8:00 am – 8:05 am
Introduction of the Apt Lecturer
Sherwin J. Isenberg, MD
8:05 am – 8:25 am
“Zika Virus: A New Kid on the Block of Ophthalmic Teratogens”
Marilyn Miller, MD
8:25 am – 8:28 am
Daniel J. Karr, MD
Zika Virus: A New Kid on the Block of Ophthalmic Teratogens
Marilyn T. Miller, MD
Introduction: There are a number of viruses such as rubella, toxoplasmosis, and others that are known teratogens (environmental agents that cause a permanent change on the developing fetus). A new addition to the list is the Zika virus that has been proven to cause severe microcephaly, neurologic, limb, ocular and other malformations. Although Zika infections have been described in the 1960s, only since the French Polynesian outbreak in 2013 have the neurologic disorders been reported in the offspring of mothers known to have had the Zika infection or those in which the infection had been suspected. In 2016 Ventura1 et al noted chorioretinal atrophy and optic nerve malformations in an infant with microcephaly and presumed Zika virus syndrome (CZS). This observation was subsequently described in other infants2,3.
Methods: Literature review and description of a Brazilian cohort of infants with systemic and ophthalmologic findings associated with a maternal history of presumed Zika virus infection.
Discussion: Zika virus is a mosquito borne flavivirus which usually causes mild or unrecognized illness. Although when pregnant women contract the disease very serious malformations may occur in the fetus especially the developing nervous system. Adults may manifest Guillain-Barrė syndrome. There are two common strains of the Zika virus, the African and Asian strains. The Polynesian outbreak which spread to northeastern Brazil was caused by the Asian strain. There has been a rapid spread of infection in South America by locally acquired mosquito-borne cases and in other areas by travel-associated transmission. In early November 2016, the CDC reported 3,988 travel associated cases and 139 locally acquired cases in the USA. Most ophthalmologic findings have been reported in association with microcephaly or neurologic findings but further studies will determine as to whether the eye findings could occur in apparent isolation.
Conclusion: The Zika virus is capable of causing severe systemic and ophthalmologic malformations in the developing fetus even when the maternal infection may go unnoticed. In a small percentage of adults neurologic sequelae may also occur.
Ventura CV, Maia M, Bravo-Filho V, Gois AL, Belfort Jr R. Zika virus in Brazil and macular atrophy in a child with microcephaly. Lancet 2016;387 (10015):228.
de Paula Freitas B, de Oliveira Dias JR, Prazeres J. et al. Ocular findings in infants with microcephaly associated with presumed Zika virus congenital infection in Salvador, Brazil. JAMA Ophthalmol 2016; 134(5):529-535.
Ventura CV, Maia M, Dias N, Ventura LO, Belfort R Jr. Zika neurological and ocular findings in an infant without microcephaly. Lancet 2016; 387(10037).2502determine as to whether the eye findings could occur in apparent isolation.
Leonard Apt Lecture
The Leonard Apt Lecture was established and first presented in 2000 by the American Academy of Pediatrics (AAP) Section on Ophthalmology to honor Leonard Apt, MD, for his dedication and contributions in the fields of pediatrics and pediatric ophthalmology.
Dr. Apt was born in Philadelphia on June 28, 1922. He entered college at the age of 14 at the University of Pennsylvania, and trained in pediatrics after completing medical school at Jefferson Medical College in Philadelphia. Physicians everywhere will recall the “Apt Test” for detecting gastrointestinal bleeding in newborns, invented by young pediatrician Leonard Apt in 1955. Over the objections of leading physicians of the day who thought that pediatric ophthalmology was conceptually absurd, he then trained in ophthalmology at Harvard, the University of Cincinnati, and the National Institutes of Health. Dr. Apt became the first physician board-certified in both pediatrics and ophthalmology. As the first National Institutes of Health Special Fellow in Pediatric Ophthalmology mentored by Drs. Frank Costenbader and Marshall Parks, he organized the first formal training program for the new specialty.
Dr. Apt served as the first Research Fellow in Pediatric Ophthalmology at Wills Eye Hospital. In 1961, at UCLA, Dr. Apt established the first full-time service in pediatric ophthalmology at a United States medical school, predating both the AAP Section on Ophthalmology and AAPOS. For many years, Dr. Apt served as the principal ophthalmology consultant for the AAP. He organized local and national courses on pediatric eye topics and spoke at Annual Meetings of the AAP. Dr. Apt became a founding member of UCLA’s Jules Stein Eye Institute.
Every ophthalmologist owes an intellectual debt to Dr. Apt. This towering intellectual figure developed the coating that first enabled the use of synthetic absorbable sutures for ocular surgery. In 1963, Dr. Apt reported on the use of povidone-iodine as a potent, safe antiseptic on the eye and surrounding skin area. It eventually became the preferred method of ophthalmic surgical preparation. In recent years, Dr. Apt and his colleague, Dr. Sherwin Isenberg, used povidone-iodine in developing countries to prevent and treat blinding eye infections in infants and children.
Dr. Apt authored more than scientific and medical 300 publications. To his numerous honors from professional societies, Harvard, Jefferson Medical College, and the University of Pennsylvania have recently been added the 2009 UCLA Emeritus Professorship Award, the 2010 AAP Lifetime Achievement Award, and the 2010 Castle Connolly National Physician of the Year Award for Lifetime Achievement. Beyond medicine, Dr. Apt was active as a founder, board member, and a major contributor to the arts, theater, music, humanities, and sports. His philanthropic gifts to UCLA have created the “Leonard Apt Fellowship in Pediatric Ophthalmology” and the “Leonard Apt Chair in Pediatric Ophthalmology.”
Dr. Apt died of natural causes in Santa Monica, California on February 1, 2013. The Leonard Apt Lecture pays continuing tribute to the late Dr. Leonard Apt not only for his monumental educational and scientific contributions, but also for his pioneering leadership in creation of pediatric ophthalmology as a medical subspecialty.
Past Apt Lectures
2000 San Diego J. Bronwyn Bateman, MD
2001 Orlando Bennett A. Shaywitz, MD & Sally E. Shaywitz, MD
2002 Seattle Mark Siegler, MD
2003 Hawaii Linda J. Mason, MD
2005 Orlando Edwin M. Stone, MD, PhD
2007 Seattle Carol D. Berkowitz, MD, FAAP
2009 San Francisco Sherwin J. Isenberg, MD
2011 San Deigo Carol L. Shields, MD & Jerry A. Shields, MD
2013 Boston Joseph L. Demer, MD, PhD
2015 New Orleans Alex V. Levin, MD, MHSc, FRCSC