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Biomedical subjects

Graham E Quinn

Publications and source records attributed to Graham E Quinn.

At least 19 recordsLinked to original sources
PubMed2006

Visual acuity at 10 years in Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) study eyes: effect of retinal residua of retinopathy of prematurity.

OBJECTIVE: To describe recognition (letter) acuity at age 10 years in eyes with and without retinal residua of retinopathy of prematurity (ROP). DESIGN: Presence and severity of ROP residua were documented by a study ophthalmologist. Masked testers measured monocular recognition visual acuity (Early Treatment of Diabetic Retinopathy Study) when the children were 10 years old. Two hundred forty-seven of 255 surviving Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) randomized trial patients participated. A reference group of 102 of 104 Philadelphia-based CRYO-ROP study participants who did not develop ROP was also tested. RESULTS: More severe retinal residua were associated with worse visual acuity, regardless of whether retinal ablation was performed to treat the severe acute-phase ROP. However, within each ROP residua category, there was a wide range of visual acuity results. CONCLUSIONS: This is the first report of the relation between visual acuity (Early Treatment of Diabetic Retinopathy Study charts) and structural abnormalities related to ROP in a large group of eyes that developed threshold ROP in the perinatal period. Visual deficits are greater in eyes with more severe retinal residua than in eyes with mild or no residua. However, severity of ROP residua does not predict the visual acuity of an individual eye because within a single residua category, acuity may range from near normal to blind.

Child↗
PubMed2006

The relation of axial length and intraocular pressure fluctuations in human eyes.

PURPOSE: To determine in human eyes whether diurnal fluctuations in axial length are related to fluctuations in intraocular pressure (IOP) by studying these fluctuations in both eyes of individual subjects and by assessing the regularity of both rhythms on two separate study days. METHODS: Ten subjects, ages 18 to 24 years, underwent serial axial length and IOP measurements using highly precise, noncontact partial coherence interferometry and Goldmann applanation tonometry, respectively. Both eyes were measured at six 3-hour intervals during each of two study days, and significant fluctuations were modeled by sine curves. RESULTS: Of the 40 data sets, 29 had significant axial length high-low differences and 32 had significant IOP high-low differences (ANOVA, P < 0.05 for each). The magnitude of the significant high-low differences were 38 +/- 22 microm for axial length and 6.0 +/- 1.9 mm Hg for IOP (mean +/- SD). Neither axial length nor IOP fluctuations necessarily occurred bilaterally on the same day, and neither rhythm was regularly observed on two separate days in individual eyes. In eyes in which both parameters fluctuated on the same day, there were no correlations in the amplitude, period or phase of the two rhythms. CONCLUSIONS: Both axial length and IOP fluctuate during the day much of the time in most subjects. However, diurnal IOP fluctuations do not appear to cause diurnal axial length fluctuations.

Adolescent↗
PubMed2006

Associations between childhood refraction and parental smoking.

PURPOSE: Motivated by pharmacologic findings linking nicotinic acetylcholine receptors to eye development in chicks, the authors studied whether the refractions of children who were passively exposed to cigarette smoke by their parents differed from those of nonexposed children. METHODS: A cross-sectional study was conducted among 323 patients (mean +/- SD age, 8.7 +/- 4.4 years; range, 1-20) in a tertiary care pediatric ophthalmology clinic. Half (162/323) of the subjects had strabismus. The accompanying parent completed a detailed questionnaire on parental smoking history and on putative risk factors for myopia. The results were compared to the subjects' cycloplegic refractions. RESULTS: If one or both parents ever smoked, their children had a lower myopia prevalence (12.4% vs. 25.4%; P = 0.004) and more hyperopic mean refractions (1.83 +/- 0.24 vs. 0.96 +/- 0.27 diopters; P = 0.02) than those whose parents never smoked. Smoking by either parent during the mother's pregnancy had a similar effect on the child's refraction. The associations largely persisted, both in multivariate models that included adjustments for the child's age, child's body mass index, child's nearwork activity, parental myopia, and parental education and also in analysis by subgroups stratified by strabismus status. CONCLUSIONS: Despite the complex constituents of cigarette smoke, neuropharmacology perspectives may prove useful in the development of new hypotheses to understand the mechanisms governing refractive development, not only in experimental animals but also in children. The associations of less prevalent myopia and a more hyperopic mean refraction with both prenatal and childhood exposures to tobacco smoke suggest that nongenetic, environmental exposures may have long-term influences on refraction and that further study of the role of nicotinic acetylcholine receptors in refractive development is warranted.

Adolescent↗
PubMed2005

Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate amblyopia in children.

OBJECTIVE: To compare patching and atropine sulfate as treatments for moderate amblyopia in children 18 months after completion of a 6-month randomized trial. METHODS: In a randomized, multicenter (47 sites) clinical trial, 419 children younger than 7 years with amblyopia (20/40 to 20/100 in the affected eye) were assigned to receive either patching or atropine eye drops for 6 months. Between 6 months and 2 years, treatment was at the discretion of the investigator. Main Outcome Measure Visual acuity in the amblyopic eye and sound eye after 2 years. RESULTS: At 2 years, visual acuity in the amblyopic eye improved from baseline a mean of 3.7 lines in the patching group and 3.6 lines in the atropine group. The difference in visual acuity between treatment groups was small: 0.01 logMAR (95% confidence interval, -0.02 to 0.04). In both treatment groups, the mean amblyopic eye acuity was approximately 20/32, 1.8 lines worse than the mean sound eye acuity, which was approximately 20/20. CONCLUSIONS: Atropine or patching for 6 months followed by best clinical care until 2 years produced similar improvement of moderate amblyopia in children between 3 and 7 years of age at enrollment. However, on average the amblyopic eye acuity was still approximately 2 lines worse than the sound eye.

Amblyopia↗
PubMed2005

15-year outcomes following threshold retinopathy of prematurity: final results from the multicenter trial of cryotherapy for retinopathy of prematurity.

OBJECTIVE: To report the ocular structure and visual acuity outcomes at age 15 years, and the incidence of retinal detachment between 10 and 15 years of age, for patients in the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP). METHODS: Subjects were 254 survivors from 291 preterm children with birth weights less than 1251 g and severe (threshold) retinopathy of prematurity (ROP) in one or both eyes, who participated in the CRYO-ROP trial. At age 15 years, unfavorable ocular structure was posterior retinal fold or worse judged by study-certified ophthalmologists. Unfavorable distance visual acuity was 20/200 or worse measured by study-certified testers using Early Treatment of Diabetic Retinopathy Study recognition acuity charts. RESULTS: Thirty percent of treated eyes and 51.9% of control eyes (P<.001) had unfavorable structural outcomes. Between 10 and 15 years of age, new retinal folds, detachments, or obscuring of the view of the posterior pole occurred in 4.5% of treated and 7.7% of control eyes. Unfavorable visual acuity outcomes were found in 44.7% of treated and 64.3% of control eyes (P<.001). CONCLUSION: The benefit of cryotherapy for treatment of threshold ROP, for both structure and visual function, was maintained across 15 years of follow-up. New retinal detachments, even in eyes with relatively good structural findings at age 10 years, suggest value in long-term, regular follow-up of eyes that experience threshold ROP.

Adolescent↗
PubMed2005

Prevalence of myopia at 9 months in infants with high-risk prethreshold retinopathy of prematurity.

PURPOSE: To examine the prevalence of myopia and high myopia at 9 months corrected age in premature infants who participated in the multicenter randomized trial of Early Treatment for Retinopathy of Prematurity (ETROP). DESIGN: Randomized, controlled clinical trial. PARTICIPANTS: Four hundred one infants with birth weights of <1251 g in whom prethreshold ROP developed in one or both eyes and who were determined to have a significant risk (> or =15%) of poor structural outcomes without treatment, based on the risk management for ROP program. INTERVENTION: Infants with bilateral high-risk prethreshold ROP (n = 317) had 1 eye randomized to early treatment, and the fellow eye was managed conventionally. In asymmetric cases (n = 84), the eye with high-risk prethreshold ROP was randomized to early treatment or conventional management (control). Eyes randomized to early treatment at high-risk prethreshold ROP and eyes randomized to conventional management in which threshold ROP developed received peripheral retinal photocoagulation or cryotherapy. Conventionally managed eyes in which threshold ROP did not develop were observed. Cycloplegic retinoscopy data were obtained at 9 months corrected age from 321 eyes treated early and 307 eyes managed conventionally. MAIN OUTCOME MEASURES: Prevalence of myopic (spherical equivalent > or = 0.25 diopters [D]) and highly myopic (> or =5.00 D) eyes in each group. RESULTS: The prevalence of myopia (64.5% vs. 69.4%; P = 0.06) and high myopia (25.5% vs. 28.3%; P = 0.20) was similar between eyes treated at high-risk prethreshold and high-risk prethreshold eyes managed conventionally. Among high-risk eyes managed conventionally, the prevalence of myopia (78.2% vs. 53.3%) and high myopia (37.6% vs. 11.2%) was higher when threshold ROP developed than when regression without treatment occurred. Among eyes treated at high-risk prethreshold ROP, the prevalence of myopia (93.3% vs. 91.7% vs. 60.6%) and of high myopia (53.3% vs. 33.3% vs. 20.8%) was higher in eyes with abnormal angle of temporal retinal vessels or macular ectopia than in eyes with no retinal residua. This also held true for conventionally managed eyes. CONCLUSIONS: Early treatment at high-risk prethreshold did not place eyes at greater risk of myopia and high myopia than did conventional management of eyes with high-risk prethreshold ROP.

Cryotherapy↗
PubMed2004

Health-related quality of life at age 10 years in very low-birth-weight children with and without threshold retinopathy of prematurity.

OBJECTIVE: To describe parental perspectives on health status and health-related quality of life (HRQL) at age 10 years in children with birth weights less than 1251 g who participated in the multicenter Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) study. METHODS: In 244 participants in the randomized CRYO-ROP trial and 102 CRYO-ROP participants who did not develop ROP, the Health Utilities Index (HUI) system was used to characterize health status for the following 8 attributes: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain. Using a utility formula, HRQL was determined for each child on a scale from 0.0 (dead) to 1.00 (perfect health). RESULTS: The proportion of the ROP-randomized group with limitations in 4 attributes or more was 20.6% compared with 2.0% for the no-ROP group. Within the ROP-randomized group, the proportion of "sighted" children with limitations in 4 attributes or more was 6.4% vs 46.5% in the "blind/low vision" group. The median HRQL score for the ROP-randomized children was lower than for the no-ROP children (0.72 vs 0.97, P<.001); the median HRQL score for the sighted-randomized children was 0.87 vs 0.27 for the blind/low vision children (P<.001). CONCLUSIONS: Threshold ROP was associated with functional limitations in health attributes and reduction in HRQL scores at age 10 years. Furthermore, among children who developed threshold ROP, a greater reduction in HRQL scores was found among children with a poor visual outcome compared with those with better sight.

Activities of Daily Living↗
PubMed2004

A randomized trial of atropine regimens for treatment of moderate amblyopia in children.

OBJECTIVE: To compare daily atropine to weekend atropine as prescribed treatments for moderate amblyopia in children younger than 7 years. DESIGN: Prospective, randomized multicenter clinical trial (30 sites). PARTICIPANTS: One hundred sixty-eight children younger than 7 years with amblyopia in the range of 20/40 to 20/80 associated with strabismus, anisometropia, or both. INTERVENTION: Randomization either to daily atropine or to weekend atropine for 4 months. Partial responders were continued on the randomized treatment until no further improvement was noted. MAIN OUTCOME MEASURE: Visual acuity (VA) in the amblyopic eye after 4 months. RESULTS: The improvement in VA of the amblyopic eye from baseline to 4 months averaged 2.3 lines in each group. The VA of the amblyopic eye at study completion was either (1) at least 20/25 or (2) better than or equal to that of the sound eye in 39 children (47%) in the daily group and 45 children (53%) in the weekend group. The VA of the sound eye at the end of follow-up was reduced by 2 lines in one patient in each group. Stereoacuity outcomes were similar in the 2 groups. CONCLUSIONS: Weekend atropine provides an improvement in VA of a magnitude similar to that of the improvement provided by daily atropine in treating moderate amblyopia in children 3 to 7 years old. This article contains additional online-only material available at http://www.ophsource.com/periodicals/ophtha.

Amblyopia↗
PubMed2004

Diurnal axial length fluctuations in human eyes.

PURPOSE: This study sought diurnal variations of eye length in human subjects, analogous to those reported in laboratory animals. METHODS: Seventeen subjects, ages 7 to 53 (median 16) years and mean spherical equivalent refractive error -0.68 D (range, -3.00 to +1.00 D), underwent axial length measurements at multiple times during the day between 7 AM and 1 AM the following day, using partial coherence interferometry (PCI), a highly precise, noncontact method. Diurnal axial length measurements were obtained on two or more days in 10 of these subjects. RESULTS: During at least 1 day, 15 subjects showed a statistically significant (ANOVA, P < 0.05) diurnal fluctuation of axial length, with a magnitude generally between 15 and 40 microm. From the diurnal tracings that fit a sine curve using statistical criteria, the mean period of fluctuation was 21.6 +/- 4.33 hours (SD), the mean amplitude was 27.1 +/- 11.9 microm (SD; range, 12.8-41.4 microm), and the maximum axial length tended to occur at midday. Each of the subjects with multiple daily measurements showed axial length fluctuations on at least 1 day, but there were day-to-day differences in the diurnal variations: most notably, four subjects showed axial length fluctuations on each day; in others, the fluctuations were not observed on each testing day. CONCLUSIONS: The human eye undergoes diurnal fluctuations in axial length, with a pattern suggesting maximum axial length at midday. Based on repeated measurements, these daily fluctuations may not appear regularly in all subjects, suggesting the possibility of physiologic influences that must be defined.

Adolescent↗
PubMed2004

Educational and social competencies at 8 years in children with threshold retinopathy of prematurity in the CRYO-ROP multicenter study.

OBJECTIVE: To describe the educational status and special education services at 8 years among children who had threshold retinopathy of prematurity (ROP). METHODS: A prospective study was conducted of a cohort of children who had birth weight of <1251 g and threshold ROP in the Cryotherapy for Retinopathy of Prematurity multicenter study. At age 5.5 years, visual status, functional skills, and social information were obtained. At 8 years, special education classes, developmental disabilities, rehabilitation therapies, and academic and social competencies were determined by questionnaire. Visual status was considered favorable/unfavorable on the basis of the better eye. RESULTS: Of 255 survivors, 216 (85%) were evaluated at both 5.5 and 8 years. Major impairments were significantly more prevalent in children with unfavorable versus favorable visual status: cerebral palsy (39% vs 16%), developmental disability (57% vs 22%), autism (9% vs 1%), and epilepsy (23% vs 3%). Special education services (63% vs 27%), below-grade-level academic performance (84% vs 48%), and school-based rehabilitation services were significantly less common in children with favorable visual status. Favorable visual status, favorable functional ratings at 5.5 years, markers of higher socioeconomic status, and nonblack race were associated with significantly lower rates of both special education placement and below-grade-level academic performance at age 8. On multivariate logistic regression, only favorable visual status and functional status remained significant predictors for decreasing special education placement. CONCLUSION: Threshold ROP is associated with high rates of developmental, educational, and social challenges in middle childhood; preserved vision was associated with a clear advantage, with more than half of the children with favorable visual status performing at grade level.

Analysis of Variance↗
PubMed2003

Risk analysis of prethreshold retinopathy of prematurity.

OBJECTIVE: To present a new multifactorial algorithm to integrate important risk factors for unfavorable retinal outcome in eyes that reached prethreshold retinopathy of prematurity (ROP) in the Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) study. A computerized risk model (RM-ROP2) was developed from this algorithm to identify high-risk prethreshold eyes for enrollment in the Early Treatment for Retinopathy of Prematurity randomized trial. METHODS: Data were analyzed from 613 eyes (1 eye per infant) in the natural history cohort of the Multicenter Trial for Cryotherapy for Retinopathy of Prematurity. These eyes were selected from infants in whom 1 or both eyes progressed to prethreshold ROP. Eyes that progressed to threshold ROP and were randomized to cryotherapy were excluded from this study, but control eyes that reached threshold ROP were included. The course of ROP for 1 prethreshold eye for each infant was tracked until the evaluation of its structural outcome at 3 months' postterm. Tables present structural outcome by selected risk characteristics. A multiple logistic risk model is used to summarize the combined effect of all of these known prognostic risk factors as they relate to structural outcome. RESULTS: Eyes were classified by predicted outcome into 10 risk categories, lowest to highest. Both the observed and predicted outcomes in each category showed an increasingly unfavorable outcome when viewed from lowest to highest risk. Prethreshold ROP eyes were then divided into 2 groups, high-risk, eyes (risk, 0.15-1.0) and low-risk eyes (risk, <0.15). High-risk eyes had an unfavorable outcome of 36% at 3 months' postterm; whereas, only 5% of the low-risk eyes had an unfavorable outcome. CONCLUSION: The model effectively identifies prethreshold ROP eyes that have a relatively high risk and eyes that have a lower risk of an unfavorable structural outcome at 3 months.

Algorithms↗
PubMed2003

A randomized trial of patching regimens for treatment of moderate amblyopia in children.

OBJECTIVE: To compare 2 hours vs 6 hours of daily patching as treatments for moderate amblyopia in children younger than 7 years. METHODS: In a randomized multicenter (35 sites) clinical trial, 189 children younger than 7 years with amblyopia in the range of 20/40 to 20/80 were assigned to receive either 2 hours or 6 hours of daily patching combined with at least 1 hour per day of near visual activities during patching.Main Outcome Measure Visual acuity in the amblyopic eye after 4 months. RESULTS: Visual acuity in the amblyopic eye improved a similar amount in both groups. The improvement in the visual acuity of the amblyopic eye from baseline to 4 months averaged 2.40 lines in each group (P =.98). The 4-month visual acuity was at least 20/32 and/or improved from baseline by 3 or more lines in 62% of patients in each group (P>.99). CONCLUSION: When combined with prescribing 1 hour of near visual activities, 2 hours of daily patching produces an improvement in visual acuity that is of similar magnitude to the improvement produced by 6 hours of daily patching in treating moderate amblyopia in children aged 3 to 7 years.

Amblyopia↗
PubMed2003

Highly precise eye length measurements in children aged 3 through 12 years.

OBJECTIVE: To determine the feasibility, reliability, and validity of using partial coherence interferometry, a noncontact method that detects interference patterns from various layers of the eye, to measure axial length in young children. METHODS: The right eye of 64 subjects (mean age, 8.4 y; age range, 3.4-12.9 y; best-corrected visual acuity >or=20/30) was measured. Subjects fixated monocularly on the collimated light pattern from a laser diode (the alignment beam) and the operator used a video monitor to align the corneal reflection in the optical path. Axial length was measured during an 0.8-second scan using interference patterns from a collimated short coherence superluminescence diode aligned coaxially with the laser diode. Five series of 16 readings each were obtained. The average axial length for each of the 5 series of readings was calculated. Main Outcome Measure Axial length. RESULTS: Within-subject precision of axial length measurements was high, with an overall SE of measurement of 8 micro m for individual subjects across the 5 sessions (95% confidence interval, +/-16 micro m). Subgroup analysis showed that sex, age, spherical equivalent, and refractive error exerted statistically significant effects on precision, but all of the differences among subgroups were 3 micro m or less and likely to be insignificant clinically. Axial length measured by partial coherence interferometry varied systematically, with factors known to influence eye length (ie, age and refractive error), further validating the measurement method. CONCLUSION: The partial coherence interferometry technique provides reproducible, extraordinarily precise eye length measurements in young children and should enable novel approaches to study eye growth and refractive development.

Body Weights and Measures↗