Week in Review: Children's Vision Screenings, Keratoconus and Black Patients, Glaucoma Risk After Steroid Injections

A weekly roundup of ophthalmic news from around the web.

Pediatric vision screening rates vary widely across the United States. An analysis of de-identified data from 30,173 school-age children enrolled in the National Survey of Children’s Health found that only 61% had undergone vision screening within the past 2 years, and just 30% of that group had been referred for an eye exam. Non-White children, those from a lower-income background, and those from a household where English was not the primary language were less likely to receive vision screening or establish care with an eye specialist. These children, however, were more likely to obtain eye exam referrals. The authors conclude that, “There is evidence of inequitable opportunities for access to vision screening and subsequent care experienced most often by socioeconomically vulnerable groups. Novel strategies are needed to improve our ability to identify children at greatest risk of preventable vision loss.” JAMA Ophthalmology

Keratoconus presents differently in Black patients than in non-Black patients, according to findings from a retrospective review of 128 consecutive patients with keratoconus seen at a single center during a 3-year period. Black patients were more likely to present with advanced disease and have thinner pachymetry and higher (worse) Belin ABCD and logMAR corrected distance visual acuity scores, had higher rates of corneal scarring, and were 7.8 times more likely to receive a keratoplasty recommendation at the initial visit than non-Black patients. Additional studies, especially in younger patients, could provide information that would lead to better visual outcomes and more recommendations for less invasive treatments such as contact lenses. Clinical Ophthalmology

Several factors can influence development of new-onset glaucoma or ocular hypertension after steroid injections. A retrospective study reviewed data from nearly 20,000 patients included in a claims database who had received periocular or intravitreal corticosteroid injections/implants during a 10-year period. The highest risk of glaucoma or ocular hypertension (OHT) was related to intravitreal implants, while triamcinolone subconjunctival injections carried the lowest risk. Receiving 2 or 3 injections rather than 1 injection also carried a greater risk of new-onset glaucoma or OHT. As there are no clear guidelines regarding glaucoma screening in patients who receive ocular steroid injections, the authors recommend conducting individualized risk stratification and patient counseling. BMJ Open Ophthalmology