The need to incorporate professional principles, attitudes and ethics in optometric education.

This paper reviews the development of ethical principles for the profession of optometry over the past 90 years, and how these principles have been modified and expanded in conjunction with the scope of practice during that period. The author discusses the mandated principles of licensing boards as well as Medicare and Medicaid requirements. In addition, areas of "non-mandated" ethical principles are reviewed such as the aging and AIDS patient, over testing, continuing education, corporate employment, patient records and referrals. The author suggests that ethical issues should be incorporated into all optometric courses in the curriculum and not just in a specific ethics course in order that many role models offer their input to students in the development of an ethical model for their professional lives.     

Advertising in ophthalmology. I. Advertising is a threat to professional autonomy

In 1977 the United States Supreme Court ruled that medicine was legally a "trade" and that physicians could not be prohibited from advertising. Since then the ethics and effects of advertising by ophthalmologists have been a source of controversy among ophthalmologists and within professional organizations. What are the effects of advertising on the patient? On the professional image and autonomy of ophthalmologists? These questions are explored in separate statements by authors with differing viewpoints, and summarized in an editorial comment.     

Field "expansion" by use of binocular full-field reversed 1.3X telescopic spectacles: a case report

Full-field reversed 1.3X telescopes were used in the treatment of a 63-year-old male retinitis pigmentosa (R.P.) patient with a 5 degree central field. The patient was highly motivated to "expand" his visual field. He was trained intensively with 1.3X, 1.7X, and 2,2X reversed telescopes prior to prescribing. Evaluations by the Orientation and Mobility staff indicated significant improvements in his functioning with the devices. The reversed telescopes expanded his field to approximately 14 degrees. Patient has been reevaluated after using the aid at home and remains enthusiastic about his successful use of the aid. This case is notable in that binocular, low-power, full-field, reversed telescopes are being used successfully for mobility, eating, and other tasks.     

Intraorbital tumoral pathology in adults--5 years of experience in Bagdasar Arseni Hospital Bucharest

The purpose of this issue is a retrospective analysis of the intraorbital tumoral pathology at adults, who were hospitalised, investigated and treated during 5 years, 1999-2004, in neurosurgery departments of the Clinical Emergency Hospital "Bagdasar-Arseni", Bucharest. The authors wish to point out the importance and usefulness of interdisciplinary co-operation, where the ophthalmologist succeed to harmonize the professional contribution of neuro-radiologist, neurosurgeon and pathologist for the sake and benefit of the patient.     

What will the scope of optometric practice be in the year 2000?

For the past 100 years, the scope of optometric practice has been constantly expanding. As the body of knowledge about visual function has increased, new treatment options have been developed. Optometry must accept the professional responsibility for treatment of all conditions of the eye and visual system. By the year 2000, optometry must be prepared with expanded curricula and accountable for the treatment of all visual conditions in order to maintain its place as a primary provider within the health care system.     

眼视光学生专业承诺及影响因素的调查分析

目的:调查西安医学院眼视光专业学生专业承诺的状况及其存在的问题,为专业的发展进一步提出相应的建议与对策提供科学依据。方法:采用整群抽样,利用《大学生专业承诺量表》问卷,对西安医学院2008/2010年级眼视光专业148名学生进行问卷调查。结果:西安医学院三个年级中2009级专业承诺均值最高;3个年级学生的专业承诺之间有一定的差异;男生与女生在规范承诺上有显著差异;调剂学生的专业承诺均值低于其他报考第一、二、三、四志愿学生。结论:眼视光教育不仅要对学生进行专业思想教育,也要通过各种渠道向社会群体宣传眼视光专业的特点和专业发展的必要性。     

Successful implementation of the EFQM management model at the Department of Ophthalmology in Graz

Background and objective

In the context of legal requirements and scarcer resources, the implementation of a quality management (QM) model will provide a competitive advantage or a site warranty for a hospital. For 3?years, the Department of Ophthalmology in Graz has been working with the EFQM model and has now accomplished the first level quality award, namely ??Committed to Excellence (C2E)??. The project work towards achieving this C2E-award is described below.

Study design and methods

EFQM stands for European Foundation for Quality Management, an organization that was founded in 1989 by the EU, together with 14 leading enterprises. In the EFQM model, the maturity of an organization in terms of quality is determined through the achievement of a number of quality awards. The C2E award is the first of these awards. At the beginning of our work for the C2E level, the strengths and weaknesses of the Department of Ophthalmology were determined by means of an EFQM questionnaire. Three improvement measures with the highest impact on the performance of the clinic were identified by the questionnaire: 1. The hospitalization of a cataract patient. 2. The lack of information between the various professional parties. 3. The lack of knowledge within the professional groups of the objectives and strategy of the Department of Ophthalmology.

Results

These areas requiring improvement were targeted, addressed and improved in a 6-months project work, structured by the EFQM model. The project work as a whole, the results obtained and the corresponding written documentation were evaluated positively in a 1-day assessment by Quality Austria.

Discussion

The EFQM model is a challenging quality management model. After the necessary training of project members or under the supervision of experienced quality managers, the EFQM model may be successfully applied to patient care, teaching and research in a department of ophthalmology.     

Entwicklung diagnosespezifischer Gruppen in der Pro Retina

The formation, development and external impact of the following eight disease-specific patient groups with rare forms of retinal degeneration (RRD) within the patient organization Pro Retina are described: Gyrate Atrophy, Bardet-Biedl Syndrome (BBS), Adult Refsum’s Disease, Usher Syndrome, Rod-Cone Dystrophy, Leber’s Congenital Amaurosis, Choroideremia and Stargardt Disease/juvenile macular degeneration. Within the project sponsored by the German Ministry of Health (BMG) approaches of patient self-help for an adequate organization and interaction with the professional medical care system were supported, analyzed and documented. In syndromic RRD a relatively high proportion of patients are organized in patient groups (Refsum’s disease 25%, BBS 14%, Usher Syndrome 8%). Patients with syndromic RRD are more highly motivated to contribute to self-help work than patients with non-syndromic RRD. At the same time, these patients are more dependent on the support from their relatives and on technical aids. The following tendencies in the development of RRD groups were observed:

increasing focus on one patient organization (PRO RETINA Deutschland, Self-Help Organisation of People with Retinal Degenerations)

all RRD groups in Pro Retina grew;

RRD groups became increasingly independent within Pro Retina;

external activities of the groups showed considerable increase. Stable work relationships with scientific and medical care institutions have been established.

The example of RRD demonstrates how rare and isolated patients receive basic coping support by self-help groups, how they deal with resources in a collective way and how they can interact with the medical care system.     

Changing practice for the non-medical ophthalmic hospital workforce in the UK—a snapshot survey

Background/objectivesTo obtain a picture of the current status, training and governance for advanced practice and extended roles in the ophthalmic hospital non-medical workforce.MethodsA 10 question, quantitative survey was designed with multidisciplinary members of the UK Ophthalmology Alliance and sent to the membership to obtain information on expanded non-medical roles.Results34 of the 58 UKOA member hospitals responded (58% response rate). All responding units were using registered optometrists, orthoptists and nurses to undertake expanded outpatient roles and 28/34 (82%) had expanded roles for undertaking procedures. Some units had large numbers of staff undertaking these roles. There were noticeable trends for certain professional groups to undertake certain roles. For example, nurses were undertaking most procedures, apart from lasers which were mainly delivered by optometrists. Nurses had the lowest banding and optometrists the highest for apparently similar roles. Training was mostly in-house apprenticeship style although some formal external qualifications were undertaken.ConclusionsOphthalmology is developing many innovative roles for the non-medical workforce and, with the launch of the OCCCF training, this is likely to increase. Terminology is confusing and a categorisation suitable for ophthalmology is proposed.Subject terms: Health occupations, Health care, Health services     

Nutritional Amblyopia Combined with Night Blindness

We report the case of an 18-year-old male who developed both nutritional amblyopia and night blindness. After nearly a lifetime of consuming a bizarre diet limited to French fries, pretzels, crackers, and carbonated sodas, he had a relatively sudden onset of night blindness and bilateral visual loss. The night blindness resolved after taking daily oral vitamin A supplements. Visual acuity gradually improved from light perception, both eyes, to 20/20 right eye and 20/25 left eye after multivitamin supplementation and vitamin B₁₂ injections. The patient had bilateral optic atrophy and bilateral ring scotomas around a small area of fixation. The patient was unable to modify his diet despite professional advice and counseling.Key words: B complex vitamins, Nutritional amblyopia, Night blindness, Vitamin A     

Quality-of-life and visual function assessment after phacoemulsification in an urban indian population

PURPOSE: To assess patients' quality of life (QoL) and overall visual function (VF) after phacoemulsification with intraocular lens (IOL) implantation in an urban Indian population. SETTING: Iladevi Cataract & IOL Research Center, Ahmedabad, India. METHODS: This prospective study comprised 300 patients with a mean age of 60.8 years +/- 9.2 (SD) who were evaluated preoperatively for visual acuity, QoL, VF, and demographic information. Postoperative evaluations included the same parameters with the addition of patient satisfaction. Also analyzed was the impact on the resumption of routine daily activities and professional work after phacoemulsification. Patients were divided into 2 categories: driving and nondriving. They were also categorized by profession and type and density of cataract. The relationship of patients' characteristics and QoL versus VF was determined by an analysis of variance and 99% confidence intervals. Effect sizes (change/difference / the standard deviation at baseline) were computed for intergroup longitudinal changes and intergroup differences. RESULTS: Correlation analysis showed a highly significant positive correlation between logMAR scores with VF and QoL. Overall, VF changed more significantly than QoL in effect size on all subscales. Postoperatively, 13% of respondents reported difficulty performing routine work; 40% resumed their daily activities within 1 week and 55%, within 1 month. More than 42% resumed professional activities within 1 week after surgery; 53% took 1 week to 1 month. Eight-six percent were fully satisfied with the results of cataract surgery. Overall, 88% reported that VF and QoL were "a lot better" and 10% responded little they were "a little better" than before surgery. CONCLUSIONS: Improvement in health-related QoL and VF occurred within 3 months of cataract extraction. The speed of visual acuity recovery after phacoemulsification matched the improvement across health-related QoL functions, resulting in rapid recovery of the patients' functional independence and health status.     

Managing the low vision patient

The low vision child has long been neglected by the professional community. A self-analysis of the usefulness of optometric service must be made as to professional attitudes and the understanding of the low vision aids as well as the patient that is expected to wear them. Once these hurdles are overcome, the optometrist is more able to help the low vision child become a productive, contributing member of society.     

Vision care benefits and optometric services in HMOs

General eye care, although not a required basic health service of federally qualified health maintenance organizations (HMOs), is being offered in virtually all HMOs. Reasons for including vision care benefits and optometric services are presented. Data from the Group Health Association of America and the Department of Health and Human Services demonstrates that HMOs are in fact providing vision care benefits and optometric services. The growth of the independent practice association (IPA) model is significant for optometry as it threatens to limit the scope of optometric practice. New professional problems arise as participating optometrists are constrained from performing the full range of optometric services. In recent years optometry has expanded its scope of licensure and practice to incorporate both diagnostic and therapeutic drugs in its management of visual problems. Managed care and alternate delivery systems, however, may restrict the advances that optometry has made in the legislative arena.     

Correlation of long term phenotypic and clinical outcomes following limbal epithelial transplantation cultivated on amniotic membrane in rabbits

AIM: To determine the epithelial phenotype in rabbits with total limbal stem cell deficiency (LSCD) after reconstruction with autologous limbal epithelial stem cells ex vivo expanded on rabbit amniotic membrane (AM). METHODS: Left eyes of 52 rabbits were rendered total LSCD, verified by impression cytology. The fibrovascular pannus of each cornea was removed. Group I (n = 10) received rabbit AM transplantation alone, while groups II-IV (n = 42) underwent transplantation of LSC cultured on rabbit AM (LSC-AM) from a small limbal biopsy taken from the right eye. Clinical outcome was graded as "success," "partial success," or "failure" depending on the corneal smoothness and avascularity. Epithelial phenotype was determined by immunostaining and graded as "corneal (K)," "conjunctival (J)," or "mixed (M)" depending on expression of K3 and Muc5AC. RESULTS: After 1 year follow up, group I showed 100% failure and groups II-IV showed 26% success (p<0.001). Clinical failure correlated with J phenotype p = 0.001), while clinical success correlated with K phenotype p = 0.01). When the phenotypic outcome was used for comparison, J phenotype was significantly high in group I (p = 0.003), while K phenotype was significantly high in groups II-IV (p<0.05). CONCLUSION: There is a strong correlation between clinical success and resultant corneal epithelial phenotype. Ex vivo expanded LSC can successfully reconstruct corneal surfaces with unilateral total LSCD.     

Central serous chorioretinopathy with subretinal deposition of fibrin-like material and its prompt response to ranibizumab injections

Purpose

Central serous chorioretinopathy (CSCR) manifests as neurosensory detachment of the macula and can be attributed to focal or multifocal leakage in the retinal pigment epithelium (RPE). Fibrin accumulation in the subretinal space is an unusual and heretofore unreported visually damaging manifestation of severe CSCR.

Methods

The patient was followed up with the use of biomicroscopy, fluorescein angiography, and optical coherence tomography (OCT).

Results

A 32-year-old woman was referred to our department complaining of metamorphopsia and decreased visual acuity in the right eye. Best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/20 in the left eye. Biomicroscopy revealed an irregularly shaped foveal elevation and wrinkling in the right eye. OCT showed a steep neurosensory retina elevation with a highly reflective material accumulation in the subretinal space, presumably fibrin. Our diagnosis was CSCR complicated by subretinal fibrin accumulation. Since most of these cases resolve spontaneously, the patient was kept under observation; 1 month later, the fibrin accumulation had expanded subfoveally (BCVA 20/200). The patient was offered 3 intravitreal ranibizumab injections. After the initial injection, BCVA improved to 20/50 and, after the 3 injections, to 20/30. Two months later (BCVA 20/30), fresh leakage was observed at the margin of the original lesion, and an additional intravitreal ranibizumab injection was performed. After another 2 months, BCVA stabilized at 20/25 and remained stable throughout the 12 months after the initial injection.

Conclusions

Prompt recognition of CSCR complicated by subretinal fibrin and immediate intervention may result in recovery from this potentially devastating complication. Ranibizumab may be an alternative treatment option in the management of refractory CSCR complicated by subretinal fibrin accumulation.Key Words: Central serous chorioretinopathy, Fibrin, Ranibizumab, Optical coherence tomography     

The cost effectiveness of selected optometric procedures

As funding of optometric care by the government and third parties increases, more regulation of vision care is anticipated. Utilization of cost effectiveness studies may largely determine the level of optometric care acceptable to these providers. Consequently, a method of determining cost effectiveness of optometric procedures has been developed and applied to three models of optometric care. Data taken from a review of patient records are used to develop quantifiable cost criteria for a specified patient group. These criteria include actual cost, patient acceptance (satisfaction), and professional acceptance of prescribed therapy. These criteria are then applied to each model of patient care to determine which is most cost effective.     

Patient expectations for medical and surgical care: a review of the literature and applications to ophthalmology

Over the past several decades, emphasis on patient-centered care, the dramatic growth of refractive surgery in the United States, and increasing competition in the eye care marketplace have made patient expectations increasingly important in the field of ophthalmology. Patient-centered care recognizes the obligation to understand and meet patient's expectations. Despite increasing patient expectations for refractive surgery and eye care in general, however, there has been limited research on patient expectations within the field of ophthalmology. The vast majority of existing research on patients' expectations has focused on expectations of primary care physicians. Because ophthalmologists are involved in both surgical and medical care, it is important to expand the consideration of patient expectations beyond the traditional primary care setting. Using elements of the taxonomy developed by Kravitz (Kravitz RL: Patients' expectations for medical care: an expanded formulation based on review of the literature. Med Care Res Rev 53:3-27, 1996), this article reviews the existing literature on patient expectations and draws attention to the limited research in specialty and surgical fields. This article has the following objectives: 1) provide a context for understanding what patient expectations are, 2) review the different ways that patient expectations are measured, 3) illustrate the content of patient expectations from empirical research, 4) outline potential determinants of patient expectations, and 5) discuss the role of patient expectations in ophthalmology.     

The incidence of liability claims in ophthalmology as compared with other specialties

Ophthalmologists continue to share in the professional liability claims that plague the medical profession. Data have been extrapolated from the April 1987 publication of the United States General Accounting Office (GAO) entitled, "Medical Malpractice Characteristics of Claims Closed in 1984." This document presents information pertaining to the comparative incidence of professional liability claims of ophthalmologists with other specialties.     

Professional discretion in cases of unfitness to drive due to impaired vision (author's transl)

The question of professional discretion is discussed in relation to cases where the physician believes that the patient's visual impairment renders him unfit to drive. It is often difficult for the ophthalmologist to make a valid judgment. Since physicians are not bound to report such cases to the traffic authorities or to third persons, any assumption of responsibility in making a statement, either without the patient's knowledge or against his will, is an infringement of professional secrecy. Article 34 of the (West German) Penal Code makes provision for "justified" disclosures. There is also a relevant verdict of the German Federal Supreme Court dated Oct. 8, 1968, case ref. VIZR 168/67, which deals with basic considerations. However, it is advisable in each case to consult the legal adviser of the responsible Medical Council prior to making any disclosure in order to establish whether it is justified.