Sickle cell retinopathy and systemic disease

Sickle cell disease(SCD)is a widespread hemoglobinopathy that results in significant patient morbidity and mortality.Vascular occlusion can cause acute pain,acute chest syndrome,and avascular necrosis,while hemolysis and endothelial disruption can cause ischemic stroke,leg ulcers,pulmonary hypertension,and priapism.All ocular and orbital structures can be affected by SCD ischemic events,including orbital bone infarction,ischemic optic neuropathy,retinal artery occlusion,hyphema,secondary glaucoma,sickle cell maculopathy,and sickle cell retinopathy.Proliferative sickle cell retinopathy(PSR)is the most common cause of vision loss.Untreated PSR can lead to macular ischemia,vitreous hemorrhage,and tractional retinal detachment.Ophthalmic screening exams and multimodal imaging can lead to earlier detection of sickle cell retinopathy and improved patient outcomes.SCD patients undergoing vitreoretinal surgery may require coordination of care with hematologists to avoid ischemic complications.While hydroxyurea was the only United States Food and Drug Administration approved treatment for several decades,patients with SCD now have several more treatment options.Despite the United States screening all infants for SCD,there can be delays in diagnosis and treatment.This review article aims to provide an overview of sickle disease for the ophthalmologist,and to discuss emerging treatment options and current management of SCD ocular complications.

Postgraduate ophthalmology training at the University of Cincinnati & in the USA

Introduction to Dr.Karl Golnik Karl Golnik,MD,MEd(Figure 1)is a neuro-ophthalmologist at the University of Cincinnati Gardner Neuroscience Institute;a professor of ophthalmology at the Cincinnati Eye Institute and the University of Cincinnati;and professor of Ophthalmology at the University of Louisville.

Program accreditation

Program accreditation is usually a voluntary process based on published standards and performed by a governmental or non-governmental agency of peers.The accreditation process has several components:self-assessment guide completion,site visit and review of program data by the accrediting body.Program accreditation’s primary function is to facilitate self-assessment,provide standards of education and lead to program improvement.It also serves to protect the student’s education and ultimately improve patient care.The International Council of Ophthalmology has developed International Guidelines for accreditation of ophthalmology residency programs and is launching a pilot program to accredit programs on demand.

Workplace-based assessments

The goal of ophthalmology residency training is to produce competent ophthalmologists.Appropriate assessments must be employed to ensure this goal is met.Valid and reliable workplace-based assessments are designed to assess competence in the many domains required of a good ophthalmologist.These assessments increase standardization and objectivity as compared to simple observational feedback.When used appropriately,workplace based assessments not only provide measures of competence but also facilitate effective formative feedback and enhance learning.

Myasthenia gravis

Myasthenia gravis(MG)is an autoimmune antibody-mediated disorder which causes fluctuating weakness in ocular,bulbar and limb skeletal muscles.There are two major clinical types of MG.Ocular MG(OMG)affects extra ocular muscles associated with eye movement and eyelid function and generalized MG results in muscle weakness throughout the body.Patients with OMG have painless fluctuating extra ocular muscles weakness,diplopia and ptosis accompanied by normal visual acuity and pupillary function.Frequently,patients with OMG develop generalized MG over 24 months.Pure OMG is more often earlier in onset(<45 years)than generalized MG.It can also occur as part of an immune-genetic disorder or paraneoplastic syndrome related to thymus tumors.Diagnosis is based on clinical manifestations,laboratory findings,electrophysiological evaluation and pharmacologic tests.Therapeutic strategies for MG consist of symptom relieving medications(e.g.,acetylcholine esterase inhibitors),immunosuppressive agents,and surgical intervention(e.g.,thymectomy).

Best practices in ophthalmic education

This special edition of Annals of Eye Science comprehensively addresses many of principles and changes that have occurred over the past couple of decades.The fairly new concept of competency-based training represents a shift from the old paradigm of showing that training programs are capable of teaching to showing that trainees can actually do what is expected of them.“Competence”is not just the ability to do something,but to do it well.In other words,teaching doesn’t equal learning!We must maximize our teaching abilities in lecture,clinic and surgery to enhance every learning opportunity.In this issue,Palis(1)provides tips on improving lecture skills;Neufeld and associates(2)define principles of good surgical teaching.Mayorga(3),Yang and associates(4)both describe a relatively new concept called the flipped classroom that is designed to maximize the expertise of the teacher and enhance higher order cognitive learning in students.Each of these articles contains many valuable concepts that if employed,will enhance learning.

Clinical evaluation exercises and direct observation of surgical skills in ophthalmology

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

Progress in neuro-ophthalmology

Change has come slowly to the field of neuro-ophthalmology.The major transformative innovations in diagnostic neuroimaging occurred decades ago but the field remained mostly a diagnostic subspecialty.Over the past few years however a new birth of innovative translational tests and treatments have emerged and have accelerated progress in neuro-ophthalmology.This dramatic wave of new testing and treatment modalities is the impetus for this monograph entitled“Progress in neuro-ophthalmology.”We hope that you enjoy this information and the continued and evolving journey of our specialty from the diagnostic to the therapeutic realm.