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Educational standards for residency training in ophthalmology are established by a nine-member committee whose members represent the American Academy of Ophthalmology, the American Medical Association, and the American Board of Ophthalmology. Residency programs are reviewed to see that they meet these standards and are accredited if they do. Over the past 11 years, the accreditation status of a total of 445 programs was reviewed: 19 programs lost accreditation (nine withdrew voluntarily), 52 programs were placed on probation or were continued on probation, 310 programs were granted full accreditation or continued accreditation, and 15 of 20 applicants were granted provisional accreditation. During this time, the Residency Review Committee for Ophthalmology on two occasions modified the "Special Requirements for Residency Training in Ophthalmology." In addition, an appeals process was instituted by the Accreditation Council for Graduate Medical Education to give program directors the opportunity to appeal adverse accreditation decisions. There is evidence that this system has had an overall beneficial effect on residency training in ophthalmology in the United States.
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The clinicopathologic review of 33 well-documented cases of granulocytic sarcoma on file in the Registry of Ophthalmic Pathology confirmed the facts that this tumor is encountered mainly in children, that boys are affected more frequently than girls, and that white Americans appear to be less vulnerable than other ethnic groups. While granulocytic sarcoma is a variant of granulocytic leukemia, the tumor may appear before, after, or concomitantly with hematologic evidence of leukemia. In the present series only four of the 33 patients were already known to have leukemia when they were first seen by an ophthalmologist for their orbital, ocular, or adnexal lessions. The Leder stain has proved extremely helpful in arriving at a definitive histopathologic diagnosis. Accurate diagnosis is important to prevent inappropriate medical or surgical treatment and to indicate the need for vigorous antileukemic chemotherapy. Prognosis at best is poor.
The evolution of our health care system toward managed care has placed primary care "gatekeeper" physicians in a position where they must examine and treat patients with diseases that are ordinarily treated by medical and surgical subspecialists. Many of these physicians may be poorly prepared to accept this new responsibility. The Association of University Professors of Ophthalmology (AUPO) has published a Policy Statement on Medical Student Education that suggests the minimum level of competence expected of general physicians when dealing with ophthalmologic problems. A recent survey of directors of residency programs in family practice, internal medicine, and pediatrics revealed that the training of primary care physicians (as opposed to academicians or subspecialists) has become a nearly universal programmatic goal. Most program directs believe that less than half of their residents meet the AUPO standard at the completion of medical school, and a significant minority do not meet the AUPO standard at the completion of their residency. An overwhelming majority of program directors believe that additional training in ophthalmology and other subspecialties should be incorporated into the training programs of primary care physicians. Ophthalmologists and other subspecialists should develop programs at the medical student level directed toward the education of primary care physicians, and should participate in the training of primary care physicians, as well as their own subspecialty residents. In the future, the primary care physician must be considered part of the "eye care team." Enhancing the ophthalmologic education of primary care physicians is in the best interest of quality patient care.
The developmental-assistance entreprise, "Opportunity Recycling in Ophthalmology (ORO)", recycles used but still usable equipment in Ophthalmology and material from the storage-rooms of eye clinics and private ophthalmological practices to responsible recipients in the Third World. ORO was found in 1977 and was given "Honorable Mention" from "Prix Rolex à l'esprit d'entreprise" in 1978. The current project consists of locating, reconditioning, and organizing the transport of material for the Dr. A.-F. Bétrix Clinic in Kusseri, in the most northern province/Cameroon. As always, ORO is here, too, dependent on the generosity of clinics and private ophthalmologists.
Six ophthalmologists and 24 specialist ophthalmology nurses from French-speaking African countries graduate from AITO each year. Their training focuses on the skills they will need to participate in the national programs to combat blindness. All the ophthalmologists (10) and specialist ophthalmology nurses (42) from Mali, Niger, Burkina Faso and Senegal, who graduated from AITO within the last ten years were interviewed. Eight of the ten ophthalmologists and all of the specialist nurses are currently working in national programs to combat blindness. The specialist nurses knew more about public eye health issues than about optics. The training given is appropriate for ophthalmology professionals working in these countries. The chief demand of both ophthalmologists and specialist nurses was that they should have continuous training and supervision.
BACKGROUND: It is well known that different types of eye involvement may develop during the course of systemic vasculitides. METHODS: We report here a case of Churg-Strauss syndrome (allergic granulomatous angiitis) characterized by the presence of multiple ophthalmological and neuro-ophthalmological lesions, i.e., mononeuritis of the fourth cranial nerve, multifocal choroidal ischaemia, and bilateral ischaemic optic neuropathy. RESULTS: Ischaemic lesions in the posterior ciliary plexus and chorio-retinal circulation, which appeared simultaneously after a phase of disease activity, were documented. CONCLUSION: The simultaneous occurrence of multiple ocular features in a patient with Churg-Strauss syndrome suggests that regional vasculitis may be the pathological mechanism underlying the multiple ophthalmological lesions in this disorder.
Dyslexia and other related learning disabilities are serious problems. The American Academy of Pediatrics, through its Committee on Children with Disabilities and the Section on Ophthalmology, the American Academy of Ophthalmology, and the American Association for Pediatric Ophthalmology and Strabismus strongly support the need for early diagnosis and educational remediation. There is no known eye or visual cause for dyslexia and learning disabilities, and no effective visual treatment. Multidisciplinary evaluation and management must be based on proven procedures demonstrated by valid research.
A research committee of the Association of University Professors of Ophthalmology disseminated a survey questionnaire to determine the state of research in departments of ophthalmology across the United States. The questionnaire contained 71 questions that were designed to assess attitudes and trends within members' departments and to solicit suggestions from the membership. Of the 145 members and affiliates queried, 140 responded. While the results of the survey indicate significant diversity among departments, departmental chairpersons view research as a major priority in the goals of their departments, and they envision maintenance or expansion of research over the next decade. The survey results have been collated and serve now as the basis for this Association of University Professors position article.
Professor Vanýsek was the first Czechoslovak ophthalmologist who overstepped the boundaries of the Republic and became one of the foremost scientist in ophthalmology. He was head of a department, consistent more with ideas of the 21st than 20th century. He founded two important ophthalmological school--in Hradec Králové and Brno. He laid the foundations for an experimental institute in Brno which would have become one of the foremost European institutions if Vanýsek had not been condemned by the totalitarian regime in the seventies.
Physician distribution continues to be important in health manpower planning. In 1980 the GMENAC Committee reported uneven geographic distribution of physicians and uneven rates of use of health services in the United States. This study uses zip code sectional areas as the geographical units to describe the geographic distribution of ophthalmologists. Ophthalmologists to population ratio was calculated for each of 532 zip code sectional areas in the US. Results indicate considerable variation in availability of ophthalmologic services. However, this variation is not necessarily indicative of a serious maldistribution problem since there are regional differences in need and supply. This study found that less than 1% of the population did not have convenient access to an ophthalmologist. Resulting data should be helpful to both ophthalmologists considering relocating and residents seeking practice opportunities. Ratios should be used in conjunction with other demographic information available for the sectional areas.
A survey is presented of the ophthalmological findings in 74 patients with drug-resistant temporal lobe epilepsy, who underwent unilateral anterior temporal lobectomy 1960-1969 at Rigshospitalet, Copenhagen. At follow-up, 1970-1971, one to ten years following the operation, 81% of the patients had no or only few seizures. Preoperatively 11% of the patients suffered from strabismus as compared to an expected frequency of 5%, but this trend just falls short of statistical significance. The visual acuity remained unchanged in all patients following the operation. Preoperatively a visual field defect was observed in 2 patients. At follow-up 51 patients had homonymous hemianopias, in 38 of them this was limited to the upper quadrants, and in 13 patients also included the lower quandrants, but was characterized as a total homonymous hemianopia in only 6 patients. The presence and extent of the visual field defects were correlated to surgical results, age at onset of epilepsy, age at operation, preoperative duration of epilepsy, presence of grand mal, preoperative complications, and neuropathological findings, but without observing any statistically significant conclusions. On the other hand, the extent of the postoperative visual field defect was significantly influenced by the side of the operation, with more and larger defects following right-sided lobectomies. In the 51 patients with postoperative hemianopias, this defect was either unobserved by the patient or regarded as a considerably less important handicap than the frequent and socially invalidating preoperative seizures...
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