Evaluation of Optic Nerve Head Examination in a Resident Based Hospital

Purpose: To evaluate the accuracy of glaucomatous optic neuropathy diagnosis in a resident based hospital. Patients and Methods:  Four hundred twenty eyes of 210 patients underwent ocular examination including intra ocular pressure and optic nerve head measurements by third and fourth year residents and suspect cases were referred to a glaucoma specialist for validation. After reevaluation by the specialist a comparison between these two examination results was performed to evaluate the over diagnosis of disease by residents. Results: In this prospective study, eighteen eyes out of 420 evaluated eyes were diagnosed as either glaucoma suspect (14 eyes) or glaucoma (4 eyes) by residents. After reevaluation by the glaucoma specialist only one eye had suspect optic nerve head which was referred for optic nerve head imaging. All other eyes had normal optic nerve head and retinal nerve fiber layer in examination by the specialist. Conclusion: The results of the present study indicate a high rate of glaucomatous optic neuropathy over diagnosis by third and fourth year ophthalmology residents. Further studies are needed to find if this over diagnosis is related to poor training or anxiety among residents to miss a real case of glaucoma.Keywords: Glaucoma, Examination, Optic Nerves, Diagnosis

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population