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Clinics (Sao Paulo, Brazil) 2020
Topics: Brazil; Humans; Ophthalmologists
PubMed: 33206765
DOI: 10.6061/clinics/2020/e2201 -
Journal of Optometry 2020The pandemic of the severe acute respiratory syndrome disease caused by the new coronavirus SARS-CoV-2 (COVID-19), had profound impact in many countries and their health... (Review)
Review
The pandemic of the severe acute respiratory syndrome disease caused by the new coronavirus SARS-CoV-2 (COVID-19), had profound impact in many countries and their health care systems. Regarding Portugal, a suppression strategy with social distancing was adopted, attempting to break the transmission chains, bending the epidemy curve and reducing mortality. These measures seek to prevent an eventual National Health Service over-running, enforcing the suspension of all elective and non-urgent health care. Despite the success in so far, there is a consensus on the need to recover the previous level of health care provision and further enhance it. The Portuguese National Health Service, as a public, universal access, health care system funded by the State proved, in this context, its importance and relevance to the Portuguese population. However, long standing issues, such as the pre pandemic over long waiting lists for hospital ophthalmology attendance, whose determinants are fully identified but still unmet, emerge amplified from this pandemic. The lack of primary eye care in the National Health Service is a significant bottleneck, placing a huge stress on hospital-based care. An exclusive ophthalmologist's center care was over-runned before pandemic and will be even more so. The optometrist's exclusion from differentiated, multisectoral and multidisciplinary eye care teams remains the main hurdle to overcome and insure universal eye care in Portugal. National Health Service highlights the consequences of an overcome model. Universal eye care more than ever demands an evidence-based, integrated approach with primary eye care, in the community, on time and of proximity.
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Delivery of Health Care; Eye Diseases; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; National Health Programs; Ophthalmologists; Optometrists; Pandemics; Personal Protective Equipment; Pneumonia, Viral; Portugal; SARS-CoV-2; State Medicine
PubMed: 32711965
DOI: 10.1016/j.optom.2020.05.001 -
BMJ Open Jul 2021Cataract surgery is very important to prevent blindness, but its productivity and efficiency in China are unknown. Our study aimed to evaluate the geographical... (Observational Study)
Observational Study
BACKGROUND
Cataract surgery is very important to prevent blindness, but its productivity and efficiency in China are unknown. Our study aimed to evaluate the geographical distribution of cataract surgeons and prospectively identify the factors associated with the increased productivity in cataract surgery and efficiency in outpatient ophthalmic services in rural Chinese hospitals.
METHODS
Data were prospectively collated from various hospital datasets and the census registered by the geographical unit county. Prior to mapping, the geographical location data of counties were cross-linked with the equivalent ophthalmologist and service output data to create categories and map multiple data attributes. Descriptive statistical analyses were performed to characterise the data stratified by county. Linear regression analyses were used to explore the factors associated with the increased productivity/efficiency.
RESULTS
The ophthalmologists, surgical productivity of ophthalmologists and outpatient efficacy of ophthalmologists significantly varied across counties. During the period between 2016 and 2018, the median (IQR) change in surgical productivity of and outpatient efficacy of ophthalmologists were 31.627 (-3.33 to 29.94) and 118.08 (-132.30 to 740.89). In the simple regression analysis for predictors of a high productivity change, only the increased number of phaco machine had statistical significance (p=0.003). In addition, only the gross domestic product per capita in 2016 was associated with an increased improvement in efficiency of outpatient services (p=0.008).
CONCLUSIONS
This study demonstrated that the ophthalmologist productivity and the efficiency of outpatient services were unequally geographically distributed, and their predictors were identified. Further studies to elucidate the extent of the problem and improve the health service delivery models are required.
Topics: Cataract Extraction; China; Hospitals, County; Humans; Ophthalmologists; Ophthalmology
PubMed: 34215595
DOI: 10.1136/bmjopen-2020-042326 -
Eye (London, England) Apr 2021
Topics: Humans; Ophthalmologists; Ophthalmology
PubMed: 32632299
DOI: 10.1038/s41433-020-1075-x -
World Journal of Gastroenterology Aug 2017Clinical manifestations of inflammatory bowel disease (IBD) are not locally restricted to the gastrointestinal tract, and a significant portion of patients have... (Review)
Review
Clinical manifestations of inflammatory bowel disease (IBD) are not locally restricted to the gastrointestinal tract, and a significant portion of patients have involvement of other organs and systems. The visual system is one of the most frequently affected, mainly by inflammatory disorders such as episcleritis, uveitis and scleritis. A critical review of available literature concerning ocular involvement in IBD, as it appears in PubMed, was performed. Episcleritis, the most common ocular extraintestinal manifestation (EIM), seems to be more associated with IBD activity when compared with other ocular EIMs. In IBD patients, anterior uveitis has an insidious onset, it is longstanding and bilateral, and not related to the intestinal disease activity. Systemic steroids or immunosuppressants may be necessary in severe ocular inflammation cases, and control of the underlying bowel disease is important to prevent recurrence. Our review revealed that ocular involvement is more prevalent in Crohn's disease than ulcerative colitis, in active IBD, mainly in the presence of other EIMs. The ophthalmic symptoms in IBD are mainly non-specific and their relevance may not be recognized by the clinician; most ophthalmic manifestations are treatable, and resolve without sequel upon prompt treatment. A collaborative clinical care team for management of IBD that includes ophthalmologists is central for improvement of quality care for these patients, and it is also cost-effective.
Topics: Gastroenterologists; Immunosuppressive Agents; Inflammatory Bowel Diseases; Intersectoral Collaboration; Ophthalmologists; Patient Care Team; Prevalence; Recurrence; Scleritis; Uveitis
PubMed: 28932076
DOI: 10.3748/wjg.v23.i32.5836 -
Continuum (Minneapolis, Minn.) Aug 2014This review emphasizes the differential diagnosis of visual loss for the neurologist. (Review)
Review
PURPOSE OF REVIEW
This review emphasizes the differential diagnosis of visual loss for the neurologist.
RECENT FINDINGS
As an expert on the CNS, of which the eye is a part, the neurologist is expected to be able to evaluate a patient's report of visual loss and provide at least a cursory examination of the ocular apparatus and visual pathways. To appropriately localize the lesion within the eye and to generate a diagnosis, the neurologist must at least be aware of the other clinical entities that can cause visual loss, especially sudden visual loss, other than optic nerve damage. Once the problem has been localized to the optic nerve, a complete differential diagnosis will include all the pathophysiologic processes that can affect any tissue, specifically any piece of brain tissue. Intracerebral visual loss from damage to the chiasm or retrochiasmal pathways or to the downstream centers of higher visual processing is also common, given that the visual pathways constitute more than one-third of the supratentorial brain mass and are frequently affected by structural lesions and a wide range of neurologic disorders. The paucity of neuro-ophthalmologists makes it essential for neurologists to feel comfortable evaluating and managing patients with visual loss from presumed optic neuropathies or lesions of the intracranial visual pathways.
SUMMARY
The diagnosis of visual loss is not always easy, even for ophthalmologists. Good collaboration between neurologists and ophthalmologists is the key to a correct diagnosis and appropriate management when a neuro-ophthalmologist is not readily available.
Topics: Adult; Blindness; Female; Humans; Nervous System Diseases; Neurologic Examination; Visual Fields; Visual Pathways; Young Adult
PubMed: 25099095
DOI: 10.1212/01.CON.0000453317.67637.46 -
Arquivos Brasileiros de Oftalmologia 2022Medical specialties have recognized that breaking bad news assists clinical practice by mitigating the impact of difficult conversations. This scenario also encourages... (Review)
Review
Medical specialties have recognized that breaking bad news assists clinical practice by mitigating the impact of difficult conversations. This scenario also encourages various studies on breaking bad news in ophthalmology since certain ocular diagnoses can be considered bad news. Thus, the objective is to review the scientific literature on breaking bad news in ophthalmology. The literature databases like MEDLINE/PUBMED, EMBASE, LILACS, SCOPUS, COCHRANE, and SCIELO, were screened for related research publications. Two independent reviewers read all the articles and short-listed the most relevant ones. Seven articles, in the formats of original article, review, editorial, oral communication, and correspondence, were reviewed. Conclusively it reveals that ophthalmologists are concerned with communicating bad news effectively but lack related studies. Nevertheless, there is a growing realization that training in breaking bad news can increase physicians' confidence during communication, thus, benefiting the therapeutic relationship with the patient and his family. Therefore, it would be valuable to include breaking bad news training in the curriculum of residencies.
Topics: Humans; Physician-Patient Relations; Ophthalmology; Internship and Residency; Communication; Ophthalmologists
PubMed: 36169442
DOI: 10.5935/0004-2749.2022-0104 -
American Journal of Ophthalmology Case... Dec 2022Cat scratch disease (CSD) frequently has ophthalmologic manifestations. The ophthalmologist's approach to treating neuroretinitis is familiar, but few eye care providers...
PURPOSE
Cat scratch disease (CSD) frequently has ophthalmologic manifestations. The ophthalmologist's approach to treating neuroretinitis is familiar, but few eye care providers are comfortable answering the next question of "what do I do with my cat?" Published guidelines are often vague in answering the complexities of real-life conundrums that can lead patients and their doctors to believe that risk mitigation should involve removal of the animal. Here, we present demonstrative scenarios informed by clinical practice and provide updated recommendations.
OBSERVATIONS
A 10-year-old boy presented with reduced vision in the right eye. Funduscopic examination identified optic nerve head edema with subretinal fluid, and a macular star developed one week later, consistent with the diagnosis of neuroretinitis. Serology confirmed antibodies and a diagnosis of CSD. The father disclosed that the family has recently adopted three kittens, who have scratched the boy and the patient's younger sister. The physician and patient's family find themselves at a loss regarding best practices for what should be done with the kittens.
CONCLUSIONS AND IMPORTANCE
. has been detected in a variety of mammals and can be transmitted via vectors such as fleas. Even well-appearing animals can transmit the bacteria, months to years after their initial infection. Symptoms, clinical and laboratory findings will depend on bacterial load and strain virulence, as well as the physiological/immunological status of the host, with people at the extremes of age and the immunocompromised being at greater disease risk. Flea control is crucial to minimize transmission risk. Our veterinary expert (EBB) recommends testing (with serology and PCR) and treating infected animals (with doxycycline and a quinolone). Patients should be counseled to speak with their pets' veterinarian. When addressing the concerns of our CSD patients in clinical practice, ophthalmologists should be aware of the strategies for minimizing transmission risk, and cognizant of the One Health approach for managing zoonoses.
PubMed: 36147775
DOI: 10.1016/j.ajoc.2022.101702 -
Scientific Reports Jun 2021Smartphone-based fundus imaging (SBFI) is a low-cost approach for screening of various ophthalmic diseases and particularly suited to resource limited settings. Thus, we...
Smartphone-based fundus imaging (SBFI) is a low-cost approach for screening of various ophthalmic diseases and particularly suited to resource limited settings. Thus, we assessed how best to upskill alternative healthcare cadres in SBFI and whether quality of obtained images is comparable to ophthalmologists. Ophthalmic assistants and ophthalmologists received a standardized training to SBFI (Heine iC2 combined with an iPhone 6) and 10 training examinations for capturing central retinal images. Examination time, total number of images, image alignment, usable field-of-view, and image quality (sharpness/focus, reflex artifacts, contrast/illumination) were analyzed. Thirty examiners (14 ophthalmic assistants and 16 ophthalmologists) and 14 volunteer test subjects were included. Mean examination time (1st and 10th training, respectively: 2.17 ± 1.54 and 0.56 ± 0.51 min, p < .0001), usable field-of-view (92 ± 16% and 98 ± 6.0%, p = .003) and image quality in terms of sharpness/focus (p = .002) improved by the training. Examination time was significantly shorter for ophthalmologists compared to ophthalmic assistants (10th training: 0.35 ± 0.21 and 0.79 ± 0.65 min, p = .011), but there was no significant difference in usable field-of-view and image quality. This study demonstrates the high learnability of SBFI with a relatively short training and mostly comparable results across healthcare cadres. The results will aid implementing and planning further SBFI field studies.
Topics: Adult; Diagnostic Techniques, Ophthalmological; Female; Fundus Oculi; Humans; Learning Curve; Male; Ophthalmic Assistants; Ophthalmologists; Retina; Smartphone; Young Adult
PubMed: 34135452
DOI: 10.1038/s41598-021-92232-w -
Ophthalmic Research 2021The aim of this study was to evaluate the prevalence of back pain among German ophthalmologists, to investigate the relationship towards age, gender, various...
INTRODUCTION
The aim of this study was to evaluate the prevalence of back pain among German ophthalmologists, to investigate the relationship towards age, gender, various profession-related factors, to correlate localization of pain to subspecialties, and to explore individual therapeutic and coping strategies.
METHODS
In this prospective, cross-sectional survey, a 9-item questionnaire was sent via mail to all members of the German professional association of ophthalmologists "Berufsverband der Augenärzte Deutschlands e.V. (BVA)." Responses were analyzed according to a pre-specified analysis plan.
RESULTS
From a total of 5,954 members contacted, 1,861 copies (31%) were received back, of which 1,807 (30%) were suitable for analysis. 913 (51%) participants were female and 876 (48%) were male, with a median age of 50 years (interquartile range: 44; 57). 1,464 ophthalmologists (81%) reported current back problems, considerably more than had been reported in the general population or in other medical specialties. Older age, female gender, and higher number of professional years appeared to be risk factors for developing back pain. Overall, neck pain was the leading symptom in 951 attendees (65%) but differed between ophthalmologists who primarily performed conservative treatment (cervical spine) and those who performed surgery (mainly lumbar spine). 1,037 participants (71%) link their complaints to their occupational activity. Exercising and back training were reported as common strategies for prevention and coping with the problem. Recommendations for improvement were mainly ergonomic optimization of the working place.
CONCLUSIONS
The prevalence of back pain complaints in German ophthalmologists is high. Neck pain (65%) was the leading localization, followed by low back pain (53%) and shoulder (38%) problems, which might emphasize a special back pain complaint profile in ophthalmologists. Low back pain seems to be more common in ophthalmologists with surgical specialization than in those with mainly medical tasks. The high prevalence of back pain in ophthalmologists should be communicated with employers, the industry, and professional societies to develop and implement a strategy to prevent occupational-related musculoskeletal disorders and preserve the ability to work and the quality of life.
Topics: Back Pain; Cross-Sectional Studies; Female; Germany; Humans; Low Back Pain; Male; Middle Aged; Neck Pain; Occupational Diseases; Ophthalmologists; Ophthalmology; Prevalence; Prospective Studies; Quality of Life
PubMed: 34348327
DOI: 10.1159/000517574