Purpose: To compare visual acuity (VA) improvement in children aged 7 to 12 years with amblyopia treated with a binocular iPad ® game plus continued spectacle correction versus continued spectacle correction alone.

Significance This pilot randomized trial, the first to evaluate a specific base-in relieving prism treatment strategy for childhood intermittent exotropia, did not support proceeding to a full-scale clinical trial. Defining and measuring prism adaptation in children with intermittent exotropia is challenging and needs further study. Purpose Determine whether to proceed to a full-scale trial of relieving base-in prism spectacles versus refractive correction alone for children with intermittent exotropia. Methods Children 3- to <13-years-old with distance intermittent exotropia control score of ≥2 points on the Intermittent Exotropia Office Control Scale1 (0 = phoria to 5 = constant), ≥1 episode of spontaneous exotropia,16–35∆ by prism-and-alternate-cover test, who did not fully prism adapt on a 30-minute in-office prism-adaptation test were randomized to base-in relieving prism (40% of the larger of distance and near exodeviations) or non-prism spectacles for 8 weeks. A priori criteria to conduct a full-scale trial were defined for the adjusted treatment group difference in mean distance control: “proceed” (≥ 0.75 points favoring prism), “uncertain” (> 0 to <0.75 points favoring prism), or “do not proceed" (≥ 0 points favoring non-prism). Results 57 children (mean age 6.6 ± 2.2 years; mean baseline distance control 3.5 points) received prism (N = 28) or non-prism (N = 29) spectacles. At 8-weeks, mean control was 3.6 and 3.3 points in prism (N = 25) and non-prism (N = 25) groups, respectively; adjusted difference 0.3 points (95% confidence interval -0.5 to 1.1) favoring non-prism (meeting our a priori “do not proceed” criterion). Conclusions Base-in prism spectacles, equal to 40% of the larger of the exodeviations at distance or near, worn for 8 weeks by 3- to 12-year-old children with intermittent exotropia did not yield better distance control than refractive correction alone, with the confidence interval indicating a favorable effect of 0.75 points or larger is unlikely. There was insufficient evidence to warrant a full-scale randomized trial.

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Ocular surface squamous neoplasia, or OSSN, is a clinical spectrum often encountered in ophthalmic practice. The incidence varies depending on the population being studied, but is more common among less pigmented males with increased occupational ultraviolet (UV) exposure as well as among those living in closer proximity to the equator. The incidence increases with age; in younger patients, the presence of OSSN is often associated with another underlying disorder, such as the genetic defect in xeroderma pigmentosum, or immunosuppression as is seen in patients infected with HIV. The challenges of complete surgical excision in patients with extensive tumors, in addition to the high recurrence rates in some series, led to a search for nonsurgical treatment modalities. In addition to avoiding surgery, topical agents may offer the additional benefit of treating clinically unapparent disease. Due to the theoretic advantages of topical chemotherapy, multiple agents have been used in both the primary and adjuvant treatment of OSSN. Mitomycin, interferon alpha-2b, and 5-fluorouracil have all been utilized with success; mitomycin may invoke a greater risk for limbal stem cell failure, and interferon is well tolerated and effective but more expensive. Future developments in imaging and chemotherapeutics will likely continue to alter the treatment paradigm for ocular surface tumors.

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