Comparison of ophthalmic training in 6 English-speaking countries

OBJECTIVE: To compare key characteristics of ophthalmology training programs in 6 different English-speaking countries: Australia, New Zealand, Canada, Ireland, the United Kingdom, and the United States. PARTICIPANTS: Seven ophthalmologists with personal knowledge of all 6 systems contributed. METHODS: The main features examined were career pathway, duration of training, surgical training, governing bodies, and examination structure. Data were collected from the literature, online resources, and personal experience. RESULTS: Several differences were highlighted, including length of training (ranging from 4 to 9 years after medical school), number of surgical procedures such as cataracts (ranging from minimum 86 to approximately 600), and structure of fellowship training. CONCLUSIONS: As trainees increasingly seek international experience to enhance their knowledge and skills, the similarities and differences between training programs in different countries have become more relevant. Some of these differences may reflect differing needs of different patient populations and different healthcare delivery systems across the globe. However, these differences should also prompt educators to more carefully scrutinize their own training system and search for potential improvements

Glaucoma diagnosis using multi-feature analysis and a deep learning technique

AbstractIn this study, we aimed to facilitate the current diagnostic assessment of glaucoma by analyzing multiple features and introducing a new cross-sectional optic nerve head (ONH) feature from optical coherence tomography (OCT) images. The data (n = 100 for both glaucoma and control) were collected based on structural, functional, demographic and risk factors. The features were statistically analyzed, and the most significant four features were used to train machine learning (ML) algorithms. Two ML algorithms: deep learning (DL) and logistic regression (LR) were compared in terms of the classification accuracy for automated glaucoma detection. The performance of the ML models was evaluated on unseen test data, n = 55. An image segmentation pilot study was then performed on cross-sectional OCT scans. The ONH cup area was extracted, analyzed, and a new DL model was trained for glaucoma prediction. The DL model was estimated using five-fold cross-validation and compared with two pre-trained models. The DL model trained from the optimal features achieved significantly higher diagnostic performance (area under the receiver operating characteristic curve (AUC) 0.98 and accuracy of 97% on validation data and 96% on test data) compared to previous studies for automated glaucoma detection. The second DL model used in the pilot study also showed promising outcomes (AUC 0.99 and accuracy of 98.6%) to detect glaucoma compared to two pre-trained models. In combination, the result of the two studies strongly suggests the four features and the cross-sectional ONH cup area trained using deep learning have a great potential for use as an initial screening tool for glaucoma which will assist clinicians in making a precise decision.</jats:p

Widespread sex differences in gene expression and splicing in the adult human brain

There is strong evidence to show that men and women differ in terms of neurodevelopment, neurochemistry and susceptibility to neurodegenerative and neuropsychiatric disease. The molecular basis of these differences remains unclear. Progress in this field has been hampered by the lack of genome-wide information on sex differences in gene expression and in particular splicing in the human brain. Here we address this issue by using post-mortem adult human brain and spinal cord samples originating from 137 neuropathologically confirmed control individuals to study whole-genome gene expression and splicing in 12 CNS regions. We show that sex differences in gene expression and splicing are widespread in adult human brain, being detectable in all major brain regions and involving 2.5% of all expressed genes. We give examples of genes where sex-biased expression is both disease-relevant and likely to have functional consequences, and provide evidence suggesting that sex biases in expression may reflect sex-biased gene regulatory structures

Vision in high-level football officials

YesOfficiating in football depends, at least to some extent, upon adequate visual function. However, there is no vision standard for football officiating and the nature of the relationship between officiating performance and level of vision is unknown. As a first step in characterising this relationship, we report on the clinically-measured vision and on the perceived level of vision in elite-level, Portuguese football officials. Seventy-one referees (R) and assistant referees (AR) participated in the study, representing 92% of the total population of elite level football officials in Portugal in the 2013/2014 season. Nine of the 22 Rs (40.9%) and ten of the 49 ARs (20.4%) were international-level. Information about visual history was also gathered. Perceived vision was assessed using the preference-values-assigned-to-global-visual-status (PVVS) and the Quality-of-Vision (QoV) questionnaire. Standard clinical vision measures (including visual acuity, contrast sensitivity and stereopsis) were gathered in a subset (n = 44, 62%) of the participants. Data were analysed according to the type (R/AR) and level (international/national) of official, and Bonferroni corrections were applied to reduce the risk of type I errors. Adopting criterion for statistical significance of p<0.01, PVVS scores did not differ between R and AR (p = 0.88), or between national- and international-level officials (p = 0.66). Similarly, QoV scores did not differ between R and AR in frequency (p = 0.50), severity (p = 0.71) or bothersomeness (p = 0.81) of symptoms, or between international-level vs national-level officials for frequency (p = 0.03) or bothersomeness (p = 0.07) of symptoms. However, international-level officials reported less severe symptoms than their national-level counterparts (p<0.01). Overall, 18.3% of officials had either never had an eye examination or if they had, it was more than 3 years previously. Regarding refractive correction, 4.2% had undergone refractive surgery and 23.9% wear contact lenses when officiating. Clinical vision measures in the football officials were similar to published normative values for young, adult populations and similar between R and AR. Clinically-measured vision did not differ according to officiating level. Visual acuity measured with and without a pinhole disc indicated that around one quarter of participants may be capable of better vision when officiating, as evidenced by better acuity (≥1 line of letters) using the pinhole. Amongst the clinical visual tests we used, we did not find evidence for above-average performance in elite-level football officials. Although the impact of uncorrected mild to moderate refractive error upon officiating performance is unknown, with a greater uptake of eye examinations, visual acuity may be improved in around a quarter of officials.Portuguese Foundation for Science and Technology (FCT) in the framework of the Strategic Funding UID/FIS/04650/2013

Dawbeney Turbervile, MD (1612-1696).

The year 2012 marks the quatercentenary of the birth of Dawbeney Turbervile,MD(1612-1696), one-time Royalist soldier and later ophthalmologist to England’s Princess Anne, the diarist Samuel Pepys, the natural philosopher Robert Boyle, and the astronomer Walter Pope. Turbervile is remarkable for many reasons: He specialized at a time when generalization was prized; though he was a qualified physician, he also practiced the trade of surgery. Furthermore, he provided in his communications with the Royal Society early descriptions of achromatopsia, ocular foreign body removal with a magnet, and tic doloreaux. He is a forebear worth rememberin

Dawbeney Turbervile, MD (1612-1696).

The year 2012 marks the quatercentenary of the birth of Dawbeney Turbervile,MD(1612-1696), one-time Royalist soldier and later ophthalmologist to England’s Princess Anne, the diarist Samuel Pepys, the natural philosopher Robert Boyle, and the astronomer Walter Pope. Turbervile is remarkable for many reasons: He specialized at a time when generalization was prized; though he was a qualified physician, he also practiced the trade of surgery. Furthermore, he provided in his communications with the Royal Society early descriptions of achromatopsia, ocular foreign body removal with a magnet, and tic doloreaux. He is a forebear worth rememberin

"The El Greco fallacy" fallacy.

To what extent does an artist's work represent his or her perceptual world, and to what extent can attributes of his or her work be ascribed to sensory defects? These issues lie at the center of a conjecture more than a century old, which has been termed the El Greco fallacy. The El Greco fallacy posits that the elongation evident in El Greco's art reflects an underlying perceptual elongation of objects caused by astigmatism. The "logical" refutation of this theory argues that any perceptual elongation that El Greco might have experienced as a result of astigmatism would have caused not only his subjects to be elongated but also his canvas. Hence, it should have been unnecessary for him to elongate his paintings to match his perception. This objection is important because it warns us against drawing the erroneous conclusion that an artist's work represents a facsimile of his or her perception. However, an analysis of the effects of astigmatism on the retinal image suggests that this "logical" refutation of the El Greco fallacy promulgates another fallacy--that of astigmatism as a source of a constant perceptual error

On seeing yellow: the case for, and against, short-wavelength light-absorbing intraocular lenses.

The normal human crystalline lens absorbs UV and short-wavelength visible electromagnetic radiation. Early intraocular lenses (IOLs) permitted the transmission of such radiation to the retina following cataract extraction. Experimental studies of the absorption profile of the crystalline lens and animal studies demonstrating the deleterious effects of short-wavelength radiation on the retina led to the development of UV-absorbing, and later, short-wavelength light-absorbing (SLA) IOLs. Short-wavelength light-absorbing IOLs were designed to mimic the absorption properties of the normal crystalline lens by absorbing some short-wavelength light in addition to UV radiation; however, debate continues regarding the relative merits of such lenses over UV-absorbing IOLs. Advocates of SLA IOLs suggest that they may theoretically offer increased photoprotection and decreased glare sensitivity and draw on in vitro, animal, and limited clinical studies that infer possible benefits. Detractors suggest that there is no direct evidence supporting a role for SLA IOLs in preventing retinal dysfunction in humans and suggest that they may have negative effects on color perception, scotopic vision, and circadian rhythms. This article examines the theoretical and empirical evidence for, and against, such lenses