Ophthalmic exam and ophthalmology residents’ subspecialty preference

AIM:To evaluate residents’perceptions and attitudes toward the various aspects of a comprehensive ophthalmic examination,and to determine if these factors correlate with their choices for fellowship and future career plans.METHODS:This is a cross-sectional study.A questionnaire on the perception of the ophthalmic exam was sent via SurveyMonkey to ophthalmology residents throughout Israel.Eighty of them(one-half of all ophthalmology residents in 2019)completed it.The first part related to how they perceived each component of the ophthalmic evaluation.The second part related to their future fellowship plans.The Chi-squared test was used to compare categorical variables and Student’s t-test and One-way ANOVA were used to compare continuous variables.Multivariate logistic regression analysis was applied as needed to detect interactions between variables and to exclude confounder effects.RESULTS:Slit-lamp examination of the anterior and posterior segments ranked as the most likeable aspects,whereas gonioscopy,ocular motility examination and visual acuity assessment were least likeable.Anterior segment and retina subspecialties were the ones most sought after.Forty-nine respondents(61.3%)noted a direct correlation between their preferred parts of comprehensive ophthalmic evaluations and their choice of subspecialty.Perceptions of selected components of those evaluations were significantly associated with responders’intentions to pursue anterior segment,retina,or oculoplastic fellowships(P<0.05).CONCLUSION:Perspectives of residents toward the ophthalmic examination,and most specifically its individual components,play an important role in their choice of subspecialty training.

Improving the training abilities of ophthalmic educators: the Ophthalmology Foundation’s initiatives

Our goal as medical educators is for our students to learn what they need to know and competently perform ophthalmic procedures.In addition,the students need to have good communication skills and behave professionally and ethically(1,2).Most medical educators are not taught how to teach but rather learn by role-modeling their mentors.This can be good or bad depending on the mentor!In addition,the amount of knowledge and numbers of surgical procedures is ever increasing and yet,in most countries,the amount of time to train and become competent is not changing.Thus,our goal of creating competent ophthalmologists is ever more challenging.

Guidelines on clinical research evaluation of artificial intelligence in ophthalmology(2023)

With the upsurge of artificial intelligence(AI)technology in the medical field,its application in ophthalmology has become a cutting-edge research field.Notably,machine learning techniques have shown remarkable achievements in diagnosing,intervening,and predicting ophthalmic diseases.To meet the requirements of clinical research and fit the actual progress of clinical diagnosis and treatment of ophthalmic AI,the Ophthalmic Imaging and Intelligent Medicine Branch and the Intelligent Medicine Committee of Chinese Medicine Education Association organized experts to integrate recent evaluation reports of clinical AI research at home and abroad and formed a guideline on clinical research evaluation of AI in ophthalmology after several rounds of discussion and modification.The main content includes the background and method of developing this guideline,an introduction to international guidelines on the clinical research evaluation of AI,and the evaluation methods of clinical ophthalmic AI models.This guideline introduces general evaluation methods of clinical ophthalmic AI research,evaluation methods of clinical ophthalmic AI models,and commonly-used indices and formulae for clinical ophthalmic AI model evaluation in detail,and amply elaborates the evaluation methods of clinical ophthalmic AI trials.This guideline aims to provide guidance and norms for clinical researchers of ophthalmic AI,promote the development of regularization and standardization,and further improve the overall level of clinical ophthalmic AI research evaluations.

Flipped classroom approach to global outreach:cross-cultural teaching of horizontal strabismus to Chinese ophthalmology residents

AIM:To evaluate the flipped classroom model for teaching horizontal strabismus didactics in an ophthalmology residency program in China as part of a visiting professorship from the United States.METHODS:Residents from an ophthalmology residency program in China were invited to participate in flipped classroom sessions taught by an experienced American ophthalmology faculty in 2018.Residents were instructed to watch a pre-class video lecture prior to the in-class-casebased activity.Content tests(5 Ophthalmic Knowledge Assessment Program style questions)and surveys were administered before and after the classroom sessions(100%response rate).These results were compared to that of an American cohort who were taught the same content.RESULTS:The Chinese cohort of 12 residents preferred the flipped classroom to the traditional classroom at higher rates than the American cohort of 40 residents(92%vs 55%,P=0.04)and felt that all ophthalmology topics would be appropriate for the flipped classroom teaching style(P-values between 0.008 and<0.001).In both Chinese and American cohorts,we found that the exotropia curriculum saw a small but significant improvement in performance following the flipped classroom session(P=0.025 for Chinese residents;P=0.001 for US residents),whereas scores in both groups for the esotropia course did not significantly improve.CONCLUSION:This is the first study to evaluate the flipped classroom model implemented by a visiting ophthalmology professor in a global outreach setting.The flipped classroom sessions are viewed favorably by the Chinese residents relative to the US cohort with a modest impact on knowledge.Decreased in-person interpreter requirement and increased student engagement make this model valuable in cross-cultural visiting professorship settings.Finally,the flipped classroom may lend itself well to a virtual format to prevent the transmission of COVID-19,although such a format requires further study.

Highly cited publication performance in the ophthalmology category in the Web of Science database:a bibliometric analysis

AIM:To determine and evaluate the features of highly cited articles(HCAs)in the ophthalmology category in the Science Citation Index Expanded(SCI-EXPANDED)from 1991 to 2020.METHODS:The Web of Science Core Collection documents with at least 100 citations from their publication year until December 31,2020,were evaluated as highly cited.The examined features were the distribution of yearly output and its average number of per publication,HCAs,authors,institutions,journals,and nations.The publication performance of nations and organizations was assessed using six publication indicators.The Y-index was employed to compare the research outputs of various authors.RESULTS:Publications that had cited the most references were highly published in high-impact factor journals.The United States of America came out on top across all six publication indicators,and it was home to eight of the top 10 most productive institutions.The articles written by Breivik et al(2006)and Farrar et al(2001)were highly cited and had a significant impact in 2020.The authors had a higher number of highly cited articles published as corresponding authors than as first authors.CONCLUSION:The findings of the present study highlight the current scope of global research in ophthalmology.The findings can help policy-makers and advisory groups of research centers to develop future policies.In addition,the findings can guide researchers in this field.

Discussion on the Teaching Methods of Ophthalmology Training for General Practitioners in Tertiary General Hospitals

General medicine is an emerging secondary clinical discipline that aims to serve the society and family health management,and it plays a key role in hierarchical diagnosis and treatment.General practitioners are the leading providers of primary medical services and are responsible for comprehensive work such as diagnosis,treatment,preventive care,health record management,and referral of common and frequently-occurring diseases.They play an essential role in the health care system,providing comprehensive medical services to communities and families to improve people’s overall health.Developing and promoting general medicine are significant to establishing a sound medical and healthcare system,and improving primary medical services.Therefore,general practitioners require a broader range of knowledge than specialists,and the training model also differs from that of specialists.Given the short training time and heavy teaching tasks for ophthalmology,this article will combine the professional characteristics of ophthalmology to explore the application of appropriate teaching methods in a short period in order to achieve exemplary teaching results.In this process,it is necessary to comprehensively consider the professional characteristics of ophthalmology and the limitations of general practitioner training time,and discover appropriate teaching methods to improve the teaching effect and ensure the all-round development of students.

Application Experience of Eyesi Operation Simulation Training System in the Teaching of Cataract Surgery for Ophthalmology Masters

Objective:To explore the application effect of the Eyesi surgical simulator in the teaching of cataract surgery for professional ophthalmology postgraduate students.Methods:The professional postgraduate students who were trained in the third year of ophthalmology at the First Affiliated Hospital of Xi’an Medical University were selected as the research objects.After passing the theoretical examination,they were randomly divided into the pig eyeball group,Eyesi group,and pig eye+Eyesi group,with 5 students in each group.The pig eyeball,Eyesi surgery simulator,and pig eye+Eyesi surgery simulator were used for microscopic technique operation and cataract surgery steps training,respectively.After the training,the overall training effects of the three groups of postgraduates were scored,and questionnaires were used to objectively evaluate the three training methods.Results:The scores of the students in the pig eye+Eyesi group were better than those in the Eyesi group,and the students in the Eyesi group were better than those in the pig eyeball group.Conclusion:The Eyesi surgical simulation training system can evaluate the microsurgical skills of professional masters and improve their surgical skills.This system is of great significance for the training of the cataract surgery skills of professional masters.

Artificial intelligence in individualized retinal disease management

Owing to the rapid development of modern computer technologies,artificial intelligence(AI)has emerged as an essential instrument for intelligent analysis across a range of fields.AI has been proven to be highly effective in ophthalmology,where it is frequently used for identifying,diagnosing,and typing retinal diseases.An increasing number of researchers have begun to comprehensively map patients’retinal diseases using AI,which has made individualized clinical prediction and treatment possible.These include prognostic improvement,risk prediction,progression assessment,and interventional therapies for retinal diseases.Researchers have used a range of input data methods to increase the accuracy and dependability of the results,including the use of tabular,textual,or image-based input data.They also combined the analyses of multiple types of input data.To give ophthalmologists access to precise,individualized,and high-quality treatment strategies that will further optimize treatment outcomes,this review summarizes the latest findings in AI research related to the prediction and guidance of clinical diagnosis and treatment of retinal diseases.

Retinoscopes:Past and present

BACKGROUND Retinoscopy is arguably the most important method in the eye clinic for diagnosing and managing refractive errors.Advantages of retinoscopy include its noninvasive nature,ability to assess patients of all ages,and usefulness in patients with limited cooperation or communication skills.AIM To discuss the history of retinoscopes and examine current literature on the subject.METHODS A search was conducted on the PubMed and with the reference citation analysis(https://www.referencecitationanalysis.com)database using the term"Retinoscopy,"with a range restricted to the last 10 years(2013-2023).The search string algorithm was:"Retinoscopy"(MeSH Terms)OR"Retinoscopy"(All Fields)OR"Retinoscopes"(All Fields)AND[(All Fields)AND 2013:2023(pdat)].RESULTS This systematic review included a total of 286 records.Publications reviewed iterations of the retinoscope into autorefractors,infrared photo retinoscope,television retinoscopy,and the Wifi enabled digital retinoscope.CONCLUSION The retinoscope has evolved significantly since its discovery,with a significant improvement in its diagnostic capabilities.While it has advantages such as non-invasiveness and broad applicability,limitations exist,and the need for skilled interpretation remains.With ongoing research,including the integration of artificial intelligence,retinoscopy is expected to continue advancing and playing a vital role in eye care.

Stem Cell Ophthalmology Treatment Study(SCOTS) for retinal and optic nerve diseases: a case report of improvement in relapsing auto-immune optic neuropathy

We present the results from a patient with relapsing optic neuropathy treated within the Stem Cell Ophthalmology Treatment Study （SCOTS）. SCOTS is an Institutional Review Board ap- proved clinical trial and has become the largest ophthalmology stem cell study registered at the National Institutes of Health to date （www.clinicaltrials.gov Identifier NCT 01920867）. SCOTS utilizes autologous bone marrow-derived stem cells （BMSCs） for treatment of retinal and optic nerve diseases. Pre-treatment and post-treatment comprehensive eye exams of a 54 year old female patient were performed both at the Florida Study Center, USA and at The Eye Center of Columbus, USA. As a consequence of a relapsing optic neuritis, the patient＇s previously normal visual acuity decreased to between 20/350 and 20/400 in the right eye and to 20/70 in the left eye. Significant visual field loss developed bilaterally. The patient underwent a right eye vitrectomy with injection of BMSCs into the optic nerve of the right eyeand retrobulbar, subtenon and in- travitreal injection of BMSCs in the left eye. At 15 months after SCOTS treatment, the patient＇s visual acuity had improved to 20/150 in the right eye and 20/20 in the left eye. Bilateral visual fields improved markedly. Both macular thickness and fast retinal nerve fiber layer thickness were maximally improved at 3 and 6 months after SCOTS treatment. The patient also reduced her mycophenylate dose from 1,500 mg per day to 500 mg per day and required no steroid pulse therapy during the 15-month follow up.

Application of artificial intelligence in ophthalmology

Artificial intelligence is a general term that means to accomplish a task mainly by a computer, with the least human beings participation, and it is widely accepted as the invention of robots. With the development of this new technology, artificial intelligence has been one of the most influential information technology revolutions. We searched these English-language studies relative to ophthalmology published on PubMed and Springer databases. The application of artificial intelligence in ophthalmology mainly concentrates on the diseases with a high incidence, such as diabetic retinopathy, agerelated macular degeneration, glaucoma, retinopathy of prematurity, age-related or congenital cataract and few with retinal vein occlusion. According to the above studies, we conclude that the sensitivity of detection and accuracy for proliferative diabetic retinopathy ranged from 75% to 91.7%, for non-proliferative diabetic retinopathy ranged from 75% to 94.7%, for age-related macular degeneration it ranged from 75% to 100%, for retinopathy of prematurity ranged over 95%, for retinal vein occlusion just one study reported ranged over 97%, for glaucoma ranged 63.7% to 93.1%, and for cataract it achieved a more than 70% similarity against clinical grading.

Stem Cell Ophthalmology Treatment Study(SCOTS) for retinal and optic nerve diseases: a preliminary report

In this report, we present the results of a single patient with optic neuropathy treated within the Stem Cell Ophthalmology Treatment Study （SCOTS）. SCOTS is an Institutional Review Board approved clinical trial and is the largest ophthalmology stem cell study registered at the National Institutes of Health to date- www.clinicaltrials.gov Identifier NCT 01920867. SCOTS utilizes autologous bone marrow-derived stem cells in the treatment of optic nerve and retinal diseases. Pre- and post-treatment comprehensive eye exams were independently performed at the Wilmer Eye Institute at the Johns Hopkins Hospital, USA. A 27 year old female patient had lost vision approximately 5 years prior to enrollment in SCOTS. Pre-treatment best-corrected visual acuity at the Wilmer Eye Institute was 20/800 Right Eye （OD） and 20/4,000 Left Eye （OS）. Four months following treatment in SCOTS, the central visual acuity had improved to 20/100 OD and 20/40 OS.

Ophthalmology simulation for undergraduate and postgraduate clinical education

This is a review education paper on the current ophthalmology simulators utilized worldwide for undergraduate and postgraduate training. At present, various simulators such as the EYE Exam Simulator （Kyoto Kagaku Co. Ltd., Kyoto, Japan）, Eyesi direct ophthalmoscope simulator （VRmagic, GmbH, Mannheim, Germany）, Eyesi indirect ophthalmoscope simulator （VRmagic, GmbH, Mannheim, Germany） and Eyesi cataract simulators （VRmagic, GmbH, Mannheim, Germany）. These simulators are thought to be able to reduce the initial learning curve for the ophthalmology training but further research will need to be conducted to assess the effectiveness of the simulation-assisted ophthalmology training. Future research will be of great value to assess the medical students and residents responses and performance regarding the usefulness of the individual eye simulator.

Trends in ophthalmology journals： a five-year bibliometric analysis （2009-2013）

AIM： To explore the trends in the ophthalmic literature over a 5-year period in relation to country, research expenditure and demographics. METHODS： Articles published between 2009 and 2013 by the 20 highest-contributing countries in the 20 top- ranked ophthalmology journals were identified by their country of affiliation. The number of articles published and mean impact factor were measured per country for each year and trends explored using regression analysis with 5-year and 10-year forecasts calculated. Data on research expenditure was collected and tested for correlation with the number of articles and mean impact factor. RESULTS： The analysis included 19 338 articles. The USA, UK and Europe accounted for 60.2% of articles published, with the USA contributing 7388 articles （34.0%）. The USA also demonstrated the highest mean impact factor （3.5）. Research expenditure was significantly correlated with both research output （r=0,86, P〈0.001） and scholarly impact （r=0.42, P〈0.001）. China （P〈0.01）, Korea （P〈0.01） and India （P〈0.02） demonstrated a significant growth in research output over the study period. The research contribution of these three countries combined is forecasted to overtake that of Europe within ten years, with China expected to be the second-largest contributor within five years. These countries were also among those demonstrating the greatest growth in research expenditure. CONCLUSION： While the USA and European countries are major contributors of ophthalmic research, the productivity of some Asian countries is growing impressively. The contribution of China, Korea and Indiais forecasted to outweigh that of Europe by 2023. Research expenditure is highly correlated with research productivity and these trends reflect the differing economic priorities across the world.

Integrating a flipped classroom and problem-based learning into ophthalmology education

Background: Ophthalmology is an important medical science subject, but it is given with insufficient attention in undergraduate medical education. Flipped classroom(FC) and problem-based learning(PBL) are well-known education methods that can be integrated into ophthalmology education to improve students' competence level and promote active learning. Methods: We used a mixed teaching methodology that integrated a FC and PBL into a 1-week ophthalmology clerkship for 72 fourth-year medical students. The course includes two major sessions: FC session and PBL session, relying on clinical and real-patient cases. Written examinations were set up to assess students' academic performance and questionnaires were designed to evaluate their perceptions. Results: The post-course examination results were higher than the pre-course results, and many students gained ophthalmic knowledge and learning skills to varying levels. Comparison of pre-and post-course questionnaires indicated that interests in ophthalmology increased and more students expressed desires to be eye doctors. Most students were satisfied with the new method, while some suggested the process should be slower and the communication with their teacher needed to strengthen.Conclusions: FC and PBL are complementary methodologies. Utilizing the mixed teaching meth of FC and PBL was successful in enhancing academic performance, student satisfactions and promoting active learning.

Flipped classroom approach to ophthalmology clerkship courses for Chinese students of eight-year program

Background:The“flipped classroom”is a learner-centered approach that centers on delivering videos,podcasts or slide-based material to learners prior to a lecture or class session.The class session is then dedicated to discussion,analysis,and problem-solving activities.The aim of this study was to investigate whether the flipped classroom could be adapted to medical(ophthalmology)students learning about ocular trauma and to assess the impact of the flipped classroom on those students’performance and attitudes.Methods:Questionnaires(using a 4-point scale)were distributed to 93 fifth-year medical students at Sun Yat-sen University,and the data showed that the majority of students preferred the flipped classroom approach to the traditional lecture method.Results:The results of pre-and post-test scores were 14.35±3.404 and 20.37±4.356,which showed a significant improvement in students’performance after the flipped classroom was introduced(P<0.05).Conclusions:Student response to the flipped classroom strategy was largely positive,indicating that the strategy received a high level of approval in an ophthalmology clerkship course taken by medical students in China.

Teaching in the operating room:trends in surgical skills transfer in ophthalmology

Cataract surgery is arguably the most commonly performed operation in ophthalmology.Surgical skills transfer from experienced surgeons to resident surgeons is complicated by the fact that the teaching surgeon primarily acts as an observer rather than directly performing the procedure.Therefore,wet lab and simulator training are utilized to reduce the learning curve of the novice surgeons,which establishes tissue awareness,dexterity and muscle memory required to perform each step of the procedure,safely.Access to a wet lab and simulator environment is accomplished by establishing a surgical training curriculum in residency programs.In the operating room,topical anesthesia is a safe alternative for teaching cataract surgery.There are three well-described approaches to teaching individual steps of cataract surgery:forward,“backwards”,and deconstructed step-by-step instruction.Simulator training can be incorporated prior to live patient experience or integrated concurrently with learner presence in the operating room.The trend towards a competency-based instruction model has necessitated appropriate evaluation tools that include Objective Assessment of Skills in Intraocular Surgery(OASIS),Global Rating Assessment of Skills in Intraocular Surgery(GRASIS),and the International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubrics(ICO-OSCAR).We review the literature on trends in surgical teaching in ophthalmology,with the focus on cataract surgery instruction to the novice surgeon.

The importance and patterns for humanities education of Chinese ophthalmology residency

At this point in time,the importance of medical humanities education has not been fully understood during the standardized training of residents in China.The study of medical humanities is an important facet of ophthalmology residency that needs to be strengthened.During the standardized training of ophthalmology residents,not only the medical sciences should be strengthened,but also the nature and practice of medical humanities knowledge should be enhanced in multiple aspects.Offering medically-relevant literature,history,philosophy and other courses,simulating real medical activities,being enthusiastic in popular medical science and increasing the contents of the examination in medical humanities would all be areas that would further advance the ophthalmology residency.Along with medical science education,residents will be led and trained on medical humanities as to build good medical humanistic spirit of patient care so that they may better serve patients.

Lasers in Ophthalmology

In recent years,lasers have entered every fieldof medicine and especially so in ophthalmol-ogy.The scientific basis of lasers in ophthal-mology is based on three mechanisms:1.Photothermal effectLasers:argon,krypton,dye and diodeA thermal effect is generated when laserenergy is absorbed by pigment leading to in-creased vibration and therefore heat content.

Oculoplastic publication trends in general ophthalmology journals

AIM: To examine the publication trend of oculoplastic articles throughout the last decade in general ophthalmology journals.METHODS: A review of all abstracts published between Januar y 2010 to December 2019 in general, clinical ophthalmic journals was conducted. Articles that were categorized as original articles in general and clinical journals were included in the study.RESULTS: Totally 10 281 abstracts were included. Of them 465(4.5%) were oculoplastic publications. The mean number of annual-publications was 46.5 and the mean annual-rate of oculoplastic publications was 4.51%. A significant decreasing trend in the number of oculoplastic publication in the last decade was found(P<0.01, R^(2)=0.770). However, there was no significant change in the annual-rate of oculoplastic publications during the last decade(P=0.191, R2=0.203). From the 465 oculoplastic articles: 179(38.5%) were articles about eyelid diseases, 160(34.40%) were about orbit diseases, 92(19.80%) were about lacrimal diseases and 34(7.30%) were about thyroid eye disease(TED). A significant decreasing trends in the number of orbital and eyelids publications were found(P<0.01, P<0.01). However, there were no significant changes in the annual-rate of orbital, eyelids, TED and lacrimal-diseases publications throughout the last decade.CONCLUSION: Oculoplastic subspecialty deals with a wide range of pathologies in different ages. However, less than 5% of the articles in general, clinical, high impact factor ophthalmology journals are about oculoplastic diseases. One of the best way for ophthalmologists from different subspecilties, nowadays, to be updated, is to read highimpact-factor, general ophthalmology journals. Therefore, it is important that those journals will include articles about breakthroughs in oculoplastic.