Objective To determine whether there is a measurable change in hyperopia in children with accommodative esotropia over time. Methods and analysis A retrospective cohort of children with fully or partially accommodative esotropia diagnosed by age 7 years, followed to age 10 or older, and with at least two cycloplegic refractions, one before age 7 years and one after age 10 years. The annual change was calculated from linear mixed-effect models, overall and during two age periods with subgroup analysis by baseline refractive error (<4D, ≥4D) and type (partial, full) of accommodative esotropia. Results 405 subjects were studied. Mean age at first and last visit was 3.2 and 12.1 years, respectively, with mean 7.6 cycloplegic refractions. The annual change (95% CI) in refractive error was −0.071 (−0.087 to –0.055) D/yr. Between ages 3 and 7, hyperopia among children with baseline hyperopia <4D increased by 0.12 (0.08 to 0.16) D/yr, while hyperopia among those with baseline 4D or greater was stable (0.0D/yr, −0.03 to 0.04) (p<0.001). Hyperopia decreased from age 7 to 15 years in both subgroups: <4D subgroup −0.17 (−0.20 to –0.14) D/yr, ≥4D subgroup −0.18 (−0.21 to –0.15) D/yr (p=0.58). There was no significant difference in refractive change between fully (n=274) and partially (n=131) accommodative esotropia (p≥0.10). Conclusion Hyperopia in children with accommodative esotropia is stable or increases up to age 7 years, depending on baseline hyperopia, but decreases gradually between ages 7 and 15 years regardless of baseline refractive error.

Among children born with laboratory-confirmed Zika virus (ZIKV) infection, visual impairment (VI) can occur despite normal ocular structure. The objective of this report is to describe ocular findings and visual function among children examined during the Department of Health Zika Health Brigade (ZHB) in the United States Virgin Islands in March 2018. This analysis is based on a retrospective chart review of children eligible to participate in the ZHB (i.e., part of the US Zika Pregnancy and Infant Registry) and who were examined by ophthalmologists. Eighty-eight children attended the ZHB. This report includes 81 children [48 (59.3%) males] whose charts were located [average gestational age = 37.6 weeks (range: 27.6–41.3) and average adjusted age at examination = 9.1 months (range: 0.9–21.9)]. Of those examined, 5/81 (6.2%) had microcephaly at birth, 2/81 (2.5%) had a structural eye abnormality, and 19/72 (26.4%) had VI. Among children with normal ocular structure and neurologic examination, 13/51 (25.5%) had VI. Despite a low incidence of abnormal ocular structure and microcephaly, about a quarter of children examined had VI. Our findings emphasize that ophthalmological examinations should be performed in all children with suspicion for antenatal ZIKV infection, even children with normal ocular structure and neurologic examination.

Purpose: To describe a patient who presented with right unilateral white-eyed posteriorly-draining carotid-cavernous fistulas (CCF) causing an isolated, acute-onset trochlear nerve palsy with atypical progression to a contralateral left red-eyed anteriorly-draining CCF associated with orbital congestion. Observation: A 74-year-old female presented with an acute onset incomitant right hypertropia consistent with the clinical diagnosis of a superior oblique palsy. Initial workup including MRI was normal. During a several-week course, she progressed to a comitant deviation. Six-weeks later she developed an episode of severe headache followed by worsening of her diplopia, reverse left hypertropia and left orbital congestive signs. CTA revealed mild opacification of the left cavernous sinus without a concomitantly present superior ophthalmic vein dilatation. A diagnostic angiogram was obtained which revealed a posterior-draining indirect CCF of the right internal carotid artery (ICA) and an anterior-draining indirect CCF of the left ICA. Transvenous Coil embolization resulted in immediate resolution of diplopia, orbital congestion, and headaches. Conclusion: Although it is atypical for a CCF – or other vascular pathology – to present with an isolated fourth nerve palsy, this case illustrates that vascular imaging should be considered in cases of acquired ocular motor paresis associated with headaches and cases with atypical progression despite normal initial cranial imaging.

Introduction: There is an increasing need for occupational therapists with the skills to provide low vision services, however, there is a lack of standardized training of low vision occupational therapy services. The purpose of this study is to design and evaluate a course for occupational therapy students to improve their skills and knowledge about ophthalmology and low vision. Methods: A multifaceted, 15-week curriculum using didactic learning, clinical experience, and reflective writing was created to instruct second-year occupational therapy students in ophthalmology and low vision. Participants included 19 occupational therapy students from Thomas Jefferson University. Each trainee participated in the course modules and then submitted their course evaluations and reflective writings for review. Participants evaluated their satisfaction with the course using a Likert-scale and open-ended comments. Reflective writing from each participant was reviewed by occupational therapy faculty authors (AB, AL). Results: Nineteen students participated in the course, with 19 (100%) of participants reporting being “satisfied” or “highly satisfied” with the course. Analysis of the reflective writings revealed three main themes: the impact of eye-related medical conditions on daily life, insight into the provider-patient interaction and relationship, and the potential role of the occupational therapist on the vision team as an agent to maximize patient adjustment and function. Discussion: This collaborative, multimodal interprofessional educational model can assist in training and sensitizing occupational therapy students in the areas of ophthalmology and low vision. Implications for Practitioners: This report provides a model for medical educators to utilize in the training of occupational therapy students.