Daniel Karr, M.D., is professor of ophthalmology, OHSU School of Medicine, head of the Elks Children’s Eye Clinic and director of the pediatric ophthalmology fellowship program.

April 20, 2015

What’s been the most interesting development in your area in the last two years?

Amblyopia therapy has traditionally consisted of wearing an appropriate glasses prescription and either patching or chemically blurring (dilation eye drops) the better seeing eye to promote vision development of the poor seeing eye. Although this “gold standard” form of therapy frequently results in improved visual acuity for the lazy eye, a revolutionary binocular approach appears to be the next quantum leap in amblyopia therapy. There is evidence to support the presumption that amblyopia patients with structurally normal eyes have an intact binocular visual system that has basically stopped working properly. This disruption of binocular function develops when one eye is misaligned or out of focus relative to the other eye. The binocular potential is not lost, however, it is suppressed and receptive to stimulation with recovery of best vision and binocular vision. We are currently participating in an NIH-funded PEDIG (Pediatric Eye Disease Investigator Group) study using a modified iPad with videogame and “stereo” glasses that reduce the input to the good eye in order to emphasize use and reduce suppression of the amblyopia eye. The amblyopia therapy, therefore, is presented in a binocular fashion.

The preliminary data used to support the current study shows impressive and exciting evidence that binocular amblyopia therapy has the potential for both successful amblyopia treatment and development of 3-D vision in children and adults. Traditional patching therapy will still have a role but may be utilized more for children with structural abnormalities.

What is the most important aspect of support that OHSU provides to you currently and how would you like this or other support to grow in the future?

OHSU and the Casey Eye Institute have been extremely supportive of international ophthalmology endeavors. We have had a series of International Ophthalmology Fellows from a number of countries including China (mainland and Taiwan), South America, and Asia – one fellow from India and four from Nepal. Conversely I have had the opportunity to participate in teaching trips to Bhutan and Nepal, taking two ophthalmology residents on the last Nepal trip. There are numerous pediatric ophthalmology teaching and service opportunities in the Third World. Personally I would make these trips yearly if time away from my clinical practice were affordable. As OHSU looks more towards global involvement, faculty support for these programs needs to be rethought.

A hypothetical: If you could have one tool that would solve a seemingly impenetrable problem in your work, what would it do? You have unlimited resources to design this tool, so think big.

I would have the best photo screening device mass-produced and placed in every pediatric and family practice clinic in the country. They would also be available for all the school nurses and preschool programs. The even bigger picture is to make these available globally. Amblyopia has to be diagnosed in order to be treated. Most of amblyopia is treatable and likely even preventable.

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