EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/115557
140 EW International March 2013 Making the case for enhanced eye monitoring in the youngest of people by Matt Young EyeWorld Contributing Writer It's time to focus on quality of vision for the little ones M uch of what ophthalmologists focus on worldwide is eye disease later in life— cataracts, age-related macular degeneration (AMD), presbyopia. But better neonatal imaging is making a big difference in vision very early on in life in China, Russia, and elsewhere. In China, which is known to have a staggering cataract backlog leading to many of the world's blind, the RetCam 3 (Clarity Medical Systems, Pleasanton, Calif.) is advancing eyecare by leaps and bounds for newborns. "In traditional fundus inspection, the radius of the light source is small and the inspection process resembles the flashing of a torch light in the dark," said Lihong Li, M.D., director, ophthalmology depart- ment, Maternal and Children's Hospital, Kunming, China. "The area inspected is inconsistent, narrow, and limited to only the part where the light can reach. Doctors may not have substantial data for a diagnosis if these images are not merged. The diagnosis of a patient's condition becomes less precise as this merging technique causes distortion to the original images." On the contrary, in Dr. Li's hands, the RetCam 3 increases precision of imaging drastically, leading to better accuracy in diagnosis and helping to get newborns the treatment they need quickly, if warranted. Most babies are found to have healthy vision, but for the ones that don't, early treatment is critical. Lurking danger, from day one Dr. Li has found that eye abnormalities are far more common than hearing ones in newborns. In one study of 3,573 full-term, healthy newborns imaged, 769 (21.5%) were found to have visual abnormalities (including retinal hemorrhage). A further 509 (14.3%) had retinal hemorrhage in both eyes, 215 (6.0%) had a level 3 retinal hemorrhage, and 67 (1.9%) had macular hemorrhage. Her data, collected using the RetCam at Maternal and Children's Hospital, was presented at the European Pediatric Ophthalmological Society meeting in October 2011. Interestingly, of two retinoblastomas found, one was the earliest detection ever recorded in China. Fifteen cases of familial exudative vitreoretinopathy (FEVR) also were found. "Comparing the rate of eye abnormalities found in newborns (1:70 in Dr. Lihong Li's study) to the rate of hearing abnormalities (1:300500), eye imaging of all newborns should be as much a part of stan- dard newborn care as hearing screening," according to Clarity. "Early detection can lead to appropriate treatment and preservation of vision." Dr. Li also found higher rates of retinal hemorrhage in babies in Kunming as compared to other parts of China and is trying to determine whether prevention can be undertaken. All in all, 24% of newborn babies that Dr. Li analyzed in her study had a pediatric eye disease, and 46% of these diseases required additional attention. That might have been enough to convince someone else in a bordering nation to purchase a series of RetCams. "The Russian Federation has purchased 42 RetCam Systems for provinces across their country," Clarity announced early last year. "Former President Dmitry Medvedev approved the purchase." Soon after, Clarity executives were invited to participate in a roundtable discussion on retinopathy of prematurity (ROP) being held by the Russian Ministry of Healthcare and Social Development. ROP, one of the diseases that the RetCam 3 can detect, can improve with early detection. "Early treatment has been shown to improve a baby's chances for normal vision," according to the A.D.A.M. Illustrated Medical Encyclopedia. "The most important factor in the outcome is early detection and treatment. Treatment should start within 72 hours of the eye exam." It lists cryotherapy, photocoagulation, and surgery as possible treatment options. Going high-tech in China's hinterland Before a baby even gets to the possibility of those procedures, a simple evaluation starts non-invasively and safely with the RetCam 3 in the hands of Dr. Li. The device consists of two major components, Dr. Li said: 1) highly precise ophthalmic visualization/ imaging technology and 2) wideangle lens pieces with a fiber-optic light source. "With a 130-degree field of view, RetCam 3 can reflect the overall condition of a patient's eye fun-