WCPOS SHARES IDEAS IN GLOBAL FORUM

Some international conferences err on the side of one part of the world thinking they know everything, telling other parts of the world this is how it should be done. Our idea with the upcoming WCPOS meeting in Milan, in contrast, is that expertise does not reside just in one region of the world. Rather we need a conversation, a sharing of information. We are putting on the podium the best people from each part of the world. Part of the great success of our initial meeting in Barcelona was what you cannot capture at home. There was a great camaraderie, and sharing that happened in between the sessions, or after a session when a crowd would come up afterwards to the front after hearing about a new procedure or technique. Whether the information came from South America, or Europe, the Middle East or Asia, there was excitement about something never heard before. We saw equally smart people from around the world talking to each other, all with the goal of helping patients. People made lasting friendships that can develop into research projects. For example, I met a young man in Barcelona that ended up coming to my centre from Egypt, and spent two years here doing a fellowship.

There is no room for dogmatic thinking I think some of my US colleagues were quite surprised by what they learned at our first meeting. Things that we thought of as dogma in the US are really not in other parts of the world. For example, the idea that many Europeans were doing strabismus surgery with an operating microscope, was surprising to the Americans.

There are so many interesting differences, for example with strabismus surgery, how do you measure? Do you cut muscle? What kind of suture are you using? This all varies across the globe. This is seen across the board. And in the retina field, we’ve seen that screening for retinopathy of prematurity is not the same the world over. What about paediatric cataract – do you operate on both eyes simultaneously? When do you operate, and which lens should you use? In Europe it is standard practice to place an Artisan clip lens in an aphakic child. This lens was only recently approved in the US, and not for aphakia. The US FDA wants us to do a study on something that has been around for more than 20 years in Europe!

It is important to understand cultural issues We also have a lot to learn about cultural considerations of care. Some of the differences are shocking. A doctor from southern India stood up in Barcelona and said that in her region strabismus was considered a blessing and good luck. Parents don’t want to straighten the eyes because it’s a gift from God. I had never in my life heard that before. Cultural differences lead to differences in care. A recent Swiss study reported that children over the age of six with strabismus don’t get invited to birthday parties. In parts of Asia we know that strabismus can lead to ostracism. We need to understand how cultures differ, and look at the psychosocial impact of the care we provide. We are planning to do shared research to try and look at those issues in different parts of the world.

Adults and children, who does what? In the US, paediatric and strabismus care have been a unified specialty for quite a while. However, this is not the case everywhere. In South America these have been considered separate specialties. Similarly, in England there were two separate societies. This is starting to change. We want to provide an opportunity to facilitate this.

In much of the world the general ophthalmologist includes paediatric patients in his/her practice. Some cataract and refractive surgeons may have upwards of 20 per cent paediatric patients.

There are so many differences between these patient groups that we have developed a programme that will update adult ophthalmologists on the latest developments in paediatrics. What do you do in a child with a corneal opacity? Who takes care of that child? The cornea surgeon may be best trained to replace the cornea, but the paediatric ophthalmologist might be the best one to deal with the refractive errors and post-op exams. We have to partner and share information. It is like the old story of the three blind men and the elephant, one grabs the tail, one the trunk, one the leg, and they all describe a different animal. We’re doing that with children. The retina people for example, are OK with injecting Avastin into the eye because they are doing it all the time, but now this is being tested in ROP in preemies. Paediatric ophthalmologists are hesitant about putting an antiangiogenesis drug into a growing child, and want to know how this will affect brain growth and what will happen to eyes later on. We’ve added special sessions on retina and cornea for the Milan meeting so we can all exchange views on these topics.

Paediatric ophthalmology is rewarding It is an incredibly exciting and satisfying career choice. Yet there are paediatric fellowships available now that are not even getting filled. The tide does seem to be turning, and we’re seeing more interest, with some medical students looking more at the intellectual challenge and favourable lifestyle profile associated with this specialty. You will see every possible form of disease: cornea, oculoplastics, cataracts, glaucoma, refractive, retina ROP and diabetes. You are a generalist and a specialist, and doing strabismus surgery on top of that. It is so rewarding because you never stand so tall as when you bend to help a child. You are having an incredible impact on these patients’ lives. With simple amblyopia therapy you will restore vision for 80 years. Being a paediatric ophthalmologist is the most rewarding thing I can possibly imagine.