At the Crossings: Pediatric Ophthalmology and Strabismus

On February 14th-16th, 2003, the New Orleans Academy of Ophthalmology (NOAO) hosted its 52nd Annual Symposium, featuring Pediatric Ophthalmology and Strabismus. Once again, the NOAO was able to attract the most innovative and respected authorities in their field. Unique to this meeting, however, was the appearance of three of the legends of Pediatric Ophthalmology and Strabismus who have significantly contributed to the success of past NOAO Symposia. Marshall M. Parks, Arthur Jampolsky, and Gunter von Noorden returned once again to this year’s meeting. Watching both present and past luminaries discuss and debate important topics was truly special. Additionally, we widened the scope of subjects to include plastics, cataracts, and orbital disease as they pertain to Pediatric Ophthalmology.

The speakers are to be commended for their inordinate efforts to bring this meeting and book to fruition. Each speaker prepared multiple lectures and panel discussions, and also participated in question and answer sessions. Their commitment to preparing the chapters and discussions for this book will be evident to all who read it.

We wish to thank all the speakers/authors for their efforts on behalf of the NOAO and the readers of this publication. We also wish to thank Laurence W. Arend, MD, President of the NOAO, and the Board of Directors, for supporting this program and its publication. We wish to give a special thanks to Amber Howell, Executive Director of the NOAO, for her tremendous organization and creativity. Finally, we thank Kugler Publications for their editorial skills and timely production of this book.

Robert J. Balkan, MD, George S. Ellis, Jr., MD, and H. Sprague Eustis, MD
Editors

On behalf of the Board of Directors of the New Orleans Academy of Ophthalmology, I would personally like to thank the speakers and the program committee for the success of the 52nd Annual Symposium on February 14th-16th, 2003. The editors, Drs George S. Ellis Jr., Robert J. Balkan, and H. Sprague Eustis, have put together a superb text that will serve as an important reference in the ophthalmic literature for the benefit of the ophthalmic community of the present and future.

The New Orleans Academy of Ophthalmology was founded in 1951 as a result of the combined wisdom and vision of the Chairmen of the Tulane and Louisiana State University School of Medicine Ophthalmology Departments, Drs James H. Allen and George Haik, Sr., together with the New Orleans ophthalmic community. The first symposium was held in 1952 and invited speakers were Sir Stewart Duke-Elder, Paul Chandler, and Peter Kronfeld. There have been six previous symposia on ocular motility and strabismus, the first having taken place in 1955. Dr Arthur Jampolsky has written a fascinating history of the New Orleans Academy meetings, which is included in this volume of the Transactions. I commend it to the reader’s attention.

Special thanks are in order for the Eye, Ear, Nose and Throat Foundation, without whose generous support neither the Transactions nor the meeting would be possible. The Foundation was formed in 1981 to support the Eye, Ear, Nose and Throat Hospital, which was founded in 1889 for the purpose of providing medical care to the indigent population of New Orleans. The Foundation’s mission is to provide funding for medical research and education for ophthalmology and otolaryngology, as well as direct patient care. The driving force behind all our efforts is our Executive Director, Amber Howell. The Transactions, the meeting, and our success in general, are in large part due to her energy, creativity, and drive. She gently nudged and prodded us all along to get the meeting organized on time, within budget, and with rave reviews by all involved.

Thanks again to the program committee, who put together such a significant symposium, to the editors of the Transactions, and most especially to the speakers, without whom none of this would be possible.

Laurence W. Arend, MD
President, New Orleans Academy of Ophthalmology

Preface

President’s letter

History

History of the New Orleans Academy of Ophthalmology, Arthur Jampolsky
History of pediatric ophthalmology and the American Association of Pediatric Ophthalmology and Strabismus, Marshall M. Parks
Round Table: One hundred years of experience. What I would have done differently and what needs to be done in the future, Forest D. Ellis, Moderator

Cataract/Refractive Update

Etiology of pediatric cataracts, Forrest D. Ellis

Monocular congenital cataracts. Is binocular vision too much to ask?, Kenneth W. Wright and Mehmet Cem Mocan
Diplopia after LASIK surgery, Edward G. Buckley
Round Table: Seeing too well – diplopia after adult cataract surgery, Edward G. Buckley, Moderator
Questions and Answers: Cataract update I, H. Sprague Eustis, Presiding Physician
Monovision may be detrimental to patients with strabismus, Burton J. Kushner and Constance E. West
My experience with pediatric refractive surgery, Kenneth W. Wright and Mehmet Cem Mocan
Questions and Answers: Cataract update II, Robert J. Balkan, Presiding Physician

Amblyopia/Strabismus Update

Why do early surgery for infantile esotropia?, Kenneth W. Wright and Mehmet Cem Mocan
Dissociated vertical deviation – a nystagmus blockage phenomenon, David L. Guyton
Surgery for dissociated vertical deviation – new approaches, David L. Guyton
Complications of inferior oblique surgery, Burton J. Kushner
Round Table: Surgery for accommodative and partially accommodative esotropia, Kenneth W. Wright, Moderator
Round Table: Pearls in the management of exotropia, Burton J. Kushner, Moderator
Questions and Answers: Strabismus update I, George S. Ellis, Presiding Physician
Evaluation of the adult with diplopia, Forrest D. Ellis
The dragged-fovea diplopia syndrome, David L. Guyton
Guidelines for the surgical treatment of paralytic strabismus, Edward G. Buckley
Round Table: Adjustable suture technique and uses, David L. Guyton, Moderator
Questions and Answers: Strabismus update II, Robert Gordon, Presiding Physician
New optotypes: are they better than Allen cards?, Kenneth W. Wright, Mehmet Cem Mocan, Mario Najera-Covarrubias and Loren Ong
Anisometropic amblyopia, Forrest D. Ellis
Round Table: Pearls for amblyopia diagnosis and treatment (Masquerade syndrome), Forrest D. Ellis, Moderator
Questions and Answers: Amblyopia update, M. Tere Vives, Presiding Physician

Oculoplastics Update

Childhood blepharoptosis: diagnostic evaluation of the patient, Forrest D. Ellis
Results of multi-pass nasolacrimal duct probing, Kenneth W. Wright, Mehmet Cem Mocan, Mario Najera-Covarrubias and Nancy Suarez
Round Table: Congenital epiphora: when and where to probe, tubes or balloons, internal or external DCR, James A. Katowitz, Moderator
Questions and Answers: Plastic surgery update I, Kyle Acosta, Presiding Physician
Childhood ptosis: an oculoplastic perspective, J.A. Katowitz and F. Kherani
Round Table: Myths and realities in oculoplastic surgery, James A. Katowitz, Moderator
Questions and Answers: Plastic surgery update II, Constance Fry, Presiding Physician

Appendix

The selective laser trabeculoplasty laser and its role in rational glaucoma therapy, James B. Wise
Questions and Answers, Daniel A. Long, Presiding Physician
Questions and Answers: Refractive update, Marguerite B. McDonald, Presiding Physician

Index of authors

American Orthoptic Journal 2004: 54: 165-166

As stated in the title, these are the proceedings of the 52nd Annual Symposium of the New Orleans Academy of Ophthalmology (NOAO), a long and venerable history of meetings that have covered all subspecialties in ophthalmology. The published strabismus symposia, in particular, have been respected as important scientific contributions, but with the addition of interesting and often entertaining round tables where each and every word has been reported. This latter aspect of the previous publications has made this meeting one of special import where more than one legend has emerged and been repeated over many years!

This Strabismus symposium, the seventh dealing with strabismus since 1958, was especially important, in that it included three of our most revered mentors in strabismus: Drs. Arthur Jampolsky, Marshall Parks, and Gunter von Noorden. All had previously participated in the NOAO symposia and all had memories to share! In the first chapter, Dr. Jampolsky gives us the history of the NOAO symposia. The first symposium dealing with ocular motility occurred in 1958 where the strabismus leaders of the time came together for their second meeting as a group. Their first meeting, had been held in Iowa City, IA, some six years earlier and included the same group that met in New Orleans: Francis Heed Adler, Harold Whaley Brown, Hermann Burian, Frank Costenbader, Walter Fink, George Guibor, Phillip Knapp, and Kenneth Swan. At the time of their second meeting in New Orleans in 1958, they decided to title the published symposium Strabismus Ophthalmic Symposium II, which was always confusing to me, given the lack of a Strabismus Ophthalmic Symposium I! (Thank you for explaining this, Dr. Jampolsky) This first strabismus symposium was dedicated to Drs. Walter Lancaster and Richard Scobee, who had both died in 1952. Dr. Jampolsky’s history refers to some of the interesting exchanges that occurred between round table members, including the oft repeated exchange between Drs. Parks and Jampolsky regarding heavenly advice. Finally, an accurate accounting of what was really said, or at least what one of the participants thinks was said!

In the next chapter, Dr. Parks relates the history of the founding of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). (Unfortunately, an editor has changed the name to the “American Association of Pediatric Ophthalmology and Strabismus.”) Though true, it does not seem possible that pediatric ophthalmology was not recognized until the late 1950s and that it has grown from a group of about 24 to over 1000 since 1969! AAPOS brought together the newly recognized field of pediatric ophthalmology with the older field of strabismology and forged a stronger union. (Watching our colleagues in Latin America just beginning to try to establish this same kind of union makes me very grateful for the wisdom of the AAPOS founding fathers.)

A round table, moderated by Dr. Forest Daryel Ellis and including these three mentors, completes the first section. It is entitled “One hundred years of experience: What I would have done differently and what needs to be done in the future.” Certainly a title to get one’s attention! I doubt you will be disappointed!

In addition to the contributors listed above, the other members participating in the symposium include a list of top (just not as old) members of our field. Drs. Edward Buckley, Howard Fine, David Guyton, James Katowitz, Burton Kushner, and Kenneth Wright present their views on a number of diverse and interesting subjects. Since this symposium includes pediatric ophthalmology, sections on “Cataract/Refractive Update” and “Oculoplastics Update” are also present. As has been the custom in NOAO meetings, the round tables are reported intact without editing and are an important contribution to this volume.

TDF

Can J Ophthalmol; 39, no 6 p 687

Presentation ****
Depth ***
Understandability ***
Clinical applicability ****
Up-to-datedness ****
Value ***

Each year since 1952 the New Orleans Academy of Ophthalmology has presented a symposium on various topics. This text is the proceedings of the 52nd annual symposium, on pediatric ophthalmology and strabismus, held in 2003.

The target audience is pediatric ophthalmologists and those with special interest in pediatric ophthalmology. There are strong chapters on various topics in amblyopia and strabismus that are current and timely. In addition, there are two sections of interest to nonpediatric ophthalmologists, a cataract and refractive surgery update and an oculoplastics update with an emphasis on children. Included in these sections are papers on diplopia after LASIK surgery, diplopia after cataract surgery and evaluation of the adult with diplopia.

A strong feature of the text is the number of chapters entitled “Questions and Answers” or “Round Table.” In these sections, questions are asked of the panel, and with the wealth of years of experience offered by the panel members, the answers could reinforce a practitioner’s view that what he or she is currently doing is appropriate or offer some insight into what has worked for the panel members in the past.

Clearly the text has a limited target audience but is very readable and informative. It should certainly find a place in the libraries of teaching hospitals.

William N. Clarke, MD, FRCSC
Children’s Hospital of Eastern Ottawa
Ottawa, Ont.