[Hebei Province Ophthalmologists current situation survey 2013]

OBJECTIVE

This survey is conducted by Hebei Society of Ophthalmology to understand the current situation of the department of ophthalmology in Hebei province, in order to help the Branch to develop an effective, highly-targeted and practical continuing education program.

METHODS

A questionnaire is used in this survey, which consists of 4 sections and 25 items, covering Basic Information, Hospital and Department, Personal Practice and Open-ended Questions. The questionnaire is distributed and collected by the Society of Ophthalmology of each region in Hebei province to all medical institutions in their area which have the ability to carry out ophthalmic clinical work. After the aggregation of the questionnaire and according to the omission, Hebei Society of Ophthalmology contacts the individuals who missed the survey by direct calls, letter post and email, etc. to finish the survey.

RESULTS

This survey covers 121 counties and cities (coverage 85.8%), 305 medical institutions and 1 485 ophthalmologists. Results shows that trained ophthalmologists take a high proportion (84.3%) in all hospitals, the percentage of ophthalmologists who are eager to learn and improve is high (94.8%), the percentage of ophthalmologists having a Bachelor degree or above is high (68.9%). However, the percentage of ophthalmologists having a Master or Doctor degree is relatively low (19.6%), the talents who can independently carry out vitrectomy are insufficient (4.1%), the percentage of the medical institutions not having basic ophthalmic equipment is high (37.3%).

CONCLUSIONS

The reasons restraining the development of Ophthalmology in Hebei province include the lack of professional talents and ophthalmic equipment. The contradiction between the increasing demand of the public for ophthalmological treatment and the limited medical service level we can provide is the primary contradiction in the departments of Ophthalmology in Hebei province. After the survey and according to the results, Hebei Society of Ophthalmology will organize more training to meet the desire and interest of the ophthalmologists in our province, to achieve the ultimately goal of improving the Ophthalmic medical level throughout the province.

Three ophthalmological instruments: the rotating contact glass holder, the cutying forceps and the diamond cystotome

Three new ophthalmological instruments are described: a rotating contact glass holder for easier control of the three-mirror Goldmann or other diagnostic contact lens which must be rotated on the eye; a suture-tying forceps combined with a sapphire blade, combining the tying and cutting functions in one instrument and a diamond cystotome for anterior capsulectomy with a cutting edge of unequalled sharpness.

Vitreous surgery as a supplement to anterior segment surgery

Selected vitreous surgery techniques can provide effective and safe means of supplementing anterior segment surgery for correction or avoidance of many problems. In my experience, the guillotine or piston action vitrectomy instruments are more effective and safer than those which have a rotating or oscillating action. Pars plana vitreous surgery has added a new dimension to anterior segment surgery. There is reason to hope that the future will bring further refinements of instrumentation and surgical technique and more precise knowledge of the indications and limitations of this type of surgery.

A survey of general practitioners' knowledge and perceived confidence with clinical ophthalmology

The quality of general practitioner (GP) ophthalmology referrals to emergency departments has been reported to be sub-optimal. It is possible that a lack of adequate formal training in ophthalmology for GPs contributes to this situation. Data in this study was obtained from a postal survey of GPs to ascertain their knowledge of, and confidence with, clinical ophthalmology skills as well as their training in this speciality. Undergraduate ophthalmology training was rated as inadequate by 35/50 (70%) respondents. 28 (56%) respondents reported to be confident with their clinical ophthalmology skills. 19 (38%) GPs reported to have good knowledge of ophthalmology, and this was strongly associated with a positive appraisal of their undergraduate ophthalmology training (92%, P < 0.01), having experience working in an ophthalmology department (80%, p = 0.14) and having received GP training abroad (52%, p = 0.16). Regarding ophthalmology equipment, 47 (94%) GPs reported to have an ophthalmoscope but only 33 (66%) were confident with its use and just 20 (40%) could confidently distinguish an abnormal optic disc. Lack of knowledge of ophthalmology may have a significant impact on patient care and could be addressed by including clinical skills training in GP specialist training or continuing professional development schemes.

The ophthalmology microscalpel versus standard scalpels and wound healing in a rat model

OBJECTIVE

We tested the hypothesis that the ophthalmology microscalpel, compared to standard incisional instruments, causes less trauma during incisions resulting in decreased inflammation and greater tensile strength of wounds.

STUDY DESIGN

Prospective animal study.

SETTING

Animal laboratory.

SUBJECTS AND METHODS

Thirty-four Sprague-Dawley rats received dorsum skin incisions with the microscalpel, electrosurgical device, 11 blade scalpel, and 15 blade scalpel. Wounds were harvested at 1 week, 2 weeks, 3 weeks, and 6 weeks, then analyzed histologically in a blinded manner for inflammation markers and tested for tensile strength.

RESULTS

The microscalpel wounds had significantly higher tensile strength compared to the 15 blade (P = .045) and electrocautery device (P = .000) but equivocal strength to the 11 blade (P = .457). The electrocautery wounds were weaker than all 3 steel blades. No significant difference was found between the microscalpel, 11 blade, and 15 blade incisions for the 5 markers of inflammation. Electrocautery wounds had significantly worse inflammatory scores, specifically, higher angiogenesis and larger wound gap compared to the microscalpel (P = .004, P = .002), 11 blade (P = .007, P = .023), and 15 blade (P = .010, P = .003), respectively.

CONCLUSION

Microscalpel incisions result in less inflammation and increased tensile strength compared with electrocautery and higher tensile strength compared to the 15 blade in the rat model. Inflammation scores were equivocal between the microscalpel, 11 blade, and 15 blade. Our findings support the use of the microscalpel blade for facial plastic and reconstructive procedures. Prospective, randomized human studies are warranted.

Medical devices; ophthalmic devices; classification of the eyelid weight. Final rule

The Food and Drug Administration (FDA or Agency) is classifying the eyelid weight into class II (special controls). The Agency is exempting the external eyelid weight from premarket notification, but continuing to require premarket notification for implantable eyelid weights in order to provide a reasonable assurance of safety and effectiveness of the device. Both external and implantable eyelid weight devices are subject to special controls. The eyelid weight may be adhered to the outer skin of the upper eyelid (external eyelid weight) or implanted into the upper eyelid (implantable eyelid weight), and is intended for the gravity assisted treatment of lagophthalmos (incomplete eyelid closure).

Measurement and analysis of the air pressure curve on the rigid lenses by use of ocular response analyzer

PURPOSE

Pressure curves obtained from Ocular Response Analyzer (ORA) differ for the same patient in form and height. In some cases measurements on the subject show significant differences between recorded pressure curves. The purpose of the paper is to examine if the differences result from the corneal properties or from the device operation.

METHODS

Examination of air pressure curves was carried out on four plano-convex glass lenses with radii of curvature close to the central corneal radius. Lenses were mounted in front of the air jet of the ORA analyzer. Series of 30 measurements on each lenses were recorded with 20 s and 60 s time interval between measurements. RESULTS were exported to computer and analyzed numerically.

RESULTS

RESULTS show much higher reproducibility of pressure curves in every series of measurements in comparison to pressure curves recorded on the patients eye. This demonstrates that ORA produces air pulses with high reproducibility.

CONCLUSIONS

Differences in air pressure pulses for the real eye can indicate the dynamics of ocular properties during measurements. Obtained pressure curves are not symmetrical and not well fitted by Gaussian curve. Type of asymmetry of air pressure curves may be explained by viscoelasticity of air.

Medical devices; ophthalmic devices; classification of the scleral plug. Final rule

The Food and Drug Administration (FDA or Agency) is classifying the scleral plug into class II (special controls), and exempting the scleral plugs composed of surgical grade stainless steel (with or without coating in gold, silver, or titanium) from premarket notification (510(k)) and continuing to require premarket notification (510(k)) for all other scleral plugs in order to provide a reasonable assurance of safety and effectiveness of the device. The scleral plug is a prescription device used to provide temporary closure of a scleral incision during an ophthalmic surgical procedure.

[Development of slit-lamp microscope and its applications in optics]

This paper mainly introduces the origin and development of the slit-lamp microscope, the basic structure, working principle and test methods, focuses on diffuse illumination, direct focal illumination, indirect illumination, retro illumination, zone of specular reflection and slit-lamp filter used in the optical inspection, to provide the reference for clinical general optometry practitioners and using slit-lamp microscope widely and standardized.

Towards automatic detection of abnormal retinal capillaries in ultra-widefield-of-view retinal angiographic exams

Retinal capillary abnormalities include small, leaky, severely tortuous blood vessels that are associated with a variety of retinal pathologies. We present a prototype image-processing system for detecting abnormal retinal capillary regions in ultra-widefield-of-view (UWFOV) fluorescein angiography exams of the human retina. The algorithm takes as input an UWFOV FA frame and returns the candidate regions identified. An SVM classifier is trained on regions traced by expert ophthalmologists. Tests with a variety of feature sets indicate that edge features and allied properties differentiate best between normal and abnormal retinal capillary regions. Experiments with an initial set of images from patients showing branch retinal vein occlusion (BRVO) indicate promising area under the ROC curve of 0.950 and a weighted Cohen's Kappa value of 0.822.

An efficient capacitive sensing scheme for an ophthalmic regional anesthesia training system

Ophthalmic regional blocks are critical preoperative procedures involving the insertion of a syringe needle into the orbital cavity at such a position and angle that akinesia and analgesia is achieved without damage or harm to the eye and its associated musculature. A training system that accurately represents the orbital anatomical features and provides qualitative feedback on the performed anesthetic technique, can be of immense help in reducing risks involved in regional block administration. In this paper, a training system that employs a special but simple capacitive sensing scheme has been developed. A rapid prototyped eye-model has been used to ensure anatomical accuracy. Capacitive transmitter electrodes placed on the orbital wall along the length of the extraocular muscles are excited with a special excitation sequence and the displacement current at the needle of the syringe is measured using simple electronic unit and a Data Acquisition System, enabling the developed Virtual Instrument to detect the depth of penetration and proximity of the syringe needle to the ocular muscles. Additionally, the system detects needle touch of the muscles accurately. The proposed electrode array system and excitation schemes have been validated on a prototype system thus demonstrating its usefulness for practical training purposes.

Descemet stripping automated endothelial keratoplasty with a donor insertion device: clinical results and complications in 100 eyes

PURPOSE

To study the clinical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) with the EndoGlide donor insertion device.

DESIGN

Retrospective interventional case series.

METHODS

We included 100 eyes that underwent DSAEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy (PBK) at a single institution. Eyes with anterior segment pathology or previous intraocular surgery (except for uncomplicated cataract surgery) were excluded. Preoperative data included visual acuity and donor endothelial cell density by specular microscopy. The main outcome measures were postoperative best spectacle-corrected visual acuity (BSCVA) and endothelial cell loss at 3, 6, and 12 months.

RESULTS

There were 59 eyes with Fuchs dystrophy and 41 eyes with PBK. In eyes without vision-limiting pathology, the median postoperative BSCVA was consistently 20/40 (range 20/20-20/400) at 3 months (n = 61 eyes), 6 months (n = 55 eyes), and 12 months (n = 48 eyes). Endothelial cell loss was 13.7% at 3 months (n = 57), 13.5% at 6 months (n = 61), and 14.9% at 12 months (n = 53). Primary graft failure occurred in 1 eye, attributable to incorrect use of the insertion device. Two eyes with complete donor dislocation were rebubbled successfully. The most common complication was glaucoma/ocular hypertension in 29 eyes (34.1%) without prior glaucoma and treatment escalation in 6 eyes (40.0%) with prior glaucoma. Of the 78 eyes with 12 months follow-up, 2 (2.6%) developed endothelial rejection, and 1 (1.3%) subsequently failed.

CONCLUSIONS

The use of this donor insertion device during DSAEK demonstrates good outcomes and potentially low endothelial cell loss at up to 12 months after surgery.

Suction-based grasping tool for removal of regular- and irregular-shaped intraocular foreign bodies

BACKGROUND AND OBJECTIVE

To describe a suction-based grasping tool for the surgical removal of irregular-shaped and nonferromagnetic intraocular foreign bodies.

MATERIALS AND METHODS

A surgical tool with suction capabilities, consisting of a stainless steel shaft with a plastic handle and a customizable and interchangeable suction tip, was designed in order to better engage and manipulate irregular-shaped in-traocular foreign bodies of various sizes and physical properties. The maximal suction force and surgical capabilities were assessed in the laboratory and on a cadaveric eye vitrectomy model.

RESULTS

The suction force of the water-tight seal between the intraocular foreign body and the suction tip was estimated to be approximately 40 MN. During an open-sky vitrectomy in a porcine model, the device was successful in engaging and firmly securing foreign bodies of different sizes and shapes.

CONCLUSION

The suction-based grasping tool enables removal of irregular-shaped and nonferromagnetic foreign bodies.

[Requirements for information about medical parameters in the field of ophthalmology]

The authors came to conclusion that modern concept of medical information systems imply the development of electronic case-record using medical archives, results of laboratory and instrumental researches, based on modern information exchange technologies. The main criterion of realisation of this concept is solving of diagnosis problems. All parameters of diagnosis and treatment can be divided into three groups: measurable, observable and calculable. Measurable parameters -parameters, whose quantitative meanings can be measured with the help of special equipment and procedures of ist application. Observable parameters--parameters that can be observed with the help of biomicroscope, fundus-camera, ophthalmoscope and etc. Specific characteristic of these parametrs is not a qualitative evaluation, but quantative description and high level of subjectivity. The third group--parameters that cannot be measured or observed. These parameters can be received computationally or in the process of simulating. These parameters are result of mechanical and mathematical simulation of physiological and pathologic process of visual organ. The authors suggested requirements for ophthalmological workstation.

Simple binocular vision examination on synoptophore determination of normative database of healthy adult subjects examination of binocular vision on synoptophore

The main goal of our study was to determine the database of parameters of simple binocular vision (SBV) in healthy adult population. Next goal was to verify current data of particular parameters of SBV Average subjective deviation for far of all 74 subjects was 2.78 +/- 3.65 cm/m, of women was 2.90 +/- 3.69 cm/m and only for men was 2.00 +/- 3.49 cm/m. According our measurements the positive fusion range of all subjects is 25.10 +/- 12.77 cm/m, negative fusion range -6.45 +/- 4.18 cm/m, accommodation convergence to accommodation ratio (AC/A) is 3.41 +/- 1.47 cm/m and subjective deviation with accommodation on 33 cm (with minus 3 D) is 13.02 +/- 5.23 cm/m. Further we proved statistically significant correlation between these parameters of SBV: Age and AC/A, SU-3 and AC/A, SU0 and SU-3, SU-3 and FS0 and FS-3. Knowledge of basic SBV parameters is important not only for ophthalmologist but also for optometrists.

Resolution improvement in spectral-domain optical coherence tomography based on classical intensity correlations

We describe a resolution-improved spectral-domain (SD) optical coherence tomography (OCT) based on classical intensity correlations as a counterpart of the recently proposed intensity-based time-domain OCT. Similarly to quantum OCT, the setup employs the Hong-Ou-Mandel interferometer at the output of the conventional SD-OCT. It is shown theoretically that a factor-of-√2 improvement in axial resolution is obtained with this arrangement. Some unique and useful features of our proposed system are addressed.

Allvar Gullstrand and the slit lamp 1911

The Swedish ophthalmologist and self-taught mathematician Allvar Gullstrand (1862-1930) invented the slit lamp to illuminate the anterior of the eye. With its rectangular beam of very bright light, he studied the structure of the cornea and the function of the lens. His dioptric investigations showed that, as well as the extracapsular mechanism described by Helmholtz, changes in the substance of the lens, that he termed intracapsular, also contribute to accommodation. However, his invention has been appropriated by clinical ophthalmologists and is now routinely used in examination of the eye.

[Analysis residues of perfluorooctane used in ophthalmic operation]

Analyzed the purity of the Perfluorooctane used for Ophthalmic operation using the FID (Flame Ionization Detector) method after the qualitative analysis of that. Research and discussion of the 1--hydrogen perfluorocarbon octane, which is the typical impurity of Perfluorooctane. The standard recovery of the 1--hydrogen perfluorocarbon octane is 93%-97% within the range of linearity, and the RSD (relative standard deviation) is below 2%. The above test method has the advantages of easy operation, stability and accuracy. So it is a good reference support to bring the specification of quality control of the Perfluorooctane which is used for Ophthalmic operation into YY of medical device.