Surgery May Not Be Necessary for AACE

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Study Shows Effective Alternative to Surgery for Treatment of AACE

A study published in the American Journal of Ophthalmology investigated the long-term efficacy of botulinum toxin injections compared with traditional strabismus surgery in children with acute, acquired, comitant esotropia (AACE). AACE often presents with moderate- to large-angle esotropia and inherently poses a risk for the development of amblyopia. The condition is typically managed with strabismic surgery.

This retrospective, multicenter, noninferiority analysis involved 76 children, 44 of whom received botulinum toxin injections and 32 of whom underwent surgery. The study’s findings indicate that botulinum toxin connections were a viable long-term alternative to surgery and required fewer resources, shorter general anesthesia durations, and less post-anesthesia care time. The success rate after 36 months was 72% for the botulinum toxin group and 56% for the surgery group, with similar outcomes regarding median deviation and stereo acuity testing.

One notable benefit of botulinum toxin injections is the reduced time from esotropia onset to treatment, which averaged 2.5 months, compared with 7.0 months for strabismic surgery. A shorter duration of intervention is ideal, as the patient is less likely to experience a loss in binocularity. The researchers who conducted the trial concluded that botulinum toxin injections require fewer resources than mentioned earlier, while offering a faster and potentially more accessible treatment option for AACE. (Read more here.)

My Two Cents

Fascinating! I hadn’t heard of botulinum toxin injections being used for AACE. I believed the treatment was either going to be vision therapy, a swing for the fences with glasses, or strabismic surgery. This could be one of those paradigm-changing studies that cause a shift in the treatment protocol for our pediatric patients. It should also be noted that many of our optometric colleagues around the country may find that this procedure falls under their scope! Imagine how amazing this could be—no referrals to a surgeon who ends up doing an invasive procedure on our youngest and most easily scared patients. Instead, these patients could potentially stay in-house or go to one of your optometric colleagues for a relatively quick procedure that’s just as effective as invasive surgery!

OUTSIDE THE LANE

A Word About Bird Flu

A recent online article details how avian influenza is developing into a rising threat as it mutates and becomes more adept at jumping to various species, including humans, pets, and zoo animals. The European Food Safety Authority and the European Centre for Disease Prevention and Control have warned that countries must enhance their surveillance and containment measures to prevent the virus from evolving further. In 2024, avian influenza viruses expanded to previously unaffected species, and key mutations have been identified that could lead to human-to-human transmission. The virus has also been found to have jumped to other species recently, including seals and dairy cows within the United States. Although human cases remain low, with the United Kingdom reporting its first case of the winter and 67 cases in the United States, the risk increases if human-to-human transmission is confirmed.

My Two Cents

This story is significant, as I believe we will start hearing more about bird flu in the coming weeks and months as it will begin to have a more substantial effect on our daily lives. We’ve already had one death attributed to bird flu in the United States, and that was right here in southern Louisiana in an older patient with underlying medical conditions.

While the threat of human death is extremely low right now, you can’t spend time on any news website without being confronted about the “price of eggs,” which can be attributed to the H5N1 strain of bird flu. Just this past December, H5N1 killed 13.2 million commercial egg-laying hens alone, and as of this writing, there are rumors that the virus has hit two of the largest egg facilities in the country. If that’s true, you can expect the price of eggs to rise and bird flu to be at the forefront of the public consciousness. And if human-to-human transmission does manage to become a reality, then we have another problem to worry about: staying healthy, recognizing symptoms (will any be of an ocular nature?), and learning how to effectively treat it.

CAN YOU RELATE

Those of you with young kids know they do some of the sweetest things imaginable. My 6-year-old son Brooks is in kindergarten, and life with him and my 11-month-old puppy Buddy could be a real-life comedy show. Sometimes I think the good Lord upstairs loves watching the funny situations we encounter. Life as a single dad can be challenging, and there’s always something new for me to try to overcome.

Take this past week’s activities at Brooks’ school, for example. The entire week was full of themed activities and days for kids to dress up and have fun. One day was patriotic day, where the kids wore their best red, white, and blue apparel; another was neon day, where they got to wear their brightest outfit. You get the idea. Well, one of the days was “dress like your favorite teacher day.” Brooks chose Mr. Raymond, who also happens to be my favorite of his teachers. He’s the school’s computer teacher and is just an incredible guy. Brooks wanted to dress like Mr. Raymond because he idolizes him, so I helped him put together his outfit, complete with some OTC readers that I popped the lenses out of and a nametag that read “Mr. Raymond.” You’ll see the photo below, but if you’ve ever met or seen me, you know I’m average (5’9”) height, average build … basically I’m an average-looking White guy, and Brooks will probably take after me. Mr. Raymond is pretty much the exact opposite: a very tall, bald Black man, so seeing Brooks next to him is so many things: adorable, funny, and heartwarming. It’s a good reminder that it’s not about where someone is from or the color of their skin. What matters more and what should be valued is the content of a person’s character.

When Brooks chose to dress like Mr. Raymond it didn’t even enter his thoughts that with the clothes and glasses he wouldn’t look exactly like Mr. Raymond. To a kid, everyone is the same and equally worthy of respect and love. The world would be a better place if we chose to look at others the same way. Everyone in your exam room chair should be a VIP—no questions asked. I’m confident that’s how Brooks would run his clinic.

IMAGE OF THE WEEK

Retinal detachment secondary to acute retinal necrosis.

Paul Hammond, OD, FAAO, @kmkoptometrypro

QUOTE OF THE WEEK

“I dream that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character.”

— Martin Luther King Jr