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Rickettsia parkeri rickettsiosis is an emerging, tick-borne disease in the United States (US), transmitted by the bite of Amblyomma maculatum group ticks. Clinical manifestations include fever, headache, myalgia, maculopapular rash, and a characteristic eschar that forms at the site of the tick bite. Arizona's index case of R. parkeri rickettsiosis was reported in 2014. Seven additional confirmed and probable cases were identified during 2016-2017 through routine investigation of electronic laboratory reports and by self-reporting to public health authorities. Serum samples were evaluated for immunoglobulin G antibodies reactive with antigens of Rickettsia rickettsii (the agent of Rocky Mountain spotted fever [RMSF]) and R. parkeri using indirect immunofluorescence antibody tests. Eschar swab specimens were evaluated using Rickettsia genus-specific and R. parkeri-specific real-time PCR assays. Patients (six male, one female) ranged in age from 29 to 69 years (median of 41 years), and became ill between July 2016 and September 2017. Fever (6/7), myalgia (5/7), and arthralgia (5/7) were most commonly reported and 5/7 patients had a documented eschar. All patients reported a tick bite acquired in southern Arizona within 2-8 days before illness onset. Four patients worked as U.S. Border Patrol agents. Antibodies reactive to R. rickettsii, R. parkeri, or to both antigens were detected in all patients. Seroconversions between acute and convalescent-phase samples were identified for two patients and DNA of R. parkeri was identified in eschar swab samples from two patients. R. parkeri rickettsiosis is endemic to a region of the southwestern United States and presents an occupational risk that could be lessened by prevention messaging to Border Patrol agents. RMSF, a closely related and more severe spotted fever rickettsiosis, is also endemic to Arizona. Public health agencies can assist clinicians in distinguishing these two infections clinically through education and accessing species-specific diagnostic assays that can improve surveillance efforts for both diseases.

Accommodation disorders are associated with a host of etiologies. Children with accommodative disorders can present with various symptoms including blur, fluctuating vision, eye pain, burning sensation, tired eyes, asthenopia, headaches, fatigue with near work, and excessive rubbing, blinking, or tearing. This chapter provides an overview of accommodation testing on pediatric patients in the clinical setting. The author describes the indications for accommodation testing and provides clinical pearls for testing accommodative function in children. The chapter covers the specific tests, equipment required, and step-by-step procedures for testing accommodative amplitude, accommodative response, and accommodative facility.

Doctors of Optometry and optometric students, interns, and residents are valuable members of the interprofessional team. Including both primary eye care and more specialized optometric care that can encompass elements of secondary and tertiary care in the collaborative care of patients ensures a holistic, whole-body approach to wellness and supports patients' quality of life. Doctors of Optometry play a vital role in ensuring optimal health throughout the lifespan, and in particular, for people with chronic conditions and complex health concerns. The authors explore examples of how optometrists participate in the healthcare team and describe how optometrists can make an impact for patients across the life span.

The objectives of the present study were to evaluate whether investigator bias influenced the Convergence Insufficiency Symptom Survey (CISS) scores of children with normal binocular vision (NBV) in our original validation study, reevaluate the usefulness of the cutoff score of 16, and reexamine the validity of the CISS.Six clinical sites participating in the Convergence Insufficiency Treatment Trial (CITT) enrolled 46 children 9 to18 years with NBV. Examiners masked to the child's binocular vision status administered the CISS. The mean CISS score was compared with that from the children with NBV in the original, unmasked CISS study and also to that of the 221 symptomatic convergence insufficiency (CI) children enrolled in the CITT.The mean (+/-standard deviation) CISS score for 46 subjects with NBV was 10.4 (+/-8.1). This was comparable with our prior unmasked NBV study (mean = 8.1 (+/-6.2); p = 0.11) but was significantly different from that of the CITT CI group (mean = 29.8 +/- 9.0; p0.001). Eighty-three percent of these NBV subjects scored16 on the CISS, which is not statistically different from the 87.5% found in the original unmasked study (p = 0.49).Examiner bias did not affect the CISS scores for subjects with NBV in our prior study. The CISS continues to be a valid instrument for quantifying symptoms in 9 to18-year-old children. These results also confirm the validity of a cut-point ofor = 16 in distinguishing children with symptomatic CI from those with NBV.

Purpose The purpose of this article is to document a comprehensive clinical profile—including the prevalence of amblyopia, strabismus, and anisometropia—of a pediatric population less than 10 years of age who manifested 6.00 diopters or more of myopia. Method A retrospective record review was performed on all pediatric patients less than 10 years of age, examined at the State University of New York (SUNY) State College of Optometry between 1998 and 2001, and with a spherical equivalent of 6.00 diopters or more of myopia. Results One hundred seventy-eight patients met the criteria. Amblyopia or reduced corrected visual acuity was present in 75.8% of the patients. Strabismus was present in 31.5% of the patients, with essentially equal numbers of esotropes and exotropes. Anisometropia was present in 35.4% of the patients. One hundred forty-five patients had high myopia in the absence of significant ocular or systemic compromising conditions. In this sample of 145, strabismus or anisometropia was an etiology for amblyopia. There was a greater prevalence of bilateral high myopia (64.8%) than unilateral high myopia. Anisometropia was present in 10.6% of the bilateral high myopes, and 78.4% of the unilateral high myopes. Conclusion Children less than 10 years of age with high myopia have a high risk of having amblyopia, strabismus, and anisometropia.

Among 13 suspected Rocky Mountain spotted fever (RMSF) cases identified through an enhanced surveillance program in Tennessee, antibodies to Rickettsia rickettsii were detected in 10 (77%) patients using a standard indirect immunofluorescent antibody (IFA) assay. Immunoglobulin M (IgM) antibodies were observed for 6 of 13 patients (46%) without a corresponding development of IgG, and for 3 of 10 patients (30%) at least 1 year post-onset. However, recent infection with a spotted fever group rickettsiae could not be confirmed for any patient, based on a lack of rising antibody titers in properly timed acute and convalescent serologic specimens, and negative findings by polymerase chain reaction testing. Case definitions used in national surveillance programs lack specificity and may capture cases that do not represent current rickettsial infections. Use of IgM antibodies should be reconsidered as a basis for diagnosis and public health reporting of RMSF and other spotted fever group rickettsiae in the United States.

Accommodative disorders are commonly encountered in pediatric eye care practices.1,2 and the two most common accommodative disorders are accommodative insufficiency and accommodative infacility.3–5 Accommodative insufficiency is a condition in which the amplitude of accommodation is less than expected for a nonpresbyopic patient’s age,5 whereas accommodative infacility is a condition in which the latency and speed of the accommodative response are abnormal compared to normative clinical data.5 Associated signs and symptoms are usually related to reading and other close work activities and include: blurred vision at near, intermittent blurred vision when looking up from near work, headaches, watering or burning of the eyes, tired eyes, loss of concentration, and avoidance of near activities.6–9 The most commonly prescribed treatments for accommodative dysfunction are a plus lens addition at near or vision therapy/orthoptics.4,5,10–13 While plus lenses worn for near activities may improve symptoms for some patients, vision therapy/orthoptics has the potential to eliminate the accommodative dysfunction rather than solely providing symptomatic relief.5 Studies have shown that voluntary control of accommodation can be learned and transferred to a variety of conditions,14,15 and objective improvements in the dynamics16 and accuracy of accommodation following vision therapy have been documented. 17,18 While clinical studies have reported success rates for the treatment of accommodative dysfunction as high as 96%,10–13,19,20 methodological limitations have prevented definitive conclusions from being made. A more rigorous scientific base, ideally a randomized controlled trial, is needed to evaluate the effectiveness of vision therapy/orthoptics for the treatment of accommodative dysfunction in children. The Convergence Insufficiency Treatment Trial (CITT),21,22 a large-scale, randomized clinical trial evaluating vision therapy/orthoptics modalities for children with symptomatic convergence insufficiency, enrolled 164 children with concomitant deficiencies in accommodative function. Accommodative amplitude and facility measures were prospectively collected using standardized methods. These data provide an opportunity to determine the effectiveness of vision therapy/orthoptics for accommodative dysfunction. Herein, we report the effectiveness of office-based vergence/accommodative therapy (OBVAT), home-based computer vergence/accommodative therapy plus pencil push-ups (HBCVAT+), home-based pencil push-up therapy (HBPP), and office-based placebo therapy (OBPT or placebo therapy) for improving accommodative amplitude and accommodative facility in school-aged children with symptomatic convergence insufficiency and accommodative dysfunction.

Influenza A viruses consisting of all known 16 HA and 9 NA subtypes have been isolated from birds. We have created a diagnostic avian cDNA microarray containing probes corresponding to the highly conserved matrix (M) gene, and selected hemagglutinin (HA), and neuraminidase (NA) subtypes of AIV. cDNA RT-PCR products from the HA, NA, and M genes of various avian influenza isolates and subtypes were used to create an avian influenza virus (AIV) cDNA microarray. The microarray was evaluated against a panel of AIV isolates in order to appraise its application in AIV detection and identification. Utilizing the M gene as a pan-influenza marker, all 10 samples were identified as being strains of type A influenza. The array was able to correctly HA- and NA-subtype subtype 7 out of 10 test samples. This included correctly identifying, subtyping, and determining the geographic origin of all of the H5 subtypes and the two H7 samples of U.S. origin.

Objective This study compares different vision screening batteries and documents the failure rates of different vision tests in children who receive periodic vision screenings. Methods Vision screenings were conducted on 1,992 preschool through fifth grade children attending schools in lower socioeconomic areas in New York City. The screening battery incorporated visual acuity, retinoscopy, cover test, stereopsis, near point of convergence, ocular motility, accommodation, color vision, and ocular health. Results Slightly less than one third (30%) of the children screened failed the State University of New York (SUNY) battery and were referred for a comprehensive examination, of which 249 (41%) children actually passed distance visual acuities. The referral rate for distance visual acuity alone was 19%. The referral rate for the Modified Clinical Technique (MCT) was 22%. A greater percentage (33%) of the children in grades kindergarten through fifth were referred compared with the preschoolers (20%). Only a small percentage (8%) of the children wore corrective lenses at the time of testing. There was a significant increase in the prevalence of binocular vision problems found in children from grades kindergarten through 5. Conclusions Poor visual acuity and binocular vision problems exist in schoolchildren despite ongoing vision screenings. The results provide evidence for the necessity of periodic rescreening starting in kindergarten and the importance of screening for hyperopia and binocular vision problems in addition to distance visual acuities.

Purpose. The Proview tonometer measures intraocular pressure by inducing a pressure phosphene through the eyelid and, if reliable and valid, may offer a quick, nonthreatening and noninvasive alternative method of obtaining intraocular pressures (lOPs) without the use of eye drops. This study compares the IOP measurements obtained in children using Proview pressure phosphene tonometry (PPPT) and Goldmann tonometry (GT). Methods. One hundred four 5- to 12-year-old patients of the University Optometric Center/SUNY College of Optometry participated in the study. Subjects were randomized to receive, by different investigators, either PPPT or GT first. Two measurements with each instrument were attempted on each eye of all subjects. A subgroup of 41 subjects was asked which of the two methods was preferred. Results. Seven percent of the subjects did not report a pressure phosphene response compared with 12% of the subjects on whom the investigators were unable to perform GT. The remaining 85 subjects completed the subject protocol. Of the 41 subjects asked, 56% preferred PPPT, 24% had no preference, and 20% preferred GT. The coefficient of repeatability between the two readings was higher for PPPT (3-4 mm Hg) than for GT (1 mm Hg). Mean IOP was 4 mm Hg higher for PPPT than GT with the difference in readings between the two instruments increasing with higher lOPs (r 2 >19%, p < 0.005). Conclusions. In our study of healthy young subjects, PPPT measurements of IOP appear to be repeatable within a few millimeters of mercury in most children, but for some children, variability in repeat measurements can be substantial. Our data showed a mean difference in readings of 4 mm Hg with a 95% confidence interval that the PPPT reading was between 12 mm Hg above GT and 4 mm Hg below GT. This wide range of values indicates that PPPT is not comparable to GT. However, because our study found that children can appreciate pressure phosphenes and most prefer PPPT over GT, the Proview monitor may have value as a noninvasive, portable screener in pediatric patients. To fully evaluate this potential, further studies are needed that include patients with high lOPs.

A boy with chromosome 14 terminal (I4q32.3) deletion presented with typical facial dysmorphism, mental retardation, and hypotonia. Ocular examination revealed esotropia, jerk nystagmus, microcornea, and retinal-choroidal colobomas. We report the first case of microcorneas and colobomas in association with chromosome 14 terminal deletion to help further define this clinical syndrome. J Pediatr Ophthalmol Strabismus 2006;43:104-106.