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American Journal of Ophthalmology Dec 2020
Topics: COVID-19; Humans; Internship and Residency; Ophthalmologists; Ophthalmology; Pandemics; SARS-CoV-2; Scholarly Communication; Stress, Psychological
PubMed: 32961117
DOI: 10.1016/j.ajo.2020.07.017 -
American Journal of Ophthalmology Dec 2020
Topics: COVID-19; Humans; Internship and Residency; Ophthalmologists; Ophthalmology; Pandemics; SARS-CoV-2; Scholarly Communication; Stress, Psychological
PubMed: 32971027
DOI: 10.1016/j.ajo.2020.07.028 -
Journal of Occupational Health Jan 2020
Review
Topics: COVID-19; China; Communicable Disease Control; Coronavirus Infections; Female; Global Health; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Male; Occupational Exposure; Occupational Health; Ophthalmologists; Ophthalmology; Pandemics; Personal Protective Equipment; Pneumonia, Viral
PubMed: 32692449
DOI: 10.1002/1348-9585.12124 -
Eye (London, England) Aug 2021In the absence of pre-admission testing for colour blindness, many of the currently practicing ophthalmologists are colour blind, accordingly their accuracy of...
PURPOSE
In the absence of pre-admission testing for colour blindness, many of the currently practicing ophthalmologists are colour blind, accordingly their accuracy of distinguishing fine diabetic retinopathy (DR) changes is still unknown. This study aims to assess the accuracy of diagnosing and staging diabetic retinopathy and macular oedema among protonopic, deutronopic and tritanopic ophthalmologists.
METHODS
Cross-sectional assessment of fundus images that were prepared to simulate the appearance in cases of colour blindness. We assessed the accuracy of staging diabetic retinopathy and macular oedema by a retina specialist on colour-blind simulated images. We used randomiser.org to randomly select images to be simulated by the previously validated Vischeck colour blindness simulator.
RESULTS
A total of 150 simulated images were reviewed, 50 images for each of simulated protanopia, deuteranopia and tritanopia. We found that the accuracy for staging DR and macular oedema for protanope grader were 50% and 60%, respectively. Accuracy within one stage difference for DR and macular oedema were 88% and 90%, respectively. For deuteranopes, 56% and 64% accuracy for DR and macular oedema, respectively. Accuracy within one stage difference for DR and macular oedema were 86% and 90%, respectively. For Tritanope, 62% and 84% accuracy for DR and macular oedema, respectively.
CONCLUSION
Colour vision is important for distinguishing fine details during retina assessment in diabetic retinopathy patients. Colour blindness is associated with low accuracy in staging diabetic retinopathy and macular oedema, particularly among protonopic graders, and to a lesser extent in tritanopic graders.
Topics: Color; Color Vision Defects; Cross-Sectional Studies; Diabetes Mellitus; Diabetic Retinopathy; Humans; Ophthalmologists
PubMed: 33106610
DOI: 10.1038/s41433-020-01232-z -
La Clinica Terapeutica Apr 2022This work describes what are the regulations in the field of safety and prevention in the workplace, with particular regard to the legal medical aspects of the doctor in... (Review)
Review
This work describes what are the regulations in the field of safety and prevention in the workplace, with particular regard to the legal medical aspects of the doctor in charge of Occupational Medicine in correlation with ergophthalmological examinations. The main subjects of this treatment are the employees videoter-minalists. The first part of this work aims to analyze the compliance, as well as laws and legislative decrees governing the obligations and duties of the employer to its employees, regarding the compliance of workplaces and equipment with the instrument that are routinely used by employees videoterminalists. The discussion continues by focusing on the specific aspects of the ergophthalmological examination. It also describes the different phases of the eye examination, starting from the identification of the employee and then to the collection of anamnestic data, which are an integratedpart of the medical-legal act and are also a useful tool for the final diagnosis. The discussion of the various phases of the ergophthalmological examination concludes with a description of indirect ophthalmoscopy with its crucial points, which are important points in any ophthalmo-logical examination. Given the considerable diffusion and the great amount of tech-nological innovations in the field of display screens, we conclude the discussion with a historical overview of the display screens that have been habitually used by employees in their workplace, describing the mechanism that underlie their operation through some hints of Physics.
Topics: Humans; Occupational Health; Occupational Medicine; Ophthalmologists; Physicians; Workplace
PubMed: 35385044
DOI: 10.7417/CT.2022.2415 -
Digital Journal of Ophthalmology : DJO Feb 2021To characterize the prevalence of work-related musculoskeletal disorders (MSD), symptoms, and risk factors among ophthalmologists.
PURPOSE
To characterize the prevalence of work-related musculoskeletal disorders (MSD), symptoms, and risk factors among ophthalmologists.
METHODS
An online survey was distributed to ophthalmologist members of the Maryland Society of Eye Physicians and Surgeons. The survey consisted of 34 questions on respondent demographics, practice characteristics, pain, and effects of MSD on their practice patterns. Participants were excluded if they were not ophthalmologists or if they had MSD symptoms prior to the start of their ophthalmology career. Demographics and practice patterns were compared for those with or without MSD symptoms using the Welch t test and the Fisher exact test.
RESULTS
The survey was completed by 127 of 250 active members (response rate, 51%). Of the 127, 85 (66%) reported experiencing work-related pain, with an average pain level of 4/10. With regard to mean age, height, weight, years in practice, number of patients seen weekly, and hours worked weekly, there was no difference between respondents reporting pain and those without. Those reporting MSD symptoms spent significantly more time in surgery than those who did not (mean of 7.9 vs 5.3 hours/week [ < 0.01]). Fourteen percent of respondents reported plans to retire early due to their symptoms.
CONCLUSIONS
A majority of respondents experienced work-related MSD symptoms, which was associated with time spent in surgery. Modifications to the workplace environment focusing on ergonomics, particularly in the operating room, may benefit ophthalmologists.
Topics: Ergonomics; Female; Humans; Male; Middle Aged; Musculoskeletal Diseases; Ophthalmologists; Prevalence; Risk Factors; Surveys and Questionnaires; United States; Workplace
PubMed: 33867881
DOI: 10.5693/djo.01.2020.02.001 -
JAMA Health Forum Sep 2023Age-related macular degeneration (ARMD) therapies aflibercept and ranibizumab are among the highest-cost Medicare Part B drugs, even though off-label use of lower-cost...
IMPORTANCE
Age-related macular degeneration (ARMD) therapies aflibercept and ranibizumab are among the highest-cost Medicare Part B drugs, even though off-label use of lower-cost bevacizumab is clinically noninferior. Payments from manufacturers of these ARMD therapies to ophthalmologists are hypothesized to be factors in ophthalmologists' therapeutic choice, controlling for ophthalmologist and patient characteristics.
OBJECTIVE
To assess the association between manufacturer payments to ophthalmologists and choice of ARMD treatment as well as to identify ophthalmologist-level characteristics associated with prescribing lower-cost ARMD therapies.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cross-sectional study of longitudinal (2013-2019) Medicare Part B data was conducted from December 2021 to December 2022. Ophthalmologists prescribing aflibercept (manufactured by Regeneron Pharmaceuticals Inc), rabinizumab, or bevacizumab (both manufactured by Genentech Inc) for ARMD treatment of Medicare Part B beneficiaries were included. Data on manufacturer payments to ophthalmologists were obtained from the Open Payments database.
MAIN OUTCOMES AND MEASURES
The primary outcome was the percentage of bevacizumab prescribed by ophthalmologists among all ARMD therapies. Regression analysis assessed variation in bevacizumab prescribing by acceptance of manufacturer payments as well as by ophthalmologist and patient characteristics. Ophthalmologist characteristics were duration of practice and Medicare Administrative Contractor region, and patient characteristics were aggregated at the ophthalmologist level and included mean beneficiary age, percentage of dual-eligible beneficiaries, mean beneficiary risk score, and percentage of White beneficiaries. Savings were estimated by projecting the change in bevacizumab use had ophthalmologists not accepted manufacturer payments, controlling for all ophthalmologist and patient characteristics and comparing with observed use and costs.
RESULTS
A total of 21 584 ophthalmologists (18 489 males [85.7%]) were included. Ophthalmologists who accepted manufacturer payments were significantly less likely to prescribe bevacizumab (28.0% [95% CI, 24.6%-42.5%] of patients) compared with those who did not accept manufacturer payments (45.8% [95% CI, 44.5%-47.1%]). Ophthalmologists who saw dual-eligible beneficiaries had greater bevacizumab prescribing (50.0% [95% CI, 40.6%-68.3%] in the highest quartile vs 36.1% [95% CI, 33.5%-38.8%] in the lowest quartile; β coefficient, 0.139; P < .001), while those who saw patients with higher mean beneficiary risk scores had lower bevacizumab use (38.0% [95% CI, 23.7%-44.1%] in the highest quartile vs 48.2% [95% CI, 45.5%-50.8%] in the lowest quartile; β coefficient, -0.102, P < .001). Had ophthalmologists who accepted manufacturer payments prescribed ARMD drugs as those who did not accept payments, Medicare spending on these treatments would have been $642 779 703.08 lower from 2013 to 2019, a 2.0% savings.
CONCLUSIONS AND RELEVANCE
Results of this cross-sectional study suggest that drug manufacturer payments to ophthalmologists were associated with selection of higher-cost therapies for ARMD, which is a factor in increased Medicare and patient spending. Development of manufacturer payment models that encourage ophthalmologists to choose lower-cost therapies are needed.
Topics: United States; Male; Humans; Aged; Medicare Part B; Bevacizumab; Cross-Sectional Studies; Ophthalmologists; Retrospective Studies; Macular Degeneration
PubMed: 37682553
DOI: 10.1001/jamahealthforum.2023.2951 -
Seminars in Ophthalmology May 2021Understanding the molecular composition of pathogenic tissues is a critical step in understanding the pathophysiology of disease and designing therapeutics. First... (Review)
Review
Understanding the molecular composition of pathogenic tissues is a critical step in understanding the pathophysiology of disease and designing therapeutics. First described in 2009, single cell RNA sequencing (scRNAseq) is a methodology whereby thousands of cells are simultaneously isolated into individual micro-environments that can be altered experimentally and the genome-wide RNA expression of each cell is captured. It has undergone significant technological improvement over the last decade and gained tremendous popularity. scRNAseq is an improvement over prior pooled RNA analyses which cannot identify the cellular composition and heterogeneity of a tissue of interest. This new approach offers new opportunity for new discovery, as tissue samples can now be sub-categorized into groups of cell types based on genome-wide gene expression in an unbiased fashion. As ophthalmologists, we are uniquely positioned to obtain pathologic samples from the eye for further study. ScRNAseq has already been applied in ophthalmology to characterize retinal tissue, and it may offer the key to understanding various pathological processes in the future.
Topics: Humans; Ophthalmologists; Sequence Analysis, RNA; Single-Cell Analysis
PubMed: 33635751
DOI: 10.1080/08820538.2021.1889615 -
Eye and Brain 2021To assess the diagnostic accuracy of visual field results generated by the newly developed software (CU-VF) and the standard automated perimetry (SAP) for detecting...
PURPOSE
To assess the diagnostic accuracy of visual field results generated by the newly developed software (CU-VF) and the standard automated perimetry (SAP) for detecting hemianopia.
PATIENTS AND METHODS
Forty-three subjects with hemianopia and 33 controls were tested with the CU-VF software on a personal computer and SAP. Hemianopia was defined as the presence of a hemianopic field respecting the vertical meridian on SAP with the corresponding neuroimaging pathology as evaluated by 2 neuro-ophthalmologists. Results of CU-VF were independently evaluated by 2 neuro-ophthalmologists, 1 general ophthalmologist, and 1 general practitioner in terms of the presence of hemianopia. Sensitivity, specificity, and kappa coefficient for inter-observer reliability were calculated. Satisfaction and ease of use were evaluated with a visual analog-scale questionnaire and analyzed using paired -test.
RESULTS
The sensitivity (95% CI) and specificity (95% CI) of the CU-VF to detect hemianopia was 74.42% (58.53-85.96) and 93.94% (78.38-99.94). Kappa coefficient between neuro-ophthalmologists versus general ophthalmologist and general practitioner were 0.71 and 0.84, respectively. The mean (SD) test duration was 2.25 (0.002) minutes for the CU-VF and 5.38 (1.34) minutes for SAP (p < 0.001). Subjects reported significantly higher satisfaction and comfort using the CU-VF software compared to SAP.
CONCLUSION
The CU-VF screening software showed good validity and reliability to detect hemianopia, with shorter test duration and higher subject satisfaction compared to SAP.
PubMed: 34512063
DOI: 10.2147/EB.S315403 -
JAMA Ophthalmology Jan 2018As the United States considers how to best structure its health care services, specialty care availability is receiving increased focus. This study assesses whether...
IMPORTANCE
As the United States considers how to best structure its health care services, specialty care availability is receiving increased focus. This study assesses whether patients lack reasonable access to ophthalmologists in states where optometrists have been granted expanded scope of practice.
OBJECTIVE
To determine the estimated travel time (ETT) to the nearest ophthalmologist office for persons residing in states that have expanded scope of practice for optometrists, and to quantify ETT to the nearest ophthalmologist for Medicare beneficiaries who received surgical care from optometrists in those states between 2008 and 2014.
DESIGN, SETTING, AND PARTICIPANTS
This study used data from the 2010 US census, a 2016 American Academy of Ophthalmology member database, and a data set of claims data for a random sample of 20% of beneficiaries enrolled in Medicare nationwide from 2008 to 2014 (n=14 063 725). Combining these sources with geographic information systems analysis, the ETT to the nearest ophthalmologist office was calculated for every resident of Kentucky, Oklahoma, and New Mexico. This study also assessed ETT to the nearest ophthalmologist for Medicare beneficiaries in those states who had received surgery from an optometrist from 2008 to 2014. Data analyses were conducted from July 2016 to July 2017.
MAIN OUTCOMES AND MEASURES
The proportion of residents of Kentucky, Oklahoma, and New Mexico who live within an ETT of 10, 30, 45, 60, or 90 minutes of the nearest ophthalmologist office.
RESULTS
The study included 4 339 367 Kentucky residents, 3 751 351 Oklahoma residents, and 2 059 179 New Mexico residents. Of these, 5 140 547 (50.6%) were female. Racial/ethnic composition included 7 154 847 people (70.5%) who were white, 640 608 (6.3%) who were black, and 1 418 246 (14.0%) who were Hispanic. The mean (SD) age was 37.8 (22.8) years. More than 75% of residents in the 3 states lived within an ETT of 30 minutes to the nearest ophthalmology office, and 94% to 99% of residents lived within an ETT of 60 minutes to the nearest ophthalmology office. Among Medicare beneficiaries who received surgery by optometrists, 58.3%, 51.1%, and 46.9% in Kentucky, Oklahoma, and New Mexico, respectively, lived within an ETT of 30 minutes from the nearest ophthalmologist office.
CONCLUSIONS AND RELEVANCE
In the states where optometrists have expanded scope of practice, most residents lived within an ETT of 30 minutes of the nearest ophthalmologist office, as do half of Medicare beneficiaries who received surgical care from optometrists. These results can help inform policy makers when weighing the pros and cons of scope of practice expansion for optometrists.
Topics: Female; Health Services Accessibility; Humans; Male; Ophthalmologists; Optometrists; Patient Care Team; Population Surveillance; Practice Patterns, Physicians'; Retrospective Studies; Time Factors; Travel; United States
PubMed: 29167903
DOI: 10.1001/jamaophthalmol.2017.5081