Shira Robbins - Academia.edu (original) (raw)
Papers by Shira Robbins
Journal of American Association for Pediatric Ophthalmology and Strabismus
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Journal of American Association for Pediatric Ophthalmology and Strabismus
Journal of AAPOS, Jul 27, 2020
In recent months, the COVID-19 pandemic has threatened the financial viability of pediatric ophth... more In recent months, the COVID-19 pandemic has threatened the financial viability of pediatric ophthalmology practices. To measure the economic impact, the American Association of Pediatric Ophthalmology and Strabismus (AAPOS) Socio-economic Committee surveyed current US members at the peak of the COVID shutdown, in April 2020. With a robust response rate, the survey portrays that some pediatric ophthalmology practices are ominously strained, if not irreparably harmed.
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2021
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2019
An increasing number of surgical strabismus patients are taking oral anticoagulant and antiplatel... more An increasing number of surgical strabismus patients are taking oral anticoagulant and antiplatelet agents, with more diverse mechanisms of action than those used in the past. The decision as to whether to continue these drugs throughout the perioperative period is difficult and must be based on the balance between hemorrhagic and thrombotic risk. To help guide strabismus surgeons with clinical management in these cases, we review potential hemorrhagic complications of strabismus surgery and examine the use of anticoagulant and antiplatelet drugs during the perioperative period. Surgical strategies that might help minimize intraoperative hemorrhage in patients on anticoagulant therapy are also discussed.
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2014
The clinical range of what we as practitioners see is so varied that it is impossible for one per... more The clinical range of what we as practitioners see is so varied that it is impossible for one person to have seen all the atypical presentations of common conditions and the typical presentations of rare conditions. This workshop allows us to share some of these cases with the audience. Target Audience: Pediatric ophthalmologists , orthoptists, vision scientists and trainees. Current Practice: Current practice for each individual is comprised of a bulk of secondary clinical cases. Exposure to tertiary and quarternary cases is limited to those working in a few academic centers across the USA. Managing or recoginising rarely presenting scenarios or diseases can be difficult. Best Practice: Ideally one day we will all have time in our schedules to have telemedicine style case conferences with other centers to discuss unusual cases. To an extent this is done now with the pediatric listserve but real time diagnosis with videos of cases would be an improvement. Expected Outcomes: At the conclusion of the workshop the audience and the panel will have shared their experiences and strategies for rare and unusual clinical scenarios. It is the exchange in strategies and approach that should encourage the attendees to consider alternative diagnoses when faced with similarly challenging cases in their own practices. Format: Each member of the panel will present one clincial scenario and the panel will discuss their approaches to diagnosis and tretment. At the end of each case the audience will be allowed to ask questions. The moderator may ask the audience for opinions during the case presentation also. Summary: Five clinical cases with appropriate audio-viual material will be presented for discussion.
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2021
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2021
Abstract. There is increasing pressure for medical care reimbursement to be linked to outcomes. N... more Abstract. There is increasing pressure for medical care reimbursement to be linked to outcomes. New medications approved for glaucoma, age-related macular degeneration (AMD), and dry eye disease may offer improved outcomes, but they have higher acquisition costs. This article reviews published pharmacoeconomic studies assessing the incremental change in outcomes achieved vs. the increased medication costs incurred. The different types of pharmacoeconomic evaluations are described. Identified pharmacoeconimic evaluations range from simple cost-consequence statements to more complex cost-utility analyses conducted across many healthcare systems. Notably missing in all analyses are the effects of improved treatment on patient productivity. Although the diversity and small number of studies limit conclusions, there is some evidence that the newer glaucoma medications, as a group, produce economic offsets such as reduced glaucoma surgeries and fewer physician visits. Photodynamic therapy...
Cockayne syndrome is an ultra-rare autosomal recessive disorder characterized by growth failure a... more Cockayne syndrome is an ultra-rare autosomal recessive disorder characterized by growth failure and multisystemic degeneration. Excision repair cross-complementation group 6 (ERCC6) mutations account for most cases. We report a child with pre- and post-natal growth failure and progressive neurologic deterioration with multi-system involvement who has bi-allelic ERCC6 variants, that were discovered by whole genome sequencing, including a previously unreported intronic variant. Pathogenicity of these variants was established by demonstrating reduced levels of ERCC6 mRNA and protein expression, normal unscheduled DNA synthesis and impaired recovery of RNA synthesis in patient fibroblasts following UV-irradiation. The study confirms the pathogenicity of a previously undescribed upstream intronic variant, highlighting the power of genome sequencing to identify non-coding variants. In addition, this report provides evidence for the utility of a combination approach of genome sequencing pl...
Challenging Cases in Pediatric Ophthalmology
Challenging Cases in Pediatric Ophthalmology
Challenging Cases in Pediatric Ophthalmology
Challenging Cases in Pediatric Ophthalmology
Ophthalmic and Physiological Optics
To determine whether coexisting accommodative dysfunction in children with symptomatic convergenc... more To determine whether coexisting accommodative dysfunction in children with symptomatic convergence insufficiency (CI) impacts presenting clinical convergence measures, symptoms and treatment success for CI.
Journal of Telemedicine and Telecare
A patient presented with acute onset of double vision during the start of the COVID-19 pandemic w... more A patient presented with acute onset of double vision during the start of the COVID-19 pandemic when elective medical care was restricted. Initially declining an in-person evaluation, she was examined using a telehealth video visit, incorporating multiple technological modalities to ascertain ophthalmic examination elements. Her findings prompted emergent neuroimaging, revealing a giant internal carotid artery aneurysm, which was successfully embolized to prevent debilitating and possibly fatal intracranial haemorrhage. This case report illustrates the successful use of telemedicine and remote patient data acquisition to make a life-saving diagnosis.
Journal of American Association for Pediatric Ophthalmology and Strabismus
Introduction: This study evaluates the extent of patient care and revenue losses within Pediatric... more Introduction: This study evaluates the extent of patient care and revenue losses within Pediatric Ophthalmology (PO) practices as they rebound from the COVID-19 pandemic shutdown. Methods: Two surveys of active AAPOS members were performed in 2020 at the pandemic peak “lockdown” phase 1 and again in the early recovery phase comparing practice data to the prior year. The authors extrapolated from AAO/ AAPOS 2018 Academetrics to identify specific clinical and financial outcomes. Results: Median surgical volume in April was 26% of normal, improving to 66% by mid-July, consequently, 76,892 surgeries were not performed. As of July, clinic examinations decreased by 27%, accounting for 461 lost examinations perprovider or 484,065 examinations not performed. Medicaid patients were disproportionately affected with 242,033 clinic examinations not performed. Clinical revenue decreased 77% in April and 55% in July. University/hospital and private practice/employed POs whose salary was consistent with the prior year were 69% and 9% respectively in July. As of July, the average doctor lost 85,358insalaryrevenuetranslatingintocumulativelossof85,358 in salary revenue translating into cumulative loss of 85,358insalaryrevenuetranslatingintocumulativelossof233,606,100 for PO physicians. Assuming PO practices continue functioning at current levels, 73% of capacity, through next April, over 1,480,670 examinations and 113,360 surgeries will not have occurred over a 1-year period since the initial survey. Conclusion/Relevance: While there has been healthy economic rebound for many, this historic event continues to jeopardize access to care for patients and threaten the economic viability of many PO practices. Societal and financial costs of morbidity due to past and future missed/delayed examinations cannot be measured at this time.
Survey of Ophthalmology
A two-year-old full-term boy with a history of an intermittent exotropia presented to the pediatr... more A two-year-old full-term boy with a history of an intermittent exotropia presented to the pediatric ophthalmology clinic for routine follow-up. He was found to have a stable sensorimotor examination however dilated fundoscopic examination of the right eye was significant for a dim foveal reflex with a new discrete, white elevated retinal lesion superotemporal to the fovea with surrounding subretinal exudates. An exam under anesthesia (EUA) was performed two days later which revealed a subretinal posterior pole granuloma with hyperfluorescence and late leakage from the lesion without telangiectatic vessels on fluorescein angiography. A repeat EUA one month later demonstrated an increase in surrounding subretinal and overlying intraretinal fluid. The patient was started on topical 1% prednisolone forte. At EUA three months later, the subretinal and intraretinal fluid had resolved. The topical steroids were tapered, and the patient continues to be followed closely.
Journal of American Association for Pediatric Ophthalmology and Strabismus
Abstract In recent months, the COVID-19 pandemic has threatened the financial viability of pediat... more Abstract In recent months, the COVID-19 pandemic has threatened the financial viability of pediatric ophthalmology practices. To measure the economic impact, the American Association of Pediatric Ophthalmology and Strabismus (AAPOS) Socio-economic Committee surveyed current US members at the peak of the COVID shutdown, in April 2020. With a robust response rate, the survey portrays that some pediatric ophthalmology practices are ominously strained, if not irreparably harmed.
Journal of American Association for Pediatric Ophthalmology and Strabismus
Journal of American Association for Pediatric Ophthalmology and Strabismus
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Journal of American Association for Pediatric Ophthalmology and Strabismus
Journal of AAPOS, Jul 27, 2020
In recent months, the COVID-19 pandemic has threatened the financial viability of pediatric ophth... more In recent months, the COVID-19 pandemic has threatened the financial viability of pediatric ophthalmology practices. To measure the economic impact, the American Association of Pediatric Ophthalmology and Strabismus (AAPOS) Socio-economic Committee surveyed current US members at the peak of the COVID shutdown, in April 2020. With a robust response rate, the survey portrays that some pediatric ophthalmology practices are ominously strained, if not irreparably harmed.
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2021
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2019
An increasing number of surgical strabismus patients are taking oral anticoagulant and antiplatel... more An increasing number of surgical strabismus patients are taking oral anticoagulant and antiplatelet agents, with more diverse mechanisms of action than those used in the past. The decision as to whether to continue these drugs throughout the perioperative period is difficult and must be based on the balance between hemorrhagic and thrombotic risk. To help guide strabismus surgeons with clinical management in these cases, we review potential hemorrhagic complications of strabismus surgery and examine the use of anticoagulant and antiplatelet drugs during the perioperative period. Surgical strategies that might help minimize intraoperative hemorrhage in patients on anticoagulant therapy are also discussed.
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2014
The clinical range of what we as practitioners see is so varied that it is impossible for one per... more The clinical range of what we as practitioners see is so varied that it is impossible for one person to have seen all the atypical presentations of common conditions and the typical presentations of rare conditions. This workshop allows us to share some of these cases with the audience. Target Audience: Pediatric ophthalmologists , orthoptists, vision scientists and trainees. Current Practice: Current practice for each individual is comprised of a bulk of secondary clinical cases. Exposure to tertiary and quarternary cases is limited to those working in a few academic centers across the USA. Managing or recoginising rarely presenting scenarios or diseases can be difficult. Best Practice: Ideally one day we will all have time in our schedules to have telemedicine style case conferences with other centers to discuss unusual cases. To an extent this is done now with the pediatric listserve but real time diagnosis with videos of cases would be an improvement. Expected Outcomes: At the conclusion of the workshop the audience and the panel will have shared their experiences and strategies for rare and unusual clinical scenarios. It is the exchange in strategies and approach that should encourage the attendees to consider alternative diagnoses when faced with similarly challenging cases in their own practices. Format: Each member of the panel will present one clincial scenario and the panel will discuss their approaches to diagnosis and tretment. At the end of each case the audience will be allowed to ask questions. The moderator may ask the audience for opinions during the case presentation also. Summary: Five clinical cases with appropriate audio-viual material will be presented for discussion.
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2021
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2021
Abstract. There is increasing pressure for medical care reimbursement to be linked to outcomes. N... more Abstract. There is increasing pressure for medical care reimbursement to be linked to outcomes. New medications approved for glaucoma, age-related macular degeneration (AMD), and dry eye disease may offer improved outcomes, but they have higher acquisition costs. This article reviews published pharmacoeconomic studies assessing the incremental change in outcomes achieved vs. the increased medication costs incurred. The different types of pharmacoeconomic evaluations are described. Identified pharmacoeconimic evaluations range from simple cost-consequence statements to more complex cost-utility analyses conducted across many healthcare systems. Notably missing in all analyses are the effects of improved treatment on patient productivity. Although the diversity and small number of studies limit conclusions, there is some evidence that the newer glaucoma medications, as a group, produce economic offsets such as reduced glaucoma surgeries and fewer physician visits. Photodynamic therapy...
Cockayne syndrome is an ultra-rare autosomal recessive disorder characterized by growth failure a... more Cockayne syndrome is an ultra-rare autosomal recessive disorder characterized by growth failure and multisystemic degeneration. Excision repair cross-complementation group 6 (ERCC6) mutations account for most cases. We report a child with pre- and post-natal growth failure and progressive neurologic deterioration with multi-system involvement who has bi-allelic ERCC6 variants, that were discovered by whole genome sequencing, including a previously unreported intronic variant. Pathogenicity of these variants was established by demonstrating reduced levels of ERCC6 mRNA and protein expression, normal unscheduled DNA synthesis and impaired recovery of RNA synthesis in patient fibroblasts following UV-irradiation. The study confirms the pathogenicity of a previously undescribed upstream intronic variant, highlighting the power of genome sequencing to identify non-coding variants. In addition, this report provides evidence for the utility of a combination approach of genome sequencing pl...
Challenging Cases in Pediatric Ophthalmology
Challenging Cases in Pediatric Ophthalmology
Challenging Cases in Pediatric Ophthalmology
Challenging Cases in Pediatric Ophthalmology
Ophthalmic and Physiological Optics
To determine whether coexisting accommodative dysfunction in children with symptomatic convergenc... more To determine whether coexisting accommodative dysfunction in children with symptomatic convergence insufficiency (CI) impacts presenting clinical convergence measures, symptoms and treatment success for CI.
Journal of Telemedicine and Telecare
A patient presented with acute onset of double vision during the start of the COVID-19 pandemic w... more A patient presented with acute onset of double vision during the start of the COVID-19 pandemic when elective medical care was restricted. Initially declining an in-person evaluation, she was examined using a telehealth video visit, incorporating multiple technological modalities to ascertain ophthalmic examination elements. Her findings prompted emergent neuroimaging, revealing a giant internal carotid artery aneurysm, which was successfully embolized to prevent debilitating and possibly fatal intracranial haemorrhage. This case report illustrates the successful use of telemedicine and remote patient data acquisition to make a life-saving diagnosis.
Journal of American Association for Pediatric Ophthalmology and Strabismus
Introduction: This study evaluates the extent of patient care and revenue losses within Pediatric... more Introduction: This study evaluates the extent of patient care and revenue losses within Pediatric Ophthalmology (PO) practices as they rebound from the COVID-19 pandemic shutdown. Methods: Two surveys of active AAPOS members were performed in 2020 at the pandemic peak “lockdown” phase 1 and again in the early recovery phase comparing practice data to the prior year. The authors extrapolated from AAO/ AAPOS 2018 Academetrics to identify specific clinical and financial outcomes. Results: Median surgical volume in April was 26% of normal, improving to 66% by mid-July, consequently, 76,892 surgeries were not performed. As of July, clinic examinations decreased by 27%, accounting for 461 lost examinations perprovider or 484,065 examinations not performed. Medicaid patients were disproportionately affected with 242,033 clinic examinations not performed. Clinical revenue decreased 77% in April and 55% in July. University/hospital and private practice/employed POs whose salary was consistent with the prior year were 69% and 9% respectively in July. As of July, the average doctor lost 85,358insalaryrevenuetranslatingintocumulativelossof85,358 in salary revenue translating into cumulative loss of 85,358insalaryrevenuetranslatingintocumulativelossof233,606,100 for PO physicians. Assuming PO practices continue functioning at current levels, 73% of capacity, through next April, over 1,480,670 examinations and 113,360 surgeries will not have occurred over a 1-year period since the initial survey. Conclusion/Relevance: While there has been healthy economic rebound for many, this historic event continues to jeopardize access to care for patients and threaten the economic viability of many PO practices. Societal and financial costs of morbidity due to past and future missed/delayed examinations cannot be measured at this time.
Survey of Ophthalmology
A two-year-old full-term boy with a history of an intermittent exotropia presented to the pediatr... more A two-year-old full-term boy with a history of an intermittent exotropia presented to the pediatric ophthalmology clinic for routine follow-up. He was found to have a stable sensorimotor examination however dilated fundoscopic examination of the right eye was significant for a dim foveal reflex with a new discrete, white elevated retinal lesion superotemporal to the fovea with surrounding subretinal exudates. An exam under anesthesia (EUA) was performed two days later which revealed a subretinal posterior pole granuloma with hyperfluorescence and late leakage from the lesion without telangiectatic vessels on fluorescein angiography. A repeat EUA one month later demonstrated an increase in surrounding subretinal and overlying intraretinal fluid. The patient was started on topical 1% prednisolone forte. At EUA three months later, the subretinal and intraretinal fluid had resolved. The topical steroids were tapered, and the patient continues to be followed closely.
Journal of American Association for Pediatric Ophthalmology and Strabismus
Abstract In recent months, the COVID-19 pandemic has threatened the financial viability of pediat... more Abstract In recent months, the COVID-19 pandemic has threatened the financial viability of pediatric ophthalmology practices. To measure the economic impact, the American Association of Pediatric Ophthalmology and Strabismus (AAPOS) Socio-economic Committee surveyed current US members at the peak of the COVID shutdown, in April 2020. With a robust response rate, the survey portrays that some pediatric ophthalmology practices are ominously strained, if not irreparably harmed.
Journal of American Association for Pediatric Ophthalmology and Strabismus