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[Use of an electronic patient record system at the Department of Ophthalmology, Otto-von-Guericke University of Magdeburg].

BACKGROUND: The electronic or paper-based patient record is the most important documentation file. The electronic patient record has many advantages compared to a paper-based record. METHODS: An example of an electronic patient record (EPR) system accessed by several departments of the Faculty of Medicine of Magdeburg is presented. RESULTS: To guarantee faculty-wide communication with sharing of clinical pictures and findings, e.g., with the Departments of Radiology and Pathology, the system of MEDOS Inc. is used in our department. Several examination devices, for example fundus camera, slit lamp, and ultrasound, are equipped with an digital picture storage and communication system via a DICOM interface to the MEDOS system. The software AnalySIS is used as a gateway for picture transferation. The MEDOS system also supports the clinical workflow. CONCLUSIONS: The use of an electronic patient record system in ophthalmology is already possible, but still needs further tuning and improvement.

Computer Communication Networks↗

[Conceiving and implementing an ISO 9001:2000 quality management system: quality improvement and efficiency increase over 3 years at the Dept. of Ophthalmology, Sultan Qaboos University in Oman].

BACKGROUND: Oman is a developing country of the Middle East with a University Hospital in a national health system. Problems related to documentation, structure, and procedure prevailing in a multicultural environment result in a lack of productivity. The aim of this study was to test the feasibility of introducing a quality management system according to ISO 9001:2000 into a university department of ophthalmology with special reference to quality and efficiency data over 3 years. MATERIALS AND METHODS: Standardized types of documentation (35 documents, 183 forms and formats, and 453 registers) under a formal roof (booklets for work instructions, quality management, procedures) were conceived in 2001 and implemented, and were evaluated by descriptive statistics over the years 2002-2005 with respect to quality and efficiency. In 2005, the departmental QMS was merged into the QMS of the whole hospital. RESULTS: Establishment of "responsibility clusters" with structured surveillance tasks, procedural improvements, and continuous audits resulted in a significant quality improvement already during the implementation until ISO 9001:2000 certification in 2002, and over the following 3 years. The data were assessed by non-conformities documented monthly (total inpatients: -50%, outpatients: -20%, operating theater: -100%, teaching: -10%; p <0.05) and increased efficiency assessed by the most important performance indicators (before QMS vs a median of 3 years with QMS): major surgery: +459%, inpatient stay: -49.7%, occupancy rate: +63.9%, technical diagnostics: +292.9%, postgraduate teaching total: +740%, research output total: +330% (p <0.05). CONCLUSIONS: It is feasible to introduce the quality management system according to ISO 9001:2000 into a developing country in the Middle East. It has an immediate effect on the increase of efficiency (measured by performance indicators) and quality in all systems providing the possibility for regional benchmarking.

Academic Medical Centers↗

[New communication media for ophthalmology].

BACKGROUND: The use of high-tech communication is undoubtedly growing and has become established in almost all sciences and research fields. This article surveys the possibilities for scientific data-exchange via the Internet, the world's largest computer network. METHODS: An introduction is given to network as a whole, its history and structure, and the hardware and software required. Examples are provided to describe the basic services on the Internet with special emphasis on World wide web applications. CONCLUSIONS: The paper indicates that the Internet has a vast potential for providing almost unlimited information of relevance to users. By using the Internet and its resources, modern ophthalmological research will become more effective and successful.

Computer Communication Networks↗

[The German Ophthalmology Society in the internet. Resources and interest].

OBJECTIVE: The German Ophthalmologic Society is rising to the challenges of the information age by offering comprehensive information resources online. METHODS: The society's board decided on the development of an Internet website in October 1996. Since February 1997, the website has been available under the Internet address www.dog.org. The amount of information offered has been growing fast during the following 12 months. RESULTS: On its website, the DOG offers information about itself, membership, further education, and a catalog of important addresses, patient information, official recommendations, and the program and abstracts of the annual sessions. The ICD10-aug was integrated into the website as a database application. A discussion group is reserved for ophthalmologists who can use this platform to share ideas and discuss clinical topics. CONCLUSIONS: The website of the DOG consists of over 4,900 files that represent the activities of the society. The website's access log indicates steady interest in the information offered. Over 53,000 users visited the DOG website. The discussion group is used by 71 members from 10 countries (all numbers as of 9/98).

Germany↗

[CO2 laser in ophthalmology].

BACKGROUND: Baker et al. used a CO2 laser for blepharoplasty for the first time. The ultra-pulse CO2 laser provides a sophisticated instrument that makes more application alternatives possible in ophthalmology. PATIENTS AND METHODS: From March 1997 to February 1998 surgical operations were performed in the eye clinics in Hagen and Darmstadt using the CO2 laser: 145 eyelid operations and 8 others (enucleation, evisceration, oral mucosa plastic surgery, secondary hydroxyapatite implantation, squint operation). In 34 patients in a total of 64 operations, after an average follow-up period of 7 (4-11) months, an examination was carried out. RESULTS: There were serious complications in only one case. Three weeks after transconjunctival fat resection and resurfacing, one patient developed an inflammatory reaction with resulting ectropion on both sides. During steroid therapy the left lower lid flattened, but on the right side a slight ectropion remained. CONCLUSION: The CO2 laser proved to be a very useful instrument for bloodless tissue-protective surgery without conspicuous scar formation.

Blepharoplasty↗

[On line ophthalmologic education. Live transfers and on demand lectures via Internet].

Continuing medical education for ophthalmologist is important and demanded from the board of ophthalmic organizations. The use of new multimedia possibilities provided by the internet, offers an alternative to acquire the training sessions requested by the board. Aim of the paper is to show the efforts made, to place an internet-based training website for ophthalmologists by transferring live ophthalmology events via the internet. The live-transfers of selected lectures is realized by transferring the original sound compatible to the software "Real-Audio-Player" with an rate of 8000 Hz (encoding-depth 14 bits). By using this software it is possible to follow the lectures live. It includes also 2 live-pictures of 2 digital camcorders to show the appropriate slides from the lecturer. The live broadcasted lectures were afterwards revised and are available at any time as "on-demand lectures" with original sound and slides. Since November 1997, 15 continuing medical education events for ophthalmologists of the University Erlangen-Nürnberg, Germany and from other universities were live broadcasted covering all aspects of phthalmology can be viewed as "on-demand lectures" with original-sound and slides under the internet-addresse http:¿www.onjoph.com/deutsch/live.html. The broadcasted events of workshops were watched via the internet with the appropriate software by 3500 persons, and approximately 5200 persons were listening at least one of the lectures since 1997.

Education, Medical, Continuing↗

The Institute of Ophthalmology of the University of London.

With the technological revolution in medicine that occurred between the two World Wars came awarness of a need for an ophthalmic institution that would combine clinical and basic scientific research, professional training, and patient services. The history of the Institute of Ophthalmology of the University of London is reviewed by Sir Stewart Duke-Elder, who was instrumental in the foundation and development of the Institute and who currently serves as its President.

Academies and Institutes↗

Clinical ophthalmology instruction for medical students.

A ten-day ophthalmology clerkship for third-year medical students is described. The curriculum, detailed in a day-by-day syllabus, sets specific student goals, evaluates attainment of the goals by a pre-post test, utilizes a student-oriented study guide keyed to major textbrooks as core material with slide-tape and videotape supplements, and emphasizes daily supervised patient examinations. Constant modification of the clerkship on the basis of student assessment has sustained it as a popular workable clinical experience.

Audiovisual Aids↗

Ophthalmology at St. Thomas' Hospital, London: the 12th to the 19th centuries.

The author recounts the history of St. Thomas' Hospital from its medieval beginnings to its establishment by the end of the 19th century as one of London's twelve teaching hospitals. Among the members of its staff have been some of the first and most illustrious ophthalmologists--those whose discoveries, teachings and writings have contributed to the foundation and development of ophthalmology.

History, 15th Century↗

Ophthalmology manpower: shortfall or windfall?

Forecasts of ophthalmology manpower depend on assumptions about future supply and requirements. The two factors that influence supply are the number of residents trained and the attrition of ophthalmologists in practice. The factors that influence requirements are the estimated amount of future ophthalmic services the public will demand and the productivity of ophthalmologists. Previous forecasts have produced widely differing results because of an inadequate data base and varying theoretical assumptions. A conservative approach is to use past ophthalmologist to population ratios as a guide, and to tailor the output of ophthalmologists accordingly. A yearly reduction from 1982 to 1990 between 5% and 10% in the number of residency positions will be necessary to bring supply in line with requirements within the next thirty years.

Aged↗

Cocaine's use in ophthalmology: our 100-year heritage.

One hundred years ago the fledgling ophthalmologist Carl Koller demonstrated that the alkaloid cocaine was a local anesthetic suitable for rendering the eye temporarily insensible to pain. It was an event of historical significance, as his discovery opened the door not only to a new era in ophthalmic surgery, but to surgery in general. In this paper we review the ancient uses of the coca leaf, the historical events leading up to and following Koller's discovery, and the present day uses of cocaine in ophthalmology and medicine.

Anesthesia, Local↗

Roman ophthalmology. A glimpse of our distant past.

Ophthalmic artifacts from a house destroyed in 275 A.D. and recently excavated in Schwarzenacker, W. Germany, are described and illustrated. The reconstructed house of ophthalmologist, Sextus Ajacius Launus, and its contents provides a fascinating glimpse of ophthalmology as practiced nearly 17 centuries ago in the Roman Empire.

History, Ancient↗

Viscoelastic substances in ophthalmology.

The desirable properties of a viscoelastic substance for ophthalmologic applications are intimately tied to its chemical and rheologic properties. This report describes the relevant rheologic properties (e.g., viscosity, viscoelasticity, pseudoplasticity, cohesiveness, and coatability) of the available viscoelastic substances and presents the general principles of their use as well as some specific technical aspects. In addition, the various uses of viscoelastic substances in ophthalmic surgery are outlined. There is no single ideal substance for all circumstances. With a knowledge of the rheologic properties of each substance, the ophthalmologist will be able to choose among the different ones as necessary to suit each clinical situation.

Acrylic Resins↗

William Ellergy Briggs: pioneer of west coast ophthalmology.

William Ellergy Briggs was California's preeminent ophthalmologist for more than fifty years. A student of Ernst Fuchs, he was a clinician, scholar, and innovator who transplanted the best of European ophthalmology to the Western United States.

California↗

Fifty years in ophthalmology.

This renowned glaucoma expert began his residency just as gonioscopy came into existence, to be followed shortly by tonography. In this memoir, Dr. Shaffer shares anecdotes and insights gained over a half century of ophthalmology practice.

Glaucoma↗

An experimental approach to the design of a scattering system for a proton therapy beam line dedicated to ophthalmological applications.

PURPOSE: The development of a scattering system for a proton therapy beam line dedicated to ophthalmological applications. METHODS AND MATERIALS: A protontherapy beam line has been developed for the treatment of uveal melanoma at the Orsay synchrocyclotron. The original 200 MeV proton beam is degraded to 76 MeV and the final beam characteristics (range, modulation, flatness, collimation) are obtained with beam modifiers in the treatment room. A passive scattering system is used to obtain a uniform dose distribution in the beam cross-section throughout 30 mm in diameter, with minimal losses in energy and dose rate. We have used an experimental approach for the scattering study. RESULTS: An elliptical ring shaped from 0.1-mm thick lead is the solution we have adopted for the scattering system. For a modulated beam, a flatness of 1% is obtained on transverse profiles. The energy loss introduced by this scatterer is only 0.5 MeV, with no appreciable change in the range over the treatment field. For an unmodulated beam, 21% of intensity is lost when the scatterer is used. The distal and the lateral dose fall-off (90-10%) for a modulated beam are 2.6 mm. These last values are independent of the range and the modulation currently used for the ophthalmic applications. CONCLUSION: A specific passive scattering system can be adapted to a particular beam emittance. A systematic experimental approach can easily be undertaken to obtain the scatterer adapted for small irradiation fields in proton therapy.

Equipment Design↗

Visual training: current status in ophthalmology.

PURPOSE: To inform ophthalmologists of the current status of visual training. DESIGN: Personal perspective. METHOD: A perspective and analysis of current practices that include a review of the literature and personal experiences of the author. RESULTS: Visual training of some sort has been used for centuries. In the first half of the twentieth century, in cooperation with ophthalmologists, orthoptists introduced a wide variety of training techniques that were designed primarily to improve binocular function. In the second half of the twentieth century, visual training activities were taken up by optometrists and paramedical personnel to treat conditions that ranged from uncomfortable vision to poor reading or academic performance. Other visual training has been aimed at the elimination of a wide variety of systemic symptoms and for the specific improvement of sight and even for the improvement of athletic performance. At present, ophthalmologists and orthoptists use visual training to a very limited degree. Most visual training is now done by optometrists and others who say it works. Based on an assessment of claims and a study of published data, the consensus of ophthalmologists regarding visual training is that, except for near point of convergence exercises, visual training lacks documented evidence of effectiveness. CONCLUSION: Although visual training has been used for several centuries, it plays a minor and actually decreasing role in eye therapy used by the ophthalmologist. At the beginning of the twenty-first century, most visual training is carried out by non-ophthalmologists and is neither practiced nor endorsed in its broadest sense by ophthalmology.

Amblyopia↗

Intraocular lens implantation during infancy: perceptions of parents and the American Association for Pediatric Ophthalmology and Strabismus members.

BACKGROUND: To determine whether a randomized clinical trial, the Infant Aphakia Treatment Study, comparing intraocular lens (IOL) implantation with contact lens (CL) correction for infants with a unilateral congenital cataract (UCC), is feasible by (1) ascertaining whether American Association for Pediatric Ophthalmology and Strabismus (AAPOS) members have equipoise regarding these two treatments and (2) evaluating the willingness of parents to agree to randomization. METHODS: All AAPOS members were surveyed in August 1997 and again in June 2001 regarding their use of CLs and IOL implants to correct infants vision after unilateral cataract surgery. In addition, a pilot study was begun in March 2002 to evaluate the safety of IOL implantation during infancy and the willingness of parents to randomize their children with a UCC to either IOL implantation or CL correction. RESULTS: In 1997, 89% of the 260 respondents reported that in the previous year they had treated at least one infant with a UCC, but only 4% had implanted an IOL in an infant <7 months old. Silsoft (Bausch & Lomb, Rochester, NY) CL correction was the preferred treatment choice for 84% of the respondents. In 2001, 21% of the 279 respondents had implanted an IOL in an infant. On a scale from 1 to 10 with 1 strongly favoring an IOL implant and 10 strongly favoring a CL, the median score was 7.5. Sixty-one percent of the respondents indicated that they would be willing to randomize children with a UCC to one of these two treatments. The main concerns about IOL implantation were poor predictability of power changes, postoperative complications, inflammation, and technical difficulty of surgery. The main concerns about CL correction were poor compliance, high lens loss rate, high cost, and keratitis. In our pilot study, 30 infants <7 months of age were evaluated at nine clinical centers for a visually significant UCC. Of 24 infants eligible for randomization, the parents of 17 (71%) agreed to randomization. CONCLUSIONS: Although most AAPOS members still favor CL correction after cataract surgery for a UCC, five times as many had implanted an IOL in an infant in 2001 compared with the number in 1997. Parents were almost equally divided in their preference for IOL implant versus CL correction. Given the relative equipoise of AAPOS members regarding these treatments and the willingness of more than two thirds of parents to agree to randomization, it seems likely that a randomized clinical trial comparing these two treatments could indeed be conducted.

Aphakia, Postcataract↗