54th Scobee Memorial Lecturer

David G. Hunter MD, PhD
Professor of Ophthalmology Harvard Medical School
Richard M. Robb Chair in Ophthalmology Boston Children's Hospital

Monday November 6, 2023
1:15 - 2:00 PM
Grand Ballroom at the Hilton Financial District San Francisco, CA

The Richard G. Scobee Memorial Lecture Selection Committee is to thank for making the decision that brings us to this day. Greater than two years ago Dr. David Hunter, the 2023 lecturer, received a phone call from the selection committee to give consideration to presenting the 2023 Richard G. Scobee Memorial Lecture here at our national meeting. Fortunately for us he answered that call affirmatively.

I never met Dr. Scobee, I was born too late. I dare say most, if not all of us, have never met Dr. Scobee, but we all live with and see the results of his efforts to promote the field of Orthoptics. He became involved with the American Orthoptic Council, being appointed to the council in 1948. In 1950 he was critical in organizing instruction courses for members of the American Association of Orthoptic Technicians, what we were called before we became the American Association of Certified Orthoptists. In 1951 he founded the American Orthoptic Journal, serving as the first editor of the journal. He is known as the Father of American Orthoptics. We honor Dr. Scobee as the namesake of this lecture.  

The 2023 lecturer is Dr. David Hunter, MD, PhD, who is the Richard Robb Chair in Ophthalmology, Professor and Vice-Chair at the Harvard Medical School. Dr. Hunter is no less interested in research and education and Orthoptics than was Dr. Scobee. He did undergraduate, graduate, and medical school in Houston, Texas, at Rice and then the Baylor School of Medicine. His residency in ophthalmology was done at the Massachusetts Eye and Ear Infirmary/Harvard Medical School. Following this his Fellowship in Pediatric Ophthalmology and Strabismus was done at the Wilmer Ophthalmological Institute, John Hopkins University. 

Dr. Hunter has spoken at every meeting to which we have asked him, participating in American Orthoptic Council and American Association of Certified Orthoptists Symposia. Dr. Hunter has published extensively, having over 150 papers on his curriculum vitae. He has published on topics ranging from the pathogenesis of ROP to surgical treatment of Duane Syndrome to the Use and Cost of Instrument-Based Vision screening. He has published papers in the Journal of AAPOS, the American Journal of Ophthalmology, and JAMA Ophthalmology. Dr. Hunter has co-authored a textbook on Strabismus Surgery and has published a review manual entitled Last Minute Optics.  He collaborates with Dr. Elizabeth Engle to study genetic contributions to common and complex strabismus including Congenital Cranial Dysinnervation Disorders. He is Editor-in-Chief Emeritus of the Journal of AAPOS. He is also founder and chairman of Rebion, a company developing technology in pediatric vision disorders and traumatic brain injury.   

Dr. Hunter is a teacher extraordinaire, having taught 68 mentees, who occupy medical positions in the United States as well as several other continents of the world.  Dr. Hunter has long been a supporter of Orthoptists.  Currently there are ten Orthoptists working at Boston Children’s Hospital.

On behalf of the Richard G. Scobee Memorial Committee and the membership of the AACO, it is my honor and pleasure to bring to the podium our 54th Annual Richard G. Scobee, Memorial Lecture entitled, “Straightforward Strabismus: When and How Strabismus Surgery Can Help Orthotropic Patients” by Dr. David Hunter.

Bruce A. Furr, CO, PhD 
AACO Chair of the Richard G. Scobee Memorial Lecture Committee 

2023 Richard G. Scobee Lecture Abstract
Straightforward Strabismus: When and How Strabismus Surgery Can Help Orthotropic Patients

While we typically offer strabismus surgery only to patients with moderate-to-large-angle misalignment, there exists a cohort of patients who are intensely symptomatic with diplopia despite small deviations, or perhaps even orthotropia, in primary gaze. These patients do not respond to traditional prism therapy, either because of an incomitant deviation or spectacle intolerance. Many are told that nothing can be done to help and that they should learn to live with their diplopia.  In this presentation I will review my experience operating on 33 patients with orthotropia or small-angle strabismus (hypertropia of ≤4 PD or a primary position esotropia of ≤5 PD) in primary gaze. I will present a metric for quantifying symmetric and asymmetric incomitance to better-characterize the pre- and post-operative status of these patients. I will then review the surgical strategies (aimed at improving comitance without creating a new deviation in primary gaze) and present outcomes in terms of objective alignment measurements and patient satisfaction. While it is unusual to offer strabismus surgery to patients with minimal or no strabismus in straight-ahead gaze, the approach that I present should reassure orthoptists and surgeons that these patients can experience transformative improvement in their symptoms while effectively managing the risk of worsening primary gaze alignment.