Faculty Bibliography

A 9-year-old boy with partial third nerve palsy underwent medial transposition of the left lateral rectus muscle and left inferior oblique myectomy. He developed optic nerve compression, which improved after a superior oblique tenotomy. A primary superior oblique tenotomy or a maximum lateral rectus muscle split may help avoid this complication. [J Pediatr Ophthalmol Strabismus. 2021;58(3):e12-e15.].

Myopia is an important public health issue, and high myopia may lead to severe complications if left untreated. Orthokeratology lenses, worn overnight to reshape the cornea, are one of many recent modalities used to slow down the progression of myopia in children. This treatment has been proven successful, as evidenced by decreased spherical refractive error and axial length relative to the control at interval follow-up ranging from 6 months to 5 years. In this systematic review, the authors collected published controlled studies that analyzed the efficacy of orthokeratology lens wear and calculated longitudinal relative changes in axial length, revealing a weighted average of -45.1% change in axial length at the 2-year follow-up. The exact mechanism by which orthokeratology lenses reduce myopia progression is unknown, but research shows that the corneal reshaping decreases peripheral hyperopic defocus and therefore increases peripheral myopic defocus to likely reduce stimuli for axial elongation and subsequent development of myopia. Use of orthokeratology lenses is generally safe, but cases of associated infectious keratitis may have a higher incidence of virulent organisms such as Pseudomonas, Acanthamoeba, and antibacterial-resistant strains of Staphylococcus, partially due to the required overnight use of these lenses. Orthokeratology is regarded as one of the most effective non-pharmacologic measures to slow progression of myopia in children and, with regular follow-up to ensure safety, continues to be one of the most effective treatments for myopia management around the world. [J Pediatr Ophthalmol Strabismus. 2017;54(3):142-148.].

The screening and detection of recurrent medulloblastoma presents the clinician with significant diagnostic challenges, including the risk of misdiagnosis. The authors present the case of a young girl with a history of a treated standard-risk medulloblastoma that highlights the risk of assuming recurrence has occurred when clinical and/or imaging changes are observed. This girl developed both new clinical deficits and had radiographic evidence of recurrence. She subsequently experienced a complete resolution of symptoms and radiographic findings with steroids alone.

OBJECTIVE:As the rate of type 2 diabetes mellitus (DM) in children is increasing, the number of children with complications of DM, such as retinopathy, will also increase. American Diabetes Association and American Academy of Pediatrics guidelines recommend annual eye exams for children with type 1 DM who are older than 10 years, starting 3-5 years after diagnosis. Adolescents with type 2 DM should have an exam when diagnosed. This study was designed to determine if these guidelines are followed and to determine factors that influence providers to follow them. PATIENTS AND METHODS/METHODS:We identified all 15- to 20-year-old patients seen in a pediatric diabetes clinic over 6 months. All patients with type 2 DM and those with type 1 DM diagnosed at least 5 years prior were included. Charts were reviewed for 18 months to determine whether patients were referred for an eye exam. Data extracted included demographics, DM type, DM duration, hemoglobin A(1C), and presence of microalbuminuria. RESULTS:Of 80 patients, 28 (35%) were referred for an eye exam. Patients with a longer duration of DM (P=.006) and those with microalbuminuria (P=.02) were more likely to be referred for screening. CONCLUSIONS:As only 35% of the patients in this study were referred for eye exams, patients at risk for retinopathy are missing opportunities for screening and early treatment. With the increasing number of children with type 2 DM, more patients will be at risk for retinopathy and its consequences. Pediatricians and endocrinologists should be educated about referring for annual eye exams.

PURPOSE OF REVIEW/OBJECTIVE:This review examines the trend toward greater rates of myopia, as well as possible reasons for this increased rate. It broaches some questions about how these increased rates will affect our society, as well as our practice of ophthalmology. RECENT FINDINGS/RESULTS:Multiple studies, as well as national and international government statistics, have found an increase in the prevalence of myopia. Other authors have been looking into causes and influences of myopia in clinical, observational, and molecular studies. SUMMARY/CONCLUSIONS:The rate of myopia is increasing in our society. There are various plausible theories as to the cause of the increase in myopia. This trend will likely affect our practice as ophthalmologists, and will probably increase the number of patients seeking refractive surgery.

BACKGROUND:There has been a dramatic rise of type 2 diabetes mellitus (DM2) in the US pediatric population, yet the presence of retinopathy and microalbuminuria in this cohort has not yet been described. AIM/OBJECTIVE:To assess the presence of retinopathy and microalbuminuria in a cohort of predominantly minority adolescents (African American and Caribbean Hispanic) with DM2. PATIENTS AND METHODS/METHODS:Forty pediatric patients with DM2 were examined between July, 2001 and June, 2003 for the presence of retinopathy. Data were also collected regarding microalbuminuria, body mass index, HbA1c, and family history of DM. RESULTS:Of the 40 patients examined, one patient (2.5%) had retinopathy, whereas nine (27.3%) had microalbuminuria. CONCLUSIONS:In young predominantly minority adolescents with DM2, retinopathy is rare, while microalbuminuria is common.