Background

The antiepileptic medication vigabatrin has been associated with ocular toxicity, and close ophthalmic monitoring has been recommended; however, there is no clear consensus regarding the value and feasibility of such monitoring in children. We describe ophthalmic assessments in children in a real-world clinical setting, the incidence of vigabatrin-related ocular toxicity, and the utility of regular screening or ancillary testing in children taking vigabatrin.

Methods

The medical records of children taking vigabatrin with one or more ophthalmic assessments at Children's Hospital of Philadelphia or University of California, San Francisco, between May 2010 and May 2021, were reviewed retrospectively. Abnormalities on ophthalmic examination, visual field (VF), electroretinogram (ERG), and optical coherence tomography (OCT) were reviewed and categorized as attributable to vigabatrin, possibly attributable to vigabatrin, or not attributable to vigabatrin.

Results

A total of 1,281 assessments of 284 children (mean age, 2.09 years) were included. Of these, 283 (99.6%) had funduscopic examination(s), 37 (13.0%) had ERG, 19 (6.7%) had OCT, and 6 (2.1%) had formal VF. Rate of examinations and ERGs per child decreased over the 10-year study period. Two children (0.7%) had definite vigabatrin-related ocular toxicity, both identified on ERG. An additional 4 children (1.4%) had optic atrophy of unclear relation to vigabatrin, categorized as possible toxicity. The remaining 278 children did not have abnormal examination or testing findings attributable to vigabatrin.

Conclusions

The incidence of vigabatrin-related ocular toxicity in children was low in our cohort. Ocular and neurologic comorbidities and limited examinations in children make identification of such toxicity challenging and the value of screening is unclear.

In preparation for the Intergovernmental Panel on Climate Change (IPCC) Fifth Assessment Report, the climate community will run the Coupled Model Intercomparison Project phase 5 (CMIP-5) experiments, which are designed to answer crucial questions about future regional climate change and the results of carbon feedback for different mitigation scenarios. The CMIP-5 experiments will generate petabytes of data that must be replicated seamlessly, reliably, and quickly to hundreds of research teams around the globe. As an end-to-end test of the technologies that will be used to perform this task, a multidisciplinary team of researchers moved a small portion (10 TB) of the multimodel Coupled Model Intercomparison Project, Phase 3 data set used in the IPCC Fourth Assessment Report from three sources-the Argonne Leadership Computing Facility (ALCF) Lawrence Livermore National Laboratory (LLNL) and National Energy Research Scientific Computing Center (NERSC)-to the 2009 Supercomputing conference (SC09) show floor in Portland, Oregon, over circuits provided by DOE's ESnet. The team achieved a sustained data rate of 15 Gb/s on a 20 Gb/s network. More important, this effort provided critical feedback on how to deploy, tune, and monitor the middleware that will be used to replicate the upcoming petascale climate datasets. We report on obstacles overcome and the key lessons learned from this successful bandwidth challenge effort. Copyright 2010 ACM.