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We ask leading experts in the field what eye disease they would cure and why.

Part 4: What if? Curing any eye disease with the snap of your finger

Viridian plans to submit a Biologics License Application (BLA) for VRDN-003 by year-end of 2026.

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Retinopathy of prematurity (ROP) expert C. Armitage Harper, III, MD, of the Austin Retina Associates in Austin, Texas, discusses his focus on treating ROP in infants across the globe, the gross inequity in ROP diagnosis and treatment between western countries and the rest of the world, as well efforts being made — and should be made — to prevent blindness in pre-term babies.

Retinopathy of prematurity expert C. Armitage Harper, III, MD, of the Austin Retina Associates in Austin, Texas, discusses his experience in treating ROP cases across the globe, and his mission to prevent pre-term blindness in infants. 

ROP: Treating and preventing blindness in preterm babies 

 Sheryl Stevenson speaks with Marc Mathias, MD, a retinal specialist from Children’s Hospital Colorado, who offers insight on managing cases of inherited retinal dystrophies in pediatric patients, as well as an update on the rapidly changing treatment landscape, thanks to ongoing clinical trials in novel IRD and genetic therapies.

Managing a changing landscape of IRD pediatric cases

Soroosh Behshad, MD, MPH, of the Emory Eye Center, speaks with 

David Hutton on the key takeaways from the presentation on, "Corneal crosslinking outcomes in children with progrssive keratoconus," during the 2020 ASCRS virtual meeting.
	
	

ASCRS

ASCRS 2020: Corneal CXL outcomes in children with progressive keratoconus

Long-term atropine use linked to higher risk of ocular complications in children

As myopia becomes a worldwide epidemic, the upcoming Paris workshop on September 8, 2025, will convene global leaders to discuss strategies, research priorities, and new treatment pathways.

Q&A: Inside the CCOI Myopia Workshop with Assoc Prof Daniel Ting

OCT changes with low-level red light therapy for myopia in children

Ocular salvage and preservation of vision are essentially dependent on early diagnosis, and several studies have been conducted to identify the factors leading to delayed diagnosis at presentation.

Study data show parental delay is biggest factor in late retinoblastoma diagnosis

Tubulointerstitial nephritis and uveitis: A multidisciplinary approach to diagnosing a rare disease

CCOI Myopia Workshop: Michael X. Repka, MD, MBA, on building consensus and future directions

In advance of the upcoming CCOI Myopia Workshop, scheduled for September 8 in Paris, France, Michael X. Repka, MD, MBA—program co-chair of the event and current president of the American Academy of Ophthalmology—spoke about the challenges and opportunities facing the field of myopia control. The Collaborative Community on Ophthalmic Innovation (CCOI) workshop will bring together clinicians, researchers, regulators, and industry leaders to address critical questions in research design, regulatory guidance, and treatment development.

Repka emphasized that the workshop will not be about providing fixed answers, but rather fostering dialogue that can guide future decisions. “We propose possible answers and let the audience try and come to consensus now and in the next few months on what kind of guidelines should be offered to people doing clinical trials design or industry interested in entering this area, as well as hopefully influencing the regulators,” he explained.

A central question in clinical trial design is duration. Repka reflected on past assumptions: “Ten years ago, when we looked at this, we sort of said 2 or 3 years—that’s good enough. But I think we’re learning that we may need longer follow-up, maybe not in the initial trial, but in follow-up of those patients.” He pointed to data from Singapore suggesting that initial optimism about halting progression may have been premature.

Long-term studies in myopia face hurdles common to many areas of research. Funding is an ongoing concern, as is the diversity of patient populations. “This is a big population that is somewhat heterogeneous around the world, and it’s hard to develop clinical trials that necessarily will hit all of the end points for each of those subgroups,” Repka said. Beyond research, industry involvement and cost considerations are essential, since effective therapies ultimately must be brought to market and priced at levels acceptable to patients and health systems.

One way to streamline progress, he suggested, is harmonization of standards across regions. “The fastest way, of course, is to have your end points laid out… getting regulators around the world to have similar end points, not necessarily the same end point, but similar… That harmony could very well help all of us, the researchers, the investment community, and our patients.”

Accessibility will also vary country to country, depending on insurance structures and willingness of doctors to prescribe new treatments. Broad adoption, Repka noted, will depend on parental demand and movement away from niche or “boutique” treatments toward mainstream care.

Looking ahead, Repka highlighted both pharmacologic and device-based approaches. Atropine eye drops have shown “some effectiveness,” though optimal dosing remains under study. Novel lens designs and contact lenses also hold promise, but more outcome data is needed in Western populations. Extending their use safely to younger children will be an important next step.

Ultimately, the workshop is meant to accelerate consensus-building. As Repka put it, live discussion “can really distill a lot of, if you will, email conversations over years into an output of a few weeks.” He underscored the growing importance of myopia, long considered a “stepchild of medical eye care,” but increasingly linked to significant long-term complications. The goal, he said, is clear: “Show that you get a benefit now and probably that translates into a benefit decades from now.”

To register or learn more about the CCOI Myopia Workshop, click 

Ahead of the September 8 meeting in Paris, the program co-chair of the event and current president of the American Academy of Ophthalmology discusses how the workshop aims to shape consensus on guidelines, research priorities, and emerging therapies in myopia control.

CCS 2025: Prethy Rao, MD

Editor's note: The below transcript has been lightly edited for clarity.

So you are presenting at 2 sessions during CCS this year. Let's start with the one that is collaborative retinal disease management in the preoperative cataract refractive surgery patient. As we talk about this presentation, what are a few key takeaways, or points, you hope to make?

Yeah, I think a few points, you know, retinal pathology in patients that are getting refractive surgery is always complicated. That discussion is not easy, because you have a patient sitting there, and they really want to see 20/20, and they don't want to wear glasses, and so that conversation is hard. A few things to consider in patients that are considering refractive surgery are if they've had retina surgery in the past. So patients that have had vitrectomies or scleral buckles, typically the cataract, the lens pathology, and their zonules are a lot weaker. So these eyes tend to have a higher risk of having dislocated lenses after surgery. 

So typically these patients, when they're being counseled, we really recommend them doing—if they're doing a clear lens extraction—a 3-piece lens and a monofocal lens. Because already these patients have distortion from their retinal detachment. So that's one thing to consider. Other patients that are highly myopic and younger typically have retinal holes or lattice degeneration. So there's no good data on the risk of retinal detachments after refractive surgery in younger patients like LASIK or PRK. But some high risk features that we typically recommend treatment for is if a patient was born premature and they have lattice-like degeneration, or if they have a high family history of retinal tears, retinal detachments, like everyone in their family had detachments. We would recommend treating those lattice and retinal holes before their refractive surgery. 

So those are the main kind of key points. Other things, other pathology, such as epiretinal membranes or myopic maculapathy changes like retinoschisis, those patients tend to have a little bit of distortion to begin with. So I typically recommend them avoiding multifocal lenses, because oftentimes they end up becoming more symptomatic after their multifocal lens with more distortion. And the last point is patients that have floaters are always going to have floaters. The multifocal refractive lenses end up causing patients to be more symptomatic from their floaters after surgery. So as long as you know the refractive surgeon is discussing that with the patients with multifocal lenses, that's the most important, so they know what to expect.

And then I see that in this presentation, you are kind of aligned with an OD. So when it comes to the management of retinal diseases or having these surgical conversations. How do you see opportunities for optometrists and ophthalmologists to work together?

Yeah, I actually thought this was a great opportunity to be of work with Dr Majcher. We had a really nice discussion about different interesting cases, and she was saying how, oh yeah, she sees a lot of myopic patients. One thing she didn't consider was, you know, like the zonule weakness and these refractive surgery cases. 

So I actually really love this collaborative opportunity, and I learned a lot of things from her in terms of how she counsels her patients when she's seeing these patients in the office, and what things to consider. Something as a retina surgeon, we just focus on the retina. So it's just really nice to be able to do that, and I hope–I feel like we should be able to do that more with our optometry colleagues, our comprehensive colleagues, and I think it's really better for the patient.

So kind of switching gears into the other presentation that's surrounding myopia. What are some of the tools that we have in our toolbox today to manage myopia that you hope to talk about in this.

Yeah, so you know, I'm going to definitely defer to our optometry colleagues, Dr Bullimore and Tamiyama, they're a great resource for that. But I know a lot of things that they're going to be talking about is contact lens use orthokeratology, atropine drops, you know, all these things that parents can do at home to kind of slow the myopia progression. I think the choice really depends on how compliant and easy it is for the parents and the kid to do that. So that's one thing to consider. From the retina standpoint, you know, I think optos imaging for color fundus photography has really revolutionized how we treat myopic patients. 

A lot of these patients are younger and highly active, and a lot of them are kids, so it's really hard to get a good exam in the office. So the optos imaging is really helpful in determining retinal pathology in the periphery that you just can't get in a brief view in a kid. So an example of optos imaging that would be helpful is to identify the high risk pathology, like high risk lattice in the periphery that are associated with genetic conditions or retinopathy of prematurity. So by identifying those kids ahead of time, you know that not only do you have to talk about myopia management from the refractive standpoint, you need to kind of look at their risk level of retinal detachment and be able to refer appropriately. And I think that's where optos imaging is really helpful.

Certainly on the more topical side of things, there are some clinical trials in the works, potential treatments down the line. What further imaging might be available, or what do you wish the imaging could do in the future to help you better understand these patients?

Yeah, I think if we had a good imaging tool to be able to measure the rate of axial elongation or the rate of retinal thinning, I mean, that would be a game changer. If we can identify kids and young adults that are fast progressors from myopia versus slow progressors, I think that would be really good for us to know what their risk level is for retinal detachments. So if we have a tool that could be similar to an optos, you'd be able to get it in 5 seconds. That would be super helpful. And then really looking at the retinal pathology in the periphery. So there's ultra wide field OCT imaging that's in the works that help identify premature kids and their risk of developing retinal tears by observing how thin the retina is over time. So that would be helpful too.

What do you wish eye care professionals, maybe outside of the retina space, or kind of just broadly knew about myopia that maybe they don't always consider?

I think the main thing is that for every increase in diopter of these patients, they have a higher risk of developing like retinal pathology. And a lot of times these myopic patients have retinal detachment risk factors. For example, a lot of these kids have been born premature, but they don't know it, and they were never treated. So in those cases, they have a higher risk of getting retinal tears or detachment. 

So something that we don't think about is their risk of detachment. And a lot of these conditions that are patients that are highly myopic have genetic conditions. So if we can identify these patients a lot sooner, we can actually reduce the risk of detaching. Genetic conditions increase the risk of detachments by 50%. And if you develop a detachment in one eye you're 80% chance of developing in the in the fellow eye. So if you can identify these patients and prophylactically treat them with laser, I mean, you're saving that kid, young adult's life and their eyes really.

When we talk about early intervention and we talk about these being young children, what's kind of the youngest that you or an optometrist or someone might see? At what point should kids be seen if they were premature or if they may have some genetic risk factors?

Yeah, I think that's the hard part. I would say for prematurity. I mean, I think any kid that was born premature should be screened as early as possible. So as soon as that mom and dad go home and they're able to, you know, sleep well enough to bring them in for an eye exam. I think that would be the best bet, because you really can't tell in some kids how fast their myopia will progress. So I think the earlier you can screen them and get that, you know, get that gauge of how fast they're progressing would be helpful. 

Again, a lot of kids that are born premature, they never fully vascularize in the retina, in the peripheral part of the vision, so the retina ends up being a lot thinner, and that makes them more prone to getting tears. Almost a 30 to 50% chance. So the sooner we can screen babies and follow, the more time that would be good.

And then from the retina side of things, how often are you seeing young children being brought in? Like, the eye exam might be done in an optometrist office, but what's the age that you sometimes get referred into?

I think it varies. I think if there's a strong family history of a retinal detachments, parents are really good at bringing in kids. Like, I've seen kids when they're like, three months old, and we know they have a genetic mutation. So those are great families, because they just know the risk. But the reality is, most kids don't come until later, when they fail an eye exam at school and someone tells them that they have a kid has a retinal detachment, but they don't know how long it's been there. Because kids don't tell us if they can't see, because their other eye is functioning. So oftentimes I see them once they hit the school age, usually kindergarten or first grade, when they're actually getting, like, vision screenings in school. 

So I almost think that we need to start that earlier, at a preschool age, or have that be a part of a normal newborn screening exam to be able to follow these kids a lot sooner. So I think the biggest thing that people need to be aware of is people that have myopia may have a genetic condition or have high risk factor for having retinal tears or detachments and lattice degeneration doesn't mean that we can watch it and leave alone. There's high risk features that we need to identify in these patients, like periovascular lattice or lattice associated with a vascular retina. Those are the highest risks of having a genetic condition or leading to tears and detachments. And I think we all need to be a little bit vigilant when we're seeing these myopic patients, because they're not going to know that they were born premature, unless you specifically ask them. So I think that's the biggest thing.

CCS 2025: Collaborative retinal disease management in the preoperative cataract/refrative surgery patient

ARVO 2025 Hsin-Yu Yang

At ARVO 2025, in Salt Lake City, Utah, Hsin-Yu Yang talked about the 9-month results from her study on the effectiveness of DIMS spectral lenses in myopic retardation for the pre-myopic preschoolers in Taiwan. 

Hello, I'm Hsin-Yu Yang from Taipei Veterans General Hospital in Yuanshan branch, and it's my pleasure to introduce my study. My study is effectiveness of DIMS spectral lenses in myopic retardation for the pre-myopic preschoolers pilot study for nine months. Instead of treating the children who has already been myopic, in this study, we are trying to focus on the children who are not myopic yet, but they are in a high risk of developing myopia in the future. So in this study, we choose pre-myopic children, most of them with a history of parental myopia, which is a strong risk factor of developing myopia in the near future. We recruited 24 children in this study, we asked them to wear the plain old photochromic DIMS lens spectacles part-time, especially at [inaudible] for nine months.

First, we will check if the compliance is good, and then we have some myopic parameters to check if there is good control of myopia. And also we will calculate the incidence of myopia over nine months. The result turns out to be nice with this pilot study, as the spherical equivalent is stable with mild hyperopic shift over nine months. And the second, the compliance of wearing glasses for these pre-myoptic children is good. As there is not a big complaint or anything that is troublesome for them, and the parents agree to keep wearing these DIMS spectacles longer. At last, the instance of myopia after wearing the spectacles is very low, and the children will keep wearing it, and we will see what will happen in the future.

Yeah, about the inclusion criteria first, because we want to intervene for the children who are younger, because for younger children who will develop myopia earlier, it will become high myopia, usually in the future. So we focus on the children who is aged five to seven years old, and their [inaudible] vertical equivalent is around plus one to minus .75 which is a definition of IMI for pre-myopia. And the third, they should have good vision without significant astigmatism or some other ocular disease.

Okay, because our children are preschoolers, so they don't go to elementary school. They go to preschool or kindergartens. Their lifestyle, usually they don't write, but they go outside, outdoor activities. They are drawing like something, but usually in a Taiwanese setting, after elementary school, there will be a strong rise of myopia, or myopic shift afterwards, because there is increased scholar burden, homework and exams. So why we want to intervene is to change that, to preserve their hyperopic reservation beforehand, just to maintain the hyperopic reservation as more as possible. Because these children are in a kindergarten, so first we ask them to wear the glasses for just part-time, especially at near work. But after entering elementary school the next year, as our study, we will ask them to wear full-time, as there is a sudden rise of the risk of myopia development and some near work increase. So at the first year, we will ask them to wear part-time, like our study results like this and the second year will ask them to wear full-time, including the daytime, afternoon and evening.

At ARVO 2025, in Salt Lake City, Utah, Hsin-Yu Yang talked about the 9-month results from her study on the effectiveness of DIMS spectral lenses in myopic retardation for the pre-myopic preschoolers in Taiwan.

ARVO 2025: Efficacy of DIMS lenses in slowing myopic shifts among pre-myopic preschoolers

ARVO 2025 Noemi Guemes-Villahoz, MD, PhD

At ARVO 2025, in Salt Lake City, Utah, Noemi Guemes-Villahoz, MD, PhD, talked about 12-month results of vision-related quality of life in myopic children using combination treatment with atropine and DIMS (Defocus Incorporated Multiple Segments) spectacle lenses.

Hello. My name is Noemi Guemes. I am an ophthalmologist. I work in hospital clinical San Carlos in Madrid, Spain. This hospital is a tertiary hospital that belongs to the public health care system, and we are here presenting our work. This is a randomized control trial. The aim of this randomized control trial is to evaluate and compare the efficacy of combination treatment with atropine eye drops, 0.025 percent and single vision lenses compared to atropine eye drops and DIMS spectacle lenses. 

We included 2 groups. One group of children, myopic children, is wearing atropine eyedrops plus single vision. The other atropine eye drops with DIMS lenses. Both of the groups were using atropine 0.025 percent. This is a 2-year randomized control trial, and we are presenting the results for the 1 year follow-up. What we found is that the axial length increased less in the combination group. The increase was 0.07 millimeters versus 0.18 millimeters in the monotherapy group. However, in terms of spherical equivalent refraction, we did find some differences. So the combination treatment progressed less. However, those differences were not significant, statistically significant. Additionally, we found that almost 4 out of 10 children in the combination group had no progression in terms of axial length over 12 months. This study has a lot of implications for clinical practice, but also, this is the first randomized control trial that evaluates combination treatment in European children. So the implications for this is, nowadays myopic children need to wear glasses either way, so we use atropine as well. So it's very nice to combine both treatments together, especially if we are going to get better efficacy.

ARVO 2025: 12-month results  in myopic children using combination treatment of atropine and DIMS spectacle lenses

Barsha Lal, PhD, discusses the way low dose atropine affects accommodative amplitude and dynamics at the 2025 ARVO meeting

Barsha Lal, PhD, is a post-doctoral researcher at the University of Houston, where she works with Lisa Ostrin, OD, PhD, FAAO, FARVO. At the Association for Research in Vision and Ophthalmology (ARVO) meeting, Dr.  Lal met with the Eye Care Network to present recent findings in myopia management.

In Prof. Ostrin's lab, Dr. Lal and colleagues are researching low-dose atropine. The aim of the study Dr. Lal presented at ARVO was to look at the 1-hour and 24-hour effects of low-dose atropine on exudative and accommodative parameters.

"The participants and the examiner both were masked to the drops, what were being put in their eyes," Dr. Lal said. "We wanted to see [if] these parameters, especially accommodation and exudative, are they changing in that 1 hour and 24 hour duration?"

Dr. Lal noted that the static part of the accommodation was measured using the Grand Seiko WAM-5500, a binocular autorefractor/keratometer, while the dynamic accommodation was measured using a power refractor. the axial length was measured using the MYAH instrument from Topcon. "It is important that we give you the details of the instruments, because it will tell you how refined our measurements were," Dr. Lal said.

Based on the measurements, Dr. Lal said, the investigators could confidently say that axial length will not change from a single atropine drop over 24 hours. But static accommodation was likely to change, and dynamic accommodation only changed in some cases, she reported. 

"The results from this study can be directly applied to clinical patients," Dr. Lal explained. "We have seen in literature that there are studies that says that atropine will cause pupil dilation, it will affect accommodation. But nobody tells you, what a child is facing on day-to-day basis...It's very important for [patients and parents] to know what will happen to them on a daily basis, what kind of problems they're facing. This study can directly relate to that."

A one-drop, low dose atropine study assesses accommodative amplitude and dynamics, with clinically applicable findings.

ARVO 2025: Barsha Lal, PhD, presents an atropine study that addresses families' accomodative concerns

Maanasa Indaram, MD, is the medical director of the pediatric ophthalmology and adult strabismus division at University of California San Francisco, and spoke about corneal crosslinking (CXL) at the 2025 ASCRS annual meeting

Maanasa Indaram, MD, is the medical director of the pediatric ophthalmology and adult strabismus division at University of California San Francisco. At the American Society of Cataract and Refractive Surgery (ASCRS) meeting, she presented findings from a study on the treatment of keratoconus using corneal cross-linking under general anesthesia. 

In the study findings presented at the ASCRS annual meeting, the investigators showed that, at the 3-year mark, patients' keratometry values remained stable and visual acuity stayed the same or improved. Importantly, there were no permanent complications from anesthesia. "The few complications that we did have were ones that we often see in crosslinking, that can [occur] without general anesthesia," Dr. Indaram said. Minor issues such as persistent epithelial defects resolved within 2 weeks, and instances of corneal haze resolved within 2 years, she said.

The study confirmed the safety and effectiveness of the procedure for pediatric patients or those with neurocognitive disabilities, she said. "General anesthesia is very, very important in this particular population, which actually will have the highest rate of progression and visual significance," Dr. Indaram emphasized.

ASCRS 2025: Maanasa Indaram, MD, offers guidance for general anesthesia in pediatric corneal crosslinking

Envision Summit 2025: Pearls for Pediatric Cataract Surgery

At the Envision Summit 2025 in San Juan, Puerto Rico, Angela Zhu, MD, offered advice on cataract surgery for all ages, focusing on pediatrics.

Hi everyone. My name is Angela Zhu. I'm an assistant professor of clinical ophthalmology at Bascom Palmer Institute and University of Miami in Miami, Florida. I am here in lovely San Juan, Puerto Rico as part of the Envision Summit 2025, and am speaking as part of the cataract and refractive surgery section. And for that, since I'm a pediatric and adult cornea and cataract specialist, I'm actually giving some tips for pediatric cataract surgery. So I'm proud to be a part of a really esteemed group of specialists from around the country, around the world, even. And the goal is to really share some of the newer insights that we have on cataract surgery for all ages.

So for my talk, specifically, I'll be giving some tips for cataract surgery evereverywhere,m infants to adults, in all different morphologies. Depending on the age of the patient, your priorities really differ. So from infancy, some of your goals may be more visual development. So the goal is really to clear the cataract more so than kind of prioritize refractive correction from an IOL standpoint. But then as you get older into the teenage and later adolescent years, you really start to prioritize visual rehabilitation, because the type of cataracts that you usually see in those ages differ. And then additional factors may play into your decision making, such as history of trauma as a cause of cataracts, or any systemic conditions, syndromes, that may also affect the patient's healing. So all of those things are key things to keep in mind, but really, really important for any pediatric cataract, the main thing is preoperative examination, so that you know what you're dealing with and what to plan for.

Envision Summit 2025: Pearls for pediatric cataract surgery

Envision Summit: Challenges in Pediatric Retinal Detachments Secondary to Trauma

At the Envision Summit 2025 in San Juan, Puerto Rico, Nita Valikodath, MD, MS, gave insight into a challenging case of a 14-year-old boy who had trauma-related retinal detachment in his right eye, where a further macula-on retinal detachment with retinal dialysis was found in the left. 

My name is Nita Valikodath. I'm a clinical assistant professor at the Kellogg Eye Center at the University of Michigan. I presented a surgical challenge that I think many of us in retina have encountered before. This was a case of a 14 year old boy who had trauma related retinal detachment. He was referred to me actually for a funnel retinal detachment in the right eye, but during my exam, I found a macula-on retinal detachment with retinal dialysis in his left eye. So the priority for the case was to address that left eye, which is his better seeing eye, as quickly as possible. Due to his brother, who had other health issues, the family couldn't do surgery until nine days later. And this was challenging, because unfortunately, by the time we got to the exam under anesthesia, his good eye, with the macula-on detachment, had progressed to a total retinal detachment with proliferative intraretinopathy. There was also a starting cataract that was forming. So completely changed the game in terms of our surgical plan.

I think takeaways from this presentation is one, we can be surprised at the time of surgery, and we need to be prepared for anything. Things that we see in clinic may not be what happens at the time of surgery. So making sure that you update the anesthesia team, your nursing team, your circulators, everyone to make sure that we have all the equipment that we need. This is a child. It's going to be a significantly longer surgery, given now that we have to do a scleral buckle and vitrectomy, possible lensectomy. So trying to optimize everything before surgery and before the patient is under anesthesia.

The other challenge, and take away from this is longer operating times can mean deteriorating views, and that was certainly a challenge in this case. And as we saw in the video, there were several membranes that we needed to peel. The decision was made to convert to a bimanual technique very early on in the case, to save the cornea essentially. We didn't end up doing a lensectomy. I felt we had a good enough view to be able to complete the surgery. We wanted to keep the lens in a child as often as we can, if possible. But unfortunately, there was subretinal PFO. Thankfully, it was out of the fovea, and it migrated out of the retina later on in the case. He did develop a visually significant cataract later, which we had to address at a later time.

Another takeaway is that this is a monocular patient, and to try to do things quickly. Unfortunately, in this case, the patient's family didn't have a cell phone or land line. To be able to contact them, we had to rely through a friend that contacted the patient, and so that made it also challenging to try to optimize care. This was a very humbling experience. I think all of us have encountered this in our training and in our career. This type of case can happen at any time. Something that I learned is just trying to be on top of contacting everyone that you can, trying multiple times to contact the family and get the patient to surgery quickly, but also being cognizant that there are other life factors that happen. In this case, the patient's family had a more emergent situation that needed to be taken care of and to be prepared as best as you can for the type of surgery that you'll be doing.

When complications or challenges like this happen, being very transparent with the family about what happened, what you've tried to do. So in terms of the delay in care, just not making them feel at fault because they're already going through so much with their other son and now this patient, and just trying to be as supportive as you can, but also being transparent and very clear about what the visual prognosis is in these cases.

Envision Summit 2025: Surgical challenges of a pediatric retinal detachment secondary to trauma

Dean McGee Eye Institute resident Ashley Ooms, MD, explores gray area strabismus surgery complications in AUPO poster

Ophthalmology resident Ashley Ooms, MD, PGY-4, at the Dean McGee Eye Institute/University of Oklahoma Department of Ophthalmology, Oklahoma City, presented research updates in a poster

 titled ‘Trainee perspectives on gray area surgical complications of strabismus surgery’ at the Association of University Professors of Ophthalmology (AUPO) 59th Annual Meeting, held in Fort Lauderdale, Florida, from January 29 to February 1, 2025.

Gray area complications in strabismus surgery are a nuanced topic, as highlighted in a recent study exploring how trainees and attending physicians approach them. The study sought to understand these perspectives by surveying 151 attendings and 32 trainees via AUPO, American Association for Pediatric Ophthalmology and Strabismus (AAPOS), and North American Neuro-Ophthalmology Society (NANOS) listservs. Respondents evaluated 11 scenarios using Likert scales to gauge their likelihood of gray area surgical complications causing postoperative problems, disclosure to patients, and inclusion in operative reports. Notably, trainees were significantly more likely than attendings to believe that gray area complications could lead to postoperative issues, and they were more inclined to disclose such events to patients and document them.

Interestingly, despite these differences, baseline anxiety levels regarding gray area complications were similar between trainees and attendings, Ooms noted. One hypothesis is that trainees lack the extensive experience of attendings, limiting their exposure to long-term outcomes. “We’re only on rotations five, maybe 10 weeks at a time, so we don’t get to see how these complications are managed for the full time.”

The implications are significant for surgical education. “This is a topic that probably needs more investigation,” with the ultimate goal of creating clearer guidelines. As Ooms noted, “Hopefully we can use this data to help make our trainees better strabismus surgeons for the future.”

Future research, including a planned presentation during AAPOS, which will be held March 5 to 9 in Salt Lake City, Utah, will focus on cases with inconsistent management practices, aiming to establish guidelines for addressing gray area complications. Ultimately, these efforts aim to enhance the training of future strabismus surgeons.

Ooms also spoke with enthusiasm for the pediatric ophthalmology specialty, valuing its diverse challenges and the joy of working with children.

Ooms A, Blakley M, Szymanski M, Melson A, Yanovitch T. Trainee perspectives on gray area surgical complications of strabismus surgery. Poster presented at: Association of University Professors of Ophthalmology 59th Annual Meeting; January 29–February 1, 2025; Fort Lauderdale, Florida.

Ooms' poster at the Association of University Professors of Ophthalmology annual meeting highlighted a study on gray area complications in strabismus surgery, showing that trainees are more likely than attendings to disclose these complications despite having similar baseline anxiety levels. Ooms is a PGY-4 ophthalmology resident at the Dean McGee Eye Institute.



DMEI resident Ashley Ooms, MD, explores gray area strabismus surgery complications in AUPO poster

Dr. Lotfi Merabet, who recently had the chance to serve as co-chairman of a National Eye Institute initiative to promote research in cerebral visual impairment. 

Lotfi Merabet, OD, PhD, MPH discusses National Eye Institute initiative on cerebral visual impairment

. Joining me today is Dr. Lotfi Merabet, who recently had the chance to serve as co-chairman of a National Eye Institute initiative to promote research in cerebral visual impairment. Thanks for joining me. First, can you describe the primary goals of the NEI initiative on CVI and how it aims to advance research in this area?

Hello, David. Thank you very much for the opportunity to speak to you today. I would say there are really 3 main objectives for this recent NEI workshop. The first is to raise awareness for the condition of cerebral cortical visual impairment. And then the second, I would say, is to establish a series of definitions/diagnostic criteria that we can use for the care of individuals with CVI. Saying the third main initiative would be to establish a registry, a national registry, that will be important for identifying children or individuals with CVI, their criteria, the diagnostic criteria that was used, and at the same time follow these individuals over time to get a sense of the natural history of the condition as well.

The National Eye Institute's initiative on cerebral visual impairment (CVI) aims to raise awareness, establish diagnostic criteria, and create a national registry for CVI. It emphasizes multidisciplinary collaboration among neuroscientists, ophthalmologists, and other specialists to address the complex nature of CVI. Public awareness and education are crucial, given the shift in visual impairment causes in children. Challenges in diagnosing CVI include the lack of universal protocols and the condition's heterogeneity. Emerging technologies like eye tracking and virtual reality hold promise for improving understanding and treatment.

Lotfi Merabet, OD, PhD, MPH, discusses his role as co-chairman of a National Eye Institute initiative focused on advancing research in cerebral visual impairment (CVI). The initiative's key goals include raising awareness about CVI, establishing clear diagnostic criteria, and developing a national registry to track patients and their conditions over time. CVI, a complex condition that affects how the brain processes visual information, requires a multidisciplinary approach involving not only ophthalmologists and optometrists but also neuroscientists, educators, and rehabilitation specialists.

Pediatrics

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