Ophthalmology division chief’s innovative vision continues to yield international awards

During his nearly 20 years as a pediatric ophthalmologist, Dr. Rahul Bhola has performed thousands of surgeries to correct strabismus, a condition in which the eyes are misaligned and do not track together.

And after each procedure, he feels an immense sense of gratitude for being able to profoundly affect the lives of children who, by the critical age of around 5, stand the best chance for successful outcomes before their brains get used to living comfortably with eye misalignment.

“What drives me is the patients we treat,” says Dr. Bhola, division chief of CHOC’s Specialists Ophthalmology and an associate clinical professor at UC Irvine School of Medicine. “The biggest thing is early diagnosis and prompt management, and with these surgical procedures, I can see the results right away. What can be better than that?”

Already the recipient of numerous national and international awards, Dr. Bhola, who joined CHOC in July 2017, continues to break new ground.

Recently, a paper he presented at a global conference of the World Society of Paediatric Ophthalmology and Strabismus won top honors in the category of innovation and strabismus surgery.

During his presentation at the WSPOS’ World Wide Connect 2020, Dr. Bhola described a new approach to surgically correct strabismus in kids diagnosed with horizontal misalignment associated with minimal vertical misalignment.

Traditionally, most surgeons would surgically correct the horizontal misalignment and hope the vertical condition would work itself out. There’s a risk, Dr. Bhola explains, in surgically correcting for mild vertical misalignment. The procedure involves cutting off and repositioning a muscle in a different spot, which can result in an overcorrection – thus making things worse than better.

Dr. Bhola came up with the idea of performing what he calls graded marginal myotomy of inferior oblique. Instead of cutting and repositioning the muscle off the eyeball, he makes an incision to weaken the muscle avoiding the potential risks of overcorrection and by grading is able to adjust the amount of vertical strabismus correction.

“We use prisms to measure the degree of misalignment to better determine how much we need to weaken the muscle,” he explains.

Dr. Bhola says he’s performed the technique on some 60 patients with excellent results.

“It sounds very intuitive, it sounds very easy, but it had never been done before,” he says.

Dr. Bhola says the paper he presented at the conference is expected to be published soon in a major medical journal.

“This (surgery) will be a great addition to our armamentarium of strabismus surgery,” he says.

Fixing the problem in one procedure

Strabismus is prevalent in about 5-7 percent of the pediatric population, Dr. Bhola says. In most cases, the condition is the result of an abnormality of the neuromuscular control of eye movement. Many children who undergo surgery for strabismus need about two to three surgeries in their lifetime for the condition to be adequately corrected, he adds.

Not so with his recently developed procedure.

“That’s one of the beauties of this surgery,” says Dr. Bhola, explaining that he’s able to correct both horizontal and vertical misalignment in one procedure.

“The chances of achieving a good outcome is best with the first surgery,” Dr. Bhola says.” In my experience, it’s best to be aggressive and adequately correct both horizontal and vertical misalignment in order to get the best possible surgical outcome.”

When Dr. Bhola joined CHOC a little more than three years ago, he was tasked with developing CHOC’s Ophthalmology Division into a destination center in Orange County and beyond.

He’s well on his way.

In 2019, CHOC’s Ophthalmology Division saw 5,500 patients (equating to 8,000 patient visits) with a 90-percent-plus patient satisfaction rate, Dr. Bhola says.

“We’re seeing exponential growth,” adds Dr. Bhola, who plans to grow the division to five or so specialists over the next few years. Currently, the division has two.

After graduating from medical school in 1996 and completing his first Ophthalmology residency from University of Delhi, India, Dr. Bhola further pursued another residency in Ophthalmology in the US. He went on to do his Pediatric Ophthalmology fellowship from two prestigious ophthalmology training programs. He says he always wanted to be a pediatrician and later fell in love with ophthalmology, and being able to practice Ophthalmology at CHOC, a world class pediatric hospital, gave him the best of both worlds.

“This is something I’m passionate about,” he says.

To learn more about Ophthalmology at CHOC, click here.

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Virtual pediatric lecture series: vision screening refresher

The CHOC virtual pediatric lecture series continues with Vision Screening: Refresher for Primary Care Clinicians.

This online discussion will be held Monday, Sept. 28 from 12:30 p.m. to 1:30 p.m. and is designed for general practitioners, family practitioners and other healthcare providers.

Dr. Rahul Bhola, medical director of ophthalmology at CHOC, will present information on several topics, including the milestones of visual development and measuring visual acuity in children. Dr. Bhola will also discuss ways to manage common pediatric ocular disorders, as well as how to determine when a child should be referred to an ophthalmologist.

This virtual lecture is part of a series provided by CHOC that aims to bring the latest, most relevant news to community providers. You can register here.

CHOC is accredited by the California Medical Association (CMA) to provide continuing medical education for physicians and has designated this live activity for a maximum of one AMA PRA Category 1 Credit™.

Please contact CHOC Business Development at 714-509-4291 or BDINFO@choc.org with any questions.

A physician shares his best tips for a successful telehealth practice

Ophthalmology might not be the first specialty that comes to mind when envisioning a telehealth practice, but Dr. Rahul Bhola, medical director of ophthalmology at CHOC, has seamlessly integrated the service in his practice, completing more than 900 telehealth visits since March.

In this Q & A, Dr. Bhola outlines his team’s success in transitioning to telehealth, and shares best practices that physicians in a variety of specialties can put into practice: 

What does an ophthalmology telehealth appointment look like?

A synchronous (live audio-video) CHOC ophthalmology telehealth appointment is divided into four components. I call them the four C’s: contact, connect, consult and care.

  1. Contact
    Our front desk reaches out to the family to confirm contact information. We send a Zoom link to the families, along with information about how to connect to Zoom and download the visual acuity app to check vision before the appointment. 
  2. Connect
    As the appointment day approaches, our technician connects with the family to discuss any technical issues that should be resolved prior to the physician consultation. The technician also goes over the at-home visual acuity check and evaluates basic medical history. 
  3. Consult
    On the actual day of the appointment, the physician connects with the families on Zoom to go over the pertinent history and visual acuity, and performs a focused examination including an external and ocular motility exam. If needed, pictures and videos from the family are requested for further evaluation. This enables us to diagnose a majority of anterior segment ocular issues as well as visual acuity concerns like amblyopia, refractive errors and ocular motility disorders.
  4. Care
    We discuss the treatment care plan and review any medical issues or concerns the patient is experiencing. Throughout this process, we can fulfill their needs ranging from prescription refills for medication or broken glasses without them having to step outside the comfort of their home.

Our office will then schedule a follow-up visit depending on the medical necessity.

Dr. Rahul Bhola offers his best tips for telehealth practices
Dr. Rahul Bhola, medical director of ophthalmology at CHOC , has completed more than 900 telehealth visits since March.

How do your patients and families feel about telehealth?

While some physicians may have been wary of telehealth care, I was pleasantly surprised that patients love telehealth.

Telehealth helped our patients and families feel secure, supported and assured that there would be no interruption in the patient’s care plan during COVID-19.  Our families are so grateful that during this time of emergency, their physician was able to connect with them to address any urgent issues and follow them in clinic on a need-to basis.

Due to the positive response we have received from our families, we will continue to offer telehealth visits for our families, when appropriate.

 Does telehealth compromise quality of care?

Not at all. Providers are often able to spend more time with patients during a telehealth visit. Children are more comfortable in their home setting and you can engage more with them and spend more time on-screen with them.

If we felt the urgency to see our patients face-to-face after the initial exam, we schedule in-person appointments.

What makes your telehealth visits successful?

The expression “Necessity is the mother of invention” really is true when it comes to telehealth.  Telemedicine has been around for a while, but it took a pandemic to make it universal and successful. As soon as the stay-at-home orders were announced we knew we had to connect with our patients to prevent any disruption of their care. Our team was not afraid of change and we realized the urgency to adapt to the circumstances right away to provide uninterrupted care to our patients and their families. We reallocated our resources to maximize our outreach; our goal was to connect with each and every patient scheduled to be seen in the clinic.

What advice and tips do you have for other providers to do telehealth successfully?

Being open minded, adaptable to the changing circumstances and embracing technology were a few things that helped us during this unprecedented time. We created a vigorous team of both technical and non-technical staff in a short span of time to enable successful initiation of a robust tele-ophthalmology program. The key was strategizing dynamically in this constantly changing environment and having frequent huddles with the team to address any issues.

Very quickly we realized that telehealth was amazing to address the four-part aim of healthcare: access, cost-effectiveness, patient satisfaction and physician satisfaction.

There will be nuances for specific specialties. In our case the American Academy of Ophthalmology right away provided resources and tools to help us initiate an effective synchronous telehealth portal.

Technological innovations like visual acuity apps and the ocular motility app were phenomenal tools developed to assist effective consultations.

Find other resources to grow your telehealth practice.