Quality, Patient Safety and Outcomes in Pediatric Ophthalmology

Providing effective eye care for children requires accurate diagnosis and a comprehensive treatment plan. Many children can tell you when their tummy hurts, but most won’t be able to recognize when their sight is affected by an eye condition. It takes skilled medical experts to understand their signs and symptoms and accurately diagnose an eye condition. Diagnosing vision problems in a timely manner is especially critical in young children because the window for maximizing visual development closes around age 7 or 8.

By treating many children with a wide range of conditions, we’ve gained the experience that helps us provide high quality care to ensure the best health and safety for our patients. And by carefully tracking our outcomes, we continuously improve the way we diagnose and treat children with eye conditions.

Why does measuring outcomes in pediatric ophthalmology matter?

Not every hospital publishes their outcomes, but our team is proud of the work we do and excited about the future of eye care. In addition to identifying ways to improve our care, we share our outcomes so you know your child is receiving the best care possible. When looking for high-quality pediatric eye care, transparency is essential to knowing you’re at the right place.

Our experienced eye care team understands that when it comes to pediatric eye care, the earlier we can diagnose a condition, the better we can treat it and avoid more serious complications. If left untreated, some eye conditions can be very harmful to your child’s sight in the future. That’s why we analyze our outcomes to develop better ways to diagnose and treat conditions earlier.

Ophthalmological outcomes we measure and why

We are a high-volume center, which means we see more children for eye conditions than most hospitals. We keep track of our volumes and take detailed notes about the severity of the condition and what other medical conditions a child has in addition to the eye condition. These other conditions are called comorbidities. Sometimes, if a child has one condition, it’s more likely they will have another. By keeping track of these comorbidities, we know to test for related conditions as well.

In order to continuously improve the quality of care we offer our patients and adapt our surgical processes, we examine things like surgical site infections and re-operation rates to identify any parts of our surgical process that may be causing complications. Identifying outcomes like this allows us to systematically improve quality and patient safety.

Cataracts surgical volumes

Cataracts is a condition that can occur in babies and children for many reasons, identified by a cloudy lens that is normally clear inside the eye. By seeing more children for conditions like cataracts, we can help identify and diagnose other conditions earlier.

Pediatric cataracts can run in families, coexist with certain genetic syndromes or be caused by eye trauma or inflammation. In many cases when only one eye is affected, the cataract reflects abnormal development of the eye. Certain features of the cataract that we observe in the clinic, or during surgery, can help guide our diagnosis and management.

As a high-volume pediatric cataract referral center, we recognize the rare conditions that are associated with pediatric cataracts. With a multidisciplinary team including many departments across our hospital, we can recommend tests or screenings for other conditions that may be associated to address those conditions as quickly as possible.

The treatment for visually significant pediatric cataracts is surgical. To provide the best quality care for our patients, we track the volume of pediatric cataract surgeries we perform. The more cataract surgeries we perform, the more experience we have with different surgical circumstances and this helps to improve our outcomes and treat an even broader ranges of cataracts.

Cataract surgeries performed per year

*As of August 15, 2024

Strabismus surgical volumes

Strabismus, or the misalignment of the eyes, is a common problem in children. Strabismus surgery is a core component of the care our department provides. As a referral center performing a high number of strabismus surgeries, we can care for every patient with strabismus that comes to us, whether it’s a straightforward strabismus surgery or a complex one.

Strabismus surgeries performed per year

*As of August 15, 2024

Surgical safety

Our surgical team is dedicated to providing the highest quality care. We track the number of unexpected returns to the operating room within 30 days after a procedure, an indicator of complications that require further surgical intervention. We also track our number of surgical site infections.

Rate of unexpected returns

*As of August 15, 2024

Rate of surgical site infections

*As of August 15, 2024

How do we improve quality and care?

Advanced screening for retinopathy of prematurity

Retinopathy of prematurity is an eye disease that affects babies born prematurely and causes blood vessels to grow abnormally in the retina. If not treated, the condition can lead to retinal detachment and affect your child’s vision. However, if screened properly, retinopathy of prematurity can be treated to avoid any serious complications.

We created an integrated system in Epic, our electronic health record, to ensure that every premature baby born at our hospital gets screened for retinopathy of prematurity. We catalogue each premature baby in our electronic system so that each is entered into a registry to ensure that every at-risk baby is screened. This is one way we’re using our experience and what we’ve learned from outcomes to create new systems that improve the quality of care we offer all our patients.

We also keep a database of all the premature babies previously screened at Children’s Colorado for retinopathy of prematurity. This resource allows us to perform further research, including quality studies, to improve the care of premature babies in the future.

Collaboration across specialties

Pediatric eye conditions often don’t occur in a vacuum. At Children’s Colorado, our eye care team frequently collaborates with other subspecialists within our system to provide the most complete care for our patients.

Retinoblastoma

Retinoblastoma is a rare form of cancer that occurs in the eye of children. It may run in families or occur sporadically. With a collaborative approach between our pediatric retina team and our Oncology Department and Genetics Department, our patients and their families receive multidisciplinary support that balances the chances of vision preservation with the child’s cosmetic outcome, while maintaining the primary goal of life-saving treatment.

Pediatric Cornea Clinic

Children with corneal problems, such as Peters anomaly, corneal dystrophies and keratoconus, often benefit from the surgical care provided by cornea specialists. We hold joint clinics in which patients see both a cornea specialist and pediatric subspecialists in a single visit. This is not only more convenient for our patients but allows our physicians to discuss their findings face-to-face and make decisions together in real-time.

Ocular genetics and inherited retinal disease

Many pediatric ocular conditions are inherited, and many inherited conditions have signs or symptoms that can be seen in the eye. As an organ that can be directly viewed and imaged in detail in the clinic, the eye can provide many clues about genetic syndromes which may be present systemically (meaning they may be linked to other systems in the body). Our multidisciplinary clinic brings together pediatric ophthalmologists, retina specialists, geneticists and genetic counselors to collaborate and provide our patients with innovative new treatments that can be tailored based on genetic causes.

Uveitis Clinic

Many patients and their families have never heard of uveitis, or inflammation in the eye, until they are diagnosed with it. Patients with certain autoimmune conditions, such as juvenile idiopathic arthritis (JIA), are at much higher risk of developing uveitis. Uveitis can also occur without a known cause. Whether uveitis is associated with a systemic condition like JIA, or occurs in isolation, unchecked inflammation inside the eye can cause a variety of sight-threatening complications — including cataract and glaucoma — unless properly managed.

The treatment of uveitis can involve local control of inflammation through medications like eye drops or injections, but often requires systemic treatment with drugs that tamp down the immune system. In our Uveitis Clinic, we collaborate with rheumatology experts, who are specialists in the safe administration of immunosuppressive medications, to provide real-time solutions for our patients.