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	PROJECTS Congenital cataract Risk indicators for amblyopia Electro-ophthalmological development in infants The Sahlgrenska Center for Pediatric Ophthalmology Research
	Congenital cataract – a longitudinal follow-up of treatment results Project Manager Gunilla Magnusson Address e-mail: gunilla.magnusson@oft.gu.se Department of Ophthalmology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden Phone: +46 31 41 61 76 Fax: +46 31 41 29 04 Description One cohort was formed between January 1980 and December 1989 and a second is formed between January 1990 and December 1999. All children with the diagnosis "congenital cataract" born in four western counties (N, O, R & P) of Sweden during this period were included in the cohort. It was then to be followed to the beginning of the next century. The majority of the children were treated at the Eye clinic at Sahlgrenska Hospital in Göteborg and for those few that were treated elsewhere data were obtained through hospital files. These children form the base of the study. There are several aims of the study. We want to describe children with congenital cataract with respect to other associated diseases, heredity, and other possible causes of the cataract. The visual outcome of different treatment regimes is to be studied both in a short and a long time perspective. The relationship between treatment timing and visual outcome is of special interest. Visual development will be compared to normal children of the same age. Supported by: Handlanden H Svenssons fond, De Blindas Vänner, Kronprinsessan Margaretas Arbetsnämnd. Publications Sjöstrand J, Abrahamsson M. Congenital cataract: A challenge to the ophthalmologist. Acta Ophthalmol (Copenh) 1987;66:595. Sjöstrand J, Abrahamsson M, Hård A-L. Glare disability as a cause of deterioration of vision in cataract patients. Acta Ophthalmol (Copenh) 1987;suppl 182:103-106. Sjöström A, Abrahamsson M, Sjöstrand J. An experimental and clinical study of the shortlatency specific VER and visual acuity. Infant development, congenital cataract and amblyopia. 27th ISCEV. Dresden: 1989:83. Sjöström A, Abrahamsson M, Sjöstrand J. The shortlatency specific VER and visual acuity. An experimental and clinical study with particula emphasis on visual development in infants with congenital cataract. Invest Ophthalmol Vis Sci (suppl)1989:30:314. Sjöström A, Abrahamsson M, Sjöstrand J. Developmental changes in infantile cataract. Invest Ophthalmol Vis Sci (suppl) 1991:32:800 Abrahamsson M, Sjöström A, Helgasson G. Shortlatency occipital response to flashed pattern VER stimuli in visually normal, amblyopic and cataractous children. 30:e ISCEV Symposium. Vienna: 1992:99. Sjöström A, Abrahamsson M, Byhr E, Sjöstrand J. Visual development in children with congenital cataract. Infant Vision ed Vital-Durand. Oxford Press Ch 26. Abrahamsson, M., et al., Changes of visual function and visual ability in daily life following cataract surgery. Acta Ophthalmologica Scandinavica, 1996. 74(1): p. 69-73. Sjöstrand, J., et al., Complications following pediatric cataract surgery. Vision Research, 1996. 36: p. 3123-3123. Abrahamsson, M., et al., The occurrence of congenital cataract in western Sweden. Acta Ophthalmologica Scandinavica, 1999. 77(5): p. 578-580. Abrahamsson, M., A. Sjöström, and J. Sjöstrand, Retarded visual development in 3 children with congenital cataract. Klinische Monatsblatter Fur Augenheilkunde, 1999. 215(2): p. 91-94. Magnusson, G., M. Abrahamsson, and J. Sjöstrand, Glaucoma following congenital cataract surgery: An 18-year longitudinal follow-up. Acta Ophthalmologica Scandinavica, 2000. 78(1): p. 65-70. Magnusson, G., M. Abrahamsson, and J. Sjöstrand, Changes in visual acuity from 4 to 12 years of age in children operated for bilateral congenital cataracts. British Journal of Ophthalmology, 2002. 86(12): p. 1385-1389. Magnusson, G., et al., Evaluation of screening procedures for congenital cataracts. Acta Paediatrica, 2003. 92(12): p. 1468-1473. Top ^
	Risc indicators for amblyopia Project Manager Johan Sjöstrand Address e-mail: johan.sjostrand@oft.gu.se Department of Ophthalmology, Sahlgrenska University Hospital/Mölndal SE-431 80 Mölndal, Sweden Phone: +46 31 3433254 Fax: +46 31 41 29 04 Description In childhood, amblyopia is one of the most common causes of visual deficit. Since amblyopia is treatable, at least in childhood, considerable efforts have been made to identify amblyopia cases as early in life as possible. A screening programme for amblyopia among preschool and school children has been widely spread throughout the world, although questions remain of its utility. The aim of this project is to evaluate the effects of general screening and to examine possible risk indicators for amblyopia in order to develope a selective screening programme. Supported by: Handlanden H Svenssons fond, De Blindas Vänner, Kronprinsessan Margaretas Arbetsnämnd, First of May Flower Annual Campaign, Felix Neubergh Foundation. Publications Abrahamsson M, Fabian G, Sjöstrand J. A longitudinal study of a population based sample of astigmatic children. II. The changeability of anisometropia. Acta Ophthalmol (Copenh) 1990;68:435-440. Abrahamsson M, Fabian G, Andersson A-K, Sjöstrand J. A longitudinal study of a population based sample of astigmatic children. I. Refraction and amblyopia. Acta Ophthalmol(Copenh) 1990;68:428-434. Abrahamsson M, Fabian G, Sjöstrand J. Longitudinal changes in refraction and riskindicators for amblyopia. Invest Ophthalmol Vis Sci (suppl) 1991;32:1238. Sjöstrand J, Abrahamsson M. Screening for amblyopia: How useful is to identify risk indicators? In: Bisantis C, Campos E, Angi M, eds. Crescita dell'occhio e sviluppo della visione nel bambino. Padova, Italia, 1991:123-133. Sjöstrand J, Abrahamsson M. Manifest strabismus in an unselected population of Swedish children longitudinally followed from 1 to 6 years of age. In: H K, ed. 19th European Strab Ass. Elunda, Crete, 1991:269-274. Abrahamsson M, Fabian G, Sjöstrand J. Refraction changes in children developing convergent or divergent squint. Br J Ophthalmol 1992;76:723-727. Abrahamsson M, Sjöstrand J. Refraction changes in normal and amblyopic children. Invest Ophthalmol Vis Sci (suppl) 1992;33:1339. Abrahamsson M, Fabian G, Norrsell K, Sjöstrand J. Heredity as a risk indicator for strabismus. Invest Ophthalmol Vis Sci Suppl Suppl 1993;34:1275. Abrahamsson M, Sjöstrand J. Longitudinal studies of patients with pronounced astigmatism at 1 year of age. Invest Ophthalmol Vis Sci (suppl) 1994;35:1805. Sjöstrand J, Abrahamsson M. Family history of strabismus as a risk indicator for selective screening. Proc 22 Euro Strab Ass 1995. Sjöstrand J, Abrahamsson M. Amblyopia and the concept of cure. Euro J Ophthalmol. In press. Abrahamsson M, Fabian G, Norrsell K, Sjöstrand J. Heredity as a risk indicator for strabismus.Submitted Br J Ophthalmol. Top ^
	Electro-ophthalmological development in vision - early diagnosis and treatment of visual impairment in children. A clinical, electrophysiological and experimental study Project Manager Anders Sjöström Address e-mail: anders.sjostrom@oft.gu.se Department of Ophthalmology Paediatric Eye Unit/Queen Silvia's Hospital Sahlgrenska University Hospital SE-416 85 Göteborg, Sweden Phone: +46 31 343 5775 Fax: +46 31 41 47 08 Researchers Anders Sjöström, MD, PhD, (ophthalmology, neurophysiology) Maria Krämer, MD, PhD student Josefin Nilsson, MD, PhD student Gerardo Villarreal Mendez, MD (ophthalmology), PhD student Graziella Garay Cerro, MD (ophthalmology), PhD student Bertil Sterner, Optician, PhD student Associate researchers/cooperations Kristina Narfström, Professor, DVM (vet. ophthalmology, retinal science) Maths Abrahamsson, PhD Paul Uvebrant, MD, PhD (pediatric neurology) Description Previous studies have shown that pre- and perinatal incidents, like growth restriction, asphyxia, intraventricular hemhorrage, hydrocephalus may cause delayed visual maturation. In experimental studies on rats, it was shown that prenatal deprivation induced alterations predominantly in the function of the cerebral, visual, cortex. In clinical studies on children, delayed visual maturation (DVM) and subnormal visual acuity in older children (SVAS) could be related to pre/perinatal distress also in cases with only subclinical distress. The SVAS children were in many cases discovered late, i.e. 4-6 years old. Also, in many cases albinism was found in the SVAS group. Experimental animal research and clinical studies have been designed to evaluate the different causes to DVM and SVAS and to study normal visual development. A standardized electrophysiological method, the light flash evoked potential (VEP), has been developed and also modified for experimental research. The VEP was combined with other clinical methods, and ERG (electro-retino-gram). Our results show, that albinism is much more common than expected. In a study on 1045 swedish 13-year-old children, = 1% had albinism. The study on 13-year-olds also showed that the incidens of myopia continue to increase and has now almost reached 45%. The study continued in Mexico as a part of an EC project. The results were similar to the swedish study, although the incidens of albinism in Mexico seems to be approximately 0.2-0.3%. The VEP method was also developed for pediatric neurological cases. A small potential could be related to the intracranial pressure (P' potential). Also, a shortlatency potential could be related to visual acuity. By using these potentials, and also the classical N1, P1/P100, N2 etc, the condition of the visual system in various neurological conditions could be estimated. Certain VEP pathology was seen in Angelmanns and Prader-Willi's syndromes, as well as in neurometabolic syndromes. Also, in cases with DVM, the lack of the development of the N1 potential could be related to the altered development of visual function in the primary cortex. Pre-and perinatal distress may cause lesions in the visual pathways, impair cortical development and induce epilepsy. Such conditions may induce defects of the visual fields and cortical visual impairment (cvi). To differ peripheral (retinal) defects from afferent pathway lesions and cvi, another design of the electrophysiological tests are necessary. One specific indication for such a method is the visual field defect induced by the Vigabatrin (a potent drug against epilepsy) at the retinal level, difficult to differ from a central visual field defect in children. A development of a combined simultanous ERG and VEP visual field test method is progressing. In some cases animal research is necesaary. We study the ERG and VEP in cats with a hereditary retinal dystrophy closely resembling human Retinitis Pigmentosa, to find methods for very early diagnostic clues and ways of differentiating homozygotic from heterozygotic inheritage ot the disease. The study will eventually be followed by retinal transplant experiments, in order to find possibilities of treatment of retinal dystophies and macular degenerations. The research project emphasizes the importance of early discovered visual impairment in children. Publications (excerps) Flashed pattern induced activity in the visual system. I. The evoked response recorded from the primary visual cortex of cat. Acta Physiol Scand 1991, 143, 1-9. (Tills. med E.K. Norrsell, M. Abrahamsson, A. Roos & G. Helgason). Original paper. Congenital cataract; treatment and visual outcome. A study from a Swedish region. Abstract In; Child Vision and Research Society (CVRS). Lyon 1993. (Tills med M Abrahamsson, E Byhr & J Sjöstrand) En longitudinell studie av barn med congenital cataract. Abstract In; 27:e Nordiska ögonläkarmötet. Göteborg 1993. Shortlatency cortical potentials of the VER. Abstract In; Int. symposium on the evoked potential and advanced methodology development. Bristol, march 1993. A comparison of pattern and non-pattern flashed VER. Abstract In; Invest Ophthalm Vis Sci (IOVS); 1993;34:4, p.1275. Alteration in cortical visual evoked response following ethanol feeding in adult rats. 1994. In; J Alcohol: Clinical and Experimental Research, 18; 6: 1392-1397. (tills med C Kjellström, B Rydenhag & N Conradi). Original paper. A new operant discrimination test procedure for resident rats. 1994. Physiology and Behaviour 55; 47-51 (Tills. med B. Rydenhag, N.G. Conradi & T. Archer). Original paper. Patterned light flash evoked short latency activity in the visual system of visually normal and amblyopic subjects. 1994. Acta Ophthalmologica, 72:195-202. (Tills. med Maths Abrahamsson). Original paper. Kongenital katarakt kräver tidig kirurgi. 1994. Läkartidningen, 91:3700-3707. (Tills. med M. Abrahamsson & J. Sjöstrand). Original paper. Visual development in children with congenital cataract. 1995. In: Infant Vision. European Brain and Behaviour Publications series No.2. Ed. F. Vital-Durand, J. Atkinson & O. Braddick, Oxford University Press. (Tills. med M Abrahamsson, J Sjöstrand & E Byhr). Bokkapitel. The flash light evoked response in hydrocephalus and increased intracranial pressure. 1995. Childs Nervous System. 11:381-387. (Tills. med A. Roos & P. Uvebrant). Original paper. Transillumination of iris and subnormal visual acuity- ocular albinism? Br J Ophthalmol. 1996, Vol 80, No 7, p617-623. (Tills. med L. Sjödell & M. Abrahamsson). Original paper. DVM/SVAS. Försenad eller subnormal synutveckling hos barn. En genomgång av 85 patientfall. 1997. Göteborgs Universitet. Sommarforskar-skolan. (Cecilia Hännel). Studentuppsats. Visual evoked responses in normal kittens and adult cats using propofol anesthesia. Abstract In: BrAVO, ECVO, ESVO, ISVO. Combined ophthalmology satellite meeting, April 1997. WSAVA/BSAVA & FECAVA World Congress. Birmingham. VEP in Small-For-Gestational-Age Infantas. Abstract In; 36th Symposium of the International Society for Clinical Electrophysiology of Vision (ISCEV). Hradec Králové, June 13-17,1998. (Tills. med M Kræmer). Normal and delayed development of visual function in infancy. 1998. Göteborgs Universitet. Maria Kræmer. Medicine licentiats-avhandling, Lack of short-latency-potentials in the VEP reflects immature extra-geniculate visual function in delayed visua maturation (DVM). 1999. Accepterat. Documenta Ophthalmologica. (Tills. med M. Kræmer). Original paper. Accommodative facility training with a long term follow up in a sample of school aged children showing accommodative dysfunction. 1999. In Press. Documenta Ophthalmologica. (Tills. med M. Abrahamsson & B. Sterner). Original paper. The effect of accommodative facility training of a group of children with accommodative insufficiency - a comparison between dioptric treatment and sham treatment. 1999. Accepterat. Documenta Ophthalmologica. (Tills. med B. Sterner & M. Abrahamsson). Original paper. The neonatal development of the light flash evoked response. 1999.In Press; Documenta Ophthalmologica. (Tills. med Maria Kræmer). Original paper. Visual Evoked Response i Pediatrisk Oftalmologi. 1999. In press. Bokkapitel: Forskning om barnsyn och barnögonvård. Sigvard & Marianne Bernadottes Forskningsstiftelse för Barnögonvård. Anmodat bidrag, (Tills. med M. Kræmer). Verzögerte Sehentwicklung bei 3 Kindern mit Kongenitaler Katarakt. 1999. Accepterat, Graefes Arch. (tills. med M Abrahammsson & J Sjöstrand). Original paper. The occurence of congenital cataract in western Sweden. 1999. Acta Ophthalm Scand. Vol. 77:578-580. (tills m M Abrahamsson, G Magnusson, Z PopoviC, J Sjöstrand). Original paper. Myopisation: The Refractive Tendency in Teenagers. Prevalence of myopia among young teenagers in Sweden. 2000. Acta Ophthalmologica Scandinavica. 78:177-181. (Tills. med G. Villareal Mendez, J Ohlsson, M Abrahamsson, & J Sjöstrand). Original paper. Impairments in cortical visual evoked response in adolescent rats following prenatal alcohol exposure. Acta Physiol Scand. Accepterat. 1999. (Tills. m. S Westergren, B Rydenhag & N G Conradi). Original paper. Ophthalmological findings in children with cerebral white matter abnormalities.. Submitted; Pediatric Ophthalmol Strab (Tills. m. R Kristjánsdóttir & P Uvebrant). Original paper. The prevalence of vep albinism in sweden. Abstract In; Symposium of the International Society for Clinical Electrophysiology of Vision (ISCEV),1999, Eilat, Israel. (Tills med Maria Kræmer, Josefin Ohlsson, Gerardo Villarreal & Maths Abrahamsson). Subnormal Visual Acuity Syndromes (SVAS): Albinism in Swedish 12 to 13- Year- Old Children: Insänt t. Br J Ophthalmol (Tills. med M Kræmer, J Ohlsson, G Villareal & M Abrahamsson). Original paper. The prevalence of albinism among 12-13 year old children in Sweden. Abstract In; The annual meeting of the Association for Research in Vision and Ophthalmology (ARVO). IOVS 1999. Ft. Lauderdale, USA. Tills. med JL Thaung, J Ohlsson, G Villareal, M Abrahamsson & J Sjostrand. The prevalence of VEP albinism in Sweden. Abstract In; 37th meeting of the International Society for Clinical Electrophysiology of Vision (ISCEV). 1999. Eilat, Israel. Tills med Maria Kræmer. Myopia prevalence in 12-13 year old children in Sweden. Abstract In; The annual meeting of the Association for Research in Vision and Ophthalmology (ARVO). IOVS 1999. Ft. Lauderdale, USA. Tills. med B Sterner, J Ohlsson, G Villareal, M Abrahamsson & J Sjostrand. Are the differences in visual evoked potential asymmetries in albinism revealing activity in separate afferent systems? Abstract In; XI International Congress of EMG and Clinical Electrophysiology (ECCS). Prag 1999. Tills. med Maria Kræmer, Josefin Ohlsson, Gerardo Villarreal & Maths Abrahamsson. Screening for amblyopia and strabismus with the lang stereocard II. Original Manuskript. Tills. med J Ohlsson, G Villareal, M Abrahamsson & J Sjöstrand. Screening merits of the Lang II, Frisby, Randot, Titmus and TNO stereotests. Original Manuskript. Tills. med J Ohlsson, G Villareal, H Cavazos, M Abrahamsson & E Traviño. Screening merits of the Lang II, Frisby, Randot, Titmus and TNO stereotests. Abstract In; The annual meeting of the Association for Research in Vision and Ophthalmology (ARVO). IOVS 2000. Ft. Lauderdale, USA. Tills. med B Sterner, J Ohlsson, G Villareal, M Abrahamsson & J Sjostrand. Neurophysiological impairment of the visual system in prenatally growth retarded infants. Abstract In; The annual meeting of the Association for Research in Vision and Ophthalmology (ARVO). IOVS 2000. Ft. Lauderdale, USA. Maria Kræmer MD, Anders Sjöström MD, PhD. Neurophysiological (VEP) impairment of the visual system in the prenatally growth retarded (SGA/IUGR) infants. Abstract In; 10th European Congress of Clinical Neurophysiology. 26/30 August 2000 (ECCS 2000), Lyon Conference Center, France. Tills. med M Kræmer. Supported by Göteborg University LUA De Blindas Vänner (Friends of the Blind Foundation) KMA Ahrnberg foundation H Svensson GLS

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Department of Ophthalmology Sahlgrenska University Hospital/MölndalSE-431 80 Mölndal