January 08, 2019
3 min read

Well-trained pediatric optometrists can help fill access gaps

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Incorporating well-trained pediatric optometrists into pediatric ophthalmology practices has helped expand primary pediatric eye care services to children, often closing gaps in access to this often routine but nonetheless important service.

An American Association for Pediatric Ophthalmology and Strabismus task force subcommittee has gathered information on pediatric optometry residency programs that provide additional child-specific training including routine comprehensive eye examinations for refraction, but also screening and treatment for many cases of amblyopia and non-surgical conditions such as accommodative esotropia, Sharon F. Freedman, MD, AAPOS member and task force chair, told Ocular Surgery News.

“While there are quite a few optometry residency programs which self-report or self-identify as pediatric training programs, many of these focus on so-called ‘vision therapy’ and ‘behavioral optometry’ techniques. There are very few programs that have the optometry training conducted entirely in a medical facility. In fact, there are currently only four such programs in the entire country that I am aware of,” she said.

Sharon F. Freedman, MD
Sharon F. Freedman

Filling gaps

Children’s Hospital Colorado, Cincinnati Children’s Hospital Medical Center and Children’s Mercy Hospital in Kansas City, Missouri, are the only three medical facilities that have had pediatric optometry residency programs. Duke Eye Center at Duke University Medical Center has an approved and accredited residency program and is interviewing to start in summer 2019, Freedman said. Others will soon have additional programs starting as well.

There is a definite need for primary pediatric eye care, and well-trained pediatric optometrists can provide much of the primary, non-surgical eye care that pediatric patients need, she said.

“Rather than trying to exclude one another, we find that working alongside our optometry colleagues allows us to create a seamless way to take care of more children in an efficient and medically excellent manner,” Freedman said.

Erin D. Stahl, MD, section chief of ophthalmology at Children’s Mercy Hospital, takes great pride in the pediatric optometry residency program there. The program was created 12 years ago due to a lack of ophthalmology residents choosing pediatric ophthalmology as their specialty and to help “provide excellent primary and tertiary care for all children with vision needs,” Stahl said.

The pediatric ophthalmology practice at Children’s Mercy Hospital currently has eight pediatric ophthalmologists and six pediatric optometrists on staff. No optometrist ever performs any type of procedure in the integrated practice, Stahl said.

“We’ve been really successful in partnering with optometry. From the beginning, many people were surprised we opened the residency. There is a general thinking among ophthalmologists that optometrists only provide vision therapy. Although much of pediatric optometric training involves vision therapy, our residents are open and eager to adapt to new thinking. Our staff optometrists now give lectures and train other ODs about the concept of ‘pediatric primary care optometry.’ We created a great model here that we want to share,” Stahl, an OSN Pediatrics/Strabismus Board Member, said.


In the Children’s Mercy training program, ophthalmologists and optometrists work together to train one pediatric optometrist per year. The resident trains alongside the ophthalmology fellow but has a greater focus on primary care and specialty services such as contact lenses and myopia control, she said.

Conducting examinations

The optometrists are the “gatekeepers” to the clinic, and unless a patient is a consult or is directly referred to the practice by a pediatrician, an optometrist will likely be the first to examine the patient, Stahl said.

Erin D. Stahl, MD
Erin D. Stahl

“They do a comprehensive pediatric examination including strabismus measurements. They’re well trained to know all the red flags and the important things to look for. If there is a concern, an ophthalmologist is always available to see a patient in tandem with the optometrist, and this is where valuable continuous learning occurs,” Stahl said.

AAPOS is currently gathering information and materials for members who are interested in creating pediatric optometry fellowship programs at their own medical settings. The organization’s task force subcommittee will provide templates and mentors to help these new fellowship programs move forward, Freedman said.

“We’re trying to make sure these new programs are high quality and that our members know how to best utilize these highly trained individuals,” she said. – by Robert Linnehan

Disclosures: Freedman reports Duke Eye Health will have a pediatric optometry residency program in 2019. Stahl reports no relevant financial disclosures.