Short Reports Incidence of amblyopia risk factors in children with nasolacrimal duct obstruction David I. Silbert, MD, FAAP,a Noelle S. Matta, CO, CRC, COT,a Ana Quintanal, BS,b and Eric Singman, MD, PhDb
Previously published research suggested that children with nasolacrimal duct obstruction and amblyopia risk factors on initial examination often develop clinical amblyopia. The present study reports the incidence of clinical amblyopia in children presenting with nasolacrimal duct obstruction but no amblyopia risk factors.
W
e recently reported that 22% of children with congenital nasolacrimal duct obstruction (CNLDO) were found to have amblyopia risk factors, raising the concern that CNLDO was itself a risk factor for amblyopia or somehow promoted the development of risk factors.1 We subsequently reported that 63% of the patients identified with CNLDO and amblyopia risk factors developed amblyopia.2 The present report addresses the incidence of amblyopia development in children with CNLDO who did not present with amblyopia risk factors, defined according to 2003 American Association for Pediatric Ophthalmology and Strabismus guidelines3: anisometropia (spherical or cylindrical) .1.5 D, any manifest strabismus; hyperopia .3.5 D in any meridian, myopia .3.0 D in any meridian, any media opacity .1 mm, astigmatism .1.5 D at 90 or 180 or .1.0 D at oblique axis, and ptosis \1 mm margin reflex distance. In the present study, approved by the Lancaster General Hospital Institutional Review Board, the medical records of consecutive patients #3 years of age were retrospectively reviewed, and a total of 402 children with CNLDO on their initial examination were identified. Each child underwent cycloplegic refraction at initial examination and follow-up. Of the 402 children, 314 (79%) did not have amblyopia risk factors. Of these, 233 (74%) underwent a follow-up
examination. The average length of time between the initial visit and the most recent follow-up visit was 49 months (range, 3-132 months). It is our office protocol to suggest a follow-up visit for all patients presenting with CNLDO. A child was classified as having clinical amblyopia if they had a difference of $2 lines in best-corrected visual acuity judged to be caused by an amblyopia risk factor. A single child was found to have amblyopia risk factors on the follow-up examination (0.4%; 95% CI, 0.048%-1.44%), but none of the children developed amblyopia or strabismus. Amblyopia occurs in approximately 1.6% to 3.6% of the general population in the United States.4 There is no way of knowing from this retrospective analysis whether untreated NLDO might interfere with emmetropization and thereby cause amblyopia in children with CNLDO. However, the present study suggests that children presenting with CNLDO but no amblyopia risk factors have an exceedingly small chance of later developing amblyopia or strabismus.
References 1. Matta NS, Singman EL, Silbert DI. Prevalence of amblyopia risk factors in congenital nasolacrimal duct obstruction. J AAPOS 2010; 14:386-8. 2. Matta NS, Silbert DI. High prevalence of amblyopia risk factors in preverbal children with nasolacrimal duct obstruction. JAAPOS 2011;15:350-52. 3. Donahue SP, Arnold RW, Ruben JB. AAPOS Vision Screening Committee. Preschool vision screening: what should we be detecting and how should we report it? Uniform guidelines for reporting results of preschool vision screening studies. J AAPOS 2003;7:314-16. 4. Simons K. Amblyopia characterization, treatment, and prophylaxis. Surv Ophthalmol 2005;50:123-66.
Author affiliations: aFamily Eye Group, Lancaster, Pennsylvania; bWilmer Eye Institute, Baltimore, Maryland Submitted March 6, 2013. Revision accepted June 27, 2013. Published online November 7, 2013. Correspondence: Noelle S. Matta, CO, CRC, COT, Family Eye Group, Vision Science Department, 2110 Harrisburg Pike Suite 215, Lancaster, Pennsylvania 17601 (email: [email protected]). J AAPOS 2013;17:618. Copyright Ó 2013 by the American Association for Pediatric Ophthalmology and Strabismus. 1091-8531/$36.00 http://dx.doi.org/10.1016/j.jaapos.2013.06.019
618
Journal of AAPOS
Previously published research suggested that children with nasolacrimal duct obstruction and amblyopia risk factors on initial examination often develop clinical amblyopia. The present study reports the incidence of clinical amblyopia in children presenting with nasolacrimal duct obstruction but no amblyopia risk factors.
W
e recently reported that 22% of children with congenital nasolacrimal duct obstruction (CNLDO) were found to have amblyopia risk factors, raising the concern that CNLDO was itself a risk factor for amblyopia or somehow promoted the development of risk factors.1 We subsequently reported that 63% of the patients identified with CNLDO and amblyopia risk factors developed amblyopia.2 The present report addresses the incidence of amblyopia development in children with CNLDO who did not present with amblyopia risk factors, defined according to 2003 American Association for Pediatric Ophthalmology and Strabismus guidelines3: anisometropia (spherical or cylindrical) .1.5 D, any manifest strabismus; hyperopia .3.5 D in any meridian, myopia .3.0 D in any meridian, any media opacity .1 mm, astigmatism .1.5 D at 90 or 180 or .1.0 D at oblique axis, and ptosis \1 mm margin reflex distance. In the present study, approved by the Lancaster General Hospital Institutional Review Board, the medical records of consecutive patients #3 years of age were retrospectively reviewed, and a total of 402 children with CNLDO on their initial examination were identified. Each child underwent cycloplegic refraction at initial examination and follow-up. Of the 402 children, 314 (79%) did not have amblyopia risk factors. Of these, 233 (74%) underwent a follow-up
examination. The average length of time between the initial visit and the most recent follow-up visit was 49 months (range, 3-132 months). It is our office protocol to suggest a follow-up visit for all patients presenting with CNLDO. A child was classified as having clinical amblyopia if they had a difference of $2 lines in best-corrected visual acuity judged to be caused by an amblyopia risk factor. A single child was found to have amblyopia risk factors on the follow-up examination (0.4%; 95% CI, 0.048%-1.44%), but none of the children developed amblyopia or strabismus. Amblyopia occurs in approximately 1.6% to 3.6% of the general population in the United States.4 There is no way of knowing from this retrospective analysis whether untreated NLDO might interfere with emmetropization and thereby cause amblyopia in children with CNLDO. However, the present study suggests that children presenting with CNLDO but no amblyopia risk factors have an exceedingly small chance of later developing amblyopia or strabismus.
References 1. Matta NS, Singman EL, Silbert DI. Prevalence of amblyopia risk factors in congenital nasolacrimal duct obstruction. J AAPOS 2010; 14:386-8. 2. Matta NS, Silbert DI. High prevalence of amblyopia risk factors in preverbal children with nasolacrimal duct obstruction. JAAPOS 2011;15:350-52. 3. Donahue SP, Arnold RW, Ruben JB. AAPOS Vision Screening Committee. Preschool vision screening: what should we be detecting and how should we report it? Uniform guidelines for reporting results of preschool vision screening studies. J AAPOS 2003;7:314-16. 4. Simons K. Amblyopia characterization, treatment, and prophylaxis. Surv Ophthalmol 2005;50:123-66.
Author affiliations: aFamily Eye Group, Lancaster, Pennsylvania; bWilmer Eye Institute, Baltimore, Maryland Submitted March 6, 2013. Revision accepted June 27, 2013. Published online November 7, 2013. Correspondence: Noelle S. Matta, CO, CRC, COT, Family Eye Group, Vision Science Department, 2110 Harrisburg Pike Suite 215, Lancaster, Pennsylvania 17601 (email: [email protected]). J AAPOS 2013;17:618. Copyright Ó 2013 by the American Association for Pediatric Ophthalmology and Strabismus. 1091-8531/$36.00 http://dx.doi.org/10.1016/j.jaapos.2013.06.019
618
Journal of AAPOS
