Here's something to look for when dealing with infants.

A recent study states that ophthalmic evaluations can help diagnose child abuse, even without obvious physical signs of injury. This, of course, leads to earlier intervention and protection of the child.

Researchers in Milwaukee -- at the Medical College of Wisconsin -- studied 123 children over a 12-year span; the children were admitted to the Children's Hospital of Wisconsin with shaken baby syndrome (SBS). Thirty-five of the patients (28%) had a medical encounter within the 6 weeks prior to their admission for brain injury caused by SBS. Study author Jane D. Kivlin, M.D., determined that a third of these encounters had occurred because the abuse wasn't recognized initially. Of the 35 victims, four died and five lost their vision because of the subsequent abuse.

Dr. Kivlin suggests that children who are admitted for lethargy and vomiting should undergo an ophthalmic evaluation, if infections have been ruled out. "Ophthalmologists who examine SBS victims can detect retinal hemorrhages," says Dr. Kivlin, "which in most cases is a sign of SBS."

Dr. Kivlin adds, "Unfortunately, ophthalmologists aren't usually called in until the signs of abuse become more apparent -- which can be too late."

Intacs vs. LASIK

A study has compared Intacs to LASIK. Results showed that corneas treated with Intacs mimic the natural shape of normal corneas.

Terry E. Burris, M.D., presented the study at this year's American Society of Cataract and Refractive Surgeons meeting (ASCRS).

In the comparative study, five subjects were treated with Intacs and three with LASIK. One patient received both treatments: Intacs in one eye, LASIK in the other.

Dr. Burris observed that corneas treated with Intacs were steep in the center and flat in the corneal periphery -- a.k.a. prolate asphericity. Corneas treated with LASIK were the reverse shape: flat in the corneal center and steep in the periphery -- a.k.a. oblate asphericity. According to Dr. Burris, prolate asphericity is less likely to produce major visual distortions.

Dr. Burris said, "Intacs create a naturally shaped 'prolate' cornea, which (based on medical literature) is the best shape for avoiding the large spherical aberrations that can result from other refractive procedures."

Dr. Burris concluded, "The study suggests that while both Intacs and laser procedures are effective in providing 20/20 vision or better, not all 20/20 vision is equal."

RETINITIS PIGMENTOSA

Chip could restore sight

Turning science fiction into science fact, surgical teams implanted artificial retinas into the eyes of three near-blind patients this past June. The artificial retinas are made of silicon chips.

The three patients who received the artificial silicon retinas (ASRs) had lost most of their vision from retinitis pigmentosa. They were part of an FDA feasibility and safety study to determine whether ASRs could be safely implanted and tolerated in the human eye.

Developed by the Optobionics Corporation, the ASR is 2 mm in diameter and one-thousandth of an inch thick. The ASR is inserted through three incisions, each the size of a pinhead, and contains about 3,500 microscopic solar cells that convert light into electrical impulses.

The purpose of the ASR is to replace damaged photoreceptors.

An Optobionics official stated that the three patients were at home and healing well. He said, "At this time, we've seen no signs of implant rejection, retinal detachment or other complications. The implants have remained in stable positions."

Visit www.optobionics.com for more information on the ASR procedure and answers to frequently asked questions.

CHOROIDAL NEOVASCULARIZATION

TTT trial has open slots

Are any of your age-related macular degeneration (AMD) patients suffering from occult choroidal neovascularization (CNV)? If so, you can consider enrolling them in a clinical trial that treats CNV with a mild form of retinal photocoagulation, transpupillary thermotherapy (TTT).

Preliminary TTT results were published in the October issue of Ophthalmology. Elias Reichel, M.D., studied 15 participants with occult subfoveal CNV secondary to AMD. Sixteen eyes were treated with TTT using an 810-nm diode laser. The laser was delivered through a contact lens, with treatment initiated in one spot for 60 seconds at a power range between 360 and 1000 milliwatts.

Three eyes (19%) showed a two or more line improvement in visual acuity over a period of 6 to 25 months; mean follow-up was 13 months. Fifteen eyes (94%) demonstrated decreased exudation on fluorescein angiography, optical coherence tomography and/or clinical examination.

Dr. Reichel concluded that TTT showed no deleterious side effects in treating occult subfoveal CNV.

For the current study -- TTT4CNV -- Dr. Reichel wishes to enroll AMD patients with occult subfoveal CNV with a visual acuity in the 20/50 to 20/400 range.

"Presently," says Dr. Reichel, "we only have 25% of the patients we need."

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