Ocular leptospirosis: lack of awareness among ophthalmologists and challenges in diagnosis.

PURPOSE OF REVIEW: Systemic leptospirosis exists worldwide. But leptospiral uveitis, an important late complication is not identified by ophthalmologists in several countries. RECENT FINDINGS: In the last 18 months numerous publications, especially on epidemiology, surveillances, and novel rapid diagnostic kits to test at the point of care site on leptospirosis have been published from all over the world. However, publications from ophthalmologists are very scarce. Remarkably ophthalmologists should know the global burden of leptospirosis, prevalence of the disease in their country, demographic factors associated, risk factors, and systemic signs to elicit relevant history and travel history. They should be aware of recent advances in investigations to confirm their clinical diagnosis. SUMMARY: It is quite evident from this work that leptospirosis is prevalent worldwide. Ophthalmologists' awareness has to improve to identify the etiological diagnosis. They should have access to simple, less expensive, and less cumbersome laboratory tests.

Practice Patterns of Pediatric Ophthalmologists During the COVID-19 Pandemic.

PURPOSE: To report the use of protective personal equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: A 12-question multiple-choice survey was posted on a discussion board used by members of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Respondents provided information about their experience, PPE use, office equipment, and approach to care during the COVID-19 pandemic. RESULTS: One hundred twenty-eight pediatric ophthalmologists completed the survey. Eighty-seven (68.0%) identified as in private practice, whereas 41 (32.0%) identified as in an academic setting. Sixty-nine pediatric ophthalmologists (53.9%) reported routinely using N95 respirators, 72 (56.3%) reported wearing medical scrubs, 41 (32.0%) reported using disposable gloves, 33 (25.7%) reported wearing goggles, and 12 (9.4%) reported using face shields during office examinations. One hundred twenty-one pediatric ophthalmologists (94.5%) reported having slit lamps with plastic shields and 52 (40.6%) reported having phoropters with plastic shields. Ninety-nine (77.3%) responded that they would see a patient older than 2 years who refused to wear a mask for a nonemergency visit. CONCLUSIONS: Practice patterns of pediatric ophthalmologists have varied during the COVID-19 pandemic. [J Pediatr Ophthalmol Strabismus. 2022;59(3):145-150.].

The Economic Factors Impacting the Viability of Pediatric Ophthalmology.

PURPOSE: To create a survey that assesses the economic factors impacting the viability of pediatric ophthalmology between January 2021 and July 2022. METHODS: A 12-question survey was distributed to United States-based pediatric ophthalmologists on the American Association for Pediatric Ophthalmology and Strabismus discussion board and various social media fora. Demographic, economic, and workforce pattern data were collected and analyzed. RESULTS: A total of 243 pediatric ophthalmologists completed the survey. One hundred seven (44.0%) respondents reported a surgical revenue decrease between 10% and 25%, 117 (48.1%) a clinical revenue decrease of less than 10%, 111 (45.6%) an overall income decrease of less than 10%, and 127 (52.2%) an overhead cost increase between 10% and 25%. Seventy-two (29.6%) respondents reported subsidizing income with pursuits outside of pediatric ophthalmology, 27 (11.1%) stopped operating due to reimbursement cuts, 75 (30.8%) limited the number of Medicaid or other public funded patients, 16 (6.5%) retired in the past 3 years, and 92 (37.8%) would not recommend a resident pursue a pediatric ophthalmology fellowship. CONCLUSIONS: There is a potential upheaval in the field of pediatric ophthalmology marked by increasing levels of disillusionment among current providers, a progressive decline in the number of trainees pursuing fellowship programs, and workforce issues suggestive of diversification of practice patterns outside of pediatric ophthalmology. The current economic crisis, in conjunction with these complex workforce issues, is and will continue to create a shortage of practicing pediatric ophthalmologists, seriously limiting access to pediatric and adult strabismus eye care. [J Pediatr Ophthalmol Strabismus. 2022;59(6):362-368.].

An insight into the altered ophthalmic dynamics during the COVID-19 pandemic.

Purpose: The objective of this survey-based study was to examine the effects of personal protective measures taken at the level of instrument and surgeon during the pandemic on the optics in ophthalmology. Methods: The study involved an online questionnaire of 24 questions which was distributed to ophthalmologists practicing in several hospitals, including residents and fellows undergoing training in ophthalmology in India. The responses were collected through an online data collection tool (Google forms). The participants could choose from multiple options provided to them in each question. Results: A total of 285 participants out of 296 had used modified methods for examining and performing surgical procedures during the pandemic, while 78.7% (265) of the participants acknowledged having encountered difficulty in interpreting the ocular findings of patients while examining in personal protective equipment. Moreover, 58.7% (198) of our study respondents also reported that there was significant worsening of the quality of ophthalmological examination with pandemic-appropriate measures and 84.8% (286) of our study participants also felt that these measures have significantly added to the time of examination, hence increasing the risk of exposure to both patient and doctor. Conclusion: The workplace study has highlighted the crucial aspects of optics in ophthalmology during the pandemic. The protective measures taken during the pandemic have significantly worsened the quality of ophthalmological examination and increased the time taken to perform outpatient department-based and surgical procedures in ophthalmology.

Economic Impact of the COVID-19 Pandemic Post-Mitigation on Pediatric Ophthalmologists.

PURPOSE: To create a survey to assess the economic impact that the coronavirus disease 2019 (COVID-19) pandemic post-mitigation (post-shutdown) has had on pediatric ophthalmologists. METHODS: A 14-question survey was disseminated to United States-based pediatric ophthalmologists on the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) discussion board and on social media. Demographic data and data on the economic effect of the COVID-19 pandemic post-mitigation were collected. RESULTS: A total of 129 pediatric ophthalmologists completed the survey. Eighty-four (65.1%) respondents reported a clinical revenue decrease of greater than 10%, 83 (64.3%) a surgical decrease of greater than 10%, and 66 (51.2%) an income decrease of greater than 10%. Fifteen (11.6%) respondents reported limiting the number of Medicaid patients. This was more prevalent among those in private practice (P = .027). Twenty-seven (20.9%) pediatric ophthalmologists responded that they planned to retire earlier than anticipated because of the pandemic and 2 (1.6%) responded that they have retired since the start of the pandemic. Six (4.7%) respondents reported that they have sold their practice since the start of the COVID-19 pandemic. CONCLUSIONS: Pediatric ophthalmologists continue to face economic challenges introduced by the COVID-19 pandemic. Reduced revenue may represent a new normal for the near future in pediatric ophthalmology. These unprecedented economic upheavals come at a time when the field of pediatric ophthalmology already faces difficulties with low reimbursement and attracting new trainees. This multitude of issues may escalate into a crisis in providing appropriate pediatric ophthalmic care. [J Pediatr Ophthalmol Strabismus. 2022;59(5):291-295.].

The socioeconomic effect of COVID-19 on pediatric ophthalmologists: data from the first 12 months.

PURPOSE: To investigate the socioeconomic effect on pediatric ophthalmologists (POs) of the first year of the COVID-19 pandemic and to assess the association of practice type with financial impact. METHODS: An email follow-up survey of all AAPOS active members (POs) in April 2021, was used in conjunction with two prior surveys. The majority of US states were represented, and respondents were categorized as academic/university (AU), hospital employee (H), or one of three types of private practice: multispecialty ophthalmology practice (MSP), pediatric ophthalmology/strabismus group (PG), or solo practice (SP). RESULTS: The cumulative results during this one-year period revealed 1,533,203 examinations not performed, of which 498,291 were Medicaid. Over 65,000 surgeries were not performed. The average salary loss per PO was $57,188. The total loss of revenue for the pediatric ophthalmology sector was over $303,788,000. Practice groups making at least 75% of their prior year revenue were as follows: H, 81%; AU, 64%; MSP, 52%; PG, 50%; SP, 40%. Salary reduction in each group was as follows: H, 4.2%; AU, 15.4%; MSP, 17.2%; PG, 23.1%; SP, 40.9%. The average loss per practice was $290,151. More than 95% of private practice POs received funds from the Paycheck Protection Program. CONCLUSIONS: At the one-year mark of the pandemic, patient care had been severely disrupted, with subsequent financial consequences. Private practice providers (and especially solo practices) were disproportionally negatively affected.

Virtual bedside clinics in pediatric ophthalmology and strabismus - An innovation in education and learning.

We piloted an innovation in teaching by conducting live virtual bedside clinics and evaluated the effectiveness compared to conventional bedside clinics. The purpose is to report the methodology and survey results of this innovation in teaching. A virtual bedside clinic was set up utilizing multiple audio-visual aids at a tertiary eye care facility. The bedside clinic was conducted and streamed live to pre-registered participants across the globe using the Zoom platform. The online survey was conducted comparing its effectiveness with conventional bedside clinics. A total of five sessions were conducted. A total of 2058 participants registered (411/session), of which 938 (45.57%) attended (187/session). A total of 287 participants (30.6%) responded to the survey. The respondents included ophthalmology residents (43.4%), fellows (19%), sub-specialty ophthalmologists (15.4%), general ophthalmologists (12%), and optometrists (9%). More than 95% of the respondents felt that these clinics were equally effective/better in imparting the following: physical examination 97%, clinical knowledge 99.3%, clinical reasoning 98.3%, procedural skills 95%, and communication skills 96.5%. Respondents suggested that these clinics were better/equally effective in the following techniques: general examination (96%), ocular motility (93.3%), nystagmus evaluation (93.3%), and anterior (80%) and posterior segment examination (73.3%). The hybrid mode presentation (97.3%) and discussion with the panel (100%) were reported to be equally effective/much better. Live virtual bedside clinics are a novel and effective way of continuing quality teaching and impactful learning. Most of the bedside manners, procedural skills, and examination techniques can be effectively taught through this virtual platform with a scope to improve anterior and posterior segment examination skills.

High User Acceptance of a Retina e-Learning App in Times of Increasing Digitalization of Medical Training for Ophthalmologists.

INTRODUCTION: The aim was to identify changes in continuing education and training in ophthalmology in the context of the COVID-19 pandemic and advancing digitalization and to analyse the acceptance of e-learning tools among German ophthalmologists using a novel Retina Case App as an example. METHODS: The participants' training behaviour before and during the COVID-19 pandemic was surveyed. Furthermore, the acceptance and usability of the Retina Case App were evaluated using the System Usability Scale (SUS). A possible influence of the app on everyday clinical practice was assessed. RESULTS: A total of 145 ophthalmologists participated in the survey. The frequency of continuing medical education did not decrease for 62.8% of ophthalmologists during the pandemic. A significant increase in at least monthly use of online courses or lectures has been observed (90.3% vs. 28.2%, p < 0.001). No significant difference was identified in terms of frequency of use of print and digital journals or printed textbooks. The majority of participants stated that online training platforms are well suited to replace the absence of face-to-face events (73.8%). The mean SUS score was 87.7 (SD 11.9), which categorizes the app's usability as excellent. The majority agreed that the newly developed app enables faster learning (82.1%) and leads to increased motivation (71.7%). Most ophthalmologists (80.7%) felt that regular use of the app would improve confidence in the treatment of retinal diseases. CONCLUSIONS: The COVID-19 pandemic has led to a significant change in training behaviour in ophthalmology towards e-learning and online courses, which has not been accompanied by a general decline in training activity. The exemplarily investigated application showed a high user acceptance among ophthalmologists.

An update on the novel approaches towards skills assessment of ophthalmology residents in the Indian scenario.

An essential part of the teaching-learning paradigm is assessment. It is one of the ways to achieve feedback for the various methods that have been used to impart a particular skill. This is true of ophthalmology training, where various clinical and surgical skills are learned as part of the residency program. In preparation for residents to become proficient ophthalmologists, both formative and summative assessments are of paramount importance. At present, assessment is primarily summative in the form of a university examination, including theory and practical examinations that are conducted at the end of the three years of residency. A formative assessment can make course corrections early on, allowing for an improved understanding of the subject and the acquisition of clinical and surgical skills. Formative assessments also allow us to customize the teaching methodology considering individual residents' learning capabilities. In addition, formative assessments have the advantage of alleviating the stress of a "final" examination, which could sometimes result in a less-than-optimum performance by the residents. The COVID-19 pandemic has forced us to adopt new teaching methods, which has led to the adoption of changes in assessment. In this regard, we discuss the different assessment tools available, their pros and cons, and how best these tools can be made applicable in the setting of an ophthalmology residency program.

Evaluation of the perception of physical and emotional health of ophthalmologists in Spain and the influence of the COVID-19 pandemic.

OBJECTIVE: The main objective was to study the perception of physical and emotional health of Spanish ophthalmologists and their health habits, as well as the possible influence of the COVID-19 pandemic. METHODS: An observational, cross-sectional, non-randomized and uncontrolled study was carried out among at Spanish ophthalmologists through an online survey of 47 questions on eating habits, tobacco, alcohol, physical exercise, workload, and perception of physical and emotional state. RESULTS: Of a total of 2,179 ophthalmologists, 260 (11.9%) of whom 55% were men responded to the survey, with a mean age of 52.9±11.4 years. 5.8% were smokers. In total, 51.5% reported good physical health, with a mean Body Mass Index of 24.4kg/m2. Overall, 53.5% reported depression, 66.9% tiredness, 34.6% difficulty sleeping, and 57.3% considered their work hard. Up to 28.5% of those surveyed had thought about leaving their job and 60.8% about reorganizing their workload. In total, 91.9% would continue to choose Ophthalmology as a specialty. In total, 36.2% reported an increase in workload, 42.3% worsening of physical state and 63.8% worsening of emotional state as a consequence of the COVID-19 pandemic. CONCLUSIONS: Spanish ophthalmologists have a positive perception of their physical and emotional health, despite having life habits that are not always healthy and feeling mostly down. The COVID-19 pandemic has had a negative influence on the physical and emotional health of ophthalmologists.

Complications of Adenoviral Keratoconjunctivitis in Ophthalmologists and Orthoptists: Epidemiology and Risk Factor, A Retrospective Questionnaire Analysis.

PURPOSE: The purpose of this study was to assess the medical history of adenoviral keratoconjunctivitis (AK) and subepithelial infiltrates (SEIs) among French ophthalmologists and orthoptists and the frequency of unreported occupational diseases. We also described short-term and long-term consequences of AK and evaluated associated factors. METHODS: The REDCap questionnaire was diffused online several times over 7 consecutive months, from October 2019 to May 2020, through mailing lists (French Society of Ophthalmology, residents, and hospital departments), social networks, and by word of mouth. RESULTS: Seven hundred ten participants were included with a response rate of 6.2% for ophthalmologists, 3.8% for orthoptists, and 28.3% for ophthalmology residents. The medical history of AK was found in 24.1% (95% confidence interval 21%-27.2%) of respondents and SEI in 43.9% (36.5%-51.3%) of the AK population. In total, 87.1% (82.1%-92.1%) of AK occupational diseases were not declared. In total, 57.7% of respondents took 9.4 ± 6.2 days of sick leave, mostly unofficial, and 95.7% stopped surgeries for 13.0 ± 6.6 days. Among the AK population, 39.8% had current sequelae, with 17.5% having persistent SEIs, 19.9% using current therapy, and 16.4% experiencing continuing discomfort. SEIs were associated with wearing contact lenses (odds ratio 3.31, 95% confidence interval 1.19-9.21) and smoking (4.07, 1.30-12.8). Corticosteroid therapy was associated with a greater number of sequelae (3.84, 1.51-9.75). CONCLUSIONS: AK and SEI affect a large proportion of ophthalmologists and orthoptists, possibly for years, with high morbidity leading to occupational discomfort. Few practitioners asked for either to be recognized as an occupational disease. Associated factors would require a dedicated study.

The evolution of the changes in the clinical course: a multicenter survey-related impression of the ophthalmologists at the peak of the COVID-19 pandemic in Turkey.

PURPOSE: The coronavirus disease-2019 (COVID-19) has become a difficult pandemic to control worldwide. The high transmission risk and mortality rates of COVID-19 cause serious concerns in ophthalmologists and may cause disruptions in clinical functioning. This study aims to identify changes in the clinical approaches of ophthalmologists, understand their anxiety levels, and exhibit how patients' follow-up processes progress during the pandemic. METHODS: A questionnaire that including demographic information, ophthalmology clinical activity scale, and Beck anxiety scale was sent to ophthalmologists in Turkey. Google Forms was used as a survey platform in this study. RESULTS: A total of 121 ophthalmologists participated in the study. The participants stated that they could not continue routine interventional diagnosis and treatment practices during the outbreak. It was clearly stated that there were changes in their clinical approach and decreased patient examination quality. For this reason, 14.9% of physicians said to missed the diagnosis in this process. Physicians who encounter infected patients state that it is more difficult to provide ophthalmological services and their clinical approaches are affected more negatively. Anxiety levels of physicians who could access personal protective equipment (PPE) and show positive solidarity with their colleagues in the process were found to be lower. CONCLUSION: Our study revealed that ophthalmologists, like other healthcare professionals, were severely affected by the COVID-19 outbreak. Accordingly, healthcare managers should provide adequate PPE for ophthalmologists, organize the clinical operation, and support the mental health of ophthalmologists.

[Viral conjunctivitis as the first sign of COVID-19 infection (clinical observation)]. / Virusnyi kon"yunktivit kak pervyi priznak koronavirusnoi infektsii COVID-19 (klinicheskoe nablyudenie).

The article presents a case of complicated viral conjunctivitis. Conjunctivitis was the initial sign of the new coronavirus infection (COVID-19) in the patient. The disease had a fairly long course and led to symmetrical scarring in the form of partial external symblepharon and dry eye syndrome. Ophthalmologists should be aware about this disease and its complications. Early treatment with corticosteroids in combination with symptomatic therapy can contribute to prevention of the development of conjunctival scarring. In addition to conjunctival scarring, this disease can possibly potentiate the development of keratitis, optic neuritis, and uveitis.

The COVID-19 Pandemic from an Ophthalmologist's Perspective.

The current coronavirus disease 2019 (COVID-19) pandemic is rapidly spreading around the world. The first doctor to report this new disease was an ophthalmologist: this exemplifies the role of ophthalmologists in an infectious disease pandemic. Here we review how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects the eye and discuss implications for ophthalmologists.

Prevalence of SARS-CoV-2 amongst ophthalmologists throughout the first and second waves of the pandemic.

ABSTRACT: The study aims to investigate the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among ophthalmology unit staff throughout the first and second waves of the outbreak, in order to verify the effectiveness of the measures adopted in containing the contagion.A retrospective observational study was conducted involving staff members, who received a naso/oropharyngeal swab when complaining of SARS-CoV-2 symptoms and once a month as a screening measure. They were tested for SARS-CoV-2 antibodies as a screening measure during the first and the second wave. Clinical activities performed during the outbreak were compared with those performed during the same period in 2019 and correlated with the number of coronavirus disease-2019 eye care workers.Analysis included 25 workers. Clinical infection was 0% and 12% whereas the prevalence of SARS-CoV-2 antibodies ranged from 4% to 8% in the first and second wave, respectively. The increase in the prevalence of SARS-CoV-2 infection between the first and the second wave was not significant (1/25 vs 3/25, P = .6092). Clinical activities significantly decreased during the first wave compared with the same period in 2019 (3256 vs 10,075, P < .0001, -68% to 2019), but increased during the second wave (8208 vs 3256, P < .0001, +152% to the first wave).Despite the increase in routine activities during the second wave, we did not observe a significant increase in SARS-CoV-2 prevalence. Strict protection measures seemed to contain the rate of contagion among the ophthalmology unit members even in a high-volume clinical setting in one of the most affected area by the coronavirus disease-2019 outbreak.