Dynamic distance direct ophthalmoscopy, a novel technique to assess accommodation in children
Aim: To describe and compare dynamic distance direct ophthalmoscopy (DDDO) with dynamic retinoscopy (DR) in assessment of accommodation in children. Materials and Methods: This prospective observational study had four components. Component 1: to understand the characteristic digital images of DDDO....
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2012-01-01
|
| Series: | Indian Journal of Ophthalmology |
| Subjects: | |
| Online Access: | http://www.ijo.in/article.asp?issn=0301-4738;year=2012;volume=60;issue=2;spage=109;epage=114;aulast=Kothari |
| _version_ | 1818366445973667840 |
|---|---|
| author | Mihir Kothari Suvarna Balankhe Shalaka Paralkar Deepali Nar Shreya Bhagat Shashank Ranade |
| author_facet | Mihir Kothari Suvarna Balankhe Shalaka Paralkar Deepali Nar Shreya Bhagat Shashank Ranade |
| author_sort | Mihir Kothari |
| collection | DOAJ |
| description | Aim: To describe and compare dynamic distance direct ophthalmoscopy (DDDO) with dynamic retinoscopy (DR) in assessment of accommodation in children. Materials and Methods: This prospective observational study had four components. Component 1: to understand the characteristic digital images of DDDO. Component 2: to compare DDDO with DR for detection of accommodative defects in children (1-16 years). Component 3: to compare DDDO with DR for the detection of completeness of pharmacologically induced cycloplegia in children (5-16 years) and Component 4: to assess which one of the two techniques was more sensitive to detect onset of cycloplegia after instillation of 1% cyclopentolate eye drops. Results: Component 1: image analysis of DDDO on two subjects (7 years and 35 years) demonstrated superior pupillary crescent that progressively disappeared with increasing accommodation. Concurrently an inferior crescent appeared that became bigger in size with increasing accommodation. Component 2: the prevalence of defects in accommodation was 3.3% (33/1000 children). Three had unilateral accommodation failure. Sensitivity of DDDO was 94%, specificity 100%, positive predictive value 100%, negative predictive value 99%, and clinical agreement (kappa) 0.97. Component 3: in the detection of completeness of pharmacologically induced cycloplegia (n=30), the sensitivity of DDDO was 94%, specificity 96%, positive predictive value 97%, negative predictive value 93% and kappa 0.9. DR had two false positives. DDDO had one false negative. Component 4: DDDO detected onset of pharmacologically induced cycloplegia 5 min earlier than DR (n=5). Conclusion: DDDO is a novel, simple, clinical and reliable method to assess accommodation in young children. This test can assess the accommodative response of both eyes simultaneously. |
| first_indexed | 2024-12-13T22:36:17Z |
| format | Article |
| id | doaj.art-3fb8081d32cd4c50809460092ada18a1 |
| institution | Directory Open Access Journal |
| issn | 0301-4738 1998-3689 |
| language | English |
| last_indexed | 2024-12-13T22:36:17Z |
| publishDate | 2012-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Ophthalmology |
| spelling | doaj.art-3fb8081d32cd4c50809460092ada18a12022-12-21T23:28:57ZengWolters Kluwer Medknow PublicationsIndian Journal of Ophthalmology0301-47381998-36892012-01-0160210911410.4103/0301-4738.94051Dynamic distance direct ophthalmoscopy, a novel technique to assess accommodation in childrenMihir KothariSuvarna BalankheShalaka ParalkarDeepali NarShreya BhagatShashank RanadeAim: To describe and compare dynamic distance direct ophthalmoscopy (DDDO) with dynamic retinoscopy (DR) in assessment of accommodation in children. Materials and Methods: This prospective observational study had four components. Component 1: to understand the characteristic digital images of DDDO. Component 2: to compare DDDO with DR for detection of accommodative defects in children (1-16 years). Component 3: to compare DDDO with DR for the detection of completeness of pharmacologically induced cycloplegia in children (5-16 years) and Component 4: to assess which one of the two techniques was more sensitive to detect onset of cycloplegia after instillation of 1% cyclopentolate eye drops. Results: Component 1: image analysis of DDDO on two subjects (7 years and 35 years) demonstrated superior pupillary crescent that progressively disappeared with increasing accommodation. Concurrently an inferior crescent appeared that became bigger in size with increasing accommodation. Component 2: the prevalence of defects in accommodation was 3.3% (33/1000 children). Three had unilateral accommodation failure. Sensitivity of DDDO was 94%, specificity 100%, positive predictive value 100%, negative predictive value 99%, and clinical agreement (kappa) 0.97. Component 3: in the detection of completeness of pharmacologically induced cycloplegia (n=30), the sensitivity of DDDO was 94%, specificity 96%, positive predictive value 97%, negative predictive value 93% and kappa 0.9. DR had two false positives. DDDO had one false negative. Component 4: DDDO detected onset of pharmacologically induced cycloplegia 5 min earlier than DR (n=5). Conclusion: DDDO is a novel, simple, clinical and reliable method to assess accommodation in young children. This test can assess the accommodative response of both eyes simultaneously.http://www.ijo.in/article.asp?issn=0301-4738;year=2012;volume=60;issue=2;spage=109;epage=114;aulast=KothariOrbitproptosisthyroidHyperhomocysteinemiaretinal arterial occlusionssystemic associationsyoung ageIlluminationletter chartsvisual acuityDacryocystorhinostomyintraocular pressuresystemic effectstimolol maleateAccommodationdynamic retinoscopyophthalmoscopyphotorefractionphotoretinoscopy |
| spellingShingle | Mihir Kothari Suvarna Balankhe Shalaka Paralkar Deepali Nar Shreya Bhagat Shashank Ranade Dynamic distance direct ophthalmoscopy, a novel technique to assess accommodation in children Indian Journal of Ophthalmology Orbit proptosis thyroid Hyperhomocysteinemia retinal arterial occlusions systemic associations young age Illumination letter charts visual acuity Dacryocystorhinostomy intraocular pressure systemic effects timolol maleate Accommodation dynamic retinoscopy ophthalmoscopy photorefraction photoretinoscopy |
| title | Dynamic distance direct ophthalmoscopy, a novel technique to assess accommodation in children |
| title_full | Dynamic distance direct ophthalmoscopy, a novel technique to assess accommodation in children |
| title_fullStr | Dynamic distance direct ophthalmoscopy, a novel technique to assess accommodation in children |
| title_full_unstemmed | Dynamic distance direct ophthalmoscopy, a novel technique to assess accommodation in children |
| title_short | Dynamic distance direct ophthalmoscopy, a novel technique to assess accommodation in children |
| title_sort | dynamic distance direct ophthalmoscopy a novel technique to assess accommodation in children |
| topic | Orbit proptosis thyroid Hyperhomocysteinemia retinal arterial occlusions systemic associations young age Illumination letter charts visual acuity Dacryocystorhinostomy intraocular pressure systemic effects timolol maleate Accommodation dynamic retinoscopy ophthalmoscopy photorefraction photoretinoscopy |
| url | http://www.ijo.in/article.asp?issn=0301-4738;year=2012;volume=60;issue=2;spage=109;epage=114;aulast=Kothari |
| work_keys_str_mv | AT mihirkothari dynamicdistancedirectophthalmoscopyanoveltechniquetoassessaccommodationinchildren AT suvarnabalankhe dynamicdistancedirectophthalmoscopyanoveltechniquetoassessaccommodationinchildren AT shalakaparalkar dynamicdistancedirectophthalmoscopyanoveltechniquetoassessaccommodationinchildren AT deepalinar dynamicdistancedirectophthalmoscopyanoveltechniquetoassessaccommodationinchildren AT shreyabhagat dynamicdistancedirectophthalmoscopyanoveltechniquetoassessaccommodationinchildren AT shashankranade dynamicdistancedirectophthalmoscopyanoveltechniquetoassessaccommodationinchildren |