Fall 2013

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Fall 2013
Wilmer Eye Institute
Donations (from p. 1)
that Raab began to see Wilmer’s facilities from a child’s perspective.
“I went into the pediatric unit and wasn’t sure I would be really comfortable in the waiting room if I was a 2- or a 3-year-old. So our foundation
gave some money to brighten things up.”
The donations also provided funds for items to help children pass
the time, say Wilmer staff that was instrumental in choosing the furnishings, toys and other amenities. And, of course, the paintings created by
Halperin, a retired oncologist, will give the young patients just a bit more
to spur their
“I derive
great pleasure
from sharing
my work. I do
mostly abstract figurative painting.
Many have
told me that
my paintings have
a childlike
quality. So it may have been an easy step to the whimsical spontaneity
of creating paintings that I hope children will enjoy,” he says. “I wanted
them to have room for imagination and the opportunity to mind play
with what is going on. I also wanted some action. I wanted some goofiness. I wanted color. So each of them has color. One with animals, one
fish and two with diverse ‘people.’”
The donations will all go a long way to ease kids’ stress as they
wait for treatment.
“Children in an eye care setting have stress,” explains Michael
Repka, M.D., M.B.A., Vice Chair for the Clinical Practice and the David
L. Guyton, M.D., and Feduniak Family Professor of Ophthalmology.
“Having these activities in our waiting area makes their care easier because they are less anxious about their visit.”
Eric Singman, M.D., Division Chief of the General Eye Service Clinic, echoes Repka’s gratitude for the ongoing support.
“Parents of patients have requested a safe, fun area where their children could play,” he says. “These gifts mean so much to our
team and to our patients.” n
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A newsletter from the Zanvyl Krieger Children’s Eye Center at the Wilmer Institute, Johns Hopkins Medical Institutions
Positive Treatment for Children with Amblyopia
of visual cues to the brain. When vision is
arents that request vision screening for have passed the screening examination” to
compromised by amblyopia or strabismus
children, whether they suspect vision
confirm the eyes are healthy.
(misalignment), so is brain development.
impairment or not, will put their children
Only then will parents know if their
The longer these conditions persist, the more
in better positions to correct amblyopia,
children have amblyopia or other vision
difficult it is to recover visual loss.
commonly called lazy eye.
concerns and move toward its cause and
Although reports generally note
amblyopia impacts three out
...the once-common belief that
of 100 children, researchers
mistakenly associate
children had to be diagnosed and
in Scandinavia have shown
amblyopia with
that universal childhood
treated by age 7 has been shattered.
vision screening projects can
(crossed eyes).
That doesn’t mean that older children’s
significantly reduce those
In fact amblyopia without
problems are untreatable. Indeed, the
rates due to the success of
once-common belief that children had to
durable therapies that include
cases in which children have
be diagnosed and treated by age 7 has been
patching, eye drops and, in
unequal refractive errors
shattered, Repka says.
some cases, surgery. Michael
(such as one near sighted
He and his colleagues are conducting
Repka, M.D., M.B.A., who
eye and one far sighted eye)
a National Eye Institute-sponsored
has studied amblyopia and its
is common and not evident
study comparing atropine with patching
treatment for more than three
to the parents. Amblyopia
Michael Repka, M.D., M.B.A.
treatments in 8 to 17-year-olds with
decades, underscores that
from both misalignment
parents should not assume
and refractive error is readily
“Parents should realize their children
children’s eyes are healthy until they have
treated with patching and eye drops.
are neither too young or too old, until they
been screened.
Discovering amblyopia early in life is ideal
have tried at least one treatment,” Repka
“If there is a suspicion of an eye
and leads to better treatment outcomes.
says. “In the past, many opthalmologists
problem, they have to be screened,” he says.
Good vision plays an important role in
“If there isn’t a suspicion, the child needs to development by providing constant feedback
(Continued on p. 2)
Generous Donations Brighten
Young Patients’ Visits
Young patients will have a few more reasons to smile when
they visit some of Wilmer’s pediatric waiting rooms.
Generous donations from the Norman Raab Foundation
and artist Joseph Halperin, M.D., have transformed some of the
clinical areas into kid friendly oases. Brightly painted rooms,
pint-sized chairs and tables, play areas and six, large kid-friendly Joseph Halperin, M.D.
paintings have been added to waiting areas including those at the
Specialty Access Center of Wilmer’s General Eye Service Clinic and at Green Spring
Stephen Raab, a long-time member of Wilmer’s Board of Governors and chair of
the foundation that bears his father’s name, said the donations his group made reflect
his commitment to Wilmer.
“My involvement with Wilmer goes back to 1975,” Raab recalls, “so I’ve been
walking around these halls for a long time.” But it wasn’t until the birth of his grandson
Lutherville, MD
The Wilmer Eye Institute
Kids Eye View Subscription
600 N. Wolfe Street, Wilmer 112
Baltimore, MD 21287-9015
[email protected]
410-955-0866 (f)
is published once a year by
the Wilmer Eye Institute at Johns Hopkins Hospital.
FALL 2013
Barney the Dinosaur May Aid
Children’s Eye Health Diagnoses
Fun and Games May Lead to
Increased Vision Screening
(Continued on p. 4)
Screening Guidelines Could
Unlock Visions Concerns
Wilmer Eye Institute
Barney the Dinosaur May Aid Children’s Eye Health Diagnoses
arney the Dinosaur might soon play
a role in better vision for young
Music from the television show that
features the oversized purple dinosaur that
has entertained children for more than 15
years is being adopted by Wilmer’s David
Guyton, M.D., Boris Gramatikov, Ph.D.,
device, a ‘point and shoot’ device that
Supporters of the Pediatric Vision
determines whether both eyes are lined
Screener project have included: up properly and focused properly,”
says Guyton, who is international• Research to Prevent Blindness
ly renowned for his contributions,
• NIH Grant RO1 EY-12883
• The Helena Rubenstein Foundation
inventions, and teaching in eye muscle
• The Alcon Research Institute
surgery for misaligned eyes (strabis• The Thomas Wilson Sanitarium for
mus) and in ophthalmic optics. “Those
the Children of Baltimore City
two findings are critical. Since
Massachusetts Lions Eye Research
about 98 percent of eye disease
• Knights Templar Eye Foundation
in kids affects either the focus or
• Roy and Niuta Titus Foundation
alignment of the eyes, an instru• Whitaker Foundation
ment that automatically assesses
• Hartwell Foundation
both of these will be a very nice
• Walman Optical Company
screening device for eye disease
• Michael Formica and Suzanne Slesin
in young children.”
• Herbert Liebich
The commercial version will
• Helen and David Leighton
be small and portable, something
• Victoria and Richard Baks
• Robert and Diane Levy
earlier prototypes of the instrument have not been.
Even though treatments
tion-attracting object,” says Guyton, who
are available for older kids with
notes work on the device has been ongoing
Drs. Boris Gramatikov, Kristina Irsch and David Guyton
amblyopia and misalignment,
since 1991, when he first conceived of the
and Kristina Irsch, Ph.D. for use in a new
catching such vision impairments early
optical design by drawing on an airplane
device they call a Pediatric Vision Screener in life—ideally by ages 2 or 3—is the
napkin. “Children like it because it seems
best time to diagnose and effectively treat
as if the music is coming from the light.
It is anticipated that pediatricians’
such conditions. The only task children
They only have to pay attention for about
offices and vision screening programs
will need to do for this device, one of
five seconds or so and the instrument meawill eagerly embrace their
sures alignment and focus every second.”
“...early detection is the key to
invention to entice children
Of course, diagnosis is only one step
from ages 1 to 5 to look at a
health. If a concern is discovproper treatment. The pediatricians
pulsating light, synchronized
ered, it’s imperative that a vision profeswith some of the music Barney will finally have the tool to make
sional conduct an eye exam to diagnose
this possible and practical.”
made famous.
and treat the cause.
In as little as five seconds,
“Our screening device tells which eye
the PVS can identify misaligned eyes and
several that Guyton and his colleagues are is defocused and which eye is misaligned,”
other risk factors for amblyopia (lazy eye). investigating, is to focus on the pulsating
says Guyton. “It will not diagnose the
“We have worked for years to perfect an
light for a few seconds.
exact cause – but early detection is the key
instrument that can help pediatricians
“It will give you the alignment and
to proper treatment. The pediatricians will
detect eye problems in pre-verbal chilfocus information right away as long as
finally have the tool to make this possible
dren. This will be an automatic screening you can get the child to focus on an attenand practical.” n
Positive Treatment for Children with Amblyopia (from p. 1)
wouldn’t treat those children much
past age 7. Now about 60 percent of the
time we can improve the vision of many
amblyopia patients to 20/25 or better, and
many older patients to nearly that level.”
Although patching is still an important treatment for many amblyopia patients—to force the lazy eye to strengthen
through use—eye drops that block vision
are a less irritating alternative that boosts
compliance. In a significant number of
cases, patients are treated with two eye
drops a week instead of two to six hours a
day of patching.
And Repka and his colleagues continue to investigate treatments for amblyopia
and other ocular concerns. Currently they
are involved with investigators at about
40 other sites in compiling a registry of
children ages birth to 13 years of age that
have undergone cataract surgery.
“This is a hypothesis-generating
study,” says Repka who adds investigators
will examine many outcomes including
the development of glaucoma in such
patients. “From this project we hope to
learn something to take us to the next
level in terms of management and study
Individual donors and organizations
including Research to Prevent Blindness,
the Alcon Research Institute and the National Institutes of Health have donated
funds for this and other research. n
Fun and Games May Lead to Increased Vision Screening
lmost half of U.S. parents with children age 12 and
To help bring such a goal to reality, Park and her colleagues
under have not taken their children for eye exams, acare currently working to develop a visual acuity test that can be
cording to a recent survey commissioned by Vision Service Plan, done in a child’s home. That test, which involves such games as
part of VSP Global, the largest not-for-profit vision benefits
letter matching, measures visual acuity and the results can then
and services company in the United States with
be quickly sent to professionals for review and
59 million members. One of the more disturbdiagnosis.
ing aspects of the survey results is that of the
“We are testing patients now,” says Park
children who received a complete, professional
of the clinical study. “We want to make sure
eye exam, 40 percent needed glasses, an addithat the test is completely consistent. Although
tional three percent had treatable eye disease and
the test could uncover ocular conditions and
four percent had allergies, a scratched cornea, or
diseases that need professional intervention,
amblyopia (lazy eye).
Park stressed that such indicators would require
Hee-Jung Park, M.D., MPH, who practices
that children be seen by professionals to confirm
at Wilmer and two satellite locations—the
the results of the on-line diagnostic tool. Of
Bayview Medical Center and White Marsh—is
course, treatment would also be needed.
working to create software that could allow easy,
Although some similar tests are currently in-home pediatric vision screening and even
Hee-Jung Park, M.D., MPH
available, most don’t have automatic algorithms
stem debilitating conditions throughout the
and can’t be performed at home by parents and
other non-vision experts.
“Imagine India where billions of people have diseases.
So far the new test promises to be a hit with the parents of
Imagine how much we can help people if they have ready access children who have tested the software.
to screening,” says Park, who volunteers for such organizations
“Children find the test fun and parents like it,” says Park.
as Mother Theresa’s Missionaries of Charity in Ethiopia and
“If parents see the test can lead to vision improvements, they are
Tibetan monasteries in Himalayan villages in India.
more compliant.” n
Screening Guidelines for Pre-School Children
Could Unlock Visions Concerns
nvestigators who conducted the Baltimore Pediatric Eye Disease Study—that
studied children ages six months to 6 years from 2002 to 2009—found that
guidelines should be formulated that describe the methods to screen, diagnose
and treat.
A small proportion of pre-school children in the Baltimore study population, as
well as a concurrent study population in Los Angeles, were identified who would likely
benefit from refractive correction such as by wearing eyeglasses. Few of the children
David Friedman, M.D., Ph.D.
with such needs were taken for such prescriptions, according to study results.
“We would like to conduct further studies in terms of follow up implications
that would be important from a public health standpoint,” says David Friedman, M.D., Ph.D., who is the Alfred
Sommer Professor at Wilmer Eye Institute and an investigator in the Baltimore Pediatric Eye Disease Study.
“The question of risk factors for different conditions is still very important.”
Further studies conducted by Friedman, Michael Repka, M.D., M.B.A., and other investigators have
determined that children in specific racial, ethnic and age groups have higher risks for such conditions of
myopia and hyperopia.
Findings from such studies—such as the discovery that mothers that stopped smoking during pregnancy
may have reduced their children’s risk of hyperopia—further triggered the investigators’ interest in follow-up
One study under development by Friedman and Repka will help practitioners determine if eye conditions
might be factors in poor reading skills. If such a study were successful it might lead to better reading
performance for some poor readers, which could greatly increase their overall academic success. n
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