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Characterizing pediatric utilization of ophthalmology-specific emergency department services
e28 Discussion: Multiple types of hemorrhages are present in ROP. The dot hemorrhages are a new observation and are similar to those seen in diabetic retinopathy. In adults with background diabetic retinopathy, dot hemorrhages are too small to be seen on indirect ophthalmoscopy. Possibly more infants with severe ROP have dot hemorrhages that are only visibly on Retcam photography under general anaesthesia. As in diabetic retinopathy they likely represent ischaemia. Conclusions: While hemorrhages are not one of the major categories routinely documented in ROP examinations, their presence may be indicative of severe disease. Retinopathy of prematurity may be more akin to diabetic retinopathy than previously realized given our report of multiple dot hemorrhages. In general, hemorrhages maybe a useful sign that ischaemia is present. 101 Characterizing pediatric utilization of ophthalmology-specific emergency department services. Kara M. Cavuoto, James C. Banta, Daniel Gologorsky Introduction: The Bascom Palmer Eye Institute, Miami, maintains a 24-hour ophthalmology-specific emergency department (ED) with an approximately 20,000 new patient visits a year. The purpose of this study is to describe the nature and utilization trends of the pediatric patient population presenting for emergency care. Methods: This is a retrospective study of all new pediatric patients (ages 0-17) over a 1 year period from June 1, 2014, to May 31, 2015. Metrics including patient demographics, insurance status, time of presentation, and diagnosis were derived from electronic medical record (EMR) data. Results: Of 19,503 total ER visits, 1,639 (8.4%) were pediatric, of which 54% were male and 46% were female. An average of 4.5 patients presented on a daily basis, with a mean age of 9.3 years. Most patients presented in the afternoon (67%) with only a minority (21%) presenting over a weekend. March witnessed the most pediatric ED visits, while November saw the least. The most common diagnoses were corneal abrasion and chalazion, followed by allergic and viral conjunctivitis. Most pediatric patients were privately insured (67%), the others having federal insurance (17%), regional insurance (1%), or self-paying (15%). Discussion: To our knowledge, this represents the first study examining the utilization patterns of pediatric patients presenting to Ophthalmology specific ED. Conclusions: This study is consistent with the literature that a sizeable proportion of ED visits are non-emergent. In the pediatric population, there was a significant degree of variation as to the demographic, indication, and urgency for pediatric visits to the ED. 102 The use of depo-medrone in the management of postoperative inflammation in congenital cataract surgery. Sarah Chamney, Chris I. Lloyd, Jane Ashworth Introduction: There is very little published on the management of postoperative inflammation following congenital cataract surgery. We aim to share the results of a case series of infants treated with orbital floor depo-medrone (Pharmacia aqueous suspension of methylprednisolone acetate 40 mg/ml) at the time of cataract surgery over a 2-year period (April 2013 to April 2015). Methods: A case note review was undertaken of patients \ 2 years of age, identified from the theater operating system as having been given orbital floor depo-medrone during congenital cataract surgery over a 2-year period. The dose varied between 10 mg and 20 mg. The postoperative drop regime was maxitrol one drop 6 times a day,
Volume 20 Number 4 / August 2016 maxitrol ointment at night and cyclopentolate either 0.5% or 1% based on the infant's age. These drops were then changed to preservative-free drops if the infants were fitted with contact lenses. Results: Nineteen eyes and 13 patients have been identified who received the orbital floor depo-medrone. The average age at the time of cataract surgery was 343 days (range, 27- 651 days); 6 infants were male. Eight of the patients had bilateral cataracts. No intra procedure complications were recorded associated with the use of depo-medrone. Two eyes developed glaucoma. No postoperative inflammation was recorded. Three eyes required anterior segment revision. Discussion: Our case series shows that the use of depo-medrone is safe and helps to control the postoperative inflammation especially in infants in whom parents may find it difficult to instil regular postoperative drops. Conclusions: The use of orbital floor depo-medrone is safe in infants and can be used to as part of a strategy to reduce postoperative inflammation following congenital cataract surgery. More data is required to determine the risk of steroid-induced glaucoma. 103 Acute acquired comitant esotropia in older children and adults. Smith Ann Chisholm, Steven Archer, Christopher Gappy Introduction: Acute acquired comitant esotropia is a rare condition that can occur at any age; however, evaluation and treatment success differ depending on age of onset. This study focuses on this condition in older children and adults. It identifies presenting characteristics, brain imaging results, surgical interventions, and surgical outcomes. Methods:Retrospective review of eleven patients with acute onset of comitant esotropia. All patients underwent a complete ophthalmic examination and brain imaging. Results: Average age at presentation was 22 years old and average follow-up was 9 months. All patients presented with acute onset of esotropia with diplopia and no other neurologic symptoms. All patients were able to demonstrate fusion. Brain imaging was negative in all patients. Strabismus surgery was undertaken in ten patients (91%). One patient opted to use prism glasses for relief of diplopia. At final follow-up, all patients had relief of diplopia and restoration of stereopsis. Alignment ranged from orthophoria to mild esophoria. Discussion: Our series shows that older children and adults who present with acute esotropia, diplopia, fusional capacity, and no other neurologic symptoms do well following strabismus surgery without adjustable sutures. The brain imaging for all patients was negative, indicating that brain imaging in this condition may be unnecessary. Conclusions: Acute comitant esotropia of older children and adults should be viewed as a defined condition. Patients do well following basic strabismus surgery and likely do not require brain imaging as part of their work-up. 104 Medically led virtual adult strabismus clinic. Jessy T. Choi, Lynne Rossiter Introduction: The purpose of creating the virtual service is to reduce waiting times in the Adult Strabismus Service and fulfil the local hospital target for new patient referrals using existing resources and to drive efficiency despite the constraint of limited contracted doctor's time. The principle of the medically led virtual care pathway was to reduce face-time contact and maintain standard of care. Methods: New referrals letter were vetted and appropriate cases were invited to attend for an assessment in the Eye Movement Service. An adult strabismus questionnaire (AS20) was completed prior
Journal of AAPOS
Volume 20 Number 4 / August 2016 maxitrol ointment at night and cyclopentolate either 0.5% or 1% based on the infant's age. These drops were then changed to preservative-free drops if the infants were fitted with contact lenses. Results: Nineteen eyes and 13 patients have been identified who received the orbital floor depo-medrone. The average age at the time of cataract surgery was 343 days (range, 27- 651 days); 6 infants were male. Eight of the patients had bilateral cataracts. No intra procedure complications were recorded associated with the use of depo-medrone. Two eyes developed glaucoma. No postoperative inflammation was recorded. Three eyes required anterior segment revision. Discussion: Our case series shows that the use of depo-medrone is safe and helps to control the postoperative inflammation especially in infants in whom parents may find it difficult to instil regular postoperative drops. Conclusions: The use of orbital floor depo-medrone is safe in infants and can be used to as part of a strategy to reduce postoperative inflammation following congenital cataract surgery. More data is required to determine the risk of steroid-induced glaucoma. 103 Acute acquired comitant esotropia in older children and adults. Smith Ann Chisholm, Steven Archer, Christopher Gappy Introduction: Acute acquired comitant esotropia is a rare condition that can occur at any age; however, evaluation and treatment success differ depending on age of onset. This study focuses on this condition in older children and adults. It identifies presenting characteristics, brain imaging results, surgical interventions, and surgical outcomes. Methods:Retrospective review of eleven patients with acute onset of comitant esotropia. All patients underwent a complete ophthalmic examination and brain imaging. Results: Average age at presentation was 22 years old and average follow-up was 9 months. All patients presented with acute onset of esotropia with diplopia and no other neurologic symptoms. All patients were able to demonstrate fusion. Brain imaging was negative in all patients. Strabismus surgery was undertaken in ten patients (91%). One patient opted to use prism glasses for relief of diplopia. At final follow-up, all patients had relief of diplopia and restoration of stereopsis. Alignment ranged from orthophoria to mild esophoria. Discussion: Our series shows that older children and adults who present with acute esotropia, diplopia, fusional capacity, and no other neurologic symptoms do well following strabismus surgery without adjustable sutures. The brain imaging for all patients was negative, indicating that brain imaging in this condition may be unnecessary. Conclusions: Acute comitant esotropia of older children and adults should be viewed as a defined condition. Patients do well following basic strabismus surgery and likely do not require brain imaging as part of their work-up. 104 Medically led virtual adult strabismus clinic. Jessy T. Choi, Lynne Rossiter Introduction: The purpose of creating the virtual service is to reduce waiting times in the Adult Strabismus Service and fulfil the local hospital target for new patient referrals using existing resources and to drive efficiency despite the constraint of limited contracted doctor's time. The principle of the medically led virtual care pathway was to reduce face-time contact and maintain standard of care. Methods: New referrals letter were vetted and appropriate cases were invited to attend for an assessment in the Eye Movement Service. An adult strabismus questionnaire (AS20) was completed prior
Journal of AAPOS