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Background: This study is aimed to evaluate the clinical approach of non-pediatric ophthalmologists, working in community-based clinics towards Pediatric Patients and their management including referral rates to Pediatric Ophthalmologists and Orthoptists., Methods: an online survey was sent to all community ophthalmologists through national society and social media platforms. The questionnaire included questions regarding the responders' professional experience as well as regarding the responders' approach to children younger than 8 years, and the level of confidence in 4 main aspects of children's management and referral rates., Results: 93 physicians working as general ophthalmologists completed the questionnaire. Most respondents have been in practice for over 10 years (64/93, 68.8%) and over two-thirds were also hospital affiliated (65/93, 69.1%). The responders estimated on average that 35.1 ± 29.6% of patients under 8 years of age are referred for a consult to a pediatric ophthalmologist The level of confidence of three aspects unique to Pediatric Ophthalmology; cycloplegic refraction, strabismus evaluation, and prescribing glasses were significantly lower ( p  < 0.01) than confidence in performing a basic eye exam., Conclusions: many Ophthalmologists do not feel fully capable or experienced to perform the appropriate tests for the pediatric population, especially during the critical timeframe, before 8 years of age. The very high rate of referrals stands in contradiction to the reported low rate of eye pathologies in the pediatric population. These findings suggest that more pediatric-specific training is needed to improve the physician's skills to perform a comprehensive evaluation of pediatric patients in order to reduce the referral burden.

Purpose: To investigate the accuracy of high frequency ultrasound biomicroscopy using the bag/balloon technique to locate recti muscle insertions before and after strabismus surgery., Methods: This was a prospective masked study. The distance from the limbus to horizontal recti muscle insertions was measured by caliper intraoperatively and ultrasound biomicroscopy preoperatively and during follow-up. Accuracy was defined as the difference between ultrasound biomicroscopy and caliper measurements., Results: Thirty-nine muscles (19 medial rectus and 20 lateral rectus) of 22 patients were included. The mean age of the patients was 34.7 ± 15.5 years (range: 18 to 78 years). Follow-up measurements were available for 25 muscles: 12 muscles were recessed and 13 were resected/advanced. Twelve of the included muscles underwent prior surgery. There was a strong correlation between preoperative mean ultrasound biomicroscopy and caliper measurements (P < .001, r p = 0.872) without significant difference between the accuracy of identification of medial rectus and lateral rectus muscles (P = .116 and .377, respectively). On average, postoperative ultrasound biomicroscopy measurements of recessed muscles were 1.15 mm greater than caliper measurements at the end of surgery (P = .003), whereas the mean difference in the resected muscles was not statistically significant (-0.07 mm, P > .999). Overall, in 16 of 25 muscles (64%), the differences between the postoperative measurements and the end of surgery measurements were less than 1 mm. There was no correlation between the accuracy and the time of ultrasound biomicroscopy after surgery (P = .516)., Conclusions: The ultrasound biomicroscopy bag/balloon technique is an accurate and reliable method of locating recti muscle insertions before and after strabismus surgery. Ultrasound biomicroscopy may assist strabismologists in planning repeated operations. [J Pediatr Ophthalmol Strabismus. 2020;57(1):12-20.]., (Copyright 2020, SLACK Incorporated.)

Purpose: To report on the surgical outcome of horizontal strabismus surgery in patients diagnosed as having unilateral vision loss., Methods: Medical records of all patients with unilateral vision loss who underwent surgical repair of horizontal strabismus between 2008 and 2013 at three medical centers were reviewed. Data collected included age at time of surgery, type of strabismus, preoperative and postoperative deviation, procedure performed, and length of follow-up. Surgical success was defined as final alignment of 10 prism diopters (PD) or less unless more than one surgery was required to realign the eyes., Results: Twenty-one patients (9 children) were reviewed. Mean age at time of surgery was 28.3 years (range: 3 to 64 years) and mean follow-up was 20 months (range: 6 months to 5 years). Mean preoperative logMAR visual acuity in the deviating eyes (14 right eyes) was 1.4 ± 0.7 (range: 1.0 to 2.8) and mean deviation was 33 PD (range: 15 to 90 PD). All procedures were performed only on the deviating eye (13 recessions and 8 recession-resection procedures). Mean postoperative deviation was 6.4 PD (range: 0 to 25 PD) and 81% of patients had a manifest ocular deviation of 10 PD or less. Surgical success was comparable in children versus adults (P = .603), in patients with esotropia versus exotropia (P = 1.000), in patients with preoperative deviations larger than 30 PD compared to patients with smaller deviations (P = .521), and in patients in whom one muscle was operated on compared to all other patients (P = .617)., Conclusions: Strabismus surgery in patients with unilateral vision loss is often successful in correcting ocular misalignment., (Copyright 2014, SLACK Incorporated.)