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Mendall J, Tolley A, Parisi V, Hornby S, Brown R, Nowak V. Confidence of Emergency Department doctors in managing ophthalmic emergencies: a systematic review. Eye (Lond) 2024:10.1038/s41433-024-03115-z. [PMID: 38729998 DOI: 10.1038/s41433-024-03115-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/10/2024] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Eye emergencies constitute a significant portion of attendances to general Emergency Departments (EDs) in the UK, therefore it is important to assess the confidence of doctors who work in this setting in managing these potentially sight- and life-threatening presentations. This systematic review aims to assess the confidence of UK doctors working in general EDs in managing ophthalmic emergencies. METHODS MEDLINE (Ovid), EMBASE (Ovid), ProQuest Central and Web of Science databases and grey literature were searched from inception to 1 October 2022 for publications that (1) featured doctors working in UK general EDs, (2) assessed doctors' confidence in managing ophthalmic emergencies, (3) contained original data, (4) were full-text, and (5) written in English. Methodological quality was assessed using the AXIS tool. RESULTS 462 articles were screened, and 7 papers included for data extraction, which collectively assessed the confidence of 956 doctors working in EDs in managing ophthalmic emergencies. There was a widespread lack of confidence amongst foundation doctors, which has worsened over time. Most doctors lacked confidence in performing funduscopy and using the slit-lamp, and considered formal ophthalmology training received in EDs to be inadequate. CONCLUSIONS Evidence suggests a lack of confidence amongst foundation doctors in managing ophthalmic emergencies. High-quality evidence investigating the confidence amongst more experienced Emergency Medicine (EM) physicians was lacking. It is important to assess why foundation doctors feel so ill-prepared to manage eye emergencies and develop further ophthalmic training for doctors working in EDs. Further investigation exploring the confidence of EM trainees and consultants is required.
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Affiliation(s)
| | - Abraham Tolley
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Stella Hornby
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruth Brown
- Imperial College Healthcare NHS Trust, London, UK
| | - Victoria Nowak
- The National Hospital for Neurology and Neurosurgery, London, UK
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Dutt DDCS, Carr SE, Scott TM, Petsoglou C, Grigg J, Razavi H. Educators' consideration of learner motivation in ophthalmology education in medical school: Influences on teaching practice and course design. MEDICAL TEACHER 2024; 46:387-398. [PMID: 37703439 DOI: 10.1080/0142159x.2023.2256956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Ophthalmology education in medical school has historically neglected the impact of autonomous motivation on student learning and wellbeing. This study aimed to understand ophthalmology educators' consideration and application of student motivation in ophthalmology medical education. MATERIAL AND METHODS Lead ophthalmology educators from Australian and New Zealand medical schools participated in an online semi-structured in-depth interview. Interview transcripts were analysed using thematic analysis. Codes were generated and aligned into overarching themes. FINDINGS Six educators participated in the study. Five main themes arose from the transcripts: the lack of explicit consideration of student motivation, implicit consideration of motivation in curriculum design and in teaching practices, the impact of innovation on motivation and the relationship between teacher and student motivation. Participants also commented on trends in ophthalmology education including generalists' confidence in managing ophthalmic disease, the role of fundoscopy in medical education and time pressure on ophthalmology in medical schools. CONCLUSION There has only been an implicit instead of explicit consideration of motivation in ophthalmology education in medical school, which leaves an unfulfilled potential for teaching practices to impact the affective along with cognitive and metacognitive aspects of learning. This study highlights the need for motivation to be explicitly incorporated into the development of teaching practices and curriculum reform.
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Affiliation(s)
- Deepaysh D C S Dutt
- Health Professions Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Sandra E Carr
- Health Professions Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Tabitha M Scott
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | | | - John Grigg
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Eye Genetics Research Group, Children's Medical Research Institute, Sydney, New South Wales, Australia
- Genetic Medicine and Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Hessom Razavi
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia
- Department of Ophthalmology, Lions Eye Institute, Perth, Western Australia, Australia
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Dutt DD, Razavi H, Carr SE. Self-determination theory in ophthalmology education: factors influencing autonomy, competence and relatedness in medical students. MEDICAL EDUCATION ONLINE 2023; 28:2258633. [PMID: 37729582 PMCID: PMC10512850 DOI: 10.1080/10872981.2023.2258633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The affective components of learning, including student motivation, has yet to be thoroughly investigated in undergraduate ophthalmology education. This study aims to use Self-Determination Theory (SDT) as a framework to describe the variations in student perceptions of motivation in studying ophthalmology through their satisfactions of autonomy, competence and relatedness, and to highlight factors that stimulate or hinder this. METHODS Penultimate year medical students from a single tertiary educational institution undertaking a clinical placement in ophthalmology participated in in-depth interviews to explore factors affecting their perceptions of motivation in studying ophthalmology. Interviews were transcribed and analysed according to the principles of interpretive phenomenography through the theoretical framework of SDT. RESULTS Of the 39 students invited, 10 agreed to participate. Variations in perceptions of experiences generated the outcome space. Participants experienced either amotivation, external locus extrinsic motivation, internal locus extrinsic motivation and intrinsic motivation (conceptions of the outcome space). This was described with respect to their satisfaction of autonomy, competence and relatedness (dimensions of the outcome space). Additionally, 21 factors that impacted on motivation were identified, of which five over-arching factors impacted all three basic psychological needs - guidance, growth mindset, assessment, curricular pressure and extracurricular pressure. CONCLUSIONS The findings of this study provide a unique insight into the motivation of medical students studying ophthalmology. This provides an exciting opportunity for medical educators to address the affective aspect of learning.
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Affiliation(s)
- Deepaysh D.C.S. Dutt
- Health Professions Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Hessom Razavi
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia
- Lions Eye Institute, Department of Ophthalmology, Perth, Western Australia, Australia
| | - Sandra E. Carr
- Health Professions Education, The University of Western Australia, Perth, Western Australia, Australia
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Abuallut I, Hurissi E, Abuageelah BM, Alfaifi M, Hakami A, Qadri A, Hakami A, Ghulaysi S. Assessment of Ophthalmology Teaching and its Impact on the Choice of Future Specialties Among Medical Students of Jazan University. Cureus 2023; 15:e49134. [PMID: 38130548 PMCID: PMC10733128 DOI: 10.7759/cureus.49134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Ophthalmology is essential for primary and specialty care physicians, as eye complaints are common, accounting for a sizable proportion of general practice consultations and emergency department visits. Fundamental ophthalmology knowledge is also relevant to other specialty fields. Thus, medical schools must provide effective undergraduate curricula to teach students about salient points, visual examination skills, emergency recognition, and referral indications. The International Council of Ophthalmology (ICO) has set guidelines that medical students should imbibe to become proficient in ophthalmology. However, there have been no recent investigations evaluating undergraduate ophthalmology education at Jazan University's Faculty of Medicine. Therefore, this study aimed to compare the curriculum at Jazan University to the ICO's requirements for undergraduate medical education. METHODS An observational cross-sectional study was conducted with both male and female student participants enrolled in an ophthalmology course at Jazan University's Faculty of Medicine. Following IRB approval, the questionnaire was distributed on social media to assess if Jazan University's undergraduate ophthalmology curriculum complies with ICO standards. RESULTS The study included a diverse sample of 322 participants, predominantly consisting of female students (n=178, 55.3%). The participants' ages ranged from 22 to 36 years, with the majority falling within the 24-25 year age range (n=173, 53.7%). Regarding academic performance, (n=117, 36.3%) of participants had a GPA of less than 4, while 66 (20.5%) had a GPA between 4.76 and 5.00. Among the respondents, 31 (9.6%) indicated having no exposure to ophthalmology, while 117 (36.3%) felt they had insufficient exposure. A considerable percentage of participants expressed competence in various areas, such as obtaining ocular history (n=113, 35.1%), testing visual acuity (n=201, 62.4%), and examining extraocular motility (n=201, 62.4%). In total, 98 participants (30.4%) expressed an interest in ophthalmology, while the majority (n=224, 69.6%) were not interested. CONCLUSION Essential improvements include increasing hands-on clinical experience, small-group learning, exposure across academic years, and early mentorship. Developing competency-based curricula aligned with ICO guidelines could significantly strengthen education. Better training quality and exposure will equip students with the necessary skills, boost confidence, and potentially expand the ophthalmology workforce.
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Affiliation(s)
- Ismail Abuallut
- Department of Surgery, Ophthalmology Division, Jazan University, Jazan, SAU
| | - Eman Hurissi
- Department of Surgery, Ophthalmology Division, Prince Mohammed Bin Naser Hospital, Jazan, SAU
| | | | - Mona Alfaifi
- Department of Medicine and Surgery, Batterjee Medical College, Aseer, SAU
| | - Alshomokh Hakami
- Department of Medicine, Emergency Division, General Jazan Hospital, Jazan, SAU
| | - Alanoud Qadri
- Department of Pediatrics, General Jazan Hospital, Jazan, SAU
| | - Afnan Hakami
- Department of Pharmacy, Maternity & Children's Hospital Bisha, Bisha, SAU
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Anthony CM, Altman AH, Otte B, Mines MJ, Mazzoli RA, Lappan CM, Legault GL. Teleophthalmology in the United States Army: A Review From 2004 Through 2018. Mil Med 2023; 188:e182-e189. [PMID: 34865104 DOI: 10.1093/milmed/usab417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION We describe results of the U.S. Army Ocular Teleconsultation program from 2004 through 2018 as well as the current condition, benefits, barriers, and future opportunities for teleophthalmology in the clinical settings and disease areas specific to the U.S. Military. MATERIALS AND METHODS This was a retrospective, noncomparative, consecutive case series. A total of 653 ocular teleconsultations were reviewed; 76 concerned general policy questions and underwent initial screening to determine the year each request was received, the average and median initial consultant response time, the number of participating consultants, the country from which the request originated, the military status and branch of each U.S. patient for which a request was submitted, and the nationality, age, and military status of foreign patients for whom consults were requested. The remaining 577 requests were further analyzed to determine the diagnostic category of the request, whether or not an evacuation recommendation was provided by a consultant, the relationship of the request to trauma, if and what type of nonocular specialty consultant(s) participated in the consultation request, and if and what type of ancillary imaging accompanied the request. RESULTS The number of requests was 13 in 2004, compared to 80 in 2011 and 11 in 2018. The average response time in 2018 was 2.27 hours compared to 9. 73 hours in 2004. The number of participating ocular specialists was 5 in 2004, compared to 39 in 2013 and 13 in 2018. Requests originating from Iraq and Afghanistan comprised 61.1% (399/653) of requests. The U.S. Army personnel comprised the largest percentage of consults at 38.6% (252/653). Nonmilitary patients from the USA accounted for 18.5% (121/653) of consults. Non-U.S. patients including coalition forces, contractors, detainees, and noncombatants accounted for 14.4% (94/653) of consults, of which 22% (21/94) were children. Anterior segment consults accounted for 45.1% (260/577) of consults, with corneal surface disease being the largest subset within this diagnostic category. Evacuation was recommended in 22.7% (131/577) of overall cases and 41.1% (39/95) of trauma cases. Requests were associated with either combat-related or accidental trauma in 16.5% (95/577) of cases. Dermatology and neurology were the most commonly co-consulted specialties, representing 40.0% (32/80) and 33.75% (27/80) of consults, respectively. Photographs of suspected ocular pathology accompanied 37.4% of consults, with the likelihood requesters included photographs being greatest in cases involving pediatric ophthalmology (7/9, 77.8%) and oculoplastics (86/120, 71.7%). CONCLUSIONS Army teleophthalmology has been an indispensable resource in supporting and advancing military medicine, helping to optimize the quality, efficiency, and accessibility of ophthalmic care for U.S. Military personnel, beneficiaries, allied forces, and local nationals worldwide. A dedicated ophthalmic care and coordination system which utilizes new advances in teleconsultation technology could further enhance our current capability to care for the ophthalmic needs of patients abroad, with opportunity for improving domestic care as well.
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Affiliation(s)
- Christopher M Anthony
- Department of Ophthalmology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Adam H Altman
- Department of Ophthalmology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Benjamin Otte
- Department of Ophthalmology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Michael J Mines
- Ophthalmology Service, Madigan Army Medical Center, Joint Base Lewis-McChord, WA 20762, USA
| | - Robert A Mazzoli
- Department of Surgery, Division of Ophthalmology, Uniformed Services University, Bethesda, MD 20814, USA.,Warfighter Eye Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD 98431, USA
| | - Charles M Lappan
- Department of Ophthalmology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Gary L Legault
- Department of Ophthalmology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA.,Department of Surgery, Division of Ophthalmology, Uniformed Services University, Bethesda, MD 20814, USA
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Goel R, Macri C, Bahrami B, Casson R, Chan WO. Assessing the subjective quality of smartphone anterior segment photography: a non-inferiority study. Int Ophthalmol 2023; 43:403-410. [PMID: 36018419 PMCID: PMC9411845 DOI: 10.1007/s10792-022-02437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/05/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the subjective quality of anterior segment photos taken from a smartphone camera adapted to the slit lamp compared to a commercial inbuilt slit-lamp camera. METHODS Non-inferiority study. Five paired images of the anterior segment of normal eyes were taken using an iPhone 11 (Apple, Inc., Calif., USA) camera attached to a universal slit-lamp adaptor and a commercial inbuilt slit-lamp camera (Haag-Streit Diagnostics, Bern, Switzerland). Images were collated into a survey in which ophthalmology students, residents, registrars, and consultants participated to select the image taken from the inbuilt slit-lamp camera. If the image quality was subjectively indistinguishable, we expected a 50:50 split for each photograph that was presented. We selected a 10% non-inferiority margin, with the hypothesis that no less than 40% of images believed to be from the conventional camera were in fact from the smartphone camera. RESULTS There were 27 respondents in the survey: ophthalmology consultants (n = 7), registrars (n = 10), residents (n = 7), intern (n = 1) and students (n = 2). The mean correct identification across the respondents was 11.3 out of 25 (45.2%) images. Overall, the smartphone camera was non-inferior to the inbuilt slit-lamp camera (p < 0.001). The non-inferiority of the smartphone camera was significant for consultants (47.4%, p < 0.01), registrars (47.6%, p < 0.001) and residents (37.7%, p < 0.0001). CONCLUSIONS Anterior segment images obtained with a smartphone camera were non-inferior to the commercial inbuilt slit-lamp camera. Smartphone cameras may be a non-inferior tool for communication of anterior segment images having implications for the ease of access to quality telehealth consultations.
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Affiliation(s)
- Raghav Goel
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia.
| | - Carmelo Macri
- grid.416075.10000 0004 0367 1221Department of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, South Australia 5000 Australia
| | - Bobak Bahrami
- grid.1010.00000 0004 1936 7304Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, North Terrace, Adelaide, South Australia 5000 Australia
| | - Robert Casson
- grid.1010.00000 0004 1936 7304Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, North Terrace, Adelaide, South Australia 5000 Australia
| | - Weng Onn Chan
- grid.1010.00000 0004 1936 7304Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, North Terrace, Adelaide, South Australia 5000 Australia
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Eye irrigation as a first-line treatment and diagnostic method for emergency department patients who complain of ocular foreign bodies. Sci Rep 2021; 11:23386. [PMID: 34862462 PMCID: PMC8642417 DOI: 10.1038/s41598-021-02989-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/16/2021] [Indexed: 01/22/2023] Open
Abstract
This prospective study aimed at determine whether eye irrigation removes ocular foreign bodies (FBs) and whether ocular pain predicts FBs. Emergency department patients complaining of ocular FBs were enrolled. In the irrigation group (n = 52), pain was evaluated with a visual analog scale before and after irrigation, and the presence of FBs was determined under a slit-lamp. In the nonirrigation group (n = 27), the evaluations were performed upon arrival. The corneal FB retention rate was found significantly lower in the irrigation (13/52, 25%) than in the nonirrigation groups (13/27, 48%; P = 0.04). After irrigation, those without FBs had more patients experiencing pain reduction (67%) compared to those with retained FBs (46%; P = 0.14) and had a greater magnitude of change in pain score (mean ± SD, − 2.6 ± 2.7 vs. − 0.7 ± 1.4; P = 0.02). An improvement in ocular pain score ≥ 5 points after irrigation predicted the absence of FBs with a negative predictive value of 100%. Eye irrigation significantly lowered corneal FB retention; if ocular pain decreased considerably, the probability of retained FBs was low, making irrigation-associated pain score reduction a feasible diagnostic method to exclude FB retention without needing specialized ophthalmic examinations.
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Al-Najmi YA, Subki AH, Alzaidi NS, Butt NS, Alsammahi AA, Madani FM, Alsallum MS, Al-Harbi RS, Alhibshi NM. Medical Schools' Ophthalmology Course: An Appraisal by Ophthalmology Residents. Int J Gen Med 2021; 14:8365-8372. [PMID: 34819744 PMCID: PMC8607127 DOI: 10.2147/ijgm.s330044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate the perception and satisfaction of ophthalmology residents with the currently provided ophthalmology curricula to medical students. Methods A cross-sectional survey involving first to fourth year ophthalmology residents (N = 106) from all regions of Saudi Arabia was conducted between December 2018 and February 2019. An online questionnaire explored opinions about the ophthalmology course regarding three dimensions. Firstly, adequacy in covering essential parts of the specialty; secondly, improvements required; and thirdly, effectiveness. A score (0–21) was calculated, indicating the overall suitability of the ophthalmology course. In addition, factors of good overall suitability (score ≥10) were analyzed. Results Regarding adequacy, respondents opined that the ophthalmology course did not reasonably cover the basic part (35.8%), clinical part (61.3%), common disease (26.4%), and emergencies (39.6%). Concerning improvements required, more than 80% of the participants expressed that the course required to be improved for all its features, including duration (80.2%), objectives (85.8%), content (82.1%), organization (83.0%), and supervision (81.1%). As to effectiveness, half of them deemed the course unhelpful in familiarizing general practitioners with common ophthalmic diseases and emergencies. Overall, the ophthalmology course was generally deemed suitable (score ≥10) for only 27.4% of the participants, with no differences across gender, level, or region. Conclusion Ophthalmology residents perceived multiple deficits in the current Saudi ophthalmology teaching course. Significant improvements in ophthalmologic curricula are required, besides coping with unprecedented technological advancement in the ophthalmological field.
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Affiliation(s)
| | - Ahmed Hussein Subki
- Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | | | - Nadeem Shafique Butt
- Department of Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Firas Mohamed Madani
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | | | - Rakan Salah Al-Harbi
- Department of Family Medicine, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
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Henry C, Manton J. Barriers to accessing good ophthalmic care in the emergency department. Emerg Med Australas 2020; 33:178. [PMID: 33164267 DOI: 10.1111/1742-6723.13679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Caoimhe Henry
- Emergency Department, Redland Hospital, Cleveland, Queensland, Australia
| | - Joanna Manton
- Emergency Department, Redland Hospital, Cleveland, Queensland, Australia
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The Study of Incidence and Characteristics of Patients with Eye-Related Chief Complaints at the Emergency Department of Thammasat University Hospital. Emerg Med Int 2020; 2020:4280543. [PMID: 33133696 PMCID: PMC7591951 DOI: 10.1155/2020/4280543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/21/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022] Open
Abstract
Background Patients with eye-related chief complaints could be diagnosed not only with eye diseases but also with noneye diseases. This study determines rates and characteristics of patients with eye-related chief complaints at the Emergency Department of Thammasat University Hospital. Methods The study design is a descriptive retrospective observational study of patients with eye-related chief complaints at the Emergency Department of Thammasat University Hospital in 2017. Demographic data, diagnosis, management, consultation, and disposition were recorded by chart review. Categorical data were reported by percentage. Results Of the 52081 patients, 704 (1.3%) presented with eye problems. 60% of the patients were males. Patients were classified into three groups which are traumatic eye disease, nontraumatic eye disease, and noneye disease. 75.9% of the patients suffered traumatic injuries. The most common diagnoses of the traumatic eye injuries were foreign bodies at the cornea and conjunctiva and minor trauma to the conjunctiva. The most common mechanisms were foreign bodies in the eyes, cuts, or pierces. The most common causes of the injuries were from metals and housewares. The most common nontraumatic eye diagnoses were conjunctivitis and corneal ulcer. The most common noneye diagnoses were exposure of healthcare providers to secretions from patients, angioedema, and hypertensive crisis. Conclusions Most of the patients who came to the ER with chief complaints of the eyes could be treated by doctors in the emergency room without consulting ophthalmologists. Chief complaints of the eyes could be the leading symptoms of many organ systems. Emergency physicians should be differentially diagnosed to cover neurologic, cardiovascular, and immunologic problems.
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He B, Tanya S, Sharma S. Perspectives on virtual ophthalmology education among Canadian medical students. Can J Ophthalmol 2020; 56:208-209. [PMID: 33098758 PMCID: PMC7577254 DOI: 10.1016/j.jcjo.2020.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 09/27/2020] [Indexed: 12/04/2022]
Abstract
Similarly structured virtual learning programs may address critical gaps in undergraduate medical education of ophthalmology. Medical students prefer interactive virtual modalities over traditional didactic methods for learning ophthalmology. Social isolation in learners and inequities in access to medical education can be mitigated with open-access virtual learning.
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Affiliation(s)
- Bonnie He
- Faculty of Medicine, University of British Columbia, Vancouver, B.C
| | - Stuti Tanya
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, N.F
| | - Sanjay Sharma
- Department of Ophthalmology, Queen's University, Kingston, Ont..
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Training in and comfort with diagnosis and management of ophthalmic emergencies among emergency medicine physicians in the United States. Eye (Lond) 2020; 34:1504-1511. [PMID: 32350451 PMCID: PMC7609324 DOI: 10.1038/s41433-020-0889-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/07/2020] [Accepted: 03/04/2020] [Indexed: 12/26/2022] Open
Abstract
Background/objectives Patients with ophthalmic emergencies often present to emergency rooms. Emergency medicine (EM) physicians should feel comfortable encountering these conditions. We assessed EM physicians’ comfort working up, diagnosing, and managing ophthalmic emergencies. Subjects/methods 329 EM physicians participated in this cross-sectional multicentre survey. Questions inquired about the amount, type, and self-perceived adequacy of ophthalmic training. Likert scales were used to assess confidence and comfort working up, diagnosing, and managing ophthalmic emergencies. Results Participants recall receiving a median of 5 and 10 h of ophthalmic training in medical school and residency, respectively. Few feel this prepared them for residency (16.5%) or practice (52.0%). Only 50.6% feel confident with their ophthalmic exam. Most (75.0%) feel confident in their ability to identify an ophthalmic emergency, but 58.8% feel well prepared to work them up. Responders feel more comfortable diagnosing acute retrobulbar hematoma (72.5%), retinal detachment (69.8%), and acute angle closure glaucoma (78.0%) than central retinal artery occlusion (28.9%) or giant cell arteritis (53.2%). Only 60.2% feel comfortable determining if canthotomy and cantholysis is necessary in the setting of acute retrobulbar hematoma, and 40.3% feel comfortable performing the procedure. There was a trend towards attending physicians and providers in urban and academic settings feeling more comfortable diagnosing and managing ophthalmic emergencies compared to trainees, non-urban, and non-academic physicians. Conclusions Many participants do not feel comfortable using ophthalmic equipment, performing an eye exam, making vision or potentially life-saving diagnoses, or performing vision-saving procedures, suggesting the need to increase ophthalmic training in EM curricula.
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Thompson LB. An Eye Simulation for Training in the Use of Ophthalmologic Equipment and Corneal Foreign Body Removal Techniques. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:155-161. [PMID: 32110136 PMCID: PMC7041601 DOI: 10.2147/amep.s228087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/04/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE This simulation curriculum is structured to teach the use of common eye assessment equipment and corneal foreign removal techniques using harvested cow eye models, the ophthalmologic burr, and the hollow-bore needle. METHODS This curriculum involves using one self-assessment (SA) station and three skills stations. The skill stations teach the use of the iCareTonometer, Woods Lamp, and Slit Lamp, and train corneal foreign body removal using a burr and hollow-bore needle. RESULTS Sixteen first, second, and third-year (PGY 1-3) residents of the University of Alabama at Birmingham (UAB) Emergency Medicine participated. 100% indicated this should be an annual training with 87% indicating this was highly realistic. There was a 44% Pre-Sim to 94% Post-Sim SA for improvement with iCareTonometer skill. There was a 7% Pre-Sim to 100% post-Sim SA for improvement with Slit-Lamp skill. There was a 32% Pre-Sim to 100% Post-Sim SA improvement with Woods Lamp skill. For CFB removal, there was a 13% Pre-Sim to 94% Post-Sim SA for improvement with burr and hollow-bore needle skill. CONCLUSION The self-assessments indicated that this simulation was successful in leading these emergency medicine residents to attaining enhanced self-assessed competencies in the use of common eye assessment equipment and for corneal foreign body removal using the burr and the hollow-bore needle. To establish curriculum globalization, reliability, and competency, larger test groups will have to be studied and objective qualified testers will need to assess competencies.
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Affiliation(s)
- Linda Brindley Thompson
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Lin J, Chua MT. A low cost surrogate eye model for corneal foreign body removal. BMC Ophthalmol 2020; 20:48. [PMID: 32028904 PMCID: PMC7006147 DOI: 10.1186/s12886-020-1310-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background Patients commonly present to the Emergency Department with a corneal foreign body (FB). There is currently a lack of adequate training for junior doctors in the management of this condition. Our self-made surrogate eye model aims to address this void in our junior doctors’ knowledge. Methods Participants were guided through a hands-on session with a slit-lamp using our eye model, which is made of a hemispherical agar embedded with pencil lead fragments simulating as FBs. Using a 7-point Likert scale, all participants completed a questionnaire both before and after training, for: (1) knowledge in corneal FB removal, (2) confidence in corneal FB removal, and (3) effectiveness of the model. Results Out of 73 participants, 82.2% (60/73) had no prior experience in corneal FBs removal. After the training session, their knowledge improved from a median score of 2 (interquartile range [IQR] 1 to 3) to 5 (IQR 5 to 6), with improvement in confidence levels from 2 (IQR 1 to 2) to 5 (IQR 4 to 6). The effectiveness of our eye model scored a median of 6 (IQR 5 to 7). Conclusions Our surrogate eye model is low-cost, quick and easy to reproduce. After use, our learners expressed greater confidence in managing the removal of corneal FBs and use of slit lamp. With a recent focus in patient safety and quality, teaching this procedure via simulation is a safe way of bridging the gap between traditional didactic teaching and the clinical environment.
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Affiliation(s)
- Jingping Lin
- Emergency Medicine Department, National University Hospital, Level 4, National University Centre for Oral Health, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore. .,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Mui Teng Chua
- Emergency Medicine Department, National University Hospital, Level 4, National University Centre for Oral Health, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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15
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Laurent C, Hong SC, Cheyne KR, Ogbuehi KC. The Detection of Spontaneous Venous Pulsation with Smartphone Video Ophthalmoscopy. Clin Ophthalmol 2020; 14:331-337. [PMID: 32099318 PMCID: PMC7006856 DOI: 10.2147/opth.s238897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 01/13/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Spontaneous venous pulsation (SVP) has a high negative predictive value for raised intracranial pressure and is a useful sign when assessing patients with headache. The objective was to determine if smartphone-based video ophthalmoscopy can detect SVP. Patients and Methods In total 233 patients and 291 eyes were recruited from the Dunedin Hospital eye clinic from July to November 2018. Patients were examined by a clinician and graded for SVP with a slit lamp and 78 Dioptre lens. Videos were taken with a smartphone ophthalmoscope and graded by two separate clinicians blinded to the slit lamp findings. Results Only 272 eyes of 215 patients were included, as others failed in the inclusion criteria for overall video quality. Sensitivity was calculated as how likely the presence of SVP on video was indicative of the presence of SVP on slit lamp. Sensitivity was 84.77% for Observer 1, with 128 videos graded as positive for SVP on video ophthalmoscopy of the 151 identified as positive on slit lamp examination. Sensitivity was 76.82% for Observer 2 with 116 videos correctly identified. The false positive rate was calculated as the number of videos graded positive for SVP that had been graded as negative on slit lamp examination. This was 10.74% for observer 1 and 31.40% for observer 2. Conclusion This study demonstrates that SVP is detected by video ophthalmoscopy. This may be a useful triage, telemedicine and referral tool to be used for patients with headache in a primary care setting.
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Affiliation(s)
- Charlotte Laurent
- Ophthalmology Department, Southern District Health Board, Dunedin, New Zealand.,University of Otago, Dunedin, New Zealand
| | - Sheng Chiong Hong
- Ophthalmology Department, Mid Central District Health Board, Palmerston North, New Zealand.,oDocs Eye Care Limited, Auckland, New Zealand
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Hogg HDJ, Pereira M, Purdy J, Frearson RJR, Lau GB. A non-randomised trial of video and written educational adjuncts in undergraduate ophthalmology. BMC MEDICAL EDUCATION 2020; 20:10. [PMID: 31918692 PMCID: PMC6953281 DOI: 10.1186/s12909-019-1923-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/30/2019] [Indexed: 05/28/2023]
Abstract
BACKGROUND Provision of relevant pre-learning materials has been shown to increase student engagement and improve outcomes in medical education. This non-randomised study attempts to quantify the educational gains, and relative efficacy of video and written pre-learning materials, in ophthalmology undergraduate teaching. METHODS Ninety-eight final year medical students were contacted prior to their three-day ophthalmology placements at a British tertiary ophthalmology unit. All participants were sent welcome packs prior to arrival requesting they undertake 90 min of work focusing on a list of specified ophthalmic conditions. One cohort (N = 33) were sent written materials, another (N = 32) was provided with video materials and a third cohort (N = 33) were not sent any materials. On arrival participants completed a simple knowledge test, a questionnaire estimating the time they spent preparing for the placement and a self-reported knowledge score. The teaching on placement was the same for all cohorts. At the conclusion of each placement participants completed a challenging knowledge test, a clinical skills test and repeated self-reported knowledge scores. RESULTS Eighty seven percent of students receiving specified materials claimed to complete pre-placement work compared to 70% of those receiving learning outcomes alone (p = 0.05). Students receiving learning materials scored higher in the post-placement tests of knowledge (p < 0.001), 74.8% (72.4-77.2%) vs 63.6% (95%CI 59.3-67.9%) and skills (p = 0.04), 86.9% (83.9-89.9%) vs 81.3% (77.2-85.4%). Students using video resources outperformed students using written materials in their visual acuity assessment test (p = 0.03), 90.4% (86.6-94.2%) vs 83.6% (80.1-87.1%) whilst those receiving written rather than video material performed better in the end of placement knowledge test (p = 0.03), 77.7% (74.3-81.1%) vs 72.0% (68.9-75.1%). CONCLUSION This study showed that providing pre-placement learning materials improves undergraduates' commitment and achievement. Written materials better facilitate knowledge acquisition while video materials preferentially promote skill acquisition. This is a novel demonstration within ophthalmology and can help address the imbalance between the expectations placed on undergraduates and the resources committed to ensuring they are met.
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Affiliation(s)
- H D Jeffry Hogg
- The University of Newcastle upon Tyne, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | - Michael Pereira
- The University of Newcastle upon Tyne, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
| | - Julian Purdy
- The University of Newcastle upon Tyne, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
| | - Richard J R Frearson
- The University of Newcastle upon Tyne, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
| | - Gordon B Lau
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
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17
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National survey of the management of eye emergencies in the accident and emergency department by foundation doctors: has anything changed over the past 15 years? Eye (Lond) 2019; 34:1094-1099. [PMID: 31649348 DOI: 10.1038/s41433-019-0645-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/20/2019] [Accepted: 09/30/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Ophthalmic emergencies comprise a significant portion of junior doctors' workload in accident and emergency (A&E). However, previous studies have demonstrated a lack of training and confidence in the management of such emergencies. This study assessed changes in basic ophthalmic training that A&E junior doctors received in dealing with eye emergencies, their perceived level of confidence and the availability of appropriate ophthalmic equipment in A&E over the last 15 years. METHODS A prospective, national, combined online and telephone survey using a previously published questionnaire was performed. Foundation year two doctors (FY2s) from each A&E department in the UK listed on the official NHS directory were contacted for participation. RESULTS Two hundred and ten A&E departments were contacted and 202 responded (response rate of 96.2%). There was no significant change in the number of A&E departments equipped with slit lamps (82.5% in 2003 vs 79.7% in 2018; p = 0.26). However, the prevalence of training in its use has decreased significantly (68.4% in 2003 vs 52% in 2018; p = 0.005). There was also a significant reduction in the prevalence of training in the management of eye emergencies (77.4% in 2003 vs 45.5% in 2018; p < 0.001) and the proportion of FY2s who felt confident in dealing with such cases (36.1% in 2003 vs 6% in 2018; p < 0.001). CONCLUSION There is a concerning decline in basic ophthalmic training for A&E FY2s, reflected by the alarmingly low level of confidence in the management of eye emergencies. This highlights an urgent need to improve ophthalmic training for junior doctors in A&E.
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Hooker EA, Faulkner WJ, Kelly LD, Whitford RC. Prospective study of the sensitivity of the Wood’s lamp for common eye abnormalities. Emerg Med J 2019; 36:159-162. [DOI: 10.1136/emermed-2018-208235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/09/2018] [Accepted: 12/15/2018] [Indexed: 11/04/2022]
Abstract
ObjectiveThe Wood’s lamp, a handheld instrument that uses long-wave ultraviolet (UV) light with magnification of 2–3 times, is commonly used by non-ophthalmologists for examining patients with eye complaints. The goal of current research was to determine the sensitivity and specificity of the Wood’s lamp for common eye abnormalities.Study designWe examined a convenience sample of patients, 18 years of age and older, who presented for eye complaints to an urgent clinic of a large ophthalmology practice. This prospective observational trial was performed from December 2016 until July 2017. An ophthalmologist examined the patient’s eyes with a Wood’s lamp, followed by examination of the eyes using a slit lamp. The Wood’s lamp was compared with the slit lamp, which served as the gold standard.ResultsThere were 73 patients recruited. The mean age of study subjects (29 female and 44 male) was 49 years. The overall sensitivity of the Wood’s lamp was 52% (38/73; 95% CI 40% to 64%). Based on the principal final diagnosis made with the slit lamp, the Wood’s lamp only detected 9 of 16 corneal abrasions, 5 of 10 corneal ulcers, 5 of 9 corneal foreign bodies, 0 of 4 cases of non-herpetic keratitis, 1 of 2 cases of herpes keratitis, 1 of 5 rust rings and 18 of 28 other diagnoses.Conclusions and relevanceExamination using the Wood’s lamp fails to detect many common eye abnormalities. Our findings support the need for a slit lamp examination of patients with eye complaints whenever possible.
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Zhang HH, Hepschke JL, Shulruf B, Francis IC, Spencer SKR, Coroneo M, Agar A. Sharpening the focus on ophthalmology teaching: perceptions of medical students and junior medical officers. Clin Exp Ophthalmol 2018; 46:984-993. [DOI: 10.1111/ceo.13342] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/26/2018] [Accepted: 05/28/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Helen H Zhang
- Faculty of MedicineUniversity of New South Wales Sydney New South Wales Australia
- Department of OphthalmologyPrince of Wales Hospital Sydney New South Wales Australia
| | - Jenny L Hepschke
- Faculty of MedicineUniversity of New South Wales Sydney New South Wales Australia
- Department of OphthalmologyPrince of Wales Hospital Sydney New South Wales Australia
| | - Boaz Shulruf
- Faculty of MedicineUniversity of New South Wales Sydney New South Wales Australia
| | - Ian C Francis
- Faculty of MedicineUniversity of New South Wales Sydney New South Wales Australia
- Department of OphthalmologyPrince of Wales Hospital Sydney New South Wales Australia
| | - Sascha KR Spencer
- Faculty of MedicineUniversity of New South Wales Sydney New South Wales Australia
- Department of OphthalmologyPrince of Wales Hospital Sydney New South Wales Australia
| | - Minas Coroneo
- Faculty of MedicineUniversity of New South Wales Sydney New South Wales Australia
- Department of OphthalmologyPrince of Wales Hospital Sydney New South Wales Australia
| | - Ashish Agar
- Faculty of MedicineUniversity of New South Wales Sydney New South Wales Australia
- Department of OphthalmologyPrince of Wales Hospital Sydney New South Wales Australia
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20
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Rathi S, Tsui E, Mehta N, Zahid S, Schuman JS. The Current State of Teleophthalmology in the United States. Ophthalmology 2017; 124:1729-1734. [PMID: 28647202 PMCID: PMC6020848 DOI: 10.1016/j.ophtha.2017.05.026] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/18/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022] Open
Abstract
Telemedicine services facilitate the evaluation, diagnosis, and management of the remote patient. Telemedicine has rapidly flourished in the United States and has improved access to care, outcomes, and patient satisfaction. However, the use of telemedicine in ophthalmology is currently in its infancy and has yet to gain wide acceptance. Current models of telemedicine in ophthalmology are largely performed via "store and forward" methods, but remote monitoring and interactive modalities exist. Although studies have examined the effects of telemedicine, few reports have characterized its current status. We perform a descriptive analysis of the current state of teleophthalmology in the United States. We describe the use of teleophthalmology in the hospital and outpatient settings. We also review the applications to retinopathy of prematurity, diabetic retinopathy, age-related macular degeneration, and glaucoma, as well as anticipated barriers and hurdles for the future adoption of teleophthalmology. With ongoing advances in teleophthalmology, these models may provide earlier detection and more reliable monitoring of vision-threatening diseases.
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Affiliation(s)
- Siddarth Rathi
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Edmund Tsui
- New York University (NYU) Langone Eye Center, NYU Langone Medical Center, Department of Ophthalmology, NYU School of Medicine, New York, New York
| | - Nitish Mehta
- New York University (NYU) Langone Eye Center, NYU Langone Medical Center, Department of Ophthalmology, NYU School of Medicine, New York, New York
| | - Sarwar Zahid
- New York University (NYU) Langone Eye Center, NYU Langone Medical Center, Department of Ophthalmology, NYU School of Medicine, New York, New York
| | - Joel S Schuman
- New York University (NYU) Langone Eye Center, NYU Langone Medical Center, Department of Ophthalmology, NYU School of Medicine, New York, New York; Department of Neuroscience and Physiology, NYU Langone Medical Center, NYU School of Medicine, New York, New York; Department of Electrical and Computer Engineering, NYU Tandon School of Engineering, Brooklyn, New York.
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21
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Accuracy of referral diagnosis to an emergency eye clinic. Can J Ophthalmol 2017; 52:283-286. [DOI: 10.1016/j.jcjo.2016.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022]
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22
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Gallagher K, Lin PF, Koukkoulli A, Puertas R, Okhravi N. "Low-tech" simulation of corneal foreign body removal. Can J Ophthalmol 2016; 51:386-389. [PMID: 27769332 DOI: 10.1016/j.jcjo.2016.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 03/25/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Kevin Gallagher
- Department of Undergraduate Education, Moorfields Eye Hospital NHSFT, London, United Kingdom.
| | - Pei-Fen Lin
- Department of Undergraduate Education, Moorfields Eye Hospital NHSFT, London, United Kingdom
| | - Antigoni Koukkoulli
- Department of Undergraduate Education, Moorfields Eye Hospital NHSFT, London, United Kingdom
| | - Renata Puertas
- Department of Undergraduate Education, Moorfields Eye Hospital NHSFT, London, United Kingdom
| | - Narciss Okhravi
- Department of Undergraduate Education, Moorfields Eye Hospital NHSFT, London, United Kingdom; NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT and UCL Institute of Ophthalmology, London, United Kingdom; Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHSFT, London, United Kingdom; Honorary Clinical Senior Lecturer, Centre for Medical Education, Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry at Queen Mary, University of London, London, United Kingdom; Consultant Ophthalmologist and Director of Undergraduate Education, Moorfields Eye Hospital NHSFT, London, United Kingdom
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23
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Shah K, Naidoo K, Chagunda M, Loughman J. Evaluations of refraction competencies of ophthalmic technicians in Mozambique. JOURNAL OF OPTOMETRY 2016; 9:148-57. [PMID: 25662363 PMCID: PMC4911439 DOI: 10.1016/j.optom.2015.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/02/2014] [Accepted: 12/27/2014] [Indexed: 05/12/2023]
Abstract
PURPOSE Ophthalmic technicians (OT) work at health facilities in Mozambique and are trained to provide primary and secondary eye care services including basic refraction. This study was designed to assess OT competence and confidence in refraction, and investigate whether an upskilling programme is effective in developing their competence and confidence at refraction. METHODS Thirty-one trainee OTs and 16 qualified OTs were recruited to the study. A background questionnaire was administered to determine the demographic profile of the OTs. A confidence levels questionnaire explored their self-reported skills. Clinical competencies were assessed in relation to knowledge (theory exam) and clinical skills (patient exams). 11 OTs were upskilled and the clinical evaluations carried out post training. RESULTS Initial evaluations demonstrated that confidence and competence levels varied depending on the OTs training (location and duration), and their location of work (clinical load, availability of equipment and other eye care personnel). The qualified OTs were more competent than trainee OTs in most of the evaluations. Post upskilling results demonstrated significant positive impact on confidence and competence levels. CONCLUSION These evaluations identified factors affecting the refraction competencies of the OTs and demonstrated that upskilling is effective in improving confidence and competence levels for refraction. They demonstrate the need for a refraction competency framework. The overarching aim of this research was to inform the development of a nationwide programme of OT mentoring, upskilling and leading to the establishment of clinical competency standards for the new OT curricula, relevant to the professional demands.
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Affiliation(s)
- Kajal Shah
- Dublin Institute of Technology, Dublin, Ireland.
| | - Kovin Naidoo
- Brien Holden Vision Institute, Durban, South Africa; African Vision Research Institute, University of Kwazulu-Natal, South Africa
| | | | - James Loughman
- Dublin Institute of Technology, Dublin, Ireland; African Vision Research Institute, University of Kwazulu-Natal, South Africa
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25
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Affiliation(s)
| | - Aamir Khan
- Surgery Department, Glasgow Royal Infirmary, Glasgow, UK
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26
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Ah-Kee EY, Scott RA, Shafi A, McCabe G, Lim LT. Are junior doctors in today's NHS competent in managing ophthalmic cases in the emergency department? Eye (Lond) 2015; 30:164. [PMID: 26449192 DOI: 10.1038/eye.2015.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- E Y Ah-Kee
- Department of Surgery, Monklands Hospital, Monkscourt Avenue, Airdrie, UK
| | - R A Scott
- Department of Surgery, Monklands Hospital, Monkscourt Avenue, Airdrie, UK
| | - A Shafi
- Department of Surgery, Monklands Hospital, Monkscourt Avenue, Airdrie, UK
| | - G McCabe
- Department of Surgery, Monklands Hospital, Monkscourt Avenue, Airdrie, UK
| | - L T Lim
- Ophthalmology Department, Royal Berkshire Hospital, Reading, UK
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Marson BA, Sutton LJ. The Newport eye: design and initial evaluation of a novel foreign body training phantom. Emerg Med J 2013; 31:329-30. [PMID: 23620502 DOI: 10.1136/emermed-2012-202230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
To improve SHO confidence in corneal foreign body removal, a novel training phantom is proposed. This phantom is a polyvinyl and gelatine-based model, easily fabricated in the emergency department (ED). Use of the phantom results in a significant improvement in SHO confidence, and therefore, makes a useful, cost-effective adjunct for ED training.
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Affiliation(s)
- Ben A Marson
- Department of Emergency Medicine, Royal Gwent Hospital, , Newport, Wales, UK
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Quirke M, Mullarkey C, Askoorum S, Coffey N, Binchy J. A prospective observational study of techniques to remove corneal foreign body in the emergency department. Emerg Med J 2013; 31:463-6. [PMID: 23543227 DOI: 10.1136/emermed-2012-201447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Patients with corneal foreign bodies (CFBs) often present to the emergency department (ED). However, removal techniques vary among emergency physicians (EPs). A prospective, single-blinded, observational study was performed to compare slit-lamp-aided (SLA) versus non-slit-lamp-aided (NSLA) CFB removal by EPs. METHODS Five EPs enrolled consecutive patients with a CFB over 3 months. One blinded EP reviewed patients after 3 days. The study end points were: change in visual acuity; visual analogue pain scale (VAS) score at 12 and 24 h; satisfaction rating; symptoms at follow-up; and rate of complications. RESULTS 54 patients were enrolled: 28 had SLA removal and 26 NSLA removal; 52 were male; 22 had undergone previous CFB removal; six were wearing eye protection at the time of injury. Forty-three patients were reviewed: 26 by attendance and 18 by telephone. There was no difference in any end points at review. However, patients in the SLA group had median VAS scores that were 1.5 cm lower after 24 h than patients in the NSLA group (p=0.43, 95% CI -2.0 to 1.0). One patient in the SLA group developed keratitis. CONCLUSIONS We show that patient satisfaction ratings, complications and visual acuity were similar for the two methods. There was a trend for increased pain in the NSLA group at 12 and 24 h. Slit-lamp biomicroscopy and the use of magnification to remove CFBs remains the gold standard of care, and more intensive training should be given to EPs at the departmental level, particularly in EDs that receive patients with eye injuries.
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Affiliation(s)
- Michael Quirke
- Emergency Department, University Hospital, Galway, Ireland
| | | | - Shakti Askoorum
- Emergency Department, Midland Regional Hospital, Tullamore, Co Offaly, Ireland
| | - Norma Coffey
- School of Mathematical Sciences/Systems Biology Ireland, University College, Dublin, Ireland
| | - James Binchy
- Emergency Department, University Hospital, Galway, Ireland
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Workload, referral characteristics and consultation outcomes of out-of-hours ophthalmology services. Eye (Lond) 2012; 26:1027-8. [DOI: 10.1038/eye.2012.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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O'Connor PM, Crock CT, Dhillon RS, Keeffe JE. Resources for the management of ocular emergencies in Australia. Emerg Med Australas 2011; 23:331-6. [PMID: 21668720 DOI: 10.1111/j.1742-6723.2011.01411.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of the present paper is to assess the practical utility of the most common print resources used by practitioners in the management of ocular emergencies. Ten print resources were identified for review (three specialty eye texts, six general emergency medicine texts and one general practice text). The main outcome measures used were the extent a text matched crucial skills criteria in clinical assessment and treatment, and usability. No single print resource addressed all criteria. Red flag systems for clinical assessment and ease of navigation were the best match areas. Only one text inadequately stressed red flag conditions and one text was not ranked as easy to navigate. All texts made assumptions regarding the knowledge/skill level of practitioners, particularly in relation to eye examination procedures and treatment. Photographs ranged in number from 8 to 1500; 3/10 texts provided no photographs. Five texts included detailed instructions on the indications and urgency of referral and follow up for all conditions covered. The remainder lacked details. Only one text used the Australasian Triage Scale. Three texts included photographs/diagrams and instructions for the slit lamp and ophthalmoscope. None covered all procedures specified in the criteria. Only two reflected drug current practice in Australia and provided adequate details on usage. A single comprehensive reference (print and/or web-based) for dealing with ocular emergencies in Australia is clearly needed. Additionally, training and confidence levels of eye care providers must be addressed so that the risk of misdiagnosis and mismanagement of eye emergencies is reduced.
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Affiliation(s)
- Patricia M O'Connor
- Centre for Eye Research Australia, The University of Melbourne, East Melbourne, Victoria, Australia.
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