Dr Richard Allen Discusses Oculoplastic Surgery in Pediatric Patients

Richard Allen, MD, PhD, FACS, professor at Baylor College of Medicine, spoke about the challenges of oculoplastic surgery in pediatric patients, as well as the continued accessibility of the procedure.

Transcript

What are some of the challenges of performing oculoplastic surgery on pediatric patients and how can surgeons and other health care professionals help mitigate them?

Well, I think first and foremost, if it's anything that needs to be taken care of soon, then we'd like to see these patients sooner than later. So a lot of it is identification by the patient's primary care provider. Pediatricians are usually attuned with regards to taking care of a lot of these problems. Ptosis, a droopy lid, if that is untreated relatively early, potentially it can cause amblyopia that can be hard to treat—so that would be a lazy eye, that would be hard to treat. So, early identification is really important with the patient's primary care provider.

Also, we see that with tearing, in the sense that, basically, pediatricians are really attuned to the fact that 5% of kids are born with tearing. But it's really important for those patients to be seen, because other things can cause tearing that can be worrisome. For example, congenital glaucoma is something that can also sometimes look like a congenital nasolacrimal duct obstruction. So we just need to make sure that the pediatricians are aware of these things.

With regards to the challenges of treating kids with oculoplastic problems, I think, as with any surgery on a child, we can't do it with them awake, we have to put then to sleep. Anesthesia in general has risk to it in children, and in general, we try to prevent putting kids to sleep if we don't have to. So I think that's one of the big challenges.

One of the things that, when I talk with parents, they're very hesitant, especially if they're relatively knowledgeable about the potential risks of anesthesia, they're very hesitant with regards to having their children put to sleep. But you know, it's hard to do surgery on kids when they're awake, so we almost have to always put them to sleep. So it can be a difficult conversation with parents, but usually if you if you educate them well, they understand that, overall, anesthesia for children is very safe, but again, repeated anesthesia would not be.

What still needs to be done to ensure that parents can access and afford oculoplastic surgery for their children with ophthalmic conditions that require surgical treatment?

Yeah, I think the biggest problem with regards to access is our current shortage of just general pediatric ophthalmologists. So a lot of pediatric ophthalmologists will do ocular plastic surgery. I'm an ocular plastic surgeon first and I take care of adults as well as kids with these problems, but many of the pediatric ophthalmologists take care of ptosis, nasolacrimal duct obstruction, etc. And a huge problem right now is the fact that we have a shortage of pediatric ophthalmologists.

That's something that the American Academy of Ophthalmology, it's one of their priorities with regards to making sure that we have enough pediatric ophthalmologists to provide care for these patients. So, currently, I think that that's probably the major concern with regards to providing appropriate access to pediatric patients.