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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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Visioli G, Zeppieri M, Iannucci V, Manni P, Albanese GM, Salati C, Spadea L, Pirraglia MP. From Bedside to Diagnosis: The Role of Ocular Fundus in Systemic Infections. J Clin Med 2023; 12:7216. [PMID: 38068267 PMCID: PMC10707096 DOI: 10.3390/jcm12237216] [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: 10/17/2023] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 01/23/2024] Open
Abstract
In this comprehensive review, we delve into the significance of the ocular fundus examination in diagnosing and managing systemic infections at the bedside. While the utilization of advanced ophthalmological diagnostic technologies can present challenges in bedside care, especially for hospitalized patients confined to their beds or during infection outbreaks, the ocular fundus examination often emerges as an essential, and sometimes the only practical, diagnostic tool. Recent discussions have highlighted that the role of an ocular fundus examination might not always be advocated as a routine diagnostic procedure. With this context, we introduce a decision tree tailored for assessing the ocular fundus in inpatients with systemic infections. We also present an overview of systemic infections that impact the eye and elucidate key signs detectable through a bedside ocular fundus examination. Targeted primarily at non-ophthalmology clinicians, this review seeks to offer a comprehensive insight into a multifaceted approach and the enhancement of patient clinical outcomes.
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Affiliation(s)
- Giacomo Visioli
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Valeria Iannucci
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
| | - Priscilla Manni
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
| | - Giuseppe Maria Albanese
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Leopoldo Spadea
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
- Eye Clinic, Policlinico Umberto I University Hospital, 00161 Rome, Italy
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3
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Khan A, Rangu N, Thanitcul C, Riaz KM, Woreta FA. Ophthalmic Education: The Top 100 Cited Articles in Ophthalmology Journals. JOURNAL OF ACADEMIC OPHTHALMOLOGY (2017) 2023; 15:e132-e143. [PMID: 37502126 PMCID: PMC10370640 DOI: 10.1055/s-0043-1771044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/12/2023] [Indexed: 07/29/2023]
Abstract
Purpose To identify the top 100 (T100) cited articles on ophthalmic education and examine trends and areas of focus in ophthalmic education. Methods A literature search was conducted for articles published between 2011 and 2021 related to ophthalmic education within ophthalmology journals using the ISI Web of Science Core Collection database. The search was performed in June 2022 and was conducted using the search phrase ([educat* OR teach* OR instruct* OR train* OR "medical student*" OR residen* OR fellow* OR undergrad* OR postgrad* OR "faculty" OR "attending"] AND *ophthalm*). Results were analyzed using VOSviewer v.1.6.18 and statistical analysis was performed using Microsoft Excel. Results The majority of articles were published in the Journal of Cataract & Refractive Surgery (19%), followed by Ophthalmology (12%), and Eye (12%). Articles were most often published in the year 2013 (15%), followed by 2014 (12%) and 2012 (12%). Articles most commonly originated from English-speaking countries, including the United States (43%), England (14%), Canada (8%), and India (8%). Topics most often examined in ophthalmic education were resident education (51%), medical school education (21%), and surgical training (21%). The most common study types were cohort studies (22%), case series (21%), and prospective trials (16%). There were 16 institutions that produced more than one article in the T100 articles list. Conclusion The T100 articles on ophthalmic education were primarily U.S. based and focused on resident education, surgical training, and medical school ophthalmic curriculum. Further research into ophthalmic education is warranted to establish evidence-based curricula guidelines.
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Affiliation(s)
- Asher Khan
- College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma
| | - Neal Rangu
- College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma
| | - Chanon Thanitcul
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kamran M. Riaz
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma
| | - Fasika A. Woreta
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Optimising fundoscopy practices across the medical spectrum: A focus group study. PLoS One 2023; 18:e0280937. [PMID: 36706098 PMCID: PMC9882965 DOI: 10.1371/journal.pone.0280937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Fundoscopy can be of great clinical value, yet remains underutilised. Educational attempts to improve fundoscopy utilisation have had limited success. We aimed to explore the barriers and facilitators underlying the uptake of clinical direct ophthalmoscopy across a spectrum of medical specialties and training levels. METHODS Ten focus groups were conducted with medical students (n = 42), emergency department doctors (n = 24), basic physician trainees (n = 7), hospital physicians (n = 6) and general practitioners (n = 7). Independent thematic analysis of transcripts was conducted by three investigators. A consensus thematic framework was developed, and transcripts were reanalysed using this framework. RESULTS Thematic analysis identified seven main themes: (1) technical barriers to performing fundoscopy examinations; (2) clinical culture and expectations regarding fundoscopy; (3) the influence of fundoscopy on clinical management; (4) motivation to perform the examination; (5) novel technology including smartphone fundoscopy, and the value of a digital fundus image; (6) training requirements, and; (7) use of limited resources. CONCLUSION Our results build a more nuanced picture of the factors which determine fundoscopy utilisation. As current barriers limit practice by clinicians and medical students, expertise and confidence performing and interpreting fundoscopy are lost. This shifts the balance of perceived clinical utility to futility in changing patient management, and reinforces a cycle of reducing fundoscopy utilisation. We identified important cultural barriers such as accepted incompetence, and misperceptions of senior discouragement. Emerging technologies reduce the technical barriers to fundoscopy. Therefore education should: focus on detecting pathology from digital images; clarify the role of fundoscopy in patient management, and; be targeted at key career progression points.
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Martins TGDS, Benchimol GL, Gameiro GR, Schor P. Learning and teaching ophthalmology in the pandemic. EINSTEIN-SAO PAULO 2022; 20:eCE6988. [PMID: 35674631 PMCID: PMC9165563 DOI: 10.31744/einstein_journal/2022ce6988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/29/2021] [Indexed: 11/09/2022] Open
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Basilious A, Govas CN, Deans AM, Yoganathan P, Deans RM. Evaluating the Diagnostic Accuracy of a Novel Bayesian Decision-Making Algorithm for Vision Loss. Vision (Basel) 2022; 6:vision6020021. [PMID: 35466273 PMCID: PMC9036270 DOI: 10.3390/vision6020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/23/2022] [Accepted: 04/02/2022] [Indexed: 12/03/2022] Open
Abstract
The current diagnostic aids for acute vision loss are static flowcharts that do not provide dynamic, stepwise workups. We tested the diagnostic accuracy of a novel dynamic Bayesian algorithm for acute vision loss. Seventy-nine “participants” with acute vision loss in Windsor, Canada were assessed by an emergency medicine or primary care provider who completed a questionnaire about ocular symptoms/findings (without requiring fundoscopy). An ophthalmologist then attributed an independent “gold-standard diagnosis”. The algorithm employed questionnaire data to produce a differential diagnosis. The referrer diagnostic accuracy was 30.4%, while the algorithm’s accuracy was 70.9%, increasing to 86.1% with the algorithm’s top two diagnoses included and 88.6% with the top three included. In urgent cases of vision loss (n = 54), the referrer diagnostic accuracy was 38.9%, while the algorithm’s top diagnosis was correct in 72.2% of cases, increasing to 85.2% (top two included) and 87.0% (top three included). The algorithm’s sensitivity for urgent cases using the top diagnosis was 94.4% (95% CI: 85–99%), with a specificity of 76.0% (95% CI: 55–91%). This novel algorithm adjusts its workup at each step using clinical symptoms. In doing so, it successfully improves diagnostic accuracy for vision loss using clinical data collected by non-ophthalmologists.
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Affiliation(s)
- Amy Basilious
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON N6A 5C1, Canada; (A.B.); (A.M.D.)
| | - Chris N. Govas
- School of Medicine, Ross University, Two Mile Hill, St. Michael, Bridgetown BB11093, Barbados;
| | - Alexander M. Deans
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON N6A 5C1, Canada; (A.B.); (A.M.D.)
| | - Pradeepa Yoganathan
- Department of Ophthalmology, Kresge Eye Institute, Wayne State University School of Medicine, Wayne State University, 540 E. Canfield Ave., Detroit, MI 48201, USA;
- Windsor Eye Associates, Department of Ophthalmology and Vision Sciences, University of Toronto, 2224 Walker Rd #198, Windsor, ON N8W 3P6, Canada
| | - Robin M. Deans
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON N6A 5C1, Canada
- Correspondence: ; Tel.: +519-980-1031
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Wu C, Luo M, Liu Y, Dai R, Zhang M, Zhong Y, Chen Y. Application of a 3D-printed eye model for teaching direct ophthalmoscopy to undergraduates. Graefes Arch Clin Exp Ophthalmol 2022; 260:2361-2368. [PMID: 35038015 DOI: 10.1007/s00417-021-05538-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/04/2022] Open
Abstract
PURPOSE This study aims to design an eye model that can simulate the fundus for teaching direct ophthalmoscopy and to evaluate its effectiveness. METHODS We first used 3D printing materials to make an eye model and then randomly assigned 92 undergraduates into group A (model-assisted training group) and group B (traditional training group) to test our model. After the same training time, real patients were used to test the students, with 120 s as the examination time limit. We recorded the students' ability to clearly see the optic disk, the time to determine the cup-to-disk ratio, and whether they were correct. RESULTS Forty-three students in group A (93.48%) successfully saw the fundus, while 21 in group B (45.65%) succeeded. The difference between the two groups was 47.83% (95% confidence interval, 29.59-66.07%, P < 0.0001). The median time to see the fundus was 29s (95% confidence interval 23-45 s) in group A, while an estimated minimum time in group B was 80 s, indicating that group A was significantly faster than group B (P < 0.0001). CONCLUSIONS This 3D-printed eye model significantly improved the students' study interest, study efficiency, and study results and is worthy of being promoted.
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Affiliation(s)
- Chan Wu
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingyue Luo
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yutong Liu
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Rongping Dai
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Meifen Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yong Zhong
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China. .,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China.
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Curtis R, Xu M, Liu D, Kwok J, Hopman W, Irrcher I, Baxter S. Smartphone Compatible versus Conventional Ophthalmoscope: A Randomized Crossover Educational Trial. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2021. [DOI: 10.1055/s-0041-1736438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Objective The aim of the study is to compare performance and ease-of-use (EOU) of optic disk assessment using a smartphone direct ophthalmoscope attachment (D-EYE) to the gold standard direct ophthalmoscope (DO).
Design The type of study involved is prospective, randomized, crossover, and educational trial.
Participants The participants involved were first year medical students inexperienced in ophthalmoscopy.
Methods Optic disks of standardized and volunteer patients were examined using the D-EYE and a conventional DO. Optic disk identification, EOU ratings of the devices, self-reported confidence level in their examination with the devices, and estimation of vertical cup-to-disk ratio (VCDR) were compared. Analyses included Chi-square tests, independent samples t-tests, correlations, and multivariable linear regression.
Results Forty-four medical students voluntarily participated in the study. Students using the DO required more attempts (3.57 vs. 2.69, p = 0.010) and time (197.00 vs. 168.02 seconds, p = 0.043) to match the patient's fundus to the correct photograph. Overall EOU between the devices (6.40 vs. 4.79, p < 0.001) and overall confidence in examination (5.65 vs. 4.49, p = 0.003) were greater when using the D-EYE. There were no statistically significant differences in accuracy of VCDR estimations between the two ophthalmoscopes.
Conclusion Smartphone ophthalmoscopy could offer additional learning opportunities in medical education and may be considered in clinical practice by non-specialist physicians given its greater EOU and increased success in visualizing the optic disk.
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Affiliation(s)
- Rachel Curtis
- Kingston Health Sciences Centre-Kingston General Hospital Research Institute, Kingston, Ontario, Canada
| | - Mark Xu
- Kingston Health Sciences Centre-Kingston General Hospital Research Institute, Kingston, Ontario, Canada
| | - Daisy Liu
- Kingston Health Sciences Centre-Kingston General Hospital Research Institute, Kingston, Ontario, Canada
| | - Jason Kwok
- Kingston Health Sciences Centre-Kingston General Hospital Research Institute, Kingston, Ontario, Canada
| | - Wilma Hopman
- Kingston Health Sciences Centre-Kingston General Hospital Research Institute, Kingston, Ontario, Canada
| | - Isabella Irrcher
- Kingston Health Sciences Centre-Kingston General Hospital Research Institute, Kingston, Ontario, Canada
| | - Stephanie Baxter
- Kingston Health Sciences Centre-Kingston General Hospital Research Institute, Kingston, Ontario, Canada
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Mahmoud A, Abid F, Ezdini M, Lahdhiri ML, Ouanes I, Messaoud R. The contribution of simulation in training for funduscopic examination. LA TUNISIE MEDICALE 2021; 99:1141-1147. [PMID: 35288920 PMCID: PMC8974430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Simulation is emerging as an essential part of health sciences training programs as it provides safer patient care by reducing the risk of error. In the healthcare environment, simulation continues to spread in emergency specialties, but it is still underdeveloped in ophthalmology and there is a shortage of publications on this subject in Tunisia. OBJECTIVE To evaluate the effectiveness of procedural simulation as a teaching tool for funduscopic examination training. Methods and population studied: This was a prospective study including students who underwent procedural simulation training sessions during their ophthalmology internship. The included students were assessed at the initiation and end of each session by a pre-test and post-test. The procedure for performing the funduscopic examination was evaluated by a specific performance score. Student satisfaction was assessed at the end of each session. RESULTS During the study period, four groups of 12 students were included, for a total of 48 participants spread over 4 simulation sessions. Simulation training improved post-test. assessment scores with an overall median delta of +4.00. It also provided specific skills for performing the funduscopic examination, with an overall median specific performance score of 5.5/8 (5/8 to 7/8). The majority of students were satisfied upon completion of the simulation session. CONCLUSION The training of fundus examination using an ophthalmoscopic simulator can improve the skills and knowledge of ophthalmic learners. This type of training can be an innovative addition to traditional learning.
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Affiliation(s)
- Anis Mahmoud
- 1- Service d’ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia / Université de Monastir, Tunisie / faculté de médecine de Monastir
| | - Fatma Abid
- 1- Service d’ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia / Université de Monastir, Tunisie / faculté de médecine de Monastir
| | | | - Mohamed Lahbib Lahdhiri
- 1- Service d’ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia / Université de Monastir, Tunisie / faculté de médecine de Monastir
| | - Islem Ouanes
- 3- Service de Réanimation Polyvalente, Centre Hospitalo-Universitaire Fattouma Bourguiba, Monastir / Université de Monastir, Tunisie / faculté de médecine de Monastir
| | - Riadh Messaoud
- 1- Service d’ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia / Université de Monastir, Tunisie / faculté de médecine de Monastir
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Pujari A. Smartphone Ophthalmoscopy: is there a place for it? Clin Ophthalmol 2021; 15:4333-4337. [PMID: 34737548 PMCID: PMC8560125 DOI: 10.2147/opth.s243103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022] Open
Abstract
Smartphone technology is advancing at a rapid pace. Their role in day-to-day life is becoming more and more intricate and irreplaceable. Of late, they have gained immense importance in different medical specialities where they possess an active ability to guide the clinician. This is particularly evident in ophthalmology, where the constantly evolving camera-illumination systems and the artificial intelligence integrated technology have unravelled many novel observations for non-contact posterior segment imaging. The scope of this review is to highlight the role of smartphones as ophthalmoscopes (direct as well as indirect). Nevertheless, their limitations and future directions are also stated here with the intention of making progress in the field of smartphone fundus imaging.
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Affiliation(s)
- Amar Pujari
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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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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13
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Mishra D, Shanmugam MP, Chaitanya EV, Murali K, Ramanjulu R, Kulkarni M, Nair S. A questionnaire-based assessment of Safe Eye Examination (SEE) technique. Indian J Ophthalmol 2021; 69:2321-2325. [PMID: 34427210 PMCID: PMC8544113 DOI: 10.4103/ijo.ijo_3316_20] [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] [Indexed: 12/31/2022] Open
Abstract
Purpose: This study aims to assess the novel and innovative method of Safe Eye Examination (SEE) technique using the model eye for the purpose of teaching, training, and resident examination. Methods: A questionnaire-based study (Descriptive Data) with 53 participants, including ophthalmology residents, fellows in various subspecialties, and trainee optometrists was used. In our study, we used the Reti Eye model, but instead of the usual retina template sheet, we used prominent pathological fundus photographs loaded into the model eye. The study participants were asked to view prominent pathological fundus images printed on a matte finish paper. A circular image was cut and was placed in the Reti Eye model. The candidates were made to perform indirect ophthalmoscopy with a + 20D lens and to fill up a Google image assessment scale questionnaire with characteristics, including pixelation, sharpness, contrast, reflexes, blotchy appearance, and diagnostic confidence, which were then analyzed and depicted. Association between categorical variables was analyzed using Fisher exact test and Chi-square test. A P value of less than 0.05 was considered statistically significant. All data were analyzed with a statistical software package (SPSS, Version 16.0 for Windows). Results: The number of positive responses (>90%) obtained for the pixelation, sharpness, contrast, reflexes, blotchy appearance, and diagnostic confidence of the image viewed were statistically more significant than the negative responses (P < 0.05). Conclusion: The SEE technique of using the model eye can be incorporated for teaching, training, and skill assessment in the examinations in these difficult times of COVID-19 (coronavirus disease 2019) pandemic.
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Affiliation(s)
- Divyansh Mishra
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
| | - Mahesh P Shanmugam
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
| | - E Vivek Chaitanya
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
| | - Kaushik Murali
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
| | - Rajesh Ramanjulu
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
| | - Mayur Kulkarni
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
| | - Sukanya Nair
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
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14
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Dunn HP, Marks S, Teo KZ, Dunn SM, Healey PR, White AJ. eFOCUS 2: A randomised crossover trial of smartphone fundoscopy and direct ophthalmoscopy aiming to improve optic disc interpretation by medical students with e-learning support. Clin Exp Ophthalmol 2021; 49:704-713. [PMID: 34291862 DOI: 10.1111/ceo.13977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/04/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ophthalmoscopy and its interpretation are complex. We aimed to compare the diagnostic accuracy of smartphone fundoscopy with traditional direct ophthalmoscopy for optic disc interpretation, with e-learning support. METHODS We conducted a randomised, crossover study of 102 medical students. Students were offered e-learning for optic disc interpretation. A fundoscopy objective structured clinical examination was conducted after an introductory lecture and 10-min practical training session on smartphone fundoscopy and traditional ophthalmoscopy. Participants examined patients and simulator slides with a randomised crossover between smartphone [D-eye (Padova, Italy) or iExaminer (Welch Allyn, Macquarie Park, Australia)] and traditional ophthalmoscopy (Welch Allyn). Optic discs were graded independently by three masked ophthalmologists. The primary outcome was the ability to interpret an optic disc as normal or abnormal. Secondary outcomes included other optic disc aspects; student preferences; and e-learning performance. RESULTS Students' agreement with the gold standard for an abnormal or normal disc was significantly greater using a smartphone (74.4%) than with direct ophthalmoscopy (68.1%, p = 0.032). More students preferred smartphone (74%) over direct ophthalmoscopy (26%, p < 0.001). E-learning led to an improvement in optic disc interpretation scores (mean improvement = 4.5%, 95% CI = 3.7-5.2, p < 0.001). CONCLUSIONS Medical students are more accurate at recognising an abnormal optic disc using smartphone fundoscopy than traditional direct ophthalmoscopy, and have a strong preference for smartphone fundoscopy. E-learning may improve the interpretation of optic disc abnormalities. Smartphone fundoscopy may mitigate some technical challenges of fundoscopy and reinvigorate use of this valuable clinical examination.
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Affiliation(s)
- Hamish P Dunn
- Northern Clinical School, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales, Australia.,Westmead Hospital, Department of Ophthalmology, University of Sydney, Westmead, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Kensington, Australia.,Department of Ophthalmology, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Samuel Marks
- Northern Clinical School, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales, Australia.,Westmead Millennium Institute for Medical Research, Westmead, Australia
| | - Kai Z Teo
- Northern Clinical School, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales, Australia
| | - Stewart M Dunn
- Northern Clinical School, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales, Australia.,Pam McLean Centre, University of Sydney, St Leonards, New South Wales, Australia
| | - Paul R Healey
- Northern Clinical School, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales, Australia.,Westmead Hospital, Department of Ophthalmology, University of Sydney, Westmead, New South Wales, Australia.,Westmead Millennium Institute for Medical Research, Westmead, Australia
| | - Andrew J White
- Northern Clinical School, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales, Australia.,Westmead Hospital, Department of Ophthalmology, University of Sydney, Westmead, New South Wales, Australia.,Westmead Millennium Institute for Medical Research, Westmead, Australia
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15
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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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16
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Bascaran C, Mwangi N, D’Esposito F, Gordon I, Ulloa JAL, Mdala S, Ramke J, Evans JR, Burton M. Effectiveness of task-shifting for the detection of diabetic retinopathy in low- and middle-income countries: a rapid review protocol. Syst Rev 2021; 10:4. [PMID: 33390182 PMCID: PMC7780379 DOI: 10.1186/s13643-020-01553-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/02/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Diabetic retinopathy is the most common ocular complication of diabetes and a cause of vision loss in adults. Diabetic retinopathy screening leading to early identification of the disease followed by timely treatment, can prevent vision loss in people living with diabetes. A key barrier to the implementation of screening services in low- and middle-income countries is the low number of ophthalmologists per million population. Interventions that shift screening to non-ophthalmology cadres have been implemented in programmes in low- and middle-income countries and are routinely used in high-income countries. The aim of this rapid review is to summarise the published literature reporting the effectiveness of task-shifting interventions for the detection of diabetic retinopathy by non-ophthalmologists in low- and middle-income countries. METHODS We will search MEDLINE, Embase, Global Health and Cochrane Register of Studies for studies reporting task-shifting interventions for diabetic retinopathy detection. The review will include studies published in the last 10 years in the English language. We will include any interventional or observational comparative study measuring outcomes in terms of participation or access to diabetic retinopathy detection services (uptake) and quality of diabetic retinopathy detection services (detection, severity, diagnostic accuracy). For included studies, cost-effectiveness of the task-shifting intervention will also be presented. Two reviewers will screen search results independently. The risk of bias assessment and data extraction will be carried out by one reviewer with verification of 10% of the papers by a second reviewer. The results will be synthesised narratively. DISCUSSION Differences in health systems organization, structure and resources will determine the need and success of task-shifting interventions for DR screening. The review will examine how these interventions have been used and/or tested in LMICs. The results will be of interest to policy makers and programme managers tasked with designing and implementing services to prevent and manage diabetes and its complications in similar settings. SYSTEMATIC REVIEW REGISTRATION OSF: https://osf.io/dfhg6/ .
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Affiliation(s)
- Covadonga Bascaran
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Nyawira Mwangi
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Kenya Medical Training College, Nairobi, Kenya
| | | | - Iris Gordon
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | | | - Shaffi Mdala
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Jacqueline Ramke
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Jennifer R. Evans
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Matthew Burton
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Moorfields Eye Hospital, London, UK
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17
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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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18
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Lee JY, Gallo RA, Alabiad CR. Evaluating the Effectiveness of Small-Group Training in Teaching Medical Students Integral Clinical Eye Examination Skills. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2020; 12:e79-e86. [PMID: 32728655 DOI: 10.1055/s-0040-1712175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objective The aim of this study is to evaluate the effectiveness of an interactive, small-group ophthalmology clinical training session by assessing medical students' self-confidence with eye examination skills and long-term retention of direct ophthalmoscopy skills. Methods The second-year medical students participated in a one-time small-group clinical training session that taught essential components of the eye examination. Students reported their confidence with each component in pre- and postsession surveys. Eight months later, direct ophthalmoscopy skills were reassessed by having students visualize the optic nerves of standardized patients and identify the matching optic nerve photograph in a multiple-choice quiz. Results Among 197 second-year medical students who participated in the training session, 172 students completed the presession survey (87.3% response rate) and 108 students completed the postsession survey (54.8% response rate). Following the training session, students reported increased self-confidence (p < 0.01) overall. A total of 107 (107/108; 99.1%) students reported that they visualized the optic nerve head, and 80 out of 85 (94.1%) students stated that they preferred the PanOptic ophthalmoscope over the traditional direct ophthalmoscope. Students reported greater self-confidence using the PanOptic ophthalmoscope (p < 0.01). In the 8-month follow-up assessment, 42 medical students (42/197; 21.3%) completed the exercise. A total of 41 (41/42; 97.6%) students stated that they saw the optic nerve with the PanOptic ophthalmoscope; 24 (24/42; 57.1%) students identified the correct optic nerve image using the PanOptic ophthalmoscope on a standardized patient; 14 (14/42; 33.3%) students stated that they saw the optic nerve with the traditional direct ophthalmoscope; and 4 (4/42; 9.1%) students from the same cohort identified the correct optic nerve image with the traditional direct ophthalmoscope on a standardized patient. Conclusion Our comprehensive, one-time eye examination skills training session seeks to prepare students to incorporate these skills in future patient care. Students' overall confidence improved in each aspect of the eye examination that was covered. A follow-up assessment on students' direct ophthalmoscopy skills suggests that the PanOptic ophthalmoscope allows for superior skills retention as compared with the traditional direct ophthalmoscope. We believe that the PanOptic ophthalmoscope should be further integrated into medical education and clinical practice.
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Affiliation(s)
- John Y Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ryan A Gallo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Chrisfouad R Alabiad
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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19
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Yang MMH, Singhal A, Hengel AR, Kerr JM, St-Pierre GH, George S, Muir K, Thiessen P, Enarson P. Video Diversion Improves Success Rate of Fundoscopic Examination in Children: A Prospective Randomized Controlled Trial. Pediatr Neurol 2018; 83:32-37. [PMID: 29681489 DOI: 10.1016/j.pediatrneurol.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/06/2017] [Accepted: 09/10/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fundoscopy is an important component of the neurological examination as it can detect pathologies such as high intracranial pressure. However, the examination can be challenging in young children. This study evaluated whether playing a video during eye examination improves the success, duration, and ease of pediatric fundoscopy. MATERIALS AND METHODS This was a prospective, multipractitioner, multiclinic, randomized controlled trial. Patients aged one to four years were recruited in the emergency department, neurology clinic, spinal cord clinic, and general pediatric clinic. Eye examination was randomized to video or non-video-assisted fundoscopy. Successful examinations were defined as visualizing the fundus within 60 seconds. Time to visualize optic disc was recorded and difficulty of examination was assessed using a 10-point Likert scale. RESULTS We recruited 101 subjects with a mean age of 2.8 years. Overall, there was a 20% absolute improvement in the success rate of visualizing the optic disc in the video versus non-video group (P < 0.001, 95%CI: 7.8% to 31%). Time to visualize optic disc was also improved (Δ5.3 seconds, P < 0.01, 95%CI: 1.4 to 9.1 seconds). Practitioners and caregivers noticed a 33% (P < 0.01, 95%CI: 21% to 44%) and 42% (P < 0.01, 95%CI: 30% to 56%) relative improvement in the ease of examination with video, respectively. CONCLUSIONS The use of videos improved the ease, duration, and, most importantly, the success of fundoscopy in younger children. This simple, inexpensive adjunct has great potential to improve the ease and efficacy of this aspect of the neurological examination and allow fundoscopic examination to be effectively performed earlier in the age-appropriate vision screening protocols.
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Affiliation(s)
- Michael M H Yang
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Ash Singhal
- Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Alexander R Hengel
- Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - John M Kerr
- Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Godefroy Hardy St-Pierre
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Shawn George
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Muir
- Division of Pediatric Neurology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Thiessen
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Enarson
- Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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20
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Cunha LP, Figueiredo EA, Araújo HP, Costa-Cunha LVF, Costa CF, Neto JDMC, Matos AMF, de Oliveira MM, Bastos MG, Monteiro MLR. Non-Mydriatic Fundus Retinography in Screening for Diabetic Retinopathy: Agreement Between Family Physicians, General Ophthalmologists, and a Retinal Specialist. Front Endocrinol (Lausanne) 2018; 9:251. [PMID: 29867777 PMCID: PMC5968305 DOI: 10.3389/fendo.2018.00251] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 05/02/2018] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To determine the level of agreement between trained family physicians (FPs), general ophthalmologists (GOs), and a retinal specialist (RS) in the assessment of non-mydriatic fundus retinography in screening for diabetic retinopathy (DR) in the primary health-care setting. METHODS 200 Diabetic patients were submitted to two-field non-mydriatic digital fundus camera. The images were examined by four trained FPs, two GOs, and one RS with regard to the diagnosis and severity of DR and the diagnosis of macular edema. The RS served as gold standard. Reliability and accuracy were determined with the kappa test and diagnostic measures. RESULTS A total of 397 eyes of 200 patients were included. The mean age was 55.1 (±11.7) years, and 182 (91%) had type 2 diabetes. The mean levels of serum glucose and glycosylated hemoglobin A1c were 195.6 (±87.3) mg/dL and 8.9% (±2.1), respectively. DR was diagnosed in 166 eyes by the RS and in 114 and 182 eyes by GO1 and GO2, respectively. For severity, DR was graded as proliferative in 8 eyes by the RS vs. 15 and 9 eyes by GO1 and GO2, respectively. The agreement between the RS and the GOs was substantial for both DR diagnosis (GO1k = 0.65; GO2k = 0.74) and severity (GO1k = 0.60; GO2k = 0.71), and fair or moderate for macular edema (GO1k = 0.27; GO2k = 0.43). FP1, FP2, FP3, and FP4 diagnosed DR in 108, 119, 163, and 117 eyes, respectively. The agreement between the RS and the FPs with regard to DR diagnosis was substantial (FP2k = 0.69; FP3k = 0.73; FP4k = 0.71) or moderate (FP1k = 0.56). As for DR severity, the agreement between the FPs and the RS was substantial (FP2k = 0.66; FP3k = 069; FP4k = 0.64) or moderate (FP1k = 0.51). Agreement between the FPs and the RS with regard to macular edema was fair (FP1k = 0.33; FP2k = 0.39; FP3k = 0.37) or moderate (FP4k = 0.51). CONCLUSION Non-mydriatic fundus retinography was shown to be useful in DR screening in the primary health-care setting. FPs made assessments with good levels of agreement with an RS. Non-mydriatic fundus retinography associated with appropriate general physicians training is essential for the DR screening.
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Affiliation(s)
- Leonardo Provetti Cunha
- Department of Ophthalmology, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
- Juiz de Fora Eye Hospital, Juiz de Fora, Brazil
- Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
- *Correspondence: Leonardo Provetti Cunha,
| | - Evelyn Alvernaz Figueiredo
- Department of Ophthalmology, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Henrique Pereira Araújo
- Department of Ophthalmology, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | | | | | | | | | - Marise Machado de Oliveira
- Division of Family Medicine, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Marcus Gomes Bastos
- Department of Nephrology, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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21
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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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22
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Bursztyn L, Woodward MA, Cornblath WT, Grabe HM, Trobe JD, Niziol L, De Lott LB. Accuracy and Reliability of a Handheld, Nonmydriatic Fundus Camera for the Remote Detection of Optic Disc Edema. Telemed J E Health 2017; 24:344-350. [PMID: 29027884 DOI: 10.1089/tmj.2017.0120] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Optic disc edema can be an important indicator of serious neurological disease, but is poorly detected using the direct ophthalmoscope. Portable fundus photography may overcome this difficulty. INTRODUCTION The purpose of this study was to determine the sensitivity and specificity of a handheld, nonmydriatic fundus camera for the detection of optic disc edema. MATERIALS AND METHODS Retrospective review of nonmydriatic optic disc photographs taken with a portable fundus camera (Pictor Plus; Volk Optical, Mentor, OH) from the University of Michigan Neuro-Ophthalmology Clinics. We included 103 consecutive eyes with optic disc edema and 103 consecutive eyes without optic disc edema of 109 patients. Four masked neuro-ophthalmologists graded a single photograph of each optic disc presented in randomized order and documented the presence of optic disc edema. Sensitivity and specificity of graders' photographic interpretation was compared with clinical examinations. Reliability of assessments within and between graders was determined using kappa statistics. RESULTS The sensitivity and specificity for detection of optic disc edema were 71.8-92.2% and 81.6-95.2%, respectively. Photos were found to be ungradable in 0-8.3% of cases. The intergrader reliabilities ranged from 0.60 [95% confidence interval (CI): 0.52-0.67] to 0.72 (95% CI: 0.66-0.77). Intragrader reliability ranged from 0.76 (95% CI: 0.63-0.92) to 0.82 (95% CI: 0.69-0.95). DISCUSSION Photographs taken with portable, nonmydriatic technology met threshold sensitivity and specificity for remote screening for optic disc edema when performed by most, but not all graders. Reliability between graders was moderate-strong and strong within individual providers. CONCLUSIONS Portable photography holds promise for use in remote screening of optic disc edema.
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Affiliation(s)
- Lulu Bursztyn
- 1 Department of Ophthalmology, Western University , London, Ontario, Canada
| | - Maria A Woodward
- 2 Department of Ophthalmology & Visual Sciences, University of Michigan , Ann Arbor, Michigan
| | - Wayne T Cornblath
- 2 Department of Ophthalmology & Visual Sciences, University of Michigan , Ann Arbor, Michigan
| | - Hilary M Grabe
- 3 Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern , Bern, Switzerland
| | - Jonathan D Trobe
- 2 Department of Ophthalmology & Visual Sciences, University of Michigan , Ann Arbor, Michigan
| | - Leslie Niziol
- 2 Department of Ophthalmology & Visual Sciences, University of Michigan , Ann Arbor, Michigan
| | - Lindsey B De Lott
- 2 Department of Ophthalmology & Visual Sciences, University of Michigan , Ann Arbor, Michigan
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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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Day LM, Wang SX, Huang CJ. Nonmydriatic Fundoscopic Imaging Using the Pan Optic iExaminer System in the Pediatric Emergency Department. Acad Emerg Med 2017; 24:587-594. [PMID: 27801997 DOI: 10.1111/acem.13128] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/12/2016] [Accepted: 10/22/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The primary objective of this study was to determine the percentage of clinically adequate (CA) fundoscopic images that could be obtained using the Pan Optic iExaminer system to perform nonmydriatic fundoscopic imaging in the pediatric emergency department (ED). Secondary objectives were to identify target age groups in which this technology is best utilized and evaluate the overall ease of use in this setting. METHODS Children 18 years of age or less who presented to the pediatric ED with a non-eye-related chief complaint were enrolled and stratified by age group (0-2, 2-6, and 6-18 years). Each enrolled patient underwent a bilateral eye examination using the Pan Optic iExaminer system. Images were submitted for review to a pediatric ophthalmologist and were graded based on clarity and field of view. Ease of use was defined as 80% of patients having at least one image of quality to be considered "clinically adequate" for obtaining a full view of the optic nerve, examination time for both eyes 15 minutes or less, and three attempts or less for each eye. RESULTS Overall, 91.06% (95% confidence interval [CI] = 86.01% to 96.1%) of children ages 2-18 years had at least one CA image obtained. A total of 16% (95% CI = 7% to 26%) of children 0-2 years, 85% (95% CI = 76% to 94.15%) of children 2-6 years, and 9% (95% CI = 92% to 100%) of 6-18 years had at least one CA image. The median total examination time was 3 minutes 24 seconds (interquartile range = 2 minutes 27 seconds to 4 minutes 49 seconds). CONCLUSION Fundoscopic images were consistently obtained using the Pan Optic iExaminer system in the pediatric ED particularly in children 2-18 years of age. CA images were obtained in children less than 2 years old, but less consistently.
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Affiliation(s)
- Lindsay M. Day
- Department of Pediatrics; Division of Pediatric Emergency Medicine; Dallas TX
| | - Serena X. Wang
- Department of Ophthalmology; UT Southwestern Medical Center/Children's Health; Dallas TX
| | - Craig J. Huang
- Department of Pediatrics; Division of Pediatric Emergency Medicine; Dallas TX
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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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Martins TGS, Costa ALFA, Helene O, Martins RV, Helene AF, Schor P. Training of direct ophthalmoscopy using models. CLINICAL TEACHER 2017; 14:423-426. [DOI: 10.1111/tct.12641] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | - Andre F Helene
- Institute of Biosciences Libraries; University of São Paulo; Brazil
| | - Paulo Schor
- Ophthalmology Department; Federal University of São Paulo; Brazil
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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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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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Thomas DB, Newman-Toker DE. Diagnosis is a team sport - partnering with allied health professionals to reduce diagnostic errors: A case study on the role of a vestibular therapist in diagnosing dizziness. ACTA ACUST UNITED AC 2016; 3:49-59. [PMID: 28758055 DOI: 10.1515/dx-2016-0009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diagnostic errors are the most common, most costly, and most catastrophic of medical errors. Interdisciplinary teamwork has been shown to reduce harm from therapeutic errors, but sociocultural barriers may impact the engagement of allied health professionals (AHPs) in the diagnostic process. METHODS A qualitative case study of the experience at a single institution around involvement of an AHP in the diagnostic process for acute dizziness and vertigo. We detail five diagnostic error cases in which the input of a physical therapist was central to correct diagnosis. We further describe evolution of the sociocultural milieu at the institution as relates to AHP engagement in diagnosis. RESULTS Five patients with acute vestibular symptoms were initially misdiagnosed by physicians and then correctly diagnosed based on input from a vestibular physical therapist. These included missed labyrinthine concussion and post-traumatic benign paroxysmal positional vertigo (BPPV); BPPV called gastroenteritis; BPPV called stroke; stroke called BPPV; and multiple sclerosis called BPPV. As a consequence of surfacing these diagnostic errors, initial resistance to physical therapy input to aid medical diagnosis has gradually declined, creating a more collaborative environment for 'team diagnosis' of patients with dizziness and vertigo at the institution. CONCLUSIONS Barriers to AHP engagement in 'team diagnosis' include sociocultural norms that establish medical diagnosis as something reserved only for physicians. Drawing attention to the valuable diagnostic contributions of AHPs may help facilitate cultural change. Future studies should seek to measure diagnostic safety culture and then implement proven strategies to breakdown sociocultural barriers that inhibit effective teamwork and transdisciplinary diagnosis.
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Addressing the 'forgotten art of fundoscopy': evaluation of a novel teaching ophthalmoscope. Eye (Lond) 2015; 30:375-84. [PMID: 26563657 DOI: 10.1038/eye.2015.238] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 09/30/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Direct ophthalmoscopy is an essential skill that students struggle to learn. A novel 'teaching ophthalmoscope' has been developed that allows a third person to observe the user's view of the fundus. OBJECTIVES To evaluate the potential use of this device as an aid to learning, and as a tool for objective assessment of competence. METHODS Participants were randomised to be taught fundoscopy either with a conventional direct ophthalmoscope (control) or with the teaching device (intervention). Following this teaching session, participant competence was assessed within two separate objective structured clinical examination (OSCE) stations: the first with the conventional ophthalmoscope and the second with the teaching device. Each station was marked by two independent masked examiners. Students were also asked to rate their own confidence in fundoscopy on a scale of 1-10. Scores of competence and confidence were compared between groups. The agreement between examiners was used as a marker for inter-rater reliability and compared between the two OSCE stations. RESULTS Fifty-five medical students participated. The intervention group scored significantly better than controls on station 2 (19.8 vs 17.6; P=0.01). They reported significantly greater levels of confidence in fundoscopy (7.3 vs 4.9; P<0.001). Independent examiner scores showed significantly improved agreement when using the teaching device during assessment of competence, compared to the conventional ophthalmoscope (r=0.90 vs 0.67; P<0.001). CONCLUSION The teaching ophthalmoscope is associated with improved confidence and objective measures of competence, when compared with a conventional direct ophthalmoscope. Used to assess competence, the device offers greater reliability than the current standard.
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Bruce BB. Nonmydriatic Ocular Fundus Photography in the Emergency Department: How It Can Benefit Neurologists. Semin Neurol 2015; 35:491-5. [PMID: 26444394 DOI: 10.1055/s-0035-1563576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Examination of the ocular fundus is a critical aspect of the neurologic examination. For example, in patients with headache the ocular fundus examination is needed to uncover "red flags" suggestive of secondary etiologies. However, ocular fundus examination is infrequently and poorly performed in clinical practice. Nonmydriatic ocular fundus photography provides an alternative to direct ophthalmoscopy that has been studied as part of the Fundus Photography versus Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) Study. Herein, the results of the FOTO-ED study are reviewed with a particular focus on the study's implications for the acute care of patients presenting with headache and focal neurologic deficits. In headache patients, not only optic disc edema and optic disc pallor were observed as would be expected, but also a large number of abnormalities associated with hypertension. Based upon subjects with focal neurologic deficits, the FOTO-ED study suggests that the ocular fundus examination may assist with the triage of patients presenting with suspected transient ischemic attack. Continued advances in the ease and portability of nonmydriatic fundus photography will hopefully help to restore ocular fundus examination as a routinely performed component of all neurologic examinations.
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Affiliation(s)
- Beau B Bruce
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
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Succar T, Grigg J, Beaver HA, Lee AG. A systematic review of best practices in teaching ophthalmology to medical students. Surv Ophthalmol 2015; 61:83-94. [PMID: 26363187 DOI: 10.1016/j.survophthal.2015.09.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 09/04/2015] [Accepted: 09/04/2015] [Indexed: 10/23/2022]
Abstract
Ophthalmic medical student education is a cornerstone to improving eye health care globally. We review the current state of the literature, listing barriers to potential best practices for undergraduate ophthalmology teaching and learning within medical curricula. We describe recent advances and pedagogical approaches in ophthalmic education and propose specific recommendations for further improvements and research. Future research should concentrate on developing teaching and learning innovations that may result in a more time- and resource-effective models for interactive and integrated learning. As well as demonstrating that a competency-based approach results not just in better eye health, but also improvements in patient care, education, and medical care in general. By optimizing teaching available through improved evidence-based education, the ultimate goal is to increase medical students' knowledge and produce graduates who are highly trained in eye examination skills, resulting in improved patient eye care through timely diagnosis, referrals, and treatment.
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Affiliation(s)
- Tony Succar
- Department of Ophthalmology, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney NSW, Australia; Envision Research Institute, Envision, Wichita, Kansas, USA; The Smith-Kettlewell Eye Research Institute, San Francisco, California, USA
| | - John Grigg
- Department of Ophthalmology, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney NSW, Australia
| | - Hilary A Beaver
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA; Department of Ophthalmology, The University of Texas Medical Branch, Galveston, Texas, USA; Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA; Department of Ophthalmology, The University of Texas Medical Branch, Galveston, Texas, USA; Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA; Department of Neurology, Weill Cornell Medical College, New York, New York, USA; Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA; Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Ophthalmology, University of Iowa Hospitals and Clinics.
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The accuracy of the Edinburgh visual loss diagnostic algorithm. Eye (Lond) 2015; 29:1483-8. [PMID: 26293143 DOI: 10.1038/eye.2015.146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 07/12/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess the diagnostic accuracy of the Edinburgh visual loss algorithm. METHODS This was a prospective study. Patients referred to the Edinburgh Eye Pavilion with visual loss were assessed using the Edinburgh Visual Loss Algorithm by either a medical student, an inexperienced ophthalmology trainee or an optometrist in the Lothian Optometry Treat and Teach clinic. Accuracy of this 'algorithm-assisted' diagnosis was then compared with the 'gold-standard' diagnosis, made by an experienced ophthalmologist. Accuracy of the pre-algorithm diagnosis, made by the referrer, was also compared with the algorithm-assisted diagnosis. RESULTS All patients referred with visual loss were eligible for inclusion. Seventy patients were assessed; two were excluded. Pre-algorithm accuracy of referral of patients with visual loss was 51% (30/59). Overall, the algorithm-assisted diagnosis was correct 84% (57/68) of the time. The algorithm correctly diagnosed: retina in 71% of cases (5/7), macula in 86% (25/29), peripheral retina in 100% (2/2), optic nerve in 71% (5/7), media opacity in 89% (16/18), post chiasmal in 100% (4/4), and refractive error in 0% (0/1). Accuracy of diagnosis was similar for each algorithm user; medical student 81%, inexperienced ophthalmology trainee 84% and optometrist 92%. DISCUSSION The baseline diagnostic accuracy of clinicians who are inexperienced in ophthalmology rose from 51 to 84% when patients were assessed using the algorithm. This algorithm significantly improves the diagnostic accuracy of referrals to the hospital eye service, regardless of the user's previous ophthalmic experience. We hope we have demonstrated its potential as a learning tool for inexperienced clinicians.
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Vuong LN, Thulasi P, Biousse V, Garza P, Wright DW, Newman NJ, Bruce BB. Ocular fundus photography of patients with focal neurologic deficits in an emergency department. Neurology 2015; 85:256-62. [PMID: 26109710 DOI: 10.1212/wnl.0000000000001759] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/26/2015] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES We evaluated the frequency and predictive value of ocular fundus abnormalities among patients who presented to the emergency department (ED) with focal neurologic deficits to determine the utility of these findings in the evaluation of patients with suspected TIA and stroke. METHODS In this cross-sectional pilot study, ocular fundus photographs were obtained using a nonmydriatic fundus camera. Demographic, neuroimaging, and ABCD(2) score components were collected. Photographs were reviewed for retinal microvascular abnormalities. The results were analyzed using univariate statistics and logistic regression modeling. RESULTS Two hundred fifty-seven patients presented to the ED with focal neurologic deficits, of whom 81 patients (32%) had cerebrovascular disease (CVD) and 144 (56%; 95% confidence interval: 50%-62%) had retinal microvascular abnormalities. Focal and general arteriolar narrowing increased the odds of clinically diagnosed CVD by 5.5 and 2.6 times, respectively, after controlling for the ABCD(2) score and diffusion-weighted imaging. These fundus findings also significantly differentiated TIA from non-CVD, even after controlling for the ABCD(2) score. CONCLUSIONS Focal and general arteriolar narrowing were independent predictors of CVD overall, and TIA alone, even after controlling for the ABCD(2) score and diffusion-weighted imaging lesions. The inclusion of nonmydriatic ocular fundus photographs in the evaluation of patients presenting to the ED with focal neurologic deficits may assist in the differentiation of stroke and TIA from other causes of focal neurologic deficits.
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Affiliation(s)
- Laurel N Vuong
- From the Departments of Ophthalmology (L.N.V., P.T., V.B., P.G., N.J.N., B.B.B.), Neurology (V.B., N.J.N., B.B.B.), Emergency Medicine (D.W.W.), and Neurological Surgery (N.J.N.), Emory University, Atlanta, GA
| | - Praneetha Thulasi
- From the Departments of Ophthalmology (L.N.V., P.T., V.B., P.G., N.J.N., B.B.B.), Neurology (V.B., N.J.N., B.B.B.), Emergency Medicine (D.W.W.), and Neurological Surgery (N.J.N.), Emory University, Atlanta, GA
| | - Valérie Biousse
- From the Departments of Ophthalmology (L.N.V., P.T., V.B., P.G., N.J.N., B.B.B.), Neurology (V.B., N.J.N., B.B.B.), Emergency Medicine (D.W.W.), and Neurological Surgery (N.J.N.), Emory University, Atlanta, GA
| | - Philip Garza
- From the Departments of Ophthalmology (L.N.V., P.T., V.B., P.G., N.J.N., B.B.B.), Neurology (V.B., N.J.N., B.B.B.), Emergency Medicine (D.W.W.), and Neurological Surgery (N.J.N.), Emory University, Atlanta, GA
| | - David W Wright
- From the Departments of Ophthalmology (L.N.V., P.T., V.B., P.G., N.J.N., B.B.B.), Neurology (V.B., N.J.N., B.B.B.), Emergency Medicine (D.W.W.), and Neurological Surgery (N.J.N.), Emory University, Atlanta, GA
| | - Nancy J Newman
- From the Departments of Ophthalmology (L.N.V., P.T., V.B., P.G., N.J.N., B.B.B.), Neurology (V.B., N.J.N., B.B.B.), Emergency Medicine (D.W.W.), and Neurological Surgery (N.J.N.), Emory University, Atlanta, GA
| | - Beau B Bruce
- From the Departments of Ophthalmology (L.N.V., P.T., V.B., P.G., N.J.N., B.B.B.), Neurology (V.B., N.J.N., B.B.B.), Emergency Medicine (D.W.W.), and Neurological Surgery (N.J.N.), Emory University, Atlanta, GA.
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Yusuf IH, Salmon JF, Patel CK. Direct ophthalmoscopy should be taught to undergraduate medical students-yes. Eye (Lond) 2015; 29:987-9. [PMID: 26043702 DOI: 10.1038/eye.2015.90] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- I H Yusuf
- Paediatric Vitreoretinal Service, Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
| | - J F Salmon
- Paediatric Vitreoretinal Service, Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
| | - C K Patel
- Paediatric Vitreoretinal Service, Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
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Abstract
BACKGROUND Fundoscopy is an important component of the neurological examination. Previous studies have shown that students and junior doctors lack confidence in fundoscopy, but to date little is known about possible barriers to the acquisition of confidence in this skill. METHODS A questionnaire was designed to quantify prior experience, and to assess confidence in direct ophthalmoscopy. This was distributed among fourth- and final-year medical students. RESULTS Forty-three per cent of final-year students responding (n = 93) were confident in examining a dilated eye by direct ophthalmoscopy, compared with 88 per cent of fourth-year students (n = 116). Of the 209 students, fewer than 40 per cent felt confident identifying papilloedema, diabetic retinopathy or vascular disease. Students that reported more opportunities to practise were significantly more confident in their ability to examine a dilated (p < 0.001) or undilated (p < 0.01) eye, but were not significantly more confident in recognising pathology. Clinical exposure to abnormal pathology was significantly associated with greater levels of confidence in recognising papilloedema (p = 0.001), diabetic retinopathy (p = 0.015) and vascular disease (p = 0.012). Students that reported receiving no assessment or feedback on their technique were significantly less confident in all aspects of fundoscopy. CONCLUSIONS Final-year medical students lack confidence in their ability to use the direct ophthalmoscope and to recognise pathology. Based on the findings of this study, we have made focused recommendations in order to improve the confidence of graduating doctors in fundoscopy: (1) early formal instruction, with refresher training for final-year students; (2) increasing clinical exposure to abnormal pathology; (3) the provision of assessment and feedback on student technique. Final-year medical students lack confidence in their ability to use the direct opthalmoscope and to recognise pathology.
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Affiliation(s)
- Christopher Schulz
- Acute Medicine, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, UK
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Yusuf I, Yang E, Knight K, Leaver L. Direct ophthalmoscopy: teaching in primary care. CLINICAL TEACHER 2015; 13:235-7. [PMID: 25982427 DOI: 10.1111/tct.12354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Imran Yusuf
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
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Effect of Spatial Resolution of T2-Weighted Imaging on Diagnostic Efficacy of MRI in Detection of Papilledema. AJR Am J Roentgenol 2015; 204:602-7. [DOI: 10.2214/ajr.14.12662] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Mackay DD, Garza PS, Bruce BB, Newman NJ, Biousse V. The demise of direct ophthalmoscopy: A modern clinical challenge. Neurol Clin Pract 2014; 5:150-157. [PMID: 26137422 DOI: 10.1212/cpj.0000000000000115] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ocular funduscopy appears to be a dying art. Physicians and medical students alike lack confidence in the use of an ophthalmoscope. As a result, few clinicians perform ophthalmoscopy, and many who do are unable to reliably detect abnormalities of the ocular fundus. Approaches to remediation in undergraduate medical education have included simulators, longitudinal skill reinforcement, Web-based teaching, and other techniques. Preservation of the ophthalmoscopic art has been hindered by technical difficulty, waning enthusiasm for ophthalmoscopy, and even discouragement from preceptors in medical education. Ocular fundus photography may serve a role in medical education to help improve student confidence in interpretation of ocular fundus findings and improve awareness of the importance of examination of the ocular fundus. Because neurology clerkships and clinical practices remain an important forum for honing ocular funduscopy skills, the neurologist should be familiar with novel alternative techniques that facilitate examination of the ocular fundus.
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Affiliation(s)
- Devin D Mackay
- Departments of Neurology, Ophthalmology, and Neurosurgery (DDM), Indiana University School of Medicine, Indianapolis, IN. Departments of Ophthalmology (PSG, BBB, NJN, VB), Neurology (BBB, NJN, VB), and Neurological Surgery (NJN), Emory University School of Medicine; and Department of Epidemiology (BBB), Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA
| | - Philip S Garza
- Departments of Neurology, Ophthalmology, and Neurosurgery (DDM), Indiana University School of Medicine, Indianapolis, IN. Departments of Ophthalmology (PSG, BBB, NJN, VB), Neurology (BBB, NJN, VB), and Neurological Surgery (NJN), Emory University School of Medicine; and Department of Epidemiology (BBB), Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA
| | - Beau B Bruce
- Departments of Neurology, Ophthalmology, and Neurosurgery (DDM), Indiana University School of Medicine, Indianapolis, IN. Departments of Ophthalmology (PSG, BBB, NJN, VB), Neurology (BBB, NJN, VB), and Neurological Surgery (NJN), Emory University School of Medicine; and Department of Epidemiology (BBB), Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA
| | - Nancy J Newman
- Departments of Neurology, Ophthalmology, and Neurosurgery (DDM), Indiana University School of Medicine, Indianapolis, IN. Departments of Ophthalmology (PSG, BBB, NJN, VB), Neurology (BBB, NJN, VB), and Neurological Surgery (NJN), Emory University School of Medicine; and Department of Epidemiology (BBB), Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA
| | - Valérie Biousse
- Departments of Neurology, Ophthalmology, and Neurosurgery (DDM), Indiana University School of Medicine, Indianapolis, IN. Departments of Ophthalmology (PSG, BBB, NJN, VB), Neurology (BBB, NJN, VB), and Neurological Surgery (NJN), Emory University School of Medicine; and Department of Epidemiology (BBB), Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA
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Bolster NM, Giardini ME, Livingstone IAT, Bastawrous A. How the smartphone is driving the eye-health imaging revolution. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2014.981532] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Validity of direct ophthalmoscopy skill evaluation with ocular fundus examination simulators. Can J Ophthalmol 2014; 49:377-81. [DOI: 10.1016/j.jcjo.2014.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 05/09/2014] [Accepted: 06/16/2014] [Indexed: 11/21/2022]
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Krohn J, Kjersem B, Høvding G. Matching fundus photographs of classmates. An informal competition to promote learning and practice of direct ophthalmoscopy among medical students. J Vis Commun Med 2014; 37:13-8. [PMID: 24694281 DOI: 10.3109/17453054.2014.884551] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To present a new approach for teaching direct ophthalmoscopy to medical students. METHODS At the University of Bergen, four consecutive classes of fourth-year medical students complete a required 9-week ophthalmology course every year. In the present project, one fundus photograph was taken of each student. The photographs were randomly numbered, printed on A4 glossy photo paper, and displayed on the classroom wall. Each student was given a form to fill in the fellow students' names matching the number of the fundus photographs. They were encouraged to practise direct ophthalmoscopy on their classmates outside formal teaching hours. At the end of the course, they returned the filled-in forms, and those with the highest number of correct matches between the fundus photographs and fellow students received a reward. RESULTS Between 2011 and 2013, 239 students completed their ophthalmology course. Of these, 220 students (92%) voluntarily participated in the project. The mean score was 70% correct matches between fundus photographs and fellow students (range 7 - 100%). The students' course evaluations were overall positive. CONCLUSIONS We recommend the use of peer fundus photographs in the context of a learning competition as a simple, inexpensive, and effective way to improve teaching of direct ophthalmoscopy.
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Affiliation(s)
- Jørgen Krohn
- Department of Clinical Medicine, Section of Ophthalmology, University of Bergen , Bergen , Norway
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Bidot S, Bruce BB, Newman NJ, Biousse V. Nonmydriatic retinal photography in the evaluation of acute neurologic conditions. Neurol Clin Pract 2013; 3:527-531. [PMID: 24353924 DOI: 10.1212/01.cpj.0000437089.75536.fd] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ocular fundus examination is a fundamental component of the neurologic examination. Finding papilledema in headache patients or retinal arterial emboli in stroke patients can be extremely useful. Although examination of the ocular fundus with a direct ophthalmoscope is an important skill for all neurologists, it is rarely and unreliably performed. Nonmydriatic ocular fundus photography, which allows direct visualization of high-quality photographs of the ocular fundus, has been recently proposed for screening neurologic patients in urgent care settings such as emergency departments. This new technology has many potential applications in neurology, including e-transmission of images for remote interpretation.
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Affiliation(s)
- Samuel Bidot
- Neuro-Ophthalmology Unit, Emory Eye Center, The Emory Clinic, Atlanta, GA
| | - Beau B Bruce
- Neuro-Ophthalmology Unit, Emory Eye Center, The Emory Clinic, Atlanta, GA
| | - Nancy J Newman
- Neuro-Ophthalmology Unit, Emory Eye Center, The Emory Clinic, Atlanta, GA
| | - Valérie Biousse
- Neuro-Ophthalmology Unit, Emory Eye Center, The Emory Clinic, Atlanta, GA
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Kelly LP, Garza PS, Bruce BB, Graubart EB, Newman NJ, Biousse V. Teaching ophthalmoscopy to medical students (the TOTeMS study). Am J Ophthalmol 2013; 156:1056-1061.e10. [PMID: 24041982 DOI: 10.1016/j.ajo.2013.06.022] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/12/2013] [Accepted: 06/12/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine medical student preferences for learning the ocular fundus examination and to assess their accuracy using different examination modalities. DESIGN Prospective, randomized study of medical student education approaches. METHODS First-year medical students received training in direct ophthalmoscopy using simulators and human volunteers. Students were randomized to receive vs not receive specific training on interpreting fundus photographs prior to accuracy assessments. Students' preferences for each of the 3 methods (direct ophthalmoscopy on simulators or human volunteers, or use of fundus photographs) and recognition of normal and abnormal fundus features were assessed. RESULTS Of 138 first-year medical students, 119 (86%) completed all required elements. For learning ophthalmoscopy, 85 (71%) preferred humans to simulators. For learning relevant features of the ocular fundus, 92 (77%) preferred photographs to ophthalmoscopy on simulators or humans. Accuracy of answers was better when interpreting fundus photographs than when performing ophthalmoscopy on simulators (P < .001). Performance improved after specific teaching about assessing fundus photographs before testing (P = .02). Examination of the ocular fundus was found easier and less frustrating when using photographs than when using ophthalmoscopy on simulators or humans. Eighty-four students (70%) said they would prefer to have fundus photographs instead of using the ophthalmoscope during upcoming clinical rotations. CONCLUSIONS Students preferred fundus photographs for both learning and examining the ocular fundus. Identification of ocular fundus features was more accurate on photographs compared to examination by direct ophthalmoscopy. In the future, the increasing availability of nonmydriatic ocular fundus photography may allow replacement of direct ophthalmoscopy in many clinical settings for non-ophthalmologists.
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Affiliation(s)
- Linda P Kelly
- Department of Ophthalmology, Emory University, Atlanta, Georgia
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Abstract
BACKGROUND Ocular fundus examination is an important element of the neurological examination. However, direct ophthalmoscopy is difficult to perform without pupillary dilation and requires extensive practice to accurately recognize optic nerve and retinal abnormalities. Recent studies have suggested that digital retinal photography can replace direct ophthalmoscopy in many settings. REVIEW SUMMARY Ocular fundus imaging is routinely used to document and monitor disease progression in ophthalmology. Advances in optical technology have made it easier to obtain high-quality retinal imaging, even without pupillary dilation. Retinal photography has a high sensitivity, specificity, and interexamination/intraexamination agreement compared with in-person ophthalmologist examination, suggesting that photographs can be used in lieu of ophthalmoscopy in many clinical situations. Nonmydriatic retinal photography has recently gained relevance as a helpful tool for diagnosing neuro-ophthalmologic disorders in the emergency department. In addition, several population-based studies have used retinal imaging to relate ophthalmic abnormalities to the risk of hypertension, renal dysfunction, cardiovascular mortality, subclinical and clinical stroke, and cognitive impairment. The possibility of telemedical consultation offered by digital retinal photography has already increased access to timely and accurate subspecialty care, particularly for underserved areas. CONCLUSIONS Retinal photography (even without pupillary dilation) has become increasingly available to medical fields outside of ophthalmology, allowing for faster and more accurate diagnosis of various ocular, neurological, and systemic disorders. The potential for telemedicine may provide the additional benefits of improving access to appropriate urgent consultation in both clinical and research settings.
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Thulasi P, Fraser CL, Biousse V, Wright DW, Newman NJ, Bruce BB. Nonmydriatic ocular fundus photography among headache patients in an emergency department. Neurology 2013; 80:432-7. [PMID: 23284060 PMCID: PMC3590046 DOI: 10.1212/wnl.0b013e31827f0f20] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 09/26/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Determine the frequency of and the predictive factors for abnormal ocular fundus findings among emergency department (ED) headache patients. METHODS Cross-sectional study of prospectively enrolled adult patients presenting to our ED with a chief complaint of headache. Ocular fundus photographs were obtained using a nonmydriatic fundus camera that does not require pupillary dilation. Demographic and neuroimaging information was collected. Photographs were reviewed independently by 2 neuroophthalmologists for findings relevant to acute care. The results were analyzed using univariate statistics and logistic regression modeling. RESULTS We included 497 patients (median age: 40 years, 73% women), among whom 42 (8.5%, 95% confidence interval: 6%-11%) had ocular fundus abnormalities. Of these 42 patients, 12 had disc edema, 9 had optic nerve pallor, 6 had grade III/IV hypertensive retinopathy, and 15 had isolated retinal hemorrhages. Body mass index ≥ 35 kg/m(2) (odds ratio [OR]: 2.3, p = 0.02), younger age (OR: 0.7 per 10-year increase, p = 0.02), and higher mean arterial blood pressure (OR: 1.3 per 10-mm Hg increase, p = 0.003) were predictive of abnormal retinal photography. Patients with an abnormal fundus had a higher percentage of hospital admission (21% vs 10%, p = 0.04). Among the 34 patients with abnormal ocular fundi who had brain imaging, 14 (41%) had normal imaging. CONCLUSIONS Ocular fundus abnormalities were found in 8.5% of patients with headache presenting to our ED. Predictors of abnormal funduscopic findings included higher body mass index, younger age, and higher blood pressure. Our study confirms the importance of funduscopic examination in patients with headache, particularly in the ED, and reaffirms the utility of nonmydriatic fundus photography in this setting.
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Affiliation(s)
- Praneetha Thulasi
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
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