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Pediatric ocular tumors and pseudotumors: quick cases and clinical pearls
e76 239 Pediatric ocular tumors and pseudotumors: quick cases and clinical pearls. Jerry A. Shields, Carol L. Shields Purpose/Relevance: To familarize the pediatric ophthalmologist with a variety of pediatric ocular tumors. Target Audience: Pediatric ophthalmologists. Current Practice: To recognize unusual, but serious ocular tumors and pseudotumors. Best Practice: Be cognizant of potenially serious eye cancers. Expected Outcomes: They will be able to recognize and know when to refer ocular tumors. Format: Open question and answer forum. Summary: (1) quick case presentations, (2) audience discussion, (3) answering questions. 240 Difficult conversations in pediatric ophthalmology and strabismus. R. Michael Siatkowski, Sharon F. Freedman, David B. Granet, George S. Ellis, Cindy Pritchard, Robert E. Wiggins, Christie L. Morse Purpose/Relevance: To improve physicians' skills in handling difficult situations in clinical practice. Target Audience: Pediatric ophthalmologists, orthoptists. Current Practice: Interpersonal/communication skills is the competency most associated with negative physician–patient experiences. Best Practice: Physicians will respond to difficult situations in an honest, ethical, compassionate manner. Expected Outcomes: Physicians will learn 2 new techniques in communication and interpersonal skills and apply principles endorsed by the AAO Ethics Committee to difficult situations in their practice. Format: Brief didactic presentations,panel discussion, audience Q & A. Summary: Circumstances addressed are: the poorly behaved child, inappropriate parental treatment of the child, dismissing a patient, non-compliance and treatment refusal, and functional visual disorders will be addressed. Application of ethical principles endorsed by the AAO will be reviewed.
241 Use of digital photoscreeners to detect amblyopia risk factors (ARFs): a multidisciplinary evidence-based approach—care and cost implications. David I. Silbert, Sean Donahue, Alan Greene, Deborah Alcorn, Robert Arnold Purpose/Relevance: Traditional vision screening utilizes visual acuity charts, requiring a subjective response from a child. This can be especially challenging for nonverbal, preverbal, and early verbal children and can lead to over-referral of young children for confirmatory examinations with significant cost implications. This has led to the wide use of photoscreeners. Target Audience: Pediatric ophthalmologists, orthoptists and ophthalmic technicians. Current Practice: Screening for ARFs are performed in the medical home, as well as the school setting utilizing both objective and subjective tests including visual acuity testing and photoscreening. Best Practice: This seminar will provide evidence-based data and will familiarize participants with the various commercially available photoscreeners. The literature will be reviewed looking at the sensitivity and specificity of the devices for detection of AAPOS ARFs and comparing this to subjective acuity testing, specifically looking at the detection of AAPOS Amblyopia Referral Criteria (ARF's) and comparing as compared to subjective acuity testing.
Volume 19 Number 4 / August 2015 Expected Outcomes: Improvement in detection of ARF's and effective treatment of target population. Format: The seminar will address: AAPOS, AAO, and AAP positions on photoscreening, AAPOS guidelines, USPF task force recommendations and the recent National Expert Panel recommendations; positive predictive value of acuity testing and photoscreening; evidencebased look at sensitivity and specificity of photoscreeners; a pediatrician's perspective on visual acuity testing and photoscreening, including challenges of vision screening in the primary care setting, understanding impact of sensitivity and specificity, and impact of over-referral to ophthalmology; evidence of benefit of early detection and treatment of amblyopia and communication with referring pediatricians to improve outcomes; partnership between primary care and pediatric ophthalmology, to enhance outcomes, the Alaska experience. Summary: Recent advances in photoscreening, have made photoscreeners a useful option for nonverbal, preverbal, and early verbal children.
242 Examination skills for the pediatric patient. Merrill StassIsern, Lisa Rovick Purpose/Relevance: To improve patient care by increasing the understanding of the basic and advanced principles and skills in the pediatric ophthalmology practice. Target Audience: Ophthalmic personnel who work with pediatric ophthalmologists and are responsible for part of the patient's workup and or treatment. Current Practice: Curriculums at opthalmic technical schools give minimal emphasis to the pediatric patient. Technicians often enter a pediatric practice with inadequate skill sets and knowledge for optimal care of the pediatric patient. Best Practice: Ophthalmic Technical Personnel should have the opportunity to learn the elements of an age appropriate exam and understand the importance of each component. Expected Outcomes: Armed with the correct skill sets the Ophthalmic technician should be able to gather relevant and accurate information from their patients, thus helping the doctor streamline his or her exam, without sacrificing important information. This will equate to more efficiency in the exam lane and increased patient satisfaction. Format: A combination of didactic lectures, video presentations and question and answer sessions. Summary: Beginning with the essential basics of history taking in the pediatric patient we will then teach age appropriate visual acuity testing, sensory testing, refractive errors and amblyopia and strabismus evaluation. There will also be presentations on adult strabismus, leucokoria, ocular anatomy/physiology, IV and VI palsies, Duane's, measuring vertical deviations, phone triage, office emergencies and efficiency in the exam lane. 243 Ophthalmic technician clinical skills workshop. Merrill Stass-Isern, Lisa Rovick Purpose/Relevance: To improve patient care by practicing different diagnostic skills in pediatric ophthalmology. Target Audience: Ophthalmic technical personnel who work with pediatric ophthalmologists. Current Practice: Members of the pediatric patient care staff may enter the pediatric practice well trained in the care of adult patients but their skill sets and knowledge are inadequate for optimal care of the pediatric patient.
Journal of AAPOS
241 Use of digital photoscreeners to detect amblyopia risk factors (ARFs): a multidisciplinary evidence-based approach—care and cost implications. David I. Silbert, Sean Donahue, Alan Greene, Deborah Alcorn, Robert Arnold Purpose/Relevance: Traditional vision screening utilizes visual acuity charts, requiring a subjective response from a child. This can be especially challenging for nonverbal, preverbal, and early verbal children and can lead to over-referral of young children for confirmatory examinations with significant cost implications. This has led to the wide use of photoscreeners. Target Audience: Pediatric ophthalmologists, orthoptists and ophthalmic technicians. Current Practice: Screening for ARFs are performed in the medical home, as well as the school setting utilizing both objective and subjective tests including visual acuity testing and photoscreening. Best Practice: This seminar will provide evidence-based data and will familiarize participants with the various commercially available photoscreeners. The literature will be reviewed looking at the sensitivity and specificity of the devices for detection of AAPOS ARFs and comparing this to subjective acuity testing, specifically looking at the detection of AAPOS Amblyopia Referral Criteria (ARF's) and comparing as compared to subjective acuity testing.
Volume 19 Number 4 / August 2015 Expected Outcomes: Improvement in detection of ARF's and effective treatment of target population. Format: The seminar will address: AAPOS, AAO, and AAP positions on photoscreening, AAPOS guidelines, USPF task force recommendations and the recent National Expert Panel recommendations; positive predictive value of acuity testing and photoscreening; evidencebased look at sensitivity and specificity of photoscreeners; a pediatrician's perspective on visual acuity testing and photoscreening, including challenges of vision screening in the primary care setting, understanding impact of sensitivity and specificity, and impact of over-referral to ophthalmology; evidence of benefit of early detection and treatment of amblyopia and communication with referring pediatricians to improve outcomes; partnership between primary care and pediatric ophthalmology, to enhance outcomes, the Alaska experience. Summary: Recent advances in photoscreening, have made photoscreeners a useful option for nonverbal, preverbal, and early verbal children.
242 Examination skills for the pediatric patient. Merrill StassIsern, Lisa Rovick Purpose/Relevance: To improve patient care by increasing the understanding of the basic and advanced principles and skills in the pediatric ophthalmology practice. Target Audience: Ophthalmic personnel who work with pediatric ophthalmologists and are responsible for part of the patient's workup and or treatment. Current Practice: Curriculums at opthalmic technical schools give minimal emphasis to the pediatric patient. Technicians often enter a pediatric practice with inadequate skill sets and knowledge for optimal care of the pediatric patient. Best Practice: Ophthalmic Technical Personnel should have the opportunity to learn the elements of an age appropriate exam and understand the importance of each component. Expected Outcomes: Armed with the correct skill sets the Ophthalmic technician should be able to gather relevant and accurate information from their patients, thus helping the doctor streamline his or her exam, without sacrificing important information. This will equate to more efficiency in the exam lane and increased patient satisfaction. Format: A combination of didactic lectures, video presentations and question and answer sessions. Summary: Beginning with the essential basics of history taking in the pediatric patient we will then teach age appropriate visual acuity testing, sensory testing, refractive errors and amblyopia and strabismus evaluation. There will also be presentations on adult strabismus, leucokoria, ocular anatomy/physiology, IV and VI palsies, Duane's, measuring vertical deviations, phone triage, office emergencies and efficiency in the exam lane. 243 Ophthalmic technician clinical skills workshop. Merrill Stass-Isern, Lisa Rovick Purpose/Relevance: To improve patient care by practicing different diagnostic skills in pediatric ophthalmology. Target Audience: Ophthalmic technical personnel who work with pediatric ophthalmologists. Current Practice: Members of the pediatric patient care staff may enter the pediatric practice well trained in the care of adult patients but their skill sets and knowledge are inadequate for optimal care of the pediatric patient.
Journal of AAPOS