgery with or without placement of an IOL.The proportion of patients in whom strabismus developed during the first 12 months of follow-up was calculated using the life-table method and was compared across treatment groups and age strata using a log-rank test.Strabismus developed within the first 12 months of follow-up in 38 pseudophakic infants (life-table estimate, 66.7%) and 42 infants (life-table estimate, 74.5%) treated with contact lenses (P = 0.59). The younger cohort (<49 days) at the time of surgery demonstrated less strabismus (29 of 50; life-table estimate, 58.0%) than the older cohort (≥ 49 days; 51 of 64; life-table estimate, 80.0%; P<0.01).Intraocular lens placement does not prevent the early development of strabismus after congenital cataract surgery. However, strabismus was less likely to develop in infants whose cataract was removed at an earlier age.The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    View details for DOI 10.1016/j.ophtha.2012.11.039

    View details for Web of Science ID 000320650700028

    View details for PubMedID 23419803

  • Candida species lens abscesses in infants with a history of neonatal Candida sepsis JOURNAL OF AAPOS Couser, N. L., Hubbard, G. B., Lee, L. B., Hutchinson, A. K., Lambert, S. R. 2013; 17 (2): 208-210

    Abstract

    We report 3 patients who were delivered prematurely and who developed a lens opacity with signs of ocular inflammation at a postgestational age of 10-52 weeks. All patients had been treated for Candida sepsis as neonates. Each patient underwent lensectomy and anterior vitrectomy. In 2 infants Candida albicans was cultured from the lens/anterior chamber membrane; in 1 Candida parapsilosis was cultured from a lens aspirate. Despite eradication of the fungal infection, outcomes were poor: 2 eyes developed glaucoma, and 1 developed a retinal detachment with subsequent phthisis.

    View details for DOI 10.1016/j.jaapos.2012.11.006

    View details for Web of Science ID 000319027700020

    View details for PubMedID 23622453

    View details for PubMedCentralID PMC3782386

  • Rebound Tonometry in Children A Report by the American Academy of Ophthalmology OPHTHALMOLOGY Lambert, S. R., Melia, M., Buffenn, A. N., Chiang, M. F., Simpson, J. L., Yang, M. B. 2013; 120 (4): E21-E27

    Abstract

    To compare intraocular pressure (IOP) measurements in children 18 years of age and younger using rebound tonometry and applanation tonometry and the feasibility of using these techniques in children.Literature searches of the PubMed and the Cochrane Library databases were last conducted in June 2012 and resulted in 43 citations, including citations not in English. Of these 43 citations, 4 studies met the inclusion criterion following full text review. A level of evidence rating was assigned to each study using criteria specifically developed for this assessment.No level I study was found in the literature search, and 2 level II and 2 level III studies were identified. Intraocular pressure was 2 to 3 mmHg higher using rebound tonometry compared with Goldmann applanation tonometry in the 2 level II studies performed in a clinic setting and in 1 level III study performed on children under general anesthesia. However, IOP was lower in 1 level III study in which noncontact applanation tonometry was compared with rebound tonometry. Bland-Altman plots showed that the difference in IOP for rebound versus Goldmann applanation tonometry increased as the IOP increased. The success rate for measuring IOP was markedly higher in children 3 years of age and younger using rebound tonometry compared with noncontact tonometry in 1 level III study.Rebound tonometry seems to be a reasonably accurate instrument that allows the IOP to be measured in many children without using general anesthesia. More data are required to assess better how the differences between instruments vary with IOP measurement.

    View details for DOI 10.1016/j.ophtha.2012.09.058

    View details for Web of Science ID 000317343500001

    View details for PubMedID 23395545

  • Cost of Intraocular Lens versus Contact Lens Treatment after Unilateral Congenital Cataract Surgery: Retrospective Analysis at Age 1 Year OPHTHALMOLOGY Carrigan, A. K., DuBois, L. G., Becker, E. R., Lambert, S. R. 2013; 120 (1): 14-19

    Abstract

    To describe the differences in treatment costs for infants randomized to contact lens correction versus primary intraocular lens (IOL) implantation after unilateral cataract surgery in the Infant Aphakia Treatment Study (IATS).Retrospective cost analysis of a prospective, randomized clinical trial based on Georgia Medicaid data and the actual costs of supplies used.The IATS is a randomized, multicenter (n=12) clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with unilateral congenital cataract.Infants underwent cataract surgery with or without placement of an IOL.The mean cost of cataract surgery and all additional surgeries, examinations, and supplies used up to 12 months of age.The mean cost of treatment for a unilateral congenital cataract with primary IOL implantation was $14 752 versus $10 726 with contact lens correction. The initial cataract surgery accounted for approximately 50% of the treatment costs for both groups. Contact lens costs accounted for 15% ($1600/patient) in the aphakic group, whereas glasses costs represented only 4% ($535/patient) in the IOL group. The increased costs in the IOL group were primarily due to the higher cost of cataract surgery in this group ($7302 vs. $5357) and the cost of additional operations.For IATS patients up to 12 months of age, cataract surgery coupled with IOL implantation and spectacle correction was 37.5% (∼$4000) more expensive than cataract surgery coupled with contact lens correction.The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    View details for DOI 10.1016/j.ophtha.2012.07.049

    View details for Web of Science ID 000313011700005

    View details for PubMedID 23047003

  • The efficacy of botulinum toxin treatment for children with a persistent esotropia following bilateral medial rectus recessions and lateral rectus resections. The American orthoptic journal Lambert, S. R., Shainberg, M. J. 2013; 63: 24-28

    Abstract

    To report on the outcomes of treating children with a persistent esotropia with an injection of botulinum toxin in a medial rectus muscle.The medical records were reviewed of all children at one institution with a persistent esotropia after bilateral medial rectus recessions and bilateral lateral rectus resections then treated with a botulinum toxin injection.Five patients with a mean preoperative esotropia of 37Δ (range 25–50Δ) underwent bilateral medial rectus recessions and then bilateral lateral rectus resections. Their residual esotropia (mean of 25Δ; range 18–35Δ) was then treated with a single injection of 3–5 units of botulinum toxin into one medial rectus muscle. The patients were then followed for a mean of 34 months (range 14–79 months). At last follow-up, two patients had an esotropia <10Δ. The other three patients had no long-term improvement in their ocular alignment. Two of these patients then underwent additional strabismus surgery. In both cases, they then developed a consecutive exotropia.Treatment with a single injection of botulinum toxin was beneficial in 2 of 5 children. Botulinum toxin treatment alone did not result in a consecutive exotropia in any patients treated.

    View details for DOI 10.3368/aoj.63.1.24

    View details for PubMedID 24260804

  • A Randomized Trial Comparing the Cost-effectiveness of 2 Approaches for Treating Unilateral Nasolacrimal Duct Obstruction ARCHIVES OF OPHTHALMOLOGY Lee, K. A., Chandler, D. L., Repka, M. X., Beck, R. W., Foster, N. C., Frick, K. D., Golden, R. P., Lambert, S. R., Melia, M., Tien, D. R., Weakley, D. R. 2012; 130 (12): 1525-1533

    Abstract

    To compare the cost-effectiveness of 2 approaches for treating unilateral nasolacrimal duct obstruction (NLDO).One hundred sixty-three infants aged 6 to less than 10 months with unilateral NLDO were randomly assigned to receive immediate office-based nasolacrimal duct probing (n = 82) or 6 months of observation/nonsurgical management (n = 81) followed by probing in a facility for persistent symptoms.Treatment success was defined as the absence of clinical signs of NLDO (epiphora, increased tear lake, mucous discharge) on masked examination at age 18 months. Cost of treatment between randomization and age 18 months included costs for all surgical procedures and medications.In the observation/deferred facility-probing group, NLDO resolved within 6 months without surgery in 44 of the 67 patients (66%; 95% CI, 54% to 76%) who completed the 6-month visit. Twenty-two (27%) of the 81 patients in the observation/deferred facility-probing group underwent surgery, 4 of whom were operated on within the initial 6 months. At age 18 months, 69 of 75 patients (92%) in the immediate office-probing group were treatment successes, compared with 58 of 71 observation/deferred facility-probing group patients (82%) (10% difference in success; 95% CI, -1% to 21%). The mean cost of treatment was $562 in the immediate office-probing group compared with $701 in the observation/deferred facility-probing group (difference, -$139; 95% CI, -$377 to $94). The immediate office-probing group experienced 3.0 fewer months of symptoms (95% CI, -1.8 to -4.0).The immediate office-probing approach is likely more cost-effective than observation followed by deferred facility probing if needed. Adoption of the immediate office-probing approach would result in probing in approximately two-thirds of infants whose obstruction would have resolved within 6 months of nonsurgical management, but would largely avoid the need for probing under general anesthesia.Although unilateral NLDO often resolves without surgery, immediate office probing is an effective and potentially cost-saving treatment option.clinicaltrials.gov Identifier: NCT00780741.

    View details for Web of Science ID 000312195300003

    View details for PubMedID 23229693

  • Botulinum toxin a treatment of consecutive esotropia in children. Strabismus Couser, N. L., Lambert, S. R. 2012; 20 (4): 158-161

    Abstract

    To assess the outcome of botulinum A toxin (BTXA) to treat surgically overcorrected intermittent exotropia in children.A retrospective analysis was performed on a series of children with consecutive esotropia treated with BTXA.Six children with a mean consecutive esotropia of 21 prism diopters (PD) were treated with BTXA at a mean of 19.8 months following strabismus surgery. Two patients underwent a single injection, three patients 2 injections, and one patient 3 injections. Complications included transient ptosis and a vertical deviation. Mean follow-up from last BTXA injection was 16 months. At last follow-up, 4 of the 6 patients were orthotropic and stereopsis was present in 4 of 5 patients old enough to cooperate with testing. One patient was treated with strabismus surgery following a single BTXA injection.BTXA is an efficacious treatment for consecutive esotropia in children. However, in our series, two-thirds of patients required multiple injections to achieve the desired outcome and one ultimately had an additional strabismus surgery.

    View details for DOI 10.3109/09273972.2012.702324

    View details for PubMedID 23211140

    View details for PubMedCentralID PMC3863577

  • Axial Elongation following Cataract Surgery during the First Year of Life in the Infant Aphakia Treatment Study INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Lambert, S. R., Lynn, M. J., DuBois, L. G., Cotsonis, G. A., Hartmann, E. E., Wilson, M. E. 2012; 53 (12): 7539-7545

    Abstract

    To compare ocular axial elongation in infants after unilateral cataract surgery corrected with a contact lens (CL) or primary intraocular lens (IOL) implantation.Baseline axial length (AL) was measured at the time of cataract surgery (1-6 months) and at age 1 year. AL at baseline and age 1 year and the change in length/mo were analyzed in relation to treatment modality, cataractous versus fellow eye, and age at surgery using linear mixed models.Mean baseline AL did not differ between the CL and IOL groups for either cataractous or fellow eyes. Eyes with cataracts were shorter than fellow eyes by an average of 0.6 mm (95% confidence interval [CI], 0.4-0.8 mm; P < 0.0001). For the operated eyes, the mean change in AL/mo was smaller in the CL group (0.17 mm/mo) than in the IOL group (0.24 mm/mo) (P = 0.0006) and was independent of age at surgery (P = 0.19). In contrast, the change in AL/mo for fellow eyes decreased with older age at surgery (P < 0.0001). At age 1 year, operated eyes treated with a CL were 0.6 mm shorter on average than operated eyes treated with an IOL (P = 0.009).At baseline, eyes with cataracts were shorter than fellow eyes. The change in AL/mo was smaller in operated eyes treated with a CL than in operated eyes treated with an IOL, but was not significantly related to age at surgery. (ClinicalTrials.gov number, NCT00212134.).

    View details for DOI 10.1167/iovs.12-10285

    View details for Web of Science ID 000313053500015

    View details for PubMedID 23074203

    View details for PubMedCentralID PMC3493185

  • The Infant Aphakia Treatment Study Contact Lens Experience: One-Year Outcomes EYE & CONTACT LENS-SCIENCE AND CLINICAL PRACTICE Russell, B., Ward, M. A., Lynn, M., DuBois, L., Lambert, S. R. 2012; 38 (4): 234-239

    Abstract

    We describe our experience correcting a cohort of infants with contact lenses in the Infant Aphakia Treatment Study.Fifty-seven infants 1-6 months of age were randomized to contact lens wear. An examination under anesthesia was performed at the time of enrollment and at approximately 1 year of age. A traveling examiner assessed visual acuity at approximately 1 year of age.Forty-two treated eyes (74 %) were fitted with silicone elastomer (SE) contact lenses; 12 eyes (21 %) with rigid gas permeable (RGP) contact lenses, and 3 eyes (5%) wore both lens types. Median visual acuity was +0.80 logMAR in both lens type-wearing groups. The mean (± SD) keratometric power of the treated eyes was 46.3±2.8 D at baseline and 44.6±2.3 D at 1 year of age for a mean decrease of 0.2±0.2 D/mo. Keratometric astigmatism of treated eyes was 1.98±1.37 D at baseline and 1.62±0.98 D at 1 year of age for a mean decrease of 0.05±0.2 D/mo. The mean RGP lens base curve at baseline was 47.62 D±2.62 D versus 47.00 D±3.50 D at 12 months after surgery. Children wearing SE lenses required a mean of 10.9 replacements (range 2-24) compared to 16.8 replacements (range 8-32) for children wearing RGP lenses. Three adverse events occurred.Contact lenses were worn successfully with relatively few adverse events by a cohort of infants with unilateral aphakia. The visual acuity results were identical independent of the contact lens material or modality. RGP lenses needed replacement more often than SE lenses.

    View details for DOI 10.1097/ICL.0b013e3182562dc0

    View details for Web of Science ID 000306083800007

    View details for PubMedID 22669008

    View details for PubMedCentralID PMC3386356

  • Detection of Clinically Significant Retinopathy of Prematurity Using Wide-angle Digital Retinal Photography A Report by the American Academy of Ophthalmology OPHTHALMOLOGY Chiang, M. F., Melia, M., Buffenn, A. N., Lambert, S. R., Recchia, F. M., Simpson, J. L., Yang, M. B. 2012; 119 (6): 1272-1280

    Abstract

    To evaluate the accuracy of detecting clinically significant retinopathy of prematurity (ROP) using wide-angle digital retinal photography.Literature searches of PubMed and the Cochrane Library databases were conducted last on December 7, 2010, and yielded 414 unique citations. The authors assessed these 414 citations and marked 82 that potentially met the inclusion criteria. These 82 studies were reviewed in full text; 28 studies met inclusion criteria. The authors extracted from these studies information about study design, interventions, outcomes, and study quality. After data abstraction, 18 were excluded for study deficiencies or because they were superseded by a more recent publication. The methodologist reviewed the remaining 10 studies and assigned ratings of evidence quality; 7 studies were rated level I evidence and 3 studies were rated level III evidence.There is level I evidence from ≥5 studies demonstrating that digital retinal photography has high accuracy for detection of clinically significant ROP. Level III studies have reported high accuracy, without any detectable complications, from real-world operational programs intended to detect clinically significant ROP through remote site interpretation of wide-angle retinal photographs.Wide-angle digital retinal photography has the potential to complement standard ROP care. It may provide advantages through objective documentation of clinical examination findings, improved recognition of disease progression by comparing previous photographs, and the creation of image libraries for education and research.Proprietary or commercial disclosure may be found after the references.

    View details for DOI 10.1016/j.ophtha.2012.01.002

    View details for PubMedID 22541632

  • Resolution of Congenital Nasolacrimal Duct Obstruction With Nonsurgical Management ARCHIVES OF OPHTHALMOLOGY Petersen, D. B., Chandler, D. L., Repka, M. X., Beck, R. W., Crouch, E. R., Lee, K. A., Melia, M., Morrison, D. G., Orge, F. H., Ticho, B. H., Sala, N. A., Hodde, R. M., Zeto, V. L., Schweinler, B. R., Plum, L. W., McMurtrey, J. R., Tien, R., Yoon-Huang, G. H., McGuinness, M. B., De La Rosa, J. M., Bailey, C. M., Marinaro, J. A., Khammar, A. J., Clausius, D. A., Coletta, J. B., Imler, B. C., Bremer, D. L., Cassady, C. M., Golden, R. P., McGregor, M. L., Rogers, D. L., Rogers, G. L., Fellows, R. R., McMillin, M. C., Rinehart, T. M., Wagner, A. J., Brendez, J. A., Cox, R. E., Weakley, D. R., Dias, C. L., Zhang, X. W., Crouch, E. R., Crouch, E. R., Ventura, G. G., Morrison, D. G., Fraine, L. A., Biernacki, R. J., Franklin, C. C., Haskins, K. J., Hoover, D. L., Huston, P. A., Lambert, S. R., Hutchinson, A. K., Lenhart, P. D., Shainberg, M. J., Robb, R. A., Couser, N. L., Morse, C. L., Fang, C. C., Christian, M. L., Karlsson, V. X., Traboulsi, E., Rychwalski, P. J., Crowe, S. W., Silbert, D. I., Singman, E. L., Matta, N. S., Leckemby, G. L., Pavlica, M. R., Summers, C. G., Bothun, E. D., De Becker, I., Holleschau, A. M., de Melo, A. I., Hogue, K. M., Merrill, K. S., Miller, A. M., Jackson, J. L., LaRiviere, S. S., Goldblum, T. A., Alfaro, A., Atkinson, S., Trythall, C. L., Hendrickson, A. B., Avallone, J. M., Bryant, C. R., Peyton, W. E., Orge, F. H., Schoeck, S. E., Colon, B. J., Mar, N. X., Vaswani, R. S. 2012; 130 (6): 730-734
  • Long-term Outcomes of Undercorrection Versus Full Correction After Unilateral Intraocular Lens Implantation in Children AMERICAN JOURNAL OF OPHTHALMOLOGY Lambert, S. R., Archer, S. M., Wilson, M. E., Trivedi, R. H., Del Monte, M. A., Lynn, M. 2012; 153 (4): 602-608

    Abstract

    To evaluate the impact of full correction vs undercorrection on the magnitude of the myopic shift and postoperative visual acuity after unilateral intraocular lens (IOL) implantation in children.Retrospective case control study.The medical records of 24 children who underwent unilateral cataract surgery and IOL implantation at 2 to <6 years of age were reviewed. The patients were divided into 2 groups based on their 1-month-postoperative refraction: Group 1 (full correction) -1.0 to +1.0 diopter (D) and Group 2 (undercorrection) ≥+2.0 D. The main outcome measures included the change in refractive error per year and visual acuity for the pseudophakic eyes at last follow-up visit. The groups were compared using the independent groups t test and Wilcoxon rank sum test.The mean age at surgery (Group 1, 4.2±0.9 years, n=12; Group 2, 4.5±1.0 years, n=12; P=.45) and mean follow-up (Group 1, 5.8±3.7 years; Group 2, 6.1±3.5 years; P=.69) were similar for the 2 groups. The change in refractive error (Group 1, -0.4±0.5 D/y; Group 2, -0.3±0.2 D/y; P=.70) and last median logMAR acuity (Group 1, 0.4; Group 2, 0.4; P=.54) were not significantly different between the 2 groups.We did not find a significant difference in the myopic shift or the postoperative visual acuity in children aged 2 to <6 years of age following unilateral cataract surgery and IOL implantation if the initial postoperative refractive error was near emmetropia or undercorrected by 2 diopters or more.

    View details for DOI 10.1016/j.ajo.2011.08.046

    View details for Web of Science ID 000302387100003

    View details for PubMedID 22206805

    View details for PubMedCentralID PMC3312935

  • Current Role of Cryotherapy in Retinopathy of Prematurity A Report by the American Academy of Ophthalmology OPHTHALMOLOGY Simpson, J. L., Melia, M., Yang, M. B., Buffenn, A. N., Chiang, M. F., Lambert, S. R. 2012; 119 (4): 873-877

    Abstract

    To evaluate the role of cryotherapy in the current treatment of retinopathy of prematurity (ROP).Literature searches of PubMed and the Cochrane Library were conducted on December 2, 2009, for articles published after 1984. The searches included all languages and retrieved 187 relevant citations. Thirteen articles were deemed relevant to the assessment question and were rated according to the strength of evidence. Four articles reported results from 2 large multicenter randomized clinical trials, and the remaining 9 articles reported results of 3 small randomized trials that directly compared cryotherapy and laser.Neither of the multicenter randomized clinical trials was a direct comparison of cryotherapy with laser. These studies were used to evaluate the comparative trials based on treatment criteria, study populations, and clinical results. Higher percentages of poor structural and functional outcomes generally were seen in eyes treated with cryotherapy compared with eyes undergoing laser treatment. Higher rates of systemic complications and myopia also were identified after treatment with cryotherapy.Despite a relative paucity of level I evidence directly comparing cryotherapy and laser treatment for threshold ROP, the literature suggests that neonatal facilities should gain access to laser technology and laser-trained ophthalmic staff to achieve better outcomes for treatment of the disease.

    View details for DOI 10.1016/j.ophtha.2012.01.003

    View details for Web of Science ID 000302355400029

    View details for PubMedID 22381808

  • Predictability of Intraocular Lens Calculation and Early Refractive Status The Infant Aphakia Treatment Study ARCHIVES OF OPHTHALMOLOGY VanderVeen, D. K., Nizam, A., Lynn, M. J., Bothun, E. D., McClatchey, S. K., Weakley, D. R., DuBois, L. G., Lambert, S. R. 2012; 130 (3): 293-299

    Abstract

    To report the accuracy of intraocular lens (IOL) power calculations and the early refractive status in pseudophakic eyes of infants in the Infant Aphakia Treatment Study.Eyes randomized to receive primary IOL implantation were targeted for a postoperative refraction of +8.0 diopters (D) for infants 28 to 48 days old at surgery and +6.0 D for those 49 days or older to younger than 7 months at surgery using the Holladay 1 formula. Refraction 1 month after surgery was converted to spherical equivalent, and prediction error (PE; defined as the calculated refraction minus the actual refraction) and absolute PE were calculated. Baseline eye and surgery characteristics and A-scan quality were analyzed to compare their effect on PE.Prediction error.Fifty-six eyes underwent primary IOL implantation; 7 were excluded for lack of postoperative refraction (n = 5) or incorrect technique in refraction (n = 1) or biometry (n = 1). Overall mean (SD) absolute PE was 1.8 (1.3) D and mean (SD) PE was +1.0 (2.0) D. Absolute PE was less than 1 D in 41% of eyes but greater than 2 D in 41% of eyes. Mean IOL power implanted was 29.9 D (range, 11.5-40.0 D); most eyes (88%) implanted with an IOL of 30.0 D or greater had less postoperative hyperopia than planned. Multivariate analysis revealed that only short axial length (<18 mm) was significant for higher PE.Short axial length correlates with higher PE after IOL placement in infants. Less hyperopia than anticipated occurs with axial lengths of less than 18 mm or high-power IOLs. Application to Clinical Practice Quality A-scans are essential and higher PE is common, with a tendency for less hyperopia than expected.clinicaltrials.gov Identifier: NCT00212134.

    View details for Web of Science ID 000301353400002

    View details for PubMedID 22411658

  • Glaucoma-Related Adverse Events in the Infant Aphakia Treatment Study 1-Year Results ARCHIVES OF OPHTHALMOLOGY Beck, A. D., Freedman, S. F., Lynn, M. J., Bothun, E., Neely, D. E., Lambert, S. R. 2012; 130 (3): 300-305

    Abstract

    To report the incidence of glaucoma and glaucoma suspects in the IATS, and to evaluate risk factors for the development of a glaucoma-related adverse event in patients in the IATS in the first year of follow-up.A total of 114 infants between 1 and 6 months of age with a unilateral congenital cataract were assigned to undergo cataract surgery either with or without an intraocular lens implant. Standardized definitions of glaucoma and glaucoma suspect were created and used in the IATS.Of these 114 patients, 10 (9%) developed glaucoma and 4 (4%) had glaucoma suspect, for a total of 14 patients (12%) with a glaucoma-related adverse event in the treated eye through the first year of follow-up. Of the 57 patients who underwent lensectomy and anterior vitrectomy, 5 (9%) developed a glaucoma-related adverse event; of the 57 patients who underwent an intraocular lens implant, 9 (16%) developed a glaucoma-related adverse event. The odds of developing a glaucoma-related adverse event were 3.1 times higher for a child with persistent fetal vasculature and 1.6 times higher for each month of age younger at cataract surgery.Modern surgical techniques do not eliminate the early development of glaucoma following congenital cataract surgery with or without an intraocular lens implant. Younger patients with or without persistent fetal vasculature seem more likely to develop a glaucoma-related adverse event in the first year of follow-up. Vigilance for the early development of glaucoma is needed following congenital cataract surgery, especially when surgery is performed during early infancy or for a child with persistent fetal vasculature. Five-year follow-up data for the IATS will likely reveal more glaucoma-related adverse events.clinicaltrials.gov Identifier: NCT00212134.

    View details for DOI 10.1001/archophthalmol.2011.347

    View details for Web of Science ID 000301353400003

    View details for PubMedID 22084157

    View details for PubMedCentralID PMC3711462

  • Congenital Fibrovascular Pupillary Membranes: Clinical and Histopathologic Findings OPHTHALMOLOGY Lambert, S. R., Buckley, E. G., Lenhart, P. D., Zhang, Q., Grossniklaus, H. E. 2012; 119 (3): 634-641

    Abstract

    To report the clinical and histopathologic findings associated with congenital fibrovascular pupillary membranes.Case series.Seven infants were included, 6 with a unilateral congenital pupillary membrane and 1 with classic persistent fetal vasculature (PFV).Patients underwent a membranectomy, pupilloplasty, or lensectomy. Histopathologic examination was performed on the excised membranes.Visual acuity and pupil size.Four of the 6 patients with a unilateral congenital pupillary membrane had 1 or more recurrences after a membranectomy and pupilloplasty. The most recent pupil size ranged from 2 to 5 mm in the affected eye. When last tested, the vision in the affected eye was excellent in 4 of the 6 patients. The 2 patients without recurrences of the pupillary membranes underwent multiple iris sphincterotomies at the time of the initial surgery. Histopathologic examination of 2 primary pupillary membranes showed fibrovascular tissue that did not stain for neuron-specific enolase. Smooth muscle actin was only present in vascular walls. In contrast, histopathology of a recurrent pupillary membrane revealed collagenized fibrovascular tissue that was immunoreactive for smooth muscle actin. Finally, histopathology of the retrolenticular membrane excised from an infant with classic PFV was similar to the latter aside from hypercellularity.Congenital fibrovascular pupillary membranes in infants are likely a variant of PFV that may recur if incompletely excised. The risk of these membranes recurring may be reduced by excising as much as the membrane as possible and enlarging the pupil with iris sphincterotomies. A lensectomy should be avoided if possible.

    View details for DOI 10.1016/j.ophtha.2011.08.043

    View details for PubMedID 22197437

    View details for PubMedCentralID PMC3294086

  • Improved Ocular Alignment with Adjustable Sutures in Adults Undergoing Strabismus Surgery OPHTHALMOLOGY Zhang, M. S., Hutchinson, A. K., Drack, A. V., Cleveland, J., Lambert, S. R. 2012; 119 (2): 396-402

    Abstract

    To assess whether outcomes of strabismus surgery are improved by using the adjustable suture technique and to determine which subgroups of strabismus patients benefit most from the adjustable suture technique.A retrospective chart review.A total of 535 adults who underwent strabismus surgery between 1989 and 2010.Success was defined as ≤10 prism diopters (PD) for horizontal deviations and ≤2 PD for vertical deviations. Differences in the proportion of successful strabismus surgery were analyzed using a chi-square test with an alpha of 0.05.Ocular alignment in primary position at a 7-day to 12-week follow-up examination.A total of 491 patients met the inclusion criteria (nonadjustable suture, n = 186; adjustable suture, n = 305). The success rates for the nonadjustable and adjustable groups were 61.3% and 74.8%, respectively (χ(2)=9.91, P=0.0016). Adjustable suture use was particularly beneficial for patients undergoing a reoperation for childhood strabismus (success rate: nonadjustable, 42.4%; adjustable, 65.7%; P=0.0268; n = 100). The differences in outcomes were not statistically significant for patients with childhood strabismus undergoing a primary surgery (nonadjustable, 65.0%; adjustable, 81.4%; P=0.1354; n = 90) or with thyroid orbitopathy (nonadjustable, 76.7%; adjustable, 74.1%; P=0.8204; n = 57).Strabismus surgery using adjustable sutures was associated with improved short-term ocular alignment compared with strabismus surgery without the use of adjustable sutures. Adjustable sutures were most beneficial for patients undergoing reoperations for childhood strabismus.

    View details for DOI 10.1016/j.ophtha.2011.07.044

    View details for Web of Science ID 000299950300031

    View details for PubMedID 22036633

    View details for PubMedCentralID PMC3270199

  • Posterior capsular plaque in bilateral congenital cataracts JOURNAL OF AAPOS Morrison, D. G., Lambert, S. R., Wilson, M. E. 2012; 16 (1): 17-20

    Abstract

    Many cases of unilateral congenital cataract have an associated posterior capsular plaque. Observations such as this have led to the hypothesis that posterior capsular plaque is caused by persistent fetal vasculature, generally a unilateral condition, even if no obvious hyaloid remnant is visible. We investigated the incidence of posterior capsular plaque associated with bilateral congenital cataracts.Children with bilateral congenital cataracts were identified from three surgical practices. Children were included if lensectomies were performed prior to age 7 months. Surgical videos were evaluated for cataract morphology.Fourteen children with bilateral cataracts were identified. Surgical videos were available for 24 eyes. Five eyes (21%) had evidence of persistent hyaloid remnants. Of the remaining 19 eyes, cataracts were categorized as nuclear in 10 cases, nuclear with cortical extension in 6 cases, and posterior cortical in 3 cases. Evidence of posterior capsular plaque was seen in seven cases (37%) on video review.Video review revealed a much lower incidence of posterior capsular plaque in eyes with bilateral congenital cataracts compared to unilateral congenital cataracts, lending presumptive evidence to the hypothesis that most unilateral lens opacities arise from persistent fetal vasculature.

    View details for DOI 10.1010/j.jaapos.2011.08.010

    View details for Web of Science ID 000301304700006

    View details for PubMedID 22244507

  • Complications, Adverse Events, and Additional Intraocular Surgery 1 Year After Cataract Surgery in the Infant Aphakia Treatment Study OPHTHALMOLOGY Plager, D. A., Lynn, M. J., Buckley, E. G., Wilson, M. E., Lambert, S. R. 2011; 118 (12): 2330-2334

    Abstract

    To compare rates and severity of complications between infants undergoing cataract surgery with and without intraocular lens (IOL) implantation.Prospective, randomized clinical trial.The Infant Aphakia Treatment Study (IATS) is a randomized, multicenter (n = 12) clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with unilateral congenital cataract.Infants underwent cataract surgery with or without placement of an IOL.The rate, character, and severity of intraoperative complications (ICs), adverse events (AEs), and additional intraocular surgeries (AISs) during the first postoperative year in the 2 groups were analyzed.There were more patients with ICs (28% vs. 11%; P = 0.031), AEs (77% vs. 25%; P<0.0001), and AISs (63% vs. 12%; P<0.0001) in the IOL group than the contact lens group. Iris prolapse was the most common IC. The most common AE was visual axis opacification, and the most common additional intraocular reoperation was a clearing of visual axis opacification.The rates of ICs, AEs, and AISs 1 year after surgery were numerically higher in the IOL group, but their functional impact does not clearly favor either treatment group.The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    View details for DOI 10.1016/j.ophtha.2011.06.017

    View details for Web of Science ID 000298138000005

    View details for PubMedID 21925737

  • The Infant Aphakia Treatment Study: Evaluation of cataract morphology in eyes with monocular cataracts JOURNAL OF AAPOS Wilson, M. E., Trivedi, R. H., Morrison, D. G., Lambert, S. R., Buckley, E. G., Plager, D. A., Lynn, M. J. 2011; 15 (5): 421-426

    Abstract

    To describe a video-documented assessment of cataract type in the eyes of patients with monocular infantile cataract who were enrolled in the Infant Aphakia Treatment Study.The Infant Aphakia Treatment Study is a randomized clinical trial in which the investigators compared intraocular lens (IOL) versus contact lens correction in 114 infants, aged 28 days to <7 months. A total of 83 videos were available for morphological analysis of cataract. Three examiners reviewed all surgical recordings and agreed on the cataract characteristics by using a score sheet to record the lens layer or configuration of the opacity.Nuclear cataract was present in 45 of 83 eyes (54%). Posterior capsule plaque was observed in 73 eyes (88%). All eyes with fetal nuclear cataract had associated posterior capsule plaque. Cortical cataract without nuclear involvement was seen in 21 eyes (25%). Posterior bowing of the posterior capsule was noted in 4 eyes (5%). Evidence of persistent fetal vasculature (PFV) was present in 18 eyes (22%). PFV was the only finding in 5 eyes but was also seen in combination with nuclear (7 eyes) and cortical cataracts (6 eyes). The entire lens was white in 3 eyes (4%), whereas the lens was partially resorbed in 7 (8%) eyes. Anterior capsule fibrosis was noted in 5 eyes with advanced cataract (1 with total cataract, 4 with partially resorbed lens).Nuclear opacities were common, but many different cataract types presented in infancy. PFV occurred in isolation or in association with cataract. Posterior capsule plaque was frequently noted, especially when a nuclear cataract was present.

    View details for DOI 10.1016/j.jaapos.2011.05.016

    View details for Web of Science ID 000297657200006

    View details for PubMedID 22108352

  • Infant Aphakia Treatment Study: Effects of persistent fetal vasculature on outcome at 1 year of age JOURNAL OF AAPOS Morrison, D. G., Wilson, M. E., Trivedi, R. H., Lambert, S. R., Lynn, M. J. 2011; 15 (5): 427-431

    Abstract

    The Infant Aphakia Treatment Study is a randomized trial that compares the treatment of unilateral congenital cataract with primary intraocular lens (IOL) implantation versus aphakic contact lens (CLs). The purpose of this study was to compare the outcomes for infants with lens opacity associated with persistent fetal vasculature (PFV) to those without.Retrospective subgroup analysis of grating visual acuity at 1 year of age and adverse events up to 1 year after surgery in eyes identified intraoperatively as having evidence of mild PFV from the IATS.Of 83 infants, 18 (22%: 11 CL, 7 IOL) had PFV. Median logMAR visual acuity was 0.88 for patients with PFV and 0.80 for patients without PFV (P = 0.46). One or more adverse events up to 1 year after surgery occurred in 12 infants (67%) with PFV and 30 infants (46%) without PFV (P = 0.18). The incidence of adverse events was significantly greater in patients with PFV compared with patients without PFV in the CL group (55% vs 20%, P = 0.049) but not in the IOL group (86% vs 71%, P = 0.65), possibly because all children receiving IOLs had greater rates of adverse events when compared with aphakic children (73% vs 29%, P < 0.001).Aphakic infants with mild PFV treated with CL had a greater incidence of adverse events after lensectomy compared with children with other forms of unilateral congenital cataract; nevertheless, similar visual outcomes at 1 year after surgery were obtained.

    View details for DOI 10.1016/j.jaapos.2011.06.004

    View details for Web of Science ID 000297657200007

    View details for PubMedID 22108353

  • Development of a Vision-Related Quality of Life Instrument for Children Ages 8-18 Years for Use in Juvenile Idiopathic Arthritis-Associated Uveitis ARTHRITIS CARE & RESEARCH Angeles-Han, S. T., Griffin, K. W., Harrison, M. J., Lehman, T. J., Leong, T., Robb, R. R., Shainberg, M., Ponder, L., Lenhart, P., Hutchinson, A., Srivastava, S. K., Prahalad, S., Lambert, S. R., Drews-Botsch, C. 2011; 63 (9): 1254-1261

    Abstract

    To determine the validity and reliability of a novel questionnaire to measure vision-related quality of life (VRQOL) in children ages 8-18 years for use in juvenile idiopathic arthritis (JIA)-associated uveitis: the Effects of Youngsters' Eyesight on Quality of Life (EYE-Q).Several steps validated the EYE-Q. We interviewed experts and children on how vision affects a child's activities. We developed new items and selected relevant items from existing instruments. We administered initial versions of the EYE-Q to normal-sighted children and those with JIA-associated uveitis. For this study, children with various (or no) ocular conditions were recruited from a clinical population. Visual acuity and contrast sensitivity were performed, and the EYE-Q and Pediatric Quality of Life Inventory (PedsQL) were administered. The EYE-Q was repeated 10 days later. Patients, parents, and physicians rated vision severity.Of 120 patients, 48% were female, 46.7% had no visual impairment, and 53.3% had bilateral eye involvement. The mean age was 11.3 years. There were significant differences in the measures based on visual acuity (P < 0.001). Children with more severe visual acuity and bilateral eye involvement had worse EYE-Q scores (P < 0.001). There were significant associations between the EYE-Q and PedsQL (r = 0.375), repeat EYE-Q (r = 0.864), and clinical measures of ocular disease (r = -0.620).Our study provides evidence of the validity and reliability of the EYE-Q in the measurement of VRQOL. The EYE-Q may complement clinical measures of visual impairment and overall QOL and become an important tool in the assessment of QOL in JIA-associated uveitis.

    View details for DOI 10.1002/acr.20524

    View details for Web of Science ID 000295254900006

    View details for PubMedID 21678564

    View details for PubMedCentralID PMC3169749

  • Partial coherence interferometry versus immersion ultrasonography for axial length measurement in children JOURNAL OF CATARACT AND REFRACTIVE SURGERY Lenhart, P. D., Hutchinson, A. K., Lynn, M. J., Lambert, S. R. 2010; 36 (12): 2100-2104

    Abstract

    To determine whether measurements obtained by partial coherence interferometry (PCI) correlate well with measurements obtained using immersion ultrasound (US) in children.Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.Evaluation of a diagnostic test or technology.The charts of pediatric patients who had cataract surgery from August 2008 to September 2009 were reviewed. Axial length (AL) measurements in the operative eye were obtained using PCI at the preoperative clinic visit and then using immersion US in the operating room before surgery. The data were compared to determine the degree of agreement.The charts of 18 patients (27 eyes) were reviewed. Preoperative AL measurements by PCI were obtained in 21 eyes (78%). On average, the PCI-measured ALs were 0.1 mm less than the immersion US values (95% confidence interval, -0.2 to -0.1; P = .002). All eyes with an AL of 23.5 mm or less had lower PCI values than immersion US values. There was no systematic pattern of 1 measurement being greater or less than the other in eyes with an AL longer than 23.5 mm.There was a systematic difference in AL measurement between PCI and immersion US, with PCI tending to give lower values, particularly in eyes with an AL of 23.5 mm or less. Depending on the length of the eye, a 0.1 mm error in AL measurement could result in a 0.25 to 0.75 diopter difference in intraocular lens calculation that could be clinically significant in some patients.

    View details for DOI 10.1016/j.jcrs.2010.07.013

    View details for Web of Science ID 000285429600014

    View details for PubMedID 21111313

    View details for PubMedCentralID PMC2991047

  • Toxic anterior segment syndrome after pediatric cataract surgery JOURNAL OF AAPOS Lambert, S. R. 2010; 14 (5): 381-382

    View details for DOI 10.1016/j.jaapos.2010.08.007

    View details for Web of Science ID 000283897900001

    View details for PubMedID 20863727

  • Simultaneous vs Sequential Bilateral Cataract Surgery for Infants With Congenital Cataracts Visual Outcomes, Adverse Events, and Economic Costs ARCHIVES OF OPHTHALMOLOGY Dave, H., Phoenix, V., Becker, E. R., Lambert, S. R. 2010; 128 (8): 1050-1054

    Abstract

    To compare the incidence of adverse events and visual outcomes and to compare the economic costs of sequential vs simultaneous bilateral cataract surgery for infants with congenital cataracts.Retrospective review of simultaneous vs sequential bilateral cataract surgery for infants with congenital cataracts who underwent cataract surgery when 6 months or younger at our institution.Records were available for 10 children who underwent sequential surgery at a mean age of 49 days for the first eye and 17 children who underwent simultaneous surgery at a mean age of 68 days (P = .25). We found a similar incidence of adverse events between the 2 treatment groups. Intraoperative or postoperative complications occurred in 14 eyes. The most common postoperative complication was glaucoma. No eyes developed endophthalmitis. The mean (SD) absolute interocular difference in logMAR visual acuities between the 2 treatment groups was 0.47 (0.76) for the sequential group and 0.44 (0.40) for the simultaneous group (P = .92). Payments for the hospital, drugs, supplies, and professional services were on average 21.9% lower per patient in the simultaneous group.Simultaneous bilateral cataract surgery for infants with congenital cataracts is associated with a 21.9% reduction in medical payments and no discernible difference in the incidence of adverse events or visual outcomes. However, our small sample size limits our ability to make meaningful comparisons of the relative risks and visual benefits of the 2 procedures.

    View details for Web of Science ID 000280909700014

    View details for PubMedID 20697007

  • Late spontaneous resolution of congenital Brown syndrome JOURNAL OF AAPOS Lambert, S. R. 2010; 14 (4): 373-375

    Abstract

    Brown syndrome is characterized by restricted elevation in adduction. Congenital Brown syndrome usually is diagnosed during early childhood. It is believed to be caused by an abnormality of the superior oblique tendon as it passes through the trochlea. The natural history of Brown syndrome is poorly characterized. Many patients with congenital Brown syndrome undergo strabismus surgery during childhood in an attempt to correct the problem surgically. This report describes spontaneous regression of congenital Brown syndrome in an adult.

    View details for DOI 10.1016/j.jaapos.2010.04.011

    View details for Web of Science ID 000281524600020

    View details for PubMedID 20637665

    View details for PubMedCentralID PMC2928416

  • Assessment of Risk Factors for Infantile Cataracts Using a Case-Control Study National Birth Defects Prevention Study, 2000-2004 OPHTHALMOLOGY Prakalapakorn, S. G., Rasmussen, S. A., Lambert, S. R., Honein, M. A. 2010; 117 (8): 1500-1505

    Abstract

    To identify risk factors for infantile cataracts of unknown etiology.Case-control study.Case infants (n = 152) and control infants (n = 4205) enrolled in the National Birth Defects Prevention Study for birth years 2000-2004.Multivariate analysis was performed exploring associations for risk factors for bilateral and unilateral infantile cataracts of unknown etiology.Infantile cataracts of unknown etiology.Maternal interviews were completed for 43 case infants with bilateral and 109 with unilateral infantile cataracts of unknown etiology. Very low birth weight (<1500 g) was associated with both unilateral (adjusted odds ratio [OR], 6.0; 95% confidence interval [CI], 2.2-16.3) and bilateral (OR, 13.2; 95% CI, 4.2-41.1) cataracts, whereas low birth weight (1500-2499 g) was only associated with bilateral cataracts (OR, 3.3; 95% CI, 1.3-8.1). Infants with unilateral cataracts were more likely to be born to primigravid women (OR, 1.6; 95% CI, 1.0-2.7) than women with > or =2 previous pregnancies, although this was of borderline significance. Although not significant, effect estimates were elevated suggesting a possible association between unilateral cataracts and maternal substance abuse during pregnancy, and between bilateral cataracts and urinary tract infection during pregnancy and aspirin use during pregnancy.Very low birth weight is associated with both bilateral and unilateral cataracts, whereas low birth weight is associated with bilateral cataracts and primigravidity with unilateral cataracts. Other associations, although not statistically significant, suggest risk factors that merit further research.

    View details for DOI 10.1016/j.ophtha.2009.12.026

    View details for Web of Science ID 000280598900006

    View details for PubMedID 20363508

    View details for PubMedCentralID PMC2994269

  • A Randomized Clinical Trial Comparing Contact Lens With Intraocular Lens Correction of Monocular Aphakia During Infancy Grating Acuity and Adverse Events at Age 1 Year ARCHIVES OF OPHTHALMOLOGY Lambert, S. R., Buckley, E. G., Drews-Botsch, C., DuBois, L., Hartmann, E. E., Lynn, M. J., Plager, D. A., Wilson, M. E., Bridgman, B., Celano, M., Cleveland, J., Cotsonis, G., Drews-Botsch, C., Freret, N., Lu, L., Nizam, A., Swanson, S., Tutu-Gxashe, T., Edwards, C., Busettini, C., Hayley, S., Everett, D. F., Russell, B., Ward, M. 2010; 128 (7): 810-818
  • A randomized clinical trial comparing contact lens with intraocular lens correction of monocular aphakia during infancy: grating acuity and adverse events at age 1 year. Archives of ophthalmology Lambert, S. R., Buckley, E. G., Drews-Botsch, C., DuBois, L., Hartmann, E. E., Lynn, M. J., Plager, D. A., Wilson, M. E. 2010; 128 (7): 810-818

    Abstract

    To compare the visual outcomes and adverse events of contact lens with primary intraocular lens (IOL) correction of monocular aphakia during infancy.In a randomized, multicenter (12 sites) clinical trial, 114 infants with a unilateral congenital cataract were assigned to undergo cataract surgery between 1 to 6 months of age either with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Grating visual acuity was tested at 1 year of age by a masked traveling examiner.Grating visual acuity at 1 year of age.The median logMAR visual acuity was not significantly different between the treated eyes in the 2 groups (contact lens group, 0.80; IOL group, 0.97; P = .19). More patients in the IOL group underwent 1 or more additional intraocular operations than patients in the contact lens group (63% vs 12%; P < .001). Most of these additional operations were performed to clear lens reproliferation and pupillary membranes from the visual axis.There was no statistically significant difference in grating visual acuity at age 1 year between the IOL and contact lens groups; however, additional intraocular operations were performed more frequently in the IOL group.Until longer-term follow-up data are available, caution should be exercised when performing IOL implantation in children aged 6 months or younger given the higher incidence of adverse events and the absence of an improved short-term visual outcome compared with contact lens use.

    View details for DOI 10.1001/archophthalmol.2010.101

    View details for PubMedID 20457949

    View details for PubMedCentralID PMC3512571

  • From the Laboratory to the Clinic: Molecular Genetic Testing in Pediatric Ophthalmology AMERICAN JOURNAL OF OPHTHALMOLOGY Drack, A. V., Lambert, S. R., Stone, E. M. 2010; 149 (1): 10-17

    Abstract

    To review the current state of molecular genetic testing as it relates to pediatric ophthalmology and to discuss its uses.Review and evaluation of available molecular genetic testing.Literature review and discussion of testing in practice based on the authors' clinical and laboratory experience.Fee-for-service testing for many genetic eye diseases now is available. A report is always generated for fee-for-service testing. Detection of DNA variants in genes known to cause eye disease must be interpreted taking into account the variability of the human genome, the presence of benign variants (polymorphisms), and the carrier frequency of recessive alleles. Negative results in genetic testing are helpful in some disorders for which most of the causative genes are known and many disease-causing variants have already been reported, but are less helpful in those that currently have many undiscovered causative genes or novel mutations. Research-based testing also is available, but does not always yield a result. Patients with RPE65-associated Leber congenital amaurosis may be eligible for the current gene therapy trial. Patients with a variety of disorders may benefit from improved surveillance if their genetic diagnosis is known.Entry into the genetic testing system often is via the patient's ophthalmologist. Collaboration with geneticists and genetic counselors, use of web sites to keep up with the ever-changing availability and detection rates, and knowledge of clinical trials, when combined with excellent clinical diagnosis, can improve diagnosis and allow eligible patients to participate in treatment trials.

    View details for DOI 10.1016/j.ajo.2009.08.038

    View details for Web of Science ID 000273270300004

    View details for PubMedID 20103038

  • The infant aphakia treatment study: design and clinical measures at enrollment. Archives of ophthalmology Lambert, S. R., Buckley, E. G., Drews-Botsch, C., DuBois, L., Hartmann, E., Lynn, M. J., Plager, D. A., Wilson, M. E. 2010; 128 (1): 21-27

    Abstract

    To compare the use of contact lenses and intraocular lenses (IOLs) for the optical correction of unilateral aphakia during infancy.In a randomized, multicenter (12 sites) clinical trial, 114 infants with unilateral congenital cataracts were assigned to undergo cataract surgery with or without IOL implantation. Children randomized to IOL treatment had their residual refractive error corrected with spectacles. Children randomized to no IOL treatment had their aphakia treated with a contact lens.Grating acuity at 12 months of age and HOTV visual acuity at 4 1/2 years of age.This study should determine whether either treatment for an infant with a visually significant unilateral congenital cataract results in a better visual outcome.Enrollment began December 23, 2004, and was completed January 16, 2009. The median age at the time of cataract surgery was 1.8 months. Fifty patients were 4 to 6 weeks of age at the time of enrollment; 32, 7 weeks to 3 months of age; and the remaining 32, more than 3 to less than 7 months of age. Fifty-seven children were randomized to each treatment group. Eyes with cataracts had shorter axial lengths and steeper corneas on average than the fellow eyes.The optimal optical treatment of aphakia in infants is unknown. However, the Infant Aphakia Treatment Study was designed to provide empirical evidence of whether optical treatment with an IOL or a contact lens after unilateral cataract surgery during infancy is associated with a better visual outcome.

    View details for DOI 10.1001/archophthalmol.2009.350

    View details for PubMedID 20065212

  • The value of serial personal photographs in timing the onset of unilateral cataracts in children JOURNAL OF AAPOS Sawhney, G. K., Hutchinson, A. K., Lambert, S. R. 2009; 13 (5): 459-462

    Abstract

    To determine the value of serial personal photographs in timing the onset of unilateral cataracts in children over 6 months of age.Personal photographs from children with unilateral cataracts who underwent cataract extraction and intraocular lens implantation when > or =6 months of age were reviewed. Photographs were evaluated for changes in the red reflex, which might indicate the presence of a cataract.Twelve children underwent cataract surgery at a mean age of 37 months. They were followed for a mean of 32 months. Ten children were diagnosed as having an acquired cataract by photographic review documenting a previously normal red reflex. The visual acuity in the affected eye of 4 of these children improved to > or =20/60. Cataracts were visible on photographs prior to clinical diagnosis in 6 patients, from 0.5 to 22 months prior to clinical diagnosis. Visual outcomes did not relate closely to the photographically documented duration of the cataract prior to treatment. Photographs were not helpful in timing the onset of cataract in 2 children due to the poor quality of the images.Serial personal photographs are sometimes helpful in determining whether cataracts are acquired. However, the usefulness of personal photographs alone in predicting the visual outcome after cataract surgery was limited in this small, retrospective study.

    View details for DOI 10.1016/j.jaapos.2009.08.007

    View details for Web of Science ID 000271051700007

    View details for PubMedID 19840724

    View details for PubMedCentralID PMC2988491

  • Outcomes of cataract surgery following radiation treatment for retinoblastoma JOURNAL OF AAPOS Payne, J. F., Hutchinson, A. K., Hubbard, B., Lambert, S. R. 2009; 13 (5): 454-458

    Abstract

    To report the outcomes after cataract extraction in eyes previously treated for retinoblastoma.We reviewed the medical records of consecutive patients treated with cataract extraction at our institution for radiation-induced cataract following retinoblastoma treatment between 1992 and 2007.Twelve eyes of 11 patients were included. The median age at diagnosis of retinoblastoma was 7.4 months. The median quiescent interval before cataract surgery was 34.6 months (range, 17-240 months). All patients underwent limbal-based extracapsular cataract extraction with scleral-tunnel wound construction. Anterior vitrectomy and posterior capsulotomy were performed in 7 eyes; an intraocular lens was placed in 10 eyes. A laser capsulotomy was subsequently performed in 5 eyes. No postoperative complications occurred. One patient underwent a pars plana vitrectomy for vitreous hemorrhage and proliferative retinopathy 5 years after cataract extraction. The median follow-up after surgery was 6.0 years (range, 1.1-12.3 years). Final visual acuity was between 20/20 and 20/60 in 6 eyes, between 20/70 and 20/200 in 2 eyes, and worse than 20/200 in 4 eyes. No intraocular tumor recurrences or metastases occurred. Two patients developed secondary rhabdomyosarcomas; 1 patient succumbed to the disease.Limbal-based cataract extraction in our series was not associated with tumor recurrence or metastasis. The optimal quiescent interval is not known; however, no tumor recurrences occurred in our series when a minimum 17-month quiescent period was achieved. Visual improvement was noted in every patient, although several patients only experienced modest gains.

    View details for DOI 10.1016/j.jaapos.2009.06.002

    View details for Web of Science ID 000271051700006

    View details for PubMedID 19840723

    View details for PubMedCentralID PMC3033780

  • Long-term visual outcome of penetrating keratoplasty in infants and children with Peters anomaly JOURNAL OF AAPOS Yang, L. L., Lambert, S. R., Drews-Botsch, C., Stulting, R. D. 2009; 13 (2): 175-180

    Abstract

    To determine the long-term visual outcome of penetrating keratoplasty for Peters anomaly and to identify prognostic factors affecting final vision.The records of children 12 years of age or younger who underwent penetrating keratoplasty for Peters anomaly between January 1, 1971 and December 31, 1992 at Emory University were reviewed. Characteristics of the recipient, eye, donor, and surgical procedure were examined with the use of multivariate analyses.One hundred forty-four keratoplasties in 72 eyes of 47 children who were followed for a minimum of 3 years from the date of first keratoplasty (median, 11.1 years) were reviewed. Visual acuities ranged from 20/25 to no light perception. Twenty-nine percent of eyes achieved 20/400 or better visual acuities, whereas 38% had light perception or no light perception. Stromal vessels (p < 0.001) and larger donor corneas (p < 0.001) were independent predictors of poor outcome. Postoperative complications included graft failure (n = 44), cataract (n = 15), glaucoma (n = 14), retinal detachment (n = 16), and phthisis (n = 22). More than half of the eyes (n = 18) without graft failure, retinal detachment and/or phthisis saw 20/400 or better.Less than one-third of eyes with Peters anomaly undergoing keratoplasty achieved a visual acuity of 20/400 or better. Stromal vessels and large corneal grafts (>or=8 mm) were the only independent predictors of a poor visual outcome.

    View details for DOI 10.1016/j.jaapos.2008.10.007

    View details for Web of Science ID 000265445100015

    View details for PubMedID 19393517

  • Visual outcome following the reduction or cessation of patching therapy after early unilateral cataract surgery ARCHIVES OF OPHTHALMOLOGY Lambert, S. R., Plager, D. A., Lynn, M. J., Wilson, M. E. 2008; 126 (8): 1071-1074

    Abstract

    To evaluate the impact on visual acuity of reducing or abandoning patching therapy during the first 6 years of life following early unilateral cataract surgery.We reviewed the medical records of 9 children with unilateral congenital cataracts who underwent cataract surgery when 6 weeks or younger. All had good compliance with optical correction until 6 years of age and with patching therapy until at least 12 months of age.The children underwent cataract surgery at a mean (SD) age of 21.7 (9.5) days. At 12 months of age, the children were patched a mean (SD) of 6.7 (2.4) hours/d. Patching compliance declined steadily thereafter. By 6 years of age, they were only being patched a mean (SD) of 1.7 (2.0) hours/d. Four of the 9 children abandoned patching prior to the 6-year examination. Acuities improved or remained the same for 3 of these children but worsened for 1 child by 2 lines.Our study suggests that some children who undergo early unilateral cataract surgery and are compliant with their optical correction and patching during early childhood can maintain a good visual outcome even if patching therapy is reduced or discontinued prior to their sixth birthday.

    View details for Web of Science ID 000258377500007

    View details for PubMedID 18695101

  • ASCRS white paper: Hydrophobic acrylic intraocular lenses in children JOURNAL OF CATARACT AND REFRACTIVE SURGERY Wilson, M. E., Trivedi, R. H., Buckley, E. G., Granet, D. B., Lambert, S. R., Plager, D. A., Sinskey, R. M., Vasavada, A. R. 2007; 33 (11): 1966-1973

    View details for DOI 10.1016/j.jcrs.2007.06.047

    View details for Web of Science ID 000250792900034

    View details for PubMedID 17964406

  • Congenital rubella syndrome: the end is in sight BRITISH JOURNAL OF OPHTHALMOLOGY Lambert, S. R. 2007; 91 (11): 1418-1419

    View details for DOI 10.1136/bjo.2007.117960

    View details for Web of Science ID 000250229300003

    View details for PubMedID 17947261

  • Longitudinal changes in the cylinder power of children with accommodative esotropia JOURNAL OF AAPOS Lambert, S. R., Lynn, M. 2007; 11 (1): 55-59

    Abstract

    To assess the longitudinal changes in the cylindrical refractive errors of children with accommodative esotropia according to the age when glasses were prescribed.Refractive errors were followed longitudinally for 120 children with accommodative esotropia for a mean of 4.4 +/- 2.5 years. Cycloplegic refractions were performed using an autorefractor. The refractive data were analyzed for three groups of children based on their age at the time spectacles were prescribed.In all three age groups, the mean cylinder power was initially about 1.0 D. Over time, the mean cylinder power in the two younger age groups gradually increased by about 0.5 D. In the oldest age group, the mean cylinder power remained relatively unchanged with some suggestion of a decrease in the later years. A regression model demonstrated the statistical significance of both the age when spectacles were prescribed (p < 0.0001) and the interaction of age and time after spectacles were prescribed (p = 0.0034).Longitudinal changes in cylinder power for children with accommodative esotropia vary according to their age when spectacle wear is initiated. The greatest increase in cylinder developed in the children who were youngest when initially treated.

    View details for DOI 10.1016/j.jaapos.2006.09.024

    View details for Web of Science ID 000244587300013

    View details for PubMedID 17307685

  • Amblyopia in the phakic eye after unilateral congenital cataract extraction JOURNAL OF AAPOS Ruth, A. L., Lambert, S. R. 2006; 10 (6): 587-588

    Abstract

    The treatment of unilateral congenital cataract remains a challenge because form deprivation early in life leads to amblyopia. Visual outcomes after congenital cataract extraction have improved dramatically with earlier surgery, greater attention to optical correction of the aphakia, and part-time occlusion therapy of the phakic eye. A published review of unilateral congenital cataract studies between 1988 and 2004 found that 88% of patients with primary intraocular lens implantation achieved 20/200 or better visual acuity and a mean of 20% achieved 20/40 or better visual acuity. Improved outcomes are attributable, in part, to surgical intervention at an earlier age. It has been shown that surgical intervention during the first 6 weeks of age is associated with a better visual prognosis than surgery at a later age. In this report, we describe a patient with unilateral congenital cataract treated with cataract extraction and intraocular lens implantation at 8 weeks of age who had a better visual outcome in his operative eye than in his phakic eye.

    View details for DOI 10.1016/j.jaapos.2006.08.003

    View details for Web of Science ID 000243239000018

    View details for PubMedID 17189159

  • Intracranial vascular anomalies in patients with morning glory disk anomaly AMERICAN JOURNAL OF OPHTHALMOLOGY Lenhart, P. D., Lambert, S. R., Newman, N. J., Biousse, V., Atkinson, D. S., Traboulsi, E. I., Hutchinson, A. K. 2006; 142 (4): 644-650

    Abstract

    An association between morning glory disk anomaly (MGDA) and intracranial vascular anomalies including Moyamoya disease has been recognized. We evaluated a series of patients with MGDA to ascertain the frequency of cerebrovascular anomalies.Retrospective observational case series.We reviewed the neurologic histories and neuroimaging studies of twenty patients with MGDA at two institutions between 1982 and 2004. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain was performed on all patients who had not undergone neuroimaging. MRI/MRA studies done for 40 pediatric patients without MGDA were also evaluated for cerebrovascular anomalies. The prevalence of anomalies in the two groups was compared by Fisher exact test.Nine of 20 patients (45%) with MGDA had cerebrovascular anomalies. Anomalies ranged from agenesis of the A1 segment of the anterior cerebral artery to bilateral stenosis of the internal carotid arteries with moyamoya disease. Three patients underwent revascularization procedures. Ten of 40 patients (25%) in the control group had any intracranial vascular anomaly, whereas only two of 40 (5%) had an abnormality of the anterior circulation, the most common finding in the MGDA group.We recommend that all patients with MGDA undergo MRI/MRA or computerized tomographic angiography to detect vascular and structural brain anomalies. It may be unclear whether cerebrovascular anomalies represent isolated congenital anomalies or findings of progressive occlusive cerebrovascular disease. Follow-up imaging should be considered in patients with cerebrovascular anomalies and is clearly indicated if neurologic signs or symptoms are present.

    View details for DOI 10.1016/j.ajo.2006.05.040

    View details for Web of Science ID 000241098900017

    View details for PubMedID 17011858

  • Cryptic cerebral visual impairment in children BRITISH JOURNAL OF OPHTHALMOLOGY Lowery, R. S., Atkinson, D., Lambert, S. R. 2006; 90 (8): 960-963

    Abstract

    To review the medical records of seven children with a delayed diagnosis of cerebral visual impairment.The charts of a consecutive series of children examined in a university based ophthalmology clinic with a delayed diagnosis of cerebral visual impairment were reviewed. Their neuroimaging studies were evaluated by a paediatric neuroradiologist.The seven patients ranged in age from 2 years to 10 years at the time of presentation and had acuities ranging from 20/40 to 20/400. Their visual fields ranged from full visual fields to homonymous hemianopias. Neuroimaging findings ranged from subtle occipital lobe abnormalities to obvious cerebral volume loss.Cerebral visual impairment can be cryptic in children with mild visual impairment. Neuroimaging studies and visual field testing can help to differentiate this condition from other causes of visual impairment.

    View details for DOI 10.1136/bjo.094250

    View details for Web of Science ID 000239111000013

    View details for PubMedID 16687450

  • Emmetropization in accommodative esotropia: an update and review. Comprehensive ophthalmology update Lowery, R. S., Hutchinson, A., Lambert, S. R. 2006; 7 (3): 145-149

    Abstract

    Many children with accommodative esotropia are able to successfully discontinue spectacle wear, while others require spectacle correction into adulthood. Parents often ask about the likelihood of glasses being required on a long-term basis and whether use of spectacles will cause dependency. Most infants are hyperopic and gradually become emmetropic. The extent to which accommodation and spectacle use affect this process is still debated. However, certain characteristics, such as degree of hyperopia, can help predict long-term spectacle requirement.

    View details for PubMedID 16882403

  • Longitudinal changes in the spherical equivalent refractive error of children with accommodative esotropia BRITISH JOURNAL OF OPHTHALMOLOGY Lambert, S. R., Lynn, M. J. 2006; 90 (3): 357-361

    Abstract

    To assess the longitudinal changes in the spherical equivalent (SE) refractive errors of children with accommodative esotropia as a function of the age when glasses were prescribed.Refractive errors were followed longitudinally for 126 children with accommodative esotropia for a mean of 4.4 (SD 2.5) years. Cycloplegic refractions were performed using an autorefractor for older children and retinoscopy for younger children. The refractive data were analysed for three groups of children based on their age at the time spectacles were prescribed.The initial SE refractive error was age dependent (<2 years, 5.1 (1.9) D; 2-<4 years, 4.2 (1.9) D; 4-8 years, 3.8 (1.7) D). Children in all age groups had an initial increase in their SE refractive error, followed by a later decrease; however, the greatest decrease occurred in the patients in the oldest age group. The SE refractive error peaked 1 year after spectacles were prescribed for the children 4-8 years of age versus 6 years after spectacles were prescribed for the children less than 2 years of age.Longitudinal changes in SE refractive error for children with accommodative esotropia vary as a function of their age when spectacle wear is initiated.

    View details for DOI 10.1136/bjo.2005.078105

    View details for Web of Science ID 000235424800030

    View details for PubMedID 16488962

  • Is there a latent period for the surgical treatment of children with dense bilateral congenital cataracts? JOURNAL OF AAPOS Lambert, S. R., Lynn, M. J., Reeves, R., Plager, D. A., Buckley, E. G., Wilson, M. E. 2006; 10 (1): 30-36

    Abstract

    It generally is accepted that cataract surgery during the first 6 weeks of life is associated with the best visual outcomes for children with dense unilateral congenital cataracts. The latent period for children with dense bilateral congenital cataracts has not been clearly defined.The best-corrected visual acuity (BCVA) at 4 to 6 years of age was collected retrospectively on a series of 43 children with dense bilateral congenital cataracts from 4 institutions. All of the children underwent a lensectomy, posterior capsulotomy, and anterior vitrectomy at 36 weeks of age or younger.Cataract surgery was performed at a mean age of 11.5 weeks for the better-seeing eye. BCVA was assessed when the children were a mean of 5.3 years of age. The visual acuities of 26 (60%) were 20/40 or better, 12 (28%) were 20/50 to 20/80, and 5 (12%) were 20/100 or worse. There was a trend for worse BCVA with increasing age at the time of surgery (r = 0.28, P = 0.07). We noted that a BCVA of 20/100 or worse occurred only among eyes undergoing surgery when infants were older than 10 weeks (10 weeks: 5/22 = 23%, P = 0.049). Children with preoperative nystagmus had worse visual outcomes; only 38% of children with preoperative nystagmus achieved a BCVA of 20/40 or better compared with 74% of children without preoperative nystagmus (P = 0.03).Previous reports have proposed that cataract surgery during the first 5 to 8 weeks of life is associated with better visual outcomes in children with dense bilateral congenital cataracts. Our results would suggest that good visual outcomes can be achieved beyond this age, but the incidence of poor visual outcomes increases if cataract surgery is delayed beyond 10 weeks of age. The absence of preoperative nystagmus is a better predictor of a good visual outcome than the age at surgery.

    View details for DOI 10.1016/j.jaapops.2005.10.002

    View details for Web of Science ID 000236083400007

    View details for PubMedID 16527677

  • A prospective study of alternating occlusion before surgical alignment for infantile esotropia: One-year postoperative motor results JOURNAL OF AAPOS Ing, M. R., Norcia, A., Stager, D., Black, B., Hoffman, R., Mazow, M., Troia, S., Scott, W., Lambert, S. 2006; 10 (1): 49-53

    Abstract

    Alternating occlusion before surgical alignment has been suggested by some strabismologists as a possible method to enhance the treatment of infantile esotropia.This report presents 1-year outcome results of a prospective trial of patients with infantile esotropia who were assigned randomly to alternating occlusion or control groups.Forty-four patients with infantile esotropia were measured at entry into the study, at the time of surgery, at 6 weeks, and 1 year postoperatively. Alternating occlusion was full time and symmetric for those with no amblyopia but asymmetric for those with amblyopia. The control group that did not receive alternating occlusion had occlusion for amblyopia only. Initial surgeries were performed when the patients were between the ages of 6 and 13 months.Overall, the patients showed an increase of 9.14 prism diopters (PD) during a mean preoperative follow-up of 4.2 months. Seventy-five percent of all patients were aligned by the initial surgery. Ninety-one percent of those patients aligned within 10 PD at 6 weeks also were aligned 1 year postoperatively. The results were similar for the alternate occlusion group and the control group.In our sample of patients, alternating occlusion does not detectably alter the increase in angle of deviation between the dates of entry and the date of the initial surgical alignment procedure, nor does it influence the postoperative alignment at 6 weeks or at 1 year.

    View details for DOI 10.1016/j.jaapos.2005.09.006

    View details for Web of Science ID 000236083400010

    View details for PubMedID 16527680

  • Conjunctival granulomas caused by synthetic fibers: Report of two cases and review of literature JOURNAL OF AAPOS Schmack, I., Kang, S. J., Grossniklaus, H. E., Lambert, S. R. 2005; 9 (6): 567-571

    Abstract

    We sought to demonstrate the histopathologic and ultrastructural features of conjunctival foreign body granulomas because of synthetic fibers and to compare them to other cases published in the literature.A 2- and a 7-year-old girl were referred for the surgical removal of slow-growing unilateral inferior conjunctival masses with a lack of primary trauma or surgery. In this report, we describe the light and electron microscopic findings of the 2 cases and review the literature of similar cases using the Medline database.Histopathologic and ultrastructural examination of both specimens revealed a granulomatous inflammatory cell response, including histiocytes and multinucleated foreign body giant cells around acellular, uniform sized, oval to round birefringent fibers with manufacturing artifacts. Thirteen other patients with conjunctival synthetic fiber granulomas were identified from the literature.On the basis of the findings in our cases and the review of literature, it appears that conjunctival synthetic fiber granulomas are not a rare entity but are not recognized frequently by ophthalmologists. The most reliable clinical sign to suggest this diagnosis is the presence of a unilateral inferior conjunctival mass in a child or adolescent. Histopathologic and ultrastructural evaluation appears to be the only way to specifically diagnose this condition with certainty.

    View details for DOI 10.1016/j.jaapos.2005.07.006

    View details for Web of Science ID 000234776400014

    View details for PubMedID 16414525

  • Iris hypoplasia and aorticopulmonary septal defect: A neurocristopathy JOURNAL OF AAPOS Bergstrom, C. S., Saunders, R. A., Hutchinson, A. K., Lambert, S. R. 2005; 9 (3): 264-267

    Abstract

    Errors in neural crest development are responsible for a number of ocular disorders. In some cases, these ocular abnormalities may be associated with systemic disorders, some of which may be life threatening.We reviewed the medical record of 3 children from 2 institutions with a similar constellation of ocular and cardiac abnormalities.All 3 children had iris hypoplasia with pupils 6-7 mm in diameter that had minimal or no response to light or pharmacological agents. The ocular examinations were otherwise normal. All 3 children also had large aorticopulmonary septal defects which were surgically repaired.We report an association between iris hypoplasia and aorticopulmonary septal defects. Like the iris stroma, the aorticopulmonary septum forms from neural crest cells during embryogenesis which divide the truncus arteriosus into the ascending aorta and pulmonary trunk. Children with iris hypoplasia should undergo an immediate cardiac evaluation. It is important that opthalmologists be aware of the association between these two disorders since an aorticopulmonary septal defect is a life-threatening disorder.

    View details for Web of Science ID 000230049700012

    View details for PubMedID 15956947

  • Trigeminal nerve hypoplasia and aplasia in children with Goldenhar syndrome and corneal hypoesthesia JOURNAL OF AAPOS VIllanueva, O., Atkinson, D. S., Lambert, S. R. 2005; 9 (2): 202-204

    View details for DOI 10.1016/j.jappos.2004.12.016

    View details for Web of Science ID 000228808400022

    View details for PubMedID 15838455

  • Neonatal aphakia retards ocular growth and alters scleral gene expression in rhesus monkeys MOLECULAR VISION Tarnuzzer, R. W., Fernandes, A., Iuvone, P. M., Lambert, S. R. 2005; 11 (2-4): 36-49

    Abstract

    We hypothesize that remodeling of the scleral extracellular matrix, involving collagen and proteoglycan synthesis and turnover, is a key process involved in ocular growth. Decreased axial elongation is observed following neonatal removal of the crystalline lens in a rhesus monkey model of congenital cataract. We wanted to determine changes in gene expression in the operated and companion eye following lensectomy, especially for extracellular matrix in the sclera.Between 4 and 7 days of age, infant monkeys underwent surgical removal of the lens from the right eye. Axial lengths of the operated and unmanipulated fellow eyes were measured and when interocular differences of >0.4 mm were achieved, monkeys were sacrificed and RNA was isolated from sclera. In order to determine changes in scleral gene expression in aphakic versus control eyes, we used Clontech's Atlas Gene Array (Human Cancer Array version 1.2) hybridized with total RNA from three monkeys.Atlas Gene Array analysis demonstrated differential expression of several genes in the operated versus the unmanipulated eye. Most notably, there was a statistically significant increase in expression of several extracellular matrix (ECM) genes including: aggrecan, decorin, biglycan, several collagens, and tenascin in the RNA from the sclera of the aphakic eyes when compared to the unmanipulated eyes. Genes for several matrix metalloproteinases (MMPs) showed no significant change following lens removal although there was a trend towards decreased expression. There were also statistically significant changes in the pattern of gene expression in the operated eye relative to the unmanipulated eye for cell adhesion, cell cycle, apoptosis, and cytoskeleton transcripts.Our results suggest that removal of the crystalline lens alters gene expression in the sclera with a prominent upregulation of ECM transcripts. These data support recent evidence that remodeling of the ECM composition of the sclera may be an important regulator of ocular growth.

    View details for Web of Science ID 000226405100003

    View details for PubMedID 15660023

  • A prospective study of alternating occlusion prior to surgical alignment for infantile esotropia: one-year postoperative motor results. Transactions of the American Ophthalmological Society Ing, M. R., Norcia, A., Stager, D., Black, B., Hoffman, R., Mazow, M., Troia, S., Scott, W., Lambert, S. 2005; 103: 31-35

    Abstract

    Alternating occlusion prior to surgical alignment has been suggested by some strabismologists to possibly enhance the treatment of infantile esotropia. This report presents the data for 44 patients prospectively enrolled by random assignment to an alternating occlusion or no occlusion subgroup followed for 1 year postoperatively.All patients were measured at entry into the study, at the time of surgery, and at 6 weeks and 1 year postoperatively. Alternating occlusion was full-time and symmetric for those with no amblyopia but asymmetric for those with amblyopia. The subgroup that did not receive alternating occlusion had occlusion for amblyopia only. Initial surgeries were performed between the ages of 6 and 13 months.The patients, as a whole, showed a significant increase of 9.14 prism diopters when followed for a mean of 4.2 months prior to initial surgery (P < .00027). Seventy-five percent of all patients were aligned by the initial surgery. Ninety-one percent of those patients aligned at 6 weeks were also aligned at the 1-year postoperative date. The results were similar for both the control group and the patients treated with alternating occlusion.In our sample of patients, alternating occlusion does not detectably alter the increase in angle of deviation between the dates of entry and the date of the initial surgical alignment procedure, nor does it influence the postoperative alignment at 6 weeks or at 1 year.

    View details for PubMedID 17057785

  • Optotype acuity and re-operation rate after unilateral cataract surgery during the first 6 months of life with or without IOL implantation BRITISH JOURNAL OF OPHTHALMOLOGY Lambert, S. R., Lynn, M., Drews-Botsch, C., Dubois, L., Plager, D. A., Medow, N. B., Wilson, M. E., Buckley, E. G. 2004; 88 (11): 1387-1390

    Abstract

    To compare optotype acuities and re-operation rates in children corrected with a contact lens (CL) compared with an intraocular lens (IOL) following unilateral cataract extraction during infancy in a non-randomised, retrospective case series.25 infants with a unilateral congenital cataract underwent cataract surgery with (IOL group, n = 12) or without (CL group, n = 13) IOL implantation when <7 months of age. Optotype acuities were assessed in 19 of these children at a mean age of 4.3 years (range 3.3-5.5 years). The number of re-operations were assessed in 21 children.The visual acuity results were similar in the two treatment groups (p = 0.99); however, two of the four (50%) children in the IOL group compared with two of the seven (28%) children in the CL group undergoing surgery during the first 6 weeks of life had 20/40 or better visual acuity. The children in the IOL group had more re-operations than the children in the CL group (mean 1.1 v 0.36). Most of the re-operations in the IOL group were membranectomies performed during the first year of life (median 8.0 months) whereas all of the re-operations in the CL group were the implantation of a secondary IOL later in childhood (mean 2.2 years).Optotype acuities were similar for the children corrected with a CL compared with IOL, while the children in the IOL group underwent more re-operations .

    View details for DOI 10.1136/bjo.2004.045609

    View details for Web of Science ID 000224510500008

    View details for PubMedID 15489478

  • Longitudinal changes in the refractive errors of children with tears in Descemet's membrane following forceps injuries JOURNAL OF AAPOS Lambert, S. R., Drack, A. V., Hutchinson, A. K. 2004; 8 (4): 368-370

    Abstract

    Eyes with tears in Descemet's membrane secondary to forceps injuries frequently develop myopic astigmatism. Little is known regarding the longitudinal changes in the refractive errors of these eyes.We performed a retrospective review of two children with tears in Descemet's membrane following forceps injuries to their left eyes. The refractive errors were followed longitudinally.Both patients developed myopic astigmatism in their affected eye and received optical correction and occlusion therapy. In both cases there was reduction in the myopic refractive error during early childhood. While the astigmatic refractive error was stable in one patient it decreased in the second patient.Myopia decreased in two children with myopic astigmatism secondary to tears in Descemet's membrane. Myopia in children with tears in Desemet's membrane is likely due to deformation of the cornea rather than form-deprivation.

    View details for DOI 10.1016/j.jaapos.2004.04.008

    View details for Web of Science ID 000223355600013

    View details for PubMedID 15314599

  • Treatment of congenital cataract BRITISH JOURNAL OF OPHTHALMOLOGY Lambert, S. R. 2004; 88 (7): 854-855

    View details for DOI 10.1136/bjo.2004.045401

    View details for Web of Science ID 000222093100002

    View details for PubMedID 15205222

  • Surgical management of glaucoma in infants and children with Peters' anomaly - Long-term structural and functional outcome OPHTHALMOLOGY Yang, L. L., Lambert, S. R., Lynn, M. J., Stulting, R. D. 2004; 111 (1): 112-117

    Abstract

    To determine the long-term outcome of surgery for congenital glaucoma in infants and children with Peters' anomaly.Retrospective review of a consecutive interventional case series.An urban academic tertiary referral institution.Thirty-four eyes of 19 children are subjects of this report. Included are all children 12 years of age or younger with Peters' anomaly who underwent surgery for primary congenital glaucoma between January 1971 and December 1992 and completed a minimum of 3 years of follow-up from the date of the first glaucoma surgery.The surgical procedures performed were trabeculectomy, trabeculotomy, goniotomy, Molteno shunt implantation, cyclodialysis, and cyclocryotherapy.Primary outcome measures were intraocular pressure (IOP) control and final postoperative visual acuity. Intraocular pressure control was defined as complete success (IOP21 mmHg with or without antiglaucoma medication, inoperable retinal detachment, phthisis, or chronic hypotony, defined as an IOP of

    View details for DOI 10.1016/j.ophtha.2003.02.002

    View details for Web of Science ID 000187806800018

    View details for PubMedID 14711722

  • Intraocular lens implantation during infancy: Perceptions of parents and the American Association for Pediatric Ophthalmology and Strabismus members JOURNAL OF AAPOS Lambert, S. R., Lynn, N., Drews-Botsch, C., Dubois, L., Wilson, M. E., Plager, D. A., Wheeler, D. T., Christiansen, S. P., Crouch, E. R., Buckley, E. G., Stager, D., Donahue, S. P. 2003; 7 (6): 400-405

    Abstract

    To determine whether a randomized clinical trial, the Infant Aphakia Treatment Study, comparing intraocular lens (IOL) implantation with contact lens (CL) correction for infants with a unilateral congenital cataract (UCC), is feasible by (1) ascertaining whether American Association for Pediatric Ophthalmology and Strabismus (AAPOS) members have equipoise regarding these two treatments and (2) evaluating the willingness of parents to agree to randomization.All AAPOS members were surveyed in August 1997 and again in June 2001 regarding their use of CLs and IOL implants to correct infants vision after unilateral cataract surgery. In addition, a pilot study was begun in March 2002 to evaluate the safety of IOL implantation during infancy and the willingness of parents to randomize their children with a UCC to either IOL implantation or CL correction.In 1997, 89% of the 260 respondents reported that in the previous year they had treated at least one infant with a UCC, but only 4% had implanted an IOL in an infant <7 months old. Silsoft (Bausch & Lomb, Rochester, NY) CL correction was the preferred treatment choice for 84% of the respondents. In 2001, 21% of the 279 respondents had implanted an IOL in an infant. On a scale from 1 to 10 with 1 strongly favoring an IOL implant and 10 strongly favoring a CL, the median score was 7.5. Sixty-one percent of the respondents indicated that they would be willing to randomize children with a UCC to one of these two treatments. The main concerns about IOL implantation were poor predictability of power changes, postoperative complications, inflammation, and technical difficulty of surgery. The main concerns about CL correction were poor compliance, high lens loss rate, high cost, and keratitis. In our pilot study, 30 infants <7 months of age were evaluated at nine clinical centers for a visually significant UCC. Of 24 infants eligible for randomization, the parents of 17 (71%) agreed to randomization.Although most AAPOS members still favor CL correction after cataract surgery for a UCC, five times as many had implanted an IOL in an infant in 2001 compared with the number in 1997. Parents were almost equally divided in their preference for IOL implant versus CL correction. Given the relative equipoise of AAPOS members regarding these treatments and the willingness of more than two thirds of parents to agree to randomization, it seems likely that a randomized clinical trial comparing these two treatments could indeed be conducted.

    View details for DOI 10.1016/j.jaapos.2003.08.004

    View details for Web of Science ID 000187624700007

    View details for PubMedID 14730292

  • Parenting stress among caregivers of children with congenital cataracts JOURNAL OF AAPOS Drews, C., Celano, M., Plager, D. A., Lambert, S. R. 2003; 7 (4): 244-250

    Abstract

    To examine parenting stress among caregivers of young children with congenital cataracts and to assess whether diagnostic and/or treatment differences are associated with differences in perceived parenting stress.Parents of 41 preschool-age children with congenital cataracts (13 with bilateral cataracts [BCCs] and 28 with unilateral cataracts [UCCs], of whom 14 were aphakic and 14 were pseudophakic) completed the Parenting Stress Index (PSI) and/or a disease-specific parental stress measure, ie, the Ocular Treatment Index (OTI).The 28-item OTI had excellent internal consistency (alpha = 0.94) and supported three of four a priori validity hypotheses. Parents of children with congenital cataracts reported normal parenting stress levels on the PSI. Parents of children with UCCs tended to report higher levels of stress, but not significantly so, than did parents of children with BCCs. Among parents of children with UCCs, those whose children were aphakic reported higher levels of stress on the OTI and all of the PSI subscales than did parents of pseudophakic children. These differences were statistically significant for two subscales (Adaptability [P =.03] and Mood [P =.01]).Although parents of children with congenital cataracts generally did not report increased parenting stress levels, clinicians should be aware that parenting stress can adversely impact patients' families. We did observe higher stress levels in parents with children who had UCCs and did not receive an intraocular lens-particularly stress related to their child's reaction to sensory stimulation and mood-compared with parents of pseudophakic children. Thus, clinicians may want to consider parenting stress levels when choosing a treatment for children with UCCs, especially because such stress has been associated with poor treatment compliance for children with other chronic conditions.

    View details for DOI 10.1016/S1091-8531(03)00118-6

    View details for Web of Science ID 000184856500005

    View details for PubMedID 12917610

  • Congenital iris coloboma repair using a modified McCannel suture technique AMERICAN JOURNAL OF OPHTHALMOLOGY Blackmon, D. M., Lambert, S. R. 2003; 135 (5): 730-732

    Abstract

    To report a repair of congenital iris coloboma using a modified McCannel suture technique.Interventional case report.Retrospective intervention procedure.Postoperative repair resulted in restoration of pupil, anterior support of posterior chamber intraocular lens, and improved appearance.The modified McCannel suture technique provides acceptable functional and cosmetic repair of congenital iris colobomas.

    View details for Web of Science ID 000182477800034

    View details for PubMedID 12719095

  • Clinical features predictive of successfully weaning from spectacles those children with accommodative esotropia JOURNAL OF AAPOS Lambert, S. R., Lynn, M., Sramek, J., Hutcheson, K. A. 2003; 7 (1): 7-13

    Abstract

    It has been reported that most children with accommodative esotropia are not able to discontinue spectacle wear as they become older. We conducted a prospective study to determine which factors are predictive of successfully weaning children from spectacles.Beginning in 1995, children with fully accommodative esotropia with a baseline refractive error of + 1.50 to + 5.00 diopters (D) were gradually weaned from their hyperopic correction. Patients with amblyopia or who had previously undergone strabismus surgery were excluded. Children were weaned in 0.50 D increments until spectacles were discontinued or they developed esotropia, asthenopia, or decreased vision. A multivariate analysis was performed to assess the association between successful weaning and various clinical characteristics.Twelve of 20 children (60%) were successfully weaned from spectacles. Spectacles were prescribed at a mean age of 4.2 +/- 1.5 years, and weaning was initiated at a mean age of 8.0 +/- 1.1 years. The spherical equivalent of the least hyperopic eye when spectacles were prescribed was 2.99 +/- 1.06 D. The clinical characteristic most clearly associated with successful weaning was the refractive error at the time glasses were prescribed. Whereas 10 of 11 (91%) patients with < 3 D of hyperopia were weaned from spectacles, only 2 of 9 (22%) patients with 3 to 5 D of hyperopia were successfully weaned from their spectacles (P =.005).Many children with fully accommodative esotropia can be weaned out of spectacles during the grade school years. The degree of baseline hyperopia appears to be one of the best predictors of success.

    View details for DOI 10.1016/S1091-8531(02)42010-1

    View details for Web of Science ID 000181952900002

    View details for PubMedID 12690363

  • Weaning children with accommodative esotropia out of spectacles: a pilot study BRITISH JOURNAL OF OPHTHALMOLOGY Hutcheson, K. A., Ellish, N. J., Lambert, S. R. 2003; 87 (1): 4-7

    Abstract

    Many children with accommodative esotropia must continue spectacle use throughout life. This study was undertaken to determine which factors are predictive of successfully weaning children with accommodative esotropia out of spectacles.A retrospective review of 10 children with accommodative esotropia, who were gradually weaned from their hyperopic correction, and three age matched controls was performed. The main outcome measure was resolution or non-resolution of esotropia following weaning and eventual discontinuation of spectacles. Secondary outcome measures were final refractive error and the final esotropic or esophoric angle without correction.Six patients were successfully weaned from spectacles. At the completion of the weaning period one child was orthophoric and the other five children had well controlled esophorias. The other four patients remained spectacle dependent because of persistent esotropia or decreased vision without spectacles. The baseline and final refractive errors were significantly lower in the children successfully weaned from spectacles (p = 0.014). While the children who were successfully weaned from spectacles were older when initially diagnosed with accommodative esotropia (4.6 v 2.5 years), this difference was not statistically significant (p = 0.09).Some children with accommodative esotropia may be weaned out of spectacles during the grade school years with resolution of their esotropia. It is likely that gradual reduction of the hyperopic correction increases divergence amplitudes, but it is unclear whether this facilitates emmetropisation.

    View details for Web of Science ID 000180180700003

    View details for PubMedID 12488252

  • The use of an image guidance system in retrieving lost medial rectus muscles JOURNAL OF AAPOS Srivastava, S. K., Reichman, O. S., Lambert, S. R. 2002; 6 (5): 309-314

    Abstract

    Finding a lost medial rectus muscle can be difficult. We present 2 patients in whom image guidance technology assisted in the recovery of a lost medial rectus muscle.Two patients (ages 19 and 33), both with lost medial rectus muscles, underwent computerized tomography of their heads, faces, and orbits. The muscles were both lost after strabismus surgery 7 and 19 years ago, respectively. These images were then loaded into an image guidance system (LandmarX, Xomed Co, Jacksonville, Fla) and served as a "map" to locate the lost medial rectus muscle intraoperatively. Using a transnasal endoscopic approach, the lamina papyracea was exposed. The area of the lamina closest to the lost medial rectus was identified using a guidance probe. After the periorbita was exposed, the guidance probe was used to confirm the location of the medial rectus muscle. The muscle was then isolated transnasally and passed into the orbit using forceps. It was then sutured onto the globe.The medial rectus was identified transnasally and reattached to the globe in both cases. Adduction improved from complete deficits in both patients to 80% and 50% adduction deficits, respectively.The transnasal endoscopic approach to retrieve the medial rectus has been described before. For these patients, image guidance technology successfully identified the appropriate areas for the surgeons to locate the lost muscle. The use of this technique decreased operative times and reduced the extent of the dissection required, which should also reduce long-term scarring.Image guidance technology, with its capability of 3-dimensional images, can be used to assist surgeons in finding lost medial rectus muscles.

    View details for DOI 10.1067/mpa.2002.127117

    View details for Web of Science ID 000178745800007

    View details for PubMedID 12381990

  • Strabisms - Are there more exotropes than esotropes in Hong Kong? BRITISH JOURNAL OF OPHTHALMOLOGY Lambert, S. R. 2002; 86 (8): 835-836

    View details for Web of Science ID 000177249200001

    View details for PubMedID 12140194

  • Clinical outcome of confluent laser photoablation for retinopathy of prematurity JOURNAL OF AAPOS Fallaha, N., Lynn, M. J., AABERG, T. M., Lambert, S. R. 2002; 6 (2): 81-85

    Abstract

    During the past decade, laser photoablation has supplanted cryotherapy as the standard treatment for threshold retinopathy of prematurity (ROP). We evaluated the progression and the complication rate in a cohort of infants with threshold ROP treated with a confluent technique.We retrospectively studied 47 patients with ROP (91 eyes), treated with confluent diode laser photoablation. Four main outcomes were evaluated: (1) the rate of progression, (2) the frequency of laser retreatment, (3) postoperative complications, and (4) postoperative refractive error.A mean of 1943 +/- 912 laser burns were administered in a confluent pattern to 91 eyes with threshold ROP. Progression to stage 4 or 5 disease occurred in 13 of 29 eyes (44.8%) with zone I and posterior zone II and in 2 of 51 eyes (3.9%) with anterior zone II ROP (P =.01). Eyes with anterior zone II ROP that received more than or equal to 2000 burns progressed more than those that received fewer than 2000 burns. Only 1 eye (1%) needed a supplemental laser treatment. Postoperative complications included corneal edema (2.3%), anterior segment ischemia (2.3%), vitreous hemorrhage (7.9%), posterior synechiae (2.3%), cataract (4.9%), and macular ectopia (12%). The mean spherical equivalent at the last follow-up was -4.52 +/- 5.63 D.In our series, infants received more laser burns than infants reported in the literature receiving scatter or near-confluent treatment. While confluent treatment almost eliminated supplemental treatment, it was associated with a similar rate of progression and complications as has been reported with other patterns of laser treatment.

    View details for DOI 10.1067/mpa.2002.121452

    View details for Web of Science ID 000175625800005

    View details for PubMedID 11997803

  • A Randomized trial of atropine vs patching for treatment of moderate amblyopia in children ARCHIVES OF OPHTHALMOLOGY GLASER, S. R., Matazinski, A. M., Sclar, D. M., Sala, N. A., Vroman, C. M., Tanner, C. E., Stager, D. R., Berry, P. M., Stager, D. R., Felius, J., Wilkerson, J. A., Pesheva, M. P., Birch, E. E., Jeffrey, B. G., O'Connor, A. R., Tien, D. R., Bulan, G. E., Christ, H. C., DeWaele, L. B., Young, D. A., Astle, W. F., Ells, A. L., Hayduk, C. R., Kerr, C. I., McAlester, M. S., Peddie, H. J., Vibert, H. M., Hertle, R. W., Mellow, S. D., FitzGibbon, E. J., Foster, G. E., Arnold, R. W., Armitage, M. D., Brusseau, N. H., Ruttum, M. S., Kivlin, J. D., Picard, V. R., Chesner, M. J., Cotter, S. A., Barnhardt, C. N., Shin, S. M., Chu, R. H., Asiain, L., Flores, Y. F., Lee, G., Lee, J. H., Fort, S. C., Slutsky, J. L., Paysse, E. A., Coats, D. K., Brady-McCreery, K. M., Sanchez, A. D., Correodor, V., Donahue, S., Foss, C., Ozier, J. A., Biernacki, R. J., Tomlinson, E., Wheeler, D. T., Beaudet, K. A., Bateman, C. L., Hartwell, M. A., Ruben, J. B., Desai, D., Parrish, S. A., Louie, T. D., Rutstein, R. P., Marsh-Tootle, W. L., Baldwin, C. H., Becker, K. T., Repka, M. X., Hunter, D. G., Mattheu, J. S., Broome, S. O., Goodman, C. R., Neely, D. E., Plager, D. A., Sprunger, D. T., Bates, D. J., Galli, J., Whitaker, M. E., Tamkins, S. M., Gonzalez, M., Jacobs, S., Collins, M. L., McCarus, C. L., Brown, J. N., Conlan, D. B., Lambert, S. R., Yang, L., Elliott, A. T., Fallaha, N., Cruz, O. A., Davitt, B. V., Havertape, S. A., Miyazaki, E. A., Bosch, M. B., Levada, A. J., Matchett, T. L., Moya, A. Z., Mulligan, C. C., Weiss, S. K., Pelletier, H. J., Droste, P. J., Peters, R. J., Hilbrands, J., Sheeran, K. A., Smith, D. K., Vanraze-nswaay, C. L., Weakley, D. R., Dias, C. L., Johnson, D. A., James, R. D., Claes, P. G., Drake, K. K., Holmes, J. M., Nielsen, B. A., Garcia, M., Kroening, R. M., Leske, D. A., Levisen, M. L., Miller, D. K., Priebe, D. M., Spitzer, J. A., Scheiman, M. M., Bailey, J. A., Zinzer, K. T., Kulp, M. T., Kitts, T. L., Earley, M. J., Awner, S., Olitsky, S. E., Silbert, D. I., Wagner, A. E., Castillo, K. M., Matta, N. S., Meshey, T. L., Myers-Ely, P., Piper, W. L., Scaringi, D. M., Snavely, P. M., Walker, L. J., Burns, C. L., Barsoum-Homsy, M., Lawrence, L. I., Wallace, D. K., Sullivan, M. J., MILLER, J. M., Aparisi, T. A., Funk-Weyant, J., Taylor, M., Bulau, S., Scott, W. E., Ottar-Pfeifer, W. I., Kutschke, P. J., Wilken, K. M., Summers, C. G., Christiansen, S. P., Holleschau, A. M., Cook, S. M., LaVoie, J. D., Merrill, K. S., Elsas, F. J., Metz, T. H., Mizell, M. L., Bennett, S. O., Crouch, E. R., Ruark, K. D., Ventura, G. G., Paciuc, M., Schnadower, M. M., Velasco, C., Dries, D. C., Vengco, V. J., Olson, R. J., Hoffman, R. O., Bracken, S. F., Remington, P. L., Yen, K. G., Wiggins, R. E., Baumgartner, S. A., Knecht, M., Constance, C. E., Benson, S. L., Hahn-Parrott, L. A., Motley, W. E., Poole, R. M., Forbes, B. J., Quinn, G. E., Ehnbom, M. L., Maturo, M. C., Phillips, D. R., Miller, M. M., Maybodi, M., Greger, C., Magoon, E. H., Kannam, P. A., McAtee, L. A., Andrews, M., Hoge, C. M., Saunders, R. A., Hoxie, J. P., Langdale, L. M., Lenhart, K. D., Moore, B., Weissberg, E. M., Duckman, R. H., Fitzgerald, D. E., Vricella, M., Beck, R. W., Moke, P. S., Blair, R. C., Cole, S. R., Kraker, R. T., Gillespie, H. A., Boyle, N. M., Lawson, A. N., Gillett, J. A., Mares, S. T., Dale, B. B., Everett, D. F., Birch, E. E., Hertle, R. W., Holmes, J. M., Repka, M. X., Quinn, G. E., Saunders, R. A., SIMONS, K., Cotter, S. A., Scheiman, M. M., MILLER, J. M., Pesheva, M. P., Picard, V. R., Sala, N. A., Tien, R., Barlow, W., Buckley, E. G., Davis, B., Dobson, V., Keltner, J. L., Osman, H., Palmer, E. A., Phelps, D. L. 2002; 120 (3): 268-278

    Abstract

    To compare patching and atropine as treatments for moderate amblyopia in children younger than 7 years.In a randomized clinical trial, 419 children younger than 7 years with amblyopia and visual acuity in the range of 20/40 to 20/100 were assigned to receive either patching or atropine at 47 clinical sites.Visual acuity in the amblyopic eye and sound eye after 6 months.Visual acuity in the amblyopic eye improved in both groups (improvement from baseline to 6 months was 3.16 lines in the patching group and 2.84 lines in the atropine group). Improvement was initially faster in the patching group, but after 6 months, the difference in visual acuity between treatment groups was small and clinically inconsequential (mean difference at 6 months, 0.034 logMAR units; 95% confidence interval, 0.005-0.064 logMAR units). The 6-month acuity was 20/30 or better in the amblyopic eye and/or improved from baseline by 3 or more lines in 79% of the patching group and 74% of the atropine group. Both treatments were well tolerated, although atropine had a slightly higher degree of acceptability on a parental questionnaire. More patients in the atropine group than in the patching group had reduced acuity in the sound eye at 6 months, but this did not persist with further follow-up.Atropine and patching produce improvement of similar magnitude, and both are appropriate modalities for the initial treatment of moderate amblyopia in children aged 3 to less than 7 years.

    View details for Web of Science ID 000174300900001

    View details for PubMedID 11879129

  • Diffusion-weighted magnetic resonance imaging in shaken baby syndrome AMERICAN JOURNAL OF OPHTHALMOLOGY Biousse, V., Suh, D. Y., Newman, N. J., Davis, P. C., Mapstone, T., Lambert, S. R. 2002; 133 (2): 249-255

    Abstract

    To evaluate the role of diffusion-weighted magnetic resonance imaging (DWIMRI) in the diagnosis and management of children with suspected or confirmed Shaken Baby Syndrome (SBS).This was a retrospective interventional case series of all infants and children younger than 2 years of age admitted to a children's hospital. We retrospectively reviewed medical records and neuroimaging findings of all children younger than 2 years of age with confirmed or suspected SBS admitted to a children's hospital. Inclusion criteria were documented ocular examination by an ophthalmologist and a brain MRI with DWI. Twenty-six infants and children were included. Other children were excluded. Children with proven SBS were diagnosed with "confirmed SBS," while children in whom the diagnosis of SBS remained uncertain were diagnosed with "suspected SBS."Twenty-six infants and children with mean age of 7.1 months (range, 6 weeks-24 months) were included, 18 with confirmed SBS. All 26 patients had a subdural hematoma, 10 had associated occult bone fractures, and 18 had retinal hemorrhages. Seven of the eight cases without retinal hemorrhages had isolated subdural hematoma without parenchymal brain lesions on both conventional MRI and DWIMRI. SBS was confirmed in only one case with a normal fundus. Among the 18 patients with retinal hemorrhages, SBS was confirmed in all but one case. All 18 patients with confirmed SBS had an abnormal DWIMRI. In 13 patients, DWI showed lesions that were larger than on conventional MRI. In patients with brain parenchymal lesions, the DWIMRI characteristics suggested cerebral ischemia, which appears to play a major role in SBS.In all patients with confirmed SBS, DWIMRI was abnormal and suggested diffuse or posterior cerebral ischemia, in addition to subdural hematomas in the pathogenesis of this disorder.

    View details for Web of Science ID 000173669900011

    View details for PubMedID 11812430

  • Pediatric cataracts. Ophthalmology clinics of North America Fallaha, N., Lambert, S. R. 2001; 14 (3): 479-492

    Abstract

    The management of infantile cataracts continues to be a challenging task, however with new surgical techniques, IOL implantation, and new patching regimens, the visual outcomes are improving.

    View details for PubMedID 11705148

  • Peters' anomaly. A synopsis of surgical management and visual outcome. Ophthalmology clinics of North America Yang, L. L., Lambert, S. R. 2001; 14 (3): 467-477

    Abstract

    Peters' anomaly is not an isolated anterior segment abnormality, but occurs as a diverse, phenotypically heterogeneous condition associated with multiple underlying ocular and systemic defects. Surgical treatment of Peters' anomaly is a complex and challenging undertaking. The broad spectrum of disease severity, the lack of uniformity in clinical features, the differences and overlap of preoperative risk factors, and the variability in the numbers and types of intraocular procedures that are performed on individual eyes, as well as postoperative complications all contribute to the difficulties involved in surgical management. This article discloses useful information pertaining to keratoplasty for Peters' anomaly. The study by Yang et al showed that long-term graft clarity could be achieved in 36% of eyes. However, 93% of all clear grafts were first grafts, whereas only 7% were second grafts. All third or subsequent grafts failed. Other important findings were: (1) the significantly greater chance of maintaining a clear graft with initial grafts, compared with subsequent grafts; (2) the disclosure of periods of differential risk for graft failure; and (3) the identification of risk factors for graft failure. Surgical intervention involving one or more procedures is effective in controlling IOP in 32% of eyes with associated congenital glaucoma. Still, multiple procedures and adjunctive medical therapy are often required to achieve and maintain adequate IOP control. The visual outcome is guarded in children with Peters' anomaly. Achieving a satisfactory visual outcome and preventing further visual loss is impeded by the presence of congenital anterior and posterior segment anomalies, structural defects of the CNS, cognitive dysfunction and amblyopia, as well as postoperative complications such as graft failure, cataract, inoperable retinal detachment, and phthisis.

    View details for PubMedID 11705147

  • Slipped and lost extraocular muscles. Ophthalmology clinics of North America Lenart, T. D., Lambert, S. R. 2001; 14 (3): 433-442

    Abstract

    A slipped or lost muscle should be considered in the differential diagnosis of a patient presenting with a marked limitation of duction and inability to rotate the eye beyond the midline. Loss of a rectus muscle can occur after strabismus surgery, trauma, paranasal sinus surgery, orbital surgery, or retinal detachment surgery. The extraocular rectus muscle most frequently slipped or lost is the medial rectus muscle. Forced ductions, active force generation, saccadic velocity studies, differential intraocular pressure measurements, and orbital imaging studies may aid in identifying a slipped or lost muscle. However, no single diagnostic test provides absolute reliability for determining a lost muscle. Slipped muscles develop when the muscular capsule is imbricated without including the muscle or muscle tendon during strabismus surgery. When the capsule is reattached to the sclera, the tendon and muscle are then free to slip posteriorally from the site of attachment. Slipped muscles are retrieved by following the thin avascular muscle capsule posteriorally until the muscle is identified. A lost muscle can be found using a traditional conjunctival approach, by an external orbitotomy, or by an endoscopic transnasal approach. Although many diagnostic maneuvers are useful in identifying a lost rectus muscle, the oculocardiac reflex is the most important. Once the lost muscle is identified, the muscle should be imbricated with a nonabsorbable synthetic suture and securely reattached to the globe.

    View details for PubMedID 11705143

  • Accommodative esotropia. Ophthalmology clinics of North America Lambert, S. R. 2001; 14 (3): 425-432

    Abstract

    Accommodative esotropia is the most common type of strabismus with a very favorable prognosis if the appropriate treatment is initiated promptly. Spectacles remain the preferred treatment, but both contact lenses and refractive surgery may be helpful in some situations to correct the associated hyperopia. Strabismus surgery should only be used if optical correction or refractive surgery are ineffective in restoring normal ocular alignment.

    View details for PubMedID 11705142

  • A comparison of grating visual acuity, strabismus, and reoperation outcomes among children with aphakia and pseudophakia after unilateral cataract surgery during the first six months of life JOURNAL OF AAPOS Lambert, S. R., Lynn, M., Drews-Botsch, C., Loupe, D., Plager, D. A., Medow, N. B., Wilson, M. E., Buckley, E. G., Drack, A. V., Fawcett, S. L. 2001; 5 (2): 70-75

    Abstract

    The method of correcting aphakia after unilateral cataract extraction during infancy is controversial. Some authorities advocate correction with an intraocular lens (IOL) whereas others advocate correction with a contact lens (CL). We compared grating visual acuity, alignment, and reoperative outcomes in age-matched children treated with these 2 modalities at 5 clinical centers.Twenty-five infants born in 1997 or 1998 with a dense unilateral congenital cataract who had cataract surgery coupled with (IOL group, n = 12) or without (CL group, n = 13) primary IOL implantation were enrolled in this study. All patients were prescribed half-time occlusion therapy. In July 1999, their grating visual acuities, ocular alignments, and reoperation rates were assessed.The mean grating visual acuity (LogMAR) for the affected eye was 0.70 +/- 0.32 for the IOL group and 0.87 +/- 0.31 for the CL group (P =.19). The mean interocular difference in grating visual acuity was 0.26 +/- 0.30 for the IOL group and 0.50 +/- 0.28 for the CL group (P =.048). The incidence of strabismus (>10 PD) was 75% in the IOL group compared with 92% in the CL group (P =.24). The incidence of reoperations was 83% in the IOL group compared with 23% in the CL group (P =.003).Our preliminary data suggest that correcting aphakia after unilateral congenital cataract surgery with primary IOL implantation results in an improved visual outcome but a higher rate of complications requiring reoperation. A randomized clinical trial, the Infant Aphakia Treatment Study, is planned to further study the optimal treatment for aphakia following unilateral cataract extraction during infancy.

    View details for Web of Science ID 000168151900002

    View details for PubMedID 11304812

  • Retrieval of lost medial rectus muscles with a combined ophthalmologic and otolaryngologic surgical approach AMERICAN JOURNAL OF OPHTHALMOLOGY Lenart, T. D., Reichman, O. S., McMahon, S. J., Lambert, S. R. 2000; 130 (5): 645-652

    Abstract

    To report retrieval of a medial rectus muscle completely detached from the globe and lost in the orbital tissue in four eyes.A lost medial rectus muscle was retrieved in four eyes of four patients with either a transcutaneous medial orbitotomy approach or a transnasal endoscopic ethmoid sinus approach.The lost medial rectus muscle was successfully retrieved in all four patients. One patient lost the medial rectus muscle secondary to trauma, and the other three cases resulted from complications of strabismus surgery. The mean preoperative angle of exotropia was 44 prism diopters. The endoscopic approach was attempted in three patients, and the medial rectus muscle was successfully found in two of these patients. In one case in which the endoscopic approach was used, an image guidance system was used to aid in finding the lost medial rectus muscle. The endoscopic approach was abandoned in one case in which the medial rectus muscle could not be identified after extensive searching, but the muscle was subsequently found by means of the transcutaneous medial orbitotomy approach. A transcutaneous medial orbitotomy alone was used to find the lost medial rectus muscle in one of the cases. The postoperative ocular deviation for primary position at distance fixation was a mean of 24 prism diopters of exotropia. With one additional operation in two patients, the mean ocular deviation was less than 12 prism diopters.We successfully retrieved a lost medial rectus muscle in four patients with the use of nontraditional strabismus surgical techniques. We effectively combined techniques taken from both ophthalmology and otorhinolaryngology to help solve this difficult problem.

    View details for Web of Science ID 000165385300011

    View details for PubMedID 11078843

  • Tonic pupil associated with congenital neuroblastoma, Hirschsprung disease, and central hypoventilation syndrome AMERICAN JOURNAL OF OPHTHALMOLOGY Lambert, S. R., Yang, L. L., Stone, C. 2000; 130 (2): 238-240

    Abstract

    To report the association of tonic pupil, congenital neuroblastoma, Hirschsprung disease, and central hypoventilation syndrome.Case reports.Two infants with central hypoventilation syndrome and Hirschsprung disease were evaluated for dilated, nonreactive pupils present since birth. In both cases, pharmacologic testing with dilute pilocarpine confirmed denervation supersensitivity consistent with tonic pupil. The diagnosis of congenital neuroblastoma was subsequently established in both infants.The close association of these conditions in these two young children supports the concept of a common neural crest abnormality being present. A careful systemic evaluation to rule out congenital neuroblastoma should be performed in any young child who presents with tonic pupil in the setting of central hypoventilation syndrome and Hirschsprung disease.

    View details for Web of Science ID 000089601800018

    View details for PubMedID 11004304

  • Isolated comitant esotropia and chiari I malformation AMERICAN JOURNAL OF OPHTHALMOLOGY Biousse, V., Newman, N. J., Petermann, S. H., Lambert, S. R. 2000; 130 (2): 216-220

    Abstract

    To report four patients with isolated comitant esotropia and Chiari I malformation and discuss the most appropriate management.Case reports and literature review.All four patients (5, 14, 16, and 37 years of age) presented with an isolated comitant esotropia that led to the diagnosis of Chiari I malformation. The first two patients underwent uncomplicated neurosurgical decompression of their malformation, followed by complete resolution of their esotropia. The third patient underwent strabismus surgery and experienced initial resolution of the esotropia, but eventual recurrence resulted in the strabismus surgery being repeated 5 years later. The fourth patient had strabismus surgery with resolution of the esotropia but only 2 months of follow-up.Although management of patients with Chiari I malformation and severe neurologic findings typically includes surgical decompression, management is less straightforward in cases with subtle findings or in which ocular findings are isolated. The decision to perform neurosurgical decompression or strabismus surgery should still be made on a case-by-case basis, with the understanding that strabismus surgery may provide only temporary ocular alignment.

    View details for Web of Science ID 000089601800011

    View details for PubMedID 11004297

  • Cataract and phthisis bulbi after laser photoablation for threshold retinopathy of prematurity AMERICAN JOURNAL OF OPHTHALMOLOGY Lambert, S. R., Capone, A., Cingle, K. A., Drack, A. V. 2000; 129 (5): 585-591

    Abstract

    To describe the visual and structural outcome of eyes that developed a dense cataract after laser photoablation for threshold retinopathy of prematurity.A retrospective review of eight consecutive infants who developed dense cataract(s) after bilateral laser photoablation for threshold retinopathy of prematurity. Of the 10 eyes with cataract, five eyes were treated with a diode laser and five with an argon laser. The stage and zone of the retinopathy of prematurity, number of burns applied, time of onset of the cataract, clinical findings at the time of cataract surgery, and the course after cataract surgery were reviewed.Six eyes had zone 1 disease and four had zone 2 disease. The mean number of burns applied per eye was 2532 +/- 856 (range, 1400 to 4500). A cataract was diagnosed a median of 3 [corrected] weeks (range, 1 to 28 weeks) after laser photoablation. Nine of the 10 cataracts were sufficiently dense to preclude a view of the fundus. All 10 eyes had clinical signs suggestive of an inflammatory or ischemic process that included one or more of the following findings: corneal edema, pupillary membrane, iris atrophy, depigmentation of ciliary processes, pigment on the anterior lens surface, posterior synechiae, hyphema, and shallow anterior chamber. Nine eyes underwent cataract surgery. Five of the 10 eyes had retinal detachment ranging in severity from stage 4A to stage 5 at the time of cataract surgery. Nine of the 10 eyes progressed to phthisis bulbi and no light perception.A dense cataract developing in the eye of an infant after laser photoablation for threshold retinopathy of prematurity is associated with a poor visual prognosis. The constellation of associated clinical findings appears to be most consistent with anterior segment ischemia.

    View details for Web of Science ID 000087281200003

    View details for PubMedID 10844048

  • Heterochromia after pediatric cataract surgery JOURNAL OF AAPOS Lenart, T. D., Drack, A. V., Tarnuzzer, R. W., Fernandes, A., Lambert, S. R. 2000; 4 (1): 40-45

    Abstract

    Changes in iris color have been noted anecdotally after cataract surgery in infants, but they have not been studied systematically. The mechanism for these iris color changes has not previously been reported in the biomedical literature.Photographs were taken of both eyes of 15 children and 11 rhesus monkeys who had undergone unilateral cataract surgery. Masked examiners reviewed the photographs and compared the iris color of the eyes that were operated on with the eyes that were not operated on. Between 4 and 6 weeks postoperatively, the level of prostaglandin F(2alpha) in the aqueous humor (n = 4) and vitreous humor (n = 2) was measured in both the operated and nonoperated eyes of 4 monkeys that had undergone a neonatal lensectomy during the first 5 days of life.Thirteen of 15 children had a darker iris color in the operated eye in relation to the nonoperated (control) eye. Four of 11 monkeys had a uniformly darker iris in the operated eye; the other 7 monkeys had regional darkening or patches of darker iris in the eye that was operated on. The prostaglandin F(2alpha) levels in neonatal monkeys were higher in the aqueous humor and in the vitreous humor of the operated eye in relation to the nonoperated eye.In some children, cataract surgery is associated with a darkening of the iris color in the operated eye. We speculate that this darkening results from an exuberant prostaglandin release stimulated by the cataract surgery and may occur through the same or a similar mechanism by which latanoprost causes the darkening of iris color.

    View details for Web of Science ID 000085455200007

    View details for PubMedID 10675870

  • A comparison of the rate of refractive growth in pediatric aphakic and pseudophakic eyes OPHTHALMOLOGY MCCLATCHEY, S. K., Dahan, E., Maselli, E., Gimbel, H. V., Wilson, M. E., Lambert, S. R., Buckley, E. G., Freedman, S. F., Plager, D. A., PARKS, M. M. 2000; 107 (1): 118-122

    Abstract

    To compare the rate of refractive growth in pseudophakic children's eyes to that of aphakic eyes.Multicenter, retrospective observational case series.83 patients with pseudophakic eyes (100 eyes) and 74 patients with aphakic eyes (106 eyes), with an age of surgery between 3 months and 10 years and a minimum follow-up time of 3 years or more, depending on the age at surgery.A logarithmic model was used to analyze the rate of refractive growth for each eye.Age at surgery, intraocular lens power, intraocular lens A-constant, initial postoperative refraction, final refraction, and final age.Overall, pseudophakic eyes showed a lesser rate of refractive growth than aphakic eyes (-4.6 diopter vs. -5.7 diopter, P = 0.03). This trend was also present but less significant when the eyes were grouped into those less than 6 months of age at surgery (-3.3 diopter vs. -4.6 diopter, P = 0.09) and older patients (-5.0 diopter vs. -6.1 diopter, P = 0.07). However, the mean quantity of myopic shift was greater in pseudophakic eyes than in aphakic eyes (-5.26 diopter vs. -4.54 diopter), despite shorter follow-up times in the pseudophakic eyes. This is due to the optical effects of a constant intraocular lens power in a growing eye.Pediatric pseudophakic eyes have a slightly lesser rate of refractive growth than aphakic eyes. The new rate values should be used for predicting future refractions in these eyes.

    View details for Web of Science ID 000084724900038

    View details for PubMedID 10647729

  • Visual outcome after contact lens and intraocular lens correction of neonatal monocular aphakia in monkeys INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Boothe, R. G., Louden, T., Aiyer, A., Izquierdo, A., Drews, C., Lambert, S. R. 2000; 41 (1): 110-119

    Abstract

    A monkey model was used to evaluate intraocular lenses (IOLs) and extended-wear contact lenses (EWCLs) for the optical treatment of infantile aphakia in humans. Specifically, the relative effectiveness of EWCLs used alone and IOLs used in combination with EWCLs in preventing amblyopia was assessed.A total of 33 rhesus monkeys was studied in this project, 24 assigned to experimental treatment groups and 9 to normal controls. Contact lenses made from a diffusing material or dyed opaque were placed on one eye at birth to simulate an infantile cataract. A unilateral lensectomy was then performed on the same eye within 2.5 weeks after birth. In 15 monkeys this was combined with implantation of an IOL. The eyes were left aphakic in the remaining 9 animals. EWCLs were used to adjust the optical correction of both aphakic and pseudophakic eyes to a near point (3-5 D). Opaque lenses were used to maintain daily part-time (approximately 70%) occlusion of the fellow eye. The primary outcome measure was grating acuity assessed with behavioral methods. Some animals were also assessed for acuity with sweep visually evoked potentials (VEPs) and for optotype acuity (Landolt C) with behavioral methods.Two of the animals with IOLs developed complications in the eye that precluded completion of the behavioral assessment protocol. Only behavioral outcomes obtained before or in the absence of surgical complications are presented. There was a developmental delay in the maturation of grating acuity in both eyes of both treatment groups. Normal adult levels of grating acuity were eventually achieved in the group treated with IOLs combined with EWCLs. Grating acuity was significantly poorer than normal in aphakic eyes treated only with EWCLs. Comparison of the two treatment groups revealed that pseudophakic eyes treated with multifocal IOLs had significantly better gating acuity than aphakic eyes. Assessments of optotype acuity and sweep VEP acuity revealed amblyopic deficits in both pseudophakic and aphakic eyes.Given an absence of serious postoperative complications, neonatal correction of aphakia with IOLs combined with EWCLs can lead to normal grating acuity in a primate model. Correction with EWCLs alone was not sufficient to produce normal grating acuity. Multifocal IOL treatments combined with EWCL provided a significantly better outcome than EWCL methods alone. However, neither IOL nor EWCL methods were able to prevent amblyopia as evaluated using behavioral testing with optotypes or with sweep VEPs.

    View details for Web of Science ID 000084634200019

    View details for PubMedID 10634609

  • Unilateral intraocular lens implantation during the first six months of life JOURNAL OF AAPOS Lambert, S. R., Buckley, E. G., Plager, D. A., Medow, N. B., Wilson, M. E. 1999; 3 (6): 344-349

    Abstract

    The purpose of this study was to determine the incidence of postoperative complications and the occurrence of myopic shift in infantile eyes after cataract surgery and implantation of an intraocular lens (IOL).Cataract surgery and IOL implantation was performed on 11 infants with unilateral congenital cataracts who had a mean age of 10+/-6 weeks at 5 clinical centers. IOLs with a mean power of 26.2+/-2.3 D were implanted using a standardized protocol. The infants were then followed up for a mean of 13+/-6 months for postoperative complications and longitudinal changes in their refractive error.Eight of the 11 eyes had postoperative complications and were treated with a reoperation. Complications included open-angle glaucoma (n = 2), lens reproliferation into the visual axis (n = 2), pupillary membranes (n = 2), and corectopia (n = 2). A younger age at the time of surgery was positively correlated with the development of a postoperative complication requiring a reoperation (P = .03). A mean myopic shift of 5.49 D occurred in these eyes a year after surgery. No preoperative factors could be identified that correlated with the magnitude of the myopic shift.IOL implantation during infancy is associated with a high complication rate frequently requiring reoperation. A large myopic shift typically occurs that necessitates an initial or a late overcorrection with spectacles or a contact lens, depending on the power of the IOL implanted. Until ongoing randomized trials are completed, we recommend that surgeons exercise caution before implanting IOLs in the eyes of infants.

    View details for Web of Science ID 000084320800006

    View details for PubMedID 10613578

  • Anterior hyaloid face opacification after pediatric Nd : YAG laser capsulotomy JOURNAL OF AAPOS Hutcheson, K. A., Drack, A. V., Ellish, N. J., Lambert, S. R. 1999; 3 (5): 303-307

    Abstract

    The purpose of this study was to examine the clarity of the visual axis after Nd:YAG laser capsulotomy following cataract extraction and primary intraocular lens implantation in a pediatric population.A retrospective review was performed of all cases of cataract extraction and primary intraocular lens implantation over a period of 5 years. A group of children who had been treated by primary surgical posterior capsulotomy and anterior vitrectomy (Group 1) was used as the "gold standard," with whom the children treated with Nd:YAG laser capsulotomy (Group 2) were compared. The groups were studied for the incidence of opacification of the visual axis after the primary procedure.Data on 78 eyes were reviewed, and 56 eyes met inclusion criteria. Of these, 33 eyes were treated with primary posterior capsulotomy and anterior vitrectomy (Group 1) and 23 eyes were treated with Nd:YAG laser capsulotomy (Group 2). One eye (3%) of Group 1 experienced postoperative visual axis reopacification. Thirteen (57%) of 23 eyes in Group 2 experienced reopacification, requiring retreatment. Four eyes (17%) treated with Nd:YAG laser required a third treatment.In our series, 57% of patients treated with Nd:YAG laser capsulotomy experienced reopacification across the anterior hyaloid face. With the removal of the anterior vitreous at the time of cataract extraction, the scaffolding for cell migration is removed and reopacification of the visual axis is rarely seen. For patients in whom slit-lamp capsulotomy is not possible, especially if there is no Nd:YAG laser available for use in the operating room or when loss to follow-up may be an issue, primary posterior capsulotomy and anterior vitrectomy should be strongly considered.

    View details for Web of Science ID 000083252200009

    View details for PubMedID 10532576

  • IOLs in the first year of life JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS Buckley, E., Lambert, S. R., Wilson, M. E. 1999; 36 (5): 281-286

    View details for Web of Science ID 000082788900007

    View details for PubMedID 10505833

  • Effect of age at time of cataract surgery on subsequent axial length growth in infant eyes JOURNAL OF CATARACT AND REFRACTIVE SURGERY Griener, E. D., Dahan, E., Lambert, S. R. 1999; 25 (9): 1209-1213

    Abstract

    To determine whether removal of the crystalline lens and placement of an intraocular lens (IOL) in human infant eyes retard the growth of the pseudophakic eye.A unilateral lensectomy with placement of a posterior chamber IOL in the sulcus was performed in 11 infants between 2 and 4 months of age. Axial length measurements of both eyes were obtained preoperatively and postoperatively.Patients were followed for a mean of 5.6 years. In 7 patients, the mean axial growth was 0.46 mm less in the pseudophakic eye than in the fellow eye (range 0.15 to 0.70 mm). In 1 patient, there was no interocular axial length difference and in 3, the pseudophakic eye was longer. When measurements from the only patient with microphthalmia were excluded, the interocular difference in axial growth was highly significant (signed rank test, P = .006). Median visual acuity of the pseudophakic eyes at the last follow-up was 20/60 (range 20/30 to 20/200). The final visual acuity in the pseudophakic eyes did not correlate with the degree of interocular axial length difference (P > .05).Our study suggests there may be a reduction in axial growth in infantile eyes following cataract extraction and IOL implantation. This effect probably reduces the magnitude of the myopic shift in these eyes.

    View details for Web of Science ID 000082249300010

    View details for PubMedID 10476503

  • Successful treatment of tractional corectopia using 2 mJ of energy with an Nd : YAG laser JOURNAL OF AAPOS Griener, E., Lambert, S. R. 1999; 3 (4): 250-251

    Abstract

    Although the Nd:YAG laser is most commonly used to perform posterior capsulotomies after cataract surgery, it has also been used to treat a variety of other anterior segment abnormalities including tractional corectopia, iridocorneal adhesions, persistent pupillary membranes, and posterior synechiae. Numerous reports on the use of the Nd:YAG laser to treat structures in the anterior segment have emphasized the need to use higher pulse energy for pupillary membranes, compared with the lower settings required for posterior capsulotomy. Steinert and Puliafito noted that single pulses of 4 to 12 mJ may be required to treat pupillary membranes "in a manner similar to that of a stonemason chipping at marble" in their description treating a membrane considerably thicker than what we describe. We report the successful treatment of tractional corectopia due to an anterior membrane strand in a child with only 2 mJ of total energy.

    View details for Web of Science ID 000082042700011

    View details for PubMedID 10477229

  • Management of monocular congenital cataracts EYE Lambert, S. R. 1999; 13: 474-479

    Abstract

    Monocular congenital cataracts have been treated for the past two decades with early surgery, contact lens correction and patching of the unaffected eye. While an occasional patient has had a good visual outcome with this treatment regiment, the majority end up being legally blind in the aphakic eye. Intraocular lenses (IOLs) are increasingly being used as an alternative means of optically correcting aphakia during infancy. A growing body of literature suggests that an IOL correction is associated with an improved visual outcome and a relatively low incidence of post-operative complications. A monkey model has also been used to study the safety and feasibility of correcting aphakia in neonates with IOLs. These studies have revealed that the visual outcome is as good if not better with an IOL correction. A multicentre clinical trial, the Infant Aphakia Treatment Study (IATS), is being organised in the United States to critically compare an IOL and contact lens correction for infantile aphakia.

    View details for Web of Science ID 000081374500013

    View details for PubMedID 10627827

  • Long-term results of corneal graft survival in infants and children with Peters anomaly OPHTHALMOLOGY Yang, L. L., Lambert, S. R., Lynn, M. J., Stulting, R. D. 1999; 106 (4): 833-848

    Abstract

    To determine the long-term results of corneal graft survival after penetrating keratoplasty for Peters anomaly and to identify risk factors for graft failure.Noncontrolled interventional case series: a single-center retrospective review of a consecutive surgical series.The records of all children 12 years of age or younger who underwent penetrating keratoplasty for Peters anomaly between January 1971 and December 1992 were reviewed. All study eyes had completed a minimum of 3 years of follow-up from the date of first keratoplasty and had undergone most of their corneal surgery at Emory University.Characteristics of the recipient, the eye, the donor, and the surgical procedure were analyzed for their influence on survival of the first graft. Survival probabilities were estimated using the Kaplan-Meier method. Multivariate regression analysis was performed to estimate relative risks and adjusted survival probabilities.Graft clarity.One hundred forty-four penetrating keratoplasties were performed in 72 eyes of 47 patients. The median age at first keratoplasty was 4.4 months. The median follow-up was 11.1 years. Fifty-four percent of eyes received one graft, 18% received two grafts, and 28% received three or more grafts. The overall probability of maintaining a clear first graft was 56% at 6 months, 49% at 12 months, 44% at 3 years, and 35% at 10 years. The probability of second or subsequent grafts surviving for 3 years was less than 10%. Thirty-nine percent of eyes had a clear graft at the time of review; 36% of eyes had a clear first graft. Multivariate analysis identified disease severity, donor cornea size, coexisting central nervous system abnormalities, and quadrants of anterior synechiae as the strongest risk factors for graft failure. Supplemental multivariate analysis, restricted to observable preoperative variables, identified stromal vessels, total limbal opacification, and preoperative glaucoma as independent preoperative predictors of graft failure. Allograft rejection was the most frequently identified cause of graft failure. Major complications after keratoplasty were phthisis, retinal detachment, cataract, and glaucoma.The overall long-term probability of maintaining a clear graft after initial penetrating keratoplasty for Peters anomaly is 35% +/- 0.06%, with subsequent grafts rarely surviving. Eyes with severe disease, larger donor corneas, coexisting central nervous system abnormalities, and anterior synechiae have significantly poorer outcomes than eyes without these factors. These data should be carefully considered before recommending corneal transplantation for Peters anomaly, particularly after previous graft failure.

    View details for Web of Science ID 000079410200044

    View details for PubMedID 10201611

  • Cyclic esotropia after a traumatic sixth nerve palsy in a child. Journal of AAPOS Hutcheson, K. A., Lambert, S. R. 1998; 2 (6): 376-377

    Abstract

    Cyclic esotropia is a rare phenomenon in which esotropia and orthophoria alternate over a period of 48 to 96 hours. The mechanism that underlies the phenomenon is unknown. Cyclic esotropia often occurs after a fusion-disrupting event. We report an unusual case of cycling esotropia with onset after a traumatic sixth nerve palsy. The cyclic phase persisted for 2 years, following a 48-hour alternate-day pattern. After strabismus surgery for the esotropic angle, the deviation disappeared and the patient remained orthotropic, with 1 year of follow-up to date.

    View details for PubMedID 10532729

  • Pseudotumor cerebri in children. Journal of AAPOS Phillips, P. H., Repka, M. X., Lambert, S. R. 1998; 2 (1): 33-38

    Abstract

    Demographic and outcome data in the era of modern neuroimaging are needed to describe pseudotumor cerebri in children.We reviewed the medical records of children less than 18 years old who were diagnosed with pseudotumor cerebri between 1977 and 1997. We defined pseudotumor cerebri as (1) increased intracranial pressure, (2) normal or small ventricles, and (3) normal cerebrospinal fluid composition. The condition might be idiopathic or the result of a nontumor etiology.Thirty-seven patients had an initial diagnosis of pseudotumor cerebri. Two patients were subsequently diagnosed with a central nervous system malignancy and were excluded from further analysis. The remaining 35 patients included 10 patients with idiopathic pseudotumor cerebri and 25 patients with disorders reported to be associated with pseudotumor cerebri. The mean age was 10.6 years with a range of 3 to 17 years. Twenty patients (57%) were female and 13 patients (37%) were obese. At presentation 4 patients had a visual acuity less than 20/40 in the best eye and 10 patients had visual field deficits. Seventeen patients (49%) had cranial nerve deficits, all of which resolved with normalization of the intracranial pressure. Follow-up data were obtained on 30 patients. Only one patient had a final visual acuity less than 20/40 in the best eye, whereas six patients had residual visual field deficits. Ten patients (33%) had optic nerve atrophy.There was no gender predominance, and associated etiologic factors were common in these children with pseudotumor cerebri. Permanent visual loss occurs in some children with pseudotumor cerebri. Quantitative perimetry and optic nerve examination were more sensitive than visual acuity determination in detecting damage to the visual sensory system. In rare instances the patient diagnosed with pseudotumor cerebri will be found after extended follow-up to harbor an intracranial neoplasm.

    View details for PubMedID 10532364

  • Electroretinographic findings in infants with the shaken baby syndrome JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS Fishman, C. D., Dasher, W. B., Lambert, S. R. 1998; 35 (1): 22-26

    Abstract

    To determine if electroretinography is helpful in the work-up of children with the shaken baby syndrome.Six children with retinal hemorrhages and the shaken baby syndrome underwent electroretinography (ERG). The ERGs of these six children were compared with six age-matched controls using the sign-rank test.Neither the implicit time nor the amplitude of the white scotopic ERG response was significantly different between these patients and age-matched controls. Although the amplitude of the blue scotopic and 30 Hz flicker responses were attenuated (p < 0.05), the implicit times were not significantly different from controls. Three of the patients had serial ERGs recorded. The b-wave implicit time and amplitude improved in two of these patients. The ERG was helpful in distinguishing between a CNS and a retinal cause of visual loss in one child.The ERG can be helpful in assessing retinal function in children with the shaken baby syndrome who have persistent visual impairment. In most cases, the ERG is not helpful in the initial assessment of children with the shaken baby syndrome.

    View details for Web of Science ID 000072042100009

    View details for PubMedID 9503311

  • Balloon dilatation for treatment of resistant nasolacrimal duct obstruction. Journal of AAPOS Hutcheson, K. A., Drack, A. V., Lambert, S. R. 1997; 1 (4): 241-244

    Abstract

    Our purpose was to report our experience with balloon catheter dilatation for resistant nasolacrimal duct obstruction.Patients enrolled had symptoms of nasolacrimal duct obstruction and (1) had failed previous probing or (2) were more than 2 years old. Balloon dilatation was performed with a LacriCATH lacrimal catheter (Atrion Medical Products, Birmingham, Ala.). A subset of patients had Silastic silicone rubber (Dow Corning, Midland, Mich.) intubation after balloon dilatation. Success was determined by clinical examination a minimum of 6 weeks later.Twenty-one lacrimal systems of 12 patients were treated (age range 4 months to 7 years). Of the patient subset treated with a LacriCATH lacrimal catheter alone, 9 of 18 systems demonstrated complete resolution of symptoms. Three of the 12 patients underwent balloon dilatation intraoperatively after attempts at Silastic silicone rubber intubation were unsuccessful. In two of these patients, who were younger, Silastic silicone rubber tubes passed easily after balloon treatment; however, in an older patient, age 5 years, intubation still could not be accomplished.Common clinical strategy for treatment of resistant nasolacrimal obstruction includes repeat probing, intubation of the nasolacrimal system with Silastic silicone rubber tubes, or dacryocystorhinostomy. Balloon catheter dilatation is an alternative or adjunct to consider. Factors that may affect the success of treatment include the age of the patient, the complexity of the nasolacrimal anatomy, and use of adjunctive systemic antibiotics and steroids.

    View details for PubMedID 10532771

  • Myopic shift after intraocular lens implantation during childhood OPHTHALMOLOGY Hutchinson, A. K., DREWSBOTSCH, C., Lambert, S. R. 1997; 104 (11): 1752-1757

    Abstract

    The purpose of the study is to evaluate the myopic shift that occurs in children 3 to 9 years of age who undergo cataract extraction with primary intraocular lens (IOL) implantation.A review of 18 children (mean, 6.3 +/- 0.5 year; range, 3-9 years) who had undergone primary IOL implantation was undertaken. Patients were observed for an average of 3.2 years. The initial and last postoperative refractive errors were compared.The mean myopic shift was -0.99 +/- 0.22 diopter (D) (median, 1.0 D) with a range of -3.25 to +0.38 D. The difference in the myopic shift of the children 3 to 5 years of age (-0.94 +/- 0.30 D) was not significantly different from the myopic shift occurring in the children 6 to 9 years of age (-1.07 +/- 0.35 D). The myopic shift was less than 1.5 D in 70% of the eyes and only 3 eyes had a myopic shift greater than 2 D. Ninety percent of the children achieved a visual acuity of 20/40 or better in their pseudophakic eye or eyes.Although each patient should be evaluated on an individual basis, the authors recommend undercorrecting most children 3 to 9 years of age by 1 D from the IOL power predicted to achieve emmetropia.

    View details for Web of Science ID A1997YF41700014

    View details for PubMedID 9373102

  • Strabismus and mitochondrial defects in chronic progressive external ophthalmoplegia AMERICAN JOURNAL OF OPHTHALMOLOGY Sorkin, J. A., Shoffner, J. M., Grossniklaus, H. E., Drack, A. V., Lambert, S. R. 1997; 123 (2): 235-242

    Abstract

    To describe the results of strabismus surgery on three patients with chronic progressive external ophthalmoplegia, a group of rare disorders characterized by ptosis and slowly progressive ophthalmoparesis that has been shown to result from defects in mitochondrial DNA.Strabismus surgery using the adjustable suture technique was performed in three patients with strabismus and chronic progressive external ophthalmoplegia confirmed by clinical, biochemical, histopathologic, and genetic criteria. All three patients had mitochondrial DNA deletions. Two patients were exotropic; one patient was esotropic.Rectus muscle recessions were initially unsuccessful in correcting strabismus in one patient, although a subsequent procedure employing rectus muscle resections was successful in alleviating a significant head turn and improved ocular alignment. In the two other patients, a single procedure consisting of rectus muscle recessions combined with large rectus muscle resections successfully achieved good postoperative alignment. The amount of surgery performed in these three patients exceeded that predicted in standard strabismus tables.The myopathic process that results in chronic progressive external ophthalmoplegia renders rectus muscle recessions less effective compared with resections for correcting the associated strabismus seen in these patients. Rectus muscle resections therefore should be an integral procedure in the surgical management of the strabismus associated with chronic progressive external ophthalmoplegia.

    View details for Web of Science ID A1997WG30500011

    View details for PubMedID 9186130

  • Longitudinal changes in axial length in pseudophakic children JOURNAL OF CATARACT AND REFRACTIVE SURGERY Sorkin, J. A., Lambert, S. R. 1997; 23: 624-628

    Abstract

    To evaluate the axial length changes that occur in children 3 to 9 years of age who had cataract extraction with primary intraocular lens (IOL) implantation.Emory Eye Center, Emory University, and Egleston Children's Hospital, Atlanta, Georgia, USA.A review of 17 eyes in 15 children (mean age 6.4 years; range 3 to 9 years) who had primary IOL implantation was undertaken. Patients were followed for an average of 3.1 years. The initial and final axial length measurements and refractive errors were compared.The overall change in mean axial length in the 17 eyes was 0.64 mm. The overall mean myopic shift was -1.01 diopters (D) (range -3.00 +0.50 D). Eyes with traumatic cataracts experienced more axial elongation than eyes with developmental/congenital cataracts (0.97 mm versus -0.01 mm; P = .03). Ninety-four percent of patients obtained a final visual acuity of 20/40 or better.Eyes with traumatic cataracts experienced more axial elongation than eyes with developmental/congenital cataracts after cataract extraction and IOL implantation.

    View details for Web of Science ID A1997XT32700006

    View details for PubMedID 9278815

  • Optic nerve hypoplasia: Absence of posterior pituitary bright signal on magnetic resonance imaging correlates with diabetes insipidus AMERICAN JOURNAL OF OPHTHALMOLOGY Sorkin, J. A., Davis, P. C., Meacham, L. R., Parks, J. S., Drack, A. V., Lambert, S. R. 1996; 122 (5): 717-723

    Abstract

    Magnetic resonance imaging has been used to examine children with optic nerve hypoplasia for pituitary abnormalities who may be at risk for anterior pituitary hormonal deficiencies. We correlated the sellar and optic pathway anatomic findings on magnetic resonance imaging in children with optic nerve hypoplasia with findings from their endocrinologic and ophthalmologic examinations to determine whether magnetic resonance imaging findings predict anterior and posterior pituitary dysfunction.A retrospective review identified five children with optic nerve hypoplasia and endocrinopathy who also underwent high resolution volumetric magnetic resonance imaging.All children had severe bilateral optic nerve hypoplasia and anterior pituitary hormone deficiencies. Three children had no recognizable intrasellar or ectopic posterior pituitary bright spot on magnetic resonance imaging; all had clinical evidence of diabetes insipidus. Two patients with a recognizable but ectopic posterior pituitary did not have diabetes insipidus.Children with optic nerve hypoplasia and no recognizable posterior lobe of the pituitary gland on magnetic resonance imaging are at risk for both anterior and posterior pituitary dysfunction, whereas those with a posterior lobe on magnetic resonance imaging appear to have intact posterior pituitary function.

    View details for Web of Science ID A1996VQ70100014

    View details for PubMedID 8909213

  • Infantile cataracts (vol 40, pg 451, 1996) SURVEY OF OPHTHALMOLOGY Lambert, S. R., Drack, A. V. 1996; 41 (1): A8-A8
  • Infantile cataracts SURVEY OF OPHTHALMOLOGY Lambert, S. R., Drack, A. V. 1996; 40 (6): 427-458

    Abstract

    Cataracts are one of the most treatable causes of visual impairment during infancy. Recent epidemiological studies have shown that they have a prevalence of 1.2 to 6.0 cases per 10,000 infants. The morphology of infantile cataracts can be helpful in establishing their etiology and prognosis. Early surgery and optical correction have resulted in an improved outcome for infants with either unilateral or bilateral cataracts. While contact lenses continue to be the standard means of optically correcting an infant's eyes after cataract surgery, intraocular lenses are gaining in popularity as an alternative means of optically correcting these eyes. Post-operative complications occur more commonly after infantile than adult cataract surgery and many of these complications do not develop until years later. As a result, it is critical that children be followed closely on a long term basis after infantile cataract surgery.

    View details for Web of Science ID A1996UM14000001

    View details for PubMedID 8724637

  • Congenital entropion and congenital corneal ulcer AMERICAN JOURNAL OF OPHTHALMOLOGY Yang, L. L., Lambert, S. R., Chapman, J., Stulting, R. D. 1996; 121 (3): 329-331

    Abstract

    We studied a case of corneal ulceration in utero from lower eyelid entropion.A 3-week-old male infant was referred for examination of a left corneal ulcer that was present at birth and unresponsive to antibiotics.Examination disclosed a lower eyelid entropion that was treated surgically by a nonincisional method, leaving a central leukoma after re-epithelialization.Congenital lower eyelid entropion should be included in the differential diagnosis of congenital corneal opacities.

    View details for Web of Science ID A1996TY95200018

    View details for PubMedID 8597283

  • Retinoblastoma recurrence after iodine 125 plaque application RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Spraul, C. W., Lim, J. I., Lambert, S. R., Grossniklaus, H. E. 1996; 16 (2): 135-138

    Abstract

    The authors report the clinicopathologic features of a recurrent retinoblastoma after radioactive iodine 125 (125l) plaque therapy.The clinical and histopathologic findings of a 1-year-old boy with a recurrent retinoblastoma after 125l radioactive plaque application were reviewed. The patient's enucleated right eye was processed for routine histologic evaluation. Immunostains for glial fibrillary acid protein and S-100 protein were performed.Examination of the enucleated eye revealed a retinal tumor composed of two populations of cells. One population consisted of poorly differentiated cells, and the second population at the base of the tumor contained well-differentiated cells with numerous fleurettes. Immunohistochemical stains were positive for glial fibrillary acid protein and S-100 protein in the well-differentiated portion of the tumor.This case illustrates a recurrent retinoblastoma that may have arisen from radioresistant well-differentiated cells after 125l plaque therapy.

    View details for Web of Science ID A1996UF08100009

    View details for PubMedID 8724958

  • ELECTRORETINOGRAPHIC FINDINGS IN STAGE-5 RETINOPATHY OF PREMATURITY AFTER RETINAL REATTACHMENT RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Cherry, T. A., Lambert, S. R., Capone, A. 1995; 15 (1): 21-24

    Abstract

    Infants with stage 5 retinopathy of prematurity (ROP) usually experience severe visual loss, even when the retina is reattached surgically. Such visual loss has been attributed to persistent retinal dysfunction in most cases, but this has not been established electroretinographically.Electroretinograms (ERGs) were performed on 5 eyes of 4 children with partial or complete retinal attachment after vitreoretinal surgery for stage 5 ROP. Duration of detachment before surgery was 2 weeks in 1 eye, 4-5.5 weeks in 3 eyes, and 15 weeks in 1 eye. The ERG findings for these eyes were then compared with ERG findings in a child with regressed ROP after laser photoablation of the peripheral avascular retina.All of the eyes with surgically repaired stage 5 ROP had nonrecordable ERGs. The child with regressed ROP after laser photoablation had an attenuated but recordable ERG.Severe retinal dysfunction persists in eyes with stage 5 ROP even after the retina is surgically reattached, which is probably one of the primary reasons that these eyes continue to have a poor visual outcome.

    View details for Web of Science ID A1995QH33400003

    View details for PubMedID 7754242

  • REAPPRAISAL OF OCCLUSION THERAPY FOR SEVERE STRUCTURAL ABNORMALITIES OF THE OPTIC DISC AND MACULA JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS Yang, L. L., Lambert, S. R. 1995; 32 (1): 37-41

    Abstract

    The visual function of some children with structural defects of the macula or optic nerve has previously been shown to improve with occlusion therapy. The charts of five children, ages 4 to 8 years, who had various types of severe structural abnormalities were reviewed. Two patients had optic nerve hypoplasia; there was one case each of foveal hypoplasia, posterior persistent hyperplastic primary vitreous, and retinopathy of prematurity. All the patients had undergone extensive amblyopia therapy prior to referral. In three children, occlusion therapy had been initiated and continued intensively for several months or longer without recognizing the presence of a severe, underlying structural abnormality. In none of the five children was there any clear-cut evidence of visual improvement. In some cases, the long period of enforced iatrogenic vision impairment resulted in significant psychosocial harm and developmental delay. In all five cases, it was structural changes rather than amblyopia that ultimately accounted for visual loss. The authors stress the importance of a meticulous fundus examination directed at finding organic defects prior to patching. Close, periodic monitoring of visual function should then follow. To spare the child unnecessary psychosocial impairment, it is advisable to follow established recommended thresholds for terminating occlusion therapy.

    View details for Web of Science ID A1995QK36500008

    View details for PubMedID 7752032

  • CLINICAL AND SUBCLINICAL OPHTHALMIC FINDINGS WITH RETINOL DEFICIENCY OPHTHALMOLOGY Newman, N. J., Capone, A., LEEPER, H. F., ODAY, D. G., Mandell, B., Lambert, S. R., THOFT, R. A. 1994; 101 (6): 1077-1083

    Abstract

    Patients at risk for retinol deficiency in developed countries include those with hepatic dysfunction and malabsorption states. Symptoms of retinol deficiency may go unrecognized or unreported.The authors describe 15 patients with hepatic dysfunction, two of whom had procedures that would predispose to malabsorption and were ophthalmologically symptomatic of retinol depletion. The other 13 patients were ophthalmologically asymptomatic liver transplant candidates examined prospectively for subclinical evidence of retinol deficiency. Combined laboratory analysis, Schirmer's testing, conjunctival impression cytology, and electroretinography were performed.Twelve of 15 patients had serum retinol levels below the lower limit of normal. Aqueous tear production was reduced in 7 of 14 patients. Abnormal conjunctival morphology was noted in 6 of 12 patients. Electroretinograms were abnormal in the two patients who were visually symptomatic and in seven of nine patients who were ophthalmologically asymptomatic.Subclinical, physiologically significant retinol deficiency may be a frequent and unrecognized problem among patients with hepatic dysfunction.

    View details for Web of Science ID A1994NR47400027

    View details for PubMedID 8008350

  • MULTIFOCAL VERSUS MONOFOCAL CORRECTION OF NEONATAL MONOCULAR APHAKIA JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS Lambert, S. R., Fernandes, A., DREWSBOTSCH, C., Boothe, R. G. 1994; 31 (3): 195-201

    Abstract

    We compared the efficacy of monofocal and multifocal intraocular lenses (IOLs) as a means of optically rehabilitating eyes with monocular congenital cataracts using a primate model. A congenital cataract was simulated in the right eye of 20 monkeys from birth to 2 weeks of age with an opalescent contact lens. A lensectomy was then performed and a monofocal IOL was implanted in 11 eyes and a multifocal IOL in 9 eyes. Any residual refractive error was then corrected with an extended-wear contact lens. The fellow eyes were then randomized to no treatment or 70% occlusion therapy. Grating acuity was assessed using forced-choice preferential looking with Teller acuity cards at regular intervals. At 32 weeks of age, the pseudophakic eyes were mildly amblyopic, but the grating acuities were not significantly different between the pseudophakic eyes with multifocal versus monofocal IOLs or between subjects who had received occlusion therapy versus no treatment of the fellow eye. We conclude that at least through 32 weeks of age, multifocal and monofocal IOLs are of similar efficacy and occlusion therapy may be less important to prevent amblyopia from developing in pseudophakic eyes compared to contact-lens corrected aphakic eyes.

    View details for Web of Science ID A1994NW52900012

    View details for PubMedID 7931955

  • CONCORDANCE AND RECESSIVE INHERITANCE OF LEBER CONGENITAL AMAUROSIS AMERICAN JOURNAL OF MEDICAL GENETICS Lambert, S. R., Sherman, S., Taylor, D., Kriss, A., Coffey, R., Pembrey, M. 1993; 46 (3): 275-277

    Abstract

    Pedigrees were obtained on 43 patients with confirmed Leber congenital amaurosis, a rare form of blindness caused by congenital dysfunction of the retina. All of the pedigrees were consistent with autosomal recessive inheritance and the segregation frequency using classical segregation analysis was 0.24 +/- 0.07. Six of the 7 affected sib pairs were concordant in regards to systemic abnormalities. Despite previous reports that Leber congenital amaurosis can be inherited either as an autosomal dominant or recessive condition, our findings support only an autosomal recessive inheritance of this disorder.

    View details for Web of Science ID A1993KZ61000006

    View details for PubMedID 8488871

  • SUPERIOR RECTUS MUSCLE OVERACTION AFTER CATARACT-EXTRACTION AMERICAN JOURNAL OF OPHTHALMOLOGY Grimmett, M. R., Lambert, S. R. 1992; 114 (1): 72-80

    Abstract

    Four patients with an ipsilateral hypertropia after cataract extraction consistent with superior rectus muscle overaction were identified between March 1990 and April 1992. Operative trauma was the most likely causative factor, as other likely conditions were excluded. The proposed pathogenesis for all cases is similar to that of botulinum type-A toxin therapy: a transient postoperative weakness of the ipsilateral inferior rectur muscle leads to a contracture or strengthening of the ipsilateral antagonist (the superior rectus muscle). Possible mechanisms of injury that would result in a transient inferior rectus muscle palsy would include anesthetic myotoxicity or direct trauma to the muscle and related structures from the retrobulbar injection (or subconjunctival injection). Surgical intervention consisting of an ipsilateral superior rectus muscle recession and posterior fixation sutures (when the vertical incomitance was large) yielded excellent results in restoring single binocular vision. Possible preventive measures would include using a minimal volume of anesthetic along with careful needle placement.

    View details for Web of Science ID A1992JC19500012

    View details for PubMedID 1621788

  • THE OPTIC DISK IN LEBER CONGENITAL AMAUROSIS JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS Sullivan, T. J., Lambert, S. R., Buncic, J. R., Musarella, M. A. 1992; 29 (4): 246-249

    Abstract

    The typical fundus appearance in Leber congenital amaurosis (LCA) in infancy is normal. Later in childhood, clinical heterogeneity develops and a variety of fundal abnormalities may be seen. These commonly include optic atrophy, retinal arteriolar attenuation, and a variety of pigmentary changes. We retrospectively reviewed the optic disc findings of 77 patients with LCA whom we had examined to confirm our clinical impression that the optic discs are frequently normal. Age at examination ranged from infancy to the fourth decade. The optic discs were normal in 53 (69%) of the 77 patients examined; 18 (23%) had varying degrees of optic atrophy; 2 (3%), pseudopapilledema; and 1 (1%), grey discs. The optic discs could not be seen in 3 (4%) patients. We conclude that the optic discs are frequently normal in appearance, even in older patients with LCA.

    View details for Web of Science ID A1992JK32800012

    View details for PubMedID 1512668

  • RIGID GAS PERMEABLE CONTACT-LENS CORRECTION OF APHAKIA FOLLOWING CONGENITAL CATARACT REMOVAL DURING INFANCY JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS AMOS, C. F., Lambert, S. R., Ward, M. A. 1992; 29 (4): 243-245

    Abstract

    Rigid gas permeable (RGP) contact lenses were prescribed and worn with little difficulty by 10 consecutive aphakic infants. Fluoroperm 92 lenses were used instead of silicone lenses (Bausch & Lomb) because of their lower cost, ease in handling, flexibility in design, and better neutralization of astigmatism. Lenses were worn on a daily wear basis (with occasional overnight wear) to reduce the risk of keratitis. Keratometry readings were taken at the time of surgery with the patient in a supine position. Trial lens fitting was performed 1 to 7 days later using a Burton Lamp. None of the patients developed keratitis, corneal neovascularization, or the sucked-on-lens syndrome. The lenses were well tolerated and the parents soon became adept at handling them. We now use RGP lenses as our lens of choice when treating aphakic infants.

    View details for Web of Science ID A1992JK32800011

    View details for PubMedID 1512667

  • ISOLATED CONGENITAL HEMIANOPIA CAUSED BY PRENATAL INJURY TO THE OPTIC RADIATION ARCHIVES OF NEUROLOGY Ragge, N. K., Barkovich, A. J., Hoyt, W. F., Lambert, S. R. 1991; 48 (10): 1088-1091

    Abstract

    Isolated congenital hemianopias are typically caused by developmental abnormalities of the occipital lobe cortex. We describe two patients with an incidental partial hemianopia associated with unilateral periventricular leukomalacia that was acquired prenatally. Magnetic resonance imaging scans suggest a late second or early third trimester unilateral cerebral ischemic event.

    View details for Web of Science ID A1991GJ52600022

    View details for PubMedID 1929905

  • EFFECTS OF APOMORPHINE, A DOPAMINE RECEPTOR AGONIST, ON OCULAR REFRACTION AND AXIAL ELONGATION IN A PRIMATE MODEL OF MYOPIA INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Iuvone, P. M., TIGGES, M., Stone, R. A., Lambert, S., Laties, A. M. 1991; 32 (5): 1674-1677

    Abstract

    The authors examined the effect of local administration of a dopamine receptor agonist on visual deprivation-induced excessive ocular growth and myopia. Eight rhesus monkeys were monocularly deprived of vision from birth with opaque contact lenses. Four of the monkeys received drops of 1% apomorphine HCl 2-3 times/day in the occluded eye; the four control monkeys received vehicle only. Axial lengths were determined by A-scan ultrasonography at birth and at 5-7 months of age. The authors assessed the axial elongation by comparing the postnatal growth in the axial dimension of the occluded eyes with the postnatal growth in nonoccluded eyes. In three of the four control monkeys, occlusion increased axial growth by an average of 1.3 mm. In contrast, they found that growth of the occluded and nonoccluded eyes of the apomorphine-treated monkeys was equivalent, except in one monkey whose nonoccluded eye did not develop normally and was anomalously small. At 6.5-9.5 months of age, three of four controls had myopic refractive errors (-3 to -7 diopters) in the occluded eyes; three of four of the apomorphine-treated monkeys had hyperopic refractive errors (+1-(+)3 diopters) in their occluded eyes. The occluded eye of the fourth monkey was only -0.5 diopters myopic. The findings suggest that apomorphine administration retards excessive axial elongation and the concomitant development of myopia associated with visual deprivation in primates.

    View details for Web of Science ID A1991FH19700033

    View details for PubMedID 2016144

  • DETECTION OF ISOLATED OCCIPITAL LOBE ANOMALIES DURING EARLY-CHILDHOOD DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Lambert, S. R., Kriss, A., Taylor, D. 1990; 32 (5): 451-455

    Abstract

    The authors report two children with isolated occipital lobe anomalies detected by visual evoked potentials (VEPs) and confirmed by MRI and CT scanning. Both had a markedly asymmetrical occipital distribution of flash and pattern VEPs. One child had acuity reduced to 6/36, and testing on confrontation suggested an homonymous hemianopia. The second child was visually inattentive to one side during infancy. Neither child had band atrophy of the optic disc or an afferent pupillary defect. Isolated abnormalities of the occipital lobes are difficult to detect by clinical examination during infancy and early childhood. Recording VEPs from a horizontal array of occipital electrodes can be helpful in detecting subtle occipital lobe abnormalities.

    View details for Web of Science ID A1990DC43400010

    View details for PubMedID 2354756

  • JOUBERT SYNDROME - A CLINICO-RADIOLOGICAL STUDY NEURORADIOLOGY Kendall, B., Kingsley, D., Lambert, S. R., Taylor, D., Finn, P. 1990; 31 (6): 502-506

    Abstract

    A characteristic malformation of the cerebellum, including dysgenesis of the vermis and enlargement of the fourth ventricle was observed on computed tomography (CT) in 16 children on review of our consecutive material. Seven of these children underwent magnetic resonance imaging (MRI) which showed hypoplasia of the brainstem in addition to cerebellar vermian dysgenesis. One child had, in addition, dysgenesis of the corpus callosum. All these children were developmentally delayed, and many had neonatal breathing abnormalities, congenital retinal dystrophy and supranuclear ocular motor abnormalities. Joubert's syndrome should be suspected in children in whom dysgenesis of the cerebellar vermis and hypoplasia of the brainstem is shown on CT or MRI.

    View details for Web of Science ID A1990CL09000008

    View details for PubMedID 2352633

  • THE INFANT WITH NYSTAGMUS, NORMAL APPEARING FUNDI, BUT AN ABNORMAL ERG SURVEY OF OPHTHALMOLOGY Lambert, S. R., Taylor, D., Kriss, A. 1989; 34 (3): 173-186

    Abstract

    Many retinal disorders present during infancy with nystagmus, decreased vision, and normal-appearing fundi, but an abnormal ERG. The most common of these disorders are Leber's congenital amaurosis, achromatopsia, and congenital stationary night-blindness. Other disorders with similar ocular manifestations may be associated with a variety of life-threatening systemic abnormalities. This review describes the clinical, electrophysiological, and laboratory findings that can be used to distinguish among these conditions.

    View details for Web of Science ID A1989CD60800002

    View details for PubMedID 2694415

  • AUTOSOMAL RECESSIVE MICROCEPHALY, MENTAL-RETARDATION WITH NONPIGMENTARY RETINOPATHY AND A DISTINCTIVE ELECTRORETINOGRAM NEUROPEDIATRICS Harbord, M. G., Lambert, S. R., Kriss, A., Brett, E. M., Baraitser, M., Supramaniam, G. 1989; 20 (3): 139-141

    Abstract

    The association of microcephaly and mental retardation with a non-pigmentary retinopathy is described in three siblings of consanguineous parents. The electroretinogram showed the distinctive appearance of markedly attenuated "b" wave but normal "a" wave suggestive of a retinal dystrophy primarily affecting post-receptoral elements in the inner retina. This appears to be an autosomal recessive condition which has not been previously reported.

    View details for Web of Science ID A1989AN16500003

    View details for PubMedID 2779741

  • FOLLOW-UP AND DIAGNOSTIC REAPPRAISAL OF 75 PATIENTS WITH LEBERS CONGENITAL AMAUROSIS AMERICAN JOURNAL OF OPHTHALMOLOGY Lambert, S. R., Kriss, A., Taylor, D., Coffey, R., Pembrey, M. 1989; 107 (6): 624-631

    Abstract

    We reexamined 75 children in whom Leber's congenital amaurosis had been previously diagnosed. On review, 30 of these patients had an ocular or systemic disorder other than Leber's congenital amaurosis. The most common of these revised diagnoses were congenital stationary night blindness, achromatopsia, infantile-onset retinitis pigmentosa, Joubert's syndrome, Zellweger syndrome, and infantile Refsum's disease. Of the 45 patients with Leber's congenital amaurosis, mental retardation occurred in six patients, and visual deterioration in six patients. Leber's congenital amaurosis should only be diagnosed if other known ocular and systemic disorders have been carefully excluded.

    View details for Web of Science ID A1989U824900007

    View details for PubMedID 2658617

  • JOUBERT SYNDROME ARCHIVES OF OPHTHALMOLOGY Lambert, S. R., Kriss, A., Gresty, M., Benton, S., Taylor, D. 1989; 107 (5): 709-713

    Abstract

    Joubert syndrome is an autosomal recessive condition in which there is a variable combination of central nervous system defects with a distinctive congenital retinal dystrophy, ocular motor abnormalities, and respiratory abnormalities in early infancy. The retinal dystrophy has been previously classified as a variant of Leber's congenital amaurosis. We report electrophysiologic and eye movement findings in a series of seven consecutive children with Joubert syndrome. Unlike patients with Leber's congenital amaurosis, all but one of these children had preserved flash and pattern-reversal visual evoked potentials. Six of the seven children had abnormalities of smooth pursuit, optokinetic nystagmus, and saccades. Six of the children had nystagmus: three had a pendular torsional nystagmus and three had a form of see-saw nystagmus. An alternating hyperdeviation was present in five of the patients, two of whom also had a tonic deviation of their eyes laterally. All seven patients had cerebellar vermis hypoplasia on a magnetic resonance imaging scan. Developmentally delayed children with an absent or highly attenuated electroretinogram should be investigated for Joubert syndrome.

    View details for Web of Science ID A1989U513600026

    View details for PubMedID 2470340

  • DELAYED VISUAL MATURATION - A LONGITUDINAL CLINICAL AND ELECTROPHYSIOLOGICAL ASSESSMENT OPHTHALMOLOGY Lambert, S. R., Kriss, A., Taylor, D. 1989; 96 (4): 524-529

    Abstract

    Delayed visual maturation is an idiopathic condition characterized by visual inattention during infancy. The authors followed longitudinally nine children with an initial diagnosis of delayed visual maturation and compared their electroretinograms (ERGs) and visual evoked potentials with those of age-matched controls. Eight of the nine patients consistently had normal visual evoked potentials to flash and to pattern stimulation. All of the children had normal ERGs. Visually mediated behavior gradually developed in all of these children when they were between 3 and 8 months of age (mean, 5.5 months). Five patients also were delayed in other spheres of development. Visual evoked potentials are helpful in formulating a visual prognosis for children with delayed visual maturation.

    View details for Web of Science ID A1989U004000017

    View details for PubMedID 2726183

  • DETECTION AND TREATMENT OF INFANTILE CATARACTS INTERNATIONAL OPHTHALMOLOGY CLINICS Lambert, S. R., Amaya, L., Taylor, D. 1989; 29 (1): 51-56

    View details for Web of Science ID A1989T328200012

    View details for PubMedID 2917818

  • OCULAR MANIFESTATIONS OF THE CONGENITAL VARICELLA SYNDROME ARCHIVES OF OPHTHALMOLOGY Lambert, S. R., Taylor, D., Kriss, A., Holzel, H., Heard, S. 1989; 107 (1): 52-56

    Abstract

    Three children developed the congenital varicella syndrome following a maternal varicella infection during the second trimester of pregnancy. Systemic findings included a bulbar palsy, mild hemiparesis, cicatricial skin lesions, developmental delay, and learning difficulties. Ocular findings included chorioretinitis, atrophy and hypoplasia of the optic discs, a congenital cataract, and Horner's syndrome. Electroretinograms and pattern-reversal visual-evoked potentials recorded from the four eyes with chorioretinitis were attenuated and degraded. Two of the children had been misdiagnosed as having congenital toxoplasmosis. Chorioretinal scars probably occur more frequently with the congenital varicella syndrome than has been previously recognized and should be included in the differential diagnosis of congenital chorioretinal scars. Hypoplasia of the optic disc may develop after an intrauterine varicella infection during the 16th week of gestation. Children with the congenital varicella syndrome should be examined by an ophthalmologist to exclude ocular abnormalities. These abnormalities are often subtle and difficult to diagnose correctly.

    View details for Web of Science ID A1989R752500020

    View details for PubMedID 2910286

  • CONGENITAL IDIOPATHIC MICROCORIA AMERICAN JOURNAL OF OPHTHALMOLOGY Lambert, S. R., Amaya, L., Taylor, D. 1988; 106 (5): 590-594

    Abstract

    Five infants had congenital unilateral microcoria. The red reflex was absent and vision was severely reduced in all five eyes preoperatively. A pupil was created surgically in three of the eyes, resulting in a variable improvement in vision. The underlying lens was clear in all three children. The origin of the pupillary anomaly is unknown, but probably is related to remnants of the fetal pupillary membrane. Early surgical treatment and vigorous occlusion therapy can result in useful vision.

    View details for Web of Science ID A1988Q822800013

    View details for PubMedID 3189475

  • VISUAL RECOVERY FROM HYPOXIC CORTICAL BLINDNESS DURING CHILDHOOD ARCHIVES OF OPHTHALMOLOGY Lambert, S. R., Hoyt, C. S., Jan, J. E., Barkovich, J., Flodmark, O. 1987; 105 (10): 1371-1377

    Abstract

    We reviewed the clinical courses and computed tomographic (CT) and magnetic resonance imaging (MRI) scans of 30 infants and children with cortical blindness following hypoxic insults. The degree of injury to the striate and parastriate cortices and the area of the optic radiations were graded from 0 to 4 by a neuroradiologist. Only two children had normal scans of the posterior visual pathway and both had favorable visual outcomes. The visual recovery differed significantly with respect to the age at which the hypoxic insult occurred and CT and MRI abnormalities in the area of the optic radiations, but not with abnormalities in the striate or parastriate cortices. Our results suggest that CT and MRI scanning are helpful in prognosticating the visual potential of children with hypoxic cortical blindness.

    View details for Web of Science ID A1987K258700024

    View details for PubMedID 3662911

  • OPTIC-NERVE HYPOPLASIA SURVEY OF OPHTHALMOLOGY Lambert, S. R., Hoyt, C. S., NARAHARA, M. H. 1987; 32 (1): 1-9

    Abstract

    Optic nerve hypoplasia is an easily overlooked, nonprogressive developmental anomaly which results in a wide range of visual deficits. It is frequently associated with clinically significant central nervous system and endocrine abnormalities. Maternal substance abuse is increasingly recognized in many cases. A supranormal regression of optic nerve axons in utero, rather than a primary failure of differentiation, is proposed as the pathogenesis.

    View details for Web of Science ID A1987K222000001

    View details for PubMedID 3310293

  • OPTIC-NERVE SHEATH AND RETINAL HEMORRHAGES ASSOCIATED WITH THE SHAKEN BABY SYNDROME ARCHIVES OF OPHTHALMOLOGY Lambert, S. R., Johnson, T. E., Hoyt, C. S. 1986; 104 (10): 1509-1512

    Abstract

    A 13-month-old child with the pathognomonic findings of the shaken baby syndrome died secondary to cerebellar herniation. Pathologic examination disclosed extensive intraocular, optic nerve sheath, and intracranial hemorrhages, despite a paucity of external signs of trauma. Many of the hemorrhages were old, suggesting that the child had experienced multiple episodes of trauma. Hemorrhages of the optic nerve sheaths have not been previously reported with the shaken baby syndrome but probably accompany this condition frequently. Our patient's ocular hemorrhages may have resulted from a sudden rise in intracranial pressure.

    View details for Web of Science ID A1986E235500024

    View details for PubMedID 3767684

  • SPONTANEOUS REGRESSION OF A CHOROIDAL MELANOMA ARCHIVES OF OPHTHALMOLOGY Lambert, S. R., Char, D. H., Howes, E., Crawford, J. B., Wells, J. 1986; 104 (5): 732-734

    Abstract

    Although spontaneous regression of uveal malignant melanoma is rare, its occurrence is not uncommon in cutaneous melanomas. We report a 15-year follow-up of an enlarging posterior pigmented tumor. It initially appeared to spontaneously regress into a flat chorioretinal scar, but, ten years later, it grew markedly and the eye was enucleated. Histopathologic changes similar to those found in regressed cutaneous melanomas were located in the region of the chorioretinal scar.

    View details for Web of Science ID A1986C174900029

    View details for PubMedID 3707414

  • SEROUS RETINAL DETACHMENTS IN THROMBOTIC THROMBOCYTOPENIC PURPURA ARCHIVES OF OPHTHALMOLOGY Lambert, S. R., High, K. A., Cotlier, E., Benz, E. J. 1985; 103 (8): 1172-1174

    Abstract

    Serous retinal detachments are a rare ocular complication of thrombotic thrombocytopenic purpura (TTP), with only six previous case reports in the literature. We have recently observed two patients with relapsing TTP who developed bilateral serous retinal detachments during acute exacerbations of their disease. In contrast to all but one of the previously described patients, both of our patients survived the episode during which retinal detachments occurred. Hypertension appears to contribute to the development of retinal detachments in TTP, and vigorous efforts at blood pressure control are indicated. Serous retinal detachments may be a more frequent component of chronic relapsing TTP than has been suspected.

    View details for Web of Science ID A1985ANL3100019

    View details for PubMedID 4040743

  • DOWN-REGULATION OCCURS NORMALLY IN CULTURED EPSTEIN-BARR VIRUS-TRANSFORMED LYMPHOCYTES FROM PATIENTS WITH EXTREME INSULIN RESISTANCE - DISCREPANCY BETWEEN DOWN-REGULATION INVIVO AND INVITRO DIABETES Wagman, L. D., Lambert, S. R., McElduff, A., Roth, J., GORDEN, P., Taylor, S. I. 1984; 33 (5): 421-427

    Abstract

    Levels of fasting plasma insulin are generally inversely correlated with 125I-insulin binding to circulating blood cells. In disease states associated with hyperinsulinemia (e.g., obesity and non-insulin-dependent diabetes mellitus), 125I-insulin binding is usually low. In contrast, 125I-insulin binding to circulating cells may be normal in patients with certain forms of extreme insulin resistance despite marked hyperinsulinemia. To explain this paradox, it has been proposed that postbinding defects in insulin action may give rise to defects in downregulation. We have employed cultured Epstein-Barr virus (EBV)-transformed lymphocytes from eight patients with extreme insulin resistance to address the question of whether there is a defect in the downregulation process in vitro. In this cell type, insulin leads to a decrease in the number of insulin receptors on the cell surface by accelerating the rate of degradation of insulin receptors. We could not detect any abnormality in in vitro down-regulation with cultured EBV-transformed lymphocytes from insulin-resistant patients. The apparent discrepancy between the in vivo and in vitro studies raises the possibility that some factor in the patient's internal milieu may prevent insulin-induced downregulation. An alternative possible explanation might be that the mechanism of downregulation in vitro differs from the mechanism whereby receptor number is regulated in vivo in insulin's target cells.

    View details for Web of Science ID A1984SR39400003

    View details for PubMedID 6327434

  • THE ORIGINS OF SATTLERS VEIL AMERICAN JOURNAL OF OPHTHALMOLOGY Lambert, S. R., Klyce, S. D. 1981; 91 (1): 51-56

    Abstract

    The symptoms of Sattler's veil accompany prolonged wear of thick contact lenses and are thought to be the result of epithelial hypoxia. We studied light scattering in the isolated rabbit cornea after hypoxia with optical techniques. We found that hypoxia produced a polygonal mesh of light scattering, outlining cells in the intermediate and basal epithelium. An optical transform of this mesh produced a halo of the same dimensions observed in Sattler's veil. Additionally, prolonged hypoxia produced an increase in stromal light scattering that may add to increased glare sensitivity. Consistent changes in epithelial thickness were not observed, raising the probability of radial swelling or compensatory epithelial volume regulation.

    View details for Web of Science ID A1981KZ33500007

    View details for PubMedID 7234929