Focus on paediatrics: CXL, ROP and more

Comment: PBKC is associated with insidious symptoms, which children may experience before parents seek help. It not only has a significant impact on children’s quality of vision and learning, but can also impact the whole family’s quality of life due to the child’s photophobia and avoidance of being outdoors. While there were no revelations in this article, it did provide a comprehensive review that would be useful for many clinicians.

Screening plus corneal crosslinking for keratoconus is cost-effective for New Zealand: a proof-of-concept Markov analysis

Hong CY, Hong SC, Wilson G

Clin Exp Ophthalmol. 2025 Dec;53(9):1125-1135

Review: Markov simulation compared screening of all New Zealanders at age 15 (and assumed positively identified cases went on to have successful treatment with crosslinking) with the usual standard of care.

Screening plus treatment was cost-saving in the model, saving an estimated $1,278 for each quality-adjusted life year (QALY) gained. Factors that had the most influence on cost-effectiveness were the specificity of the screening test, the prevalence of keratoconus at the time of screening, the discount rate, the probability of patients being progressors, adherence and efficacy of crosslinking treatment.

Comment: It is evident to anyone involved in keratoconus care that New Zealand should have screening and reliable access to corneal crosslinking to save the disability and financial burden of advanced keratoconus. As a comparison, routine cataract surgery costs approximately $4,380 per QALY gained and mainly affects retirees. Keratoconus can cause significant structural changes to the cornea for which the surgical treatment options are limited. Māori and Pacific Peoples are disproportionately affected by this disease (up to 2.2% of Māori high-school students), increasing the challenges faced by this group of rangatahi. In the Auckland keratoconus study, 43% of corneal transplants for keratoconus were performed on Pasifika patients, despite Pasifika representing only 7% of the population. The faster we can implement the Eye Health National Clinical Network’s keratoconus action plan the better.

Review of retinopathy of prematurity management in the anti-VEGF era: evolving global paradigms, persistent challenges and our AI-assisted future

Marra KV, Chen JS, Nudleman E, Robbins SL

Clinical & Experimental Ophthalmology 53, no. 9 (2025): 1202–1217

Review: Anti-VEGF therapies have revolutionised retinopathy of prematurity (ROP) treatment, offering better structural outcomes and less retinal destruction than traditional laser therapy, particularly for zone I disease. Anti-VEGF agents are associated with lower rates of high myopia compared to laser treatment but come with a risk of late reactivation due to areas of peripheral avascular retina (PAR). Laser still has a role to play in ROP care, particularly in managing PAR.

Adults with a history of ROP are at increased lifelong risk of ocular hypertension and glaucoma. Late retinal findings are also common, with one untreated ROP series reporting retinal detachment in 38.6% of eyes.

Studies are investigating additional therapeutics to reduce the incidence of ROP. Bedside fundus photography and AI-assisted systems are also being implemented in many large centres and may reduce the burden of disease in the near future.

Comment: This review article is recommended reading for allied health team members involved in ROP care, ophthalmology trainees and NICU registrars. ROP represents 18% of childhood blindness in New Zealand, so we have room to improve!

The anti-VEGF era of ROP treatment is established and has resulted in changes to the way we screen, treat and follow up babies at risk of ROP. In 2025, New Zealand saw the national rollout of the super widefield retinal cameras and Harmony for digital image sharing (a project led by Dr Sarah Welch and the Eye Health National Clinical Network, Dr Cheefoong Chong and Joce Carr). This should support more streamlined care and national consistency in our management of ROP in 2026.