November 26-30, 2018

Alex V. Levin, MD, MHSc, FRCSC
Chief, Pediatric Ophthalmology
Wills Eye Hospital
Thomas Jefferson University
Philadelphia

Day 1

Lecture to Visualiza doctors on inheritance patterns and genetic counseling.  Also discussed ways to develop genetic counseling.  Great dialogue with continued ongoing conversation about having someone do an ocular genetics fellowship at Wills and/or have an ophthalmic tech come to Wills to be trained as a genetic counsellor.

Saw social clinic (and two private) patients, one on one, with Visualiza pediatric ophthalmologist.  Great teaching, focusing on pediatric glaucoma and ocular genetics and some cataract.  Covered a wide range of topics ranging from exam techniques to disease entities.  Scheduled two examinations under anesthesia (EUAs) cases for tomorrow in addition to already scheduled surgeries. 

Day 2

Although the pediatric ophthalmologist from Day 1 was unable to attend, surgery performed today with the glaucoma specialist included EUAs, trabeculotomies on two patients, cryotherapy on two patients and chalazion removal on another.  We were joined by a university pediatric ophthalmologist from the city and his fellow.  Much teaching about EUAs and identified needs for proper patient assessment (e.g., they need a Tonopen or Perkins in the operating room, Ascan,  Bscan).  Demonstrated cell-phone photography of optic nerves. Also reviewed how to plan glaucoma surgery.  I was the teaching assistant for surgery. 

Day 3

Saw private and clinic patients, one on one, with the pediatric ophthalmologist and taught on a wide variety of topics related to patient care ranging from the disorders we saw (including postops from day before), drug availability/cost/selections, to well-child eye care and screening. We met as a group to put together an EUA protocol and identify equipment needs.  Being segregated away from the busy clinic allowed for better one on one teaching.  Also discussed various genetic principles and program development options as well as possibilities for shorter training options for their adult glaucoma doctors who do childhood glaucoma to come to Wills for observerships.  Discussed various useful websites (e.g. www.pgcfa.org) and methods to improve records such as Dragon for OR dictations.

Day 4

Saw clinic patients, one on one, with the pediatric ophthalmologist.  There was a variety of more minor issues so discussions were more about general pediatric ophthalmology.  Also met with 3 surgeons to discuss cataract and glaucoma surgery tips.  Met with pediatric ophthalmologist and pediatric glaucoma specialist to make plans to assist them in furthering their research and writing – will do case report to start of one of the interesting cases we saw and did surgery on this week (phakomatosis pigmentovascularis type 2b with glaucoma).  

Evening lecture to Visualiza doctors and almost all pediatric ophthalmologists in Guatemala City.

            Tips for Pediatric Cataract
            Tips for Pediatric Uveitis

Day 5 

Lectures to Visualiza staff

            How ocular genetics is changing the world of ophthalmology
            OCT in children

This included a further discussion about developing ocular genetics at Visualiza.

Then did a clinic of 5 patients at the public hospital, Roosevelt Hospital, with their pediatric ophthalmology attending, 3 residents, and 2 fellows and theVisualiza pediatric ophthalmologist.  Long discussions of the complex cases they presented including Peters anomaly with failed transplants and glaucoma, two cases of Hallermann-Streiff, and two cases of glaucoma.

The one-on-one approach was an excellent teaching opportunity and we did some great planning/strategizing.  I think because of this visit, we can make significant upgrades to pediatric ophthalmology and ocular genetics in Guatemala 

Next identified need is pediatric (and adult) cornea with transplant. They have an eye bank.  Dr. Rapuano is interested and I will speak with him.  They are also interested in adult oculoplastics and medical and surgical retina.  Let me know if you want me to help find folks to do this.

I had conversations with Dr Silva, Nico Yee and CEO Chito Yee about the above and the plan below.  I urged follow-up and follow-through. They do seem very committed and I am hopeful good things will happen.

Next steps

1.  They are identifying a doctor to come to Wills for a 1 year Ocular Genetics Fellowship and 1 or 2 glaucoma doctors to come to Wills for 1-3 months pediatric glaucoma training.
2.  They are identifying a technician or optometrist to come to Wills for a 6-12 month course in ocular genetic counseling.
3.  They will source local funds to support 1 and 2.
4.  They will establish a budget to submit to me for top priority items on the EUA list so we can work jointly to identify funding.
5.  I will work with WEM to identify future visiting professors.
6. I am donating two books to Visualiza. 

Submitted 12/2/18
Alex Levin, MD

(Vice President’s note:  This was Dr. Levin’s fifth visit to Guatemala as a WEM visiting professor.)