The following article is a part of Ophthalmology Advisor’s conference coverage of the Southeastern Educational Congress of Optometry (SECO) 2021, held in Atlanta and virtually from April 28 to May 2, 2021. The team at Ophthalmology Advisor will be reporting on the presentations offered by these leading experts in optometry and ophthalmology. Check back for more from the SECO 2021 Meeting.
At times, clinicians may find that a specific ocular topic has not yet been well-defined in the literature. “When the patient is sitting in your chair and the research has not yet been done, you must do something,” according to Glen Steele, OD, and Marie Bodack, OD, who presented the latest tools for pediatric care in their course “Integrating the PEDIG Studies into Clinical Practice,” at Southeastern Educational Congress of Optometry (SECO) 2021 Conference, held April 28 to May 2 in Atlanta.
Currently, 300 practitioners at 100 US sites comprise the Pediatric Eye Disease Investigator Group (PEDIG). The course offered research-based assessment techniques and therapy options for managing amblyopia, intermittent exotropia, and hyperopia based on the investigation.
Drs Steele and Bodack discussed bilateral refractive and anisometropic amblyopia, including studies that compare atropine, optical correction, Bangerter filters, and patching regimens. For example, results for atropine 1% so far show weekend treatment can be “as effective as daily atropine and patching,” in patients up to 12 years old. Bangerter foils have also shown comparable effectiveness with patching. The investigators will address possible regression after amblyopia treatment, as well as successful therapy for teenagers, and binocular therapy dichoptic video games.
Regarding amblyopia, it is key to observe retinoscopic reflex, Drs Steele and Bodack explained. On the topic of intermittent exotropia, they will cover benefits and detractors of observation, surgery, base-in prism, patching, and overminus. For children 3 to <11 years of age, studies show observation and part-time patching both yield acceptable results, while for those 12 to 25 months of age, not enough evidence exists to support part-time patching. In overminus therapy, beneficial effects may not persist and myopic progression can occur, according to a multicenter study.
The 2 experts addressed overarching philosophies on hyperopia. The course also shared data from the hyperopia treatment study (HTS1, ClinicalTrials.gov Identifier: NCT01515475), including comparisons of immediate spectacle prescription with thoughtful observation. In one of the individual cases the investigators will detail, they illustrate why it may be premature to prescribe by “full cyclo” without performing near dynamic retinoscopy.
This course also offered a refresher on current practices for evaluating infants. Early screening can uncover vision deficits as well as learning problems. The presenters believe that clinicians must consider the lifelong impact of prescribing for young children — instead of thinking in terms of not prescribing or over-prescribing, it may be better to continually evaluate “every step of the way.” One of the elements in these steps includes checking for decreased accommodative facility in hyperopes — retinoscopy is vital here, as well as the presenting complaints, and speed of response to lens change in plus and minus directions.
Overall, Drs Steele and Bodack suggest that when prior studies prove clear patterns, clinicians will want to consider treatment based on these findings. However, specific research may be lacking. “Don’t hold off with management and intervention just because there is no study.”
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Steele GT, Bodack, MI. Integrating the PEDIG studies into clinical practice. Southeastern Educational Congress of Optometry (SECO) 2021 Annual Meeting; April 28-May 2, 2021; Atlanta, GA. Course 115.