They reflect the questions and challenges that arise daily from the care of infants and children in varied and specialist eye clinics.
Anterior segment programme
The window to the eye, the cornea, together with the aqueous chamber, iris and lens are regarded as the anterior segment of the eye. The anterior segment must be clear for vision to develop.
Surgeons at Great Ormond Street Hospital (GOSH) have extensive experience and expertise in the management of paediatric cataracts and dislocated lenses. More importantly, the preoperative evaluation and postoperative visual rehabilitation is organised by an extremely skilled multi-specialty team including; optometrists, orthoptists and visual scientists.
The role of different lens materials and techniques of surgery especially in infants have been examined.
Research into modalities of treatment of paediatric glaucoma has included studies on types of medical therapy; high frequency guided cyclophotocoagulation and augmented filtration procedures.
Collaboration with developmental biologists within the Institute of Child Health (ICH) allows for extensive research.
Eye surgeons at GOSH are world leaders in corneal grafting infants who have complex metabolic disorders and compromised corneal clarity, and have extensive experience managing infants with dysgenesis of the anterior segment and glaucoma.
The team works closely with scientists studying limbal stem cell research and developmental eye genes, and with clinicians from other disciplines e.g. metabolic medicine, to understand and treat the consequences of these diseases.
Posterior segment study programme
A clear focused image needs a functioning retina to send bioelectrical messages along the optic nerve to the brain. Some congenital retinal dystrophies have almost normal retinal cells but lack signalling proteins.
The eye unit is working with colleagues in the Institute of Ophthalmology (IOO), to identify those patients who may be the first potential recipients of gene therapy designed to rescue retinal photoreceptors.
The eye team is also working to combine measures of retinal function with structure to assess treatments for chronic and acute inflammation associated with autoimmune disease.
The eye unit is also involved in a major multi centre and multidisciplinary study of retinal function in deaf children, Ushers syndrome.
We are collaborating with the audiology unit at GOSH, genetics in ICH and Sense and colleagues in IOO.
Visual pathway study programme
The eye unit has a special interest in visual development and the functional consequences of congenital pathway misrouting associated with albinism and achiasmia.
We also have active research interests in monitoring and managing acquired pathway compromise in children with craniosynostosis, glioma, and haemangioma. The role of the eye unit in the multidisciplinary care pathway of children with craniofacial anomalies has received supra regional support.
Dedicated clinics for children with albinism have allowed international collaboration, with extensive work on the electrophysiology and eye movements of these children.
Special clinics have allowed a systematic study of these childrens' visual pathway function, binocularity, strabismus and eye movements. There is a supraregionally funded ophthalmic craniofacial team.
Children's clinical network from GOSH to home
In all this the child's welfare remains paramount and the continued care in the community is ensured through the expanding role of the community link nurse.
The community link nurses are working to develop nationwide pathways and strategies of support and care for the visually impaired.