Ophthalmologe最新文献

Background: The coronavirus disease 2019 (COVID-19) pandemic restricted face-to-face interactions of medical students and teachers.

Objective: To develop and evaluate an online course for ophthalmology examination techniques for medical students and to determine the impact of the course on the practical objective structured clinical examination (OSCE).

Material and methods: The online examination course was developed as a video-based tutorial according to the SMART (specific, measurable, activating, reasonable, time-bound) principle covering all topics of the National Competency-based Catalogue of Learning Objectives for Medical Education and made available to medical students in the ophthalmology course. At the end of the semester the students graded the online examination course on an ordinal scale from 1 (strongly agree) to 6 (strongly disagree) anonymously and were asked for comments. The grades of the OSCE (range 1-5) were compared with the OSCE results of the previous semester.

Results: Of the 164 students 67 participated in the online evaluation (41%). The students reported to be well-prepared for the OSCE (mean grade 2.0; SD 1.0). In the future, 70% of the students would prefer combined online and on-site teaching (47 out of 67 students). Among all 164 students, the mean OSCE results were excellent (mean grade 1.1; SD 0.2) and comparable to the previous semester (mean grade among 166 students, 1.1; SD 0.2; two-sided t-test, p = 0.86).

Conclusion: The online course on ophthalmology examination techniques allowed medical students to prepare for the OSCE. Beyond the COVID-19 pandemic, online teaching options can support on-site teaching.

Background: Bilateral medial rectus muscle recession with or without Cüppers' posterior fixation suture and recess and resect surgery are used to correct for large angle esotropia. There are only few reports on three muscle surgery (3MS). We analyzed the results of 3MS.

Patients and methods: Between June 2016 and May 2020, 61 patients received 3MS for esotropia ≥ 27° (50 PD) together with oblique muscle surgery, if needed. Angles of strabismus were measured by simultaneous prism and cover testing (SPCT) and alternating prism and cover testing (APCT) at 5 m and 0.3 m. Grading was around 0.51 mm/degree (at 5 m). Medium-term results of 57 patients were available.

Results: Medians and ranges (min-max) were: age, 6 years (3-56 years). Preoperative APCT, far 34° (27-45°), near 36° (27-50°). Amount of surgery, 17 mm (15-21 mm), oblique muscle recession in 21 cases. The APCT after 5 months (3-24 months), far 2° (-10-18), near 2° (-8-18). Success rates (absolute deviation ≤ 6° [10 PD]), APCT far 68%, near 67%, SPCT far 79%, near 74%. Exotropia > 6° occurred in 4 cases (7%) at far and 3 (5%) at near, esotropia > 6° in 14 cases (25%) at far and 16 (28%) at near.

Conclusion: The use of 3MS is a suitable first step procedure to correct for large angle esotropia.

Background: Open and minimally invasive tear duct surgery are among the common surgical indications; however, little is known so far about the respective influences on the quality of life.

Objective: The aim of this study was to compare the subjective influence on the quality of life of patients after open and minimally invasive surgical techniques for recanalization of dacryostenosis.

Material and methods: From the collective of patients who were surgically treated at the University Medical Center Hamburg-Eppendorf from 2015 to 2018, a total of 169 patients (111 dacryocystorhinostomy, DCR, 58 endoscopy) took part in the survey and answered 9 questions about subjective satisfaction, which were evaluated also comparatively.

Results: When asked about postoperative satisfaction, the patients were significantly more satisfied after DCR (p = 0.001) than the patients who underwent a lacrimal endoscopy. There was no significant difference in terms of postoperative complications (p = 0.348). The rate of reoperations, however, was significantly higher in the patient group who underwent lacrimal endoscopy (χ²-test, p = 0.004).

Conclusion: In summary it can be said that DCR is not inferior to lacrimal endoscopy in terms of patient satisfaction.

Background: We present a pilot project to improve eye health in schoolchildren: annual optometric screening with a focus on early detection of school myopia. The logistical proof-of-concept is illustrated by way of a pilot project at a state high school in North Rhine-Westphalia. The collected biometric parameters also contribute to the collection of epidemiological data.

Material and methods: On organized examination days objective and subjective refractions of schoolchildren in grades 5-7 (ages 9-16 years) were determined, children were tested for abnormalities in binocular vision and the photopic and mesopic pupil diameters were determined. Noncontact biometry was used to measure the corneal radius, central corneal thickness, anterior chamber depth, lens thickness and axial length of the eyes. Optical coherence tomography (OCT) was used to also determine the central choroidal thickness of the eyes. Questionnaires were employed to inquire about the visual habits of the schoolchildren.

Results: In the fall of 2019 a total of 274 schoolchildren (11.2 ± 1.2 years) voluntarily participated in the examinations: 22% (61) showed myopia (spherical equivalent ≤ -0.50 D), of which 11% (7) were previously uncorrected (uncorrected distance visual acuity < 0.8). Of the schoolchildren 8% (5) showed an increase in myopia of more than -0.5 D compared to their actual spectacle values (distance visual acuity with ophthalmic lens < 0.8). A class of about 25 pupils can be examined within 2 regular periods.

Conclusion: There is an actual need for optometric screening because a total of 4.4% (12) myopic schoolchildren could be identified who had a distance visual acuity of less than 0.8 even with the correction. By determining the axial length and classifying this value depending on age in the literature can help to predict the individual risk of myopia and to raise awareness among parents and children to address this problem. The planned repetition of these examinations enables a better understanding of eye growth in schoolchildren.

Background: Glaucoma care has extended enormously in recent years. We performed a survey among the members of the German Ophthalmological Society (DOG) and the Professional Association of Ophthalmologists in Germany (BVA) to explore treatment patterns, the importance of different diagnostic parameters as well as treatment guidelines in the daily practice of glaucoma care.

Objective: Assessment of the current practice of glaucoma care among German ophthalmologists, evaluation of key diagnostic parameters and their use in daily practice.

Material and methods: Our survey was conducted using an online questionnaire that consisted of 26 questions (107 items) about the treatment practice for the diagnosis and treatment of glaucoma. Complete responses were available from 1361 participants.

Results: Slit-lamp examination still remains the most important tool for diagnosis in glaucoma. A very high ranking was also achieved for optical coherence tomography (OCT) parameters. With respect to clinical interpretation and diagnostic certainty parameters analyzing the optic disc were ranked higher than others. Guideline-oriented care is being practiced by the vast majority of ophthalmologists according to self-reported results-two thirds perform perimetry two or more times and a structural analysis once in the first year after diagnosis. The importance of gonioscopy is controversial among the survey participants and is therefore being practiced with different intensity.

Discussion: The diagnosis of glaucoma is challenging. Different diagnostic parameters are of different values to the ophthalmologists. Morphometric tools have achieved a highly important role for the diagnosis of glaucoma and enable assisted, yet not automated diagnosis. Treatment guidelines and standards are requested and should be implemented in education and care practice.

Background: Ophthalmoscopy is part of the medical curriculum but the teaching of medical contents is often unsatisfactory. No systematic learning of pathologies and their treatment options is possible because appropriate patient populations are often unavailable; instead of that healthy students examine each other. For this reason, we have developed a project to improve teaching at the medical faculty of the JWG University in Frankfurt/Main, which offers the opportunity for training in ophthalmoscopy using a newly developed online platform (EyesiNet) in addition to simulator training. Defined learning contents are reproducible and made equally available to everyone.

Aim: The aim of this study was to evaluate a format for improving the teaching of direct and indirect ophthalmoscopy for students. Practical exercises on virtual reality-based simulators were intertwined with newly developed theoretical content adapted to the teaching catalog in the online platform EyesiNet.

Material and methods: On the first and last days of the internship, the students worked on cases in Eyesi Direct and Eyesi Indirect. In the meantime, they were able to deal with the theoretical basics of these ophthalmological clinical pictures in the web-based EyesiNet on a voluntary basis.

Results: Eyesi Direct: with p = 0.29, both groups had the same state of knowledge and did not have significantly different results in case processing on the first day of the internship. In the group without training (n = 54), a significant improvement in simulator training was observed on the last day of the practical training with p = 0.02 but with a small effect size of 0.1. Among the trainees (n = 32) a highly significant improvement with an effect size of 0.3 was observed with p = 0.0004. Eyesi Indirect: both groups had no significant difference in the stage of knowledge in the Eyesi Indirect at the beginning of the training period (p = 0.10). After training both groups performed slightly better but without significance (without training p = 0.41/with training p = 0.17).

Conclusion: The online platform EyesiNet supports the learning of the most important disease patterns. Learning contents are made available in a reproducible and standardized way for all students. The skills of direct ophthalmoscopy can be learned much faster than those of indirect ophthalmoscopy.