import json

data = {
 "topic": "Refractive Error",
 "slug": "refractive-error",
 "category_id": 15239,
 "summary": "Refractive error - myopia, hyperopia, and astigmatism - is the most common cause of decreased visual acuity in children, diagnosed objectively by cycloplegic retinoscopy and corrected primarily with glasses to prevent amblyopia and strabismus.",
 "written_by": "claude-sonnet",
 "references": [
  {"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024", "author": None, "pages": [3950, 3952]},
  {"title": "Ghai Essential Pediatrics, 9e (Vinod K Paul, Arvind Bagga)", "author": "CamScanner", "pages": [671]},
  {"title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition", "author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.", "pages": [454]},
  {"title": "Zitelli and Davis' Atlas of Pediatric Physical Diagnosis: Expert Consult - Online", "author": None, "pages": [758]},
  {"title": "AAP Developmental and Behavioral Pediatrics", "author": "AAP Section on Developmental and Behavioral Pediatrics,Robert G. Voigt,Michelle M. Macias ,Scott M. Myers ,Carl D Tapia", "pages": [686]},
  {"title": "Cover", "author": "Vitalsource Download", "pages": [8707]},
  {"title": "The Clinician's Guide to Pediatric Nutrition", "author": "Natalie D. Muth;Mary Tanaka;", "pages": [486]},
  {"title": "Netters Pediatrics (Florin Т., Ludwig St.)", "author": None, "pages": [219, 853]}
 ],
 "short": [
  {"title": "In short", "content": (
   "- Refractive error (ametropia) is a deviation from the normal emmetropic state in which parallel light rays fail to focus accurately on the retina; the three common types are myopia (nearsightedness), hyperopia (farsightedness), and astigmatism\n"
   "- Refractive state is determined mainly by corneal curvature, and to a lesser extent by lens shape and axial (front-to-back) length of the eye\n"
   "- Presenting clues noticed by parents/teachers/the child: blurred or poor vision, eye rubbing, squinting, sitting too close to the television, holding objects too close to the eyes, headaches, and fatigue with visual tasks; failure of a vision screening is also a common trigger for evaluation\n"
   "- Children at particular risk for refractive errors needing correction include those born prematurely, those with Down syndrome, those with a parent with refractive error, and those with certain systemic conditions (Stickler, Marfan, or Ehlers-Danlos syndrome)\n"
   "- High refractive errors or inequality of refractive state between the two eyes (anisometropia) can cause amblyopia and must be identified and treated promptly\n"
   "- Objective measurement in children uses cycloplegic retinoscopy: cycloplegic-mydriatic eye drops (cyclopentolate or tropicamide) are instilled to temporarily paralyze accommodation and dilate the pupil, then a retinoscope projects light into the eye and the examiner neutralizes the reflected light with corrective lenses to measure refractive error objectively - this can be performed at any age, including the newborn period\n"
   "- Autorefractors (instrument-based screening) can overestimate the degree of nearsightedness in children, so cycloplegic retinoscopy remains the gold standard for accurate measurement; photoscreening cameras can aid ancillary staff in refractive error screening\n"
   "- Subjective refinement (asking the patient for lens preference) supplements retinoscopy and can be done in many school-age children, but objective cycloplegic retinoscopy is essential in younger or less cooperative children\n"
   "- First-line treatment is glasses; contact lenses are reserved for very high or asymmetrical refractive errors and for adolescents who prefer not to wear glasses\n"
   "- Laser refractive surgery (e.g., LASIK) is not approved/indicated for most children and not routinely used, but is occasionally used off-label for amblyopiogenic refractive errors or high refractive error in children who cannot tolerate wearing corrective lenses (e.g., due to neurobehavioral impairment or poor compliance) - refractive surgery corrects myopia by flattening corneal curvature (central ablation) and hyperopia by steepening it (mid-peripheral ablation)"
  )}
 ],
 "long": [
  {"title": "Definition", "content": (
   "Refractive error, or ametropia, is a deviation from the normal emmetropic (properly focused) state of the eye in which an abnormality in the eye's refractive and focusing apparatus prevents parallel rays of light from distant objects from being accurately focused on the retina. The three common types are myopia (nearsightedness), hyperopia (farsightedness), and astigmatism; inequality of refractive state between the two eyes is termed anisometropia. The refractive state of the eye is determined primarily by the shape/curvature of the cornea, and to a lesser degree by the shape of the lens and the axial length of the eye."
  )},
  {"title": "Clinical features", "content": (
   "Refractive error manifests as poor or blurred vision, which may be noticed by the child or reported by parents, relatives, friends, or school teachers. Indirect behavioral clues include eye rubbing, squinting, sitting or moving too close to the television, and holding objects too close to the eyes. Additional symptoms and signs of uncorrected refractive error include headaches, fatigue with visual tasks, and failure of a vision screening test. Significant refractive errors - myopia, hyperopia, astigmatism, or anisometropia - can cause decreased visual acuity and, if left uncorrected, can lead to amblyopia and strabismus."
  )},
  {"title": "Epidemiology", "content": (
   "Certain groups of children are at particular risk for refractive errors requiring corrective glasses: those born prematurely, those with Down syndrome, those with a parent who has a refractive error, and those with certain systemic connective tissue or collagen disorders such as Stickler syndrome, Marfan syndrome, or Ehlers-Danlos syndrome."
  )},
  {"title": "Diagnostics", "content": (
   "Assessment of visual acuity is followed by cycloplegic refraction as part of a comprehensive ophthalmic evaluation. In children, objective measurement of refractive error is best obtained using cycloplegic-mydriatic eye drops - cyclopentolate or tropicamide - which temporarily paralyze accommodation (cycloplegia) and dilate the pupil (mydriasis); approximately 30 minutes after instillation, a retinoscope is used to project a beam of light into the eye, illuminating the retina, and the light reflected back through the pupil and optical system is neutralized by placing appropriate lenses in front of the eye, allowing the examiner to accurately and objectively measure the refractive error. This process, retinoscopy, can be performed at any age, including in the newborn period, and in young children is best done using cyclopentolate 1% eye drops. Instrument-based (autorefractor) screening is an alternative but can overestimate the degree of nearsightedness (myopia) in children, so cycloplegic retinoscopy remains the more accurate standard, particularly when treatment decisions are being made. Subjective refinement of refraction, in which the examiner asks the patient for their preference between lens options, can supplement retinoscopy and is feasible in many school-age children, but is not reliable in younger or uncooperative children. Photoscreening cameras can assist ancillary medical personnel in screening children for refractive errors requiring further evaluation."
  )},
  {"title": "Treatment", "content": (
   "Glasses are the most common and first-line treatment for refractive errors in children; an eye care professional determines whether a given refractive error requires correction. Contact lenses are generally reserved for children with very high or asymmetrical (anisometropic) refractive errors, and for adolescents who prefer not to wear glasses. Laser refractive surgery is not indicated for most children and is not approved for pediatric use, but it is occasionally used off-label to treat select cases of amblyopiogenic refractive error or other high refractive error states in children who are unable to wear proper glasses or contact lenses - for example, children with neurobehavioral impairment who cannot tolerate corrective lenses, or those with poor compliance wearing glasses/contacts who have an amblyopiogenic refractive error. Refractive surgery works by reshaping the cornea: myopia is corrected using central ablation to flatten corneal curvature, while hyperopia is corrected using mid-peripheral ablation to steepen corneal curvature."
  )},
  {"title": "Complications", "content": (
   "Uncorrected significant refractive error, or a large disparity in refractive state between the two eyes (anisometropia), can cause amblyopia (reduced vision from abnormal visual development) and strabismus (misalignment of the eyes) if not identified and corrected promptly - underscoring the importance of vision screening and prompt referral for cycloplegic refraction in at-risk children."
  )}
 ],
 "clinical": [
  {"title": "Approach at the bedside", "content": (
   "When a child fails vision screening, or a parent/teacher reports squinting, eye rubbing, sitting too close to the television, headaches, or fatigue with visual tasks, refer for a comprehensive ophthalmic evaluation including cycloplegic retinoscopy rather than relying on instrument-based (autorefractor) screening alone, since autorefraction can overestimate myopia in children. Prioritize referral in children with recognized risk factors for refractive error - prematurity, Down syndrome, a parent with refractive error, or connective tissue disorders such as Stickler, Marfan, or Ehlers-Danlos syndrome - even in the absence of specific complaints, since young children may not reliably report visual symptoms themselves.\n\nOnce a significant refractive error or anisometropia is identified, arrange prompt correction with glasses as first-line treatment to prevent amblyopia and strabismus - the risk that drives the urgency of treating refractive error in children rather than in adults. Reserve contact lenses for very high or markedly asymmetric refractive errors or for adolescents who decline glasses. Only consider referral for off-label laser refractive surgery in the specific circumstance of a child who cannot tolerate glasses or contact lenses (due to neurobehavioral impairment or severe compliance issues) and has an amblyopiogenic refractive error, recognizing this is not a routine or approved pediatric treatment. Ensure any child treated for amblyopia or anisometropia has consistent follow-up to confirm the corrective strategy (glasses, contacts) is being used as intended, since compliance failures in this population directly translate into missed windows for preventing permanent visual impairment."
  )}
 ]
}

with open("/tmp/refractive-error.article.json", "w") as f:
    json.dump(data, f, indent=1)
print("written")