Knowledge In Ophthalmology Research Articles

Direct ophthalmoscopy should be taught to undergraduate medical students--No.

Experienced physicians using the direct ophthalmoscope lack confidence and often fail to notice important abnormalities.1, 2, 3 Missed or delayed detection of ophthalmic signs can result in harm to patients: undetected disc swelling could lead to loss of vision from persistently raised intracranial pressure; an undiagnosed retinal artery occlusion could prevent potentially life-saving risk factor modification in a patient at risk of stroke; failure to spot Roth spots could delay the diagnosis of bacterial endocarditis. Ophthalmology—but not direct ophthalmoscopy—is an essential part of undergraduate medical education. The diagnosis of many systemic conditions can be made or assisted by the identification of ophthalmic features, and knowledge of ophthalmology in relation to acute medical and surgical problems in invaluable for any doctor. However, these signs must first be detected before they can be acted upon. The time spent in ophthalmology by undergraduate medical students in the UK is limited, with most students spending 5–10 days of their entire training in compulsory ophthalmology education,4 and trends across the developed world predict further reduction,5 so it is vitally important that these precious hours are used wisely to ensure tomorrow’s doctors are best equipped to serve their patients. Considering such time restraints, rather than struggling to wield a direct ophthalmoscope in busy clinics, further clinical teaching is more of a priority for the modern medical student, which would enhance their ability to interpret signs from fundus images that can be captured by other means.

Histological workup of enucleated eyes

The appraisal of enucleated eyes presents a particular challenge to pathologists. In German-speaking countries, this task has mostly been in the hands of ophthalmologists. It requires particular ophthalmologic knowledge including nosology, implants, surgical procedures, and nomenclature. This CME article teaches the basics needed for pathologic appraisal of enucleated eyes. The first part focusses on the macroscopic evaluation and describes the exterior and interior of the eye. Competent interpretation of the macroscopic findings is crucial to identify adequate cutting planes for histology. Anatomic landmarks on the globe's exterior and common section planes are described. Diseases that typically lead to enucleation will be explained in detail and illustrated with images. In the second part of this article, a histologic description of eye-specific tissue types is provided.

Standardized Training Examinations among Ophthalmology Residents and the American Board of Ophthalmology Written Qualifying Examination First Attempt: The Morsani College of Medicine Experience

Purpose The aim of the study is to demonstrate whether resident performance on the United States Medical Licensing Exam (USMLE) Step 1 and the Ophthalmology Knowledge Assessment Program (OKAP) correlates to American Board of Ophthalmology Written Qualifying Examination (ABO-WQE). Design This is a retrospective cohort study. Participants Forty-one residents who completed their postgraduate training between 1999 and 2011 from our institution were included in the study. Methods Percentiles on the USMLE Step 1, OKAP, and ABO-WQE first attempt were recorded and analyzed for possible correlations among scores across examinations using Pearson rank correlation, chi-square analysis, Fisher exact test, and Student t-test. Results The percentile score on the USMLE Step 1 was the only standardized test that had a statistically significant association with the percentile score on the ABO-WQE (Pearson rank coefficient = 0.45, p = 0.01). Not achieving a score of 20th percentile on the OKAP examination among second-year residents had the highest statistical association with failing the ABO-WQE on first attempt (p = 0.001) with an odds ratio of 20.4, and the relative risk of failing the ABO-WQE was 11.3; however, the relative risk of passing if the cutoff was achieved was only 1.8, and a positive predictive value for failing the ABO-WQE on first attempt of 0.47. Conclusions Percentile scores on the OKAP are not indicative of percentile scores on the ABO-WQE. While OKAP examinations in the second and third year appear to separate out residents at risk of failing the ABO-WQE, there is a large disparity between the risk of passing and failing which is likely due to the inadequate prognostic value of the test. It is likely OKAP examinations may be a useful tool to identify residents who are at low risk for failing the ABO-WQE on first attempt, but much less useful for identifying residents who are at high risk for failing the ABO-WQE.

European Board of Ophthalmology new subspecialty diploma; example: glaucoma surgery

AbstractThe main goal of the European Board of Ophthalmology is promoting education in Ophthalmology and harmonizing medical care in the field of Ophthalmology in European countries. The current EBO diploma ensures a minimum standard of knowledge in general Ophthalmology and is actually attended by a growing number of candidates, reaching in 2014 more than 500 from 28 countries. As there is a growing interest and real need for subspecialty training in different fields, the EBO is currently creating, with the help of European specialist societies , a sub‐specialty exam in order to award Ophthalmologists who complete sub‐specialty training and pass the exam with a formal recognition of their expertise by a Diploma. The aim is also to protect Sub‐Specialists and for the benefit of our patients in general, by inviting interested colleagues to obtain a distinction as a proof of excellence. During this course the example of the EBO‐Glaucoma Subspecialty exam with particular emphasis on surgical training, will be discussed.

On Textual and Contextual Position of The Ophthalmological Treatise of Bodhisattva Nagarjuna

Medical knowledge in India began to be introduced to China in earliest from the Later Han Dynasty period to the times of Wei-Qin and South & North Dynasties. This is proved by many Buddhist medical books appeared in those days. Of the contents of Indian medicine, the theory of four major elements affected Chinese medicine more than did the theory of body fluids. Based on the theory of four major elements that was began to be introduced in Fú shuō fú yī jīng, an attempt to establish a new medical system was made in Zhŏu hòu băi yīfāng written by Táo Hóng-jĭng and Sūn Sī-miăo who tried to develop etiology further but could not achieve any great outcomes. Unlike the foregoing situation, Indian medicine aroused a large echo in China in the field of ophthalmology with ophthalmological knowledge mentioned in Suśrutasa hitā and 'Jīnzhēn-shù'(cataract couching) introduced as a surgical treatment of cataract. The Suśrutasa hitā which is one of the three major texts of Indian medicine contains additional information on surgical operations not introduced in the Carakasa hitā. The technique of cataract surgery was particularly popular in the Tang and Song dynasty periods in China under the name Lóng shù pú sà yăn lùn(The Ophthalmological Treatise of Bodhisattva Nāgārjuna) or Lóng shù lùn and was even designated as a subject to educate medical officers. While the original text of Lóng shù pú sà yăn lùn was not handed down, the first testimony that show the trace of the introduction of this text into China was the Tiān zhú jīng lùn yăn mentioned in Wài tái mì yào(Arcane Essential from the Imperial Library) written by Wang Tao. Long shàng dào ren who was mentioned as the compiler of the book is assumed to be Lóng shù. Although Tiān zhú jīng lùn yăn introduced anatomical knowledge about the eyeball that could have not been in the traditional Chinese medicine, this book has only limited quantity of information in this regard. Thereafter, Tài píng shèng huì fāng (Holy Prescriptions for Universal Relief) compiled by a national agency at the beginning of the Song Dynasty period introduced Lóng shù pú sà yăn lùn without clear indication of the reference. Contemporary with this book, many ophthalmological books such as Mì chuán yăn kē lóng mù lùn(Longmu's Ophthalmology Secretly Handed Down) were published. As Chinese culture was spreading out into surrounding countries, medical knowledge was also introduced to Korean peninsula and Japan. The ophthalmological knowledge contained in Lóng shù pú sà yăn lùn was also reflected and some parts of it were introduced in I shin bō in Japan. Based on the policy decision of King Sejong, the fourth king of Joseon Dynasty, large scaled promoting projects of medical knowledge was established. It is notable that the Ui bang ryu chwi compiled as a result of the synthesis of the medical treatises available at that time initiated by King Sejong contained a considerable part of Lóng shù pú sà yăn lùn in reedited form that had already passed into oblivion in China. The intellectuals in Joseon Dynasty who participated in the compilation of Ui bang ryu chwi not only indicated that Lóng shù pú sà yăn lùn was a medical text published in the times of Wei-Qin and South & North Dynasties in China but also clearly indicated the textual reference and left the original text for later generation without modifying the contents. According to the Ui bang ryu chwi, the Lóng shù pú sà yăn lùn indicated that the core causes of eye diseases were heat, winds, and three body fluids(trido a) and contained the analyses of symptoms, related treatments, and several analyses of wrong treatments. In addition, Lóng shù pú sà yăn lùn explained diverse eye diseases through more than 30 medical treatments. In particular, this book accurately described golden needle acupuncture for treatment of a Nèi-zhàng understood to be cataract. Therefore, this book is a significant textual record in the history of ophthalmological medicine in East Asia. Along with the golden needle acupuncture which is a method of removing the crystalline lens in which white turbidity occurred by stabbing the eyeball with a needle, traces of Indian medicine that had been already lost in China were clearly indicated in Lóng shù pú sà yăn lùn kept in the Ui bang ryu chwi. In particular, the book indicates that the eyes were directly correlated with the brain and that to treat the internal disorder, treating the brain that lost stability due to heat and bodily wind was indispensable; these are the traces of Indian influence. This textual source demonstrates a case of knowledge exchange in field of medicine with concrete cases of the encounter and clash between the standpoints of understanding human body.

Red Eye: Next Steps for Conducting Research in Knowledge, Attitude and Practice in Ophthalmology

Background: Research in Knowledge, Attitude and Practice (KAP) in health sciences is relevant to health care providers and patients to identify factors to address educational interventions. Methods: A pilot study based on surveys amongst participants in a medical update conference in Cali, Colombia, was conducted to estimate participants’ knowledge on red eye in 2011. Results: The population was composed of medical students and general practitioners, with 72.7% of students being in their final year of their training. The classification of red eye was correct in 47% of respondents and we found errors in the classification of emergency, glaucoma and uveitis.Conclusions: Further research proposals in KAP are required for the recognition of this medical education indicator.

Eye problems on expeditions

Visual loss in the wilderness setting is at best disabling and at worst potentially fatal. However many physicians have a poor knowledge of ophthalmology and the basic skills that could be applied in situations away from definitive care. This paper is intended for physicians, interested non-medical people and expedition operators as a practical guide to the treatment and prevention of eye problems on expeditions. Some of the eye conditions described in this paper are unique to the high altitude setting, such as high altitude retinopathy and some could happen in any environment, such as trauma, dry eyes and contact lens problems. As with any aspect of an expedition, preparation is vital to prevent and avoid eye problems. It is therefore important that pre-existing ocular conditions are known about and appropriate drugs and equipment are available in expedition first aid kits. In the event of a visual problem, it is always better to be cautious and evacuate a patient rather than a risk a sight-threatening complication. However this paper should provide a non-ophthalmologist with the skills to treat the eye conditions described.

COA examination review course

To improve patient care by ensuring that ophthalmic technical personnel have the basic knowledge of ophthalmology needed to provide patients with the best possible care. This workshop provides an overview of the examination topics for the Certified Ophthalmic Assistant (COA) examination. Ophthalmic technical personnel with work experience in ophthalmology who have been preparing for certification and have a basic understanding of the anatomy and physiology of the eye. The majority of ophthalmic technical personnel are trained on the job. For those who are not certified, there is no standardization of ophthalmic knowledge or skills. It is difficult to evaluate the effectiveness of informal training and this can lead to gaps in understanding by the eye care assistant rendering their care inefficient and less satisfactory. Ophthalmic technical personnel should have a standardized understanding of the basics of ophthalmology and the skills necessary to take appropriate care of the ophthalmology patient. After completing the workshop, the technical personnel should be able to demonstrate knowledge and understanding of the content areas of the COA examination. After completing the workshop, the technical personnel should be able to demonstrate knowledge and understanding of the content areas of the COA examination. A review of COA content topics to include medical terminology, anatomy and physiology, history taking, patient services, basic skills, lensometry, basic tonometry, instrument maintenance, and general medical knowledge.

Cats: a gold mine for ophthalmology.

Over 200 hereditary diseases have been identified and reported in the cat, several of which affect the eye, with homology to human hereditary disease. Compared with traditional murine models, the cat demonstrates more features in common with humans, including many anatomic and physiologic similarities, longer life span, increased size, and a genetically more heterogeneous background. The development of genomic resources in the cat has facilitated mapping and further characterization of feline models. During recent years, the wealth of knowledge in feline ophthalmology and neurophysiology has been extended to include new diseases of significant interest for comparative ophthalmology. This makes the cat an extremely valuable animal species to utilize for further research into disease processes affecting both cats and humans. This is especially true in the advancement and study of new treatment regimens and for extended therapeutic trials. Groups of feline eye diseases reviewed in the following are lysosomal storage disorders, congenital glaucoma, and neuroretinal degenerations. Each has important implications for human ophthalmic research.

Die „Akiurgischen Abbildungen“ von Ernst Blasius (1802–1875)

The work ”Akiurgische Abbildungen” (surgical illustrations) by the surgeon Ernst Blasius from Halle compiles the surgical equipment of the nineteenth century in a unique guide. Not only does it illustrate the enormous number of more than 3,000 instruments, it also impresses with its accuracy. Additionally, each instrument is explained in detail by indications and function.During the 33 years in his position as the Chair of surgery at the Friedrichs University in Halle, Blasius left behind an amazing life’s work and also trained many subsequently famous doctors. He collected the surgical and ophthalmological knowledge of his time in several textbooks. Especially their aspects concerning vascular surgery are emphasized in part II of this article.Derived from the ligature of arteries, operations on blood vessels as described by Blasius were performed in almost all topographies of the human body. However, they were carried out more or less close to the body surface. Established in France and England these operations had been utilized for almost 100 years before Blasius’ time and hence originate from a period prior to narcosis. It is thus surprising that Blasius delivers no more information about the development of vascular surgery after the introduction of narcosis.

Ocular Disorders Due to Eyelash Extensions

Eyelash extensions are a beauty treatment in which individual synthetic extensions are applied, lash by lash, to natural eyelashes. The procedure is becoming popular worldwide because they seem more natural and last longer than other types of false eyelashes. However, partly because a bonding agent (glue) containing organic substances is applied near the eyes, consultations with ophthalmologic clinics and the National Consumer Affairs Center of Japan have increased annually. In the present study, we investigated eye disorders due to eyelash extensions. Ocular disorders were retrospectively investigated in 107 women (age 21-52 years) who visited ophthalmologic clinics in Japan with complaints of eye symptoms resulting from eyelash extensions between March 2007 and March 2010. The patients had no history of eye diseases. Of the patients 42 were 21 to 29 years of age, 44 were 30 to 39 years, 19 were 40 to 49 years, and 2 were 50 to 60 years. Three glues, the ingredients of which are not disclosed, were chemically analyzed for detection of more than 70 substances suspected to be ingredients. The ocular disorders due to eyelash extensions included keratoconjunctivitis due to invasion of glue or removing agents in 64 patients, allergic blepharitis due to glues in 42 patients (4 of these patients developed both keratoconjunctivitis and allergic blepharitis), conjunctival erosion due to eyelid-fixing tapes in 3 patients, allergic blepharitis due to eyelid-fixing tapes in 1 patient, and subconjunctival hemorrhage due to compression during removal of extensions in 1 patient. In all 107 patients, the symptoms were resolved by adequate treatments with eye drops and/or ointments. Ingredient analysis detected formaldehyde in concentrations above the standard threshold level in all 3 glues. In addition, lead and benzoic acid were also detected; however, concentrations of these particular compounds were low and therefore unlikely to cause disorders in humans. Eyelash extension procedures may cause ocular disorders, such as keratoconjunctivitis and allergic blepharitis; indeed, all glues for eyelash extensions analyzed in the present study contained formaldehyde, which can cause keratoconjunctivitis. From the viewpoint of hygienics, it is necessary to disinfect devices, provide handling instructions for organic solvents, improve glue ingredients, and improve the ophthalmologic knowledge of the practitioners.

Assessing the knowledge and skills in clinical ophthalmology of medical interns: survey results from enugu, South-eastern Nigeria.

Purpose:To compare the skills and knowledge of clinical ophthalmology among medical interns in Enugu, Nigeria, to the recommendations of the International Council of Ophthalmology (ICO).Materials and Methods:A questionnaire-based cross-sectional survey was conducted of Medical Interns attending the University of Nigeria Teaching Hospital and Enugu State University Teaching Hospital, from April 2010 to June 2010. Data on cohort demographics, undergraduate ophthalmology exposure, clinical skills and diagnostic competencies were collected and analyzed. Statistical significance was indicated by P < 0.05.Results:The cohort comprised 81 males and 48 females (sex ratio = 1.7 : 1), aged 21–35 years (mean: 26.8 ± 2.4 years). The gender difference was significant (P < 0.05). The response rate was 88.7%. The duration of undergraduate ophthalmology exposure ranged from 1 to 4 weeks. Exposure was often adequate in cornea/external eye (95.3%), lens/cataract (95.3%) and glaucoma (92.2%); but not in vitreo-retinal disease (47.3%), neuro-ophthalmology (45.7%) and refractive surgery (0.0). The majority were competent at visual acuity testing (97.7%) and visual field examination (93.0%). There was lower competency at anterior chamber assessment (49.6%) and slit-lamp examination (39.5%). The majority could confidently diagnose conjunctivitis (96.1%) and cataract (90.7%), but not strabismus (42.6%) or macular degeneration (20.2%).Conclusions:Medical interns in Enugu displayed gaps in their undergraduate ophthalmology exposure, clinical knowledge and skills. This has implications for stakeholders in medical education and eye care delivery. Review of the curriculum, provision of training resources and compliance with ICO guidelines could address the deficiencies.

Training of an ophthalmologist in concepts and practice of community eye health

Training in community eye health (CEH; public health applied to ophthalmology) complements clinical ophthalmology knowledge and enhances the physician's ability to meet the needs at the individual and community level in the context of VISION 2020. The upcoming version of the ophthalmological residency curriculum that was developed by the International Council of Ophthalmology (ICO) includes a new, specific section on CEH. It has basic, standard, advanced and very advanced levels of goals (the last one is exclusively for fellows/master students), and provides a public health approach to the main causes of blindness and low vision. The number of individuals aged ≥60 years is increasing twice as fast as the number of ophthalmologists, and as this age group is more likely to become blind/visually impaired, accessibility to eye care in the near future might be suboptimal even in wealthier countries. In order to achieve VISION 2020 goals, it is necessary to train more ophthalmologists and other eye care workers. However, the adoption of CEH component of the ICO curriculum for ophthalmology residents will enable them to meet local needs for eye care.

Rating Visual System Impairment using the Sixth Edition: Technical Aspects

Abstract Use of The Visual System section of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, requires knowledge and skills in ophthalmology and assessing impairment. Visual acuity usually is measured using symbols (letters, numbers, pictures, or other symbols) presented in a letter chart format. The Visual Acuity Scale (VAS) is a linear scale with fixed increments and provides a reasonable estimate of acuity-related visual abilities; the associated impairment rating is a reasonable estimate of acuity-related performance loss. This article shows how to perform visual acuity calculations and how to assess impairment of visual fields, including visual field test procedures and calculations. Additional factors can lead to a loss of functional vision and can limit the individual's ability to perform activities of daily living and include contrast sensitivity, glare sensitivity, color vision defects, and binocularity, stereopsis, suppression, and diplopia. If functional vision is affected and is not accounted for by visual acuity or visual field loss, the impairment rating of the visual system can be adjusted but should be limited to an increase of the impairment rating of the visual system by, at most, 15 points (ie, less severe than the total loss of one eye). The ability to rate visual impairment requires significant knowledge and education, and therefore a physician trained in ophthalmology should perform the visual examination and visual system impairment rating.

Reproducibility of Anterior Chamber Angle Measurements with Anterior Segment Optical Coherence Tomography

To study the reproducibility and variability of iridocorneal angle (ICA) measurements by using anterior segment optical coherence tomography (AS-OCT) by expert and nonexpert observers.Twenty-three healthy volunteers (nonexperts with a basic knowledge of ophthalmology) acquired five consecutive AS-OCT images in the enhanced anterior segment single mode in the 180° to 0° meridian of the right eyes of their peers. Two experts and the 23 nonexperts analyzed the images. The ICA software tool was used to determine the angle opening distance (AOD) and the trabecular iris surface area (TISA) at 500 and 750 μm. A random intercept model was fitted to evaluate the variability of acquiring an image. For both the experts and the nonexperts, inter- and intraobserver variability of analyzing an AS-OCT image was determined with the coefficient of variation (CV). Reproducibility was qualified by using the intraclass correlation coefficient (ICC).There was no statistically significant difference in the variability of acquiring an image. The range of intraobserver variability in image analysis was from 9.4% to 12.5% in the experts and from 4.2% to 17.4% in the nonexperts. Interobserver variability was 10.7% in the experts and 10.2% in the nonexperts. The reproducibility was high, 0.875 and 0.942 in the experts and 0.906 in the nonexperts.The overall reproducibility of the ICA measurements with the AS-OCT is good in open angles. Inter- and intraobserver variability showed similar mean values of reproducibility between the experts and nonexperts. The wide range of intraobserver variation in the nonexperts suggests that this group should undergo extensive instruction before routinely analyzing AS-OCT images.

Avaliação dos conhecimentos oftalmológicos básicos em estudantes de Medicina da Universidade Federal do Piauí

PURPOSE: To evaluate the Piaui Federal University graduating medical students’ knowledge in basic ophthalmology, in order to promote curricular changes in this course. METHODS: Students that had already passed the ophthalmology course were asked to answer a standard questionnaire containing 10 multiple choice questions about some ophthalmology topics considered important in the general Doctor’s graduation, such as blinding prevention and ophthalmic emergencies. The students were also asked if they would feel secure and comfortable if they had to manage an [...]

Edinburgh FOCUS course: foundation course in ophthalmology

Eyes tend to be a mystery to many non-specialists, particularly given the minimal exposure to ophthalmology at medical school. Eye problems are common, however, and a basic knowledge of ophthalmology is useful in many settings. This course aims to give a practical introduction to the assessment and management of common eye problems. The course is aimed primarily at doctors preparing for their first job in ophthalmology, but it is useful for all non-specialists who deal with eye problems on a regular basis. The course I attended had a good mix of accident and emergency doctors, general practice trainees, …

An analysis of undergraduate ophthalmology training in Canada

Objective: To investigate the adequacy of undergraduate ophthalmology education in Canada in comparison with the International Council of Ophthalmology (ICO) guidelines. Design: Cross-sectional survey. Participants: First-year residents who had graduated from Canadian medical schools. Methods: Eligible residents were invited to participate in an online survey in 2007. Data were categorized by demographic variables, and basic statistics were done. Results: Responses were obtained from 386 of the 1425 individuals (27.0%) contacted. The majority (64.0%) stated they had “too little” or “no exposure” to ophthalmology in medical school. The majority (76.2%) of respondents stated that they had had 1 week or less of overall exposure to ophthalmology. Sufficient exposure to several ICO core subspecialty areas was reported, including lens/cataract (81.1%) and cornea/external diseases (81.6%); however, some areas did not receive adequate time allocation, such as vitreoretinal disease (41.9%). Similarly, competency was obtained in certain ICO examination skills, including assessment of visual acuity (83.3%) and pupillary reflexes (90.7%) but was not achieved for other skills, such as fundoscopy (52.3%), slit-lamp examination (44.8%), and intraocular pressure assessment (19.9%). When asked whether sufficient ophthalmology knowledge and skills had been obtained during medical school, only 42.9% and 25.9% agreed, respectively. Conclusions: Undergraduate ophthalmology training in Canada contains gaps in certain key areas. Developing a national, standardized curriculum could ensure that medical students acquire competency in the ophthalmology knowledge and skills required for future clinical practice.

This issue of Acta

This issue of Acta is dominated by paediatric ophthalmology. The cover illustrations show fundus photographs and optical coherence tomography (OCT) images from a girl with 3-hydroxyacyl-CoA dehydrogenase deficiency as reported by Teär Fahnehjelm et al. in this issue. Teär Fahnehjelm discusses the role of paediatric ophthalmologists and their interaction with paediatricians. The second editorial is the yearly report by the Editor in Chief on the state of the journal. Berker & Batman, in Ankara, review several approaches to the surgical treatment of central retinal vein occlusion. Teär Fahnehjelm et al., in Stockholm, found dry eye to be common in children treated with stem-cell transplantation, particularly in patients treated with high levels of cyclosporine A. These children need intensive ophthalmological care. Lindqvist et al., in Trondheim, found that children born prematurely with very low birth weight are at risk for poor binocular function and eye movement in adolescence, whereas this does not apply to very low birth weight children who are born at term. Lavezzo et al., in São Paulo, found that newborn babies blink their eyes slower and less frequently than 4–6-year-old children. Uretmen et al., in Turkey, report that accommodative esotropia developed in 50% of children who underwent surgical treatment for presumed infantile esotropia. Teär Fahnehjelm et al., in Sweden, describe the ocular characteristics of a group of children with 3-hydroxyacyl-CoA dehydrogenase deficiency with variable degrees of chorioretinal pathology and visual impairment. Soliman et al., in Copenhagen and Egypt, propose that OCT analysis can predict the visual outcome 1 month following laser photocoagulation for diffused diabetic macular oedema. Maca et al., in Vienna, used the retinal thickness analyser to demonstrate that cystoid macular oedema is common in children with uveitis – even some with good visual acuity. Mahdizadeh et al., in Iran, found that retinal cryopexy did not benefit the anatomical reattachment rate from scleral buckling surgery. Donati et al., in Geneva, found that both necrosis and apoptosis are involved in neuronal cell death following experimental retinal vein occlusion in pigs. Krøyer et al., in Copenhagen, described the effect of acute retinal pigment epithelial loss, which destroyed scotopic but not photopic retinal function in a 68-year-old woman. Bertschinger et al., in Geneva, used the Vryghem macular function test and found this to be reliable in predicting postoperative visual acuity after cataract surgery. Cillino et al., in Italy, found Gore-Tex® implants to be useful adjuvants in glaucoma filtration surgery. Yoeruek et al., in Tübingen, used Avastin® eyedrops to reduce corneal damage and neovascularization following experimental chemical burns to the cornea. Al-Jamal & Kivelä describe an optic nerve tumour leading to progressive visual loss in a young man. I hope that this issue of Acta offers an opportunity to brush up on our knowledge in paediatric ophthalmology and provides educational opportunities in all subspecialties of ophthalmology.

Genetic syndromes in deaf patients with mental health problems

At the mental Health Unit for the Deaf of the Gregorio Maranon Hospital in Madrid we have observed that our Deaf patients as a group experience a greater number of Genetic Syndromes than the general population. Clinical diagnosis and intervention of deaf patients is particularly complex, professionals that work with this population must update their knowledge in ORL, Nephrology and Ophthalmology. Our goal is to show how common are these syndromes among our patients treated at our unit from 2003 and describe their psychopathology. Most common genetics syndromes among our patients are Usher syndrome, Waardenburg, syndrome, Noonan syndrome, Cornelia de Lange syndrome and Pendred syndrome. The Gregorio Maranon Hospital in Madrid is one of the few mental health units for deaf people in Europe -that is, the Unidad de Salud Mental para Sordos (USMS). This unique service counts with a psychiatrists, a psychologist and a social worker.