Why ophthalmology? Analysis of the motivating factors influencing the choice of ophthalmology as a career among different generations in Brazil

OBJECTIVES: The increasing demand for medical specialties with flexible working hours has been associated with the important role of quality of life as a determining factor when choosing a career in medicine, which might change the motivations for pursuing a career in ophthalmology. We aim to identify the main determinants of ophthalmology as a career choice as well as the reasons that motivated previous generations to follow this path. METHODS: Responses to self-administered online questionnaires were analyzed. RESULTS: A total of 225 responses were analyzed, including those of baby boomers (21), generation X (48), generation Y (131) and generation Z (25). Although the main reasons for choosing ophthalmology as a career are the same for all the generations in this study (flexible working hours, self-satisfaction from helping people improve their vision and the possibility of performing surgical procedures), some reasons for this career choice are more important to the younger generations (short-term results and short procedures), and some are more important to the older generations (the influence of an ophthalmologist in the family). CONCLUSION: The main reasons for choosing ophthalmology as a career are essentially

Changes on the Amsler grid test in patients with senile cataract

OBJETIVO: Verificar a influência de alguns tipos de opacidade lenticular no teste da tela de Amsler entre portadores de catarata senil. MÉTODOS:Foram avaliados 200 pacientes portadores de catarata senil através da aplicação da tela de Amsler, antes e após a cirurgia. O estudo foi feito em um único centro, simples cego, randomizado e prospectivo. Os pacientes foram submetidos a exame de acuidade visual (AV) corrigida, para longe e perto, biomicroscopia do segmento anterior e da região macular. RESULTADOS:A acuidade visual média pré-operatória para longe dos 200 pacientes foi de 0,5 logMAR (20/60 Tabela de Snellen). Após a cirurgia, dos 11 pacientes que haviam apresentado alteração na tela de Amsler pré-operatória, dez não tiveram alteração no exame de reavaliação da tela. Os 10 indivíduos apresentaram acuidade visual pós-operatória, com a melhor correção óptica, para distância de 20/20 e para perto de J1. No presente estudo foi constatado 5,5% com alteração na tela de Amsler antes da cirurgia, em 5% dos pacientes estas alterações estavam diretamente relacionados a opacidade do cristalino e 0,5% relacionados a opacidade vítrea. CONCLUSÃO: Conclui-se que a alteração no exame da tela de Amsler pode ser diretamente relacionada à catarata, na ausência de alterações maculares clínicas.PURPOSE: To assess the influence of some forms of lenticular opacification in the Amsler grid test among patients suffering from senile cataract. METHODS: Randomized, prospective interventional trial. Two hundred patients with senile cataract were evaluated with Amsler grid, measurement of best corrected visual acuity for near distance and far distance, biomicroscopy of the anterior segment and macular region. RESULTS: With a two months minimum of follow-up, the average visual acuity after surgery for far distance among the 200 patients was 0.48 logMAR, 11 (5.5%) had changes in the Amsler grid test before surgery. After surgery, from the 11 subjects with changes in the preoperative Amsler grid test, 10 had no more changes in the Amsler grid. These 10 subjects had postoperative best corrected visual acuity of 20/20, and Jaeger 1, no abnormalities of the fundus having been detected. Under this study conditions, the prevalence of changes in the Amsler grid test was 5.5%, and in 5% of the patients these changes were likely related to cataract whereas in 0.5% they were related to vitreous opacification. CONCLUSION: Some patient with cataract showed changes in the Amsler grid test that can be directly related to cataract, in the absence of clinically detected macular disorders

Socioeconomic Barriers to Rhegmatogenous Detachment Surgery in Brazil

Purpose. To verify access barriers patients with retinal detachment face to arrive at a reference center and to evaluate patients’ knowledge about the disease. Methods. Transversal study that applied a questioner to 65 patients of the Clinical Hospital of the University of Sao Paulo with retinal detachment between February and August of 2010. Results. Reasons for not performing the surgery in other services were as follows: 47% were referred because there was not vitreoretinal surgeon at original service; 27% could not afford the surgery, had no health insurance, or had no coverage at health insurance plan for the procedure. Time between the first symptom and the arrival at our service was as follows: 18 patients arrived in up to 7 days; 35 between 8 and 30 days; 8 between 31 and 90 days; 5 in more than 90 days. Reasons for delay were as follows: 70% did not know how serious the pathology was; 56% thought that it had spontaneous cure; 16% did not have money to pay for ophthalmic evaluation, 10% did not know where to go and 24% for other reasons. Conclusion. Educational programs about disease and measures to optimize the referral to specialized services are needed to accelerate the treatment of patients with rhegmatogenous retinal detachment

Idiopathic Organ Transplant Chorioretinopathy after Liver Transplantation

Idiopathic organ transplant chorioretinopathy is a rare disease associated with kidney and heart transplantation. We present a case secondary to liver transplantation including its multimodal imaging, differential diagnosis, and physiopathology discussion

Carcinoma basocelular periocular: custo da imunoterapia tópica versus custo estimado do tratamento cirúrgico

Purpose: The objective of this study was to compare the estimated cost of clinical and surgical treatment for basl cell carcinoma of the eyelid. Methods: This was a pilot study of 12 patients with basal cell carcinoma receiving treatment with 5% imiquimod cream at the ocular plastic surgery center, medical school University of Sao Paulo (HC-FMUSP, Brazil). The cost of clinical treatment was estimated based on the time of treatment and amount of medication consumed by patients in the home setting. The cost of surgical treatment was estimated by ophthalmologists with experience in reconstructive plastic surgery based on analysis of images of the same patients. Surgeons responded to a questionnaire with four questions about surgical technique, surgical materials required, estimated duration of surgery and type of anesthesia. Results: Immunotherapy lasted from 8 to 12 weeks. All patients reported each cold-stored sachet with 5% imiquimod cream lasted 3 days. According to the institution, a box with 12 sachets costs BRL 480.00. Patients required 1.58-3.11 boxes for complete treatment, corresponding to a total cost of BRL 758.40-1,492.80. Based on image analysis, surgeons evaluated surgery would require 1-3 hours. The estimated cost of surgery room and staff was BRL 263.00, to which the cost of supplies was added. Thus, the total cost of surgical treatment was BRL 272.61-864.82. On the average, immunotherapy was 57,64% more costly than surgical treatment. Conclusions: Malignant eyelid tumors are a common finding in clinical ophthalmology. Surgery is still the treatment of choice at our institution, but immunotherapy with 5% imiquimod cream may be indicated for patients with multiple lesions or high surgical risk and for patients declining surgery for reasons of fear or esthetic concerns. The ability to estimate costs related to the treatment of malignant eyelid tumors is an important aid in the financial planning of health care institutions. Further studies should evaluate the possibility of institutions equating the cost of immunotherapy and surgical treatment by acquiring similar but less expensive medications.OBJETIVO: O objetivo deste estudo foi comparar os custos do tratamento clínico e cirúrgico para carcinoma basocelular palpebral. \ud MÉTODO: Neste estudo piloto, doze pacientes com carcinoma basocelular atendidos no departamento de Plástica Ocular do Hospital das Clínicas da Universidade de São Paulo (HC-FMUSP) foram tratados com imiquimode creme 5%. O Custo do tratamento clínico foi estimado baseado no tempo de tratamento e quantidade de medicação utilizada pelo paciente no domicilio. O custo do tratamento cirúrgico foi baseado na análise das imagens dos mesmos pacientes submetidos ao tratamento clínico, por Oftalmologistas experientes em cirurgia plástica reconstrutiva. Os profissionais responderam um questionário com quatro perguntas relacionadas à técnica cirúrgica, à quantidade de material gasto, ao tempo cirúrgico estimado e anestesia utilizada. \ud RESULTADOS: O tempo de tratamento clínico variou entre 8 a 12 semanas.Todos os pacientes referem que um sachê dura 3 dias e armazenaram na geladeira. O valor informado pela instituição na compra do imiquimode creme 5% foi de 40,00 reais/sachê, portanto o custo da caixa medicação foi de R$480,00 a caixa.A média de caixas consumidas por tratamento variou de 1,58 a 3,11 caixas, portanto o custo do tratamento clínico variou de R$ 758,40 a R$1.492,80. Os cirurgiões avaliaram as imagens dos pacientes submetidos ao tratamento clínico e informaram que o tempo estimado de cirurgia para cada paciente seria de 1 a 3 horas se a opção fosse cirúrgica.Foi estimado um custo de centro cirúrgico, incluindo espaço físico e pessoal de R$ 263,00 ao qual foi acrescido o valor do material que seria utilizado.Assim, observou-se que o valor variou entre R$272,61 a R$ 864,82 para o tratamento cirúrgico. O tratamento clínico em média foi de 57,64% superior ao tratamento cirúrgico. \ud CONCLUSÃO: As lesões palpebrais malignas são responsáveis por uma porção importante na prática clínica oftalmológica. A cirurgia continua sendo o padrão ouro em nossa instituição, porém casos em que a cirurgia não é uma opção, como pacientes com alto risco cirúrgico, aqueles com múltiplas lesões ou que se negam a cirurgia, seja por fobia ou motivo estético, podemos lançar mão de terapias alternativas como a imunoterapia com o imiquimode creme 5%. Conhecer a estimativa dos custos relacionados ao tratamento dessa patologia é fundamental para o planejamento financeiro das instituições. A instituição com a possibilidade de aquisição de uma mesma medicação com valor mais acessível permitiria equilibrar o custo do tratamento clínico com o cirúrgico e deverão ser avaliados em trabalhos futurosApoio do CNPq [480144/2008-7

Liga de Prevenção à Cegueira – 29 anos de ensino, pesquisa e assistência em oftalmologia

Uma parcela significante das doenças sistêmicas mais prevalentes em nosso meio vem acompanhada de acometimento ocular e muitas doenças oftalmológicas exigem atendimento imediato e cuidados específicos para evitar-se a cegueira. O curso de Oftalmologia da graduação abrange os temas essenciais à adequada formação do médico generalista, porém carece de treinamento prático e cirúrgico. A fim de suprir tal deficiência, a Liga de Prevenção à Cegueira foi fundada em 1985 como alternativa para aprofundar os conhecimentos na área, aproximar-se da prática oftalmológica e atender indagações profissionais futuras. [...

GEODIVULGAR: Geología y Sociedad

Fac. de Ciencias GeológicasFALSEsubmitte