Nonophthalmologist Physicians Research Articles

The output of cataract surgery performed by trained non-ophthalmologist physicians in rural areas: study of cataract outcomes and up-take of services report 7.

Cataract is the leading cause of blindness worldwide and surgery can restore vision in most patients. Some patients have little access to surgical services due to lack of cataract surgeons and the unaffordable costs. In 2005 we built a service model that trained rural non-ophthalmologist physicians to perform cataract surgeries in rural China. This study evaluates the long-term impacts of this model. We conducted a retrospective cohort study to analyze patients' hand-written medical records and electronic outpatient record between January 2005 and December 2019 at two rural health clinics in Southern China. In total, 34,601 patients (49,942 eyes) underwent cataract surgery by non-ophthalmologist physicians from 2005 to 2019.Visual acuity was clearly documented in 38,251 eyes. Before surgery, the unaided distance visual acuity (UDVA) of 60.7% (23,205/38,251) eyes was less than 0.05 decimal. On the first day after surgery, the percentage of UDVA < 0.05 eyes was reduced to 6.0%, and 96.7% (36,980/38,251) of the eyes achieved a better UDVA compared to pre-operation. Surgical-related complications occurred in 218 eyes. The most common complication was posterior capsule rupture (114, 0.23%). 44.3% (15,341/34,601) of the patients chose to have a second eye cataract surgery (SECS) in the same clinic. At one of the outpatient clinics, 21,595 patients received basic eye care apart from cataract surgery between 2018 and 2020. Non-ophthalmologist physicians trained for cataract surgeries in rural clinics can improve cataract related visual acuity and basic eye care to the local population.

Development of a standardized Canadian undergraduate medical education ophthalmology curriculum

ObjectiveTo create a standardized undergraduate medicine ophthalmology curriculum for Canadian medical schools. DesignTwo-stage modified Delphi technique. ParticipantsUndergraduate ophthalmology leads at all the medical schools in Canada and 6 nonophthalmologist physicians with medical education expertise. MethodsIn stage 1, a preliminary list of curricular objectives was developed using the 2018 Association of University Professors in Ophthalmology's list of curricular objectives as a foundation. Subsequently, an online survey was sent to 24 individuals (18 ophthalmology undergraduate curriculum leads and 6 non-ophthalmology medical educators) at 17 institutions to evaluate the objectives using a 5-point Likert-type scale. In stage 2, the ophthalmology curriculum leads were invited to participate in a virtual meeting during which the list of curricular objectives was discussed and finalized by consensus. ResultsIn stage 1, a preliminary list of 76 learning objectives organized into 10 overarching topics was developed. A total of 21 survey responses were received (87.5% response rate), allowing for the creation of a revised list. In stage 2, five participants from four schools met, achieving consensus following one round of feedback. The final undergraduate ophthalmology curriculum contained 10 topics and 75 objectives; it covered common presentations of a variety of acute and chronic eye diseases that were felt to be relevant to a wide medical audience. ConclusionsThe consensus obtained on a comprehensive list of undergraduate medicine ophthalmology curricular objectives identified in this study is the first of its kind in Canada. These objectives can be used by medical schools across Canada to standardize undergraduate ophthalmology teaching.

The ocular manifestations in IBD screening (OMIS) questionnaire: pilot study on detection of ocular involvement in inflammatory bowel diseases

To assess the usefulness of a dedicated questionnaire for patients with inflammatory bowel diseases (IBD) treated with biological drugs for the detection of ocular extraintestinal manifestations (EIMs). IBD can cause extraintestinal symptoms including ocular complaints which are frequently ignored and may be associated with significant morbidity, including blindness. We developed a questionnaire, named Ocular Manifestations in IBD Screening (OMIS) questionnaire, after agreement between gastroenterologists and ophthalmologists. The questionnaire was administered by a non-ophthalmologist physician to 96 IBD patients treated with biological drugs. 35 patients (36.5%) were selected for the ophthalmologic examination on the basis of a positive screening test. Ocular EIMs were detected in 29 of 35 patients (83%). A specific questionnaire can be useful for non-ophthalmologist physicians in a real world setting in order to select patients to be addressed to an ophthalmological visit, creating an integrated multidisciplinary clinical team, to improve management of IBD in order to prevent disability and guarantee quality of life.

Identification of Optic Nerve Swelling Using Point-of-Care Ocular Ultrasound in Children.

The aim of this study was to determine the feasibility and accuracy of point-of-care (POC) ocular ultrasound (US) when performed by a pediatric emergency medicine (PEM) physician to detect optic nerve abnormalities concerning for swelling, as compared with the fundus examination performed by an ophthalmologist. This was a single-center, prospective cohort pilot study of children aged 12 months to 18 years who required optic disc evaluation by an ophthalmologist. Eligible subjects were enrolled from the emergency department, inpatient wards, and neuro-ophthalmology outpatient clinic of an urban, tertiary care children's hospital. Point-of-care ocular US, specifically assessing optic nerve sheath diameter and optic disc elevation, was performed. Findings on US were compared with findings identified by an ophthalmologist on dilated fundus examination. Seventy-six subjects were enrolled; 20 (26%) of 76 had findings concerning for optic nerve swelling diagnosed by an ophthalmologist on fundus examination. Using a sonographic definition for optic nerve swelling of optic nerve sheath diameter greater than 4.5 mm or the presence of optic disc elevation, the sensitivity and specificity were 90% and 55%, respectively. The success rate of POC ocular US was 100%, and the mean time to completion was 8 minutes. For emergency department subjects in whom direct fundus examination was attempted, the PEM physician could visualize the optic disc and assess for swelling in only 40% (14/35) of examinations. The results of our study suggest that POC ocular US performed by PEM physicians was feasible and determined to be sensitive but nonspecific in the detection of optic nerve swelling. Additional larger studies may determine generalizability to other nonophthalmologist physicians performing POC ocular US.

Frequency, comprehension and attitudes of physicians towards abbreviations in the medical record

AimsAbbreviations are common in the medical record. Their inappropriate use may ultimately lead to patient harm, yet little is known regarding the extent of their use and their comprehension. Our...

Ophthalmoscopy in the 21st century

Although the usefulness of viewing the ocular fundus is well-recognized, ophthalmoscopy is infrequently and poorly performed by most nonophthalmologist physicians, including neurologists. Barriers to the practice of ophthalmoscopy by nonophthalmologists include not only the technical difficulty related to direct ophthalmoscopy, but also lack of adequate training and discouragement by preceptors. Recent studies have shown that digital retinal fundus photographs with electronic transmission and remote interpretation of images by an ophthalmologist are an efficient and reliable way to allow examination of the ocular fundus in patients with systemic disorders such as diabetes mellitus. Ocular fundus photographs obtained without pharmacologic dilation of the pupil using nonmydriatic fundus cameras could be of great value in emergency departments (EDs) and neurologic settings. The Fundus Photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) study showed that ED providers consistently failed to correctly identify relevant ocular funduscopic findings using the direct ophthalmoscope, and that nonmydriatic fundus photography was an effective alternate way of providing access to the ocular fundus in the ED. Extrapolating these results to headache clinics, outpatient neurology clinics, and adult and pediatric primary care settings seems self-evident. As technology advances, nonmydriatic ocular fundus imaging systems will be of higher quality and more portable and affordable, thereby circumventing the need to master the use of the ophthalmoscope. Visualizing the ocular fundus is more important than the method used. Ocular fundus photography facilitates nonophthalmologists' performance of this essential part of the physical examination, thus helping to reestablish the value of doing so.

Drug-prescribing patterns among optometrists and nonophthalmologist physicians at a tertiary care centre in Kingston, Ontario

ObjectiveTo report on patterns of optometry prescribing and adherence to prescribing regulations at a tertiary care ophthalmology centre. DesignProspective cohort study. ParticipantsAll new referrals from optometrists and other health care professionals to the emergency eye care service (n = 1965) between July 2011 and June 2012, as well as optometry referrals to 2 subspecialty services (glaucoma [n = 71] and cornea [n = 212]). MethodsIn our primary analysis, the frequency of prescribing and classes of medications prescribed were reported and compared amongst various referral sources to the emergency eye care service. As a secondary analysis, we reported frequency of prescribing in optometry referrals to 2 subspecialty clinics. Adherence to prescribing guidelines was reported for all optometry referrals. ResultsOf 296 referrals from optometrists to the emergency eye care service, 20 (6.8%) had received a prescription medication; this was significantly less compared to emergency and family physicians (p < 0.001). Topical antibiotics were the most frequently prescribed medication class. The frequency of prescribing by optometrists was 5.2% (11/212) and 4.2% (3/71) for patients referred to the cornea and glaucoma services, respectively. Among those patients referred after being given a prescription for a glaucoma medication by an optometrist, 89% cases (8/9) did not adhere to prescribing regulations. ConclusionsAfter the introduction of prescribing privileges, optometrists prescribe a variety of medications in their practices. Current prescribing guidelines are not always followed in practice, suggesting that continued study and collaboration is necessary to create an optimal model of interdisciplinary care that provides access to the highest quality of care.

Retinopathy in patients with hipertension and/or diabetes in a family health unit

Objetivo: Identificar a prevalencia de alteracoes a oftalmoscopia direta em pacientes com diagnostico de hipertensao e/ou diabetes mellitus em uma Unidade de Saude da Familia (USF). Metodo: Estudo individual, observacional, prioritariamente descritivo, do tipo transversal, com amostra composta por coorte de 50 pacientes hipertensos e/ou diabeticos matriculados no programa HIPERDIA de uma Unidade de Saude Familiar (USF) do municipio de Ananindeua - Para, entre os meses de setembro e novembro de 2009. Resultados: Foi realizada oftalmoscopia em 46 pacientes. Observou-se alteracao a oftalmoscopia em 27 (58,7%). Ao realizar a analise especifica (excluindo-se os achados de estreitamento arteriolar e ingurgitamento venoso) houve alteracoes em 18 (39,1%), sendo 45,5% com DM e HAS, quarenta por cento com DM e 36% com HAS. Conclusao: A elevada prevalencia de alteracoes a oftalmoscopia encontradas no presente estudo demonstra sua eficacia como metodo de rastreio no contexto da atencao primaria a saude, justificando seu uso. Corrobora, ainda, a importância da atencao primaria a saude na prevencao da retinopatia hipertensiva e diabetica, atraves do controle periodico de pacientes de alto risco vascular como a populacao estudada.

Current surgical methods for advanced glaucoma

The author summarizes the most effective types of glaucoma surgery in advanced glaucoma. In high pressure advanced glaucoma a low target intraocular pressure is to be set. The most effective method of reaching this target pressure level is mitomycin C trabeculectomy combined with effective pre- and postoperative antiinflammatory treatment. However, in several cases glaucoma filtering surgery gradually fails due to increased episcleral fibrosis. In these cases use of long-tube glaucoma drainage devices is recommended. In Hungary use of the Ahmed implant has provided favourable clinical outcome even in the most complicated, high pressure, advanced glaucoma cases. Modern types of surgical treatment of advanced glaucoma need to be known by non-ophthalmologist physicians for more than a decade. This may help them to propose the optimal treatment modality to their glaucoma patients.

The Utility of Non-ophthalmologist Examination of Eyes at Risk for Serious Retinopathy of Prematurity

Background: Retinopathy of Prematurity (ROP) is the main cause of preventable blindness in premature babies. Currently, there is a shortage of trained ophthalmologists, which has resulted in an alarming increase in cases of vision loss and related complications. This study’s aim was to determine the utility of examinations conducted by non-ophthalmologist physicians to assess posterior pole vessel abnormalities in eyes at risk for ROP.Method: Non-ophthalmologist physicians (pediatrician and neonatologist) were trained to use an indirect ophthalmoscope to view the posterior pole of babies at risk for ROP. Examinations were conducted on both eyes of premature infants born before 35 weeks gestational age (GA) starting at the third week after birth and weekly thereafter. The presence of Plus disease was identified by the non-ophthalmologist and results compared to the clinical examination by a pediatric ophthalmologist experienced in ROP detection and treatment. Chi-square was used for proportions and the Mann Whitney U test for medians. Fagan’s nomogram was determined for diagnostic usability. The Kappa index was used to rate inter-observer agreement.Results: Results of 228 examinations performed on 150 premature infants were analyzed to determine the correlation of the non-ophthalmologist findings and the eye examination. For any vascular change in posterior pole diagnostic, findings were 87% and 87% accuracy for pediatrician and neonatologist, 82% and 83% sensitivity, 90% and 90% specificity respectively. There was no significant difference found in the detection of Plus disease for the examinations performed by the ophthalmologist compared to those performed by the non-ophthalmologist (P < 0.05).Conclusions: After training in the use of an indirect ophthalmoscope, non-ophthalmologist physicians can reliably detect posterior pole retinal vessel changes for ROP diagnosis.

Malarial retinopathy in northern Nigerian children

This is a prospective study involving two centres. Children younger than 16 years old who had severe malaria underwent funduscopy. In one centre, direct ophthalmoscopy was performed by both an ophthalmologist and a non-ophthalmologist physician. At the other, two ophthalmologists performed a funduscopy on each patient using different methods (one using direct and the other indirect ophthalmoscopy). The objective was to determine the frequency of retinopathy and evaluate the effectiveness of direct ophthalmoscopy in detecting retinopathy in constantly dilated eyes. Of 62 children seen at both centres, 37% were found to have malarial retinopathy. Macula whitening was the most common finding. There was substantial agreement between the ophthalmologists using either the direct or indirect ophthalmoscopy techniques (Kappa value 0.604). However, at the centre using only direct ophthalmoscopy, there was poor agreement between the ophthalmologist and the non-ophthalmologist (kappa value -0.244). Direct ophthalmoscopy seemed to be effective in detecting malarial retinopathy, but only when performed by experienced personnel.

Community-based transconjunctival marginal rotation for cicatricial trachoma in Indians from the Upper Rio Negro basin.

The objective of the present study was to describe, for the first time in Brazil, the use by a non-ophthalmologist of a community-based marginal rotation procedure by a posterior approach in the indigenous population from the Upper Rio Negro basin. Seventy-three upper eyelids of 46 Indians (11 males and 35 females) with cicatricial upper eyelid entropion and trichiasis were operated in the Indian communities using a marginal rotational procedure by a posterior approach by a non-ophthalmologist physician who had general surgery experience but only an extremely short period (one week) of ophthalmic training. Subjects were reevaluated 6 months after surgery. Results were classified according to the presence and location of residual trichiasis and symptoms were assessed according to a three-level subjective scale (better, worse or no change). Fifty-six eyelids (76.7%) were free from trichiasis, whereas residual trichiasis was observed in 17 eyelids (23.3%) of 10 subjects. In these cases, trichiasis was either lateral or medial to the central portion of the lid. Of these 10 patients, only 4 reported that the surgery did not improve the irritative symptoms. We conclude that marginal rotation by a posterior approach is an effective and simple procedure with few complications, even when performed by non-specialists. Due to its simplicity the posterior approach is an excellent option for community-based upper eyelid entropion surgery.

Long-Term Outcome of Patients Who Undergo Tonometry as Part of a General Physical Examination

To determine the value of including tonometry as part of a general physical examination. Between Feb. 14, 1977, and Dec. 31, 1980, 849 residents of Rochester, Minnesota, underwent measurement of intraocular pressure by trained ophthalmic technicians at the request of a nonophthalmologist physician as part of a general physical examination. In 1995 and 1996, these cases were reviewed to determine how many patients in this study cohort had subsequently been diagnosed as having glaucoma. The outcome was derived from the examination of medical records and from the responses to mailed questionnaires and telephone interviews with study patients and their physicians. In patients whose intraocular pressures were less than 16 mmHg at baseline, the risk of being diagnosed as having glaucoma within 10 years was 1% (95% confidence interval [CI], 0 to 2%) and within 15 years was 2% (95% CI, 0 to 4%). In patients whose pressure in the higher-pressure eye was 16 to 21 mmHg at baseline, the risk of having glaucoma in 10 years was 3% (95% CI, 2 to 5%) and in 15 years was 5% (95% CI, 3 to 7%). Twenty-four patients were found at baseline to have an intraocular pressure of 22 mmHg or higher in at least one eye or a difference of 5 mmHg or more between the two eyes. In this group, the risk of having glaucoma in 10 years was 17% (95% CI, 0 to 31%) and in 15 years was 26% (95% CI, 6 to 43%). When included as part of a general physical examination of older persons, tonometry and a few simple questions provide information that can be used to help the clinician determine the advisability of more detailed ophthalmic examinations.

Use of Eye Care Services among the 1991 Medicare Population

To determine the use of eye care services by type of provider (ophthalmologist, optometrist, and non-ophthalmologist physician) in the Medicare population. As a basis for characterizing eye conditions and ophthalmic services among a population 65 years of age and older, 1991 claims from a representative 5% sample of Medicare beneficiaries were analyzed using a previously described classification scheme. Analysis was specifically conducted by type of provider as well as by the service provided. Almost one half of the approximately 30 million Medicare beneficiaries 65 years of age or older received eye care services in 1991, resulting in more than 35,000,000 visits (claims). Ophthalmologists provided services to 71% of this eye care population, and optometrists to 22%; 36% of this population received ophthalmic-related services from other providers, and 14% from only other providers (commonly for eye lid dermatitis and tumors). Cataract was the most common condition, accounting for 41% of visits to ophthalmologists (and 1.2 million cases of surgery), glaucoma accounted for 19% of visits, and retinal diseases for 14%. The visit percentages for optometrists are 58%, 8%, and 11%, respectively. Ophthalmic examination and evaluation accounted for 63% of the 28,000,000 paid ophthalmologists' procedures, and 58% of the 5,500,000 optometrists' procedures. Optometrists and physicians other than ophthalmologists were the sole providers of ophthalmic-related services to a large percentage of beneficiaries who received eye care in 1991. Within the universe of service provided by ophthalmologists, the majority of all care consisted of evaluation and management services as opposed to surgical procedure-based care.

The Efficacy of a Multimedia Educational Campaign to Increase the Use of Eye Care Services

Effective eye care, both preventive and problem-directed, requires that patients actually see trained eye care providers. The authors examined the impact of a multimedia campaign on patient behavior in using eye care. The authors surveyed 2000 individuals 1 year after they mailed in a contrast sensitivity screening card during a focused multimedia educational campaign. The response rate was 39%, allowing precision of estimates to +/- 4%. Those who failed the screening test were much more likely to have had an eye examination in the year after the campaign and were much more likely to have seen an ophthalmologist for their care. Other important factors significantly related to using eye care services were: having had prior examinations, having a non-ophthalmologist physician, and having a history of cancer or macular degeneration. Importantly, 22% of those who failed the screening test thought they had had normal results when asked 1 year later. A focused multimedia campaign combined with interactive patient involvement can directly increase the use of eye care services. In addition, such care is much more likely to be delivered by ophthalmologist as opposed to other providers.

Prevalent Attitudes Regarding Residency Training in Ocular Anesthesia

To determine the current level of formal training in ocular anesthesia provided to nonophthalmologist physicians, the rationale for this training or lack thereof, and the perceived need for this training by anesthesia residency training programs. A two-page survey questionnaire was forwarded to all residency directors of ophthalmology and anesthesia training programs listed with the American Medical Association. A second mailing followed 2 months after the initial mailing if no response was received from a particular program. An overwhelming response of 92% of ophthalmology programs and 76% of anesthesiology programs was achieved. In 93% of ophthalmology programs and 77% of anesthesiology programs, no formal training was provided to nonophthalmologist physicians in retrobulbar or peribulbar anesthesia. In addition, 78% of ophthalmology and 65% of anesthesiology programs denied having any plans to provide this training even though 40% of the anesthesia departments wanted to initiate and coordinate such training. Currently, few ophthalmology programs offer formal training to anesthesiology residents in ocular anesthesia. Following are the predominant factors involved in this decision: (1) the operating surgeon is ultimately responsible for any complications; (2) there is a lack of knowledge of orbital anatomy and axial eye length by anesthesia personnel; and, most importantly, (3) there is a brief episodic nature in which anesthesia residents encounter ophthalmologic procedures resulting in minimal opportunities for training and experience from which the residency training program could ensure quality outcome and proper credentialling.

The Potential Role of Ophthalmology as an Entry Point to the Healthcare System

To evaluate whether patients who receive ophthalmic care have other physicians and whether ophthalmologists can serve as a significant entry point to the healthcare system. Two hundred fourteen patients at a tertiary care eye institute were surveyed regarding their non-ophthalmologist physicians. Demographic, medical, and other data also were collected through the survey. Twenty-eight percent of patients did not have a physician healthcare provider other than their ophthalmologist at their initial visit. Fifteen percent had no other physician, whereas 13% had one as a consequence of subsequent referral by the ophthalmologist. Even among those patients who were 40 years of age and older, 31% initially only had an ophthalmologist as their sole physician provider. Being older, female, and having Medicare, a Health Maintenance Organization membership, or private indemnity insurance were associated with a higher likelihood of having non-ophthalmologist physicians. These results suggest that a significant number of patients seeking eye care from an ophthalmologist have no other physician. These findings stress the need for eye care providers to have thorough medical education and clinical training. In addition, eye care may serve as a useful entry point into the healthcare system for a significant number of patients in the United States.

Improved Detection and Referral of Patients With Diabetic Retinopathy by Primary Care Physicians

We studied the effect of a 4-hour course in recognition and management of diabetic retinopathy on the ability of nonophthalmologist physicians to detect and to appropriately refer patients with sight-threatening diabetic retinopathy. Participants completed a written examination covering case management and performed a total of 340 dilated ophthalmoscopic examinations on selected patients before and 2 weeks following the teaching session. Accuracy of ophthalmoscopy was assessed by comparison with standardized grading of fundus photographs. Scores on the written examination increased from a mean of 49% to 78% correct. The likelihood of failing to detect and appropriately refer patients with proliferative or preproliferative retinopathy decreased from 60% to 15%. Similarly, for patients with maculopathy, the likelihood of failure to detect and to appropriately refer decreased from 83% to 15.6%. These data suggest that education may significantly improve the ability of nonophthalmologists to detect and to appropriately refer patients who are at risk for vision loss.

Clinical Ophthalmology: A Text and Colour Atlas

<i>Clinical Ophthalmology: A Text and Colour Atlas</i>is an introductory text primarily intended for the nonophthalmologist physician, medical student, and others looking for a short yet well-rounded overview of the specialty. While boasting numerous superb color photographs, however, this book is more than just an atlas. The ophthalmologic examination, symptom-related diagnosis, and common pathologic conditions affecting the eye are addressed in a succinctly written fashion. The book comprises 15 chapters. The first discusses the techniques and instrumentation used for the eye examination. Special attention is given to direct ophthalmoscopy. After brief chapters devoted to refractive errors, color vision defects, and aging changes in the eye, a well-illustrated review of eyelid conditions is presented. In this latter section, as throughout the book, the photographs are reproduced in an appealing and clearly illustrative manner. The subsequent chapters deal with the causes of epiphora and the red eye, briefly discussing both common and

Color Atlas of Ophthalmological Diagnosis

The author has updated his color atlas of the more common ophthalmologic diagnoses with new photographs and a text revision. He points out that it is intended for the busy family physician or medical student who needs to have a ready reference manual rather than wade through a major textbook. In this publication are assembled numerous excellent color photographs that are certainly superior to the black-and-white reproductions found in most eye textbooks. Mr Bedford disclaims any attempt at producing a textbook but does give a brief description and suggested treatment of each entity. He also nicely outlines the rudiments of the examination of the eye, with emphasis on the use of basic examining equipment. "Numerous excellent color photographs... superior to the blackand-white reproductions found in most eye textbooks." Photographs of the external diseases and injuries are of good quality and would be of obvious help to the nonophthalmologist physician. The