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Pediatric Optometry at Byers Eye Institute, Stanford University

Department of Ophthalmology
2452 Watson Court
Palo Alto, CA 94303
(650) 736-1621

Optometry Student Extern Director for Byers Pediatric: 
Tawna Roberts, OD
tawnar@stanford.edu

Administrative Coordinator:
Samuel DeKlerk
samueldk@stanford.edu

Type of Practice:

Pediatric Ophthalmology and Optometry services at Stanford are provided at three clinical locations in Palo Alto (two locations) and Los Gatos (one location). Both the Welch Road and Los Gatos locations are located in a Stanford Children’s multidisciplinary out-patient clinic. Our third clinical location is at Byers Eye Institute, a free standing, state-of-the-art medical and surgical facility dedicated to combating blindness and preserving vision.  Home to over 40 full-time faculty members of the Department of Ophthalmology at Stanford spanning every clinical subspecialty of eye and vision care, the Institute is equipped with state-of-the-art technologies that allow comprehensive care for patients with diseases that range from simple refractive disorders to the most complex ocular and visual disease states.  Attended by a faculty comprised of internationally renowned ophthalmologists and optometrists specializing in the complete range of ophthalmic disorders, patients receive treatment in a comfortable environment from staff who are dedicated to alleviating suffering caused by ocular diseases.  Patients can receive diagnostic services using the most advanced and up to date equipment and when surgery is required, receive therapy in a state-of-the-art-equipped surgical facility, assisted by a perioperative and anesthesia staff dedicated solely to the care of patients requiring ophthalmic surgery.  Each year, more than 70,000 patients receive clinical and surgical care at the Byers Eye Institute.  The department is actively involved in clinical and basic research, with over 30 open clinical trials enrolling patients, helping Stanford Department of Ophthalmology in its goal to remain a leader in the forefront of new scientific advances to preserve and restore vision.

Pediatric Optometry at Byers Eye Institute offers a clinical externship in optometry to fourth-year students from the University of California, Berkeley, School of Optometry.  In this challenging, fast-paced externship, students will work with expert pediatric optometrists and pediatric ophthalmologists in the Lucile Packard’s Children’s Hospital (LPCH), which is a part of Stanford’s medical system. Patients age from several weeks old to 18 years old, with most patients being under the age of 8 years old, and oftentimes they have multi-system medical conditions being co-managed by Stanford’s medical teams.

Students will receive a mixture of direct patient care and shadowing opportunities. Common conditions seen include strabismus, amblyopia, vergence and accommodative disorders, and nasolacrimal duct malformations. As a tertiary care facility, students will also encounter conditions that are less common, such as congenital glaucoma and cataracts, oculomotor dysfunctions and palsies, and genetic conditions or syndromes with ocular manifestations. Students will additionally have the opportunity to shadow in sub-specialties, such as pediatric neuro-ophthalmology, pediatric glaucoma, pediatric contact lenses, and vision therapy.

Highly motivated students with an intent to pursue pediatric optometry are preferred. Students will be expected to review key clinical studies in pediatric vision care (list of reading will be provided) as well as prior coursework from pediatrics and binocular vision courses prior to their first day of clinic as these concepts will be applied on the first day of clinic. Students will also be expected to be self-motivated learners throughout the rotation and will be expected to continue their learning opportunities by reading relevant publications and case reports throughout the rotation. The LPCH department of ophthalmology is fortunate to have a high patient load, thus students will need to work efficiently in order to maximize their learning opportunities.

The rotation is structured to give the student exposure to both acute and chronic ocular conditions that require accurate diagnosis and appropriate therapeutic intervention.  Approximately 60% of the clinical rotation will involve working with full-time ophthalmic faculty in pediatric optometry and neurorehabilitation.  The remaining 40% of the clinical experience will be spent in neuro-ophthalmology, pediatric ophthalmology, pediatric glaucoma, and pediatric cataracts. The student will participate in direct patient care and under the oversight of attending faculty two and a half days a week.  The remaining half day will be spent attending educational sessions, which will include will grand rounds, clinical case conferences, journal clubs, research conferences and didactic lectures.

Demographics

  • Patients cared for by the Pediatric Ophthalmology and Optometry services come from a diverse background of all socioeconomic and ethnic backgrounds from infancy to elderly.

Prerequisites for Student Interns

  • Please see Externships Documentation and Immunization Requirements page for requirements.
  • Student must contact Externship coordinator at least 30 days prior to rotation to allow time for credentialing, EMR training and Immunization requirements.
  • Complete required readings prior to the first day the of the rotation.
  • Review age-appropriate procedures relevant to providing vision care to the pediatric population (ocular alignment, binocular vision testing, visual acuity, etc.).

Educational Objectives

This rotation emphasizes learning through direct patient care, in most cases with infants, toddlers and preschoolers, and school-aged children, with the following goals and objectives:

  • Goal I – To be familiar with the diagnostic modalities needed to care for patients at each stage of vision development (i.e., infants, toddlers, pre-schoolers, and school-aged children).
  • Goal II – To be familiar with the appropriate prescribing guidelines to manage refractive error at each stage of vision development (i.e., infants, toddlers, pre-schoolers, and school-aged children).
    1. Working closely with the faculty, the students will initiate diagnostic workups as well as institute therapies to treat patients with abnormal refractive error based on current evidence.
    2. Students will be expected to be familiar with current literature outlining standard of care for various refractive errors.
  • Goal III – To become familiar with current trends in the treatment and management of amblyopia, strabismus, and non-strabismic binocular vision disorders, including concussion-related vision disorders.
    1. The students will have exposure to various types of unilateral amblyopia (strabismic, anisometropic, and deprivation) and bilateral amblyopia (meridional, isometropia).
    2. Students will be expected to be familiar with current literature and clinical trials regarding the treatment of amblyopia.
    3. Students will be expected to be familiar with current literature and clinical trials regarding the treatment of strabismus (i.e., intermittent exotropia, accommodative esotropia, etc.).
    4. Students will be expected to be familiar with current literature and clinical trials regarding the treatment of convergence insufficiency and accommodative disorders.
  • Goal IV – To enhance the student’s proficiency and competency in performing a complete binocular vision examination.
    1. Students will enhance their ability to obtain a comprehensive case history.
    2. Students will perform a comprehensive binocular vision examination including assessment of visual function, motility, vergence, and accommodation.
  • Goal V – To become comfortable treating non-strabismic binocular vision disorders.
    1. They will become familiar basic vision therapy techniques for vergence and accommodation.
  • Goal VI – To stimulate the students’ knowledge of eye care and to stimulate the students’ scholarly development.

Student Responsibilities

  • Students have direct patient care responsibilities under faculty supervision two and a half days per week.
  • Complete accurate patient records in electronic medical record and obtain faculty co-signature on all notes on the day of the exam.
  • Review pathophysiology and treatment of disorders seen in clinics.
  • Come prepared each day having reviewed the patients scheduled for visits and be prepared to perform appropriate testing.
  • Students must come to the clinic in professional attire and must wear clinic jackets with identification.
  • Bring handheld lenses.
  • Participate in clinical conferences and Pediatric Journal Club.

Miscellaneous Information

  • Please know that there are many providers at this site other than the Optometry Student Extern Director. You will be working with the Optometry Student Extern Director and the other providers in patient care.
  • Normal clinic hours are Monday through Friday from 8:00am to 6:00pm.
  • Educational conferences are held on Thursdays from 7:00am to 12:00pm and every other Tuesday from 7:00-8:00am.
  • Directions from Berkeley: Get on CA-24 W in Oakland from Shattuck Avenue. Take I880 S and CA-84 W to Embarcadero Road in Palo Alto.  Take Embarcadero Road/Oregon Expressway exit from US-101 S.  Continue on Embarcadero Road.  Byers Eye Institute is on your right.
  • Schedule of clinics as of 9-25-2023:

    • Tuesday all day: 730 Welch Road, Palo Alto

    • Wednesday morning: 2352 Watson Ct., Palo Alto

    • Wednesday afternoon: Rotates between 3 clinics

    • Thursday all day:  14601 S. Bascom Ave, Suite 200. Los Gatos, CA, 95032

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