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ObjectivesTo evaluate the use of a three-dimensional heads-up microscope (3DM) during 25-gauge pars plana vitrectomy (PPV) compared with a traditional ophthalmic microscope (TM) in terms of efficacy, safety, and teaching and learning satisfaction.MethodsProspective comparative interventional study. Fifty eyes affected by one of the following diseases: rhegmatogenous or tractional retinal detachment, epiretinal membrane, full-thickness macular hole, vitreous hemorrhage, or dropped lens. The 50 eyes were randomly assigned to one of two groups: group A (25 eyes) underwent 25-gauge PPV with 3DM, and group B (25 eyes) underwent 25-gauge PPV with TM. The main outcome measures were the duration of the operation, intraoperative complications, and surgeon and observer satisfaction. A questionnaire was used to assess surgeon satisfaction according to the following parameters: comfort, visibility, image quality, depth perception, simplicity of use, maneuverability, and teaching. A questionnaire to assess observer satisfaction was completed by 20 observers (surgical residents or ophthalmic surgeons).ResultsThe degree of satisfaction was higher using 3DM for both surgeons and observers (P < 0.001). The average duration of the operation did not differ significantly between the two methods. No major complications occurred for either method.ConclusionsPPV with 3DM is more comfortable for the surgeon and poses no substantially greater risk of complications for the patient. The high-definition screen delivers excellent depth perception and better screen parameter control, which results in high-quality surgical performance. 3DM surgery helps to significantly improve teaching and learning intra-operative surgical procedures.

Background The use of simulators for ophthalmology training is growing globally. However, all developed simulators have certain limits based on different circumstances. The study aims to evaluate training performance and student satisfaction of the new refractive adjustment simulator \"ICEyeModel\" compared with a traditional simulator for direct ophthalmoscopy training among medical students. Methods This constitutes a comparative, randomised, cross-over study. Our study enrolled 50 participants from a 6-year medical student training programme at Phramongkutklao Hospital. They underwent a refresher lecture on primary direct ophthalmoscopy use and a short course review of common retinal diseases. They were randomised into two training sequence groups: Training sequence 1 started with a traditional film photograph simulator called Eye Retinopathy Trainer (developed by Adam, Rouilly Co., Sittingbourne, UK) followed by the ICEyeModel. Training Sequence 2 started with the ICEyeModel, followed by a traditional simulator. Participants in both groups completed the fundoscopic description tests and satisfaction questionnaires immediately following each simulator training session. Results On an 18-point prospective rubrics scale, medical students trained with ICEyeModel achieved significantly higher fundoscopic examination scores (14.42 ± 2.34) compared to those trained with traditional simulators (11.30 ± 2.64), with p  < 0.001. For the ICEyeModel, 86% of the participants can correctly adjust the direct ophthalmoscope power match to the refractive state of the trial lens placed in the simulator. The ICEyeModel has a higher satisfaction score regarding picture quality, enhancing motivation and confidence than a traditional simulator. Conclusion In comparison with the Eye Retinopathy Trainer, the ICEyeModel significantly enhanced performance with increased satisfaction and self-confidence in simulated direct ophthalmoscopy training. Although these improvements were observed in a simulation setting and do not necessarily translate to superior performance in patient examinations, our findings suggest that the ICEyeModel may offer a promising alternative for training with direct ophthalmoscopes, indirect ophthalmoscopes, and retinoscopes in clinical settings.

Introduction Non-ophthalmologists often lack sufficient operational training to use a direct ophthalmoscope proficiently, resulting in a global deficit of basic ophthalmological skills among general practitioners. This deficiency hampers the timely diagnosis, referral, and intervention of patients. Consequently, the optimization of teaching tools and methods to enhance teaching efficiency is imperative. This study explores the effectiveness of the Eyesi Direct Ophthalmoscope Simulator (Eyesi) as an innovative tool for fundus examination training. Methods Medical undergraduates were randomly assigned to Group A or B ( n  = 168). All participants completed a pre-training questionnaire. Group A received Eyesi training, while Group B underwent traditional direct ophthalmoscope (TDO) training. Subsequently, participants answered questionnaires relevant to their respective training methods. Both groups exchanged training tools and completed a summary questionnaire. Results After training, 54.17% of participants believed that images presented by the Eyesi were consistent with the real fundus. Group A scored significantly higher than Group B in fundus structure recognition and self-confidence in examination. The degree of mastery over fundus theory score increased from 6.10 ± 0.13 to 7.74 ± 0.16 ( P  < 0.001) in Group A, but Group B did not demonstrate a significant difference. We also compared undergraduates’ tendencies for different learning purposes, 75.59% of participants preferred the Eyesi to TDO as a training tool, and 88.41% of participants were receptive to introducing the Eyesi in training. Conclusion According to subjective participant feedback, Eyesi outperformed TDO in fundus observation, operational practice, and theoretical learning. It effectively equips undergraduates with fundus examination skills, potentially promoting the use of direct ophthalmoscopes in primary medical institutions.

PurposeTo investigate whether the observed international differences in retinopathy of prematurity (ROP) treatment rates within the Benefits of Oxygen Saturation Targeting (BOOST) II trials might have been caused by international variation in ROP disease grading.MethodsGroups of BOOST II trial ophthalmologists in UK, Australia, and New Zealand (ANZ), and an international reference group (INT) used a web based system to grade a selection of RetCam images of ROP acquired during the BOOST II UK trial. Rates of decisions to treat, plus disease grading, ROP stage grading, ROP zone grading, inter-observer variation within groups and intra-observer variation within groups were measured.ResultsForty-two eye examinations were graded. UK ophthalmologists diagnosed treat-requiring ROP more frequently than ANZ ophthalmologists, 13.9 (3.49) compared to 9.4 (4.46) eye examinations, P=0.038. UK ophthalmologists diagnosed plus disease more frequently than ANZ ophthalmologists, 14.1 (6.23) compared to 8.5 (3.24) eye examinations, P=0.021. ANZ ophthalmologists diagnosed stage 2 ROP more frequently than UK ophthalmologists, 20.2 (5.8) compared to 12.7 (7.1) eye examinations, P=0.026. There were no other significant differences in the grading of ROP stage or zone. Inter-observer variation was higher within the UK group than within the ANZ group. Intra-observer variation was low in both groups.ConclusionsWe have found evidence of international variation in the diagnosis of treatment-requiring ROP. Improved standardisation of the diagnosis of treatment-requiring ROP is required. Measures might include improved training in the grading of ROP, using an international approach, and further development of ROP image analysis software.

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.

Aim:To compare the diagnostic accuracy of wide-field digital retinal imaging (WFDRI) with the current “gold standard” of binocular indirect ophthalmoscopy (BIO) for retinopathy of prematurity (ROP) screening examinations.Methods:A consecutive series of premature infants undergoing ROP screening at Edinburgh Royal Infirmary were eligible for recruitment into this prospective, randomised, comparative study. Infants were screened using both WFDRI (Retcam II with neonatal lens) and BIO by two paediatric ophthalmologists who were randomised to the examination technique. Both examiners documented their clinical findings and management plans in a masked fashion. WFDRI eye findings were compared with those of BIO.Results:A total of 81 infants were recruited, and information from 245 eye examinations was analysed. The sensitivity of WFDRI in detecting any stage of ROP, stage 3 ROP and “plus” disease was 60%, 57% and 80%, respectively, and specificity 91%, 98% and 98%, respectively. The proportional agreement between WFDRI and BIO was 0.96 for detecting stage 3 disease and 0.97 for detecting “plus” disease. There was very good agreement on management decisions (kappa 0.85).Conclusion:When used in a routine ROP screening setting, a randomised comparison of WFDRI and BIO, WFDRI showed relatively poor sensitivity in detecting mild forms of ROP in the retinal periphery. This resulted in difficulty in making decisions to discharge infants from the screening programme. Sensitivity was better for more severe forms of ROP, but at present WFDRI should be regarded as an adjunct to, rather than a replacement for, BIO in routine ROP screening.

BACKGROUND AND OBJECTIVE: Establish quality and diagnostic utility of mydriatic smartphone ophthalmoscopy (SO) fundus images compared to fundus camera (FC) images. PATIENTS AND METHODS: In this prospective, cross-sectional study, 94 consecutive patients in an urban eye emergency department underwent SO and FC fundus imaging via one of three study arms: medical student 1 (MS1), medical student 2 (MS2), and ophthalmology resident (OR). Images of 188 eyes were graded for overall quality by two masked reviewers, and observed critical fundus findings were compared to dilated fundus examination documentation. RESULTS: SO images were higher quality in the OR arm than in the MS1 and MS2 arms (SO images were higher quality in the OR arm than in the MS1 and MS2 arms ( P < .017). There were no differences in FC image quality between photographers (all P > .328). In the OR arm, SO images detected 74.3% of critical fundus findings, whereas FC images detected 77.1%. CONCLUSION: SO produces fundus images approaching the quality and diagnostic utility of traditional FC photographs. [[ Ophthalmic Surg Lasers Imaging Retina . 2015;46:631–637.]

Background: Medical school and residency training in ophthalmoscopic evaluation is limited, reducing diagnostic accuracy. We sought to evaluate the efficacy of self-study using an ophthalmoscopy simulator to improve the technical motor skills involved in direct funduscopy in postgraduate pediatric residents. Methods: In this randomized-controlled study, 17 pediatric residents (postgraduate years 1-3) were randomized to control (n=8) or intervention (n=9) groups. Participants were asked to correctly identify the funduscopic findings presented to them on an ophthalmoscopy simulator after being trained on its use. Each participant was asked to review 20 images of the fundus, and then record their multiple-choice response on a scantron sheet listing all possible funduscopic pathologies. Pre- and post-intervention testing was performed. Survey data assessing exposure to funduscopy skills during undergraduate and postgraduate training and overall experience with the simulator were collected. Results: Most (65% [11/17]) participants reported minimal or no formal teaching in ophthalmology during their undergraduate medical studies. Average pre-intervention score (of 20) was 10.24±1.75 (51%) for the entire group, with no statistically significant difference between average pre-score in the control (10.63±1.77) versus intervention (9.89±1.76, p=0.405) groups. Intervention subjects experienced a statistically significant improvement in scores (9.89±1.76 vs. 12.78±2.05, p=0.006 [95% confidence interval 4.80-0.98]), but control subjects did not. Conclusions: A single session with an ophthalmoscopy simulator can improve diagnostic accuracy in postgraduate pediatric trainees. Use of ophthalmoscopy simulation represents a novel addition to traditional learning methods for postgraduate pediatric residents that can help trainees to improve their confidence and accuracy in performing this challenging examination. Évaluation de l’impact de simulateurs pour enseigner à des résidents en pédiatrie des habiletés techniques en ophtalmoscopie. Contexte: La formation offerte par les écoles de médecine et les programmes de résidence en matière d’ophtalmoscopie est plutôt limitée, ce qui réduit la précision des diagnostics posés par la suite. Notre intention a été d’évaluer l’efficacité de l’autoformation offerte par simulateur afin d’améliorer les habiletés motrices techniques de résidents en pédiatrie appelés à réaliser un examen ophtalmoscopique. Méthodes: Dans cette étude contrôlée randomisée, 17 résidents en pédiatrie (de la 1ère à la 3e années postdoctorales) ont été répartis de façon aléatoire entre un groupe témoin (n=8) et un groupe de sujets formés à l’usage d’un simulateur (n=9). On a ensuite demandé à ces sujets d’identifier correctement des observations ophtalmoscopiques leur étant soumises à l’aide d’un simulateur, et ce, après avoir suivi une formation relative à son utilisation. On a ainsi demandé à chacun d’entre eux d’examiner 20 images de fond d’œil pour ensuite consigner, sur des feuilles du test Scantron® établissant une liste de toutes les pathologies ophtalmoscopiques possibles, leurs réponses à des questions à choix multiples. Une évaluation de leurs habiletés pré et post-formation a été effectuée au moyen d’une collecte de données. On a ainsi cherché à évaluer leur niveau d’exposition aux habiletés ophtalmoscopiques durant leur formation universitaire et postuniversitaire ainsi que leur expérience générale avec un simulateur. Résultats: La plupart des participants (65 % [11/17]) ont révélé n’avoir été que peu ou pas du tout formés en matière d’ophtalmologie pendant leurs premières années d’études en médecine. Le score moyen en ce qui regarde leurs habiletés préformation (sur 20) a été de 10,24±1,75 (51%), aucune différence statistique notable n’ayant émergé entre le groupe témoin (10,63±1,77) et celui appelé à être formé (9,89±1,76 ; p=0,405). Les sujets formés ont par la suite expérimenté une amélioration importante sur le plan statistique en ce qui regarde leurs scores (9,89±1,76 c. 12,78±2,05 ; p=0,006 [IC 95 % ; 4,80-0,98]), ce qui n’a pas été le cas des sujets du groupe témoin. Conclusions: Une simple séance de formation à l’aide d’un simulateur ophtalmoscopique peut améliorer la précision des diagnostics posés par des résidents en pédiatrie. L’usage d’une telle simulation représente une addition innovatrice aux méthodes traditionnelles d’apprentissage. Elle pourrait permettre aux résidents d’améliorer leur confiance et l’exactitude de leur intervention au moment de procéder à ces examens complexes.

Purpose To compare the diagnostic efficacy of wide-field digital retinal imaging (WFDRI) with binocular indirect ophthalmoscopy (BIO) for retinopathy of prematurity (ROP) screening. Methods Premature infants admitted for ROP screening were included in this prospective, randomized and double-blind comparative study. They were examined by using BIO and WFDRI. Results A total of 58 infants were enrolled in the study. The sensitivities of WFDRI in detecting any stage of ROP, treatment-requiring ROP and plus disease were 58.6, 100, and 100% respectively, with a specificity of 100% for all. The proportional agreement between WFDRI and BIO was 0.903 for detection of any stage of ROP, 1.0 for treatment-requiring ROP, and 1.0 for plus disease. Conclusion The sensitivity and specificity of WFDRI was excellent for the diagnosis of severe and treatment-requiring ROP. However, BIO was superior in mild ROP particularly for the ones in retinal periphery.

The purpose of this study was to evaluate optic nerve head (ONH) differences of the patients with Alzheimer’s disease (AD) measured by confocal scanning laser tomography [Heidelberg Retina Tomograph (HRT) III] and compare with glaucoma and control subjects. Eighty-four patients were enrolled into the study: 44 eyes of 24 patients with mild to moderate AD (Group 1), 68 eyes of 35 patients with glaucoma (Group 2), and 49 eyes of 25 heathy volunteers as a control (Group 3). A complete ophthalmologic examination as well as a confocal scanning laser ophthalmoscopic assessment with HRT III were performed on all patients. Mean values of the ONH topographic parameters such as rim area (RA), rim volume (RV), height variation contour, linear cup/disc ratio, cup shape measure, and retinal nerve fiber layer (RNFL) were recorded. Mean values of RNFL thickness was 0.23 ± 0.07 in AD, 0.22 ± 0.09 in glaucoma and 0.24 ± 0.07 in the control group ( p  = 0.323). RA and RV were significantly lower, and linear C/D ratio was significantly higher in the glaucoma group when compared to AD and control ( p  < 0.05). There was no statistically significant difference between AD and control for the optic disc parameters tested ( p  > 0.05). We observed a negative correlation of the age with RNFL in all of the groups ( p  < 0.005). Age was the most important parameter affecting RNFL. Our results suggest that HRT does not demonstrate ONH differences between AD and control group, while it successfully differentiates glaucoma from AD and control cases of older age.