Private Ophthalmology Practice Research Articles

MicroPulse® Transscleral Laser Therapy (MP-TLT) in Patients with Glaucoma and Ocular Cicatricial Pemphigoid.

A non-comparative retrospective case-series study was performed on 6 patients (12 eyes) with a confirmed diagnosis of ocular cicatricial pemphigoid (OCP), treated with MicroPulse® Transscleral Laser Therapy (MP-TLT), between January 2018 and 2020, with a minimum follow-up of 2 years, in a private ophthalmology practice with offices in Argentina and Colombia. Mean age was 75±6.3 years (66-83yrs). The severity of OCP remained stable 2 years after MP-TLT. Baseline mean IOP was 19.5±5.9mmHg (13-30mmHg) and, 24 months after treatment, IOP decreased to a mean of 13.9±1.9mmHg (10-18mmHg). The mean IOP reduction was 25.1% (P: 0.002). The mean number of anti-glaucomatous drugs at baseline was 3.1±0.7, decreasing to 0.6±0.7, 2 years after MP-TLT (P<0.001). MP-TLT may be considered as a non-incisional approach to glaucoma care for patients with ocular surface diseases, prospective long term studies are needed.

Photodynamic therapy in Germany-Quo vadis?

Photodynamic therapy (PDT) was originally approved for the treatment of neovascular age-related macular degeneration (nAMD) and secondary choroidal neovascularization in myopia (mCNV). In addition, it is used as an off-label treatment in patients with choroidal hemangioma, polypoidal choroidal vasculopathy (PCV), and central serous chorioretinopathy (CSC). To track the development of PDT treatment numbers in Germany between 2006 and 2021 and to investigate the composition of the therapeutic indications. In this retrospective study the quality reports of German hospitals were evaluated in the period from 2006 to 2019 and the number of PDTs performed was recorded. In addition, the range of indications for PDT was determined exemplarily for the Eye Center at Medical Center, University of Freiburg and the Eye Center at St. Franziskus Hospital in Münster between 2006 and 2021. Finally, the estimated prevalence of CSC and an estimate of cases requiring treatment were used to calculate the number of patients in need of PDT treatment in Germany. The number of PDTs performed in Germany decreased from 1072 in 2006 to 202 in 2019. While PDT was used in 86% of cases in patients with nAMD and in 7% of cases with mCNV in 2006, it was mainly performed in patients with CSC (70%) and choroidal hemangiomas (21%) from 2016 to 2021. With an estimated incidence of CSC of 1:10,000 and assuming that 16% of patients develop chronic CCS requiring treatment, approximately 1330 PDTs would need to be performed per year in Germany for patients with newly diagnosed chronic CSC alone. The decreasing numbers of PDT treatment performed in Germany is mainly due to achange to intravitreal injections as the preferred treatment for nAMD and mCNV. As PDT is currently the recommended treatment of choice for chronic CSC, an underprovision of PDT in Germany can be assumed. To enable an appropriate treatment for patients, areliable verteporfin production, asimplified approval process by health insurance companies and aclose cooperation between ophthalmologists in private practice and larger centers are urgently needed.

The economic importance of individual health services (IGeL) in ophthalmology over time: survey results from 2010 and 2020

Individual health services (IGeL) enable patients to receive medical services not covered by social health care; however, there is no central data collection on IGeL in Germany. This study illustrates the spectrum of IGeL provided in the field of ophthalmology as an example of the importance of IGeL in Germany based on survey results. Nationwide, 10% of ophthalmologists in private practice were randomly selected in this anonymous survey in 2010 and 2020 while in 2020 in addition to the randomized 10% of ophthalmologists the same ophthalmologists from 2010 were contacted. By means of awritten questionnaire, ophthalmologists were asked about their practice structure, total revenue from IGeL as well as the frequency and price of specific IGeL. Income from IGeL was estimated at an average of 21% of the regular service volume in 2010 and 23% in 2020. Glaucoma IGeL and medical report IGeL were offered by almost all ophthalmologists and glaucoma screening being performed most frequently with an average frequency of over 150 examinations/month. IGeL, such as HRT IGeL were offered by significantly fewer ophthalmologists in 2020 than in 2010, while IGeL based on other technological procedures such as glaucoma OCT were offered more frequently in 2020. The volume of IGeL provided in established ophthalmological practices was stable between 2010 and 2020. The range of services offered in 2020 compared to 2010 reflects adynamic change associated with the entry of new technologies into routine care.

Social media and ophthalmology: A review.

Social media is being widely used across ophthalmology. Its communication tools have been employed more often by ophthalmologists in private practice than academia, although academic institutions may be more impactful influencers. There are opportunities to promote ophthalmic services and to augment traditional clinical care. Social media provides a medium to disseminate peer-reviewed literature in ophthalmology, and to expand conference experiences. It is used for teaching ophthalmology at medical schools and attracting medical students into ophthalmology training, and for research in ophthalmology. Important considerations when using social media include the required time commitment and the public nature of interactions. The high level of misinformation in medical social media remains a challenge for both ophthalmologists and their patients, and the ophthalmologist can play an active role in addressing the issue. This review considers the role that social media is playing in ophthalmology today, including impact on ophthalmic practice, applications in ophthalmic education and training, and patient-focused networking.

Obstacles and Challenges Facing Iraqi Women Ophthalmologists.

The purpose of this study was to address disparities between male and female Iraqi ophthalmologists in terms of personal circumstances, professional profiles, and attitudes toward work and family life. A Google Form-based questionnaire was released on a social media platform including 500 ophthalmologists between September 1, and December 1, 2021. The survey included three domains: (1) demographic characteristics, (2) clinical practice profile, and (3) career satisfaction and work/family balance. The study included a total of 209 specialists, with a response rate of 45.5%. About 69.4% of them were 45 years and younger. The female-to-male ratio was 1:1.6, 188 (90%) were married and 186 (88.9%) had children. Women ophthalmologists worked fewer hours, days, and operations than male ophthalmologists (P = 0.091). Moreover, women ophthalmologists in private practice were considerably underrepresented. General ophthalmologists represented 77%. The number of women ophthalmologists with subspecialty degrees was far less 9 (11.5%) than males 38 (29.2%), P = 0.003, and they performed significantly fewer operations than male ophthalmologists (P = 0.001). Family duties were the biggest deterrent for female ophthalmologists. For males, the private clinic is an obstacle to acquiring a specialty degree in 45.6%, but for women, it is just 25.7%. Overall satisfaction was 65.1%. Women respondents were less satisfied with their practice (P = 0.009) and thought that they are facing more challenges (0.007). Men believed they had less time to spend with family, implying that women sacrifice working time/income to satisfy family obligations and expectations. Work-life balance is achieved by limiting work hours and including family members. Women ophthalmologists in Iraq might be facing greater obstacles to their professional advancement than their male counterparts. Female doctors were working fewer hours and doing fewer surgical procedures, and they were less likely to pursue subspecialty certification.

Real-World Application of Home Visual Acuity Testing for Pediatric Teleophthalmology During the COVID-19 Pandemic.

To review the ability of home visual acuity testing during teleophthalmology consultations to accurately assess visual acuity in pediatric patients in a real-world setting. This was a retrospective study of pediatric patients who were examined via teleophthalmology consultation due to the coronavirus disease 2019 (COVID-19) pandemic-related community restrictions between May and June 2020 at a single private ophthalmology practice. Home visual acuity findings were compared with the subsequent in-person assessment to determine agreement between measures. Forty-three patients (86 eyes) were included in the study. The mean patient age at the time of teleophthalmology assessment was 75.9 months (range: 29 to 173 months). The correlation between home visual acuity findings and subsequent in-person assessment across all participants was 0.56 (P < .001). The upper and lower limits of agreement were 0.38 logarithm of the minimum angle of resolution (logMAR) units and -0.33 logMAR. The correlation reduced to 0.46 (P = .013) in patients younger than 5 years and increased to 0.70 (P < .001) in patients 8 years and older. Home visual acuity assessment for teleophthalmology is of increased clinical value in older pediatric patients. In-person assessment by a trained clinician is the optimal method to determine visual acuity. Because home visual acuity assessment may be necessitated by local and global factors, further research is required regarding the optimal methods for assessment, particularly in younger patients. [J Pediatr Ophthalmol Strabismus. 2022;59(5):296-302.].

PREVALENCE AND CONTROL OF MYOPIA AMONG CHILDREN IN PLEVEN, BULGARIA

Purpose: To observe the factors affecting the prevalence and control of myopia among children in Pleven, Bulgaria. Methods: A retrospective study was done. From March 2019 to March 2021, 404 consecutive patients from 3 to 18 years old with the main diagnosis myopia after cycloplegia passed through the private ophthalmology practice. The following signs were analyzed: age, sex, location, type and degree of myopia, review result and accompanying diseases. Results: The demographic profile of the evaluated children was: 43.8% males and 56.2% females (р&lt; 0.05); most of them are living in the city (89.2%). The most significant number of children with myopia were between 9 and 12 years old. Children with new onset myopia were 27.7% and 72.3% were with existing one. Patients between 8 and 18 years of age with existing myopia are more than those with new onset one (p &lt;0.05). There were 76.7% children with a low degree of myopia, 17.6% with a medium degree and 2.0% with a high degree. Without accompanying diseases were 65.6% of our patients. Conclusion: The control and treatment of myopia seem promising. However, it is necessary to develop a state policy for the prevention of children's eye health in Bulgaria.

Eye injuries from fireworks used during celebrations and associated vision loss: the international globe and adnexal trauma epidemiology study (IGATES).

To report on the factors associated with severe vision loss from fireworks-related ocular trauma during celebrations, including festivals. Tertiary eye care hospitals in 5 countries and private ophthalmology practices in the Netherlands. Patients included received treatment for fireworks-related ocular trauma during celebrations. Demographic and clinical data for patients affected were analyzed and associations with severe vision loss reported. Of 388 patients, 71 (18.3 %) had severe vision loss (worse than 6/60) at 4-week follow-up due to fireworks-related ocular trauma. Mean age overall was 20.6 years (range 2 to 83 years), and there was a male predominance of 4:1. Clinical factors associated with severe vision loss included penetrating injury (OR 4.874 [95% CI 1.298-18.304; p = 0.02]) and lens injury (OR 7.023 [95% CI 2.378-20.736; p = 0.0004]). More patients with closed-globe injuries (CGIs) had improved vision after 4 weeks (OR 3.667, 1.096-12.27) compared to those with open-globe injuries (OGI) (p = 0.035). Eye protection use was reported by 7 patients, and 39.4% patients < 18 years were unsupervised by an adult at the time of injury. Severe vision loss from fireworks-related ocular trauma occurred during celebrations in a variety of countries and was associated with penetrating and/or lens injury and poor presenting vision. New initiatives are needed to prevent severe vision loss associated with these injuries.

Clinical Outcomes of Rhegmatogenous Retinal Detachment Treated With Pneumatic Retinopexy

Pneumatic retinopexy (PR) is the only clinic-based method of rhegmatogenous retinal detachment (RRD) repair. Registry-acquired clinical practice setting outcomes data with this procedure have not yet been reported. To describe the clinical outcomes associated with RRD treated primarily with PR. In this retrospective cohort study, data from patients 19 years and older with noncomplex RRD treated at academic and private ophthalmology practices participating in the American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight) were analyzed. Data were collected from January 1, 2013, to December 31, 2019, and data were analyzed from January to December 2020. Data from the IRIS Registry were queried for eyes that underwent PR for noncomplex RRD and had at least 3 months of follow-up. Cases were identified by a combination of diagnosis code for RRD and a Current Procedural Terminology code for PR. The number of eyes that achieved single-operation success (SOS), defined as retinal reattachment without a subsequent retinal detachment surgery or repeated PR. Of 9553 included patients, 5827 (61.0%) were male, and the mean (SD) age was 62 (10) years. A total of 9659 eyes were identified. SOS was achieved in 6613 eyes (68.5%). Best-corrected visual acuity significantly differed 9 to 12 months after treatment between the SOS group, with a mean of 0.24 logMAR (95% CI, 0.23-0.25; approximate Snellen equivalent, 20/35), and the single-operation failure group, with a mean of 0.43 logMAR (95% CI, 0.40-0.46; approximate Snellen equivalent, 20/54). Among all patients, the mean time to maximal visual recovery was 268 days (95% CI, 260-276). Endophthalmitis was observed in 3 eyes (0.03%). SOS was associated with female sex (odds ratio, 1.51; 95% CI, 1.38-1.65), while current smoking status was associated single-operation failure (odds ratio, 0.78; 95% CI, 0.68-0.91). In this registry-based study, which encompasses a large number of eyes drawn from multiple, heterogenous electronic health record systems, SOS was achieved in 68.5% of eyes with noncomplex RRD treated by primary PR. It is unknown how these outcomes would have compared with other methods of RRD repair in this cohort.

Comparison of a new sublingual sedation troche with midazolam, ketamine, and ondansetron with intravenous sedation and the effects on vital signs.

To compare effects of the MKO Melt (midazolam 3 mg, ketamine 25 mg, and ondansetron 2 mg) with intravenous (IV) sedation on vital signs of patients who underwent cataract surgery. Two private ophthalmology practices in Sioux Falls, South Dakota, USA. Retrospective analysis. Preoperative, intraoperative, and postoperative vital signs were compared between individuals who underwent cataract surgery and received exclusively either MKO (n = 991) or traditional IV methods (n = 120) for sedation. Clinical significance was defined as a 5 mm Hg change in blood pressure, 3 beats per minute (bpm) change in heart rate, a change of 2 respirations per minute, or a change of 3% in O2 saturation. MKO Melt but not IV sedation was given before the reported preoperative vital signs. There were 1111 patients included in this study. Preoperative systolic blood pressure (SBP) was 133.7 ± 15.6 mm Hg in the MKO group and 139.6 ± 17.3 mm Hg in the IV group (P = .0001). Postoperative SBP was 130.8 ± 12.9 mm Hg in the MKO group and 135.8 ± 19.3 mm Hg in the IV group (P < .01). Postoperative heart rate was 66.3 ± 10.4 bpm in the MKO group compared with 69.8 ± 10.5 bpm in the IV group (P < .001). No other clinically and statistically significant differences were found. The mean number of melts used was 1.5. Clinically and statistically significant improvements in preoperative and postoperative SBP and postoperative heart rate were observed in patients who received MKO Melt. The MKO Melt was safe, effective, and well tolerated and a viable alternative to IV sedation.

Visual and Refractive Outcomes of Cataract Surgeries Performed in One Year in a Private Practice Setting: Review of 2714 Procedures.

Methods Our center's database was used to identify all isolated cataract procedures performed during 2017. The electronic records were reviewed to collect the preoperative information, presence of intra- or postsurgical complications, and visual and refractive outcomes one month after surgery. Results In 2017, 2714 eyes of 1543 patients underwent cataract surgery in our center. Mean patient age was 70.42 years. 775 eyes (28.55%) had prior ophthalmic pathologies, and 113 eyes (4.16%) had undergone previous surgical procedures. Surgical complications developed in 35 eyes (1.29%), including 9 posterior capsule tears (0.33%) and 3 cases of dropped lens fragments (0.11%). A toric or multifocal intraocular lens was implanted in 45.6% of eyes. As regards postoperative complications, 59 eyes (2.17%) required a return to the operating theater, including 29 eyes (1.07%) requiring reinterventions due to an unexpected refractive result. There were no cases of endophthalmitis. Mean LogMAR-corrected distance visual acuity (CDVA) improved from 0.25 (SD 0.34) preoperatively to 0.04 (SD 0.17) postoperatively; 86.5% of eyes achieved a CDVA ≤0.0, with 97.5% achieving ≤0.3. In 86.4% of eyes, the difference between target and residual spherical equivalent difference was of 0.50 D or lower; 88% of eyes had a spherical equivalent ±0.50 D. Conclusions The visual and refractive outcomes of cataract surgery in a private practice setting were excellent, well over the benchmarks set by the ESCRS. The safety profile was also within expected standards. This study provides information for ophthalmologists in private practice on expected outcomes.

Alcohol-assisted epithelial debridement for treatment of recurrent corneal erosion: a case series

Purpose: Recurrent corneal erosion is characterized by recurrent episodes of spontaneous breakdown of the corneal epithelium. Alcohol delamination of the corneal epithelium has a high success rate, but the procedure requires the use of an operating microscope in an operating theater. We present a case series of alcohol assisted epithelial debridement in the clinic setting. Methods: Records of eight consecutive patients aged >18 years who presented to a private ophthalmology practice clinic in Hong Kong between October 2012 and March 2018 with recurrent corneal erosion that did not respond well to conservative or surgical management with persistent symptoms of >3 months were retrospectively reviewed. 75% alcohol was applied directly to the site of abnormal epithelium under slit lamp, followed by debridement of the epithelium using a surgical sponge. A bandage contact lens was then inserted. Patients were followed up until complete healing of the epithelial defect. Results: All eight patients achieved complete healing of the epithelial defect within 2 weeks with no major complication or recurrence. Conclusion: Alcohol-assisted epithelial debridement is simple, safe, and effective for the treatment of recurrent corneal erosion. It can be performed in a clinic setting under slit lamp.

Qualitative assessment of visual impairment in patients with age-related macular degeneration using standardized, image-based questionnaires

The purpose of the study is to test a simple approach for characterizing subjective perception in patients with choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). This multi-center study was performed in four private ophthalmology practices including 20 patients with CNV. Subjects were presented the original image on the affected eye and afterwards modified candidate images to the contralateral eye. Then they chose one image that most closely matched the perception on the affected eye. This was repeated with three different images representing three everyday life scenes manipulated to mimic visual perception with reduced color perception (image 1), central scotomas (image 2), and blurring with four varying sizes (image 3). The frequency of response to the forced choice questionnaire experiment for each image was recorded. Our results show that images manipulated using a Gaussian blur filter, a brightness filter, and a sinusoidal distortion filter were selected by 9, 10, and 1 patients, respectively. Size of modification was not associated with visual acuity in image 1 or image 3. In image 2, however, the size of the modification was dependent on visual acuity ( p = .01). In conclusion, subjective perception in patients with AMD may significantly differ between individual patients. A better understanding of the visual disturbance will facilitate communication and involvement of patients in treatment decisions.

Ocular Diseases at the Medical-Surgical Clinic Ophthalmology of Brazzaville

The causes of blindness are diverse, including infectious (dominated by trachoma and onchocerciasis) and non infectious. The objective of this study was to identify the most common ocular diseases in ophthalmology consultation. Patients and methods: This was a retrospective descriptive study, based on information collected from medical records at the medical-surgical clinic Ophthalmology of Brazzaville. The study period was from January 1 to December 31, 2018, a period of 1 year. All patients who consulted during the study period were included. The variables studied were age, sex, motive for consultation and diagnosis. Results: Our sample consisted of 908 females versus 528 males, or a sex ration of 0.58. It was represented by 10.72% of patients under 15 years against 21.58% of patients over 60 years. Overall, the most common ocular disease were refractive errors followed by conjunctivitis. Cataracts were the third leading cause of consultation with 12.39% of cases followed by glaucoma with 6% of cases. Conclusion: Ocular diseases in private ophthalmology practice in Brazzaville remain dominated by conjunctivitis and refractive errors, followed by cataract and glaucoma. We found no cases of trachoma or onchocerciasis.

Influence of anterior chamber depth on postoperative refractive outcome in Chinese eyes

Aim or Purpose: This study aims to evaluate the refractive surprise (RS) after cataract surgery with various intraocular lens (IOL) formulas in eyes with very shallow or deep anterior chamber depth (ACD).&#x0D; Design: This is a prospective cohort study of patients from a private ophthalmology practice in Sydney.&#x0D; Methods: Thirty-one patients who had their cataract surgery in 2014 were included. The cohort consists of 20 eyes with ACD &lt; 2.8 mm and 25 eyes with ACD &gt; 3.2 mm. Patients’ demographic variables and their predicted refractive outcomes using the SRK-T, Haigis, Holladay 1, and Holladay 2 IOL formulas were collected. Actual refractive outcomes were obtained from consultations at least one-month postoperatively. RS was calculated from the difference between predicted refraction outcome of IOL formulas and the actual postoperative refraction achieved.&#x0D; Results: The linear correlations between ACD and RS were not significant (p &gt; 0.05). In the group with ACD &lt; 2.8 mm, the mean refractive surprise using SRK-T, Haigis, Holladay 1, and Holladay 2 formulas were -0.191 ± 0.541, -0.189 ± 0.444, -0.201 ± 0.449, and -0.154 ± 0.489 D, respectively. In the group with ACD &gt; 3.2 mm, the mean refractive surprise using the IOL formulas were -1.364 ± 0.541, -1.420 ± 0.541, 0.027 ± 0.394, and -0.045 ± 0.343 D, respectively. &#x0D; Conclusion: The positive linear correlation between ACD and RS was weak. In eyes with ACD &lt; 2.8 mm, the least RS was found with the Holladay 2 formula, while in eyes with ACD &gt; 3.2 mm, this was found with Holladay 1.

Subjective and objective work stress among ophthalmologists in private practice in Thuringia : Results of astate-wide survey

Physicians are highly vulnerable to work-related stress; however, little is known about the workload of ophthalmologists. In March 2017 across-sectional and paper-based survey of all practice-based ophthalmologists in the federal state of Thuringia was conducted. Additionally, data from 2016 and 2009 using physician fee schedule datasets provided by the Thuringian Association of Statutory Health Insurance Physicians were analyzed. The response rate was 27% (n = 42 ophthalmologists) of which 95% (n = 40) exceeded the effort-reward cut-off value (>1) indicating ahigh level of work stress. The overall number of treatment cases did not show a statistically significant difference between 2016 and 2009 (n = 118 ophthalmologists, p = 0.412). In contrast, the number of treatment cases of patients with type2 diabetes mellitus and essential (primary) hypertension was statistically significantly higher in 2016 compared to 2009 (n = 118 ophthalmologists, p < 0.05). Almost all respondents reported ahigh level of work stress and this was reflected in the number of treatment cases of patients with type2 diabetes mellitus and essential hypertension, which was statistically significantly higher in 2016 than in 2009. The results suggest that working conditions should be adapted to meet the needs of chronically ill patients and reduce physicians' workload at the same time.

Knowledge, attitudes and self-care practices of patients with glaucoma in uThungulu in KwaZulu-Natal

Background: Glaucoma remains one of the leading causes of blindness in South Africa. Early detection, effective treatment and strict compliance with treatment are instrumental to prevent further damage to the optic nerve and thus preserve vision.Aim: The purpose of this study was to assess the knowledge, attitude and self-care practices of patients with glaucoma in KwaZulu-Natal.Setting: The study was conducted in the ophthalmology outpatient department of a public hospital and a private ophthalmology practice in the uThungulu district.Methods: This was an observational, analytic, cross-sectional study. Structured questionnaires assessing knowledge, attitudes and self-care practices were administered to patients presenting for follow-up glaucoma management.Results: The median age of the 384 patients in this study was 60 (interquartile range [IQR] 48.5–69.5) and 59 years (IQR 49.0–66.5) for males and females, respectively (p &gt; 0.05). Two hundred and thirty-eight (62.0%) patients had good knowledge of glaucoma. Age, gender and duration of glaucoma diagnosis were significantly associated with good knowledge of glaucoma. Three hundred and forty-four (89.6%) patients reported having good self-care practices. Patients over the age of 65 years were significantly less likely to have good self-care practices compared to patients aged 26–45 years (odds ratio [OR]: 0.2, confidence interval [CI]: 0.1–0.6, p = 0.01). Good knowledge of glaucoma was significantly associated with good self-care practices of glaucoma (p &lt; 0.001).Conclusion: Elderly patients do not have sufficient knowledge of glaucoma and have poor self-care glaucoma practices. It is important to involve family members of these patients in the education and counselling of glaucoma to facilitate improved disease management.

Molecular typing and whole genome next generation sequencing of human adenovirus 8 strains recovered from four 2012 outbreaks of keratoconjunctivitis in New York State.

Ocular infections caused by human adenovirus (HAdV) are highly contagious. The most severe are usually caused by members of species HAdV-D (types HAdV8, 19, 37, 53, 54, and 56) and can manifest as epidemic keratoconjunctivitis (EKC), often resulting in prolonged impairment of vision. During the early months of 2012, EKC outbreaks occurred in neonatal intensive care units (NICUs) in 3 hospitals in New York State (New York and Suffolk Counties). A total of 32 neonates were affected. For 14 of them, HAdV8 was laboratory-confirmed as the causative agent. Nine healthcare workers were also affected with 3 laboratory-confirmed, HAdV-positive EKC. A fourth EKC outbreak was documented among patients attending a private ophthalmology practice in Ulster County involving a total of 35 cases. Epidemiological linkage between the neonatal intensive care unit outbreaks was demonstrated by molecular typing of virus isolates with restriction enzyme analysis and next generation whole genome sequencing. The strain isolated from the ophthalmology clinic was easily distinguishable from the others by restriction enzyme analysis.

Professional skills and advanced training for residents in ophthalmology

Career paths have become very complex and variable in the field of ophthalmology. The common way of ophthalmologists in private practice is still avery popular model, especially with regard to the autonomy which has been missing for years in hospitals. It is still an attractive way but alternative developmental options which appear more exciting and flexible, are on the increase.

Experiences of patients undergoing repeated intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration

Current therapy to slow disease progression in patients with neovascular age-related macular degeneration (AMD) entails regular intravitreal anti-vascular endothelial growth factor (VEGF) injections, often indefinitely. Little is known about the burden imposed on patients by this repetitive treatment schedule and how this can be best managed. The aim of this study was to explore the psychosocial impact of repeated intravitreal injections on patients with neovascular AMD. Forty patients (16 males, 24 females) with neovascular AMD undergoing anti-VEGF treatment were recruited using purposive sampling from a private ophthalmology practice and public hospital in Melbourne. Patients were surveyed using the Macular Disease Treatment Satisfaction Questionnaire (MacTSQ; Bradley, Health Psychology Research Unit, Surrey, England) and underwent semi-structured, one-on-one interviews. Interview topics were: treatment burden and satisfaction; tolerability; barriers to adherence; treatment motivation; and patient education. Interviews were audio recorded and thematic analysis performed using NVivo 10 (QSR International, Doncaster, Australia). Patients recognised the importance of treatment to preserve eyesight, yet experienced significant psychosocial and practical burden from the treatment schedule. Important issues included treatment-related anxiety, financial considerations and transport burden placed on relatives or carers. Many patients were restricted to sedentary activities post-injection owing to treatment side effects. Patients prioritised treatment, often sacrificing family, travel and social commitments owing to a fear of losing eyesight if treatment was not received. Whilst anti-VEGF injections represent the current mainstay of treatment for neovascular AMD, the ongoing treatment protocol imposes significant burden on patients. An understanding of the factors that contribute to the burden of treatment may help inform strategies to lessen its impact and assist patients to better manage the challenges of treatment.