Retinopathy of Prematurity: Progress and Debate

Pediatric Ophthalmology at AAO

Hello. I am Dr. Monte Mills, Director of the Division of Ophthalmology at The Children's Hospital in Philadelphia. Welcome to Medscape Ophthalmology Insights. I am at the American Academy of Ophthalmology (AAO) meeting in Orlando, and I wanted to share some of the latest developments in pediatric ophthalmology.

Bevacizumab: Data and Controversy

The hottest topic in pediatric ophthalmology has been the use of bevacizumab (Avastin®; Genentech, Inc.; South San Francisco, California) for retinopathy of prematurity (ROP). The BEAT-ROP data, which were published this year by Mintz-Hittner and coworkers,^[1] continued to be a major topic of discussion and controversy in pediatric ophthalmology.

We continue to see favorable outcomes in some large series, including a series presented at this meeting by Martinez-Castellanos and other authors,^[2] that included 307 patients in Mexico and India who had favorable short-term outcomes following bevacizumab treatment, and very few and limited local complications.

The very long-term outcomes are still not available, and many safety and long-term concerns continue to be presented. A poster at the meeting by Sato and associates^[3] demonstrated reduced serum vascular endothelial growth factor (VEGF) for up to 2 weeks after the injection of infants who had ROP. The same study saw detectable bevacizumab levels in the serum of these treated infants, which clearly demonstrates that the agent does get outside of the eye and may be expected to have some systemic effects. That remains one of the hottest topics in pediatric ophthalmology and at this meeting.

Infant Aphakia

Additional information was presented from the Infant Aphakia trial,^[4] including a comparison of complication rates among the treated pseudophakic patients vs those left aphakic. Once again, the long-term results are still pending in that study.

Amblyopia Treatment: Who Benefits?

Another interesting topic that was discussed widely at the meeting was a meta-analysis published this year by Holmes and colleagues^[5] from the Amblyopia Treatment Study (ATS) describing the effects of age on the results of amblyopia therapy. They demonstrated that some children even above the age of 7 benefit from amblyopia therapy. The benefit of amblyopia therapy was less in children over the age of 7 than in younger children.

This is new information from the meta-analysis of data from ATS, which is now moving into a new phase where the existing data can be used for answering more sophisticated questions about amblyopia and questions that may affect our clinical treatment of amblyopia.

Fresh Air, Exercise, and Myopia Risk

Also at this meeting, an interesting meta-analysis of 8 studies in myopia risk factors, Khawaja and associates^[6] demonstrated that exposure to outdoor activities seems to be protective for the development of myopia in young children. Fresh air and exercise have benefits in addition to preventing obesity, and one benefit of these outdoor activities in young children appears to be the reduced development of myopia.

Those were among some of the hot topics that we had here at the AAO and pediatric ophthalmology. Thanks for listening. This is Monte Mills for Medscape Ophthalmology Insights.