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PLOS Digital Health Nov 2022The objective of this study was to compare the sensitivity and specificity of handheld fundus cameras in detecting diabetic retinopathy (DR), diabetic macular edema...
The objective of this study was to compare the sensitivity and specificity of handheld fundus cameras in detecting diabetic retinopathy (DR), diabetic macular edema (DME), and macular degeneration. Participants in the study, conducted at Maharaj Nakorn Hospital in Northern Thailand between September 2018 and May 2019, underwent an ophthalmologist examination as well as mydriatic fundus photography with three handheld fundus cameras (iNview, Peek Retina, Pictor Plus). Photographs were graded and adjudicated by masked ophthalmologists. Outcome measures included the sensitivity and specificity of each fundus camera for detecting DR, DME, and macular degeneration, relative to ophthalmologist examination. Fundus photographs of 355 eyes from 185 participants were captured with each of the three retinal cameras. Of the 355 eyes, 102 had DR, 71 had DME, and 89 had macular degeneration on ophthalmologist examination. The Pictor Plus was the most sensitive camera for each of the diseases (73-77%) and also achieved relatively high specificity (77-91%). The Peek Retina was the most specific (96-99%), although in part due to its low sensitivity (6-18%). The iNview had slightly lower estimates of sensitivity (55-72%) and specificity (86-90%) compared to the Pictor Plus. These findings demonstrated that the handheld cameras achieved high specificity but variable sensitivities in detecting DR, DME, and macular degeneration. The Pictor Plus, iNview, and Peek Retina would have distinct advantages and disadvantages when applied for utilization in tele-ophthalmology retinal screening programs.
PubMed: 36812561
DOI: 10.1371/journal.pdig.0000131 -
International Journal of Ophthalmology 2023To evaluate the clinical application value of the artificial intelligence assisted pathologic myopia (PM-AI) diagnosis model based on deep learning.
AIM
To evaluate the clinical application value of the artificial intelligence assisted pathologic myopia (PM-AI) diagnosis model based on deep learning.
METHODS
A total of 1156 readable color fundus photographs were collected and annotated based on the diagnostic criteria of Meta-pathologic myopia (PM) (2015). The PM-AI system and four eye doctors (retinal specialists 1 and 2, and ophthalmologists 1 and 2) independently evaluated the color fundus photographs to determine whether they were indicative of PM or not and the presence of myopic choroidal neovascularization (mCNV). The performance of identification for PM and mCNV by the PM-AI system and the eye doctors was compared and evaluated the relevant statistical analysis.
RESULTS
For PM identification, the sensitivity of the PM-AI system was 98.17%, which was comparable to specialist 1 (=0.307), but was higher than specialist 2 and ophthalmologists 1 and 2 (<0.001). The specificity of the PM-AI system was 93.06%, which was lower than specialists 1 and 2, but was higher than ophthalmologists 1 and 2. The PM-AI system showed the value of 0.904, while the values of specialists 1, 2 and ophthalmologists 1, 2 were 0.968, 0.916, 0.772 and 0.730, respectively. For mCNV identification, the AI system showed the sensitivity of 84.06%, which was comparable to specialists 1, 2 and ophthalmologist 2 (>0.05), and was higher than ophthalmologist 1. The specificity of the PM-AI system was 95.31%, which was lower than specialists 1 and 2, but higher than ophthalmologists 1 and 2. The PM-AI system gave the value of 0.624, while the values of specialists 1, 2 and ophthalmologists 1 and 2 were 0.864, 0.732, 0.304 and 0.238, respectively.
CONCLUSION
In comparison to the senior ophthalmologists, the PM-AI system based on deep learning exhibits excellent performance in PM and mCNV identification. The effectiveness of PM-AI system is an auxiliary diagnosis tool for clinical screening of PM and mCNV.
PubMed: 37724265
DOI: 10.18240/ijo.2023.09.07 -
JAMA Ophthalmology May 2022Representation of women in medicine and ophthalmology has increased in recent years. However, substantial inequities still exist between salaries for male and female...
IMPORTANCE
Representation of women in medicine and ophthalmology has increased in recent years. However, substantial inequities still exist between salaries for male and female physicians.
OBJECTIVES
To evaluate the status of disparities in compensation among US academic ophthalmologists and compare compensation across specialties.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study analyzed data for full-time academic physicians practicing in 154 accredited US medical schools. Data from the Association of American Medical Colleges Faculty Salary Report for fiscal year 2019-2020 were used to evaluate disparities in total compensation for female and male academic ophthalmologists.
MAIN OUTCOMES AND MEASURES
Median total compensation for female and male ophthalmologists in fiscal year 2019-2020.
RESULTS
Female academic ophthalmologists were paid a mean of $50 300 (95% CI, $4600-$96 000) less than their male counterparts. This trend was present across other specialties with women earning less than men by amounts ranging between $25 100 (95% CI, $1000-$49 300) in nonsurgical specialties and $104 400 (95% CI, $62 800-$146 600) in general surgery. Including all academic ranks, women's total compensation was between 75% (general surgery) and 82% (nonsurgical specialties) of men's compensation.
CONCLUSIONS AND RELEVANCE
These findings indicate that female academic ophthalmologists are paid less than their male counterparts. Future research and efforts to increase awareness and close the pay gaps seem warranted to encourage more women to pursue careers in ophthalmology and to achieve parity in the field.
Topics: Cross-Sectional Studies; Faculty, Medical; Female; Humans; Male; Ophthalmologists; Salaries and Fringe Benefits; Sex Characteristics; United States
PubMed: 35323861
DOI: 10.1001/jamaophthalmol.2022.0376 -
JAMA Ophthalmology Dec 2022In order to continue to clarify and maintain their role as eye physicians and surgeons, ophthalmologists may want to understand how they are viewed in the public eye and...
IMPORTANCE
In order to continue to clarify and maintain their role as eye physicians and surgeons, ophthalmologists may want to understand how they are viewed in the public eye and online.
OBJECTIVE
To determine the representation of ophthalmologists (OMD) and optometrists (ODs) when a Google search for "eye doctor near me" is made from each county in the US.
DESIGN, SETTING, AND PARTICIPANTS
This population-based cross-sectional study used publicly available data on OMDs and ODs and a Google search application programming interface (API) to search the phrase "eye doctor near me" from the geographic coordinates of each county centroid in the US (searched June 30, 2021). The top 10 sites and 3 Google map links, excluding physician ratings sites, were recorded. Data from the US Centers for Medicare and Medicaid Services were used to estimate the real number of OMDs and ODs per county.
MAIN OUTCOME AND MEASURES
The primary outcome was the mean proportion of OMDs listed by Google search as compared with the real proportion of OMDs for the US overall and for each state and county.
RESULTS
A total of 2955 counties from 52 states and territories were included. The overall mean proportion of OMDs (OMDs with ODs) from the Google search of all counties was 4726.97 of 16 345.93 (28.91%), which was also less than the real proportion of ODs (15 778 of 41 975 [37.58%], a difference of 8.67%; 95% CI, 37.13-38.05%; P < .001). OMDs were underrepresented by Google in 35 of 52 states and territories (67.3%).
CONCLUSIONS AND RELEVANCE
In most counties in the US, Google search of the phrase "eye doctor near me" may underrepresent ophthalmologists. Ophthalmologists may want to pursue search engine optimization to try to achieve balanced representation online.
Topics: Aged; United States; Humans; Cross-Sectional Studies; Search Engine; Medicare; Optometrists; Ophthalmologists; Vision Disorders
PubMed: 36264555
DOI: 10.1001/jamaophthalmol.2022.4343 -
Indian Journal of Ophthalmology Aug 2023The use of human amniotic membrane transplantation is rapidly increasing for the management of various ocular surface disorders. Despite its numerous advantages,...
BACKGROUND
The use of human amniotic membrane transplantation is rapidly increasing for the management of various ocular surface disorders. Despite its numerous advantages, amniotic membrane is not widely available due to the lack of awareness among ophthalmologists regarding its preparation and preservation techniques.
PURPOSE
To provide an instructional video demonstrating the technique of harvesting, preparation, preservation of human amniotic membrane, and its uses in the management of ocular surface diseases.
SYNOPSIS
The amniotic membrane is the innermost layer of the human placenta. Properties of the amniotic membrane, like the presence of various growth factors, anti-inflammatory and anti-angiogenic factors, and its low immunogenicity, contribute to its ability to promote epithelial growth and differentiation with the reduction in fibrosis during healing. To harvest amniotic membrane, informed consent is obtained from a patient undergoing an elective caesarian section, and the donor is screened to exclude the risk of infections. Under sterile precautions, the amniotic membrane is separated from the chorion and washed free of blood clots. With the epithelial surface up, the amniotic membrane is spread uniformly without folds or tears on individually sterilized 0.22 μm nitrocellulose filter papers of the required sizes. The prepared filter paper with the adherent amniotic membrane is placed in freshly prepared Dulbecco's Modified Eagle's Medium and stored at -80°C. The amniotic membrane can be used for surgical procedures like symblepharon release, pterygium or dermoid excision, perforated ulcers, nonhealing epithelial defects, etc.
HIGHLIGHTS
Instructional videos demonstrating the preparation and preservation of amniotic membrane are very sparse. This video clearly explains how any ophthalmologist can learn to prepare and preserve the human amniotic membrane and gives a glimpse of its properties, advantages, and scope of use.
VIDEO LINK
https://youtu.be/8HfSjXUKoiY.
Topics: Pregnancy; Female; Humans; Amnion; Eye Diseases; Conjunctiva; Plastic Surgery Procedures; Pterygium
PubMed: 37530302
DOI: 10.4103/IJO.IJO_674_23 -
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 -
Deutsches Arzteblatt International Nov 2021Acute closed-angle glaucoma has an incidence of 2.2-4.1 cases per 100 000 persons per year in Europe. It is an ophthalmological emergency in which markedly elevated...
BACKGROUND
Acute closed-angle glaucoma has an incidence of 2.2-4.1 cases per 100 000 persons per year in Europe. It is an ophthalmological emergency in which markedly elevated intraocular pressure can damage vision permanently. Because the acute symptoms are not always clearly referable to the eyes, patients often present to physicians who are not ophthalmologists.
METHODS
This review is based on pertinent articles retrieved by a selective search in PubMed.
RESULTS
The diverse symptoms of acute closed-angle glaucoma include eye redness, worsening of vision and other visual disturbances, headache, and nausea. Acute closed-angle glaucoma has multiple causes. Not all predisposing factors have been definitively identified; above all, there are certain anatomical configurations of the eye that make it more likely to arise. The goals of treatment are to reduce the elevated intraocular pressure rapidly, which usually leads to marked symptom relief, as well as to eliminate the situation that led to closed-angle glaucoma. For proper treatment, the patient should be seen by an ophthalmologist without delay, on the day of symptom onset if possible.
CONCLUSION
Primary prevention of acute closed-angle glaucoma is not always possible. Even physicians who are not ophthalmologists can diagnose markedly elevated intraocular pressure by palpation of the globe. Proper, specific treatment can help patients rapidly and lastingly.
PubMed: 34551857
DOI: 10.3238/arztebl.m2021.0264 -
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