Asia Pacific Unites for Paediatric Vision

Also focussing on myopia, the conference’s premier partner, EssilorLuxottica, hosted a breakfast symposium, bringing together ophthalmologists, optometrists, and researchers. Beginning with a question to the floor, Dr Loren Rose (Australia) elicited the huge variability in the initial approaches to management from the clinicians present. Dr Rose described her own approach, beginning with myopia control spectacles with full correction, and baseline lifestyle modification advice. Following this, she advocated for close follow-up and consideration of axial length monitoring, with initiation of low dose atropine (with a careful discussion on the side effects). Titration of atropine should follow progression of myopia.

Dr Rose was joined by Dr Kate Gifford (Australia) who presented the emerging evidence and growing international consensus around myopia management. Her message was clear: communication is key, and parents need to understand that treatment is designed to slow, rather than to reverse or completely halt progression. Part of the myopia management process is setting parental expectations, she said. She further explained the current state of pre-myopia management and assessment of hyperopic reserves, reminding attendees that six-year-olds with hyperopic reserve less than 0.75D are the ones that need to be watched, and premyopic treatment might be considered.

Professor Chris Lloyd (United Kingdom) presented the paediatric cataract update lecture. Bilateral congenital cataract is the most common cause of potentially treatable blindness in infancy. Though a rare condition (with prevalence of five per 10,000 by age 15) it accounts for 9% of vision impairment among children in the UK. Prof Lloyd quoted a colleague who once remarked “if you have to have congenital cataracts, you need to pick your parents first”, emphasising the importance of compliance to prescribed postoperative care and follow-up reviews.

Timing the management of paediatric cataract is one area of considerable debate. Prof Lloyd advocated for intervention by week six of life (counted from birth, rather than corrected gestational age) for dense unilateral cataracts because of the amblyogenic potential of these. Counselling families around realistic expectations is paramount; with a median vision outcome of around 6/18, and the association of congenital cataract with foveal hypoplasia. Intraocular lens (IOL) usage at a young age remains a controversy. In his opinion, a contact lens on an aphakic eye is gold standard management but access to appropriate contact lenses remains a significant barrier for many jurisdictions. IOL implantation demonstrates an overall benefit after the age of two though the argument has been made for early infantile implantation. Per the literature, early infantile implantation appears to be associated with more reoperations, and no added protection against glaucoma. When implanting a lens, Prof Lloyd advocated for hydrophobic acrylic in all cases, and three-piece lenses in younger children.

Crescendo therapy involves trialling refractive correction first, followed by patching only if needed, while decrescendo therapy begins with combination treatment from the outset. Prof Holmes presented data in children with mixed anisometropic amblyopia showing that amblyopia resolved in more than a quarter of patients with glasses alone. He also demonstrated that refractive correction achieved similar rates of improvement in strabismic amblyopia. Using a stringent goal of more than three lines of logMAR improvement to define success, nearly onethird of children were successfully treated with glasses alone. Prof Holmes noted that these results surprised even him, and the mechanism remains unclear.

Following widespread recognition of the harms associated with external beam radiotherapy around the turn of the millennium, systemic intravenous chemotherapy became the standard for non-disseminated RB. While this approach significantly improved outcomes, Prof Munier noted that more than 40% of eyes with Group D tumours still required enucleation when treated with intravenous (IV) chemotherapy alone. The field then moved toward intraarterial chemotherapy, which reduced systemic toxicity by delivering treatment directly to the ophthalmic artery. However, this method did not achieve adequate concentrations in the vitreous, limiting its effectiveness against vitreous seeding. This limitation prompted the development of intravitreal chemotherapy for vitreous disease, followed by intracameral chemotherapy for anterior chamber involvement. Through the integration of these modalities, Prof Munier reported an overall eye survival rate of 84% in his primarily advanceddisease cohort, with survival exceeding 60%, even in eyes with Group E tumours, eclipsing the outcomes previously seen in Group D eyes treated with IV chemotherapy alone.

The Australia and New Zealand Strabismus Society (ANZSS) plenary featured a distinguished international panel, including Dr Wendy Marshman (Australia), Prof Donny Suh (USA), Prof Gill Roper-Hall (USA), Dr John Dickson (New Zealand), Prof Holmes, and Dr Andrea Molinari (Ecuador). Taking a casebased approach to strabismus care, they invited seven patients ranging from eight to 43 years old to the stage to demonstrate their complex squints. Pathologies discussed included Brown syndrome, possible thyroid eye disease, posttraumatic strabismus due to orbital fracture, and oculocutaneous albinism. The session was rich with surgical nuance and clinical insight.

Having now been available for five years in Australia, and for a similar period in other jurisdictions, experience with Luxturna (voretigene neparvovec), a gene therapy used to treat retinal dystrophy associated with variants in the RPE65 gene, was presented from both medical and surgical perspectives. This experience has highlighted several system-level considerations, such as the importance of coordinated multidisciplinary care and timely patient work-up. It has also revealed key clinical implications, including anticipated treatment outcomes and potential complications of intraocular gene therapy. These themes featured prominently in discussions of inherited retinal diseases throughout the Congress.

One notable finding, presented across two separate populations, was that individuals with a family history of inherited retinal disease (IRD) were diagnosed later than those without a family history. Given the increasing availability of gene therapy trials, including those currently enrolling in Australia, this population represents a key target for early clinical and genetic evaluation. Professor Robyn Jamieson (Australia) underscored the importance of timely diagnosis through real-world implementation of multidisciplinary IRD testing pathways, and discussed how genomic medicine services and research frameworks can be integrated with ophthalmology to support therapy readiness.

Professor Susan Carden (Australia) noted in one of the opening sessions of the conference that “the topic of the decade is AI”. Many speakers advocated for machine learning applications in clinical care, including AI-assisted myopia screening programmes and the interpretation of retinal imaging in cases of suspected abusive head trauma using fundus photography. As Prof Suh put it, “The AI doesn’t give us the diagnosis, but it helps us to interpret the signs”. Other AI applications presented included automated grading systems for retinopathy of prematurity and widefield imaging analysis tools, reflecting the future of integration of AI into frontline ophthalmic practice.

Although screening programmes often attract less attention than gene therapies or surgical innovations, they emerged as a central theme at APSPOS 2025. In a collaborative symposium, nurses, orthoptists, policymakers, and ophthalmologists from across the region came together to examine screening delivery models. The increasing use of technology, such as the Welch Allyn Spot Vision Screener, in well-resourced settings was contrasted with programmes in lower-resource countries, where vision screening often relies on donated equipment and industry support. Professor Elisabeth Murphy (Australia) clearly outlined both the successes and ongoing challenges of New South Wales’ StEPS programme. Professor Frank Martin (Australia) closed the session by urging the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) to show leadership in pushing to advocate for vision screening nationally, noting that broader implementation would require national and local representation to influence government policy.