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    <recommendedItem id="20090101_19_3457"
                     title="AAO: Mixed Results for Pediatric Eye Surgery (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAO/tb/16687?impressionId=1265793335247"
                     
      &lt;p&gt;SAN FRANCISCO  --  Refractive surgery provides good long-term outcomes for children and young teens when lasers are used to correct anisometropia, but problems arise over time after lens implantation, according to separate studies reported here.&lt;/p&gt;
&lt;p&gt;Lasik in children ages 8 to 15 appeared to maintain safety and efficacy up to 12 years later, according to researchers led by Belquiz Nassaralla, MD, PhD, of Brazil&apos;s Goiania Eye Institute.&lt;/p&gt;
&lt;p&gt;Another study reported here at the American Academy of Ophthalmology meeting suggested that all lens types implanted for pediatric cataract are eventually plagued by a higher-than-expected rate of posterior capsule opacification, necessitating Nd:YAG laser treatment.&lt;/p&gt;
&lt;p&gt;&quot;The problem is treating people who still have 70 years ahead of them,&quot; Nassaralla said.&lt;/p&gt;
&lt;p&gt;In her study, Lasik was used to treat nine children who had a difference greater than 3.5 diopters between their two eyes, secondary to high myopia, or myopic astigmatism.&lt;/p&gt;
&lt;p&gt;Nassaralla cautioned that these findings were in carefully selected patients, not a general population of children with refractive defects.&lt;/p&gt;
&lt;p&gt;Contacts fit poorly for all the children, and they refused to wear glasses regularly. In any case, Nassaralla said, external lenses don&apos;t work well when there is a refractive difference of more than 3 diopters.&lt;/p&gt;
&lt;p&gt;Because the untreated eye had at least a 20/40 uncorrected visual acuity and would improve to 20/20 with glasses, the children were treated only in the eye with the higher refractive error, using an excimer laser.&lt;/p&gt;
&lt;p&gt;One concern with Lasik for children was how well they would tolerate the procedure, which usually involves only a sedative rather than general anesthesia.&lt;/p&gt;
&lt;p&gt;However, the standard technique was used for all nine of the children, even the 8-year-old. A protective transparent shield was put over the eye at the end of the procedure and sealed with surgical tape rather than patching the eye.&lt;/p&gt;
&lt;p&gt;Vision normalized in the treated eye within three months after the procedure, with the mean spherical equivalent refraction improving to a mean of 0.16 (range +2.50 to -1.00) from -7.66 diopters at baseline. Overall, 33.3% came within 0.50 diopters of the desired outcome and 88.8% within 1.00 diopters.&lt;/p&gt;
&lt;p&gt;After close follow-up in the first year, the children were examined once a year for at least 10 years, and two youngsters were followed out to 12 years. At 10 years after surgery, anisometropia remained far below the 7.36-diopter baseline, at an average of 1.47 (range 0.75 to 3.24 diopters).&lt;/p&gt;
&lt;p&gt;The mean spherical equivalent also fell slightly over time (-2.33 diopters at 10 years, range +1.00 to -5.25) but remained much better than at baseline.&lt;/p&gt;
&lt;p&gt;Visual acuity while wearing glasses didn&apos;t decline for any of the patients over 10 years. Nor did corneal thickness change much.&lt;/p&gt;
&lt;p&gt;But whereas corneal endothelial cells appeared largely unaffected over time after Lasik, cell proliferation appeared to be a problem after pediatric cataract surgery in the second study.&lt;/p&gt;
&lt;p&gt;Brian Zaugg, a medical student at the University of Utah in Salt Lake City, reported that all lenses they studied were susceptible to formation of posterior capsule opacification.&lt;/p&gt;
&lt;p&gt;His group examined more than 500 cadaver eyes that had been treated with extracapsular cataract extraction and intraocular lens insertion to see to what extent postoperative fibrosis and posterior capsule opacification had been a problem -- and thus what the prospects were that the lenses would stand the test of time for children.&lt;/p&gt;
&lt;p&gt;Opacification from growth of cells left behind in the procedure is a problem in adults, but an Nd:YAG laser can be used for posterior capsulotomy to blast the cells, though it breaks the lens capsule.&lt;/p&gt;
&lt;p&gt;For children -- who have more rapid cell proliferation to begin with -- the implanted lens needs to last longer. Keeping the posterior capsule intact helps keep things stable for when it becomes necessary to replace the lens, Zaugg said.&lt;/p&gt;
&lt;p&gt;The researchers found that older designs of lens were associated with up to 66.67% rate of YAG laser treatments and 72.22% rate of central posterior capsule opacification.&lt;/p&gt;
&lt;p&gt;Overall for all the lenses together, the YAG rate was 28.78%, and 43.06% of eyes had central posterior capsule opacification, whether treated or not.&lt;/p&gt;
&lt;p&gt;The newest three-piece silicone and PMMA lens had the lowest YAG treatment rate (0.00%), but already it had a 5.56% rate of central posterior capsule opacification.&lt;/p&gt;
&lt;p&gt;The key is time, Zaugg said.&lt;/p&gt;
&lt;p&gt;The longer the follow-up with a particular lens, the higher the rate of this complication. With the newest lenses, there just hasn&apos;t been enough time for the clinical consequences to become noticeable, he said.&lt;/p&gt;
&lt;p&gt;&quot;The companies are reporting that these lenses prevent posterior capsule opacification,&quot; Zaugg said, but &quot;all lenses are susceptible.&quot;&lt;/p&gt;
&lt;p&gt;A Soemmerring&apos;s ring -- the peripheral precursor of the complication -- occurred in 100% of cases after five to seven years.&lt;/p&gt;
&lt;p&gt;Based on the results, he reported, &quot;current intraocular lens designs and materials do not provide lasting protection against intraocular lens-related visual complications in the pediatric patient.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Nassaralla reported no conflicts of interest.&lt;/p&gt;&lt;p&gt;Zaugg reported no conflicts of interest, but his laboratory is supported by Advances Medical Optics, Alcon Laboratories, and Bausch &amp;amp; Lomb.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_86"
                     title="Bifocals Fight Myopia Progression in Children (CME/CE)"
                     score="-0.008"
                     href="http://www.medpagetoday.com/Ophthalmology/GeneralOphthalmology/tb/17890?impressionId=1265793335247"
                     
      &lt;p&gt;Bifocals can slow the deterioration of vision in children with rapidly progressing myopia, researchers found.&lt;/p&gt;
&lt;p&gt;In this population, a prescription for regular bifocals reduced progression to -0.96 D compared with the -1.55 D seen with single-vision glasses over a 24-month period, according to Desmond Cheng, OD, MSc, PhD, of Queensland University of Technology in Brisbane, Australia, and colleagues.&lt;/p&gt;
&lt;p&gt;Their randomized clinical trial, reported in the January &lt;em&gt;Archives of Ophthalmology&lt;/em&gt;, showed prismatic bifocals to be more effective, with a drop of only 0.70 D over the same period (&lt;em&gt;P&lt;/em&gt;=0.03 versus regular bifocals).&lt;/p&gt;
&lt;p&gt;While the treatment effects of bifocals were modest, both types appeared significantly better than single-vision glasses (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), the researchers wrote.&lt;/p&gt;
&lt;p&gt;In the end, they recommended offering bifocals to rapidly-progressing myopic children &quot;with caution,&quot; weighing the extra cost and poor cosmetic appearance.&lt;/p&gt;
&lt;p&gt;Prior studies have produced mixed results for bifocal and multifocal lenses against progressive myopia.&lt;/p&gt;
&lt;p&gt;Since the most effective of these trials was done exclusively in myopes with a high progression rate, the research team led by Dr. Cheng sought to confirm this in a similar population.&lt;/p&gt;
&lt;p&gt;The prior study had been conducted in Hong Kong. There, as in much of East Asia, myopia is a virtual epidemic, with rates reaching up 60% by age 12.&lt;/p&gt;
&lt;p&gt;The prevalence of myopia also has &lt;a href=&quot;http://www.medpagetoday.com/Ophthalmology/GeneralOphthalmology/17531&quot; mce_href=&quot;http://www.medpagetoday.com/Ophthalmology/GeneralOphthalmology/17531&quot; target=&quot;_blank&quot;&gt;risen 66%&lt;/a&gt; in the U.S. over the past three decades, and nearsightedness now affects 33% of the adult population.&lt;/p&gt;
&lt;p&gt;The particularly high prevalence among Asian children in Western countries allowed Cheng&apos;s group to recruit only rapidly progressive myopes among Canadian Chinese children.&lt;/p&gt;
&lt;p&gt;The reason for this choice was that it may be &quot;that children with lower annual progression rates are closer to the end of their myopia development process and that treatment would be ineffective or less effective in such a child,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;There&apos;s little reason to think that ethnicity would change the fundamental process of myopic progression, Cheng&apos;s group said, so the results should generalize.&lt;/p&gt;
&lt;p&gt;The 135 trial participants all had myopia of -1.00 D or greater (mean -3.08 D) and a progression of at least -0.50 D in the preceding year.&lt;/p&gt;
&lt;p&gt;They were randomly assigned to single-vision lenses or +1.50-D executive bifocals with or without a three-prism diopters base-in prism in the near segment of each lens.&lt;/p&gt;
&lt;p&gt;In addition to the reduced rate of progression with bifocals, the researchers found a lower mean increase in axial length over 24 months with regular and prismatic bifocals than with single-vision lens glasses (both 0.41 mm versus 0.62 mm, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.005).&lt;/p&gt;
&lt;p&gt;Adjusting for age, initial progression, and sex had little effect on either comparison.&lt;/p&gt;
&lt;p&gt;One reason researchers believe bifocal or prismatic lenses work better against progression of myopia than normal lenses is that positive lenses can disrupt the equilibrium of the eye muscles for those who already have some degree of exophoria, or even those with a normal alignment.&lt;/p&gt;
&lt;p&gt;Addition of prisms has been shown to reduce this effect, which makes the eyes &quot;pull&quot; outward, the researchers noted.&lt;/p&gt;
&lt;p&gt;However, in the trial, there was no interaction of treatment type by eye muscle equilibrium (orthophoria, esophoria, or exophoria, &lt;em&gt;P&lt;/em&gt;=0.55).&lt;/p&gt;
&lt;p&gt;The only factor that tended to influence treatment effect was how rapidly the eye changed focus.&lt;/p&gt;
&lt;p&gt;Children didn&apos;t appear to benefit from bifocals if they had low lag of accommodation, but did benefit if they had high lag. Prismatic bifocals significantly reduced myopic progression for both high and low lag groups.&lt;/p&gt;
&lt;p&gt;However, these findings were based on smaller numbers in the subgroup analysis, so further research is needed to validate this results, Cheng&apos;s group said.&lt;/p&gt;
&lt;p&gt;In addition to a lack of blinding of the investigators, the authors noted that the treatment effects were modest. There is also no consensus on what constitutes a clinically meaningful reduction in myopia progression.&lt;/p&gt;
&lt;p&gt;&quot;Whether or not the effect tapers off will decide clinical significance,&quot; they wrote. &quot;If the treatment effects continued over time, then the treatment could have a significant role in preventing the development of very high pathologic myopia.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported in part by Essilor International of France. The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_2_620"
                     title="AAO: Laser Procedure May Offer Another Option for Glaucoma"
                     score="-0.008"
                     href="