Ophthalmology surgical competency assessment rubric for strabismus surgery (OSCAR:Strabismus)

Volume 16 Number 1 / February 2012 Results: In addition to detailed photographs of the modification method, An 8 minute movie with 27 toys will be shown continuously during poster viewing hours, demonstrating historical toys and the new toys that sing and dance and the surprisingly simple surgical technique for accessing the wires and connecting them to a remote-control switch. (Battery-powered video equipment will be provided by the presenter). Discussion: Widely available toys that sing and dance can now be used for distance fixation devices in the pediatric strabismus exam. One toy can be easily exchanged for another; the toys can even be seasonally appropriate. Conclusions: Fun mechanical toys that sing and dance can now be easily modified for remote control and used by the pediatric ophthalmologist and/or the orthoptist in pediatric strabismus examinations. 085 Achieving postoperative target range increases strabismus surgery success in adults. Kamiar Mireskandari, Melissa Cotesta, Jennifer Schofield, Derek Stephens, Stephen P. Kraft Purpose: Strabismus surgery aims to obtain long-term alignment success for all patients. Many factors influence the surgical success rates. The purpose of this study was to determine whether achieving the ideal ocular alignment immediately postoperatively influences the outcome of surgery. Methods: The charts of patients 12 years and over who underwent strabismus surgery were reviewed. The ideal immediate postoperative target range was deemed to be within 4D of orthotropia for patients with esotropia or hypertropia, and between orthotropia and esotropia of 8D for patients with exotropia. Surgical success was defined as a postoperative angle under 10D for horizontal deviations and under 4D for vertical deviations, with the absence of diplopia. The main outcome measure was surgical success. Results: A total of 353 patients were included. The mean follow up was 12 months. Patients in whom the target range was achieved had surgical success of 83.6% compared to those who did not, at 63.7% (P \ 0.0001, c2 test). Multiple logistic regression analysis showed this to be the only statistically significant factor in success of surgery. Discussion: In this study, including primary and reoperations, the success of strabismus surgery significantly improved when the patient was in the ideal target range in the first three postoperative days. The use of adjustable surgery may therefore improve outcomes by allowing surgeons to control this variable. Conclusions: Achieving the ideal postoperative target alignment is the most important factor in the success of strabismus surgery. 086 Incidence of strabismus in an adult population. Brian G. Mohney, Jennifer M. Martinez, Jonathan M. Holmes, Nancy N. Diehl Background: Although strabismus is a commonly recognized disorder of childhood, there is no population-based data on new-onset strabismus in adults. The purpose of this study was to report the incidence of adult-onset strabismus in a geographically defined population. Methods: The medical records of all adults (.18 years) residing in a defined population when newly diagnosed with any form of strabismus from January 1, 1985, through December 31, 2004, were retrospectively reviewed. Results: A total of 754 adults were identified as being newly diagnosed with strabismus during the twenty-year period, yielding an overall age- and sex-adjusted annual incidence of 54.2 per 100,000 persons (95% CI, 50.2-58.1). The median age at diagnosis was 65.2 years (range, 19.2-99.6 years) and 413 (54.8%) were female. Esotropia

Journal of AAPOS

e23 was diagnosed in 266 (35.3%) individuals, exotropia in 248 (32.9%), and hypertropia in 240 (31.8%). The four most common types of new-onset strabismus were paralytic strabismus (39.3%), convergence insufficiency (15.6%), unspecified hypertropia (12.9%), and divergence insufficiency (10.6%). The overall incidence of strabismus, as well as the four most common types, increased with age (P \ 0.001). Discussion: The incidence of adult strabismus increases significantly with age and paralytic strabismus is the most common form. In contrast to childhood strabismus, in which esotropia predominates over other forms, esotropia, exotropia, and hypertropia were equally represented among newly presenting adult strabismus cases in this population. Conclusions: Adult-onset strabismus is a common disorder that increases with age and is most often the result of a paralytic etiology.

087 Ophthalmology surgical competency assessment rubric for strabismus surgery (OSCAR:Strabismus). William W. Motley, Karl C. Golnik, Huban Atilla, Rachel Pilling, Aravind Reddy, Pradeep Sharma Purpose: To produce an internationally valid tool to assess ophthalmology resident skill in performing strabismus surgery. Methods: A panel of 7 international content experts adapted a previously published tool for assessing strabismus surgical skill by using a modified Dreyfus scale of skill acquisition and providing behavioral descriptors for each level of skill in each category. The tool was then reviewed by 12 international outside content experts for their constructive comments. Results: The resulting OSCAR:Strabismus tool involves assessment of 17 skills required for strabismus surgery using rubric anchors for skill levels from "Novice" to "Beginner" to "Advanced Beginner" to "Competent". Comments of 12 outside content experts were incorporated, establishing face and content validity. Discussion: The OSCAR:Strabismus tool can be used globally to assess ophthalmology resident strabismus surgical skill. Reliability and predictive validity still need to be determined. Conclusions: The OSCAR:Strabimus tool can be useful in assessing ophthalmology resident competence in strabismus surgical skills as mandated by the Accreditation Council for Graduate Medical Education. 088 Results of graded recession of inferior oblique in unilateral superior oblique palsy. Reza Nabie, Minoo Azadeh, Dima Andalib Purpose: To evaluate the result of graded recession of inferior oblique in unilateral superior oblique palsy. Methods: A group of 32 patients with unilateral superior oblique palsy and deviation of up to 25D who underwent graded recession of inferior oblique enrolled in a retrospective study. Demographic data such as age, gender, mean preoperative and postoperative deviation, inferior oblique overaction, superior oblique overaction and mean follow up were analyzed. Results: Patients mean age was 15.00  12.60 years and 56.3% were female. Mean deviation before and after operation were 15.00  1.23 and 2.00  0.63 (P \ 0.001). Mean inferior oblique over action before operation was 2.78  0.14 that reduced to 0.21  0.07 after operation (P \ 0.001). Mean preoperative and postoperative superior oblique underaction was ( 1.18  0.16) and ( 0.25  0.07) (P \ 0.001). Mean follow-up period was 8.18  2.51 months. Overall success rate was 78.1%. (hypertropia within 4D of ortotropia). Discussion: Most authors adcocated two muscle surgery in deviations more than 15D. Our overall success rate was 78.1% that comparable to other studies.In contrast to other studies, in deviations