Volume 17 Number 1 / February 2013 e25

Conclusions: PRK is an effective and stable surgical alternative inchildren with refractive errors who are unable to tolerate traditionaltherapy.

088 Surgical outcomes in adult sixth nerve palsy. Jason H.Peragallo, Beau B. Bruce, Nancy J. Newman, Amy K. Hutchinson,Valerie Biousse, Scott R. LambertIntroduction: Sixth nerve palsy (6NP) is the most common adult ocu-lar motor nerve palsy. Our goal was to identify factors associatedwith surgical outcomes in 6NP.Methods: Medical records of all adult patients from 1988-2012 with6NP who underwent strabismus surgery or botulinum toxin injectionswere retrospectively reviewed. Success was defined as absence ofdiplopia without prisms, vertical deviation #2D, and horizontal devi-ation #10D.Results: 83 patients from four surgeons were included [50 (60%)women; mean age 52 (range, 20-86)]. 66 (80%) had unilateral sixthnerve palsies. Palsies were complete in 34 (41%). 21 (25%) had .1surgery. Underlying etiology was idiopathic/microvascular in 23(28%), traumatic in 23 (28%), neoplastic in 19 (23%), and miscella-neous causes in 18 (22%). Success frequency was similar across eti-ologies. 16/42 patients (38%) with trauma or neoplasm requiredrepeat surgery vs 5/41 (12%) with other etiologies (P\0.05). Successwas more frequent with Hummelsheim-type procedures than verticalrectus transposition (VRT) among patients with complete palsies (7/95 78% vs 8/235 35%; P\0.05). Success was more frequent amongall surgically-treated 6NP patients who had adjustable vs nonadjust-able sutures (21/29 5 73% vs 22/44 5 52%; P 5 0.06).Discussion: Etiology of 6NP does not appear to affect surgical suc-cess in adults, but patients with traumatic and neoplastic causeswere more likely to require repeat procedures. Despite a small num-ber of patients, success was more frequent using the Hummelshiem-type procedure and with adjustable sutures.Conclusions: Surgical success in adults does not correlate with theetiology of the sixth nerve palsy, but may vary based on the type ofprocedures in this patient population.

089 Prospective evaluation of the spot (Pediavision) vision screeneras autorefractor and in the detection of amblyogenic risk factorscompared to Plusoptix and a comprehensive pediatric ophthalmologyexamination. Mae Millicent Peterseim, Rupal H. Trivedi, Vera A. Ball,Maria E. Shtessel, M. Edward Wilson, Jennifer D. DavidsonIntroduction: The Pediavision Spot photorefractor screener has beenmarketed over the last year (1) without published validation. We re-port a prospective study of the Spot compared to the more validatedPlusoptix screener and to a comprehensive examination. We also re-port these evaluations utilizing modifications to photorefractor refer-ral criteria that have been proposed to improve specificity whilemaintaining sensitivity. (2)Methods:After informed consent, patients underwent screening withthe Spot and with the Plusoptix prior to their comprehensive exami-nation by a pediatric ophthalmologist masked to the results. Data in-cluding refractions, pass/refer, strabismus and any ocular pathology,were entered into a Redcap database for statistical analysis.Results: Currently, 161 patients have been enrolled (average age, 6years). The sensitivity and specifity of the Spot for detection of pro-posed AAPOS amblyopia risk factors (3) are 0.98 and 0.49. With pro-posed modifications to the manufacturers criteria the Spot sensitivityis 0.87 and specificity 0.72 and with the Plusoptix, sensitivity 0.91 andspecificity 0.61. Compared to cycloplegic retinoscopy (right eyes),the Spot showed a mean difference of -0.99D � 1.15 for SE and

Journal of AAPOS

0.36 D � 0.63 for cylinder. Corresponding numbers for the Plusoptixwere �0.37D � 1.20 for SE and 0.31D � 0.63 cylinder.Discussion: In this ongoing study, sensitivity for the Spot with man-ufacturers guidelines is excellent and is comparable to the more es-tablished Plusoptix. Proposed modifications to manufacturersreferral criteria improve specificity with acceptable sensitivity forboth the Spot and the Plusoptix. The Spot underestimates hyperopiamore than does the Plusoptix.Conclusions: The Spot is an effective pediatric vision screener com-parable to the Plusoptix. Proposed modifications to the manufac-turers criteria may be useful for the Spot and for the Plusoptix.

090 Hypertropia in unilateral, isolated abducens nerve palsy.Matthew S. Pihlblad, Joseph L. DemerIntroduction: If hypertropia is observed with 6NP, multiple cranialneuropathies or a skew deviation are often considered. Understand-ing of the association of hypertropia with 6NP would facilitate etio-logic evaluation.Methods:We retrospectively reviewed binocular alignment in a con-secutive series of 43 cases of unilateral, isolated, previously unoper-ated 6NP. Complete 6NP was defined as inability to abduct pastmidline, and incomplete palsy as lesser limitation.Results: Etiologies of 6NP included: microvascular-15, trauma-5, me-ningioma-4, idiopathic-3, nasopharyngeal carcinoma-2, meningitis-2,aneurysm-2, migraine-2, arteriovenous malformation-1, neovascularcompression-1, retrobulbar block-1, abducens schwanomma-1, sar-coma-1, stroke-1, carotid-cavernous fistula-1, and Arnold-Chiari mal-formation-1. Hypertropia in any gaze position was found on objectivealternate cover or Krimsky testing in 30% (13/43), and on subjectiveHess screen testing in 63% (22/35) of 6NPcases. Hypertropia on objec-tiveor subjective testingwere found in 50%(7/14) of patientswith com-plete and 62% (18/29) with partial 6NP. Mean (�SD) hypertropia was5.3D � 2.2D, range, 2D -10D on clinical examination, and 4.7�2.1D,range, 2D -10D on Hess screen testing. The ipsilesional eyewas hyper-tropic in 64% (14/22), and hypotropic in 36% (8/22) of cases.Discussion: Small angle hypertropia is frequently associated with6NP, not necessarily implying another neurological lesion. Recent an-atomical and physiological studies have demonstrated that the lat-eral rectus muscle has separately-innervated superior and inferiorcompartments. Some hypertropias associated with 6NP may resultfrom pathology weakening one lateral rectus compartment morethan the other, thus inducing a vertical imbalance.Conclusions: Measurable hypertropia is commonly seen in unilat-eral, isolated 6NP, whether complete, or partial.

091 The association of prematurity and nonglaucomatous opticdisk cupping in children. Alexander E. PogrebniakPurpose: To examine the association of premature birth and nonglau-comatous optic disc cupping in children and the neurologic correlatesin premature and nonpremature cohorts with nonglaucomatous opticdisc cupping.Methods: Within a comprehensive pediatric ophthalmology practiceassociated with a childrens hospital, a computerized databasesearch was conducted of all patients seen over a four year periodwith nonglaucomatous optic disc cupping. Optic disc parametersmeasured with digital photographs and history with regard to prema-turity were evaluated and compared to control groups from the samepractice. Data regarding associated systemic or neurologic diseasewas tabulated and existing neuroimaging reviewed.Results: Forty-five eyes (mean horizontal cup/disc 0.704 � SD 0.021)with nonglaucomatous cupping had clinically larger discs than 31eyes (mean horizontal cup/disc 0.407 � 0.095) without large cups