Digital Education in Ophthalmology

Social media for international surgical skills transfer: using pneumatic retinopexy as a model

OBJECTIVE

To assess social media as a potential method of bridging the gap between randomized controlled trial evidence and the implementation of pneumatic retinopexy (PnR).

DESIGN

Cross-sectional study.

PARTICIPANTS

Vitreoretinal surgeons from a Telegram chat group that was initiated in May 2020 for educating ophthalmologists about PnR.

METHODS

Between July 25, 2023, and September 25, 2023, longitudinal chat usage was recorded using an automated chatbot, and a subgroup of surgeons was surveyed about the effect of the Telegram group on their PnR practice.

RESULTS

Telegram group membership increased from 43 members in May 2020 to 885 members in June 2024, with representation from 64 different countries. A subset of 653 members sent a mean (SD) of 2.6 (28.2) messages and were active 56.4 (195.0) times between July and September 2023. Eighty-one surgeons from 35 different countries completed the survey. Between the year before and year after joining the Telegram group, the proportions of surgeons that treated >25% of RRD cases with PnR (8.6% vs 44.4%; p < .001) and self-reported >80% primary anatomical reattachment rate (27.2% vs 48.1%; p < .001) increased.

CONCLUSIONS

Social media may be leveraged to support the refinement of surgical techniques such as PnR for physician trainees and practicing surgeons, as well as increase surgical adoption into routine practice, a process that can otherwise take several decades. A randomized implementation trial that compares social media to other dissemination and implementation strategies while incorporating effectiveness and safety outcomes is warranted.

Evaluation of Tele-Education in Malawi for Detection of Macular Features Using Optical Coherence Tomography

PURPOSE

The study aimed to assess the reliability of tele-education in training a Malawian ophthalmology resident to interpret optical coherence tomography (OCT) images of patients with macular conditions.

METHODS

This was a retrospective analysis of 1000 macula-centered OCT image series from 1000 eyes of 1000 consecutive patients from Malawi, which involved initial interpretation by a German retina specialist (observer 1) (T0). Observer 1 then trained a Malawian resident (observer 2) via email, and observer 2 independently interpreted images at T1, followed by face-to-face training in Malawi and reinterpretation at T2 and T3 (3-month intervals). The observers had to recognize, on OCT imaging, the normal macular structure, vitreofoveal traction (VFT), absent fovea depression (FD), epiretinal membrane (ERM), lamellar macular hole (LMH), full-thickness macular hole (FTMH), foveoschisis, intraretinal pseudocyst (IPC), intraretinal hyperreflective foci (IHF), subretinal fluid (SRF), pigment epithelial detachment (PED), and drusen. Cohen's Kappa statistic measured inter-observer agreement.

RESULTS

At T1 post-tele-education, almost perfect agreement (κ = 0.86; 99.6% agreement) was observed for FTMH. Agreement remained high at T2 post-face-to-face training (κ = 0.9; 99.7%) and decreased substantially at T3 (κ = 0.77; 99.4%). Following tele-education (T1), substantial agreement (κ range: 0.77 - 0.86) was found for IPC, PED, IHF, and FD, while ERM showed fair agreement (κ = 0.33; 81%). Face-to-face training notably improved agreement for SRF (T1 κ = 0.6, T2 κ = 0.63), LMH (T1 κ = 0.6, T2 κ = 0.67), and normal macular structure (T1 κ = 0.6, T2 κ = 0.62).

CONCLUSION

There was good agreement in the detection of the majority of the OCT features seen in most of the macular pathologies following training through tele-education and the results did not change significantly following face-to-face teaching. Tele-education could reliably complement training in vitreoretinal diagnostic skills in resource-limited settings.

Teleophthalmology Through Online Mentorship Over a 20-Year Period: Education and Capacity Building

PURPOSE

Telemedicine is widely used for diabetic retinopathy, retinopathy of prematurity, and other ophthalmic diseases. However, there is limited research on the use of teleophthalmology in retinoblastoma. The goal of this study was to explore how Orbis Cybersight affected the capacity for treatment and management of children with retinoblastoma through online mentorship and to assess the efficacy of online mentoring through disease-specific knowledge change over time.

METHODS

A retrospective review of Orbis Cybersight retinoblastoma consultations from 2004 to 2023 was conducted. Each participant was scored from 0 to 39 points on the basis of information provided throughout the consultation. These points were separated into six categories: patient history, clinical findings, grouping/staging, diagnostic findings, treatment plan, and patient and ocular outcomes. Data were analyzed by linear regression models to identify changes over time.

RESULTS

Among 653 patients from 38 different mentees, significant improvement in total points over time was observed (β = .012 [SE, 0.004]; P = .009). The mean score for total points at first consult was 17.7 (standard deviation [SD], 3.5) and at fifth consult was 19.8 (SD, 5.2). Three management categories showed significant improvement: clinical findings (P = .005), grouping/staging (P < .0001), and patient and ocular outcomes (P = .002). However, there was a significant decline in patient history points over time (P = .0006).

CONCLUSION

Mentorship via Orbis Cybersight improved retinoblastoma disease-specific knowledge and management over a 20-year period. Tele-education provides an opportunity for disease-specific capacity building in low- and middle-income countries for the treatment of retinoblastoma.

Advances and prospects of multi-modal ophthalmic artificial intelligence based on deep learning: a review

BACKGROUND

In recent years, ophthalmology has emerged as a new frontier in medical artificial intelligence (AI) with multi-modal AI in ophthalmology garnering significant attention across interdisciplinary research. This integration of various types and data models holds paramount importance as it enables the provision of detailed and precise information for diagnosing eye and vision diseases. By leveraging multi-modal ophthalmology AI techniques, clinicians can enhance the accuracy and efficiency of diagnoses, and thus reduce the risks associated with misdiagnosis and oversight while also enabling more precise management of eye and vision health. However, the widespread adoption of multi-modal ophthalmology poses significant challenges.

MAIN TEXT

In this review, we first summarize comprehensively the concept of modalities in the field of ophthalmology, the forms of fusion between modalities, and the progress of multi-modal ophthalmic AI technology. Finally, we discuss the challenges of current multi-modal AI technology applications in ophthalmology and future feasible research directions.

CONCLUSION

In the field of ophthalmic AI, evidence suggests that when utilizing multi-modal data, deep learning-based multi-modal AI technology exhibits excellent diagnostic efficacy in assisting the diagnosis of various ophthalmic diseases. Particularly, in the current era marked by the proliferation of large-scale models, multi-modal techniques represent the most promising and advantageous solution for addressing the diagnosis of various ophthalmic diseases from a comprehensive perspective. However, it must be acknowledged that there are still numerous challenges associated with the application of multi-modal techniques in ophthalmic AI before they can be effectively employed in the clinical setting.

Nursing students' perception of digital technology in clinical education among undergraduate programs: A qualitative systematic review

BACKGROUND

Although past research has highlighted the importance of digital technology in clinical education among undergraduate nursing programs, facilitators and barriers to application still need to be systematically understood.

AIM

The objective of this systematic review is to synthesize existing literature reporting on nursing students' experiences with digital technology in clinical education among undergraduate programs to identify gaps and design future educational programs.

METHODS

We conducted a qualitative systematic review and reported the following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed, Embase, CINAHL, Web of Science databases were searched for studies published in English. Qualitative studies focusing on nursing students' experiences of digital technology in clinical education were included, and data were synthesized by extracting findings, developing categories, and developing synthesized findings.

RESULTS

Six synthesized findings were concluded:1) nature of digital education, 2) facilitators, 3) barriers, 4) benefits to learning, 5) mixed experience, and 6) challenges.

CONCLUSIONS

The systematic review revealed that the utilization of digital technology in clinical practice is beneficial to the learning of undergraduate nursing students. Facilitators and challenges of digital education, as well as barriers to digital education identified in this review can be used to design more effective digital education activities. Digital technology can be used to supplement traditional teaching, and it is worthwhile to explore more in the area of digital education to promote the cultivation of nursing students' competency.

Artificial intelligence in retinal image analysis: Development, advances, and challenges

Modern advances in diagnostic technologies offer the potential for unprecedented insight into ophthalmic conditions relating to the retina. We discuss the current landscape of artificial intelligence in retina with respect to screening, diagnosis, and monitoring of retinal pathologies such as diabetic retinopathy, diabetic macular edema, central serous chorioretinopathy, and age-related macular degeneration. We review the methods used in these models and evaluate their performance in both research and clinical contexts and discuss potential future directions for investigation, use of multiple imaging modalities in artificial intelligence algorithms, and challenges in the application of artificial intelligence in retinal pathologies.

Surfing the COVID-19 Tsunami with Teleophthalmology: the Advent of New Models of Eye Care

Purpose of Review

In this article, we reviewed the impact resulting from the COVID-19 pandemic on the traditional model of care in ophthalmology.

Recent Findings

Though virtual eye care has been present for more than 20 years, the COVID-19 pandemic has established a precedent to seriously consider its role in the evolving paradigm of vision and eye care. New hybrid models of care have enhanced or replaced traditional synchronous and asynchronous visits. The increased use of smart phoneography and mobile applications enhanced the remote examination of patients. Use of e-learning became a mainstream tool to continue accessing education and training.

Summary

Teleophthalmology has demonstrated its value for screening, examining, diagnosing, monitoring treatment, and increasing access to education. However, much of the progress made following the COVID-19 pandemic is at risk of being lost as society pushes to reestablish normalcy. Further studies during the new norm are required to prove a more permanent role for virtual eye care.

Ophthalmology residency training in Nigeria: The trainers' perspective

Introduction

Periodic evaluations are an indispensable part of any training programme. This study assessed ophthalmology residency training in Nigeria from the perspective of ophthalmology trainers.

Materials and Methods

This was a nationwide web-based survey of ophthalmology trainers at the 30 institutions accredited by the National Postgraduate Medical College of Nigeria from April 2021 to June 2021. Trainers were invited to complete a Google form via E-mail and WhatsApp. Data were collected on the characteristics of trainers and the training programme.

Results

One hundred and fifty-eight (71.2%) out of 222 trainers responded to the survey comprising 67 (42.4%) males and 91 (57.6%) females, amongst whom were 97 (61.4%) subspecialists. The mean age (±standard deviation) was 51.47 ± 8.61 years (range, 38-75 years). Most respondents rated human resources (trainers and support staff) as 'much more' than adequate (n = 30, 19%), the volume of surgery as 'less or much less' than adequate (n = 82, 51.9%), the conduct of examinations as 'good' or better than good (n = 120, 75.9%) and impact of emigration of ophthalmologists on training as 'very negative' (n = 36, 22.8%). Overall, 94 (59.4%) respondents rated the quality of training as 'good' or better than good. Respondents recommended improving funding and training resources, revising the current conduct of examinations, increasing the use of appropriate technology and improving remunerations and national security.

Conclusions

The majority of ophthalmology trainers rated ophthalmology residency training in Nigeria as 'good' but rated 'volume of surgery' as inadequate for training. Recommendations were made to improve the quality of training, revise examination practices and reduce the negative impact of emigration.

The Role of Technology in Ophthalmic Surgical Education During COVID-19

Purpose of Review

To describe the effect of COVID-19 on ophthalmic training programs and to review the various roles of technology in ophthalmology surgical education including virtual platforms, novel remote learning curricula, and the use of surgical simulators.

Recent Findings

COVID-19 caused significant disruption to in-person clinical and surgical patient encounters. Ophthalmology trainees worldwide faced surgical training challenges due to social distancing restrictions, trainee redeployment, and reduction in surgical case volume. Virtual platforms, such as Zoom and Microsoft Teams, were widely used during the pandemic to conduct remote teaching sessions. Novel virtual wet lab and dry lab curricula were developed. Training programs found utility in virtual reality surgical simulators, such as the Eyesi, to substitute experience lost from live patient surgical cases.

Summary

Although several of these described technologies were incorporated into ophthalmology surgical training programs prior to COVID-19, the pandemic highlighted the importance of developing a formal surgical curriculum that can be delivered virtually. Novel telementoring, collaboration between training institutions, and hybrid formats of didactic and practical training sessions should be continued. Future research should investigate the utility of augmented reality and artificial intelligence for trainee learning.