Converting from ECCE to SICS

Cataract continues to be the cause of almost half the cases of blindness worldwide and the challenge to meet the needs and develop the required resources is as great as ever.Cataract surgery has evolved from couching, first practised several thousand years ago, through intra- and extracapsular extraction (ECCE), to phacoemulsification. However, whatever the technique, the most important aspect is the outcome for patients. Today, the focus is more and more on excellence, which was one of the central themes of the 8th General Assembly

Excellence and equity in eye care

The theme of the 8th General Assembly was ‘Excellence and equity in eye care’ - superlative sound bites perhaps, but when those words are considered in the context of VISION 2020, they take on a meaning that should define all our efforts to combat avoidable blindness

How to figure out what CPD/CME you need.

Do you feel totally in control of every situation? We need to be honest about the gaps in our knowledge or skills, keep motivated and find solutions to the challenges

Postoperative endophthalmitis.

Endophthalmitis may have devastating consequences for a patient’s vision and therefore should be treated as an emergency. The time from diagnosis to treatment is critical for favourable outcomes. In order to achieve a rapid response, it is important to have an accessible protocol and an endophthalmitis kit at hand for all eye surgeons who see postoperative patients. We have produced a simple protocol of recommended practice collated from a range of sources

Endophthalmitis: controlling infection before and after cataract surgery

Endophthalmitis is a rare, but serious, postoperative complication of cataract surgery. It can have a devastating consequence on a patient’s vision: some patients may lose all light perception.The incidence of endophthalmitis has been reported to be between 0.13% and 0.7%.1 The primary source of this intraocular infection is considered to be bacteria from the patient’s ocular surface (cornea, conjunctiva) or adnexa (lacrimal glands, eyelids, and extraocular muscles). The bacteria most frequently isolated are gram-positive coagulase-negative cocci (mainly Staphylococcus epidermidis) which account for 70% of culture-positive cases. Staphylococcus aureus is isolated in 10% of culture-positive cases, Streptococcus species in 9%, Enterococcus species in 2%, and other gram-positive species in 3% of cases. Gram-negative bacteria account for just 6% of culture-positive cases; however, an infection with these bacteria, particularly with Pseudomonas aeruginosa, can lead to a devastating visual outcome

Detecting and managing complications in cataract patients.

In order to ensure good cataract outcomes with the minimum of complications, a number of key aspects are essential. Even if these are all in place, problems can arise with a patient who can’t keep still in theatre, an eye that is deep-set and difficult to access, a small pupil, weak lens zonules (whether due to pseudo-exfoliation or subluxation) or a hyper-mature cataract that requires a high degree of surgical skill

Working with patients to optimise cataract outcomes.

One of the delights of ophthalmology is to witness the joy on the face of a patient with cataract when the dressing is taken off and sight has been restored. Unfortunately, for some patients, the result does not live up to their expectations. Despite cataract surgery being one of the most successful surgical interventions available, there is evidence that the visual outcome of cataract surgery in sub-Saharan Africa is not always good (defined as a VA of 6/18 or better). The proportion of good outcomes range from only 23% up to 70%, failing to reach the WHO target of 85% or better

Cascading training the trainers in ophthalmology across Eastern, Central and Southern Africa.

BACKGROUND: The Royal College of Ophthalmologists (RCOphth) and the College of Ophthalmology of Eastern Central and Southern Africa (COECSA) are collaborating to cascade a Training the Trainers (TTT) Programme across the COECSA Region. Within the VISION 2020 Links Programme, it aims to develop a skilled motivated workforce who can deliver high quality eye care. It will train a lead, faculty member and facilitator in 8 countries, who can cascade the programme to local trainers. METHODS: In phase 1 (2013/14) two 3-day courses were run for 16/17 selected delegates, by 3 UK Faculty. In phase 2 (2015/16) 1 UK Faculty Member ran 3 shorter courses, associated with COECSA events (Congress and Examination). A COECSA Lead was appointed after the first course, and selected delegates were promoted as Facilitators then Faculty Members on successive courses. They were given appropriate materials, preparation, training and mentoring. RESULTS: In 4 years the programme has trained 87 delegates, including 1 COECSA Lead, 4 Faculty Members and 7 Facilitators. Delegate feedback on the course was very good and Faculty were impressed with the progress made by delegates. A questionnaire completed by delegates after 6-42 months demonstrated how successfully they were implementing new skills in teaching and supervision. The impact was assessed using the number of eye-care workers that delegates had trained, and the number of patients seen by those workers each year. The figures suggested that approaching 1 million patients per year were treated by eye-care workers who had benefited from training delivered by those who had been on the courses. Development of the Programme in Africa initially followed the UK model, but the need to address more extensive challenges overseas, stimulated new ideas for the UK courses. CONCLUSIONS: The Programme has developed a pyramid of trainers capable of cascading knowledge, skills and teaching in training with RCOphth support. The third phase will extend the number of facilitators and faculty, develop on-line preparatory and teaching materials, and design training processes and tools for its assessment. The final phase will see local cascade of the TTT Programme in all 8 countries, and sustainability as UK support is withdrawn