The James H. Hall Eye Center's programs are directed toward early intervention and providing opthalmologic care to a critically underserved population.

Aphakic Rehabilitation

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In 2006 10 indigent children had their sight restored through cataract surgery. The Center provided ultrasound exam for 10 patients with cataracts at $350 per patient, eye exams for 10 patients at $185 per patient at no charge.

Drs. Marc Greenberg and Mark Bordenca, both previous fellows, perform these surgeries. The aphakic contact lenses replace the focusing power that is lost when a cataract is removed from the lens of the eye. In infants, it is essential that the focusing power be restored as quickly as possible, or normal visual development may never occur. Some children receive medical insurance through the Georgia Medicaid program, which unfortunately does not provide for the expedited lenses needed by these patients. The assistance provided by the Hall Eye Center has been critical in the visual rehabilitation of congenital cataracts in these very young patients.

The parents of these infants have learned to put the lenses in and take them out every day. These children will require ongoing evaluation throughout their childhood, as well as the aphakic contact lenses, to maximize vision development.

Newborn Intensive Care Unit

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Dr. Mark Bordenca examines 2-3 babies a week for retinopathy of prematurity at Piedmont Hospital nursery; the training fellow accompanies him for most of the exams.

Direct Patient Care

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The Center’s Pediatric Director, Dr. Zane Pollard examines patients who range in age from newborns to age 18 at the Scottish Rite Office free of charge. Some patients, born prematurely, come to the Center to have their retinas examined. Some are referred to the Center, because they failed a vision screening test at school, some are diagnosed with amblyopia (lazy eye) and require patching of their good eye to improve vision in their poorly seeing eye. Some patients have optic nerve inflammation and require treatment with steroids. Others present with strabismus, conjunctivitis (pink eye) and need antibiotics. In 2006, the comprehensive services provided by the Center were estimated to cost $30,500. All services were provided free of charge.

• 144 indigent patients received eye exam and subsequent treatment.
• 5 strabismus surgeries were performed on indigent patients.

The Center collaborates with other organizations to provide ophthalmologic care for underserved children, including Babies Can’t Wait, Children’s Healthcare of Atlanta and Children’s Medical Services. We also coordinate care for needy children who are not eligible for government-assisted services.

The Center sends letters to all referring physicians after an initial visit with a referred patient, and continues correspondence as needed. In addition, we have contact with community providers through inpatient and emergency department consultation at Scottish Rite Hospital. We also field calls from more remote providers who need help managing a child with an eye problem, until arrangements can be made for transfer of care to our facility.

"Early and comprehensive intervention is critical, as many potentially vision-threatening conditions can be rehabilitated if detected in time, allowing the ophthalmologist to reduce the severity of visual disorders that can damage sight, and prevent the loss of sight," says Dr. Zane F. Pollard, the Center’s Pediatric Director. Few of the 9 pediatric ophthalmologists in the Atlanta area will treat non-paying patients, but poor patients from around the state get immediate emergency and surgical intervention at the Hall Eye Center.

We treat an average of 25 emergency cases weekly, 1,300 yearly, mostly children without financial resources or Medicaid who receive treatment for a gamut of ocular disorders. We treat indigent patients with the same accessibility to our services as full paying patients and spend 20-30 minutes per visit with each patient. For example, the parents of an indigent child with an early corneal infection may not seek medical help until the infection is far advanced and the child cannot open his or her eye; only then do they go to an emergency room. Many of these patients are referreed to the Center from emergency rooms and pediatricians throughout the greater Atlanta area, including Gwinnett, Marietta, Jonesboro and Scottish Rite Hospital.

• 273 patients received preventive or curative care at Fulton Health Clinic.
• 76 patients received emergency care at Scottish Rite Hospital.

Glaucoma Prevention

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The Hall Eye Center is the only organization in Atlanta providing Phospoline Iodide drops to control ocular pressure.

Over 90% of children with congenital glaucoma are either born with the condition or it appears in the first year of life. For the remainder glaucoma appears after age one. Glaucoma, if left untreated, destroys the optic nerve leading to blindness. The Center provided monthly supplies of drops to six indigent patients in 2006. Ongoing treatment for these children gives them vision to last a lifetime.

Glaucoma can be associated with other children diseases or syndromes such as Sturge-Weber syndrome in which a port-wine stain is present on the face. If the port-wine stain involves the upper eyelid, then glaucoma is likely to occur. Glaucoma can also be associated with neurofibromatosis.

Glaucoma can occur in up to 30% of children who have had cataract surgery. Often the glaucoma will not appear for 4-10 years after the cataract surgery. This is one reason that the child who has had cataract surgery must be examined yearly for the rest of their lives.

Some children who have iritis will develop glaucoma and this can often be a difficult glaucoma to treat. The glaucoma is secondary to the inflammatory cells produced from the iritis plugging the outflow channels from the anterior chamber.

Sometimes surgery provides a permanent cure and sometimes after surgery the pressure can be controlled with eye drops. Children who are born with glaucoma will not respond to drops and must have surgery. However the children who develop glaucoma after cataract surgery or secondary to iritis often can be controlled with drops and not need surgery.

Many of these children are quite nervous about having their pressures taken, as it is quite intimidating to have an object touch your cornea even if it is anesthetized with drops. These children must be put to sleep to measure their pressures. Measuring the pressure either in the office or in the operating room follows the progress. If the cornea is cloudy as is often the case with congenital glaucoma, a clear cornea is a sign that the pressure has normalized.

Also we check the size of the cornea to see if it is no longer enlarging telling us that the pressure is probably being controlled. This is only true for the first year or 2 of life. After that, strict control of pressure is the main way we follow the progress of these children. Formal visual field testing cannot be accurately performed until 7-10 years of age. At that time often we can already see a loss of part of the visual field due to the effects of glaucoma.