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Purpose: This study implements and demonstrates a deep learning (DL) approach for screening referable horizontal strabismus based on primary gaze photographs using clinical assessments as a reference. The purpose of this study was to develop and evaluate deep learning algorithms that screen referable horizontal strabismus in children's primary gaze photographs.
Methods: DL algorithms were developed and trained using primary gaze photographs from two tertiary hospitals of children with primary horizontal strabismus who underwent surgery as well as orthotropic children who underwent routine refractive tests. A total of 7026 images (3829 non-strabismus from 3021 orthoptics [healthy] subjects and 3197 strabismus images from 2772 subjects) were used to develop the DL algorithms. The DL model was evaluated by 5-fold cross-validation and tested on an independent validation data set of 277 images. The diagnostic performance of the DL algorithm was assessed by calculating the accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC).
Results: Using 5-fold cross-validation during training, the average AUCs of the DL models were approximately 0.99. In the external validation data set, the DL algorithm achieved an AUC of 0.99 with a sensitivity of 94.0% and a specificity of 99.3%. The DL algorithm's performance (with an accuracy of 0.95) in diagnosing referable horizontal strabismus was better than that of the resident ophthalmologists (with accuracy ranging from 0.81 to 0.85).
Conclusions: We developed and evaluated a DL model to automatically identify referable horizontal strabismus using primary gaze photographs. The diagnostic performance of the DL model is comparable to or better than that of ophthalmologists.
Translational Relevance: DL methods that automate the detection of referable horizontal strabismus can facilitate clinical assessment and screening for children at risk of strabismus.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846951 | PMC |
http://dx.doi.org/10.1167/tvst.10.1.33 | DOI Listing |
Ophthalmology
September 2025
From the Johns Hopkins University School of Medicine, Baltimore, Maryland, and the American Academy of Ophthalmology, San Francisco, California.
Purpose: To describe strabismus surgery reoperation rates and risk factors for children and adults in the United States.
Design: Retrospective cohort analysis of health care data PARTICIPANTS: 79,424,597 patients in IRIS® Registry (Intelligent Research in Sight) METHODS: Description of strabismus, strabismus surgery and reoperations from 2013 to 2022. Multivariable models of factors associated with a reoperation within one year were developed.
Invest Ophthalmol Vis Sci
September 2025
Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, United States.
Purpose: Simulations suggest that displacement of rectus extraocular muscle pulleys in superior oblique (SO) palsy accounts for incomitant strabismus patterns even without postulating SO contractile weakness. We asked how rectus extraocular muscle pulleys reorient during head tilt in SO palsy.
Methods: In 13 subjects with unilateral SO palsy, supine magnetic resonance imaging (MRI) in 2-mm-thick quasi-coronal planes in target-controlled central gaze was repeated in both lateral decubitus positions equivalent to 90° head tilts.
BMC Ophthalmol
September 2025
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Purpose: To evaluate children's reading performance with intermittent exotropia (IXT) and investigate possible associations among reading abnormalities, binocular visual function, and visual information processing.
Methods: This cross-sectional, case-control study involved 61 children with basic-type IXT and 40 healthy controls aged 7 to 13. Reading performance was assessed objectively using the Development Eye Movement (DEM) test and subjectively with the Dyslexia Checklist for Chinese Children (DCCC).
BMC Ophthalmol
August 2025
Postgraduate Training Base of Jinzhou Medical University (Third Medical Center of Chinese People's Liberation Army General Hospital) Ophthalmology, Beijing, 100039, China.
Background: Convergence insufficiency intermittent exotropia (CIX(T)) is a common type of strabismus in children, characterized by greater ocular deviation at near fixation compared to distance fixation. This study aimed to explore impact of slanted lateral rectus recession (S-LRc) compared to conventional lateral rectus recession (LR) on pediatric patients with CIX(T).
Methods: This retrospective study enrolled pediatric patients with CIX(T) at Shanxi Aier Eye Hospital between June 2022 and December 2024.
Strabismus
August 2025
Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, India.
Purpose: To report the clinical presentation and surgical outcomes of patients with Duane syndrome with primary position hypertropia, with or without coexisting horizontal deviation.
Methods: We retrospectively reviewed records of patients diagnosed with Duane syndrome with vertical and associated horizontal deviations from January 2008 to July 2017. We collected data regarding patient age, gender, refractive error, presence or absence of amblyopia and history of strabismus surgery, as well as clinical subtype of Duane syndrome, abnormal head posture, measurement of horizontal and vertical deviation, and outcomes of strabismus surgery.