Strabismus is a common condition in which the eyes do not align properly, turning inward, outward, upward or downward. Two to four percent of children have some form of it. Some cases can be treated with glasses or eye patching; other cases require eye muscle surgery. But the treatments don’t address the root causes of strabismus, which experts believe is neurologic.
For decades, Elizabeth Engle, MD, in Boston Children’s Hospital’s F.M. Kirby Neurobiology Center, has been studying rare forms of strabismus, such as Duane syndrome, in which strabismus is caused by limited eye movements. Her lab has identified a variety of genes that, when mutated, disrupt the development of cranial nerves that innervate the eye muscles. These genetic findings have led to many insights about motor neurons and how they develop and grow.
More recently, with postdoctoral research fellow Sherin Shabaan, MD, PhD, Engle’s lab has been gathering families with common, non-paralytic strabismus, in which both eyes have a full, normal range of motion yet do not line up properly.
Such “garden variety” forms of strabismus have been much harder to pin down genetically. …
Three to five percent of the population has amblyopia, a.k.a. lazy eye, in which a healthy eye never “learns” to see because isn’t used. This usually happens because of a focusing problem or subtle misalignment of that eye. The brain learns to ignore input from that eye, and unless this is noticed early, it weakens and can slowly go blind.
“When I can diagnose amblyopia early enough, I can treat it with an eye patch or eye drops to block the ‘good’ eye,” says David Hunter, MD, PhD, chief of ophthalmology at Boston Children’s Hospital. “This gives the eye with amblyopia time to catch up.”
Unfortunately, eye patching doesn’t work well at older ages, and kids hate the socially stigmatizing patches, which often need to be worn for more than a year. As Dean Travers, cofounder of Luminopia, put it at Boston Children’s Hospital’s Innovators’ Showcase last week, “Being a pirate isn’t cool for very long.” …
As a pediatric ophthalmologist, I do my best to assure that every young patient I examine will have a lifetime of perfect sight. The condition that I battle most commonly is amblyopia, or “lazy eye,” in which the eye is healthy but does not develop vision — simply because the brain doesn’t receive proper input when a child’s visual system is “learning” how to see.
When I can diagnose amblyopia early enough, I can treat it with an eye patch or eye drops to block the “good” eye, giving the eye with amblyopia time to catch up. But amblyopia does not fight fairly: about half of affected kids have no visible signs of the condition. As a result, amblyopia silently steals the sight of hundreds of thousands of children — many of whom will never get their vision back because treatment started too late.
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