Cataract surgery in children: Complicated cases and controversies

Volume 14 Number 1 / February 2010 members are assigned sections such as ROP and Prematurity or Strabismus and Strabismus surgery, etc. The member then selects the articles he/she feels are the most relevant and creates a PowerPoint presentation. These are all melded into a workshop designed to provide participants with a fast paced overview of the most important information generated over the previous year. The Professional Education Committee appreciates your consideration. 142 The pediatric retina could be the clue to systemic disease. Carol L. Shields, Jerry A. Shields So what diseases should you think of when you see a child with Coats disease in both eyes? There are numerous pediatric retinal diseases that could imply a systemic disease including albinism, optic disc anomalies, retinal vascular diseases like bilateral Coats disease, vasoproliferative tumors, retinal arterial aneurysms, familial retinal arteriolar tortuosity, sickle cell, thallasemia, incontinentia pigmenti, and retinal vascular tumors and others. What systemic associations should come to mind? The clinical features of these conditions will be reviewed. Classification schemes will be presented for the various conditions. This workshop will be divided into 2 parts, including didactic lecture on pediatric retinal diseases for 45 minutes and then case discussion for 15 minutes. 143 Legislative Committee Update: The Optometric Mandatory Pre-K Eye Examination Initiative. John W. Simon, Mary Lou Collins, David Wheeler, Dan Briceland, Jean Ramsey The AAPOS Legislative Committee continues its work, in collaboration with the AAO and the state ophthalmologic societies, to thwart the national optometric comprehensive eye examination initiative. As part of this effort, we have advanced screening bills in states where such legislation is needed and is in the interest of pediatric ophthalmologists, our patients, and the public. During the past year, activity has been seen in Arizona, Washington, Oregon, Hawaii, Missouri, Illinois, Arkansas, Tennessee, Florida, and New York. Although our efforts have been successful in every state during the past year, we expect optometrists to advance their initiative in other states. This symposium is intended to update AAPOS members on the progress we have made in reaching out to stakeholders and policy makers and to prepare them for the expected incursions of optometry in other states. The session will be organized as follows: 1. Introduction: John W. Simon 2. Overview of the threat: Dan Briceland 3. Summary of state-by-state activities: Jean Ramsey, David Wheeler 4. Likely next steps by optometry, and how we can respond: Mary Lou Collins 5. How to approach legislators and other stakeholders: Panel 6. Summary: John W. Simon. 144 Adult strabimus workshop. David R. Stager Sr, Edward Buckley, Arthur Rosenbaum, David Guyton 1. Adjustable suture techniques 2. Professional and public education efforts reguarding adult strabimus. 145 Prediction and treatment of ROP: Emerging strategies. Deborah K. VanderVeen, Ann Hellstrçm, Kimberly Drenser, Lois E. H. Smith Retinopathy of Prematurity(ROP) is a leading cause of childhood visual impairment and blindness in developed countries, and is increasingly prevalent in developing countries. Ablative therapy for Type 1 ROP usu-

Journal of AAPOS

e35 ally allows favorable outcomes, but less destructive and preventative treatment strategies would be optimal. We need ways to predict early those infants who will develop ROP, particularly for locales where ophthalmologists are not readily available. Low IGF-1 levels and poor postnatal weight gain are important predictors in ROP development, and weight surveillance alone may help identify infants at highest risk of severe ROP development. We developed an algorithm (WINROP) that predicts significant ROP early (median time to development of ROP, 9 weeks, and treatable ROP, 8 weeks) with very high specificity and sensitivity. A multicenter trial to evaluate this method is underway, and we will discuss results to date and discuss expanding the use of this method in more US and world NICUs. Dietary supplementation has also been a topic of ROP research, and since composition of parenteral nutrition and breast milk plays an important role in brain and eye development, recognition of deficiencies with supplementation to normal levels could play an important role in ROP prevention. VEGF inhibitors for ROP treatment offer promise and will also be discussed, though current use in the US is limited to compassionate use or as part of a clinical trial such as BLOCK-ROP. The panel will discuss recent clinical research in these areas and how this information may be used in the clinical setting. 146 Double trouble: Tips and pearls for prevention and management of pre- and postperative diplopia. Kyle Arnoldi, Katherine Fray, Claire Hennessey, Rachael Jenkins, Lisa Rovick, David R. Weakley, Rich Freeman Are your diplopic patients making you see red? Frustrated? Relax. This course will give you some insight into how to anticipate, prevent, and manage diplopia in children and adults with preoperative sensorimotor testing and postoperative orthoptic intervention. Our panel of seasoned orthoptists and ophthalmologists will share tips and pearls to improve your success in managing these difficult patients from preoperative evaluation and management to post-operative manipulations, Panels members will present both common and unusual cases to demonstrate their techniques. When is prism adaptation helpful? How can you minimize the risk of postoperative diplopia? How can prisms or the synoptophore to help guide surgical plans? Should I use prisms pre- or postoperatively? Are fusional amplitudes important and can they help predict outcomes? When is postoperative diplopia desirable and when is it unacceptable? When do you consider reoperation? The careful collection and interpretation of clinical data in patients with diplopia can make the difference between a successful or failed surgical plan. Questions and comments from the audience will be encouraged. 147 Cataract surgery in children: Complicated cases and controversies. M. Edward Wilson, Edward Buckley, Scott Lambert, David Plager, Erick D. Bothun This workshop is completely video-based and will present a diverse group of pediatric cataract cases from the practice of the lead author. The workshop is presented on behalf of the Pediatric Clinic Committee of the American Association of Cataract and Refractive Surgery. Panel and audience discussion will be used as each case unfolds. Complications and complicated solutions will be shown and the video paused for discussion before the video resumes. This fun and interactive format will utilize videos selected especially for this meeting. The workshop will focus on surgeries in children beyond their infancy. Topics covered may include (time and discussion dependent—fast paced) ectopia lentis, PFV, pre-existing and surgeon-induced capsular rupture, vitreous problems, piggyback IOLs, vision blue, Kenalog use, uveitis, secondary after-cataract, and some surprising complications.