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Diana Kim, Leila Khazaeni, Jennifer Dunbar; Physician Effort in Pediatric Examination Under Anesthesia. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4131.
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© ARVO (1962-2015); The Authors (2016-present)
Vision plays a crucial role in a child’s early development. Thorough examination and early intervention is crucial for the detection of vision-threatening diseases. The inability to tolerate a complete eye examination in the clinic is an indication for an eye examination under anesthesia (EUA). This occurs in the pediatric population due to age, developmental delays, poor cooperation, or the need for detailed and lengthy examination techniques. This study analyzes the time effort required (by indication) for EUA compared to comprehensive examination in the clinic.
The medical records of 143 patients age < 18 undergoing EUA from September 1, 2010 to September 1, 2015 were reviewed. The age, gender, diagnoses, indication for, and length of time spent in the operating room were recorded. For patients with multiple EUAs, each EUA was counted as a separate exam. Patients who had additional procedures (i.e. suture removal, fluorescein angiogram, vitrectomy, cataract extraction) were excluded.
110 EUA operative records met inclusion criteria. The average time spent in the operating room for an EUA was 66 minutes. The most common indications for EUAs were developmental delay (25%), glaucoma (21%), history of trauma (15%), and retinopathy of prematurity (ROP) (6%). ROP patients averaged the longest EUAs (79 minutes), followed by glaucoma (77 minutes), developmental delays (63 minutes), and globe trauma (62 minutes).
EUAs require significant time, effort, and coordination on behalf of the pediatric ophthalmologist. The average time of 66 minutes for an EUA would only allow 4 EUAs in an operative half day compared to the 8-10 comprehensive examinations that can be performed in a clinic half day. The results bring to question the current billing and reimbursement for EUAs. Further analysis of clinic exam times for comparison as well as surveys for pediatric ophthalmologists regarding level of satisfaction with current billing could be helpful in further analyzing the current data.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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