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PubMed1996

Ophthalmologic considerations in using antimalarials in the United States.

Ophthalmologic considerations continue to be important in the use of antimalarials. In the United States, hydroxychloroquine is prescribed much more frequently than chloroquine. Despite the favorable safety record, potential retinal problems cause patients to often be afraid to take antimalarial medicine. Ophthalmologic visits are recommended every three months by the drug manufacturer, but most often are scheduled every six months by physicians. Ophthalmologic examination includes questioning about visual symptoms, visual acuity tests, careful fundoscopic evaluation and a visual field assessment. Amsler grid self evaluation is not yet wide-spread.

Antimalarials↗

PubMed1997

[Ophthalmological involvement in Behçet disease. Apropos of 520 cases].

PURPOSE: The aim of this paper is to compare our results with the literature and to discuss some therapeutical aspects of the disease. METHODS: This retrospective study concerned 520 cases of Behçet's disease followed by internal diseases department and ophthalmology service of U.H.C. Averroes (Casablanca, Morocco) during 10 years. RESULTS: There were 432 men (83%) and 88 women (17%). The mean age of the patients was 20 years. Ophthalmological involvements are found in 80%, bilateral in 60%. The disease occurred at the rate of 2 or 3 episodes a year in 5% of cases. Irreversible blindness was noted in 24.4% of cases, predominately panuveitis in 37% of cases, followed by anterior uveitis in 36.3% and retinal vasculitis in 37% of cases. Good results were obtained by a medical care with corticoids and chloraminophen in case of threatening blindness. CONCLUSION: Behçet's disease remains frequent in our country. It requires early diagnosis and steady ophthalmological surveillance in order to delay onset of blindness.

Adolescent↗

PubMed2006

Development and face and content validity of an eye surgical skills assessment test for ophthalmology residents.

PURPOSE: The Accreditation Council for Graduate Medical Education has called for the development of new tools for teaching and assessment in core residency competencies. Aims of this study were to respond to this mandate by developing an objective method of evaluating the surgical skills of ophthalmology residents in a microsurgery laboratory environment that could become a part of the ophthalmic surgical curriculum and competency determination, and to evaluate the face and content validity of this assessment by surveying experts in the field. DESIGN: Survey. PARTICIPANTS: Twenty-two content experts (residency program directors and faculty members involved with resident surgical training). METHODS: We have developed a 3-station (skin suturing, muscle recession, phacoemulsification/wound construction and suturing technique) wet laboratory surgical skills obstacle course for ophthalmology residents. Each station includes instructions to the resident for completing the task as well as assessment forms, a station-specific checklist, and a global rating scale of performance, for expert surgeons to complete while reviewing the resident's videotaped performance. To establish face and content validity, content experts were sent a detailed explanation of the assessment along with a survey to facilitate constructive feedback. MAIN OUTCOME MEASURES: Survey responses. RESULTS: Experts felt that the Eye Surgical Skills Assessment Test (ESSAT) is a useful and representative tool for assessing surgical skills of residents. Suggestions were incorporated, thus establishing the face and content validity. CONCLUSIONS: The ESSAT has face and content validity. This tool will be useful for assessing residents' surgical skills in a laboratory environment and the impact of various teaching methods on performance. Further studies to establish the interrater reliability and construct validity of the ESSAT are underway.

Animals↗

PubMed1998

Real-time telementoring in ophthalmology.

PURPOSE: To determine if current telemedicine technology can support real-time telementoring to teach ophthalmologic surgical procedures in remote areas. METHOD: Using an integrated systems digital network (ISDN) line conveying information at a rate of 128 kbps, an endoscopic laser-assisted dacryocystorhinostomy (ELA-DCR) procedure was transmitted in real time from the Saint Francis Medical Center in Honolulu, Hawaii, to ophthalmologists at the Makati Medical Center in Manila, Philippines, more than 5000 miles away. Live surgical and endoscopic images were sent real time with explanations by the surgeon and with interactive questions and answers during and after the procedure. RESULTS: The ELA-DCR procedure was transmitted in real time from Honolulu to more than 100 ophthalmologists at the Makati Medical Center in the Philippines. CONCLUSION: Current technology in telemedicine can support the use of real-time surgical telementoring to teach complex ophthalmologic procedures.

Computer Communication Networks↗

PubMed2002

[History of academic ophthalmology in Wroclaw, Poland in 1812-2002].

The authors present the history of the Department of Ophthalmology in Wroclaw, since 1812. Special attention is paid to following professors of ophthalmology and directors of the University Eye Hospital: T.V.G. Benedict, A.T. Mitteldorf, R. Foerster, H.L. Cohn, H. Magnus, A. Groenouw, H. Willbrand; W. Uhthoff, Th. Axenfeld, G. Lenz, A. Huszcza, L. Baran, A. Bielschowsky, W. Dieter, A. Bednarski, M. Grzedzielski, L. Hirschfeld, W.J. Kapuscinski, S. Drozdowska, E. Ogielska, P. Hanczyc, M.H. Nizankowska

Academic Medical Centers↗

PubMed2003

[Notes on the state of ophthalmology in the ancient Egypt].

The article presents the state of ophthalmological knowledge in the ancient Egypt. Medical and ophthalmological information included in Smith's and Ebers papyruses are discussed. The first ever known ophthalmologist by the name of Iry is mentioned. The article also presents the history of medical school in Alexandria.

Egypt, Ancient↗

PubMed2003

Use of best and final visual acuity outcomes in ophthalmological research.

OBJECTIVE: To evaluate how often visual acuity outcomes are reported in the ophthalmological literature as best or final outcomes, despite potential bias with this type of analysis, as compared with interval outcomes, when a specific condition may continue to cause gain or loss of visual acuity beyond the time that the best or final outcome is determined. METHODS: Each article published in the 3 most frequently cited comprehensive clinical ophthalmological journals in the United States from January through December 2000 was reviewed. Clinical studies were identified in which visual acuity was used as an outcome measure. Visual acuity outcomes were examined throughout the articles and classified as follows: best visual acuity, defined as an outcome at any time during follow-up; final visual acuity, defined as an outcome at last follow-up; and interval visual acuity, defined as an outcome at specified follow-up times. A few factors that might be associated with the different types of outcome were evaluated. Reproducibility of the categorization between 2 ophthalmologists evaluating the articles was determined by using the kappa statistic. RESULTS: A total of 527 clinical studies met the criteria. Among these, authors of 195 reported visual acuity as an outcome measure. Authors of 1 article (0.5%) reported only best visual acuity, authors of 6 (3%) reported both best and final visual acuity, authors of 113 (58%) reported only final visual acuity, and authors of 73 (37%) reported interval visual acuity outcomes. Reproducibility of these categorizations between 2 ophthalmologists was considered excellent, as compared with chance alone (kappa = 0.84). Authors of only 2 of the 120 articles that used either best or final visual acuity outcomes discussed the limitations or potential bias of reporting outcomes in this way. Randomized trials and other prospective study designs more often were associated with interval outcomes than were nonrandomized and retrospective studies. CONCLUSIONS: Despite potential bias with use of best or final visual acuity outcomes, these end points alone were used in most studies published during 2000 in the 3 most commonly cited journals. Authors of clinical studies should consider avoiding use of best or final visual acuity outcomes whenever possible to minimize possible data misinterpretation. If best or final outcomes are used, authors should consider discussing the limitations of these methods and their potential effect on the interpretation of results.

Bias↗

PubMed2003

Professor Ernst Fuchs (1851-1930): a defining career in ophthalmology.

Although his name is commonly recognized in conjunction with various corneal and anterior segment disorders, Ernst Fuchs' contribution to ophthalmology exceeds purely the delineation of ocular diseases and the detailed description of signs. Fuchs' collection of microscopic samples laid the foundation for anatomical and pathological understanding of blood vessels, muscles, and most other tissues of the eye. Additionally, Fuchs was able to pass on his unique knowledge, educating ophthalmologists at an international level. His textbook was, for many decades, the most extensively used reference book in the field of ophthalmology worldwide.

Austria↗

PubMed2004

Ophthalmological observations made during the mid-19th-century European encounter with Africa.

European travelers in Africa in the mid-19th century encountered environments quite unlike those of their native lands. These provided many new and unanticipated health challenges. The ophthalmological consequences of exposure to such climates, as recorded incidentally in travelogues, are of potential interest. In this article, the almost contemporaneous narratives of 3 travelers with considerable medical training, David Livingstone and his sometime companion John Kirk, who journeyed in southern Africa, and Gustav Nachtigal, who traveled in northern Africa, are examined for information on ophthalmological problems, both observed and personally experienced. This affords an opportunity to compare observations made in Saharan and sub-Saharan Africa.

Africa↗

PubMed2006

Resident physician mentoring program in ophthalmology: the Tennessee experience.

OBJECTIVE: To establish a mentoring program to provide resident physicians in ophthalmology with career guidance in practice management and to identify new and creative ways to involve future eye physicians in the legislative and political process. METHODS: A multicenter prospective study was conducted of the mentorship experiences of 24 (88.9%) of 27 resident physicians in Tennessee during the 2000-2001 academic year. Participants were assigned into 1 of 3 groups: an active mentorship group, a passive mentorship group, and a no mentorship group. The active mentorship group participated in preceptorship activities with "mentor" community-based eye physicians and scheduled meetings with state legislators and regulators. The active mentorship and passive mentorship groups attended a 1-day practice management seminar, but the no mentorship group received no formal mentorship during the 4-month study period. A survey instrument was given to all participants before and after the 4-month study period. RESULTS: Following completion of the mentorship program, the active mentorship group had favorable changes in perceptions and attitudes toward medical organizations (P<.03) when compared with baseline prementorship responses. Compared with the no mentorship group, the active mentorship group also reported an increased willingness to make political campaign donations (P<.05) and expressed an increased desire for the Tennessee Academy of Ophthalmology to offer practice management programs (P<.02). CONCLUSION: A short 4-month mentorship program can elicit favorable changes in residents' perceptions and attitudes toward medical professional organizations. Additional opportunities may lie with a lengthier and more intensive mentoring program.

Career Choice↗

PubMed1988

Selection of controls for clinical research studies in ophthalmology.

Ophthalmologists are becoming increasingly aware of the need for well-designed, controlled studies to investigate etiology and treatment of ocular conditions. While patients with the conditions of interest, or with characteristics that place them at high risk of eventual development of such conditions, may be readily identified in the ophthalmology clinic, identification of appropriate controls to be used for comparison may be quite difficult. In this article, epidemiologic principles for selection of controls for retrospective (case-control) and prospective (cohort) studies are reviewed. Two related studies, a case-control study in which multiple control groups were employed and a 15-year cohort study of all cases and controls, provided an opportunity to compare controls selected at random from an ophthalmology practice with controls selected at random from the general population. Participation rates were higher among office patients selected for study, both in the case-control study and in the cohort study. In the cohort study, office controls were more likely to lose visual acuity and to develop new degenerative eye conditions. These differences between control groups selected from two different sources emphasize the need for careful evaluation of potential groups of controls with respect to biases that each may bring to interpretation of clinical research findings.

Biometry↗

PubMed1993

The Resource-Based Relative Value Scale. Methods, results, and impacts for ophthalmology.

In January 1992, the Health Care Financing Administration implemented sweeping legislation that reformed the way Medicare pays for physicians' services. The cornerstone of the reform consists of a new fee schedule based on the Resource-Based Relative Value Scale. This article summarizes the methods and data used to derive the scale for ophthalmology. The results and impacts of the new Medicare payment rates for ophthalmology are also assessed. Using our methods and assumptions, ophthalmologists stand to lose 16% of their Medicare revenues under a fully implemented relative value-based fee schedule. Overall, the fees for performing evaluation and management services will increase, while those for most surgical procedures and diagnostic tests will decrease. Physicians' practice decisions and medical students' specialty choices could be affected. Ophthalmologists who perform work-intensive surgical procedures and spend the majority of their time in the operating room will continue to earn much higher incomes than those who do not.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1993

Ophthalmology and the Resource-Based Relative Value Fee Scale.

The Medicare Resource-Based Relative Value Scale for ophthalmology has significantly reduced the level of reimbursement for surgical fees and only minimally increased evaluation and management fees. Some observers have felt that the methods for determining fees were flawed, and, generally, practitioners have been concerned about a potential loss of income. While reimbursement for individual services is being cut, projections through 1996 indicate that ophthalmology, as a specialty, will receive 55% more funding due to historical trends and increasing ranks of providers. This will translate into a more moderate global reduction in revenue of approximately 11%. The possible implications of the Resource-Based Relative Value Scale include a concentration of ophthalmic surgery into fewer practices, which may be able to distribute medical liability costs over a larger number of procedures. To counter the constraints of fee limits, individual physicians will probably seek to enhance their net income by greater use of paraprofessional personnel, the acquisition of new technologies, and the application of improved management skills.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1996

Molecular biology in ophthalmology. A review of principles and recent advances.

Molecular biology is a young scientific discipline that has already had a profound impact on biomedical science, including basic and clinical eye research. In the coming years, molecular advances will increasingly influence aspects of diagnosis, prognosis, and therapy in clinical ophthalmology. Our current understanding of ocular pathophysiology and classification of eye disease will be advanced and challenged by new discoveries in molecular biology. A knowledge of genotype can clarify apparent phenotype. At the present time, diagnostic tests in ophthalmology for both acquired and inherited diseases are being revolutionized by molecular technology. The molecular genetics of ocular disease is currently the subject of intense investigation using techniques of gene mapping and isolation. Rapid progress in understanding the molecular basis of eye diseases will advance the treatment of these conditions, including the potential for gene therapy.

Amino Acid Sequence↗

PubMed1987

Field processes in stereovision. A description of stereopsis appropriate to ophthalmology and visual perception.

There is, as yet, no satisfactory theory of stereopsis, despite the fact that our overt knowledge of "solid seeing" is now about 150 years old, and that contributions to our understanding come today from many fields: ophthalmology, psychology, psychophysics, neurophysiology, computer modelling, and optical-TV display technology. We review herein, and demonstrate for the reader whenever possible, certain key perceptual properties of the stereoscopic event of which any general theory must take account: vector stereoscopy and the neural grid, depth in empty visual fields, the relationship between stereoscopic and cognitive contours, stereoscopic contour formation in the presence of blur (thus, at low levels of central visual acuity), the phenomenon of cortical locking and of neural grid evocation in the presence of either peripheral or central rivalry, certain unusual ranges of figural mismatch and the concept of the horopter in relation to modern single cell electroneurophysiology in animals and to the constancy of visual directions. Some comments are also made on the concept of disparity processing by single cortical neurons, together with a short discussion of the implications of certain views of the genetics of stereovision for the perception of novel random texture sine-wave stereograms. We conclude that any theory pertinent to ophthalmology and visual science must combine the global concepts of cortical integration, the neural lock and the neural grid, herein introduced, with the more classical concepts of particulate or local binocular cortical correspondence. Certain preliminary steps in this direction are presented.

Cognition↗

PubMed1992

Ophthalmology in Europe in the days of the French Revolution.

The authors highlight the political and scientific landmarks in 18th century France; the Revolution of 1789 had positive effects, in that it marked the accession of the French middle-class to political power and enabled the promotion of young scientists without consideration of social class or fortune; it had negative effects, in that France lost the scientific edge it had gained when all existing chairs in ophthalmology were abolished. The status of ophthalmology and of physiological optics in the 18th century are discussed, with a brief mention of the most important innovators in the field.

Europe↗

PubMed1991

Ophthalmological therapy in hospitals (xenones) in Byzantium.

Based on the typikon of the Imperial Monastery of the Pantocrator of Constantinople (12th century) and the manuscripts used in the Byzantine hospitals as well as the published Lives of the Saints and other related sources, it is undeniable that special ophthalmological departments existed in the xenones of Byzantium. It is also proven, that specific ophthalmological therapy was practised here including surgery and particularly in the cataract operation. This last operation is attested to, not only by the medical writings of Byzantine writers but also from the therapies of the physician-saints Cosmas and Damian.

History, Ancient↗

PubMed1994

Further ophthalmological information on Byzantine chroniclers and historians.

The historical importance of information on ophthalmological topics by Byzantine chroniclers and historians prompted us to enlarge our researches on this subject. Thus we present 17 various subjects in continuation of our previous article published in Documenta Ophthalmologica, 'History of Ophthalmology' (Vol. 5, 121-132, 1992).

Byzantium↗