Eyeworld

hunting down and old archive discs: You'd have Synergy. Y EW IN OTHER NEWS 106 October 2011 by Faith A. Hayden EyeWorld Staff Writer A regular Doogie Howser 16-year-old impresses with presentation at ARVO meeting W hen Ariel Silbert strode up to the podium to give a lec- ture on her pseudo- esotropia study at the Association for Research in Vision and Ophthalmology (ARVO) meet- ing in May, the 300 or so physicians listening had no reason to suspect anything out of the ordinary. She breezed over terms such as "exotropia" and "cycloplegic refrac- tion." She spoke clearly and authori- tatively on strabismus, drawing conclusions and making recommen- dations to surgeons based on her re- search. Sure, she looked young, but plenty of medical students and doc- tors are blessed with a fresh face, right? Maybe not this fresh. Ariel isn't a doctor and she isn't a medical stu- dent. She's a 16-year-old high- schooler. "I thought she was one of the medical students," said Agnes Wong, M.D., director, Eye Move- ment & Vision Neuroscience Labora- tory, The Hospital for Sick Children, Toronto, and co-moderator of the ARVO session. "The way she pre- sented was excellent, very calm and clear." How did a high school junior end up at ARVO, one of the most es- teemed ophthalmology conferences state side? For Ariel, medicine is in her roots. Her father, David Silbert, M.D., is a pediatric ophthalmologist practicing in Pennsylvania, where the family is based. "In the office, we've been doing clinical research and publishing pa- pers for the last 5 years," he ex- plained. "But one of the biggest problems for us is finding someone to do the grunt work, to rummage through all the charts." Ariel attends a girl's prep school in Lancaster County, where she's in the Advanced Scholars Program. She takes all honors and advanced place- ment classes and has to complete a thesis project in her junior or senior year. During a medical mission in Honduras, which Ariel accompanied her father on, Dr. Silbert consistently examined children with pseudo- esotropia. This got the family think- ing. Do children with pseudo- esotropia have a higher likelihood of developing strabismus than the nor- mal population? Should these pa- tients be more closely followed? For her project, Ariel decided to find out. Over the course of 200 hours and many Saturdays, Ariel sat in her father's practice sifting through the charts of every child who presented in the office between January 1, 2001 and February 26, 2010. She wasn't without help though; she worked alongside her father and Noelle Matta, a certified research coordinator within the practice. "I had to explain to her what certain things were," said Dr. Silbert. "But quite frankly, when I'm work- ing on a paper, our researcher has to help me. Ariel basically did every- thing. She wrote the abstract and the paper." Ariel identified 309 patients with pseudoesotropia, all of whom were advised to have a follow-up exam after the initial visit. Of those, 204 came back for a second exami- nation. Results were conclusive. Ten percent of the 204 children were later diagnosed with strabismus, and 4% developed a significant refractive error. The paper was submitted to ARVO, where it received high marks, and Ariel was invited to present. Dr. Silbert was careful to let Ariel do all the talking, including fielding ques- tions from the audience. "As soon as the questions started, I braced myself to have to jump in and answer some," said Dr. Silbert. "But I didn't. She handled all the questions very well. She did a re- ally good job." The audience never caught on to her age —some doctors actually approached her afterward to give her tips on her "practice." But one oph- thalmologist from the U.K. nearly tipped everyone off by tossing around a single unfamiliar, mono- syllabic word: squint, the British term for strabismus. "I thought to myself, 'What the heck is squint?'" Ariel said. "When I was learning to read, I learned that if I didn't know a word I should skip over it and try to figure it out through context. And if I couldn't figure it out by context, just ignore it. So I ignored [squint] and an- swered the question anyway." Ariel said she wasn't nervous be- fore or during the presentation, and actually found the whole experience "really fun." Although she's at- tracted to ophthalmology, she's in- terested in many other things as well, like photography, theatre, ski- ing, and surfing. "I'm only 16," she said. "I'm in- terested in pursing ophthalmology, but I'm just not sure yet. I'd have to get into medical school first." Should she choose medicine, her ARVO presentation will be a nice addition to her CV. So would a pub- lished paper in a scientific journal. Ariel submitted the ARVO study to the Journal of the American Associa- tion of Pediatric Ophthalmology and Strabismus, and it has been accepted pending revisions. "Getting a chance to present at ARVO is an extremely prestigious opportunity. It shows rigorous scien- tific investigation," said Dr. Wong. "She changed my clinical practice. After hearing the talk, I realized a portion of these children develop strabismus as they get older. Now in- stead of sending the children away, I ask them to come back and see me in 6 or 9 months. I'm very im- pressed by her achievement." Dr. Wong wants to find out more about Ariel's methodology and details about the patient population so she can fine-tune her policy, but for now she's erring on the more conservative side, all because of a high school junior. EW Editors' note: Ms. Silbert and Drs. Silbert and Wong have no financial interests related to their comments. Contact information Ariel Silbert: dsilbert@familyeyegroup.com David Silbert: dsilbert@familyeyegroup.com Wong: agnes.wong@sickkids.ca Ariel recently went on a medical mission to Honduras with her family Source: David Silbert, M.D. 106-108 ION_EW October 2011-dl2_Layout 1 9/29/11 4:30 PM Page 106

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