April 15, 2019

A brand-new clinic at Texas Children’s West Campus is empowering children with visual impairment to make the most of the sight they have and live more independent lifestyles.

Texas Children’s Vision Enhancement Center – the only pediatric low vision clinic in Houston and one of only a few in the nation – was started this past January to meet the tremendous need for specialty care for children in Greater Houston living with various forms of visual impairment that can’t be corrected with glasses, contact lenses, surgery or medicine.

The clinic, made possible through a generous gift from Kathy and George Bishop, is spearheaded by Texas Children’s pediatric optometrist Dr. Kelsie Morrison and provides children with tools and techniques to maximize their functional vision so they can perform daily tasks and educational activities.

“The Vision Enhancement Center is the product of a partnership between Dr. Morrison, the Eye Care Department at Texas Children’s and our wonderful hospital administrative partners,” said Dr. David Coats, Texas Children’s chief of Ophthalmology. “This great new service provides promise and hope, and I am very proud to be a part of a team that is so committed to helping children with vision impairment live healthy, happier lives.”

The most common causes of visual impairment, or low vision, in children are inherited or congenital eye diseases, such as oculocutaneous albinism, retinal dystrophies (such as retinitis pigmentosa or Stargardt’s disease), retinopathy of maturity, nystagmus, and optic nerve hypoplasia.

These conditions typically cause one or more of the following symptoms:

  • Loss of ability to see detail (visual acuity)
  • Loss of side or peripheral vision (visual field)
  • Constant double vision (diplopia)
  • Inability to navigate steps or the edge of curbs (contrast sensitivity)
  • Inability to distinguish colors

Children with low vision face special challenges in school, where great emphasis is placed on learning in a visual environment.

“The majority of what we learn as children is absorbed visually,” said Morrison. “The conditions that our patients have make it difficult to take in visual input and process it. Our job is to get a baseline measurement of their functional vision and then test different solutions, such as magnification devices or electronic systems, to find the best fit for each individual patient and to improve their quality of life.”

The Vision Enhancement Center administers a complete assessment of visual function, eye health and the visual demands each patient experiences in educational, home and community settings. This initial exam is a critical step in determining how the child uses their vision to function and whether visual aids and other environmental modifications can make daily tasks – such as reading and writing – more comfortable and manageable. To help gain a clearer picture of the child’s needs, teachers, therapists or other health care workers are encouraged to attend appointments if possible.

A review of visual equipment already in use at home and school, as well as of textbooks and school materials, helps the optometrist make suggestions and offer guidance on what other magnification tools may be needed, such as telescopes, magnifiers, electronic systems (e.g., video displays, virtual reality mountings), or special tools to help patients who have difficulty with contrast or glare. Additional guidance may be offered on potential environmental alterations that can be made at home or in the classroom to help maximize the patient’s vision and improve their daily life.

The response from the community has been tremendous. Volume has been high since the clinic’s opening and there are already plans for expanding clinic space.

“The care and healing provided at this clinic have the ability to transform children’s lives,” said Dr. Allen Milewicz, Texas Children’s chief of Community Surgery and chief surgical officer at Texas Children’s Hospital West Campus. “These impactful therapies, and the work of dedicated physicians like Dr. Morrison, make me proud to be part of Texas Children’s.”

Learn more about the Vision Enhancement Center and other services provided by Texas Children’s Division of Ophthalmology.

February 25, 2019

Experts from Texas Children’s Hospital are regularly invited to give lectures and presentations at national and international conferences, where they share their knowledge and experiences caring for some of the rarest and most complex pediatric medical conditions. Now a new video series from Texas Children’s Service Line Marketing provides direct access to those experts.

Medically Speaking features some of the brightest minds from several Texas Children’s specialty and subspecialty areas. The series is meant to be a helpful educational resource for parents and a convenient way for physicians and other caregivers to stay up-to-date on the latest in pediatric medicine. Viewers can watch talks on a variety of interesting topics, including advancements in surgery, breakthroughs in research, new clinical trials, and novel and back-practice treatments for specific conditions.

In this episode, you’ll hear from Texas Children’s ophthalmologist Dr. Madhuri Chilakapati speaking about strabismus, an eye muscle imbalance commonly known as crossed eyes, lazy eyes or wandering eyes. During the talk, Madhuri reviews the different types of strabismus, shares common pain points from parents and ways to offer better support, and shares possible treatment options.

Be on the lookout for more Medically Speaking episodes on Connect, or view additional episodes now.

Learn more about the services provided and conditions treated by Texas Children’s Division of Ophthalmology.

This presentation is not intended to present medical advice or individual treatment recommendations, and does not supplant the practitioner’s independent clinical judgment. Practitioners are advised to consider the management of each patient in view of the clinical information. All content is shared for informational purposes only, and reflects the thoughts and opinions of the original author. No physician-patient relationship is being created by the use of this presentation. The presentation sets out recommendations based upon similar circumstances and is provided as an educational tool. The presenters are not attorneys, and to the extent this presentation provides commentary on current laws and regulations affecting health care activities, it is not intended as legal advice.

April 3, 2018

Candice Gardemal can calm the most nervous patient visiting Texas Children’s Specialty Care Cy-Fair for an eye exam. The certified ophthalmic technician wins over patients of all ages with her warm, bubbly personality and an endless amount of tricks up her sleeve, some of which are so effective they have been published in medical journals.

“She’s phenomenal,” said Dr. Mary Kelinske, an optometrist at the center who has been working with Gardemal for the past five years. “I couldn’t do my job as effectively without her.”

Gardemal’s role at the center is to get the vitals of a patient’s eye before Kelinske walks into the exam room. Most of the time, this includes patients reading various charts containing letters, numbers, and sometimes, pictures. And, almost always, it requires a patient’s eyes being dilated, a process adults, much less children, find unsettling.

Gardemal’s stealthy moves and methods of distraction, however, are magical, allowing her to get the job done quickly and usually with no fuss. From the moment she walks into the exam room, she is smiling, talking and pulling out toys from various drawers and cabinets around the room.

“Look right here,” she said energetically while pointing to a silver, shiny pinwheel that lights up in the dark. “There you go! You did it! You are so smart!”

For some of her tougher cases, Gardemal puts on a super hero mask just to get a laugh. Other times she points to one of the colorful, sea-themed murals she has painted on the exam room walls.

“Ms. Gardemal is an exceptional artist,” said Chief-of-Ophthalmology Dr. David Coats. “She combines her charisma and her art to enhance the appeal of our clinics and to put our children as ease. Her work includes small paintings and huge murals, some of which hide instruments that can be frightening to children.”

When dilating a patient’s eyes, Gardemal uses a technique she developed that involves a pile of tissue, the patient’s belly button and a tall tale that goes something like this:

“OK now, hold these tissues real tight over your belly button so that none of these eye drops can get inside,” Gardemal enthusiastically tells her patients. “If the drops get inside your belly button, hair will start sprouting up around it!”

This simple technique is so effective, Gardemal published an article about it in the Journal of American Association of Pediatric Ophthalmology. She got another article published in the same journal about a technique Gardemal came up with called the pinch patch. The technique uses a pinch in the fold of an eye patch to make what is typically a flat surface over a patient’s eye convex and therefore much more comfortable.

“Ms. Gardemal routinely dreams up and implements innovative ways to improve patient comfort,” Coats said. “One of the best innovations she has developed is the pinch patch. This is a simple modification to an eye patch that makes wearing an eye patch much more comfortable, which has been great news for our young patients who often must wear an eye patch several hours a day for many months or even years.”

Most recently, Gardemal has been working with Kelinske to provide a better clinical experience to patients with a range of physical, developmental and behavioral differences, including ADHD and Autism. Through exams geared toward the unique requirements of these patients, Gardemal and Kelinske have modified their approaches, as needed, to keep patients as comfortable as possible, both physically and emotionally, and to help get information and deliver care as accurately and efficiently as possible.

“My goal is to distract my patients with fun and leave them with a good memory of the eye doctor,” said Gardemal, who as a child had to visit the ophthalmologist frequently due to a condition called strabismus. “My childhood doctor always gave me a high five and a smile to make me feel more comfortable and it worked. I want to do the same for my patients. I want them to leave the clinic feeling like they had a good time.”

Click here to learn more about the Texas Children’s Special Needs Eye Clinic.

July 17, 2017

Dr. Jane Edmond has been selected to serve as president of the American Association of Pediatric Ophthalmology and Strabismus in 2020.

The organization’s goals are to advance the quality of children’s eye care, support the training of pediatric ophthalmologists, support research activities in pediatric ophthalmology, and advance the care of adults with strabismus.

Edmond is board certified and a fellow of the American Academy of Ophthalmology. She is a member of the American Association for Pediatric Ophthalmology and Strabismus, and has held many offices within the organization. She is an oral board examiner for the American Board of Ophthalmology. She is on the editorial board of the Journal of AAPOS. She is the author of numerous peer-reviewed journal articles and book chapters. She is a frequently invited presenter at national and international professional society meetings and conferences. She is the recipient of the Secretariat and Achievement Award, presented by the American Academy of Ophthalmology; and an Honor Award, presented by the American Association for Pediatric Ophthalmology and Strabismus. She is considered a national expert in craniofacial disorders and pediatric neuro-ophthalmology.

Edmond’s interests and specialties are:

  • Pediatric neuro-ophthalmology (brain-based vision abnormalities, optic nerve disease, pupil problems, visual impact of brain tumors or other intracranial insults)
  • Craniofacial disorders and their ocular and impact to the visual system
  • Childhood and adult eye strabismus, medical and surgical treatment (all forms of eye misalignment, double vision, eye misalignment secondary to thyroid eye disease)
  • Amblyopia
March 21, 2017

Dr. Gunter K. von Noorden, former chief and founder of Texas Children’s Hospital Ophthalmology, passed away February 18, 2017, at the age of 88. He was known as one of the “fathers of pediatric ophthalmology” for his contributions to strabismus surgery and overall leadership in the field for more than 40 years.

Von Noorden committed his entire career to the study and treatment of strabismus and amblyopia. He was a pioneer researcher in the area of visual neurophysiology and transferred those new discoveries in strabismic and anisometropic amblyopia into improved clinical care. Through his relentless efforts and inspiration, ophthalmologists worldwide acquired new knowledge and understanding in pediatric ophthalmology and strabismus.

“Dr. von Noorden made Texas Children’s Hospital Ophthalmology Division what it is today,” said Chief of Ophthalmology Dr. David Coats. “His contributions to the hospital will forever be remembered and appreciated.”

Born in Germany in 1928, von Noorden’s family moved to Berlin in 1937. This had a profound impact on his life – exposing him to Adolf Hitler’s dictatorship and Nazi propaganda. Following his involvement in Battle of Berlin in 1945 and the end of WWII, von Noorden was determined to dedicate his life to healing others, and he worked his way through medical school at the Johann-Wolfgang Goethe University.

Von Noorden began his medical career as a resident at the University of Iowa in 1957, which was followed by a fellowship at the University of Tuebingen Eye Clinic in Germany. He then returned to the University of Iowa, spending two years as an assistant professor of ophthalmology. In 1963, von Noorden became a professor at the Wilmer Eye Institute at Johns Hopkins in Baltimore. In 1972, he moved to Houston to direct the Ocular Motility Service at Baylor College of Medicine.

Von Noorden was a professor of Ophthalmology and Pediatrics at Baylor, chief of the Ophthalmology Service at Texas Children’s Hospital, and adjunct professor of Neuroscience at the University of Texas at Houston from 1972 to 1995. Following an interval of retirement and appointment as professor emeritus, he rejoined the Baylor faculty as professor of Ophthalmology in July 2006, until resigning in October 2008. The Board of Trustees of Baylor then appointed von Noorden Distinguished Emeritus Professor of Ophthalmology in December 2008.

Von Noorden was charter member and former president of the American Association of Pediatric Ophthalmology (AAPOS), the International Strabismological Association (ISA), and the American Orthoptic Council (AOC). He also served as former president of the American Association of Research in Vision and Ophthalmology (ARVO).

In his lifetime, he published 310 scientific papers and authored four books, including Ocular Motility and Binocular Vision: Theory and Management of Strabismus. The book has been heralded as the “gold-standard text for ocular motility disorders.”

Von Noorden presented 21 named lectures worldwide and received numerous awards. His many honors included the Jackson Lecturer (American Academy of Ophthalmology – AAO), Bowman Lecturer (British Ophthalmological Society), Costenbader Lecturer (American Association for Pediatric Ophthalmology and Strabismus – AAPOS), first Bielschowsky Lecturer (International Strabismological Association – ISA), Proctor Lecturer (Association for Research in Vision and Ophthalmology), and Ticho Lecturer (Israel Society of Ophthalmology).

He received the Franceschetti-Liebrecht-Award from the German Ophthalmological Society in 1984 and, in 1996, was awarded an honorary doctorate of medicine and surgery from the University of Bologna. In 2015, von Noorden was inducted in the American Society of Cataract and Refractive Surgery Hall of Fame as being “truly unique in his field and the ultimate triple threat: outstanding clinician, world-renowned teacher and author, and incredibly productive research scientist, highlighted by his path finding studies on the neuropathology of amblyopia.”

June 7, 2016

6816charlenecrockett175Texas Children’s Hospital is excited to welcome Dr. Charlene Crockett to the hospital’s Ophthalmology Division.

Crockett joined Texas Children’s Hospital in March as a pediatric ophthalmologist and is currently leading the hospital’s new Urgent Care Eye Clinic, which opened in January and currently receives patients with urgent ophthalmological needs.

Prior to being brought on as a full member of the ophthalmology team, Crockett was a fellow at Texas Children’s Hospital. During her one-year fellowship, she studied pediatric ophthalmology and strabismus.

Crockett earned her medical degree from Baylor College of Medicine and, along with the fellowship at Texas Children’s Hospital, completed an internship at the University of Texas at Houston.

In addition to her duties at Texas Children’s, Crockett is an assistant professor of ophthalmology at the Cullen Eye Institute and Baylor College of Medicine.

“The field of ophthalmology is fascinating,” Crockett said. “I love it and I love working with children and families.”

June 1, 2016

6116craniosynostosis640More than 120 people recently attended Texas Children’s Hospital’s annual Craniosynostosis Reunion, which honors families whose children have undergone craniosynostosis surgery at the hospital.

Donned in superhero T-shirts and capes, patients and their families enjoyed a day filled with games, socializing and laughter as they celebrated healed scars, which were barely visible in the patients’ hair. Families shared stories and remembered the hope and strength they received when their child had surgery.

At Texas Children’s, the comprehensive Craniosynostosis Surgery Program brings together a multidisciplinary team of pediatric neurosurgeons and plastic surgeons as well as geneticists, ophthalmologists, social workers, otolaryngologists and anesthesiologists to meet the needs of each patient.

“It is a privilege to take care of children,” said Dr. Sandi Lam, pediatric neurosurgeon and co-director of the Craniosynostosis Surgery Program at Texas Children’s. “We are lucky to be able to support and connect patients and families in a meaningful way, beyond surgery. Seeing these children and families reminds us why we do what we do every day.”

Led by Lam and Dr. Laura Monson, pediatric plastic surgeon and the program’s co-director, Texas Children’s Craniosynostosis Surgery Program is among the largest in the country, offering a spectrum of treatment strategies including minimally invasive surgery and complex reconstructions. For more information about the program, visit the website.

Billie Casteel, Mary Kana, Lorraine Cogan, Show Bower and Sarah Colton organized the annual Craniosynostosis Reunion event, mobilizing other dedicated Texas Children’s staff and volunteers. A special treat was “SteveO,” a Houston area professional photographer who graciously volunteered his services for this special Texas Children’s Hospital event.