Wait Times for Scheduling Appointments for Prevention of Macrovascular and Microvascular Complications of Diabetes: Cross-Sectional Descriptive Study

BACKGROUND

Diabetes is a chronic disease that requires lifelong management and care, affecting around 422 million people worldwide and roughly 37 million in the United States. Patients newly diagnosed with diabetes must work with health care providers to formulate a management plan, including lifestyle modifications and regular office visits, to improve metabolic control, prevent or delay complications, optimize quality of life, and promote well-being.

OBJECTIVE

Our aim is to investigate one component of system-wide access to timely health care for people with diabetes in New York City (NYC), namely the length of time for someone with newly diagnosed diabetes to obtain an appointment with 3 diabetes care specialists: a cardiologist, an endocrinologist, and an ophthalmologist, respectively.

METHODS

We contacted the offices of 3 different kinds of specialists: cardiologists, endocrinologists, and ophthalmologists, by telephone, for this descriptive cross-sectional study, to determine the number of days required to schedule an appointment for a new patient with diabetes. The sampling frame included all specialists affiliated with any private or public hospital in NYC. The number of days to obtain an appointment with each specialist was documented, along with "time on hold" when attempting to schedule an appointment and the presence of online booking capabilities.

RESULTS

Of the 1639 unique physicians affiliated with (private and public) hospitals in the 3 subspecialties, 1032 (cardiologists, endocrinologists, and ophthalmologists) were in active practice and did not require a referral. The mean wait time for scheduling an appointment was 36 (SD 36.4; IQR 12-51.5) days for cardiologists; 82 (SD 47; IQR 56-101) days for endocrinologists; and 50.4 (SD 56; IQR 10-72) days for ophthalmologists. The median wait time was 27 days for cardiologists, 72 days for endocrinologists, and 30 days for ophthalmologists. The mean time on hold while attempting to schedule an appointment with these specialists was 2.6 (SD 5.5) minutes for cardiologists, 5.4 (SD 4.3) minutes for endocrinologists, and 3.2 (SD 4.8) minutes for ophthalmologists, respectively. Over 46% (158/341) of cardiologists enabled patients to schedule an appointment on the web, and over 55% (128/228) of endocrinologists enabled patients to schedule an appointment on the web. In contrast, only approximately 25% (117/463) of ophthalmologists offered web-based appointment scheduling options.

CONCLUSIONS

The results indicate considerable variation in wait times between and within the 3 specialties examined for a new patient in NYC. Given the paucity of research on wait times for newly diagnosed people with diabetes to obtain an appointment with different specialists, this study provides preliminary estimates that can serve as an initial reference. Additional research is needed to document the extent to which wait times are associated with complications and the demographic and socio-economic characteristics of people served by different providers.

Ophthalmologists' Attitudes, Knowledge, and Willingness to Report Child Abuse

The aim of the present study was to explore ophthalmologists' attitudes, knowledge, and willingness to report child abuse. One-hundred-and-seven ophthalmologists employed in various hospitals in Israel completed an online questionnaire. Less than half the ophthalmologists (44.9%) reported that they had treated children whom they identified or suspected as being victims of child abuse, while only 43.9% of these reported child abuse. Despite generally positive attitudes towards reporting of child abuse among the ophthalmologists, their average level of knowledge was low. Ophthalmologists who had received training on child abuse and residents displayed a higher level of knowledge. In addition, female ophthalmologists tended to agree more that ophthalmologists are obligated to screen for and report child abuse. Moreover, female ophthalmologists expressed higher willingness to report child abuse. The present study reveals that underreporting of child abuse, and more precisely the discrepancy between identification and reporting, is present among ophthalmologists. It seems that lack of knowledge regarding identification and reporting of child abuse is the main barrier to reporting, especially among medical specialists. These findings underscore the importance of training programs on child abuse, both during formal education in medical school, and post-qualification, for all ophthalmologists, irrespective of seniority.

Prevalence and determinants of asthenopia among ophthalmologists in China: a national cross-sectional survey

Introduction

The role of ophthalmologists is defined by tasks requiring visual effort, emphasizing the importance of examining their condition within the realm of occupational visual health. Our goal was to explore the occurrence of asthenopia among Chinese ophthalmologists and identify contributing factors through the use of a reliable and validated survey instrument.

Methods

A national cross-sectional online survey was carried out in June 2017, involving 6,220 practicing ophthalmologists in China. Utilizing an 11-item Asthenopia Survey Questionnaire with established reliability and validity. Prevalence rates of asthenopia among subgroups categorized by age, gender, hospital classification, physician level, daily near vision activity duration, sleep duration, sleep quality, presbyopia status, and history of eye surgery were determined using the independent t-test, chi-square test and bonferroni test. Multiple logistic regression analysis was employed to pinpoint independent factors linked to asthenopia.

Results

Out of the 5,009 ophthalmologists who completed the survey, a 40.7% prevalence of asthenopia was identified. Multivariate analysis revealed that good sleep quality (OR: 0.24, 95%CI: 0.20-0.30), moderate sleep quality (OR: 0.47, 95%CI: 0.38-0.59), engaging in daily near vision activities for less than 7 h (OR: 0.76, 95%CI: 0.68-0.86), having daily sleep duration exceeding 7 h (OR: 0.87, 95%CI: 0.77-0.98), and working in tertiary hospitals (OR: 0.88, 95%CI: 0.78-0.99) were protective factors against asthenopia. Conversely, presbyopia was identified as a risk factor (OR: 1.33, 95%CI: 1.04-1.70). All calculated p values were below 0.05. Age, gender, physician level, and eye surgery history were not related factors.

Conclusion

Asthenopia is prevalent among Chinese ophthalmologists, with employment in tertiary hospitals providing a protective effect and presbyopia is a risk factor. Preventive strategies include improving sleep quality, restricting daily near vision activity to under 7 h, and extending daily sleep duration to over 7 h. Further investigation is needed to explore the protective implications of working in tertiary hospitals.

Knowledge, attitude, and practice patterns of Indian ophthalmologists regarding medicolegal issues

PURPOSE

To assess the knowledge, attitude, and practice patterns (KAPP) of Indian ophthalmologists regarding medicolegal issues using an initial survey.

METHODS

An online form was circulated among Indian ophthalmologists of all ages over social media and email by the Young Ophthalmologists Society of India (YOSI) and its medicolegal working group. Anonymous responses were obtained and analyzed for each question. The questionnaire comprised questions about demographic details, KAPP of medicolegal issues including how to deal with medicolegal issues (if faced), medical indemnity insurance, deviation from the recommended minimum sum assured (Rs. 1 crore for Indian ophthalmologists), and legal service providers.

RESULTS

A total of 109 responses were obtained. The majority of the respondents were male (60, 55%). More than 50% of respondents (58, 53.2%) were younger than 35 years. More than one-fourth of the respondents were private practitioners (29, 27%), and the majority were of senior consultant designation (45, 41%). Around 80% of respondents (89, 81.6%) were aware of professional indemnity insurance; however, only 54% (n = 59) bought the insurance cover. A majority of the respondents (38, 64.4%) had an indemnity cover of a maximum of Rs. 50 lacs. Only 20% of respondents were aware of the expert body at the state/national level that deals with medicolegal cases. Thirty percent of respondents recommended the ideal cover amount to be more than Rs. 1 crore.

CONCLUSION

The current survey highlights the dismally low rate of awareness of medicolegal issues among ophthalmologists. Specifically, a majority of Indian ophthalmologists surveyed did not have recommended minimum insured cover for professional indemnity insurance. Larger studies are needed to further explore KAPP of Indian ophthalmologists in various medicolegal issues.

Myopia management -A survey of optometrists and ophthalmologists in Israel

PURPOSE

Myopia management is practiced by ophthalmologists and optometrists. This study evaluated the approach and standard of myopia management among eye-care practitioners (ECPs) in Israel. The findings may ultimately affect the quality of care.

METHODS

A questionnaire was sent to 954 optometrists and 365 ophthalmologists, including demographic questions; whether they owned any devices to monitor myopia progression; the lowest progression they considered significant; various questions pertaining to myopia management and treatment methods.

RESULTS

Responses from 135 optometrists and 126 ophthalmologists were collected, the majority practicing more than five years; 94% of optometrists, and 64% of ophthalmologists. Around 53% of optometrists and 27% of the ophthalmologists proclaimed to practice myopia management. ECPs primary parameters influencing risk assessment for progression were age, genetic background and history of progression. Time outdoors, during daylight hours, is advised by ophthalmologists (97%) and optometrists (78%). Limiting screentime is encouraged by 87% of ophthalmologists and 69% of optometrists. Myopia progression of 0.50D-0.75D after six months is regarded to require intervention by 93% of ophthalmologists and 83% of optometrists. Optometrists selected multiple myopia management treatments, primarily optical (ophthalmic myopia management lenses 40%, multifocal ophthalmic lenses 24%, peripheral blur contact lenses 38%, orthokeratology 11%), while 95% of ophthalmologists chose atropine and only 3-11% selected any additional treatments to consider.

CONCLUSION

This study highlighted ECPs' agreement on the principles, importance of, and timeline of intervention with myopia management. The disconnect between the two professions lies in management methods. Genuine dialogue and co-management should be encouraged for maximum implementation, benefit and effectiveness of available patient treatments.

Ophthalmology Practice and Social Media Influences: A Patients Based Cross-Sectional Study among Social Media Users

Many physicians consider social media a good tool for building their brands and attracting patients. However, limited data exist on patients' perceptions of the value of social media in ophthalmology. Therefore, our objective was to examine how social media influences patients when choosing an ophthalmologist among social media users, and people's behaviors toward ophthalmologists' social media accounts. This was a cross-sectional study including 1086 participants. Males represented 77.3% of the sample. The majority of the participants (71.3%) were aged between 25 and 54 years. Regarding social media sites frequently checked, Twitter ranked first (75.3%), followed by Snapchat (52.8%) and YouTube (48.7%). The majority (92.3%) used social media sites at all times of the day. Concerning the importance of ophthalmologists' social media sites, around 36.3% considered it either very or extremely important. As regards the important factors about an ophthalmologist's social media site from participants' perspectives, medical information written by the ophthalmologist (45.5%) and recommendations by friends (45.4%) were the most common reasons. Around 21% of females, compared to 16.8% of males, perceived the ophthalmologists' social media sites as extremely important, p = 0.041. A quarter of participants aged between 18 and 24 years, compared to only 5.5% of those aged 65 and above, perceived the ophthalmologists' social media sites as extremely important, p = 0.018. In conclusion, a considerable proportion of the people who used social media described ophthalmologists' social media sites as very/extremely important in their choice of an ophthalmologist.

Clinical Practice and the Attitude of Ophthalmologists Regarding Amblyopia in the Population of Jordan: A Cross-Sectional Study

Aim The study was aimed at finding out the knowledge and attitude among ophthalmologists regarding amblyopia in the population of Jordan. Methodology This was an observational cross-sectional study conducted in 2021 among ophthalmologists who live and work in the local society of Jordan and were aged between 30 and 50 years. The survey was conducted using an online questionnaire administered through email and various social media platforms. The level of knowledge and awareness of amblyopia, its causes, methods of treatment, and the best age for treating amblyopia was assessed. Results Out of 200 participants, the majority were in the age group of 30-34 years (47.5%). The male:female ratio was 1:1. The average better age for examination and treatment of amblyopia was three to five years (46%). The most common cause of amblyopia was strabismic amblyopia (50%). Children's and parents' cooperation most significantly influenced the treatment's success (49%). The preferred assessment was cycloplegic refraction (56%), and the preferred patching treatment was a direct cover placed over the eye (77%). The average time to treat amblyopia was less than three years in the majority (53.5%). The most critical factor determining the success of treatment was when the treatment began (57.5%). Conclusions Our study found that although the majority of the participants were less experienced overall, they had a good knowledge of the amblyopia age group and the method of examination. Still, there was a mixed response regarding the treatment. Hence there is a need to increase awareness regarding amblyopia by Jordanian ophthalmologists, social organizations, and educational institutes.

Perspectives on the provision of diabetic retinopathy screening: Survey of eye health care professionals in Haryana

Purpose:

To examine the current provision and practice patterns of diabetic retinopathy screening (DRS) in Haryana.

Methods:

This was a descriptive cross-sectional survey in Haryana. All ophthalmologists registered with Haryana Ophthalmological Society in Haryana state were invited to participate on an online survey comprised of twenty questions exploring diabetic retinopathy screening provision, and barriers to screening services in Haryana.

Results:

The response rate was 82% (153/186). The majority (84%) of the eye care providers practiced in urban areas. Most ophthalmologists (89%, 136/153), considered diabetic retinopathy screening by non-ophthalmic human resource inappropriate because of technical feasibility issues (62%) followed by non-availability of trained staff (33%). Only half (54%) of the respondents had access to written protocols for the diagnosis and management of diabetic retinopathy in their practice. Barriers to optimize diabetic retinopathy screening were lack of knowledge or awareness among patients (95.5%), perception that eye complications were unlikely (76%) and cost of care (30%).

Conclusion:

Diabetic retinopathy screening practices are mainly opportunistic and urban-centric, likely delivering inequitable services for the rural populations in the state. The inclusion of other personnel in screening will require stakeholder engagement from all health professions and changing the perceptions of ophthalmologists about task shifting.

Ophthalmologists and climate change

It is indisputable that human activities have caused climate change and that, if left unchecked, these activities will lead to worsening of weather extremes including fire, drought, and flood with all their attendant human suffering. Reducing future climate change requires limiting cumulative emissions of CO₂ and other greenhouse gases including methane. We have written this evidence-based perspective to highlight interventions with the largest effect to help the average ophthalmologist make the changes with the highest impact in their day-to-day lives.

Digital Survey Assessment of Factors Associated with Musculoskeletal Complaints Among US Ophthalmologists

Purpose

To quantify features of musculoskeletal (MSK) complaints among US ophthalmologists and analyze factors related to symptom severity.

Methods

Cornea, glaucoma, retina, and comprehensive practitioners were invited to complete a web-based survey via email. Data on demographics, practice and procedural volumes, wellness activities, job stress, MSK health, the Total Disability Index (TDI), and ergonomics were collected. Significance testing was performed to evaluate factors related to TDI score.

Results

Of the 245 ophthalmologists contacted, 58.8% (n = 144) responded at least in part to the survey. Pain episodes were reported in 81.4% (n = 83) of 102 respondents, with 48.1% (n = 49) experiencing daily or weekly attacks. The neck, low back, and shoulders were commonly affected, yet only 57.1% (n=20) of those with shoulder pain reported a corresponding diagnosis. The mean TDI score was 6.2 ± 7.3%, indicating minimal disability related to the spine. Demographics, volume metrics, and wellness hours were each not significantly associated with TDI score (p > 0.05). Higher job stress ratings were reported by those who experienced more frequent pain attacks (p = 0.02) and those with higher TDI scores (p = 0.001). Greater difficulty with clinic, laser, and surgery job tasks was observed in respondents with higher TDI scores (p < 0.001, p = 0.005, and p < 0.001) and more bodily pain locations (p = 0.002, p = 0.002, and p = 0.001). Respondents who pursued practice modifications (p = 0.03) and treatments (p = 0.01) to reduce or prevent pain had higher mean TDI scores, and 94.2% of respondents (n = 97) were interested in learning more about ergonomics.

Conclusion

Mild MSK complaints were highly prevalent among the surveyed ophthalmologists, and a similar trend could be expected for other US ophthalmologists. Greater frequency and severity of pain may contribute to physician burnout. There may be underdiagnosis of MSK pathology yet also high demand for ergonomic strategies and MSK treatments, suggesting a need for practical solutions.

The Role of Infection Control Measures in Ophthalmology: Do They Prevent COVID-19 Infection Among Ophthalmologists in Egypt? A Survey-Based Study

Introduction

Ophthalmologists are at a high risk of coronavirus disease 2019 (COVID-19) infection owing to their working environments and proximity to patients during examinations. Compliance with infection control measures in examination offices can lessen the risk of infection to this group. In Egypt, several deaths from COVID-19 have been reported among ophthalmologists; therefore, we studied the prevalence of COVID-19 infections in this group and assessed ophthalmologists' commitments to recommended infection control measures.

Aim

To evaluate the rate of COVID-19 infections among ophthalmologists, identify risk factors for infections, and evaluate ophthalmologists' commitments to infection control measures in their medical facilities.

Methods

An online questionnaire was designed and distributed to ophthalmologists in the Cairo Governorate from May 1, 2021 to mid-June 2021.

Results

Out of 161 responders, the percentage of COVID-19 infections was 52.8% (85 responders). This was significantly higher among younger ophthalmologists (P-value = 0.019) and those with fewer years of experience (P-value = 0.010). Adopting full precautions while examining patients with or without respiratory illness were significantly associated with a lower infection rate (P-value = 0.019 and 0.046, respectively). A significantly higher infection rate was reported for ophthalmologists who examined known COVID-19 patients at outpatient clinics, even when taking precautions (P-value = 0.032). A lower rate of COVID-19 infection was significantly associated with adopting full precautions while operating on suspected or nonsuspected COVID-19 patients (P-value = 0.007 and 0.003, respectively).

Conclusion

Both young age and limited experience were significant infection risk factors in our study. The most important infection control measures that significantly decreased infection risks were adherence to full protective measures while working in outpatient clinics and operating rooms.

Evidence-based of conjunctival COVID-19 positivity: An Italian experience: Gemelli Against COVID Group

BACKGROUND

The possible transmission of severe acute respiratory coronavirus 2 (SARS-CoV-2) by tears and conjunctiva is still debated.

METHODS

Main outcome was to investigate the agreement between nasopharyngeal swab (NPs) and conjunctival swabs (Cs) in patients with SARS-CoV-2 infection. We divided patients into four groups: (1) NPs and Cs both negative (C-NF-), (2) NPs positive and Cs negative (NFs+Cs-), (3) NPs negative and Cs positive (NFs-Cs+), and (4) NPs and Cs both positive (NFs-Cs+). The secondary outcomes were to correlate Cs results with systemic clinical parameters such as: oxygen saturation (SpO2), dyspnea degree (DP), radiologic pulmonary impairment based on chest radiography (XR) or computed tomography (CT), blood chemistry as D-Dimer (D-Dimer), fibrinogen, ferritin, lactate dehydrogenase (LDH), and C-reactive protein (C-RP).

RESULTS

A total of 100 conjunctival swabs in 50 patients with SARS-CoV-2 have been enrolled in this interventional clinical trials. Ocular signs (conjunctivitis) were present in five patients (10%). NPs and Cs highlighted a poor level of agreement (0.025; p = 0.404). Median SpO2 levels are the highest in the NF-C- group (98%) and the lowest (90%) in the group NF+C+ (p = 0.001). Pulmonary impairment was statistically significantly different between NFs and Cs groups (p = 0.019). Pulmonary impairment score increased from NFs-Cs- group (3.8 ± 3.9), to NFs+Cs+ group (6.7 ± 4.1). Intensive care unit patients showed higher COVID-19 Cs positivity in conjunctiva (12.5%) against hospitalized ones (5.8%).

CONCLUSIONS

In patients hospitalized for SARS-CoV-2 the virus can be detected in conjunctival swab. Intensive care unit patients may reveal a higher COVID-19 presence in the conjunctiva. The most severe pulmonary impairment can be observed in NFs and Cs positivity.

TRIAL REGISTRATION

Clinicaltrials.gov registration.

ETHICAL COMMITTEE AUTHORIZATION

ID number: 0013008/20.

Conjunctivitis as the only sign and symptom of COVID-19: A case report and review of literature

Similar to several viruses, coronaviruses can affect the eye and cause conjunctivitis. In addition to ocular involvement, it causes systemic manifestations, mainly respiratory symptoms. However, conjunctivitis as the only sign and symptom of coronavirus disease 2019 (COVID-19) is a rare presentation. We present a case of a 20-year-old male patient who presented with conjunctivitis for 3 days and diagnosed on the same day with COVID-19 without other manifestations. Conjunctivitis affected both eyes and resolved over 2 weeks with artificial tears only and without any ocular complications.

Conjunctivitis can be the only sign and symptom of COVID-19 in some patients. Therefore, healthcare providers, particularly ophthalmologists, should take precautions when dealing with patients presenting with conjunctivitis amid the COVID-19 pandemic.

The Impact of COVID-19 Pandemic on Practice Patterns and Psychological Status of Ophthalmologists in Turkey

Aim: To investigate the changes in ophthalmologists' working conditions and mental health status in Turkey during the first wave of the COVID-19 outbreak and reveal the relevant individual and workplace-related factors.

Methods: This cross-sectional, nationwide, the survey-based study collected data between June and September 2020. Demographic characteristics, working conditions, precautionary measures in the workplace, and participants' Depression Anxiety Stress Scale (DASS-21) and Insomnia Severity Index (ISI) ratings were investigated.

Results: This study included 360 actively working ophthalmologists. While 64% of them worked in the pandemic hospitals, 44% were actively involved in COVID-related departments. Among those, 56 (35%) declared that they had all personal protective equipment in sufficient quantity in their COVID department. Despite the restrictions, 32% reported continuing to see 25 to 50 patients per day in ophthalmology clinics, with the most common complaint being the ocular "itching and burning" sensation. 53% stated that they did not perform any surgeries. Symptoms of depression, anxiety, stress and insomnia were present in 65%, 56.9%, and 43% and 46.9% of participants, respectively. All DASS-21 subscales and ISI scores were found to be significantly higher during the pandemic. Female gender, older age, and lower satisfaction levels of hygiene conditions in COVID clinics were independent predictors of higher DASS-21 subscale scores in multivariate analysis. Being a resident was a major predictor of depression. Ophthalmologists working in a pandemic hospital were more likely to experience insomnia.

Conclusion: Ophthalmologists have actively worked in COVID departments during the pandemic. Increased psychological distress among ophthalmologists compared to the pre-pandemic period is caused by personal factors and many determinants related to the workplace and practice patterns. Therefore, decreasing the transmission risk by creating a protective workplace and developing psychological support policies should be considered to minimize adverse psychological effects.

COVID 19 repercussions in ophthalmology: a narrative review

BACKGROUND

The new coronavirus of 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread globally and has repercussions within ophthalmological care. It has caused ocular manifestations in some patients, which can spread through eye secretions.

OBJECTIVES

The purpose of this review was to summarize the currently available evidence on COVID-19 with regard to its implications for ophthalmology.

DESIGN AND SETTING

Narrative review developed by a research group at Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil, and at Ludwig-Maximilians-Universität, Munich, Germany.

METHODS

We searched the literature on the repercussions of COVID-19 within ophthalmological care, using the MEDLINE and LILACS databases, with the keywords "COVID-19", "ophthalmology" and "coronavirus", from January 1, 2020, to March 27, 2021. Clinical trials, meta-analysis, randomized controlled trials, reviews and systematic reviews were identified.

RESULTS

We retrieved 884 references, of which 42 were considered eligible for intensive review and critical analysis. Most of the studies selected reported the evidence regarding COVID-19 and its implications for ophthalmology.

CONCLUSIONS

Knowledge of eye symptoms and ocular transmission of the virus remains incomplete. New clinical trials with larger numbers of patients may answer these questions in the future. Moreover, positively, implementation of innovative changes in medicine such as telemedicine and artificial intelligence may assist in diagnosing eye diseases and in training and education for students.

All India Ophthalmological Society Financial Impact Survey on ophthalmology practice in India during COVID-19

Purpose:

A survey was conducted by the All India Ophthalmological Society (AIOS) to document the initial coronavirus disease 2019 (COVID-19)-related financial impact on ophthalmology practice in India. It also assessed various measures taken by ophthalmologists and the possible role of AIOS in mitigating the economic crisis.

Methods:

An online questionnaire-based cross-sectional survey was conducted among its registered members from July to August 2020. The prevalidated questionnaire contained 25 items related to the impact of COVID-19 on patient volume, the extent of financial distress faced by the ophthalmologists, and various proactive measures taken by them. All valid responses were tabulated and analyzed.

Results:

Out of 1,026 respondents, more than 90% ophthalmologists faced a 25% or more reduction in outpatient and surgical volume. Nearly 59% reported that they can suffer from serious financial distress in near future due to COVID-19 pandemic-related losses. Those who are young (P < 0.0005), salaried (P < 0.0005), and practicing in private sector (P < 0.0005) and Tier 1 cities (P < 0.0005) are reported to be more vulnerable to become financially unstable. The major concerns were revenue losses (70%), preexisting debts (39%), and increased operating costs (27%). The majority (90%) believed that AIOS can help in alleviating the distress. There was also hesitancy regarding the adoption of teleophthalmology and home-based care.

Conclusion:

COVID-19 has significantly affected the financial sustainability of ophthalmologists practicing in India. Identification of vulnerable groups and timely advocacy efforts by AIOS can help in mitigating this financial crisis.

Iberoamerican Ophthalmologists IOL Selection for Use on Themselves: Survey Results

Purpose

To determine the preferred type of intraocular lens (IOL) that ophthalmologists would choose for themselves in case of cataract surgery.

Design

Prospective convenience questionnaire study.

Materials and Methods

We developed an electronic survey with seven (7) questions, combining multiple and open options. The following categories were established: monofocal (MonoIOL) without monovision (MonoIOL-SM) and with monovision (MonoIOL-CM) and multifocal (MultiIOL) that could be either a bifocal (MultiIOL-B), trifocal (MultiIOL-T) or extended focus (MultiIOL-E). The link for the survey was sent to ophthalmologists from Latin America and Spain through different ways. The 1209 responses were analyzed statistically.

Results

We received 1209 responses from 14 countries. The average age was 47.977 years (SD 11.711 years). Gender distribution was 839 males (72.8%) and 313 females (27.2%). Overall preference was MonoIOL-SM 23.90% (289), MonoIOL-CM 12.16% (147), MultiIOL-B 4.63% (56), MultiIOL-T 34.99% (423), MultiIOL-E 15.22% (110), and unsure 9.10% (110). Ophthalmologists that implant IOLs showed a greater preference for MultiIOL (64%) than those who did not implant IOLs (32.3%). Although all ophthalmologists preferred MultiIOL, anterior segment specialists chose them more frequently (59.1%) than posterior segment specialists (41%).

Conclusion

Ophthalmologists would prefer to receive a multifocal IOL implantation despite the lower frequency of multifocal IOL implantation observed in the general population. The frequency was greater among ophthalmologists who implant IOLs compared to those who do not implant them. It was also greater among those who identified themselves as anterior segment specialists compared to posterior segment specialists.

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Referral Process in Patients with Uveitis: A Challenge in the Health System

Purpose

To describe the evaluation and referral process from a group of patients with uveitis presented at a specialized uveitis center in Bogotá, Colombia.

Methods

An observational descriptive cross-sectional study was performed. After applying the selection criteria, 315 clinical records were recovered. Univariate and bivariate analyses were used, reporting proportions, means and standard deviations.

Results

The mean age of the sample was 45.23 years old and 63.8% of them were females. Patients were mostly referred by retina specialists, general ophthalmologists, rheumatologists, and cornea specialists. Meantime between the first ocular symptom and uveitis specialist evaluation was 2.08 years. Patients had been previously evaluated by a mean of 1.9 ophthalmologists. In 79.9% of patients, inflammation was recognized by the remittent; however, only 4.7% of patients were correctly graded according to SUN classification. At first time consultation with the uvea specialist, 52.1% of the patients arrived with an adequate infectious panel, 58.1% with an adequate rheumatologic panel, 11.6% with aqueous humor PCR study, 65.1% with an initial etiological diagnosis, 34.9% with inadequate topical treatment, and 59.6% with inadequate systemic treatment. The mean time to reach a diagnosis by the uvea specialist was 5.27 weeks (0.10 years). A diagnostic coincidence was not reached in 58.7% of the cases.

Conclusion

The referral process to uveitis specialists is complex but highly relevant for those who suffer from this pathology. Health professionals must be aware of the standardized classification of the disease, the appropriate treatment according to the classification, and early referral to the uveologist with adequate laboratory tests.

Prevalence of laser refractive surgery among ophthalmologists in Saudi Arabia

PURPOSE:

The primary aims of this study are to assess the prevalence of excimer laser refractive surgery among ophthalmologists in Saudi Arabia, evaluates the satisfaction rates among ophthalmologists who have undergone laser refractive surgery and whether they would recommend the procedure to their immediate family members.

METHODS:

A cross-sectional study surveyed ophthalmologist irrespective of specialty or subspecialty in Saudi Arabia. A self-reported survey tool has been used for data collection. Candidates were contacted by email and WhatsApp messages that introduced the nature of the study and an online link to a survey was included. For those who did not respond to the digital contact, direct survey interviews were conducted at an Ophthalmology conference in Riyadh, Saudi Arabia, 2018.

RESULTS:

The final study sample was comprised of 183 ophthalmologists. Most of them 107 (58%) reported that they currently are performing laser refractive surgery.There were 73 (39.89%) ophthalmologist who self-reported that they are emmetropic, 110 (60.11%) self-reported themselves as ametropic, not including presbyopia.Of the 110 ophthalmologists with refractive errors, 52 (47.27%) were candidate for laser refractive surgery for myopia, hyperopia or astigmatism. Most of non- candidates attributed the non-candidacy to non- specific reasons and dry eye. Of the 52 participants who reported themselves as candidates for laser refractive surgery, 20 (38.46%) reported that they had undergone laser refractive surgery, and 32 (61.54%) had not. Most of them (50%) reported that they “like to wear glasses or contact lenses. In general, 14 (70%) reported complete satisfaction with the postoperative outcome.Of all ophthalmologists participated in the study, 94% would advise laser refractive surgery to their first-degree relatives.

CONCLUSION:

Excimer laser vision correction among ophthalmologists in Saudi is much higher than the market penetration in the general population reported in other countries. Most of the ophthalmologists who underwent the procedure were satisfied with the outcome.

Awareness, Perceptions, and Attitude Regarding Coronavirus Disease 2019 (COVID-19) Among Ophthalmologists in Jordan: Cross-Sectional Online Survey

Purpose

COVID-19 pandemic is a serious public health concern, and the role of health care workers is essential in preventing spread. The study objective is to investigate awareness, perception, and attitude towards COVID-19 and infection control measures among ophthalmologists in Jordan.

Methods

The design of the study was a cross-sectional survey among Jordanian ophthalmologists. An online survey was sent to 197 ophthalmologists on March 23, 2020. Information on participants’ socio-demographic characteristics, knowledge of clinical features of COVID-19, risk assessment and infection control measures for preventing disease transmission, and attitude towards treating patients with COVID-19 were collected.

Results

A total of 132 ophthalmologists (mean age 40.5 years) responded, 23 (17.6%) had received training on infection control in ophthalmology. Most ophthalmologists were aware of COVID-19 symptoms and ways to identify patients at risk of having the disease, correctly reported modes of transmission and were aware of measures for preventing COVID-19 transmission in the ophthalmic setup. Social media was the commonest source of information on COVID-19 (75%), and 38.2% were not provided with instructions on infection control plan to reduce transmission of COVID-19. Most ophthalmologists (79.5%) thought that the virus could be detected in tears, and 72.2% thought that red eye as a symptom of COVID-19.

Conclusion

Ophthalmologists in Jordan were aware of the epidemiology of COVID-19 and related infection preventive measures. Knowledge was lacking regarding ocular aspects of the disease. Training on infection prevention needs to be improved. Access to guidelines from international ophthalmological organizations should be promoted and seeking updated literature from peer-reviewed journals needs to be encouraged.

Effect of 2019 Coronavirus Pandemic on Ophthalmologists Practicing in Saudi Arabia: A Psychological Health Assessment

PURPOSE:

To assess the psychological impact and mental health outcomes including depression, anxiety, and insomnia during COVID-19 crisis among ophthalmologists.

METHODS:

This was a simple random study in which ophthalmologists practicing in Saudi Arabia were asked to fill in a self-administered online survey during the period from March 28, 2020, to April 04, 2020. Four validated psychiatric assessment tools were used to detect symptoms of depression, anxiety, insomnia, and stress perception.

RESULTS:

One hundred and seven participants successfully completed the survey with a response rate of 30.6%. Males constituted 56.1% (n = 60). Ophthalmology residents constituted the majority (n = 66, 61.7%). About half of the physicians exhibited symptoms of depression (n = 56, 50.5%), anxiety (n = 50, 46.7%), and insomnia (n = 48, 44.9%). Symptoms of stress ranged between low (28%), moderate (68.2%), and high (3.7%). According to the cutoff values for severe symptoms, 29% were identified as having depression, 38.3% had anxiety, and 15% had insomnia.Depression was found to be more common among female ophthalmologists (P = 0.06), those living with an elderly (P = 0.003), and fellows (P = 0.006). Female ophthalmologists suffering from anxiety were significantly more than male ophthalmologists (P = 0.046). There was a trend toward suffering from anxiety in frontline health-care providers (P = 0.139) and in ophthalmologists who are living with an elderly (P = 0.149). Female participants exhibited significantly more moderate-to-high symptoms of stress (P = 0.018).

CONCLUSIONS:

Ophthalmologists' psychological needs, females in particular, should be addressed appropriately during the COVID-19 pandemic. Establishing psychological support units, especially for high-risk individuals, should be considered to minimize psychological adverse effects.

Geographic distribution of eye-care practitioners in Aotearoa/New Zealand: implications for future eye health workforce

BACKGROUND

The New Zealand Ministry of Health provides funding for the delivery of health care across regions via 20 District Health Boards. Funding includes the subsidisation of therapeutic pharmaceutical agents/drugs. The distribution of optometrists and ophthalmologists across the regions was investigated to understand the accessibility of eye care in New Zealand. Changes made to the optometrists' scope of practice in 2005 and in 2014 increased the range of drugs that suitably qualified optometrists could prescribe. Therefore, the distribution of optometrists authorised to prescribe drugs and those not authorised to prescribe drugs was also investigated.

METHODS

Information from the New Zealand Optometrists and Dispensing Opticians Board register and information from the Medical Council's website were used to create a database of ophthalmic practitioners and their locations. The χ² goodness-of-fit test was carried out to determine whether the distribution of the number of practitioners across the regions was in proportion to the population of the regions.

RESULTS

Ophthalmologists were distributed across the regions in proportion to the regional population size. However, optometrists were concentrated in Auckland and other regions with high populations. Optometrists authorised to prescribe drugs comprised over 74 per cent of optometrists and were the majority of optometrists in most regions. Many of the regions with populations less than 200,000 had high population-to-practitioner ratios, indicating that they may not have sufficient numbers of ophthalmic practitioners in order to provide for the ocular needs of the community.

CONCLUSION

Better distribution of the optometric workforce could make eye care more accessible in many regions of New Zealand.

Precaution and prevention of coronavirus disease 2019 infection in the eye

Although current studies suggested that conjunctivitis is not a common presentation of coronavirus disease 2019 (COVID-19), several studies have reported the presence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in ocular secretions. Coronavirus had not yet been successfully cultured from tears or conjunctival swabs in humans, neither SARS-CoV-2 nor SARS-CoV. However, live feline coronavirus has been isolated from conjunctival swabs. In addition, infection of COVID-19 through unprotected eye exposure had been suspected in several articles. Reports of ophthalmologists and otolaryngologists died of COVID-19 also raised concern on ocular transmission. As a result, we strongly suggest that personal protective equipment (PPE) should cover the mouth, nose, and eyes of ophthalmologists, especially when conjunctivitis caused by SARS-CoV-2 is clinically indistinguishable from other viral follicular conjunctivitis.

Psychological impact of COVID-19 on ophthalmologists-in-training and practising ophthalmologists in India

Purpose:

To evaluate the psychological impact of the COVID 19 crisis on ophthalmologists-in-training and practising ophthalmologists during lockdown in India.

Methods:

An online survey was completed by ophthalmologists and ophthalmology trainees during the lockdown. The information collected included demographics (age, gender), domicile (state, union territory), current professional status (in training or practising), type of practice (solo, group, institutional, governmental, non-governmental), marital status (married, single), impact of COVID-19 on their training or practice, and impact on income and ability to meet living expenses. Psychological distress was assessed using the Patient Health Questionnaire-9 (PHQ-9).

Results:

In all, 2,355 ophthalmologists responded. Mean age was 42.5 (range, 25-82 years; SD, 12.05) years. Of these, 1,332 (56.7%) were males; 475 (20.2%) were still not in practice; 366 (15.5%) were single; 1,244 (52.8%) felt that COVID-19 would impact on their training or professional work; and 869 (37%) had difficulty in meeting their living expenses. The mean PHQ-9 score was 3.98 (range, 0-27; SD, 4.65). In terms of psychological impact, 768 (32.6%) had some degree of depression; mild in 504 (21.4%), moderate in 163 (6.9%), and severe in 101 (4.3%). Multivariable analysis showed that depression was significantly higher at younger age. The odds of depression decreased by 3% with 1 year increase in age. It was higher in non-practicing ophthalmologists, especially those who were considerably worried about their training or professional growth, and those with difficulty in meeting living expenses.

Conclusion:

A strikingly high proportion of ophthalmologists are psychologically affected and may require personalized mental health care.

Impact of referral refinement on management of glaucoma suspects in Australia

BACKGROUND

In ageing populations, the prevalence of chronic diseases such as glaucoma is projected to increase, placing additional demands on limited health-care resources. In the UK, the demand for secondary care in hospital eye clinics was inflated by high rates of false positive glaucoma referrals. Collaborative care models incorporating referral refinement, whereby glaucoma suspect referrals are triaged by suitably trained optometrists through further testing, can potentially reduce false positive referrals. This study examined the impact of a referral refinement model on the accuracy of glaucoma referrals in Australia.

METHODS

Optometrist-initiated glaucoma suspect referrals to the Glaucoma Management Clinic (Sydney, Australia) were prospectively recruited. Glaucoma suspect referrals arising from two pathways were eligible for inclusion, either directly from a community optometrist (standard care) or following comprehensive assessment at the Centre for Eye Health (referral refinement). Main outcome measures were the positive predictive value and false positive rate of referrals. The impact of referral letter content on management outcomes was also investigated.

RESULTS

Of 464 referrals received between March 2015 and June 2018, 252 were for treatment of naïve glaucoma suspects and eligible for inclusion. Following ophthalmological assessment, 45.6 per cent (n = 115/252) were prescribed treatment for open angle glaucoma or ocular hypertension. Positive predictive value of community optometry referrals was 33.8 per cent (n = 25/74) and 50.6 per cent (n = 90/178) following referral refinement. The first visit discharge (false positive) rate was 26 per cent (n = 19/74) for community referrals compared to four per cent (n = 8/178) with referral refinement. Positive predictive value increased with the number of abnormal clinical examination findings associated with referral (χ² test, p < 0.0001). The number of abnormal findings reported in referrals was significantly higher with referral refinement compared to without (n = 1.9 versus 1.5, t-test, p < 0.0001).

CONCLUSION

Referral refinement can improve the diagnostic accuracy of optometry-initiated referrals for glaucoma suspects in Australia, thereby decreasing unnecessary referrals to hospital and other secondary clinics.

[The Personnel Problem in Specialized Opthalmologic Care]

The article presents results of analysis of staffing with ophthalmologists in ambulatory polyclinic section in the Russian Federation and the federal okrugs in 2007-2012. The significant variations in analyzed indices are established and also increasing of moonlighting among specialists against the background of increasing of morbidity of diseases of eye and its adnexa and aging of population. The most unfavorable situation emerged in the south Federal okrug where deficiency of ophthalmologists made up to 11.7%. Alongside with that, staffing with specialists of this profile drastically decreased up to 6.7% in the Dalnevostochnii Federal okrug.

Cost-effectiveness of community versus hospital eye service follow-up for patients with quiescent treated age-related macular degeneration alongside the ECHoES randomised trial

OBJECTIVES

To assess the cost-effectiveness of optometrist-led follow-up monitoring reviews for patients with quiescent neovascular age-related macular degeneration (nAMD) in community settings (including high street opticians) compared with ophthalmologist-led reviews in hospitals.

DESIGN

A model-based cost-effectiveness analysis with a 4-week time horizon, based on a 'virtual' non-inferiority randomised trial designed to emulate a parallel group design.

SETTING

A virtual internet-based clinical assessment, conducted at community optometry practices, and hospital ophthalmology clinics.

PARTICIPANTS

Ophthalmologists with experience in the age-related macular degeneration service; fully qualified optometrists not participating in nAMD shared care schemes.

INTERVENTIONS

The participating optometrists and ophthalmologists classified lesions from vignettes and were asked to judge whether any retreatment was required. Vignettes comprised clinical information, colour fundus photographs and optical coherence tomography images. Participants' classifications were validated against experts' classifications (reference standard). Resource use and cost information were attributed to these retreatment decisions.

MAIN OUTCOME MEASURES

Correct classification of whether further treatment is needed, compared with a reference standard.

RESULTS

The mean cost per assessment, including the subsequent care pathway, was £411 for optometrists and £397 for ophthalmologists: a cost difference of £13 (95% CI -£18 to £45). Optometrists were non-inferior to ophthalmologists with respect to the overall percentage of lesions correctly assessed (difference -1.0%; 95% CI -4.5% to 2.5%).

CONCLUSIONS

In the base case analysis, the slightly larger number of incorrect retreatment decisions by optometrists led to marginally and non-significantly higher costs. Sensitivity analyses that reflected different practices across eye hospitals indicate that shared care pathways between optometrists and ophthalmologists can be identified which may reduce demands on scant hospital resources, although in light of the uncertainty around differences in outcome and cost it remains unclear whether the differences between the 2 care pathways are significant in economic terms.

TRIAL REGISTRATION NUMBER

ISRCTN07479761; Pre-results.

Evaluating Adherence to Dilated Eye Examination Recommendations Among Patients with Diabetes, Combined with Patient and Provider Perspectives

BACKGROUND

Diabetes mellitus remains the leading cause of new cases of blindness among US adults. Routine dilated eye examinations can facilitate early detection and intervention for diabetes-related eye disease, providing an opportunity to reduce the risk for diabetes-related blindness in working-aged Americans. The Healthcare Effectiveness Data and Information Set (HEDIS) established criteria for performing dilated eye examination in patients with diabetes.

OBJECTIVES

To obtain information about adherence and nonadherence to diabetic eye examinations among insured patients to understand the barriers to routine dilated eye examinations, and to identify ways to improve the quality of care for these patients.

METHODS

This retrospective claims analysis is based on administrative claims from the HealthCore Integrated Research Database, a broad database representing claims from a large commercially insured population. Patients with diabetes and who had ≥1 dilated eye examinations between August 1, 2011, and July 31, 2013, were defined as adherent to the HEDIS recommendations. The analysis was augmented with findings from focus groups. The patient focus groups included adherent and nonadherent patients. The provider focus group participants were general practice or internal medicine physicians and ophthalmologists who provided medical care for the study population. For the administrative claims analysis, comparisons between the adherent and nonadherent patients were performed using t-tests for continuous data and chi-square tests for categorical data.

RESULTS

Of 339,646 patients with diabetes identified in a claims data set, 43% were adherent and 57% were nonadherent to the HEDIS eye examination performance measure. The common barriers to routine eye examination cited by 29 patients across 4 focus groups included a lack of understanding of insurance benefits (N = 15), a lack of awareness of the importance of dilated eye examinations (N = 12), and time constraints (N = 12). The common barriers cited by 18 providers included the patient's level of education (N = 13), eye examinations as a lower priority than the management of other diabetes-related health issues (N = 12), and a lack of symptoms (N = 11).

CONCLUSION

Several reasons for patient nonadherence to routine eye examination were identified, including a lack of understanding of insurance benefits, a lack of awareness or low prioritization of having an examination, patient education level, time constraints, and a lack of symptoms. These may be considered by providers and payers when developing programs to increase the rates of eye examinations and improve outcomes among patients with diabetes.

Public's knowledge of the differences between ophthalmologists and optometrists: a critical issue in eye care service utilisation

AIM

To assess the public's knowledge of the differences between ophthalmologists and optometrists and identify the factors associated with knowledge.

METHODS

The study was a population-based random survey of adults aged 18 years or older conducted in Enugu, south eastern Nigeria, between March and June, 2011. Data on respondents' socio-demographics, clinical profile, and knowledge of the differences between ophthalmologists and optometrists were collected using a 28-item questionnaire. Data were analysed using descriptive and analytical statistics. Values of P<0.05 were considered statistically significant.

RESULTS

The respondents (n=394) comprised 198 males and 196 females (sex ratio=1.01:1), aged 18-70 (30.9±10.8) years. The majority of respondents were single (57.4%), possessed secondary education (96.9%), employed (65.2%) and had no health insurance (77.4%). Their clinical profile showed previous eye exam 54.1%, spectacle wear 41.6% and contact lens wear 5.6%. In the multivariate analysis, participants' good knowledge of the differences between ophthalmologists and optometrists was significantly associated with educational status (OR: 0.32, 95% CI: 0.23-0.44, P<0.0001, β=-0.988), employment status (OR: 1.8, 95% CI: 1.45-2.25, P<0.0001, β=0.124) and previous eye examination (OR: 1.63, 95% CI: 1.29-2.07, P<0.0001, β=0.549).

CONCLUSION

Participants' socio-demographic and clinical characteristics are important predictors of good knowledge. The findings may have implications for all stakeholders in eye care delivery. There is need for knowledge enhancement, by the government and eye care providers, through population-based eye health literacy campaigns.

Future requirements for and supply of ophthalmologists for an aging population in Singapore

BACKGROUND

Singapore's population, as that of many other countries, is aging; this is likely to lead to an increase in eye diseases and the demand for eye care. Since ophthalmologist training is long and expensive, early planning is essential. This paper forecasts workforce and training requirements for Singapore up to the year 2040 under several plausible future scenarios.

METHODS

The Singapore Eye Care Workforce Model was created as a continuous time compartment model with explicit workforce stocks using system dynamics. The model has three modules: prevalence of eye disease, demand, and workforce requirements. The model is used to simulate the prevalence of eye diseases, patient visits, and workforce requirements for the public sector under different scenarios in order to determine training requirements.

RESULTS

Four scenarios were constructed. Under the baseline business-as-usual scenario, the required number of ophthalmologists is projected to increase by 117% from 2015 to 2040. Under the current policy scenario (assuming an increase of service uptake due to increased awareness, availability, and accessibility of eye care services), the increase will be 175%, while under the new model of care scenario (considering the additional effect of providing some services by non-ophthalmologists) the increase will only be 150%. The moderated workload scenario (assuming in addition a reduction of the clinical workload) projects an increase in the required number of ophthalmologists of 192% by 2040. Considering the uncertainties in the projected demand for eye care services, under the business-as-usual scenario, a residency intake of 8-22 residents per year is required, 17-21 under the current policy scenario, 14-18 under the new model of care scenario, and, under the moderated workload scenario, an intake of 18-23 residents per year is required.

CONCLUSIONS

The results show that under all scenarios considered, Singapore's aging and growing population will result in an almost doubling of the number of Singaporeans with eye conditions, a significant increase in public sector eye care demand and, consequently, a greater requirement for ophthalmologists.

Neck and upper back pain among eye care professionals

BACKGROUND

Ophthalmologists and optometrists have reported a higher prevalence of neck, hand/wrist and lower back pain than family medicine physicians. Work-related musculoskeletal disorders have not previously been studied in Saudi eye care professionals.

AIMS

To determine the magnitude and determinants of neck and upper back pain among eye care professionals at a tertiary hospital in Saudi Arabia in 2013.

METHODS

A cross-sectional study using a close-ended questionnaire to determine the frequency of neck and back pain and its association with age, sex, weight, comorbidities, duration of professional work, history of injury and physician sub-speciality.

RESULTS

The response rate was 82% and 165 eye care professionals participated, 70% (113) of whom reported neck and back pain. The rate was similar in ophthalmologists and allied eye care professionals and among surgical and medical ophthalmologists. The prevalence rate of neck and upper back pain was not associated with number of years in the profession, comorbidities, self-reported weight or injury. Pain appeared to be associated with reported physical discomfort during professional activities (P < 0.01) but not with mental stress. Pain was thought to be work related by 50% of participants. A lower rate of neck and upper back pain was associated with regular exercise [odds ratio = 0.5 (95% confidence interval 0.2-0.9)].

CONCLUSIONS

Neck and back pain was reported by 70% of eye care professionals. The pain was graded as mild to moderate and improved when on holidays. Regular physical exercise appeared to prevent or reduce neck and upper back pain.

Clinical features of diabetic patients referred by general physicians due to less ophthalmic examinations

BACKGROUND

The purpose of this study was to determine the clinical features of patients with type 2 diabetes, and less ophthalmic examinations, referred by general physicians to ophthalmologists.

METHODS

The medical charts of 327 patients with type 2 diabetes referred to our department from general physicians were reviewed. A detailed medical history was taken and a complete ophthalmic examination was performed for all patients. The patients were divided into two groups, ie, those with a history of missing ophthalmic examinations for more than a year (noncompliant group) and those with no previous ophthalmic examinations (never-examined group). Serum levels of glycosylated hemoglobin and creatinine, estimated glomerular filtration rate, and urine albumin/creatinine ratio were obtained from medical records.

RESULTS

Of the 327 patients, 102 had diabetic retinopathy (31.2%), with a mean best-corrected visual acuity of 0.037±0.36 logMAR (logarithm of the minimum angle of resolution) units. Of the 327 patients, 203 were in the never-examined group and 124 were in the noncompliant group. The incidence of diabetic retinopathy in the noncompliant group was significantly higher than that in the never-examined group (P<0.001). Best-corrected visual acuity in the noncompliant group was significantly worse than in the never-examined group (P=0.004). Glycosylated hemoglobin levels and estimated glomerular filtration rate in the noncompliant group were significantly lower than in the never-examined group (P<0.001 and P<0.003, respectively); serum creatinine levels and urine albumin/creatinine ratio were significantly higher (P=0.020 and P=0.001, respectively). The severity of the diabetic retinopathy was significantly correlated with compliance in terms of ophthalmic examinations and with urine albumin/creatinine ratio (multiple regression analysis, P=0.047 and P<0.001, respectively).

CONCLUSION

Our results show that diabetic patients referred from general physicians due to less ophthalmic examinations generally have good visual acuity, but one third of them have diabetic retinopathy. A history of missing ophthalmic examinations and albuminuria are risk factors for diabetic retinopathy.

Job satisfaction amongst Nigerian ophthalmologists: an exploratory study

AIM

This study aimed to assess job satisfaction amongst Nigerian ophthalmologists.

METHODS

The study was conducted during the annual congress of the Ophthalmological Society of Nigeria in September 2008. One hundred and ten ophthalmologists were selected by simple random sampling and asked to complete a structured questionnaire.

RESULTS

The response rate was 73%. The resulting sample comprised of 48 consultants (60%), four diplomates (5%), and 28 residents (35%). Most respondents 62 (78.5%) were satisfied with their job as ophthalmologists and 17 (21.5%) were not satisfied. Only 12 (15.4%) were satisfied with their remuneration and 42 (53.2%) were satisfied with their skill. Most respondents (75.6%) expressed readiness to pursue a career in ophthalmology if they were to make a choice again.

CONCLUSION

Most respondents were satisfied with their job, but only minorities were satisfied with their remuneration. Therefore, there is a need to address the issue of enhancement of remuneration for ophthalmologists in Nigeria.

Job satisfaction amongst Nigerian ophthalmologists: an exploratory study

AIM

This study aimed to assess job satisfaction amongst Nigerian ophthalmologists.

METHODS

The study was conducted during the annual congress of the Ophthalmological Society of Nigeria in September 2008. One hundred and ten ophthalmologists were selected by simple random sampling and asked to complete a structured questionnaire.

RESULTS

The response rate was 73%. The resulting sample comprised of 48 consultants (60%), four diplomates (5%), and 28 residents (35%). Most respondents 62 (78.5%) were satisfied with their job as ophthalmologists and 17 (21.5%) were not satisfied. Only 12 (15.4%) were satisfied with their remuneration and 42 (53.2%) were satisfied with their skill. Most respondents (75.6%) expressed readiness to pursue a career in ophthalmology if they were to make a choice again.

CONCLUSION

Most respondents were satisfied with their job, but only minorities were satisfied with their remuneration. Therefore, there is a need to address the issue of enhancement of remuneration for ophthalmologists in Nigeria.

The sclera, the prion, and the ophthalmologist

Prions have emerged in the past 5 years as serious transmissible infective agents. Ocular tissue transplantation has come under scrutiny after potential infected tissue was transplanted into healthy patients. In this review we examine the evidence for the risk of transmission of prions after scleral transplantation and explore alternative materials that may be used in ocular surgery.