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Liu C, Lin J, Wu S, Zhu Y, Zou Y, Zhang Q, Li Z, Zhuo Y, Li Y. Eyesi direct ophthalmoscope simulator: an effective training tool for medical undergraduates. BMC MEDICAL EDUCATION 2024; 24:783. [PMID: 39033099 PMCID: PMC11265108 DOI: 10.1186/s12909-024-05780-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Non-ophthalmologists often lack sufficient operational training to use a direct ophthalmoscope proficiently, resulting in a global deficit of basic ophthalmological skills among general practitioners. This deficiency hampers the timely diagnosis, referral, and intervention of patients. Consequently, the optimization of teaching tools and methods to enhance teaching efficiency is imperative. This study explores the effectiveness of the Eyesi Direct Ophthalmoscope Simulator (Eyesi) as an innovative tool for fundus examination training. METHODS Medical undergraduates were randomly assigned to Group A or B (n = 168). All participants completed a pre-training questionnaire. Group A received Eyesi training, while Group B underwent traditional direct ophthalmoscope (TDO) training. Subsequently, participants answered questionnaires relevant to their respective training methods. Both groups exchanged training tools and completed a summary questionnaire. RESULTS After training, 54.17% of participants believed that images presented by the Eyesi were consistent with the real fundus. Group A scored significantly higher than Group B in fundus structure recognition and self-confidence in examination. The degree of mastery over fundus theory score increased from 6.10 ± 0.13 to 7.74 ± 0.16 (P < 0.001) in Group A, but Group B did not demonstrate a significant difference. We also compared undergraduates' tendencies for different learning purposes, 75.59% of participants preferred the Eyesi to TDO as a training tool, and 88.41% of participants were receptive to introducing the Eyesi in training. CONCLUSION According to subjective participant feedback, Eyesi outperformed TDO in fundus observation, operational practice, and theoretical learning. It effectively equips undergraduates with fundus examination skills, potentially promoting the use of direct ophthalmoscopes in primary medical institutions.
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Affiliation(s)
- Canying Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Jicheng Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Siting Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yingting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yuxian Zou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Qi Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Zhidong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China.
| | - Yiqing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China.
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Sebbag L, Ofri R, Arad D, Handel KW, Pe'er O. Using a smartphone-based digital fundus camera for screening of retinal and optic nerve diseases in veterinary medicine: A preliminary investigation. Vet Rec 2024; 194:e4088. [PMID: 38637964 DOI: 10.1002/vetr.4088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/30/2024] [Accepted: 03/14/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Ophthalmoscopy is a valuable tool in clinical practice. We report the use of a novel smartphone-based handheld device for visualisation and photo-documentation of the ocular fundus in veterinary medicine. METHODS Selected veterinary patients of a referral ophthalmology service were included if one or both eyes had clear ocular media, allowing for examination of the fundus. Following pharmacological mydriasis, fundic images were obtained with a handheld fundus camera (Volk VistaView). For comparison, the fundus of a subset of animals was also imaged with a veterinary-specific fundus camera (Optomed Smartscope VET2). RESULTS The large field of view achieved by the Volk VistaView allowed for rapid and thorough observation of the ocular fundus in animals, providing a tool to visualise and record common pathologies of the posterior segment. Captured fundic images were sometimes overexposed, with the tapetal fundus artificially appearing hyperreflective when using the Volk VistaView camera, a finding that was less frequent when activating a 'veterinary mode' that reduced the sensitivity of the camera's sensor. The Volk VistaView compared well with the Optomed Smartscope VET2. LIMITATION The main study limitation was the small sample size. CONCLUSIONS The Volk VistaView camera was easy to use and provided good-quality fundic images in veterinary patients with healthy or diseased eyes, offering a wide field of view that was ideal for screening purposes.
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Affiliation(s)
- Lionel Sebbag
- Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Ron Ofri
- Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Dikla Arad
- Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Karin W Handel
- Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Oren Pe'er
- Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
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Liao J, Wright RR, Vora GK. The Decline of Basic Ophthalmology in General Medical Education: A Scoping Review and Recommended Potential Solutions. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241245635. [PMID: 38596233 PMCID: PMC11003344 DOI: 10.1177/23821205241245635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE This literature review aims to explore research and conceptual pieces on the state of ophthalmology education and suggest potential ways to address current challenges. METHODS A search was conducted in PubMed, ERIC, Web of Science, and Google Scholar with combinations of the following search terms: "ophthalmology education," "undergraduate medical education," "medical student," "United States," and "Canada." Eliminating irrelevant articles yielded 47 articles. Three were excluded because of region and focus, leaving 44. After examining the citations, we generated an additional 22 texts for review, totaling 66 articles. RESULTS Four primary themes were identified: (1) challenges to ophthalmological education in the U.S. and Canada, (2) potential remedies for optimizing ophthalmology curriculum, (3) technology in ophthalmology education, and (4) innovative ophthalmology teaching approaches. Major challenges included the lack of a standardized curriculum and inadequate clinical exposure and skills training. A number of remedies were proposed, such as standardizing curriculum and furthering faculty involvement, utilizing technology as time-effective learning aids, and employing innovative teaching approaches such as service learning. CONCLUSION In light of challenges in ophthalmology education, curriculum designers should consider Cognitive Load Theory (CLT) to assist students to remember meaningful exposures to ophthalmology knowledge and techniques. Based on CLT, we suggest two potential approaches to incorporating ophthalmology curriculum. The first is to embrace interdisciplinary collaborations and place ophthalmology knowledge in varied contexts to facilitate schema construction. The second is to incorporate ophthalmology diagnostics requirements into OSCEs and utilize simulation models for students to gradually increase the fidelity of tasks and devote cognitive resources fully to learning.
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Affiliation(s)
- Jennifer Liao
- Department of Ophthalmology, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Robin Redmon Wright
- Department of Behavioral Sciences and Education, Pennslyvania State University Harrisburg, Middletown, PA, USA
| | - Gargi K Vora
- Department of Ophthalmology, Yale School of Medicine, New Haven, CT, USA
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Kherani IZ, Kritzinger J, Micieli JA, Wong JCY. Evaluating smartphone fundoscopy as a pedagogical tool in medical education: a narrative review. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00305-8. [PMID: 37865120 DOI: 10.1016/j.jcjo.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 03/05/2023] [Accepted: 07/31/2023] [Indexed: 10/23/2023]
Abstract
Direct ophthalmoscopy continues to be the "gold standard" method for retinal and optic nerve evaluation despite known challenges for learners to acquire this clinical skill and minimal opportunities for patient-facing practice. Here we review current literature regarding smartphone fundoscopy (SF) as an alternative learning tool that remains underutilized in Canadian medical schools. SF has significant advantages over direct ophthalmoscopy, such as enhanced learner visualization of ocular structure and pathologies, greater learner usability in comparison, and improved fundus assessment during more difficult ocular examinations such as with pediatric patients. Furthermore, SF provides opportunities for instructor exchange and feedback, group learning, increased learner confidence, and most important, an improved patient experience. Yet challenges remain with SF, including patient confidentiality during data capture and sharing and meaningful integration into an already limited and saturated curriculum. Our review finds SF to be a pedagogic tool with the potential to reinvigorate fundoscopy learning to improve competency in this important clinical skill.
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Affiliation(s)
| | | | - Jonathan A Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Kensington Vision and Research Center, Toronto, Ont
| | - Jovi C Y Wong
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont..
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Corr RH. Fundoscopy in the smartphone age: current ophthalmoscopy methods in neurology. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:502-509. [PMID: 37257471 DOI: 10.1055/s-0043-1763489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The observation of the human retina in vivo began in 1851 after the invention of the first ophthalmoscope by the German physicist Hermann von Helmholtz. In the following decades, direct and indirect ophthalmoscopy, with the use of ophthalmoscopes and condensing lenses, respectively, became part of the clinical examination, especially in ophthalmology and neurology. Today, over 170 years later, many ophthalmoscopes and condensing lenses exist on the market. Nevertheless, ophthalmoscopy is still not widely adopted as part of the physical exam of general practitioners, and the teaching of ophthalmoscopy in medical school remains challenging. Studies have shown that students prefer using newer ophthalmoscope models or condensing lenses during training, but most do not feel confident in performing ophthalmoscopy afterwards, regardless of the models used. Also, few students acquire ophthalmoscopes for their future practice, and clinical trials have not clearly demonstrated superiority of newer ophthalmoscope models over the conventional ones in diagnostic accuracy. The technological improvement of smartphone cameras in recent years has made it feasible to photograph the fundus of the eye using ophthalmoscopes or condensing lenses, reducing the need for retinographs and similar equipment. Smartphone assisted indirect fundoscopy is becoming increasingly popular. This approach allows adequate identification of the structures of the fundus, is cost-efficient, easy to implement, and permits easy recording and sharing of the images obtained, which is useful for case discussions and medical teaching. However, controlled clinical trials validating this method in the evaluation of optic nerve pathologies are needed.
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Affiliation(s)
- Richard Henrik Corr
- Universidade Federal do Rio de Janeiro, Hospital Federal dos Servidores do Estado, Rio de Janeiro RJ, Brazil
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Bouthour W, Biousse V, Newman NJ. Diagnosis of Optic Disc Oedema: Fundus Features, Ocular Imaging Findings, and Artificial Intelligence. Neuroophthalmology 2023; 47:177-192. [PMID: 37434667 PMCID: PMC10332214 DOI: 10.1080/01658107.2023.2176522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/12/2023] [Accepted: 01/29/2023] [Indexed: 02/18/2023] Open
Abstract
Optic disc swelling is a manifestation of a broad range of processes affecting the optic nerve head and/or the anterior segment of the optic nerve. Accurately diagnosing optic disc oedema, grading its severity, and recognising its cause, is crucial in order to treat patients in a timely manner and limit vision loss. Some ocular fundus features, in light of a patient's history and visual symptoms, may suggest a specific mechanism or aetiology of the visible disc oedema, but current criteria can at most enable an educated guess as to the most likely cause. In many cases only the clinical evolution and ancillary testing can inform the exact diagnosis. The development of ocular fundus imaging, including colour fundus photography, fluorescein angiography, optical coherence tomography, and multimodal imaging, has provided assistance in quantifying swelling, distinguishing true optic disc oedema from pseudo-optic disc oedema, and differentiating among the numerous causes of acute optic disc oedema. However, the diagnosis of disc oedema is often delayed or not made in busy emergency departments and outpatient neurology clinics. Indeed, most non-eye care providers are not able to accurately perform ocular fundus examination, increasing the risk of diagnostic errors in acute neurological settings. The implementation of non-mydriatic fundus photography and artificial intelligence technology in the diagnostic process addresses these important gaps in clinical practice.
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Affiliation(s)
- Walid Bouthour
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nancy J. Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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Muhsen S, Roto A, Al-Sabbagh MQ, Al-Huneidy L, AlRamahi N, Alhalaybeh N, Kotkot D, Alkiswani S, Al-Ani A, Abu-Yaghi N. Smartphone ophthalmoscopy versus slit-lamp biomicroscopy for optic nerve head evaluation: A digital apparatus into medical education. Eur J Ophthalmol 2023; 33:341-351. [PMID: 35837720 DOI: 10.1177/11206721221113827] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Th aim of this study is to explore the diagnostic accuracy of smartphone-based D-EYE ophthalmoscopy in the diagnosis of optic nerve head (ONH) abnormalities and screening for glaucoma. METHODS This is a prospective clinical-based validation study performed on 90 patients recruited from a tertiary teaching hospital. Patients underwent dilated fundus examination by slit-lamp and smartphone-based D-EYE fundoscopy operated by two experienced ophthalmologists. RESULTS The diagnostic accuracy of smartphone-based D-EYE ophthalmoscopy of normal vertical cup-to-disc ratio (VCDR) was acceptable (sensitivity 85.8%-96.4%; specificity 51.4%-96.4%). The D-EYE would often underestimate VCDR values as mean VCDR was significantly lower among overall and glaucoma cohorts (all p-value <0.001) for D-EYE in comparison with slit-lamp. In terms of ONH abnormalities, the D-EYE adequately demonstrated high sensitivity in the identification of only margins-related abnormalities (sensitivity 92.5%-96.6%). Overall, the diagnostic accuracy and agreement between expert ophthalmologists using the D-EYE and the reference slit-lamp examination were significantly poor. CONCLUSION We demonstrated that the D-EYE is a highly specific tool for VCDR within the normal range but not in patients with glaucoma. Despite being an easy and portable tool to measure VCDR, it is limited in terms of diagnosing ONH and blood vessel abnormalities.
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Affiliation(s)
- Sana Muhsen
- Special Surgery Department/Ophthalmology Division, School of Medicine, University of Jordan, Amman, Jordan
| | - Allaa Roto
- Special Surgery Department/Ophthalmology Division, School of Medicine, University of Jordan, Amman, Jordan
| | | | | | - Nura AlRamahi
- School of Medicine, University of Jordan, Amman, Jordan
| | | | - Duaa Kotkot
- School of Medicine, University of Jordan, Amman, Jordan
| | | | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, 37559King Hussein Cancer Center, Amman, Jordan
| | - Nakhleh Abu-Yaghi
- Special Surgery Department/Ophthalmology Division, School of Medicine, University of Jordan, Amman, Jordan
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Hairol MI, Lee YR. Accuracy of vertical cup-to-disc ratio discrimination among clinical optometry trainees with different years of clinical experience. PLoS One 2022; 17:e0274834. [PMID: 36112726 PMCID: PMC9481025 DOI: 10.1371/journal.pone.0274834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/02/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Accurate evaluation of the cup-to-disc ratio is crucial for optometrists and may be influenced by their clinical experience. The study’s objective was to compare the thresholds for discriminating vertical cup-to-disc ratio (VCDR) between years 2, 3, and 4 clinical optometry trainees. Methods One hundred fundus photos with various VCDR sizes were selected from a clinic database. The median VCDR (0.43) photo was assigned as the standard, while the other 99 were assigned as the test photos. The participant’s task was to discriminate using a 2-alternate-forced-choice paradigm whether the test photos’ VCDR were larger or smaller than the standard VCDR. Data were fit with a Weibull function, and three discrimination thresholds were determined: the point of subjective equality (PSE), the range of VCDR uncertainty, and the ability to judge VCDR that was 0.1 unit larger than the standard photo. Results Year 4 trainees had better VCDR discrimination thresholds. However, the difference between the three participant groups was not statistically different for all measurements (PSE: F(2,27) = 0.43, p = 0.657; VCDR uncertainty range: F(2,27) = 0.12, p = 0.887), and thresholds for correctly discriminating VCDR 0.1 larger than the standard photo’s VCDR: F(2,27) = 0.69, p = 0.512). Conclusion Although Year 4 optometry trainees performed slightly better at estimating VCDR than their Year 3 and Year 2 peers, the number of years of clinical experiences did not significantly affect their VCDR discrimination thresholds when 2-dimensional fundus photos were used as stimuli.
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Affiliation(s)
- Mohd Izzuddin Hairol
- Optometry & Vision Science Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- * E-mail:
| | - Yun Rou Lee
- Optometry & Vision Science Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Biousse V, Danesh-Meyer HV, Saindane AM, Lamirel C, Newman NJ. Imaging of the optic nerve: technological advances and future prospects. Lancet Neurol 2022; 21:1135-1150. [DOI: 10.1016/s1474-4422(22)00173-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 01/02/2023]
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Howell GL, Chávez G, McCannel CA, Quiros PA, Al-Hashimi S, Yu F, Fung S, DeGiorgio CM, Huang YM, Straatsma BR, Braddock CH, Holland GN. Prospective, Randomized Trial Comparing Simulator-based versus Traditional Teaching of Direct Ophthalmoscopy for Medical Students. Am J Ophthalmol 2022; 238:187-196. [PMID: 34801508 DOI: 10.1016/j.ajo.2021.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare results of simulator-based vs traditional training of medical students in direct ophthalmoscopy. DESIGN Randomized controlled trial. METHODS First-year medical student volunteers completed 1 hour of didactic instruction regarding direct ophthalmoscopes, fundus anatomy, and signs of disease. Students were randomized to an additional hour of training on a direct ophthalmoscope simulator (n = 17) or supervised practice examining classmates (traditional method, n = 16). After 1 week of independent student practice using assigned training methods, masked ophthalmologist observers assessed student ophthalmoscopy skills (technique, efficiency, and global performance) during examination of 5 patient volunteers, using 5-point Likert scales. Students recorded findings and lesion location for each patient. Two masked ophthalmologists graded answer sheets independently using 3-point scales. Students completed surveys before randomization and after assessments. Training groups were compared for grades, observer- and patient-assigned scores, and survey responses. RESULTS The simulator group reported longer practice times than the traditional group (P = .002). Observers assigned higher technique scores to the simulator group after adjustment for practice time (P = .034). Combined grades (maximum points = 20) were higher for the simulator group (median: 5.0, range: 0.0-11.0) than for the traditional group (median: 4.0, range: 0.0-9.0), although the difference was not significant. The simulator group was less likely to mistake the location of a macular scar in 1 patient (odds ratio: 0.28, 95% confidence interval: 0.056-1.35, P = .013). CONCLUSIONS Direct ophthalmoscopy is difficult, regardless of training technique, but simulator-based training has apparent advantages, including improved technique, the ability to localize fundus lesions, and a fostering of interest in learning ophthalmoscopy, reflected by increased practice time.
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Vloka C, Wingrove P, Ong J, Koretz Z, Yadav S, Dmitriev A, Bowers L, Miller T, Samanthapudi K, Beale O, Waxman E. A Novel Approach to Teaching Fundoscopy Using a Virtual Format. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11252. [PMID: 35692603 PMCID: PMC9135915 DOI: 10.15766/mep_2374-8265.11252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022]
Abstract
Introduction Ophthalmology education has been underemphasized in medical school curricula despite the fact that patient eye-related complaints are commonplace across primary care specialties. Although previous curricula used direct ophthalmoscopy to teach medical students the fundamentals of ophthalmic examination, there has been a growing call to teach these fundamentals through reading fundus photos due to the increasing prevalence and decreased costs of fundus cameras in primary care settings. We developed a virtual workshop to teach ophthalmoscopy to medical students using fundus photography. Methods First-year medical students were enrolled in a 2-hour, synchronous, virtual ophthalmoscopy workshop as part of an advanced physical exam curriculum at the University of Pittsburgh School of Medicine. Students participated in a pretest, introductory lecture, interactive small-group session, and posttest. Breakout groups were led by senior medical students or residents. We compared pre- and posttest results for improved understanding of concepts covered in the workshop. Results Of 147 students, the average scores on the pretest and posttest were 39% and 75%, respectively (p < .01). Students were significantly more confident in their ability to identify various pathologies on fundus photography. After the workshop, the student preceptors indicated increased comfort in a teaching role and greater interest in medical education. The preceptors were also more confident in their own ability to interpret fundus photography and in their understanding of various ocular pathologies. Discussion Our virtual, interactive workshop is effective in teaching medical students a systematic approach to the interpretation of fundus photographs.
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Affiliation(s)
- Caroline Vloka
- Third-Year Resident, Department of Ophthalmology, University of Pittsburgh Medical Center
| | - Peter Wingrove
- Fourth-Year Medical Student, University of Pittsburgh School of Medicine
| | - Joshua Ong
- Fourth-Year Medical Student, University of Pittsburgh School of Medicine
| | - Zachary Koretz
- Third-Year Resident, Department of Ophthalmology, University of Pittsburgh Medical Center
| | - Sanya Yadav
- Fourth-Year Medical Student, University of Pittsburgh School of Medicine
| | - Aidan Dmitriev
- Fourth-Year Medical Student, University of Pittsburgh School of Medicine
| | - Levi Bowers
- Fourth-Year Medical Student, University of Pittsburgh School of Medicine
| | - Tyler Miller
- Fourth-Year Medical Student, University of Pittsburgh School of Medicine
| | | | - Oliver Beale
- Fourth-Year Medical Student, University of Pittsburgh School of Medicine
| | - Evan Waxman
- Residency Program Director and Associate Professor, Department of Ophthalmology, University of Pittsburgh Medical Center
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Henick D, Labkovich M, Radell JE, Chopra N, Chadha N. Medical Student Attitudes Toward the Use of Peer Physical Exam for Learning Fundoscopy. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2022. [DOI: 10.1055/s-0042-1743582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Background Peer physical examination learning is commonly practiced in medical schools during preclinical curricula and has been shown to improve empathy for patients. While there is literature regarding medical student attitudes toward peer physical exam learning, no studies to date have specifically examined student attitudes toward fundoscopy and dilation of the eyes for the purposes of learning fundoscopy. This study evaluates medical student preferences with regards to learning fundoscopy on peers and explores attitudes toward alternate approaches.
Methods First year medical students at the Icahn School of Medicine at Mount Sinai participated in a 2-hour fundoscopy skills workshop in March 2020. Following the session, the authors administered a voluntary survey querying students on attitudes toward peer physical exam learning and its use in learning peer fundoscopy. Primary study endpoints evaluated (1) student attitudes toward the use of peer physical exam learning, (2) learning benefit of the session, including student comfort with conducting the fundoscopy exam, and (3) empathy toward patients experiencing dilation. Secondary endpoints focused on alternative teaching methods and preferences for nonmydriatic fundoscopy. Analysis of survey data was performed using nonparametric Spearman's correlations, chi-square tests, t-tests, and Mann–Whitney U tests.
Results A total of 51/138 (37%) students completed the survey, with 78% indicating they felt peer physical exam learning was a helpful instructional method, including for the fundoscopic exam. The session led to improved self-rated fundoscopy skills and empathy for patients. However, when considering learning with dilation versus alternative nonmydriatic techniques, 96% of students indicated a preference for using alternative nonmydriatic techniques.
Conclusion This study found that students' attitudes toward fundoscopy generally aligned with their overall peer physical exam preferences. However, they preferred not using dilation and learning with nonmydriatic fundoscopic techniques. Assessing student learning preferences and incorporating novel instructional tools can help facilitate more successful fundoscopy skills acquisition. These considerations are particularly important in the context of COVID-19 and with advances in teleophthalmology.
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Affiliation(s)
- Daniel Henick
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Margarita Labkovich
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jake E. Radell
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nitin Chopra
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye and Ear Infirmary, Eye and Vision Research Institute, New York, New York
| | - Nisha Chadha
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye and Ear Infirmary, Eye and Vision Research Institute, New York, New York
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Pyatka N, Banks MK, Fotedar N, DeLozier SJ, Morgan M, Preston DC. Nonmydriatic Retinal Photography in the Outpatient Neurology Resident Clinic. J Neuroophthalmol 2022; 42:68-72. [PMID: 34999652 DOI: 10.1097/wno.0000000000001236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The funduscopic examination is an essential component of the neurologic examination. However, examination of the ocular fundus with a direct ophthalmoscope is often difficult. Nonmydriatic ocular fundus photography allows direct visualization of the ocular fundus with high-quality photographs. We used nonmydriatic ocular fundus photography to improve patient care and funduscopy skills of residents in the Neurology Resident Clinic. METHODS At the time of triage, funduscopic photographs of all new neurology resident clinic patients were taken. The images were imported into the hospital's imaging software. The residents completed a full neurologic examination, including a funduscopic examination with a handheld ophthalmoscope. At the time of staffing the patients with the attendings, the residents received immediate feedback and teaching on retina photograph evaluation. RESULTS A total of 255 patients were enrolled. Of those, 230 (90%) had at least one high-quality funduscopic photograph. Retinal photographs were normal in 161 (70%). Out of the 69 abnormal photographs, only 7% of abnormalities were detected by the residents. Ninety-three percent of residents found the retinal photographs useful. CONCLUSIONS Nonmydriatic ocular fundus photography improved the care in patients presenting to a Neurology resident clinic and facilitated residents in recognizing funduscopic findings. Its benefits are clear when one considers (1) the high risk of negative patient outcomes and possible medicolegal consequences due to missed findings, (2) the ease of incorporating retinal photographs into the patients' medical records, and (3) the benefit of improving resident education in regard to the ophthalmologic examination.
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Affiliation(s)
- Nataliya Pyatka
- Neurology Department, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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14
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Virtual and Augmented Reality Direct Ophthalmoscopy Tool: A Comparison between Interactions Methods. MULTIMODAL TECHNOLOGIES AND INTERACTION 2021. [DOI: 10.3390/mti5110066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Direct ophthalmoscopy (DO) is a medical procedure whereby a health professional, using a direct ophthalmoscope, examines the eye fundus. DO skills are in decline due to the use of interactive diagnostic equipment and insufficient practice with the direct ophthalmoscope. To address the loss of DO skills, physical and computer-based simulators have been developed to offer additional training. Among the computer-based simulations, virtual and augmented reality (VR and AR, respectively) allow simulated immersive and interactive scenarios with eye fundus conditions that are difficult to replicate in the classroom. VR and AR require employing 3D user interfaces (3DUIs) to perform the virtual eye examination. Using a combination of a between-subjects and within-subjects paradigm with two groups of five participants, this paper builds upon a previous preliminary usability study that compared the use of the HTC Vive controller, the Valve Index controller, and the Microsoft HoloLens 1 hand gesticulation interaction methods when performing a virtual direct ophthalmoscopy eye examination. The work described in this paper extends our prior work by considering the interactions with the Oculus Quest controller and Oculus Quest hand-tracking system to perform a virtual direct ophthalmoscopy eye examination while allowing us to compare these methods without our prior interaction techniques. Ultimately, this helps us develop a greater understanding of usability effects for virtual DO examinations and virtual reality in general. Although the number of participants was limited, n = 5 for Stage 1 (including the HTC Vive controller, the Valve Index controller, and the Microsoft HoloLens hand gesticulations), and n = 13 for Stage 2 (including the Oculus Quest controller and the Oculus Quest hand tracking), given the COVID-19 restrictions, our initial results comparing VR and AR 3D user interactions for direct ophthalmoscopy are consistent with our previous preliminary study where the physical controllers resulted in higher usability scores, while the Oculus Quest’s more accurate hand motion capture resulted in higher usability when compared to the Microsoft HoloLens hand gesticulation.
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Ayub G, Souza RB, de Albuquerque AM, de Vasconcellos JPC. Comparison of conventional and wide field direct ophthalmoscopy on medical students' self-confidence for fundus examination: a 1-year follow-up. BMC MEDICAL EDUCATION 2021; 21:507. [PMID: 34565378 PMCID: PMC8474948 DOI: 10.1186/s12909-021-02942-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/15/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Fundus examination is an easy, quick and effective way to diagnose sight- and life-threatening diseases. However, medical students and physicians report lack of proficiency and self-confidence in perform fundoscopy. The aim of this study was to compare students' self-confidence in fundus examination, using two different direct ophthalmoscopes, 1 month and 1 year after practical training. METHODS In this prospective cohort, medical students (MS) of the same class were divided in small groups for PanOptic (PO) or conventional (CO) direct ophthalmoscope training. The intervention group encompassed MS of the 4th -year (class of 2019), and the control group encompassed MS of year behind (class of 2020). A questionnaire to measure self-confidence in fundoscopy technique assessing optic nerve, cup-to-disc ratio and macula was translated and validated to Portuguese, and applied 1-month and 1-year after practical training. RESULTS One-hundred and sixty-seven MS were enrolled (35 PO group, 38 CO group, and 94 control group). PO group had a significantly higher overall self-confidence comparing either control or CO groups, respectively (3.57 ± 0.65 vs. 2.97 ± 1.03 vs. 2.46 ± 0.87, p < 0.01) as well as in evaluate cup-to-disc ratio (3.09 ± 0.75 vs. 2.32 ± 0.87 vs. 1.46 ± 0.81, p < 0.01), optic disc margins (3.26 ± 0.85 vs. 2.71 ± 0.96 vs. 2.01 ± 0.97, p < 0.01) and macula (3.43 ± 1.12 vs. 2.89 ± 1.08 vs. 2.02 ± 0.89, p < 0.01) 1-month after practical training. One-year after intervention, CO group showed a significantly higher score compared to PO group in overall self-confidence (3.31 ± 0.69 vs. 3.18 ± 0.73, p = 0.03) and in optic disc margins assessing (3.16 ± 0.85 vs. 2.95 ± 0.78, p = 0.03), but not significant in the evaluation of cup-to-disc ratio (2.78 ± 0.97 vs. 2.68 ± 0.94, p = 0.08), and macula (3.34 ± 0.79 vs. 3.27 ± 0.98, p = 0.07). CONCLUSIONS Students were more confident in use PO as an instrument to perform direct ophthalmoscopy immediately after practical training, but confidence level of CO was higher compared to PO one year after practical training. These findings would help medical schools decide which ophthalmoscope to choose to teach fundus examination.
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Affiliation(s)
- Gabriel Ayub
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, 251 Vital Brazil St, SP, 13083-888, Campinas, Brazil.
| | - Rafael Boava Souza
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, 251 Vital Brazil St, SP, 13083-888, Campinas, Brazil
| | - Andrelisa Marina de Albuquerque
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, 251 Vital Brazil St, SP, 13083-888, Campinas, Brazil
| | - José Paulo Cabral de Vasconcellos
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, 251 Vital Brazil St, SP, 13083-888, Campinas, Brazil
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Dunn HP, Browning SD, Thomson D, Yates WB, McCluskey P, Keay L, White AJ, Fraser CL. Impact on patient management of non-mydriatic fundus photography compared to direct ophthalmoscopy in a regional Australian emergency department. Emerg Med Australas 2021; 34:186-193. [PMID: 34448357 DOI: 10.1111/1742-6723.13845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the management impact of non-mydriatic fundus photography (NMFP) implementation for appropriate ED patients; compare the diagnostic accuracy of direct ophthalmoscopy (DO) and NMFP, and determine the prevalence of fundus pathology in a regional Australian ED. METHODS This before/after crossover study prospectively enrolled patients presenting with headache, neurological deficit, visual disturbance and/or hypertensive urgency. Patients received DO examination, then separate NMFP examination. Emergency clinicians (ECs) were surveyed on their patient management plans following both DO examination and NMFP imaging. Telemedicine review of NMFP images was performed by an ophthalmologist within 48 h, and any additional management changes were documented. RESULTS The use of NMFP influenced changes in management in 52 (39%) of 133 enrolled patients (95% confidence interval 31-48%). Of these, 65% were escalations of management due to acute fundus pathology, while 35% were de-escalating changes following normal fundus findings. ECs diagnostic accuracy for acute fundus pathology improved from 0% to 29% sensitivity, and 59% to 84% specificity using DO and NMFP respectively, and telemedicine registrar review increased this to 50% sensitivity and 86% specificity. The period prevalence of acute fundus pathology was 10.5% (95% confidence interval 6-17%). CONCLUSION The addition of NMFP images can significantly impact the management of ED patients requiring fundus examination, facilitating expedited and optimised patient care. NMFP improves ECs diagnostic acumen for fundus pathology over DO examination and telehealth specialist review is important for diagnostic accuracy. There is a clinically important prevalence of fundus pathology in this regional ED setting.
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Affiliation(s)
- Hamish P Dunn
- Faculty of Medicine, The University of New South Wales, Port Macquarie, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Samuel D Browning
- Faculty of Medicine, The University of New South Wales, Port Macquarie, New South Wales, Australia
| | - David Thomson
- Faculty of Medicine, The University of New South Wales, Port Macquarie, New South Wales, Australia
| | - William B Yates
- Faculty of Medicine, The University of New South Wales, Port Macquarie, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter McCluskey
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew J White
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia.,The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Clare L Fraser
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
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Shikino K, Rosu CA, Yokokawa D, Suzuki S, Hirota Y, Nishiya K, Ikusaka M. Flexible e-learning video approach to improve fundus examination skills for medical students: a mixed-methods study. BMC MEDICAL EDUCATION 2021; 21:428. [PMID: 34389012 PMCID: PMC8364022 DOI: 10.1186/s12909-021-02857-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 07/26/2021] [Indexed: 06/07/2023]
Abstract
BACKGROUND Training for the fundus examination using traditional teaching is challenging, resulting in low generalist physicians' confidence in performing the funduscopic examination. There is growing evidence suggesting a flexible e-learning video approach's value in teaching physical examination procedures. However, whether the flexible e-learning video approach is superior to the traditional, face-to-face (F2F) lecture-based teaching for the funduscopic exam and the cognitive processes supporting its effectiveness has not yet been determined. METHODS We conducted a sequential explanatory mixed-method study to compare the flexible e-learning video approach's effectiveness versus the F2F lecture-based approach for teaching the funduscopic exam to medical students at Chiba University in Japan. Medical students were randomly assigned to either a flexible e-learning video approach group or a F2F lecture approach group. We then quantitatively measured the diagnostic accuracy of funduscopic findings before and after attending the specific classrooms. Next, we conducted student focus groups to explore the students' thinking processes in the flexible e-learning video approach vs. the F2F lecture-based teaching of fundus examination. The qualitative data were analyzed using the qualitative content analysis method. RESULTS The mean diagnostic accuracy scores in the post-test significantly increased from pre-test in the intervention group (36.6 to 63.4%, p < 0.001). Post-post comparisons across the two groups revealed a significant difference (intervention group 63.4% vs. control group 34.6%, p < 0.001). Six semi-structured focused group interviews were conducted (n = 36). In the flexible e-learning video approach group, we identified ten categories corresponding to four levels of the revised Bloom's taxonomy: remember, understand, apply, analyze. Five categories were identified in the traditional F2F lecture approach group corresponding to three revised Bloom's taxonomy levels: understand, apply, analyze. Interrater reliability was substantial (Cohen's kappa = 0.81). CONCLUSIONS Teaching medical students funduscopic examination using the flexible e-learning video approach leads to improved diagnostic accuracy of funduscopic examinations. The flexible e-learning video teaching method enabled higher cognitive activity levels than the traditional, lecture-based classroom, as assessed using the revised Bloom's taxonomy. TRIAL REGISTRATION This study was registered with the University Hospital Medical Information Network Clinical Trials Registry on 08/02/2020 (Unique trial number: UMIN 000039434 ).
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Affiliation(s)
- Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan.
- Health Professional Development Center, Chiba University Hospital, Chiba, Japan.
| | - Claudia A Rosu
- Health Professions Education Program, MGH Institute of Health Professions, Boston, MA, USA
| | - Daiki Yokokawa
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Shingo Suzuki
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Department of Internal Medicine, Chiba Medical Center, Chiba, Japan
| | - Yusuke Hirota
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Department of Diabetes, Endocrinology and Metabolism, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Katsumi Nishiya
- Center for Medical Education, Kansai Medical University, Hirakata, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
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Tso HL, Young J, Yung CW. Comparing Eyesi Virtual Reality Simulator and Traditional Teaching Methods for Direct Ophthalmoscopy: Students' Perspectives at Indiana University School of Medicine. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2021. [DOI: 10.1055/s-0041-1726349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Background The fundus examination is an essential part of any ophthalmologic evaluation. However, medical students and primary care physicians often lack confidence with direct ophthalmoscopy. Virtual reality simulators are being employed in medical education to teach this technically challenging examination.
Objective To compare medical student ratings of the Eyesi Direct Ophthalmoscope Simulator and traditional small group teaching methods for learning direct ophthalmoscopy skills.
Methods All medical students at Indiana University School of Medicine traditionally learn direct ophthalmoscopy in their first 2 years during a small group session led by a physician instructor. Students who later enrolled in ophthalmology clinical electives during 2019 and 2020 were invited to additionally complete the Eyesi Direct Ophthalmoscope Simulator virtual reality curriculum. A voluntary, anonymous survey was sent between June and August 2020 to students who had completed both the traditional and Eyesi simulator sessions. Students were asked to rate their confidence in performing direct ophthalmoscopy following each session, and to indicate which teaching method was superior and why. Chi-square analysis was used to compare categorical variables.
Results Students' confidence ratings for performing direct ophthalmoscopy were significantly higher following completion of the Eyesi simulator session compared with the traditional small group session (p < 0.001). Four-fifths of respondents felt that the Eyesi simulator was superior to the traditional small group for learning the skills of direct ophthalmoscopy, while one-fifth felt that the two sessions were equally effective (p < 0.001). None of the students responded that the small group session was the superior teaching method.
Conclusion The Eyesi Direct Ophthalmoscope Simulator was rated highly among medical students and offers distinct learning advantages that could not be replicated in a traditional small group environment, such as providing numerous examples of pathological findings and allowing unlimited examination time without concern for patient's inconvenience or light exposure. The Eyesi simulator is a promising tool for teaching direct ophthalmoscopy to medical students. Ultimately, familiarity with the fundus examination will enable future physicians across specialties to better evaluate and appropriately refer patients with ocular fundus pathology.
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Affiliation(s)
- Hanna L. Tso
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jason Young
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana
| | - C. W. Yung
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana
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Pradeep TG, Sundaresh DD, Ramani S. Adoption of newer teaching methods to overcome challenges of training in ophthalmology residency during the COVID-19 pandemic. Indian J Ophthalmol 2021; 69:1292-1297. [PMID: 33913881 PMCID: PMC8186639 DOI: 10.4103/ijo.ijo_3063_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disrupted training programs across all specialties. Surgical specialties, such as ophthalmology, that need continued microsurgical training are affected the most. The pandemic has resulted in ophthalmology residents being taken off their regular duties in ophthalmology and inducted into COVID duties. The focus on COVID care has de-emphasized training in ophthalmology. We highlight the challenges that teachers face in continuing the training programs of theory, clinical skill, and surgical skill transfer. Embracing technology is the need of the hour. We discuss the multiple options available to enable continued training programs and emphasize the need for all training institutes to include technology as an additional component of their training curricula.
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Affiliation(s)
- Thanuja G Pradeep
- Department of Ophthalmology, Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Divya Dabir Sundaresh
- Department of Ophthalmology, Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Soumya Ramani
- Department of Ophthalmology, Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
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20
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Kohler J, Tran TM, Sun S, Montezuma SR. Teaching Smartphone Funduscopy with 20 Diopter Lens in Undergraduate Medical Education. Clin Ophthalmol 2021; 15:2013-2023. [PMID: 34012252 PMCID: PMC8128496 DOI: 10.2147/opth.s266123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/15/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess attitudes of pre-clinical undergraduate medical students toward learning smartphone funduscopy (SF) and its appropriateness as a teaching tool. Patients and Methods Second year medical students received instruction on direct ophthalmoscopy (DO) and SF; they were then paired with a peer and randomly assigned to perform DO or SF first. The SF technique involved freehand alignment of the axes of the smartphone camera with a condenser lens. Both techniques were done through a maximally dilated pupil. A questionnaire was completed to acquire data on baseline experience, performance of both examination techniques, attitudes, and appropriateness. Statistical significance testing and Bland-Altman analysis were used to determine differences between DO and SF, and a multivariable mixed regression model was fitted to identify any predictors for positive attitudes toward DO or SF. Results One hundred thirty-seven (137) individuals completed the study. A similar proportion of students could identify the optic nerve, macula, and vessels using DO and SF. However, self-reported quality scores were higher for DO for the optic nerve (p = 0.006) and macula (p = 0.08). The mean (standard deviation) attempts to identify these major structures were 2.7 (SD 2.3) for DO and 4.5 (SD 2.9) for SF (p < 0.001). Attitudes of students were consistently more positive toward DO across the five questions assessed. A small subset of students had equally positive attitudes toward DO and SF. Improved quality scores were predictive of positive attitudes for both DO and SF. Ultimately, 24% of students preferred SF over DO. Conclusion Among inexperienced examiners of the fundus through a dilated pupil, SF is a non-inferior technique to DO in identifying structures. Despite overall favorable attitudes towards the more familiar DO, those students who quickly learned the SF technique had similar satisfaction scores. Teaching SF should be considered in undergraduate medical education.
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Affiliation(s)
- James Kohler
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - Tu M Tran
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - Susan Sun
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - Sandra R Montezuma
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
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21
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[Combination of simulation-based and online learning in ophthalmology : Efficiency of simulation in combination with independent online learning within the framework of EyesiNet in student education]. Ophthalmologe 2021; 119:20-29. [PMID: 33449201 PMCID: PMC7809651 DOI: 10.1007/s00347-020-01313-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 11/17/2022]
Abstract
Hintergrund Die Ophthalmoskopie ist Bestandteil des medizinischen Curriculums, jedoch das Vermitteln der Inhalte oft unbefriedigend, da ein systematisches Lernen von Pathologien und deren Behandlungen dadurch erschwert ist, dass oftmals das passende Patientengut nicht zur Verfügung steht und dadurch gesunde Studenten einander untersuchen müssen. Aus diesem Grund haben wir eine Online-Plattform entwickelt, die in Kombination mit simulationsgestütztem Training sowohl das eigenständige als auch das angeleitete Lernen von Untersuchungsmethoden und Pathologien ermöglicht. Ziel der Arbeit Ziel der vorliegenden Arbeit war, ein Format für die Verbesserung der Lehre der direkten und indirekten Ophthalmoskopie im Studierendenunterricht zu evaluieren. Dabei wurden praktische Übungen an Virtual-Reality-basierten Simulatoren mit neu entwickelten und an den Lehrkatalog angepassten theoretischen Inhalten in der Online-Plattform EyesiNet verschränkt. Material und Methoden Die Studierenden bearbeiteten am ersten sowie am letzten Praktikumstag zufällig ausgewählte Fälle, die ihnen von den Eyesi Direct- und Eyesi Indirect-Simulatoren präsentiert wurden. Zwischen diesen beiden Einheiten konnten sie sich auf freiwilliger Basis mit den theoretischen Grundlagen typischer ophthalmologischer Krankheitsbilder im EyesiNet beschäftigen. Ergebnisse Eyesi Direct: Die Bewertung des Simulators ergab am ersten Praktikumstag für beide Gruppen keinen signifikant unterschiedlichen Wissensstand (p = 0,29). In der Gruppe OHNE Training (n = 54) ergab sich am letzten Praktikumstag mit p = 0,02 eine signifikante Verbesserung dieser Bewertung, jedoch mit einer geringen Effektgröße von 0,1. In der Gruppe MIT Training (n = 32) konnte mit p = 0,0004 eine hoch signifikante Verbesserung mit einer Effektgröße von 0,3 nach Rosenthal festgestellt werden. Eyesi Indirect: Die simulatorgestützte Bewertung ergab am ersten Praktikumstag keinen signifikanten Unterschied im Wissensstand der beiden Gruppen (p = 0,1). Nach dem Training schnitten zwar beide Gruppen etwas besser ab, jedoch ohne signifikanten Unterschied (OHNE Training p = 0,41/MIT Training p = 0,17). Diskussion Die Online-Plattform EyesiNet unterstützt beim Erlernen der wichtigsten Erkrankungsbilder. Lerninhalte werden reproduzierbar und auf für alle Lernenden standardisierte Weise zur Verfügung gestellt. Die Fertigkeiten der direkten Ophthalmoskopie sind hierbei deutlich schneller als die der indirekten Ophthalmoskopie zu erlernen.
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22
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Dunn HP, Kang CJ, Marks S, Witherow JL, Dunn SM, Healey PR, White AJ. Perceived usefulness and ease of use of fundoscopy by medical students: a randomised crossover trial of six technologies (eFOCUS 1). BMC MEDICAL EDUCATION 2021; 21:41. [PMID: 33419444 PMCID: PMC7793394 DOI: 10.1186/s12909-020-02469-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/21/2020] [Indexed: 06/02/2023]
Abstract
BACKGROUND Fundoscopy outside ophthalmology is in decline, and the technical demands of the traditional direct ophthalmoscope examination are likely contributing. Alternative fundoscopy technologies are increasingly available, yet valid comparisons between fundoscopy technologies are lacking. We aimed to assess medical students' perceptions of usefulness and ease of use of traditional and contemporary fundus-viewing technologies including smartphone fundoscopy. METHODS One hundred forty-six second-year medical students participated in a cross-sectional, randomised, cross-over study of fundoscopy methods. Medical students completed small group training sessions using six current fundoscopy technologies including: a non-mydriatic fundus camera; two types of direct fundoscopy; and three types of smartphone fundoscopy. A novel survey of perceived usefulness and ease of use was then completed by students. RESULTS Repeated-measures ANOVA found students rated both the perceived usefulness (p< 0.001) and ease of use (p< 0.001) of smartphone fundoscopy significantly higher than both the non-mydriatic camera and direct fundoscopy. CONCLUSIONS Smartphone fundoscopy was found to be significantly more useful and easier to use than other modalities. Educators should optimise student access to novel fundoscopy technologies such as smartphone fundoscopy which may mitigate the technical challenges of fundoscopy and reinvigorate use of this valuable clinical examination.
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Affiliation(s)
- H P Dunn
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia.
- Department of Ophthalmology, Westmead Hospital, Sydney, Australia.
| | - C J Kang
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | - S Marks
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | - J L Witherow
- Discipline of Physiotherapy, Faculty of Medicine & Health Services, Macquarie University, Sydney, Australia
| | - S M Dunn
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | - P R Healey
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
- Department of Ophthalmology, Westmead Hospital, Sydney, Australia
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - A J White
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
- Department of Ophthalmology, Westmead Hospital, Sydney, Australia
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
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Chadha N, Gooding H. Twelve tips for teaching ophthalmology in the undergraduate curriculum. MEDICAL TEACHER 2021; 43:80-85. [PMID: 32400234 DOI: 10.1080/0142159x.2020.1758649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Ophthalmology education in the undergraduate medical curriculum has declined, and graduating healthcare professionals express discomfort with basic evaluation and management of ophthalmic complaints. With the growing aging population, ophthalmic needs will continue to rise, underscoring the need for increased eye care. This article offers 12 tips for increasing undergraduate ophthalmic education, which can be implemented strategically within limited established curricular time, or in novel ways outside the traditional curriculum. Within the curriculum, existing ophthalmology sessions can be enhanced through use of simulation technology and partnership with ophthalmology faculty. Additional curricular time can be justified through needs assessments and alignment of content with other disciplines, and ophthalmology content on licensing examinations. Finally, ophthalmology can be reinforced in service-based initiatives and through use of online resources and social media.
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Affiliation(s)
- Nisha Chadha
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye and Ear Infirmary, Eye and Vision Research Institute, New York, NY, USA
| | - Holly Gooding
- Division of Pediatrics and Adolescent Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Wilcox S, Okut H, Badgett R, Hassouneh S, Ablah E. Effectiveness of Flow Sheet Implementation on Diabetes Progression Screening at a Student-Run Free Clinic. Kans J Med 2020; 13:285-289. [PMID: 33312411 PMCID: PMC7725131 DOI: 10.17161/kjm.vol13.13423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Diabetes mellitus (DM) disproportionately affects people with low socioeconomic status (SES). Student-run free clinics (SRFC) aim to care for low SES populations and experience high clinician turnover. Flow sheets have been used to improve care for those with diabetes, yet no research has assessed the use of such a flow sheet in a SRFC. The aim of this project was to determine if use of a flow sheet improved care for people with DM in an SRFC. Methods Charts from all patients receiving care for DM at one SRFC in the year before (n = 53) and after (n = 56) implementation of the flow sheet were reviewed. Pre- and post-group comparisons and post subgroup comparisons were made for glycosylated-hemoglobin (HgbA1c), microalbumin, and foot and eye exams. Results During a one-year period, a larger proportion of patients who received care post flow sheet introduction received at least two HgbA1c tests (53%), a microalbumin test (46%), and a foot-exam (46%) compared to those receiving care before the flow sheet (28%, 2%, and 25%, respectively). There was no difference in proportions of patients undergoing eye exams. In post subgroup analysis, flow sheets were used for 50% of patients, and patients who received care with the flow sheet were more likely to receive at least two HgbA1c tests and a foot exam per year. Conclusion Flow sheets may improve the process of care for patients with diabetes in a SRFC, but the effect must be studied further. Regardless, a systematic integration of the flow sheet is being implemented in the SRFC evaluated in this study.
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Affiliation(s)
- Samuel Wilcox
- Northwest Washington Family Medicine Residency, Bremerton, WA
| | - Hayrettin Okut
- Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS.,Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Robert Badgett
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS.,Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Stephanie Hassouneh
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Elizabeth Ablah
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
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Mortensen P, Enzor R, Keppel K, Williamson R, Jones P, Nkrumah G, Safiullah Z, Michelson S, Nadimpalli S, Shue A, Waxman E. The Ophthalmology Mini-Elective Gives Vision to Preclinical Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11024. [PMID: 33274290 PMCID: PMC7703479 DOI: 10.15766/mep_2374-8265.11024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 07/16/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Ophthalmology education during medical school is often very limited. To provide exposure to areas beyond its standard curriculum, the University of Pittsburgh School of Medicine offers mini-elective courses in various disciplines. We developed such a course to provide instruction in the basics of clinical ophthalmology to interested preclinical medical students. METHODS First- and second-year medical students electively enrolled in our course (mean number of students per year = 12), which included four sessions combining didactics and hands-on learning. Additionally, each student individually spent time with an ophthalmologist in the operating room. Our course was held each year from 2015 to 2019. RESULTS Participants completed pre- (n = 25) and postsurveys (n = 20), reflecting increased comfort with the ophthalmologic history and physical examination. In 2019, participants also completed pre- and posttests, demonstrating increased knowledge of ophthalmology. DISCUSSION The Ophthalmology Mini-Elective is a unique educational tool that introduces the principles of ophthalmology to preclinical medical students, addressing an area of medicine that is generally minimally included in the required curriculum.
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Affiliation(s)
- Peter Mortensen
- Ophthalmology Resident, Department of Ophthalmology, University of Pittsburgh Medical Center
| | - Rikki Enzor
- Ophthalmology Resident, Department of Ophthalmology, University of Pittsburgh Medical Center
| | - Kevin Keppel
- Preliminary Year Resident, University of Pittsburgh Medical Center
| | - Ryan Williamson
- Medical Student, University of Pittsburgh School of Medicine
| | - Peter Jones
- Preliminary Year Resident, University of Pittsburgh Medical Center
| | - Gideon Nkrumah
- Medical Student, University of Pittsburgh School of Medicine
| | - Zaid Safiullah
- Medical Student, University of Pittsburgh School of Medicine
| | - Sarah Michelson
- Ophthalmology Resident, Department of Ophthalmology, University of Michigan Medical School
| | - Sameera Nadimpalli
- Ophthalmology Resident, Department of Ophthalmology, Northwestern University Feinberg School of Medicine
| | - Ann Shue
- Clinical Assistant Professor, Department of Ophthalmology, Stanford University School of Medicine
| | - Evan Waxman
- Residency Program Director and Associate Professor, Department of Ophthalmology, University of Pittsburgh Medical Center
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26
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Dunn HP, Teo KZ, Smyth JW, Weerasinghe LS, Costello J, Pampapathi P, Keay L, Green T, Vukasovic M, Bruce BB, Newman NJ, Biousse V, White AJ, McCluskey P, Fraser CL. Using non-mydriatic fundus photography to detect fundus pathology in Australian metropolitan emergency departments: A prospective prevalence and diagnostic accuracy study. Emerg Med Australas 2020; 33:302-309. [PMID: 32945132 DOI: 10.1111/1742-6723.13619] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the prevalence of fundus pathology in metropolitan Australian EDs utilising a non-mydriatic fundus photography screening programme. Secondary objectives include diagnostic accuracy among emergency physicians compared to telehealth ophthalmologist review. METHODS Prospective cross-sectional study investigating non-mydriatic fundus photography as a new diagnostic test in two tertiary Australian EDs. Consecutive adult patients were enrolled if they presented with headache, focal neurological deficit, visual disturbance or diastolic BP >120 mmHg. Diagnostic agreement was determined using kappa statistics and sensitivity and specificity using a reference standard consensus ophthalmology review. RESULTS A total of 345 consecutive patients were enrolled among whom 56 (16%, 95% confidence interval [CI] 13-21) had urgent fundus pathology. Agreement between emergency physician and ophthalmic assessment of fundus photographs was 74% (kappa = 0.196, P = 0.001). Emergency physicians had 40% sensitivity (95% CI 27-54) and 82% specificity (95% CI 76-86) for detecting urgent pathology on photographs. CONCLUSIONS Fundus photography detects a clinically significant proportion of fundus pathology and urgent diagnoses. Telehealth specialist image review is important to detect some important, time-critical illnesses that can be missed in routine care. This offers an accurate alternative to direct ophthalmoscopy that warrants further research in Australian EDs.
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Affiliation(s)
- Hamish P Dunn
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kai Zong Teo
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia
| | - James Wp Smyth
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Emergency Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Lakni S Weerasinghe
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Julia Costello
- Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Preethi Pampapathi
- Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Lisa Keay
- School of Optometry and Vision Science and The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Tim Green
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Emergency Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Matthew Vukasovic
- Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Beau B Bruce
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Epidemiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew J White
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia.,School of Optometry and Vision Science and The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Peter McCluskey
- Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Clare L Fraser
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Retinal Diseases that Can Masquerade as Neurological Causes of Vision Loss. Curr Neurol Neurosci Rep 2020; 20:51. [PMID: 32930896 DOI: 10.1007/s11910-020-01071-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW This review aims to discuss retinal diseases that may masquerade as neurological causes of vision loss and highlights modern ophthalmic ancillary testing that can help to establish these diagnoses. RECENT FINDINGS Retinal diseases with signs and symptoms overlapping with neurological causes of vision loss include central serous chorioretinopathy, retinal ischemia, acute macular neuroretinopathy, Acute zonal occult outer retinopathy (AZOOR) complex diseases, paraneoplastic retinopathy, retinal dystrophy, and toxic retinopathy. Diagnosis is facilitated by electrophysiologic studies and multimodal ophthalmic imaging including optical coherence tomography and fundus autofluorescence imaging. Looking into the future, translation of adaptive optics ophthalmoscopy into clinical practice may facilitate early detection of microscopic retinal abnormalities that characterize these conditions. With conventional methods of physical examination, diagnosis of retinal diseases that may masquerade as neurological causes of vision loss can be challenging. Current advance in multimodal ophthalmic imaging along with electrophysiologic studies enhances the provider's ability to make early diagnosis and monitor progression of these conditions.
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Shih KC, Chau CYC, Chan JCH, Wong JKW, Lai JSM. Does the COVID-19 Pandemic Spell the End for the Direct Ophthalmoscope? Ophthalmol Ther 2020; 9:689-692. [PMID: 32860621 PMCID: PMC7456205 DOI: 10.1007/s40123-020-00295-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Indexed: 02/04/2023] Open
Abstract
Despite advances in ophthalmic diagnostics, the direct ophthalmoscope remains a key clinical skill taught to medical students and is the tool of choice for retina examination among non-ophthalmic physicians. However, in recent years viable alternatives have become available. The coronavirus disease 2019 (COVID-19) pandemic has forced a major re-thinking in medical education worldwide. In this commentary, we examined the current merits and limitations of the direct ophthalmoscope in both the clinical sense and in the context of infection control. Furthermore, we compared the direct ophthalmoscope with alternatives, including commercially available portable non-mydriatic fundus cameras, that would allow a change in focus during ophthalmic teaching. We concluded that the latter will better prepare our medical students for the age of telemedicine and deep-learning systems. While the COVID-19 pandemic will not be the sole reason for the ‘death’ of the direct ophthalmoscope, the global situation will inevitably serve to expedite long overdue changes in our teaching of ophthalmic skills to non-ophthalmic physicians.
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Affiliation(s)
- Kendrick C Shih
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, SAR.
| | - Charlene Y C Chau
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, SAR
| | - Jonathan C H Chan
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, SAR
| | - Jasper K W Wong
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, SAR
| | - Jimmy S M Lai
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, SAR
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Samaranayake UMJE, Mathangasinghe Y, Samaranayake UMNP, Wijayatunga M. Non-simulator-based techniques in teaching direct ophthalmoscopy for medical students: a systematic review. Int J Ophthalmol 2020; 13:660-666. [PMID: 32399420 DOI: 10.18240/ijo.2020.04.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/16/2019] [Indexed: 11/23/2022] Open
Abstract
Non-simulator-based examination methods of the fundal examination have shown to be cost-effective. We reviewed different non-simulator-based direct fundoscopy examination methods used in undergraduate curricula and their outcomes. PubMed (MEDLINE) and Cochrane Database of Systematic Reviews were searched using standard Medical Subject Heading (MeSH) terms ophthalmoscopy, medical education, undergraduate medical education, medical student, educational assessment and learning. The search included publications until 28th February 2019. We obtained 34 articles after screening abstracts; of them, 12 articles were included in the qualitative synthesis. The studies were comprised of diverse teaching methods which included fundal photograph matching with corresponding eye, continuous education using community-based eye clinics, formal instructions and demonstrations prior to skills training, ophthalmoscopy skills practice using eye pathologies, teaching versus conventional ophthalmoscopy and group-based teaching. We concluded that non-simulator-based techniques such as use of fundal photograph matching of an eye of a volunteer, introduction to eye pathologies, smaller student groups and formal instructions with video demonstrations prior to skills training were highly effective in teaching direct ophthalmoscopy for undergraduate medical students.
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Affiliation(s)
| | - Yasith Mathangasinghe
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
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30
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Ahmad SR, Moss HE. Update on the Diagnosis and Treatment of Idiopathic Intracranial Hypertension. Semin Neurol 2019; 39:682-691. [PMID: 31847039 DOI: 10.1055/s-0039-1698744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Advances in ophthalmic diagnostics and results of interventional clinical trials are shifting diagnosis and management of idiopathic intracranial hypertension (IIH) to be more technology- and evidence-based. In this article, the evidence supporting current diagnostic criteria, evaluation, and medical and surgical management of IIH are reviewed.
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Affiliation(s)
- Sarah R Ahmad
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California
| | - Heather E Moss
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California.,Department of Ophthalmology, Stanford University, Palo Alto, California
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31
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Smartphone ophthalmoscopy: patient and student practitioner perceptions. J Med Syst 2019; 44:10. [PMID: 31797206 PMCID: PMC6890584 DOI: 10.1007/s10916-019-1477-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/11/2019] [Indexed: 10/26/2022]
Abstract
It can take several years to become proficient at direct ophthalmoscopy; the instrument's single eyepiece allows only one individual to view the image at a time, which is considered disadvantageous during teaching. The introduction of smartphone ophthalmoscopes enables groups of teachers and students to view images together which could encourage peer-to-peer learning. In addition, the technology is significantly cheaper than the direct ophthalmoscope. User acceptability and engagement is essential to the success of any (medical) technological innovation. We sought to understand student opinions of a new commercially-available smartphone device for fundus examination, and compare usability to the traditional ophthalmoscope, from the perspective of both student practitioners and patients. Fifty-four undergraduate optometry students with prior experience of the traditional direct ophthalmoscope were asked to examine at least one eye with the D-EYE smartphone ophthalmoscope and also given an opportunity to experience the D-EYE from a patient's perspective. Minimal instructions were provided and all examinations conducted through undilated pupils. Participants completed an opinion survey to feedback on aspects such as the ease of handling and working distance. Compared to the direct ophthalmoscope, 92% of students preferred the (longer) working distance of the D-EYE; 77% felt it was easier to handle; and 92% preferred the patient experience with the D-EYE. Despite the positive feedback, only 43% of students preferred the D-EYE when assuming the role of the practitioner. Free text responses indicated that students felt the D-EYE may be most useful as a teaching tool. Student opinions indicated that smartphone ophthalmoscopes are an effective training tool for students as an accompaniment to learning the traditional ophthalmoscope method.
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32
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Katherine M, Michael W. Direct Ophthalmoscopy… Soon to be Forgotten? THE ULSTER MEDICAL JOURNAL 2019; 88:115-117. [PMID: 31061561 PMCID: PMC6500418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/26/2019] [Indexed: 11/08/2022]
Affiliation(s)
| | - Williams Michael
- Dr Michael Williams, Centre for Medical Education, Queen’s University of Belfast
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33
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Kim Y, Chao DL. Comparison of smartphone ophthalmoscopy vs conventional direct ophthalmoscopy as a teaching tool for medical students: the COSMOS study. Clin Ophthalmol 2019; 13:391-401. [PMID: 30858689 PMCID: PMC6387606 DOI: 10.2147/opth.s190922] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the utility of smartphone ophthalmology for medical students for learning fundoscopy compared with direct ophthalmoscopy. Methods After 1 hour of didactic instruction on ophthalmoscopy, second-year medical students in a small group setting were randomized to start training with the direct ophthalmoscope vs smartphone ophthalmoscope and crossed over to the other instrument through the session. Main outcome measures Ability to visualize the optic nerve and retinal blood vessels in an undilated pupil as well as a survey evaluating ease of use, confidence, and ability to visualize the optic nerve with the two instruments. Results One hundred and one medical students participated. Significantly more medical students were able to visualize the optic nerve with the smartphone ophthalmoscope vs the direct ophthalmoscope in an undilated pupil (82.3% vs 48.5%, P<0.0001). Students reported a more positive experience with the smartphone ophthalmoscope, specifically regarding ease of use (median of 4 vs 3; P<0.0001), their confidence in performing ophthalmoscopy (median of 4 vs 3; P<0.0001), and their ability to visualize features of the optic nerve (median 4 vs 3; P<0.0001). A significant number of participants preferred the smartphone ophthalmoscope over the traditional direct ophthalmoscope for learning how to identify the optic disc and for evaluating patients (78.2% and 77.2%, respectively; P<0.0001). Conclusion Smartphone ophthalmoscopy may serve as a useful adjunctive tool to teach direct ophthalmoscopy as well as being an alternative for examining the fundus for noneye care physicians.
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Affiliation(s)
- Yeji Kim
- Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, CA, USA,
| | - Daniel L Chao
- Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, CA, USA,
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Vilela MA, Valença FM, Barreto PK, Amaral CE, Pellanda LC. Agreement between retinal images obtained via smartphones and images obtained with retinal cameras or fundoscopic exams - systematic review and meta-analysis. Clin Ophthalmol 2018; 12:2581-2589. [PMID: 30587904 PMCID: PMC6294162 DOI: 10.2147/opth.s182022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Smartphone fundoscopy is a new option for visualizing the ocular fundus but must be validated before being included in population-based examinations. Our aim was to evaluate the quality of fundoscopic images obtained via smartphone and to compare their agreement with retinal camera images or clinical examination. Methods The database for this study included all observational studies with smartphone fundoscopy that have comparative analyses with the gold standard methods. Results Out of 121 potentially relevant studies, nine were included in this analysis, comprising a total of 4,219 eyes. Mean age was 56.6 years (SD±8.5). Combined kappa (κ) agreement statistics were equal to 77.77% (95% CI: 70.34%, 83.70%). No heterogeneity was measured by random effects (I2=zero). Conclusion Fundoscopic images obtained by using smartphones have substantial agreement with gold standards for clinical or photographic exams.
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Affiliation(s)
- Manuel Ap Vilela
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil, .,Institute of Cardiology, Cardiology University Foundation, Porto Alegre, Rio Grande do Sul, Brazil,
| | - Felipe M Valença
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil,
| | - Pedro Km Barreto
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil,
| | - Carlos Ev Amaral
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil,
| | - Lúcia C Pellanda
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil, .,Institute of Cardiology, Cardiology University Foundation, Porto Alegre, Rio Grande do Sul, Brazil,
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35
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36
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Evaluation of an Ophthalmoscopy Simulator to Teach Funduscopy Skills to Pediatric Residents. Can J Neurol Sci 2018; 45:320-324. [DOI: 10.1017/cjn.2017.291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground: Medical school and residency training in ophthalmoscopic evaluation is limited, reducing diagnostic accuracy. We sought to evaluate the efficacy of self-study using an ophthalmoscopy simulator to improve the technical motor skills involved in direct funduscopy in postgraduate pediatric residents. Methods: In this randomized-controlled study, 17 pediatric residents (postgraduate years 1-3) were randomized to control (n=8) or intervention (n=9) groups. Participants were asked to correctly identify the funduscopic findings presented to them on an ophthalmoscopy simulator after being trained on its use. Each participant was asked to review 20 images of the fundus, and then record their multiple-choice response on a scantron sheet listing all possible funduscopic pathologies. Pre- and post-intervention testing was performed. Survey data assessing exposure to funduscopy skills during undergraduate and postgraduate training and overall experience with the simulator were collected. Results: Most (65% [11/17]) participants reported minimal or no formal teaching in ophthalmology during their undergraduate medical studies. Average pre-intervention score (of 20) was 10.24±1.75 (51%) for the entire group, with no statistically significant difference between average pre-score in the control (10.63±1.77) versus intervention (9.89±1.76, p=0.405) groups. Intervention subjects experienced a statistically significant improvement in scores (9.89±1.76 vs. 12.78±2.05, p=0.006 [95% confidence interval 4.80-0.98]), but control subjects did not. Conclusions: A single session with an ophthalmoscopy simulator can improve diagnostic accuracy in postgraduate pediatric trainees. Use of ophthalmoscopy simulation represents a novel addition to traditional learning methods for postgraduate pediatric residents that can help trainees to improve their confidence and accuracy in performing this challenging examination.
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Mowat FM, Royal KD, Westermeyer HD. Ophthalmoscopy skills in primary care: a cross-sectional practitioner survey. Vet Rec 2018; 182:435. [PMID: 29331983 DOI: 10.1136/vr.104569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/01/2017] [Accepted: 12/24/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Freya M Mowat
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Kenneth D Royal
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Hans D Westermeyer
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA
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Bruce BB, Bidot S, Hage R, Clough LC, Fajoles-Vasseneix C, Melomed M, Keadey MT, Wright DW, Newman NJ, Biousse V. Fundus Photography vs. Ophthalmoscopy Outcomes in the Emergency Department (FOTO-ED) Phase III: Web-based, In-service Training of Emergency Providers. Neuroophthalmology 2018; 42:269-274. [PMID: 30258471 DOI: 10.1080/01658107.2017.1419368] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 12/16/2017] [Indexed: 10/18/2022] Open
Abstract
We evaluated a web-based training aimed at improving the review of fundus photography by emergency providers. 587 patients were included, 12.6% with relevant abnormalities. Emergency providers spent 31 minutes (median) training and evaluated 359 patients. Median post-test score improvement was 6 percentage points (IQR: 2-14; p = 0.06). Pre- vs. post-training, the emergency providers reviewed 45% vs. 43% of photographs; correctly identified abnormals in 67% vs. 57% of cases; and correctly identified normals in 80% vs. 84%. The Fundus photography vs. Ophthalmoscopy Trial Outcomes in the Emergency Department studies have demonstrated that emergency providers perform substantially better with fundus photography than direct ophthalmoscopy, but our web-based, in-service training did not result in further improvements at our institution.
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Affiliation(s)
- Beau B Bruce
- Ophthalmology, Emory University, Atlanta, Georgia, USA.,Neurology, Emory University, Atlanta, Georgia, USA.,Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Samuel Bidot
- Ophthalmology, Emory University, Atlanta, Georgia, USA
| | - Rabih Hage
- Ophthalmology, Emory University, Atlanta, Georgia, USA
| | | | | | | | | | - David W Wright
- Emergency Medicine, Emory University, Atlanta, Georgia, USA
| | - Nancy J Newman
- Ophthalmology, Emory University, Atlanta, Georgia, USA.,Neurology, Emory University, Atlanta, Georgia, USA.,Neurological Surgery, Emory University, Atlanta, Georgia, USA
| | - Valérie Biousse
- Ophthalmology, Emory University, Atlanta, Georgia, USA.,Neurology, Emory University, Atlanta, Georgia, USA
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39
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Biousse V, Bruce BB, Newman NJ. Ophthalmoscopy in the 21st century: The 2017 H. Houston Merritt Lecture. Neurology 2017; 90:167-175. [PMID: 29273687 DOI: 10.1212/wnl.0000000000004868] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/05/2017] [Indexed: 11/15/2022] Open
Abstract
Although the usefulness of viewing the ocular fundus is well-recognized, ophthalmoscopy is infrequently and poorly performed by most nonophthalmologist physicians, including neurologists. Barriers to the practice of ophthalmoscopy by nonophthalmologists include not only the technical difficulty related to direct ophthalmoscopy, but also lack of adequate training and discouragement by preceptors. Recent studies have shown that digital retinal fundus photographs with electronic transmission and remote interpretation of images by an ophthalmologist are an efficient and reliable way to allow examination of the ocular fundus in patients with systemic disorders such as diabetes mellitus. Ocular fundus photographs obtained without pharmacologic dilation of the pupil using nonmydriatic fundus cameras could be of great value in emergency departments (EDs) and neurologic settings. The Fundus Photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) study showed that ED providers consistently failed to correctly identify relevant ocular funduscopic findings using the direct ophthalmoscope, and that nonmydriatic fundus photography was an effective alternate way of providing access to the ocular fundus in the ED. Extrapolating these results to headache clinics, outpatient neurology clinics, and adult and pediatric primary care settings seems self-evident. As technology advances, nonmydriatic ocular fundus imaging systems will be of higher quality and more portable and affordable, thereby circumventing the need to master the use of the ophthalmoscope. Visualizing the ocular fundus is more important than the method used. Ocular fundus photography facilitates nonophthalmologists' performance of this essential part of the physical examination, thus helping to reestablish the value of doing so.
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Affiliation(s)
- Valérie Biousse
- From the Departments of Ophthalmology (V.B., B.B.B., N.J.N.), Neurology (V.B., B.B.B., N.J.N.), Epidemiology (B.B.B.), and Neurological Surgery (N.J.N.), Emory University School of Medicine, Atlanta, GA
| | - Beau B Bruce
- From the Departments of Ophthalmology (V.B., B.B.B., N.J.N.), Neurology (V.B., B.B.B., N.J.N.), Epidemiology (B.B.B.), and Neurological Surgery (N.J.N.), Emory University School of Medicine, Atlanta, GA
| | - Nancy J Newman
- From the Departments of Ophthalmology (V.B., B.B.B., N.J.N.), Neurology (V.B., B.B.B., N.J.N.), Epidemiology (B.B.B.), and Neurological Surgery (N.J.N.), Emory University School of Medicine, Atlanta, GA.
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Gupta DK, Khandker N, Stacy K, Tatsuoka CM, Preston DC. Utility of Combining a Simulation-Based Method With a Lecture-Based Method for Fundoscopy Training in Neurology Residency. JAMA Neurol 2017; 74:1223-1227. [PMID: 28892534 DOI: 10.1001/jamaneurol.2017.2073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Fundoscopic examination is an essential component of the neurologic examination. Competence in its performance is mandated as a required clinical skill for neurology residents by the American Council of Graduate Medical Education. Government and private insurance agencies require its performance and documentation for moderate- and high-level neurologic evaluations. Traditionally, assessment and teaching of this key clinical examination technique have been difficult in neurology residency training. Objective To evaluate the utility of a simulation-based method and the traditional lecture-based method for assessment and teaching of fundoscopy to neurology residents. Design, Setting, and Participants This study was a prospective, single-blinded, education research study of 48 neurology residents recruited from July 1, 2015, through June 30, 2016, at a large neurology residency training program. Participants were equally divided into control and intervention groups after stratification by training year. Baseline and postintervention assessments were performed using questionnaire, survey, and fundoscopy simulators. Interventions After baseline assessment, both groups initially received lecture-based training, which covered fundamental knowledge on the components of fundoscopy and key neurologic findings observed on fundoscopic examination. The intervention group additionally received simulation-based training, which consisted of an instructor-led, hands-on workshop that covered practical skills of performing fundoscopic examination and identifying neurologically relevant findings on another fundoscopy simulator. Main Outcomes and Measures The primary outcome measures were the postintervention changes in fundoscopy knowledge, skills, and total scores. Results A total of 30 men and 18 women were equally distributed between the 2 groups. The intervention group had significantly higher mean (SD) increases in skills (2.5 [2.3] vs 0.8 [1.8], P = .01) and total (9.3 [4.3] vs 5.3 [5.8], P = .02) scores compared with the control group. Knowledge scores (6.8 [3.3] vs 4.5 [4.9], P = .11) increased nonsignificantly in both groups. Conclusions and Relevance This study supports the use of a simulation-based method as a supplementary tool to the lecture-based method in the assessment and teaching of fundoscopic examination in neurology residency.
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Affiliation(s)
- Deepak K Gupta
- The Neurological Institute of New York, Columbia University Medical Center, Columbia University, New York
| | - Namir Khandker
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristin Stacy
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Curtis M Tatsuoka
- Department of Neurology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
| | - David C Preston
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
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Ricci LH, Ferraz CA. Ophthalmoscopy simulation: advances in training and practice for medical students and young ophthalmologists. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2017; 8:435-439. [PMID: 28721118 PMCID: PMC5498681 DOI: 10.2147/amep.s108041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To describe and appraise the latest simulation models for direct and indirect ophthalmoscopy as a learning tool in the medical field. METHODS The present review was conducted using four national and international databases - PubMed, Scielo, Medline and Cochrane. Initial set of articles was screened based on title and abstracts, followed by full text analysis. It comprises of articles that were published in the past fifteen years (2002-2017). RESULTS Eighty-three articles concerning simulation models for medical education were found in national and international databases, with only a few describing important aspects of ophthalmoscopy training and current application of simulation in medical education. After secondary analysis, 38 articles were included. CONCLUSION Different ophthalmoscopy simulation models have been described, but only very few studies appraise the effectiveness of each individual model. Comparison studies are still required to determine best approaches for medical education and skill enhancement through simulation models, applied to both medical students as well as young ophthalmologists in training.
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Affiliation(s)
- Lucas Holderegger Ricci
- Department of Ophthalmology, School of Medicine, Laureate International Universities, São Paulo (SP), Brazil
| | - Caroline Amaral Ferraz
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo (SP), Brazil
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Biousse V, Newman NJ. Diagnosis and clinical features of common optic neuropathies. Lancet Neurol 2017; 15:1355-1367. [PMID: 27839652 DOI: 10.1016/s1474-4422(16)30237-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 12/25/2022]
Abstract
Disorders of the optic nerves (optic neuropathies) are some of the most common causes of visual loss, and can present in isolation or with associated neurological or systemic symptoms and signs. Several optic neuropathies-especially inflammatory optic neuropathies-are associated with neurological disorders and thus are often diagnosed and treated by neurologists. The mechanisms underlying optic neuropathies are diverse and typically manifest with decreased visual acuity, altered colour vision, and abnormal visual field in the affected eye. Diagnosis is made on the basis of clinical history and clinical examination, of which several aspects are particularly important, including the mode of onset of visual loss, the presence of pain with eye movements, the visual acuity, and the retention of colour vision. Advances in optic nerve imaging-particularly retinal digital photography, optical coherence tomography, and MRI techniques-have revolutionised the diagnosis and follow-up of patients with an optic neuropathy. Furthermore, improvement and generalisation of some ancillary tests, such as diagnostic antibodies for neuromyelitis optica, allows better phenotyping of the heterogeneous inflammatory optic neuropathies.
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Affiliation(s)
- Valérie Biousse
- Neuro-Ophthalmology Unit, Emory Eye Center, Emory University, Atlanta, GA, USA.
| | - Nancy J Newman
- Neuro-Ophthalmology Unit, Emory Eye Center, Emory University, Atlanta, GA, USA
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Evaluation of an online peer fundus photograph matching program in teaching direct ophthalmoscopy to medical students. Can J Ophthalmol 2017; 52:441-446. [PMID: 28985801 DOI: 10.1016/j.jcjo.2017.02.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/22/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Direct ophthalmoscopy is an important clinical skill that is often poorly performed by medical professionals and students. This is attributable to a declining emphasis on ophthalmology in medical school. We present and evaluate a self-directed approach of teaching ophthalmoscopy to medical students that is suitable for the current medical curriculum. DESIGN Prospective medical education trial. PARTICIPANTS Ninety-five second-year medical students at Queen's University: 32 in the experimental group and 63 in the control group. METHODS The experimental group consisted of medical students who practised ophthalmoscopy with one another using an online peer fundus photograph matching exercise created by the Department of Ophthalmology at Queen's University. To use the program, students first examined a peer with an ophthalmoscope and then selected an online photograph of a fundus corresponding to that of the examinee. The program notifies students if a correct selection is made. To encourage use of the program, students participated in a 2-week ophthalmoscopy competition during their ophthalmology rotation. The control group consisted of students who did not participate in the learning exercise. RESULTS On assessment at the end of the ophthalmology rotation, the experimental group (n = 32) was more accurate in matching fundus photographs compared with the control group (n = 63) (p = 0.02). Participants were faster at performing ophthalmoscopy at the end of the learning exercise (p < 0.01). All students in the experimental group reported increased confidence levels in ophthalmoscopy after participation in the learning exercise. CONCLUSIONS Matching online peer fundus photographs in a self-directed manner appeared to increase the skill and confidence of medical students in ophthalmoscopy.
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Wilson AS, O'Connor J, Taylor L, Carruthers D. A 3D virtual reality ophthalmoscopy trainer. CLINICAL TEACHER 2017; 14:427-431. [DOI: 10.1111/tct.12646] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Andrew S Wilson
- School of Computing and Digital Technology; Birmingham City University; Birmingham UK
| | - Jake O'Connor
- School of Computing and Digital Technology; Birmingham City University; Birmingham UK
| | - Lewis Taylor
- Sandwell and West Birmingham Hospitals Trust; Birmingham UK
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Yusuf IH, Ridyard E, Fung THM, Sipkova Z, Patel CK. Integrating retinal simulation with a peer-assessed group OSCE format to teach direct ophthalmoscopy. Can J Ophthalmol 2017; 52:392-397. [PMID: 28774522 DOI: 10.1016/j.jcjo.2016.11.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/16/2016] [Accepted: 11/14/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the conception and evaluation of a novel educational intervention to teach direct ophthalmoscopy with retinal simulators using a peer-assessed group objective structured clinical examination (OSCE) format. DESIGN Prospective, single-centre educational trial at Oxford University Medical School, Oxford, U.K. PARTICIPANTS A total of 160 consecutive undergraduate fifth-year medical students participated in the study. METHODS Students identified prior experience, teaching, examination, and feedback relevant to direct ophthalmoscopy. Students self-evaluated their perceived confidence across 6 domains of direct ophthalmoscopy examination before and after the educational intervention using a Likert-type psychometric scale. Wilcoxon matched pair testing was used to determine statistical significance for each domain. RESULTS The group OSCE intervention increased confidence in direct ophthalmoscopy overall from 2.5% to 63.8% (p < 0.001). Confidence improved in all 6 domains, most significantly in controls of ophthalmoscope (p < 0.001) and sequence of examination (p < 0.001) but also in the identification and interpretation of retinal signs (p < 0.001). Students rated the tutorial as very effective or effective across all 6 domains, and 96.29% rated the tutorial as effective overall. CONCLUSIONS Retinal simulation, integrated with a peer-assessed group OSCE format, is effective in increasing confidence in all aspects of direct ophthalmoscopy. It may be insufficient alone for training in the identification and interpretation of posterior segment clinical signs. Diminishing ophthalmology clerkships worldwide require ophthalmologists to identify innovative teaching methods, using modern technology and pedagogy to deliver high-quality, yet high-throughput, training in direct ophthalmoscopy. This novel teaching strategy may be considered by ophthalmologists responsible for direct ophthalmoscopy training in a teaching hospital context.
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Affiliation(s)
- Imran H Yusuf
- The Oxford Eye Hospital, John Radcliffe Hospital, Oxford, U.K..
| | - Edward Ridyard
- The Oxford Eye Hospital, John Radcliffe Hospital, Oxford, U.K
| | | | - Zuzana Sipkova
- The Oxford Eye Hospital, John Radcliffe Hospital, Oxford, U.K
| | - Chetan K Patel
- The Oxford Eye Hospital, John Radcliffe Hospital, Oxford, U.K
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Gilmour G, McKivigan J. Evaluating medical students' proficiency with a handheld ophthalmoscope: a pilot study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2016; 8:33-36. [PMID: 28096708 PMCID: PMC5207205 DOI: 10.2147/amep.s119440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Historically, testing medical students' skills using a handheld ophthalmoscope has been difficult to do objectively. Many programs train students using plastic models of the eye which are a very limited fidelity simulator of a real human eye. This makes it difficult to be sure that actual proficiency is attained given the differences between the various models and actual patients. The purpose of this article is to introduce a method of testing where a medical student must match a patient with his/her fundus photo, ensuring objective evaluation as well as developing skills on real patients which are more likely to transfer into clinical practice directly. PRESENTATION OF CASE Fundus photos from standardized patients (SPs) were obtained using a retinal camera and placed into a grid using proprietary software. Medical students were then asked to examine a SP and attempt to match the patient to his/her fundus photo in the grid. RESULTS Of the 33 medical students tested, only 10 were able to match the SP's eye to the correct photo in the grid. The average time to correct selection was 175 seconds, and the successful students rated their confidence level at 27.5% (average). The incorrect selection took less time, averaging 118 seconds, yet yielded a higher student-reported confidence level at 34.8% (average). The only noteworthy predictor of success (p<0.05) was the student's age (p=0.02). CONCLUSION It may be determined that there is an apparent gap in the ophthalmoscopy training of the students tested. It may also be of concern that students who selected the incorrect photo were more confident in their selections than students who chose the correct photo. More training may be necessary to close this gap, and future studies should attempt to establish continuing protocols in multiple centers.
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Affiliation(s)
- Gregory Gilmour
- Physical Medicine and Rehabilitation, Michigan State University, Lansing, MI
| | - James McKivigan
- School of Physical Therapy, Touro University, Henderson, NV, USA
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Williams DL, Wager C, Brearley J. Student attitudes regarding the educational value and welfare implications in the use of model eyes and live dogs in teaching practical fundus examination: evaluation of responses from 40 students. Open Vet J 2016; 6:172-177. [PMID: 27822453 PMCID: PMC5095501 DOI: 10.4314/ovj.v6i3.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 09/26/2016] [Indexed: 12/02/2022] Open
Abstract
This study sought to document student opinions on the educational value and welfare implications of use of artificial model eyes and live dogs in the training of veterinary students in examination of the canine fundus. Forty students who had undertaken a practical class on canine fundoscopy involving both use of artificial model eyes and live dogs were asked to complete a short questionnaire using a Likert scale to gauge their opinion on whether the use of live dogs and artificial eyes was very valuable (scoring 2), valuable (1), a neutral response (0), not particularly valuable (-1) or not at all valuable (-2) and to write a free text response on their views of the educational value and welfare implications of using artificial model eyes or live dogs in training for ophthalmic examination of the canine ocular fundus. Likert responses were 1.84±0.37 for using live greyhounds and 0.58±0.79 for using simulator eyes (p<0.0001). Thematic analysis of the written responses showed that while the artificial eyes were considered somewhat valuable in initial training, the live dogs were significantly preferred for their realism and the opportunity to examine the eye while handling a live animal. In conclusion, while model eyes are valuable initial training in use of the ophthalmoscope for funduscopic examination, students consider that examining the eye in the live dog is significantly more valuable and that the welfare of dogs thus used is not in their view unduly compromised.
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Affiliation(s)
- D L Williams
- Queen's Veterinary School Hospital, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - C Wager
- Clinical Skills Center, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - J Brearley
- Clinical Skills Center, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
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Borgersen NJ, Henriksen MJV, Konge L, Sørensen TL, Thomsen ASS, Subhi Y. Direct ophthalmoscopy on YouTube: analysis of instructional YouTube videos' content and approach to visualization. Clin Ophthalmol 2016; 10:1535-41. [PMID: 27574393 PMCID: PMC4993418 DOI: 10.2147/opth.s111648] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Direct ophthalmoscopy is well-suited for video-based instruction, particularly if the videos enable the student to see what the examiner sees when performing direct ophthalmoscopy. We evaluated the pedagogical effectiveness of instructional YouTube videos on direct ophthalmoscopy by evaluating their content and approach to visualization. Methods In order to synthesize main themes and points for direct ophthalmoscopy, we formed a broad panel consisting of a medical student, junior and senior physicians, and took into consideration book chapters targeting medical students and physicians in general. We then systematically searched YouTube. Two authors reviewed eligible videos to assess eligibility and extract data on video statistics, content, and approach to visualization. Correlations between video statistics and contents were investigated using two-tailed Spearman’s correlation. Results We screened 7,640 videos, of which 27 were found eligible for this study. Overall, a median of 12 out of 18 points (interquartile range: 8–14 key points) were covered; no videos covered all of the 18 points assessed. We found the most difficulties in the approach to visualization of how to approach the patient and how to examine the fundus. Time spent on fundus examination correlated with the number of views per week (Spearman’s ρ=0.53; P=0.029). Conclusion Videos may help overcome the pedagogical issues in teaching direct ophthalmoscopy; however, the few available videos on YouTube fail to address this particular issue adequately. There is a need for high-quality videos that include relevant points, provide realistic visualization of the examiner’s view, and give particular emphasis on fundus examination.
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Affiliation(s)
- Nanna Jo Borgersen
- Department of Ophthalmology, Zealand University Hospital, Roskilde; Copenhagen Academy for Medical Education and Simulation, the Capital Region of Denmark; Faculty of Health and Medical Sciences, University of Copenhagen
| | - Mikael Johannes Vuokko Henriksen
- Copenhagen Academy for Medical Education and Simulation, the Capital Region of Denmark; Faculty of Health and Medical Sciences, University of Copenhagen
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, the Capital Region of Denmark; Faculty of Health and Medical Sciences, University of Copenhagen
| | - Torben Lykke Sørensen
- Department of Ophthalmology, Zealand University Hospital, Roskilde; Faculty of Health and Medical Sciences, University of Copenhagen
| | - Ann Sofia Skou Thomsen
- Copenhagen Academy for Medical Education and Simulation, the Capital Region of Denmark; Faculty of Health and Medical Sciences, University of Copenhagen; Department of Ophthalmology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Yousif Subhi
- Department of Ophthalmology, Zealand University Hospital, Roskilde; Faculty of Health and Medical Sciences, University of Copenhagen
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Ah-kee E, Husni D, Khan A, Lim LT. An alternative to direct ophthalmoscopy. CLINICAL TEACHER 2016; 13:316. [DOI: 10.1111/tct.12506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Lik Thai Lim
- Ophthalmology Department; Royal Berkshire Hospital; Reading UK
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Mackay DD, Bruce BB. Non-mydriatic fundus photography: a practical review for the neurologist. Pract Neurol 2016; 16:343-51. [DOI: 10.1136/practneurol-2016-001443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 11/03/2022]
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