Eyeworld

EW MEETING REPORTER 120 September 2015 Reporting from the 28th APACRS annual meeting, August 5–8, Kuala Lumpur, Malaysia Reporting from the 28th APACRS annual meeting Confronting challenges in pediatric ophthalmology The Keshmahinder Singh Oration, an annual event held by the Ma- laysian Society of Ophthalmology, was established in 1997 to honor Malaysian ophthalmologist Keshmahinder Singh. Frank J. Martin, MD, Sydney, Australia, gave the lecture on "Challenges in Pediatric Ophthalmology," outlining his approach to diagnosing vision loss in infants and children and how to effectively communicate visual defects with the patient and the family. Visual defects in babies can be due to a variety of issues, from anterior segment abnormalities and optic glioma to congenital motor or idiopathic nystagmus. Visual development begins immediately after birth, and most babies can blink within several days and make eye contact with a parent by about 6 weeks of age. Visual de- fects usually present when the infant is 2–4 months old, and lack of eye contact is what prompts parents to seek medical attention most often. The etiology of poor vision in infants can sometimes be subtle and difficult to detect, so ophthalmolo- gists should approach this issue as if it were any other medical problem— observe the infant, take a history, and do an examination. When taking a history, be sure to include the pre-, peri-, and postnatal history as well as that of the family. Babies recognize contours, not details, Dr. Martin said, so the best way to assess vision is to have the baby look at the mother's face. Nystagmus is the most import- ant clinical sign when assessing a baby with potential visual defects, Dr. Martin said, because the pres- ence or absence of nystagmus will determine whether the defect is anterior or posterior to the optic chi- asm. If nystagmus is present and the infant has poor vision, the defect is anterior to the chiasm. If nystagmus is present but the infant has a nor- mal eye exam and good vision, the nystagmus is most likely a congen- ital motor defect or idiopathic, but this is only a diagnosis by exclusion, Dr. Martin said. If nystagmus is absent but the child has poor vision and a normal eye exam, the defect is posterior to the chiasm and is most likely due to cortical visual impair- ment or a delay in visual matura- tion. In these situations, it's import- ant to counsel and reassure the family, Dr. Martin said. Pannet Pangputhipong, MD, delivers the APACRS LIM Lecture.

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