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PubMed2006

Ophthalmological events in patients receiving risedronate: summary of information gained through follow-up in a prescription-event monitoring study in England.

BACKGROUND: In the UK, the nitrogen bisphosphonate risedronate is licensed for the prevention and treatment of osteoporosis and corticosteroid-induced osteoporosis in postmenopausal women. It is also licensed for the treatment of Paget's disease. During a prescription-event monitoring (PEM) study on risedronate we noted a number of ophthalmological events. Recently, case reports of ophthalmological adverse drug reactions in patients taking bisphosphonates were published in the medical literature. The aim of this study was to further evaluate the association of ophthalmological events reported in relation to risedronate treatment during a PEM study on the drug. METHODS: An observational cohort study (PEM study) was conducted in England between September 2000 and June 2002. General practitioners (GPs) were asked for follow-up information on selected events. Events followed up were classified as either 'probably', 'possibly' or 'unlikely' to be related to risedronate, using a modified WHO classification. If insufficient information was obtained on the follow-up questionnaire, the cases were categorised as 'unassessable'. RESULTS: Of the total PEM study cohort of 13 643 patients, 11 156 (82%) were females and 2398 (18%) were males. We received 359 reports of ophthalmological events in 313 patients during the entire study period. Of these we followed up 178 events in 178 patients. Nineteen events in 19 patients were assessed as possibly or probably related to risedronate. The age range for these patients was 50-92 years and the time to onset ranged from 7 days to 5 months. Dry eye (six reports), sore eye (five reports) and conjunctivitis (three reports) were the most frequently reported ophthalmological events assessed as probably or possibly related to risedronate therapy. GPs also reported several other inflammatory conditions of the eye, amongst them two events each of iritis and episcleritis as well as one of keratitis. However, the information received on follow up of these events was insufficient to make causality assessments. CONCLUSION: Patients receiving risedronate can present with a variety of signs and symptoms affecting the eye with different degrees of severity. Patients may present after the first month of treatment. Doctors should have an increased awareness of possible ophthalmological adverse drug reactions in patients receiving this drug, which may affect the eyesight in a population at increased risk of fracture if they fall.

Adverse Drug Reaction Reporting Systems↗
PubMed2003

Adherence to ophthalmologic monitoring for antimalarial toxicity in a lupus cohort.

OBJECTIVE: Antimalarial agents (hydroxychloroquine and chloroquine) are important in the treatment of various rheumatic diseases, including systemic lupus erythematosus (SLE). Although these agents may lead to ocular complications, little is known about adherence to policies for ophthalmologic monitoring. We investigated adherence to the 1996 American College of Rheumatology (ACR) guidelines (recommending yearly ophthalmologic assessments) at our clinic, and determined the factors associated with nonadherence. METHODS: Chart review of the Montreal General Hospital lupus clinic cohort. RESULTS: Of 195 subjects with at least one full year of antimalarial exposure during 1996-2001, 5 refused participation and data on ophthalmology monitoring was incomplete for 42. Of the remaining 148 patients, 47 (32%) had missed at least one annual ophthalmology assessment (were nonadherent) during the interval; almost half of these had missed </= 2 assessments. Nonadherence was present in 50% of the 52 patients who had been taking an antimalarial agent for </= 5 years. In adjusted logistic regression models, cumulative damage (measured by the Systemic Lupus International Collaborating Clinics/ACR Damage Index) and antimalarial exposure </= 5 years were predictive of nonadherence. Adjusted estimates indicated a 1.2-fold increase (95% CI 1.0, 1.5) in the odds of nonadherence for every point increase in the total Damage Index score. The adjusted OR for individuals exposed to an antimalarial for </= 5 years was 5.2 (95% CI 2.1, 13.8). CONCLUSION: Our results indicate incomplete adherence to ACR guidelines at our center. Because patients with higher Damage Index scores were more likely to have missed ophthalmology appointments, even after adjusting for pertinent covariates, it suggests that sicker patients may be more at risk of nonadherence. The association of nonadherence with duration of antimalarial exposure, while not surprising, is still an important reminder that adherence to ophthalmologic monitoring may decrease as risk for retinal toxicity is increasing.

Adult↗
PubMed1998

[The present status of ophthalmological management for diabetics].

A questionnaire regarding management of patients with diabetes was mailed to 315 ophthalmologists. The status of ophthalmological management at the hospitals and clinics was investigated. The return rate of questionnaires was 73%. The problems at the clinics were 1. many cases have ophthalmological symptoms at the first ophthalmological examination (longer time from the onset of diabetes to the first ophthalmological examination), 2. appropriate cooperation between ophthalmology and internal medicine is lacking, 3. the collection of information on blood glucose control level is difficult, and 4. there is not enough consultation by appointment. The common problems to both hospitals and clinics were 1. satisfactory measures are not taken regarding dropout ophthalmology patients, and 2. a system of patient education does not exist. There is a pressing need for comprehensive measures to be taken by medical association leaders and medical administrators to settle these problems.

Adult↗
PubMed2006

Ophthalmology resident surgical competency: a national survey.

PURPOSE: To describe the prevalence, management, and career outcomes of ophthalmology residents who struggle with surgical competency and to explore related educational issues. DESIGN: Fourteen-question written survey. PARTICIPANTS: Fifty-eight program directors at Accreditation Council on Graduate Medical Education-accredited, United States ophthalmology residency programs, representing a total of 2179 resident graduates, between 1991 and 2000. METHODS: Study participants completed a mailed, anonymous survey whose format combined multiple choice and free comment questions. MAIN OUTCOME MEASURES: Number of surgically challenged residents, types of problems identified, types of remediation, final departmental decision at the end of residency, known career outcomes, and residency program use of microsurgical skills laboratories and applicant screening tests. RESULTS: One hundred ninety-nine residents (9% overall; 10% mean per program) were labeled as having trouble mastering surgical skills. All of the programs except 2 had encountered such residents. The most frequently cited problems were poor hand-eye coordination (24%) and poor intraoperative judgment (22%). Most programs were supportive and used educational rather than punitive measures, the most common being extra practice-laboratory time (32%), scheduling cases with the best teaching surgeon (23%), and counseling (21%). Nearly one third (31%) of residents were believed to have overcome their difficulties before graduation. Other residents were encouraged to pursue medical ophthalmology (22%) or to obtain further surgical training through a fellowship (21%) or a supervised practice setting (12%); these residents were granted a departmental statement of satisfactory completion of residency for Board eligibility. Twelve percent were asked to leave residency. Of reported career outcomes, 92% of residents were practicing ophthalmology, 65% as surgical and 27% as medical ophthalmologists. Ninety-eight percent of residency programs had microsurgical practice facilities, 64% had a formal teaching course, and 36% had mandatory practice time. Most programs (76%) did not perform applicant vision or dexterity screening tests; questions existed about the legality and validity of such tests. CONCLUSIONS: The issue of ophthalmology residents who struggle to develop surgical competency appears common. Although many problems appear to be remediable with time, practice, and dedicated, patient teachers, more specific guidelines for a statement of surgical competency are likely necessary to standardize the Board certification process.

Career Choice↗
PubMed2001

Considerations for choosing an electronic medical record for an ophthalmology practice.

OBJECTIVES: To give a brief overview of issues pertinent to selecting an ophthalmic electronic medical record (EMR) program and to outline the company demographics and software capabilities of the major vendors in this area. METHODS: Software companies shipping an EMR package were contacted to obtain information on their software and company demographics. The focus was on companies selectively marketing to ophthalmology practices, and, therefore, most were selected based on their representation at the 1998 and/or 1999 American Academy of Ophthalmology meeting. Software companies that responded to repeated inquiries in a timely fashion were included. RESULTS: Sixteen companies were evaluated. Electronic medical records packages ranged from $3000 to $80 000 (mean, approximately $30 000). Company demographics revealed a range from 1 to 1600 employees (mean, 204). Most of these companies have been in business for 6 years or less (range, 1-15 years; mean, 6 years). My opinions concerning various aspects of the EMR are presented. CONCLUSIONS: There is a wide range of EMR products available for the ophthalmology practice. Computer technology has matured to a point at which the graphical demands of the ophthalmology EMR can be satisfied. Weaknesses do exist in the inherent difficulty of recording an ophthalmology encounter, the relative adolescence of software companies, and the lack of standards in the industry.

Humans↗
PubMed1997

Samuel Theobald M.D. Ophthalmology at the Johns Hopkins Hospital before the Wilmer Institute 1889-1925.

Although ophthalmology today at the Johns Hopkins Hospital is synonymous with the name of Wilmer, it should be remembered that the Wilmer Ophthalmological Institute was not founded until 1925. Thus, to appreciate fully the ophthalmic heritage of Johns Hopkins we must look back to the beginnings of the medical institutions. When the Johns Hopkins Hospital opened in 1889 and the medical school followed in 1893, Samuel Theobald, M.D., was appointed ophthalmic and aural surgeon, and later clinical professor of ophthalmology and otology. Dr. Theobald, a native Baltimorean, was a member of the prestigious Smith family, which distinguished itself in early American medicine. He was raised in the home of his grandfather, Dr. Nathan Ryno Smith who directed his education. Dr. Theobald studied ophthalmology and otology abroad before opening a practice in Baltimore in 1871. Before his appointment at Johns Hopkins he was one of the founders of the Baltimore Eye, Ear and Throat Charity Hospital in 1882. In addition to his teaching at the medical school and his work in the dispensary, he contributed many articles in journals, and presentations to society meetings. He is especially remembered for his development of 'Theobald lacrimal probes', the introduction of boric acid as a collyrium, and his text book Prevalent Diseases of the Eye. He was a member of the American Ophthalmological Society for 50 years and its 14th President. In 1925 at the age of 79 years, he retired and became emeritus.

Baltimore↗
PubMed2006

[Value-based medicine in ophthalmology].

PURPOSE: Value-based medicine (VBM) unifies costs and patient-perceived value (improvement in quality of life, length of life, or both) of an intervention. Value-based ophthalmology is of increasing importance for decisions in eye care. METHODS: The methods of VBM are explained and definitions for a specific terminology in this field are given. The cost-utility analysis as part of health care economic analyses is explained. RESULTS: VBM exceeds evidence-based medicine by incorporating parameters of cost and benefits from an ophthalmological intervention. The benefit of the intervention is defined as an increase or maintenance of visual quality of life and can be determined by utility analysis. The time trade-off method is valid and reliable for utility analysis. The resources expended for the value gained in VBM are measured with cost-utility analysis in terms of cost per quality-adjusted life years gained (euros/QALY). Numerous cost-utility analyses of different ophthalmological interventions have been published. CONCLUSION: The fundamental instrument of VBM is cost-utility analysis. The results in cost per QALY allow estimation of cost effectiveness of an ophthalmological intervention. Using the time trade-off method for utility analysis allows the comparison of ophthalmological cost-utility analyses with those of other medical interventions. VBM is important for individual medical decision making and for general health care.

Consumer Behavior↗
PubMed1984

Ophthalmology operating room standards and infection control concerns.

Postoperative infection is a rare complication of intraocular surgery. Although the incidence is low, the morbidity is high in terms of long-term sequelae. Because some ophthalmologists have requested separate operating rooms to reduce the risk of exogenous sources of infection, ophthalmology training program directors were surveyed to determine national standards of practice. Among the 100 centers responding, most were university affiliated (73%), had more than 500-bed hospitals (67%), and had fewer than 50 practicing ophthalmologists (92%). A single operating room was used in 50 centers and only 33 did not permit nonophthalmology cases in the ophthalmology operating rooms. Centers with a greater ophthalmology volume did not differ from low-volume centers in the scheduling of ophthalmology and nonopthalmology clean or infected cases. Program directors from larger centers, however, were more frequently of the opinion that a separate ophthalmology operating room was needed: 86.2% vs. 63.5% (p = 0.04).

Cross Infection↗
PubMed2003

Earlier detection of amblyopia and strabismus by ophthalmologic screening card attached to the vaccination card.

BACKGROUND: In 1983, in Rijeka, Croatia, an ophthalmologic screening card was introduced for the detection and prevention of ophthalmologic diseases, including amblyopia and strabismus, in children. The card was attached to the vaccination card. The main goal of this study was to investigate whether this model of screening decreased the age at which children were first admitted to our Department of Strabismus and Pediatric Ophthalmology. METHODS: We randomly selected 100 of the 225 children who underwent examination for the first time in the Department of Pediatric Ophthalmology and Strabismus of a clinical hospital centre in Rijeka in 1980, and 100 of the 412 examined for the first time in 1990. Only children aged 5 years or less who were born in the maternity hospital in Rijeka were included in the study. We reviewed the records for these groups, noting the sex, age, diagnosis, refraction and visual acuity. RESULTS: The average age of the children examined in 1980 was 4.4 (standard deviation 1.4) years, compared with 2.5 (standard deviation 1.2) years in 1990, a statistically significant difference (p < 0.01, Student's t-test). In 1980, 17% of the children were under 3 years, compared with 80% in 1990 (p << 0.01). INTERPRETATION: The ophthalmologic screening card contributed to reducing the age at which strabismus and amblyopia are detected. This method of detection has been applied to the entire child population, and detection is performed continuously.

Age Factors↗
PubMed1996

History of the Secretariats of the American Academy of Ophthalmology.

The American Academy of Ophthalmology and Otolaryngology grew steadily during its 82-year existence, and since 1979, the American Academy of Ophthalmology has had an accelerated increase in membership and activity. In 1995, as the Academy approached its centennial, the AAO had more than 20,000 members and an annual budget of more than +26 million. Total registration for the 1994 Annual meeting was slightly more than 27,000, an all-time high. Instruction Courses numbered 450,300 scientific papers were presented, and 130 posters were displayed. The original postgraduate course in 1921 served as the predecessor to the more than 700 hours of instruction presented at the 1994 Annual Meeting. The original committee of four was the predecessor of what has become the Secretariats of the Academy. The popular Home Study Courses were the forerunners of the Academy's programs, formulated and supervised by the Education Secretaries. The Clinical Education Programs include the Basic and Clinical Science Courses, Focal Points, Continuing Ophthalmic Video Education, Manuels, Regional Update Courses, Special Focus/Skills Courses, Monographs, PROvision, slide scripts, and other programs produced for allied health personnel, medical students, and other physicians. The Secretaries originate, produce, and oversee all the important functions of the Academy. The individuals who have served the Academy as Secretaries through the years have been dedicated volunteers. Their contributions have been incalculable. In recent years, the various Secretaries have been ably assisted by Associate Secretaries, Advisory Committees, and Subcommittees, spreading the workload of each Secretary. Credit for the success of the Academy's endeavors, while under the guidance of the Secretaries, also must be given to the Academy's many committee chairs and committee members who have diligently worked to achieve their goals and objectives. In 1995, the Executive Vice President, the 11 Secretaries, and the Editor were aided and assisted by 46 committees. The Secretaries, through the years, and the Academy are further indebted to a wonderful, dedicated staff who willingly and conscientiously contribute to the many Academy programs. When you stand back and look at this history of active, participating Academy members who have contributed so many hours in travel, meeting, and homework within the Secretariats, you marvel at the dedication and forces at work in the American Academy of Ophthalmology. Is it any wonder that, through the years, so many Secretaries, because of their proven ability, talents, and contributions to ophthalmology, have been selected by the membership to serve as President of the American Academy of Ophthalmology.

History, 19th Century↗
PubMed2003

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.

Attitude of Health Personnel↗
PubMed2004

Dollars and sight: the economics of ophthalmology.

PURPOSE OF REVIEW: The purpose of this paper is to detail the economics of ophthalmology including trends in utilization, cost, and expenditure. RECENT FINDINGS: Eye care accounts for $23.1 billion, or approximately 1.93% of total health care expenditures annually. In 1991, eye care service costs in those 65 years or older were $5.5 billion, comprising 4.7% of Medicare spending. By 1999, the cost of eye care services in the 65 or older group had increased to $6 billion, but comprised only 2.8% of Medicare spending. SUMMARY: Although it is imperative that national health expenditure be controlled, ophthalmology has shouldered a disproportionate share of the cost cutting in recent years. When we consider the advances in ophthalmology and the contributions of ophthalmology to improved quality of life, the financial burden absorbed by ophthalmology is striking.

Cost of Illness↗
PubMed2003

Nordic research in ophthalmology.

PURPOSE: To provide an overview of some of the current activities in eye research in the Nordic countries. METHODS: The presentations at the biannual Nordic Congress of Ophthalmology, held in Tampere, Finland in 2002, were reviewed and the contributions found most noteworthy are included in this article along with a limited discussion of each research field. However, space requirements prevented the inclusion of many interesting scientific contributions. RESULTS: Important contributions in various subfields of eye research and ophthalmology are reviewed. These include cornea, cataract, paediatric ophthalmology, glaucoma, diabetic eye disease, age-related macular degeneration, physiology and pharmacology and oncology. CONCLUSIONS: Eye research is very active in the Nordic countries and significant contributions are being made to ophthalmology in several fields on a world scale. We hope to continue to review Nordic contributions to eye research after each Nordic Congress of Ophthalmology and plan to make the reviews more systematic and comprehensive in the future.

Biomedical Research↗
PubMed2005

Implementation of national diabetes retinal screening programme is associated with a lower proportion of patients referred to ophthalmology.

AIMS: To examine the impact of a new national retinal screening programme on screening attendance, technical quality of images, and referrals to the ophthalmology clinic. METHODS: Results from the previous ad hoc retinal screening service were compared with data from the first year of the new Scottish Diabetes Retinal Screening Programme in Dundee, which was administered according to criteria recommended by the Health Technology Board Scotland. RESULTS: Of 5150 patients invited for screening, 10.3% of patients did not attend. Overall, 4574 patients underwent single-field digital retinal photography and 25.4% required mydriasis for an adequate image. After screening, 1.9 and 90.5% were recalled for repeat photography at 6 months and 1 year, respectively, whilst 4.6% were ungradable and 3.0% were referred to the ophthalmology clinic. Compared with the last 18 months of the previous scheme, with the new programme a smaller proportion of patients were referred to ophthalmology (3.0 vs. 5.9%; P < 0.001, difference 2.9%: 95% confidence interval 2.1-3.7%). Moreover, the attendance was higher (89 vs. 82%; P < 0.01) and there were fewer ungradable images (4.6 vs. 7.1%; P < 0.001). CONCLUSIONS: Introduction of a systematic retinal screening programme can reduce the proportion of patients referred to the ophthalmology clinic, and use ophthalmology services more efficiently.

Adult↗
PubMed2002

[Citation analysis of originals in Chinese Journal of Ophthalmology].

OBJECTIVE: To evaluate the academic level and the popularity of Chinese Journal of Ophthalmology. METHOD: According to the information of Chinese science and technology papers and citation database (CSTPC), I statistically analyzed the amount and distribution of the originals in Chinese Journal of Ophthalmology cited by the journals included by CSTPC. RESULT: The originals of Chinese Journal of Ophthalmology were high-qualified and influential, and their authors were all over the country. CONCLUSION: With the unique style and character, Chinese Journal of Ophthalmology is the main medical core periodical and one of the most important information resources in the field of ophthalmology in China.

Bibliometrics↗
PubMed2006

[To strengthen the academic morality standard for promoting the further development of ophthalmology].

It is imperative and urgent to strength the academic ethic construction in ophthalmology in China. In the rapid development of ophthalmology in recent years, there exit some manifests of academic ethic anomy and unhealthy climate. We should adopt some effective measures to standardize the academic behavior, and clean and create the favourable academic behavior, in order to promote the academic activities in ophthalmology. The rule on the academic ethic standard by Chinese Ophthalmological Society published in this journal is an important measure for strengthening the academic ethic construction in ophthalmology, and deserve to be noted and practiced by all of ophthalmologists and visual researchers.

China↗
PubMed2006

Medical students perception of undergraduate ophthalmology training in Nnamdi Azikiwe University Nnewi Campus.

AIM: To determine the perception and aspiration of medical students towards ophthalmology. METHOD: Information for the study was obtained through forced-choice questionnaire set to 102 medical students in 2000/2001 graduating class in Nnamdi Azikiwe University. RESULTS: One hundred questionnaires were completed. As a specialty of choice ophthalmology ranked fourth {16.0%} as a first choice; second {21.0%} as a second choice and first {26.0%} as a third choice. Ninety-five of respondents found ophthalmology training useful. CONCLUSION: This cohort of medical students considered ophthalmic training in this institution essential and adequate. Undergraduate ophthalmic course should ensure an understanding of the basic principles of ophthalmology and should be designed to motivate the interest and confidence of the medical students in the specialty. Training period should be at least 4 weeks. With appropriate training ophthalmology can attract reasonable interest as a choice for specification.

Adult↗
PubMed2001

Ophthalmological findings in patients with spinocerebellar ataxia type 1 are not correlated with neurological anticipation.

BACKGROUND: Optic atrophy, attenuation of the oscillatory potentials (OPs) of the electroretinogram (ERG), and enlargement of corneal endothelial cells, have been reported in patients with spinocerebellar ataxia type 1 (SCA1). These patients have a trinucleotide repeat expansion in the SCA1 gene and show neurological anticipation. The purpose of this study was to determine whether the ophthalmological findings are correlated with the neurological disorders, and whether ophthalmological anticipation is present in patients with SCA1. METHODS: The visual acuity, ERGs, and corneal endothelial cell density were examined in 14 patients whose DNA analysis revealed an expanded trinucleotide repeat in an allele of the SCA1 gene. The results of the tests were compared with the trinucleotide repeat number and the duration of the neuronal disease. RESULTS: The neurological disorders in the patients showed anticipation. The negative correlation between the trinucleotide repeat number and the neurological disorder was statistically significant (P<0.0001). However, the correlations between trinucleotide repeat number and visual acuity, amplitude of OPs, and corneal endothelial cell density were not significant. Statistically significant correlations were found between the duration of the neuronal disease and the visual acuity, OPs, and corneal endothelial cell density (P<0.0001, P=0.0004, and P<0.0001, respectively). The ophthalmological disorders were prominent in patients who had neuronal disease for more than 10 years. CONCLUSION: Unlike the neurological findings, the ophthalmological disorders in patients with SCA1 were not correlated with the trinucleotide repeat number of the SCA1 gene. The ophthalmological findings were most highly correlated with the duration of the neuronal disease.

Adult↗