Yair Morad
Tel Aviv University, Sackler School of Medicine, Faculty Member
Myopia is the most common refractive error in the world, and its’ prevalence continually increases. The potential pathological and visual complications of progressive myopia have inspired researchers to study the sources of myopia, axial... more
Myopia is the most common refractive error in the world, and its’ prevalence continually increases. The potential pathological and visual complications of progressive myopia have inspired researchers to study the sources of myopia, axial elongation, and explore modalities to arrest progression. Considerable attention has been given over the past few years to the myopia risk factor known as hyperopic peripheral blur, the focus of this review. The primary theories currently believed to be the cause of myopia, the parameters considered to contribute and influence the effect of peripheral blur, such as the surface retinal area or depth of blur will be discussed. The currently available optical devices designed to provide peripheral myopic defocus will be discussed, including bifocal and progressive addition ophthalmic lenses, peripheral defocus single vision ophthalmic lenses, orthokeratology lenses, and bifocal or multifocal center distance soft lenses, as well as their effectivity as ...
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Objectives: To assess the decrease in myopia progression and rebound effect using topical low-dose atropine compared to a combined treatment with contact lenses for myopic control. Methods: This retrospective review study included 85... more
Objectives: To assess the decrease in myopia progression and rebound effect using topical low-dose atropine compared to a combined treatment with contact lenses for myopic control. Methods: This retrospective review study included 85 children aged 10.34 ± 2.27 (range 6 to 15.5) who were followed over three years. All had a minimum myopia increase of 1.00 D the year prior to treatment. The children were divided into two treatment groups and a control group. One treatment group included 29 children with an average prescription of 4.81 ± 2.12 D (sphere equivalent (SE) range of 1.25–10.87 D), treated with 0.01% atropine for two years (A0.01%). The second group included 26 children with an average prescription of 4.14 ± 1.35 D (SE range of 1.625–6.00 D), treated with MiSight 1 day dual focus contact lenses (DFCL) and 0.01% atropine (A0.01% + DFCL) for two years. The control group included 30 children wearing single-vision spectacles (SV), averaging −5.06 ± 1.77 D (SE) range 2.37–8.87 D)....
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The goal of this retrospective case series is to demonstrate the effectivity of combination low-dose atropine therapy with peripheral defocus, double concentric circle design with a center distance soft contact lenses at controlling... more
The goal of this retrospective case series is to demonstrate the effectivity of combination low-dose atropine therapy with peripheral defocus, double concentric circle design with a center distance soft contact lenses at controlling myopia progression over 1 year of treatment. Included in this series are 3 female children aged 8–10 years with progressing myopia averaging −4.37 ± 0.88 D at the beginning of treatment. Their average annual myopic progression during the 3 years prior to therapy was 1.12 ± 0.75 D. They had not attempted any myopia control treatments prior to this therapy. The children were treated with a combination of 0.01% atropine therapy with spherical peripheral defocus daily replacement soft lenses MiSight® 1 day (Cooper Vision, Phoenix, AZ, USA). They underwent cycloplegic refraction, and a slit-lamp evaluation every 6 months which confirmed no adverse reactions or staining was present. Each of the 3 children exhibited an average of 0.25 ± 0.25 D of myopia progres...
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As life expectancy grows, so too will the number of people adversely affected by age. Although it is acknowledged that many conditions and diseases are associated with age, this mini-review will present a current update of the various... more
As life expectancy grows, so too will the number of people adversely affected by age. Although it is acknowledged that many conditions and diseases are associated with age, this mini-review will present a current update of the various visual changes that generally occur in healthy individuals disregarding the possible effects of illness. These alterations influence how the world is perceived and in turn can affect efficiency or the ability to perform ordinary daily tasks such as driving or reading. The most common physical developments include a decreased pupil size and retinal luminance as well as changes both in intercellular and intracellular connections within the retina along the pathway to the visual cortex and within the visual cortex. The quantity and the physical location of retinal cells including photoreceptors, ganglion and bipolar retinal cells are modified. The clarity of intraocular organs, such as the intraocular lens, decreases. These all result in common visual man...
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Retinitis pigmentosa (RP) is a group of clinically and genetically heterogeneous hereditary retinal diseases that result in blindness due to photoreceptor degeneration. Mutations in the rhodopsin (RHO) gene are the most common cause of... more
Retinitis pigmentosa (RP) is a group of clinically and genetically heterogeneous hereditary retinal diseases that result in blindness due to photoreceptor degeneration. Mutations in the rhodopsin (RHO) gene are the most common cause of autosomal dominant RP (adRP) and are responsible for 16% to 35% of adRP cases in the Western population. Our purpose was to investigate the contribution of RHO to adRP in the Israeli and Palestinian populations. Thirty-two adRP families participated in the study. Mutation detection was performed by whole exome sequencing (WES) and Sanger sequencing of RHO exons. Fluorescence PCR reactions of serially diluted samples were used to predict the percentage of mosaic cells in blood samples. Eight RHO disease-causing mutations were identified in nine families, with only one novel mutation, c.548-638dup91bp, identified in a family where WES failed to detect any causal variant. Segregation analysis revealed that the origin of the mutation is in a mosaic health...
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To evaluate the association among elevated intraocular pressure (IOP), the metabolic syndrome (MetS), body mass index (BMI), and some of their components in the Israeli population. We retrospectively reviewed the charts of 12 747 soldiers... more
To evaluate the association among elevated intraocular pressure (IOP), the metabolic syndrome (MetS), body mass index (BMI), and some of their components in the Israeli population. We retrospectively reviewed the charts of 12 747 soldiers of the Israeli Defense Forces, aged 35y or older, who underwent a routine periodical medical examination between 1991 and 2004. None of the subjects received medical treatment for either glaucoma or ocular hypertension. High IOP (>21 mm Hg) was correlated with age, sex, arterial blood pressure, total blood cholesterol levels, triglyceride levels, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, smoking, BMI and MetS. A statistically significant difference was found between the IOP of subjects with a low risk and higher risk for the development of MetS (P<0.0001 for males, P=0.0026 for females). A statistically significant positive correlation was found in male subjects between high BMI and elevated IOP (r=0.11677, P&...
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To compare the 10-2 SITA-standard and SITA-fast visual field programs in patients with glaucoma. We enrolled 26 patients with open angle glaucoma with involvement of at least one paracentral location on 24-2 SITA-standard field test. Each... more
To compare the 10-2 SITA-standard and SITA-fast visual field programs in patients with glaucoma. We enrolled 26 patients with open angle glaucoma with involvement of at least one paracentral location on 24-2 SITA-standard field test. Each subject performed 10-2 SITA-standard and SITA-fast tests. Within 2 months this sequence of tests was repeated. SITA-fast was 30% shorter than SITA-standard (5.5 ± 1.1 vs 7.9 ± 1.1 minutes, P < 0.001). Mean MD was statistically significantly higher for SITA-standard compared with SITA-fast at first visit (Δ = 0.3 dB, P = 0.017) but not second visit. Inter-visit difference in MD or in number of depressed points was not significant for both programs. Bland-Altman analysis showed that clinically significant variations can exist in individual instances between the 2 programs and between repeat tests with the same program. The 10-2 SITA-fast algorithm is significantly shorter than SITA-standard. The two programs have similar long-term variability. Ave...
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To date, more than thirty nine genetic loci have been associated with congenital cataracts. Despite this progress, current diagnostic techniques are insufficient for unraveling the underlying genetic defect in sporadic patients and small... more
To date, more than thirty nine genetic loci have been associated with congenital cataracts. Despite this progress, current diagnostic techniques are insufficient for unraveling the underlying genetic defect in sporadic patients and small families. In the present manuscript we demonstrate the contribution of routine laboratory tests in the search for genetic defects of childhood cataracts. Two families with congenital cataracts and hematologic findings that included hyperferritinemia and the "ii" blood type underwent detailed ophthalmologic and clinical examinations. Mutation analysis of the ferritin light chain (FTL) and glucosaminyl (N-acetyl) transferase 2, I-branching enzyme (GCNT2) genes was performed in the two families, respectively. In the family with the "ii" blood group we found a novel GCNT2 mutation c.G935A (p.G312D) in the cataract patients, while in the family with hyperferritinemia cataract syndrome we identified a G→C heterozygous mutation at posit...
Research Interests: Biology, Medicine, Israel, Molecular, Humans, and 15 moreChild, Mutation, Female, Male, Cataract, Pedigree, Genetic linkage analysis, Optometry and Ophthalmology, Adult, Consanguinity, Biological markers, Cataracts, DNA mutational analysis, blood group antigens, and Genetic predisposition to disease
To identify the genetic cause underlying autosomal recessive cone-rod dystrophy (CORD) and high myopia. Nine members of a consanguineous Arab family were clinically examined and were given fluorescein angiography (FA), biometry, and full... more
To identify the genetic cause underlying autosomal recessive cone-rod dystrophy (CORD) and high myopia. Nine members of a consanguineous Arab family were clinically examined and were given fluorescein angiography (FA), biometry, and full field electroretinogram (ERG) testing. Blood samples were collected for DNA extraction. A homozygousity genome-wide scan was performed using >382 polymorphic microsatellite markers on genomic DNA from three affected family members. Regions of homozygosity were further analyzed in all members of the family. Mutation analysis of the PROM1 gene was performed by direct sequencing of PCR-amplified exons. The phenotype is characterized by severe visual impairment evident in the first decade of life. Affected family members have bull;s-eye macular appearance, peripheral retinal pigment clumps, and cone-rod type ERG changes. Additionally, they have high myopia with axial lengths exceeding 25.3 mm. A genome-wide scan detected a region of 2.1 Mb on chromos...
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Research Interests: Medicine, Free Radical, Biological Sciences, Dexamethasone, Chemical Warfare Agents, and 15 moreMetal Complexes, Animals, Antioxidant, Oxidoreductases, Intraocular Pressure, Nitrogen, Atrophy, Corneal Opacity, Combination drug therapy, Iris, Organometallic Compounds, Glucocorticoids, Deferoxamine, Corneal neovascularization, and Medical and Health Sciences
Research Interests: Military Medicine, Ophthalmology, Immigration, Adolescent, Medicine, and 15 moreAmblyopia, Israel, Biological Sciences, Refractive Error, Humans, Female, Male, Population based study, Jews, former Soviet Union, Israel Defense Forces, Prevalence, Ethnic Group, Military Personnel, and Medical and Health Sciences
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Research Interests: Ophthalmology, Treatment Outcome, Optical coherence tomography, Cornea, Medicine, and 15 moreElasticity, Prospective studies, Humans, Collagen, Keratoconus, Female, Male, Clinical Sciences, Optometry and Ophthalmology, Adult, Disease Progression, Corneal topography, Riboflavin, Biomechanical Phenomena, and Ultraviolet Rays
Research Interests: Ophthalmology, Comparative Study, Medicine, Primary, Israel, and 15 moreCatheterization, Paediatrics, Humans, Female, Male, Statistical Significance, Infant, Clinical Sciences, Retrospective Studies, Catheter, Balloon Catheter, Dilatation, Child preschool, Dacryocystorhinostomy, and Nasolacrimal duct
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This retrospective case series demonstrates the combination of 0.05% atropine with MiSight® 1 day (Cooper vision, Sar Ramon, CA, USA) in rapid progression of myopia of 4 children. MiSight® 1 day is a peripheral defocus, center-distance... more
This retrospective case series demonstrates the combination of 0.05% atropine with MiSight® 1 day (Cooper vision, Sar Ramon, CA, USA) in rapid progression of myopia of 4 children. MiSight® 1 day is a peripheral defocus, center-distance soft contact lens and is effective at controlling moderate progression of myopia during the course of 1 year. The current case series included 2 females and 2 males with an average age of 9.68 ± 0.26 years and an average axial length of 24.81 ± 0.92 mm. Their myopic progression during the previous year was −1.45 ± 0.27 D. The children had not attempted any myopia control thus far. This relatively high increase prompted a combination treatment of daily instillation of 0.05% atropine and MiSight, a daily replacement soft contact lens. Cycloplegic refraction and a slit-lamp evaluation were performed every 6 months to confirm no adverse reactions or staining was present. The 8-item contact lens dry eye questionnaire (CLDEQ-8) score of these children was 1...
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Postmortem examination is a cornerstone in identifying the cause of unexplained sudden death in children. Even in cases of suspected or known abuse, an autopsy may help characterize the nature of the abuse, which is particularly important... more
Postmortem examination is a cornerstone in identifying the cause of unexplained sudden death in children. Even in cases of suspected or known abuse, an autopsy may help characterize the nature of the abuse, which is particularly important in the forensic autopsy of children in the first 3 to 4 years of life when inflicted neurotrauma is most common. Forensic examinations are vital in cases that might otherwise be diagnosed as sudden infant death syndrome. The ocular autopsy in particular may demonstrate findings that were not appreciated on antemortem clinical examination. This protocol for postmortem examination of the eyes and orbits was developed to promote more consistent documentation of findings, improved clinical and forensic decision making, and more replicable and coherent research outcomes.
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To evaluate the experiences, attitudes, and perceptions of the caregivers of children with cataracts who were visually rehabilitated with contact lenses. One hundred twenty-three caregivers of children... more
To evaluate the experiences, attitudes, and perceptions of the caregivers of children with cataracts who were visually rehabilitated with contact lenses. One hundred twenty-three caregivers of children &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;8.1 years old treated for unilateral and bilateral cataracts at one pediatric hospital. Survey by questionnaire. Primary caregivers were asked to complete an anonymous questionnaire. Caregiver responses to questions assessing background and demographic and clinical information, as well as perceptions, attitudes, levels of compliance, and anxiety with respect to treatment, were reviewed. Caregivers were also asked to choose between aphakic rehabilitation with contact lenses, aphakic glasses, or intraocular lenses, given various hypothetical scenarios differing in regard to their final visual prognosis, risks of treatment complications, and cost. The response rate was 82.9%. Absolute average stress levels for contact lens use were 1.36 +/- 1.79 and 0.79 +/- 1.48 (scale, 0-5) for insertion and removal, respectively, compared with 4.03 +/- 1.64 and 2.40 +/- 1.92 for cataract surgery and patching therapy, respectively. Although average paired initial resistance to treatment (RT) levels for contact lens insertion and removal on a scale of 0 to 3 were high (2.09 +/- 1.15) and moderate (1.63 +/- 1.20), respectively, final RT levels were significantly lower (1.09 +/- 1.14 and 0.66 +/- 1.07, respectively; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). The vast majority of caregivers chose contact lens use in hypothetical scenarios that depicted realistic expectations for other forms of aphakic rehabilitation. In our study, contact lenses seemed to be well tolerated by most patients, as assessed by caregivers. Although initial resistance to contact lens use is high, this decreases with time. Relative to other events in the treatment of pediatric cataracts, contact lens use is not a major stressor for most caregivers and patients. This study supports the notion that contact lenses should continue to receive serious consideration as a treatment option for pediatric cataracts.
Research Interests: Ophthalmology, Visual acuity, Contact Lenses, Humans, Child, and 14 moreFemale, Male, Infant, Patient Compliance, Attitude, Caregivers, Clinical Sciences, Questionnaires, Optometry and Ophthalmology, Public health systems and services research, Vision Disorders, Health surveys, Eyeglasses, and Child preschool
Research Interests: Pediatrics, Surgery, Treatment, Adolescent, Visual acuity, and 20 moreSafety, Humans, Derivation, Child, Glaucoma, Female, Male, Intraocular Pressure, Infant, Follow-up studies, New World, American, Clinical Sciences, Optometry and Ophthalmology, Public health systems and services research, Retrospective Studies, Prosthesis Implantation, Nino, Postoperative Complications, and Child preschool
Research Interests: Rheumatology, Immunology, Juvenile Idiopathic Arthritis, Adolescent, Visual acuity, and 17 moreHumans, Child, Female, Male, Follow-up studies, American, Risk factors, Clinical Sciences, Optic Neuritis, Adult, Public health systems and services research, Retrospective Studies, Disease Progression, Risk Factors, Glucocorticoids, immunoglobulin G, and Child preschool
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PURPOSE: To report the successful control of intraocular pressure with endoscopic cyclophotocoagulation after repeated failure of trans-scleral diode-laser cyclophotocoagulation.DESIGN: Interventional case report.METHODS: A 3 1/2-year-old... more
PURPOSE: To report the successful control of intraocular pressure with endoscopic cyclophotocoagulation after repeated failure of trans-scleral diode-laser cyclophotocoagulation.DESIGN: Interventional case report.METHODS: A 3 1/2-year-old child had intraocular pressure around 30 mm Hg in one eye despite full medical treatment and three procedures of trans-scleral diode laser photocoagulation.RESULTS: Endoscopic view of the ciliary body revealed many misplaced laser burns in the pars plana region. Using direct endoscopic visualization of the ciliary body, precise, confluent burns were applied to the ciliary body. Six months after the procedure, intraocular pressure has remained under 20 mm Hg.CONCLUSION: Endoscopic cyclophotocoagulation can effectively lower intraocular pressure after recurrent external diode-laser photocoagulation has failed to do so. The direct visualization during the endoscopic procedure is particularly advantageous in cases with atypical ciliary body morphology, such as in pediatric glaucoma.
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To study the distribution of ocular higher-order aberrations (HOAs) in a myopic population and to assess the repeatability of HOA measurements determined by a commercially available skiascopic wavefront sensor. Department of... more
To study the distribution of ocular higher-order aberrations (HOAs) in a myopic population and to assess the repeatability of HOA measurements determined by a commercially available skiascopic wavefront sensor. Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel. Ocular HOAs were examined 3 times across a 6.0 mm naturally dilated pupil in 61 eyes using the Optical Path Difference (OPD)-scan wavefront aberrometer. Root-mean-square (RMS) values of HOAs, total spherical aberration (TSA), total coma (TC), and total trefoil (TT) were analyzed. Correlation analysis was performed to assess the aberration symmetry between right and left eyes. The repeatability of the OPD-scan measurements was assessed by calculating Pearson r correlation coefficients between each pair of measurements and the interclass correlation coefficients between the 3 measurements of each score. The mean RMS values of HOAs, TSA, TC, and TT were 0.347 microm +/- 0.252 (SD), 0.120 +/- 0.174 microm, 0.165 +/- 0.168 microm, and 0.252 +/- 0.157 microm, respectively. The HOAs, TSA, TC, and TT changed slightly and not significantly with increasing refractive error (all P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;.05). The RMS level of HOAs and TTR of the 3rd measurement was significantly different from the 1st and 2nd measurements (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05), with overall low correlation between the 3 measurements for the HOAs, TSA, TC, and TT. The ocular wavefront aberrations varied greatly from subject to subject. Ocular HOAs were not correlated with refractive error. The repeatability of HOAs measurements with the OPD-aberrometry was low.
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Ocular parameters are influenced by sleep derivation and the use of chemical substances which are two major causes for traffic accidents. We assessed the use of these parameters as an objective screening tool for a... more
Ocular parameters are influenced by sleep derivation and the use of chemical substances which are two major causes for traffic accidents. We assessed the use of these parameters as an objective screening tool for a driver&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s fitness for duty. Pupillary diameter, pupil reaction to light and saccadic velocity were measured in 29 army truck drivers every morning for two months and compared to baseline measurements taken while the subjects were alert. An index which expressed the difference between study and baseline measurements was calculated, and drivers with significant deviation from baseline were disqualified and interviewed. Non-disqualified drivers served as controls. Twenty-nine percent of disqualified drivers reported sleeping less than the minimum of 7h required by army regulations compared with 8% of control drivers (p=0.01). Disqualified drivers had worse sleep quality the night before the test (Groningen Sleep Quality Scale, p=0.03) and incurred more accidents per driving day during their service (0.023 vs. 0.015 accidents/day, p=0.03). Two disqualified drivers admitted to using alcohol or sleeping pills. Thus, these ocular parameters may serve as a screening tool for drivers that are at high risk for driving. Drivers who were disqualified even once, tend to be involved in more motor vehicle accidents than their peers.
Research Interests: Psychology, Risk assessment, Fatigue, Israel, Humans, and 12 moreSleep Quality, Sleep Deprivation, Eye, Wakefulness, Questionnaires, Accident analysis and prevention, Public health systems and services research, Risk Assessment, Indexation, Motor Vehicle Accident, Traffic Accident, and Motor vehicles act
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Research Interests: Cognitive Science, Psychiatry, Performance, Adolescent, Fatigue, and 21 moreProprioception, Fourier Analysis, Humans, Sleep Deprivation, Circadian Rhythm, Spectral analysis, Female, Male, Reaction Time, Sleep, Vigilance, Posture, Cognitive Performance, Clinical Sciences, Arousal, Adult, Postural Balance, Indexation, Individual Difference, Weight Bearing, and Neurosciences
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Research Interests: Ophthalmology, Singapore, Treatment Outcome, Cornea, Adolescent, and 24 moreVisual acuity, Humans, Keratoconus, Female, Male, Astigmatism, Follow-up studies, Clinical Sciences, Middle Aged, Optometry and Ophthalmology, Adult, Public health systems and services research, Time Factors, Retrospective Studies, Prognosis, Corneal transplantation, Eyeglasses, Graft Rejection, Trabeculectomy, Somatic Cell Count, Refractive Errors, Penetrating keratoplasty, Corneal topography, and Postoperative Complications
To assess changes in biomechanical properties of human cornea after treatment of keratoconus with UV-A-riboflavin corneal collagen cross-linking (CXL). Single-center, prospective, interventional study. Ten eyes of 10 patients aged 26.5... more
To assess changes in biomechanical properties of human cornea after treatment of keratoconus with UV-A-riboflavin corneal collagen cross-linking (CXL). Single-center, prospective, interventional study. Ten eyes of 10 patients aged 26.5 +/- 5.7 (mean +/- SD) years with progressive keratoconus were treated with UV-A-riboflavin CXL and assessed with the Ocular Response Analyzer (ORA) that measured corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal compensated intraocular pressure (IOPcc). Intraocular pressure was also measured by Goldmann applanation tonometry (GAT-IOP). Patients were assessed with ORA preoperatively, at week 1, months 1, 3, and 6 after treatment. Postoperative measurements at each visit were compared with preoperative values. CH and CRF were transiently elevated after cross-linking treatment, with the difference not statistically significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.3). IOPcc and IOPg were statistically significantly higher at 1 week and 1 month but not subsequently (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.04). GAT-IOP was statistically significantly higher at 1 week and at 1 and 3 months (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). There were no significant differences in corneal biomechanical properties, as measured with the ORA parameters CH and CRF, after CXL in keratoconus. IOPcc, IOPg, and GAT-IOP values were transiently elevated after CXL treatment in our study. Whether this reflects a measurement artifact resulting from corneal changes or true elevation of intraocular pressure is unclear.
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PURPOSE: To report correlation between retinal and intracranial abnormalities and to evaluate pathogenesis of retinal hemorrhages in the shaken baby syndrome (SBS).DESIGN: Observational case series.METHODS: Seventy-five children with... more
PURPOSE: To report correlation between retinal and intracranial abnormalities and to evaluate pathogenesis of retinal hemorrhages in the shaken baby syndrome (SBS).DESIGN: Observational case series.METHODS: Seventy-five children with apparent nonaccidental head trauma consistent with SBS had complete physical examination, complete ophthalmologic examination, neuroimaging by CT or MRI, or both, and skeletal radiographic survey. In this retrospective review, ophthalmoscopic and intracranial abnormalities were correlated.RESULTS: The age of patients ranged from 2 to 48 months (mean - SD, 10.6 ± 10.4 months). Neuroimaging was abnormal in all 75 cases. Findings included subdural hematoma (70 children, 93%), cerebral edema (33 children, 44%), subarachnoid hemorrhage (12 children, 16%), vascular infarction (nine children, 12%), intraparenchymal blood (six children, 8%), parenchymal contusion (six children, 8%), and epidural hemorrhage (one child, 1%). Sixty-four (64/75, 85%) children had retinal abnormalities, mostly (53/64, 82%) confluent multiple hemorrhages that were subretinal, intraretinal, and preretinal in 47/64 (74%) and bilateral in 52/64 (81%). No association was found between anatomic site (left, right, or bilateral) of intracranial and retinal findings (McNemar test kappa = −0.026–0.106) or between any of the intracranial findings mentioned above and the following retinal findings: normal or abnormal retinal examination, multiple (>10) or few retinal hemorrhages (≤10), symmetric or asymmetric retinal findings, or retinoschisis (kappa = −0.127–0.104). Signs of possible increased intracranial pressure were not correlated with any retinal abnormality (kappa = −0.03–0.073). There was no correlation between evidence of impact trauma to the head and retinal hemorrhages (kappa = 0.058). Total Cranial Trauma Score and Total Retinal Hemorrhage Score, both indicating the severity of injury, were correlated (P = .032).CONCLUSIONS: Our study supports previous observations that the severity of retinal and intracranial injury is correlated in SBS. We cannot support the suggestions that in most children with SBS retinal bleeding is caused by sustained elevated intracranial, elevated intrathoracic pressure, direct tracking of blood from the intracranial space, or direct impact trauma. The correlation in severity of both eye and head findings may suggest, however, that retinal abnormalities are the result of mechanical shaking forces.