Pediatric ophthalmologists consider patients with failed vision screening tests

Roundtable Participants

M. Edward Wilson, MD: Many groups like ours, in academics, are deciding that we have to hire pediatric optometrists or optometrists who enjoy the pediatric side of the practice and teach them ourselves. Then, we ophthalmologists can say, “I don’t see failed vision screenings. If they’re found to have something medical, transfer them over to my schedule.”

It should be a team approach. You could potentially get buried in myopia cases and failed school screenings, and then the surgical patients cannot get in to see you.

Gold: In our area, there is no academic institution. We are the institution. We have accommodated our patients and pediatricians as well as enabled our patients to be seen in a reasonable period of time.

Wilson: We are all required to do that. If there is a failed vision screening, then those patients get in to see us. But I am defining “us” a little more broadly. As an individual, you cannot be all things to all people if you are a surgeon.

Gold: I look at it a little differently. I look at it as being both a medical doctor and a surgical doctor. Maybe in a private practice setting that is a little different from in an academic institution.

Wilson: I agree with you, and I see the dilemma. I worry that when I am trying to convince residents to go into pediatric ophthalmology that if the surgical volume per doctor goes down because of these other valid needs, that is not going to help increase the number of pediatric ophthalmologists.

Gold: Good point.

Douglas R. Fredrick, MD: In Northern California, we have UC Berkeley School of Optometry, which is a good non-vision therapy optometric school. They have a residency, which is their fellowship, in pediatric optometry, and you can get good optometrists to work for academic institutions. There are fewer than 10 pediatric ophthalmologists in private practice in the Bay area, so optometrists are rushing to fill the need.

Here at Kaiser, we have optometrists who enjoy caring for young children. We are lucky. Southern California is lucky in that regard as well.

There is also a good optometry school at SUNY with non-vision therapy optometrists. However, other parts of the country might not have this availability of manpower. I agree with Dr. Wilson so long as we are the captain of the ship with a team that includes pediatric optometrists as well as orthoptists. We want to grow the profession of orthoptists as well. I think that by creating an efficient collaborative team of ophthalmologists, orthoptists and optometrists, it is possible to deliver great care while generating revenue for the enterprise.

Rudolph S. Wagner, MD: The manpower issue is real, at least in the Northeast, as far as the need for additional pediatric ophthalmologists. I would anticipate that, if SYD-101 (Sydnexis) is approved by the FDA, the demand for our services will increase dramatically. I believe that media coverage will increase the number of parents that are aware of this treatment and ask for it.

• For more information:
• Douglas R. Fredrick, MD, of Kaiser Permanente South San Francisco, can be reached at douglas.r.fredrick@kp.org.
• Robert S. Gold, MD, of Eye Physicians of Central Florida, can be reached at rsgeye@gmail.com.
• Rudolph S. Wagner, MD, of Rutgers New Jersey Medical School, can be reached at r.s.wagner@rutgers.edu.
• M. Edward Wilson, MD, of Storm Eye Institute, Medical University of South Carolina, can be reached at wilsonme@musc.edu.