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PubMed1985

Andrew Sexton Gray (1826-1907). A founder of Australian ophthalmology: his life and times.

Andrew Sexton Gray was born in Limerick, Ireland, medically trained in Dublin, and was assistant to William Wilde, the distinguished oculist and aurist. He migrated to Victoria in 1859, was surgeon to a railway's construction company, then in 1862 began practice as a surgeon and oculist in Melbourne. In 1863 he founded a charitable eye and ear hospital, and had a very active, long life devoted mostly to ophthalmology. The hospital progressively expanded and became the centre for training for many ophthalmologists, as well as the nucleus for the cohesion of Victorian ophthalmology. History shows Andrew Sexton Gray to have been a founder of Australian ophthalmology.

Australia↗

PubMed2001

Analysis of publication trends in two internationally renowned ophthalmology journals.

International journals represent a forum for exchange of current information with contributions from all over the world. High standards are essential. In this report, we compared the publishing trends of two internationally renowned ophthalmology journals--the British Journal of Ophthalmology (BJO) and the American Journal of Ophthalmology (AJO).

Bibliometrics↗

PubMed2006

Patient-centred measurement in ophthalmology--a paradigm shift.

Ophthalmologists and researchers in ophthalmology understand what a rapidly evolving field ophthalmology is, and that to conduct good research it is essential to use the latest and best methods. In outcomes research, one modern initiative has been to conduct holistic measurement of outcomes inclusive of the patient's point of view; patient-centred outcome. This, of course, means including a questionnaire. However, the irony of trying to improve outcomes research by being inclusive of many measures is that the researcher may not be expert in all measures used. Certainly, few people conducting outcomes research in ophthalmology would claim to be questionnaire experts. Most tend to be experts in their ophthalmic subspecialty and probably simply choose a popular questionnaire that appears to fit their needs and think little more about it. Perhaps, unlike our own field, we assume that the field of questionnaire research is relatively stable. This is far from the case. The measurement of patient-centred outcomes with questionnaires is a rapidly evolving field. Indeed, over the last few years a paradigm shift has occurred in patient-centred measurement.

Humans↗

PubMed2005

The efficacy of telemedicine for ophthalmology triage by a general practitioner.

Although there are enough ophthalmologists for the Brazilian population, they are not evenly distributed throughout the country. Tele-ophthalmology may therefore be a useful tool. We have examined the feasibility of ophthalmology triage, performed by a general practitioner (GP) with remote support from an ophthalmologist. Forty patients with a variety of external and internal eye disorders were examined by the GP and also reassessed by an ophthalmologist, face to face, and then remotely by another ophthalmologist. There was agreement in 95% of the diagnoses between face-to-face and distant evaluation. The use of a digital camera and slit-lamp allowed greater accuracy of telediagnosis than the use of a digital camera alone. The GP would have referred 36 patients to an ophthalmologist, while both the local and the remote ophthalmologist saw the need for referral in 31 cases, i.e. assessment by tele-ophthalmology resulted in a 14% decrease in referrals. GP triage therefore appears to be feasible after appropriate training.

Adolescent↗

PubMed1998

A pilot study of tele-ophthalmology outreach services to primary care.

We have begun a randomized study of tele-ophthalmology. General practitioners in two participating health centres in the Negev region of Israel, serving a local population of 40,000, were invited to participate. The study group consisted of 50 consecutive patients attending the general eye outpatient clinic and 50 consecutive patients suffering from various retinal diseases attending a hospital outpatient clinic. The initial assessment was carried out via the tele-ophthalmology system. There was then a face-to-face re-examination of the same patients, in randomized order, by the same ophthalmologist on the same day, at an outpatient ophthalmology clinic.

Costs and Cost Analysis↗

PubMed2006

Association between burnout and anger in oncology versus ophthalmology health care professionals.

The prevalence of burnout in oncology staff was compared with that of the ophthalmology staff, who normally present a low prevalence of burnout as described in this literature. The correlation of burnout with the emotion of anger was also investigated. Thirty-six subjects working in an oncology department and 32 working in an ophthalmology department were examined using the Maslach Burnout Inventory and the State-Trait Anger Expression Inventory. The oncology group showed higher mean scores on the MBI Emotive Exhaustion and Depersonalization scales with respect to ophthalmology staff. Correlation analysis showed that increasing burnout was associated with higher anger expressed towards the environment and loss of anger control. Anger, as a response to frustration, appears to be a feature constantly associated with the clinical expression of burnout and it should not be underestimated in theoretical and preventive contexts.

Adult↗

PubMed2006

[Results of an outpatient major surgery program in ophthalmology].

PURPOSE: To evaluate the outcomes in our hospital of an ambulatory major surgery program in patients with a variety of different ocular pathologies. METHOD: This retrospective study includes 13,878 patients who underwent programmed surgery by the Department of Ophthalmology between September 1998 and December 2004. Different ophthalmological surgical procedures were performed as outpatient surgery in 11,187 patients, with cataract surgery (phacoemulsification) being the most frequent operation performed (8,155 cases). We have analysed several indicators (substitution, suspension, admission and readmission rates), as well as surgical yield and systemic and ocular complications which appeared within 72 hours after surgery. The variables were measured as relative frequencies. The evolution of complications during the study period was analysed by the Chi-square trend test. RESULTS: 13,878 patients had ophthalmic surgery during the study period; 11,187 had outpatient surgery with a global substitution ratio of 80.6%. The median surgical yield was 74.36%. The admission rate after surgery was 4.46% (499 patients), with 92.18% (460) of these requiring immediate admission. Twenty-one patients suffered from severe complications (cardiovascular, neurological, metabolic, infectious), representing a proportional risk of 1:532. Forty-five patients had less severe complications (arterial hypertension, nausea, vomiting, vasovagal syncope) that required admission to hospital. Ophthalmologic complications occurred in 79 cases (0.56%). CONCLUSIONS: Ambulatory major surgery (AMS) is an excellent organization model of multidisciplinary surgical assistance that makes it possible to treat well selected patients in an effective, safe and efficient manner. There is a low incidence of postoperative complications of variable severity despite following the optimum requisites, although fortunately mortality is practically absent.

Aged↗

PubMed1981

Relationship of the Southern California Sensory Integration Tests, the Southern California Postrotary Nystagmus Test, and clinical observations accompanying them to evaluations in otolaryngology, ophthalmology, and audiology: two descriptive case studies.

A preliminary investigation was conducted into the relationship of the Southern California Sensory Integration Tests (SCSIT), the Southern California Postrotary Nystagmus Test (SCPNT), and clinical observations accompanying these tests to evaluations in otolaryngolgoy, ophthalmology, and audiology, ophthalmology, and audiology. The subjects were two children with vestibularly based sensory integrative dysfunction. The results revealed that there was no agreement between the results of the SCPNT and the otolaryngological evaluation. There was some agreement between the ophthalmology evaluation and the clinical observations accompanying the SCSIT. Both subjects scored poorly in two areas of auditory processing. Possible reasons for these results are discussed as well as implications for occupational therapy reached and practice.

Audiology↗

PubMedDate not supplied

Telemedicine ophthalmology consultation in remote Queensland.

OBJECTIVE: To assess the use of remote telemedicine ophthalmology in patients presenting to an emergency department with acute eye problems. DESIGN: A prospective review from 1 December 1996 to 28 February 1997 of referral patterns and telemedicine consultations, comparing referral patterns with the same period one year before. PARTICIPANTS AND SETTING: 24 patients presenting to the emergency department of a remote base hospital in Queensland with an acute ophthalmological problem requiring a specialist opinion. MAIN OUTCOME MEASURES: Clinical outcomes; use of the Patient Transit Scheme for isolated patients; acceptability to patients and doctors; and ophthalmologists' opinions of the system. RESULTS: No adverse outcomes were identified. Patients transferred for urgent assessment fell from 17 for the corresponding period in the previous year to four during the study period, while respective numbers of patients requiring non-urgent transfers (for surgery or postoperative review) during the same periods were 41 and 30. Both patients and staff (including the ophthalmologists) found the telemedicine facility very acceptable. CONCLUSION: Ophthalmology is well suited to telemedicine for the diagnosis and management of acute conditions and postoperative assessment of patients in remote areas. It offers considerable potential benefits to patients, and enhances the skills of local practitioners.

Acute Disease↗

PubMed1990

Physician assistants in ophthalmology: a national survey.

Fifty-two physician assistants employed in ophthalmologic practice throughout the United States were identified. Demographic and role-delineation data from 40 PAs agreeing to participate in the study were collected by questionnaire and telephone interviews. The data indicated that the majority of ophthalmologic PAs are employed in large practices that specialize in cataract and radial keratotomy procedures and that those practices are primarily located in the Southeast and Gulf regions of the United States. The authors conclude that most PAs are being utilized appropriately by ophthalmologists, that more formalized educational and credentialing programs may be necessary for the future, and that PAs can be positive adjuncts to ophthalmologic practice.

Employment↗

PubMed1999

Neuro-ophthalmologic diagnosis and therapy of central nervous system trauma.

Careful examination and judicious use of neuroimaging will lead to the initiation of appropriate management for injuries of the afferent and efferent visual systems. This article concentrates on those aspects of neuro-ophthalmologic trauma that are most relevant to the neurosurgeon, particularly those disorders that are commonly faced when caring for acutely injured patients. Although direct injury to the orbit and globes can easily result in neuro-ophthalmologic disorders, it is less appreciated that distant head injury can similarly result in injury to the retrobulbar afferent visual pathways or cranial nerves. It is therefore necessary that the neurosurgeon be suspicious of both latent and manifest injuries to the neuro-ophthalmologic system after head trauma, and maintain awareness of the need for timely intervention in a subset of these disorders. Therefore, even patients with injuries removed from the eyes should be checked for visual problems, and, if any are detected, an ophthalmologist or neuro-ophthalmologist should be consulted.

Brain Injuries↗

PubMed1999

[New avenues of communication for continuous medical education: first experiences of live broadcasting of ophthalmologY congresses via Internet].

BACKGROUND: The usage of the Internet in live-broadcasting ophthalmological lectures might be helpful in the education of eye doctors. The purpose is to report first experiences of a live-broadcasted congress. METHOD: The congress "Autonomic Innervation and Microcirculation of the Eye--Implications in Glaucoma Pathophysiology", held in the Department of Ophthalmology of the University Erlangen-Nürnberg at the 27th January 1999 was live-broadcasted via Internet by the electronic journal "Online Journal of Ophthalmology" (www.onjoph.com). The congress was organized by the "Sonderforschungsbereich 539, Glaukome, einschliesslich PEX" of the University Erlangen-Nürnberg. The original sound of the lectures was digitized by 8000 Hz and coded with 14 bit. Using the free software "Real-Audio-Player" the user could hear the speech of the lecturer in radio quality. Two live-pictures from two digital video cameras and the digitized slides were available at the screen within two frames. Two weeks before all 6576 ophthalmologists in Germany were informed about the event by conventional mail. RESULTS: The live-broadcasted congress was followed by 899 online-participants (899/6576 = 13.6%). 238 of 899 participants were able to hear the original sound. 154 of 6576 (2.3%) ophthalmologists answered by FAX. 18% of the answering eye doctors have followed the congress by Internet. Mainly all (98%) of them were very interested in live-broadcasted lectures or congresses and wanted to be informed about the next lecture or congress broadcasted by means of Internet. The lectures-on demand of this congress with sound and pictures are now available under the address http:/(/)www.onjoph. com/global/livewrk1/Default.htm. CONCLUSION: The major part of eye doctors in Germany seems very interested in live-broadcasted lectures for online-education. In the first national-wide trial 899 of 6576 informed eye doctors followed the congress.

Communications Media↗

PubMed1999

Overview on community ophthalmology.

Community ophthalmology requires a comprehensive approach for primary, secondary and tertiary prevention of all eye diseases like vitamin A deficiency, trachoma, measles, diabetic retinopathy, refractive errors, etc. Community ophthalmology is based on the principles of primary health care approach. Equitable distribution, community involvement, focus on prevention, appropriate technology and multisectorial approach are to name a few in primary health care approach. In India, National Programme for Trachoma Control was launched in 1963 and National Programme for Control of Blindness was launched in 1976. Prevention of blindness was included in 20-point plan in early 1980s. Increase in blindness was reassessed in 1986-89 and the strategy was changed. World Bank came to help in planning 11 million cataract operations in 7 years in 7 States where there was the highest prevalence of cataract. Departments of community ophthalmology have recently been developed in several institutions. If the problem of blindness is to be solved, extension of community-based approach including all strata of society is the need of the hour.

Blindness↗

PubMed1999

Ophthalmology's future in the next decade: a historical and comparative perspective.

PURPOSE: To gain a historical and comparative perspective about the future of ophthalmology within the profession of medicine. METHODS: A literature search is made of disciplines other than medicine (history, sociology, philosophy, economics, and ethics) in order to assess factors responsible for survival and healthiness of a profession. The "learned" professions (medicine, law, and theology) are assessed. Other "professional" careers valued by society (sports and classical music) are reviewed. RESULTS: From the perspective of other disciplines, the future of ophthalmology is seen as vulnerable and fragile. Survival of professions, be they classically or economically defined, is linked to societal needs, a profession's unique commitment and ability to provide services to society, and the profession's maintenance of knowledge as well as skill-based services. Historical evidence has shown erosion of a profession's power consequent to capitalist influences, government influences, access of skills by less trained individuals, and elitist posturing by a profession. Comparative evidence has shown societal acceptance of an escalation of salaries for designated superstars, increasing roles and influence of managerial personnel, and trivialization of values other than economic ones. CONCLUSION: Attention to historical and comparative trends by individual ophthalmologists as well as associations representing ophthalmologists is mandatory if ophthalmology as we know it is to survive within the profession of medicine.

Education, Medical↗

PubMed2001

[Evaluation of the work time used in outpatient ophthalmology techniques].

PURPOSE: To determine the work time used for out-patients seen in the ophthalmology out-patient clinic according to treatment for each diagnosis and examination guidelines. Another objective was to discover the diagnostic related outpatient demand as well as the time spent on each technique. METHOD: We have designed a computer database system that includes examinations, treatments and medical services. Their duration was measured in a random sample of 127 ophthalmology outpatients in the General Hospital of Castellon. Sixty five of the patients had come to their first visit and 62 to the follow-up visits. RESULTS: A new patient spends a mean of 42 minutes and a follow-up patient spends a mean of 27 minutes. The most frequent diagnoses are retinal diseases (30%), cataract (18.6%), glaucoma (11.8%) and ocular motility disorders (11.8%). We present the mean times used by the physician in the ophthalmic techniques used in outpatients. CONCLUSIONS: We have modified the standard times of 30 minutes for the first visit and 15 minutes for the follow-up visit. Data on the work time used for all the ophthalmics techniques in our outpatient clinic are presented. This ophthalmology survey can be used for health care managers to establish the < > and health care plan administration to adapt the resources to the demand.

Ambulatory Care Facilities↗

PubMed2002

The interface between ophthalmology and optometric vision therapy.

Considerable disparity lies between ophthalmologic impressions of optometric vision therapy, and the reality of optometric vision therapy as practiced in the United States. The viewpoint shared by ophthalmology in particular, and the medical field in general, is one that is filtered through organizational policy statements and the isolated experiences of influential individual practitioners. This has resulted in a skewed portrayal of optometric vision therapy. The purpose of this paper is to present a balanced perspective on this subject, and one that should be of assistance in creating an interface between ophthalmology and optometry that better serves the public.

Adult↗

PubMed2002

Two ophthalmology departments financed by compulsory health insurance: what is it that makes a difference in costs and clinical effectiveness?

AIM: To identify factors contributing to significant differences between two university hospital departments of ophthalmology, one in Paris, France, and the other in Zagreb, Croatia, in their clinical effectiveness and cost-efficiency. METHOD: Structural, clinical, and financial characteristics of a Croatian and French ophthalmology department were compared for the 1996-2000 period. We used Paris ophthalmology department reports from 1996-2000 period as data source. Data on the Zagreb department performance for the same time period were obtained from the financial department. After comparative analysis of performance to show consistency and comparability of the two departments according to the type and prevalence of pathology, case-mix, and approaches to therapeutic, educational, and research activities, hospital budget analysis was performed, with special reference to the length of hospital stay according to diagnosis, number of examinations, material expenses, salaries, and investment. The variables analyzed were the number of emergency, regular, and hospitalized patients; number of physicians; number and type of surgical procedures; number of patients and length of hospital stay according to diagnosis; hospital budget distribution; and usage of hospital beds. RESULTS: Although the structure, technology, level of education, organization, and patient profile at the two departments were similar, the mean number of operative procedures per specialist per year was different (109.4 for Zagreb vs 199.2 for Paris). Hospital bed occupancy was 99.4% in Zagreb and 74.9% in Paris. The mean duration of hospital stay was 7.5 days in Zagreb and 2.2 days in Paris. Zagreb had considerably longer hospital stay for all diagnoses except severe infections. Zagreb had lower investment in new technologies (0.4%) than Paris (20.1%), and higher material expenses (33.2% vs 10.1%, respectively). CONCLUSION: Different instruments of hospital services payment result in different clinical and organizational behavior of the hospital personnel and management. The three-fold longer stay in Zagreb can be explained by the mechanism of service payment, which is based on payment for capacity and structure and process in Zagreb instead of payment for service and service-related outcomes in Paris. Comparison of the two departments indicates that clinical efficiency and effectiveness cannot and should not be separated from financial incentives that can stimulate (Paris) or discourage (Zagreb) rational and evidence-based clinical behavior.

Cost-Benefit Analysis↗

PubMed2002

[Gene therapy prospects in ophthalmology].

PURPOSE: Presentation of newest achievements from borderland of ophthalmology and molecular biology and their clinical employment areas in the therapy of eye diseases. MATERIAL AND METHODS: MEDLINE database has been searched for terms gene, gene therapy, ocular, eye in title and summary fields. RESULTS: Based on the latest literature eye disorders have been selected that are currently in focus of gene therapy. Experimental approaches in vitro as well as in vivo have been reviewed. CONCLUSIONS: Modern ophthalmology profits more and more from newest achievements in molecular biology such as gene therapy. Transfer of additional genes to selected target cells within eye is able to change function and allows to achieve required effects. It is performed through employment of so called vectors, small particles allowing the gene to be transferred. Presently most often used vectors are derived from viruses (retrovirus, adenovirus, viruses AAV). Experimental studies have been performed in following eye diseases: retinitis pigmentosa, Leber congenital amaurosis, glaucoma, retinoblastoma, postoperative posterior capsule opacification, corneal diseases, age related macular degeneration, uveal melanoma. In each case the experimental results were promising. However, possible side effects of such therapy are not sufficiently known. There have been no clinical gene therapy studies in ophthalmology so far.

Adenoviridae↗