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Introduction: The MTI photoscreener (MTI) and the Welch-Allyn SureSight™ autorefractor are commonly used for preschool vision screening. We compared both of these methods on 100 consecutive patients in a prospective, randomized, masked, clinical trial conducted at a tertiary care center. Methods: One hundred patients between 1 and 6 years of age were included in the study. All participants underwent a comprehensive eye examination with cycloplegic refraction. Examination failure analysis was done on the SureSight™ data using the manufacturer’s referral criteria, the Vision in Preschoolers study (VIP) 90% specificity criteria, the VIP 94% specificity criteria, and the referral criteria proposed by Rowatt and colleagues. Results: Data were successfully obtained on 76% of children using the SureSight™ and 96% with the MTI. The sensitivity and specificity of the SureSight™ to detect clinically significant amblyogenic factors using the manufacturer’s criteria was 96.6 and 38.1%, using the VIP 90% criteria was 79.3 and 64.3%, using the VIP 94% criteria was 67.2 and 69.0%, and using criteria proposed by Rowatt and colleagues was 62.1 and 73.8%. The sensitivity and specificity of the MTI photoscreener was 94.8 and 88.1%, respectively. Conclusions: Using the manufacturer’s referral criteria, the SureSight™ had a sensitivity equal to the MTI photoscreener; however, the specificity was low and over-referrals were anticipated. As specificity levels were increased, a substantial number of children with amblyogenic risk factors were not appropriately identified within our study population..▪ [Copyright &y& Elsevier]

This paper focuses on three theoretical perspectives and their ability to explain a community's adoption of land use controls: population growth, community affluence, and organizational size. Comparisons are made between 79 communities ranging in population size from 1,000 to 100,000. The population-growth and community-affluence perspectives are both supported by the data. [ABSTRACT FROM AUTHOR]

Although the proportion of females who are employed has been increasing, female workers remain concentrated in a small number of occupations. Previous studies suggest social-psychological reasons for this. We hypothesize that characteristics of the local community also are related to sexual segregation in occupations. To test this, we use secondary data from 71 relatively independent communities. Measures of availability, economic necessity, class structure, and heterogeneity in the community are related to an index of occupational segregation by sex changes little from 1960 and 1970, the most efficient explanatory variables change from economic-necessity items to class-structure measures. But further analysis reveals that variables from each set combine to provide the best explanation of occupational segregation in small communities. [ABSTRACT FROM AUTHOR]

Industrialization has generally been thought of as beneficial for communities. Case studies have shown that industrializing communities experienced increases in aggregate, median family, and per capitaincome, and in the equitable distribution of income. This study investigates the impact of industrialization on changes in income levels and distribution between 1960 and 1970 for all Iowa towns of 2,500 to 10,000 population (N = 75). Relationships between change in manufacturing and change in levels of income found support when employment data were used but not when institutional data on firms were examined. No support was found for relationship between changes in manufacturing activity and the distribution of income. Controls for population size and change, distance to SMSA, and type of industry did not change the original relationships. [ABSTRACT FROM AUTHOR]

Organizational goals are investigated in farmer cooperatives. An organizational goal model is constructed on the basis of Talcott Parsons' functional imperatives. The goal model includes: flexibility, satisfaction, efficiency, and productivity. Two dimensions of organizational goals are compared: general importance of the goals and the specific pressure to achieve each goal. The results show that the managers differentiated among the goal on both dimensions. The goals of efficiency and satisfaction were found to be that most important and convey the most pressure to the managers. Limited relationship was found between the dimension of importance and pressure. [ABSTRACT FROM AUTHOR]

This paper seeks to improve the conceptualization and measure-merit of interorganizational fields and organization-environment relations. Cohesiveness of interorganizational fields and centrality of organizations vis-à-vis other units in their task environments are examined. Matrix algebra and sociograms are used to analyze data collected through interviews with the top administrator in 159 community development organizations. Cohesion of 16 interorganizational fields (counties) and centrality of 15 different types of organizations were determined using both high and low intensity of interaction measures. Three organizational coalitions were located and found to group around concerns about agriculture, social services, and natural environment. [ABSTRACT FROM AUTHOR]

Public services have been studied because of their importance for community development and their usefulness as indicators of quality of life. Current work on community services, however, is limited by the lack of a system for classifying services that has both theoretical and applied usefulness. This paper compares two methods for constructing a taxonomy of community public services. Data were drawn from a 50 percent sample of Iowa communities ranging in size from 500 to 10,000 residents (N = 195). Completed questionnaires were returned by 174 city clerks who indicated which of 38 public services were available in their communities. Reliability and Guttman analyses were performed on eight intuitively developed service categories. All eight met the basic requirement of internal consistency and five met the minimal requirement for reproducibility. Factor analysis was performed to determine whether common factors occurred among the items. Seven unique factors were identified. Discussion centers on the use of community service groupings within applied and theoretical dimensions. [ABSTRACT FROM PUBLISHER]

Behavioral and affective forms of membership involvement are compared on the basis of data collected from members of three farm organizations in Wisconsin. The relative effect of selected independent variables on each involvement form is the key problem of this article. The rank order of independent variables as determined by the size of their partial beta coefficients varies considerably between the two forms. However, when the immediateness of the variables is considered, specific attitudes are found to account for a larger percentage of the variance in both involvement forms than are general attitudes or social background characteristics. The results of the study suggest the need for developing models of involvement, the necessity of using multivariate techniques, and the potential contribution of path analysis to an understanding of membership involvement. [ABSTRACT FROM AUTHOR]

Control in voluntary farm organizations was analyzed by the use of data from 220 memberships in numerous local units of the Farm Bureau, Farmers Union, and National Farmers Organization in Wisconsin. We hypothesized that three aspects of control—amount, distribution, and congruence between actual and ‘ideal’—would be related in a positive direction to affective and behavioral measures of membership involvement and to perceptions of income and other organizational benefits. The results are only partly consistent with those of previous studies. As expected, at • least moderate correlations of involvement and benefits with amount of control are evident. Neither the hypothesis about correlations with the distribution of control nor that about correlations with the congruence between actual and ‘ideal’ amounts of control received positive support. [ABSTRACT FROM AUTHOR]

Background The modified Dandy criteria and the newer diagnostic criteria for pseudotumor cerebri syndrome (PTCS) are both used to diagnose intracranial hypertension (IH). In comparison to the modified Dandy criteria, the PTCS criteria stratify the IH diagnosis into definite, probable, and suggested categories, exclude clinical symptoms, and use radiologic evidence for diagnosis. There is a lack of consensus on which criteria should be used in the pediatric population. The purpose of this study was to compare the diagnostic criteria for PTCS to the modified Dandy criteria and to identify limitations within both sets of criteria. Methods The PTCS criteria were retrospectively applied to 50 patients originally diagnosed with IH under the modified Dandy criteria. Results Of the 50 patients, 31 (62%) met diagnostic criteria for definite PTCS, 10 (20%) met criteria for probable PTCS, and 9 patients (18%) failed to meet sufficient PTCS criteria for diagnosis. Conclusions Although the PTCS criteria use objective data to make the IH diagnosis, we found subjective symptoms to be useful indicators of disease in this group of patients. Additionally, distinguishing probable from definite IH may not have clinical relevance, because both groups were treated similarly. The absence of radiographic evidence of IH should not preclude a diagnosis of the condition, as it was present in a minority of patients included in this study. Further research is needed to clarify the disease process in patients who present with signs and symptoms of elevated intracranial pressure but lack ocular pathology. [ABSTRACT FROM AUTHOR]

Low-dose and very low-dose intravitreal bevacizumab (IVB) have been reported to be successful in short-term treatment of type 1 retinopathy of prematurity (ROP), down to an initial dose of 0.004 mg. We now report 12-month outcomes for these infants. Masked, multicenter, dose de-escalation study. One hundred twenty prematurely born infants with type 1 ROP. A cohort of 120 infants with type 1 ROP in at least 1 eye from 2 sequential dose de-escalation studies of low-dose IVB (0.25 mg, 0.125 mg, 0.063 mg, and 0.031 mg) or very low-dose IVB (0.016 mg, 0.008 mg, 0.004 mg, and 0.002 mg) to the study eye; the fellow eye (if also type 1) received 1 dose level higher of IVB. After primary success or failure at 4 weeks, clinical management was at investigator discretion, including all additional treatment. Reactivation of severe ROP by 6 months corrected age, additional treatments, retinal and other ocular structural outcomes, and refractive error at 12 months corrected age. Sixty-two of 113 study eyes (55%) and 55 of 98 fellow eyes (56%) received additional treatment. Of the study eyes, 31 (27%) received additional ROP treatment, and 31 (27%) received prophylactic laser therapy for persistent avascular retina. No trend toward a higher risk of additional ROP treatment related to initial IVB doses was found. However, time to reactivation among study eyes was shorter in eyes that received very low-dose IVB (mean, 76.4 days) than in those that received low-dose IVB (mean, 85.7 days). At 12 months, poor retinal outcomes and anterior segment abnormalities both were uncommon (3% and 5%, respectively), optic atrophy was noted in 10%, median refraction was mildly myopic (–0.31 diopter), and strabismus was present in 29% of infants. Retinal structural outcomes were very good after low- and very low-dose IVB as initial treatment for type 1 ROP, although many eyes received additional treatment. The rate of reactivation of severe ROP was not associated with dose; however, a post hoc data-driven analysis suggested that reactivation was sooner with very low doses. [ABSTRACT FROM AUTHOR]

Purpose: To compare a single surgeon's surgical outcomes for treating intermittent exotropia using bilateral lateral rectus recession (BLR), unilateral lateral rectus recession and medial rectus resection (RR), and unilateral lateral rectus recession and medial rectus plication (RP)., Methods: A retrospective review of all surgeries for basic intermittent exotropia between 2015 and 2023 was performed. Only patients with initial correction using BLR, RR, or RP were included. Exclusion criteria included age older than 18 years, vertical deviation, any nonrefractive ocular diagnoses, prior ocular surgery, and inadequate follow-up., Results: There were 460 patients identified; 123 met inclusion criteria with 54 in the BLR group, 41 in the RR group, and 28 in the RP group. The average pre-operative distance alignment (and standard error) values for the BLR, RR, and RP groups were 25.07 (7.35), 22.44 (5.95), and 23.84 (6.42) prism diopters (PD), respectively. At 1 year, the postoperative distance alignment values for the BLR, RR, and RP groups were 8.72 (7.89), 7.46 (6.31), and 12.83 (6.82) PD, respectively ( P = .03). A subanalysis found a significant difference between the BLR and RP ( P = .02) and RR and RP ( P = .02) groups. There was no difference between the BLR and RR groups ( P = .57)., Conclusions: This study of three surgical approaches for intermittent exotropia found RP had a significantly larger angle of exodeviation compared to BLR and RR at 1 year of follow-up. Both BLR and RR were equally effective approaches for treating intermittent exotropia. [ J Pediatr Ophthalmol Strabismus . 2024;61(4):287-290.] .

Background: Currently no guidelines for repeating a lumbar puncture to guide management in primary intracranial hypertension (PIH) exist., Methods: An institutional database of patients 18 years and younger followed in the institution's pediatric intracranial hypertension clinic was examined for opening pressure changes in PIH at diagnosis, before medication wean, and following medication wean, as well as to examine whether measurements at the time of diagnosis differed between those with and without disease recurrence., Results: Forty-two patients were included in this study; 36% were male and the mean age at diagnosis was 11.01 years. Treatment duration averaged 9.68 months in those without recurrence and 8.5 months in those with recurrence. Average body mass index percentile of patients with disease recurrence was 83.7 and 72.1 in those without recurrence (P = 0.16). Average opening pressure values of all patients at diagnosis, prewean, and postwean was 36.53 cm H 2 O, 30.7 cm H 2 O, and 31.1 cm H 2 O, respectively. There was no statistically significant difference in opening pressures across these time points (P = 0.14). The change in opening pressure from diagnosis to postwean was statistically significant with a reduction of 5.18 cm H 2 O (P = 0.04). There was no statistical difference between change in opening pressure at diagnosis versus postwean between those with and without recurrence (P = 0.17)., Conclusions: This clinical observational study suggests that mean opening pressure measurements in patients with PIH remain elevated both before and after medication wean despite papilledema resolution and patient-reported PIH symptoms. Clinically, this suggests that other features such as signs of optic disc edema and symptoms should be used to inform a clinical determination of disease recurrence and treatment course., Competing Interests: Declaration of competing interest S.C. Aylward receives honoria as associate editor of Pediatric Neurology. The remaining authors have no relevant conflicts of interest to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Classically, peripheral vascular changes in the retina in patients with neuronal ceroid lipofuscinosis type 2 (CLN2) are described as vascular attenuation seen in the late stages of disease on the Weill Connell Ophthalmic Severity Score (WCOSS) staging system. We describe isolated, mild, peripheral vasculitis with peripheral arteriolar dropout identified by fluorescein angiography in patients with a WCOSS grade of stage 2. We believe this vasculitis represents an early vasodegenerative phase of disease that leads to the vascular attenuation seen in later stages of the disease., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To report 2-year ocular and developmental outcomes for infants receiving low doses of intravitreal bevacizumab for type 1 retinopathy of prematurity (ROP)., Methods: A total of 120 premature infants (mean birthweight, 687 g; mean gestational age, 24.8 weeks) with type 1 ROP were enrolled in a multicenter, phase 1 dose de-escalation study. One eye per infant received 0.25 mg, 0.125 mg, 0.063 mg, 0.031 mg, 0.016 mg, 0.008 mg, 0.004 mg, or 0.002 mg of intravitreal bevacizumab; fellow eyes when treated received one dosage level higher. At 2 years, 70 of 120 children (58%) underwent ocular examinations; 51 (43%) were assessed using the Bayley Scale of Infant and Toddler Development., Results: Correlation coefficients for the association of total dosage of bevacizumab with Bayley subscales were -0.20 for cognitive (95% CI, -0.45 to 0.08), -0.15 for motor (95% CI, -0.41 to 0.14), and -0.19 for language (95% CI, -0.44 to 0.10). Fourteen children (21%) had myopia greater than -5.00 D in one or both eyes, 7 (10%) had optic nerve atrophy and/or cupping, 20 (29%) had strabismus, 8 (11%) had manifest nystagmus, and 9 (13%) had amblyopia., Conclusions: In this study cohort, there was no statistically significant correlation between dosage of bevacizumab and Bayley scores at 2 years. However, the sample size was small and the retention rate relatively low, limiting our conclusions. Rates of high myopia and ocular abnormalities do not differ from those reported after larger bevacizumab doses., (Copyright © 2023. Published by Elsevier Inc.)

Purpose: To evaluate the incidence of surgical intervention in pediatric intracranial hypertension (IH), evaluate the visual outcomes of surgically managed patients, and identify potential predictors for surgical intervention., Methods: The medical records of patients with primary and secondary IH at Nationwide Children's Hospital from 2010 to 2017 were reviewed retrospectively. Presenting characteristics of medically and surgically managed patients were compared, and the clinical courses of surgically managed patients were reviewed., Results: A total of 129 medically and 14 surgically managed patients were included. The surgical incidence was 9.8%. Final visual acuity in 27 of 28 surgically managed eyes was 20/25 or better. In combined primary and secondary IH patients, elevations in body mass index (BMI; OR = 1.06; 95% CI, 1.01-1.11; P = 0.022) and lumbar puncture opening pressures ≥52 cm H 2 O (OR = 6.17; 95% CI, 1.93-19.67; P = 0.002) were significantly associated with the likelihood of surgical intervention when assessed by univariate logistic regression; grade of papilledema >2 was of marginal significance. After controlling for BMI, a lumbar puncture opening pressure of ≥52 cm H 2 O was more likely to result in surgery (adjusted OR = 4.69; 95% CI = 1.39-15.98; P = 0.013)., Conclusions: Most pediatric IH can be treated medically. Patients with lumbar puncture opening pressures ≥52 cm H 2 O at the time of diagnosis are at a higher risk of surgical intervention and should be monitored closely. Elevations in presenting BMI and grade of papilledema may also increase the odds of surgery., (Copyright © 2019. Published by Elsevier Inc.)

Purpose: To determine the accuracy of identifying referral-warranted retinopathy of prematurity (RW-ROP, defined as any zone I ROP, stage 3 or worse, or plus disease) from retinal image sets using three grading protocols: a single optic disk-centered image, a set of 3 horizontal images, and a 5-image set., Methods: In this secondary analysis of images from the e-ROP study, a weighted sample of 250 image sets from 250 infants (125 with RW-ROP and 125 without RW-ROP) was randomly selected. The sensitivities and specificities for detecting RW-ROP and its components from a single disk center image, along with nasal and temporal retinal images, were calculated and compared with the e-ROP grading of RW-ROP of all 5 retinal images (disk center and nasal, temporal, superior, and inferior retinal images)., Results: RW-ROP was identified with a sensitivity of 11.2% (95% CI, 6.79%-17.9%) using a single disk center image, with a sensitivity of 70.4% (95% CI, 61.9%-77.9%) using 3 horizontal images, and a statistically higher sensitivity of 82.4% (95% CI, 75.0%-89.0%) using all 5 images (P = 0.002). The specificities were 100%, 86.4%, and 90.4%, respectively. For grading using 3 horizontal images, sensitivity was 14.3% for plus disease, 25% for zone I ROP, and 71.2% for stage 3 or worse compared to 40.8%, 50%, and 79.8% for grading using 5-image sets, respectively., Conclusions: Both a single, disk-centered, posterior pole image and 3 horizontal images were less effective than a 5-image set in determining the presence of RW-ROP on qualitative grading by trained readers., (Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Background: Cerebral sinovenous thrombosis (CSVT) has been proposed as an alternative cause of retinal hemorrhage (RH) in children being evaluated for abusive head trauma. This study investigated the prevalence and characteristics of RH in children with CSVT., Methods: The medical records of children >6 weeks of age with newly diagnosed CSVT and fundus examination by an ophthalmologist were examined retrospectively. Primary outcomes were presence and patterns of RH., Results: A total of 29 children (median age, 9 years; range, 7 weeks to 17 years) were studied. Of these, 5 (17%) had RH, in 4 of whom RH were peripapillary, superficial, intraretinal, and adjacent to a swollen optic disk. In the fifth child, who had meningitis, sepsis, and multiple cerebral infarcts, there were a moderate number of posterior pole intraretinal hemorrhages. Eighteen children (62%) had optic disk swelling. In 13 children, cerebrospinal fluid opening pressure was recorded (range, 27-59 cm H 2 O). CSVT risk factors included meningitis, mastoiditis, and hypercoagulability., Conclusions: RH in pediatric CSVT was uncommon. When RHs were present, the appearance matched RH patterns known to be caused by medical conditions, such as raised intracranial pressure and sepsis, also present in these children. These findings suggest that the RHs are due to these other causes and not directly to CSVT itself. In children with CSVT, if RHs are multilayered, extend beyond the peripapillary region into the rest of the posterior pole or retinal periphery, or occur in the absence of optic disk swelling, another etiology for the RH should be sought., (Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Purpose: To report the clinical characteristics of infants with severe retinopathy of prematurity (ROP) and glaucoma-based on review of the Early Treatment for Retinopathy of Prematurity (ETROP) study., Methods: All infants randomized in the ETROP trial were included. Each infant developed high-risk prethreshold ROP in at least one eye. Infants were examined until 6 years postnatal age. The following data were collected: corneal clarity, depth of the anterior chamber, status of the optic nerve and cup/disk ratio, retinal structure, and visual acuity. The diagnosis of glaucoma was based on the investigators best clinical judgment. All infants diagnosed with glaucoma were included in the study., Results: A total of 12 of 718 eyes (1.67%) were diagnosed with glaucoma. Of these, 5 were first reported as having glaucoma at 9 months, 2 at 2 years, 1 each at 3 and 4 years, and 3 at 5 years. The anterior segment was shallow in 7 eyes. Three eyes had normal retinal structure, 1 had macular dragging, and 8 had retinal detachments involving the fovea (stage 4B or worse). At the 6-year follow-up examination only one eye with glaucoma had measurable vision., Conclusions: Although earlier treatment of significant ROP has resulted in better retinal structure and visual acuity outcomes, nearly 2% of the eyes with high-risk prethreshold ROP developed glaucoma at some point during the first 6 years of life., (Copyright © 2012 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.)