The study, at the Fernandes Figueira Institute in Rio de Janeiro, Brazil, considered a cohort of 112 infants born to mothers with polymerase chain reaction-confirmed Zika virus infection. The infants, examined between January and October 2016, ranged in age from birth to 1 year old. The institute is a government-sponsored referral center for high-risk pregnancies and infectious diseases in children.
In the study, researchers sought to answer this question: Which infants exposed to Zika virus infection in pregnancy should undergo an eye examination?
Their answer: All infants. They recommend universal testing, while acknowledging access to care may be an issue there.
"Eye abnormalities may be the only initial finding in congenital Zika virus infection," researchers at the Instituto Nacional de Saúde da Mulher reported in a July 17 article in JAMA Pediatrics.
"All infants with potential maternal Zika virus exposure at any time during pregnancy should undergo screening eye examinations regardless of the CNS abnormalities, timing of maternal infection during pregnancy, or laboratory confirmation."
Researchers noted that current guidelines in Brazil only recommend eye exams for infants "born in areas endemic for Zika virus only in the presence of microcephaly." If microcephaly (birth defects of the brain), the presence of CNS and lab evidence were the only criteria for examinations, three infants with abnormal eye exams would have been missed, they say.
The new study appears to stand in contrast to guidance by the Centers for Disease Control and Prevention (CDC) in the U.S., the researchers say. Says the CDC on its website:
"Testing is recommended for infants born to mothers who have laboratory evidence of Zika virus infection during pregnancy and for infants who have abnormal clinical findings suggestive of congenital Zika syndrome and a maternal epidemiologic link suggesting possible exposure during pregnancy, regardless of maternal test results."
Read about CDC guidance on providing care for infants and children born to infected mothers and also the new CDC guidance regarding care by providers for pregnant women with possible Zika exposure released in the July 28 Morbidity and Mortality Weekly Report.
Optometry's role with Zika
Pregnant women are at risk of giving birth to children with microcephaly. Zika also has been linked to Guillain-Barré syndrome. In 2016, about 1 in 10 women in the U.S. with Zika had a fetus or baby born with birth defects, and the CDC continues to recommend that pregnant women not travel to areas where there is a transmission risk.
Glen Steele, O.D., chair of the AOA's InfantSEE ® and Children's Vision Committee, notes the study's location in Brazil, a Zika hotspot in 2015 when an "exceeding high number" of microcephaly cases were detected.
Dr. Steele also is professor of pediatric optometry at Southern College of Optometry in Memphis, Tennessee.
"Even though the article is not in alignment with the CDC recommendations, the people in Brazil have more direct involvement with consequences from the Zika virus," says Dr. Steele, citing differences in culture and access to care in Brazil as potentially influencing the research's outcomes.
"I would recommend the U.S. doctors follow the CDC recommendations," Dr. Steele says.
He also noted limitations of the study mentioned by the researchers: Study participants had been referred on the basis of being infected and the absence of a control group. The researchers said they could not be sure "that all eye findings were attributable to Zika virus infection."
Dr. Steele encourages utilizing comprehensive eye examinations, as so many of the babies even in this study were asymptomatic. Read more about the difference in a vision screening and a comprehensive eye and vision examination.
Current vision screening methods aren't reliable when it comes to effectively identifying individuals needing vision care. In some cases, vision screening may hinder correct diagnosis and give a false sense of security for those individuals who "pass" the screening but actually have a vision problem.
Still the study's findings highlight the role doctors of optometry can play in detecting systemic diseases such as the Zika virus,
"This continues to support the need for early and periodic in-person examinations by an eye doctor," Dr. Steele says.
Low Vision Awareness Month is a perfect opportunity to consider implementing such services in your practice and to ensure you have the right connections for necessary referrals to other doctors of optometry who provide this essential care.
Researchers found only about 30% of patients with diabetes abide by four diabetes care practices—including eye exams.