- Email: [email protected]
How HITECH can make your practice more high tech
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
Volume 14 Number 1 / February 2010 financial impact to your practice, vendor selection, e-prescribing, and the ‘meaningful use’ clause. The participant will gain the knowledge necessary to begin an implementation of EHR for his or her practice. 130 Difficult problems: Nonstrabismus. Brian Forbes, Ken Nischal, Alex V. Levin, Scott Olitsky, David Wallace, Sean Donahue In this workshop, we will discuss 5 patients with primary ocular disease processes, other than strabismus, whose diagnosis, findings, or treatment present a clinical dilemma to the pediatric ophthalmologist. The goal of the discussion will be to elucidate basic lines of thinking that should direct the clinician toward appropriate diagnostic and therapeutic solutions. The audience is encouraged to participate in the discussion. 131 Does this child have glaucoma? Applying newer technologies to the diagnosis and management of pediatric glaucoma. Sharon F. Freedman, Allen D. Beck, Alex V. Levin Does this child have glaucoma? Applying newer technologies to the diagnosis and management of pediatric glaucoma. Synopsis: Pediatric glaucoma sometimes presents with clear objective signs that make its diagnosis (though not necessarily its successful treatment!) rather straightforward. Yet at other times, abnormalities of the optic nerve or other features of the child’s case raise suspicion of the glaucoma diagnosis but doubt remains. This workshop is intended to review cases of known and suspected glaucoma, with emphasis on newer technologies and thorough discussion of what the `experts' really use to make (or exclude) the diagnosis of pediatric glaucoma. Technologies to be discussed include: central corneal thickness and other features affecting pressure evaluation (including new devices for measuring intraocular pressure), optic nerve head (and macular?) imaging (optical coherence tomography, etc.), visual field evaluation, and modern strategies for medical management of the high-risk or confirmed glaucoma case. A case-based format will be utilized, and attendee questions and comments will be encouraged. 132 Findings from the Early Treatment for Retinopathy of Prematurity Study. William V. Good, Bradley A. Davitt, Robert J. Hardy, Earl A. Palmer, Dale L. Phelps, Graham E. Quinn In this workshop, the findings from the Early Treatment for Retinopathy of Prematurity Study (ETROP) will be reviewed, explained, and discussed. Dr. Good will begin with an overview of the study, factors that were considered at the study’s inception, and major findings of the study. Dr. Hardy will review statistical methods used to determine findings. Drs. Davitt and Quinn will discuss refractive error changes noted in the ETROP Study, and how these compare with the CRYOROP Study. Dr. Quinn will review ICROP findings that are relevant to the ETROP Study. Dr. Phelps will discuss the neonatologist's perspective, and also compare the ETROP Study to other ROP clinical trials. Dr. Palmer will discuss significant findings from the CRYO-ROP Study and how these compare with the ETROP Study. At the conclusion, the panel will look forward to discuss further analyses underway in the ETROP Study. We expect a vigorous debate on the subject of plus disease and the future of photoscreening, as it may pertain to findings from the ETROP Study. The audience will have the opportunity to interact with the panel to review study methodology and findings. 133 Reading, dyslexia, and vision therapy. Sheryl M. Handler, Megan Rees This workshop will give a comprehensive summary of the latest information on language acquisition, reading, dyslexia, and eye functions
Journal of AAPOS
e33 necessary to read. We will cover in depth controversial theories such as the Magnocellular Theory and the Irlen Syndrome (Scotopic Sensitivity Syndrome). Behavioral/Developmental Optometric theories and practice will be reviewed. Behavioral Optometric testing, training (developmental) lenses, and vision therapy will be extensively discussed and examples shown. The participant will gain a thorough understanding of the issues and controversies and be better equiped to discuss this subject with our patients and their families. 134 Management of hemangiomas: Past, present, and future. Daniel J. Karr, Gregg T. Lueder, Burton J. Kushner, David A. Plager Hemangioma management will be examined in detail, starting with earlier treatment modalities and culminating in the pioneering use of intralesional corticosteroid injections. More recent utilization of topical and systemic corticosteroid therapy, surgical excision, surface laser treatment and the emergence of propranolol therapy will be presented. Clinical indications, strategies and clinical examples of successes, failures and complications of these treatments will be discussed. 135 Infant cataract surgery techniques—video lessons learned from the infant aphakia treatment study. Scott R. Lambert, M. Edward Wilson, David A. Plager, Edward G. Buckley Cataract surgery during infancy can be very challenging. These eyes are often microphthalmic and lack scleral rigidity. They are also more prone to intraoperative complications such as iris prolapse and hemorrhaging. It can be particularly challenging to implant an intraocular lens in the capsular bag in these eyes. The Infant Aphakia Treatment Study (IATS) is a NEI sponsored randomized clinical trial comparing treatment with an intraocular lens versus a contact lens following cataract surgery in infants \7 months of age with a unilateral congenital cataract. One-hundred fourteen infants were enrolled in IATS between December 2004 and January 2009. The IATS protocol required that all of the primary cataract surgeries be videotaped and submitted for review. One or more of the instructors for this workshop reviewed all of these videos to ensure that the IATS protocols were being followed. All of the IATS videos were subsequently re-reviewed in preparation for this workshop. Videos will be shown that show some of the most successful surgeries as well as surgeries that were particularly challenging. The workshop will focus on lessons that the instructors have learned from performing these surgeries as well as lessons learned from reviewing all of the surgical videos. This course will teach pediatric ophthalmologists new techniques that will allow them to perform cataract surgery during infancy more successfully. 136 Surgical secrets. Scott E. Olitsky, Evelyn Paysse The acquisition and enhancement of surgical skills is a lifelong journey. During the course of a career, each surgeon develops a range of surgical secrets to facilitate care. These secret personal techniques may make a difficult step easier, make surgery more efficient, make surgery safer, or may enhance outcomes. The purpose of this workshop is to reveal an assortment of these surgical secrets that both the novice and expert surgeon will find valuable for the treatment of both strabismus and nonstrabismus related problems. With a heavy emphasis on video presentations, individual presenters, with varying levels of surgical experience, will be allowed a maximum of 5 minutes to present her or his favorite surgical tip(s). This workshop promises to be fast-paced, entertaining, and very informative.
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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
Volume 14 Number 1 / February 2010 financial impact to your practice, vendor selection, e-prescribing, and the ‘meaningful use’ clause. The participant will gain the knowledge necessary to begin an implementation of EHR for his or her practice. 130 Difficult problems: Nonstrabismus. Brian Forbes, Ken Nischal, Alex V. Levin, Scott Olitsky, David Wallace, Sean Donahue In this workshop, we will discuss 5 patients with primary ocular disease processes, other than strabismus, whose diagnosis, findings, or treatment present a clinical dilemma to the pediatric ophthalmologist. The goal of the discussion will be to elucidate basic lines of thinking that should direct the clinician toward appropriate diagnostic and therapeutic solutions. The audience is encouraged to participate in the discussion. 131 Does this child have glaucoma? Applying newer technologies to the diagnosis and management of pediatric glaucoma. Sharon F. Freedman, Allen D. Beck, Alex V. Levin Does this child have glaucoma? Applying newer technologies to the diagnosis and management of pediatric glaucoma. Synopsis: Pediatric glaucoma sometimes presents with clear objective signs that make its diagnosis (though not necessarily its successful treatment!) rather straightforward. Yet at other times, abnormalities of the optic nerve or other features of the child’s case raise suspicion of the glaucoma diagnosis but doubt remains. This workshop is intended to review cases of known and suspected glaucoma, with emphasis on newer technologies and thorough discussion of what the `experts' really use to make (or exclude) the diagnosis of pediatric glaucoma. Technologies to be discussed include: central corneal thickness and other features affecting pressure evaluation (including new devices for measuring intraocular pressure), optic nerve head (and macular?) imaging (optical coherence tomography, etc.), visual field evaluation, and modern strategies for medical management of the high-risk or confirmed glaucoma case. A case-based format will be utilized, and attendee questions and comments will be encouraged. 132 Findings from the Early Treatment for Retinopathy of Prematurity Study. William V. Good, Bradley A. Davitt, Robert J. Hardy, Earl A. Palmer, Dale L. Phelps, Graham E. Quinn In this workshop, the findings from the Early Treatment for Retinopathy of Prematurity Study (ETROP) will be reviewed, explained, and discussed. Dr. Good will begin with an overview of the study, factors that were considered at the study’s inception, and major findings of the study. Dr. Hardy will review statistical methods used to determine findings. Drs. Davitt and Quinn will discuss refractive error changes noted in the ETROP Study, and how these compare with the CRYOROP Study. Dr. Quinn will review ICROP findings that are relevant to the ETROP Study. Dr. Phelps will discuss the neonatologist's perspective, and also compare the ETROP Study to other ROP clinical trials. Dr. Palmer will discuss significant findings from the CRYO-ROP Study and how these compare with the ETROP Study. At the conclusion, the panel will look forward to discuss further analyses underway in the ETROP Study. We expect a vigorous debate on the subject of plus disease and the future of photoscreening, as it may pertain to findings from the ETROP Study. The audience will have the opportunity to interact with the panel to review study methodology and findings. 133 Reading, dyslexia, and vision therapy. Sheryl M. Handler, Megan Rees This workshop will give a comprehensive summary of the latest information on language acquisition, reading, dyslexia, and eye functions
Journal of AAPOS
e33 necessary to read. We will cover in depth controversial theories such as the Magnocellular Theory and the Irlen Syndrome (Scotopic Sensitivity Syndrome). Behavioral/Developmental Optometric theories and practice will be reviewed. Behavioral Optometric testing, training (developmental) lenses, and vision therapy will be extensively discussed and examples shown. The participant will gain a thorough understanding of the issues and controversies and be better equiped to discuss this subject with our patients and their families. 134 Management of hemangiomas: Past, present, and future. Daniel J. Karr, Gregg T. Lueder, Burton J. Kushner, David A. Plager Hemangioma management will be examined in detail, starting with earlier treatment modalities and culminating in the pioneering use of intralesional corticosteroid injections. More recent utilization of topical and systemic corticosteroid therapy, surgical excision, surface laser treatment and the emergence of propranolol therapy will be presented. Clinical indications, strategies and clinical examples of successes, failures and complications of these treatments will be discussed. 135 Infant cataract surgery techniques—video lessons learned from the infant aphakia treatment study. Scott R. Lambert, M. Edward Wilson, David A. Plager, Edward G. Buckley Cataract surgery during infancy can be very challenging. These eyes are often microphthalmic and lack scleral rigidity. They are also more prone to intraoperative complications such as iris prolapse and hemorrhaging. It can be particularly challenging to implant an intraocular lens in the capsular bag in these eyes. The Infant Aphakia Treatment Study (IATS) is a NEI sponsored randomized clinical trial comparing treatment with an intraocular lens versus a contact lens following cataract surgery in infants \7 months of age with a unilateral congenital cataract. One-hundred fourteen infants were enrolled in IATS between December 2004 and January 2009. The IATS protocol required that all of the primary cataract surgeries be videotaped and submitted for review. One or more of the instructors for this workshop reviewed all of these videos to ensure that the IATS protocols were being followed. All of the IATS videos were subsequently re-reviewed in preparation for this workshop. Videos will be shown that show some of the most successful surgeries as well as surgeries that were particularly challenging. The workshop will focus on lessons that the instructors have learned from performing these surgeries as well as lessons learned from reviewing all of the surgical videos. This course will teach pediatric ophthalmologists new techniques that will allow them to perform cataract surgery during infancy more successfully. 136 Surgical secrets. Scott E. Olitsky, Evelyn Paysse The acquisition and enhancement of surgical skills is a lifelong journey. During the course of a career, each surgeon develops a range of surgical secrets to facilitate care. These secret personal techniques may make a difficult step easier, make surgery more efficient, make surgery safer, or may enhance outcomes. The purpose of this workshop is to reveal an assortment of these surgical secrets that both the novice and expert surgeon will find valuable for the treatment of both strabismus and nonstrabismus related problems. With a heavy emphasis on video presentations, individual presenters, with varying levels of surgical experience, will be allowed a maximum of 5 minutes to present her or his favorite surgical tip(s). This workshop promises to be fast-paced, entertaining, and very informative.