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To determine the predictive value of International Classification of Diseases, 9th Revision (ICD-9) codes for identifying infantile eye diagnoses. Population-based retrospective cohort study of all residents of Olmsted County, Minnesota diagnosed at ≤1 year of age with an ocular disorder. The medical records of all infants diagnosed with any ocular disorder from January 1, 2005, through December 31, 2014, were identified. To assess ICD-9 code accuracy, the medical records of all diagnoses with ≥20 cases were individually reviewed and compared to their corresponding ICD-9 codes. Main outcome measures included positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of ICD-9 codes. In a cohort of 5,109 infants with ≥1 eye-related ICD-9 code, 10 ocular diagnoses met study criteria. The most frequent diagnoses were conjunctivitis (N = 1,695) and congenital nasolacrimal duct obstruction (N = 1,250), while the least common was physiologic anisocoria (N = 23). The PPVs ranged from 8.3% to 88.0%, NPVs from 96.3% to 100%, sensitivity from 3.0% to 98.7%, and specificity from 72.6% to 99.9%. ICD-9 codes were most accurate at identifying physiologic anisocoria (PPV: 88.0%) and least accurate at identifying preseptal cellulitis (PPV: 8.3%). In eye specialists versus non-eye specialists, there was a significant difference in PPV of ICD-9 codes for conjunctivitis (26.8% vs. 63.9%, p <.001), pseudostrabismus (85.9% vs. 25.0%, p <.001), and physiologic anisocoria (95.5% vs. 33.3%, p =.002). The predictive value of ICD-9 codes for capturing infantile ocular diagnoses varied widely in this cohort. These findings emphasize the limitations of database research methodologies that solely utilize claims data to identify pediatric eye diseases.Abbreviations/Acronyms PPV: positive predictive value; NPV: negative predictive value; CNLDO: congenital nasolacrimal duct obstruction [ABSTRACT FROM AUTHOR]

To describe the incidence and distribution of eye diseases affecting children in the first year of life in Olmsted County, Minnesota. We conducted a population-based, retrospective medical record review of infants (≤1 year of age) residing in Olmsted County diagnosed with an ocular disorder from January 1, 2005, through December 31, 2014. A total of 4,223 infants were diagnosed with an ocular disorder, yielding an incidence of 20,242/100,000 births per year, or 1 in 4.9 live births (95% CI, 19,632-20,853). The median age at diagnosis was 3 months, and 2,179 (51.5%) were female. The most common diagnoses included conjunctivitis, in 2,175 (51.5%), nasolacrimal duct obstruction, in 1,432 (33.6%), and pseudostrabismus, in 173 (4.1%). Visual acuity was decreased in one or both eyes in 23 (0.5%) infants because of strabismus in 10 (43.5%) and cerebral visual impairment in 3 (13.0%). A majority of the infants (3,674 [86.9%]) were diagnosed and managed by a primary care provider, and 549 (13.0%) were evaluated and/or managed by an eye care provider. Although ocular disorders occurred in 1 in 5 infants in this cohort, most conditions were evaluated and managed by primary care providers. Understanding the incidence and distribution of ocular diseases among infants is useful for planning clinical resources. [ABSTRACT FROM AUTHOR]

To report the incidence and clinical characteristics of pediatric ocular and adnexal injuries diagnosed over a 10-year period in Olmsted County, Minnesota. This multicenter retrospective, population-based cohort study included all patients <19 years of age in Olmsted County diagnosed with ocular or adnexal injuries from January 1, 2000, through December 31, 2009. A total of 740 ocular or adnexal injuries occurred during the study period, yielding an incidence of 203 (95% CI, 189-218) per 100,000 children. Median age at diagnosis was 10.0 years, and 462 (62.4%) were males. Injuries presented to the emergency department or urgent care setting most frequently (69.6%) and often occurred while outdoors (31.6%) during summer months (29.7%). Common injury mechanisms included blunt force (21.5%), foreign bodies (13.8%), and sports activities (13.0%). Isolated anterior segment injuries occurred in 63.5% of injuries. Ninety-nine patients (13.8%) had visual acuity of 20/40 or worse at initial examination, and 55 patients (7.7%) had visual acuity of 20/40 or worse at final examination. Twenty-nine injuries (3.9%) required surgical intervention. Significant risk factors for reduced visual acuity and/or the development of long-term complications include male sex, age ≥12 years, outdoor injuries, sport and firearm/projectile injury mechanism, and hyphema or posterior segment injury (P < 0.05). Most pediatric eye injuries are minor anterior segment injuries with infrequent long-lasting effects on visual development. [ABSTRACT FROM AUTHOR]

Purpose: To report both the incidence of pediatric keratoconus (PKC) in a population-based cohort and the risk for undergoing corneal surgery over a 20-year period at a single institution., Methods: The medical records of all patients <19 years of age diagnosed with keratoconus while residing in Olmsted County, Minnesota, from January 1, 1975, through December 31, 2019, were retrospectively reviewed. The records of patients <19 years with keratoconus examined at our institution from January 1, 2001, through December 31, 2020, were also reviewed., Results: The incidence of PKC in this population over the 45-year study period was 2.48 cases per 100,000 people per year (95% CI, 1.67-3.29). The mean age at diagnosis was 15.25 years (range, 7-18) years, and 28 (77.8%) were male. During a mean follow-up of 2.8 years (range, 0-17.3 years), 33 of 71 patients managed at our institution (46%) underwent at least one corneal procedure. In this cohort, the Kaplan-Meier risk of requiring a procedure by 10 years following diagnosis was 60%., Conclusions: The incidence of PKC in Olmsted County, Minnesota, over a 45-year period was 2.48 cases per 100,000 people per year. Nearly half of the patients managed at our institution over the past 20 years required a procedure during follow-up., (Copyright © 2024 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Purpose: To report the population-based birth prevalence of pseudostrabismus in the first year of life and the subsequent diagnosis of strabismus., Design: Retrospective population-based cohort study., Methods: All residents of Olmsted County, Minnesota ≤1 year old diagnosed with pseudostrabismus from January 1, 2005 through December 31, 2014, were identified using a medical record linkage system that captures virtually all medical care provided in a single Midwestern United States county population. The birth prevalence of pseudostrabismus and the subsequent diagnosis of strabismus were assessed., Results: A total of 184 infants were diagnosed with pseudostrabismus during the 10-year study period, which yielded a birth prevalence of 1 in 113 children in the first year of life. There were 165 (89.7%) infants initially diagnosed by a non-ophthalmology care provider (NOCP) and confirmed by an ophthalmologist, 13 (7.1%) patients were diagnosed by an ophthalmologist alone, and 6 (3.3%) patients were diagnosed by a NOCP alone. Eighty-eight (49.4%) infants had at least 1 follow-up visit with an ophthalmologist, and the median follow-up time from pseudostrabismus diagnosis to the last health care visit that included an eye examination was 7.7 years (interquartile range: 5.8 years). Nine (4.9%) of the 184 infants were subsequently diagnosed with strabismus at a mean age of 4.5 years (range: 1.3 to 8.7 years) (7 with esotropia and 2 with exotropia)., Conclusion: Pseudostrabismus is a relatively frequent diagnosis in the first year of life. The prevalence of strabismus among infants with pseudostrabismus in this cohort was lower than those in previous reports and similar to strabismus rates reported in the same population., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: To report the incidence, demographics, and ocular findings of children with myasthenia., Design: Retrospective cohort study., Methods: The medical records of all children (<19 years) examined at Mayo Clinic with any form of myasthenia from January 1 1966, through December 31, 2015, were retrospectively reviewed., Results: A total of 364 children were evaluated during the study period, of which 6 children were residents of the Olmsted County at the time of their diagnosis, yielding an annual age- and sex-adjusted incidence of 0.35 per 100 000 <19 years, or 1 in 285 714 <19 years. The incidence of juvenile myasthenia gravis (JMG) and congenital myasthenic syndrome (CMS) was 0.12 and 0.23 per 100 000, respectively. Of the 364 study children, 217 (59.6%) had JMG, 141 (38.7%) had CMS, and 6 (1.7%) had Lambert-Eaton syndrome, diagnosed at a median age of 13.5, 5.1, and 12.6 years, respectively. A majority of the JMG and CMS patients had ocular involvement (90.3% and 85.1%, respectively), including ptosis and ocular movement deficits. Among children with at least 1 year of follow-up (JMG; median, 7.1 years, CMS; median, 7.0 years), improvement was seen in 88.8% of JMG patients (complete remission in 31.3%) and in 58.3% of CMS patients., Conclusion: Although relatively rare, myasthenia gravis in children has 2 predominant forms, CMS and JMG, both of which commonly have ocular involvement. Improvement is more likely in children with the juvenile form., (Copyright © 2019 Elsevier Inc. All rights reserved.)

This article presents the results of a retrospective analysis of anesthesia care and perioperative outcomes in children up to 2 years of age who underwent strabismus surgery during a five-year period at the University of Minnesota Amplatz Children's Hospital. We reviewed the charts of 74 children to determine perioperative outcomes--namely discomfort, emergence agitation/delirium, and postoperative nausea and vomiting (PONV).We found that although PONV was not an issue in this age group, as it was with older children, discomfort and emergence agitation/delirium do need to be considered during their care.

The eye screening done by pediatricians and other primary care providers is vital for ensuring that children with eye conditions get diagnosed and treated early. Thus, it's important that primary care providers remain knowledgeable about the eye conditions that may affect their youngest patients. This article reviews critical pediatric eye problems that primary care providers may encounter and highlights advances in their treatment.