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Improving Lifelong Visual Potential

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LEXINGTON Maximizing lifelong visual potential is the passion behind the pediatric ophthalmology practice of Palak Wall, MD. Wall joined KentuckyOne Health in November 2014 to fulfill a need for pediatric ophthalmology, according to Eric Gilliam, president of Saint Joseph Hospital East. The need was recognized based on feedback he received from pediatricians and other healthcare providers in the community. “Many of our premature babies in the neonatal intensive care unit (NICU) require care and follow up from pediatric ophthalmology, so Dr. Wall is a good fit for us,” Gilliam says.

Wall was initially interested in pursuing general pediatrics, but a rotation in ophthalmology at The Ohio State University College of Medicine led her to the specialty of pediatric ophthalmology. “I saw how it could make a difference in the quality of life for a child,” she says. She also enjoyed the combination of medicine and surgery. Wall states she was fortunate to do her fellowship at the Cleveland Clinic where she received vigorous academic training and exposure to multiple eye-related diseases.

Pediatrics to Adults

Wall’s pediatric patients come from central and eastern Kentucky. Her referrals come from pediatricians, neonatologists, and other eye care professionals. The presentations range from retinopathy of prematurity to normal visual screening. Wall also sees adult patients for strabismus, especially if they require surgical intervention. She works closely with many specialty providers stating, “I work with other pediatric subspecialties such as ENT and neurology on patients who have complex diseases that affect vision. I may identify an issue such as papilledema that requires referral to neurology.” Wall does take care of some plastics-related issues such as sties, nasolacrimal duct obstruction, eyelid lesions, and ptosis and works with oculoplastic and plastic surgeons to manage the visual issues related to more complex pathology. She performs surgery at the Lexington Surgery Center and Saint Joseph Hospital East.

Retinopathy of Prematurity

Advances in neonatal care have led to increased survival of extremely premature babies. These babies are at risk for retinopathy of prematurity (ROP) due to immaturity of retinal blood vessels and oxygen exposure leading to abnormal growth of retinal blood vessels that can lead to scarring and retinal detachment, says Wall. She performs retinal screening exams on all babies under 32 weeks gestation in the St. Joseph East NICU. According to Wall, the need for treatment depends on the stage of ROP, as the milder stages usually resolve on their own. She refers patients to retina specialists for laser treatment and/or Avastin injections for more severe cases. “I believe Avastin injections should be reserved for aggressive ROP due to the unknown long-term risks associated with systemic exposure to anti-VEGF drugs,” she says. Referral to a retinal specialist is also required for repair of retinal detachment, she adds. Wall envisions a role for telemedicine and further training on ROP for rural areas that may not have access to pediatric ophthalmology or retina services.

Scope of Practice

Other pediatric eye disorders Wall sees in her practice include:

Pediatric cataracts – uncommon, but can produce significant visual impairment if not removed. Infants can be screened by observing for red reflex on eye exam.

Trauma – pediatric ophthalmology may be called for eye injuries such as corneal abrasions, hyphemas, or open globes. “Patients with open globes usually require surgery within 24 hours,” says Wall. A common injury in spring/summer is a baseball or tennis ball to the eye with the associated risk of bleeding. Wall encourages her patients to use eye protection.

Amblyopia – decreased vision in one eye from multiple causes such as ptosis, strabismus, astigmatism, cataracts, etc. According to Wall, it can be treated by patching the good eye if it is asymmetric and treating the underlying cause.

Nasolacrimal duct obstruction – Wall describes this as a common problem that usually resolves in the first year of life. It can be treated with massage of the lacrimal sac but may require surgery if it does not resolve.

Genetic disorders – Wall has experience with many of the retinal dystrophies and eye abnormalities that occur with some genetic disorders. “I was lucky to train under Dr. Elias Traboulsi at the Cleveland Clinic, one of the top ocular geneticists in the country,” she says.

From children to adults, Wall is providing a lifetime of vision for her patients.

Palak Wall, MD Pediatric Ophthalmology A Department of Saint Joseph East 120 N. Eagle Creek Drive, Suite 104 Lexington, KY 40509 To schedule an appointment, call 859.967.5923.