David Robbins Tien

Pediatric Associates, Tampa, Florida, United States

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Publications (13)34.31 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: IMPORTANCE Initial treatment for amblyopia of the fellow eye with patching and atropine sulfate eyedrops improves visual acuity. Long-term data on the durability of treatment benefit are needed. OBJECTIVE To report visual acuity at 15 years of age among patients who were younger than 7 years when enrolled in a treatment trial for moderate amblyopia. DESIGN, SETTING, AND PARTICIPANTS In a multicenter clinical trial, 419 children with amblyopia (visual acuity, 20/40 to 20/100) were randomly assigned to patching (minimum of 6 h/d) or atropine sulfate eyedrops, 1% (1 drop daily), for 6 months. Treatment after 6 months was at the discretion of the investigator. Two years after enrollment, an unselected subgroup of 188 children were enrolled into long-term follow-up. INTERVENTION Initial treatment with patching or atropine with subsequent treatment at investigator discretion. MAIN OUTCOMES AND MEASURES Visual acuity at 15 years of age with the electronic Early Treatment Diabetic Retinopathy Study test in amblyopic and fellow eyes. RESULTS Mean visual acuity in the amblyopic eye measured in 147 participants at 15 years of age was 0.14 logMAR (approximately 20/25); 59.9% of amblyopic eyes had visual acuity of 20/25 or better and 33.3%, 20/20 or better. Mean interocular acuity difference (IOD) at 15 years of age was 0.21 logMAR (2.1 lines); 48.3% had an IOD of 2 or more lines and 71.4%, 1 or more lines. Treatment (other than spectacles) was prescribed for 9 participants (6.1%) aged 10 to 15 years. Mean IOD was similar at examinations at 10 and 15 years of age (2.0 and 2.1 logMAR lines, respectively; P = .39). Better visual acuity at the 15-year examination was achieved in those who were younger than 5 years at the time of entry into the randomized clinical trial (mean logMAR, 0.09) compared with those aged 5 to 6 years (mean logMAR, 0.18; P < .001). When we compared subgroups based on original treatment with atropine or patching, no significant differences were observed in visual acuity of amblyopic and fellow eyes at 15 years of age (P = .44 and P = .43, respectively). CONCLUSIONS AND RELEVANCE At 15 years of age, most children treated for moderate amblyopia when younger than 7 years have good visual acuity, although mild residual amblyopia is common. The outcome is similar regardless of initial treatment with atropine or patching. The results indicate that improvement occurring with amblyopia treatment is maintained until at least 15 years of age. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00000170.
    Jama Ophthalmology 05/2014; · 3.83 Impact Factor
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    ABSTRACT: To determine whether change in refractive error is associated with ocular alignment in 105 children 3 to <7 years of age who previously participated in a randomized trial comparing atropine and patching for moderate amblyopia. Prospective cohort study. One hundred five children 3 to <7 years of age previously participated in a randomized trial comparing atropine with patching for moderate amblyopia. Cycloplegic refraction was measured at baseline and 10 years of age. Ocular alignment at baseline was categorized as orthotropic, microtropic (1-8 Δ horizontal tropia), or heterotropic (>8 Δ horizontal tropia). Multivariate regression models evaluated whether change in spherical equivalent refractive error was associated with alignment category, after adjusting for age, baseline spherical equivalent refractive error, and type of amblyopia treatment. Between enrollment and the age 10-year examination, there was a decrease in spherical equivalent refractive error from hyperopia to less hyperopia (amblyopic eye: -0.65 diopter, 95% CI -0.85, -0.46; fellow eye: -0.39 diopter, 95% CI -0.58, -0.20). A greater decrease in amblyopic eye refractive error was associated with better ocular alignment category (P = .004), with the greatest decrease occurring in orthotropic patients. There was no relationship between ocular alignment category and change in fellow-eye refractive error. Among children treated for anisometropic, strabismic, or combined mechanism amblyopia, there is a decrease in amblyopic eye spherical equivalent refractive error to less hyperopia after controlling for baseline refractive error. This negative shift toward emmetropia is associated with ocular alignment, which supports the suggestion that better motor and sensory fusion promote emmetropization.
    American Journal of Ophthalmology 05/2012; 154(2):297-302.e1. · 4.02 Impact Factor
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    Archives of ophthalmology 09/2009; 127(9):1225-7. · 3.86 Impact Factor
  • Alexandra M Tien, David Robbins Tien
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    ABSTRACT: This report describes a case of orbital dermoid cyst presenting with a discharging sinus tract. The embryologic basis for orbital dermoids in general is discussed, as well as their typical presentation and management. In the current case, patient presentation and management were somewhat different because of signs of infection and a communicating sinus tract, both highly unusual for orbital dermoids. However, after complete excision of the dermoid and sinus tract, the patient showed complete recovery.
    Journal of Pediatric Ophthalmology & Strabismus 07/2009; · 0.73 Impact Factor
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    ABSTRACT: To compare the outcomes of balloon catheter dilation and nasolacrimal intubation as treatment for congenital nasolacrimal duct obstruction after failed probing in children younger than 4 years. We conducted a prospective, nonrandomized, multicenter study that enrolled 159 children aged 6 months to younger than 48 months who had a history of a single failed nasolacrimal duct probing and at least 1 of the following clinical signs of nasolacrimal duct obstruction: epiphora, mucous discharge, or increased tear lake. One hundred ninety-nine eyes underwent either balloon catheter nasolacrimal duct dilation or nasolacrimal duct intubation. Treatment success was defined as absence of epiphora, mucous discharge, or increased tear lake at the outcome visit 6 months after surgery. Treatment success was reported in 65 of 84 eyes (77%; 95% confidence interval, 65%-85%) in the balloon catheter dilation group compared with 72 of 88 eyes (84% after adjustment for intereye correlation; 74%-91%) in the nasolacrimal intubation group (risk ratio for success for intubation vs balloon dilation, 1.08; 0.95-1.22). Both balloon catheter dilation and nasolacrimal duct intubation alleviate the clinical signs of persistent nasolacrimal duct obstruction in a similar percentage of patients.
    Archives of ophthalmology 06/2009; 127(5):633-9. · 3.86 Impact Factor
  • Archives of Ophthalmology - ARCH OPHTHALMOL. 01/2009; 127(3):349-349.
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    ABSTRACT: To evaluate the monocular oral reading rate, accuracy, fluency, and comprehension in 10-year-old children previously treated for amblyopia. Prospective, observational case series. Seventy-nine children (mean age, 10.3 years) previously treated in a multicenter randomized trial comparing patching and atropine were tested at seven sites using a modification of the Gray Oral Reading Test, Fourth Edition (GORT-4). The mean visual acuities (VA) in the amblyopic and fellow eyes at the time of the reading assessment were 0.17 logarithm of the minimum angle of resolution (logMAR) units (approximately 20/32) and -0.03 logMAR units (approximately 20/20), respectively. Compared with the sound eye, amblyopic eye performance was worse when reading orally with respect to rate (P < .001), accuracy (P = .03), and fluency (P < .001). Reading comprehension scores were similar with the amblyopic and fellow eyes (P = .45). Similar results were found with respect to original treatment group assignment (atropine or patching). There was a modest correlation between interocular difference (IOD) of VA at age 10 years and IOD in reading rate (r = 0.37; 95% confidence interval [CI], 0.18 to 0.56) and fluency (r = 0.28; 95% CI, 0.08 to 0.49). There was no correlation between the IOD in VA and IOD in accuracy (r = 0.08; 95% CI, -0.14 to 0.30) or comprehension (r = 0.16; 95% CI, -0.05 to 0.37). The monocular oral reading ability when measured with the GORT-4 was slightly worse when reading with previously treated amblyopic eyes compared with fellow eyes in terms of rate, accuracy, and fluency, but reading comprehension testing was similar.
    American Journal of Ophthalmology 08/2008; 146(6):942-7. · 4.02 Impact Factor
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    ABSTRACT: To determine the visual acuity outcome at age 10 years for children younger than 7 years when enrolled in a treatment trial for moderate amblyopia. In a multicenter clinical trial, 419 children with amblyopia (visual acuity, 20/40-20/100) were randomized to patching or atropine eyedrops for 6 months. Two years after enrollment, a subgroup of 188 children entered long-term follow-up. Treatment after 6 months was at the discretion of the investigator; 89% of children were treated. Visual acuity at age 10 years with the electronic Early Treatment Diabetic Retinopathy Study test. Patching and atropine eyedrops produce comparable improvement in visual acuity that is maintained through age 10 years. The mean amblyopic eye acuity, measured in 169 patients, at age 10 years was 0.17 logMAR (logarithm of the minimum angle of resolution) (approximately 20/32), and 46% of amblyopic eyes had an acuity of 20/25 or better. Age younger than 5 years at entry into the randomized trial was associated with a better visual acuity outcome (P < .001). Mean amblyopic and sound eye visual acuities at age 10 years were similar in the original treatment groups (P = .56 and P = .80, respectively). At age 10 years, the improvement of the amblyopic eye is maintained, although residual amblyopia is common after treatment initiated at age 3 years to younger than 7 years. The outcome is similar regardless of initial treatment with atropine or patching.
    Archives of ophthalmology 08/2008; 126(8):1039-44. · 3.86 Impact Factor
  • Journal of American Association for Pediatric Ophthalmology and Strabismus 02/2007; 11(1):107-108. · 1.14 Impact Factor
  • Alexandra M Tien, David Robbins Tien
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    ABSTRACT: We describe a case of bilateral congenital lacrimal sac fistulas, associated with ectrodactyly-ectodermal dysplasia-clefting syndrome. The embryologic basis for this condition is discussed, as well as the epidemiology, typical presentation, and possible treatment modalities. After we excised the fistulas and intubated the nasolacrimal ducts in this patient, he experienced improvement in symptoms by report.
    Journal of American Association for Pediatric Ophthalmology and Strabismus 01/2007; 10(6):577-8. · 1.14 Impact Factor
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    ABSTRACT: To develop and validate a new parental questionnaire addressing symptoms and health-related quality of life (HRQL) in childhood nasolacrimal duct obstruction (NLDO). Cross-sectional study. Children ages 6 to younger than 48 months with and without clinical signs of NLDO. A new questionnaire was developed using semistructured interviews with parents of children with NLDO and through discussions with expert clinicians. Questionnaires were completed by parents of children with and without NLDO. Cronbach's alpha was calculated as a measure of internal-consistency reliability. Factor analysis was used to evaluate a priori subscales: symptoms and HRQL. Discriminant construct validity was assessed by comparing questionnaire scores between children with and without NLDO and between affected and unaffected eyes of children with unilateral NLDO. Instrument responsiveness was determined by comparing presurgical and postsurgical intervention scores in a subset of NLDO patients who underwent surgical treatment. The NLDO questionnaire score. Eighty-seven children were enrolled, 56 with and 31 without NLDO. All but 2 questions on the questionnaire showed a good distribution of responses, a high correlation with the rest of the questionnaire, and excellent discrimination between patients with and without NLDO. Cronbach's alpha values were good for the overall questionnaire (0.95), and for 2 predetermined subscales: symptoms (0.95) and HRQL (0.85). On a 0 to 4 scale, NLDO patients had worse scores compared with non-NLDO patients for both symptoms (mean difference, 2.1; 95% confidence interval [CI], 1.9-2.3) and HRQL (mean difference, 1.2; 95% CI, 0.9-1.5) subscales. The NLDO patients had worse scores before intervention compared with after intervention for both the symptoms (mean difference, 2.2; 95% CI, 1.6-2.9) and HRQL (mean difference, 1.4; 95% CI, 0.8-2.1) subscales. Finally, NLDO patients had worse symptom scores for affected eyes compared with unaffected eyes (mean difference, 2.3; 95% CI, 1.9-2.6). This novel NLDO questionnaire is useful in quantifying parental perception of symptoms and HRQL in childhood NLDO. The questionnaire may have a role in future clinical studies of NLDO.
    Ophthalmology 10/2006; 113(9):1675-80. · 5.56 Impact Factor
  • David Robbins Tien, David Young
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    ABSTRACT: Our purpose is to report our experience with balloon catheter dilation of the nasolacrimal duct after failed probing for congenital nasolacrimal duct obstruction. We undertook a retrospective chart review. Patients who were enrolled had symptoms of persistent nasolacrimal duct obstruction after simple probing and irrigation. Balloon nasolacrimal ductoplasty was performed using the LacriCATH system (Quest Medical, Inc. An Atrion Company, Allen, TX). Outcomes were determined by postoperative examination and telephone follow-up. Thirty-nine lacrimal systems of 26 patients (age range, 10 months to 84 months) were treated. Of the obstructed ducts treated, 82% (32/39) showed resolution of epiphora. There were 9 children older than the age of 2, with 15 nasolacrimal systems studied. These had 11 of 15 successes for a success rate of 73%. There were 17 children between the ages of 10 months and 2 years with 24 nasolacrimal systems studied. These had 21 of 24 successes for a success rate of approximately 88%. The difference was not statistically significant (P = 0.28). Balloon dilation of the nasolacrimal duct is an alternative to silicone intubation in the treatment of congenital nasolacrimal duct obstruction after failed simple probing. Although our success rate was slightly lower than some published reports of nasolacrimal system intubation, this simple and atraumatic procedure was successful in 82% of cases for this specific situation.
    Journal of American Association for Pediatric Ophthalmology and Strabismus 11/2005; 9(5):465-7. · 1.14 Impact Factor
  • Journal of American Association for Pediatric Ophthalmology and Strabismus 11/2005; 9(5):493-4. · 1.14 Impact Factor

Publication Stats

70 Citations
34.31 Total Impact Points

Institutions

  • 2009
    • Pediatric Associates
      Tampa, Florida, United States
    • Jaeb Center for Health Research
      Tampa, Florida, United States