A cure in sight
Scientists are looking at implantable lenses to treat lazy eye - an optical
disorder affecting millions worldwide which is difficult to detect, and may
lead to virtual blindness
AP
Megan Garvin, second from left, listens with her parents Chris and Rosie as Dr
Paul Dougherty explains the procedure to implant a rolled-up intraocular
lens in her eye using a tiny incision (illustrated in inset), which could help
restore vision in lazy eye sufferers like Megan
Paul Dougherty delicately slipped a tiny lens inside the right eye of
7-year-old Megan Garvin - a last-ditch shot at saving her sight in that eye.
Last week, the Californian girl became one of a small number of US children to
try an experimental surgery to prevent virtual blindness from lazy eye diagnosed
too late or too severe for standard treatment.
The new approach is implantable lenses - the same kind that near-sighted adults
can have inserted for crisper vision, but which aren’t officially approved
for use in children.
“Without this technology, we couldn’t help her,” says Dr Dougherty, a prominent
eye surgeon. “This would be written off as a blind eye.”
Up to 5 per cent of the world’s population have amblyopia, commonly called lazy
eye, where one eye is so much stronger than the other that the brain learns
to ignore the weaker eye. Untreated at an early stage, the proper neural
connections for vision don’t form, eventually rendering that eye useless.
The leading cause is eyes that aren’t in perfect alignment. But a big
difference in focusing power also triggers amblyopia. It can be difficult to
detect,
and that’s what happened with Megan.
PROBLEMS WITH EARLY TREATMENT
It’s tricky: Kids don’t realise they’re seeing clearly out of only one eye, and
often won’t squint or otherwise signal there’s a problem.
So Megan was passing the window to correct amblyopia when a kindergarten eye
exam flagged a problem.
“She reads perfectly, she’s a very normal active child,” says her mother, Rosie
Garvin. “If she would not have had that vision test, I would never have
known.”
But ophthalmologists called it one of the worst cases they’d ever seen.
Glasses weren’t doable due to a high prescription on one side. Her parents
tried inserting a contact lens in the bad eye, but contact lenses and young
kids are a tough match. Megan cried when her mother inserted it and teachers
would call to say it had popped out.
Frustrated, the Garvins ultimately opted for the implant. Days after the
surgery, they are now feeling hopeful.
EXPERIMENTAL THERAPY
Implantable lenses - called phakic intraocular lenses (IOLs) - are put on top
of a natural eye lens that can’t focus properly, thus helping sharpen vision.
They have some risks - such as surgical infection, inflammation, a potential
for cataracts to form - and are very expensive at about $4,000 an eye. But
the upside is that the lenses can be removed if there are problems.
But, “how this lens is going to work in a child’s eye, we don’t know,” cautions
Dr Punin Shah, a cornea specialist at Ochsner Medical Centre in New Orleans.
In a French study of a dozen children who underwent the procedure, all had
improved vision after the surgery, and half recovered normal binocular vision.
As for Megan, the procedure went well. It’s blurry, she says, but she can see
out of her eye.
The tiny incisions will take a week to heal. Months of patching lie ahead to
try to reverse the lazy eye, or the brain would just stick with the connections
it has already formed to her strong eye. Dougherty gave no guarantees.
Cautioning that the research is still in its infancy, Dr Michael Repka, a
paediatric ophthalmologist and a spokesman for the American Academy of
Ophthalmology
says: “It’s an exciting thing in a patient who has had conventional therapy and
failed.”
Repka’s own research shows that it can be possible to treat lazy eye after age
9, long the cut-off, and he is to publish details soon.
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