Exposure of Ophthalmology Residents to Cornea and Keratorefractive Surgeries in the United States

Purpose: To describe the cornea and keratorefractive surgeries experience of U.S. ophthalmology residents. Methods: Deidentified case logs of residents graduating in 2018 were collected from ophthalmology residency program directors in the United States. Using Current Procedure Terminology codes, case logs were reviewed in the categories of cornea and keratorefractive surgeries. Accreditation Council for Graduate Medical Education national graduating resident surgical case logs on cornea procedures published from 2010 to 2020 were also analyzed. Results: Case logs were received for 152/488 (31.1%) residents from 36/115 (31.3%) ophthalmology residency programs. The most common procedures logged by residents as primary surgeons were pterygium removal (4.3 ± 4.2) and keratorefractive surgeries (3.6 ± 6.2). Residents logged an average of 2.4 keratoplasties as primary surgeon, performing an average of 1.4 penetrating keratoplasties (PKs) and 0.8 endothelial keratoplasties (EKs). As assistants, the most common procedures logged were keratorefractive surgeries (6.1 ± 4.9), EKs (3.8 ± 3.3), and PKs (3.5 ± 2.3). Medium or large residency class size was associated with higher cornea procedural volumes (odds ratio: 8.9; 95% confidence interval: 1.1–75.6; p  Conclusion: The most common cornea surgeries performed by residents include keratoplasty, keratorefractive, and pterygium procedures. Larger program size was associated with greater relative cornea surgery volume. More specific guidelines for logging of procedures could provide a more accurate assessment of resident exposure to critical techniques such as suturing as well as reflect trends in current practice such as the overall increase in EKs.</p

Bitot’s Spots following Bariatric Surgery: An Ocular Manifestation of a Systemic Disease

Background: To present a case of ocular complications from vitamin A deficiency following bariatric surgery. Case Report: A 41-year-old woman presented with symptoms of dryness and diminished night vision. Examination revealed corneal punctate staining, keratinization of the conjunctiva, and multiple mid-peripheral white lesions at the level of the retinal pigment epithelium. Given the patient’s history of bariatric surgery, anemia, and vitamin D deficiency, further investigation into micronutrient levels was performed and indicated a severe vitamin A deficiency. Oral vitamin A supplementation resulted in the complete resolution of her symptoms within two months. Conclusions: Nutritional deficiencies following bariatric surgery are common and can be disruptive to normal systemic health and visual function. Given that the number of patients pursuing bariatric surgery for weight loss management has increased over the past 50 years, eye care professionals should be aware of the ophthalmic manifestations associated with micronutrient deficiency

Epithelial ingrowth through venting incision into laser-assisted in situ keratomileusis flap interface after descemet stripping automated endothelial keratoplasty

Purpose: To present a case of epithelial ingrowth into the laser-assisted in situ keratomileusis (LASIK) flap interface after a patient underwent descemet stripping automated endothelial keratoplasty (DSAEK) surgery with venting incisions. Observations: We present a case of a 48-year-old man with previous history of LASIK that underwent DSAEK for pseudophakic bullous keratopathy after complicated cataract surgery requiring an intraocular lens (IOL) exchange. The patient developed epithelial ingrowth into the LASIK flap interface from one of the venting incisions. The epithelial ingrowth was observed as it was a small peripheral area that did not affect his visual acuity. Conclusions and Importance: Epithelial ingrowth is a well-described complication following LASIK but has rarely been described to occur after endothelial keratoplasty (EK). Even rarer, are reports of epithelial ingrowth after EK cases that have been found to result from venting incisions. To the authors’ knowledge, this is the first case of the ingrowth into a LASIK flap interface occurring after EK through a venting incision. Although it may be an uncommon occurrence in which a patient with a history of LASIK requires EK, surgeons should take extra precautions to avoid this complication. Keywords: Epithelial ingrowth, Descemet stripping automated endothelial keratoplasty, Venting incision

PAs\u27 skills in providing vision and ocular care

OBJECTIVE: To evaluate characteristics, training, and self-reported skills and abilities in vision and ocular care among PAs not specializing in ophthalmology. METHODS: A survey on PA practice was administered to 5,763 randomly selected US-based PAs, and 537 respondents who completed the survey were invited to complete a separate vision and ocular care survey. Of those respondents, 382 completed the vision and ocular care survey. RESULTS: Among respondents, 23% of PAs were involved in eyecare by providing patient information, answering questions, and initiating discussions about vision care and ocular health more than once per month. More than 77% received vision and ocular care training in and/or outside PA training. PAs involved in eyecare had significantly greater odds of reporting higher desired and current skill and ability levels compared with PAs not involved in eyecare, in six of eight vision and ocular care domains. CONCLUSIONS: PAs who do not practice in ophthalmology provide vision and ocular care but have varying amounts of training and desire higher skill and ability levels. Ophthalmologists and PA institutions may develop vision and ocular care training for PA schools and continuing medical education

Webinars and Continuing Medical Education: Pros, Cons, and Controversies

One of the most important effects of the crisis caused by coronavirus disease 2019 (COVID-19) at a global level was on education and its delivery, mainly of the face-to-face type.1,2 The pandemic posed challenges and necessitated changes to the previously used system and created opportunities for growth and innovation. At the university level, institutions acted rapidly to implement teaching and learning through digital platforms, a resource that has been used by academic institutions.3,4 Furthermore, digital interaction has increased almost exponentially in the last decade in medicine and academics, with technology applied to patient care such as through telemedicine.3Fil: Torres, Rodrigo Martín. ROMAT Creator Center; ArgentinaFil: Torres, Rodrigo Martín. Sanatorio Allende–Sede Cerro. The Instituto De La Visión Cerro De Las Rosas; ArgentinaFil: Torres, Rodrigo Martín. Universidad Católica de Córdoba. Ciencias de la Salud; ArgentinaFil: Torres, Rodrigo Martín. The Instituto Oftalmológico Quironsalud; EspañaFil: Torres, Rodrigo Martín. Johns Hopkins University School of Medicine. The Wilmer Eye Institute; Estados UnidosFil: Reviglio, Víctor. ROMAT Creator Center; ArgentinaFil: Reviglio, Víctor. Sanatorio Allende–Sede Cerro. The Instituto De La Visión Cerro De Las Rosas; ArgentinaFil: Reviglio, Víctor. Universidad Católica de Córdoba. Ciencias de la Salud; ArgentinaFil: Reviglio, Víctor. The Instituto Oftalmológico Quironsalud; EspañaFil: Reviglio, Víctor. Johns Hopkins University School of Medicine. The Wilmer Eye Institute; Estados UnidosFil: Basanta, Iván. ROMAT Creator Center; ArgentinaFil: Basanta, Iván. Sanatorio Allende–Sede Cerro. The Instituto De La Visión Cerro De Las Rosas; ArgentinaFil: Basanta, Iván. Universidad Católica de Córdoba. Ciencias de la Salud; ArgentinaFil: Basanta, Iván. The Instituto Oftalmológico Quironsalud; EspañaFil: Basanta, Iván. Johns Hopkins University School of Medicine. The Wilmer Eye Institute; Estados UnidosFil: Srikumaran, Divya. ROMAT Creator Center; ArgentinaFil: Srikumaran, Divya. Sanatorio Allende–Sede Cerro. The Instituto De La Visión Cerro De Las Rosas; ArgentinaFil: Srikumaran, Divya. Universidad Católica de Córdoba. Ciencias de la Salud; ArgentinaFil: Srikumaran, Divya. The Instituto Oftalmológico Quironsalud; EspañaFil: Srikumaran, Divya. Johns Hopkins University School of Medicine. The Wilmer Eye Institute; Estados Unido

Supervision and autonomy of ophthalmology residents in the outpatient Clinic in the United States: a survey of ACGME-accredited programs

Abstract Background The development and demonstration of incremental trainee autonomy is required by the ACGME. However, there is scant published research concerning autonomy of ophthalmology residents in the outpatient clinic setting. This study explored the landscape of resident ophthalmology outpatient clinics in the United States. Methods A link to an online survey using the QualtricsTM platform was emailed to the program directors of all 115 ACGME-accredited ophthalmology programs in the United States. Survey questions explored whether resident training programs hosted a continuity clinic where residents would see their own patients, and if so, the degree of faculty supervision provided therein. Metrics such as size of the resident program, number of faculty and clinic setting were also recorded. Correlations between the degree of faculty supervision and other metrics were explored. Results The response rate was 94%; 69% of respondents indicated that their trainees hosted continuity clinics. Of those programs, 30% required a faculty member to see each patient treated by a resident, while 42% expected the faculty member to at least discuss (if not see) each patient. All programs expected some degree of faculty interaction based upon circumstances such as the level of training of the resident or complexity of the clinical situation. 67% of programs that tracked the contribution of the clinic to resident surgical caseloads reported that these clinics provided more than half of the resident surgical volumes. More ¾ of resident clinics were located in urban settings. The degree of faculty supervision did not correlate to any of the other metrics evaluated. Conclusions The majority of ophthalmology resident training programs in the United States host a continuity clinic located in an urban environment where residents follow their own patients. Furthermore, most of these clinics require supervising faculty to review both the patients seen and the medical documentation created by the resident encounters. The different degrees of faculty supervision outlined by this survey might provide a useful guide presuming they can be correlated with validated metrics of educational quality. Finally, this study could provide an adjunctive resource to current international efforts to standardize ophthalmic residency education

National trends in imaging rates for eye-related emergency department visits in the United States

Purpose: To identify nationwide trends and factors associated with advanced imaging (computed tomography [CT] and magnetic resonance imaging [MRI]) use for eye-related emergency department (ED) visits.Design: Retrospective, trend study.Methods: Setting: National Hospital Ambulatory Medical Care Survey 2007-2015.Patient population: Eye-related ED patients who underwent CT or MRI.Main outcome measure(s): Population-based CT/MR imaging rates and independent factors associated with imaging.Results: An estimated 7 million eye-related ED visits occurred between 2007 and 2015. Adjusted for annual eye-related ED visits, the rate of imaging use rose 94%, from 121.7 per 1,000 eye-related ED visits in 2007 to 236.0 per 1,000 eye-related ED visits in 2015. Visual disturbances, contusion of the eye and/or adnexa, open globes and open wounds of ocular adnexa, diplopia, superficial corneal and/or conjunctival injuries, and orbital fractures accounted for 73.2% of all visits where imaging was performed. On multivariable analysis, older patients (odds ratio [OR] = 1.02, 95% confidence interval [CI] 1.01-1.03) and females (OR=2.07, 95% CI 1.18-3.63) were more likely to undergo imaging than younger patients and males. Imaging was also more likely to be performed for Medicare beneficiaries (OR=2.12, 95% CI 1.08-4.15) than for privately insured patients. Patients who were admitted to the hospital were 6 times more likely (OR=6.39, 95% CI 2.04-20.0) to undergo imaging than those who were not admitted.Conclusions: Advanced imaging for eye-related ED visits has escalated at a higher rate than ED visits for eye complaints. Future studies to develop evidence-based algorithms for use of CT/MR imaging for eye complaints that can help balance benefits against financial costs and health risk are warranted

Survival of penetrating keratoplasty: a claims-based longitudinal analysis

Objectives: To report real-world long-term survival of primary penetrating keratoplasty (PK) in the United States and analyze risk factors associated with failure