Community support and research continue to boost treatment in children
This article was reviewed by Richard W. Hertle, MD
New standards have emerged for treating visual diseases in pediatric populations during the previous two decades, thanks to community involvement and external funding of research, according to Richard W. Hertle, MD, who described the progress achieved in various diseases as a result of these factors.
Such progress is likely to continue in the future and spark continuing improvements in the treatment of a range of disorders.
Hertle is chief of pediatric ophthalmology and director of the Vision Center at Akron Children’s Hospital in Akron, Ohio, United States. He is also director of the hospital’s pediatric ophthalmology fellowship program, the Dr Robert “Boomer” and Jill Burstine Chair in pediatric ophthalmology, and a professor of surgery at Northeast Ohio Medical University in Rootstown, Ohio.
Retinopathy of prematurity
Numerous studies of retinopathy of prematurity (ROP) have evaluated interventions such as cryotherapy, supplemental oxygen, light reduction and early laser treatment, which reduced blindness caused by abnormal development of blood vessels in thousands of infants annually to about 500.
A more recent treatment is injection of intraocular bevacizumab (Avastin, Genentech), which, when compared with laser therapy, has been found by physicians to be equally efficacious, with the same long-term benefits and fewer adverse effects, Hertle said.2
The Pediatric Eye Disease Investigator Group in the US, a collaborative that conducts multicenter clinical research in strabismus, amblyopia and other diseases treated by pediatric ophthalmologists, functions internationally with hundreds of physicians. These trials, funded by more than $65 million raised since inception of the group in 1997, have developed new treatment protocols for strabismus, amblyopia, nasolacrimal duct obstruction, myopia, hyperopia and uveitis.3
Hertle further recounted major findings of this group that were not the standard of care before the clinical trials, including the following:
“The changes in the current standards of practice in common eye diseases are the result of these large clinical trials,” Hertle explained. “We are moving from anecdotes to the ability to practice rigorous ways to treat amblyopia and strabismus.”
The Infant Aphakia Treatment Study5 evaluated the use of an IOL compared with a contact lens during the first 6 months of life to treat unilateral congenital cataract. The results showed equal vision with both.
Children aged between 9 and younger than 18 years diagnosed with this disorder, which is present in 5–7% of children, were treated in a multicenter, randomized clinical trial6 to determine the effectiveness of four therapies: office-based vergence/accommodative therapy plus home reinforcement; home-based pencil push-ups; home-based computer vergence/ accommodative therapy and pencil push-ups; and office-based placebo therapy.
“The results showed that doing therapy in the office with home reinforcement was better than any other type of therapy, including pencil push-ups,” Hertle said. A separate convergence trial that included 221 patients showed that convergence therapy to treat attention and reading was ineffective for attention and reading and only helped convergence.6
When considering all the studies performed in thousands of patients with a variety of visual diseases, the community support was the most consequential factor.
“By allowing the family and their children to participate in these trials and the grants, gifts, endowments and time, we were able to progress in pediatric eye care,” Hertle said.