Research The foundation of innovative care

SickKids Ophthalmology is internationally recognized for our cutting-edge research. Our high-impact research programs allow for rapid translation of innovative methods to the bedside. We provide unparalleled research training opportunities for residents, fellows, and graduate students from local, national and international institutions.

Research programs include

Retinoblastoma

Retinoblastoma is a rare form of cancer but the most common eye cancer in children.

Although 98% of children in developed countries survive, unfortunately, 70% of children with retinoblastoma worldwide die, particularly those born in lower income countries, where access to specialized care is limited.

The impacts of treatment are significant: often removal of an eye, chemotherapy and many sessions of laser treatments are required, as well as long-term repeated examinations to watch for cancer progression, recurrence and new cancers.

Expert care for retinoblastoma is available in a limited number of centres around the world, including SickKids in Toronto, Canada. The 8% of children born in high-income countries have potential to access expert care. Our One Retinoblastoma World program is a collaboration initiative to open a clear path of optimized care for children worldwide, with the goal of making retinoblastoma a “Zero Death Disease.”

High Income

survivors627 (7.8%)
deaths13 (0.2%)

Low Income

survivors1,760 (22%)
deaths5,600 (70%)

SickKids is a major international leader in retinoblastoma research, focusing on three key areas:

  • Translation of molecular knowledge to save vision in the next generation of children.

  • Collaboration to optimize outcomes for all children with retinoblastoma.

  • Development of a global cloud-based database system to collect point-of-care data for caregivers, to support clinical choices.

City

Facility

TorontoSickKids
HamiltonMcMaster Children’s Hospital
KitchenerGrand River Hospital NICU
BarrieRoyal Victoria Hospital NICU
SudburyHealth Sciences North NICU
TimminsTimmins and District Hospital NICU

TELEMEDICINE AND ROP

Retinopathy of prematurity (ROP) is a disease of the retina affecting premature infants. It can cause abnormal blood vessels, which may bleed, scar or detach the retina, leading to poor vision or a lifetime of blindness. Timely and frequent screening examinations are necessary to watch for and treat the disease.

As neonatal care advances and more premature infants survive, the demand for ROP screening is increasing. While these children may receive effective overall care from remote facilities, a shortage of ophthalmologists with ROP expertise poses difficulties for children in need of screening. Under the leadership of Drs. Tehrani and Mireskandari, our Ontario ROP Telemedicine program is working to improve these conditions.

Using a specialized wide-angle retinal camera, the infant’s eyes are photographed by trained nurses in the neonatal intensive care unit (NICU). Images are sent to SickKids to be evaluated by the ophthalmologists. This program has ensured that infants from NICUs in Sudbury and Barrie no longer need to be transferred to SickKids for eye examinations. Additionally, infants at risk of ROP can be transferred a shorter distance to Sudbury, from the NICU at Timmins. Our model has also been used as a template to start a second telemedicine network between the McMaster Children’s Hospital in Hamilton and the Grand River Hospital NICU in Kitchener.

Expansion of the program to provide coverage for other remote NICUs is being planned, and the location of the next screening site location will be confirmed by fall of 2015.

The program was a recipient of the Ontario Ministry of Health and Long-Term Care’s achievement award for improving access to care at the Celebration of Innovation in 2010.

neurovision

The eye is an extension of the brain. NeuroVision is an innovative, multidisciplinary research program that brings together clinicians and scientists to assess different aspects of visual function.

The goal of the program is to understand how vision develops in normal infants and children, in comparison to children with different eye diseases. NeuroVision investigates how vision is received from the retina and optic nerve, through to the visual cortex and higher levels of brain processing. Our research also examines the basis of eye movement control and the associated development of binocular vision and depth perception.

SickKids Ophthalmology is one of the few paediatric centres around the world with all of the expertise and technology needed to study visual processing in children under one roof. Clinical questions guide our research, while new knowledge revolutionizes the assessment and treatment of visual and neurological disorders in children, which can then be applied directly at the bedside. Ultimately, NeuroVision seeks to optimize visual outcomes by better understanding visual functions and dysfunctions.

image of brain from top

Papilledema due to large arachnoid cyst

Normal left temporal lobe
Pons
Cerebellum
A large arachnoid cyst displacing the right temporal lobe
  • Ocular Genetics

    The field of Ocular Genetics has grown significantly in the last decade, with over 300 genes now associated with diseases of the eye. We are one of the largest users of genetic testing in Canada. This has allowed us to decipher the basis of several eye disorders through our research. Dr. Héon leads numerous genetic studies of eye disorders that are present at birth and deteriorate over time, known as retinal dystrophies. Our patients have benefitted from access to the earliest clinical trials of new therapeutic interventions, such as gene replacement therapy. The application of innovative therapies to treat inherited forms of blindness is rapidly evolving, and we are prepared to be active players in this exciting new era.

  • Surgical Innovation

    Surgical Innovation is a research program that focuses on techniques to improve the management of various kinds of vision loss, including trauma, severe retinal damage, and deformities of the eye existing at birth. This means introducing new techniques and instrumentation, improving ways of planning surgery using imaging, and reviews of surgical outcomes. The goal of the program is to improve care for these patients, many of whom have very complex problems that demand unconventional solutions. Innovative techniques developed and studied in our department include conventional and selective corneal transplantation, ocular surface reconstruction and corneal neurotization surgery.

  • CHILD EYE CARE ADVOCACY

    Children are not small adults—their eyes are different and require proper development to be healthy. Our Child Eye Care Advocacy research program develops unique and effective eye care strategies that are critical for promoting excellent vision. Research on strategies that improve overall health is of growing interest for decision makers when allocating resources. Our long-term goal is to devise the best and most cost-effective eye care strategies for children of all ages in Ontario.

Our Research

Electrophysiological tests
Electrophysiological tests

Electrophysiological tests help to decipher and characterize retinal and visual pathway disorders. SickKids Ophthalmology offers a wide array of electrophysiological tests to aid diagnosis and management of patients. Jeff Locke (orthoptist) and Elizabeth Gomes (ophthalmic assistant) perform a visual evoked potential test on Dr. Ajoy Vincent.

Drs. Westall and Vincent discussing findings with lab members
Drs. Westall and Vincent discussing findings with lab members

Cone photoreceptor dysfunction is the underlying cause of several retinal disorders. Dr. Westall’s Retinal Imaging Laboratory focuses on imaging single cone cells in vivo and studying the retinal micro-vasculature. Drs. Westall and Vincent discuss findings with lab members.

laterally-shifting prism goggles
laterally-shifting prism goggles

Seeing the world from a shifted perspective: Jaime Sklar, MSc adapts to laterally-shifting prism goggles in Dr. Wong’s Eye Movement & Vision Neuroscience Laboratory.

soundproof chamber for testing audiovisual integration
soundproof chamber for testing audiovisual integration

Apparatus in a soundproof chamber for testing audiovisual integration in patients with lazy eye.

genetic basis of eye disorders
genetic basis of eye disorders

The genetic basis of eye disorders is intriguing with over 300 disease-causing loci. Dr. Héon’s Ocular Genetic Laboratory focuses on characterization of known and unknown genetic eye diseases.