ROP screening still tops the list of hot topics for pediatric

Other key issues include nystagmus surgical techniques and tear duct surgery.

ByRobert S. Gold, MD

Robert S. Gold

Optical coherence tomography has the potential to become a major tool for pediatric ophthalmologists, just as it is in other subspecialties. There are now many pediatric ophthalmologists who have these units, particularly among glaucoma and retina specialists.

In addition, we are using pachymetry measurements in pediatric patients, and as a result, we are getting more accurate IOP measurements. This development has actually decreased the amount of glaucoma we are diagnosing, especially in aphakic patients.

Another change we have seen is that plus disease in retinopathy of prematurity (ROP) is now recognized as an official indicator for more aggressive treatment of the disease. The results of the Early Treatment for Retinopathy of Prematurity Study have been known for many years, but it was not until recently that we started recognizing plus disease as warranting early and aggressive treatment.

Telemedicine screening

One of the most cutting-edge tools we now have is the art of telemedicine in rural areas where ophthalmologists are not located. This may pave the way for children in these remote places to get referred to treatment centers more rapidly and could help save their vision.

Everybody knows that Avastin (bevacizumab, Genentech) has changed retinal medicine and its therapy. There is no question that this is at the forefront of what is happening in pediatrics and in ROP. There have been numerous studies of the use of bevacizumab in severe ROP cases, including a recent presentation given by Alay S. Banker, MD, at the All India Ophthalmological Society meeting, which was reported on the OSN SuperSite.

Helen Mintz-Hittner, MD, of Houston also recently published results about bevacizumab for stage 3 ROP in a zone 1 or posterior zone 2 case. Multicenter studies are being planned for bevacizumab as a treatment for high-risk ROP cases.

Nystagmus, tear duct surgery

Surgery for nystagmus in pediatric ophthalmology is something that has been talked about for years, in particular by Richard W. Hertle, MD, and his group in Pittsburgh. Also, four-muscle tenotomy procedures are being investigated more and more, and it is possible that this will change the way that we treat nystagmus. Some of these children are debilitated, and some of these procedures, including the four-muscle tenotomy procedure, will decrease the amplitude and frequency of nystagmus, allowing these patients to see where they could not previously.

Tear duct surgery is going through different modalities. Pediatric ophthalmology is currently going through the process of deciding which approach is best: standard probes, balloon dilations or monocanalicular stents, which are extremely popular. There are also the new Crawford and Ritleng systems.

At the American Association for Pediatric Ophthalmology and Strabismus meeting in April, I am chairing the first wet lab allowing pediatric ophthalmologists to come in to a clinical laboratory setting and do procedures they may or may not be comfortable with. There will be approximately 30 people who will have the ability to get instruction on many different tear duct surgical techniques and get hands-on experience in performing them in the wet lab setting. We are very excited about it, and it is being sponsored by industry, including Quest Medical, FCI Ophthalmics and Rhein Medical.

For more information:

Robert S. Gold, MD, 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 is a paid consultant to Quest Medical.