Uveitic glaucoma-like features in Yap conditional knockout mice

Glaucoma is a multifactorial neurodegenerative disease characterized by the progressive and irreversible degeneration of the optic nerve and retinal ganglion cells. Despite medical advances aiming at slowing degeneration, around 40% of treated glaucomatous patients will undergo vision loss. It is thus of utmost importance to have a better understanding of the disease and to investigate more deeply its early causes. The transcriptional coactivator YAP, an important regulator of eye homeostasis, has recently drawn attention in the glaucoma research field. Here we show that Yap conditional knockout mice (Yap cKO), in which the deletion of Yap is induced in both Müller glia (i.e. the only retinal YAP-expressing cells) and the non-pigmented epithelial cells of the ciliary body, exhibit a breakdown of the aqueous-blood barrier, accompanied by a progressive collapse of the ciliary body. A similar phenotype is observed in human samples that we obtained from patients presenting with uveitis. In addition, aged Yap cKO mice harbor glaucoma-like features, including deregulation of key homeostatic Müller-derived proteins, retinal vascular defects, optic nerve degeneration and retinal ganglion cell death. Finally, transcriptomic analysis of Yap cKO retinas pointed to early-deregulated genes involved in extracellular matrix organization potentially underlying the onset and/or progression of the observed phenotype. Together, our findings reveal the essential role of YAP in preserving the integrity of the ciliary body and retinal ganglion cells, thereby preventing the onset of uveitic glaucoma-like features.

Cataract surgical training in Europe: European Board of Ophthalmology survey

PURPOSE

To survey recently graduated European ophthalmologists concerning cataract surgery (CS) training opportunities.

SETTING

Countries affiliated to the European Board of Ophthalmology (EBO).

DESIGN

Cross-sectional study of anonymous survey results.

METHODS

A 23-question online survey was emailed to candidates who sat the EBO Diploma Examination as residents between 2018 and 2022.

RESULTS

821 ophthalmologists from 30 countries completed the survey. The mean residency duration was 4.73 (SD 0.9) years. The mean reported number of entire CS procedures performed was 80.7 (SD 100.6) at the end of residency, but more than 25% of respondents (n = 210) had received no live CS training during their residency. The self-confidence (scale, 1 to 10) to perform a simple case or challenging case, manage posterior capsular rupture, and realize a corneal stitch were rated 4.1, 3.2, 4.2, 2.4, respectively. We observed extensive variation in clinical exposure to CS and self-reported confidence to perform CS between European trainees. Females reported a mean of 18% fewer entire procedures than their male colleagues and were also less confident in their surgical skills (P < .05). Trainees in residency programs longer than 5 years performed fewer procedures and were less confident than trainees in residences of shorter duration (P < .001). The importance of fellowships to complete surgical education was rated 7.7 out of 10.

CONCLUSIONS

CS training across European countries lacks harmony. Female ophthalmology trainees continue, as in other specialties, to experience apparent gender bias. European level recommendations seem necessary to raise and harmonize competency-based CS training programs and promote post-residency fellowship training programs.

Microlearning to improve CPD learning objectives

BACKGROUND

Despite active involvement in teaching, clinical educators facilitating the continuing professional development (CPD) of their fellow specialists may not have formal training in medical education. Although required to write focused, measurable, topic-relevant, attainable and time-bound learning objectives to clearly inform learners on their learning intentions, CPD educators often receive no training on how to develop them. Microlearning is an online learning format occurring without real-time or interpersonal interaction, aiming to deliver easily accessible small units of focused information that are readily applicable for professionals. We hypothesised that Portuguese ophthalmologist educators lecturing to their fellow specialists would benefit from a microlearning experience (MLE) to improve the quality of their learning objectives.

METHODS

We created an MLE about writing effective learning objectives. In phase 1, 25 clinical educators, scheduled to lecture at an ophthalmology conference in Portugal, were invited to watch the MLE, write and classify their learning objectives according to Bloom's modified taxonomy, and complete an evaluation survey. In phase 2, 86 clinical educators were invited to view the MLE and complete the survey.

RESULTS

In phase 1, 20% of participants completed the exercise and survey. They categorised their objectives high on Bloom's taxonomy, considered the MLE useful and stated their intent to apply the principles learned in practice. In phase 2, 29% of participants provided feedback. All agreed that the intervention was clear and useful and 87% expressed an intent to use this information in their educational practice.

CONCLUSIONS

The majority of participants found the MLE clear and useful. Further studies are necessary to measure the impact of the MLEs used by clinical educators.

"Certified … now what?" On the Challenges of Lifelong Learning: Report from an AMEE 2017 Symposium

The increasing mobility of patients and healthcare professionals across the countries of Europe has highlighted the wide variations in both medical training, and provision of medical competency and skills. The maintenance of the standards defining competency and skills have national and international implications and have proved challenging for national regulatory bodies. Thus each nation has introduced different types of Continuing Professional Development (CPD), recertification and relicensing systems. At the Symposium entitled: " 'Certified … now what?' On the Challenges of Lifelong Learning" in August 2017 at the Association for Medical Education in Europe (AMEE) annual conference, we reviewed differing European national relicensing systems were reviewed. The review highlighted various lifelong learning and competence assessment approaches using examples from different medical specialties across several European countries.

The International Council of Ophthalmology 360-degree assessment tool: development and validation

BACKGROUND

The Accreditation Council for Graduate Medical Education and other organizations recommend 360-degree assessments for evaluation of interpersonal and communication skills, professional behaviours, and some aspects of patient care and system-based practice. No such tool has been developed for ophthalmology or received international content validation.

OBJECTIVE

To develop a valid, internationally applicable, ophthalmology-specific 360-degree assessment tool.

DESIGN

Exploratory study.

METHODS

A literature review was conducted. Individual 360-degree evaluation items from several publications were catalogued and classified according to different groups of assessors. A panel of international authors reviewed the list and voted on items that were most appropriate for international use. The list was trimmed to reduce redundancy and to make it as brief as possible while still capturing the essential components for each category. A second panel of international ophthalmic educators reviewed the international applicability and appropriateness of this collated list; relevant comments and suggestions were incorporated.

RESULTS

A tool for the evaluation of interpersonal and communication skills, professionalism, and system-based practice was developed. The tool has face and content validity.

CONCLUSION

This assessment tool can be used internationally for giving formative feedback based on the opinions of the different groups of people who interact with residents.

Unusual Straatsma Syndrome - How dogmatic is a bad prognosis?

Purpose

To show that Straatsma Syndrome can have a good outcome and to highlight an unusual presentation of this disease.

Observations

A four-year-old boy presents with severe right eye amblyopia in association with high myopia, esotropia, heterochromia iridum and extensive myelinated retinal fibers involving both temporal arcades and the optic nerve head. Right eye initial visual acuity was less than 20/400 for distance and less than R6W10 for near. Left eye examination was unremarkable. Despite the indicators for bad prognosis, intensive occlusion therapy was prescribed. Parents were strongly involved in the treatment regimen. After four months, the patient presented an unexpected good visual recovery both for distance and near, that has persisted until present. Right eye visual acuity is 20/30 with -9.00 dioptres contact lens for distance and R2W1 for near. Esotropia also improved to 12 prism dioptres. Fundoscopic alterations and heterochromia iridum have remained stable. Spectral-domain optical coherence tomography images of the right eye showed thinner superior outer ring measurements.

Conclusions and importance

Straatsma Syndrome can present with heterochromia iridum. When strabismus is present, early surgery should be withheld. Intensive treatment of Straatsma Syndrome can yield an unexpected good result, despite initial high degree anisometropia and low vision acuity.

Pilot study assessing reflection ability of practicing Australian and New Zealand ophthalmologists using the Groningen Reflection Ability Scale

This article was migrated. The article was not marked as recommended. Background: The benefits of reflective practice to foster high standards of patient care are well documented. Reflective practice is a continuing professional development (CPD) requirement of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO), the Australian Health Practitioners Regulation Agency (AHPRA) and the Medical Council of New Zealand (MCNZ). However, the level of reflection ability among Australian and New Zealand ophthalmologists has not been previously measured. Methods: Fellows of RANZCO were surveyed in late 2011, 18 months after reflective practice became an AHPRA requirement for medical registration. Fellows undertook the college regular triennial CPD feedback survey and were given the option to proceed to the Groningen Reflection Ability Scale (GRAS, English version) test questions using a 5-point Likert scale (1=strongly disagree, 5=strongly agree). Results were collated using SurveyMonkey®. Average response for each question was calculated, and a single score calculated for the responding ophthalmologists. Results: One hundred and sixty Fellows participated in the survey, 89% Australian and 11% from New Zealand, and 81% male. Fifteen percent of practicing ophthalmologists responded. On average, responding ophthalmologists showed a high level of personal reflection ability, with total score 90.78 (possible range 23 - 115). Small numbers, potential bias among responders and lack of a control group limit the study. Conclusions: RANZCO ophthalmologists responding to the GRAS instrument in 2011 on average demonstrated a high level of personal reflection ability. This study is a useful baseline for future studies of ophthalmologists' reflective practice and of educational interventions designed to improve reflective behavior.

Refractory aqueous misdirection syndrome: A possible complication of penetrating keratoplasty

CLINICAL CASE

An 85 year-old woman presented with a flat anterior chamber of the left eye, severe ocular hypertension, and a normal ultrasound examination in the day following a penetrating keratoplasty (PK). The clinical status did not respond to maximum medical therapy, laser posterior capsulotomy, anterior hyaloidotomy, and complete 23 G vitrectomy. The patient refused further intervention, and light perception was lost after 6 months of follow-up.

DISCUSSION

This is the first report of refractory aqueous misdirection syndrome following primary PK. Despite maximum medical and surgical management efforts, aqueous misdirection syndrome subsequent to primary PK may have a catastrophic outcome.

Developing educators for continuing professional development

Continuing professional development (CPD) is part of the medical education continuum, has been shown to produce improved physician practice and good patient outcomes, and is increasingly required for revalidation of medical licensure. CPD can be considered a discipline in its own right but is the least formally organized stage in medical education. CPD educators play a central role, but there has been remarkably little published work specifically describing CPD educators. This narrative review, using ophthalmology as exemplar medical specialty, describes trends affecting CPD educators and their sources, attributes, and development needs, mainly extrapolated from information regarding other medical educators in the medical education continuum spectrum. Future research needs are discussed.