December 01, 2013
2 min read
Save

Evolution of pediatric ophthalmology continues

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Thirty-five years ago, after completing a 3-year residency in ophthalmology and 2 years of fellowship training in cornea, anterior segment surgery and glaucoma, I joined a well-established private practice in Dallas for 2 years before eventually returning to the University of Minnesota to direct the Cornea/Anterior Segment Service.

The senior partner of the group in Texas, who represented the second generation of ophthalmologists in this practice, informed me that it was the junior associate’s responsibility to care for the children in the practice, including performance of the associated surgery, such as strabismus surgery, nasolacrimal probing and dacryocystorhinostomy, when needed, and any plastic surgery on children and adults. Fortunately, my training at the University of Minnesota was quite strong in pediatric ophthalmology and oculoplastics, and with reference to quality textbooks and journals and frequent phone calls to prior mentors, I dutifully performed the task my senior partner demanded of me.

This delegation of pediatric ophthalmology and strabismus to younger associates as they worked to build their adult practice of cataract, glaucoma and cornea was quite common in those days. Nonetheless, I never felt fully comfortable with this responsibility and was pleased when I returned to the University of Minnesota to rejoin an ophthalmology department with a strong team of fellowship-trained pediatric ophthalmologists and orthoptists. For the last 33 years, whether in an academic institution or now in private practice at Minnesota Eye Consultants, I have routinely referred pediatric and adult strabismus cases to subspecialists trained in the field. Fortunately, the fellowship-trained pediatric ophthalmologist is now widely available.

I find the history of the development of pediatric ophthalmology in America interesting. The Europeans led in the development of doctors dedicated to the care of children. Frank D. Costenbader, MD, and his first mentee, Marshall M. Parks, MD, are generally credited with founding the subspecialty in the U.S., creating the first fellowship training program at Children’s Hospital in Washington, D.C. Later, the American Association for Pediatric Ophthalmology and Strabismus was created with the mission to promote high-quality medical and surgical eye care worldwide for children in general and for adults with strabismus. AAPOS oversees the training programs for pediatric ophthalmologists, with 30 accredited 1- to 2-year programs available in the U.S. It also has annual meetings, supports research and advocates with the American Academy of Ophthalmology to enhance the care of the pediatric patient and adult with strabismus. The society has 842 regular members who have completed 1 or more years of fellowship in an accredited program, 286 international members, 37 associate members, 99 affiliated orthoptists, 82 emeritus members and 147 candidates in training. I am especially impressed by the large number of current candidates in training.

Of note is the fact that appropriate pediatric eye care is a mandated benefit in the Affordable Care Act. Every child is covered for a “vision screening” at his or her primary care “medical home,” usually by a pediatrician or family physician. If referred to an ophthalmologist, the child may undergo an insurance-covered complete eye examination. Correction of refractive errors with glasses or contact lenses and appropriate medical or surgical treatment are also covered.

AAPOS maintains a high-quality website, and the AAPOS positions on vision screening as well as a comprehensive set of practice guidelines for treatment of the pediatric patient are available.

I still find myself caring for the occasional pediatric patient with congenital corneal disease, glaucoma or both, but never without the collaboration of a fellowship-trained pediatric ophthalmologist. For me and our practice, the days of delegating the care of the younger patient to the most junior ophthalmologist in the group are history.