Co-Management of Pediatric Patients PDF

CO-MANAGEMENTOF PEDIATRIC PATIENTS M atthew T. Vaughn OD FAAO Pediatric Optometry and Vision Development August 1, 2024 1 Outline:Co-Management with whom? Pediatric Ophthalmology* Pediatricians* School Nurse Educators...

CO-MANAGEMENTOF PEDIATRIC PATIENTS M atthew T. Vaughn OD FAAO Pediatric Optometry and Vision Development August 1, 2024 1 Outline:Co-Management with whom? Pediatric Ophthalmology* Pediatricians* School Nurse Educators/Teachers O cc upational Therapists* Physic al Therapists Teachers for the Visually Impaired/Orientation and Mobility Instructors 2 Pediatric Ophthalmology Strabismus Ptosis Congenital C atarac ts and Infant Aphakia Contac t Lenses Prism Other 3 Pediatric Ophthalmology Types of Deviations Exotropia Esotropia C N 3,4, o r 6 Pa lsy Dua ne Synd ro me 4  Strabismus Surgery Recession Resection -recession is a weakening procedure and moving it back on the eye and changing where the eye muscle is inserted so it doesn’t have the same pulling action it once had -resection is cutting a piece of the muscle out and shortening the wire that’s connected to the eyeball so the same amount of force is going to have a stronger effect and the muscle is tighter 5  Congenital Exotropia Large angle divergent strabismus present within 1st yea r of life Associa te d with ne urolo g ic a l a b norma litie s or craniofacial syndromes >35 p d à ty p ic a lly p a r e n t s w o n ’ t m is s it Exotropia Alte rna te fixa tor Devia tio n simila r a t D a nd N Surgery Typ ic a lly no sig nific a nt RE Surgery: Bilateral LR recessions or monocular MR resection with LR recession -treatment is surgical -typically fixate with the eye that points to where they need to so we typically don’t see amblyopia in these pts bc they have good vision unilateral -bilateral LR recession à weakening the lateral muscles -monocular MR and LR recession à tightening the medial rectus and weakening the lateral 6  Exotropia Surgery Sensory Exotropia Consec utive Exotropia O cular trauma s/p ET surg e ry Severe amblyopia Prism vs. mo re surg e ry Corneal opac ity Cataract Convergenc e Insuffic ienc y?? Retinal disease Optic nerve hypoplasia 7  Intermittent Exotropia Will eye turn deteriorate, stay stable, or improve? When is the best time to recommend treatment? Is surgical or non-surgical intervention necessary? -different in the morning compared to after school -very inconsistent - 8  IXT2:C HARAC TERISTICS 653 children, a g e 3 to 50% of the time during observation (before dissociation) 3 Exotropia 5 seconds PHORIC 1 No exotropia unless dissociated, recovery 1-5 seconds 0 Pure phoria (XP):