Volume 18 Number 4 / August 2014 e3

0.0�; P5 0.03), lateral rectus (LR) (4.9� vs 0.0�; P5 0.02), inferior rectus(7.4� vs 1.2�;P5 0.00003), and superior rectus (0.6� vs 0.0�;P5 0.04). Instrabismic subjects, themeasuredAAIwas significantly greater for theMR in abducens palsy (9.9� vs 0.5�; P5 0.0007) and after MR resection(9.9� vs 3.5�;P5 0.02), but not after LR recession (2.9� vs 0.0�;P5 0.23).Single subjects had similar AAIs after MR recession, but markedlydifferent AAIs after MR and LR posterior fixation.Discussion: Contrary to the arc of contact model and traditionalconcept of posterior fixation, normal and postsurgical EOMs aresignificantly nontangent to the globe at their scleral insertions.Conclusion: The arc of contact model inaccurately predicts EOManatomy and should be supplanted in biomechanical modeling byexperimentally measured angles at tendon insertions.

References

1. Beisner DH. Reduction of ocular torque by medial rectus recession. ArchOphthalmol 1971;85:13-17.

2. Scott AB. The faden operation: Mechanical effects. Am Orthop J 1977;27:44-7.

3. Kushner BJ, Fisher MR, Lucchese NJ, Morton GV. How far can a medialrectus safely be recessed? J Pediatr Ophthalmol Strabismus 1994;31:138-46.

007 Improving vision in underserved Los Angeles Countypreschoolers. Anne L. Coleman, Stuart Brown, Bartly J. MondinoPurpose: To describe first year results of the UCLA / First 5 LA VisionProgram.Methods: The Vision Program aims to screen 90,000 three to 5-year-old preschoolers of Los Angeles County in 5 years. On the first visit,trained program personnel use the Retinomax 3 to perform an initialscreening and identify those who benefit a complete eye examina-tion. On the second visit, the UCLA Mobile Eye Clinic staff and oph-thalmologists provide follow-up examinationss. When refractivecorrection is recommended, prescribed eyeglasses are providedand fit by program personnel on the school site on a separate visit.Results: Our goal for the 2012-2013 school year was 8,000. From aneligible population of 12,000 children in 215 preschools, 11,258 pre-schoolers were screened successfully. In this sample, the mean agewas 4.3 years, 49.2%were girls,more than 85%were Latino, andalmostall (96.7%) either spoke Spanish (49.1%) or English (47.6%). Of thescreened sample, 1,554 (13.8%) needed refraction and eye examinationand 1006 (8.9%) were examined for the first time by a UCLAMobile EyeClinic ophthalmologist. More than 850 pairs of prescription eyeglasseswere provided. 147 preschoolers (1.3%) were diagnosed with ambly-opia and another 179 (1.6%) were at risk.Discussion: A large proportion of Los Angeles County preschoolerswith refractive errors have unmet needs in terms of refractivecorrection and amblyopia.Conclusion: Further studies are recommended to understand parentsperceptions and barriers to seeking eye care for their children, and todevise initiatives programs to increase awareness and willingness.

008 Using spectral-domain optical coherence tomography tomonitor optic neuropathy in patients with craniosynostosis.Linda R. Dagi, Laura M. Tiedemann, David Zurakowski, Caroline D.Robson, Amber Hall, Gena HeidaryIntroduction: Detecting optic neuropathy in patients with craniosy-nostosis can be challenging. We evaluated the ability of spectral-domain optic coherence tomography (SD-OCT) to recognize opticneuropathy in this population.

Journal of AAPOS

Methods: A retrospective chart review of patients with craniosynos-tosis over age 4 years who presented for examination (January-December 2013) documented diagnosis, sutures involved, surgicalinterventions, history of elevated intracranial pressure, papilledemaor optic atrophy, radiographic features, corrected acuity, cycloplegicrefraction, amblyopia, color acuity, visual fields, optic nerve appear-ance, and retinal nerve fiber layer (RNFL) thickness measured byHeidelberg SD-OCT. SD-OCT data was compared to published pedi-atric norms for those under age 18 and to validated adult norms forolder patients.Results: Fifty of 60 patientswere eligible (median age, 9.99� 5.36 years) with 10 excluded because of limited cooperation, nystagmus, or poorscan quality. Seventy-three percent of 15with current papilledema, op-tic atrophy, and/or venous congestion had associated SD-OCT abnor-malities. The presence of an abnormal visual field along with diskedema or atrophy guaranteed predicted SD-OCT abnormalities.Discussion: Sensitivity and specificity of OCTconfirming optic atrophywas 88% and 90%, respectively. Prior impact of the disorder did notresult in RNFL aberrancy in all patients with suspected optic neuropa-thy. Abnormality inRNFL thickness in thosewithout apparent optic neu-ropathy was associated with high hyperopia, prior history of elevatedintracranial pressure or concommitant systemic abnormality.Conclusion: SD-OCT provides adjunctive evidence for assessingoptic neuropathy in patients with craniosynostosis but should be in-terpreted in the context of all clinical features.

References

1. Yanni SE, Wang J, Cheng CS, Locke KI, Wen Y, Birch DG, Birch EE. Norma-tive reference ranges for the retinal nerve fiber layer, macula, and retinallayer thicknesses in children. Am J Ophthalmol 2013;155:354-60.

2. Turk A, Ceylan OM, Arici C, Keskin S, Erdurman C, Durukan AH, Mutlu FM,Altinsoy HI. Evaluation of the nerve fiber layer and macula in the eyes ofhealthy children using spectral-domain ocular coherence tomography.Am J Ophthalmol 2012;153:552-9.

009 Ocular growth after primary piggyback IOL implantation.Brita S. Deacon, M. Edward Wilson, Rupal Trivedi, MuralidharRamappa, Courtney L. KrausPurpose: To analyze ocular growth from date of piggyback IOL place-ment to date of planned removal in young children.Methods: A retrospective chart analysis of patients with primary pig-gyback IOL implantation in the first 24 months of life was conducted.Ocular growth and refractive change between the time of IOL place-ment and IOL removal were analyzed. In the patients who underwentunilateral surgery, ocular growth of the operative and non-operativeeyes was compared.Results: Thirty-five eyes of 28 patients were included. Average age atsurgery was 6.31 months (range 1-24). The average preoperative axiallength was 18.85 mm. The piggyback IOL (mean 10.01 D) underwentplanned removal in 23 eyes at an average of 35.43 months (5-95) afterplacement. The average axial length at time of piggyback IOL removalwas 21.31 mm (19.26-24.38) and average refraction was �6.84 D(�3.25 to�10.25). On average, the eyes grew2.70mm (SD 1.12) betweenplacement and removal. In the unilateral group, the average AL growthwas 2.61 mm in the operative eye in comparison to 2.48 mm in the fellow,non-operative eye (P value5 0.69). Patients who underwent piggybackIOL removal were followed for an average of 103.87 months (14-157).Discussion: Piggyback IOLs eliminate residual hyperopia after cata-ract surgery in infants. When sufficient ocular growth has occurred,the anterior sulcus-placed IOL is removed. The removal timing washighly variable.