Relationship Between the American Board of Ophthalmology Maintenance of Certification Program and Actions Against the Medical License.

PURPOSE: To evaluate the likelihood of disciplinary actions against medical licenses of ophthalmologists who maintained board certification through successful completion of the American Board of Ophthalmology Maintenance of Certification program compared with ophthalmologists who did not maintain certification. METHODS: This was a retrospective cohort study of ophthalmologists certified by the American Board of Ophthalmology from 1992 to 2012 with time-limited certificates. Rates and severity of disciplinary actions against medical licenses were analyzed among ophthalmologists who did and did not maintain certification. RESULTS: Of 9111 ophthalmologists who earned initial board certification between 1992 and 2012, 8073 (88.6%) maintained their certification and 1038 (11.4%) did not maintain their certification. A total of 234 license actions were identified in the study group. Among ophthalmologists who did not maintain board certification, the risk of a license action was more than 2 times that of those who maintained board certification (hazard ratio = 2.34, 95% CI=1.73-3.18). License actions were significantly higher in men than in women (hazard ratio = 2.02, 95% CI=1.43-2.86). Ophthalmologists who had a lapse in their certification had a higher severity of disciplinary actions (χ2 = 9.21, p <.01) than ophthalmologists who maintained their certification. CONCLUSIONS: This study supports prior literature in other specialties demonstrating a higher risk of disciplinary licensure actions in physicians who did not maintain board certification as compared with those who did. Physicians who did not maintain certification were also more likely to have actions against their license reflecting a higher severity violation. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

The Evolution of the American Board of Ophthalmology Written Qualifying Examination.

Since the inception of board certification in ophthalmology in 1916, a written assessment of candidates' knowledge base has been an integral part of the certification process. Although the committee structure and technique for writing examination questions has evolved over the past 100 years, the written qualifying examination remains an essential tool for assessing the competency of physicians entering the workforce. To develop a fair and valid examination, the American Board of Ophthalmology builds examination questions using evidence-based, peer-reviewed literature and adheres to accepted psychometric assessment standards.

Well-tolerated intracorneal wood foreign body of 40-year duration.

PURPOSE: To report the diagnosis and management of a patient with a well-tolerated, long-standing retained intracorneal foreign body. METHODS: We describe the case of a 62-year-old man with a 40-year-old retained wood foreign body within the posterior stroma of the cornea. To the authors' knowledge, this is the longest standing intracorneal foreign body reported in the literature. RESULTS: The foreign body was asymptomatic, well tolerated, and appeared encapsulated, so the patient was carefully observed. One year later, the examination remained stable. CONCLUSIONS: Our case seems to violate the classic teaching that some inorganic intracorneal foreign bodies are well tolerated, whereas organic foreign bodies are poorly tolerated. It is possible that foreign organic material--if early infection is avoided--can be well tolerated by the eye.

Evaluation of a tool to teach medical students direct ophthalmoscopy.

INTRODUCTION: With declining exposure to the ophthalmologic examination in medical school, medical students and their instructors need a simple, effective method for teaching direct ophthalmoscopy. OBJECTIVE: Evaluation of canisters as direct ophthalmoscopy teaching aids for medical students. METHODS: Two ounce plastic canisters were designed to simulate an eye with 35 mm fundus photographs placed at the base and an 8mm hole drilled in the center of the cap to simulate a dilated pupil. These tools were used as an optional supplement to the instruction of ophthalmoscopy. Participants included 102 second-year medical students from the Medical College of Wisconsin and 11 residents and instructors from The Eye Institute in Milwaukee, Wis. RESULTS: Effectiveness and ease of use of the canisters were assessed by analyzing questionnaires completed by the medical students and instructors. According to 76% of students and 93% of instructors, the canisters "supplemented their learning/teaching." Most students (90%) and instructors (88%) found them "easy to use." CONCLUSION: This device is a simple and effective tool for teaching direct ophthalmoscopy to medical students.

Does pregnancy accelerate the rate of progression of diabetic retinopathy?: an update.

Pregnancy may be associated with several ocular changes, including the development of new ocular conditions or modifications of existing conditions. The most common ocular condition modified by pregnancy is diabetic retinopathy. Pregnancy is associated with an increased risk of development and progression of diabetic retinopathy. The factors associated with its progression include the pregnant state itself, duration of diabetes, amount of retinopathy at conception, blood glucose control, and the presence of coexisting hypertension. Although the rate of regression of diabetic retinopathy at the end of pregnancy or the postpartum period is high, careful monitoring of these patients is necessary to optimize the vision and pregnancy outcomes.

Accuracy of surrogate decision making in elective surgery.

PURPOSE: To assess the accuracy of surrogate decision making for elective cataract surgery. SETTING: Comprehensive Ophthalmology Department of Tertiary Care Hospital. METHODS: Decisions regarding elective cataract surgery of currently competent, elderly patients were compared with the predictions of patient-identified surrogate decision makers in scenarios of current state of mental health and progressive dementia. Patients were identified (age >50 years, Mini-Mental Status Score >20, absence of significant noncataract pathology) consecutively at a scheduled clinic visit to a single provider. Preferences for cataract surgery in the current state of health and hypothetical progressive dementia were assessed on a Likert scale. The same interviewer contacted patient-identified surrogate decision makers within 48 hours. Independently, a survey of community ophthalmologists was performed. The concordance of surrogate predictions with patient preferences (32 pairs) was assessed using percentage agreement, the kappa coefficient with dichotomous Likert scale data, and chi-square analyses (concordance beyond chance). RESULTS: In their current state of health, most patients said they would prefer to have surgery if they were deemed to have a visually significant cataract, which was accurately predicted by surrogates (72% agreement, kappa = 0.65, chi square = 16.5). In a hypothetical dementia scenario, contrary to perceptions of patients and their surrogates, proxies were unable to accurately represent a patient's wishes for elective cataract surgery (34% agreement, kappa = 0.23, chi square = 14.4). Physicians tended to withhold intervention in the dementia scenario. CONCLUSIONS: The findings suggest that current methods of decision making in elective surgery for patients unable to make autonomous decisions may be seriously flawed. This extends previous findings of inaccuracy with the substituted judgment approach to end-of-life issues to reflect elective surgical scenarios.

Does pregnancy accelerate the rate of progression of diabetic retinopathy?

Pregnancy may be associated with a number of ocular changes, including the development of new ocular conditions or modifications of existing conditions. The most common ocular condition modified by pregnancy is diabetic retinopathy. Pregnancy is associated with an increased risk of development and progression of diabetic retinopathy. The factors associated with its progression include the pregnant state itself, duration of diabetes, amount of retinopathy at conception, blood glucose control, and the presence of coexisting vascular disease. Although the rate of regression of diabetic retinopathy at the end of pregnancy or the postpartum period is high, careful monitoring of these patients is necessary to optimize both the vision and pregnancy outcomes.