The Ahmanson Foundation
The Discovery Fund for Eye Research
The Henry L. Guenther Foundation
The Gustavus and Louise Pfeiffer Research Foundation
The Plum Foundation
The Seidel Family Foundation ~ The Lon V. Smith Foundation
Water Buffalo Lodge of Los Angeles
Wells Fargo Foundation
The Weingart Foundation
Wright Foundation for Pediatric Ophthalmology and Strabismus
and Private Donations
Research depends on funding to make it succeed. Even with generous donations received thus far, the need for additional funding is vital to keep our projects going and continue our research. There is very little money allocated to pediatric eye research from government, industry, or private benefactors. We are determined to make a difference in improving vision and eye care in children and are convinced that our work will provide breakthroughs that will impact eye health worldwide. But we need your help. Please take a moment and read about our research.
The Wright figures are designed to test visual acuity in preschool children and illiterate patients in a comparable manner to Snellen acuity. The figures are made up of white and black bars, with the overall footprint being approximately 2x the size of a normal Snellen letter, but the resolution is equivalent to Snellen letters. Separation of the bars is uniform throughout the figures. This has the advantage over Allen figures and even Snellen letters where the line separation is quite variable. The Wright figures are identified as the patient resolves the 2 point discrimination between the white and black bars. Our laboratory has compared the Wright Figures to Snellen letters and Landolt C in normal patients, and the correlation is excellent. Our research has found that the Wright Figures measure equivalent visual acuity as Landolt C and Snellen acuity testing. The figures are easy for children to identify, and the larger figures are helpful as they attract the child’s attention.
This is a retrospective study of the incidence of severe Retinopathy of Prematurity (ROP) in premature infants weighing less than or equal to 1500 grams before and after implementation of a new clinical protocol of early oxygen curtailment, minimizing oxygen dose fluctuations, implemented in March 1998 in a large level III NICU (CSMC). After obtaining approval from the hospital’s investigational review board, data was collected from CSMC 1997 through 2001 using a local database. Recorded outcome measures included the worse stage of ROP for each patient and patients reaching Threshold ROP (severe retinal damage) requiring laser therapy. Outcomes before and after the protocol change were compared, as well as outcomes from Vermont Oxford Network (VON) and natural history data from the Cryo-rop study.
Prior to implementation of the new oxygen protocol at Cedars-Sinai Medical Center, the incidence of severe ROP at CSMC was similar to or higher than VON. After the new oxygen protocol severe ROP significantly decreased at CSMC, while VON did not significantly change and even slightly increased over a similar time period. CSMC had significantly less Stage III & IV and Threshold laser ROP than VON in 2000 after the new protocol. At CSMC, there were no cases of Threshold ROP and no laser therapy over the past 3 years out of 188 infants examined. Cryo-ROP study data on premature infants birth weight less than or equal to 1250 grams showed 6% threshold similar to CSMC prior to the new oxygen curtailment protocol. After the new oxygen protocol, CSMC had a significantly lower incidence of Threshold ROP than the Cryo-ROP study in 1999 through 2001. Infant survival at CSMC improved slightly after the new oxygen protocol.
The results of this retrospective study, the incidence of severe ROP, including
Threshold ROP, in very low birth weight infant's significantly decreased in association with the implementation of this protocol for early curtailment of oxygen. Strict curtailment of oxygen early in the premature infant's course has apparently eliminated Threshold ROP over the last 3 years at Cedars-Sinai Medical Center, a large level III NICU. Results of this study have been reported at national and international meetings and published in journals. These results were so robust and provocative that our study was published in the prestigious journal Pediatrics in 2003 (Pediatrics Vol. 111(2): p. 339-345, 2003). Summaries of these presentations and copies of the articles can be found on the: ROP Links Page.
This study continues to collect information and retrospective data from premature infant's in the NICU at Cedars-Sinai Medical Center. We now have 5 years of experience using the physiologic low oxygen protocol on over 400 premature infants born at Cedars. Since the new protocol was initiated, we have had no blind babies from ROP - not one! This data confirms the earlier data on the decreased incidence of severe ROP and shows that systemic outcomes associated with premature birth may be positively affected because of the strict oxygen protocol.
After our publication appeared in Pediatrics, many hospitals around the world have adopted this protocol of low oxygen. The Wright Foundation is now supporting a study of the combined results of University of Southern California, Good Samaritan Hospital Los Angeles, National University Hospital Singapore, and Cedars Sinai Medical Center Los Angeles. Follow-up studies are needed, as some centers are concerned that lower oxygen levels could cause insufficient development of organ systems, including the brain. The Foundation is supporting a detailed long-term outcome study on vision, neuro-development and systemic outcomes. Support of this research promises to change the course of ROP and hopefully eliminate blindness from this terrible disease. For me, eliminating blindness from ROP is a miracle!
A blurred image in a child disrupts normal visual development of the brain and can result in permanent visual loss, which is termed Amblyopia (often called lazy eye by lay people). Children with farsightedness (hypermetropia) in one eye have a constantly blurred image in that eye. The child adapts to this visually disruptive state by the brain turning off the blurred image in preference to using the clear image from the good eye. Over time, constant rejection of the blurred image results in permanent vision loss (ie, amblyopia). The standard treatment has been to correct the farsightedness with glasses or contact lenses, but the treatment often fails since many children refuse to wear the unbalanced, unbecoming glasses or cannot handle contact lenses. Amblyopia is present in approximately 2-3% of the pediatric population, and these children present a special problem for the pediatric ophthalmologist. Correcting the farsightedness with laser refractive surgery represents a new option for these children.
Currently, there is very little data known on the use of eye laser surgery in children with farsightedness and amblyopia. Recently, “off label” use of pediatric eye laser refractive surgery has been done on a case by case basis; however, to date, there has not been a prospective clinical study in the United States evaluating hypermetropic photo refractive keratectomy (PRK) for pediatric anisometropic amblyopia. Preliminary results using PRK in children for myopic anisometropia have been encouraging, but no studies on hypermetropic anisometropia have been reported. Our hypothesis is that PRK is a safe and effective treatment for children and adolescents with hypermetropic anisometropic amblyopia.
PRK has potential advantages over standard treatment with spectacles or contact lens for the following reasons: First, PRK eliminates the risk of noncompliance with wearing the prescribed contact lenses or glasses. This is of particular importance for adolescents who, because of cosmetic concerns, often discontinue spectacle correction and lose binocular function. Second, the long-term risk of bacterial keratitis associated with contact lens wear can be avoided. Third, aniseikonia associated with unbalanced spectacles can be eliminated with this refractive procedure. In addition, patients who fail glasses or contact lens therapy have no other treatment options, and PRK may be the only method of correcting the anisometropic amblyopia.
Refractive surgery has the potential to provide a clear retinal image 100% of the time, which is the main goal of treatment. The use of PRK for the treatment of hypermetropic anisometropic amblyopia would be a major breakthrough in pediatric ophthalmology.
Information on Investigational Device Exemption Study by the FDA
Cedars-Sinai Medical Center IRB# 3390
IDE:
G010074/S2
VISX STAR S3 Excimer Laser System
Indications for Use:
Photo refractive Keratectomy (PRK) for the Treatment of Hypermetropic
Anisometropia (With and Without Astigmatism) With a History of Amblyopia
This study is currently following patients regarding the safety and efficacy of using photo refractive keratectomy (PRK) as a modality to treat only the amblyopic eye of patients with hypermetropic anisometropia. The Institutional Review Board at Cedars-Sinai and the FDA (Food and Drug Administration) allowed ten patients to be enrolled in this pilot study at Cedars-Sinai Medical Center. Signatures were obtained by both children and parents/legal guardians prior to any testing. After signatures, study tests included a full ophthalmologic exam with a cycloplegic refraction, assessment of eye alignment, a dilated fundus exam, a slit lamp exam, intraocular pressure measurement, corneal topography, and evaluation of binocular visual function. PRK was performed on qualified eyes using the VISX excimer laser that has been approved for adults. Patients were examined daily until the cornea tissue completed regrowth, and again at 2 weeks, 1 month, 3 months, 6 months, 9 months, and at 1 year. Long-term follow-up visits will be obtained on an annual basis for a total of 3 additional years. Data analysis will be performed on the following parameters: parent and patient satisfaction, pachymetry (corneal thickness), stereo acuity (depth perception), refractive error, visual acuity, topography (corneal surface mapping), and corneal haze. The goal for the post-treatment eye is emmetropia (no refractive error), or within 1 diopter of refractive error of the fellow (good) eye. Only the anisometropic amblyopic eye is operated.
