Ophthalmological Society Research Articles

Chinese expert consensus on the diagnosis and treatment of dry eye (2024)

With the societal aging and the excessive use of video terminals, the prevalence rate of dry eye is increasing, and the causative factors are complex and diverse. Unremitting research and discussions on the diagnosis and treatment of dry eye have been carried out. An expert consensus on this issue was released in 2013. To further standardize and promote the diagnosis and treatment of dry eye, the Cornea Group of Chinese Ophthalmological Society and the Cornea Group of Ophthalmology Branch of Chinese Ophthalmologist Association have recently summarized the latest clinical findings and experience. A new version of the expert consensus has been formed to meet the needs of clinical practice.

Survey on the management of retinal arterial occlusions in Spain

ObjectiveTo determine the current status of retinal artery occlusion (RAO) management in Spain. Material and MethodsAn anonymous questionnaire of 22 questions was carried out on the Google Forms® platform between April 27 and May 28, 2023. This questionnaire was distributed via email by the Spanish Society of Retina and Vitreous and the Spanish Society of Ophthalmology. Results159 ophthalmologists from 91 public and 44 private centers in the 17 autonomous communities answered the questionnaire. Fifty-one percent of the ophthalmologists who answered the survey were women, 56.6% worked in public centers, 9.4% in private centers and 34% in both centers.Of the ophthalmologists working in public centers, 41.7% attend ophthalmologic emergencies 24 hours a day, 365 days a year, while the rest delay their attention outside the usual hours. In 62.6% of the public centers with responses collected there are no protocols for the management of OAR in the ophthalmology services and as for multidisciplinary protocols, 57% recognize that they do not have one, 23% have one with neurology or internal medicine and only 13% of the centers include OAR within the stroke code. The most frequently reported treatments are hypotensors and anterior chamber paracentesis.In private centers, 73.7% report not having their own protocol, and 78.9% do not have a protocol with other services.The main barriers perceived by the ophthalmologists surveyed were: patients arriving outside the window period (77.2%), no specific treatment and lack of established protocols (55.4%), low incidence (32.9%).Suggestions for improvement were: need to implement protocols, coordination with other services and that OAR be included as a stroke code. ConclusionsDespite its limitations, (simple questionnaire, open design of some questions, lack of representation of centers and provinces and contradictory responses within the same center), we consider that it can serve as an approximation to the current management of RAO in Spain. It is necessary to develop protocols adapted to the different centers and to comply with them effectively in order to improve accessibility and equity.

Sustainable practices in ophthalmology-steps towards environmental stewardship in healthcare.

The healthcare sector, responsible for approximately 4-5% of global carbon dioxide equivalent (CO2eq) emissions, significantly impacts the environment due to its high energy consumption and waste generation. As aspecialty, ophthalmology has adisproportionately large environmental impact because of the high annual volume of ophthalmic surgeries. In recent years, significant organized efforts have focused on reducing ophthalmology's carbon footprint while maintaining quality patient care. As one example, EyeSustain is acoalition of 50global ophthalmology societies collaborating to advance sustainability in the delivery of eye care through education, research, and advocacy. Education and advocacy are critical to raising awareness and promoting the implementation of sustainable practices among physicians. Many of these practices can and should be applied throughout the broader healthcare system, and EyeSustain is amodel of how other specialties can organize education and advocacy efforts through medical societies. We review current initiatives, advocacy efforts, and waste-reduction strategies aimed at reducing the environmental footprint of ophthalmic procedures.

Impact of Ophthalmic Knowledge Assessment Program Scores and Surgical Volume on Subspecialty Fellowship Application in Ophthalmology Residency: Retrospective Cohort Study

Abstract Background Ophthalmology residents take the Ophthalmic Knowledge Assessment Program (OKAP) exam annually, which provides percentile rank for multiple categories and the total score. In addition, ophthalmology residency training programs have multiple subspecialty rotations with defined minimum procedure requirements. However, residents’ surgical volumes vary, with some residents exceeding their peers in specific subspecialty rotations. Objective This study aims to identify if there is a difference in OKAP examination scores and surgical volume exposure during ophthalmology residency training between nonfellowship and fellowship applicants and among various subspecialties. Methods A retrospective review of OKAP scores and surgical procedure numbers of graduating residents in an accredited academic ophthalmology residency program in the Midwest United States was conducted. Data were collected from 2012 to 2022. Results A total of 31 residents were identified. Most residents decided to pursue fellowship training upon graduation (20/31, 65% residents), and the rest chose to practice comprehensive ophthalmology (11/31, 35% residents). A total of 18/31 residents had OKAP score reports available. The fellowship group outperformed the nonfellowship group in multiple subsections and the total exam (P=.04). Those pursuing fellowship training in glaucoma performed higher on the Glaucoma section (P=.004) and the total exam (P=.005). Residents pursuing cornea performed higher on nearly all subsections, including External Disease and Cornea (P=.02) and the total exam (P=.007). The majority of the surgical volume exposure was identical between fellowship and nonfellowship groups. Those who pursued glaucoma fellowship performed more glaucoma filtering and shunting procedures (P=.03). Residents going into pediatrics fellowship were primary surgeons in more strabismus cases (P=.01), assisted in fewer strabismus cases (P<.001), and had no difference in the total number of strabismus surgeries. Conclusions In our program, residents pursuing fellowship training had higher OKAP scores on multiple sections and the total exam. There was no significant difference in the overall surgical volume averages between fellowship and nonfellowship groups, but few differences existed in subspecialty procedures among fellowship applicants. Larger multicenter studies are needed to clarify the relationship between OKAP scores and ophthalmology fellowship decisions nationwide.

Statement of the Legal Committee of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA) on the Prognosis Assessment in Private Accident Insurance (PUV) - Status: July 2024

Statement of the Legal Committee of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA) on the Prognosis Assessment in Private Accident Insurance (PUV) - Status: July 2024

Expert consensus on the diagnosis and treatment of immunoglobulin-G4 related ophthalmic disease (2024 edition)

Immunoglobulin-G4 related ophthalmic disease (IgG4-ROD) is an immune-mediated fibroin flammatory condition characterized by ocular mass lesions and elevated plasma IgG4 level. Since all the ocular tissues can be involved, and it can be accompanied by multiple organ and systemic diseases, the diagnosis and treatment require multidisciplinary collaboration. The Oculoplastic and Orbital Disease Group of Chinese Ophthalmological Society of Chinese Medical Association and the Chinese Rheumatology Association convened experts in ophthalmology, and rheumatology and immunology, and formulated "Expert consensus on the diagnosis and treatment of immunoglobulin-G4 related ophthalmic disease (2024 edition)" for the diagnosis and treatment of IgG4-ROD based on domestic and international studies and experience. The consensus mainly standardized the diagnostic criteria of IgG4-ROD from the aspects of ocular imaging, serum IgG4 level and ocular histopathology, and recommended the methods and indications of drug therapy (glucocorticoids, immunosuppressants and biologics) and surgical treatment.

Anterior ischemic optic neuropathy (AION) : S1guidelines of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA). Version: 30.08.2024

Anterior ischemic optic neuropathy (AION) : S1guidelines of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA). Version: 30.08.2024

Statement of the Legal Committee of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA) ondetermination of visual acuity during the medical assessment : Status July 2024

Statement of the Legal Committee of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA) ondetermination of visual acuity during the medical assessment : Status July 2024

Statement of the Legal Committee of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA) on the prognosis assessment in private accident insurance (PUV) : Status July 2024

Statement of the Legal Committee of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA) on the prognosis assessment in private accident insurance (PUV) : Status July 2024

Experience of observation skill workshop intervention for ophthalmologists in fellowship training.

To gauge the impact of an interventional workshop conducted to measure the observation skills of 34 postgraduates during induction into an ophthalmology fellowship. A seven-hour workshop was conducted with the ophthalmology trainees. Trainees from the 2022 batch of ophthalmology fellowships (21 females and 13 males) were included in the study. The pre-workshop assessment comprised two non-clinical images to spot the difference and five clinical images from various subspecialties of ophthalmology. This was followed by workshop and Post workshop assessment. The pre- and post-observation grades of participants were then compared by masked ophthalmologists. The Wilcoxon signed-rank test was used to compare scores at two time points, with a p-value < 0.05 for statistical significance. Statistical analysis revealed that the observation skill score was significantly higher after the workshop intervention (M d = 4.00, n = 34) compared to the pre-workshop score (M d = 1.85, n = 34), p-value = 0.000. Workshops on specific/selected foundational skills, such as observation skills and communication skills, must be integrated into the curricula of basic medical degree and specialty medicine to equip medical professionals with attentive observation and deep learning.

The Rise of Ophthalmology as a Specialty: Albrecht von Graefe's Pioneering Contributions.

Albrecht von Graefe (1828-1870) is celebrated as a pivotal figure in the evolution of ophthalmology. He is renowned for his transformative contributions that established the field as a distinct medical specialty separate from general surgery. This biography review delves into von Graefe's pioneering efforts that reshaped ophthalmology, highlighting his innovations and establishing fundamental practices that define modern ophthalmic care. von Graefe's introduction of iridectomy for glaucoma, development of specialized surgical instruments, and advocacy for the use of the ophthalmoscope marked significant advancements in treating eye disorders. Additionally, his role in founding the first ophthalmological society and journal underscored his commitment to creating a structured, scientific approach to the field. Through meticulous examination of his work and its impact, this article underscores how von Graefe's pioneering spirit and dedication fostered the growth of ophthalmology into an independent and respected medical specialty.

Female Leadership in Pediatric Ophthalmology: A Descriptive Analysis.

To examine female representation among current chiefs of pediatric ophthalmology services of academic medical centers and children's hospitals, as well as program directors of ophthalmology residency and pediatric ophthalmology fellowship programs in the United States. Data collection for this cross-sectional study occurred between December 2023 and February 2024, using publicly available sources to compile a list of academic medical centers and children's hospitals, as well as ophthalmology residency programs and pediatric ophthalmology fellowship programs that participated in the 2023-2024 San Francisco Match. Chi-squared analyses were performed using Excel 2021 software, where a P value less than .05 was considered statistically significant. Of the dedicated pediatric ophthalmology services across academic medical centers and children's hospitals in the United States, 38.3% (64/167) are led by a female chief. Female representation was greater at children's hospitals (40.0%, 36/90) than at academic medical centers (36.4%, 28/77), although no significant difference was observed (P = .69). Gender distribution was near equivalent at both academic training program levels, with slightly more female directors of fellowship programs (45.7%, 21/46) than ophthalmology residency programs (42.3%, 52/123) (P = .33). The authors report near equivalent female representation in the leadership of academic training programs at the residency and fellowship level. However, the proportion of female pediatric ophthalmology division chiefs lags behind the actual gender composition of the workforce. Given the increasing prevalence of female pediatric ophthalmologists, promotion of concordant representation in leadership is necessary to reflect the changing sociocultural landscape and to close the gender gap. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

DOG-EyeTeacher: a response by the Teaching Association to the medical study restructuring

The Masterplan Medicine 2020 adopted in 2017 entails many changes to the medical studies curriculum. The new structure affects the content of the coursework and its main focus. Amajor goal of this masterplan is to prepare young physicians by teaching the skills that are essential for the future profession. The National Competence-Based Learning Objectives Catalog for Medicine (NKLM) provides the basis for the teaching content. The Working Group Teaching of the German Society of Ophthalmology (Arbeitsgemeinschaft Lehre der DOG) actively supports this transformation. In cross-site collaboration, teaching materials for various teaching formats have been compiled by relying on the NKLM (e.g., recordings of operations, slides for small group instruction, image galleries, case studies). An online library named the DOG-EyeTeacher was then created. The aim of the DOG-EyeTeacher is to relieve the training clinics and to establish basic standards in teaching materials, thereby enabling the necessary focus on medical education. The provision of these teaching materials should deepen the interest in ophthalmology among future doctors. The DOG-EyeTeacher is our response to the challenges associated with the planned restructuring of the medical curriculum. Since October 2023, any DOG member involved in teaching can create an account free of charge to use our materials.

Data-driven 2D-EWT based diabetic retinopathy identification using hybrid neural network

Diabetic retinopathy (DR) is one of the primary reason of blindness over the globe. During DR, retina deteriorates continuously with the presence of lesions. It is difficult to detect DR in early stage and manual diagnosis is resource-intensive. To full-fill the requirement, two-dimensional empirical wavelet transform (2D-EWT) and composite neural network based automated DR diagnosis system is developed. The informative part of fundus image is extracted from the given image. The 2D-EWT computes different number of boundaries in magnitude spectrum followed by different modes. Therefore, a data-driven uniform boundary identification method is suggested for DR classification purpose. The acquired decomposed modes are given to the composite neural network for classification. The developed system is assessed on three different datasets MESSIDOR-1, MESSIDOR-2, and AsiaPacific Tele Ophthalmology Society (APTOS) dataset on which proposed method achieved 75%, 83.82%, and 89.28% accuracy, respectively. Efficacy of the proposed system is superior than the compared methods in terms of accuracy, area under the curve, precision, specificity, and sensitivity.

Genetic Risk Stratification of Primary Open-Angle Glaucoma in Japanese Individuals

To assess the impact of genetic risk estimation for primary open-angle glaucoma (POAG) in Japanese individuals. Cross-sectional analysis. Genetic risk scores (GRSs) were constructed based on a genome-wide association study (GWAS) of POAG in Japanese people. A total of 3625 Japanese individuals, including 1191 patients and 2434 controls (Japanese Tohoku), were used for the model selection. We also evaluated the discriminative accuracy of constructed GRSs in a dataset comprising 1034 patients and 1147 controls (the Japan Glaucoma Society Omics Group [JGS-OG] and the Genomic Research Committee of the Japanese Ophthalmological Society [GRC-JOS]) and 1900 participants from a population-based study (Hisayama Study). We evaluated 2 types of GRSs: polygenic risk scores using the pruning and thresholding procedure and a GRS using variants associated with POAG in the GWAS of the International Glaucoma Genetics Consortium (IGGC). We selected the model with the highest areas under the receiver operating characteristic curve (AUC). In the population-based study, we evaluated the correlations between GRS and ocular measurements. Proportion of patients with POAG after stratification according to the GRS. We found that a GRS using 98 variants, which showed genome-wide significance in the IGGC, showed the best discriminative accuracy (AUC, 0.65). In the Japanese Tohoku, the proportion of patients with POAG in the top 10% individuals was significantly higher than that in the lowest 10% (odds ratio [OR], 6.15; 95% confidence interval [CI], 4.35-8.71). In the JGS-OG and GRC-JOS, we confirmed similar impact of POAG GRS (AUC, 0.64; OR [top vs. bottom decile], 5.81; 95% CI, 3.79-9.01). In the population-based study, POAG prevalence was significantly higher in the top 20% individuals of the GRS compared with the bottom 20% (9.2% vs. 5.0%). However, the discriminative accuracy was low (AUC, 0.56). The POAG GRS was correlated positively with intraocular pressure (r= 0.08: P= 4.0× 10-4) and vertical cup-to-disc ratio (r= 0.11; P= 4.0× 10-6). The GRS showed moderate discriminative accuracy for POAG in the Japanese population. However, risk stratification in the general population showed relatively weak discriminative performance. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Gender analysis of ophthalmology fellowship program directors and trainees

PurposeTo determine the gender ratios of ophthalmology fellows and fellowship program directors. DesignQuantitative cross-sectional study. MethodsPrograms were identified using the Association of University Professors of Ophthalmology (AUPO) and the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) websites. Programs were contacted via email survey to determine the gender of the current fellow(s) and fellowship program director in the academic year 2022–2023. Fisher's Exact Test* was undertaken to establish statistical significance (p < 0.05) between female program director percentages across fellowship subspecialties. Results220 out of 287 programs were analyzed: pediatrics (9.1 %), neuroophthalmology (9.5 %), cornea (13.2 %), oculoplastics (16.8 %), uveitis (4.1 %), glaucoma (18.6 %), surgical retina (24.1 %), medical retina (2.3 %), and oncology/pathology (2.3 %). Women fellow-dominated subspecialties (>50 %) included pediatric ophthalmology (69.4 %), neuro-ophthalmology (65.6 %), oculoplastics (61.4 %), and cornea (58.8 %). Uveitis (45.4 %), glaucoma (44.6 %), and surgical retina (32.8 %) were considered women fellow minority subspecialties (< 50 %). Medical retina and oncology/pathology had equal representation of fellows (50 %). Women fellowship directors remain in the minority (< 50 %) across six of the nine fellowships examined; neuro-ophthalmology, oculoplastics, cornea, glaucoma, surgical retina, and oncology/pathology. The women fellow-dominated subspecialties had higher rates of women fellowship program directors (40.2 %) versus women fellow minority subspecialties (28.1 %) (p = 0.0811*). ConclusionThere is a lack of women representation throughout the ophthalmology fellowship program leadership. Subspecialties with predominant women program directors have higher women fellow representation. Future investigations will focus on fellowship applicants and the influence the gender of the program director may have on selection criteria for various subspecialty training.

Glaucoma Severity Stage at First Visit at a University Eye Clinic in Congo.

Initial presentation of glaucoma at a major eye clinic mostly features advanced disease with a high proportion of blindness. This is likely a microcosm of a nationwide issue requiring concerted strategies to detect glaucoma early. To characterize the severity stage of new glaucoma patients and identify the predictors of late presentation in Congolese attending a university eye clinic. New glaucoma patients (n=118) were labelled as early or late presenters based visual field sensitivity in the worse eye. Predictors of late presentation were determined through logistic regression analytical models. Mean age was 58.9±15.7 years, 51.7% were males. Overall, the worse eye had advanced whereas the better eye had moderate glaucoma, with an asymmetry of -7.4dB (P<0.001). Blindness was present in 30.5% of worse and 5.1% of better eyes. Seventy-two patients (61.0%) were late presenters. Visual acuity was lower (P<0.001), intraocular pressure (IOP) higher (P=0.02), cup-to-disc ratio larger (P=0.011), and retinal nerve fiber layer thinner (P=0.001) in late presenters' worse than better eye. The worse and better eyes of late presenters had advanced glaucoma, with a -9.6dB interocular asymmetry (P<0.001); 40.3% and 8.3% were blind, respectively. In early presenters, the worse and better eye had moderate and early disease, respectively; the asymmetry was -3.2dB (P<0.001), and 15.2% were blind. Overall, 58.5% and 65.3% presented with advanced disease in the worse eye based on visual field and cup-to-disc ratio criteria of the Canadian Ophthalmological Society staging scale, respectively. Most new glaucoma patients had bilateral advanced but asymmetric disease. These findings call for the establishment of community-based measures for early detection of glaucoma and a referral network system connecting community healthcare to tertiary eye clinics.

Ophthalmological research in Germany: suggestions by an international expert panel.

To evaluate the research performance in ophthalmology in Germany based on the findings of the recent research map of the German Ophthalmological Society (DOG) and to suggest strategies for future improvements on anational level both to DOG as well as to politics. The focus is on preclinical and translational clinical research. International expert panel evaluation and discussion organized by the Task Force Research of the German Ophthalmological Society (DOG). The international view on the German ophthalmological research landscape was generally positive. The value for money relationship was judged as very good. As Germany is facing an aging society and vision impairment will create an ever-increasing socioeconomic burden, the reviewers suggested several lines of future activities: an increased activity of securing intellectual property, more lay audience lobbying, intensified collaboration and critical mass building between "lighthouses" of ophthalmic research in Germany, as well as the establishment of aGerman national eye institute equivalent. The ophthalmological research performance in Germany was rated to be very good by an international expert panel. Nonetheless significant improvements were requested in the fields of translation (clinical trials, IP), synergy between specialized institutions and governmental funding for aGerman center for eye research.

Assessing the Impact of Simulated Color Vision Deficiency on Ophthalmologists' Ability to Differentiate between Choroidal Melanoma and Choroidal Nevus.

Background: Color vision deficiency (CVD) is an often-overlooked issue within the medical community, and its consequences remain insufficiently explored. We aim to evaluate how CVD affects diagnostic accuracy and distinguish between malignant choroidal melanoma and benign choroidal nevus among ophthalmologists. Methods: In this cross-sectional study, we engaged ophthalmologists through a web-based survey distributed via the professional ophthalmology society's social media channels. The survey encompassed a series of three fundus images representing normal fundus, choroidal nevus, and choroidal melanoma. Each image underwent simulation for the three primary types of CVD-protanopia, deuteranopia, and tritanopia-alongside a non-simulated version. Results: The study included 41 participants, averaging 40 years of age (±9.2), comprising 28 (68%) men and 13 (32%) women. Significantly lower rates of identifying orange pigments were observed in simulated protanopia images compared to non-simulated ones (p = 0.038). In simulated deutranopia images, the recognition of melanotic lesions was notably reduced compared to non-simulated images (p = 0.048). No such limitation was observed for tritanopia. However, participants retained their ability to identify subretinal fluid and estimate tumor thickness in simulated and non-simulated images. Concerning simulated images of choroidal nevi, participants misdiagnosed nevi as choroidal melanoma in 37% of cases in simulated protanopia nevi images and 41% in simulated deutranopia nevi images. This resulted in unnecessary referrals of benign lesions as malignant, emphasizing the potential for mistaken diagnoses. Nevertheless, almost all simulated images of malignant melanoma were correctly referred for specialized oncological treatment. Conclusions: The simulated CVD conditions of protanopia and deuteranopia affected the accuracy of identifying the melanotic nature of the choroidal tumor and the presence of orange pigments. This limitation led to challenges in correctly diagnosing choroidal melanoma and choroidal nevus, resulting in extra referrals for nevus cases. However, participants were safe and could still determine the possible risk of eyes with choroidal melanoma, so most referred melanoma cases to specialized oncologists as needed.

Allvar Gullstrand: The Only Ophthalmologist Who Won the Nobel Prize.

Allvar Gullstrand, the Swedish ophthalmologistand Nobel laureate, was a self-taught mathematician who applied mathematics and higher-order equations to understand the optic system. His inventions, the slit lamp, and the ophthalmoscopeareused in clinical practice for the diagnosis of eye diseases. With his efforts, he explained the accommodation, the process of changing the shape of the lens to focus on near or distant objects.In 1911, he was awarded the Nobel Prize in Physiology or Medicine. In 1913, he was elected as the first president of the Swedish Ophthalmological Society. In 1927, he was awarded the Graefe Medal of the Deutsche Ophthalmologische Gesellschaft.