[Career prospects for ophthalmologists under 49 years old : A survey in Germany from 2022]

OBJECTIVE

The need for care in ophthalmology is constantly increasing due to demographic changes. The study analyzed the current professional situation and future prospects of ophthalmologists under 49 years old.

METHODS

The survey of members of the German Association of Ophthalmologists (Berufsverband der Augenärzte Deutschlands) and the German Ophthalmologic Society (Deutsche Ophthalmologische Gesellschaft) was conducted in 2022. All members under the age of 49 years received an online questionnaire on the current professional situation as well as future perspectives (desired working hours, form of organization). The results of the survey were additionally compared with the 2016 survey of the German Association of Ophthalmologists. A similar questionnaire was used at that time.

RESULTS

A total of 1014 people participated in the survey (62.7% women, mean age 39.3 ± 8 years, 75.6% specialists). The response rate to the survey was 25%. Specialist practice from 0 to 5 years showed a higher number of employed ophthalmologists (21% self-employed vs. 32% employed); over time the number of self-employed ophthalmologists increased (6-10 years: 40%, > 10 years: 59.3%). Overall, 46% of women were employed in a practice compared with 33% of men. Of the self-employed specialists, 95.9% said they planned to work in the same type of employment in 10 years as currently. Regarding ophthalmologists' career future, the other employment types showed a desire to move to independent practice. Compared to the 2016 survey, gender differences related to the current type of employment were evident. The number of self-employed women decreased from 43% to 26% and self-employed men decreased from 63% to 39%. The number of ophthalmologists in ambulatory healthcare centers was doubled compared to 2016. Ophthalmologists reported similar future perspectives at both survey times.

CONCLUSION

The results of the survey of ophthalmologists under 49 years in Germany showed similar perceptions as in 2016. It became clear that the desire to be self-employed in 10 years is very high; however, ophthalmologists expected large practices or medical care centers to prevail in the market. The number of self-employed doctors is decreasing and the desire for self-employment is difficult to realize.

[Diagnostics, clinical aspects and genetics of congenital corneal opacities]

BACKGROUND

Congenital corneal opacities are comparatively rare diseases with high amblyogenic potential.

PURPOSE

The present work provides an overview of the diagnostics, clinical aspects and genetics of congenital corneal opacities.

METHODS

A literature search was carried out to compile an overview and illustration with own clinical case examples.

RESULTS

Differentiated diagnostics are of high importance in the treatment of patients with congenital corneal opacities. A close cooperation between the medical departments involved and also the parents is absolutely essential. The structured classification of congenital corneal opacities provides the basis for a targeted treatment.

DISCUSSION

The causes and the clinical symptoms of congenital corneal opacities are manifold. The correct diagnosis should be made early and in an interdisciplinary manner. Based on this, conservative and surgical treatment measures can be planned and an impending development of amblyopia can be specifically counteracted.

[Treatment of vascularized high-risk eyes with a Boston keratoprosthesis]

BACKGROUND

In severely compromised and vascularized high-risk eyes, the Boston keratoprosthesis procedure is often the last treatment option. The transparency of the optics is not impaired by endothelial immune reactions.

METHODS

This review article discusses relevant literature as well as our own data and experiences with the Boston keratoprosthesis in high-risk eyes. The relevant complications as well as the postoperative management are discussed.

RESULTS

In more than 60% of the high-risk eyes a long-term increase in visual acuity can be achieved. Keratoprosthesis retention rates show a variable span with reported mean 5‑year retention rates of 75%. The most common postoperative complications include the formation of a retroprosthetic membrane and keratolysis in up to 50% each. More than 70% of the eyes already suffer from (secondary) glaucoma preoperatively, so that glaucoma surgery is performed simultaneously in at least 20% of cases and in the postoperative course further antiglaucomatous surgery is necessary in up to 31%. Vitreoretinal complications include, in particular, sterile vitritis and infectious endophthalmitis but persistent hypotonia is also described in one third of patients.

CONCLUSION

The Boston keratoprosthesis is an alternative to conventional corneal replacement if the prognosis for allogeneic transplants is poor. Postoperative complications are common; therefore, postoperative management plays an important role. For vascularized high-risk eyes, however, it is often the only remaining option for visual rehabilitation.

[Boston type I keratoprosthesis implantation technique : Video article]

BACKGROUND

Keratoprosthetics refer to the replacement of human corneal tissue with an artificially produced exchange product. The most widely implanted keratoprosthesis worldwide is the Boston Type I Keratoprosthesis (BI-KPro, Massachusetts Eye and Ear Infirmary, Boston, MA, USA).

METHODS

This video article demonstrates the surgical technique of BI-KPro implantation as routinely performed at this institution. In addition, an overview of the surgical indications, patient consent, anesthesia and positioning, postoperative treatment and complications as well as the evidence of the technique is provided in the article based on experience with 31 BI-KPro implantations.

RESULTS

The indications for BI-KPro primarily include patients in a high-risk keratoplasty setting particularly after repeatedly failed keratoplasty. A thorough patient examination and assessment of the indications as well as detailed disclosure of information to the patient about the individual prognosis, the risk profile, the postoperative therapy and follow-up enable a positive postoperative result.

CONCLUSION

The BI-KPro provides an established and relatively standardized option for surgical treatment of eyes in a high-risk keratoplasty setting. Patients should be preoperatively informed with respect to the individual prognosis, complication profile and life-long follow-up.

[Intraoperative optical coherence tomography for examination of newborns and infants under general anesthesia]

BACKGROUND

Examination of newborn and children under general anesthesia is essential to prevent amblyopia and blindness; however, the validity was often limited due to a lack of state of the art diagnostic tools in the intraoperative set-up, e. g. optical coherence tomography (OCT). Since OCT devices have been integrated into surgical microscopes, this technique is also available for examination with patients under general anesthesia.

OBJECTIVE

To give an overview about the possibilities of intraoperative OCT (iOCT) during examination of newborn and infant children under general anesthesia.

MATERIAL AND METHODS

Analysis of recent literature (PubMed) and initial experiences at the Center for Ophthalmology of the University Hospital of Cologne.

RESULTS

The use of iOCT enables real-time high-resolution imaging during examinations of children under general anesthesia. All relevant structures of the anterior eye segment (including cornea, lens, chamber angle and iris) can be visualized. Especially when the anterior chamber view is limited due to corneal opacifications, iOCT can deliver important information in addition to that obtained using a surgical microscope. This information is important for the further therapy of the patients.

CONCLUSION

Online iOCT is a useful extension of the normal surgical microscope, especially for examination of children under general anesthesia and limited view into the anterior chamber. In our experience it also makes sense to transfer this technique to anomalies of the posterior pole because high-resolution imaging of the macula and optic nerve head is possible.

[Intraoperative optical coherence tomography in corneal and glaucoma surgical procedures]

BACKGROUND

Optical coherence tomography (OCT) is the clinical gold standard for anterior and posterior segment imaging. Since OCT devices have been integrated into surgical microscopes, this technique is also available intraoperatively in anterior segment surgery. OCT is well established in imaging very thin or transparent structures as they appear in corneal or glaucoma surgery. Therefore, intraoperative OCT can deliver important information for the surgeon which is superior to the normal surgical microscope.

OBJECTIVES

In the present work, an overview about the opportunities of intraoperative OCT in cornea and glaucoma surgery are presented.

MATERIAL AND METHODS

The recent literature (PubMed) and our own experience at the Center for Ophthalmology, University Hospital of Cologne are analysed.

RESULTS

Intraoperative OCT enables real-time imaging during corneal and glaucoma surgery. Several clinical studies exist, indicating its benefit, e. g. in DMEK, DALK, DSAEK, Boston Keratoprosthesis, canaloplasty or trabectome surgery. Several structures, not visible in the surgical microscope, can be visualized using intraoperative OCT.

CONCLUSIONS

As a real-time and high-resolution imaging device, intraoperative online OCT delivers additional information in glaucoma and corneal surgery, compared to the normal operating microscope. Nonetheless one of the main problems is the shadowing produced by surgical instruments. Today the main limitation is the lack of randomized-controlled clinical trials, evaluating the benefit of microscope-integrated intraoperative OCT, compared to the microscope.

[Intraoperative Optical Coherence Tomography In Deep Anterior Lamellar Keratoplasty]

BACKGROUND

Like penetrating keratoplasty (pKPL), deep anterior lamellar keratoplasty (DALK) is a standard treatment for keratoconus and stromal corneal dystrophies. Intraoperative optical coherence tomography permits live or real-time monitoring during surgery, especially if it is necessary to estimate distances or if the anterior chamber view is limited.

METHODS

Review of literature from PUBMED and our own clinical and experimental data. Key words were "intraoperative Optical Coherence Tomograph", "DALK", "Deep anterior lamellar keratoplasty" and "iOCT". The time frame was set from 2005 to 2016.

RESULTS

All surgical steps were visualisable by intraoperative OCT during DALK surgery. Intraoperative OCT permits depth estimation during deep needle insertion and allows the visualisation of intraoperative interface fluid.

CONCLUSION

Intraoperative OCT facilitates standardisation during several steps of DALK. Future prospective studies should concentrate on the safety profile of intraoperative OCT-guided DALK compared to DALK without intraoperative monitoring.

[Therapy for Ocular Graft-vs-Host Disease]

Therapy for ocular graft-vs-host disease (ocular GvHD) is challenging for ophthalmologists as progress of the disease often occurs rapidly and is unforeseeable. Primary goal is the preservation or restoration of visual acuity, however, studies on ocular GvHD that have investigated therapeutic concepts are limited. In contrast, most therapeutic recommendations from consensus conferences derive from studies on dry eye diseases other than ocular GvHD. This review demonstrates the available therapies in the following categories: local, systemic, surgical and prophylactic. Primary targets are anti-inflammation, anti-fibrosis and lubrification of the ocular surface. In conclusion, studies strictly on ocular GvHD are needed to enable better evidence-based therapeutic decision-making in the future.

[Non-Invasive Diagnosis of Ocular Graft-versus-Host Disease]

Ocular graft-vs-host disease (GvHD) is a major complication following allogenic blood stem cell transplantation (aBSCT) leading to a disturbance of the ocular surface integrity with a broad range of severity. Leading symptom is a pronounced autoinflammatory reaction in particular at the ocular surface with typical features of dry eye disease. Potential complications include visual loss, pain and damage to the ocular structures with, e. g. corneal ulcerations. Diagnosis and treatment of ocular GvHD are a challenge for attending ophthalmologists and require intensive interdisciplinary patient care in particular with haemato-oncologists. First and follow-up examinations consist of several diagnostic steps that include quantitative and qualitative analysis of tearfilm, visual acuity, ocular surface and retinal integrity, cataract development and subjective symptoms. Available tests are mostly evaluated for usage in dry eye diagnosis but are, however, mostly unspecific for diagnosing ocular GvHD reliably. Only combinations of several clinical tests together with the experience of specialised ophthalmologists may lead to the certain diagnosis and treatment decisions at state. This review illustrates the available established and innovative non-invasive diagnostic tests and evaluates their potential use for diagnosing ocular GvHD.