Eyeworld

ents may be distraught at the thought of having to do something to their child. They want us to do everything. They want the treat- ments to be complete when they leave the office, and that's not al- ways possible. Parents need to be our partner." In order to cultivate an effective partnership, pediatric ophthalmolo- gists spend a great deal of time teaching parents drop-administering techniques and doling out specific instructions. They also have cheer- leading appointments where doctors check in on the parent and child to see how things are going. "These are visits to congratulate the child, congratulate the parent, and offer encouragement, help, or technique alteration," said Dr. Wilson. Pediatric ophthalmologists gen- erally try to make themselves as available to their patients as possi- ble, especially when the child must undergo surgery. Surgery can be par- ticularly nerve-racking for parents, as there are always risks. "I give the parents of my sur- gery patients my direct cell phone number," said Dr. Lee. "As much ef- fort as it takes me to address all of their questions and talk to other ex- perts in the field, I know that's what these parents need to get through this. If they don't and their child still goes blind, which is a very real possibility, then they are going to be wondering if they did enough. When they ask questions and be- come emotional, they are doing their job as a parent. I can't be upset or annoyed with them for doing what comes naturally." Pediatric ophthalmologists are generally very compassionate and understanding with parent irra- tionality and compliance problems, but there are situations where tough love is necessary to keep the child healthy. For example, if a child misses appointments because the parent can't get him or her to the doctor's office, sometimes a call to Child Protective Services is needed. "If we think that failure to bring the child back or failure to imple- ment treatment will put the child's visual future in danger, then we have to step in," Dr. Wilson said. "Usually what happens is we call child welfare and they send a police car to the house and the sher- iff knocks on the door. That gener- ally gets the child in," said Dr. Lee. "We don't think twice about making that phone call." Sometimes the child will end up in foster care because of the call. In those situations, the parent may be poor with little access to transporta- tion, have a drug or alcohol prob- lem, or be overwhelmed with other children in the home. "Social Services doesn't take this lightly," said Dr. Wilson. "But ne- glecting any required medical treat- ment that affects the ability of the child to function when he or she gets older is a form of child abuse." Medication needs Doctors in this subspecialty have to pay close attention to the medica- tion they prescribe to children. Most medicines are tested on adults and not children, so the potential side effects on kids aren't as well known. Also, some drug doses are based on adult weight, and children are smaller overall. "There's a long list of drugs we have to be very cautious with in kids," said Dr. Wilson. "Children, es- pecially young children, are more likely to absorb the drug through their skin. The skin is thinner and the blood vessels are closer to the surface, so if the medication is spilled out of the eyes, it can be ab- sorbed through the circulation more readily." One example of this is as simple as dilating drops. Children can get systemic reactions from the drops being absorbed through the circula- tion of the skin or even through the nose. Drops go down the tear duct and inside the nose, where there are a lot of blood vessels waiting to ab- sorb the drug. Another example is brimonidine for glaucoma. This medication can cause severe depression in kids and can be extremely dangerous. Symp- toms of depression in babies are re- duced alertness, excessive sleeping, and generally being inactive. "Beta-blockers have more sys- temic risks when children have air- way diseases. The small amount of medicine that's in an eye drop may not cause a problem in an adult, but continued on page 104 March 2011 PHARMACEUTICAL CORNER 088-104 Feature_EW March 2011-DL_Layout 1 2/27/11 5:39 PM Page 103

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