Dr William Katowitz Discusses Pediatric Ophthalmic Surgical Decisions

Surgical decisions with children who have ophthalmic conditions need buy in from parents, but also the children as they get older, said William Katowitz, MD, attending surgeon in the Division of Ophthalmology at Children's Hospital of Philadelphia.

Transcript

How do you handle it when your view on whether ophthalmic surgery is or is not needed for a child differs from the parents' view?

I mean, I'm always thinking first of the child. And then, obviously, second is the family. You know, surgeries are elective, in most cases, and in emergent settings, there's less of a conversation. But when we consult, and consent parents, we talk about the risks, benefits, and alternatives to surgery. And sometimes parents are quite adamant about not having surgery. And my role as a physician and as an advocate for their child, is just to educate them on what that alternative of the surgery is.

Now, in my field, I treat tearing, tumors, trauma, and ptosis—I call it the 4 Ts, even though ptosis spelled with a P—and very few of that is urgent unless you're in the setting of ruling out malignancy or it's something that involves trauma where you're trying to put tissues back together again. But in the things that are more elective, the basic tenets that I try to express to the parents, and this applies maybe to some of the other questions, is that I care about how a child feels, how they appear, but mostly how they see, and that's really our role as eye care providers, first and foremost, is to protect vision and, in our case, in the pediatric world, visual development.

So, whenever I think about surgery, usually in the backdrop is, you know, is the visual development of this patient somehow being compromised? And if that is involved, if that's what we're trying to treat, that does change the tenor of my recommendation.

So, to answer your question, more directly, it's up to the parents to have surgery. It's very rare that a surgery is truly indicated that we would have to step in and disagree with a parent, and I’ve never had to get a legal matter involved. I think the bigger problem is if parents are not in agreement, or sometimes you have complex social situations, let's say separation or divorce, where maybe 2 parents aren't in agreement.

I think the bigger subtlety that I've had to deal with is when the parents want the surgery, but the child doesn't want the surgery. And there are definitely scenarios like that. And I try to counsel the parents that, especially for elective procedures, when kids are becoming more aware, that they must be bought in to the surgery they're about to have, because if they're not, it really becomes very unpleasant for everybody.