The evolving multimodal imaging approach to the pediatric eye

e52 Best Practice: Clinicians will gain a more thorough understanding of the surgical approaches and techniques which yield better outcomes in adults with strabismus. Expected Outcomes: At the conclusion of the workshop, attendees will have a better understanding of effective strategies for managing adults with complicated forms of strabismus, especially adjustable sutures. Format: The workshop will include case presentations and discussions by a panel of experts. In addition, time for audience participation with questions of the panelists is planned. Use of video for teaching will be included. Throughout the discussions, pertinent scientific literature will be presented and reviewed. Summary: Topics will include challenging cases of adults with complicated forms of strabismus; including reoperation strategies, management of torsion and incomitant deviations, and correction after other ocular surgery or disease, as well as tips, pearls, and advice regarding adjustable sutures all from surgeons with years of experience. 190 Dyslexia: what pediatric ophthalmologists and families need to know. Sheryl M. Handler, Walter M. Fierson, A. Melinda Rainey, Kim Cooper Purpose/Relevance: Dyslexia, also called reading disability, is the most common learning disability. Most parents are unfamiliar with dyslexia and may believe that it is a vision-based disorder. Pediatric ophthalmologists need to be thoroughly informed about dyslexia, its controversial treatments, evidence-based educational treatments, and resources available to be able to provide information and guidance to families of struggling readers. Target Audience: Pediatric ophthalmologists and certified orthoptists. Current Practice: Pediatric Ophthalmologists are often asked to evaluate children with reading or learning problems early in the process but may not have enough information to guide families. Best Practice: Pediatric ophthalmologists will be able to evaluate and manage children with reading and learning problems, become familiar with the new AAPOS Learning Disabilities Package and guide families to resources and local educational experts. Expected Outcomes: The participant will gain a thorough understanding of the issues, controversies, evidence and resources on dyslexia to be better equipped to evaluate the patient who is experiencing reading difficulties, discuss dyslexia and provide guidance to our patients and their families. Format: Didactic lecture with question and answer session. Summary: This workshop will give a comprehensive summary of the latest information on language acquisition, reading, dyslexia, evidence-based educational treatments, the eye functions necessary to read and how to test for them in the ophthalmic exam. It will explore the controversial topics of vision therapy and colored lenses and filters. It will also provide information and guidance on what to tell parents using the new AAPOS Learning Disabilities Package as an aid so that we can assist our patients in receiving the correct diagnoses and beneficial evidence-based therapies and accommodations. 191 Strategies for the successful management of complex strabismus resulting from orbital pathology and iatrogenic causes. Ramesh Kekunnaya, Linda Dagi, David Granet, Scott Lambert, Manoj Parulekar, Federico Velez Purpose/Relevance: Ocular misalignment following treatment of retinal detachment, after placement of glaucoma drainage devices, post orbital trauma, resulting from thyroid eye disease, craniosynos-

Volume 20 Number 4 / August 2016 tosis and high myopia, presents a challenge to even the most seasoned strabismus surgeon. Target Audience: These cases are complex, and often require close coordination with other subspecialists. Current Practice: This workshop will address focused clinical assessment and decision making through a mixture of didactic lectures, case presentations and illustrative videos. Best Practice: We will provide a succinct guide to the pearls and pitfalls guiding treatment of each disorder. Expected Outcomes: Attendee participation and questions will be encouraged, time permitting. Format: Didactic lecture, Case and video presentations and panel discussion. Summary: At the end of the course, we anticipate the attendee will enjoy a more sophisticated understanding of the successful management of each form of complex strabismus. 192 Myopia—pathogenesis, control, and treatment a practical update for the clinician. Sharon Lehman, Ken K. Nischal, Evelyn Paysse, Seo Wei Leo, Audrey Chia, David B. Granet Purpose/Relevance: Myopia has become an epidemic affecting vast numbers of children in the world. The purpose of this workshop is to describe current knowledge about its etiology, point out which genetic conditions cause pathological myopia, and discuss treatment modalities to arrest myopia or treat it once it has developed. Target Audience: Pediatric ophthalmologists, orthoptists, general ophthalmologists and trainees. Current Practice: The plethora of studies available about myopia is at best confusing and at worst misleading. Yet, pediatric ophthalmologists, general ophthalmologist and orthoptists are increasingly seeing children who have progressive myopia or high myopia. These professionals may not have a succinct guideline as to what therapies are available and what may be causing either high myopia or progression of childhood myopia. Best Practice: Ideally we should all be aware of the etiology of childhood myopia, when to recognize pathological myopia secondary to an ocular or a systemic disease and be able to counsel parents appropriately. Expected Outcomes: We aim to discuss the etiology of myopia in childhood so that an assessment can be made as to whether myopia arresting therapies are viable and valid treatment options and also whether refractive surgery is an option or not . Format: Experienced pediatric ophthalmologists will discuss 6 topics : emmetropisation, recognizing myopia secondary to ocular or systemic disease, the role of peripheral retina in myopia progression, using atropine to arrest myopia, using orthokeratology and refractive options in pediatric myopia. Summary: An understanding of the causes of myopia will be discussed. Interactive discussion will help delineate viable and valid myopia arresting strategies. Audience biased discussion about the roles of orthokeratology and refractive surgery will help clarify options in these controversial areas. 193 The evolving multimodal imaging approach to the pediatric eye. Lea Ann Lope, Kanwal K. Nischal, Giulio Zuccoli, Christin L. Sylvester, Ellen B. Mitchell Purpose/Relevance: The world of ocular and neuroimaging has changed dramatically in the last decade. While OCT has been a disruptive technology, pediatric ophthalmologists are still very dependent on MRI and ultrasound (USS) for diagnostic evaluation, which have evolved also. This workshop aims to explain these

Journal of AAPOS

Volume 20 Number 4 / August 2016 evolutions and how they help improve diagnostic accuracy in pediatric ophthalmology. Target Audience: pediatric ophthalmologists, general ophthalmologists, neuro-radiologists, orthoptists, and trainees. Current Practice: Pediatric ophthalmologists are often reliant on radiologists to report MRI scans. Recent MRI techniques such as diffusion weighted imaging (DWI), susceptibility weighted imaging (SWI), post contrast volumetric fluid attenuated inversion recovery (FLAIR) and fast imaging employing steady-state acquisition (FIESTA), have allowed differentiation of various pathologies in a way not previously possible. Similarly, the availability of linear ultrasound and Doppler ultrasound, and an understanding of the role of the pediatric lens in ultrasound attenuation, has improved diagnostic capability and understanding. If pediatric ophthalmologists or orthoptists are unaware of these changes, the ability to confirm or concur with diagnostic conclusions may be compromised. Best Practice: Ophthalmologists should be able to understand the techniques used in MRI. Similarly, confidence in understanding the type of ordinary ultrasound (not UBM) being used, and how to avoid false negative testing, especially in children with swollen optic disks, should improve diagnostic accuracy. Expected Outcomes: The workshop will raise awareness of these evolutions in MRI and USS, and help initiate bridging the gap in knowledge in this type of imaging. Format: With a panel of four pediatric ophthalmologists and one pediatric neuroradiologist, we will conduct clinical case presentations and a panel discussion. Audience participation is a crucial part of this workshop. Summary: Techniques in MRI and USS have evolved. Ophthalmologists may not be fully aware of the implications of these developments. This workshop will help them use the correct imaging. 194 Five cases in pediatric corneal disease you dont want to miss. Ken K. Nischal, Marcia Tartarella, Bibiana Reiser, Erin Stahl Purpose/Relevance: Increasingly pediatric corneal disease presents to the pediatric ophthalmologist before it presents to the corneal specialist. This workshop provides an insight into immediate treatment options and a knowledge of what might be available so that parents can be appropriately counseled if further referral to a cornea specialist is needed. Target Audience: Pediatric ophthalmologists,orthoptists and trainees. Current Practice: Access to corneal specialists for a child presenting with photophobia or with a difficult examine is usually limited, so these children present commonly to pediatric ophthalmologists. Training in the newer concepts of managing corneal disease for pediatric ophthalomologist is scarce which leaves pediatric ophthalmologists vulnerable in such cases. Best Practice: Ideally pediatric ophthalmologists and orthoptists should be aware of at least 5 common corneal diseases that they are likley to encounter in their daily practice at least once a year or more. They should be aware of their diagnostic and treatment options and also what subspecilaty treatments may be available via the cornea specialist. Expected Outcomes: This workshop aims to help bridge any knowledge gaps the audience may have so that an adeqaute assessment and treatment plan can be formulated for 5 common pediatric corneal pathologies. Format: Four experienced pediatric ophthalmologists with a subspecialty interest in corneal diseases will present cases for interactive discussion with the audience and co-panellists using video and still

Journal of AAPOS

e53 images. The thrust of the presentations will be to intiate audience participation. Summary: 5 of the commonest pediatric corneal diseases presenting to pediatric ophthalmologists will be discussed. Interactive discussion will help delineate tips and clues to reach a diagnosis. Interactive questions and discussions will allow formulation of treatment plans for each case. 195 Size matters! The management of extra-large (XXL) strabismus. Manoj V. Parulekar, Ramesh R. Kekunnaya, David Plager, David Hunter, Lionel Kowal, Venkateshwar B. Rao Purpose/Relevance: Very large-angle (80-100D) strabismus cannot be managed using the usual surgical dosage tables, and legitimate differences of opinion exist. Strategies include two, three, or even four muscle operations, extra large resections or recessions, or staged operations. This workshop delivered by a panel of experienced surgeons from tertiary referral institutes will discuss principles of treatment, pros and cons of the various approaches, and share treatment algorithms. Target Audience: Pediatric ophthalmologists, ophthalmology residents. Current Practice: If a surgeon encounters these situation he/she will review sparse and anecdotal literature review or listserv to find an answer to manage these cases. Best Practice: Very large angle (80-100D) strabismus cannot be managed using the usual surgical dosage tables. The clinical situations include: (1) Large-angle esotropia; (2) large-angle exotropia; (3) large superior oblique palsy (4) myopic strabismus fixus; (5) WEBINO syndrome, myasthenia, CFEOM? (6) large dissociated vertical deviation; (7) large strabismus due to thyroid myopathy. Meeting patient expectations and achieving safe outcomes can be challenging in such situations. Expected Outcomes: Strategies vary and include two-, three-, or even four-muscle operations, extra large resections or recessions, or staged operations, and will be discussed, with illustrative cases. After completing the workshop, participants should be able to manage this challenging group of patients with large angle strabismus using treatment algorithms discussed above. Format: Case and video presentation. Relevant literature will be referenced. Audience quiz will be encouraged. Summary: Very large angle (80-100D) strabismus cannot be managed using the usual surgical dosage tables, and legitimate differences of opinion exist. Strategies include two, three, or even four muscle operations, extra large resections or recessions, or staged operations. This workshop will discuss principles of treatment, pros and cons of the various approaches, and share treatment algorithms. 196 Order in the court: the art and ethics of the witness stand and other legal issues in pediatric ophthalmology. S. Grace Prakalapakorn, Kara Cavuoto, Lisa Bohra, Janine Collinge, Rebecca Leenheer, Robert S. Gold, Anne N. Menke, Ron W. Pelton, Robert E. Wiggins Jr, Christie L. Morse: Submitted and officially sponsored by the AAPOS Young Ophthalmologist Committee Purpose/Relevance: While Young Ophthalmologists are taught to provide excellent patient care, there is no formal education during residency or fellowship regarding legal issues that ophthalmologists may face during their careers. This workshop provides an introduction to legal and ethical issues that pediatric ophthalmologists may encounter, techniques to limit legal liability and malpractice claims,