Ron Zimmerman

May 01, 2012

May 1, 2012 (San Antonio, Texas) — Good distance fixation during test measurements is essential in the management of pediatric strabismus.

James L. Mims III, MD, who is in private practice in San Antonio, Texas, displayed a set of mechanical toys he modified here at the American Association for Pediatric Ophthalmology and Strabismus 38th Annual Meeting. Unlike the standard set of barking dogs that briefly hold the attention of a child, Dr. Mims can trigger his toys' movements at the exact moment he needs to grab a child's attention during test measurements.

He uses toys powered by 8x lithium batteries so that he is not dependent on wall current. He surgically taps into the 2 wires in the toys' press-on, press-off switch in the toys' limb or paw. He runs a larger-gauge wire (14 or 16 gauge) to the 2 wires attached to that switch, then adds a new remote switch that he can control.

"I put in the yapping puppies 30 years ago, but they give you so little attention, about 30 seconds, that you have to use a foot pedal. I had about 10 of these other singing toys laying around, and in desperation one day I just tore into one.... I'm a surgeon, right? My wire cutters hit the wires and it turned the toy on and off. That was my first big breakthrough.... Then all I had to do was figure out a way to touch the wires," Dr. Mims told Medscape Medical News.

Through trial and error, Dr. Mims figured out a way to control his animated figures and determined he needed to use a larger-gauge wire with lower resistance to cover the 26 feet he needed. "The next big breakthrough was these lithium AA batteries that last more than a year," he said. "Another big deal is that the routine [of these new toys] is so good and so long, compared to the barking puppies, that you can afford to hit the switch and then pick up your paddle and your prism. With the puppies, you only have 30 seconds for 3 dogs, and you have to have your prism and paddle in your hand when you start them. My favorite toy has a 2-minute routine. That's long enough for me to do 5 cardinal positions."

His presentation delighted other eye surgeons as much as it might pediatric patients.

Deborah Lenahan, MD, in private practice in Grand Junction, Colorado, laughed as she reacted to Dr. Mims remotely operated toys. "I think it's wonderful, the diversity. You're limited now to 1 or 2 vendors and they're really, really expensive. They don't last long; they wear out and you have to order another. Kids won't look at a static toy, not even a dinosaur. They need something like this, something that flaps and sings. This is the good part of being an ophthalmologist — I get to play with toys all day!"

Dr. Mims said that battery-operated figures are readily available. "Walgreens is full of the seasonal ones around Valentine's Day and Christmas — hundreds of kinds. And they're relatively cheap," he said.

Denise Satterfield, MD, from Sacramento, California, emphasized that despite the fun appearance of the dancing animals, they are absolutely necessary in her ophthalmology practice. "You have to have something like this for a 2-year-old," she said. "You have to get them to look at the end of the room.... When a kid sees a dancing animal, they're glued to it. They won't look away; you can turn their head this way and that way. You can even get a corneal foreign body off their eye and they won't even know you've gotten near them."

Dr. Mims seems to love the joy his animated toys bring to other ophthalmologists. He even posts a small sign near his display: "No live animals were harmed in this research."

Dr. Mims, Dr. Lenahan, and Dr. Satterfield have disclosed no relevant financial relationships.

American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 38th Annual Meeting: Poster 45. Presented March 27, 2012.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.