ARVO 2015 Annual Meeting Abstracts
108 Education and training for patients and clinicians
Sunday, May 03, 2015 8:30 AM–10:15 AM
Exhibit Hall Poster Session
Program #/Board # Range: 120–145/B0254–B0279
Organizing Section: Clinical/Epidemiologic Research
Contributing Section(s): Anatomy/Pathology, Eye Movements/
Strabismus/Amblyopia/Neuro-Ophthalmology, Lens,
Multidisciplinary Ophthalmic Imaging, Retina
Program Number: 120 Poster Board Number: B0254
Presentation Time: 8:30 AM–10:15 AM
Decadelong Gender Presence in Editorials of Ophthalmic
Literature
Valentina Franco-Cardenas2, Irena Tsui1. 1Retina, Jules Stein Eye
Institute, Los Angeles, CA; 2Retina, Asociación para Evitar la
Ceguera en México, Mexico City, Mexico.
Purpose: Gender imbalance matters because it wastes half of
humankind intellectual resources. In recent decades, there has been
an increase in the number of women practicing medicine. This shift
has reached academic publications in ophthalmology and is changing
gender trends. The purpose of this study is to asses if this change is
reaching editorials as well, since editorials are articles written by an
expert in a field only by invitation of journals editors.
Methods: Four leading ophthalmology journals were included
in the study: Ophthalmology (Ophthalmol), American Journal of
Ophthalmology (AJO), JAMA Ophthalmology (formerly Archives
of Ophthalmology) and British Journal of Ophthalmology (BJO). All
editorials written in 2000 and 2010 were included in the study. Data
collected for each editorial consisted of the name and gender of the
first and last author (if available), total number of authors and number
of references. A X2 analysis was performed to discern if there was a
change over the last decade.
Results: A total of 66 editorials were written in 2000 and 69
editorials in 2010 in 4 leading ophthalmology journals (Ophthalmol
13, AJO 13, JAMA 12, BJO 28). In 2000, 86.4% of all editorials
were written by men authors and 13.6% by women either as first
or last author; in 2010, 87% were written by men authors only and
13% by women either as first or last author, for a difference of 0.6%
(p=0.9023). Single author editorials in 2000 accounted for 72.7%
(48), of which 12.5% were written by women (6). For 2010, single
author editorials decreased to 60.9% (42), of which 9.5% were
written by women (4), for a difference of 11.8% (p=0.512). Multiple
author editorials in 2000 accounted for 27.3%, of which 33.3%
were written by women; half of them as first and half of them as last
authors. In 2010 multiple authorship editorials increased to 39.1%, of
which 18.5% were written by women, 2 as first and 3 as last authors,
for a 14.8% decrease, which was not significant (P=0.252). Editorials
in which a woman was either first or last author had a mean number
of references of 15.55+11, editorials written by men only had an
average of 12.12+9, (P=0.522).
Conclusions: During the last decade there was no increase in women
publishing editorials in this four leading ophthalmology journals.
There is a trend towards an increase in multiple authorship editorials
in which woman showed a trend to participate more.
Commercial Relationships: Valentina Franco-Cardenas, None;
Irena Tsui, None
Program Number: 121 Poster Board Number: B0255
Presentation Time: 8:30 AM–10:15 AM
Knowledge about diabetic retinopathy: Patients vs. Professionals
(diabetologists, diabetes advisors)
Daniel Röck1, Lydia Marahrens1, Raimar Kern2, Tjalf Ziemssen2,
Andreas Fritsche3, Focke Ziemssen1. 1Eberhard Karl University,
Center for Ophthalmology, Tuebingen, Germany; 2University
Hospital Carl Gustav Carus at the Dresden University of Technology,
Autonomic and Neuroendocrinological Laboratory Dresden,
Department of Neurology, Dresden, Germany; 3Department of
Internal Medicine, Division of Endocrinology, Diabetology, Vascular
Disease, Nephrology and Clinical Chemistry, Tuebingen, Germany.
Purpose: Extensive revisions have recently been made to the
treatment recommendations for diabetic macular edema. In order
to achieve a better disease management the cooperation with other
disciplines is of utmost importance.
Methods: A survey was adpopted to the Eye-Q test (® National
Eye Institute, translated into German). The patient version of the
questionnaire was used to assess the knowledge in the DiabCheck®
trial cohort, a non-interventional prospective cross-sectional study
in secondary diabetes care centers. All patients were included after
diagnose of diabetes and underwent also a comprehensive eye
examination. In addition, health care professionals answered the
same questions in attendance of the 49th congress of the German
Diabetologic Society (DDG). 190 physicians and 90 diabetes advisors
participated. For comparison, a total score was calculated after
checking for correct answers. The statistical evaluation of focus areas
was done using SPSS software package (significance level α=0.05).
Results: The mean score of the persons with diabetes was 4.9
(of 9 possible points, answers for n=797 of 880). Although the
large majority was aware of the need of yearly examinations by
an ophthalmologist (782 of 806), a considerable number (272 of
805) did expect early warning signs in the presence of retinopathy.
The importance of metabolic control was well established (689 of
806). Dry eye (25%), cataract (34%) and glaucoma (34%) were
underestimated eye complications.
In the 280 diabetes caregivers, the unawareness of glaucoma
(69%), dry eye (54%) and cataract (40%) was even higher. Health
professionals had a mean total score of 6.8, with diabetologists
(7.5), specialists for internal medicine (7.2) and primary care
physicians (7.0) having superior results to diabetes counselors (5.8)
and assistants (5.7). No difference in scores was found based on the
number of years in practice. Questions regarding prevention were
answered correctly by ≥60% of the professionals (n=280). However,
knowledge gaps were detected regarding newer techniques (correct
answers i] use of OCT: 38% ii] intravitreal drugs: 16%).
Conclusions: Health care professionals were found to have a
superior knowledge in contrast to the persons affected. However,
regarding the broad field of eye complications and especially more
recent diagnostic and therapeutic modalities, a regular refreshment of
education content seems to be important.
Commercial Relationships: Daniel Röck, Novartis (F); Lydia
Marahrens, None; Raimar Kern, Bayer-Schering (R), Biogen
Idec (R), Genzyme (R), Merck Serono (R), Novartis (R), Teva (R);
Tjalf Ziemssen, Almiral (R), Bayer-Schering (C), Bayer-Schering
(R), Biogen (R), Biogen Idec (C), Deutsche Diabetes Stiftung (F),
Deutsche Diabetes Stiftung (F), Genzyme (R), GSK (R), Hertie
Foundation (F), Merck Serono (R), MSD (R), Novartis (C), Novartis
(R), Robert Pfleger Foundation (F), Roland Ernst Foundation (F),
Sanofi-Aventis (R), Teva (R); Andreas Fritsche, None; Focke
Ziemssen, Alcon (R), Alimera (C), Allergan (C), Allergan (R), Bayer
(C), Bayer (R), Biogen (C), Biogen (R), Novartis (C), Novartis (F),
Novartis (R)
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at pubs@arvo.org.
ARVO 2015 Annual Meeting Abstracts
Clinical Trial: NCT02311504
Program Number: 122 Poster Board Number: B0256
Presentation Time: 8:30 AM–10:15 AM
The Impact of Educational Workshops on Individuals at Risk
for Glaucoma in the Philadelphia Glaucoma Detection and
Treatment Project
Shayla Stratford, Michael Waisbourd, Deiana M. Johnson, Harjeet
Sembhi, Jeanne Molineaux, Lisa A. Hark, George L. Spaeth, L.Jay
Katz, Jonathan S. Myers. Research, Wills Eye Hospital, Philadelphia,
PA.
Purpose: The Philadelphia Glaucoma Detection and Treatment
Project is a community-based project that aims to improve detection,
management, treatment, and follow-up care of individuals at high
risk for glaucoma in community-based settings in Philadelphia. The
purpose of this study was to investigate the impact of educational
workshops on the level of knowledge, perceived risk of glaucoma,
and rate of attendance in a subsequent glaucoma detection exam.
Methods: Participants completed an 8-question pre-test to assess
knowledge about glaucoma, attended an educational workshop,
and completed a post-test. A paired samples t-test was used to
assess mean differences in composite scores, correct responses, and
perceived risk of glaucoma from pre-test to post-test. The rate of
attendance of the eye exam following the educational workshops was
assessed.
Results: Seven hundred and seven pre- and post-test surveys were
completed. For all 8 questions, there was a significant increase in
the level of knowledge about glaucoma (P<0.001). The composite
scores increased from M=3.86 (SD=1.95) to M=4.97 (SD=1.82),
P<0.001. There was a 30% increase in participants’ perceived risk
of glaucoma (from 30% to 39%, P<0.001). Out of the 5 largest sites,
44% (n=221/480) of the participants who attended an educational
workshop made a glaucoma examination appointment and
33%(n=160/480) kept their appointment and attended the glaucoma
detection exam.
Conclusions: Our study is in agreement with others, showing
an increase of individuals’ knowledge of glaucoma following
educational intervention. To the best of our knowledge, this is the
first study investigating the impact of educational workshops on
recruitment of patients for a glaucoma detection exam in communitybased settings. Educational workshops increased knowledge and
awareness about glaucoma and were helpful in recruiting patients
for community-based glaucoma detection exams. We recommend
including these workshops in outreach programs.
Commercial Relationships: Shayla Stratford, None; Michael
Waisbourd, None; Deiana M. Johnson, None; Harjeet Sembhi,
None; Jeanne Molineaux, None; Lisa A. Hark, None; George L.
Spaeth, None; L.Jay Katz, None; Jonathan S. Myers, None
Support: CDC Grant- 1U58DP004060-01
Program Number: 123 Poster Board Number: B0257
Presentation Time: 8:30 AM–10:15 AM
Evaluation of knowledge of patients with Glaucoma.Author
Moussalli María A Coauthor Montañez N,Tapia C, Echeverría
B,Burchakchi A Glaucoma Unit: Hospital Italiano de BsAs
Maria Moussalli. Oftalmologia, Hospital Italiano de Buenos Aires,
Buenos Aires, Argentina.
Purpose: Non Compliance with treatment and ignorance
of Glaucoma disease is major cause of blindnes.This can be
solved by improving patient-doctor relation.We performed a
retrospective,descriptive-analytic study to learn the knowledge of
our patients, through an anonymous question survey,allowing patients
to make written comments
Methods: Survey was carried out in a monthly glaucoma
workshop for a year supporting consultation in our Ophthalmology
Service. We evaluated the answers of 84 patients (mean
age:68;76%women,24%men) under Glaucoma treatment
Results: 20 questions.15 were directly related to the patient-doctor
relation.1st example of this problem in communication is that 25%of
the treated patients did not know what glaucoma was. 91%had
had their IOP controlled less than 2 years earlier As for glaucoma
treatment, 7% didnot know how it was treated while 43%knew that it
was treated with eye drops,40%with laser, surgery and drops,5%with
laser and drops and 5%with surgery and drops SD0.2. 82%knew that
it was a lifetime disease,11%did not know it and 7%believed that it
lasted a few years SD 0.42. When they were asked if Glaucoma could
be transmitted from parents to children 43%gave a negative answer.
When asked how often they should go to the ophthalmologist for a
check-up, 39%answered once every 3months,25%answered once
a year,15%once a month, 4%didnot know and 1% just when they
needed to have their glasses adjusted.When asked if the medical
treatment had to be suspended, 18% answered they didnot know,
25% thought that it was a decision of the doctor and 56%responded
that the treatment never stopped. Concerning how frequently a
healthy person should have an IOP examination, 79% answered
once a year. When requested the options to help them to fulfil the
doctors’ treatment, 38%coincided that it was important to schedule
their medication and to follow their doctor’s advice.19% of the
respondents told it was important more frequent medical controls,
IOP and exhaustive examinations
Conclusions: Doctor-patient relationship is still the cornerstone in
treatment of chronic diseases.We should consider having extratime
in consultations and scheduling several consultations with the same
patients until they have a deep and precise knowledge of their disease
and its treatment. We suggest conducting informative workshops for
patients
Commercial Relationships: Maria Moussalli, None
Program Number: 124 Poster Board Number: B0258
Presentation Time: 8:30 AM–10:15 AM
Glaucoma Educational Ball, aka “Glaucoball,”™ in the Geriatric
Setting
Kimberly Pham2, Victoria Phan1, Vidhya Gunasekaran5, Victor Chen4,
Andrew Nam3, Don B. Kim1, David A. Lee7, Gloria Wu6. 1University
of California, Berkeley, San Jose, CA; 2University of California,
Berkeley, Berkeley, CA; 3Santa Clara University, Santa Clara, CA;
4
University of California, San Diego, La Jolla, CA; 5Ophthalmology,
Aravind Eye Hospital, Madurai, India; 6Ophthalmology, Tufts
University, Medford, MA; 7Ophthalmology, University of Texas,
Houston, Houston, TX.
Purpose: Use of Glaucoma Balls, “Glaucoball,”™ to educate health
care professionals caring for a geriatric population at a senior care
center.
Methods: Using a set of glaucoma balls, “Glaucoball,”™ calibrated
to 40 mm Hg, 20 mm Hg and 10 mm Hg, we visited a skilled nursing
facility. Informed consent was obtained from nurses and caregivers
at the skilled nursing facility. The ophthalmologist (GW) performed
tactile finger tension to approximate the pressure of the volunteers,
then instructed the volunteers to palpate their own eye pressure to
match their eye pressure to the set of 3 balls. Normal eye pressure
was explained to the volunteers. A questionnaire of seven qns was
administered at the end of the demonstration. TM (12/1/2014)
Results: n=30 volunteers; Age: 22-68 yrs; avg= 38.14; sd= 13.78 yrs.
Job Position: RN: 8/30 (25%); Other RN: 12/30 (39.3%); Social
Service Aide: 1/30 (3.6%); Dietary Aide: 1/30 (3.6%); Ward clerks:
8/30 (28.6%)
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at pubs@arvo.org.
ARVO 2015 Annual Meeting Abstracts
Other RN= LVN, LPN, CNA, MA, NA
Questionnaire Results: Have you heard of glaucoma: No 3/30
(10%); Yes 27/30 (90%); Have you heard of angle closure glaucoma:
No 8/30 (26.7%); Yes 22/30 (73.3%); How often do patients
complain of red eye: 1/week 4/30 (13.3%); 1/mo 3/30 (10%); 1/6
mo 10/30 (33.3%); few/yr 3/30 (10%); 1/yr 2/30 (6.7%); Never 7/30
(23.3%); How often do patients complain of eye pain: 1/week 2/30
(6.7%); 1/mo 4/30 (13.3%); 1/6 mo 10/30 (33.3.%); few/yr 2/30
(6.7%); 1/yr 3/30 (10%); Never 6/30 (20%); Did you know that angle
closure glaucoma is in the differential diagnosis of red eye: No 14/29
(48.3%); Yes 15/29 (51.7%); Those who said No: 3 RN, 1 DSD, 1
SSA, 4 other RN, 5 others; Is this educational kit helpful: Yes 100%;
Would you be interested in showing this to your family members: No
4/30 (13.3%); Yes 26/30 (86.7%).
Number who chose correct ball: 26/28 (92.9%)
Conclusions: The glaucoma ball educational tool kit, introduced
at ARVO 2013, may be useful as a teaching tool in demonstrating
intraocular pressure to nurses and caregivers in a senior care facility.
While most volunteers have heard of glaucoma, 48.3% of the
caregivers and 3 RNs did not know that angle closure glaucoma
is in the differential diagnosis of the red eye. The overwhelming
majority wanted to share this information with their family members.
This small kit would aid in the eye self exam in geriatric health care
facilities.
Commercial Relationships: Kimberly Pham, None; Victoria
Phan, None; Vidhya Gunasekaran, None; Victor Chen, None;
Andrew Nam, None; Don B. Kim, None; David A. Lee, None;
Gloria Wu, None
Program Number: 125 Poster Board Number: B0259
Presentation Time: 8:30 AM–10:15 AM
Training Eye-care Providers to Deliver Smoking Cessation
Counseling to Their Patients
Taghrid Asfar1, David J. Lee1, Cynthia Owsley2, Gerald McGwin2,
Emily W. Gower3, David S. Friedman4, Ann P. Murchison5,
Eileen L. Mayro5, Jinan Saaddine6. 1Department of Public Health
Sciences, University of Miami Miller School of Medicine, Miami,
FL; 2Ophthalmology, University of Alabama at Birmingham,
Birmingham, AL; 3Public Health Sciences and Ophthalmology, Wake
Forest School of Medicine, Winston-Salem, NC; 4Ophthalmology,
Johns Hopkins University, Baltimore, MD; 5Ophthalmology, Wills
Eye Institute, Philadelphia, PA; 6Division of Diabetes Translation,
Centers for Disease Control & Prevention, Atlanta, GA.
Purpose: Mounting scientific evidence indicates that smoking can
lead to visual impairment and blindness. Eye care providers are
uniquely positioned to help their patients quit smoking. The current
study developed, implemented, and evaluated a smoking cessation
internet-based training program targeting eye care providers. The
training program was based on the 3A1R: “Ask about tobacco use,
Advise to quit, Assess willingness to quit, and Refer to a telephone
tobacco quit line (QL)”.
Methods: The training program was developed and pre-tested
among 10 eye-care providers. Feedback from these providers was
used to improve the training materials. Eye care providers (n=654)
at four academic centers were invited to participate in the study.
The program included a 30-minute video integrated into the Wills
Eye Hospital Knowledge Portal (http://www.willseyeonline.org/).
Providers were asked to complete pre- and post-training survey to
test their current smoking cessation practices, knowledge with the
QL, and changes in their attitudes and knowledge with respect to the
3A1R.
Results: A total of 116 eye care providers participated in the study.
Eighty (69.0%) participants were White, 20 (17.2%) Asian, 4 (3.4%)
Black, and 5 (4.3%) Hispanic. Half of the participants were male
62 (53.4%), 49 (42.2%) ophthalmologists, 10 (8.6%) optometrists,
42 (36.2%) ophthalmology residents and 14 (12.1%) fellows. Only
half of the participating providers reported routinely asking patients
about their smoking status, 47.4% advised their patients to quit,
23.3% assessed patients’ motivation to quit, 2.6% assisted patients
in quitting, and 0.9% arranged a follow-up to address smoking.
Surprisingly, 69% of providers were not familiar with tobacco QLs,
and only 7.8% referred their smoking patients to tobacco QLs. At the
post-training survey, providers’ confidence improved with respect to
the 3A1R guidelines by 9% for Ask (95% Confidence Interval CI;
0.05-0.16;p<.001); 23.0% for Advise (0.15-0.32;p<.001); 12.8% for
Assess (0.07-0.21;p<.001); and 46.8% for Refer (0.37-0.56;p=.25).
Conclusions: Eye-care providers’ perceived efficacy in helping
their smoking patients improved significantly and immediately after
receiving the training. On-line training targeting eye health care
professionals has the potential to reduce the burden of tobaccoassociated eye disease.
Commercial Relationships: Taghrid Asfar, None; David J. Lee,
None; Cynthia Owsley, None; Gerald McGwin, None; Emily
W. Gower, None; David S. Friedman, None; Ann P. Murchison,
None; Eileen L. Mayro, None; Jinan Saaddine, None
Support: CDC Grant U58DP002652
Program Number: 126 Poster Board Number: B0260
Presentation Time: 8:30 AM–10:15 AM
A Comparison Study of Parents Consenting versus Parents Nonconsenting for Resident Participation in Private Practice Based
Pediatric Strabismus Surgery
Patricia Terp1, Richard H. Legge1, Jiangtao Luo2. 1Ophthalmology,
University of Nebraska Medical Center, Omaha, NE; 2College of
Public Health Biostatistics, University of Nebraska Medical Center,
Omaha, NE.
Purpose: The Accreditation Council for Graduate Medical
Education establishes minimum numbers of surgical procedures to
be performed by residents as a prerequisite for graduation, and these
surgical minimums must be met with patients’ consent for resident
participation in their surgery. A retrospective chart review was
performed to analyze specific pediatric patient characteristics relative
to their parents’ consent for resident participation in their child’s
strabismus surgery.
Methods: Included in the study were pediatric patients (age <19)
that received strabismus surgery with one private practice pediatric
ophthalmologist during 2011 and 2012. Patient characteristics
were analyzed individually in relationship to consenting “yes” or
“no” for resident participation. Characteristics investigated were
age, gender, gestational age at birth, primary strabismus surgery
versus reoperation, insurance type, number of past surgeries, past
medical history, and home location. The data were analyzed using
Fisher exact and Chi-squared testing. As no patient identifiers were
collected, the University of Nebraska Medical Center Institutional
Review Board deemed this study exempt from requiring patient
consent.
Results: A total of 84 surgeries on 79 patients met the inclusion
criteria. One patient was excluded because the consent form had not
been filled out by the parent. Twenty-eight patients (34%) consented
for resident participation in their surgery. Five patients had 2
surgeries each. Each surgical consent was analyzed separately. None
of these 5 changed consent status (all opted “no”) between the first
and second surgery. There was no statistical significance between
those consenting and those non-consenting for resident participation
in relationship to any of the individual patient characteristics
analyzed.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at pubs@arvo.org.
ARVO 2015 Annual Meeting Abstracts
Conclusions: This analysis found no relationship between patient
age, gender, gestational age at birth, primary strabismus surgery
versus reoperation, insurance type, number of past surgeries, past
medical history, or home location and the likelihood that a parent
will consent to resident participation in pediatric strabismus surgery.
It is not possible to predict which parents may or may not grant
permission for resident participation based on the characteristics
studied.
Commercial Relationships: Patricia Terp, None; Richard H.
Legge, None; Jiangtao Luo, None
Program Number: 127 Poster Board Number: B0261
Presentation Time: 8:30 AM–10:15 AM
Choosing Wisely: An Educational Initiative
Anastasia Traband, Susannah Rowe. Ophthalmology, Boston
University, Boston, MA.
Purpose: In 2012 the AAO joined other medical societies in
the Choosing Wisely campaign that was initiated by the ABIM
Foundation. Each participating society created a list of “5 Things
Physicians and Patients Should Question.” These 5 things are
specialty-specific, evidence-based recommendations that providers
and patients should discuss to help make appropriate decisions
about their care. The initiative stems from growing concerns across
the United States regarding the overuse of healthcare resources. It
is imperative that patients and providers join in the conversation
to contribute to reducing these costs. The purpose of this study
is to assess and spread awareness of this campaign and its five
recommendations specifically as it relates to Ophthalmology at
Boston University Medical Center.
Methods: A baseline survey was distributed to 31 Boston University
Medical Center Department of Ophthalmology providers, residents,
and fellows, asking (1) whether the provider had ever heard of
the Choosing Wisely campaign and (2) if they could list any of its
5 recommendations. Educational materials were then distributed
throughout the department and fliers were posted in provider rooms.
After one month, the survey was redistributed and the results were
reviewed.
Results: All 31 providers participated and completed the baseline
survey. Of these, 26 (84%) had never heard of the Choosing
Wisely campaign. Of the remaining 5 (16%) participants, 3
could not list any of the campaign’s 5 recommendations, 1 could
list 1 recommendation, and 1 could list all 5. After one month
implementing the educational initiative, all 31 (100%) participants
had heard of the Choosing Wisely campaign. 31 (100%) participants
could name at least 2 recommendations; 29 (94%) could name at
least 3; 23 (74%) could name at least 4; and 19 (61%) could name all
5 recommendations.
Conclusions: This study provides valuable information regarding
the awareness and potential future implementation of the Choosing
Wisely campaign. Although this campaign has been on going since
2012, general awareness appears to be significantly lacking. Our
study was successful in increasing awareness within our department
from 16% to 100%. Future efforts will focus on assessing and
improving compliance with the 5 goals. It is imperative that we
continue these types of educational initiatives in order to continue
to foster the physician/patient discussion regarding the proper use of
healthcare resources.
Commercial Relationships: Anastasia Traband, None; Susannah
Rowe, None
Program Number: 128 Poster Board Number: B0262
Presentation Time: 8:30 AM–10:15 AM
Practice patterns among eye care providers at US-based teaching
hospitals with respect to educating patients regarding risks of
smoking and providing smoking cessation counselling
Ramunas Rolius, Ingrid U. Scott, Daniel Brill, Zachary Landis.
Ophthalmology, Penn State Milton S. Hershey Medical Center,
Hershey, PA.
Purpose: Smoking is a risk factor for several ocular diseases,
including age-related macular degeneration and cataract. However,
little is known about practice patterns among eye care providers
with respect to educating patients regarding risks of smoking and
providing smoking cessation counselling. Our study was designed to
investigate such practice patterns among eye care providers at USbased teaching hospitals.
Methods: An anonymous survey including multiple choice and
Likert-style questions was created on www.surveymonkey.com.
An email containing an explanation of the study, an invitation to
participate, and the survey link was sent to the coordinator of each
ophthalmology residency program accredited by the Accreditation
Council for Graduate Medical Education, and the program
coordinators were asked to forward the email to all ophthalmologists,
optometrists, ophthalmology residents and fellows in the program.
Weekly reminders were emailed for 4 consecutive weeks.
Results: To date, 15 program coordinators confirmed distribution of
the survey to 469 eye care providers; 103 completed surveys were
received. Ophthalmologists, optometrists, ophthalmology residents
and fellows contributed 38%, 11%, 43% and 8% of responses,
respectively. Overall, 37% of respondents reported they always ask
their patients about smoking status, 37% advise patients who smoke
to quit smoking, 32% always educate their patients about ocular
diseases associated with smoking, and 20% always educate patients
about systemic risks associated with smoking. Fewer than half of
the respondents (46%) reported having received adequate training in
smoking cessation counselling during residency/fellowship.
Conclusions: Survey results collected to date indicate that a minority
of eye care providers at US-based teaching hospitals consistently ask
their patients about smoking status, educate patients about ocular
and systemic risks associated with smoking, and advise patients who
smoke to stop smoking. This suggests that interventions designed to
encourage eye care providers to educate patients about the risks of
smoking and advise patients to stop smoking may have a substantial
impact on patients’ general and ocular health.
Commercial Relationships: Ramunas Rolius, None; Ingrid U.
Scott, None; Daniel Brill, None; Zachary Landis, None
Program Number: 129 Poster Board Number: B0263
Presentation Time: 8:30 AM–10:15 AM
Medical practices overview in wAMD in France: comparison
between 2014 and 2013.
Alexandre Bourhis1, Flore De Bats2, Pierre Loic Cornut2, Audrey
Derveloy3, Vincent Gualino4, Jeremie Halfon5, Philippe Koehrer6,
Etienne lecallier3. 1Ophthalmology, Polyclinique de l’Atlantique,
Saint Herblain, France; 2Centre d’ophtalmologie, Ecully, France;
3
Novartis, Paris, France; 4Clinique Caves, Montauban, France;
5
Cabinet Ophtalmologie, Tours, France; 6Centre hospitalier, Semur en
auxois, France.
Purpose: Although intravitreal injection (IVT) with anti-vascular
endothelial growth factor (VEGF) is the mainstay of treatment for
wet age-related macular degeneration (wAMD), there is a lack of
knowledge regarding medical practices pertaining to wAMD in
France. Therefore we have conducted a survey in 2013 administered
to ophthalmologist. The wAMD treatment protocols is still a debate
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at pubs@arvo.org.
ARVO 2015 Annual Meeting Abstracts
and the aim of this survey that has been conducted with the same
methods used in 2013 is to evaluate the change in medical practice in
2014 compared to that of 2013.
Methods: Kantar Health (subsidiary of TNS Sofres) is carrying
a quantitative survey among 150 ophthalmologists (90 general
ophthalmologists and 60 retina specialists) in December 2014.
A 46 question quantitative internet survey has been developed
by a committee of experts. These questions evaluate i) diagnosis,
treatment, and follow-up parameters, ii) logistical organization and
access to care for wAMD patients, iii) current treatment protocols.
For questions specific to treatment protocols, physicians are filling
out a 12 months calendar for efficacy check-ups and for injection
schedules.
Results: The data of the 2013 survey, that was administered to 163
ophthalmologists (63% general ophthalmologists and 37% retina
specialists), revealed that there were discrepancies between academic
protocols definition and routine clinical practices. A third of patients
were injected after the 5th and within the 10 days after diagnosis.
This delay considered as too long is a consequence of patient
transportation issues and IVT room availability. Although the practice
of using 3 loading doses (1 IVT per month for 3 months) is well
established, treatment practices and strategies after the loading phase
are inconsistent. Compared with these data, the data of the 2014
survey will show if the management of wAMD (diagnosis, treatment,
and follow-up), the logistical organization and treatment protocols
have changed from 2013 through 2014.
Conclusions: The comparison of the results between the survey
conducted in 2013 and 2014 will provide key information about
the change in wAMD medical practice in France. 2014 results are
expected in February 2015.
Commercial Relationships: Alexandre Bourhis, Allergan (R),
Bayer (C), Novartis (C); Flore De Bats, Bayer (C), Novartis (C);
Pierre Loic Cornut, Novartis (C); Audrey Derveloy, novartis (E);
Vincent Gualino, allergan (C), bayer (C), novartis (C); Jeremie
Halfon, Novartis (C); Philippe Koehrer, Novartis (C); Etienne
lecallier, Novartis (E)
Support: NOVARTIS Sponsoring for this study
Program Number: 130 Poster Board Number: B0264
Presentation Time: 8:30 AM–10:15 AM
Impact of Surgical Simulator Training on Patients’ Perceptions of
Resident Involvement in Cataract Surgery
Zachary C. Landis1, John Fileta1, Ingrid U. Scott1, 2, Allen
Kunselman2, Joseph W. Sassani1. 1Ophthalmology, Penn State
University College of Medicine, Hershey, PA; 2Public Health
Sciences, Penn State University College of Medicine, Hershey, PA.
Purpose: To investigate the impact of resident training with a
cataract surgical simulator on patients’ perceptions of resident
involvement in cataract surgery and to identify patient characteristics
associated with willingness to have resident-performed cataract
surgery.
Methods: An anonymous 26-question survey was distributed to
430 consecutive patients at the Penn State Hershey Eye Center.
The survey included demographic information, questions assessing
willingness to have a resident involved in cataract surgery, and
questions assessing knowledge of the role of residents in patient
care. Patients were assigned randomly to one of two groups. Patients
assigned to group one watched a brief video explaining the role
of a surgical simulator in resident training, and were then asked to
complete the survey. Patients assigned to group two were asked to
complete the survey without watching the video. Standard t-test was
used to compare demographic data. Odds ratios were used to compare
responses between the two groups.
Results: 410 patients (95.3%) completed the survey, including 203
patients in group one and 207 patients in group two. Compared to
patients in group two, patients in group one were twice as likely to
express willingness for a resident to perform their cataract surgery
(O.R. 2.02; p <0.001). Across all patients, men were more likely
than women to express a willingness for a resident to perform their
cataract surgery (O.R. 1.65; p=0.0065). Overall, 25% of patients
expressed willingness to allow a resident to perform their cataract
surgery, and this percentage increased to 54% if patients were
informed that an experienced cataract surgeon supervises the resident.
Ninety-five percent of patients felt they should be informed in
advance if their cataract surgery was to be performed by a resident.
Conclusions: Patients were more likely to express willingness to
allow a resident to perform his/her cataract surgery after watching
a video explaining the role of a surgical simulator in resident
training for cataract surgery. A thorough informed consent process,
including information regarding supervision of resident-performed
cataract surgery and a brief video detailing resident training with a
surgical simulator, may increase patient willingness to allow resident
participation in cataract surgery.
Commercial Relationships: Zachary C. Landis, None; John
Fileta, None; Ingrid U. Scott, None; Allen Kunselman, None;
Joseph W. Sassani, None
Program Number: 131 Poster Board Number: B0265
Presentation Time: 8:30 AM–10:15 AM
The Implementation Of Cataract Simulator To Improve Junior
Ophthalmology Residents’ Confidence In Cataract Training
Daniel S. Ting, Mohamad Rosman, Ai Tee AW, Ian Yeo. Training and
Education, Singapore National Eye Centre, Singapore, Singapore.
Purpose: To evaluate the residents’ performance on the cataract
simulator and residents’ feedback on the usefulness of the simulator
in improving their confidence in the phacoemulsification surgeries.
Methods: Ten junior Ophthalmology residents from Singapore
National Eye Centre participated in this study and they underwent
a 2-hour instructional course prior to the commencement of the
cataract simulator training using Eyesi Cataract Simulator (VRmagic,
GmbH, Mannheim, Germany). Upon completion of the learning
modules, the number of the individual’s attempts, scores and time
taken were recorded. In addition, the residents were also asked to fill
out a satisfaction questionnaire using 5-point Likert scale regarding
the effectiveness of the simulator to improve their confidence in
phacoemulsification surgeries.
Results: Of the participants, 70% were year 1 residents, 30% were
male with the mean age of 28.9 ± 1.7. Of the basic microsurgical
skills, the residents found that the navigation skills, intracapsular
navigation and the forceps training were the most useful modules.
About half of the resident (50%) did not find the anti-tremor
training improved their confidence in their cataract surgeries.
Most of the residents (90%, n=9) agreed that the EyeSi simulator
helps to improve instrument handling under microscope, hand/
eye coordination and handling of the foot pedals. Regarding the
performance, the overall mean score, time taken and number of
attempts per module were 61.2 ± 35.7, 86.3 s ± 83.8 and 4.9,
respectively. The year 2 residents had better mean task score than
the year 1 residents (67.8 vs 58.7, p < 0.001) using a shorter time
(66.2 seconds vs 75.5 seconds, p=0.002). There was no significant
difference in the number of attempts between the year 1 and 2
residents. Overall, 90% of the residents agreed that the use of
cataract simulator has improved their confidence in performing
phacoemulsification in the operating room.
Conclusions: The use of cataract simulator has been shown
to increase the self-reported confidence level of the junior
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at pubs@arvo.org.
ARVO 2015 Annual Meeting Abstracts
Ophthalmology residents in performing their cataract surgeries.
A further study will be of great value to evaluate the impact of the
cataract simulator training on the performance of the residents’
cataract surgeries such as the intraoperative time, postoperative visual
outcome and complication rate.
Commercial Relationships: Daniel S. Ting, None; Mohamad
Rosman, None; Ai Tee AW, None; Ian Yeo, None
Program Number: 132 Poster Board Number: B0266
Presentation Time: 8:30 AM–10:15 AM
Computer-aided evaluation of cataract surgery; a metric
comparison of continuous circular capsulorhexis by trainee and
specialist surgeons
Augustinus Laude1, Praseedha K. Aniyath2, Kiam Tian Seow2,
Jian Wah Kwok1, Han Bor Fam1, Wee Jin Heng1, Deepu Rajan2.
1
National Healthcare Group Eye Institute, Tan Tock Seng Hospital,
Singapore, Singapore; 2School of Computer Engineering, Nanyang
Technological University, Singapore, Singapore.
Purpose: There is a correlation between the centration and quality
of the continuous circular capsulorhexis (CCC) and the subsequent
refractive outcomes in cataract surgery. We developed a novel
software evaluation tool based on video processing to assess the
execution of CCC by comparing trainee and specialist surgeons from
a teaching hospital. The software incorporates a novel performance
metric that quantifies their performance.
Methods: We first detected the limbus of the eye in each video
frame using Hough circle detection. Next, the capsulorhexis forceps
is detected based on its linearity and specularity. Then a visual tooltracking function is invoked based on an image similarity measure
which is illumination invariant and computationally inexpensive. The
number of capsular grasps is then found from a functional plot of
distance between the pair of forceps tips. Other parameters computed
include surgical efficiency with respect to surgical time, circularity
index and absolute decentration of the CCC with respect to the
optical centre. These parameters are integrated into a single novel
performance metric for each surgery (Fig 1).
Results: The software was implemented in MATLAB and we
evaluated 35 capsulorhexis videos of surgeries done by 19 specialist
and 16 trainee surgeons. The quantitative parameters for all
videos are listed in Fig 2. A student t-test comparison of the mean
performance metric scores found that the trainee group scored 0.4244
(±0.2322) which was significantly lower than the specialist group
which scored 0.8676 (±0.1211) (P=0.0001), indicating that the two
groups could be differentiated.
Conclusions: We developed a tool for evaluation of the performance
of capsulorhexis during cataract surgery. The proposed performance
metric computed by the software could differentiate the two groups
of surgeons. Using quantitative parameters, we can have an objective
and repeatable way for surgical assessment to identify areas for
improvement.
Fig.1 Computer-aided metric evaluation for CCC.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at pubs@arvo.org.
ARVO 2015 Annual Meeting Abstracts
EBIO training ? 4. How realistic is this simulator (EBIO) ? 5. Are you
considering specializing in ophthalmology? 6. Would you consider
such a training to be relevant for your profession in future. 7. If yes :
when and for how long ?
Results: The students appreciated the training setup with EBIO
and also improved their skills. Around 80% of students were in the
4th year, 10% in the 5th and 10% in the 3rd year (1); 60 % said that
they could benefit from conventional training (2); almost 95% got
benefit in EBIO training (3); 100% found EBIO realistic as much
as real world training (4); 15 % wanted to do specialization in
ophthalmology (5); 80 % considered the training to be relevant for
their future profession no matter what subspecialty. (6); 2 hours per
day for at least one week (7).
Conclusions: The evaluation provides evidence that EBIO training is
efficient to improve ophthalmoscopy skills. Our study also indicates
that this training is important not only for ophthalmologists.
REFRENCES:
1. Leitritz MA, Ziemssen F, Suesskind D, Partsch M, Voykov
B, Bartz-Schmidt KU, Szurman GB. Critical evaluation of the
usability of augmented reality ophthalmoscopy for the training of
inexperienced examiners. Retina. 2014 Apr;34(4):785-91.
2. Schuppe, O., C. Wagner, et al., (2009). Eyesi ophthalmoscope - a
simulator for indirect ophthalmoscopic examinations. Stud Health
Technol Inform 142: 295-300.
Commercial Relationships: Pankaj Singh, None; Svenja
Deuchler, None; michael mueller, None; Adonis Chedid De
Robaulx, None; Markus Schill, VRmagic (P); Clemens Wagner,
VRmagic (P); Thomas Kohnen, None; Frank H. Koch, None
Fig.2. Performance parameters of (a) specialist and (b) trainee
surgeons performing capsulorhexis.
Commercial Relationships: Augustinus Laude, None; Praseedha
K. Aniyath, None; Kiam Tian Seow, None; Jian Wah Kwok, None;
Han Bor Fam, None; Wee Jin Heng, None; Deepu Rajan, None
Program Number: 133 Poster Board Number: B0267
Presentation Time: 8:30 AM–10:15 AM
Evaluation of questionnaire of the medical students after
implementing the Eyesi® Binocular Indirect Ophthalmoscope
(EBIO) into the Ophthalmology Curriculum of medical students
Pankaj Singh1, Svenja Deuchler1, michael mueller1, Adonis Chedid
De Robaulx1, Markus Schill2, Clemens Wagner2, Thomas Kohnen1,
Frank H. Koch1. 1Retina and Vitreous Unit, University Eye Clinic
Frankfurt am Main, Germany, Frankfurt am Main, Germany;
2
VRmagic, Mannheim, Germany.
Purpose: To measure the acceptance and the educational benefit of
the Eyesi® Binocular Indirect Ophthalmoscope (EBIO) as substantial
aid in the Ophthalmology Curriculum in the Goethe University
Hospital.
Methods: We implemented EBIO in the Ophthalmology Curriculum
in our University Hospital. Students (n=211) were asked to perform
the conventional training with regular examination on each other
plus training in the EBIO. At the end, they were asked to fill a
questionnaire focussing on the following questions.
We asked them 1. In which year of your medical school are you ? 2.
Did you benefit from conventional training ? 3. Did you benefit from
Program Number: 134 Poster Board Number: B0268
Presentation Time: 8:30 AM–10:15 AM
Assessment of Glaucomatous Optic Nerve Head Damage by
Ophthalmology Residents Using Discus Software
Faisal A. Almobarak1, 2, Paul Artes2, Abdullah Alfawaz1.
1
Ophthalmology, King Saud University, Riyadh, Saudi Arabia;
2
Ophthalmology, Dalhousie University, Halifax, NS, Canada.
Purpose: Discus is a freely accessible online software package that
allows observers to assess their skills at interpreting non-stereoscopic
optic disc photographs for signs of glaucomatous damage. The aim of
this study was to validate Discus software and to establish reference
data for performance and repeatability with Discus software in
participants of a four-year Ophthalmic residency training program in
Saudi Arabia.
Methods: Fifty four residents participated in this study. All residents
tested themselves three times over five days. The software display
non-stereoscopic optic disc images, 80 images without evidence
of repeatable visual field (VF) loss (VF negatives) and 20 with
repeatable VF loss (VF positives), for up to 60 seconds. The software
displays 2 VF positive and 24 VF negative images were repeated
to asses consistency. Each observer will rate optic disc image on a
5-point scale (definitely healthy, probably healthy, not sure, probably
damaged, definitely damaged). At the end of each test, online
feedback was given to each participant.
Results: The mean AUROC was 0.68, 0.68, 0.69 and 0.71 for
first, second, third and fourth years residents respectively (p=0.04,
Kruskal-Wallis test). The overall performance of residents was 0.69
(95% CI, 0.65, 0.74) compared to a panel of experts which was
0.79 (95% CI, 0.58, 0.96). Fourth years residents had the highest
correlation with experts(r=0.64,p=0.02). There was no difference in
the performance on the three repeated tests (P=0.6) with high degree
of reliability (ICC=0.76). But there was more variability among
junior residents which did not influence the mean performance
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at pubs@arvo.org.
ARVO 2015 Annual Meeting Abstracts
(relationship between mean performance and mean difference in
performance was -0.056, p=0.64).
Conclusions: Senior residents had better performance and less
variability on repeated tests compared to junior residents . Discus
allows efficient and precise assessment of resident’s performance at
assessing optic disc photographs in patients with glaucoma.
Mean AUROC of three tests.
Commercial Relationships: Faisal A. Almobarak, None; Paul
Artes, None; Abdullah Alfawaz, None
Program Number: 135 Poster Board Number: B0269
Presentation Time: 8:30 AM–10:15 AM
A survey of the evolving role of virtual eye surgery simulators in
ophthalmic graduate medical education
Yasir Ahmed, Ingrid U. Scott. Ophthalmology, Penn State Hershey
Medical Center, Hershey, PA.
Purpose: To survey ophthalmology residency program directors
(PDs) with regards to their familiarity, experiences, and attitudes
towards virtual eye surgery (VES) simulators. Recently reported data
concerning virtual reality training to operating room performance
for VES simulators may impact their adoption in ophthalmology
residency training programs.
Methods: This study received an exemption from the Penn State
College of Medicine IRB. An anonymous survey consisting of
multiple choice and Likert style questions was created on www.
surveymonkey.com. The survey link was sent to the 116 ACGME
Ophthalmology Residency Program Directors listed on the AMA
online database (www.ama-assn.org/go/freida). Any outdated or
undeliverable addresses were verified with the AUPO database 2014.
Each survey question was analyzed independently with respect to the
total number of responses to the question.
Results: The response rate was 35% (41/116). A VES simulator was
used by 78% (32/41) of ophthalmology residency training programs.
Among the programs without a VES simulator, cost was the main
limiting factor in 89% (8/9). Among programs using VES simulators,
97% (28/29) used the EyeSi simulator (VRmagic, Mannheim,
Germany), 80% (24/30) mandated the use of a VES simulator in the
residency curriculum, and 83% (25/30) used it to evaluate resident
surgical skills quantitatively. A VES simulator had been personally
used by 85% (33/39) of PDs; 54% (21/39) of PDs reported that
department faculty used a VES simulator to help residents improve
surgical skills. Most PDs agreed that VES is a useful tool for
improving and measuring resident surgical skills and that it could be
incorporated into the resident training model given the current level
of evidence but they did not support VES evolving into a mandatory
component of resident training.
Conclusions: VES has become prevalent in US ophthalmology
residency training programs. This may be due, at least in part, to
recent evidence showing improved operating room performance
associated with virtual reality training. The VES simulator is also
being increasingly integrated into the resident surgical teaching
model due to its valuation as a useful surgical training modality.
However, the expense of a VES simulator is a barrier to its use in
some programs and may represent the main obstacle to its integration
as a mandatory component of ophthalmic surgical training.
Commercial Relationships: Yasir Ahmed, None; Ingrid U. Scott,
None
Program Number: 136 Poster Board Number: B0270
Presentation Time: 8:30 AM–10:15 AM
Assessment of the BIONIKO prosthetic surgical training tools
Ken Steinegger, Ali Dirani, Ciara Bergin, Cedric Mayer, François
Majo, Francine Behar-Cohen, Jean-Antoine C Pournaras.
University Hospital, Hôpital Ophtalmique Jules-Gonin, Lausanne 7,
Switzerland.
Purpose: Prosthetic models of components of the eye have been
developed as surgical training aids in ophthalmology. This study was
designed to examine the utility of the rhexis-model and the keratomodel developed by BIONIKO LLC (Miami, Florida, US) as a
training tools for surgically naive residents. The aim was to quantify
the improvement in surgical skills afforded, in terms of change in
speed and accuracy when performing capsulorhexis and corneal
sutures.
Methods: Nineteen surgically naive ophthalmology residents
participated in this study. Every resident had 10 rhexis-models
and 5 kerato-models for training. Performance was assessed based
on the outcome of the first 2 rhexis-model/the first kerato-model
and compared to the outcome from the last 2 rhexis-model/the last
kerato-mode. Between the assessment points the resident trained
independently using the remaining 6 rhexis-model and 3 keratomodel prostheses provided. A “capsulorhexis score” based on time
taken, corneal wound integrity, shape and centration of the rhexis was
developed to reflect overall performance. Similarily a “kerato score”
based on average time taken to perform sutures, position and integrity
of the graft, symmetry, radiality and tightness of the corneal sutures
was also developed. Paired t-tests were used to compare pre and post
training outcome measures.
Results: In rhexis-model, comparing outcomes at the beginning
and at the end of training, the maneuver was performed 39% faster
(3.6 minutes vs 2.2 minutes, p<0.01); circularity improved by
42% (0.43 vs 0.25, where 0 represents a perfect circle p<0.01) and
rhexis decentration significantly decreased (0.83 mm vs 0.47 mm,
p<0.01). In the kerato-model, corneal sutures were performed 42%
faster (9.6mins vs 5.5 mins, p<0.01) Position, integrity of the graft,
symmetry, radiality and tightness also improved significantly[b1] .
The capsulorhexis and kerato scores improved significantly from 2
and 13.8 before training to 5 and 23.1 at the end of training (p<0.01
for both respectively).
Conclusions: The BIONIKO prosthetic models were shown to be
effective training tools for improving the accuracy and speed of
surgically naive residents in performing the capsulorhexis and corneal
sutures. Also since there is no special storage, sanitary or expiration
considerations these tools have the potential to simplify practice and
maintenance in surgical skills laboratories.
Commercial Relationships: Ken Steinegger, None; Ali Dirani,
None; Ciara Bergin, None; Cedric Mayer, None; François Majo,
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
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ARVO 2015 Annual Meeting Abstracts
None; Francine Behar-Cohen, None; Jean-Antoine C Pournaras,
None
Program Number: 137 Poster Board Number: B0271
Presentation Time: 8:30 AM–10:15 AM
Evaluating the Utility of Postoperative Photos as Educational
Tools in Trichiasis Surgery Training
Richard S. Dykstra1, Shannath L. Merbs2, Beatriz E. Munoz2, Emily
W. Gower1, 3. 1Epidemiology, Wake Forest School of Medicine,
Winston Salem, NC; 2Wilmer Eye Institute, Johns Hopkins Sch of
Medicine, Baltimore, MD; 3Ophthalmology, Wake Forest School of
Medicine, Winston-Salem, NC.
Purpose: In trachomatous trichiasis (TT) surgery, poor surgical
quality contributes significantly to high postoperative TT rates. We
examined 1) the accuracy of experts in evaluating a standard set
of immediate post-op photos and 2) the expert trainers’ perceived
benefits of such photos for improving training.
Methods: We compiled a series of post-op photos with an equal
distribution of each outcome of interest: good quality, over-rotation,
under-rotation, and eyelid contour abnormality (ECA). We assigned
each photo a gold-standard grade, based on our team consensus. We
asked a group of TT surgery experts, including ophthalmologists
and ophthalmic nurses to participate. First, we showed a series of
immediate post-op photos to discuss common surgical mistakes
and long-term consequences. Next, the participants evaluated 122
immediate post-op photos and recorded the most apparent surgical
mistake (none, over-rotation, under-rotation, or ECA). We compared
participant responses to our gold standard answers. Participants
completed a questionnaire regarding their opinions on the feasibility
and potential benefit of these photos as educational tools.
Results: 19 participants evaluated the photos and completed the
questionnaire. Overall, participant responses agreed with the gold
standard 84% of the time. Individual participant scores ranged from
67%-98%; 15 agreed with the gold standard response on at least 80%
of the photos. Participants had the least difficulty identifying eyelids
with under- or over-correction (84 and 89% accuracy, respectively).
However, the gold standard photos for ECA were difficult to identify;
only 74% of the time did participants correctly record ECA. For
these, many participants recommended having the option to mark
multiple mistakes. Participants agreed that post-op photos would be
beneficial for improving the classroom (94%), live-surgery (100%),
and examination (94%) portions of training. They indicated that the
photos would be useful for demonstrating common mistakes (100%),
good surgical outcomes (89%), and long-term complications (79%).
Conclusions: This study showed significant promise for developing
a set of training materials that can be used both in teaching and
examining trichiasis surgery trainees. From these findings, we
can begin to develop meaningful, internationally-standardized
educational tools based on documented consensus and discussion.
Commercial Relationships: Richard S. Dykstra, None; Shannath
L. Merbs, None; Beatriz E. Munoz, None; Emily W. Gower, None
Support: NIH Grant R21 EY02303
Program Number: 138 Poster Board Number: B0272
Presentation Time: 8:30 AM–10:15 AM
Resident compliance with the American Academy of
Ophthalmology (AAO) Preferred Practice Patterns (PPPs) for
Primary Open-Angle Glaucoma Suspects (POAGS)
Melanie Mihlstin1, Jia Yin1, Mark S. Juzych1, Kromrei Heidi2, Frank
Hwang1. 1Ophthalmology, Kresge Eye Institute, Detroit, MI; 2GME,
Wayne State University School of Medicine, Detroit, MI.
Purpose: POAG is a leading cause of irreversible blindness in the
United States and other industrial countries [1-3]. Epidemiological
studies found that fewer than 50% of cases of visual field loss
due to glaucoma have been diagnosed [4-6]. Visual field loss and
progression of glaucoma are major concerns when following patients
suspected of having glaucoma or POAGS. To address these risks the
AAO developed PPPs for POAGS patients based on scientific data
and clinical trial data when available [7, 8]. Monitoring adherence
to these guidelines ensures residents deliver quality patient care
early in their careers and integrates evidence-based medicine into
residency curricula [9, 10]. The purpose of this study was to examine
conformance with the AAO PPPs for the evaluation of POAGS in a
resident ophthalmology clinic.
Methods: 200 charts were selected for a retrospective chart review of
new adult patients diagnosed with POAGS using the ICD-9 code for
glaucoma suspect who underwent evaluation between Nov 2010 and
May 2014 at the Kresge Eye Institute resident ophthalmology clinic.
These clinic visits were evaluated for 17 different PPP elements.
Compliance rates for the elements of PPPs were averaged in all
charts, averaged per resident, compared among 39 residents and then
were compared between 1st, 2nd and 3rd year of residency.
Results: Mean compliance was 73.8% for all charts (n=200), 74.4%
for 1st residents, 74.5% for 2nd and 73.3% for 3rd. Compliance rates
were high (>90%) for 9 elements, which included most elements
of the physical examination and history. Documentation of ocular
history, central corneal thickness, gonioscopy, optic nerve head and
retinal nerve fiber layer analysis and visual field ranged from 40%
to 80%. Documentation was lowest for patient education elements
which ranged from 0% to 10%. Compliance was not significantly
(P0.05) different between residents or between different resident
years for any of the elements.
Conclusions: Residents’ compliance for most elements was high
for most elements in the PPP guidelines for POAGS. However,
documentation of patient education was very poor. Adherence
to AAO PPPs can be a helpful method of evaluating resident
performance during training. A target level of compliance should be
set and maintained to ensure that residents are developing quality and
evidence-based patient care skills.
Commercial Relationships: Melanie Mihlstin, None; Jia Yin,
None; Mark S. Juzych, None; Kromrei Heidi, None; Frank
Hwang, None
Support: N/A
Program Number: 139 Poster Board Number: B0273
Presentation Time: 8:30 AM–10:15 AM
Current Practice Patterns in the Treatment of Periocular
Infantile Hemangiomas
Christopher Weller, Ravi Patel, Jason R. Mayer, Michael Wilkinson,
Ingrid U. Scott, Ajay Soni. Ophthalmology, Penn State Hershey Eye
Center, Middletown, PA.
Purpose: To investigate whether the emergence of systemic and
topical non-selective beta-blocker therapy has altered the practice
patterns of pediatric ophthalmologists when treating infantile
hemangiomas in the periocular region.
Methods: An anonymous fourteen question survey was constructed
using surveymonkey.com. Participants were recruited for voluntary
participation through advertisement in an AAPOS newsletter and
postings on a pediatric ophthalmology listserv.
Results: A total of 205 fellowship trained pediatric ophthalmologists
completed the survey. Respondents chose private (48%), academic
(30%), or combination (22%) when asked to characterize their
current practice landscape. Most respondents (71%) completed
training greater than ten years ago. A majority (81%) noted their
approach to the treatment of infantile hemangiomas changed over
the past 5 years, with the most common change being the use of non-
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at pubs@arvo.org.
ARVO 2015 Annual Meeting Abstracts
selective beta blocker therapy as identified by freetext response. For
the treatment of non-vision threatening lesions, 43% of respondents
selected observation as their preferred intervention, while 24%
and 20% identified topical and systemic non-selective beta blocker
therapy, respectively. Timolol 0.5% gel was the most commonly
preferred topical therapy (38%). When treating vision-threatening
lesions, 86% of respondents identified systemic non-selective beta
blocker therapy as their preferred intervention. Prior to initiating
systemic beta-blocker therapy, 92% utilized a pre-treatment screening
protocol, 28% of which included inpatient observation, while only
27% employed a pre-treatment screening protocol prior to initiation
of local beta-blocker therapy.
Conclusions: The discovery of non-selective beta-blocker therapy
for the treatment of infantile hemangiomas has altered the approach
of pediatric ophthalmologists when treating such lesions in the
periocular region. A predominant percentage of those polled
identified systemic non-selective beta-blocker therapy as their
preferred intervention for vision-threatening lesions and employed
a pre-treatment screening protocol prior to initiation of therapy. No
clear-cut approach to non-vision threating lesions was identified.
In such cases, the determination for intervention may be guided
by factors not explored in our survey, such as aesthetic concerns
or ambylogenic potential; this serves as a potential area for future
investigation.
Commercial Relationships: Christopher Weller, None; Ravi Patel,
None; Jason R. Mayer, None; Michael Wilkinson, None; Ingrid U.
Scott, None; Ajay Soni, None
Program Number: 140 Poster Board Number: B0274
Presentation Time: 8:30 AM–10:15 AM
An appraisal of clinical practice guidelines for diabetic
retinopathy
Connie Wu1, Annie Wu1, Benjamin Young1, Dominic J. Wu1, Curtis
Margo2, Paul B. Greenberg1. 1Ophthalmology, Alpert Medical
School, Providence, RI; 2Ophthalmology, Pathology, Cell Biology,
Morsani College of Medicine, Tampa, FL.
Purpose: To evaluate the methodological quality of clinical
practice guidelines (CPGs) published by the American Academy of
Ophthalmology (AAO), Canadian Ophthalmological Society (COS),
and Royal College of Ophthalmologists (RCO) for the management
of diabetic retinopathy in adults.
Methods: Four evaluators independently appraised the three CPGs
using the Appraisal of Guidelines for Research and Evaluation
(AGREE) II Instrument, which covers six domains (Scope and
Purpose, Stakeholder Involvement, Rigor of Development, Clarity
of Presentation, Applicability, and Editorial Independence).
This includes an Overall Assessment summarizing guideline
methodological rigor across all domains, using a seven-point scale
where perfect adherence equals a score of seven.
Results: Scores ranged from 35% to 78% for the AAO guideline;
60% to 92% for the COS guideline; and 35% to 82% for the RCO
guideline. Intraclass correlation coefficients for the reliability of
mean scores for the AAO, COS, and RCO were 0.78, 0.78, and 0.79;
95% CIs [0.60-0.89], [0.56-0.90], and [0.56-0.91], respectively.
The strongest domains were Scope and Purpose and Clarity of
Presentation (COS). The weakest were Stakeholder Involvement
(AAO), Rigor of Development (AAO, RCO), Applicability, and
Editorial Independence (RCO).
Conclusions: Diabetic retinopathy practice guidelines can
be improved by targeting stakeholder involvement, rigor of
development, applicability, and editorial independence.
Commercial Relationships: Connie Wu, None; Annie Wu, None;
Benjamin Young, None; Dominic J. Wu, None; Curtis Margo,
None; Paul B. Greenberg, None
Program Number: 141 Poster Board Number: B0275
Presentation Time: 8:30 AM–10:15 AM
Critical Appraisal of Clinical Practice Guidelines for Age-Related
Macular Degeneration
Annie Wu1, 3, Connie Wu1, 3, Benjamin Young1, 3, Dominic J. Wu1, 3,
Curtis Margo2, Paul B. Greenberg1, 3. 1Warren Alpert Medical School
of Brown University, Providence, RI; 2Ophthalmology, Morsani
College of Medicine, Tampa, FL; 3Section of Ophthalmology,
Providence VA Medical Center, Providence, RI.
Purpose: To evaluate the methodological quality of age-related
macular degeneration (AMD) clinical practice guidelines (CPGs).
Methods: AMD CPGs published by the American Academy of
Ophthalmology (AAO) and Royal College of Ophthalmologists
(RCO) were appraised by independent reviewers using the Appraisal
of Guidelines for Research and Evaluation (AGREE) II instrument,
which comprises six domains (Scope and Purpose, Stakeholder
Involvement, Rigor of Development, Clarity of Presentation,
Applicability, and Editorial Independence) and an Overall
Assessment score summarizing methodological quality across all
domains.
Results: Average domain scores ranged from 35% to 83% for the
AAO CPG and 17% to 83% for the RCO CPG. Intraclass correlation
coefficients for the reliability of mean scores for the AAO and RCO
CPGs were 0.74 and 0.88, respectively. The strongest domains were
Scope and Purpose and Clarity of Presentation. The weakest were
Stakeholder Involvement (AAO) and Editorial Independence (RCO).
Conclusions: Future AMD CPGs can be improved by involving
all relevant stakeholders in guideline development, ensuring
transparency of guideline development and review methodology,
improving guideline applicability with respect to economic
considerations, and addressing potential conflicts of interest within
the development group.
Commercial Relationships: Annie Wu, None; Connie Wu, None;
Benjamin Young, None; Dominic J. Wu, None; Curtis Margo,
None; Paul B. Greenberg, None
Program Number: 142 Poster Board Number: B0276
Presentation Time: 8:30 AM–10:15 AM
A Vision Research Training and Mentoring Program: The Wills
Eye Hospital Experience
Lisa A. Hark1, 3, Carrie Wright6, Michael Waisbourd2, David M.
Weiss1, Eileen L. Mayro1, Katherine Scully7, Ann P. Murchison1, 3,
Julia A. Haller4, 3, Edward Jaeger5, 3. 1Department of Research, Wills
Eye Hospital, Philadelphia, PA; 2Glaucoma Research Center, Wills
Eye Hospital, Philadelphia, PA; 3Department of Ophthalmology,
Sidney Kimmel Medical College, Thomas Jefferson University,
Philadelphia, PA; 4Ophthalmologist-In-Chief, Wills Eye Hospital,
Philadelphia, PA; 5Medical Education, Wills Eye Hospital,
Philadelphia, PA; 6Crozer Chester Medical Center, Upland, PA;
7
College of Nursing, Villanova University, Villanova, PA.
Purpose: Over the past 50 years, there has been a decline in the
number of physicians pursuing careers in clinical research. In
ophthalmology, the need for clinician investigators continues to grow
with the increasing eye care demands of the aging population. Expert
panels have recommended structured, didactic curricula with clinical
research experience for students interested in ophthalmology early in
their careers.
Methods: To address this need, the Wills Eye Hospital Department
of Research and Glaucoma Research Center developed an 8-week
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at pubs@arvo.org.
ARVO 2015 Annual Meeting Abstracts
Clinical Vision Research Training and Mentoring Program for four
undergraduate and 13 medical students interested in ophthalmology.
Students attend lectures on study design and methodology; actively
participate in vision research projects; and write and submit a
manuscript to a peer-reviewed journal. The majority of students
participate in glaucoma research projects. This program provides
students with an introduction to ophthalmology, experience in
clinical research, and relevant skills for conducting vision research,
specifically recruitment, assessment and data analysis.
Results: Students in the 2014 program were required to complete
a pre-test and post-test to assess knowledge of vision research
methods and ophthalmology. The test contained 40 multiple-choice
questions, at least 4 for each topic presented during the lecture series.
Students scored statistically significantly higher on the post-test
(M=80.1%, SD=5.74) than on the pre-test (M=74.4%, SD=6.72);
t(17)=2.52, P=0.02. They also completed an anonymous survey of
their satisfaction with the overall program, including the lecture
series, manuscript-writing workshop series, pre- and post-tests, and
mentor-trainer experience. Students strongly agreed that they were
satisfied with the overall program, including supervision, and that the
lecture series and manuscript-development workshops enhanced their
learning.
Conclusions: The 2014 Wills Eye Clinical Vision Research Training
and Mentoring Program provides an evidence-based foundation in
critical thinking, research methods, and manuscript development
for students interested in careers in ophthalmology. Students
emerge with clinical research skills and an appreciation of vision
research. The success of this pilot has led to the establishment of a
permanent program and can serve as a research training model for
ophthalmology and other medical specialties.
Commercial Relationships: Lisa A. Hark, None; Carrie Wright,
None; Michael Waisbourd, None; David M. Weiss, None; Eileen
L. Mayro, None; Katherine Scully, None; Ann P. Murchison,
None; Julia A. Haller, Advanced Cell Technology (C), Alcon (C),
Allergan (C), KalVista (C), LPath Pharmaceuticals (C), Merck (C),
Regneron Pharmaceuticals (C), Second Sight (C), ThromboGenics
(C); Edward Jaeger, None
Program Number: 143 Poster Board Number: B0277
Presentation Time: 8:30 AM–10:15 AM
Evaluation of a new residency program at the department of
ophthalmology of the Heinrich-Heine-University Duesseldorf
Eva L. Bramann, David Finis, Gerd Geerling. Eye hospital,
University Hospital Düsseldorf, Düsseldorf, Germany.
Purpose: The German ophthalmological training is yet a very
individual-dependent system with only one final oral exam at the end
of the five year residency. In the beginning of 2013 we introduced a
new residency program at the department of ophthalmology of the
Heinrich-Heine-University Duesseldorf. This study evaluates the
satisfaction of the residents with the new concept.
Methods: The new residency program consists of three main
changes: first a structured training with fixed rotation in the various
subdisciplines of ophthalmology, second a list of practical skill
exams (PUTs), that has to be completed during the 5-year program
and third yearly oral examinations as well as an additional practical
examination in optics and refraction. The satisfaction of the residents
with the new program was anonymously evaluated with a likert scale
based questionnaire with 15 items and additional free text comments.
Results: The structured training was positively evaluated by 6 of 10
residents. 4 were unsatisfied with the implementation of the concept.
The evaluation of the PUTs was inconsistent. 5 of 10 residents
described a positive effect on motivation and learning curve and
wanted to keep up the skill examinations. The other 5 were not
satisfied with this part of the concept, mainly due to procedural
problems.
9 of 10 trainees agreed that their learning motivation had accelerated
before the yearly examinations. Also 9 described an advance in
their learning curve. 8 agreed that this exam should be performed
regularly.
Conclusions: Overall the residency concept was well accepted.
Especially the yearly examinations were reviewed favorably.
However, the practical examinations and the structured training need
to be revised in order to further increase the learning motivation of
the trainees.
Commercial Relationships: Eva L. Bramann, None; David Finis,
None; Gerd Geerling, None
Program Number: 144 Poster Board Number: B0278
Presentation Time: 8:30 AM–10:15 AM
Learning styles among ophthalmology residents
Brian C. Stagg, Jason Jensen, Adam Jorgensen, Cody Olsen, Jeff
Pettey. Univ of Utah School of Medicine, Salt Lake City, UT.
Purpose: Individual learning style can affect the acquisition of
ophthalmic knowledge by trainees. The Kolb Learning Style
Inventory is a survey tool used to categorize learning styles. We
administered this survey to ophthalmology residents across the
country to improve our understanding of the way residents learn.
Methods: The survey was distributed electronically to residents
at 99 residency programs across the country. Responses from 82
residents were obtained and analyzed. The Kolb Learning Styles
Inventory v3.1 (Kolb LSI) is a well-studied, validated assessment
that categorizes learners into four broad learning styles: converging,
assimilating, accommodating, and diverging. Additional questions
asked of participants included basic demographics, Ophthalmic
Knowledge and Assessment Exam (OKAP) percentile range, USMLE
Step 1 score range, ranking of various study methods based on
educational value, and ranking of lecture styles based on educational
value. The Kolb LSI responses were plotted on a Kolb Learning
Styles inventory graph and a best-fit analysis was done to evaluate for
non-random distribution among the four learning styles.
Results: Responses from 82 residents were analyzed. 45.1% of
those polled showed a converging learning style. 20. 7% showed
an assimilating learning style. 20.7% showed an accommodating
learning style. 13.4% showed a diverging learning style. This was a
non-random distribution (p <0.01).
Conclusions: The most common learning style of ophthalmology
residents was converging. Converging implies preference for “handson” learning combined with understanding of theory. The prevalence
of converging in ophthalmology is similar to other surgical
subspecialties, but different from the medical subspecialties based
on previous studies. However, there is significant representation
from all four learning styles among ophthalmology residents and
ophthalmologic training should not neglect any of these styles.
Commercial Relationships: Brian C. Stagg, None; Jason Jensen,
None; Adam Jorgensen, None; Cody Olsen, None; Jeff Pettey,
None
Support: ARCS Foundation Scholarship
Program Number: 145 Poster Board Number: B0279
Presentation Time: 8:30 AM–10:15 AM
Pediatric Ophthalmology: Analysis of Fellowships and the Job
Market
Christine O’Brien1, Ryan Marsh2. 1Michigan State University College
of Human Medicine, Bloomfield Hills, MI; 2Analysis Group, Dallas,
TX.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at pubs@arvo.org.
ARVO 2015 Annual Meeting Abstracts
Purpose: To assess the specialty of pediatric ophthalmology in terms
of supply (fellowships positions filled) and demand (compensation
and job market) in order to perform an economic analysis of the
present state of pediatric ophthalmology.
Methods: Fellowship match data for the past 4 years was acquired
from the San Francisco Match. Reimbursement data was gathered
from the Medscape Physician Compensation Report and the Medical
Group Management Association (MGMA) physician compensation
survey. Job market data is currently being collected from American
Association for Pediatric Ophthalmology and Strabismus (AAPOS).
Results: From 2010-2013 an average of 43 participating programs
offered 57 fellowship positions in pediatric ophthalmology. Over
this period of time an average of 75% of pediatric ophthalmology
positions were filled (range 63-88%) compared to an average of 91%
across all other ophthalmic subspecialties (range 88-93%). In 2009
the average salary in multi-physician private practices for pediatric
ophthalmology ($304,931) was lower than for comprehensive
ophthalmology ($376,943) and retinal surgery ($619,114). Salary and
job market data collection is ongoing.
Conclusions: Pediatric ophthalmology is currently in high
demand across the United States. In spite of high demand the
average reimbursement for pediatric ophthalmology is lower than
comprehensive ophthalmology and every year a large number of
fellowship positions go unfilled. A discrepancy exists between supply
and demand because high demand and low supply should imply high
wages. Lower reimbursement rates for pediatric ophthalmology are
likely due to the time-intensive nature of both examining children
and performing strabismus surgery. Residents are likely choosing to
pursue other subspecialties due to the relatively lower reimbursement,
difficulty examining pediatric patients, and interest in performing
intraocular surgery with greater frequency.
Commercial Relationships: Christine O’Brien, None; Ryan
Marsh, None
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at pubs@arvo.org.