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Take Home Message The total burden of urolithiasis in terms of incidence, disability-adjusted life years, and deaths has increased globally since 1990, while age-standardized rates have decreased. Importantly, areas of lower sociodemographic index have seen an increased burden. Understanding variation and factors affecting the burden of urolithiasis is necessary for policymakers., Background Urolithiasis is among the most common urologic diagnoses globally, with substantial burden and cost on healthcare systems worldwide. Increasing evidence links urolithiasis with an array of risk factors, including diet and lifestyle trends, noncommunicable diseases such as diabetes and obesity, and global warming. Objective To examine geographic, temporal, and sociodemographic patterns to better understand global disease burden of urolithiasis. Design, setting, and participants We extracted data on age-standardized incidence rate (ASIR), deaths, and disability-adjusted life years (DALYs) attributed to urolithiasis for 21 regions, including 204 countries, for 1990–2019 from the Global Burden of Disease (GBD) study. Outcome measurements and statistical analysis Data were analyzed at the global, regional, and country levels, as well as stratified by the Socio-Demographic Index. The average annual percentage change (AAPC) was calculated to measure temporal trends across groups. Results and limitations Globally, total cases, DALYs, and deaths attributed to urolithiasis increased over the study period, while the age-standardized rates of these measures decreased. The age-standardized incidence of urolithiasis decreased from 1696.2 (95% confidence interval [CI] 1358.1–2078.1) cases per 100 000 population in 1990 to 1394.0 (95% CI, 1126.4–1688.2) cases per 100 000 population in 2019, with an AAPC of −0.7 (95% CI [−0.8, −0.6]). Of the GBD regions, Eastern Europe demonstrated a consistently higher ASIR of urolithiasis than all other regions, while the Caribbean had the highest AAPC. This study is limited by the available national and regional data, as described in the original GBD study. Conclusions Worldwide, total cases, DALYs, and deaths attributed to urolithiasis have increased since 1990, while age-standardized rates have decreased, with demonstrated regional and sociodemographic variation. Multifaceted strategies to address urolithiasis prevention and treatment are necessary. Patient summary In this study, we looked at trends in the global burden of stone disease using data from 204 countries from 1990 to 2019. We found that the overall burden has increased, but it varies by age, sociodemographic variables, and geographic region. We conclude that we need adaptable policies that suit the specific needs of the country to address this burden.

This article describes the development and testing of a novel creative and reflective writing task. Following the rationale of sand-tray and play therapies, participants were asked to meaningfully incorporate four objects from a randomly generated matrix of options into a creative short story. They then composed a second story that incorporated four possessions from home associated with important memories. Afterwards, participants produced interpretive statements or reflections on what the stories meant to them. An exploratory qualitative study was conducted based on narrative data from 15 young adult participants in Canada. Our goals were to: (a) explore the extent to which object familiarity was associated with qualitative differences in stories and interpretations, and (b) investigate for connections between features of participants’ stories and depth of interpretation. Analysis of creative stories resulted in a scheme of four response categories with ten subcategories. Participants’ interpretations of their own stories were coded based on self-described sources of inspiration, such as critical life episodes or popular media. Results are accompanied with excerpts of participants’ stories and reflections, and percentage comparisons are reported. Findings are presented in dialogue with established interpretive frameworks originating in depth psychology. Manipulation of object familiarity resulted in demonstrable differences at the levels of word length, point of view, narrative forms and features, self-disclosure, and reflection. Use of familiar objects in such a task appears to be a largely untapped resource that shows promise as a route to insight.

To evaluate representation trends of historically underrepresented minority (URM) groups in gynecologic oncology fellowships in the United States using a nationwide database collected by the Accreditation Council for Graduate Medical Education (ACGME).Data on self-reported ethnicity/race of filled residency positions was collected from ACGME Database Books across three academic years from 2016 to 2019. Primary chi-square analysis compared URM representation in gynecologic oncology to obstetrics and gynecology, other surgical specialties, and other medical specialties. Secondary analysis examined representation of two URM subgroups: 1) Asian/Pacific Islander, and 2) Hispanic, Black, Native American, Other (HBNO), across specialty groups.A total of 528 gynecologic oncology positions, 12,559 obstetrics and gynecology positions, 52,733 other surgical positions, and 240,690 other medical positions from ACGME accredited medical specialties were included in analysis. Primary comparative analysis showed a statistically significant lower proportion (P 0.05) of URM trainees in gynecologic oncology in comparison to each of obstetrics and gynecology, other surgical fields, and other medical fields. Secondary analysis also demonstrated a significantly lower proportion (P 0.05) of HBNO physicians in gynecologic oncology in comparison to obstetrics and gynecology, as well as all other medical and surgical specialties.This study illustrates the disparities in URM representation, especially those who identify as HBNO, in gynecologic oncology fellowship training in comparison to obstetrics and gynecology as well as other medical and surgical fields. Improvements to the current recruitment and selection practices in gynecologic oncology fellowships in the United States are necessary in order to ensure a diverse and representative workforce.

Introduction: Peripheral arterial disease (PAD) is a progressive atherosclerotic disease associated with significant morbidity and mortality in the US, however, data regarding mortality trends is limited. This study uses national death certificate data to characterize contemporary trends in PAD-related mortality in the US. Methods: The Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) was queried for data regarding PAD-related deaths from 2000 to 2019 in the overall sample and from different demographics (age, sex, race). Crude and age-adjusted mortality rates (AAMR) per 100,000 people were calculated. Associated average percentage changes (APC) were computed using Joinpoint trend analysis software. Results: Between 2000 and 2019, a total of 1,959,050 PAD-related deaths occurred in the study population. Overall, AAMR decreased from 2000 to 2016, but remained relatively the same between 2016 to 2019. Men, Non-Hispanic (NH) Black or African American, NH American Indian or Alaska Native, and NH Asian or Pacific Islander showed a decline in AAMR. Women, NH White, Hispanic or Latino, ages 55 to 69 years, and 70 to 84 years showed initial declines, with no change in recent years. Ages 40 to 54 only had a change in crude mortality between 2002 and 2010. Overall, men, NH Black or African American individuals, and people aged 85+ were associated with the highest AAMRs of their respective subgroups throughout the study period. Notably, there was an increase in crude mortality rate amongst individuals 25-39 years of age from 2009 to 2019. Conclusion: PAD-related mortality in the US decreased from 2000 to 2016 but has stabilized in recent years. Despite improvement, disparities amongst sex, race, and age remain. Figure 1. PAD-related mortality rates by 1.A. sex 1.B. race 1.C. ages 25-54 and 1.D. ages 55-85+ in the United States, 2000 to 2019. *Indicates that APC is significantly different from zero at α=0.05.

Introduction: YouTube™ has grown into one of the largest disseminators of health care information. We assessed the quality of information on varicoceles and their treatment, available on YouTube™. Methods: Using a YouTube™ search query with the keyword “varicocele,” the quality of the first 50, nonrepeat videos in English were assessed as a representative group for the topic. DISCERN and Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-AV) standardized tools were utilized by three independent reviewers to grade the quality of these videos based on content, understandability, and actionability. Results: The average and median DISCERN score was 31.34 (±9.37) and 31 (interquartile range 25–35), respectively, indicating poor quality. The interrater reliability (IRR) scores ranged from 0.51 to 0.93, indicating fair to excellent reliability. The average PEMAT-AV understandability and actionability scores were 69.8% ±15.4% and 11.0% ±24.6%, respectively, indicating mostly understandable but poor actionability. The t-test results showed that international videos scored higher without statistical significance in the DISCERN or PEMAT-AV scores (P = 0.18, 0.59, and 0.20). Conclusions: The current quality of videos on YouTube™ on the topic of varicoceles is of poor quality due to a lack of a holistic approach in explaining the wide range of treatment options available. With the ease of access to produce and disseminate health information, there is a need to create high-quality videos on varicoceles that empower a patient to make an informed decision.

Women have historically been underrepresented in gastroenterology (GI). Currently they compose only a small percentage of practicing GI physicians in the United States. Despite the rise in women graduating medical school, the percentage of current female GI fellows has remained low in recent years. In this study, we sought to examine the trends of female representation in GI over the past 10 years, to further elucidate the disparity, and to illustrate if any major changes have occurred. The findings were compared to those for other specialties to shed light on the relationship between them.This retrospective study used data on the gender of residents obtained through the Accreditation Council for Graduate Medical Education Data Resource Books from 2009-2019. Chi-square statistical testing was used to compare representation percentages across groups. Significance was determined at the P0.05 level, while P0.01 was also reported.Over a 10-year period from 2009-2019, an average of 33.6% of GI fellowship positions were filled by women, an increase of only 3.3% since 2009. Chi-square analysis of proportions across groups demonstrated a significantly lower percentage of female representation in GI in comparison to other specialties.Despite an increase in the number of women entering and graduating from medical school within the last decade, the number of female gastroenterologists remains a poor reflection of it. GI continues to have a significantly lower female representation than other specialties over the last decade.

Introduction: While understanding the impact of mental health on health status perception improves patient-centered care, this relationship is not well-established in cardiac patients. We examined the association between psychological distress and health status perception in patients with a previous myocardial infarction (MI) and/or stroke. Methods: We extracted data for patients with a previous MI and/or stroke from the 2019 National Health Interview Survey (NHIS). Health perception was self-reported and grouped as poor/fair (0) or good/very good/excellent (1). Anxiety and depression were estimated using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-8 (PHQ-8) and grouped based on severity. Multivariable logistic regressions controlling for sex, age, education level, smoking status, race, and BMI were performed to assess our hypothesis that higher GAD-7 and PHQ-8 scores are associated with worse health perception in patients with a previous MI/stroke. Results: Of 31,948 individuals for whom data on MI/stroke was available, 6.8% (n=2,181) reported a previous MI and/or stroke. Of these patients, 36.6% (n=799) had scores consistent with anxiety and/or depression on the GAD-7 or PHQ-8. The odds of reporting good/very good/excellent health status were lower for individuals with anxiety (OR 0.245, 95% CI = 0.192-0.314, P P Table 1 ). Respondents identifying as “Black” or “Other” race and those with lower education levels also demonstrated significantly worse perceived health status. Conclusion: Patients with previous MI/stroke and concomitant psychological distress have worse perception of health status. Understanding the range of patient health perceptions can help physicians provide more patient-centered care.

Introduction: Peripheral artery disease (PAD) is a common progressive atherosclerotic disease associated with significant morbidity and mortality in the US; however, data regarding PAD-related mortality trends are limited. This study aims to characterize contemporary trends in mortality across sociodemographic and regional groups. Methods: The Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) was queried for data regarding PAD-related deaths from 2000 to 2019 in the overall sample and different demographic (age, sex, race/ethnicity) and regional (state, urban–rural) subgroups. Crude and age-adjusted mortality rates (CMR and AAMR, respectively) per 100,000 people were calculated. Associated annual percentage changes (APC) were computed using Joinpoint Regression Program Version 4.9.0.0 trend analysis software. Results: Between 2000 and 2019, a total of 1,959,050 PAD-related deaths occurred in the study population. Overall, AAMR decreased from 72.8 per 100,000 in 2000 to 32.35 per 100,000 in 2019 with initially decreasing APCs followed by no significant decline from 2016 to 2019. Most demographic and regional subgroups showed initial declines in AAMRs during the study period, with many groups exhibiting no change in mortality in recent years. However, men, non-Hispanic (NH) Black or African American individuals, people aged ⩾ 85 years, and rural counties were associated with the highest AAMRs of their respective subgroups. Notably, there was an increase in crude mortality rate among individuals 25–39 years of age from 2009 to 2019. Conclusion: Despite initial improvement, PAD-related mortality has remained stagnant in recent years. Disparities have persisted across several demographic and regional groups, requiring further investigation.

The demographics of practicing physicians in the US have not represented the diverse populations they serve, and there is no exception in oncology care.1,2 Recognizing the detrimental effects of these disparities on public health, oncology training programs have instilled benchmarks and initiatives to increase diversity among oncology physicians nationwide.3 However, data about representation in oncology specialties and the impact of these initiatives is lacking. This study aims to assess underrepresented minority (URM; ie, Black or African American individuals, Hispanic or Latino individuals, and Native American, American Indian, or Alaskan Native individuals) representation trends across training programs in oncology specialties from 2015 to 2020.

INTRODUCTION AND OBJECTIVE:Urolithiasis is among the most common urologic diagnoses globally, with substantial burden and cost on healthcare systems worldwide. Increasing evidence links urolithiasi...

10561 Background: Disruptions to cancer care during the COVID-19 pandemic due to disease mitigation efforts, supply-chain issues, and fear of COVID-19 have all been reported, but study of their extent has been limited. The purpose of this study is to evaluate the extent and associations with patient reported disruptions to cancer treatment and other care during the COVID-19 pandemic using nationally representative data. Methods: This cross-sectional study uses data from the 2020 National Health Interview Survey (NHIS), an annual, cross-sectional survey of US adults. Adults who reported requiring current cancer treatment or other care related to their cancer in the second half of 2020 were included. Rates of patients with self-reported changes, delays, or cancellations to cancer treatment or other cancer-related care due to the COVID-19 pandemic were calculated and their associations with demographic and other variables were analyzed. All data were adjusted using sample weights and specific variables to account for stratification and other survey characteristics using the Stata svy command. Chi-square testing was used to compare proportions across variable groups. Univariable logistic regression analysis was utilized to assess variable associations with change, delay, or cancellations to cancer care during the COVID-19 pandemic. Multivariable logistic regression analysis was used to create a model adjusted for select demographic variables. Results: A sample-weighted 2,867,326 adults (n=574) reported requiring cancer treatment and/or other cancer care since the start of the COVID-19 pandemic. Of these, 189 (32.1%) reported any change, delay, or cancellation due to the pandemic. On univariable analysis, patients who were younger, female, had comorbidities, and uninsured were significantly more likely to report care disruptions. On adjusted analysis, younger age and female sex remained significant predictors. In a sample-weighted subset of 1,600,587 patients (n=331), 291 (87.9%) reported virtual appointment use. There was no association with disruptions across breast, prostate, lung, and colorectal cancer groups. Conclusions: Approximately 1/3 of patients experienced disruptions to cancer care during the COVID-19 pandemic. Patients with younger age or female sex were more likely to have disruptions in care, which may reflect risk stratification strategies in the early stages of the pandemic. The longitudinal impact of these disruptions on outcomes merits further study. [Table: see text]

e17054 Background: Prostate cancer (PC) is the most common cancer and second leading cause of cancer-related death among males in the United States. Screening recommendations and treatments for PC have changed considerably over the past two decades, with differential effects across sociodemographic groups. This study aims to characterize trends in incidence of PC from 2000 to 2018 by age, race, region, and rurality to better understand these effects on incidence. Methods: Data were obtained from the National Program of Cancer Registries (NPCR), which represents patients for all 50 states. Incidence rates and average annual percent change (AAPC) were calculated using SEER*Stat software. Incident rates were calculated as the number of new cancers arising in the prostate (ICD-O-3 Site Code: C619) per 100,000 males. Trends across sociodemographic groups were analyzed and visualized in R. Results: PC incidence decreased significantly for all ages 40 and above from 2000 to 2018. Ages 85+ experienced the sharpest decline with an AAPC of -5.5% (95% CI: -6.0% to -5.1%). However, for all 5-year age brackets between 60 and 85, incidence reaches a minimum in 2014 before rising again as shown by segmented regression analysis. All race/ethnicity groups experienced a significant decline in incidence from 2000 to 2018 with sharpest decline in Hispanics -3.9% (95% CI: -4.5% to -3.3%). All regions also experienced a significant decline, with the greatest decline in the West at -4.0 (95% CI: -4.7 to -3.3). Metropolitan counties experienced a greater decline than nonmetropolitan. Patients ages 65 to 79, of Black race/ethnicity, and metropolitan groups had the highest overall incidence over the study period in their respective categories with 2018 incidences of 663, 181, and 115 per 100,000 males respectively. Conclusions: Nearly all sociodemographic groups have experienced a decline in the incidence of PC from 2000 to 2018. However, PC incidence increased from 2014 to 2018 for several sociodemographic groups. Importantly, 65 to 79 year olds, Black Americans, and metropolitan groups had the highest incidence over the study period. This study demonstrates a sustained rise in incidence of PC for several sociodemographic groups, as well as identifies groups at higher risk of PC. These trends may be due to evolving PC screening guidelines and merit further investigation.

10571 Background: The COVID-19 pandemic has caused unprecedented disruptions in medical care, especially in those with cancer. Prior studies have demonstrated a higher risk of mortality in patients with cancer and COVID-19, which could be due to factors such as immunosuppression and higher burden of co-morbidities. However, there are limited studies examining the impact of sociodemographic factors including race, gender, rurality, and region on mortality in patients with COVID-19 and cancer. This study aims to characterize and analyze sociodemographic trends in COVID-19 mortality in patients with cancer. Methods: Data on patients with COVID-19 and cancer listed on death certificates from the Multiple Cause of Death Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database were extracted. Age-adjusted mortality rates (AAMR) were calculated and compared across sociodemographic groups. Results: A total of 18,467 total deaths occurred in patients with COVID-19 and cancer listed on multiple cause of death certificates in 2020, with overall AAMR of 4.4 (95% CI: 4.4-4.5). AAMR for patients with COVID-19 and cancer was significantly higher in Non-Hispanic (NH) Black or African American (7, 95% CI: 6.8-7.3), NH American Indian or Alaska Native (6.4, 95% CI: 5.4-7.3), and Hispanic or Latino (5.4, 95% CI: 5.2-5.7) groups than NH White (4, 95% CI: 3.9-4.1) and NH Asian or Pacific Islander (2.5, 95% CI: 2.3-2.7). AAMR was also higher in males (5.9, 95% CI: 5.8-6.1) and those in Northeast (5.6, 95% CI: 5.4-5.8) and Midwest (5.3, 95% CI: 5.2-5.5) census regions. Those in medium metro counties had significantly lower AAMR (3.8, 95% CI: 3.7-4) compared to other locations based on the NCHS Urban-Rural Classification Scheme for Counties. Conclusions: AAMR in patients with any cancer and COVID-19 was significantly higher in NH Black or African American, NH American Indian or Alaskan, and Hispanic or Latino race/ethnicity groups, as well as in males. Regional and rurality disparities also exist. This study highlights persistent disparities in COVID-19 and cancer outcomes and identifies groups at higher risk of mortality. Future studies examining sociodemographic trends in COVID-19 mortality in patients with specific cancers are necessary. [Table: see text]

The Apolipoprotein L1 (APOL1) gene plays an important role in determining risk for chronic kidney disease (CKD) and is prevalent in countries with large populations of African ancestry.1,2 The effects of the presence of high risk variants pose a challenge when considering kidney transplantation in endemic populations due to the potential detrimental effects on recipients and donors alike. For recipients, grafts from both living and deceased donors with two APOL1 risk variant alleles are associated with shorter graft survival and decreased glomerular filtration rate (GFR) in comparison to those with zero or one variant.3 Similarly, living donors with two risk variant APOL1 alleles experience significantly decreased pre- and post-donation GFR when compared to those with zero or one variant, precipitating the introduction of APOL1 risk variant screening of potential living kidney donors (pLKDs) across many institutions in resource-rich settings such as the United States.4,5 This is the first study to screen for APOL1 risk variants in pLKDs located in Nigeria, and Antigua & Barbuda, countries with large populations of African descent.

11043 Background: The ASCO and American Society of Radiation Oncologists (ASTRO) have recently committed to initiatives on increasing URM representation in the radiation oncology workforce. This study aims to assess representation trends in radiation oncology training programs across five academic years in order to understand representation trends and better guide initiatives moving forward. Methods: Data on racial and ethnic representation from the ACGME Data Resource Books over a span of five academic years (2015-2020) was included. URM was defined as those who identified as Hispanic, Black, or Native American/Alaskan in concordance with AAMC definition. Chi square testing was used to compare the proportion of residency positions occupied by URM residents by self-identified race and ethnicity in radiation oncology to that of hematology and medical oncology, complex general surgical oncology, and all other specialties. Results: A total of 3,315 radiation oncology positions were identified over the study period, 2015 and 2020. 1,938 (58.5%) of radiation oncology residency positions were filled by residents who identified as White, 967 (29.2%) as Asian/ Pacific Islander, 126 (3.8%) as Hispanic, 120 (3.6%) as Black, 7 (0.2%) as Native American/ Alaskan, and 157 (4.7%) as Other. URM representation was 7.6% in total and was relatively stagnant, remaining between 7.3% and 8.0% across study years. Results of chi square comparative analysis demonstrated lower rates of representation in radiation oncology in comparison to hematology and medical oncology as well as all other specialties (Table). Conclusions: There is lack of racial and ethnic diversity in radiation-oncology residency training positions in the United States. Over the five-year study period, only 7.6% of trainees identified as URM. URMs have significantly lower rates of representation in radiation-oncology compared to hematology and medical oncology, and other specialties. Efforts to mitigate disparities require a multifaceted approach.[Table: see text]

Although unilateral visual impairment (UVI) is a common pediatric vision disorder, its functional significance is not fully understood1. Hyperopic refractive errors identified at infant screening are associated with poor visuomotor test performance in early childhood2, but it is unclear to what extent UVI affects children’s motor development. UVI and associated abnormalities of binocular depth perception result from a number of conditions, including eye misalignment (strabismus), refractive imbalance (anisometropia), or image deprivation (e.g., from cataract). Treatment of these conditions typically includes occlusion of the eye with better vision during a sensitive period for visual development, which coincides with the stage during which children develop and integrate key motor skills, including reaching/grasping and postural stability and control. Therefore, children with UVI may be at risk for delayed development of motor skills due to poor vision, lack of binocular function, and/or to lack of practice in ambulating or manipulating objects. Children with UVI resulting in amblyopia generally perform worse on tests of motor skills than age-matched children with normal vision, particularly on fine motor tasks that require speed and dexterity1, 3–5. However, only some of these studies used standardized, norm-referenced tests to assess motor skills, and none examined multiple domains of motor functioning. Most of this research assesses only fine motor skills or eye-hand coordination. Relatively few studies measured postural control/stability or gross motor skills of children with UVI. Arguably, UVI and associated deficits in binocular vision might interfere in performance of tasks assessing balance, posture, and gait, as these activities require integration of vestibular signals relating to head or body position/motion with proprioceptive information and visual perception of the environment. There are no published reports of motor skills in children with UVI secondary to unilateral congenital cataract. It is unclear to what extent the relatively poor motor test performance of children with UVI is due to poor visual acuity in the affected eye, to reduced binocular vision, or both. Multiple regression analyses suggest that strabismus5 or reduced stereovision4 has a greater adverse impact on fine motor performance than the degree to which the two eyes differ in acuity among children with amblyopia. However, the relative importance of stereopsis versus degree of amblyopia may vary according to the child’s age3, given developmental changes in reach-to-grasp strategies6. The Movement Assessment Battery for Children – 2nd edition (MABC-27), a standardized, norm-referenced assessment of children’s everyday motor competence, includes eight tasks assessing three domains: manual dexterity, ball skills, and static and dynamic balance. The primary aim of this study was to assess motor functioning using the MABC-2 in 4.5 year old children enrolled in the Infant Aphakia Treatment Study (IATS), a randomized, multicenter (n = 12) trial comparing treatment with a primary intraocular lens (IOL) or contact lens (CL) in 114 infants with surgery for unilateral cataract extraction between 1 and 7 months of age. Key research questions include the following: (a) Are there significant differences in motor functioning between the treatment groups? (b) How does the motor functioning of the IATS sample compare to that of the MABC-2 standardization sample? (c) To what extent are motor skills predicted by visual acuity and/or stereopsis? Multivariate analyses control for earlier age of surgery and the absence of strabismus, as these variables have been associated with better stereoacuity in previous studies (8, 9).

Purpose This investigation compared 2 commonly used care systems, Boston Advance® care system and Boston Simplus™ (Bausch & Lomb, Rochester, New York) multipurpose solution, and the effects of these solutions on unaided daytime vision, care, and handling and comfort with Paragon corneal refractive therapy (CRT)® (Paragon Vision Sciences, Mesa, Arizona) lenses. Methods Eighteen subjects wearing CRT lenses were recruited. Three evaluations were conducted over 2 months. Subjects were randomly assigned a solution and returned for a follow-up visit after 1 month. At the conclusion of the 1-month visit, each patient was reassigned the other solution for the second month. The final visit included an additional questionnaire regarding which solution was deemed the best and worst for unaided daytime vision, comfort, care, and handling. Results From the responses of the 18 patients, a trend is evident that patients favor Boston Simplus over Boston Advance for comfort, unaided daytime vision, and care and handling. However, the sample size is small in this study; therefore, most of the differences are not significant at the 0.05 level except the preference for care and handling (P = 0.03). Conclusions Patients preferred Boston Simplus to Boston Advance with corneal reshaping lens wear when evaluated for comfort, unaided daytime vision, and care and handling. The preference of Boston Simplus to Boston Advance for care and handling is very strong and statistically significant, whereas other such advantages of Boston Simplus were not found to be statistically significant in this study. Further confirmation of these results as well as a better understanding of other visual and ocular interactions of Boston Simplus versus conventional solutions, will require using a larger sample in further studies.

Purpose To determine whether stereopsis of infants treated for monocular cataracts varies with the type of optical correction used. Design Randomized prospective clinical trial. Methods The Infant Aphakia Treatment Study randomized 114 patients with unilateral cataracts at age 1–7 months to either primary intraocular lens (IOL) or contact lens correction. At 4.5 years of age a masked examiner assessed stereopsis on these patients using 3 different tests: (1) Frisby; (2) Randot Preschool; and (3) Titmus Fly. Results Twenty-eight patients (25%) had a positive response to at least 1 of the stereopsis tests. There was no statistically significant difference in stereopsis between the 2 treatment groups: Frisby (contact lens, 6 [11%]; IOL, 7 [13%]; P = .99), Randot (contact lens, 3 [6%]; IOL, 1 [2%]; P = .62), or Titmus (contact lens, 8 [15%]; IOL, 13 [23%]; P = .34). The median age at surgery for patients with stereopsis was younger than for those without stereopsis (1.2 vs 2.4 months; P = .002). The median visual acuity for patients with stereopsis was better than for those without stereopsis (20/40 vs 20/252; P = .0003). Conclusion The type of optical correction did not influence stereopsis outcomes. However, 2 other factors did: age at surgery and visual acuity in the treated eye at age 4.5 years. Early surgery for unilateral congenital cataract and the presence of visual acuity better than or equal to 20/40 appear to be more important than the type of initial optical correction used for the development of stereopsis.

Purpose To compare rates and severity of complications between infants undergoing cataract surgery with and without intraocular lens (IOL) implantation. Design Prospective randomized clinical trial. Methods A total of 114 infants were enrolled in the Infant Aphakia Treatment Study, a randomized, multi-center (12) clinical trial comparing the treatment of unilateral aphakia in patients under 7 months of age with a primary IOL implant or contact lens. The rate, character, and severity of intraoperative complications, adverse events, and additional intraocular surgeries during the first 5 postoperative years in the 2 groups were examined. Results There were more patients with intraoperative complications (28% vs 11%, P = .031), adverse events (81% vs 56%, P = .008), and more additional intraocular surgeries (72% vs 16%, P Conclusion The increased rate of complications, adverse events, and additional intraocular surgeries associated with IOL implantation in infants