Pediatrics

Surgeons should review the new discoveries in orbital anatomy and consider expanding their surgical armamentarium to include surgery of the pulley system says one ophthalmologist.

Parents of children with amblyopia may have several reasons (or excuses) for not following a prescribed patching regimen. Ophthalmologists who are following the Pediatric Eye Disease Investigator Group guidelines but are not achieving the desired results, should first examine whether patients are adhering to the prescribed therapy.

The adequate management of posterior uveitis in children is difficult but imperative. Many treatment options exist, but to determine the best one for patients, it may be best to divide them into two groups at least initially: those with unilateral disease and those with bilateral disease. Treatment decisions then will follow, based on the severity of the disease.

Children with convergence insufficiency improved significantly more with office-based treatment plus home reinforcement compared with home-based or placebo office therapy, according to a study published in the October issue of Archives of Ophthalmology.

Significant changes in cylindrical measurements were observed following unilateral horizontal strabismus surgery in a retrospective study. In addition, investigators found clinically significant changes in a large number of operated eyes as well as a portion of control eyes.

Asking young athletes key questions during the eye exam or at the dispensing table can enable eye-care professionals to recommend the appropriate protective eyewear for children involved in sports.

Clinicians who have been wary of fitting younger children with soft contact lenses may want to consider findings from a three-year study of myopic progression.

A new pediatric patient can be more easily oriented into a practice with games, movies, and comfortable seating in the waiting room. Specialized equipment like fixation targets with small puppets placed on the end of the transmitter make the exam more like play time. Breaking the ice by talking to the child about his or her interests and joking will also help make a better experience for the child.

A new visual screening process (PediaVision) is available to pediatricians and can take less than 5 seconds to complete and can assist in the detection of refractive errors, media opacities, and other abnormalities.

Epinastine HCl 0.05% does not have a drying effect on the ocular surface and may be kinder to patients being treated for seasonal allergies and underlying dry eye disease.

Results of a pivotal phase III trial of a cyclosporine A product for the treatment of vernal conjunctivitis (VKC) in children showed that the drug improved symptoms and signs of the orphan disease, and tolerability was excellent, according to the manufacturer.

A pooled analysis of three randomized, double-masked, placebo-controlled, conjunctival allergen challenge trials demonstrates that once-daily treatment with olopatadine 0.2% (Pataday, Alcon Laboratories) is equally effective for improving ocular itching caused by exposure to indoor or outdoor allergens.

Epinastine HCl 0.05% does not have a drying effect on the ocular surface and may be kinder to patients being treated for seasonal allergies and underlying dry eye disease.

The hygiene hypothesis suggests that smaller family sizes as well as the use of antibiotics and vaccines has led to an allergy epidemic. Probiotics could reverse that epidemic and reduce the risk of developing atopic diseases and, potentially, nasal and ocular symptoms of respiratory allergies.

Las Vegas-Identification and pretreatment of allergy patients can improve refractive surgical outcomes, said Deepinder K. Dhaliwal, MD, at a continuing medical education symposium at the American Academy of Ophthalmology annual meeting. About 20% to 30% of refractive surgery patients have associated allergies, she added.

Las Vegas-Ocular allergies affect up to 40% of the pediatric population, and this high prevalence has ramifications beyond providing symptom relief, said Terry Kim, MD, during a continuing medical education symposium here at the annual meeting of the American Academy of Ophthalmology.

Baltimore-Beta blockers continue to play an important role as an ocular hypotensive agent for both primary and adjunctive treatment, and when a beta blocker is indicated, the novel formulation of timolol maleate 0.5% ophthalmic solution with potassium sorbate (Istalol, ISTA Pharmaceuticals) is a good choice, said Alan L. Robin, MD.

Las Vegas-In pediatric eyes with uncontrolled aphakic glaucoma and no history of previous surgical intervention, trabeculectomy with mitomycin-C (MMC) and placement of an Ahmed glaucoma implant (AGI, New World Medical) result in comparable outcomes with respect to successful IOP control and rate of complications, according to the findings of a prospective, randomized study undertaken at the Shaheed Beheshti Medical University, Tehran, Iran.

Ocular surface disease (OSD) in patients with glaucoma is surprisingly common, yet it remains an under-recognized condition by eye-care specialists. Among patients with severe OSD, approximately two-thirds concurrently are afflicted with glaucoma (range, 42.9% to 88.4%).1 OSD encompasses a myriad of ocular conditions, including keratoconjunctivitis sicca.

Irvine, CA-ISTA Pharmaceuticals Inc. has submitted an investigational new drug application with the FDA for its eye-drop formulation of bepotastine to treat allergic conjunctivitis.

Jersey City, NJ-Now that the 30-day waiting period has ended for the investigational new drug application filed by Lux Biosciences Inc. for the development of LX211 in uveitis, the company will begin three controlled, double-masked clinical trials of the next-generation calcineurin inhibitor in early 2007. The studies collectively will enroll more than 500 patients in North America and Europe.

Houston-Intestinal surgeries-such as gastric bypass, resections of the large and small bowel, and gallbladder removal-may interfere with the intestine's ability to absorb vitamin A, resulting in the potential for severe deficiencies and compromised vision.

New Paradigms

Pellucid marginal degeneration is a subtle condition that could lead to corneal ectasia following laser eye surgery. Although it is atypical and rare, clinicians should learn how to identify pellucid and screen patients for it preoperatively, said Yaron S. Rabinowitz, MD, director of ophthalmology research, Cedars Sinai Medical Center, Los Angeles.

Stockholm, Sweden-The Perfect Capsule (Milvella), a sealed capsule irrigation device, seems to be very useful in very small eyes for preventing posterior capsular opacification (PCO), according to Maria Kugelberg, MD, PhD.

Below is a partial list of the contributions made by researchers at the Jules Stein Eye Institute and the University of California, Los Angeles, over the past 40 years.

Las Vegas-Bausch & Lomb has received U.S. FDA approval to add a cold oxygen plasma treatment to the manufacturing process of gas permeable (GP) contact lenses made with Boston materials. B&L made the announcement recently at the American Optometric Association Congress and Annual American Optometric Student Association Conference.

Charleston, SC-Pediatric cataract surgery with IOL implantation and primary posterior capsulectomy plus vitrectomy is associated with a satisfactory outcome, especially in children operated on after their first birthday, said Rupal H. Trivedi, MD, MSCR.

New York-Cynthia L. Grosskreutz, MD, PhD, co-director of Glaucoma Service, Massachusetts Eye and Ear Infirmary, Boston, and assistant professor of ophthalmology, Harvard Medical School, Boston, received the New York Academy of Medicine's 2006 Lewis Rudini Glaucoma Prize for the discovery of an enzyme that contributes to nerve cell death in the eye in glaucoma.

Joseph L. Demer, MD, PhD, acknowledges that stunt flying makes even the pilot flying the plane sick. But for part of his 22 years of flying, Dr. Demer did stunts in the skies over California.