Skills and habits of young ophthalmologists in the diagnostics of glaucoma

Abstract

Introduction: Globally, glaucoma is the second leading cause of blindness. The diagnosis of the disease, especially at an early stage, is often an occupational challenge for young ophthalmologists. Adequate diagnostics requires a comprehensive ophthalmologic examination that is related to a broad range of knowledge, skills and various high-tech devices. Bulgarian scientific literature does not offer information about the currently used methods for treatment and diagnosis by residents and young ophthalmologists; there is also no detailed information about the difficulties that ophthalmologists experience in the management of the disease. Aim: The main goal of this study is to provide information about the methods used for the management of glaucoma by residents and young ophthalmologists in Bulgaria, as well as data on the potential difficulties and problems that may reduce the quality of health care. Methods: Detailed anonymous questionnaires about workplace, used equipment, methods of investigation, potential weaknesses in the diagnosis and management of the disease, as well as personal attitude towards the problems in the field, were sent to residents and young ophthalmologists with experience of up to 5 years by e-mail and with the help of social networks. Results: One hundred and twenty questionnaires were sent but only 45 individuals responded to the survey. Of these, 30 were classified as residents (66.7%) and 15 as specialists with up to 5 years of experience (33.3%). Regarding the number of glaucoma patients examined, 27 of the participants (60.0%) indicated that they have examined under 5 patients who suffer from glaucoma or are suspected of glaucoma, 14 (31.1%) under 10 and only four (8.9%) managed less than 20 glaucoma patients per day. Thirty-four of the participants (75.6%) mentioned air tonometry as the main method in their practice. Eleven percent of the participants never performed gonioscopy, and 4.4% had tried but failed. Only 11 (24.4%) of the participants said they had no difficulty performing gonioscopy. A preferred method of determining the depth of the anterior chamber was Van Herick's method (51.1%). Regarding perimetry, 43 (95.6%) of the participants always required the presence of a glaucoma diagnosis, and 39 (86.7%) reported that they always performed a visual examination to evaluate the optic nerve and the neurofibrillary layer. Fifteen respondents (33.3%) (of them 12 residents) never assisted in an anti-glaucoma operation. Thirty-eight (84.4%) of the participants found a need for more trainings and seminars on glaucoma. Conclusion: Diagnosis of glaucoma is a challenge for doctors as well as for patients. Identifying potential weak spots among ophthalmology residents and young professionals and obtaining sufficient feedback is essential to improve the proper management of the disease nationwide.