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Ophthalmology: Our team’s multidisciplinary approach to treating vision and eye disorders
Photo courtesy of Texas Children's Hospital
As chief of Ophthalmology at Texas Children’s, I oversee a dedicated team of diverse subspecialists who provide care to children here and from around the world in need of medical or surgical treatment for eye disorders and plastic surgery of the eyes. Today, we have a robust Ophthalmology Division which includes 14 surgeons and three optometrists who serve patients across Greater Houston and in Austin. We also have a fantastic group of ophthalmic technicians and support staff who add to this team effort.
When I think about our subspecialty, ophthalmology combines the best of both worlds in terms of allowing me to provide surgical care while also being able to take care of the medical needs of children’s eyes. Besides medically and surgically treating eye conditions, we develop relationships with our patients that continue to grow over the years.
Being able to see many of my cataract patients whom I treated in infancy grow up, is particularly special to me. I know if I hadn’t intervened and performed cataract surgery on these children during infancy, their lives could be very different today. The most rewarding aspect about ophthalmology, like any other pediatric subspecialty, is being able to make a positive impact in our patient’s lives and seeing them thrive – that’s what I enjoy the most.
So, what do ophthalmologists do? To give you a brief overview of what our team does, I’ve provided answers to some of the most commonly-asked questions about pediatric ophthalmology.
What is ophthalmology?
I think many people, when they hear the word, “ophthalmology,” instantly think of eyes and vision. But, pediatric ophthalmology goes much deeper than that. Our specialty is very complex and includes diverse subspecialties that focus on treating common to very complex eye conditions in children.
Unlike an optometrist, a health care professional who provides non-surgical vision care ranging from eyesight testing to correcting vision via prescription glasses or contact lenses, an ophthalmologist is a medical doctor who went to medical school and ophthalmology residency and performs medical and surgical interventions for eye conditions. Our optometrists collaborate closely with our pediatric ophthalmologists in the care and treatment of patients and also have expertise in areas such as low vision and aphakic contact lens management.
Our ophthalmologists perform more than 1,600 surgical procedures and see more than 34,000 patients annually. We also provide care to international pediatric patients who need access to surgical treatment.
What training do our pediatric ophthalmologists receive?
Unlike general ophthalmologists who focus mainly on adult patients, our pediatric ophthalmologists received subspecialty fellowship training in pediatric ophthalmology. With this additional experience, we can provide medical and/or surgical care for diseases and conditions that are specific to children’s eyes. While many adult or general ophthalmologists are uncomfortable examining children’s eyes, pediatric ophthalmologists are specially trained in this skill.
In addition to our core pediatric ophthalmologists, we have ophthalmologists who have completed additional training in various subspecialties of ophthalmology. We have ophthalmologists who have the expertise to manage eye diseases including pediatric cataracts, pediatric glaucoma, strabismus, tear duct obstructions, retinopathy of prematurity, retinoblastoma, plastic surgery around the eye, and orbital diseases of the eye socket.
What common conditions do pediatric ophthalmologists treat?
The most common eye problem that our pediatric ophthalmologists correct with surgery is strabismus, which is an eye muscle imbalance commonly known as crossed eyes or wandering eyes. We see patients with many types of strabismus, such as esotropia (eyes turning inward) and exotropia (eyes drifting outward). In our clinic, we also treat children with amblyopia, or lazy eye, which is a leading cause of decreased vision among children. In addition, we treat many patients who have blocked tear ducts and eyelid abnormalities. But, we also manage many less common eye conditions that you may not see in private practice around the community. Examples of these conditions include pediatric cataracts, pediatric glaucoma, and inflammations like iritis (inflammation of the iris) and orbital cellulitis, a serious infection that causes inflammation of the soft tissue behind the eye.
I have a special interest in treating infants and children with pediatric cataracts. Many parents are surprised when they learn their child has a cataract because they have never heard of this condition occurring in children. The same is true for children with pediatric glaucoma. While many consider glaucoma an age-related disease affecting older adults, glaucoma is also a childhood eye condition that can impact children of all ages.
While we see a fairly high number of patients with these uncommon eye conditions at Texas Children’s, we also see patients with eye disorders stemming from systemic disease or who have medical conditions which may put them at risk for eye conditions such neurologic and genetic conditions, juvenile arthritis, or cancer.
Click here for a complete list of eye conditions we treat.
How would you describe your team’s multidisciplinary approach to patient care?
Since there are many diseases that affect the eye and the body – and depending on the type of condition being treated – our ophthalmologists work closely with many different subspecialties. We’re often called to evaluate patients for eye diseases or their risk of developing an eye condition. We may also need to coordinate surgical cases. For example, when patients are having ear tubes or undergoing certain dental procedures, we might coordinate eye surgeries with these other services, if it is appropriate to do so.
Some of our ophthalmologists who treat pediatric eye conditions have even closer collaborations with other services.
A great example of this multidisciplinary collaboration is in our Retinoblastoma Program. Dr. Dan Gombos, clinical co-director for the Retinoblastoma Center, works closely with our pediatric oncologists and leverages their expertise and guidance to treat patients with retinal cancers. As the only center of its kind in the Southwestern U.S., Dr. Gombos collaborate with specialists in pediatric oncology, radiation therapy, cell and gene therapy, ocular pathology, cancer genetics and counseling, psychosocial support and a wealth of other multi-disciplinary services for patients and their families.
When our oculoplastics surgeon, Dr. Richard Allen, treats children with orbital cellulitis (infection of the soft tissues that hold the eye in its socket) or other fractures around the face and orbit, he works with our ear, nose and throat specialists or plastic surgeons. Since orbital cellulitis can come from sinusitis and fractures can occur around the orbit or in other areas as well, there are a lot of crossovers and interactions with other subspecialties in his subspecialty.
Another important collaboration is the screening of patients for a condition called retinopathy of prematurity. Drs. Amit Bhatt, Honey Herce and David Coats provide support for screening patients in the neonatal intensive care units at Texas Children’s and Ben Taub Hospital for this potentially blinding condition. They also provide a telemedicine program to screen infants at a number of community hospitals for retinopathy of prematurity.
What types of clinical research is your team involved in to improve patient outcomes?
We participate in a large number of clinical trials in the areas of childhood eye problems including amblyopia, strabismus and tear duct obstructions. We also collaborate with researchers on NIH-funded clinical trials on retinopathy of prematurity, pediatric cataracts, retinoblastoma and eye tumors.
Our team is also performing smaller clinical studies such as retrospective chart reviews of various eye conditions to assess outcomes and improve our team’s management of these conditions.
Click here to learn more about our ophthalmology team and services offered at Texas Children’s.