Keywords: Diabetic macular edema (DME); diabetic macular oedema (DMO); anti-vascular endothelial growth factor (anti-VEGF); laser photocoagulation; randomised clinical trials (RCTs); retina; diabetic retinopathy

Abstract: To describe the current aging population in China and globally, especially as it applies to age-related macular degeneration (AMD). To review the current standards of care for treating both wet (exudative) eAMD and dry (atrophic) aAMD. And to introduce a model for experimentation that is based on the Age-Related Eye Disease Study (AREDS) using eye bank tissue. A literature search that outlines current aging populations, standards of clinical treatment as defined by large, multicenter, randomized clinical trials that present level-I data with a low risk for bias. An experimental model system of AMD is presented that enables scientific analysis of AMD pathogenesis by applying grading criteria from the AREDS to human eye bank eyes. Analysis includes proteomic, cellular, and functional genomics. The standard of care for the treatment of eAMD is currently defined by the use of several anti-vascular endothelial growth (anti-VEGF) agents alone or in combination with photodynamic therapy. Monotherapy treatment intervals may be monthly, as needed, or by using a treat-and-extend (TAE) protocol. There are no proven therapies for aAMD. AMD that is phenotypically defined at AREDS level 3, should be managed with the use of anti-oxidant vitamins, lutein/zeaxanthin and zinc (AREDS-2 formulation). By understanding the multiple etiologies in the pathogenesis of AMD (i.e., oxidative stress, inflammation, and genetics), the use of human eye bank tissues graded according to the Minnesota Grading System (MGS) will enable future insights into the pathogenesis of AMD. Initial AMD management is with lifestyle modification such as avoiding smoking, eating a healthy diet and using appropriate vitamin supplements (AREDS-2). For eAMD, anti-VEGF therapies using either pro re nata (PRN) or TAE protocols are recommended, with photodynamic therapy in appropriate cases. New cellular information will direct future, potential therapies and these will originate from experimental models, such as the proposed eye bank model using the MGS, that leverages the prospective AREDS database.

Abstract: In a rapidly changing world, there is an increased need to cultivate ophthalmologists who are not only technically capable but also possess the leadership skills required to be at the forefront of change. Ophthalmologists make daily frontline decisions that determine the quality and efficiency of care based on their leadership qualities. However, they also educate, advocate, perform research, run departments and work in practices—all of which require the practice of effective leadership. Although the need for ophthalmic leadership has been recognised, few training programs offer leadership skills as a component of their core curricula, focussing on clinical knowledge with less emphasis on teaching of non-clinical professional competencies. Clinicians who participate in leadership development are more likely to feel empowered to provide patient-centred care, develop a greater self-awareness and confidence to initiate positive change and promote better team alignment. In turn, the ophthalmic profession collectively benefits from effective leadership as organizations are better run, issues are advocated more globally and challenges are address holistically by ophthalmologists who are not merely technically capable surgeons or researchers, but effective communicators and collaborators. In this paper, we explore the role of leadership in the spheres of healthcare and ophthalmology. We discuss the value of leadership across clinical, educational and organisational levels, with specific emphasis on the current state of development and conclude with a series of recommendations to ensure the continued development of effective ophthalmic leaders into the future.

Background: To investigate and analyze the hospitalization costs of inpatients with primary acute angle closure glaucoma (PACG), and to explores the influencing factors of hospitalization cost and to provide reference for specialized hospitals to carry out clinical pathways.

Methods: The first page diagnostic data of PACG patients’ medical records were collected, and an Excel database was established according to the International Classification of Diseases (ICD-10) code. Statistical analysis of hospitalization data was performed using SPSS 17.0 software.

Results: Hospitalization days and clinical pathway which affect the change of the hospitalization cost (P<0.001).

Conclusions: Hospitalization day is an important factor affecting the hospitalization cost, reducing unnecessary hospitalization time can control the increase of hospitalization cost.

Abstract: Contrast is the differential luminance between one object and another. Contrast sensitivity (CS) quantifies the ability to detect this difference: estimating contrast threshold provides information about the quality of vision and helps diagnose and monitor eye diseases. High contrast visual acuity assessment is traditionally performed in the eye care practice, whereas the estimate of the discrimination of low contrast targets, an important complementary task for the perception of details, is far less employed. An example is driving when the contrast between vehicles, obstacles, pedestrians, and the background is reduced by fog. Many conditions can selectively degrade CS, while visual acuity remains intact. In addition to spatial CS, “temporal” CS is defined as the ability to discriminate luminance differences in the temporal domain, i.e., to discriminate information that reaches the visual cortex as a function of time. Likewise, temporal sensitivity of the visual system can be investigated in terms of critical fusion frequency (CFF), an indicator of the integrity of the magnocellular system that is responsible for the perception of transient stimulations. As a matter of fact, temporal resolution can be abnormal in neuro-ophthalmological clinical conditions. This paper aims at considering CS and its application to the clinical practice.

Abstract: Timely and widely available, social media (SM) platforms and tools offer new and exciting learning opportunities in medical education. Despite scarce, we sought for a body of consistent evidence allowing us to substantially approach the concept of SM and how physicians as learners and medical educators can use SM based-education to benefit their clinical practice and their patients’ outcomes. We correlate education theories with the progression of world-wide web phases and how this influences the process of teaching and learning. We mention some examples of SM tools already in use in healthcare education. Potential advantages and effectiveness SM in medical education, as well as limitations of SM and pre-requisites for its use are discussed. Our concluding remarks underline the good practices in effectively utilizing SM in healthcare education.

Abstract: Training in residency programs is highly competitive, it requires the formation of competent physicians that achieve the performance standards that were declared for their technical skills, attitudes and interpersonal abilities. The use of simulation and technology on the medical education has increased considerably. Particularly in ophthalmology the simulators used are: live models from animal or cadavers, mannequins, wet laboratories, simulated patients, part-task moles, laser or surgical models, and more recently, virtual reality (VR). VR places a person in a simulated environment that has a specific sense of self-location, where the participant interacts with the objects within the setting. Teaching with VR refers to the use of the available resources in technology and visualization of structures to improve the educational experience of medical students, residents and physicians in professional continuous development programs. Several authors highlight the benefits of assessing trainees with the tools, they argue that the key contribution of this model is in the formative assessment. Rather than evaluating and putting a score on student’s grades, VR provides a powerful experience for the acquisition of skills. A conclusion is the need to develop studies to document the effects that it has on knowledge, skills and behaviors, and to patient related outcomes.

Abstract: Ophthalmology residency training programs need authentic methods of assessment to show that trainees have learned and can do what is expected upon graduation. Written and oral examinations are necessary to assess knowledge but other methods are needed to assess skill. Workplace-based assessments (WPBAs) should be utilized to observe resident skill in the clinic and during surgery. Several such assessment tools have been published and validated. These tools have the additional benefit of facilitating specific formative feedback and thus can be used for both teaching and assessing.