Journal of Academic Ophthalmology
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An Ophthalmology Resident-Led Quality Improvement Initiative to Decrease the Incidence of Perioperative Corneal Injury
No full textAn Ophthalmology Resident-Led Quality Improvement Initiative to Decrease the Incidence of Perioperative Corneal Injur
Characteristics and Incidence of Inpatient Ophthalmology Consultations to Screen for Papilledema
No full textCharacteristics and Incidence of Inpatient Ophthalmology Consultations to Screen for Papilledem
Urology Residency Directors\u27 Awareness of Association between α-Adrenergic Antagonists and Floppy Iris Syndrome and Practice Patterns Regarding Prophylactic α-Adrenergic Antagonists
No full textUrology Residency Directors\u27 Awareness of Association between α-Adrenergic Antagonists and Floppy Iris Syndrome and Practice Patterns Regarding Prophylactic α-Adrenergic Antagonist
Assessment of Intravitreal Injection Training among U.S.-Based Ophthalmology Residents
No full textPurpose To describe the intravitreal injection training of ophthalmology residents in the United States in 2018.
Design Cross-sectional survey.
Methods An anonymous, 29-question, internet-based survey was emailed to 119 ophthalmology residency program directors with the instructions to forward the survey to their ophthalmology residents.
Results A total of 117 ophthalmology residents (7.89%) responded to the survey. The majority of residents stated that their intravitreal injection training began during their first year of ophthalmology training, PGY 2 year, (92.3%). The majority of residents performed at least 25 injections per year (78.6%). All residents use antiseptic on the conjunctiva prior to the injection, 94% use a lid speculum, and 84.6% avoided talking in the procedure room. Most injections are performed with gloves (83.8%). A minority of residents stated that they are trained to use povidone-iodine on the eyelids prior to performing an injection (45.3%). Only 6.0% of residents claimed to use postinjection antibiotic drops. Performance of bilateral, simultaneous intravitreal injections was split with nearly half of residents not being trained in this method (47.9%).
Conclusion Ophthalmology residents from across the country experience a variety of different injection protocols when being trained on how to perform intravitreal injections. Conjunctival antisepsis has reached a clear consensus while topics such as simultaneous, bilateral injections and eyelid antisepsis are still uncertain among the resident community
Institution of a Surgical Curriculum for Trabecular Microbypass Stent Placement
No full textPurpose This article evaluates whether a targeted, stepwise curriculum for microbypass stent placement leads to successful insertion of the iStent (Glaukos, Laguna Hills, CA) by resident surgeons.
Participants Senior (postgraduate year 4) ophthalmology residents (9 residents) from three classes during the 2015 to 2016, 2016 to 2017, and 2017 to 2018 academic years.
Design Residents participated in a three-stage surgical curriculum. First, a wet laboratory was held for residents to gain familiarity with the device and develop bimanual surgical proficiency. The wet laboratory involved several stations, with each station requiring increased dexterity for successful completion. Next, residents practiced bimanual intraoperative gonioscopy after routine phacoemulsification procedures. Finally, residents performed combined phacoemulsification and iStent insertion under the supervision of an experienced attending surgeon. Primary success was determined by correct anatomical placement of the device confirmed via subsequent intraoperative gonioscopy by the supervising surgeon. Secondary success was measured by change in intraocular pressure (IOP) and number of topical hypotensive medications used after surgery. Residents provided feedback about the effectiveness of the curriculum via an online survey.
Results There were a total of 43 cases. There were no significant intraoperative complications, including hyphema. The iStent location was confirmed during both intraoperative and postoperative gonioscopy and was noted to be in appropriate position for the duration of the follow-up period (6–12 months) for all patients. Average preoperative IOP in our subjects was 17.5 ± 4.0 mm Hg and mean number of preoperative medications was 1.4 ± 1.0. At 6 months\u27 postoperative, average IOP was 14.5 ± 2.2 mm Hg (13% reduction from baseline [±15%]). At 12 months\u27 postoperative, average IOP was 14.4 ± 3.5 mm Hg, with a reduction of 14% (±18%). The mean number of medications at follow-up was 1.2 ± 1.1. Mean postoperative IOP at 6 and 12 months was significantly lower compared with baseline (p = 0.0002, p = 0.0001). Residents agreed that the curriculum prepared them to perform iStent insertion during residency and most residents felt prepared after residency.
Conclusion This stepwise surgical curriculum for trabecular microbypass stent placement leads to successful performance of the procedure by residents and is a useful model for other residency programs
TDABC Cost Analysis of Ocular Disorders in an Ophthalmology Emergency Department versus Urgent Care: Clinical Experience at Massachusetts Eye and Ear
No full textPurpose To perform a cost analysis comparison for managing common ocular disorders in an eye emergency department (ED) versus an urgent care setting using a time-driven activity-based cost model (TDABC) to assist physicians and staff in appropriate allocation of resources at their own institution.
Design Retrospective analysis.
Setting Massachusetts Eye and Ear (MEE) ED and Same-Day Services (SDS), which runs as an urgent care clinic.
Population Patients diagnosed with corneal abrasions, dry eyes, conjunctivitis, and styes were identified between April 2014 and August 2015 (n = 2,408 [ED], 26 [SDS]). We determined resources used in delivery of care, which included personnel, consumables, space capacity, and equipment. Costs were identified based on time the patient spent with each resource.
Main Outcome Average visit length and associated personal, space, equipment, and consumable costs.
Results Average visit length was 196 and 53 minutes, respectively, primarily due to longer wait times in the ED. Personnel and space costs were higher in the ED compared with SDS (51.37 and 12.86, respectively). This led to an overall higher total resource cost for patients seen in the ED compared with SDS (81.53, respectively).
Conclusion For common ocular disorders, total SDS costs were 25% less than ED costs at MEE primarily due to personnel and space utilization. Treating patients with nonemergent ocular problems outside the ED can lead to shorter visit times for patients as well as lower overall costs
A Virtual Reality Cataract Surgery Course for Residents
No full textAbstract
We report on two key updates to the publically available Brown ophthalmology residency virtual reality (VR) cataract surgery course. The first is a validated proficiency-based VR simulator test. The second is a mental skills training curriculum derived from a course shown to decrease novice general surgeons\u27 cognitive stress under difficult performance conditions
The Pediatric Examination Assessment Rubric (PEAR): A Pilot Project
No full textPurpose The pediatric ophthalmic examination is often considered a challenge to ophthalmologists at any level of training. New tools need to be developed and tested to enhance resident and fellow training in pediatric ophthalmology. To our knowledge, this pilot project introduces the first educational rubric designed specifically for a pediatric ophthalmic examination.
Methods Preliminary surveys were completed by 11 ophthalmic residents, of all three postgraduate years (PGY), to gauge comfort level with the pediatric ophthalmic examination. A one-page Pediatric Examination Assessment Rubric (PEAR) was developed and reviewed by 13 content experts (12 pediatric ophthalmologists and a lead developer of the Ophthalmic Clinical Exercise Examination [OCEX] tool) at eight academic institutions. A total of five educators from three academic institutions used the rubric to evaluate a total of six residents during a new strabismus evaluation. Postevaluation surveys were completed by both the five educators and the six residents.
Results Preliminary surveys showed that only 18.2% of residents felt their pediatric examination skills were good. Residents noted higher levels of frustration and less comfort with the pediatric examination when compared with an adult examination. Thirteen experts\u27 comments were incorporated into the rubric to establish content validity. Postevaluation surveys showed that 60% of faculty and 100% of residents found the rubric to be very effective in providing feedback.
Conclusion In this pilot project, we established the need for more concrete educational tools in pediatric ophthalmology, created an educational tool, established content validity, and demonstrated feasibility. The PEAR helps residents identify skills to target for improvement based on the quality of their pediatric ophthalmic examinations. At three academic institutions, the PEAR was shown to be easy to use and a useful tool for training residents to perform the pediatric ophthalmic examination
The Relative Financial Cost and Benefit of an Ophthalmology Resident Compared to an Advanced Practice Provider, Optometrist, or Faculty Ophthalmologist
No full textObjective The main objective of the article is to determine the relative direct financial cost and benefit of an advanced practice provider (APP), optometrist, and faculty ophthalmologist compared with an ophthalmology resident.
Design Single center cost–benefit financial analysis.
Methods The direct total expenses, including mean salary and benefits; the cost/week, based upon calculated hours worked; and net revenue, based upon technical collections subtracted from total expenses were collected for all APPs, optometrists, faculty ophthalmologists, and ophthalmology residents at the University of Kentucky for the 2016 to 2017 academic year. Optometry and ophthalmology faculty collections were adjusted for clinical full-time equivalents.
Results Total annual mean salary and benefits for 242 APPs, 4 optometrists, 17 faculty ophthalmologists, and 9 ophthalmology residents were 117,021, 71,210, respectively. Assuming a 50-hour-work week, the calculated hourly costs were 45.01, 27.39, respectively. Ophthalmology residents do not directly generate work relative value units or collections. On this basis, the net annual revenues were −122,757, 71,210, respectively.
Conclusions Ophthalmology residents are relatively inexpensive compared with potential substitute health care providers, although they are unable to generate direct revenue. Indirect costs and benefits are likely substantial, but currently incalculable. More candid analyses of the role and financial impact of trainees in health care are needed