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OCT and IOLs are important developments in pediatric ophthalmology
In this report from the OSN Section Editor Summit, Robert S. Gold, MD, focuses on optical coherence tomography and the Infant Aphakia Treatment Study.
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A note from the editors:Ocular Surgery News convened its annual Section Editor Summit in February. In this installment of reports from the summit, Pediatrics/Strabismus Section Editor Robert S. Gold, MD, discusses OCT and IOLs in children.
Optical coherence tomography has the potential to become an increasingly important technology for certain pediatric ophthalmic patients.
Optical coherence tomography (OCT) is a noninvasive technology, unlike fluorescein angiogram, and it can be performed in children age 3 years and older. It is starting to have some indications with children who have slightly decreased vision but a normal fundus.
 Robert S. Gold |
In one of the latest publications in the Journal of Pediatric Ophthalmology and Strabismus, Shields, Singh and Shields discussed some of the new uses and ramifications of this great technology.
Dr. Jerry Shields compared OCT to a low-power histopathology, as it can identify retinal astrocytic tumors and evaluate retinoblastoma. OCT can differentiate between retinal astrocytic hamartomas, combined hamartomas and choroidal nevi, which may appear similar, as opposed to choroidal melanomas.
In children, OCT can play a role in looking at foveal health and determining a visual prognosis, particularly in children who have nystagmus, albinism or retinopathy of prematurity. OCT may reveal macular abnormalities, lesions after plaque radiation therapy or macular edema that is not readily seen by ophthalmoscopy. It is also useful in looking at retinal capillary hemangiomas.
In the future, OCT will have the cutting-edge application of looking at optic nerve lesions in children, as well as looking at the health of the optic nerve in pediatric glaucoma suspects. This will be especially useful in children on whom we cannot perform visual field testing.
Infant Aphakia Treatment Study
Another cutting-edge development in pediatrics is the Infant Aphakia Treatment Study, which attempts to determine when it is safe to place an IOL in a child.
Currently, most pediatric ophthalmologists put IOLs in children 2 years of age and older. Some put secondary implants in patients age 18 months or younger who are noncompliant with contact lenses.
In the Infant Aphakia Treatment Study, however, the participants are younger than 7 months old and are randomized to contacts or IOLs for unilateral congential cataract. It is wonderful to see the children getting IOLs at this young age, but we are obviously concerned with what may happen down the road.
The study, which has been going on for more than 2 years, is being coordinated by Scott Lambert, MD, a leading ophthalmologist at Emory University. Twelve centers in the United States are actively recruiting patients — they have 61 patients enrolled and the target is 114.
Next month
Look in our June 15 issue for a report from Jack T. Holladay, MD, MSEE, who will discuss corneal inlays.
For more information:
- Robert S. Gold, MD, is the OSN Pediatrics/Strabismus Section Editor. He can be reached at 225 W. State Road 434, Suite 111, Longwood, FL 32750; 407-767-6411; fax: 407-767-8160; e-mail: rsgeye@aol.com. Dr. Gold does not have any financial interest in the products mentioned.