the soop box fall 2018.pdf · ophthalmology subspecialty day program that is held in conjunction...

The SOOp Box http://tinyurl.com/aapsoop

© American Academy of Pediatrics Section on Ophthalmology 2018

Section on OphthalmologyNewsletter

Fall 2018

Dan Karr

Chairperson’s ReportDaniel J. Karr

It is hard to believe that with this newsletter we are reaching the end of my two-year term as Chairperson of the AAP Section on Ophthalmology (SOOp). November 1 is our transition date. At that time, Geoff Bradford will become our new Chairperson, Steve Rubin will transition into the role of Chairperson-Elect, and Sylvia Yoo will begin her term as a new Executive Committee member. For more information on these leadership transitions see page 5 of this newsletter.

We recently welcomed Dr. Honey Herce to the Executive Committee as our new liaison from the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) Committee on Young Ophthalmologists. Dr. Herce replaces Eniolami Dosunmu in that role. A note of congratulations here for Dr. Dosunmu who was sponsored by SOOp for the opportunity to participate in the 2019 AAO Leadership Development Program and was recently selected. We look forward to hearing about her project as part of that program.

Despite our 200+ member size, the Section continues to have a significant influence on the 66,000+ member AAP. We advise, edit or author all pediatric ophthalmology related publications and policy statements for the AAP:

• A revision of the clinical report on “The Eye Examination in the Evaluation of Child Abuse” was published in Pediatrics in July 2018. The Section along with the AAP Council on Child Abuse and Neglect hosted a webinar titled “Is it All in the Eyes?” to coincide with the publication of the statement.

• A revision of the 2013 joint AAP/AAPOS/

AAO/AACO policy statement on the “Screening Examination of Premature Infants for Retinopathy of Prematurity” has recently been approved for publication in Pediatrics.

• Paperwork has recently been completed for the reaffirmation of the joint policy statement and technical report on “Learning Disabilities, Dyslexia, and Vision”

• A revision of the 2006 Clinical Report, “Ophthalmologic Examination in Children with Juvenile Idiopathic Arthritis” is currently under consideration. There is a proposal to re-title the document to encompass a second patient population: “Screening for Early Detection of Ocular Disorders in Two Populations: Children with Juvenile Idiopathic Arthritis and Children Being Treated with Hydroxychloroquine.”

• An intent for the revision of the 2005 Clinical Report, “Screening for Retinopathy in the Pediatric Patient with Type 1 Diabetes Mellitus” has recently been submitted.

• In January 2018, the AAP approved endorsement of “Ophthalmic Screening of Children at Risk for Retinoblastoma: A Consensus Statement from the American Association of Ophthalmic Oncologists and Pathologists.”

• In May 2018, the Section sponsored the publication of a “Focus on Subspecialties” article in AAP News: “Are old wives’ tales regarding myopia true?” See page 9 to read the full article.

• The Section has recently been asked to provide feedback on: an upcoming AAP consumer book titled Caring For Your School-Age Child: Ages 5 to 12, a HealthyChildren.org article on Screen

In This Issue …Chairperson’s Report . . . . . . . . . . . . . . . . 1Call for Nominations for 2019 Apt Lectureship Award . . . . . . . . . . . . . . . . . . 3Seen in Pediatrics, AAP News, and PIR. . 3SPOTLIGHT ON ADVOCACY . . . . . . . . . 4• AAP Unveils New Blueprint

for Children Updates . . . . . . . . . . . . . . 4• Public Charge Advocacy Toolkit . . . . . 4• AAP SOOp Webinar on Medicaid

Payment Advocacy . . . . . . . . . . . . . . . 4AAP Move to New Headquarters . . . . . . . 5Section Welcomes New Leaders . . . . . . . 5CDC Updates . . . . . . . . . . . . . . . . . . . . . . 6New Policy: Eye Exam in Evaluation of Child Abuse . . . . . . . . . . . . . . . . . . . . . . . 6Looking Back and Forward: AAP Leads the Way for Child Health . . . . 7AAP’s Care Coordination Policy Statement & Implementation Resource . . . . . . . . . . . 82017 National Survey of Children’s Health . . . . . . . . . . . . . . . . . 8AAP News: Are Old Wives’ Tales Regarding Myopia True? . . . . . . . . . . . . . 9Ophthalmology Sessions @ 2018 NCE . . . . . . . . . . . . . . . . . . . . . 10Encouraging Professionalism in Medicine . . . . . . . . . . . . . . . . . . . . . . . 11Updated: Clinical Report on Health Care Transitions for Youth and Young Adults. . . . . . . . . . . 12Member Roster. . . . . . . . . . . . . . . . . . . . 13AAO 2018 Quick Reference Guide. . . . . 14• Pediatric Ophthalmology

Subspecialty Day . . . . . . . . . . . . . . . 15• Pediatric Focused Educational Sessions

at the 2018 AAO Meeting . . . . . . . . . 21• 2018 AACO National Meeting . . . . . . 25

Continued on page 2

http://www.aappublications.org/news/2018/01/11/Retinoblastoma011118

The SOOp Box Fall 2018 / 2

Time and its Effects on Children’s Eyes, the second edition of AAP’s title, Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide, an AAP Council on Sports Medicine and Fitness clinical report on “Sport-Related Concussion in Children and Adolescents,” the 2nd edition of an AAP publication, Neonatology for Primary Care, an AAP consumer resource, Caring for Your Baby and Young Child: Birth to Age 5, a new AAP Clinical Practice Guideline for the Management of Infantile Hemangiomas, and a revised clinical report from the AAP Council on Sports Medicine and Fitness on “Soccer Injuries in Children and Adolescents.”

• In 2017, the SOOp and AAPOS established a joint subcommittee on Concussion. This subcommittee has been charged with developing a joint organizational policy statement, “Vision & Concussions: Symptoms, Signs, Evaluation & Treatment”. Pediatricians need guidance in this area when it comes to making referrals so the AAP’s involvement is crucial. The Subcommittee has developed an intent for a new policy statement, which was formally approved by the AAP Board of Directors in August 2018.

The Section participates in numerous annual meeting and educational endeavors:

• At the 2018 AAP National Conference and Exhibition (NCE) in November, the section will sponsor two hands-on sessions titled “Eye Examination Skills Using the Ophthalmoscope,” two audience-response sessions titled, “Pediatric Ocular Emergencies You Can’t Afford to Miss; When to Refer and When to Treat?,” and one selected short subject session titled, “Learning Disabilities: What Pediatricians Need to Know”. For more information, please see page 10.

• The Section sponsors a workshop at the AAPOS meeting annually to explore conditions of concern for the pediatrician and the pediatric ophthalmologist. At the 2018 AAPOS annual meeting the SOOp offered a workshop titled, “Cortical/

Cerebral Visual Impairment 2018: What You Need to Know Including Perspective from a Parent of a Child with CVI.”

• The SOOp has an agreement with AAPOS to co-sponsor the Pediatric Ophthalmology Subspecialty Day program that is held in conjunction with the AAO Annual Meeting. We look forward to the upcoming meeting in Chicago, “Winds of Change in the Windy City”. To view the full program for the October 27th Sub-Day meeting, see page 14.

• The Section works annually with AAO, AAPOS, AACO and CEF to support a joint children’s eye health exhibit booth, which travels to a number of important meetings throughout the country (including the AAP’s National Conference and Exhibition)

• The AAP Department of Federal Affairs hosted a Medicaid Advocacy webinar specifically for the members of our AAP Section on Ophthalmology in September 2018. If you missed it and want to learn more, see page 4.

• For 18 years our Section has overseen the Leonard Apt Lectureship Award. Please consider a nomination for the 2019 Apt Lecture which will take place in a new venue for the first time - during the 2019 joint AAP/AAPOS Subspecialty Day in conjunction with the AAO Annual meeting. The call for nominations appears on page 3 of this newsletter.

In the pages to come, we have highlighted some of the important advocacy work that the AAP has been doing this year. As an AAP member, you help to support this work.

I wish to thank all the SOOp members for the generous donation of their time and expertise to accomplish the many and diverse endeavors noted above. If you would like to become more involved in Section activities please contact me or any of our Executive Committee members. I look forward to seeing you in Chicago at the AAO Sub-Day and at AAPOS in San Diego next spring.

Kindest Regards,

Dan Karr

Chairperson’s Report (Continued from page 1) 2017-2018

Executive Committee Daniel J Karr, MD FAAP Chairperson Portland, OR Geoffrey E Bradford, MD FAAP Chairperson-Elect / Newsletter Editor Morgantown, WV Kanwal (Ken) Nischal, MD FAAP Pittsburgh, PA John Roarty, MD FAAPDetroit, MISteven E Rubin, MD FAAP Great Neck, NY Donny Won Suh, MD FAAP Omaha, NE George S Ellis Jr, MD FAAPSection Historian New Orleans, LASharon S Lehman, MD FAAP Immediate Past Chair Wilmington, DE

Liaisons Pamela Erskine Williams, MD FAAP American Academy of Ophthalmology (AAO) Gregory T Lueder, MD FAAP American Academy of Ophthalmology Council (AAOC) Christie L Morse, MD FAAP American Association for Pediatric Ophthalmology and Strabismus (AAPOS) Sarah McKinnon, CO, COMT American Association of Certified Orthoptists (AACO)

Staff Jennifer Riefe, MEd Section Manager [email protected]

Calling for newsletter articles! For our next SOOp newsletter, the Spring edition Please send proposals to Geoff Bradford, Newsletter Editor, at [email protected] by February 1, 2019.


The Leonard Apt Lectureship was established and first presented in 2000 by the American Academy of Pediatrics (AAP) Section on Ophthalmology (SOOp) to honor Leonard Apt, MD, for his dedication and contributions in the fields of pediatrics and pediatric ophthalmology. Dr. Apt was the first physician to be board-certified in both pediatrics and ophthalmology. The Leonard Apt Lecture pays tribute to Dr. Apt not only for his educational and scientific contributions, but also for his pioneer role in helping to create pediatric ophthalmology as a new medical subspecialty.

At this time, the AAP Section on Ophthalmology Apt Nominations Committee is ready to review nominations for the 2019 Leonard Apt Lectureship Award. The Apt lectureship has traditionally been given every other year at the AAPOS annual meeting in the spring; In 2019 and going forward, the Lectureship will be given at a

new venue, the Pediatric Subspecialty Day meeting, held in conjunction with the AAO’s annual conference in the fall. If you have a potential nominee in mind, please complete a nomination form online at https://www.surveymonkey.com/r/QQQGQLL and complete your submission by sending a 2-3 page bio-sketch of the nominee to Jennifer Riefe, Manager, AAP Section on Ophthalmology, by email to [email protected] by November 15, 2018. The Leonard Apt Lecturer should be nationally or internationally recognized as an expert in a field that is considered relevant to understanding disease processes and/or treatments in pediatric ophthalmic patients.

Thank you for your interest in the Leonard Apt Lectureship Award and for your consideration of becoming involved in the nominations process. The AAP Section on Ophthalmology Apt Nominations Committee greatly appreciates the feedback of all pediatric ophthalmologists as it generates a list of potential individuals to receive this esteemed award.

Leonard Apt Lectureship Award Winners2000: Jane Bronwyn Bateman, MD

(San Diego, CA) Topic: Cataract Genetics

2001: Bennett A. Shaywitz, MD and Sally E Shaywitz, MD (Orlando, FL) Topic: Dyslexia

2002: Mark Siegler, MD (Seattle, WA) Topic: Bioethics

2003: Linda Jo Mason, MD (Honolulu, HI) Topic: Pediatric Anesthesia

2005: Edwin Stone, MD, PhD (Orlando, FL) Topic: Ocular Genetics

2007: Carol Berkowitz, MD (Seattle, WA) Topic: Child Abuse Prevention

2009: Sherwin Isenberg, MD (Los Angeles, CA) Topic: Pediatric Blindness

2011: Jerry Shields, MD, and Carol Shields, MD (Philadelphia, PA) Topic: Ocular Tumors

2013: Joseph Demer, MD, PhD (Los Angeles, CA) Topic: Strabismus

2015: Alex V. Levin, MD, MHSc (Philadelphia, PA) Topic: Child Abuse

2017: Marilyn T. Miller, MD (Chicago, IL) Topic: Zika Virus

Call for Nominations for the 2019 Leonard Apt Lectureship Award

Leonard Apt

Seen in PEDIATRICS, AAP News, and PIR

Vitamin A Deficiency Due to Selective Eating as a Cause of Blindness in a High-Income Setting – April 2018

Recalcitrant Atopic Keratoconjunctivitis in Children: A Case Report and Literature Review – April 2018

Case 1: Eye Discharge in a 10-day-old Neonate Born by Cesarean Delivery – April 2018

Consortium, Networks Dedicated to Improving Treatments for Neonates – April 2018

Pediatric Vision Screening - May 2018

Visual Diagnosis: Newborn Girl with Congenital Unilateral Eye Opacity May 2018

Temporal Course of Retinopathy of Prematurity in Extremely Premature Infants – May 2018

Trends in the Diagnosis of Retinopathy of Prematurity in the United States from 1997-2012 – May 2018

The Eyes Have it – Time to Examine Pain Management for ROP June 2018

Pain-Relieving Interventions for Retinopathy of Prematurity: A Meta-analysis – July 2018

Preterm Neuroimaging and School-Age Cognitive Outcomes – July 2018

Call in Ophthalmologist When Abusive Head Trauma Is Suspected – July 2018

CDC: Brain, Eye Abnormalities 30 Times Higher in Infants Exposed to Zika – August 2018

Visual and Hearing Impairments After Preterm Birth – August 2018

AAP talks with UnitedHealthcare result in revised policies – September 2018

Eye Findings in Infants With Suspected or Confirmed Antenatal Zika Virus Exposure – October 2018

https://www.surveymonkey.com/r/QQQGQLLhttp://pediatrics.aappublications.org/content/141/Supplement_5/S439http://pediatrics.aappublications.org/content/141/Supplement_5/S470http://pedsinreview.aappublications.org/content/39/4/210http://www.aappublications.org/news/2018/04/02/fdaupdate040218http://pedsinreview.aappublications.org/content/39/5/225http://pedsinreview.aappublications.org/content/39/5/e24http://pediatrics.aappublications.org/content/142/1_MeetingAbstract/144http://pediatrics.aappublications.org/content/142/1_MeetingAbstract/149http://www.aappublications.org/news/2018/06/18/the-eyes-have-it-time-to-examine-pain-management-for-rop-pediatrics-6-18-18http://pediatrics.aappublications.org/content/142/1/e20180401http://pediatrics.aappublications.org/content/142/1/e20174058http://www.aappublications.org/news/2018/07/23/eyeexam072318http://www.aappublications.org/news/2018/08/07/zika080718http://pediatrics.aappublications.org/content/142/2/e20173888http://www.aappublications.org/news/2018/09/06/ppaac090618http://pediatrics.aappublications.org/content/142/4/e20181104


Continued from page 2

SPOTLIGHT ON ADVOCACYAAP Unveils New Blueprint for Children Updates

The national midterm elections will be held on Tuesday, November 6, 2018, when federal, state and local officials across the country will be elected. The Academy’s Get Out the Vote campaign, #VoteKids, encourages pediatricians and others who care for children to vote with kids in mind this election. The campaign website, aap.org/votekids, includes information on what’s at stake for children, how and where to register to vote and what members can do to speak up for children at the ballot box.

In September 2016, the American Academy of Pediatrics (AAP) released its Blueprint for Children: How the Next President can Build a Foundation for a Healthy Future. The Blueprint outlined policy proposals to advance child health and well-being. Two years later, the Academy assessed the status of federal child health policy and the AAP’s work to realize the vision laid out in the Blueprint. This update outlines the ways in which the Academy’s expertise has helped to protect foundational elements of child health policy and advance new initiatives in the interest of children. The Blueprint update is available at https://www.aap.org/enus/Documents/AAP-BLUEPRINT-Achievements.pdf.

The AAP has also recently unveiled a new document, which looks ahead at our federal advocacy efforts: 2018 Update: What’s Next in Child Health Advocacy.As you look through each of the documents, please take a moment to reflect on all that the AAP and its membership (thank you!) has been able to do for children in the two years since the original Blueprint came out. From our elected member leaders to individual AAP members, our chapters and our committees, councils and sections, we can be so proud of what is possible when we come together and speak up for children and what they need to be healthy.

Public Charge Advocacy ToolkitIn response to the public charge proposal issued by the U.S. Department of Homeland Security (DHS) in October 2018, the American Academy of Pediatrics (AAP) is engaging its chapters and members in a multi-faceted advocacy campaign to oppose the proposal and protect children’s health. The proposal was officially published on October 10 and the public has until December 10 to weigh in with comments. Immigrant families have faced a variety of recent harmful policies and practices, and this new public charge proposal puts their health and well-being at further risk. The AAP Public Charge Advocacy Toolkit has been created for chapters’ advocacy efforts and includes key messages, public comments, state-specific data and information, social media messages, public charge news coverage, and op-ed guidelines. It is designed to equip you with what you need to be an effective voice for children at a crucial, consequential moment.

The new proposal from DHS expands the definition of what it means to be a “public charge,” making it harder for immigrants to enter the United States and advance through the immigration process. “Public charge” has long been a part of our country’s immigration laws.

Currently, a “public charge” is defined as someone who is primarily dependent on the government for subsistence. A public charge determination is made when a person applies for a visa to enter the United States or to adjust status to obtain a green card (not when applying for citizenship). In other words, someone who is found to be a public charge under this definition could be denied a visa or green card. Under the new public charge proposal, an immigrant’s use, or likely use, of certain public benefits can now be considered to deny entry or permanent legal status in the United States. For the first time, the government will look at an immigrant’s use of Medicaid, the Supplemental Nutrition Assistance Program (SNAP), housing assistance, and Medicare Part D low income subsidy. The administration is also contemplating adding use of the Children’s Health Insurance Program (CHIP) to the list of programs that would count toward a public charge determination. Additionally, the proposal would consider family income as a factor in determining whether an immigrant is a public charge, putting low-income parents with children at a disadvantage compared to adults without children. To avoid scrutiny under the public charge test, a family of four would need to earn nearly $63,000 annually. And, the proposal

would discriminate against people with preexisting conditions. Specifically, a low-income immigrant with a medical condition that may require extensive treatment who is unable to cover the cost of such treatment could be determined to be a public charge.

The use of public benefits by U.S. citizen children will not directly be a factor in a parents’ public charge test. However, if a child is an immigrant, his or her own use of benefits counts toward his or her own public charge determination. Under the proposal, benefits used before the proposal is finalized and effective will not be considered in the public charge determination. It is important to note that the changes proposed in this rule will not go into effect until after the administration publishes a final rule. The AAP is encouraging its 67,000 members to make their voices heard and submit comments opposing the proposal so that the Department of Homeland Security (DHS) hears and hopefully addresses the vast impact of the proposal on immigrant children and families.

Ultimately, the AAP urges DHS to rescind this proposal and, instead, work to promote the health and well-being of all children, regardless of where they or their parents were born.

Webinar on AAP Medicaid Payment Advocacy

On September 12, 2018, the AAP Departments of Federal Affairs and State Government Affairs hosted a webinar on Medicaid payment advocacy specifically for Section on Ophthalmology members. Wish you would have been able to listen in? No problem. The webinar can be streamed using the following link: https://aap.webex.com/aap/ldr.php?RCID=c4ffa4c3006d80d5797f8e5fcd94c046. Please note that the presentation does not begin until the 4 minute mark so you may want to skip forward to that time mark when you begin.

https://www.aap.org/en-us/Vote/Pages/default.aspxhttps://www.aap.org/enus/Documents/AAP-BLUEPRINT-Achievements.pdfhttps://www.aap.org/en-us/Documents/AAP-BLUEPRINT-AtStake.pdfhttps://www.federalregister.gov/documents/2018/10/10/2018-21106/inadmissibility-on-public-charge-grounds?utm_campaign=subscription mailing list&utm_source=federalregister.gov&utm_medium=emailhttps://na01.safelinks.protection.outlook.com/?url=http:%2F%2Fwww.mmsend70.com%2Flink.cfm%3Fr%3DOYnH4KjS5KnXIUslywC3ww~~%26pe%3Dw4a0HD2-Q3RQRsUI1EDLSNov0-hmfcL1q0Ma95cTVFuSO9X03oRrpV3R9sqq6-X-AiXgYOk89Xf52ZCKbCh0oA~~%26t%3D62OS9WFqHYWbWOXAahg8Jw~~&data=02%7C01%7Castorey%40aap.org%7Ccad141bcfd9f481cdc0408d6339ab3ae%7C686a5effab4f4bad8f3a22a2632445b9%7C0%7C0%7C636753136869754837&sdata=7q7sV%2B%2FVoVnsef6ewUbfenVIIUwqZ2LZHNSfbpeOXRQ%3D&reserved=0https://aap.webex.com/aap/ldr.php?RCID=c4ffa4c3006d80d5797f8e5fcd94c046


AAP Move to New HeadquartersIn December 2017, the AAP moved into a new headquarters building in Itasca, IL. The AAP Headquarters of the Future is designed to be the center for child health around the world and the home of the profession of pediatrics. It is a physical and virtual space where all who serve children can convene to advance child health and wellness.

The new building will:• Allow us to meet the changing needs of children and

pediatricians• Engage more fellows and child advocates in the United States

and around the world with updated technology• Provide dynamic meeting and conference spaces with greater

online connectivity and healthy work spaces• Attract and retain the most qualified staff for Academy programs• Decrease meeting expenses and reduce the Academy’s carbon

footprint and energy costs• Give donors a variety of opportunities to honor mentors,

colleagues, family, friends and patients

Our new address and phone numbers are below:• New Mailing Address: American Academy of Pediatrics,

345 Park Blvd., Itasca, IL 60143• New AAP Main Number: 630-626-6000• AAP Toll Free: 800-433-9016• AAP Customer Service: 866-843-2271• AAP Main Fax: 847-434-8000

Dr. Geoff Bradford Takes on Role of Section ChairpersonAfter serving 6 years as an Executive Committee member and 2 years as Chair-Elect, Dr. Geoff Bradford will take on the role of Section Chairperson as of November 1, 2018. Geoff will serve a two year term as Chair through Fall 2020.

About Dr. BradfordAfter earning his advanced degrees from Penn State University, Dr Bradford completed his residency in Ophthalmology at Summa Health Care System and Akron Children’s Medical Center in Akron, OH. His fellowship in Pediatric Ophthalmology was done with Zane Pollard, MD, at Scottish Rite Children’s Hospital in Atlanta, GA.

Initially in private practice five years, Dr Bradford joined the Departments of Ophthalmology and Pediatrics at West Virginia University in 1998. He is also the Residency Program Director and has served as Vice President of the West Virginia Academy of Ophthalmology. He has been an AAP SOOp member for twenty years and has served on its Executive Committee for nearly eight years, working in part as the editor for its biannual newsletter. At present he also serves as Chair of the AAPOS Vision Screening Committee and has been a member of the Legislative Affairs Committee. Recently he also joined the Expert Advisory Committee of the National Center for Children’s Vision

and Eye Health and serves as the AAO representative to the American Orthoptist Council.

Dr Bradford has presented nationally and published in the areas of early childhood vision screening and legislative affairs. His most recent work includes contributions to the recently updated AAP Vision screening recommendations. For ten years he served as Director of the WVU Vision Initiative for Children Program, which developed and taught improved vision screening practices amongst lay and professional pediatric care providers throughout West Virginia.

Dr Bradford sincerely appreciates the opportunity to serve as the Chairperson of the SOOp Executive Committee and plans to work to continue its current initiatives and to develop new initiatives advocating for improved ophthalmic care for all children.

Dr Bradford and his wife Kathy, a pediatric infectious disease specialist at WVU, have a cabin in the woods, two boys in college, three dogs, and enjoy the cultural and outdoor opportunities that WVU and West Virginia offer. Thank You to Dr. Daniel Karr!The AAP Section would like to thank Dan Karr as he completes his term as Chair of the Section. Dr. Karr is a long-time member of the Executive Committee, having served in a leadership position for the last 10 years in some capacity. Dr. Karr was instrumental in his role as Chair of the Section’s Education Committee for six years, and the Section leadership is very grateful for his

guidance. Dan, we won’t let you go far. As Immediate Past Chairperson, Dan will serve an additional two years on the Executive Committee to bring his years of service to a total of twelve as of Fall 2020!

Dr. Steve Rubin Takes on Role of Section Chairperson-ElectAfter serving 5 years as an Executive Committee member, Dr. Steve Rubin will take on the role of Chair-Elect as of November 1, 2018. Steve will serve a two-year term as Chair-Elect through Fall 2020 when he will take over as Section Chair. Note that Steve also serves as the current Chair of the Section’s Education Committee.

About Dr. RubinDr Rubin is a NYC native and a graduate of the Stuyvesant High School, SUNY Buffalo, and the Downstate Medical Center. He was an intern at the University of Miami-Jackson Memorial Hospital and completed his Ophthalmology residency at the University of Pennsylvania’s Scheie Eye Institute in Philadelphia. After a fellowship in Pediatric Ophthalmology at the Wills Eye Hospital across town, he returned to Penn to serve for one year as Assistant Chief-of-Service. Dr Rubin returned to New York in 1984, initially as the first Chief of Pediatric Ophthalmology at the Schneider Children’s Hospital of the Long Island Jewish Medical Center (now the Cohen Children’s Medical

The Section Welcomes New Leaders

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Geoff Bradford

Steve Rubin


Center of NY), and then in 1991 to the same position at the North Shore University Hospital in Manhasset, where he was also Residency Program Director since 1993 until he resigned from that role in 2014. Dr Rubin retired from full-time clinical practice in the Ophthalmology Department in June of 2018 and accepted a position as a Physician Advisor in Northwell Health’s Revenue Cycle division.

Dr Rubin has been board certified in Ophthalmology since 1983, and is past President and past Secretary/Treasurer of the American Association for Pediatric Ophthalmology & Strabismus. He is also past president of the Long Island Ophthalmological Society, and a past Treasurer of the Nassau County Medical Society as well as an active member of various Ophthalmological and Pediatric societies. Dr Rubin also serves as an Examiner for the American Board of Ophthalmology and is on their Exam Development Committee. In 2013 he was elected to the Executive Committee of the Section on Ophthalmology of the American Academy of Pediatrics, where he has also served as Chair of the Education Subcommittee. until becoming Chair of the Executive Committee in 2018.

Dr Rubin has authored scores of peer-reviewed journal articles and book chapters on strabismus, amblyopia,

and visual development, and is a reviewer for several leading peer-review journals in ophthalmology and pediatric ophthalmology. He has also been listed several times as one of New York Magazine’s “Best Doctors in New York” and is an annual selection for that same honor from Newsday. He frequently serves as an expert witness in abusive head trauma cases and medical malpractice cases. Dr Rubin is Professor of Ophthalmology at the Zucker School of Medicine at Hofstra/Northwell.

Dr. Sylvia Yoo to Join the Section Executive Committee This FallWe are pleased to welcome Dr. Sylvia Yoo to our AAP Section on Ophthalmology Executive Committee as of November 1, 2018. Sylvia will serve a three-year term concluding in the fall of 2021 and will be eligible for re-election to a second three-year term at that time.

A little bit about our new leader…Dr. Yoo grew up in Alabama and attended Cornell University where she majored in Biological Engineering. She then returned to Alabama to attend medical school in Birmingham at UAB. She went on to complete her residency in pediatrics at Stanford University in 2010 during which she became interested in

pediatric ophthalmology. Subsequently she completed her ophthalmology residency at UCLA in 2013. After residency, Dr. Yoo returned to the east coast to complete a fellowship in pediatric ophthalmology and strabismus at Johns Hopkins Hospital prior to accepting her current position at Tufts Medical Center. In addition to teaching ophthalmology residents in both the pediatric eye clinic and in the resident comprehensive ophthalmology clinic, she has worked with pediatric residents and medical students through both didactic teaching and clinical teaching when pediatric residents rotate in her clinic.

Dr. Yoo’s background is in both pediatrics and ophthalmology, having completed residencies in both. While she changed her career course from pediatrics to ophthalmology, her love of caring for and advocating for children’s health has remained. As a pediatrics resident, she recalls her own limited understanding of pediatric eye disease and strabismus and, in her subsequent training, she says she “became more aware of the gap that sometimes occurs in the management of pediatric eye disease.” Dr. Yoo has worked to establish good working relationships with referring pediatricians to provide the best care possible for her patients. She hopes to to use this experience to be more actively involved in the work of the section and to ensure that productive and educational programs be planned and executed for the AAP.

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Sylvia Yoo

CDC Updates

Developmental Milestone Tracker AppA FREE Milestone Tracker app from the Centers for Disease Control and Prevention (CDC) helps parents to track their child’s milestones from age 2 months to 5 years. Interactive checklists with photos and videos make tracking milestones easy and fun. The app generates a personalized summary to help physicians perform developmental surveillance, offers parents tips for developmental promotion, and provides information about what to do if there’s a developmental concern.For more information on developmental surveillance, visit the CDCs Learn the Signs. Act Early. webpage.

New Concussion Guidelines For Children.New children’s concussion guidelines from the Centers for Disease Control and Prevention recommend against routine X-rays and blood tests for diagnosis and reassure parents that most kids’ symptoms clear up within one to three months. Researchers arrived at the new guidelines after assessing 25 years of scientific research on managing concussions in children and chose procedures with the strongest evidence of benefit. The guidelines were published online in JAMA Pediatrics. While the AAP has guidance for managing sports concussions, and for returning to school after a concussion, the CDC’s guidelines are for concussions from all causes, including falls, sports and car accidents. Take a look!

SOOp Revises Policy on The Eye Examination in the Evaluation of Child Abuse

The Academy has released an updated clinical report on The Eye Examination in the Evaluation of Child Abuse from the Section on Ophthalmology and the Council on Child Abuse and Neglect, along with the American Association of Certified Orthoptists, the American Association for Pediatric Ophthalmology and Strabismus, and the American Academy of Ophthalmology. The report is available at https://doi.org/10.1542/peds.2018-1411 and was published in the August 2018 issue of Pediatrics.

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Letter from the President

Looking back and forward: AAP leads the way for child healthby Colleen A. Kraft M.D., M.B.A., FAAP, President, American Academy of Pediatrics

Summer is underway, and so are our district meetings. This is a great opportunity to connect with members fromeach chapter to celebrate your achievements and address our challenges. I am interested in your perspectiveon the future of pediatrics, the Academy and how best to lead child health forward.

Because of you, the AAP remains the national leader in child health. Here are examples of the progress we'vemade at a national level in the 2017-'18 fiscal year:

We are creating a Child Health Data Registry that will allow us to collect and analyze data for everychild in the U.S. regarding health, disease, wellness and development - from birth to age 21. Thisunprecedented initiative has the potential to improve health services research and the practice ofpediatrics and help millions of children and families.

�

Our Digital Transformation Initiative is improving the way members navigate and access informationon AAP.org and ensuring the information you access on our digital platforms is the best and latestavailable.

�

We have expanded our commitment to health equity by establishing a task force to address bias anddiscrimination. Joseph L. Wright, M.D., M.P.H., FAAP, is overseeing six work groups that will preparepediatricians to help families identify, manage and prevent adverse physical and emotional outcomeswhile promoting health equity.

�

In a related effort, our Task Force on Diversity and Inclusion delivered its final report which ensuresthat allof our AAP members will feel welcome and that our leadership reflects the strength anddiversity of our membership.

�

To pursue our strategic priority of Physician Health and Wellness, we are partnering with other medicalprofessional groups through the National Academy of Medicine to identify elements of our workenvironments, learning environments and general culture of medicine that adversely affect clinicianwellness and well-being. We are developing the Women's Wellness through Equity and Leadershipprogram to equip female physicians of all ages with the skills they need to take leadership roles in theirhospitals, health plans or health systems.

�

We successfully advocated to get key federal child health priorities, including the Children's HealthInsurance Program; Maternal, Infant, and Early Childhood Home Visiting Program; and the FamilyFirst Prevention Services Act, funded through the Bipartisan Budget Act of 2018.

�

We announced our Gun Safety and Injury Prevention Research Initiative that will define and fundresearch to evaluate and implement effective interventions in clinics and communities to protect thehealth - and lives - of children.

�

We are taking on child health threats like the national opioid epidemic, electronic nicotine deliverysystems and marijuana among youths and young adults. We expose the dangers and lend the voice ofscience and reason to a national debate that will have lasting impact on the health and life trajectory ofAmerica's children.

�

Many organizations talk about changing the world, but few have the talent, resources and expertise to make itContinued on page 9


Letter from the Presidenthappen. The Academy has an abundance of all three.

Our Strategic Plan and Agenda for Children continue to set our direction. Our Blueprint for Children maps outwhat we must ask our lawmakers to do to improve the lives of children and build a healthier future.

With clarity of purpose and a strong sense of mission, we move ahead with full confidence. Our course is theright one, and I'm honored to continue this journey with you.

Copyright © 2018 American Academy of Pediatrics

Reprinted with permission from AAP News; Originally Published June 2018

Letter from the Presidenthappen. The Academy has an abundance of all three.

Our Strategic Plan and Agenda for Children continue to set our direction. Our Blueprint for Children maps outwhat we must ask our lawmakers to do to improve the lives of children and build a healthier future.

With clarity of purpose and a strong sense of mission, we move ahead with full confidence. Our course is theright one, and I'm honored to continue this journey with you.

Copyright © 2018 American Academy of Pediatrics

Reprinted with permission from AAP News; Originally Published June 2018

Letter from the President

Looking back and forward: AAP leads the way for child healthby Colleen A. Kraft M.D., M.B.A., FAAP, President, American Academy of Pediatrics

Summer is underway, and so are our district meetings. This is a great opportunity to connect with members fromeach chapter to celebrate your achievements and address our challenges. I am interested in your perspectiveon the future of pediatrics, the Academy and how best to lead child health forward.

Because of you, the AAP remains the national leader in child health. Here are examples of the progress we'vemade at a national level in the 2017-'18 fiscal year:

We are creating a Child Health Data Registry that will allow us to collect and analyze data for everychild in the U.S. regarding health, disease, wellness and development - from birth to age 21. Thisunprecedented initiative has the potential to improve health services research and the practice ofpediatrics and help millions of children and families.

�

Our Digital Transformation Initiative is improving the way members navigate and access informationon AAP.org and ensuring the information you access on our digital platforms is the best and latestavailable.

�

We have expanded our commitment to health equity by establishing a task force to address bias anddiscrimination. Joseph L. Wright, M.D., M.P.H., FAAP, is overseeing six work groups that will preparepediatricians to help families identify, manage and prevent adverse physical and emotional outcomeswhile promoting health equity.

�

In a related effort, our Task Force on Diversity and Inclusion delivered its final report which ensuresthat allof our AAP members will feel welcome and that our leadership reflects the strength anddiversity of our membership.

�

To pursue our strategic priority of Physician Health and Wellness, we are partnering with other medicalprofessional groups through the National Academy of Medicine to identify elements of our workenvironments, learning environments and general culture of medicine that adversely affect clinicianwellness and well-being. We are developing the Women's Wellness through Equity and Leadershipprogram to equip female physicians of all ages with the skills they need to take leadership roles in theirhospitals, health plans or health systems.

�

We successfully advocated to get key federal child health priorities, including the Children's HealthInsurance Program; Maternal, Infant, and Early Childhood Home Visiting Program; and the FamilyFirst Prevention Services Act, funded through the Bipartisan Budget Act of 2018.

�

We announced our Gun Safety and Injury Prevention Research Initiative that will define and fundresearch to evaluate and implement effective interventions in clinics and communities to protect thehealth - and lives - of children.

�

We are taking on child health threats like the national opioid epidemic, electronic nicotine deliverysystems and marijuana among youths and young adults. We expose the dangers and lend the voice ofscience and reason to a national debate that will have lasting impact on the health and life trajectory ofAmerica's children.

�

Many organizations talk about changing the world, but few have the talent, resources and expertise to make it

American Academy of Pediatrics Reaffirms Care Coordination Policy Statement and Offers Implementation Resource for Pediatric Clinicians

The American Academy of Pediatrics (AAP) recently reaffirmed its policy statement on care coordination. For pediatric clinicians, care coordination is an important component of the medical home model and has been shown to improve family and provider satisfaction, facilitate a child’s access to services, and improve health care outcomes. The Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems (AAP Policy Statement) has laid the foundation for various care coordination tools and resources developed collaboratively by the National Center for Care Coordination

Technical Assistance (NCCCTA) and the National Center for Medical Home Implementation. These free resources include:• Pediatric Care Coordination Curriculum

which demonstrates the principles, key concepts and activities that are necessary to successfully provide care coordination to patients and families

• Care coordination Webinar Series that showcase real-world experiences from diverse health care providers with the common goal of capturing the value of care coordination using the Care Coordination Measurement Tool and Adaptation and Implementation Guide

• Promising Practices that demonstrate the practical application of care coordination to enhance the care provided to patients/families.

These tools and resources are available in the public domain to assist clinicians and other practice staff with care coordination activities. Additional care coordination tools and resources can be found on the NCCCTA Web site. For technical assistance and support, contact [email protected].

The Health Resources and Services Ad-ministration (HRSA) announces that data from the 2017 National Survey of Children’s Health (NSCH) is now available. A brief overview of the 2017 NSCH, and new estimates of key child health indicators, are found in the NSCH Fact Sheet.

This voluntary survey, funded and directed by HRSA’s Maternal and Child Health Bureau (MCHB), provides annual national-

and state-level estimates of key measures of children’s health and well-being. Anyone can access the data free of charge. HRSA MCHB works with the U.S. Census Bureau to conduct the survey, oversee sampling, and produce a final data set for public use.

For more information about the National Survey of Children’s Health, please visit https://mchb.hrsa.gov/data/national-surveys.

2017 National Survey of Children’s Health Data Release

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News Articles, Focus on Subspecialties, Ophthalmology

Are old wives' tales regarding myopia true?by Kanwal Nischal M.D., FAAP

"Don't read too much. It will hurt your eyes."

"You need to get outdoors to be healthy."

"Don't wear glasses too young. It will weaken your eyes."

Are these old wives' tales true?

Myopia is the most common eye disorder in the world, and it has become more common over the last several decades. Research shows the prevalence of near-sightedness among Americans ages 12-54 increased from 25% in 1971-1972 to about 42% in 1999-2004 (Vitale S, et al. Arch Ophthalmol.2009;127:1632-1639).

Increasing rates of myopia not only pose an economic burden but they also increase the risks of myopic maculopathy (damage to the central seeing part of the retina), retinal detachment, glaucoma, cataracts and visual impairment.

As a result, myopia is one of the five immediate priorities in Vision 2020: The Right to Sight, a joint initiative of the World Health Organization and the International Agency for the Prevention of Blindness.

Why is myopia increasing?

Emmetropization is an active mechanism that controls eye growth in the first two decades of life. Disruption of this control process can cause excessive axial length elongation of the eyeball, leading to myopia.

While a component of myopia development in childhood may be genetic, evidence suggest that the environmental influence may be more prevalent.

In a recent systematic review and meta-analysis, Huang H-M, et al. looked at 11 cohort studies with 10,384 participants and concluded that near work was associated with increased risk of myopia (PLoS One. 2015;10:e0140419).

Factoring in different definitions of near work and different near work activities from all the studies evaluated, the authors concluded that the odds of myopia increased by 2% for every one diopter-hour of near work per week.

In addition, recent epidemiological studies have shown that outdoor time and/or sunlight exposure are protective against myopia development. In both Singaporean and Australian children, total time spent outdoors was associated with less myopia, independent of indoor activity, reading and engagement in sports (Dirani M, et al. Br J Ophthalmol. 2009;93:997-1000; Rose KA, et al. Ophthalmology. 2008;115:1279-1285).

Groundbreaking work has shown that the traditional concave lenses used to correct myopia may in fact promote axial elongation. While the central retina has light correctly focused on it, the periphery of the concave lenses actually causes light to be focused behind the peripheral retina (peripheral hyperopic blur). In the growing eye, it is the peripheral retina that drives axial elongation, and the hyperopic blur makes the eyeball grow so as to "catch the focus of the light" on the peripheral retina.

What's the solution?

Strategies can be used to at least retard myopia progression if not arrest it.Continued on page 10


News Articles, Focus on Subspecialties, OphthalmologySimple measures of not reading in dim light and getting at least two hours of sunlight (even if it is by sitting by awindow) appear to have a protective effect against myopia progression.

The challenge is how to reduce near work when academic achievement influences children's lives so heavily.One approach would be to reduce the intensity of near work. For example, instead of reading for 60 minutescontinuously, read for a shorter period of time and take more breaks.

New lenses that are concave centrally and convex peripherally have been developed. Some studies haveshown a reduction in progression of myopia using theses lenses especially in 6- to 12-years-olds.

Evidence also suggests that orthokeratology, the practice of using hard contact lenses overnight, is effective inretarding myopic progression. While reports of corneal ulcers causing vision impairment have deterred their use,newer materials and products appear to have a better safety record and are popular in the U.S.

Perhaps the most promising development has been from Singapore where studies have shown that daily use ofatropine 0.01% eye drops appears to be effective in retarding juvenile myopic progression. While these studieswere done in Asian populations, studies in other populations appear to confirm the efficacy of this treatment in amajority of children. However, the drops may need to be used for several years.

While recent research indicates that the three old wives' tales appear to be true, it also shows that steps can betaken to slow down or stop the progression of myopia.

Dr. Nischal is a member of the AAP Section on Ophthalmology Executive Committee.

Re-Printed with permission from AAP News; Original Publication: May 2018

Saturday, November 3, 20183:00 PM - 3:45 PMF1103 Learning Disabilities: What Pediatricians Need to Know (Presented by Sheryl Handler, a Pediatric Ophthalmologist; Covers Dyslexia and Visual Functions Necessary to Read)Location: W311EF, Orange County Convention Center

Sunday, November 4, 20188:30 AM - 10:00 AMW2045 Eye Examination Skills: Using the Ophthalmoscope (Repeats as W2104)Location: W308AB, Orange County Convention Center

2:00 PM - 3:30 PMA2094 Pediatric Ocular Emergencies You Can’t Afford to Miss (Repeats as A3033)Location: W311AB, Orange County Convention Center

2:00 PM - 3:30 PMW2104 Eye Examination Skills: Using the Ophthalmoscope (Repeats from W2045)Location: W308AB, Orange County Convention Center

Monday, November 5, 20188:30 AM - 10:00 AMA3033 Pediatric Ocular Emergencies You Can’t Afford to Miss (Repeats from A2094)Location: W312BC, Orange County Convention Center

Share with Your Referring Pediatricians!Ophthalmology Sessions @ the NCE


Encouraging Professionalism in MedicineEllen M. Friedman, MD, FAAP

Professor of Otolaryngology and Director for the Center for Professionalism in Medicine at Baylor College of Medicine/Texas Children’s Hospital

Email: [email protected]

Subspecialization in medicine and technologies continue to evolve, resulting in an increase in physicians’ interdependence on one another. It is impossible currently to be up to date on all aspects of medicine and surgery. This is not a new problem. In fact, Dr. William J. Mayo noted in a commencement speech he gave at Rush College in 1910, “As we grow in learning, we more justly appreciate our dependence upon each other. The sum-total of medical knowledge is now so great and wide spreading that it would be futile for one man to attempt to acquire, or for one man to assume that he has, even a good working knowledge of any large part of the whole. The very necessities of the case are driving practitioners into cooperation. The best interest of the patient is the only interest to be considered, and in order that the sick may benefit of advancing knowledge, union of forces is necessary.”

While this quotation demonstrates that the importance of collaboration among physicians is not new, many new challenges in the professional environment have emerged complicating our professional life. These distractions include productivity requirements, decreased reimbursements, increased bureaucracy, and the electronic medical record. The increasing commercialization of medicine has created many struggles that can cause physicians to become less engaged, cynical or even demoralized. At times, physicians can feel alone in the pursuit of excellence, at times victimized by the system. The breakdown of morale of the medical staff has many ramifications, including the widely publicized epidemic of burnout. These feelings can create a negative work environment with mounting territorialism and excessive competitive feelings.

At Baylor College of Medicine, a small hedge against this epidemic is the Power of Professionalism Award (POP Award). The POP Award can be given to anyone who demonstrates the finest qualities of professionalism. The award was created to show appreciation of positive professional behavior, such as compassion, integrity, honesty and humility, inspire peers to emulate these behaviors and demonstrate an institutional culture that values these positive behaviors. A recent nomination came in that was thought provoking. It was submitted by a medical student who wanted to honor a urologist she had observed respond with kindness when a gynecologist called from the OR to ask for help managing an intraoperative complication. The medical student was impressed that

the urologist immediately agreed to come in without judgement, without any smack talking or eye rolling. For me, the significance of this nomination wasn’t that a urologist responded to a colleague in need with generosity of spirit, but that this generosity appeared highly unusual to the medical student. Apparently, the medical student had seen repeated incivilities among a variety of specialists during her rotations. So have I.

Incivilities in the health care system flow in many directions, between primary care physicians and specialists, between surgeons and internal medicine physicians, between emergency room physicians and inpatient consultants. Poor behavior can be manifest in many ways such as becoming impatient, easily annoyed, argumentative or dismissive. Common courtesy among colleagues has become less common. In fact, surveys in medical schools indicate that a large majority of medical students throughout the country acknowledge that they have witnessed faculty bad mouthing other physicians and other institutions. The impact of witnessing this behavior on medical students is interesting and concerning, but equally or more important is that these conflicts threaten respectful communication and that damages patient safety as well as physicians’ sense of satisfaction in their careers.

Physician-to-physician conflicts impact patient safety by limiting cooperation and communication among care team members. A study by the Institute of Medicine points to poor communication and deficient teamwork as common causes of adverse patient outcomes, even more common than lack of knowledge or clinical skills. Poor communication results in medical and surgical errors as well as poor patient compliance with recommended treatments. Conversely, the benefits of improved teamworkexceed purely patient-centered benefits; it also createsa more satisfying and pleasant work environment forphysicians, which, in turn, helps to combat burnout. In other words, improved communication and teamwork is not purely altruistic, you will also personally benefit by working in a more civil and enjoyable setting. Of course, I applaud kindness to patients, however, kindness to colleagues is also very important, yet is infrequently discussed.

Although as physicians we may feel powerless to reverse many of the negative aspects of the march toward the

commercialization of medicine, we can personally address

Continued on page 12


Page 12 Section on Urology • Spring 2018

The Annual AAP Legislative Conference was held in Washington, DC, from April 8 – 10, 2018. Three hundred and fifty general pediatricians, pediatric subspecialists, advanced practice providers, residents, and fellows attended two days of informational sessions and training before taking to Capitol Hill to meet with lawmakers. Along with me, pediatric urology was represented by Dr. Richard Sutherland of North Carolina and Dr. Audrey Rhee of Cleveland.

The first day introduced attendees to the basic “ ins and outs” of advocacy, delineating the current issues challenging our nation’s children, prioritizing the AAP’s message to lawmakers on the third day, and providing coaching on how to craft a message, build a coalition, and effect change through advocacy. Current topics include access to primary and subspecialty care (particularly for children with special healthcare needs), the opioid epidemic and its impact on children, advocacy for immigrant children, child nutrition, and global and local social determinants of health. The second day involved a mock “re-election” campaign where attendees learned to juggle the many demands on lawmakers’ time and attention, and an afternoon workshop to practice meeting

with elected officials.

On Tuesday, it was off to Capitol Hill! This year, the AAP asked those of us at the Legislative Conference to focus on firearm violence and its public health impact. In the United States, 74 children per day are either killed or injured by a firearm; the AAP is asking legislators to direct $50 million to the Centers for Disease Control in the next fiscal year for research into the public health aspects of firearm safety, as well as to raise the age for firearm purchases to 21 years old and to ban semiautomatic assault weapons. As such, this was our primary message; however, legislators with whom we had more time were also receptive to hearing about challenges specific to pediatric urology, in particular access to subspecialty care, insurance challenges, and proposed legislation in several states to make genital surgery illegal below the age of consent. Nonetheless, staying “on message” with the AAP’s “big asks” enabled us as pediatric urologists to connect with our senators and representatives, underscore our commitment to child safety and public health, and promote the involvement of specialists in advocacy.

Encouraging Professionalism in Medicine

our own ability to communicate respectfully to one another. This will improve our connection and engagement to our colleagues and our patients. How to begin?

• Make the decision to be the first to pursue a gentler,kinder approach to your colleagues.

• Renew your empathy by believing that everyone comesto work to do a good job because, in the vast majority of cases, that is true.

• When you encounter an individual with whom youhave conflicts, remember that all of the unpleasantfactors that are challenging and frustrating you are alsochallenging him or her. In fact, your colleague evencould have additional undisclosed distressing personalissues.

• Recall that while you are dealing with well-intentionededucated colleagues with different training, differentexpertise and different points of view, you also have ashared desire to help the patient.

• Remember that your words are powerful and that ineach verbal or digital interchange, you can choose to use that opportunity to be respectful, kind and encouraging instead of confrontational, condescending or negative.

If you make a daily effort to extend empathy to your colleagues, it is highly likely that your positive approach will be contagious. The benefits will be felt and appreciated by your patients, your team members and you. You could be the beginning of a mini–cultural revolution! Let’s call for a truce on physician-to-physician conflicts and focus our energy to improve respectful communication. This cease-fire will strengthen our professional identity and provide us with greater job satisfaction and the resilience necessary to combat burnout during these challenging times while simultaneously benefiting patient safety.

Advocacy Report

Annual AAP Legislative ConferenceKathleen Kieran, MD, FAAP

Chair, AAP Advocacy/Health Policy CommitteeSeattle Children’s Hospital/University of Washington

Email: [email protected]

Continued on Page 13

Reprinted with permission from the Spring 2018 edition of the AAP Section on Urology newsletter

The American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians Release Updated Clinical Report on Health Care Transitions for Youth and Young Adults

The National Survey for Children’s Health reveals that only 15% of youth with and without special health care needs receive transition planning assistance from their health care providers. To address this gap, the American Academy of Family Physicians and American College of Physicians join AAP in calling on clinicians to establish a structured process to ensure a planned transition from pediatric to adult health care as part of routine care for adolescents and young adults. The new clinical report, “Supporting the Health Care Transition from Adolescence to Adulthood in the Medical Home,” provides new practice-based quality improvement guidance on key elements of transition: planning, transfer, and integration into adult care. This report, an update of the 2011 Clinical Report on Transition, will be published in the November 2018 issue of Pediatrics (published online Oct. 22).

“This new 2018 Clinical Report is an exciting extension of the thoughtful work of the AAP, AAFP, and ACP to offer practical assistance to their members regarding needed transition services for adolescent and young patients. It also identifies where further work is needed in the transition field,” said Dr. Patience White, lead author of the report.

The 2018 report describes an evidence-informed, structured health care transition process called the Six Core Elements of Health Care Transition, developed by Got Transition, that guides clinicians in the development of transition services and have been shown to improve health care transition processes in primary care, subspecialty care, school-based health clinics and Medicaid managed care. The Six Core Elements process clarifies the roles of pediatric, family medicine, med-peds, and internal medicine clinicians in the transition process. Practical tools are provided and designed to be customized by the practice according to the needs of their patients and the resources available. In addition, the report summarizes the status of transition preparation among US youth, common transition barriers and preferences experienced by youth and families as well as pediatric and adult clinicians, outcome evidence, and recommendations for infrastructure, education and training, payment, and research. The transition from pediatric to adult health care is especially important for youth and young adults with special needs or chronic conditions, according to the report. Research has shown that

without a structured transition process, youth and young adults are more likely to have problems with medical complications, limitations in health and wellbeing, difficulties with treatment and medication adherence, discontinuity of care, preventable emergency department and hospital use, and higher costs of care. This 2018 clinical report addresses the needs of special populations, including those with medical complexity, intellectual and developmental disabilities, behavioral health conditions, and social complexity. “When health care clinicians working in pediatric and adult care settings communicate with each other during the transfer of care and share records with each other and with youth and young adults, it assists the receiving clinician to offer better continuity of care,” said M. Carol Greenlee, MD, FACP, Chair, Council of Subspecialty Societies, the American College of Physicians, also an author on the paper. “Having the adult care clinician know something about them and their medical issues at that initial encounter helps the young adult feel more comfortable with their new clinician.”


Rebecca AdamsSamuel AndorskySteven ArcherRaymond AreauxRobert ArnoldKyle ArnoldiSteven AwnerDarron BacalMichael BartissJane BatemanCasey BealCynthia BeauchampNancy BenegasJay BernsteinAmit BhattGlen BianchiGil BinenbaumJohn BishopLouis BlumenfeldDean BonsallGeoffrey BradfordTara BraggDon BremerKatherine BritoEdward G BuckleyAngela BuffennMiles BurkeCybil CassadyRobison ChanEdward CheesemanLiyuan ChenMichael ChiangAlex ChristoffCindy ClineDavid CoatsJeffrey ColburnKim CooperDeborah CostakosSusan CulicanAlejandra de Alba CampomanesMonte Del MonteJoseph DemerPatrick DeRespinisJohn DeVaroMary DeYoung-SmithClare DiasAngela DillonEniolami DosunmuPatrick J Droste

Paula EdelmanNaomi EllenhornW. EngelRobert EnzenauerK. David EpleyChristopher FecarottaWalter FiersonDouglas FredrickBruce FurrMarlo GalliStephen GlaserRobert GoldTodd GoldblumRichard GoldenRichard GolubDavid GranetMichael GrayDaniel GreningerRobert GrossAshima GuptaTara GuretzkyCarl GutermanLaurie Hahn-ParrottSheryl HandlerLarisa HeiserHoney HerceRobert HeredRichard HertleJohn HinrichsenRobert O. HoffmanDavid HunterJeffrey HunterMohamed HusseinMohamad JaafarJorie JacksonJing JinAnthony JohnsonDaniel KarrMary KelinskeRoss KennedyNatalie KerrMarshall P KeysLeila KhazaeniMichael A. KippShelley KleinDeborah KlimekSylvia KodsiStacey KrugerAnnie KuoJulie Lange

Sharon S LehmanDeborah LenahanThomas LenartAlejandro LeonAndrew LevadaAlex LevinEric LichtensteinSteven LichtensteinStephen LipskyMichael LopezJennifer LuckGregg T LuederSarah MacKinnonLinn ManganoJason MantagosGary MarkowitzMaury MarmorStephen A. MathiasMary Lou McGregorNorman MedowKevin J. MickeyAaron MillerJoseph MillerMarijean MillerHelen Mintz-HittnerEmily MiyazakiDorothy MooreChristie MorseSarah MurrayKanwal NischalJulie NishimuraGregory OstrowAnthony PanarelliKatie PattersonMaria PattersonEvelyn PaysseCaryn PearlsteinDavid PetersenRobert PetersenSusan PharisLaura PlummerWilliam PotterSasapin PrakalapakornAnn RanelleKristiane RansbargerDorothy ReynoldsLeah ReznickRobert RheeJohn Denis RoartyShira Robbins

David RogersGary L. RogersJay RosinLeemor RotbergAdam RovitJames RubenSteven RubinDenise SatterfieldDonald SauberanSusan SchloffBruce SchnallVeeral ShahMarla ShainbergKaren ShimshakMelissa ShipleyR. Michael SiatkowskiLance SiegelDavid SilbertSujata SinghJanine Smith-MarshallRobert SpectorMichael SpedickDavid StagerAnn StoutDonny SuhRonald TeedDonald TingleyJohn TongDimitra TriantafilouSebastian TroiaIrene TungLawrence TychsenVivian TzanetakosVirginia UtzJean VaheyGonzalo VicenteBarry WassermanAmy WexlerSarah WhangDavid WheelerJanette WhiteSarah WhitecrossRobert WigginsR WinkleKimberly YenSylvia YooHawke YoonWilliam YoungElaine ZiavrasJocelyn Zurevinsky

Thank You to All Of Our Current Members for Your Support


Attending the AAO Annual Meeting in Chicago October 27-30?Wish you had a Quick Reference Guide for All Events

Focused on Pediatric Ophthalmology?

As the AAP Section on Ophthalmology, we figured we’d help you out. What follows is a listing of all pediatric-focused events at the upcoming AAO meeting,

including the schedule for the Pediatric Subspecialty Day meeting, which will take place on Saturday, October 27, and the schedule for the American Association of

Certified Orthoptists (AACO) educational program.

Section 1 (Pages 15-20) Subspecialty Day - Pediatric Ophthalmology and Strabismus:

Winds of Change in the Windy City

Section 2 (Pages 21-24) AAO 2018 Annual Meeting Scientific Schedule

Pediatric Ophthalmology and Strabismus Educational Sessions

Section 3 (Pages 25-31) AACO Educational Program


Pediatric Ophthalmology Subspecialty Day Schedule

In conjunction with the American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Pediatrics

Winds of Change in the Windy CitySaturday, Oct. 27, 2018McCormick Place, Chicago, IL

7:00AM

Continental Breakfast

8:00AM

Welcome and Introductions Jonathan M. Holmes, MDScott A. Larson, MD

Section I: Weathering the Storm: Surgical Approaches to Vertical StrabismusModerator: Jonathan M. Holmes, MDPanelists: Sonal R. Farzavandi, FRCS; Jon Peiter Saunte, MD; Rosario Gomez De Liano, MD; Stacy L. Pineles, MD

8:01 AM

Introduction Jonathan M. Holmes, MD

8:06AM

Drizzle or Downpour? Medium Angle Hypertropia Jonathan M. Holmes, MD

8:11AM

Inferior Oblique Recession Alone Sonal R. Farzavandi, FRCS

8:16AM

Adding a Short-Tag Adjustable Inferior Rectus Recession Jon Peiter Saunte, MD

Pediatric Ophthalmology Subspecialty Day Schedule

In conjunction with the American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Pediatrics

Winds of Change in the Windy CitySaturday, Oct. 27, 2018McCormick Place, Chicago, IL

7:00AM

Continental Breakfast

8:00AM

Welcome and Introductions Jonathan M. Holmes, MDScott A. Larson, MD

Section I: Weathering the Storm: Surgical Approaches to Vertical StrabismusModerator: Jonathan M. Holmes, MDPanelists: Sonal R. Farzavandi, FRCS; Jon Peiter Saunte, MD; Rosario Gomez De Liano, MD; Stacy L. Pineles, MD

8:01 AM

Introduction Jonathan M. Holmes, MD

8:06AM

Drizzle or Downpour? Medium Angle Hypertropia Jonathan M. Holmes, MD

8:11AM

Inferior Oblique Recession Alone Sonal R. Farzavandi, FRCS

8:16AM

Adding a Short-Tag Adjustable Inferior Rectus Recession Jon Peiter Saunte, MD


8:21AM

Panel Discussion

8:26AM

Low Pressure? Small-Angle Graves Hypotropia Jonathan M. Holmes, MD

8:31AM

Topical Inferior Rectus Recession Rosario Gomez De Liano, MD

8:36AM

Topical Marginal Tenotomy Stacy L. Pineles, MD

8:41AM

Panel Discussion

8:46AM

High Pressure? Small-Angle Hypertropia with Excyclotropia Jonathan M. Holmes, MD

8:51AM

Superior Rectus Recession with Transposition Rosario Gomez De Liano, MD

8:56AM

Leave That Superior Rectus Alone Sonal R. Farzavandi, FRCS

9:01AM

Panel Discussion

9:06AM

Twisting in the Wind: Residual Excylotropia after Harada-Ito Jonathan M. Holmes, MD

9:11AM

Repeat Harada-Ito Jon Peiter Saunte, MD

9:16AM

Inferior Rectus Recessions Stacy L. Pineles, MD

9:21AM

Panel Discussion

9:26AM

Wrap-Up Jonathan M. Holmes, MD

Section II: Sudden Showers—Late Breaking RCTs and Observational StudiesModerator: Scott A. Larson, MD

9:31AM

Introduction Scott A. Larson, MD

9:32AM

Glasses for Hyperopia Donny Won Suh, MD


9:46AM

Low-Dose Avastin for ROP Sharon F. Freedman, MD

10:00AM

Natural History of Intermittent Exotropia Christie L. Morse, MD

10:14AM

Binocular Treatment for Amblyopia Lisa C. Verderber, MD

10:28AM

Wrap-Up Scott A. Larson, MD

10:29AM

REFRESHMENT BREAK and AAO 2018 EXHIBITS

Section III: Raining Cats and Dogs—Challenges of Applying Evidence-Based MedicineModerator: Michael F. Chiang, MD

10:59AM

Introduction: What Is an Evidence-Based Practice? Michael F. Chiang, MD

11:04AM

Evidence: Two vs. 6 Hours of Patching for Amblyopia Michael X. Repka, MD, MBA

11:09AM

Amblyopia in the Real World Edward L. Raab, MD

11:14AM

Rebuttal Michael X. Repka, MD, MBA

11:16AM

Rebuttal Edward L. Raab, MD

11:18AM

Evidence: Treating ROP Based on ETROP Guidelines William V. Good, MD

11:23AM

ROP in the Real World R. V. Paul Chan, MD

11:28AM

Rebuttal William V. Good, MD

11:30AM

Rebuttal R. V. Paul Chan, MD

11:32AM

Evidence: Treating Intermittent Exotropia Based on PEDIG and UK Studies

David K. Wallace, MD, MPH


11:37AM

Intermittent Exotropia in the Real World Burton J. Kushner, MD

11:42AM

Rebuttal David K. Wallace, MD, MPH

11:44AM

Rebuttal Burton J. Kushner, MD

11:46AM

Conclusions: Value-Based Models and Outcome Measures Michael F. Chiang, MD

11:53AM

LUNCH and AAO 2018 EXHIBITS

Section IV: Ice Breaker—What Our Adult Specialty Colleagues Can Teach UsModerator: Tammy L. Yanovitch, MD

12:53PM

Introduction Tammy L. Yanovitch, MD

12:54PM

Cataract-Partly Cloudy Thomas A. Oetting, MD

1:04PM

Oculoplastics-Orbiting the Eye of the Storm Julie A. Woodward, MD

1:14PM

Retina- Lightning Strikes Michael M. Altaweel, MD

1:24PM

NeuroOphth-A Head in the Clouds Andrew G. Lee, MD

1:34PM

Glaucoma-A High Pressure System Steven J. Gedde, MD

1:44PM

Cornea-The Tip of the Iceberg Christina R. Prescott, MD

1:54PM

Wrap-Up Tammy L. Yanovitch, MD

Section V: Here Comes the Sun: Myopia PreventionModerator: Nils K. Mungan, MD

1:55PM

Advocating for Profession and Patients Kenneth P. Cheng, MD


2:00PM

Introduction Nils K. Mungan, MD

2:01PM

The Myopia Epidemic Terri L. Young, MD, MBA

2:06PM

Atropine for Myopia Donald Tan, MD, FRCS, FRCOphth

2:14PM

Contact Lens Therapies for Myopia Control Bruce H. Koffler, MD

2:22PM

Other Therapies for Myopia Prevention Daniel Ian Flitcroft, MD

2:30PM

Wrap-Up Nils K. Mungan, MD

2:31PM


Section VI: London Fog: What am I Doing Differently in Pediatric Anterior SegmentModerator: Erick D. Bothun, MD

3:01PM

Introduction Erick D. Bothun, MD

3:03PM

Newer Intraocular Instruments and IOLs M. Edward Wilson, Jr., MD

3:13PM

Genetics of Pediatric Cataracts Ian Christopher Lloyd, MBBS

3:24PM

Mainstreaming Corneal Crosslinking Erin D. Stahl, MD

3:35PM

Topical Treatment for the Toughest Cornea Ulcer Michael C. Struck, MD

3:46PM

Use of IOL Optic Capture Erick D. Bothun, MD

3:57PM

Wrap-Up Erick D. Bothun, MD

Section VII: Electrical Storm—Imaging in Pediatric OphthalmologyModerator: Serena X. Wang, MD

11:37AM

Intermittent Exotropia in the Real World Burton J. Kushner, MD

11:42AM

Rebuttal David K. Wallace, MD, MPH

11:44AM

Rebuttal Burton J. Kushner, MD

11:46AM

Conclusions: Value-Based Models and Outcome Measures Michael F. Chiang, MD

11:53AM

LUNCH and AAO 2018 EXHIBITS

Section IV: Ice Breaker—What Our Adult Specialty Colleagues Can Teach UsModerator: Tammy L. Yanovitch, MD

12:53PM

Introduction Tammy L. Yanovitch, MD

12:54PM

Cataract-Partly Cloudy Thomas A. Oetting, MD

1:04PM

Oculoplastics-Orbiting the Eye of the Storm Julie A. Woodward, MD

1:14PM

Retina- Lightning Strikes Michael M. Altaweel, MD

1:24PM

NeuroOphth-A Head in the Clouds Andrew G. Lee, MD

1:34PM

Glaucoma-A High Pressure System Steven J. Gedde, MD

1:44PM

Cornea-The Tip of the Iceberg Christina R. Prescott, MD

1:54PM

Wrap-Up Tammy L. Yanovitch, MD

Section V: Here Comes the Sun: Myopia PreventionModerator: Nils K. Mungan, MD

1:55PM

Advocating for Profession and Patients Kenneth P. Cheng, MD


3:58PM

Introduction Serena X. Wang, MD

3:59PM

Corneal Topography in Children Luca Buzzonetti, MD

4:10PM

Anterior Segment OCT: Corneal/Intraocular Surgery Kanwal K. Nischal, MBBS

4:21PM

Anterior Segment OCT: Glaucoma and Other Indications Yasmin Bradfield, MD

4:32PM

Retinal Fluorescein Angiography in Pediatric Uveitis Jennifer Hsu Lee Jen Cao, MD

4:43PM

In-Office Handheld ERG in Pediatric Patients Melanie A. Schmitt, MD

4:54PM

Wrap-Up Serena X. Wang, MD

4:55PM

CLOSING REMARKS and ADJOURN Jonathan M. Holmes, MDScott A. Larson, MD

2:00PM

Introduction Nils K. Mungan, MD

2:01PM

The Myopia Epidemic Terri L. Young, MD, MBA

2:06PM

Atropine for Myopia Donald Tan, MD, FRCS, FRCOphth

2:14PM

Contact Lens Therapies for Myopia Control Bruce H. Koffler, MD

2:22PM

Other Therapies for Myopia Prevention Daniel Ian Flitcroft, MD

2:30PM

Wrap-Up Nils K. Mungan, MD

2:31PM


Section VI: London Fog: What am I Doing Differently in Pediatric Anterior SegmentModerator: Erick D. Bothun, MD

3:01PM

Introduction Erick D. Bothun, MD

3:03PM

Newer Intraocular Instruments and IOLs M. Edward Wilson, Jr., MD

3:13PM

Genetics of Pediatric Cataracts Ian Christopher Lloyd, MBBS

3:24PM

Mainstreaming Corneal Crosslinking Erin D. Stahl, MD

3:35PM

Topical Treatment for the Toughest Cornea Ulcer Michael C. Struck, MD

3:46PM

Use of IOL Optic Capture Erick D. Bothun, MD

3:57PM

Wrap-Up Erick D. Bothun, MD

Section VII: Electrical Storm—Imaging in Pediatric OphthalmologyModerator: Serena X. Wang, MD


Day/Time Session Session Type Session Title Location Faculty

Saturday, Oct 27, 20189:00 AM to 1:00 PM V28 Video A New Technique for Plication HALL A Pradeep Sharma MD9:00 AM to 1:00 PM V29 Video Pointers for Performing Successful

Trabeculotomy: Tips for Beginners HALL A Rashmi Krishnamurthy

9:00 AM to 1:00 PM V30 Video Surgical Approach to PFV HALL A Sudarshan K Khokhar, MD, FRCS(ED)

Sunday, Oct 28, 20187:30 AM to 8:30 AM B114 Breakfast

with ExpertsCataract Surgery and IOL Implantation in Children

HALL A M Edward Wilson Jr MD

7:30 AM to 8:30 AM B115 Breakfast with Experts

Treating Difficult Cases in Amblyopia for the Comprehensive Ophthalmologist

HALL A Patrick J Droste MS,MD

8:00 AM to 10:00 AM LAB105 Lab Adjustable Sutures for Strabismus Surgery N230 S. Grace Prakalapakorn, MD, MPH

10:15 AM to 12:30 PM 211 Instruction Course

What’s New and Important in Pediatric Ophthalmology and Strabismus for 2018

S504ABC Darron A Bacal MD

11:30 AM to 12:30 PM LEC125 Skills New Techniques for Strabismus Surgery S101AB Yi Ning Strube MS, MD, FRCSC

12:45 PM to 1:45 PM PO175 Scientific Poster

Changes in Choroidal Blood Flow and Thickness After Treatment in Patients With Anisohypermetropic Amblyopia

HALL A Ryuya Hashimoto, MD


The Increasing Concern of Cataract Caused by Intravitreal VEGF Injection in ROP Eyes of Preterm Infants

HALL A Murugesan Vanathi, MD


Safety of Intracameral Moxifloxacin in Pediatric Lens Surgery: An Equivalence Study

HALL A Sina Khalili, MD


Outcomes of Unilateral Cataracts in Infants and Toddlers Age 7 to 24 Months Operated on During the Infant Aphakia Treatment Study

HALL A Erick D Bothun MD


Precision Medicine Through Next-Generation Sequencing in Inherited Eye Diseases

HALL A Hye Won Park, MD


Determinants of Visual Outcome in Human Foveal Hypoplasia

HALL A Keyla D Bordonada, BS


Pediatric Corneal Topography: Feasibility and Findings in Three Pediatric Risk Groups

HALL A Rebecca Freedman Neustein, MD


Digital Teller Acuity in Children Using Eyetracking

HALL A Pradeep Sharma MD


Surgical Loupe Customization to Improve Ergonomics Among Ocular Surgeons

HALL A Safeer Farrukh Siddicky, PHD

AAO 2018 Annual Meeting Scientific Schedule Pediatric Ophthalmology and Strabismus Educational Sessions Note: Because this information was pulled from the AAO website and is subject to change, the SOOp is not responsible for any published information that is inaccurate


Day/Time Session Session Type Session Title Location Faculty


Fluorescein Angiography Findings Following Intravitreal Bevacizumab for ROP: Can It Predict the Late-Onset Risk of Recurrence?

HALL A Andres Gonzalez, MD


Quantitative Measurement of Horizontal Strabismus With Digital Photography

HALL A Eren Cerman, MD


Resection vs. Plication for the Management of Exotropia

HALL A Phoebe D Lenhart MD


Management of Near Work–Induced Divergent Insufficiency Esotropia

HALL A Wang Jianan


Intramuscular Nerve Distribution in the Medial Rectus Muscle and Its Clinical Implications

HALL A Hyun Jin Shin, MD

2:00 PM to 3:00 PM 228 Instruction Course

New Approaches to the Prevention and Treatment of Myopia—Update 2018

S102D Andrzej Grzybowski MD

2:00 PM to 3:00 PM PT04 Poster Theater

Poster Theater: Pediatric Ophthalmology, Strabismus

HALL A Kara M Cavuoto MD

3:15 PM to 5:30 PM 262 Instruction Course

Surgical Management of Pediatric Glaucoma S501ABC Alana L Grajewski MD

3:30 PM to 5:30 PM LA-B125A

Lab New Techniques for Strabismus Surgery N230 Yi Ning Strube MS, MD, FRCSC

3:45 PM to 5:15 PM SYM23 Symposium Don’t Miss This! Red Flags in the Pediatric Eye Examination

E350 Stephen P Christiansen MD

Monday, October 297:30 AM to 8:30 AM B143 Breakfast

with ExpertsLasers / Anti-VEGF/ Fluorescein Angiography Use in the Treatment of ROP

HALL A Swati Agarwal MD

7:30 AM to 8:30 AM B144 Breakfast with Experts

How to Be a Good Expert Witness HALL A Edward L Raab MD

9:00 AM to 10:00 AM 414 Instruction Course

Killer Pediatric Eye Disease: How to Avoid a Fatal Flaw

S504ABC Laura B Enyedi MD

10:15 AM to 12:00 PM OP06 Original Paper

Pediatric Ophthalmology, Strabismus Original Papers and Best of AAPOS

S405 Hilda Capo MD

10:15 AM to 10:22 AM PA041 Scientific Poster

Assessment of Pediatric Foveal Vasculature Using Optical Coherence Tomography Angiography

S405 Stephanie Tammy Hsu, BA

10:27 AM to 10:34 AM PA042 Paper Identifying Signaling Pathways Underlying Different Types of Pediatric Cataracts

S405 Jyoti Matalia, MBBS

10:39 AM to 10:46 AM PA043 Paper Surgical Outcomes of Ab Externo Illuminated Microcatheter Circumferential Trabeculotomy as a Secondary Procedure in PCG

S405 Ibrahim A Aljadaan, MD

10:51