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Costenbader Lecture

45th Annual Frank D. Costenbader Lecture

Strides & Challenges in the Diagnosis, Classification & Treatment of Childhood Retinal Dystrophies

Elias I. Traboulsi, MD, MEd

Cole Eye Institute
Cleveland Clinic Foundation

Introduction: The recognition of clinical manifestations of inherited infantile and childhood retinal dystrophies, combined with the appropriate diagnostic tests, remains the mainstay of their diagnosis. This presentation attempts to clarify the current approaches to diagnosing, classifying and managing children with inherited retinal disorders.

Methods: Review of the current literature and personal experience of the presenter.

Discussion: Advances in molecular diagnostic technology have allowed precise genetic diagnosis in a majority of cases and have paved the way to a broader classification scheme in which a blur has emerged between clinical diagnostic entities that at one time were better defined. Genetic heterogeneity has become the rule as more genes are recognized to cause the same phenotype and more mutations in the same gene to cause different clinical disorders. Finally, a better understanding of the underlying molecular mechanisms in childhood retinal disorders and advances in biotechnology have brought novel therapies very close and into the clinic.

Conclusion: The ophthalmic community is updating its approach to diagnosing and classifying childhood retinal dystrophies and is preparing for their treatment.

Schedule

8:00–8:05 AM
Introduction of Costenbader Lecturer – Mohamad S. Jaafar, MD, FACS, FAAP

8:05–8:30 AM
Costenbader Lecture – supported by the Children’s Eye Foundation
Elias I. Traboulsi, MD, MEd

8:30–8:33 AM
Presentation Ceremony – M. Edward Wilson, Jr, MD

Frank D. Costenbader Lecture

The Frank D. Costenbader Lecture was inaugurated in 1974 at the Annual Meeting of the Costenbader Society to honor Dr. Costenbader. The American Association for Pediatric Ophthalmology, later the American Association for Pediatric Ophthalmology and Strabismus was created at this meeting. From its inception, AAPOS undertook to sponsor the Costenbader Lecture as the keynote presentation at its annual meeting. Due to failing health, Dr. Costenbader was unable to attend any of the lectures which honored him.

Dr. Costenbader was born and educated in Virginia and was a true Virginia Gentleman. He received his undergraduate education at Hampton-Sydney College, his medical degree from the University of Virginia and completed his residency at the Episcopal Eye, Ear and Throat Hospital in Washington, DC.

Dr. Costenbader started practice in 1932 in the depression and began a lifetime commitment to teaching, which set the stage for the tremendous influence he had on ophthalmology when he began to only see children. In 1933, Dr. Costenbader was appointed Instructor in Ophthalmology at Georgetown University and he became Special Lecturer and Conferee there in 1964. He also was on the faculty of George Washington University advancing to the rank of Clinical Professor. He was known for his enormous patience, generous with his time, always offering complete answers to even the weakest questions, and he rarely lost his equanimity. He changed the Children’s Hospital Clinic from one of service only to teaching and clinical care. He committed a full day a week to teaching for many years, spending Tuesday afternoons at Children’s and another half day a week at the Episcopal EET Hospital. In 1946, the Episcopal residents started rotating at Children’s, and he was able to focus his teaching efforts there.

Dr. Costenbader is referred to as the Father of Pediatric Ophthalmology. That designation is because of his decision in 1943 to limit his practice to pediatric ophthalmology, and he was the first ophthalmologist to do so. He moved his office to a stately brownstone townhouse on 22nd Street in Washing- ton, DC. His waiting room was referred to as Dr. Costenbader’s living room by many of his young patients because of its small furniture. He had two exam rooms on the first floor, which he used, and there were additional exam rooms on the lower level for his orthoptist, Ms. Dorothy Bair, and associates, fellows and preceptors. It was a center for wonderful patient care and the first real education or training center for pediatric ophthalmology. His exam tools were limited. Dr. Costenbader had a picture of an airplane and a phone on a rotating box at the end of his room and kids would beg to come in and see his airplane and talk to him about it. The patient’s examination chair was a kitchen chair placed on a small wooden platform.

When asked why he limited his practice to pediatrics, the first thing Dr. Costenbader would say was that kids are just so much more fun. He also was fascinated with the eye problems of children and at that time, ophthalmologists interested in strabismus were more interested in adults and older children and in cosmetic alignment.

Dr. Costenbader was an advocate for children. His concern for their health and the financial welfare of families in providing for the health of their children led him to establish and financially support the Eye Fund at Children’s Hospital to pay for indigent patient surgery. This fund is now used to support the training program at the Children’s National Medical Center in Washington, DC.

Continuing with his concern for providing for children’s health care, he was co- founder of the Medical Service Plan (today Blue Shield) of the District of Columbia and was the first president from 1946 to 1951. He remained on the board for many years. In addition, he started having parents be with their child in the anesthesia induction room before surgery, he eliminated bandages on eyes following strabismus surgery, and he changed strabismus surgery from two inpatient nights to same-day surgery. Dr. Costenbader was Chief of Ophthalmology at Children’s Hospital of Washington, DC, now The Children’s National Medical Center from 1938 to 1965. He had a remarkable effect on children’s eye care and children’s health in general.

This lecture memorializes the man who had the foresight and the courage to begin a subspecialty in ophthalmology and the talent and dedication to train and mold the nest generation according to his ideals.


Past Costenbader Lectures

1974 Los Angeles   Marshall M. Parks, MD

1975 Lake Tahoe   Robert N. Shaffer, MD

1976 Bermuda   Lorenz E. Zimmerman, MD

1977 San Francisco   T. Keith Lyle, MD

1978 Williamsburg   Jules Francois, MD

1979 Toronto   Robison D. Harley, MD

1980 San Diego   David G. Cogan, MD

1981 Orlando   Philip Knapp, MD

1982 Monterey   Joseph Lang, MD 

1983 Vancouver   Jack C. Crawford, MD 

1984 Vail   Gunter K. von Noorden, MD 

1985 Puerto Rico   Arthur J. Jampolsky, MD 

1986 Maui    Robert M. Ellsworth, MD

1987 Scottsdale    John E. Wright, MD 

1988 Boston    Alan B. Scott, MD 

1989 Kiawah    Kenneth C. Swan, MD 

1990 Lake George    John T. Flynn, MD 

1991 Montreal    John A. Pratt-Johnson, MD 

1992 Maui    Eugene M. Helveston, MD

1993 Palm Springs    Henry S. Metz, MD

1994 Vancouver    William E. Scott, MD

1995 Orlando    Eugene R. Folk, MD

1996 Snowbird    Marilyn T. Miller, MD

1997 Charleston    Robert D. Reinecke, MD

1998 Palm Springs    David L. Guyton, MD

1999 Toronto    Malcolm L. Mazow, MD 

2000 San Diego    David R. Stager, Sr., MD 

2001 Orlando    Forrest Daryel Ellis, MD 

2002 Seattle    Creig S. Hoyt, MD 

2003 Hawaii    Burton J. Kushner, MD 

2004 Washington, DC    Arthur L. Rosenbaum, MD

2005 Orlando    Albert W. Biglan, MD 

2006 Keystone    Earl A. Palmer, MD 

2007 Seattle    John D. Baker, MD 

2008 Washington, DC    Edward G. Buckley, MD

2009 San Francisco    Richard A. Saunders, MD

2010 Orlando    A. Linn Murphree, MD

2011 San Diego    Susan H. Day, MD 

2012 San Antonio    Michael X. Repka, MD 

2013 Boston     M. Edward Wilson, MD

2014 Palm Springs  John F. O’Neill, MD

2015 New Orleans    David S. Walton, MD

2016 Vancouver   Edward L. Raab, MD, JD

2017 Nashville   Steven M. Archer, MD

March 19 @ 08:00

08:00

– 08:35

(35′)

International Ballroom Center

Elias I. Traboulsi, MD, MEd

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