AS AN OPTOMETRIST and educator specializing in pediatric eye care and vision therapy, I am always on the lookout for clinical advancements that refine my practice and enhance the quality of care I provide to my young patients. I also take every opportunity to contribute to these advancements through my role as a clinical investigator for the Pediatric Eye Disease Investigator Group (PEDIG). Occasionally, these endeavors overlap allowing me to implement changes in my practice because of the results of trials I have participated in.
One recent example highlights a potentially major change in how I and other optometrists treat childhood intermittent exotropia in young children. Previously for young children with intermittent exotropia, I often considered overminus lenses as a treatment option to temporarily improve the control of exotropia until they are older to undergo vision therapy or before considering surgery. The overminus lenses allow the child to control their eye turn better as they focus their eyes through the glasses.
After first conducting a pilot study within PEDIG on the short-term effects of the overminus lenses on intermittent exotropia, we then completed a full-scale randomized trial, and we encountered a fairly surprising finding. We found that overminus lenses do in fact help children with intermittent exotropia to improve the control of their eye turn. But we also discovered that children who used this treatment had a greater shift towards nearsightedness compared to those who were not using the treatment. So, even though the treatment can help the child control their eye turn, there is a potentially detrimental effect that we didn’t realize. A review of past literature on the topic reveals some ambiguity; this is why the evidence that comes from this randomized trial is so important for informing clinical decisions.
PEDIG has also studied the natural history of childhood intermittent exotropia and found that the likelihood of the eye turn deteriorating into a constant eye turn is low over a three-year observation period. Because of these findings, now when I discuss overminus lenses as a treatment option with parents, I am sure to provide a full explanation of all potential effects – both the benefits for improving control and the risk of increased nearsightedness, so that we can make an informed decision together about the best way forward for their child. More often than not, I simply monitor the condition very closely.
I believe that it is also crucial to apply the rigor of objective, randomized trials to industry research. When corporations conduct their own studies, the data can sometimes be presented in a way that may overstate the significance of the findings. I am currently participating in two PEDIG clinical trials that are exploring the effectiveness of FDA-approved devices that are designed to treat amblyopia in children.
As clinicians working with children with amblyopia, we are familiar with the range of treatment options available, from traditional treatment like patching and atropine penalization to newer methods like binocular therapy. These clinical trials are important because we can see how well these devices work compared to patching, an essential consideration given the substantial cost associated with these devices (depending on insurance coverage). As a clinician, I strive to strike the balance between treatment benefits and affordability. Ultimately, I want to be able to give families the necessary, evidence-based information so that they can make informed decisions about the best way to help their child improve their vision.
Each of these trials represents a collaboration of sorts between many optometrists and ophthalmologists, showcasing why PEDIG is such an effective research group. When studying hundreds of patients, there’s no way for a few doctors to manage enrollment at this scale. Therefore, it’s essential to have a network of participating investigators who are willing to help contribute to the valuable work of answering critical clinical questions and to help broadcast the “answers” to these questions to a wide audience.
About the Author
Dr. Angela Chen received her Doctor of Optometry and Master of Science in Vision Science from the State University of New York, College of Optometry. She then completed a residency in Pediatric Optometry and Vision Therapy at the Southern California College of Optometry (SCCO). Dr. Chen joined the Vision Therapy and Pediatric Vision Care faculty at SCCO in 2009. Currently, she is a Professor at SCCO and co-teaches the Strabismus/Amblyopia Diagnosis and Management courses with Dr. Susan Cotter. In addition, she provides clinical teaching to optometric interns in the Vision Therapy and Pediatric Vision Care Services at Ketchum Health. She is the coordinator for the residency program in Pediatric Optometry, Vision Therapy and Vision Rehabilitation and works with residents in the Pediatric Contact Lens Service.
Dr. Chen is a Fellow of the American Academy of Optometry and a Diplomate of the Binocular Vision, Perception, Pediatric Optometry Section. Her research interests include strabismus, amblyopia, non-strabismic binocular vision disorders, and management of refractive error in children. She serves as a clinical investigator in several NEI supported studies for the Pediatric Eye Disease Investigator Group (PEDIG) and the Convergence Insufficiency Treatment Trial-Attention and Reading Trial (CITT-ART).
