Kids with NK Fare Better than Adults

Amblyopia was also more prevalent in younger patients compared to older groups with an overall prevalence of 9% in the NK pediatric cohort, emphasizing the need for early intervention, particularly in amblyogenic age groups. Photo: Megan Mannen, OD. Click image to enlarge. Neurotrophic keratopathy (NK) results from corneal nerve damage, leading to corneal epitheliopathy and persistent epithelial defects, with a prevalence of 22 per 100,000 individuals among people ages three to 89 in the United States. However, the prevalence in the pediatric population is unknown. Compared with adults, the pediatric cornea differs in nerve structure and thickness. Diagnosing and managing NK in the pediatric population presents additional challenges with higher risks of complications like scarring and amblyopia. This necessitates long-term monitoring and adapting adult treatment protocols.A recent study published in Ophthalmology used the large patient volume in the IRIS (Intelligent Research in Sight) Registry to evaluate the prevalence and clinical characteristics of NK in the pediatric population. It determined that the condition had a higher prevalence and worse vision in infancy and early childhood compared to older children. However, unlike adults, there was significant visual improvement following NK diagnosis. The researchers concluded that timely management is critical to prevent amblyopia and permanent vision loss.Of these pediatric NK patients, 52% were female. Compared to the overall pediatric population in the IRIS Registry, the pediatric NK cohort had significantly higher proportions of Caucasian patients and Southern residents. The median age at NK diagnosis was 10 years, compared to 13 years for any diagnosis in the IRIS Registry pediatric population. NK prevalence within the IRIS Registry was at its highest in children younger than age three (244.4 per 100,000) and ages three to five (23.6 per 100,000). Among pediatric patients with NK, 66.2% had unilateral involvement.“This high prevalence may be due to the low volume of IRIS patients under three years old; however, potential developmental factors that influence early childhood susceptibility to NK cannot be ruled out,” the researcher suggested in their paper.Mean best-corrected visual acuity (VA) at diagnosis was 0.61 logMAR (20/80). VA was significantly better in ages 13 to 17 (0.49 logMAR, 20/60) compared to ages six to 12 (0.73, 20/100), three to five years (0.83, 20/125) and younger than age three (1.08, 20/250). Longitudinal analysis of VA showed significant deterioration by 0.18 logMAR units in the year preceding NK diagnosis, with an adjusted mean VA of 0.68 logMAR (20/100) at diagnosis. VA improved to 0.59 logMAR (20/80) in the following year and continued to improve to 0.52 logMAR (20/63) up to two years after diagnosis. Race, ethnicity and corneal comorbidities such as corneal opacity or ulcer were not significantly associated with VA over time.Common corneal diagnoses in these patients were herpetic keratitis (4.9%), burn injury (2.3%) and contact lens-related corneal disorders (2.3%), with the latter more common in adolescents (ages 13 to 17 years: 4.7%). Notably, corneal burn was less common in adults with NK. Other corneal findings included corneal opacity (29%), corneal ulcer (29.5%) and corneal anesthesia (1.8%). Corneal opacity was more common in the ages three to five group (38%), while anesthesia was more prevalent in those younger than three years old (8.7%).Common pediatric NK interventions included punctal plugs (6.5%), therapeutic contact lenses (5.6%), amniotic membrane transplantation (5.2%) and tarsorrhaphy (2.9%), which was more frequent in children younger than age three (10%). Nerve growth factor treatment was used in 2.7% of cases.“This low rate of NK interventions may reflect limited reporting and pediatric challenges, including poor cooperation and treatment adherence,” the researchers suggested.The study pointed out that the challenges in assessing VA in young children may lead to overestimation of vision improvement, as patients learning to read over time could be a confounding factor in the reported outcomes. Survivorship bias, particularly in children under three years, could result from their underrepresentation in the IRIS Registry, potentially inflating prevalence estimates. Click here for the journal source.  Zidan AA, Gilbert JB, Goldberg E, et al.; on behalf of the IRIS Registry Analytic Center Consortium. Neurotrophic keratopathy in pediatric population: an IRIS Registry report. Ophthalmology. April 25, 2025. [Epub ahead of print].