Pediatric retina: Lessons from the past and goals for the future

Abstract

Over the past 20 years, pediatric retina has developed into a subspecialty of the retina that incorporates traditional medical approaches as well as evolving therapies, such as drug and gene therapy, and exciting new regenerative medical therapies. This editorial will outline where we have come from, where we are today, and where we hope to be in the future. Although pediatric retinal diseases have been recognized early as retinal drawings of congenital X‐linked retinoschisis in 1881,[1] just after the development of the ophthalmoscope, it really was not until retinopathy of prematurity was described that a more organized approach to understanding the pathogenesis, and then pathogenetically driven treatments followed.[2,3] People such as Arnall Patz, Everett Kinsey, Tatsuo Hirose, and William Tasman have all made great contributions to pediatric retina especially with regard to retinopathy of prematurity and other pediatric retinal diseases. Schepens and Criswick described familial exudative vitreoretinopathy, and Paul Sieving has spent many years describing the disease congenital X‐linked retinoschisis.[4,5] Interestingly, ophthalmology provided the first randomized prospective clinical trial to try and determine the treatment for diabetic retinopathy.[6] This was actually the first randomized clinical trial in medicine. It showed us that to be able to perform such a trial, the classification of the disease needed to be understood by the physicians around the world and be consistent at each location. It was not until that was done that testing of different treatment modalities could be performed. Following the lead of the diabetic retinopathy study, a standard classification system for retinopathy of prematurity was developed largely driven by John Flynn and other people interested in retinopathy of prematurity. The international classification of retinopathy of prematurity or ICROP led to an understanding of the progression of the disease process, and that understanding allowed us to test a treatment that had been initially tried in Japan for peripheral ablation of the avascular retina. This early treatment was performed with cryotherapy and was referred to as the CRYO‐ROP study.[7] This showed us that peripheral destruction of the retina was able to reduce severe blinding retinopathy of prematurity disease. The classification system allowed us to understand the progression of the disease and change the name from retrolental fibroplasia to retinopathy of prematurity, which includes all the stages of retinopathy of prematurity from Stages 1 to 5.