Marcia Frellick

October 21, 2016

CHICAGO — One in every two babies with congenital Zika syndrome can have ocular findings related to the virus, experts said here at the American Academy of Ophthalmology 2016 Annual Meeting.

"Mothers infected in the first trimester have more chance of having a baby with ocular findings," said Camila Ventura, MD, PhD, an ophthalmologist from the Altino Ventura Foundation in Recife, Brazil.

And "babies born with a smaller head circumference also have a higher chance of having ocular findings," she reported.

Although there have been reports of damage to the retina, the optic nerve, and the retinal vessels, the most common finding is a scar in the macula, said Dr Ventura.

The connection between Zika and eye problems was first made in Recife, after the four neonatal intensive care units began to see babies born with microcephaly.

"Because we were screening for retinopathy of prematurity, we started detecting ocular findings in these babies. One month later, we were able to prove the association between Zika and microcephaly," Dr Ventura explained.

Reports began to flood the media about microcephaly, but "that was just the tip of the iceberg," she said. "Now we know this is a syndrome. There is no doubt that Zika is causing a syndrome and it involves not only neurologic findings, but also hearing deficits, ocular findings, and skeletal findings."

Optic nerve hypoplasia is being seen in more patients. "We are thinking the next steps are to analyze the optic nerves of these babies to try to determine when in the embryologic period this is happening and when it's triggering the effects in these babies' eyes," she added.

It is not clear at the moment whether the virus can reactivate, she pointed out.

Need for Testing Beyond Microcephaly

Zika is on the radar of most ophthalmologists, but the extent of ocular related issues might not be.

"We're seeing from the team in Brazil how important it is to consider not just evaluating microcephalic infants but also infants born to mothers exposed to Zika in their pregnancy," said Steven Yeh, MD, from the Emory Eye Center in Atlanta.

"The group out of Bascom Palmer Eye Institute in Miami is also starting to see these eye-related findings associated with Zika," he told Medscape Medical News.

"With microcephalic infants, we know there can be retinal abnormalities, but in adults who are infected with Zika, there have been reports of uveitis," Dr Yeh pointed out.

Rubella, the last virus to cause an epidemic of congenital defects, was more than 50 years ago, said Sonja Rasmussen, MD, director of the Division of Public Health Information Dissemination at the Centers for Disease Control and Prevention (CDC).

An ophthalmologist identified congenital rubella syndrome on the basis of cataracts, she said. That phenotype was later expanded to include hearing loss and heart defects.

As of last week, Zika was in 59 countries and territories, including 49 in the Americas. Dr Sonja Rasmussen

The scope of the Zika is extensive. "As of last week, Zika was in 59 countries and territories, including 49 in the Americas," Dr Rasmussen reported.

The latest figures show that more than 800 pregnant women in the United States are infected with Zika, and most of these infections are related to travel or sexual transmission. In Puerto Rico and the other territories, more than 1800 pregnant women are infected.

There's no vaccine and no specific antiviral treatment, so the current goal is to treat the symptoms, said Dr Rasmussen.

Poverty Plays a Role

It is important not to forget the "cause of the causes," said Rubens Belfort Jr, MD, PhD, head professor of ophthalmology at the Federal University of Sao Paulo.

"This is related to poverty," he explained. "And we as ophthalmologists should emphasize the importance of addressing the social aspects."

Care for affected children is complex and expensive. "Often what the whole family receives per month is less than what they need to purchase their milk," he reported.

A camera to scan the retina currently costs more than $100,000, which points to the need for affordable equipment options.

Zika, in many aspects, is like HIV. It is here to stay, and we'll be dealing with it for a long time. Dr Rubens Belfort Jr

It is premature to expect a vaccine, Dr Belfort added. "Zika, in many aspects, is like HIV. It is here to stay, and we'll be dealing with it for a long time. Don't expect a miracle in the short term."

The development of a Zika vaccine and testing for the virus are complicated by the fact that human antibody responses after infection with the dengue, yellow fever, and chikungunya viruses are highly cross-reactive to Zika.

"A lot of chikungunya diagnosed in Brazil last year was misdiagnosed as Zika," Dr Belfort pointed out.

Dr Ventura and Dr Rasmussen have disclosed no relevant financial relationships. Dr Yeh reports receiving consultant fees from Clearside and Santen. Dr Belfort reports receiving support or consultant fees from AbbVie, Alcon Laboratories, Allergan, Novartis Pharmaceuticals, Ophthalmos, Ophthotec, Roche, and Santen.

American Academy of Ophthalmology (AAO) 2016 Annual Meeting: Symposium SYM61. Presented October 10, 2016.

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