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Conclusions: Careful assessment of eye movements is essential for
accurate diagnosis of Moebius syndrome and related entities.
080 Does adding stereo testing to Plusoptix photoscreening
improve sensitivity? Noelle S. Matta, David I. Silbert
Introduction: To determine whether adding Lang stereoacuity to Plu-
soptix photoscreening improves sensitivity.
Methods: Retrospective chart review of children who had a plusoptiX
A09 photoscreening and Lang stereoacuity performed by a lay
screener in our office. All children also underwent a comprehensive
pediatric ophthalmology examination, including cycloplegic refrac-
tion performed by one pediatric ophthalmologist. Children were de-
termined to have amblyopia risk factors based on the current
AAPOS referral criteria. Children were considered to pass the
Lang stereo test if they had any measurable stereoacuity.
Results: 92 patients ages 3-11 were included, 76% of children were
found to have amblyopia risk factors. The Lang Stereo test alone
was found to have a sensitivity of 63% and specificity of 64%. The plu-
soptiX alone was found to have a sensitivity of 93% and specificity of
91%. Assuming that all children who were initially a pass on the plu-
soptiX but were referred on the Lang stereo, the sensitivity increased
to 97% but the specificity decreased to 62%.
Discussion: While it is important to maximize sensitivity (reducing
false negatives) programs must also ensure they are maximizing
specificity (reducing false positives).
Conclusions: The Lang stereo test has a low sensitivity and specificity
and should not be used alone for pediatric vision screening. Adding this
test to a Plusoptix photoscreening program would improve sensitivity
only minimally, while at the same time would decrease specificity sig-
nificantly. The Lang stereo-acuity test is not sensitive or specific enough
to be recommended as an adjunct to pediatric vision screening.
081 Traumatic hyphema in children: A review of 137 consecutive
cases. Emily A. McCourt, Brett W. Davies
Introduction: The purpose of this study is to evaluate the mecha-
nisms of injury resulting in traumatic hyphema in children, the set-
tings in which these injuries occur, and the outcomes of these
injuries.
Methods: This was a eight-year retrospective review of all patients
seen at Childrens Hospital Colorado between September 1, 2003,
and December 31, 2011, and diagnosed with traumatic hyphema.
Results: One hundred and thirty-seven patients were identified as
having a traumatic hyphema. Eighty-eight percent of cases oc-
curred in boys. The mean and median ages of the patients was 10
and 11 years respectively. A small number of these injuries were
documented as occurring outside of the home setting (12/135).
Mechanisms of injury were myriad with the most common mecha-
nisms being horseplay (37), missiles such as ball bearing guns, air-
soft pellet guns, or paintball guns (36), and sports injuries (32).
Accidental trauma (14), Bungee cords (10), and assault (5) were
other causes of traumatic hyphema in children. Of the patients
with at least one month of follow-up (103), all but four (3.8%) recov-
ered excellent vision. The vision loss in these four cases was due to
retinal scarring, traumatic optic neuropathy, and amblyopia. The
mechanisms of injury in these cases were baseball (2), paintball
(1) and BB (1).
Discussion: This study highlights the frequency in which serious eye
injuries occur in the home setting and the dangers of children using
guns and participating in horseplay.
Conclusions: The use of protective eyewear during sports, supervi-
sion of children at home, and the avoidance of children using guns
could prevent the majority of the eye injuries resulting in hyphema.
This study is the largest review of pediatric traumatic hyphema.
082 The efficacy of the plusoptiX S04 photoscreener as a vision
screening tool in children with autism. Thomas C. Mccurry, Linda
Lawrence, Liliana Mayo
Introduction: Children with autism and related disorders reportedly
have an increased prevalence (40%) of ocular disorders. Compre-
hensive eye examinations by a pediatric ophthalmologist are recom-
mended for all children with autism and related disorders. 1
Examinations can be very time consuming, expensive, and stressful
for the child. A photoscreener such as the plusoptiX S04 may be
a cost-effective, time-saving, and less invasive method for examining
patients with autism. The purpose of this study is to determine the
efficacy of photoscreening with the plusoptiX S04 in detecting treat-
able ocular conditions in children with autism and related disorders.
Methods: Photoscreening and complete ophthalmologic examina-
tions were performed on 45 children with autism. Prevalence, sensi-
tivity, specificity, positive predictive value, and negative predictive
value were calculated using ophthalmologic examination as the
gold standard.
Results: The plusoptiX S04 referred30 (67%) of 45 children with autism.
16 (36%) children had treatable eye disease upon examination. The
plusoptiX S04 had a sensitivity of 94% (CI: 0.68 to 0.99).The specificity,
positive predictive value, and negative predictive value were 48% (CI:
0.30-0.67), 50% (CI: 0.32-0.68), and 93% (CI: 0.66-0.99), respectively.
Discussion: The plusoptiX S04 is sensitive butless specific at detecting
treatable ocular conditions in children with autism. Most children with
autism and amblyogenic risk factors will be detected on screening,
however about half of all referrals will have no amblyogenic ris kf actors.
Conclusions: The use of the plusoptiX S04 photoscreener in children
with autism is effective and has the potential to save time and ex-
pense related to routine eye examinations.
083 Timing of dacryostenosis resolution and the development of
anisometropia. Brian G. Mohney, Ma Khin, Pyi Son, David O. Hodge
Introduction: Anisometropia was recently shown to develop in ten
percent of infants diagnosed with dacryostenosis at a mean age of
one year. The purpose of this study was to determine whether earlier
(\1 year) spontaneous resolution or probing decreases or eliminates
this risk.
Methods: The medical records of all patients diagnosed as an infant
with dacryostenosis from January 1, 1988, through December 31,
1992, were retrospectively reviewed. Anisometropia was defined
as $1 D of refractive error between the two eyes.
Results: Among 662 consecutive infants, 244 (36.9%) subsequently
underwent a complete ophthalmic examination: 189 (77.5 %) sponta-
neously resolved at a mean age of 4.5 months (range, 0.3-35 months),
and 55 (22.5 %) underwent probing at a mean age of 16 months
(range, 0-53 months). Anisometropia was diagnosed in 17 (9.0%) of
the 189 who spontaneously resolved and in two (3.6%) of the 55 op-
erated children (P50.19). There was a tendency, although not sta-
tistically significant, for earlier resolution to be associated with
higher rates of anisometropia.
Discussion: Although dacryostenosis is associated with the develop-
ment of anisometropia, especially among those with early spontane-
ous resolution, it remains unknown whether this relationship is
causal or merely an association and whether early surgical interven-
tion can modify or eliminate this risk.
Conclusions: Early spontaneous resolution of dacryostenosis was
more likely to have a higher, not lower, rate of anisometropia than
Journal of AAPOS
Volume 17 Number 1 / February 2013 e23