The edition · Ophthalmology
For children under 8, the HOTV chart referred fewer and caught more than tumbling E
In 995 Shanghai children tested on both, tumbling E under-read young children's vision and wrongly flagged about three times as many preschoolers. Plus a retinal sign that separates arteritic from non-arteritic optic neuropathy.
The edition in brief
In 995 children aged 3 to 15 tested with both charts in random order, the HOTV letter-matching test gave better measured acuity than tumbling E in children under 8, by about a line at age 3. In 183 preschool children, HOTV referred 18.6% against 31.2%, with higher true positive rate (0.68 vs 0.44) and specificity (0.93 vs 0.79); by age 8 the tests agreed. In 80 patients with biopsy-proven giant cell arteritis and 179 with non-arteritic ischaemic optic neuropathy, paracentral acute middle maculopathy on OCT was found in 28% of the former and none of the latter, including in patients without visual symptoms. A single-centre Chinese trial of 120 children found virtual-reality defocus training slowed axial elongation by 0.11 mm over 6 months, a small short-term effect. An American Academy of Ophthalmology assessment found mitomycin C by injection or by sponge gave similar trabeculectomy success and safety. The pearl covers the urgent work-up of suspected giant cell arteritis.
An OCT sign was seen in over a quarter of giant cell arteritis and never in NAION
Look for PAMM on OCT when GCA is suspected; it supports the diagnosis but cannot exclude it.
Virtual-reality defocus training slowed myopia slightly over six months
Treat VR defocus training as experimental; use established myopia control measures first.
Mitomycin C by injection or by sponge: similar trabeculectomy results
Use either injected or sponge mitomycin C at trabeculectomy; outcomes and safety were similar.
Suspected giant cell arteritis is a same-day problem
When giant cell arteritis is suspected, send inflammatory markers and start steroids the same day.
HOTV outperformed tumbling E for vision screening under age 8
Screen children under 8 with an HOTV matching chart rather than tumbling E to reduce false referrals.
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