Research Spotlight: Dr. Ida Chung
Ida Chung, OD, MSHE, FCOVD, FAAO, is Associate Dean of Academic Affairs for WesternU’s College of Optometry.
Describe one of your current research projects.
PEDIG is the Pediatric Eye Disease Investigator Group. I am proud to be a Principal Investigator for PEDIG at WesternU College of Optometry. I am one of hundreds of clinical optometrists and ophthalmologists participating in multi-center clinical research on pediatric conditions. What separates PEDIG from other research groups is its shear diversity of investigators and clinical sites. The diversity of patients will allow a broader application of research findings to the general population.
PEDIG is a collaborative network dedicated to facilitating multicenter clinical research in strabismus, amblyopia and other eye disorders that affect children. The network, which was formed in 1997, is funded by the National Eye Institute (NEI). The NEI is a part of the National Institutes of Health, which is the branch of government that funds medical research. There are currently over 100 participating sites (offices) with over 300 pediatric ophthalmologists and pediatric optometrists in the United States, Canada and the United Kingdom participating in the network.
Two of my current research projects that is just about to wrap up is ATS20 and IXT6.
ATS20 is studying amblyopia, a condition sometimes called lazy eye whereby vision in one eye is reduced even with prescription eyeglasses or contact lenses, that affects 1-5% of children worldwide. The eye itself looks normal but it is not being used normally because the brain is favoring one eye. In most cases, only one eye is affected. But in some cases, amblyopia can occur in both eyes. The cause may be any condition that affects the normal use of the eye and negatively impacts vision development, such as uncorrected refractive errors, strabismus, and visual axis obstruction. ATS20 is investigating a new treatment modality following the theory that amblyopia is a binocular process and treatment should take into account both eyes. ATS20 is studying binocular visual stimulation through the use of dichoptic glasses while playing video games, to determine its effectiveness compared to traditional patching therapy.
IXT6 is studying intermittent exotropia, one of the most common strabismus conditions in children. Intermittent exotropia is when one or both eyes turn outward, sometimes. Its incidence is 32 out of 100,000 people. The current management of IXT includes observation as well as surgical and non-surgical interventions. Many practitioners treat IXT patients using non-surgical approaches such as part-time patching, over-minus lenses, vision therapy, or prism. IXT6 investigates using base-in prism glasses for treatment of intermittent exotropia in 3 -12 year olds, to determine its therapeutic effects. Although prism treatment for IXT is used in clinical practice by some eye care providers, there have been no randomized clinical trials evaluating its effectiveness. The results from this pilot study will provide important information to determine whether to proceed to a full-scale, longer-term randomized trial.
What do you want people to know about your research?
My research interest is in children’s vision, studying conditions including refractive errors of hyperopia and myopia, convergence insufficiency, amblyopia, exotropia, esotropia, and vision therapy.
Performing research involving children is challenging. The relative rarity of some child eye conditions presents challenges in conducting clinical trials with large enough sample sizes. For many of the PEDIG studies, we are talking about recruiting children as young as 3 years of age. There are protections for children as subjects, and the strict eligibility requirements make it important to have dozens of participating offices in order to recruit the necessary number of subjects.
How would you like people to use the results of your research?
I want people to utilize the results of my research to benefit the eye care of important children’s conditions. As practitioners, we find ourselves treating many conditions based on what we know or how we were taught. But there are things we just don’t know. Research changes that. Research can provide evidence-based treatment which becomes the standard of care for some conditions. When there is information on how to treat a condition, there should be no lag in using the most up to date information and providing that care to my patients.
Through PEDIG research, amblyopia management with patching, atropine, and spectacle correction have been proven to be clinically effective, patient-centered, and safe.
Prior to PEDIG trials on the duration of daily patching for amblyopia, full-time patching was commonly recommended. PEDIG studies showed that moderate amblyopia (20/40-20/100) responds equally well to 2 hours/day patching of the sound eye compared with 6 hours/day and full-time patching in young children 3-7 years old. Clinicians can now decrease their recommended patching time to 2 hours/day for moderate amblyopia and counsel parents that 62% of patients achieve either 20/30 visual acuity or at least 3 lines of improvement from baseline within about 4 months of treatment.
The prescription of full-time glasses in young children is often a bitter pill for parents to swallow. The initial and replacement costs of spectacles, variable cooperation with wear time, and perceived cultural stigmata of wearing glasses are obstacles to treatment success. PEDIG studies have shown that a large percentage (77%) of children with anisometropic amblyopia improve 2 or more lines of vision within 15 weeks of wearing glasses.
PEDIG has shown that atropine penalization of the sound eye to treat moderate amblyopia is equally effective and enduring as patching. Weekend-only versus daily atropine penalization showed equal improvement of moderate and severe amblyopia.
Recurrence of amblyopia is much more likely to occur if treatment is abruptly suspended rather than slowly tapered prior to discontinuation. Parents should be counseled that approximately 20% of children will have regression after amblyopia treatment cessation. Surveillance for amblyopia recurrence is necessary.
Publications for the above studies and many more with free access is housed at this public website: https://public.jaeb.org. I want all doctors to utilize this information in providing vision care to children. I want all parents to know it is never too late to treat amblyopia. To prevent eye and vision problems, get an eye exam by an eye doctor. I want doctors to know to refer all children for their first eye exam by age 1 year, then again when entering preschool, in kindergarten and annually. I want doctors to know vision screenings may not detect learning related vision problems. There is a public health program called InfantSEE® to support early detection of eye problems. Go to infantsee.org for more information.
Remember most children are not able to help themselves, especially when they have only seen the world the way they were born; preventive comprehensive eye exams are critical.
What inspires you most about your research?
My inspiration for research is helping children, to improve the lives of children and the adults they will become. I believe that healthcare is a right and not a privilege. It is my mission to provide quality care by treating my patients with the most updated information. Who wouldn’t want that for their patients? But with unanswered questions, participating in research will bring us closer to answering and knowing how best to treat certain conditions.
What would you as a researcher today tell yourself as a researcher when you were starting out?
Research is hard work. Research takes dedication. Research takes time. Conducting pediatric research presents unique challenges and requires special support. I am thankful to Western University College of Optometry for allowing me the time to continue my research in pediatric optometry.
Augmenting the researcher pipeline in pediatric research must be a priority. This approach will require training programs to support interested individuals with a research career. With fewer doctors choosing and sustaining research careers, I will utilize my position as Associate Dean of Academic Affairs to encourage and inspire the next generation of scholars.
