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New treatments being evaluated for management of pediatric ophthalmic diseases
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NEW YORK — Citing current literature and studies, a speaker here said that strides are being made in the diagnosis, treatment and management of pediatric ophthalmic diseases.
“Anti-VEGF is not the standard of care, but it does have a role in the treatment of ROP,” Rudolph S. Wagner, MD, OSN Pediatrics/Strabismus Board Member, said at OSN New York 2012. “But proper informed consent by parents or guardians is critical in these treatments.”
Citing the ETROP and BEAT-ROP studies, Wagner said intravitreal anti-VEGF agents may be promising treatments for retinopathy of prematurity.
At this time, though, 0.625 mg in 0.025 mL intravitreal Avastin (bevacizumab, Genentech) has demonstrated superiority over conventional laser for only zone 1, stage 3 ROP. Recurrence of ROP may still occur late in the treatment course, he said, and the ideal dose amount is still in question.
Intravitreal Lucentis (ranibizumab, Genentech) may also be a promising ROP treatment because it has more rapid systemic clearance than bevacizumab, he said.
Wagner also reported on the treatment of amblyopia in the PEDIG studies. He said glasses are the most effective initial tool for disease management, and physicians should wait a few months before starting occlusion or pharmacological penalization.
Occlusion provides equally successful results as atropine in children aged 3 to 6 years with moderate amblyopia, Wagner said, and no advantage exists in patching a child with amblyopia for 2 hours vs. 6 hours.
According to Wagner, a low dose of atropine for the treatment of myopia is as effective as a higher dose and is not associated with reduced near vision, loss of accommodation or increased pupil size.
Exophoria, caused by a conflict between convergence eye movement and accommodation, decreased fusional amplitude, and an excessive image disparity, may be the largest implication for 3-D asthenopia in children experiencing discomfort induced by viewing 3-D images, Wagner reported.
Disclosure: Wagner is on the speakers bureau for Alcon.