Predicting IOL Power for Pediatric Patients

Courtney L. Kraus, MDKids Eye View
Winter 2015

For Courtney L. Kraus, M.D., assistant professor of ophthalmology at the Johns Hopkins Wilmer Eye Institute, who recently joined the pediatric team here, the goal is to conduct outcomes-based studies of children undergoing cataract surgery. There are a lot of factors that go into determining the best power for the intraocular lens (IOL) in this population, Dr. Kraus explains. “It’s trying to understand the way that the eye grows and if you put an IOL in at a certain age, what growth is left to happen,” she says, adding that you’re trying to predict what vision or refractive error will be best when these pediatric patients ultimately become adults. Dr. Kraus hopes to fine-tune that prediction and prognostic model. “So, when I put an IOL in a 5-year-old, it’s actually the best IOL for them when they’re 25,” she says.

Currently, it remains unclear whether the best outcome in pediatric patients undergoing cataract surgery is to remain free of glasses at age 2 or 3, but perhaps need thick ones by the time they are around 13 years of age, or to wear glasses initially and not need them later. “I don’t think that we have a clear idea or algorithm to help us in that decision tree right now,” Dr. Kraus says.

In addition to launching research in this area, Dr. Kraus is seeing patients at Wilmer’s East Baltimore, Bethesda and Bel Air locations. She is enthusiastic about the kids themselves. It was the idea of working with children that drew her to pediatric ophthalmology in the first place. Even as a child herself, Dr. Kraus knew she wanted to be the type of doctor who worked with kids. “So when I went to medical school, every rotation I would always ask if there was a way to shadow the pediatric version of the doctors, whether that was pediatric orthopedics or pediatric neurosurgery,” she recalls.

It was as a third-year medical student that she decided to learn a little bit more about the eye. True to form, she asked if she could do a pediatric week in the specialty. From the first day of the rotation, she was hooked.  “I was sure this is what I was going to do for the rest of my life,” she says. “It was that beautiful combination of not taking yourself too seriously – putting stickers on your nose, singing silly songs, and pretending to see magical animals at the backs of kids’ eyes – and a delicate surgical subspecialty where research and innovation can push the limits on how we treat complicated pediatric eye disorders. For my personality, it was a complete and total fit.”

To this day, she still views herself as part-clown, entertaining kids during their visits, and part-doctor. The more fun you’re having with a kid, the more information you actually get out of them, Dr. Kraus points out. The other aspect of pediatric ophthalmology that enticed her during that first pediatric ophthalmology rotation was the opportunity to operate. “I thought to myself, ‘Oh my gosh, I get to operate too?’ because I love operating,” she says. “I like seeing problems, offering surgical solutions and then seeing the outcomes.”

Dr. Kraus is excited about the chance to help patients at Wilmer, as well as to hone in on her research. “Wilmer really gives you the opportunity to take these great patients and combine with incredible resources to really start doing these big research projects,” she says. Dr. Kraus’s ultimate goal is to develop a consistent model for IOL replacement so that pediatric ophthalmologists across the country can be more uniform in the way that they approach pediatric cataract patients. She wants to help maximize visual outcomes in these often complicated patients, where a host of factors such as amblyopia, issues with glasses and spectacle intolerance, and the possible need for additional surgeries down the line can all muddy the situation. Dr. Kraus hopes to consider all of these factors to ultimately get a child who presents at 21 months with a cataract to be an adult who sees well at age 21.

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