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- Aring, Eva, 1959, et al.
(författare)
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The FASD Eye Code: a complementary diagnostic tool in fetal alcohol spectrum disorders
- 2021
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Ingår i: Bmj Open Ophthalmology. - : BMJ. - 2397-3269. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective To create an easy-to-use complementary ophthalmological tool to support a fetal alcohol spectrum disorder (FASD) diagnosis. Methods and Analysis The FASD Eye Code was derived from 37 children with FASD evaluated along with 65 healthy age-matched and sex-matched controls. Four ophthalmological categories, which are abnormalities commonly found in children with FASD, were ranked independently on a 4-point scale, with 1 reflecting normal finding and 4 a strong presence of an abnormality: visual acuity, refraction, strabismus/binocular function and ocular structural abnormalities. The tool was validated on 33 children with attention deficit/hyperactivity disorder (ADHD), 57 children born moderate-to-late premature (MLP) and 16 children with Silver-Russell syndrome (SRS). Among children with ADHD none was born prematurely or small for gestational age (SGA) or diagnosed with FASD. Among children born MLP none was SGA, had a diagnosis of ADHD or FASD, or a history of retinopathy of prematurity. Children with SRS were all born SGA, half were born preterm and none had FASD. Children with FASD were re-examined as young adults. Results An FASD Eye Code cut-off total score of >= 10 showed an area under the curve (AUC) of 0.78 (95% CI 0.69 to 0.87), with 94% specificity and 43% sensitivity, in discriminating between FASD and controls, MLP and ADHD, corresponding to a positive likelihood ratio (LR+) of 7.5. Between FASD and controls, an AUC of 0.87 (CI 0.80 to 0.95), with 100% specificity and 43% sensitivity, was found; between FASD and SRS, an AUC of 0.60 (CI 0.45 to 0.75) was found, with 88% specificity and 43% sensitivity. A cut-off score of >= 9 showed a specificity of 98% and a sensitivity of 57% for FASD versus controls, corresponding to an LR+ of 36.9. Scores in individuals with FASD were stable into young adulthood. Conclusion The FASD Eye Code has the potential to serve as a complementary tool and help to strengthen an FASD diagnosis.
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- Ayoub, L., et al.
(författare)
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Visual and ocular findings in children with fetal alcohol spectrum disorders (FASD): validating the FASD Eye Code in a clinical setting
- 2023
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Ingår i: Bmj Open Ophthalmology. - : BMJ. - 2397-3269. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveFetal alcohol spectrum disorders (FASD) is an umbrella term covering a spectrum of medical conditions caused by prenatal alcohol exposure. The FASD Eye Code is a new complementary ophthalmological diagnostic tool created to corroborate the complex FASD diagnosis. The aim of this work was to validate the FASD Eye Code by testing it on a second group of children diagnosed with FASD in a clinical setting.Methods and analysisA clinical study was carried out in a group of 21 children (13 males, 8 females, mean age 13.3 years) investigated for suspected FASD and a healthy sex-matched and age-matched control group (n=21). The participants underwent a detailed ophthalmological examination including visual perception problems (VPPs) assessment. Clinical examination results were compiled, and total scores were calculated according to the FASD Eye Code protocol (range 4-16).ResultsThe median total score in the FASD group was 8. Eight individuals in the FASD group and none of the controls obtained a total score of >= 9 corresponding to 38% sensitivity and 100% specificity with an area under the curve of 0.90. A cut-off total score of >= 8 showed 52% sensitivity and 95% specificity. One individual in the FASD group versus 12 controls had a total score of 4, representing normal findings. No significant difference between the two groups regarding VPPs was seen.ConclusionThe FASD Eye Code can be used as a complementary diagnostic tool for FASD to assist in diagnosis and to detect ophthalmological abnormalities in individuals with suspected FASD.
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- Gyllencreutz, Emelie, et al.
(författare)
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Evaluation of vision screening in five- to eight-year-old children living in Region Västra Götaland, Sweden - a prospective multicentre study.
- 2019
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Ingår i: Acta ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 97:2, s. 158-164
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate the current vision screening criteria regarding amblyopia and refractive errors, with emphasis on screening limits and retesting, in Region Västra Götaland (VGR), Sweden. Visual acuity (VA) screening is performed by nurses at primary healthcare centres (PHCs) in 4-year-old children and at school in 6- or 7-year-old children. Children with VA <0.65 (>0.19 logMAR) at either eye are referred. If VA is 0.65 in one or both eyes, a retest is performed by nurses at PHCs and schools, the children are then referred if VA is <0.8 (>0.10 logMAR).We included all children aged ≥5 and <8years referred between October 2014 and June 2015 from PHCs and schools to the four eye clinics in VGR, with VA ≥0.65 in one or both eyes. At the eye clinic, children underwent assessment of VA, refraction in cycloplegia, eye motility, cover test, stereo test and a slit lamp examination.Among the 259/295 children (139 female) participating, median age was 5.7years (5.0-7.8years) at referral. Glasses were prescribed due to subnormal VA with refractive errors in 20% of the children, 22% displayed heterophoria, none had heterotropia and one younger child had amblyopia. Accurate retesting gave fewer false-positive referrals.Our results showed that a vision screening referral cut-off limit of VA <0.65 would leave undetected refractive errors. Residual amblyopia was uncommon. Accurate referral criteria, retesting and training of those performing the screening as well as re-evaluation of the screening programme are all important.
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- Gyllencreutz, Emelie
(författare)
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Fetal Alcohol Spectrum Disorders in Children and Young Adults with an emphasis on ophthalmology
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Fetal alcohol spectrum disorders (FASD) are a group of disorders caused by prenatal alcohol exposure (PAE). The most severe and most studied FASD condition is fetal alcohol syndrome. Other conditions include partial fetal alcohol syndrome and alcohol-related neurodevelopmental disorder. Longitudinal reports based on individuals with FASD are few, especially ophthalmological studies. Aims and Methods: The overall aim of this thesis was to describe the long-term consequences of FASD; both in general (Paper I) and with an emphasis on ophthalmological findings (Paper II–IV). A total of 71 children adopted from eastern Europe to Sweden were examined by a multidisciplinary team in 2000–2001; 37 of them (13 female [f], median age 8 years [y]) were diagnosed with FASD. Of these 37, 36 were reassessed in 2014–2019 (13 f, median age 22y). A social, medical, psychiatric, psychological, and an ophthalmological evaluation, which included visual acuity, refraction, binocular function, motility, slit lamp examination, optical coherence tomography, structured history-taking of visual perception, and questionnaires regarding quality of life (QoL) were performed. A group of 29 healthy young adults (20 f, median age 25 y) were recruited as controls in Paper III and IV. Results: Paper I: 14/36 had attended special education, 20/36 were dependent on social welfare or disability pension, 22/32 showed gross motor coordination abnormalities, 29/32 had psychiatric co-morbidity, and 7/32 had attempted suicide. Mean intelligence quotient was low in both childhood (86) and young adulthood (68) (n=29). Paper II: Ophthalmological findings such as astigmatism (14/30), strabismus (13/30), and optic nerve abnormalities (11/30) were common. Findings from childhood persisted into young adulthood. Paper III: The peripapillary and macular nerve fiber layers were thinner in the FASD group than in the controls. Paper IV: Visual perception problems were more common in the FASD group, and self-reported health-related and vision-related QoL scores were lower than in the controls. Conclusion: These long-term follow-up studies show that the young adults with FASD in our cohort have general health problems including psychiatric disorders, impaired cognitive function, poor QoL, and ophthalmological conditions such as astigmatism, strabismus, structural abnormalities, and VPPs. The long-lasting effects of PAE must be considered when evaluating young adults with complex health issues. Given the high frequency of ophthalmological aberrations, an ophthalmological evaluation of individuals with FASD is important in both childhood and early adulthood. Keywords: Fetal Alcohol Syndrome, Optic Nerve, Optical Coherence Tomography, Strabismus, Vision, Visual Perception, Quality of Life
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- Gyllencreutz, Emelie, et al.
(författare)
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Ophthalmologic Findings in Fetal Alcohol Spectrum Disorders : A Cohort Study From Childhood to Adulthood
- 2020
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Ingår i: American Journal of Ophthalmology. - : Elsevier. - 0002-9394 .- 1879-1891. ; 214, s. 14-20
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To investigate whether ophthalmologic findings in children with fetal alcohol spectrum disorders (FASD) persist into young adulthood.DESIGN: Prospective cohort study.METHODS: Thirty children (13 female) adopted from eastern Europe to Sweden in the 1990s and diagnosed with FASD by a multidisciplinary team at the median age of 7.9 years were followed up by the same team 13-18 years later. Visual acuity (VA), refraction, stereoacuity, strabismus, ocular media, and fundus were investigated.RESULTS: Median VA in right/left eye (OD/OS) was 20/32/20/32 (0.2/0.2 logMAR) in childhood and 20/22/20/20 (0.05/0.0 logMAR) in adulthood. Median (range) refraction OD/OS was +0.88/+1.25 (-8.75 to +4.75/-9.38 to +5.25) spherical equivalent diopter (D) in childhood and -0.25/-0.25 (-12 to +2.75/-13.25 to +2.63) in adulthood. Astigmatism (≥1 D) was the most common refractive error, in 13 (40%) and 14 (47%) subjects, respectively. Defective stereoacuity (>60 arc second) was noted in 20 subjects (67%) in childhood and 22 (73%) in adulthood. Heterotropia occurred in 12 subjects (40%) in childhood and 13 (43%) in adulthood. Increased tortuosity of the retinal vessels was found in 8 (27%) subjects in childhood vs 11 (37%) in adulthood. Optic nerve hypoplasia was recorded in 3 children and in 4 young adults.CONCLUSIONS: Ophthalmologic findings such as refractive errors, strabismus, and fundus abnormalities are frequent in children with FASD and persist into early adulthood. The facial features characteristic of FAS diminish with age, making a dysmorphology evaluation in adulthood less reliable. An ophthalmologic examination is an important part of the evaluation of FASD in childhood as well as in young adulthood.
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