Purpose: To evaluate topographic changes in choroidal thickness during development of choroidal neovascularization (CNV) in treatment-naive age-related macular degeneration (AMD) and to test the value of such changes as a predictive tool of CNV development. Methods: This retrospective cohort included 86 eyes that developed CNV from intermediate AMD, 43 eyes with intermediate AMD, and 36 eyes without AMD. Patients with intermediate AMD underwent spectral domain optical coherence tomography using enhanced depth imaging mode every 6 months until CNV was detected. Choroidal neovascularization was localized to one of the subfields of Early Treatment of Diabetic Retinopathy Study grid on fluorescein angiography. Average choroidal thickness of each subfield was calculated. Results: Choroidal thickness of the subfield where CNV developed at first clinical detection significantly increased compared with that 6 months before (P = 0.000 for central, P = 0.001 for superior parafoveal, P = 0.002 for temporal parafoveal, P = 0.002 for inferior parafoveal, and P = 0.001 for nasal parafoveal subfield). In eight patients who visited unexpectedly 3 months before CNV development in central subfield, choroidal thickness of central subfield increased significantly compared with that 6 months before CNV development (P = 0.001). Conclusion: Choroidal neovascularization development accompanied choroidal thickening of the corresponding subfield. Regular measurement of choroidal thickness may assist in prediction of CNV.

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Purpose: To report a case of progressive decrease in retinal thickness in a pediatric patient diagnosed with Alport syndrome. Case summary: An 11-year-old boy diagnosed with Alport syndrome underwent ophthalmic examination. At the time of the first visit, his corrected visual acuity was 20/20 in the right eye and 20/20 in the left eye. No abnormalities in the lens were observed in slit-lamp biomicroscopy. On fundus examination, there was parafoveal dot-and-fleck retinopathy in both eyes. Optical coherence tomography showed no thickness reduction in retinal nerve fiber layers, but a thinner retina was found on the temporal side on macula comparison with the nasal side. He was followed regularly for 8 years. Corrected visual acuity of 20/20 was maintained in both eyes and no abnormality in the lens was observed on slit-lamp biomicroscopy, but optical coherence tomography showed a progressive decrease in retinal thickness. Conclusions: This is the first reported case of progressive decrease in retinal thickness in an Alport syndrome patient without lens abnormalities. Alport syndrome patients should undergo regular fundus examination and optical coherence tomography even when lens abnormalities are absent.

Purpose: To investigate the clinical efficacy of the Spot Vision Screener in measuring refractive power and detecting strabismus in pediatric patients. Methods: We retrospectively analyzed the spherical equivalent, cylinder, and strabismus using the Spot Vision Screener before cycloplegic refraction for pediatric patients <10 years of age. We compared the spherical equivalent and cylinder using the Spot Vision Screener with the results of cycloplegic refraction, and we measured the accuracy of the Spot Vision Screener in detecting strabismus compared with the alternate prism cover test. Results: A total of 38 eyes of 19 patients were included in this study. There was no significant difference in spherical equivalent between the Spot Vision Screener before cycloplegic refraction and cycloplegic refraction (paired t-test: -0.25 ± 1.12 diopters [D] vs. 0.04 ± 1.86 D; p = 0.12). There was a significant difference in cylinder between the Spot Vision Screener before cycloplegic refraction and cycloplegic refraction, but the difference was only -0.25 D (paired t-test: -1.41 ± 1.16 D vs. -1.16 ± 1.25 D; p = 0.01). The sensitivity of the Spot Vision Screener was 42.86%, and the specificity was 66.67% for detecting strabismus. Conclusions: The Spot Vision Screener was a useful instrument to measure the refractive power in pediatric patients before cycloplegic refraction, but it had poor sensitivity and specificity for detecting strabismus.