Workshop 16

Mar 04, 2017 by AAPOS editor in  Workshop

AOC/AAPOS Workshop: Controversies in Pediatric Ophthalmology and Orthoptics

Stephen P. Christiansen, MD; Erick D. Bothun, MD; Casey Mickler, MD; David Hunter, MD, PhD;
Kyle Arnoldi, CO, COMT; Cindy Pritchard, CO; Ron Biernacki, CO; Amy Hutchinson, MD


Purpose/Relevance:  In our clinics and OR’s, patient care is often driven more by our training and personal experience than by high-level evidence.  Even when clinical studies exist, the evidence may be compromised by insufficient numbers, intrinsic biases, or poor study design.  When clinical practice is experientially driven, it is inevitable that bias and controversy will arise because our clinical settings, our patient cohorts, and our own observations may vary significantly.  A discussion of controversial clinical topics is useful as it frames the state of the art but also highlights gaps in our knowledge base that require further study.

Target Audience:  Orthoptists, Pediatric Ophthalmologists

Current Practice:  The controversy that surrounds initial management of the child with poorly-controlled intermittent exotropia highlights the conundrum that orthoptists and pediatric ophthalmologists confront when no clear, data-driven guidelines exist.  Should the child have surgery? Should the child be monitored longer without treatment?  Should alternate patching or over-minused glasses be prescribed?  All are currently acceptable approaches, and we have little to support our choices.  Many controversies like this exist in our day-to-day practices, highlighting the need both for more study and for a more cautious approach with our own preferences and biases as to how best to treat our patients.

Best Practice:  Clinical and surgical management supported by high-level evidence.

Expected Outcomes:  Attendees will be prepared to treat patients whose management is controversial and not supported by high-level evidence by understanding the limits of existing knowledge and the potential risks and benefits of alternate approaches.

Format:  Point-counterpoint discussions of controversial topics in the clinical and surgical care of patients.

Summary:  Topics which will be addressed in this workshop include: Bifocals vs single-vision lenses for high AC/A accommodative esotropia; Surgery vs non-surgical modalities for initial treatment of poorly-controlled intermittent exotropia; Refractive surgery vs conservative management of refractory anisometropic amblyopia; and, Incisional surgery vs chemodenervation for small-angle esotropia.

References:  1. Whitman MC, MacNeill K, Hunter DG. Bifocals fail to improve stereopsis outcomes in high AC/A accommodative esotropia. Ophthalmology. 2016;123:690-696.
2..Daoud YJ, Hutchinson A, Wallace DK, Song J, Kim T. Refractive surgery in children: treatment options, outcomes, and controversies. Am J Ophthalmol. 2009;147:573-582.

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