Effect of the number of threshold determinations on short-term fluctuation in automated perimetry

The authors studied the effect of multiple threshold determinations on local and global (root-mean-square) short-term fluctuation in 30 subjects (10 controls, 10 glaucoma suspects, and 10 glaucoma patients) with a mean age of 56.70 years. Five custom programs were designed on the Octopus perimeter in which the total number of threshold determinations was equal but in which thresholds at 2 principal locations were determined between 2 and 15 times. One randomly selected eye of each subject was first tested with the standard Octopus programs G1 and 31 followed by the custom programs. Local fluctuation initially increased with the number of threshold determinations and then stabilized after five determinations. Global fluctuation was not influenced by the number of determinations and the values obtained by the shorter custom programs were not significantly different from those obtained by the standard programs. Programs that determine thresholds only twice at a given location may underestimate local fluctuation. Furthermore, local fluctuation is de-emphasized by the "watering-down" effect of estimating global fluctuation.     

Federal low vision services reimbursement mechanisms

This paper is a synopsis of the present federal legislative programs that offer reimbursement for low vision services. The programs are reviewed with specific attention given to 1) The Social Security Act, 2) the Education of the Handicapped Act, 3) the Rehabilitation Act, and 4) the Veteran's and Uniformed Services Act. A comparison of these programs is presented along with a brief discussion about the effectiveness of these programs to meet our present and future needs.     

Barriers in establishing systematic diabetic retinopathy screening through telemedicine in low- and middle-income countries

Vision-threatening diabetic retinopathy (VTDR) is one of the leading causes of impaired vision in the working-age population. Early identification, timely diagnosis, and prompt treatment of VTDR have to be tackled simultaneously to reduce the rate of blindness due to this condition. Considerable emphasis has been placed globally on establishing diabetic retinopathy screening (DRS) programs to enable early identification and referral of VTDR for treatment. However, there is an urgent need to shift from the common practice of opportunistic screening to a systematic DRS pathway to ensure that individuals with diabetes are screened at regular intervals and treated appropriately. While systematic DRS programs have been successfully established in countries such as the United Kingdom (UK), it continues to be a challenge to initiate and sustain such programs in low- and middle-income countries (LMIC), home to approximately 80% of people with diabetes. Telemedicine is widely recognized as an ideal DRS screening program. Although it has resulted in an upsurge of opportunistic screening, systematic recall of screened patients remains a challenge. In addition, the link between referred patients from the telemedicine programs to treatment centers is often not established or has failed to deliver; so, there is minimal impact of these telemedicine programs on VTDR blindness at present. This review covers the various barriers of establishing and sustaining systematic telemedicine DRS programs, especially in resource-constrained settings, and the challenges in aligning telemedicine to VTDR treatment pathways to ensure patients with VTDR are treated promptly and effectively.     

American ophthalmology graduate medical education and the web: current state of internet resource utilization

PURPOSE: To evaluate the presence and accessibility of ophthalmology graduate medical education (GME) programs on the internet and the degree to which web-based resources are currently being utilized by American Ophthalmology training programs. DESIGN: Prospective sampling of internet postings of ophthalmology GME programs. METHODS: Ophthalmology residency programs listed in the American Medical Association Fellowship and Residency Electronic Interactive Database (FREIDA) online website (http://www.ama-assn.org/ama/pub/category/2997. html) were evaluated. Departmental websites were accessed either directly from the FREIDA website or from one of eight search engines or four metacrawlers utilized in the study. Each site was evaluated for the presence, extent, and type of postings in the following categories: residency, medical student resources, faculty, patient care, video utilization, and links. RESULTS: Departments with websites numbered 102 (83%). Specific posting rates were residency 84%; medical student resource 12%; faculty 72%; patient care 69%; video 2%; links 70%. CONCLUSIONS: Most departments have websites, but only a small number have postings in all categories.     

Assessment of ophthalmology residents' contact lens training.

PURPOSE: To characterize the nature and duration of contact lens training in ophthalmology residency training programs and to ascertain the comfort level of residents in fitting various types of contact lenses and in dealing with common contact lens-related complications. METHODS: Surveys were mailed to 126 ophthalmology residency program directors/coordinators and requested to be distributed to 1,381 ophthalmology residents. The questionnaire addressed issues related to contact lens training, hours of clinical and didactic training, comfort with fitting a variety of different types of contact lenses and dealing with common contact lens-related complications, and plans for incorporation of contact lens dispensing into future practice. RESULTS: Two hundred and forty-nine residents (18%) responded from 84 programs (67%). Most programs (87%) have some form of supervised contact lens training, frequently conducted by an optometrist (61% of programs), that consists of 20 hours or less of clinical experience and 20 hours or less of didactic training. A majority of the responding graduating residents (66%) feel comfortable fitting spherical soft contact lenses, while less than half of all residents feel comfortable fitting any other type of contact lens. In addition, most residents (65%) feel comfortable diagnosing and treating common contact lens-related complications. CONCLUSIONS: Most ophthalmology residency programs offer some form of supervised contact lens training which allows a majority of residents to feel comfortable fitting only spherical soft contact lenses, while also dealing comfortably with most contact lens-related problems. A comparison with previous data suggests increasing comfort with fitting most types of contact lenses over the last decade.     

Vision screening and the private practitioner--a status report

Private optometric practitioners have traditionally been involved with schools and other organizations in conducting vision screening programs, although the extent of the involvement varies considerably from one location to another. A national survey of 500 optometrists (49% response rate) was conducted to examine the extent of optometric involvement in screening programs. Seventy percent of the optometrists surveyed have participated in screening during their professional careers although only 30% are currently active. Most screenings were done in the schools with the Modified Clinical Technique (MCT) battery although only 7% knew of perceptual screening activities. The study indicates that in areas where vision screening is conducted, most practitioners are involved and where programs are infrequent, knowledge about screenings is limited.     

Lions Clubs International Foundation Core Four Photoscreening: results from 17 programs and 400,000 preschool children.

INTRODUCTION: Photoscreening programs for preschool vision screening have been promoted by Lions Clubs International Foundation (LCIF) via their 17 Core Four grant project awards since 1999. Results from 15 Core Four grant programs in the United States and one in Taiwan are presented here. METHODS: Photoscreening was modeled after the Tennessee program and instituted statewide in each area. Programs were given latitude with respect to screening instrument and referral criteria, but a partnering academic institution and medical director were expected. Preschool children were screened by volunteers; referred children were examined by community optometrists and ophthalmologists who returned results to each program's coordinating center. Outcome data included number of children screened, referral rate, follow-up rate, and positive predictive value, which was generally determined using AAPOS-defined vision screening criteria. RESULTS: All but one program used the MTI photoscreener (it chose not to participate); photoscreening referral criteria were standard for 13 programs. Through December 2004, more than 400,000 preschool children had been screened. The referral rate for programs using the MTI photoscreener averaged 5.2% (range, 3.7-12.6%). The predictive value of a positive photoscreen was 80%. Overall, 54% of referred children received follow-up examinations. Follow-up rate was the largest variable: 4 programs, screening nearly 250,000 children, had follow-up rates 70% or greater; 10 programs had follow-up data from fewer than 40% of referred children. CONCLUSIONS: Volunteer-led photoscreening programs can be instituted in other locations, including overseas, with high levels of effectiveness. Limitations include the possibility of poor success and variable attention to follow-up.     

Evaluation of motivating factors for selecting optometric residency education.

There are now more than 50 accredited optometric residency programs. We sought to learn the primary motivating factors for selecting residency education beyond the traditional 4-year professional program. Questionnaires addressing this issue were sent in May 1990 to directors of all Council on Optometric Education (COE)-accredited residency programs for distribution to currently participating residents. Of the 81 existing residency positions, 61 questionnaires (75 percent) were returned. Three residents (5 percent) accepted positions in residency programs because they had no definite practice plans following graduation. One resident (2 percent) could not take state board examinations and elected to enter a residency program until licensure could be obtained. Fifty-three (85 percent) selected residency education to enhance their clinical skills, and five residents (8 percent) cited other reasons, such as to prepare for a career in optometric education, to enhance long-term career objectives, and to mature. For 50 (83 percent) of the respondents, residency education was their first choice following graduation from optometry school. We conclude that optometric residency education is highly valued as a source of enrichment of clinical skills.     

Attrition from ophthalmology residency programs

PURPOSE: To investigate the incidence of and reasons for voluntary resident attrition from ophthalmology training programs. DESIGN: Retrospective survey. METHODS: A survey was mailed to residency program directors of the 121 Accreditation Council for Graduate Medical Education-accredited ophthalmology residency programs asking them to report the number of residents who withdrew from training during 2001 to 2002 and the reasons for withdrawal. RESULTS: Of 102 responding programs, 13 (12.7%) had one resident withdraw from training in the academic year 2001 to 2002. These 13 residents represented 1.1% of all ophthalmology residents in training at the responding institutions during that academic year. The most frequent reason for withdrawing was to enter another medical specialty. CONCLUSIONS: Voluntary resident attrition from ophthalmology training programs is uncommon. The 1.1% attrition rate in this study is the lowest among published reports of attrition from other specialties.     

Glaucoma medical treatment--2002: does yearly cost now equal the year?

BACKGROUND: To review costs of the wide array of glaucoma medications available today as well as patient-assistance programs. METHODS: Potential yearly costs for current frequently used single and multiple drug therapies were determined, taking into account the actual (not labeled) volume of drops in the bottled medications. Alternative modes for obtaining medications, such as compassionate-use programs, were also surveyed. RESULTS: "Maximum" medical therapy may cost over $2000 per year. Allergan, Ciba, Merck, Pharmacia-Upjohn, and Alcon offer patient-assistance programs of variable simplicity of use. DISCUSSION: The cost of maximum glaucoma medical therapy can assume a significant proportion of an elderly patient's yearly income.     

Microcomputer-based recording system for clinical electrophysiology

We developed a personal computer-based system for clinical electrophysiologic measurements. The computer interfaced with a commercially available A/D converter, a low-noise isolation preamplifier, filter circuits, pattern and Ganzfeld stimulators, and a hardcopy unit. Separate programs were developed for electroretinography (ERG), pattern ERG and simultaneus visual evoked potential (VEP), flash and pattern-shift VEP, and electro-oculographic measurements. The complete control of the applied hardware (eg, stimulus control, automatic gain, and filter selection) is a common feature of the computer programs. These programs provide oscilloscopic functions, overload protection, artifact elimination, averaging, automatic peak latency and amplitude determination, baseline correction, smoothing, and digital filtering. The results can be presented on matrix, laser printers, or digital plotters. The hardware components and the features of the driver software are demonstrated on normal and pathologic signals.     

Adoption of newer teaching methods to overcome challenges of training in ophthalmology residency during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has disrupted training programs across all specialties. Surgical specialties, such as ophthalmology, that need continued microsurgical training are affected the most. The pandemic has resulted in ophthalmology residents being taken off their regular duties in ophthalmology and inducted into COVID duties. The focus on COVID care has de-emphasized training in ophthalmology. We highlight the challenges that teachers face in continuing the training programs of theory, clinical skill, and surgical skill transfer. Embracing technology is the need of the hour. We discuss the multiple options available to enable continued training programs and emphasize the need for all training institutes to include technology as an additional component of their training curricula.     

Which is the best method to learn ophthalmology? Resident doctors′ perspective of ophthalmology training

The study aimed to gauge ophthalmology resident doctors' perception of their teaching programs and various methods used in it and to formulate a well structured program for teaching ophthalmology. Closed ended and open-ended questionnaires were used for survey of ophthalmology residents in West Maharashtra, India. Sixty-seven out of 69 residents of seven residency programs completed the questionnaire. On a scale of 0 (most unsatisfactory) to 4 (best), lectures with power point presentation had a median score of 4, didactic lectures 2, seminar 3, case presentation 4, wet lab 3 and journal club 3. There was a discrepancy in the actual number of surgeries performed by the resident doctors and their perception of the number needed to master those surgeries. Phacoemulsification and non-cataract surgery training was neglected in most programs. The residents wanted to be evaluated regularly and taught basic ophthalmic examination, use of equipments and procedures in greater depth.     

Microcomputer Applications in Clinical Ophthalmology

An Apple II computer was programmed for use as a clinical tool in ophthalmology. Currently, eleven distinct programs compose the Ophthalmology Program Library (OPL). These are used in diagnostic and therapeutic situations and are based on equations in physiologic optics. Problems in intraocular lens power calculation, astigmatism control, and spectacle over-refraction with spherocylinder addition (among others) are discussed. To demonstrate the usability of such a system, programs concerned with postcataract extraction astigmatism are discussed in depth. Practicing ophthalmologists should find this system of clinical value.     

Comparison of a five-degree visual field between two programs of different testing field range

PURPOSE: A five-degree visual field with two programs of different testing field size was studied, and the visual fields between them were compared. DESIGN: Observational study. METHODS: Forty-six patients with open-angle glaucoma were tested by Humphrey field analyzer (Carl Zeiss Meditec, Inc, Dublin, California, USA) programs 30-2 full threshold and 10-2 full threshold. Forty reliable results with both programs were analyzed. RESULTS: Sensitivity of the same position within a five-degree field was significantly higher with the 10-2 program than with the 30-2 program. Higher sensitivity within a five-degree field with the 10-2 program significantly correlated with that with the 30-2 program. CONCLUSIONS: Visual field determined by automated perimetry was influenced by testing field size.     

Praktische Aspekte der Perimetrie beim Glaukom

Automatic static white-on-white perimetry is state of the art for the visual field examination of glaucoma patients. Full threshold measurements require at least 5 min. Careful instruction and supervision of the patient help to achieve high quality results. Alternative methods, such as the various types of flicker perimetry have a higher sensitivity and complement the early diagnosis. Attention must be paid to the specificity of these methods. Diagnosis may be difficult because the first changes do not have a typical topography. The typical examination interval for follow-up is 1 year but should be shorter in the beginning and in cases with deterioration. The evaluation of visual field development is highly important for glaucoma therapy control. Modern analysis programs offer excellent tools for this purpose. Some programs automatically detect learning effects and unreliable examinations. The change in global indices, e.g. median defect depth (MD), functional defect (FD) and visual field index (VFI) is plotted and statistically analyzed. Local trends are shown in symbol maps. Some programs calculate a prognosis of the future development of the visual field.     

Mapping the landscape of cataract surgery teaching assessment in Canadian residency programs

Objective

The Royal College of Physicians and Surgeons of Canada has mandated a shift in post-graduate residency education in Canada towards a competency-based model. Within this context, it is unclear how resident's competence in cataract surgery is currently being assessed for both formative and summative purposes. Therefore, we conducted a national survey to evaluate the current landscape of cataract surgery teaching in Canadian Ophthalmology programs.

Variation of sensitivity in the central visual field by the range of measurement

We compared two programs with different measurement field ranges in terms of sensitivity for common coordinates using an automated perimeter Octopus. The combination of programs consisted of programs 31 and 61, 31 and PSQ, 61 and 11, 61 and PSQ. The center of program 61 was (0, 0). PSQ was made by the sargon program and a program which measured the outer 16 points of the 61. The mean sensitivity of the common coordinates in 11 was significantly better than that in 61, which was better than that in 31, and that in PSQ better than that in 31 and in 61. The sensitivity was better in programs which tested a smaller size of measurement in the central visual field.