Search

Aims: To investigate whether ophthalmology trainees are able to assess their own competence in cataract surgery and whether this judgement improves as they progress through training., Methods: A prospective, blinded, single-centre comparative study of ophthalmology trainee surgeons was performed. 16 junior trainees (150-499 cataract operations) and 16 senior trainees (>500 cataract operations) were recruited. They performed a single videotaped cataract operation and filled in the validated Objective Structured Assessment of Cataract Surgical Skill (OSACSS) assessment form. The videotapes were anonymised, randomised and then graded by a single expert reviewer using the OSACSS assessment. Trainees' OSACSS scores were compared with Mann-Whitney tests and inter-rater agreement between the assessor and the trainees was compared using Cohen's κ coefficient., Results: Senior trainees performed statistically better than junior trainees at all task-specific and global OSACSS indices, apart from draping (p=0.23) and overall score (p=0.09). Overall, trainees were better at assessing their OSACSS performance in global indices such as tissue handling, iris protection and overall speed. They were worse at assessing their performance in task-specific indices, particularly use of the phacoemulsification probe and second instrument. Comparing the two trainee groups, senior trainees had a higher level of agreement with the assessor in more OSACSS indices (15/19) than junior trainees (4/19)., Conclusions: Trainees were more proficient at assessing their own competence at the global indices of cataract surgery, rather than task-specific components. Compared with junior trainees, senior trainees performed better surgically and were more proficient at assessing their own competence in cataract surgery., Trial Registration Number: SALH1001., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective: Although theory-based schemes for course design are widely used in educational settings, making use of cognitive theory in the design of surgical skills courses in ophthalmology is rare. The primary aim of this study is to describe the application of instructional design, an established theory-based approach in course design, to the development of a surgical skills course for ophthalmology residents. The secondary aim of this study is to assess the educational effect of this theory-based course., Design: A 1-day skills course was designed according to Gagné׳s events of instruction model, which was employed as a template for the instructional sequence of learning steps. Skills acquisition following the implementation of the model was measured with precourse and postcourse assessments., Setting: Moorfields Eye Hospital organized the 1-day annual intermediate surgical skills course, which was hosted at the Royal College of Ophthalmologists' microsurgical skills laboratory., Participants: A total of 20 ophthalmology residents of Moorfields Eye Hospital participated in the study., Results: A 1-day surgical skills course was formulated according to the instructional design principles outlined. The 4 objectives of the course (corneal suturing, corneal gluing, intravitreal injections, and eyelid suturing) were addressed in a parallel fashion as to allow for multiple objectives to be processed simultaneously, in the context of the instructional design sequence. Assessments demonstrated significant improvement in skills acquisition for the 4 course objectives., Conclusions: Instructional design is a valuable tool for planning effective surgical training courses as it is portable, allowing its application to a wide variety of outcomes and settings, and its terminology is simple and understandable to those working in clinical education., (Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the impact of a skills course on microsurgical skills acquisition and to investigate the validity of a video-based modified Objective Structured Assessment of Technical Skill (OSATS) assessment tool that has not previously been applied to ophthalmic surgery., Design: Prospective longitudinal cohort study., Participants: Fourteen residents were recruited from 20 attendees at the Moorfields Eye Hospital microsurgical skills course for residents., Methods: Each resident performed a standardized microsurgical task consisting of the placement of a 10-0 nylon corneal suture into a model eye using an operating microscope with standardized equipment in a standardized environment. Objective measurements were made using the Imperial College Surgical Assessment Device (ICSAD). This is a motion-tracking device returning 3 parameters for economy of movement: total path length, time, and number of individual hand movements. A concurrent video recording was made of each task by 2 independent observers who were masked to the time of the recording relative to the course and the identity of the resident. Video footage was marked in accordance with the OSATS video scoring template., Main Outcome Measures: Each resident had motion-tracking analysis performed during corneal suturing before and after the course (total path length, time, and number of individual hand movements), along with concurrent OSATS video scores., Results: Skills improvement after the course was found to be statistically significant for all 3 ICSAD economy of movement parameters: path length, P = 0.001; hand movements, P = 0.012; and time, P = 0.009. Differences in the combined OSATS scores of the 2 raters before and after the course were found to be significant (P = 0.039). Interrater reliability of OSATS scorers was 0.78 (alpha Cronbach). Correlations between the OSATS scores and each of the ICSAD parameters were found to be significant (P<0.001)., Conclusions: A video-based OSATS scoring system has significant correlation with the ICSAD motion-tracking parameters, demonstrating concurrent validity between the 2 assessment tools. These data also demonstrate that surgical skill, as measured by a validated motion-tracking system, is significantly improved after a 1-day microsurgical skills course., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Background The aetiology of blepharospasm remains unclear. There is evidence that the afferent pathway is important, but this area remains under-researched. Aim To explore the hypothesis that the afferent arm of the blink reflex is abnormal in blepharospasm by assessing a range of measures of corneal sensory function. Methods In this prospective case-control study, 21 patients with blepharospasm and 21 age-matched and gender-matched controls completed the Ocular Surface Disease Index questionnaire and underwent the following assessments: tear osmolarity, Shirmer test, tear-film break up time, corneal and conjunctival vital staining, meibomian gland dysfunction, corneal aesthesiometry and confocal microscopy. Results Corneal sensitivity was significantly lower in patients with blepharospasm than in controls (right eyes p=0.009; left eyes p=0.009, paired t test). The median number of main nerve trunks was lower for patients with blepharospasm than for controls, and this was statistically significant at the 5% level (p=0.04, paired t test). Mean nerve density, median number of nerve branches and median total number of nerves were lower for blepharospasm cases than controls, but this did not reach statistical significance. Tortuosity was greater for blepharospasm cases than controls, but this was not statistically significant. Conclusions Blepharospasm is associated with reduced corneal aesthesiometry and a tendency towards a reduced number of nerves in the sub-basal plexus, implying an impairment in corticosensory processing, possibly a defect of the sensorimotor gating mechanism resulting in a loss of inhibition of the blink reflex. [ABSTRACT FROM AUTHOR]

Graves’ orbitopathy (GO) is a disfiguring and sometimes blinding disease, characterised by inflammation and swelling of orbital tissues, with fibrosis and adipogenesis being predominant features. Little is known about the disease aetiology and the molecular mechanisms driving the phenotypic changes in orbital fibroblasts are unknown. Using fibroblasts isolated from the orbital fat of undiseased individuals or GO patients, we have established a novel in vitro model to evaluate the dual profile of GO cells in a three-dimensional collagen matrix; this pseudo-physiological 3D environment allows measurement of their contractile and adipogenic properties. GO cells contracted collagen matrices more efficiently than control cells following serum or TGFβ1 stimulation, and showed a slightly increased ability to proliferate in the 3D matrix, in accordance with a fibro-proliferative phenotype. GO cells, unlike controls, also spontaneously differentiated into adipocytes in 3D cultures - confirming an intrinsic adipogenic profile. However, both control and GO cells underwent adipogenesis when cultured under pathological pressure levels. We further demonstrate that a Thy-1-low population of GO cells underlies the adipogenic - but not the contractile - phenotype and, using inhibitors, confirm that the contractile and adipogenic phenotypes are regulated by separate pathways. In view of the current lack of suitable treatment for GO, we propose that this new model testing the duality of the GO phenotype could be useful as a preclinical evaluation for the efficacy of potential treatments. [ABSTRACT FROM AUTHOR]

Background/Aims To explore the factors associated with the mood and quality of life (QoL) of patients with strabismus due to undergo realignment surgery. Methods A cross-sectional study was undertaken with adult patients. Along with demographic, clinical and psychosocial process variables, the Hospital Anxiety and Depression Scale and AS-20 QoL measures were administered. Regression models were used to identify the factors associated with QoL and mood. Results Of the 220 participants, 11% were experiencing clinical levels of depression, and 24% clinical anxiety. This is in line with other forms of facial disfigurement but higher than other chronic diseases. Although mood and QoL were associated with age and diplopia, it was beliefs and cognitions which were more consistently associated with well-being. This included feelings of social anxiety and avoidance, a belief that strabismus has negative consequences, poor understanding of strabismus, social support, fear of negative evaluation and the perceived visibility of their condition. Conclusions Psychosocial rather than clinical characteristics were identified as determinants of wellbeing in this population. It is important for clinicians planning surgery to be aware of these factors which could influence outcomes. Longitudinal studies need to be conducted to explore the direction of causality before interventions to improve well-being are developed and evaluated. [ABSTRACT FROM AUTHOR]

Objective: Many patients are satisfied with their ocular prosthesis, but some describe problems with social interactions, body image and self-esteem. Although both clinical practice and research suggest that the severity of a disfiguring condition does not predict distress, there has been little research with patients living with an ocular prosthesis. The objective was to explore the psychological impact of living with an artificial eye or cosmetic shell and determine the relationship between psychological well-being and clinical and psychosocial factors. Methods: A cross-sectional study between March and September 2008 at the ocular prosthesis clinic of Moorfields Eye Hospital, UK. The primary outcome measures were mood as measured by the Hospital Anxiety and Depression Scale (HADS) and appearance-related social anxiety and social avoidance, as measured by the Derriford Appearance Scale (DAS24). Results: Mean scores on the HADS and DAS24 were within normal range, but a considerable proportion of participants were experiencing significant levels of distress. Psychosocial adjustment was unrelated to most clinical and demographic variables, but was associated with a series of cognitive processes. Conclusions: Psychological variables, rather than clinical or demographic factors, are associated with how a patient adjusts to wearing an ocular prosthesis. Such factors might be amenable to change through psychosocial intervention. [ABSTRACT FROM AUTHOR]

A detailed understanding of the anatomy of the upper eyelid is fundamental to any consideration of the approaches to surgical treatment of eyelid disorders. This review covers the detailed anatomy of the major components of the upper lid, which are commonly encountered in surgical practice. A review of this anatomy in a historical context is provided. In addition, the impact of contemporary anatomical information deriving from newer techniques and technologies is appraised. [ABSTRACT FROM AUTHOR]