Ophthalmology in the undergraduate curriculum. A review in Queensland.

Three hundred and sixty-nine postal questionnaires related to the content and teaching of the undergraduate medical course were sent to Queensland city and provincial ophthalmologists, general practitioners, physicians and surgeons. The return rate was 53%. The views of the four groups were similar in most respects. The majority of respondents thought that ophthalmology should be taught as a separate course. They stated visits to operating theatre and eye casualty unit should be included in the course. Ophthalmologists and general practitioners stated the course should be longer, physicians thought it should remain the same length and surgeons felt less time should be dedicated to the teaching of ophthalmology. Topic areas regarded as essential were the acute care areas: trauma; glaucoma; infection; use of an ophthalmoscope; acute visual loss; and red eye. Squint was also regarded as an essential area by ophthalmologists.     

Undergraduate ophthalmology education survey of New Zealand ophthalmologists, general practitioners and optometrists

Aim : To determine what New Zealand ophthalmologists, general practitioners and optometrists consider important ophthalmic topic areas requiring emphasis in the medical undergraduate curriculum. Method : A total of 793 questionnaires related to the content and teaching of undergraduate ophthalmology were sent to ophthalmologists, general practitioners and optometrists. Results were analysed separately for the three respondent groups and as a whole. Results : Four hundred and fourteen questionnaires were returned (52% return rate). Overall responses of the three participant groups were similar and agreed favourably with the current curriculum. The ability to measure visual acuity (97%) and pupillary reflexes (93%), perform ophthalmoscopy (92%), and assess visual fields (68%) were regarded as ‘important or essential’ by the majority of respondents. Only 53% of respondents consider the ability to diagnose chronic open angle glaucoma as important. The respondents stressed the importance of the diagnosis of predominantly anterior segment disease contrasting with the traditional bias towards the teaching of ophthalmoscopy and posterior segment disease. The majority of respondents stressed the importance of graduating medical students being able to treat bacterial and allergic conjunctivitis, styes, blepharitis, corneal abrasion, and corneal and conjunctival foreign bodies, areas present but not normally emphasized in current curricula. Conclusion : The findings of this study provided additional data to facilitate curriculum design and illustrated the value of an integrated problem‐based learning approach in ophthalmology undergraduate teaching.     

Ophthalmology in Taiwan

We herein report the current status of ophthalmology in Taiwan. There are 1667 ophthalmologists in Taiwan (up to the year 2011), with an average of 7.22 eye specialists/100,000 people. The ophthalmology residency program is a 4-year course in Taiwan, and around 40–44 new residents pass out each year. The Ophthalmological Society of Taiwan and many other professional ophthalmological organizations, and 30 teaching hospitals provide continuing education for practicing ophthalmologists and hospital staff. From 2002 to 2010, the average yearly cataract surgery rate in Taiwan was 5350/million people. Taiwan has held many international congresses. The major areas of biomedical research in ophthalmology in Taiwan are ophthalmic epidemiology, glaucoma, vitreoretinal diseases, cornea, and stem cells. From 1990 to 2010, Taiwan ophthalmologists have published 15 monographs, 15 textbooks, and 2184 scientific articles. The future objectives of Taiwanese ophthalmologists are to promote preventive ophthalmology, to expand efforts in basic research, to establish a national eye-diseases registry, and to support the Taiwan Journal of Ophthalmology in becoming a Science Citation Index journal.     

Geographical distribution of eye health professionals and cataract surgery in Lao People’s Democratic Republic

Purpose: To assess the geographical distribution of eye health professionals and cataract surgery procedures in Lao People’s Democratic Republic (PDR) over the last decade.

Methods: The number of ophthalmologists (defined as physicians who have completed full education and training in ophthalmology), eye doctors (defined as physicians who have completed education and training in only cataract surgery), ophthalmic nurses, and cataract surgery procedures across 16 provinces and Vientiane municipal for the middle/late 1990s, the year 2000, and the most recent year (2005–2006) were obtained from the registration system of eye health professionals and the track record in cataract surgeries in the Ophthalmology Center, Ministry of Health. The number of cataract surgeons (total number of ophthalmologists and eye doctors) per million population, the number of ophthalmic nurses per million population, and the cataract surgical rate were calculated for various geographical units using available population data from the census in 1995, 2000, and 2005. The Gini coefficients, measures of inequality that range from 0 (total equality) to 1 (total inequality), were computed at three time points.

Results: The number of ophthalmologists, ophthalmic nurses, and cataract surgery procedures increased in this country as a whole, although the number of eye doctors did not change after 2000. The Gini coefficients for them also improved (Cataract surgeons: 0.792, 0.415, and 0.361; Ophthalmic nurses: 0.448, 0.354, and 0.259 and; Cataract surgery: 0.366, 0.309, and 0.248 in the 1990s, 2000, and 2005-6, respectively).

Conclusion: Imbalances in the geographical distribution of eye health professionals and cataract surgery decreased over the last decade.     

循序渐进地进行眼科研究生的培训

在临床医学中,眼科学是相对独立的学科,严密精细是眼科诊断治疗的特色,眼科医生既要着眼于局部,又要放眼于整体。因此在眼科研究生的培训中,我们不仅改进教学方法、利用现有资源进行研究生的理论培训,还要更好地完善临床技能培训,让研究生通过不同阶段的培训具备独立思考和应对的能力,并掌握利用现有教学资源获取前沿知识的技能。（眼科, 2016,25： 425-426）     

The differential diagnosis of red eye: a survey of medical practitioners from Eastern Europe and the Middle East

A survey amongst ophthalmologists and general medical practitioners from nine countries in Eastern Europe and the Middle East was conducted to estimate the percentage of patients presenting with a red eye and to examine differential diagnosis and treatment. Practitioners recorded brief details of every patient seen and detailed information concerning signs and symptoms, differential diagnosis and treatment for all patients presenting with a red eye during 20 consecutive days in the period between May and September 2004. Red eyes accounted for approximately 15% of consultations with ophthalmologists and almost 6% with general medical practitioners. Allergic conjunctivitis was the most common diagnosis (35%), followed by dry eye (25%) and bacterial conjunctivitis (24%). General medical practitioners were far more likely to prescribe a combination topical antibiotic and steroid preparation than ophthalmologists. This survey illustrates that red eye remains a very important problem for both ophthalmologists and general medical practitioners. Identification of dry eye as a common cause of red eye symptoms and more appropriate treatment of dry eye, allergic conjunctivitis and viral conjunctivitis are key messages to emerge.     

Cataract Extraction in an Eye with a Filtering Bleb

Seventy-two ophthalmologists with a major interest in glaucoma (glaucoma surgeons) responded to a questionnaire as to how they would remove a cataract from a hypothetical 60-year-old patient with a functioning filtering bleb in the superior nasal quadrant. The majority recommended an intracapsular cataract extraction through a lateral or inferolateral limbal incision or a superior corneal incision anterior to the bleb. Most of the glaucoma surgeons preferred to close the wound with five to nine interrupted 10—0 nylon sutures. Estimates of the percentage of blebs failing after cataract extraction ranged from zero to more than 50%, with a median of 30%. The majority of the glaucoma surgeons stated that they would never, or only under exceptional circumstances, implant an intraocular lens in an eye with a filtering bleb. Twelve ophthalmologists with a major interest in intraocular lens implantation (implant surgeons) responded to the same questionnaire. They were more likely than the glaucoma surgeons to recommend extracapsular cataract extraction and to implant an intraocular lens in an eye with a filtering bleb.     

Attitudes to research and research training among ophthalmologists and ophthalmology trainees in New Zealand

Purpose: To determine the attitudes to research and research training among ophthalmologists and ophthalmology trainees in New Zealand. Methods: A structured, self‐administered questionnaire was devised and after preliminary validation a postal survey was sent to all ophthalmologists and ophthalmology registrars and fellows in New Zealand. Results: A total of 82 replies were received from 115 questionnaires sent out; a response rate of 71.3%. An overwhelming majority found research to have benefited their education, clinical practice and career; 67.1% of the respondents intended to do research in the future. Although a majority (56.4%) felt research to be beneficial to ophthalmology training, 42.3% felt research would be of limited or no benefit when selecting candidates for vocational training. However, 97.5% of respondents felt that ophthalmology trainees should undertake some form of research during training, with most supporting small studies or case reports (44.4%) or a short structured training course in research (42.0%). Interestingly, 86.6% felt that research methodology and data analysis should be taught in a structured fashion with most supporting courses or seminars of a few weeks duration during the vocational training period. Many ophthalmologists felt inadequately equipped or trained to mentor and supervise trainees undertaking research and 41.5% of consultant ophthalmologists felt further training to fulfil this role would be beneficial. Conclusions: This survey suggests that New Zealand ophthalmologists generally approve of and support a place for research, possibly of a more structured design, during ophthalmology training.     

An audit of disease diagnoses made by optometrists

Background : Several Australian ophthalmologists have sworn affidavits that, in their opinion, optometrists have deficient training in the detection of eye disease and systemic disease having ocular manifestations, and are unable to detect a number of medical conditions having ocular manifestations. The deponents swore that optometrists could not make a medical diagnosis because they lack medical Hampton, Victoria training. To test these opinions this report details a prospective comparison of diagnoses made by three optometrists with the diagnosis subsequently made by the ophthalmologist or physician to whom the patients were referred. Methods : All referrals made to ophthalmologists or physicians were recorded, together with the optometrists' diagnoses, which were recorded prior to referral. On receipt of the medical practitioner's report, his or her diagnosis was recorded and compared with the optometrist's diagnosis. Results : Four patients referred to ophthalmologists were lost to follow-up. Agreement between the optometrist's and ophthalmologist's diagnoses was unequivocally correct in 114 (93.4 per cent) of the 122 referrals for which follow-up was available. The optometric diagnoses of ophthalmic disease were correct, but incomplete, in six cases and, in two cases (Saltzman's dystrophy and Chandler's syndrome), the optometrist's diagnosis was inappropriate. Referrals to family physicians totalled 18, of which three were lost to follow-up. Of the remaining 15 patients referred, 12 diagnoses (70 per cent) were correct and three were incorrect. The three incorrect diagnoses were one case of suspected cranial arteritis and two cases of suspected diabetes, or impaired glucose tolerance. There were 38 separate diagnostic conditions referred to ophthalmologists and 11 separate conditions referred to general physicians. Conclusions : The optometrists who conducted this study were able to make diagnoses over a wide range of ocular and systemic diseases. These diagnoses were substantially in agreement with the diagnoses made by ophthalmologists and general physicians. This suggests that die training and clinical experience of optometrists can be adequate to provide a high standard of primary eye care and that optometrists are able to detect disease conditions that require referral to medical practitioners.     

Factors influencing career choice in ophthalmology

BACKGROUND: To investigate the factors influencing choice of ophthalmology as a career in medicine. METHODS: Data were extracted from the 2004 National Physician Survey, a questionnaire distributed to all physicians across Canada. Data were categorized by medical discipline, and chi2 comparative analyses were done. RESULTS: Intellectual stimulation emerged as the most frequently cited factor influencing career choice for ophthalmologists and nonophthalmologists alike (81% and 79%, respectively). Compared with other physicians, ophthalmologists were significantly more likely to cite flexibility (58% vs. 42%, respectively), mentorship (42% vs. 31%, respectively), and earning potential (38% vs. 26%, respectively) as important factors (p<0.001). INTERPRETATION: Intellectual stimulation is the principal reason physicians pursue a career in ophthalmology. Ophthalmologists cite flexibility, mentorship, and earning potential as important factors more frequently than do physicians of other disciplines.     

Attitudes and behaviour of ophthalmologists to smoking cessation

AIMS: Growing evidence suggests a causal association between smoking and eye disease. This study explores the current beliefs and practice among UK consultant ophthalmologists towards delivering smoking cessation advice to eye clinic attenders. METHODS: A cross-sectional survey using a postal questionnaire of all UK NHS hospital based consultant ophthalmologists was conducted. The questionnaire explored whether: ophthalmologists identify the smoking status of their patients, advise about the increased risk of eye diseases among smokers, and deliver smoking cessation advice. The availability of departmental smoking cessation resources was also ascertained. RESULTS: The response rate was 55% (485/886). Of the responders 79% were males. Only 35% of responders asked about smoking status every time or most times for new patients and 5% for follow-up patients. In all, 40% claimed to always or usually advise patients to quit smoking and 61% claimed to always or usually mention eye disease as a reason to quit. Only 14% assessed motivation to quit and 22% provided advice and assistance about how to stop smoking to smokers who wished to quit. Female ophthalmologists were more likely to undertake most aspects of smoking assessment and intervention. Only 18% of responders stated that their departments provide information about smoking for patients and 6% stated that support is available for patients wanting to quit smoking. CONCLUSION: The assessment of smoking status and provision of targeted support for smokers to quit could be substantially improved in UK ophthalmology departments. There is a need to introduce smoking cessation support into routine ophthalmic practice and provide the resources to support this.     

Optometry/Ophthalmology: the Future

• 1 The most serious problem for the future of optometry and ophthalmology is surplus manpower. It is imperative that the two groups immediately join in future eye-manpower studies before we face an insoluble problem.
• 2 It is important that moderate leadership of optometry and ophthalmology put more time and effort into reducing the conflict between our two professions. The present actions by optometry and ophthalmology in legislative hearings are producing nothing but harm and a lack of credibility for optometry and ophthalmology. In general we are looked upon as ‘money grabbers’.
• 3 It is important that greater efforts be made in the area of joint education between optometry and ophthalmology in order to obtain not only better patient care but also to develop a better understanding of our roles in the eye-healthcare field. To obtain this, ophthalmology should provide leadership in developing programmes for optometrists. However, it is equally important that optometry ask ophthalmology to assist in formulating joint programmes.
• 4 It is important that we expand MD-OD or OD-MD committees that meet on a regular basis in order to discuss inter professional problems and to present a joint front in areas of common interests where unified action will be of benefit to the public, optometrists and ophthalmologists.
• 5 It is desirable to form more group practices of optometrists and ophthalmologists in order to provide better services at lower costs. The increasing costs of instruments, salaries, rent, etc., are making solo practice in metropolitan areas too expensive to provide services at a reasonable cost.
• 6 If optometry and ophthalmology fail to form closer relationships, the future is not good for either group, because the third party who pays the bills and the public will take advantage of our inability to respond rapidly to social problems and health-care costs.
• 7 It is important that optometry and ophthalmology review their individual attempts to obtain consumer attention, because the present actions result in consumer confusion. Despite both optometry's and ophthalmology's efforts to ‘educate the public’, a majority of consumers think of eye doctors and not the difference between the skills and practices of optometrists and ophthalmologists. Many consumers interpret these educational efforts of the public by both optometry and ophthalmology as serving the self-interest of each group and increasing eye-health-care costs.

(The Carel C. Koch Award Lecture, 1977 reprinted by kind permission of the American Journal of Optometry and Physiological Optics 55, 1 .)     

Cataract surgery training using surgical simulators and wet-labs: Course description and literature review

Cataract surgery is the most common surgery to face the ophthalmology training resident. To facilitate achieving surgical competency and reduce complication rates, wet laboratories and surgical simulators are used in surgical disciplines worldwide. We developed a simulator and wet-lab course that aims to build the microsurgery skills of trainees and improve safety during real surgical procedures. Herewith, we describe the standardized hands-on course that incorporates these tools for advanced training. Additionally, we review the literature on wet-lab and surgical simulators in ophthalmology, focusing on their importance in training centers. The course is offered four times per year since it started in December 2015, and t total of 88 trainees participated to date. Feedback received from the trainees’ supervising surgeons showed that this course addresses a major training challenge, and that a permanent version of this course should be established at each training center. We suggest incorporating fixed wet-lab and surgical simulator competencies in ophthalmology training programs. Additionally, we recommend that residents be allowed to operate on real patients only after passing the course. We believe that these steps would foster ophthalmologists with advanced training, decrease their learning curve, and empower them to safely conduct cataract surgery with low complication rates.     

Ocular drug abuse in Lagos, Nigeria

Ocular complications as severe as blindness are encountered as a result of drug abuse in the eye patients seen at the Lagos University Teaching Hospital, Nigeria. They are due to self-administered medications, ignorance, social and economic factors and malpractice. There is an acute need for the Nigerian general practitioners to be trained on the management of ocular problems with demarcation as to when references to the ophthalmologists are imperative. Traditional healers still see a lot of the patients before they come to the hospitals. An understanding between the Western trained doctors and the traditional healers is necessary to curb the unnecessary complications and blindness. Public enlightenment programmes in the national medias should be implemented in order to dissuade patients from self-administration of medications and from consulting the unspecialized.     

Training of an ophthalmologist in concepts and practice of community eye health

Training in community eye health (CEH; public health applied to ophthalmology) complements clinical ophthalmology knowledge and enhances the physician's ability to meet the needs at the individual and community level in the context of VISION 2020. The upcoming version of the ophthalmological residency curriculum that was developed by the International Council of Ophthalmology (ICO) includes a new, specific section on CEH. It has basic, standard, advanced and very advanced levels of goals (the last one is exclusively for fellows/master students), and provides a public health approach to the main causes of blindness and low vision. The number of individuals aged ≥60 years is increasing twice as fast as the number of ophthalmologists, and as this age group is more likely to become blind/visually impaired, accessibility to eye care in the near future might be suboptimal even in wealthier countries. In order to achieve VISION 2020 goals, it is necessary to train more ophthalmologists and other eye care workers. However, the adoption of CEH component of the ICO curriculum for ophthalmology residents will enable them to meet local needs for eye care.     

Survey of german clinical prescribing philosophies for hyperopia.

PURPOSE: We surveyed a group of German ophthalmologists to evaluate their prescribing philosophies for hyperopic refractive error in symptom-free children and to compare them with the two groups of U.S. pediatric ophthalmologists and U.S. pediatric optometrists as surveyed by Lyons et al. METHODS: Practitioners were selected from a list of ophthalmologists on the Internet. They were either in general practice in three cities in northern Bavaria or affiliated with large ophthalmology teaching hospitals in Wuerzburg and Erlangen. The survey questions of Lyons et al. were translated into German and mailed to 103 ophthalmologists. The data received from the German ophthalmologists were compared with those of the U.S. optometrists and ophthalmologists. RESULTS: A total of 45 surveys (44%) were returned to us and analyzed. In cases of asymptomatic bilateral hyperopia, German ophthalmologists did not prescribe significantly differently from U.S. optometrists at all patient age groups (p > or = 0.05), but they did differ significantly from U.S. ophthalmologists (p < 0.001). Prescribing fractional amounts of hyperopia or astigmatism was not a popular rule of thumb among the German ophthalmologists, and there was no statistical difference between the German and U.S. practitioners. German ophthalmologists would prescribe for anisometropia for all patient age groups in the same way as both U.S. optometrists and U.S. ophthalmologists. CONCLUSION: The prescribing philosophies of German ophthalmologists for pediatric patients did not differ from those of U.S. ophthalmologists and U.S. optometrists when prescribing for anisometropia; they did differ from those of U.S. ophthalmologists but not of those of the U.S. optometrists when prescribing for asymptomatic bilateral hyperopia.     

J Donald M Gass MD: father of macular diseases, and one of the ten most influential ophthalmologists of the 20th century

John Donald MacIntyre Gass, MD was one of the most significant figures to emerge in ophthalmology in the last 100 years. There could be few ophthalmologists who cannot attribute part of their increase in understanding of retinal disease to the influence of Don Gass. His insights opened up opportunities for many new effective therapies. He has influenced ophthalmic thought worldwide, if not by his presence as a visitor, then through his scientific publications, his outstanding books and the international fellows he trained. Like many distinguished physicians, Don Gass's clinical acumen was well grounded in his understanding of ocular pathology. This experience was gained under the mentorship of Lorenz E Zimmerman, MD, who trained a number of distinguished ophthalmologists, who subsequently became professors. Professor Gass passed away on February 26, 2005 at the age of 76 years from pancreatic carcinoma. With the demise of Don Gass, the world of ophthalmology has lost an extraordinary physician of great talent, commonsense and humility. On the other hand it has gained a generation of young ophthalmologists inspired by his example.     

Recruitment and manpower in pediatric ophthalmology and strabismus.

PURPOSE: Many have observed what appears to be declining interest on the part of ophthalmology graduates in pediatric ophthalmology and strabismus (PO&S) as a career. Four questions might address this concern: (1) Has there been a decline in the number of fellowship positions filled in the period 2000 to 2005? (2) Why do graduates choose other career paths? (3) Assuming there has been a decrease in interest in PO&S, does it reflect dissatisfaction on the part of pediatric ophthalmologists in their field? (4) What can be done to enhance the appeal of the subspecialty? METHODS: Data from the San Francisco Matching Programs covering the years 2000 through 2005 included the numbers of ophthalmology graduates, their subspecialty choices, the number of applicants to PO&S and other subspecialty fellowships, and the number of fellowship positions offered. Supplemental surveys assessed positions filled outside the match and international fellows. Factors influencing residents' career choices and the job satisfaction of pediatric ophthalmologists were analyzed in separate surveys. RESULTS: The number of fellowship positions in PO&S increased from 41 to 50 between 2000 and 2004. The number of graduates participating in the match has varied but remained the same (38) in 2005 as in 2000. Graduates were discouraged from PO&S by inadequate mentoring, by aversion to children, and by higher compensation in other fields. Pediatric ophthalmologists generally are highly satisfied in their careers, although financial compensation is a concern for many. CONCLUSIONS: Pediatric ophthalmologists should remain optimistic about recruitment but could enhance the appeal of PO&S by teaching more effectively and by promoting the field.     

眼科学PBL教学模式可行性调查与分析

目的:探讨我国高等医学院校眼科学教学引入PBL教学模式的可行性。方法:以问卷形式对157名处于临床实习阶段的长江大学2009级临床医学专业学生进行调查,然后对调查结果进行分析。结果:调查显示,尽管77.9%的学生对目前眼科学传统教学模式的教学效果比较满意,但仍有82.8%的学生赞成眼科学课堂引入PBL教学模式;如果在传统教学模式与PBL教学模式两者间做选择,则有83.4%的学生愿意选择PBL教学模式;56.6%的学生认为PBL教学模式有利于培养学生的自学能力。虽然主客观条件为眼科学引入PBL教学提供了可行性,但PBL教学模式也存在不足,73.1%的学生认为学校教学设施还不够,78.6%的学生认为只有部分眼科学内容适合采用PBL教学模式教学。结论:PBL教学模式值得在眼科学教学中进行改革与探索,以创建适合我国国情的眼科学教学模式。     

Suspected giant cell arteritis: a study of referrals for temporal artery biopsy

Background: The purpose of this study is to describe the nature of cases undergoing temporal artery biopsy (TAB) for suspected giant cell arteritis (GCA). Methods: A retrospective review of case notes was undertaken for all patients on whom ophthalmologists had performed TAB in 2 teaching hospitals between 1995 and 2001. Presenting symptoms, referring specialty, TAB result, treatment, and discharge diagnosis were recorded.Results: Ophthalmologists performed TAB on 110 patients for suspected GCA. A variety of specialties referred patients to ophthalmology for TAB; presenting symptoms varied with referral source. Of the 110 TABs, 21 (19%) were reported as positive for GCA, 84 (76%) were negative, and 5 (4.5%) were reported as inadequate. The symptoms most commonly associated with a positive TAB were visual disturbance (15/21) and headache (15/21). The odds ratios for having a positive TAB result rather than a negative result were 1.0 for the presence of headache, 4.1 for visual disturbance, and 6.7 for jaw claudication. Interpretation: Physicians were faced with a different population of GCA suspects than ophthalmologists. While physicians should be alert to the significance of visual symptoms or jaw claudication, ophthalmologists should be ready to facilitate prompt TABs when appropriate. TAB should be performed promptly and an adequate length of artery taken for biopsy. An argument can be made that TAB is not needed in cases of suspected GCA. However, a positive result provides firm justification for the use of steroids. We feel that TAB has a useful role and we make reference to methods to maximize its usefulness.