cle was measured before and after severing the frenulum.Results: For the first group, the anterior edge of the SOtendon moved 5.9 � 0.2, 8.0 � 0.2, 9.8 � 0.3, 10.5 � 0.2, and11.5 � 0.3 mm for superior rectus suspension distances of 6,8, 10, 12, 14 mm, respectively. After severing the frenulum,the superior oblique tendon moved less (0.3 � 0.5, 0.6 � 0.5,0.7 � 0.3, 1.0 � 0.4, 1.2 � 0.6 mm). For the second group, themean recession distance of the superior oblique tendon inser-tion after disinsertion, before and after stripping the frenulum,was 2.4 � 0.3 and 8.5 � 0.6 mm, respectively ( paired t-test �0.001). Discussion: The frenulum constrains recession of thesuperior oblique tendon after disinsertion and pulls the ten-don posteriorly as the superior rectus is recessed. Conclusion:The relative location of the SR muscle and the SO tendon isinfluenced by a fascial connection between them. This mayhave important surgical implications.

Treatment outcomes following toddler photoscreening.Valerie Kirk, Michelle M. Clausen, Mary Diane Armitage,Robert W. ArnoldBackground: If we can get reliable objective refractive screeningin infants, is it any better than waiting for preschool acuityscreening? Conventional vision screening and PEDIG amblyopiastudies rely on the ability to attain monocular acuity cooperation,whereas objective screening for amblyopiagenic factors can bedone at much younger ages. Donahue just reported that suchearly intervention can be better. Methods: The IRB-approvedAlaska Blind Child Discovery (ABCD) has community photo-screened with 85% PPV, 5.7% referral in over 21,000 childrensince 1996. All those “positive” interpreted images for “toddlers”(less than 48 months) followed until older than 6 years werereviewed for treatment compliance and success. Results: ABCDinterpreted 410 toddlers as “positive” who were now older than6 years. The positive-predictive value using AAPOS criteria was87%. Of children photoscreened before age 2 (36%) and com-pliant with treatment, none had eventual acuity worse than 20/32, whereas the 64% aged 2.1 to 4.0 years at age of photoscreen-ing, 23% did not achieve best corrected acuity better than 20/32.Conclusions: To our knowledge, ABCD and Tennessee Lion’sare the only venerable, ongoing state efforts from which outcomeof amblyopia treatment endpoint can be currently assessed forcommunity-screened infants and toddlers; we concur with theincreased value of objective screening in toddlers.

Postoperative povidine-iodine prophylaxis in strabismussurgery. Natalie Marie Koederitz, Daniel E. Neely, David A.Plager, Blair Boehmer, Derek Sprunger, Naval SondhiIntroduction: While antibiotic/steroid combinations are rou-tinely administered during the first week after strabismus sur-gery; they are costly, inconvenient, and may be unnecessary. Thepurpose of this study was to evaluate the safety and efficacy ofsingle-dose 5% povidone-iodine drops as a prophylaxis againstpostoperative infection in extraocular muscle surgery. Methods:Retrospective chart review was performed of 1752 patients un-dergoing strabismus surgery from January 2002 to June 2006.Patients received either a single application of 5% povidone-iodine solution to the operative eye(s) at the conclusion of thesurgical procedure or they received a standard week-long courseof topical antibiotic/steroid. If treated with only the single doseof povidone-iodine, patients did not receive any additional post-operative antibiotics or steroids. Postoperative records, includingoffice visits and telephone logs, were then reviewed to identify

any abnormalities or complications occurring during the first 2months after the strabismus surgery. Abnormalities were definedas any unusual amount of discharge, pain, swelling, or redness.Results: Complete documentation was found for 1502 patients.Single-dose povidone-iodine prophylaxis was used in 950 cases(63%) and a topical antibiotic/steroid combination was used in552 cases (37%). Of the 1502 cases, possible infection occurredin 43 patients (2.86%). Of the 43 possible infections, 17 (3.08%)occurred in 552 patients on an antibiotic/steroid combinationand 26 (2.74%) occurred in the 950 patients treated with single-dose povidone-iodine prophylaxis. This difference was not sta-tistically significant ( p � 0.7008). No cases of orbital cellulitis orendophthalmitis occurred in either group. Conclusions: Single-dose povidone-iodine is a safe and inexpensive alternative topostoperative antibiotic/steroid prophylaxis in routine strabismussurgery.

The relationship between magnitude of anisometropia andamblyopia depth. Alejandro Leon, Sean P. Donahue, DavidG. Morrison, Robert L. Estes, Chun LiIntroduction: Anisometropia is a significant cause of amblyopia.The relationship between anisometropia depth and amblyopiamagnitude is not well characterized since previous studies onlyincluded patients identified because of their amblyopia. We an-alyzed results from anisometropic patients identified with pho-toscreening to eliminate this selection bias. Methods: Retro-spective review of 721 charts of anisometropic children identifiedover a 6-year period. Visual acuity, cycloplegic refraction data,and age were used for analysis. Amblyopia was defined as two ormore lines decrease in visual acuity. Patients with anisometropiagreater than 1 D difference were included. We grouped aniso-metropia greater than 1 and less than 2 D as mild, 2 to 4 D asmoderate, and greater than 4 D as severe. Results: Amblyopiaprevalence and depth both increased with greater anisometropia( p � 0.001). Patient age and anisometropia magnitude impactedamblyopia severity ( p � 0.001). There was no correlation be-tween age and depth of anisometropia ( p � 0.65). Prevalence offour or more lines amblyopia was 14.3, 37.6, and 51.2% in themild, moderate, and severe anisometropia patients, respectively.Discussion: Patients with deeper anisometropia have greatermagnitude of amblyopia. Visual screening should aim to detectpatients with highest magnitude of refractive error.

Dissociated vertical deviation in patients with intermittentexotropia. Hyun Taek Lim, David R. Smith, Stephen P.Kraft, J. Raymond BuncicIntroduction: Dissociated vertical deviation (DVD) is aunique ocular motor disorder regarded as a marker of earlydisruption of normal binocular interactions. Although it iscommonly associated with infantile esotropia, DVD may alsooccur in patients with intermittent exotropia [X(T )] in whombinocular functions are relatively normal. The purpose of ourstudy was to describe the clinical characteristics of DVD inpatients with X(T ). Methods: Retrospective medical recordreview (1996 to 2005) for patients with a diagnosis of X(T )with concurrent DVD was performed. Data collected includedage of onset, strabismus measurements, response of DVD toBielschowsky head tilt test (BHTT ), degree of stereopsis, andamblyopia status. Results: Fifty children (mean age: 8.0 � 2.5years) were identified. Mean age of strabismus onset was 12.7� 6.0 months. Mean amount of exodeviation and DVD inprimary position was 25.4 � 5.8 and 9.7 � 3.8�, respectively.

Volume 11 Number 1 February 200780 Abstracts

Journal of AAPOS