COMMENTARY

Pediatric Eye Disease Update

American Academy of Ophthalmology 2012

Monte D. Mills, MD

Disclosures

November 21, 2012

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Hello. I'm Dr. Monte Mills, Director of the Division of Ophthalmology at the Children's Hospital of Philadelphia. Welcome to Medscape Ophthalmology Insights. I am here at the Academy of Ophthalmology (AAO) meeting in Chicago, and I wanted to share some of the latest developments in pediatric ophthalmology from Pediatric Ophthalmology Subspecialty Day.

Retinopathy of Prematurity

First, I would like to talk about the detection and treatment of retinopathy of prematurity (ROP), as well as telemedicine approaches for ROP.

Detection. Deborah VanderVeen,[1] from the Children's Hospital of Boston reviewed the use of biometric information involving weight gain as a predictor of ROP. Two large studies that have now been published -- the PINT ROP study[2] and the WINROP study[3] -- have validated weight gain as a predictor of severe ROP risk. These studies developed algorithms that may be able to reduce the number of screening examinations that will be required in the future for babies at risk for ROP.

Telemedicine. Michael Chiang[4] from the University of Oregon reviewed the progressive development of tools that will allow telemedicine approaches for ROP. Many of the questions related to the cost, quality, and feasibility have already been resolved. Logistical problems related to real-world validation are currently being investigated in the E-ROP study, and reimbursement and workflow remain potential barriers in the future that need to be resolved for the adoption of telemedicine approaches for ROP.

Treatment. Graham Quinn[5] discussed alternative treatments for ROP. Many concerns remain about safety (both ocular safety and systemic safety) of anti-vascular endothelial growth factor (VEGF) treatment for ROP. Experience related to the long-term patterns of regression after anti-VEGF treatment, including late neovascularization and late retinal detachment, have been published. We don't yet know the long-term ocular outcomes with this treatment, and data are limited from clinical trials, so dosing, timing of treatment, and long-term safety are still unanswered questions about this treatment.

Other potentially innovative medical treatments were discussed by Bill Good[6] from the Smith-Kettlewell Eye Research Institute. These include beta-blockers and inositol. Multicenter trials are under development for these treatments.

Pediatric Retinal Degenerations

On the topic of pediatric retinal degenerations, Arlene Drack[7] from the University of Iowa and Richard Lewis[8] from the Baylor College of Medicine discussed the evaluation of children with inherited retinal degenerations.We have entered the age of gene therapy for these diseases, and our clinical evaluations need to involve early genotyping for these conditions. It's not enough any longer to do clinical classification and electroretinography, because the gene therapies are specific for each genotype.

Edwin Stone,[9] also from the University of Iowa, discussed the status of gene therapy for pediatric retinal degenerations. In addition to the current trials for the treatment of Leber congenital amaurosis, trials are under development for Stargardt disease, Usher syndrome, X-linked retinoschisis, and other retinal conditions. Early diagnosis and early genotyping will be very important because early treatment may improve outcomes with these new gene therapy treatments.

Pediatric Cataract

Finally, pediatric cataract was a topic of discussion. Sharon Freedman[10] from Duke University presented further analysis from the Infant Aphakia Treatment Study (IATS) which showed that the data continue to find no difference in visual outcomes between the infant cataracts treated with intraocular lenses and those treated with contact lenses. Both groups show increased risk for glaucoma associated with smaller corneas, earlier surgery, and persistent fetal vasculature-type of cataracts.

Thanks for joining us. This is Monte Mills for Medscape Ophthalmology Insights.

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