Workshop 10

Mar 04, 2017 by AAPOS editor in  Workshop

Teratogens, Neonatal Infections and the Visual System

Alan O. Mulvihill, FRCSEd, FRCSI; Alan B. Richards, MD; Ruth Hamilton, PhD; Andrew Blaikie, FRCOphth

1. Princess Alexandra Eye Pavilion. 2. LSU Health Sciences Centre. 3. Glasgow Children’s Hospital.
1. Edinburgh, United Kingdom. 2. Shreveport, LA. 3. Glasgow, United Kingdom.

Handout 1
Handout 2
Handout 3
Handout 4

Purpose/Relevance:  To update clinicians on the presentation, clinical features and prognosis for the most commonly encountered teratogens affecting the eyes and visual system.

Target Audience:  All clinicians seeing children with visual problems.

Current Practice:  Many clinicians have limited knowledge of the effects of teratogens on the visual system.

Best Practice:  Improved understanding of the visual system consequences of teratogens.

Expected Outcomes:  Improved understanding of the visual system consequences of teratogens.

Format:  Presentations with illustrative clinical cases plus published and ongoing research by the authors.

Summary:  The workshop will firstly address the wide variety of infectious agents (bacteria, viruses, fungi and protozoa) that may have long-term consequences both for the visual system and developing CNS.
We will discuss the visual system consequences of exposure to opioids in utero. There has been a five-fold increase in the number of babies born in the United States who are addicted to opioids, between 2000 and 2012 (1). There has been a parallel rise in the numbers of babies with opioid related problems presenting to pediatric ophthalmologists. Clinicians in the United Kingdom have been dealing with large numbers of opioid exposed children for many years and will share their experiences. The workshop will describe the presentation, examination findings and long-term visual consequences of opioids on unborn children (2). Additionally, we will discuss the profound visual evoked potential [VEP] changes observed in these neonates (3).
Finally, the workshop will address a perhaps surprising genetic component to this problem. Namely that teratogenic agents may alter DNA in affected individuals and propagate abnormalities into succeeding generations.

References:  1. https://www.drugabuse.gov/related-topics/trends-statistics/infographics/dramatic-increases-in-maternal-opioid-use-neonatal-abstinence-syndrome.
2. Gupta M, Mulvihill AO, Lascaratos G et al. Nystagmus and reduced visual acuity secondary to drug exposure in utero: long-term follow-up. J Pediatr Ophthalmol Strabismus. 2012 Jan-Feb;49(1):58-63. doi:10.3928/01913913-20110308-01.
3. McGlone L, Hamilton R, McCulloch DL et al. Neonatal visual evoked potentials in infants born to mothers prescribed methadone. Pediatrics. 2013 Mar;131(3):e857-63. doi:10.1542/peds.2012-2113.

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