Fee for service genetic testing in ophthalmology: What is available, who should be tested, and who understands the results?

WorkShop 123 ROP risk management. Hans K. Bruhn, James Sprague, Denise Chamblee Retinopathy of prematurity ROP continues to represent a threat to the eyesight of infants born prematurely. They also pose a high risk of professional liability claims for both the ophthalmologist and the hospitals where these patients are examined and treated. Claim settlements exceeding 20 million dollars underscore the severity of these claims and the urgent need for a comprehensive effort to increase the awareness of these risks and to continue to develop & implement effective risk management strategies to ensure these babies are examined and treated in a timely manner. This presentation will provide an update on efforts involving various professional organizations and the insurance industry to protect the eye sight of this patient population. A review of claim activity as well as system & clinical issues will be discussed during this presentation. OMIC Risk Management Committee Ophthalmologists, Denise Chamblee, MD, and James Sprague, MD, along with Risk Management Specialist Hans Bruhn, MHS, will lead this discussion. Participation will provide ophthalmologists involved in ROP care with a clearer understanding of the risks involved and the need to coordinate closely with hospitals in order to eliminate the potential for babies to go undiagnosed for ROP. It will also provide recommendations to ensure timely treatment. 124 Optic nerve abnormalities in children: A practical approach. Hilda Capo, Michael X. Repka, Jane C. Edmond, Arlene V. Drack, Louis C. Blumenfeld, R. Michael Siatkowski The purpose of this workshop is to provide a practical approach to common abnormalities of the optic nerve in children. We will discuss optic nerve atrophy, enlarged cup of the optic nerve (physiologic cupping vs. glaucoma), swelling of the optic nerve (papilledema vs. pseudopapilledema), and developmental anomalies such as optic nerve hypoplasia, coloboma, and morning glory disc anomaly. Using a case study format, emphasis will be placed on important aspects of the history, examination, ancillary testing, and associated systemic, endocrine and CNS abnormalities. The role of visual fields, color vision testing, neuroimaging studies, visual evoked potentials, optical coherence tomography, and genetic testing in the evaluation of these patients, along with the appropriate management of these disorders, will be discussed by the panel. After completing the workshop the participants should be able to perform a focused work-up and properly manage children with optic nerve abnormalities. 125 Knapp Lecturer workshop—new IOL technique. Jan-Tjeerd H. N. de Faber 126 Fee for service genetic testing in ophthalmology: What is available, who should be tested, and who understands the results? Arlene V. Drack, Terri Young In the recent past, most ophthalmic genetic testing was research based. Testing was usually ordered for ‘‘academic’’ reasons, and it was understood that a result may not be found, or may take years to be reported. Testing was also free of charge. Today, fee for service (FFS) genetic testing is available for many eye diseases. Fees vary, as does the willingness of insurance companies to pay. Gene replacement therapy is now in clinical trials for one genetic eye disorder, and will likely be available for more soon, making a genetic diagnosis more than of academic interest. The availability of FFS genetic testing in ophthalmology means clinicians should discuss genetic testing for disorders such as Leber congenital amaurosis, Usher syndrome, Stargardt disease, and retinitis pigmentosa. Testing is becoming available

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even for very rare disorders, such as achromatopsia and microphthalmia/anophthalmia. Opportunities for treatment, and for scholastic and reproductive planning, may be missed if a correct diagnosis is not made. Medical–legal issues may also arise. After completing this course, participants will be able to: identify at least 3 common genetic eye diseases for which FFS genetic testing is available; access information on where testing is available, cost, and how to send a sample; read and understand a genetic test result; understand when to consult a geneticist or ophthalmic genetics specialist; discuss how to stay up-to-date on current clinical trials for genetic eye diseases. 127 Difficult problems: Strabismus. Jane C. Edmond, Oscar A. Cruz, Stephen Kraft, David A. Plager, Arthur L. Rosenbaum This workshop will cover the diagnosis and management of challenging but not necessarily unusual problems in strabismus. This will be done through detailed case presentations using images and other relevant data, followed by a panel discussion. 128 The ABCs of children's eye health: Educating school nurses. Jane C. Edmond, Sandi Delack, Sheryl M. Handler, Daniel E. Neely, Mary Louise, Z. Collins School nurses care for hundreds of thousands of children across the country and are often the primary medical interface with many underserved children. Pediatric ophthalmologists share a common mission with school nurses of protecting and caring for children's ocular health. We as pediatric ophthalmologists should take a active role in educating school nurses about ophthalmic diseases and conditions that affect school children. This symposium will introduce a pediatric ophthalmologist to the some of the most commonly asked questions and concerns of school nurses, with presentations on:  Learning disabilities, vision therapy and the recent AAPOS policy statement  Vision screening and vision screening devices, age appropriate tests  Conjunctivitis and up-to-date information about management and contagion risk  Advocacy issues such as mandatory comprehensive eye exams for children A CD-ROM containing a PowerPoint lecture for use when speaking to school nurses will be distributed to attendees, as well as a contact list of state school nurse representatives. A brief overview of the topics contained within will be presented. Educating school nurses is good public health and advocates for the role of the pediatric ophthalmologist as the key provider of eye care to children. 129 How HITECH can make your practice more high tech. K. David Epley, Paul J. Rychwalski The HITECH Act of 2009 offers significant opportunities for healthcare organizations to adopt electronic health records (EHRs). Technology is only a small part of the equation. The larger and more important part is setting your practice up to be able to use the EHR in a productive manner. This includes designing appropriate workflows, obtaining physician and administrator buy-in, managing change, and providing clear communication and sufficient training to ensure that your practice is prepared to receive benefits from your EHR long after the financial incentives have passed. According to the HITECH mandates, merely purchasing an EHR is not sufficient to obtain additional funding; organizations must appropriately utilize the EHR as evidenced by e-prescribing, reporting on clinical information, and using the EHR as a vehicle to deliver a higher level of care to your patients. This workshop will provide a roadmap to help your practice navigate the details of this change by reviewing current requirements to obtain stimulus money, EHR preparation and planning,

Journal of AAPOS