Corneal grafting: what eye care workers need to know

This article provides guidance to eye care workers who want to know who should be referred for a corneal graft and what complications they may need to manage after patients have had their operation

Improving surgical outcomes

Outcomes of cataract surgery are worse than we would like them to be. Community-based studies show that up to 40% of eyes have a postoperative presenting vision of < 6/60. Eyes with intraocular lenses (IOLs) do better; however, it has been shown that even in prosperous middle-income countries, such as Venezuela, in 20% of pseudophakic eyes presenting vision was < 6/60 and in 15% best corrected vision was worse than 6/60.Poor outcomes matter. Patients deserve improved vision whenever possible and poor outcomes deter prospective patients from coming for surgery and probably reduce their willingness to pay for their treatment – particularly if they have to pay in advance!In this article, we offer some suggestions for improving the quality of cataract surgery. We admit that there is little evidence base for most of these suggestions and that some of them are controversial. However, we hope to stimulate debate

Clinical auditing to improve patient outcomes

Clinical audit is about measuring the quality of care we provide against relevant standards. If we are failing to meet these standards, the audit should help us understand the factors that are causing us to fail, so that we can set priorities and make improvements

Emergency management: retinal detachment

The retina is the light-sensitive part of the eye. The outer layer of the retina is composed of photoreceptor cells, which generate a nerve signal in response to light. Normally, this photoreceptor layer is in close contact with the choroid and retinal pigment epithelium. The photoreceptor cells depend on this contact for their metabolism. If they are separated from the choroid by a retinal detachment, they may be irreversibly damaged. This is why retinal detachment is an ophthalmic emergency

Managing emergencies: lessons from aviation

There is no need to be surprised by an eye emergency – preparation and practice make all the difference

Managing errors in the eye unit.

It takes a team to deliver eye care. When things go wrong, it is important to focus on the patient and to learn from the error while working supportively with the health professionals involved

QUIET PLEASE! Effect of distraction on simulated posterior segment surgical performance

Purpose To determine the effect of distraction on posterior segment surgical performance using a virtual reality simulator in expert and novice ophthalmic surgeons. Methods Twenty subjects were given six minutes to read an unpublished research paper and then randomized into two groups. Group 1 subjects were allowed three minutes to complete a standardized vitreoretinal simulated task undistracted. Group 2 subjects were asked six questions on the research paper whilst completing the same task. Each subject then performed the alternate scenario. Finally, all participants were asked six questions on the research paper whilst not operating. Results There was no evidence of a difference in the odometer values (p=0.127), cognitive task score (p=0.390) or overall surgical task scores (p=0.113) between the two groups. The time taken by the distracted group was significantly greater (95% CI -26.03 to -1.67, t-test p=0.028). Conclusion Distraction significantly increases the time taken to perform a simulated vitreoretinal surgical task for all grades of surgeon. More studies are required to understand the impact on different types of distraction on surgical performance