Importance
Worldwide, ophthalmology teaching is being reduced or eliminated from medical school curricula. The current state of ophthalmic teaching in Australia is unknown.
Background
To evaluate the ...perceptions of junior medical officers (JMOs) and medical students on ophthalmology teaching in Australian medical schools.
Design
Survey‐based cross‐sectional study.
Participants
A total of 838 JMOs and medical students from across Australia.
Methods
Fifty‐six hospitals and 20 medical schools across Australia were contacted. Hardcopy and online surveys were distributed to participants at consenting institutions, evaluating the characteristics of ophthalmology teaching received during medical school and participant confidence in basic ophthalmological clinical skills and knowledge. Factor analysis was performed on confidence scores.
Main outcome measures
Likert scale confidence ratings, teaching methods encountered versus preferred.
Results
Four hundred and thirty‐two (51.6%) surveys were received from JMOs and 406 (48.4%) from medical students. The most common form of teaching received were lectures (71.3% JMOs, 65.5% medical students), while the most preferred type were hospital tutorials (37.7% JMOs, 61.6% medical students). Mean confidence in ophthalmology‐specific skills and knowledge topics were not high for medical students (skills: 2.66/5, 95% confidence interval CI = 2.55–2.76; knowledge: 2.88/5, 95% CI = 2.80–2.96) and JMOs (skills: 2.52/5, 95% CI = 2.43–2.60; knowledge: 2.84/5, 95% CI = 2.77–2.91). Many participants voiced the need for more ophthalmology teaching, particularly clinically oriented opportunities.
Conclusions and relevance
JMOs and medical students do not show high levels of confidence in basic ophthalmological clinical skills and knowledge, and report inadequate emphasis on ophthalmology during medical school.
The authors greatly appreciated the implications of the study by Pan and associates,1 which determined whether some patients with newly diagnosed central serous chorioretinopathy (CSC) may be ...candidates for evaluation for obstructive sleep apnea (OSA). UED is derived from the authors’ published data from the Lateralising Eyelid Sleep Compression study by Figueira and associates, in Ophthalmic Plastic and Reconstructive Surgery in 2014. ...sight-threatening complications of OSA including nonarteritic anterior ischaemic optic neuropathy and normal pressure glaucoma can be diagnosed and managed in a timely fashion.
Dynamic assessment of retinal vascular characteristics can aid in identifying glaucoma-specific biomarkers. More specifically, a loss of spontaneous retinal venous pulsations (SVPs) has been reported ...in glaucoma, but a lack of readily available tools has limited the ability to explore the full potential of SVP analysis in glaucoma assessment. Advancements in smart technology have paved the way for the development of portable, noninvasive, and inexpensive imaging modalities. By combining off-the-shelf optical elements and smart devices, the current study aims to determine whether SVPs can be detected and quantified using a novel tablet-based ophthalmoscope in glaucoma and glaucoma suspects.
Thirty patients, including 21 with confirmed glaucoma (9 men; average age 75 ± 8 years) and 9 glaucoma suspects (5 men; average age 64 ± 9 years), were studied. All patients had intraocular pressure measurements, Humphrey visual field assessment, optical coherence tomography, and a 10-second videoscopy of the retinal circulation. The retinal vasculature recordings (46° field of view at 30 frames per second) were analyzed to extract SVP amplitudes.
SVPs were detected and quantified in 100% of patients with glaucoma and those with suspected glaucoma using the novel device. The average SVP amplitudes in glaucoma and glaucoma suspects were 42.6% ± 10.7% and 34% ± 6.7%, respectively.
Our results suggest that a novel tablet-based ophthalmoscope can aid in documenting and objectively quantifying SVPs in all patients.
Outcomes of this study provide an innovative, portable, noninvasive, and inexpensive solution for objective assessment of SVPs, which may have clinical relevance in glaucoma screening.
To evaluate current routine trabeculectomy technique preferences among Australian and New Zealand Glaucoma Society surgeons regularly performing trabeculectomy surgery.
Survey of experienced surgeons ...who perform trabeculectomy.
Forty-nine surgeons (33 male:16 female) participated in the survey. Trabeculectomy was performed as day surgery (39/47, 83.0%) under local anesthesia (44/47, 93.6%). The surgical techniques most commonly used were a corneal traction suture (44/47, 93.6%), fornix-based conjunctival flap (43/47, 91.5%) and half-thickness scleral flap (38/47, 81.0%). Mitomycin C antifibrotic agent was used in routine cases by 45/46 (97.8%) surgeons. Surgeons applied the antifibrotic agent under the Tenon layer with a pledget (36/46, 78.2%) with a concentration of 0.02% (37/46, 80.4%) for 2 (11/46, 23.9%) or 3 min (30/46, 65.2%). The Kelly (26/46, 56.5%) and the Khaw Descemet (19/46, 41.3%) punches were used to perform the sclerostomy. Most surgeons performed a peripheral iridectomy in all phakic patients (46/47, 97.9%), but less commonly in pseudophakic patients (34/47, 72.3%). Techniques for closure of the limbal conjunctival edge were quite varied with a combination of suturing including purse string (21/47, 57.4%), wing (20/47, 42.6%) and horizontal mattress sutures (33/47, 70.2%). Surgeons reviewed their routine patients four times in the first month (29/47, 61.7%) and continued the postoperative topical steroids for 3-4 months (28/47, 59.6%).
Although a wide range of techniques for trabeculectomy exists among surgeons, there are consistent procedures currently in use to optimize patient outcomes. This report will assist surgeons in choosing which surgical techniques fit their best practice.
Importance
Cataract and primary open‐angle glaucoma (POAG) commonly co‐exist, and cataract surgery is thought to reduce intraocular pressure (IOP), the major modifiable risk factor of POAG.
...Background
Previous studies exploring the effect of cataract surgery on IOP are limited by retrospective design, lack of a control group, medication use and washout and loss to follow up.
Design
Prospective, multicentre, matched case‐control Australian study.
Participants
171 eyes of 108 POAG patients who underwent cataract surgery, matched to 171 control eyes.
Methods
Serial longitudinal IOP measurements were compared before and after cataract surgery, and relative to the controls. A mixed‐effect model was used for the longitudinal data.
Main Outcome Measures
Change in IOP.
Results
The mean follow‐up time was 4.8 (1.4) years. Cataract surgery reduced mean IOP by 2.22 mmHg (95% confidence interval: 1.93‐2.52 mmHg, P < .001) with 59 eyes (34%) achieving at least 3 mmHg reduction. Compared to matched controls, the mean reduction in IOP was 1.75 mmHg (95% confidence interval 1.15‐2.33 mmHg; P < .001). Higher preoperative IOP and being on fewer topical glaucoma medications preoperatively were strongly predictive of a larger IOP reduction in a multivariable model. Anterior chamber depth was not associated with IOP reduction. Eyes with preoperative IOP ≥24 mmHg had a mean IOP reduction of 4.03 mmHg with 81% experiencing at least 3 mmHg reduction. Sub‐analysis of medication naïve and pseudoexfoliation patients showed similar results.
Conclusions and Relevance
Cataract surgery has a confirmed effect in reducing IOP in a “real world” setting of early glaucoma patients.
Purpose To determine whether the incidence of major complications and postoperative corrected distance visual acuity are comparable for surgery on low-grade versus medium-grade nuclear sclerotic ...cataracts. Design This was a prospective, consecutive, single-surgeon, no-exclusion study of 1025 cataract cases with one-month follow-up. Methods Patients were divided into two cohorts according to the nuclear sclerosis grade at presentation, as classified using the Lens Opacities Classification System (LOCS) III. Cohort A, representing low-grade nuclear sclerotic cataracts (grades 1-2), consisted of 739 eyes, while Cohort B, representing medium-grade nuclear sclerotic cataracts (grades 3-6), consisted of 286 eyes. Results There was no significant difference in major intraoperative or postoperative complications (p>0.999) between Cohorts A and B. The mean logMar preoperative corrected distance visual acuity (CDVA) in Cohort A was 0.245 as compared with 0.346 in Cohort B (p<0.001). There was no significant difference between cohorts for postoperative CDVA at one day (-0.168 versus -0.118; p=0.070), one week (-0.180 versus -0.147; p=0.405), or one month (-0.185 versus -0.161; p=0.569). Conclusions There was no significant difference in the incidence of operative complications or postoperative CDVA between the cohorts. These findings suggest that, in experienced hands, surgery for medium-grade nuclear sclerotic cataracts is equally effective and safe as compared with that for low-grade nuclear sclerotic cataracts.
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