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Physician effort in pediatric eye examination under anesthesia
e34 cost for the control group was inter-hospital transfer cost ($19,489 $13,605) compared to ($635 $3,968) for the telemedicine group. Discussion: The telemedicine group reported significantly lower average total cost per visit compared to the hypothetical control group. Inter-hospital transfer was the main contributing cost. Conclusions: Telemedicine screening for ROP appears to be cost saving for this remote neonatal unit when compared to inter-hospital transfers for BIO. This information will be useful for planning similar ROP services for remote areas. 123 A randomized trial of Amblyz liquid crystal occlusion glasses versus traditional patching for treatment of moderate unilateral amblyopia in children: 6-month outcome. Griffin J. Jardine, Charline S. Boente, Jingyun Wang, Daniel E. Neely, Jay G. Galli, Heather A. Smith, Kathryn M. Haider, Gavin J. Roberts, Derek T. Sprunger, David A. Plager Introduction: We have previously reported the promising 3-month outcome data on our clinical trial comparing Amblyz intermittent occlusion glasses with traditional adhesive patching for the treatment of moderate unilateral amblyopia. We now report our 6-month outcomes. Methods:Children 3-8 years of age with previously untreated, moderate, unilateral amblyopia were enrolled. All subjects had worn optimal refractive correction (if needed) for at least 12 weeks. Their amblyopia was associated with either strabismus, anisometropia or both. Subjects were randomized into two treatment groups: 4-hour daily Amblyz occlusion glasses with the liquid crystal shutter at 30second opaque/transparent intervals (Amblyz group), or 2-hour adhesive patching (patching group). For each patient, visual acuity was measured with ATS-HOTV methods for enrollment and at 3 and 6 month follow-up examinations. Results: Eighteen children were available for 6-month follow-up visits (Amblyz group N 5 9; patching group N 5 9). Both groups were significantly improved compared with the baseline at enrollment. Visual acuity in the amblyopic eye improved an average of 0.11 0.13 logMAR in the Amblyz group and 0.20 0.18 logMAR in the patching group. Although slightly lower in the Amblyz group, this difference between two groups was not statistically significant (P 5 0.24). Discussion: Compared to traditional patching, treatment with Amblyz glasses was not significantly different in the treatment of moderate amblyopia. Both groups showed the most amount of improvement during the first 3 months of treatment. Conclusions: Amblyz liquid crystal occlusion glasses are a promising alternative treatment to traditional adhesive patching for moderate amblyopia in children 3-8 years of age. 124 Second intraocular surgery after successful primary pediatric cataract surgery: Indications and outcomes during long term followup. Ramesh Kekunnaya, Sushma Katkuri, Virender Sachdeva Introduction: Due to the inherent nature of the developing eye and surgery, additional surgical interventions are not uncommon after pediatric cataract surgery. The purpose of this study was to analyze the incidence of complications following paediatric cataract surgery which required an intraocular intervention. Methods: The records of children (\7 years) who underwent cataract surgery with or without primary intraocular lens (IOL) between January 2004 to December 2014 were retrospectively analyzed. Complications that required second intraocular surgery was analyzed. Results: Records of 814 eyes of 500 children (570 pseudophakic and 244 aphakic), were reviewed. Mean age at first surgery was
Volume 20 Number 4 / August 2016 1.61 1.99 years (0.08-6). Mean follow-up duration was 4.83 2.31years. Overall incidence of the second surgery was 5.53% (45 eyes). Most common indications were visual axis opacification (VAO) (2.9%), followed by glaucoma (0.73%). Other indications were IOL decentration/dislocation requiring IOL exchange (3 eyes), YAG capsulotomy (4), residual cortex (2), vitreous wick syndrome (1), endophthalmitis (2), IOL decentration and wound leak (1). Repeat interventions were slightly less in pseudophakes (4.91%) versus aphakes (6.91%, P 5 0.31). VAO was less in pseudophakics (2.1%) vs aphakics (4.9%, P 5 0.05) and glaucoma in pseudophakia (0.4%) vs. in aphakia (1.6%; P 5 0.12). Visual acuity improved from 1.16 to 0.8 logMAR after intervention. Discussion: The overall incidence of children needing re-surgery was lower in pseudophakic children. Most common intraocular reoperation was for VAO In addition, incidence of VAO and glaucoma was found to be less as compared to previous reports. Conclusions: Our study suggests that incidence of second intraocular surgery is quite low over 5 years follow-up. VAO and secondary glaucoma remain the most common indications. 125 Physician effort in pediatric eye examination under anesthesia. Leila M. Khazaeni, Diana J. Kim, Jennifer A. Dunbar Introduction: The inability to tolerate a complete eye examination is an indication for an eye examination under anesthesia (EUA). This occurs in the pediatric population due to poor cooperation of the patient, or the need for detailed and lengthy examination techniques. The length of time spent in the operating room for EUAs were analyzed. Methods:After IRB approval, the medical records of 127 patients age \18 undergoing EUA from 9/1/2000 - 9/1/2015 were retrospectively reviewed. The length of time spent in the operating room, diagnoses and number of EUAs over the 5-year time period were recorded for each patient. Results: The operative records of 143 EUAs were reviewed. 33 records of patients who were concurrently undergoing an operative procedure in addition to EUA were excluded. The average time spent in the operating room for EUA was 65.8 minutes. Discussion: Eye examinations under anesthesia performed in the operating room require significant time and effort on behalf of the pediatric ophthalmologist. Our results demonstrate that only 4 EUAs could be performed in a half day, compared to 8-10 comprehensive examinations for established patients performed on average in a clinical half day. The amount billed for EUA (CPT 92018) is $425 compared to $320 billed for a comprehensive eye examination for an established patient (CPT 99214), despite the greater amount of time required for EUA in the OR. Conclusions: While a significant amount of time and effort is spent on examination under anesthesia in the operating room, current billing and reimbursement does not reflect this. 126 Restrictive fibrous bands originating from the oculomotor nerve (CN3) in familial Duane retraction syndrome (DRS). Hiba H. Khraisat, Joseph L. Demer Introduction: Fibrous bands cause restrictive strabismus, yet their pathogenesis is mysterious. We studied a familial case suggest neural origin of bands. Methods: We employed high resolution, T2 weighted, surface coil orbital MRI to investigate the anatomy of incomitant strabismus in a father and son with DRS, correlating with clinical motility. Results: The 2 year old son had right enophthalmos with markedly limited abduction, supraduction, and infraduction, and mildly limited
Journal of AAPOS
Volume 20 Number 4 / August 2016 1.61 1.99 years (0.08-6). Mean follow-up duration was 4.83 2.31years. Overall incidence of the second surgery was 5.53% (45 eyes). Most common indications were visual axis opacification (VAO) (2.9%), followed by glaucoma (0.73%). Other indications were IOL decentration/dislocation requiring IOL exchange (3 eyes), YAG capsulotomy (4), residual cortex (2), vitreous wick syndrome (1), endophthalmitis (2), IOL decentration and wound leak (1). Repeat interventions were slightly less in pseudophakes (4.91%) versus aphakes (6.91%, P 5 0.31). VAO was less in pseudophakics (2.1%) vs aphakics (4.9%, P 5 0.05) and glaucoma in pseudophakia (0.4%) vs. in aphakia (1.6%; P 5 0.12). Visual acuity improved from 1.16 to 0.8 logMAR after intervention. Discussion: The overall incidence of children needing re-surgery was lower in pseudophakic children. Most common intraocular reoperation was for VAO In addition, incidence of VAO and glaucoma was found to be less as compared to previous reports. Conclusions: Our study suggests that incidence of second intraocular surgery is quite low over 5 years follow-up. VAO and secondary glaucoma remain the most common indications. 125 Physician effort in pediatric eye examination under anesthesia. Leila M. Khazaeni, Diana J. Kim, Jennifer A. Dunbar Introduction: The inability to tolerate a complete eye examination is an indication for an eye examination under anesthesia (EUA). This occurs in the pediatric population due to poor cooperation of the patient, or the need for detailed and lengthy examination techniques. The length of time spent in the operating room for EUAs were analyzed. Methods:After IRB approval, the medical records of 127 patients age \18 undergoing EUA from 9/1/2000 - 9/1/2015 were retrospectively reviewed. The length of time spent in the operating room, diagnoses and number of EUAs over the 5-year time period were recorded for each patient. Results: The operative records of 143 EUAs were reviewed. 33 records of patients who were concurrently undergoing an operative procedure in addition to EUA were excluded. The average time spent in the operating room for EUA was 65.8 minutes. Discussion: Eye examinations under anesthesia performed in the operating room require significant time and effort on behalf of the pediatric ophthalmologist. Our results demonstrate that only 4 EUAs could be performed in a half day, compared to 8-10 comprehensive examinations for established patients performed on average in a clinical half day. The amount billed for EUA (CPT 92018) is $425 compared to $320 billed for a comprehensive eye examination for an established patient (CPT 99214), despite the greater amount of time required for EUA in the OR. Conclusions: While a significant amount of time and effort is spent on examination under anesthesia in the operating room, current billing and reimbursement does not reflect this. 126 Restrictive fibrous bands originating from the oculomotor nerve (CN3) in familial Duane retraction syndrome (DRS). Hiba H. Khraisat, Joseph L. Demer Introduction: Fibrous bands cause restrictive strabismus, yet their pathogenesis is mysterious. We studied a familial case suggest neural origin of bands. Methods: We employed high resolution, T2 weighted, surface coil orbital MRI to investigate the anatomy of incomitant strabismus in a father and son with DRS, correlating with clinical motility. Results: The 2 year old son had right enophthalmos with markedly limited abduction, supraduction, and infraduction, and mildly limited
Journal of AAPOS