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

The Effects of Macular Photocoagulation on Visual Field

Purpose: To evaluate visual field and nerve fiber layer thickness changes after Macular photocoagulation for treatment of diabetic macular edema. Setting: Rassoul Akram Hospital, Tehran, Iran. Material and method: Twenty six eyes with history of diabetes and clinically significant macular edema candidate for Macular photocoagulation were included in this prospective interventional case series. All patients underwent 10-2 and 24-2 Humphrey Visual Field Test with Swedish Interactive Thresholding Algorithm (SITA) standard strategy and also optic nerve and macular optical coherence tomography (OCT), before and 6 months after macular laser photocoagulation. Then visual field, peripapillary and macular nerve fiber layer thickness of each eye were compared before and after photocoagulation. Results: The mean age of patients was 57.60 ± 8.99 (range 33-73) years. There was no statistically significant change after photocoagulation compared to before the procedure regarding the mean deviation, pattern standard deviation and foveal threshold in visual field 10-2 and 24-2 tests except for pattern standard deviation in 10-2 test. Conclusion: Based on our results it seems that visual field is not affected by macular laser photocoagulation

Comparison of the long-term outcomes of resident versus attending performed trabeculectomy

Purpose: To compare the long-term outcomes obtained by residents and attending surgeons performing trabeculectomy. Methods: After reviewing medical records of the patients, 41 residents performing trabeculectomy under supervision of attendings were compared to 41 attendings performing trabeculectomy. The primary outcome measure was the surgical success defined in terms of intraocular pressure (IOP) ≤ 21 mmHg (criterion A) and IOP ≤ 16 mmHg (criterion B), with at least 20% reduction in IOP, either with no medication (complete success) or with no more than 2 medications (qualified success). IOP, number of glaucoma medications, surgical complications, and visual acuity were analyzed as secondary outcome measures. Results: Mean age of the patients was 59.5 ± 8.6 years in the resident group and 59.6 ± 12.31 years in the attending group (P = 0.96). Furthermore, mean duration of the follow-up was 62.34 ± 5.51 months in the resident group and 64.80 ± 7.80 months in the attending group (P = 0.10). The cumulative success according to criterion A was 87.8% in the resident group and 85.3% in the attending group (P = 0.50). Moreover, according to criterion B, it was 87.8% and 83% in the resident and attending groups, respectively (P = 0.62). Repeated glaucoma surgery was required in 12.2% and 2.4% of the patients in the resident and attending groups, respectively (P = 0.09). Rate of complications was 12.2% and 4.8% in the resident and attending groups, respectively (P = 0.23). Conclusion: There were comparable results with respect to success rates and complications between residents and attending surgeons performing trabeculectomy in the long-term follow-up. Keywords: Glaucoma, Trabeculectomy, Intraocular pressur